We’ve been hearing quite a lot about The Science these days. So, what is science? How does science guide medical practice and naturopathic medicine?
The science council defines science as, “the pursuit and application of knowledge and understanding of the natural and social world following a systematic methodology based on evidence.” The answer is, science is a methodology.
It is applied in medicine through Evidence Based Medicine (EBM) which starts with the individual patient and incorporates: clinical expertise, scientific evidence (that best that exists according to a hierarchy), and patient values and preferences.
“Evidence medicine is the conscientious, explicit, judicious and reasonable use of modern, best evidence in making decisions about the care of individual patients. EBM integrates clinical experience and patient values with the best available research information.”
The Evidence-Based Pyramid
In EBM, evidence exists in a hierarchy, represented by the Evidence Based Pyramid (shown above). Animal studies are at the bottom, case reports (clinical anecdotes) somewhere in the middle and randomized control trials and meta-analyses (the Gold Standard of evidence) at the top.
Dave Sackett (the Father of EBM) et al. write in the British Medical Journal (1996),
“Good doctors use both individual clinical expertise and the best available external evidence and neither alone is enough.”
In addiction to scientific evidence, EBM must incorporate:
Patient values
A bottom-up approach (it is patient-centred, not guideline-centred)
The needs of the individual (EBM is not a one-size-fits-all formula)
Clinical expertise
The best available evidence: this does not mean using only randomized control trials. Sometimes the best evidence we have are case reports, historical and traditional use of an herb or animal studies. We still owe our patients the opportunity to see if a treatment works for them, especially if the risk of a given treatment is low.
As clinicians, we use our knowledge in different ways. We start with an assessment of the individual in front of us. This assessment takes into account the factors that influence this patient’s life, their lifestyle, their health condition and their overall health goals.
We then turn to clinical experience, research, our scientific knowledge and guidelines.
We share this information with our patient. Our job is to educate and convey the options so that the individual can provide informed consent. How does this knowledge fit into the patient’s life? How does it inform their choice?
Science is not a set of values. It is not a religion. We do not follow it.
Science provides us with a methodology for seeking the answers to questions we might ask about how the principles of nature, including the human body, are organized.
Science encourages us to ask questions and testing hypotheses in order to find answers.
It is never settled.
Most of all, science doesn’t tell us how to use scientific knowledge.
Our choices are governed by our goals, preferences and values.
So, “follow the sicence?”
No. Follow your goals, preferences, values and dreams.
And use science to help guide your way.
Reference:
Sackett, D. L., Rosenberg, W. C., Gray, J. M., Haynes, R. B., & Richardson, W. S. (1996). Evidence based medicine: What it is and what it isn’t. BMJ, 312(7023), 71–72.
“I don’t believe in diseases anymore, I treat stories.
“…No other medical system in the world ever believed in diseases. They all treat everybody as if, you know it’s whether it’s the ancestors or meridians–it’s none of this rheumatoid arthritis, strep throat kind of thing. That’s just this construct that we kind of… made up.”
– Dr. Thomas Cowan, MD
Dr. Cowan is admittedly a (deliciously) controversial figure. His statement, I’m sure, is controversial. But that’s why it intrigues me.
In naturopathic medicine, one of our core philosophies, with which I adhere very strongly, is “treat the person, not the disease”.
And, in the words of Sir William Osler, MD, “It is much more important to know what sort of person has a disease, than to know what sort of disease a person has”.
And, I guess it’s relevant to ask, what is disease in the first place?
I see disease as an non-hard end point, a state that our biological body enters into. On the continuum between perfect health (which may be an abstract and theoretical construct) and death, disease I believe is near the far end of the spectrum.
Disease happens when the body’s proteins, cells, tissues, or organs begin to malfunction in a way that threatens our survival and disrupts our ability to function in the world. For example, a collection of cells grows into a tumour, or the immune system attacks the pancreas and causes type I diabetes.
But, of course there is always more to the story.
What causes disease?
I have heard biological disease boiled down to two main causes: nutrient deficiencies and toxicities. And, I’m not sure how strongly I agree with this, but on a certain level I find this idea important to consider.
However, it is definitely not how Western Medicine views the cause of disease!
Diseases, as they are defined, seem to be biological (as opposed to mental or emotional). They have clinical signs and symptoms, certain blood test results, or imaging findings, and they can be observed looking at cells under a microscope.
Medical textbooks have lists of diseases. Medicine is largely about memorizing the characteristics of these diseases, differentiating one from another, diagnosing them, and prescribing the treatment for them.
As a naturopathic doctor, I see a myriad of patients who don’t have a “disease”, even though they feel awful and are having difficulty functioning. These patients seem to be moving along the disease spectrum, but their doctors are unable to diagnose them with anything concrete–they have not yet crossed the threshold between “feeling off” and “disease”.
Their blood tests are “normal” (supposedly), their imaging (x-rays, MRIs, ultrasounds, etc.) are negative or inconclusive, and their symptoms don’t point to any of the diseases in the medical school textbooks.
And yet they feel terrible.
And now they feel invalidated.
Often they are told, “You haven’t crossed the disease threshold yet, but once you reach the point where you’re feeling terrible and our tests pick it up too, come back and we’ll have a drug for you”.
Obviously not in so many words, but often that is the implication.
Our narrow paradigm of disease fails to account for true health.
Even the World Health Organization states that health is not the mere absence of disease.
So if someone does not have health (according to their own personal definition, values, dreams, goals, and responsibilities), but they don’t have disease, what do they have?
They have a story.
And I don’t mean that what they’re dealing with is psychological or mental or emotional instead, and that their issues are just “all in their head”. Many many times these imbalances are very biological, having a physical location in the body.
Subclinical hypothyroidism, insulin resistance, nutrient deficiencies, chronic HPA axis dysfunction, and intestinal dysbiosis are all examples of this. In these cases we can use physical testing, and physical signs to help us identify these patterns.
An aside: I believe the categories of biological, mental, environmental, and emotional, are false.
Can we have minds without biology? Can we have emotions without minds or physical bodies? How do we even interface with an environment out there if we don’t have a body or self in here?
Aren’t they all connected?
Ok, back to the flow of this piece:
Your story matters.
This is why it takes me 90 minutes to get started with a new patient.
It’s why I recommend symptom and lifestyle habit tracking: so that we can start to pay attention.
It’s why I’m curious and combine ancient philosophies, research (because yes, research is useful, there’s no doubt–we should be testing out our hypotheses), and my own intuition and skills for pattern-recognition, and my matching my felt-sense of what might be going on for a patient with their felt sense of what they feel is going on for them.
Attunement.
I write about stories a lot. And I don’t mean “story” in a woo way, like you talk about your problems and they go away.
No. What I mean is that you are an individual with a unique perspective and a body that is interconnected but also uniquely experienced. And my goal is to get a sense of what it’s like to be you. What your current experience is like. What “feeling like something’s wrong” feels like. What “getting better” feels like.
And all of that information is located within story.
Your body tells us a story too. The story shows up in your emotions, in your physical sensations, in your behaviours (that might be performed automatically or unconsciously), in your thoughts, in your energy, and in the palpation of your body.
No two cases of rheumatoid arthritis are the same. They may have similar presentations in some ways (enough to fit the category in the medical textbooks), but the two cases of rheumatoid arthritis in two separate people differ in more way than they are the same.
And that is important.
We’re so used to 15 minute insurance-covered visits where we’re given a quick diagnosis and a simple solution. We’re conditioned to believe that that’s all there is to health and that the doctors and scientists and researchers know pretty much everything there is to know about the human body and human experience.
And that if we don’t know about something, it means that it doesn’t exist.
When we’re told “nothing is wrong” we are taught to accept it. And perhaps conclude that something is wrong with us instead.
When we’re told that we have something wrong and the solution is in a pill, we are taught to accept that too. And perhaps conclude that something is wrong with our bodies.
But, you know what a story does?
It connects the dots.
It locates a relevant beginning, and weaves together the characters, themes, plot lines, conflicts, heroes, and myths that captivate us and teach us about the world.
A story combines your indigestion, mental health, microbiome, and your childhood trauma.
A story tells me about your shame, your skin inflammation, your anxiety, and your divorce.
Maybe you don’t have a disease, even if you’ve been given a diagnosis.
In September of 2019, Jakobsen, Gluud and Kirsch published a review in the British Medical Journal: Evidence-Based Medicine entitled “Should antidepressants be used for major depressive disorder?” (1)
Their conclusion was this:
“Antidepressants should not be used for adults with major depressive disorder before valid evidence has shown that the potential beneficial effects outweigh the harmful effects.”
Now, before we move on with what drove them to make this seemingly radical conclusion, I want to be clear:
I am not stigmatizing medication.
All of those who take medication for depression have asked for help.
Asking for help is important.
Asking for help is brave.
And, whatever help works for you is the right kind of help.
But imagine this; imagine you are a pretty decent swimmer.
You’ve practiced swimming all your life. You’ve gotten lots of experience swimming in pools, lakes, and oceans. You know how to swim, just like you know how to cope with turmoil. But, despite your strength, one day you find yourself drowning.
“No, I’m not drowning,” you might say at first. “I can’t be drowning. I know how to swim! If I’m drowning, it means I’m a failure…
“What will everyone think?”
And so you continue to splash around a bit, until it becomes undeniable. You gasp some water-filled air. Your head submerges and you think, indeed, “I’m drowning.”
When you get your head above water you call for help.
This takes a lot.
It’s not easy to admit that you need help.
It’s not easy to overcome that little voice that tells you that asking for help is troubling other people, admitting defeat, showing weakness—and whatever else that darned little voice thinks it means.
“HELP!” You exclaim, louder this time—little voice be damned.
“HEEELP!”
And someone on shore sees you. They have a life-preserver in their hands and they throw it your way.
Your shame is peppered with relief—and gratitude: there’s an answer to all this suffering. You thrust your hand towards the life preserver, grasping it with a firm bravery.
Only, it starts to sink. It’s full of holes.
“What’s the matter?” The person waiting on the shore exclaims, as you continue to struggle, “Don’t you want help?”
The shame returns. Hopelessness joins it.
I advocate for mental health awareness. I advocate for perpetuating the message that it’s ok to talk about mental illness. It ok to admit you need help.
I believe the following:
Depression is not a a sign of weakness.
It’s not a sign that you are defective.
It’s not a sign that you haven’t learned proper coping skills, or that your coping skills are defective, or that you’re fragile.
It’s also not fixed by simple solutions like eating salad, running or putting “mind over matter”.
Depression happens to a lot of us.
It affects 300 million people globally. It is the leading cause of disability world-wide, with a lifetime prevalence of 10 to 20%. This means that 1 in 5 people will experience depression in their lifetimes.
We all know someone who suffers. Maybe you suffer.
And a lot of people ask for help. The National Health and Nutrition Examine Survey (NHANES) in 2017 found that 1 in 8 people over the age of 12 are taking an anti-depressant, a 65% increase over the last 15 years.
This means that 65% more of us are asking for help.
That’s a lot of life preservers.
So, just how effective is this help?
First, we need to understand how the efficacy of anti-depressants are measured.
The symptoms of depression are subjective. This means they are not observable. There is no imaging that shows if someone is depressed. There are no blood tests for depression. There are no physical exams.
Therefore, to assess the presence and severity of depression, clinicians use questionnaires. The most commonly used depression questionnaire is The Hamilton Depression and Rating Scale (HDRS), a 52-point checklist that assesses various symptoms of depression and rates them on a scale of no-depression to severe.
When patients with depression first see a family doctor or psychiatrist they are often issued the HDRS and given a score.
Let’s use Janet’s story as an example. Janet first came to see her psychiatrist two years ago. She wasn’t sleeping and yet felt sleepy all the time. She’d gained weight but had no appetite. Her entire body was sore, as if she had the flu. She’d lost interest in all of the activities that used to fire her up. She’d lost interest in everything.
After a few weeks of feeling progressively worse, Janet began to be plagued by thoughts of suicide. This scared her. She went to her family doctor, who referred her to a psychiatrist.
Janet’s HDRS score was 25. This meant she was moderately to severely depressed.
Janet was given an anti-depressant, a Selective Serotonin Re-uptake Inhibitor (SSRI). She was told it would correct her “brain imbalance”, and treat the cause of her symptoms. Janet was relieved that there was a solution.
If an anti-depressant can decrease the HDRS by 3 points, then the medication “works”. Or at least the results are statistically significant.
However, if Janet’s symptoms improve by 3 points, from a score of 25 to, say, a score of 22, how does she feel?
Not much different, it turns out.
To experience “minimal improvement”, a decrease in symptoms that someone with depression would notice, say an increase in energy, an improvement in sleep, or a change in mood, a patient’s HDRS score would need to decrease by at least 7 points.
This means the Janet would need to bring her HDRS down to 18 or lower before she starts to feel noticeably better.
Studies show that anti-depressants, on average, don’t do this.
Some randomized control trials do show that anti-depressants decrease the HDRS score by at least 3 points, which is still registered by patients as having no perceptible effect, but the results are mixed.
A large 2017 systematic review showed that anti-depressants only decreased patients’ HDRS by about 1.94 points (2) and another large study published in the Lancet (3) also failed to show that anti-depressants produce a statistically significant effect, let alone a clinically significant one.
In addition to the minimal changes in symptoms, anti-depressant research is also polluted with for-profit bias. Most studies are conducted or funded by the drug companies.
This makes a difference: an analysis showed a study was 22 times less likely to make negative statements about a drug if the scientists worked for the company that manufactured it (4).
Studies at high-risk of for-profit bias were also more likely to show positive effects of a drug (5).
Another limitation of anti-depressant trials is the lack of active placebo control. In Randomized Control Trials, participants are sorted into two groups: an active group, in which they receive the medication, and a placebo group, in which they receive an inert pill.
The goal of this process is to control for something called the “meaning response”, or “placebo effect” where our expectations and beliefs about a therapy have the potential to affect our response to it.
Remember that depression, as I mentioned before, is a condition made up of subjective symptoms.
If I asked you to rate your energy on a scale of 1 to 10, how would you rate it? What if I asked you tomorrow? What if I asked you after giving you a drink of something that tastes suspiciously like coffee?
Because of its subjective nature, and the subjective questionnaires, like the HDRS, that measure it, depression is very susceptible to the placebo response.
Therefore, it’s important to control for the placebo response in every trial assessing anti-depressants.
But it might not be enough to just take a sugar pill that looks like an anti-depressant.
SSRI medication produces obvious side effects: gastrointestinal issues, headaches, changes in energy, and sleep disturbances, to name a few.
When a patient taking a pill (either placebo or active treatment) starts to feel these side effects, they immediately know which group they have been randomized to, and they are no longer blinded.
This can be solved by giving an “active placebo”: a placebo that produces similar side effects to the active medication. Unfortunately anti-depressant trials that use active placebo are lacking.
But what about the people who DO benefit from anti-depressants?
Janet knew a few. She had a cousin who also suffered from depression. He took medication to manage his symptoms. He’d told her many times that he just wasn’t the same without it.
Perhaps you, reading this article have found benefit from an anti-depressant medication. Perhaps you know someone who has: a family member, or a friend. Maybe it was their lifeline. Maybe it’s yours.
According to Jakobson et al., there are indeed some people who benefit from anti-depressants. Anecdotally we know this to be true. However, the results of large studies show minimal to no benefit from medication, on average.
This means that some people might benefit; we know that some do. It also means that an equal number of people are harmed.
In order for the net effect of anti-depressant medication to be close to zero, an equal number of people experience negative effects that outweigh the positive effects seen in others.
So, while some may have already tried medication and benefited from it, those considering medication won’t know if they’ll be in the group who benefits, or the group who is harmed.
The side effects of anti-depressant medication are often underrepresented. In the Lancet study, adverse effects were neither recorded nor assessed (3).
The most common side effects include gastrointestinal problems, sleep disturbances, and sexual dysfunction. More serious side effects, like increased risk of suicide, are also possible. Some of these effects may persist even after the medication is stopped.
Anti-depressant trials are short-term. Most trials assess patients for 4 to 8 weeks, while most people take anti-depressants for 2 years or longer.
Anti-depressants also put people at risk of physiological dependence and withdrawal.
Withdrawal symptoms can occur a few days, or even weeks, after tapering anti-depressant medication. They sometimes last months.
Withdrawal symptoms are often mistaken for depressive relapse. This can make it difficult, or even impossible, for patients to come off medication. This is worrisome considering the lack of research on long-term medication use.
It is sometimes argued that anti-depressants are more effective, or even essential, for severe depression, however the evidence for this is lacking (4).
In their paper, Jakobson, Gluud and Kirsch conclude that, based on the evidence, anti-depressants show a high risk of harm with minimal benefit.
Before prescribing them, Jakobson et al recommend more non-biased, long-term studies that use active placebo, and honestly assess the negative effects of the medications.
They recommend that studies use improved quality of life and clinically meaningful symptom reduction, not just statistical significance, as standards for treatment success.
Despite these conclusions, SSRIs remain a first-line treatment for major depressive disorder. They are also prescribed for conditions like severe PMS, IBS, anxiety, grief, and fibromyalgia, or other pain conditions. 1 in 8 adults in North America are taking them.
As a clinician who focuses in mental health, I am not against medication.
I have seen patients benefit from SSRI or SNRI medications. Sometimes finding relief with medication when nothing else worked.
My clinical practice keeps me humble.
If a patient comes into my practice on medication, or considering medication, I listen. I ask how I can support them. I answer questions to the best of my ability. I trust my patients.
Patient experience trumps clinical papers.
However, for every patient who benefits from medication, just as many experience negative side effects, or no effect. I trust their experiences too.
I also trust the experiences of the patients who have been trying for months, or years, to wean off medications.
Let me repeat it again: depression is real. Asking for help is hard. And it’s important.
Depression is a multi-factorial condition.
This means that it stems from hundreds of complex causes. This is why it’s so difficult to treat. This is why so many people suffer.
Let me also repeat: depression is not easily fixed.
There is no one solution, and there are certainly no ONE-SIZE-FITS-ALL solutions.
So, if you or someone you care about is suffering from depression, what can you do?
First, get help. This is not something you can get through alone.
Second, seek lots of help: gather together a team of professionals, family and friends. You can start with one person: your family doctor or a naturopathic doctor, and then assemble your support network.
Choose people you trust: people who listen, provide you with options, and seek your full informed consent.
It is important to work with a healthcare team who take into account the factors that may be contributing to your symptoms: brain health, gut health, life stressors, nutrition, inflammation levels, presence of other health conditions, sleep hygiene, family history, contributing life circumstances, such as grief, trauma, or poverty, and who lay out various treatment options while filling you in on the risks, benefits and alternate therapies of each.
Medication may be part of this comprehensive treatment plan, or it may not.
It is brave to ask for help.
And I believe that bravery should be rewarded with the best standard of care—with the best help.
References:
Jakobsen JC, Gluud C, Kirsch IShould antidepressants be used for major depressive disorder?BMJ Evidence-Based Medicine Published Online First: 25 September 2019. doi: 10.1136/bmjebm-2019-111238
Jakobsen JC, Katakam KK, Schou A, et al. Selective serotonin reuptake inhibitors versus placebo in patients with major depressive disorder. A systematic review with meta-analysis and trial sequential analysis. BMC Psychiatr2017;17:58
Cipriani A, Furukawa TA, Salanti G, et al. Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: a systematic review and network meta-analysis. The Lancet2018;391:1357–66
Kirsch I, Deacon BJ, Huedo-Medina TB, et al. Initial severity and antidepressant benefits: a meta-analysis of data submitted to the food and drug administration. PLoS Med2008;5:e45.doi:10.1371/journal.pmed.0050045
Ebrahim S, Bance S, Athale A, et al. Meta-Analyses with industry involvement are massively published and report no caveats for antidepressants. J Clin Epidemiol2016;70:155–63.doi:10.1016/j.jclinepi.2015.08.021
I appeared on the Rebel Talk Podcast with Dr. Michelle Peris, ND. Dr. Michelle writes,
“Not a week goes by that I do not discuss mental health with patients in my office. Rates of depression and anxiety are on the rise. So I really wanted to unpack this important topic for you, giving you relevant information and diving deep into interventions that can help optimize mental health. ⠀
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In this episode, Dr. Talia details how our brains work while suffering from depression, anxiety and stress. Her deep knowledge of neuroscience is combined with mindfulness practices and also with microdosing, an approach that consists in taking low doses of psychedelic drugs, such as LSD or psilocybin-containing “magic” mushrooms, in order to prevent and treat symptoms of depression. ⠀
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Dr. Talia talks about mental and physical barriers, that can holds us back from making the changes needed for a healthier and more balanced life. Listen to this podcast and be inspired by this out-of-the-box conversation about neuroscience, mental health and mindfulness.”
I will die in here today, I thought to myself, as I sat hunched and cramped in an oven-hot temazcal, or sweat lodge, somewhere on the Mexican pacific.
The straw flap covering the opening of our sweaty mud hut was thrown off momentarily by someone outside, flooding our hellish cave with light. I gazed hopefully at the entrance: were we getting water? Were they letting in fresh air? Was it finally over?
It was none of those things. Instead of relief, they were increasing the heat; a pile of hot rocks appeared at the door.
“Gracias, Abuelita“, said our leader, Marciano, receiving a giant steaming rock with metal tongs and pulling it inside the hut. The change in temperature was immediate. The heat coming off the rocks was like fire. I struggled to breathe.
Marciano is Spanish for martian, abuelita an affectionate term for “grandmother”. Did he know what he was doing, this martian? Was there even enough oxygen in here for all of us? I am not related to these rocks, I thought.
“Gracias, Abuelita,” We numbly replied, thanking the rocks and fanning ourselves with imaginary cool air.
The hut was crowded with ten people. I had to sit hunched over and there was no space to lie down. If I wanted to leave, everyone else would have to get out first. The combination of darkness, stifling humidity, claustrophobic quarters and angry heat was almost intolerable. Sweat was pouring so profusely off my body that I had become one with it.
Every cell of my body was on fire with craving: water, space to lie down, fresh oxygen, freedom.
Whenever I thought I couldn’t stand another moment, the heat intensified.
The tiny flap in the door opened again. Another grandmother rock from Mars? No, it was water! My heart flooded with gratitude until I realized that the tiny glass being passed around was for all of us to share.
I will die in here.
I will never again complain of ice and snow.
This is supposed to be therapeutic?
When it was over, I emerged gasping desperately for air and water. After chugging a bucketful of water, I dumped another on my scorching hot skin. I swear it emitted a hiss.
I had survived! However, as my body cooled, I realized that I had done more than survive. Despite my resistance throughout its entirety, the sweat lodge had left me feeling absolutely elevated.
The feelings of energized calm lasted well into the next few days. My brain seemed to work better, evidenced by an elevation in the fluency of my Spanish.
It was amazing.
Current research shows that heat therapy, like sweat lodges and saunas, can indeed be therapeutic. Subjecting the body to high temperatures can improve the symptoms of major depressive disorder as effectively as the leading conventional therapies, such as medication.
Intrigued by the cultural practices of using intense heat to induce transcendental spiritual experiences (the Native American sweat lodges and Central American temazcales, for instance), a psychiatrist name Dr. Charles Raison decided to investigate heat as a therapy for improving mental and emotional well-being.
Raison and his team, in their 2016 JAMA Psychiatry study, took 60 randomized individuals suffering from major depressive disorder, and subjected them to a standardized questionnaire, the Hamilton Depression Rating Scale (HDRS), which quantifies depressive symptoms. The treatment group received Whole Body Hyperthermia, an average of 107 minutes in an infrared heating chamber that heats core body temperatures to 38.5 degrees celsius.
The placebo group spent the same amount of time in an unheated box that was nearly identical (complete with red lights and whirring fans). 71.5% of the study participants who were put in the sham heating chamber believed that they were receiving the full heat therapy.
After one week of receiving the single session of heat therapy, the active group experienced a 6 point drop on the HDRS. This decrease outperformed even the standard anti-depressant treatment, selective serotonin re-uptake inhibitor medications (according to a 2017 meta-analysis SSRI medications drop patients only 2 points on the HDRS), and lasted for 6 weeks.
Previous fMRI research has shown that heat sensing pathways in the skin can activate brain areas associated with elevated mood, such as the anterior cingulate cortex (the ACC is also activated during mindfulness meditation). The raphe nucleus, which releases serotonin, our “happy hormone”, is also activated by this skin-to-brain thermoregulatory pathway.
Heat is also thought to calm immune system activation present in the brains of individuals suffering from depression. People with depression tend to have higher body temperatures than non-depressed people. This is possibly due to the present of inflammatory cytokines, such as TNF-a and IL-6, that increase inflammation and fever and have been shown to negatively impact mood. Perhaps heat therapy acts by “resetting” the immune system.
Furthermore, when the body is exposed to high temperatures, it results in the release of heat shock proteins. Heat shock proteins respond to short, intense stressors: hot, cold, and even fasting conditions. They have a variety of effects on our hormonal systems. Some can reset the body’s stress response, correcting the cortisol resistance that is present in the brains of depressed individuals. One particular heat shock protein, HSP105, has been shown to prevent depression and increase neurogenesis (the creation of new brain cells) in mice.
Reduced neurogenesis in the hippocampus is a risk factor and side effect of depression. It is thought that traditional anti-depressants, in addition to altering brain levels of serotonin, may exert some of their effects through inducing brain-derived neurotrophic factor (BNDF), a growth factor that encourages the development of new brain cells.
Conventional theories tell us that depression is a disorder resulting from a chemical imbalance in the brain requiring medication to “correct” that imbalance. However, an overwhelming amount of research tells us that this is simply incorrect: depression is a complicated condition stemming from multiple causes.
Naturopathic doctors focus on the whole person. We look at how an individual’s symptoms are expressed within the context of their biology, physiology, psychology, and social and physical environments. We know that, when it comes to a condition like depression, every body system is affected. We also know that the health of our digestive and hormonal systems are essential for optimal mood.
Naturopathic doctors have also traditionally used hydrotherapy, the therapeutic application of hot and cold water, to benefit digestion, boost detoxification pathways, and regulate the immune system.
Therefore, as a naturopathic doctor, the idea that heat exposure can have a profound effect on depressive symptoms makes sense. However, as a clinician, I’ve found it difficult to convince my patients suffering from depression to try heat therapy. Perhaps it’s because the remedy seems so simple it borders on insulting—sweat for an hour and experience profound changes to a condition that has debilitated me for months? Get out of here.
I get it.
However, research suggests that since depression is a multi-factorial condition, it deserves to be addressed with a variety of therapies: diet, sleep hygiene, exercise, nutrition, and psychotherapy, to name a few. Heat therapy can be another important one.
So, here are some suggestions for implementing heat therapy without having to do a sweat lodge:
If you have access to a sauna, us it! Alternate 15 to 20 minute stints that induce sweating with 60-second cold rinses in a shower. Cycle back and forth for up to an hour.
Go to a hot yoga class a few times a month.
Exercise. Exercise has been shown to induce temperature changes that are similar to heat therapy. This may be why exercise has been so well studied for its mental health benefits.
Take epsom salt baths regularly. Add 1 to 2 cups of epsom salts to a warm bath and soak for 20 minutes or more, or to the point of sweating.
Try Alternate Hot and Cold Showers: alternate between one-minute bursts of hot water and 30-seconds of cold for about 3 to 5 cycles.
I will never get annoyed at a patient’s “lack of compliance” again.
Health care is scary, even when you know what you’re doing. When it’s your own health, putting yourself in the hands of a professional is not easy.
Yesterday I had an initial consult for myself with a nutrition specialist. She’s well-known in her field, super-academic, in her 70s, and has published books and papers.
She knows her stuff. She’s also really helped a friend of mine and the referral came from him. I had every reason to trust her and feel good about putting myself in her hands.
However, I was nervous getting ready to see her. I filled out a diet diary… what would she think? What would she say about my blood work? Would she be nice? Would she be understanding? Would we get along?
Survival instincts kick in.
We talked about a few things in the first visit (which cost an arm and a leg, but will be worth it if I’m left feeling great) and she prescribed some supplements for me to take.
I left, kind of satisfied. Ready to get on with our journey, with a list of things to pick up, dosages to tweak, things to consider and instructions to book again in 3 to 4 weeks.
Ok.
I woke up this morning, in the early hours tossing and turning, thinking to myself, “I don’t want to take vitamin E!” And “Did she truly understand my concerns?” And “what are all these supplements treating?” and “did she really hear me out?” And, “is all this going to actually help?”
The impulse to not trust, to run and hide, to override her assessment and recommendations with my own were overwhelming. (And, of course, as someone who does what she does for a living, the struggle to overcome this is real, we’re “experts” on the body, but it’s nice to let someone else give direction for a change, especially someone with 30+ more years’ experience).
Still, trusting is hard.
Being aware of the impulse to run and avoid, while also resisting the impulse, is hard.
I have people who neglect booking a follow-up even when they know that we still have lots of work to do.
I have people who don’t fill out diet diaries for fear of actually taking a hard look at their food intake.
I have people who email me that “nothing is working” when in fact they haven’t started taking their nutrients and supplements yet.
And, guess what, as frustrating as that may be (because ultimately, I want people to have success! I want people to heal), I’m doing the same thing.
Jeez, being in the patient chair is mighty humbling.
I highly recommend it to all my health practitioner colleagues out there.
And, yes, now I’m taking vitamin E. I’ve decided to just trust. (But I’m still taking my own multi-vitamin… hey, doctors make the worst patients… amiright?)
I often get emails like this, “Dear Doctor, please tell me your favourite natural cure for anxiety”, to which I often reply:
Dear, Anxiety,
Imagine you are a gardener, tending to your garden. You are a skilled gardener: you tend lovingly to your plants every day and you care deeply for their welfare.
You are the perfect gardener in every way, except for one: for some reason you don’t know anything about soil.
No one has ever taught you about the damp, dark soot that envelopes the roots of your beloved plants, kindly offering to them its protection, water, and nutrients.
You are a gardener, but are innocently oblivious to the fact that soil must be nurtured by millions of microbes, and that nutrients in the soil must be replenished. You have no idea that the other plants sharing the soil with your garden form a complex network of give and take, depositing nutrients into it, while greedily sucking others away.
Now, as this soil-ignorant gardener, imagine your surprise when, despite your care and attention, the plants in your garden wither and die, bearing no flowers or fruit.
Imagine your frustration when your efforts to prop up tired stems fail. You apply water and fertilizer to buds, leaves and stems. You stand by, powerless, as your garden dies.
Notice the weeds taking over your garden, which you lop off at their stems, unaware that their roots reside deep inside the earth.
When the weeds pop up again and again, you slash at them, burn them, and you curse the skies.
“Why me?”
Why you, indeed.
You are unaware of root gardening, soil gardening, just as many of us are unaware of root medicine—soil medicine.
You see, Anxiety, there are many natural remedies that can help.
However, tossing natural pills at twitching nerves, imbalanced blood sugar, unregulated stress responses, and various nutrient deficiencies, might be as naive a practice as spray painting your roses while they wilt in sandy earth, beneath their red paint.
It might be akin to prescribing anxiety medication or a shot of vodka to calm your trembling mind; you might feel better for a time, propped up with good intentions, before collapsing in the dry soil encasing you.
With no one to tend to your roots you eventually crumple, anxiety still rampant.
“Why me?” You curse the skies.
Rather than asking, “Why me?” it might help to simply start asking, “Why?”
While it is important to understand the “What” of your condition—What disease is present? What is the best natural cure for anxiety?—naturopathic doctors are far more interested in the “Why”.
As Dr. Mark Hyman, functional medical doctor, asks:
Why are your symptoms occurring?
Why now?
And why in this way?
Naturopathic doctors prescribe natural remedies for conditions such as anxiety, it’s true. However, naturopathic medicine is a medicine that first tends to the soil.
Naturopathic doctors first look for and addresses the roots of symptoms, working with the relationships that exist between you and your body, your food, the people in your life, your society, your environment—your soil.
Healing involves taking a complete inventory of all the factors in your life that influence your mental, physical, and emotional wellness. It requires looking at the air, water, sunlight, nutrients, stressors, hormones, chemicals, microbes, thoughts and emotions that our cells bathe in each day.
Healing means looking closely at the soil that surrounds us. It requires asking, What are the roots that this condition stems from? And, What soil buries these roots? Does it nourish me?
Do I nourish it?
The causes of disease can be interconnected and complex. Very often, however, there are common root networks from which many modern-day chronic health conditions arise.
Starving Gut Bacteria.
It was Hippocrates, the father of medicine, who first proclaimed that “All disease begins in the gut.”
Our digestive systems are long, hollow tubes that extend from mouth to anus, and serve as our body’s connection to the outside world. What enters our digestive system does not fully become the body until the cells that line that digestive tract deem these nutrients worthy of entering.
Along their 9 metre-long, 50-hour journey, these nutrients are processed by digestive enzymes, broken down by trillions of beneficial bacteria, and sorted out by the immune cells that guard entrance to our vulnerable bodies.
Our immune cells make the judgement call between what sustains us, and what has that potential to kill us. For this reason, about 70% of our immune system is located along our digestive tract.
Our gut bacteria, containing an estimated 30 trillion cells, outnumber the cells in our body 3 to 1. Science has only just begun to write the love story between these tiny cells and our bodies. These bacteria are responsible for aiding in the digestion of our food, producing essential nutrients, such as B vitamins and fat-soluble vitamins, and keeping our intestines healthy.
However, this love story can turn tragic when these little romantics are not properly fed or nurtured, or when antagonists enter the story in the form of pathogenic bacteria or yeast.
Our microbiome may impact our health in various ways.
Studies are emerging showing that obese people have different gut profiles than those who are normal weight. Our gut bacteria have a role in producing the hormones that regulate hunger, mood, stress, circadian rhythms, metabolism, and inflammation. They regulate our immune system, playing a role in soothing autoimmune conditions, and improving our ability to fight off infections and cancer.
Psychological and physical stress, inflammation, medication use, and a diet consisting of processed food, can all conspire to negatively affect the health of our gut. This can lead to a plethora of diseases: mood disorders, psychiatric illness, insulin resistance, cardiovascular disease, chronic pain and inflammation, obesity, hormonal issues, such as endometriosis, autoimmune disease, and, of course, chronic digestive concerns such as IBS, among others.
As Hippocrates long knew, one doesn’t have to dig for long to uncover an unhappy gut microbiome as one of the primary roots of disease.
Our gut has the power to nurture us, to provide us with the fuel that keeps our mood bright and our energy high. However, if we fail it, out gut also has the power to plague our cells with chronic inflammation and disease.
To be fully healthy, we must tend to our gut like a careful gardener tends to her soil.
This involves eating a diet rich in fermented foods, like kefir, and dietary fibre, like leeks, Jerusalem artichokes, and black beans. It also means, consuming flavonoid-rich foods like green tea, and cocoa, and consuming a colourful tapestry of various fruits and vegetables.
Healing our gut requires avoiding foods it doesn’t like. These may include foods that feed pathogenic bacteria, mount an immune response, kill our good bacteria, trigger inflammation, or simply those processed foods that fail to nurture us.
To heal ourselves, first we must feed out gut.
Confused Circadian Rhythms.
For hundreds of thousands of years, all of humanity rose, hunted, ate, fasted, and slept according to the sun’s rhythms.
To align us with nature, our bodies contain internal clocks, a central one located in brain, the suprachiasmatic nucleus, which is susceptible to light from the sun, and peripheral clocks located in the liver and pancreas, which respond to our eating patterns.
Our gut bacteria also respond to and influence our body’s clocks.
However, the invention of electricity, night shifts, and 24-hour convenience stores, means that our bodies can no longer rely on the outside world to guide our waking and sleeping patterns. This can confuse our circadian rhythms, leading to digestive issues, insomnia, daytime fatigue, mood disorders, and problems with metabolism, appetite, and blood-sugar regulation.
Dr. Satchin Panda, PhD, a researcher at the Salk Institute in California, found that mice who ate a poor diet experienced altered circadian rhythms. However, he found that when these mice were fed the same diet in accordance with their natural rhythms, they weighed less, had lower incidences of diabetes and cardiovascular disease, had better cognitive health, and lived longer.
These findings indicate that perhaps it is not what we eat but when that may impact our health.
Perhaps it is that an unnatural diet disconnects us from nature, or that this disconnection tempts us to choose non-nutritive foods, but the research by Dr. Panda and his team reveals the importance of aligning our daily routines with our bodies’ natural rhythms in order to experience optimal health.
According to Dr. Panda’s findings, this involves eating during an 8 to 12-hour window, perhaps having breakfast at 7am and finishing dinner early, or simply avoiding nighttime snacking.
For many of us, this may involve making the effort to keep our sleep schedules consistent, even on weekends.
For most of us, it involves avoiding exposure to electronics (which emit circadian-confusing blue light) after the sun goes down, and exposing our eyes to natural sunlight as soon after waking as possible.
Nature Deficit Disorder.
Nature Deficit Disorder is a phrase, coined by Richard Louv, in the 2005 book, Last Child in the Woods.
According to Louv, a variety of childhood problems, especially mental health diagnoses like ADHD, are a direct result of our society’s tendency to increasingly alienate children from nature.
With most of humanity living in cities, nature has become a place we visit, rather than what immerses us. However much modernization might remove us from nature, our bodies, as well as the food, air, water, sunlight, and natural settings they require to thrive, are products of nature, and cannot be separated from it.
A Japanese practice called Shinrin-Yoku, or “Forest Bathing”,developed in the 1980’s toattempt to reconnect modern people with the healing benefits of spending time in a natural setting. There is an immediate reduction in stress hormones, blood pressure, and heart rate when people immerse themselves in natural environments, such as a forest.
Whether we like it or not, our roots need soil. It is possible that the components of this soil are too complex to manufacture. When we try to live without soil, essential elements that nourish us, and the various relationship between these elements are left out.
When we remove ourselves from nature, or ignore it fully, we become like gardeners oblivious to the deep dependency their plants have on the soil that enshrouds them.
Connecting with nature by spending time outside, retraining our circadian rhythms, connecting with our food sources, and consuming natural, whole foods, may be essential for balancing our minds, emotions, and physical bodies.
A Lack of Key Building Blocks.
Our bodies are like complex machines that need a variety of macro and micronutrients, which provide us with the fuel, building blocks, vitamins and minerals that we need to function.
As I child, I would play with Lego, putting together complex structures according to the blueprints in the box. When I discovered that a piece was missing, I would fret. It meant that my masterpiece would no longer look right, or work. If I was lucky, I might find a similar piece to replace it, but it wouldn’t be the same.
After looking long and hard for it, sometimes the missing piece would turn up. I’d locate it under the carpet, my brother’s bottom, or lodged in a dark corner of the box. Often our bodies don’t get that lucky.
Nutrients like vitamin B12, perhaps, or a specific essential amino acid, or a mineral like magnesium, help our body perform essential steps in its various biochemical pathways.
These pathways follow our innate blueprint for health. They dictate how we eat, sleep, breathe, and create and use energy. They control how our bones and hair grow. They control our mood and hormones. They form our immune systems. These pathways run us.
Our bodies carry out the complicated instructions in our DNA to will us into existence using the ingredients supplied from food. If our bodies are missing one or several of these ingredients—a vitamin or mineral—an important bodily task simply won’t get done.
Dr. Bruce Ames, PhD, theorized that when nutrient levels are suboptimal, the body triages what it has to cove tasks essential to our immediate survival, while compromising other jobs that are important, but less dire.
For example, a body may have enough vitamin C to repair wounds or keep the teeth in our mouths—warding off obvious signs of scurvy, a disease that results from severe vitamin C deficiency. However, it may not have enough to protect us from the free radicals generated in and outside of our bodies. This deficiency may eventually lead to chronic inflammation, and even cancer, years later.
According to Dr. Ames’ Triage Theory, mild to moderate nutrient deficiencies may manifest later in life, as diseases that arise from the deprivation of the building blocks needed to thrive.
In North America, despite an overconsumption of calories, nutrient deficiencies are surprisingly common.
25-50% of people don’t get enough iron, which is important for the transport of oxygen, the synthesis of neurotransmitters, and for proper thyroid function.
One third of the world’s population is deficient in iodine, which affects thyroid health and fertility.
Up to 82% of North Americans are vitamin D deficient. Vitamin D regulates the expression of over 1000 genes in the body, including those involved in mood regulation, bone health, immunity, and cancer prevention.
Vitamin B12 is commonly deficient in the elderly, vegans and vegetarians. It is important for lowering inflammation, creating mood-regulating neurotransmitters, and supporting nervous system health. Deficiency in vitamin B12 can result in fatigue. Severe deficiency can lead to irreversible nerve damage, dementia, and even seizures.
Magnesium is an essential mineral involved in over 300 chemical reactions, including mood and hormone pathways. Over 40% of North Americans do not consume enough magnesium, which is found in leafy green vegetables.
Our bodies have requirements for fats, which make up our brain mass and the backbone of our sex hormones, and protein, which makes up our enzymes, neurotransmitters and the structure of our body: bones, skin, hair, nails, and connective tissue.
Our gut microbiota require fibre.
Our cells need antioxidants to help protect us from the free radical damage from our own cells’ metabolism and our exposure to environmental toxins.
We certainly are what we eat, which means we can be magnificent structures with every piece in place, thriving with abundance and energy.
Despite reasonably good intentions, we can also suffer from nutrient scarcity, forced to triage essential nutrients to keep us from keeling over, while our immune health, mood, and overall vitality slowly erode.
A Body on Fire: Chronic Inflammation.
When we injure ourselves—banging a knee against the sharp edge of the coffee table, or slashing a thumb with a paring knife—our immune systems rally to the scene.
Our immune cells protect us against invaders that might take advantage of the broken skin to infect us. They mount an inflammatory response, with symptoms of pain, heat, redness, and swelling, in order to heal us. They recruit proteins to the scene to stop blood loss; they seal our skin back up, leaving behind only a small white scar—a clumsiness souvenir.
Our inflammatory response is truly amazing.
One the danger has been dealt with, the immune response is trained to turn off. However, when exposed to a stressor, bacteria, or toxin, for prolonged periods, our immune system may have trouble quieting. Chronic issues can contribute to chronic inflammation.
Scientists argue that an inflammatory response gone rogue may be the source of most chronic diseases, from heart disease, cancer, and diabetes, to schizophrenia and major depressive disorder.
The gut is often the source of chronic inflammation as it hosts about 70% of the immune system. When we eat something that our immune system doesn’t like, an inflammatory response is triggered. This can cause digestive issues such as inflammatory bowel disease, celiac disease, and the more common irritable bowel syndrome. It can also lead to more widespread issues like chronic pain, arthritis, migraines, and even mood disorders like Bipolar.
Ensuring optimal gut health through nurturing the gut microbiome, and eating a clean diet free of food sensitivities, is essential for keeping the body’s levels of inflammation low.
Constant Fighting and Fleeing.
Like inflammation, our stress response is essential to our survival.
When facing a predatory animal, our body is flooded with stress hormones that aim to remove us from the danger: either through fighting, fleeing, or freezing. Our stress response is affectionately called our “Fight or Flight” response.
However, like inflammation, problems arise when our stress response refuses to turn off. Traffic, exams, fights with in-laws, and other modern-day struggles, can be constant predators that keep us in a chronically stressed-out state.
Chronic stress has major implications for our health: it can affect the gut, damage our microbiome, alter our circadian rhythms, mess with mood and hormones, and contribute to chronic inflammation. Stress gets in the way of our ability to care for ourselves: it isolates us, encourages us to consume unhealthy foods, and buffer our emotions through food, alcohol, work, and drugs.
We also know that stress has a role in the development of virtually every disease. Like chronic inflammation, it has been found to contribute to chronic anxiety, depression, digestive concerns, weight gain, headaches, heart disease, insomnia, chronic pain, and problems with concentration and memory, among others.
Discomfort with Discomfort.
To assess its impact on health, it helps to determine between two key types of stress: distress, the chronic wear and tear of traffic, disease, and deadlines, and eustress.
Eustress is beneficial stress—the short-lived discomfort of intense exercise, the euphoric agony of emotional vulnerability, or the bitter nutrients of green vegetables—that makes the body more resilient to hardship.
Whenever I feel discomfort, I try to remember the ducks.
Several years ago, on a particularly frigid winter day, I was walking my dog. Bundled against the cold wind, we strolled along the semi-frozen lake, past tree branches beautifully preserved in glass cases of ice. Icebergs floated on the lake. So did a group of ducks, bobbing peacefully in the icy waters.
With nothing to protect their thin flippers from the sub-zero temperatures, they couldn’t have felt comfortable. There couldn’t have been even a part of them that felt warm, cozy, or fed.
There was no fire for them to retreat to, no dinner waiting for them at home, no slippers to stuff frozen, wet flippers into. This was it. The ducks were here, outside with us, withstanding the temperatures of the icy lake. A part of them must have been suffering. And yet, they were surviving.
Far from surviving, the ducks looked down-right content.
I think of the ducks and I think of the resilience of nature.
We humans are resilient too. Like the ducks, our bodies have survived temperature extremes. Our ancestors withstood famine, intense heat, biting cold, terrible injury, and the constant threat of attack and infection, for millenia. You were born a link on an unbroken chain of survivors, extending 10,000 generations long.
Our bodies have been honed, over these hundreds of thousands of years, to survive, even thrive, during the horrendous conditions that plagued most of our evolutionary history.
Investigations into the human genome have revealed genes that get turned on in periods of eustress: bursts of extreme heat or cold, fasting, and high-intensity exercise. When our body encounters one of these stressors, it activates a hormetic responseto overcome the stress. Often the response is greater than what is needed to neutralize the threat, resulting in a net benefit for our bodies.
These protective genes create new brain cells, boost mitochrondria function, lower inflammation, clear out damaged cells, boost the creation of stem cells, repair DNA, and create powerful antioxidants. Our bodies are flooded with hormones that increase our sense of well-being.
It’s like the old adage, “What doesn’t kill you makes you stronger.”
Our bodies were made for discomfort. In fact, we have entire genetic pathways waiting to kick in and heal us as soon as they experience hardship.
There are a growing number of studies on the healing power of small troubles. Fasting may have a role in treating autoimmune diseases, decreasing the signs of aging, and as an adjunct therapy for cancer; sauna therapy boosts detoxification and may prevent dementia; cryotherapy, or exposure to extreme cold, has the potential to heal arthritis and autoimmunity; and High Intensity Interval Training has been shown to boost cardiovascular health more than moderate-intensity exercise.
Plants may benefit us through flavonoids, which, rather than serving as nutrients, act as small toxins that boost these hormetic pathways, encouraging the body to make loads of its own, powerful antioxidants to combat these tiny toxins.
Mindfully embracing discomfort—the bitter taste of plants, the chilly night air, the deep growling hunger that occurs between meals—may be essential for letting our bodies express their full healing potential.
Not Minding Our Minds.
Our ability to withstand powerful emotions may have healing benefits.
Many of us avoid painful feelings, allowing them to fester within us. We buffer them with excess food, or drugs, leading to addictions. Mindfulness can help us learn to be with the discomfort of the emotions, thoughts and physical sensations that arise in the body as inevitable side effects of being alive.
Research has shown that mindfulness can help decrease rumination, and prevent depressive relapse. It also helps lower perceived stress. How we perceive the stressors in our lives can lower the damaging effects they have on us. Research shows that those who view their life stressors as challenges to overcome have lower stress hormone activation, and experience greater life satisfaction.
According to Cognitive Behaviour Therapy (CBT), our thoughts create our emotions. Becoming more aware of our thoughts, through CBT or mindfulness, allows us to identify which thoughts may be limiting us or exacerbating our reactions to stressful situations.
When we learn to observe our thoughts, we create some distance from them. We become less likely to see the dismal thoughts in our minds as absolute truths.
Practicing mindful meditation, CBT, or cultivating positive thoughts, such as engaging in a daily gratitude practice, may improve our resilience to chronic stress.
Inattention.
According to Stephen Cope, yoga teacher and author of The Great Work of Your Life, “You love what you know deeply. Get to know yourself deeply”. We get to know things deeply by paying attention to them.
Georgia O’Keefe’s admiration for flowers, or Monet’s adoration of landscapes, is apparent to anyone who sees their work. In order to commit images to canvas, the artists gets to know their subject matter deeply. Their art celebrates what they took the time to pay attention to, and eventually came to love.
As a naturopathic doctor, I believe that healing begins with attention. When we become aware of our bodies, we begin to know them deeply. Awareness allows us to respond to symptoms lovingly, the way a mother learns to skillfully attend to her baby’s distinct cries.
When I first meet a new patient, the first thing I have them do is start to pay attention.
We become curious about their symptoms, their food intake, their sleep patterns, their habits and routines, the physical sensations of their emotions, the thoughts that run through their heads.
Through paying attention, with non-judgmental curiosity, my patients start to understand their bodies in new ways. They learn how certain foods feel in their bodies, how certain sleep habits affect their energy levels the next day, and how specific thoughts contribute to their feelings.
Once we begin to open up this dialogue with our bodies, it becomes impossible not to answer them with love. It becomes hard not to eat, sleep, and move in ways that convey self-respect.
A gardener who pays deep attention cannot ignore the obvious—her plants have roots, embedded in soil. The gardener quickly learns, through careful observation, that the health of this soil is vital to the health of her plants.
And so, back to the original question, “What is your favourite natural cure for anxiety?”
My favourite remedy isn’t a bottle of pills we reach for, it’s a question we reach for from within:
“What do I need to heal?”
After asking the question, we wait.
We wait for the answer to emerge from some primal place within, just as a gardener waits for new buds to rise out of the mysterious depths of the dark, nutritious soil.
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.
A naturopathic doctor offers tips for navigating the often contradictory and confusing world of modern human nutrition.
As soon as we start to feel comfortable with our grasp of human nutrition—which foods are healthy, which ones are unhealthy, and how to eat a balanced diet for optimal health—a new study gets published that shatters our once-felt sense of confidence.
Confusingly contradictory health claims constantly appear in the news, like the American Heart Association’s vilification of coconut oil. The vegan diet-promoting documentary What the Health, currently trending on Netflix, turns convention on it head by assuaging our fears of refined sugar, instead blaming animal protein, eggs and dairy for the worldwide diabetes epidemic. Even I find myself doubting the 15 years I’ve spent studying and working in the field of human health every time paradoxical nutritional data is uncovered.
When I was in high school, I remember patting myself on the back for choosing fat-free options, hoping the leanness of my food would encourage leanness of my flesh. I gave up meat, understanding that I was making a healthier choice; I was told that meat, fat and cholesterol were all culprits of heart disease. I tried giving up eggs and dairy, trying on veganism in order to minimize my impact on the environment. I did an elimination diet while at naturopathic medical school, removing gluten. When my colleagues started reading about the Paleo Diet—grains were the enemy all along, while meat was good for us—I slowly began to embrace a “primal” diet. I started removing myself from the influence of decades’ worth of poorly conducted research and began welcoming saturated fat back into my life. Fat was fine; it was carbs that were the root of all disease. Atkins had gotten it right from the beginning. Eventually I cut out all carbs and sugar and tried a ketogenic diet, eating lots of fat, moderate amounts of meat, and some vegetables.
My journey brings me here, to my Facebook newsfeed, which has been infiltrated with articles condemning coconut oil and saturated fat for raising LDL cholesterol and contributing to cardiovascular disease. “But I thought it was healthy!” Friends, family and patients cry, tearing their hair out in confusion over the news. Some patients have watched Netflix’s What the Health, a documentary from the makers of Cowspiracy, which asserts that sugar’s link to type II diabetes may not bas as strong as previously thought.
The flip-flopping is frustrating for sure, especially for those of us who are committed to living healthy lives for as long as possible. But before we toss our tubs of coconut oil and liquid stevia drops in the garbage and start pulling out the white sugar and margarine again, we should consider how nutritional research is conducted. Let’s entertain different traditional, holistic viewpoints on food and nutrition in order to learn how to feed our bodies optimally.
The Problem with Nutritional Research
There are several problems with how we study nutrition. One of the challenges lies within science itself; scientific studies, by their very nature, attempt to isolate all of life’s complexity down to two variables in order to study them while nutrition, as it’s practised in the day to day lives of human beings, consists of an infinite number of important factors that are often not taken into account.
Most human diet studies are epidemiological. Researchers follow populations of people for years, tracking what they eat and noting how many diseases they get over time. They then synthesize the data to create story. For instance, how much fibre did the people who had heart disease eat? Did those who avoided gluten have a higher risk of diabetes?
In order to assess dietary intake, most epidemiological studies use Food Frequency Questionnaires, or FFQs. Study participants are asked how often they eat certain foods (such as chicken) per week. They are asked to check a box, from “none” to “more than 6 times a week”. As a clinician interested in how my patients’ nutrition may be affecting their health, I assess diet in a few different ways. In the initial appointment, I ask my patients to recall everything they’ve consumed in the past 24 hours to get a rough overview of how they typically eat. Then, between the first and second appointments, I have my patients track their foods in a diet diary over the course of one to two weeks. The accuracy with which my patients report their food intake from the day before depends on their memories, perceptions, and diligence in recording, among other things, and this can compare drastically with their diet diaries that are recorded in real time. Not only do the mundane memories of daily meals evade us, we are often found guilty of deceiving ourselves based on how we feel we should be eating, rather than how we actually are. I find it hard to believe that participants are filling out FFQs accurately.
Also, the stories that epidemiological studies create from the data establish correlation, not causation. With many correlations (like one of my favourites: ice cream consumption and drowning—both occur in summer) there is often no direct relationship. If assessing the connection between fat intake and diabetes, a good study will take into account all meaningful variables, such as how often the participants exercised, or whether they had existing cardiovascular disease. However, considering all the possible factors that might effect the relationship is virtually impossible. For instance, what was the status of the gut flora of the participants? What was their antioxidant or mineral status; were they magnesium deficient? Were they consuming meat that was pasture-raised or corn-fed? How high was their daily toxic exposure? Did they experience chronic stress? How well were they sleeping? What were their levels of inflammation like? And so on.
The trouble with studying nutrition and disease is that, when it comes to health, context matters; context may be all that matters. For instance, while we know that barbecued meat can produce carcinogens that potentially lead to cancer, a study found that when the meats were seasoned with rosemary the carcinogenic load of the meat was neutralized. It’s nearly impossible to form a complete picture when we insist on studying isolated factors, leaving out many important details.
Animal studies, while allowing for tighter control (we don’t ask mice to report their diets, we just feed them), are also flawed. Firstly, mice and humans are completely different species with different nutrient requirements. However, animal study designs can also be problematic. Animals are given lard and white sugar to assess the effects of a high fat, high sugar diet on their health—their diets are exaggerated for the purpose of the study. Human beings, however, eat burgers, cake, and ice cream. We don’t eat single nutrients like fat and sugar, we eat food. If a mouse gets sick on a diet of lard and table sugar is it because of the foods it was eating, something he wasn’t eating, or some other unforeseen factor? There may be a huge difference between eating a high-fat diet with no vitamins and minerals, and eating a high-fat diet that contains complete nutrition.
A third method for studying human nutrition is through randomized control trials, or RCTs. In RCTs humans are randomized into a group that receives an intervention, like a dietary plan, or a control group that is told to follow some other diet or just eat normally. These trials control as many variables as possible, but the timeframe for these studies is often too short to garner meaningful information about health outcomes, which may take years to manifest. It is also difficult to get participants to stick to meal plans. Further, it’s hard to establish consensus for each diet being studied. For example, when assessing the nutritional merits of the Paleo diet, how many servings of vegetables should participants be told to consume? How many grams of fat? What types of fat?
It’s important that we can use studies to seek answers to our questions about the relationship between nutrition and health. However, due to its many limitations, nutritional research can only take us so far. This is why one study may indicate that high sugar diets contribute to diabetes risk, while another study finds no relationship.
A New Food Guide
If we can’t trust research studies to tell us what to eat, who do we trust? Surely we can’t rely on Canada’s Food Guide, with it’s outdated recommendations that simultaneously overemphasize grains and dairy, while continuing to uphold archaic views on fat. Primarily created in the 40’s to help Canadian families ration their food during the war, the Food Guide was not necessarily created to promote the optimal health of those who follow it.
Dr. Ray Cronise, a former NASA scientist, outlines a food pyramid in his paper to help organize food into nutrient content. I often borrow his pyramid to depict nutritional balance to my patients.
Ray’s pyramid is composed of four circles, three that form the base of the pyramid, forming the three main groups of macronutrients: protein, fat, and carbohydrates, and foods that are composed primarily of each. The circle at the top represents the foods that contain a higher number of micronutrients: vitamins and minerals, which are mainly non-starchy vegetables like leafy greens.
Protein-rich foods include meat and animal products, including fish, eggs and dairy. Fat-rich foods include nuts, seeds and oils like coconut oil, avocado and olives. Carbohydrate-rich foods include starchy vegetables like potatoes, grains, legumes and fruit. Ray concedes, however, that none of these foods are composed of a single macronutrient; animal products often contain a significant amount of fat; nuts and seeds also contain protein and carbohydrates; and legumes and grains contain some protein as well.
Ray points out that most diets, particularly the Standard American Diet, is bottom-heavy. North Americans generally over-consume macronutrient-rich foods that are higher in fats, carbs, proteins, and calories in general, and under-consume micronutrient-rich foods like fruits and vegetables. Because of this, North Americans consistently fail to meet the levels of vitamins, minerals and antioxidants essential for optimal bodily function.
It seems that even “healthy” diets tend to focus on the bottom of the pyramid, restricting certain groups of foods while making up the balance by over-emphasizing others. Paleo and low-carb dieters often fixate on the right side of the pyramid, including animal products, nuts and seeds, but avoiding grains and legumes, while vegan and vegetarian diets concentrate on the left side of the pyramid, eschewing all animal products and getting protein from grains, legumes and nuts instead.
One thing all healthy diets seem to emphasize, however, is fruit and vegetable consumption. When studying the merits of a vegan or paleo diet, it is the non-starchy, micronutrient-rich vegetables that may confer most of the health benefits, regardless of the carb, fat and protein content. Therefore, Ray recommends focusing on the top of his food pyramid, eating as many vegetables as possible, while eating a balance of foods from the base.
Since we rarely eat pyramids, I often depict this balance for my patients using a plate. I divide the plate into four quarters. One half of the plate is dedicated to colourful vegetables, with at least a full quarter dedicated to greens. The other two quarters of the plate are divided into starches: grains, legumes, tuberous vegetables, and proteins: meat, dairy, eggs, fish, or legumes. Oils and fats can be used to cook with or added to the meal in the form of avocados, nuts and seeds.
Listening to the Body as Guide
So, while Ray’s advice to eat as many green and colourful vegetable as we can while eating a balance of the foods at the bottom of the pyramid is sound, how can we establish what the right balance is for us? Many of us will have vastly different requirements for the macronutrients: carbs, fat and protein. My body has an energy demand that is different from that of my 6′ friend who lifts weights daily, or my 90-year old hypertensive, mainly sedentary Italian grandmother. As a naturopathic doctor, who believes in an individualized approach to health, I tend to reject top-down dietary recommendations that ignore the variabilities among people.
A friend of mine, having damaged his health through a string of restrictive dieting, argues that all food—even refined sugar and saturated fat—has a place in a healthy diet. He believes our bodies are designed to crave fat, protein and carbohydrates in ratios that promote optimal health. He writes in his book that we can eat whatever we want as long as we eat intuitively and avoid foods laden with “fake” flavours and processed oils, like corn oil, that confuse our internal cues and hunger signals. He also argues, like the filmmakers in the Netflix documentary, What the Health, that there is no evidence that refined sugar causes diabetes, and that diets based on avoidance of certain foods are detrimental for health.
While I’m not convinced that refined sugar deserves to be completely cleared of all charges, I agree that mindful and intuitive eating may be the key to maintaining balance. Healing with Whole Foods by Paul Pitchford places awareness and physical activity at the base of its Integrative Food Pyramid. The idea is that we need to first establish the foundations of movement and mindfulness before we begin to talk about food intake. As my friend says, perhaps the key is tuning in to our own internal physiological and emotional cues through mindfulness, paying attention to hunger and cravings, rather than measuring calories, carbs, protein, or fat grams.
Following our internal cues may be difficult, as the book TheDorito Affect outlines. The author points out how certain foods are engineered to override our hunger and satiation signals and monopolize our cravings, leading us to overeat. Therefore, if we’re going to follow our body’s signalling, mindfulness is a requirement, but so is following the advice of Michael Pollen, author of The Omnivore’s Dilemma, who famously tells us to “Eat food. Not too much. Mostly Plants.”
Pollen urges us to stick to foods that resemble something we might encounter in nature: eat foods our grandmothers would recognize; purchase foods that come from a plant, not foods that are made in one; and to stick to whole foods or packaged foods with five listed ingredients or less. Pollen also encourages us to cook and prepare as much of our own foods as possible. Do you have a craving for potato chips, ice cream, or dark chocolate? Feel free to indulge, as long as you make it yourself using the raw, natural ingredients. The theory is that, when the body is given clean, whole food, it regulates its hunger and satiety signals to communicate to you exactly what it needs.
Heal the Individual
When it comes to whole foods, I believe that there are no “good” or “bad” foods, generally speaking. Observational studies that examine how traditional societies ate suggest to us that saturated fat, animal protein, dietary cholesterol, and carbohydrates all have a place in a balanced diet. However, when it comes to diet, especially therapeutic diets, it’s my job to consider the individual and their health context: there are no good or bad foods, but some foods are better or worse for certain people, and some may even be better or worse for certain people at certain points along their health journeys.
When I am helping my patients calm inflammation, heal their digestive systems, clear their skin, or manage autoimmune disease, I often recommend identifying food sensitivities and eliminating those foods from the diet. Oftentimes these foods need to removed only temporarily, but sometimes foods may need to be removed indefinitely. Patients with insulin resistance, such as in the cases of obesity, PCOS, diabetes or metabolic syndrome, often do well on a low-carbohydrate diet to restore insulin sensitivity. Again, these anti-inflammatory, reduced-carbohydrate diets may only be required until hormonal balance is restored. Older adults concerned with promoting longevity, or patients undergoing cancer treatment, may do better restricting protein to lower their levels of growth factors, while athletes and stressed out adults may require higher amounts of protein to promote muscle building, or to synthesize mood-regulating neuro-chemicals. A woman who is stressed, depressed, exhausted and iron deficient may feel much better increasing her dietary intake of red meat to help regulate her nervous system. Another woman, with a family history of colon cancer, may do better avoiding it.
Endless factors need to be taken into account when we consider which dietary style is right for us. Our health goals, health status, nutrient status, digestive system health, immune system health, liver functioning, insulin sensitivity and hormone balance, levels of stress, toxic load and inflammation are just some of the things that I consider when making lifestyle recommendations for my patients. Lifestyle preferences, tradition, culture, religious backgrounds, cooking abilities, time constraints, and other factors, will also all play a role in our food choices and eating habits.
Our emotional connection to food and our ethics also matter. While veganism is certainly not a diet I recommend, if consuming animal products is out of line with one’s morals, then following a vegan diet may be the healthiest way for them to live in accordance his or her beliefs. Similarly, someone with a history of disordered eating may need to lift all food limitations, even junk food, in order to heal his or her relationship with food and hunger.
Investigations into the eating patterns of traditional societies tell us that human beings thrive on a variety of different diets. Optimizing diet for the individual goes beyond following the latest research or government and industry-funded health recommendations. It involves eating a variety of natural, whole foods, learning to pay attention to the body’s hunger signals, and even working with a health professional who uses diet to help promote health and manage disease on an individual level.
I talk about the supplements I take on a daily basis and their indications.
Hey, Everybody, my name is Dr. Talia Marcheggiani and I’m recording to you guys from my kitchen in Toronto. And this video is about the supplements that I take as a naturopathic doctor and health experimenter. When it comes to making treatment plans for my patients I prefer to focus on the Therapeutic Order, so starting with the foundations of health, which usually means making adjustments to diet and lifestyle and if possible using food prescriptions and functional foods to help heal the body as opposed to relying on supplements. And this is just from clinical experience and from a cost-benefit perspective. So, of course it’s better to get these nutrients from food sources, because, when you eat a pile of kale, like a big plate of leafy greens, you’re getting all of the vitamins that we know about: the magnesium, the fat-soluble vitamins, like A, D, E, and K, some iron, and all of the flavonoids, and anti-oxidants that are present in that big pile of greens, but you’re also getting a lot of nutrients that we haven’t been able to isolate and that we don’t know is present in those foods. Some of those nutrients may act synergistically. And so it’s always better to get things from their whole-food source, I think. That’s the philosophy that I come at when it comes to health and healing. And I’m always looking for the obstacles to cure. Ideally I’m prescribing something like magnesium to replenish a magnesium depletion or to compensate for a diet that may be inadequate for magnesium, or to replenish magnesium deficiency. So I’m not a big fan of prescribing a ton of supplements, and I think my patients appreciate that, because of the cost and the annoyance of taking a lot of things. That being said, there is definitely a benefit to supplementing with vitamins and minerals and other sort of functional supplements to improve optimal health. We’re trying, obviously, to eat a diet that meets the recommended daily nutrition intake for all the vitamins and minerals that the body needs to function optimally, but there’s some evidence that increasing these levels and taking higher doses of these vitamins and minerals may actually help our body perform properly. So, if you take something like vitamin C, if someone is completely deficient in vitamin C that will manifest as a disease called scurvy, where you’ve got loose gums, or you’re experiencing problems in creating collagen. You’re getting sore on the skin, there’s skin issues, there’s gum issues. And then there’s an adequate amount of vitamin C, where you’re not seeing those symptoms, and then there’s having optimal vitamin C, where your body is able to not just meet its daily requirements for all of the chemical reactions that it needs for us to feel our best, and look our best, but now it’s got an abundance of vitamin C and now it’s able to really divert a lot of the vitamin C that it’s getting to increase energy, to boost immunity, to target cancer cells, to exert an anti-oxidant effect, to accommodate all of the free radicals we might be exposed to, living in our modern times.
So, that being said, I do my own self-experimentation with vitamins and minerals, and there’s a few things that I’ll take on the regular, that I’ll take all the time, and then there’s other things that I might play around with, just to see what it’s like to take the medicine. Depending on what it is, I think doctors should taste their own medicine every now and then to know what the effect is on their patients and what their patients’ experience would be, experimenting with these vitamins and minerals.
So, the first thing I take, and this is something that I started taking in school, is a B complex. And a B complex contains all of the B vitamins. Some people get confused, they’ll refer to their B12 supplement as a B complex or they’ll refer to a B complex as B12, or they’ll get confused about all of the different B vitamins. In this product there are all of the B vitamins, from B1 all the way to folate. These B vitamins are cofactors in thousands of chemical reactions in the body. We need vitamin B6, for example, to make serotonin out of tryptophan and 5HTP, those are all the amino acids that are present in the pathway to synthesize serotonin and without B6 we’re not able to make serotonin, no matter how many of those building blocks, tryptophan building blocks, may be present in the body. So, if we’re deficient in these cofactors, our body is just not able to function properly. And we burn through B vitamins a lot more quickly when we’re under stress and some people have higher requirements for them. And some people have an issue metabolizing certain forms of B vitamins. So, for example, there’s some people that have an issue taking folic acid, which is often thrown into a lot of our grains and cereals, that are fortified and lots of multivitamins and taking that folic acid and making it into its active form, about 40%of people have a genetic polymorphism that reduces their ability to methylate and to make active folate and, therefore, they need to supplement with the activated from of folate otherwise the folic acid that’s in all of their foods starts to build up in their tissues and there’s some evidence that that can cause problems.
I showed you which B vitamin I use. I use the AOR brand and one thing to look for in a B vitamin is, what is the form of folate in it? So, you want to look for one that has L-5-MTHF or that’s the methyl-tetrahydrafolate, that’s the active form of folate. And you also want to look at the B12, what’s the form of B12? So there’s 3 different forms of B12: cyanocobalamin, hydroxycobalamin and methylcobalamin. Cyanocobalamin is the synthetic form and, for the same reason that people have a problem activating folate, they may have a problem activating B12 and using it. And it’s the methylated form, methylcobalamin, that crosses the blood brain barrier, and that would have effects on depression and anxiety, and help with cognitive decline, and energy and all of those things. So, it’s important to look for a B vitamin that’s got those activated forms of the B complex. And you also want one that has adequate forms and that will be better absorbed. And so, taking a B complex is not something that you can overdose on readily because it’s water-soluble, so you may notice, as you start to take it, that your body starts to up-regulate the receptors to absorb them, for the initial weeks of taking it, you might have really yellow pee. And that’s normal, that shouldn’t cause any issues, but it’s one side effect that sometimes surprises people when your first morning urination is highlighter neon yellow.
The other thing that’s a staple in my supplement regime is magnesium. So, magnesium is, again a cofactor in tons of chemical reactions, and one of the really important functions that magnesium has is in DNA repair and also in mitochondrial function. So, mitochondria are the furnaces in our cells. Without magnesium, our DNA won’t have that ability to repair itself, which can cause us to allow DNA mutations or issues with DNA replication to go unnoticed and that can cause problems such as cancer down the line. It’s not that you’re deficient in magnesium one day and that manifests as symptoms, it’s something that will manifest over time, over decades of having just insufficient magnesium to achieve optimal health. So, you might be meeting your general needs where you’re not outwardly deficient in magnesium but, you’re not getting those levels to really have your body functioning at its best. Magnesium deficiency can manifest as symptoms, as physical, clinical symptoms in people and a big one is tense and tight muscles. Magnesium is a skeletal muscle relaxant and a smooth muscle stimulant. So what that means is that, if you’re the kind of person that has got really tense shoulders, lots of muscle knots, lots of aches and pains, that are muscular in nature, magnesium can help relax that skeletal muscle. And if you’re the type of person that suffers from menstrual cramps, or constipation, then magnesium is helpful for getting things moving and stimulating motility of the digestive tract and relaxing the uterus as well. Magnesium, there’s been some studies showing that magnesium can be beneficial for headaches, and that is probably due to its muscle-relaxant properties. Magnesium is also a great remedy for fatigue and, like B vitamins we burn through magnesium a lot more quickly when we’re stressed. 40% of people have a diet that it is inadequate to obtain their optimal levels of magnesium. This may be because we’re not eating enough leafy greens, which is a really great source of magnesium. It’s about 2 cups of spinach or chard a day to get the 300 mg of the magnesium, and also from soil depletion. So, when crops are not rotated, and the soil’s not replenished, the next round of crops are grown in a soil that’s depleted and therefore those plants aren’t absorbing the nutrients that were then going to enter our bodies after we eat those plants. And from this soil depletion, it’s hypothesized that that’s why our magnesium levels are so low. Also, a diet that’s high in processed sugar increases our magnesium needs, and a lifestyle that’s high in stress also increases our magnesium needs, as we need it to make stress hormones.
So, B complex and magnesium.
I often recommend to my patients to take magnesium before bed because of the skeletal muscle-relaxant properties, it helps to calm the body and the mind. There’s different forms of magnesium and the forms are prescribed based on what your therapeutic goals are. So, something like a magnesium citrate will be prescribed for somebody who’s tending more to the constipation, because it can help draw water into the bowels and have a bit of an osmotic laxative effect. So, it doesn’t sort of stimulate the bowels, like a laxative would, like sennakot, but it will draw water into the bowels to kind of flush the system out. That can be problematic over the long-term so do that under the supervision of a doctor or naturopathic doctor. And then, for people that are really sensitive to those laxative effects of magnesium, they may want to go with a magnesium that’s conjugated to an amino acid such as glycine. And so I often recommend magnesium glycinate, because a lot of us are also deficient in glycine. Another good source of glycine is collagen, or gelatin, and glycine has this sort of relaxant and modulating effect on the nervous system, and so it can be great for depression and anxiety, more so for anxiety because of its calming effect on the brain.
So, another supplement that I take is zinc. So, this is not the best form of zinc, I just picked this up because it was cheap and I could find it—I think I got this one at Bulk Barn, this is a zinc citrate. Even better absorbed form is zinc picolinate, so there’s a study that shows that that’s the best-absorbed form of zinc, which is appropriate for somebody that experiences nausea when they take zinc, which goes away in a few minutes, but it kind of sucks to have so, if that’s happening to you, then going with a more absorbable form of zinc, or taking zinc with food. A zinc deficiency manifests as dry skin, and depressed immune system, so you’re getting infections a lot more often than the average person. But inadequate levels of zinc can manifest as hair loss, leaky gut, depression and anxiety. Zinc helps us with neurogenesis, so it actually helps us make BDNF, brain-derived neurotropic factor, which is a chemical that our brain uses to make new neurons, and to promote resilience against stress. It sort of protects the brain against mental and emotional stress. And I also prescribe it for cystic acne and hormonal acne. And zinc is a really good remedy for PMS and heavy menstrual periods and vegetarians are often deficient in zinc.
4th is a fish oil. So a fish oil is combined with two kinds of omega 3 fatty acids: EPA and DHA.The one I use has got a 5:1 ratio for EPA. So, EPA is the anti-inflammatory omega 3, the anti-inflammatory fish oil. DHA is the fish oil that we use to build up our brain tissues. Most of our brain mass is made of fat and it’s mostly this kind of fat, DHA. So there’s some good studies that, because of its anti-inflammatory properties, EPA can help increase symptoms of depression. And this is probably because there’s some evidence that depression, like other mental health conditions, is an inflammatory condition in the brain. We don’t have pain receptors in our brain, so if our brain is experiencing even a small level of inflammation, it can kind of go undetected. It may just manifest as negative thoughts, mental chatter, low mood, lower or impaired neurogenesis. We’re not experiencing that acute, sharp memory that we’re used to, maybe we’ve got some brain fog, maybe we’re having trouble recollecting names and those kind of things. And there’s a little bit of evidence that it can be heart healthy as well. Our diet is really rich in omega 6 fatty acids. These are the more, inflammatory—this is sort of a general statement—they’re little bit more on the inflammatory side. I think our diet is about 10:1 omega 6:omega 3. And that’s mainly because we’re consuming animal products from animals that are not fed their natural diet, so for example cows should be eating grass, but we’re feeding them corn, which tends to make the fat in their meat more composed of the omega 6 fatty acids, and also because we’ve been told to avoid saturated fats and to eat a lot of industrial seed oils, like canola oil and corn oil, and vegetable oil, which is just corn oil, and soy oil. And so, these kind of oils are also rich in omega 6, those kind of pro-inflammatory fats. It’s been shown that our ancestors, our hunter-gatherer ancestors, had a diet that was more 1:1, for omega6:omega3. So, supplementing with omega 3 fish oils or eating fish a few times a week, those fatty fish I mentioned in other videos, decreases that ratio of omega 6 to omega 3. I also take NAC. And the reason I take NAC is I did a genetic test that showed that I have impaired phase II liver enzymes. So my body has a little bit of difficulty making glutathione, which helps detoxify all of the toxins and free radicals that pass through my body, all of the hormone metabolites. So, no matter how clean I live, if I’m using natural cleaning products, natural body care products, I’m still exposed to toxins, as we all are: there’s car exhaust outside, we’re consuming things that are wrapped in plastic, so no matter how perfect you try and be, you’re still going to be exposed to things. And so, to encourage my body to make more glutathione, I give it NAC, which is a precursor to making glutathione, the antioxidant. NAC helps with liver detoxification, so it also helps decrease symptoms of hormone metabolites, that estrogen dominance, that I also talk about in other videos, and it can also help with detoxifying the brain, so neurons. And that’s through its antioxidant effects and it kind of cleans out mitochondria. So you imagine if you’re running your car in your garage, the process of your car metabolizing, so spending its fuel, is creating some chemicals that are coming out of the exhaust pipe. And if your garage door is closed, all of those chemicals are filling the garage. And so, taking NAC is a little bit like opening a window, it’s just helping your body get rid of all of those toxic metabolites from performing its chemical duties. So I’ll take NAC and I’ll recommend NAC for mental health conditions, especially OCD and bipolar disorder. And sort of on that note, I also take something called estro-adapt. And it doesn’t have to be this product, there’s many other products that are similar to this, estroadapt has DIIM and calcium d-glucarate. Both of those are chemicals that help the body metabolize estrogen. So I’ve talked about estrogen dominance and other videos and the estrogen is not just one hormone, it’s a group of hormones and that there’s also these xenoestrogens, so these estrogens that are toxins in our environment that exert estrogenic effects. So, some of these include fragrances, and bisphosphenol A, BPA, that’s found in plastic, that has received a lot of media attention, what DIIM and calcium d-glucarate do is help us with normal estrogen processing. So, estrogen, when don’t need it any more, when it’s already done its thing, or those more toxic forms of estrogen, they’re conjugated in the liver, so the liver makes them inactive and then they’re dumped into the colon, where they’re removed from the body. And what happens if any of those steps are impaired, so if your liver is sort of overburdened processing other things, or you’re not able to process those hormones as well, is you’re going to have a higher level of metabolites in the body, or if you’re constipated, or if you’ve got a dysbiosis situation happening, and some pathogenic gut bacteria that aren’t able to keep estrogen conjugated, so they sort of put it back into it’s active form and the body reabsorbs it, which is not what you want. You want to get rid of those toxic estrogens.
So what I’ll recommend is doing a detox twice a year, Spring and Fall is a great time to do a detox and I’ll do another video on detoxification because our body can detoxify pretty effectively. It takes care of all of our detoxification needs, but sometimes it helps to give it a little bit of a boost, and so a product like this, with DIIM and I3C, or indole-3-carbinol, which is not in this product, or calcium d-glucarate, is really helpful for lowering those estrogen toxicity symptoms, which could be heavy menstrual periods, anxiety before your period, PMS, hormonal acne, irregular periods, weight gain, especially around the hips and a predisposition to female cancers, such as breast cancer. Another way you can get this from diet is from green leafy vegetables. So those are all the crucifates, broccoli, cauliflower, cabbage, brusselsprouts, chard, spinach, kale, all of those vegetables are really rich in I3C and DIIM and those help us clean estrogen from our body. Finally, I take an adaptogen. So, adaptogens, this is Withania complex, they’re herbs that literally just help the body adapt to stress. So my two favourites are withania, or ashwaghanda, and rhodiola. And I like taking them together, this complex doesn’t have rhodiola in it, but it does have ginseng, which is a little bit more stimulating. It’s got withania, it’s got ginseng, and it’s got licorice, and it has skullcap, which is a little bit more calming, nervous system calming. And, so what withania does, these just help us against the pro-aging and pro-inflammatory stress effects. So, they help sort of protect our tissues against stress, they protect our brain against stress, they can help calm the body down, they help the adrenal glands function more optimally, and rhodiola in particular, helps increase BDNF, just like zinc, so it increase brain-derived neurotropic factor, NAC also does this as well, and there’s a connection between low levels of BDNF and depression and anxiety and mental health conditions. The low levels of BDNF may be from nutrient deficiencies, or it could be from inflammation in the brain and that inflammation could be just a stress resistance. So, the stress hormone is coursing through our body 24/7 and our brain sort of stops responding to them as well, kind of like a diabetic, a type II diabetic, stops responding as effectively to insulin, an a resistance develops and, since those stress hormones have an anti-inflammatory effect, when you start becoming resistant to them, inflammation ensues. And so what withania and rhodiola do is just help calm down that inflammation. I’m a big fan of herbal medicine because in addition to sort of its active medicinal properties, herbs are also flavonoids, and have really important nutrients, like I talked about that big pile of leafy greens, we’re not exactly sure what is in these nutrients. We just know that, as a whole, they work really well. And so they’re flavonoids, they’re also anti-inflammatory, they’ve got anti-oxidants, as well as their medicinal properties that we can isolate and study. So I like herbs, it sort of brings us closer to nature, it puts a piece of nature into our body and some of that intelligence of nature, rather than just one supplement or one ingredient would do. And, because we’re so stressed out, and not all stress is bad. You think of a new mom, she just had a baby, she’s full of love and joy, but there’s sleep-deprivation, there’s all these kind of thoughts, and new responsibilities that are filling her life, so she’s stressed out, but she’s not full of negativity and negative thoughts. And so that’s still stress, the body still perceives that as stress. Some signs of stress are waking up in the middle of the night wide awake, inability to fall asleep, that tired and wired feeling, feeling like you’re getting an energy crash around 2-4pm, feeling a little bit more tired than usual, feeling a little bit more burnt out, feeling a little bit of ennui, and lack of motivation, so a lot of those signs of depression are actually present in someone who’s chronically stressed out: lots of mental chatter, lots of negative thinking and irritability can also be signs of stress. It manifests differently in every single person and so I’ll go through a full work-up to see how stressed out somebody is feeling and what their state of stress is. And there’s a difference between perceived stress and how stressed out you think you are, and actual, physiological stress and what the body’s under. And being in a state of inflammation, as well as riding the blood sugar roller coaster can also increase our physiological stress.
Finally, I take 5HTP. And I take this before my period, so I don’t take it all the time. I may take a couple hundred mg of it before bed, just to help with sleep. And, so 5HTP is a precursor to make serotonin. A lot of women will experience a dip in serotonin right before their period, sometimes up to a week before, so these women will experience irritability, those mental and emotional PMS symptoms, cravings for sugar, inability to sleep, worsening of depression and anxiety right before their period. And so sometimes they can benefit from 5HTP, which is an amino acid. 5HTP needs magnesium and B6 to work properly, though. So, we need to make sure the body has got adequate amounts of those nutrients, either through supplementation or diet, so that it can take that 5HTP and make it into serotonin. 5HTP crosses the blood brain barrier and so that sort of helps us get it into our brains where it can be made into serotonin. And the good thing about amino acids, like NAC and 5HTP and some of the other ones I mentioned in my amino acid video, is that they work pretty quickly, so sometimes they can exert their effects within hours and sometimes even within a matter of days, whereas something like fish oil can take months to be incorporated into the cell membranes and change the fatty acid profiles of our cells.
Even B vitamins work pretty quickly as well. So, these are what I take. You’re going to need something different, maybe less things, maybe more things. Some of these things are things that I experiment with, and sometimes I’ll do a wash. So, a lot of the time, if my patients are on a ton of things and they come in in that state, I’ll wash them, we’ll have them stop a few things, see if symptoms return, see what their baseline of health is. Because sometimes we just need a boost and to just take these things for a few years or months, and then our body gets back on track, sometimes we need some continual support throughout our lives. And so, everyone is different, everybody has different individual biochemical needs and everyone has different challenges with getting diet into their life and exercise and meeting those foundational health needs. And so someone who is a little bit more challenged in that department, who’s got a really busy and stressful lifestyle may need more nutritional support, someone who’s in a chronic disease state, recovering from more serious health issues may need more support and someone who’s having trouble maintaining their minimal nutritional requirements through diet may need some more support.
Again, I always tell people to pay for a consult with a functional medical doctor or a naturopathic doctor to figure out what your supplement regime would be. I see a lot of people in healthfood stores kind of going it alone and, not to say that you can’t get great information from the internet, but it may result in your taking a lot of things that you don’t really need, spending a lot of money that’s not targeting a specific health concern or meeting your higher levels of nutritional requirements. And also the form of the supplements and the dosing is something that’s individualized, that we need to talk about. So, there was a Marketplace study with CBC that showed that a lot of these vitamins and minerals that aren’t from professional brands and aren’t 3rd party tested don’t actually contain what they say they contain. This is specifically a problem with herbal remedies. So, if you have any questions leave me a comment below my video and you can check out my website at taliand.com .
