#TTC Obsession – Confessions

Getting pregnant is scary and exciting. The process of wanting to conceive and then waiting to find out…. not priceless. I am intimately aware of this as a Naturopathic Doctor with a focus on In/Fertility. I have also been privately preparing for this moment of my late 30’s when I am ready to conceive.  I have treated and supported many women through this process already. And here I am, alone with my OPK stick in the bathroom, discerning the workings of a secret universe. CONCEPTION.

I am amused at my complete immersion in the consuming nature of trying to predict my own ovulation. I cannot believe how often I think of the subject. I am constantly turning the information over in my mind. I read fertility forums online to gather information; I delve into friends’ personal experiences. Medicine looks so different when one is the patient! Suddenly there are a thousand things I do not know… Ovulation Predictor Kits are only the beginning.

And, in the obsession of pregnancy, it becomes everywhere. Books and television remind me that women have been torturing themselves about the ability to get pregnant forever! First, it was conceiving a boy, and whether or not the First Son would be born.  With rampant infertility, the collective obsession has turned to the BFP and away from gender preference.

We want to be able to control this event with every ounce of heart and mind. We are so used to be able to create what we need, if we only put enough effort into the act! It is maddening to have to develop techniques like trust and patience to achieve our highest goal…. and yet that is what it comes down to in the end. Do we hold the ultimate responsibility of whether or not life occurs in our very body?  It is appears to be the hugest responsibility, and yet it is one we cannot. create. on. our. own.  As my friend said yesterday, “We are accomplished and often privileged women! Powerful creations, and yet…” we cannot read what should be the simplest signs of all from our flesh. Are we ovulating today? Are we pregnant? It’s a huge pressure.

For same sex couples and single folks, there is the additional stress of genetic material to procure. The art of conception (often) looks very different for lesbian and gay couples. Not only will the inseminations need to be precisely timed, but the acquisition of said tools of conception must also be arranged. The cost of becoming pregnant begins with the very first try, an additional ingredient in the pressure-cooker of preparation. (In a call-out to women with biologically male partners, I do understand that when women hit the fertility clinics, we are all in the same machine.  The sex or gender of our partner becomes much less relevant although issues of accessibility to and cost of genetic material remains an additional stress.) It’s a wonder any of us become pregnant at all! But we do, in every increasing numbers.

The minute details, test results, and potential scenarios become an endless gerbil wheel of anxiety. It is important to step back from your own fertility and restore some normalcy to your daily routine. I was wound up over the timing of what was only a pre-cycle. Imagine how physically stressed out I could be for the real thing! One of my friends advised me after her first birth – make it fun. Try to relax around it. And she laughed knowing how hard that would be. I suggest distracting yourself as much as possible from thinking the same old anxious thoughts.  HOW? Listen to music that makes you sing. Watch a movie that engages you. Make time for friends or family who you like talking to and who are interesting. Write in a journal so you can get the thoughts out of your head and onto paper. The less time that is spent obsessing about the timing or prediction of said events will be in your best interest overall!

There is no conclusion to the story. The (new brand of) OPK kits wait for next cycle in my bathroom cupboard. I am going to pray for myself, light candles of hope, and continue to make the daily small offerings I do towards pregnancy – high quality prenatal vitamins, DHA essential fats, green tea, and other things appropriate for my personal care. My sweetheart and I also have a plan B, and C in place to rely on. When I get in the hamster mind of prediction anxiety again, please remind me of this post. Stress inhibits Ovulation!

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Mediterranean Adventure II

We were concerned that traveling Gluten Free would be tough. And not even just gluten free – I can’t eat potato or corn, and my sweetheart can’t have rice. So, we were both headed abroad knowing that food choices could be tough. We had the good fortune of staying with family, so for most of the journey we had a kitchen and fridge to stock with staples we could rely on. For me – mostly eggs, rice cakes, delicious olive paste, incredible fresh green olives. For my sweetheart – she had the bonus of finding gluten free bread, plus corn cakes, jam, and yogurt. Then we  shared fruit, veggies and local cheeses. She brought her own corn pasta, and I had no trouble finding rice pasta as needed in the local “Veritas” (organic) market for family dinners. We even found quinoa! Local markets and/or supermarkets also had lovely fresh meats, fish and produce for family dinners. We both brought some snack bars (Kits Organics for her and Luna Protein for me) as well as trail mixes. Of course, there were also lots of delicious treats we could both have. Europe has an impressive array of yogurts, puddings, and other cold delights in small jars. (Less ice cream though, in the freezer sections.)

Overall, food turned out to be less of a problem than we feared. When going out, my sweetheart was invariably able to get “patatas bravas,” a local dish of fried potato with a yummy spicy mayonnaise. Tapas (or pinxtos as they are called in San Sebastian) were harder for me to navigate, so often I just didn’t. Dinners out were easier – I could almost always find some delicious fish or chicken and vegetable options in the Menu del Dia – a 10-15 Euro daily menu with 3 courses and wine and coffee included. As my sweetheart is more sensitive to gluten and cant get away with any exposure, she usually stuck to Ensalada Mixta (salad, tuna, olives, and hardboiled eggs) with a potato side dish. All in all, it worked out well. We weren’t able to sample the breadth of Spanish gourmet cuisine, but we still had some flavorful dishes and local delicacies.

As a Naturopathic Doctor, I was constantly assessing the Mediterranean Diet and to see how the classic reputation of the region matched the real fare. As I suspected, there was plenty of bread, cheese, sugar, and packaged foods available as in the Standard American Diet (SAD.) There were a few noticeable differences though that may account for some of Europe’s lower body weights and improved life expectancy. First, there was no bacon. Yes, “bacin” was on some menus, but it was peameal-style bacon, pan-fried and not the true “bacon” of North American fame. Second, beef was rare to see on a menu or in the supermarkets, and was quite expensive. This made sense as we drove across the country, as there were very few cows. European terrain is not made for grazing the way Texas is.

Finally, and perhaps most impressive to me was the rest stops for food along highways. Each one was set up like a classy buffet restaurant, complete with chefs behind the food casing presenting grilled vegetables, roasted chicken, and a wide arrays of sandwiches, jambon, fruit and cheese choices. There were mini bottles of wine and cans of beer at every register, as if instead of being on a roadtrip one was intentionally stopping at that location for a meal. And stop everyone did, even for coffee. The American in me was shocked that people were literally getting perfect little iced espressos and walking to sit down and drink it before they got back on the road. We are such a to go culture! The contrast was very strong, and was I think the best illustration of the differences between our SAD diet culture and that of the Mediterranean. They sit down and savor a meal, a coffee, and a moment in time. It’s a lifestyle, a way of thinking, and a paradigm. We eat on the go, “para llavales”. We Rush, wolfing down food, eating mindlessly as we multitask and gulping down our beverages while we push on ahead. And we pack on the pounds and generate chronic disease as we go along, coercing our nervous systems into simultaneously digesting and running at the same time.

I am still filtering through layers of impressions, photos and reflecting on the whole experience of world travel. I highly recommend Spain to anyone – Barcelona is the second most popular tourist destination in the world, and well worth the hype. Traveling gluten free was not a problem; we were able to find great local resources and food options, especially for a food adventurist. For those who can eat gluten, there is an incredible world of tapas out there just waiting your arrival! But do yourself a favor – eat like you have all the time in the world.

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A Note from Behind the Curtain

So many patients are looking for answers. As a doctor I know that the best answers are in each individual. Usually, we do not want to know the real answer. We want a pill, or a cream, or a smoothie containing the essential nutrients that will add up to the ultimate results. Dont get me wrong – products will help. Testing can uncover imbalances and deficiencies to be corrected and appropriate formulations to improve symptomology. However… until you are actually ready to change something – that thing- – which needs changing in your personal landscape, it is unlikely that you will find your own true answer to health. I will use myself as an example.

After I graduated from Naturopathic Medical School in 2000, I opened a clinic in downtown Toronto with some of my classmates. Over the next 12 years I developed my professional identity, grew my patient base, and pursued my personal passion of fertility medicine. I had a wonderful partner, a beautiful home and fantastic friends. I was never fully content, despite my abundance. I doubted my career and profession, and was constantly seeking something outside of myself to fill the inherent void. No amount of adrenal supplements, detox regimes or magnesium quieted the inner voice. This was not an organic condition, it was a calling that took me many years to acknowledge.

Eventually, I moved to Portland Maine in March 2011. I sold my clinic, left my clinic faculty position, and my sweetheart and I parted ways. Here, life is different. I smell the ocean every day. I do yoga (occasionally.) I walk the dog. I drink green tea. I am redefining myself as a Naturopathic Doctor and am inspired by the new turns my professional identity is taking. I am becoming a better doctor – the best version of myself. It has been a massively stressful process to redefine my life in my late 30’s. However – the gray hairs are worth the evolution. I am happy in a way I have never been. And it is not because my physical, emotional, or mental health has changed drastically. It is because I have found my own answer.

Not everyone’s answer will involve so many miles and such upheaval. The answer to your own health and wellness questions may simple or complex. Part of my job as a Naturopathic Doctor is to look beyond pills and dietary restrictions to see your truth behind your curtain, and support you in finding your own evolutions. If I can do it, I am sure to believe in you.

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Caffeine, Detoxification, and the Healing Crisis

Days after quitting caffeine, I started coughing up and eliminating nasty amounts of toxic looking phlegm from my sinus and lungs. (sorry for the descriptors.) I had been suffering from sneezing, clear drippy nose and “allergy” or “cold” symptoms for a couple of months previous to this. So, while I was disappointed to be getting sick over the holidays, it felt like I was finally getting “something out” of my system that had been brewing for a long time.

I have searched many databases for evidence based articles linking caffeine and sinus and have only found articles related to caffeine and heart disease. Apparently there is no evidence based link. However, in searching Dr. Google for other peoples opinions on caffeine and sinus health, there is a relationship between the two. Caffeine diminishes adrenal health by deleting epinephrine and affecting cortisol levels. This in turn affects the immune system and inflammatory levels, which can lead to increased candida levels causing chronic sinusitis.

The body wants to be in homeostasis. This means, the body seeks balance. In its natural state, without drugs, the human body will naturally produce secretions to eliminate microbes and return to its state of best health. This is one of the basic tenets of Naturopathic Medicine. This can produce what is known as a healing crisis. Fevers, vomiting, diarrhea, vaginal discharge, phlegm – secretions of various kinds are produced to aid the body in returning to its natural state. It can feel pretty awful to be in a healing crisis, but if you are able to trust that the body is actually working towards a state of improved health rather than spiraling towards destruction, it can bring about an awesome recovery. (This is also often what modern medicine is appropriate,  when medications or other medical interventions are appropriate interventions. The differential between the safe healing crisis and the situation needing medical intervention is the job of a ND.)

I haven’t felt too awful with this current “sinus and bronchial infection.” Although I have had copious elimination of some nasty stuff, my energy, appetite and general mood have been pretty good. I have been able to lay low, watch TV, do castor oil packs for my lungs, make soups, drink Cold Care and Throat Coat teas, and take anti-fungal and lung herbs to support the elimination. Overall although I am sick in a classical sense, I feel a renewal taking place. And, I have finally been able to kick the caffeine and headaches while avoiding the fatigue by resting so much! I will need to continue to work on my adrenal health and decrease sugar intake as candida has been flagged as a potential long term issue by this detox experience.

Everyone will have a different experience, and a different potential for a healing crisis. Age, stress levels, number of years on caffeine, gender, diet and nutrition levels all play into the effect caffeine has on the body, and the resulting effect its elimination can inspire.

Exerpt from http://www.health4youonline.com/article_sherridan_stock_conquering_candida.htm#Hypoadrenia

Hypoadrenia 

Several years ago we noted a correlation between healthy adrenal glands and the absence of candidiasis, and formed the opinion that healthy adrenal glands help protect against candidiasis. We now realize that the other side of the coin is perhaps more important: Candida commonly impairs adrenal functioning, sometimes severely so.

Having made this latter observation, we wondered about the possible mechanism.  Initially we supposed that the Candida infection constituted an adrenal stressor, like any other infection.  We then saw a lady in whom candidiasis was a major cause of hypoadrenia, and noted that the amino acids that supported her adrenal glands best were taurine, cysteine, and glycine – all antioxidants.  Following up this clue we then ascertained that Candida and its toxins appeared to be exerting a direct cytotoxic effect on the adrenal glands via free-radical activity.

Another mechanism suggested by our testing is that of Candida-induced autoimmune damage to the adrenal glands.  Several studies do, in fact, implicate Candida as a major cause of autoimmunity since it can reduce suppressor T-cell activity.(3)  Further, it is possible that because of a similarity between the protein sequence of the cell walls of Candida and that of human cells, antibodies directed at Candida may cross-react with human cells.(5)  We also wonder whether the presence of Candida and its toxins within a tissue causes the body to regard that tissue as non-self and therefore to initiate autoimmune attack.

Additionally, Candida toxins interfere with acetyl coenzyme A activity,(3) which could inhibit the synthesis of adrenal steroids, and further, it is believed that Candida possesses receptor sites that can bind adrenal steroids thus competing with host cells, producing apparent adrenal insufficiency.(3)

Exerpt: CONQUERING CANDIDA by Sherridan L. Stock BSc(Hons) CBiol FBiol FZS FRES

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Stress: Applied Physics

Stress =  Force/ Area

Think literally for a minute about your body as a solid object governed by Newtonian Physics. The body as an object seeks constant equilibrium, and often finds it. How can we aid our body in maintaining the balance essential to feeling good?

The equation above gives all the answers, in proper Newtonian fashion. Stress equals a Force that needs to be balanced over an Area large enough to balance it. The Area becomes the places that we can spread out the Force of Stress and diffuse the pressure of modern life. What are the Areas in your life you use to diffuse stress? Look to meditation, time alone, exercise, family, intimacy, sex, reading, massage, acupuncture, counseling, baths, yoga, vacation, down time, friends, nature, and journaling as potential areas to consider for this kind of equation. Wine/ beer/cocktails, pot, white powder drugs, valium, ativan, television and eating are also common “areas” used to relieve stress ~ but these all have additive and addictive elements that create additional stress in a cyclic fashion.

Sometimes a Force in our life suddenly escalates – while the basic life Stress and Areas we balance it with stay the same. This force acts like a nailgun driving the nail of stress into your health. Therefore, it is imperative in times of high stress like a family illness, death, marital problems, a significant move or an exam period to reduce the force of other stresses and increase the area to contain them! During these periods of spiked pressure, improving nutrition is an important way to decrease oxidative stress and add another area of health to your equation. Simple changes like reducing sugar and coffee and increasing green vegetables and whole grains will make a big difference in the way your body reacts.

We all have stress – it’s a fundamental component of life. Even on a desert island with perfect weather, abundant food and no work, stress would present (eventually.) We are made to withstand stress, and even thrive in stressful environments. But when the Force of Stress cannot be spread over a large enough Area, or when Stress escalates in addition to basic Forces, equilibrium is lost and physical, mental and emotional  health problems ensue.

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Keeping the Pace – Part 2

Maintaining Adrenal Health


Proper adrenal supplementation is as personalized as your causes of stress. The way the body adapts to stress can take many forms, and the best treatments will reflect your individual constellation of symptoms. However, everyone has some levels of adrenal fatigue just from the life we live, and daily generic supplementation will assist your body in maintaining adrenal health.  Healthy adrenal glands are like rich ripe plums, sitting atop our kidneys, playing key notes in our endocrine orchestra. Stress and exhaustion can cause them to become dried up and shriveled like prunes, which sequentially affects all the other players of our hormone system. Nourishing your adrenals and caring for them will help keep your entire hormone system playing smooth and true.

So, what products are best for you? The endocrine system includes a diverse set of very important glands including pituitary, thyroid, pancreas, adrenals and ovaries. This system often triangulates in function, and it is very rare to have a solo organ problem. Therefore, when choosing adrenal supplementation the rest of the endocrine system is also assessed in best practice treatment. Nourishment is multifactoral and includes vitamins to restore deficiencies caused by stress and botanical medicine to restore glandular function. This assessment is best done by a licensed professional who has had training in natural medications, contraindications, pharmaceutical interactions and adverse reactions.

Generally – an adrenal supplement taken daily will include Vitamin B5 and Vitamin C, both required for adrenal function. Rhodiola is a botanical that increases endurance and mental focus. In Russian army trials it proved to improve responses to stress – the typical dose is 150-300mg. Holy Basil is a lovely botanical that helps the body to regulate cortisol’s relationship to blood sugar; therefore,  it may be helpful for emotional binge eaters.  It has just come out a tea called Tulsi Tea. Relora is also a patented neutraceutical that has evidence based studies supporting its ability to re-regulate cortisol to normal diurnal patterns. It can also help reduce abdominal adiposity related to stress. My favorite general adrenal supplement for (US) long-term use is Vitanica’s Adrenal Assist – 3 capsules daily, which contains several of the above-mentioned products and more. In Canada, I like CanPrev’s Adrenal Thyroid Pro. Please note – if you are taking medications especially cardiac or blood pressure medications there is a potential for multiple interactions with these products, please seek advice from a Naturopathic Doctor or other professional trained in pharmaceutical-herbal interactions.

Adrenal Supplementation is a multi million-dollar industry as modern culture whips us into looking 15 years younger and doing the work of 3!  There are many approaches to restoring adrenal health, and new products available on a daily basis. One can be very scientific about adrenal disease, approach it from an energetic perspective, or start from somewhere in between.  Adrenal restoration is best done with a medical practitioner whether it’s a Naturopathic, Osteopathic or Allopathic Physician. Chiropractors are often trained in prescriptions for endocrine health, as are Nutritionists, Herbalists and Nurse Practitioners. Even some Pharmacists have jumped on the bandwagon. There is no Right answer or best practice that has been established, so finding someone with good credentials, experience and an approach to wellness you resonate with is the best place to start.

Depending on your state of health, laboratory testing may or may not be recommended. Salivary Hormone Testing of the hormone cortisol is a common place to start. This can be done as a single assessment or a 4-point panel reflecting an entire day. The 4-point is a more thorough and accurate assessment of daily cortisol activity. (Cortisol is pumped out by the adrenal gland in response to stress along with epinephrine and norepinephrine.) An entire endocrine panel including pituitary, thyroid and reproductive hormones can also be done for a good quality snapshot of the whole hormone system. Salivary testing is not required, but it is helpful to tailor an accurate treatment plan. However, a good practitioner will be able to read signs and symptoms of adrenal dysfunction from the initial interview, and will be able to do a differential diagnosis of whether or not there is thyroid involvement present. Therefore, laboratory testing is not always required. Bloodwork may also be suggested to assess whether the adrenal diseases Cushings and Addisons need to be ruled out.

Treatment of adrenal fatigue and endocrine dysfunction is a long slow process. Prescribed herbs and vitamins will need to be taken for a minimum of 3 months, and often over a 6-9 month period. This is especially true for women as the female reproductive hormones change weekly over a four-week period, so rebalancing can require several cycles for a noticeable response.

 

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Keeping the Pace – Part One

Part One – Making Choices

 Keeping pace with life’s To Do list, career, academics, and family… its tough. Its hard on the body, its hard on the mind, and it can be hard on the waistline too. It’s worth it – for evolution, advancement, and a life well lived – but how can one minimize the toll of stress?

Adapting effectively to stress requires both a short term and long-term commitment to nourishing and sustaining hormonal response. The body responds to chronic stress by first an alarm phase, then sustained effort, then exhaustion. Making appropriate nutritional choices and choosing herbal adaptogens that match the endocrine condition relieve strain and sustain long-term health.

First and Foremost – What can you actually do when you are exhausted, and hungry, and cant stop? One answer: eat something green. A fresh arugula salad would be perfect; however a greens drink is very convenient. Spirulina and other microalgae are the red blood cell equivalents of the plant kingdom. They provide an instant nutrient-rich boost of antioxidants, alkalinizing and balancing your starved system and tiding over the hunger until you can take a break. Mix greens with juice for blood sugar support, or choose green protein-enhanced shakes or bars if needed. Odwalla has a yummy green pre-made green Superfood smoothie. There are several products available in one-serving envelopes that travel well. If you are on *any* medications, including Hypertension, Birth Control, Antidepressant and Anti-Anxiety medications, please choose a formula that ONLY has the microalgae, and/or wheat grasses, without herbal components.  The energy-supporting herbs used in many “energy greens” can have multiple medication interactions.

Protein is also an integral component of a high stress diet. The immune and hormonal systems require adequate protein for sustained cellular responses. This protein must be high quality: fast food meats or veggie burgers do not “count!” Good quality protein will create a smooth and better-sustained blood sugar response decreasing headaches, crabbiness, and dizziness while improving energy and balance. Include one serving of protein in most significant meals, and look for protein snacks on busy days.

Sugar, crackers, pastries, fruit or raw vegetables alone will burn quickly and leave you depleted. Lunchtime protein can include tahini on a cooked whole grain or steamed vegetables, avocado, hard-boiled eggs, nut butters and nut butter sauces, quinoa salads, and cheese in addition to fish or meat. Prepare ahead! Protein and fiber rich snacks like applesauce and cottage cheese, hard-boiled egg, toasted nuts and seeds with raisins, celery and nut butter can be pre-made and stored in little “to go” containers. It’s best to avoid consistent intake of processed proteins including whey and soy protein isolates as bars or shakes, but occasional use is well tolerated.

Therefore, the immediate moment, when you hit a wall look to greens and to protein for a boost. This will keep you from turning to sugar or fat to maintain your energy, keeping your waistline trim and nourishing your body rather than taxing it further.

If you cant get away from the piece of chocolate that seems like its the only thing that will save your day in that moment, choose a small piece of good quality chocolate! Research shows that small amounts of high quality chocolate actually have beneficial effects on our health. It is an antioxidant, and releases GABA neurotransmitter that is one of the “off” buttons in our brain. Commercial “industrial” chocolate, mochas, lattes, cookies, and other quick fixes have low nutritional value and provide high fat calories that lead to abdominal weight gain and create sugar addictions. Cacao Nibs are Nature’s superfood candy, and are a must for any true chocolate addict. Rich in magnesium, these replenish lost minerals lost through caffeine. Add Cacao Nibs to your trail mix with home-toasted walnuts, pumpkin seeds and organic raisins.

Long-term adrenal restoration in the form of individualized and endocrine-specific supplementation is also integral. Adrenal fatigue is a buzz term in today’s medicine, and will be the topic of Keeping the Pace  – Part Two!

Cocoa and chocolate in human health and disease. Katz DL, Doughty K, Ali A, Antioxidants & Redox Signaling [Antioxid Redox Signal], ISSN: 1557-7716, 2011 Nov 15; Vol. 15 (10), pp. 2779-811; PMID: 21470061; http://web.ebscohost.com.ezproxy.ccnm.edu/ehos/viewarticle?data=dGJyMPPp44rp2%2fdV0%2bnjisfk5Ie46bNNsa6zTrOk63nn5Kx95uXxjL6nrkewrq1KrqevOK%2bwsVC4qbE4zsOkjPDX7Ivf2fKB7eTnfLujsUm2p7NMsaakhN%2fk5VXj5KR84LPrhuac8nnls79mpNfsVbCntE6zqbdIpNztiuvX8lXk6%2bqE8tv2jAAA&hid=17

The impact of chocolate on cardiovascular health. Fernández-Murga L, Tarín JJ, García-Perez MA, Cano A, Maturitas [Maturitas], ISSN: 1873-4111, 2011 Aug; Vol. 69 (4), pp. 312-21; PMID: 21665390

 

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