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Antioxidant effects on Muscle Recovery after Moderate Exercise The way exercise works is by creating enough stress on the muscle to make tiny little tears which heal and over time make the muscle stronger and more energy efficient. Inside the muscle this could either grow the muscle (through hypertrophy training) or cause it to create more mitochondria to increase oxidative capacity and therefore making it more energy efficient (through endurance training) (Merry & Ristow, 2016). Reactive oxygen species (ROS) come into the muscle from both the mitochondria and non-mitochondrial sources, though there are also reactive nitrogen species (RNS) such as nitric oxide which both cause stress. Usually this is combated by the antioxidant defence system made of: superoxide dismutase (SOD), catalase, glutathione peroxidases, peroxiredoxins and thioredoxins. These reduce ROS; though glutathione, for example, can scavenge both ROS and RNS (Merry & Ristow, 2016). Willis (2019) reports that ROS encourages the formation of actin fibres around the tears in the muscle which go on to support the structure when cells repair the holes. This is a normal and regular process. The health industry extensively stouts the positive benefits of antioxidants for wellbeing, and while some conditions do benefit immensely from antioxidant therapy - in a regular healthy person, they may not be as good as they are made to sound. Merry and Ristow (2016) suggest the traditional view of increased oxidative metabolism (that impairs muscle function and causes oxidative damage resulting in ROS) is not a negative response. They in turn, suggest that the excessive dosing of antioxidants promoted in the health and fitness industry hampers normal skeletal muscle adaptation. Beneficial biological adaptations are a response to stressors, such as a low continuous or high intermittent exposure (such as exercise) which would be harmful in larger amounts. Therefore such exercises as HIIT and weight training (done responsibly) would provide enough stress to provoke a positive adaptation, in which the ROS and RNS act as messengers to the body in order to regulate the processes of repair and adaptation. More of the smoke rather than the fire in this example. Willis (2019) describes them as the major “go” signals for muscle growth and recovery, without which important messages may not get delivered. Merry and Ristow (2016) report antioxidant treatment following a single bout of exercise can alter glucose uptake, sodium-potassium pump function, mitochondrial biogenesis markers and insulin sensitivity. They report no solid in vivo evidence to support this, but the theory is consistent with scientific understanding. Ranchordas, Rogerson, Soltani & Costello (2018) suggest rather than spending money on antioxidant supplements that theoretically slow muscle recovery, focus on supporting the balance of ROS and antioxidants with diet and recovery movements which let the body do its job in controlling the balance. This follows the naturopathic principle “Vis medicatrix naturae” whereby the body has an inherent ability to heal itself and simply needs support. Merry, T. & Ristow, M. (2016). Do antioxidant supplements interfere with skeletal muscle adaptation to exercise training. The Journal of Physiology, vol 594. Issue 18. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5023714/#:~:text=Antioxidants%20can%20prevent%20protein%20oxidation,recovery%20during%20longer%20rest%20periods. Ranchordas, M., Rogerson, D., Soltani, H. & Costello, J. (2018). Do antioxidant supplements prevent or reduce muscle soreness after exercise. British Journal of Sports Medicine. Retrieved from: https://blogs.bmj.com/bjsm/2018/03/09/do-antioxidant-supplements-prevent-or-reduce-muscle-soreness-after-exercise/ Willis, B. (2019). Why you shouldn’t be always taking antioxidants, especially if you want to build muscle. Examine.com. Retrieved from: https://examine.com/nutrition/antioxidants-muscle-building/

Uterine positions and physical barriers to pregnancy. The uterus is a hollow space which normally allows for a healthy embryo to grow, but not everyone’s uterus is the same. So what are the abnormalities which can make it more difficult to conceive? There are a few which can require surgery or are present at birth and may or may not impact the ability to conceive: Segmental hypoplasia - undeveloped uterus Unicornuate uterus - only half of the uterus develops, usually with one fallopian tube Uterine didelphys - the uterus develops as two sections with two cervices, two for one! Bicornuate uterus - the uterus develops as two sections with one cervix Septate uterus - a septum divides in the inner portion of the uterus but it’s still one uterus Other drug exposure changes. There are also other physical barriers to pregnancy which affect the uterus: Polyps - a little growth, kind of like an internal skin tag, which can cause abnormal bleeding Leiomyoma or fibroids - a benign tumour which can cause abnormal bleeding or miscarriage Endometrial hyperplasia - excess growth of endometrial tissue inside the uterus Adenomyosis - endometrial tissue grows into the uterine myometrium and usually causes heavy, painful periods Endometriosis - endometrial tissue which grows outside of the uterus and causes pain and difficulty falling pregnant Uterine cancer Some of these may need surgery to resolve and some can be managed with treatment and medication (Ameer, Fagan, Sosa-Stanley & Peterson, 2020). The treatment will vary depending on the condition and other presenting symptoms, but it is useful to understand how the positioning and condition affects conception rates or ability. Additionally to this, the uterus can also be in one of three different positions; anteverted, midposition or retroverted. Midposition means the uterus stands up vertically. Anteverted just means the uterus is tilted forwards and is the most common presentation. A retroverted uterus is more rare, where the uterus is tilted backwards and can cause an issue if you have endometriosis (Ameer, Fagan, Sosa-Stanley & Peterson, 2020). It may not always stay in that position, after pregnancy it may appear differently. Usually the position will not affect ability to conceive, but a retroverted uterus may come with symptoms (which can be because of an associated condition) (Feminist Midwife, 2013).

A vegan diet includes everything grown on the earth that isn’t made from an animal, animal product or animal by-product. Vegan diets can of course be healthy for most people… when well planned. I hate to say it, but if you’re not educated and aren’t mindful of your food intake - you won’t likely thrive on a vegan diet. That’s not to say it’s hard, but here’s a few things to consider. Vegan diets are typically short in protein (for poorly planned diets), iron, zinc and calcium (Cleveland Clinic, 2020). They are absent in vitamin B12, a nutrient absolutely essential for DNA synthesis, as well as brain and nervous function so this is an absolute must to supplement (Osiecki, 2007). Women may find they need to supplement with iron every now and again, but please base this on blood tests before beginning a supplement. Protein - this one is so easy to supplement in the diet; eat your beans and rice, tofu and if you like protein powders, and eat them every day. Remember that the adequate intake is 0.8-1g per kilogram of body weight and should make up between 10-25% of your daily intake (NHMRC, 2014). Protein is essential for making enzymes, muscle tissue, chemical messengers, and general repair of the cells that reach the end of their life on a daily basis (Osiecki, 2007). Iron - menstruating women and young children especially need to pay attention here. Plant iron (non-heme) is not as absorbable as iron from animals (heme) which makes it all the more important to ensure it’s present in your diet. Iron deficiencies are common in young children regardless of eating meat or not, and they typically present pale and lacking energy. Other symptoms may include trouble thinking, cold sensitivity, poor immunity, increased heart rate, shortness of breath on exertion and change in menstrual flow. Some vegan sources include: almonds, apricots, parsley, avocado, soybeans, seeds and a bit in wheat germ (Osiecki, 2007). Children require between 4-15mg depending on age, whereas adult men need 6-8mg and adult women need 8-18mg a day (NHMRC, 2014). Zinc - a micronutrient found in various places (seeds, vegetables, seafood and beef). There are many symptoms associated with zinc deficiency, and as well as it being a super antioxidant, it’s important in fertility cases and helps to make various enzymes and maintain integrity of protein structures (Osiecki, 2007; NHMRC, 2014). Children require between 2.5mg and 13mg depending on age and gender. Adults between 6.5mg and 14mg, also based on gender (NHMRC, 2014). Calcium - known to be found in dairy products, calcium is also found in spinach (please cook), rhubarb, beans, seeds, soy, and some dark leafy greens. Calcium is stored in our bones and makes them strong, though it’s also used in muscle contraction (NHMRC, 2014). It’s more important for growing children who need to acquire healthy bone mass before their 20’s and in menopausal women to prevent osteoporosis. Plant fortified milks should be a part of a vegans diet. The requirements of calcium range from 500 to 1300mg for children, based on age. For adults the daily requirements are around 1000mg, and then 1300mg when you reach 70 years (NHMRC, 2014). Children under 2 years have been excluded here as they will likely be receiving breast milk which is based on the mother's health, or fortified formula. Pregnant and breastfeeding mothers requirements will also be different and should be under the guidance of a health professional.

Reflux is categorised under Gastroesophageal reflux disease (GERD/GORD), but it may not always be GORD. Mayo Clinic states that GERD occurs when stomach acid frequently back into the oesophagus. This can damage the mucosal lining of the oesphagus and cause irritation, leading to a chronic cough, laryngitis and/or disturbed sleep. For reflux to be classified as GERD it must occur at least twice a week, or severely once a week. The symptoms include heartburn, chest pain, difficulty swallowing, sour regurgitation or the sensation of a lump in the throat. It may be caused by lying down too soon after eating, excessive weight compressing the stomach, smoking (in any amount), or insufficient stomach acid which interferes with digestion. Poor hydrochloric (stomach) acid production and secretion impacts food breakdown and nutrient availability and can continue to impact digestion further down the GIT because of this. It also acts to destroy incoming pathogens contained in our food, so you can see why not secreting enough can be bad for our health. To ‘treat’ reflux, there a few food based options, as well as herbs that support digestive function. Diet wise, reducing the amount of spices, tomatoes, large refined carbohydrate meals, coffee and alcohol for a while can help reduce symptoms. Increasing protein, one serving at each meal, perhaps ⅓ cup of nuts as a snack, can help improve tissue repair in the oesophagus and help support hydrochloric acid production. Herbs that are mucilaginous (mucoprotective and demulcent) like marshmallow, slippery elm and licorice coat the oesophagus and gastric mucosa to protect it. Anti-inflammatory herbs such as turmeric, chamomile, willow bark, aloe vera, or nettle may aid to reduce inflammation if needed. Lastly, I may suggest some mucus membrane tonics or vulnerary herbs to support the healing of the mucous membrane. This may include calendula, yarrow, or goldenseal. Some things you can do at home is drinking marshmallow, chamomile or nettle tea, sleeping with your head and shoulders propped up a bit a night (use 2 pillows) to prevent the stomach contents from reaching your oesophagus. Additionally, try to keep dinner and snacks 3 hours aways from bedtime - no overeating; this way your food have moved past your stomach by the time you get to bed. Reduce or remove the things that you notice cause reflux, making sure it's that isolated 'thing'. As always, ensure you’re drinking enough water (2-3L) and exercising on a regular basis.

If you're new to the nutrition world or are trying to improve your diet, macro's might be a part of diet plan. But, what are they? Basically, macro's is short for macronutrients. As in, the large components that make up a foods composition. These components are the parts of food that give us energy. These do not include nutrients, vitamins or minerals - these are collected under the term 'micronutrients'. There are three macro's (some would argue four): Carbohydrates, Fats, and Protein Some people like to follow certain macronutrient breakdowns to help them manage their dietary intake. Examples of this include 50% carbohydrates, 20% protein, and 30% fat. Most people in Australia trying to eat healthily would naturally eat around this amount. Others prefer a higher fat intake, around 40 and even 50%. People who eat low carb or keto may have fats as high at 75% while keeping carbohydrates as low as 5% (which is really hard to do). It's good to keep a balance to ensure you're feeding your body the right way, but some people do live well on different macronutrient breakdowns. Examples of different foods groups into their main macro Carbohydrates Pasta Breads Oats (contains good nutrients too) Cereals Grains (can be nutrient dense) Most fruit (nutrient dense) Most vegetables (although also nutrient dense) Fats Avocado Oils Eggs (also have protein) Butter Dairy Nuts & seeds (nutrient dense, also contain decent protein) Protein All animal meats Legumes (contain plenty of carbohydrates) Beans (also contain plenty of carbohydrates) Soy Of course, all these foods are much more than one macronutrient, some foods are made up of two macronutrients almost equally. However, if are looking to monitor the way you eat, choosing nutrient dense foods that follow a macronutrient breakdown you thrive on, can be a positive way to "diet".

Menopause it an incredible season of change for a woman. It often occurs around the age of 51, beginning in Perimenopause between 45 and 50 years of age. Perimenopausal women often experience mood changes, changes in sleep or insomnia, hot flushes, night sweats, less frequent menstruation, bone density loss, vaginal dryness, and lowered libido all due to the body re-regulating hormones to begin this new phase. It’s an extraordinarily natural process of life. While the number of eggs starts to get low, the hormones that regulate egg production decrease and oestradiol (oestrogen), testosterone and progesterone production also decreases. The uterine lining stops building up, and therefore doesn’t need to shed. Follicle Stimulating Hormone (FSH), Luteinising Hormone (LH) can be elevated. Menstruation can become more frequent followed by long cycles, becoming more irregular as the women gets closer to menopause. Menopause itself is diagnosed a year after the final menstruation, i.e. 12 months of amenorrhoea (no period). At this point, there are no eggs left and there is no follicular ovarian activity. Oestrone becomes the dominant form of oestrogen in post menopausal women. The naturopathic treatment during this season of change is largely symptomatic support. We can provide advice and support for the prevention of any disease processes that are of an increased risk post-menopause, such as osteoporosis and cardiovascular disease. Select dietary inclusions that you and your health provider choose may include: increased phyto-oestrogens (such as soy, legumes, and beans) which act similarly to oestrogen and can assist in reducing symptoms, fresh ground flax seeds to reduce hot flushes, and plenty of calcium rich foods such as dark green leaves, bone broth, dairy, nuts and seeds. A diet full of fresh fruits and vegetables ensures adequate levels of antioxidants (vitamin C, Zinc, vitamin A) and healthy fats (vitamin E, vitamin D) to maintain strong bone health and reduce oxidative stress. Herbs such as Black Cohosh and Wild Yam can reduce hot flushes and headaches due to their effects which decrease luteinising hormone and potentially interact with oestrogen receptors. And of course, varied and quality sources of calcium. Herbs such as black cohosh and wild yam may assist with hot flashes and headaches due to their hormonal actions. Some women find sage tea helpful for night sweats also, along with alfalfa. You might find sedative, nervine, and anxiolytic herbs helpful to reduce feelings of anxiety and assist sleep disturbances. Red clover, available as a tea, is useful in all parts of a woman’s life, but in perimenopause it may help to reduce symptoms and vaginal dryness in particular . Adaptogenic and oestrogenic* herbs are helpful in perimenopause to support the body in regulating itself. Chaste tree for example acts on dopaminergic pathways to reduce PMS symptoms that may present with irregular cycles, such as in late perimenopause Additionally, some herbalists and naturopaths may assess adrenal function and mood, especially as the changes and symptoms often cause some stress. As with all medical needs, it’s best to seek professional advice (from a naturopath) before undertaking anything drastic. Small dietary additions such as mentioned above may be more individualised and targeted towards you with such advice. I am available for appointments at the Think Wellbeing Centre (ph: 3270 1040).

The reason for sleep is to repair and it’s important for general health and wellbeing. If you want to get technical about the hormones and where they come from, read this. If not, skip to the next paragraph. The hypothalamus, midbrain and brain stem produce GABA and adenosine to relax us, these are incredibly important for the falling asleep part and to generally feel relaxed; the pineal gland produces melatonin (sleep hormone which helps regulate your body temperature, blood pressure and hormone levels), then the thalamus and cerebral cortex act together to create dreams (4). While we sleep, the amygdala (in our brain) increases activity, which suggests a lot of processing emotions and “sorting through” stimulus happens. If you don't know, there are different stages of sleep, the length and pattern of these stages is important for us to feel restored when we wake up. There are three or four stages of non-REM (non-rapid eye movement) sleep where our bodies slow and rest, and then there’s REM (rapid eye movement - super inventive with the names, right?) sleep where we have vivid dreams. We cycle through the stages throughout the night, spending only about 2 hours actually dreaming (4). Slow wave sleep (SWS) encompasses non-REM stages 3 and 4, and this is where it is suggested most recovery occurs (5). How stress disrupts sleep is largely based on the Hypothalamus-Pituitary-Adrenal (HPA) axis and the subtle changes in dominance between the sympathetic nervous system and the parasympathetic nervous system. The parasympathetic nervous system (PNS) controls homeostasis and the body at rest and is responsible for the body's "rest and digest" function. The sympathetic nervous system (SNS) controls the body's responses to a perceived threat and is responsible for the "fight or flight" response. Stress impacts the circadian rhythm due to the higher levels of cortisol and epinephrine (adrenaline) that are activated by catecholamines (a group of neurotransmitters) released immediately after exposure to stressors (2). Glucocorticoids (such as cortisol) and epinephrine, released from the adrenal gland, can act as synchronizers of circadian tissue clocks, meaning that changes in their levels or release times can alter the circadian rhythm. Because of this change in chemical messengers, one can experience insomnia, more frequent waking during the night, bad dreams, and unrefreshing sleep. These two hormones (cortisol and epinephrine) oppose melatonin and other relaxing hormones to control the sleep cycle. As cortisol is high, melatonin is low, and vice versa. A change in these hormones levels, such as increased cortisol for a longer period of time, impacts the strength of the effect and timing of release of melatonin, impacting the sleep pattern. A review of human sleep change studies found that daily life stress and acute stress, such as an exam, had a similar impact to major stressors such as the death of a loved one, with longer sleep latency (how long it takes to sleep), and lower REM density (i.e. lower repair and relax time) (1). This type of stress also changed the pattern of sleep, reducing SWS in the first cycle, and increasing it in the second cycle. This led to a reduced sleep efficiency, more awakenings, decreased REM and SWS (1). Purely the worry about going to work the next day decreased SWS. Shift workers had increased sleep latency, decreased SWS and increased REM (1). Now, remember that SWS is where a large part of the repairing comes in. If you don't get properly "repaired" during sleep, you wake up feeling like sh*t. Imagine doing that almost every day, for work, at different times. This means waking feeling unrefreshed and never getting the normal amount of recovery they would get because of the disrupted sleep cycle. What's interesting is that physical activity delayed REM latency and increased SWS, likely due to the repair needed from muscle use (1). It is these differences in the actual sleep cycle itself, that lead to increased fatigue and difficulty focusing during the day - potentially causing further stress and perpetuating the cycle. Now, there are many factors that play into stress. Having a good, hard look at your life and bedtime routine may identify some of those. You can also try to de-stress in the few hours before bed with meditation, some enjoyable reading, or listening to your favourite music. Try to keep the screens off so your melatonin levels are rising normally too (or put them on warm night lights). If you'd like a post about these resources, let me know. As an health bonus: Interestingly, there is also recent evidence regarding the microbiome, where microorganisms and circadian genes interact with each other. This suggests yet another pathway that the microbiome impacts, potentially in that physiological and emotional stress can affect the microbiome composition and lead to inflammation or changes in the chemical messages the gut sends out (3). This is particularly relevant because the microbiome are responsible for the production of various neurotransmitters and metabolites such as GABA, dopamine and melatonin - all of which play a role in the circadian rhythm and sleep onset (3, 4).

*Please see your health care provider, this is not for self treatment. Dysmenorrhea is defined as painful menstruation and can be a result of dysfunctional uterine tissue, or an underlying disease such as endometriosis or pelvic inflammatory disease (PID)(5). Oftentimes, clients will self prescribe pain medication and anti-inflammatories to ‘get through’ the period, potentially bed bound by the pain. The pain makes it difficult to do daily tasks and prevents you from living normally during menstruation. Dysmenorrhea is defined as painful menstruation and can be a result of dysfunctional uterine tissue, or an underlying disease such as endometriosis or pelvic inflammatory disease (PID)(5). Oftentimes, clients will self prescribe pain medication and anti-inflammatories to ‘get through’ the period, potentially bed bound by the pain. The pain makes it difficult to do daily tasks and prevents you from living normally during menstruation. A large part of helping a client through dysmenorrhea is lessening the cramping and pain. The way we do that is by increasing the blood flow to help things move along, and reducing the inflammation that's present. We can also slow down cramps so they aren't as intense, and help the body release the menstrual tissue. There are several herbs that are able to reduce the uterine contractions that cause the pain, by reducing prostaglandins (inflammatory markers) and aiding the flow of blood to the area (4). Blood flow to the area can be increased with warmth (physically, with heating pads) and with warming herbs, ginger has shown positive results for dysmenorrhea (2,4). To treat dysmenorrhea, uterine tone must be normalised as it using herbs such as red raspberry leaf tea ( Rubus idaeus) or dong quai ( Angelica sinensis) (1,5). Raspberry leaf tea can be consumed all throughout the period, but watch for changes in your cycle if you're consuming too heavily. Antispasmodic (lessens cramps) and anti-inflammatory (pain) herbs are key here to reduce pain of cramps, and emmenagogues can be used to help with the release of expired uterine tissue (especially for slow, lengthy menstruation) (5). Herbs such as Guelder-rose, Paeonia, Wild Yam can help here (1,3) . These can be combined with nervine herbs to support the nervous system and reduce stress, and licorice ( Glycyrrhiza glabra ) which is anti-inflammatory and has demonstrated some antispasmolytic activity in animal studies (1). Paeonia has been shown in animal studies to inhibit prostaglandin E2 production and may be immuno-suppressive, i.e. reducing the proinflammatory response (3). The anti-inflammatory action will be important in reducing symptoms. Guelder-rose and Blackhaw may both be used to treat dysmenorrhea as both have shown efficacy in human and animal trials. Some suggest that each is used for pain radiating to different areas (6). Analgesic and sedative herbs (Californian poppy - Eschscholzia californica ) can be used as needed to manage symptoms, if necessary (5). Nearly all of these herbs are best provided by your naturopath or herbalist, they should not be self-prescribed because there could be interactions with medication that the public aren't aware of, or they might not be the right choice when taking everything in holistically. Other therapies that may assist a female with dysmenorrhea include massage, acupuncture, hot and cold hydrotherapy, drinking warm liquids, and kinesiology. If you need to see someone but aren't ready to invest your money, the Think Wellbeing student clinic offers heavily discounted appointments. You just pay for the herbs and/or supplements. See their details here .

It is fairly well known (in science circles), that Firmicutes, Bacteroidetes, and Actinobacteria are the predominant microbial groups in the gut (Singh, et al. 2017; Kho & Lal, 2018). The figure below shows the taxonomy (Rinninella, et al. 2019). However, as the microbiome is a reflection of our lives (and diet), there are significant changes in the combination and volume of microbes from birth to death. As babies, we have what’s called commensal microbes which protect us from pathogens along with supporting our immune system. Some commensal bacteria can predisposition us for immune-mediated diseases from birth, e.g. E. coli encourages gliadin (a protein in gluten) to flare the immune system, where Bifidobacteria spp inhibit this (Tlaskalvoa-Hogenova, et al. 2011). We get our commensal microbiome from the vaginal canal during a natural birth, or from the hospital and skin tissues we brush as we are pulled from a cesarean. Microbiome colonisation in infants is also different, depending on whether they were preterm or full term (preterm being less diverse) (Rinninella, et al. 2019). Although, “human milk oligosaccharides (HMOs) related to different mother phenotypes modulate gut microbiota composition in infants” and may be protective (Rinninella, et al. 2019). The mother's microbiome in this case plays an integral role, and would be significant to the predisposing and excitatory factors for the child (Rinninella, et al. 2019). Bifidobacterium are responsible for the fermentation of galactooligosaccharide (GOS), one of the main components of breast milk, so if an infant was struggling to digest breast milk this may be an indication of low levels of Bifidobacterium at that time. Kho and Lal (2018) report that commensal bacteria such as Bacteroides fragilis, Bifidobacterium infantis, and Firmicutes are crucial in regulating inflammation and tolerance. Building up these particular microbes with prebiotics and specific probiotics may improve the patients symptoms. This is important to achieve their optimal microbiome at a peak age (between 3 and 8 years), before it begins to degrade over time - improving their chances of having a well-positioned microbiome (and therefore a well-maintained immune system, etc.) in the long-term. During weaning from breastmilk (or formula), the microbiome changes. High-fibre and carbohydrate foods encourage Firmicutes and Prevotella, where high-fibre and animal protein encourage Bacteroidetes (Rinninella, et al. 2019). At one year of age the microbiome composition has Akkermansia muciniphila, Bacteroides, Veillonella, Clostridium coccoides spp., and Clostridium botulinum spp.. By three years old, a child’s microbiome should have a similar diversity and composition to an adult - yet still stabilises with age (Rinninella, et al. 2019). There is significant variation in Bacteroidetes and Firmicutes between individuals, though the individuals experience less variability over time (Saraswati & Sitaraman, 2015). Any use of antibiotics (generally) reduced bifidobacteria and the Bacteroides-Prevotella group, therefore consistent or recurrent use at any age (though, more so with age) can predispose an individual to infection and increase the chance of a poorly performing microbiome in old age (Saraswati & Sitaraman, 2015). Belov (2019) seems to suggest that by age 60, the microbiome is less diverse, with less beneficial microbial activity and more enterobacteria (pro-inflammatory bacteria). They generally have a higher volume of proteobacteria, but compared to young adults, have a higher proportion of Bacteroidetes (Aleman & Valenzano, 2019; Saraswati & Sitaraman, 2015). The elderly also likely to have less lactobacilli, Bacteroides/Prevotella and Faecalibacterium prausnitzii, and an increase in the proportion of Ruminococcus, Atopobium, and Enterobacteriaceae (i.e. less protective microbes). This was more associated with “frailty scores” and a general decrease in diversity, diet diversity and increase in inflammatory markers - which is increasingly common (Saraswati & Sitaraman, 2015). The authors particularly note that this negative change in the elderly microbiome was worse for living in care and stay in hospital (Saraswati & Sitaraman, 2015). Interestingly Saraswati & Sitaraman (2015) report that genes involved in aromatic amino acid metabolism and SCFA production may have some control over the microbiome in old age, suggesting that a decreased number of these genes may play a part in a longer life. Therefore, encouraging a strong population of SCFA producing microbes is important in maintaining health. Reasonably, diet is the largest controllable factor that influences microbiome composition - one which also then impacts the next generation. High fat and high sugar diets generally promote Bacteroides-dominance, and high fibre generally promotes Firmicutes (e.g. Lactobacillus, Bacillus, Clostridium, Enterococcus spp) (Saraswati & Sitaraman, 2015). Largely, diversity of foods also allows diversity in microbes. Even if an individual starts out with a poor microbiome, there is time to build it up before they reach their peak. REFERNCES: Aleman, F. & Valenzano, D. (2019). Microbiome evolution during host aging. PLoS Pathogens. Retrieved from: https://journals.plos.org/plospathogens/article?id=10.1371/journal.ppat.1007727 Belov, A. (2019). Ageing and the microbiome: what happens when you get older?. Altas Blog. Retrieved from: https://atlasbiomed.com/blog/ageing-and-the-gut-microbiome/#age Kho, Z. & Lal, S. (2018). The Human Gut Microbiome - A Potential Controller of Wellness and Disease. Frontiers in Microbiology, vol 9. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6102370/ Rinninella, E., Raoul, P., Cintoni, M., Franceschi, F., Miggiano, G., Gasbarrini, A. & Mele, M. (2019). What is the Healthy Gut Microbiota Composition? A Changing Ecosystem across Age, Environment, Diet, and Diseases. Microorganisms, vol 7. Issue 1. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6351938/ Saraswati, S. & Sitaraman, R. (2015). Aging and the human gut microbiota - from correlation to causality. Frontiers in Microbiology. Retrieved from: https://www.frontiersin.org/articles/10.3389/fmicb.2014.00764/full Singh, R., Chang, H., Yan, D., Lee, K., Ucmak, D., Wong, K., Abrouk, M., Farahnik, B., Nakamura, M., Zhu, T., Bhutani, T. & Liao, W. (2017). Influence of diet on the gut microbiome and implication for human health. Journal of Translational Medicine, vol 15. Issue 73. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5385025/ Tlaskalvoa-Hogenova, H., Stepankova, R., Kozakova, H., Hudcovic, T., Vannucci, L., Tuckova, L., Rossmann, P., Hrncir, T., Kverka, M., Zakostelska, Z., Klimesova, K., Pribylova, J., Bartova, J., Sanchez, D., Fundova, P., Borovska, D., Srutkova, D., Zidek, Z., Schwarzer, M., Drastich, P. & Funda, D. (2011). The role of gut microbiota (commensal bacteria) and the mucosal barrier in the pathogenesis of inflammatory and autoimmune diseases and cancer: contribution of germ-free and gnotobiotic animal models of human diseases. Cellular & Molecular Immunology, vol 8. Issue 2. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4003137/

Surgery on any part of the body creates massive vulnerability, but especially in the oral cavity, opening the skin provides opportunity for infection. There are various organisms which naturally live in the mouth, not to mention all the exogenous (meaning, from outside the body) substances placed there for consumption bring in more potential pathogens. The mouth and oral area heals quite quickly because of this risk, but there are strategies you can employ to reduce risk of infection and support healing. Nutrition plays a significant role in recovery from surgery, more so if the one is part of an already compromised group (Giridhar, 2016). Oral and jaw surgery in particular, pose an increased nutritional threat as it interferes with the one's ability to eat normally post-surgery. Soups, smoothies and broths will be required until normal functions of the mouth or jaw can resume. Depending on the operation, the covering Doctor may provide oral antibiotics and/or an oral rinse to prevent infection from Staphylococcus aureus or streptococci (penicillin-sensitive) (Otero, Detriche & Mommaerts, 2017). This is good to note, as a naturopath can compliment the treatment with other antimicrobial herbals or support the body around this. The top 3 areas within nutrition that are important for post-operative care are: protein, immune supportive vitamins and minerals (to prevent infection), as well as vitamins and minerals which support tissue healing. Protein is required for cellular proliferation including immune cells, tissue repair and maintenance, in addition to energy. Giridhar (2016) suggests bone broth as an easily digestible protein source (specifically glutamine and arginine containing) that’s accessible for patients after oral surgery, though a protein powder drink may be used as an alternative. Vitamins which support the immune system and tissue healing include vitamin A, and C, in addition to the minerals zinc, selenium and magnesium (Giridhar, 2016; Palmieri, et al. 2019; Barchitta, et al. 2019). Vitamin A supports B and T cell function, antibody production, and aids in development of epithelial cells and fibroblast activity (Barchitta, et. al, 2019). B vitamins are also important in collagen synthesis. Vitamin C has many uses, but in this case it is used in wound healing by calling cells to the wound site, collagen synthesis in increasing stability and strength of the collagen matrix; as well as antioxidant activity (Barchitta, et. al, 2019). The mineral Zinc is highly involved in cell replication - especially in immune cells, activating lymphocytes, producing antibodies, collagen production and fibroblast production (Barchitta, et. al, 2019). Therefore, focussing on nutrient dense foods - fruits and vegetables (rainbow foods), and rich protein sources - which can be easily blended or minced (at least initially) will support the healing process. You may like to use the rainbow foods idea to help vary sources of vitamins and minerals. Focus on reds, purples, oranges and deep greens. Slight side note: Barchitta, et. al (2019) also suggests the use of curcmin in improving wound healing via reducing excessive inflammation, facilitating collagen synthesis and fibroblast functions. Barchitta, M., Maugeri, A., Favara, G., Lio, R., Evola, G., Agodi, A. & Basile, G. (2019). Nutrition and Wound Healing: An Overview Focusing on the Beneficial Effects of Curcumin. International Journal of Molecular Sciences, vol 20. Issue 5. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6429075/ Giridhar, V. (2016). Role of nutrition in oral and maxillofacial surgery patients. National Journal of Macillofacial surgery, vol 7. Issue 1. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5242071/ Otero, J., Detriche, O. & Mommaerts, M. (2017). Fast-track Orthognathic Surgery: An Evidence-based Review. Annals of Maxillofacial Surgery, vol 7. Issue 2. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5717890/ Palmieri, B., Vadala, M. & Laurino, C. (2019). Nutrition in wound healing: investigation of the molecular mechanisms, a narrative review.  Journal of Wound Care, voll 28. Issue 10. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/31600106/#:~:text=In%20the%20proliferative%20phase%2C%20vitamin,vera%20supports%20granulation%20tissue%20generation.

Postpartum depression typically affects anywhere from 10-60% of women in the first years after their child’s birth, and can ‘set in’ within the first 3 months. Depending on the severity, it can affect the mother’s quality of life, the care she is able to provide her child, and strain bonding and relationships. This is no place to lay blame, or feel shame - anyone could be in this position and recognition needs to be given to decrease the stigma so mother's feel safe to seek help. If you yourself feel that you could be suffering with postpartum/ post-abortion depression - I strong advise telling someone you trust who will help you to find the help you need. This is a good resource for symptoms and a helpline - HERE. Personal and family history of depression, socioeconomic status/ environment, pregnancy circumstances contribute to the mental health of the mother; although, the hormonal changes undergone in pregnancy/birth/postpartum  are highly involved. Li, et al. (2016) reviewed a large number of trials on TCM treatments for Post-Partum Depression (PPD), finding that a combination of traditional herbal remedies and routine treatments (e.g. music therapy, vitamin D drops, Cognitive Behavioural Therapy, relaxation therapy) were most effective. Finding a therapy that works for you and is accessible may take time, but working with your health care providers can help you assess what's working using functional, standarised surveys. One safe place to start is a simple walk with or without your baby outside. Numerous studies have shown the benefit of time in nature, and vitamin D is a regulatory 'hormone' in the body which a scary amount of people are deficient in. 15-30 minutes is a good place to start for mental and physical recovery. You may like to double up with music therapy by listening to music that you enjoy. Regarding the use of herbal remedies in depression, there is very little research specific to postpartum depression and herbal treatment. This is arguably due to the ethical nature of such trials - who would want to mess around with the mental health of someone providing care to an infant - let alone the impact of any negative outcomes on the mother or child. Naturopathic remedies to treat depression (in non-pregnant individuals) includes: omega-3 fatty acids, saffron, passionflower, chamomile, black cohosh, lavender, and chasteberry show positive results (Yeung, Hernandez, Mao, Haviland & Gubili, 2019; Kendall-Tackett, 2010). Some of these are not safe or cautioned for consumption in breastfeeding or pregnant women, such as Black cohosh or chasteberry (vitex) as they interfere with HPO axis and may cause unintended effects (Dugoua, et al. 2006). Meanwhile, herbs such as saffron and lavender (externally only) are gentle anxiolytics and thymoleptics which are safe in pregnancy and lactation (Sadi, et al. 2016; Koulivand, Ghadiri & Gorji, 2013). Chamomile is cautioned in pregnancy due to lack of evidence, though it is safe for use in children (Balbontin, et al. 2019). There may be space to use Chamomile under supervision with experienced pracitioners, but you should always be made aware of any safety issues from your practitioner. From an alternative adaptogen (= help you deal with stressors better) angle, the commonly used Withania (or Ashwagandha) demonstrated no negative side effects when tested on rats but human studies are limited (Prabu & Panchapakesan, 2015). Braun and Cohen (2015) report that its use in pregnancy should be cautioned, with little supportive evidence, though there is a traditional historic use in Ayurvedic medicine during pregnancy and lactation. Studies on rats show improved pregnancy outcomes (Braun & Cohen, 2015). As such a multifaceted herb with various protective and modulating actions, it’s use in pregnancy and lactation would provide benefit to the patient. Withania is a strengthening tonic, without being overly stimulating like some other adaptogens, this is an ideal recovery and convalescence herb. In combination with other supportive herbs, such as saffron, and other therapeutics, this would support a new/ new again mother through her postpartum period. As always, more research into herbal treatments in pregnancy and lactation are important, as traditional use (excluding if they have been proven unsafe) is often relied upon in such cases. If a treatment or herb discussed here peaks your interest, please speak to your practitioner before you attempt any self treatment. They may be able to point you in the direction for an effective therapy more efficiently that google. Safe - meaning there are limited negative outcomes possible. Cautioned - meaning dosage or indications may be important. Herbs or nutrients cautioned should always be used under supervision and by an experienced practitioner. Not safe - meaning negative side effects or fatal outcomes have occured in testing (in animals or humans) References used: Balbontin, Y., Stewart, D., Shetty, A., Fitton, C. & McLay, J. (2019). Herbal Medicinal Product Use During Pregnancy and the Postnatal Period: A Systematic Review. Obstetrics and Gynecology, vol 133. Issue 5. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6485309/#:~:text=Chamomile%20has%20also%20been%20identified,used%20concurrently%20with%20prescribed%20medicines.&text=Considering%20the%20scarce%20evidence%20available,used%20with%20caution%20during%20pregnancy. Braun, L. & Cohen, M. (2015). Herbs and Natural Supplements: An evidence-based guide Volume 2. [4th Ed.]. Elsevier, Australia. Dugoua, J., Seely, D., Perri, D., Koren, G. & Mills, E. (2006). Safety and efficacy of black cohosh (Cimicifuga racemosa) during pregnancy and lactation. The Canadian Journal of Clinical Pharmacology, vol 13. Issue 3. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5938102/ Kendall-Tackett, K. (2010). Long-Chain Omega-3 Fatty Acids and Women’s Mental Health in the Perinatal Period and Beyond. Journal of Midwifery & Women’s Health, vol 55. Issue 6. Retrieved from: https://www.sciencedirect.com/science/article/abs/pii/S152695231000070X Koulivand, P., Ghadiri, M. & Gorji, A. (2013). Lavender and the Nervous System. Evidence Based Complementary and Alternative Medicine, vol 2013. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3612440/ Li, Y., Chen, Z., Y u, N., Yao, K., Che, Y., Xi, Y. U& Zhai, S. (2016). Chinese Herbal Medicine for Postpartum Depression: A Systematic Review of Randomized Controlled Trials. Evidence Based Complementary and Alternative Medicine, vol 2016. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5059536/ Prabu, P. & Panchapakesan, S. (2015). Prenatal developmental toxicity evaluation of Withania somnifera root extract in Wistar rats. Drug and Chemical Toxicology, vol 38. Issue 1. Retrieved from: https://pubmed.ncbi.nlm.nih.gov/24649920/ Sadi, R., Mohammed-Alizadeh-Charandabi, S., Mirghafourvand, M., Javadzadeh, Y. & Ahmadi-Bonabi, A. (2016). Effect of Saffron (Fan Hong Hua) On the Readiness of The Uterine Cervix In Term Pregnancy: A Placebo-Controlled Randomized Trial. Iranian Red Crescent Medical Journal, vol 18. Issue 10. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5285732/#:~:text=However%2C%20it%20is%20believed%20that,9%2C%2021%2C%2022). Yeung, K., Hernandez, M., Mao, J., Haviland, I. & Gubili, J. (2019). Herbal Medicine for Depression and Anxiety: A Systematic Review with Assessment of Potential Psycho-Oncologic Relevance. Phytotherapy Research, vol 32. Issue 5. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5938102/

We're gonna get super sciencey in here, I was on a research roll. If it goes over your head, don't worry, I wrote it for practitioners. According to research from Liu, et al. (2017) Fructooligosaccharide (FOS) and Galactooligosaccharide (GOS) supplementation in healthy young individuals, was shown to increase relative abundance beneficial Bifidobacterium . Normally, this would seem positive, except for the consequence whereby butyrate-producing bacteria (i.e. Phascolarctobacterium and Ruminococcus ) were reduced. Butyrate is a short chain fatty acid synthesised by some microbes which works to transport fluid, dampen mucosal inflammation (inhibition of NF-kB) and oxidation, modulate visceral sensitivity (through ion absorption and GLP-1) and intestinal motility (Canai, et al. 2011). Whilst not the most significant of the short chain fatty acids (60% acetate, 25% propionate), butyrate has a key role in homeostatic chain reactions which impact health (Canai, et al. 2011). FOS more significantly reduced butyrate-producing bacteria, when compared to GOS. However, in the Liu, et al. (2017) study, the source of the FOS was hydrolysed sucrose rather than extracted from foods or mixed with inulin (another prebiotic fibre). Perhaps the nature of the FOS and the dose (the maximum) produced a different effect that noted in other studies. In a realistically healthy diet, volume of FOS (e.g. fruit and veg) and GOS (e.g. legumes) would be quite low compared to ingested volume of resistant starch (e.g. whole grains, legumes, & green bananas). Resistant starch is one of the prebiotic sources that encourage butyrate production, remembering that FOS and GOS tend to reduce the bacteria which produce this (Davani-Davari, et al. 2019). Other prebiotics include oligosaccharides such as pectin, and non-carbohydrate oligosaccharides, such as flavanols found in cocoa. Davani-Davari, et al. (2019) further mention that natural sources of GOS and FOS do not quantify a “ prebiotic effect ” and they must therefore be manufactured. Most of these prebiotics stimulate Bifidobacterium , a beneficial and naturally dominant family (Davani-Davari, et al. 2019; Liu, et al. 2017; Slavin, 2013). In most cases, whereby there isn’t a specific [strain of] pre/probiotic which improves symptomatology, a mixture of prebiotic sources should be included to support multiple families of beneficial microbes, and their respective diversity.  Canai, R., Costanzo, M., Leone, L., Pedata, M., Meli, R. & Calignano, A. (2011). Potential beneficial effects of butyrate in intestinal and extraintestinal diseases. World Journal of Gastroenterology, vol 17. Issue 12. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3070119/ Davani-Davari, D., Negahdaripour, M., Karimzadeh, I., Seifan, M., Mohkam, M., Masoumi, S., Berenjian, A. & Ghasemi, Y. (2019). Prebiotics: Definition, Types, Sources, Mechanisms, and Clinical Applications . Foods, vol 8. Issue 3. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6463098/ Liu, F., Li, P., Chen, M., Luo, Y., Prabhakar, M., Zheng, H., He, Y., Qi, Q., Long, H., Zhang, Y., Sheng, H. & Zhou, H. (2017). Fructooligosaccharide (FOS) and Galactooligosaccharide (GOS) Increase Bifidobacterium but Reduce Butyrate Producing Bacteria with Adverse Glycemic Metabolism in healthy young population. Scientific Reports, vol 7. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5603605/ Slavin, J. (2013). Fiber and Prebiotics: Mechanisms and Health Benefits . Nutrients, vol 5. Issue 4. Retrieved from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3705355/