Throughout Korean history, public bathing has evolved. In the 10th century, Koreans bathed together in rivers and hot springs. Centuries later, when Koreans adopted tubs, a hot bath was seen as an exclusive luxury for royalty.
When the cholera epidemic in the early 1800s spurred policymakers to consider average citizens with no access to indoor plumbing at home, they created public bathhouses, and the modern Korean bath culture was born.
Karen Kim grew up in Toronto, half a world away from the Korean peninsula, and launched a fashion career that took her to Vancouver and New York. In 2015, Kim came home to Canada and founded Binu Binu Soap House, a line of bath items featuring simple, elegant soaps rooted in Korean culture.
Her Boricha soap is named for barley tea, a staple in Korean households. There is the super-mild Ae Gi, the Korean word for baby, and two soaps named for traditional women’s work: Shaman, a charcoal soap, and Haenyo Sea Woman, made with sea tangle kelp and salt and named for coastal women who free dive in the ocean, foraging for abalone, octopus or sea cucumbers to sell and to feed their families.
View this post on Instagram
In her first year of business making soaps, Kim was featured in Vogue. The press hasn’t let up since: Vanity Fair, The New York Times, Architectural Digest—Kim’s fashion-forward evolution of an ancient practice seems to have struck a chord.
Kim first experienced Korean bath culture during a trip to Korea in her late 20s. There, her mother and four aunts took her to a bathhouse spa, or jjimjilbang, every single day. The bathing areas, with their showers and baths, are divided by gender.
“It wasn’t what you would think of as a spa in North America. It was just a modest building,” Kim explains. “You go in, there’s a shower area and you strip completely naked. I was like, What? I remember saying, ‘Okay, Mom, by the way… I have a tattoo.’ I gave her a two-second warning,” Kim laughs.
“You do a pre-shower. There’s bar soap there. It’s very no frills. Once you take off your clothes, you get over yourself really quickly. No one’s even looking at you. There is such a sense of relaxation that that brings about, you know? You’re like, I’m okay. You’re okay. We’re just people.”
That deep sense of relaxation, for Kim, comes from being in community. “North American spas are about pampering and luxury and ‘me time.’ To me, the bathhouse wasn’t me time but ‘us time,’ which is, of course, a form of self-care too, but it’s community care. I love that.”
Kim says her work is a way for her to connect the present with the past. “It’s a familiar story for children of immigrants. You grow up, you reject being Korean or ‘other,’ and you try to get as far away from that as possible. And now, I’m desperate to just explore that and speak about it. What guides me today is thinking about other people like me, connecting and just being like, ‘Hey, I’m here and thinking about these things, too.’”
This story is part of Best Health’s Preservation series, which spotlights wellness businesses and practices rooted in culture, community and history. Read more from this series here:
This Soap Brand Is Sharing the Healing Power of Inuit Tradition
Sharing Chinese Herbal Soups and Teas, Steeped in Tradition
Meet Sisters Sage, an Indigenous Wellness Brand Reclaiming Smudging
Get more great stories delivered straight to your inbox by signing up for the Best Health Must-Reads newsletter. Subscribe here.
Warning: This story contains mentions of domestic violence.
Anna Maria Tremonti’s voice is immediately recognizable. As a veteran CBC journalist and 17-year host of CBC Radio One’s The Current, Tremonti brought Canadians crucial stories from across the country as well as from international conflict zones with her signature mix of hard-hitting questions and empathy. She built her award-winning journalism career by sharing the stories of others, particularly the victims of gender-based violence. Now, for the first time, Tremonti is sharing her own story, and an experience she kept quiet for 40 years.
“When I’m in broadcast mode, this voice of mine has hidden my greatest secret,” Tremonti says in the first episode of her new CBC podcast Welcome to Paradise. The six-part series, available on CBC Listen and all other podcast platforms, details Tremonti’s experience with intimate partner violence—an issue that affects more than 107,000 Canadians every year.
“Welcome to Paradise looks at the long tail of intimate partner violence through the prism of my own experience, in a marriage that I managed to get out of 40 years ago. So, I’m not only telling my story of what happened to me, I’m looking at how things have followed me over time,” says Tremonti. What followed her, she explains, includes “the shame, the self-blame, the physical reactions to things,” like her persistent impulse to hide bruises.
During the pandemic, the World Health Organization dubbed violence against women a “shadow pandemic” with rates of domestic violence in Canada rising dramatically. Support for victims of domestic abuse have never been more needed. With these statistics in mind, we spoke with Tremonti about her personal experience with intimate partner violence, and her message for victims and their loved ones.
Note: If you are reading this and need support, don’t wait. Please visit Ending Violence Association of Canada to find support services and resources available across Canada.
How are you doing today?
I’m fine. To get to this point to release a podcast, I had a lot of angst and second guessing before in the writing of this thing. I have dealt with all of that. So, I’m fine. I’m glad that it’s getting out.
Tell me a bit about that angst, where does that come from? What were you afraid of?
I think that comes from the shame that I’ve carried. What I’ve now been able to really identify is the deep-seated shame. I knew that intellectually, it was there, but I do think that was part of it, that fear of being judged. Fear of going public with something that I have not been public about, and just letting anybody weigh in. I’m not so afraid of that anymore—but that’s been a process.
I find that when I write about my own experiences, I learn about myself through how the story comes together. What did you learn about yourself in telling this story?
The main thing was the effect of the therapy. I originally wanted to work with [psychotherapist] Farzana Doctor so that she could be a touchstone for me as I told this story, just to keep me feeling emotionally stable through what I knew I would have to talk about. I thought she might be a little part of this podcast, but she ended up becoming a real thread. And through working with her, I ended up identifying the shame.
I’ve done other therapy, and it has helped, but I’ve never identified the shame, to the degree and the depth that I did in my sessions with her. By the time I got to writing the final part of the podcast, I realized that that shame had fallen away. I wasn’t expecting to rid myself of that because I had not quite registered how embedded it was.
That’s the main thing. The other thing was that my family and friends knew that I was in an abusive marriage. And after I got out, I told them. But I never got into the real detail of individual incidents of assault. I did for the sake of this podcast and there is one particular assault that I remember really well, but there was one aspect of it that I did not. It was the last time he beat me up, days before my first job interview with the CBC in Fredericton. And I remember having to figure out if the blouse I was wearing would cover the bruises around my neck. I went to the interview and managed to get the job. But I couldn’t remember how I got those bruises. And I realized going over it and writing about it that I must have blacked out. I had never thought about that before.
That must be such a scary realization, finding pieces of your story you didn’t know you were missing.
It’s funny, intellectually, I understood that I wanted to write about this. Viscerally, I had a real hard time writing that scene. But you know, in the case of my experience with intimate partner violence, there has always been that emotional and visceral disconnect. I know I was not to blame. I know I shouldn’t carry the shame. And yet I did. I knew at the time that what was happening to me was wrong. But I absorbed what he would say to me, that I drove him to it. So even though it didn’t make any sense—especially as a 23-year-old, who was confused and emotionally distraught about what was happening to me—I accepted those things and carried them with me.
Looking back, do you have a better understanding of why you accepted those things at the time?
I do because I have read about this stuff. Jane Monckton Smith’s book “In Control” lays out the eight steps of coercive control, which if not intervened with, can end up in homicide. And when I read it, I thought, Oh my God, I’m textbook. Farzana reminded me that everyone is, which is why they write these things.
Coercive control is akin to a hostage taking—this is how experts who work in the field describe it. So it often starts with a whirlwind and by the time that control kicks in, you have a victim who will sometimes willingly change their behavior because if they don’t, they know what’s coming. In her book, [Monckton Smith] writes at the end, that her own daughter ends up in a case of coercive control and you can’t just barge in and change it because the victim has to buy into the idea that they are being coercively controlled.
(Related: What Is Gaslighting—and How to Tell if You’re Experiencing It)
I imagine when people hear the first few episodes, their response is: Why didn’t you leave? But as you say, it is much more complicated than that.
Yes, it is. People also ask: Did you see red flags? I don’t think red flags exist. They exist for people observing from the outside who can see it maybe a little more dispassionately.
I really relate to the urge to barge in when you see a loved one in danger. But when you were going through it, was there anything anyone could have said to break that cycle?
Not when I was in the thick of it, no. When it comes to someone who’s a victim of [domestic violence], the level of shame and unworthiness is already there, right? So, the idea that you are worthy of having a different kind of life is really a hard one. I have not tried to get someone else out of a situation like that and I think it would be very hard. We have real professionals who work with that. They’re very careful to help people see that there are options they don’t realize they have.
You mentioned how working Farzana Doctor really helped you. Do you have any advice for finding professionals to help in these situations?
We have a really sophisticated system for trying to help people now, which didn’t exist in the early 80s. So, we have resources out there where people can ask professionals how to move forward. I will also say, look for somebody who does talk therapy. In my job, I’ve always been a big believer in the power of conversation and the therapy that I was doing is about a conversation. It’s not solely about finding the right person—and I do accept that it’s hard—but it’s also about being at a point where you’re willing to open up.
(Related: 3 Survivors Share Their Stories of Escaping and Healing From Domestic Violence)
Now that you’re sharing this story, I imagine you’re getting a ton of responses. Have any been particularly meaningful for you?
I have been contacted by people I do not know, people I know pretty well and people I know in passing who have confided in me since realizing that I was going public with this. I was really taken by how many people mentioned their shame. It’s something that we carry, and it’s something that we shouldn’t be carrying. It would be such a wonderful thing for anyone to be able to release themselves from shame that was never theirs to have.
Do you have a message for people who are watching a loved one go through this right now and feel unsure of what to do?
I don’t think you can demand that they get out. You have to be there to help them when they feel it is safe for them to get out. Be available to listen without judgment. And then maybe go through resources and find out from people who work in this field what else you can do to be ready to help. It seems so simple, but listening is hard. And the more you listen, the more people will tell you and the more they will tell you about their fears and what they hope for themselves.
What do you hope listeners take away from Welcome to Paradise?
I really do want people to understand that they are worthy, because that’s the hardest thing, you know? That somehow you think you deserve that kind of treatment. And you don’t.
This interview has been edited and condensed for clarity.
Next: 12 Things Most People Don’t Realize About Domestic Violence
Stop in at a juicery, walk through Whole Foods or even just scroll through Instagram, and you’ll probably find a product claiming to support gut health.
There are five-day cleanses that “flush toxins” out of the body to help you “get regular” and “shed pounds.” There are drink mixes with impressive names like “superpowders” that are said to reduce bloating and promote healthy bowel function. And then there are colonics—a treatment in which water is shot up the derrière—that “promise” to remove harmful bacteria to “enable essential nutrients to be absorbed more effortlessly.”
Do these products and treatments actually work, or are they just another wellness-washing marketing ploy? Four experts weigh in on the buzziest gut health trends right now.
Cleanse Kits
“Most box-prepared cleanses contain mostly laxatives and diuretics,” says Dr. Courtney Holmberg, a naturopathic doctor in Toronto. They can give a false sense of improvement by forcing the bowel to empty and reducing water retention, she says, but they show no long-term benefits.
The Keto Diet
A 2016 study suggested the ketogenic diet (which is high in fat and protein) can help improve an imbalanced gut. But that diet won’t do you any good unless you’re eating a lot of vegetables, says Holmberg. “A diet high in vegetables, balanced fibre and lean fats shows to have the best long-term benefit [on the gut].”
An example of a gut-friendly diet is the Mediterranean diet—it’s high in fibre and rich in polyphenols, which can stimulate good gut microbes, says Dr. Jessica ter Haar, a microbiology expert and probiotic educator in Toronto.
Colonics
“People have been doing colonics for a long time, but what’s the evidence for their efficacy?” asks Dr. Leah Gramlich, a gastroenterologist and physician nutrition specialist at the Royal Alexandra Hospital in Edmonton. Their purported health benefits (Weight loss! Toxin removal! Mood-boost!) are not proven, and there are severe risks involved—colon cleanses can lead to dehydration, infection and rectum tears.
A better alternative? Concentrate on eating gut-supporting foods, says Gramlich. “[The goal is] a well-rounded diet that contributes to gut health, as manifested by regular bowel movements.”
Trendy drinks and supplements
Those digestion-supporting teas and anti-bloating supplements sure have pretty packaging—but that might be all they offer. “These kinds of supplements often contain foods we don’t need or that we already get in our healthy diet,” says Dr. Abby Langer, a registered dietician in Toronto. “And sometimes, they just don’t contain enough active ingredients.”
At-home gut tests
Gut health test kits claim to be able to detect thousands of microbes in your gut so you can select the best food and supplements for you, but the tests aren’t actually all that useful. “There’s no evidence behind making dietary predictions or recommendations based on somebody’s microbiome,” says Langer, “because we have no idea what a healthy microbiome looks like for each individual person.”
Instead of spending $150 to $400 on a kit, Langer suggests listening to your body’s response to certain foods to learn what works and doesn’t for you and finding the right probiotic by talking to your doctor or using the Canadian app Probiotic Guide.
Pickles and kombucha
The supposedly fermented foods you eat to boost your gut health may not actually be fermented. In North America, many pickled foods, like cucumbers, are made with vinegar to provide that fermented tang and pasteurized to increase their shelf life so they can be kept at room temperature. “But that’s not really fermentation,” says ter Haar. Real fermented foods have been microbially fermented, and that’s evident in the liquid they’re in—it should be carbonated.
The same goes for Kombucha. It shouldn’t be pasteurized, says ter Haar. If the one you’re shopping for isn’t stored in a fridge, skip it.
Next: Digestive Disorders Affect More Women Than Men. So Why Is It So Hard To Get a Diagnosis?
Canadians use their smartphones for just about everything, from online shopping to working to staying connected. According to a report by analytics company App Annie, Canadians spent an average of 4.4 hours a day on mobile apps in 2021—up from 3.9 hours a day the previous year. A 2020 StatsCan survey further noted that 84 percent of Canadians rely on a smartphone for communication, research and entertainment. It’s a device that, for many of us, is always within reach if not in use.
While it’s clear that smartphones are an integral part of daily life, reliance on our mobile devices might also be leading to hand, wrist and arm pain. A 2015 study published in the Journal of Physical Therapy Science found there is a clear link between smartphone use and general musculoskeletal pain and injuries, with about 27 percent of those studied feeling pain in their wrists, 19 percent feeling pain in their arms and nearly 20 percent experiencing finger pain.
Jennifer Howey, the owner of Inside Out Physiotherapy in Toronto and a clinical lecturer at the University of Toronto, notes that many of her patients are coming in with repetitive strain injuries that are a result of being glued to their phones. “These are conditions we used to see in someone who is working their hands all day long, like a jeweler,” says Howey. “These aren’t conditions that used to be associated with the general population, but now they increasingly are.”
Here’s what experts want you need to know about common smartphone-related injuries, including how you can avoid the pain and when to see a professional.
What are repetitive strain injuries?
According to Howey, repetitive strain injuries occur when you continually repeat a motion with little to no break, so the muscles and tendons in use don’t get to rest. Before smartphones, she says, these are the type of injuries that factory workers experienced often—they had one task that they repeated all day long.
Smartphone-related repetitive strain injuries are caused by the constant pressure being put on the thumb and index finger when we’re texting, swiping and scrolling. “The tendons can get inflamed,” says Howey. “When the inflammation starts to accumulate, the tendons get stuck—and tendons are meant to glide amongst each other.”
Repetitive strain injuries are common, according to Howey. Gautam Sadarangani, the co-founder and COO of Tenzr Health, a company that provides clinicians with personalized physical therapy technology, notes that more than 70 percent of patients using Tenzr have a repetitive strain-related diagnosis. The most common smartphone-related repetitive strain injury is called texting thumb.
What is texting thumb?
Texting thumb, a.k.a. smartphone thumb or trigger finger, occurs when there’s inflammation in the tendons in the fingers, says Howey. This condition is most common in the pointer finger and the thumb and is characterized by your finger being stuck in a curved position, like you’re about to pull a trigger.
Untreated, smartphone-related injuries like texting thumb can lead to weak hands and wrists and pain.
What can you to do to prevent texting thumb?
“It’s in the name—repetitive stress. So, reducing the total amount of use throughout the day is important,” says Sadarangani. Take time away from your phone, or rest it against something like a stand or even a pillow to reduce the time you’re gripping it.
If you need to type something long, switch to your computer. “On a keyboard, your hands are free to move around more,” says Howey. “On a phone, they’re working in a really confined space.” Or, instead of texting your friend the latest drama in your life, try sending a voice memo or hopping on a call to cut your fingers some slack.
Howey also suggests getting a stress ball and rolling your hands out with it to stretch out the tendons. Plus, you can squeeze it gently to promote blood circulation. Another great way to get those muscles worked through? Go for a manicure. “Get someone else to massage that arm,” says Howey, and opt for the warm wax treatment—warmth helps increase blood flow, relax muscles and decrease joint stiffness.
Finally, loosen your grip. “You don’t need to grip your phone as hard as you think you do,” says Howey. “We grip sometimes up to 30 percent more than we need to.” Add-ons like popsockets can also help your hand into a more relaxed position while holding the phone.
What if my hand hurts, but it’s not a repetitive strain injury?
The way we hold our phones—with most of our fingers supporting the back and our thumb on the touchscreen—puts stress on the ulnar nerve (which runs from the neck all the way down to the hand) and the median nerve (which runs from the armpit area through the forearm to the fingers). “A nerve is like an elastic band, and it doesn’t like to be held in one position,” says Howey. If you’ve strained those nerves, you’ll feel a tingle or pain when you release your hand or extend your arm, according to Howey.
Many of solutions for texting thumb will also work for nerve-related pain: stretch out your fingers with a ball, switch to a computer or keyboard and indulge in some heat therapy like an Epsom salt bath.
When should I see a professional?
As soon as possible, say both Howey and Sadarangani. “If the pain isn’t going away, if it’s starting to wake you up at night, if you’re having difficulty with other tasks, you want to get right in [to see a professional],” Howey says. “We can catch things early and teach preventative techniques and work with you to try to make it feel better.”
Next: WTF Is WFH Doing to My Back?
Purple Reign
1. This groovy purple foam roller isn’t just prettier than your standard option, it has added benefits, too. The ridges help release tension in your back, legs and other body parts, making it essential for taming aches.
Lululemon Double Roller, $58, lululemon.com
2. Soothe cold-irritated skin, diminish puffiness and relieve facial tension by gliding this ice-cold glass globe across your face. Cyro-Facial Cooling Globe, $10, Marshalls
3. Sip a cup of this lavender-chamomile tea and settle your racing mind—each bag is infused with 10 mg of CBD and a small amount of THC.
Everie CBD Lavender Chamomile Tea, $19, fikasupply.com
(Related: Why Cryotherapy-Based Skin Care Products Are Currently Trending)
Cozy Corner
4. Slip into a pair of wool-topped, rubber-soled breathable shoes that’ll keep your feet warm while you putter around the house. Allbirds Wool Loungers, $135, allbirds.ca
5. The sculptural design and cheery hue of this handmade soap dish will bring a little flair to your washroom.
Recreation Center Soap Dish, $38, nordstrom.ca
6. This bubbly cube candle adds a soft glow to any reading nook or workspace.
BrighterSkyBoutique Bubble Candle, $16, etsy.com
7. This lavender-infused body lotion helps speed you off to sleep.
Body Lotion Sleepy, $13, lush.ca
8. Whether you’re working at your desk or surfing through Netflix on your couch, this pillow helps support your head and prevent shoulder tension.
Wellness Weighted Grey Neck Pillow, $50, chapters.indigo.ca
9. This handmade purple scalloped mug makes a nice addition to your afternoon coffee routine.
Recreation Center Mug, $58, nordstrom.ca
10. Your standard-issue weighted blanket gets a makeover with this chunky cotton jersey knit that’s soft, breathable and sunshiney bright—and still delivers comfort and warmth.
Knit Weighted Throw Blanket, $279, chapters.indigo.ca
11. Going anywhere this weekend? Us neither! How about tackling this adorable 1000-piece puzzle?
Whiled Ladies Who Lounge 1000-Piece Puzzle, $45, nordstrom.ca
12. You know practicing gratitude is good for you, but sometimes it’s hard to get started. This book will help you recognize the good things in your life.
The Five Minute Journal, $32, nordstrom.ca
13. This illustrated book offers tips for managing anxiety and shares tools for practicing self-compassion and staying focused.
The Illustrated Self-Care Bible, $13, Homesense
(Related: How Journal Writing Can Make You Healthier)
Float on
14. Drop this lavender-scented bath bomb into your tub and it’ll release stars as it fizzes from pink to purple to indigo.
Bath Bomb Twilight, $8, lush.ca
15. Inspired by #cottagecore, this shades-of-green bath bomb delivers notes of apricot and amber that’ll leave you feeling warm and fuzzy.
Bath Bomb Lakes, $8, lush.ca
16. Patchouli, lemongrass, orange and pine come together to create a soft and soothing bar of soap.
Soap Karma, $9, lush.ca
17. The magnesium chloride in these bath salts helps relieve muscle tension and soreness. Papaya enzyme, passionflower augments and French green clay work together to calm you down before bed.
Fortifying Magnesium Soak by Nature of Things, USD$36, goodeeworld.com
(Related: 6 Bath Products That’ll Help You Escape Reality and Relax)
Peace offerings
18. Chill out with these CBD-infused passionfruit and mango gummies.
Ace Valley Passionfruit Mango CBD, $35, toykosmoke.com
19. Need help finding your happy place? Try this grapefruit-flavoured sparkling water, which contains THC.
Houseplant Grapefruit Sparkling Water, $5, fikasupply.com
20. Slow down with this cucumber- and mint-flavoured sparkling water that’s spiked with a little CBD.
Quatreau Cucumber and Mint Sparkling Water, $5, tokyosmoke.com
21. These cannabis gummies taste like summer and contain 10 mg of THC to help you feel at ease.
Ace Valley CBN Blackberry Lemon Dream Soft Chews, $10, tokyosmoke.com
(Related: Our Favourite CBD Edibles, Available in Canada)
A new leaf
22. This classic organic black tea delivers the caffeine (and antioxidant) boost you need.
The Champion, USD$20, firebellytea.com
23. Satisfy your sweet tooth with a fruity tea like this hibiscus-raspberry blend. A portion of Cup of Te’s proceeds are donated to causes that support mental health awareness.
Noms Berry Delight, $15, cupofte.ca
24. On dark winter days, reach for this Japanese Gyokuro green tea with hints of cherry—it tastes like spring sunshine.
Blossom, USD$30, firebellytea.com
25. Sip peppermint tea to freshen your breath, boost digestion and calm your stomach.
Peppermint Devotion, $15, cupofte.ca
26. This flower-infused jasmine green tea is a brilliant mood-lifter.
Flower Power, USD$19, firebellytea.com
27. Calming chamomile, lavender and lemon tea can help you catch some much-needed Zzzs.
Paradise, USD$15, firebellytea.com
28. Make time for a cup of this spicy-floral chamomile rosehip tea before bed—it’s the perfect antidote to a frenzied day.
Sip & Chill, $15, cupofte.ca
(Related: Sharing Chinese Herbal Soups and Teas, Steeped in Tradition)
29. We love this white glossy-topped teapot for its sturdy handle, stainless steel filter, non-drip spout and striking silhouette.
Firebelly Tea pot, USD$100, firebellytea.ca
30. Anyone can get a handle on this pert little teacup.
Firebelly Teacup, USD$23, firebellytea.ca
(Related: Spearmint Tea May Be Able to Help Your PCOS Symptoms)
On the scent
31. Boost your mind, spirit and living space with a refreshing, relaxing aroma. This best-selling diffuser mists for up to 22 hours and features a timer and automatic shut-off for fuss-free use.
Aroma Om Deluxe Diffuser, $138, saje.com
32. This budget-friendly diffuser provides the health-supporting benefits of aromatherapy and comes in a slender shape.
White Stone Diffuser, $30, Winners
33. Create a calming atmosphere with this eco-friendly soy wax candle that delivers notes of flowers, leather and smoke. Haeckels Dreamland GPS 23’ 5”N Candle, $68, goodeeworld.com
34. Soak up the decadent notes of flowers, suede and amber with this perfect-for-all-seasons candle.
Boy Smells Kush Candle, $44, fikasupply.com
35. Transform any room into a tranquil escape with these spicy-floral scented incense sticks.
Aphrodisia Incense by Supersense Studios, $24, nordstrom.ca
Next: 9 New Books to Read to Ease Stress and Reset Your Mind
Months after contracting COVID-19, many Canadians are still battling lingering symptoms ranging from shortness of breath and fatigue to a loss of taste and smell.
“The official name is post-COVID condition, which occurs in individuals with a history of probable or confirmed SARS COV-2 infection, usually three months from the onset of COVID-19 with symptoms that can last for at least two months, and it cannot be explained by an alternative diagnosis,” says Dr. Angela Cheung, a senior physician and scientist at the University Health Network in Toronto. Cheung is leading multiple studies to learn more about the disease and create treatment plans for Canadians. Her description of long COVID is based on the definition from the World Health Organization (WHO), and Cheung says that based on current research, 10 to 50 percent of COVID patients will develop long COVID.
We spoke to Cheung about long COVID’s effects, potential treatments and how the disease might impact Canada’s health care systems in the future.
What are some of the most common long COVID symptoms?
Fatigue, shortness of breath, cognitive impairment or dysfunction, sleep issues, and tachycardia or heart palpitations. Those are some of the common symptoms, but there are as many as 200 symptoms.
What are some of the less common symptoms?
Change in smell and taste. Muscle aches and pains, joint pains as well are other issues. But I think the most concerning thing is that a number of these patients can’t go back to their usual activities. Some studies are saying that around 10 percent of people experiencing long COVID have symptoms that are severe enough they can’t go back to their usual activities.
And what might that mean for someone’s quality of life and livelihood?
There’s a wide range of severity [of symptoms]. For some people, it’s more of a nuisance and they continue to do their daily activities. Other people can’t work, they can’t look after their families, they are debilitated and spend the day in bed.
Aside from the physical symptoms of long COVID, how is this condition impacting mental health?
As you can imagine, it can be quite scary. We have some highly physically active people, like people who’ve been running marathons, who now have trouble walking a block … that can be very scary and can cause anxiety and depression. Plus, there’s the unknown of not knowing if this will be for their whole life. For some patients, they’ve lost their whole family and they have post-traumatic stress disorder (PTSD). And the sicker you were, the higher the likelihood of having anxiety, depression and PTSD. When someone is confronted with an unknown and unexpected disease, like cancer for example, people have similar [mental health] symptoms.
(Related: How to Embrace Your Sexuality After a Cancer Diagnosis)
There’s been a lot of discussion around the burden that the pandemic has put on women, particularly mothers. What might long COVID mean for women’s recovery after the pandemic?
It’s definitely harder for women because women often have multiple roles that affect both the workplace and the home front. When a patient tells me they don’t see improvement in their symptoms, I ask them what they’re doing at home. Because if they’re not working outside [because of their symptoms], what they may be doing is looking after kids more and doing more housework and looking after their parents and not resting.
We are still understanding the scope of this problem, but what could long COVID mean for Canada’s health care systems down the line?
So, we know how many people have had COVID in Canada, it’s estimated that that’s more than 3.1 million people across Canada. If we take the low end of the 10 percent estimate [of long COVID occurrences] that’s more than 300,000 people with long COVID. But we think it’s more than that.
It’s going to increase health care utilization. People will want to see specialists and there will certainly be many issues. Not only in terms of accessing health care, but the loss of productivity and loss of salary and livelihoods.
Can you tell me about some of the research you and your colleagues are working on right now?
There are multiple studies we’re working on. One is called CanCov—it’s a study that’s been going on now for over a year. We’ve recruited more than 2,000 participants across five provinces and 18 centres across a severity of illness and we’re following them. What we have learned is that one, our first COVID patient in Canada was diagnosed on January 25, 2020. But through antibody testing, we found a COVID-19 case on December 25, 2019. The second thing that we learned is that those who have more severe diseases, like those who have survived the ICU, have the highest antibody levels compared to those who were not hospitalized.
We also have a randomized adaptive platform trial called RECLAIM (Recovering from COVID-19 Lingering Symptoms Adaptive Integrative Medicine), and we are testing various therapies for long COVID.
From what we’ve learned, we have developed some treatments and have been using them in rehab across the country and testing out if there are better ways than what we’re currently doing to treat COVID patients so they can recover faster.
What can you tell us about these long COVID treatment programs?
For COVID-19, we want them to move, but we don’t want to push them too much because they can relapse or have flare-ups. We have adopted some pathways for rehabilitation, depending on how much a person can do and where their threshold is as well, in terms of trying to do things under that threshold. In general, people do improve over time if they do it right though there can be bumps on the way if people exert too much and relapse.
There are self-management programs. Because there’s so many people, you can’t really get them all into rehab, so we focus on education. So, for example, we teach patients that they have a pot of energy and physical, mental and emotional exertion takes energy from this pot. Then, if they relapse, they have to look back and see what they did the last few days. Some patients have said, “watching a sad movie makes me totally exhausted” because it taps into the emotional piece.
Are there any in-patient treatments being done right now?
Yes, there are in-patient treatments that work with physiotherapists and occupational therapists. The principles are quite similar. [Professionals] have to gauge what [patients] can do, and then try to progress them but keep under that [energy] threshold. Usually, we try to do the activities of daily living first. That means if someone takes a shower and they feel exhausted and have a flare-up after, then we try to teach them what to do so that they’re not exerting themselves to take that shower.
The treatments we’ve been talking about so far are mostly targeting energy and fatigue. Are there treatments to help with other symptoms?
For sure. So, for example, with shortness of breath, we teach people to take deep breaths in slowly and expand their lungs. At the maximum end of an inhalation, you take a little bit more in. And then slowly let it out, and at the end of the exhalation, try to squeeze the last piece of air out. And you want to do that cycle for six to 10 seconds. It gives you a sense of slow breathing and strengthens the breathing muscles—you have muscles in between your ribs and muscles in your diaphragm that help move your lungs. For most people [the shortness of breath is] a muscle issue, not a lung issue—unless they have prior lung disease. The additional advantage of the breathing exercises is that it modulates your autonomic system.
We’ve been talking through the pandemic about how our health care system isn’t built this level of demand. What will it take to accommodate all this future need?
We need to advocate for more long COVID clinics that can look after patients. We need family physicians to be on board and to know how to treat long COVID patients. We need to open rehab facilities.
Our health care system on a good day prior to the pandemic was a bit stretched. I’m a general internist and I work in an acute care hospital, so every year, especially in the winter when there’s flu and we are very stretched, we have patients in the hallway. The problem is most rehab is not funded by the government in most provinces, so are these [costs] going to come out of pocket for the patient? How are people going to access care? There are many, many questions.
This interview has been edited for length and clarity.
Next, here’s what you need to know about whether you’ll need a fourth COVID vaccine dose.
There is no greater sexual partner than one who is willing to explore with you, as I’ve recently learned. My current friend-with-benefits and I swap sex fantasies, share theories about the best ways to boost intimacy and have a rather filthy checklist of all the things we’d like to do with each other’s body.
Our relationship is the most open sexual environment I’ve ever experienced, which has given us both a greater sense of liberation. The key, for us, was learning about the five erotic blueprints. The concept—created by Jaiya (who goes by only her first name), a renowned somatic sexologist who looks at the mind-body sexual connection—helps people identify what they need in order to establish better sexual connections.
Last fall, Jaiya gained notoriety when she appeared on Gwyneth Paltrow’s Netflix series, Sex, Love & Goop, with the task of helping couples improve their sex lives. “Your erotic blueprint is a map to your own wiring and your own turn-ons,” she told the couples in one of the episodes. “People speak different erotic languages, and we can learn how to speak any of them.”
The blueprints are: energetic (someone who is turned on by anticipation, teasing and longing), sensual (turned on by senses, like taste and smell), sexual (turned on by the most traditional view of sex, like nudity or penetration), kinky (turned on by a taboo), and shape-shifter (turned on by any of the other blueprints, and can shape-shift to match their partner’s). Many of us have a primary one that activates our arousal in an especially intense way, which ideally leads to more powerful orgasms.
“It’s a person’s sexual template and is an extension of the popular five love languages, which can tell you how your partner prefers to communicate their love. In this case, it’s about sex,” says Vancouver-based sex therapist Soraya Mortimer. “That psychological aspect is the fun part of a sexual relationship. It’s what drives the excitement.”
My partner and I took Jaiya’s quiz, which can be found on her website, and I learned I have a sensual blueprint, while he’s a shape-shifter. We then decided to play with our senses more when we have sex by carefully considering the music we’d play and the material of the sheets under us. For him, we’d have nights dedicated to one blueprint or another to help him discover where his interest lies. It has created a greater intimacy between us and built a space where there is less fear of saying or doing the “wrong” thing. In other words, it made us better communicators, which added to the thrill.
“Understanding not only what turns you on but also what turns you off are key elements in creating an ideal sexual experience,” says Josyln Nerdahl, a clinical sexologist and intimacy coach based in Vancouver. “All too often in my coaching practice, I encounter partners who have a desire discrepancy, meaning they have a miscommunication around the different types of touch being offered or requested.”
(Related: 5 Sex Tips from Canadians Living with Disabilities)
Nerdahl gives an example of a man approaching his partner from behind, arms around their waist; she says each person may interpret this action in different ways. While one might see it as an affectionate gesture, the other might see it as an unwanted sexual touch. Situations like this can lead to resentment and arguments, says Nerdahl. Knowing your erotic blueprint makes it easier to minimize these stressful occurrences because each blueprint has its own “shadows,” which are the parts that might need healing. For instance, a sensual blueprint might often get stuck in their own head if everything in their physical space isn’t just right, while a person with an energetic blueprint might shut down if they’re too stimulated.
It’s all about communication—and it can lead to better sex. When a person is supported with the knowledge of their erotic blueprint and its shadows, they can come fully armed to ask for what they need and discuss their struggles. For us, it took the quiz and a lot of vulnerability to determine our blueprints. For others, it may take speaking with a sex therapist who can moderate that conversation for you.
“Talking about sex, fantasies or desires can be really intimidating for folks, especially if they haven’t had much practice with it,” says Nerdahl. “You have to receive the information without judgment. If you’re creating an honest, open dialogue that is about agreement, curiosity and tolerance, you’re setting yourself up for success.”
Don’t panic, though, if you discover that you and your partner have different blueprints. “A lot of people don’t go into relationships thinking about this, so it’s easy to end up with someone who doesn’t have a similar blueprint or has a very fixed blueprint,” says Mortimer. “Maybe they only connect with one type, or maybe you’re wanting more variety. When I was married for 15 years, we did the same thing over and over again and, for us, it was beautiful, because we learned how to build energy. Now, with my current partner, we’re into kink. So it’s possible to experience and find joy in different dynamics.”
In other words, you might not know until you try. And the discovery can be the best part because it encapsulates the entire body—the physical, the mental, the emotional. Your blueprint tells you what makes you respond to your partner, creating space for surprises, quirks, kinks and ultimately a deeper connection.
It’s worth keeping in mind that an orgasm is “a brain event,” according to sex educator and Come As You Are author Emily Nagoski. That means that sex is so much more than a physical act. “Bringing mental and emotional elements into our erotic understanding deepens our awareness of ourselves and also our partner,” says Nerdahl. “It creates the space for greater exploration and opens a doorway into heightened sexual experiences. And that is something that we can all benefit from.”
Next: Polyamory 101—Everything You Need to Know to Get Started
If you’re someone who relies on disposable menstrual products, like pads and tampons, you know exactly why period underwear is such a big deal. They’re made to look and feel like normal underwear, so you can say goodbye to the discomfort of pads and not worry about carrying around tampons. Plus, if you need to be extra cautious on heavier days, you can pair period undies with another product for extra leak-proofing (RIP white jeans, I should have known day 2 was too soon for you).
Aside from the comfort factor, switching to period undies is a great way to lower your period’s environmental impact. From tampon applicators, to pad wrappers, to pads themselves, standard menstrual products result in a lot of waste. According to UK-based organization Friends of the Earth, a person who menstruates is predicted to throw out about 400 pounds of waste from these products over their lifetime. And while tampon applicators are only used for a few seconds, plastic takes years to degrade (if ever).
(Related: Everything You Need to Know About the Arm Implant for Birth Control)
These are the reasons I was excited to try Canadian brand Knix’s Super Leakproof Period Underwear; I care deeply about the environment and plastic pollution, but I also want to be comfortable during what are usually the most uncomfortable 5-7 days of the month. Going on the birth control pill calmed my monster-periods and I barely bleed enough to justify a tampon. So, I’ve been stuck with pads and pantyliners, which, unlike underwear, you never forget you’re wearing.
Period underwear all work the same way: there’s an absorbent gusset (the part of your underwear that covers the genitals) that soaks everything up. Knix’s product claims to hold eight tampons worth of blood — their triple layer technology is designed to keep you “fresh, dry, and protected,” says Joanna Griffiths, CEO and founder of Knix. “The anti-odour top layer wicks away moisture from your skin using natural seaweed fibre that leaves you feeling dry; the middle-layer absorbs the liquid and locks it in; and the leak-resistant outer layer keeps any liquid from spotting your clothes.”
The underwear is designed for low maintenance and hygienic use. To wash your period underwear, “you can throw it directly into the washing machine, on cold water, with dark colours or you can rinse them beforehand,” says Griffiths. “Just make sure to lay them flat to dry.”
They’re also designed for more than just for periods, she adds. “Bladder leaks, sweat, you name it,” Griffiths says. “They can be worn to keep you dry and fresh during a workout and they can also help with incontinence.”
(Related: Everything You Need to Know About Taking Care of Your Pelvic Floor)
Those are some high expectations. But I found there was a lot to love about Knix’s Super Leakproof Period Underwear. First, it was a gamechanger to be able to exercise on my period without feeling that uncomfortable pad chafe. Next, I loved just how easy it all was. No more weird squat to insert a tampon. No more loud plastic crinkling as I unwrapped my pad (though, this hasn’t been a problem since transitioning to WFH life). Best of all, clean-up was so simple: I just needed to toss them in with the rest of my laundry (I did rinse them off first, just in case).
I started with the brand’s low to medium flow product, which did feel like wearing normal underwear. Though the gusset did a good job absorbing blood, I wished that it was a bit longer, as I did have a leak into the front of my pants. On my second day, traditionally my heaviest, I tried their Dream Shorts, which is a boy short-style underwear that’s designed for heavy flow or overnight wear. The gusset fit better, but the shorts rolled up my thighs and I could feel the edges bunching up under my pants.
Despite some of my problems with fit (though this might be temporary—Knix’s website says the fabric is designed to be snug at first but relax with wear and wash), I’m definitely going to continue wearing my leakproof underwear when I’m on my period. I’m glad to have a product that’s perfect for my low-flow life, and I’m more than happy to just toss them in the wash. Plus, and maybe most importantly, you can’t beat the positive impact it has on my environmental footprint.
Knix Super Leakproof Period Underwear, starting at $27, knix.ca.
Next: The Honest, Expert-Backed Truth About Having Sex While on Your Period
Several years ago, not long after we welcomed a puppy into the family, my shoulder became stiff and sore. It quickly morphed into “frozen shoulder,” a condition that commonly strikes women in their 40s and can be triggered by repetitive strain. I assumed it was from the dog constantly pulling on her leash like an out-of-control yo-yo.
My husband of nearly two decades was, of course, sympathetic about the searing pain that shot down my arm like a lightning bolt whenever I reached for something slightly out of range. But then, a few months later, a weird thing happened: Just as my shoulder was loosening up and the sharp pain was receding to a dull ache, my husband developed a frozen shoulder in his left arm, too. It wasn’t from the dog—I did most of the walking and by the time his pain appeared, the puppy was all trained up.
I would have chalked it up to coincidence, but when I started experiencing tendonitis in my right elbow last year—likely a result of too many hours spent clacking on my laptop—hubby began complaining about pain in his elbow at the same time, and he rarely sits at a desk all day long. What were the chances? And also, how annoying! Instead of being nursed through my ailment I was once again mustering sympathy for his copycat symptoms.
A quick Google search turned up a story about how long-term couples have a tendency to become in sync, health-wise, over time. “People have been aware of this phenomenon for the last half century—that we’re connected—but now we have the methodology to begin to model these dynamics in new ways,” says Shannon Mejia, an assistant professor in the department of kinesiology and community health at the University of Illinois Urbana-Champaign. “As we’re studying how people’s lives unfold, we recognize that they’re unfolding with others’.”
(Related: ‘It’s Just One Thing After Another’: Can Our Relationships Survive Covid-19?)
Mejia calls her area of research “lifespan psychology.” It looks at the way individuals shape their own development, and how shared environments, shared behaviors, shared beliefs about aging, and partner selection all intersect to influence health as couples age together.
Her research has shown that couples who share optimism about aging are healthier overall. They share fewer constraints on daily activities, such as climbing a flight of stairs or picking up a coin, as they get older. What’s more, partners who have weathered decades together have similar cholesterol levels, kidney function and grip strength, which is an important indicator of muscle endurance and overall health. Other studies have linked these shared health behaviours—termed “spousal concordance”—with diabetes, cardiovascular disease and depression, making a strong argument that long-term intimate relationships can influence physical and mental health trajectories over time.
To explain how my husband and I both became stricken with a frozen shoulder within months of each other, Mejia posits that shared behaviours over the years might have led to similarities in posture and vulnerability, which could have resulted in the same shoulder injury. Called “postural synchrony” in psychology circles, ours is a more extreme case of two people whose feet fall into step while walking or who lean into one another like mirror images to show interest on a date.
(Related: I Worry About Other People’s Problems Like They’re My Own. How Can I Set Healthy Boundaries?)
Playing into it, too, is the notion of “pain empathy”—the fact that seeing someone in pain creates, at the very least, psychological pain in the observer. Watching another person suffer, particularly a loved one, “evokes a strong psycho-social reaction,” says Kenneth Craig, director of the B.C. Pain Research Network and professor emeritus of psychology at the University of British Columbia. “There’s going to be some correlation between the reaction of the observer and the person who’s actually in pain.”
An instance of this phenomenon is a sympathetic pregnancy, where non-pregnant people find themselves experiencing much the same symptoms as their partners. “Extreme reactions can go beyond pain to include weight gain, fatigue, difficulty walking,” Craig says. But he points out that it can also include pain that mirrors their partner’s distress during contractions.
These examples all tie into the idea that shared experiences, beliefs, behaviours and environments lead to similarities in health, for better or worse, and that’s really the crux of Mejia’s research.
She’s found that up to 20 percent of the differences in health that married adults experience are due to the relationship rather than the individual. So why not harness the power of two for good? Couples can inspire each other to stick with healthy habits like exercising, eating well and going to bed at a reasonable hour.
After nearly 25 years of marriage—and two healed shoulders—I like to think that my husband and I share a lifestyle that’s conducive to healthy aging (our adorable pulling dog aside).
(Related: 5 Factors Linked to Successful Relationships)
So do Liz and Remy Tompkins, both 55, a couple from Calgary married 31 years. They recently sold their home and just about all of their possessions and are currently driving across North America in a retrofitted van, taking the time to stretch, exercise and meditate daily. Though they each have their own individual aches and pains, they’re eerily sympatico when it comes to a low resting heart rate and healthy blood pressure. They chalk it up to genetics and an active lifestyle, but it also looks a lot like spousal concordance.
The Tompkins share the dream of a future where they’re healthy and active. They’ve gone so far as to set intentions around these healthy behaviours, and a big motivator has been watching their own parents age.
“I don’t want to end up in the same sort of condition as I see [my parents] in their 80s,” says Remy, whose dad has had a couple of strokes and whose mom is diabetic. “I want to preserve my abilities.”
Liz is also of the “use it or lose it” mentality and shares her husband’s positive vision about aging. “We’re going to have a very active old age because we share an active, healthy lifestyle,” she says.
Talking about health in this way and figuring out how to support each other through aging are steps in the right direction for couples who don’t want to be limited as they grow old, says Mejia.
“I would advocate for formalizing this shared environment. ‘Who are we? How do we think about our health? How do we want to support our health?’” she says. “Really recognize that you’re in this together.”
Next: 5 Sex Tips from Canadians Living with Disabilities
There were a lot of low points along Amanda Propp’s four-year journey to a diagnosis for her digestive disorder, but she has a pretty clear memory of the lowest.
During the last year of her undergraduate studies at Queen’s University, she regularly visited the campus health clinic because of frequent stomach pain. At first, she thought she’d developed a lactose intolerance, but over a period of four months, her symptoms ramped up from inconvenient and distracting to excruciating and frightening. Anything she ate would go right through her. Scariest of all, she was seeing blood in her stool.
One night, the pain and bleeding were so severe that she checked herself into the emergency department. But she didn’t get the help she’d hoped for. “I went to the hospital, and the nurse said to me, ‘Well, are you sure that you’re bleeding from your bum and that it’s not your period?’” recalls Propp recalls, who had been dealing with symptoms for months and was very familiar with her menstrual cycle. “Even a doctor said to me, ‘I don’t really think you had blood.’ I just remember feeling like my experience was being minimized.”
According to the Canadian Digestive Health Foundation, more than 20 million Canadians suffer from digestive disorders each year. And yet, for many who experience one—whether it’s recurring diarrhea or constipation, or more severe symptoms—getting to a diagnosis (never mind treatment and relief) can feel like a confusing, uphill battle.
And of those millions of sufferers, most are women. According to the American College of Gastroenterology, women are diagnosed with irritable bowel syndrome (IBS) two to six times more often than men, and with inflammatory bowel disease (IBD)—which includes Crohn’s disease and ulcerative colitis—twice as often. Canada also has the unfortunate title of being first in the world for prevalence of IBD: One in 150 Canadians is diagnosed with the condition. (Theories as to why include western dietary patterns, stress levels and vitamin D deficiencies due to our greater distance from the equator, as well as the so-called “hygiene hypothesis”: Countries that focus on “clean” environments have fewer microbial contaminants, and their citizens seem to be at a higher risk for developing autoimmune conditions like IBD.) Additionally, up to 73 percent of women experience gastrointestinal symptoms—ranging from abdominal pain and diarrhea to nausea and vomiting—related to their menstrual cycle.
(Related: The Benefits of Adjusting Your Workouts to Your Cycle)
Despite this prevalence, getting to a diagnosis can be incredibly frustrating. The first barrier isn’t that surprising: Sufferers often feel stigma and shame around conversations about, well, poop. And it’s something that women seem to feel more acutely than men. While men will casually (and publicly) grab a newspaper on their way to the bathroom, one survey of 1,000 Canadian women found that 71 percent of them went to huge lengths to avoid having a bowel movement, particularly in a public bathroom. We see it reflected in pop culture and in our own experiences: A guy farts, and it’s hilarious; a woman does, and she’s mortified.
“It can definitely feel awkward for some people to talk about gas and bloating, diarrhea and constipation,” says Amy Chow, a registered dietician in Vancouver whose Chow Down Nutrition helps patients struggling with digestive issues related to food allergies and intolerances. But it’s not always squeamishness at the root of that awkwardness, she notes. “Some people feel embarrassed because they brought it up in the past and were dismissed by their practitioner.”
There’s certainly evidence that women experience that dismissal more often, too. One study in the journal Academic Emergency Medicine found that women experiencing abdominal pain in the ER had to wait an average of 33 minutes longer than men for pain-control medications—and were less likely to be prescribed them in the first place. Another found that women’s pain was underestimated compared to men’s, and they were more likely to be prescribed psychotherapy rather than pain medication. (Horrifyingly enough, the word “hysteria” comes from the Greek word for uterus.)
Once women do open up, their digestive disorders can still be tough to diagnose because the symptoms often overlap across several conditions. “The biggest challenge with many digestive health diagnoses is that the symptoms are very non-specific,” says Dr. Maitreyi Raman, gastroenterologist, nutrition specialist and clinician researcher and associate at the University of Calgary who studies the role of the diet on gut inflammation, as well as the relationship between the gut and the brain. “Symptoms of IBS may mimic symptoms seen with IBD. It may even mimic symptoms seen amongst new diagnoses of colon cancer.” Symptoms like abdominal pain, bloating and gas, as well as constipation or diarrhea (or both), can indicate any number of disorders—is it something you ate, or does it just never go away? That’s why context and supportive information like blood work, imaging and colonoscopies are very important to make a diagnosis, as are more alarming symptoms like bright red blood in your stool or unexpected weight loss.
(Related: Food for Thought: Can What We Eat Influence Our Mental Health?)
Patients can go long periods of time without a formal diagnosis, Raman notes, particularly if there is a lengthy wait to see a specialist. “It becomes very challenging in terms of how to apply therapies, or how to seek therapy,” she says.
Propp’s symptoms were repeatedly dismissed. Over eight months, she was in and out of the hospital twice and a regular visitor to the campus clinic. And while she underwent tests for parasites and bacterial infection, no doctor ever ordered a colonoscopy, a key step when a patient has what’s known as an “alarm” symptom: blood. Plus, like many women, she found herself being judged for her appearance—that she hadn’t lost enough weight to be as sick as she felt. “They just looked at me and said, ‘Well, you look pretty healthy.’ Because I wasn’t a size two, I feel there was a lack of appreciation for the severity of what I was experiencing,” she says. “I’m in health care now, and if anybody said, ‘I have blood in my stool,’ you know it’s a red flag.”
Propp was diagnosed with IBS—a common disease that can cause stomach cramps, bloating, diarrhea or constipation—but that wasn’t sitting right with her. “I was looking up irritable bowel syndrome, and I thought, ‘This just doesn’t describe me,’” she says, noting that IBS sufferers never have blood in their stool. “I remember how it impacted my life back then. I remember being so worried about going out anywhere in case I urgently needed a washroom. And it just felt like no one could offer me any help.”
She continued to have bouts of diarrhea and pain, and then four years later, she hit another so-called “flare”: “Every time I went to the bathroom, it felt like my insides were going to fall out, the pain was so bad,” she says. But by this time, she had a family physician who took her seriously. He ordered blood tests, spotted inflammatory markers and got her an appointment with a gastroenterologist, who immediately arranged for an emergency colonoscopy.
The results were clear: She had ulcerative colitis. It’s a form of IBD that can come with life-threatening complications if left untreated, and by the time Propp was finally diagnosed, her colon was so inflamed she was in danger of it perforating. She’d also spent the previous four years missing classes and fretting about bathroom locations anytime she was out of the house—an incredible emotional burden, and a lot of time she won’t get back. Propp will likely be on and off medications for the rest of her life (she’s presently considered in remission), but having a viable treatment plan, as well as a group of doctors who finally recognized what was going on with her, meant everything.
When women come up against these kinds of walls in their path to a diagnosis, it can sometimes help to get another opinion, like Propp did. She believes it made a different to have her own doctor, who knew her well, rather than rely on walk-in clinics, as she did when she was a student. When Chow sees a patient who’s either been unsuccessful in getting answers from their GP or hasn’t spoken with a doctor at all, she’ll look at their symptoms and outline the tests they need to ask for. In some cases, she will recommend a referral to a specialist for a colonoscopy. “We can also advocate for the clients by communicating directly to the doctor if they don’t feel comfortable or they already tried in the past,” she says. “But I always encourage people to continue that relationship with their doctor, going back for follow-ups and letting them know that you’re still not feeling well.”
And if you’re feeling outright dismissed, like Propp was? “Get another opinion,” she says. “Nowadays, it’s pretty convenient with telehealth services.”
(Related: 14 Virtual Care Services in Canada You Need to Know About)
While Propp’s symptoms were severe, a digestive disorder doesn’t have to be that debilitating to have a serious impact on a person’s life. Ivy Young, who works in curriculum development for the University of Calgary, was in her late 20s when she started to experience bloating and stomach aches almost every time she ate. She was a vegetarian, and things she’d eaten for years—peanut butter, tofu dogs, wheat of any kind—were suddenly triggering a reaction.
Six years into the bouts of symptoms, and still without a diagnosis, she developed a bumpy, painful rash. She first sought a test for celiac disease from her GP, which came back negative, so that was the end of that road. “It was my vanity that got me to seek out other help, since these bumps on my jawline and my throat were so visible and large,” she says. “I had to accept the fact that I wasn’t feeling good.”
She’d been seeing a doctor of traditional Chinese medicine to help with stress and her digestive issues, and while her treatments were helping with the former, she also connected with a naturopath to try an elimination diet. It took about a year of cutting out and re-introducing foods to discover what was triggering her reactions. She learned that when she stopped consuming wheat, sugar, tofu, vinegar, wine and dairy, she would feel better. “I noticed such a decrease in inflammation, increase in mental clarity and decrease in depression,” she says.
(Related: 8 Signs You Need a Mental Health Day)
Still, says Young, she sometimes feels frustration over the lack of answers—and no clear diagnosis—for why her body started to reject foods she’d always eaten. And the new diet is not always easy to stick with. “If I’m looking for that external validation that, yes, I don’t feel good after these foods, it’s never happened. Because no doctor has ever said, ‘You really shouldn’t eat this.’”
Chow herself has seen how that lack of clarity can be deflating for her patients. “When you don’t have a diagnosis, it can feel like your symptoms aren’t true or valid,” she says. “A lot of the clients I work with, they’ve already tried different diets, they’ve reduced foods, and the restrictions become more [intense] without them really understanding the reasons why these foods are bothering them.”
Elimination diets, which are often used to see if a food sensitivity is the cause of symptoms, can be tricky to manage on your own—particularly when it comes to determining when and how to reintroduce a food to identify if it’s a trigger for gastrointestinal issues, as well as ensuring a balanced diet of vital nutrients. And without a support person to guide you through dietary changes, other problems can come up. “Because of the gut-brain connection, going through these diets can be very stressful and anxiety-provoking, and then that cycle of having more stress, anxiety and depression is going to fuel your symptoms‚” says Chow. “You’re just really guessing at that point—and there’s just a lot of misinformation out there.”
It can still seem like there is a lot of trial and error involved on the path to feeling better, but there are some encouraging current studies in gut health. Many of them look at the gut microbiome—the trillions of bacteria, fungi and microbes that are part of the digestive system—and have focused on how food, stress and other factors can shift that system toward “healthy” bacteria that can affect GI symptoms for the better. In fact, shifts in the makeup of our microbiome are among the prevalent theories for why people can develop allergies or intolerances to foods later in life, whether it’s from travel (eating foods that introduce new bacteria to the gut), life events like pregnancy, or even doses of antibiotics that the gut doesn’t fully recover from.
The University of Calgary’s Raman has been studying the role of various therapeutic diets in the context of IBD, like the Mediterranean diet, which emphasizes healthy oils, fruits and vegetables, dietary fibre, limited processed foods, food additives and meat proteins. An anti-inflammatory diet like the Mediterranean diet has been linked to lower levels of diabetes, heart disease and other conditions, as well as the potential to recover a healthy gut microbiome. Raman was recently published in the Lancet Gastroenterology and Hepatology showing that the Mediterranean diet can also go a long way toward reducing gut inflammation and alleviating suffering from Crohn’s disease. Hers and similar research concluded that after 12 weeks on an anti-inflammatory diet, not only did patients feel better, their gut bacteria also shifted in a positive, healthy direction—and that shift toward more diverse bacteria in the gut microbiome may be protective against developing future flares in patients with Crohn’s disease.
As to why women are more likely to suffer from diseases like IBS or constipation, there are a few theories, but surprisingly few studies on it. A 2015 study from the American Physiological Society suggested it was because nerve cells that control the movement of food through a woman’s intestine are more sluggish in response to brain input than in men. Stress is also a major contributor to diseases like IBS, and the American Psychological Association notes that women are more likely than men to report physical and emotional symptoms of stress. And then layer on the hormone changes that happen during women’s menstrual cycles—those same hormones are also known to exacerbate IBS symptoms.
For Young, a big part of recovery was learning to let go of the social angst and stigma she felt about not being able to eat certain foods. “I’m still embarrassed about saying that I have food sensitivities if I’m going to somebody’s house for dinner, and I minimize it constantly in my own mind,” she says. “But for me, it is a women’s issue, because we’re often not validated with our health issues. I guess I’ve had to learn that it’s okay—it’s okay that I’ve got special needs. I wish I could eat everything that I wanted. But this is a real thing.
Next: How to Build a Strong Microbiome to Improve Your Gut Health
