Dr. Samantha Bell, ND

05/02/2020

Hi everyone!

I’ll be back in the office this Monday, May 4th.

Fortify will be diligent in following guidelines, as set by governing bodies in Manitoba. We will safely welcome patients back into our clinic, while still offering the option of virtual care (video or phone) for both new and existing patients. If you have any questions about booking or protocols, feel free to get in touch with our team at (204) 231-5333, ext. 1.

Thanks for your patience and support - I look forward to seeing you again soon! ✨

04/24/2020

How is your skin?

If you’re breaking out, here are some things to think about. These are usually the things running through my head when I work with acne. If you think something here applies to you, start there, and work on that.

Ages ago, a dermatologist told me it didn’t matter what I ate. And I accepted that. Years later, I begrudgingly took dairy out of my diet for 3 months and realized it was a significant trigger for my acne. I always felt I had so little control over my acne, and once I figured that out, it allowed me to gain some control over my own skin.

If you have dealt with acne - what are some things you have found helpful in healing your skin?

04/13/2020

04/03/2020

Look, even I know this list is relatively basic. But I can admit that I’m not fully adhering to my own advice - and what will happen once I do?

As someone who typically sleeps really well without much effort, this has made me reflect on what it takes to initiate a sleep routine - when all other things feel out of routine.

Reflecting on my own habits, I’ve realized that taking my bedtime supplements has become my step 1 of “winding down” to sleep. And then step 2 is me falling asleep to TV. I know, not ideal (don’t judge me). 🤦🏻‍♀️

A patient of mine realized that her step 1 was a glass of wine. She swapped it out with some tea and her sleep is noticeably more restful.

So, what’s your obstacle to a good sleep?

And what are some simple changes you can make to foster a deeper, more restful sleep?

04/02/2020

VIRTUAL CARE // Ft. Me in my home office, just waiting for my patient to join our call. 😂🤓

(Not pictured: a cat on my lap, my massive cup of coffee and candle from ). ❤️

03/20/2020

Hi everyone! ❤️

This week has been nuts and like many, many others I’ve had to pivot and figure it out. I’m so grateful for a community that works to take care of eachother, and our vulnerable. And I’m grateful for those who continue to work for us, while we are safe at home (thank you!).

For the sake of physical distancing, I’ve been providing care via telemedicine (secure video and/or phone). This is a helpful option for existing patients to continue care and provides an opportunity for those wanting to start looking closer at their health.

If you are wanting to learn more about Naturopathic Medicine, or how it can be part of your care - I always offer 10-minute meet and greets so that you can explore that further.

Take care. ❤️

02/24/2020

So excited to celebrate International Women’s Week with all the incredible women I work with at . 💃🏻

And I’ll be talking about periods. What more could I want? 🤣

@ Fortify

11/26/2019

I can’t wait to talk about OPTIMIZING health. 🤓

I hope to see you there tomorrow! @ St. Boniface

11/25/2019

And the theme of the November goes to “wired and tired!” Exhausted during the day and wide awake at bedtime.

Who else? 🙃

Model: Professor Martin

11/19/2019

Pregnancy loss brings many women into my care. As you can see, there are many factors to think about and investigate when it comes to recurring pregnancy loss.

// I’ve written about these perspectives for the Naturopathic Currents - and you can access this article through the link in my bio.

If this is something you’re dealing with, I hope you’ll read it and find it helpful.

Take care. ❤️

10/24/2019

September and October have brought in a wave of so many people with severe exhaustion. It’s the theme of fall, and I’ve never seen so much of this, all at once.

There are many contributing factors to fatigue, but today, let’s talk about melatonin.

Melatonin is a ‘neurohormone’ which can be used to regulate sleep-wake cycles. Endogenous (what’s made in your body) melatonin is released by the pineal gland, found within the brain. Production and release of endogenous melatonin is activated by darkness and depressed by external/environmental light sources (yes, me too – falling asleep to crime TV isn’t helpful).

And yes, we can supplement melatonin but lifestyle is even more important.

🌘 Reducing and limiting exposure to blue light at NIGHT: setting ‘night shift’ on your iPhone & iPad, f.lux for Macs, ‘night light’ for PCs and blue light-blocking glasses (or filter added directly into your prescription lenses (1). And hey, if you can avoid screens for the entire evening, I am deeply impressed and encourage you to keep it up. 🙌🏻

🌒 Bright light exposure (ex. SAD lamps) during DAYTIME hours: some studies show that individuals with seasonal affective disorder (SAD) may have abnormal melatonin levels (increased daytime melatonin and delays in night-time release of melatonin). (2) This point is also of particular importance to those who have compromised bright/daytime light exposure - night shift workers and those who travel often. (2)

The NCCIH discourages the use of melatonin without medical supervision. It is important to be properly informed and supervised on dosage and type (immediate vs. extended release). Melatonin is NOT indicated for everyone and does have a number of interactions with common pharmaceuticals. In fact, in Europe, melatonin is available by prescription only (and is referred to as Circadin®).

Melatonin is also not the be-all, end-all to all sleep woes. Sleep is influenced by a number of factors and melatonin is simply one intervention of many.

And melatonin is not just helpful for sleep - it can be used both orally and topically for a number of concerns. 😍 We’ll talk about that another time!

10/16/2019

Taking Charge of Your Fertility by Toni Weschler

More than EVER, I’m seeing patients who are interested in learning more about their fifth vital sign – their period! Speaking my love language here! 😆

If you’re looking to get a better understanding of your cycle, and/or want to learn how to chart your cycle – this is worth the read. I don’t have a ton of time to walk patients through all of this during our visits, so this is the book I refer them to.

And honestly, regardless of trying to conceive or not, it’s incredibly empowering (and fascinating) to have a better understanding of your cycle. I honestly question why we don’t teach charting in school. 🧐

P.S. Having fun isn’t hard when you’ve got a library card – this book is available through the Winnipeg Public Library 🙌🏻

10/10/2019

If you’re anything like me, you’ve excused yourself from exercise because of your period. 😬 The last time I did this, I pondered it. Would it make me feel better? Or would I actually just continue hanging out with Aunt Flow in misery?

A quick PubMed search led me to this Cochrane Review, published just last month (September 2019).

Now, this review was looking at the effectiveness of exercise on primary dysmenorrhea (period pain that isn’t caused by ‘pelvic pathology’ – disease, disorder, infection, etc.). This review & meta-analysis included studies with women who experienced moderate-to-severe (primary) period pain. And it’s worth noting - none of these trials compared exercise to the birth control pill.

The studies included in the review used low-intensity exercise (core strengthening, yoga, stretching) or high-intensity exercise (which they considered aerobic training, Zumba), but none of those studies looked at resistance training.

The review concludes that to-date, there is only low-quality evidence. But that evidence suggests that workouts between 45-60 minutes, 3+/week, REGARDLESS OF INTENSITY, may provide a clinically significant reduction in menstrual pain intensity. The authors conclude that given the overall health benefits of exercise (and relatively low risk of side effects in the general population), women might want to consider using exercise to provide relief of menstrual pain (alone, or in addition to typical treatments for painful period(s)).

There you have it; prioritize movement during Aunt Flow’s visit. I’ll try to remind myself of this too. 🙃

Reference(s): PMID: 31538328

10/07/2019

Acupuncture // Clearly, acupuncture can’t be explained in a few paragraphs, but here’s a simple way to start understanding how it can vary:⁠

In Traditional Chinese Medicine (TCM), your entire being (physical and emotional; your constitution) is taken into consideration and an acupuncture protocol is created based on your particular goals and needs. Points are picked according to their action and can be stimulated in a number of ways – ex. acupuncture (dry needling), electroacupuncture, acupressure, moxabustion and ear seeds.⁠

Now, anatomical/contemporary acupuncture focuses a little bit more on the anatomy and physiology of the body, and a little less on the TCM approach. If someone comes in with a rotator cuff injury, those utilizing the contemporary approach would start by strategically placing needles into the shoulder - in order to support greater circulation into the area, provide pain relief, stimulate the nerve(s), etc. The contemporary approach typically has a greater focus on muscles, tendons, ligaments and nerves.⁠

In theory & in clinical practice, it can be seamless when combining both approaches. We can focus on specific, localized areas, but then incorporate points to address your entire constitution.⁠

Acupuncture is utilized by a number of healthcare providers, and the approach of the acupuncture can vary. For example, a licensed Acupuncturist might focus in fertility acupuncture, whereas a Physiotherapist might utilize acupuncture in a sports medicine setting. And most Naturopathic Doctors can perform acupuncture and may also focus in a particular area.⁠

When considering acupuncture, think about what you hope to achieve and seek out someone who utilizes acupuncture to meet that goal.

P.S. Yes, that cute, little, baby needle (an intradermal needle) is a needle we use on the face - for facial rejuvenation acupuncture!

10/01/2019

Mittelschmerz – the lovely, weird name for the physical sensation experienced during or directly after the release of an egg from an o***y (ovulation). This pain is felt in the lower part of your abdomen and is often one-sided (but can alternate between sides, month-to-month). Some women will experience this ovulatory pain as a mild, dull, aching sensation and some women may even experience even greater discomfort. Some won’t experience it at all. The cramping can last minutes-hours, but really shouldn’t last longer than a day (some sources state that anything longer than 8 hours is abnormal, and I’d agree). (1)

Women ovulate at different times, but the general rule of thumb is mid-cycle (around days 12-16 of your cycle (1); and yes, I know some of you ovulate outside that range - we can talk about that another time!). And if you track your cycle and know when you ovulate, all to ya. 💃🏻

So, why on earth might we experience discomfort during ovulation?

Rupture of the Graafian follicle (which contains the egg) can cause pain itself, but ovulation can also result in some mild bleeding into the peritoneal cavity (essentially, causing irritation in that area). (2)

All that said, this is for educational purposes only. There are a number of predisposing conditions that can cause ovulatory pain. If you have concerning and/or chronic ovulatory pain, get assessed by your healthcare provider.

Reference(s):
(1) Auerbach, PS. Constance, BB. Freer, L. Field Guide to Wilderness Medicine: Gynecologic and Obstetric Emergencies, 31, p. 343-370.
(2) Ness, TJ. Kukreja, P. Wall & Melzack’s Textbook of Pain: Genitourinary Pain, 54, p. 758-771.

09/17/2019

Officially taking patients at Fortify for October 2019. ✨

Come meet the team in our beautiful space, located in the St. Boniface area of Winnipeg. We are so excited to meet you!

Here’s the link to book your first visit: https://thisisfortify.com/clinic/. See you soon. ☺️

09/11/2019

Androgens are often referred to as ‘male s*x hormones,’ but they’re present in both men and women. When it comes to women, we hear the most about testosterone, DHEA-S and DHT.

And androgen excess is exactly what it sounds like – too much of those hormones (we might start investigating this by testing testosterone levels in your blood). But hey, let’s not demonize androgens either – androgens are important for your libido, energy, bone health, muscle growth and strength.

When it comes to androgen excess, the ⚡️WHY⚡️is of utmost importance – approximately 85% of androgen excess is caused by PCOS (scroll back to my PCOS post) and idiopathic hyperandrogenism (essentially, we don’t know why). (1) There are many, less common causes, but they can include things like thyroid dysfunction, adrenal dysfunction, medications, pregnancy, tumor (ovarian, adrenal) and abnormal s*xual development. (2)

Anyway – why would women care? Because the major manifestations of androgen excess include acne, hirsutism and androgenic alopecia. (2)

Hirsutism is defined as excessive body/facial hair growth that appears in a male pattern (feel free to Google the Ferriman-Gallwey tool).
Androgenic alopecia is also sometimes described as female pattern hair loss. Please note that there are many other causes of this type of hair loss; so don’t jump to any conclusions on Dr. Google.

So, hirsutism = increased hair on the face and body, androgenic alopecia = decreased hair on the head. Not ideal, I agree. 😒

When we can figure out what’s causing the androgen excess, we can target it and help balance out your androgens. I speak from personal experience here – during naturopathic school I had terrible acne on my chin and neck (ugh). 🙄Through diet and herbal medicine I was able to have greater control over the beast that is hormonal acne – by targeting those androgens safely and gently.

Reference(s): (1) PMID: 31361105, (2) Lobo, R.A. Comprehensive Gynecology: Hyperandrogenism and Androgen Excess: Physiology, Etiology, Differential Diagnosis, Management. 40, pp 865-880. E3.

Photo:

09/05/2019

Here’s hoping that this isn’t you. 😬

Question: Is there a more natural way to effectively deal with extreme cramps than the pill?

I want to just state that I am not anti-birth control. And I do not shame people who use birth control. In fact, I used to volunteer as a birth control/unplanned pregnancy counsellor with the Women’s Health Clinic – and I loved educating women on their birth control options. Now that that’s out of the way -

Birth control is NOT the only option for painful (dysmenorrhea) and/or heavy periods (menorrhagia). And before jumping on a medication or supplement your HCP should always look into potential causes of extreme cramping – ie. endometriosis, fibroids, etc.

Prostaglandins are a major factor in menstrual cramps – once a month (when Aunt Flow comes to town) they cause uterine muscles to contract in order to release the uterine lining (endometrium). Prostaglandins aren’t bad (they are important for blood clots, inducing labour, etc.), but if certain prostaglandins are high in your cycle – this can predispose to more painful menstrual cramping.

To start, here’s a couple of questions I’d ask:
- When did the painful periods begin? How long into the cycle does the pain last?
- What other symptoms are experienced?
- What has worked to relieve the pain?
- Are you s*xually active?
- Do you smoke?
- How much alcohol do you drink?
- How are you managing stress?
- What does your typical diet look like?

First, we need to focus on REGULATING hormones. In conjunction with doing so, there are other therapeutic options to consider in dysmenorrhea:
- Diet (this is a big one – sorry ladies)
- Smoking cessation
- Herbal medicine: a number of herbs (including ginger, peppermint, curcumin) have been studied and compared to ibuprofen, mefenamic acid
- Vitamins & minerals: depending on what symptoms are being experienced in conjunction with the painful period, magnesium, calcium and vitamin D may be considered useful
- Acupuncture

Now please, do not Dr. Google or self-prescribe. Talk to a licensed HCP to investigate and discuss cause(s) and treatment options.

08/29/2019

Being heard. 🖤

Really – we want someone to listen to us. We want the time to explain what’s going on – both mentally and physically. We want someone to hear us out – to have a deeper understanding of why things are the way they are.

Being a patient myself, I know the importance of having time to communicate. And in my own practice, I work hard to create a space where patients have the time to share comfortably and honestly.🖤

Photo:

08/22/2019

Thanks for all your questions! I had a number of you ask about periods in the postpartum phase - specifically while breastfeeding.

I’ve seen great variation in the amount of time it takes for a woman’s period to return and regulate. To start, prolactin is the main hormone responsible for milk production. And when elevated (hence, for breastfeeding) it works to prevent ovulation.

So, typically, if you aren’t breastfeeding, your period (and potential ovulation) will return much quicker than someone who is breastfeeding. Once you’ve had a period, you should assume that you are fertile, and should use protection (if you prefer not to become pregnant again). In fact, you may be ovulating prior to that first postpartum period - so be aware of this!

During breastfeeding, return of that first period and further regulation of the cycle can depend on a number of factors:
- How often is the baby nursing?
- Are you pumping?
- Is the baby being bottle-fed at all?
- Has the baby already been introduced to solids?
- How long is the baby sleeping at night? Are you going an entire night without feeding or pumping?

Basically, the more stimulation the breasts receive, the more prolactin = less likely to menstruate. The less stimulation the breasts receive (ie. going an entire night without feeding or pumping) = more likely to menstruate.

Interestingly enough, the Lactational Amenorrhea Method strategically utilizes breastfeeding as a birth control method – and one of the biggest factors is night nursing. Night nursing is considered ‘protective’ against pregnancy, and is highly correlated with anovulation (lack of ovulation) and amenorrhea (lack of period). (1)

And to complicate things further, prolactin can be increased by a number of factors, including the following: (2)
- Stress (vague, I know)
- Hypoglycemia (low blood sugars)
- Sexual activity
- Exercise (say what?)
- Pituitary tumor (prolactinoma)
- Cushing’s
- Thyroid dysfunction
- Medications: dopamine antagonists, and some antidepressants, psychotropics and antihypertensives

Reference(s):
(1) Rivlin, K. Westhoff, C. Family Planning, Comprehensive Gynecology; 13, p. 237-257. E1.
(2) Bronstein, M. Disorders of Prolactin Secretion and Prolactinomas, Endocrinology: Adult and Pediatric; 7, p. 104-128. E6.

08/20/2019

Amenorrhea: the absence of your period.

Furthermore, amenorrhea is divided into 2 categories: primary and secondary.

We’re going to talk about secondary amenorrhea, which can be observed as: the absence of a period for 3 months in women who had previously had REGULAR cycles, or the absence of a period for 6 months in women who had already been experiencing IRREGULAR cycles. 🗓

Functional hypothalamic amenorrhea (FHA) is the loss of a period caused by under-eating (or even not eating enough carbohydrates)/disordered eating, excessive exercise and/or stress. This leads to disruption of the hypothalamic-pituitary-ovarian (HPO) axis. And women with normal, ‘healthy’ BMIs can also experience this – this does not simply apply to underweight women! This disruption can lead to estrogen deficiency – with potentially disastrous effects on mental health (women with FHA have shown greater susceptibility to anxiety and depression) (1), cardiovascular health, bone health and fertility. (2)

While FHA is considered a diagnosis of exclusion (your healthcare provider should work to rule out other causes, like PCOS, pregnancy, thyroid dysfunction, etc.), it’s important to consider in women who have lost their period in times of extreme mental or physical stress or during ketogenic, low-carb, or extremely restrictive dieting. Losing your period during a diet is not a good sign – period (literally)! ⭕️

Low estrogen in premenopausal women is not normal and should always be addressed at the root cause.

Reference(s): (1) PMID: 11476778, (2) PMID: 28658709

08/14/2019

Let’s talk about the effect of alcohol on your hormones. And for the sake of this topic, I’m talking about consistent alcohol consumption, not the odd glass of wine. I get it, I like wine too - this post doesn’t come from a place of judgement. 💁🏻‍♀️

So - the liver is responsible for detoxing alcohol. But it’s also important for metabolizing estrogen. In women, more than one alcoholic drink per day has been shown to increase circulation of androgens (ie. testosterone) and estrogens (1, 2) – this predisposes you to symptoms of estrogen dominance.

In women, estrogen dominance (essentially, not being properly balanced with progesterone) can present as severe PMS (irritability, headaches, breast tenderness), and heavy, clotty (and/or painful) periods. In fact, fibroids are strongly associated with estrogen dominance. Additionally, estrogen dominance (among many other factors) can increase the risk of hormone-dependent cancers (breast, uterine and ovarian). (3)

Significant, consistent alcohol intake is also associated with increased levels of cortisol. (4) And speaking of cortisol – higher levels will contribute to low progesterone (which further amplifies the estrogen dominance)! (3) And as we’ve previously discussed (go take a peek at older posts), inappropriate cortisol moderation is also involved with sleep concerns, weight gain and all sorts of other fun things.

For both men and women alike, better moderation of alcohol can create great improvements in hormones. 🙌🏻

Reference(s): (1) PMID: 15784178, (2) PMID: 26728472, (3) Warshowsky, A. Integrative Medicine: Uterine Fibroids. Chapter 58, 578-591. E2., (4) PMID: 23584113

08/07/2019

Sleep, cortisol and weight gain.

When you have healthy, restful sleep, cortisol levels are reduced to their lowest levels (typically around midnight). If cortisol doesn’t drop appropriately, this contributes to fat production and provides very little fuel (glycogen) to the muscles. So, you’ve got weight gain. And you’re tired. 🙄

👏🏻GOOD sleep👏🏻 happens when cortisol levels are low at night. And if your blood sugars aren’t regulated well enough, they might be dropping during sleep – so your cortisol will spike to raise those blood sugars. That jump in cortisol will wake you up – and then you’re waking up unnecessarily during those early hours. 🙄



The key is to moderate cortisol and have it low at night, and have it at it’s highest levels after 6 a.m., in order to help you wake up and seize the day. 💃🏻

Cortisol imbalance is important in weight management - if you feel like you’re doing everything right but can’t seem to lose the weight, it might be worth looking into.

08/01/2019

Hi! FYI (a number of people have been asking!) - I will definitely be continuing my practice at the Charleswood Medical Clinic as I join the team at Fortify Natural Wellness.

Very soon, my availability at both clinics will be updated on my website.

Take care and have a wonderful weekend!

07/30/2019

The World Health Organization (WHO) recognizes BURN-OUT as an occupational phenomenon. “Burn-out is a syndrome conceptualized as resulting from chronic workplace stress that has not been successfully managed.” (1)

Some questions to ask yourself if you deal with burn-out:
- Are you eating enough protein and fibre? How is your digestion?
- Are you having deep, restful, uninterrupted sleep? Do you wake up feeling rested?
- Do you have enough energy to get through the week? A day at work?
- What are you doing to truly REST? Are you doing it enough?
- Are you moving your body? And is the right type of movement for what you need?
- Are you engaging in a mental practice such as prayer, meditation or deep breathing?
- Do you need to seek counselling to digest what’s going on at work?
- Are you hydrated? (Or are you simply jacked up on coffee?)
-Do you have social supports to discuss your workplace stress with?
- What measures do you need to take at work in order to effectively work through that stress while at work? (ie. I spend some time doing deep breathing between patients if I’m feeling anxious or stressed out!)

What do you really need to help yourself overcome workplace stress?

Reference: World Health Organization: Burn-Out an “Occupational Phenomenon”: International Classification of Diseases. May 28, 2019.

07/24/2019

Hope to see you there! 🖤

07/16/2019

Are you taking your iron supplement with your morning cup of coffee or tea? I used to take mine with a cup of green tea. 😶🤦🏻‍♀️

Both coffee and tea (primarily green, black, white, chamomile) contain high concentrations of polyphenols – which can reduce iron absorption by 60%, or even more. In fact, coffee consumption, with or just after a meal may reduce iron absorption by 40%.

So - don’t waste that precious iron. Take it away from your coffee and tea. 💃🏻

Gropper, Sareen A. S, Jack L. Smith, and James L. Groff. Advanced Nutrition and Human Metabolism. 2009.

07/10/2019

Vitamin B12 (cobalamin). That fun one on blood work that says anything over 220 pmol/L is sufficient (remember, sufficient does not mean optimal). 🤓

So, yes - if you’re plant-based, you’ll very likely need to supplement B12 (but get your levels tested first). That’s cool, I’m right there with you.

And then there’s a quite a few other factors that predispose to vitamin B12 deficiency :
- Pancreatic insufficiency
- Pernicious anemia (yeah, there’s a lot of you)
- Achlorhydria (low stomach acid - there’s also a lot of you out there, but you just don’t know it [yet])
- Celiac disease
- Small intestine bacterial overgrowth (SIBO)
- Medications - for example, prolonged use of proton pump inhibitors (often used to treat GERD).

I actually don’t usually care if people take vitamin B12 orally or through injection (intramuscular - typically in the deltoid muscle) - but it’s those individuals with pernicious anemia and malabsorption disorders that absolutely require injection.

And to complicate things a little further, there are different vitamin B12 supplements: cyanocobalamin, hydroxocobalamin, adenosylcobalamin and methylcobalamin. Hint: only 2/4 of these are active as coenzymes.

It isn’t always about supplementing more, but smarter.

So - which form are you taking? And is it working for you? Get your levels tested and talk to a Naturopathic Doctor to figure out which form is best for YOUR body.

📷 :