Dawn's Testimonial

I was always an active person, going to the gym 5 days a week and playing on various sports teams for fun. However, I was not in the shape I wanted to be in. I didn't know what I was doing wrong - after all I was very active and eating "healthy", even if I was grinding away at my desk job 8-14 hours a day (depending on the season). In January 2014, I set a personal goal to compete in a fitness competition. I was referred to Endurance on 8th, by a friend and hit it off with Wendy right away. She was knowledgeable and tailored my meal plans specific to my intolerances, as I have a several dietary restrictions which I realize now were causing me to be bloated, have inflammation, and left me feeling overall rundown. I wasn't sure I would be able to achieve my goal with no whey proteins, no dairy, no gluten, and being allergic to tree products (nuts, certain spices ... especially pepper), but Wendy was able to create an effective meal plan taking into consideration all my restrictions. While there were times, I was envious of some of the foods other people got to eat during their prep, I knew sticking to my plan was the best thing for my health! 
 
I fell in love with the lifestyle: the training, meal prep (even though some days were tough) and the friends I made during the process. I competed at the NPAA Canada Championships, placing 4th in Bikini tall and 6th in Fitness tall in my second show. I'm continuing to train and I'm embracing the "off-season" or muscle building phase, with the goal of competing again in the future.
 
Thank-you for believing in me Wendy!

- Dawn Munro

Acupuncture for Ovulation Disorders and PCOS

By Fiona McCulloch, ND

Polycystic ovarian syndrome is the number one reproductive disease in women.   This disease disrupts normal ovulatory cycles which can result in heartbreaking infertility for millions of women.  Known hormonal changes in PCOS include excess androgens (ie: testosterone), and insulin resistance.  Most thought now is leaning towards insulin resistance being the primary cause of PCOS, with genetic factors playing a role, but once the cycle of anovulation begins it feeds back on itself, causing the condition to remain in a vicious cycle.  Women with PCOS have not only insulin resistance, but also have neuroendocrine imbalances, resulting in elevated LH (lutenizing hormone) levels.  Having a high LH to FSH ratio is one of the hallmarks of polycystic ovarian syndrome or persistent anovulation.  In response to a combination of high LH and insulin resistance, the follicles in the ovary will begin to secrete too many male hormones (androgens) which then inhibit the hormonal pathways that are needed to stimulate ovulation.

 

Various medications are traditionally used to induce ovulation in women with PCOS.  A growing body of evidence now exists indicating that low-frequency electroacupuncture is as effective as commonly used medications in inducing ovulation.  Furthermore, this form of acupuncture can benefit many of the hormonal imbalances seen in polycystic ovarian syndrome.  Thousands of women worldwide use acupuncture therapy for PCOS and so I’d like to discuss how it works, and why it is so beneficial to induce ovulation.

General principles of how electroacupuncture stimulates the ovaries through the nervous system

Electroacupuncture has been found to profoundly effect the reproductive organs, through mechanisms in the sympathetic nervous system, endocrine system, and neuroendocrine system.  When needles are inserted into certain points and stimulated in a specific manner, this produces a neurological reflex transmitted to the organ correlated with that nerve pathway.  For example, needles inserted into the leg muscles below the knee, lower back, or abdomen in specific regions cause a response which measurably affects the ovary.  In addition, the nervous system will transmit a signal to the brain, and the brain then emits a response which affects the organ from a central mechanism.  These effects have been investigated through measurements of hormones, neuropeptides, and circulatory changes on both animals and humans receiving this specific type of electroacupuncture.

Nervous system alterations in PCOS

Evidence indicates that women with pcos have abnormal circulating levels of a neurohormone called β-endorphin.  β-endorphin is known to increase insulin production and reduce insulin excretion by the liver, which is very much implicated in PCOS.   It has also been found that women with PCOS have unusually high amounts of sympathetic nerve fibres in their ovaries.  These nerve fibres cause unusual stimulation of the ovary by the sympathetic nervous system (the part of the nervous system associated with “flight or fight” responses in the body, among other processes).  Stimulation of these nerve fibres can cause the ovaries to produce androgens, which then impair normal ovulation.  Women with PCOS have also been found to have high amounts of nerve growth factors in their ovaries, something which is associated with high levels of sympathetic nervous system activity.   Disturbances in central and peripheral β-endorphin release, high androgens, insulin resistance, abdominal obesity, and cardiovascular disease are associated with increased sympathetic nervous system activity, and all of these are also associated with the pathology of PCOS.  In a recent study by Elizabet Stener-Vitorin in Sweden, direct intraneural testing found a strong correlation between levels of sympathetic nervous system activity and testosterone levels in women with PCOS.  Those who had the highest amounts of sympathetic nervous system activity were found to have the highest testosterone levels and the most severe PCOS conditions.

What evidence exists for acupuncture inducing ovulation?

Several studies exist on low frequency electroacupuncture and ovulation induction.  In one trial, the effect of a series of 14 electroacupuncture treatments on 24 anovulatory women with pcos was investigated.  In 38% of these women, regular ovulation was induced.   Three months after the last treatment, LH/FSH ratios and testosterone levels were significantly decreased, a sign of improvement in PCOS pathology.   In another study done on a group of women given human menopausal gonadotrophin (a commonly used drug in the treatment of infertility), acupuncture was compared to hCG injections in order to assess its effect on ovulation.  Traditionally hCG is given to stimulate ovulation during medicated cycles at fertility clinics.  It was found that a single acupuncture treatment induced ovulation as effectively as the as the hCG injection and reduced the incidence of ovarian hyperstimulation syndrome, a painful side effect of medicated cycles.  Other studies have also indicated enhanced ovarian response when acupuncture is added to medicated cycles.  Female rats with PCOS induced by chronic exposure to DHT (a form of testosterone) were given low frequency electroacupuncture and physical exercise.  The treatment increased the amount of healthy follicles in the ovaries,  and significantly normalized cycles.

Effects of electroacupuncture on nervous system changes in PCOS

It has also been found that electro-acupuncture can regulate parts of the central nervous system related to dysfunction in PCOS.  Specifically, beneficial effects on neurohormones such as GnRH(Gonadotropin releasing hormone) and androgen receptor proteins, indicate that electro-acupuncture significantly benefits the hypothalamic-pituitary-ovarian axis and through this can help to restore normal cycling.  Electroacupuncture was also found in 3 recent studies to increase ovarian blood flow through effects on sympathetic nervous system pathways.  In addition, it has been found in two studies to reduce high peripheral circulating β-endorphins in women with PCOS, and thereby improve insulin resistance.   As sympathetic nerve activity appears to contribute to the development and maintenance of PCOS, the beneficial effects of electroacupuncture, and also exercise, may be mediated by nervous system modulation to the ovaries.

Electro-acupuncture appears to work through multiple pathways to disrupt the “vicious cycle” of PCOS.  Even though much more research needs to be done to determine all of the mechanisms involved, its safety and low incidence of side effects makes it an excellent therapy to stimulate ovulation naturally for the many women who suffer with this disease.

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References

Andersson, S., Lundeberg, T., 1995. Acupuncture — from empiricism to science:functional background to acupuncture effects in pain and disease. Med. Hypotheses 45, 271–281.

Cai, X., 1997. Substitution of acupuncture for HCG in ovulation induction. J. Tradit. Chin. Med. 17, 119–121.

Carmina, E., Ditkoff, E.C., Malizia, G., Vijod, A.G., Janni, A., Lobo, R.A., 1992. Increased circulating levels of immunoreactive beta-endorphin in polycystic ovary syndrome is not caused by increased pituitary secretion. Am. J. Obstet. Gynecol. 167,

Chen, B.Y., Yu, J., 1991. Relationship between blood radioimmunoreactive beta-endorphin and hand skin temperature during the electro-acupuncture induction of ovulation. Acupunct. Electrother.

Lobo, R.A., Granger, L. R., Paul, W.L., Goebelsmann, U., Mishell Jr., D.R., 1983. Psychological stress and increases in urinary norepinephrine metabolites, platelet serotonin, and adrenal androgens in women with polycystic ovary syndrome. Am. J. Obstet. Gynecol. 145, 496–503.

Feng, Y., Johansson, J., Shao, R., Manneras, L., Fernandez-Rodriguez, J., Billig, H., Stener-Victorin, E., 2009. Hypothalamic neuroendocrine functions in rats with dihydrotestosterone-induced polycystic ovary syndrome: effects of low-frequency electroacupuncture. PLoS ONE 4, e6638. produces skeletal muscle vasodilation following antidromic stimulation of unmyelinated afferents in the dorsal root in rats. Neurosci. Lett. 283, 137–140.

Jin, C.L., Tohya, K., Kuribayashi, K., Kimura, M., Hirao, Y.H., 2009. Increased oocyte production after acupuncture treatment during superovulation process in mice. J. of Reprod. & Conception 20, 35–44.

Manneras, L., Cajander, S., Lonn, M., Stener-Victorin, E., 2009. Acupuncture and exercise restore adipose tissue expression of sympathetic markers and improve ovarian morphology in rats with dihydrotestosterone-induced PCOS. Am. J. Physiol. Regul. Integr. Comp. Physiol. 296, R1124–R1131.

Stener-Victorin, E., Wu, X., Effects and mechanisms of acupuncture in the reproductive system, Auton. Neurosci.(2010)

Stener-Victorin, E., Lindholm, C., 2004. Immunity and beta-endorphin concentrations in hypothalamus and plasma in rats with steroid-induced polycystic ovaries: effect of low-frequency electroacupuncture. Biol. Reprod. 70, 329–333.

Stener-Victorin, E., Waldenstrom, U., Tagnfors, U., Lundeberg, T., Lindstedt, G., Janson, P.O., 2006. Effects of electro-acupuncture on anovulation in women with polycystic ovary syndrome. Acta Obstet. Gynecol. Scand.

Stener-Victorin, E., Lundeberg, T., Waldenstrom, U., Manni, L., Aloe, L., Gunnarsson, S., Janson, P.O., 2000a. Effects of electro-acupuncture on nerve growth factor and ovarian morphology in rats with experimentally induced polycystic ovaries. Biol. Reprod. 63, 1497–1503.

Stener-Victorin, E., Lundeberg, T., Waldenstrom, U., Bileviciute-Ljungar, I., Janson, P.O., 2001. Effects of electro-acupuncture on corticotropin-releasing factor in rats with experimentally-induced polycystic ovaries. Neuropeptides 35, 227–231.

Stener-Victorin, E., Kobayashi, R., Kurosawa, M., 2003a. Ovarian blood flow responses to electro-acupuncture stimulation at different frequencies and intensities in anaesthetized rats. Auton. Neurosci.: Basic and Clin. 108, 50–56.

Stener-Victorin, E., Lundeberg, T., Cajander, S., Aloe, L., Manni, L., Waldenstrom, U., Janson, P.O., 2003b. Steroid-induced polycystic ovaries in rats: effect of electro- acupuncture on concentrations of endothelin-1 and nerve growth factor (NGF), and expression of NGF mRNA in the ovaries, the adrenal glands, and the central nervous system. Reprod. Biol. Endocrinol. 1, 33.

Stener-Victorin, E., Fujisawa, S., Kurosawa, M., 2006. Ovarian blood flow responses to electroacupuncture stimulation depend on estrous cycle and on site and frequency of stimulation in anesthetized rats. J. Appl. Physiol. 101, 84–91.

Stener-Victorin, E., Jedel, E., Manneras, L., 2008. Acupuncture in polycystic ovary syndrome: current experimental and clinical evidence. J. Neuroendocrinol. 20, 290–298.

Stener-Victorin, E., Jedel, E., Janson, P.O., Sverrisdottir, Y.B., 2009. Low-frequency electro-acupuncture and physical exercise decrease high muscle sympathetic nerve activity in polycystic ovary syndrome. Am.J.Physiol.Regul.Integr.Comp.Physiol. 297 (2), R387R395.

Zhao, H., Tian, Z.Z., Chen, B.Y., 2003a. An important role of corticotropin-releasing hormone in electroacupuncture normalizing the subnormal function of hypothalamus–pituitary–ovary axis in ovariectomized rats. Neurosci. Lett. 349, 25–28.

How do Physiotherapists Help Treat Diabetes?

Source:  Physiotherapy Alberta

Diabetes is a disease that happens when the body is unable to sufficiently produce or properly use insulin. Insulin is a hormone that allows the body’s cells to absorb sugar from the blood stream and use that sugar for energy.¹ An estimated 2.7 million Canadians have diabetes,² and as many as one in five of these people don’t know that they are diabetic.¹

Diabetes leads to high blood glucose levels (hyperglycemia), which over time, causes complications such as heart disease, kidney disease, lower leg amputations and eye problems.¹ People with diabetes are three times more likely to be admitted to hospital with heart disease (including high blood pressure), 12 times more likely to be hospitalized with kidney disease, and 20 times more likely to require a leg amputation than people who are not diabetic.¹

People with diabetes are also more likely to experience other chronic conditions such as arthritis, chronic obstructive pulmonary disease (COPD) and depression, partly because these conditions have similar risk factors and underlying causes.¹

Most importantly, although diabetes does not typically directly cause death, complications associated with diabetes do. As many as 29.9% of people who died in 2007 had diabetes, though only 3.1% of deaths were directly attributable to diabetes.¹ In fact, people with diabetes have double the mortality rate of people without diabetes and experience decreased life expectancy.¹

There are several types of diabetes:¹

• Type 1 diabetes:
  • Previously known as juvenile diabetes.
  • Usually occurs in those under 40.
  • An autoimmune disease in which the person’s immune system attacks insulin producing cells.
  • Requires an external source of insulin.
• Gestational diabetes:
  • Diagnosed when hyperglycemia occurs during pregnancy.
  • Usually resolves following the baby’s delivery.
  • Risk factor for type 2 diabetes later in life.
• Type 2 diabetes:
  • Sometimes referred to as non-insulin-dependent diabetes.
  • Usually seen in those over age 40, but can occur in children and youth.
  • Occurs when the body can’t produce enough insulin or when the body cannot effectively use the insulin it makes.
  • Most common among people who are overweight or obese, inactive, or members of certain ethnic groups.
  • People who are overweight or obese are two to four times more likely to have diabetes.¹
  • Smoking is also associated with an increased risk of type 2 diabetes.¹
  • The vast majority (90-95%) of people with diabetes have type 2 diabetes.¹

Risk Factors

When blood glucose levels are not well controlled, people with diabetes are at an increased risk of infection, demonstrate delayed wound healing, and experience damage to the blood vessels of the body (leading to eye problems, nerve damage and heart and kidney disease).¹ Many people with diabetes also benefit from lowering blood pressure and cholesterol, as there is an increased risk of illness and death due to heart disease.³ Given the alarming statistics related to type 2 diabetes (both how common it is and the many associated complications), it is critical to take steps to manage blood glucose levels. Achieving glycemic control (keeping blood glucose levels in a desired range) and managing heart disease risk factors will limit diabetes’ impact on the health and wellbeing of those with this disease.

Treating diabetes

Treatment of type 2 diabetes often includes medications to reduce blood glucose levels. Aggressive medical management of blood glucose has long been the norm for people living with diabetes, and many people with type 2 diabetes are treated with pills, injections or a combination of both to control their blood glucose.³ However, there has been some indication that this approach can, over time, lead to a variety of complications and negative outcomes.³

Non-pharmaceutical treatment of diabetes focuses on dietary changes and exercise for weight loss and to improve glycemic control.⁴ For diabetics who are overweight or obese, the benefits of weight loss also extends to a reduction in cardiovascular risk factors (e.g., blood pressure, cholesterol).⁵

Researchers suggest that physical activity paired with weight loss increases insulin sensitivity,⁶ with clinical guidelines suggesting that lifestyle changes including diet and physical activity advice can be the first line of treatment for some individuals diagnosed with type 2 diabetes.³

Among those who require medication at the time of diagnosis, successful lifestyle changes can lead to a change or discontinuation of medications when glycemic control is achieved.³ In one study a two to five percent weight reduction achieved through lifestyle change was shown to lead to clinically significant improvement in glycemic control.⁶ A combined analysis of several studies also demonstrated that successful lifestyle change interventions had a similar impact on glycemic control as pharmaceutical treatment when compared over a two year period.⁷

How physiotherapy can help

Research has demonstrated that effective treatments to improve blood glucose and cardiac risk factors include intensive lifestyle interventions and behavior modification,^4,5,7 and that structured exercise interventions are more effective than general advice to be more active.⁸ That’s how physiotherapy can help people with, or at risk of developing diabetes!

Despite the strong evidence to support exercise as a treatment for people with diabetes, it can be hard to change behavior. Many people, both with and without diabetes, struggle to incorporate exercise into their daily lives; however, several of the conditions associated with diabetes can make participation in exercise more difficult. Physiotherapists are movement experts. Physiotherapists can help by providing tailored exercise recommendations that consider a person’s baseline activity level and other health concerns. Physiotherapists are also skilled in coaching people to make the type of behavior changes that are needed to improve patient outcomes in diabetes.

In addition to helping with lifestyle change to treat diabetes itself, physiotherapists can also help people with diabetes manage the complications and conditions associated with diabetes. For example, some physiotherapists work in the area of wound care, treating people with diabetic foot wounds and providing advice regarding skin care and footwear to help prevent wounds. Many physiotherapists focus on balance, which can be impaired in diabetics who have sensation loss in their feet due to peripheral neuropathy (nerve damage). Others work in the area of pain management and treat people with pain caused by diabetic neuropathy.

Ronnie's Testimonial

"Kevin and Wendy have always been supportive and helpful on my journey.  They made sure that I was comfortable with the workout programs and meal planning.  I was very pleased and shocked that I did not experiences any mood change: ie grumpy or crankiness the week before my competition. Everyone warned me about that possibility.  Kevin and Wendy’s approach to preparing you for the stage is one in which focuses on being healthy and happy throughout the journey.  Their knowledge and approach are just a couple of reasons why I keep going back. They are also two of the most amazing and genuine people I have had the pleasure of meeting."

- Ronnie Shiu

Barbell Row Variations

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Try completing 5 sets of the below exercises and

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5 Barbell Rows (any of the above options)
10 Barbell Squats
10 Push Ups
10 High Knees
10 Barbell Curls

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