Introducing the Safe and Sound Protocol

Introducing the Safe and Sound Protocol

by Dr. Stephanie Cordes, ND
 

I’m excited to share that I’ve officially completed training in the Safe and Sound Protocol (SSP) and am now offering this intervention to my naturopathic clients.

The Theory

If you know me or you’ve followed me for a while on social media, you’ve likely heard me talk about Polyvagal Theory (PVT). Developed by Dr. Stephen Porges, this framework has deepened my understanding of the nervous system and what happens when our nervous systems interact with others. It highlights the important role of the vagus nerve in regulating our heart rate and breath, as well as body language, emotional responses, and our ability to detect safety or danger. If you’re curious to learn more, you can check out this blog post or this handout about Polyvagal Theory.

White-presenting woman with dark brown hair wearing a peach cardigen and light blue pants, sitting on a grey couch, leaning back with her eyes closed, with a set of over-the-ears headphones on.

The Intervention

The Safe and Sound Protocol is a gentle, evidence-based listening intervention developed by Dr. Porges to support nervous system regulation. It uses filtered music to engage the tiny muscles of the middle ear, encouraging the brain to tune in to calming, safe sounds (similar to the “sing-songy” voices many of us reflexively use with babies or animals). These sounds send cues of safety through the vagus nerve, helping to shift the body out of “fight or flight” or “shut down” states and into a more relaxed, socially engaged mode. In this calmer state, other modalities and treatments may work more effectively.

As with many healing approaches, the Safe and Sound Protocol (SSP) will not be the right fit for everyone. If you’re curious to learn more or would like to explore whether this intervention could support you and your health, feel free to reach out or book a free meet and greet consultation.

Click here for more information on the Safe and Sound Protocol.

World Menopause Day 2025 – Lifestyle Medicine for the win

October marks Menopause Month, with October 18 recognized as World Menopause Day.

 

In 2025, the International Menopause Society (IMS) has highlighted the theme of lifestyle medicine, a timely reminder of how everyday choices can shape health and well-being during the menopause transition.

 

Remember, menopause is not a disease. But is true that the hormonal changes it entails can make many people feel pretty lousy by increasing risks for hot flashes, sleep difficulties, bone loss, cardiovascular concerns, weight changes, and mood shifts, among other things.

There is a *lot* of talk about menopause hormone therapy these days. Our understanding of benefits and risks has changed and matured since the fear-inducing Women’s Health Initiative study from the early 2000s. Hormone therapy today looks different in many ways and can play a foundational role in a person’s menopause transition. Unfortunately, it can also seem that without hormone therapy, someone is destined not only to suffer, but to be wholly unsupported at this time. That is simply not true, and this is where lifestyle strategies become especially important.

Lifestyle medicine provides a foundation of non-pharmacologic strategies that not only reduce symptoms but also lower long-term risks.

 

Six pillars of lifestyle medicine stand out for this stage of life

 

Nutrition:

Healthy eating patterns such as the Mediterranean or DASH diets support cardiovascular, metabolic, mood, and bone health.

  • Plant forward (prefential consumption of plant-based foods)
  • Reduced intake of red and processed meat
  • Reduced intake of added sugars

Diets rich in fruits and vegetables may reduce vasomotor symptoms.

Adequate calcium and vitamin D intake; supplementation often required

  • Calcium: 700-1200 mg
  • Vitamin D: 400-600 IU minimum, 800-1000 IU more likely (especially in Canada)
  • note: identified vitamin D deficiency likely requires higher doses short-term

Physical activity:

Reduced physical activity is commonly seen throughout the menopause transition and contributes to central adiposity, among other things. Intentional activity can help mitigate it as well as improve sleep, reduce vasomotor symptoms, and strengthen both heart and bones. Given the particular impact hormonal changes exert on the body at this time, increasing aerobic exercise from current baseline is likely needed to see best results.

Aim for 150 to 300 minutes of moderate aerobic exercise weekly along with resistance training twice weekly.

Multi-component exercises combining both (such as high-intensity-interval training) may be a more “convenient” way of achieving this for some.

 

Stress:

This midlife time can feel like being in the middle of a Venn diagram with all the things overlapping at once to overwhelm us. Life events, work changes, caring for children and parents (and sometimes spouses) layered on the physical, metabolic and psychological changes inherent to the menopause transition can be … a lot.

Using stress management techniques such as mindfulness, relaxation exercises, or CBT helps reduce symptom intensity. This stress reduction may also reduce physical symptoms including vasomotor ones. Harness the power and convenience of your wearable trackers or online apps to find approaches that resonate with you.

 

Avoiding risky stuff:

The number of substance-using of women is generally increasing, and problem awareness and treatment approaches are notoriously male-centric. There is tentative data showing that greater use of things like alcohol may be precipitated by uncomfortable menopausal symptoms while making those symptoms worse at the same time.

Smoking cessation is an important consideration at any time, but since the cardiovascular risk of women goes up at this time, greater efforts should be made to discontinue permanently. Non-smokers also typically have fewer vasomotor symptoms and better quality of life during this transition.

 

Sleep:

Although how much sleep you get matters, so does quality. Restorative sleep, supported by good sleep hygiene or CBT-I, is central for health maintenance. There is evidence linking non-restorative sleep to negative impacts on cognitive, bone, mental health, metabolic, and cardiovascular outcomes at this time.

This is compounded by an increased prevalence of obstructive sleep apnea after menopause which in itself contributes to non-restorative sleep and cardiovascular issues.

 

Healthy relationships:

Social connection fosters resilience and enhances quality of life. As a key factor in healthy aging, we want to foster environments which reduce loneliness and social isolation. This can be easier said than done, but take this as a sign to prioritize and invest time in existing relationships (you enjoy) which actively seek new ones through shared hobbies, volunteering, or other forms of community involvement.

 

Conclusion

These above strategies are cost-effective, adaptable, and accessible across diverse populations. Most of us know that these things are important but may not realize the extent of it. Not only that, but we may also struggle to implement those strategies in our own lives given our particular set of challenges.

 

My takeaway? Reach out to your healthcare providers – share those struggles, and let us help you find a way to take a lifestyle-fueled active role in your health during and after the menopause transition.

 

Happy Menopause Month 2025!

Dr. Alex Verge, ND

 

Anekwe, C. V., Cano, A., Mulligan, J., Ang, S. B., Johnson, C. N., Panay, N., … Nappi, R. E. (2025). The role of lifestyle medicine in menopausal health: a review of non-pharmacologic interventions. Climacteric, 1–19.

But I’m Not Anemic

Women with messy black hair sitting at laptop drinking coffee and doing on OK sign with left hand

It’s something many women hear after blood work — as though the absence of anemia means iron status is just fine. The truth? You can be iron deficient without being anemic, and this is often when the most frustrating symptoms show up.

Continue reading

What is a Safe Amount of Alcohol?

Canada’s Proposed New Alcohol Guidelines

Having a partner who doesn’t drink alcohol has been a blessing. Before we met, I was a proud drinker, attributing my robust alcohol tolerance to my German heritage. My intake dramatically decreased once we moved in together, and even more so during the COVID lockdowns when bars and restaurants were closed. In 2020, I had a 7-month alcohol-free period and realized how much better I felt in general without drinking. I began to explore the research on alcohol and became frustrated by the Canadian drinking guidelines that falsely assured the public that drinking more than one standard drink a day was low risk.

People drink for various reasons, and I don’t intend to shame or guilt-trip anyone with this post. I still drink on the odd occasion (although not for a while now, considering I’m 40 weeks pregnant). However, I think it’s incredibly important that Canadian guidelines and health care practitioners are generally more realistic about the health risks associated with alcohol consumption.

Canada’s Low-Risk Alcohol Drinking Guidelines are finally undergoing some dramatic changes. The proposed update recognizes the increased health risks when people consume three or more drinks per week. This is a significant shift from our previous guidelines set out in 2011 that recommended people limit their alcohol intake to no more than 10 or 15 drinks per week, depending on their sex (Government of Canada, 2021).

Canadian Centre on Substance Use and Addiction, 2022
Photo by Ales Maze on Unsplash.

The research is now clear that no amount of alcohol is good for you, no matter what form you drink it in. Drinking a small amount of alcohol still comes with significant health risks. 

However, research has suggested that all-cause mortality (death from any cause) increases exponentially above 100g of ethanol per week, which is about seven standard 14g drinks per week (Wood et al., 2018). Multiple studies, including one from Sherk et al. in 2020, had found that the risk of death increased when people drank more than 10 grams of alcohol daily, less than one standard drink. Sherk (2020) looked at hospital stays in North America and found that more than 50% of alcohol-related deaths and hospital stays were people in the current 2011 guidelines low-risk drinking category. I think it’s pretty clear our guidelines need a serious update.

But what if you have a drink or more every night and want to change this habit but don’t know where to start? It may be best to focus on being honest with yourself and your practitioners about your alcohol use. Practice self-compassion; you likely drink for several reasons, and guilt and shame will likely make it more difficult to change your alcohol consumption. And please be careful; quitting alcohol cold turkey can be very dangerous if you have a physical alcohol dependence as it can cause seizures and even death, you may need some medical support during alcohol withdrawal.

Are you curious about how much alcohol you actually drink per week? Most people underestimate the number of standard drinks, as we are often offered drinks in amounts that are larger than one standard drink. For example, a tall can of beer that contains 5% alcohol works out to about 1.4 standard drinks, that’s 19.6g of ethanol. Consuming one of these tall cans every day of the week would amount to about 137.2g of ethanol per week (and remember, health risks go up exponentially once we go over 100g per week). Click here for a great standard drink calculator.

National Institute on Alcohol Abuse and Alcoholism (n.d.). 

The good news? Although no alcohol is healthiest, we also know that long-term reduction of alcohol intake can reduce the risk of death. Wood et al. (2018) estimated that decreasing alcohol consumption from 196g a week to 100g per week might increase life expectancy by an additional 1-2 years at 40 years old. The current 2011 guidelines advise male-bodied individuals to drink no more than 15 standard drinks per week to reduce risk, that’s 210g of alcohol. It’s clear that the old guidelines may be causing a significant amount of harm with outdated information.

Still, reducing alcohol intake can be incredibly challenging. Focusing on lifestyle and addressing why we drink in the first place can often make a big difference. Getting enough sleep, working on stress levels, eating regular meals, and talking with people we find supportive (especially your health practitioners) may all be good places to start.

Related news stories

Szklarsi, C. (2022, August 30). Proposed update to Canada’s alcohol guidelines suggests as few as 3 drinks per week. Global News. https://globalnews.ca/news/9095085/proposed-update-canadas-alcohol-guidelines/ 

Dubois, S., & Roumeliotis, I. (2022, August 29). More than 6 drinks a week leads to higher health risks, new report suggests — especially for women. CBC News. https://www.cbc.ca/news/health/drinking-health-risks-study-1.6565723

References

Canadian Centre on Substance Use and Addiction (2022). Update of Canada’s Low-Risk Alcohol Drinking Guidelines: Final Report for Public Consultation. https://ccsa.ca/sites/default/files/2022-08/CCSA-LRDG-Update-of-Canada%27s-LRDG-Final-report-for-public-consultation-en.pdf 

National Institute on Alcohol Abuse and Alcoholism (n.d.). What is a Standard Drink? National Institutes of Health. https://www.niaaa.nih.gov/alcohols-effects-health/overview-alcohol-consumption/what-standard-drink 

Robertson, J. (2021, September 14). Alcohol: What do we do here? [PowerPoint slides]. The Confident Clinician.

Sherk, A. (2020). At-a-glance – The alcohol deficit: Canadian government revenue and societal costs from alcohol. Government of Canada. https://doi.org/10.24095/hpcdp.40.5/6.02 
Wood, A., Kaptoge, S., Butterworth, A., Willeit, P., Warnakula, S., Bolton, T., Paige, E., Paul, D., Sweeting, M., Burgess, S., Bell, S., Astle, W., Stevens, D., Koulman, A., Selmer, R., Verschuren, M., Sato, S., Njølstad, I., Woorward, M., … Danesh, J. (2018). Risk thresholds for alcoholic consumption: combined analysis of individual-participant data for 599 912 current drinking in 83 prospective studies. The Lancet, 391(10129), 1513-1523. https://doi.org/10.1016/S0140-6736(18)30134-X

Hair Loss Help – Common Causes and Next Steps

a person touching their scalp to reveal hair loss

Hair loss is not what typically prompts people to book an appointment at our clinic, but it is a common secondary concern. This has been particularly true over the last few years as some people have experienced, and worried about, post-COVID hair loss.

There are several types of loss, divided into scarring and non-scarring categories. The non-scarring types are much more common and include telogen effluvium, pattern hair loss (formerly known as androgenic hair loss), and alopecia areata.

a person touching their scalp to reveal hair loss

Before describing these three types, it’s important to know the main phases of hair growth/loss.

  1. Anagen (3-6 years) – active growth phase
  2. Catagen (1-2 weeks) – hair follicle change/slowing
  3. Telogen (2-4 months) – resting state, hair not well attached but not actively falling out (a new hair is coming up behind)
  4. Exogen – hair is lost, time of active shedding

The human head has approximately 100,000 hair follicles and about 10% of these are in the telogen (resting) phase at any given time.

Main types of hair loss

1. Telogen effluvium (TE)

TE is a common experience of rapid shedding when more than the average number of hair follicles are pushed into the telogen phase due to some sort of “shock”. This leads to an increase in loss over the following 1–3-month period of time.

These shocks or events can include:

  • Stress (various)
  • Infection (especially if there was a fever)
  • Hormone changes (e.g. postpartum, hypothyroidism, loss of estrogen, starting and/or stopping the birth control pill)
  • Dieting

TE leads to a diffuse loss from all areas of the scalp and is not specific to just one spot. After the shedding event, follicles re-enter the anagen phase and growth resumes. Keep in mind that it may take many months after the loss before you feel like things are fully recovered.

2. (Female or Male) Pattern Hair Loss (FPHL/MPHL)

The most important thing I want you to know about pattern hair loss is that it is almost completely genetic and affects up to 50% of people. Half of us experience genetically related hair loss (to varying degrees) over our lifetime. Half of us. I’m not saying it isn’t frustrating or upsetting. I am saying that there are tons of people in the same boat, and it isn’t because of something you’re doing (or not doing).

Although related to androgen hormones in some form, the details vary and can be inconsistent from person to person. In contrast to TE, pattern hair loss more specifically affects the crown/vertex area of the scalp and is usually more complete in men.

In pattern loss, a few things happen:

  1. Hairs prematurely move through the anagen phase and there is an increased delay in onset of next anagen (which means you see less hair present and less growth overall)
  2. Follicles “miniaturize” so your larger, thicker, and pigmented hairs become shorter, thinner, and less-pigmented

3. Alopecia Areata (AA)

Seen as patchy loss, AA is believed to be autoimmune and is more common in those with other pre-existing autoimmune diseases such as celiac disease, Hashimoto’s thyroiditis, lupus, or vitiligo. It’s also associated with smoking and sleep disturbances.

4. Nutrient Deficiency

Not a specific type of loss, but a potential consequence of insufficient amounts of these hair-growth-necessary nutrients.

  1. Iron
  2. Vitamin D

Testing

Testing can be broken down into two main categories, blood and hair.

1. Blood tests:

  • a. Ferritin and CBC
  • b. Vitamin D
  • c. Thyroid
  • d. PCOS tests
  • e. Autoimmune tests

2. Hair:

  • a. Hair-card test (checking for degree of miniaturization)
  • b. Hair-pull test (degree of loss and areas of loss)
  • c. Hair-collection test (degree of loss)

Treatment

Treatment obviously depends on the type of loss you are experiencing. Correcting an iron deficiency or simply waiting out a TE loss is relatively straightforward. Addressing pattern loss or alopecia areata is a more involved process.

There are several treatments to explore: oral, topical (shampoos and lotions) and physical (laser and microneedling). Results are better when multiple strategies are used together, and combinations can depend on tolerance, cost, and length of use.

Conclusion

Hair thinning/loss is common. It can be caused by many things including nutrient deficiencies, stress, infection, hormones, genetics, and autoimmunity. Treatment is usually long-term and can be costly, with results which may not be as complete as we would like.

There are many supplements out there purporting to help solve your hair loss. Very few (if any) will work. Please save your money and your disappointment. As mentioned above, there are some evidence-based strategies. None of them are magical and improvement likely requires a combination approach.

That doesn’t mean it isn’t worth looking at! All of us at Kura have recently done extra training in hair loss and we look forward to helping you get the information you need.

Premenstrual Dysphoric Disorder (PMDD): it’s not “just in your head”

PMDD is similar to PMS, but much more severe and often debilitating. It involves mood, cognitive, and physical symptoms caused by the normal variations in estrogen and progesterone levels during the later half of the menstrual cycle leading up to the next period. It can be difficult to get a diagnosis by a health professional, which may be partly due to confusion about whether it is a psychiatric or a hormonal disorder, and likely also because doctors are taught that patients are not trustworthy when it comes to reporting their menstrual symptoms. (If you type “medical sexism period pain” into your search bar you’ll find a slew of fairly recent articles from Harvard University, the BBC, the Atlantic and more about doctors not taking menstrual complaints or womens’ pain in general seriously.) A 2020 study that interviewed 17 folks with a diagnosis of PMDD found an average of 20 years of living with the condition before being correctly diagnosed, meaning these participants suffered for 20 years before they had access to appropriate treatment for PMDD.

For the record: if you tell us that your symptoms are severe enough to be considered PMDD, we’ll believe you!

There is a popular belief that severe pain and intense emotional distress with periods are “normal”—just a fact of life if you have a uterus and ovaries. We’re here to tell you that menstruation does not actually have to be a horrible physical and emotional experience and that although we need more research on PMDD and more treatment options, there are treatments out there for PMDD that may help you feel better during the most difficult time of your cycle. 

The cause of PMDD has been tricky to pin down. Research suggests that PMDD may be the result of heightened brain sensitivity in response to normal hormonal changes, thus affecting chemical signaling in the brain (specifically serotonin activity and GABA receptors). This makes sense if you consider the conventional treatment options that have shown some benefit: both SSRIs (taken either for the full cycle or only during the two weeks leading up to menses) and birth control (specific treatment protocols to affect hormonal balance) have been shown in research to decrease both emotional and physical symptoms of PMDD. Keep in mind there is no one-size-fits-all treatment; some SSRI treatments may work, while others may not and the same thing can be said for oral contraceptives (the birth control pill can even make symptoms worse).

However, pharmaceutical drugs aren’t the only things you can try to alleviate some of the symptoms of PMDD. There are multiple other options whether or not you choose to take medication. For example, an herb called vitex has been shown to help both physical and psychological symptoms of PMS and PMDD, although research has suggested that when compared to a popular SSRI, the antidepressant was better at treating mood symptoms while vitex did a better job at helping with physical symptoms. 

While there are some studies on PMDD and acupuncture that suggest benefit, we have not been able to find any well-conducted research on the topic. In our experience however, acupuncture works really well for some people who experience severe PMS or PMDD. We’ve had patients who can tell from their PMS/PMDD symptoms whether or not they’ve had acupuncture that month. For some, regular acupuncture can be the difference between tolerable PMS and utterly debilitating mood/physical symptoms for the latter half of the cycle.

If you have any questions about how we can support you with PMS or PMDD, please get in touch.

Written by: Lisa Baird, RAc and Stephanie Cordes, ND

Lisa and Stef started writing together for the Guelph Community Acupuncture blog, and even though Stef no longer works at GCA, they continue to write about conditions they see in their respective practices, approaches to care, and barriers to accessing treatment.

REFERENCES

Cerqueira, R., Frey, B., Leclerc, E., & Brietzke E. (2017). Vitex agnus casatus for permenstrual syndrome and premenstrual dysphoric disorder: a systemic review. Archives of Women’s Mental Health, 20(6), 713-719. https://doi.org/10.1007/s00737-017-0791-0

Csupor, D., Lantos, T., Hegyi, P., Benkő, R., Viola, R., Gyöngyi, Z., Csécsei, P., Tóth, B., Vasas, A., Márta, K., Rostás, I., Szentesi, A., & Matuz, M. (2019). Vitex agnus-castus in premenstrual syndrome: A meta-analysis of double-blind randomised controlled trials. Complementary Therapies in Medicine, 47, 102190. https://doi.org/10.1016/j.ctim.2019.08.024

Hofmeister, S., & Bodden, S. (2016). Premenstrual Syndrome and Premenstrual Dysphoric Disorder. American Family Physician, 94(3), 236–240.

Osborn, E., Brooks, J., O’Brien, P. M. S., & Wittkowski, A. (2020). Suicidality in women with Premenstrual Dysphoric Disorder: A systematic literature review. Archives of Women’s Mental Health. https://doi.org/10.1007/s00737-020-01054-8

Rapkin, A. J., Korotkaya, Y., & Taylor, K. C. (2019). Contraception counseling for women with premenstrual dysphoric disorder (PMDD): Current perspectives. Open Access Journal of Contraception, 10, 27–39. https://doi.org/10.2147/OAJC.S183193 Robertson, J. (nd). PMS and PMDD [Webinar]. The Confident Clinician Club. https://theconfidentclinicianclub.com/