The endocannabinoid system. This term sounds complex, but it is actually just what it sounds like: the body’s internal (“endo”) system that responds to cannabinoids. The endocannabinoid system (ECS) is so named because it was first discovered when scientists were studying the effects of cannabis on the body.1 The ECS is perhaps most notable for its role in regulating the limbic system, a part of the brain responsible for emotions, motivation, and our stress response. This system responds to our body’s own endogenous cannabinoids, anandamide and 2-AG, and to exogenous cannabinoids. A well-toned endocannabinoid system can help us recover from major stresses, prevent stress-related overwhelm, regulate cortisol levels, and will naturally increase during times of stress.
Here are a few ways you can boost your body’s own production of endocannabinoids, and ways to supplement to further support your ECS.
A randomized-controlled study showed that massage and osteopathic manipulation greatly increased levels of endocannabinoids in the blood.2 Another reason to get a massage!
A type of acupuncture called electroacupuncture has been shown to increase levels of anandamide in the blood.3 Acupuncture also supports your hypothalamic-pituitary axis (HPA) by reducing the amount of the stress hormone cortisol.
- Dark chocolate
Dark chocolate contains anandamide, one of the cannabinoids that our body produces even on its own. Anandamide is named after “ananda” the Sanskrit word for bliss, which comes as no surprise to chocolate lovers. Chocolate also contains N-acylethanolamines which are thought to activate our body’s cannabinoid receptors.4
Medium to high intensity exercise increases endocannabinoids and activates the cannabinoid receptors in your body—making you more responsive to the signals your body is making!5
- Alternating hot and cold
Try ending your shower with a full minute of cold water. The rush of cold is not only energizing and good for your circulation, but it increases endocannabinoids and activates their primary receptor CB1.6
Orgasm has been shown to increase levels of endocannabinoid 2-AG, or 2-arachidonoylglycerol. 2-AG activates the CB1 receptor, which is associated with pain, cognition, fear, and emotion.7
- Omega-3 Fatty Acids.
Oils that are rich in omega-3 fatty acids like cold water fish are well-known for their anti-inflammatory and neuroprotective properties. These fatty acids also serve as precursors to endocannabinoids, which our body readily converts to help our ECS.8
- Botanical medicines
Even common kitchen spices can play a role in the ECS. Nutmeg, for instance, supports the ECS by slowing down the rate at which endocannabinoids are broken down by the body’s enzymes.9
Black pepper also boosts natural endocannabinoids by decreasing their reuptake, thus making more available to your body for longer.10 Other plants have phytocannabinoids, too, including electric daisy, echinacea, and chocolate.11
Probiotics, namely Lactobacillus acidophilus, increases expression of cannabinoid receptors in the gut. In one study, L. acidophilus’s effect on the endocannabinoid system and on endogenous opioid receptors led to a decrease in abdominal pain in people with irritable bowel syndrome.12
Cannabidiol, or CBD, is one of the most direct ways to support the endocannabinoid system. CBD is a non-psychoactive phytochemical derived from cannabis. It has been very well-studied in the treatment of seizure disorders and is known to have a balancing effect on the central nervous system. If you are considering using CBD, please consult with a licensed medical provider for information on dosing and to review possible medication or supplement interactions.
- Gaoni Y, Mechoulam R. Isolation, Structure, and Partial Synthesis of an Active Constituent of Hashish. J Am Chem Soc. 1964;86(8):1646-1647. doi:10.1021/ja01062a046
- McPartland JM, Giuffrida A, King J, Skinner E, Scotter J, Musty RE. Cannabimimetic effects of osteopathic manipulative treatment. J Am Osteopath Assoc. 2005;105(6):283-291.
- Chen L, Zhang J, Li F, et al. Endogenous anandamide and cannabinoid receptor-2 contribute to electroacupuncture analgesia in rats. J Pain Off J Am Pain Soc. 2009;10(7):732-739. doi:10.1016/j.jpain.2008.12.012
- James JS. Marijuana and chocolate. AIDS Treat News. 1996;(No 257):3-4.
- McPartland JM, Guy GW, Di Marzo V. Care and feeding of the endocannabinoid system: a systematic review of potential clinical interventions that upregulate the endocannabinoid system. Plos One. 2014;9(3):e89566-e89566. doi:10.1371/journal.pone.0089566
- Krott LM, Piscitelli F, Heine M, et al. Endocannabinoid regulation in white and brown adipose tissue following thermogenic activation. J Lipid Res. 2016;57(3):464-473. doi:10.1194/jlr.M065227
- Fuss J, Bindila L, Wiedemann K, Auer MK, Briken P, Biedermann SV. Masturbation to Orgasm Stimulates the Release of the Endocannabinoid 2-Arachidonoylglycerol in Humans. J Sex Med. 2017;14(11):1372-1379. doi:10.1016/j.jsxm.2017.09.016
- McDougle DR, Watson JE, Abdeen AA, et al. Anti-inflammatory ω-3 endocannabinoid epoxides. Proc Natl Acad Sci. 2017;114(30):E6034-E6043. doi:10.1073/pnas.1610325114
- El-Alfy AT, Joseph S, Brahmbhatt A, Akati S, Abourashed EA. Indirect modulation of the endocannabinoid system by specific fractions of nutmeg total extract. Pharm Biol. 2016;54(12):2933-2938. doi:10.1080/13880209.2016.1194864
- Reynoso-Moreno I, Najar-Guerrero I, Escareño N, Flores-Soto ME, Gertsch J, Viveros-Paredes JM. An Endocannabinoid Uptake Inhibitor from Black Pepper Exerts Pronounced Anti-Inflammatory Effects in Mice. J Agric Food Chem. 2017;65(43):9435-9442. doi:10.1021/acs.jafc.7b02979
- Shunney A. Intro to CBD. Therapeutic Value and Pharmacology of Exogenous Cannabinoids. NDNR.; 2018.
- Rousseaux C, Thuru X, Gelot A, et al. Lactobacillus acidophilus modulates intestinal pain and induces opioid and cannabinoid receptors. Nat Med. 2007;13(1):35-37. doi:10.1038/nm1521
- Felice J. Endocannabinoid System. NDNR.; 2018.
With the menopause transition comes a change in estrogen levels. That change affects just about EVERYTHING, including sex. Estrogen is responsible for keeping the tissue of the vagina moist and well lubricated. It keeps this tissue plump and healthy and even helps keep the good bacteria in the vagina healthy! When estrogen levels decline, the tissue in the vagina can become dry, thin, less lubricated and less elastic, all of which can cause sex to feel painful or cause a burning or tearing sensation. For some, this pain can be significant enough to deter all interest in sexual activity. Fortunately, there are many things that can be done to protect this tissue and to keep sex (touch and/or penetration) comfortable.
Vaginal moisturizers and lubricants are the first options to consider but the two are quite different from each other. We can think of vaginal moisturizer similarly to lotion that we use on the rest of our bodies when we have dry skin. The purpose of a vaginal moisturizer is simply to provide moisture to vaginal tissue and should be used on a regular, even daily basis. Lubricants are used to increase pleasure and decrease friction with sexual activity. They are typically made in a base of water, oil, or silicone but some brands can have some less desirable additives such as parabens and petroleum so make sure to read the labels, because there may be some undesirable short and long term effects of these two ingredients.
Ideally, your lubricant will have a pH that is similar to that of the vagina helping to keep your vagina healthy and balanced. If vaginal moisturizers and lubricants are just not doing the job, we have other options! Lose-dose, select hormones applied directly to the vagina and/or vulva can often provide substantial benefit to the local tissue.
Research strongly supports the use of either vaginal estrogen or DHEA (Dehydroepiandrosterone) low-dose hormones for the treatment of vaginal dryness. Fortunately, very little of these low-dose hormones are absorbed into the blood stream, which makes them a good option for a wide range of women. There are even vaginal estrogen products and vaginal DHEA products that are considered safe for some breast/endometrial/ovarian cancer patients. However, if you have a history of breast or other hormone sensitive cancer it is always best to speak with your doctor prior to attempting any hormone therapy. It is also important to note that there are numerous methods by which these hormones can be delivered including: suppositories (large and small), creams, tablets, and rings. Having this variety of options allows clinicians to individualize the treatment to find the best delivery method for you. Finally, regular sexual activity can help maintain healthy blood flow to the genitals, which diminishes with the loss of estrogen. Remember, sexual activity does not always have to be between two people and self-administered sexual activity also is relevant to the topic at hand.
We know that vulvo-vaginal changes with menopause are very common. Over 30 million women in the US have symptoms of vaginal dryness, irritation, and pain with sex. But pain with sex isn’t always due to a feeling of dryness. The decrease in estrogen can lay the groundwork for noxious microbes to grow, which may lead to vaginal infection. Most commonly, women can develop bacterial vaginosis or yeast vaginitis both of which can have unique symptoms of discharge, irritation, and even odor. Infections like these can leave this already delicate tissue feeling raw and very irritated, making sex or even the thought of it, out of the question. If you feel you have a change in vaginal discharge or new vaginal irritation, it is best to see your provider for appropriate evaluation and treatment. Similarly, to the increased potential for vaginal infections with the menopause transition, there can also be an increase in urinary tract infections (UTIs). Estrogen therapy can be quite supportive to the urethral tissue, decreasing risk for UTIs and can even help prevent annoying urinary leakage.
Of course there are other causes of pain with sex, which may be the case for women who describe their pain with sex as deep pelvic pain. For starters, the muscles of the pelvic bowl are subject to “knots” or trigger points just like the muscles in our neck and shoulders when we are under stress. Penetrative sexual activity can further irritate these trigger points causing pain. Specialized physical therapists with training in pelvic floor physical therapy can often provide great relief to women in this situation. Additionally, pelvic organ prolapse (a feeling of the vaginal or rectum falling out) can cause sex to be uncomfortable. Pelvic organ prolapse is often noticed in the menopause years and is usually associated with prior pregnancy. Depending on the severity, this displacement of tissue may be addressed by pelvic floor physical therapy but in some cases might require surgery. Other factors like vulvar skin disorders, scar tissue from previous abdominal surgeries, endometriosis, inflammatory bowel disease, chronic pain syndromes, or other medical condition may also contribute to pain with sex.
Of special note, psychosocial elements can most assuredly play a role in pain with sex. People who have a history of trauma may also have pain with sex. This pain should be evaluated just like any other reported pain and amongst other treatments may also benefit from counseling support.
Whatever the cause, if you are experiencing pain with sex, check-in with your women’s health provider so it may be appropriately assessed and treated.
A Woman’s Time Clinical Note:
At our clinic, we have not only special expertise in this area of gynecology/women’s health, but we offer both conventional and natural treatment options.
Dr. Erin Conlon is accepting new patients for this specialty area of women’s health.
Roughly 75% of reproductive aged females will experience at least one vaginal yeast infection (vulvovaginal candidiasis or VVC), with half of them developing a second episode at some point. Additionally, between 5-9% of these women will go on to develop recurrent vulvovaginal candidiasis, meaning numerous episodes over the course of a year.
Vulvovaginal candidiasis is clearly noted as one of the most common vaginal infections experienced by women of childbearing age with symptoms that are very familiar to many of us. Symptoms of VVC often include vaginal and vulvar itching, burning, irritation, pain with intercourse, and a thick, white discharge. Unfortunately, symptoms of VVC often overlap with other vulvovaginal conditions and thus are often assumed to be VVC when in fact they are a constellation of symptoms attributable to another condition. Furthermore, it is not uncommon for individuals to have more than one microbe responsible for the upset within her vaginal ecosystem. For these reasons it is important for women experiencing vaginal symptoms to be evaluated by a provider so that objective testing may be used to decipher the precise cause of imbalance. Such testing may include vaginal pH evaluation, microscopy, culture, or testing for fungal DNA.
There are numerous factors that play a role in the development of recurrent VVC. For example, an increased estrogenic state such as that seen in pregnancy or achieved with use of oral contraceptive pills may increase the risk of a patient developing VVC. The use of antibiotic medications should be considered as a potential risk factor for a woman developing VVC as it likely alters the vaginal microbiota. While I am in no way advocating against the above listed medications, I am encouraging a heightened awareness of VVC in persons with these conditions or using these medications. Additionally, persons with compromised immune systems are often at heightened risk for the development of recurrent VVC. Although most women with VVC do not have the following conditions, individuals who have been diagnosed with diabetes, human immunodeficiency virus (HIV), or who routinely take glucocorticoids or immune suppressing agents may experience recurrent episodes of VVC
Conventional treatment of VVC generally includes an anti-fungal agent, often one that falls into the azole class of medications, such as oral fluconazole or topical miconazole. Although there are numerous additional options within the azole class, additional classes of antifungal medications are few. These limited treatment options have presented a challenge, as there are increasing numbers of cases of azole resistant candida.
Candida albicans is the predominant culprit with VVC, however, several other species of yeast may contribute to symptoms. Knowledge of the distinct species may be helpful in selection of treatment as not all species of candida are susceptible to the same methods of treatment. For example, Candida glabrata is generally not impacted by the use of azole medications but will often respond favorably to a course of vaginal boric acid. Evidence suggests that the use of boric acid 600 mg used intravaginally daily for two weeks may be helpful in the resolution of VVC in cases where non-C. albicans strains have been detected. One study in women with diabetes indicated greater VVC cure rate of C. glabrata with use of vaginal boric acid 600mg for 14 days (63% cure rate) than a single-dose of oral fluconazole 150 mg (28% cure rate). These findings further advocate for knowledge of specific strains prior to treatment.
There are various boric acid regimens depending on the severity of the infection, recurrence, and an individual’s health history. And while it may be enticing to attempt treatment with boric on one’s own, it is best to seek care from your women’s health provider. It should be noted that it is possible that boric acid used vaginally may result in temporary irritation to vulvovaginal tissue. In such instances, a topical barrier salve or ointment may be used to protect the tissue. With regards to safety, boric acid should be avoided during pregnancy and it must not be consumed orally, as it can be fatal.
The take away:
- Vulvovaginal yeast infections are common but so are other vaginal infections.
- It is important to see your women’s health provider for appropriate evaluation of vaginal discharge or vulvovaginal irritation.
- There are numerous methods by which VVC may be treated but specific treatment protocols are dependent upon the type of infectious agent as well as a person’s health history.
June was National Safety Month and it brings to mind an important form of safety that is different from wearing seat belts, applying sunscreen or not talking to strangers. Challenges with mental health, such as those caused by depression, are a significant factor to consider when ensuring a child’s safety.
This article briefly lists the risk factors, presenting signs, screening tools and management of pediatric and adolescent depression. It does not replace a conversation or evaluation with a healthcare provider. Please consult with you doctor as soon as possible if you believe your child or teenager may be struggling with depression and/or anxiety.
Risks for childhood and teen depression include family history of depression, bipolar disorder, suicidality, substance use, or other psychiatric illness.
Other risk factors include:
– history of trauma, personal or family abuse
– adverse events, stressors, neglect or major transitions in the family
– struggles with gender or emerging sexual identity
– having witnessed a natural disaster
– hormonal or metabolic imbalances
Depression appears in a variety of ways and many of the symptoms overlap with other health conditions. I highly recommend speaking with a doctor first before diagnosing depression yourself- a trained eye can identify if there are other causes for your child’s symptoms other than, or in addition to, depression.
- Depressed or irritable mood
- Loss of interest or pleasure in almost all activities
- Weight change, failure to achieve expected weight gain
- Sleep disturbance- sleeping too much or too little
- Fatigue, low energy
- Feelings of worthlessness, excessive guilt
- Decreased concentration, inability to make decisions
- Suicidal ideation or thoughts of death
Often, a brief conversation during an office visit can serve as an appropriate screening. If your child is a teenager, the doctor may ask to spend some time alone with them to create a safe, confidential space for discussion.
One tool used in screening for depression is the Patient Health Questionnaire-2 item screen (also known as the PHQ-2). Each question receives points for the following answers: “not at all” (0 points); “several days” (1 point); “more than half the days” (2 points); and “nearly every day” (3 points).
Over the past two weeks, how often have you been bothered by any of the following problems:
- Little interest or pleasure in doing things?
- Feeling down, depressed, or hopeless?
Patients who score 3 or more on the PHQ-2 should undergo additional assessment for depressive disorder with a mental health specialist.
Conventional treatment for depression typically starts with a referral to psychotherapy, either performed by a counselor, cognitive behavior therapist or in group therapy. More advanced cases of depression may require pharmaceutical management, often with SSRI’s (selective serotonin reuptake inhibitors).
Naturopathic medicine has various additional and well-researched therapies that address depression, these include targeted nutritional, herbal and nutraceutical support, lab testing to identify metabolic and/or neurotransmitter imbalances, mind/body tools and much, much more. Each treatment plan is individualized to treat your child’s unique needs and presentation.
Intuition and Observation
I encourage you to seek medical attention at the first sign of a mental health disorder in your child. Your intuition is a powerful tool- it can detect disturbances or patterns in your child’s behavior well before depression develops. Trust these feelings and discuss them with a doctor that will acknowledge and address your concerns.
Imagine running through a field of tall grass and wildflowers, arms spread wide, sunshine on your face and the breeze blowing in your hair. That may sound like an afternoon well spent! For many of us however… the scene I described just sounds like an allergy nightmare! What can one do to start enjoying the outdoors again?
Hay fever is very common among the general population. Most of us know the symptoms- stuffy or runny nose, itchy red eyes, brain fog, sneezing, headache and even sinus pressure. An underlying immune signal stimulates these processes. It involves an antibody named immunoglobin E (or IgE for short).
IgE travels through our body by circulating in our blood, and when it encounters an immune cell called a mast cell- it causes the mast cell to release histamine. It is this histamine release that triggers fluid buildup in our nose, makes our eyes itch and can even make our skin itch.
Conventional treatments work by suppressing histamine release- most of the allergy meds available over-the-counter at the pharmacy are called anti-histamines. They’re available as pills, liquid (usually for children) or nose sprays.
In naturopathic medicine, we offer similar quick-fixes but the foundational treatment is to find the root cause of your allergy symptoms and work from there. We often prescribe rapid-acting treatments specific to your symptoms, then make specific recommendations for long-term prevention of future allergies (and so much more!).
Naturopathic Approaches to Seasonal Allergies
If you find yourself immersed in a full-blown allergic state, our quickest-acting natural medicines use ingredients like freeze-dried nettle leaf, quercetin, vitamin C, bromelain and a unique strain of probiotic called lactobacillus L-92. These begin acting right away and are usually required at higher doses than average during an acute allergic flare.
Other natural approaches focused toward preventing future flares include supplementing with omega-3 fatty acids, probiotic blends and various lifestyle modifications. More intensive strategies will be needed for some individuals that address some specifics of the immune system, and in particular the gastrointestinal tract and the lining of the small intestines where much of the status of our immune system is determined.
Lifestyle recommendations for preventing allergies may include:
- changing out of outdoor shoes and clothing upon entering your home
- keeping pets and outdoor gear off the bed
- keeping the bed covered during the day (with a thick blanket) and uncovering it for sleep
- running an air filter in the bedroom
- frequent washing, dusting and cleaning of the home to prevent dust buildup
Testing is also an option to identify which pollens or environmental exposures you may be allergic to. This usually involves a blood draw to analyze your immune system’s antibodies.
Lastly, a cornerstone to every naturopathic treatment plan is to address and optimize nutrition. The foods we eat and how we eat them have an immense impact on almost every aspect of our health, either positively or negatively.
Vaginal discharge? Vaginal irritation? Odor? What to do? Vaginal infections are exceedingly common. In fact, they are so common that the majority of women will experience at least one in her lifetime. Vaginitis complaints are responsible for roughly 10% of doctor visits each year, amounting to nearly $10 million in annual costs.
Outlined below are the major causes of vaginal infections, associated complications, and how they are identified and treated.
The majority of vaginitis cases in women of childbearing age can be attributed to bacterial vaginosis (BV), yeast vaginitis, and trichomoniasis.
Bacterial vaginosis (BV) is the most common cause of infectious vaginitis, and is characterized by white, thin discharge with a fishy odor, and elevated vaginal pH that is often attributed to an imbalance of normal vaginal bacteria. Some women note symptoms are worse after intercourse or menses, while others experience no symptoms at all. It is important to treat symptomatic BV because this disruption in vaginal flora has been shown to increase risk for acquiring and transmitting sexually transmitted infections (STIs). Additionally, BV can lead to poor pregnancy outcomes. Your provider can diagnose this condition after doing a pelvic exam and collecting a sample of vaginal fluid. Conventional treatment primarily includes oral or vaginal antibiotics. Natural agents such as boric acid suppositories, vitamin C suppositories, and very specific species of probiotics may be sufficient in some cases or may augment conventional treatment in other cases. Unfortunately, BV recurs in as many as 58% of women who were previously treated and experienced resolution. For these cases we can look to other factors that may influence the existence of BV like biofilms that can harbor bacteria, preventing adequate exposure to antibiotics. Additionally, douching, low vitamin D status, smoking, diet, and stress may play a role in development and recurrence of BV.
Yeast vaginitis is also known as vulvovaginal candidiasis (VVC) and can cause symptoms of itching, burning, pain with intercourse, red and inflamed tissue, along with a yellow-white “cottage cheese” discharge. The most common culprits are Candida albicans (80–90 % of symptomatic cases), Candida glabrata (2–5 %), and Candida krusei (1-2 %). VVC is one of the most common vaginal infections – responsible for 40-50 % of all vaginal infections. About 75% of reproductive aged women will experience at least one episode of VVC. Unfortunately, up to 50% of these women will develop a second infection of VVC and up to 5% will become recurrent cases. Conventional treatment includes oral or local antifungal and restoration of the vaginal microbiota. In addition to conventional treatments, Naturopathic physicians may use botanical/nutraceutical antifungal agents to re-establish normal vaginal flora, as well as address gastrointestinal function and flora and many other risk factors for development and recurrence of VVC, namely, diet, lifestyle, and co-morbid conditions.
Trichamoniasis symptoms can range from none at all to including a thin, foamy, yellow-green discharge, vaginal itching, burning sensation or odor, pain with urination, lower abdominal pain, and irregular spotting especially after penetrative intercourse. Your doctor will do a pelvic exam and in addition to the discharge, may see red spots on your cervix, a presentation that is referred to as “strawberry cervix,” although this finding is rare. During the examination, your provider will likely take a sample of the discharge for testing and will likely note an elevated vaginal pH greater than 5. If trichamoniasis is confirmed, you will be prescribed an antibiotic to treat the infection. And since trichamoniasis is a sexually transmitted infection (STI), it warrants testing and treatment of your sexual partner as well.
Aerobic vaginitis (AV) is caused by aerobic bacteria, for example: Staphylococci, Streptococci, E. coli, E. faecalis, to name a few. Symptoms include vaginal redness, inflammation, and burning with a persistent green, yellow, gray discharge, and elevated vaginal pH. Your provider will test a sample of the discharge and if aerobic bacteria are confirmed, treat with antibiotics that are specific to the pathogenic bacteria and steroids for inflammation. A naturopathic approach can include the use of the antibiotics along with vaginal ecology restoration with select species of probiotics along with supporting overall immune health.
Mixed vaginitis can include a combination of the bacteria responsible for causing bacterial vaginosis and/or aerobic vaginitis and/or yeast vaginitis. Symptoms can include a yellow-green discharge, and a burning sensation, redness, and inflammation of the vulva/vagina. Examination and laboratory evaluation of vaginal discharge is very important so that targeted treatment may be used to eradicate the problematic bacteria. Restoration of healthy normal vaginal bacteria is also important as well as addressing any potential lifestyle factors that could have led to the infection.
Cytolytic vaginitis is a controversial condition where the abundant growth of lactobacilli results in the breakdown of vaginal epithelial cells. Symptoms mimic those of yeast vaginitis: vaginal/vulvar itching, burning, pain with intercourse and urination, and may be accompanied with a discharge. Treatment may include a sodium bicarbonate vaginal rinse as well as stress management and blood sugar control.
Chlamydia and gonorrhea are the most common bacterial causes of sexually transmitted infections. In women there are rarely symptoms indicating either infection, however, some women experience yellow vaginal discharge, urinary urgency or frequency, pain with urination, bleeding between periods, or pain with sex. Routine STI testing is highly recommended as once an infection is identified, targeted treatment can be administered to you and your partner. Left untreated, both gonorrheal and chlamydial infections can cause pelvic inflammatory disease (PID), ectopic pregnancy, chronic pelvic pain, and infertility and other severe complications. Other sexually transmitted infections like herpes simplex virus (HSV) and syphilis may also cause an abnormal vaginal discharge.
As you can see, there are numerous types of vaginal infections that can present similarly. As such, it is important that you see your provider so that proper assessment and possibly testing be performed in order to get you the most appropriate treatment. If you are experiencing any of these symptoms contact your provider for an office visit.
Constipation is a common complaint among pediatricians’ offices. Most children experience brief periods of constipation over time that usually resolve on their own. Symptoms that warrant medical attention include recurrent, prolonged constipation, bleeding, pain, excessive straining or fear of passing stool. Many children who have previously experienced painful bowel movements instinctively begin to withhold their stool, causing a vicious cycle of even harder-to-pass stool that may lead to impaction.
This article discusses common causes of constipation, prevention strategies and treatment. This article is not intended to diagnose, treat or replace the advice of a medical provider. Please share your concerns with your child’s doctor if he or she struggles with constipation. Routine well-child visits are important for ruling out metabolic, neurologic and endocrine causes for these symptoms.
Initiating solid foods or introducing cow’s milk to the diet may lead to constipation as it is easier to offset the correct ratio of fiber and water required to make soft, easy-to-pass stool. Cow’s milk slows intestinal movement and can satiate the child’s appetite, making it less likely they will drink water or eat fiber-rich foods.
Dysbiosis of our microflora can cause a multitude of symptoms, many of them gastrointestinal. Stool testing can help identify if the child is missing important probiotic bacteria in their gut- facilitating a more customized treatment plan. A different approach is to test for food allergies- another condition that can cause a wide variety of symptoms. Food allergy testing can be completed using a simple finger stick- no blood draw is needed.
Starting school can be a significant transition for children; they must learn to navigate new schedules, locations and classmates. A change in routine may interrupt a child’s natural bowel movement pattern- leading to withholding or a reluctance to use the restroom at school.
Stress is another common cause of disordered bowel habits. During times of stress, it is harder for a child to sense (and act) when their body is ready to have a bowel movement. Toilet training, travel and the arrival of a new sibling are all very common times when children may experience brief interruptions in their body’s natural routines.
Below are some general tips for avoiding constipation. Ultimately, evaluation and treatment by a medical professional is always recommended for a more personalized approach.
Routine: if a child is toilet trained, encourage they spend time on the toilet after every meal. If the child has struggles using an adult-sized toilet, start with a portable children’s toilet or use a stool to raise their feet so their knees are flexed. If the child is at school for a portion of the day, encourage time on the toilet before and after school.
Water: encourage 16-32 ounces of non-milk fluids per day. If the child is reluctant, you may add a small splash of juice or herbal tea to add natural flavor to the water. If the child drinks milk, lightly diluting the milk with a small amount of water can encourage adequate hydration while offsetting the constipating effects of dairy.
Fiber: a great starting point for calculating children’s optimal fiber intake is:
child’s age + 5-10 grams = total fiber intake per day.
For example: a 3-year old’s optimal intake is 8-13 grams of fiber per day (for a 6-year old child it’s 11-16 grams, etc.) Specific foods that can help treat constipation include prunes, pears, apples, chia seeds and flax seeds.
Below this article you’ll find some charts with the average fiber content of various fruits, vegetables and cereals. A nutritionist or dietician familiar with children’s nutrition is also a fantastic resource and can teach you and your family how to eat for all stages of life.
Below are general treatment guidelines for mild-moderate constipation. For severe or chronic constipation, more aggressive treatment is warranted and must be supervised by a physician.
For mild constipation, a conventional doctor may prescribe laxatives like Miralax or lactulose in weight-specific doses. As a naturopathic physician, I may consider starting with magnesium that helps draw more water into the stool and thus make them easier to pass.
Severe constipation and/or stool impaction involve both oral as well as rectal medications. This treatment usually involves a bowel “clean out” to start, then is followed by supplementation of stool softeners to prevent recurrence. A clinician may recommend daily laxative use for several weeks, then taper down the dose very slowly once the child returns to normal bowel tone.
Water, diet and fiber will also be a part of a holistic treatment strategy.
The Bottom Line (get it?): Prevention is the best cure for constipation. Fiber, fruits, vegetables, water and regular physical activity create a recipe for lifelong healthy bowel function. Intervene at the first sight of constipation- prolonged pain with bowel movements will cause the child to withhold stool and can trigger fear of going to the bathroom. Stool withholding leads to even worse constipation and often will require a “bowel clean-out” if the constipation becomes severe or prolonged.
Oh, and lastly….. have you heard of that movie called Constipation?
You haven’t?? That’s probably because it hasn’t come out yet!
Table 1: Fiber content of fruits, vegetables and cereals.
References and Resources:
UpToDate: Prevention and treatment of acute constipation in infants and children
Dr. Val Manning sees patients from infancy into adulthood, focusing on preventive strategies when possible and creating sustainable, integrative treatment plans that fit the whole family. She is credentialed with various insurance companies and is currently accepting new patients.
If you want to find out more about nutrition and how it affects the topic discussed in this blog you might be interested in seeing our Registered Dietitian Nutritionist. Call the clinic to learn more or schedule an appointment.
Carly Kellogg Knowles, MS, RDN, LD
Carly has a Master of Science degree in Nutrition and is a certified Registered Dietitian Nutritionist. She is the owner of Vibrant Nutrition & Health – An Integrative and Functional Nutrition Practice in NW Portland, OR.
She specializes in medical nutrition therapy for:
-Chronic disease (anemia, autoimmune disease, cancer, pre-diabetes/diabetes, gallbladder disease, heart disease, high blood pressure, inflammation, osteoarthritis, weight management)
-Eating disorder recovery
-Fertility, pregnancy, postpartum, and breastfeeding
-Intuitive eating and wellness
She is credentialed with various insurance companies and is currently accepting new patients.
The previous posts outlined lifestyle modifications for improving sleep, as well as various nutraceutical and botanical treatments for attaining better sleep.
However, what if it’s been several weeks and none of these treatments seem to be helping? This is where the investigation begins. You doctor will perform a more detailed evaluation- often including lab testing and referrals- to help discern the cause of this hard-to-treat insomnia.
Lab workup may start by analyzing your thyroid function, ruling out hyperthyroidism as a cause and/or blood sugar testing to determine if highs or lows are involved. Another test, unique to alternative medicine, provides a salivary 4-part cortisol measurement. This will help to identify if the insomnia occurs because of abnormal cortisol secretion. Another valuable test measures neurotransmitter levels (including serotonin, histamine, GABA and others) to identify and treat deficiencies or excesses.
It is likely your doctor has already performed a full physical exam; however, they may choose to repeat it and pay special attention to heart function, neurological function, as well as oral and throat anatomy.
Other conditions that are important to rule out include restless leg syndrome and musculoskeletal pain or spasm.
If needed, your doctor may refer you to a sleep specialist to rule out sleep apnea. Physical therapy or orthopedic referrals can be useful to help treat chronic pain. Lastly, your doctor may choose to refer to a mental health practitioner for further evaluation; it is important to identify if sleep difficulties originate from mental or emotional causes.
Contact your doctor today if you suffer from sleep difficulties that do not respond to treatment. It is an important issue to address as poor sleep has negative health effects, both short and long term.
To a good night’s rest!
Image courtesy of www.theinsomniaclinic.co.uk
A note about supplements and botanicals: herbs are powerful medicines that hardly ever have just one function. On the contrary, herbs and nutraceuticals have various actions that act synergistically. Please check with your clinician who is knowledgeable in these areas before initiating a new product as it carries the risk of interfering with other medications.
In the beautiful and vast world of botanical medicine, there are well-known, tried-and-true herbs for insomnia. The classic insomnia herbs, and some with published research include skullcap, valerian, lemon balm, kava, hops, passion flower and chamomile. Other great herbs that may help relax the body and brain for sleep include lavender, oatsraw, and even poppy. Ashwaghanda has been studied for its sleep-inducing effects over time and may help establish a healthy sleep cycle with regular use.
The herbs mentioned above come in a variety of forms- alcohol/water based tinctures, non-alcohol based tinctures, capsules, tablets, loose leaf teas or powdered root. They’re available as single-herb products or are combined with multiple herbs and/or nutrients for a stronger effect. At many naturopathic clinics, doctors can even create a customized combination of herbs that are specific to your unique needs; this is called an herbal formulation. Tea blends are also a great option, but could potentially interrupt sleep if it ultimately causes you to wake in the night to urinate!
Soothing scents like lavender, chamomile or rose can switch our brains into nighttime mode. These oils vaporize well in an essential oil diffuser. You can also take a warm Epsom salt bath with a few drops of oil sprinkled in… with a candle burning nearby. Some soothing, relaxing music playing softly in the bathroom won’t hurt either! Are you getting sleepy yet?
DIY- To make a lavender hydrosol spray at home, add 10 drops of lavender oil into a spray bottle full of water. Spray this mixture in the air, on your skin or even in your bedroom for maximum aromatherapy effect.
While browsing the aisles at our local health foods store, there is no shortage of products to help us sleep. The art of the medicine lies in selecting the correct one for the type of insomnia you have. Examples of products on the market for insomnia include 5-HTP, L-tryptophan, melatonin, magnesium, l-theanine, GABA, phenibut…. and there are many more. Each of these products boasts a different mechanism for shifting our body into sleep mode. The most effective way to know which one works for you is to have a comprehensive intake with your doctor who will take a careful and informed health history. There are also situations where underlying causes need testing such as thyroid, glucose, cortisol, melatonin, and neurotransmitters. Many times, we encourage our patients to use a product regularly for a few weeks before we determine its effectiveness .
Over the counter pharmaceutical and prescription-only drugs for sleep are our last resort as naturopathic physicians. These are necessary in some situations; however our goal is short term use while we work on other aspects of your overall health. There are various types of medications for insomnia- some have a risk for dependence and can cause unpleasant side effects. For these reasons, they are best discussed at your doctor’s office.
Up next: PART 3- Investigating Insomnia: when treatments aren’t helping
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Although it may be an obvious fact, it must be said; sleep is an integral part of our lives. A good night’s sleep allows the body and brain to rest.
While we sleep, our immune system goes on high alert and scans the body for infection. Our brain converts short term memories into long term storage, a process called consolidation. And lastly, our conscious brain temporarily takes the back seat while our subconscious runs loose.
When sleep quality starts to diminish, consequences are felt immediately and their detrimental effects accumulate over time. Studies suggest that poor sleep (or less than 7 hours per night) increases one’s chances of heart disease, obesity, depression and even diabetes. Yikes!
“OK you’ve scared me enough Dr. Manning- what am I going to do to start sleeping better??”
While often a challenging chronic health issue, insomnia is one of the most responsive conditions to naturopathic treatment modalities. The solution for you could be an easy switch or it may require a comprehensive evaluation and plan- always check with your doctor before initiating any treatments listed in this article.
Below you will find an overview of naturopathic approaches to insomnia- split into three parts:
- Insomnia Basics: finding the root cause and lifestyle interventions
- Botanical and nutraceutical treatments for insomnia
- Investigating insomnia: when treatments aren’t helping
Insomnia Basics: finding the root cause and lifestyle interventions
Treatment for insomnia should never be “one size fits all.” As always in naturopathic medicine, identifying and addressing the root cause of why you can’t sleep is paramount to treatment success and long term cure.
So… Why can’t I sleep?
Looking deeply and with depth at your problem can help you identify the reason why sleep is not a satisfying, refreshing experience. Your doctor may ask the following questions:
- Do you have trouble falling asleep?
- Do you have trouble staying asleep?
- Do you wake often throughout the night?
- How much time do you spend in bed? Sleeping? Doing other activities in bed like reading, watching TV, eating?
- What is your work/school/home schedule like?
Some causes of insomnia are obvious while others may take a little digging (e.g .nutrition, pain, medications, anxiety) and maybe testing for a thyroid disorder, a blood sugar problem or cortisol dysregulation among others.
Food, News and Booze
Do you eat large meals shortly before bedtime? Do you watch headline news at night? Do you engage in a liquor, beer or wine night cap most evenings? These all have the potential to significantly interfere with your body’s “winding down” process, either by causing a spike in your blood sugar or even worse- a spike in your body’s stress hormone, cortisol.
Experiment this week by replacing your evening TV time with a relaxing book, a warm bath or gentle stretches before bed. Save the headline news for the following morning or afternoon.
Aim to eat your last meal for the day at least 60-90 minutes before you hit the hay, that way your body will be finished digesting food once it’s time to sleep. If you find yourself hungry before bedtime, eat a light protein-focused snack like veggie sticks, nut butter, hummus, hardboiled egg or a small piece of cheese.
Aim to limit your exposure to inflammatory or stimulating social media, television or music if you’re the sensitive type. Often, these images, words and/or articles linger in our subconscious mind long afterward and inhibit truly restful sleep.
Ready… Set… Sleep! Establishing a Bedtime Routine
The body responds surprisingly well to routine. If you regularly repeat a similar sequence events leading up to bedtime your body will begin to learn that these activities equal sleep- and over time it will become easier to fall asleep. There is a practice called sleep hygiene that outlines several practices for attaining satisfying sleep. More info regarding this can be found here.
Try brushing your teeth, changing into your PJ’s, dimming the lights, etc. in the exact same order every night for a week. Notice if your body begins to relax and prepare for sleep as soon as you start that routine. Often, preparing our bag, supplies, outfits, etc. for the following day can make us feel less stressed and more clear-minded as we drift off to sleep.
Other lifestyle tips for sleep
Meditation offers a multitude of benefits for sleep. Try mindfulness meditation, progressive muscle relaxation, loving kindness or mantra meditations. Meditation can be self-guided or guided by a podcast, audio recording or book. Stretching, yoga and tai chi are also great ways to enhance your sleep if you prefer movement meditation. Journaling our day, our thoughts or even our concerns can help free more of our mental space for rest, sleep and rejuvenation.
Napping is a great way to recover from a poor night’s sleep, however it can interfere with the following night’s sleep. If you must nap, limit to 30 minutes only and avoid napping too late in the evening.
Exercise is the one of the most underrated, untold secrets in medicine. The benefits of regular exercise (150 minutes per week, to be exact) are immense. Regular exercise not only helps us sleep better at night, it improves almost every aspect of our health. Start small: a few minutes per day or a few days per week. Increase your amount/intensity slowly and ask for guidance if you run into difficulties or develop pain in your joints.
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Coming up next: Botanical and nutraceutical approaches to insomnia.
– “Sleep and Chronic Disease,” www.CDC.gov