In the winter of 2019 I took a surfing lesson in Costa Rica. I fell in love–the sun and salt water on my skin, the beautiful view of the beach, the spray off the back of the waves, the loud crashing of translucent turquoise, and the feeling of power, ease, flow and grace as I stood on a board, using the energy of the earth to fly across water.
The problem was, however, I would be going home in a week to a landlocked part of the world that spends a lot of its months covered in ice.
It was depressing.
Then I met a girl from Toronto, a psychotherapist who worked at a clinic just down the street from my old one.
“You can surf in Toronto, you know”, she informed me.
Where? I thought, astounded.
“On the lakes!” She exclaimed.
I was flabbergasted–perhaps I could be a surfer after all. The beach bum lifestyle, the rock hard abs, the zinc oxide cheek bones, the chronically wet hair, watching the winds and tides and slipping out for a sun-soaked hour during a work break. Could this be true–could you surf the Great Lakes?
“The thing is,” she continued, “the surf season is from October to March”.
Oh.
Winter surfing.
It was still interested, though.
Back in Toronto, I waited for the next strong February East wind and headed to a surf spot I’d heard about on Lake Ontario. I was met with a crowd of black neoprene-clad surfers, soaked by water, wind and sleet. The elements were harsh. The stoke, however, was infectious.
Ok, I could do this, I thought.
My next stop was the surf shop. I purchased gear and the rest is history.
Not a lot of us are built to slip into near-freezing water during the frigid winter months to catch a few waves. Lake waves are harder to catch, the currents are strong, ice chunks are a thing to watch out for, and… it’s friggin’ cold! But, surfing is surfing. The lakes provide beautiful landscapes, just like the ocean, and the feeling of catching a wave and riding it is the same.
There’s also the benefit of body hardening.
We modern humans are very different from our hunter-gatherer ancestors. Our genes may be the same, but our lifestyles couldn’t be further apart. Down-filled jackets and central heating protect us from the discomfort of the elements. In a sense, our lives are temperature controlled.
However, our incidence of chronic degenerative disease has never been higher.
Body hardening practices involves exposure against natural stimuli, such as intense cold, that results in increased resilience–resistance to disease and improved health.
A 1998 study in QJM: an international journal of medicine looked at antioxidant production in German winter swimmers.
Winter swimming, just like winter surfing, is a thing. As of the 90s, there were 3000 Germans who participated in winter swimming clubs. They were known to experience a 40% reduction in respiratory diseases compared to the rest of the population, debunking the notion that if you exposure yourself to cold you’ll “catch a cold”.
The study looked at 23 male and 13 female who had been members of a Berlin winter swimming club for more than two years. On average they swam for 5 to 10 minutes on a weekly basis in water between 1 and 5 degrees celsius. Their blood levels of glutathione were compared with that of 28 healthy men and 12 healthy women who had never participated in cold-exposure body hardening therapies such as winter swimming.
Glutathione is our body’s main antioxidant. It protects us from free radicals (reactive oxygen and reactive nitrogen species, ROS and RNS, respectively) that are harmful to our cells. It is produced from three amino acids: glycine, cysteine, and glutamine.
Glutathione reduces oxidative stress produced by these free radicals that occur in cells as a result of their energy production, as well as toxins, pollutants and other stressors. A deficiency of glutathione is associated with an increased risk of cancer, accelerated aging, and other diseases, such as metabolic disease like diabetes and cognitive diseases like Parkinson’s. It decreases as a result of aging, chronic disease, toxin exposure, and chronic stress.
Elevating glutathione status has been shown to improve conditions like insulin resistance, autoimmune diseases, cognitive and mental health conditions, fatty liver and cirrhosis, autism, and respiratory diseases.
It was found that after cold water exposure, blood levels of antioxidants like glutathione decreases, indicating that cold water exposure induces oxidative stress on the body. However, after a period of time, glutathione levels rose higher than that of baseline.
Baseline blood levels of glutathione were higher in cold water swimmers, indicating that their bodies were more efficient at producing glutathione in response to the temporary oxidative stress imposed on them by the cold exposure.
In essence, “what doesn’t kill you makes you stronger”.
This is called hormesis: when temporary stress is imposed on our bodies, we respond with adaptive measures, such as increased glutathione production to combat that stress. However, our bodies are smart. They figure that if we’re exposed to some cold stress, there might be more coming. Therefore, it might be a good idea to invest energy into hardening, preparing for more of that same stress in the future and, in essence, becoming more resilient. And so, when exposed to a stressor, we often produce more antioxidant than is needed to simply overcome that stressor, and this results in an overall net benefit to our health and well-being.
Just like lifting weights makes us stronger for the next time we lift weights, we become stronger and more resilient at our baseline as we prepare for the next hit of cold, heat, exercise, or stress.
The 1998 study also revealed that cold water swimmers had more enzymes that combat free radicals such as superoxide dismutase, glutathione peroxidase, and catalase, meaning that their cells were better prepared to ramp up antioxidant production quickly and neutralize free radicals at a moment’s notice, if needed.
Cold water swimmers also produced four times more norepinephrine after their cold exposure. Norepinephrine is part of our fight or flight response, but is also associated with increased energy, mood, motivation and well-being. Imagine a hit of caffeine–that’s a bit what cold burst can do to you via norepinephrine. Heart race increases, and we’re filled with an excited euphoria.
Norepinephrine is part of the reason why cold therapy has been touted as a remedy for depression. Cold exposure provides a much-needed burst of mobilizing chemicals to kickstart feelings of well-being and motivation for people who are struggling with low mood and arousal.
Cold therapy also increases dopamine by 250%, according to a 2000 study in the European Journal of Applied Physiology. Dopamine gives us the sense of motivation and meaning in pursuing a goal. It fills us with purpose and drive. So many of us are starved of dopamine and therefore so much of our culture involves trying to increase dopamine: scrolling social media, consuming sugar, playing video games, and so on.
The problem with many of these attempts to boost dopamine is that they come with a cost. We get a hit of pleasure from consuming sugar, for example, followed by a dip in our baseline levels of dopamine. Overall, we’re left feeling empty, foggy, purposeless, and addicted. We experience cravings that need to be filled.
Even supplements like Macuna pruriens and l-tyrosine, designed to boost dopamine levels, result in crashes 30 to 45 minutes after they peak.
Cold exposure, however, gives us a hit of dopamine that remains elevated for hours without a resulting crash. This provides an intense boost to mood, motivation, cognitive function, concentration, focus, purpose and drive. Like norepinephrine this can also contribute to cold therapy’s anti-depressive effect.
It seems that if we engage in something hard and uncomfortable, something that requires effort–like cold exposure–our body rewards us with an increase in mood, motivation and drive through the enhancement of dopamine production in our brains.
Winter surfing has been an immense gift to my health and well-being. It’s given me purpose, community, exposure to nature, and a wonderful outlet for body hardening. If I go more than a week without a surf session I start to feel a bit of withdrawal. There is nothing more therapeutic than hours spent checking the forecast, and driving to chase waves in order to end up floating in the middle of a beautiful lake, surrounded by nature and friends.
With regular winter surfing I feel invigorated, energized and fit–the mood-lifting effects of the cold exposure is comparable to nothing else.
This winter my message to everyone is: get outside. Exposure yourself to cold. Expose yourself to nature. Use the elements and the changing seasons as tools to enhance your health.
There are incredible mood-elevating, immune system-boosting and anti-aging benefits to becoming more resilient. While it may be uncomfortable, cold adaptation is a sign of your improved vitality and disease resistance.
Nature’s harshness evolved us. Temperature extremes helped to shape our DNA. Our genes contain codes for amazing mental, emotional, and physical resilience. They are waiting to be turned on at a moment’s notice, if only they’re given a reason.
Cold exposure flips the on-switch to your body’s incredible superpowers. Let’s explore the potential of this beautiful vessel in which we all live.
References:
Šrámek, P., Šimečková, M., Janský, L. et al. Human physiological responses to immersion into water of different temperatures. Eur J Appl Physiol81, 436–442 (2000). https://doi.org/10.1007/s004210050065
W.G. Siems, R. Brenke, O. Sommerburg, T. Grune, Improved antioxidative protection in winter swimmers, QJM: An International Journal of Medicine, Volume 92, Issue 4, April 1999, Pages 193–198, https://doi.org/10.1093/qjmed/92.4.193
We all have thought spirals. You know, where your thoughts feel like they’re on an automatic playback loop? If you suffer from OCD, your thought spirals likely plague your existence.
Those with OCD have very strong and triple-thick rubber resistance band kinds of thought spirals. In OCD, the part of their brain that “gear shifts” (called the caudate nucleus, if you’re curious), unhooking the rubber band to start to play something else–a kind of “thank you, brain for sharing”–isn’t working. The thought loop plays and plays, intrusively, sometimes horrifyingly.
Even if you don’t have OCD and you can gear shift, you still probably know the rubber band thought loop I’m describing. I think that OCD is likely a spectrum and we all fall somewhere on the spectrum of our brain’s ability to shut off the caudate nucleus and gear shift out of a thought spiral.
Mental states such as fatigue, low blood sugar, dehydration, depression, anxiety, brain inflammation, and so on, make it more difficult to gear shift, because the brain requires a lot of energy to shut off the caudate nucleus.
The difference in those who have OCD is that the gear shift gets stuck way more frequently and the gears get lodged more strongly than those on the far other end of the spectrum.
On the far end of the spectrum may be those who hardly think about anything and let everything go and are super chillax and take nothing personally and all that (possibly some very experienced mediators can get there too).
So, back to the original question. Can you locate your thought loop?
That rubber band that fixates on whether your friends hate you because they took longer than 15 minutes to answer in the group text?
That rubber band that convinces you that the strange mole on your left thigh looks two shades darker than yesterday and you read on Google that that could mean that it’s cancerous, and your doctor looked at it (and then the doctor whose second opinion you sought) and said it was fine but that doctor might be a quack, what medical school could they even have gone to anyways, and now you’re planning your funeral?
Can you identify your thought spirals when they occur?
Thought rubber bands have a flavour. They sometimes speak in their own voice, or a particular tone. Or the way the thoughts jump from concept to concept is different from your normal, balanced and sober thoughts.
The thought spirals might produce a certain feeling in your body that is familiar (and often unpleasant): perhaps a sinking feeling in your stomach, or a 60-lb labrador retriever sitting on your chest. There may be a couple rubber band flavours: a mean one, a frenzied one, one that sounds like your mother, and so on.
Can you locate yours?
Does it have a name?
Sometimes people call it “OCD”–this is probably why people with OCD (especially “Harm OCD”, or thought loops that involve harming others, more on those later), often feel such relief at receiving the label. The label might help us (and our loved ones) recognize that we have a rubber band in the first place. That just because we have thoughts doesn’t necessarily mean anything. And this begins the process of something called Externalization.
Sometimes “OCD” isn’t the best name.
Some people call their thought loop “Herbert”.
I once heard a hilarious story where an individual named hers “Yes, Ma’am!”
Externalization.
Externalization is the act of locating the phenoma we have identified with as something outside of ourselves.
Oh my, imagine if you actually were Herbet (or OCD, or “Yes, Ma’am”). What if you actually believed them? Imagine believing OCD when she tells you that your best friend Glenda from 5th grade saw that funny look on your face that you let slip for a second when she revealed to you that she’s getting a divorce and you now think she thinks that you’re judging her and now she thinks you’re a horrible person or her feelings are hurt and that’s not the type of person you are you should have looked more supportive or asked more questions.
Ugh, that would be horrible.
Now you can think of OCD (or whatever your thought loop is called) as a person, or an entity separate from yourself that occupies your head from time to time. You can see it as a separate thing that might be helpful sometimes. Maybe you have the same values as your OCD sometimes (like the values of being a good and supportive friend and not making weird involuntary faces at Glenda).
Maybe the OCD stepped in quickly once to remind you to check your watch and you did and you actually did need to leave because more time had passed than you thought.
But, you can also think of OCD as a person who you are not 100% overlapped with. Maybe you’re really not friends with OCD if she’s the kind of person who keeps talking about you harming your dog, even though you love your dog (this is reference to certain versions of OCD, called Unwanted Thought Syndrome, or Harm OCD, where people have disturbing, often violent thoughts that are completely unaligned with their true selves. People might think about harming their dog or engaging in violent acts even thought they love their dog more than anything and haven’t squashed so much as a mosquito in their lives).
If you externalize these rubber band thought spirals, you are able to start the process of disconnecting from them. Then, you can start work with them. You can start to realize that they don’t mean anything.
Externalization helps us realize that thoughts of harming your dog aren’t your thoughts. And, more importantly, they don’t actually mean anything about you, your friend Glenda, or reality.
And, if you’re reading this and identify with any of the examples, let me just be your gear shift here and remind you that you are not these thoughts!
I’ll say it a different way: the fact that you’re upset by certain thoughts and think you’re a bad person for thinking them is more proof that you are not these thoughts.
In fact, for a moment I want you to think of a way in which you can’t possibly be that thought. Let’s just stop here for a second. I want you to think of a time you did something really nice for your dog. Did you get her a treat? Ok, then you’re not the type of person who would harm her!
(In an interview, Dr. Steven Phillipson says that he wouldn’t hesitate to let one of his patients with intrusive thoughts about pedophilia babysit his kids. “I’d be far more worried about you than them,” he assures his patients, highlighting that intrusive and unwanted thoughts don’t mean the thinker will act on them–but cause immense distress for the person thinking them).
Externalization helps us share our thoughts. This is why I believe the “Stop the Stigma” campaign is so important. It’s super hard to gear shift on your own. It’s especially hard to do it when you’re under-slept, or undernourished, or having a bad day. We need other people to be the gear shift for us sometimes, while we’re learning to grease the gears ourselves.
I call this “Outsourcing the Prefrontal Cortex”, running something by a friend who knows you and can reassure you that whatever horrific thought or idea is looping in your brain isn’t true or important or indication that you’re a bad person or need to call the police and go back and check if you ran someone over or text the person again.
There are times when I can get caught in thought spiral and I remember yanking at the gear (so there was a part that was able to externalize and even determine that the gear needed to be shifted, which already takes lots of practice). Despite my efforts, though I just wasn’t able to nudge it.
So I talked to a friend. And sometimes even saying it out loud helped—saying it out loud was a way to confront the thoughts. And she and I laughed and she reassured me. And I felt silly but it was what I needed to hear. And the gear moved. And I relaxed. And my brain could move on.
Sometimes seeking reassurance can be a compulsion, however. The difference lies in whether you can tolerate the thoughts and externalize them as thoughts, and Outsource your Prefrontal Cortex in order to unstick your gear shift.
There are three brain areas involved in OCD: the Orbitofrontal Cortex, the Anterior Cingulate Cortex and the Caudate Nucleus.
We are smart social creatures and our brains are geared so that we can learn from our mistakes. The orbitofrontal cortex sounds off an alarm when it thinks we’ve done something wrong. It is our error detection system. It’s the shock you feel when you realize, “Hey did I run over a speed bump back there or…”
The anterior cingulate cortex keeps us feeling uneasy and unsettled until the mistake is corrected. And the caudate nucleus, our “gear shifter” responds to error correction and turns off once we’ve done something correctly so we can move on.
In OCD all three areas are hyperactive. The main neurotransmitter of this brain circuit is glutamate, our excitatory neurotransmitter. This is why NAC (n-acetyl cysteine) can be such a helpful supplement for OCD, tourettes, tics, skin picking and hair-pulling, binge eating, and thought spirals and compulsions, as it “mops” up glutamate in the brain and can calm down the entire circuit. It’s also thought that the orbitofrontal cortex might be low in serotonin, why many people with OCD are prescribed Zoloft or another SSRI medications and can see some benefit from them–5HTP can be a helpful supplement for supporting serotonin synthesis in the brain but shouldn’t be mixed with SSRIs.
The gold standard treatment for OCD is Exposure and Response Prevention Therapy, or ERP.
ERP works by first viewing the thought loops as sticky, addictive substances while addressing our fears surrounding them by exposing us to the thoughts. If you’re afraid of snakes, exposure therapy engages a step by step process of getting you in front of a snake until the fear centre of your brain, the amygdala no longer associates friendly, non-poisonous snakes with danger. ERP is similar–when we face the intrusive thoughts head-on they start to lose their power over us.
ERP involves sitting with the thought loops and refraining from engaging in any compulsions until the brain stops caring about them, and the alarm stops sounding. OCD doesn’t necessarily involve compulsions–often the compulsions can be mental, such as constantly telling a friend (over-outsourcing the prefrontal cortex, let’s say).
It involves heading into the intrusive thoughts, and thought spirals, perhaps listening to recordings of yourself saying them, and sitting with the feelings of discomfort until you are used to them. You know when someone’s car alarm goes off in a parking lot and no one even turns to look? That’s how ERP wants you to engage with your intrusive thoughts.
Mindfulness and externalization are helpful tools to aid the process of ERP.
Often it’s necessary to explore why certain subject matter of the thoughts is so “hot”–perhaps looking under the hood at traumas and implicit memories that you may have experienced that may have led to an over-active alarm system. However, it’s probably necessary to start by building the skills of exposure and response prevention so that you can stay stabilized throughout your trauma therapy, by dampening the alarm system that kicks off the thought spirals.
One thing not to do, if you have OCD, is to go to a therapist who does more psychodynamic therapy, or who examines the “deeper” meaning of the thoughts. Your brain is already trying to do that (“What kind of person has these kind of thoughts?”) and it’s not helpful. Addressing trauma maybe be incredibly helpful at some point in your treatment plan, but analyzing and picking apart the thoughts is probably more damaging than useful.
Seeing the thoughts as just thoughts that show up in the mind and don’t mean anything important is a better attitude to take towards them.
You might not have OCD (again, I believe that it’s a spectrum), but you definitely have thought loops. You do have rubber band thoughts. And you do have a gear shifter.
When I get stuck in thought loops I try to gear shift by saying, “I’m enough”.
It’s not much, but it sometimes settles things down. Whatever I’m worrying about and obsessing about doesn’t matter as much–because I’m enough, just as I am.
It’s simple, and it’s been working.
If you suffer from OCD or you are having a hard time managing your intrusive thoughts, finding a therapist who focuses in ERP, or working with an ND who can help you strengthen your “gear shift” can be incredibly helpful places to get started.
I appeared on the Rebel Talk Podcast with Dr. Michelle Peris, ND. Dr. Michelle writes,
“Not a week goes by that I do not discuss mental health with patients in my office. Rates of depression and anxiety are on the rise. So I really wanted to unpack this important topic for you, giving you relevant information and diving deep into interventions that can help optimize mental health. ⠀
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In this episode, Dr. Talia details how our brains work while suffering from depression, anxiety and stress. Her deep knowledge of neuroscience is combined with mindfulness practices and also with microdosing, an approach that consists in taking low doses of psychedelic drugs, such as LSD or psilocybin-containing “magic” mushrooms, in order to prevent and treat symptoms of depression. ⠀
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Dr. Talia talks about mental and physical barriers, that can holds us back from making the changes needed for a healthier and more balanced life. Listen to this podcast and be inspired by this out-of-the-box conversation about neuroscience, mental health and mindfulness.”
My friend Nelson (not his real name) was depressed.
Depression frequently came in and out of Nelson’s life, but this last bout was the worst.
Severe job stress compounded by issues with his relationship sent Nelson into a downward spiral, leaving him broken, sobbing and exhausted after engaging in the simplest of tasks.
Sadness and a feeling of doom rushed in to greet him at the end of each sleepless night. Nelson gained weight, despite never truly feeling hungry. His face appeared sunken and swollen. Despite sleeping 14 hours a day, dark circles hung under his eyes.
Since focusing and concentrating on work was impossible, he asked his psychiatrist to help him apply for mental health leave. Nelson was granted sick leave, as well as a prescription for Effexor, and a recommendation to get as much rest as possible.
After a year, Nelson felt worse. When rest and the medication weren’t working, he started exercising vigorously. He hired a nutritionist who cleaned up his diet, and he started taking fish oil and a B complex, among other supplements.
Even then, he still struggled. The hopelessness was still there. Returning to work at this point seemed impossible.
Nelson opened up to a friend about his struggles.
“I went through a similar thing a few years ago,” Nelson’s friend confessed. “And the thing that helped the most was micro-dosing.”
Micro-dosing, taking small doses of psychedelic substances, like LSD or psilocybin-containing “magic” mushrooms, entered the public consciousness in early 2015, after James Fadiman, PhD and author of The Psychedelic Explorer’s Guide, appeared on the Tim Ferris Podcast.
It involves taking a “sub-perceptual” dose of a hallucinogen, like LSD or Psilocybe cubensis “magic” mushrooms, that contain the hallucinogen psilocybin. A sub-perceptual dose means that, while these substances still exert effects, they don’t produce a noticeable hallucinogenic “high”.
According to Paul Austin at the The Third Wave, people micro-dose for two main reasons: to remove negative mood states, such as depression, anxiety, PTSD, addiction, and ADD; and to increase positive mood states such as flow, creativity, improved productivity and focus, and sociability.
Micro-dosing has been used experimentally in individuals trying to quit smoking and to heal depression.
After listening to the podcast and reading some of the articles his friend sent him, Nelson managed to obtain capsules containing 200 mg of dried psilocybin mushrooms. Procuring these substances is still illegal, but Nelson figured he had nothing to lose.
When I caught up with Nelson, he was already a few weeks into his micro-dosing regimen. I asked him how he was doing.
“I’m actually feeling better than I have in months,” he told me, smiling. “I’m not passing out on the couch anymore. I wake up at 7 every morning without an alarm. I feel optimistic for the first time in months. And it seems to be consistent!
“This week I’ve managed to attend three social events and I seem… more motivated. My workout game improved too. Also, I’m not sure I’m ready to go back to work just yet but I’ve noticed my motivation has picked up. So much so that I’ve started taking free programming courses online. I—I can’t really believe it.”
Research on Psychedelics for Depression
Unfortunately, we can’t draw any sound conclusions from Nelson’s experience; scientific data from randomized control studies is still lacking. However, the growing collection of anecdotes on the benefits of micro-dosing for mental health and well-being has caught the attention of researchers.
Thomas Anderson, a PhD candidate at the University of Toronto, polled almost one thousand participants on social media channels and message boards, like Reddit, to gather some initial data on the benefits and drawbacks of micro-dosing hallucinogens.
The micro-dosers that Anderson and his team polled reported higher levels of creativity, and improved mood and focus. They claimed to notice a reduction in depression and anxiety symptoms, increased motivation to eat right and exercise, cognitive enhancement, improved self-efficacy and heightened social functioning.
They reported that the main drawback they experienced was obtaining these substances, which are currently illegal in The US and Canada.
Although interesting, this self-reported data isn’t hard science. To increase objectivity, Anderson and his team presented the participants with tests of creativity (finding out how many uses they could find for common objects, for instance) and questionnaires that measured wisdom. The micro-dosers scored high on both these metrics. They also scored lower in tests that measured negative emotion.
Anderson and his colleagues plan to publish these preliminary findings in a series of papers. They are currently in the process of obtaining Health Canada approval for a controlled study.
Psychedelic research was terminated in the 1960’s, leaving a massive knowledge gap of their therapeutic potential. But now, with the publication of Fadiman’s Psychedelic Explorer’s Guide and Michael Pollen’s even more recent How to Change Your Mind, psychedelics are receiving a fresh surge of interest, particularly for their mental health benefits.
One of the prominent names in this new-wave research community is Robin Carhart-Harris, PhD, at Imperial College London, who is investigating psilocybin as a treatment for severe depression.
Published in a 2016 issue of Lancet Psychiatry, Carhart-Harris administered two doses (one small and one moderate) of psilocybin, spaced one week apart, to twelve patients with Major Depressive Disorder. The doses were administered in a controlled, therapeutic setting, and symptoms were rated immediately after therapy, and then again at one and three months.
The study results were remarkable. Five of the twelve patients dropped from “severe depression” to “no depression” immediately after receiving the second dose. All of the study participants experienced an overall reduction in symptoms with five of the study participants remaining depression-free after three months.
Roland Griffiths, Phd, at John Hopkins, is involved in a number of studies examining psilocybin’s ability to induce mystical experiences in terminally ill patients.
In a 2016 randomized, double-blind, placebo-controlled crossover trial published in the Journal of Psychopharmacology, he and his team found that administering high-dose psilocybin to terminally ill cancer patients increased mood, quality of life and optimism, and decreased death anxiety. These benefits were sustained at the six month follow-up. Over 80% of the study participants claimed to experience greater life satisfaction and feelings of well-being.
How Psychedelics Work to Boost Mood
LSD, psilocybin, and other psychedelics, work like serotonin in the brain by acting on serotonin receptors, specifically the 5HT2A serotonin receptors.
Like psychedelics, anti-depressant medications, like SSRI and SNRI medications (Selective Serotonin and Selective Serotonin and Norepinephrine Re-uptake Inhibitors), Cipralex and Effexor, respectively, also work on serotonin pathways. However, these medications’ effects are limited: some people improve on them, while others feel no different, or even worse.
SSRI and SNRI medications activate 5HT1A receptors. According to Carhart-Harris, this makes a difference. In his paper on the “Bipartite Model of Serotonin Signalling” he proposes that these receptor pathways help people cope differently.
5HT1A receptors, acted on by anti-depressants, help with “Passive Coping”. They help individuals with depression tolerate the stress in their lives, be it a toxic work environment or destructive relationship—nothing has changed about the situation, you can just deal with it better.
Psychedelic stimulation of 5HT2A receptors activate pathways involved in “Active Coping”: identifying and directly addressing sources of stress. Active coping might mean asserting boundaries at work or applying to new jobs. It might look like ending an unhealthy relationship.
In other words, 5HT2A receptors stimulate neural pathways that reveal previously elusive solutions to problems. They do this by increasing a chemical called Brain-Derived Neurotropic Factor, or BDNF.
BDNF promotes the growth of new brain cells and neural pathways in the brain. These processes, called “neurogenesis” and “neuroplasticity” , are essential for learning, creativity and memory. Research shows that increased neuronal plasticity benefits mood.
Psychedelics also work by disconnecting the brain’s Default Mode Network. The Default Mode Network, or DMN, connects frontal areas of the brain, such as the Medial Prefrontal Cortex, with lower brain areas like the Posterior Cingulate Cortex.
When we’re daydreaming, stuck in traffic, sitting in a waiting room, or otherwise not actively engaged in a mental task, our DMN lights up. In these quiet moments, we lapse into a state of reflection and self-referential thinking. In other words, our minds wander.
If we’re in a good mood, this mind-wandering creates narratives, daydreams and fantasies about the future. If we’re depressed, it leads to rumination, negative over-thinking, and self-criticism, which worsens mood.
Disrupting the DMN allows old thought patterns to fall away, opening up novel possibilities.
Activating Flow States
Shutting off the DMN can help us enter a state of Flow. Flow states occur when we are completely immersed in an activity so worthwhile that our sense of time and self cease. When in flow, we toe the limits of our talents, making these states incredibly rewarding and enriching. They are the antithesis to depressive and anxious mood states.
Psychedelic substances, along with other practices like meditation, help put us in a state of flow. These states are characterized by elevated levels of serotonin and dopamine and calming and focussing alpha brain wave oscillations. When in them, we become capable of incredible things.
In The Psychedelic Explorer’s Guide, James Fadiman writes about “Clifford”, a premed student. Clifford shares,
“I was taking a biology course to prepare for medical school, and we were studying the development of the chick embryo…I realized that in order to stay alert, a tiny dose of LSD could be useful.
“With that in mind, I licked a small, but very potent, tablet emblazoned with the peace sign before every class. This produced a barely noticeable brightening of colours and created a generalized fascination with the course and my professor, who was otherwise uninteresting to me.”
Due to some health issues, Clifford ends up missing the final exam. His professor agrees to a make-up. Before the exam, Clifford pops the rest of the now-tiny LSD tablet into his mouth.
The make-up exam consists of drawing the complete development of the chick from fertilization to hatching—the entire course.
“As I sat there despondently, I closed my eyes and was flooded with grief. Then I noticed that my inner visual field was undulating like a blanket that was being shaken at one end. I began to see a movie of fertilization!
“To my utter amazement, I was able to carefully and completely replicate the content of the entire course, drawing after drawing, like the frames of animation that I was seeing as a completed film!
“It took me an hour and a quarter drawing as fast as I could to reproduce the twenty-one-day miracle of chick formation. Clearly impressed, my now suddenly lovely professor smiled and said, ‘Well, I suppose you deserve an A!’ …the gentle wonder of life was everywhere.”
While impressive, Clifford’s account, like Nelson’s, is merely an anecdote. Far more research is warranted.
Micro-Dosing for Mood
Micro-dosing allows individuals to tap into the 5HT2A receptor-stimulating, BDNF-increasing, DMN-uncoupling, and flow state activating benefits of psychedelics, without the mind-stabilizing effects.
At a sub-perceptual doses there are no weird colours and visuals, alternate realities, or ego deaths. Micro-dosers report that the world merely appears brighter, or that they feel “sparklier”—they experience greater well-being. Otherwise, they can proceed with their lives normally.
Fadiman’s micro-dosing protocol consists of taking a tenth of a full dose, about 10 to 20 mcg of LSD, or 200 to 500 mg of dried-weight psilocybin mushrooms, every three days. This means that if the first dose is taken on Monday (Day 1), then the second dose is taken on Thursday (Day 4). According to Fadiman, spacing doses avoids tolerance, keeping the doses effective.
Participants are encouraged to engage in their daily activities: working, eating, sleeping and exercising normally.
Fadiman recommends participants keep a record of mood, cognition, motivation and productivity. People often report that they feel the best on Day 2, the day after taking a micro-dose.
Drawbacks to Micro-Dosing
In my role as a naturopathic doctor, I can’t recommend or counsel on the use of psychedelic substances for the treatment of any health condition. While the scientific interest in their use as therapeutic agents is growing, these substances are illegal to obtain and possess, and there is a lack of solid research on their safety and efficacy.
As of right now, the only way to legally access psychedelic therapies is through research. MAPS, the Multidisciplinary Association for Psychedelic Studies, often lists recruitment opportunities for ongoing studies. Thomas Anderson, at the University of Toronto, is in the stages of obtaining Health Canada approval for a randomized control trial on the benefits of micro-dosing in healthy volunteers.
Like all therapies, there are risks to taking these substances, even at low doses. While LSD and psilocybin confer a low risk for addiction and are ten times less harmful than alcohol (the harm scores of LSD and psilocybin are 7 and 5, respectively, compared to 72 for alcohol), they are not completely benign.
Psychedelics can aggravate schizophrenia, psychosis, dissociation, severe anxiety, and panic. They can also interact with medications and supplements that act on serotonin pathways. Their effects at high doses can be disorienting and oftentimes unpleasant: in the studies that showed positive benefit, they were administered under careful supervision, in a therapeutic set and setting.
Our society’s mental health is in crisis. As a clinician who focuses on mental health, I am always excited to learn of new therapies that have the potential to heal mood. With Canada’s 2018 legalization of cannabis, gateways are opening for future uses of psychedelics as medicine. Perhaps with more research and advocacy, we’ll one day see micro-dosing of psychedelic substances as a safe and effective mainstay therapy for promoting mental and emotional well-being.
An interview outlining my adventures providing free naturopathic medicine to street youth at the Evergreen Yonge Street Mission health centre, originally featured in Pulse, a publication for members of the Ontario Association of Naturopathic Doctors.
What is the Evergreen Yonge Street Mission?
On the fourth Friday of every month, I leave my Bloor West Village practice for a few hours and head down Yonge Street.
Just south of Gerard, I stop at a rather unimpressive-looking building tucked between fast-food restaurants and strip clubs, where an admittedly intimidating crowd of young people are smoking and laughing loudly, hoodies drawn.
I nod to them briefly before heading past them, through a glass-paneled doorway.
The entrance is crowded. Youth and tattooed counselors blast rap music out of large headphones. Some of them have notebooks, writing lyrics.
Beyond them is an open area where food is being served; more young people sit at round tables, finishing hot catered lunches, or drinking coffee. A few are involved in some community project or other, conspiring excitedly in groups. Everyone seems to be embracing a perplexing combination of busyness and inertia.
I smile at them and rush downstairs to the basement, past the career centre to the unglamorous health centre where my tiny office is located.
The Evergreen Yonge Street Mission (YSM) is a drop-in centre for street-involved youth aged 18 to 24 that offers afternoon programming, including a hot lunch, career services, daycare, community-based art projects, and drop-in healthcare centre.
The health centre is run by nurse practitioners and staffed by volunteer health professionals: adolescent health specialists, family doctors, Sick Kids residents, dentists, hygienists, acupuncturists, chiropractors, physiotherapists, social workers, psychiatrists and, of course, two naturopathic doctors, Dr. Leslie Solomonian, and myself.
Youth drop in during health centre hours and sign up for 30-minute appointments with the practitioner of their choice.
How did you start working with the Mission?
I first visited the Evergreen YSM for a launch party for the second issue of Street Voices, a magazine for and by street-involved youth. A friend of mine had volunteered to do most of the graphic design and illustration work for the issue and brought me along.
At the party, while eating tiny sandwiches, I noticed a message board advertising YSM services. Naturopathic medicine was listed under health services provided at the centre. I took down the number of the health centre, and gave them a call the following week.
By February 2015, I was volunteering two Fridays a month.
Why did you decide to get involved with the Mission?
I came across Evergreen at the beginning of my naturopathic career. I’d just obtained my license in 2014, and was looking for a way to balance the cost of living and running a practice with providing access to naturopathic services.
Naturopathic medical services have the potential to be very cost-effective; our profession was built on the foundations of clean air, food, and water as vehicles for healing. Nature cure, lifestyle therapies, and in-house treatments like acupuncture can all be very inexpensive to administer.
Unfortunately, the cost of education, licensing fees, and practice overhead all conspire to bring up the cost of naturopathic services, making it difficult for those without third-party insurance coverage to afford them.
When I first started my practice, I tried to find various solutions to this problem. I dabbled in sliding scales but quickly started to notice burnout and resentment polluting my therapeutic relationships. Separating cost, value and worth, while accurately assessing need, complicated things for me—I found it very difficult to lower my rates while still recognizing the value I was offering.
Dispensing with sliding scales at my main practice while offering free services to a marginalized population felt like a satisfactory compromise: I could build my practice, pay for my groceries, and give back, while maintaining clear boundaries.
What type of naturopathic care do you provide at the YSM?
There are a few ways that my YSM practice differs from my practice in Bloor West Village.
Firstly, visits are shorter. The YSM suggests keeping visits to 30 minutes to serve as many patients as possible. Keeping visits short is a challenge for me, considering appointments in my Bloor West practice run 60 to 90 minutes.
Secondly, therapeutic options are limited. Patients don’t have the cash to buy supplements. Making significant dietary changes is impossible for most to tackle. Therefore, I try to offer therapies in the clinic: acupuncture, B12 shots, homeopathic remedies, and counseling, to reduce the work between appointments.
Sometimes we have supplements to dispense—Cytomatrix generously donated last year. At times we’ve been able to offer things like magnesium, vitamin D, iron, immune support, adaptogens, and sample packs of various probiotics.
Treatment plans often require a bit of innovation. For example, I teach patients how to use the probiotic samples to make coconut yogurt using canned coconut milk from food banks. We talk about how to follow an anti-inflammatory diet while eating at a shelter.
Thirdly, there are many obstacles that prevent patients from attending appointments in the first place. I try to treat each visit as a stand-alone encounter—a new patient I see at Evergreen may never come back. This means I focus on stress-reduction and providing as much benefit as possible in the 30-minute session.
What does a typical visit look like?
Visits can differ greatly depending on the particular needs of the patients I see.
Sometimes new patients come in asking specifically for trigger-point release acupuncture.
One patient came in with her friend so they could Snapchat their first acupuncture session amidst violent giggling.
Some patients come to talk about their struggles and share their stories.
Sometimes patients come in to read me their rap or poetry.
Sometimes patients just come in to sleep—the flimsy chiropractic table we use serving as a quiet, 30-minute refuge from the street. Sometimes we do a mindfulness practice. Other times we say very little, or nothing at all.
Others come for full intakes, with complicated psychiatric cases, or PCOS, or chronic diarrhea. I try to hand out any supplements that might be useful, and to give practical recommendations.
Sometimes patients with part-time jobs have a little money that they can spend on things like St. John’s Wort, magnesium, or vitex.
I have to be extremely economical with my therapies, which I feel is a helpful skill to have as an ND in general—I learn what simple treatments have the biggest impact on certain conditions. This helps me resist the temptation of loading patients down with complicated, expensive treatment plans.
What are some strategies for working with this population?
When working with street-involved youth, I’ve found it helpful to humbly take a step back and listening first before jumping in with solutions.
A de-centred practitioner posture can be particularly helpful in a population experiencing homelessness, violence, complex trauma, addiction, teen pregnancy, abuse, conflict with authority, and severe psychiatric illnesses, among other complex challenges—it’s not always clear what to do, what might best help the individual in front of me, and deferring to their experience is often the wisest first step.
De-centring positions the clinician as a guide, facilitator, or someone of service to the patient. This means that I offer my tools: an ear, acupuncture, vitamin D, or a sanctuary of silence, and let my patients choose whatever they want for their 30-minute appointment.
Another helpful skill is being interested in all my patients’ stories, even the ones that aren’t being told about them.
In Narrative Therapy this is called “double-listening”. Accompanying every story of illness, addiction, label of mental illness, or history of trauma, is a parallel story of strength, courage, generosity, and overcoming tremendous obstacles.
I can be a witness to the alternative stories, which are often begging to be told.
Sometimes addiction, self-harm, or other seemingly “destructive” behaviours, may be hidden coping mechanisms that serve as powerful lifelines for survival. Listening between the lines can highlight certain skills and strengths of those who suffer.
A mentor of mine, when faced with an “angry” client, always asks, “What are you protesting?” With that simple reframing question she often uncovers previously hidden stories of belief in fairness, advocacy for justice, courage, and resilience.
Patients tell me about their issues, but also about their beloved pets, how they wish they could be a better father to their children than their fathers were to them, family loyalty in the face of abuse, their dreams for the future, the steps they’ve taken to confront a friend’s addiction, their hopes for a healthier romantic relationship, and many other stories. These narratives depict the complex facets of their identities: street-youth, yes, but also loving parents, friends, budding entrepreneurs, and gifted artists.
One patient who’d recently been diagnosed with schizophrenia told me about the voices in her head. I asked her what the voices said when they spoke to her.
She looked at me, stunned.
“No one’s ever asked me that before.”
This question led us to an important discussion about how she’d turned to writing poetry and her faith to help her stop using methamphetamine. The voices, while often unpleasant, were keeping her sober in their own complex way, she realized.
Through paying careful attention to these stories, patients can reframe and foster preferred identities.
Do you have any stories in particular?
There are many stories of resilience at Evergreen. I have had the opportunity to watch one of my patients transform his life over the past couple of years.
With a criminal record for assault, anger management issues, difficulty holding a job, a mild learning disability, and a history of complex trauma, this individual picked up the pieces of himself, slowly.
The last time I saw him he had completed a yoga teacher training, begun classes at U of T, and was getting ready to move out of the shelter he’d been living in, into his own small apartment.
Through his own remarkable resilience, and some support he was able to receive at Evergreen, he was able to get himself onto an amazing and exciting path. Seeing potential realized is an amazing experience.
Like tending to a garden of souls; you might help plant seeds, or tend to the soil in very simple, minimal ways, and yet amazing things bloom.
What benefits has this work brought to you as an ND?
I believe working with diverse populations enriches practitioner experience. It reminds me to stay open to experiences, personalities, viewpoints, and unique patient histories.
Listening helps me calm the “righting reflex”: the reflex to jump quickly to a solution in order to soothe my own discomfort of sitting with the agony of uncertainty.
I notice in my own practice when I take a more de-centred stance, roll with resistance, and really pay attention to my patient’s preferences and intuition, I am better able to assist them in healing. Not only does letting the patient take the lead result in better outcomes, it also reduces the burden of (impossible) responsibility by shifting the locus of control, preventing burnout.
I struggle with this in my own practice at times; I frequently feel pressure to prove myself. Working at Evergreen helps remind me that we can’t necessarily help everyone for everything in every circumstance.
All of our patients surpass incredible external and internal obstacles to arrive at our offices and face still more difficulties between visits. Trying to recognize and work with these struggles as best we can, taking small but meaningful steps in and between visits, and acknowledging that sometimes it’s about planting seeds of change, which may take months or even years before they’re ready to bloom.
No matter how impatient I might be feeling with a patient’s progress, I try to remember that steps are constantly being taken in the direction of healing.
What are some challenges?
Like any novice practitioner I am accompanied by two familiar acquaintances: self-doubt and second-guessing. These two friends take their place beside me both in my Bloor West practice and at Evergreen.
Celebrating small victories has been important, but so has staying humble. As the mantra goes: the patient heals them-self.
I try to remember this when I’m either feeling too self-congratulatory or too down on myself.
Funding for supplements, energy, avoiding burnout, and being productive with time, are all familiar challenges I also routinely experience.
I always wish I had more time, better and more exciting remedies to dispense, and more energy to really immerse myself in the dedication community work demands.
I try to take the stance of simply being of service while trying to remain free of expectation.
How can other NDs wanting to do similar work get involved?
If you’re interested in working with marginalized populations, the first thing to do is get in touch with local shelters, such as Covenant House or Eva’s Place.
Many shelters offer satellite health services, such as massage therapy. Perhaps start by offering acupuncture, or other forms of bodywork. Acupuncture is an accessible modality that is cost-efficient and fits well with a drop-in model—patients derive benefit from the session and aren’t expected to make significant lifestyle changes or purchase supplements, both of which may be impossible.
Often stress-relief is the first primary goal of care, as is creating a safe space and nurturing trust between the clinician and community.
If you’re willing to offer your services for free there are many populations in Toronto and the GTA that could benefit greatly from naturopathic care.
How can we help?
The YSM is currently accepting donations to help build their new location, and complete their new health centre. Visit https://www.ysm.ca/donate/ to make a one-time, or monthly donation, and help a great cause.
If you would like to donate supplements, acupuncture needles, homeopathic, or herbal remedies please contact me!
Estrogen levels in the brain and body affect our brain’s levels of dopamine and norepinephrine, two neurotransmitters that are implicated in mood disorders like depression, psychosis and anxiety.
Our brain has several built-in recycling processes to keep us level-headed. When neurotransmitters (brain chemicals that have mood-regulating effects) are finished with their tasks, enzymes recycle them, breaking them down into their chemical parts to be reused again at a later date. This process controls the level of chemical nervous system stimulation in our brains and keeps our moods regulated.
You’re at home, late a night, working on an important assignment, driven by the excitement of the topic at hand. Your brain is flooded with dopamine, a brain chemical that is connected to positive mood and motivation, pleasure and reward; dopamine pathways are activated when we’re engaged in a task that is pleasurable and rewarding, when our lives are flooded with meaning and we’re working towards a goal. Dopamine, however can also be connected to psychosis, conditions like schizophrenia and bipolar disorder, and also be linked to impulsive behaviour, aggression and irritability, when over-expressed.
Typing happily, you near the end of your assignment. Suddenly, your computer screen goes dark. Your heart begins to race, your skin prickles and you’re overtaken by anxiety, panic and fear. Your body is releasing norepinephrine, a chemical connected to stress, anxiety and the “Fight or Flight” response, but that also allows us to feel alert and energized. Your heart pounds as your reboot your computer. You are hyperaware of the sounds and smells around you. Your skin prickles and your breathing is loud and rapid.
You exhale with relief as your computer screen lights up again, revealing that your assignment is unharmed. Stress drains out of your body, and your norepinephrine levels fall. You begin to tire; it’s time for bed. You add some finishing touches to your work, hit “save” and turn in for the night. The stress and motivation you felt only hours before dwindle, as the neurotransmitters responsible for these responses are swept out of your synaptic clefts and recycled.
When our brains have had enough stimulation of dopamine (mood, reward, pleasure, but also aggression, irritability, impulsivity and psychosis) and norepinephrine (stress and anxiety, “Fight or Flight”, but also alertness and energy), both get recycled through COMT, which pulls them out of circulation, breaks them down into their chemical parts, and reassembles them for later use.
We all have variability in how fast our COMT enzyme works, based on the expression of the COMT genes in our DNA. Some of us have slower COMT genes, meaning that our brain levels of dopamine and norepinephrine tend to be higher than other people’s, as our ability to clean up and recycle these hormones is slowed. This might result in an individual (depending on other genetic and lifestyle factors) who is at a higher risk of mental health conditions like psychosis or bipolar disorder, or someone who is more irritable, prone to aggression, or stress intolerant.
Others have more COMT gene expression, resulting in a faster enzyme that clears dopamine and norepinephrine more quickly, resulting in lower brain levels of these neurotransmitters. If other factors are present, these individuals may be more at risk for mental health conditions such as depression, low mood, lack of motivation, or susceptible to addictions.
Beyond genetics, there are several environmental and biological factors that may affect the speed of the COMT enzyme. One of these factors is estrogen. Estrogen slows the COMT enzyme down by as much as 30%. This means that when estrogen levels are high (seen in many women around ovulation or premenstrually, or in women with generally high estrogen levels, termed “Estrogen Dominance”, COMT performs more slowly and dopamine and norepinephrine levels remain elevated.
Depending on the extent of the problem, women with high estrogen often experience anxiety and irritability and a low tolerance for stress. On the more severe end of the spectrum, some women experience conditions such as PMDD (Premenstrual Dysphoria Disorder) or PMS-induced psychosis, resulting from abnormally high brain levels of dopamine and norepinephrine due to high estrogen. These conditions probably result from a combination of high estrogen, slowed COMT and other genetic and lifestyle factors. Xenoestrogens from environmental toxins, or birth control pills may also slow COMT and further exacerbate some of the symptoms of estrogen dominance.
Conversely, women with lowered levels of estrogen, such as those with amenorrhea (missed menstrual cycles) from various causes—PCOS is one, so is the birth control pill, especially progestin-only pills, or hormonal IUDs—or women who are peri-menopausal or menopausal, will have a faster COMT enzyme. This means that dopamine and norepinephrine will be cleared from the brain more quickly. Low levels of these neurotransmitters may result in depression: low mood, low energy and lack of motivation. On the extreme end, low levels of dopamine in the brain may result in conditions like Parkinson’s. Currently, research is being done on estrogen-replacement therapy as a treatment for Parkinson’s because of its ability to increase brain dopamine levels through slowing COMT.
When it comes to birth control pills, which are combination of synthetic estrogen and synthetic progesterone (“progestins”), or just straight progestin, either in pill-form or in a hormonal IUD, effects can be unpredictable. There is evidence that oral contraceptive use, especially progestin-only contraception, can exacerbate anxiety and depression, especially in teens. The pill acts by suppressing ovulation and suppressing natural hormone production, which may result in low levels of naturally-occurring progesterone and estrogen, which can slow COMT. However, the synthetic estrogens from the pill may interact with COMT, speeding it up in some women. Therefore the effects of specific forms of birth control on individual women is hard to predict; if functional medicine and genetic research tells us anything, it’s that there is no one-size-fits-all when it comes to striking the right hormonal balance.
Estrogen also has effects on another enzyme, called MAO-A, that recycles serotonin, the “Happy Hormone”, often implicated in depression and anxiety. Like COMT, estrogen slows down MAO, reducing the speed at which the body breaks down serotonin, resulting in higher brain serotonin levels. Drops in estrogen around and before a woman’s period, or low estrogen levels, may result in feelings of depression. Many women report feeling depressed and craving carbs and sugar around their periods. This is often related to a drop in serotonin as estrogen levels fall right before menses. Drops in serotonin levels due to drops in estrogen levels after childbirth may explain postpartum depression, according to some researchers.
The link between estrogen and its effects on COMT and MAO hint at the complexities of the body and brain’s hormonal milieu and its implications for hormonal regulation and mental health. Mental wellness is a complex state involving a variety of factors: hormones, enzymes and neurochemical pathways that are affected by our environment, our genetics and our hormonal predispositions. This is why I believe in taking a functional approach to mental health, seeing our mental health symptoms for what they are: symptoms, and making efforts to uncover underlying causes rooted in lifestyle, genetics and our environment. I believe the way to address symptoms is to trace them back to their source.
For many women, treating depression, anxiety and stress-intolerance may involve balancing estrogen levels and healing the menstrual cycle. For others it may involve supporting genetic susceptibilities with lifestyle changes, finding a birth control method that balances (or coming off entirely), and reducing exposure to xenoestrogens, supporting estrogen detoxification pathways, and addressing women’s health conditions such as irregular menses, and conditions like PMS, fibroids, endometriosis and PCOS.
Certain amino acids, when taken therapeutically, can affect our body’s ability to produce neurotransmitters that can greatly impact our mental and emotional health. These therapies can help treat depression, food addictions, alcoholism, psychosis and anxiety, among other things.
Transcript:
Hello, everybody, my name is Dr. Talia Marcheggiani. I am a naturopathic doctor and I work in Toronto and I focus on mental health and hormones, especially women’s hormones.
Today I want to talk to you guys about amino acid therapy and amino acid supplementation in preventing cravings, particularly for substance addictions or sugar addiction, but also for improving our mood and mental health and for treating specific psychiatric conditions.
Amino acids are the building blocks of protein. If you think of a string of beads, amino acids are the individual beads that get connected in a string and then folded up into the proteins that make up our body. Our body is basically just a hunk of protein and water. And these proteins set the stage for all of the chemical reactions, as well as the structure of our body.
When it comes to addictions and mental health conditions, there’s a lot of debate around what sets the stage for someone to experience addiction, or struggle with addictions throughout their life. And one of the things that gets a lot of blame, that also fits the pharmaceutical model, especially when it comes to depression and the prescription of serotonin re-uptake inhibitors, is this idea that mental health and addiction is something innate, that we’re born with and that needs to be corrected chemically with something like a drug like an SSRI. And we know that there’s obviously a genetic component to addictions and mental health and it’s certainly not the fault or moral failing in the person that’s suffering from these kind of things, but we also know that our genes don’t write the entire story of our experience and that, for many people, there’s lifestyle changes that can really influence genetic predispositions.
So a study that was done in rats who had a built-in genetic predisposition to addiction, to cocaine addiction, particularly, because they had a deficiency in a hormone called “dopamine”, or issues with their dopamine synthesis, and cocaine is a really potent stimulator of dopamine, which is kind of like a pleasure and reward hormone, or neurotransmitter, in our brains. These kinds of rats that were treated with amino acids, they didn’t display addictive behaviours, so they were essentially cured and their genetics were no longer relevant in terms of how they were acting out, or their behaviour, which is really promising because it was just amino acid therapy.
So neurotransmitters are hormones that work in our brain; they’re produced and act in the brain. Well, we know now with more research, I mean that’s the traditional definition of neurotransmitter, but from more research we’ve found that there’s evidence for the gut producing certain neurotransmitters like serotonin. So you can watch another video where I talk about the gut and how important it is to have a healthy gut when it comes to managing mental health, especially in depression and anxiety.
There’s a few neurotransmitters that are really, that really influence our behaviour and our mental health status and so the first one I already mentioned is dopamine, which gives us that sense of reward and gives us a sense of pleasure. So, dopamine is active when you’re doing something that is really internally motivating. You’re engrossed in a task. In terms of addictions, it’s that seeking behaviour. So a lot of people will experience pleasure in seeking out their substance of choice or thinking about indulging in sugar when they get home from work. So, that’s dopamine, that’s sort of our—the pleasure that we get from acting in the world and it definitely runs part of the show when it comes to addictions.
To quote another study in rats, so dopamine is really prevalent in our hypothalamus and so, with rats, you can give them a lever where they can direct cocaine directly into that area, and so it gives them a giant hit of dopamine. And rats that are given that option, will choose that option over food and so they’ll just stimulate their brain until they die. They’ll drink some water here and there but most of the time all they do is stimulate their dopamine. So that’s how pleasurable it is. It’s pretty much the influence of how we behave in the world and what goals we set for ourselves in the world as well. It’s how we get our delayed gratification, it’s how we work towards pleasurable tasks and how we engage in things like study or work goals or things like that.
Another neurotransmitter, serotonin, which I’ve talked about before, and that’s what the SSRIs, so selective serotonin re-uptake inhibitors are working on. And those are the most widely prescribed psychiatric medications. And that’s the hypothesis that people with depression and anxiety have a deficiency in serotonin: just this kind of innate serotonin deficiency where they either don’t make enough or they’re metabolizing it more quickly than other people. So serotonin is kind of our happy hormone, that’s what gives us a sense of well-being and pleasure. And, there’s no evidence for this hypothesis, however know that through stimulating serotonin pathways, to an extent, we can get some favourable outcomes. We also know that SSRI medications deplete serotonin, and that there’s a connection between serotonin and sugar addictions, because eating sugar will increase serotonin. So a lot of women with sugar cravings during PMS. So a couple of weeks, sometimes up to two weeks before their periods, some women will get really intense cravings for sugar and carbs, and that’s indication of a fall in serotonin before their period, which is causing them to seek out these things to boost their serotonin levels. And that can be treated with amino acids.
And then a third is acetylcholine. So acetylcholine is involved in memory and cognition and sort of that feeling of being engrossed in a task. Not so much involved in pleasure, but in our ability to stay focussed and to concentrate.
A fourth neurotransmitter is called GABA. GABA suppresses our nervous system. So, this is relevant in people with anxiety and this is what the drug class benzodiazepines work on, is GABA receptors. So, in our limbic system, GABA kind of calms down that fight or flight, or that fear state in our body. And oftentimes people who have a heightened nervous system or stress response could use some GABA to calm them down.
So there’s a few amino acids that work on these neurotransmitters. So these neurotransmitters are built with an amino acid backbone. By giving these amino acids, we’re kind of like—if you think of all these neurotransmitters assembled on a factory line, the amino acid is the starting point. So if you’re giving a lot of the supplies, then you’re more likely to cause in increase in production of the thing that you’re increasing the supply for.
We also know that there can be deficiencies in amino acids and therefore, if there’s a shortage of supplies for the key ingredients for the things you’re producing in a factory, you’re not going to get the end result because there’s just not enough of the raw materials to make what you’re trying to make.
So, we can have things like serotonin deficiency not so much because there’s a genetic predisposition, or an issue with the brain’s ability to metabolize it or make it, but maybe that there’s a deficiency in the amino acids, or the vitamins and minerals that are needed to create serotonin.
When it comes to naturopathic medicine and functional medicine, we kind of look at this. We try and see how we can influence the body’s biochemical pathways to get more of what we’re noticing is lacking. And so one of the ways that we can find out which neurotransmitters are lacking is by running some functional tests. That’s not really a big part of my practice because of the cost involved in that, but we can tell a lot through symptoms. So we can tell a lot by asking, are people getting sugar cravings, what’s their drug of choice, are they heading towards cocaine or are they calming their nervous system down and stimulating their GABA pathways with alcohol. Are they trying to get that pleasure sensation with something like heroin? Are they going for stimulants or central nervous system depressants? So, based on what someone is addicted to, or looking at and really breaking down their addictive behaviours, we can find out more about which neurotransmitters might be off. And in a lot of cases there’s a deficiency in many of them.
One of the first things to recommend, just generally, is to increase more protein in the diet, because we know that these amino acids are contained in proteins. And, strangely enough, we don’t get a lot of high-quality protein in our diet in the Standard American Diet, so you think of a bacon and eggs breakfast and McDonald’s lunch and you’re like, ‘well, there’s protein in those foods…’ But, in something like eggs, we’re only getting about 6 grams of protein an egg, whereas I recommend more like 20 to 30 grams of protein in the morning for breakfast. And the reason for this is, of course, to just increase the amount of amino acids that your body can then use to make neurotransmitters, but also to keep blood sugar stable, because drops in blood sugar are going to cause stress hormones to be released and potentially for these neurotransmitters to be altered, worsening addictions, especially addictions to sugar and alcohol, which boost our blood sugar.
So the first thing, dopamine, that amino acid that creates dopamine is tyrosine. So, for some people, and tyrosine is a very stimulating amino acid, so people that kind of have that 2 pm slump, sometimes benefit with some tyrosine, or tyrosine in the morning when they’re feeling really low. And so these people kind of suffer from boredom, they really like stimulants, so they’ll do the caffeine, or they’ll use cocaine on the weekends, or they’re really involved in pleasure-seeking behaviour like, maybe they had a diagnosis of ADHD as a kid, or adult-onset ADHD, which is more involved in traumatic experiences and mental health and neurotransmitter imbalance than it is some genetic predisposition.
Sometimes with these people, supplementing with tyrosine can help, just give them that dopamine boost and keep their nervous system more stimulated so that they don’t need to stimulate it with substances.
For serotonin, the building block is l-tryptophan, which is then made into something called 5-HTP. So some naturopaths will prescribe l-tryptophan as a supplement, I tend to go more with 5-HTP because it passes a step so that your body has to do less work. 5-HTP is really great to help with sleep. It’s good to help with boosting mood, to a certain level, and it’s also really great for PMS sugar cravings, and alcohol cravings. I find myself, personally, so this Christmas I’m going sugar and alcohol free. I’ve been sugar and alcohol free for a few months, but I’m going to carry that on through the holidays, so I’ve had to turn to 5-HTP before my period because I realized how many sugar cravings I get before then. And, miraculously, just with a few hundred milligrams of 5-HTP, I’ve noticed a giant change in the foods that I was craving and in my ability to hold off on having sugar and alcohol. So, pretty powerful.
So, in order to make serotonin, 5-HTP also needs some B vitamins and magnesium. So, people that are deficient in things like B6 and B12 and folate, so I’m looking at vegetarians who often have B12 deficiencies, or vegans. And, actually I see a lot of B12 deficiency or suboptimal B12 in people that eat meat as well, so this isn’t necessarily something is only applicable to vegetarians.
But it’s important for a lot of people to supplement then with these other cofactors that help make serotonin, especially if they’re on an SSRI already. And I don’t advise just doing this on your own, it’s better to do this with a professional who can figure out what’s the underlying cause of a neurotransmitter imbalance and then help prescribe a comprehensive treatment plan that will get you to better neurotransmitter synthesis and treat your symptoms, or the underlying condition.
Something else that I find really helpful, and this is one of my favourite nutrients in psychiatry and in women’s health and something I take is something called N-acetyl cysteine, or NAC, “NAC”. And NAC is from the amino acid cysteine and it produces something called glutathione. So glutathione is the primary antioxidant in the body. This is what our body uses to neutralize all of the free radicals, that is kind of a buzzword—people will tell you to drink green tea, eat blueberries, to get antioxidants, well, the main antioxidant our body uses is something called glutathione, and NAC helps produce glutathione.
It helps our liver detoxify and, in hospitals medical professionals will give people intravenous NAC to treat Tylenol overdose, which we know is liver toxic, so it’s widely recognized that NAC can treat toxicity of the liver. It’s also a powerful antioxidant for the lungs so I prescribe it to patients who are smokers or recovering from smoking or aren’t really ready to quit smoking yet but are experiencing some of the bronchitis, the emphysema, or the increased phlegm or lung issues that go along with a chronic habit of smoking. So, it’s a powerful antioxidant and it has an affinity for the lungs and for excess mucus production. It also helps balance estrogen because of the liver detoxification, so it helps us detoxify estrogen through the liver, and is really helpful for a condition called polycystic ovarian syndrome, which is when the ovaries are producing testosterone and not responding to other hormones properly, so this is really helpful. It also helps with blood sugar balance. NAC’s the best. And so, there’s lots of research for NAC in things like bipolar disorder and schizophrenia and psychosis and OCD. So these more serious psychiatric conditions, NAC can really help balance. And we’re not sure exactly why but one of the hypothesis is that, because it creates glutathione, it helps lower inflammation, and we know that inflammation is implicated in mental health conditions and so that’s why NAC might be so useful. It doesn’t interact with psychiatric medications and so it’s a really big part of my practice.
New research has shown that NAC can help with addictions and cravings for things like nicotine, cannabis, food, so binge eating, cocaine and gambling, interestingly enough. And then there’s a new study that NAC can help treat porn addiction. So, it’s involved in helping lower that desire for, not necessarily substances, or food, but behavioural addictions as well, which is useful. And there’s studies in trichotillomania, so that’s like, compulsive hair plucking—so people will pluck their eyelashes or pluck their hair—or skin picking, and NAC can work pretty rapidly in bringing down those desires and stopping those behaviours.
GABA is something you also might have heard of. So, GABA was a neurotransmitter that I cited before, that calms the nervous system down. GABA, there’s debate about whether it crosses the blood brain barrier. So, our brain has this really tight wall that it prevents certain substances from crossing. That’s to protect our brain tissue from toxins and foreign objects, or foreign substances. So we’re not sure, necessarily, if GABA’s acting on the brain unless there’s a leaky brain situation happening, so kind of like leaky gut, we can also have that with our blood brain barrier. But there’s herbal combinations that help stimulate GABA, that I implement in my practice sometimes to help people that are experiencing panic attacks or anxiety, to get them to a level where they can then make the changes that are going to sustain them. So, things like valerian and hops, and passionflower and something that I prescribe a lot, kava, another herb called lemon balm. So, sometimes combinations of these, or just one of these things can help, especially before bed. And so, one of the indications for GABA deficiency is a craving for wine, especially at the end of the day, and particularly white wine. I guess it has more GABA-stimulating properties. I have a lot of patients, many of them female patients, that just really crave a glass of wine at the end of the day. And a few other patients that will have an after-work beer. So, just doing some GABA, or some GABA herbs, on the way home from work might be enough to decrease that need to reward and balance that nervous system, because the alcohol does have a GABA-stimulating effect and calms people down. It’s us looking for a way to self-medicate and trying to balance our neurotransmitters through the actions that we’re familiar with that don’t necessarily set us up for powerful health because they perpetuate further addictions, like turning to alcohol to calm ourselves back down, or as a reward and stress relief.
And the last neurotransmitter I’m going to talk about is something called l-glutamine. So, glutamine is a fuel for brain cells and for gut cells, as well as kidney cells. It’s another amino acid, it’s involved in creating the neurotransmitter glutamate, which is excitatory. So, this is something that increases our nervous system tone.
So, glutamine we prescribe as naturopaths a lot for leaky gut because it helps feed our enterocytes, or our gut cells, it can help repair them. So, somebody with celiac disease who’s experienced a lot of intestinal damage and has now taken out gluten, might need some glutamine, some l-glutamine to repair the gut cells that were damaged or increase that cell turnover so that they’re no longer experiencing symptoms.
L-glutamine has kind of got a sugary taste, but it doesn’t stimulate us like sugar does, and so one thing that people do when they’re experiencing sugar and alcohol cravings is to take some glutamine powder or open up a capsule of l-glutamine and let it dissolve under their tongue. And they experience a remarkable decrease in their sugar and alcohol cravings, those physiological cravings—the emotional cravings are another piece, obviously—but the physical cravings where our body is really asking for these foods, the l-glutamine can really help calm that down powerfully. So this is something that I’m going to experiment with myself and with some patients that I know could really benefit from this.
So I wanted to give this talk, just to give you guys some easy things to try over the holidays, especially when you’re experiencing some of those sugar or alcohol cravings or getting into a situation where your vices are playing out in excess. I know that this is going to be helpful for me, because of my commitment to no sugar or alcohol this holiday season, which is actually easier than it sounds. And one thing to note too, is that with amino acids, because we’re pushing pathways, they don’t work necessarily like drugs that can take, like an SSRI can take 4 to 6 weeks before it’s effect comes on. These work within days. So, when I was experiencing sugar cravings before my period last month, and I started to take 5-HTP, which remember stimulates serotonin, or helps us produce serotonin, and can help with sugar cravings, and carb cravings. When I started to take 5-HTP, I noticed this sense of well-being and uplifted mood within a few days and it was a noticeable effect, as well as deepened sleep. My sugar cravings immediately dissipated when I started taking it. So it took a few doses to eliminate my sugar cravings and then a few days to increase my mood, which I didn’t even realize was kind of falling, based on that serotonin deficiency before my period. So, these are really powerful therapies that you can try. I don’t advise doing it on your own, but seeking the help of a professional, but these are things that can really help balance brain chemistry during the holiday season and set you up for better mental health.
So, next talk I’m going to talk about leaky gut and leaky brain and how avoiding gluten can help with mental health conditions. So, have a great holiday, everyone and I’ll see you next time. My name is Dr. Talia Marcheggiani, and I’m a naturopathic doctor who practices in Toronto. If you have any questions give me a shout on my email at connect@taliand.com. Happy Holidays.
My mother tells a story about my childhood where she is standing in the kitchen, preparing dinner. I stand below her, tugging at her shirt, and begging for food.
“I’m hungry”, I say, according to her recollection of that moment and many others like it; she says that as a child I was always preoccupied with food. My constant yearning for something munch got to the point where every time she tried to cook dinner, I’d follow her to the kitchen, like a hungry dog, and persistently beg for food. I was insatiable, she claims. But, as an adult looking back I wonder, insatiable for what?
I remember that moment, but from the third person perspective. So I wonder if it’s as past events sometimes go, where the telling of a memory from an outsider’s perspective serves to reshape it in the imagination. I can feel the emotions, however, watching my 4-year old form tugging on my mother’s clothing, her body towering over me, her face far away. She stands at the stove. I remember feeling full of… what was that yearning? Was it for food? Was it hunger for physical sustenance or nutrition from some other source? I wonder if the constant, nagging hunger was an articulation, in 4-year old vocabulary, of the need for something else: attention, affection or reprieve from boredom. I remember being told at one point that my favourite show was on and felt some of the anxiety of missing what I was lacking dissipate: a clue.
As a child, adults occupy the gateway to food. As adults, the gateways take on another form. Perhaps it is anxiety about body shape or the guilt of knowing that eating too much of a certain kind of thing isn’t nutritious. Perhaps the barrier to sustenance is financial. However, when I stand now in the kitchen, bent over the fridge, arm slung over the open door, contemplating a snack, I know that I am making a choice. And, for myself, as for many others, it’s not always clear whether the call to eat is hunger and physiologically based.
In the west, we have an abundance problem. More and more adults are reaching obese proportions. Metabolic diseases of excess like diabetes and cardiovascular disease are increasing and more and more women are experiencing the hormonal dysregulation that can come from carrying more body fat.
While I don’t recommend aspiring to the emaciated standard that we see plastered on magazines, Pinterest ads or runways, I do think that, for many people, balancing energy intake with energy output could be beneficial for optimal health and hormonal signalling. Body fat is metabolically active. It also stores toxins and alters that way our body metabolizes and responds to hormones, insulin being just one example, estrogen being another. Therefore, conditions like PCOS, infertility, diabetes, PMS and dysmenorrhea, or certain inflammatory conditions might benefit from a certain amount of weight loss.
An addition here: this post is not about body-shame or even necessarily about weight loss per se. It’s about overcoming emotional eating patterns that might even derive from the same disordered patterns that manifest in anorexia or bulimia. The goal of this post is to bring more awareness to how we operate within the complex relationships many of have with food and with our own bodies.
There are many reasons why we eat and physiological hunger is only one of them. Tangled up in the cognitive understanding of “hunger” is a desire for pleasure, a desire to experiment, to taste, to experience a food, to share with family and friends, to enjoy life. There are also deeply emotional reasons for wanting food: to nurture oneself, as reward, to combat boredom and to smother one’s emotions like anxiety, depression, ennui, yearning for something else— we often eat to avoid feeling.
Health issues aside, I believe that Emotional Eating (as it’s so-called) is problematic because it dampens our experience of living. By stuffing down our emotions by stuffing our faces we prevent ourselves from feeling emotions that it might be beneficial for us to feel in order to move through live in ways that are more self-aware, mature, self-developed and meaningful. While some emotional reasons to eat might be legitimate (acknowledging your beloved grandmother’s hard work by having a few bites of her handmade gnocchi, for instance), many of the reasons we eat linger below the surface of our conscious mind, resulting in us suffering from the consequences of psychological mechanisms that we are unaware of. I believe in making choices from a place of conscious awareness, rather than a place of subconscious suffering.
In heading directly into the reasons I am tempted to emotionally eat, I’ve learned quite a lot about myself. I’ve ended up eating less, as I’ve become more aware of the non-hunger-related reasons that I reach for a snack, but that doesn’t have to be the end goal for everyone. I believe that just understanding ourselves through uncovering and analyzing the emotions that influence our everyday behaviours can have life-changing effects; it allows us to know ourselves better.
As I work through the process of understanding why I overeat, I’ve realized there are a few steps to address. I believe that there are layers to the reasons we enact unconscious behaviours and first, it is important to untangle the physiological from the emotional reasons for eating, understand what real hunger feels like, address the “logical” reasons for overeating and then, when ready, head straight into the emotions that might cause overeating to occur
Distinguishing between physiological hunger and emotional hunger:
The first step, of course, is to distinguish between physiological/physical hunger—the body’s cry for food, calories and nourishment—and emotional hunger. Typically, physiological hunger comes on slowly. It starts with a slow burn of the stomach, growling, a feeling of slight gnawing. It grows as the hours pass. For some it might feel like a drop in blood sugar (more on this later): feeling lower energy, dizzy and perhaps irritable. Physiological hunger occurs hours after the last meal, provided the last meal was sufficient. Usually, if one drinks water at this time, the physiological hunger subsides and then returns. Essentially, eating a meal or snack will result in the hunger vanishing and returning again still hours later.
Emotional hunger, however, is different. It starts with an upper body desire to eat. It might be triggered by commercials, social situations, or certain strong emotions. There might be cognitive reasons to eat (“I might be hungry later” or, “Oh! We’re passing by that taco place I like!”) that are not directly guided by the physical desire for sustenance. Emotional eating is often felt in the mouth, rather than the stomach. It might be brought on by the desire to taste or experience the food, rather than to fill oneself. The cravings might be specific, or for a certain food-source, such as cookies (this is not a hard and fast rule, however). Emotional hunger does not vanish from drinking water. Emotional hunger comes on suddenly, and is often not relieved by eating the prescribed amount of food (having a full meal); oftentimes we finish lunch only to find ourselves unable to get the cookies at the downstairs coffee shop out of our heads.
2. Settling hormonal reasons for overeating: serotonin, insulin, cortisol:
Not all physiological hunger, however, is experienced as the slow, gnawing, slightly burning, grumbling stomach sensation described above. Sometimes we experience the need to eat because our blood sugar has crashed, or our neurological needs for serotonin have gone up. We might eat because stress hormones have caused blood sugar to spike and then crash. We might also experience certain cravings for food because our physiological needs for macronutrients; like carbs, fat or protein; or micronutrients, like sodium or magnesium, have not been met.
Therefore, it becomes essential to address the hormonal imbalances and nutritional deficiencies that might be causing us to overeat. Oftentimes, getting off the blood sugar rollercoaster is the first step. This often involves a combination of substituting sugar and refined flours for whole grains, increasing fats and protein, and, of course, avoiding eating carbohydrate or sugar-rich foods on their own. It often involves having a protein-rich breakfast. I tend to address this step first whenever my patients come in and express feeling “hangry”: irritable and angry between mealtimes.
Often drops in brain-levels of serotonin cause us to crave carbohydrate-rich foods. This is very common for women experiencing PMS. In this case, balancing hormones, and perhaps supplementing with amino acids like l-glutamine, tryptophan and 5-HTP, can go a long way.
One of the questions I ask my patients who crave a snack at 2-3 pm (a mere 2-3 hours after their lunchtime meal), assuming their lunch contained adequate nutrients, is “Do you crave, sugar, caffeine, salt or a combination of the above?” Cravings for sugar or salt at this time might indicate a drop in cortisol and give us a clue, combined with the presence of other symptoms, that this person is in a state of chronic stress, burnout or adrenal fatigue. In this case, it is essential to support the adrenal glands with herbs, nutrients, rest, and consuming adequate protein during the afternoon crash.
Finally, when it comes to cravings for foods like chocolate, meat or nuts, or even specific vegetables (when living in South America I would experience over-whelming cravings for broccoli, funnily enough), I find it important to identify any nutrient deficiencies. It is common to experience a deficiency in something like magnesium, iron, selenium, zinc, and the fat-soluble vitamins A, D, E and K; and our bodies will do their best to beg us for the specific foods they’ve come to learn contain these nutrients. Either consciously eating more of these foods (like brazil nuts in order to obtain more selenium), preferably in their healthiest form (such as dark chocolate, as opposed to milk chocolate, to obtain magnesium), or directly supplementing (in the case of severe deficiency), often results in the cravings diminishing.
3. The Hunger Scale and food diaries:
One of the first things I have patients do is understand the Hunger Scale. There are a variety of these scales on the internet that help us cognitively understand the stages the body goes through on its quest to ask for food and it’s attempt to communicate fullness. Being able to point to certain levels of hunger and fullness and pinpoint those physiological feelings on the Hunger Scale allows us to further flush out the subtleties between a physical or emotional desire for food.
Food diaries, I find, can help bring more awareness to one’s daily habits. Oftentimes, keeping a food diary for a few weeks is enough for some patients to drop their unwanted eating behaviours altogether. Other times, it can help us detect food sensitivities and unhealthier eating patterns or food choices. It also helps me, as a practitioner, work off of a map that illustrates a patient’s diet and lifestyle routines in order to avoid imposing my own ideas in way that may not be sustainable or workable for that particular individual.
A word about diet diaries, however: when recording food for the purpose of uncovering emotional eating behaviours, I often stress that it is important to record every single food. Sometimes people will avoid writing in their diary after a binge, or outlining each food eating when they feel that they’ve lost control, writing instead “junk food”. Guilt can keep us from fully confronting certain behaviours we’d rather not have acted out. However, I want to emphasize that the diary is not a confession. It’s not, nor should it be, an account of perfect eating or evidence that we have healed. Keeping a diet diary is simply a tool to slow down our actions and examine them. It’s a means of finding out how things are, not immediately changing them into what we’d like them to be. This is an important reminder. The best place to start any investigation into being is from a place of curiosity. Remember that the point of this exercise is to observe and record, not necessarily to change, not yet; it is very difficult or even, I would argue, impossible to completely eradicate a behaviour if the reasons for engaging in that behaviour escape our conscious awareness.
Therefore, recording food allows us to begin to poke at the fortress that contains the subconscious mind. We start to slow down and uncouple the thoughts and emotions from the actions that they precede and, in doing so, develop some insights into how we work. It can also help to start jotting down other relevant points that might intersect with what was eaten. These pieces of information might include time of day, where you were, what thoughts were popping into your head, and how you felt before and after eating the food. As we observe, more information begins to enter our conscious experience, allowing us to better understand ourselves.
4. Pealing back the layers: Understanding the “practical” and logical reasons for overeating:
One of the things that I have noticed, through my own work with addressing emotional eating, is that there are often layers to the “reasons” one might overeat. Some of the first layers I encountered were cognitive, or seemingly “logical” reasons. For example, I noticed that before eating without hunger I might justify it by thinking “I need to finish the rest of these, I don’t want them to go to waste”, or “I’ll finish these in order to clean out the container”, or “I should eat something now so I won’t be hungry later”, or “I didn’t eat enough (insert type of food) today so I’ll just eat something now, for my health”, or “If I don’t have some (blank) at so and so’s house, she’ll be offended”.
When looking more closely into these justifications, I found them to be flawed. However, they were logical enough for me to eat for reasons other than to satisfy a legitimate, physiological yearning for nutrients. It’s interesting to see how the mind often tries to trick us into certain behaviours and how we comply with its logic without argument.
5. Addressing the practical reasons: Planning:
In order to address the first layer of rationale for eating when not hungry, I decided to do the following: I would plan my next meal and either have it ready in the fridge, or pack it with me to go, and then I would wait all day until I was hungry enough to eat it. I would repeatedly ask myself, every time I thought of reaching for my portions, “Am I hungry now?” And would answer that question with, “Is there a rumbling in my stomach? No? Then it’s not time to eat.”
I found it would often be a several hours later before my body would genuinely ask for the food. I also found that eating satisfied the physical hunger often much sooner than it took me to finish the food. I realized how I often eat much more food and much more often, than I genuinely need.
However, holding off eating until physical hunger arises takes a conscious effort that is often unsustainable. Few of us can move through our busy lives constantly asking ourselves how hungry we are and when, and then have food at the ready to satisfy that hunger with appropriate, healthy choices. Therefore, I used this practice as a mere stepping stone to move through the deeper layers of emotional eating. By addressing the rational and logical reasons for overeating, I was able to get in touch with the deeper, emotional (and, arguably, real) reasons for which I was eating without hunger.
6. Pealing back the layers: Understanding the deeper, emotional reasons for overeating:
For a while I would wake up, make myself a coffee, and then wait until I felt hungry. Sometimes the feeling would arise in a few minutes, sometimes it would take hours. Depending on what I’d eaten the previous day and what my activity levels were, I would often not get hungry until well into the afternoon. However, the thoughts of eating something would frequently persist. And when the thoughts came up, whereas before they would be satisfied by me having something to eat, I now resisted them. When I resisted the thoughts, their associated emotions would strengthen. I then decided to journal before reaching for food, especially when I wasn’t sure if I was actually hungry or not.
Journalling can help us pull up, process and make sense of some of our emotions. I would write about what I might be feeling—what I might be asking for that wasn’t food. Through doing this, emotional reasons for hunger began to surface. The more I held off eating, the stronger and more clear the emotions became. It was a deeply uncomfortable process. This is why we emotionally eat—removing the emotions is often far more pleasant than dealing with them.
Emotions that surfaced were anxiety, ennui, boredom, loneliness and sometimes even anger. However, boredom and a listless, almost nihilistic, sense of ennui were among the two most common emotions I realized that eating medicated for me. For me, eating was entertainment. It broke up the monotony of the day and gave my senses something to experience. It gave my body something to do: chewing, tasting and digestion. Not eating made that sense of boredom grow stronger.
7. Addressing the emotional reasons: Nurturing and preventing:
Knowing more about the root emotional causes for overeating allowed me to work more closely with the source of my behaviour. I find that the closer we get to the source, to the roots, the more effective we are at removing the weeds, or behaviours, from our lives. I knew now that if I didn’t want to overeat, I would have to prevent myself from getting bored. I would have to have checklists of things to do. I would stay active and engaged in life: in my work, my friendships, and the other non-food-related things that brought meaning to my life.
During this time, I did more yoga and meditated. I journaled and wrote. I also meditated on boredom. I traced it back to where I might have felt it in my life before and noticed themes of boredom in my childhood. I realized that the child tugging on her mother’s shirt and asking when dinner was ready was probably a child who needed something to do, a child who was bored.
8. Pealing back the layers further: Working directly with core emotions:
Going even further, we can begin to peal back the layers of the emotional reasons for overeating in order to avoid replacing one “addiction” with another—such as replacing overeating with over-busying oneself, distraction or overworking. I began to find other emotions that ran deeper than mere boredom. I also realized that whenever I had felt boredom in the past, there was a threshold, often filled with discomfort, that I would eventually surpass. Once surpassing this threshold, a well of creativity, or a plethora of interesting insights, would spring forth. I remember as a child I would create stories, or lie on my bed and stare that the ceiling of my bedroom, contemplating the nature of the universe. These beautiful moments had been made possible by boredom and my courage to not distract myself from it.
Working with a therapist, or doing some deep inner work, we can access the core beliefs and emotions that might cause these emotional reasons for overeating to exist. Oftentimes we encounter core beliefs whose effects spill out into other areas of our lives, preventing us from living fully and consciously. Working through these beliefs can be deeply satisfying and help us experience transformational self-growth.
9. Setbacks: Understanding Change Theory:
Finally, engaging in this process of self-discovery doesn’t follow the same pattern in every person. Some people may find that their reasons for overeating are dissolved as soon as they start recording the foods they eat (this is surprisingly common). Others might find that years of working with a therapist have resulted in a mere dent in their ability to eat in response to hunger and to stop unwanted eating behaviours. In most everyone progress is not linear.
Change Theory and the Stages of Change schema depicts the alteration of behaviours as cyclical, rather than linear. As we move through the stages, we enter a cycle of pre-contemplation, contemplation, planning, action and maintenance. Sometimes we fall out of the cycle and relapse. Many people working with behavioural changes and addictions prefer to rename relapse “prolapse”, claiming that prolapse is a necessary stage for continuing the cycle of change and that much is to be learned from failing at something. It is through observing how the world produces unexpected results, and then attempting to understand the unexpected while trying again, where learning takes place. We don’t really learn if we don’t fail.
Sometimes addictive behaviours, emotional eating included, worsen at a time when someone is on the verge of making a massive breakthrough. Sometimes poking at a new layer of the source of unwanted behaviour accompanies an exacerbation in the practice of that behaviour. Having curiosity and self-compassion throughout the process is essential. Savouring the increased self-awareness that comes with any effort to effect change in one’s life is part of the enjoyment of the experience.
I talk about how to manage stress and promote mental health and emotional wellness through assessing balance in the key areas of your life that promote a healthy mind and body.
Hello, everybody, my name is Dr. Talia Marcheggiani. I’m a mental health and hormone expert.
Stress is a big reason why a lot of people come to see me, for support in their lifestyle and optimization of their health, especially their mood and mental health.
And, one of the things that I’ve come to understand in working with people one on one is that stress in life is an inevitability, especially in our society.
Work is just one aspect of the stress that influences our lives, but things like loss of loved ones, and ending of relationships, pressure from work, monetary struggles. These things in society are inevitabilities. So, we’re sooner or later going to be faced with major stressors in our lives regardless of how well our life is happening right now.
One of the big things in terms of working with people is helping with their resilience to stress. That means building up resources. So, before I meet with a patient I have them fill out an online intake form. And this is sent to their email and one of the—the intake form goes over what their concerns are, what they’re coming in for, it goes through all the areas of their health, their physical health and mental health and one aspect as well, in the chart is something called The Wheel of Balance. And, what the Wheel of Balance does is, it looks at all the major pillars that make up somebody’s life. It asks the potential patient or the new patient, to assess, to rate on a scale of 1 to 10 how satisfied they are with that area of their life.
So, for example, one of the areas is health and so on a scale of 1 to 10 how you feel that your health is managed? How satisfied are you with your level of health? Are you in chronic pain? Do you feel unwell generally? Or do you feel like health is pretty well managed, despite the fact that you’re coming in with a health concern?
Another area is relationships. So, personal relationships. So, some people don’t have a significant other and, if that’s so, how do you feel about that? Or, if you do have a significant other, how satisfying is that relationship? How well do you feel that relationship supports you in your life?
There’s several reasons for this Wheel of Balance. One is to just get a general understanding of the life of the person I’m going to be working with, what the broad picture is in terms of their life.
And another reason is that we know a lot of these factors such as relationships, and health and career, and money and whether you have hobbies, whether you have something that fills you, something that gives you a sense of purpose, we know that these things are determinants of health. So, your socioeconomic status is one of these factors that determines your longevity or your resilience against disease, especially your resilience against stress. If I have somebody coming in with depression and anxiety who’s recently been laid off, no amount of herbs—well, the herbs can buffer the stress response and relax the physical body so that somebody can look for work, but on the high priority list is helping them find a job again, because no matter how calm you’re feeling physically, or much meditation you’re doing, the fact that you don’t have a way to pay your bills is a major stressor that won’t go away until it’s dealt with.
And, another reason as well for doing this Wheel of Balance, if we’re assessing this holistic scope of what someone’s life is, is the fact that these pillars, when they’re strengthened, they provide the basis for the resilience against onslaughts of stress that come in.
So, many of the people that come in and see me who are dealing with mental health issues, they’re often struggling with an onslaught of stress that’s hit them. So it could be that they’ve recently been laid or separated from a partner in a romantic relationship, or it could be a great loss or trauma or somethings are surfacing.
Organizing these pillars of resilience is really effective for helping somebody deal with the stress and survive a new wave of stress.
In naturopathic school we learned about something called the Stress Wall, so it’s sort of a similar idea. You’re building up these resilience factors, you’re strengthening relationships, you’re dedicating time and energy to creating a career that you love, you’re arming yourself with hobbies and interests and purpose and passion and, therefore, when a stress wave hits you, you’re able to withstand it, or you’re able to recover more quickly. It doesn’t throw you, it doesn’t send you into chaos, physically, mentally and emotionally.
And sometimes these waves of stress they test our stress wall, so sometimes people are doing all right and then a really stressful time at work will show them how well their stress wall’s been built.
So one thing you can do, right now, having said all this, is do a Wheel of Balance with me. So, all you need is a piece of paper, and you’re just going to draw a circle on it. And you’re going to divide the circle up into 8 sections. So, divide it in half, then in quarters, then divide those quarters into halves so that you have 8 sections on your wheel.
And then you’re going to label each pie slice with a title. So, the first one is career. The second one, money, because those are two separate things. Our career is not always tied to our money. Sometimes satisfaction with a career doesn’t necessarily mean monetary satisfaction. So we separate those two things, although they can be linked. The third is health. The fourth is relationships, and this is romantic relationships or significant other.
The fifth is family and friends, supporting relationships. If you don’t have a significant other, you can also rate your satisfaction with the fact that you don’t have a significant other, so if you’re single and feeling pretty good about it, pretty happy with your independence, or are you in the search of looking for a significant other, or are you recently single and upset about that. So this is something where you can evaluate your satisfaction because it is a piece of the puzzle and piece of the Wheel of Balance in terms of resilience, because one of the biggest sources of stress is from romantic partnership or lack thereof.
So the sixth pie slice is fun and hobbies. This is something meaningful that you pursue outside of your work, whether you have one or more things. In that section is sort of what you do to destress, so do you come home and flip on the TV and is that a fulfilling and stress-reducing activity for you? It can be for a lot of people, but bringing awareness and consciousness to that is very helpful.
The seventh is purpose and growth. So, are you everyday creating meaning in your life? Is there a clear meaning for your life and are you fulfilling that meaning and purpose? Do you feel like you’re growing and learning every day? That’s really important for a lot of people and I often find that people mark that pretty low especially when they’re dealing with a mental health condition or a high amount of stress in their lives.
And then the final thing is your physical environment. Physical environment is, are you happy with where you’re living? So how your living arrangement is, physically. Is it a comfortable space to live in? Do you like how it’s decorated? Do you like where you’re living? What city you’re in? What part of the city you’re in? Are you exposed to nature on a regular basis and, if not or if so, how important is that to you? So you’re evaluating what the state is of the physical surroundings that you’re in. So that’s why we clean our houses or why we care about where we’re living because a cluttered environment does affect our internal and mental state.
So, again, those categories are career, money, health, relationship, family and friends, fun and hobbies, purpose and growth, and physical environment. So, when you’re finished you’ll have a chart that looks like this. So it’s got eight different slices with different labels. And, on your own I want you to fill in the pie according to your level of satisfaction, so if you’re 100% satisfied in the area of your career then you colour in the entire pie slice. If you’re only 50% satisfied or one quarter than you fill the corresponding amount out. Then you look at the areas you’re not as satisfied in and the areas you might be over-compensating in. So you might be really dedicated to maintaining a healthy lifestyle but may be sacrificing in the area of fun and haven’t really invested in making sure you’re creating fun activities.
You also might not want these categories. There might be another category that’s more important to you. If you don’t care about one of these categories it might mean that you’re satisfied with it, or you don’t feel that it brings meaning to your life, and that’s totally cool.
But, it’s sort of an idea of these areas that we build our lives around. And so what I do with people, because a lot of the time when people are feeling a lot of stress, or have a mental/emotional issue that they’re coming in with, depression or anxiety, neurosis or anything like that, a lot of the time they’re missing a few areas, or their Wheel of Balance is skewed in one area or it’s just generally weak all over. And so what we have to do—that means these people are very susceptible and vulnerable and the first thing to do, instead of working on diet or giving herbs and that kind of thing, is to strengthen some of those areas to create a more robust Wheel of Balance. And so what we do is, if there’s an area that you’re weak in, is creating one concrete thing you can do, more or less immediately, so let’s say within the week, that would strengthen and kind of balance out your Wheel of Balance.
And so, an area that is often lacking for most adults and busy people is fun, so if you put 25% of satisfaction in the area of fun, then coming up with a strategy, one thing you can do this week that would increase your satisfaction, even a little bit, and start to build up that pie slice, in the Wheel of Balance. So, thinking of something you would do that you would classify as fun. In the area of family and friends, how can I reach out to somebody, or strengthen an existing friendship or look for a way that I could put myself in a position to meet new people. So we start working on these areas. So once you’ve developed resilience and strength, we’re better able to weather the new waves of stress that hit us because they will, inevitably. Some of us are blessed to not have as many stress waves, but eventually there is something that will affect us and will affect our state of balance and our mental health so the stronger our pillars of resistance and the more robust our Wheel of Balance is, the better able we are to weather these storms and maintain our mental and emotional health and our physical health, because we know they’re all connected.
My name is Dr. Talia Marcheggiani, thanks for listening and if you want to contact me, my email is connect@taliand.com. I practice in Bloor West Village in Toronto.
Someone, I think it was Eckhart Tolle, once said that when it comes to mental illness, anxiety is about worry for the future, while depression is concerned with regret for the past. While, I’m not entirely (or even nearly) convinced that this is true, there is little doubt that those with both depression and anxiety can get caught in the paralysis of going over past events and regrets in their minds. Therefore, healing regret becomes important for reframing our past experiences and present identity and improving mood and self-esteem.
Regret is a sticky emotion. It reminds us of who we once were. It’s the cold hand on the shoulder and the voice that whispers “remember…” in our ear when we’re getting a little too confident, when we’re actually feeling happy with who we are now.
My patients will often tell me that when they find themselves in a spiral of low mood, their minds are often playing and replaying past events over and over. They mull over painful memories until they are distorted, painting themselves as the villain the more they rewind and press play. Remembering in this way smears grey over their entire sense of self, and discolours the possibilities they see for themselves in the future and, worse, their abilities to take meaningful action in the present. It leads to deep feelings of self-hate and worthlessness. It causes feelings of hopelessness. And so I tell them this:
Regret, while painful, is not always bad. It is a reflection, a comparison between two people: the person you are now and the person you used to be. When this comparison is particularly vast, when the you you used to be is particularly painful to remember, then know this; you have changed. Regret comes with looking back with pain, wishing we’d taken a different course of action than the ones taken. However, when we flip this concept over and examine its shinier underbelly, we realize that in order to feel regretful about past events we are acknowledging that we (present we) would not have performed the same action or made the same choice now. The flip side is not that we’re bad, it’s a reflection of our goodness. We have learned and evolved. We’re different.
Looking back is different from looking forward. Our lessons are what shape us. The fact that we regret is proof that we learn, we grow and we change into better, preferred versions of ourselves. If we sit in the experience of regret, we can feel proud that, if faced with the same situation today, we’d be better. Regret doesn’t mean that we are bad people, it’s proof that we’re good people. In order to regret the past we’ve had to have changed.
To transform mulling over painful life choices and past actions, I recommend a writing exercise, inspired by Narrative Therapy. In every story of regret and “badness” there is also a story of values, skills, preferred identity and goodness. The next time you find yourself cycling through feelings of regret grab a pen and paper and answer the following questions:
1) What happened? What were the events that transpired? What did you do? What did other people in the story do? What were the events leading up to the action you and others took? What was the context surrounding you at the time? What influenced your decision to act as you did?
2) Looking back, what would you have done differently? What parts are particularly painful to remember? What actions or events do you regret?
3) What might these regrets say about you now? What might it say about you to know that you would have acted differently if you were faced with the same situation? What values do you embody that enable you to recognize that what you did in the past was regretful for you?
4) Looking at these values, how have you shown you have this value in the past in other situations? Do you have a particular story you remember?
5) How has that value or skill made an impact on the lives of others? In the story that you remembered, what might the actions you took in #4 have meant to the people around you?
6) How do you embody this value in the present? Where does it show up in the actions you take today? How might you embody this value in the future? What actions might you take while remembering this value? What does remembering this value and the story from #4 make possible for the future?
Going through this writing exercise can help us look back with more compassion for the person we were, who was growing into the person we are now. It might make possible ways that we can rectify anyone or anything was impacted in the past, if it means an apology, paying forward a good act, taking different steps in a similar present situation or even moving on and letting go of our tendency to hold onto the memory.
