Fatigue After 50

We’ve all felt tired at times. But if you’re over 50 and waking up just as tired as when you went to bed, or if you find yourself needing more and more coffee just to get through the day, it may be time to ask: what’s really going on?

Fatigue is one of the most common reasons people visit their doctor, yet it’s often brushed off as a natural part of aging. While energy levels do shift over time, persistent fatigue is not something you have to accept. It’s often a sign that something deeper needs attention.

As a naturopathic physician, my first step when a patient comes in with fatigue is a thorough assessment. That includes listening to their story, performing a detailed physical examination, and ordering targeted lab tests to uncover the root cause.

Iron and B12 are classic culprits, especially in women who’ve had years of heavy periods, or in anyone with digestive issues that impact absorption. Low iron can make you feel foggy, weak, or short of breath. B12 deficiency, more common with age, can sneak up with symptoms like numbness, low mood, and deep fatigue.

Thyroid function is another key area to check. The thyroid acts like your internal thermostat; when it’s underactive, everything slows down. You might feel cold, sluggish, constipated, or gain weight without trying. A proper thyroid assessment includes not only TSH, but often free T4, free T3, and thyroid antibodies for a complete picture.

Sleep apnea, surprisingly under-diagnosed, is a major cause of fatigue. Even people who think they sleep fine may not be getting deep, restorative sleep if their breathing is interrupted throughout the night. If a partner notices snoring or pauses in breathing, or if you wake up groggy or with headaches, it’s worth investigating.

Chronic stress over decades can tax the body. HPA axis dysfunction refers to a disruption in the normal functioning of the hypothalamic-pituitary-adrenal axis, a key system regulating the body’s stress response. When imbalanced, people may experience poor stress resilience, low morning energy, and that ‘wired but tired’ feeling.

In addition, persistent fatigue can be an early sign of more serious conditions like cardiovascular disease, cancer, digestive disorders, autoimmune disease, MS, and more. I believe in being very thorough with my fatigue patients to look for clues of deeper pathology. Once we’ve ruled out or addressed medical causes, it’s time to look at restoration. This is where naturopathic medicine shines.

Restoration means nourishing your body with quality sleep, balanced meals, and rhythm in your day. It may involve replenishing nutrients like iron or B12, supporting thyroid or adrenal function with herbs, or improving sleep hygiene and stress management.

Sometimes, we use natural supports like ashwagandha, rhodiola, or magnesium, and can prescribe pharmaceutical treatments when appropriate.

The goal isn’t just to mask the fatigue, but to help your body function optimally again. Because yes, energy changes with age, but you should still feel vital, sharp, and engaged with life. Fatigue is a signal. The question is: are we listening?

Dr. Deidre Macdonald is a naturopathic physician who has practiced in downtown Courtenay since 1997. www.getwellhere.com or 250 897-0235

 

Ten Ways to Boost Your Immune System Naturally

Ever wonder why some people rarely catch a cold while others seem to get every bug in the air? While genetics may play a role, daily habits and lifestyle choices often make a bigger impact. Here are ten effective, natural ways to keep your immune system strong.

  1. Keep Your Vitamin D Levels Up

Vitamin D, known as the “sunshine vitamin,” is crucial for immune function, but in the Comox Valley, winter sun exposure is minimal. To meet the recommended 2000 IU a day, consider a supplement. Research shows that keeping your vitamin D levels up can help protect against colds and flu.

  1. Focus on Whole, Colourful Foods   

A diet rich in fruits and vegetables provides essential vitamins, minerals, and antioxidants that help the immune system function at its best. Leafy greens like kale, along with berries, carrots, and bell peppers, are loaded with nutrients to fend off illness. The variety of colours on your plate reflects a diversity of immune-boosting compounds.

  1. Make Movement Part of Your Routine   

Regular physical activity enhances immune health, yet the winter months make it tempting to skip workouts. Even short daily walks, indoor yoga, or a few bodyweight exercises can help keep the lymphatic system moving, which is essential for immune function. Try to find activities you enjoy so that exercise becomes a consistent part of your week.

  1. Prioritize Good Sleep   

Sleep is a powerful, natural immune booster. When we sleep, the body produces and releases proteins called cytokines that aid the immune response. Aim for 7–8 hours nightly and establish a calming bedtime routine. Relaxation apps, like Insight Timer, can guide you through breathing exercises or meditations that help you wind down.

  1. Manage Stress Proactively   

Chronic stress raises cortisol, which can inhibit the immune system. Taking small, daily steps to manage stress—whether through deep breathing, meditation, or gentle stretching—can help. Herbal adaptogens like ashwagandha may also support resilience to stress over time.

  1. Soak in Natural Light   

Sunlight exposure, even on cloudy days, can lift mood and strengthen immune health. Time outdoors, especially near water or in the snow, provides a natural light boost that supports well-being.

  1. Consider Herbal Support   

Certain herbs have shown benefits in bolstering the immune system. Echinacea may help reduce the duration of colds, and reishi mushrooms contain compounds that can enhance immune response. Oil of Oregano can also offer antiviral support when used at the first sign of symptoms.

  1. Wash Hands Often   

Frequent handwashing with soap and water is a simple yet highly effective way to reduce exposure to viruses and bacteria. It may also help to avoid handshakes and keep hands away from the face, especially in winter.

  1. Support Your Lungs by Quitting Smoking   

If you’re a smoker, know that smoking has a suppressive effect on immune function. Quitting can make a substantial difference, and options like our Laser Quit Smoking program have helped many people to ease the transition.

  1. Get Personalized Support   

If you frequently catch colds or have lingering health issues, a naturopathic consultation could uncover root causes. We offer an in-depth, personalized approach to improving immune health, including tailored nutrition and lifestyle guidance, natural medicines and sometimes pharmaceutical medicines.

These practices don’t require drastic changes but can lead to significant improvements in immune resilience. A well-rounded approach to immune health can help you stay well through winter and beyond, building a strong foundation for lifelong vitality.

Protein Power: Your Ally in Aging Gracefully and Staying Strong

When it comes to healthy aging, protein is like the unsung hero of nutrition—always there, quietly working behind the scenes to keep your muscles strong, your brain sharp, and your body resilient. But how much protein do you really need, and is it possible to have too much of a good thing? As a naturopathic physician with a focus on nutrition and healthy aging, these are questions I commonly get from my patients. So, let’s dive into the science and myths of protein and how it can help you stay fit and vibrant at any age.

First, let’s get the numbers straight. The science says that most adults benefit from consuming 1.2 to 1.6 grams of protein per kilogram of body weight daily. Calculate your protein requirements using your estimated lean body weight. For a person whose lean weight is 150 pounds or 68 kg, that’s an average of 26-36 grams of protein three times a day. Considering that one chicken breast has about 50g of protein, those numbers aren’t out of reach for most people. 

Dietary protein supports maintaining and building muscle, which plays a vital role in balance, strength, blood sugar regulation, metabolic health, and more. After 50, we typically lose 1% of our muscle mass per year; after 70, that number goes up to 4%. However,  exercise and protein intake can reverse that trend. And if you’re trying to build or maintain muscle, a post-workout protein shake isn’t just trendy—it’s genuinely effective. While there’s no need to obsess over a narrow “anabolic window” after exercise, having protein before or after a workout gives your muscles the building blocks they need. 

Not all proteins are created equal, though. Animal proteins like chicken, eggs, and dairy tend to pack the biggest punch when it comes to essential amino acids, especially leucine—the star amino acid that triggers muscle growth. But if you’re vegetarian or vegan, don’t fret. By consuming a variety of plant-based proteins, like beans, soy, quinoa, and lentils, and perhaps adding a plant-based protein powder, you can absolutely meet your needs. 

What about concerns that high-protein diets might harm your kidneys or speed up aging? For most healthy people, these fears are more myth than fact. Research shows that regular exercise changes how the body processes protein, directing its benefits to where they’re needed most—your muscles and brain. Staying active essentially turns protein into a tool for health, not harm.

Now, let’s tackle a common concern: IGF-1, a hormone that spikes with higher protein intake. Some studies suggest this could increase cancer risk, but here’s the nuance: exercise flips the script. Physical activity directs IGF-1 to muscle repair and brain health while limiting its availability to potential problem areas. Simply put, a balanced diet paired with regular movement lets protein do its job without unintended consequences.

Ultimately, the magic of protein lies not just in what you eat, but in how you live. Pairing a thoughtful protein intake with resistance training or even a daily brisk walk can help keep your body strong and your mind sharp. After all, isn’t that the goal of healthy aging—staying active, independent, and ready for life’s adventures?

So, whether you’re whipping up a protein-packed smoothie, enjoying a hearty lentil soup, or indulging in a grilled salmon dinner, remember every bite is an investment in your future. Protein isn’t just for athletes or bodybuilders; it’s for anyone who wants to age gracefully, stay fit, and feel amazing in their skin. Cheers to that.

ND’s Top 7 Favorite Pharmaceuticals

As a naturopathic doctor, my primary focus is helping people achieve better health through lifestyle changes and natural medicine. Diet, exercise, and holistic treatments form the foundation of my practice. However, there are times when I prescribe pharmaceutical medicines to support the healing process. The key is using them thoughtfully, as part of a broader, holistic plan. When combined with natural remedies, these medications can offer valuable support in promoting overall health and well-being.

Topical Diclofenac

Topical Diclofenac is an anti-inflammatory cream that can be applied directly to sore joints, tendons, or muscles. This option can reduce the need for systemic pain drugs like ibuprofen or acetaminophen, both of which can have side effects when used long-term. Diclofenac can be compounded to include medications for nerve pain, making it a versatile tool for managing discomfort while working on healing the underlying tissue.

Metformin

Metformin is a common blood sugar lowering medication that works by improving the body’s response to insulin. While diet and exercise are critical to managing blood sugar levels, Metformin can provide a significant boost for some patients. Beyond its role in diabetes management, emerging research suggests that Metformin may have broader health benefits, including potential roles in cancer prevention and cognitive health.

Vaginal Estrogen

For postmenopausal women, vaginal dryness is a common and often uncomfortable issue. While special moisturizers can offer some relief, topical or vaginal estrogen is the most effective way to treat this condition. Used in moderation vaginal estrogen is considered very safe.

Bioidentical Hormone Replacement Therapy (BHRT)

In the right context, Bioidentical Hormone Replacement Therapy (BHRT) can be a safe and effective option for women experiencing menopausal symptoms. The understanding of hormone replacement has evolved significantly over the years. Current research suggests that BHRT, in the right person, in the right form, not only alleviates symptoms like hot flashes but may also offer benefits for long-term cognitive and bone health.

Enteric Coated Digestive Enzymes (Cotazym 20)

Prescription digestive enzymes, like Cotazym 20, can be very helpful for some individuals struggling with bloating, irritable bowel syndrome (IBS), or other digestive issues. These enzymes augment the enzymes the pancreas produces which break down food. What makes Cotazym 20 particularly useful is its enteric coating, which protects the enzymes from being destroyed by stomach acid, allowing them to work more effectively in the intestines where they’re needed. This targeted support can make a significant difference in digestive health for people who need it.

Rifaximin

As a naturopathic doctor, I generally avoid antibiotics unless necessary because of their impact on the intestinal microbiome, a key factor in overall health. However, Rifaximin is an exception. This antibiotic is used to treat certain cases of Irritable Bowel Syndrome, particularly those involving diarrhea caused by Small Intestine Bacterial Overgrowth (SIBO). Uniquely, Rifaximin primarily works only in the small intestine, preserving the microbiome in the large intestine. Plus, 97% is eliminated through the colon, meaning it poses minimal risk to the liver and kidneys, and doesn’t cause yeast infections or other common antibiotic side effects. As part of a comprehensive program it can be a very helpful for people with IBS.

Low Dose Naltrexone

This medication is a very exciting addition to my toolkit when helping people with complex, chronic diseases like Long Covid, Chronic Fatigue Syndrome, autoimmune disease, cancer, neurodegenerative diseases and more. It gently tricks the body into activating its own immune balancing mechanisms, and helps reduce neuro-inflammation. Studies show demonstrable benefits for Inflammatory bowel disease, rheumatoid arthritis and more. It’s relatively safe and expensive. 

 

While pharmaceuticals like these are never my only treatment option, they can serve as valuable tools in a comprehensive health plan. When used wisely and alongside lifestyle changes and natural therapies, they can give patients the extra support they need to achieve their health goals. The beauty of a naturopathic approach is in finding the balance between all available options—natural and pharmaceutical—working together for the best possible outcome.

 

Dr. Deidre Macdonald is a naturopathic physician practicing in downtown Courtenay since 1997. www.getwellhere.com 250 897-0235a

Pain Relief – Naturally

If you feel like aches and pains are holding you back from enjoying life fully, just cutting back on exercise is not the answer, as that comes at a high cost. As a naturopathic physician I love helping people to keep their bodies strong, vital and flexible as they age, so they can stay active and engaged. I aim to help my patients activate their bodies’ own healing mechanisms with a healthy lifestyle, natural medicines and physical therapy. One physical treatment that integrates with this philosophy is Low-Level Laser Therapy (LLLT), also known as cold laser therapy.

This non-invasive and gentle approach utilizes the power of light, concentrated by lasers, to stimulate cellular activity and promote tissue repair. The treatments are painless and lasting results are often seen after only a few weeks of treatment. Laser therapy is unique in that it helps to promote healing of damaged tissue including cartilage, ligaments, tendons, muscles and nerves. It can penetrate deeply into joints like knees and hips and can get right inside the spine to help with the disc issue and arthritis that can cause pinched nerves. 

Hundreds of scientific studies have shed light on the effectiveness of LLLT across various conditions including a groundbreaking meta-analysis published in 2024 which looked at 14 high quality studies using laser therapy for osteoarthritis of the knee. The review showed that laser therapy significantly reduced pain and increased range of motion, a result I have witnessed many times in my clinical practice. Additionally, a meta-analysis of many studies on laser therapy and neck pain showed significant benefit compared to placebo treatments. These results showcase laser therapy’s ability to ramp up the body’s regenerative processes even in chronic, degenerative conditions like arthritis. 

The gentle, non-invasive nature of LLLT makes it an appealing option for those seeking natural approaches for conditions such as acute and chronic back pain, arthritis, neck pain, rotator cuff issues, carpal tunnel syndrome, plantar fasciitis, pinched nerves, tendonitis and more. In the 17 years I have used this treatment in my clinic, I have helped countless people to reduce pain, reduce pain medication, and increase their enjoyment of life. I have many patients who rely on laser therapy to keep their various aches and pain in check so they can work and play to their full potential. 

Once the injured and painful areas are on the path to healing, then treatments that restore optimal alignment and strength are important to prevent reinjury. In addition, naturopathic physicians coach their patients on how to create a healthy environment for the body to heal itself by optimizing diet, digestion, sleep and movement. We also utilize natural medicines that can help with pain management like Palmitoylethanolamide (PEA) and natural anti-inflammatory medications like curcumin (from turmeric). For some people with nerve pain or autoimmune diseases, I can prescribe a prescription drug called Low Dose Naltrexone that can reduce pain and inflammation as well as balance the immune system. So as nature invites us to get outside this spring, consider utilizing Low-Level Laser Therapy and other naturopathic strategies to help you overcome any aches and pains that might limit your activity. To learn more click here. 

Effective and Safer Pain Management

Chronic pain affects the lives of over eight million Canadians. While opiates were once considered a humane choice for pain relief, their addictive potential has contributed to the opiate crisis, leading to a decline in their use as a solution. In my naturopathic medical practice, I often encounter patients suffering from chronic pain who are seeking alternatives that won’t harm their bodies or lead to addiction. Treating the Root Cause of Pain: The primary goal of pain management is to address the underlying cause. At our clinic, we offer laser therapy, a non-invasive treatment that accelerates the healing process for arthritis, injuries, back pain, and more. Additionally, there are many treatments and home programs that can provide relief. However, supplemental pain management is crucial during the healing process and for individuals who don’t respond sufficiently to other therapies. In this article, we will explore safer options for treating pain. Exploring Safer Alternatives:
  1. PEA (Palmitoylethanolamide): PEA is a natural medicine that shows promising results in pain management. It possesses pain-blocking effects and reduces neural inflammation, which is a common feature of many chronic pain conditions. From post-concussion syndrome and long-COVID to chronic fatigue syndrome, fibromyalgia, sciatic nerve pain, and peripheral neuropathy, PEA has demonstrated effectiveness. Importantly, this naturally occurring fat extract rarely causes side effects. A review published in the British Journal of Clinical Pharmacology concluded that PEA reduces pain and is considered very safe. In my experience, I have successfully used PEA to help patients dealing with complex chronic pain issues.
  2. Low Dose Naltrexone (LDN): As a naturopathic physician, I find LDN particularly intriguing because it helps balance the immune system and promote nervous system healing. Moreover, it is a relatively safe and cost-effective pharmaceutical medication. LDN has shown promising results in pain conditions such as fibromyalgia, low back pain, and rheumatoid arthritis. I customize the prescription according to each patient’s needs, and many individuals consider it a significant part of their wellness plan.
  3. CBD (Cannabidiol): CBD, the non-psychoactive component of cannabis, is extensively used for pain management in Canada. However, the lack of human clinical trials has hindered our understanding of its efficacy and appropriate dosages. With the recent legalization of cannabis, more studies are underway. The Canadian Arthritis Society is actively funding research in this area but has not yet endorsed CBD as a treatment. Nevertheless, one study revealed that CBD use allowed patients attending a chronic pain clinic to reduce their opioid medication intake.
  4. Natural Anti-inflammatory Agents: Use of natural anti-inflammatory agents can reduce the need for more toxic over-the-counter drugs. Curcumin, an extract of turmeric, has been proven to be more effective than ibuprofen in a five-month study on human osteoarthritis knee pain, with fewer side effects. It lowers inflammatory chemicals in the body, benefiting various disease processes. Additionally, fish oil high in EPA content possesses anti-inflammatory properties, and Boswellia, another herb, has shown anti-inflammatory effects as well. Your naturopathic physician is trained as an herbalist and can tailor herbal formulas to suit your needs and ensure they align with any existing prescriptions. They can also assist you in creating a lifestyle plan that reduces inflammation and promotes healing.
    5. Helping people live fuller lives with less pain is incredibly rewarding. Effective pain management strategies can be implemented using solutions that offer side benefits instead of side effects.

Dementia Prevention

According to the Alzheimer’s Society of Canada, in 2020, 124,000 Canadians were diagnosed with dementia.  By 2030, it is projected that upwards of one million Canadians will be living with Dementia.  These are staggering numbers.

There are many causes and multiple types of dementia, including vascular dementia and Alzheimer’s disease.  While there is no cure, there are factors that can be addressed to reduce one’s risk.  As a naturopathic doctor, I aim to help you identify risk factors and develop a plan to address them.  A comprehensive bloodwork panel can test for several risk factors, including blood sugar, inflammatory markers, homocysteine, and more.  Genetic tests can also be ordered as part of Alzheimer’s disease risk.

Reducing risk factors is critical, including making dietary changes to support blood sugar and heart health.  One particular way of eating, the Mediterranean diet, reduces inflammation, is rich in antioxidants, and is known to improve diabetes and cardiovascular disease risk.  All of these are aspects to address with dementia. 

A Mediterranean diet includes fish as a significant component, many of which are rich in omega-3 fatty acids.  One consideration when eating fish is to avoid those higher in mercury.  This is because mercury has toxic effects on the body, especially the brain.  Lower mercury fish include shrimp, salmon, pollock, and canned light tuna. 

Lifestyle choices can also be impactful for dementia, including eliminating smoking, reducing excessive alcohol consumption, and exercising.  Exercise can improve memory, brain function, and increase blood flow to the brain.  Exercise can also improve blood sugar and heart health (the risk factors I discussed above).  There are different ways to exercise and various types to enjoy, but enjoyment is the key factor.  Like anything, the chance of continuing to exercise highly depends on whether you enjoy the activity.  So, the first step with exercising is picking something you enjoy doing.

One of the key aspects that I address with patients looking to prevent dementia is to reduce chronic inflammation.  This is because inflammation that affects the brain is a contributor to the progression of dementia and Alzheimer’s.  When thinking about a foundation for optimal brain health, we turn back to what we eat.  A diet that is rich in plant foods (fruits, vegetables, whole grains, nuts, seeds) tends to include more antioxidants, which reduces inflammation in the body. 

On top of diet, there are herbal medicines and supplements that are anti-inflammatory.  Two examples include curcumin and fish oil, both of which help to reduce inflammation.  There are various types and qualities of curcumin and fish oil on the market, so ensure you pick the right one for you.  If in doubt, your naturopathic doctor can clarify.

Dr. Shawn Peters, ND is a naturopathic doctor practicing in downtown Courtenay.

Book a Complimentary 15-minute, no-obligation appointment with Dr. Shawn to see if Naturopathic Medicine is right for you!

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Early Cancer Testing You Should Know About

Part of being a health-conscious person is being aware of the early signs of cancer and taking advantage of cancer screening. Cancers caught early are often treatable. An estimated two in five Canadians will be diagnosed with cancer in their lifetime and about one in four will die from cancer, making it the leading cause of death in Canada. Having a relationship with a doctor who can provide regular checkups, blood work, and cancer screening simply saves lives. But because fewer people in the Comox Valley have a family doctor, these non-urgent conversations happen less often. People without a family doctor often only use the walk-in clinics for urgent concerns and miss out on regular screening. And what woman wants to go to a stranger at a walk-in clinic for intimate exams? As a naturopathic physician, more of my patients are accessing my services for basic medical screening tests and exams and I’m glad they have options. Here I’ll remind you of the key symptoms you should watch for and tests you should do regularly to screen for cancer. 

Paying attention to changes in your body and not ignoring them is important. It’s better to have a symptom checked out and found to be normal than ignore it and have it progress into overt issues. Symptoms that warrant investigation include unexplained: fatigue or weight loss, persistent lymph node enlargement, persistent hoarseness or coughing, bladder changes, any vaginal bleeding after menopause, easy bleeding or bruising, difficulty swallowing, unusual lumps, digestive issues, night sweats, neurological symptoms, changes to moles, white areas in the mouth and more.

Regular testing offers the chance to pick up cancer before it becomes serious. For women, PAP smears test the cervix for abnormal cells that can be or become cervical cancer. Current guidelines are for women aged 25-69 to do a PAP smear every three years. MDs or NDs can offer this service. Only about 75% of eligible Canadian women are up to date on this important test. 

Mammograms save lives. Women can just call the Comox Valley North Island Hospital. They can use an MD or an ND as the doctor who receives the results. Since one in five cases of breast cancer is found in women under 50, I agree that women in their 40s should be screened every two years.

The FIT test is a simple stool test that picks up invisible blood in the stool, which can be a sign of colon cancer. About one in 17 Canadians will get colon cancer, so it makes sense to regularly screen for it. Your MD or ND can provide the requisition for this test.

Prostate cancer screening is controversial because the harms associated with testing for and treating prostate cancer can outweigh the benefits. That said, research shows that screening blood tests do save lives, especially for high-risk populations.

I regularly provide skin cancer checks as part of a yearly physical exam, especially a patient has light-coloured skin, eyes and hair, has many moles or freckles, or report having had several blistering sunburns as a child. MDs can refer patients to dermatologists or skin specialists for diligent tracking or treatment of suspicious spots. 

I also recommend an annual full basic blood work-up, physical exam and discussion of any health issues that may be cropping up. It’s not possible to do good cancer screening when patients can only bring up one symptom, since it is often the constellation of symptoms that provides the clues needed to suspect cancer. Plus we want to be discussing healthy lifestyle practices to increase the chances of living long and well.

Dr. Deidre Macdonald is a naturopathic physician who has practiced in downtown Courtenay since 1997. 250 897-0235 or www.getwellhere.com

Chronic Pain: Four Legs of a Stool

Every day in my naturopathic medical practice, I see people who have chronic pain from conditions arising from their back, nerves, muscles, joints, digestive system, autoimmune disease and more.  In fact one in five Canadians over 18 suffer with chronic pain. Optimal treatment plans are more complex than those for acute pain. For chronic pain, the best treatment involves “four legs of a stool”.  Each leg provides important support in the journey of living with chronic pain while working towards real solutions.

One leg of that stool may be pain management with pharmaceutical drugs.  Living with chronic pain can affect mood, sleep, the immune system, the nervous system and more and sometimes the humane choice is to help dull the pain. But medications for pain all come at some cost when used long term.  Extended use of anti-inflammatory drugs is hard on the gastrointestinal system, kidneys and ears.  Tylenol in excess can damage the liver. Opiate pain killers are of course a last resort due to their highly addictive nature. Meds for nerve pain have a long list of side effects and have limited benefits.  There is a place for pain management, but the goal is to use as little as possible for the shortest time possible. Cannabis may provide some relief for pain sufferers, and I look forward to the day when we have the research and quality control necessary for doctors to effectively guide patients in the best use of this medicine.

The second leg of the stool is what I call passive treatments.  There is a place for surgery, however there is always the risk of complications so often more conservative treatments are preferential.  Physiotherapy, massage, chiropractic, osteopathy, injection therapy such as prolotherapy, PRP, and stem cells can all be helpful.  The form of physical therapy that has impressed me most is low level laser therapy.  This painless, safe treatment uses therapeutic wavelengths of light to stimulate rapid growth and repair of tissues, resulting in resolution of pain.  Hundreds of  human, placebo controlled clinical trials have been done on laser therapy and it has been shown to be effective in the treatment of many conditions including arthritis (to which I can personally attest), back pain, carpal tunnel syndrome, plantar fasciitis, neck pain, nerve impingement and more. This is the treatment that I have used in my clinic for 12 years on over 1,000 patients with mostly good to excellent results.

The third leg of the stool is to work towards creating a body that is balanced and vital so that it can heal itself.  When a person is full of inflammation, high blood sugar, nutrient deprived, lacks exercise, and suffers from stress and poor sleep, their cells simply don’t have what it takes to heal.  As a naturopathic physician, I coach my patients to better understand what they can do for themselves to reduce inflammation, promote healing and improve vitality.

The fourth leg of the stool in treating chronic pain is addressing the mind-body connection.  The body naturally sends alarm bells to the brain and nervous system in response to pain.  That makes sense for acute pain, as it helps us to remove ourselves from dangerous situations or protect injured areas.  To live well with chronic pain, we have to deliberately learn how to be with the pain without sending out panic signals.  Teaching my patients skills to address the emotions and thoughts around the pain helps them to experience the painful sensations without all the distress and suffering.  I also encourage them to be curious about any unhealed emotional issues that may be causing tension or energy blocks in the body.  In Chinese medicine, they say that emotional issues can block chi, and wherever chi is blocked pain or disease can occur. In Western medicine we understand that the body’s natural healing mechanisms are activated when the nervous system is in a more relaxed state. With chronic stress we can get stuck in a state of “fight or flight” instead of being able to go into the more relaxed, healing state of a calm nervous system. 

People with chronic pain do well to consider engaging in a comprehensive plan to reduce the stress of chronic pain while working actively to promote healing and resolution of the causes of their pain.  ss

Bioidentical Hormones – Research Update

The pros and cons of hormone replacement therapy (HRT) for perimenopausal and menopausal women have been hotly debated for many years. As a naturopathic physician, I’ve helped women navigate the choppy waters of menopause for over two decades. I believe that hormone management should be very individualized and I  generally recommend lifestyle first, natural medicines second, and pharmaceuticals third, if possible. I recently completed a course that analyzed the research on HRT over the last 20 years. When you look carefully at the research, there is a role for hormone replacement therapy to help manage symptoms of perimenopause and menopause safely and effectively and to serve as a preventative medicine. 

First, some history. HRT was used for 70 years before the Women’s Health Initiative (WHI) did the first large placebo-controlled study in 2002. This groundbreaking study sounded alarms regarding increased breast cancer risk in women who took Premarin (estrogen) and Provera (synthetic progesterone).  In addition, they found a higher rate of blood clots, potentially leading to strokes and more, so many women were unprescribed HRT as a result. 

Subsequent analysis determined that the study had major flaws. The average age of the women starting estrogen therapy was 65. We now understand there is a critical window for starting hormone therapy to maximize the benefits and reduce the risks, which is within ten years of one’s menopause, or under 60. 

Second, the estrogen used in the experiment was extracted from pregnant mares’ urine and contained non-human estrogens. Now, most prescriptions written use a bioidentical estrogen called estradiol or E2. It is processed much differently in the body and has fewer risks. The progesterone used was a synthetic cousin of our progesterone called progestin, which comes with many more side effects. Third, the route of administration of estrogen matters. Yes, taking oral pills of estrogen does increase blood clotting, especially in women over 60. However, using a patch or cream on the skin does not do so in any significant way. We’ve come a long way from 2002 to understand how to use these hormones safely. 

According to the esteemed North American Menopause Society, estrogen has strong evidence showing it helps with hot flashes and night sweats. They say it can be used for women of any age in low doses locally for genital and urinary symptoms and to improve sexual function. Systemic estrogen also helps to prevent bone loss and fracture associated with osteoporosis. The research shows this benefit is most relevant if estrogen is started within five years of menopause and the benefit is lost after ceasing the estrogen therapy. Topical estrogen therapy can slightly reduce cardiovascular disease risk but only if started early.  

The most interesting evidence regarding estrogen replacement therapy is around reducing cognitive decline. One in three people develop a significant cognitive decline in their lifetime, and ⅔ of the people with Alzheimer’s are women. Estrogen has many protective effects on the brain, including increasing neuronal growth and repair, increasing neuroplasticity, decreasing the build-up of tau proteins and amyloid plaques (associated with Alzheimer’s), and much more. Estrogen therapy seems to help slow cognitive decline, not reverse it. One study showed that women who started estrogen at 75 years old had a worse rate of decline. So, yes, there is a critical window for starting estrogen. Women who have their ovaries removed or have very early menopause may especially benefit from starting estrogen therapy right away. 

Evidence shows that estrogen may help somewhat with joint pain, muscle weakness, sleep issues, depression, skin aging, dry eyes, hearing loss, and diabetes. But what about breast cancer? Well, after years of analysis of the WHI study, it has been shown that when they started giving horse estrogens and synthetic progestin to women far older than the critical age window in oral vs. transdermal doses, after three years, an increase of less than one case of breast cancer over the placebo rate per 1,000 women per year could be attributed to the hormones. That risk is less than the increased risk of breast cancer associated with drinking two glasses of wine a day, and the same as the risk of being obese or inactive. In women who took only estrogen (women who’d had a hysterectomy), there was a slight decrease in breast cancer rate vs. placebo. Three French studies showed that when bioidentical estrogen is used with women in a better age window and coupled with bioidentical progesterone, there was no increase in breast cancer rates.  

HRT isn’t for everyone, so discuss it with a conventional or naturopathic doctor up to date on the latest research analysis to see if you would be a suitable candidate and what to expect. For people without extended health insurance, compounding pharmacies can make up HRT prescriptions for about ⅓ to ½ the cost of pharmaceutical suppliers—tell your naturopathic or conventional doctor your preference.  Another advantage of compounded bioidentical hormones is various delivery methods can be used depending on the desired effects and preference of the patient. Transdermal absorption of hormones has been well established in scientific research. So the bottom line is that bioidentical estrogen with bioidentical progesterone can have a role to play not only in the management of symptoms of menopause but also in the enhancement of the ageing process.