Here Comes the Sun: How Circadian Rhythms Can Heal Our Mental Health and Hormones

Here Comes the Sun: How Circadian Rhythms Can Heal Our Mental Health and Hormones

Gorf is a man of his age, which, in his case, happens to be the Stone Age.

Yes, Gorf is a caveman.

And, perplexingly, Gorf suffers from insomnia.

Gorf wakes up sluggish, long after the sun has risen, wishing he had a snooze button to smash.

He struggles through the day, exhausted. In the early afternoon, he sucks glycogen from the raw meat of a fresh kill to get an extra blood sugar boost.

Gorf prays for someone to discover coffee and refined sugars so that he can join the ranks of modern zombies getting through their 3 pm slumps with artificial pick-me-ups.

When the sun sets, Gorf feels depleted, but also restless and wired. He frustratedly tosses on his bed of mammoth skins beside the dying embers of his campfire while his family snoozes on.

Wide awake at 2 am, Gorf knows that the next morning he’ll begin the cycle again, his body completely out of sync with the Earth’s rhythms. Such is the cursed life of a Prehistoric Insomniac.

If this story seems preposterous, it’s because it probably is. Whatever we imagine prehistoric humans to be, insomniacs is not high on the list.

Those of us who have spent a night outside—whether it was a weekend camping trip or longer—might remember how deeply we slept under the darkness of the starry night sky and how refreshed we woke when the sun began to warm our faces in the early morning.

The closer we get to nature, the better our bodies seem to align with the Earth’s light and dark rhythms.

Now, if we took poor Gorf, dressed him in a suit, and dumped him in a desk chair in an office building in any major modern city, we might believe his claim to insomnia.

Now that Gorf is one of us, his eyes are exposed to bright lights at night as he slogs away at his computer, answering emails, or surfing social media pages into the late hours.

During the day, Gorf now spends his time indoors, where light exposure is 400 times less than that of a bright sunny day.

On bright days when he has a chance to get outside, Gorf protects his fragile eyes with dark glasses.

Welcome to the modern industrial lifestyle, Gorf. Don’t forget to help yourself to the coffee and cookies.

Our Body’s Circadian Rhythms

Our body runs on a 24 hour clock, which is orchestrated by an area in the hypothalamus of the brain called the Suprachiasmatic Nucleus (which we will refer to as “the SCN” from now on).

Our organs, body tissues and cellular processes, from our digestive function, hormones, mood, body temperature, metabolism, sleepiness and wakefulness, cellular repair, to detoxification, among others, have different objectives for certain times of day. The SCN coordinates these functions with the Earth’s daily cycles.

The SCN runs without the aid of outside influence, however several zeitgebers, German for “time givers”, or environmental cues, tell our internal clock what time of day it is to sync our internal and external worlds. The most important zeitgeber is light, which directly activates the SCN through a pathway that connects the retina in our eyes to the hypothalamus (the retinohypothalamic tract). 

In our bodies, timing is everything. The more we are able to sync our cycles with the environment, the better our body organs function. Working against circadian rhythms by engaging in activities like sleeping and eating at the wrong time of day can negatively affect our health, decrease our lifespan, and make us miserable (like poor, sad Gorf in his dimly lit office).

The digestive system, for example, is wired to break down, absorb and convert food energy into fuel during the day  and repair and regenerate itself at night.

At night, the pineal gland, located in the brain, releases melatonin, a hormone produced in the absence of light, to help us sleep. However, exposure to bright lights before bed can impede the natural release of melatonin, preventing restful sleep.

Even pain and cancer growth follow a circadian rhythm.

Science shows that healthy circadian rhythms equal optimal metabolic health, cognitive function, weight, energy levels, cardiovascular health, immune function, digestive health, coordination and mental health. Regulating our circadian rhythms can increase our health-span. 

Our Liver, Muscles and Adrenal Glands Also Have Clocks

While the SCN is the chief executive officer of the circadian cycle, other organs, such as the liver, muscle and adrenal glands, help regulate our body’s rhythms through peripheral clocks.

These clocks register cues from the environment and report back to the SCN.  In turn, the SCN tells the organs what jobs they are supposed to be performing according to the time of day.

Dr. Satchin Panda, PhD, a researcher at the Salk Institute, is discovering how important our eating times are for setting our circadian clock.

The first bite of our breakfast tells our liver clock to start making the enzymes and hormones necessary to digest our food, regulate our metabolism, and use the food we eat throughout the day to fuel our cells.

A few hours later, our digestive system requires relief from food intake to invest its resources into repair rather than spending precious resources on digesting food.

Dr. Panda found that restricting a “feeding window” to 8 to 12 hours in mice and human participants (for example, eating breakfast at 7 am and finishing dinner no later than 7 pm), allowed the system to digest optimally, left time for the system to repair itself at night, and also acted as a powerful circadian regulator.

New research suggests that food is a potent zeitgeber, which has the power to regulate our circadian rhythms. This suggests that eating at the right time of day can heal our adrenal glands and sleep cycles.

Fasting for 10 to 16 hours at night, or “Time Restricted Eating”, helps optimize health and increase lifespan in mice. In human participants, it improves sleep and results in modest weight loss.

Similarly, more research shows that eating before bed can lead to adverse health effects and cause us to gain weight. 

According to Dr. Panda, we become more insulin resistant at night, which means that late-night snacking makes us more likely to store the calories we consume as fat.

Consuming calories in a state of insulin resistance can also predispose use to metabolic syndrome and type II diabetes.

In addition to light and food intake, rest and movement are important zeitgebers. Therefore, engaging in these activities at the right time of day has the potential to promote physical and mental health.

Circadian Rhythms and the Stress Response are Tightly Connected. 

If the internet is any indicator, it seems that everyone is suffering from the modern illness of “adrenal fatigue”, or HPA (Hypothalamic-Pituitary-Adrenal) axis dysfunction

Because of the stress of our modern lifestyles, our adrenal glands and brains are no longer able to regulate the stress response.

This leads to a host of symptoms that wreck havoc on the entire body: fatigue, anxiety, sugar cravings, and insomnia. It also negatively impacts digestion, hormone production, and mood. 

Our adrenal glands make cortisol, the “stress hormone”, a hormone involved in long-term stress adaptation but also in wakefulness, motivation, reward, and memory.

Deficiencies in cortisol signalling can result in issues with inflammation and depression. Too much cortisol floating around in the body can cause weight gain, cardiovascular issues, such as hypertension, and metabolic syndrome.

Cortisol has a circadian rhythm of its own. Our cortisol levels rise within an hour of waking; 50% of the total cortisol for the day is released in the first 30 minutes after we open our eyes. This rise in cortisol wakes us up. It allows us to perform our daily activities in a state of alert wakefulness.

Cortisol levels decline steadily throughout the day, dipping in the evening when melatonin rises.

A flattened or delayed rise in morning cortisol results in grogginess, brain fog and altered HPA axis function throughout the day. Elevated cortisol in the evening cause us to feel “tired and wired” and affect sleep. Waking at night, especially in the early morning between 2 and 4 am can be due to cortisol spikes. 

Our adrenal glands help regulate our circadian rhythms through the production of cortisol. Both the adrenals and the SCN communicate with each other as early as 2 in the morning to ready the system to generate the waking response a few hours later.

Psychiatrist Dr. Charles Raison, MD says, “The most stressful thing you do most days is get up in the morning. Your body prepares for it for a couple of hours [before waking by activating] the stress system. The reason more people die at dawn [than any other time] is because it’s really rough to get up.”

Waking up is a literal stress on the body. 

However, we need the stress response to get through our day effectively and healthy HPA axis function and optimal mood and energy are a result of properly functioning circadian rhythms.

Without these rhythms functioning properly we feel tired, groggy, tense, and depressed. Like Gorf, we need sugar and caffeine to help us through the day.

Circadian Rhythms Affect Our Mental Health

In nearly everyone I work with who suffers from anxiety, depression, or other mental health disorders, I see disrupted circadian rhythms and HPA axises.

Many of my patients feel exhausted during the day and wired at night. They have trouble getting up in the morning (or stay in bed all day) and postpone their bedtime. Most of them skip breakfast due to lack of hunger, and crave sweets after dinner, which further throws off the circadian cycle. 

Lack of sleep can disrupt circadian rhythms leading to obesity, depression, diabetes and cardiovascular disease. Even two nights of shortened sleep can affect cortisol production and the HPA axis, worsening mood and energy levels. 

Depression severity on the Hamilton Depression Rating Scale (HDRS) falls by 6 full points when sleep is restored, which is enough to bring a patient from moderate/severe depression to mild. In comparison, the standard medication SSRIs, like cipralex, only drop the HDRS by 2.

Bipolar disorder is particularly affected by a misaligned circadian clock. In an interview, Dr. Raison claims that a single night of missed sleep has brought on episodes of mania in his bipolar patients. Their moods level once the sleep cycle is restored. 

Our mood is tightly connected to our circadian rhythms and sleep.

Circadian Rhythms and Chinese Medicine

Thousands of years ago, the Chinese developed the Theory of Yin and Yang to describe the dynamics nature, including the cycles of night and day.

Yin and yang (symbolized by a black-and-white circle with dots) represent the process of change and transformation of everything in the universe.

Yang, represented by the white part of the circle, is present in things that are hot, light, awake, moving, exciting, changing, transforming and restless.

Yin is present in material that is cold, dark, soft, inhibited, slow, restful, conversative, and sustaining.

Yin and yang are dependent on each other. Yin feeds into yang, while yang feeds and transforms into yin. Everything in nature consists of a fluctuating combination of these two states.

The circadian cycle transforms the yin night into the yang of daytime.

Yang zeitgebers such as food, light, and physical and mental activity, help stimulate yang in the body, which helps us feel energized, light and motivated.

Before bed, yin zeitgebers like darkness, rest and relaxation help our bodies transition into the yin of night, so that we can sleep restfully.

Lack of sleep and relaxation can deplete our body’s yin energy, causing yin deficiency. Individuals with yin deficiency feel fatigued, anxious, and hot, experiencing night sweats, hot flashes, and flushed skin. Conventionally, yin deficiency can look like burnout compounded by anxiety, or peri-menopause.

Out-of-sync circadian rhythms can result in yang deficiency resulting in morning grogginess, an insufficient rise in morning cortisol, and a failure to activate yang energy throughout the day.

Yang deficiency is characterized by the build-up of phlegm in the body, leading to weight gain, feelings of sluggishness, slow digestion, bloating, weakness, and feeling foggy, pale and cold. Yang deficiency symptoms can look like depression, chronic fatigue syndrome, IBS, estrogen dominance, hypothyroidism, or obesity and metabolic syndrome.

In Chinese medicine, the organs have specific times of activity as well. 

The stomach is most active from 7 to 9 am, when we eat our breakfast, the most important meal of the day according to Traditional Chinese doctors. The spleen (which in Traditional Chinese Medicine operates much like the Western pancreas) is active from 9 to 11 am, converting the food energy from breakfast into energy that can be utilized by the body. 

According to the Chinese organ clock, the liver is active from 1 to 3 am. Individuals with chronic stress, insomnia and irritability, sometimes called “Liver Qi Stagnation”, frequently wake up restless during those early morning hours.

Entraining our circadian clock with environmental cues can help us remain vital by balancing the flow and transformation of yin and yang energies in the body. 

Healing the Circadian Clock:

When I work with patients with depression, anxiety and other mental health conditions, or hormonal conditions such as HPA axis dysfunction, one of our goals is to heal circadian rhythms. 

This involves coordinating our internal rhythms with the Earth’s night and dark cycle by setting up a series of routines that expose the body to specific zeitgebers at certain times of day.

How to Heal Your Circadian Rhythms

Morning Activities: Increasing Yang with movement, light and food:

1. Expose your eyes to bright light between the hours of 6 and 8 am. This stimulates the SCN and the adrenal glands to produce cortisol, which boosts mood, energy and wakefulness in the morning and can help reset the HPA axis.

2. Have a large breakfast high in protein and fat within an hour of waking. The intake of a meal that contains all of the macronutrients wakes up the liver clock. This activates our metabolism, digestive function, blood sugar regulation, and HPA axis.

Consider eating 3 eggs, spinach and an avocado in the morning. Or consume a smoothie with avocado, MCT oil, protein powder, berries and leafy greens.

Eating a breakfast that contains at least 20 grams of protein and a generous serving of fat will help stabilize blood sugar and mood throughout the day while obliterating night-time sugar cravings.

3. Move a little in the morning. Morning movement doesn’t necessarily have to come in the form of exercise, however, it’s important to get up and start your routine, perhaps making breakfast and tidying, or having an alternate hot and cold shower (1 minute hot bursts alternating with 30 seconds cold for 3 to 5 cycles).

Muscle movement triggers another important peripheral clock that helps entrain our circadian cycle with the day.

4. Turn on lights in the morning, especially in the winter time. Spend time outside during the day, and avoid using sunglasses unless absolutely necessary so that light can stimulate the SCN. Consider investing in a sunlamp for the winter, particularly if you suffer from seasonal affective disorder.

5. Consume most of your supplements in the morning, with breakfast. Taking adaptogens (herbs that help reset the HPA axis) and B vitamins can help promote daytime energy and rebalance our morning cortisol levels. This, of course, depends on why you’re naturopathic doctor has recommended specific supplements, so be sure to discuss supplement timing with her first.

Night Routine: Increasing Yin with dark and stillness:

1. Maintain a consistent sleep and wake time, even on the weekends. Retraining the cycles starts with creating a consistent routine to get your sleep cycle back on track.

2. Try to get to bed before 11pm. This allows the body to reach the deepest wave of sleep around 2 am. It also allows for 7 to 8 hours of continuous sleep when you expose your eyes to bright lights at 6 to 8 am, when cortisol naturally rises. Of course, this sleep routine will vary depending on personal preferences, lifestyles and genetics.

It’s important to first establish a routine that will allow you to get at least 6 hours of continuous sleep a night. If you suffer from chronic insomnia, working with a naturopathic doctor can help you reset your circadian cycle using techniques like Sleep Restriction Therapy to get your body back on track.

3. Avoid electronic use at least an hour before bed. Our smartphones, tablets, computers and TVs emit powerful blue light that activates our SCN, confusing all of our body’s clocks. Blue light also suppresses melatonin release, making us feel restless and unable to fall asleep.

For those of you who must absolutely be on electronics in the late hours of the evening, consider investing in blue light-blocking glasses, or installing an app that block blue light, such as F.lux, on your devices. These solutions are not as effective as simply turning off electronics and switching to more relaxing bedtime activities, but can be a significant form of harm reduction.

4. Fast for at least 2 to 3 hours before bed. Avoid late-night snacking to give the body a chance to rest and to signal to the peripheral digestive clocks, such as the liver clock, that it’s now time to rest and repair, rather than digestive and assimilate more food.

Avoiding food, especially carbohydrate-rich food, at night can also manage blood sugar. A drop in blood sugar is often a reason why people wake in the early hours of the morning, as blood sugar drops spike cortisol, which wake us up and off-set our entire circadian system.

5. Engage in relaxing activities in dim lighting. Turn off powerful overhead lights, perhaps lighting candles or dim reading lights, and engage in at least 30 minutes of an activity that feels restorative and relaxing to you. This might include taking an epsom salt bath, reading a book while enjoying an herbal tea, doing yoga or meditation, or cuddling with a partner.

Taking this time helps us step out of the busyness of the day and signals to the body and its clocks that it’s time to sleep.

6. Take nighttime supplements before bed. I often recommend sleep-promoting supplements like prolonged-release melatonin (which is a powerful circadian rhythm and HPA axis resetter), magnesium or phosphatidylserine, before bed to help my patients’ bodies entrain to the time of day. Talk to your ND about what supplements might be right for you.

If you suffer from chronic stress and mood disorders, do shift work, or are dealing with jet lag, you may need to engage in these routines diligently for a few months to get your circadian cycles back on track. 

These practices can also be beneficial at certain times of year: daylight savings time, periods of stress and heightened mental work, and the transition of seasons, especially early Spring and Fall. 

Finally, consider working with a naturopathic doctor to obtain and individual plan that can help you reset your body’s rhythms.

Some Like it Hot: Using Heat to Heal Depression

Some Like it Hot: Using Heat to Heal Depression

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.

 

21-Day Blood Sugar Reset

21-Day Blood Sugar Reset

Introducing a 21-Day Blood Sugar Reset 

The Low Carb, High Fat or “Ketogenic” Diet has been touted as a health solution for weight loss, mental health, hormonal health, as well as a treatment for insulin resistance, diabetes, childhood seizures, migraines, and dementia.

It consists of eating foods like meat, fish, and non-starchy vegetables, and plenty of healthy fats from avocados, coconut, olives, nuts and seeds, while avoiding starchy foods like grains, legumes, fruit and root vegetables.

Our bodies and brains can use two main types of fuel: sugar and fat.

In this 21-day challenge we will teach our bodies to burn fat for fuel.

Some argue that fat is a “cleaner” fuel source than carbohydrates.

Ketone bodies, produced from fat have been shown to decrease inflammation, improve mitochondrial function—our cells’ power supply—and boost cognition. Ketone bodies also keep us full for longer, our brain sharp and focussed, and our energy abundant and sustained.

Many are introduced to low carb diets through their weight loss journeys. When we restrict carbohydrates, our bodies burn dietary fat and body fat for energy. Furthermore, less dietary carbohydrates means less insulin release. Insulin is our storage hormone, that prevents our bodies from breaking down fat, possibly impeding weight loss. When we cut out carbs we reduce our insulin levels, helping to heal insulin resistance, and helping our bodies shed fat.

To be perfectly honest, I don’t believe in diets,

particularly trendy diets that have names and followers, like groupies at a rock concert.

I believe that how we eat has a LOT to do with our individual biochemistry, our genes, our gut bacteria, our culture, our preferences, our job, our family, our free time, our individual health goals and health challenges.

Diet (or since diet is often a trigger word, but honestly all I mean by it is “way of eating”, or daily nutritional practice), is highly individualized. There is no one-size-fits-all diet.

HOWEVER, I do believe in resets.

I believe all adults could do well with a dedicated amount of time: 14 days, 20 days, 30 days, etc.: in which we really examine our relationship with food. In which we strip our diets down to the bare bones and examine our blood sugar, food sensitivities, food addictions, tendencies to emotionally eat, taste buds, etc.

After all, the human “diet” is essentially meat and vegetables. What happens when we strip all the fluff away? What might we discover about our bodies and minds? About our habits? About ourselves?

This way of eating restores metabolic flexibility, gets us burning fat for fuel (in addition to carbs when you add them back in after the 21 days). It helps us manage blood sugar, which is implicated in chronic stress, acne, diabetes, and hormonal disruption to name a few conditions and symptoms.

Obviously this challenge is not for those who struggle emotionally with food and need more one-on-one focused support, but it is an excellent way to be held accountable, to take on a challenge in which you’re given all the tools you need to do the discovery work.

You might discover that this is the best eating style for you.

You might restore your insulin sensitivity but discover that you need some carbs, or certain carbs, to feel your best.

You might discover hidden food sensitivities that have been plaguing you with inflammation for years.

For more information visit taliand.com/programs/

Reflections on Being a Patient

Reflections on Being a Patient

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?)

A Letter to Myself at 32

A Letter to Myself at 32

I often encourage my patients to write a letter to themselves on their birthdays for the following year using a website called FutureMe.org, where you can post-date emails to yourself to any date in the future. This exercise is great to do on any day, really. Tomorrow is my birthday. I’ll be 32. Here is my letter. 

This is it.

This is your life.

As Cheryl Strayed wrote, “The f— is your life. Answer it.”

There are some things that you thought were temporary, mere stepping stones on your way to someplace better, that you now realize are familiar friends, ever present in their essence, but varying in their specific details.

For instance:

1) You will ride buses.

You will never escape the bus. For a while taking the bus was seen as a temporary stop on your way to something else (a car?). You took the bus as a pre-teen, excited to finally be allowed to venture to parts of town alone. As a student, you took the bus to the mall, laughing at the ridiculousness of Kingston, Ontario, once you’d left the protective bubble of the student community, completely inappropriately, yet affectionately (and ignorantly) called The Ghetto.

You will visit other ghettos, also by bus, that are far more deserving of their names. However these ghettos will instead have hopeful names such as El Paraiso, or La Preserverancia. Those who live there will persevere. So will you.

Buses will take you over the mountains of Guatemala, to visit student clients in Bogota, Columbia. To desirable areas of Cartagena. You’ll ride them through India. They will carry you through Asia, bringing you to trains and airports.

You’ll ride buses as a doctor. You’ll ride the bus to your clinic every day.

Sometimes, on long busy days in Toronto, it’ll seem like you’ll spend all day trapped in a bus.

The bus is not a temporary reality of your life. The bus is one of the “f—s” of your life. You’ll learn to answer it. You’ll learn to stop dissociating from the experience of “getting somewhere” and realize you are always somewhere. Life is happening right here, and sometimes “right here” is on the seat of a bus. Eventually you start to open up, to live there. You start to live in the understanding that the getting somewhere is just as important as (maybe more than) arriving.

We breathe to fill our empty lungs. Almost immediately after they’re full, the desire to empty them overwhelms. Similarly, you board a bus to get somewhere, while you’re on the bus, you start to understand.

You’re already here.

Maybe you’ll graduate some day, to a car.

But sooner or later, you’ll board a bus.

And ride it again.

2). You’ll experience negative emotion, no matter who you are or what your life circumstance.

Rejection, worthlessness, sadness, and heart break, are constant friends. Sometimes they’ll go on vacation. They’ll always visit again.

You will never reach the shores of certainty. You will never be “done”. You may take consolation in momentary pauses, where you note your confidence has found a rock to rest its head against. But you’ll grow bored of your rock (it is just a rock, lifeless, after all). You’ll then dive back into the deep waters of doubt, risk despair, and swim again.

Happiness isn’t a final destination. Instead, it’s a roadside Starbucks: a place to refuel, and maybe passing through is an encouragement you’re headed in the right direction.

3). The people in your life are like wisps of smoke.

They will come and go. Some of them will simply whiff towards you, visiting momentarily. Their names you’ll hardly remember. You’ll share ice cream and one deep, healing conversation about love that you’ll remember for years to come. You’ll reflect on this person’s words whenever you consider loving someone again.

You’ll remember the ice cream, the warm sea breeze, the thirst that came afterwards, the laughter. But it will be hard to remember his name… David? Daniel? You won’t keep in touch, but you’ll have been touched.

There will be others who come to seek your help. You might help them. You might not. They might come back regardless, or never return. Many times it will have nothing to do with the quality of your help. Or you.

Sometimes the smoke from the flame will thicken as you breathe oxygen into it. People will come closer, you’ll draw them in, inhale them.

Sometimes you’ll cough and blow others away.

You’ll wonder if that was a wise choice. You’ll think that it probably was.

Does a flame lament the ever-changing smoke it emits? Does the surrounding air try to grasp it? Do either personalize the dynamic undulations of smoke, that arise from the candle, dance in the fading light and dissipate?

Flames don’t own their smoke. They don’t seem to believe that the smoke blows away from them repelled by some inherent deficiency in them. Flames seem to accept the fact that smoke rises and disappears, doing as it’s always done.

4). Not everything is about you.

There will be times when failure lands in your lap. You’ll wonder if it’s because there is some nascent problem with you, that only others can see. These failures will tempt you to go searching for it.

You’ll find these faults. These deficiencies. In yourself, in others, in life itself.

You’ll wonder if it explains your failures. You’ll wonder why the failures had to happen to you.

You think that people can smell something on you, that your nose is no longer able to detect, like overwhelming perfume that your senses have grown used to, but that assaults the senses of others around you.

Failure and rejection, cause your heart to ache. Your heart aches, as all hearts do. The hearts of the virtuous, famous, heroic, and rich ache just as hard. The hearts of those who have committed evil deeds also split apart. (The only hearts that don’t may be the truly broken, the irredeemable. And those people are rare.)

You will experience joys. Your heart will mend and break, a thousands times.

And it has nothing to do with you.

5). Success is not a final destination.

There are no destinations. You will ride buses, you will feel happy, you will feel joy. You will try. You will succeed.

And you won’t.

You’ll pick up the pieces of your broken heart. You will mend them. You will flag down the next bus.

You will board it.

You will grasp—you can’t help it. Grasping will only push the wisps of smoke away, causing it to disappear in your hands. This will frustate you, but you’ll keep doing it.

Over and over.

And failing.

You’ll grasp some more and come up empty, thinking that it is because something is wrong with me. There is lots wrong with you.

There is lots right with you.

Most things have nothing to do with you. (That might be just as painful to accept

But healing as well.)

No one said healing didn’t hurt. Sometimes it f—ing hurts! But, as Cheryl Strayed wrote, “the f— is your life”.

And answering it is your life’s process.

Volunteering at the Evergreen Yonge Street Mission

Volunteering at the Evergreen Yonge Street Mission

An interview outlining my adventures providing free naturopathic medicine to street youth at the Evergreen Yonge Street Mission health centre, originally featured in Pulse, a publication for members of the Ontario Association of Naturopathic Doctors.

What is the Evergreen Yonge Street Mission?

On the fourth Friday of every month, I leave my Bloor West Village practice for a few hours and head down Yonge Street.

Just south of Gerard, I stop at a rather unimpressive-looking building tucked between fast-food restaurants and strip clubs, where an admittedly intimidating crowd of young people are smoking and laughing loudly, hoodies drawn.

I nod to them briefly before heading past them, through a glass-paneled doorway.

The entrance is crowded. Youth and tattooed counselors blast rap music out of large headphones. Some of them have notebooks, writing lyrics.

Beyond them is an open area where food is being served; more young people sit at round tables, finishing hot catered lunches, or drinking coffee. A few are involved in some community project or other, conspiring excitedly in groups. Everyone seems to be embracing a perplexing combination of busyness and inertia.

I smile at them and rush downstairs to the basement, past the career centre to the unglamorous health centre where my tiny office is located.

The Evergreen Yonge Street Mission (YSM) is a drop-in centre for street-involved youth aged 18 to 24 that offers afternoon programming, including a hot lunch, career services, daycare, community-based art projects, and drop-in healthcare centre.

The health centre is run by nurse practitioners and staffed by volunteer health professionals: adolescent health specialists, family doctors, Sick Kids residents, dentists, hygienists, acupuncturists, chiropractors, physiotherapists, social workers, psychiatrists and, of course, two naturopathic doctors, Dr. Leslie Solomonian, and myself.

Youth drop in during health centre hours and sign up for 30-minute appointments with the practitioner of their choice.

How did you start working with the Mission?

I first visited the Evergreen YSM for a launch party for the second issue of Street Voices, a magazine for and by street-involved youth. A friend of mine had volunteered to do most of the graphic design and illustration work for the issue and brought me along.

At the party, while eating tiny sandwiches, I noticed a message board advertising YSM services. Naturopathic medicine was listed under health services provided at the centre. I took down the number of the health centre, and gave them a call the following week.

By February 2015, I was volunteering two Fridays a month.

Why did you decide to get involved with the Mission?

I came across Evergreen at the beginning of my naturopathic career. I’d just obtained my license in 2014, and was looking for a way to balance the cost of living and running a practice with providing access to naturopathic services.

Naturopathic medical services have the potential to be very cost-effective; our profession was built on the foundations of clean air, food, and water as vehicles for healing. Nature cure, lifestyle therapies, and in-house treatments like acupuncture can all be very inexpensive to administer.

Unfortunately, the cost of education, licensing fees, and practice overhead all conspire to bring up the cost of naturopathic services, making it difficult for those without third-party insurance coverage to afford them.

When I first started my practice, I tried to find various solutions to this problem. I dabbled in sliding scales but quickly started to notice burnout and resentment polluting my therapeutic relationships. Separating cost, value and worth, while accurately assessing need, complicated things for me—I found it very difficult to lower my rates while still recognizing the value I was offering.

Dispensing with sliding scales at my main practice while offering free services to a marginalized population felt like a satisfactory compromise: I could build my practice, pay for my groceries, and give back, while maintaining clear boundaries.

What type of naturopathic care do you provide at the YSM?

There are a few ways that my YSM practice differs from my practice in Bloor West Village.

Firstly, visits are shorter. The YSM suggests keeping visits to 30 minutes to serve as many patients as possible. Keeping visits short is a challenge for me, considering appointments in my Bloor West practice run 60 to 90 minutes.

Secondly, therapeutic options are limited. Patients don’t have the cash to buy supplements. Making significant dietary changes is impossible for most to tackle. Therefore, I try to offer therapies in the clinic: acupuncture, B12 shots, homeopathic remedies, and counseling, to reduce the work between appointments.

Sometimes we have supplements to dispense—Cytomatrix generously donated last year. At times we’ve been able to offer things like magnesium, vitamin D, iron, immune support, adaptogens, and sample packs of various probiotics.

Treatment plans often require a bit of innovation. For example, I teach patients how to use the probiotic samples to make coconut yogurt using canned coconut milk from food banks. We talk about how to follow an anti-inflammatory diet while eating at a shelter.

Thirdly, there are many obstacles that prevent patients from attending appointments in the first place. I try to treat each visit as a stand-alone encounter—a new patient I see at Evergreen may never come back. This means I focus on stress-reduction and providing as much benefit as possible in the 30-minute session.

What does a typical visit look like?

Visits can differ greatly depending on the particular needs of the patients I see.

Sometimes new patients come in asking specifically for trigger-point release acupuncture.

One patient came in with her friend so they could Snapchat their first acupuncture session amidst violent giggling.

Some patients come to talk about their struggles and share their stories.

Sometimes patients come in to read me their rap or poetry.

Sometimes patients just come in to sleep—the flimsy chiropractic table we use serving as a quiet, 30-minute refuge from the street. Sometimes we do a mindfulness practice. Other times we say very little, or nothing at all.

Others come for full intakes, with complicated psychiatric cases, or PCOS, or chronic diarrhea. I try to hand out any supplements that might be useful, and to give practical recommendations.

Sometimes patients with part-time jobs have a little money that they can spend on things like St. John’s Wort, magnesium, or vitex.

I have to be extremely economical with my therapies, which I feel is a helpful skill to have as an ND in general—I learn what simple treatments have the biggest impact on certain conditions. This helps me resist the temptation of loading patients down with complicated, expensive treatment plans.

What are some strategies for working with this population?

When working with street-involved youth, I’ve found it helpful to humbly take a step back and listening first before jumping in with solutions.

A de-centred practitioner posture can be particularly helpful in a population experiencing homelessness, violence, complex trauma, addiction, teen pregnancy, abuse, conflict with authority, and severe psychiatric illnesses, among other complex challenges—it’s not always clear what to do, what might best help the individual in front of me, and deferring to their experience is often the wisest first step.

De-centring positions the clinician as a guide, facilitator, or someone of service to the patient. This means that I offer my tools: an ear, acupuncture, vitamin D, or a sanctuary of silence, and let my patients choose whatever they want for their 30-minute appointment.

Another helpful skill is being interested in all my patients’ stories, even the ones that aren’t being told about them.

In Narrative Therapy this is called “double-listening”. Accompanying every story of illness, addiction, label of mental illness, or history of trauma, is a parallel story of strength, courage, generosity, and overcoming tremendous obstacles.

I can be a witness to the alternative stories, which are often begging to be told.

Sometimes addiction, self-harm, or other seemingly “destructive” behaviours, may be hidden coping mechanisms that serve as powerful lifelines for survival. Listening between the lines can highlight certain skills and strengths of those who suffer.

A mentor of mine, when faced with an “angry” client, always asks, “What are you protesting?” With that simple reframing question she often uncovers previously hidden stories of belief in fairness, advocacy for justice, courage, and resilience.

Patients tell me about their issues, but also about their beloved pets, how they wish they could be a better father to their children than their fathers were to them, family loyalty in the face of abuse, their dreams for the future, the steps they’ve taken to confront a friend’s addiction, their hopes for a healthier romantic relationship, and many other stories. These narratives depict the complex facets of their identities: street-youth, yes, but also loving parents, friends, budding entrepreneurs, and gifted artists.

One patient who’d recently been diagnosed with schizophrenia told me about the voices in her head. I asked her what the voices said when they spoke to her.

She looked at me, stunned.

“No one’s ever asked me that before.”

This question led us to an important discussion about how she’d turned to writing poetry and her faith to help her stop using methamphetamine. The voices, while often unpleasant, were keeping her sober in their own complex way, she realized.

Through paying careful attention to these stories, patients can reframe and foster preferred identities.

Do you have any stories in particular?

There are many stories of resilience at Evergreen. I have had the opportunity to watch one of my patients transform his life over the past couple of years.

With a criminal record for assault, anger management issues, difficulty holding a job, a mild learning disability, and a history of complex trauma, this individual picked up the pieces of himself, slowly.

The last time I saw him he had completed a yoga teacher training, begun classes at U of T, and was getting ready to move out of the shelter he’d been living in, into his own small apartment.

Through his own remarkable resilience, and some support he was able to receive at Evergreen, he was able to get himself onto an amazing and exciting path. Seeing potential realized is an amazing experience.

Like tending to a garden of souls; you might help plant seeds, or tend to the soil in very simple, minimal ways, and yet amazing things bloom.

What benefits has this work brought to you as an ND?

I believe working with diverse populations enriches practitioner experience. It reminds me to stay open to experiences, personalities, viewpoints, and unique patient histories.

Listening helps me calm the “righting reflex”: the reflex to jump quickly to a solution in order to soothe my own discomfort of sitting with the agony of uncertainty.

I notice in my own practice when I take a more de-centred stance, roll with resistance, and really pay attention to my patient’s preferences and intuition, I am better able to assist them in healing. Not only does letting the patient take the lead result in better outcomes, it also reduces the burden of (impossible) responsibility by shifting the locus of control, preventing burnout.

I struggle with this in my own practice at times; I frequently feel pressure to prove myself. Working at Evergreen helps remind me that we can’t necessarily help everyone for everything in every circumstance.

All of our patients surpass incredible external and internal obstacles to arrive at our offices and face still more difficulties between visits. Trying to recognize and work with these struggles as best we can, taking small but meaningful steps in and between visits, and acknowledging that sometimes it’s about planting seeds of change, which may take months or even years before they’re ready to bloom.

No matter how impatient I might be feeling with a patient’s progress, I try to remember that steps are constantly being taken in the direction of healing.

What are some challenges?

Like any novice practitioner I am accompanied by two familiar acquaintances: self-doubt and second-guessing. These two friends take their place beside me both in my Bloor West practice and at Evergreen.

Celebrating small victories has been important, but so has staying humble. As the mantra goes: the patient heals them-self.

I try to remember this when I’m either feeling too self-congratulatory or too down on myself.

Funding for supplements, energy, avoiding burnout, and being productive with time, are all familiar challenges I also routinely experience.

I always wish I had more time, better and more exciting remedies to dispense, and more energy to really immerse myself in the dedication community work demands.

I try to take the stance of simply being of service while trying to remain free of expectation.

How can other NDs wanting to do similar work get involved?

If you’re interested in working with marginalized populations, the first thing to do is get in touch with local shelters, such as Covenant House or Eva’s Place.

Many shelters offer satellite health services, such as massage therapy. Perhaps start by offering acupuncture, or other forms of bodywork. Acupuncture is an accessible modality that is cost-efficient and fits well with a drop-in model—patients derive benefit from the session and aren’t expected to make significant lifestyle changes or purchase supplements, both of which may be impossible.

Often stress-relief is the first primary goal of care, as is creating a safe space and nurturing trust between the clinician and community.

If you’re willing to offer your services for free there are many populations in Toronto and the GTA that could benefit greatly from naturopathic care.

How can we help?

The YSM is currently accepting donations to help build their new location, and complete their new health centre. Visit https://www.ysm.ca/donate/ to make a one-time, or monthly donation, and help a great cause.

If you would like to donate supplements, acupuncture needles, homeopathic, or herbal remedies please contact me!

Preventive Medicine: 9 Root Causes of Disease

Preventive Medicine: 9 Root Causes of Disease

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 to attempt 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 response to 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.

 

When Your Doctor Says, “You’re Fine!”

When Your Doctor Says, “You’re Fine!”

I hear this a lot:

“I followed X, Y, Z (controversial) diet, and my doctor said my blood is fine!”

Firstly, what do we think doctors are testing our blood for? Most standard blood tests look at cholesterol, check for anemia, and to see if our kidneys are failing or not.

If you’re lucky, your doctor might test your iron levels, B12, and thyroid function (using one hormone measure, TSH, which often fails to pick up cases of under-active, or autoimmune, thyroid).

Your doctor is likely not looking at inflammation levels, vitamin levels, hormone levels, insulin resistance, or delving into the nuances of your cholesterol levels. Standard blood tests do not provide a comprehensive analysis of your health status. Rather, they rule out the presence of serious disease.

Your blood tests are “fine” because the markers that might actually be negatively (or positively) impacted by your diet and lifestyle are simply not tested for.

Secondly, let’s challenge the notion of “fine”.

For most practitioners, “fine” means, “You don’t qualify for a diagnosis of X disease, which would justify the prescription of Y medication.”

I meet a lot of patients whose B12 levels aren’t “fine”, or whose thyroid levels are certainly not “fine”.

Sure, they are not deficient to the point where they have dementia (from low B12), or where they need thyroid hormone replacement medication, but their bodies are not working optimally.

If we dig a bit below the surface, we find that they are insulin resistant, they have elevated anti-thyroid antibodies, their B12 and iron levels are suboptimal, or their ovaries are not making progesterone.

Someone with these lab markers may not get a disease diagnosis from their medical doctor, and they may not need medication yet, but they’re not “fine”.

Oftentimes your blood tests are fine for decades—until they’re not fine.

This is a classic problem for those who are diagnosed with diabetes. I believe that for many patients, if we had done some exploration of their symptoms and blood 15 to 20 years earlier, we could have detected insulin resistance simmering below the surface of the conventional lab tests. (https://www.ncbi.nlm.nih.gov/pubmed/16627374)

Perhaps we could have prevented their diabetes, and subsequent cellular and metabolic damage, altogether.

I love it when we can do more in-depth lab testing based on your individual signs, symptoms, and risk factors. We take a full inventory of your lifestyle and health history and really dive into the nitty-gritty when it comes to preventing the diseases that your doctor looks for when ordering lab tests.

With the right approach, we might be able to keep those lab tests looking “fine”.

I Am Not My Thoughts: A Lesson in Meta-Awareness

I Am Not My Thoughts: A Lesson in Meta-Awareness

Mindfulness philosophy tells us that our thoughts and emotions are simply phenomena that arise in our bodies and minds: they are not us.

Those of us who suffer from depression and anxiety tend to enter cycles of over-thinking. The mind wanders and engages in self-focused rumination that feeds negative emotions, worsening mood.

While ruminating, we think about the causes and consequences of our depression; we reflect on mistakes we’ve made in the past, we dwell on our perceived personal faults, and we speculate about how we’ll fare negatively in the future.

This kind of rumination becomes a scratch-itch cycle that causes us to feel worse.

However, learning to engage the contents of self-focussed mind-wandering as a non-judgmental observer may be the key to stopping this cycle.

Those who are able to step back and become aware of awareness or think about thoughts, as opposed to getting lost in them, tend to have better control over their thought processes as a whole, and thus their emotions. Mindfulness involves taking a non-judgmental, curious stance about the contents of the mind, as an impartial witness.

Studies show that mindfulness, or taking this non-judgmental, curious stance, can change brain areas associated with rumination, and emotional regulation.

This fall I took a course to obtain a facilitator certificate for Mindfulness-Based Cognitive Therapy (MBCT), an evidence-based 8-week program that aims to treat depression and anxiety through imparting mindfulness skills. Because of the growing evidence base on the benefits of mindfulness for stress and mental health, the facilitator program attracts many medical professionals.

One of the course participants, a psychiatrist, didn’t like me. I noticed her frowning in my direction every time I spoke. She deliberately avoided and ignored me, talking to everyone else in the course but me.

As the only naturopathic doctor in the group, the other participants showed some curiosity towards my field. When I answered their questions, the psychiatrist’s face seemed to twist into a subtle expression of disgust and disapproval.

She thought I was a quack, a hack; I didn’t have enough training. She assumed I wasn’t qualified enough to provide care to those who suffer from mental health concerns. I could feel her judging energy from across the room every time I lifted my hand to answer a question, or make a comment. Her deploring gaze scrutinized my every move.

I was a naturopathic doctor and she, a psychiatrist. We had emerged from different worlds, philosophies, and backgrounds—we were from incompatible ends of the mental health professional spectrum. Of course she didn’t approve of me: it was only to be expected.

We were spending all day meditating, and this is the story my mind had decided to write.

At the end of day 3 of the course, with days of evidence selectively compiled to support my story about this disapproving psychiatrist’s opinion of me, I left class to head for the bus stop. Waiting for the same bus was no one other than my nemesis.

Great, I thought. I smiled at her, stiffly.

She smiled at me.

“Talia, right?” She asked.

I nodded: yes, Talia.

“You’re the naturopath, right?” She inquired, brows kneaded together in a frown.

I nodded again, bracing myself. Are we really going to do this here? 

But then, time-space cracked and split open, revealing an alternate universe to the one in my own head. Her face melted into a warm grin, “Oh, I love naturopaths!” She exclaimed warmly.

She went on to describe her wonderful encounters with the members of my profession who had attended to the various personal health concerns she’d faced.

“I’m so interested in holistic health for managing mental health concerns,” She said, before leaning in a bit, conspiratorially, and adding in hushed tones, “You know, psychiatry doesn’t work.”

I stood there, dumbfounded.

Her particular opinions about psychiatry aside: not only was the entire story I’d written and held onto for the past few days wrong, it was way wrong. I had fabricated an entire story in my head, corroborated by what I had been convinced was real evidence. The realization of how avidly I’d bought into this story, as if it were simple fact, was earth-shattering.

My story, had just been that: a story, conjured up by thoughts. These thoughts bore no relationship to reality at all, no matter how convincingly they had presented themselves.

It rare to have the opportunity to experience our mental constructs and biases topple so dramatically. The mind has a tendency to rationalize away any evidence contrary to our beliefs—”Well, I only passed because I got lucky”, or “The test was easy”, or “She said she liked my hair—liar”.

Very few of us entertain the idea that our thoughts and emotions don’t represent our ultimate reality.

According to Mindfulness Theory it helps to think of our minds as movie screens and our thoughts, emotions, and body sensations as contents of the movie. We can watch the action, identify with the characters, and follow the plot with invested interest. The movie can inspire thoughts and emotions within us, both positive and negative. The movie can grip us; we might lose ourselves in the drama, forgetting that we are mere witnesses to it.

It can help to remember that we are not the movie. Sometimes it’s helpful to remember that we’re not even acting in the movie.

No matter how deeply the film may move us, we can always take the stance of movie-going witness. We can take various perspectives in relation to the drama on screen. We can immerse ourselves in the drama, losing our sense of self completely. We can remember that we are audience members, enjoying a film. We can ignore the movie altogether and laugh to a friend sitting beside us. We can be aware of the contents of the movie theatre, the people sitting around and behind us, or the sticky floor under our feet. We can even leave the theatre, which we will certainly do once the credits roll—it’s just a movie after all, a distraction from the reality of our lives.

In the way that we approach the contents on a movie screen, we can take various stances towards the contents of our minds.

Meta-awareness is the act of remembering that we are movie watchers—the act of becoming aware of awareness itself. When we practice meta-awareness, we take a non-judgmental view of our thoughts and emotions, watching them arise in our bodies and minds like the drama in a movie arises onscreen.

We can easily identify with the tens of thousands of thoughts that appear on the movie screens of our lives. We may be convinced that we’re unloveable, that we’re failures, or that life is hopeless, simply because these particular thoughts have appeared in our mind’s screen. We can also identify with positive thoughts, such as the idea that we’re excellent swimmers, or good fathers.

Our thoughts may reflect reality—we may have the thought that if we step into a pool of water our feel will get wet—but simply having a thought does not create reality itself.

While taking the bus that day, I realized that I had unwittingly cast my psychiatric colleague as the guest-star of People Who Are Judging Me, an episode in Unloveable: The Series, which is a piece of entertaining fiction that my mind has written, directed, produced, and cast me as the lead in. I often forget that I’m simply an audience member watching the movie of my mind’s creation—this movie is not necessarily the truth about my life.

Research has identified a network in the brain called the Default Mode Network (DMN), that connects the lower brain areas, like the amygdala and hippocampus, with higher brain centres in the prefrontal cortex. The DMN is active when our minds are wandering and is particularly active when those with depression are ruminating and engaging in narrative self-referencing: or attributing one’s self as the cause of (negative) events in one’s life—for example, interpreting an expression on someone’s face to be a look of disgust and assuming it’s because they disapprove of your profession.

Meditation, particularly practicing meta-awareness, can produce shifts in the DMN that decrease rumination. Practicing meta-awareness allows us to rescue our identities from the tyranny of thought. We watch and detach from thought, watching them rise and fall in the mind without clinging to them. By becoming aware of our thoughts and emotions and taking a curious attitude towards them, we can break the cycle of rumination, thereby supporting our mental health. Observing thoughts, rather than becoming lost in their drama, allows us to feel and behave independently of them.

For example, simply having the thought, “I’ll always be alone,” doesn’t have to produce a negative emotion, if I recognize it as just a thought.

We might reframe the thought “She hates me” to be: “I just had a thought that this person hates me. It’s just a thought that I have no way of knowing for certain is true. I will smile warmly at her anyways. I might be completely wrong.”

Or, we can do nothing, waiting until the thought “She hates me” passes through the screen of our minds.

We can turn off this particular movie, and put on a new one. After all, we can’t stop the flow of thoughts: there will always be others to take their place.

Lesson learned: I am not my thoughts.

And: some psychiatrists are way more hippy than I am.

Feeling Tired? Try These 15 Ways to Beat Fatigue

Feeling Tired? Try These 15 Ways to Beat Fatigue

Like many people I see, Sandra was experiencing debilitating exhaustion.

Completing her PhD, she was working all day and collapsing on the couch at 8 pm.

She stopped going out in the evening. She ceased spending time with friends, engaging in activities outside of her studies, exercising, and having sex.

Her motivation and zest for life were at all-time lows.

Her marriage, and her life, were being sidelined in the service of her fatigue.

Her family doctor met her complaints with a defeated shrug. “You’re just getting older,” he offered by way of explanation.

Sandra was 27.

My patient is not alone. At least 20% of patients approach their family doctors complaining of fatigue.

24% of North American adults report feeling fatigued for more than two weeks, unable to find a cause. 

Additionally, one third of adolescents report feeling tired most days.

Surely these teens are not just “getting older”.

Lack of energy is a problem that can arise from any body system. Fatigue can be an early warning sign that something has been thrown off balance.

I frequently see fatigue in patients suffering from hormone imbalances, including suboptimal thyroid function, insulin resistance, and low estrogen, progesterone, or testosterone. But also in chronic stress, depression, and anxiety.

Fatigue is often connected to mental health conditions, digestive issues, lifestyle imbalances, chronic inflammation, chronic stress, and lack of restful sleep. It’s no wonder, then, that most of the people I work with experience some level of low energy.

Conversely, I see improvement in energy as one of the first signs that someone is moving towards more robust health. Some of the first signs of healing are a clear mind, bright mood, and vibrant, buoyant energy.

There are a few steps you and your naturopathic doctor can take to identify and remove the cause of fatigue, while optimizing your health and energy levels.

  1. Differentiate between sleepiness and fatigue.

It is important to determine if low energy is fatigue or sleepiness.

Sleepiness is characterized by the tendency to fall asleep when engaging in non-stimulating activities like reading, watching TV, sitting in a meeting, commuting, or lying down.

Sleepiness:

  • Is often improved by exercise, at least in the short-term
  • Is improved with rest

Fatigue is characterized by a lack of energy, both physical and mental. Fatigue is often worsened by exertion.

Those who are fatigued:

  • Suffer from mental exhaustion
  • Experience muscle weakness
  • Have poor endurance
  • Typically feel worse after physical exercise and take longer to recover
  • Don’t feel restored after sleeping or napping
  • Might experience ease in initiating activities but progressively experience more weakness as they continue them (e.g.: engaging in social activities, movement, working, etc.)

To determine between sleepiness and fatigue, your naturopathic doctor will ask you a series of questions about the nature of your low energy.

2. Assess sleep.

Assessing and optimizing sleep is essential for beginning to treat all low energy and, in particular, sleepiness.

Assessing sleep involves looking at a variety of factors such as:

  • Bedtime and waking time
  • Sleep onset: how long it takes
  • Sleep routine and sleep hygiene habits
  • Sleep duration: how many times you wake up, how quickly you can fall back asleep after waking
  • Causes of interrupted sleep such as sleep apnea, chronic pain, frequent urination, children/pets/partners, etc.
  • Nap frequency and length
  • Ability to wake up in the morning
  • Perceived sleep quality: do you wake feeling rested?
  • The use of sleep aids
  • Exercise routines, how close to bedtime you eat or exercise.

And so on.

Using a sleep app or undergoing a sleep study are two additional tools for assessing the quality and duration of your sleep cycles that may be useful.

3. Address sleep issues.

Whether the cause of fatigue is sleepiness or not, restful sleep is essential to restoring our energy levels. Optimizing sleep is an important foundational treatment for all health conditions.

Restorative sleep regulates hormones and balances the stress response, called the hypothalamic-pituitary-adrenal axis (HPA axis). It improves cell repair, digestion, memory, and detoxification.

Mental and emotional stress, artificial light, blood sugar dysregulation, inflammation, and hormone imbalances can interfere with sleep.

To address issues with sleep, it is important to:

  • Maintain a strict sleep schedule. This means keeping bedtime and waking time consistent, even on weekends.
  • Practice good sleep hygiene by avoiding electronics at least an hour before bedtime, using blue light-blocking glasses if necessary, and keeping the bedroom as dark as possible.
  • Avoid stimulating activities like exercise in the hours before bed.
  • Keep the bedroom cool and dark.
  • Reserve the bed and bedroom for sleep and sex only.
  • Balance circadian rhythms by exposing your eyes to sunlight immediately upon waking and eating protein in the morning.

In addition to sleep hygiene and balancing circadian rhythms, sleep aids can be helpful. I start my patients with melatonin, a non-addictive antioxidant, to reset the sleep cycle and help with obtaining deeper, more restorative sleep.

It is important to take melatonin in a prolonged-release form a few hours before bedtime and to use it in addition to a dedicated sleep routine.

  1. Determine whether the fatigue is secondary to an underlying medical condition.

Secondary fatigue is defined as low energy, lasting from 1 to 6 months, that is caused by an underlying health condition or medication.

With your medical or naturopathic doctor, be sure to rule out any issues with your immune system, kidneys, nervous system, liver, and heart, and to assess the side effects of any medications you’re taking.

Ruling out chronic infections, pregnancy, anemia, and cancer may be necessary, depending on other signs and symptoms that are present, your individual risk factors, and family history.

While the vast majority of fatigue is not caused by a serious health condition, ruling out more serious causes is an essential part of the diagnostic process.

Remember that this is not a job for Dr. Google! Because fatigue is a sign that something in the body is not functioning optimally, it can be implicated in virtually every health condition, alarmingly serious ones, but also more benign conditions as well.

Taking into account your entire health history, risk factors and particular symptoms, as well as assessing blood work is a complex job that a regulated health professional can assist you with.

  1. Get blood work done.

Assessing blood work is necessary for ruling out common causes of fatigue.

Blood tests are used to rule out anemia, infections, suboptimal iron, B12, and folate levels, under-functioning thyroid, inflammation, insulin resistance, and hormonal imbalances.

To evaluate the cause of fatigue, your doctor will look at:

  • A complete blood count (CBC) that looks at your red and white blood cells.
  • inflammatory markers like ESR and hs-CRP
  • TSH, to assess thyroid function, and occasionally free thyroid hormones and thyroid antibodies, if further investigation is indicated
  • B12, iron and folate
  • Other tests such as fasting insulin, fasting blood glucose, liver enzymes, and hormones like estradiol, testosterone, estrone, LH, FSH, and progesterone, depending on the health history and the constellation of symptoms.

Your doctor may take further measures to assess your heart and lungs, or to rule out chronic infections.

6. Identify physiologic fatigue, or burnout.

Once sleepiness and any underlying health conditions have been ruled out, your doctor may determine whether you have physiologic fatigue.

Physiologic fatigue, also commonly called “burnout” or “adrenal fatigue”, is the result of an imbalance in sleep, exercise, nutrition intake, and rest.

It is by far the most common category of prolonged fatigue that I see in my practice. Two thirds of those experiencing fatigue for two weeks or longer are experiencing this type of fatigue. 

Feeling a lack of motivation, low mood, and increased feelings of boredom and lethargy are characteristics of this kind of fatigue.

Physiologic fatigue can be confused with depression, leading to a diagnosis and subsequent antidepressant prescription, which may fail to uncover and address contributing lifestyle factors.

To tell if you might be experiencing physiologic fatigue, or burnout, see if you answer yes to any of the following questions, adopted from the Maslach Burnout Inventory

  • I feel emotionally drained at the end of the day.
  • I feel frustrated with my job.
  • I feel I’m working too hard.
  • I feel fatigued when I have to face another day.
  • I have a hard time getting up in the morning on weekdays.
  • I feel less sympathetic and more impatient towards others.
  • I am more irritable and short-tempered with colleagues, my family, my kids.
  • I feel overwhelmed.
  • I have more work than I can reasonably do.
  • I feel rundown.
  • I have no one to talk to.

Fortunately, there are many solutions to improving low energy and mood caused by burnout.

  1. Balance the HPA Axis

Balancing the stress response, otherwise known as the Hypothalamus-Pituitary-Adrenal (or HPA) axis, is an important component of treating physiologic fatigue.

Our HPA axis becomes activated in the morning when the hormone cortisol is released from the adrenal glands. Cortisol suppresses inflammation and gives us the motivated, focussed energy to go about our day.

Towards the end of the day, cortisol levels naturally fall. In the evening, cortisol is at its lowest, and melatonin, our sleep hormone, rises.

Those with HPA dysfunction have an imbalance in this healthy cortisol curve.

They commonly experience sluggishness in the mornings, a crash in the afternoon (around 2 to 4 pm), and restless sleep, often waking up at 2 to 4 am as a result of nighttime cortisol spikes and an impairment in melatonin release.

These individuals often experience cravings for salt and sugar. They may have low blood pressure and feelings of weakness.

It is common for those experiencing burnout to get sick when they finally take a break or experience prolonged healing time from common infections, likes colds and flu.

They may suffer from inflammatory conditions like chronic migraines, muscular tension, and report feeling depressed or anxious.

In this case, balancing the HPA axis is a treatment priority.

Treatment involves:

  • HPA axis balancing through adaptogenic herbs
  • Optimizing adrenal nutrient levels
  • Regulating blood sugar
  • Improving circadian rhythms
  • Reducing workload and perceived stress through addressing perfectionism, practicing setting boundaries, and developing mindfulness, among other skills.
  • Improving sleep
  • Engaging in regular, scheduled exercise
  • Reducing inflammation, improving digestion, or regulating hormones
  • Being proactive about mental health and emotional wellness
  • Improving self-care and stress resilience

Cognitive Behaviour Therapy can be used to teach healthy coping skills while balancing sleep and stress. Studies show it can be more effective than medication for the depression and anxiety related to physiologic fatigue.

Of course, from a holistic perspective, the above strategies are the foundations for improving general health and wellness for all fatigue-related conditions, regardless of whether the fatigue is due to sleepiness, secondary fatigue, physiologic fatigue, or chronic fatigue syndrome.

  1. Talk to your naturopathic doctor about adaptogenic herbs.

Adaptogenic herbs are an important natural tool for improving mood and energy.

Adaptogens help the body “adapt” to stress. They up-regulate genes involved in boosting the body’s natural stress resilience.

They also balance the cortisol curve, and protect the brain from the effects of stress.

Because of this, adaptogens not only improve energy and mental and physical endurance, they also improve attention and concentration, immune system function, and mental work capacity.

They can treat depression and anxiety, and regulate circadian rhythms.

Common adaptogens are withania (or ashwaghanda), rhodiola, holy basil, the ginsengs, like Siberian gingseng (or eleuthrococcus), schizandra, liquorice, and maca, among others.

My two favourite adaptogens are ashwaghanda and rhodiola, however your naturopathic doctor can work with you to pick the best herbal combination for your individualized needs.

9. Rule out Chronic Fatigue Syndrome.

Chronic fatigue syndrome (CFS) is characterized by fatigue that lasts 6 months or longer, is not improved by exercise and rest, is not related to an imbalance in lifestyle, and is not caused by a primary health condition.

Those with CFS often have signs of an activated immune system such as enlarged lymph nodes, a low-grade fever, or a sore, inflamed throat. Sufferers may experience generalized weakness and pain.

CFS can be an extremely debilitating condition that results in a 50% reduction of daily functioning.

The cause of CFS is not known, however balancing HPA axis function, improving nutrient status, reducing inflammation, healing the gut, reducing toxic burden, boosting mitochondrial functioning, and promoting self-care are all useful treatment strategies.

  1. Rule out food sensitivities.

Research may suggest that fatigue, including CFS, may be caused by food sensitivities. IBS and food intolerance are also linked to fatigue of various types.

Our gut is the seat of the immune system, sampling foreign substances from the external environment and activating an immune response, if it finds any of those substances pose a threat to the health of the body.

If our immune system comes into contact with something doesn’t like, even if that something is a benign food substance, an inflammatory reaction can be triggered. Chronic inflammation can exacerbate fatigue.

To test for food sensitivities, your naturopathic doctor will either order a blood test, or recommend an elimination diet where suspicious food is removed from the diet, the gut is healed, and foods are later reintroduced.

Common foods to eliminate are gluten, dairy, sugar, eggs and soy. Stricter Autoimmune Paleo diets involve the removal of all dairy, eggs, grains, legumes, and nuts.

  1. Mind your mitochondria.

Our mitochondria are the “powerhouses” of the cell, responsible for making ATP, our body’s energy currency, out of the carbs, protein, and fats from our food.

Research has shown a link between mitochondrial dysfunction and chronic fatigue.

The mitochondria need a variety of different nutrients to function optimally. These nutrients include B vitamins, magnesium, Coenzyme Q10, and certain amino acids.

When the mitochondria are unable to produce sufficient ATP, fatigue may result. Similarly, a problem with antioxidant production can result in the buildup of reactive oxygen and nitrogen species, otherwise termed “free radicals”, in the mitochondria.

Free radicals can trigger inflammation and immune system activation in the entire body, causing us to feel ill and fatigued.

B vitamins are also important for a process called “methylation” which is essential for energy and hormone production, immune function, detoxification, mitochondrial function, and DNA repair.

  1. Balance your blood sugar.

Insulin resistance, hypoglycaemia, type II diabetes, and metabolic syndrome are all common conditions that reflect the body’s inability to regulate blood sugar.

All of these conditions can cause frequent energy crashes, fatigue after eating, brain fog, and lethargy.

Even those free of the above conditions may still struggle with blood sugar imbalances. Signs of blood sugar dysregulation are craving sweets, feeling hungry less than 3 hours after a meal, getting “hangry”, feeling weak and dizzy if missing meals, waking at night, and snacking at night.

Balancing blood sugar by eating enough fibre, fat and protein at every meal is essential to maintaining the endurance to get through the day.

Your naturopathic doctor can help you come up with a diet plan that keeps your blood sugar balanced and your energy levels stable throughout the day.

  1. Support your immune function and eradicate chronic infections.

Chronic infections can result in prolonged activation of the immune system, resulting in chronic fatigue.

Viral infections, like mononucleosis and Epstein Barr, and gut bacteria imbalances, such as SIBO, C. Difficile, and candida overgrowth can be implicated in chronic fatigue.

Supporting the immune system with herbs, balancing the HPA axis, and using natural remedies to eradicate the infection are all courses of action you may take with your naturopathic doctor to eradicate infectious causes of fatigue.

  1. Uncover and treat hormone imbalances.

Our hormones, the messengers of the body, regulate how our cells talk to each other.

Hormones are responsible for blood sugar control, the stress response, ovulation and fertility, sex drive, metabolism, and, of course, energy production and utilization.

It is possible that those who suffer from low energy have an imbalance in the hormones cortisol, insulin, estrogen, progesterone, DHEA, testosterone, or thyroid hormones. Directly addressing hormones is then the main treatment goal for improving energy.

Uncovering other signs of hormonal imbalance, such as the presence of PCOS, endometriosis, or symptoms of hypothyroidism, as well as ordering blood tests, can help reveal if an imbalance in hormones is the main cause of your fatigue.

  1. Encourage detoxification.

Our body has the powerful ability to process and eliminate the 500 chemicals and toxic substances we come into contact with daily, as well as the hormone metabolites and immune complexes produced as a result of normal metabolic functioning.

Our livers, kidneys, colon, and skin regularly filter hundreds of harmful substances from our bodies. This process happens naturally without the aid of outside support.

However, it is possible that an increased toxic burden on the body paired with a sluggish liver and digestive system, can increase the body’s overall toxic load.

Toxic overload can contribute to fatigue by increasing inflammation and immune system activation, as well as impairing energy production pathways, and disrupting hormonal function.

Reducing contact with harmful toxins, while supporting kidney, liver and colon function can help restore optimal energy and health.

Treating fatigue first involves developing a relationship with your healthcare provider: finding someone who takes your concerns seriously.

Conducting a thorough assessment of blood, lifestyle factors, sleep, hormones, and digestion, and as many other factors as possible, is essential to uncovering the cause of fatigue.

Treatment involves removing obstacles to healing, supporting energy production, balancing lifestyle, and using herbs to boost energy and stress resilience.

When we consider fatigue as an important sign that something in our body is functioning sub-optimally, we can use our energy levels are important indicators for health.

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