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An Orthomolecular Approach to Mental Health

Posted September 18, 2018

By: Dr. Colin O’Brien ND, Medical Doctor, Cyto-Matrix

Depression and anxiety are conditions that affect us all, either personally or through the suffering of friends, family and patients.  While there are a seemingly endless number of factors to consider that are unique to each individual, one area that should always be addressed is nutritional status.

Anecdotal evidence and clinical research has shown us that mental health concerns can arise in the presence of single or multiple nutrient deficiencies. Here is a brief summary of some of the most common nutrients to consider when treating mental health:

 

Magnesium: Although we typically associate magnesium with musculoskeletal function, it has been shown to increase brain-derived neurotrophic factor (BDNF) and GABA, while down-regulating ACTH and blocking NMDA receptors. Benefits for improving depression markers have been seen with supplementation after only 1-2 weeks in many different forms (such as oxide, glycinate and taurinate). Although clinical trials have shown benefits for depression and anxiety between 125-300mg of elemental magnesium per day, clinically it may be most useful to dose to bowel tolerance.

 

Zinc: The hippocampus, the area of the brain responsible for emotion, memory and motivation, has one of highest concentrations of zinc in the body. Many studies have shown that lower zinc levels are associated with depression, and interventional trials support its use for this purpose. Specifically, zinc sulphate has successfully been used in Multiple Sclerosis patients and zinc gluconate has been used in obese patients, with both improving Beck Depression scores after 12 weeks. The evidence based dose is 25-50mg of elemental zinc per day and zinc supplementation can also safely improve SSRI outcomes.

 

B-vitamins: A 2015 Systematic Review found that B12 and Folate reduced the onset and relapse risk for depression with long-term supplementation. Similarly, a combination of 500mcg vitamin B12, 2mg Folate and 25mg vitamin B6 has been shown to improve antidepressant medication response over a full year. Clinically, a well-balanced B-complex supplement or intramuscular methylcobalamin and folate injections can have an immediate positive impact on mood and energy, if patients have suboptimal levels. I prefer my mental health patient’s serum B12 levels to be above 500 pmol/L.

 

Iron: Iron is not only needed for hemoglobin synthesis, but also serotonin production and the proper conversion of thyroxine (T4) to triiodothyronine (T3). Although no interventional studies have been done with iron and depression or anxiety, there is a strong and convincing correlation noted between low hemoglobin and depression with a dose-response relationship, meaning those with worse anemia demonstrate more severe depression. Ferritin levels below 45 ng/mL and hemoglobin below 120 g/L for women (less than 130 g/L for men) are associated with depressive symptoms

 

Vitamin D: Higher serum levels have been associated with a 43% lower risk of depression and panic disorder, with various interventional trials showing benefits for depression with a wide range of dosing (ie 50,000 IU/week vs. 2,000 IU/day). Similarly, benefits for vitamin D supplementation in depressed adolescent females, obese populations and perinatal mothers has been demonstrated. However, there are also many interventional trials showing lack of benefit which could be due to adequate vitamin D status in subjects at baseline. The target blood levels for optimal mood should be 75 nmol/L or greater.

 

Omega-3’s: A 2018 analysis of 19 RCTs found that fish oil supplementation provided a modest improvement in those with anxiety, with a greater effect in those taking more than 2,000mg/day of combined EPA and DHA. When it comes to depression, some evidence has shown that it is not beneficial to simply restore polyunsaturated fatty acid (PUFA) status in the body, but rather that omega-3’s can be beneficial in cases of systemic inflammation. In fact, your depressed patients are most likely to respond to omega-3 supplementation if their high sensitivity C-reactive protein (hs-CRP) is above 3.0. The evidence based dosage in depression is 1000-2000mg of EPA per day.

 

Selenium: Time to eat those brazil nuts! There are at least 5 studies associating low selenium with depression & anxiety, while one interventional study of 100mcg/day improved mood after only 5 weeks.

 

When it comes to choosing the right nutrient(s) for supplementation, lab testing, clinical signs and symptoms, and knowledge of common medication depletions should be considered. But the take home message from all of this should be that, when it comes to mental health, diet matters…a lot. There are many nutrients necessary to keep the brain balanced.

Perhaps the best study to illustrate this was the 2017 RCT of 67 individuals with moderate to severe depression. After 12-weeks of eating a modified Mediterranean diet, 32% went into remission compared to only 8% of the control group. The key here is that the dietary intervention was ad libitum, meaning the focus was on food quality and not calories. The group was even allowed up to 3 servings per week of “extras” such as refined sugars, alcoholic drinks and fast-foods, showing that it doesn’t need to be an “all-or-none” approach.

Even encouraging patients to “Eat the rainbow” to get a wide variety of nutrients and to focus on “Eating whole foods” to reduce sugars and additives is often an easy starting point for many individuals that feel overwhelmed with dietary changes. In fact, simply reducing the glycemic index of foods can reduce the risk for depression.

When it comes to mental health, part of the solution for our patients may be simpler than we think. In the words of Michael Pollan, “Eat real food. Not too much. Mostly plants.”

 


 

References:

[1]  Tarleton EK, Littenberg B, MacLean CD, Kennedy AG, Daley C (2017) Role of magnesium supplementation in the treatment of depression: A
randomized clinical trial. PLoS ONE 12(6).

[2]  Rajizadeh, Afsaneh et al. Effect of magnesium supplementation on depression status in depressed patients with magnesium deficiency: A
randomized, double-blind, placebo-controlled trial. Nutrition, Volume 35, 56 – 60.

[3]  Eby GA, Eby KL. Rapid recovery from major depression using magnesium treatment. Med Hypotheses. 2006;67(2):362-70. Epub 2006 Mar 20.

[4]  Levenson CW. Zinc: the new antidepressant? Nutr Rev. 2006 Jan;64(1):39-42.

[5] Salari S et al. Zinc sulphate: A reasonable choice for depression management in patients with multiple sclerosis: A randomized, double-blind,
placebo-controlled clinical trial. Pharmacol Rep. 2015 Jun;67(3):606-9.

[6] Solati Z et al. Zinc monotherapy increases serum brain-derived neurotrophic factor (BDNF) levels and decreases depressive symptoms in
overweight or obese subjects: a double-blind, randomized, placebo-controlled trial. Nutr Neurosci. 2015 May;18(4):162-8.

[7] Nowak G, Szewczyk B, Pilc A. Zinc and depression. An update. Pharmacol Rep. 2005 Nov-Dec;57(6):713-8.

[8]Almeida OP, Ford AH and Flicker L. Systematic review and meta-analysis of randomized placebo-controlled trials of folate and vitamin
B12 for depression. Int Psychogeriatr. 2015 May;27(5):727-37.

[9] Almeida OP, Ford AH, Hirani V, Singh V, vanBockxmeer FM, McCaul K, Flicker L. B vitamins to enhance treatment response to antidepressants in
middle-aged and older adults: results from the B-VITAGE randomised, double-blind, placebo-controlled trial. Br J Psychiatry. 2014 Sep 25.

[10] Vulser H et al. Association between depression and anemia in otherwise healthy adults. Acta Psychiatr Scand. 2016 Aug;134(2):150-60.

[11] Stewart R and Hirani V. Relationship between depressive symptoms, anemia, and iron status in older residents from a national survey
population. Psychosom Med. 2012 Feb-Mar;74(2):208-13.

[12] Maddock J, Berry DJ, Geoffroy MC, Power C, Hypponen E. Vitamin D and common mental disorders in mid-life: cross-sectional and prospective
findings. Clin Nutr. 2013 Jan 21.

[13] Bahrami A et al. High Dose Vitamin D Supplementation Is Associated With a Reduction in Depression Score Among Adolescent Girls: A Nine-
Week Follow-Up Study. J Diet Suppl. 2017 Jul 31:1-10.

[14] Vaziri F et al. A randomized controlled trial of vitamin D supplementation on perinatal depression: in Iranian pregnant mothers. BMC
Pregnancy Childbirth. 2016 Aug 20;16:239.

[15] Jorde R et al. Effects of vitamin D supplementation on symptoms of depression in overweight and obese subjects: randomized double blind
trial. J Intern Med. 2008 Dec;264(6):599-609.

[16] Gowda U et al. Vitamin D supplementation to reduce depression in adults: meta-analysis of randomized controlled trials. Nutrition. 2015
Mar;31(3):421-9.

[17] Su K, Tseng P, Lin P, et al. Association of Use of Omega-3 Polyunsaturated Fatty Acids With Changes in Severity of Anxiety Symptoms: A
Systematic Review and Meta-analysis. JAMA Network Open.2018;1(5):e182327. doi:10.1001/jamanetworkopen.2018.2327.

[18] Appleton KM, Gunnell D, Peters TJ, Ness AR, Kessler D, Rogers PJ. No clear evidence of an association between plasma concentrations of n-3
long-chain polyunsaturated fatty acids and depressed mood in a non-clinical population. Prostaglandins Leukot Essent Fatty Acids. 2008
Jun;78(6):337-42.

[19] Rapaport MH et al. Inflammation as a predictive biomarker for response to omega-3 fatty acids in major depressive disorder: a proof-of-
concept study. Mol Psychiatry. 2016 Jan;21(1):71-9.

[20] Benton D. Selenium intake, mood and other aspects of psychological functioning. Nutr Neurosci. 2002 Dec;5(6):363-74.

Male Infertility: A Step-Wise Approach

Posted June 4, 2018

By: Dr. Colin O’Brien ND, Medical Director, Cyto-Matrix

Up to 50% of male infertility cases have no clear cause and sperm counts continue to dwindle.[1] Yet, countless research studies have uncovered environment factors that may contribute to male infertility through their negative impact on sperm parameters. This means that there are also countless treatment avenues to explore with our male fertility patients.

If physical and anatomical obstructions are ruled out as causes of infertility, consider this step-wise approach for male patients either struggling with fertility due to poor sperm health (i.e. documented low sperm counts and/or poor motility and morphology) or looking to optimize their fertility through proactive means:

 

Step 1: Address diet

It’s no surprise that diet must be the foundational treatment for improving male fertility. Although many of these changes may seem common sense, they are important to reinforce with your patients before exploring more targeted treatments:

  • Remove or reduce alcohol, marijuana, caffeine and cigarette smoke: Collectively, an increased exposure to these substances has shown a dose-dependent increase in free radical production, reduction in semen amounts, and worse sperm motility and morphology.[2] [3] [4] 
  • Add healthy fats: Research has shown that just 75 grams per day of walnuts, a whole food source of polyunsaturated fatty acids, added to a typical Western diet can improve sperm counts, morphology and motility.[5] This study confirms other research showing that there are lower levels of Omega-3 fatty acids in infertile men when compared to fertile males,[6] and that EPA and DHA supplementation can improve sperm counts and concentrations.[7] Finally, excess saturated fat intake is associated with reduced semen volume.[8]
  • Remove refined sugars: As if we needed another reason to advise patients to avoid refined sugars, research has shown that even just an increased consumption of sugar-sweetened beverages (greater than 1.3 per day) can significantly reduce sperm motility.[9]
  • Consider organic: Reduced pesticide exposure through organic food choices may make a powerful impact on the sperm quality of your male population. A 2008 review found that increased pesticide exposure can affect spermatogenesis and may prolong time-to-pregnancy.[10]

It should be noted that both obesity and being underweight have been associated with lowered testosterone and poor sperm count, respectively.[11] When appropriate, a focus on healthy weight management should be encouraged.

 

Step 2: Review personal care products

Education surrounding environmental toxin exposure is key when discussing male fertility concerns.

In addition to other ‘clean-living’ options such as choosing Bisphenol A (BPA)-free options in plastics and cans, consider the impact of these important endocrine disruptors:

  • Triclosan: This anti-microbial agent commonly found in toothpaste, deodorants, shampoos and other household products, has been demonstrated to be negatively associated with normal sperm morphology, concentration and count.[12]  
  • Parabens: Commonly discussed in the context of xenoestrogen activity and female fertility concerns, these preservatives appear to damage mitochondrial function in sperm. [13] A 2017 study showed that urinary paraben levels were significantly associated with abnormal morphology, decreased sperm motility and decreased testosterone levels.[14]
  • Phthalates: The compounds commonly found in plastics and, unfortunately, also beauty products, have also been shown to negatively impact sperm parameters. For example, one study found urinary mono-methyl-phthalate (MMP) concentrations to strongly correlate with sperm concentration, length and maturity.[15] 

 

Step 3: Add in antioxidant support

Now that you have done some removal, it’s time to add more of the good stuff! Antioxidants help to quench the reactive oxygen species that are generated often in response to environmental exposures and, ultimately, reduce the damage done to sperm mitochondria.

A number of reviews and meta-analyses have definitively demonstrated the ability for antioxidants to not only improve sperm parameters[16], but also increase live birth rates and pregnancy rates in subfertile couples.[17]

Consider a combination of the following antioxidants:

  • Vitamin C: A dose-dependent improvement in sperm motility has been found with vitamin C supplementation in smokers.[18] [19] Many studies have used ascorbic acid in combination with vitamin E and zinc for improved sperm parameters. 
  • Vitamin E: Tocopherols are a well-known group of antioxidants that are widely deficient in the modern-day diet. Vitamin E has been shown to improve sperm parameters on its own[20], but particular improvements have been noted when it is combined with selenium[21], and vitamin C.[22] 
  • Selenium: Not only is selenium beneficial for sperm parameters when combined with Vitamin E or N-acetylcysteine, but solo supplementation also shows benefit for sperm counts and motility (100 mcg over 3 months).[23] This makes sense given that selenium is necessary for proper spermatogenesis.[24]
  • Zinc: Zinc’s function in various aspects of male health, including testosterone production, has long been studied and its impact on fertility and spermatogenesis is no different. A recent meta-analysis of 20 studies found that zinc concentrations in seminal plasma were significantly lower in infertile males and that supplementation is capable of increasing semen volume, while also improving sperm motility and morphology.[25] Zinc in combination with folate has also shown benefit for sperm count[26]
  • L-Carnitine and Acetyl-L-Carnitine: Carnitine provides energy to the sperm by transporting fatty acids into the mitochondria, thereby improving sperm motility. Over a dozen human clinical trials have confirmed the use of either L-carnitine, Acetyl-L-carnitine (the form capable of entering the central nervous system) or a combination of both for improved sperm motility, while a number of these same studies have shown improved pregnancy rates.[27]
  • N-acetylcysteine: most well-known for its ability to increase glutathione levels, at only 600mg/day this amino acid can improve sperm motility and volume.[28] The addition of 200mcg/day of selenium has found even better results in these areas, also with improved sperm morphology.[29]

There are many other antioxidants that have shown benefits for improving sperm markers. The key is to individualize your treatments to target patient-specific dietary and environmental factors. Also consider coenzyme-Q10, arginine, astaxanthin, lycopene, folate and melatonin.

 

Step 4: Address stress and consider botanicals and acupuncture

Although diet, lifestyle and nutritional support have a profound ability to improve male fertility outcomes, stress management needs to be considered as elevated stress can alter testosterone levels and, thereby, sperm numbers and functionality.[30]

Many stress reduction techniques may be indicated (i.e. deep breathing) but herbal extracts can act through multiple mechanisms. For example, adaptogens with the ability to positively impact the HPA-axis can also provide powerful antioxidant support.

Two herbs to consider include:

  • Mucuna pruriens: Also known as velvet bean, this herb contains a high concentration of dopamine, can improve psychological stress scores and also improve sperm parameters.[31] 
  • Withania somnifera: More commonly known as ashwagandha, this adaptogenic herb is best known for its ability to reduce stress and anxiety, but it is also a traditional aphrodisiac capable of treating male sexual dysfunction and infertility. A 2013 placebo-controlled study confirmed this ancient wisdom by showing significant improvements in sperm parameters after 3 months of treatment intervention with 225mg, three times per day.[32] A 167% increase in sperm count was seen, with a 53% increase in sperm volume, a 57% increase in sperm motility and a 17% increase in testosterone levels.

Other herbs to consider with positive research for male fertility outcomes include Eurycoma longifolia, Mucuna pruriens and Panax Ginseng.[33]

Finally, acupuncture may be an appropriate intervention capable of not only reducing stress, but also improving blood flow to the testicles and, thereby, offering multiple mechanisms for improved fertility outcomes.

Various studies have shown acupuncture may be beneficial for male infertility through scrotal temperature control, increased testosterone and improved sperm parameters.[34] [35]

 


 

References: 

[1] Levine H et al. Temporal trends in sperm count: a systematic review and meta-regression analysis. Hum Reprod Update. 2017 July 25:1-14.

[2] Wogatzky J et al. The combination matters – distinct impact of lifestyle factors on sperm quality: a study on semen analysis of 1683 patients according to MSOME criteria. Reprod Biol Endocrinol. 2012; 10: 115.

[3] Fronczak CM, Kim ED, Barqawi AB. The insults of illicit drug use on male fertility. J Androl. 2012:33(4):515-528.

[4] Elena Ricci et al. Coffee and caffeine intake and male infertility: a systematic review. Nutr J. 2017; 16: 37.

[5] Robbins WA et al. Walnuts improve semen quality in men consuming a Western-style diet: randomized control dietary intervention trial. Biol Reprod. 2012; 87(4): 101.

[6] Safarinejad MR et al. Relationship of omega-3 and omega-6 fatty acids with semen characteristics, and anti-oxidant status of seminal plasma: a comparison between fertile and infertile men. Clin Nutr. 2010;29(1):100-105.

[7] Safarinejad MR. Effect of omega-3 polyunsaturated fatty acid supplementation on semen profile and enzymatic anti-oxidant capacity of seminal plasma in infertile men with idiopathic oligoasthenoteratospermia: a double-blind, placebo-controlled, randomized study. Andrologia. 2011; 43(1): 38-47.

[8] Hajar Dadkhah et al. The Relationship between the Amount of Saturated Fat Intake and Semen Quality in Men. Iran J Nurs Midwifery Res 2017 Jan-Feb; 22(1): 46–50.

[9] Y.H. Chiu et al. Sugar-sweetened beverage intake in relation to semen quality and reproductive hormone levels in young men. Hum Reprod. 2014 Jul; 29(7): 1575–1584.

[10] Roeleveld N and Bretveld R. The impact of pesticides on male fertility. Curr Opin Obstet Gynecol. 2008 Jun; 20(3): 229-33.

[11] Wogatzky J et al. The combination matters – distinct impact of lifestyle factors on sperm quality: a study on semen analysis of 1683 patients according to MSOME criteria. Reprod Biol Endocrinol. 2012; 10: 115.

[12] Zhu W et al. Environmental Exposure to Triclosan and Semen Quality. Int J Environ Res Public Health. 2016; 13(2): 224.

[13] Tavares RS, Martins FC, Oliveira PJ, et al. Parabens in male infertility—Is there a mitochondrial connection? Reprod Toxicol. 2009; 27(1):1-7.

[14] Jurewicz J. Human Semen Quality, Sperm DNA Damage, and the Level of Reproductive Hormones in Relation to Urinary Concentrations of Parabens. J Occup Environ Med. 2017; 59(11): 1034-1040.

[15] Bloom MS et al. Associations between urinary phthalate concentrations and semen quality parameters in a general population. Hum Reprod. 2015; 30(11): 2645-2657.

[16] Ross C et al. A systematic review of the effect of oral antioxidants on male infertility. Reprod Biomed Online. 2010 Jun; 20(6):711-23.

[17] Showell MG et al. Antioxidants for male subfertility. Cochrane Database Syst Rev. 2011 Jan 19; (1):CD007411.

[18] Dawson EB, Harris WA, Powell LC. Relationship between ascorbic acid and male fertility. World Rev Nutr Diet. 1990; 62: 1–26.

[19] Agarwal A, Sekhon LH. The role of antioxidant therapy in the treatment of male infertility. Hum Fertil. 2010;13(4):217-225.

[20] Kessopoulou E et al. A double-blind randomized placebo cross-over controlled trial using the antioxidant vitamin E to treat reactive oxygen species associated male infertility. Fertil Steril. 1995 Oct;64(4):825-31.

[21] Keskes-Ammar L et al. Sperm oxidative stress and the effect of an oral vitamin E and selenium supplement on semen quality in infertile men. Arch Androl. 2003 Mar-Apr; 49(2): 83-94.

[22] Baker HW et al. Protective effect of antioxidants on the impairment of sperm motility by activated polymorphonuclear leukocytes. Fertil Steril. 1996 Feb; 65(2): 411-9.

[23] Scott R et al. The effect of oral selenium supplementation on human sperm motility. Br J Urol. 1998;82(1):76-80.

[24] Boitani C and Puglisi R. Selenium, a key element in spermatogenesis and male fertility. Adv Exp Med Biol. 2008; 636: 65-73.

[25] Zhao J et al. Zinc levels in seminal plasma and their correlation with male infertility: A systematic review and meta-analysis. Scientific Reports. 2016; 6: 22386.

[26] Wong WY et al. Effects of folic acid and zinc sulphate on male factor subfertility: a double-blind, randomized, placebo-controlled trial. Fertil Steril. 2002;77(3):491-498.

[27] Mongioi L et al. The role of carnitine in male infertility. Andrology. 2016 Sep;4(5):800-7.

[28] Ciftci H et al. Effects of N-acetylcysteine on semen parameters and oxidative/antioxidant status. Urology. 2009 Jul;74(1):73-6.

[29] Safarinejad MR and Safarinejad S. Efficacy of selenium and/or N-acetyl-cysteine for improving semen parameters in infertile men: a double-blind, placebo-controlled, randomized study. J Urol. 2009; 181(2): 741-751.

[30] Nargund VH. Effects of psychological stress on male infertility. Nat Rev Urol. 2015 Jul; 12(7): 373-82.

[31] Shukla KK et al. Mucuna pruriens Reduces Stress and Improves the Quality of Semen in Infertile Men. Evid Based Complement Alternat Med. 2010; 7(1): 137-144.

[32] Ambiye VR et al. Clinical Evaluation of the Spermatogenic Activity of the Root Extract of Ashwagandha (Withania somnifera) in Oligospermic Males: A Pilot Study. Evid Based Complement Alternat Med. 2013; 2013: 571420.

[33] Salvati G et al. Effects of Panax Ginseng C.A. Meyer saponins on male fertility. Panminerva Med. 1996; 38(4): 249-254.

[34] Siterman S et al. Success of acupuncture treatment in patients with initially low sperm output is associated with a decrease in scrotal skin temperature. Asian J Androl. 2009;11(2):200-208.

[35] Pei J et al. Quantitative evaluation of spermatozoa ultrastructure after acupuncture treatment for idiopathic male infertility. Fertil Steril. 2005; 84(1): 141-147.

Lesser-Known and Broad-Reaching Effects of Iron Deficiency

Posted May 1, 2018

By: Dr. Colin O’Brien ND, Medical Director, Cyto-Matrix

Every healthcare practitioner should be able to rhyme off the keynote symptoms of iron-deficiency: fatigue, weakness, dizziness and pallor (pale skin) probably come to mind first. This makes sense given that iron is the most commonly deficient nutrient in the world and a concern often seen in private practice. But the implications of suboptimal iron extend much further than low hemoglobin and low energy. Iron is needed for so much more.

Many practitioners, myself included, have likely missed opportunities to successfully treat patients with iron restoration therapies over the years because of more “atypical” signs and symptoms of inadequate iron. Yes, iron is classically needed in hemoglobin formation and, therefore, oxygen delivery and energy levels, but here are some other conditions and physiological functions that may warrant a more thorough exploration of iron levels:

 

Restless Leg Syndrome (RLS): Iron deficiency has been found to be a common cause of RLS occurring in about 25% of cases! Supplemental iron is certainly most effective in those with documented iron deficiency, however, some patients respond to iron supplementation even without anemia. Iron is thought to be beneficial for RLS through its ability to upregulate dopamine synthesis (it is needed to convert tyrosine into dopamine). If the RLS is refractory to iron therapy, consider deficiencies of magnesium, B12 and vitamin E instead.

 

Female Infertility: Case reports have found that iron supplementation resulted in pregnancy within 28 weeks in infertile woman with borderline low ferritin levels (14-40 ng/mL). Certainly, this is not to say that iron is the ‘silver bullet’ for female infertility, but it deserves attention amidst all other factors.

 

Diffuse Hair Loss: General hair loss can be a symptom of iron deficiency, even before anemia sets in. Restoring optimal iron levels has been shown to offset this symptom and iron supplementation can also be useful in cases of brittle, dry and splitting hairs (if you’re having compliance issues with iron supplements in iron-deficient female patients, this may be worth mentioning!)

 

Poor Immune function: Iron is needed for proper immune function through cytokine production in macrophages and an iron-deficient state may lead to an insufficient immune response. For example, one study in individuals with oral candidiasis found that iron restoration led to lower salivary candida counts and reduced oral lesions.

 

Thyroid Function: We classically discuss the need for selenium to convert T4 into the more bioactive T3, but iron is another mineral that is necessary to promote this conversion through deiodinase activity (and iron is also needed for thyroid peroxidase action). To make matters worse, low thyroid function can lead to worse iron absorption. In cases of hypothyroidism with concomitant iron deficiency, combination treatment with iron and levothyroxine has been shown to be superior over each therapy alone.

 

Menorrhagia (heavy menstrual bleeding): Substantial blood loss can obviously lead to iron deficiency. However, few people are aware that an iron deficiency can actually cause a recurring state of heavy menstrual bleeding through weakened uterine muscles that cannot properly clamp down on blood vessels (iron is a cofactor for cytochrome oxidase, an enzyme necessary for muscle contraction). Ultimately, interventional trials confirm that iron supplementation is necessary not only for symptom control but also to reduce the heavy bleeding itself.

 

Cognition, Mood & Intelligence: It is well-documented that children and adults perform poorer on mental function tests in states of iron deficiency, with areas such as attention, memory and concentration being affected. This is the case even in the absence of outright anemia. Mechanistically, inadequate iron supply leads to a dysregulation of dopamine and serotonin metabolism. Both animal trials and human studies have shown that severe iron deficiency during infancy may have long-standing implications on brain health that persist well into adulthood, regardless of adequate iron intake later on in life.

 

As clinicians, it is easy to start down a rabbit-hole to find a medical explanation for complex issues. Yet, it’s generally best to follow the principle of ‘Occam’s razor’: the simplest solution is typically the correct solution. If a patient is vegan, has heavy bleeding or any of the conditions listed above, get back to the basics and test their hemoglobin, ferritin and other blood markers. A well-absorbed iron might be the simple answer that you and your patients are looking for. 

 

Select References:

  1. Earley, C. J. (2009). The importance of oral iron therapy in restless legs syndrome. Sleep Medicine, 10(9), 945-946.
  2. Rushton DH, Ramsay ID, Gilkes JJH, Norris MJ. Ferritin and Fertility. Lancet 1991; 337:1554.
  3. Hard S. Non-anemic iron deficiency as an etiological factor in diffuse loss of hair of the scalp in women. Acta Derm Venereol 1963; 43:562-569.
  4. Sato S. Iron deficiency : structural and microchemical changes in hair, nails and skin. Semin Dermatol 1991; 10:313-319.
  5. Ganz T, Nemeth E. Iron homeostasis in host defence and inflammation. Nat Rev Immunol. 2015 Aug;15(8):500-10.
  6. Higgs JM. Chronic mucocutaneous candidiasis: iron deficiency and the effects of iron therapy. Proc R Soc Med 1973; 66:802-804.
  7. Soliman AT, De Sanctis V, Yassin M, Wagdy M, Soliman N. Chronic anemia and thyroid function. Acta Biomedica. 2017 Apr 28;88(1):119-127.
  8. Ravanbod M, Asadipooya K, Kalantarhormozi M, et al. Treatment of iron deficiency anemia in patients with subclinical hypothyroidism. Am J Med. 2013;126(5):420-4.
  9. Taymor, ML, Sturgis SH, Goodale WT, Ashbaugh D. Menorrhagia due to chronic iron deficiency. Obstet Gyneacol 1960; 16:571-576.
  10. Cinemre H, Bilir C, Gokosmanoglu F, Bahcebasi T. Hematologic effects of levothyroxine in iron-deficient subclinical hypothyroid patients: A randomized, double-blind, controlled study. J Clin Endocrinol Metab. 2009;94(1):151-156.
  11. Taymor ML, Sturgis SH, Yahia C. The etiological role of chronic iron deficiency in production of menorrhagia. JAMA 1964; 187:323-327.
  12. Beard J. Iron deficiency alters brain development and functioning. J Nutr. 2003; 133(5), 1468S-1472S.
  13. Walter T. Impact of iron deficiency on cognition in infancy and childhood. Eur J Clin Nutr 1993; 47:307-316.

Rhodiola: Root Yourself for Back to School and Work!

Posted September 14, 2017

By: Dr. Colin O’Brien ND, Ontario Regional Manager, Cyto-Matrix

Summer has once again come and gone and it’s time to get back into a solid routine. Whether you’re a parent with toddlers headed back to school, a graduate student or just an everyday worker going back into the office after some vacation time, we all could use a little extra support to help us push through the busy fall season. Regular sleep, a healthy diet and moderate exercise will always be the foundation for stress resiliency, but when more support is needed, a little-known herb called Rhodiola rosea can help your body adapt and adjust accordingly.

What is Rhodiola?

Rhodiola rosea, also known as ‘golden root’, is a medicinal herb that has traditionally been used in Russia, Scandinavia and other European countries for a wide variety of health concerns. It is considered an adaptogenic herb, meaning that it can help your body adapt to stress! As you can imagine, the ability to increase resiliency to stress is highly sought after by many parents, students, workers and others in high pace lifestyles, so the popularity of rhodiola has been growing steadily in North America.

 

Why Should You Consider Using Rhodiola?

Traditionally, rhodiola has been used as a stimulant, to increase attention span, memory and physical endurance, but also to treat a wide variety of health concerns such as anxiety, depression, fatigue, anemia, infections and impotence. Most importantly, rhodiola is particularly effective for these concerns when stress is at the root cause of the problem.

Clinical research has been able to confirm many of these wonderful applications for rhodiola root extract. Here are a few highlights:

Burnout: Although rhodiola has been traditionally used for this purpose for many years, brand new research has supported its ability to help people suffering from symptoms of burnout. 118 men and women between the ages of 30-60 took rhodiola rosea extract for 12 weeks and significant improvements were noted in areas of emotional exhaustion, fatigue and joy. An increased ‘zest of life’ and sexual interest and functioning were also found in those taking rhodiola root.

Exercise Performance & Recovery: Research has shown that even short term dosing (ie 4 days) of rhodiola can increase time to exhaustion and oxygen utilization during athletic performance. Perhaps just as important, rhodiola has been found to reduce levels of inflammation in the body 5 hours post-exercise and also 5 days after intense exercise, meaning that it can speed recovery times.

Depression & Anxiety: In a 2007 study of 60 patients suffering from mild to moderate depression, rhodiola extract was shown to significantly improve depression markers such as insomnia, self-esteem and emotional stability when compared to placebo. Similar improvements have been noted in studies and in practitioner feedback when examining the benefits on generalized anxiety disorder. Clinically, many practitioners recommend rhodiola to patients that present as “wired and tired”, meaning anxious and on edge, yet exhausted.

How Does Rhodiola Work in the Body?

Research has found that one of the ways in which rhodiola positively impacts the mental health of an individual is through the balancing of neurotransmitters, chemicals in the brain that are responsible for regulating mood. Rhodiola specifically prevents the breakdown of adrenaline, serotonin, dopamine and acetylcholine, thereby increasing their action in the brain. This ultimately improves cognitive measures such as mood, memory and attention.

Although there are many active ingredients within the whole plant extract, rosavins appear to hold most of the medicinal power. With this in mind, it is important to select a rhodiola supplement that specifies the rosavin content.

 

But is Rhodiola Safe?

            Yes, rhodiola is extremely safe for the vast majority of the population. However, pregnant women, nursing mothers and those diagnosed with bipolar disorder should avoid or consult with a qualified healthcare practitioner before beginning supplementation.

In the end, rhodiola root is a great option for those feeling stressed or overwhelmed. Whether high stress in your life leads to poor sleep, depressed mood, low energy or even recurring colds and flus, rhodiola may be that missing piece to help get you out of your slump. Everyone needs support from time to time and rhodiola can be the much-needed crutch during a busy transition!

 

Select References:

  1.  Hung SK, Perry R, Ernst E. The effectiveness and efficacy of Rhodiola rosea L.: A systematic review of randomized clinical trials. Phytomedicine 18 (2011) 235–244.
  2. Bystritsky A, Kerwin L, Feusner JD. A pilot study of Rhodiola rosea (Rhodax) for generalized anxiety disorder (GAD). J Altern Complement Med. 2008 Mar;14(2):175-80.
  3. Kasper S and Dienel A. Multicenter, open-label, exploratory clinical trial with Rhodiola roseaextract in patients suffering from burnout symptoms. Neuropsychiatr Dis Treat. 2017; 13: 889–898.
  4. De Bock, K., Eijnde, B.O., Ramaekers, M., et al., 2004. Acute Rhodiola rosea intake  an improve endurance exercise performance. International Journal of Sport Nutrition & Exercise Metabolism 14 (3), 298–307.
  5. Abidov, M., Grachev, S., Seifulla, R.D., et al., 2004. Extract of Rhodiola rosea radixof Experimental Biology and Medicine 138 (1), 63–64. reduces the level of C-reactive protein and creatinine kinase in the blood. Bulletin of Experimental Biology and Medicine 138 (1), 63–64.
  6. Darbinyan, V., Aslanyan, G., Amroyan, E., et al., 2007. Clinical trial of Rhodiola rosea L .extract SHR-5 in the treatment of mild to moderate depression. Nordic Journalof Psychiatry 61 (6), 503.

Clinical Feedback from 2 years of Bio-Ferra prescribing

Posted November 15, 2016

By: Dr. Andrew Krause ND CSCS CISSN, Ontario Regional Manager, Cyto-Matrix

One of my favourite parts of my role with Cyto-Matrix is how often I get to see colleagues at their clinics, and hear about their clinical successes in practice. One product that has been getting particular mention in meetings over the past few months is Bio-Ferra.

Bio-Ferra is a liquid iron that uses a form of iron called Polyaccharide Iron Complex (PIC). We chose to use this form of iron in Bio-Ferra for three reasons:
1. PIC is a non-ionic form of iron, which means it does not need high stomach acid to be absorbed. This runs contrary to many other forms of iron that are prominent on the market, since an ionic form of iron requires high stomach acid to break the bond between the iron and whatever agent has been bound to it. Common agents bound to iron are: gluconate, fumarate, succinate, and bisglycinate. (1)
2. PIC is also significantly less constipating than other forms of iron, and therefore encourages better compliance than with other forms of iron (Bio-Ferra also has a palatable green apple taste). PIC has a higher lethal dose (LD50) than any other form of iron on the market (2,3), which makes it safe, along with being tolerable.
a. Bio-Ferra has been on the market for 26 months as of this writing, and we have yet to have a patient call in and complain about constipation related to the product!
3. PIC is a vegan source of iron! At Cyto-Matrix, we are always mindful of ensuring that our products can be used by the largest proportion of patients possible, so this was an important feature when choosing PIC.

 

Now that you understand the “why” behind Bio-Ferra, here are some of the clinical results we’ve seen and heard from clinicians using Bio-Ferra in practice over the last 2 years.
1. A pregnant patient was able to double her ferritin (16 to 32mcg/L) in two weeks with 2 teaspoons of Bio-Ferra per day, even considering her 1L of blood loss during the birthing process.
2. One clinician has had 4 cases in the past year where giving 2 tsps per day of Bio-Ferra doubles the patient’s ferritin levels in 3-6 months.
3. Another pregnant patient was able to raise her ferritin from 16 to 52 mcg/L with 3tsp per day dosing in 6 weeks, having also lost blood during the birthing process.
Among the many other iron products on the Canadian natural health product market, Bio-Ferra is a safe option that limits constipation, and is clinically effective at improving the symptoms of iron deficiency.
References:
1. Ma et al. Effects of Different Doses and Duration of Iron Supplementation on Curing Iron Deficiency Anemia: an Experimental Study. Biol Trace Elem Res (2014) 162:242–251
2. Oral Iron for Anemia: A Review of the Clinical Effectiveness, Cost-effectiveness and Guidelines. Ottawa (ON): Canadian Agency for Drugs and Technologies in Health; 2016 Jan.
3. Klein-Schwartz, Wendy. Toxicity of Polysaccharide–Iron Complex Exposures Reported to Poison Control Centers. Ann Pharmacother 2000; 34:165-9.

Clear Skin Matters: Your Guide for Treating Acne

Posted April 21, 2016

Written by: Emily Elliot
Edited by: Ali Cockerill

Many patients concerned with acne arrive at the naturopathic doctor perplexed and frustrated as they express, ‘I have tried everything and nothing works!’ While the number of ‘acne fighting’ products that line the shelves of drug stores and supermarkets are constantly growing and promises of clear skin are endless, the treatment of acne is complex and the exact science has not yet been discovered. While the exact pathogenesis of acne is still largely a topic of scientific investigation, the good news is that many lifestyle changes have well documented results. Additionally, acknowledging that as patients that their hormonal status is unique may be a starting place for answers. While expensive lotions and creams are an excellent addition to a proper skin care regiment, acne is truly a journey from the inside out. Our skin is a very important messenger that can offer us insight into what is happening internally. Let’s review some of the strategies that are effective for clearing up the skin.

Mastering your meals, the best diet for acne:
The debate on whether or not diet contributes to acne is longstanding. However, studies are finally identifying what dermatologists have always truly known – yes, there is definitely a link between diet and breakouts. It is no coincidence that some non- Westernized populations report almost zero occurrence of acne lesions! (1)
Specifically, studies have shown reduced acne lesions and the associated improvements in insulin sensitivity with the consumption of a lower glycemic diet (RCI) (1). A diet in higher glycemic foods will ultimately spike blood sugars leading to increased androgens and IGF-1, which increases secretion of oil and clogs pores.

A low glycemic diet for acne should include lots of healthy fats (olive oil, fatty fish, nuts and seeds), plenty of fibre (25 g for women and 38 g for men), lots of dark leafy greens and an appropriate protein calculation for one’s body weight (a minimum of 0.8g/Kg of body weight). The anti-acne diet should also minimize dairy products as they have also been linked to increased IGF-1 production.

Focusing on lymph is no waste:
Exercise recommendations for the patient with acne can be met with some resistance. Fears may emerge regarding how ‘sweat build up’ may detriment the skin. However, it is important to focus on the benefits that come from regular exercise and to promote proper hygiene practices before and after workouts. Many patients working with acne have issues detoxifying and may display signs of a sluggish lymphatic system like: allergies, itching, chronic fatigue etc. Recommendations like cycling, running, walking, yoga and ‘rebounding’ (trampoline jumping) have all been documented for their lymphatic benefits (2). Through daily movement and generating lymphatic flow, the body brings forth oxygen and nutrients to the skin’s surface as it works to eliminate cellular debris and waste products that can build up in acne (3). There really is no substitute for a healthy, active lifestyle. Explaining the mechanics of lymphatic detox may empower the patient to see how movement can positively promote their anti-acne efforts.

Tame hormonal havoc:
Once diet and lifestyle have been approached, hormonal status is a vital part of the acne investigation. Hormonal acne is often linked to the menstrual cycle and can appear around the region of the chin, hairline and back. High androgens (testosterone and its breakdown product dihydrotestosterone) are frequently cited as a hormonal cause of acne (voice changes, hair loss on the head, irregular menstrual cycles in women, weight gain etc.)(4). However, it is important to rule out other hormonal presentations that could use balancing. For example, are there signs of high progesterone (depression, weight gain and increased fat storage, poor blood sugar balance) or low progesterone (hair loss, anxiety, increased allergies, sluggish metabolism etc.) (4). Testosterone, estrogen and progesterone all keep each other in fine balance, so don’t forget to assess all three of these important hormones. (Note: high cortisol can be implicated in testosterone production as well, a quick check on cortisol status may be well indicated too).

Skin superstars: In general, improving skin vitality and health relies on a few key players. Typical recommendations are Vitamin A 25000-50000 IU (contraindicated in pregnancy), Vitamin C 1000-5000 mg and Zinc 15-25 mg, making Cyto-Matrix’s ‘ACEs and Zinc’ truly a ‘skin basic’ (5). Reduced levels of serum zinc have also been identified in patients with increased acne lesions making it an excellent addition to the anti-acne treatment plan (1).

Essential fatty acids are also crucial in maintaining that healthy skin glow we all long for. EFAs found in Cyto-Matrix’s Omega D3 liquid forte not only hydrate the skin and replenish the skin’s barrier but also offer anti-inflammatory properties that are highly beneficial in an inflamed condition like acne. An important focus in skincare is not just combating the condition but also promoting the formation of healthy skin in general.

Boosting bowel terrain:
Oral probiotics help to reduce systemic inflammation and oxidative stress that are characteristic of acne as well as modulate IGF-1, one of the primary proteins linked to acne proliferation. The benefits of supplementation have also been documented for patients who are taking antibiotic treatment and suffering from the side effects of these treatments. One study showed the synergistic benefit of taking probiotics with minocycline when compared to the antibiotic alone as the combination group showed the greatest reduction in acne lesions when compared to the other controls (6).

Mindful medicine for acne:
The emotional effects of acne can be intense and extensive. One important study revealed that even in patients with mild acne, there were feelings of low self-esteem, depression and suicidal thoughts (7). Checking in on one’s overall journey with acne and validating their frustration is a crucial part of patient care and may hold one of the final pieces of the puzzle. When mind, body and soul are all honored as part of the patient’s journey, the truest healing begins.

(1) Logan, C and Treloar, V. The Clear Skin Diet. Naperville, IL. Cumberland House Publishing.
(2) Exercise for the Lymphatic System. (2016). Retrieved from http://cancercompassalternateroute.com/detox/various-exercises-for-the-lymphatic-system/#
(3) The Lymphatic System. (2013). Retrieved from http://www.lymphnotes.com/article.php/id/151/
(4) Turner, N. The Hormone diet. USA. Random House.
(5) Natural Ways to Treat and Prevent Acne. (October 2012). Retrieved from http://www.huffingtonpost.ca/natasha-turner-nd/natural-adult-acne-solutions_b_1952491.html
(6) Kober, M and Bowe, W. (2014). The Effect of Probiotic on Immune Regulation, Acne and Photoaging: International Journal of Women’s Dermatology , 1 (85-89).
(7) Dunn, L. (2011). Acne in Adolescents: Quality of life, self-esteem, mood and psychological disorders: Dermatology Online Journal, 17 (1): 1.

Coffee Lovers Listen Up! A novel and delicious way to boost protein in the morning

Posted March 3, 2016

We want to let you in on a little secret. Are you a lover of coffee? A health-nut? Always on the hunt for easy breakfast solutions that make crawling out of bed just a little easier? Here’s our favourite coffee drink… ever. Give it a go and shake up your morning.

Coffee blend

Provitalex powdered creamy latte:

  • 2 tbsp coconut oil
  • 1 scoop of Cyto-Matrix Provitalex® Protein Powder
  • ½ (ish) cup of coffee (decaf or regular)

Blend up and serve immediately.

This creamy delight will have you boosted up on blood sugar stabilizing protein and hunger satiating fats as well as offer a delicious coffee treat that’s not laden with artificial syrups or other unhealthy fillers. Can it get any better than this? We’re not sure.

Who knew you could merge your morning protein shake and coffee into one? So go ahead and hit snooze, your morning routine just got a little easier.

Written by: Emily Elliot
Credit to Ashley Margeson who is the founder of the Cyto-Matrix version of this drink. Connect with Ashley at https://www.facebook.com/ashley.margeson/

 

8 Ways to Master Stress as a Naturopathic Student

Posted May 22, 2015

By Emily Elliot
Student Representative, Canadian College of Naturopathic Medicine

You have heard it all before, everything in balance. In fact, as a student of naturopathic medicine you preach it to friends and family. Yin cannot steal too much from yang or it depletes. Light must draw from dark to expand. Soy can have positive estrogen modulating effects, only in certain amounts. Get your cardio, but don’t take too much impact on your knees. Although we teach balance as one of the primary pillars of Naturopathic Medicine, it sometimes feel like an extraordinary task. After writing over 113 exams at CCNM and finishing over 107 assignments, here are my tips for managing stress as a naturopathic student.

1. Create space

Take time at the start of every semester, every week and every day to lay out your priorities. Waking up each day with priorities in mind will make sure that they never slip through the ‘to do list’. By taking the time to indulge in those things that ignite you and those people that love you, you can better attack your school work – more focused, more inspired, more efficient. If everything seems to be just a little too much, sometimes we just need to change our perspective. Where is your place of perspective – the park, the climbing gym, on the open trails? Change your vantage point daily and watch how your perspective changes too.

2. Call a friend

In days past, we were more connected. Ironically, as we have become more ‘plugged in’ in a vast sense, we’ve lost touch with our small, local communities. Not only can studying in a small group speed along studying, it offers us a sense of belonging. (Believe it or not, someone else was courageous enough to sign up for 18 exams a semester too.)

3. Let loose in your studying

Did you know that lots of musical bands have a creative process that they use to write and memorize music? They will throw jars of magenta, turquoise and yellow onto a white wall in order to ‘see their music’. Studying is also an art. Let your logistical side escape you and let loose in your studying. Take turns acting out homeopathic traits (you won’t believe how well this works!) Record yourself speaking in Chinese and play it back to yourself. Turn your physical medicine assessments into a dance, (who knew that ‘speeds test’ is the second move in the macarena?) Studying isn’t a sentence, it’s a word.

4. Reinvent the wheel

They say not to reinvent the wheel, but why not? A demanding program shouldn’t squash us but rather, it should call on our creativity. Were you in the routine of trekking 45 minutes to the gym and 45 minutes back? Did Professor. Surprise just announce that next week’s final is actually cumulative? Try youtubing ‘shoulder workouts’ or ‘squats in 5 minutes’. You will be amazed at how sore you can feel after a youtube workout. Don’t mistake quantity of workout for quality. Not motivated to do workouts at home? Post a challenge above your desk and encourage yourself to study for 45 minutes and then move for 15 minutes every hour for four hours. Reward yourself for your discipline. (One more episode of Game of Thrones?)

5. Power up

Isn’t it ironic that just as we need the most energy and nourishment we decide that we don’t have time to plan it, make it or eat it? Try cooking in batches and freezing nutrient-dense soups and stews. Ensure adequate protein by adding a scoop of Cyto-Matrix’s Provitalex Pure Whey into your morning smoothies. As exams come around and we start to give into Tim Horton’s herb and garlic bagels, our protein intake can be the first thing to go. A daily dose of Provitalex will ensure at least 22g of protein daily. Last but not least, pack small snacks to stabilize blood sugar. Almonds, carrots, hummus and apples are some easy go-tos.

6. Don’t sacrifice sleep

At the time it makes so much sense, if you don’t go to bed you have 8 more hours to get through 2 more lectures. You should definitely not go to sleep! Then the night progresses, ‘avena sativa’ sounds like a spell from Harry Potter, you have checked your Instagram 22 times and you know you’ve read the same slide over and over, but it is just not sinking in. Tried, tested and true, it is almost guaranteed that you will learn faster and smarter by sleeping, for at least a while. Give those brain waves a chance on exam day and catch some ZZZs. While zero sleep during exams is not the way to go, a little less sleep is inevitable. Try Cyto-Matrix’s Rhodiola for periods of stress and increased exertion. Not only will it improve concentration and focus but it will improve your overall energy and exam stamina

7. Get in the zone

Naturopathic medicine attracts a lot of type A personalities. Naturally, a type A personality desires to know everything there is to know about every single topic. Not only will this detriment how much you really know, it can also lead to burn out and a loss of passion in the field. Early in the game, take time to map out what you love the most. What is that topic you actively seek out and read up on? Is it hormones? Physical medicine? Adjunctive cancer care? Attracting patients into your future practice will depend on your passion and knowledge, your ability to become a sought after expert. Why not start early? Pay particular attention to what special topic feels like the easiest to learn and start honing your knowledge and skills.

8. Above all, faith

You have confirmed with all of your friends, parents friends, people at the dog park etc. that you are in fact, not going to school to become a homeopath. You have spent time in the shower perfecting your explanation of what it means to be a Naturopathic Doctor. You have silently celebrated when your grandma says, “I can’t believe it, you were right about the gout in my right toe.” Let’s face it, it is a lot of work to defend your profession. Although it is hard work, remind yourself that you have handpicked one of the greatest professions on the planet. You will change people’s lives, shape the future of healthcare and feel the honor that comes with hearing someone say ‘I feel well’. Faith is what called you here and faith is what will carry you forward into a future of fulfillment and abundance. Keep chugging along, the greatest days in your career have yet to come.