My mother tells a story about my childhood where she is standing in the kitchen, preparing dinner. I stand below her, tugging at her shirt, and begging for food.
“I’m hungry”, I say, according to her recollection of that moment and many others like it; she says that as a child I was always preoccupied with food. My constant yearning for something munch got to the point where every time she tried to cook dinner, I’d follow her to the kitchen, like a hungry dog, and persistently beg for food. I was insatiable, she claims. But, as an adult looking back I wonder, insatiable for what?
I remember that moment, but from the third person perspective. So I wonder if it’s as past events sometimes go, where the telling of a memory from an outsider’s perspective serves to reshape it in the imagination. I can feel the emotions, however, watching my 4-year old form tugging on my mother’s clothing, her body towering over me, her face far away. She stands at the stove. I remember feeling full of… what was that yearning? Was it for food? Was it hunger for physical sustenance or nutrition from some other source? I wonder if the constant, nagging hunger was an articulation, in 4-year old vocabulary, of the need for something else: attention, affection or reprieve from boredom. I remember being told at one point that my favourite show was on and felt some of the anxiety of missing what I was lacking dissipate: a clue.
As a child, adults occupy the gateway to food. As adults, the gateways take on another form. Perhaps it is anxiety about body shape or the guilt of knowing that eating too much of a certain kind of thing isn’t nutritious. Perhaps the barrier to sustenance is financial. However, when I stand now in the kitchen, bent over the fridge, arm slung over the open door, contemplating a snack, I know that I am making a choice. And, for myself, as for many others, it’s not always clear whether the call to eat is hunger and physiologically based.
In the west, we have an abundance problem. More and more adults are reaching obese proportions. Metabolic diseases of excess like diabetes and cardiovascular disease are increasing and more and more women are experiencing the hormonal dysregulation that can come from carrying more body fat.
While I don’t recommend aspiring to the emaciated standard that we see plastered on magazines, Pinterest ads or runways, I do think that, for many people, balancing energy intake with energy output could be beneficial for optimal health and hormonal signalling. Body fat is metabolically active. It also stores toxins and alters that way our body metabolizes and responds to hormones, insulin being just one example, estrogen being another. Therefore, conditions like PCOS, infertility, diabetes, PMS and dysmenorrhea, or certain inflammatory conditions might benefit from a certain amount of weight loss.
An addition here: this post is not about body-shame or even necessarily about weight loss per se. It’s about overcoming emotional eating patterns that might even derive from the same disordered patterns that manifest in anorexia or bulimia. The goal of this post is to bring more awareness to how we operate within the complex relationships many of have with food and with our own bodies.
There are many reasons why we eat and physiological hunger is only one of them. Tangled up in the cognitive understanding of “hunger” is a desire for pleasure, a desire to experiment, to taste, to experience a food, to share with family and friends, to enjoy life. There are also deeply emotional reasons for wanting food: to nurture oneself, as reward, to combat boredom and to smother one’s emotions like anxiety, depression, ennui, yearning for something else— we often eat to avoid feeling.
Health issues aside, I believe that Emotional Eating (as it’s so-called) is problematic because it dampens our experience of living. By stuffing down our emotions by stuffing our faces we prevent ourselves from feeling emotions that it might be beneficial for us to feel in order to move through live in ways that are more self-aware, mature, self-developed and meaningful. While some emotional reasons to eat might be legitimate (acknowledging your beloved grandmother’s hard work by having a few bites of her handmade gnocchi, for instance), many of the reasons we eat linger below the surface of our conscious mind, resulting in us suffering from the consequences of psychological mechanisms that we are unaware of. I believe in making choices from a place of conscious awareness, rather than a place of subconscious suffering.
In heading directly into the reasons I am tempted to emotionally eat, I’ve learned quite a lot about myself. I’ve ended up eating less, as I’ve become more aware of the non-hunger-related reasons that I reach for a snack, but that doesn’t have to be the end goal for everyone. I believe that just understanding ourselves through uncovering and analyzing the emotions that influence our everyday behaviours can have life-changing effects; it allows us to know ourselves better.
As I work through the process of understanding why I overeat, I’ve realized there are a few steps to address. I believe that there are layers to the reasons we enact unconscious behaviours and first, it is important to untangle the physiological from the emotional reasons for eating, understand what real hunger feels like, address the “logical” reasons for overeating and then, when ready, head straight into the emotions that might cause overeating to occur
Distinguishing between physiological hunger and emotional hunger:
The first step, of course, is to distinguish between physiological/physical hunger—the body’s cry for food, calories and nourishment—and emotional hunger. Typically, physiological hunger comes on slowly. It starts with a slow burn of the stomach, growling, a feeling of slight gnawing. It grows as the hours pass. For some it might feel like a drop in blood sugar (more on this later): feeling lower energy, dizzy and perhaps irritable. Physiological hunger occurs hours after the last meal, provided the last meal was sufficient. Usually, if one drinks water at this time, the physiological hunger subsides and then returns. Essentially, eating a meal or snack will result in the hunger vanishing and returning again still hours later.
Emotional hunger, however, is different. It starts with an upper body desire to eat. It might be triggered by commercials, social situations, or certain strong emotions. There might be cognitive reasons to eat (“I might be hungry later” or, “Oh! We’re passing by that taco place I like!”) that are not directly guided by the physical desire for sustenance. Emotional eating is often felt in the mouth, rather than the stomach. It might be brought on by the desire to taste or experience the food, rather than to fill oneself. The cravings might be specific, or for a certain food-source, such as cookies (this is not a hard and fast rule, however). Emotional hunger does not vanish from drinking water. Emotional hunger comes on suddenly, and is often not relieved by eating the prescribed amount of food (having a full meal); oftentimes we finish lunch only to find ourselves unable to get the cookies at the downstairs coffee shop out of our heads.
2. Settling hormonal reasons for overeating: serotonin, insulin, cortisol:
Not all physiological hunger, however, is experienced as the slow, gnawing, slightly burning, grumbling stomach sensation described above. Sometimes we experience the need to eat because our blood sugar has crashed, or our neurological needs for serotonin have gone up. We might eat because stress hormones have caused blood sugar to spike and then crash. We might also experience certain cravings for food because our physiological needs for macronutrients; like carbs, fat or protein; or micronutrients, like sodium or magnesium, have not been met.
Therefore, it becomes essential to address the hormonal imbalances and nutritional deficiencies that might be causing us to overeat. Oftentimes, getting off the blood sugar rollercoaster is the first step. This often involves a combination of substituting sugar and refined flours for whole grains, increasing fats and protein, and, of course, avoiding eating carbohydrate or sugar-rich foods on their own. It often involves having a protein-rich breakfast. I tend to address this step first whenever my patients come in and express feeling “hangry”: irritable and angry between mealtimes.
Often drops in brain-levels of serotonin cause us to crave carbohydrate-rich foods. This is very common for women experiencing PMS. In this case, balancing hormones, and perhaps supplementing with amino acids like l-glutamine, tryptophan and 5-HTP, can go a long way.
One of the questions I ask my patients who crave a snack at 2-3 pm (a mere 2-3 hours after their lunchtime meal), assuming their lunch contained adequate nutrients, is “Do you crave, sugar, caffeine, salt or a combination of the above?” Cravings for sugar or salt at this time might indicate a drop in cortisol and give us a clue, combined with the presence of other symptoms, that this person is in a state of chronic stress, burnout or adrenal fatigue. In this case, it is essential to support the adrenal glands with herbs, nutrients, rest, and consuming adequate protein during the afternoon crash.
Finally, when it comes to cravings for foods like chocolate, meat or nuts, or even specific vegetables (when living in South America I would experience over-whelming cravings for broccoli, funnily enough), I find it important to identify any nutrient deficiencies. It is common to experience a deficiency in something like magnesium, iron, selenium, zinc, and the fat-soluble vitamins A, D, E and K; and our bodies will do their best to beg us for the specific foods they’ve come to learn contain these nutrients. Either consciously eating more of these foods (like brazil nuts in order to obtain more selenium), preferably in their healthiest form (such as dark chocolate, as opposed to milk chocolate, to obtain magnesium), or directly supplementing (in the case of severe deficiency), often results in the cravings diminishing.
3. The Hunger Scale and food diaries:
One of the first things I have patients do is understand the Hunger Scale. There are a variety of these scales on the internet that help us cognitively understand the stages the body goes through on its quest to ask for food and it’s attempt to communicate fullness. Being able to point to certain levels of hunger and fullness and pinpoint those physiological feelings on the Hunger Scale allows us to further flush out the subtleties between a physical or emotional desire for food.
Food diaries, I find, can help bring more awareness to one’s daily habits. Oftentimes, keeping a food diary for a few weeks is enough for some patients to drop their unwanted eating behaviours altogether. Other times, it can help us detect food sensitivities and unhealthier eating patterns or food choices. It also helps me, as a practitioner, work off of a map that illustrates a patient’s diet and lifestyle routines in order to avoid imposing my own ideas in way that may not be sustainable or workable for that particular individual.
A word about diet diaries, however: when recording food for the purpose of uncovering emotional eating behaviours, I often stress that it is important to record every single food. Sometimes people will avoid writing in their diary after a binge, or outlining each food eating when they feel that they’ve lost control, writing instead “junk food”. Guilt can keep us from fully confronting certain behaviours we’d rather not have acted out. However, I want to emphasize that the diary is not a confession. It’s not, nor should it be, an account of perfect eating or evidence that we have healed. Keeping a diet diary is simply a tool to slow down our actions and examine them. It’s a means of finding out how things are, not immediately changing them into what we’d like them to be. This is an important reminder. The best place to start any investigation into being is from a place of curiosity. Remember that the point of this exercise is to observe and record, not necessarily to change, not yet; it is very difficult or even, I would argue, impossible to completely eradicate a behaviour if the reasons for engaging in that behaviour escape our conscious awareness.
Therefore, recording food allows us to begin to poke at the fortress that contains the subconscious mind. We start to slow down and uncouple the thoughts and emotions from the actions that they precede and, in doing so, develop some insights into how we work. It can also help to start jotting down other relevant points that might intersect with what was eaten. These pieces of information might include time of day, where you were, what thoughts were popping into your head, and how you felt before and after eating the food. As we observe, more information begins to enter our conscious experience, allowing us to better understand ourselves.
4. Pealing back the layers: Understanding the “practical” and logical reasons for overeating:
One of the things that I have noticed, through my own work with addressing emotional eating, is that there are often layers to the “reasons” one might overeat. Some of the first layers I encountered were cognitive, or seemingly “logical” reasons. For example, I noticed that before eating without hunger I might justify it by thinking “I need to finish the rest of these, I don’t want them to go to waste”, or “I’ll finish these in order to clean out the container”, or “I should eat something now so I won’t be hungry later”, or “I didn’t eat enough (insert type of food) today so I’ll just eat something now, for my health”, or “If I don’t have some (blank) at so and so’s house, she’ll be offended”.
When looking more closely into these justifications, I found them to be flawed. However, they were logical enough for me to eat for reasons other than to satisfy a legitimate, physiological yearning for nutrients. It’s interesting to see how the mind often tries to trick us into certain behaviours and how we comply with its logic without argument.
5. Addressing the practical reasons: Planning:
In order to address the first layer of rationale for eating when not hungry, I decided to do the following: I would plan my next meal and either have it ready in the fridge, or pack it with me to go, and then I would wait all day until I was hungry enough to eat it. I would repeatedly ask myself, every time I thought of reaching for my portions, “Am I hungry now?” And would answer that question with, “Is there a rumbling in my stomach? No? Then it’s not time to eat.”
I found it would often be a several hours later before my body would genuinely ask for the food. I also found that eating satisfied the physical hunger often much sooner than it took me to finish the food. I realized how I often eat much more food and much more often, than I genuinely need.
However, holding off eating until physical hunger arises takes a conscious effort that is often unsustainable. Few of us can move through our busy lives constantly asking ourselves how hungry we are and when, and then have food at the ready to satisfy that hunger with appropriate, healthy choices. Therefore, I used this practice as a mere stepping stone to move through the deeper layers of emotional eating. By addressing the rational and logical reasons for overeating, I was able to get in touch with the deeper, emotional (and, arguably, real) reasons for which I was eating without hunger.
6. Pealing back the layers: Understanding the deeper, emotional reasons for overeating:
For a while I would wake up, make myself a coffee, and then wait until I felt hungry. Sometimes the feeling would arise in a few minutes, sometimes it would take hours. Depending on what I’d eaten the previous day and what my activity levels were, I would often not get hungry until well into the afternoon. However, the thoughts of eating something would frequently persist. And when the thoughts came up, whereas before they would be satisfied by me having something to eat, I now resisted them. When I resisted the thoughts, their associated emotions would strengthen. I then decided to journal before reaching for food, especially when I wasn’t sure if I was actually hungry or not.
Journalling can help us pull up, process and make sense of some of our emotions. I would write about what I might be feeling—what I might be asking for that wasn’t food. Through doing this, emotional reasons for hunger began to surface. The more I held off eating, the stronger and more clear the emotions became. It was a deeply uncomfortable process. This is why we emotionally eat—removing the emotions is often far more pleasant than dealing with them.
Emotions that surfaced were anxiety, ennui, boredom, loneliness and sometimes even anger. However, boredom and a listless, almost nihilistic, sense of ennui were among the two most common emotions I realized that eating medicated for me. For me, eating was entertainment. It broke up the monotony of the day and gave my senses something to experience. It gave my body something to do: chewing, tasting and digestion. Not eating made that sense of boredom grow stronger.
7. Addressing the emotional reasons: Nurturing and preventing:
Knowing more about the root emotional causes for overeating allowed me to work more closely with the source of my behaviour. I find that the closer we get to the source, to the roots, the more effective we are at removing the weeds, or behaviours, from our lives. I knew now that if I didn’t want to overeat, I would have to prevent myself from getting bored. I would have to have checklists of things to do. I would stay active and engaged in life: in my work, my friendships, and the other non-food-related things that brought meaning to my life.
During this time, I did more yoga and meditated. I journaled and wrote. I also meditated on boredom. I traced it back to where I might have felt it in my life before and noticed themes of boredom in my childhood. I realized that the child tugging on her mother’s shirt and asking when dinner was ready was probably a child who needed something to do, a child who was bored.
8. Pealing back the layers further: Working directly with core emotions:
Going even further, we can begin to peal back the layers of the emotional reasons for overeating in order to avoid replacing one “addiction” with another—such as replacing overeating with over-busying oneself, distraction or overworking. I began to find other emotions that ran deeper than mere boredom. I also realized that whenever I had felt boredom in the past, there was a threshold, often filled with discomfort, that I would eventually surpass. Once surpassing this threshold, a well of creativity, or a plethora of interesting insights, would spring forth. I remember as a child I would create stories, or lie on my bed and stare that the ceiling of my bedroom, contemplating the nature of the universe. These beautiful moments had been made possible by boredom and my courage to not distract myself from it.
Working with a therapist, or doing some deep inner work, we can access the core beliefs and emotions that might cause these emotional reasons for overeating to exist. Oftentimes we encounter core beliefs whose effects spill out into other areas of our lives, preventing us from living fully and consciously. Working through these beliefs can be deeply satisfying and help us experience transformational self-growth.
9. Setbacks: Understanding Change Theory:
Finally, engaging in this process of self-discovery doesn’t follow the same pattern in every person. Some people may find that their reasons for overeating are dissolved as soon as they start recording the foods they eat (this is surprisingly common). Others might find that years of working with a therapist have resulted in a mere dent in their ability to eat in response to hunger and to stop unwanted eating behaviours. In most everyone progress is not linear.
Change Theory and the Stages of Change schema depicts the alteration of behaviours as cyclical, rather than linear. As we move through the stages, we enter a cycle of pre-contemplation, contemplation, planning, action and maintenance. Sometimes we fall out of the cycle and relapse. Many people working with behavioural changes and addictions prefer to rename relapse “prolapse”, claiming that prolapse is a necessary stage for continuing the cycle of change and that much is to be learned from failing at something. It is through observing how the world produces unexpected results, and then attempting to understand the unexpected while trying again, where learning takes place. We don’t really learn if we don’t fail.
Sometimes addictive behaviours, emotional eating included, worsen at a time when someone is on the verge of making a massive breakthrough. Sometimes poking at a new layer of the source of unwanted behaviour accompanies an exacerbation in the practice of that behaviour. Having curiosity and self-compassion throughout the process is essential. Savouring the increased self-awareness that comes with any effort to effect change in one’s life is part of the enjoyment of the experience.
In response to my very popular article about the Mirena IUD and how that can upset hormone balance, or further an existing imbalance, I talk about a condition called “estrogen dominance” can result in hormonal symptoms, such as PMS, infertility, weight gain and anxiety.
Hello everyone, my name is Dr. Talia Marcheggiani. I’m a naturopathic doctor with a special focus in mental health and hormones, especially women’s hormones.
So, today I’m going to talk about an article I wrote about a year and a half ago that gotten a lot of activity online and it’s called “Let’s Talk Mirena: Anxiety and Hormone Imbalance”. I wrote the article because I was seeing a few patients who had the Mirena IUD and a series of similar symptoms. So, anxiety, panic attacks, and just a general sense of hormone imbalance. And when we ran their labs, when I looked at the levels of progesterone in their blood, they had very low progesterone. So I wrote an article about this and about the phenomenon of “estrogen dominance” that we naturopaths talk about a lot. And I got this resounding response online, so even today, sometimes, I’ll get a couple emails a day of people expressing their experiences and their agreement with the article and their confusion and frustration and anxiety around some of the symptoms that they’ve been experiencing since getting the IUD.
So, the reason I wrote the article is not because I don’t agree with the Mirena IUD. I’ve written another article called “Having a Healthy Birth Control Experience” in which I state that as a form of contraception, a hormonal birth control and a hormonal implant such as the IUD can be really great measures against unwanted pregnancy, because their efficacies are very very high—I think the Mirena IUDis about 99%pregnancy avoidance— and you don’t need to think about it, you don’t need to take a pill every day, so for some women this is ideal.
The issue is that a lot of women are being prescribed the Mirena IUD as a solution for Estrogen Dominance. And so what I find in my clinical practice, and I’ll talk more about estrogen dominance in the course of this video, but what I find in my clinical practice is, because it doesn’t address the underlying cause, and because it’s hormonal in and of itself, and it adds more hormones to the body, in a specific location, the uterus, and because it doesn’t address the underlying imbalance, it either worsens or ignores the condition of estrogen dominance, causing symptoms to get worse and women to feel frustrated and lost and then write to me.
Mirena is often prescribed to women with heavy and painful menstrual bleeding. So, this could be a diagnosis of endometriosis, or ovarian cysts, or just symptoms that they’re experiencing. So a lot of them might be experiencing iron deficiency because of the heaviness of the bleeding and a lot of women are out of commission for a couple of days every month because their period is so heavy and uncomfortable and they feel weak and they’re in pain and maybe they deal with really intense PMS. Some of my patients deal with PMS for 2 weeks out of the month, which is crazy and super uncomfortable.
Conventional medical doctors prescribe the Mirena IUD to combat these symptoms because with birth control and the IUD, one of the side effects is really light periods and some people don’t even get their period at all on Mirena and so you can imagine, if you’re period is this time of the month where you can’t go to work and you’re just basically hemorrhaging from the insides, then it would be a massive relief to not have to deal with a period anymore for 5 years, which is how long the hormones last in Mirena.
But one of the issues is that we need to look at the cause of these symptoms. Oftentimes these symptoms are caused by a difference in estrogen and progesterone, so these are two of the main female sex hormones. One of the things that happens in conditions like endometriosis or heavy and painful periods is that the estrogen is high in relation to the progesterone in the body. And so this is really apparent in a condition like endometriosis where there’s often high estrogen and also fibroids. So both of those cause terrible periods, and they need to be ruled out when periods are heavy and uncomfortable. And then there’s ways that we can deal with that as naturopaths.
But even without an underlying health condition, just primary dysmenorrhea, that’s not caused by another diagnosis is often the result of estrogen dominance.
And so the Mirena, because it’s made of only progesterone, can help with the uterine symptoms of estrogen dominance, which would be the heavy and painful periods. However, we have estrogen and progesterone receptors all over our body, not just in our uterus, and so when we’re putting hormones in one part of the body, and they’re not ending up in the rest of the body, we start to worsen that deficiency, or that relative deficiency in progesterone.
So women will mention, and one of the most common symptoms is anxiety and panic attacks, because progesterone this kind of calming effect on the central nervous system, on the brain, so it kind of chills you out and helps you handle stress.
Estrogen is a hormone that causes women to ovulate, so it’s a pro-ovulatory hormone and it also helps build up the uterine lining. So the more estrogen we have, the thicker the lining and therefore when we shed the lining during our period, the more we have to shed. So, more estrogen, the thicker the lining, the heavier and, by proxy, more painful the period.
Progesterone is a hormone that, in terms of reproduction, it helps us maintain the lining (of the uterus). So, if you ovulate and then that egg gets fertilized by sperm, then the egg gets implanted in the uterus and progesterone starts to increase, so pregnancy is a very progesterone dominant condition and one of the signs of a low progesterone state is when women who have been pregnant say that that’s the most balanced they’ve ever felt because progesterone is naturally higher in pregnancy.
Progesterone starts to rise when you become pregnant and that maintains the lining throughout the 9 months and then, after the 9 months, you have your baby. If the egg doesn’t become fertilized then progesterone rises for the last 2 weeks of the cycle and then it falls, along with estrogen, you shed your lining and then you have a period.
And for some women, they sail right into their periods. They have no PMS symptoms, they might feel a little bit bloated a couple of hours before and then they go to the washroom and go, “ok, look, there’s blood I’m having my period.” And for other women, it’s not the case, they get warning signs, like i said, before two weeks, so pretty much from ovulation to when their period happens. So, half of their life: 2 weeks out of every month.
And so, what happens with a lot of women is that there’s higher estrogen in relation to progesterone. So we call this “Estrogen Dominance”. And there can be three possibilities in this state. One is that estrogen is abnormally high and progesterone is normal, or optimal. Another is that estrogen is normal or optimal, progesterone is low, and a third option is that you have both at the same time: so estrogen is high and abnormal and progesterone is low and that’s more common than you think in a lot of women who are dealing with really severe symptoms, that divide between the two hormones is really off. And, as I mentioned before, prescribing birth control pill or Mirena IUD are not solutions because they’re not correcting the underlying imbalance. They’re not looking at the cause of why this imbalance is happening in the first place. Instead, they introduce foreign, fake or synthetic hormones into the system to try and correct the balance, but our body has a delicate balance and a delicate ecology and so when we try and shift that balance artificially sometimes we pay the price and we don’t necessarily feel balanced.
So, why does this occur? Why do people get estrogen dominance and how do you fix it? So, when it comes to the first situation, high estrogen, and normal progesterone, there’s a couple of reasons why estrogen might be high. So the first is exposure to foreign estrogen, or excess estrogens in the environment. And, so many of you may have heard of these “xenoestrogens”, or toxic estrogens, from sources such as BPA, so the lining of tin cans, or those plastic water bottles or baby bottles that everyone was throwing out and replacing with glass and stainless steel, which is a great idea. So, we’re in contact with these in the environment through the cosmetics, cleaning products, and some of the plastics that we hold and interact with on a daily basis. And paper receipts have this as well. So cashiers and people that handle receipts regularly are in contact with BPA. And it’s absorbed through the skin. So just this exposure to these toxic estrogens can activate estrogen receptors and it increases estrogen in the body. And that’s problematic. We know that these can also set the stage for hormonal cancers, like breast cancer, you might have heard of estrogen-receptor positive breast cancer, or ovarian cancer and endometrial cancer and cervical cancer. So these are all kind of these foreign estrogens influence the body’s hormones in a negative way causing growths.
The second reason why estrogen might be high is the reduced ability of the body to detoxify estrogens. So, when we’re done using the estrogen that we need, our liver cleans our blood of estrogen, then we dump the estrogen biproducts into the colon and then we eliminate them by having a bowel movement. And this is a normal process in lowering the toxic estrogen or the estrogen metabolites, the estrogen we don’t need anymore. And so when this process is either over-burdened by too many xenoestrogens, so those plastic estrogens, or limited in some way because our liver is trying to detoxify other things, such as alcohol, or tylenol, or some of these over-the-counter drugs, the liver just can’t handle the burden and so, in terms of treatment we need to bolster the liver’s detoxification abilities. And a lot of the time those two things exist at the same time: you’re getting too many foreign estrogens, we need to clean up the environment and the diet and make sure everything you’re getting is promoting a healthy estrogen metabolism.
And then, why progesterone might be low, which is the other arm or possibility of this estrogen dominance condition that I’m speaking of is stress, mainly. So, when we’re stressed out, and we’re dealing with a lot our body produces a hormone called cortisol and that’s the “stress hormone” that helps us deal with high amounts of pressure and stress. And a lot of the time stress is not perceived so, just this feeling of being tired and wired, disrupted sleep, sugar cravings around 3-4pm, having a difficult time getting up in the morning, feeling a little bit stretched thin, maybe feeling a drop in motivation, are all signs of chronic stress. So what happens is our adrenal glands, these pyramid-shaped endocrine glands that sit on top of the kidneys, they make cortisol. And when our body has more cortisol than it needs, or when it needs to make progesterone, it takes the cortisol and it makes progesterone with it. So it’s kind of like leftover cortisol that it’s not using gets made into progesterone. After ovulation, the ovaries also produce progesterone, but part of the progesterone production in the body come from the adrenal glands.
So you can imagine: if you’re stressed out and you’re spending all of your adrenal function on making cortisol you’re not going to have enough time or resources to make progesterone. So a lot of bringing up progesterone balance is by either lowering environmental stress or increasing adrenal function. We also look a nutrient deficiencies and we can also look at bringing pituitary balance by using an herb called vitex, which can help balance hormones and kind of right that estrogen-progesterone imbalance that might be going on.
So what happens when you give the Mirena, or you give an oral contraceptive to deal with this? Well, what happens is, there’s an imbalance and you induce another imbalance kind of over top. So, the body is still not making enough progesterone, there’s still too much estrogen, toxic estrogen, and what you’re doing is giving synthetic progesterone, which doesn’t have the same effects, progestins, synthetic progesterone, it doesn’t have the same effects as regular progesterone and often doesn’t work on the brain, so it doesn’t have that low anxiety effect, that calming effect, and it doesn’t prevent the estrogen-dominant cancers, it doesn’t help with ovarian cysts, it doesn’t manage endometriosis, other than stopping your periods, perhaps, if you’re reacting to it. And then you’re also, if you’re doing a combined oral contraceptive pill, you’re introducing more xenoestrogens to the body that your liver then has to clear out and that are going to cause more of those estrogen-dominant symptoms. And, in the colon we know that oral contraceptives can cause a bacterial imbalance, so a dysbiosis in the gut and potentially constipation and so that throws off our whole system. I’ve talked about how important that gut bacteria is for mental health and mood and just digestion and everything. So, more cells are in our gut than in the rest of our body. So our gut microbiome is super important to our health and well-being.
So, how does a naturopathic doctor address estrogen dominance? This is a big part of my practice especially because I see a lot of women with month-long PMS, acne, polycystic ovarian syndrome, so irregular periods, or missed periods, or they have a family history of hormone-dominant cancers and they’re trying to prevent these things from happening down the line, or they’re just having terrible periods. They’re having weight gain, or bloating, or anxiety that’s related to the period or really bad PMS, so mood swings, depression around their period or a condition called PMDD, which is really really severe depression right before the period.
So the first thing I do is order labs. And so your medical doctor might have done labs, gotten your estrogen and progesterone measured in your blood and your doctor might have said, “oh, it’s fine, it’s normal”, and this is true to the extent that when your medical doctor is evaluating your labs, they’re looking at massive reference ranges. So our reference ranges are a bit more narrow because we’re trying to look at the optimal levels for fertility and for feeling like your optimal, amazing self. We’re looking at, “is your estrogen within an optimal range, is your estrogen on the high side, and therefore, could be brought down? And does that match your symptom picture? Do you have estrogen dominance symptoms and a relatively high estrogen level? Is your progesterone lower than optimal to maintain a uterine lining in pregnancy, to not have a miscarriage in the first trimesters, etc. etc.” So we look at labs, and then we, using our natural therapies, we prescribe diet, supplements, and some lifestyle changes to help re-establish that hormonal balance.
So, if you have any more questions, just send me an email, at connect@taliand.com or check out some of the articles that I mentioned in this video.
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
I talk about how to manage stress and promote mental health and emotional wellness through assessing balance in the key areas of your life that promote a healthy mind and body.
Hello, everybody, my name is Dr. Talia Marcheggiani. I’m a mental health and hormone expert.
Stress is a big reason why a lot of people come to see me, for support in their lifestyle and optimization of their health, especially their mood and mental health.
And, one of the things that I’ve come to understand in working with people one on one is that stress in life is an inevitability, especially in our society.
Work is just one aspect of the stress that influences our lives, but things like loss of loved ones, and ending of relationships, pressure from work, monetary struggles. These things in society are inevitabilities. So, we’re sooner or later going to be faced with major stressors in our lives regardless of how well our life is happening right now.
One of the big things in terms of working with people is helping with their resilience to stress. That means building up resources. So, before I meet with a patient I have them fill out an online intake form. And this is sent to their email and one of the—the intake form goes over what their concerns are, what they’re coming in for, it goes through all the areas of their health, their physical health and mental health and one aspect as well, in the chart is something called The Wheel of Balance. And, what the Wheel of Balance does is, it looks at all the major pillars that make up somebody’s life. It asks the potential patient or the new patient, to assess, to rate on a scale of 1 to 10 how satisfied they are with that area of their life.
So, for example, one of the areas is health and so on a scale of 1 to 10 how you feel that your health is managed? How satisfied are you with your level of health? Are you in chronic pain? Do you feel unwell generally? Or do you feel like health is pretty well managed, despite the fact that you’re coming in with a health concern?
Another area is relationships. So, personal relationships. So, some people don’t have a significant other and, if that’s so, how do you feel about that? Or, if you do have a significant other, how satisfying is that relationship? How well do you feel that relationship supports you in your life?
There’s several reasons for this Wheel of Balance. One is to just get a general understanding of the life of the person I’m going to be working with, what the broad picture is in terms of their life.
And another reason is that we know a lot of these factors such as relationships, and health and career, and money and whether you have hobbies, whether you have something that fills you, something that gives you a sense of purpose, we know that these things are determinants of health. So, your socioeconomic status is one of these factors that determines your longevity or your resilience against disease, especially your resilience against stress. If I have somebody coming in with depression and anxiety who’s recently been laid off, no amount of herbs—well, the herbs can buffer the stress response and relax the physical body so that somebody can look for work, but on the high priority list is helping them find a job again, because no matter how calm you’re feeling physically, or much meditation you’re doing, the fact that you don’t have a way to pay your bills is a major stressor that won’t go away until it’s dealt with.
And, another reason as well for doing this Wheel of Balance, if we’re assessing this holistic scope of what someone’s life is, is the fact that these pillars, when they’re strengthened, they provide the basis for the resilience against onslaughts of stress that come in.
So, many of the people that come in and see me who are dealing with mental health issues, they’re often struggling with an onslaught of stress that’s hit them. So it could be that they’ve recently been laid or separated from a partner in a romantic relationship, or it could be a great loss or trauma or somethings are surfacing.
Organizing these pillars of resilience is really effective for helping somebody deal with the stress and survive a new wave of stress.
In naturopathic school we learned about something called the Stress Wall, so it’s sort of a similar idea. You’re building up these resilience factors, you’re strengthening relationships, you’re dedicating time and energy to creating a career that you love, you’re arming yourself with hobbies and interests and purpose and passion and, therefore, when a stress wave hits you, you’re able to withstand it, or you’re able to recover more quickly. It doesn’t throw you, it doesn’t send you into chaos, physically, mentally and emotionally.
And sometimes these waves of stress they test our stress wall, so sometimes people are doing all right and then a really stressful time at work will show them how well their stress wall’s been built.
So one thing you can do, right now, having said all this, is do a Wheel of Balance with me. So, all you need is a piece of paper, and you’re just going to draw a circle on it. And you’re going to divide the circle up into 8 sections. So, divide it in half, then in quarters, then divide those quarters into halves so that you have 8 sections on your wheel.
And then you’re going to label each pie slice with a title. So, the first one is career. The second one, money, because those are two separate things. Our career is not always tied to our money. Sometimes satisfaction with a career doesn’t necessarily mean monetary satisfaction. So we separate those two things, although they can be linked. The third is health. The fourth is relationships, and this is romantic relationships or significant other.
The fifth is family and friends, supporting relationships. If you don’t have a significant other, you can also rate your satisfaction with the fact that you don’t have a significant other, so if you’re single and feeling pretty good about it, pretty happy with your independence, or are you in the search of looking for a significant other, or are you recently single and upset about that. So this is something where you can evaluate your satisfaction because it is a piece of the puzzle and piece of the Wheel of Balance in terms of resilience, because one of the biggest sources of stress is from romantic partnership or lack thereof.
So the sixth pie slice is fun and hobbies. This is something meaningful that you pursue outside of your work, whether you have one or more things. In that section is sort of what you do to destress, so do you come home and flip on the TV and is that a fulfilling and stress-reducing activity for you? It can be for a lot of people, but bringing awareness and consciousness to that is very helpful.
The seventh is purpose and growth. So, are you everyday creating meaning in your life? Is there a clear meaning for your life and are you fulfilling that meaning and purpose? Do you feel like you’re growing and learning every day? That’s really important for a lot of people and I often find that people mark that pretty low especially when they’re dealing with a mental health condition or a high amount of stress in their lives.
And then the final thing is your physical environment. Physical environment is, are you happy with where you’re living? So how your living arrangement is, physically. Is it a comfortable space to live in? Do you like how it’s decorated? Do you like where you’re living? What city you’re in? What part of the city you’re in? Are you exposed to nature on a regular basis and, if not or if so, how important is that to you? So you’re evaluating what the state is of the physical surroundings that you’re in. So that’s why we clean our houses or why we care about where we’re living because a cluttered environment does affect our internal and mental state.
So, again, those categories are career, money, health, relationship, family and friends, fun and hobbies, purpose and growth, and physical environment. So, when you’re finished you’ll have a chart that looks like this. So it’s got eight different slices with different labels. And, on your own I want you to fill in the pie according to your level of satisfaction, so if you’re 100% satisfied in the area of your career then you colour in the entire pie slice. If you’re only 50% satisfied or one quarter than you fill the corresponding amount out. Then you look at the areas you’re not as satisfied in and the areas you might be over-compensating in. So you might be really dedicated to maintaining a healthy lifestyle but may be sacrificing in the area of fun and haven’t really invested in making sure you’re creating fun activities.
You also might not want these categories. There might be another category that’s more important to you. If you don’t care about one of these categories it might mean that you’re satisfied with it, or you don’t feel that it brings meaning to your life, and that’s totally cool.
But, it’s sort of an idea of these areas that we build our lives around. And so what I do with people, because a lot of the time when people are feeling a lot of stress, or have a mental/emotional issue that they’re coming in with, depression or anxiety, neurosis or anything like that, a lot of the time they’re missing a few areas, or their Wheel of Balance is skewed in one area or it’s just generally weak all over. And so what we have to do—that means these people are very susceptible and vulnerable and the first thing to do, instead of working on diet or giving herbs and that kind of thing, is to strengthen some of those areas to create a more robust Wheel of Balance. And so what we do is, if there’s an area that you’re weak in, is creating one concrete thing you can do, more or less immediately, so let’s say within the week, that would strengthen and kind of balance out your Wheel of Balance.
And so, an area that is often lacking for most adults and busy people is fun, so if you put 25% of satisfaction in the area of fun, then coming up with a strategy, one thing you can do this week that would increase your satisfaction, even a little bit, and start to build up that pie slice, in the Wheel of Balance. So, thinking of something you would do that you would classify as fun. In the area of family and friends, how can I reach out to somebody, or strengthen an existing friendship or look for a way that I could put myself in a position to meet new people. So we start working on these areas. So once you’ve developed resilience and strength, we’re better able to weather the new waves of stress that hit us because they will, inevitably. Some of us are blessed to not have as many stress waves, but eventually there is something that will affect us and will affect our state of balance and our mental health so the stronger our pillars of resistance and the more robust our Wheel of Balance is, the better able we are to weather these storms and maintain our mental and emotional health and our physical health, because we know they’re all connected.
My name is Dr. Talia Marcheggiani, thanks for listening and if you want to contact me, my email is connect@taliand.com. I practice in Bloor West Village in Toronto.
Someone, I think it was Eckhart Tolle, once said that when it comes to mental illness, anxiety is about worry for the future, while depression is concerned with regret for the past. While, I’m not entirely (or even nearly) convinced that this is true, there is little doubt that those with both depression and anxiety can get caught in the paralysis of going over past events and regrets in their minds. Therefore, healing regret becomes important for reframing our past experiences and present identity and improving mood and self-esteem.
Regret is a sticky emotion. It reminds us of who we once were. It’s the cold hand on the shoulder and the voice that whispers “remember…” in our ear when we’re getting a little too confident, when we’re actually feeling happy with who we are now.
My patients will often tell me that when they find themselves in a spiral of low mood, their minds are often playing and replaying past events over and over. They mull over painful memories until they are distorted, painting themselves as the villain the more they rewind and press play. Remembering in this way smears grey over their entire sense of self, and discolours the possibilities they see for themselves in the future and, worse, their abilities to take meaningful action in the present. It leads to deep feelings of self-hate and worthlessness. It causes feelings of hopelessness. And so I tell them this:
Regret, while painful, is not always bad. It is a reflection, a comparison between two people: the person you are now and the person you used to be. When this comparison is particularly vast, when the you you used to be is particularly painful to remember, then know this; you have changed. Regret comes with looking back with pain, wishing we’d taken a different course of action than the ones taken. However, when we flip this concept over and examine its shinier underbelly, we realize that in order to feel regretful about past events we are acknowledging that we (present we) would not have performed the same action or made the same choice now. The flip side is not that we’re bad, it’s a reflection of our goodness. We have learned and evolved. We’re different.
Looking back is different from looking forward. Our lessons are what shape us. The fact that we regret is proof that we learn, we grow and we change into better, preferred versions of ourselves. If we sit in the experience of regret, we can feel proud that, if faced with the same situation today, we’d be better. Regret doesn’t mean that we are bad people, it’s proof that we’re good people. In order to regret the past we’ve had to have changed.
To transform mulling over painful life choices and past actions, I recommend a writing exercise, inspired by Narrative Therapy. In every story of regret and “badness” there is also a story of values, skills, preferred identity and goodness. The next time you find yourself cycling through feelings of regret grab a pen and paper and answer the following questions:
1) What happened? What were the events that transpired? What did you do? What did other people in the story do? What were the events leading up to the action you and others took? What was the context surrounding you at the time? What influenced your decision to act as you did?
2) Looking back, what would you have done differently? What parts are particularly painful to remember? What actions or events do you regret?
3) What might these regrets say about you now? What might it say about you to know that you would have acted differently if you were faced with the same situation? What values do you embody that enable you to recognize that what you did in the past was regretful for you?
4) Looking at these values, how have you shown you have this value in the past in other situations? Do you have a particular story you remember?
5) How has that value or skill made an impact on the lives of others? In the story that you remembered, what might the actions you took in #4 have meant to the people around you?
6) How do you embody this value in the present? Where does it show up in the actions you take today? How might you embody this value in the future? What actions might you take while remembering this value? What does remembering this value and the story from #4 make possible for the future?
Going through this writing exercise can help us look back with more compassion for the person we were, who was growing into the person we are now. It might make possible ways that we can rectify anyone or anything was impacted in the past, if it means an apology, paying forward a good act, taking different steps in a similar present situation or even moving on and letting go of our tendency to hold onto the memory.
I’m tired of hearing mental health conditions blamed on a “chemical imbalance”. Patients everywhere are being told that their mental health conditions are, literally, “all in their heads”. With this diagnosis—often distributed insensitively, and without much attention to the complex factors in thoughts, beliefs, emotions, the environment, biology, nutritional status, mental and emotional as well as physical stressors, and life circumstances (just to name a few) that can contribute to mental health imbalances—patients are left with the message that they are somehow damaged, broken, or that their condition arose out of an inherent weakness that they somehow possess. Through the numerous conversations I’ve had with those struggling with mental health symptoms, I have come to understand that oftentimes there are phrases that rob power more than the term “brain/chemical imbalance”.
Fortunately, there is still more to emerge in the wonderful world of science. Very little actual evidence supports the chemical imbalance theory of depression and researchers and clinicians alike are forced to admit that symptoms of conditions such as depression and anxiety are often the result of multiple factors that come together. Contrary to the common narrative of mental illness being a sign of weakness, evolutionary biologists are uncovering evidence that symptoms of depression might be the result of a highly adaptive strength based on preserving the body during times of great mental, emotional and physiological stress—showing, in fact, that depression and anxiety might in fact be afflictions of the strong, not the weak.
In my practice, I approach depression and anxiety from a functional medicine standpoint. This means, simply, that I look not at the title of the condition my patients come in with (I care very little if you have depression, or anxiety, or bipolar disorder, etc.—the name is not the thing itself), but how the condition occurs uniquely for them. By paying close attention to the multitude of symptoms, thoughts, and factors that influence the mood and emotions, I am able to uncover underlying pathways that point to imbalance in the body and dig up the roots from where the symptoms might have arisen in the first place. Through this method, focussing on the functioning of the body rather than it’s pathology, we’re able to bring the body back into a state of balance and reverse symptoms permanently, rather than simply slapping a band-aid over them.
When it comes to mental health, it is important to emphasize that depression and anxiety (as well as other mental health diagnoses) are not diseases at all; they are symptoms. When presented with low mood, feelings of sadness and worthlessness, lack of motivation, lethargy, brain fog, changes in appetite and weight, abysmal self-esteem and so on—all symptoms that many patients with depression face—we need to follow the threads of symptoms back to the point where things began unraveling. It is necessary to backtrack to the biological imbalances where symptoms first began.
There is an overwhelming amount of research coming out in the field of mental health that links the gut and digestive health to mental health symptoms, indicating that depression might not be a brain chemical imbalance at all, but a gut chemical imbalance. Where there is depression and anxiety, there is more often than not, a digestive issue.
We have always known that the digestive track and brain have an intimate bond. From the vagus nerve that enervates the gut and begins in the cranium, to the mood-regulating neurotransmitters that are created in the gut, we all have the experienced the tummy aches linked to grief or the power of anxiety to loosen our bowels. We’ve all noted the phenomenon that great ideas or moments of clarity seem to spontaneously arise from, not the brain, where we always assumed our thoughts were formed, but the gut (hence the term, “gut feeling”, which we use to characterize intuitive insights).
When it comes to issues with the brain—thoughts, moods, emotions, feelings, etc., where else should we look for answers than our brain’s close cousin, friend and confidant, the gut. Mental health symptoms can arise from impaired digestion in a number of ways:
A failure of the gut cells (enterocytes) to create neurotransmitters. The majority of serotonin (the “Happy Hormone”) is produced in the gut. Inflamed and unhappy gut cells are often unable to make serotonin.
An imbalance in the healthy gut bacteria that influences whole-body health. We have 10x more cells in our gut than in our body in the form of almost 5 lbs of symbiotic gut bacteria. This bacteria ensures our well-being by helping us digest our food, soothing inflammation, educating our immune system, killing off harmful pathogens, creating bulk for our stools and, relevant to the field of mental health, producing neurotransmitters important for regulating mood, such as serotonin and dopamine.
Research has gone into the connection between a low-level of inflammation in the brain and its affect on mood. Inflammation is usually a product of our diet, stress and food sensitivities. In naturopathic medicine and functional medicine we treat inflammation with the assumption that nearly all inflammation begins in the gut. A condition called “Leaky Gut” is a failure of the important seal between the intestinal walls and the rest of the body. When this seal is broken, toxins, proteins and other debris are free to enter the bloodstream, wrecking havoc, setting the immune system off course and, eventually, triggering symptoms of inflammation, autoimmunity and mental health issues.
Our body requires many building blocks to maintain its complex fortress. Difficulties in the digestive cells’ ability to absorb essential fats, amino acids and vitamins required for brain health, hormone regulation, detoxification and immunity, among the thousands of other chemical reactions in the body, will result in impairment in overall functional. Nutrient deficiencies are more common, even in developed societies, than one might think. Deficiencies arise from: impaired absorption, inadequate diet, increased amounts of stress and the ingestion of foods or medications the deplete the body of nutrients. In any case, optimizing the gut’s ability to digest and absorb the nutrients we’re either eating or supplementing is key for improving health and mood.
When it comes to understanding mental health issues I, as a clinician, realize it is hardly ever just one factor involved. Properly helping someone with anxiety or depression heal involves understanding the constellation of potential causes and how they inter-connect and relate to one another. Through this detective work, we can begin the journey of unraveling the imbalances and restoring the body’s ability to function and heal.
Treatment plans usually involve a combination of replenishing essential nutrients that patients are deficient in (deficiency can be detected through blood work, health history or symptoms), repairing the gut’s ability to absorb, restoring the body’s balance of healthy gut bacteria, removing food sensitivities and healing digestive inflammation, balancing hormones, and managing lifestyle stress and environmental factors that may be contributing to low mood.
My patients make impressive commitments to healing and are willing to examine their bodies and past experiences, in order to do the hard work of healing. Beyond my role as a doctor, I am committed to working as a facilitator, teacher and guide. My job is not to tell people the right path to walk, but to help them understand their body’s complex language, listen to the signals and messages that arise from it, and understand what those signals are asking of them.
For more information, click here. I run a practice with a special focus in mental health, youth mental health and hormonal conditions. I work in Bloor West Village in Toronto, Canada.
When our minds are stressed, how do our bodies react? We experience something called “adrenal fatigue” that can closely mimic the symptoms of depression.
Hi, naturopathic doctor, Talia Marcheggiani, here. I’m a mental health expert and I’m at Bloor West Wellness Clinic and today we’re going to talk about the Stress-Depression Connection.
Most of us are stressed in North America. There’s a major stress epidemic. We know that anywhere from 70-90% of doctors’ visits are directly or indirectly attributed to stress and the symptoms that it causes in the body.
Most people are stressed, I think the estimate is 70% to 90% of North American women are experiencing some kind of chronic stress. Many are unaware of it and very few are doing anything about it or actively managing their stress through methods of self-care, relaxation techniques, and other therapies to lower the cortisol, or the stress hormones, that are producing that chronic stress in the body.
So, physiologically, when we get stressed, so, let’s say, you know, you’re in the paleolithic times, you’re walking through the forest and you encounter a giant bear running towards you. Our bodies would immediately start secreting epinephrine, or adrenaline, which is the first stress hormone. This is released from the adrenal glands, these pyramid-shaped endocrine or hormone glands, located on top of both of our kidneys. Epinephrine, or adrenaline, many of us have felt the effects of before, this makes our heart race, we start sweating, we start to, you know, you might feel like you have to go to the washroom, you might notice digestive effects. What will happen is, our blood vessels will dilate, our pupils will dilate, so that we can’t see fine detail but we can see movement much more easily so we can see the subtle movements of the bear lunging towards us and our body is primed for fight, flight or freezing so that we can get away from this immediate stressor, this threat to our safety and survival.
And really incredible things can happen when we’re in this hyper-arousal state, this sympathetic nervous system state.
A friend of mine was walking in Greece and she fell off a side walk, the side walk just ended, and in the fall, she fell off like cliff, and one of her arms broke so, she managed, in this superhuman ability, that all of a sudden she had, through the adrenaline that was coursing through her body to deal with this stress and surprise, she with the hand that wasn’t broken, grabbed the edge of the sidewalk and pulled herself to safety. And this was a woman, my friend, that can’t even do one pull-up she can’t do pushups, she doesn’t have the arm strength to, in a calm and not hyper-aroused state, perform that kind of physical act.
So, epinephrine and the stress response is amazingly powerful. This stress response can save our lives if called into action for the right reasons and at the right time.
However what’s going on in North America now, is that, especially in this modern society that we live in, with technology and all of the stressors that we’re encountering on a day-to-day basis and the pressures we put on ourselves, we’re in the hyper-arousal state far more often than normal.
Back when we were chased by bears and we had to respond physiologically to that stressor, we would have just, as soon as we reached safety or finished fighting the bear, or froze, played dead, so the bear would walk away, we would have returned back to a state of relaxation. I mean, our hearts would have continued to pound as we kind of got over that stressor, but eventually we would have returned to our rest and digest state, our parasympathetic state.
Back in those days we used to work an estimated 15 hours a week hunting, gathering food, um, in our paleolithic time, in our hunter-gatherer times, which is what our genes have evolved to succeed in—our genes haven’t evolved to catch up with the rapid change in the environment that we’ve created for ourselves and so we’re not used to working 40 to 80-hour work weeks and racing home, through traffic, to pick up the kids and do after school activities and finish up late assignments, getting to get after 12 pm and getting up at 6 am to do a workout so we can lose weight and all of the things that are filling our lives and causing us stress.
The issue with many of the women that I work with, many of the people that I work with, is that we don’t really notice that we’re under stress, like a lot of people will say that they don’t feel stressed and then the signs and symptoms that they’re bodies are exhibiting point me in a direction of some kind of stress response.
So, I described what adrenaline/epinephrine do. But our body doesn’t have a very big reserve of adrenaline and epinephrine, so when we’re in that fight or flight response for prolonged periods of time, the adrenal glands, those pyramid-shaped glands on top of the kidneys, they start to secrete another hormone, called cortisol.
Cortisol has some similar effects, but it’s better for prolonged periods of stress. Cortisol kind of makes us feel alert, it gives us this grounded energy so we can be effective when we have these daily things thrown at us. So, when we wake up in the morning, we feel kind of groggy and then we start to feel alert, maybe we have a quick workout or cold shower or we eat something, we start to feel like we’re becoming alive, we’re greeting the day. That’s cortisol starting to build up in our bodies and prepare us for the things that we have to do, for the mental tasks, or the physical tasks, or the juggling of all the tasks that we have coming up for us in that day.
Cortisol is a good thing. We want to have cortisol because without it, we can’t perform, we can’t be who we need to be. And we can’t bring ourselves into the world and do the things that we’re supposed to do that day.
The problem is, of course, and I’ve already mentioned this, is when stress is prolonged and when stress is taking over more than 50% of our day and our bodies are in that fight or flight state for more time than they’re in the rest and digest state.
Some of the effects of being in this state and, as I mentioned, a fair amount of us are this state most of the time, or have to be. Some of the effects are high blood pressure, high cholesterol, heart diseases, even some cancers, suppressed immunity, things like skin issues, hormonal imbalances, such as infertility, or PCOS or endometriosis, changes in eyesight, changes in hearing, hair loss, acne, impotence, and various other symptoms. And, of course, depression and mental illness.
One of the effects of cortisol is that it can lower serotonin, which is the feel-good, the happy neurotransmitters that our brain secretes and dopamine, another neurotransmitter that promotes feelings of well-bring and happy mood and also helps with that motivation and reward cycle.
Cortisol also controls inflammation and, when we have too much of it, it suppresses inflammation, but once we start to become deficient in cortisol, inflammation can increase and when our body’s relying on cortisol all the time, the balance of cortisol can get thrown off and we can have highs and lows of cortisol in the body.
We know that there is an implication in inflammation and mood, so cortisol is often at the root of excess inflammation or inflammatory symptoms.
There’s also a condition that’s not really recognized in conventional medicine, but naturopathic doctors recognize, as well as functional doctors. So functional doctors and naturopathic doctors, we don’t really work with diseases that you come in with, I mean we work with those too, but where we really excel is when we’re looking at the patterns and the symptoms and the blood work showing disease processes before they actually become diseases. And I think depression and most mental health conditions fall in that area because we know that there’s no blood tests for things like depression. Direct blood tests, I mean. There’s no real diagnostic criteria beyond the subjective criteria that’s in the DSM V. So, when somebody’s depressed, we have to rely on a variety of symptoms and then I can order some blood tests to rule out why someone might be feeling that, but it’s not a disease like diabetes where you run lab tests and you can infer from those lab tests directly what’s going on in the person’s blood and in their body and in their cells. And, of course, the result or the solution for depression is much different than diabetes, especially type I diabetes where it’s an insulin deficiency, you inject insulin and the disease is managed.
With things like depression, we have to reason backwards and try and understand what might have led to those symptoms or what’s going on in the person’s body that’s causing this imbalance that’s causing the symptoms to arise.
So, back to adrenal fatigue. So, when patients come in, and they’re experiencing prolonged stress that begin with something called the resistance phase. So this is when you’re feeling like life is busy you have a lot on your plate, but it almost, you almost thrive in this situation. It feels kind of good. You feel like you’re in control, you feel motivated and you feel like you’re getting things done. You might be tired at the end of the day, you might not be sleeping as well as you could. And you’re definitely not feeling zen. You’re not feeling relaxed and like a Buddhist monk most of the time. You’re feeling that there’s pressure on you, but you’re coping. Things are ok. This is called the Resistance Phase. And this means that your body is producing enough cortisol to deal with the daily tasks at hand.
After months to years of this, however, if this prolonged and we’re not taking enough breaks to allow our bodies to replenish, we can experience something called Adrenal Fatigue. This is when our body’s not able to produce the cortisol needed to cover those daily tasks. So remember how I said that cortisol kind of makes us feel alert and alive and ready to deal with the day ahead of us. In Adrenal Fatigue we’re not able to activate that stress response when we need it because we’ve had it turned on all the time. It’s almost like the gas tank’s empty and we’re kind of sputtering to get it going again. We’re trying to get our car to run on the fumes that are leftover. And, we might call this Burnout, this is another word for it, is burnout.
And so, in adrenal fatigue, and this is a really common situation that often leads to depression and also often has symptoms that actually mirror or overlap with depression. In adrenal fatigue, first of all, the main symptom is just feeling tired, fatigued. There are sleep disturbances. We feel weak, we feel unmotivated, and one of the key symptoms is that we’re not relieved by exercise.
So a lot of my patients will tell me, “I want to exercise, I know I should exercise but I just don’t have the energy to exercise.” And I’ll ask them, “do you feel like you are able to push yourself to do some exercise, like go for a brisk 30-minute walk or even, you know, a quick jog. How do you feel afterwards?” And if they tell me they feel like it depletes them more, this is often a sign that they’re in that burnout phase, they’re in adrenal fatigue.
Because when you’re in a resistance phase, exercise can kind of boost your cortisol a little bit, so if you’re still able to make it, it feels pretty good because it kind of revives you and it perks you back up. But if you’re in an adrenal fatigue situation, you just don’t have the cortisol reserves to get through that exercise, to get through that workout and to feel good afterwards. So that’s one of the symptoms.
How cortisol is supposed to work in a healthy person that has adrenal glands that aren’t depleted, is when you wake up in the morning, your cortisol begins and it’s high. And that’s why you test blood and salivary cortisol in the morning as soon as you get up. So that means you wake up and you feel like you’ve slept pretty well and you’re ready to start the day, you feel alert. You’re not groggy, you don’t wish that you could just stay in bed for the rest of the day.
Throughout the day your cortisol will gradually decline. It might have a few dips and usually perks up with eating or exercise. So if you have a protein-rich, or carbohydrate-rich meal, your cortisol can come back up and that’s around meal-times you’ll feel a little bit more alert. And your cortisol will decline until bedtime when you feel tired and you feel ready to go to sleep and it will stay low throughout the night so you won’t be waking up at night. You’ll feel rested and if you have one of those sleep trackers or a Fitbit, it will show you that you have restful sleep and that you spend a lot of your time in REM sleep or deep wave sleep. And then the cycle starts again, you wake up, your cortisol starts to peak and gets higher again.
When our cortisol cycle is off. When we’re in adrenal fatigue or even the end stages of stress resistance, which proceeds that burnout adrenal fatigue stage and often proceeds depression. The resistance phase is more associated with anxiety, burnout is more associated with depression.
When we’re in that burnout phase, we’re not able to get the cortisol up in the morning so you wake up feeling exhausted. You will often even have a crash, you might kind of get going and ready to go or you might just be used to having that level of energy, on a scale of 1 to 10, you might be anywhere from a 3 to a 7. Around 10 am, though, you’ll notice a dip in your energy, so a lot of people will have this kind of energy crash around 10 am and then they get a second wind, they can kind of go. A very typical thing that happens is around 3-4 pm, 2-4pm, after lunch, there’s a massive energy crash and we’re still at work, most of the time, those of us that work 9-5 and so you’re at work and you’re just feeling exhausted.
And then people kind of get a second wind and another thing that happens, which is not great, is that you get a second wind right before bedtime. When you’re supposed to be going to sleep, you feel this kind of “tired and wired”, like you’re not able to, you know, wind yourself down to get a restful night’s sleep. You feel like you need to be up and on your electronics and doing some work, catching up on some things that you need to get done.
And eventually you might go to bed and usually this happens close to midnight or after midnight, and then most people will have a cortisol spike in the middle of the night between 2 and 4 am where you wake up and are unable to fall back asleep. And thus the cycle begins again where you had a spike in the middle of the night, your sleep’s been broken, you’re tired again in the next morning.
So how do we get out of this cycle? Because, you know, depression has low mood, depression has low motivation, depression has changes in weight and metabolism and appetite and these feelings of sadness and adrenal fatigue and burnout have a lot of those same symptoms. There’s not motivation, you’re gaining weight in the abdomen, you’re immune system is thrown off, you’re feeling just this general malaise and muscle pain and exhaustion and sadness and low mood and low self-worth and all of these things that we see in depression.
So how do we solve this? So the first thing we do is, if possible, we try and manage stress, to establish self care routines and this is a process that we need to work towards, it doesn’t happen in one visit, in a day it takes a few months to a few years to rebuild and reestablish. We make sure that we’re living a balanced life and we’re managing our cortisol and we also might prescribe supplements and herbs to stimulate cortisol production and to help our bodies manage stress and to help our adrenal glands work more optimally. And this often has a dramatic shift in mood after a few months. I have personal experience with this myself and it’s amazing. In a few months you look back to where you were and you notice big shifts.
It’s also necessary to make sure that blood sugar is not spiking throughout the day because cortisol and blood sugar are tightly interconnected. If our blood sugar drops, our body needs to create cortisol to bring it back up and likewise, if our blood sugar is high, this is a stress on the body and it can affect the cortisol balance. If our blood sugar is nice and steady and we’re eating enough fats and proteins to keep our neurotransmitters and our hormones productive and in production in the body, we notice a more even mood and energy level and this is really important so I go over nutrition and how to plan meals, especially in the morning with a protein and fat-rich breakfast.
And, finally, things like bodywork and things like, if not psychotherapy, then things to help with the life stressors that are going on, directly addressing those things. Even helping with the body stress response, the body’s perceived response because a lot of the time we have stress stored in our thoughts and emotions in the head, which is what addressed usually with many forms of psychotherapy. But oftentimes we also store stress in the body and so I find that acupuncture can be really affective and there’s studies that show that acupuncture actually outperforms Prozac in some 6-week trials as well as acupuncture can also help the brain move into that parasympathetic rest and digest state.
So, from 4-6 sessions of acupuncture can really shift us into a more relaxed state and help us with that stress response that we often be stuck in.
So, for more information, visit my website. I’m at TaliaND.com, or you can send me an email at connect@taliand.com. I work at Bloor West Wellness in Toronto. And if you want, leave your questions or comments below and we’ll start the discussion. Thanks, bye! 🙂
We all have a critic inside of our heads. Through talking to people, I’ve been able to form more complete pictures of what these critics look like. I’ve found them to be as varied as the heads they inhabit, with personalities and characteristics of their own.
Some critics speak in fragments, muttering key words in people’s ears: fat… failure… loser… always…be… alone. Some are quite articulate, forming complex arguments. All inner critics, however, are sharp in their cruelty and ingenious in the way they intrude into our thoughts and convince us of our lack of worth.
Our inner critics were born out of a need for protection. The inner critic’s job is to spare us shame and pain. If it criticizes us before we have the chance to say or do the “wrong” thing, it can help us avoid social humiliation, rejection and isolation. However, the disparaging, constant stream of criticism often leads to depression, low self-esteem and negative identity conclusions in many people–a strong critical voice has the power to convince the person it talks to that he or she is wrong. The critical voice in our heads has the power to poke holes in the social armour of our self-esteem, diminishing the good feelings we have about ourselves and destroying our sense of personal value, self-worth and resilience.
There are many ways to develop a healthy relationship with the critical inner voice and address issues of low self-worth and low self-esteem. One of these ways is to strengthen other, more positive voices, that serve to give us a balanced view of ourselves. Self-help books and feel-good memes emphasize the importance of positive affirmations.
“Write down ten things you love about yourself before you go to bed every night!”
“Recite ‘I am beautiful, healthy and happy’ five times each day!”
“Write ‘I love you!’ and ‘You’re awesome!’ in lipstick in the bathroom mirror and look at it every morning before you to go to work!”
“Paper your workspace with feel-good Post-it notes!”
The suggested ways of talking to ourselves are endless. A sample:
According to Guy Winch, PhD and author of Emotional First Aid, research shows that positive affirmations can be very effective at raising self-esteem. However, their efficacy only applies to a certain group of people (like Jessica here). Affirmations can boost the morale of those who already have high self-esteem and a high sense of self-worth. In people who struggle with strong critical voices, depression and feelings of self-loathing, positive affirmations only result in making them feel worse.
Science tells us that we accept statements and ideas when they fall into our current belief system. Therefore, people with healthy levels of self-worth, who already believe that they are loved, good at their jobs and successful, will reinforce those feelings through reciting positive affirmations about themselves. However, my patients struggling with issues of self-esteem will comment that when they feel unattractive, unloved or unworthy, reciting the opposite sentiments as affirmations (“I am beautiful, loved, worthy!”) only reinforces their current feelings of unworthiness and unattractiveness. When a positive affirmation doesn’t overlap with the beliefs we hold about ourselves, we will reject it, thereby failing to convince or persuade ourselves to feel otherwise. Trying to force oneself into feeling a positive emotion can often only serve to remind us of how unhappy we are actually feeling.
Dr. Winch offers an alternate 3-step exercise, which reminds me in many ways of Narrative Therapy as it aims to build on one’s preferred identity. The exercise is based on increasing the aspects of our identity we already believe of ourselves. It takes about 20 minutes and requires writing. Writing helps us process the information on both sides of the brain, properly integrating and enforcing these more balanced thoughts about ourselves. The exercise only works when you write your thoughts down.
Step 1: Choose a specific situation in which you feel bad or unworthy. Perhaps you have a test coming up and feel unprepared or convinced that you’ll fail. Perhaps there is a date you’re going to go on but you feel ugly and unworthy of someone’s time or attention. Maybe you feel unpopular and have come to the conclusion that you are a bad friend. Using context is important for creating an alternate voice to that our the critic.
Step 2: Once the context has been selected, write down a list of things—traits or behaviours you exhibit—that you have to offer that you believe are valuable to the situation. This list should be exhaustive. Perhaps you would make a good date because you are generous, always offering to pay. Perhaps you’re loyal or you care about others. Perhaps you remember important dates and make your partner feel special on his or her birthday. Perhaps you’re a good student because you get to class on time or study for an hour after class instead of watching movies. Perhaps you always take notes in class and often share them with others. Focussing on even the tiniest detail of what you have to offer the situation will help you in the creation of your list. If you can’t think of anything positive about yourself, pretend that you are writing it for a friend. What would your friend have to offer if he or she were faced with the same context and self-defeating thoughts as you?
Step 3: Choose one of the items on your list and write a short essay on why these traits or qualities are important to the context you are in. Why is being thoughtful (remembering birthdays, for instance) important for dating? How have you managed to manifest this trait in the past? How will you manifest this trait or behaviour in the future? Write about how this trait has been valued by others or might be of value to others in the context that you’re in. Focusing on specific details helps to flush out the narrative of how this trait has helped shaped your identity. Again, if you are unable to write about yourself, continue to write as if it were about a friend, sticking to more general ideas. Then put the paper aside, pick it up 24 hours later, and read it as if it were about you.
Writing a short, detailed essay about what we know we have to offer and why these offerings are worthwhile can help to build a more balanced view of ourselves and the qualities we bring to the world. Narrative exercises serve to strengthen what we already know about ourselves, thickening the preferred identity stories that either fail to get told or get drowned out by the dominant stories of negative labels and personal failings. The aim is not to shut up the inner critic, but to strengthen the voices that oppose it, balancing and creating a dynamic sense of self.
My mother tells a story about my childhood where she is standing in the kitchen, preparing dinner. I stand below her, tugging at her shirt, and begging for food.
