by Dr. Talia Marcheggiani, ND | Sep 11, 2021 | Anxiety, Art, Depression, Emotional Wellness, Emotions, Exercise, Fitness, Happiness, Health, Inflammation, Letting Go, Medicine, Meditation, Mental Health, Mind Body Medicine, Mindfulness, Naturopathic Philosophy, Psychology, Self-care
About a month ago I fractured my right 5th metatarsal (an avulsion fracture, aka “The Dancer’s Fracture” or a “Pseudo-Jones Fracture”).
As soon as I laid eyes on the x-ray and the ER doctor declared, “Ms. Marcheggiani,” (actually, it’s doctor, but ok) “you broke your foot!” things changed.
I have never broken anything before, but if you have you know what it’s like. In a matter of seconds I couldn’t drive. I could barely put weight on it. I was given an Aircast boot to hobble around in, and told to ice and use anti-inflammatories sparingly. My activities: surfing, skateboarding, yoga, even my daily walks, came to a startling halt.
I spent the first few days on the couch, my foot alternating between being elevated in the boot and immersed in an ice bath. I took a tincture with herbs like Solomon’s Seal, mullein, comfrey, and boneset to help heal the bone faster. I was adding about 6 tbs of collagen to oats in the morning. I was taking a bone supplement with microcrystalline hydroxyapatite, pellets of homeopathic symphytum, zinc, and vitamin D.
We call this “treatment stacking”: throwing everything but the kitchen sink at something to give the body as many resources as possible that it may use to heal.
My brother’s wedding came and went. I was the emcee, and the best man. I bedazzled my boot and hobbled around during set-up, photos, presentations, and even tried shaking and shimmying, one-legged on the dance floor. The next few days I sat on the couch with my leg up.
I watched the Olympics and skateboarding videos. I read The Master and the Margarita and Infinite Jest. I got back into painting and created some pen drawings, trying to keep my mind busy.
I slept long hours–an amount that I would have previously assumed to be incapable. The sleep felt necessary and healing. I was taking melatonin to deepen it further.
I closed down social media apps on my phone to deal with the immense FOMO and stop mindlessly scrolling. I journaled instead, turning my focus from the outside world to my inner one.
It was a painful process, and not necessarily physically.
I was confined to my immediate surroundings–not able to walk far or drive. I was at the mercy of friends and family to help me grocery shop. The last year and a half has made many of us grow accustomed to social isolation and a lot of my social routines from years prior had fallen by the wayside.
My world, like the worlds of many, had gotten smaller over the last 18 months. With a broken foot, my world shrunk even further.
The loneliness was excruciating.
It would come in waves.
One moment I would relish the time spent idle and unproductive. The next I would be left stranded by my dopamine receptors, aimless, sobbing, grieving something… anything… from my previous life. And perhaps not just the life I had enjoyed pre-broken foot, but maybe a life before society had “broken”, or even before my heart had.
I thought I would be more mentally productive and buckle down on work projects but it became painfully obvious that my mental health and general productivity are tightly linked to my activity levels. And so I spent a lot of the weeks letting my bone heal in a state of waiting energy.
My best friend left me a voicemail that said, “Yes… you’re in that waiting energy. But, you know, something will come out of it. Don’t be hard on yourself. Try to enjoy things… watch George Carlin…”
During the moments where I feel completely useless and unproductive, waiting for life to begin, I was reminded of this quote by Cheryl Strayed. This quote speaks to me through the blurry, grey haze of boredom and the existential urgency of wasting time.
It says,
“The useless days will add up to something. The shitty waitressing jobs. The hours writing in your journal. The long meandering walks. The hours reading poetry and story collections and novels and dead people’s diaries and wondering about sex and God and whether you should shave under your arms or not. These things are your becoming.”
These things are your becoming.
Something will come out of it.
When I did a 10-Day Vipassana (silent meditation) retreat in the summer of 2018, I learned about pain.
It was Day 3 or 4 and we had been instructed to sit for an entire hour without moving. The pain was excruciating. The resistance was intense. I was at war with myself and then, when the gong went off and there was nothing to push against, I noticed a complete relief of tension. I was fine.
The next time I sat to meditate (another hour after a 10 minute break), I observed the resistance and released it. It’s hard to describe exactly what I did. It was something like, letting the sensations of pain flow through me like leaves on a river, rather than trying to cup my hands around them, or understand or making meaning out of them.
The sensations ebbed and flowed. Some might have been called “unpleasant” but I wasn’t in a space to judge them while I was just a casual observer, watching them flow by. They just were.
And when I have intense feelings of loneliness, boredom or heart-break I try to remember the experience I had with pain and discomfort on my meditation cushion. I try to allow them.
“This too shall pass”.
When I have a craving to jump off my couch and surf, or an intense restlessness in the rest of my body, the parts that aren’t broken, I try to let those sensations move through me.
I notice how my foot feels. How while apparently still, beneath my external flesh my body is busy: it’s in a process. It’s becoming something different than it was before. It’s becoming more than a foot that is unbroken. It’s becoming callused and perhaps stronger.
Maybe my spirit is in such a process as well.
The antidote to boredom and loneliness very often is a process of letting them move through, of observing the sensations and stepped back, out of the river to watch them flow by. A patience. Letting go.
I can’t surf today. But, it is the nature of waves that there will always be more.
Pima Chodron in her book When Things Fall Apart also references physical pain and restless in meditation while speaking of loneliness.
She writes,
“Usually we regard loneliness as the enemy. Heartache is not something we choose to invite in. It’s restless and pregnant and hot with desire to escape and find something or someone to keep us company. When we can rest in the middle, we begin to have a nonthreatening relationship with loneliness, a relaxing and cooling loneliness that completely turns our usual fearful patterns upside down.”
She continues,
“When you wake up in the morning and out of nowhere comes the heartache of alienation and loneliness, could you use that as a golden opportunity? Rather than persecuting yourself or feeling that something terribly wrong is happening, right there in the moment of sadness and longing, could you relax and touch the limitless space of the human heart?
“The next time you get a chance, experiment with this.”
In other words, something will come of this.
by Dr. Talia Marcheggiani, ND | Aug 27, 2021 | doctor as teacher, Health, Medicine, Mental Health, Mind Body Medicine, Philosophy, Physical Medicine, Preventive Medicine
“The right to determine what shall or shall not be done with one’s own body, and to be free from non-consensual medical treatment is a right deeply rooted in Canadian common law. The right underlines the doctrine of informed consent.
“With very limited exceptions (such emergency use or incapacity), every person’s body is considered inviolate and accordingly every competent adult has the right to be free from unwanted medical treatment.
“The fact that serious risks or consequences may result from a refusal of medical treatment does not vititate the right of medical self-determination.
“The doctrine of informed consent ensures the freedom of individuals to make choices about their medical care. It is the patient, not the physician (or others) who ultimately must decide if treatment–any treatment–is to be administered.” Justice Robbins of the Ontario Court of Appeal.
I deeply believe that the key to optimal health is taking full responsibility and accepting all personal power for one’s own health. This may involve doing research, educating oneself, or assembling a team of trusted health professionals, with you, the patient at the centre.
We have a busy and overloaded healthcare system and even well-meaning professionals can find themselves hurriedly having a conversation in which they are not properly informing patients of the risks and benefits, or alternatives to treatment that they are recommending. I have had patients hurriedly scheduling for surgeries they weren’t sure they wanted, or pressured into hysterectomies or long-term treatments whose risks they didn’t understand.
I have also had patients make perplexing choices in the name of their own care–choices I didn’t necessarily agree with, such as forgoing conventional cancer treatments or further testing or screening.
However, it is the duty of the healthcare provider to provide advice. And it is the right of every patient to accept or reject that advice.
In light of recent, disturbing events, I have started posting some facts on Canadian law and Informed Consent only to be met with surprise–many people are not aware of their rights to refuse medical treatment, to be informed of the risks, and to be allowed to make a choice free of pressure or coercion.
Despite it being deeply enshrined in Canadian law, many patients are not aware of their right to full bodily integrity, autonomy, and choice.
Since 1980, the Supreme Court of Canada made it the right of every patient to be given full informed consent before any medical procedure such as taking blood, giving an injection or vaccination, performing a physical examination, exposing the patient to radiation, and so on.
“The underlying principle is the right of a patient to decide what, if anything, should be done with his body.” Is quote from the famous Supreme Court case of Hopp v. Lepp.
Every health professional under the Regulated Health Professions Act, including naturopathic doctors has a duty to uphold informed consent. We are well versed in it. We are required to uphold it, document it, and maintain it with every patient we see.
Our naturopathic guidelines on consent state, “The ability to direct one’s own health care needs and treatment is vital to an individual’s personal dignity and autonomy. A key component of dignity and autonomy is choice. Regulated health professionals hold a position of trust and power with respect to their patients and can often exercise influence over a patient; however, decision-making power must always rest with the patient.”
In 1996 Ontario passed the Health Care Consent Act, a legal framework for documenting, communicating, establishing and maintaining informed consent in all healthcare settings.
Informed consent is required before all treatment can be administered. Treatment includes: “anything that is done for a therapeutic, preventive, palliative, diagnostic, cosmetic or other health-related purpose, and includes a course of treatment, plan of treatment or community treatment plan.”
Informed consent must be present in 4 key areas:
- The consent must relate to the treatment.
- The consent must be informed.
- The consent must be given voluntarily, i.e.: made by the patient, and under no coercion, pressure, or duress.
- The consent must not be obtained through misrepresentation or fraud.
In order to obtain your full informed consent, you must be given the following information:
- The nature of the treatment.
- The expected benefits of the treatment.
- The material risks of the treatment, no matter how small, especially if one of the risks of side effects is death. The risks should not be minimized for the purpose of influencing your decision-making. The risks should be in relation to your health history. For example, if you suffer from cardiovascular disease, you should be made aware of the the risk of blood clots or myocarditis. It should also be disclosed if certain risks remain unknown.
- The material side effects of the treatment. Again, these side effects should be explicitly stated, no matter how small, and if long-term side effects are unknown, that should be stated.
- Alternative courses of action.
- The likely consequences of not having the treatment. These consequences should not be exaggerated and must be related to the particular patient at hand. What is the actual risk of the patient not receiving the treatment?
Consent cannot be given in a state of duress or coercion. Healthcare providers must be aware that they hold a position of authority and may maintain a power imbalance. They must not misrepresent the benefits of the treatment, and they must disclose any conflict of interest.
Healthcare providers must ensure that patients are not acting under the pressures of someone else, such as an employer, government agency or family member, and are making this decision on their own.
Finally,
The Informed Consent Guide for Canadian Physicians states, “Patients must always be free to consent to or refuse treatment, and be free of any suggestion of duress or coercion. Consent obtained under any suggestion of compulsion either by the actions or words of the physician or others may be no consent at all and therefore may be successfully repudiated. In this context physicians must keep clearly in mind there may be circumstances when the initiative to consult a physician was not the patient’s but was rather that of a third party, a friend, an employer, or even a police officer.
“Under such circumstances, the physician may be well aware that the paitent is only very reluctantly following the course of action suggested or insisted upon by a third person. Then, physicians should be more than usually careful to assure themselves that patients are in full agreement with what has been suggested, that there has been no coercion and that the will of other persons has not been imposed on the patient”.
It is your body and it is your choice. You always have the right to do what’s best for you. True, empowered health cannot come from a place of coercion or pressure.
Know that you always have a choice–your doctor has a duty to inform you of your choice, as well as the information necessary for you to make the right choice for you, regardless of what is happening in the media or in politics.
Informed consent is your right and it’s the law.
by Dr. Talia Marcheggiani, ND | Aug 25, 2021 | Anxiety, Depression, Diet, Hormones, Mental Health, metabolic health, mood, Nutrition, Paleo
Quentin Crisp says, “Repeat yourself loudly and often” and so I’m repeating myself on blood sugar regulation.
I guess if I had to leave a legacy in the world of natural health and lifestyle medicine, if I could sum everyone’s problems down to one key major concept and one key take-home action plan it would be: blood sugar regulation and: eat protein.
Last week was pretty busy in my little homegrown virtual naturopathic practice and I found myself repeating myself loudly (well, in a normal volume voice) and definitely often, the importance of eating protein at every meal and the connection between their symptoms and blood sugar with virtually every patient I saw.
All of my patients last week seemed to be suffering from some combination of the following symptoms:
Fatigue, anxiety, overwhelm, disrupted, restless, and non-restorative sleep, sugar cravings, emotional eating, binge-eating/stress-eating, nausea and bloating, PMS, migraines, low focus and concentration, low libido, low motivation, poor exercise recovery, and weight gain/puffiness/body image issues.
Of course, many of these symptoms were presented as being unrelated to the other. Perhaps stress and stress-eating were related, but sugar cravings and low motivation weren’t necessarily related in my patients’ minds. Neither were their sugar cravings, overwhelm and low libido.
And yet, the common thread that connects all of these symptoms is, you guessed it: blood sugar.
I explained to one patient: even if I gave you a magic wand, that you could wave to make all of your life’s problems disappear, you would probably still be feeling that deep, disconcerting, restless, anxious, “all-is-not-well” feeling in your gut. The reason for this? Blood sugar dys-regulation.
Our body has certain physiological mechanisms that it likes to keep tightly regulated. Among them are blood levels of our sugar (which controls the amount of fuel our brain has for its minute-to-minute functioning), carbon dioxide, salt, and water. When these levels drop in the body we start to feel off. Our stress response is triggered.
Imagine the feeling of holding your breath, as carbon dioxide starts to build up in your blood, you’d pay someone a million dollars to be able to take a breath. Similarly, if you’re seriously thirsty it’s likely all you can think about.
When our blood sugar drops, we feel terrible. The symptoms are anxiety, shakiness, fatigue, low mental energy, burnout, decision fatigue, waking up in the middle of the night, irritability, dizziness and weakness, and an unsettled, doom and gloom feeling. Most of all, however, we crave sugar.
Despite all of the symptoms my patients were expressing last week, one of the main issues they were contending with were sugar cravings. “I just don’t have the motivation to cook a meal”, one patient expressed, “and so I end up eating a bag of chips for dinner, even though I’m not really hungry.”
“You are hungry,” I explained, “the hunger is just not manifesting in the way that you’re used to.
Let me repeat this loudly, ala Quentin Crisp: if you ever find yourself at the end of a bag of chips, or a plate of cookies, or a pile of donuts–you were hungry.
Eating disorder expert Tabitha Ferrar highlights a phenomenon in people recovering from anorexia as “mental hunger”. Physical hunger, the grumbling, gurgling, empty feeling in your stomach is the result of ghrelin and gastric motility, which builds up when leptin levels fall and our stomach is physically empty and creates what many of us assume are the sensations of “true hunger”.
For more on leptin and hunger and how to regulate your metabolism check out my course You Weigh Less on the Moon https://learn.goodmoodproject.ca/courses/you-weigh-less-on-the-moon
However, these symptoms require energy form our body to produce. This is the reason why people with hypothryoidism are constipated–gastric motility takes metabolic energy.
If your body is malnourished, such as the case of anorexia, or even chronic stress and under-eating throughout the day, we often don’t get these signals of “true” hunger.
Our bodies simply don’t have the battery power to create these symptoms. And yet, we need nourishment, particularly we need to elevate our blood sugar to supply our brains with energy.
And so our body sends our signals of “mental hunger”, that feeling of “I can’t stop thinking about the chips in the cupboard”, that often leads to mindless binging as our body tries to replenish its reserves.
If you’re craving sugar, emotionally eating, devouring chips in the afternoons or evenings, or feeling decision fatigue/ or “lack of willpower”, you might need to start focussing on your blood sugar.
Blood sugar dysregulation is also tightly connected to our moods. Think of our body’s homeostatic mechanism as a tightly regulated machine, a fuel gauge on our body’s resources, which are needed in times of stress. When our blood salt, sugar or water levels dip, and our blood CO2 levels rise, we start to feel uncomfortable. This can be remedied by drinking water, sighing, deep breathing, or eating something. When these levels fluctuate and we fail to notice, our body releases stress hormone.
Cortisol is our stress hormone, but it’s also the hormone that plays a role in blood sugar regulation. When blood sugar dips beyond homeostatic levels, cortisol steps in to save the day. Low blood sugar is a stressor on the body. This might look like morning anxiety, feeling tired and wired, waking in the middle of the night unable to fall back asleep.
Again, you might not feel hungry during these moments–just overwhelmed, anxious, irritable, unsettled, weak, dizzy, and fatigued.
You’re in a fight with your partner. You’ve been cleaning out the garage and it’s hot out. You’re annoyed at the way he breathes, at the slow methodical way he goes through your stuff. The mess feels overwhelming, the heat feels stifling. You leave in a huff, ready to set fire to the entire operation.
Grumbling and fuming, you go inside. You take a breather, you eat something, you exhale deeply, you drink some water.
Gradually, as your body starts to shift into physiological neutral, your perception starts to change. The garage feels slightly more tolerable. It’s really just above moving one box at a time, going through it and then starting on the next one. You can do it.
Before you know it, you’re done.
When blood sugar is low our prefrontal cortex, the “ego”, “decision-maker”, executive functioning, planning and cognitive part of the brain, becomes depleted. We might call this “decision fatigue”, “willpower fatigue” or “ego depletion”.
A New York Times article states,
“Administering glucose completely reversed the brain changes wrought by depletion…
“When glucose is low, [your brain] stops doing some things and starts doing others. It responds more strongly to immediate rewards and pays less attention to long-term prospects.”
In essence, you stop being able to make calm and effective decisions.
Brain sugar levels (the brain uses up 60% of available blood sugar) directly contribute to the feeling of being “solid”–able to make rational decisions, to respond to fears and anxieties, to emotionally regulate, to make competent and calm decisions.
When our blood sugar levels dip we start to spiral: we might think erratically, gloomily, catastrophically, and irrationally.
I had a patient who crashed at 3pm everday after school, when his major depression would “come back”. I asked him what he had for lunch, to which he replied he often worked through lunch. Breakfast was a croissant or piece of toast.
His first real (and only) meal was at dinner. The rest of the day was a sea of grazing on ultra-processed foods, sugar and white flour. No real food in sight.
Scarfing down an emergency granola bar every time blood sugar drops is one solution, however whenever we eat carbohydrates on their own, particularly the quick-release carbs like white sugar, or refined grains, our blood sugar spikes. Soon after, insulin is released, causing it to drop again.
Many of us start the day without food, or with a measly breakfast of toast or cereal, or some other carb-only meal. As I tell patients, though, a serving of carbohydrates is not a real meal.
You know what I mean: a bagel for breakfast, a sandwich and pb for lunch, a plate of pasta for dinner. Carbs, while an important part of a complete meal, are completely inadequate at keeping you fuelled for the hours of mental, emotional and physical labour you engage in between meals.
Does this mean you should eat low-carb? No, not necessarily.
What it means is that a meal contains fats, carbs, and protein. Therefore all meals, especially breakfast, and even snacks, should combine those three macronutrients to assure proper fuelling and blood sugar regulation.
When you eat a proper meal in the morning, your blood sugar rises slowly. It requires less insulin to get the fuel into your cells. Your blood sugar is metered out slowly throughout the next few hours instead of being rapidly absorbed.
This means no more spikes and crashes–in blood sugar, energy, mood or cravings. A proper meal provides hours of calm focus, more willpower, and more ability to concentrate and emotionally regulate.
Instead of just toast in the morning, add about 20g of protein to your meal: a scoop of protein powder, 3-4 eggs, a piece of chicken, 3 tbs of collagen powder– in essence, have a proper meal.
Then, for lunch do it again–have a chicken breast on your salad, or a piece of salmon or beef.
Make yourself a smoothie with protein powder. Have a cold soak oats with collagen powder. Make yourself an omelette. Have a bean soup with 1 cup of beans.
Substitute your wheat or rice pasta (which is just carbohydrate) for a legume pasta made of mung bean or lentils, or black beans, which contain fibre and protein and are easier to make into a fast, complete meal.
When patients start having complete meals, starting with breakfast, their change in mood is often dramatic. They feel more mentally and emotionally stable. They have more energy.
Often we feel we get our second wind in the evening: (“I’m more of a night owl”). But so many of us work through our morning meals and only sit down to a complete meal at dinnertime. Maybe your “second wind” is actually just your first wind, purchased from the proper meal you had when you finally sat down and nourished your body.
What about intermittent fasting? Whenever I speak about breakfast there’s at least one DM or question, or “but I thought that…” and the topic of intermittent fasting almost always comes up.
Giving the body a break from eating is a good idea. For about 12 hours, if possible, stop eating.
This usually means stopping eating 3 hours before bedtime and creating an eating window from something like 7am to 7pm.
12:12 (12 hours of fasting and 12 hours of eating) can be great for resting the digestive system and supporting sleep. However, many of my patients use more extreme version of “intermittent fasting”, such as the 16:8 (16 hours fasting and 8 hours feeding) as a go-ahead to skip breakfast.
They wake up and get through the morning on coffee (with cream and sugar, which isn’t actually a real “fast”), and then eventually binge on sugar and chips after dinner, when they finally give their bodies permission to eat. It’s rare that they see the connection.
Most of us attribute the feelings of lack of control around food an issue with emotional eating and willpower. I find that in 99% of cases, “emotional eating” us usually just a result of blood sugar dys-regulation, protein deficiency and under-nourishing earlier on in the day.
A morning without food is a stressor on the body. Female bodies in particular respond to stress by becoming more insulin resistant, which further affects blood sugar dys-regulation and affects metabolic health–this is not what you want.
If you’d like to restrict your eating window, research shows that removing any after-dinner snacking (when our bodies are naturally more insulin resistant) is the way to go.
It’s also important to take a Protein Inventory. Sometimes I just have patients track their protein intake on a website or app like cronometer.com
The exercise is often enlightening, as patients are able to see how the protein density of their diet connects to their mood and energy.
I often get them to track their food for a few days to a week and then ask them: How do you feel on a higher protein day, where you meet your nutritional needs vs. a low protein day? What is your energy like? Your sugar cravings? Your mood? Your mental focus and clarity?
Conditions like OCD, ADHD, depression, anxiety, PMS, PMDD, cognitive issues, dementia, diabetes, pre-diabetes, weight gain, and bipolar all have roots in blood sugar regulation.
Blood sugar dys-regulation, over time can start to result in insulin resistance (often detected far before any changes to lab blood glucose start to show up).
Insulin resistance is the process in which the cells stop responding to insulin, requiring more insulin to be released. This causes inflammation and weight gain and, over time, elevated blood sugar. Insulin resistance can contribute to mood and hormonal issues, cognitive issues, like dementia, and metabolic conditions over time. This is definitely something you don’t want.
If you think you might have insulin resistance (characterized by sugar cravings, fatigue, abdominal weight gain, difficulty losing weight, hormonal issues, mood issues, low energy, and cognitive issues) consider getting your fasting insulin and fasting glucose tested. These two numbers can give you a HOMA-IR score, used to gauge insulin resistance, so you can work to reverse it before it progresses to pre-diabetes and type II diabetes.
Often insulin resistance, inflammation and stress are a never-ending cycle and all need to be addressed, with blood sugar regulation as a key strategy to getting your body’s insulin signal working again.
Signs that your metabolic health is healing are more energy, less cravings, better mood, better sleep, and some weight loss (which usually starts occurring about 6 weeks into a lifestyle change program).
Low calorie diets can also be a significant stressor on the body affecting blood sugar. Making sure that your fat and protein intake are sufficient (aiming for about 1 g of protein per lb of body weight for an active person) is essential to regulating blood sugar, cravings, mood and energy.
For more information on how low-calorie and restrictive diets can actually work against your weight loss, mood and energy goals, check out my course You Weigh Less on the Moon. https://learn.goodmoodproject.ca/courses/you-weigh-less-on-the-moon
So, how do you take control of your sugar cravings today?
Here are some places to start:
- Start your day with a complete breakfast that includes fat, carbs and 20 g of protein
- Eat full meals regularly throughout the day
- “front-load” your calories, eating 60% or more of your food before 1pm
- Aim for 1 g of protein per lb of body weight, or 90g of protein as a minimum
- Track your protein intake along with your mood, energy levels and cravings so that you can have more agency over your food choices, dietary patterns and symptoms.
- Have ready-to-grab protein sources like pumpkin seeds, eggs, protein powder, legume pasta, precooked chicken breasts, canned salmon, and so on.
- If you’re going to try Intermittent Fasting start slowly, begin by avoiding late-night snacking or snacking before dinner.
Finally, book an appointment if you feel ready to support your metabolic health and get your nutrition right to support your hormones and mood!
For more on how to regulate your blood sugar (as well as nutrient levels and inflammation levels) to eat for your mood, check out my course Feed Your Head:
https://learn.goodmoodproject.ca/courses/feed-your-head
by Dr. Talia Marcheggiani, ND | Jul 28, 2021 | Anxiety, Balance, Exercise, Health, Lifestyle, Medicine, Mental Health, Mind Body Medicine, Physical Medicine, Yoga
I was sitting with my friend and her ex-partner. Their kids are soccer stars–one is headed towards a professional career and the younger one is not far behind.
My friends ex-partner, a fit soccer fan himself, lamented, “I’m getting old. I don’t recover like I used to. I’m not as fast as I used to be. I feel more sore after a game of soccer now in my 40s than when I was in my teens and 20s. Getting old sucks.”
“When you were younger you played soccer everyday,” my friend retorted. “Is it that you’re getting old or is that, as an adult, you have more obligations and responsibilities than you did when you were in your teens and yet expect yourself to be able to pick up the sport and play once a week as hard as when you were playing everyday?”
We blame old age on everything in our society.
I’m tired of “you’re getting older” being the main throwaway diagnosis of my friends, family, and patients’ sliding health and fitness. Kelly Slater is almost 50–he plans to keep surfing into his 70s. I’ll bet he can, too.
Coco is like 70 in dog years and climbs steep hills and races and chases and bites (with the 5 teeth he has left) like a puppy.
As adults, I think we need to take responsibility for our bodies and take our range of motion, flexibility and strength seriously if we’d like to retain the physical mobility of our youth. It’s not your age—it’s what your age means to your movement patterns that will dictate your injury susceptibility, your recovery, your progress in your sport of choice, and your overall fitness and health.
I’ve been thinking about this lately because I’ve been taking my surf training a bit more seriously this year.
Surfing is an incredibly difficult sport. Tiny increments in progression happen over years, not months. Going from a beginner (which I would classify myself as: an advanced beginner) to an intermediate surfer is a timeline of almost daily sessions for at least a couple of years.
I’ve been surfing for two years and still have massive leaps and bounds to go before I’d classify my skills as “intermediate”.
Because the lakes don’t offer as much consistency as the ocean, I figured I wasn’t going to make progress fast enough unless I started to do dry-land training, focusing on physical strength for paddling and speed pumping down the line, and flexibility and mobility to be able to put my body in the positions that the sport demands–this means core strength, glute strength, hip and ankle flexibility and upper body strength.
It also means balance and practicing upper and lower body coordination.
It means I need to practice certain movement patterns on dry land, and train on a surfskate. It means I need to make sure my body has the range of motion necessary to surf, and the joint and muscle health necessary to recover faster, and prevent injury. It’s not fun to get injured as an adult when you have a job to go to that pays the bills.
I dislocated my shoulder at age 20 while snowboarding and it affected my ability to study effectively at university. My shoulder still gives me trouble, particularly if I put it in “backstroke” position, internal rotation and overhead extension– I can feel it slide out, in danger of redislocating. I don’t want another injury in my 30s.
I’ve also been watching the Olympics and thinking of professional surfers like 19-year old Caroline Marks. Her prodigy-like talent comes from a combination of learning the sport early in order to instil proper motor patterns, a competitive spirit, familial encouragement, financial resources, body type (a strong lower body and lower centre of gravity), and amazing coaching.
According to William Finnegan it’s almost impossible to be “any good” at surfing if you start learning after the age of 14.
Damn.
However, learning new movements and teaching your body how to coordinate in new ways does wonders to stave off depression and dementia as well as keep your body strong and supple.
I find focusing on performance in a sport helps with my body image: I focus on how my body looks in its postures and positions while performing the sport vs. the shape of it in general.
I also find the dopamine hits and adrenaline highs are addictive and calming—If I go too long without surfing I feel a bit if ennui-like withdrawal.
I also find that surfing is an amazing way to connect me with a community, with nature, with the lakes and the ocean, and my breath and body.
And I find it satisfying to work towards goals.
As a kid I was fairly athletic but not particularly talented at any competitive sport. I did gymnastics for a second, and played soccer for a number of years. I was on the swim team in high school and taught and coached swimming myself. I am still a strong swimmer but was nothing more than an average racer.
I was on the triathlon team at Queen’s for a couple of years, and had a job as a snowboarding instructor throughout high school. I loved snowboarding during that time until going to school in a relative flat place and suffering an injury drastically reduced the amount of time I was able to spend on the hill.
I’ve been fascinated about the technical aspect of skills I’m interested in acquiring.
I love learning what the optimal stance is and how to position my body to mimic it. I’m interested in learning how to breathe right, which muscles need stretching and which ones need strengthening.
I love the video analyses and the tips from friends on how to improve. I enjoy the struggle and the frustration and the plateaus followed by random bursts of improvement that fill you with giddy excitement. That slam dunk, arms in the air feeling.
When taking a history, I always ask patients about their physical activity levels and their movement patterns.
Many are physically active in order to support their health: walking daily, going to the gym to lift weights or take exercise classes, doing yoga or pilates. But many will tell me that their activity comes mostly from playing sports–they play hockey or golf once a week.
And many of my surfing friends just surf.
That’s fine if you’re like my friend Steve who surfs or skateboards virtually everyday, but if you’re the type of athlete who only has the time or opportunity to engage in your sport once a week or less you’re most likely putting yourself at risk of injury without any dry-land functional training.
Functional movement helps our bodies stay optimally healthy and… well, functional. The functional movements include pushing, pulling, squatting, lunging, twisting, gait, and rotation. We need them to stay mobile and injury free. I read somewhere that most 50 year olds can’t stand in a lunge position.
I know that many people in their 30s can’t sit crosslegged on the floor, or squat. Our hip flexors are tight, our glutes are loose, and our ankles are immobile. We aren’t training our bodies for functional existence, like sitting on the floor and standing up out of a chair without using your hands.
It’s important to stretch daily to prevent muscle and joint injury. It’s important to keep certain muscles strong–like the upper body muscles for paddling. Our bodies weren’t meant to perform repetitive movements on demand after staying locked in a shed for weeks. They need to move regularly and need to stay tuned up to perform the sport of your choice, especially if you’re still interested in progressing at it.
Many sports are asymmetrical as well. This can leave us vulnerable to injury as certain flexors are tighter than their extensors, and so on, putting strain on joints.
Being able to move your body through space, not just linearly, in 2D, like in running or walking, but across all dimensions: front and back and side to side and twisting and jumping and crawling, is important for maintaining proprioception and body awareness.
Open hip flexors (can you do a squat? Can you sit cross-legged on the floor? What about Pigeon Pose?) are important for maintaining optimal back and digestive health.
The glutes are the most metabolically active muscles in the body and for most of us they just lie around flaccid all day as we sit in our chairs and work on our computers. This causes tightness and strain in other areas of the body such as the hip flexors, calves and hamstrings.
I noticed that my left calf was so tight it was impacting my ankle flexibility. I learned this through yoga–noticing that when I would try to get into skandasana (side lunge), my heel wasn’t able to touch the floor on the left side. This left ankle tightness is inevitably going to impact my surfing because my body cannot literally get into the posture necessary for certain maneuvers and therefore will limit my progress.
And so I’ve been focusing on more sport-specific dry land training for the sport of surfing–a challenging feat to take on as someone in her mid-30s who doesn’t live near an ocean–but also to maintain optimal health, body awareness, and functional movement.
Challenge you body and brain through finding a sport you love, or activities that you love that you’d like to get better at. Train for these activities, stretch daily and begin to explore your body in new ways: learn what muscles need loosening and what muscles need strengthening, Begin to expand the range of motion of your joints to prevent injury.
Strengthen your bone mass through applying repetitive stress to long bones (through walking, running, jumping and weight-lifting).
Explore fluidity of movement through swimming, dance, yoga, pilates, or other activities that require complex movements, coordination, grace, style, and flow.
Watch your body shape transform into something you are genuinely proud of: not so much because of what it looks like, but for what it is capable of, how it supports you, and what it can do.
Develop and hone your body awareness. Deepen your breath. Pay attention to pain and physical sensations, including the physiological sensations of hunger, thirst, and fatigue. Body awareness can help to heal injury, process trauma, and engage in self-care. It can help with emotional regulation, and interpersonal relationships.
And, most of all, stay active. Whatever you do, find joy in movement.
by Dr. Talia Marcheggiani, ND | Jun 28, 2021 | Addiction, Anxiety, Mental Health, Mind Body Medicine, Mindfulness
Can you do me a favour?
I want you to think about your thoughts.
Not just any thoughts: The Thought Spiral.
We all have thought spirals. You know, where your thoughts feel like they’re on an automatic playback loop? If you suffer from OCD, your thought spirals likely plague your existence.
Those with OCD have very strong and triple-thick rubber resistance band kinds of thought spirals. In OCD, the part of their brain that “gear shifts” (called the caudate nucleus, if you’re curious), unhooking the rubber band to start to play something else–a kind of “thank you, brain for sharing”–isn’t working. The thought loop plays and plays, intrusively, sometimes horrifyingly.
Even if you don’t have OCD and you can gear shift, you still probably know the rubber band thought loop I’m describing. I think that OCD is likely a spectrum and we all fall somewhere on the spectrum of our brain’s ability to shut off the caudate nucleus and gear shift out of a thought spiral.
Mental states such as fatigue, low blood sugar, dehydration, depression, anxiety, brain inflammation, and so on, make it more difficult to gear shift, because the brain requires a lot of energy to shut off the caudate nucleus.
The difference in those who have OCD is that the gear shift gets stuck way more frequently and the gears get lodged more strongly than those on the far other end of the spectrum.
On the far end of the spectrum may be those who hardly think about anything and let everything go and are super chillax and take nothing personally and all that (possibly some very experienced mediators can get there too).
So, back to the original question. Can you locate your thought loop?
That rubber band that fixates on whether your friends hate you because they took longer than 15 minutes to answer in the group text?
That rubber band that convinces you that the strange mole on your left thigh looks two shades darker than yesterday and you read on Google that that could mean that it’s cancerous, and your doctor looked at it (and then the doctor whose second opinion you sought) and said it was fine but that doctor might be a quack, what medical school could they even have gone to anyways, and now you’re planning your funeral?
Can you identify your thought spirals when they occur?
Thought rubber bands have a flavour. They sometimes speak in their own voice, or a particular tone. Or the way the thoughts jump from concept to concept is different from your normal, balanced and sober thoughts.
The thought spirals might produce a certain feeling in your body that is familiar (and often unpleasant): perhaps a sinking feeling in your stomach, or a 60-lb labrador retriever sitting on your chest. There may be a couple rubber band flavours: a mean one, a frenzied one, one that sounds like your mother, and so on.
Can you locate yours?
Does it have a name?
Sometimes people call it “OCD”–this is probably why people with OCD (especially “Harm OCD”, or thought loops that involve harming others, more on those later), often feel such relief at receiving the label. The label might help us (and our loved ones) recognize that we have a rubber band in the first place. That just because we have thoughts doesn’t necessarily mean anything. And this begins the process of something called Externalization.
Sometimes “OCD” isn’t the best name.
Some people call their thought loop “Herbert”.
I once heard a hilarious story where an individual named hers “Yes, Ma’am!”
Externalization.
Externalization is the act of locating the phenoma we have identified with as something outside of ourselves.
Oh my, imagine if you actually were Herbet (or OCD, or “Yes, Ma’am”). What if you actually believed them? Imagine believing OCD when she tells you that your best friend Glenda from 5th grade saw that funny look on your face that you let slip for a second when she revealed to you that she’s getting a divorce and you now think she thinks that you’re judging her and now she thinks you’re a horrible person or her feelings are hurt and that’s not the type of person you are you should have looked more supportive or asked more questions.
Ugh, that would be horrible.
Now you can think of OCD (or whatever your thought loop is called) as a person, or an entity separate from yourself that occupies your head from time to time. You can see it as a separate thing that might be helpful sometimes. Maybe you have the same values as your OCD sometimes (like the values of being a good and supportive friend and not making weird involuntary faces at Glenda).
Maybe the OCD stepped in quickly once to remind you to check your watch and you did and you actually did need to leave because more time had passed than you thought.
But, you can also think of OCD as a person who you are not 100% overlapped with. Maybe you’re really not friends with OCD if she’s the kind of person who keeps talking about you harming your dog, even though you love your dog (this is reference to certain versions of OCD, called Unwanted Thought Syndrome, or Harm OCD, where people have disturbing, often violent thoughts that are completely unaligned with their true selves. People might think about harming their dog or engaging in violent acts even thought they love their dog more than anything and haven’t squashed so much as a mosquito in their lives).
If you externalize these rubber band thought spirals, you are able to start the process of disconnecting from them. Then, you can start work with them. You can start to realize that they don’t mean anything.
Externalization helps us realize that thoughts of harming your dog aren’t your thoughts. And, more importantly, they don’t actually mean anything about you, your friend Glenda, or reality.
And, if you’re reading this and identify with any of the examples, let me just be your gear shift here and remind you that you are not these thoughts!
I’ll say it a different way: the fact that you’re upset by certain thoughts and think you’re a bad person for thinking them is more proof that you are not these thoughts.
In fact, for a moment I want you to think of a way in which you can’t possibly be that thought. Let’s just stop here for a second. I want you to think of a time you did something really nice for your dog. Did you get her a treat? Ok, then you’re not the type of person who would harm her!
(In an interview, Dr. Steven Phillipson says that he wouldn’t hesitate to let one of his patients with intrusive thoughts about pedophilia babysit his kids. “I’d be far more worried about you than them,” he assures his patients, highlighting that intrusive and unwanted thoughts don’t mean the thinker will act on them–but cause immense distress for the person thinking them).
Externalization helps us share our thoughts. This is why I believe the “Stop the Stigma” campaign is so important. It’s super hard to gear shift on your own. It’s especially hard to do it when you’re under-slept, or undernourished, or having a bad day. We need other people to be the gear shift for us sometimes, while we’re learning to grease the gears ourselves.
I call this “Outsourcing the Prefrontal Cortex”, running something by a friend who knows you and can reassure you that whatever horrific thought or idea is looping in your brain isn’t true or important or indication that you’re a bad person or need to call the police and go back and check if you ran someone over or text the person again.
There are times when I can get caught in thought spiral and I remember yanking at the gear (so there was a part that was able to externalize and even determine that the gear needed to be shifted, which already takes lots of practice). Despite my efforts, though I just wasn’t able to nudge it.
So I talked to a friend. And sometimes even saying it out loud helped—saying it out loud was a way to confront the thoughts. And she and I laughed and she reassured me. And I felt silly but it was what I needed to hear. And the gear moved. And I relaxed. And my brain could move on.
Sometimes seeking reassurance can be a compulsion, however. The difference lies in whether you can tolerate the thoughts and externalize them as thoughts, and Outsource your Prefrontal Cortex in order to unstick your gear shift.
There are three brain areas involved in OCD: the Orbitofrontal Cortex, the Anterior Cingulate Cortex and the Caudate Nucleus.
We are smart social creatures and our brains are geared so that we can learn from our mistakes. The orbitofrontal cortex sounds off an alarm when it thinks we’ve done something wrong. It is our error detection system. It’s the shock you feel when you realize, “Hey did I run over a speed bump back there or…”
The anterior cingulate cortex keeps us feeling uneasy and unsettled until the mistake is corrected. And the caudate nucleus, our “gear shifter” responds to error correction and turns off once we’ve done something correctly so we can move on.
In OCD all three areas are hyperactive. The main neurotransmitter of this brain circuit is glutamate, our excitatory neurotransmitter. This is why NAC (n-acetyl cysteine) can be such a helpful supplement for OCD, tourettes, tics, skin picking and hair-pulling, binge eating, and thought spirals and compulsions, as it “mops” up glutamate in the brain and can calm down the entire circuit. It’s also thought that the orbitofrontal cortex might be low in serotonin, why many people with OCD are prescribed Zoloft or another SSRI medications and can see some benefit from them–5HTP can be a helpful supplement for supporting serotonin synthesis in the brain but shouldn’t be mixed with SSRIs.
The gold standard treatment for OCD is Exposure and Response Prevention Therapy, or ERP.
ERP works by first viewing the thought loops as sticky, addictive substances while addressing our fears surrounding them by exposing us to the thoughts. If you’re afraid of snakes, exposure therapy engages a step by step process of getting you in front of a snake until the fear centre of your brain, the amygdala no longer associates friendly, non-poisonous snakes with danger. ERP is similar–when we face the intrusive thoughts head-on they start to lose their power over us.
ERP involves sitting with the thought loops and refraining from engaging in any compulsions until the brain stops caring about them, and the alarm stops sounding. OCD doesn’t necessarily involve compulsions–often the compulsions can be mental, such as constantly telling a friend (over-outsourcing the prefrontal cortex, let’s say).
It involves heading into the intrusive thoughts, and thought spirals, perhaps listening to recordings of yourself saying them, and sitting with the feelings of discomfort until you are used to them. You know when someone’s car alarm goes off in a parking lot and no one even turns to look? That’s how ERP wants you to engage with your intrusive thoughts.
Mindfulness and externalization are helpful tools to aid the process of ERP.
Often it’s necessary to explore why certain subject matter of the thoughts is so “hot”–perhaps looking under the hood at traumas and implicit memories that you may have experienced that may have led to an over-active alarm system. However, it’s probably necessary to start by building the skills of exposure and response prevention so that you can stay stabilized throughout your trauma therapy, by dampening the alarm system that kicks off the thought spirals.
One thing not to do, if you have OCD, is to go to a therapist who does more psychodynamic therapy, or who examines the “deeper” meaning of the thoughts. Your brain is already trying to do that (“What kind of person has these kind of thoughts?”) and it’s not helpful. Addressing trauma maybe be incredibly helpful at some point in your treatment plan, but analyzing and picking apart the thoughts is probably more damaging than useful.
Seeing the thoughts as just thoughts that show up in the mind and don’t mean anything important is a better attitude to take towards them.
You might not have OCD (again, I believe that it’s a spectrum), but you definitely have thought loops. You do have rubber band thoughts. And you do have a gear shifter.
When I get stuck in thought loops I try to gear shift by saying, “I’m enough”.
It’s not much, but it sometimes settles things down. Whatever I’m worrying about and obsessing about doesn’t matter as much–because I’m enough, just as I am.
It’s simple, and it’s been working.
If you suffer from OCD or you are having a hard time managing your intrusive thoughts, finding a therapist who focuses in ERP, or working with an ND who can help you strengthen your “gear shift” can be incredibly helpful places to get started.
You are not your thoughts.
by Dr. Talia Marcheggiani, ND | Jun 27, 2021 | Anxiety, Depression, Medicine, Mental Health, Mind Body Medicine, Mindfulness
In my last post on “I Treat Stories“, I talked about the spectrum between perfect “health” (perhaps better defined as “potential”) and disease, and death. The Disease Spectrum, perhaps we can call it.
And I also talked about the conflict many naturopathic patients experience when they are clearly not feeling well but are dismissed by the medical establishment because “there is nothing wrong”, i.e.: their signs and symptoms don’t fit into a disease classification.
I talk about functional conditions like insulin resistance and HPA axis dysfunction or estrogen dominance (or IBS, depression, anxiety) as these conditions in which functioning is impaired in someway, or the person doesn’t feel like themselves, and yet they are dismissed.
I want to correct this, however. I don’t believe that these conditions, even most diseases, per se, are the result of the body malfunctioning.
Instead, I think we should look at symptoms, and so-called pathologies and diseases, as the body adapting in a very functional way to circumstances that might be challenging, or malfunctioning.
Depression and anxiety are terrific examples of this.
In these conditions (which do fit a disease classification system, with which I very much do not agree–these classification systems rely only on symptoms, therefore they cannot possibly be viewed as true “diseases”), patients are told that they have an inborn malfunction–their brains don’t work properly. They might be told they have a chemical imbalance, or something to that nature, and that they require a lifetime of medication.
This can’t be farther from the truth.
Firstly, there has never been any evidence of these so-called brain imbalances. And there are no concrete physical signs of these “diseases” either. There are no universal changes to the brain, nothing that shows up on blood tests, and no issues with brain chemistry.
Even the therapies, usually SSRI medications, actually cause brain imbalances–there is no evidence that they solve them. There is also no evidence that they are safe and effective long-term (and limited evidence that they are safe and effective in the short-term).
What we do know is that animals in the wild become anxious when they are threatened.
And that animals in the wild become depressed when their anxiety response (their fight or flight survival response) is burnt out.
And that is the story I hear again and again in patients.
They have a history of anxiety–their nervous systems are wired “up”. This could be because of early childhood trauma. It could be attachment trauma, receiving insecure attachment or inadequate attunement from their caregivers. They might be contending with a great deal of conflict at the time of diagnosis. They may have psychological schemas about not being enough, leading to perfectionism and self-criticism, which their nervous system perceives as constant attack. They may have experienced anxious modelling from a parent or caregiver who suffers from anxiety (generational trauma, essentially).
They may be suffering from nutrient deficiencies, or a metabolic issue, giving their nervous system the input that there is a food shortage, one of our main historical stressors throughout human history.
And so on.
Ultimately, there is something happening in the environment in which their nervous system either lacks adequate safety signals or is receiving signals of danger or threat.
When patients present with depression they often describe a history of anxiety. Maybe they experienced it as “active” anxiety: feeling shaky and jittery, hyperactive, fearful, etc., or more “passive” or “mental” anxiety: worrying, ruminating, narrating, over-thinking, constant striving, self-criticism, thought loops, etc.
Not that anyone has ever asked them before reaching for the prescription pad, but when I talk to my patients presenting with depression they almost always report a baseline level of anxiety that has gone on for some time, followed by a period of acute stress, or shock, or loss, that led to this collapse of sorts.
At this point they experience extreme fatigue, low motivation, shut-down, paralysis, and intense self-criticism, even suicidal thoughts and intense feeling of hopelessness. The world starts to seem pointless. Their bodies and mind “shut down” in a sense.
And, of course they eventually seek solutions, firstly from the medical system (because we have been trained to medicalize the problemm–something has gone “off” with the machinery of the body. We locate the problem within ourselves, not with our situation.) and the response is pathologized, and most often medicated.
And then we talk about ending the stigma of mental illness (when in fact, many cases, if not most are not illnesses at all). What could be more stigmatizing or disempowering that the way we currently frame mental health?
Depression and anxiety are not sicknesses, or weaknesses. They are adaptations.
Depression is an inflammatory shutdown state that results from chronic overstimulation of the fear response in the nervous system. It is a symptom. It reflects the health of your very well-functioning brain and nervous system and their ability to adapt to adversity.
This adversity can be biological (infectious, a nutrient deficiency, metabolic issues, inflammation, etc.), mental, emotional, and environmental. It can (most often) be a confluence of one or more of these categories.
When a deer is trying to escape a predator and their fight or flight response fails to get them out of harms’ way, their nervous systems shut down. Their body releases opiates. They feel far away. Their limbs go limp. They can’t escape in body, so they escape in their minds and emotions. They despair. This is depression.
This is why the story is so important.
Without story, we can’t possibly understand what is going on for you specifically. We can’t possibly understand your situation. And, therefore, we can’t figure out what to do to help.
Is someone asking you about your story? Or are they just cataloguing your symptoms?
Are they asking about your family history, your history of trauma, the circumstances going on in your life? Are they talking to you about your thoughts, or your tendency to self-criticism and perfectionism? Are they asking you what you eat, how you move, how well you sleep, and how you recover from stress? Are they ruling out anemia, nutrient deficiencies, thyroid issues, fatty liver, insulin resistance, hormonal imbalances, and chronic inflammation, or gut issues?
Are they asking how content you are with your job? What your dreams are for the future? How fulfilled and loved you feel in your primary relationships? Are they asking you about poverty? Discrimination? Whether you feel safe in your neighbourhood? Whether you felt safe growing up as a kid?
Are they misdiagnosing your grief?
Does your healthcare practitioner get you? Can they connect the dots for you? Does talking to them give you a glimmer of hope, even in this hopeless time? Do you feel empowered and strong when you walk out of their office?
Or are they telling you you have a brain imbalance, or a in-born defect?
In reality, you are not defective. You are incredibly strong. Your body is adapting. It is resilient. And in its process of adaptation it is giving you these symptoms. Now, you don’t have to just tolerate these symptoms. There is so so much we can do. Perhaps pharmaceuticals are supportive for you while you start to compassionately look deeper.
But, there is so much more to the puzzle than just pharmaceuticals.
It’s worth asking,
What are you adapting to?
To learn more about nutrition and mental health, check out my course Feed Your Head.
by Dr. Talia Marcheggiani, ND | Jun 26, 2021 | Asian Medicine, Ayurvedic Medicine, Diagnostics, Evidence Based Medicine, Healing Stories, Medicine, Mental Health, Mind Body Medicine, Naturopathic Philosophy, Philosophy, Preventive Medicine, Traditional Chinese Medicine
“I don’t believe in diseases anymore, I treat stories.
“…No other medical system in the world ever believed in diseases. They all treat everybody as if, you know it’s whether it’s the ancestors or meridians–it’s none of this rheumatoid arthritis, strep throat kind of thing. That’s just this construct that we kind of… made up.”
– Dr. Thomas Cowan, MD
Dr. Cowan is admittedly a (deliciously) controversial figure. His statement, I’m sure, is controversial. But that’s why it intrigues me.
In naturopathic medicine, one of our core philosophies, with which I adhere very strongly, is “treat the person, not the disease”.
And, in the words of Sir William Osler, MD, “It is much more important to know what sort of person has a disease, than to know what sort of disease a person has”.
And, I guess it’s relevant to ask, what is disease in the first place?
I see disease as an non-hard end point, a state that our biological body enters into. On the continuum between perfect health (which may be an abstract and theoretical construct) and death, disease I believe is near the far end of the spectrum.
Disease happens when the body’s proteins, cells, tissues, or organs begin to malfunction in a way that threatens our survival and disrupts our ability to function in the world. For example, a collection of cells grows into a tumour, or the immune system attacks the pancreas and causes type I diabetes.
But, of course there is always more to the story.
What causes disease?
I have heard biological disease boiled down to two main causes: nutrient deficiencies and toxicities. And, I’m not sure how strongly I agree with this, but on a certain level I find this idea important to consider.
However, it is definitely not how Western Medicine views the cause of disease!
Diseases, as they are defined, seem to be biological (as opposed to mental or emotional). They have clinical signs and symptoms, certain blood test results, or imaging findings, and they can be observed looking at cells under a microscope.
Medical textbooks have lists of diseases. Medicine is largely about memorizing the characteristics of these diseases, differentiating one from another, diagnosing them, and prescribing the treatment for them.
As a naturopathic doctor, I see a myriad of patients who don’t have a “disease”, even though they feel awful and are having difficulty functioning. These patients seem to be moving along the disease spectrum, but their doctors are unable to diagnose them with anything concrete–they have not yet crossed the threshold between “feeling off” and “disease”.
Their blood tests are “normal” (supposedly), their imaging (x-rays, MRIs, ultrasounds, etc.) are negative or inconclusive, and their symptoms don’t point to any of the diseases in the medical school textbooks.
And yet they feel terrible.
And now they feel invalidated.
Often they are told, “You haven’t crossed the disease threshold yet, but once you reach the point where you’re feeling terrible and our tests pick it up too, come back and we’ll have a drug for you”.
Obviously not in so many words, but often that is the implication.
Our narrow paradigm of disease fails to account for true health.
Even the World Health Organization states that health is not the mere absence of disease.
So if someone does not have health (according to their own personal definition, values, dreams, goals, and responsibilities), but they don’t have disease, what do they have?
They have a story.
And I don’t mean that what they’re dealing with is psychological or mental or emotional instead, and that their issues are just “all in their head”. Many many times these imbalances are very biological, having a physical location in the body.
Subclinical hypothyroidism, insulin resistance, nutrient deficiencies, chronic HPA axis dysfunction, and intestinal dysbiosis are all examples of this. In these cases we can use physical testing, and physical signs to help us identify these patterns.
An aside: I believe the categories of biological, mental, environmental, and emotional, are false.
Can we have minds without biology? Can we have emotions without minds or physical bodies? How do we even interface with an environment out there if we don’t have a body or self in here?
Aren’t they all connected?
Ok, back to the flow of this piece:
Your story matters.
This is why it takes me 90 minutes to get started with a new patient.
It’s why I recommend symptom and lifestyle habit tracking: so that we can start to pay attention.
It’s why I’m curious and combine ancient philosophies, research (because yes, research is useful, there’s no doubt–we should be testing out our hypotheses), and my own intuition and skills for pattern-recognition, and my matching my felt-sense of what might be going on for a patient with their felt sense of what they feel is going on for them.
Attunement.
I write about stories a lot. And I don’t mean “story” in a woo way, like you talk about your problems and they go away.
No. What I mean is that you are an individual with a unique perspective and a body that is interconnected but also uniquely experienced. And my goal is to get a sense of what it’s like to be you. What your current experience is like. What “feeling like something’s wrong” feels like. What “getting better” feels like.
And all of that information is located within story.
Your body tells us a story too. The story shows up in your emotions, in your physical sensations, in your behaviours (that might be performed automatically or unconsciously), in your thoughts, in your energy, and in the palpation of your body.
No two cases of rheumatoid arthritis are the same. They may have similar presentations in some ways (enough to fit the category in the medical textbooks), but the two cases of rheumatoid arthritis in two separate people differ in more way than they are the same.
And that is important.
We’re so used to 15 minute insurance-covered visits where we’re given a quick diagnosis and a simple solution. We’re conditioned to believe that that’s all there is to health and that the doctors and scientists and researchers know pretty much everything there is to know about the human body and human experience.
And that if we don’t know about something, it means that it doesn’t exist.
When we’re told “nothing is wrong” we are taught to accept it. And perhaps conclude that something is wrong with us instead.
When we’re told that we have something wrong and the solution is in a pill, we are taught to accept that too. And perhaps conclude that something is wrong with our bodies.
But, you know what a story does?
It connects the dots.
It locates a relevant beginning, and weaves together the characters, themes, plot lines, conflicts, heroes, and myths that captivate us and teach us about the world.
A story combines your indigestion, mental health, microbiome, and your childhood trauma.
A story tells me about your shame, your skin inflammation, your anxiety, and your divorce.
Maybe you don’t have a disease, even if you’ve been given a diagnosis.
Maybe you have a story instead.
What do you think about that?
by Dr. Talia Marcheggiani, ND | Jun 25, 2021 | Body Image, Mental Health, Mind Body Medicine, Mindfulness, Self-care, Self-esteem, Weight Loss
I’ve struggled with body image as much as the next woman. In certain influencer, nutrition and health circles I find “skinny” is confused for “healthy”. When we talk about health and wellness, people assume we mean “thinness”, or weight loss.
And I want to confess something: I hate treating weight loss.
I love love love when people notice positive side effects from their treatment plans: they’re sleeping better, more relaxed, have better skin and yes, have even noticed some weight loss, but when weight loss is our primary goal, something we’re aiming for at all costs, (and this is the key point) beyond the weight OUR BODY WANTS to be for health, then I’m often stumped.
My goal is to support the healing process of the body, and to do no harm.
Fat, while vilified in our society, is not a 4-letter word. (I also mean that literally… it’s… a 3-letter word).
Our bodies love fat. Fat is stored energy. It’s your cushy bank account—resources saved for a rainy day.
It’s mental, emotional, and physical protection. Our cushioning protects us against falls.
It’s a storage reserve for reproductive needs (growing a baby’s brain and breast-feeding).
It’s the rubber insulation of the electrical wiring of our nervous system and brain. It’s brain mass.
It’s a layer of warmth.
Stress, famine, lack of sleep, inflammation, and hormonal resistance, are some common signals that tell the body to store and maintain fat.
Our bodies also have a set point range at which they feel most comfortable—and this set point, unfortunately for our Instagram followers, may be higher than society tells us it should be.
I have found in my practice that if we treat the underlying causes of fat gain: the inflammation, poor sleep, chronic stress, insulin resistance, etc., we might notice weight loss as a happy side effect of improved metabolic functioning.
Sometimes our bodies have experienced mental, emotional, physical or metabolic trauma and need to hold onto their protective layer a little while longer.
Maybe your body thinks you need a little softness…
I created a course: Intuitive + Mindful Eating, body image, metabolic health, hormones and more.
So, if another diet “failed”, trust me, that’s normal. It’s not your fault.
Diets don’t work.
In fact, in the long run they do the OPPOSITE of what their supposed to do: improve our metabolic health.
Instead they DAMAGE our metabolic health, through cyclical restriction (which often leads to binging and weight gain). And this leads to guilt, shame, and a poor relationship with our body image and food.
The solution is to work with your body where it’s at.
– Understand how your metabolism works, and learn about your Set Point Weight.
– Listen to your cravings and hunger cues and use them as tools for communicating with your body to heal your metabolism
– Make peace with your body size through developing Body Neutrality (easier to achieve than body positivity for a lot of people) and becoming more “embodied”–feeling at home in your body vs. trying to change it.
– Recognizing that you can feel at peace with your body where it’s at right now: and that losing weight (if it means working against your metabolism) won’t make you healthy. And it won’t make you happy.
– Making peace with food through Intuitive and Mindful Eating.
– Practicing gentle nutrition that honours hunger cues and cravings and keeps you fuelled throughout the day.
– Self-compassion
– Understanding how hormones play a role in body size and metabolism and how to nurture them to feel your best.
I cover all of this in more in my course You Weigh Less on the Moon.
Because it’s true, you do!
by Dr. Talia Marcheggiani, ND | Jun 25, 2021 | Anxiety, Depression, Diet, Mental Health, Mind Body Medicine, Mindfulness, Nutrition, Psychology
“A human being can endure anything.
“As long as they see the end in sight.
“The problem with depression is, you can’t see the end.”
Depression is like a ditch. Sometimes you head into and get stuck, but you manage to wiggle out. Other times you’re in a major rut and can’t get out at all. In those cases you need to call someone.
It happened to me once. I was driving in the winter to a hiking spot and I thought that a flat-looking patch of snow was the side of the road and before you know it I’d driven into a ditch. I couldn’t get out. I tried gunning it, putting rocks under my tires, getting a friend to push.
Eventually I just had to call someone. Within a few minutes, a tow truck came. The man driving it unceremoniously and unemotionally told me to put the car in neutral. He hooked a giant chain to my bumper. He yanked me out of the ditch. And then he drove off.
Roadside assistance.
In my last post I said something akin to “health is not emotional”. It’s sometimes just an equation.
With patients I educate them on their prefrontal cortex, on brain inflammation, on Polyvagal Theory and the nervous system and how depression is a normal response of the nervous system to abnormal circumstances, and how to they can work with their body and environment to get the help they need to yank them out of the ditch.
But I also talk about the people around us. We need them. We need them to be our prefrontal cortexes (because when you’re depressed or anxious yours isn’t working at full capacity–you CAN’T just yank yourself out a ditch, you need a tow truck, a chain and an unceremonious dude who knows what to do).
You need a strategy. You need a hand. You need help.
Who’s your support team? Who are the people around you?
I talk to my patients about bringing their loves ones on board to help them set up systems to regulate their nervous systems, nourish their brains and bodies (don’t even think for a second that I didn’t have a snack to munch on while waiting for the two truck–this fact is not even metaphorical. You NEED a literal snack to fuel your brain), and reduce inflammation.
There is a theory of depression that it is an ADAPTIVE state meant to get us through a difficult time.
Famine.
Capture by a predator.
Infection or illness.
Isolation from the group.
These may have been the historical hunter-gatherer inputs that caused depression but now it seems that depression can be triggered anytime our bodies are in a perceived or real “stuck” state with no way out.
Many, if not most, or all, depressive episodes I’ve worked with follow a period of intense anxiety. Our body’s stress response burns out, we can no longer “get away from danger” and we shutdown and collapse.
We turn inwards. We immobilize. We ruminate (possibly as a way to THINK our way out of danger).
This is why the 2a serotonin receptors that encourage “active coping” or things like BDNF, which is involved in making new brain cells, have important roles in the treatment research for major depression.
I’ll bet you’ve been told you have a disease, though. Something incurable that you’ll deal with your whole life.
But what if, rather than a disease, depression is a STATE you visit, and sometimes get stuck in that follows anxiety, stress and certain triggers?
How might that change the way you see yourself and your mental health? How might that change the way you seek solutions to how you’re feeling?
“The Adaptive Rumination Hypothesis by Andrews and Thomson posits that depression is not a pathology but a set of useful complex thoughts and behaviours that enable troubled people to withdraw temporarily from the world, deliberate intensively about their social problems, and devise solutions.”
From the Psychiatric Times
The major problem with depression that keeps us stuck in the state is when we turn our rumination back on ourselves and engage in self criticism.
Support your mood from the gut up by Feeding Your Head.
by Dr. Talia Marcheggiani, ND | Jun 25, 2021 | Body Image, Mental Health, Mind Body Medicine, Mindfulness, Weight Loss
Yes.
Have you heard of something called “self-objectification”?
It is the effect of moving through the world imagining how your body looks to others: perhaps checking yourself out in the mirror, adjusting clothing, taking selfies–the awareness of your body moving through space and the impact your “image” has on others. As if part of your consciousness is outside of yourself, looking in.
Self-objectification is so so common. We all do it.
Does my hair look ok?
Can you take another picture?
I wish my thighs were more toned.
Do this ____make my ____ look _____?
Remember when you were a kid and you just went to the beach? Or, maybe take a page out of Teddy’s book, in the first photo. She doesn’t care about her beach body. She just wants to be on the beach, running, free.
Self-objectification prevents us from being present, from enjoying life. It blocks creativity and flow state.
The remedy?
Embodiment.
Presence.
Body neutrality (the art of worrying about other things—how you look is truly probably the least interesting thing about you!)
Mindfulness.
How does my body feel?
What can my body do?
Am I hungry?
What food do I love to eat?
Am I thirsty?
What would I like to drink?
How does the sun or water FEEL on my skin?
How does the sand feel between my toes?
Can I taste the air on my tongue?
Do my muscles feel tense or relaxed?
Am I breathing from my belly or my chest?
Do I want to move or rest?
And so on.
No matter what, though, the beach is ready for you.
I created a course to introduce you to these topics and more. It’s called you Weigh Less on the Moon.
