This is one of my favourite exercises from Mindfulness Based Cognitive Therapy, or MBCT, and just one exercise in an 8-week course directed at those who suffer from depression and anxiety.
This exercise helps us practice staying with difficult thoughts, emotions, and body sensations, teaching us to turn towards difficulty, rather than turning away.
It is better to do this exercise when difficulty is already present.
Try to use a 10 lb weight, not a 100 lb weight. However, in many situations, we don’t get to choose. If the practice is particularly intense, you can perhaps focus on the breath, or open your eyes and let go of the practice.
Note: this video is to support a mindfulness practice and to use in conjunction with help from a licensed mental health professional.
Since publising the original article about the Mirena IUD on this blog, thousands of women have come out of the woodwork writing to me asking for help.
When I originally wrote the article, I was spurned on by my observations of the women in my practice who had experienced a rise in estrogen dominance and low progesterone after the insertion of their IUDs (which were often inserted to treat hormone imbalances!).
At that point I never imagined that so many women would be affected by the IUD, or that even more were suffering from so many hormonal symptoms that drastically affected their lives and health.
It makes sense: our society does not set us up for proper hormonal function.
Our diets are carbohydrate-heavy, promoting insulin resistance and blood sugar dysregulation, which impacts our ovaries’ ability to make estrogen properly.
An excess amount of body fat produces more estrogen in the body and acts as a reservoir for the toxic estrogens in our environment.
We lack many of the micronutrients necessary to process our hormones properly, such as vitamin D, B vitamins, magnesium, zinc, omega 3 fatty acids, glutathione, and amino acids.
Many of us have impaired or suboptimal liver function, or sluggish digestion, which keeps hormones in our bodies around longer than they should be.
A dysbiotic gut has the tendency to turn estrogen in the gut back “on”, putting it back into circulation when it was otherwise on its way out of the body.
Stress alters our hormonal function, including our ability to make progesterone, DHEA-S, convert thyroid hormones, and process estrogen properly.
Xenoestrogens in our food and environment, from plastics, fragrances, pesticides, and processed soy products, contribute to overall body burden of the hormones in our body, throwing off our delicate balance, and contributing to symptoms.
The result of all this is that many women suffer from hormonal imbalances.
10% of women have some form of PCOS, or Polycystic Ovarian Syndrome, characterized by the body’s inability to properly make progesterone or estrogen, instead making loads of male hormones, like testosterone. PCOS alters fertility, promotes weight gain, and causes things like unwanted facial hair growth, acne, and missed periods. PCOS is often connected to stress and insulin resistance.
Many women in my practice suffer from PMS or PMDD, experiencing often debilitating symptoms sometimes even two weeks before their periods begin. They might get migraines, intense cravings for sugar, and massive mood changes, such as anxiety, intense irritability, or devastating depression. Panic attacks can occur at this time as well. Many of them comment that their mood and personalities flip once their hormones levels reach a certain point, causing them to act like different people. This can jeopardize their relationships with spouses and children, coworkers, friends and family.
Tender and painful breasts, or breast lumps, are also common in many of these women.
Acne, weight gain, stress, fatigue, disrupted sleep, depression and anxiety are all symptoms I see in women with hormonal imbalances.
Many women have horrific cycles, experiencing painful and heavy periods that often cause them to miss days of work every month. Many of these women struggle to keep their iron levels in the optimal range, suffering from hair loss, fatigue and weakness.
Many women are diagnosed with fibroids, or endometriosis, or are concerned about their risk of female cancers like breast, ovarian, uterine and cervical cancer.
All of these symptoms are often linked to relatively higher levels of estrogens compared to progesterone, sometimes termed Estrogen Dominance by functional medical practitioners who look at the underlying causes of bodily imbalances.
I feel terrible that I can’t help more of the women who write to me. My license prevents me from giving advice to those who live abroad, especially to non-patients over the internet. It’s a shame, however, because oftentimes the solutions are relatively simple, despite how complicated many of these symptoms might seem.
I’m hoping that this article can provide some direction to many of the women who suffer.
Firstly, I want to state that I am not against birth control or even the Mirena IUD (or other IUDs, for that matter). The vast majority of women with the IUD tolerate it. For many women with debilitating heavy periods and endometriosis it can be the only viable solution that makes life tolerable.
In my social practice at Evergreen, many of the women I see experiencing homelessness, drug addiction, or PTSD from relationship trauma, rely on the efficacy of IUDs to prevent unwanted pregnancies. Their lives often don’t allow for them to remember to consistently take pills every month.
Many women don’t tolerate combination birth control because of a history of blood clots, female cancers, or migraine headaches associated with their periods, and therefore the Mirena IUD, which is progesterone only, is a safe alternative for preventing unwanted pregnancy.
That all being said, many women do suffer on the Mirena IUD (or other forms of birth control). They were perhaps put on the Mirena to deal with some of the above symptoms of hormonal imbalance, or for contraception. Many of them noticed that their symptoms became worse after insertion of the IUD.
How the Mirena IUD and Birth Control Works:
The Mirena works by secreting small amounts of progestins, a synthetic form of progesterone, into the uterus and surrounding tissues. While it is not fully known how the Mirena works, the end result is a suppression of ovulation. This results in either very light periods or a complete cessation of periods until the IUD is removed (after 5 years when its hormones run out).
It is important to say here that, while birth control can certainly treat the symptoms of hormonal imbalances, it does not correct them.
All forms of birth control, with their synthetic versions of the hormones estrogen and progesterone, simply induce further hormone imbalances in the body. They introduce versions of hormones that may suppress or alter symptoms (such as heavy and painful bleeding, or acne), but the versions of hormones are not fully recognized by the body and therefore don’t fully replace all the hormones’ important functions, such as mood regulation, immunity, or blood sugar balance.
The effects of both altering the body’s natural hormonal balance, while ignoring the underlying cause of hormonal issues, is often what causes symptoms to continue or worsen.
For example, women with PCOS are prescribed birth control to manage acne or promote monthly periods. However, when women with PCOS miss periods, it is because they are not ovulating. The missed periods are not the problem; the lack of ovulation is.
Despite that, many women with PCOS experiencing amenorrhea (or missed cycles) will be prescribed birth control. However, birth control does not address the underlying cause of amenorrhea. It simply further suppresses ovulation (because its main purpose is to prevent unwanted pregnancy).
The periods you get while on birth control are not periods. Periods from birth control are withdrawal bleeds. After 21 days of taking hormonal pills, pills are stopped or replaced with placebo pills. The withdrawal of hormones in the pills induces a bleed that resembles a period, but is not one.
Hormonal contraception does not correct hormonal imbalance, it imposes further hormonal imbalance to manage symptoms. This is not always bad!
But it is an important difference.
Many women do require symptom suppression, particularly if their symptoms are severe. Many individuals in my practice experience periods so heavy that the only way for them to get through the month is with an IUD. Genetic variability in how our bodies process hormones can make us susceptible to intense hormonal symptoms, through no fault of our own.
In my opinion, however, it is important to attempt to address the underlying cause and to set our bodies up for better hormonal regulation, making as many changes as our lifestyles will allow.
What You Can Do About It:
If you are like any of the people I described above who seek my help, there are a few things that you can do to get started on correcting hormones.
Working With a Professional:
The first thing I advise is finding a licensed naturopathic doctor or functional medicine practitioner who understands hormones, can order lab tests, and will address the underlying cause of your hormonal imbalances by taking the time to fully understand your body and lifestyle.
This practitioner might be a naturopathic doctor (you can find one in North America by looking one up at naturopathic.org), or a medical doctor, a chiropractor, or a highly skilled nutritionist or nurse practitioner. Research this person well, read their articles, and perhaps book in with them for a complimentary meet and greet.
Testing:
I often test patients using simple blood tests, on day 21 of their cycles (or about 7-9 days before they expect their next period).
I will test their blood, looking for anemia, will test iron and B12 levels, homocysteine (to gauge their ability to methylate), vitamin D, cholesterol (to see if their diets are promoting proper hormone synthesis), estradiol, estrone (the more toxic, problematic estrogen), progesterone, free testosterone, a thyroid panel, fasting glucose and fasting insulin (to calculate insulin resistance using something called the HOMA-IR), HbA1C (to look a long-term blood glucose control), FSH and LH (two hormones made in the brain that talk to the ovaries and orchestrate the menstrual cycle), DHEA-S, to name a few.
Some women will require more testing. Others will require less.
These labs are interpreted from a functional perspective. Even though you are in the “normal” ranges (which take into account the entire population, many of which are not healthy—they are seeing their doctors, after all!), these blood markers may not be optimally balanced, giving us an opportunity to correct things before they go further.
Testing allows us to match symptoms to underlying imbalances and to be able to properly direct treatment protocols. Women with estrogen dominance may be experiencing high levels of estrogen and normal progesterone, which indicates a body burden of estrogen or impaired liver and digestive system clearance. Other women may be experiencing normal levels of estrogen but low progesterone, indicating a failure of their bodies to ovulate, due to high stress, and PCOS (or the Mirena IUD and birth control pill).
Other options for hormonal testing are month-long salivary hormone testing, or DUTCH testing, which looks at hormone breakdown in the urine. I sometimes run these tests, but find that blood testing is useful, accurate, and more cost-effective.
Treatment:
Once you understand your individual hormonal situation through testing (and through working with a practitioner who is putting the testing together with your symptoms and health history), your practitioner may recommend a variety of treatments.
I personally combine diet and lifestyle with key herbal and nutritional supplements, to target what is going on under the surface with my particular patients.
These treatments may include herbs that boost ovulation, aid liver detoxification, or regulate the stress response. I might recommend nutraceuticals that encourage methylation, or aid in hormone production.
My treatments take into account the individual’s symptoms, labs, diet, lifestyle, and any other health issues she may be facing like fatigue, digestive disturbances, or poor sleep.
What You Can Do Today:
Barring more individualized assessment and advice, there are some best lifestyle practices that can help most women balance their hormones better, whether they are still using birth control to control and address their hormonal symptoms or prevent pregnancy.
Diet:
When it comes to diet and hormone support, we need to ensure that we are balancing blood sugar, boosting liver detoxification pathways, promoting hormone synthesis, and supporting digestion, especially if experiencing constipation.
Consume more leafy greens: kale, spinach, collards, beet greens, arugula, etc. Eat 1-2 cups of these foods every day. Leafy greens contain active folate, which boosts methylation and detoxification. They also contain magnesium which is essential for hormonal regulation as well as 300 other important biochemical reactions in the body that balance mood and hormones.
Consume more cruciferous vegetables: broccoli, cauliflower, brussel sprouts, cabbage, bok choy, etc. Eat 1-2 cups of these foods every day. Crucifates help the body make glutathione, and contain indole-3-carbinole, which helps eliminate excess estrogens from the body. Broccoli sprouts are potent players in these pathways. Consume them as often as possible.
Ensure adequate dietary fibre intake: I often recommend ground flaxseeds or chia seeds in smoothies, avocados, fruits and vegetables and legumes (if tolerated) to make sure that women are having regular bowel movements to clear excess estrogens out of the body. 2 tbs of ground flaxseed (or more) every day can help balance estrogen levels and promote daily bowel movements.
Balance blood sugar: consume protein, fat and fibre at every meal. Avoid refined starches and flours. Avoid all sugar, even natural sugar like maple syrup, coconut sugar, cane sugar, honey, agave, etc. Try stevia or avoid sweets. Limit carbs (grains, legumes, root vegetables like potatoes or sweet potatoes, to 1/2 cup to 1 cup per meal). Only consume whole grains like quinoa, buckwheat, steel cut oats, millet, and teff. Cook them yourself!
Avoid soy, particularly processed soy, like vegan burgers, or soy milk.
Consume omega 3 fatty acids in fatty fish like salmon and sardines, or nuts and seeds like flax and chia seeds, walnuts, and pumpkin seeds. Get 2-4 tablespoons of these nuts and seeds every day and 3-4 servings of fatty fish a week.
Consume animal products: eggs contain choline, which is essential for liver function, meat contains vitamins B6 and B12, which are essential for hormonal regulation and production. Cholesterol in animal products are the backbones of our sex hormones. Iodine, found in animal foods, regulates estrogen balance in the body. If possible, try to obtain organic animal products from pastured or free-range animals to boost omega 3 intake, to lower your impact on the environment, and to promote animal welfare.
Other Lifestyle Practices:
Boost progesterone production by managing stress:
Establish a self-care routine: plan regular vacations, even small outings, do meditation or yoga, take breaks from work, spend quality time with family, have a plan to get your work done on time, ask for help.
Sleep! Aim for at least 8 hours of sleep, and try to get to bed before 12am. Practice good sleep hygiene by avoiding electronics before bed, keeping the bedroom as dark as possible, and setting a bedtime and wake time, even on weekends. Body scan meditations and some key supplements can be helpful for resetting circadian rhythms. Regulating blood sugar can have a major impact on improving sleep. Talk to your functional medicine doctor or naturopathic doctor for individualized sleep solutions.
Eliminate exposure to toxic estrogens and boost estrogen clearance:
Avoid exposure to xenoestrogens: whenever possible use natural body products, deodorants and shampoos, or “edible” body products for face and hair. Avoid plastic water bottles and plastic food containers. Use natural cleaning products around the house. Avoid fragrances and processed foods, especially processed soy.
Encourage sweating: get regular exercise or engage in regular sauna therapy. If you don’t have access to a sauna, epsom salt baths can also work—anything that helps you sweat. Heat therapy has also been shown to benefit mood and the stress response.
Heal your digestion: make this a priority with your naturopathic doctor, so that you can absorb the nutrients from the foods you’re eating as well as encourage daily bowel movements and optimal microbiome balance.
Maintain a healthy weight: body fat is metabolically active and can increase overall estrogenic load. Work with your naturopathic doctor to manage your weight. We often attempt to lose weight to become healthy, however I find my patients have far more success (and fun!) getting healthy in order to lose weight. Healthy weight loss often involves managing stress, sleeping 8 hours a night, avoiding sugar and processed foods, and regulating blood sugar, as well as encouraging proper sweating and liver detoxification.
Want to balance your hormones, energy and mood naturally? Check out my 6-week foundational membership program Good Mood Foundations. taliand.com/good-mood-learn
Mindfulness philosophy tells us that our thoughts and emotions are simply phenomena that arise in our bodies and minds: they are not us.
Those of us who suffer from depression and anxiety tend to enter cycles of over-thinking. The mind wanders and engages in self-focused rumination that feeds negative emotions, worsening mood.
While ruminating, we think about the causes and consequences of our depression; we reflect on mistakes we’ve made in the past, we dwell on our perceived personal faults, and we speculate about how we’ll fare negatively in the future.
This kind of rumination becomes a scratch-itch cycle that causes us to feel worse.
However, learning to engage the contents of self-focussed mind-wandering as a non-judgmental observer may be the key to stopping this cycle.
Those who are able to step back and become aware of awareness or think about thoughts, as opposed to getting lost in them, tend to have better control over their thought processes as a whole, and thus their emotions. Mindfulness involves taking a non-judgmental, curious stance about the contents of the mind, as an impartial witness.
Studies show that mindfulness, or taking this non-judgmental, curious stance, can change brain areas associated with rumination, and emotional regulation.
This fall I took a course to obtain a facilitator certificate for Mindfulness-Based Cognitive Therapy (MBCT), an evidence-based 8-week program that aims to treat depression and anxiety through imparting mindfulness skills. Because of the growing evidence base on the benefits of mindfulness for stress and mental health, the facilitator program attracts many medical professionals.
One of the course participants, a psychiatrist, didn’t like me. I noticed her frowning in my direction every time I spoke. She deliberately avoided and ignored me, talking to everyone else in the course but me.
As the only naturopathic doctor in the group, the other participants showed some curiosity towards my field. When I answered their questions, the psychiatrist’s face seemed to twist into a subtle expression of disgust and disapproval.
She thought I was a quack, a hack; I didn’t have enough training. She assumed I wasn’t qualified enough to provide care to those who suffer from mental health concerns. I could feel her judging energy from across the room every time I lifted my hand to answer a question, or make a comment. Her deploring gaze scrutinized my every move.
I was a naturopathic doctor and she, a psychiatrist. We had emerged from different worlds, philosophies, and backgrounds—we were from incompatible ends of the mental health professional spectrum. Of course she didn’t approve of me: it was only to be expected.
We were spending all day meditating, and this is the story my mind had decided to write.
At the end of day 3 of the course, with days of evidence selectively compiled to support my story about this disapproving psychiatrist’s opinion of me, I left class to head for the bus stop. Waiting for the same bus was no one other than my nemesis.
Great, I thought. I smiled at her, stiffly.
She smiled at me.
“Talia, right?” She asked.
I nodded: yes, Talia.
“You’re the naturopath, right?” She inquired, brows kneaded together in a frown.
I nodded again, bracing myself. Are we really going to do this here?
But then, time-space cracked and split open, revealing an alternate universe to the one in my own head. Her face melted into a warm grin, “Oh, I love naturopaths!” She exclaimed warmly.
She went on to describe her wonderful encounters with the members of my profession who had attended to the various personal health concerns she’d faced.
“I’m so interested in holistic health for managing mental health concerns,” She said, before leaning in a bit, conspiratorially, and adding in hushed tones, “You know, psychiatry doesn’t work.”
I stood there, dumbfounded.
Her particular opinions about psychiatry aside: not only was the entire story I’d written and held onto for the past few days wrong, it was way wrong. I had fabricated an entire story in my head, corroborated by what I had been convinced was real evidence. The realization of how avidly I’d bought into this story, as if it were simple fact, was earth-shattering.
My story, had just been that: a story, conjured up by thoughts. These thoughts bore no relationship to reality at all, no matter how convincingly they had presented themselves.
It rare to have the opportunity to experience our mental constructs and biases topple so dramatically. The mind has a tendency to rationalize away any evidence contrary to our beliefs—”Well, I only passed because I got lucky”, or “The test was easy”, or “She said she liked my hair—liar”.
Very few of us entertain the idea that our thoughts and emotions don’t represent our ultimate reality.
According to Mindfulness Theory it helps to think of our minds as movie screens and our thoughts, emotions, and body sensations as contents of the movie. We can watch the action, identify with the characters, and follow the plot with invested interest. The movie can inspire thoughts and emotions within us, both positive and negative. The movie can grip us; we might lose ourselves in the drama, forgetting that we are mere witnesses to it.
It can help to remember that we are not the movie. Sometimes it’s helpful to remember that we’re not even acting in the movie.
No matter how deeply the film may move us, we can always take the stance of movie-going witness. We can take various perspectives in relation to the drama on screen. We can immerse ourselves in the drama, losing our sense of self completely. We can remember that we are audience members, enjoying a film. We can ignore the movie altogether and laugh to a friend sitting beside us. We can be aware of the contents of the movie theatre, the people sitting around and behind us, or the sticky floor under our feet. We can even leave the theatre, which we will certainly do once the credits roll—it’s just a movie after all, a distraction from the reality of our lives.
In the way that we approach the contents on a movie screen, we can take various stances towards the contents of our minds.
Meta-awareness is the act of remembering that we are movie watchers—the act of becoming aware of awareness itself. When we practice meta-awareness, we take a non-judgmental view of our thoughts and emotions, watching them arise in our bodies and minds like the drama in a movie arises onscreen.
We can easily identify with the tens of thousands of thoughts that appear on the movie screens of our lives. We may be convinced that we’re unloveable, that we’re failures, or that life is hopeless, simply because these particular thoughts have appeared in our mind’s screen. We can also identify with positive thoughts, such as the idea that we’re excellent swimmers, or good fathers.
Our thoughts may reflect reality—we may have the thought that if we step into a pool of water our feel will get wet—but simply having a thought does not create reality itself.
While taking the bus that day, I realized that I had unwittingly cast my psychiatric colleague as the guest-star of People Who Are Judging Me, an episode in Unloveable: The Series, which is a piece of entertaining fiction that my mind has written, directed, produced, and cast me as the lead in. I often forget that I’m simply an audience member watching the movie of my mind’s creation—this movie is not necessarily the truth about my life.
Research has identified a network in the brain called the Default Mode Network (DMN), that connects the lower brain areas, like the amygdala and hippocampus, with higher brain centres in the prefrontal cortex. The DMN is active when our minds are wandering and is particularly active when those with depression are ruminating and engaging in narrative self-referencing: or attributing one’s self as the cause of (negative) events in one’s life—for example, interpreting an expression on someone’s face to be a look of disgust and assuming it’s because they disapprove of your profession.
Meditation, particularly practicing meta-awareness, can produce shifts in the DMN that decrease rumination. Practicing meta-awareness allows us to rescue our identities from the tyranny of thought. We watch and detach from thought, watching them rise and fall in the mind without clinging to them. By becoming aware of our thoughts and emotions and taking a curious attitude towards them, we can break the cycle of rumination, thereby supporting our mental health. Observing thoughts, rather than becoming lost in their drama, allows us to feel and behave independently of them.
For example, simply having the thought, “I’ll always be alone,” doesn’t have to produce a negative emotion, if I recognize it as just a thought.
We might reframe the thought “She hates me” to be: “I just had a thought that this person hates me. It’s just a thought that I have no way of knowing for certain is true. I will smile warmly at her anyways. I might be completely wrong.”
Or, we can do nothing, waiting until the thought “She hates me” passes through the screen of our minds.
We can turn off this particular movie, and put on a new one. After all, we can’t stop the flow of thoughts: there will always be others to take their place.
Lesson learned: I am not my thoughts.
And: some psychiatrists are way more hippy than I am.
Like many people I see, Sandra was experiencing debilitating exhaustion.
Completing her PhD, she was working all day and collapsing on the couch at 8 pm.
She stopped going out in the evening. She ceased spending time with friends, engaging in activities outside of her studies, exercising, and having sex.
Her motivation and zest for life were at all-time lows.
Her marriage, and her life, were being sidelined in the service of her fatigue.
Her family doctor met her complaints with a defeated shrug. “You’re just getting older,” he offered by way of explanation.
Sandra was 27.
My patient is not alone. At least 20% of patients approach their family doctors complaining of fatigue.
Lack of energy is a problem that can arise from any body system. Fatigue can be an early warning sign that something has been thrown off balance.
I frequently see fatigue in patients suffering from hormone imbalances, including suboptimal thyroid function, insulin resistance, and low estrogen, progesterone, or testosterone. But also in chronic stress, depression, and anxiety.
Fatigue is often connected to mental health conditions, digestive issues, lifestyle imbalances, chronic inflammation, chronic stress, and lack of restful sleep. It’s no wonder, then, that most of the people I work with experience some level of low energy.
Conversely, I see improvement in energy as one of the first signs that someone is moving towards more robust health. Some of the first signs of healing are a clear mind, bright mood, and vibrant, buoyant energy.
There are a few steps you and your naturopathic doctor can take to identify and remove the cause of fatigue, while optimizing your health and energy levels.
Differentiate between sleepiness and fatigue.
It is important to determine if low energy is fatigue or sleepiness.
Sleepiness is characterized by the tendency to fall asleep when engaging in non-stimulating activities like reading, watching TV, sitting in a meeting, commuting, or lying down.
Sleepiness:
Is often improved by exercise, at least in the short-term
Is improved with rest
Fatigue is characterized by a lack of energy, both physical and mental. Fatigue is often worsened by exertion.
Those who are fatigued:
Suffer from mental exhaustion
Experience muscle weakness
Have poor endurance
Typically feel worse after physical exercise and take longer to recover
Don’t feel restored after sleeping or napping
Might experience ease in initiating activities but progressively experience more weakness as they continue them (e.g.: engaging in social activities, movement, working, etc.)
To determine between sleepiness and fatigue, your naturopathic doctor will ask you a series of questions about the nature of your low energy.
2. Assess sleep.
Assessing and optimizing sleep is essential for beginning to treat all low energy and, in particular, sleepiness.
Assessing sleep involves looking at a variety of factors such as:
Bedtime and waking time
Sleep onset: how long it takes
Sleep routine and sleep hygiene habits
Sleep duration: how many times you wake up, how quickly you can fall back asleep after waking
Causes of interrupted sleep such as sleep apnea, chronic pain, frequent urination, children/pets/partners, etc.
Nap frequency and length
Ability to wake up in the morning
Perceived sleep quality: do you wake feeling rested?
The use of sleep aids
Exercise routines, how close to bedtime you eat or exercise.
And so on.
Using a sleep app or undergoing a sleep study are two additional tools for assessing the quality and duration of your sleep cycles that may be useful.
3. Address sleep issues.
Whether the cause of fatigue is sleepiness or not, restful sleep is essential to restoring our energy levels. Optimizing sleep is an important foundational treatment for all health conditions.
Restorative sleep regulates hormones and balances the stress response, called the hypothalamic-pituitary-adrenal axis (HPA axis). It improves cell repair, digestion, memory, and detoxification.
Mental and emotional stress, artificial light, blood sugar dysregulation, inflammation, and hormone imbalances can interfere with sleep.
To address issues with sleep, it is important to:
Maintain a strict sleep schedule. This means keeping bedtime and waking time consistent, even on weekends.
Practice good sleep hygiene by avoiding electronics at least an hour before bedtime, using blue light-blocking glasses if necessary, and keeping the bedroom as dark as possible.
Avoid stimulating activities like exercise in the hours before bed.
Keep the bedroom cool and dark.
Reserve the bed and bedroom for sleep and sex only.
Balance circadian rhythms by exposing your eyes to sunlight immediately upon waking and eating protein in the morning.
In addition to sleep hygiene and balancing circadian rhythms, sleep aids can be helpful. I start my patients with melatonin, a non-addictive antioxidant, to reset the sleep cycle and help with obtaining deeper, more restorative sleep.
It is important to take melatonin in a prolonged-release form a few hours before bedtime and to use it in addition to a dedicated sleep routine.
Determine whether the fatigue is secondary to an underlying medical condition.
Secondary fatigue is defined as low energy, lasting from 1 to 6 months, that is caused by an underlying health condition or medication.
With your medical or naturopathic doctor, be sure to rule out any issues with your immune system, kidneys, nervous system, liver, and heart, and to assess the side effects of any medications you’re taking.
Ruling out chronic infections, pregnancy, anemia, and cancer may be necessary, depending on other signs and symptoms that are present, your individual risk factors, and family history.
While the vast majority of fatigue is not caused by a serious health condition, ruling out more serious causes is an essential part of the diagnostic process.
Remember that this is not a job for Dr. Google! Because fatigue is a sign that something in the body is not functioning optimally, it can be implicated in virtually every health condition, alarmingly serious ones, but also more benign conditions as well.
Taking into account your entire health history, risk factors and particular symptoms, as well as assessing blood work is a complex job that a regulated health professional can assist you with.
Get blood work done.
Assessing blood work is necessary for ruling out common causes of fatigue.
Blood tests are used to rule out anemia, infections, suboptimal iron, B12, and folate levels, under-functioning thyroid, inflammation, insulin resistance, and hormonal imbalances.
To evaluate the cause of fatigue, your doctor will look at:
A complete blood count (CBC) that looks at your red and white blood cells.
inflammatory markers like ESR and hs-CRP
TSH, to assess thyroid function, and occasionally free thyroid hormones and thyroid antibodies, if further investigation is indicated
B12, iron and folate
Other tests such as fasting insulin, fasting blood glucose, liver enzymes, and hormones like estradiol, testosterone, estrone, LH, FSH, and progesterone, depending on the health history and the constellation of symptoms.
Your doctor may take further measures to assess your heart and lungs, or to rule out chronic infections.
6. Identify physiologic fatigue, or burnout.
Once sleepiness and any underlying health conditions have been ruled out, your doctor may determine whether you have physiologic fatigue.
Physiologic fatigue, also commonly called “burnout” or “adrenal fatigue”, is the result of an imbalance in sleep, exercise, nutrition intake, and rest.
It is by far the most common category of prolonged fatigue that I see in my practice. Two thirds of those experiencing fatigue for two weeks or longer are experiencing this type of fatigue.
Feeling a lack of motivation, low mood, and increased feelings of boredom and lethargy are characteristics of this kind of fatigue.
Physiologic fatigue can be confused with depression, leading to a diagnosis and subsequent antidepressant prescription, which may fail to uncover and address contributing lifestyle factors.
To tell if you might be experiencing physiologic fatigue, or burnout, see if you answer yes to any of the following questions, adopted from the Maslach Burnout Inventory:
I feel emotionally drained at the end of the day.
I feel frustrated with my job.
I feel I’m working too hard.
I feel fatigued when I have to face another day.
I have a hard time getting up in the morning on weekdays.
I feel less sympathetic and more impatient towards others.
I am more irritable and short-tempered with colleagues, my family, my kids.
I feel overwhelmed.
I have more work than I can reasonably do.
I feel rundown.
I have no one to talk to.
Fortunately, there are many solutions to improving low energy and mood caused by burnout.
Balance the HPA Axis
Balancing the stress response, otherwise known as the Hypothalamus-Pituitary-Adrenal (or HPA) axis, is an important component of treating physiologic fatigue.
Our HPA axis becomes activated in the morning when the hormone cortisol is released from the adrenal glands. Cortisol suppresses inflammation and gives us the motivated, focussed energy to go about our day.
Towards the end of the day, cortisol levels naturally fall. In the evening, cortisol is at its lowest, and melatonin, our sleep hormone, rises.
Those with HPA dysfunction have an imbalance in this healthy cortisol curve.
They commonly experience sluggishness in the mornings, a crash in the afternoon (around 2 to 4 pm), and restless sleep, often waking up at 2 to 4 am as a result of nighttime cortisol spikes and an impairment in melatonin release.
These individuals often experience cravings for salt and sugar. They may have low blood pressure and feelings of weakness.
It is common for those experiencing burnout to get sick when they finally take a break or experience prolonged healing time from common infections, likes colds and flu.
They may suffer from inflammatory conditions like chronic migraines, muscular tension, and report feeling depressed or anxious.
In this case, balancing the HPA axis is a treatment priority.
Treatment involves:
HPA axis balancing through adaptogenic herbs
Optimizing adrenal nutrient levels
Regulating blood sugar
Improving circadian rhythms
Reducing workload and perceived stress through addressing perfectionism, practicing setting boundaries, and developing mindfulness, among other skills.
Improving sleep
Engaging in regular, scheduled exercise
Reducing inflammation, improving digestion, or regulating hormones
Being proactive about mental health and emotional wellness
Improving self-care and stress resilience
Cognitive Behaviour Therapy can be used to teach healthy coping skills while balancing sleep and stress. Studies show it can be more effective than medication for the depression and anxiety related to physiologic fatigue.
Of course, from a holistic perspective, the above strategies are the foundations for improving general health and wellness for all fatigue-related conditions, regardless of whether the fatigue is due to sleepiness, secondary fatigue, physiologic fatigue, or chronic fatigue syndrome.
Talk to your naturopathic doctor about adaptogenic herbs.
Adaptogenic herbs are an important natural tool for improving mood and energy.
Adaptogens help the body “adapt” to stress. They up-regulate genes involved in boosting the body’s natural stress resilience.
Because of this, adaptogens not only improve energy and mental and physical endurance, they also improve attention and concentration, immune system function, and mental work capacity.
They can treat depression and anxiety, and regulate circadian rhythms.
Common adaptogens are withania (or ashwaghanda), rhodiola, holy basil, the ginsengs, like Siberian gingseng (or eleuthrococcus), schizandra, liquorice, and maca, among others.
My two favourite adaptogens are ashwaghanda and rhodiola, however your naturopathic doctor can work with you to pick the best herbal combination for your individualized needs.
9. Rule out Chronic Fatigue Syndrome.
Chronic fatigue syndrome (CFS) is characterized by fatigue that lasts 6 months or longer, is not improved by exercise and rest, is not related to an imbalance in lifestyle, and is not caused by a primary health condition.
Those with CFS often have signs of an activated immune system such as enlarged lymph nodes, a low-grade fever, or a sore, inflamed throat. Sufferers may experience generalized weakness and pain.
CFS can be an extremely debilitating condition that results in a 50% reduction of daily functioning.
The cause of CFS is not known, however balancing HPA axis function, improving nutrient status, reducing inflammation, healing the gut, reducing toxic burden, boosting mitochondrial functioning, and promoting self-care are all useful treatment strategies.
Our gut is the seat of the immune system, sampling foreign substances from the external environment and activating an immune response, if it finds any of those substances pose a threat to the health of the body.
If our immune system comes into contact with something doesn’t like, even if that something is a benign food substance, an inflammatory reaction can be triggered. Chronic inflammation can exacerbate fatigue.
To test for food sensitivities, your naturopathic doctor will either order a blood test, or recommend an elimination diet where suspicious food is removed from the diet, the gut is healed, and foods are later reintroduced.
Common foods to eliminate are gluten, dairy, sugar, eggs and soy. Stricter Autoimmune Paleo diets involve the removal of all dairy, eggs, grains, legumes, and nuts.
Mind your mitochondria.
Our mitochondria are the “powerhouses” of the cell, responsible for making ATP, our body’s energy currency, out of the carbs, protein, and fats from our food.
Research has shown a link between mitochondrial dysfunction and chronic fatigue.
The mitochondria need a variety of different nutrients to function optimally. These nutrients include B vitamins, magnesium, Coenzyme Q10, and certain amino acids.
When the mitochondria are unable to produce sufficient ATP, fatigue may result. Similarly, a problem with antioxidant production can result in the buildup of reactive oxygen and nitrogen species, otherwise termed “free radicals”, in the mitochondria.
Free radicals can trigger inflammation and immune system activation in the entire body, causing us to feel ill and fatigued.
B vitamins are also important for a process called “methylation” which is essential for energy and hormone production, immune function, detoxification, mitochondrial function, and DNA repair.
Balance your blood sugar.
Insulin resistance, hypoglycaemia, type II diabetes, and metabolic syndrome are all common conditions that reflect the body’s inability to regulate blood sugar.
All of these conditions can cause frequent energy crashes, fatigue after eating, brain fog, and lethargy.
Even those free of the above conditions may still struggle with blood sugar imbalances. Signs of blood sugar dysregulation are craving sweets, feeling hungry less than 3 hours after a meal, getting “hangry”, feeling weak and dizzy if missing meals, waking at night, and snacking at night.
Balancing blood sugar by eating enough fibre, fat and protein at every meal is essential to maintaining the endurance to get through the day.
Your naturopathic doctor can help you come up with a diet plan that keeps your blood sugar balanced and your energy levels stable throughout the day.
Support your immune function and eradicate chronic infections.
Chronic infections can result in prolonged activation of the immune system, resulting in chronic fatigue.
Viral infections, like mononucleosis and Epstein Barr, and gut bacteria imbalances, such as SIBO, C. Difficile, and candida overgrowth can be implicated in chronic fatigue.
Supporting the immune system with herbs, balancing the HPA axis, and using natural remedies to eradicate the infection are all courses of action you may take with your naturopathic doctor to eradicate infectious causes of fatigue.
Uncover and treat hormone imbalances.
Our hormones, the messengers of the body, regulate how our cells talk to each other.
Hormones are responsible for blood sugar control, the stress response, ovulation and fertility, sex drive, metabolism, and, of course, energy production and utilization.
It is possible that those who suffer from low energy have an imbalance in the hormones cortisol, insulin, estrogen, progesterone, DHEA, testosterone, or thyroid hormones. Directly addressing hormones is then the main treatment goal for improving energy.
Uncovering other signs of hormonal imbalance, such as the presence of PCOS, endometriosis, or symptoms of hypothyroidism, as well as ordering blood tests, can help reveal if an imbalance in hormones is the main cause of your fatigue.
Encourage detoxification.
Our body has the powerful ability to process and eliminate the 500 chemicals and toxic substances we come into contact with daily, as well as the hormone metabolites and immune complexes produced as a result of normal metabolic functioning.
Our livers, kidneys, colon, and skin regularly filter hundreds of harmful substances from our bodies. This process happens naturally without the aid of outside support.
However, it is possible that an increased toxic burden on the body paired with a sluggish liver and digestive system, can increase the body’s overall toxic load.
Toxic overload can contribute to fatigue by increasing inflammation and immune system activation, as well as impairing energy production pathways, and disrupting hormonal function.
Reducing contact with harmful toxins, while supporting kidney, liver and colon function can help restore optimal energy and health.
—
Treating fatigue first involves developing a relationship with your healthcare provider: finding someone who takes your concerns seriously.
Conducting a thorough assessment of blood, lifestyle factors, sleep, hormones, and digestion, and as many other factors as possible, is essential to uncovering the cause of fatigue.
Treatment involves removing obstacles to healing, supporting energy production, balancing lifestyle, and using herbs to boost energy and stress resilience.
When we consider fatigue as an important sign that something in our body is functioning sub-optimally, we can use our energy levels are important indicators for health.
Prefrontal Cortex: …Right, so the deadline for the article is Monday. I can work on it tomorrow morning, but then I also need to schedule time for grocery shopping—what am I going to make for the week to eat? There’s a giant load of laundry in the bin too, which I should get to, maybe I can squeeze that in while I’m writing. Laundry is such an involved process sometimes… I also have that doctor’s appointment on Thursday, then I there’s that package I have to pick up at the post office, and I have to mail out my passport for—oh, right, we needed the bathroom—
Amygdala: Good God, NO!!!! OH IT’s THE END OF TIMES! THERE’S A THING there! A crawly, thing, so many legs, evil legs. We’re going to die!!!!!
PFC: It’s a centipede. Trapped in the bathtub.
A: What’s a centipede?! It looks like an alien. Those legs will crawl up our legs, into our mouths, eyes, under our skin—
PFC: Centipede’s don’t do crawl under your skin. I believe that’s…uh, scabies? Centipedes are relatively harmless. Besides, this one is extra harmless; it’s trapped in the tub. Look, see how he’s struggling to get out? He can’t. Poor guy… It reminds me of a time when I felt helpless…
A: It needs to die, we need to kill it, we can’t go on like this!!!
PFC: What, with a centipede in the tub?
A: It’s LEGS. They’re hideous, it crawls, it’s fast. Oh, God, I hate it. We need to call someone.
PFC: We can’t call someone. We’re a strong, independent 30-something woman. We’ve handled massive spiders as big as our heads in the Amazon, giant Caribbean cockroaches in our granola—
A: LOOK AT IT. It keeps moving… Oh god, I hate it.
PFC: It keeps moving because it’s trying to get out of the tub.
A: AND CRAWL ON OUR FACE. LOOK AT IT’S BILLIONS OF DISGUSTING LEGS!
PFC: Why discriminate against something that has many legs? Hindu gods have an extra set of arms and they’re divine. Remember all the times we wished we had another set of arms so we could hold grocery bags while looking for our keys and texting?
A: THAT’S DIFFERENT THIS… MONSTER—
PFC: —centipede.
A: CENTIPEDE… can’t text. It has nefarious plans for us once it gets out of its white, porcelain prison. WHAT ARE WE GOING TO DO?
PFC: Well, we could just leave it there… he doesn’t seem happy in the tub, though…
A: WE’LL NEVER BE ABLE TO BATHE AGAIN! WHAT IF IT CRAWLS OUT?
PFC: It can’t crawl out. Ok, you’re right, we can’t leave it there. The noble thing to do would be to scoop him out and put him in the garden.
A: NOOONONNONONNONONO GOD NO WE’RE NOT TOUCHING IT!
PFC: Why? It’s small, harmless. It’s trapped. We could use a water glass and a card, or book…
A: NO, NOT THE BOOKS, WE DON’T PLAY CARDS WE’RE NOT TOUCHING IT.
PFC: We could… kill. it.
A: OK OK OK!!! HOW?! How?
PFC: Well, we could squish it? Flush him down the drain? I feel like that goes against our moral principles. And, I’d also have to conclude that, quite frankly, it would be an act of cowardice, the ethically inept thing to do—
A: —which option requires the least amount of touching it and squishiness?!
PFC: Flushing. But it will also result in a slow, agonizing death for the poor creature, who we have decided to persecute for simply being in our tub, and for possessing many legs. I’m not sure of the extent to which a centipede feels pain and suffers, though. I mean, does it suffer like we do? Suffering, after all, is often in the stories we tell ourselves about our expectations and identities, our beliefs about what should be and what we deserve, rather than what is. I don’t know if centipedes have identities or expectations but, if we flush him, he’ll struggle, which means he is resisting what is, which is suffering. Causing suffering to another being is wrong. We can also clearly observe that he prefers to stay alive—
A: SHUT UP AND DO IT! FLUSH HIM!
PFC: It would be wrong. We’d feel bad about it. I would, you would. Let’s put him in the garden, please?
A: NO NO NO FLUSH PLEASE.
PFC: Let’s just leave him, pretend he’s not there and come back later.
A: What if he gets out? Crawls on our face while we’re sleeping?
PFC: I don’t think that’s likely. I think he’s trapped in there.
A: He’s going to die eventually let’s kill him, get rid of him!
PFC: Eventually, like you mean at the end of his lifespan? That’s true. I’m not sure how long centipedes live… It’s also cold outside, I don’t think putting him in the garden would do any good. He obviously came in to escape the cold. We’re seeing more centipedes inside now as the weather changes.
A: OH STOP REASONING and just do it!
PFC: …. ok.
….
PFC: Amygdala, it’s done. It was horrible, we’re horrible brain areas. Are you happy? You don’t have to worry about it anymore. I also made sure I let plenty of water flush down the drain so he can’t crawl back up, even though highly unlikely, I knew you might have something to say about that… Amygdala?
A: …
PFC: Amygdala? You’ve… gone quiet.
A: So how are you going to get your article written, laundry done, groceries bought AND cook something for the week? You also made plans with your friend this weekend and you need to shower in the centipede-infested bathroom, and CLEAN the bathroom, it’s filthy. You’ll never get it done… Fear, dread, overwhelm! IT’S THE END OF TIMES!
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.
In the past I used to suffer from “hanger”, feeling hungry and irritable if going more than a few hours without food. Now my body is adapted to fasting, going prolonged periods without food—and I feel all-the better for it.
When I was a kid, no one ever had to convince me to finish my dinner. Perpetually “hangry” (hungry and angry), I was the Tasmanian devil of snacking, vacuuming up whatever food substances crossed my path, leaving wrappers and crumbs in my wake. “Never get between Talia and her food,” my brother facetiously coined when, like a voracious bull, I would bully my way into the kitchen to fix myself an emergent after-school snack. From the moment I was born, it seems, going more than two hours without eating was a physical impossibility. “I’m sick with hunger,” I would complain whenever my blood sugar levels dipped.
Now I sit here writing this article, in my adult incarnation, comfortably having abstained from eating for more than 14 hours. Whereas before I couldn’t go more than 2 hours without some kind of sugary snack, my body is now adapted to thriving during prolonged periods without food—and I feel all-the better for it.
“Eat a snack every 2-3 hours to keep blood sugar stable and lose weight,” dieticians and nutritionists often advise . However, as we dig into the disease prevention, anti-aging and weight management research, we learn that there may be benefits to going without food for prolonged periods.
We humans spent much of our evolutionary history hunting and gathering with extended periods of food scarcity. Our bodies adapted to survive through, and perhaps even thrive and depend on, periodic fasts. We now live in a society that enjoys food abundance: with 24-hour convenience stores and fast food restaurants at our disposal, we rarely go hungry. This recent lifestyle change may contribute to the increase in the diseases of excess that afflict modern bodies.
Ancient healing systems like Ayurvedic medicine and Traditional Chinese Medicine have long recognized the benefits of fasting for purifying and healing the body. Today, a body of research is accumulating that suggests that fasting may help treat diseases like multiple sclerosis and cancer, reduce the risk of chronic metabolic diseases, such as diabetes, battle dementia and cardiovascular disease, and reverse the effects of aging, helping us live longer.
What Happens During Fasting:
Human physiology fluctuates between two modes: the fasted and the fed state. After eating, a hormone called insulin rises in response to the intake of dietary carbohydrates and, to a lesser extent, protein. Insulin allows glucose to enter cells where it can be used for energy. Insulin encourages the storage of body fat and glycogen—a molecule stored in the muscles and liver that can be broken down quickly for energy. Insulin is an anabolic hormone that promotes tissue building and growth.
Our bodies are in the fed state, or postprandial state, for up to 4 hours following a meal, when blood sugar and insulin levels rise and the body begins to store food energy. 4-6 hours after eating, our bodies enter the post-absorptive state. Insulin and blood sugar levels fall, and blood sugar is maintained through the breakdown of liver and muscle glycogen. At the 10-12 hour mark post-meal, the body enters the fasting state. At this stage, glycogen stores have been depleted and blood glucose is maintained through a process called gluconeogenesis: glucose is created from fat, lactate and protein. In the fasting state, the body taps into fat stores to create ketone bodies, which are used for fuel.
Approximately 24-48 hours after a meal, the body enters a state called autophagy (or self-eating). The body breaks down old, damaged cells into their proteins and reuses them to build new cells or for fuel, through gluconeogenesis. Autophagy has gained the attention of researchers who recognize its benefits for managing inflammation, slowing the effects of aging, and treating various chronic diseases, such as autoimmune disease and cancer—more on this later!
Fasting to Treat Cancer:
Valter Longo, PhD, at the Longevity Institute at the University of Southern California, examined the effects of 2 to 4-day fasts on patients with cancer who were undergoing chemotherapy. The study found that several days of fasting improved the efficacy of chemotherapy, while reducing its side effects, protecting healthy, non-cancerous cells. Healthy cells responded to the periods of food restriction by shutting down, protecting them from the toxicity of the chemotherapy. Cancer cells don’t have such a response, leaving them susceptible to the chemotherapy. “Cancer cells are dumb cells,” says Dr. Longo.
The fasting period not only improved the effects of cancer treatments, it stimulated the regeneration of the immune system through the creation of progenitor stem cells. Fasting cleared out damaged immune cells and cancer cells through autophagy and new cells were regenerated upon re-feeding. Dr. Longo and his team found that up to 40% of the immune system is rebuilt in mice after a fasting and re-feeding cycle.
Fasting Mimicking Diets:
Recognizing the difficulty in going 3 days without food, Dr. Longo developed a 5-day “Fasting Mimicking Diet” that allows for the consumption of about 700-1000 calories per day in the form of small snacks. The Fasting Mimicking Diet is low enough in calories, protein and carbohydrates to mimic the physiological conditions and benefits of fasting like autophagy, ketone body production, beneficial stress response, and cancer cell starvation.
Mice given the Fasting Mimicking Diet (FMD) lost 30% of their body weight through the breakdown of body fat and clearing away of old, damaged cells. When the mice were re-fed, their blood, brain and bone cells were rebuilt. The mice who underwent the Fasting Mimicking Diet had rejuvenated immune systems, decreased incidences of cancer, reduced body fat, improved cognitive performance, decreased inflammation, and increased lifespans.
Fasting to Treat Autoimmunity:
Research in mice showed promising results in using the Fasting Mimicking Diet to treat multiple sclerosis, a debilitating autoimmune condition that attacks the nervous system. When following the diet, immune cells that were attacking the brain and spinal cord were destroyed. Upon re-feeding, new progenitor stem cells were created that repopulated the immune systems of the affected mice, and aided in repairing the damage to the brain and spinal cord. The Fasting Mimicking Diet resulted in a 20% reduction in autoimmunity in mice with multiple sclerosis.
A study that examines the effects of the Fasting Mimicking Diet on humans with Crohn’s Disease, an autoimmune disease the affects the digestive system, are currently underway.
Fasting to Reverse Aging:
Autophagy, the process of removed and recycling old and damaged cells, is a new area of research for reversing the effects of aging. Autophagy alleviates the body burden of senescent cells that have stopped dividing but are still robbing the body of essential nutrients and energy.
When cells become senescent, they release inflammatory mediators, which can damage neighbouring cells and cause inflammation and disease. Cellular senescence is thought to be one of the primary mechanisms by which we age. As we age, more cells become senescent, causing age-related inflammation. A study found that inflammation is the primary factor that drives the aging process, damaging DNA and contributing to various diseases, such as cardiovascular disease, diabetes, arthritis, cancer, and autoimmunity.
The process of fasting and re-feeding stimulates the production of new, healthy progenitor stem cells in the immune system. Mice and human volunteers who underwent cycles of the Fasting Mimicking Diet had decreased numbers of myeloid cells, the inflammatory immune cells that become more numerous as we age, and increased numbers of cytotoxic T cells, which protect the body against viruses and cancer.
Fasting promotes longevity through its inhibition of Insulin-like Growth Factor -1 (IGF-1), a growth factor that promotes cellular growth, and prevents the death of senescent cells. Growth factors are important for growing babies and children, developing fetuses, boosting muscle, and growing new brain cells. However, growth factors like IGF-1 are negatively associated with longevity because of their potential to stimulate the growth of cancer and prevent autophagy. Mice whose growth factor-dependent genes were removed, or “knocked out”, lived 40-50% longer and suffered from less diseases as they aged. IGF-1 is stimulated by protein and carbohydrate intake; it is elevated in the fed state and inhibited when fasting.
Healthy humans who underwent cycles of the Fasting Mimicking Diet had lower risk factors that were associated with cardiovascular disease and diabetes, such as lowered blood pressure, reduced CRP (a marker of inflammation in the blood), and reduced fasting blood glucose levels. These markers remained improved even after the subjects returned to a normal diet, which indicates that fasting may help reduce the risk of chronic diseases, such as diabetes and heart disease, promoting health longevity and increased lifespan.
Fasting for Energy and Resilience to Stress:
Hormesis is the process in which the body’s response to a stressor like the slightly toxic flavonoids in plants, intense exercise, or extreme temperatures, benefits the body as a whole. Hormesis is one of the reasons that exercise and green leafy vegetables are so good for us; they impose minor stressors on the body, boosting its healing properties, and improving resilience.
Fasting, in addition to other positive stressors, up-regulates a stress-response gene called FOX03. When FOX03 is activated, it produces proteins that reduce inflammation, increase anti-oxidant production, repair DNA, and increase cellular energy production through the creation of new mitochondria. Humans with a more active version of the FOX03 gene have an almost 300% chance of living to be over 100 years old.
Fasting also promotes a process called mitophagy. Similar to autophagy, mitophagy involves removing and recycling damaged mitochondria that are no longer able to effectively produce energy. Through activation of the FOX03 gene, more mitochondria are created to replace the old, improving energy production. The creation of new mitochondria only occurs in response to exercise, extreme temperatures, and periods of fasting.
Fasting for Weight Loss:
It doesn’t take a researcher to figure out an obvious truth about fasting: when you don’t eat, you lose weight. Dr. Jason Fung, MD, a Toronto-based nephrologist, prescribes fasting to his obese and diabetic patients. In his book, The Obesity Code, Dr. Fung discusses how the old paradigm of restricting calories for weight loss—eating 1500 calories a day while burning 2000, for example—is out-dated and ineffective for keeping weight off longterm. Dr. Fung argues that fat storage and breakdown are not the result of a simple calories in minus calories out equation, but the performance of a hormonal orchestra conducted by insulin. Insulin stores fat and glycogen, while inhibiting the release of fat breakdown. The body only begins to tap into its glycogen and fat stores when insulin drops during the post-absorptive and fasting phases after a meal. Once it depletes its glycogen stores, the body burns fat as its main source of fuel as long as insulin levels remain low.
According to Dr. Fung, fasting is superior to caloric restriction diets because it keeps insulin levels low for long enough to allow the body to deplete its glycogen stores and tap into fat. Fasting also releases surges of growth hormone, which prevents muscle loss, and norepinephrine, which boosts energy and feelings of well-being. Unlike caloric restriction diets, studies have shown that metabolism increases during and after fasting, preventing weight regain. Dr. Fung argues that fasting can spare muscle, boost metabolism, increase energy, and increase feelings of well-being, making it an effective tool for lasting weight loss.
Ways to Fast:
While the health benefits may be numerous, fasting isn’t easy. The first time I tried a prolonged fast, all I could think about was food. Food was everywhere and the people around me seemed to be eating all the time. My body, accustomed to being constantly fed, wasn’t too happy with the sudden metabolic switch I was demanding from it. Many of our metabolisms have been trained to run on dietary carbohydrate and glycogen as their primary fuel sources, making the first few hours to days of fasting a challenge. However, there are many ways to ease into the practice of fasting. You can obtain Dr. Valter Longo’s Fasting Mimicking Diet kit from a healthcare provider through ProLon, or practice small intermittent fasts, such as Time-Restricted Feeding.
Time-Restricted Feeding:
A researcher at the Salk Institute in Califoronia, Dr. Sachin Panda, PhD, found that restricting eating time had amazing health benefits in mice. Mice were fed an unhealthy diet of lard and sugar. The mice, as you might expect, had shorter lifespans and a variety of health problems: diabetes, obesity, and heart disease. However—and this part is miraculous—when Dr. Panda and his team restricted the time the mice were fed the exact same crappy diet to 12 hours (instead of allowing them to eat whenever they wanted), none of the negative health benefits occurred; the Time-Restricted Fed mice were 70% leaner, lived longer and were free from diabetes or heart disease.
Further investigation revealed that restricting feeding time to 8-12 hours a day, resulted in mice that had less body fat, improved muscle mass, decreased inflammation, increased cardiovascular function, increased mitochondrial function, higher levels of ketone body production, increased cellular repair processes and anti-oxidant production, and increased aerobic endurance. It was when the mice ate, not what they ate, that conferred these health benefits.
North Americans, on average, eat on a 15-hour clock. We seem to eat constantly, stopping only to sleep. To study the effect of Time-Restricted Feeding on humans, Dr. Panda had human participants restrict their food intake to 12 hours a day; if the volunteers had their first sip of coffee at 7 am, they were told to cease all food intake by 7pm. After the completion of the 16-week study, the volunteers lost 3-5% of their body fat without making a conscious change to their diets. The participants reported sleeping better and feeling more energized in the morning. They noted that their overall calorie consumption decreased by about 20% without effort.
Research into Time-Restricted Feeding indicates that allotting at least 12 hours a day to fasting boosts the body’s repair mechanisms, improves digestive function and motility, provides time for the body to switch to ketone body production (which tends to happen 10-12 hours after a meal), improves blood sugar control, regulates appetite, and enhances stress resilience. Taking a break from eating allows the body to invest its energy into repair, rather than digestion. The best part about Dr. Sachin Panda’s research is its simplicity; to obtain all of the benefits, simply avoid after-dinner snacks!
Intermittent Fasting:
Similar to Time-Restricted Feeding, Intermittent Fasting plays with the ratio of fasted to fed hours. Proponents of Intermittent Fasting refrain from eating from 12 to 23 hours within a 24-hour period. A common ratio of fasted to fed time is 16 to 8 hours: fasting for 16 hours a day and eating within an 8-hour window. For example, if breakfast is at 8am, then those following a 16:8 intermittent fast stop eating by 4pm in the afternoon.
Alternate Daily Fasting or the 5:2 Diet:
Studies with mice and human subjects found that alternating daily food intake, or following a 23:1 fast (having just one meal a day) every second day, was effective for weight loss. The protocol is beautifully simple: every second day either fast completely or indulge in only one meal. While people tend to eat more on their “fed” days, they don’t seem to make up the calories that are lost on the fasting days, resulting in an overall reduction in calories and weight loss.
Water Fasts:
It’s estimated that we need to fast for at least 36 hours to get the autophagy benefits, which makes water fasting a powerful therapeutic and anti-aging practice. Water fasting is simple: withstand extended periods, usually 3 to 5 days, but often longer, only consuming water.
The longest recorded water fast was 382 days, performed in 1973 by a 27-year old male who weighed 456 lbs. During the months he fasted, the 27-year old consumed only water and a multivitamin and, according to the study published on him, experienced “no ill-effects”. While water fasts can have amazing therapeutic benefits, it is advised that they be medically supervised.
Ketogenic Diets:
Ketogenic diets are high-fat diets that restrict carbohydrates and limit protein, and can mimic the low-insulin conditions of fasting. Because carbohydrates and protein are restricted, the body is forced to turn dietary fat into ketone bodies, which it can use for energy.
Ketone bodies, especially beta-hydroxybutyrate, produced from either dietary or body fat, have important therapeutic uses. They provide more energy for the brain than glucose, which can have benefits for memory, mood, concentration and cognitive performance. Ketogenic diets have been recommended for treatment-resistant epilepsy, and diseases associated with cognitive decline like Alzeimer’s and Parkinson’s. More recently ketogenic diets have been recommended for mental health conditions, such as depression and anxiety.
Ketone bodies also help cells resist oxidative stress, preventing cellular damage, which makes ketogenic diets of interest to cancer researchers because or their ability to starve cancer cells of protein and carbohydrates, while fuelling healthy cells.
Ketogenic diets can deliver many of the benefits of fasting because of the low-insulin, low growth factor conditions they induce. When a person becomes “keto-adapted”, able to burn ketone bodies efficiently for fuel, the transition to fasting is easy. For this reason, ketogenic diets and fasting often go hand-in-hand.
Cautions:
While fasting can deliver many health benefits, it can impose a temporary stress on the body for those who haven’t adapted to ketosis or prolonged periods without food. Therefore, it’s important to fast under the supervision of a medical professional, especially if deciding to embark on an extended fast.
Before deciding to fast, the individual’s energy levels and vitality, health status, hormone regulation (those who are taking insulin should practice extreme caution when fasting), age, health history, and health goals, should all be considered. A woman of fertility age will have different health goals than a 72-year old woman with type II diabetes. The former may want to preserve body fat and promote fertility and ovulation, while the latter may want to reduce her insulin and growth factor levels, and lose weight in order to promote health longevity.
Fasting may not be appropriate for everyone. For example, those who are underweight, pregnant, breastfeeding or suffering from an eating disorder should not fast. Fasting in women of reproductive age has the potential to produce hormonal imbalances such as hypothalamic amenorrhea (irregular or absent menstrual cycle). Fasting can exacerbate or cause dysregulation in stress hormones, particularly cortisol, known as “adrenal fatigue”, and potentially effect thyroid function, as a result of the body’s starvation response. Fasting while under the pressure of chronic mental and emotional stress is probably not a good idea. Working with a professional and listening to your body are key elements to doing fasting right.
However, when used correctly, it can be a simple, free, powerful therapeutic tool for healing the body, treating chronic disease, and promoting longevity.
I talk about root causes of anxiety, the most common mental health condition, and what to do about it from a functional medicine perspective.
Hi, everybody, Dr. Talia Marcheggiani here. I’m a naturopathic doctor who practices in Bloor West Village, in Toronto and today I’m going to talk to you guys about the roots of anxiety.
Anxiety is the most common mental health condition. It affects about 18%of North Americans and it encompasses a wide range of different diagnoses including generalized anxiety disorder, panic disorder, OCD, phobias, PTSD and depression, and social anxiety. It’s a huge umbrella of different conditions. So the first thing I do when I meet my patients is try to understand how anxiety manifests for them. The word anxiety means very little to me. What I care about is how the symptoms are manifesting in my individual patient in front of me and how it affects their life. So, I’ll ask them what does it mean when you tell me that you have anxiety? Walk me through a situation when your anxiety gets triggered, tell me what it’s like to live inside your shoes, inside your head, what kind of things do you worry about? What goes on in your body? And, how do you know that you have anxiety? Did you decide that you had that diagnosis or did someone else give it to you and what do you feel or think about having that diagnosis? Do you agree with it? Do you disagree? Do you have any doubts? The symptoms of anxiety encompass the body because it affects our nervous system, every single bodily organ is affected, potentially, by anxiety and some people have some of the symptoms or all of them and sometimes very few, just the mental and emotional symptoms, and many of us don’t even identify with having chronic anxiety or anxiety disorders or anxiety symptoms.
First of all, we have the mental symptoms. People with anxiety will commonly experience worrisome thoughts, anticipatory anxiety, so, being worried about the immediate future or the distant future. They might feel irritable or excited, they may have depressed mood. A lot of the people I see with anxiety have this kind of “chilled out” demeanour because it’s very common for someone who’s got a high level of anxiety in their body to dissociate a little bit from those feelings and appear very calm. They kind of describe it as a duck on a pond. On the surface, you see this calm animal, just floating along, but when you look under the water you see the duck legs busily working away and so that’s how a lot of people will describe their mind. They say, on the surface I’m really calm, but once you look under the surface, you see that there’s a lot of mental activity and a lot of worry that’s happening.
There may be fears, such as specific fears, such as phobias, or just general fears, like in the case of generalized anxiety disorder, or fears may be triggered in certain situations like in the case of social anxiety. Insomnia is very common, an overactive and busy mind is very common, fatigue is another common symptom as well as difficulty concentrating, memory loss, brain fog. So all of these conditions that show that the person who’s experiencing anxiety and who is dealing with anxiety is distracted and focused on other things, rather than what’s right in front of them. So a lot of the time my patients will describe an inability to feel present and feel connected and enjoy the moment. Their mind is always on something else. Sometimes the anxiety is based around specific concerns and sometimes it’s just very general and it doesn’t really matter what’s going on in someone’s life, there’s this sense of impending doom that they’re dealing with on a daily basis. Anxiety and depression are very common, they’re comorbid mental health conditions, and it’s very difficult to tell the difference a lot of the time. There’s a hypothesis that they’re similar conditions, or the same condition, but one is a more extraverted, so that would be anxiety, version of depression, which is a more introverted and internalized manifestation of the same disease process. This is still a hypothesis, but it makes some sense and it resonates with a lot of people that I talk to.
Then we have the bodily symptoms of anxiety. A lot of people will experience muscle tension, aches and pains. This is typically in the shoulders where they carry their worries or they’ll find themselves tensing their muscles without being aware of it. They may experience twitching, and they experience pain from the tight muscles. There’s also sensory symptoms, such as ear ringing, hot and cold flushes, changes in vision, tingling, numbness, muscle cramps. It’s very common to have cardiovascular symptoms, such as a racing heart or heart palpitations and this often occurs in people who have panic attacks, which often sends them into the emergency room, because it can be difficulty breathing, racing heart, chest pains, sweating, all these kinds of autonomic symptoms that one might experience if they were having a cardiovascular event, can occur in someone with anxiety or panic disorder. It can be really frightening.
Then there’s gastrointestinal symptoms, so there’s definitely a connection between IBS and anxiety. And those of us who don’t necessarily suffer from anxiety but have experienced nervousness, which I’m sure we all have, will notice that our gut is definitely affected and we may have looser bowels, bloating, difficulty digesting, or we might not have an appetite or want to eat. And this all common in people who have chronic anxiety. Genitourinary symptoms, such as frequent urination, or frequent thirst, often leading people to think that they have diabetes. Also, there might be a delay in urination, so you feel like you have to go to the washroom, you go to the toilet and then there’s a moment where you can’t really go, and you’re trying to wrestle with yourself, which is really common. So urinary hesitancy, it’s called. And then we have the autonomic, so the symptoms that are related to the autonomic, or automatic, nervous system, such as a dry mouth, dilated pupils, sweating or flushing, and this also related to our GI symptoms.
So, these are just a few of the anxiety symptoms. And, as you can see, they affect pretty much every single system in the body. Our nervous system, which is what is affected in anxiety, consists of our brain, our spinal cord and all of our nerves. Nerves that go to and from different body organs and our nervous system is divided into the voluntary and the involuntary, or autonomic, nervous system and our autonomic nervous system is divided into the sympathetic and parasympathetic nervous systems. So our sympathetic nervous system is the “fight or flight” nervous system. This gets turned on when we sense an immediate danger and our body is primed to respond to that danger.
The parasympathetic nervous system is turned on when we’re sleeping and digesting, and when we’re a state of otherwise calm, when there is no danger around. You can think of these two systems as a seesaw. One gets turned on while the other gets turned off and our body should be able to toggle back and forth between these two arms of the autonomic nervous system easily and without getting stuck in either one and depending on the situation and what’s going on. So imagine that you’re walking through the forest, and you’re feeling calm, and you’re feeling at peace, and then you look down at what you think is a stick on the ground that starts to move, your autonomic nervous system is going to kick you into the sympathetic, fight or flight, response. In this response your body will be primed to either fight, flight, run away, or freeze. And these three responses are what will get us away from the danger or meet that impending danger and this is what our body will respond with in order to ensure our survival when there are dangerous situations that we’re faced with.
Once that danger’s gone, we’ve either fought, flown, or frozen and the danger has forgotten about us and left, we’ll return to the parasympathetic nervous system. We need the parasympathetic nervous system turned on when we’re eating and when we’re sleeping. If we have problems, so if we get stuck in that fight or flight response for too long, either because we perceive there to be danger, or our body simply can’t switch back into the parasympathetic state, we’re going to have problems with feeling relaxed, sleeping soundly, and digesting our food properly.
Those of us who are experiencing chronic stress, our nervous system is just taxed, and we’re in the sympathetic nervous response far longer than we should be, because we’re constantly facing deadlines, or we have a lot more responsibility and a lot less control, on our plate, we’re going to experience this feeling of chronic stress. This will exacerbate someone who’s already got a predisposition towards anxiety. There’s a hypothesis, or personality theorists hypothesize that some of us are just born with a higher level of neuroticism as part of our constitutional tendencies. So I see that a lot of anxiety will run in families, especially in female patients, many of them will have grown up with a mother who suffered from anxiety. So there’s definitely a nature component to the nature-nurture debate in terms of what causes anxiety. So, while we can’t really affect our nature, or our genetics, we can affect how those genes are expressed and we can look at the environmental factors that might trigger those genes to be expressed. So that’s what I’m here for. My goal as a naturopathic doctor is to take a full assessment, understand what someone’s symptoms of anxiety are, what the external factors, the environment of their life is like, and look for potential causes that might be exacerbating the anxiety, making it difficult for them to function and perform and live the life that they know they can live. Living a life that’s full of abundant health.
So, the first cause that I want to talk about is chronic stress. when we’re stressed out, like I described when we encounter that snake in the grass, our body will release hormones called norepinephrine and epinephrine. Those are our fight or flight hormones. Those are short-lived, and when those run out, our body starts to make cortisol. Cortisol is a more long-term stress hormone. However, when we’re stuck in that sympathetic state our body becomes, well a theory is that our body becomes unable to produce as much cortisol for long periods of time, that our adrenals get “fatigued”. Another theory is that our brain stops responding to cortisol and we develop a kind of cortisol resistance. And this we’ll see with a lot of brain fog, memory loss, difficulty concentrating, there’ll be a lot of weight gain, especially around the abdomen, and people will experience a lot of inflammatory symptoms, so that’s when we’ll see joint pain and muscle aches and, potentially, worsening of depression as cortisol can kind of motivate us and get us going, because, if you think about it, when we’re in a state of fight, flight or freeze, that’s an action-oriented state, once our body stops responding to that, we enter this kind of burnout and exhaustive phase.
What’s more, once our body stops responding to cortisol, in order to maintain that sympathetic tone, to stay in that fight or flight state, that for whatever reason our body is turned on to, we start to make those catecholamines, norepinephrine and epinephrine again and that contributes to those symptoms of anxiety. So essentially what anxiety is is a high cortisol, high norepinephrine state, where we have that racing heart, we have those tense muscles, we’re looking for danger and our body, for one reason or another, expects that there’s some kind of danger that it needs to defend itself against.
So, not all stress is bad stress. You think of a new mom, she’s full of love and all these feel-good hormones, but the lack of sleep, the added responsibility, all of the things that having a new baby might mean to her and her life, are going to contribute to more stress hormones going through her system. And so I’ll ask a lot of my patients if they’re stressed and, even though I’m kind of getting a sense of high stress from them in terms of their level of busyness, and their level of downtime and just the demands on them in their day-to-day life, a lot of them will say that they don’t feel stressed, that they love their job. So it’s not about whether you love your job, or whether or not you love the things that are, basically, getting piled onto your plate, it’s your body’s perception of those things. So, our body does well when it has enough down time, it has enough restful sleep, and it gets enough breaks. So that keeps that toggle from the sympathetic nervous system, to the parasympathetic nervous system, fluctuating in a healthy way, without getting in one or the other.
Another common cause of anxiety that I see, or definitely a factor that exacerbates anxiety symptoms, is blood sugar imbalance. So, when we wake up in the —a lot of us wake up in the morning and we have cereal, or we have those packaged oatmeals. So, in North America we eat high-carb, high-sugar breakfasts, or we skip breakfast, or we just eat a lot of carbs and sugar in general throughout the day. When you eat a food that’s high on the glycemic index, that contains a lot of easily digestible carbs or refined flours and sugar, we get this immediate spike in blood sugar, as those sugars are absorbed directly into our blood stream. When we get this high level of sugar, we might feel a lot of energy, we might feel really good, we get a lot of dopamine release, and it feels pretty awesome, we get a lot of immediate energy that our body can use. But then, because our body wants to maintain a certain level of blood sugar, what gets released next is a hormone called insulin. Insulin helps that glucose, that sugar, get inside of our cells, where we can use it for energy. If our blood sugar shoots up too high our body sends more insulin into the blood stream to lower that sugar. Sometimes it sends too much insulin and our blood sugar plummets, we get hypoglycaemia symptoms: dizziness, “hangry”, irritability, weakness, fatigue, you’d kill someone for a piece of toast kind of situation, and carb cravings, and we respond by eating more carbs and the cycle begins again. That can exacerbate anxiety because our energy levels are going to be rising really quickly and falling really quickly. Stress hormones are going to get triggered everytime we enter a hypoglycaemic state. And, because cortisol also releases sugar into the blood, so cortisol and insulin work together. Going through this eb and flow of blood sugar, basically riding the blood sugar rollercoaster, is going to exacerbate and mimic a lot of the anxiety symptoms that I described. So a lot of people I talk to, when they’re experiencing anxiety, oftentimes, during the day when they’re experiencing anxiety, it’s between meals, or it’s after a high carb, high sugar meal. And, so a big part of managing their anxiety, or at least creating a terrain where their mental health can function optimally, and their emotional wellness has a chance to function optimally, is to get their blood sugar nice and level. And this means adding protein and fat to every single meal, lowering those refined carbohydrates, beginning each day with a high-fat, and high-protein breakfast. Nutrient deficiency is another really big cause that I look for when it comes to anxiety. So, the happy hormone, serotonin, which is implicated in both depression and anxiety, that’s what the antidepressant and anti-anxiety drugs like cipralex or prozac act on, so those selective-serotonin re-uptake inhibitors. This is a hormone that gives us a feeling of satisfaction, it gives us a feeling of uplift, it’s often what tanks when we crave carbs, and so eating carbohydrates kind of perks our serotonin levels up. In order to make serotonin, we need an amino acid called tryptophan, which we get from protein, and we need the vitamins B6, magnesium, B12, and zinc, and iron. And those take tryptophan and turn it into another amino acid called 5HTP, which then gets turned into serotonin. And then, once we have enough serotonin, that gets turned into melatonin, which helps us sleep and regulates our circadian rhythms. So any break in either of those pathways is going to result is us having lower levels of serotonin and melatonin available to our nervous system for us to have proper mental and emotional regulation. When we’re stressed out, our demand for those nutrients goes up, because our adrenal glands are also sucking in a lot of those nutrients to make cortisol and the catecholamines. Protein is super important, not just for blood sugar regulation, but to give us the amino acids that we need to make the proper neurotransmitters. So, I mentioned serotonin, I also mentioned norepinephrine and epinephrine and other ones include dopamine, GABA, which is a nervous system calming neurotransmitter, glycine, another nervous system calming neurotransmitter, and a good source of glycine is collagen, or gelatin, which I’ve mentioned in other videos. See the “8 Foods for Mental Health”, and tyrosine, which makes dopamine and also makes the catecholamines. So we need tryptophan, which makes serotonin and melatonin, we need GABA, which makes GABA, and that calms our nervous system down, we need tyrosine, which makes dopamine, this is a feel-good hormone that helps us seek rewards and feel motivated, and energized, also tyrosine gets made into thyroid hormones, again, which helps us feel energized and keeps our energy levels stable and our metabolism revved up, and the catecholamines, norephinephrine and epinephrine, which we need for that fight or flight response and that we’re going to be burning through a lot more quickly when we’re in that fight or flight response. And then glycine, another nervous system-calming amino acid. And glycine also helps balance the nervous system. Typically we don’t suffer from protein deficiency in North America, but I see it more and more, especially low-quality sources of protein. So, chicken nuggets, yeah they have chicken in them, but they only have about 10 grams of protein and a ton of trans fats and a lot of processed carbohydrates. So, although we might be eating hamburgers and chicken fingers and omelettes on waffle, we’re not necessarily getting enough good sources of protein. So, ensuring protein from things like legumes, nuts and seeds, clean animal products, fish, like salmon, and white fish, are all really important and I often suggest people get 30 grams of protein per meal, so three times a day, but it depends on your weight, it depends on your energy demands and it depends on your lifestyle and how stressed out your are, because our demands for protein definitely go up during stress. It also depends on how level your blood sugar is and if you’re getting those hypoglycaemic symptoms, sometimes those people need to increase their protein, while decreasing some of the carbohydrates, especially those refined carbohydrates, and give their body more fibre-rich carbohydrates that the body has to work harder to extract and release into the bloodstream. Another really common cause, or contribution, or exacerbation to anxiety is iron deficiency. So I see this a lot in menstruating women. It’s not super common in young men to have iron deficiency, but women who are menstruating every month, especially women with heavy periods, and who are experiencing fatigue, definitely need to get their ferritin levels tested. So, ferritin, in our blood, will tell us what our iron stores are like. So, how much iron we have available to our tissues. Iron is useful for participating in lots of different chemical reactions in the body, as part of normal metabolism, but it’s also important for caring oxygen to our tissues and oxygen is what we need in a process called oxidative phosphorylation, which gives us energy. So, no oxygen, no energy. And what will happen is, if we lower levels of iron in our blood and lower levels of oxygen, our heart starts to beat faster in order to send more volumes of blood to our tissue. So, it figures, if, with each heartbeat, i’m not sending as much oxygen, if I just double up my heartbeats, I might send double the amount of oxygen and try to meet the demands of the tissues that I’m sending oxygen to. You can kind of figure out, then that quick heartbeat mimics those heart palpitation symptoms of anxiety and can trigger some anxiety symptoms. Iron’s also go this grounding affect. It gives us this nice, level energy. And there’s a very specific feeling to iron deficiency fatigue that a lot of women may have experienced. It’s not quite like a sleepiness, or a lethargy, it’s a very specific feeling of just depletion. So it’s important to get ferritin checked and then find a kind of iron that you can take every day to build your levels up, at least for a few months, and one that’s easily absorbed.
So, another reason why iron might be low is in the case of leaky gut, or malabsorption syndrome, so this can occur in somebody with inflammatory bowel disease, or celiac disease, where the intestinal cells are just not able to absorb as many nutrients, or somebody with IBS, so, just generally sluggish digestion, inefficient digestion, perhaps a lack of stomach acid, or a lack of those digestive enzymes that help us absorb our food. IBS and leaky gut are other common symptoms and causes of anxiety. So it’s kind of a chicken or an egg situation. Our gut bacteria produces serotonin, dopamine. We’ve got about 5 trillion in our gut, and that’s about 10x more cells than we have in our bodies. For the most part, when it comes to a cell-to-cell basis, we have 10x more gut bacteria than we have cells. So we’re more gut bacteria than us. Our gut bacteria, there’s good ones, there’s bad ones, we haven’t been able to isolate all of them, there’s very little, relatively, that we know about the microbiome, but a lot more research is coming out, especially in the area of mental health. We know that these gut bacteria can make their own neurotransmitters. They can even specifically ask for food, so a lot of people with sugar cravings have a dysbiosis going on where the gut bacteria need those refined carbohydrates and that sugar, in order for them to grow. And so they’re sending out ghrelin, or hunger-stimulating signals to try and get us to eat more sugary foods. Our gut bacteria also make most of the serotonin in the body and our gut cells also make most of the serotonin in the body. So if we have unhealthy gut cells, they’re not going to be able to regulate our nervous system. And if we have an imbalance in gut bacteria, again we won’t be able to regulate our nervous system, because we won’t be producing those neurotransmitters that we need to balance and to be able to toggle seamlessly between the parasympathetic and sympathetic nervous systems. The gut is also where a lot of our immunity lies. And our immune system is going to be the cause of low-levels of inflammation, especially if there’s a little bit of autoimmunity or food sensitivities, or allergies going on. Low levels of inflammation are going to affect our brain. So there is a hypothesis that depression is caused by low-grade inflammation in the brain. We don’t have pain receptors in our brains, so we ‘re not able to detect inflammation in the way you would with an inflamed knee. If you injured your knee or had arthritis in your knee, and you would notice that your knee was red, and swollen and it would hurt to touch and you wouldn’t be able to walk on it. We don’t get those symptoms in our brain because of the lack of pain receptors and so how brain inflammation might manifest is brain fog, difficulty concentrating, depression, anxiety, mental chatter, negative self-talk, negative thoughts, those symptoms that are really common, mental symptoms, in something like depression and anxiety.
There’s a lot more we need to research about this, but there’s something called LPS, lipopolysaccharide, that’s produced by some of the “bad” gut bacteria. When rats were injected with lipopolysaccharide, or when human volunteers were injected with lipopolysaccharide, we mimic the symptoms of depression. When those same patients and rats were given EPA, which is a very anti-inflammatory fatty acid that’s from fish, marine sources like salmon and sardines, the depression symptoms went away. There’s also some studies in depression with prednisone and corticosteroids, which lower inflammation really rapidly. They come with a host of side effects, so that they’re not that great of a remedy for depression, but they actually lowered depressive symptoms. There’s a lot of a connection, that we’re noticing, between inflammation and depression and anxiety and we’re just not sure to the extent that inflammation causes depression. I tend to think that, probably most cases of depression and anxiety have some kind of inflammation present, especially when we consider that just chronic, turned on, sympathetic nervous system and high levels of cortisol is going to contribute to a cortisol resistance in the brain and increase neuroinflammation, especially in the hypothalamus.
We also know, as I mentioned before that symptoms of anxiety and symptoms of IBS often go hand in hand. And so, a lot of the anxiety symptoms that people will get are looser bowels, bloating, loss of appetite, just difficulty digesting their food. And a lot of symptoms that people with IBS will get are anxiety. And one of the treatments for IBS are selective-serotonin re-uptake inhibitors, which, you guessed it, are also drugs that treat anxiety.
So another common cause that fits really well into my practice, my focus is on mental health and hormones, and these two areas overlap, probably more than they don’t overlap, it hormonal imbalance. So, especially in women, men have their own host of issues when it comes to hormonal imbalance, but women, because our hormones are cycling and going through different phases all month long, we’re more susceptible to problems with proper hormone regulation, especially in the face of female endocrine disorders such as PMS, PMDD, PCOS, all of the acronyms, endometriosis, fibrocystic breasts, and just dysmenorrhea, so painful and heavy menstruation, or irregular cycles. So all of these point to symptoms of hormonal imbalance. Estrogen and progesterone are the two female hormones and they do have effects, yes on the ovaries, and they control ovulation, they control building up of our uterine lining and shedding of the uterine lining, when those two hormones fall away, and that causes our period to occur, so they definitely control our fertility, but they also have affects on other tissues in the body. One of those tissues, one of those organs, is our brain, our nervous system, so estrogen can work a little bit like serotonin and, so what you might notice, right before your period when your estrogen levels drop, or women that are going through menopause and have a drop in estrogen levels, is you’ll get irritable, you’ll get depressed, and you’ll crave carbs like crazy. And a lot of women get something called premenstrual dysphoric disorder, where they have fluctuations in their estrogen levels. So, lowering of estrogen, or insufficient estrogen, may cause some of those more depressive anxiety symptoms, progesterone acts like a GABA agonist, which, I mentioned before, is a calming neurotransmitter. So, lower levels of progesterone, and I see this in a lot with women who have something called “estrogen dominance”, I have another video on this, and women with PCOS as well, and women who have high estrogen symptoms, or conditions such as endometriosis and fibroids, and fibrocystic breasts, and those kind of symptoms, or conditions where estrogen levels tend to be high, and progesterone levels tend to be low or deficient, they’ll often have anxiety with these symptoms. And lower levels of progesterone, especially premenstrually, often are related to low mood and anxiety, and cravings. So, looking at hormones, especially when the patient sitting across from me has a lot of menstrual issues, and irregular cycles and all of the other things I mentioned, I’ll definitely look into hormones and promote proper estrogen detoxification and building up of progesterone. A common cause of low progesterone is being in that fight or flight state. So, now I’m starting to reveal how this web interconnects, how everything is tangled together and how cortisol and blood sugar all relate to everything. So, cortisol, it uses the same precursor to make progesterone, and, when our body needs more cortisol, it will steal progesterone from the system to make cortisol. Because our body has to prioritize sometimes, and getting away from that snake in the grass, and saving our life is more important than making babies to our body in the short-term. So, we suffer in the long-term if that snake in the grass never goes away and we’re always kind of worried about juggling all the things in our lives. But a lot of women who are chronically stressed, or are in that sympathetic nervous state, will have lower levels of progesterone, so doing a lot of adrenal support is one of the ways that we help their bodies build up some progesterone.
And then, finally, I think I mentioned before, there’s a reason that we have anxiety, it’s not an irrational fear. A lot of the time when I sit across from patients, the things that they’re worried about are legit things to worry about. Maybe they’re out of work, or there’s financial worries, maybe there’s just so much on their plate that it’s difficult to find any time for themselves, or make ends meet, maybe they’re unhappy with their career, they’re relationship is in jeopardy. There’s all kinds of things that people deal with on a daily basis. And then, that being said, there’s also people who are just primed to be more neurotic than others, based on that spectrum of neuroticism in terms of personality and constitutional predisposition. And I think we know this, there’s some people who are just a little bit more anxious than others and that diversity in human personality probably helped us evolutionarily and so I think there was obviously an evolutionary advantage for someone who’s nervous system was a bit more responsive. Those people could get away from danger, they were expecting danger more often, and they probably ended up surviving and passing their genes on to their ancestors more readily than those who were way too laid back and didn’t think about danger and got themselves into risky situations.
So, those who are a little bit more neurotic may be predisposed to negative thinking, over-estimating the negative outcomes of certain events or maybe engaging in critical self-talk. Especially in the case of post-traumatic stress disorder, PTSD, there’s definitely a connection between early childhood trauma, or just trauma in adulthood, some of these experiences can teach us to turn our nervous system on, or to get triggered more easily as a way of surviving in the future. There’s different areas of psychotherapy that deal with these phenomena, and they term them different ways, but they can be called core beliefs, or certain mental schemas, so when our brain experiences very strong emotions, the amygdala wires those emotions down in implicit memories. They’re really tightly wired and those memories get triggered again whenever there’s a situation that reminds us of the situation that wired down those responses. It might be a certain smell, or a certain sound, or a certain song, something that activates those memories, that may not be conscious, because the amygdala is pre-verbal, will trigger those feelings of fear and prime our body to respond. And the problem is that we’re surrounded by potential stimuli all the time that can trigger that. And so, really understanding what triggers anxiety symptoms, where those triggers may have come from, and bringing those memories up to the cognitive, cerebral cortex and rational mind, so that we can help dissolve those memories, is a big part of psychotherapy and how we manage anxiety with psychotherapy. Especially if we think the cause of anxiety may be related back to some sort of childhood trauma or implicit memory that was consolidated.
Those are some root causes of anxiety that I would look for as a naturopathic doctor, among many others. What an intake will look like is a 90-minute conversation with the person in front of me where I get to know them, and understand the environment surrounding the phenomena of their symptoms, the symptoms themselves, and all of the other different factors that might be contributing to the anxiety that they’re displaying. So, I’ll ask about period health, I’ll ask about sleep, I’ll ask about their energy levels, I’ll ask about any other physical symptoms they might be experiencing, their digestion, what their stress levels are like. We’ll go through a review of systems, looking at every single organ system and trying to create a tabulation of how anxiety might be manifesting for them, and we may even explore what their core beliefs are, or implicit memories are in future visits. And we’ll talk about diet. And then I’ll make some recommendations as I begin to understand what those root causes of anxiety might be. So we’ll look at whether they may be experiencing nutrient deficiencies, leading to an imbalance in proper neuroendocrine production, if there might be some inflammation going on, if they may be experiencing some digestive issues, or some hormonal imbalances, or if there’s chronic stress going on in their life. And so what we’ll do is, once we find out the causes, we’ll engage in some psycho-education, so I really believe in empowering my patients to understand their bodies, to be able to notice when things are triggering them, to notice what exacerbates their anxiety, what makes it better, and to develop a self-care plan where we’re eating right, we’re thinking right, we’re exercising right and we’re getting enough rest, if possible.
So that’s the gist of it, that’s Root Causes of Anxiety, my name is Dr. Talia Marcheggiani, I work in Bloor West Village in Toronto.
I talk about contrast showers for boosting immunity, lowering inflammation, mood, pain and weight loss.
Hello everyone, my name is Dr. Talia Marcheggiani, I’m a naturopathic doctor and today I’m going to talk about hot and cold contrast showers. As naturopathic doctors, one of our modalities is hydrotherapy. Hydrotherapy comes from naturopathic medicine’s roots, using hot and cold water to make changes to circulation, hormonal functioning and immune functioning. I’m going to talk about some of the science behind hot and cold contrast showers.
This is something I recommend to my patients to increase their immune activation, decrease autoimmunity, improve mood and hormonal functioning, as well as increase circulation and there’s some evidence that it might help with weight loss as well.
So, firstly, things like exercise and hot and cold therapies induce a little bit of stress. There’s two kinds of stress: distress, which is sort of that chronic, cortisol-fuelled stress that a lot of people come in with, in a state of burnout that’s causing things like inflammation, and mental-emotional illness, and autoimmune issues, and dysbiosis, and then there’s something called eustress, which is more like exercise, cold therapy: short, small bursts of stress that actually up-regulate proteins and genes in our body to combat stress. These genes are involved in DNA repair, increase antioxidant synthesis, and the antioxidants that our body makes are far more powerful than the ones that you’re going to get from food or supplements.
So, by upregulating these genes, we can protect ourselves from cancer, neurodegenerative disease, and other chronic diseases. It’s really powerful stuff, this is called a “Hormetic” response, hormesis, where small stressors mount bigger responses by the body than is needed to deal with those stressors and overall we’re better off; there’s this net beneficial effect. This is one of the proposed mechanisms for some of the antioxidants or flavonoids in green leafy vegetables. It’s not that they provide us with antioxidants, it’s that they encourage our body to make antioxidants due to the small, toxic load that they present to us. And so there’s some evidence that getting short bursts, or longer bursts of cold, very cold, will increase a hormone called norepinephrine. Norepinephrine is involved in depression and mood. Norepinephrine is a catecholamine and it increases the sympathetic nervous system, which is that fight or flight nervous system. When boosted in small amounts, it can actually elevate mood and so a lot of anti-depressant medications also induce, or inhibit the reuptake of norepinephrine. So these are called SNRIs and they include things like Venlafaxine and Cymbalta. So there’s some evidence that norepinephrine increases 2-3 times after only 20 seconds of immersion in cold water. There’s a connection between norepinephrine lowering pain and inflammation and increasing metabolism and there’s some anecdotal evidence and one study, at least, was done to show that cold immersion therapy actually decreased symptoms of depression.
There’s also these things called hot and cold shock proteins, heat shock proteins and cold shock proteins. So, for example, one is called RBM3, which is a cold shock protein, and these proteins can actually help increase longevity and they can actually help decrease incidences of neurodegenerative diseases and neurodegeneration, so something like Alzeimer’s disease or Parkinson’s disease, which can help us with health longevity, so staying healthier into our later years.
We know that inflammation is one of the drivers of the aging process. Probably the primary driver of the aging process, and one of the main factors in chronic, debilitating disease, and, especially in my focus, mental health, there’s more and more researching coming out that inflammation, low levels of inflammation in the brain, is the main cause of mental health conditions, such as depression, and anxiety, bipolar disorder, OCD, ADHD. There’s these low levels of inflammation that contribute to the symptoms of low mood and by increasing norepinephrine, through small bursts of cold and increasing those cold shock proteins, we’re actually able to combat these mental health conditions. Norepinephrine decreases inflammation by decreasing a cytokine called TNF-a that is known to increase inflammation in the body and in the brain. TNF-a can cross the blood brain barrier and it can inhibit serotonin synthesis and it can actually also increase neuro-inflammation, causing symptoms of mental health disorders.
There’s some studies that cryotherapy, for rheumatoid arthritis actually decreased pain significantly. And there’s also some studies that being in cold water, that cold shock, can actually increase the immune system activation. It’s good to increase our immune system activation if our immune cells are behaving properly. If our immune cells are attacking ourselves, then we want to decrease the immune response. But having higher levels of lymphocytes, especially cytotoxic T lympthocytes that are involved in killing cancer cells, is a very positive thing and that’s been shown to increase in people that underwent cryotherapy, or really acute, short exposure to intense cold.
There’s also an ability to lose weight when exposed to cold, over the long term. There’s a man called Ray Cronise who lost over 80 lbs by just habitually exposing himself to mildly cold temperatures. And one of the mechanisms for this weight loss is through non-shivering thermogenesis, in which the cells in the mitochondria uncouple proteins that make energy and they dedicate all the stored energy in fat to making heat. Kind of like cutting your bike chain. So instead of biking, you’re not moving forward, but you’re generating energy and you’re generating heat. And so our body will do this when it’s slightly cold that it can increase heat. Our body is always striving to maintain constant temperature, between 1 or 2 degrees. This process is regulated by norepinephrine, which rises acutely as soon as we’re exposed to just a few seconds of cold. This can be 40-50 degree water. And then I already mentioned that short, cold exposure can increase the production of antioxidants. Our mitochondria are constantly creating reactive oxygen species and reactive nitrogen species. This is just a product of normal cell metabolism. These become toxic, though and damage DNA if our body doesn’t also produce anti-oxidants to clear out those reactive oxygen species and reactive nitrogen species. The cold induces a little bit of a stress that increases our metabolism that increases the reactive oxygen and nitrogen species in our mitochondria and therefore our body is incited to up-regulate the enzymes that create those powerful anti-oxidants that I talked about that are far more powerful than the ones that you can get from food: vegetables, fruits, vitamin C supplement. A couple of these enzymes are glutathione reductase and superoxide dismutase, which are very powerful to our cells.
There’s some evidence that hot and cold therapy can increase muscle mass, can increase muscular strength and aerobic endurance. So this is great for athletes post-workout to lower inflammation and improve muscle regensis. And then, it can also increase something called mitochondrial biogenesis, which is the production, or the replication of more mitochondria in the tissues, especially the muscle tissue. So our body will increase the mitochondria content, the mitochondrial mass, in muscle tissue under certain conditions. These conditions are mainly fasting, exercise, and hot and cold shock.
So, what I’ll recommend to my patients, somebody who’s suffering from low immunity, so they’re getting frequent colds and flus, or maybe autoimmunity, or maybe just general inflammation and pain, brain fog sluggishness adrenal fatigue, that kind of sluggish lethargy from depression. So it’s more the sluggish depression, I’ll recommend hot and cold showers.
So what you do is, in your shower, either during your shower, during your regular cleaning routine, or after your shower is done, and you’ve already washed your hair and everything, you’re going to turn the water on to a reasonably hot temperature, so not so hot that it’s scalding, and you’re going to leave that hot water on for 30 seconds to 1 minute. When that’s done, you’re going to turn the shower to as cold as you can tolerate. So with my patients I often coach them to start with a lukewarm temperature before going whole hog and doing cold. And this is just to coax the body into that stress response that we want, that short, quick stress response that’s going to do all those good things: up-regulate anti-oxidant production, increase norepinephrine, decrease inflammation, increase mitochondria synthesis, burn fat. So you’re going to try and make it as cold as possible, for 20 to 30 seconds, and then you’re going to cycle back and forth at least 5 to 10 times, always end on cold, and then, when you’re done, towel off and keep warm.
There’s some evidence that doing this before bed can actually increase REM sleep and help you sleep more soundly without waking up in the middle of the night. We all know that a good sound sleep is going to set the tone for the next day and your energy for the next day. And then there’s also some evidence that doing this in the morning can increase your energy and alertness throughout the day, so it’s almost like this same practice at different times of day impacts our circadian rhythms differently and can give us more of what we want: either more profound sleep or more daytime energy.
So, that was hot and cold showers, my name is Dr. Talia Marcheggiani and you can check out my website at taliand.com or contact me at connect@taliand.com . A lot of this research came from Dr. Rhonda Patrick at foundmyfitness.com .
I talk about 8 functional foods that can help calm inflammation, boost neurotransmitter synthesis and restore common nutrient deficiencies that might contribute to low mood and mental health conditions.
My name is Dr. Talia Marcheggiani. I’m a naturopathic doctor with a focus in mental health and emotional wellness as well as hormonal health and hormone balancing, and today I’m going to deliver a short video about some foods that you can add to your diet to help your mental health.
These are all medicinal foods that act like prescriptions, like anti-depressants, that you can just add to your diet. So, a lot of these foods are recommended based on the idea that depression is an inflammatory condition in the brain. There’s more and more research that shows that there’s low levels of inflammation in people who have depression and anxiety and other mental health conditions like bipolar disorder, schizophrenia, ADD, ADHD and even sub-diagnostic symptoms, such as brain fog and cognitive disruptions. So all of these are a result of some kind of inflammation in the brain. And so a lot of these foods are working to heal depression and anxiety with their ant-inflammatory properties.
And so the first thing that’s recommended to eat are lots of anti-inflammatory fats. These are omega 3 fatty acids such as fish oil. So you can either increase the amount of fish oil by having fatty fish three times a week. You can remember what a fatty fish is by the acronym SMASH. And SMASH stands for sardines, mackerel, anchovy, salmon and herring, and also trout, so SMASHT. And these kinds of fish are rich in the omega 3’s EPA and DHA. Our body can make EPA, but some of us have impaired ability to make it. And so supplementing is necessary for a lot of these people. If you’re looking for a fish oil, make sure you look for one that has a higher amount of EPA compared to DHA. This is very important, because studies on depression are very favourable for fish oil supplementation, but the ratio of EPA to DHA has to be at least 3:1 or higher, and the higher the ratio, the higher the amount of EPA relative to DHA, the better the anti-depressant effects, and the mood-regulating effects. So, fish oil actually showed positive outcomes treating bipolar disorder and schizophrenia, so there’s a mood-stabilizing effect as well. And we think because our brain is made up largely of DHA and EPA, but also the anti-inflammatory effects are very helpful for mood and emotional balancing and mood balancing.
Coconut oil is also another great oil you can add to your diet. Coconut oil is a saturated fat, but it’s rich in something called Medium Chain Triglycerides. So these are saturated fats that the body uses readily for energy. So they don’t go through the normal process of digestion that other fats have to go through. They’re absorbed in our lymphatic system. So we get those fats, the energy from those fats, right away.
Coconut oil is very anti-bacterial and anti-fungal, so it can help regulate bacterial balance in our gut and it can give you a boost of energy. There’s also some evidence that being in ketosis, so this means relying on fats for energy, as opposed to carbohydrates, and, to an extent, proteins. Being in ketosis, so burning fat for fuel: body fat or dietary fat, has a mood-stabilizing effect. And so you might read about intermittent fasting, Ketogenic diet. I wouldn’t recommend doing that without working with a functional medicine practitioner, nutritionist or a naturopath, because there are some negative downsides to doing those kinds of diets prolonged, without supervision, but there is some growing evidence for that. But one thing you can do is add coconut oil to a morning smoothie, or eat a couple of tablespoons in the morning, even looking at some Bulletproof coffee recipes, that can also help with keeping your mood steady or your energy high in the morning.
Staying on the topic of fats and nuts, something that is really great for mental health are Brazil nuts. And Brazil nuts are high in a nutrient called selenium, which our body needs to create an anti-oxidant, the main anti-oxidant in our body, glutathione. You may have heard me talk about n-acetyl cysteine, NAC, which is an amino acid that I often recommend for people with bipolar disorder, for schizophrenia and, to an extent, depression and anxiety, and especially personality disorders, like borderline personality. There can be a very strong mood-stabilizing effect with NAC. And that’s probably because—we’re not exactly sure why that is—but it’s probably because NAC is the precursor to what our body uses to make glutathione, but we can’t make glutathione without selenium. So two brazil nuts a day, and they’re really delicious and fun to eat, they’re big nuts—two brazil nuts a day gives you the 200 mcg of selenium that’s the therapeutic dose. It’s also helpful for thyroid health.
Another thing I tend to recommend and am recommending a lot more in my practice is collagen, specifically gelatin, but for the more health-food minded people, going with a collagen hydrosylate supplement from grass-fed meat is something that I often recommend. But, for most people and myself, I just throw some gelatin that you can buy at Bulk Barn, into a shake or into a seed bowl, or into something that I’m eating like oatmeal, or I’ll make jello out of it.
So, gelatin is really rich in collagen, so it’s made from the hooves of animals, and collagen has a gut-stabilizing effect, so it can help heal the gut. A lot of us suffer from something called “leaky gut” in which inflammation in the gut makes its way to the rest of our body and can affect our brain. Leaky gut can often result in “leaky brain”, resulting in inflammation in the brain and then mental health symptoms. So, collagen helps to repair the gut barrier and the blood-brain barrier. It’s also very anti-inflammatory because it’s high in an amino acid called glycine, which is a calming neurotransmitter as well as an amino acid. It can also help balance the immune system. So anyone that has a low level of autoimmunity, or maybe your immune system is on the sluggish side and you’re getting colds and flus and infections more readily than others, collagen is a great supplement for that. Because our main sources of protein: meat, legumes, whole grains, nuts and seeds, don’t contain a lot of glycine. We’re pretty glycine deficient in our society because we’re not eating that much gelatin, we’re not getting as much bone broth. And so you can get collagen from from making bone broth, from stewing bones and accessing that bone marrow, or you can get it from something like gelatin, which is from hooves, from the collagen-rich membranes, the cartilages, of animals. There’s also fish collagen for more pescatarian-oriented people.
Collagen is also really great for anti-aging, for treating hair loss, for skin and for cellulite. So, all aesthetic things that might bring someone in to my practice, but also really great for mood balancing. A good source of protein as well.
You can either just throw it into a shake, mix it into some water or make your own jello. And I make jello by boiling some fruit, about a cup of blueberries in water. I boil it until the blueberry juice is extracted, then I add a couple tablespoons of gelatin and then I put it in the fridge until it’s hard. And you have a natural jello you can serve to your kids. It’s pretty good.
Another great food to help balance your mood and mental health is turmeric. Turmeric, or curcumin, as it’s scientifically called, is a spice that is used mostly in India. It’s a yellow spice, it stains things yellow: your clothes, your counter, your intestines. It has very very strong anti-inflammatory benefits. It also helps the liver detoxify, it’s been shown to have anti-cancer properties, it’s a really powerful, nutrient-rich plant, root. So studies have shown that two grams per day of turmeric actually outperformed Prozac for treating depression and probably this is due to its anti-inflammatory properties in really lowering inflammation in the brain, which we know is really one of the underlying roots of depression. The way that we get to that inflammation is different in every person with depression, but there is this kind of common thread of inflammation that’s going on in every case of mental health condition, mental illness. So, adding turmeric to foods, or supplementing with turmeric, is a great way to combat that inflammation and keep moods balanced.
Some other foods you might want to add to your diet are foods that are rich in zinc. So, these are mainly things like pumpkin seeds. You’ve got to get around two cups, though, of pumpkin seeds, to get a decent therapeutic dose of zinc, or oysters. Or you can supplement with zinc. Zinc, again, is anti-inflammatory, it can help heal the gut. We need it to make neurotransmitters and enzymes that our brain needs to rebalance mood. And there’re also some studies that zinc increases something called BDNF. BDNF is a chemical in the brain that help with neurogenesis, this is the creation of new neurons in an area of the brain called the hippocampus. So you may have heard “you can’t teach and old dog new tricks” or that our neurons never regenerate once we reach a certain age, and this is not true because new research has shown that we do have neurogenesis, something called neurogenesis, that increases and changes and grows new neurons even as we age. And so anyone suffering from brain fog or really high amounts of cognitive stress, or mental illness, maybe benefit from zinc as that increases the neurogenic abilities of the brain. It’s also very anti-inflammatory and it can help with leaky gut and leaky brain situations. Vegetarians, unfortunately, are often deficient in zinc just because we get most of it from animal products and animal sources, but really upping your pumpkin seed intake might get you to a therapeutic level of zinc or you can supplement as well.
Another really great addition to your diet to help balance mood and to improve your mental and cognitive health are fermented foods. So, these include things like kefir, kombucha, kim chee, saurkraut, and yogurt, if you do dairy. These things, they contain probiotics, and studies show that it may be better to supplement or to add fermented foods to your diet rather than supplementing with a probiotic, and this is obviously an individualized recommendation that would have to be made by a doctor, but adding fermented foods to your diet, especially if you make them at home and ferment them at home, like you make your own kombucha or your own kefir, that can actually boost the probiotic capacity of your gut. Probiotics actually make neurotransmitters, they make things like serotonin, and the calming neurotransmitter GABA and they can help us digest our food, like gluten, as well as combat inflammation and regulate our entire immune system. It’s also important to feed those probiotics with something called resistant starch that you can find in carbohydrates that have been cooled to room temperature after they’ve been cooked, so, for example brown rice that’s after it’s been cooked as been cooled to room temperature, potato starch, green bananas, black beans, and jerusalem artichokes. These are all starches that bacteria feed on and that keeps them populated in the gut. Coconut oil tends to kill more pathogenic bacteria and therefore can promote a healthy bacterial balance.
And lastly, I’m going to talk about leafy greens. So, adding a cup of spinach, or two cups of spinach or chard to your diet will give you the amount of magnesium you need. Magnesium has a calming effect on the body. We need it to make the neurotransmitters like serotonin, dopamine and melatonin, to help with sleep. Magnesium also can help balance mood and help us with stress. A lot of us suffer from stress. It can also make our brain more resilient to stress, as stress is one of the major causes of neuro-inflammation in people with mental illness and this can be stress from a significant trauma, it can be psychosocial stress, interpersonal stress, the stress of being out of work, even long-term chronic stress or burnout from school and work and things like that. So, two cups of spinach gives you your daily magnesium serving. You can also get it from chocolate but you need to eat quite a bit of chocolate.
So, in boosting your mental health, or in promoting mental and emotional wellness, you can add all of these foods to your diet and balance your inflammation, feel good and nourish yourself.
