Melatonin is a natural hormone found in humans. Circulating levels of melatonin vary in the daily cycle and it helps to maintain several biological functions. For this reason, it is most commonly used as a supplement to help promote good sleep. Recently, it's been discovered that melatonin can protect against heartburn, also known as gastro-esophageal reflux disease (or GERD). GERD develops when the contents of the stomach work their way upward and cause irritation. In normal digestion, the lower esophageal sphincter opens to allow food to pass into the stomach, but should close after that. If it becomes weaker or opens when it shouldn't, GERD can develop and acid can flow up into the esophagus. Many drugs are used to treat heartburn and they typically decrease the amount of acid produced by the stomach, but they can cause side effects. Melatonin has been found to be protective to the gastro-intestinal system. In this recent study, melatonin was tested with or without an acid-decreasing drug (1). The results showed that melatonin was useful in both circumstances. It was able to relieve stomach pain and heartburn. In addition to melatonin, there are many dietary triggers than can also aggravate heartburn. These include things like chocolate, mint, fatty foods, coffee, and alcohol. It's usually recommended that those who have heartburn avoid these foods.

In many respects, Europe is more progressive compared to North America in its approach to medicine and use of natural therapies. In Germany, many herbal medicines are in common use by conventionally trained physicians. Menopausal symptoms are a challenging area for many women, and there is often a lack of treatments that are both safe and effective available to women suffering with menopausal symptoms. These typically include hot flashes, night sweats, and mood disturbance including irritability, anxiety, or depression. Given the harms associated with use of conventional hormone replacement therapy, there is a lack of treatments available, and women often resort to using herbal or other natural strategies.

Recently, a survey was conducted among German gynecologists, evaluating their experiences with using complementary therapies in the treatment of menopausal symptoms. Over 9500 gynecologists were surveyed about the effectiveness of a range of natural therapies, including black cohosh, chaste tree berry, St. John’s wort, acupuncture, homeopathy, and lifestyle change.^[1]

Notably, over 98% of gynaecologists had experience with some form of complementary medicine. Therapies that rated highly for their effectiveness included lifestyle changes, and herbal therapies including St. John’s wort and black cohosh. Therapies that were regarded as less effective were yoga, acupuncture, and homeopathy. This may also be due to less experience with these particular therapies.

This study is important because it shows the growing integration of natural strategies within conventional medicine in progressive areas of the world. Several natural therapies are regarded as effective for the management of menopausal symptoms by specialists in women’s health.

The health benefits of dark chocolate are becoming well known. The antioxidants in dark chocolate have a host of health benefits, including lowering blood pressure and improving blood glucose. The trick to healthy use of chocolate is caloric equilibrium. Because chocolate is very calorie dense, adding dark chocolate consumption on top of one’s regular diet, may result in weight gain for many. If the number of total calories consumed can be kept the same, however, adding dark dark chocolate to one’s diet offers many health benefits. A recent study assessed the effect of dark chocolate consumption in “normal weight obese” women.^[1]

Normal-weight-obese is defined as a condition wherein subjects are of normal body mass index (ie. not overweight) however they carry an excessive proportion of body fat. This body composition is associated with higher risk of cardiovascular disease.^[1] This study administered 100g per day of dark chocolate (70% cocoa) to 15 women with normal-weight-obesity, for a total of seven days.

Even after this brief study period, changes were seen in the women’s cholesterol profile, immune function, and abdominal circumference. After dark chocolate consumption, HDL cholesterol (“good” cholesterol) increased by 10%, LDL cholesterol (“bad” cholesterol) decreased over 11%, and the ratio of total cholesterol to HDL cholesterol (TC:HDL), a very powerful predictor of heart disease, was reduced by 11%. In addition there was a reduction in abdominal circumference, and this despite the fact that these subject were technically not overweight to begin with!

This study lends further weight to the cumulative evidence demonstrating health benefits associated with consumption of dark chocolate.

N-acetylcysteine (NAC) is best known among the naturopathic community for its glutathione enhancing effects. NAC is a nutrient precursor for glutathione. Glutathione is one of the most important antioxidant enzymes present within cells. It is critical in protecting cells from chemical damage inflicted by exposure to toxins, including drug breakdown products or metabolites. A particularly well known example of this is Tylenol (acetaminophen or paracetamol). Tylenol metabolites need to be safely degraded by glutathione; in the event of Tylenol overdose, where there is excess of Tylenol metabolites relative to cellular content of glutathione, there is risk of serious, permanent liver damage. The conventional antidote for this is intravenous NAC. A recent study published in the prestigious journal, the Lancet reported again that intravenous NAC is an effective antidote for Tylenol (aka paracetamol).^[1]

The study was a randomized, double blind study involved three hospitals in the United Kingdom. Patients with Tylenol overdose were randomized to the standard treatment with intravenous NAC for 20-25 hours, or a shorter, modified protocol lasting for 12 hours. The study assessed whether NAC treatment would reduce vomiting, retching and the need for anti-nausea medication, as well as a decrease in ALT, a marker of liver damage. A total of 222 patients were included.

Results showed that both protocols of NAC administration were effective in reducing vomiting and retching at two hours, and lowered ALT levels, indicating less liver damage. The 12 hour protocol appeared to be more effective. This study shows the powerful impact of this nutrient in protecting the liver and improving metabolism of toxic byproducts.

Individuals with hypothyroidism require life-long thyroid hormone replacement therapy. Typically, patients are put on a synthetic version of T4 called Synthroid or levothyroxine. Some patients however do not tolerate this medication well, or do not achieve adequate symptom relief using this strategy. Desiccated thyroid is a preparation of thyroid gland taken from an animal source, and contains both T4 and T4 thyroid hormone. Anecdotally, naturopathic doctors sometimes observe that a selection of patients exhibit a better response to desiccated thyroid compared to levothyroxine. A recent study compared the tolerability and effectiveness of levothyroxine compared to desiccated thyroid.^[1]

In a randomized, double-blind, cross-over study, a total of 70 patients were treated with one of the two forms of thyroid replacement. They received one treatment for 16 weeks, then crossed over to the other treatment for another 16 weeks. Results showed that both treatments, desiccated thyroid and levothyroxine were equally effective in managing hypothyroid symptoms as well as neurocognitive measurements. However, patients on desiccated thyroid lost an average of 3lb over the course of treatment, while patients on levothyroxine did not, and this was statistically significant.

When asking patients (blinded to treatment) what treatment, A or B, they preferred, 48% preferred desiccated thyroid, 18% preferred levothyroxine, and 32% had no preference. Those patients who preferred desiccated thyroid lost an average of 4lb over the course of treatment, and also had a significant subjective improvement in hypothyroid symptoms. It appears that in a subgroup of patients, desiccated thyroid may be a preferential, more effective therapy.

Creatine is a naturally occurring substance often used in supplement form by many body builders to increase muscle mass. It has several mechanisms of action but it is well known to increase ATP in the body. A recently published study shows the promising use of this nutrient in Huntington, a disease that currently has no cure.^[1] The first clinical trail of its kind, researchers found high doses of creatine may have the potential to slow brain atrophy and in turn potentially slow disease progression. Dose of 15g used in the study was found to be well tolerated and safe for periods of up to 18months. Previous studies published have also found this supplement to be safe, and tolerable at high doses.^[2,3] In one a marker linked with oxidative injury to DNA was found to be decreased in the creatine group, a marker normally found elevated in Huntington disease.^[3]

Hormonal changes are a natural part of aging for both men and women. For years the focus had been on women and menopause. This is partly due to the less dramatic way in which hormones decline in men. Hormonal changes in men, such as low testosterone, can cause significant adverse effects for some including sexual dysfunction, sleep disturbance, weight gain, low energy, memory impairment and even depression. Testosterone replacement therapy has increased over the past decade and is now even being marketed to healthy aging men as a wondrous anti-aging drug. Recent studies however are showing that perhaps we should be more cautious. A cohort study published last month in PLOS looking at the risk of non-fatal myocardial infarction (heart attack) in a group of 55, 593 men found that those over 65 year of age on a testosterone therapy had a two fold increase risk of myocardial infarction.⁽¹⁾ Younger men with a history of heart disease had a two to three fold increase whereas those without such history had no excessive risk. Several other studies have also found this increase risk. A meta-analysis looking at several randomized control trails found testosterone therapy increases cardiovascular-related events in men; with the risk being greater in studies not funded by pharmaceutical companies.⁽²⁾ One small randomized control trial studying the safety and efficacy of testosterone in older men was halted due to excessive number of cardiovascular related events in the treatment group versus the placebo.⁽³⁾ These studies raise serious concerns amidst the growing trend towards aging men seeking and requesting to be put on testosterone replacement.

Intravenous (IV) Vitamin C is a popular adjunct treatment in cancer patients that is offered by many integrative practitioners, including naturopathic doctors as well as some medical doctors. Its efficacy has been in question over the years despite much supportive research. A recently published study in the journal Science Translational Medicine showed that vitamin c when supplied directly to ovarian cancer cells of both mouse and human killed off the cancerous cells while not affecting normal ones.⁽¹⁾ Their research also found when IV vitamin c was given in conjunction with chemotherapy in women with cervical cancer as well as in those with ovarian cancer, it decreased unwanted toxic side effects. Other studies including some case studies also show benefit, safety and tolerability of intravenous vitamin c when given alone as well as in conjunction with chemotherapy.^{(2, 3, 4)} Larger trials need to be conducted, however, funding for such research isn’t easily accessible. In the interim cancer patients should consider the addition of intravenous vitamin C in their treatment plan and discuss with their healthcare team if this adjunct treatment might be an option for them.

Iron deficiency anemia is the most common cause of anemia, affecting roughly two billion people worldwide.⁽¹⁾ It can cause low energy, weakness, frequent infections, dizziness, and can affect appetite, cognitive and motor development in the young. Though normally not thought of as a life threatening condition, a number of studies have found that iron deficiency anemia may increase risk of ischemic stroke. A recent study looked at data of 497 patients with hereditary haemorrhagic telangiectasia, a condition that puts them at risk of stroke by allowing clots to more easily travel to the brain.⁽¹⁾ Their data found those who were low in iron were more likely to experience a stroke, and that even moderately low iron appeared to double the risk of stroke when compared to normal iron levels. Platelets from those with low iron were also found to clot more quickly than normal. It follows other studies that have also shown a link between iron deficiency and ischemic stroke in both adults and children.^{(3, 4, 5)} A small case-control study published in Pediatrics assessed data in 15 previously healthy children without an underlying illness aged one to roughly three that were brought into the Hospital for Sick Kids due to a stroke.⁽²⁾ Their blood work was compared to that of 143 healthy children and found those with stroke were ten times more likely to also have iron deficiency anemia than their healthy counterparts. Iron deficiency accounted for more than half of all the stroke cases in these otherwise healthy children.

Fenugreek is an herb used in cooking by certain Asian cultures; it has also been used traditionally and historically to treat diabetes. A meta-analysis looking at several clinical studies on the effect Fenugreek seeds have on diabetic parameters has found support for it traditional use.⁽¹⁾ Studies assessed looked at fasting blood glucose, 2 hour post load glucose and HbA1c and overall found all parameters were significantly reduced in the treatment groups. Higher doses were found to have more significant effects on the fasting and 2 hour post-load levels. Another study showed fenugreek seeds had a significant ability to decrease fasting blood sugar, triglycerides and LDL when the administered after being soaked in hot water, they also found when given in a food such as yogurt there was no significant benefit.⁽²⁾ It is interesting to note that certain food may impair the ability of fenugreek to impart it benefits. Fenugreek also appears to benefit Type I diabetics. Defatted fenugreek seed powder administered in 50g doses at lunch and again at dinner were found to significantly reduce fasting blood sugar, improve glucose tolerance test and even reduce cholesterol and lipid levels in Type I diabetics.⁽³⁾ While studies are showing beneficial effect of fenugreek for diabetes, it doesn’t mean you shouldn’t run to the local health food store and start taking it on your own accord. Management and treatment of diabetes should always be monitored by a health care professional in order to ensure levels normalize without falling too low. Dangerously low blood sugar can happen quickly, especially in those taking medication and/or supplements or herbs, and can be deadly.

Perhaps surprising to many, the notion that a fever is best treated by being reduced is not one that is supported by solid scientific evidence. A recently published study presented evidence that the use antipyretics to suppress a fever due to the seasonal flu actually increase the number of cases of influenza by 5%.⁽¹⁾ In fact most of the research over the past 20 years in this area doesn’t showcase antipyretics as having much benefit. Not only does it increase spread of illness but often delays recovery time, increases risk of a secondary infection and can even worsen symptoms.^{(2, 3)} There is always great fear and panic around fevers and yet this is our natural built- in mechanism to fight unwanted invaders. Most viruses have a narrow temperature tolerance in which they survive and replicate. By increasing the body’s temperature, it can inactivate and kill such organisms. This adaptive response has been around for eons and isn’t limited to just us humans, it is seen throughout the animal kingdom.⁽⁴⁾ Although there are cases in which fevers can rise to dangerous levels and do require medical attention, including fever reducing meds, these are far and few between. Most infections and the subsequent fever that arises are not-life threatening^{(3, 4)} and the use of antipyretics for these cases are not supported by the research. So what should we do when we get hit with the flu? Stay home, rest, drink plenty of fluids, monitor your temperature and if in doubt always seek the guidance and care of a healthcare professional.

Proton Pump Inhibitors (PPIs) are one of the top 10 dispensed medications in Canada, with prescriptions that reached roughly 19 million in 2008. ⁽¹⁾ The widespread use of these drugs makes them that much more important to highlight, as they can adversely affect the health of many. Research over the past few years has brought to light numerous adverse effects of long term PPI use. From increased risk of pneumonia to acquiring Clostridium difficile infections as well as increased risk of osteoporotic fractures, ^{(2, 3)} these are just a few of the health concerns that can arise. They affect how other drugs get metabolized as well as how nutrients, such as calcium, magnesium, iron and vitamin B12, get absorbed. ^{(4, 5)} Inadequate levels of these nutrients can have significant effects on health and well-being. Insufficient calcium levels might present with neuromuscular symptoms of numbness/tingling, anxiety/depression, muscle tension, spasms or pain; low magnesium with arrhythmia, muscle weakness, spasms or cramps. Iron deficiency can present with heart palpitations, light-headedness/ dizziness, and often with generalized fatigue while B12 deficiency can present with numbness/tingling in the hands/feet, decreased cognitive function/memory issues, generalized weakness and fatigue. Most people on these medications, as well as others, aren’t forewarned about these effects and assume them to be safe and fine to take on a long term basis. The reality is medications come with side effects and almost always impact nutrient status.

Fibromyalgia is a disorder that brings about great debility and suffering for those that must deal with it. It is a diagnosis of exclusion that presents with widespread musculoskeletal pain, fatigue, poor memory and mood issues. There is much that natural medicine can offer. A recently published randomized control trial, the first in focused on fibromyalgia looked at the effect Vitamin D has on fibromyalgia suffers. ⁽¹⁾ It found that the individuals in the treatment group that received Vitamin D supplementation reported a marked reduction of pain when compared to the control group that received placebo. Other studies albeit with less strength have also supported the notion of inadequate vitamin d status in this group of individuals. ^{(2, 3)} It appears that the benefit increases as the blood levels of vitamin D reach more optimal levels. ⁽²⁾ As the studies continue to pile up in the area of vitamin d research, it is becoming more apparent that adequate levels are critical for so many areas of health. It is unfortunate that the routine measurement of vitamin d status is no longer covered by OHIP as so many are going undiagnosed with low levels. A minimum of 1000IU/day is needed to maintain an adequate level of vitamin D in the blood; ⁽⁴⁾ more is likely needed in those with very low levels. Best to see your health care practitioner, get your levels tested and supplement accordingly.

A Mediterranean diet pattern (rich in fruit, vegetables, whole grains, Omega-3 and -9 containing plant oils such as olive/flax/canola, fish, and low in trans fat, saturated fat, and red meat) has been reproducibly shown to achieve a long list of important health benefits, most importantly benefit to cardiovascular health, including reduced risk of death from sudden heart attack, and reduced risk of developing cardiovascular disease.⁽¹⁾Recently, a group of researchers assigned 522 individuals at high risk for cognitive decline to a contemporary low- fat diet or a Mediterranean diet rich in olive oil and nuts and followed them for 6.5 years. Participants assigned to the Mediterranean diet showed highly significant improvements to several markers of cognition and mental health. ⁽²⁾

A growing body of literature has shown vitamin D to be a useful tool in the fight against depression, used alone or in combination with prescription antidepressant medications.^(1,2,3) A recent study randomized 42 patients with depression to one of two groups: fluoxetine (Prozac) alone, or Prozac plus vitamin D (1500IU per day) for eight weeks. Using the Hamilton Depression Rating Scale as the primary outcome measure the study showed that vitamin D plus Prozac worked better than Prozac alone to improve depression symptoms. ⁽⁴⁾