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Group B Strep in Pregnancy

Group B Strep (GBS), otherwise known as Streptococcus agalactiae, can cause serious, sometimes fatal infections in newborn babies. Pregnant women in Canada are routinely screened by a vaginal swab for Group B Strep at around 35-37 weeks gestation. Guidelines for Group B Strep positive women recommend IV antibiotics during labour to prevent infection for the baby.

A positive test for GBS is very common (25-30%). It isn’t very common for babies to contract it, especially if the mom does the IV antibiotics during labour. The rate of GBS infection is only approximately 0.4 babies per 1000 births, and only 10% of those babies infected die from it.

Your best bet is to do the IV antibiotics during labour. Prior to that, taking a good quality probiotic can help. Probiotics are the good bacteria that normally populate the vagina and which the baby will pick up at delivery. Keep your immune system healthy with diet, sleep, stress reduction, exercise and be sure to breast feed. Breastmilk, especially the first milk called colostrum, is full of antibodies that will help keep the baby healthy and fight infection.

You can also use a vaginal probiotic. There are specific strains of probiotics that benefit the vagina and help prevent Group B Strep from being able to take hold. Lactobacillus rhamnosus and Lactobacillus gasseri are two such strains.

Here is some relevant research, the second study specifically studied the effect of lactobacillus rhamnosus on streptococcus agalactiae (group B strep).

http://www.ncbi.nlm.nih.gov/pubmed/22437191
http://www.ncbi.nlm.nih.gov/pubmed/24469557

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Is GSM Anything Like GMO?

Nope! GSM stands for Genitourinary Symptoms of Menopause. It’s a brand new diagnosis to encompass the symptoms women usually experience in the vagina and urinary tract with menopause. Menopausal and peri-menopausal women can tell you that there are some changes going on down there, and not exactly pleasant ones! The symptoms associated with GSM include overactive bladder, leakage, vaginal dryness and irritation, burning, pain or bleeding with intercourse, reduced arousal and libido, and recurrent bladder infections.

Having a new name for it doesn’t necessarily help you though. It’s the hormone changes associated with menopause that are responsible for these symptoms. While you can’t turn back the clock and reverse the hormones, there are herbs to keep hormones better balanced and nutrients like vitamin A, vitamin E and NAG among others that can help support healthy vaginal and urinary tract tissue.

Reference:
Portman D, Gass M. and consensus panel. Genitourinary syndrome of menopause: new terminology for vulvovaginal atrophy from the International Society for the Study of Women’s Sexual Health and The North American Menopause Society. 1063-1068

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What Kind of Carbs Should I Eat?

The best kind of carbs are the ones that have minimal impact on blood sugar levels. High glycemic index and high glycemic load carbs (for example rice, wheat and wheat products) cause a sharp spike in blood sugar levels and insulin. A glycemic index of less than 55 is considered low and glycemic load of less than 10 is low. Rice, even if it’s brown rice, has a glycemic index of 58-84 and a glycemic load of 19-46. This will mean high insulin requirements to deal with the resulting spike in blood sugar.

So what’s wrong with that? Insulin’s job is to transport all of that sugar from the blood into the muscle, fat and other tissues and it causes the liver to store glucose as it’s storage form, glycogen. Once there is enough stored glycogen, the liver starts to produce fatty acids, which can be turned into triglycerides in fat cells, contributing to high blood lipids, atherosclerosis and fatty liver disease.

Insulin also preserves body fat, the more insulin the less breakdown of fat tissue. Not so good if you are trying to lose weight.

Insulin can also lower blood levels of potassium, a vital mineral for normal heart function.

Frequent insulin production, induced by frequent carb intake, can lead to insulin resistance or pre-diabetes. Insulin resistance can cause infertility, PCOS, heart disease, and is linked to an increased risk of cancer as both insulin and IGF1 have a role in tumor initiation and progression in insulin-resistant patients.1. How would you know if you were insulin resistant? Neither you nor your doctor would likely know until the point that your fasting blood sugar became abnormal, at which point you are diabetic. If you have PCOS you are already at a much higher risk of being insulin resistant and eventually becoming diabetic.

So what are the best kinds of carbs? Whole grain (not processed into bread, crackers, cereal, pasta), high fiber and lower glycemic index grains like quinoa, amaranth, lentils, beans and to a lesser extent spelt and kamut. Should you eat these at every meal? Probably not, best to give your body a break from the need to make insulin at every meal, even if it is a lower amount. Aim for small servings of lower glycemic index and load grains, once per day.

Have I Ever Put Anyone on a Zero Carb Diet?
No, because that is ridiculous. Unless you consumed nothing but water, you would have to be taking in carbs, even meat contains some amount of carbohydrate. For the average sedentary person, vegetables and fruit will supply sufficient carbohydrate for what your body needs. More active than usual? Great, add in a serving of one of the lower GI/GL carb sources listed above.

As a naturopathic doctor, it is my obligation to “do no harm”. If you suffer from a condition where frequent insulin production would do harm, like PCOS(2-6), I am bound by the Hippocratic oath to recommend decreasing carb intake and the need to make insulin. I’m happy to provide counselling and assistance in making the transition from a higher carbohydrate diet to a lower carbohydrate one.

1. Source: Exp Diabetes Res. 2012; 2012: 789174. Insulin Resistance and Cancer Risk: An Overview of the Pathogenetic Mechanisms, Biagio Arcidiacono, Stefania Iiritano, Aurora Nocera, Katiuscia Possidente, Maria T. Nevolo, Valeria Ventura, Daniela Foti, Eusebio Chiefari, and Antonio Brunetti.
2. Low carb ketogenic diet improves weight, percent free testosterone, LH/FSH ratio & fasting insulin in women with obesity & PCOS over a 24 week period. (Mavropoulos et al, Int J Endocrinol Metab. 2012)
3. PCOS patients ingesting a high protein diet experienced greater weight loss & body fat loss than the standard protein diet. (Sorenson et al, Am J Clin Nutr, 2012 )
4. In women with PCOS, consumption of a diet lower in CHO resulted in preferential loss of fat mass from metabolically harmful adipose depots, whereas a diet higher in CHO appeared to promote repartitioning of lean mass to fat mass. (Gossa et al, Metabolism, Oct 2014)
5. Energy restriction & weight loss in PCOS improve ovulation rates, conception, hyperandrogenemia, glucose & insulin levels, insulin resistance & satiety hormones. A low carb diet has an additional effect to caloric restriction in terms of weight loss. (Frary et al, Minerva Endocrinol, June 2014)
6. A diet containing 25% carbohydrates improved insulin resistance, whereas a diet that included 45% carbohydrates did not. Source: International Journal of Obesity and Related metabolic Disorders 20 no. 12:1067-1072

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IBS and PCOS

What do these two things have in common besides being acronyms for common medical syndromes (Irritable Bowel Syndrome and Polycystic Ovarian Syndrome)? Recent research suggests that there is a connection between insulin resistance and leaky gut, which may then in turn cause irritable bowel syndrome. Want your gut to be healthier? Cut back on carbs and exercise daily to maintain normal insulin levels. Your hormones will be better balanced and you’ll be less prone to food sensitivities.

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Menstrual and Premenstrual Migraines

For clues as to what may be causing premenstrual migraines, we have to look at what is happening hormonally at that time. On Day 21 of your cycle, progesterone is hitting a peak and estrogen levels are starting to rise a little to come to a second peak around day 23-24. By about day 25, assuming you are not pregnant or on the birth control pill, both levels are starting to fall which is the cue to your body to release the uterine lining and have a period. The peak of progesterone around day 21 is thought to be protective against migraines. The drop in estrogen is also thought to be associated with migraines. In the women that I have worked with who had premenstrual migraines, what has worked beautifully is an approach that optimizes progesterone production and balances estrogen.

1. Headache. 2008 Nov-Dec;48 Suppl 3:S124-30. doi: 10.1111/j.1526-4610.2008.01310.x. pidemiology and biology of menstrual migraine. Martin VT1, Lipton RB.
2. Headache. 2006 Mar;46(3):365-86. Ovarian hormones and migraine headache: understanding mechanisms and pathogenesis–part 2. Martin VT1, Behbehani M.

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Polycystic Ovarian Syndrome or Not?

Irregular periods, acne, hair loss, fatigue, weight gain, sluggish metabolism, at first glance these symptoms seem to point to PCOS. However, blood tests show a different story, in PCOS you would expect to see high androgen levels (testosterone, DHEAs) but this patient has low testosterone, low DHEAs, low estradiol and here’s the kicker – high cortisol! Her doctor had refused to do the cortisol testing which ultimately provided the solution to the puzzle of her symptoms which she has complained to her doctor about for years. It still remains to investigate why her cortisol is elevated. There are herbs that can be used to lower cortisol, but we’ll refrain from that until we can collect more data on why it’s elevated.

It’s easy in medicine to make assumptions and jump to conclusions, but this patient is a perfect example of why doing our due diligence and thoroughly investigating through diagnostic testing is important.

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Your Hormone Levels are “Fine” (Not!)

Many of the women that I see every day feel like there is a problem with their hormones, however, they’ve been to their family doctor who has told them that their hormone levels are “fine”. These women are suffering from infertility, hair loss, irregular periods, excessive facial or body hair, acne, peri-menopause, mood swings, low libido and PCOS, all of which are fairly obvious signs of hormone imbalance.

Here’s why you may be told that your hormones are “fine” when they’re actually not:
1. Countless patients haven’t even had the tip of the iceberg measured when it comes to their hormones. They’ve been trying to conceive for 3 years, yet no one has ever thoroughly measured their hormones. They’ve never had testosterone, DHEAs, androstenedione, and DHT measured. These are all hormones that can impact fertility.
2. Hormones vary from day to day and certain ones are really only clinically relevant at certain points of the menstrual cycle, but no one specified what day to have them measured. LH, FSH and estradiol should be measured on day 3 of a menstrual cycle. Progesterone should be measured 7 days post ovulation. If there is a hormone related problem, the relevant hormones should probably be measured more than once to confirm if they’re normal or not.
3. Hormone “normal” ranges are actually “abnormal” ranges. The lab ranges for hormones are particularly unreliable as indicators of good hormonal health. As a lab insider (I worked in one for 20 years), I know how normal ranges are set. Lab technologists average the results from a given number of samples and the average of those samples becomes the “normal” range. The problem with this is that doctors only order hormone blood work from people with a hormone related condition like infertility, hair loss, irregular periods, excessive facial or body hair, acne, peri-menopause, mood swings, and low libido. So if you average the results of an abnormal population and then call that your normal range, what you’ve actually got is an “abnormal range” and abnormal people will fit nicely into it so that their results look “normal” even though they clearly have a hormone related problem.

When I’m looking a patient’s blood work, I use my own optimal range, rather than the lab’s abnormal range to interpret whether the hormone blood tests are normal or not. I also like to see thorough hormone blood work and have it done at specific points in the menstrual cycle.

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What Will Be Your Wake-up Call?

With so many demands on our time and our thoughts, it’s easy to push health to the back burner. Don’t! Maintaining your health on a daily basis and actively preventing disease is crucial so that you can keep enjoying life to the fullest. Injuries, chronic or recurring infections, low energy, exhaustion, allergies, headaches, these are all your body trying to give you a wake-up call that something isn’t right: you’re not taking care of me well enough or you’re overworking or otherwise abusing me. Will it take cancer, a heart attack or stroke to be the wake-up call you need?

Check out Kathy Smith’s story:
http://www.silverhillsbakery.ca/investing-in-yourself/?utm_source=Silver+Hills+Ad+-+November+2014&utm_campaign=Silver_Hills_Nov_2014&utm_medium=email

Great health is a habit worth investing in.

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Weight Gain at Menopause

Menopausal weight gain is a common, yet upsetting, occurrence.

What causes weight gain at menopause?
As estrogen levels decline at menopause, so does insulin sensitivity. Insulin transfers sugar from the blood stream into the tissue and tells the tissue to make fat from this sugar. This means that the body doesn’t respond to insulin as well as it used to, sugar doesn’t get moved from the blood into the tissue as well as it did, which means a need to make more insulin. Since insulin promotes fat production, more insulin means more fat production. If sugar isn’t getting moved into the tissues well, the tissues are lacking fuel which can lead to carb cravings.

So the solution to menopausal weight gain is to reduce carb intake to minimize the need to make insulin and there are various natural means to promote insulin sensitivity. Exercise is one of the best ones. If you are not already exercising somehow daily, that is essential and can make a significant difference.

Growth hormone levels also tend to decline as we age which means decreased muscle mass. Muscle burns more calories even while you are sleeping. Adding weight training to your workouts can help maintain growth hormone levels.

High levels of stress deplete the function of the adrenal glands, your stress glands that help maintain your blood pressure, blood sugar, balance your hormones and keep inflammation in check. Adrenal glands produce at least half of your testosterone and testosterone helps maintain muscle mass. Supporting healthy adrenal glands can help stabilize blood sugar, give you more energy, help you deal with stress more easily and maintain healthy hormone levels as you age.

In summary, at menopause it is especially important to:
1. Lower your carb intake
2. Exercise
3. Weight train
4. Lower your stress level
5. Support adrenal gland function with vitamins, minerals and herbs

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Think You’re Getting Unbiased Opinions About Pharmaceuticals?

Sadly, there isn’t any such thing. Your doctor only gets to read research results that have positive outcomes.

Dr Irving Kirsch, a psychologist, dug out the following information regarding psychiatric drug studies:
They found that out of 38 drug studies showing positive outcomes, 37 were published. 36 studies showing negative outcome, only 3 were published and 11 had their data manipulated to show a more positive outcome.

Many UNpublished studies show little or no difference between taking an anti-depressant and placebo.

More on Dr Kirsch’s study here:
http://www.huffingtonpost.com/irving-kirsch-phd/antidepressants-the-emper_b_442205.html