I review my adventurous year of living on the Low Carb High Fat Ketogenic Diet.
I’ve always had a sweet tooth.
I remember binging on Halloween candy as a kid, stuffing one tiny chocolate bar after another into my mouth, as fast as my little fingers could unwrap them, trapped in some kind of sugar-filled trance.
“Never get between Talia and her food!” My family would joke when my blood sugar would crash between meals and I’d rage towards the fridge for a snack to keep me sane.
I remember digging into the little bags of cheese popcorn reserved for school lunches, finishing off one after another and then hiding the wrappers in their big Costco box so that it would look like it was still full, the way rebellious teens top up empty vodka bottles with water.
I can gain weight with the drop of a hat (but also put on muscle fairly easily), and it takes concentrated effort and dedication to take it off.
After a period of temporary stress and bagel-related weight gain, I decided to embark on a bit of experimentation. Work was getting busy and I wanted to supply my brain with constant energy without having to take snack breaks every few hours. Also enticed by anecdotes of shattered weight loss plateaus, I decided to “go Keto”.
I like experimenting with diet. Like many health-conscious people, finding the right nutrition regime for me has been a process. In my teens I started controlling portions and switching out white breads for whole grain rye and Jolly Ranchers for carrot sticks. In my early 20’s, I was vegetarian. I tried being vegan for a while before deciding it was a disaster for my health when I began to experience nutrient deficiencies, weight gain, and hormonal issues.
Later on, I followed my naturopathic school classmates to a modified Paleo diet (keeping in some gluten-free grains and legumes), then moved to a more traditional Paleo diet (taking out the grains and legumes), before going back to the modified version (which is probably the best eating style for me—more on that later).
For the most part, my diet is comprised of whole foods, with lots of vegetables, but in the Fall of 2016, when this all began, I was in a pretty Standard North American place when it came to food intake. At the time I was suffering from IBS, some issues related to subclinical PCOS, and fatigue. I was also starting to see some signs of impaired glucose control.I wasn’t feeling good and I was in need of a kind of reset of sorts.
I was interested in seeing how relying on ketone bodies for fuel would help my body, mental performance, and improve my blood glucose control and symptoms. I have a family history of type II diabetes and I wanted to do what I could to prevent insulin resistance and metabolic syndrome. Drastic times call for drastic measures, I thought.
Ergo, The Ketogenic Diet.
About the Diet:
The Classic Ketogenic Diet was first developed in the 1920’s to treat children with medication-resistant epilepsy.
When our brains are starved of glucose, their preferred fuel source (our brains use up 60% of the body’s glucose), the liver creates ketone bodies from stored or dietary fat that the brain can use as a substitute source of energy.
One of these ketone bodies, beta-hydroxybutyrate, is thought to be a particularly therapeutic molecule for the brain, conveying anti-convulsive benefits, thereby helping to reduce the incidence of seizures in children who don’t respond to medication.
However, the original Ketogenic diet is more extreme than the general health and weight loss-aimed diet we see described in recipe books these days. The Classic Ketogenic diet consists of about 90% of calories coming from fat. In order to achieve that, followers need to severely restrict their protein intake, and virtually eliminate all dietary sources of carbohydrate, which drastically limits their nutrition choices.
Since, the benefits of beta-hydroxybutyrate are being studied for other neurological disorders, such as Parkinson’s disease, dementia, migraine headaches and narcolepsy. It’s being looked at as a potential treatment for mental health conditions, like autism and depression, and metabolic disorders such as type II diabetes, and even to increase the efficacy of chemotherapy and radiation treatments in cancer. Other studies are looking at its role in improving cognitive function in mice and humans.
Some research shows that beta-hydroxybutyrate can expand lifespan by interacting with genes that slow aging. It is also shown to confer anti-inflammatory and antioxidant benefits.
In the 1970’s, Dr. Atkins responded to the high-carbohydrate, low-fat dogma of the nutrition world at the time, by bringing a modified Ketogenic diet into vogue. Restricting all forms of carbohydrates and encouraging a consumption of the still-vilified high-fat foods like bacon, eggs and cheese, Atkins affirmed that people could lose weight by eating fat, as long as they restricted carbohydrates at the same time.
The modern version of the Ketogenic Diet is slightly more health-conscious, promoting a higher intake of vegetables. The current diet restricts carbohydrates to under 20 to 50 grams per day, and encourages a high fat intake and a moderate protein intake, in order to encourage the body to turn to fat as its primary source of fuel. The current version of “Keto” is less strict than it’s initial epilepsy-treating incarnation, with anywhere from 60-85% of its calories coming from fat.
My Version of Keto:
I started the whole journey by tracking my food intake (using My Fitness Pal). My aim was to consume 20 grams of net carbs, or less, per day to push my body into using fat-turned-to-ketone bodies as a its primary fuel source.
Net carbs are calculated by subtracting dietary fibre from total grams of carbohydrates. For example, 1 cup of raw broccoli contains 6 grams of carbs. 2.5 of those are fibre. Therefore, the net carbs in broccoli are 3.5, which would count towards my net carb goal of 20 grams per day.
This isn’t easy. Take a look at any package of food you regularly consume. 1 cup of cooked oatmeal contains 23 grams of net carbs: 3 grams over my entire daily allotment. Therefore all high-carb foods like grains, legumes, starchy nuts, all fruits, and some starchier vegetables, were off limits.
Many people opt to test their blood, breath or urine for ketone bodies to determine whether or not their bodies are in ketosis. I dabbled in this, using the urinalysis strips in my clinic to test for urinary ketones. However, even though I was sticking to the diet, the strips would mostly turn up negative for ketones.
There are a few reasons why ketone strips may not be a reliable marker for ketosis. Firstly, the don’t test for beta-hydroxybutyrate, which is the main ketone body utilized by the brain, but acetoacetate, another ketone body produced in the liver.
Secondly, urinalysis strips only test for urine ketone spillover. They don’t necessarily reflect blood levels, and they won’t pick up the ketones that are being utilized as fuel by the body. If cells are absorbing all the ketones the liver produces, urine testing may not be positive.
The most accurate, albeit more expensive, method for testing ketone bodies is through a skin-prick test that analyzes blood levels of beta-hydroxybutyrate.
While I knew that the urine strips weren’t highly accurate, not having my state of ketosis validated was discouraging. I was often left in doubt over whether things were “working”. I wondered if there was some other mechanism going on. Was my body finding carbohydrates from someplace else? Did I have Small Intestinal Bacteria Overgrowth that was digesting my fibre and allowing me to absorb it somehow? Were my blood ketones being used up somewhere else (by the yeast in my gut, for instance)?
I did have signs of being in ketosis that I could watch for, however. When I avoid carbs, or fast for a few days, I start to develop a metallic taste on the tip of my tongue. It’s not a common sign of ketosis, a more common sign is a “nail polish” or “paint thinner” taste in the back of the throat, but still a symptom that some people report.
Keto Flu:
During the first few days of switching to Low Carb High Fat, I had to white knuckle through a phase realistically termed the “Keto or Low Carb Flu”. This horrible phenomenon is thought to be a result of the body switching from burning glucose as its primary fuel source to adapting to ketone body production. There is often a painful adjustment period for brains that have to learn how to rely on ketones for their main fuel source after a lifetime of glucose abundance.
It was nasty. I felt intense hunger and sugar cravings, nausea, dizziness, and weakness—it truly was a “flu”.
I knew that I had spent most, if not all, of my life as a sugar burner. Before Keto, I would crave food even just two hours after a full meal. I would often feel “hangry”: dizzy and shaky in between meals, and irritable if made to wait for food for too long. I had been existing between carb-dense meals, experiencing insanity-inducing reactive hypoglycemia between my regular sugar fixes.
The more I read about others’ experiences, the more I was assured that the keto flu symptoms were actually a sign of my body healing. I was becoming adapted to other fuel sources, which was a good thing, I thought.
So, I muscled through and followed the online advice: I consumed more fat to provide more fuel to my brain, including medium chain triglyceride (MCT) oil, which is quickly absorbed by the lymphatic system and turned into ketones by the liver, and I consumed electrolytes, which are more rapidly excreted from the bodies of low carb dieters.
For some people, Keto flu can last for days, for others it lasts weeks. For me, the Keto flu thankfully only lasted two days, after which my body began to adjust and my cravings for sugar went down. I began to feel more energy, which felt encouraging.
Daily Meal Plan:
For breakfast, I would typically eat a high-fat smoothie containing coconut milk yogurt, gelatin, and avocado, and topped with pumpkin seeds and cacao. Sometimes I’d make fat bombs or homemade unsweetened chocolate.
I’d have my second meal of the day in the mid-afternoon, around 2 to 3 pm, for which I’d consume a few cups of cruciferous vegetables, like broccoli or cabbage, with a fatty cut of meat like ground beef, chicken thighs, or salmon, all topped with liberal amounts of fat from coconut, olives, avocados, or grass-fed ghee. I made a lot of batch-cooked grain-free curries and stews.
If I had a third meal or snack in the day, it would be another serving of fat: a handful of macadamia nuts or a hunk of creamed coconut.
Eating this way made me feel like Obama and his grey suits—I didn’t have to plan my meals too carefully. All I had to do was eat fat. My food was so calorie dense and my blood sugar so stable that I didn’t need to eat often. This meant that I didn’t need to worry about bringing food with me everywhere I went; one meal could satiate me for half the day. Hunger was never an emergency situation, as it had been in the past. Hunger would come on very slowly, and it would never be “hanger”; my already low blood sugar had nowhere to dip to. If I needed more food, I could always wait until I got home to eat.
More Benefits:
Within a few days, my PCOS- related cystic acne cleared. I also felt slimmer as some water retention deflated. This felt good. Our body stores carbohydrate in the form of glycogen in the liver and muscles. Glycogen stores retain water.
When glycogen stores are used up, a rapid 5 or more pound drop in weight can occur. This is the “water weight” that people talk about losing when they first begin some kind of nutrition plan.
It’s also common to notice a drop in water weight from a decrease in inflammation, when embarking on a new eating plan. I know that I am sensitive to certain carbs and dairy and, because those things were out of my diet overall (although Keto can certainly include high-fat dairy products for those who can tolerate them), the water retention caused by chronic inflammation seemed to clear.
Although it seems to attract people primarily for its hip-slimming potential, the Ketogenic diet probably does not cause weight loss in and of itself. Instead, the diet encourages a passive reduction in calories by stabilizing blood sugar and insulin levels, while promoting the intake of highly satiating foods containing protein and fat. Ketone bodies also have appetite-suppressing effects. Therefore, it’s probably a calorie deficit that causes the weight loss, rather than any specific biochemistry in the diet itself.
I didn’t lose much more weight than the water weight. However, my mood was brighter. I would wake up in the morning looking forward to the day, which often doesn’t happen in the winter. I felt more sustained energy throughout the day, and really enjoyed the decreased appetite, which led to more productivity.
I felt fine consuming two meals a day, able to get through hours of back-to-back patient visits without needing a snack or a break. It was actually incredible to need so few meals; it was like becoming another person, one no longer ruled by sugar cravings. I was like a camel, switching to stored fuel when the fat from my last meal had run out, and the transition was seamless. There was no wall to hit, and no hypoglcyemic crash to be seen.
I also noticed less bloating and digestive issues, probably from the lack of fermentation in my gut and the reduction in foods that tend to aggravate IBS, like certain vegetables, fruit, and legumes.
However, all was not roses on the Keto diet. While the first few months were dreamy, the longer I stayed on it the more I started to notice changes in my body that indicated the honeymoon period I was enjoying wasn’t going to last.
The Microbiome:
The research is in: human beings probably need 10 servings of fruits and vegetables a day (roughly 5 cups), or 800 g, a day to get the most heart disease, stroke and cancer-preventing benefits that diet can afford us. The International Journal of Epidemiology concluded that, if the correlations found in their February 2017 study were causal, almost 8 million lives might have been saved in 2013 if everyone in the world had simply consumed their fruits and veggies.
It’s one thing all diets, even the faddy ones, agree on—from the Paleo Peeps, to Plant-Based Hippies, to Raw Macrobiotic Sun Worshippers, to Whole Foods Michael Pollen Omnivores, to the dejected nagged-at husband pushing brusselsprouts around on his plate—fruit and vegetables are good for you. You should eat them. If you’re a typical North American, you should probably eat more than you’re eating. The health value of everything else we eat seems to be up for debate: red meat, saturated fat, soy, bread, coffee. The benefits of eating enough fruits and vegetables, however? There’s no contest.
It’s hard to pick one way in which fruits and vegetables are so health protective. It could be because of their high concentrations of micronutrients, reducing the risk of common nutrient deficiencies, like magnesium and vitamin C. It could be because, if you’re filling your body with a kilogram of fruits and vegetables a day, you probably aren’t scarfing down an entire medium-sized pizza and supersized orange pop as well—there just isn’t room. It could also be the antioxidants they contain that protect cells against free radical damage, protecting DNA. Or perhaps its the fermentable fibres present in fruits and vegetables that feed our invaluable microbiome.
The problem with keeping net carbs under 20 grams a day was that I needed to restrict my fruit and vegetable intake. I was eating no fruit at all, and staying away from the starchier veggies, like carrots and beets. I still stuck to my beloved leafy greens and crucifates, but even eating 2 to 3 cups of those guys a day would push me to the upper limits of my carbohydrate intake, which meant I couldn’t eat them as liberally as I had been.
Getting enough vegetables and (any) fruits on the keto diet is hard, if not impossible. This can impact our ability to get the micronutrients we need, but also enough fermentable fibres from vegetables like garlic, onions, yams, Jerusalem artichokes, and legumes, which provide food for our microbiome.
Feeding our gut bugs is important. They benefit us in numerous ways, from digesting out food, to calming inflammation, to fuelling gut cells by producing a short-chain fatty acid called butyrate. They help our immune systems function optimally. They produce neurotransmitters for our brains to work. They balance our stress responses and our circadian rhythms.
Jeff Leach, at the Human Microbiome Project speculates that the lack of dietary fibre in most low-carb diets may impact the health of the microbiome in negative ways by depriving the gut bacteria of their preferred food sources, as well as altering the acidity of the colon and intestines. He cites this article, in which obese subjects on a high-protein and low-carb diet had lower levels of butyrate in their bodies and intestines, likely due to decreased diversity in their guts.
There are, however, some studies that suggest that a Ketogenic diet can improve the microbiome in children with epilepsy, and autism, and some speculation by the researchers that that may be how the diets treat these conditions. However, since these studies are not done in “healthy” children, with an already healthy microbiota, it’s hard to extrapolate the findings to the healthy adult population.
Then there’s the fact that most studies that look at high fat diets and their impact on the microbiome are mostly done in rats. Of course, rats aren’t humans, despite there being relative genetic similarities. In these animal studies, researchers refer to “a high fat diet” when in fact they mean a high fat, high sugar diet. The sources of fat in these “high fat” mouse diets are often corn, margarine, or soy oil, which we know are highly inflammatory and offer few if any health benefits.
In other words, many studies on “high fat” diets are not looking at a relatively balanced Ketogenic diet that consists of vegetables, proteins, and healthy sources of fats from avocados, coconut, fish, olives, nuts and seeds and grass-fed meats.
Context is important as well. Is it the high fat diet that causes a reduction in gut diversity or the absence of fibre? This one mouse study showed that simply providing the mice with fibre in addition to their high fat diets decreased their risk of obesity.
I felt that my gut initially improved in the first few months on Keto: the diet was low in foods that aggravate me: namely refined carbs, sugar, gluten and dairy, as well as some of the fermentable fibres that can aggravate IBS. However, it never fully healed. After a few months, I started to notice the symptoms of bloating and digestive irregularities coming back.
Candida, a yeast that resides in the gut and can overgrow in the intestines in some people, especially the immunocompromised, causing symptoms of fatigue, IBS, and weight gain, among a variety of other symptoms, can survive on ketone bodies. Yeasts have mitochondria of their own. Some species of gut bacteria can consume protein, bile salts and even fats.
Contrary to what many claim, a Ketogenic diet doesn’t necessarily “starve out” the bad gut bugs. Combined with the lack of fibre to feed the beneficial gut bacteria and promote more bacterial diversity, a prolonged Ketogenic diet may be a recipe for gut dysbiosis.
Hormones:
Throughout my year spent in ketosis, I definitely noticed an improvement in my insulin signalling and glucose control, especially in the first few months. Looking at my blood work in March, after about a year of the Ketogenic diet (and then having been off it for a few months), my fasting insulin was very low and fasting blood glucose levels were in the low-optimal range. HOMA-IR, a calculation that is used as a marker of insulin resistance, was also low, indicating good insulin sensitivity.
I personally believe that this means that my risk for getting metabolic syndrome or type II diabetes is low, as long as I maintain this level of insulin sensitivity by watching the glycemic load of my diet and my stress levels.
The metabolic flexibility awarded to me from my year in ketosis also proved to be invaluable. Now, I no longer fear fasting and I can survive on other fuel sources besides sugar. My brain knows how to tap into stored and dietary fat more efficiently, and use those for energy. Even when not following any sort of low-carb diet, I noticed that I could survive between meals while travelling in Southeast Asia for two months, whereas normally I would have had to exist on unhealthy, sugary snacks.
However, after a few months on the diet, I began to notice a decline in my menstrual health. My cycles began to get longer, and soon I started missing periods. I noticed more hair falling out in the shower and more cystic acne developing on my chin. When I ran my blood estrogen and progesterone levels, I was surprised to see that their levels were very low.
We know that insulin, while often vilified as a “fat storage” hormone is actually responsible for storing everything, including nutrients. It also correlates with estrogen levels and the conversion of T4, one of our thyroid hormones, to its active friend, T3, which runs our metabolism. Insulin builds muscle, bone and brain cells. Very low insulin levels, in my case, were contributing to amenorrhea and a disruption in my sex hormones.
This wasn’t good.
While not quite the same as Intermittent Fasting (IF), Keto is often grouped into the same category because of its similar impact on blood glucose and insulin. The difference is that Intermittent Fasting induces ketosis through periodic food restriction, as opposed to carb restriction. Keto and IF often go hand in hand, however. The reduced hunger and high-nutrient density of the foods eaten on a Ketogenic diet often lend well to practicing intermittent fasting. It did in my case—I was only eating two main meals a day.
I always found it interesting, however, that most proponents of intermittent fasting are men. The male body appears to thrive in the fasted state, getting a boost of growth hormone and norepinephrine, both of which provide men with energy, motivation, and an improved sense of well-being.
This hormonal change may be a remnant of our ancestral hunter-gatherer days where it would be an advantage to feel motivated and energized to go out and hunt during periods of food scarcity.
I don’t think female bodies experience exactly the same effect. Some preliminary animal research tends to suggest that as well.
A few rat studies indicate that fasting may impair female insulin sensitivity, and induce amenorrhea, or missed periods. Female bodies rely on a consistent influx of calories and carbohydrates to stimulate insulin, which plays a role in stimulating thyroid hormones and estrogen, to continue to ovulate. Another study showed that fasting tended to “masculinize” female rats, lowering their female hormones, and increasing their levels of androgens, the male sex hormones, like testosterone.
Of course, these studies were done on fasted rats, which cannot be fully translated to the effects of Intermittent Fasting and Ketogenic diets on women. However, some of these findings did validate my experience, which certainly wasn’t being validated in the podcasts and blog posts I was exposed to, largely written and followed by men.
I did experience positive hormonal effects: the increased insulin sensitivity and lowered blood glucose. However, I was not happy about my irregular cycles and estrogen deficiency.
Therefore, I decided to increase my carbohydrate intake, returning to a more moderate Paleo diet that consists of some fruit, starchier vegetables and legumes. After a few months, my periods returned to normal, my skin cleared up, my hair stopped falling out, and my thyroid hormones, estrogen and progesterone levels all returned to their optimal ranges.
I have still have low fasting insulin levels, suggesting that the Ketogenic diet did help to reset my insulin sensitivity and that this effect may be lasting.
Metabolic Health:
After a year of doing the Ketogenic diet, and then a few months of returning to a moderate-carb paleo diet, I tested my cholesterol levels and inflammatory markers. My HDL cholesterol (the “good” cholesterol, to put it very simply) was high, my triglycerides (a risk factor for heart disease) were very low, and my LDL cholesterol (the “bad” cholesterol that statin drugs target) was also low. My inflammatory markers: C-Reactive Protein (CRP) and erythrocyte sedimentation rate (ESR), were also low.
While it is typically the monounsaturated fats, like olive oils and avocados, that are associated with increased levels of the heart-protective HDL cholesterol, even saturated fats from coconut oil can raise HDL. LDL is often lowered by these healthy monounsaturated fats, however saturated fats, even healthy ones, can raise LDL in certain individuals.
All else being equal, higher levels of LDL may not be as big of a problem as we think. Especially in the context of low risk factors, like low inflammation, absence of smoking and a healthy body weight. What’s more, the triglycerides and cholesterol/HDL ratio may be more important factors for determining heart disease risk. Further, assessing LDL particle size may also provide those concerned about their LDL levels with more information concerning their cardiovascular health. That being said, it is important to be aware that some of the fats present in a Ketogenic diet have the potential to raise blood levels of LDL in certain susceptible individuals, and that not everyone’s blood lipid results will look like mine.
Triglyceride levels are associated with liver function, and generally reflect dietary sugar, fructose and refined carbohydrate intake, rather than fat intake. Reducing refined dietary carbohydrates like white grains, flours and sugars is a good strategy for reducing triglyceride levels and reducing heart disease risk.
Some individuals can experience elevated levels of inflammation on a Ketogenic diet, depending on the quality of foods consumed. A Ketogenic diet low in fibre that fails to feed the microbiome; high in foods that a person may have an individualized sensitivity to (such as dairy, eggs, nuts or soy); or high in inflammatory fats like trans fats, and industrial oils like canola and corn oil, may all contribute to increased inflammation.
That being said, certain ketone bodies like beta-hydroxybutyrate may have anti-inflammatory properties. Many of the fats consumed in a mindful, whole foods Ketogenic diet, such as olives, avocados, seeds, salmon, and coconut, are also anti-inflammatory.
I found my blood markers a good indicator of the power of a high-fat, low-carb diet to, at least in my case, improve HDL cholesterol and lower triglycerides, fasting insulin and fasting glucose levels. Whether I needed an entire year in ketosis, or whether I even needed to actually enter ketosis to receive these benefits, isn’t clear. Perhaps I could have gotten the same results by moderately lowering my carb intake while increasing my dietary intake of healthy fats.
Modified Ketogenic Diets:
While I do think I benefitted from entering into ketosis, I would not necessarily recommend a Ketogenic diet to patients unless to achieve some sort of therapeutic goal, such as improved insulin resistance, or for adjunct cancer care, to reduce inflammation, or to improve severe depression, migraines, or narcolepsy.
However, there may be a benefit to cyclical Ketogenic diets for memory and cognition, and increased life span in mice. Cyclical Ketogenic diets involve entering ketosis on alternate weeks. On the other weeks, participants return to a normal, whole foods diet that contains higher amounts of carbohydrates. In this case, individuals gets the benefits of beta-hydroxybutyrate production and increased metabolic flexibility on their weeks on, while also being able to eat a high amount of fermentable carbs and fibres on their weeks off, essentially getting the best of both worlds.
Adding medium chain triglycerides to food may also confer health benefits, similar to being on a Ketogenic diet. One study showed that adding MCT oil to a high-carb breakfast (pasta), reduced appetite in men. This is likely because, after burning through the glucose in the pasta, the men’s brains were able to access the ketone bodies that were made readily available by burning the MCT oil. This kept their brains fuelled and their bodies satiated for longer.
The men eating pasta and MCT oil in the study had a ketone blood level of 0.3, which is similar to that obtained from a diet that derives 10% of its calories from carbohydrates, which is an essentially a very low-carb, if not Ketogenic, diet. This may indicate that simply adding MCT oil to a moderate to low-carbohydrate diet, may confer some of the benefits of having a slightly higher rate of circulating ketone bodies without having to follow a strict diet. Again, following this strategy, you can get the best of both worlds: consume a diet high in fibre, while also getting a steady flow of ketone bodies to the brain.
Other interesting areas of research are the use of supplemental, or exogenous, ketones for therapeutic use, however the area is new and not something I currently recommend in my practice (although this may change when more research begins to emerge and better supplements enter the market).
My Plan Moving Forward?
I’m happy that I gave the Ketogenic diet a try, but now I’m back to my more modified Paleo diet, aimed at promoting gut health, optimizing my micronutrient intake, regulating hormones, and supporting my energy levels. I now consume berries and apples, legumes, starchier vegetables and lean proteins more often and aim to get 10 servings of fruits and vegetables a day, with 8 to 9 of servings coming from vegetables, as opposed to fruit.
I currently start my day with a smoothie with berries, an avocado, spinach and protein powder. For lunch I have some sort of protein, fat, and tons of veggies. I eat more often than when I was in ketosis: about 3 meals a day with a vegetable and fat as a snack, or no snack at all in between, depending on my schedule.
My total daily carbohydrate intake falls around 100 grams a day with a net carb intake between 50 to 70 grams a day, depending on the fibre content of the vegetables, seeds, and legumes I’ve eaten that day. I try to get upwards of 30 grams of dietary fibre per day.
I avoid all sugar, including sweeter fruits like tropical fruits, and dried fruits, like dates. I especially stay away from refined sugars, even “natural” coconut sugars and agave. I avoid processed carbohydrates and flours. I mostly avoid grains, except when travelling or visiting someone’s house, getting my carbs from starchy vegetables and tubers, legumes and berries. I continue to avoid dairy (which I’m sensitive to), gluten, and processed industrial oils like canola, corn, and soy oil.
Right now, rather than focussing on macronutrient ratios, I’m directing my food intake towards obtaining the Recommended Daily Allowances of the micronutrients that run all of our cellular reactions, and the fibres that feed a healthy gut microbiota. I use an app called Cronometer to track this.
I definitely eat more fat than before, adding MCT oil to my morning smoothie, especially on days when I need to stay full and focused for longer. I also aim to do at least 12 hours of fasting a day, trying to get in 16-18 hour fasts where I can, ending dinner at 4pm, for example. I no longer do regular long bouts of Intermittent Fasting, particularly not when I’m feeling stressed and burnt out.
Would I Recommend the Ketogenic Diet to Patients?
One of the main tenants of Naturopathic Medicine is “Do no harm”. While it may seem like making diet and lifestyle recommendations are relatively benign therapies, I believe that they do have the potential to do physical and psychological harm, particularly if they are strict recommendations.
Following a strict diet may have health benefits, but it also may isolate us from friends and family, frustrate us and restrict our intake of certain nutrients, like fibre, vitamins and minerals. This is one of the reasons I do not ever advocate a Vegan diet, although if patients are following one already, I believe in guiding them to optimize their nutrient intake.
Furthermore, at least in my personal experience, the cure was stronger than the disease. I probably didn’t need to do the Ketogenic diet for so long; this was evidenced by the hormonal imbalances that I began to experience towards the end of my year on the diet.
However, particularly for patients who are suffering from metabolic syndrome, type II diabetes and insulin resistance or PCOS, there may be some powerful benefits to entering ketosis in order to dramatically reverse metabolic dysfunction. In this case, a modified regime combining Intermittent Fasting and cyclical Ketogenic diets could be beneficial.
Of course, it all depends on where patients are at in their nutrition journeys. Sometimes I meet patients who require, and respond well to, more heroic lifestyle interventions. Other times I meet patients relying on several sugary treats a day to get them through. In these cases, simply tweaking their diet in small ways, using baby steps may also have powerful disease-risk-reversing effects.
I will never get annoyed at a patient’s “lack of compliance” again.
Health care is scary, even when you know what you’re doing. When it’s your own health, putting yourself in the hands of a professional is not easy.
Yesterday I had an initial consult for myself with a nutrition specialist. She’s well-known in her field, super-academic, in her 70s, and has published books and papers.
She knows her stuff. She’s also really helped a friend of mine and the referral came from him. I had every reason to trust her and feel good about putting myself in her hands.
However, I was nervous getting ready to see her. I filled out a diet diary… what would she think? What would she say about my blood work? Would she be nice? Would she be understanding? Would we get along?
Survival instincts kick in.
We talked about a few things in the first visit (which cost an arm and a leg, but will be worth it if I’m left feeling great) and she prescribed some supplements for me to take.
I left, kind of satisfied. Ready to get on with our journey, with a list of things to pick up, dosages to tweak, things to consider and instructions to book again in 3 to 4 weeks.
Ok.
I woke up this morning, in the early hours tossing and turning, thinking to myself, “I don’t want to take vitamin E!” And “Did she truly understand my concerns?” And “what are all these supplements treating?” and “did she really hear me out?” And, “is all this going to actually help?”
The impulse to not trust, to run and hide, to override her assessment and recommendations with my own were overwhelming. (And, of course, as someone who does what she does for a living, the struggle to overcome this is real, we’re “experts” on the body, but it’s nice to let someone else give direction for a change, especially someone with 30+ more years’ experience).
Still, trusting is hard.
Being aware of the impulse to run and avoid, while also resisting the impulse, is hard.
I have people who neglect booking a follow-up even when they know that we still have lots of work to do.
I have people who don’t fill out diet diaries for fear of actually taking a hard look at their food intake.
I have people who email me that “nothing is working” when in fact they haven’t started taking their nutrients and supplements yet.
And, guess what, as frustrating as that may be (because ultimately, I want people to have success! I want people to heal), I’m doing the same thing.
Jeez, being in the patient chair is mighty humbling.
I highly recommend it to all my health practitioner colleagues out there.
And, yes, now I’m taking vitamin E. I’ve decided to just trust. (But I’m still taking my own multi-vitamin… hey, doctors make the worst patients… amiright?)
Since publising the original article about the Mirena IUD on this blog, thousands of women have come out of the woodwork writing to me asking for help.
When I originally wrote the article, I was spurned on by my observations of the women in my practice who had experienced a rise in estrogen dominance and low progesterone after the insertion of their IUDs (which were often inserted to treat hormone imbalances!).
At that point I never imagined that so many women would be affected by the IUD, or that even more were suffering from so many hormonal symptoms that drastically affected their lives and health.
It makes sense: our society does not set us up for proper hormonal function.
Our diets are carbohydrate-heavy, promoting insulin resistance and blood sugar dysregulation, which impacts our ovaries’ ability to make estrogen properly.
An excess amount of body fat produces more estrogen in the body and acts as a reservoir for the toxic estrogens in our environment.
We lack many of the micronutrients necessary to process our hormones properly, such as vitamin D, B vitamins, magnesium, zinc, omega 3 fatty acids, glutathione, and amino acids.
Many of us have impaired or suboptimal liver function, or sluggish digestion, which keeps hormones in our bodies around longer than they should be.
A dysbiotic gut has the tendency to turn estrogen in the gut back “on”, putting it back into circulation when it was otherwise on its way out of the body.
Stress alters our hormonal function, including our ability to make progesterone, DHEA-S, convert thyroid hormones, and process estrogen properly.
Xenoestrogens in our food and environment, from plastics, fragrances, pesticides, and processed soy products, contribute to overall body burden of the hormones in our body, throwing off our delicate balance, and contributing to symptoms.
The result of all this is that many women suffer from hormonal imbalances.
10% of women have some form of PCOS, or Polycystic Ovarian Syndrome, characterized by the body’s inability to properly make progesterone or estrogen, instead making loads of male hormones, like testosterone. PCOS alters fertility, promotes weight gain, and causes things like unwanted facial hair growth, acne, and missed periods. PCOS is often connected to stress and insulin resistance.
Many women in my practice suffer from PMS or PMDD, experiencing often debilitating symptoms sometimes even two weeks before their periods begin. They might get migraines, intense cravings for sugar, and massive mood changes, such as anxiety, intense irritability, or devastating depression. Panic attacks can occur at this time as well. Many of them comment that their mood and personalities flip once their hormones levels reach a certain point, causing them to act like different people. This can jeopardize their relationships with spouses and children, coworkers, friends and family.
Tender and painful breasts, or breast lumps, are also common in many of these women.
Acne, weight gain, stress, fatigue, disrupted sleep, depression and anxiety are all symptoms I see in women with hormonal imbalances.
Many women have horrific cycles, experiencing painful and heavy periods that often cause them to miss days of work every month. Many of these women struggle to keep their iron levels in the optimal range, suffering from hair loss, fatigue and weakness.
Many women are diagnosed with fibroids, or endometriosis, or are concerned about their risk of female cancers like breast, ovarian, uterine and cervical cancer.
All of these symptoms are often linked to relatively higher levels of estrogens compared to progesterone, sometimes termed Estrogen Dominance by functional medical practitioners who look at the underlying causes of bodily imbalances.
I feel terrible that I can’t help more of the women who write to me. My license prevents me from giving advice to those who live abroad, especially to non-patients over the internet. It’s a shame, however, because oftentimes the solutions are relatively simple, despite how complicated many of these symptoms might seem.
I’m hoping that this article can provide some direction to many of the women who suffer.
Firstly, I want to state that I am not against birth control or even the Mirena IUD (or other IUDs, for that matter). The vast majority of women with the IUD tolerate it. For many women with debilitating heavy periods and endometriosis it can be the only viable solution that makes life tolerable.
In my social practice at Evergreen, many of the women I see experiencing homelessness, drug addiction, or PTSD from relationship trauma, rely on the efficacy of IUDs to prevent unwanted pregnancies. Their lives often don’t allow for them to remember to consistently take pills every month.
Many women don’t tolerate combination birth control because of a history of blood clots, female cancers, or migraine headaches associated with their periods, and therefore the Mirena IUD, which is progesterone only, is a safe alternative for preventing unwanted pregnancy.
That all being said, many women do suffer on the Mirena IUD (or other forms of birth control). They were perhaps put on the Mirena to deal with some of the above symptoms of hormonal imbalance, or for contraception. Many of them noticed that their symptoms became worse after insertion of the IUD.
How the Mirena IUD and Birth Control Works:
The Mirena works by secreting small amounts of progestins, a synthetic form of progesterone, into the uterus and surrounding tissues. While it is not fully known how the Mirena works, the end result is a suppression of ovulation. This results in either very light periods or a complete cessation of periods until the IUD is removed (after 5 years when its hormones run out).
It is important to say here that, while birth control can certainly treat the symptoms of hormonal imbalances, it does not correct them.
All forms of birth control, with their synthetic versions of the hormones estrogen and progesterone, simply induce further hormone imbalances in the body. They introduce versions of hormones that may suppress or alter symptoms (such as heavy and painful bleeding, or acne), but the versions of hormones are not fully recognized by the body and therefore don’t fully replace all the hormones’ important functions, such as mood regulation, immunity, or blood sugar balance.
The effects of both altering the body’s natural hormonal balance, while ignoring the underlying cause of hormonal issues, is often what causes symptoms to continue or worsen.
For example, women with PCOS are prescribed birth control to manage acne or promote monthly periods. However, when women with PCOS miss periods, it is because they are not ovulating. The missed periods are not the problem; the lack of ovulation is.
Despite that, many women with PCOS experiencing amenorrhea (or missed cycles) will be prescribed birth control. However, birth control does not address the underlying cause of amenorrhea. It simply further suppresses ovulation (because its main purpose is to prevent unwanted pregnancy).
The periods you get while on birth control are not periods. Periods from birth control are withdrawal bleeds. After 21 days of taking hormonal pills, pills are stopped or replaced with placebo pills. The withdrawal of hormones in the pills induces a bleed that resembles a period, but is not one.
Hormonal contraception does not correct hormonal imbalance, it imposes further hormonal imbalance to manage symptoms. This is not always bad!
But it is an important difference.
Many women do require symptom suppression, particularly if their symptoms are severe. Many individuals in my practice experience periods so heavy that the only way for them to get through the month is with an IUD. Genetic variability in how our bodies process hormones can make us susceptible to intense hormonal symptoms, through no fault of our own.
In my opinion, however, it is important to attempt to address the underlying cause and to set our bodies up for better hormonal regulation, making as many changes as our lifestyles will allow.
What You Can Do About It:
If you are like any of the people I described above who seek my help, there are a few things that you can do to get started on correcting hormones.
Working With a Professional:
The first thing I advise is finding a licensed naturopathic doctor or functional medicine practitioner who understands hormones, can order lab tests, and will address the underlying cause of your hormonal imbalances by taking the time to fully understand your body and lifestyle.
This practitioner might be a naturopathic doctor (you can find one in North America by looking one up at naturopathic.org), or a medical doctor, a chiropractor, or a highly skilled nutritionist or nurse practitioner. Research this person well, read their articles, and perhaps book in with them for a complimentary meet and greet.
Testing:
I often test patients using simple blood tests, on day 21 of their cycles (or about 7-9 days before they expect their next period).
I will test their blood, looking for anemia, will test iron and B12 levels, homocysteine (to gauge their ability to methylate), vitamin D, cholesterol (to see if their diets are promoting proper hormone synthesis), estradiol, estrone (the more toxic, problematic estrogen), progesterone, free testosterone, a thyroid panel, fasting glucose and fasting insulin (to calculate insulin resistance using something called the HOMA-IR), HbA1C (to look a long-term blood glucose control), FSH and LH (two hormones made in the brain that talk to the ovaries and orchestrate the menstrual cycle), DHEA-S, to name a few.
Some women will require more testing. Others will require less.
These labs are interpreted from a functional perspective. Even though you are in the “normal” ranges (which take into account the entire population, many of which are not healthy—they are seeing their doctors, after all!), these blood markers may not be optimally balanced, giving us an opportunity to correct things before they go further.
Testing allows us to match symptoms to underlying imbalances and to be able to properly direct treatment protocols. Women with estrogen dominance may be experiencing high levels of estrogen and normal progesterone, which indicates a body burden of estrogen or impaired liver and digestive system clearance. Other women may be experiencing normal levels of estrogen but low progesterone, indicating a failure of their bodies to ovulate, due to high stress, and PCOS (or the Mirena IUD and birth control pill).
Other options for hormonal testing are month-long salivary hormone testing, or DUTCH testing, which looks at hormone breakdown in the urine. I sometimes run these tests, but find that blood testing is useful, accurate, and more cost-effective.
Treatment:
Once you understand your individual hormonal situation through testing (and through working with a practitioner who is putting the testing together with your symptoms and health history), your practitioner may recommend a variety of treatments.
I personally combine diet and lifestyle with key herbal and nutritional supplements, to target what is going on under the surface with my particular patients.
These treatments may include herbs that boost ovulation, aid liver detoxification, or regulate the stress response. I might recommend nutraceuticals that encourage methylation, or aid in hormone production.
My treatments take into account the individual’s symptoms, labs, diet, lifestyle, and any other health issues she may be facing like fatigue, digestive disturbances, or poor sleep.
What You Can Do Today:
Barring more individualized assessment and advice, there are some best lifestyle practices that can help most women balance their hormones better, whether they are still using birth control to control and address their hormonal symptoms or prevent pregnancy.
Diet:
When it comes to diet and hormone support, we need to ensure that we are balancing blood sugar, boosting liver detoxification pathways, promoting hormone synthesis, and supporting digestion, especially if experiencing constipation.
Consume more leafy greens: kale, spinach, collards, beet greens, arugula, etc. Eat 1-2 cups of these foods every day. Leafy greens contain active folate, which boosts methylation and detoxification. They also contain magnesium which is essential for hormonal regulation as well as 300 other important biochemical reactions in the body that balance mood and hormones.
Consume more cruciferous vegetables: broccoli, cauliflower, brussel sprouts, cabbage, bok choy, etc. Eat 1-2 cups of these foods every day. Crucifates help the body make glutathione, and contain indole-3-carbinole, which helps eliminate excess estrogens from the body. Broccoli sprouts are potent players in these pathways. Consume them as often as possible.
Ensure adequate dietary fibre intake: I often recommend ground flaxseeds or chia seeds in smoothies, avocados, fruits and vegetables and legumes (if tolerated) to make sure that women are having regular bowel movements to clear excess estrogens out of the body. 2 tbs of ground flaxseed (or more) every day can help balance estrogen levels and promote daily bowel movements.
Balance blood sugar: consume protein, fat and fibre at every meal. Avoid refined starches and flours. Avoid all sugar, even natural sugar like maple syrup, coconut sugar, cane sugar, honey, agave, etc. Try stevia or avoid sweets. Limit carbs (grains, legumes, root vegetables like potatoes or sweet potatoes, to 1/2 cup to 1 cup per meal). Only consume whole grains like quinoa, buckwheat, steel cut oats, millet, and teff. Cook them yourself!
Avoid soy, particularly processed soy, like vegan burgers, or soy milk.
Consume omega 3 fatty acids in fatty fish like salmon and sardines, or nuts and seeds like flax and chia seeds, walnuts, and pumpkin seeds. Get 2-4 tablespoons of these nuts and seeds every day and 3-4 servings of fatty fish a week.
Consume animal products: eggs contain choline, which is essential for liver function, meat contains vitamins B6 and B12, which are essential for hormonal regulation and production. Cholesterol in animal products are the backbones of our sex hormones. Iodine, found in animal foods, regulates estrogen balance in the body. If possible, try to obtain organic animal products from pastured or free-range animals to boost omega 3 intake, to lower your impact on the environment, and to promote animal welfare.
Other Lifestyle Practices:
Boost progesterone production by managing stress:
Establish a self-care routine: plan regular vacations, even small outings, do meditation or yoga, take breaks from work, spend quality time with family, have a plan to get your work done on time, ask for help.
Sleep! Aim for at least 8 hours of sleep, and try to get to bed before 12am. Practice good sleep hygiene by avoiding electronics before bed, keeping the bedroom as dark as possible, and setting a bedtime and wake time, even on weekends. Body scan meditations and some key supplements can be helpful for resetting circadian rhythms. Regulating blood sugar can have a major impact on improving sleep. Talk to your functional medicine doctor or naturopathic doctor for individualized sleep solutions.
Eliminate exposure to toxic estrogens and boost estrogen clearance:
Avoid exposure to xenoestrogens: whenever possible use natural body products, deodorants and shampoos, or “edible” body products for face and hair. Avoid plastic water bottles and plastic food containers. Use natural cleaning products around the house. Avoid fragrances and processed foods, especially processed soy.
Encourage sweating: get regular exercise or engage in regular sauna therapy. If you don’t have access to a sauna, epsom salt baths can also work—anything that helps you sweat. Heat therapy has also been shown to benefit mood and the stress response.
Heal your digestion: make this a priority with your naturopathic doctor, so that you can absorb the nutrients from the foods you’re eating as well as encourage daily bowel movements and optimal microbiome balance.
Maintain a healthy weight: body fat is metabolically active and can increase overall estrogenic load. Work with your naturopathic doctor to manage your weight. We often attempt to lose weight to become healthy, however I find my patients have far more success (and fun!) getting healthy in order to lose weight. Healthy weight loss often involves managing stress, sleeping 8 hours a night, avoiding sugar and processed foods, and regulating blood sugar, as well as encouraging proper sweating and liver detoxification.
Want to balance your hormones, energy and mood naturally? Check out my 6-week foundational membership program Good Mood Foundations. taliand.com/good-mood-learn
I often encourage my patients to write a letter to themselves on their birthdays for the following year using a website called FutureMe.org, where you can post-date emails to yourself to any date in the future. This exercise is great to do on any day, really. Tomorrow is my birthday. I’ll be 32. Here is my letter.
This is it.
This is your life.
As Cheryl Strayed wrote, “The f— is your life. Answer it.”
There are some things that you thought were temporary, mere stepping stones on your way to someplace better, that you now realize are familiar friends, ever present in their essence, but varying in their specific details.
For instance:
1) You will ride buses.
You will never escape the bus. For a while taking the bus was seen as a temporary stop on your way to something else (a car?). You took the bus as a pre-teen, excited to finally be allowed to venture to parts of town alone. As a student, you took the bus to the mall, laughing at the ridiculousness of Kingston, Ontario, once you’d left the protective bubble of the student community, completely inappropriately, yet affectionately (and ignorantly) called The Ghetto.
You will visit other ghettos, also by bus, that are far more deserving of their names. However these ghettos will instead have hopeful names such as El Paraiso, or La Preserverancia. Those who live there will persevere. So will you.
Buses will take you over the mountains of Guatemala, to visit student clients in Bogota, Columbia. To desirable areas of Cartagena. You’ll ride them through India. They will carry you through Asia, bringing you to trains and airports.
You’ll ride buses as a doctor. You’ll ride the bus to your clinic every day.
Sometimes, on long busy days in Toronto, it’ll seem like you’ll spend all day trapped in a bus.
The bus is not a temporary reality of your life. The bus is one of the “f—s” of your life. You’ll learn to answer it. You’ll learn to stop dissociating from the experience of “getting somewhere” and realize you are always somewhere. Life is happening right here, and sometimes “right here” is on the seat of a bus. Eventually you start to open up, to live there. You start to live in the understanding that the getting somewhere is just as important as (maybe more than) arriving.
We breathe to fill our empty lungs. Almost immediately after they’re full, the desire to empty them overwhelms. Similarly, you board a bus to get somewhere, while you’re on the bus, you start to understand.
You’re already here.
Maybe you’ll graduate some day, to a car.
But sooner or later, you’ll board a bus.
And ride it again.
2). You’ll experience negative emotion, no matter who you are or what your life circumstance.
Rejection, worthlessness, sadness, and heart break, are constant friends. Sometimes they’ll go on vacation. They’ll always visit again.
You will never reach the shores of certainty. You will never be “done”. You may take consolation in momentary pauses, where you note your confidence has found a rock to rest its head against. But you’ll grow bored of your rock (it is just a rock, lifeless, after all). You’ll then dive back into the deep waters of doubt, risk despair, and swim again.
Happiness isn’t a final destination. Instead, it’s a roadside Starbucks: a place to refuel, and maybe passing through is an encouragement you’re headed in the right direction.
3). The people in your life are like wisps of smoke.
They will come and go. Some of them will simply whiff towards you, visiting momentarily. Their names you’ll hardly remember. You’ll share ice cream and one deep, healing conversation about love that you’ll remember for years to come. You’ll reflect on this person’s words whenever you consider loving someone again.
You’ll remember the ice cream, the warm sea breeze, the thirst that came afterwards, the laughter. But it will be hard to remember his name… David? Daniel? You won’t keep in touch, but you’ll have been touched.
There will be others who come to seek your help. You might help them. You might not. They might come back regardless, or never return. Many times it will have nothing to do with the quality of your help. Or you.
Sometimes the smoke from the flame will thicken as you breathe oxygen into it. People will come closer, you’ll draw them in, inhale them.
Sometimes you’ll cough and blow others away.
You’ll wonder if that was a wise choice. You’ll think that it probably was.
Does a flame lament the ever-changing smoke it emits? Does the surrounding air try to grasp it? Do either personalize the dynamic undulations of smoke, that arise from the candle, dance in the fading light and dissipate?
Flames don’t own their smoke. They don’t seem to believe that the smoke blows away from them repelled by some inherent deficiency in them. Flames seem to accept the fact that smoke rises and disappears, doing as it’s always done.
4). Not everything is about you.
There will be times when failure lands in your lap. You’ll wonder if it’s because there is some nascent problem with you, that only others can see. These failures will tempt you to go searching for it.
You’ll find these faults. These deficiencies. In yourself, in others, in life itself.
You’ll wonder if it explains your failures. You’ll wonder why the failures had to happen to you.
You think that people can smell something on you, that your nose is no longer able to detect, like overwhelming perfume that your senses have grown used to, but that assaults the senses of others around you.
Failure and rejection, cause your heart to ache. Your heart aches, as all hearts do. The hearts of the virtuous, famous, heroic, and rich ache just as hard. The hearts of those who have committed evil deeds also split apart. (The only hearts that don’t may be the truly broken, the irredeemable. And those people are rare.)
You will experience joys. Your heart will mend and break, a thousands times.
And it has nothing to do with you.
5). Success is not a final destination.
There are no destinations. You will ride buses, you will feel happy, you will feel joy. You will try. You will succeed.
And you won’t.
You’ll pick up the pieces of your broken heart. You will mend them. You will flag down the next bus.
You will board it.
You will grasp—you can’t help it. Grasping will only push the wisps of smoke away, causing it to disappear in your hands. This will frustate you, but you’ll keep doing it.
Over and over.
And failing.
You’ll grasp some more and come up empty, thinking that it is because something is wrong with me. There is lots wrong with you.
There is lots right with you.
Most things have nothing to do with you. (That might be just as painful to accept
But healing as well.)
No one said healing didn’t hurt. Sometimes it f—ing hurts! But, as Cheryl Strayed wrote, “the f— is your life”.
An interview outlining my adventures providing free naturopathic medicine to street youth at the Evergreen Yonge Street Mission health centre, originally featured in Pulse, a publication for members of the Ontario Association of Naturopathic Doctors.
What is the Evergreen Yonge Street Mission?
On the fourth Friday of every month, I leave my Bloor West Village practice for a few hours and head down Yonge Street.
Just south of Gerard, I stop at a rather unimpressive-looking building tucked between fast-food restaurants and strip clubs, where an admittedly intimidating crowd of young people are smoking and laughing loudly, hoodies drawn.
I nod to them briefly before heading past them, through a glass-paneled doorway.
The entrance is crowded. Youth and tattooed counselors blast rap music out of large headphones. Some of them have notebooks, writing lyrics.
Beyond them is an open area where food is being served; more young people sit at round tables, finishing hot catered lunches, or drinking coffee. A few are involved in some community project or other, conspiring excitedly in groups. Everyone seems to be embracing a perplexing combination of busyness and inertia.
I smile at them and rush downstairs to the basement, past the career centre to the unglamorous health centre where my tiny office is located.
The Evergreen Yonge Street Mission (YSM) is a drop-in centre for street-involved youth aged 18 to 24 that offers afternoon programming, including a hot lunch, career services, daycare, community-based art projects, and drop-in healthcare centre.
The health centre is run by nurse practitioners and staffed by volunteer health professionals: adolescent health specialists, family doctors, Sick Kids residents, dentists, hygienists, acupuncturists, chiropractors, physiotherapists, social workers, psychiatrists and, of course, two naturopathic doctors, Dr. Leslie Solomonian, and myself.
Youth drop in during health centre hours and sign up for 30-minute appointments with the practitioner of their choice.
How did you start working with the Mission?
I first visited the Evergreen YSM for a launch party for the second issue of Street Voices, a magazine for and by street-involved youth. A friend of mine had volunteered to do most of the graphic design and illustration work for the issue and brought me along.
At the party, while eating tiny sandwiches, I noticed a message board advertising YSM services. Naturopathic medicine was listed under health services provided at the centre. I took down the number of the health centre, and gave them a call the following week.
By February 2015, I was volunteering two Fridays a month.
Why did you decide to get involved with the Mission?
I came across Evergreen at the beginning of my naturopathic career. I’d just obtained my license in 2014, and was looking for a way to balance the cost of living and running a practice with providing access to naturopathic services.
Naturopathic medical services have the potential to be very cost-effective; our profession was built on the foundations of clean air, food, and water as vehicles for healing. Nature cure, lifestyle therapies, and in-house treatments like acupuncture can all be very inexpensive to administer.
Unfortunately, the cost of education, licensing fees, and practice overhead all conspire to bring up the cost of naturopathic services, making it difficult for those without third-party insurance coverage to afford them.
When I first started my practice, I tried to find various solutions to this problem. I dabbled in sliding scales but quickly started to notice burnout and resentment polluting my therapeutic relationships. Separating cost, value and worth, while accurately assessing need, complicated things for me—I found it very difficult to lower my rates while still recognizing the value I was offering.
Dispensing with sliding scales at my main practice while offering free services to a marginalized population felt like a satisfactory compromise: I could build my practice, pay for my groceries, and give back, while maintaining clear boundaries.
What type of naturopathic care do you provide at the YSM?
There are a few ways that my YSM practice differs from my practice in Bloor West Village.
Firstly, visits are shorter. The YSM suggests keeping visits to 30 minutes to serve as many patients as possible. Keeping visits short is a challenge for me, considering appointments in my Bloor West practice run 60 to 90 minutes.
Secondly, therapeutic options are limited. Patients don’t have the cash to buy supplements. Making significant dietary changes is impossible for most to tackle. Therefore, I try to offer therapies in the clinic: acupuncture, B12 shots, homeopathic remedies, and counseling, to reduce the work between appointments.
Sometimes we have supplements to dispense—Cytomatrix generously donated last year. At times we’ve been able to offer things like magnesium, vitamin D, iron, immune support, adaptogens, and sample packs of various probiotics.
Treatment plans often require a bit of innovation. For example, I teach patients how to use the probiotic samples to make coconut yogurt using canned coconut milk from food banks. We talk about how to follow an anti-inflammatory diet while eating at a shelter.
Thirdly, there are many obstacles that prevent patients from attending appointments in the first place. I try to treat each visit as a stand-alone encounter—a new patient I see at Evergreen may never come back. This means I focus on stress-reduction and providing as much benefit as possible in the 30-minute session.
What does a typical visit look like?
Visits can differ greatly depending on the particular needs of the patients I see.
Sometimes new patients come in asking specifically for trigger-point release acupuncture.
One patient came in with her friend so they could Snapchat their first acupuncture session amidst violent giggling.
Some patients come to talk about their struggles and share their stories.
Sometimes patients come in to read me their rap or poetry.
Sometimes patients just come in to sleep—the flimsy chiropractic table we use serving as a quiet, 30-minute refuge from the street. Sometimes we do a mindfulness practice. Other times we say very little, or nothing at all.
Others come for full intakes, with complicated psychiatric cases, or PCOS, or chronic diarrhea. I try to hand out any supplements that might be useful, and to give practical recommendations.
Sometimes patients with part-time jobs have a little money that they can spend on things like St. John’s Wort, magnesium, or vitex.
I have to be extremely economical with my therapies, which I feel is a helpful skill to have as an ND in general—I learn what simple treatments have the biggest impact on certain conditions. This helps me resist the temptation of loading patients down with complicated, expensive treatment plans.
What are some strategies for working with this population?
When working with street-involved youth, I’ve found it helpful to humbly take a step back and listening first before jumping in with solutions.
A de-centred practitioner posture can be particularly helpful in a population experiencing homelessness, violence, complex trauma, addiction, teen pregnancy, abuse, conflict with authority, and severe psychiatric illnesses, among other complex challenges—it’s not always clear what to do, what might best help the individual in front of me, and deferring to their experience is often the wisest first step.
De-centring positions the clinician as a guide, facilitator, or someone of service to the patient. This means that I offer my tools: an ear, acupuncture, vitamin D, or a sanctuary of silence, and let my patients choose whatever they want for their 30-minute appointment.
Another helpful skill is being interested in all my patients’ stories, even the ones that aren’t being told about them.
In Narrative Therapy this is called “double-listening”. Accompanying every story of illness, addiction, label of mental illness, or history of trauma, is a parallel story of strength, courage, generosity, and overcoming tremendous obstacles.
I can be a witness to the alternative stories, which are often begging to be told.
Sometimes addiction, self-harm, or other seemingly “destructive” behaviours, may be hidden coping mechanisms that serve as powerful lifelines for survival. Listening between the lines can highlight certain skills and strengths of those who suffer.
A mentor of mine, when faced with an “angry” client, always asks, “What are you protesting?” With that simple reframing question she often uncovers previously hidden stories of belief in fairness, advocacy for justice, courage, and resilience.
Patients tell me about their issues, but also about their beloved pets, how they wish they could be a better father to their children than their fathers were to them, family loyalty in the face of abuse, their dreams for the future, the steps they’ve taken to confront a friend’s addiction, their hopes for a healthier romantic relationship, and many other stories. These narratives depict the complex facets of their identities: street-youth, yes, but also loving parents, friends, budding entrepreneurs, and gifted artists.
One patient who’d recently been diagnosed with schizophrenia told me about the voices in her head. I asked her what the voices said when they spoke to her.
She looked at me, stunned.
“No one’s ever asked me that before.”
This question led us to an important discussion about how she’d turned to writing poetry and her faith to help her stop using methamphetamine. The voices, while often unpleasant, were keeping her sober in their own complex way, she realized.
Through paying careful attention to these stories, patients can reframe and foster preferred identities.
Do you have any stories in particular?
There are many stories of resilience at Evergreen. I have had the opportunity to watch one of my patients transform his life over the past couple of years.
With a criminal record for assault, anger management issues, difficulty holding a job, a mild learning disability, and a history of complex trauma, this individual picked up the pieces of himself, slowly.
The last time I saw him he had completed a yoga teacher training, begun classes at U of T, and was getting ready to move out of the shelter he’d been living in, into his own small apartment.
Through his own remarkable resilience, and some support he was able to receive at Evergreen, he was able to get himself onto an amazing and exciting path. Seeing potential realized is an amazing experience.
Like tending to a garden of souls; you might help plant seeds, or tend to the soil in very simple, minimal ways, and yet amazing things bloom.
What benefits has this work brought to you as an ND?
I believe working with diverse populations enriches practitioner experience. It reminds me to stay open to experiences, personalities, viewpoints, and unique patient histories.
Listening helps me calm the “righting reflex”: the reflex to jump quickly to a solution in order to soothe my own discomfort of sitting with the agony of uncertainty.
I notice in my own practice when I take a more de-centred stance, roll with resistance, and really pay attention to my patient’s preferences and intuition, I am better able to assist them in healing. Not only does letting the patient take the lead result in better outcomes, it also reduces the burden of (impossible) responsibility by shifting the locus of control, preventing burnout.
I struggle with this in my own practice at times; I frequently feel pressure to prove myself. Working at Evergreen helps remind me that we can’t necessarily help everyone for everything in every circumstance.
All of our patients surpass incredible external and internal obstacles to arrive at our offices and face still more difficulties between visits. Trying to recognize and work with these struggles as best we can, taking small but meaningful steps in and between visits, and acknowledging that sometimes it’s about planting seeds of change, which may take months or even years before they’re ready to bloom.
No matter how impatient I might be feeling with a patient’s progress, I try to remember that steps are constantly being taken in the direction of healing.
What are some challenges?
Like any novice practitioner I am accompanied by two familiar acquaintances: self-doubt and second-guessing. These two friends take their place beside me both in my Bloor West practice and at Evergreen.
Celebrating small victories has been important, but so has staying humble. As the mantra goes: the patient heals them-self.
I try to remember this when I’m either feeling too self-congratulatory or too down on myself.
Funding for supplements, energy, avoiding burnout, and being productive with time, are all familiar challenges I also routinely experience.
I always wish I had more time, better and more exciting remedies to dispense, and more energy to really immerse myself in the dedication community work demands.
I try to take the stance of simply being of service while trying to remain free of expectation.
How can other NDs wanting to do similar work get involved?
If you’re interested in working with marginalized populations, the first thing to do is get in touch with local shelters, such as Covenant House or Eva’s Place.
Many shelters offer satellite health services, such as massage therapy. Perhaps start by offering acupuncture, or other forms of bodywork. Acupuncture is an accessible modality that is cost-efficient and fits well with a drop-in model—patients derive benefit from the session and aren’t expected to make significant lifestyle changes or purchase supplements, both of which may be impossible.
Often stress-relief is the first primary goal of care, as is creating a safe space and nurturing trust between the clinician and community.
If you’re willing to offer your services for free there are many populations in Toronto and the GTA that could benefit greatly from naturopathic care.
How can we help?
The YSM is currently accepting donations to help build their new location, and complete their new health centre. Visit https://www.ysm.ca/donate/ to make a one-time, or monthly donation, and help a great cause.
If you would like to donate supplements, acupuncture needles, homeopathic, or herbal remedies please contact me!
I often get emails like this, “Dear Doctor, please tell me your favourite natural cure for anxiety”, to which I often reply:
Dear, Anxiety,
Imagine you are a gardener, tending to your garden. You are a skilled gardener: you tend lovingly to your plants every day and you care deeply for their welfare.
You are the perfect gardener in every way, except for one: for some reason you don’t know anything about soil.
No one has ever taught you about the damp, dark soot that envelopes the roots of your beloved plants, kindly offering to them its protection, water, and nutrients.
You are a gardener, but are innocently oblivious to the fact that soil must be nurtured by millions of microbes, and that nutrients in the soil must be replenished. You have no idea that the other plants sharing the soil with your garden form a complex network of give and take, depositing nutrients into it, while greedily sucking others away.
Now, as this soil-ignorant gardener, imagine your surprise when, despite your care and attention, the plants in your garden wither and die, bearing no flowers or fruit.
Imagine your frustration when your efforts to prop up tired stems fail. You apply water and fertilizer to buds, leaves and stems. You stand by, powerless, as your garden dies.
Notice the weeds taking over your garden, which you lop off at their stems, unaware that their roots reside deep inside the earth.
When the weeds pop up again and again, you slash at them, burn them, and you curse the skies.
“Why me?”
Why you, indeed.
You are unaware of root gardening, soil gardening, just as many of us are unaware of root medicine—soil medicine.
You see, Anxiety, there are many natural remedies that can help.
However, tossing natural pills at twitching nerves, imbalanced blood sugar, unregulated stress responses, and various nutrient deficiencies, might be as naive a practice as spray painting your roses while they wilt in sandy earth, beneath their red paint.
It might be akin to prescribing anxiety medication or a shot of vodka to calm your trembling mind; you might feel better for a time, propped up with good intentions, before collapsing in the dry soil encasing you.
With no one to tend to your roots you eventually crumple, anxiety still rampant.
“Why me?” You curse the skies.
Rather than asking, “Why me?” it might help to simply start asking, “Why?”
While it is important to understand the “What” of your condition—What disease is present? What is the best natural cure for anxiety?—naturopathic doctors are far more interested in the “Why”.
As Dr. Mark Hyman, functional medical doctor, asks:
Why are your symptoms occurring?
Why now?
And why in this way?
Naturopathic doctors prescribe natural remedies for conditions such as anxiety, it’s true. However, naturopathic medicine is a medicine that first tends to the soil.
Naturopathic doctors first look for and addresses the roots of symptoms, working with the relationships that exist between you and your body, your food, the people in your life, your society, your environment—your soil.
Healing involves taking a complete inventory of all the factors in your life that influence your mental, physical, and emotional wellness. It requires looking at the air, water, sunlight, nutrients, stressors, hormones, chemicals, microbes, thoughts and emotions that our cells bathe in each day.
Healing means looking closely at the soil that surrounds us. It requires asking, What are the roots that this condition stems from? And, What soil buries these roots? Does it nourish me?
Do I nourish it?
The causes of disease can be interconnected and complex. Very often, however, there are common root networks from which many modern-day chronic health conditions arise.
Starving Gut Bacteria.
It was Hippocrates, the father of medicine, who first proclaimed that “All disease begins in the gut.”
Our digestive systems are long, hollow tubes that extend from mouth to anus, and serve as our body’s connection to the outside world. What enters our digestive system does not fully become the body until the cells that line that digestive tract deem these nutrients worthy of entering.
Along their 9 metre-long, 50-hour journey, these nutrients are processed by digestive enzymes, broken down by trillions of beneficial bacteria, and sorted out by the immune cells that guard entrance to our vulnerable bodies.
Our immune cells make the judgement call between what sustains us, and what has that potential to kill us. For this reason, about 70% of our immune system is located along our digestive tract.
Our gut bacteria, containing an estimated 30 trillion cells, outnumber the cells in our body 3 to 1. Science has only just begun to write the love story between these tiny cells and our bodies. These bacteria are responsible for aiding in the digestion of our food, producing essential nutrients, such as B vitamins and fat-soluble vitamins, and keeping our intestines healthy.
However, this love story can turn tragic when these little romantics are not properly fed or nurtured, or when antagonists enter the story in the form of pathogenic bacteria or yeast.
Our microbiome may impact our health in various ways.
Studies are emerging showing that obese people have different gut profiles than those who are normal weight. Our gut bacteria have a role in producing the hormones that regulate hunger, mood, stress, circadian rhythms, metabolism, and inflammation. They regulate our immune system, playing a role in soothing autoimmune conditions, and improving our ability to fight off infections and cancer.
Psychological and physical stress, inflammation, medication use, and a diet consisting of processed food, can all conspire to negatively affect the health of our gut. This can lead to a plethora of diseases: mood disorders, psychiatric illness, insulin resistance, cardiovascular disease, chronic pain and inflammation, obesity, hormonal issues, such as endometriosis, autoimmune disease, and, of course, chronic digestive concerns such as IBS, among others.
As Hippocrates long knew, one doesn’t have to dig for long to uncover an unhappy gut microbiome as one of the primary roots of disease.
Our gut has the power to nurture us, to provide us with the fuel that keeps our mood bright and our energy high. However, if we fail it, out gut also has the power to plague our cells with chronic inflammation and disease.
To be fully healthy, we must tend to our gut like a careful gardener tends to her soil.
This involves eating a diet rich in fermented foods, like kefir, and dietary fibre, like leeks, Jerusalem artichokes, and black beans. It also means, consuming flavonoid-rich foods like green tea, and cocoa, and consuming a colourful tapestry of various fruits and vegetables.
Healing our gut requires avoiding foods it doesn’t like. These may include foods that feed pathogenic bacteria, mount an immune response, kill our good bacteria, trigger inflammation, or simply those processed foods that fail to nurture us.
To heal ourselves, first we must feed out gut.
Confused Circadian Rhythms.
For hundreds of thousands of years, all of humanity rose, hunted, ate, fasted, and slept according to the sun’s rhythms.
To align us with nature, our bodies contain internal clocks, a central one located in brain, the suprachiasmatic nucleus, which is susceptible to light from the sun, and peripheral clocks located in the liver and pancreas, which respond to our eating patterns.
Our gut bacteria also respond to and influence our body’s clocks.
However, the invention of electricity, night shifts, and 24-hour convenience stores, means that our bodies can no longer rely on the outside world to guide our waking and sleeping patterns. This can confuse our circadian rhythms, leading to digestive issues, insomnia, daytime fatigue, mood disorders, and problems with metabolism, appetite, and blood-sugar regulation.
Dr. Satchin Panda, PhD, a researcher at the Salk Institute in California, found that mice who ate a poor diet experienced altered circadian rhythms. However, he found that when these mice were fed the same diet in accordance with their natural rhythms, they weighed less, had lower incidences of diabetes and cardiovascular disease, had better cognitive health, and lived longer.
These findings indicate that perhaps it is not what we eat but when that may impact our health.
Perhaps it is that an unnatural diet disconnects us from nature, or that this disconnection tempts us to choose non-nutritive foods, but the research by Dr. Panda and his team reveals the importance of aligning our daily routines with our bodies’ natural rhythms in order to experience optimal health.
According to Dr. Panda’s findings, this involves eating during an 8 to 12-hour window, perhaps having breakfast at 7am and finishing dinner early, or simply avoiding nighttime snacking.
For many of us, this may involve making the effort to keep our sleep schedules consistent, even on weekends.
For most of us, it involves avoiding exposure to electronics (which emit circadian-confusing blue light) after the sun goes down, and exposing our eyes to natural sunlight as soon after waking as possible.
Nature Deficit Disorder.
Nature Deficit Disorder is a phrase, coined by Richard Louv, in the 2005 book, Last Child in the Woods.
According to Louv, a variety of childhood problems, especially mental health diagnoses like ADHD, are a direct result of our society’s tendency to increasingly alienate children from nature.
With most of humanity living in cities, nature has become a place we visit, rather than what immerses us. However much modernization might remove us from nature, our bodies, as well as the food, air, water, sunlight, and natural settings they require to thrive, are products of nature, and cannot be separated from it.
A Japanese practice called Shinrin-Yoku, or “Forest Bathing”,developed in the 1980’s toattempt to reconnect modern people with the healing benefits of spending time in a natural setting. There is an immediate reduction in stress hormones, blood pressure, and heart rate when people immerse themselves in natural environments, such as a forest.
Whether we like it or not, our roots need soil. It is possible that the components of this soil are too complex to manufacture. When we try to live without soil, essential elements that nourish us, and the various relationship between these elements are left out.
When we remove ourselves from nature, or ignore it fully, we become like gardeners oblivious to the deep dependency their plants have on the soil that enshrouds them.
Connecting with nature by spending time outside, retraining our circadian rhythms, connecting with our food sources, and consuming natural, whole foods, may be essential for balancing our minds, emotions, and physical bodies.
A Lack of Key Building Blocks.
Our bodies are like complex machines that need a variety of macro and micronutrients, which provide us with the fuel, building blocks, vitamins and minerals that we need to function.
As I child, I would play with Lego, putting together complex structures according to the blueprints in the box. When I discovered that a piece was missing, I would fret. It meant that my masterpiece would no longer look right, or work. If I was lucky, I might find a similar piece to replace it, but it wouldn’t be the same.
After looking long and hard for it, sometimes the missing piece would turn up. I’d locate it under the carpet, my brother’s bottom, or lodged in a dark corner of the box. Often our bodies don’t get that lucky.
Nutrients like vitamin B12, perhaps, or a specific essential amino acid, or a mineral like magnesium, help our body perform essential steps in its various biochemical pathways.
These pathways follow our innate blueprint for health. They dictate how we eat, sleep, breathe, and create and use energy. They control how our bones and hair grow. They control our mood and hormones. They form our immune systems. These pathways run us.
Our bodies carry out the complicated instructions in our DNA to will us into existence using the ingredients supplied from food. If our bodies are missing one or several of these ingredients—a vitamin or mineral—an important bodily task simply won’t get done.
Dr. Bruce Ames, PhD, theorized that when nutrient levels are suboptimal, the body triages what it has to cove tasks essential to our immediate survival, while compromising other jobs that are important, but less dire.
For example, a body may have enough vitamin C to repair wounds or keep the teeth in our mouths—warding off obvious signs of scurvy, a disease that results from severe vitamin C deficiency. However, it may not have enough to protect us from the free radicals generated in and outside of our bodies. This deficiency may eventually lead to chronic inflammation, and even cancer, years later.
According to Dr. Ames’ Triage Theory, mild to moderate nutrient deficiencies may manifest later in life, as diseases that arise from the deprivation of the building blocks needed to thrive.
In North America, despite an overconsumption of calories, nutrient deficiencies are surprisingly common.
25-50% of people don’t get enough iron, which is important for the transport of oxygen, the synthesis of neurotransmitters, and for proper thyroid function.
One third of the world’s population is deficient in iodine, which affects thyroid health and fertility.
Up to 82% of North Americans are vitamin D deficient. Vitamin D regulates the expression of over 1000 genes in the body, including those involved in mood regulation, bone health, immunity, and cancer prevention.
Vitamin B12 is commonly deficient in the elderly, vegans and vegetarians. It is important for lowering inflammation, creating mood-regulating neurotransmitters, and supporting nervous system health. Deficiency in vitamin B12 can result in fatigue. Severe deficiency can lead to irreversible nerve damage, dementia, and even seizures.
Magnesium is an essential mineral involved in over 300 chemical reactions, including mood and hormone pathways. Over 40% of North Americans do not consume enough magnesium, which is found in leafy green vegetables.
Our bodies have requirements for fats, which make up our brain mass and the backbone of our sex hormones, and protein, which makes up our enzymes, neurotransmitters and the structure of our body: bones, skin, hair, nails, and connective tissue.
Our gut microbiota require fibre.
Our cells need antioxidants to help protect us from the free radical damage from our own cells’ metabolism and our exposure to environmental toxins.
We certainly are what we eat, which means we can be magnificent structures with every piece in place, thriving with abundance and energy.
Despite reasonably good intentions, we can also suffer from nutrient scarcity, forced to triage essential nutrients to keep us from keeling over, while our immune health, mood, and overall vitality slowly erode.
A Body on Fire: Chronic Inflammation.
When we injure ourselves—banging a knee against the sharp edge of the coffee table, or slashing a thumb with a paring knife—our immune systems rally to the scene.
Our immune cells protect us against invaders that might take advantage of the broken skin to infect us. They mount an inflammatory response, with symptoms of pain, heat, redness, and swelling, in order to heal us. They recruit proteins to the scene to stop blood loss; they seal our skin back up, leaving behind only a small white scar—a clumsiness souvenir.
Our inflammatory response is truly amazing.
One the danger has been dealt with, the immune response is trained to turn off. However, when exposed to a stressor, bacteria, or toxin, for prolonged periods, our immune system may have trouble quieting. Chronic issues can contribute to chronic inflammation.
Scientists argue that an inflammatory response gone rogue may be the source of most chronic diseases, from heart disease, cancer, and diabetes, to schizophrenia and major depressive disorder.
The gut is often the source of chronic inflammation as it hosts about 70% of the immune system. When we eat something that our immune system doesn’t like, an inflammatory response is triggered. This can cause digestive issues such as inflammatory bowel disease, celiac disease, and the more common irritable bowel syndrome. It can also lead to more widespread issues like chronic pain, arthritis, migraines, and even mood disorders like Bipolar.
Ensuring optimal gut health through nurturing the gut microbiome, and eating a clean diet free of food sensitivities, is essential for keeping the body’s levels of inflammation low.
Constant Fighting and Fleeing.
Like inflammation, our stress response is essential to our survival.
When facing a predatory animal, our body is flooded with stress hormones that aim to remove us from the danger: either through fighting, fleeing, or freezing. Our stress response is affectionately called our “Fight or Flight” response.
However, like inflammation, problems arise when our stress response refuses to turn off. Traffic, exams, fights with in-laws, and other modern-day struggles, can be constant predators that keep us in a chronically stressed-out state.
Chronic stress has major implications for our health: it can affect the gut, damage our microbiome, alter our circadian rhythms, mess with mood and hormones, and contribute to chronic inflammation. Stress gets in the way of our ability to care for ourselves: it isolates us, encourages us to consume unhealthy foods, and buffer our emotions through food, alcohol, work, and drugs.
We also know that stress has a role in the development of virtually every disease. Like chronic inflammation, it has been found to contribute to chronic anxiety, depression, digestive concerns, weight gain, headaches, heart disease, insomnia, chronic pain, and problems with concentration and memory, among others.
Discomfort with Discomfort.
To assess its impact on health, it helps to determine between two key types of stress: distress, the chronic wear and tear of traffic, disease, and deadlines, and eustress.
Eustress is beneficial stress—the short-lived discomfort of intense exercise, the euphoric agony of emotional vulnerability, or the bitter nutrients of green vegetables—that makes the body more resilient to hardship.
Whenever I feel discomfort, I try to remember the ducks.
Several years ago, on a particularly frigid winter day, I was walking my dog. Bundled against the cold wind, we strolled along the semi-frozen lake, past tree branches beautifully preserved in glass cases of ice. Icebergs floated on the lake. So did a group of ducks, bobbing peacefully in the icy waters.
With nothing to protect their thin flippers from the sub-zero temperatures, they couldn’t have felt comfortable. There couldn’t have been even a part of them that felt warm, cozy, or fed.
There was no fire for them to retreat to, no dinner waiting for them at home, no slippers to stuff frozen, wet flippers into. This was it. The ducks were here, outside with us, withstanding the temperatures of the icy lake. A part of them must have been suffering. And yet, they were surviving.
Far from surviving, the ducks looked down-right content.
I think of the ducks and I think of the resilience of nature.
We humans are resilient too. Like the ducks, our bodies have survived temperature extremes. Our ancestors withstood famine, intense heat, biting cold, terrible injury, and the constant threat of attack and infection, for millenia. You were born a link on an unbroken chain of survivors, extending 10,000 generations long.
Our bodies have been honed, over these hundreds of thousands of years, to survive, even thrive, during the horrendous conditions that plagued most of our evolutionary history.
Investigations into the human genome have revealed genes that get turned on in periods of eustress: bursts of extreme heat or cold, fasting, and high-intensity exercise. When our body encounters one of these stressors, it activates a hormetic responseto overcome the stress. Often the response is greater than what is needed to neutralize the threat, resulting in a net benefit for our bodies.
These protective genes create new brain cells, boost mitochrondria function, lower inflammation, clear out damaged cells, boost the creation of stem cells, repair DNA, and create powerful antioxidants. Our bodies are flooded with hormones that increase our sense of well-being.
It’s like the old adage, “What doesn’t kill you makes you stronger.”
Our bodies were made for discomfort. In fact, we have entire genetic pathways waiting to kick in and heal us as soon as they experience hardship.
There are a growing number of studies on the healing power of small troubles. Fasting may have a role in treating autoimmune diseases, decreasing the signs of aging, and as an adjunct therapy for cancer; sauna therapy boosts detoxification and may prevent dementia; cryotherapy, or exposure to extreme cold, has the potential to heal arthritis and autoimmunity; and High Intensity Interval Training has been shown to boost cardiovascular health more than moderate-intensity exercise.
Plants may benefit us through flavonoids, which, rather than serving as nutrients, act as small toxins that boost these hormetic pathways, encouraging the body to make loads of its own, powerful antioxidants to combat these tiny toxins.
Mindfully embracing discomfort—the bitter taste of plants, the chilly night air, the deep growling hunger that occurs between meals—may be essential for letting our bodies express their full healing potential.
Not Minding Our Minds.
Our ability to withstand powerful emotions may have healing benefits.
Many of us avoid painful feelings, allowing them to fester within us. We buffer them with excess food, or drugs, leading to addictions. Mindfulness can help us learn to be with the discomfort of the emotions, thoughts and physical sensations that arise in the body as inevitable side effects of being alive.
Research has shown that mindfulness can help decrease rumination, and prevent depressive relapse. It also helps lower perceived stress. How we perceive the stressors in our lives can lower the damaging effects they have on us. Research shows that those who view their life stressors as challenges to overcome have lower stress hormone activation, and experience greater life satisfaction.
According to Cognitive Behaviour Therapy (CBT), our thoughts create our emotions. Becoming more aware of our thoughts, through CBT or mindfulness, allows us to identify which thoughts may be limiting us or exacerbating our reactions to stressful situations.
When we learn to observe our thoughts, we create some distance from them. We become less likely to see the dismal thoughts in our minds as absolute truths.
Practicing mindful meditation, CBT, or cultivating positive thoughts, such as engaging in a daily gratitude practice, may improve our resilience to chronic stress.
Inattention.
According to Stephen Cope, yoga teacher and author of The Great Work of Your Life, “You love what you know deeply. Get to know yourself deeply”. We get to know things deeply by paying attention to them.
Georgia O’Keefe’s admiration for flowers, or Monet’s adoration of landscapes, is apparent to anyone who sees their work. In order to commit images to canvas, the artists gets to know their subject matter deeply. Their art celebrates what they took the time to pay attention to, and eventually came to love.
As a naturopathic doctor, I believe that healing begins with attention. When we become aware of our bodies, we begin to know them deeply. Awareness allows us to respond to symptoms lovingly, the way a mother learns to skillfully attend to her baby’s distinct cries.
When I first meet a new patient, the first thing I have them do is start to pay attention.
We become curious about their symptoms, their food intake, their sleep patterns, their habits and routines, the physical sensations of their emotions, the thoughts that run through their heads.
Through paying attention, with non-judgmental curiosity, my patients start to understand their bodies in new ways. They learn how certain foods feel in their bodies, how certain sleep habits affect their energy levels the next day, and how specific thoughts contribute to their feelings.
Once we begin to open up this dialogue with our bodies, it becomes impossible not to answer them with love. It becomes hard not to eat, sleep, and move in ways that convey self-respect.
A gardener who pays deep attention cannot ignore the obvious—her plants have roots, embedded in soil. The gardener quickly learns, through careful observation, that the health of this soil is vital to the health of her plants.
And so, back to the original question, “What is your favourite natural cure for anxiety?”
My favourite remedy isn’t a bottle of pills we reach for, it’s a question we reach for from within:
“What do I need to heal?”
After asking the question, we wait.
We wait for the answer to emerge from some primal place within, just as a gardener waits for new buds to rise out of the mysterious depths of the dark, nutritious soil.
Mindfulness philosophy tells us that our thoughts and emotions are simply phenomena that arise in our bodies and minds: they are not us.
Those of us who suffer from depression and anxiety tend to enter cycles of over-thinking. The mind wanders and engages in self-focused rumination that feeds negative emotions, worsening mood.
While ruminating, we think about the causes and consequences of our depression; we reflect on mistakes we’ve made in the past, we dwell on our perceived personal faults, and we speculate about how we’ll fare negatively in the future.
This kind of rumination becomes a scratch-itch cycle that causes us to feel worse.
However, learning to engage the contents of self-focussed mind-wandering as a non-judgmental observer may be the key to stopping this cycle.
Those who are able to step back and become aware of awareness or think about thoughts, as opposed to getting lost in them, tend to have better control over their thought processes as a whole, and thus their emotions. Mindfulness involves taking a non-judgmental, curious stance about the contents of the mind, as an impartial witness.
Studies show that mindfulness, or taking this non-judgmental, curious stance, can change brain areas associated with rumination, and emotional regulation.
This fall I took a course to obtain a facilitator certificate for Mindfulness-Based Cognitive Therapy (MBCT), an evidence-based 8-week program that aims to treat depression and anxiety through imparting mindfulness skills. Because of the growing evidence base on the benefits of mindfulness for stress and mental health, the facilitator program attracts many medical professionals.
One of the course participants, a psychiatrist, didn’t like me. I noticed her frowning in my direction every time I spoke. She deliberately avoided and ignored me, talking to everyone else in the course but me.
As the only naturopathic doctor in the group, the other participants showed some curiosity towards my field. When I answered their questions, the psychiatrist’s face seemed to twist into a subtle expression of disgust and disapproval.
She thought I was a quack, a hack; I didn’t have enough training. She assumed I wasn’t qualified enough to provide care to those who suffer from mental health concerns. I could feel her judging energy from across the room every time I lifted my hand to answer a question, or make a comment. Her deploring gaze scrutinized my every move.
I was a naturopathic doctor and she, a psychiatrist. We had emerged from different worlds, philosophies, and backgrounds—we were from incompatible ends of the mental health professional spectrum. Of course she didn’t approve of me: it was only to be expected.
We were spending all day meditating, and this is the story my mind had decided to write.
At the end of day 3 of the course, with days of evidence selectively compiled to support my story about this disapproving psychiatrist’s opinion of me, I left class to head for the bus stop. Waiting for the same bus was no one other than my nemesis.
Great, I thought. I smiled at her, stiffly.
She smiled at me.
“Talia, right?” She asked.
I nodded: yes, Talia.
“You’re the naturopath, right?” She inquired, brows kneaded together in a frown.
I nodded again, bracing myself. Are we really going to do this here?
But then, time-space cracked and split open, revealing an alternate universe to the one in my own head. Her face melted into a warm grin, “Oh, I love naturopaths!” She exclaimed warmly.
She went on to describe her wonderful encounters with the members of my profession who had attended to the various personal health concerns she’d faced.
“I’m so interested in holistic health for managing mental health concerns,” She said, before leaning in a bit, conspiratorially, and adding in hushed tones, “You know, psychiatry doesn’t work.”
I stood there, dumbfounded.
Her particular opinions about psychiatry aside: not only was the entire story I’d written and held onto for the past few days wrong, it was way wrong. I had fabricated an entire story in my head, corroborated by what I had been convinced was real evidence. The realization of how avidly I’d bought into this story, as if it were simple fact, was earth-shattering.
My story, had just been that: a story, conjured up by thoughts. These thoughts bore no relationship to reality at all, no matter how convincingly they had presented themselves.
It rare to have the opportunity to experience our mental constructs and biases topple so dramatically. The mind has a tendency to rationalize away any evidence contrary to our beliefs—”Well, I only passed because I got lucky”, or “The test was easy”, or “She said she liked my hair—liar”.
Very few of us entertain the idea that our thoughts and emotions don’t represent our ultimate reality.
According to Mindfulness Theory it helps to think of our minds as movie screens and our thoughts, emotions, and body sensations as contents of the movie. We can watch the action, identify with the characters, and follow the plot with invested interest. The movie can inspire thoughts and emotions within us, both positive and negative. The movie can grip us; we might lose ourselves in the drama, forgetting that we are mere witnesses to it.
It can help to remember that we are not the movie. Sometimes it’s helpful to remember that we’re not even acting in the movie.
No matter how deeply the film may move us, we can always take the stance of movie-going witness. We can take various perspectives in relation to the drama on screen. We can immerse ourselves in the drama, losing our sense of self completely. We can remember that we are audience members, enjoying a film. We can ignore the movie altogether and laugh to a friend sitting beside us. We can be aware of the contents of the movie theatre, the people sitting around and behind us, or the sticky floor under our feet. We can even leave the theatre, which we will certainly do once the credits roll—it’s just a movie after all, a distraction from the reality of our lives.
In the way that we approach the contents on a movie screen, we can take various stances towards the contents of our minds.
Meta-awareness is the act of remembering that we are movie watchers—the act of becoming aware of awareness itself. When we practice meta-awareness, we take a non-judgmental view of our thoughts and emotions, watching them arise in our bodies and minds like the drama in a movie arises onscreen.
We can easily identify with the tens of thousands of thoughts that appear on the movie screens of our lives. We may be convinced that we’re unloveable, that we’re failures, or that life is hopeless, simply because these particular thoughts have appeared in our mind’s screen. We can also identify with positive thoughts, such as the idea that we’re excellent swimmers, or good fathers.
Our thoughts may reflect reality—we may have the thought that if we step into a pool of water our feel will get wet—but simply having a thought does not create reality itself.
While taking the bus that day, I realized that I had unwittingly cast my psychiatric colleague as the guest-star of People Who Are Judging Me, an episode in Unloveable: The Series, which is a piece of entertaining fiction that my mind has written, directed, produced, and cast me as the lead in. I often forget that I’m simply an audience member watching the movie of my mind’s creation—this movie is not necessarily the truth about my life.
Research has identified a network in the brain called the Default Mode Network (DMN), that connects the lower brain areas, like the amygdala and hippocampus, with higher brain centres in the prefrontal cortex. The DMN is active when our minds are wandering and is particularly active when those with depression are ruminating and engaging in narrative self-referencing: or attributing one’s self as the cause of (negative) events in one’s life—for example, interpreting an expression on someone’s face to be a look of disgust and assuming it’s because they disapprove of your profession.
Meditation, particularly practicing meta-awareness, can produce shifts in the DMN that decrease rumination. Practicing meta-awareness allows us to rescue our identities from the tyranny of thought. We watch and detach from thought, watching them rise and fall in the mind without clinging to them. By becoming aware of our thoughts and emotions and taking a curious attitude towards them, we can break the cycle of rumination, thereby supporting our mental health. Observing thoughts, rather than becoming lost in their drama, allows us to feel and behave independently of them.
For example, simply having the thought, “I’ll always be alone,” doesn’t have to produce a negative emotion, if I recognize it as just a thought.
We might reframe the thought “She hates me” to be: “I just had a thought that this person hates me. It’s just a thought that I have no way of knowing for certain is true. I will smile warmly at her anyways. I might be completely wrong.”
Or, we can do nothing, waiting until the thought “She hates me” passes through the screen of our minds.
We can turn off this particular movie, and put on a new one. After all, we can’t stop the flow of thoughts: there will always be others to take their place.
Lesson learned: I am not my thoughts.
And: some psychiatrists are way more hippy than I am.
Like many people I see, Sandra was experiencing debilitating exhaustion.
Completing her PhD, she was working all day and collapsing on the couch at 8 pm.
She stopped going out in the evening. She ceased spending time with friends, engaging in activities outside of her studies, exercising, and having sex.
Her motivation and zest for life were at all-time lows.
Her marriage, and her life, were being sidelined in the service of her fatigue.
Her family doctor met her complaints with a defeated shrug. “You’re just getting older,” he offered by way of explanation.
Sandra was 27.
My patient is not alone. At least 20% of patients approach their family doctors complaining of fatigue.
Lack of energy is a problem that can arise from any body system. Fatigue can be an early warning sign that something has been thrown off balance.
I frequently see fatigue in patients suffering from hormone imbalances, including suboptimal thyroid function, insulin resistance, and low estrogen, progesterone, or testosterone. But also in chronic stress, depression, and anxiety.
Fatigue is often connected to mental health conditions, digestive issues, lifestyle imbalances, chronic inflammation, chronic stress, and lack of restful sleep. It’s no wonder, then, that most of the people I work with experience some level of low energy.
Conversely, I see improvement in energy as one of the first signs that someone is moving towards more robust health. Some of the first signs of healing are a clear mind, bright mood, and vibrant, buoyant energy.
There are a few steps you and your naturopathic doctor can take to identify and remove the cause of fatigue, while optimizing your health and energy levels.
Differentiate between sleepiness and fatigue.
It is important to determine if low energy is fatigue or sleepiness.
Sleepiness is characterized by the tendency to fall asleep when engaging in non-stimulating activities like reading, watching TV, sitting in a meeting, commuting, or lying down.
Sleepiness:
Is often improved by exercise, at least in the short-term
Is improved with rest
Fatigue is characterized by a lack of energy, both physical and mental. Fatigue is often worsened by exertion.
Those who are fatigued:
Suffer from mental exhaustion
Experience muscle weakness
Have poor endurance
Typically feel worse after physical exercise and take longer to recover
Don’t feel restored after sleeping or napping
Might experience ease in initiating activities but progressively experience more weakness as they continue them (e.g.: engaging in social activities, movement, working, etc.)
To determine between sleepiness and fatigue, your naturopathic doctor will ask you a series of questions about the nature of your low energy.
2. Assess sleep.
Assessing and optimizing sleep is essential for beginning to treat all low energy and, in particular, sleepiness.
Assessing sleep involves looking at a variety of factors such as:
Bedtime and waking time
Sleep onset: how long it takes
Sleep routine and sleep hygiene habits
Sleep duration: how many times you wake up, how quickly you can fall back asleep after waking
Causes of interrupted sleep such as sleep apnea, chronic pain, frequent urination, children/pets/partners, etc.
Nap frequency and length
Ability to wake up in the morning
Perceived sleep quality: do you wake feeling rested?
The use of sleep aids
Exercise routines, how close to bedtime you eat or exercise.
And so on.
Using a sleep app or undergoing a sleep study are two additional tools for assessing the quality and duration of your sleep cycles that may be useful.
3. Address sleep issues.
Whether the cause of fatigue is sleepiness or not, restful sleep is essential to restoring our energy levels. Optimizing sleep is an important foundational treatment for all health conditions.
Restorative sleep regulates hormones and balances the stress response, called the hypothalamic-pituitary-adrenal axis (HPA axis). It improves cell repair, digestion, memory, and detoxification.
Mental and emotional stress, artificial light, blood sugar dysregulation, inflammation, and hormone imbalances can interfere with sleep.
To address issues with sleep, it is important to:
Maintain a strict sleep schedule. This means keeping bedtime and waking time consistent, even on weekends.
Practice good sleep hygiene by avoiding electronics at least an hour before bedtime, using blue light-blocking glasses if necessary, and keeping the bedroom as dark as possible.
Avoid stimulating activities like exercise in the hours before bed.
Keep the bedroom cool and dark.
Reserve the bed and bedroom for sleep and sex only.
Balance circadian rhythms by exposing your eyes to sunlight immediately upon waking and eating protein in the morning.
In addition to sleep hygiene and balancing circadian rhythms, sleep aids can be helpful. I start my patients with melatonin, a non-addictive antioxidant, to reset the sleep cycle and help with obtaining deeper, more restorative sleep.
It is important to take melatonin in a prolonged-release form a few hours before bedtime and to use it in addition to a dedicated sleep routine.
Determine whether the fatigue is secondary to an underlying medical condition.
Secondary fatigue is defined as low energy, lasting from 1 to 6 months, that is caused by an underlying health condition or medication.
With your medical or naturopathic doctor, be sure to rule out any issues with your immune system, kidneys, nervous system, liver, and heart, and to assess the side effects of any medications you’re taking.
Ruling out chronic infections, pregnancy, anemia, and cancer may be necessary, depending on other signs and symptoms that are present, your individual risk factors, and family history.
While the vast majority of fatigue is not caused by a serious health condition, ruling out more serious causes is an essential part of the diagnostic process.
Remember that this is not a job for Dr. Google! Because fatigue is a sign that something in the body is not functioning optimally, it can be implicated in virtually every health condition, alarmingly serious ones, but also more benign conditions as well.
Taking into account your entire health history, risk factors and particular symptoms, as well as assessing blood work is a complex job that a regulated health professional can assist you with.
Get blood work done.
Assessing blood work is necessary for ruling out common causes of fatigue.
Blood tests are used to rule out anemia, infections, suboptimal iron, B12, and folate levels, under-functioning thyroid, inflammation, insulin resistance, and hormonal imbalances.
To evaluate the cause of fatigue, your doctor will look at:
A complete blood count (CBC) that looks at your red and white blood cells.
inflammatory markers like ESR and hs-CRP
TSH, to assess thyroid function, and occasionally free thyroid hormones and thyroid antibodies, if further investigation is indicated
B12, iron and folate
Other tests such as fasting insulin, fasting blood glucose, liver enzymes, and hormones like estradiol, testosterone, estrone, LH, FSH, and progesterone, depending on the health history and the constellation of symptoms.
Your doctor may take further measures to assess your heart and lungs, or to rule out chronic infections.
6. Identify physiologic fatigue, or burnout.
Once sleepiness and any underlying health conditions have been ruled out, your doctor may determine whether you have physiologic fatigue.
Physiologic fatigue, also commonly called “burnout” or “adrenal fatigue”, is the result of an imbalance in sleep, exercise, nutrition intake, and rest.
It is by far the most common category of prolonged fatigue that I see in my practice. Two thirds of those experiencing fatigue for two weeks or longer are experiencing this type of fatigue.
Feeling a lack of motivation, low mood, and increased feelings of boredom and lethargy are characteristics of this kind of fatigue.
Physiologic fatigue can be confused with depression, leading to a diagnosis and subsequent antidepressant prescription, which may fail to uncover and address contributing lifestyle factors.
To tell if you might be experiencing physiologic fatigue, or burnout, see if you answer yes to any of the following questions, adopted from the Maslach Burnout Inventory:
I feel emotionally drained at the end of the day.
I feel frustrated with my job.
I feel I’m working too hard.
I feel fatigued when I have to face another day.
I have a hard time getting up in the morning on weekdays.
I feel less sympathetic and more impatient towards others.
I am more irritable and short-tempered with colleagues, my family, my kids.
I feel overwhelmed.
I have more work than I can reasonably do.
I feel rundown.
I have no one to talk to.
Fortunately, there are many solutions to improving low energy and mood caused by burnout.
Balance the HPA Axis
Balancing the stress response, otherwise known as the Hypothalamus-Pituitary-Adrenal (or HPA) axis, is an important component of treating physiologic fatigue.
Our HPA axis becomes activated in the morning when the hormone cortisol is released from the adrenal glands. Cortisol suppresses inflammation and gives us the motivated, focussed energy to go about our day.
Towards the end of the day, cortisol levels naturally fall. In the evening, cortisol is at its lowest, and melatonin, our sleep hormone, rises.
Those with HPA dysfunction have an imbalance in this healthy cortisol curve.
They commonly experience sluggishness in the mornings, a crash in the afternoon (around 2 to 4 pm), and restless sleep, often waking up at 2 to 4 am as a result of nighttime cortisol spikes and an impairment in melatonin release.
These individuals often experience cravings for salt and sugar. They may have low blood pressure and feelings of weakness.
It is common for those experiencing burnout to get sick when they finally take a break or experience prolonged healing time from common infections, likes colds and flu.
They may suffer from inflammatory conditions like chronic migraines, muscular tension, and report feeling depressed or anxious.
In this case, balancing the HPA axis is a treatment priority.
Treatment involves:
HPA axis balancing through adaptogenic herbs
Optimizing adrenal nutrient levels
Regulating blood sugar
Improving circadian rhythms
Reducing workload and perceived stress through addressing perfectionism, practicing setting boundaries, and developing mindfulness, among other skills.
Improving sleep
Engaging in regular, scheduled exercise
Reducing inflammation, improving digestion, or regulating hormones
Being proactive about mental health and emotional wellness
Improving self-care and stress resilience
Cognitive Behaviour Therapy can be used to teach healthy coping skills while balancing sleep and stress. Studies show it can be more effective than medication for the depression and anxiety related to physiologic fatigue.
Of course, from a holistic perspective, the above strategies are the foundations for improving general health and wellness for all fatigue-related conditions, regardless of whether the fatigue is due to sleepiness, secondary fatigue, physiologic fatigue, or chronic fatigue syndrome.
Talk to your naturopathic doctor about adaptogenic herbs.
Adaptogenic herbs are an important natural tool for improving mood and energy.
Adaptogens help the body “adapt” to stress. They up-regulate genes involved in boosting the body’s natural stress resilience.
Because of this, adaptogens not only improve energy and mental and physical endurance, they also improve attention and concentration, immune system function, and mental work capacity.
They can treat depression and anxiety, and regulate circadian rhythms.
Common adaptogens are withania (or ashwaghanda), rhodiola, holy basil, the ginsengs, like Siberian gingseng (or eleuthrococcus), schizandra, liquorice, and maca, among others.
My two favourite adaptogens are ashwaghanda and rhodiola, however your naturopathic doctor can work with you to pick the best herbal combination for your individualized needs.
9. Rule out Chronic Fatigue Syndrome.
Chronic fatigue syndrome (CFS) is characterized by fatigue that lasts 6 months or longer, is not improved by exercise and rest, is not related to an imbalance in lifestyle, and is not caused by a primary health condition.
Those with CFS often have signs of an activated immune system such as enlarged lymph nodes, a low-grade fever, or a sore, inflamed throat. Sufferers may experience generalized weakness and pain.
CFS can be an extremely debilitating condition that results in a 50% reduction of daily functioning.
The cause of CFS is not known, however balancing HPA axis function, improving nutrient status, reducing inflammation, healing the gut, reducing toxic burden, boosting mitochondrial functioning, and promoting self-care are all useful treatment strategies.
Our gut is the seat of the immune system, sampling foreign substances from the external environment and activating an immune response, if it finds any of those substances pose a threat to the health of the body.
If our immune system comes into contact with something doesn’t like, even if that something is a benign food substance, an inflammatory reaction can be triggered. Chronic inflammation can exacerbate fatigue.
To test for food sensitivities, your naturopathic doctor will either order a blood test, or recommend an elimination diet where suspicious food is removed from the diet, the gut is healed, and foods are later reintroduced.
Common foods to eliminate are gluten, dairy, sugar, eggs and soy. Stricter Autoimmune Paleo diets involve the removal of all dairy, eggs, grains, legumes, and nuts.
Mind your mitochondria.
Our mitochondria are the “powerhouses” of the cell, responsible for making ATP, our body’s energy currency, out of the carbs, protein, and fats from our food.
Research has shown a link between mitochondrial dysfunction and chronic fatigue.
The mitochondria need a variety of different nutrients to function optimally. These nutrients include B vitamins, magnesium, Coenzyme Q10, and certain amino acids.
When the mitochondria are unable to produce sufficient ATP, fatigue may result. Similarly, a problem with antioxidant production can result in the buildup of reactive oxygen and nitrogen species, otherwise termed “free radicals”, in the mitochondria.
Free radicals can trigger inflammation and immune system activation in the entire body, causing us to feel ill and fatigued.
B vitamins are also important for a process called “methylation” which is essential for energy and hormone production, immune function, detoxification, mitochondrial function, and DNA repair.
Balance your blood sugar.
Insulin resistance, hypoglycaemia, type II diabetes, and metabolic syndrome are all common conditions that reflect the body’s inability to regulate blood sugar.
All of these conditions can cause frequent energy crashes, fatigue after eating, brain fog, and lethargy.
Even those free of the above conditions may still struggle with blood sugar imbalances. Signs of blood sugar dysregulation are craving sweets, feeling hungry less than 3 hours after a meal, getting “hangry”, feeling weak and dizzy if missing meals, waking at night, and snacking at night.
Balancing blood sugar by eating enough fibre, fat and protein at every meal is essential to maintaining the endurance to get through the day.
Your naturopathic doctor can help you come up with a diet plan that keeps your blood sugar balanced and your energy levels stable throughout the day.
Support your immune function and eradicate chronic infections.
Chronic infections can result in prolonged activation of the immune system, resulting in chronic fatigue.
Viral infections, like mononucleosis and Epstein Barr, and gut bacteria imbalances, such as SIBO, C. Difficile, and candida overgrowth can be implicated in chronic fatigue.
Supporting the immune system with herbs, balancing the HPA axis, and using natural remedies to eradicate the infection are all courses of action you may take with your naturopathic doctor to eradicate infectious causes of fatigue.
Uncover and treat hormone imbalances.
Our hormones, the messengers of the body, regulate how our cells talk to each other.
Hormones are responsible for blood sugar control, the stress response, ovulation and fertility, sex drive, metabolism, and, of course, energy production and utilization.
It is possible that those who suffer from low energy have an imbalance in the hormones cortisol, insulin, estrogen, progesterone, DHEA, testosterone, or thyroid hormones. Directly addressing hormones is then the main treatment goal for improving energy.
Uncovering other signs of hormonal imbalance, such as the presence of PCOS, endometriosis, or symptoms of hypothyroidism, as well as ordering blood tests, can help reveal if an imbalance in hormones is the main cause of your fatigue.
Encourage detoxification.
Our body has the powerful ability to process and eliminate the 500 chemicals and toxic substances we come into contact with daily, as well as the hormone metabolites and immune complexes produced as a result of normal metabolic functioning.
Our livers, kidneys, colon, and skin regularly filter hundreds of harmful substances from our bodies. This process happens naturally without the aid of outside support.
However, it is possible that an increased toxic burden on the body paired with a sluggish liver and digestive system, can increase the body’s overall toxic load.
Toxic overload can contribute to fatigue by increasing inflammation and immune system activation, as well as impairing energy production pathways, and disrupting hormonal function.
Reducing contact with harmful toxins, while supporting kidney, liver and colon function can help restore optimal energy and health.
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Treating fatigue first involves developing a relationship with your healthcare provider: finding someone who takes your concerns seriously.
Conducting a thorough assessment of blood, lifestyle factors, sleep, hormones, and digestion, and as many other factors as possible, is essential to uncovering the cause of fatigue.
Treatment involves removing obstacles to healing, supporting energy production, balancing lifestyle, and using herbs to boost energy and stress resilience.
When we consider fatigue as an important sign that something in our body is functioning sub-optimally, we can use our energy levels are important indicators for health.
Is your multivitamin or B-complex making you sick?
Take a look at the label on your multivitamin or B-complex and see if it contains “folic acid”.
Folic acid is often used interchangeably with “folate”, which is a vitamin needed for DNA synthesis and repair.
Every time our bodies make new cells (which is all the time), we need folate to move that process along.
Because very few of us North Americans get enough folate from leafy greens, folic acid, a synthetic precursor to folate, has been added to grain products, to “fortify” them.
Folate deficiency in pregnant women can lead to neural tube defects. Therefore making sure that your body has enough folate, especially if you’re pregnant or planning to conceive, is essential.
However, folic acid, the synthetic vitamin is NOT the same as the folate (look at the bottom of the chart below, another word for folate is 5-methyltetrahydrafolate, or 5-MTHF) that our bodies use for cell division and DNA synthesis.
As you can see by the picture, folic acid needs to go through several stages of transformation before it can be of any use to the body.
All of us are really poor at converting folic acid to DHF (first step in the pathway). This step is faster in rats. In humans, it’s abysmally slow.
This means we take folic acid from supplements and fortified grains and slowly pass it through the narrow DHFR sieve that all of us are born with. This slowly transforms our synthetic folic acid into DHF.
The same DHFR enzyme must take DHF and turn it into THF. Two steps: folic acid –> DHF –> THF. So far, none of these products is useful.
3 steps and 2 enzymes later, our body makes a product called 5,10 methylene THF, or folinic acid, which can be used for DNA repair and synthesis.
After that, an enzyme called MTHFR turns folinic acid into folate (5-MTHF). And yes, MTHFR does remind you of the word you’re thinking of!
About 40-60% of us are poor at the last step, making 5-MTHF, which results from a slow or completely impaired MTHFR gene which has trouble producing a fully functioning MTHFR enzyme.
Slow enzymes mean very few of us are going to take the folic acid from foods and cheap vitamins, and turn them into methylfolate.
Methylfolate (remember, NOT folic acid), is needed for important chemical reactions called “methylation” reactions.
Methylation is needed for with detoxification, liver function, managing inflammation, hormone production and recycling, and producing neurotransmitters. Research is establishing a connection between MTHFR gene mutations and mental health conditions, autoimmune conditions and heart disease, among other common health complaints.
Folic acid, when added to supplements isn’t just useless, however.
When it can’t be broken down (and remember, all of us are slow at the first stop, some of us just plain can’t perform the last step), it builds up in tissues, and can block ACTUAL methylfolate action.
It can also trigger inflammatory reactions.
Not good.
Most multivitamin and B complex brands at health food stores contain cheaper forms of B vitamins. Companies use folic acid and a cheaper, synthetic form of B12, called cyanocoblamin, when making products to cut costs.
This doesn’t mean you have to shell out a lot of cash for quality B complex vitamins, it just means you need to be smart about the B-complexes you buy.
B-complex vitamins can be useful for those who experience inflammation, hormone imbalances and chronic stress. We tend to use more B-vitamins, which are water-soluble, when stressed, and when on certain medications, such as birth control pills. Supplementing in these cases can be extremely helpful for boosting energy and mood, while lowering symptoms of PMS and inflammation, among other things.
Most of the patients who come into my office already on a B complex are on a form that contains folic acid. At best, their body is working harder than needed to convert this synthetic vitamin into something useful. At worst, this product may be causing them harm.
The first thing you can do, is check your multivitamins and B-complex products and see if they contain “folic acid” or “cyanocobalamin”. If so, you can toss them.
You can also consider getting tested to see if you have an MTHFR mutation. Keep in mind that naturopathic doctors who are registered in Ontario, Canada cannot recommend or interpret genetic testing.
Next, you can reassess your diet. Folic acid is also added to enriched grains. Those who are particularly sensitive to folic acid, may experience a worsening of inflammatory symptoms and mental health issues when consuming high amounts of these foods.
Also, eat plenty of leafy green vegetables, which DO provide your body with a useable form of folate, among their many other health benefits.
Finally, if you’re considering getting pregnant, have a naturopathic doctor assess your prenatal vitamins to tell you if the form of folate you’re taking is appropriate for you.
Humour me for a moment. Take a moment to imagine your “happy place”—the place you feel most at home. Where are you? What are you doing? Who is there with you?
What are the sights, sounds, smells, tastes, and sensations that fill the air and tickle your skin? What are the internal bodily sensations you notice when you find yourself here, in this place? What emotions do you feel?
I’ll venture some guesses: you feel calm, at peace, safe, energized, connected, and integrated. If you turn your attention to your breathing you probably notice that it’s slow, deep, restorative. That head cloud of frenzied thoughts and worries that you tend to spend your time in might have cleared. Your sense of “self” has probably moved out of your head and into your body.
Maybe, through doing this short exercise, you’ve come home to yourself, even just a little.
1) Understand what “self-care” means.
A friend recently shared a Collegehumor video with me depicting three women in a nail salon, bragging about what horrible things they’ve done, from eating 13 glazed donuts in a single sitting, to “enslaving the entire office”, in the name of their own self-care. Because, according to the video, “You can be terrible if you call it ‘Self-care’”.
Humorous? Perhaps. An accurate depiction of self-care? Well, no.
I asked followers of my Facebook page to tell me what the phrase “Self-Care” means to them. They enthusiastically replied:
“Silence. No social media, or anything electronic.”
“Floating in water—buoyant, effortless.”
“Being kind and gentle to myself.”
“Meditation and time to oneself.”
“Eating healthy foods.”
“Respecting your body.”
“Epsom salt baths.”
“Peace.”
“Rest.”
“Hygge.” (a Danish word that is roughly translated as “warm and cozy”)
“Yoga.”
“Commitment.”
“Masturbation.” (There’s one in every crowd.)
In essence, their responses boiled down to, “Self-care is feeling good, taking care of myself, and taking care of my body, by engaging in activities that feel nourishing while reducing external stress and overwhelm.”
Put even more simply, self-care is the act of practicing self-compassion, whatever that might look like to you.
2) Understand the impacts of stress.
The relationship between self-care and stress is important. According to The American Institute of Stress, about 75% of us have significant physical and psychological stress in our lives.
This stress takes a toll; it produces physical, mental and emotional symptoms, sending us into emergency rooms with panic attacks, and drugstores with prescriptions for pain, anxiety, or anti-hypertensive medications.
Stress lands us in doctor’s offices, pouring over junky magazines waiting to discuss our latest health complaint—digestive issues, mental health issues, fatigue, autoimmune disease, metabolic syndrome, chronic pain, weight gain, and so on.
Our bodies have a built-in stress response to save our lives when triggered by a life-threatening danger. Now, this fight-flight-freeze mechanism is chronically set off by the abundant stressors in our modern era—traffic, deadlines, relationship woes, artificial lighting, and in-laws.
When our body encounters a stressor, one of the hormones it releases is cortisol.
Cortisol affects every system in the body; it elevates blood sugar, heart rate, and blood pressure. It suppresses the immune system, redistributes fat, shrinks certain areas of our brain involved in learning and emotional regulation, causes painful muscle contraction, impairs digestion, and affects our sleep.
Managing stress involves two main goals: lowering external stressors, and managing internal perceived stress by boosting our physical, mental, and emotional resilience. Self-care is our armour against the internal and external stress we put up with daily.
3) Make a list of your nourishing and depleting daily activities.
Let’s try an exercise from Mindfulness-Based Cognitive Therapy. Write down a list of routine activities in your typical day: hauling yourself out of bed, brushing your teeth, eating breakfast, sitting in traffic, working, exercising, making dinner, and so on.
Decide if each activity is nourishing, depleting, or neutral. In other words, does this activity fill your cup or drain it?
For instance, I find that breakfast is nourishing, but less so when I scroll through Facebook feeds or answer emails while eating it. Coffee immediately feels nourishing to me but, hours later, caffeine-fuelled and wired, I often feel more depleted than if I had opted for an herbal tea, or hydrating water instead.
4) Find out what brings you pleasure or mastery.
To get a deeper understanding of your day, determine if the activities that nourish you provide you with pleasure, mastery, or both.
Pleasurable activities feel good in our bodies, and minds when we do them. They bring us positive emotions like safety, calm, peace, happiness, joy, excitement, gratitude, and awe. Sleeping, eating, laughing with friends, cuddling with my dog, and consuming art, are all activities that give me pleasure.
Activities of mastery give us a sense of accomplishment and achievement. We feel that we are developing ourselves and moving closer towards an important goal. When we engage in activities that give us a sense of mastery, we experience our lives to be rich in meaning. Checking things off a to-do list gives me a sense of accomplishment. So does making strides at work, and taking a course, or studying.
5) Make some changes to your list.
Oftentimes, patients recoil in horror when they realize that their lists contain only depleting and neutral activities. There are no activities in their day that nourish them: either through pleasure or self-development. I ask them:
Are there any depleting activities that you can stop doing?
Are there more nourishing activities that you can start doing?
How can you make a depleting activity feel more nourishing?
Self-care and self-compassion are the agents through which we answer these questions.
6) Set healthy boundaries.
Before we can reduce the invasion of depleting activities in our lives, we must learn to prioritize our needs. Many of us put others’ needs first. We ignore the advice of every flight attendant—we put on everyone else’s oxygen mask before our own. Before long, we run out of air.
In order to nourish ourselves, we need to learn to create healthy boundaries around our energy and time; we need to say “no.” Author Cheryl Strayed writes, “No is golden. No is the kind of power the good witch wields… [It involves] making an informed decision about an important event in your life in which you put yourself and your needs and your desires front and centre.” When we say no to the people, activities, commitments, and responsibilities that drain us, we say “yes” to ourselves.
Think of your list of depleting, nourishing and neutral activities. What activities, if you could just say “no” to them, would bring you immense relief? What would saying no to those activities allow you to say yes to instead?
7) Recognize perceived stress.
Whether or not external events elicit a stress response in our body depends on our perception. Stressful events are woven into how harmful and uncontrollable we perceive them to be, rather than their intrinsic capacity to cause us harm.
Our perception of stress can be influenced by biochemical factors, such as our levels of neurotransmitters, and hormones. It can also be influenced by our mindset, our capacity for resilience, and how far into burnout we’ve begun to drift.
Lowering our perception of stress requires that we practice the skill of mindfulness: being aware of how external situations affect our thoughts, emotions, body sensations, and behaviours. It also requires that we pay attention to our internal physiology: our hormones and circadian rhythms, and inflammation levels, to support our body’s physical capacity to deal with stress.
8) Practice Mindfulness.
A tarot reader friend of mine once said, “It is impossible to be healthy in this day and age without mindfulness.” She was probably right.
Mindfulness helps us lower our perception of stress. It is the act of bringing attention to the present moment, intentionally, without judgement. Through mindfulness we can be intentional about our behaviours: how often we exercise and what it feels like, what certain foods feel like in our bodies, and what activities we engage in.
Mindfulness also allow us to parse out our overwhelmed, worried, personalizing, catastrophizing, black-and-white, future-telling, and negative, thoughts from our body sensations and emotions. We realize that our thoughts are just that—thoughts. Thinking something doesn’t necessarily make it so.
Research shows that mindful meditation strengthens the connections between the rational brain and the emotional brain. It helps us develop awareness of our moment to moment experience. It connects us to our bodies and our emotional states.
There are many different mindfulness techniques. You can do sitting meditations, standing meditations, and walking meditations. You can do mindful yoga. You can wash the dishes mindfully.
However, the simplest way to begin a mindful practice is to sit or lie down in a comfortable position, with an relaxed and alert posture, and focus on the experience of breathing.
Focussing on the breath helps us practice bringing our awareness to the present moment. As we learn to ride the waves of our breathing, we eventually learn to ride the waves of stress that sometimes lap gently at our floating bodies, and other times rock us to our core.
With mindfulness we can begin to relax our resistance to the waves. As Jon Kabat Zinn says, “You can’t stop the waves, but you can learn to surf.” Mindfulness is the surfboard that carries you.
9) Practice self-soothing.
Self-soothing helps us regulate our emotions in the presence of external stressors. Dialectical Behaviour Therapy teaches self-soothing as a means of returning to the “Window of Tolerance”.
When we’re in the Window of Tolerance we’re not in fight, flight or freeze. We aren’t depleted, disconnected and dissociated. We feel relaxed and safe, but also alert and focussed. We are present, in control of our bodies. Self-soothing allows us to enter the window of tolerance by boosting the hormone oxytocin, which helps us feel calm, nurtured, and connected.
To boost oxytocin:
Lie or sit in a comfortable position, place your hands on your chest and breathe slowly and deeply.
Connect deeply with a trusted other: a person in your life, a pet, or an entity (God, your higher self, a deceased loved one, etc.).
Use body weights or heavy blankets on your body.
Recite believable affirmations of self-love.
Ask someone you trust for a hug.
Boost pleasure through engaging the senses: listen to soothing music, savour delicious food, look at beautiful images, touch soft fabrics, and use aromatherapy and calming essential oils, like lavender.
Poet Mary Oliver tells us, “You do not have to be good… You only have to let the soft animal of your body love what it loves.”
Self-soothing requires practicing mindful awareness to recognize if you’re slipping outside your Window of Tolerance. It also involves implementing nourishing rituals that “the soft animal of your body” loves, to release oxytocin, and return to feelings of calm.
10) Balance blood sugar to balance your mood.
Our blood sugar is complexly intertwined with our other hormones, like insulin and cortisol, but also our neurotransmitters, like serotonin, epinephrine and dopamine, which influence our mood.
More than 1 in 3 American adults has pre-diabetes. This indicates an impairment in our body’s ability to control blood sugar, which throws mood and hormones off balance.
One of the main life-saving actions of the body’s stress response is to regulate glucose in the blood. Fluctuations in blood sugar can trigger cortisol and stress hormone release. Stressful events can also wreak havoc on our body’s ability to control blood sugar. Regulating blood sugar, therefore becomes a priority for managing our body’s internal stress cues.
To balance blood sugar:
Eat a full 20 to 30 g serving of protein and healthy fat at each meal.
Eat a large, protein-rich breakfast that contains at least 200 calories’ worth of healthy fats: 1 avocado, a handful of nuts or seeds, coconut oil, full fat yogurt or kefir, 3 eggs, etc., within an hour of waking.
Eat snacks that contain 10-15 g of protein. A great snack for balancing blood sugar is a 1/4 cup of pepitas, or raw pumpkin seeds. Rich in protein, fibre and healthy fats, they also contain zinc and magnesium, two important minerals for balancing mood and supporting stress hormones.
Ensure that every meal contains gut-loving fibre: eat 2-3 cups of vegetables at every meal.
Avoid refined sugars and flours wherever possible.
Experiment with Time-Restricted Feeding, leaving at least 12 hours of the day open where you consume only water and herbal teas, to give the digestive system a rest. For example, if you have breakfast at 7am, finish your dinner by 7pm, to allow 12 hours of fasting every night.
11) Calm your stress response through healing your circadian rhythms.
The body’s stress response is tightly connected to our circadian rhythms. Cortisol, the stress hormone, follows a predictable daily pattern, rising within an hour of waking in the morning, and then falling throughout the day. Low cortisol levels at night coincide with the rise in melatonin, our sleep hormone.
Morning fatigue, afternoon crashes, and waking at night, all point to a flattened or altered stress response that has negatively impacted our body’s circadian rhythms. Sleep is also the greatest reset for the stress response. We build up our metabolic reserve and internal stress resilience every night when we rest.
To heal your circadian rhythms:
Expose yourself to bright, natural daylight soon after waking.
Eat a large, fat and protein-rich breakfast within an hour of waking.
Avoid exercising too close to bedtime.
Keep blood sugar stable.
Practice sleep hygiene: keep your bedroom dark and cool, and reserve your bed for sleep and sex.
Avoid blue light after 7 to 8 pm. Wear blue light-blocking glasses, use a blue light-blocking app on your devices, such as F.Lux, or simply avoid all electronics in the evening, switching to paper instead.
Try to get to bed before midnight, as the deepest sleep occurs around 2 am.
Talk to your naturopathic doctor or natural healthcare professional about melatonin supplementation or other natural remedies to help reset your sleep cycle.
12) Manage Inflammation and nurture your microbiome.
Cortisol, the stress hormone, is an important anti-inflammatory. High levels of inflammation have been associated with mental health conditions like depression and anxiety.
Keeping inflammation levels low not only reduces our need for stress-hormone-signalling, but keeps us healthy. Most chronic conditions, like cardiovascular disease and diabetes, are associated with inflammation.
To keep inflammation levels low:
Eat a variety of anti-inflammatory colourful fruits and vegetables.
Avoid processed oils like soy and corn oil, whose omega 6 fatty acids are known to contribute to inflammation.
Eat healthy fats from avocados, fish, coconut, olives, nuts, seeds and grass-fed animals.
Avoid processed foods and fried foods wherever possible.
Nurture your gut health by eating lots of fibre, and consuming fermented foods, like kefir and sauerkraut.
Our gut is the seat of the immune system. Keeping it healthy is a powerful preventive measure for keeping inflammation levels low. Our gut bacteria also play a role in our mood and stress-hormone regulation. Therefore, keeping them healthy and happy is essential for boosting our internal resilience against external stressors.
13) Recognize that balance doesn’t exist.
None of us are born cool and collected. Those of us who seem to “have it together” are simply quick to respond to life’s tendency to fall apart. Balance doesn’t exist; as soon as we feel like we have the details our lives lined up, a sharp gust of wind sends them tumbling in all directions. Therefore prioritizing self-care becomes an ever-evolving balancing act that we must commit ourselves to through nurturing our internal resilience.
A poem by Kelly Diels says it best, “when your love knocks you down or your weak ankles trip you up, stop worrying about balancing—‘cuz you’re not — and bounce.”
I review my adventurous year of living on the Low Carb High Fat Ketogenic Diet.
For breakfast, I would typically eat a high-fat smoothie containing coconut milk yogurt, gelatin, and avocado, and topped with pumpkin seeds and cacao. Sometimes I’d make fat bombs or homemade unsweetened chocolate.
After a year of doing the Ketogenic diet, and then a few months of returning to a moderate-carb paleo diet, I tested my cholesterol levels and inflammatory markers. My HDL cholesterol (the “good” cholesterol, to put it very simply) was high, my triglycerides (a risk factor for heart disease) were very low, and my LDL cholesterol (the “bad” cholesterol that statin drugs target) was also low. My inflammatory markers: C-Reactive Protein (CRP) and erythrocyte sedimentation rate (ESR), were also low.
