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.
If your test results indicate insulin resistance or early signs of type 2 diabetes, taking action as soon as possible is key to managing and even reversing the condition. Lifestyle modifications, such as adopting a whole-food, low-glycemic diet, engaging in regular physical activity, and prioritizing sleep, can significantly improve insulin sensitivity. In some cases, medication may be necessary to help regulate blood sugar levels effectively.
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.
Just like getting out of a ditch requires outside help, navigating depression and mental health challenges often means reaching out to someone who knows how to guide you through. It’s not a weakness—it’s a recognition that sometimes you need a strategy, a hand, and a steady presence to help you find your footing.
Therapy isn’t about being told what to do—it’s about working with someone who understands the underlying patterns and can help you create a plan to move forward. Depression can make even the simplest tasks feel insurmountable, but having someone to listen, validate your experience, and help you develop tools to regulate your nervous system makes all the difference.
Depression often feels like an insurmountable barrier, making it hard to see beyond the immediate struggles. It’s essential to recognize that this condition is not a personal failing but a natural response of the nervous system to overwhelming circumstances.
By understanding the interplay between brain inflammation, the prefrontal cortex, and the nervous system through frameworks like Polyvagal Theory, patients can gain insights into their experiences and find ways to support their mental health effectively. This knowledge can empower individuals to take proactive steps, but it’s also crucial to remember that overcoming depression frequently requires external support.
With the right support and strategy, individuals can find their way through challenging times and work towards regaining their mental well-being.
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.
by Dr. Talia Marcheggiani, ND | Jan 9, 2021 | Anxiety, Depression, doctor as teacher, Healing Stories, Medicine, Mental Health, Mind Body Medicine, Naturopathic Philosophy, Philosophy
Imagine that you’re stuck in the middle of the Amazon forest. You have no idea where you are. You’re terrified and hungry.
All of a sudden a man (or a woman) emerges from the bushes. They tell you, “I can help you get out of here. I can help you find your way home”. With relief, you follow them.
They slash through the bush with a certain confidence. They feel comfortable to be around. But after some time, doubt fills your mind.
A little while later you, still following this guide, but mind racing with doubt, both come upon someone else, coming from the other direction.
“That’s not the way out,” this new person exclaims, once you’ve greeted one another, “Follow me, I know how to get you out of here.” And there’s something about their scent or voice, you’re not sure what, but you like them better than the other guide, or maybe the same, you don’t know, but for whatever reason you choose to follow them.
And so you leave the first guide, thank them for their help (they really were helpful after all, but this new guide, well they’re really something) and all, and say, “My heart says I should follow this new guide”. And now you’re off, travelling in an entirely different direction, on what you hope is your way out of the jungle.
The truth is, every way is the way out. Perhaps some ways are faster than others, but one thing is certain, if you continue to travel in any one direction for a long enough period of time, you will eventually leave the dark woods.
What will keep you in the jungle, however, is switching direction, switching guides. Imagine you’re almost out of there: a few hundred metres away, and you find a new guide, turn around and immediately follow them further into the bush.
So it is with healing.
Sometimes we need to pick someone–a therapist, doctor, teacher, mentor, sometimes for no better reason than we like their voice or their website or we resonate with something they’re sharing from the heart–and we need to choose them and let them guide us.
No, we don’t need to do everything they say. We don’t need to follow them blindly. We can follow them with a sense of integrity and skepticism, of course, but if we choose their guidance, and their path towards healing, perhaps we need to see it through.
I find that, as it’s often the case with anxious patients, we constantly feel the need to reach for the new solution, the new single ingredient that will make us healthy and whole. That extra thing. That missing thing. That shiny new theory, or condition, or treatment.
“Perhaps I have histamine intolerance”
“Maybe I’m eating too many lectins”
“I think I need to test my oxalates”
“Maybe I’m zinc deficient”
“Maybe it’s my estrogen dominance”
It could be any one of those things, but if you find your wheels spinning, flipping from one therapist to another, and preventing any one of them from really getting a sense of who you are or what you need then I suggest you… stay.
Who do you stay with?
Stay with the one who listens.
If anyone is offering you a simple solution, a one-trick fix (and if any one is a one-trick pony, you know them, the ones who apply their theory to everyone they work with), then please run.
Your health and wellness does not boil down to one thing, one practice, one supplement, one root cause.
Stay with the one who listens. The one who repeats back to you what you said and adds more to it. The one who synthesizes and summarizes your problem in a way that clicks something into place.
Stay with the one who talks to you, not their team of followers.
The one who has your case information, not the yoga instructor you chat with after class while you’re putting your shoes back on, not the supplements salesperson who said “It’s probably your hormones” and hands you a bottle of 15 ingredients, not the documentary you watched on Netflix that applies one-size-fits-all diet advice to you and 6 billion others without even knowing your name.
Or, maybe stick with them… but stick with one of them. See their advice through to the end.
Maybe stick with the one who says, “Hm, this sounds like…” and proceeds to connect the dots for you, in front of your eyes. Who seeks to educate you. Who thinks about your case between visits. Who says things like “I consulted with my colleagues about your case to ask and…” and things like “I was thinking about/reviewing your case the other day and thought about…”
Stay with the one who refers you to other practitioners. Stay with the one who answers your pointed health questions with “It depends” or “Normally yes, but in your case…” or “A lot of the time no, but it’s possible that in your case…”
Psychoanalyst Francis Weller urges us to practice restraint. To pause. To reflect on our needs. He urges us to practice humility.
I love working with patients who show up humble, kneeling at the alter of their own healing, saying, “I found your website” or “My friend referred you” and then proceed to tell their stories, and receive my assessment.
They help me practice humility as well. To receive their cases with humility (not with my already always listening). To receive them with patience. To take my time. To do my research. To check in: “How does this sound…”.
I kneel at the alter of healing beside them.
We set an intention of working together–walking together—out of this wilderness.
So that side-by-side, we may find our way home.
by Dr. Talia Marcheggiani, ND | Jan 8, 2021 | Anxiety, Depression, Food, Mental Health, Nutrition, Uncategorized
Our beliefs come from external factors: our research, others’ stories, things we read, things we see, and internal factors: personal observation of our own experiences.
My beliefs about food have formed through reading scientific studies and nutritional studies, to an understanding of biochemistry and anthropological data, to my own embodied experiences and my clinical experience.
These beliefs inform the way I practice and form biases in the way I do further research or understand patient experience and my own experience with food. These beliefs informed the way I put together my foundational program and how I position food on Instagram and on Youtube–these are the beliefs that form the messaging and the medicine.
I thought it would be interesting to write them down to declare them explicitly and examine them.
What do you believe about food and nutrition?
- I believe that food contributes to our health and to disease.
I don’t believe that food is the ONLY factor in contributing to these things, obviously. I think food plays more of a role in our health (much more) than conventional medicine would claim. But, I also believe it is less of a direct factor in our health than many Instagram influencers or nutritional salespeople (you know the ones I’m talking about, the ones who write books call “The Cure for X Disease” and things like that) would assert.
For example, I don’t think that you can cure cancer with carrot juice.
I also don’t think that, if you’re sick or know someone who is sick in some way that you or they got there because of your food choices. Chocolate cake didn’t give you diabetes. Gluten didn’t cause your depression.
But I do wholeheartedly believe that food plays a key role in shaping us: our physical and emotional and mental bodies. Food contains the nutrients we need to function. It feeds our cells, our microbiome, it shapes our bodies.
It’s crucial to recognize that while food is a significant aspect of our overall health, it’s not the sole determinant of our well-being.
Each person’s health journey is unique and multifaceted, encompassing not just dietary choices but also lifestyle factors, mental health, and environmental influences.
When we realize that our health is shaped by an interconnected web of factors, we’re less likely to fixate on any one “magic bullet” and more likely to invest in a sustainable, compassionate path toward healing.
While no one-size-fits-all answer exists, combining personalized support with evidence-based brain training can empower individuals to reclaim their sense of balance and clarity in both body and mind.
Food is one of the important ways that our bodies receive input from the outside environment. This information is communicated through specific plant nutrients, like resveratrol found in red grapes, or in the foreign compounds and toxins that pollute the regions where we live.
Through food we can heal. Through food choices, over time—nutrient deficiencies, or surviving off of too many things that aren’t really food—disease can start to form.
Food connects us to the earth.
2. I believe that our bodies are intelligent. Our bodies have evolved mechanisms that can communicate to us what they need–if we listen.
Our taste receptors tell us about the quality of the food we’re consuming. Freshly picked in-season fruits and vegetables taste very different than out-of-season, bland ones. The richness of flavour often corresponds to the richness of the nutrients present in the foods we eat.
We crave animal fat. We crave sugar. We crave salt.
We crave these things because they represent a density of nutrients that our bodies need.
We’re drawn to colours, because colourful foods represented foods that were fresh and ripe and packed with nutrition.
I look at a lot of things in medicine through the lens of evolutionary biology. A lot of people in my field and in science do. I trust that the way my body is formed as a response to an environment that is ever changing.
The humans who were most drawn to ripe, nutrient-dense fruit, or the saltiness of animal protein, or the delicious texture of fat, ate more of these foods. And eating more of these foods gave them an evolutionary advantage, allowing them to survive and pass on their genes to future generations who inherited preferences for these tastes.
Therefore I believe that consuming animal fat and sweet foods and salty foods is not bad.
Craving these foods is not bad. Cravings and taste preference represent a complex chemical system that evolved over hundreds of thousands of years to bring us to the things that helped us thrive.
I actually believe that we should listen to our cravings–they can be quite sophisticated. However, I also believe that:
3. Big Food has highjacked our taste buds.
There is something called “The Dorito Effect” where food companies high-jack these natural drives, these cravings, these taste preferences to get us to eat more frankenfoods. A Cheeto has been engineered to get you to consume the whole bag.
Therefore I don’t think we can trust our cravings when we’re consuming a high amount of “fake” foods–foods grown in a lab, foods made in a plant, foods that have 5+ ingredients that didn’t exist in 1913 or whatever.
How much of these foods is appropriate to eat? I try to minimize my consumption as much as possible. I’m not sure what the right answer is for you. I do know, however that I can’t let my body take the reins on what foods I might be needing if I consume too many of these processed foods.
How do I know I need more carbohydrates when I crave sugar or if my body is just chemically addicted to Sweettarts? I try to satisfy cravings with the whole food version of the thing and I find that that often works create an ongoing, trusting relationship (which takes time) between my taste receptors, the environment, my stomach, my mind, and my cells.
I believe that these relationships can help my body relax and know that it will be fed, like a crying baby who knows its caregiver will respond to its cries.
4. I believe that humans should consume a combination of plants and animals.
This may be a fairly controversial belief.
Of course there are many animal rights activists, vegans and plant-based diet advocates who would tell me that you don’t need animals to be healthy. There are many people who swear the Carnivore Diet cured their autoimmune disease.
And, maybe they’re both right. However, I believe that humans evolved eating some sort of combination of animal and plant foods and that there are distinct nutrients that are rare in plants and others that are rare in animals.
I can’t personally get enough protein on a plant-based diet. And, after eating a diet that is too meat-focused I start to crave salads, whole grains and beans.
High-quality protein, iron, choline, Vitamin D, EPA and DHA (marine omegas), zinc, tryptophan, B12, and other nutrients are hard to get enough of in a plant-based diet while preserving ratios, keeping the body’s hormonal systems (like blood sugar) balanced, and honouring cravings.
5. I don’t necessarily think, however that the Paleo Diet is the best diet.
I don’t think any diet is.
I think in principle Paleo was a cool idea: we humans spent the majority of our time in a hunter and gatherer before food processing and agriculture made things like grains and legumes digestible.
Therefore, like we should feed dogs like wolves, and we should eat like our primal ancestors, as our bodies haven’t evolved fast enough to keep up with high fructose corn syrup, etc.
I agree with the premise. But I also think that there is evidence that grains and legumes were consumed before agriculture, perhaps just not as in high amounts. Our bodies are different from the way they were when we were hunters and gatherers: we have more stress for example and higher complex carbs may help us manage this stress.
Also, animals fats, while good for us evolutionarily now exist inside of the context of an environment that is filled with thousands of chemicals. Animal fat is where chemicals are sequestered and therefore consuming lard, butter, and tallow as the main fats in the diet may not be as good for us anymore.
I’m not sure, but I think we need to appreciate our modern context and consume foods that are relatively unprocessed and well-digested that weren’t necessarily available when we were hunting and gathering our own food.
In essence, I think the research points to the fact that whole gains like oats and buckwheat and legumes like lentils are good for us.
6. Food is social. We don’t make nutrition decisions in a vacuum.
We use food to communicate: I love you, thanks for lending me your Back to the Future DVD set. Sharing food is an important part of our biology, of the human existence.
Humans are social creatures. And our socialness orients around food for a variety of reasons: celebration, socialization of children, peace-making, reward, pleasure, art.
I eat differently depending on who I’m with. I eat differently depending on the foods available at my local grocery store.
When I’m with my ND buddies I eat differently than when I’m with “muggles” or, non-NDs.
Navigating food in the social realm can be difficult–a balancing act between our own internal values around food and our values around connection–not offending someone, for instance.
I have suffered when my food choices didn’t fall into the realm of the society I was living (for example, being a vegan while living in South America) and trying to live with my Nonna, my Italian grandmother, while also learning that gluten was making me sick.
We may have conflicting values about food. But I believe that that’s ok.
I believe certain foods can contribute to inflammation but I also believe that they can help soothe my troubled emotions and overwhelm at times, and that that is anti-inflammatory.
To be honest, I don’t really like wearing socks and shoes–they feel weird on my feet.
I would rather prance around barefoot as the bonafide urban-dwelling earth-child I know myself to be deep down. But, I’m aware that we live in a world where the ground is sharp, and cold.
Sometimes it’s not safe, or socially acceptable to walk around barefoot.
And so I don’t. Because even though I love being barefoot, I can’t always do it. It’s not always appropriate.
And so it is with eating ice cream. Sometimes you’re trying to avoid it, but other times it’s appropriate to have some.
Under certain circumstances, eating ice cream might be the healthier choice.
7. Food obsession and shame have no place in health.
Of course eating well can bring is closer to health. However, steer the ship slowly. Be patient with yourself. Be curious about the process and learn to pay attention.
8. Embodiment is the key to bringing us back to nature and understanding our relationship with food again.
Sometimes we need help with our relationship with food.
Sometimes we need to unwind the years of food shame and diet culture to figure out what we even like, let alone what’s good for us.
I sometimes tell patients to have protein every time they crave something.
Just try it. See what happens.
Sometimes a craving for salty snacks means you need protein. It doesn’t mean it’s bad to satisfy a salty craving with popcorn, but if you do how do you feel? Is the salty craving gone?
Sometimes cravings for carbs and salt is the body asking for more protein. And then, in that case, it might be better to try having some protein. Just like sometimes you’re tired and food can help but so can a nap and a nap might help more.
It’s a process that involves trying things, from a place of curiosity, not judgement. And paying attention to how you feel.
If someone asks you for directions to a coffee shop in a language you don’t understand, and so, trying to be helpful you send them to a greenhouse.
They’ll love the greenhouse, you think. It’s beautiful there. And it is a beautiful place. But, they actually wanted a coffee and a piece of pie. And your intentions were pure. You were trying to help, trying to listen.
You just didn’t speak the language.
So I tell patients, have protein when you experience cravings and that might help you get enough protein.
Cravings aren’t bad. They’re essential. They’re a language.
Feeling stuffed isn’t bad. It’s another language. So is hunger. Hunger, satiation, cravings, mind-hunger, feeling stuffed to the gills, are all important syntax in the language your body uses to talk to you, to tell you how to feed it.
It’s hard to listen in a room full of shame, so it can take time to learn.
