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.

Is Melatonin Safe for Long-Term Use?

Does it prevent our body from making melatonin on its own? Are there withdrawal effects when you stop taking it? These are all great questions we are asked often. To answer them, let’s review what melatonin is, what it is used for, and what the research is saying.

What is melatonin?

Melatonin is a hormone that is produced in response to darkness by the pineal gland. It was once thought that its sole purpose was to regulate our internal circadian rhythm (our internal 24 hour clock) and aid in sleep[1]. However, we are now discovering it has roles far beyond this. We now know melatonin has anti-oxidant, anti-ageing, immunomodulating and anticancer properties as well[2]. Research suggests that melatonin may also play roles in our levels of human growth hormone[3] [4], eye health [5] [6], Gastroesophageal reflux disease (heartburn) treatment [7] [8] [9], anxiety prevention[10] [11], and the treatment (adjunctive) and prevention of cancers such as breast cancer[12] [13].

Here's what the research says:

To date, researchers appear to agree that supplementing melatonin (including doses up to 100mg/day) is well tolerated and is not typically associated with any serious adverse affects[14] [15]. The mild adverse effects that have been reported include drowsiness, headaches and dizziness and nausea[16]. Of these mild adverse effects, research suggests they either resolve spontaneously within a few days with no adjustment in melatonin, or immediately upon withdrawal of treatment[17]. Melatonin has not been found to be addictive in nature nor cause hangover symptoms[18], which is why it has been considered as a possible alternative to many sleep medications. In addition to this, research also suggests that the supplementation of melatonin does not interfere with the bodies internal production of melatonin once treatment has ceased[19] [20]. This makes sense when we consider that the half life (the time it takes for half of a drug to be cleared) of melatonin is only 1-2 hours depending on the formulation. This means that in 1-2 hours 50% of the melatonin will be removed from the body. Therefore, in 5 hours the amount of melatonin in the body is negligible and the body knows start producing a “new batch” of melatonin in the pineal gland as soon as you are exposed to light in the morning. Given that melatonin has a short half life, melatonin only targets sleep onset and not maintenance. Because of the short half life, we see so many prolonged release formulations of melatonin to slow down the absorption into the bloodstream to ensure the levels of melatonin are maintained in blood stream for a longer period to extend its sleep benefits. Prolonged release formulas allow you to maintain higher active levels of melatonin throughout the night if your goal with supplementing melatonin is to prevent nighttime waking.

But what about our more vulnerable populations such as children or elderly people?

In children, research suggests adverse effects of melatonin supplementation were few and mild[21]. Of these adverse effects, fatigue and somnolence were mentioned and were found to resolve with dose reduction. In addition, studies on pediatric populations looking at the long term effects of melatonin supplementation (two, three and four years on average) in doses of 2mg-10mg/day, found no notable long term effects on vitals signs or measures of child growth[22] [23]. In a two year long study assessing sleep, growth and puberty in children taking melatonin, a two week placebo period was implemented after treatment to assess withdrawal effects to which there were no apparent signs of withdrawals (mallow).

A 2022 review article discussing the safety of melatonin use in the elderly found that adverse effects were similar to those found in adult populations such as dizziness, nausea and headaches[24].However, there may be an increased risk of hypothermia if melatonin levels reach above normal physiologic levels as well as fractures in those who are at risk of falling due to the possibility of daytime sedation [25]. In regards to discontinuation, research suggests there is no evidence of withdrawal effects in populations 55 years and older[26].

It is important to note that the above research does not include individuals on medications or health concerns/diagnoses outside the parameters of each individual study. Therefore, it is important to discuss melatonin supplementation with your healthcare provider before taking.

In summary, it is SAFE to say melatonin is SAFE for those who are taking melatonin long term as recommended by their health care provider for one of the many clinical benefits we see with melatonin supplementation. 

[1] Ferracioli-Oda E, Qawasmi A, Bloch MH. Meta-analysis: melatonin for the treatment of primary sleep disorders. PLoS One. 2013 May 17;8(5):e63773. doi: 10.1371/journal.pone.0063773. PMID: 23691095; PMCID: PMC3656905.

[2] Bhattacharya S, Patel KK, Dehari D, Agrawal AK, Singh S. Melatonin and its ubiquitous anticancer effects. Mol Cell Biochem. 2019 Dec;462(1-2):133-155. doi: 10.1007/s11010-019-03617-5. Epub 2019 Aug 26. PMID: 31451998.

[3] Forsling ML, Wheeler MJ, Williams AJ. The effect of melatonin administration on pituitary hormone secretion in man. Clin Endocrinol (Oxf). 1999 Nov;51(5):637-42. doi: 10.1046/j.1365-2265.1999.00820.x. PMID: 10594526.

[4] Valcavi R, Zini M, Maestroni GJ, Conti A, Portioli I. Melatonin stimulates growth hormone secretion through pathways other than the growth hormone-releasing hormone. Clin Endocrinol (Oxf). 1993 Aug;39(2):193-9. doi: 10.1111/j.1365-2265.1993.tb01773.x. PMID: 8370132.

[5] Lundmark PO, Pandi-Perumal SR, Srinivasan V, Cardinali DP. Role of melatonin in the eye and ocular dysfunctions. Vis Neurosci. 2006 Nov-Dec;23(6):853-62. doi: 10.1017/S0952523806230189. PMID: 17266777.

[6] Yi C, Pan X, Yan H, Guo M, Pierpaoli W. Effects of melatonin in age-related macular degeneration. Ann N Y Acad Sci. 2005 Dec;1057:384-92. doi: 10.1196/annals.1356.029. PMID: 16399908.

[7] Pereira Rde S. Regression of gastroesophageal reflux disease symptoms using dietary supplementation with melatonin, vitamins and aminoacids: comparison with omeprazole. J Pineal Res. 2006 Oct;41(3):195-200. doi: 10.1111/j.1600-079X.2006.00359.x. PMID: 16948779.

[8] Kandil TS, Mousa AA, El-Gendy AA, Abbas AM. The potential therapeutic effect of melatonin in Gastro-Esophageal Reflux Disease. BMC Gastroenterol. 2010 Jan 18;10:7. doi: 10.1186/1471-230X-10-7. PMID: 20082715; PMCID: PMC2821302.

[9] Pereira Rde S. Regression of gastroesophageal reflux disease symptoms using dietary supplementation with melatonin, vitamins and aminoacids: comparison with omeprazole. J Pineal Res. 2006 Oct;41(3):195-200. doi: 10.1111/j.1600-079X.2006.00359.x. PMID: 16948779.

[10] Khare A, Thada B, Jain N, Singh D, Singh M, Sethi SK. Comparison of Effects of Oral Melatonin with Oral Alprazolam used as a Premedicant in Adult Patients Undergoing Various Surgical Procedures under General Anesthesia: A Prospective Randomized Placebo-Controlled Study. Anesth Essays Res. 2018 Jul-Sep;12(3):657-662. doi: 10.4103/aer.AER_90_18. PMID: 30283171; PMCID: PMC6157235.

[11] Ghaeli P, Solduzian M, Vejdani S, Talasaz AH. Comparison of the Effects of Melatonin and Oxazepam on Anxiety Levels and Sleep Quality in Patients With ST-Segment-Elevation Myocardial Infarction Following Primary Percutaneous Coronary Intervention: A Randomized Clinical Trial. Ann Pharmacother. 2018 Oct;52(10):949-955. doi: 10.1177/1060028018776608. Epub 2018 May 11. PMID: 29749262.

[12] Li Y, Li S, Zhou Y, Meng X, Zhang JJ, Xu DP, Li HB. Melatonin for the prevention and treatment of cancer. Oncotarget. 2017 Jun 13;8(24):39896-39921. doi: 10.18632/oncotarget.16379. PMID: 28415828; PMCID: PMC5503661.

[13] Yang A, Peng F, Zhu L, Li X, Ou S, Huang Z, Wu S, Peng C, Liu P, Kong Y. Melatonin inhibits triple-negative breast cancer progression through the Lnc049808-FUNDC1 pathway. Cell Death Dis. 2021 Jul 16;12(8):712. doi: 10.1038/s41419-021-04006-x. PMID: 34272359; PMCID: PMC8285388.

[14] Menczel Schrire Z, Phillips CL, Chapman JL, Duffy SL, Wong G, D'Rozario AL, Comas M, Raisin I, Saini B, Gordon CJ, McKinnon AC, Naismith SL, Marshall NS, Grunstein RR, Hoyos CM. Safety of higher doses of melatonin in adults: A systematic review and meta-analysis. J Pineal Res. 2022 Mar;72(2):e12782. doi: 10.1111/jpi.12782. Epub 2021 Dec 30. PMID: 34923676.

[15] Andersen LP, Gögenur I, Rosenberg J, Reiter RJ. The Safety of Melatonin in Humans. Clin Drug Investig. 2016 Mar;36(3):169-75. doi: 10.1007/s40261-015-0368-5. PMID: 26692007.

[16] Savage RA, Zafar N, Yohannan S, et al. Melatonin. [Updated 2021 Aug 15]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK534823/

[17] Besag FMC, Vasey MJ, Lao KSJ, Wong ICK. Adverse Events Associated with Melatonin for the Treatment of Primary or Secondary Sleep Disorders: A Systematic Review. CNS Drugs. 2019 Dec;33(12):1167-1186. doi: 10.1007/s40263-019-00680-w. PMID: 31722088.

[18] Cardinali DP, Srinivasan V, Brzezinski A, Brown GM. Melatonin and its analogs in insomnia and depression. J Pineal Res. 2012 May;52(4):365-75. doi: 10.1111/j.1600-079X.2011.00962.x. Epub 2011 Sep 23. PMID: 21951153.

[19] Matsumoto M, Sack RL, Blood ML, Lewy AJ. The amplitude of endogenous melatonin production is not affected by melatonin treatment in humans. J Pineal Res. 1997 Jan;22(1):42-4. doi: 10.1111/j.1600-079x.1997.tb00301.x. PMID: 9062869.

[20] Hack LM, Lockley SW, Arendt J, Skene DJ. The effects of low-dose 0.5-mg melatonin on the free-running circadian rhythms of blind subjects. J Biol Rhythms. 2003 Oct;18(5):420-9. doi: 10.1177/0748730403256796. PMID: 14582858.

[21] Maras A, Schroder CM, Malow BA, Findling RL, Breddy J, Nir T, Shahmoon S, Zisapel N, Gringras P. Long-Term Efficacy and Safety of Pediatric Prolonged-Release Melatonin for Insomnia in Children with Autism Spectrum Disorder. J Child Adolesc Psychopharmacol. 2018 Dec;28(10):699-710. doi: 10.1089/cap.2018.0020. Epub 2018 Oct 11. PMID: 30132686; PMCID: PMC6306655.

[22] Malow BA, Findling RL, Schroder CM, Maras A, Breddy J, Nir T, Zisapel N, Gringras P. Sleep, Growth, and Puberty After 2 Years of Prolonged-Release Melatonin in Children With Autism Spectrum Disorder. J Am Acad Child Adolesc Psychiatry. 2021 Feb;60(2):252-261.e3. doi: 10.1016/j.jaac.2019.12.007. Epub 2020 Jan 23. PMID: 31982581; PMCID: PMC8084705.

[23] Kennaway, D.J. (2015), Melatonin use in paediatrics. J Paediatr Child Health, 51: 584-589. https://doi.org/10.1111/jpc.12840

[24] Zhdanova IV, Wurtman RJ, Regan MM, Taylor JA, Shi JP, Leclair OU. Melatonin treatment for age-related insomnia. J Clin Endocrinol Metab. 2001 Oct;86(10):4727-30. doi: 10.1210/jcem.86.10.7901. PMID: 11600532.

[25] Should Melatonin Be Used as a Sleeping Aid for Elderly People? Can J Hosp Pharm. 2019 Jul-Aug;72(4):327-329. Epub 2018 Aug 31. PMID: 31452545; PMCID: PMC6699865.

[26] Lemoine P, Nir T, Laudon M, Zisapel N. Prolonged-release melatonin improves sleep quality and morning alertness in insomnia patients aged 55 years and older and has no withdrawal effects. J Sleep Res. 2007 Dec;16(4):372-80. doi: 10.1111/j.1365-2869.2007.00613.x. PMID: 18036082.

Glutathione in the Treatment of Fatty Liver/NASH/NAFLD

Have you been told you have a “fatty liver” despite not consuming high amounts of alcohol? If so, you have NAFLD or NASH.

What is NASH/NAFLD?

>> Nonalcoholic Fatty Liver Disease (NAFLD, Hepatic Steatosis, NASH)

Non-alcoholic fatty liver disease (NAFLD) is a chronic and multifactorial disorder characterized by excessive fatty acid accumulation in liver cells. Associated with metabolic syndromes, NAFLD is increasingly being recognized as a major cause of liver disease. It is a spectrum of liver abnormalities that ranges from nonalcoholic fatty liver to steatohepatitis, cirrhosis, and liver cancer. It is estimated that 25% of the global population has NAFLD, a number projected to continue to rise, and as it does, it is expected that more of these cases will progress to end-stage disease states requiring liver transplantation. A larger percentage of liver cancers in these cases occur before end-stage liver failure, and thus are less likely to be screened for, increasing the tendencies for liver tumors to be larger and more difficult to treat at the time they are diagnosed. Testing and diagnosis of NAFLD may include blood tests, imaging, and biopsy.

What causes it? 

Risk Factors

•    Metabolic syndrome (strongest risk factor)

• increased waist circumference (obesity)

• insulin resistance

• elevations in:

  • blood sugar

  • cholesterol

  • triglycerides

  • blood pressure

  • uric acid

•    Diabetes (up to 75% of individuals with type 2 diabetes have NAFLD)

•    Sleep apnea

•    Gut microbiome effects

•    Genetic factors

Image: Friedman et al. 2018

Why is it important to address?

Patients with NAFLD are twice as likely to die of cardiovascular disease than liver disease as a result of these shared risk factors. NAFLD in itself is an independent risk factor for cardiovascular disease due to its impacts on vascular health and inflammation.

How does it happen & what you can do about it?

Free fatty acids from either adipose tissue (fat), or from the conversion of excess carbohydrate intake, accumulate in the liver cell resulting in oxidative stress, inflammation, and liver injury.

As such, healthy eating habits and regular exercise can reduce the amount of free fatty acids and thereby prevent or reverse NAFLD. Glutathione supplementation can also help in the recovery of NASH/NAFLD.

What is Glutathione?

Glutathione (GSH) is a tripeptide made from amino acids, that is present in every cell of the human body, though is highly concentrated in the liver. Known as the ‘master antioxidant’ it directly scavenges reactive oxygen species, protecting your body from oxidative damage, and plays a crucial role in detoxification and cellular health. Reduced levels of glutathione have been associated with increased disease risk and progression, including NAFLD and other liver pathologies.

In addition to healthy diet and lifestyle habits, preliminary studies have shown beneficial effects of supplemental glutathione in the treatment of NAFLD, demonstrating a reduction of ALT–a liver enzyme elevated in liver dysfunction and one of the principal NAFLD biomarkers–after four months of treatment. Other studies demonstrated intravenous glutathione rapidly improved liver function, also evidenced by reduced biomarkers, in the treatment of other liver pathologies including chronic hepatitis B. Various nutrients, amino acids, herbal extracts, and probiotics have also been shown to increase glutathione activity in the body, and may be used in conjunction for enhanced therapeutic effect.

Find out if Glutathione is an option for you!

At Saskatoon Naturopathic Medicine, we offer both oral and intravenous glutathione for the treatment of NAFLD and other conditions, as part of our comprehensive approach to our patients’ unique health history and needs. If you are interested in learning more about how we can assist you, give us a call or book online to connect with one of our naturopathic doctors who would be happy to assess your case and discuss treatment options appropriate for you.

*IV therapy requires a consultation and evaluation by one of our IV doctors to assess patient eligibility and treatment goals. For more information see our IV therapy page. 

Jacalyn Sieben, ND

Sources:

Friedman, S. L., Neuschwander-Tetri, B. A., Rinella, M., & Sanyal, A. J. (2018). Mechanisms of NAFLD development and therapeutic strategies. Nature medicine, 24(7), 908–922. https://doi.org/10.1038/s41591-018-0104-9

Honda et al. (2017). Efficacy of glutathione for the treatment of nonalcoholic fatty liver disease: an open-label, single-arm, multicenter, pilot study. BMC Gastroenterology. 17:96 DOI 10.1186/s12876-017-0652-3. https://pubmed.ncbi.nlm.nih.gov/28789631/

Vairetti, M., Di Pasqua, L. G., Cagna, M., Richelmi, P., Ferrigno, A., & Berardo, C. (2021). Changes in Glutathione Content in Liver Diseases: An Update. Antioxidants, 10(3), 364. MDPI AG. Retrieved from http://dx.doi.org/10.3390/antiox10030364

Qian, L., Wang, W., Zhou, Y., & Ma, J. (2017). Effects of reduced glutathione therapy on chronic hepatitis B. Central-European journal of immunology, 42(1), 97–100. https://doi.org/10.5114/ceji.2016.65894

Make Every Day Self-Care Day!

Our busy, modern lives can sometimes make it hard for us to tune into our body’s needs. Here are some of our favorite tips on how to keep balanced while keeping busy!

At home…

Get Outside

Being in nature has numerous mental and physical benefits. Nature therapy has gained popularity as a means to reduce stress and promote healing. Research has come to the same conclusion as nature therapy practices have been shown to reduce heart rate, blood pressure, and the stress hormone, cortisol, when compared to measurements in other environments. (1)

Connect With Loved Ones

It likely does not come as a surprise that social isolation is associated with increased risk for mental health problems–in particular, depression, anxiety, stress-related disorders, and anger. Try to make an active effort to spend time with people you love whether you are able to do so in person or via a virtual connection. (2)

Screen Time Breaks

While technology has improved our lives in an abundance of ways, there can be too much of a good thing. Studies show that increased screen time is associated with negative outcomes such as lowered self-esteem, increased incidence and severity of mental health issues and addictions, slowed learning and acquisition, and an increased risk of premature cognitive decline. Use your screen time wisely–in moderation and with intention. Consider setting time limits on your devices and cleaning up your follow lists on social media to make your social feeds more of a positive space to engage with. (3)

Balanced Nutrition

Enjoying a balanced variety of nutrient-rich, whole foods to fuel your body optimally helps to reduce inflammation and keep your blood sugar (and moods) stable. In general, you should aim for half of your plate to be vegetables, 1/4 complex carbs (whole grains, starchy vegetables), and 1/4 protein. Healthy fats should be incorporated into each meal (avocado, nuts, olive oil, etc), and fruit makes for excellent snacks or dessert. Water intake is imperative for the maintenance of good health and most healthy adults should aim for 2-3L of water daily.

Sleep

It’s not just for beauty! As neuroscientist Matthew Walker says, “There does not seem to be one major organ within the body, or process within the brain, that isn’t optimally enhanced by sleep (and detrimentally impaired when we don’t get enough).” Adequate, quality sleep (7-9 hours per night) is vital for tissue regeneration, and slacking on your sleep can increase your propensity for weight gain, chronic disease, and even cancer. If you are struggling to get a good night’s sleep, our naturopathic doctors would love to help!

At Saskatoon Naturopathic Medicine…

Acupuncture

An effective traditional therapy for many conditions including stress, anxiety, sleep, pain, digestion, and hormonal concerns.

Massage

Our knowledgeable massage therapists offer relaxing and therapeutic massage as well as myofascial release and patient self-care education such as stretching, strengthening and postural awareness.

Somatic Experiencing™

Somatic Experiencing™ is a body-based approach to treating the effects of trauma. Specifically, the symptoms that arise when trauma is held in the body, including chronic or severe pain that does not respond well to medication, headaches, digestive issues, fear, difficulty sleeping, anxiety and depression. Somatic Experiencing™ works with the nervous system and the body’s innate ability to heal and recover from the symptoms of physiological stress. Treatment is gentle, supportive and enhances the effectiveness of the traditional exercise-based physiotherapy and counselling approaches.

Nutritional IV Therapy

IV nutrient therapy is a method of administering water-soluble nutrients (vitamins, minerals, antioxidants, and amino acids) directly into the blood stream. When you infuse nutrients intravenously, you bypass the digestive system, and this achieves a higher blood concentration beyond what is orally possible, especially if digestive function is compromised. Great for many conditions as well as health optimization and energy support. (See our website or call the clinic for more details).

Targeted Therapeutics

If you are looking for a comprehensive approach to your self-care, book a consultation with one of our naturopathic doctors who will conduct a thorough assessment of your health and come up with a customized plan just for you! With a variety of treatment modalities and testing options available, a targeted treatment plan can eliminate some of the guess-work and help you reach your self-care goals more quickly.

Written by Jacalyn Sieben ND

Sources:

1. Hansen, M. M., Jones, R., &amp; Tocchini, K. (2017). Shinrin-Yoku (Forest Bathing) and Nature Therapy: A State-of-the-Art Review. International Journal of Environmental Research and Public Health, 14(8), 851. https://doi.org/10.3390/ijerph14080851

2. Henssler, J., Stock, F., van Bohemen, J. et al. (2021). Mental health effects of infection containment strategies: quarantine and isolation—a systematic review and meta-analysis. Eur Arch Psychiatry Clin Neurosci 271, 223–234. https://doi.org/10.1007/s00406-020-01196-x

3. Neophytou, E., Manwell, L.A. &amp; Eikelboom, R. (2021). Effects of Excessive Screen Time on Neurodevelopment, Learning, Memory, Mental Health, and Neurodegeneration: a Scoping Review. Int J Ment Health Addiction 19, 724–744. DOI: 10.1007/s11469-019-00182-2

Interested in IV therapy to help you feel on top of your game?

Here’s what you need to know:

IV therapy is available at our clinic for current patients of our clinic. If you are not a patient of the clinic, please book an initial visit with one of our doctors.

(If you are under the care of a naturopathic doctor or integrative medical doctor outside this clinic, you may reach out to our reception team to request an external IV referral form to be completed by your health care practitioner.)

If you are a current patient and you are interested in starting IV therapy, these are the next steps you need to follow:

STEP 1 : Call in to book a 30min IV consultation appointment. Please note that Dr. Reid ND does NOT perform IV therapy.

STEP 2: Bring in any blood work that you have had completed in the last 6-12months to this IV Consultation.

At this IV consultation, one of our three IV trained naturopathic doctors will want to hear what your health goals are and assess your eligibility for IV therapy.  This assessment includes a review of your medical history,  current blood work, a brief physical exam and a discussion on options available to you.  Based on the IV required, baseline health, and the review of past blood work, the naturopathic doctor may request more blood work be completed prior to the first IV booking.

When the assessment is complete and you are deemed eligible for IV therapy, the naturopathic doctor will customize an IV treatment plan with goals, expectations, and monitoring parameters set out. The naturopathic doctor will inform you of how to prepare for you IV treatment and give you information on what to expect for the process. At this point, you can proceed to book you first IV with our front reception team.

After a series of IVs are completed, you may book a follow up IV consultation with your naturopathic doctor to review evaluate your response and need for ongoing IV therapy. (Usually updated blood work and/or imaging is reviewed at this time)

Introducing...Creative Therapy at Saskatoon Naturopathic Medicine!

We are so excited to collaborate with Mandy Hollands Ish from Sunflower Holistic Arts ! Mandy will be offering 1-hour Creative Therapy sessions on select days at the clinic, and we are ready to book your appointment with her now!

Mandy has a particular interest in working with cancer care patients and their families as she personally journeyed alongside both of her parents when they were each diagnosed with cancer. Creative Therapy can be very healing when working through a cancer diagnosis and the journey ahead, as here is often a significant emotional toll on the care provider and family members as well. It should be noted, however, that Creative Therapy sessions are open to anyone who is interested in taking part, regardless if you are going through a cancer journey or not!

Join Mandy for a one-on-one, 60-minute session to help you take a break from all the cognitive noise and process whatever you are struggling most with, by means of Creative Therapy. This is perfect if you are looking for an outlet different from talk therapy.

Details:

One session is $90 per person. If you are a cancer care patient or are a caregiver for someone who is, we are offering a special rate of $45 per session.

*Care providers of cancer patients who have passed on are also encouraged to book in for a Creative Therapy session.

Want to learn more about Mandy and Creative Therapy? Please visit www.sunflowerholisticarts.com

Available Dates:

March 29, 2022

Space is limited - book your Creative Therapy Session by calling the clinic at (306) 664-2150!

What happens at a Creative Therapy session?

Seasonal affective disorder & vitamin d

Saskatchewan is known for its long, cold winters. As the temperatures decrease, so do the daylight hours, significantly diminishing the amount of sun we might see each day. To add to that, to avoid the cold, we spend more time indoors and the time we do spend outside has us wrapped from head-to-toe to keep warm. This means less sun exposure and therefore reduced opportunity for us to synthesize vitamin D from its light. For some people, the change in seasons also brings on the “winter blues” also known as Seasonal Affective Disorder (S.A.D.). It is currently thought that a combination of physiologic, psychologic, genetic, and environmental factors play a role in S.A.D., one of them being vitamin D deficiency.

What is seasonal affective disorder?

Also termed “S.A.D.”, Seasonal Affective Disorder is a form of depression that typically occurs in the winter months when our exposure to sunlight is limited. Approximately 2-3% of Canadians will experience S.A.D. at some point and 15% more will experience a milder version of the condition.

There is a natural tendency to slow down in winter compared to the high-energy lifestyles we tend to carry on in summer months. However, if you notice you are feeling particularly low or experiencing the signs & symptoms below, it might be time to consider consulting a healthcare professional for an assessment.

Signs & Symptoms

• Feelings of hopelessness & sadness

• Thoughts of suicide

• Oversleeping

• Cravings for sweet or starchy foods

• Weight gain

• Fatigue/low energy

• Decreased physical activity

• Difficulty concentrating

• Irritability

• Increased sensitivity to social rejection

• Avoidance of social situations

In S.A.D., these signs and symptoms appear and disappear at about the same time each year, and the sad, despairing mood:

• is present most days and lasts most of the day

• lasts for more than two weeks

• impairs performance at work, school or in social relationships

Vitamin D - the sunshine vitamin

Vitamin D, which actually functions more like a hormone, acts on receptors in every tissue in the body including the brain and immune system. As it is a fat-soluble vitamin, we get it through diet from sources such as fatty fish (sardines, salmon, tuna), eggs, and liver; and are also able to synthesize it through our skin when we get sufficient exposure to the sun. As such, vitamin D levels have been shown to fluctuate with exposure to sunlight. Levels tend to decline from fall to winter, and are naturally lower the further north you live from the equator.

Vitamin D has many functions within the body. It is needed for calcium absorption (healthy bones, teeth), healthy immune function, and also has a role in the release of dopamine and serotonin - signalling molecules that, in the brain, are associated with drive, pleasure, and happiness.

So, how much vitamin D do you need?

Health Canada recommends a daily dietary intake of 600-800 IU’s of Vitamin D for adults. However, according to their statistics, most Canadians are not achieving this. While we also know sunlight does provide Vitamin D, here in Saskatchewan, the exposure we get at our northern location is often inadequate, especially in the winter months. Vitamin D levels also decrease with age, skin pigmentation, liver and kidney disease, obesity, certain medications, genetic mutations and other conditions.

How do I know if I’m getting enough vitamin D?

Luckily, there is a test for that! A simple blood test can assess whether you are getting sufficient amounts of vitamin D, or if supplementation may be indicated–or, in some cases, contraindicated. There can be too much of a good thing especially when it comes to supplementation. Vitamin D toxicity related to excessive long-term intake of vitamin D can cause hypercalcemia and related symptoms such as confusion, apathy, vomiting, abdominal pain, pathological calcification, increased thirst and increased urination. It is also important to note that everyone metabolizes vitamin D differently, so some people can experience vitamin D toxicity even at lower doses that are considered safe for the general population. It is always recommended to consult a healthcare practitioner before implementing any new health regimen to see if it is right for you, including vitamin D supplementation.

If you are experiencing symptoms of the “winter blues” or are curious about your vitamin D status or other natural approaches to mental health, you are invited to book a consult with myself or one of my colleagues to discuss your healthcare options.

We look forward to working with you!

In health, Jacalyn Sieben, ND

References:

1. CAMH. (2019). Seasonal affective disorder (SAD). Retrieved from: https://www.camh.ca/en/health-info/ mental-illness-and-addiction-index/seasonal-affective-disorder

2. Canadian Mental Health Association, BC Division. (2013). Seasonal affective disorder. Retrieved from: https://cmha.bc.ca/documents/seasonal-affective-disorder-2/

3. Health Canada. (2012). Vitamin d and calcium: Updated dietary reference intakes. Retrieved from: https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/vitamins-minerals/ vitamin-calcium-updated-dietary-reference-intakes-nutrition.html

4. Marcinowska-Suchowierska E, Kupisz-Urbańska M, Łukaszkiewicz J, Płudowski P and Jones G (2018) Vitamin D Toxicity–A Clinical Perspective. Front. Endocrinol. 9:550. doi: 10.3389/fendo.2018.00550

5. Melrose S. (2015). Seasonal Affective Disorder: An Overview of Assessment and Treatment Approaches. Depression research and treatment, 2015, 178564. https://doi.org/10.1155/2015/178564

Physical Activity for Prostate Cancer - HIIT it up!

Physical activity is one of the many ways in which we can optimize our health before, during and after cancer treatment. Prostate cancer patients undergoing active surveillance can benefit from optimizing their physical activity levels (missed our post on active surveillance? Check it out here)

The Canadian research study Exercise During Active Surveillance for Prostate Cancer (ERASE) trial looked at how exercise during active surveillance in men with prostate cancer influenced their cardiorespiratory fitness [1]. Prostate cancer patients on active surveillance who did a supervised high intensity interval training (HIIT) three times per week for 12 weeks had improved cardiorespiratory fitness levels and reduced PSA levels compared to the control group (prostate cancer patients on active surveillance who did not do the HIIT training) [1]. Although we don’t know the long-term effects of this training, other studies have suggested that improving fitness levels can provide benefits in heart health and weight management and may reduce side effects associated with prostate cancer treatment [2-5].

Quick ways to incorporate more physical activity into your day:

• Take the stairs instead of the elevator/escalator

• Add daily walks on your own or with family/friends

• Get up from your work desk every 20 minutes for a quick stretch and stroll, or get a standing desk

• Do household chores such as snow shovelling, raking the leaves, mowing the lawn, gardening, vacuuming and others

• Dance!

• Enroll in leisurely sporting teams or engage in sports such as golf, tennis or others with friends or family

Talk to your doctor to make sure any high intensity types of exercises are safe for you. 

References:

[1] Kang, D.-W., Fairey, A. S., Boulé, N. G., Field, C. J., Wharton, S. A., & Courneya, K. S. (2021). Effects of Exercise on Cardiorespiratory Fitness and Biochemical Progression in Men With Localized Prostate Cancer Under Active Surveillance: The ERASE Randomized Clinical Trial. JAMA Oncology, 7(10), 1487. https://doi.org/10.1001/jamaoncol.2021.3067

[2] Kim, S. H., Seong, D. H., Yoon, S. M., Choi, Y. D., Choi, E., Song, Y., & Song, H. (2018). The Effect on Bone Outcomes of Home-based Exercise Intervention for Prostate Cancer Survivors Receiving Androgen Deprivation Therapy: A Pilot Randomized Controlled Trial. Cancer Nursing, 41(5), 379–388. https://doi.org/10.1097/NCC.0000000000000530

[3] Galvão, D. A., Taaffe, D. R., Spry, N., Cormie, P., Joseph, D., Chambers, S. K., Chee, R., Peddle-McIntyre, C. J., Hart, N. H., Baumann, F. T., Denham, J., Baker, M., & Newton, R. U. (2018). Exercise Preserves Physical Function in Prostate Cancer Patients with Bone Metastases. Medicine and Science in Sports and Exercise, 50(3), 393–399. https://doi.org/10.1249/MSS.0000000000001454

[4] Bourke, L., Smith, D., Steed, L., Hooper, R., Carter, A., Catto, J., Albertsen, P. C., Tombal, B., Payne, H. A., & Rosario, D. J. (2016). Exercise for Men with Prostate Cancer: A Systematic Review and Meta-analysis. European Urology, 69(4), 693–703. https://doi.org/10.1016/j.eururo.2015.10.047

[5] Keilani, M., Hasenoehrl, T., Baumann, L., Ristl, R., Schwarz, M., Marhold, M., Sedghi Komandj, T., & Crevenna, R. (2017). Effects of resistance exercise in prostate cancer patients: A meta-analysis. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 25(9), 2953–2968. https://doi.org/10.1007/s00520-017-3771-z