Certain amino acids, when taken therapeutically, can affect our body’s ability to produce neurotransmitters that can greatly impact our mental and emotional health. These therapies can help treat depression, food addictions, alcoholism, psychosis and anxiety, among other things.
Transcript:
Hello, everybody, my name is Dr. Talia Marcheggiani. I am a naturopathic doctor and I work in Toronto and I focus on mental health and hormones, especially women’s hormones.
Today I want to talk to you guys about amino acid therapy and amino acid supplementation in preventing cravings, particularly for substance addictions or sugar addiction, but also for improving our mood and mental health and for treating specific psychiatric conditions.
Amino acids are the building blocks of protein. If you think of a string of beads, amino acids are the individual beads that get connected in a string and then folded up into the proteins that make up our body. Our body is basically just a hunk of protein and water. And these proteins set the stage for all of the chemical reactions, as well as the structure of our body.
When it comes to addictions and mental health conditions, there’s a lot of debate around what sets the stage for someone to experience addiction, or struggle with addictions throughout their life. And one of the things that gets a lot of blame, that also fits the pharmaceutical model, especially when it comes to depression and the prescription of serotonin re-uptake inhibitors, is this idea that mental health and addiction is something innate, that we’re born with and that needs to be corrected chemically with something like a drug like an SSRI. And we know that there’s obviously a genetic component to addictions and mental health and it’s certainly not the fault or moral failing in the person that’s suffering from these kind of things, but we also know that our genes don’t write the entire story of our experience and that, for many people, there’s lifestyle changes that can really influence genetic predispositions.
So a study that was done in rats who had a built-in genetic predisposition to addiction, to cocaine addiction, particularly, because they had a deficiency in a hormone called “dopamine”, or issues with their dopamine synthesis, and cocaine is a really potent stimulator of dopamine, which is kind of like a pleasure and reward hormone, or neurotransmitter, in our brains. These kinds of rats that were treated with amino acids, they didn’t display addictive behaviours, so they were essentially cured and their genetics were no longer relevant in terms of how they were acting out, or their behaviour, which is really promising because it was just amino acid therapy.
So neurotransmitters are hormones that work in our brain; they’re produced and act in the brain. Well, we know now with more research, I mean that’s the traditional definition of neurotransmitter, but from more research we’ve found that there’s evidence for the gut producing certain neurotransmitters like serotonin. So you can watch another video where I talk about the gut and how important it is to have a healthy gut when it comes to managing mental health, especially in depression and anxiety.
There’s a few neurotransmitters that are really, that really influence our behaviour and our mental health status and so the first one I already mentioned is dopamine, which gives us that sense of reward and gives us a sense of pleasure. So, dopamine is active when you’re doing something that is really internally motivating. You’re engrossed in a task. In terms of addictions, it’s that seeking behaviour. So a lot of people will experience pleasure in seeking out their substance of choice or thinking about indulging in sugar when they get home from work. So, that’s dopamine, that’s sort of our—the pleasure that we get from acting in the world and it definitely runs part of the show when it comes to addictions.
To quote another study in rats, so dopamine is really prevalent in our hypothalamus and so, with rats, you can give them a lever where they can direct cocaine directly into that area, and so it gives them a giant hit of dopamine. And rats that are given that option, will choose that option over food and so they’ll just stimulate their brain until they die. They’ll drink some water here and there but most of the time all they do is stimulate their dopamine. So that’s how pleasurable it is. It’s pretty much the influence of how we behave in the world and what goals we set for ourselves in the world as well. It’s how we get our delayed gratification, it’s how we work towards pleasurable tasks and how we engage in things like study or work goals or things like that.
Another neurotransmitter, serotonin, which I’ve talked about before, and that’s what the SSRIs, so selective serotonin re-uptake inhibitors are working on. And those are the most widely prescribed psychiatric medications. And that’s the hypothesis that people with depression and anxiety have a deficiency in serotonin: just this kind of innate serotonin deficiency where they either don’t make enough or they’re metabolizing it more quickly than other people. So serotonin is kind of our happy hormone, that’s what gives us a sense of well-being and pleasure. And, there’s no evidence for this hypothesis, however know that through stimulating serotonin pathways, to an extent, we can get some favourable outcomes. We also know that SSRI medications deplete serotonin, and that there’s a connection between serotonin and sugar addictions, because eating sugar will increase serotonin. So a lot of women with sugar cravings during PMS. So a couple of weeks, sometimes up to two weeks before their periods, some women will get really intense cravings for sugar and carbs, and that’s indication of a fall in serotonin before their period, which is causing them to seek out these things to boost their serotonin levels. And that can be treated with amino acids.
And then a third is acetylcholine. So acetylcholine is involved in memory and cognition and sort of that feeling of being engrossed in a task. Not so much involved in pleasure, but in our ability to stay focussed and to concentrate.
A fourth neurotransmitter is called GABA. GABA suppresses our nervous system. So, this is relevant in people with anxiety and this is what the drug class benzodiazepines work on, is GABA receptors. So, in our limbic system, GABA kind of calms down that fight or flight, or that fear state in our body. And oftentimes people who have a heightened nervous system or stress response could use some GABA to calm them down.
So there’s a few amino acids that work on these neurotransmitters. So these neurotransmitters are built with an amino acid backbone. By giving these amino acids, we’re kind of like—if you think of all these neurotransmitters assembled on a factory line, the amino acid is the starting point. So if you’re giving a lot of the supplies, then you’re more likely to cause in increase in production of the thing that you’re increasing the supply for.
We also know that there can be deficiencies in amino acids and therefore, if there’s a shortage of supplies for the key ingredients for the things you’re producing in a factory, you’re not going to get the end result because there’s just not enough of the raw materials to make what you’re trying to make.
So, we can have things like serotonin deficiency not so much because there’s a genetic predisposition, or an issue with the brain’s ability to metabolize it or make it, but maybe that there’s a deficiency in the amino acids, or the vitamins and minerals that are needed to create serotonin.
When it comes to naturopathic medicine and functional medicine, we kind of look at this. We try and see how we can influence the body’s biochemical pathways to get more of what we’re noticing is lacking. And so one of the ways that we can find out which neurotransmitters are lacking is by running some functional tests. That’s not really a big part of my practice because of the cost involved in that, but we can tell a lot through symptoms. So we can tell a lot by asking, are people getting sugar cravings, what’s their drug of choice, are they heading towards cocaine or are they calming their nervous system down and stimulating their GABA pathways with alcohol. Are they trying to get that pleasure sensation with something like heroin? Are they going for stimulants or central nervous system depressants? So, based on what someone is addicted to, or looking at and really breaking down their addictive behaviours, we can find out more about which neurotransmitters might be off. And in a lot of cases there’s a deficiency in many of them.
One of the first things to recommend, just generally, is to increase more protein in the diet, because we know that these amino acids are contained in proteins. And, strangely enough, we don’t get a lot of high-quality protein in our diet in the Standard American Diet, so you think of a bacon and eggs breakfast and McDonald’s lunch and you’re like, ‘well, there’s protein in those foods…’ But, in something like eggs, we’re only getting about 6 grams of protein an egg, whereas I recommend more like 20 to 30 grams of protein in the morning for breakfast. And the reason for this is, of course, to just increase the amount of amino acids that your body can then use to make neurotransmitters, but also to keep blood sugar stable, because drops in blood sugar are going to cause stress hormones to be released and potentially for these neurotransmitters to be altered, worsening addictions, especially addictions to sugar and alcohol, which boost our blood sugar.
So the first thing, dopamine, that amino acid that creates dopamine is tyrosine. So, for some people, and tyrosine is a very stimulating amino acid, so people that kind of have that 2 pm slump, sometimes benefit with some tyrosine, or tyrosine in the morning when they’re feeling really low. And so these people kind of suffer from boredom, they really like stimulants, so they’ll do the caffeine, or they’ll use cocaine on the weekends, or they’re really involved in pleasure-seeking behaviour like, maybe they had a diagnosis of ADHD as a kid, or adult-onset ADHD, which is more involved in traumatic experiences and mental health and neurotransmitter imbalance than it is some genetic predisposition.
Sometimes with these people, supplementing with tyrosine can help, just give them that dopamine boost and keep their nervous system more stimulated so that they don’t need to stimulate it with substances.
For serotonin, the building block is l-tryptophan, which is then made into something called 5-HTP. So some naturopaths will prescribe l-tryptophan as a supplement, I tend to go more with 5-HTP because it passes a step so that your body has to do less work. 5-HTP is really great to help with sleep. It’s good to help with boosting mood, to a certain level, and it’s also really great for PMS sugar cravings, and alcohol cravings. I find myself, personally, so this Christmas I’m going sugar and alcohol free. I’ve been sugar and alcohol free for a few months, but I’m going to carry that on through the holidays, so I’ve had to turn to 5-HTP before my period because I realized how many sugar cravings I get before then. And, miraculously, just with a few hundred milligrams of 5-HTP, I’ve noticed a giant change in the foods that I was craving and in my ability to hold off on having sugar and alcohol. So, pretty powerful.
So, in order to make serotonin, 5-HTP also needs some B vitamins and magnesium. So, people that are deficient in things like B6 and B12 and folate, so I’m looking at vegetarians who often have B12 deficiencies, or vegans. And, actually I see a lot of B12 deficiency or suboptimal B12 in people that eat meat as well, so this isn’t necessarily something is only applicable to vegetarians.
But it’s important for a lot of people to supplement then with these other cofactors that help make serotonin, especially if they’re on an SSRI already. And I don’t advise just doing this on your own, it’s better to do this with a professional who can figure out what’s the underlying cause of a neurotransmitter imbalance and then help prescribe a comprehensive treatment plan that will get you to better neurotransmitter synthesis and treat your symptoms, or the underlying condition.
Something else that I find really helpful, and this is one of my favourite nutrients in psychiatry and in women’s health and something I take is something called N-acetyl cysteine, or NAC, “NAC”. And NAC is from the amino acid cysteine and it produces something called glutathione. So glutathione is the primary antioxidant in the body. This is what our body uses to neutralize all of the free radicals, that is kind of a buzzword—people will tell you to drink green tea, eat blueberries, to get antioxidants, well, the main antioxidant our body uses is something called glutathione, and NAC helps produce glutathione.
It helps our liver detoxify and, in hospitals medical professionals will give people intravenous NAC to treat Tylenol overdose, which we know is liver toxic, so it’s widely recognized that NAC can treat toxicity of the liver. It’s also a powerful antioxidant for the lungs so I prescribe it to patients who are smokers or recovering from smoking or aren’t really ready to quit smoking yet but are experiencing some of the bronchitis, the emphysema, or the increased phlegm or lung issues that go along with a chronic habit of smoking. So, it’s a powerful antioxidant and it has an affinity for the lungs and for excess mucus production. It also helps balance estrogen because of the liver detoxification, so it helps us detoxify estrogen through the liver, and is really helpful for a condition called polycystic ovarian syndrome, which is when the ovaries are producing testosterone and not responding to other hormones properly, so this is really helpful. It also helps with blood sugar balance. NAC’s the best. And so, there’s lots of research for NAC in things like bipolar disorder and schizophrenia and psychosis and OCD. So these more serious psychiatric conditions, NAC can really help balance. And we’re not sure exactly why but one of the hypothesis is that, because it creates glutathione, it helps lower inflammation, and we know that inflammation is implicated in mental health conditions and so that’s why NAC might be so useful. It doesn’t interact with psychiatric medications and so it’s a really big part of my practice.
New research has shown that NAC can help with addictions and cravings for things like nicotine, cannabis, food, so binge eating, cocaine and gambling, interestingly enough. And then there’s a new study that NAC can help treat porn addiction. So, it’s involved in helping lower that desire for, not necessarily substances, or food, but behavioural addictions as well, which is useful. And there’s studies in trichotillomania, so that’s like, compulsive hair plucking—so people will pluck their eyelashes or pluck their hair—or skin picking, and NAC can work pretty rapidly in bringing down those desires and stopping those behaviours.
GABA is something you also might have heard of. So, GABA was a neurotransmitter that I cited before, that calms the nervous system down. GABA, there’s debate about whether it crosses the blood brain barrier. So, our brain has this really tight wall that it prevents certain substances from crossing. That’s to protect our brain tissue from toxins and foreign objects, or foreign substances. So we’re not sure, necessarily, if GABA’s acting on the brain unless there’s a leaky brain situation happening, so kind of like leaky gut, we can also have that with our blood brain barrier. But there’s herbal combinations that help stimulate GABA, that I implement in my practice sometimes to help people that are experiencing panic attacks or anxiety, to get them to a level where they can then make the changes that are going to sustain them. So, things like valerian and hops, and passionflower and something that I prescribe a lot, kava, another herb called lemon balm. So, sometimes combinations of these, or just one of these things can help, especially before bed. And so, one of the indications for GABA deficiency is a craving for wine, especially at the end of the day, and particularly white wine. I guess it has more GABA-stimulating properties. I have a lot of patients, many of them female patients, that just really crave a glass of wine at the end of the day. And a few other patients that will have an after-work beer. So, just doing some GABA, or some GABA herbs, on the way home from work might be enough to decrease that need to reward and balance that nervous system, because the alcohol does have a GABA-stimulating effect and calms people down. It’s us looking for a way to self-medicate and trying to balance our neurotransmitters through the actions that we’re familiar with that don’t necessarily set us up for powerful health because they perpetuate further addictions, like turning to alcohol to calm ourselves back down, or as a reward and stress relief.
And the last neurotransmitter I’m going to talk about is something called l-glutamine. So, glutamine is a fuel for brain cells and for gut cells, as well as kidney cells. It’s another amino acid, it’s involved in creating the neurotransmitter glutamate, which is excitatory. So, this is something that increases our nervous system tone.
So, glutamine we prescribe as naturopaths a lot for leaky gut because it helps feed our enterocytes, or our gut cells, it can help repair them. So, somebody with celiac disease who’s experienced a lot of intestinal damage and has now taken out gluten, might need some glutamine, some l-glutamine to repair the gut cells that were damaged or increase that cell turnover so that they’re no longer experiencing symptoms.
L-glutamine has kind of got a sugary taste, but it doesn’t stimulate us like sugar does, and so one thing that people do when they’re experiencing sugar and alcohol cravings is to take some glutamine powder or open up a capsule of l-glutamine and let it dissolve under their tongue. And they experience a remarkable decrease in their sugar and alcohol cravings, those physiological cravings—the emotional cravings are another piece, obviously—but the physical cravings where our body is really asking for these foods, the l-glutamine can really help calm that down powerfully. So this is something that I’m going to experiment with myself and with some patients that I know could really benefit from this.
So I wanted to give this talk, just to give you guys some easy things to try over the holidays, especially when you’re experiencing some of those sugar or alcohol cravings or getting into a situation where your vices are playing out in excess. I know that this is going to be helpful for me, because of my commitment to no sugar or alcohol this holiday season, which is actually easier than it sounds. And one thing to note too, is that with amino acids, because we’re pushing pathways, they don’t work necessarily like drugs that can take, like an SSRI can take 4 to 6 weeks before it’s effect comes on. These work within days. So, when I was experiencing sugar cravings before my period last month, and I started to take 5-HTP, which remember stimulates serotonin, or helps us produce serotonin, and can help with sugar cravings, and carb cravings. When I started to take 5-HTP, I noticed this sense of well-being and uplifted mood within a few days and it was a noticeable effect, as well as deepened sleep. My sugar cravings immediately dissipated when I started taking it. So it took a few doses to eliminate my sugar cravings and then a few days to increase my mood, which I didn’t even realize was kind of falling, based on that serotonin deficiency before my period. So, these are really powerful therapies that you can try. I don’t advise doing it on your own, but seeking the help of a professional, but these are things that can really help balance brain chemistry during the holiday season and set you up for better mental health.
So, next talk I’m going to talk about leaky gut and leaky brain and how avoiding gluten can help with mental health conditions. So, have a great holiday, everyone and I’ll see you next time. My name is Dr. Talia Marcheggiani, and I’m a naturopathic doctor who practices in Toronto. If you have any questions give me a shout on my email at connect@taliand.com. Happy Holidays.
My mother tells a story about my childhood where she is standing in the kitchen, preparing dinner. I stand below her, tugging at her shirt, and begging for food.
“I’m hungry”, I say, according to her recollection of that moment and many others like it; she says that as a child I was always preoccupied with food. My constant yearning for something munch got to the point where every time she tried to cook dinner, I’d follow her to the kitchen, like a hungry dog, and persistently beg for food. I was insatiable, she claims. But, as an adult looking back I wonder, insatiable for what?
I remember that moment, but from the third person perspective. So I wonder if it’s as past events sometimes go, where the telling of a memory from an outsider’s perspective serves to reshape it in the imagination. I can feel the emotions, however, watching my 4-year old form tugging on my mother’s clothing, her body towering over me, her face far away. She stands at the stove. I remember feeling full of… what was that yearning? Was it for food? Was it hunger for physical sustenance or nutrition from some other source? I wonder if the constant, nagging hunger was an articulation, in 4-year old vocabulary, of the need for something else: attention, affection or reprieve from boredom. I remember being told at one point that my favourite show was on and felt some of the anxiety of missing what I was lacking dissipate: a clue.
As a child, adults occupy the gateway to food. As adults, the gateways take on another form. Perhaps it is anxiety about body shape or the guilt of knowing that eating too much of a certain kind of thing isn’t nutritious. Perhaps the barrier to sustenance is financial. However, when I stand now in the kitchen, bent over the fridge, arm slung over the open door, contemplating a snack, I know that I am making a choice. And, for myself, as for many others, it’s not always clear whether the call to eat is hunger and physiologically based.
In the west, we have an abundance problem. More and more adults are reaching obese proportions. Metabolic diseases of excess like diabetes and cardiovascular disease are increasing and more and more women are experiencing the hormonal dysregulation that can come from carrying more body fat.
While I don’t recommend aspiring to the emaciated standard that we see plastered on magazines, Pinterest ads or runways, I do think that, for many people, balancing energy intake with energy output could be beneficial for optimal health and hormonal signalling. Body fat is metabolically active. It also stores toxins and alters that way our body metabolizes and responds to hormones, insulin being just one example, estrogen being another. Therefore, conditions like PCOS, infertility, diabetes, PMS and dysmenorrhea, or certain inflammatory conditions might benefit from a certain amount of weight loss.
An addition here: this post is not about body-shame or even necessarily about weight loss per se. It’s about overcoming emotional eating patterns that might even derive from the same disordered patterns that manifest in anorexia or bulimia. The goal of this post is to bring more awareness to how we operate within the complex relationships many of have with food and with our own bodies.
There are many reasons why we eat and physiological hunger is only one of them. Tangled up in the cognitive understanding of “hunger” is a desire for pleasure, a desire to experiment, to taste, to experience a food, to share with family and friends, to enjoy life. There are also deeply emotional reasons for wanting food: to nurture oneself, as reward, to combat boredom and to smother one’s emotions like anxiety, depression, ennui, yearning for something else— we often eat to avoid feeling.
Health issues aside, I believe that Emotional Eating (as it’s so-called) is problematic because it dampens our experience of living. By stuffing down our emotions by stuffing our faces we prevent ourselves from feeling emotions that it might be beneficial for us to feel in order to move through live in ways that are more self-aware, mature, self-developed and meaningful. While some emotional reasons to eat might be legitimate (acknowledging your beloved grandmother’s hard work by having a few bites of her handmade gnocchi, for instance), many of the reasons we eat linger below the surface of our conscious mind, resulting in us suffering from the consequences of psychological mechanisms that we are unaware of. I believe in making choices from a place of conscious awareness, rather than a place of subconscious suffering.
In heading directly into the reasons I am tempted to emotionally eat, I’ve learned quite a lot about myself. I’ve ended up eating less, as I’ve become more aware of the non-hunger-related reasons that I reach for a snack, but that doesn’t have to be the end goal for everyone. I believe that just understanding ourselves through uncovering and analyzing the emotions that influence our everyday behaviours can have life-changing effects; it allows us to know ourselves better.
As I work through the process of understanding why I overeat, I’ve realized there are a few steps to address. I believe that there are layers to the reasons we enact unconscious behaviours and first, it is important to untangle the physiological from the emotional reasons for eating, understand what real hunger feels like, address the “logical” reasons for overeating and then, when ready, head straight into the emotions that might cause overeating to occur
Distinguishing between physiological hunger and emotional hunger:
The first step, of course, is to distinguish between physiological/physical hunger—the body’s cry for food, calories and nourishment—and emotional hunger. Typically, physiological hunger comes on slowly. It starts with a slow burn of the stomach, growling, a feeling of slight gnawing. It grows as the hours pass. For some it might feel like a drop in blood sugar (more on this later): feeling lower energy, dizzy and perhaps irritable. Physiological hunger occurs hours after the last meal, provided the last meal was sufficient. Usually, if one drinks water at this time, the physiological hunger subsides and then returns. Essentially, eating a meal or snack will result in the hunger vanishing and returning again still hours later.
Emotional hunger, however, is different. It starts with an upper body desire to eat. It might be triggered by commercials, social situations, or certain strong emotions. There might be cognitive reasons to eat (“I might be hungry later” or, “Oh! We’re passing by that taco place I like!”) that are not directly guided by the physical desire for sustenance. Emotional eating is often felt in the mouth, rather than the stomach. It might be brought on by the desire to taste or experience the food, rather than to fill oneself. The cravings might be specific, or for a certain food-source, such as cookies (this is not a hard and fast rule, however). Emotional hunger does not vanish from drinking water. Emotional hunger comes on suddenly, and is often not relieved by eating the prescribed amount of food (having a full meal); oftentimes we finish lunch only to find ourselves unable to get the cookies at the downstairs coffee shop out of our heads.
2. Settling hormonal reasons for overeating: serotonin, insulin, cortisol:
Not all physiological hunger, however, is experienced as the slow, gnawing, slightly burning, grumbling stomach sensation described above. Sometimes we experience the need to eat because our blood sugar has crashed, or our neurological needs for serotonin have gone up. We might eat because stress hormones have caused blood sugar to spike and then crash. We might also experience certain cravings for food because our physiological needs for macronutrients; like carbs, fat or protein; or micronutrients, like sodium or magnesium, have not been met.
Therefore, it becomes essential to address the hormonal imbalances and nutritional deficiencies that might be causing us to overeat. Oftentimes, getting off the blood sugar rollercoaster is the first step. This often involves a combination of substituting sugar and refined flours for whole grains, increasing fats and protein, and, of course, avoiding eating carbohydrate or sugar-rich foods on their own. It often involves having a protein-rich breakfast. I tend to address this step first whenever my patients come in and express feeling “hangry”: irritable and angry between mealtimes.
Often drops in brain-levels of serotonin cause us to crave carbohydrate-rich foods. This is very common for women experiencing PMS. In this case, balancing hormones, and perhaps supplementing with amino acids like l-glutamine, tryptophan and 5-HTP, can go a long way.
One of the questions I ask my patients who crave a snack at 2-3 pm (a mere 2-3 hours after their lunchtime meal), assuming their lunch contained adequate nutrients, is “Do you crave, sugar, caffeine, salt or a combination of the above?” Cravings for sugar or salt at this time might indicate a drop in cortisol and give us a clue, combined with the presence of other symptoms, that this person is in a state of chronic stress, burnout or adrenal fatigue. In this case, it is essential to support the adrenal glands with herbs, nutrients, rest, and consuming adequate protein during the afternoon crash.
Finally, when it comes to cravings for foods like chocolate, meat or nuts, or even specific vegetables (when living in South America I would experience over-whelming cravings for broccoli, funnily enough), I find it important to identify any nutrient deficiencies. It is common to experience a deficiency in something like magnesium, iron, selenium, zinc, and the fat-soluble vitamins A, D, E and K; and our bodies will do their best to beg us for the specific foods they’ve come to learn contain these nutrients. Either consciously eating more of these foods (like brazil nuts in order to obtain more selenium), preferably in their healthiest form (such as dark chocolate, as opposed to milk chocolate, to obtain magnesium), or directly supplementing (in the case of severe deficiency), often results in the cravings diminishing.
3. The Hunger Scale and food diaries:
One of the first things I have patients do is understand the Hunger Scale. There are a variety of these scales on the internet that help us cognitively understand the stages the body goes through on its quest to ask for food and it’s attempt to communicate fullness. Being able to point to certain levels of hunger and fullness and pinpoint those physiological feelings on the Hunger Scale allows us to further flush out the subtleties between a physical or emotional desire for food.
Food diaries, I find, can help bring more awareness to one’s daily habits. Oftentimes, keeping a food diary for a few weeks is enough for some patients to drop their unwanted eating behaviours altogether. Other times, it can help us detect food sensitivities and unhealthier eating patterns or food choices. It also helps me, as a practitioner, work off of a map that illustrates a patient’s diet and lifestyle routines in order to avoid imposing my own ideas in way that may not be sustainable or workable for that particular individual.
A word about diet diaries, however: when recording food for the purpose of uncovering emotional eating behaviours, I often stress that it is important to record every single food. Sometimes people will avoid writing in their diary after a binge, or outlining each food eating when they feel that they’ve lost control, writing instead “junk food”. Guilt can keep us from fully confronting certain behaviours we’d rather not have acted out. However, I want to emphasize that the diary is not a confession. It’s not, nor should it be, an account of perfect eating or evidence that we have healed. Keeping a diet diary is simply a tool to slow down our actions and examine them. It’s a means of finding out how things are, not immediately changing them into what we’d like them to be. This is an important reminder. The best place to start any investigation into being is from a place of curiosity. Remember that the point of this exercise is to observe and record, not necessarily to change, not yet; it is very difficult or even, I would argue, impossible to completely eradicate a behaviour if the reasons for engaging in that behaviour escape our conscious awareness.
Therefore, recording food allows us to begin to poke at the fortress that contains the subconscious mind. We start to slow down and uncouple the thoughts and emotions from the actions that they precede and, in doing so, develop some insights into how we work. It can also help to start jotting down other relevant points that might intersect with what was eaten. These pieces of information might include time of day, where you were, what thoughts were popping into your head, and how you felt before and after eating the food. As we observe, more information begins to enter our conscious experience, allowing us to better understand ourselves.
4. Pealing back the layers: Understanding the “practical” and logical reasons for overeating:
One of the things that I have noticed, through my own work with addressing emotional eating, is that there are often layers to the “reasons” one might overeat. Some of the first layers I encountered were cognitive, or seemingly “logical” reasons. For example, I noticed that before eating without hunger I might justify it by thinking “I need to finish the rest of these, I don’t want them to go to waste”, or “I’ll finish these in order to clean out the container”, or “I should eat something now so I won’t be hungry later”, or “I didn’t eat enough (insert type of food) today so I’ll just eat something now, for my health”, or “If I don’t have some (blank) at so and so’s house, she’ll be offended”.
When looking more closely into these justifications, I found them to be flawed. However, they were logical enough for me to eat for reasons other than to satisfy a legitimate, physiological yearning for nutrients. It’s interesting to see how the mind often tries to trick us into certain behaviours and how we comply with its logic without argument.
5. Addressing the practical reasons: Planning:
In order to address the first layer of rationale for eating when not hungry, I decided to do the following: I would plan my next meal and either have it ready in the fridge, or pack it with me to go, and then I would wait all day until I was hungry enough to eat it. I would repeatedly ask myself, every time I thought of reaching for my portions, “Am I hungry now?” And would answer that question with, “Is there a rumbling in my stomach? No? Then it’s not time to eat.”
I found it would often be a several hours later before my body would genuinely ask for the food. I also found that eating satisfied the physical hunger often much sooner than it took me to finish the food. I realized how I often eat much more food and much more often, than I genuinely need.
However, holding off eating until physical hunger arises takes a conscious effort that is often unsustainable. Few of us can move through our busy lives constantly asking ourselves how hungry we are and when, and then have food at the ready to satisfy that hunger with appropriate, healthy choices. Therefore, I used this practice as a mere stepping stone to move through the deeper layers of emotional eating. By addressing the rational and logical reasons for overeating, I was able to get in touch with the deeper, emotional (and, arguably, real) reasons for which I was eating without hunger.
6. Pealing back the layers: Understanding the deeper, emotional reasons for overeating:
For a while I would wake up, make myself a coffee, and then wait until I felt hungry. Sometimes the feeling would arise in a few minutes, sometimes it would take hours. Depending on what I’d eaten the previous day and what my activity levels were, I would often not get hungry until well into the afternoon. However, the thoughts of eating something would frequently persist. And when the thoughts came up, whereas before they would be satisfied by me having something to eat, I now resisted them. When I resisted the thoughts, their associated emotions would strengthen. I then decided to journal before reaching for food, especially when I wasn’t sure if I was actually hungry or not.
Journalling can help us pull up, process and make sense of some of our emotions. I would write about what I might be feeling—what I might be asking for that wasn’t food. Through doing this, emotional reasons for hunger began to surface. The more I held off eating, the stronger and more clear the emotions became. It was a deeply uncomfortable process. This is why we emotionally eat—removing the emotions is often far more pleasant than dealing with them.
Emotions that surfaced were anxiety, ennui, boredom, loneliness and sometimes even anger. However, boredom and a listless, almost nihilistic, sense of ennui were among the two most common emotions I realized that eating medicated for me. For me, eating was entertainment. It broke up the monotony of the day and gave my senses something to experience. It gave my body something to do: chewing, tasting and digestion. Not eating made that sense of boredom grow stronger.
7. Addressing the emotional reasons: Nurturing and preventing:
Knowing more about the root emotional causes for overeating allowed me to work more closely with the source of my behaviour. I find that the closer we get to the source, to the roots, the more effective we are at removing the weeds, or behaviours, from our lives. I knew now that if I didn’t want to overeat, I would have to prevent myself from getting bored. I would have to have checklists of things to do. I would stay active and engaged in life: in my work, my friendships, and the other non-food-related things that brought meaning to my life.
During this time, I did more yoga and meditated. I journaled and wrote. I also meditated on boredom. I traced it back to where I might have felt it in my life before and noticed themes of boredom in my childhood. I realized that the child tugging on her mother’s shirt and asking when dinner was ready was probably a child who needed something to do, a child who was bored.
8. Pealing back the layers further: Working directly with core emotions:
Going even further, we can begin to peal back the layers of the emotional reasons for overeating in order to avoid replacing one “addiction” with another—such as replacing overeating with over-busying oneself, distraction or overworking. I began to find other emotions that ran deeper than mere boredom. I also realized that whenever I had felt boredom in the past, there was a threshold, often filled with discomfort, that I would eventually surpass. Once surpassing this threshold, a well of creativity, or a plethora of interesting insights, would spring forth. I remember as a child I would create stories, or lie on my bed and stare that the ceiling of my bedroom, contemplating the nature of the universe. These beautiful moments had been made possible by boredom and my courage to not distract myself from it.
Working with a therapist, or doing some deep inner work, we can access the core beliefs and emotions that might cause these emotional reasons for overeating to exist. Oftentimes we encounter core beliefs whose effects spill out into other areas of our lives, preventing us from living fully and consciously. Working through these beliefs can be deeply satisfying and help us experience transformational self-growth.
9. Setbacks: Understanding Change Theory:
Finally, engaging in this process of self-discovery doesn’t follow the same pattern in every person. Some people may find that their reasons for overeating are dissolved as soon as they start recording the foods they eat (this is surprisingly common). Others might find that years of working with a therapist have resulted in a mere dent in their ability to eat in response to hunger and to stop unwanted eating behaviours. In most everyone progress is not linear.
Change Theory and the Stages of Change schema depicts the alteration of behaviours as cyclical, rather than linear. As we move through the stages, we enter a cycle of pre-contemplation, contemplation, planning, action and maintenance. Sometimes we fall out of the cycle and relapse. Many people working with behavioural changes and addictions prefer to rename relapse “prolapse”, claiming that prolapse is a necessary stage for continuing the cycle of change and that much is to be learned from failing at something. It is through observing how the world produces unexpected results, and then attempting to understand the unexpected while trying again, where learning takes place. We don’t really learn if we don’t fail.
Sometimes addictive behaviours, emotional eating included, worsen at a time when someone is on the verge of making a massive breakthrough. Sometimes poking at a new layer of the source of unwanted behaviour accompanies an exacerbation in the practice of that behaviour. Having curiosity and self-compassion throughout the process is essential. Savouring the increased self-awareness that comes with any effort to effect change in one’s life is part of the enjoyment of the experience.
In response to my very popular article about the Mirena IUD and how that can upset hormone balance, or further an existing imbalance, I talk about a condition called “estrogen dominance” can result in hormonal symptoms, such as PMS, infertility, weight gain and anxiety.
Hello everyone, my name is Dr. Talia Marcheggiani. I’m a naturopathic doctor with a special focus in mental health and hormones, especially women’s hormones.
So, today I’m going to talk about an article I wrote about a year and a half ago that gotten a lot of activity online and it’s called “Let’s Talk Mirena: Anxiety and Hormone Imbalance”. I wrote the article because I was seeing a few patients who had the Mirena IUD and a series of similar symptoms. So, anxiety, panic attacks, and just a general sense of hormone imbalance. And when we ran their labs, when I looked at the levels of progesterone in their blood, they had very low progesterone. So I wrote an article about this and about the phenomenon of “estrogen dominance” that we naturopaths talk about a lot. And I got this resounding response online, so even today, sometimes, I’ll get a couple emails a day of people expressing their experiences and their agreement with the article and their confusion and frustration and anxiety around some of the symptoms that they’ve been experiencing since getting the IUD.
So, the reason I wrote the article is not because I don’t agree with the Mirena IUD. I’ve written another article called “Having a Healthy Birth Control Experience” in which I state that as a form of contraception, a hormonal birth control and a hormonal implant such as the IUD can be really great measures against unwanted pregnancy, because their efficacies are very very high—I think the Mirena IUDis about 99%pregnancy avoidance— and you don’t need to think about it, you don’t need to take a pill every day, so for some women this is ideal.
The issue is that a lot of women are being prescribed the Mirena IUD as a solution for Estrogen Dominance. And so what I find in my clinical practice, and I’ll talk more about estrogen dominance in the course of this video, but what I find in my clinical practice is, because it doesn’t address the underlying cause, and because it’s hormonal in and of itself, and it adds more hormones to the body, in a specific location, the uterus, and because it doesn’t address the underlying imbalance, it either worsens or ignores the condition of estrogen dominance, causing symptoms to get worse and women to feel frustrated and lost and then write to me.
Mirena is often prescribed to women with heavy and painful menstrual bleeding. So, this could be a diagnosis of endometriosis, or ovarian cysts, or just symptoms that they’re experiencing. So a lot of them might be experiencing iron deficiency because of the heaviness of the bleeding and a lot of women are out of commission for a couple of days every month because their period is so heavy and uncomfortable and they feel weak and they’re in pain and maybe they deal with really intense PMS. Some of my patients deal with PMS for 2 weeks out of the month, which is crazy and super uncomfortable.
Conventional medical doctors prescribe the Mirena IUD to combat these symptoms because with birth control and the IUD, one of the side effects is really light periods and some people don’t even get their period at all on Mirena and so you can imagine, if you’re period is this time of the month where you can’t go to work and you’re just basically hemorrhaging from the insides, then it would be a massive relief to not have to deal with a period anymore for 5 years, which is how long the hormones last in Mirena.
But one of the issues is that we need to look at the cause of these symptoms. Oftentimes these symptoms are caused by a difference in estrogen and progesterone, so these are two of the main female sex hormones. One of the things that happens in conditions like endometriosis or heavy and painful periods is that the estrogen is high in relation to the progesterone in the body. And so this is really apparent in a condition like endometriosis where there’s often high estrogen and also fibroids. So both of those cause terrible periods, and they need to be ruled out when periods are heavy and uncomfortable. And then there’s ways that we can deal with that as naturopaths.
But even without an underlying health condition, just primary dysmenorrhea, that’s not caused by another diagnosis is often the result of estrogen dominance.
And so the Mirena, because it’s made of only progesterone, can help with the uterine symptoms of estrogen dominance, which would be the heavy and painful periods. However, we have estrogen and progesterone receptors all over our body, not just in our uterus, and so when we’re putting hormones in one part of the body, and they’re not ending up in the rest of the body, we start to worsen that deficiency, or that relative deficiency in progesterone.
So women will mention, and one of the most common symptoms is anxiety and panic attacks, because progesterone this kind of calming effect on the central nervous system, on the brain, so it kind of chills you out and helps you handle stress.
Estrogen is a hormone that causes women to ovulate, so it’s a pro-ovulatory hormone and it also helps build up the uterine lining. So the more estrogen we have, the thicker the lining and therefore when we shed the lining during our period, the more we have to shed. So, more estrogen, the thicker the lining, the heavier and, by proxy, more painful the period.
Progesterone is a hormone that, in terms of reproduction, it helps us maintain the lining (of the uterus). So, if you ovulate and then that egg gets fertilized by sperm, then the egg gets implanted in the uterus and progesterone starts to increase, so pregnancy is a very progesterone dominant condition and one of the signs of a low progesterone state is when women who have been pregnant say that that’s the most balanced they’ve ever felt because progesterone is naturally higher in pregnancy.
Progesterone starts to rise when you become pregnant and that maintains the lining throughout the 9 months and then, after the 9 months, you have your baby. If the egg doesn’t become fertilized then progesterone rises for the last 2 weeks of the cycle and then it falls, along with estrogen, you shed your lining and then you have a period.
And for some women, they sail right into their periods. They have no PMS symptoms, they might feel a little bit bloated a couple of hours before and then they go to the washroom and go, “ok, look, there’s blood I’m having my period.” And for other women, it’s not the case, they get warning signs, like i said, before two weeks, so pretty much from ovulation to when their period happens. So, half of their life: 2 weeks out of every month.
And so, what happens with a lot of women is that there’s higher estrogen in relation to progesterone. So we call this “Estrogen Dominance”. And there can be three possibilities in this state. One is that estrogen is abnormally high and progesterone is normal, or optimal. Another is that estrogen is normal or optimal, progesterone is low, and a third option is that you have both at the same time: so estrogen is high and abnormal and progesterone is low and that’s more common than you think in a lot of women who are dealing with really severe symptoms, that divide between the two hormones is really off. And, as I mentioned before, prescribing birth control pill or Mirena IUD are not solutions because they’re not correcting the underlying imbalance. They’re not looking at the cause of why this imbalance is happening in the first place. Instead, they introduce foreign, fake or synthetic hormones into the system to try and correct the balance, but our body has a delicate balance and a delicate ecology and so when we try and shift that balance artificially sometimes we pay the price and we don’t necessarily feel balanced.
So, why does this occur? Why do people get estrogen dominance and how do you fix it? So, when it comes to the first situation, high estrogen, and normal progesterone, there’s a couple of reasons why estrogen might be high. So the first is exposure to foreign estrogen, or excess estrogens in the environment. And, so many of you may have heard of these “xenoestrogens”, or toxic estrogens, from sources such as BPA, so the lining of tin cans, or those plastic water bottles or baby bottles that everyone was throwing out and replacing with glass and stainless steel, which is a great idea. So, we’re in contact with these in the environment through the cosmetics, cleaning products, and some of the plastics that we hold and interact with on a daily basis. And paper receipts have this as well. So cashiers and people that handle receipts regularly are in contact with BPA. And it’s absorbed through the skin. So just this exposure to these toxic estrogens can activate estrogen receptors and it increases estrogen in the body. And that’s problematic. We know that these can also set the stage for hormonal cancers, like breast cancer, you might have heard of estrogen-receptor positive breast cancer, or ovarian cancer and endometrial cancer and cervical cancer. So these are all kind of these foreign estrogens influence the body’s hormones in a negative way causing growths.
The second reason why estrogen might be high is the reduced ability of the body to detoxify estrogens. So, when we’re done using the estrogen that we need, our liver cleans our blood of estrogen, then we dump the estrogen biproducts into the colon and then we eliminate them by having a bowel movement. And this is a normal process in lowering the toxic estrogen or the estrogen metabolites, the estrogen we don’t need anymore. And so when this process is either over-burdened by too many xenoestrogens, so those plastic estrogens, or limited in some way because our liver is trying to detoxify other things, such as alcohol, or tylenol, or some of these over-the-counter drugs, the liver just can’t handle the burden and so, in terms of treatment we need to bolster the liver’s detoxification abilities. And a lot of the time those two things exist at the same time: you’re getting too many foreign estrogens, we need to clean up the environment and the diet and make sure everything you’re getting is promoting a healthy estrogen metabolism.
And then, why progesterone might be low, which is the other arm or possibility of this estrogen dominance condition that I’m speaking of is stress, mainly. So, when we’re stressed out, and we’re dealing with a lot our body produces a hormone called cortisol and that’s the “stress hormone” that helps us deal with high amounts of pressure and stress. And a lot of the time stress is not perceived so, just this feeling of being tired and wired, disrupted sleep, sugar cravings around 3-4pm, having a difficult time getting up in the morning, feeling a little bit stretched thin, maybe feeling a drop in motivation, are all signs of chronic stress. So what happens is our adrenal glands, these pyramid-shaped endocrine glands that sit on top of the kidneys, they make cortisol. And when our body has more cortisol than it needs, or when it needs to make progesterone, it takes the cortisol and it makes progesterone with it. So it’s kind of like leftover cortisol that it’s not using gets made into progesterone. After ovulation, the ovaries also produce progesterone, but part of the progesterone production in the body come from the adrenal glands.
So you can imagine: if you’re stressed out and you’re spending all of your adrenal function on making cortisol you’re not going to have enough time or resources to make progesterone. So a lot of bringing up progesterone balance is by either lowering environmental stress or increasing adrenal function. We also look a nutrient deficiencies and we can also look at bringing pituitary balance by using an herb called vitex, which can help balance hormones and kind of right that estrogen-progesterone imbalance that might be going on.
So what happens when you give the Mirena, or you give an oral contraceptive to deal with this? Well, what happens is, there’s an imbalance and you induce another imbalance kind of over top. So, the body is still not making enough progesterone, there’s still too much estrogen, toxic estrogen, and what you’re doing is giving synthetic progesterone, which doesn’t have the same effects, progestins, synthetic progesterone, it doesn’t have the same effects as regular progesterone and often doesn’t work on the brain, so it doesn’t have that low anxiety effect, that calming effect, and it doesn’t prevent the estrogen-dominant cancers, it doesn’t help with ovarian cysts, it doesn’t manage endometriosis, other than stopping your periods, perhaps, if you’re reacting to it. And then you’re also, if you’re doing a combined oral contraceptive pill, you’re introducing more xenoestrogens to the body that your liver then has to clear out and that are going to cause more of those estrogen-dominant symptoms. And, in the colon we know that oral contraceptives can cause a bacterial imbalance, so a dysbiosis in the gut and potentially constipation and so that throws off our whole system. I’ve talked about how important that gut bacteria is for mental health and mood and just digestion and everything. So, more cells are in our gut than in the rest of our body. So our gut microbiome is super important to our health and well-being.
So, how does a naturopathic doctor address estrogen dominance? This is a big part of my practice especially because I see a lot of women with month-long PMS, acne, polycystic ovarian syndrome, so irregular periods, or missed periods, or they have a family history of hormone-dominant cancers and they’re trying to prevent these things from happening down the line, or they’re just having terrible periods. They’re having weight gain, or bloating, or anxiety that’s related to the period or really bad PMS, so mood swings, depression around their period or a condition called PMDD, which is really really severe depression right before the period.
So the first thing I do is order labs. And so your medical doctor might have done labs, gotten your estrogen and progesterone measured in your blood and your doctor might have said, “oh, it’s fine, it’s normal”, and this is true to the extent that when your medical doctor is evaluating your labs, they’re looking at massive reference ranges. So our reference ranges are a bit more narrow because we’re trying to look at the optimal levels for fertility and for feeling like your optimal, amazing self. We’re looking at, “is your estrogen within an optimal range, is your estrogen on the high side, and therefore, could be brought down? And does that match your symptom picture? Do you have estrogen dominance symptoms and a relatively high estrogen level? Is your progesterone lower than optimal to maintain a uterine lining in pregnancy, to not have a miscarriage in the first trimesters, etc. etc.” So we look at labs, and then we, using our natural therapies, we prescribe diet, supplements, and some lifestyle changes to help re-establish that hormonal balance.
So, if you have any more questions, just send me an email, at connect@taliand.com or check out some of the articles that I mentioned in this video.
Want to balance your hormones, energy and mood naturally? Check out my 6-week foundational membership program Good Mood Foundations. taliand.com/good-mood-learn
In this video I give an education talk to a group of seniors at the Bernard Betel Centre about naturopathic medicine. I discuss our philosophy, education, what kinds of conditions we treat and answer some questions along the way.
I talk about how to manage stress and promote mental health and emotional wellness through assessing balance in the key areas of your life that promote a healthy mind and body.
Hello, everybody, my name is Dr. Talia Marcheggiani. I’m a mental health and hormone expert.
Stress is a big reason why a lot of people come to see me, for support in their lifestyle and optimization of their health, especially their mood and mental health.
And, one of the things that I’ve come to understand in working with people one on one is that stress in life is an inevitability, especially in our society.
Work is just one aspect of the stress that influences our lives, but things like loss of loved ones, and ending of relationships, pressure from work, monetary struggles. These things in society are inevitabilities. So, we’re sooner or later going to be faced with major stressors in our lives regardless of how well our life is happening right now.
One of the big things in terms of working with people is helping with their resilience to stress. That means building up resources. So, before I meet with a patient I have them fill out an online intake form. And this is sent to their email and one of the—the intake form goes over what their concerns are, what they’re coming in for, it goes through all the areas of their health, their physical health and mental health and one aspect as well, in the chart is something called The Wheel of Balance. And, what the Wheel of Balance does is, it looks at all the major pillars that make up somebody’s life. It asks the potential patient or the new patient, to assess, to rate on a scale of 1 to 10 how satisfied they are with that area of their life.
So, for example, one of the areas is health and so on a scale of 1 to 10 how you feel that your health is managed? How satisfied are you with your level of health? Are you in chronic pain? Do you feel unwell generally? Or do you feel like health is pretty well managed, despite the fact that you’re coming in with a health concern?
Another area is relationships. So, personal relationships. So, some people don’t have a significant other and, if that’s so, how do you feel about that? Or, if you do have a significant other, how satisfying is that relationship? How well do you feel that relationship supports you in your life?
There’s several reasons for this Wheel of Balance. One is to just get a general understanding of the life of the person I’m going to be working with, what the broad picture is in terms of their life.
And another reason is that we know a lot of these factors such as relationships, and health and career, and money and whether you have hobbies, whether you have something that fills you, something that gives you a sense of purpose, we know that these things are determinants of health. So, your socioeconomic status is one of these factors that determines your longevity or your resilience against disease, especially your resilience against stress. If I have somebody coming in with depression and anxiety who’s recently been laid off, no amount of herbs—well, the herbs can buffer the stress response and relax the physical body so that somebody can look for work, but on the high priority list is helping them find a job again, because no matter how calm you’re feeling physically, or much meditation you’re doing, the fact that you don’t have a way to pay your bills is a major stressor that won’t go away until it’s dealt with.
And, another reason as well for doing this Wheel of Balance, if we’re assessing this holistic scope of what someone’s life is, is the fact that these pillars, when they’re strengthened, they provide the basis for the resilience against onslaughts of stress that come in.
So, many of the people that come in and see me who are dealing with mental health issues, they’re often struggling with an onslaught of stress that’s hit them. So it could be that they’ve recently been laid or separated from a partner in a romantic relationship, or it could be a great loss or trauma or somethings are surfacing.
Organizing these pillars of resilience is really effective for helping somebody deal with the stress and survive a new wave of stress.
In naturopathic school we learned about something called the Stress Wall, so it’s sort of a similar idea. You’re building up these resilience factors, you’re strengthening relationships, you’re dedicating time and energy to creating a career that you love, you’re arming yourself with hobbies and interests and purpose and passion and, therefore, when a stress wave hits you, you’re able to withstand it, or you’re able to recover more quickly. It doesn’t throw you, it doesn’t send you into chaos, physically, mentally and emotionally.
And sometimes these waves of stress they test our stress wall, so sometimes people are doing all right and then a really stressful time at work will show them how well their stress wall’s been built.
So one thing you can do, right now, having said all this, is do a Wheel of Balance with me. So, all you need is a piece of paper, and you’re just going to draw a circle on it. And you’re going to divide the circle up into 8 sections. So, divide it in half, then in quarters, then divide those quarters into halves so that you have 8 sections on your wheel.
And then you’re going to label each pie slice with a title. So, the first one is career. The second one, money, because those are two separate things. Our career is not always tied to our money. Sometimes satisfaction with a career doesn’t necessarily mean monetary satisfaction. So we separate those two things, although they can be linked. The third is health. The fourth is relationships, and this is romantic relationships or significant other.
The fifth is family and friends, supporting relationships. If you don’t have a significant other, you can also rate your satisfaction with the fact that you don’t have a significant other, so if you’re single and feeling pretty good about it, pretty happy with your independence, or are you in the search of looking for a significant other, or are you recently single and upset about that. So this is something where you can evaluate your satisfaction because it is a piece of the puzzle and piece of the Wheel of Balance in terms of resilience, because one of the biggest sources of stress is from romantic partnership or lack thereof.
So the sixth pie slice is fun and hobbies. This is something meaningful that you pursue outside of your work, whether you have one or more things. In that section is sort of what you do to destress, so do you come home and flip on the TV and is that a fulfilling and stress-reducing activity for you? It can be for a lot of people, but bringing awareness and consciousness to that is very helpful.
The seventh is purpose and growth. So, are you everyday creating meaning in your life? Is there a clear meaning for your life and are you fulfilling that meaning and purpose? Do you feel like you’re growing and learning every day? That’s really important for a lot of people and I often find that people mark that pretty low especially when they’re dealing with a mental health condition or a high amount of stress in their lives.
And then the final thing is your physical environment. Physical environment is, are you happy with where you’re living? So how your living arrangement is, physically. Is it a comfortable space to live in? Do you like how it’s decorated? Do you like where you’re living? What city you’re in? What part of the city you’re in? Are you exposed to nature on a regular basis and, if not or if so, how important is that to you? So you’re evaluating what the state is of the physical surroundings that you’re in. So that’s why we clean our houses or why we care about where we’re living because a cluttered environment does affect our internal and mental state.
So, again, those categories are career, money, health, relationship, family and friends, fun and hobbies, purpose and growth, and physical environment. So, when you’re finished you’ll have a chart that looks like this. So it’s got eight different slices with different labels. And, on your own I want you to fill in the pie according to your level of satisfaction, so if you’re 100% satisfied in the area of your career then you colour in the entire pie slice. If you’re only 50% satisfied or one quarter than you fill the corresponding amount out. Then you look at the areas you’re not as satisfied in and the areas you might be over-compensating in. So you might be really dedicated to maintaining a healthy lifestyle but may be sacrificing in the area of fun and haven’t really invested in making sure you’re creating fun activities.
You also might not want these categories. There might be another category that’s more important to you. If you don’t care about one of these categories it might mean that you’re satisfied with it, or you don’t feel that it brings meaning to your life, and that’s totally cool.
But, it’s sort of an idea of these areas that we build our lives around. And so what I do with people, because a lot of the time when people are feeling a lot of stress, or have a mental/emotional issue that they’re coming in with, depression or anxiety, neurosis or anything like that, a lot of the time they’re missing a few areas, or their Wheel of Balance is skewed in one area or it’s just generally weak all over. And so what we have to do—that means these people are very susceptible and vulnerable and the first thing to do, instead of working on diet or giving herbs and that kind of thing, is to strengthen some of those areas to create a more robust Wheel of Balance. And so what we do is, if there’s an area that you’re weak in, is creating one concrete thing you can do, more or less immediately, so let’s say within the week, that would strengthen and kind of balance out your Wheel of Balance.
And so, an area that is often lacking for most adults and busy people is fun, so if you put 25% of satisfaction in the area of fun, then coming up with a strategy, one thing you can do this week that would increase your satisfaction, even a little bit, and start to build up that pie slice, in the Wheel of Balance. So, thinking of something you would do that you would classify as fun. In the area of family and friends, how can I reach out to somebody, or strengthen an existing friendship or look for a way that I could put myself in a position to meet new people. So we start working on these areas. So once you’ve developed resilience and strength, we’re better able to weather the new waves of stress that hit us because they will, inevitably. Some of us are blessed to not have as many stress waves, but eventually there is something that will affect us and will affect our state of balance and our mental health so the stronger our pillars of resistance and the more robust our Wheel of Balance is, the better able we are to weather these storms and maintain our mental and emotional health and our physical health, because we know they’re all connected.
My name is Dr. Talia Marcheggiani, thanks for listening and if you want to contact me, my email is connect@taliand.com. I practice in Bloor West Village in Toronto.
I’m tired of hearing mental health conditions blamed on a “chemical imbalance”. Patients everywhere are being told that their mental health conditions are, literally, “all in their heads”. With this diagnosis—often distributed insensitively, and without much attention to the complex factors in thoughts, beliefs, emotions, the environment, biology, nutritional status, mental and emotional as well as physical stressors, and life circumstances (just to name a few) that can contribute to mental health imbalances—patients are left with the message that they are somehow damaged, broken, or that their condition arose out of an inherent weakness that they somehow possess. Through the numerous conversations I’ve had with those struggling with mental health symptoms, I have come to understand that oftentimes there are phrases that rob power more than the term “brain/chemical imbalance”.
Fortunately, there is still more to emerge in the wonderful world of science. Very little actual evidence supports the chemical imbalance theory of depression and researchers and clinicians alike are forced to admit that symptoms of conditions such as depression and anxiety are often the result of multiple factors that come together. Contrary to the common narrative of mental illness being a sign of weakness, evolutionary biologists are uncovering evidence that symptoms of depression might be the result of a highly adaptive strength based on preserving the body during times of great mental, emotional and physiological stress—showing, in fact, that depression and anxiety might in fact be afflictions of the strong, not the weak.
In my practice, I approach depression and anxiety from a functional medicine standpoint. This means, simply, that I look not at the title of the condition my patients come in with (I care very little if you have depression, or anxiety, or bipolar disorder, etc.—the name is not the thing itself), but how the condition occurs uniquely for them. By paying close attention to the multitude of symptoms, thoughts, and factors that influence the mood and emotions, I am able to uncover underlying pathways that point to imbalance in the body and dig up the roots from where the symptoms might have arisen in the first place. Through this method, focussing on the functioning of the body rather than it’s pathology, we’re able to bring the body back into a state of balance and reverse symptoms permanently, rather than simply slapping a band-aid over them.
When it comes to mental health, it is important to emphasize that depression and anxiety (as well as other mental health diagnoses) are not diseases at all; they are symptoms. When presented with low mood, feelings of sadness and worthlessness, lack of motivation, lethargy, brain fog, changes in appetite and weight, abysmal self-esteem and so on—all symptoms that many patients with depression face—we need to follow the threads of symptoms back to the point where things began unraveling. It is necessary to backtrack to the biological imbalances where symptoms first began.
There is an overwhelming amount of research coming out in the field of mental health that links the gut and digestive health to mental health symptoms, indicating that depression might not be a brain chemical imbalance at all, but a gut chemical imbalance. Where there is depression and anxiety, there is more often than not, a digestive issue.
We have always known that the digestive track and brain have an intimate bond. From the vagus nerve that enervates the gut and begins in the cranium, to the mood-regulating neurotransmitters that are created in the gut, we all have the experienced the tummy aches linked to grief or the power of anxiety to loosen our bowels. We’ve all noted the phenomenon that great ideas or moments of clarity seem to spontaneously arise from, not the brain, where we always assumed our thoughts were formed, but the gut (hence the term, “gut feeling”, which we use to characterize intuitive insights).
When it comes to issues with the brain—thoughts, moods, emotions, feelings, etc., where else should we look for answers than our brain’s close cousin, friend and confidant, the gut. Mental health symptoms can arise from impaired digestion in a number of ways:
A failure of the gut cells (enterocytes) to create neurotransmitters. The majority of serotonin (the “Happy Hormone”) is produced in the gut. Inflamed and unhappy gut cells are often unable to make serotonin.
An imbalance in the healthy gut bacteria that influences whole-body health. We have 10x more cells in our gut than in our body in the form of almost 5 lbs of symbiotic gut bacteria. This bacteria ensures our well-being by helping us digest our food, soothing inflammation, educating our immune system, killing off harmful pathogens, creating bulk for our stools and, relevant to the field of mental health, producing neurotransmitters important for regulating mood, such as serotonin and dopamine.
Research has gone into the connection between a low-level of inflammation in the brain and its affect on mood. Inflammation is usually a product of our diet, stress and food sensitivities. In naturopathic medicine and functional medicine we treat inflammation with the assumption that nearly all inflammation begins in the gut. A condition called “Leaky Gut” is a failure of the important seal between the intestinal walls and the rest of the body. When this seal is broken, toxins, proteins and other debris are free to enter the bloodstream, wrecking havoc, setting the immune system off course and, eventually, triggering symptoms of inflammation, autoimmunity and mental health issues.
Our body requires many building blocks to maintain its complex fortress. Difficulties in the digestive cells’ ability to absorb essential fats, amino acids and vitamins required for brain health, hormone regulation, detoxification and immunity, among the thousands of other chemical reactions in the body, will result in impairment in overall functional. Nutrient deficiencies are more common, even in developed societies, than one might think. Deficiencies arise from: impaired absorption, inadequate diet, increased amounts of stress and the ingestion of foods or medications the deplete the body of nutrients. In any case, optimizing the gut’s ability to digest and absorb the nutrients we’re either eating or supplementing is key for improving health and mood.
When it comes to understanding mental health issues I, as a clinician, realize it is hardly ever just one factor involved. Properly helping someone with anxiety or depression heal involves understanding the constellation of potential causes and how they inter-connect and relate to one another. Through this detective work, we can begin the journey of unraveling the imbalances and restoring the body’s ability to function and heal.
Treatment plans usually involve a combination of replenishing essential nutrients that patients are deficient in (deficiency can be detected through blood work, health history or symptoms), repairing the gut’s ability to absorb, restoring the body’s balance of healthy gut bacteria, removing food sensitivities and healing digestive inflammation, balancing hormones, and managing lifestyle stress and environmental factors that may be contributing to low mood.
My patients make impressive commitments to healing and are willing to examine their bodies and past experiences, in order to do the hard work of healing. Beyond my role as a doctor, I am committed to working as a facilitator, teacher and guide. My job is not to tell people the right path to walk, but to help them understand their body’s complex language, listen to the signals and messages that arise from it, and understand what those signals are asking of them.
For more information, click here. I run a practice with a special focus in mental health, youth mental health and hormonal conditions. I work in Bloor West Village in Toronto, Canada.
The gut-brain connection has gotten the attention of researchers and functional medical practitioners. I discuss, briefly, what research has shown us in regards to the complex realm of the microbiome and how depression may be a result of inflammation in the brain, stemming from inflammation in the gut.
My name is Dr. Talia Marcheggiani and I am a naturopathic doctor and mental health expert in Toronto.
Today we’re going to talk about the gut-brain connection and how that can influence your mental health symptoms.
I think we intuitively know that the gut and brain are connected. When you feel mental symptoms of anxiety we immediately notice the effects on our gut.
During times of stress, we know that we have indigestion, we’re more predisposed to things like diarrhea and irritable bowel syndrome.
Even anatomically there’s a nerve, called the Vagus nerve, that directly connects the brain to our digestive system.
This nerve is responsible for putting into that “rest and digest” state.
When this nerve is stimulated, our bodies start to secrete digestive enzymes, saliva starts to be secreted and we’re able to break down our food and absorb the nutrients from the food that we’re eating.
A lot of research has been going on, that you might be aware of, about healthy gut bacteria. And more and more people, especially medical doctors, happily, are prescribing probiotics anytime someone is prescribed antibiotics for a bacterial infection.
Scientists have started to study more about these gut bacteria. We know we have, like, 5 lbs of gut bacteria, sitting in our digestive systems. Over 100 trillion cells, this is more than 10x the amount of cells we have in our physical bodies, and more DNA than we have in our body.
We’re more bacteria than we are human!
And these gut bacteria, we can’t survive without without them, they influence the very physiology we experience and they definitely impact our health.
These bacteria are responsible for helping us digest our food, and for our mental and emotional wellness as well as keeping our immune system in check.
So, a disbalance in bacteria, or an increase in that negative, bad bacteria and not good strains of healthy bacteria, can lead to diseases like autoimmune disease or multiple sclerosis, or things like chronic fatigue syndrome as we’re seeing in research.
Scientists are starting to study more about how the bacterial balance in our gut can influence our mood and mental health.
These gut bacteria can actually produce serotonin. So that’s the happy hormone in the brain. And you may have heard of serotonin, especially if you suffer from depression or anxiety because your doctor might have recommended a kind of medication called SSRIs, or Selective Serotonin Reuptake Inhibitors, or a similar drug, SNRIs, like Venlafaxine, which is a Selective Serotonin and Norepinephrine Reuptake inhibitors.
This is based on on the Monoamine Hypothesis that there is this chemical imbalance in the brain. That your body is either not making enough, or absorbing enough or reacting to serotonin enough.
When we’re given these antidepressants, the idea is that we’re recorrecting this brain imbalance and that’s as much of the story as we’ve got. We don’t know why these brain imbalances are around.
So I think that, if we’re going to stick with this hypothesis, which is still controversial in science, we should look to the gut bacteria because we know that gut bacteria produces a significant amount of serotonin and, if we’re blaming depression and anxiety on serotonin deficiencies, why not look at the gut and find out how we can influence the balance of healthy gut bacteria so that we’re producing enough serotonin. Especially if we’re relying on drugs to correct the imbalance and we don’t have enough serotonin for the drugs to work properly.
Gut cells on their own produce 95% of the serotonin in the body so basically every single chemical that we have in our brain is produced or exists in the gut.
So, we need to be able to feed the gut cells so that they’re producing healthy amount of hormone we need to experience a healthy mood and live our lives in ways that are stress-free and energized and happy so that we can effective in our lives.
Mentally and emotionally, you might know this “gut feeling” that we talk about in language and that’s kind of permeated throughout cultures. So, we know that when we have this feeling in the gut that, it’s almost like an intuition. Some people will say, “I just knew it, because I felt it in my gut.” And I think that we’ve always had this intuition. We’ve always had this connection between what our mental state, our thoughts, beliefs and emotions are telling us and what our gut is telling us.
We think that we think with our brains and that all of the mental symptoms we experience are happening at the level of the brain, but because of this tight gut-brain connection, we know that’s not true.
People that have done brain studies actually find that we have thoughts before we have brain activity a lot of the time so, I wonder if we’re actually thinking with our gut, which is a revolutionary and radical thought, but we’re finding more and more evidence for this in science.
You may have heard of the condition called “Leaky Gut” or the more official, scientific term is “Intestinal Permeability”. Our gut is really selective about what it absorbs for good reason. What happens, though, when we’re experiencing chronic stress, or we use a lot of antibiotics or maybe eat things like high-sugar foods, caffeine, or a lot of alcohol, we can cause gut inflammation, which starts to allow bacteria, food toxins, or whole proteins from food into the blood, into the body by breaking down the integrity of the gut.
So, when it comes to health, for most health conditions, especially when there’s a few symptoms that seem disconnected and it’s hard to find the relationship between them, naturopathic medicine and, now, functional medicine and, hopefully soon, conventional medicine, begins to look at gut health.
So if I’m sitting across from a patient who has a long list of health symptoms that seems like they’re not connected and has digestive symptoms—and 40-60% of the population, in general has some kind of digestive symptom, whether it be bloating after eating, feeling fatigued after eating, just feeling like your food is sitting in your stomach and not really moving through, GERD, so acid reflux, heartburn, diarrhea and constipation, or those IBS symptoms, gas and bloating—when I sit across from a patient with any of those symptoms, the first place we go, in terms of treatment, is to look at the gut.
So how do you keep your gut healthy? There’s a few things. The first is to eliminate anything that’s causing gut inflammation, so this could be excessive caffeine and alcohol, excessive refined sugars, antibiotics without doing a probiotic immediately after or during an antibiotic treatment, chronic mental and emotional stress, or physical stress, and food sensitivities: something we’re eating that’s causing our immune system to react and our gut to become inflamed.
Ensuring a proper bacterial balance by either supplementing with a probiotic or eating a variety of fermented foods such as kefir, yogurt, kombucha or saurkraut, and making sure that we’re eating a variety of whole foods: whole grains, fruits and vegetables, and healthy fibres that are going to feed that healthy gut bacteria.
So, when it comes to mental health, such as depression and anxiety, chronic mental stress, even things like bipolar, OCD, conventional medicine tends to just look at the brain and blame the brain on the host of symptoms that patients might experience.
Naturopathic medicine looks at the entire body. And since we know that the gut and brain are connected, and our patients are simultaneously experiencing mental health symptoms and digestive symptoms, we definitely have to treat the gut.
For more information, you can visit my website at taliand.com, or send me an email at connect@taliand.com.
I work at Bloor West Wellness Clinic in Bloor West Village, in Toronto.
When our minds are stressed, how do our bodies react? We experience something called “adrenal fatigue” that can closely mimic the symptoms of depression.
Hi, naturopathic doctor, Talia Marcheggiani, here. I’m a mental health expert and I’m at Bloor West Wellness Clinic and today we’re going to talk about the Stress-Depression Connection.
Most of us are stressed in North America. There’s a major stress epidemic. We know that anywhere from 70-90% of doctors’ visits are directly or indirectly attributed to stress and the symptoms that it causes in the body.
Most people are stressed, I think the estimate is 70% to 90% of North American women are experiencing some kind of chronic stress. Many are unaware of it and very few are doing anything about it or actively managing their stress through methods of self-care, relaxation techniques, and other therapies to lower the cortisol, or the stress hormones, that are producing that chronic stress in the body.
So, physiologically, when we get stressed, so, let’s say, you know, you’re in the paleolithic times, you’re walking through the forest and you encounter a giant bear running towards you. Our bodies would immediately start secreting epinephrine, or adrenaline, which is the first stress hormone. This is released from the adrenal glands, these pyramid-shaped endocrine or hormone glands, located on top of both of our kidneys. Epinephrine, or adrenaline, many of us have felt the effects of before, this makes our heart race, we start sweating, we start to, you know, you might feel like you have to go to the washroom, you might notice digestive effects. What will happen is, our blood vessels will dilate, our pupils will dilate, so that we can’t see fine detail but we can see movement much more easily so we can see the subtle movements of the bear lunging towards us and our body is primed for fight, flight or freezing so that we can get away from this immediate stressor, this threat to our safety and survival.
And really incredible things can happen when we’re in this hyper-arousal state, this sympathetic nervous system state.
A friend of mine was walking in Greece and she fell off a side walk, the side walk just ended, and in the fall, she fell off like cliff, and one of her arms broke so, she managed, in this superhuman ability, that all of a sudden she had, through the adrenaline that was coursing through her body to deal with this stress and surprise, she with the hand that wasn’t broken, grabbed the edge of the sidewalk and pulled herself to safety. And this was a woman, my friend, that can’t even do one pull-up she can’t do pushups, she doesn’t have the arm strength to, in a calm and not hyper-aroused state, perform that kind of physical act.
So, epinephrine and the stress response is amazingly powerful. This stress response can save our lives if called into action for the right reasons and at the right time.
However what’s going on in North America now, is that, especially in this modern society that we live in, with technology and all of the stressors that we’re encountering on a day-to-day basis and the pressures we put on ourselves, we’re in the hyper-arousal state far more often than normal.
Back when we were chased by bears and we had to respond physiologically to that stressor, we would have just, as soon as we reached safety or finished fighting the bear, or froze, played dead, so the bear would walk away, we would have returned back to a state of relaxation. I mean, our hearts would have continued to pound as we kind of got over that stressor, but eventually we would have returned to our rest and digest state, our parasympathetic state.
Back in those days we used to work an estimated 15 hours a week hunting, gathering food, um, in our paleolithic time, in our hunter-gatherer times, which is what our genes have evolved to succeed in—our genes haven’t evolved to catch up with the rapid change in the environment that we’ve created for ourselves and so we’re not used to working 40 to 80-hour work weeks and racing home, through traffic, to pick up the kids and do after school activities and finish up late assignments, getting to get after 12 pm and getting up at 6 am to do a workout so we can lose weight and all of the things that are filling our lives and causing us stress.
The issue with many of the women that I work with, many of the people that I work with, is that we don’t really notice that we’re under stress, like a lot of people will say that they don’t feel stressed and then the signs and symptoms that they’re bodies are exhibiting point me in a direction of some kind of stress response.
So, I described what adrenaline/epinephrine do. But our body doesn’t have a very big reserve of adrenaline and epinephrine, so when we’re in that fight or flight response for prolonged periods of time, the adrenal glands, those pyramid-shaped glands on top of the kidneys, they start to secrete another hormone, called cortisol.
Cortisol has some similar effects, but it’s better for prolonged periods of stress. Cortisol kind of makes us feel alert, it gives us this grounded energy so we can be effective when we have these daily things thrown at us. So, when we wake up in the morning, we feel kind of groggy and then we start to feel alert, maybe we have a quick workout or cold shower or we eat something, we start to feel like we’re becoming alive, we’re greeting the day. That’s cortisol starting to build up in our bodies and prepare us for the things that we have to do, for the mental tasks, or the physical tasks, or the juggling of all the tasks that we have coming up for us in that day.
Cortisol is a good thing. We want to have cortisol because without it, we can’t perform, we can’t be who we need to be. And we can’t bring ourselves into the world and do the things that we’re supposed to do that day.
The problem is, of course, and I’ve already mentioned this, is when stress is prolonged and when stress is taking over more than 50% of our day and our bodies are in that fight or flight state for more time than they’re in the rest and digest state.
Some of the effects of being in this state and, as I mentioned, a fair amount of us are this state most of the time, or have to be. Some of the effects are high blood pressure, high cholesterol, heart diseases, even some cancers, suppressed immunity, things like skin issues, hormonal imbalances, such as infertility, or PCOS or endometriosis, changes in eyesight, changes in hearing, hair loss, acne, impotence, and various other symptoms. And, of course, depression and mental illness.
One of the effects of cortisol is that it can lower serotonin, which is the feel-good, the happy neurotransmitters that our brain secretes and dopamine, another neurotransmitter that promotes feelings of well-bring and happy mood and also helps with that motivation and reward cycle.
Cortisol also controls inflammation and, when we have too much of it, it suppresses inflammation, but once we start to become deficient in cortisol, inflammation can increase and when our body’s relying on cortisol all the time, the balance of cortisol can get thrown off and we can have highs and lows of cortisol in the body.
We know that there is an implication in inflammation and mood, so cortisol is often at the root of excess inflammation or inflammatory symptoms.
There’s also a condition that’s not really recognized in conventional medicine, but naturopathic doctors recognize, as well as functional doctors. So functional doctors and naturopathic doctors, we don’t really work with diseases that you come in with, I mean we work with those too, but where we really excel is when we’re looking at the patterns and the symptoms and the blood work showing disease processes before they actually become diseases. And I think depression and most mental health conditions fall in that area because we know that there’s no blood tests for things like depression. Direct blood tests, I mean. There’s no real diagnostic criteria beyond the subjective criteria that’s in the DSM V. So, when somebody’s depressed, we have to rely on a variety of symptoms and then I can order some blood tests to rule out why someone might be feeling that, but it’s not a disease like diabetes where you run lab tests and you can infer from those lab tests directly what’s going on in the person’s blood and in their body and in their cells. And, of course, the result or the solution for depression is much different than diabetes, especially type I diabetes where it’s an insulin deficiency, you inject insulin and the disease is managed.
With things like depression, we have to reason backwards and try and understand what might have led to those symptoms or what’s going on in the person’s body that’s causing this imbalance that’s causing the symptoms to arise.
So, back to adrenal fatigue. So, when patients come in, and they’re experiencing prolonged stress that begin with something called the resistance phase. So this is when you’re feeling like life is busy you have a lot on your plate, but it almost, you almost thrive in this situation. It feels kind of good. You feel like you’re in control, you feel motivated and you feel like you’re getting things done. You might be tired at the end of the day, you might not be sleeping as well as you could. And you’re definitely not feeling zen. You’re not feeling relaxed and like a Buddhist monk most of the time. You’re feeling that there’s pressure on you, but you’re coping. Things are ok. This is called the Resistance Phase. And this means that your body is producing enough cortisol to deal with the daily tasks at hand.
After months to years of this, however, if this prolonged and we’re not taking enough breaks to allow our bodies to replenish, we can experience something called Adrenal Fatigue. This is when our body’s not able to produce the cortisol needed to cover those daily tasks. So remember how I said that cortisol kind of makes us feel alert and alive and ready to deal with the day ahead of us. In Adrenal Fatigue we’re not able to activate that stress response when we need it because we’ve had it turned on all the time. It’s almost like the gas tank’s empty and we’re kind of sputtering to get it going again. We’re trying to get our car to run on the fumes that are leftover. And, we might call this Burnout, this is another word for it, is burnout.
And so, in adrenal fatigue, and this is a really common situation that often leads to depression and also often has symptoms that actually mirror or overlap with depression. In adrenal fatigue, first of all, the main symptom is just feeling tired, fatigued. There are sleep disturbances. We feel weak, we feel unmotivated, and one of the key symptoms is that we’re not relieved by exercise.
So a lot of my patients will tell me, “I want to exercise, I know I should exercise but I just don’t have the energy to exercise.” And I’ll ask them, “do you feel like you are able to push yourself to do some exercise, like go for a brisk 30-minute walk or even, you know, a quick jog. How do you feel afterwards?” And if they tell me they feel like it depletes them more, this is often a sign that they’re in that burnout phase, they’re in adrenal fatigue.
Because when you’re in a resistance phase, exercise can kind of boost your cortisol a little bit, so if you’re still able to make it, it feels pretty good because it kind of revives you and it perks you back up. But if you’re in an adrenal fatigue situation, you just don’t have the cortisol reserves to get through that exercise, to get through that workout and to feel good afterwards. So that’s one of the symptoms.
How cortisol is supposed to work in a healthy person that has adrenal glands that aren’t depleted, is when you wake up in the morning, your cortisol begins and it’s high. And that’s why you test blood and salivary cortisol in the morning as soon as you get up. So that means you wake up and you feel like you’ve slept pretty well and you’re ready to start the day, you feel alert. You’re not groggy, you don’t wish that you could just stay in bed for the rest of the day.
Throughout the day your cortisol will gradually decline. It might have a few dips and usually perks up with eating or exercise. So if you have a protein-rich, or carbohydrate-rich meal, your cortisol can come back up and that’s around meal-times you’ll feel a little bit more alert. And your cortisol will decline until bedtime when you feel tired and you feel ready to go to sleep and it will stay low throughout the night so you won’t be waking up at night. You’ll feel rested and if you have one of those sleep trackers or a Fitbit, it will show you that you have restful sleep and that you spend a lot of your time in REM sleep or deep wave sleep. And then the cycle starts again, you wake up, your cortisol starts to peak and gets higher again.
When our cortisol cycle is off. When we’re in adrenal fatigue or even the end stages of stress resistance, which proceeds that burnout adrenal fatigue stage and often proceeds depression. The resistance phase is more associated with anxiety, burnout is more associated with depression.
When we’re in that burnout phase, we’re not able to get the cortisol up in the morning so you wake up feeling exhausted. You will often even have a crash, you might kind of get going and ready to go or you might just be used to having that level of energy, on a scale of 1 to 10, you might be anywhere from a 3 to a 7. Around 10 am, though, you’ll notice a dip in your energy, so a lot of people will have this kind of energy crash around 10 am and then they get a second wind, they can kind of go. A very typical thing that happens is around 3-4 pm, 2-4pm, after lunch, there’s a massive energy crash and we’re still at work, most of the time, those of us that work 9-5 and so you’re at work and you’re just feeling exhausted.
And then people kind of get a second wind and another thing that happens, which is not great, is that you get a second wind right before bedtime. When you’re supposed to be going to sleep, you feel this kind of “tired and wired”, like you’re not able to, you know, wind yourself down to get a restful night’s sleep. You feel like you need to be up and on your electronics and doing some work, catching up on some things that you need to get done.
And eventually you might go to bed and usually this happens close to midnight or after midnight, and then most people will have a cortisol spike in the middle of the night between 2 and 4 am where you wake up and are unable to fall back asleep. And thus the cycle begins again where you had a spike in the middle of the night, your sleep’s been broken, you’re tired again in the next morning.
So how do we get out of this cycle? Because, you know, depression has low mood, depression has low motivation, depression has changes in weight and metabolism and appetite and these feelings of sadness and adrenal fatigue and burnout have a lot of those same symptoms. There’s not motivation, you’re gaining weight in the abdomen, you’re immune system is thrown off, you’re feeling just this general malaise and muscle pain and exhaustion and sadness and low mood and low self-worth and all of these things that we see in depression.
So how do we solve this? So the first thing we do is, if possible, we try and manage stress, to establish self care routines and this is a process that we need to work towards, it doesn’t happen in one visit, in a day it takes a few months to a few years to rebuild and reestablish. We make sure that we’re living a balanced life and we’re managing our cortisol and we also might prescribe supplements and herbs to stimulate cortisol production and to help our bodies manage stress and to help our adrenal glands work more optimally. And this often has a dramatic shift in mood after a few months. I have personal experience with this myself and it’s amazing. In a few months you look back to where you were and you notice big shifts.
It’s also necessary to make sure that blood sugar is not spiking throughout the day because cortisol and blood sugar are tightly interconnected. If our blood sugar drops, our body needs to create cortisol to bring it back up and likewise, if our blood sugar is high, this is a stress on the body and it can affect the cortisol balance. If our blood sugar is nice and steady and we’re eating enough fats and proteins to keep our neurotransmitters and our hormones productive and in production in the body, we notice a more even mood and energy level and this is really important so I go over nutrition and how to plan meals, especially in the morning with a protein and fat-rich breakfast.
And, finally, things like bodywork and things like, if not psychotherapy, then things to help with the life stressors that are going on, directly addressing those things. Even helping with the body stress response, the body’s perceived response because a lot of the time we have stress stored in our thoughts and emotions in the head, which is what addressed usually with many forms of psychotherapy. But oftentimes we also store stress in the body and so I find that acupuncture can be really affective and there’s studies that show that acupuncture actually outperforms Prozac in some 6-week trials as well as acupuncture can also help the brain move into that parasympathetic rest and digest state.
So, from 4-6 sessions of acupuncture can really shift us into a more relaxed state and help us with that stress response that we often be stuck in.
So, for more information, visit my website. I’m at TaliaND.com, or you can send me an email at connect@taliand.com. I work at Bloor West Wellness in Toronto. And if you want, leave your questions or comments below and we’ll start the discussion. Thanks, bye! 🙂
It seems like the world is falling apart. These days more than ever.
Race wars, weapons, war, wealth concentrated into the hands of a few, and violence, Facebook is filled with videos that fill our heads and hearts with a complicated mixture of sadness, anger, anguish, confusion, frustration, enrage, injustice and a deep-felt sense of powerlessness. We struggle through these events to go on living—to go about our lives in a dignified fashion, to pay our rent, to engage our relationships, to find happiness and satisfaction in our lots in this world. It seems like the world is ending, and yet we still have our daily responsibilities. Our cynicism is engaged; our idealism is crumbling. Many of us feel hope leaving our bodies. Many of us feel frustration morphing into despair.
Stress is estimated to be the number one cause of disease. As a naturopathic doctor, my role often involves cleaning up the debris from chronic, long-term stress responses gone haywire. Oftentimes my patients don’t even perceive the stress they’re under. “I’m type A! I thrive under stress and pressure”, some will tell me. Other times the people I work with are so far in a state of overwhelm it’s all they can do to keep moving forward with their daily routines.
The World Health Organization estimates that 75-90% of doctor’s visits are attributed to by stress. I would estimate that 100% of the people I work with have on-going stress in their lives.
We doctors know that some people, the “Type B’s” in society, are more susceptible to stress. We know these people, we may even be one of them ourselves: the sensitive individuals, the intuitives, the feelers, the artists, empaths, activists and light-workers. We are individuals who are often drawn to artistic and healing professions, who care deeply about relationships, people, feelings and soft-ness in this world. We often find ourselves pushed up against hard edges, struggling to pay bills and cope with cruelty and injustice. We face daily struggles and the pain of living a disconnected, yet intricately interdependent life in modern-day society. Some natural doctors have terms us “parasympathetic dominants”—people whose nervous systems tend to get stuck in the parasympathetic (as opposed to stress-fuelled sympathetic) arm of the autonomic nervous system (the “automatic” nervous system).
We often feel overcome with a sense of overwhelm when faced with packed schedules, high stakes jobs that affect others, achievement-oriented striving and the prioritization of money and numbers over people. In this world of deadlines, assertion, aggression, fear, war and material wealth, we can often feel like we don’t fit in. We can suffer from burnout.
Burnout, “adrenal fatigue” or “parasympathetic dominance” happens when our stress response becomes depleted. It is characterized by naturopathic doctors as fatigue, excessive needs for sleep and quiet, lack of motivation, disrupted sleep schedules, difficulty losing weight, sluggish digestion, bloating and IBS, headaches and brain fog, poor memory, hormonal imbalance resulting in heavy or irregular periods, PMS, infertility and acne. Mental illness can begin to surface or worsen in this state, resulting in depression, anxiety, or even bipolar disorder and psychosis. The narrative of the mad, artistic genius, burdened by the weight and troubles of the world, surfaces to mind—the creative genius who is too sensitive for this world. We run the risk of becoming irritable, and losing some of our natural compassion as we drift off into exhausted survival mode.
Many of the people I work with are these sensitive individuals, myself included, and I’m proud to help this population. Through healing the sensitive feelers, we heal the world. The world needs a little more softness and more compassion. It needs people who can pick up on emotional nuances and care deeply about others. It needs people who listen, who feel, who create and share their versions of the human experience to teach others. Through the artists, we experience the depths of our own humanity. Through the artists, we see our pain and, through seeing our pain, we can begin to heal it. It is important that we can find fulfilling work and lives that nurture us, so that we may have the energy to extend our gifts to the world.
Healing parasympathetic dominance in my practice often manifests first as establishing a therapeutic relationship. We crave openness, time and space to explore emotional nuances and engage our natural sense of curiosity. We crave being deeply heard and felt. As a doctor, I do my best to listen, not just to the words, but the space between them, and the symptoms of the body. We look for root causes to issues so that we can establish lifestyle patterns that nurture us.
Creating a clean, nutritious diet: With lean protein, usually meats that stimulate metabolism and manage stress, healthy fats, anti-inflammatory nutrients and lots of fruits and vegetables, especially berries and leafy greens, we can begin to re-feed ourselves and heal inflammation.
Gentle, nurturing movement: I often suggest exercise that blends into the lifestyles of my patients, that works with them. Slow, meditative walking for an hour a day is a wonderful, scientifically proven method of bringing down stress hormone levels. It also creates space in the day for contemplation and integration.
Restful sleep: Through sleep hygiene and some strategically dosed supplements, improving sleep allows the body to repair itself and rest. Those suffering from burnout may need more sleep. Dealing with the guilt that can arise through sleeping in and saying no to non-essential activities to prioritize sleep is often a psychological hurdle in those who feel best when they are nurturing and giving to others, and not themselves.
Self-care: Journalling, meditation and engaging in creative pursuits are helpful armour in allowing one to integrate, express and stay open, energized and creative.
Nurturing mental health and emotions: Speaking to family and friends or a trained therapist or naturopathic doctor can allow us to dive more deeply into our own psyches. When we explore the corners of our mind we are able to heal mental-emotional obstacles to health and learn more about ourselves and others and alter the way we engage in the world. Opening ourselves up to deep-seated anger, fear and sadness is essential to clearing this repressed emotions and improving our experience in the world. My favourite forms of talk therapy are Narrative Therapy and Coherence Therapy. Both involve openly engaging the emotional and mental experience of the other to alter core beliefs and narratives and explore possibilities for living a preferred life experience.
Through the times we are facing, I urge us all to band together, embrace the healers and artists among us and engage in deep, nurturing self-care. Journal, spend time with friends and create. Take time from your activist pursuits and political readings to reflect, to meditate, to get some healing acupuncture and to cry or express anger. Feel the emotions that arise during this time. Take the time to listen to the narratives that emerge. Eat a diet filled with protein, try to keep to a sleep schedule, if possible. Nurture yourself and the complicated emotions that are arising within you and others.
We need you to help us through this time. It is people like you who can heal others, but only if you strive to heal yourself as well.
With 18% of the population suffering, anxiety is the most common mental health condition in North America. Through clinical practice, I’ve quickly come to learn that “anxiety” is a term that means many different things to different people. Its symptoms can range from a mild sense of unease to full-blown panic attacks and the burdensome weight of impending doom. Anxiety disorders are quite diverse. They include, according to the DSM-IV, specific phobias, generalized anxiety disorder (GAD), post-traumatic stress disorder (PTSD), social anxiety, obsessive compulsive disorder (OCD) and even mixed anxiety and depression. Oftentimes the symptoms become crippling; they prevent the patients I see from living their optimal, authentic lives, instead living in a state of fear and self-loathing.
Symptoms
The symptoms of anxiety are holistic. They range from mental symptoms: excessive worry, insomnia, nervousness and anticipation, to name a few, to genitourinary symptoms like frequent urination, and gastrointestinal symptoms. There is a strong connection between anxiety and mental stress and irritable bowel syndrome (IBS), an elusive condition of the gut that results in unpredictable symptoms like bloating, diarrhea, constipation and stomach pain, which is often debilitating for those who suffer from it and very difficult to effectively treat. Other symptoms of anxiety include excessive sweating, muscle tension, rapid heart rate, changes in vision, hot and cold flushes and can be associated with suicidal ideation, self-harm and substance abuse disorders, when anxiety becomes severe.
Conventional Treatment
Unfortunately the conventional treatment for anxiety is limited. The first-line treatment is pharmaceutical and involves using a medication like citalopram, a selective-serotonin re-uptake inhibitor (SSRI), the same medication used to treat mild-moderate depression. This medication is prescribed based on the theory that anxiety is a extraverted version of depression, and that both involve disturbances in the production and signalling of serotonin, the “happy hormone”, in the brain. Benzodiazepines are another line of drugs used to treat anxiety symptoms, as they increase brain GABA levels, a calming brain chemical. However, “benzos” are best prescribed only in the short term (2-4 weeks) to manage serious symptoms. They are addictive in the long-term and can have serious side effects, such as being overly sedating, and depressing breathing, especially when mixed with other sedatives, such as alcohol.
Naturopathic Approach
When I first meet a patient who is suffering with anxiety, I begin by taking a complete case. I have never met two patients who have had identical anxiety symptoms—no two cases of anxiety are alike and therefore, no two cases should be approached in the same way. Therefore, it is important for me to get a complete case history, with details of how anxiety manifests in my patients’ lives: how it affects them, where it might have come from and what specific symptoms are faced on a daily basis. I also inquire about hormonal systems, digestive symptoms, sleep, diet and past medical history. It is important for me to treat the person, not the condition. This means that my patients and I spend time developing a relationship. I make an effort to get to know them during the first few visits, thereby getting to know how their condition uniquely occurs for them.
A large portion of the naturopathic diagnostic process is identifying the cause of anxiety. While conventional medicine points to dysfunctions in the brain, naturopathic medicine approaches anxiety holistically. We understand that because anxiety can affect nearly every body system, it can also manifest as a result of imbalances in a number of organ systems. In the first few visits, we spend time analyzing the web of our patients’ symptoms in order to untangle the clues that might lead us to the root cause.
The Root Causes of Anxiety
A holistic approach to anxiety aims to uncover the root cause of symptoms by investigating imbalances in a variety of body systems. In the body there is a balance between the sympathetic nervous system (fight or flight) and the parasympathetic nervous system (rest and digest). When one system is turned on, the other is turned off. A healthy body can oscillate between the two states easily, activating the fight and flight response during times of stress and activating the rest and digest response the rest of the time. Anxiety is present in the fight or flight, sympathetic nervous system state.
Cause: Stress
More than half of North American adults are experiencing some sort of mental, emotional or physical stress. Chronic stress relies on production of the hormone cortisol, which on its own can disrupt brain levels of happy hormones, like serotonin and dopamine. Chronic stress can also lead to burnout, or adrenal fatigue, which results in an inability of the body to respond to stress in a healthy manner. Instead of producing cortisol, the adrenal glands rely on epinephrine and norepinephrine (adrenaline and noradrenaline) to confront stressful situations. These hormones result in symptoms of anxiety like racing heart-rate, rapid respiration, muscle tension, mental worry, dry mouth and sweating palms. Being stuck in the fight or flight state, can cause anxiety or worsen existing symptoms.
2. Cause: Malnutrition and Hypoglycaemia
Protein, vitamins and minerals are the building blocks our bodies need to perform its millions of chemical reactions. Trying to heal anxiety without the proper ingredients for health is like trying to build a house without bricks, cement or nails. Neurotransmitters like serotonin and dopamine, and hormones like cortisol require the amino acids (protein) tryptophan and tyrosine for their synthesis, respectively. They also require cofactors, or “builders”, to make neurotransmitters, which include zinc, b-vitamins, magnesium and iron. Stress, because of it’s demands on cortisol production, can deplete these precious ingredients, increasing our dietary requirements. Decreasing vitamin and mineral content in food due to poor quality food production also means we’re not getting enough of these key nutrients and supplementation might be necessary to ensure our body is running optimally.
In addition, rising and falling blood sugar levels from a high-carb diet can cause hypoglycaemia. Hypoglycaemic symptoms can mimic anxiety symptoms, such as dizziness, racing heart, irritability, sweating and fatigue.
Iron deficiency is also a common finding in North Americans, especially menstruating women or vegetarians. Since iron is responsible for carrying oxygen in the blood, a decrease in oxygen carrying capacity results in rapid heart-rate and increased breathing rate, which can also be confused for symptoms of anxiety or panic attacks.
3. Cause: Digestive Issues
Although serotonin, the happy hormone, is primarily active in the brain, studies show that up to 90% of it is made in the intestinal tract. Therefore, a disruption in the health of digestive cells or the bacteria that coats the gut, can result in a disruption in mood as well as digestive symptoms like IBS. 40-60% of people have some sort of digestive issue in North America and there is a close connection between digestive issues and mood, termed the “gut-brain connection”.
Food sensitivities and issues with the health and integrity of intestinal cells can lead to wide-spread inflammation in the body, affecting the nervous system. Scientists have found that low levels of inflammation in the brain and an overactive immune system can contribute to depression and other mental health conditions as well as the breakdown of brain function, contributing to memory loss, headaches and difficulty concentrating and retaining information.
Furthermore, an inability to break down and absorb protein and micronutrients results in an inability for the body to make neurotransmitters like serotonin, which require protein and various vitamins and minerals for its production.
4. Cause: Hormonal Imbalance
Because of the high exposure to xeno-estrogens, or toxic estrogens, many women in North America suffer from a phenomenon called “estrogen dominance”, where there is either too much estrogen in the body or not enough progesterone to provide hormonal balance. Symptoms of estrogen dominance include, weight, gain, painful and heavy periods, irregular periods, fibroids, acne, PMS, infertility and an increased incidence of female cancers, such as breast and ovarian cancer. Estrogen and progesterone, in addition to being female hormones that control secondary sex characteristics like breast and hip development and fertility, also exert effects on the brain. Estrogen can cause irritability and anxiety symptoms, while progesterone has a stress-relieving and calming effect. Estrogen dominance, when not controlled, can worsen existing anxiety or be the cause.
5. Cause: Core Beliefs and Mental Schemas
Our brains are wired to retain the lessons we learn, especially if these lessons have been experienced alongside strong emotions, such as trauma. These emotional memories are often implicit and non-verbal, located in lower brain centres, below the level of our conscious thoughts. Once the memories are laid down, they can last a lifetime, influencing our thoughts, emotions and behavioural reactions to present day triggers. Anxiety and other mental health conditions can often be symptoms of these emotional memories, also called “core beliefs” or “mental schemas”. These beliefs dictate to us implicitly how the world works and, if left unexamined, can limit what is possible for us in our lives. When these beliefs get triggered, anxiety symptoms can result. Getting to the core of the symptoms and making the implicit memories verbal is the key to unlocking hidden psychological causes of mood disorders.
Holistic Solutions for Anxiety
Healing anxiety first involves identifying the specific symptoms that my patients present with and looking for potential causes among the common causes outlined above. In addition to a thorough history, I may order blood work to check the B12 and iron status of my patients. I may order a food sensitivity test or check for hormone levels like progesterone, estrogen and cortisol in the saliva and blood, depending on the symptoms a patient presents with.
When I work with patients, we often work together to develop a comprehensive strategy for coping with stress. Oftentimes this involves looking for ways to decrease stress in their lives, such as cutting back on work hours and setting healthy boundaries. Other times it involves looking for activities to incorporate into their lifestyles to manage stress, such as going for long walks (walking slowly for 1 hour can lower cortisol levels and help manage stress), engaging in meditation, yoga, nature exposure, journalling and other activities that have been proven to lower stress hormones.
Creating a nutritional plan is also important for managing anxiety. I work with the place my patients are at, rather than pushing a full dietary overhaul. Making minor adjustments to diet, such as adding more protein, especially in the morning, more fruits and vegetables and less refined carbs and sugars, can do wonders for decreasing anxiety symptoms. Reducing caffeine and alcohol consumption can also greatly benefit symptoms.
Depending on the specific symptoms and lifestyle of my patients, I might recommend nutritional supplementation to improve neurotransmitter synthesis. I also prescribe supplements to help my patients’ bodies through times of stress, depending on their stress levels and other symptoms they present with. Keeping supplements to a few key nutrients that treat the root cause of symptoms is preferable to taking handfuls of pills every day.
Improving gut health is important. This means supplementing with a good quality probiotic, identifying and removing food sensitivities, and eating a diet that is low in inflammatory fats and high in health-promoting omega 3 fatty acids. A digestive aid such as digestive enzymes or herbal bitters can also help with the body’s ability to absorb valuable nutrients from a healthy diet.
Balancing hormones by supporting liver function, adjusting birth control brand and dosage, and minimizing exposure to hormonal toxins such as BPA, fragrances or phthalates can help treat symptoms of estrogen dominance, if present.
Finally, counselling to identify core beliefs can also be beneficial for eradicating emotional memories that are no longer beneficial to patients and that can be contributing negatively to symptoms of anxiety and mood, is important. CBT, narrative therapy, mindfulness training and Coherence therapy are all processes through which patients can begin to identify and challenge the core beliefs that may be contributing to or causing their anxious symptoms.
For more information on a naturopathic approach to your anxiety, visit my contact page.
