So WTF is Insulin Resistance?

When we consume carbohydrates, our pancreas produces the hormone insulin to allow cells to uptake the sugar, taking it out of our bloodstream.  When we consume more carbohydrate calories than our body can use, the pancreas has to make more insulin to try and get all the excess glucose out of bloodstream.

Eventually, our cells just can’t take up any more glucose.  They stop responding to insulin and become “insulin resistant.”  So blood sugar levels stay high, and our body keeps trying to lower them by producing more and more insulin.  It’s a vicious circle.

And there are consequences.

1. Fatigue – if our cells aren’t taking up sugars to create energy, we feel fatigued. Even though we have lots of circulating sugar in our bloodstream, we can’t use it.
2. Sugar cravings – you are starving at a feast. Your body HAS all the glucose it could possibly need, but because your cells are not responding to insulin, the sugar isn’t entering cells.  So your cells and brain send out the signal asking for more sugar – perpetuating the cycle.
3. Weight gain – if our body can’t use the available sugars for energy, they are sent back to the liver and packaged up to be stored as fat. Fat that is most often deposited around our midsection.
4. High blood sugar – high blood sugar can eventually lead to a diagnosis of diabetes.
5. Increased inflammation – high levels of insulin in the body can disrupt cellular metabolism and increase inflammation.

Insulin Resistance in Perimenopause

Women in perimenopause are at an increased risk of developing insulin resistance.  When our estrogen levels are more balanced during our monthly cycles, estrogen helps to sensitize our cells to insulin, reducing the chances that we will become resistant to insulin.  During perimenopause when estrogen levels can fluctuate dramatically, we are more at risk of developing insulin resistance.

Additionally, many women in perimenopause are not engaging in the healthy lifestyle behaviours that reduce risk of insulin resistance such as regular exercise, reduced carbohydrate consumption, adequate dietary fiber, and maintenance of a healthy body weight.

Testing for insulin resistance

Yes.  There are tests that can be done to assess for insulin resistance.  Typically we look at fasting glucose, HbA1C, fasting insulin, and triglyceride levels to identify insulin resistance.  Another useful test is C-peptide, a more stable measure of insulin production.Your medical doctor or naturopathic doctor can support you in getting these tests.

A less exact test, but one that research has shown to be useful, is taking your waist measurement.  If a woman’s waist is over 88cm (35 inches) then she is at greater risk of insulin resistance.

How Do I Reverse Insulin Resistance?

The good news is that if you take action, you can reduce insulin resistance.  You should speak to your health care professionals to get an individualized plan, but some of the key things to consider are:

1. Increase dietary protein – this can help to provide alternate forms of energy for your body and improve your metabolism
2. Reduce total intake of refined carbohydrates – simply cutting back on refined carbs, like breads, pastas, crackers, bagels, and white rice and replacing them with vegetables or whole grain options can reduce your total carbohydrate load and improve insulin resistance
3. Eat your vegetables – seriously. Eat at least 6 (ideally more!) servings of vegetables every day.  ½ cup is a serving of most vegetables.  Aim to eat a rainbow – leafy greens, zucchini, peppers, mushrooms, broccoli, cauliflower, carrots, celery, peas, edamame – the list goes on and on!
4. Fiber supplements – research has shown that having 5g of a psyllium based fiber supplement 15-20 minute before eating lunch and dinner can help to reverse insulin resistance, support weight loss, and be helpful in reducing cholesterol.
5. Exercise – the benefits of exercise are not to be ignored. Not only can you help to reduce insulin resistance, but you can also help to prevent muscle mass loss (sarcopenia) which occurs during perimenopause and menopause.  AND it’s one of the most effective antidepressants and mood lifters as well.  30-60 minutes of daily exercise is recommended in almost all studies of insulin resistance.
6. Appropriate supplementation – you really need to discuss supplements with your naturopathic doctor, but the one that has the best research for insulin resistance is Berberine. Berberine has robust research showing benefits in lowering blood sugar levels. It works similar to many blood sugar stabilizing agents, and may be as effective as Metformin for reducing fasting blood sugar, HbA1C, and cholesterol.

Disclaimer

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Select References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC558285/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10254920/

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6485276/

Women who become menopausal before age 45 have what is known as early menopause.  Women with menopause before age 40 have primary ovarian insufficiency (POI), also sometimes called primary ovarian failure.

Regardless of what age women become menopausal, the symptoms are the same.  Hot flashes, night sweats, mood changes, brain fog and cognitive decline, and vaginal changes.  However, there are some serious long term risks associated with early age of menopause that women should know about.

Long Term Health Consequences of Early Menopause and POI 

The emotional effects of losing ovarian function at a young age can be devastating.  Especially for women who are diagnosed in their teens and twenties and learn that they will not be able to have children without donor eggs.

Then there are the troubling symptoms of menopause that can negatively impact quality of life.

And still yet, there are the long term concerns of having estrogen deficiency for a significant portion of a woman’s life.  We know that women with POI and early menopause have higher risk of death from some types of heart disease as well as from all causes – known in medical terminology as all-cause mortality.  Women with earlier onset of menopause also have an increased risk of cardiovascular diseases, digestive tract cancer, neurological diseases such as Parkinson’s disease, psychiatric diseases, osteoporosis and fractures.  And the risks are higher with earlier age.

Women with POI or early surgical or natural menopause have higher risks of bone loss, heart disease, and cognitive or affective disorders associated with estrogen deficiency

Bioidentical Hormone Replacement Therapy for Early Menopause and POI

Women who are diagnosed with early menopause or premature ovarian failure should strongly consider using hormone replacement therapy until the average age of menopause.  The North American Menopause Society (NAMS) in their 2017 position statement suggest that the benefits of hormone replacement outweigh the risks for women with earlier age of menopause until the average age of menopause (52 years of age.)

For women with POI, the higher risks of bone loss, heart disease, and cognitive or mood disorders associated with estrogen deficiency can be reduced to normal levels if hormone replacement therapy is given until 52 years of age.  After 52 years of age, women can reconsider whether to continue hormone replacement or stop.

This may be new information for many women, who consider hormone therapy to only be a treatment for menopausal symptoms, and not a means of preventing future disease.  This approach recognizes the immense benefits that can be achieved through thoughtful use of hormones, both in treatment of symptoms and prevention of future disease.  And I think we should talk about it more.

Reach out

If you are concerned that you may be in early menopause, or have questions, don’t hesitate to get in touch.  I’m here to help.

Selected Resources

http://www.thelancet.com/journals/lanonc/article/PIIS1470-2045(06)70869-5/abstract

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2815011/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3791619/

Disclaimer 

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

Myo-Inositol

A unique molecule created in our bodies, inositol is a secondary insulin messenger, it impacts how our body uses insulin to regulate blood sugar.  While most of us have heard of myo-inositol and d-chiro inositol, there are actually nine different forms of inositol in our bodies. 

We know that women with PCOS tend to have altered inositol levels, especially lower myo-inositol in their bodies, and in particular in their follicular fluid.  This impacts the ways that their bodies, and their ovaries, respond to insulin.  This is likely something we inherit in our genetics, and is not something we caused by our diet or lifestyle choices. 

A NOTE ON D-CHIRO INOSITOL

Our bodies convert myo-inositol into d-chiro inositol through a fancy little enzyme called eperimase. In women with PCOS levels of this enzyme can be increased, resulting in increased production of d-chiro inositol, at the expense of myo-inositol. The presence of increased d-chiro inositol can inhibit our aromatase enzyme and result in increased testosterone levels.

This is important because some people on the internet are advocating for formulas that include d-chiro inositol (so-called 40:1 ratios.) This is never recommended for PCOS as adding additional d-chiro inositol can potentially reduce egg quality, increase testosterone levels, and make it more challenging to achieve hormone balance in PCOS.

The research on myo-inositol in PCOS has given us a great understanding of why it is so beneficial for women.  Some of the most profound benefits include:

• Improves insulin sensitivity, reduces fasting insulin
• Improves ovarian response to FSH
• Increases aromatase activity, increasing estrogen and decreasing testosterone
• Increases SHBG levels, further decreasing free testosterone
• Improves ovulation rates and menstrual regularity
• Improves egg quality (and pregnancy rates)
• Reduces rates of gestational diabetes in PCOS pregnancies
• Improves cholesterol levels, including triglycerides

While we do eat myo-inositol in our diets, even the most diligent of us consume only around 500-700mg per day.  In clinical studies the typical effective dose is 2000-4000mg (or 2-4g) with women who are overweight potentially needing a bit more. 

Myo-inositol does not work instantly, the best benefits are seen over 6 months, but research suggests that most women with PCOS will ovulate within the first 24-40 days on this supplement. 

Myo-inositol should be taken away from meals, typically dosed morning and night.  The most common side effect is bloating which can be minimized by slowly increasing the dosage over time, or taking it with an alpha lactoalbumin supplement (usually in the form of whey protein powder.)  Folic acid is added to most treatment plans with myo-inositol as it can further support egg development. 

Interestingly, when compared to one of the most common medications for PCOS, metformin, the results achieved with myo-inositol are very similar.  They both improve blood sugar, insulin levels, ovulation and period regularity, and hormone levels.  Myo-inositol may in fact be better than metformin at reducing elevated androgens and the symptoms associated with that hormone balance (acne, hirsutism, and hair loss.)

You will need to stay on the myo-inositol as long as you want to derive the benefits from it. Remember, PCOS is a genetic condition, and your body needs the myo-inositol for it to function optimally. If you can’t make it, you need to take it.

If you become pregnant while taking myo-inositol, do not discontinue it. Myo-inositol during pregnancy can reduce the incidence and severity of gestational diabetes and reduce the risk of miscarriage, which is significantly elevated in women with PCOS.

N-Acetyl Cysteine

N-acetyl cysteine (NAC) is a precursor for the conditionally essential amino acid cysteine.  Used for its powerful antioxidant and anti-inflammatory effects, NAC is one of our cornerstone treatments for PCOS. 

NAC has unique benefits for PCOS not found with other treatments, most notable improvements in endometrial lining thickness.  Other benefits of NAC include:

• Improved insulin response
• Lowered androgens and improved symptoms of androgen balance
• Improved ovulation and menstrual regularity
• Improved fertility outcomes – better egg quality, reduced miscarriage rates, fewer drugs needed in fertility treatments, thicker endometrial lining, higher pregnancy and live birth rates

NAC has also been compared to metformin and found that it has similar pregnancy rates, similar reductions in total testosterone, and patients taking NAC had a greater reduction in body weight.  NAC wasn’t as successful at lowering fasting insulin as metformin, but it still does benefit blood sugar balance and insulin sensitivity. 

The dosage of NAC is usually 500mg given three times per day with meals.  It should be taken for a minimum of three months to see benefit, with most benefit seen after six months.  For women who are overweight, the dose may go up to 1000mg three times per day.   

For women undergoing fertility treatment, improvements have been seen with NAC in as few as four days of supplementation.  However, for most women, three months of supplementation is recommended before undergoing as assisted fertility cycle. 

Unlike myo-inositol which is continued throughout pregnancy, NAC is used up until ovulation or oocyte retrieval in a fertility cycle, and then stopped.  It can be resumed in the next month if pregnancy is not achieved.   

Omega 3 Fatty Acids

Omega 3 fatty acids are essential fatty acids, meaning that they are essential for our bodies to function.  As we don’t easily make omega 3s ourselves, we need to consume them in food, or take them as supplements. 

For PCOS omega 3 fatty acids are most useful for improving mood – especially depression – associated with PCOS.  Omega 3s have also been found in studies to improve fasting insulin, total testosterone, measures of inflammation, and the appearance of abnormal hair growth (hirsutism.) 

With additional benefits in balancing cholesterol levels, and reducing fatty liver disease, omega 3 fatty acids are often incorporated into a holistic treatment plan for PCOS, but are rarely used on their own. 

The most abundant source of omega 3 fatty acids in the diet is cold water fish – trout, mackerel, herring, salmon, and sardines.  Some eggs are good sources, and plant based sources include walnuts, flax, chia, hemp seeds, and the oils made from these nuts and seeds.  Most research studies use supplemental omega 3s with dosages ranging from 2000-3500mg per day. 

Vitamin D

Vitamin D is one of the most important nutrients for hormonal conditions because it acts as a pro-hormone in our bodies, influencing the way that our hormones act.  It also regulates genes that are crucial for blood sugar metabolism and fat metabolism (i.e. weight loss.)  It is also one of the most common nutrient deficiencies, due to low sunlight exposure during the winter months and sunscreen usage in the summer months. 

For women with PCOS, vitamin D can improve blood sugar stability and reduce insulin resistance, while also supporting healthy follicle development and cycle regularity.  Vitamin D, through its actions on serotonin, has also been found to improve mood, and as depression and anxiety are more common in women with PCOS, this benefit is not to be ignored.   For women considering pregnancy, improving vitamin D status was one of the most significant ways to reduce miscarriage rates and improve live birth rates (with a four-fold increase in birth rates for women with sufficient vitamin D in one study.) 

It has been estimated in studies that up to 75% of women with PCOS are deficient in vitamin D.  Deficiency is more common in women who are overweight as well.  And while blood testing for vitamin D is not commonly done, it is recommended for all women with PCOS.  Be mindful, however, that the “normal” lab range is not considered adequate for PCOS.  In women with PCOS we want a minimum of 110nmol/L of vitamin D for positive benefits. 

For most women a higher dosage is needed to achieve these blood levels of vitamin D.  Dosing of 25 000
to 40 000IU are common in studies.  Your dosage will be determined based on blood work, and your
body weight. 

Berberine

One of the best researched botanical medicines for PCOS, berberine has a lot of potential benefits.  Research over the past 20 years has shown that berberine can:

• Reduce total testosterone and increase SHBG
• Improve insulin sensitivity
• Decreased total cholesterol and improved HDL (“good” cholesterol)
• Improve ovulation rates
• Improvements in non-alcoholic fatty liver disease

Studies on berberine have found that it is comparable to metformin in improving ovulation rates, and may be more effective than metformin in reducing elevated testosterone and androgens.  Some studies have even shown higher live birth rates in women with PCOS who were trying to conceive, compared to placebo and to women taking metformin.

Berberine is most effective when combined with other treatments, including NAC, myo-inositol, and Clomid.  Studies have also shown improvements when combining berberine with lifestyle and dietary counseling. 

For women who are trying to get pregnant, berberine should be stopped once you are pregnant, or after a transfer if you are doing IVF. 

Cinnamon

The research on cinnamon for PCOS is somewhat lacking, however, with the known benefits on blood sugar stability from diabetes research, some information on using Cinnamon for PCOS is starting to emerge.

Cinnamon can help in balancing blood sugar and improving cholesterol for women with PCOS.  However, there isn’t much evidence that cinnamon helps restore ovulation and cycle regularity for women with PCOS.  It’s a nice part of your diet, but maybe isn’t impactful enough to use as a supplement just yet. 

Metformin

A treatment for diabetes, metformin is used to balance blood sugar and reduce insulin resistance in women with PCOS.  Most often used in women who are overweight, metformin can also be given at lower doses for women with lean PCOS, or teens with PCOS. 

Metformin is often used in pregnancy for women with PCOS as it can reduce early pregnancy loss.  It is known that using metformin reduces the diagnosis of gestational diabetes in women with PCOS, but it doesn’t seem to change meaningful outcomes – including rates of late miscarriage, preterm delivery, or birth weight. 

In general, I don’t recommend metformin routinely for PCOS as there are other options, such as myo-inositol, and NAC, that perform at least as well, if not better than metformin, with fewer side effects and potentially more benefits. 

Spironolactone

An aldosterone receptor antagonist, spironolactone is mostly used in the treatment of edema, high blood pressure, heart, and kidney disease.  In PCOS it is used exclusively to reduce the appearance of hirsutism (abnormal hair growth patterns.) 

It does not have benefits for ovulation, cholesterol, or insulin sensitivity.  The most common side effect associated with spironolactone in women is mid-cycle bleeding, which can be confusing for women with PCOS who already have irregular cycles and may misinterpret this side effect.

Oral Contraceptives (“The Pill”)

While the pill is one of the most common treatment recommendations for PCOS, more and more women are opting for alternative treatments due to side effects and risks associated with the pill.  While many women use the pill with no concerns, there are some facts about the pill that women with PCOS should consider:

• Birth control pills increase the risk of blood clots, and women with PCOS already have a 1.5 times higher baseline risk of clots (and a 3.7 times increased risk on the pill)
• The pill can increase cholesterol levels, a concern many women with PCOS already have
• Increased risk of depression associated with using the pill, again, a condition that PCOS also has an associated increased risk
• The progesterone only pill is associated with increased weight gain
• Increased risk of abnormal PAP tests with oral contraceptive use
• The “period” experienced on the pill is not a period, but a withdrawal bleed.  It does not “normalize” cycles as many women are told.

The benefit of the pill is that it can protect women from one of the more harmful consequences of PCOS – endometrial cancer.  When a woman with PCOS does not have a regular period, her uterine lining (endometrium) can be exposed to estrogen for prolonged periods of time, leading to an increased risk of precancerous changes.  The birth control pill contains progestins, medications that are similar to progesterone, that protect the endometrium from the impacts of unopposed estrogen.

If you are considering the pill, be sure to get the preliminary testing done prior to best understand your risk factors associated with the pill.  Your BMI, waist circumference, blood pressure, hirsutism score, fasting blood sugar, fasting cholesterol, and liver function tests should all be done before a prescription is made. 

Disclaimer

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

But I want you to know, you can have an abundantly healthy pregnancy eating a plant-based diet.  Whether you are vegan or vegetarian, it is possible to get all the nutrients you need for your health, and for the health of your child.  The most important thing to know is what the key nutrients are for a healthy pregnancy, where the challenges of a plant-based diet are, and how you can make powerful decisions with your food to have a healthy, happy plant-based pregnancy. 

KEY NUTRIENTS IN PREGNANCY

We all recognize that nutritional needs are higher during pregnancy than in any other stage of life.  We are no longer eating for ourselves, but we are eating to support the growth and development of the next generation of our family.  All nutrients are important in pregnancy, however, some nutrients are more crucial during pregnancy for the health of both mother and child.  In this section I’ll be paying special attention to those nutrients that are more difficult to get in a plant-based diet. 

FOLATE

The most well-known nutrient for pregnancy, folate (or folic acid) is necessary for DNA replication and the growth and development of tissues and organs in the fetus.  It is well established in the research that folic acid supplementation helps to reduce the risk of several different birth defects and all women should take a folic acid supplement before and during their pregnancy.

Folate is abundant in leafy green vegetables – in fact it gets its name from the foliage that it is found in.  Excellent food sources include spinach, kale, arugula, and other greens, as well as black eyed peas, beans, asparagus, broccoli, citrus fruits, and fortified grains and cereals. 

VITAMIN D

Known as the “sunshine vitamin”, vitamin D is produced by the action of UV rays on special cells in our skin.  Vitamin D is essential for the health of both mother and baby.  It is needed for bone health, immune health, and mood support in mothers, and it is essential for fetal growth, bone development, and tooth formation. 

Unfortunately research has found that more than half of pregnant women are deficient in pregnancy.  Vitamin D deficiency is associated with an approximately 60% increased risk of preeclampsia in pregnancy, and all the complications that come with this diagnosis.  As we live in Canada, deficiency is likely more prevalent because of poor vitamin D production during the winter months.

Currently vitamin D testing is not standard in pregnancy, but I recommend all women do vitamin D testing either before pregnancy, or within the first few weeks of pregnancy to allow for time to correct deficiencies if one is noted.

For plant based parents, there is an increased risk of vitamin D deficiency as supplemental vitamin D is often added to dairy products, making it the second most common source for vitamin D, after sun exposure. 

Supplementation is recommended for most pregnancies, however dosing should be based on laboratory testing. 

IRON

The most common nutrient deficiency worldwide is iron.  It is no surprise that many women go into pregnancy with low iron status – especially those women with a history of heavy periods, fibroids, and women who eat a plant-based diet.  The demand for iron skyrockets in pregnancy as it is needed to make red blood cells.  Red blood cell production dramatically increases after week 16 of pregnancy and continues to accelerate right up until the final days of pregnancy.  This is concerning for women with preexisting iron deficiency because they need more iron during the pregnancy to keep up with the demand for red blood cells, and red blood cells only live for 120 days.  If they were deficient to start with they will never be able to catch up to the high demand and turnover of red blood cells. 

Iron is absolutely essential for fetal growth and development, as well as oxygen delivery to the fetus and placenta through red blood cells.  Low iron status in pregnancy is associated with low birth weight babies, preterm delivery, and an increased risk of autism, ADHD, schizophrenia, poor school performance in childhood, and even an increased risk of anxiety and depression in teens and young adulthood. 

Iron is found in many plant foods, however it may not be sufficient to overcome deficiencies.  Beans, soy, lentils, molasses, tomatoes, peas, wheat bran, broccoli, apricots, figs, raisins, and dates are all vegetarian sources of iron.  It is imperative for all pregnant people to test their iron levels early in pregnancy, and again in the second trimester, to monitor for iron deficiency, and take supplements if needed. 

ZINC

Zinc is a nutrient especially important in plant-based pregnancies, as it is rarely deficient in an omnivorous diet.  Studies have found that a majority of vegan and vegetarians during pregnancy are not getting the recommended daily intake of zinc.

Zinc is essential for immune function, especially for supporting pregnant women in resisting infectious diseases.  It is also needed for fetal growth and development, and for preventing prolonged labour. 

Plant based food sources of zinc include beans, cashews, peas, and oats.  However, supplementation is recommended for all plant-based parents during and before pregnancy. 

CALCIUM

Necessary for bone development in babies, calcium helps to provide nutrients for a growing baby, while preventing bone loss for pregnant parents.  Research has suggested that in most pregnancies intake of calcium is falling below the recommended daily intake. 

Ensuring adequate calcium in pregnancy can also help to reduce the risk of preeclampsia and hypertension in pregnancy. 

Plants are abundant sources of calcium, but with the daily requirements being high (1200-1500mg) reaching this level can be challenging for plant-based pregnancies.  Supplementation can be a simple way of ensuring adequacy is reached.  Plant sources include beans, lentils, greens, broccoli, bok choy, celery, leeks, nuts and nut butters, tahini, sesame seeds, amaranth, fortified cereals, brown rice, soy, tofu, figs, rhubarb, raisins, and dried apricots. 

CHOLINE

The most underappreciated nutrient for prenatal development, choline is one of the most important for plant-based parents to be aware of.  Choline is essential for brain development and it is estimated that most vegans and vegetarians are getting less than half of the daily recommended amount for pregnancy (studies have shown the average intake in a plant based diet is 192mg per day whereas the daily recommended intake in pregnancy is at least 450mg/day.)  Pregnant individuals who eat eggs and dairy are more likely to consume adequate choline compared to those who do not – two eggs provide nearly all the recommended daily choline. 

Some plant foods do contain choline, such as legumes, soy and tofu, green vegetables, potatoes, nuts, seeds, and grains.  However, plant sources are naturally low in choline, so supplementation is very highly recommended in pregnancy.

IODINE

Worldwide, iodine deficiency during pregnancy is one of the major causes of neurological defects in children.  Essential for brain development iodine requirements increase during pregnancy from 150mcg to 250mcg per day.  As most iodine in our diet comes from seafoods it is found in the research that vegans are at an increased risk for iodine deficiency.

Research has found that low iodine during pregnancy can increase the risk of having a child with ADHD or a child on the autism spectrum. 

Plant sources of iodine include fortified bread products (a possible concern for deficiency in people eating a gluten free diet), sea vegetables like wakame and nori, iodized table salt, green beans, zucchini, kale and watercress.  However the amount of iodine in this foods is highly variable depending on the iodine content of the soil they are grown in.

In Canada all prenatal supplements contain the daily recommended amount of iodine so your iodine requirements should be covered by that daily supplement. 

SUPPORTING A PLANT BASED PREGNANCY

If you are vegan or vegetarian and need more support in your pregnancy – whether it is diet recommendations, support selecting supplements, or accessing the essential laboratory testing for your health and the health of your baby, reach out. I’m here to help.

Disclaimer

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem. 

SELECTED RESOURCES

Wallace TC, Blusztajn JK, Caudill MA, Klatt KC, Natker E, Zeisel SH, Zelman KM. Choline: The Underconsumed and Underappreciated Essential Nutrient. Nutr Today. 2018 Nov-Dec;53(6):240-253. doi: 10.1097/NT.0000000000000302. Epub 2018 Nov 13. PMID: 30853718; PMCID: PMC6259877. https://pubmed.ncbi.nlm.nih.gov/30853718/

Sebastiani G, Herranz Barbero A, Borrás-Novell C, Alsina Casanova M, Aldecoa-Bilbao V, Andreu-Fernández V, Pascual Tutusaus M, Ferrero Martínez S, Gómez Roig MD, García-Algar O. The Effects of Vegetarian and Vegan Diet during Pregnancy on the Health of Mothers and Offspring. Nutrients. 2019 Mar 6;11(3):557. doi: 10.3390/nu11030557. PMID: 30845641; PMCID: PMC6470702. https://pubmed.ncbi.nlm.nih.gov/30845641/

Avnon T, Paz Dubinsky E, Lavie I, Ben-Mayor Bashi T, Anbar R, Yogev Y. The impact of a vegan diet on pregnancy outcomes. J Perinatol. 2021 May;41(5):1129-1133. doi: 10.1038/s41372-020-00804-x. Epub 2020 Sep 1. PMID: 32873905. https://pubmed.ncbi.nlm.nih.gov/32873905/

Baroni L, Goggi S, Battaglino R, Berveglieri M, Fasan I, Filippin D, Griffith P, Rizzo G, Tomasini C, Tosatti MA, Battino MA. Vegan Nutrition for Mothers and Children: Practical Tools for Healthcare Providers. Nutrients. 2018 Dec 20;11(1):5. doi: 10.3390/nu11010005. PMID: 30577451; PMCID: PMC6356233. https://pubmed.ncbi.nlm.nih.gov/30577451/

Yisahak SF, Hinkle SN, Mumford SL, Li M, Andriessen VC, Grantz KL, Zhang C, Grewal J. Vegetarian diets during pregnancy, and maternal and neonatal outcomes. Int J Epidemiol. 2021 Mar 3;50(1):165-178. doi: 10.1093/ije/dyaa200. PMID: 33232446; PMCID: PMC7938506. https://pubmed.ncbi.nlm.nih.gov/33232446/

Kesary Y, Avital K, Hiersch L. Maternal plant-based diet during gestation and pregnancy outcomes. Arch Gynecol Obstet. 2020 Oct;302(4):887-898. doi: 10.1007/s00404-020-05689-x. Epub 2020 Aug 10. PMID: 32776295. https://pubmed.ncbi.nlm.nih.gov/32776295/

Melina V, Craig W, Levin S. Position of the Academy of Nutrition and Dietetics: Vegetarian Diets. J Acad Nutr Diet. 2016 Dec;116(12):1970-1980. doi: 10.1016/j.jand.2016.09.025. PMID: 27886704. https://pubmed.ncbi.nlm.nih.gov/27886704/

THE SHINE LAB TEST ESSENTIALS

HORMONES

TSH and the comprehensive thyroid panel

Thyroid hormones are one of the most important drivers of our energy.  Necessary for our cells to use oxygen, no system in our body works smoothly without thyroid hormones.  The most important test for thyroid is TSH (thyroid stimulating hormone) and if this hormone is even slightly outside the optimal range, I always suggest following up with a comprehensive thyroid panel to look at T4 and T3 – the main hormones produced by the thyroid gland – and autoimmune antibodies that determine if the thyroid is being harmed by the immune system.   

Morning Cortisol

Cortisol, together with melatonin, regulate our daily energy levels.  Cortisol rises in the morning, helping us to feel energized and ready to face the day.  Because cortisol is also one of our powerful stress hormones, it is strongly influenced by our stress levels.  If cortisol is too high, or too low, it can have significant impacts on our energy, mood, inflammation, and overall well being.  It is one of the most important tests for the SHINE energy protocol.  This test must be done at 8am. 

Fasting Glucose, Fasting Insulin, and HbA1C

Blood sugar regulation is important for keeping our body energized with a steady state of our main fuel source – glucose.  Unfortunately for many of us our bodies are provided with too many carbohydrates, causing our blood sugar and insulin levels to fluctuate wildly, leaving us tired, unmotivated, and craving more and more sugar.  Fasting glucose, fasting insulin, and HbA1C (a measure of three month blood sugar stability) gives us the information we need to regulate these essential energy hormones. 

INFLAMMATION

Erythrocyte Sedimentation Rate (ESR)

This mouthful of a test measures the speed at which red blood cells settle at the bottom of a test tube.  How is that important you ask?  Well it helps us to understand the level of inflammation that the red blood cells are exposed to.  When inflammation happens, fibrinogen is released into the bloodstream in high amounts and causes red blood cells to stick together, which raises the ESR.  This gives us a good overview of the overall inflammatory burden of the body.  As inflammation is a crucial obstacle to identify and overcome for peak energy, ESR is a simple way of understanding its impact on our body.

High Sensitivity C-Reactive Protein (hsCRP)

Another measure of inflammation, CRP rises quickly with acute inflammation (like an injury or tissue damage) and drops quickly as well – it has a half life of only about 18 hours.  When we measure CRP we can determine if there is on going inflammation in your body.  If your CRP is increased we know that cells are being damaged due to inflammation, and if it stays high, we know the damage is still happening.  Typically we will follow up an elevated CRP with further autoimmune testing. 

Epstein Barr Virus (EBV)

The virus best known for causing mononucleosis, EBV is often a contributing factor for fatigue many years after exposure to the virus.  Testing for the presence of the Epstein Barr Virus Nuclear Antigen can tell us if you have had mono previously, and if we need to support your immune system to keep the virus in its inactive latent state. 

NUTRITION

Complete Blood Cell Count (CBC)

The CBC reflects the size, shape, and number of platelets, and red and white blood cells present in your blood stream.  This can help us to identify nutritional deficiencies, such as low iron, low vitamin B12, and low folate.  It also helps us to identify issues with inflammation, infection, allergies, and blood clotting disorders.  Conditions that impact energy like anemia and thalassemia can be quickly identified with this simple test. 

Ferritin

A measure of the stored form of iron, ferritin is one of the most common tests used to identify the underlying causes of low energy.  Iron deficiency is the most common nutritional deficiency in children and adults.  As iron is essential for the delivery of oxygen to our cells, even a mild iron deficiency can lead to fatigue symptoms. 

Vitamin B12

Vitamin B12 is essential for the function of our nervous system, making red blood cells, and for driving energy production in our cells.  Vitamin B12 deficiency is common as we get older, in people with digestive issues, in people who regularly consume alcohol, or use prescription medications (including antacids and diabetes medications), and in people who consume an exclusively plant based diet.  As the number one symptom of low B12 is fatigue, this is an important nutrient to assess when exploring how to make your energy SHINE. 

Vitamin D

Living in Canada, we are at increased risk for vitamin D deficiency during our long winters.  Often called “the sunshine vitamin”, vitamin D is essential for bone health, immune system function, hormone balance, and anti-inflammatory activity in our bodies.  Optimal vitamin D levels are important to maintain year round for our health and wellbeing.  Unfortunately vitamin D levels are very rarely checked and current supplementation guidelines leave many of us with low vitamin D status.  Vitamin D levels are typically checked in the fall (October) and winter (February), but can be checked at any time if there are concerns about your vitamin D. 

Interested in understanding your energy better? Reach out. Let’s talk. I’m here to take you from feeling burnt out, to fired up!

Disclaimer

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem. 

Welcome to Medical Menopause 

If a woman’s ovaries are removed during a hysterectomy she will immediately go into menopause, a state known as ‘medical menopause’.  Even if the ovaries are not removed, many women begin to have symptoms of menopause immediately after a hysterectomy and more will follow within the first year.

When the uterus is removed, the ovaries lose an important blood supply from the uterine artery, and their production of hormones can drop off significantly.

For women with medical menopause the symptoms can be quite alarming.  Speaking on the topic of medical menopause, Dr. Randy Randolph MD said

“because there is no opportunity for gradual adjustment to the hormonal drop-off, the symptoms of artificial menopause can be sudden, severe, and debilitating, requiring an immediate intervention of supplemental hormone therapy.”

Long Term Health After Hysterectomy

After hysterectomy the symptoms of menopause can come on fast and furious.   Like a rollercoaster no one wanted to get on, and no one knows how to get off, this can significantly impact your quality of life.  In particular, hot flashes, night sweats, sleep disturbances, mood instability and vaginal changes commonly occur for women after hysterectomy.

We also need to consider the long-term consequences of a woman going into menopause before the average age of menopause.  Women with early menopause due to hysterectomy, medications or primary ovarian insufficiency are at increased risk of heart disease, overall mortality, neurological diseases, psychiatric diseases, osteoporosis and fractures.  And the risk is higher with an earlier age of menopause.  With 1 in 10 women having a hysterectomy between 40-44 years of age, this is a large number of women with increased risk factors for ill health in their later years.

Hormone Replacement Therapy After Hysterectomy

For women with medical menopause, who are younger than the average age of menopause (52 years), many experts suggest that the benefits of hormone replacement therapy may outweigh the risks.

Estrogen therapy alone, without progesterone, is often recommended for symptoms of hot flashes, night sweats and vaginal changes.  Some experts also recommend using bioidentical progesterone to support mood, stress tolerance, and libido.

As these women are no longer experiencing menstrual cycles, many will use the hormones continuously throughout the month.  For women who still have some experience of hormone fluctuations (those women who still have their ovaries), the use of hormones in a more cyclical fashion is also appropriate.

To prevent the long term impact of medical menopause, women are counselled to continue hormone replacement therapy until the average age of menopause, and beyond if needed for symptom management.

Next Steps

Hormone replacement therapy, including bioidentical hormone therapy, most certainly is not for everyone.  I take prescribing bioidentical hormones very seriously.  If you want to know if you are a candidate for bioidentical therapy, check out this article.  And if you are in Ontario and want to work together, don’t hesitate to reach out.  I’d love to talk.

Disclaimer

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

The Understanding Bioidentical Hormones series is here to help dispel some myths, and provide some solid information to women who just want to understand more about their options.

Now, bioidenticals won’t be the solution for everyone, and as a Naturopathic Doctor they are rarely the first step in balancing hormones, but I believe women need information to make the right decisions for themselves.

Hormones are one of the key ways that women differ from men, and they profoundly influence the way women experience our lives – influencing our moods, our energy, our libido, and our quality of life.

Hormones are the chemical messengers that communicate information in our body – they are produced in one place (like the ovaries or the thyroid gland), but exert their impact at other locations (like the brain, breast or bone).  Hormones are one of the key ways that we maintain balance (or “homeostasis”) in our bodies, our minds, and our moods.

When a hormone travels through the body, it seeks out hormone receptors.  And like a lock in a key, the binding of that hormone can change the function of that cell.  Usually the hormone will tell the cell to do something, like make a protein, or stop doing something, like making inflammatory compounds.

No hormone acts in isolation.  Each hormone can interact with other hormones, establishing a healthy balance in our bodies.  For example, our melatonin supports our sleep, and our cortisol supports our wakeful state.  Insulin lowers our blood sugar, and glucagon raises it.

It is only when we understand how our hormones work, how they influence and interact with each other and how hormonal balance is achieved, can we hope to positively impact hormone imbalances.  In the symphony of hormone balance, absolute levels of hormones are not as important as the relative balance between the hormones – if one hormone is overwhelming the others, it doesn’t matter if all the others are at the appropriate level, the symphony will still sound imbalanced.

What is a Bio-Identical Hormone?

Bio-identical hormones are unique compounds that have the exact same structure as the hormones our body makes itself.   While the bio-identical hormones may be made in a lab (progesterone is made from wild yams!), their identical structure allows them to bind to hormone receptors in our body and precisely mimic the actions of our own hormones.

Bio-identical hormones may never be embraced by conventional medicine, because there is no profit to be made from them.  As naturally occurring compounds, bio-identical hormones can not be patented by pharmaceutical companies and marketed to doctors and patients.  The only benefit to be gained from bio-identical hormones is improved quality of life for the people using them.

Next steps

Now that you know the basics of what a hormone is, and what makes a hormone bioidentical, I want you to read the article on the key differences between conventional hormone replacement therapy and bioidenticals.  I think this is the MOST important information women need to understand when considering bioidenticals.  And then look at the Eligibility for Bioidenticals article to understand if they might be right for you.

As always, I implore you to work with an experienced and skill practitioner when exploring hormone therapy of any kind.  If you are in Ontario and want to discuss working together, just reach out.

x

Dr. Lisa

Disclaimer

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

The Bioidentical Difference

While the hormones used in bio-identical hormone replacement therapy (BHRT) sound similar to those used in conventional HRT – estrogen and progesterone being the most common – there are some significant differences that are compelling enough for many women to reconsider bioidenticals, even if they are cautious about conventional hormone replacement therapy.

Bio-Identical Hormones are Bio-Identical

The most important factor setting BHRT apart from HRT is the type of hormones used.  While conventional HRT uses natural estrogens (natural in that they come from horse urine – which may be natural for horses, but certainly isn’t natural for humans), the type of progesterone used is not progesterone at all – but a “progestin” – a compound that is similar to progesterone but has a very different molecular structure.  This change in structure results in significant changes in the actions that result from the use of the synthetic hormone. 

Bio-identical hormones on the other hand are just that, bio-identical.  They are exactly the same as the hormones you have been making through your reproductive years.  And as a result, they exert the same powerful actions when reintroduced to your body. 

Bio-Identical Hormones are Used Topically

While this may not seem like a huge difference, the use of BHRT in a topical form has a massive impact on how your body uses it, and the dose necessary for positive effects.

When taking any medication orally (by mouth) it dissolves in the digestive tract and is moved from the digestive tract into the portal circulation – this takes the drug immediately to the liver, where large amounts of it are inactivated.  This is called the “first pass metabolism” and hormones are highly susceptible to this process.  This means that you need to take much higher doses to compensate for the loss of hormones that occurs before your body can use them.

When you use a hormone topically, by applying it directly to the skin, the pharmacokinetics change significantly.  The hormone no longer goes directly to the liver, but instead is absorbed into fatty tissues where it can begin to bind to receptors, and exert benefits, before it meets the liver and is metabolized.  This allows us to use much lower doses of hormones, because we don’t need to dose high to compensate for the loss of hormones in the first pass through the liver.

Bio-identical hormones are used in physiological patterns

The last significant distinction between conventional HRT and BHRT is that in BHRT we try to mimic the hormonal patterns established by nature.  Rather than giving a steady dose of hormones, with BHRT we try to maintain the natural rhythms and patterns of hormones in the body, especially for women in perimenopause.  This can diminish the possible side effects of taking the same dose of hormones all the time.  

Reach Out for Support

If you have questions – and I bet you do – check out the other articles in the Understanding Bioidentical Hormones series. And if you are in Ontario, and would like to reach out to discuss working together, I’d love to chat.

In health,
Dr. Lisa

Disclaimer

The advice provided in this article is for informational purposes only.  It is meant to augment and not replace consultation with a licensed health care provider.  Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem. 

So whether you have been diagnosed with endometriosis, or just suspect you may have it, a good place to start is to follow the Endometriosis Diet.

The Endometriosis Diet

While most women look at the Endo Diet as a means of reducing painful periods, there are actually a number of reasons to follow the recommendations discussed below.

The Endo Diet is anti-inflammatory, nutrient rich, and supports not just your reproductive health, but your overall health. Some of the benefits of following the Endo Diet include:

• Balancing the immune system
• Decreasing inflammation
• Supporting hormone regulation
• Improving detoxification

The Endo Diet: Foods to Avoid

1. Avoid alcohol

Studies have found that women who consume alcohol have up to a 50% increased risk of developing endometriosis.  Drinking alcohol depletes B vitamins that are necessary for hormone detoxification. It also has estrogen-like effects on the body and can worsen endometriosis symptoms.  If there is one change to make to positively impact endo, it’s cutting out alcohol.

2. Avoid refined sugar

Sugar is another major culprit in messing up our hormone balance.  For endo it looks something like this: when we have refined sugars it causes a spike in insulin and insulin-like growth factor production.  These cause a reduction in sex hormone binding globulin, which causes more estrogen to be free and active in our bodies.  In animal studies this has been shown to cause a proliferation in endometrial tissue and a potential concern for development and worsening of endometriosis.

Long story short – sugar is fuel for endometriosis.  Best to not throw fuel on the fire and cut it out of your diet.

3. Avoid caffeine

While research studies are inconclusive, we know that the consumption of caffeinated beverages can increase the availability of estrogen during the peak estrogen phases of our cycle.  We also know that there is some research showing women consuming two cups of coffee per day have twice the risk of developing endometriosis.  So best to cut this back, or out altogether!

4. Avoid red meat

Despite my status as a long time vegetarian (over 30 years), I have many patients who regularly consume red meat.  Unfortunately for women with endometriosis the research is quite well established that red meat can promote the production of inflammatory prostaglandins, increasing inflammation and pain. Another major issue is that  cattle and pigs fed grains treated with pesticides tend to concentrate these hormone-disrupting chemicals (such as dioxin) in their fat and muscle tissues. Consumption of these meats is a leading source of human exposure to organochlorines – which are disastrous for endo.

5. Avoid gluten

While the research is a bit dated (2012 is the most referenced study), there are thousands, if not hundreds of thousands of women who have shared their experience of improving their endo symptoms with avoiding gluten.  In that notable 2012 study  of the 200 women in the study 75% of them reported an improvement in pain and none reported an increase in pain. Honestly, it’s one of the most common recommendations I make with my patients, and I often see remarkable results.

7. Avoid saturated and TRANS FATS

Fats are one of the most important macronutrients for hormone balance and human health.  However, the type of fat really matters.  For women with endo the biggest concerns come from saturated fats – found mostly in red meats and butter (and other dairy products).  Women with higher saturated fat intake are typically found to have higher estrogen levels and are a higher risk for developing endo.  Trans fats, found in highly processed “foods”, are associated with higher levels of inflammatory mediators like interleukin 6 and C-reactive protein.  Best to cut out all sources of saturated fats – butter, red meat, and stick with lower fat dairy products, hard cheeses, and healthier oils such as flax oil, olive oil, and nut oils.

Endo Diet: Foods to Enjoy

1. Organic fruits and vegetables

Fruits and vegetables provide fiber that support healthy digestive function as well as nutrients to support immune function, detoxification and decrease inflammation. Women who consume two servings of fruit per day have a 20% decreased risk of endometriosis. There is research that shows women who eat one citrus fruit per day are at a lower risk for developing endo compared to women who ate citrus infrequently.  And honestly, selecting organic fruits and vegetables whenever possible will minimize intake of pesticides that further disrupt hormone function.

2. Vegetarian proteins

Women who eat a vegetarian diet excrete 2-3 times more estrogen in their feces and have half as much estrogen in their blood as meat-eaters. While estrogen doesn’t cause endometriosis, we know that supporting estrogen detoxification is important in managing the spread and severity of endo.  Focus on eating soy, almonds and nuts and nut butters, beans, lentils and legumes – especially since I want you to cut back on your red meat!

3. Fish

Fish, especially cold-water fish like salmon and mackerel, are a rich source of anti-inflammatory omega 3 fatty acids. While supplements of omega 3s are often necessary to achieve the optimal anti-inflammatory benefits, consuming fish as a protein is a good recommendation.  Two servings per week seems to be ideal – more than this can result in undesirable exposure to PCBs and other environmental contaminants.

4. Flax seeds

Another rich source of omega 3s, ground flax seeds also contain lignans that provide an ideal source of fiber to support digestion and healthy bacteria balance.  As we learn more about the impact the microbiome has on endometriosis, this recommendation gets more and more support.

5. Cabbage family vegetables

The Brassica (cabbage) family of vegetables support detoxification and encourage a healthy estrogen balance by favouring production of the less active form of estrogen. Consume broccoli, brussels sprouts, cabbage, kale, kohl rabi and cauliflower regularly to reap these benefits.

6. Leafy green vegetables

Leafy green vegetables provide key minerals for detoxification and support liver function. Frequent consumption of leafy greens (two servings per day) has been shown to significantly decrease the incidence of endometriosis.

7. Onions, garlic and leeks

These vegetables contain organosulfur compounds that enhance immune function and induce enzymes that detoxify the liver. They are also rich sources of quercetin, a bioflavonoid that stimulates the immune system and decreases inflammation.

8. High fiber foods

High fiber foods are incredibly important for endometriosis because they support the optimal balance of friendly bacteria in the digestive tract. Friendly bacteria support the elimination of estrogen in the feces. Focus on fiber in the form of vegetables, fruits and whole grains such as barley, quinoa, millet, brown and wild rice.

9. DairY

While dairy used to be on the AVOID side of the endo diet, research has really brought a lot of light to the situation as far as this food group goes.  Dairy has been found in studies to REDUCE the risk of developing endometriosis.  Now, I suspect this may be due to the impact of the vitamin D and calcium found in dairy, as these interventions have both been shown in studies to benefit women with endo.  But who am I to argue the research?  If you enjoy dairy, then you can continue to do so.  HOWEVER,  I’d recommend sticking with the lower saturated fat dairy products – low fat choices instead of higher fat choices, because of the research on saturated fats and endo.

Far More Than Food

Following the Endometriosis Diet is going to improve more than just your endometriosis symptoms. It will likely improve your overall health and vitality as well. And research has found that women who DO try dietary interventions to manage their endo most often report feeling better – and not just in reducing their pain.  A 2019 study found that women who made changes to their diet reported feeling more connected to their bodies, felt less endo symptoms, felt more healthy overall, and had more energy to live a full life.  Sounds like something all of us could benefit from.

A quick reminder: diet isn’t the only important aspect of endometriosis treatment. I’ve written MANY other articles about endometriosis.  You can check them out here: Understanding Endometriosis, Acupuncture for Endometriosis, Endometriosis and the Immune System, Endometriosis and Infertility, Endometriosis in Adolescence and Naturopathic Treatment of Endometriosis.

Read on, and if you’re ready to take a well-rounded, fired-up approach to your endometriosis, feel free to book for a free Meet and Greet to see if we’re a good fit to work together.

updated References (2022)

Hudson, Tori. Women’s Encyclopedia of Natural Medicine. New York: McGraw Hill, 2008.

Helbig M, Vesper AS, Beyer I, Fehm T. Does Nutrition Affect Endometriosis?. Geburtshilfe Frauenheilkd. 2021;81(2):191-199. doi:10.1055/a-1207-0557

Marziali M, Venza M, Lazzaro S, Lazzaro A, Micossi C, Stolfi VM. Gluten-free diet: a new strategy for management of painful endometriosis related symptoms? Minerva Chir. 2012 Dec;67(6):499-504. PMID: 23334113.

Vennberg Karlsson J, Patel H, Premberg A. Experiences of health after dietary changes in endometriosis: a qualitative interview study. BMJ Open. 2020 Feb 25;10(2):e032321. doi: 10.1136/bmjopen-2019-032321. PMID: 32102806; PMCID: PMC7044830.

Disclaimer

The advice provided in this article is for informational purposes only. It is meant to augment and not replace consultation with a licensed health care provider. Consultation with a Naturopathic Doctor or other primary care provider is recommended for anyone suffering from a health problem.

We met through common circles, social media and our deep connection with women’s health. Our friendship is in the beginning of it’s becoming, but one thing is for certain, we are both incredibly passionate readers. 

In these last two years in which books have been even more of a haven than before, we found ourselves chatting on similar readings, recommending to each other the ones we hadn’t read, discussing, briefly, a character or a philosophy prescribed. It’s been wonderful to find a kindred spirit who loves books as passionately.

Books are windows into other worlds. They are the opportunity to live lives you will never be able to live, to experience things you will never be able to experience, to understand things you didn’t understand before. Books are a possibility to escape and to live with others’ for a while, in others’ worlds and lives and views and loves and hurt and pain and childhood and loss. Books are the mirrors that allow us to see ourselves, our humanity, reflected directly at us. 

We become more of ourselves when we see parts of us we didn’t know existed, written by a stranger in a page that is in front of us. 

Talking about books brings the experience of reading to a different level. It allows us to see what others saw in the same book, which will always be a different experience than our own. It allows us to understand varied perspectives on the same topic, it opens us to debate and conversation and, most of all, community.

That is what the Fire & Ice Book Club is all about.

We want to share readings by female and non-binary authors with you, to laugh, have ‘aha moments’, share a cup of tea over conversation and enjoy some time outside of the reality that can become overtly heavy,

The books we’ve chosen are both Fiction and Non-Fiction and focus on female and non-binary characters, they speak of encountering oneself and exploring sexuality, they are books that will make you think, smile, underline and talk to friends about.

We hope you join us,

Lisa and Kelly

How to Join

To allow this book club to flourish and to give something back to our community, we are asking each participant to give $15 per month, which will be donated to the Red Door Shelter, a charity that focuses on providing care for women and families in need. You can join for either a 3-month subscription ($45) or a 6-month subscription ($80).

Once we receive the confirmation of your payment you’ll be added to our exclusive mailing list (ooooh) which will provide you with the Zoom link for our monthly meeting as well as our discussion guides and other goodies.

Just click the link below to join! And if you have any questions, just reach out to us at fireicebookclub@gmail.com

Join the Fire & Ice Book Club