Progesterone: Too Much of a Good Thing?

Bio-identical progesterone isn’t without risk

By: Marika Geis, ND

Ask anyone suffering from extreme PMS or early menopause if they’ve benefited from bio- identical hormones and they’ll tell you that along with B vitamins, Fish oil, Chaste-tree, seed rotations, calcium/magnesium, liver and adrenal support, bio-identical progesterone was a game changer. The benefits of bio-identical progesterone don’t stop there. In women with PCOS, progesterone can lower the male type hormones responsible for some of their symptoms along with balancing the pituitary hormones that help regulate their cycle. While the processes that contribute to the above conditions are complex, the one common denominator is the relative excess of estrogen, a hormone, which if left unopposed, can have a significant impact on our health. Nowhere was this made clearer than with the Women’s Health Initiative in 1991. Of the 3 interventions, one sought to determine which would have the greater benefit on reducing cardiovascular risk, cancer and osteoporosis: estrogen only therapy or estrogen in combination with progesterone. Women with intact uteruses given ‘estrogen only’ therapy were at significantly greater risk of developing uterine cancer, a risk that was reduced when estrogen was given in combination with progesterone. As a result the study ended in 2004, two and a half years early.

In a world that seems determined to ensure that we are swimming in vast amounts of estrogen, both from the environment: plastics and their petrochemical cousins, pesticides and herbicides etc…and internally: lack of ovulation (a process that produces progesterone), compromised liver function (which will hold onto estrogen as opposed to eliminating it) and excessive stress (a process that sequesters progesterone to make more stress hormone), progesterone might seem a likely antidote for all this exposure given its role in balancing the effects of estrogen. This of course, after liver function has been corrected and balance has been restored to the nervous system, right? For the most part this is true but what happens when we’re given too much of a good thing? What might present as a baffling array of symptoms apparently implicating the thyroid gland, the nervous system and cardiovascular system, could actually have their roots in supra-physiologic amounts of progesterone as we shall soon see.shutterstock_90840794

Lucy, a 47 year-old mother of 3 children, experiencing increasingly irritable episodes prior to her cycle along with night sweats that leave her sleepless and drained of energy went to her doctor’s office asking for advice on how to handle this new development. She has a good rapport with her physician and reports that she has also been experiencing frequent headaches, some flushing during the day and increasingly irregular periods that are quite heavy and painful. Her intrepid doctor, resisting the urge to recommend antidepressants and/or birth control pills, and having just read Dr. John Lee’s ‘What Your Doctor May Not Tell You About Menopause’, correctly sees this as the relative imbalance of estrogen and progesterone that occurs in early menopause and goes about prescribing her the standard dose of bio-identical progesterone to be taken during the last 2 weeks of her cycle. Lucy left relieved and began taking her medication at the appropriate time. Well, she was astonished. Most of her symptoms had disappeared, she felt more like her old self and life went back to normal. After about 6 months or so she found herself back in the doctor’s office with the same symptoms. What happened? More progesterone is prescribed except this time the symptoms aren’t getting any better. In fact, Lucy is now experiencing heart palpitations, hair loss, extreme fatigue, depression, low libido, cravings and weight gain. Some preliminary blood work by her doctor showed a normal value for thyroid function but a high fasting blood sugar along with a cholesterol profile that increased her risk of having a cardiovascular event in the future. Perhaps Diabetes? Maybe.

Lucy decided to take matters into her own hands unwilling to accept the fact that within 6 months she went from a healthy 47 year old woman to one that could potentially be taking 4-5 different medications to mitigate the cardiovascular risks associated with Type 2 Diabetes. She had some brave friends that had seen Naturopathic Doctors with some encouraging results and decided to make an appointment. During the course of the interview, her naturopath suggested something called ‘salivary hormone testing’ to see where her levels of estrogen and progesterone were at given that her decline started with common peri-menopausal symptoms. They decided on a hormone panel that included the hormones in question in addition to assessing the status of her nervous system. The results clearly indicated where the problem was. Estrogen was within the normal range for a woman her age but her progesterone was clearly out of balance. And not by a little. The normal reference range for this particular test for progesterone is 0-50. Her result came back as

Lucy decided to take matters into her own hands unwilling to accept the fact that within 6 months she went from a healthy 47 year old woman to one that could potentially be taking 4-5 different medications to mitigate the cardiovascular risks associated with Type 2 Diabetes. She had some brave friends that had seen Naturopathic Doctors with some encouraging results and decided to make an appointment. During the course of the interview, her naturopath suggested something called ‘salivary hormone testing’ to see where her levels of estrogen and progesterone were at given that her decline started with common peri-menopausal symptoms. They decided on a hormone panel that included the hormones in question in addition to assessing the status of her nervous system. The results clearly indicated where the problem was. Estrogen was within the normal range for a woman her age but her progesterone was clearly out of balance. And not by a little. The normal reference range for this particular test for progesterone is 0-50. Her result came back as 3200!!

When the body encounters an agent that is in excess of what it needs, it will attempt to protect itself from its effects by down regulating the number of receptors on the target organs that respond to the agent in question.

Take adult onset Diabetes as an example. In response to chronically high blood sugar, the pancreas makes more and more insulin in an attempt to keep levels with range. However, when the body registers that too much is being made, the number of receptors to insulin is reduced and the body secretes even more insulin to achieve the same blood sugar lowering effect. This is what is known as insulin resistance – the precursor to Type II Diabetes. Progesterone receptors will act in much the same way in that once the body is flooded with progesterone and all receptors are saturated, the body will make less receptors available because it no longer needs to maintain sensitivity. Since the target tissues no longer need progesterone it is often repurposed to other systems.

One common fate of excess progesterone is cortisol. Anyone with a history of PMS that was improved by including adrenal support to their health regimen can attest to this. When the body is under chronic stress, it will sequester progesterone to make more cortisol leaving the patient with a relative excess of estrogen. But what happens when there’s a relative excess of progesterone? The same thing, although the stimulus won’t be excessive long term stress. Excess progesterone will be shunted to making additional cortisol. Excess cortisol can have a suppressive effect on the thyroid gland – the metabolic powerhouse of the body. The end result is a spectrum of symptoms that involve the pancreas, adrenals, thyroid and ovaries: extreme fatigue, depression, low libido, hair loss, weight gain, palpitations, insomnia, cravings and perhaps more troublesome is the potential to precipitate progesterone receptor positive cancers.

So what’s the bottom line? As a naturopath, I can’t say that bio-identical progesterone is my first choice when it comes to treating things like PMS, peri-menopause, PCOS or some other kind of estrogen dependent condition. I usually try and support the systems whose dysfunction is lending the body to manifest those particular symptoms. This can go a very long way! However, when my patients are doing their very best to support healthy blood sugar levels, manage their stress and take their supplements and things are still just not quite right, I have no qualms about recommending bio-identical hormones. But, and a very BIG but, it is usually done with appropriate testing to ensure that the recommended dosage actually reflects what their body needs. A good rule of thumb is to start low and go slow. Test every 2-3 months for the first 12 months to ensure that your levels are within range and make corrections accordingly. A good compounding pharmacist is a crucial ally when a patient’s needs go beyond the standard available dose. Avoid unintended consequences….test don’t guess!

Happy summer ?

Genetic Roulette

Film Review: Jeffrey Smith’s Genetic Roulette

By Dr. Marika Geis, BSc, ND

A couple of months ago I came across a film that can only be described as a public service announcement. The spirit of common sense that keeps us wearing our seatbelts andfrom getting behind the wheel while under the influence will be the same that makes your resolution for 2013 an easy one, or so I hope. The argument is so compelling that it leaves you with little choice. The Institute for Responsible Technology’s founder, Jeffery Smith expertly distills an overwhelming body of research against the use of Genetically Modified foods into a relevant, accessible and impassioned plea to those that would do right by themselves and their children. The documentary, “Genetic Roulette”, systematically exposes the astonishing truth behind the consumption of genetically modified foods. From the manipulation of the legislative process that deems these products ‘safe’, to the repeated and ostensibly successful attempts to paralyze the research engine that overwhelmingly concludes that genetically modified foods pose a significant health risk, to farmers observing dramatic changes to the health of their livestock after stopping GM feed for just three days, to the dismantling of the GMO myths claiming that genetically modified food are the only way to meet the ‘world food shortage’ and the more than 40 health risks associated with GM foods, Jeffrey Smith provides a clear and comprehensive body of work that leaves little doubt in the viewer’s mind that the only way to reclaim control of your body is to be selective about what you put in it.

I have to admit that before seeing this film, my decision to avoid GM foods was largely emotional. I remember an interview with David Suzuki many years ago. He was asked whether or not GM foods were safe to eat. His response was something along the lines of “We have no idea how these organisms will behave in nature because they’ve never existed before now”. Made sense; it was good enough for me. As a physician, I was more concerned with avoiding commercial foods because of the health risks associated with the chemicals used in industrialized agriculture and how they affected overall toxicity. But after seeing this film, not only am I more vigilant about what I bring into my home for my family, I have now begun to refine my prescriptions to my patients, particularly those who are just experiencing naturopathic medicine for the first time ; “Don’t worry about the wheat, dairy and sugar just yet, we’ll have time for that later. Eliminate processed foods from your diet”.

In clinical practice the GM issue is particularly relevant to our pediatric genetic_roulettepatients in that we see time and time again  health concerns stemming from ‘Leaky Gut Syndrome’: allergies, eczema, allergies, autoimmune and neurological disorders and immune dysfunction all have their roots in a compromised digestive tract. When we see so many systems affected in a single individual, it seems obvious that one must consider the ‘source’. In Chinese medicine, one of the sources of our life force or Qi comes from the food we eat. Likewise, when the parents, veterinarians, and farmers that were interviewed in this film, stopped to consider why their children and animals were so ill they too had no choice but to question the food they were eating. When people found out about how Bt toxin contributes to gut permeability or how RoundUp ready crops contribute to malnutrition and therefore make us more vulnerable to virulent diseases, there was never really any choice for them except not to look back. Of all the allergists, immunologists, pediatricians, registered dieticians, hematologists, oncologists,naturopaths and internal medicine specialists who commented on the rise of the conditions listed above, every one stated that when GM foods were eliminated from their patient’s diets their health improved.

When you experience this film, there may be the tendency to despair. Indeed the problem of GM foods is global leaving no one, not even our infants, untouched. However, as Jeffery Smith describes, it is possible to reverse the damage done. You have a choice about where you spend your money. You have a choice about what you eat. Avoiding GM foods is far from impossible. The ‘Genetic Roulette’ website has a vast number of resources that you can access to ensure that you avoid GM foods. An epiphany takes only a moment of clarity, a resolution, only the sincere intention of doing better. If you haven’t already, know that when you make your resolution this year that you will not only be benefitting yourself but your family and generations to come.

Juvenile Rheumatoid Arthritis: Naturopathic Medicine in Action

A Case of Juvenile Idiopathic Arthritis AKA Juvenile Rheumatoid Arthritis.

By Dr Marika Geis, ND

When I think of two years old’ a vision of the Merry Melodies Tasmanian Devil comes to mind: A screaming whirlwind of dust leveling everything in its path or in the case of my own children, launching themselves off the couch and flushing my watch down the toilet along with a whole roll of toilet paper. The last thing I would imagine would be a child cautious about moving too fast because their joints were hot and swollen, or having to take breaks several times throughout the day to recharge because it takes so much to work through the discomfort and stiffness of juvenile idiopathic arthritis (JIA). Yet this was exactly the case when I met little Katie in August of last year. Her parents had noticed that her big toe was quite swollen and didn’t seem to be going away on its own. Two weeks later her parents noticed that Katie would move carefully in the morning and take her time initiating movement. To them it seemed as she was moving like someone sore and stiff. A week after that her knees became involved; they were swollen and warm to touch. Her mother, a registered nurse, promptly took her daughter to the doctor and did some preliminary bloodwork. The results showed that inflammation was present but did not point to a cause. Treatment options at the time were to prescribe Naproxen (a non-steroidal anti-inflammatory or NSAID associated with bleeding in the digestive tract), to do cortisone shots in the affected joints which, with repeated use, degrades connective tissue and lastly to prescribe prednisone, a steroid drug associated with several damaging side effects. The parents opted for the naproxen with the intention of buying a little time before the other treatments became necessary. At this point they came to our clinic looking for ways to augment her treatment given that, despite the naproxen, the number of joints involved was growing.shutterstock_296807261

It’s important to understand the prognosis of kids with JIA/JRA as these children are at increased risk for the
involvement of other organ systems, have mobility issues stemming from chronic inflammation and potential joint deformities. Conventional treatment is ‘comprehensive’ in that it involves pharmacotherapy, physical therapy, academic counselling, occupational therapy and psychological counselling. For kids with more than one joint involved complete remission is rare. Although Katie’s parents were absolutely prepared to do whatever was required of them they couldn’t help but wonder if there wasn’t something that was being overlooked.

Up until Katie, I had never treated anyone with JIA/JRA but as naturopaths we routinely treat multiple manifestations of autoimmune disease of which JIA/JRA is one. The working naturopathic theory behind autoimmunity is one that I am sure you’ve heard of before although perhaps in different contexts. Leaky gut syndrome or gastrointestinal permeability is a process by which material from the cavity of the intestines enters into the bloodstream through the tissue wall before it’s intended to. Once in the bloodstream, the regional lymphatic tissue, correctly recognizing it as foreign, begins making an abundance of antibodies in an attempt to neutralize this ‘threat’. The problem is that in certain populations where the genetic susceptibility exists, those antibodies, having a similar structure to some of our bodies own tissues will now go and attack various systems throughout the body. The thyroid in Hashimoto’s hypothyroidism, the myelin sheath in Multiple Sclerosis, the joint capsule in Rheumatoid Arthritis, the colon in Crohn’s Disease, The liver in Autoimmne Hepatitis….the list goes on. From a naturopath’s point of view, it matters less how it manifests and more that it’s autoimmune in nature.

There are several ways by which permeability in the gut arises. In children, one of the more common ways is through foods. At birth and by design, babies are born with several gaps in the tissue lining the intestines as this is how babies absorb proteins and fat from mom’s breast milk. As baby grows and their intestines mature they can gradually begin to tolerate different foods provided that the food matches their capacity to digest it. In many cases however, foods, often allergenic foods, get introduced too early, are recognized as ‘foreign’ and the above process of antibody production begins. In Katie’s case it wasn’t so easy to pinpoint possible food sensitivities given that gluten, a common allergen wasn’t introduced until 8 months of age and dairy wasn’t introduced until 12 months of age. She did not present with any significant digestive concerns although she did manifest eczema, a classic sign of ‘leaky gut’. This, despite the parents having done all the right things.

We discussed the possibility of starting a hypoallergenic diet prefaced by a Food Sensitivity test for what’s called an IgG response (or ‘delayed’ immune response) to 96 different foods. This, in addition a small number of supplements to help heal the gut and modulate the immune response. They did the test and began the dairy, soy, corn, egg, gluten, and sugar free diet in earnest. What they noticed initially was that the swelling was on its way down. However, Katie was also still taking Naproxen so it was difficult to tell what was helping. When the results came back it allowed Katie’s family to further refine her diet. As it turned out grapes and citrus were high on the list as were the foods she was already avoiding. Remarkably, her eczema disappeared indicating to her mother that her gut was indeed permeable and in the process of healing. Another significant development was that Katie was able to have a fever during a cold without aggravating her joint symptoms, something that previously went hand in hand. Slowly but surely the swelling was going down and her range of motion was improving. Finally, to do away with the residual inflammation, Katie’s parents opted to proceed with the cortisone shots allowing for full recovery of her range of motion. To date, Katie is now in complete remission, off the Naproxen, bouncing off the walls and threating to flush her mother`s watch down the toilet. There have not been any further flare ups in her joints or skin, she is sleeping better, has more energy and is fearless in her exploits.

This story has a tremendous ending. It`s a testament to what children can endure and how well and completely they can heal once the true cause has been found. These parents have literally changed the trajectory of their daughter`s life. I feel so fortunate to have participated in this family`s journey and witness our body`s innate wisdom and the healing power of nature. Thank you Katie!

The Benefits of Water in Your Life

By: Marika Geis, BSc, ND

Beverage wars. With the multitudes of choices out there, sodas, ‘vitamin water’, sugar laden antioxidant juices, white teas promoting ‘anti-aging’ benefits, it’s a safe bet that water remains the healthiest choice. However, when it comes to water, consumers often are faced with mixed messages. You’re making a healthier choice sure, but at what expense? Each time we dispose of a plastic bottle, we are told that it remains in a landfill for a minimum of 700 years before it begins to decompose. Coupled with the fact that 80% of bottles are not recycled, the environmental impact is significant to say the least. Space in the landfill is not the only issue. 24 million gallons of oil are needed to produce a billion plastic bottles.

The average Canadian consumes approximately 167 bottles per year. So what to do? According to David Suzuki, who insists on drinking municipal water wherever he goes, drinking bottled water is an unimaginable waste not to mention a significant health hazard, and that the only way to mitigate the damage is to drink tap water. Increasingly, Canadians fear that their water is unsafe. The Environmental Working Group states that there are over 315 pollutants in municipal tap water. More than half of the chemicals detected are not subject to health or safety regulations and can legally be present in any amount. While the federal government in the United States has health guidelines for some, at least 49 of these contaminants have been found in one place or another at levels above those guidelines, polluting the tap water for 53.6 million Americans. Despite these infractions, at least the United States Environmental Protection Agency’s (USEPA) guidelines for maximum contaminant levels in water are standards enforced by law. In Canada, our water quality guidelines are at best, recommendations which do not necessarily have the force of law behind them; responsibility for water quality rests with the administrators of the myriad local and municipal water systems across Canada. One only need be reminded of the May 2000 Walkerton E-coli outbreak that resulted in seven deaths and 2000 illnesses, to want to take control of their water quality.

Water filters are becoming an increasingly popular way to reconcile the need for less waste with healthier and safer water. But how to choose? Just like the myriad of choices available to you when choosing a beverage, choices of water filters are equally overwhelming not to mention the confusing selection criteria. What follows is an attempt to demystify the selection process and give you a few guidelines to begin choosing which filtration system is right for you.

The first step is to choose a filter that is shutterstock_141717046independently certified. At a minimum filters (available in two types: point of entry or point of use) should meet NSF 53 (National Sanitation Foundation) certification. NSF 53 is designed to reduce specific health-related contaminants, such as Cryptosporidium, Giardia, lead, volatile organic chemicals (VOCs), MTBE (methyl tertiary-butyl ether), that may be present in public or private drinking water.

The second step is to choose your filtration process. There are a variety of ways to meet or exceed the NSF 53 standard although only 4-5 options are available to the general public. Activated carbon filters are positively charged and highly absorbent. They reduce bad tastes and odors, including chlorine. NSF 53 activated carbon filters can substantially reduce many hazardous contaminants, including heavy metals such as copper, lead and mercury (although it should be mentioned that a solid carbon block cannot achieve this – it must be combined with a KDF, see below); disinfection by- products; parasites such as Giardia and Cryptosporidium ; pesticides; radon; and volatile organic chemicals such as methyl-tert-butyl ether (MTBE), dichlorobenzene and trichloroethylene (TCE). The advantage of using activated carbon as a filter is that it retains all the positively charged minerals (what makes water ‘hard’ or ‘alkaline’) such as calcium, magnesium potassium and sodium; minerals necessary to maintain optimal health.

KDF resin filtration has limited utility in that it needs long exposure to untreated water and large amounts of the resin in order for it to exert its effects; mainly to remove chlorine. As such, KDF resin is usually applied in point of entry systems and in some cases shower heads to reduce chlorine exposure. One of the disadvantages of using KDF resin as a filter is that in some cases it can leach copper and zinc into the water as both minerals are used to reduce bacterial growth within the filter itself. KDF filters also clog fairly easily and require huge amounts of hot water to decongest the apparatus with no way to stem the flow of the dislodged pollutants into the treated water.

Distillation is an expensive process that heats the water to the vapor point and aids in removing some impurities from the water. The process itself requires electricity and adequate water, since it wastes gallons of water for every gallon produced. However the main disadvantage is that it leaves the water ‘soft’ or mineral free. If drunk over a long period the body tends to lend its own minerals to balance the effect on the body’s pH. Bones and teeth get weak with time. Another disadvantage is that distillation is not effective at removing VOC’s because many of them re-condense back into liquid just like water does. For this reason, a distiller is usually combined with a carbon filter to remove additional chemicals.

Reverse osmosis was developed to remove salt from sea water for military submarines. The reverse osmosis process draws water through a membrane. Salt water is put on one side of the membrane and pressure is applied to stop, and then “reverse,” the osmotic process. It generally takes a lot of pressure and is fairly slow removing all minerals in the process (similar to distilled water). For every one gallon of water produced, 10 gallons of water is used in the RO process. It does however get rid of most contaminants such as Cryptosporidium and Giardia; heavy metals: cadmium, copper, lead, mercury and other pollutants including arsenic, barium, nitrites, perchlorate and selenium.

UV Disinfection uses ultraviolet light to kill bacteria and viruses. Class A systems protect against harmful bacteria and viruses, including Cryptosporidium and Giardia, while Class B systems are designed to make non-disease-causing bacteria inactive. Unfortunately, it is not effective against parasites, heavy metals and VOC’s. Because of this it is often used in combination with a carbon filter and sediment screen.

Once you have decided on your filter, it’s important to maintain it properly as its performance will decrease over time as contaminants build up and potentially back up into your ‘treated’ water. Make sure to follow the manufacturer’s maintenance directions. Some filters only require a cartridge change, while others are better maintained by a certified professional. Many filter distributors offer maintenance and service contracts for their products. Before buying any water treatment system, compare not only filter prices, but also operating and maintenance costs for the different units.

Here’s to your good health! Dr. Marika Geis, ND

Chronic Yeast: Why Does This Keep Happening?

The impact of hormones on vaginal immunity.

By Dr. Marika Geis

For most women, yeast infections are nothing new. We know that if we take a prescription of antibiotics for a sinus infection that just won’t go away, we run the risk of getting a yeast infection. As doctors, we also know that those who use steroids regularly, have Diabetes, or are immunocompromised also have a greater likelihood of developing vaginal yeast infections. However, there are women out there who suffer from this minor annoyance, monthly or worse yet- constantly, often for years. The pattern usually presents as gradually getting worse prior to menstruation followed by relief for up to 10 days afterwards before the whole cycle starts again. These women know about the role of antibiotics and how they disrupt the healthy balance of bacteria in the body leaving yeast the opportunity to grow and proliferate. They are often aware that sugar, breads, dairy and alcohol feed yeast and will mostly be avoiding these. Often times women will report taking “yeast busting” cleanses that temporarily relieve their symptoms for a month or two only to have it return. So why does this keep happening? The timing of the infections is our clue. While optimal hormone balance rarely leaves us susceptible to this type of chronic infection, a relative excess of estrogen has an enormous impact on the immune micro-environment of the vagina. It not only allows the vulnerability to the yeast in the first place but goes on to feed it throughout the cycle.shutterstock_152301968

Besides the relative acidity of the vagina created by the presence of Lactobacillus (the main factor protecting us from infection), there are several types of immune cells that reside within various zones of tissue that provide further protection. Through a complex interplay of chemical messages and interactions, these cells essentially reveal microorganisms to other cells that will then ingest them. There is also a formidable complement of something called ‘secretory IgA’, a type of antibody that: neutralizes viruses, blocks the adherence of microbes to the tissue wall and enhances the microbe eating activity of other immune cells. Under normal conditions, secretory IgA begins to increase during the second half or luteal phase of a woman’s cycle and is lowest at ovulation thus allowing for insemination and possible conception. This leaves a woman vulnerable to infection for the first two weeks of her cycle which is typically when we start to see the symptoms returning.

Where we see problems is when a woman expresses an excess of estrogen relative to progesterone during the last half of the cycle. While estrogen can lower the amount of secretory IgA, it can also decrease the ability of certain immune cells to present microbes to the other types of cells that would otherwise engulf the pathogen. Furthermore, excessive estrogen shifts the immune response from one that is cell mediated to on that is antibody mediated. In other words, the simple ingestion of a foreign invader vs a more specialized approach which requires an initial exposure, an initial exposure that leads to symptoms; symptoms that would not have manifested had the microbe been dealt with by cells that just eat what’s not supposed to be there in the first place. Once an organism has overwhelmed the local immunity, estrogen makes things worse by allowing more vaginal epithelial cells (skin cells) to slough off and provide a food source (glycogen) for the growing microbes. Normally this food source would be reserved for the Lactobacillus that maintain the acidic pH of the vagina, however given the balance in favor of the invading microbe, the glycogen stored in the skin cells of the vagina actually contribute to their proliferation.

Dealing with excessive estrogen can be tough. Poor liver function caused by stress and poor diet, the exposure to environmental estrogens, the relative estrogen excess that comes with peri-menopause from lack of ovulation, oral contraceptive pills and under-function of the adrenal glands can all tip the scales overwhelmingly in favor of estrogen. Luckily, this pattern seems to be quite amenable to naturopathic interventions. Our strategies usually involve enhancing elimination by the liver and gall bladder, improving nutrient status, reducing exposure to petrochemicals and correcting adrenal function. Correcting adrenal function, by the way, is extremely important in that high levels of stress in and of themselves can drive down overall secretory IgA levels. So in addition to using the herbs, glandulars and vitamins available to us, outlining a stress management program is essential to minimizing the impact of stress on our immunity.

The occasional yeast infection is usually just a transient shift in the body’s ecology and is quite responsive to dietary changes, probiotics, antifungals a sitz bath and even a garlic clove suppository. However, when the infections are chronic and sometimes constant one must consider that the yeast itself isn’t the cause but rather the consequence of a greater imbalance – beyond slips in diet or taking prescription medications. Exploring the relationship between estrogen balance and secretory IgA levels in the vagina provides one possibility for treatment and has implications beyond yeast in that maintaining robust immunity in this area can protect us from all manner of infections including the possibility of cancer.

Japan Does Not Want Any More American Wheat

More Questions Raised About the Modern-Day ‘Staff of Life’:

Japan Refuses to Import US Wheat By: Dr. Marika Geis, ND

The future of the U.S. wheat industry looks a bit uncertain as of the end of May, 2013. Japan, upon the discovery of a genetically modified strain of ‘white wheat’ coming from Oregon, announced that all wheat imports coming from the United States were to cease immediately; this pending a thorough investigation as to the extent of the contamination and an assurance by the USDA that no such GM strain will ever make it into U.S. exports again.

Why all the uproar? Well, no country in the world has ever approved genetically modified wheat for sale. What’s more is that the strain found in Oregon, developed by the biotechnology giant, Monsanto, between 1998 and 2005 was never approved for sale because growers and buyers opposed Monsanto’s intent to seek approval to market the seeds.

People are right to be leery of GM foods. GM soy and corn are implicated in a number of human and livestock illnesses that literally leave no part of the body untouched (gut, liver and kidney function, the immune and endocrine systems, blood composition, allergic response, effects on the unborn, the potential to cause cancer, and impacts on gut bacteria). What’s even more concerning is that over 80% of processed foods contain GM foods with no labelling to identify products as such. However, despite their presence in processed foods, and the effects notwithstanding, GM soy, corn and more recently hay (alfalfa), are largely intended for animal feed. Wheat would be the first GM crop ever to be consumed en masse by people directly.

According to the U.S Food and Drug Administration policy statement on the safety of GMO’s, they are essentially equivalent to heritage seeds and crops and need no government regulation. It went on to say that the food producer bears responsibility for assuring safety. This is problematic as government officials from other countries often use FDA assessments to inform their own policies. If it’s happening south of the border it’s likely happening here.

The concern regarding GM wheat is compounded by the problems surrounding the hybridized varieties already being used. Driven by a mandate to combat world hunger, wheat went through a rapid period of cross-breeding resulting in thousands of varieties that dramatically increased yields from 8 to 65 bushels per acre. With each stage of hybridization (repeated thousands of times), 5% of the proteins are new and may have novel characteristics. Gluten seems particularly vulnerable to these structural changes and is therefore inherently more allergenic given that these new proteins have never existed before today. Clinically, we see time and again how symptoms ranging from total debility to softer syndromes improve with the elimination of wheat. Celiac disease is four times more common today than it was 65 years ago.

The average person eats 133 pounds of wheat per year, up 26 pounds from 1970. 99% of that wheat is the modern day, high yielding ‘dwarf’ and ‘semi dwarf’ variety containing ever changing gluten proteins. This coupled with the discovery

of GM strains of wheat making their way into our food supply presents a potentially dangerous combination and necessitates serious examination of our food’s safety. Until an unbiased consensus is reached, I think the precautionary principle exercised by Japan is an essential move. The best way to avoid wheat/gluten is simply to avoid using recipes that call for it or provide suitable replacement flours. Better yet, avoid recipes that call for any kind of flour. Eating seasonally and locally is the healthiest way to support your own health, your family’s health and the longevity of our environment.

Ever Our Faithful Servant: The Liver

Where would we be without you?

Dr. Marika Geis, BSc, ND

The natural medicine of today is a far different animal than it was a generation ago. In a society hungry for alternatives to conventional medical practices, ‘natural medicine’ has come to include any method that avoids the use of pharmacotherapy. With Dr. Oz touting the latest and greatest natural health phenomenon, detox foot baths, oil pulling, and so on, it can be easy to lose sight of the conceptual model that make natural medicine so effective. It’s not unusual for people to come to their appointments with their entire arsenal of supplements hoping for some clarity as to what they need to be taking. When asked why they are taking supplement ‘x’ I often hear “That’s agood question! I’m not actually sure. I think I read it somewhere in a magazine”. As naturopaths, a big piece of the education we offer to our patients is providing the framework with which to interpret their symptoms and decide on an appropriate course of action. This framework, regardless of how your naturopath formulates their assessment or the modality used, ultimately works on a ‘systems based’ approach in that our symptoms are the result of an issue ‘upstream’. Support the weakened system and the ‘downstream’ issues get resolved. It’s this ‘systems based’ approach that provides the direction necessary to focus on the remedies needed and hold off on others even though they might be ‘good for you’.liver

One such ‘upstream’ system is your liver. To those of you who have been receiving this newsletter for a while, this may seem like old news. So old in fact that it is often forgotten when attempting to figure out, as a for instance, why at the age of fifty, you’re all of a sudden constipated, bloated, fatigued and having the worst hot flushes of your life. It can be easy to think of all the herbs and vitamins that are involved in balancing out hormones like estrogen and progesterone or to make dietary changes that avoid the inflammation associated with troublesome hot flushes. But what’s to be done when these interventions don’t quite deal with the problem as you had hoped? Have we forgotten that a well-functioning liver is essential for optimal hormone balance? As another ‘for instance’, what if all of a sudden you are beset by a rash so itchy that you can’t sleep at night and you’re wearing socks on your hands to protect yourself for scratching yourself to infection? Have we forgotten that toxic compounds not eliminated by the liver and kidneys will look to the skin as a way to be eliminated?

“But I detoxify twice a year” you say. Detoxifying semi-annually and annually is certainly helpful in mitigating the toll of modern life on your liver but it is not a guarantee that your liver will never be impacted and in need of support outside those times. Excessive stress, pharmaceutical drugs, alcohol and sugar consumption, nutritional deficiencies, processed food, environmental chemicals, plastics in the home, the list goes on, can all potentially compromise liver function. Signs of dysfunction go beyond jaundice, pain in the upper right hand side and abnormal liver function tests. They can also include: lowered immunity, headaches, trouble balancing blood sugar, poor metabolism of fats (LDL will go up and HDL will go down), digestive issues (bloating, constipation, IBS, heartburn), rashes, bad breath, difficulties absorbing nutrients from our food (liver has a role in making the nutrition from our food bioavailable) which impacts mood, memory and concentration, keeping anger in check, and premenstrual symptoms such as breast tenderness, cramping and a heavy flow with clotting. The Chinese take it further implicating the liver in such things as sleep patterns (anyone out there consistently get up between 1 and 3 am?), the quality of your sight and health of your nails.

As naturopaths, we often see the chronic issues that the conventional model is at a loss to deal with. At times pharmacotherapy is needed to help manage symptoms that are intolerable. Life may become more manageable but the underlying cause goes unaddressed. Using a ‘systems based’ approach provides a broader framework with which to interpret symptoms and offers a direction in terms of treatment. Treating the liver is not the answer to all chronic health issues but it is certainly a key player in maintaining our overall health. It’s a little like a rain barrel: try never to let it get too full by keeping the spigot open at the bottom. Our humble liver is the spigot and our bodies, the rain barrel. Provided we have a little room at the top to collect rainwater, we’ll never spill over.

For more information on how liver health might relate to your specific health concerns, your naturopath is a wealth of knowledge. In the meantime (especially over the holiday season) you may want to incorporate the following:

  • A little lemon juice first thing in the morning (helps stimulate the flow of bile)
  • 1-2 tablespoons of non-GM soy or sunflower lecithin (helps the flow of bile)
  • Turmeric daily
  • Castor oil packs nightly
  • A good quality greens powder daily
  • A diet full of dark, leafy and bitter greens
  • Keep caffeine, alcohol and sugar to a minimum.

Demystifying Fever

by Dr Marika Geis ND

There’s nothing quite like waking up to a screaming child at 3 am and discovering that they have a fever. Half asleep, the worry creeps in; there’s no cough, no sniffles, no apparent discomfort, only the disconcerting cries of your child and what feels like a forehead about to burst into flames. Conventional wisdom and parental instinct often compel parents to fight their child’s fever. Who can blame them? Your child is suffering and is looking to you to for help. Naturally, reducing the fever is the surest way to ease their discomfort and persistent crying. Here’s the thing though, the fever is not the disease. In fact, your child’s fever is confirmation that they have a healthy and robust immune system

. Defined loosely as a form of inflammation, fever makes it less likely for harmful viruses and bacteria to develop into serious infections. It’s quite simple really: bacteria and viruses have a hard time replicating in warm environments. A beautiful example is chicken pox. Here, lesions will take longer to crust over if a fever is reduced prematurely. Besides making your body inhospitable to potentially harmful microbes, fever has several other roles that encourage healing. It stimulates cell growth, stimulates thyroid function, increases circulation, increases filtration by the liver and kidney and increases the production of immunoglobulins or antibodies.shutterstock_256541887

In children aged 3 to 36 months of age, viral infection is the most common cause of fever and can last up to three
days. It’s also important to know that the level of a fever does not necessarily correspond to the severity of the illness. A child with a mild cold can have a fever of 104.5 F (40.5) while a child with a serious illness can have a fever of 100F (38.0C). There are a few other reasons for fever, however. Teething, dehydration, insect stings, allergic reactions, overdressing and reactions to some medications can all produce a fever and should therefore be ruled out before deciding on a course of action.

But what about the number one fear of parents of a child with a fever, febrile seizures? Parents can take comfort in the fact that fevers rarely cause seizures. They do not seem to be related to the height of the fever or the rates at which it rises, but rather an idiosyncratic predisposition of certain children (about
4%). ½ of children who experience a febrile seizure will go on to have another one. About 1/3 of those will go on to have a third. They are more common in boys and most will occur from 6 months to 4 years peaking between 17-22 months.

Although terrifying to watch, there is no evidence that having a febrile seizure causes any permanent harm or that having this type of seizure will lead to epilepsy or other seizure disorders. That said, if your child does experience a febrile seizure they should be evaluated to rule out any underlying condition. A seizure should not last more than 15 minutes.

A few guidelines are provided for you as we head into this next wave of cold and flu season.

  • Consider the big picture: how sick does your child seem? How is their feeding pattern, ability to be consoled, level of irritability, responsiveness, level of activity, appearance (pale or flushed, dry or perspiring?)
  • Fever is defined as a rectal temperature of over 38 (100.4), oral temperature over 37.5C(99.5) and axillary (armpit) temperature of 37.2 (99)
  • Rectal temperature is considered the most accurate and is preferable for children aged 5 years and under. After that oral temperature is recommended.
  • A temperature ranging from 101.5-102.5 F (38.6- 39.2) is considered bacteriostatic, i.e. that it stops cell growth.
  • Temperatures over 104 F (40) are bacteriocidal, i.e. that it kills bacteria
  • VERY high temperatures of 105 F (40.5) can result in cell death
  • Tepid water baths may be helpful but never ice or alcohol baths due to their discomfort and potential toxicity
  • Mint tea and cold socks have saved my kids more than one occasion
  • Teething rarely elicits a fever of more than 38.4 or 101.2

You should seek medical attention immediately if your child is:

  • lethargic
  • unusually sleepy – difficult to wake up
  • in pain, cries when touched or moved
  • extremely irritable, inconsolable or whimpering
  • if he complains of a headache and stiff neck
  • having difficulty breathing
  • Appears confused or looses consciousness, or
  • Has purple spots on skin
  • Child is drooling profusely and unable to swallow anything
  • A convulsion has occurred

In general, low grade fevers 102 F (38.9) rarely need treatment, however your child may be very uncomfortable and unable to rest. With a fever of more than 103 F (39.4) your child will look and feel quite ill. Here, you may want to moderate the fever and not suppress it. Make sure your child is well hydrated particularly if they have diarrhea or are vomiting, even if it’s only a teaspoon every few minutes. If, after you’ve brought down the fever, your child looks and feels noticeably better it’s a good indication that the fever was responsible for your child’s discomfort. A child with a serious bacterial infection will continue to look unwell.

Each parent has their own threshold for deciding when and how to intervene. At the end of the day it’s important to remember to treat your child and not the thermometer. There are times when allopathic intervention is needed, but in the vast majority of cases supportive measures are all that is required: a cuddle, quiet distraction, rocking them to sleep and making sure they are hydrated and well-nourished can help them get over a fever faster. As a parent, sometimes the hardest thing to do is to do nothing except watch and behold the wonder of how our children’s bodies can learn to be well….all on their own.

Embracing Chicken Pox

By Dr Marika Geis

I have to admit that I felt some apprehension about writing this article. The issue of vaccination is contentious; it’s difficult to find a parent or health care professional with an unbiased opinion regarding immunization. That said, I thought I’d tackle one of the simpler vaccines in that the decision to immunize or not might be more straightforward compared to the others that are available: Chicken Pox.
Much of my work is focused on prenatal care, labor and delivery support and of course the little ones that come after. When the time comes to make a decision about immunizations, confused parents often reach out for help in hopes of gaining some clarity on the issue, a task made increasingly difficult by intensely opposing views and an overwhelming body of information. When it comes to chicken pox however, parents often feel that this is a ‘no brainer’ given that most of us have had chicken pox as children without consequence. Perhaps this is what accounts for its low vaccination rate: 32% on average. However, it might be worth taking a look at what prompted the development of the vaccine just so that we can be assured that it really is a ‘no-brainer’. We’ll briefly look at its clinical presentation and course, populations affected and potential complications. In the end, I hope to offer what are clear and comprehensive criteria for vaccination of chicken pox.

The Chicken Pox, borne of the varcicella zoster virus (VZV), is a highly contagious (infection rates exceeding 90%) rash characterised by its blister like appearance and intense itching. Its peak occurrence is in children aged 4-10 years with more complications associated with increasing age. In both age groups the rash usually affects the head and torso with limited blisters found on the extremities. Transmission of the virus is airborne with an incubation period of 10-21 days. People infected with the virus however, are only contagious for the 2 days prior to the appearance of the rash and until all blisters have healed over, a process that usually take about 6 days. In children, often the only indication that they have contracted the virus is the rash itself whereas adults will usually suffer from nausea, diminished appetite, aching muscles, a low grade fever and general feeling of malaise a few days prior to the outbreak. Adults, particularly males, are at risk of developing serious complications such as varicella pneumonia (90% of varicella pneumonia occur in adults), hepatitis and encephalitis although these are rare. In children the most common complication is infection arising from scratching itchy pox.

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Another common complication (regardless of the age at which you were infected) is shingles an exquisitely painful condition where the virus, having been dormant for decades, reappears and affects the superficial nerves supplying the skin. Pregnant, non-immunized women who contract the virus prior to 28 weeks can pass the virus onto their unborn child posing very serious consequences that include birth defects among others. After 28 weeks the risk is premature delivery, after which the baby is at risk for developing the infection if exposed 7 days prior to birth or 7 days after birth. Non-immunized pregnant women are also at risk of developing pneumonia with the severity increasing with increasing gestation. This is also relatively infrequent as only 10% of non-immunized pregnant women with chicken pox will go onto develop pneumonia. People that are immunocompromised have it the worst in that the infection can be potentially fatal as this population tends to manifest the most serious complications associated with the virus.

Given the potential consequences to adults, neonates, non-immune pregnant women, and immunocompromised patients (eg: HIV), not to mention that it’s responsible for a third of all strokes in children (2.03 strokes per 100,000 Canadian children under 19 years of age. Make that even less when you consider we’re taking about kids ages 4-10) it’s no wonder that companies sought to limit the occurrence and severity of this infection. Limit the number of infections and you reduce the number of complications overall, right? Not quite. There are a few important factors to consider when deciding whether or not the virus is the right choice for you and your family. I was surprised to find out that the manifestation of VZV changes depending on your climate. In temperate zones, VZV will have the clinical presentation and course that we are familiar with; a self-limiting rash affecting primarily kids aged 4-10 years. However, in tropical countries the virus rarely affects children and typically saddles adults with the more severe form of infection and associated complications. Next, is the vaccine itself in that it does not confer lifelong immunity (needs a booster after 5 years), whereas natural infection does. The vaccine also loses efficacy at a rate of 3% annually, with the duration of protection from the virus being unknown. What this means is that while the vaccine may protect children during the age range of least vulnerability to severe consequences of the virus, adults who were vaccinated as children and therefore never contracted the virus naturally renew their susceptibility to the infection and its complications. The risk of shifting the affected population of chicken pox to more vulnerable cohorts must be carefully considered against the generally benign nature of the naturally occurring illness.

So, what to do?

Well, I guess if you were one of the 10% of children who hadn’t contracted the virus by the time you reached 15 years old lived in a tropical country, had a compromised immune system, were a caregiver to someone who could not get vaccinated and hadn’t had the infection yourself then this might be the best solution for you. And certainly very special consideration needs to be taken if you are non immunized pregnant woman or have a baby less than 6 months of age. However, if you are a parent struggling with whether or not to vaccinate against this particular virus in your healthy and well- nourished child you might want to give some thought as to whether or not this might be a vaccine you can do without given that 75% of kids will get chicken pox by the time they are 15. With the benefit of lifelong natural immunity the issue of contracting the virus while pregnant ceases to be an issue in addition to reducing the serious consequences associated with infection at an older age. My advice as both a parent and physician: If you hear of a child in your community with the chicken pox, invite yourself over and enjoy a chicken pox party! Your healthy but itchy toddler/child will be protected FOR LIFE!

Kootenai Health News 1

Clinic News

The Doctor Is In!

After several extended absences from clinical practice, I am pleased to announce that my baby growing days are behind me and I am ready to shift my focus back to my practice. It is only by your unwavering support and encouragement that I have been able maintain my practice while also having the freedom to be a constant presence in the lives of Felix Jasper (now age 2½) and Leisl Soleil (now 11 months old). I am grateful for your patience during this time of transition. I’m so looking forward to seeing your familiar faces and meeting some new ones as well.

My new hours are as follows:

  • Tuesday 9am to 5pm
  • Wednesday 9am to 5pm
  • Thursday 11am to 8pm

Harmonized Sales Tax

As of July 1, 2010, naturopathic consultation fees, as well as supplements, will be subject to 12 percent HST. The British Columbia Naturopathic Association is currently working with the provincial government to exempt naturopathic visits from this combined tax. I will keep you informed of events as they progress.

Seasonal Allergies

Quercetin, nature’s anti-histamine

Many vegetables and fruits are rich in QuercetinUbiquitous in our food supply, quercetin is renowned for its use in cataract prevention, cardiovascular protection, as well as anti-cancer, anti-ulcer, anti-allergy, antiviral, and anti-inflammatory activity. Its unique flavonoids are founds in commonly consumed foods such as apples, onions, tea, berries, and brassica vegetables, as well as many seeds, nuts, flowers, barks, and leaves. It is also found in medicinal botanicals and is often a component of the medicinal activity of the plant.

Quercetin has a mast cell (cells that release histamine) stabilizing effect, making it an obvious choice for anyone that suffers from seasonal allergies. Quercetin is best taken with bromelain as this helps to improve its absorption which on its own is quite poor.

If you’re interested in finding out more about quercetin or about naturopathic approaches to seasonal allergies, call me at the clinic anytime. I would be happy to answer your questions.

Eat Locally: Homegrown Goodness

As Canadians, we are acutely aware of our growing season; it is short. As a result we have become dependent on produce that has traveled from far away places to reach our plates. By the time those exotic fruits and vegetables reach our northern climes they have little if any nutrition left having been picked too early and allowed to ripen in transit versus on the plant. There are also the hidden costs to consider. Grapes from Chile may be cheap, and by all accounts delicious, but what about the fossil fuel it took to bring those grapes here? How does that bode for the health of our planet, ourselves?

We can mitigate these costs both tangible and intangible by EATING LOCALLY. With the summer sun melting down on us and local gardens bursting with produce there couldn’t be a better time to take advantage of what a Canadian summer has to offer; Homegrown Goodness. In our valley there are many ways to enjoy local produce whether it is by starting your own garden, heading down to the Invermere Farmers’ Market or visiting Edible Acres, WinValley Farms, Hopkins Harvest or one of the many other farms or produce stands in the valley. By eating locally we act globally by reducing the carbon emissions that result from transporting food over large distances as well as by supporting and maintaining the infrastructure of our beautiful Columbia Valley.

  • Edible Acres – Lin Steedman & Liver Egan – edibleacrescsa@gmail.com – (250) 342-7472
  • Hopkins Harvest – just off 93/95 Highway by the Windermere Fire Hall – (250) 342-6437

Products For New Moms

Here are just a few items that may be of use to you as you carefully navigate the health choices available to you and your newborn.

Nursing tea

A soothing, safe and effective herbal lactation formula helps moms to quickly improve the quantity and quality of their milk supply.

Vitamin D drops

From Biotics Research, supplies vitamin D3 in an emulsified form providing 400IU per drop. Just one drop for baby to take off the nipple is all you need to ensure that optimal vitamin D levels are met.

Baby probiotics

From Genestra, provides a highly concentrated combination of friendly bacterial strains essential to the development and maturation of the newborn’s immune system thereby assisting in the prevention of allergies and infectious disease.

Castor oil

An incredibly easy to use yet potent remedy that strengthens the development of baby’s immune system, prevents constipation, treats both diarrhea and colic and feels lovely to baby to boot. A quarter sized amount, rubbed in a clockwise over baby’s belly nightly (or almost nightly) is all you need.
New Gluten-Free Recipes

When I counsel people on making changes to their diet in order to achieve some therapeutic goal, my crestfallen clients invariably ask me, “What’s there to eat?”

The answer: Lots! Dietary changes are by no means punitive and can actually be a fun and exciting opportunity to find new ways to titillate your taste buds. What follows is the beginning of a new resource that I intend to archive for my clients. Enjoy.

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Warm quinoa and spinach salad with grape tomatoes

From Gluten-Free Goddess

This naturally gluten-free salad is dairy-free and vegan. If you do eat dairy, a crumble of goat cheese or feta would also be fabulous.

  • Extra virgin olive oil
  • 1 clove garlic, minced
  • 1/2 to 2/3 cup cooked quinoa per person
  • 1 generous cup washed organic baby spinach leaves per person
  • A handful of organic grape tomatoes per person, halved
  • 1 scallion per person, washed, sliced
  • Sea salt and fresh ground pepper, to taste
  • Sprinkle of nutmeg
  • Sprinkle of fresh or dried herbs- parsley, thyme, basil, or mint
  • Squeeze of fresh lemon juice (or Champagne vinegar if, like me, you’re allergic to lemon)

Gently heat a large pan. Pour in some extra virgin olive oil. Add the garlic; stir and warm the oil for a minute. Add the cooked quinoa and heat through. Add the baby spinach leaves, tomatoes and scallions. Season with sea salt and fresh ground pepper. Sprinkle with nutmeg and herbs. Stir to mix. Sprinkle with lemon juice and stir. When the spinach begins to wilt remove from heat.

Serve in a bowl. Dig in. Be happy.