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

Have You Started Thinking About Your Breast Health?

Breast health is an important matter for women of all ages as breast cancer is the second leading cause of death in Canadian women over the age of 50 years old. Naturopathic doctors look at the person as a whole and work to address root causes to help reduce individual risk factors and build resilience within the body. Various factors can play a role in increasing the risk of breast cancer, such as poor nutrition, lifestyle habits (like smoking and/or alcohol use), family history and genetics, and exposure to environmental toxins (including radiation, dioxins, and carcinogens).

As a refresher here are some symptoms of breast cancer:

• Peeling and/or flaking of the skin of the nipple

• Inverted nipples

• Changes in breast size or shape

• Lumps, nodules, or cysts that differ from other parts of the breast

• Nipple discharge when not lactating

• Breast skin changes such as redness, pitting, or dimpling

If you are experiencing any of the above symptoms, please get in touch with your primary healthcare provider. Ensure that you are following the Canadian Cancer Society’s screening guidelines.

It is never too early to begin thinking about your breast health. By working with an ND, you can optimize your breast health through a holistic approach. Here are some things you can start doing today to reduce your risk of developing breast cancer:

Diet and Nutrition Changes

Chronic inflammation is recognized as a key player in the initiation and progression of various cancers. Increasing the consumption of anti-inflammatory foods such as fruits, vegetables, whole grains, and nuts and seeds can reduce oxidative stress – a process that happens when antioxidant levels are low in the body. Why are antioxidants important? These are the molecules that fight free radicals in your body - the cell-damaging bad guys that cause illness and aging. Studies have shown that following the Mediterranean Diet is useful in the prevention of breast cancer. For more information on the Mediterranean Diet, please check out our blog post.

Green tea contains a catechin called EGCG that has antioxidant and anti-inflammatory properties which help reduce the risk of breast cancer by modulating the inflammatory pathways and protecting the cells from DNA damage.

Alcohol and Smoking Reduction

It is widely known that cigarettes contain carcinogens which can lead to the potential of cancer development. As well, alcohol is classified as a Class 1 carcinogen by the International Agency for Research on Cancer (IARC). Emphasizing the importance of both smoking cessation and alcohol reduction is encouraged to help reduce breast cancer risk in young women, as the synergistic effect can further increase your risk. If you are reflecting on your alcohol usage, check out the most recent guidelines for Canadians - this report was released in 2023.

Physical Activity

Ten percent of breast cancer incidents are attributed to inactivity. Exercise should be used for primary prevention of the disease. Increasing physical activity levels can help decrease body weight and thus reduce the risk of breast cancer, especially in post-menopausal women. Physical activity has also been shown to help enhance immune function and reduce inflammation within one’s body – this can help provide the body with better defenses against cancerous cell growths. A study of breast cancer survivors showed women who exercised 3-5 hours per week had an almost 50% reduction in occurrence (Holmes et. al, 2005).

The takeaway - get moving! Aim for at least 150 minutes of moderate to vigorous physical activity per week. Be sure to include both resistance and aerobic exercise, with the goal of elevating your heart rate and increasing your body temperature. This is a great habit to include in your everyday life for overall better health.

vitamin d

Finally, ensure you get your levels tested and supplement accordingly, as low levels increase the risk of developing breast cancer.

If you are interested in learning more about breast health strategies and treatments, our NDs would love to chat with you!

In good health.

Sami Leung, ND (Cand.)

References

1. Breast Cancer Basics - High Risk Conditions. Canadian Breast Cancer Network. (n.d.). https://cbcn.ca/en/high-risk-conditions

2. Centers for Disease Control and Prevention. (2023, July 25). What are the symptoms of breast cancer? Centers for Disease Control and Prevention. https://www.cdc.gov/cancer/breast/basic_info/symptoms.htm

3. Wang, K., Sun, J.-Z., Wu, Q.-X., Li, Z.-Y., Li, D.-X., Xiong, Y.-F., Zhong, G.-C., Shi, Y., Li, Q., Zheng, J., Shivappa, N., Hébert, J. R., Foukakis, T., Zhang, X., Li, H.-Y., Xiang, T.-X. & Ren, G.-S. (2020). Long-term anti-inflammatory diet in relation to improved breast cancer prognosis: A prospective cohort study. Npj Breast Cancer, 6(1). https://doi.org/10.1038/s41523-020-00179-4

4. Laudisio D, Castellucci B, Barrea L, Pugliese G, Savastano S, Colao A, Muscogiuri G. Mediterranean diet and breast cancer risk: a narrative review. Minerva Endocrinol (Torino). 2021 Dec;46(4):441-452. doi: 10.23736/S2724-6507.20.03266-6. Epub 2020 Sep 24. PMID: 32969630. https://pubmed.ncbi.nlm.nih.gov/32969630/

5. Gianfredi, V., Nucci, D., Abalsamo, A., Acito, M., Villarini, M., Moretti, M. & Realdon, S. (2018). Green tea consumption and risk of breast cancer and recurrence—a systematic review and meta-analysis of observational studies. Nutrients, 10(12), 1886. https://doi.org/10.3390/nu10121886

6. Johnson, K. C., Miller, A. B., Collishaw, N. E., Palmer, J. R., Hammond, S. K., Salmon, A. G., Cantor, K. P., Miller, M. D., Boyd, N. F., Millar, J. & Turcotte, F. (2010). Active smoking and secondhand smoke increase breast cancer risk: The report of the Canadian expert panel on tobacco smoke and breast cancer risk (2009). Tobacco Control, 20(1). https://doi.org/10.1136/tc.2010.035931

7. https://www.who.int/europe/news/item/20-10-2021-alcohol-is-one-of-the-biggest-risk-factors-for-breast-cancer

8. Boyle, P. & Boffetta, P. (2009). Alcohol consumption and breast cancer risk. Breast Cancer Research, 11(S3). https://doi.org/10.1186/bcr2422

9. Wu Y, Zhang D, Kang S. Physical activity and risk of breast cancer: a meta-analysis of prospective studies. Breast Cancer Res Treat. 2013 Feb;137(3):869-82. doi: 10.1007/s10549-012-2396-7. Epub 2012 Dec 30. PMID: 23274845. https://pubmed.ncbi.nlm.nih.gov/23274845/

10. NIEMAN, D. C., HENSON, D. A., GUSEWITCH, G., WARREN, B. J., DOTSON, R. C., BUTTERWORTH, D. E. & NEHLSEN-CANNARELLA, S. L. (1993). Physical activity and immune function in elderly women. Medicine & Science in Sports & Exercise, 25(7), 823–831. https://doi.org/10.1249/00005768-199307000-00011

11. Pierobon, M. & Frankenfeld, C. L. (2012). Obesity as a risk factor for triple-negative breast cancers: A systematic review and meta-analysis. Breast Cancer Research and Treatment, 137(1), 307–314. https://doi.org/10.1007/s10549-012-2339-3

12. Holmes MD, Chen WY, Feskanich D, Kroenke CH, Colditz GA. Physical activity and survival after breast cancer diagnosis. JAMA. 2005 May 25;293(20):2479-86. doi: 10.1001/jama.293.20.2479. PMID: 15914748. https://pubmed.ncbi.nlm.nih.gov/15914748/

13. Hossain S, Beydoun MA, Beydoun HA, Chen X, Zonderman AB, Wood RJ. Vitamin D and breast cancer: A systematic review and meta-analysis of observational studies. Clin Nutr ESPEN. 2019 Apr;30:170-184. doi: 10.1016/j.clnesp.2018.12.085. Epub 2019 Jan 9. PMID: 30904218; PMCID: PMC6570818. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6570818/

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

Save Our Supplements!

Have you ever used supplements to:

• Help you sleep?

• Get your kids pooping?

• Navigate PMS symptoms?

• Accelerate healing after illness or surgery?

• Manage the unpleasant symptoms of GERD?

• Improve athletic performance?

If supplements have helped you improve your overall health or supported your specific health concerns, then keep reading…

71% of Canadians use Natural Health Products (NHPs) like vitamins and supplements toothpaste, sunscreen, deodorant, probiotics, and infant/children’s products as part of their proactive health and well-being.[1] As Canadians take a more active role in their health, the sector continues to grow - across the country, NHPs are available at pharmacies, naturopathic clinics, health food stores, grocery stores, and independent retailers, employing 54,000 Canadians in the sector.[2]

Health Canada is making significant regulatory changes to natural health products, leading to increased costs and fewer products in store shelves. These unnecessary changes will treat natural health products like pharmaceutical drugs. This over-regulation will negatively impact how these brands can do business in Canada and will ultimately have a negative effect on you, the consumer.

What happened:

Health Canada announced a public consultation regarding new fees which would raise the price of NHPs - this was to be open for 90 days, beginning on May 12, 2023.[3] However, on June 22, 2023 the government passed Bill C-47 - and the sections pertaining to NHPs (500-504) were well-hidden inside a lengthy budget bill.[4] This bill was passed much earlier than anticipated, was not reviewed by the Standing Committee on Health (since it was labelled as a budget bill), and Canadians were not made aware.

What should have happened:

Health Canada should have introduced a standalone bill to amend the Food and Drugs Act. The bill would have ended up at the Standing Committee on Health - a committee comprised of experts on the regulation of health products.[5] Public consultation should not have been cut short - brands, retailers, and consumers did not get a fair say. Ideally, discussion of proposed fees should have been pushed back until completion of the Self-Care Framework by the NNHPD (Natural and Non-Prescription Products Directorate).

For historical context - Health Canada first attempted to pass these regulations in 2008 with Bill C-51, but the pushback was so strong that the bill did not pass.[6]

Potential impact:

• 1 out 5 NHP brands say they are seriously considering leaving the Canadian market due to Health Canada’s new rules.[7] This could have serious consequences to our patient treatment plans and care - many small to medium-sized businesses will be forced to shut down Canadian operations. Prices will increase and product availability will suffer.

• Health Canada is adding additional fees for NHP developers, manufacturers, and distributors - all of whom will likely increase their individual prices before they even reach the customer.

• Healthcare practitioners will have limited ability to help their patients assess which NHPs are best suited to their particular needs. There will be less access to new and innovative products that offer a better clinical benefit than their dated versions.

• There will be an increased influx of unregulated products from international markets. As a clinic that recognizes the importance of high-quality products for our patients, this is a problematic, and potentially dangerous development.

• Strict labelling regulations will cause packaging sizes to double but for the same amount of product. This creates a dramatic increase in the use of plastic, fuel, glue, wood and water and will have serious implications on our environmental footprint.

TO BE CLEAR - as health care professionals, we are all for good regulation on NHPs to ensure accessibility to high-quality products. The regulatory changes outlined in Bill C-47 seem to be a BIG overreach in NHP regulation without proper consideration of the negative impact these changes will have.

We believe it is essential to have access to high-quality supplements at an affordable price.

We need your help in this advocacy effort if we are to succeed in getting Health Canada to reconsider its proposal.

1. Please reach out to your MP by clicking HERE and tell them to Save Our Supplements.

2. Please sign Petition e-4474 and request Health Canada suspend the proposed fees discussion until the Self-Care Framework has been completed and the NNHPD has cleared its current backlog.

3. Please print off this letter template and send a paper copy to your MPs office. Traditional letters get more attention and have more impact - letters let elected officials know the impact of their decisions.
   

[1] https://www.canada.ca/en/health-canada/services/drugs-health-products/natural-non-prescription/regulation/about-products.html

[2] Deloitte LLP. (May 2023). Economic Contribution Study of Canada’s Natural Health Product Sector.

[3] https://www.canada.ca/en/health-canada/programs/consultation-proposed-fees-natural-health-products/consultation-process.html

[4] https://www.parl.ca/DocumentViewer/en/44-1/bill/C-47/royal-assent

[5] https://www.ourcommons.ca/Committees/en/HESA/About

[6] https://www.cbc.ca/news/science/criticism-of-natural-health-products-bill-c-51-mounts-1.719529

[7] https://www.saveoursupplements.ca/changing-regulations

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.

Calm for the Holidays

The most wonderful time of the year can also be the most stressful time of the year. So many expectations, events to attend, planning and preparation, and all the costs associated can all add up and put a damper on the Christmas spirit. The less talked about cost of the Christmas season, is the toll it can put on your mental health. Here are a few tips to help you get through the holidays!

✴ Breathe. All the pressure and stress of planning can be overwhelming, which can cause feelings of anxiety. Deep breathing exercises and meditation can help to bring us back into the present moment, and calm the ‘monkey brain’ when we are overthinking. There are apps for your phone (eg. Calm, Headspace, Buddhify, etc) that  will guide you through meditation and breathing exercises if you need a little guidance, or you can practice Box Breathing - inhale for 4 seconds, hold for 4 seconds, exhale for 4 seconds, hold for 4 seconds, repeat.

✴ Set boundaries. Set boundaries early and stick to them! It can be easy to get swept up in the holidays and get overly generous with our time, event attendance, gift giving, hosting, etc., which can deplete our energy, time, and resources. Get clear on what your capacity is and then set firm limits and boundaries so that you aren’t needing a holiday to recover from the holiday season.

✴ Simplify. Look for ways to streamline your holiday tasks - online shop, use a grocery delivery service, opt out of less meaningful gift exchanges and events, etc. Reducing your task list of errands and unnecessary engagements will leave you more time to spend with the people you care about or even to take some time for yourself. 

✴ Sleep. While it’s important to get proper rest all year round, the holidays can be extra busy with planning, and we often can let our bedtime creep up later and later to get it all done. Set a hard bedtime and stick to it. You’ll wake up more refreshed and be able to tackle the to-do-list more effectively tomorrow.

✴ Mind the sugar. Holiday treats are delicious and meant to be enjoyed, but overdoing it can take a toll on your energy, mood, skin, digestion, and waistline. Enjoy in moderation and opt for healthier substitutes of your favourite recipes when possible.

✴ Mind the alcohol. Holiday parties might mean you’ll be consuming a few more alcoholic beverages than average. We all are aware of the after effects of overconsumption, (which can be quite unpleasant) so do your best to practice moderation. Try switching for a glass of water between drinks to reduce your consumption naturally as well as to stay hydrated - you’ll thank yourself for it in the morning!

✴ Stay active. It can be tempting to let your exercise routine slide during the holidays but sticking with it can help you reduce stress and burn off the extra calories from those holiday feasts! This will leave you in a much better position, both physically and mentally when the holidays are over.

✴ Get outside. Walking outside in nature has been found to reduce blood pressure and the stress hormone, cortisol. If you’re going to hit the mall, why not take a walk around your neighborhood afterwards to destress.

✴ Practice Gratitude. While it is the season to be making lists of things we want, I would also invite you to make lists of gratitude for the things you already have. A roof over your head, food in the fridge, loving friends and family, etc., etc. There are so many ways in which we are fortunate that we take for granted every day. An attitude of gratitude can shift your perspective from lack to abundance, which is a much more pleasant and helpful state of mind to operate from. Challenge yourself to make a list of 10 things you’re grateful for each morning for the month of December and see how it changes your outlook by the New Year!

Above all, remember the reason for the season! The holidays should be about joy, connection, and making memories with the people you love.

Wishing you a happy + healthy holiday,

Jacalyn Sieben, ND

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.