Image:http://www.stanfordchildrens.org/en/topic/default?id=gastroesophageal-reflux-disease-gerdheartburn-in-children-90-P01994

The summer season is here! That means spending time with friends and family, work parties, bbq's with yummy food and drink, and sunscreen. With all the summer fun, usually comes the dreaded summer heartburn (insert spooky music here). Summer Heartburn is not a diagnosis you’ll find in any textbook, it’s just how I refer to the consequences of maximizing the enjoyment of the summer. So, the question is, how do I prevent Heartburn?? The key to prevention is understanding the cause, so as per usual I’ll do my best to break it all down for you.
 
What is Heartburn?
Heartburn is formally known as Gastro Esophageal Reflux Disease (GERD), the action of the acid from your stomach moving up and splashing your esophagus. This is what leads to that burning feeling you get in your chest and the back of your throat.
 
What causes heartburn?
There’s a couple theories:

1. Stomach acid overproduction
   1. This theory is why you take antacids. It's the main treatment principle that your doctor uses when dealing with heartburn. They will prescribe you medication to decrease and suppress stomach acid production (not ideal for long term use, but that's a whole other topic).
2. Weak Lower Esophageal Sphincter (LES)
   1. "What the heck is the LES", you ask? Great question! This may be a bit tricky so bare with me. The LES acts like a rubber band at the top of your stomach to prevent stomach acid from going up and out of the stomach. It's like a clamp that stops everything from moving up and out of the stomach. If at any point the LES isn’t functioning properly, stomach acid will move up and out of your stomach leading to the common heartburn symptoms.

What triggers my heartburn?
Everyone has slightly different triggers, but the main offenders are usually from lifestyle and diet.

• Lifestyle triggers: Eating too quickly, not chewing your food adequately, eating large meals, eating then going into a food coma, stress, sleeping on your right side.
• Diet triggers: caffeine, alcohol, spicy foods, acidic foods, mint

How do I treat my heartburn?
Basically do the opposite of the things that trigger your heartburn
Lifestyle:

1. Slow down when you eat
2. Chew 20-30 times before you swallow
3. Eat smaller portions throughout the day
4. Minimize stress
5. Sleep on your left side
   

Diet: avoid the above foods

There you have it, simple and realistic ways to prevent and minimize your heartburn symptoms. Now get out there and enjoy the rest of your summer! (insert sunglasses smiley emoji here)

With the recent news that there are multiple confirmed cases of the Mumps virus here in Whistler, I thought it would be a good idea to get the facts before we rush to Dr Google. I’ve put the basic info that you would need to know here.
 
What are the mumps? 
It’s an acute viral infection that results in swelling and tenderness of the parotid gland. The parotid gland is below your ear along the jaw line.
 
Symptoms

• Early phase
  • Mimics a cold/flu with low grade fever, weight loss, headache, fatigue.
  • Contagious 3 days before and 4 days after the onset of symptoms.
• Parotid gland swelling and tenderness
  • Starts on one side over 2 to 3 days, then may spread to the opposite side
  • Can lead to trouble chewing and speaking
  • Pain can be worsened with acidic and citrus foods
  • Swelling usually resolves within 1 week
• Ear tenderness
• Complications from mumps virus can occur so consult your doctor
  • Endocarditis
  • Meningitis
  • Encephalitis
  • Hearing loss
  • Orchitis
  • Pancreatitis in kids
• If you have mumps, it must be reported to your local health department

 
Treatment

• It’s a viral infection so there is no need for antibiotics
• Rest, lots of fluids
• Ice to reduce the swelling
• Immune antiviral support
• Stay home to minimize the spread of the virus to others
• Consistent hand washing throughout the day to minimize the spread
• Getting the virus results in lifelong immunity

With all the buzz around fermented drinks like kombucha and kvass I figured I should take the opportunity to tell you about another tasty treat out there that also has beneficial properties for digestive health. 
I've been hearing more and more about this tasty drink that seems to have a lot of digestive benefits. It's incredibly simple to make, so lets get right to it!

But first, let's break this drink down:

1. Apple cider vinegar has long been used to help improve stomach acid, liver and digestive function​.
2. Maple syrup is about as Canadian as it gets when you want to think about it. The bonus here is that it has potassium, magnesium and calcium. So this helps when considering using it as part of an electrolyte replacement or just a tasty treat. The alternative sweetener is honey. 
3. Ginger is a classic anti-inflammatory and anti-nauseant that is consistently used for poor digestion, gas, cramping, nausea and arthritis.
4. Water is water. Most people need to increase their water intake. One common thing with most of my patients is the lack of water intake. Having this as the base of Switchel helps to increase fluid intake and get all the benefits of water.

Serves: 4
Ingredients:

• 4 teaspoons apple cider vinegar
• 4 tablespoons pure maple syrup or honey
• 1 teaspoon grated fresh ginger; you can also add in extra slices
• 4 cups water or carbonated water if you like a fizzy touch

Directions:

1. Combine all the ingredients in a large jar with a lid.
2. Shake to combine.
3. At this point, you can drink it over ice cubes or refrigerate and let steep
4. Stir well before serving.
5. If you don't like the bits of grated ginger, simply strain it out after it has steeped then put it back in the fridge...if there's any left ;)

Yes, the rumours are true. Bacon and other processed meats have been deemed a Group 1 carcinogen. Sorry Jim Gaffigan. 

The announcement last week has left people quite surprised. Not because they thought that processed meats were bad, (they already knew that) but because now the World Health Organization (WHO) has told us they're bad. So now people have to pay attention. The WHO reported that "with each 50g portion of processed meat you eat, there is an 18% increased risk in colon cancer...this is among people with a higher intake of processed foods." Associations were also seen with pancreatic and prostate cancers but they weren't mentioned much of in this report.

So what else is considered a Group 1 carcinogen?:
Arsenic, Asbestos, Benzene, Cadmium, Diesel Exhaust, Hepatitis, HIV, Oral Contraceptives, Plutonium, Tamoxifen, Tobacco, and X-rays just to name a few. 

So what is colon cancer? 
Colorectal cancer is a neoplasm or over growth of cells that can grow anywhere within your large intestine. This is where you normally reabsorb water and your fat soluble vitamins (A,D,E,K).

Why do we care?
According to the Canadian Cancer Society, colorectal cancer is the 3rd most common cancer and 2nd leading cause of deaths. 
It is estimated that in 2015:

• 25,100 Canadians will be diagnosed with colorectal cancer. This represents 13% of all new cancer cases in 2015.
• 9,300 Canadians will die from colorectal cancer. This represents 12% of all cancer deaths in 2015.
• 14,000 men will be diagnosed with colorectal cancer and 5,100 will die from it.
• 11,100 women will be diagnosed with colorectal cancer and 4,200 will die from it.
• On average, 69 Canadians will be diagnosed with colorectal cancer every day.
• On average, 25 Canadians will die from colorectal cancer every day.

This is why you should care about what you eat. You should want to be healthy and live happily. As always, focus on high veggie, fruit and lean proteins.

Remember, the best diet is variety.

Updated January 18 2021

When you walk into a grocery store in Whistler, the first thing you notice is the cost. The price here is much more than people are used to. So, what do we do? We start to shop smart. How do we shop smart? Well I'm glad you asked...
 
The key here is to have a plan in mind.  Here’s 5 easy steps to help keep you healthy and within your budget.
 
Step 1:
COOK AT HOME. It’s almost always cheaper to eat at home.
 
Step 2:
Take a second and PLAN OUT YOUR MEALS. If you have a plan, it makes shopping that much easier. This way you can avoid randomly spending $10 on ice cream and put $10 more towards the food you SHOULD be eating. Team up with housemates, family, friends etc to make the meals, this will decrease your costs. It's also a great reason to meet up with friends and family members. 
 
Step 3:
CHECK THE FLYERS THAT WEEK. It’s very simple but rarely done. This lets you know what’s on sale before you even set foot in the store. I’ve attached links to our local grocery stores so you can check them out weekly.
 
Creekside Market
The Grocery Store
Fresh Street
Nesters Market
Independent 
 
Step 4:
SHOP THE OUTSIDE AISLES OF THE MARKET.
This is where we always find our healthy food. Our veggies, fruits, and proteins etc... Once we enter the middle aisles, that's where we tend to find the foods we want to avoid, the processed foods. If we stick to our budget and spend our money on these healthy foods, then we wont blow our cash on the unhealthy stuff. One of my supervisors in med school Dr Afsoun Khalili taught me this part. She would actually take patients to the grocery stores and teach them how to shop effectively.
 
Step 5:
EAT WELL… for cheap
 
That's it… eat in, plan ahead, check for sales, shop the outside aisles. That's your basic blueprint to eating well and not spending a fortune. Let me know how it goes.
 
At this time of year, a lot of the local restaurants offer a seasonal meal deal. Check out some of your favourites to see if they have any deals on for you to save some cashola. 
​
Don't forget about Whistler’s farmers market in the summer. This can be great for finding your healthy food for cheap!!
http://www.whistlerfarmersmarket.org

There's no need to go out and buy those super sugary, highly salty sport drinks. You can make your own at home for dirt cheap and it honestly tastes better, and is better for you.

This one is super simple. I can't take credit for this recipe, it was passed on to me by my wise supervisors while in med school.

This recipe is for 1 litre of water. You can adjust the scale to make as much or as little as possible. I suggest making a big batch to keep in the fridge on standby.

The ingredients:

• 1L water (for hydration)
• 1 Tbsp honey (to give us fuel while being active)
• 1/4 Tsp salt (to replace electrolytes lost)
• 1/4 Tsp baking soda (to replace electrolytes lost)
• 1/2 a lemon 
• Combine all the ingredients into a glass container and stir. You can tweak the amounts based on your personal preference and needs. This is the recipe that I personally like. Squeeze as much lemon as you like until you find your fav ratio. 

And voila! You are now officially sponsored by your own electrolyte drink company! Well not really, but you can pretend.

Please feel free to submit comments or questions

Updated May 31 2015



Now that the snow has melted, the sun is out, temperatures are rising, moods are happier and people are spending more time outside. But for some, there's an ugly side to the coming of spring....the return of allergy season.
For those of you that are familiar with allergies, you know the classic symptoms all too well:

• Itchy, watery eyes
• Runny nose, congestion
• Sneezing, changes in breathing
• Skin changes
• Headaches

So what can you do to minimize your allergy symptoms? The key here is to be proactive and begin addressing the issue 1 month before your triggers usually start. For most people that start is in april/may. There are many things you can do to address this common problem. Depending on what your triggers are, the approach varies. Here are some of the main diet and lifestyle approaches you can take to minimize your issues:

• Avoid known allergy triggers
• Minimize exposure to histamine containing foods like aged cheeses, wine, very ripe foods.
• Minimize stress. Stress will cause increased symptoms of your allergies. Minimizing stress will help decrease your symptoms.
• Increase flavonoids in your diet (oranges, lemons, limes, berries, broccoli, brussel sprouts, mango, papaya, spinach, green tea, garlic, onions, parsley). These foods help to calm the inflammatory substances released from allergens.
• Wash your clothes in hot water to kill possible allergens (dust, pollen etc)
• Use air purifiers and dehumidifiers to decrease dust and mold in your home/workplace
• Discuss the use of Antihistamines (Claritin, Reactine, heartburn medications etc...) with your naturopathic doctor

On top of the above mentioned approaches, naturopathic doctors offer specifically tailored plans to help you with your specific allergy symptoms. These plans may consist of botanicals, acupuncture, homeopathics, and supplements. There are many options to help you minimize these symptoms. These approaches can help curb the intensity of your allergy symptoms and get you back out enjoying your day.

Consult with your healthcare provider for your best treatment and prevention options.

Usually the chat about probiotics comes up pretty often. A lot of people are aware of probiotics, but aren't always clear on exactly what probiotics are or what they do. I like to explain what probiotics are and how they can help the health of the individual. Quite a few people know about probiotics from yoghurt or from an ad they saw on TV. However, very few of my patients really know how probiotics can help their specific health concern. This is a great opportunity to learn and take charge of their health and make informed decisions. So let me take this opportunity to try and explain what probiotics are and how they work.

What are probiotics?
Probiotics are small bacteria that are used to increase and or replace the good bacteria already present in the body. They promote a healthy digestive tract and support defense mechanisms. 
There are over 500 different strains of bacteria that live in your digestive tract. It is believed that there are 10X more bacteria in your body then there are normal cells. They combine to weigh roughly 1 kg. The genes from these organisms may be as much as 150 times larger than the total human gene content. That's a lot of bacteria!!
The 4 most dominant classes of bacteria are: Bacteroidetes, Firmicutes, Proteobacteria,and Actinobacteria.

There are many many different strains of probiotics for sale out there, each with a claim as to why that strain is the best (that is a whole different topic that should be discussed with your healthcare provider). It is believed that different strains of probiotics have different functions in the body. 

How do probiotics work?
Probiotics have multiple functions in the body such as:

• Barrier of protection - by forming a physical barrier and lining the cells of your digestive tract. This keeps the food from irritating the digestive lining.
• Produce Short Chain Fatty Acids (SCFA's) - promotes growth and differentiation of intestinal cells leading to decreased risk of Colon Cancer and Intestinal Hyperpermeability (aka Leaky gut)
• Increase immune function - by modulating Th1 and Th2 immune responses
• Breaking down food to get more nutrients out of it - probiotics begin digestion of food
• Minimize fermentation in the digestive tract.
• Vitamin K2 production - Vitamin K2 can't be stored in the body so consistent formation of vitamin K2 is crucial to prevent bleeding disorders.

When can I use probiotics?
Probiotics can be useful in many scenarios, here are the most common situations:

• Post-Antibiotic treatment
• Digestive health
• Allergies
• Skin conditions
• Pregnancy
• Urinary tract infections
• Inflammatory conditions

Thats the simple explanation of what probiotics are and how they work. Before picking any probiotics, consult with your healthcare provider to find the best strains for you and your health needs. 

Updated May 31 2015

I was talking to a patient last week about her new years resolution to get healthy.  She mentioned to me that she was interested in doing a detox, like the one she saw on that popular Dr show. I said "ok, no problem, but my detox plan is different than his though. My plan is longer than just a few days." She paused briefly and looked a bit puzzled. I asked "what's the matter?" She said, "wait a sec, what exactly is a detox?" I said "that's a great question...allow me to explain..." This is what I told her:

Detoxification is any process of decreasing the negative impact of xenobiotics (external foreign toxic molecules) on bodily functions. It includes biotransformation of endogenous (within the body) and exogenous (outside the body) molecules into excretable metabolites and or waste products.

There are SIX main pathways of elimination:

1. Skin: sweating promotes removal of soluble toxins
2. Breath: increased breathing helps eliminate water soluble toxins
3. Intestines: all fat soluble toxins leave the liver and are excreted via fecal matter
4. Kidney: all water soluble toxins leave the liver and are excreted via the urine
5. Lymphatics: removes wastes from tissues and is responsible for immune system function.
   
6. Liver: primary organ of detoxification. 

How the Liver detoxifies
The Liver is the primary organ of detoxification. Detoxification occurs in the liver through 3 major pathways: Phase I, Phase II and Phase III. 

• Phase I breaks down fat, glucose, carbohydrates, proteins and toxins to intermediate substances. At this point, these intermediate substances are actually MORE toxic to the body and MUST enter Phase II for proper breakdown. Phase I is "non inducible". This means that for the majority of people, Phase I breakdown occurs non stop in the body, it is not inducible or controlled based on the amount of nutrients it has to use in the breakdown.
• Phase II - the broken down products are converted to fat soluble and water soluble products. These products are now less toxic and able to leave the body through bowel movements (fat soluble) and/or urination (water soluble). Phase II is "inducible". This means that Phase II can be increased or enhanced to help with further breakdown of toxic products. This is why liver health is such a large part of the focus of most detox plans.
• Phase III, the elimination of the products. This step is usually the one that most people forget about. Elimination is done via the 6 pathways mentioned earlier. However, the most important at this stage are the kidneys and intestines. If these organs systems aren't eliminating properly, then you will have an accumulation of waste products. 

• This is why its important to focus on all 6 pathways when you are trying to do a "detox" program. 

After discussing this with my patient, we then setup a specific plan tailored for her to optimize her detox plan and achieve her results.
Always consult with your healthcare provider to have the proper guidance to complete your "detox". 

Updated Oct 2016:
This link is a 15min video that summarizes even more about B12 and B12 deficiency.

I've had quite a few patients ask me, "so what's the difference between all the different types of B12 and why does the cost vary so much, and why should i care?" Ive also had just as many patients tell me that they didn't know that there were different forms of B12. So I put this together to give everyone an idea of the functions of B12 and the differences between the 3 forms of B12. 

B12 Functions
B12 (cobalamin) is one of the many water soluble vitamins that your body needs for good health. B12 is needed to promote digestion; nervous system health; fatty acid metabolism, protein metabolism and folic acid metabolism as well as many enzyme reactions in the body. 

"How can I know that Im low or deficient?"
It is indicated in pernicious and macrocytic anemia. People with low stomach acid will likely absorb less because stomach acid and other factors aid in B12 absorption. It can also manifest in fatigue, cardiac problems, neurological disorders (memory loss, sensation changes, confusion, depression), orthostatic hypotension (feeling dizzy when you stand up quickly), and decreased immune function. It may also affect melatonin production leading to sleep issues. It is also indicated in people taking the oral contraceptive pill. The dosage and method of B12 administration should be discussed with your Naturopath or MD prior to starting the supplement.

Some people have genetic defects that cause them to not convert B12 into the active format effectively. This can be evaluated by genetic testing.

Testing your B12
Serum B12 (blood test) is the most common way to have your B12 levels evaluated. Since B12 is involved in so many processes in the body, I like to see the levels in the mid-high range on the blood test. 

Food sources
According to the Dieticians of Canada, the majority of B12 in your diet comes from meat sources. Therefore people who don't consume meat should consider B12 supplementation. There are currently mixed reviews about algae and its use as a B12 source in the diet. 

So now that we know what B12 does and we know its food sources, "what's the difference between all the different B12 forms?"
There are 3 main forms: Cyano, Methyl, and Hydroxy.

Cyanocobalamin
Is the synthetic form of cobalamin used in many supplements. It's popular because of its low cost and stability. It's usually found only in trace amounts in the body. Cyanocobalamin must be converted to the methylcobalamin form in order to become active in the body. Therefore it has no real function in the body other than to be broken down into an active form. When cyanocobalamin is metabolized, it dissociates leaving the cobalamin (B12) and a cyanide ion. Cyanide is a poison to humans. Due to the cyanide portion of this form of B12, it is contraindicated in smokers and people with kidney problems. It as also been mentioned to be avoided in children with autism (still being debated).

Methylcobalamin
This is the coenzyme form of B12 that is used in the metabolism of all the processes mentioned earlier. This form does not require conversion in the body and is therefore more direct in its actions as a supplement. The main difference here is that the methyl form of B12 costs more. However, now the cost difference between cyano and methyl is not so large. 

Hydroxycobalamin
Is another form of B12 that is very similar to methylcobalamin. These two forms of B12 have shown very similar methods of action, absorption efficiency and effectiveness. The difference here is that Hydroxycobalamin lasts longer in your body. It is not put into the more bioactive form of Methyl right away so your body doesn't use it all up at once. 

The debate will continue on whether to choose cyano or methyl or hydroxy. For my patients, I will always choose methyl or hydroxy forms. For me, there is no point in trying to save money in choosing cyano if I don't absolutely need to. I suppose if something happens to the world's supply of methyl and hydroxy, making them extinct, then yes, I would use cyano. However, until that day comes, I really don't see the need to do so. As for the cyanide safety debate, rather than take a chance with my patients, I would rather just go with the form that is known to not have any concerns with cyanide. It just makes sense to not take the chance with your health. As of now the research claims there is no significant risk in choosing the cyano form, but we used to say the same things about plastics (phthalates, BPA), lead paint, leaded gas, asbestos, hand washing before surgery, and the use of cocaine in coca cola.
So for the minimal difference in cost and the less risk of harm, I would go with methyl or hydroxy, it's more bioavailable and is the more natural form.