Breast Health: Prevention, Empowerment, and Wellness

Breast health is a vital aspect of overall well-being for women of all ages. Did you know that breast cancer is the second-most diagnosed cancer in Canada and is the second leading cause of death among Canadian women over 50?[i] This October, as we honor Breast Cancer Awareness Month, we want to empower you to take proactive steps towards your breast health – because it’s never too early to start.

At Saskatoon Naturopathic Medicine, we believe in supporting you with an individualized approach looking at the body’s weaknesses and vulnerabilities that may make you susceptible to disease. Through optimizing nutrition, addressing environmental factors, or supporting your body’s natural defenses, we are committed to providing comprehensive care that treats the whole person.

Know the Risk Factors

Several factors can influence your risk of developing breast cancer. Some are within your control, while others – like family history or genetics – are not. Here are some key considerations:

• Nutrition : A balanced diet plays an essential role in reducing risks. Not only can a healthy diet directly improve our health, but it can also positively interact with many other factors involved in health like inflammation, body weight, hormone levels, and our gut microbiome. It is estimated that 30%-50% of cancers can be prevented through dietary changes.[ii] [iii] [iv]

• Exercise and healthy lifestyle: Lack of exercise contributes to obesity, which in itself is a risk factor for breast cancer. In breast cancer patients, physical activity - both before and after the cancer diagnosis - has been associated with a lower risk of disease recurrence and reduced overall cancer-specific mortality compared to their sedentary counterparts. [v]

• Family history and genetics: Understanding your genetic predispositions can guide proactive prevention.

• Environmental toxins: Exposure to harmful chemicals (including alcohol and tobacco) can contribute to increased risk.

• Dense breast tissue: Dense breasts not only elevate cancer risk but also make it difficult for cancerous lesions to be seen on a mammogram.

Being informed about these factors helps you take charge of your health, empowering you to make choices that align with your long-term wellness goals. Naturopathic doctors can break down these risk factors further to help you understand your vulnerabilities and strategize an individualized prevention plan.

Symptoms to Watch For

Breast cancer can manifest in various ways, some of which may be subtle. If you notice any of the following symptoms, it’s important to reach out to your healthcare provider for further evaluation:

• Changes in breast size, shape, or appearance

• New lumps, nodules, or cysts

• Nipple discharge when not breastfeeding

• Redness, pitting, or dimpling of the skin

• Peeling or flaking of the nipple

• Inverted nipples

Understanding Dense Breasts

Breast density[vi] is not about how your breasts look or feel – it is about tissue. Dense breasts have more glandular and fibrous tissue, making it harder for mammograms to detect cancer. However, having dense breasts is quite common, particularly in younger women. As women get older, their breasts typically become fattier and less dense (but this isn’t always the case). It is important to know your breast density so you can understand the risks and complications and make informed screening decisions.[vii]

You can learn more at www.densebreastscanada.ca.       

Screening: Early Detection Saves Lives

Early detection is crucial, and regular screening is an important part of taking care of your breast health. As of January 2025, you will be able to self-refer for a mammogram in Saskatchewan beginning at the age of 40 (currently, the minimum screening age is 50).[viii]

Read that again – you do not need a doctor’s referral to make an appointment for a screening mammogram!

Just call 1-855-584-8228 to book your screening through the Screening Program for Breast Cancer. With screening centres throughout Saskatchewan (including a mobile unit that serves rural and northern Saskatchewan) accessing this potentially life-saving service is available to you.

How We Can Help

We are dedicated to helping you navigate these complex factors, providing tailored recommendations that fit your unique situation. Whether you are seeking prevention or already managing a diagnosis, our collaborative model works alongside conventional approaches to give you the best outcomes. From optimizing your nutrition and lifestyle to helping you understand your risks, we’re here to empower you at every step of your health journey, You deserve to feel confident, supported, and in control of your health.

[i] https://cancer.ca/en/cancer-information/cancer-types/breast/statistics

[ii] Mentella MC, Scaldaferri F, Ricci C, Gasbarrini A, Miggiano GAD. Cancer and Mediterranean Diet: A Review. Nutrients. 2019; 11(9):2059. https://doi.org/10.3390/nu11092059

[iii] Monllor-Tormos A, García-Vigara A, Morgan O, García-Pérez MÁ, Mendoza N, Tarín JJ, Cano A. Mediterranean diet for cancer prevention and survivorship. Maturitas. 2023 Dec;178:107841. doi: 10.1016/j.maturitas.2023.107841. Epub 2023 Aug 24. PMID: 37660598.

[iv] Rock CL, Doyle C, Demark-Wahnefried W, Meyerhardt J, Courneya KS, Schwartz AL, Bandera EV, Hamilton KK, Grant B, McCullough M, Byers T, Gansler T. Nutrition and physical activity guidelines for cancer survivors. CA Cancer J Clin. 2012 Jul-Aug;62(4):243-74. doi: 10.3322/caac.21142. Epub 2012 Apr 26. Erratum in: CA Cancer J Clin. 2013 May;63(3):215. PMID: 22539238.

[v] Moore SC, Lee IM, Weiderpass E, Campbell PT, Sampson JN, Kitahara CM, Keadle SK, Arem H, Berrington de Gonzalez A, Hartge P, Adami HO, Blair CK, Borch KB, Boyd E, Check DP, Fournier A, Freedman ND, Gunter M, Johannson M, Khaw KT, Linet MS, Orsini N, Park Y, Riboli E, Robien K, Schairer C, Sesso H, Spriggs M, Van Dusen R, Wolk A, Matthews CE, Patel AV. Association of Leisure-Time Physical Activity With Risk of 26 Types of Cancer in 1.44 Million Adults. JAMA Intern Med. 2016 Jun 1;176(6):816-25. doi: 10.1001/jamainternmed.2016.1548. PMID: 27183032; PMCID: PMC5812009.

[vi] https://cancer.ca/en/treatments/tests-and-procedures/mammography/breast-density

[vii] https://densebreastscanada.ca/faq/

[viii] https://densebreastscanada.ca/breast-cancer-screening-in-saskatchewan/

Love the Skin You're In

Your skin is the largest organ in your body. It protects and gives you signals from the environment, and regulates temperature and water. We often don’t think about the functions of our skin until it starts to cause us problems – itching, rashes, acne, discoloration, premature aging, etc – all of which can be a signal of something deeper going on in our body. The skin is also a great absorptive surface, for better or for worse. We can use this effect to our benefit for absorbing certain medications or nutrients applied topically (eg. estrogen, testosterone, magnesium), though the absorptive nature of skin also makes us susceptible to adverse effects from environmental exposures that may be allergic or irritant in nature.

ouTSIDE IN VS AND INSIDE OUT

Whether it’s limiting exposures to harmful substances, or increasing exposure to therapeutic agents, both internal and external approaches can, and should, be used in conjunction to promote optimal skin health.

outside in

Skin & The Immune System —> Allergies

An allergic response occurs when the immune system reacts abnormally to a substance found in the environment. The substance that provokes the reaction is called an allergen.

3 Categories of Allergens:

• Ingested allergens - reactions to food or things consumed orally

• Inhaled allergens - reactions to substances we breathe in

• Contact allergens - reactions to substances applied on skin or mucus membranes (lips, mouth, groin)

Skin Allergies

1. Allergic reactions tend to happen after repeated exposure to a substance. The reaction never happens to the first exposure because the immune system must first become sensitized to the chemical.

2. Once you have been sensitizes, you will always be allergic to it.

3. Sudden development of allergies is possible.

4. Even small amounts of allergen can trigger a reaction that can last for several weeks.

5. With each new exposure, the reaction becomes stronger.

6. The reaction can spread beyond the exposure site.

7. A reaction need not happen immediately - it can take hours or days to present.

Allergy Testing

• Prick testing - for allergens ingested or inhaled

• Patch testing - for contact allergens

Top Allergens in Personal Care Products

1. Fragrances

2. Preservatives

3. Hair dyes

4. Lanolin

5. Synthetic detergents

6. Botanicals

7. Nail cosmetics

8. Sunscreens

Skin and The Immune System —> Irritants & Intolerances

Skin irritants elicit non-allergy reactions, that may be immediate, dose-dependent, and/or cumulative.

Irritant Reactions

• Irritation is dose-dependent - the more you are exposed, the more severe the reaction.

• Irritation is cumulative - multiple exposures, multiple chemicals.

• Irritation can happen after a single exposure.

• Irritation does not necessarily happen after every exposure (cumulative exposures impact the outcome).

• An irritant reaction can happen immediately after exposures and can resolve quickly after exposure ends.

Top Irritants in Personal Care Products

1. Water

2. Soap and detergents

3. Fragrances

4. Botanicals

5. Alcohol

6. Abrasive scrubs

7. Vitamin A derivatives and Alpha-Hydroxy Acid (AHA)

8. Shampoos and conditioners

inside out

Your skin is also reflective of what is going on within your body. We see this often with certain conditions that have dermatologic manifestations, such as Celiac disease (dermatitis herpetiformis), systemic lupus erythematosus (malar erythema), PCOS (acne) and many others. Aside from diagnosable pathologies, functional imbalances and other factors can also impact the quality and health of our skin. These may include:

• Inflammation

• Hormonal imbalances

• Diet

• Digestive issues

• Food sensitivities

• Sun exposure

• Stress

• Nutrient deficiencies

• Immune dysfunction

• Medications or supplements

• Smoking

• Infections

Skin problems are often multifactorial, and as such often require a multi-factorial approach. Whether you are addressing the symptoms of chronic disease or looking to improve the appearance and health of your skin overall, optimizing and correcting any one or several of these factors may be necessary to achieve desired results.

THE FIRST STEP TO TREATMENT IS A PROPER ASSESSMENT.

Deciding where to start can be overwhelming. With no shortage of information online, many times patients are confronted with information and option overload. A detailed history taking with a health professional can help to narrow down areas to focus on and get you started on a treatment plan tailored to your individual needs to help you love the skin you’re in.

In health,

Dr. Jacalyn Sieben, ND

PS - for more information about a holistic Outside-In approach I highly recommend the book referenced below.

Reference:

Skotnicki, S. (2018). Beyond soap: The real truth about what you are doing to your skin and how to fix it for a beautiful, healthy glow. Penguin Random House.

Harnessing the Power of Fibre

It is easy to overlook the importance of dietary choices in safeguarding against various ailments. One such silent protector in our diet is fibre, a nutrient with profound implications for our digestive health and, notably, in the prevention of colorectal cancer. Colorectal cancer is the 4th most diagnosed cancer in Canada[i], and lifestyle factors such as diet can play a significant role in its development.

At Saskatoon Naturopathic Medicine, we practice a comprehensive approach to wellness, and understanding the role of fibre in colorectal cancer is paramount.

What is fibre?

Fibre is the portion from plant-based foods that our bodies cannot fully digest and end up being fermented or broken down by the bacteria that live in our digestive tracts (called the gut microbiome).

The fermentation of fibre by our gut bacteria produces short-chain fatty acids (SCFAs) including butyrate, which is the main source of energy for colon cells.

Why is fibre important?

Fibre helps move substances through our GI system, thereby facilitating the elimination of carcinogenic substances. Additionally, the SCFAs (including butyrate) have anti-inflammatory, immune-modulating, and anti-carcinogenic effects on the cells of our colon and help slow the growth of colon cancer cells.

Gut Dysbiosis

Our diet plays an important role in balancing the bacterial populations that make up our gut microbiome. Diets that are higher in fibre help to promote bacteria that produce butyrate and reduce inflammation. Diets low in fibre can lead to gut dysbiosis (a decrease in the beneficial bacteria and an increase in bacteria that promote inflammation).

We believe in empowering our patients with actionable steps to optimize their health. Here are some practical tips for incorporating more fibre into your diet:

• Embrace whole foods over refined, highly-processed options.

• Load up on produce, aiming for a colorful variety to maximize your nutrient intake.

• Snack smart to curb cravings and boost fibre intake throughout the day.

• Experiment with legumes in soups, salads, and stews.

Great sources of fibre for fermentation, butyrate production, and promoting microbiome diversity include soluble fibres such as:

Beta-glucans – oats, barley, sorghum, rye, mushrooms

Pectins – Apples, oranges, apricots, white beans, black beans

Inulin – Agave, artichokes, asparagus, bananas, chicory root, garlic, onions, leeks, wheat

A diet rich in a variety of dietary sources of fibre is beneficial for health – it helps substances move through the gut, balances sugar and cholesterol levels, and promotes a healthy gut microbiome. Aim for 30 grams of fibre per day from foods including grains, vegetables, fruits, legumes, nuts and seeds.

We stand committed to guiding you on your journey to vibrant health, one fibre-filled meal at a time.

[i] https://www.colorectalcancercanada.com/colorectal-cancer/statistics/

Sources:

Fratila, T. D., Ismaiel, A., & Dumitrascu, D. L. (2023). Microbiome modulation in the prevention and management of colorectal cancer: A systematic review of clinical interventions. Medicine and Pharmacy Reports, 96(2), 131–145. https://doi.org/10.15386/mpr-2526

Madrigal-Matute, J., & Bañón-Escandell, S. (2023). Colorectal Cancer and Microbiota Modulation for Clinical Use. A Systematic Review. Nutrition and Cancer, 75(1), 123–139. https://doi.org/10.1080/01635581.2022.2108468

Rinninella, E., Mele, M. C., Cintoni, M., Raoul, P., Ianiro, G., Salerno, L., Pozzo, C., Bria, E., Muscaritoli, M., Molfino, A., & Gasbarrini, A. (2020). The Facts about Food after Cancer Diagnosis: A Systematic Review of Prospective Cohort Studies. Nutrients, 12(8), 2345. https://doi.org/10.3390/nu12082345

Holscher, H. D. (2017). Dietary fiber and prebiotics and the gastrointestinal microbiota. Gut Microbes, 8(2), 172–184. https://doi.org/10.1080/19490976.2017.1290756

Bashir, K. M. I., & Choi, J.-S. (2017). Clinical and Physiological Perspectives of β-Glucans: The Past, Present, and Future. International Journal of Molecular Sciences, 18(9), 1906. https://doi.org/10.3390/ijms18091906

Ross, J. K., English, C., & Perlmutter, C. A. (1985). Dietary fiber constituents of selected fruits and vegetables. Journal of the American Dietetic Association, 85(9), 1111–1116.

Tosif, M. M., Najda, A., Bains, A., Kaushik, R., Dhull, S. B., Chawla, P., & Walasek-Janusz, M. (2021). A Comprehensive Review on Plant-Derived Mucilage: Characterization, Functional Properties, Applications, and Its Utilization for Nanocarrier Fabrication. Polymers, 13(7), 1066. https://doi.org/10.3390/polym13071066

Dhingra, D., Michael, M., Rajput, H., & Patil, R. T. (2012). Dietary fibre in foods: A review. Journal of Food Science and Technology, 49(3), 255–266. https://doi.org/10.1007/s13197-011-0365-5

Don’t Settle For Just “Getting By”

understanding and addressing depression

Now that spring is well on its way, is your mood picking up? If you’re still feeling the “blahs” – low energy, persistent sadness, changes in appetite or sleep patterns, and a loss of interest in activities you once enjoyed – this might be more than the winter blues.

While Seasonal Affective Disorder (SAD) is a well-known culprit for winter blues, it’s crucial not to overlook other underlying issues that may contribute to depressive symptoms. Booking an appointment with your ND can provide valuable insights into your mental and physical well-being. During your visit, we can explore various factors contributing to depression, including hormonal imbalances, nutritional deficiencies, lifestyle habits, and environmental stressors.

By taking a comprehensive approach, we can tailor a treatment plan to address your unique needs. This may include a combination of dietary adjustments, supplementation, herbal remedies, lifestyle modifications, and acupuncture. Additionally, we will work collaboratively with you to uncover any potential root causes and develop strategies for long-term wellness.

Here a few tips to consider as we hop into spring…

Protein

Foods that are rich in protein contain amino acids that help produce neurotransmitters like dopamine and serotonin. If your protein intake is low, you may experience low mood. Most adults require 1g of protein per kilogram of body weight. Fortunately, it is easy to increase your protein intake – here are some easy ideas to snack on:

• A handful of unsalted almonds, walnuts, and/or pecans

• A hard-boiled egg

• No-bake energy balls

• An apple with 2 tbsp nut butter of your choice

• Sausage sticks or jerky (aim for ones with no fillers)

• Edamame

Mediterranean Diet

The Mediterranean Diet is a diet high in fish, legumes, whole grains, vegetables, fruits, seeds, and olive oil. It is low in high fat meats and dairy products. Following the Mediterranean Diet has been shown to be protective against depression at all ages throughout a person’s lifespan. For more information, check out our past blog post.

Exercise

Adults (including seniors) should get at least 150 minutes of moderate to vigorous physical activity per week[i]. Think that’s a stretch? Here are some ways to incorporate more movement into your day:

• Do squats or lunges while you brush your teeth

• Park farther away from stores or work

• Take the stairs

• Spontaneous dancing (at home OR in public 😊)

• Deep clean something

• Get up and move your body during commercial breaks – marching in place, jumping jacks, walking lunges across the room…be creative!

Sunshine

Exposure to sunlight increases serotonin levels in the brain. While you may be taking a Vitamin D supplement to keep your levels up, being in the sunshine is the best source of natural Vitamin D[ii]. In order to optimize your exposure, we recommend spending anywhere between 5-30 minutes each day outside[iii] – and while you’re out there, why don’t you get in that little extra bit of exercise and take a walk around the block?

Did you know that Vitamin D is not typically tested when you have bloodwork completed by your physician? Many people may be deficient in this important vitamin and not even know it. If this is something you are concerned about or would like to know more, bring it up with your naturopathic doctor - it may be worth investigating!

Don’t forget…

You don’t have to navigate depression alone. Your mental health matters every day and every season of the year.

[i] https://www.canada.ca/en/public-health/services/publications/healthy-living/physical-activity-tips-adults-18-64-years.html

[ii] Raymond-Lezman JR, Riskin SI. Benefits and Risks of Sun Exposure to Maintain Adequate Vitamin D Levels. Cureus. 2023 May 5;15(5):e38578. doi: 10.7759/cureus.38578. PMID: 37284402; PMCID: PMC10239563.

[iii] Srivastava SB. Vitamin D: Do We Need More Than Sunshine? Am J Lifestyle Med. 2021 Apr 3;15(4):397-401. doi: 10.1177/15598276211005689. PMID: 34366736; PMCID: PMC8299926.

Naturopathic Supports for Alzheimer's Disease

naturopathic medicine can provide a great deal of support for patients dealing with alzheimer’s disease and other cognitive conditions.

Alzheimer’s Disease (AD) is a progressive neurodegenerative disorder that affects millions of people worldwide and is the most common form of dementia. Risks for AD can include smoking, diabetes, hypertension, alcohol consumption, obesity, and increasing age as these can cause neuroinflammation within the body. While there is no cure for AD, naturopathic approaches offer a holistic perspective by focusing on lifestyle, nutrition, and complementary therapies.

As it is never too early to begin thinking about your cognitive health, here are some things you can start doing today to reduce your risk of developing Alzheimer’s disease.

Mediterranean Diet

Studies have shown that individuals who adhered to a Mediterranean diet were associated with a reduced risk of dementia and cognitive decline in comparison to individuals who did not adhere to the diet. The Mediterranean diet is a diet that emphasizes the consumption of whole grains, fruits, vegetables, and healthy fats to lower inflammation within the body thus lowering the risk of developing AD.

Omega-3 Fatty Acids

Dietary intake or supplementation of omga-3 fatty acids has also been shown to help reduce risk of cognitive decline due to their anti-inflammatory properties. Foods rich in omega-3 include nuts and seeds including flaxseeds, walnuts and chia seeds or cold-water fish including salmon, mackerel, sardines, and herring.

Vitamin D

Patients with AD have a higher prevalence of Vitamin D deficiency, low mood and impaired cognitive performance so ensuring that Vitamin D levels are being tested and supplemented accordingly with foods and fats is beneficial.

Yours in good health,

Sami Leung

1. Lu’o’ng, K. V., & Nguyên, L. T. (2011). The beneficial role of vitamin D in Alzheimer’s disease. American Journal of Alzheimer’s Disease & Other Dementias, 26(7), 511–520. https://doi.org/10.1177/1533317511429321

2. Scarmeas, N., Stern, Y., Tang, M. X., Mayeux, R., & Luchsinger, J. A. (2006). Mediterranean diet and risk for Alzheimer’s disease. Annals of Neurology, 59(6), 912–921. https://doi.org/10.1002/ana.20854

3. Sobue, A., Komine, O. & Yamanaka, K. Neuroinflammation in Alzheimer’s disease: microglial signature and their relevance to disease. Inflamm Regenen 43, 26 (2023). https://doi.org/10.1186/s41232-023-00277-3

4. Wei, B. Z., Li, L., Dong, C. W., Tan, C. C., Alzheimer’s Disease Neuroimaging Initiative, & Xu, W. (2023). The Relationship of Omega-3 Fatty Acids with Dementia and Cognitive Decline: Evidence from Prospective Cohort Studies of Supplementation, Dietary Intake, and Blood Markers. The American Journal of Clinical Nutrition, 117(6), 1096–1109. https://doi.org/10.1016/j.ajcnut.2023.04.001

5. Welty F. K. (2023). Omega-3 fatty acids and cognitive function. Current Opinion in Lipidology, 34(1), 12–21. https://doi.org/10.1097/MOL.0000000000000862

Your Health, Your Comfort: Embracing a Scent-Free Environment

We talk a lot about keeping our clinic a scent-free space, but we thought it would be important to explain the reason WHY. You may be thinking, “I don’t wear perfume”, but you may be surprised to know that scents can be following you around through the detergent or fabric softener you use, the shampoo you wash your hair with, or the cleaning products you just used to clean your home and have stuck onto your clothes. In fact, these substances can be found in thousands of consumer and industrial products - and they may be wreaking havoc on your body.

A growing number of scented products are available on store shelves, and our homes are becoming more and more saturated with airborne chemicals. It’s almost impossible to avoid exposure to these substances, and they are contributing to poor indoor air quality all around the world. While Canadians spend approximately 90% of their time indoors [i], the concentrations of some pollutants are often 2 to 5 times higher than typical outdoor concentrations [ii] [iii]. Usually this boils down to a lack of ventilation. In addition to scents and fragrances from various products we use indoors, when outdoor pollutants make their way indoors (tracked in on shoes, residue on clothing, etc.), they end up concentrating in higher amounts than they would outside (because there is less airspace for them to occupy inside). [iv] All of this adds to the challenges of keeping your indoor air clean.

Let’s look at one of the biggest offenders: Phthalates.

What are phthalates? Phthalates are the reason why your deodorant keeps you smelling fresh on hot summer days. They are why a new diaper has that powdery-soft baby smell. Or why your sheets still smell clean even after sleeping in them for a day or two. Phthalates are used to make fragrances last longer.

But it doesn’t stop there. Fake Christmas trees have phthalates. Vinyl flooring contains phthalates. Rubber duckies contain phthalates. Phthalates can even be found in food products. This is a reason why phthalates are called the “Everywhere Chemical”.

A single product may contain up to 300 different fragrance ingredients, but there are over 3000 different chemicals a manufacturer can choose from – even ones that are known irritants, allergens, and carcinogens. Health Canada says that most phthalates don’t pose a risk to health, and therefore phthalates will not appear on ingredient labels; instead, they are grouped in as “fragrance” or “perfume/parfum.”[v]

After tobacco smoke, perfumes are one of the most noticeable air contaminants in public places and the workplace. They are reported to cause difficulties for most people with environmental sensitivities.[vi] A 2009 study that appeared in the Journal of Environmental Health showed that around 30% of the general population found other people wearing fragrances to be irritating.[vii] “Irritating” doesn’t mean that someone is merely bothered by it – we are talking nausea, migraines, difficulty breathing, rashes, stuffy or runny noses…the list goes on. For people who have asthma, the study found that 37% of people were aggravated by scented products.

Further, there is growing evidence that shows the link between these chemicals and a long list of health conditions. We’re talking changes to fertility, hormonal imbalance, inflammation, excess weight, sleep disturbances, elevated stress levels, issues with childhood growth and development…this list also goes on.

When we ask for your help to make Saskatoon Naturopathic Medicine a scent-free space, it’s so we can make our clinic a safe and comfortable place for all patients who visit. As your trusted experts in natural health care, it is our job to share our knowledge to help you make better choices for yourself and those around you. If you are interested in learning more, our NDs would love to chat with you!

[i] https://www.canada.ca/en/environment-climate-change/campaigns/canadian-environment-week/clean-air-day/indoor-quality.html          

[ii] https://www.epa.gov/report-environment/indoor-air-quality#note2    

[iii] https://www.epa.gov/indoor-air-quality-iaq/inside-story-guide-indoor-air-quality             

[iv] https://www.airqualitycanada.ca/news/indoor-and-outdoor-air-pollution          

[v] https://www.canada.ca/en/health-canada/services/chemicals-product-safety/phthalates.html

[vi] https://www.chrc-ccdp.gc.ca/sites/default/files/envsensitivity_en.pdf

[vii] https://pubmed.ncbi.nlm.nih.gov/19326669/

Probiotics, Your Microbiome and Your Mood

Have you ever noticed that what you eat impacts your mood? Have you felt worse after binging on junk food or after a night of drinking? There is compelling research suggesting that it may not be just the guilt talking - your microbiome may be contributing in a large way to the conversation.  

What is the microbiome?  

There are 10- to 100-trillion symbiotic microbes of various species existing in and around the human body, collectively referred to as the microbiome [1]. These friendly microbes outnumber your own human cells and have recently become popularized for the growing body of evidence detailing the vast impacts they have on human physiology and behaviour. 

The microbes in your intestines make vitamins, amino acids, hormones, neurotransmitters and other signaling molecules that impact the way your brain and body function [2], [3]. They also produce short-chain fatty acids as byproducts that your intestinal cells use for energy, which contributes to healthy gut function [3].  

These microbes live in our digestive tract and survive off the foods that we eat. Just like any other living organism, their health (and therefore ours) depends on consuming a healthy diet. It has been shown that dietary changes (e.g. from animal-based to plant-based), as well as any significant systemic stress and inflammation can alter the composition (i.e. diversity and abundance of species) of your microbiome within just 24 hours [3].  

Altered microbiome composition has been associated with many conditions, such as inflammatory bowel disease (IBD), psoriasis, atopic dermatitis, autoimmune arthritis, type 2 diabetes, obesity, and atherosclerosis [3]. This is not surprising given the significant role these organisms have in regulating metabolism and immunity. In fact, researchers are finding that the microbiome composition in a given disease seem to have a different complement of microbes associated with it. For example, an IBD microbiome has less diversity (fewer species of healthy microbes), and lower numbers of good bacterial species. Therefore, it has lower short-chain fatty acid production [3]. Short-chain fatty acids (SCFAs) are essential to the health of your intestinal cells and are also thought to be anti-inflammatory in the gut [3]. 

The Microbiome’s Effect on Mood & Behaviour  

Gut microbes relay messages to the brain via various direct and indirect mechanisms - bacterial metabolites, metabolic precursors, immune signalling, vagus nerve signalling, and Hypothalamic Pituitary-Adrenal axis activation [4], [5]. It is through these mechanisms that neurodevelopment or neurodegeneration are influenced [5]. A significant portion of the microbiome influence on the brain comes via the gut-brain axis: a bi-directional pathway connecting the nervous system in your digestive tract to the central nervous system (your brain) [4], [5]. As shown in the graphic below, your gut and your brain communicate directly via nerves that transmit different signals and molecules, which can have a profound effect both ways to both systems [6].

Photo credit: https://fhs.mcmaster.ca/forsythe-lab/microbiota_gut_brain_axis.html 

Considering the gut-brain axis and the physical manifestations that different microbiome composition can produce, it should be no surprise that there are mental/emotional implications as well. Many psychiatric and neurological pathologies have gastrointestinal co-morbidities, including schizophrenia, autism, neurodegenerative diseases, anxiety, and depression [7]. As noted above, different pathologies have different microbiome composition. This extends to mood and neurodegenerative disorders, such as major depressive disorder, schizophrenia, Parkinson’s disease, and autism spectrum disorder [2], [5], [8]. There is also data suggesting that alterations in the microbiome from addictions (e.g. alcohol, cocaine) may be associated with substance cravings and increased risk of developing associated psychiatric disorders, such as anxiety and depression [9], [10]. 

Probiotics & Your Mood 

Probiotics are supplements that contain healthy microbes that ,when ingested, influence the health of your microbiome. Probiotics used to benefit mood and cognition have been coined “psychobiotics,” and are a burgeoning new area of interest in research. A study by Tillisch et al. used brain scans (functional magnetic resonance imaging) to demonstrate the ability of probiotics to alter brain activity in areas associated with processing emotion and sensation, and to reduce negative thinking associated with sad mood [4], [7], [11], [12]. While most studies indicate that further research in this area is needed, associations between specific strains of microbial species and their benefits on various conditions are rapidly emerging [7], [13][14]. A recent human clinical trial of adjunctive probiotic intervention for Major Depressive Disorder (MDD) showed that compared with placebo, probiotic intervention exhibited greater improvement in depressive symptoms [15]. Participants who received the probiotic intervention experienced reductions in both depression and anxiety, and the probiotics were well-tolerated, prompting the authors to suggest probiotics as an acceptable adjunctive intervention for adults with MDD [15]. 

How Can I Support My Microbiome? 

Lifestyle 

A healthy lifestyle goes a long way in supporting your microbiome, and healthy eating is just one part of it. As mentioned earlier, dietary changes, significant systemic stress, and inflammation can alter your microbiome within just 24 hours. There are many different types of stress - physical, mental and emotional - that can lead to physiologic changes that can alter the microbiome. Practicing stress management through self-care, meditation, social connection, thoughtful schedule planning, getting adequate sleep, and setting appropriate boundaries with people and responsibilities will help you be more resilient in dealing with stress. The better you are at managing stress, the less likely it will spill over into added physical or mood-related symptoms.  

Digestive Supports 

Probiotics are a great start to improving your gut health and mood, though quality and potency matter!  Our naturopathic doctors are here to assess if and which type of probiotics are most suitable for you, as well as to review if any further testing or treatments are indicated to optimize your digestive and mental health.  

We are here to help, so reach out if you are looking for professional guidance! 

In Health,  

Dr. Jacalyn Sieben, ND 

[1] Ursell, L.K. et al. (2012). Defining the human microbiome. Nutrition Reviews. Vol. 70 (Suppl. 1):S38- S44. doi:10.1111/j.1753-4887.2012.00493.x

[2] Dinan, T.G. & Cryan, J.F. Mood by microbe: Towards clinical translation. Genome Medicine. 8:36. DOI  10.1186/s13073-016-0292-1

[3] Corfe, B.M. et al. (2015). The multifactorial interplay of diet, the microbiome, and appetite control:  current knowledge and future challenges. Proceedings of the Nutrition Society. 74, 235-244.  doi:10.1017/S0029665114001670

[4] Dinan, T.G., Stilling, R.M., Stanton, C., Cryan, J.F. (2015). Collective unconscious: How gut microbes shape human behavior. Journal of Psychiatric Research. 63:1-9. http://dx.doi.org/10.1016/ j.jpsychires.2015.02.021

[5] Sharon, G. et al. (2016). The central nervous system and the gut microbiome. Cell. 167. http:// dx.doi.org/10.1016/j.cell.2016.10.027

[6] McMaster University. (2019). The microbiota-gut-brain axis. [Digital Image] Retrieved from: https:// fhs.mcmaster.ca/forsythe-lab/microbiota_gut_brain_axis.html

[7] Sampson, T.R. & Mazmanian, S.K. (2015). Control of brain development, function, and behavior by the microbiome. Cell Host & Microbe. http://dx.doi.org/10.1016/j.chom.2015.04.011

[8] Jiang, H. et al. (2015). Altered fecal microbiota composition in patients with major depressive disorder. Brain, Behavior, and Immunity. 48:186-194. http://dx.doi.org/10.1016/j.bbi.2015.03.016

[9] Hillemacher, T., et al. (2018). Alcohol, microbiome, and their effect on psychiatric disorders. Progress in Neuro-Psychopharmacology and Biological Psychiatry. Volume 85, Pages 105-115. https://doi.org/ 10.1016/j.pnpbp.2018.04.015

[10] Kiraly, D.D. et al. (2016). Alterations of the host microbiome affect behavioral responses to cocaine. Scientific Reports. 6:35455. DOI: 10.1038/srep35455

[11] Rea, K., Dinan, T.G., Cryan, J.F. (2016). The microbiome: A key regulator of stress and neuroinflammation. Neurobiology of Stress. 23-33. http://dx.doi.org/10.1016/j.ynstr.2016.03.001

[12] Tillisch, K., Labus, J., Kilpatrick, L., Jiang, Z., Stains, J., Ebrat, B., Guyonnet, D., Legrain-Raspaud, S., Trotin, B., Naliboff, B., et al. (2013). Consumption of fermented milk product with probiotic modulates brain activity. Gastroenter- ology 144, 1394–1401. DOI: https://doi.org/10.1053/j.gastro.2013.02.043

[13] Foster, J.A., Rinaman, L., & Cryan, J.F. (2017). Stress & the gut-brain axis: Regulation by the microbiome. Neurobiology of Stress. 124-136. http://dx.doi.org/10.1016/j.ynstr.2017.03.0 01

[14] Sarkar, A. et al. (2016). Psychobiotics and the manipulation of bacteria-gut-brain signals. Trends in Neurosciences. Vol 39, No. 11. http://dx.doi.org/10.1016/j.tins.2016.09.002

[15] Nikolova VL, Cleare AJ, Young AH, Stone JM. (2023). Acceptability, Tolerability, and Estimates of Putative Treatment Effects of Probiotics as Adjunctive Treatment in Patients with Depression: A Randomized Clinical Trial. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2023.1817

Spring Cleaning - For Your Body!

Liver health is so important for eliminating toxins, processing hormones, and supporting overall health. When it lacks essential nutrients or is overloaded with toxins, it obviously won't perform as it should.

Here are our favorite liver-loving tips as we enjoy spring...

1. Limit alcohol intake.

2. Choose organic when you can. (A recent study published this month found that lifetime exposure of glyphosate - the most heavily-used pesticide on the planet - was associated with liver inflammation and metabolic syndrome by early adulthood. (PMID: 36856429)

3. Include bitter foods in your diet such as endive, brussels sprouts, arugula, artichokes, apple cider vinegar, dandelion greens, citrus fruits, and microgreens. These foods stimulate bile flow (the carrier product for unwanted toxins, hormonal waste, and cholesterol) to dump into your bowels for elimination. Beets are great for this, too!

4. Try having a glass of warm lemon water on an empty stomach first thing in the morning to stimulate the liver and bile flow.

5. Avoid processed foods (including products with high amounts of sugar and artificial sweeteners).

6. Diaphragmatic breathing with long, full exhales supports TCM liver health, along with MOVEMENT. Sweat for at least 10 minutes through movement - dance/run/bike/flow.

7. Enjoy lots of sulfur-rich foods such as Allium vegetables (onions, garlic, shallots, leeks) and cruciferous veggies (brussels sprouts, cabbage, kale, arugula, broccoli, cauliflower).

8. Consume generous amounts of healthy fats such as olive oil, nuts/seeds, and avocado to supply the liver the fats it needs to keep the bile flowing well.

9. Add in B-complex vitamins, especially if grains are limited in your diet.

Remember:

• This all works best when combined with other healthy living practices such as regular activity, adequate hydration, and a low-sugar whole foods diet.

• Ensure you are having daily bowel movements to keep the waste products moving through and to prevent absorption of unwanted toxins.

• Phase 2 liver "detox" requires amino acid from the protein in your diet, so ensure your protein needs are being met!

Chat with your ND if you want to learn more about your specific liver health needs!

How Optimizing Gut Health Can Keep Your Cholesterol Levels in Check

First off, what is cholesterol anyway?

Cholesterol is a waxy, fat-like substance that is produced by your liver. Cholesterol is actually vital for many different structures and functions in the body such as the formation of cell membranes, hormone production, and the synthesis of vitamin D from the sun. So if it plays all of these key roles, why are we so concerned when cholesterol levels get high?

You may have heard by now that we have “good” (HDL) and “bad” (LDL) types of cholesterol. HDL and LDL stand for high density and low density lipoprotein. These are particles made from fat and protein that attach themselves to cholesterol to transport them throughout the blood stream. LDL is associated with the bad form of cholesterol as its function is to carry cholesterol to the arteries. When LDL levels get too high it may collect in vessel walls and contribute to plaque formation (atherosclerosis) in addition to increasing your risk of heart disease and stroke. HDL on the other hand functions by transporting cholesterol back to the liver – almost like a clean up crew- to prevent blood cholesterol levels from getting too high. So when cholesterol gets returned to the liver – what happens next? In the liver, cholesterol is secreted directly into bile where it is then secreted into the intestines. This is where optimizing gut health comes into play.

Once cholesterol reaches the intestines one of two things can happen. One, the bile is removed from the body via fecal excretion or two, the cholesterol is re-absorbed by enterocytes (cells that line our gut) and returned back to circulation. The intestine typically absorbs about 50% of the cholesterol presented to it – but this can vary from 20%-80% depending on the person. Of the absorbed cholesterol, approximately 80% comes from bile and only ~20% comes from diet (which is why eggs might not be so bad after all). Given that it seems our bodies own production and subsequent elimination of cholesterol seems to be the larger issue, how can we help swing our reabsorption percent from 50-80% down to 20%?

1. FIBER:

   • Soluble fiber can reduce the absorption of cholesterol into your blood stream. Insoluble fiber decreases intestinal transit time thus promoting regular bowel movements to ensure your LDL cholesterol is being eliminated efficiently. It is suggested to consume between 25-30g of fiber per day.

   • Soluble fiber foods: Brussels sprouts, avocados, flax seeds, and black beans

   • Insoluble fiber foods: nuts, beans and vegetables, such as cauliflower, green beans and potatoes

2. Probiotics:

• Probiotics are healthy bacteria found in our gut. Fermented foods contain them and fiber containing foods feed them. Probiotics are suggested to reduce cholesterol by deconjugating bile acids, using cholesterol for nourishment, and/or incorporating cholesterol into the cell wall of the probiotic bacteria. Probiotics also help to keep us regular which decreases the chance for cholesterol to become re-absorbed.

• Sources of probiotics: yogurt, sauerkraut, kimchi, kombucha, miso, tempeh, pickles.

Lastly, outside of gut health and moving more into diet in general, the Mediterranean diet has been shown to be an effective approach to supporting healthy cholesterol levels. The Mediterranean diet includes the following:

Increased Omega 3 consumption:

• Foods high in omega 3’s can increase HDL while reducing triglycerides — a type of fat found in blood — as well as reduce your blood pressure and risk of developing blood clots.

• Omega 3 rich foods: Fish and other seafood (especially cold-water fatty fish, such as salmon, mackerel, tuna, herring, and sardines) Nuts and seeds (such as flaxseed, chia seeds, and walnuts)

Increased consumption of Nuts/Seeds:

• Almonds and other tree nuts can improve blood cholesterol levels by reducing LDL. Almonds have been suggested to reduce LDL levels by reducing LDL reabsorption in the gut, increasing cholesterol and bile secretion into the gut, and regulating enzymes involved in cholesterol syntheses. 

Olive oil:

• Foods that contain monounsaturated fats (including olive oil) may raise HDL (good) cholesterol. The least processed form of olive oil to use is cold pressed extra virgin olive oil.

In health,

Dr. Brittany Pearce, ND., RHN.

References:

Vrins CL. From blood to gut: direct secretion of cholesterol via transintestinal cholesterol efflux. World J Gastroenterol. 2010;16(47):5953-5957. doi:10.3748/wjg.v16.i47.5953

Jesch ED, Carr TP. Food Ingredients That Inhibit Cholesterol Absorption. Prev Nutr Food Sci. 2017;22(2):67-80. doi:10.3746/pnf.2017.22.2.67

Freeman AM, Morris PB, Aspry K, Gordon NF, Barnard ND, Esselstyn CB, Ros E, Devries S, O'Keefe J, Miller M, Ornish D, Williams KA, Batts T, Ostfeld RJ, Litwin S, Aggarwal M, Werner A, Allen K, White B, Kris-Etherton P. A Clinician's Guide for Trending Cardiovascular Nutrition Controversies: Part II. J Am Coll Cardiol. 2018 Jul 31;72(5):553-568. doi: 10.1016/j.jacc.2018.05.030. PMID: 30049315.

Cohen DE. Balancing cholesterol synthesis and absorption in the gastrointestinal tract. J Clin Lipidol. 2008;2(2):S1-S3. doi:10.1016/j.jacl.2008.01.004

Cartolano FC, Dias GD, Miyamoto S, Damasceno NRT. Omega-3 Fatty Acids Improve Functionality of High-Density Lipoprotein in Individuals With High Cardiovascular Risk: A Randomized, Parallel, Controlled and Double-Blind Clinical Trial. Front Nutr. 2022 Feb 23;8:767535. doi: 10.3389/fnut.2021.767535. PMID: 35281761; PMCID: PMC8905646.

Berryman CE, Preston AG, Karmally W, Deckelbaum RJ, Kris-Etherton PM. Effects of almond consumption on the reduction of LDL-cholesterol: a discussion of potential mechanisms and future research directions. Nutr Rev. 2011 Apr;69(4):171-85. doi: 10.1111/j.1753-4887.2011.00383.x. PMID: 21457263.

Does Sugar Impact Our Immune System?

We all know it’s not ideal to have a diet high in sugar. Most of us know this with respect to managing our weight – but what about the immune system? What about colds, flus, autoimmune conditions, diabetes, cancer – does sugar consumption make us more susceptible? And if it does, how much does it take to make a difference?  Before we dive in, lets do a quick review of the immune system.

Above you’ll notice two main subdivisions of our immune system. We have our innate immunity, which can be thought of as the offense players and the adaptive immunity which could be considered the defence players. The innate immune system is first to respond (within minutes to hours) when there is a foreign invader. It’s the part of our immune system responsible for mounting a fever and initiating inflammation. Inflammation is useful in the short term for acute injuries or illnesses. Long term however, inflammation plays a strong role in the development of several diseases such as autoimmune diseases, cardiovascular disease, diabetes mellitus, chronic kidney disease, non-alcoholic fatty liver disease and neurodegenerative disorders3. The innate immune response has no memory which means it responds the same way to all encountered pathogens. The adaptive immune system, also known as “acquired immunity” takes days to weeks to kick in. It is very specific and diverse to each type of pathogen it encounters which means it mounts a unique response to each pathogen after it has been “primed” or exposed to that pathogen. The adaptive immune system does have a memory which means it will respond faster the next time you are exposed to that pathogen.

How does sugar affect the immune system?

When we consume foods high in simple sugars, we get a post prandial (post meal) spike in the amount of sugar and triglycerides in our blood[1]. This is also known as “post prandial dysmetabolism” and it induces a wide variety of negative changes in the body. Just one high sugar meal can trigger transient effects such as:

Inhibition of neutrophils[2]

o  Neutrophils are part of the innate (first response) immune system. They patrol for foreign invaders and then trap and kill pathogens when discovered. High blood sugar prevents neutrophils from being able to get to the site of microbial infection (inhibition of migration), decreases their ability to trap pathogens (phagocytosis), and furthermore inhibits their ability to kill microbes2.

Increased inflammation and inflammatory markers such as C-reactive protein1

o  Long term inflammation (such as with repeated exposure to a diet high in sugar) can cause a breakdown of immune tolerance which may lead to major alterations in all tissues and organs, as well as normal cellular physiology, which can increase the risk for various non-communicable diseases in both young and older individuals[3]. It can also impair normal immune function leading to increased susceptibility to infections and tumors as well as poor response to vaccines3.

Immediate oxidant stress (free radical production)1

o  Oxidant stress acutely triggers inflammation which negatively impacts the immune system3. In addition, this oxidant stress also increases LDL oxidation, vessel constriction and clot formation, all of which contribute to cardiovascular disease1.

Endothelial (blood vessel) dysfunction1 2

o  High blood sugar decreases blood vessel dilation (reducing blood flow) while simultaneously increasing leakiness of the blood vessels and how quickly the blood clots due to the inflammatory response. This reaction is similar to how a viral infection would trigger vascular inflammation leading to endothelial dysfunction, coagulation and cardiovascular disease[4]. Long term vessel “hyperpermeability” has been associated with increased aging and diseases such as Parkinson’s and Alzheimer’s[5].

Glycosylation of proteins and alteration of tertiary structures of complement2

o  While this might sound complicated, what is important to understand is that these changes make it difficult for the body to recognize foreign pathogens and eliminate them2. Changes in glycosylation may increase the inflammatory response, enable viral immune evasion (ability to escape), and promote cancer cell metastasis[6]. Auto-immune disease development such as lupus and irritable bowel disease involve glycosylation of one or more glycoproteins6.

This diagram shows a summary of how systemic chronic inflammation (SCI) develops and what it can lead to. 

How much sugar does it take?

To provide a little bit of context, the chart below shows the immediate effects of consuming a beverage containing 75g of glucose. This amount of sugar is similar to a cup and a half of white rice (68g). You will notice that within a few hours the amount of glucose and triglycerides increase significantly which leads to immediate oxidant stress (nitrotyrosine), inflammation (C reactive protein [CRP]) and endothelial dysfunction via decreased blood flow via reduction in the diameter of blood vessels (FMD).

Another study looking at the immediate effects of sugar consumption found that people who consumed 40 grams of added sugar from just one 375ml can of soda experienced an increase in inflammatory markers, insulin resistance and LDL cholesterol[7].

In addition to the above, high sugar containing meals can alter our gut barrier function and drive gut bacteria imbalances (also known as dysbiosis). This can lead to what is referred to as “leaky gut” or intestinal permeability which fuels inflammation and taxes the immune system further[8]. In addition, altered gut bacteria has been suggested to contribute to a multitude of immune-mediated disorders such as irritable bowel disease [9]. Furthermore, as mentioned above, diets high in sugar have been implicated in the development of all kinds of diseases such as cardiovascular disease, type two diabetes, obesity, non alcoholic fatty liver disease, gout and autoimmune conditions such as rheumatoid arthritis[10].

How much sugar should we have and how can we reduce the negative impacts of sugar on our immune system and overall health?

The Heart and Stroke Foundation recommends that you consume no more than 10% of your total calories per day from added sugar – ideally less than 5%[11]. This means for someone with a 2000 calorie/day diet you should consume less than 48g (10%) of sugar. This is slightly more than one can of pop. The following are some key things you can consider doing to reduce the impact of high sugar foods on your immune system and overall health:

Fiber and low glycemic carbohydrates:

o  When eating carbohydrates, try to choose high fiber, low glycemic index (glycemic index <55) foods such as whole grains, beans and legumes, vegetables and berries. Carbohydrates in these forms are much harder to digest thus slowing the rate sugar enters the blood stream.

Protein and fat

o  Ensure you consume a healthy source of protein and/or fat with each meal or snack. The addition of protein and fat also helps to slow the rate sugar is released into the blood stream which prevents a spike in blood sugar. An example might be having almond butter with your banana.

o  Below on the left is an example of how adding whey protein to the same glucose drink reduced the increase of blood sugar after drinking1. On the right we have an example of how adding 90g of almonds to a high glycemic index meal reduced the area under the curve for glucose by 58%1.

Vinegar:

o  Research suggests that 1-2 tablespoons of vinegar added to a meal can lower post prandial glucose by 25%-35% as well as increase post meal satiety by more than two-fold1.

Avoid low glycemic and highly processed foods/beverages

o  Avoid highly processed foods and beverages which often contain high amounts of simple sugars, high fructose corn syrup and white flour.

Walk/Exercise

o  Walk for 10-30 minutes after each meal[12]. Short walks after each meal were found to be more effective for blood sugar control than one-time daily exercise regimes or the use of metformin alone[13] [14].

Reading food labels can help you make an informed decision on the foods you are eating. Remember, the daily recommended amount of sugar is less than 48g.

Ex: Tropicana – One serving of Tropicana juice is 34g of sugar. This is 72% of the recommended daily intake of sugar. In addition, orange juice in general is considered to have a glycemic index of 66-76 which is considered moderately to very high in regard to how much it will raise our blood sugar. 

Another example is BBQ sauce. Bulls Eye BBQ sauce has 12g of sugar/2tbsp. This means that just two tablespoons equal to 25% of the daily recommended sugar intake. However often in meals with BBQ sauce (such as a burger) we are having a bun, and ketchup and french-fries as well. This one meal quickly throws us far over the daily recommended intake.

Working with a healthcare provider can help you pinpoint which risk factors you have and how to safely reduce your risk and support better overall immune health. Be sure to talk with your health care provider before making any drastic lifestyle or dietary changes.

In health,

Dr. Brittany Pearce, RHN., ND.

[1] O'Keefe JH, Gheewala NM, O'Keefe JO. Dietary strategies for improving post-prandial glucose, lipids, inflammation, and cardiovascular health. J Am Coll Cardiol. 2008 Jan 22;51(3):249-55. doi: 10.1016/j.jacc.2007.10.016. PMID: 18206731.

[2] Jafar N, Edriss H, Nugent K. The Effect of Short-Term Hyperglycemia on the Innate Immune System. Am J Med Sci. 2016 Feb;351(2):201-11. doi: 10.1016/j.amjms.2015.11.011. PMID: 26897277.

[3] Furman, D., Campisi, J., Verdin, E. et al. Chronic inflammation in the etiology of disease across the life span. Nat Med 25, 1822–1832 (2019). https://doi.org/10.1038/s41591-019-0675-0

[4] Xu S, Jin T, Weng J. Endothelial Cells as a Key Cell Type for Innate Immunity: A Focused Review on RIG-I Signaling Pathway. Front Immunol. 2022 Jul 5;13:951614. doi: 10.3389/fimmu.2022.951614. PMID: 35865527; PMCID: PMC9294349.

[5] Oakley R, Tharakan B. Vascular hyperpermeability and aging. Aging Dis. 2014;5(2):114-125. Published 2014 Apr 1. doi:10.14336/AD.2014.0500114

[6] Reily C, Stewart TJ, Renfrow MB, Novak J. Glycosylation in health and disease. Nat Rev Nephrol. 2019 Jun;15(6):346-366. doi: 10.1038/s41581-019-0129-4. PMID: 30858582; PMCID: PMC6590709.

[7] Aeberli I, Gerber PA, Hochuli M, Kohler S, Haile SR, Gouni-Berthold I, Berthold HK, Spinas GA, Berneis K. Low to moderate sugar-sweetened beverage consumption impairs glucose and lipid metabolism and promotes inflammation in healthy young men: a randomized controlled trial. Am J Clin Nutr. 2011 Aug;94(2):479-85. doi: 10.3945/ajcn.111.013540. Epub 2011 Jun 15. PMID: 21677052.

[8] Camilleri M. Leaky gut: mechanisms, measurement and clinical implications in humans. Gut. 2019 Aug;68(8):1516-1526. doi: 10.1136/gutjnl-2019-318427. Epub 2019 May 10. PMID: 31076401; PMCID: PMC6790068.

[9] Zheng, D., Liwinski, T. & Elinav, E. Interaction between microbiota and immunity in health and disease. Cell Res 30, 492–506 (2020). https://doi.org/10.1038/s41422-020-0332-7

[10] Moling O, Gandini L. Sugar and the Mosaic of Autoimmunity. Am J Case Rep. 2019;20:1364-1368. Published 2019 Sep 15. doi:10.12659/AJCR.915703

[11] https://www.heartandstroke.ca/healthy-living/healthy-eating/reduce-sugar

[12] Bellini A, Nicolò A, Bazzucchi I, Sacchetti M. The Effects of Postprandial Walking on the Glucose Response after Meals with Different Characteristics. Nutrients. 2022;14(5):1080. Published 2022 Mar 4. doi:10.3390/nu14051080

[13] Pahra D, Sharma N, Ghai S, Hajela A, Bhansali S, Bhansali A. Impact of post-meal and one-time daily exercise in patient with type 2 diabetes mellitus: a randomized crossover study. Diabetol Metab Syndr. 2017;9:64. Published 2017 Aug 31. doi:10.1186/s13098-017-0263-8

[14] Erickson ML, Little JP, Gay JL, McCully KK, Jenkins NT. Postmeal exercise blunts postprandial glucose excursions in people on metformin monotherapy. J Appl Physiol (1985). 2017 Aug 1;123(2):444-450. doi: 10.1152/japplphysiol.00213.2017. Epub 2017 May 18. PMID: 28522762.