Dr. Courtenay Boer, ND

An important message re: COVID-19 - see below!

Sending our love, support and thanks to all the frontline workers. You know who you are. Keep up the incredible work and know that every day we are sending energy to help you through this. Until then please know that you’re in our hearts and mind. ❤️

We’d also like to thank everyone who is continuing to practice physical distancing and self isolation. Let’s continue to do our part and help bend the curve.

It might not be glamorous. It might be a little sweaty, and really red (don’t worry, 🍅-face is a healthy part of life 😂). But 🌟Movement Is Medicine🌟

Running, dancing, yoga, cycling, gym workouts, weightlifting - however you choose - moving your body has so many benefits. It can provide release: for pent up energy, racing thoughts, and yes, endorphins of course!

This is something we’ve known for a while, and now there is plenty of research to tell us it’s true. Exercise releases endorphins, among other neurotransmitters, which can increase mood and a sense of well-being. Movement can be a powerful ally to support mental health, it can help to mitigate stress, it is beneficial for your immune system, it’s important for heart health, and maintaining healthy bones - and that’s just a start.

Inviting movement into our lives is a way to wish our body well. How can you incorporate movement as part of your ?

How can we cultivate calm in the presence of anxiety?

I spent yesterday morning sitting in the sun, listening to Brené Brown’s podcast “Unlocking Us” and found it so insightful that I wanted to share a few take-aways.

Just like anxiety, calm can be a somewhat nebulous term. Brené offers two key points for understanding calm:
1. Defining “calm” - as perspective, mindfulness, and the ability to manage emotional reactivity
2. Calm is a practice (and we all have the ability to practice it).

It can be easy to think that some people are naturally more calm, but it’s an important distinction to see calm as a practice. For most people, unless your parents modelled calm really well, it’s unlikely to be your default emotional response. However, everyone has the ability to practice. So how do we do that?

Brené’s Steps To Practicing Calm:
1. Try to be slow to respond and quick to think “Do I have all the information I need to emotionally respond?”
2. Stay mindful about the effect that calm has on anxious situations (a panicked response produces more panic and fear, while a calm response is equally contagious)
3. Commit to practicing it. Small things matter. This can be counting to 10 before responding, taking 5 deep breaths, giving yourself permission to say “let me think about it” before responding. Take small, actionable steps.

How are you holding up? Are you riding the roller coaster of emotions day to day, too?

One thing that has been coming up for me more often lately is anxiety. Amongst the uncertainty and fear, I can feel it rising. I’ve been practicing tuning into my body and the way that anxiety shows up there - and the way that I show up to anxiety. I want to share a bit of that with you.

Firstly, let’s talk about bringing mindfulness to the presence of anxiety in the body. This can be knots in the stomach, quickened or shallow breathing, feeling your heartbeat in your chest, flushing and/or sweating. Yes, anxiety can show up with thoughts (and those are important to explore), but it is also a visceral experience. Drop into your body and notice areas of comfort and discomfort.

Next - ask yourself how you show up to anxiety? Some of us go into hyperdrive, wanting to do all the things and leaning into productivity. Some of us experience overwhelm, shut down, or numb. Or maybe you swing between those two. Brené Brown talks about “over and under-functioning” in response to anxiety. Do you identify with either or both of those?

Why is naming anxiety in this way useful?
There are a few reasons. I believe that naming anxiety can decrease shame and allow us to ask for support. Our bodies can signal a nervous system reaction before we consciously have words to put to anxious thoughts. Naming these bodily sensations can give us an awareness of what’s happening even if we can’t pinpoint why. Naming how we show up to anxiety can help us identify behavioural patterns, both helpful and unhelpful. And together, this awareness gives us agency to allow us to create new practices in the face of anxiety.

We are all in this together // COVID-19 Practice Update

The safety and health of our communities are of the utmost importance. In an effort to keep our community safe, all consultations have been moved to telemedicine (phone or video), while temporarily suspending injection and acupuncture therapies. Both Juniper Family Health and Active Solutions Health + Sport are taking active and preventative measures that reflect the current recommendations of Health Canada, the BC CDC, and our governments - I will share more details in my stories.

On a personal level, my husband and I just returned from a trip to Hawaii this past weekend, and are on Day 3 of a 14-day self-isolation.

To my patients, I will continue working from home, offering support through telemedicine. Thank you for your patience and understanding during this unprecedented time.

Sending love, kindness, and compassion as we all do our best to navigate these uncertain times. Please don’t hesitate to reach out if you need support or have any questions. We are all in this together 💚💚💚

Fantastic news from BC Women's Hospital!

Endometriosis often go years undiagnosed, and that may be in part due to women not knowing what their symptoms mean. Empowering young women with information about this common condition is such a big step in the right direction!

New program aims to break taboo by teaching high school students about endometriosis Because few discuss the symptoms or regard the severe pain and nausea during menstruation as abnormal, many suffer for years before getting treatment

Is there any good way to take a picture with a speculum? 🤷‍♀️ My husband recently asked me if I liked doing PAP testing, and I told him unequivocally YES! I get excited when a patient books in for a pelvic exam, because it means that she is invested in her health.

Many of us dread having to get a PAP test, and I would like to see that change! I believe PAP testing is ⋒ Important
⋒ Preventative
⋒ Empowering
⋒ Educational
⋒ A way to wish your body well

There is no doubt that getting a PAP test can feel vulnerable, but that does not mean it should feel disempowering or embarrassing. There is so much room for improvement in this area of healthcare, and I love providing a service that uplifts and supports women. If you would like to book in for a PAP, please visit the link in my bio or call 778-265-8340 💫

PAP Testing Guidelines // Do you know if you’re up to date with your PAP testing?

The BC Cancer Agency recommends having a PAP test done every 3 years, from age 25-69, for people with a cervix.
⋒ Note that PAPs are required yearly for those that are immunocompromised or have a history of pre-cancerous lesions or cervical cancer
⋒ Follow-up will also vary if atypical cervical lesions are found (please discuss with your healthcare provider).

What exactly are we testing? 🤔
The PAP test is a sample of cells taken along the transformation zone (squamocolumnar junction) of the cervix. This is an area of active cell remodelling, and therefore more prone to dysplasia (abnormal cell growth) and carcinoma.

Are you up to date with your PAP testing?

If you would like to book in for a PAP, please book online (https://www.smartnd.ca/online-booking/774) or call 778-265-8340.

PAP Testing // When you come in to my office for a PAP test, this is what you will see. A raised bed so that we can talk to each other throughout the exam, a table warmer to keep you cozy, my PAP station prepped with everything we need for the exam, and a calm energy.

Many folks with a cervix have experiences with PAP testing that range from uncomfortable to traumatic - and that is a problem. I believe that this screening is a good and important part of preventative medicine. My goal is to make PAP testing as comfortable and empowering as possible.

Have questions? Shoot me a DM.

If you would like to book in for a PAP, please book online (https://www.smartnd.ca/online-booking/774/drboer) or call 778-265-8340.

Happy New Year!!

I was so fortunate to soak up some sun and spend time with my family over the holidays. Reflecting on 2019, I have been feeling immense gratitude for so many of the things that enrich my life. I am taking some time in these first few days of 2020 to set intentions and create goals for this coming year that truly align with what I value.

Wishing you the very best as we step into this new year and new decade! ✨

RESEARCH REVIEW // Let’s talk about testing🩸🔬🧬 Laboratory testing, when taken along with clinical signs and symptoms 🩺 is one of our greatest diagnostic tools: it gives us deeper insight into what is happening in the body and it is important in establishing a diagnosis, and treatment plan.

But testing has to be done right, and timing is everything! ⏱ Many of the markers we test for can fluctuate - whether that be on a daily basis, a monthly basis (the menstrual cycle is a great example), or in response to fasting, just to name a few. Without taking these fluctuations into consideration, the results can be misinterpreted.

I recently came across this study, which adds liver enzymes to the list of biomarkers that fluctuate during the menstrual cycle. They found that these markers peak in the mid-follicular phase (typically cycle days 6-8), and are lowest in the later luteal phase (cycle days 24-28).

What does this mean for testing? It tells us that if we’re testing liver enzymes in cycling women, we should ideally be testing on the same cycle day each time we test - or at very least, take into consideration these fluctuations when interpreting the results 👩‍⚕️📋📊

Is there anything better than baby snuggles? Sweet baby Hadley (2 months old here) is looking so peaceful - but she also struggled with colic for the first few months of her life.

Colic is the term used for frequent and intense crying, which can be difficult or impossible to soothe. While the pathogenesis (cause) of colic is not fully understood, there is a growing body of research that suggests gut microbiota are involved, and that probiotics might have a therapeutic benefit in treating colic.

“Probiotics” is a pretty large blanket term - there are many genus, species and strains, and not all are equal. Research around probiotics should be specific to truly understand the therapeutic potential of certain gut bacteria for certain conditions. Two strains that have been studied for colic are Lactobacillus reuteri (DSM 17938), and more recently Bifidobacterium animalis subsp. lactis (BB-12).

A randomized, double-blind, placebo-controlled study on Bifidobacterium that came out last week was particularly promising, showing improvement in stool frequency and consistency💩, reduction in crying time (by up to 50%!)👶,and increased sleep duration😴, all seen within 28 days of taking the probiotic. No adverse reactions were reported. The authors concluded that the probiotic is a safe and effective treatment for colic. That’s pretty amazing!

To happy tummies and snuggly babes 🤱

PMID: 31797399
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PMID: 29439395
PMCID: PMC4507410

R E S T // Lately, I’ve been reflecting on the value and importance of rest. I used to buy into the glorification is busy. My sweet spot was hovering between being constantly busy and feeling like I couldn’t keep up with everything. And the truth is, my sense of self-worth got all tangled up in the being busy. If I wasn’t being productive, then what was I? It has taken lot of work to slowly unlearn the beliefs I held around being busy (and I am still learning, because who isn’t?). I’m learning how to rest well, and to value that time.

Kailem and I took a mid-week rest to get massages and dip in the mineral pools at this beautiful place, and we’re both feeling refreshed and recharged! Just a friendly reminder that a sustainable lifestyle balances work, play and rest. You cannot pour from an empty cup - filling your own lets you show up for others. As we head into a typically busy season, give yourself permission and space to rest ♡

RESEARCH REVIEW // Hormones are a delicate and finely tuned dance, and we are starting to better understand how this complex system works within our bodies. The feedback loops that control various hormonal interactions are called ‘axes’ and a recent study I came across talked about two of these - the HPG and HPA axes:

The HPG (hypothalamic-pituitary-gonadal) axis regulates fertility and reproduction - here’s a brief overview:
The hypothalamus secretes GnRH (in pulses) ⭢
This tells the pituitary to release LH and FSH (at certain times in the menstrual cycle)⭢
This signals the ovaries to produce estrogen, progesterone and testosterone and to release an egg (again, at certain times in the cycle)

The HPA(hypothalamic-pituitary-adrenal) axis plays an important role in our stress response and stress hormone singling:
The hypothalamus secretes CRH ⭢
This signals the pituitary to release ACTH ⭢
This signals the adrenal glands to secrete cortisol

Still with me? The important things to note are that these ‘axes’ can be controlled at each level and they do not act in isolation: the HPG and HPA axes can and do modulate each other to balance survival and reproduction. If the body is in a state of high stress, cortisol can disrupt the pulsatile GnRH secretion (the top of the ‘reproduction axis’, and reproduction is put on the back burner. What’s equally interesting is that there are estrogen receptors in the brain which can increase or decrease reactivity of the stress response.

Okay, this post is getting too long! All of this to say, when it comes to fertility, one of the best things you can do is to find and practice techniques to manage stress. That’s different for everyone - spending time in nature, reading a book, playing sports, meditating. Find what you love and go do it ✨

⭐️ Event Alert!! ⭐️

Do you want to stay healthy this cold and flu season? Then you won’t want to miss this!

Next Wednesday, I’m so excited to be hosting a free talk at Juniper Family Health () about all things immunity - lifestyle, nutrition, herbal allies (we’ll even taste a few!) and beyond for making it through cold and flu season unscathed. I hope you’ll join me!

Sign up at the link below to save your spot 💥

https://www.eventbrite.ca/e/lets-talk-sustainable-immune-health-tickets-84072536219

We might be a bit early this year, but can you blame a girl for getting into the holiday spirit?

We drove this beauty home on the roof our tiny red Honda 🚗🎄 It was a wild ride!

Running is something I’ve fallen in and out with, in and out with. I run regularly for a while, then I take a break. And you know what? That’s okay! I have let go of rigidity in favour of gentleness when it comes to fitness. My relationship to running has shifted immensely in the past year (see below)

Running is not
⋒ Punishment or painful
⋒ An excuse to eat poorly
⋒ A way to control
⋒ Only about counting km’s and pace

Running is
⋒ A way to connect with my body
⋒ An expression of gratitude
⋒ A way to wish my body good

That last one is from (swipe right). I’ve been following their writing prompts as a way to deepen my relationship with running and exercise and bring intention. Our bodies are good - we don’t need to fight against them, but rather love them. This wasn’t always true for me, but this is running for me now: an expression of love and gratitude to my body. How can you bring tenderness to fitness and wish your body good? @ Cowichan Valley

Since moving to the west coast, one of my favourite fall activities is watching the salmon run. We visited Goldstream this past week to eat lunch outside and watch the salmon. Here, thousands of them show up in mid-October after swimming upstream. It’s here that they were born, and after spending their lives in the Pacific Ocean, they find their way back to spawn, and eventually die. It’s not fully known why, or how they do this. I love the mystery around that - there’s something magical about it! @ Goldstream Provincial Park

Happy Tuesday morning! Well, it’s been a minute since I’ve posted in this space!! The last few weeks had my husband and I knocked out with the flu and colds (a great reminder to rest), then traveling to beautiful Prince Edward County in Ontario to visit our best friends and their kids (can you tell we’re just a little excited to be together? 😂 With 5 kids under 5 there was not a dull moment!)

I also attended a conference in mid-October, learning all about the interplay of the environment and our health. If you’ve been following me for a bit, you know I’m passionate about environmental toxins and their effects on hormones and fertility, so this was a great opportunity to deepen that knowledge.

After an impromptu break, I’m excited to be back - I’ve been reading up a storm and I can’t wait to share more research with you! Happy November friends 🍂🍁

You read that right - women with PCOS tend to have lower Vitamin D status than their “healthy” counterparts. The prevalence of Vitamin D deficiency in women with PCOS is striking: one study found Vitamin D deficiency in 44% of women with PCOS (versus 11% in control groups), while another found deficiency to be as high as 70%! Lower Vitamin D levels were associated with metabolic syndrome features in PCOS women, such as higher BMI, fasting insulin (and HOMA-IR), blood pressure, and cholesterol levels. Part of this might be explained by genetic polymorphisms (variations) for the Vitamin D receptor in PCOS women.

Supplementation in Vitamin D deficient women with PCOS can improve metabolic status and markers of inflammation. But it is of course most beneficial when repleting vitamin deficiencies!

The bottom line: Vitamin D deficiency should be screened in anyone with PCOS. Have you been tested?
This post is for educational purposes only.
PMID 24078159
PMID 30096464
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PMID 28127831

PCOS Awareness Month - all September long!

Diagnosis of PCOS requires at least 2 out of 3 of the Rotterdam criteria:
- Irregular or absent periods
- Hyperandrogenism (clinical or biochemical signs)
- Polycystic ovaries on ultrasound

What about treatment? Here’s the low-down:
Nutrition is important
Exercise is important.
Stress is important.
Sleep is important.

And yes, medications and supplements can help.

PCOS has a strong metabolic component, and this means that lifestyle plays a big role in its treatment. I believe this can feel both empowering and intimidating. You have the ability to change the course of this syndrome - but it’s going to take change and effort. Building small, sustainable goals is my approach. Want to read more? Head to the linked article 👊

https://www.drcourtenayboer.com/post/pcos-part-2-nutritional-and-lifestyle-approaches

Polycystic O***y Syndrome (PCOS) Part 2: Nutritional and Lifestyle Approaches A naturopath's guide to nutritional and lifestyle approaches to PCOS. For menstrual regularity and fertility.

Komorebi (木漏れ日) has no direct translation, although its meaning is understood as “sunlight filtering through the trees”

This is one of my absolute favourite things and always makes me stop in admiration😍

Happy weekend! What are you doing to fill your cup and get inspired?

Polycystic O***y Syndrome (PCOS) is one of THE most common endocrinological disorders among women of reproductive age. It’s also incredibly complex and can be difficult to navigate. There’s a lot of variability in how it manifests and what the underlying causes are. We are continuing to learn more about it as new research emerges every year.

Click the link below to read an article I wrote about the underlying causes and mechanisms involved in PCOS, and why it is important to treat at any age!

https://www.drcourtenayboer.com/post/polycystic-ovarian-syndrome-pcos-part-1-what-causes-it

Did you know that I offer environmental allergy testing at Juniper Family Health?

In B.C., tree 🌳 and grass 🌾 pollens are the main causes for seasonal allergies, which show up in early spring (February) and later spring (April) respectively, and can last into the end of summer. I test for these, along with dust, dust mites, mold, weeds, ragweed, dogs and cats.

Allergy symptoms can include itching, sneezing, runny eyes and nose, and post-nasal drip. Allergy Skin Prick testing is a simple way to test for some of the most common environmental allergens. I recommend testing at least 4 months prior to allergy season, as some allergy treatments are best started early⏱

If you think you may be suffering from allergies, but have not identified the cause, consider Allergy Skin Prick testing! Curious to know more? Send me a DM!📩

NOTE: Allergy Skin Prick testing is not for everyone. Please consult a healthcare practitioner to see if this option is right for you. @ Juniper Family Health

RESEARCH REVIEW // September is PCOS Awareness Month! If you’ve been following along here, you’ll know that I love sharing research relating to polycystic ovarian syndrome (PCOS). This became a clinical passion of mine after a close friend undergoing fertility struggles learned she had PCOS. At the time, I knew very little about this syndrome, but soon learned just how common it is (affecting 1 in 10 women of childbearing age) and how treatable it is, especially through nutrition and lifestyle.

Today I want to share research around one of my favourite adjunct treatments for PCOS: myo-inositol (MI). MI is a stereoisomer of inositol, a sugar alcohol. It acts as a messenger in the regulation of several hormones, including follicle-stimulating hormone (FSH) and insulin. In women with PCOS, a recent meta-analysis found MI to improve fasting insulin levels, HOMA-IR (a measure of insulin resistance that compares fasting glucose with fasting insulin), and SHBG (sex-hormone binding globulin) levels, which can in turn improve androgen features. Another study showed inositol regulated menstrual cycles and improved ovulation in women with PCOS. It is also well-tolerated and shown to be safe to use within recommended dosing strategies. In a 2019 head-to-head trial with Metformin, researchers found MI to perform just as well and recommended it above Metformin due to its better tolerability. That’s pretty awesome!

Click the link below to access to the articles mentioned above and further research into myo-inositol ✨

https://www.drcourtenayboer.com/research-review

❗️Victoria friends and patients❗️
I am so excited to be hosting a talk this Thursday at Juniper Family Health! I’ll be covering all things menopause 🙌 Come and learn about the roles of hormones, signs and symptoms of imbalance, hormone testing options, nutritional recommendations, supplementation, and the pros and cons of bio identical hormone replacement therapy.

Have questions? Send me a DM! I hope to see you there ✨

Yesterday had me feeling on top of the world!

I hope your weekend has you feeling recharged for Monday and ready to take on the week💪

RESEARCH REVIEW // Let’s talk endocrine-disrupting chemicals (EDCs): bisphenols and phthalates. In a recent study, BPA and a phthalate known as MCOP were associated with shorter luteal phases in women (the luteal phase is the second half of the cycle, when progesterone is made - and it’s essential for female health and fertility!). Of course, association is not causation, but the body of research surrounding EDCs is pretty damning: they are affecting our health and reproductive abilities 🤯

Keep in mind that research compares highest to lowest concentrations - the goal is to reduce your exposure. Although toxin exposure can feel overwhelming, my goal is to encourage you to make small changes, which have profound impacts for your health💪

Bisphenols are frequently found in plastics (bottles, food and take-out containers, baby bottles), linings of canned foods, and thermal papers (receipts). Phthalates are found in cosmetics, as well as perfumes, soaps, and shampoos (disguised under the name ‘Fragrance’).

Here are some practical tips to reducing your BPA and phthatale exposure:
>> Switch out plastic food containers for glass or metal (at very least, do not heat food in plastic containers)
>> Choose a glass or stainless steel water bottle over plastic water bottles
>> Leave the receipt at the counter - choose an e-receipt rather than handling paper receipts
>> Check the labels of canned foods and choose BPA-free cans
>> Check your cosmetics labels and look for fragrance-free products

Click the link in my bio to access the article and read more!