digestion, GI health, healing, hood river naturopath

A German Writer Translates a Puzzling Illness Into a Best-Selling Book

MANNHEIM, Germany — IF Giulia Enders had not contracted a mysterious illness as a teenager that left her covered with sores, she, like most of us, might never have thought much about her digestive tract, except when it was out of whack. She might never have enrolled in medical school, either, and she almost certainly would not have written a best-selling book about digestion last year that has captivated Germany, a nation viewed, fairly or not, as exceedingly anal-retentive.

Back in 2007, after a series of mostly ineffective treatments prescribed by doctors, Ms. Enders, then 17, decided to take matters into her own hands. Convinced that the illness was somehow associated with her intestines, she pored over gastroenterological research, consumed probiotic bacterial cultures meant to aid digestion and tried out mineral supplements.

The experiments worked (although she is not sure which one did the trick), leaving her with healthy skin and a newfound interest in her intestines. “I experienced with my own body that knowledge is power,” she writes of the episode in “Gut: The Inside Story of Our Body’s Most Underrated Organ,” which was published in North America last month after its surprising success in Germany, where it has sold almost 1.5 million copies since its release in March 2014.

Inspired by her successful self-experimentation, Ms. Enders enrolled in medical school in 2009 at Goethe University Frankfurt and is now working toward a doctoral degree in microbiology there.

DURING a recent interview in a cafe here next to the Neckar River, not far from her childhood home, Ms. Enders, now 25, sipped chamomile tea and described with characteristic enthusiasm the first stomach operation she saw in person. “The whole body moves like this or like that, but the intestines move in entirely a different way,” she said. “It’s incredibly harmonious!”

Ms. Enders’s wonder at the strange ways of the gut is matched only by her incredulity at the limited public knowledge on the subject. “I’m almost shocked,” she recalled thinking during her first years in medical school as she learned, for example, that it is easier to burp lying on your left side than your right because of the position at which the esophagus connects to the stomach. “Why doesn’t everybody know this?”

In 2012, she began taking it upon herself to fill people in. She had heard about a student event space in Freiburg that was hosting a “science slam,” an open-mike event where young researchers give presentations, and decided to prepare a short lecture on digestion.

Onstage, Ms. Enders was bouncy and jocular, as a video of the event shows. She speaks rapidly, hardly able to contain her excitement, describing the components of the digestive system and lamenting its poor reputation.

“It’s really too bad, because the intestines are totally charming,” she says, citing as evidence the sophisticated communication between our inner and outer sphincter muscles and the some hundred trillion bacteria in our guts that facilitate digestion.

The crowd was smitten. Ms. Enders won the competition and went on to participate in two more science slams in Karlsruhe and Berlin. Soon, videos of her presentations were attracting attention online, and a literary agent contacted her about writing a book.

FANS have praised Ms. Enders for translating abstruse gastroenterological research into breezy, entertaining prose. On a talk show here last April, she described the large intestine as the “chiller” of the two because it processes nutrients at a leisurely pace of about 16 hours on average, compared with the two to five hours that the small intestine needs.

In her book, she catalogs the myriad elaborate operations that our guts dutifully perform every day, like the cleaning mechanism that kicks in a few hours after we eat and keeps the small intestine — all 20 or so feet of it — remarkably tidy. This “little housekeeper,” as Ms. Enders calls it, turns out to be the real source of the grumbling that most attribute to the stomach and mistake as a sign of hunger.

Then there is the growing body of research indicating that our intestines may have a far greater influence on our feelings, decisions and behavior than previously realized. The primary evidence for this, Ms. Enders writes, is the vast network of nerves attached to our guts that monitors our deepest internal experiences and sends information to the brain, including to those regions responsible for self-awareness, memory and even morality.

Just how much your lunch will affect ethical decision making remains unclear; we still know very little about this “gut brain,” as Ms. Enders refers to it. But this byzantine neural architecture suggests that our intestines may play a large part in determining who we are and what we do.

These essential but little-known features of our guts — our identities at their most raw and visceral, Ms. Enders suggests — have riveted Germans. The surprising popularity of Ms. Enders’s book has itself become a topic for discussion, with some commentators invoking Freud to explain Germans’ apparent fascination with their bowels. Profanity here tends to skew to the scatological, and Germans are, according to stereotypes, obsessed with order and neatness.

Ms. Enders dismisses such talk, noting that the book has also topped best-seller lists in Finland, the Netherlands and elsewhere. She suggests that its appeal lies in its frank treatment of topics usually left undiscussed. “Shame always disappears when you really understand something,” she said.

MS. ENDERS grew up on the outskirts of Mannheim, a sleepy city of almost 300,000 residents that was largely flattened by Allied bombs in World War II and filled back in with prim, modern buildings. Her parents split up when she was young, and her father was an irregular presence during her childhood. “You can only say Lebenskünstler,” she said to describe him — a term that means “life artist” and connotes a bohemian disregard for societal conventions.

Instead, it was her mother, a former documentary filmmaker, and grandmother who raised Ms. Enders and her older sister, now a graphic designer based in Karlsruhe who contributed illustrations to the book. Her grandmother, an interpreter by training, proved particularly influential. “She showed us very early on that intellectuality doesn’t have to be so serious,” said Ms. Enders, who recalled free-form games of chess with her grandmother in which they ignored half of the rules.

But Ms. Enders’s interest in science is relatively new. She was, by her own assessment, a mediocre student in elementary school, owing mostly to self-described boredom with the rote exercises in primary education. While her grades improved in high school, her fascination with medicine began outside the classroom, with the unexplained sores she had as a teenager.

By her own account, Ms. Enders’s sudden fame has not changed her life very much. She still shares the same apartment in Frankfurt with five friends. She recently completed a state medical exam and will soon begin a yearlong residency at a hospital.

She does not have any immediate plans to write another book. “If I have that feeling again,” she said, referring to her surprise at how little most people knew about digestion, “then I’d do it. But only then. And if that feeling doesn’t come, then hopefully I’ll just be a good doctor.”

childbirth, labor, oxytocin, pregnancy

Pitocin Is Not Oxytocin

The role of hormones in our body are so vast and dynamic!  Here is a quick article looking at only one of the hormones that help regulate us.


“The Love Hormone”.  Sounds important, no? Turns out that we know very little about the hormone oxytocin, beyond that it is incredibly relevant to multiple metabolic, behavioral, and endocrine functions. In a compelling review entitled Beyond Labor: The Role of Natural and Synthetic Oxytocin in the Transition to Motherhood, Bell et al explore the literature suggesting that, once again, we cannot outsmart, outdo, or circumvent nature with pharmaceutical products.

What is Oxytocin?

One of the known roles of oxytocin is in the complex physiology of labor and birth. Perceived by the obstetrical establishment to be a “contraction chemical”, oxytocin’s effects are bodywide, and most notably, brain-based. During pregnancy, oxytocin receptors increase in areas of the maternal brain related to mood, stress, and attachment behavior. Specifically, its activity has been studied in the hypothalamus, lateral septal nucleus, periaqueductal grey, Broca’s area, nucleus basalis of Meynert, locus coeruleus, vagus, solitary tract, trigeminal nerve, and lateral reticular formation. It is secreted continuously in the brain and in a pulsatile manner to the body through the posterior pituitary. Despite efforts, the brain-blood ratio has not been well-elucidated leaving major gaps in our understanding. When it comes to hormones, the production and release of the hormone is critical, but so is the receptor activity – the action of the baseball in the catchers mitt, and receptor sensitivity varies from person to person based on genetics and adaptation to experience.

What is Pitocin?

So, when we manufacture a synthetic version of this hormone and commandeer a woman’s labor physiology, it should come as no surprise that there are unintended and poorly understood consequences. Pitocin®  or “Pit” as it’s called on the floors, is the obstetrician’s whip. They snap this whip when your baby is not conforming to their non-evidenced-based schedules. When your due date is wrong, when you’re forced to birth in highly artificial circumstances, or when your physiology has been hijacked by an epidural.

Bell et al discuss a number of concerns related to the administration of synthetic oxytocin:

  • Because of its hydrophilic (fat-loving) nature and molecular size,Pitocin®  is unlikely to cross the blood brain barrier. But maternal oxytocin is very active in the brain, inducing secretion of other hormones including endorphins (buffering fear and pain). It is also active in the fetalbrain, protecting receptors such as GABA, from potential hypoxia of birth.
  • If, in fact, synthetic oxytocin does reach the maternal brain (because of barrier permeability or active transport of some kind), the authors state:

    “Whether the maternal brain will reliably respond to exogenous oxytocin by decreasing or increasing the synthesis or release of endogenous oxytocin is unknown.”

What about after labor is over?

Women are struggling to breastfeed in proportions likely never seen in human history. Bell et al reference a powerful study that implicates Pitocin in this phenomenon.

“Compared to all other study groups, women exposed to Pitocin® in labor combined with an epidural demonstrated significantly lower oxytocin levels during breastfeeding. Overall, the total quantity of synthetic oxytocin administered during parturition was negatively correlated to levels of oxytocin in plasma two days following birth.”

This may be related to the effects of a pharmaceutical-grade agonist stimulating the oxytocin receptor and causing modeling changes at the membrane level. When receptors are overstimulated, they are internalized and downregulated through changes in gene transcription. Bell et al reference a study demonstrating that:

Participants with oxytocin-induced labor had a 300-fold down-regulation of the OTR gene in uterine muscle, when compared to receptor availability in spontaneous labor.

The role of oxytocin in the HPA axis (hypothalamic-pituitary-adrenal) may explain why:

“Lactating women show increased vagal tone, decreased blood pressure and decreased heart rate when compared to non-lactating women, especially in response to a stressor.”

Data analyzing the role of oxytocin in response to postpartum stress suggests that it is a buffer to the negative effects of the experience. When this buffering effect is inadequate, we may see the emergence of postpartum depressive symptoms. One study found that bottle feeding women had lower levels of oxytocin, higher heart rates, and higher cortisol, but that breastfeeding depressed women shared this profile, implicating low oxytocin levels in depression.

Amazingly, some of oxytocin’s effects may actually be mediated by gut bacteria (is there anything the microbiome doesn’t manage?) as was demonstrated in this study showing a lactic acid bacteria accelerated (doubled) wound healing in rodents by increasing oxytocin levels. In psychiatry, there is sparse literature supporting the use of intranasal oxytocin in autism, schizophrenia, OCD, social phobia, depression/postpartum depression, and anorexia but notable theoretical underpinnings for consideration in these cases and minimal risk.

While we attempt to understand the variables contributing to altered oxytocin response in the body, deliberately interfering with this feedback system through the use of synthetic hormone should be exposed for what it really is: a dangerous fix for the problems of a medicalized birth.

alternative medicine, bone broth, columbia gorge, health, hood river midwife, hood river naturopath, nutrition, paleo, pdx, pnw, portland, primal, wellness

Portland Gets Its First Dedicated Bone Broth Bar

bone-broth_vyg6haIt was only a matter of time. Portland will soon be home to Broth Bar—located on NE Sixth and Couch next door to Ristretto Roasters—showcasing bone broth from grass-fed and pasture-raised animals.

Packed with easily digestible minerals and gut-healing gelatin, bone broth has been a nutritional darling for years, slowly working its way from the fringes to full-on trend status alongside green smoothies, hot yoga, and organic apothecaries. Popularized by proponents of the paleo diet, ancestral health movements, and food-as-medicine folks, it’s hard to open a magazine or scan a health blog without the buzzy broth popping up. Broth windows, food trucks, and cafés have been popping up in New York, Los Angeles, and Vancouver, BC. Several local restaurants have also jumped on the trend, including Noraneko, Lincoln, and JoLa Café—but Broth Bar will be the first Portland destination to focus first and foremost on the nutritional powerhouse.

What’s more, the idea may capture the healthy food zeitgeist, but the bar is the brainchild of Portland’s own bone broth pioneer, Tressa Yellig of Salt, Fire & Time, who brought retail bone broth to Portland in 2009. Long before broth became the “It Ingredient” of celebrity detoxes, Yellig was crafting healing, small-batch broths from pasture-raised, hormone-free bones sourced from local ranchers, and has earned a loyal following of fans who credit her products with restoring health during and after cancer treatments and other major health crises.

The small-but-mighty 800-square-foot Broth Bar will feature a rotating selection of bone broths—including chicken, beef, turkey, lamb, pork, and bison—with optional add-in “bundles” to turn a mug of broth into a meal, from seasonal kraut and kelp noodles to chickpea miso, grated turmeric, ginger, and soft boiled eggs. A self-serve condiment bar will take the customization even farther, with a dash of tamari, Hot Mama hot sauce, housemade seaweed gomasio, and a variety of salts.

In addition to the main event in a mug, the bright and cheery bar will offer four varieties of Salt, Fire & Time’s kombucha on tap, grab-and-go “picnic-style” fare, and a micro-market stocking hard-to-find supplements, high-quality butter, artisan ingredients, and seasonal produce from local farms.

Broth Bar is set to open in late June, and Yellig—along with sister and business partner Katie Yellig—hopes to host small classes, tastings, cookbook signings, healing food pop-ups, and weekly hamburger nights (featuring Salt, Fire & Time’s organ burgers and fermented condiments).

With the expansion, Yellig wants fans of the brand to have no doubt about the company’s continued dedication to impeccable sourcing of bones, add-ins, and market products. “We want people to never doubt the quality of the ingredients,” says Yellig. “We’re not compromising about how we source, and that will never change.” So grab a mug, get ready, and stay tuned for more details.

Broth Bar
115 NE Sixth, off of NE Couch

cultivate, express, happiness, hood river midwife, hood river naturopath, journal, mental health, naturopath, write

Keep a One-Sentence Journal, Be Happier

UnknownEver since I can remember, my grandma has kept a daily journal. Not a “Dear Diary,” emotion-filled journal — just a couple of lines jotting down what she did that day and whom she was with. Often, when the family is together, she’ll dig out one of her old journals and tell us what she and various other family members were doing on a random day, in, say, 1994. I’ve always been amazed at how interesting these little moments are in retrospect.So this morning, as I listened to the newest episode of Gretchen Rubin’s “Happier” podcast, I was intrigued to hear her urge her listeners to adopt the habit my grandma has been following for years. Rubin calls it a one-sentence journal, and she herself has kept one for nearly a decade now. On her show, she talked about how she believes that reliving those daily moments has helped make her happier.

There’s even some research backing up Rubin (and my grandma) on this: Last year, Ting Zhang at Harvard Business School published a paper in Psychological Science outlining a series of experiments testing how much people appreciate memories of the day-to-day moments from their lives. She asked people, for example, to write about a recent conversation, and then to rate whether the chat was ordinary or extraordinary; they then guessed how much they’d appreciate reading their written account of the chat in the future.

Seven months later, Zhang contacted participants, asked them to read the memory they’d written down, and then to tell her how much they enjoyed it. Not only did most participants enjoy rediscovering the written record of the months-old conversation more than they’d anticipated, but those who’d written about an ordinary conversation were particularly likely to underestimate how much they’d appreciate reliving the memory.

What seems like an ordinary moment today, in other words, could become a little more special with time. As one participant in Zhang’s study said, “Re-reading this event of doing mundane stuff with my daughter has certainly brightened my day. I’m glad I chose that event to write about because of the incredible joy it gives me at this moment.”

alternative medicine, columbia gorge, homeopathy, hood river midwife, hood river naturopath

FDA Ponders Putting Homeopathy To A Tougher Test

Katherine Streeter for NPR

Katherine Streeter for NPR

It’s another busy morning at Dr. Anthony Aurigemma’s homeopathy practice in Bethesda, Md.

Wendy Resnick, 58, is here because she’s suffering from a nasty bout of laryngitis. “I don’t feel great,” she says. “I don’t feel myself.”

Resnick, who lives in Millersville, Md., has been seeing Aurigemma for years for a variety of health problems, including ankle and knee injuries and back problems. “I don’t know what I would do without him,” she says. “The traditional treatments just weren’t helping me at all.”

Aurigemma listens to Resnick’s lungs, checks her throat and then asks detailed questions about her symptoms and other things as well, such as whether she’s been having any unusual cravings for food.

Aurigemma went to medical school and practiced as a regular doctor before switching to homeopathy more than 30 years ago. He says he got disillusioned by mainstream medicine because of the side effects caused by many drugs. “I don’t reject conventional medicine. I use it when I have to,” Aurigemma says.

Throughout his career, homeopathy has been regulated differently from mainstream medicine.

In 1988, the Food and Drug Administration decided not to require homeopathic remedies to go through the same drug-approval process as standard medical treatments. Now the FDA is revisiting that decision. It will hold two days of hearings this week to decide whether homeopathic remedies should have to be proven safe and effective.

“So this will be the first dose,” he says. “Then I’ll give you a daily dose, to try to get underneath into your immune system to try to help you strengthen your energy, basically.”

Homeopathic medicine has long been controversial. It’s based on an idea known as “like cures like,” which means if you give somebody a dose of a substance — such as a plant or a mineral — that can cause the symptoms of their illness, it can, in theory, cure that illness if the substance has been diluted so much that it’s essentially no longer in the dose.

“We believe that there is a memory left in the solution. You might call it a memory. You might call it energy,” Aurigemma says. “Each substance in nature has a certain set of characteristics. And when a patient comes who matches the physical, mental and emotional symptoms that a remedy produces — that medicine may heal the person’s problem.”

Critics say those ideas are nonsense, and that study after study has failed to find any evidence that homeopathy works.

“Homeopathy is an excellent example of the purest form of pseudoscience,” says Steven Novella, a neurologist at Yale and executive editor of the website Science-Based Medicine. “These are principles that are not based upon science.”

Novella thinks consumers are wasting their money on homeopathic remedies. The cost of such treatments vary, with some over-the-counter products costing less than $10.

Some of the costs, such as visits to doctors and the therapies they prescribe, may be covered by insurance. But Novella says with so many people using homeopathic remedies, the costs add up.

There’s also some concern that homeopathic remedies could be dangerous if they’re contaminated or not completely diluted, or even if they simply don’t work.

Somebody who’s having an acute asthma attack, for example, who takes a homeopathic asthma remedy, “may very well die of their acute asthma attack because they were relying on a completely inert and ineffective treatment,” Novella says.

For years, critics like Novella have been asking the FDA to regulate homeopathy more aggressively. The FDA’s decision to revisit the issue now was motivated by several factors, including the growing popularity of homeopathic remedies and the length of time that has passed since the agency last considered the issue.

The FDA is also concerned about the quality of remedies, according to Cynthia Schnedar, director of the FDA’s Center for Drug Evaluation and Research Office of Compliance. The agency has issued a series of warnings about individual homeopathic products in recent years, including one that involved tablets being sold to alleviate teething pain in babies.

“So we thought it was time to take another look at our policy,” Schnedar says.

The FDA’s decision to examine the issue is making homeopathic practitioners like Aurigemma and their patients nervous. “It would be a terrible loss to this country if they were to do something drastic,” he says.

He also disputes claims that homeopathy doesn’t work and is unsafe.

“There’s no question that it helps patients. I have too many files on too many patients that have shown improvements,” Aurigemma says, although he acknowledges some homeopathic products sold over the counter make misleading claims.

Companies that make homeopathic remedies defend their products as well.

“Homeopathic medicines have a very long history of safety,” says Mark Land, vice president of operations and regulatory affairs for Boiron USA, which makes homeopathic products. “One of the hallmarks of homeopathic medicines is safety,” says Land, who is also president of the American Association of Homeopathic Pharmacists.

“The potential risk [of greater FDA regulation] to consumers is if any change in regulation were to limit access to these products,” says Land.

That’s what worries Resnick. She says homeopathic remedies have helped alleviate a long list of health problems she’s experienced over the years. “Why would they want to take that away from us?” she says. “Let us have the freedom to decide what works the best for us.”

The FDA says this week’s hearing is just a chance to start gathering information to decide what — if anything — the agency should do about homeopathy.

For full story see: http://www.npr.org/blogs/health/2015/04/20/398806514/fda-ponders-whether-homeopathy-is-medicine

breastfeeding, frenulum, inants, newborn, pregnancy, tongue tie

The Basics of Tongue and Lip Tie: Related Issues, Assessment and Treatment

By Melissa Cole, IBCLC, RLC and Bobby Ghaheri, MD., Portland OR.

“Tongue-tie” has become quite a buzz word in some circles and is still quite unknown in others.  Tongue-tie, professionally known as ankyloglossia, is a congenital condition in which the lingual (tongue) or labial (lip) frenulum is too tight, causing restrictions in movement that can cause significant difficulty with breastfeeding and, in some instances, other health concerns like dental, digestive and speech issues.  Mothers of infants dealing with feeding challenges are often desperate to find solutions; as awareness increases about tongue and lip tie, some mothers wonder if this is something their baby may be coping with.

Parents often want to know what some typical signs of tongue/lip tie are.  Each mother/baby dyad is very unique and therefore tongue/lip tie issues can present differently for everyone.  Some common symptoms that may point to the infant being tongue/ lip tied include: poor latch/inability to latch, sliding off the nipple, fatigue during feeds ,sleepy feeds, poor weight gain, clicking during a feed , maternal nipple pain/damage (can feel like the infant is compressing, chewing, gumming, pinching, scraping the nipple, etc), increased maternal nipple/breast infections, compromised maternal milk supply, dribbling milk at the breast/bottle, digestive issues (increased gassiness, reflux, etc due to extra are being swallowed and poor control of the milk during a swallow), and various other feeding related challenges. Some mothers and babies may cope with some of these issues, all of these issues or even none of these issues when a tongue/lip tie presents. We must keep in mind having a frenulum is not the problem; compromised tongue mobility and functionality that cause problems for the mother and/or baby are the problem!

Mothers are tech-savvy and often turn to the computer first to research what might be causing their feeding concerns. When moms go online, they will most likely encounter some discussion about how tongue and/or lip ties can cause feeding issues.  If parents suspect a tongue/ lip tie then families will often want to see a provider in-person to have their baby evaluated and treated.  Sometimes families are lucky enough to have a local provider well-versed in evaluating and treating oral restrictions like tongue and lip tie.  However, many mothers may not have access to this expertise in their local communities. If you suspect that your infant may have a tongue or lip tie and you’re not able to find a provider in your community to evaluate and treat this condition, consider connecting with a local international board certified lactation consultant (IBCLC) that should be able to help connect you with additional resources. Another resource is the website for the International Affiliation of Tongue-Tie Professionals (IATP) (please note that the website is just about to be launched and may or may not be live at present, do check back if needed).

Tongue and lip ties come in various shapes and sizes and can present uniquely in every baby.  Many providers have only been trained to look for very prominent, classic tongue ties that often create a heart-shaped tongue.  However, tongue ties can be sneaky and restrictions that are more posterior (toward the base of the tongue) cannot be easily visualized.  Proper assessment and evaluation are key when identifying these types of ties because they can easily be missed at first glance.  Not all providers know how to properly assess for all types of tongue and lip restrictions.  While there are various assessment tools and tongue-tied classification scales that have been published, there is still no universally accepted standard of assessment and care when it comes to tongue and lip tie.  This fluctuation in assessment and treatment standards can be extremely frustrating for parents trying to seek evaluation and care for their potentially tongue and lip tied infant.  If you are unsure of whether or not your provider is adept at assessing or treating various types of tongue and lip tie you may want to ask your provider the following questions:

  • How do you assess for tongue/lip tie?
  • How often do you treat tongue/lip tie in your practice?
  • Do you treat posterior tongue ties?
  • How do you perform the procedure?
  • What type of follow-up care to recommend after the procedure?

Providers that routinely assess and treat babies for tongue and lip tie should be able to easily answer these questions and provide parents with enough information so that they can make an informed decision.  Providers that may not be the best to assess or treat your baby include ones that rarely assess or treat for this condition, tell parents that the tongue tie will stretch or that it’s not a big deal, tell parents that they have never heard of it posterior tongue tie, or tell parents that this must be done under general anesthesia.  Parents should always feel empowered to seek additional opinions and advocate for the needs of their child if they are struggling to find a provider that understands and treat oral restrictions.

If a tongue or lip tie is present and parents wish to seek treatment, what can parents expect?  Various types of providers treat tongue and lip tie including: ear nose throat doctors (ENTs), pediatric dentist, oral surgeons, pediatricians, naturopathic physicians, and others qualified to do minor surgery.  In most all cases, releasing the frenulum for infants is an in-office procedure, with no sedation needed.  In some rare cases, or in cases with older children, sometimes light sedation is used if the parents or provider feel that the older child would be too stressed while alert, but in infants this is usually not necessary at all.  Some providers release the frenulum with sterile scissors, others use laser technology. The availability and types of providers in any given community will vary as will the course of treatment.  In general, this is what we tell parents coming to our practice to expect (please note that other providers may perform the treatment slightly different ways):

What to expect when your baby needs a frenotomy/frenectomy:

In general, the procedure is very well tolerated by babies.  We take every measure to ensure that pain is minimized.

1)    For a typical frenotomy (an incision of the frenulum), a topical numbing gel is applied once or twice and occasionally, if a frenectomy (frenulum tissue is removed) is needed, a small amount of local anesthetic is injected.  Often, ice chips are applied directly to the area before (and sometimes after), as this helps numb the area.

2)    Crying and fussiness are quite common, and most children lose only a small amount of blood.  They will frequently drool afterwards until the numbing medicine wears off.

3)    Pressure and ice are held to help minimize any bleeding, and the child will be returned back to you, where you have the option of immediate breastfeeding, bottle feeding or soothing depending on your preference.

4)    Tylenol may be used afterwards but is often not even needed.

5)    You may notice some dark brown stools or spit-ups afterwards as some blood may get swallowed after the procedure.

There is very little risk involved with the frenotomy/frenectomy procedure.  The biggest risk of the procedure is the potential for re-attachment to occur.  In order to prevent this from happening, we work with the patient’s in our practice to keep the newly-released area open and healing well by encouraging specific mouth-work after the procedure.  We encourage gently massaging/stretching the incised area, targeted oral motor work to help the tongue and mouth learning patterns, supportive bodywork, and other complementary healing modalities.  By incorporating this type of gentle aftercare, we do see a reduction in reattachment and better progress overall.

Over the decades, it is no doubt that many breastfeeding relationships have probably suffered greatly due to undiagnosed tongue or lip restrictions.  While more providers and parents are becoming educated about ties, we must be mindful not to think that every feeding challenge is created by a tongue or lip tie or that releasing restrictions will immediately improve the feeding situation.  Sometimes there is immediate improvement after the procedure and sometimes it is a gradual process as the tongue is supported in moving in new ways.  Feeding challenges can be complex and involve layers of issues.  In addition, tongue/lip tie can create other issues that may need to be proactively addressed.  Infants and mothers may cope with muscular tightness, nipple damage/pain, milk supply issues, infant weight gain concerns, etc. that need further support before and after a tongue/lip tie is evaluated and treated.  Working with a qualified, experienced board certified lactation consultant or other care providers that are familiar with oral restrictions is highly suggested.  Coping with feeding challenges in a tongue/lip tied infant can be an emotional and physical roller coaster for families.  It is our goal in writing this article that all mothers and babies receive the care they need and that awareness in regards to tongue/lip tie issues will continue to increase worldwide.

For additional resources on tongue and lip tie, please visit Luna Lactation’s website resource page and scroll down to the tongue tie section.

exercise, hood river naturopath, women's health

The Underground Guide To Planning Your Exercise Around Your Menstruation Cycle.

BG ArticleIntroduction

With adult women making up such a large percentage of people at the gym and out pounding the pavement, coaches and trainers (regardless of their sport) must educate themselves on the complexities of the menstrual cycle.

Ever heard of the pregnenolone steal?

That the luteal phase of menstruation lowers your insulin sensitivity while at the same time giving you an increase in metabolism?

Progesterone depletion?

You may not be familiar with all these terms, or how to use knowledge of them to your advantage or your clients’ advantage for exercise, so continue reading to figure out how you can help educate yourself or your clients on factors to track during menstruation.

And trust me, don’t stop reading if you’re a guy! Us men will benefit greatly from knowing how our partners, spouses, mothers, wives, daughters, sisters and clients can plan their exercise more intelligently. But before learning ways to plan training during menstruation, let’s dive into the basics of the menstrual cycle.

The Start Of Menstruation

The menstruation cycle starts at Day 1 after the unfertilized egg causes the uterus lining to break down.  A menstrual cycle lasts around 28 days but can vary depending on many factors.  For simplicity, in this article I will use a 28 day cycle as the example to cover the phase variances. Body-wide fluctuations occur during this time, but we’ll pay extra attention to levels of estrogen, progesterone, and insulin sensitivity.

BG Fitness


Follicular Phase

The follicular phase comes first (lasting roughly from Day 1 to Day 14) and occurs when the ovary releases an egg. At this point, estrogen increases, while progesterone and body temperature stays the same (See diagram below).  This first phase is a time where the female body is primed to hit intense workouts that are of an anaerobic nature.  Increased insulin sensitivity, along with an increase in pain tolerance, can explain this capability.

An article from The Globe and Mail by Alex Hutchinson stated that carbohydrate loading the day before an endurance competition is more important during this phase.  Later in the article, Hutchinson interviewed a scientist that stated that the metabolic effects during each phase can be negated with purposeful nutrition.  For example, if competition falls on this phase, carb loading during this phase is more important than other periods of the menstruation cycle. Hutchinson also found that performance during menstruation is highly variable. Supposedly, this whole carbohydrate need is due to the body’s ability to better dip into intense glycolytic efforts during the follicular phase, although it would be interesting to see if women who follow a high-fat diet have quite as high a need for carbohydrates during this phase. Regardless, you may want to try to adjust carb intake slightly up during your follicular phase, while at the same time planning your more intense, glycolytic workouts during this phase.

Some women perform unaffected, and others have phases that hinder performance if left unattended.  During training in the follicular phase, coupling intense workouts with refeed meals should be utilized, preferably including carbohydrate sources such as sweet potatoes, yams, rice, or starchy vegetables such as carrots, parsnips and beets.

The American Journal of Nutrition stated that basal metabolic rate decreases at the beginning of menstruation and reaches the lowest point a week before ovulation.  Doing more intense workouts and including metabolism-boosting post-workout meals in the follicular phase will help counteract this slower metabolism, says Shannon Clark in this T-nation article.


Ovulation occurs around Day 14.  Estrogen has peaked and begins a decline, while progesterone surges.  It is normal during ovulation for a woman to feel warmer for the remainder of the cycle. Clark stated in her T-nation article cited earlier that metabolism will start to climb, while insulin sensitivity will begin to decline.

As progesterone surges, a slight decrease in serotonin can happen, and since carbs can boost serotonin, food cravings can often occur at this time. You can use some of these tips to avoid giving into the serotonin boosting carbohydrate gluttony. During ovulation, estrogen and overall strength is peaked, so heavier weight training can be appropriate during this phase (rather than the more difficult cardiovascular anaerobic efforts of the follicular phase) – however, the American Journal of Sports Medicine found that due to joint laxity and estrogen-induced changes in collagen structure, ACL tears are four to eight times more likely to happen during this phase.

Consider supplementing with a tablespoon of collagen in your morning smoothie, place more emphasis on your warm-up, include recovery sessions, and be aware of fatigue and proper form.  More applicable recommendations that you can use for yourself or female clients will be listed below, but let’s finish the details of the menstruation cycle, shall we?

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Luteal Phase

Next is the luteal phase, which begins on ovulation day, for which we will say is happening on approximately Day 14.  During this phase, your body is not primed to workout at very high intensities, the body will prefer fat as its primary fuel source instead of glycogen, and you might retain more water at this time due to PMS symptoms. This might cause discomfort during short burst exercise – plan for lack of motivation here, and stick to aerobic activities as your primary exercise.

Fat burning workouts should be emphasized during the luteal phase.  If you are doing a workout that is strength or glycolytic, note that the luteal phase is not ideal for these domains and you may not perform to your usual capabilities. This is the time of the phase to plan things like aerobic trail runs, flat bike rides, easy swims and other aerobic activities that are at a slightly conversational pace.

After the luteal phase, the transition back to he menstrual phase, will bring metabolism, insulin sensitivity, body temperature, and water retention back to a slightly more “normal” feeling.  For a graphic representation, you can reference the first picture posted under “The Start of Menstruation” above to better understand phases.

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Eight Recommendations For Planning Exercise Around Your Menstrual Cycle

So now that you have your head wrapped around the menstrual cycles, let’s jump into even more practical advice. What considerations should you take for programming for females? Here are some of my top tips.

1) Achieve Nervous System Balance.

Every week must include a slow, long distance workout of around an one hour of conversational paced work.  This will help women have smoother cycles because their body won’t feel as much stress in the sympathetic nervous system.  Not only will this help increase your heart stroke volume, stimulate parasympathetic nervous system growth, but it will also provide a nice active recovery for your body allowing your body to flush out lactic acid from muscle tissue. Going for an unplugged trek can be therapeutic and help build a more robust cardiovascular system.  Mothers and wives – this is also a good chance to bring your family along!

2) Know Where You’re At.

Begin tracking performance during each phase for your entire menstruation cycle.  Take notes on sleep, macronutrient consumption, and exercise intensity.  Communicate these notes with your coach. Try the “Flow” app to make tracking your cycle easier.

3) Moderate Stimulants.

Another important stressor to monitor includes avoiding dependence on caffeine as a stimulant. Allow your sensitization to caffeine to recover after drinking caffeinated coffee by following Ben Greenfield’s habit of alternating three weeks of caffeine with at least one week of decaf, including a variety of nourishing teasguayausachinese adaptogenic herbs, etc.

4) Eliminate Soy.

Along with regulating caffeine intake, eliminating commercial soy sources such as tofu and soy milk can help some women avoid estrogen dominance, which can lead to menstrual cycle irregularities.

5) Use Supplements.

To reverse the effects of estrogen dominance, Beyond Training by Ben Greenfield asks you to consider drinking 2-3 cups of organic green tea powder, consuming more fiber, supplementing with a Vitamin B/antioxidant complex, and many more found in Chapter 14 of his book.

6) Keep Moving No Matter What.

Movement (not necessarily a daily Crossfit WOD!) will help relieve cramping and headaches.  The release of endorphins will help reduce crankiness.  Movement can also help put you to sleep and resist cravings, as long as macronutrient needs are met depending on exercise intensity and the given phase of menstruation. But if you have cramps, excessive flow, or have a poor reading on your HRV that morning, take that day off from structured exercise or hard workouts.  Now, this is not an excuse to sit on the couch all day, so don’t get too excited!  Instead, try techniques like ‘greasing the groove’*, using a standing desk, reading a book, working on your mobility (especially your lower body mobility), spending some time on a rumble roller, and ensure you have proper foods prepared for the next couple days.

*Popular movements to ‘grease the groove’ include: jumping jacks, band pull-aparts, strict pull-ups, bodyweight squats, lunges, or something as simple as going up and down the stairs a few times, refilling your water bottle, and holding a few stretches.  Movement throughout the day is very important for overall health because GLUT-4 will shuttle more glucose into the body and lipoprotein lipase will be produced by muscle tissue when leg muscles are being flexed.  A lack of lipoprotein lipase is associated with many heart problems, including heart disease, so please get an adjustable standing desk.

7) Know Your Fat Burning Zone.

Know your fat burning zone for that luteal phase! Superhuman-approved example fat burning workouts, most especially for the luteal phase of a cycle, are a great way to shred fat at a time where your body is primed to do just that.  For example, you can perform 8 sets of 5 minutes at 60-70% of your VO2 max of running, biking, swimming, rowing, hiking, brisk walking or elliptical, with 3 minutes of easy movement between each bout (as opposed to a follicular phase workout, which might be something like 20 sets of 1 minute bursts at the same pace with 30 seconds of recovery in between, or an ovulatory phase workout, which might be a 5×5 style weight training routine).

How do you find your fat burning zone? Many tests exist to approximate your VO2 max, but the one Superhuman Network coaches use is a 20-30 minute run at a maximum sustainable pace while wearing a heart rate monitor and taking the average heart rate that you had, then subtracting 20 beats for your fat burning zone (more details here). Even though these are easy, fat-burnign workouts, you should not perform these or any workouts without following up with proper post workout nutrition if you have a history of missing your period.

8) Go Beyond Training.

A few more lifestyle basic tips from Ben’s book would include: do not skip meals, consume a high protein breakfast on your harder workout days, eat a diet high in ancestral meats such as liver and bone broth, consume a high amount of healthy fats, get proper quantity and quality of sleep, and track your HRV. These are all small ways to enhance your performance and can also lead to a more consistent menstrual cycle, along with better exercise sessions and better recovery. Maintaining low energy movements throughout the day, eating enough carbohydrate to fuel workouts as well as support menstruation (e.g. timing your carbohydrates to happen in conjunction with your workouts – here are some good post workout nutrition ideas for endurance and strength athletes.),  consuming fat from healthy nut butters or MCT oil, and performing no more than three very intense workouts (like Crossfit wods, Tabata sets, longer track sessions, etc.) per week can also be helpful, especially if you tend to miss periods.

Check out the podacst:  the podcast episode “#310: The Menstrual Cycle And Athletic Performance, How To Get Kids To Grow Taller, Fueling For Soccer Matches & More!”, I