Welcome Baby Bentham!

Jude Liam Bentham was born at 3:30 am on Christmas morning.  Here's the Coles' notes on how it all went down, with a pic of Chels with babe, and one of me right out of the tub!

Chels and I planned on having Christmas at her aunt and uncles in Cloverdale, 45 minutes outside of Vancouver.  Although we planned on staying the night, Chels started having some contractions around 8 pm.  We decided to come home for the night just in case.  At 10 pm the contractions were 10 minutes apart and not that painful.  By 1 am they were 4 minutes apart, lasted for over 2 minutes, and felt like grim death.  It was go-time. 

We met our Doctor (Kiran Nayar - she's amazing btw) at the hospital at 1:30 am and Chels was 3-4 cm dilated.  She hopped in the tub in the birthing suite which made her considerably more comfortable.  When they checked her cervix at 3:15 she was fully dilated.  She hopped back in the tub (I joined her this time) and after 14 minutes of pushing and screaming like she was lifting a bus off of a bunch of school children, out came our little man!  All 7 lbs 11 oz of him.

What a champ she was to blast him out in 2 hours!  Many thanks to the people of South Community Birth Program, and the people at BC Women's Hospital... especially to the kid who came in and played Christmas carols on his trumpet on Christmas morning!  We're thankful for all your support and care.  

Jude means (and I paraphrase) give praise and thanks to the Lord.  What a fitting name for a Christmas baby born in such a way - one that succinctly, in one syllable articulates exactly how we feel as parents.  

As for Jude, What can I tell you about him?  Well, thus far not much.  He likes boobs and sleeping.  That and he can't wait to meet you.

Chels - you're my hero,

Bryn

Had it happened this year...

This is how it may have unfolded.  Not really a medical topic, except maybe that it involves childbirth..  I just thought it was fun to watch.

Best,


B

Why I love December 21st.

Today is December 21st, literally the darkest day of the year.  In Vancouver, BC where I live, sunrise was at 8:05, and sunset is scheduled for 4:16.  This gives us a dreary 8 hours and 11 minutes of "sunlight".  This can leave many people feeling SAD, the apt acronym for seasonal affective disorder.  If this applies to you, then in times like these, you can use a boost, so I'll make three suggestions for you.

1.  Google image search the term "light therapy" and try to keep a straight face.  I particularly like the visor that beams lasers directly into your eyes.

2.  Consider investing in a light box.  Daylight stimulates your brain to release stimulating neurotransmitters, while darkness sedating ones.  Boosting the amount of time you're exposed to light can help give you that edge.  One trial showed that it was as effective as prozac for treating seasonal depression.  For specifics, consult with a health provider who has some knowledge in this area.

3.  The reason I love December 21st, is that from now until June, it's only going to get better!  We gain about a minute or so of daylight each day until the summer solstice.

If you want to nerd out on the science of light therapy, click here.

Warm Regards,

B

How can I get my baby to stop crying?

As I await the arrival of baby #1, I've been inundated with "advice" from friends and family.  Here's a link I was sent that features Dr. Harvey Karp - a pediatrician who claims to have some expertise in the area of calming colicky babies.  The basic gist is to help your baby feel like she did back in her happier days, ie in the womb.  It also showcases some inspiring hairstyles.

To anyone who has experience, any thoughts?

Do Epidural's result in more C-sections or birth complications?

As an expectant father, my wife and I have been attending prenatal classes in anticipation of our first little one. Over the last couple weeks the topics of discussion have largely centred around interventions commonly used in the birthing process. These include oxytocin, epidural anesthesia, forceps, vacuum extraction, and C-section among others. Fear and confusion tend to be the common sentiments of most of the expectant parents (ourselves included) and so the intent of this entry is to help bring some clarity and understanding.

As a physician shared and informed decision making is my goal when discussing treatment options with patients. In order to do this effectively, we need to have an understanding not just that treatment "A" will increase risk for outcome "B", but more importantly by how much will it be able to do so. For example, if someone were to tell you that taking an aspirin a day would decrease your risk of having a heart attack, you'd likely think you should do it, despite the fact that it can cause GI bleeding. But what if the amount that it decreased your risk was only by 0.5% (ie from 8% to 7.5% risk over the next 10 years)? Then, when faced with how small the benefit it, you may decide otherwise. The key is having some sort of context for quantifying the risk or benefit, not just a statement that something may help or harm.

In order to get some answers, I spent some time reading research articles that asked the questions "do epidurals increase the risk of needing more medical intervention", and "do epidurals result in adverse outcomes for mothers and babies?". Before discussing what I've found, I should state that as a Naturopathic Doctor I do not have expertise in the area of obstetrics, nor do I deliver babies. The research I've done is that of someone who has a personal interest in the questions being asked, and a reasonable amount of expertise in interpreting scientific data. I should also state that as a naturopath, my bias would be toward avoiding unnecessary interventions. I also want to state that the following discussion is for women who are on their first baby, and who are not induced. I'll do this in three sections: no difference category, increased risk category, and increased benefit category. That said, here we go!

1. No difference.

The higher quality trials I looked at, and the meta-analysis (a statistical pooling of a bunch of separate trials) suggest that there is no increased risk of having a c-section for women receiving an epidural. There was also no difference noted in neonatal outcomes as evidenced by their apgar scores. One study of interest looked at a hospital in Missouri that compared groups of women giving birth before and after the hospital gave on-demand epidural service. They found that monthly total c-section rates were the same before and after they were made available on demand, indicating that increased rates of epidurals didn't increase the total rate of c-sections. Interestingly, when they looked more closely at the patients who had epidural on demand, they found that the women who were having dystocia tended to be the ones that were asking for epidurals. What they concluded was not that epidurals increased rates of c-section, but rather women who were already having difficulty with their labour tended to be the ones who requested epidurals. In that instance, it was difficulty labouring that resulted in higher c-section rates vs the epidural being the cause. Another question of interest is will an epidural increase risk for long term backache? Again, no difference.

2. Increased risks.

As for increased risks from epidural anesthesia? The consensus among most of the studies I read were that epidurals did 2 things: 1 - prolonged the second stage of labour by an average of 15-30 minutes; and 2 - increased risk for needing instrumentation (forceps, or vacuum extraction). Estimates range from anywhere between a 25-38% increase in risk relative to those who don't have an epidural. That may initially sound high, but to get a sense of what that really means you need to know what the risk is to start with. For example, if in most normal circumstances the risk of needing instrumentation for delivery is about 10%, an epidural would increase it to between 12.5%-13.8% (10% base risk, plus 25% of that 10%, which is 2.5%). Think of it like money: if your initial risk is $10, and you increase that by 25%, your total risk would be $12.50.

Serious adverse events are also possible with any intervention, however these tend to be rare. One study in the UK looked at the previous 500,000 births involving epidurals. They reported 108 events, of which 5 resulted in a permanent disability.

3. Benefits.

Interestingly, when women are polled after their birthing experience, satisfaction rates among women tended to be higher in the groups that had epidurals.

Conclusions.

Through my cursory reading of some of the literature surrounding epidurals and childbirth, I've learned that epidurals are a reasonable and relatively safe form of coping with pain in labour. Although there are always risks associated with such interventions in the short term (many of which were not addressed here), overall they don't seem to increase the need for c-section in most normal circumstances, or cause serious long term complications to mother and baby. I hope this has helped dispel some confusion and quantify some of the risks. It certainly has for me.

Regards,

Bryn

What's the difference between wheat allergy, gluten allergy, and celiac disease?

There is confusion among many people surrounding the question of celiac disease, wheat and/or gluten allergy. Perhaps I can help shed some light.


First, Celiac disease is an autoimmune reaction that is triggered by exposure to gluten. What this means is that when your body sees gluten, it starts attacking itself - primarily in the small intestine, but also in other parts of the body. Symptoms can include bloating, chronic diarrhea, irritable bowel syndrome, constipation, skin rash, and other disease states such as anemia, hypothyroidism, and osteoporosis. Diagnosis can be tricky as there is no one perfect diagnostic test. There are a couple blood tests that are pretty good provided you've been eating gluten regularly for the couple weeks preceding the test. The other test is via a biopsy, where they actually go in to the small intestine and take a tissue sample. This is considered to be the "gold standard" among many clinicians, however it's still not 100%. A third option (and one gaining some momentum in the evidence circles) is to use a genetic test to aid in diagnosis. There are a couple genes that when present can give you an estimate of your lifetime risk of developing celiac disease (the DQ2 and DQ8 alleles). One of the benefits of this test is that if you DON'T have the genetics, you don't have celiac disease.


Second, food allergies and sensitivities (in this case wheat or gluten) can lead nebulous discussion on semantics. One type of allergy is the classic "eat a peanut and your throat swells closed and you die" type reaction. Those are well defined and understood. As for the rest, let's just call them "having an undesirable reaction to a food". These are less well understood, but still problematic for many people. For more info, see my previous post entitled "Are blood tests for food allergies a waste of time".


So given these two scenarios, what now? Barring laboratory diagnosis, a clinically useful option is to eliminate gluten (anything containing wheat, rye, barley, or oats) completely from the diet and to watch for symptomatic improvement. There is debate on how long one should abstain - anywhere from a few days to 6 months, but that should be tailored to the patient by the clinician depending on a number of factors. If there is an improvement in symptoms, that's your first clue. If not, it's not likely the culprit. If you notice an improvement, the next step is to challenge the food you suspect.


To distinguish between wheat and gluten as a problem, you can start by challenging rye or barley. These both contain gluten, but are not wheat - hence if you note a reaction, it's from the gluten. If that's ok, then challenge wheat. If that is a problem you have your answer. When challenging foods it's best to use that particular food in it's purest form ex/ cream of wheat (for wheat), or straight barley. This helpful because in bread for example, there are a number of other ingredients you may be reacting to. These types of diagnostic experiments are best done with the help of a health provider you trust, to ensure they're being done properly.


Since the treatments for allergies and intolerances are the same (avoidance of your problem food), does it really matter what one calls the problem?  In my opinion it does,  as accurate diagnoses are the hallmark of good medical care and decision making.  Food "allergies" and celiac disease have significant differences in long term health outcomes, so knowing what one is up against is an important step.


Speak soon,


B

Key Elements to an Effective Detox

Summary

In order to effectively rid your body of accumulated toxins, they need to be released from where they're hiding, processed by our liver, and eliminated from the body. The first requires calorie restriction, the second requires nutritional density, and the third requires optimal functioning of our organs of elimination. These include the skin (via sweating), kidneys (via urine), liver (through bile), colon (acting like a sewer), and lungs (through evaporation).

Details

Periodic "detoxes" as they have been come to know are a beneficial practice among those looking to kick start a healthier routine, or just hit their body's reset button. In order to get the most out of your experience you'll want to consider the 3 key elements: mobilizing the toxins from where they're hiding, processing them in the liver, and eliminating them from the body.

Many toxins end up getting stored in our fat cells. In order to get them out, you need to start burning that fat. That's why all "detox" protocols have one thing in common: calorie restriction. When you limit your energy intake, you start burning your fat, and the toxins move out in the blood and lymphatic system. This initial phase often shuffles the toxins around and people often experience headaches or flu like symptoms. Then next step is to make sure your body has the tools it needs to handle the impending toxic storm.

The liver has many roles in the human body, not the least of which is metabolizing toxic materials. What this means is taking something that is fat soluble, and making it water soluble so that it can make its way to the kidneys and out through the urine. This requires many nutritional co-factors. One common and effective way to get these is to incorporate fresh vegetable and fruit juices. Using carrots as an example, the juice of 5 or 6 carrots may only amount to a small glass of liquid, whereas if you were to try and eat 6 carrots, you won't have much room left in your stomach for anything else. Ideally you'll want to juice a variety of fruits and vegetables to get the full array of beneficial nutrients. There are also some products available on the market designed specifically for medical fasts that provide your body with a good mix of nutrients for the job. The downside to juices is that they tend to be high in sugar, and almost completely void of fibre.

Our organs of elimination are the final and in my opinion the most important component of any healthy detox regime. Without enhancing our ability to get rid of the toxins that have been mobilized and processed, they'll just get reabsorbed and redistributed in our bodies. The obvious organs are the kidneys - which produce urine; the colon - which acts more as a sewer system than anything else; the skin - which eliminates through sweat; the liver - which processes the toxins and makes bile to be eliminated through feces; and the lungs - through evaporation.

The kidneys are sensitive organs and susceptible to damage by heavy metals and other toxins. In order to help them out, drinking at least a couple litres of clean water will help ease their burden. Also, since sweat is essentially just a more dilute version of urine, the skin serves as a large, nearly indestructible extra kidney if you know how to use it. Saunas and exercise are great ways to get sweating. Public saunas are often too hot to tolerate any longer than a 10 minute sweat, which isn't sufficient to get the toxins flowing out. if you can keep the temperature between about 140-180 F, it will be much more tolerable for longer periods. If using a sauna is an option for you, be sure to hydrate with electrolytes to prevent dehydration.

As for the liver/colon connection, fiber is the key. Bile from the kidney enters the sewer superhighway (colon) en route to entering the real sewer through the toilet. If there's no fiber in the colon, it's unable to keep things moving and the system slows down. The toxins pumped into the colon from the liver will get broken down by bacteria and reabsorbed into the body. To prevent this, we need to make sure we're getting fibre. My recommendation for the juice fasters is to eat some of the pulp they get from their juicing. This helps bind up the toxins in the feces and carries them out of the system.

The lungs are helpful to eliminate certain types of toxins through evaporation. Clean air and deep breaths are the keys here.

In conclusion, occasional detoxes are a very beneficial practice for your health. Although this article provides an overview of the principles, medically supervised detoxification is optimal. Discerning physicians are able to identify the best course of action based on your exposures to target the specific toxins that are likely to be problematic for you.

Are blood tests for food allergies a waste of time?

This is a question that came up last week when talking to a friend with some digestive issues surrounding specific foods. It's a bit of a complex topic, so I'll try to boil it down to the basics.

First of all, the term "food allergy" can manifest in different ways. It's like saying "vehicles". There are cars, which are common and generally well understood, but there's also helicopters, airplanes, and hovercrafts that we don't see everyday and most people don't have a clue how they work.

The first category of food allergies (lets call them the cars) are the classic ones that are mediated by histamine. They develop rather quickly and produce symptoms in the skin (hives, swelling), the gastrointestinal tract (nausea, vomiting, diarrhea, itchy mouth), and in the cardiopulmonary system (anaphylaxis). Peanut allergies are a common example. Respiratory allergies such as hay fever are mediated by the same mechanism.

The other category (helicopters and hovercrafts) is mediated by another class of antibodies called IgG. I like to think of these as personalized "kick-me" signs that your body makes for each foreign invader it has seen before. Of all the antibody classes, these are the most abundant in the body and their job is to activate the immune system to destroy the invader quicker than the first time you were exposed. So how are these related to food?

Although the human gastrointestinal tract was once thought of an impenetrable brick wall, the reality is that it can become damaged, and partially digested food comes in contact with the immune system. This can result in the body making the "kick me" signs against food proteins. Upon subsequent encounters, these food particle/"kick me sign" complexes clump together and circulate around and eventually deposit themselves somewhere, producing a myriad of symptoms that can seem totally unrelated to your GI system. These include skin rashes, fatigue, joint pains, and many others. This form of allergy is less well understood and the symptoms can be less predictable. It is also not yet an exact science.

As for the food allergy testing, the first type is done by most allergists by skin-prick testing. The second type (IgG) is done from the blood, usually ordered through specialty labs. The bottom line is that the tests have yet to be perfected and a lot hinges on the specific lab's methodology. No test is perfect, and this is certainly no exception. That said, they can provide a doctor with some useful information. For example, perhaps someone tends to show reactivity to oranges and grapefruits, suggesting that the whole citrus family may be problematic for them. In another case, someone may show reactivity to almost all foods on the panel. This would indicate that their digestive tract has become leaky (for lack of a better word) at some point, and they need to start by healing it. If nothing else, they provide a starting point for doing a clinical food elimination and re-challenge, which is after all the most certain way of identifying problematic foods. A recent review was published out of John's Hopkins University School of Medicine came to a similar conclusion - though diagnosing food reactions remains a challenge, IgG food allergy panels have shown promise for directing elimination diets, with clinically meaningful results.

Long as this post has become, it is far from comprehensive. If you suspect you have difficulty with some foods, I recommend seeing a medical professional with expertise in this area.

Regards,

Bryn

Is flax oil as good a source of omega 3's as fish oil?

The importance of Omega 3 fatty acids was first noted in inuit populations who ate a high fat marine diet, and yet had no cardiovascular disease. We've since learned that it was the nature of the fats that was responsible for the protective effects. It is now known that they are also important in brain development and our ability modulate inflammatory processes, which is the basic foundation of most diseases.

While it is true that flax oil does contain omega 3 fatty acids, they are not the same as those found in fish oils. The bottom line is the flax versions need to be converted in the body to the DHA and EPA, which are the beneficial omega 3's found in fish oil. Unfortunately this is an inefficient conversion at best, estimated to be between 5-20%. Flax is still a useful source, however it will not have the same therapeutic effects as the oils found in cold water fish. There are a few things to keep in mind when it comes to getting your fish oils.

1. Sources should come from small, cold water fish. The cold temperatures is what causes the fish to make omega 3's to prevent their cell membranes from freezing (think of butter in the fridge vs olive oil - butter is solid, olive oil is fluid). Also, the older and larger the fish, the more time it has been spending accumulating mercury and other toxic residues in it's fat tissue. Tuna is a well known example of a fish to limit/avoid because of it's mercury content. Good sources include sardines, herring, anchovies, cod, and salmon. Incorporating these into the diet is helpful, and in my opinion, the way we were meant to get them.

2. Supplements: You get what you pay for. When purchasing supplements, look at the label and see what fish they extracting the oils from. Also, look for EPA and DHA content. If all it says is "Fish oil" and/or it doesn't list the sources, it's best to move on. Although not required, some manufacturers test each batch for quality and heavy metal content, which is a huge advantage. With regards to supplements, one caveat - if you're pregnant, beware of cod liver oil. For most other people it's great, because it has vitamin A and D, which are both important. Vitamin A can be toxic to fetuses though, and should be avoided in pregnant mom and infants under the age of 1.

3. Omega 3 to Omega 6 ratio. A healthy balance between the two are optimal, and our culture tends to have an overwhelming abundance of 6 and a deficiency of 3. So, when considering supplementing, avoid ones that contain omega 6 and or 9 as well - they compete for the same enzymes as omega 3's, and just get in the way. Fatty acids are what make up our cell membranes. As you can imagine, there are a lot of them in our body! it takes time to shift the balance in favour of the omega 3's, but it's well worth it.

Warm regards,

Bryn

Today's task? Eat blueberries.

Blueberries are a personal favourite, and they happen to be in season. They have a lot going for them and if you want to start cultivating a healthy habitus, they provide an easy place to start. Without nerding-out (ok, maybe a little) on biochemistry, here's why:

Anthocyanin's are the blue-red pigments that give dark berries their colour. These pigments are at work to protect the fruit from oxidative damage from the sun, and to prevent them from breaking down. The result is that they're very high in antioxidants (one study estimates 20-50 times as powerful as vitamin C and E), which is what's responsible for many of the benefits listed below.

So here's what the blueberries will do for you:

1. Anti-aging, through it's antioxidant effects. It helps keep connective tissues strong and elastic.

2. Obesity, diabetes, and metabolic syndrome. A recent study compared rats fed high fat diets with or without blueberries for 3 months. The rats with the blueberries had less abdominal fat, lower cholesterol, lower triglycerides, and lower blood sugar and insulin levels than the ones eating the fat diet alone. The results were even better for rats on low fat diets and blueberries (no surprise there).

3. Preserve vision. The coloured pigments from fruits and veg help make up the part of our retina that is responsible for vision. Blueberries (and the like) have been shown to prevent age-related visual degeneration.

4. Brain function. Studies have shown that they can help improve memory and cognitive function. For you young ones out there, this (as many of these other benefits) is most effective if consumed regularly over the course of a lifetime rather than trying to play catch-up later in life.

5. Cancer prevention. Other compounds in the berries have cancer preventative and anti-cancer effects. I'll spare you the details.

6. Heart health. The combination of high fibre and antioxidants can help lower the bad cholesterol. They also enhance the quality of your blood vessels. It will make them stronger and more elastic through its' antioxidants; and can also help lower blood pressure.

7. Better elimination. And yes, I do mean dumps. 1 cup of blueberries contains about 15% of your daily intake of fibre. In addition to the number 2's, blueberries contain d-mannose, which is the same component responsible for the cranberry's effects on urinary tract infections. The d-mannose interferes with certain bacteria's ability to cling to the bladder and urinary tract wall. This helps prevent them from climbing up and infecting the bladder.

In conclusion, the kicker with blueberries (and why they're today's topic) is that they demonstrate an important concept - nutritional density. They have very high levels of nutrients, and yet are very low in calories. This is a concept we will likely revisit in the future.

Hope all is well,

B

For more information about this and other healthy foods, http://www.whfoods.com is a great resource.

Vitamin D and pregnancy

A curious mother-to-be in a recent prenatal class asked how much vitamin D she should be taking during her pregnancy. First of all, this was a great question as it calls into question the importance of Vitamin D for everybody, not just pregnant mothers. Our understanding of the "vitamin" has expanded greatly in recent years. Previously it was mainly implicated in calcium regulation and bone health, and the recommended daily amounts were set with that function in mind. It is now understood that contrary to it's name, vitamin D is actually a steroid hormone that has direct effects on our immune system, pancreas, cardiovascular system, brain, muscle, and cell cycle regulation (whose dysregulation is central in the development of cancer). The previous recommendations for adequate intake are not sufficient to positively affect these other systems. Thus, it's deficiency has been linked to development of many chronic diseases including multiple sclerosis and cancers (breast, colon, prostate, ovarian, lymphomas, among others).

As with most medically related questions, there's no blanket answer that applies to every person. Factors such as ethnicity, age, sun exposure, and season all affect a person's vitamin D status. Here are the important factors to consider when contemplating supplementing this important vitamin:

1. Get your vitamin D levels checked by a health professional (Naturopath, MD, Nurse practitioner) who is up to date on current standards and recommendations. This is the BEST way to determine how much you need, and for how long. Each persons circumstances are different and individualized care is ideal.

2. Season. Here in British Columbia, even if it were sunny 365 days/year and you spent the entire year stark naked at Wreck Beach, the UV index wouldn't be high enough to generate Vitamin D most of the year. June-August are great, but beyond these months it's just not strong enough. Throughout the late fall - early spring, it's most likely a good idea to supplement Vitamin D. In the summer time, 10-15 minutes of midday sun can provide you with about 3 days worth of vitamin D.

3. Skin tone. Melanin is the pigment in skin that makes it dark. In dark skinned individuals this reduces their ability to produce Vitamin D from sunlight.

4. The safe "Tolerable Upper Intake Level" established by the Food and Nutrition board of the National Research Council (in the USA) is 2000 IU per day. That's to say healthy people taking 2000 IU/day are unlikely to experience any adverse effects. Although some now are considering this to be too low, it is a well established level that would apply to most people north of California.

5. Vitamin D3 is a more active form than D2, so go with that one if given the choice. Also, it is a fat soluble vitamin, which means that if you take it with food that contains some fat (olive oil, etc..) it will help your body absorb it. For the pregnant mothers out there, be cautious with some food sources of vitamin D, as some can be harmful to the fetus. Cod liver oil for example, contains large amounts of vitamin A (which is also a steroid hormone) that can cause birth defects.

In conclusion, I want to reiterate the importance of consulting a health professional for specific advice regarding dose and form. The information presented here is intended educate on the importance of vitamin D, and to provide some basic understanding on how we get it. Hope this has been helpful,

B