My Amygdala and Prefrontal Cortex Discuss a Centipede Trapped in the Bathtub

Prefrontal Cortex: …Right, so the deadline for the article is Monday. I can work on it tomorrow morning, but then I also need to schedule time for grocery shopping—what am I going to make for the week to eat? There’s a giant load of laundry in the bin too, which I should get to, maybe I can squeeze that in while I’m writing. Laundry is such an involved process sometimes… I also have that doctor’s appointment on Thursday, then I there’s that package I have to pick up at the post office, and I have to mail out my passport for—oh, right, we needed the bathroom—

Amygdala: Good God, NO!!!! OH IT’s THE END OF TIMES! THERE’S A THING there! A crawly, thing, so many legs, evil legs. We’re going to die!!!!!

PFC: It’s a centipede. Trapped in the bathtub.

A: What’s a centipede?! It looks like an alien. Those legs will crawl up our legs, into our mouths, eyes, under our skin—

PFC: Centipede’s don’t do crawl under your skin. I believe that’s…uh, scabies? Centipedes are relatively harmless. Besides, this one is extra harmless; it’s trapped in the tub. Look, see how he’s struggling to get out? He can’t. Poor guy… It reminds me of a time when I felt helpless…

A: It needs to die, we need to kill it, we can’t go on like this!!!

PFC: What, with a centipede in the tub?

A: It’s LEGS. They’re hideous, it crawls, it’s fast. Oh, God, I hate it. We need to call someone.

PFC: We can’t call someone. We’re a strong, independent 30-something woman. We’ve handled massive spiders as big as our heads in the Amazon, giant Caribbean cockroaches in our granola—

A: LOOK AT IT. It keeps moving… Oh god, I hate it.

PFC: It keeps moving because it’s trying to get out of the tub.

A: AND CRAWL ON OUR FACE. LOOK AT IT’S BILLIONS OF DISGUSTING LEGS!

PFC: Why discriminate against something that has many legs? Hindu gods have an extra set of arms and they’re divine. Remember all the times we wished we had another set of arms so we could hold grocery bags while looking for our keys and texting?

A: THAT’S DIFFERENT THIS… MONSTER—

PFC: —centipede.

A: CENTIPEDE… can’t text. It has nefarious plans for us once it gets out of its white, porcelain prison. WHAT ARE WE GOING TO DO?

PFC: Well, we could just leave it there… he doesn’t seem happy in the tub, though…

A: WE’LL NEVER BE ABLE TO BATHE AGAIN! WHAT IF IT CRAWLS OUT?

PFC: It can’t crawl out. Ok, you’re right, we can’t leave it there. The noble thing to do would be to scoop him out and put him in the garden.

A: NOOONONNONONNONONO GOD NO WE’RE NOT TOUCHING IT!

PFC: Why? It’s small, harmless. It’s trapped. We could use a water glass and a card, or book…

A: NO, NOT THE BOOKS, WE DON’T PLAY CARDS WE’RE NOT TOUCHING IT.

PFC: We could… kill. it.

A: OK OK OK!!! HOW?! How?

PFC: Well, we could squish it? Flush him down the drain? I feel like that goes against our moral principles. And, I’d also have to conclude that, quite frankly, it would be an act of cowardice, the ethically inept thing to do—

A: —which option requires the least amount of touching it and squishiness?!

PFC: Flushing. But it will also result in a slow, agonizing death for the poor creature, who we have decided to persecute for simply being in our tub, and for possessing many legs. I’m not sure of the extent to which a centipede feels pain and suffers, though. I mean, does it suffer like we do? Suffering, after all, is often in the stories we tell ourselves about our expectations and identities, our beliefs about what should be and what we deserve, rather than what is. I don’t know if centipedes have identities or expectations but, if we flush him, he’ll struggle, which means he is resisting what is, which is suffering. Causing suffering to another being is wrong. We can also clearly observe that he prefers to stay alive—

A: SHUT UP AND DO IT! FLUSH HIM!

PFC: It would be wrong. We’d feel bad about it. I would, you would. Let’s put him in the garden, please?

A: NO NO NO FLUSH PLEASE.

PFC: Let’s just leave him, pretend he’s not there and come back later.

A: What if he gets out? Crawls on our face while we’re sleeping?

PFC: I don’t think that’s likely. I think he’s trapped in there.

A: He’s going to die eventually let’s kill him, get rid of him!

PFC: Eventually, like you mean at the end of his lifespan? That’s true. I’m not sure how long centipedes live… It’s also cold outside, I don’t think putting him in the garden would do any good. He obviously came in to escape the cold. We’re seeing more centipedes inside now as the weather changes.

A: OH STOP REASONING and just do it!

PFC: …. ok.

….

PFC: Amygdala, it’s done. It was horrible, we’re horrible brain areas. Are you happy? You don’t have to worry about it anymore. I also made sure I let plenty of water flush down the drain so he can’t crawl back up, even though highly unlikely, I knew you might have something to say about that… Amygdala?

A: …

PFC: Amygdala? You’ve… gone quiet.

A: So how are you going to get your article written, laundry done, groceries bought AND cook something for the week? You also made plans with your friend this weekend and you need to shower in the centipede-infested bathroom, and CLEAN the bathroom, it’s filthy. You’ll never get it done… Fear, dread, overwhelm! IT’S THE END OF TIMES!

And so on.

 

The Naturopathic Guide to Snacking: 12 Blood-Sugar Balancing Snack Ideas

The Naturopathic Guide to Snacking: 12 Blood-Sugar Balancing Snack Ideas

When helping someone improve their daily nutrition, it helps to start with one meal at a time.

With my patients, I first tackle breakfast, the most important meal of the day for glucose control, which has major implications in mood and hormone regulation for the rest of the day.

Once that’s covered, we go after The Afternoon Snack.

You know the one I mean: it’s after lunch. You’re at the office. The clock is moving backwards. Your brain is barely functional.

You’re hungry… or are you? You’re tired. Kind of. Not physically tired, but…huh? What were we talking about just now?

Right, tired. Mentally tired. Brain in fog. Can’t think. Can’t concentrate.

Need sugar.

Someone is bringing around a tray of muffins.

There are Halloween candies in your desk—what month is it again? It was from last Halloween, right? Or the one before that?

How long is the Tim Horton’s line?

You think about making it through the last two hours of the work day, consider slogging over to the gym, feel a sinking feeling somewhere in your empty abdomen at the thought of your evening commute.

You wonder what the hey is going to end up on the table for dinner.

Take out, probably.

So, yes; once breakfast is sorted, this is the time of day I go after next.

Generally, I try not to recommend snacking. 

Ideally our blood sugar is so on point that we have 3 big meals a day (or 2 for some people, maybe 4 for others), spaced out by about 5 to 6 hours, and then a nice, long nightly fast of about anywhere from 12 to 15 hours, or longer, depending on your body, goals, and so on.

That being said, there are few reasons some of us might need to snack: 

  • Your blood sugar is off the rails and, while you have the goal of getting into a more stable 2 to 3 meals-a-day kind of routine, you need something to tide you over in the meantime while you heal.
  • Your adrenal glands are off the rails and, while you have the goal of sleeping soundly, and getting your cortisol up and moving at the right times (with the right breakfast), you need something to help keep things balanced in the meantime while you heal.
  • You’re sorting out your insulin and leptin, or other hormones involved in satiation.
  • You have a medication you need to take at this time that must be taken with food.
  • Your healing goals involve listening to your hunger signals. You are healing from emotional eating and learning to trust your body, which means that your meal times might not be predictable.
  • You don’t have time for a big lunch, or your lunchtime is too early for you to be hungry enough to eat a big meal (teacher’s often have this problem).
  • Your schedule fluctuates.
  • You’re swamped with the kind of work where all you can do is shove something portable into your mouth during an 8-hour shift or else you’ll pass out.
  • You have a hard workout right after work.
  • Your digestion doesn’t allow you to eat 2 to 3 big meals a day.
  • You’ve tried eating 2 to 3 big meals a day and, even though your hormones are seriously sorted, you find it just doesn’t work for you and your body.
  • You have dinner late: your partner gets home late and you want to share a meal with him/her, or you take a hip hop cardio, abstract drawing, or throat singing class at night, and then try to get some food into you afterwards.
  • You snack at night and are working on healing that pattern by trying to eat more during the day. Snacking helps with this.
  • You are on insulin or drugs for diabetes and need to eat whenever your blood sugar drops.
  • And so on.

When patients ask me what they should have for snacks, I enthusiastically exclaim, “a quarter cup of pumpkin seeds!”

My enthusiasm is rarely returned, even after I excitedly spell out the health benefits.

Sometimes, I think, people just want to be told which carrot muffin is the healthiest or which birthday-cake flavoured protein bar I recommend. However, while snacks can certainly be fun, I look at food primarily as fuel, especially if we’re going to heal our mood, stress signals, and hormones.

If your snack goals involve looking for an excuse to eat chocolate fudge snack protein bars with 1 g of sugar per serving (oh, just have an actual chocolate bar and get on with it!), then snacking might not be right for you.

Snacking is not:

  • An excuse for emotional eating: “Ugh, the boss is a dick—time for a scone!”
  • A response to riding the blood sugar rollercoaster: if you need a snack to stay stable we have some deeper healing to get into.
  • A response to not setting up good sugar control (i.e.: not liking breakfast, not feeling like eating what you brought for lunch, not feeling full from your protein-sparse lunch, etc. See above).
  • A reward for getting through the work day. “It’s 2 o’clock… I guess I can head over to the muffin tray now—I’ve earned it!”
  • An excuse for a break. If you’re not hungry, take a walk instead.
  • An excuse to eat something “not awesome” for you, unless it’s a once-in-a-while treat you’re really savouring.

So, that being said, what makes a good snack?

The anatomy of a good snack is as follows: 

  1. It consists of about 100-400 calories, depending on your goals for the snack (Workout fuel or brain fuel? How long does this snack need to last you? What is your body doing with the energy?), your energy requirements, your health goals, your health status. Most people’s snacks are around 250 calories.
  2. Snacks should contain protein to keep blood sugar steady (aim for about 10-20 g of protein, depending on the size of the snack).
  3. Snacks should contain healthy fats.
  4. Snacks should be nutrient-dense, containing essential vitamins and minerals that your body needs to keep its enzymes and chemical reactions and hormones buzzing.
  5. Most of all, however, snacks should feel good in your body, which means: you aren’t sensitive to them, they don’t suck more energy from you hours later, and they help balance your blood sugar. How do you know that this is what’s happening in your body? You feel good, strong and clear-headed after your snack. You don’t feel the need to snack at night, and you feel insatiable cravings diminish.

Here are some of my favourite snacks:

 

  1. Pumpkin seeds. A great snack is just this: 1/4 cup of pumpkin seeds, or pepitas, the green kind. These little babies have about 23g of protein per serving, zinc, magnesium, healthy fats, and tons of fibre. A great, low-carb, satiating snack.
  2. Macadamia nuts: 10-20 macadamia nuts are delicious nuts consisting of the “good” fats, heart-healthy, anti-inflammatory monounsaturated fatty acids, or MUFAs, also found in olives and avocados that help lower LDL cholesterol and raise HDL.
  3. Mini frittatas: I love these for breakfast too.
  4. Date balls: Which can be combined with any form of dates/nut butters/chocolate/coconut/seeds and nuts. Just go easy on the dates. Teachers and those who work in nut-free environments can experiment with tahini, pumpkin seed, and sunflower seed butters.
  5. Fat bombs: Using a combination of coconut oil, avocado, cocoa butter and stevia, blend ingredients and then freeze in muffin tins. Add some protein powder, nuts and/or seeds to them to round out the macronutrients.
  6. Hummus and veggies: Make your own hummus to avoid the canola, corn and soy oil that is often snuck into store-bought versions. I love this fuchsia beet hummus recipe.
  7. Smoothies: Always a great go-to. Remember: the perfect smoothie combines a) a leafy green b) a scoop of protein powder c) a healthy fat, like coconut oil or avocado, and d) something for sweetness like berries, a banana, or stevia.
  8. Yogurt parfait: I often mix some coconut milk yogurt, pumpkin seeds, cacao nibs, a few drops of liquid stevia, and gelatin together for breakfast. It also makes a yummy snack.
  9. Chocolate avocado pudding: One of my go-tos for snacking. Mash one avocado with 2 tbs cocoa powder. Add in some protein powder and liquid stevia drops.
  10. Homemade Jello: Get your collagen a-building. You can take any liquid, creamy or clear, warm it up in a saucepan until steaming, add gelatin (1 tbs per cup of liquid), and let it cool down to room temperature, then cool further in the fridge overnight. Try putting it into gummy bear molds, or experimenting with gelling up golden milk, or teas. The possibilities are endless if you’re a jello fan.
  11. Sardines: The kind in the can soaked in olive oil, or water (avoid the canola oil or soya oil versions, please). Your brain will love the omega 3 fatty acid hit.
  12. Leftovers! I often tell my patients to bring a big meal with them to work: a salad with protein and avocado, or a cabbage “rice” pad thai with chicken thighs, or a paleo chilli with kale and spinach packed into it and curry spices. Eat one half for your early lunch and the other half at 3pm.

What about a piece of fruit?

Fruit on its own, while a portable snack, is often a disaster for blood-sugar regulation. To keep it more satiating, add some nut butter to it, or throw it into a yogurt parfait or smoothie. Alternatively, add some dried fruit to your pumpkin seed, macadamia and almond trail mix for sweetness.

Remember: the goal of snacking is to balance blood sugar. 

Through good blood sugar balance, we have better stress hormone responses, healthier weights, better hormone balance, clearer focus, and brighter mental health.

Happy snacking!

What’s your favourite protein and fat-rich snack? 

 

Can I Support My Mental and Hormonal Health as a Vegan?

Can I Support My Mental and Hormonal Health as a Vegan?

“Dear Dr. Talia,

I have been a vegan for 6 years. I also suffer from mental health conditions and possible hormonal imbalances. After doing some research on diets for anxiety and depression, I found that most of them include meat and animal products. I’m wondering: can my vegan diet be harming my mental health? I am primarily a vegan for ethical reasons and would hate to have to harm animals unless you think it’s absolutely necessary for promoting my mental health and wellness.”

 

Nutrition, especially where it pertains to more emotionally-charged topics like human health, the environment, or animal welfare, is surprisingly controversial.

I know that broaching this subject is a little bit like walking into a lion’s den (lions, for the record, are not vegans), therefore let me preface this conversation with a few disclaimers. 

In writing about veganism and mental health, I’m not looking to get into a debate. I am writing to provide information for those who are wondering if it is possible to heal mental health and hormonal conditions, including women’s health conditions, thyroid conditions and adrenal conditions, while following an entirely plant-based diet.

If you feel that you might be triggered by this information and are not willing to approach this essay with an open mind, then this article is not for you.

Let me point out that I fully understand and sympathize with the ethical arguments for veganism. In my 20’s I was vegetarian for five years. For one of those years I was a vegan. Contrary to what some die-hard vegan fans have suggested, I did follow the diet “right” by eating whole foods, balancing the macronutrients of my meals (as best I could), and striving to eat enough. I eventually had to stop, but it was not because I “missed meat”.

While following a vegetarian diet, I took comfort in the fact that no animal had to die for me to survive. I loved the taste of plant-based foods and the ease of preparing them. I was satisfied in knowing that my diet was having a minimal impact on the environment. 

(I also enjoyed bathing in the feelings of moral superiority that this diet earned me. However, that’s besides the point.)

Around that time, I read The Ethics of What We Eat by Peter Singer, which remains the single most thought-provoking book on human nutrition that I have read to this day (and I have read mountains of books on human nutrition).

In no way do I advocate for factory farming practices. I urge omnivores to consume the most ethically sourced meat, fish, eggs, and dairy that they can afford. Not only is sustainable animal farming better for animal welfare and for the environment, it is better for human health.

I don’t push for any single one-size-fits-all diet. I believe that an individual determines his or her “perfect” diet through experience. I carefully approach conversations about diet with my patients to avoid shaming their eating habits and pressuring them into a diet that they feel uncomfortable with.

That being said, it is my duty as a doctor to provide my patients with all the information they need to make empowered choices by drawing on the 15 years I have spent studying nutrition through formal education, and personal and clinical experience.

While it may certainly be possible to survive and, perhaps even thrive (depending on your genetics, most likely), on a vegan or vegetarian diet, there are major limitations to this diet that we need to face if we’re committed to supporting optimal mental and hormonal health.

The intention of this essay is to outline some of these limitations. 

Protein quality and quantity: 

Protein makes up 16% of the human body (62% is water). It is required for body structure: our bones, muscles, connective tissues, skin and hair.

Amino acids, which make up protein, comprise the hormones and neurotransmitters that regulate our mood and gene signalling.

Tryptophan, an amino acid, is used to make serotonin and melatonin, hormones that enable use to regulate our feelings of well-being and circadian rhythms, respectively. Cysteine is used to make glutathione, the main antioxidant of the body that neutralizes cancer-causing free radicals, prevents damage to our DNA, and protects us from the incessant chemical onslaught of our increasingly toxic lives. Glycine and GABA calm the nervous system, prevent over-activation of our brains’ fear centres, and soothe anxiety. Glutamine stimulates the nervous system and fuels our gut and kidney cells, allowing us to absorb the nutrients from our food and filter waste from our bodies. 

The human body is essentially a protein sac filled with water that hums with the metabolic activity orchestrated by tens of thousands of enzymes, which are also protein. 

When it comes to dietary proteins, not all are created equal. Foods that claim the title “complete proteins” boast all 9 essential amino acids that are not synthesized by the body and must be obtained exclusively from diet. Many vegetarian sources of protein are not complete proteins, and therefore protein-combining must be practiced to avoid deficiency in specific amino acids

Proteins also differ in their absorbability. Some vegan foods rich in protein contain anti-nutrients or fibres that make them difficult to digest. For example, the protein digestibility of whey (from dairy) or egg is 100%, meaning that 100% of the protein from these foods is absorbed. In contrast, only 75% of the protein in black beans is absorbed. Even more dismally, those who hope to get a significant source of their protein from the peanut butter on their morning toast are only absorbing about 52% of it.

The Recommended Daily Allowance (RDA) for protein is 0.8 g per kg of body weight for the average person. However, when it comes to supporting optimal health, the RDAs of important nutrients are set notoriously low. In my opinion, even higher nutrients are required for those with chronic health conditions such as mental health issues, chronic stress, hormonal imbalances, obesity, diabetes, cardiovascular disease, cancer, and autoimmune disease, to name a few.

For my patients I tend to recommend between 1.0 to 1.2 g of protein per kg of body weight per day. For those who are particularly active, who need to lose weight, and who are obtaining their protein from lower-absorbable sources, I may even recommend higher amounts. For women with conditions like PCOS, depression, and anxiety, I often recommend at least 30 g of protein per meal, especially at breakfast, to balance blood sugar, fuel neurotransmitter synthesis, sustain energy throughout the day, and promote optimal adrenal function. I believe the RDA for protein to prevent muscle wasting is set far too low. This is especially true if the protein sources are difficult to digest and of lower quality.

But what about claims that high protein diets can be detrimental to our kidney health? A one-year crossover study showed that active men who consumed very high amounts of protein—over 3 g of protein per kg of body weight—suffered no ill effects.

Getting adequate protein is difficult on a vegan diet but not impossible. Tracking your macronutrients and considering supplementing with a high-quality protein powder, may be required.

Understanding exactly how much protein your diet delivers is essential. For instance, while quinoa is a complete protein, containing all 9 essential amino acids, it only contains 8 g of protein per cup. One cup of black beans contains 39 g of protein but only 29 g are absorbed.

Furthermore, for conditions like PCOS that require managing carbohydrate intake, getting the protein without the additional carbs can be a challenge. Legumes typically contain a 3:1 ratio of carbs to protein—one cup of black beans contains 116 g of carbohydrates. This is often too high for the many women suffering from the mental health and hormonal issues that I treat in my practice, who often feel best when keeping their dietary carbohydrate intake well under 150 g a day.

Autoimmunity: 

Chronic inflammation runs rampant in the bodies of many of my patients. More research is coming out showing that inflammation is at the root of most chronic health complaints, such as mental health conditions like depression and bipolar disorder, and hormonal conditions like PCOS and endometriosis. Cardiovascular disease and diabetes are recently thought to begin as autoimmune diseases, spurred on by chronic inflammation.

To manage conditions of autoimmunity and chronic inflammation, it is often appropriate to follow an “anti-inflammatory” diet that is low in allergenic potential.

For patients with hormonal issues, autoimmunity, gut issues, and mental health conditions (which research shows are inflammatory conditions are their root), reducing the diet down to leafy green vegetables, chicken, beef and fish can aid in lowering inflammation, healing the gut and restoring immune function. After a time, foods are slowly reintroduced, to find out what the body can tolerate.

Grains and legumes contain anti-nutrients like lectins and phytates that protect plants from being ingested and destroyed. Along with other common allergenic foods like dairy and eggs, grains and legumes, with their anti-nutrient content, have a high potential for irritating the digestive tract, causing gastrointestinal inflammation and immune system activation, leading to chronic inflammation that permeates the entire body.

The higher protein content in legumes like peas, black beans, lentils, and soy, and grains like wheat and corn, makes these foods staples in plant-based diets. Therefore, even attempting an anti-inflammatory elimination diet as a vegan is virtually impossible. Vegetarian diets are hardly better, as vegetarians often rely on dairy and eggs to balance their diet, both of which are common food sensitivities that can trigger autoimmunity and inflammation.

Vegan studies:

Doesn’t following a plant-based diet confer amazing health benefits, though?

While many studies of vegan and vegetarian diets show benefit for improving markers of various metabolic conditions, like diabetes and cardiovascular disease, it is important to keep in mind that most of these publications are comparing a diet rich in whole grains, vegetables, fruit, nuts and seeds with the Standard American Diet, with its grain-fed, hormone-pumped animal byproducts deep-fried in rancid corn oil.

To better paint the picture, coffee is the number one source of dietary antioxidants in the United States, revealing that virtually no one in North America is eating fresh fruits and vegetables. 

Therefore, it makes sense that adding a few servings of micronutrient-containing fruits and vegetables to your daily nutritional intake will radically alter your health status. When I first began my foray into the world of plant-based living I felt amazing too. After a few months, though, the health benefits slowly faltered and I started to suffer negative health consequences: weight gain, fatigue, depression, hypothyroidism, IBS, and various nutrient deficiencies. 

My health improved when I added some animal products to my vegetarian diet and removed dairy, grains and legumes. However, my experience is a mere anecdote.

To my knowledge there hasn’t been a study comparing a whole foods-based diet that includes ethically-sourced animal products with a whole foods vegan diet. I would be very interested in seeing such a study if it is ever conducted. 

Individual variability:

Rich Roll, a vegan super-athlete, is often dredged up as an example of how the human body can thrive on a plant-based diet. However, more than his diet, Rich’s individual genetics may have more to do with his success as an athlete (and his training, clearly).

Even after 8 years of returning to omnivorous living with occasional iron and desiccated liver supplementation, my ferritin level (a measure of iron status) still only hovers around 44 (80 is considered optimal). 

My constitution is that of Parasympathetic Dominance. This means I look at a piece of toast and gain 10 lbs. I tend to suffer from congestive lymphatic conditions and a sluggish metabolism. I tend to have low energy unless I constantly stoke my metabolic furnace. When stressed, I tend to gain weight and slip into lethargic depression. If not taking care of myself, I get headaches and suffer from hormonal imbalances.

Like other parasympathetic doms, I tend to have a higher requirement for dietary iron and crave red meat and leafy green vegetables. I seem to do better with a diet higher in protein and healthy fats.

Many of the  people I work with fit this profile as well. My patients are highly creative and intuitive, but also suffer from mental health and hormonal conditions and are very susceptible to stress. I find that most do better through moderating their carbohydrate intake, ensuring high micronutrient and healthy fat consumption, and eating more protein, particularly from some red meat.

New research into MTHFR genes reveals that certain diets may have more health benefits for certain individuals. About 40-60% of North Americans are unable to convert folic acid (a synthetic nutrient added to multivitamins and fortified grains) into methylfolate, which is used for a chemical process called “methylation”. 

Methylation pathways are involved in the fight-or-flight response; the production and recycling of glutathione (the body’s master antioxidant); the detoxification of hormones, chemicals and heavy metals through the liver; genetic expression and DNA repair; neurotransmitter synthesis; cellular energy production; the repair of cells damaged by free radicals; balancing inflammation through the immune response, controlling T-cell production, and fighting infections, to name a few.

Individuals with impaired MTHFR function often suffer from autoimmune conditions and mental health conditions, such as depression. They tend to feel better when avoiding grains that contain folic acid and eating green leafy vegetables that contain methylfolate. They require higher amounts of protein in their diet. They require higher levels of vitamin B12, which is also important for methylation, and choline, found in eggs and liver, which helps bypass methylfolate pathways, working as an alternative methyl donor. Choline is also necessary for estrogen metabolism. 

Nutrients Deficiencies:

You thought I would lead with this, didn’t you? I’ll bet you were wondering when this would come up: 

B12: 

Of course it’s no secret that the vegan diet is essentially devoid of vitamin B12, an important nutrient for detoxification, methylation, neurotransmitter synthesis and energy metabolism. Animal sources are the only sources of B12. Our gut bacteria can make B12, but how much is absorbed in the colon for the body’s use is not clear.

B12 deficiency is serious. A friend of a friend of mine (no, but really) suffered permanent neurological damage, leading to seizures and almost death, from B12 deficiency. The neurological damage caused by B12 deficiency is irreversible (I’ve had patients who experience some improvement with restoring B12 levels, but it can take some time and the progress is not always linear).

B12 deficiency can have serious neuropsychiatric symptoms that mimic severe bipolar disorder or schizophrenia and that resolve once B12 injections are given. Horrific case reports tell stories of B12-deficient patients treated with rounds of electric shocks for their “treatment-resistant” psychosis, before the true cause of their symptoms was uncovered. 

The blood reference range for B12 is roughly 130-500 pmol/L but I find that people don’t feel their best until their levels are over 600, and many experience severe B12 deficiency symptoms under 300. This means that if your doctor tells you that “your blood levels are normal,” your body could still be operating at a sub-optimal level of B12. 

For vegans, supplementing with a good, absorbable form of B12 is non-negotiable. B12 from vegetarian sources, such as dairy products, is damaged in the pasteurization process and therefore supplementation may still be required.

Other nutrients:

B12 aside, other nutrients that are commonly deficient in vegan diets are iron, zinc, iodine, EPA and DHA, choline, vitamin A and vitamin D, to name a few.

Zinc is essential for immune function, skin health, neurogenesis (making new brain cells), memory and cognition, gut integrity, neurotransmitter synthesis, and hormonal health, among other essential functions. 

Iodine is required for thyroid and ovarian function. It is also important for estrogen detoxification.

Iron is important for supplying tissues with oxygen, optimal thyroid function, and fertility. Menstruating women are commonly operating at a sub-optimal level of iron, resulting in fatigue, dry skin, chronic infections, and heavy periods.

Vitamin D regulates over 1000 different genes in the body. Supplementing with D3 is required for the 70-90% of North Americans who are deficient. Sadly, vitamin D3 supplements are all animal sourced, obtained from the lanolin in sheep’s wool. D2 from mushrooms is a vegan form of vitamin D that is likely not as effective as animal-derived D3.

Vegans are 75% more deficient than omnivores in vitamin D, which is alarming, considering how deficient most North Americans are—that’s 1000 vegan genes that aren’t being properly regulated! 

EPA and DHA, omega 3 fatty acids found in fish and algae, are essential for cell membranes and brain function. While DHA can be made from ALA, found in flax and walnuts, many of us are not effective at converting it. Even the best converters among us only synthesize about 18% of our ALA into DHA. Further, the conversion of ALA to DHA requires zinc and iron, two nutrients that are typically deficient in vegan diets. 

Vegans and vegetarians have lower levels of EPA and DHA than meat eaters.

Even for omnivorous patients with mental health conditions, supplementation of EPA is often required for therapeutic benefit. Vegan supplements of algae-derived EPA and DHA exist, however, many of the studies that show benefit for fish oil supplementation in depression, bipolar and OCD require that the EPA to DHA ratio be 3 to 1 or higher. This high EPA to DHA ratio is not available in algae-sourced supplements that I have seen, making it almost impossible to derive enough EPA from vegan sources. 

That being said, it is possible to supplement with iron bisglcyinate, iodine, zinc picolinate and vitamin A, inject methylcobalamin weekly, chug algae oil by the jugful, and drip vitamin D2 drops on your tongue and hope for the best.

You can pray to the methylation gods that your MTHFR enzymes are all operating at top speed so that your body doesn’t need to depend on protein and choline-dependent pathways for its liver function and DNA repair.

You can dump Vega protein powder into your smoothies and hope that you don’t have a sensitivity to grains and legumes (vegan protein powders usually contain some combo of rice, soy, and pea). You can obsessively track your macronutrients on My Fitness Pal. 

You might still be ok.

There are a few people, the Rich Rolls of the world, who will claim that they feel great on an entirely plant-based diet. They do all of the above-mentioned things and feel amazing and I’m happy to hear it! However, I wonder how these genetically gifted individuals would fare if following a nutritionally complete whole foods omnivorous diet that contains grass-fed chicken, fish, meat, gelatin, eggs and, perhaps, dairy, in addition to a variety of plant foods.

If just one important nutrient pathway that depends on iodine, zinc, vitamin D, iron, B12, EPA or DHA is working sub-optimally, if you’re suffering from a hormonal condition, a mental illness, an autoimmune disease, or a digestive issue, then it’s possible that, if you follow a vegan or vegetarian diet, you’ll never feel as well as you’re meant to. 

In the words of a vegan-turned-omnivore friend of mine, when disclosing why she decided to start eating meat again:

“I still love the environment and animals, of course, but I just love myself more.”

To watch the video:

Estrogen Balance and Mental Health: Depression, Anxiety and Stress

Estrogen Balance and Mental Health: Depression, Anxiety and Stress

Estrogen levels in the brain and body affect our brain’s levels of dopamine and norepinephrine, two neurotransmitters that are implicated in mood disorders like depression, psychosis and anxiety.

Our brain has several built-in recycling processes to keep us level-headed. When neurotransmitters (brain chemicals that have mood-regulating effects) are finished with their tasks, enzymes recycle them, breaking them down into their chemical parts to be reused again at a later date. This process controls the level of chemical nervous system stimulation in our brains and keeps our moods regulated.

You’re at home, late a night, working on an important assignment, driven by the excitement of the topic at hand. Your brain is flooded with dopamine, a brain chemical that is connected to positive mood and motivation, pleasure and reward; dopamine pathways are activated when we’re engaged in a task that is pleasurable and rewarding, when our lives are flooded with meaning and we’re working towards a goal. Dopamine, however can also be connected to psychosis, conditions like schizophrenia and bipolar disorder, and also be linked to impulsive behaviour, aggression and irritability, when over-expressed.

Typing happily, you near the end of your assignment. Suddenly, your computer screen goes dark. Your heart begins to race, your skin prickles and you’re overtaken by anxiety, panic and fear. Your body is releasing norepinephrine, a chemical connected to stress, anxiety and the “Fight or Flight” response, but that also allows us to feel alert and energized. Your heart pounds as your reboot your computer. You are hyperaware of the sounds and smells around you. Your skin prickles and your breathing is loud and rapid.

You exhale with relief as your computer screen lights up again, revealing that your assignment is unharmed. Stress drains out of your body, and your norepinephrine levels fall. You begin to tire; it’s time for bed. You add some finishing touches to your work, hit “save” and turn in for the night. The stress and motivation you felt only hours before dwindle, as the neurotransmitters responsible for these responses are swept out of your synaptic clefts and recycled.

When our brains have had enough stimulation of dopamine (mood, reward, pleasure, but also aggression, irritability, impulsivity and psychosis) and norepinephrine (stress and anxiety, “Fight or Flight”, but also alertness and energy), both get recycled through COMT, which pulls them out of circulation, breaks them down into their chemical parts, and reassembles them for later use.

We all have variability in how fast our COMT enzyme works, based on the expression of the COMT genes in our DNA. Some of us have slower COMT genes, meaning that our brain levels of dopamine and norepinephrine tend to be higher than other people’s, as our ability to clean up and recycle these hormones is slowed. This might result in an individual (depending on other genetic and lifestyle factors) who is at a higher risk of mental health conditions like psychosis or bipolar disorder, or someone who is more irritable, prone to aggression, or stress intolerant.

Others have more COMT gene expression, resulting in a faster enzyme that clears dopamine and norepinephrine more quickly, resulting in lower brain levels of these neurotransmitters. If other factors are present, these individuals may be more at risk for mental health conditions such as depression, low mood, lack of motivation, or susceptible to addictions.

Beyond genetics, there are several environmental and biological factors that may affect the speed of the COMT enzyme. One of these factors is estrogen. Estrogen slows the COMT enzyme down by as much as 30%. This means that when estrogen levels are high (seen in many women around ovulation or premenstrually, or in women with generally high estrogen levels, termed “Estrogen Dominance”, COMT performs more slowly and dopamine and norepinephrine levels remain elevated.

Depending on the extent of the problem, women with high estrogen often experience anxiety and irritability and a low tolerance for stress. On the more severe end of the spectrum, some women experience conditions such as PMDD (Premenstrual Dysphoria Disorder) or PMS-induced psychosis, resulting from abnormally high brain levels of dopamine and norepinephrine due to high estrogen. These conditions probably result from a combination of high estrogen, slowed COMT and other genetic and lifestyle factors. Xenoestrogens from environmental toxins, or birth control pills may also slow COMT and further exacerbate some of the symptoms of estrogen dominance.

Conversely, women with lowered levels of estrogen, such as those with amenorrhea (missed menstrual cycles) from various causes—PCOS is one, so is the birth control pill, especially progestin-only pills, or hormonal IUDs—or women who are peri-menopausal or menopausal, will have a faster COMT enzyme. This means that dopamine and norepinephrine will be cleared from the brain more quickly. Low levels of these neurotransmitters may result in depression: low mood, low energy and lack of motivation. On the extreme end, low levels of dopamine in the brain may result in conditions like Parkinson’s. Currently, research is being done on estrogen-replacement therapy as a treatment for Parkinson’s because of its ability to increase brain dopamine levels through slowing COMT.

When it comes to birth control pills, which are combination of synthetic estrogen and synthetic progesterone (“progestins”), or just straight progestin, either in pill-form or in a hormonal IUD, effects can be unpredictable. There is evidence that oral contraceptive use, especially progestin-only contraception, can exacerbate anxiety and depression, especially in teens. The pill acts by suppressing ovulation and suppressing natural hormone production, which may result in low levels of naturally-occurring progesterone and estrogen, which can slow COMT. However, the synthetic estrogens from the pill may interact with COMT, speeding it up in some women. Therefore the effects of specific forms of birth control on individual women is hard to predict; if functional medicine and genetic research tells us anything, it’s that there is no one-size-fits-all when it comes to striking the right hormonal balance.

Estrogen also has effects on another enzyme, called MAO-A, that recycles serotonin, the “Happy Hormone”, often implicated in depression and anxiety. Like COMT, estrogen slows down MAO, reducing the speed at which the body breaks down serotonin, resulting in higher brain serotonin levels. Drops in estrogen around and before a woman’s period, or low estrogen levels, may result in feelings of depression. Many women report feeling depressed and craving carbs and sugar around their periods. This is often related to a drop in serotonin as estrogen levels fall right before menses. Drops in serotonin levels due to drops in estrogen levels after childbirth may explain postpartum depression, according to some researchers.

The link between estrogen and its effects on COMT and MAO hint at the complexities of the body and brain’s hormonal milieu and its implications for hormonal regulation and mental health. Mental wellness is a complex state involving a variety of factors: hormones, enzymes and neurochemical pathways that are affected by our environment, our genetics and our hormonal predispositions. This is why I believe in taking a functional approach to mental health, seeing our mental health symptoms for what they are: symptoms, and making efforts to uncover underlying causes rooted in lifestyle, genetics and our environment. I believe the way to address symptoms is to trace them back to their source.

For many women, treating depression, anxiety and stress-intolerance may involve balancing estrogen levels and healing the menstrual cycle. For others it may involve supporting genetic susceptibilities with lifestyle changes, finding a birth control method that balances (or coming off entirely), and reducing exposure to xenoestrogens, supporting estrogen detoxification pathways, and addressing women’s health conditions such as irregular menses, and conditions like PMS, fibroids, endometriosis and PCOS.

Root Causes of Anxiety, a Functional Medicine Approach

I talk about root causes of anxiety, the most common mental health condition, and what to do about it from a functional medicine perspective.

Hi, everybody, Dr. Talia Marcheggiani here. I’m a naturopathic doctor who practices in Bloor West Village, in Toronto and today I’m going to talk to you guys about the roots of anxiety.

Anxiety is the most common mental health condition. It affects about 18%of North Americans and it encompasses a wide range of different diagnoses including generalized anxiety disorder, panic disorder, OCD, phobias, PTSD and depression, and social anxiety. It’s a huge umbrella of different conditions. So the first thing I do when I meet my patients is try to understand how anxiety manifests for them. The word anxiety means very little to me. What I care about is how the symptoms are manifesting in my individual patient in front of me and how it affects their life. So, I’ll ask them what does it mean when you tell me that you have anxiety? Walk me through a situation when your anxiety gets triggered, tell me what it’s like to live inside your shoes, inside your head, what kind of things do you worry about? What goes on in your body? And, how do you know that you have anxiety? Did you decide that you had that diagnosis or did someone else give it to you and what do you feel or think about having that diagnosis? Do you agree with it? Do you disagree? Do you have any doubts? The symptoms of anxiety encompass the body because it affects our nervous system, every single bodily organ is affected, potentially, by anxiety and some people have some of the symptoms or all of them and sometimes very few, just the mental and emotional symptoms, and many of us don’t even identify with having chronic anxiety or anxiety disorders or anxiety symptoms.

First of all, we have the mental symptoms. People with anxiety will commonly experience worrisome thoughts, anticipatory anxiety, so, being worried about the immediate future or the distant future. They might feel irritable or excited, they may have depressed mood. A lot of the people I see with anxiety have this kind of “chilled out” demeanour because it’s very common for someone who’s got a high level of anxiety in their body to dissociate a little bit from those feelings and appear very calm. They kind of describe it as a duck on a pond. On the surface, you see this calm animal, just floating along, but when you look under the water you see the duck legs busily working away and so that’s how a lot of people will describe their mind. They say, on the surface I’m really calm, but once you look under the surface, you see that there’s a lot of mental activity and a lot of worry that’s happening.

There may be fears, such as specific fears, such as phobias, or just general fears, like in the case of generalized anxiety disorder, or fears may be triggered in certain situations like in the case of social anxiety. Insomnia is very common, an overactive and busy mind is very common, fatigue is another common symptom as well as difficulty concentrating, memory loss, brain fog. So all of these conditions that show that the person who’s experiencing anxiety and who is dealing with anxiety is distracted and focused on other things, rather than what’s right in front of them. So a lot of the time my patients will describe an inability to feel present and feel connected and enjoy the moment. Their mind is always on something else. Sometimes the anxiety is based around specific concerns and sometimes it’s just very general and it doesn’t really matter what’s going on in someone’s life, there’s this sense of impending doom that they’re dealing with on a daily basis. Anxiety and depression are very common, they’re comorbid mental health conditions, and it’s very difficult to tell the difference a lot of the time. There’s a hypothesis that they’re similar conditions, or the same condition, but one is a more extraverted, so that would be anxiety, version of depression, which is a more introverted and internalized manifestation of the same disease process. This is still a hypothesis, but it makes some sense and it resonates with a lot of people that I talk to.

Then we have the bodily symptoms of anxiety. A lot of people will experience muscle tension, aches and pains. This is typically in the shoulders where they carry their worries or they’ll find themselves tensing their muscles without being aware of it. They may experience twitching, and they experience pain from the tight muscles. There’s also sensory symptoms, such as ear ringing, hot and cold flushes, changes in vision, tingling, numbness, muscle cramps. It’s very common to have cardiovascular symptoms, such as a racing heart or heart palpitations and this often occurs in people who have panic attacks, which often sends them into the emergency room, because it can be difficulty breathing, racing heart, chest pains, sweating, all these kinds of autonomic symptoms that one might experience if they were having a cardiovascular event, can occur in someone with anxiety or panic disorder. It can be really frightening.

Then there’s gastrointestinal symptoms, so there’s definitely a connection between IBS and anxiety. And those of us who don’t necessarily suffer from anxiety but have experienced nervousness, which I’m sure we all have, will notice that our gut is definitely affected and we may have looser bowels, bloating, difficulty digesting, or we might not have an appetite or want to eat. And this all common in people who have chronic anxiety. Genitourinary symptoms, such as frequent urination, or frequent thirst, often leading people to think that they have diabetes. Also, there might be a delay in urination, so you feel like you have to go to the washroom, you go to the toilet and then there’s a moment where you can’t really go, and you’re trying to wrestle with yourself, which is really common. So urinary hesitancy, it’s called. And then we have the autonomic, so the symptoms that are related to the autonomic, or automatic, nervous system, such as a dry mouth, dilated pupils, sweating or flushing, and this also related to our GI symptoms.

So, these are just a few of the anxiety symptoms. And, as you can see, they affect pretty much every single system in the body. Our nervous system, which is what is affected in anxiety, consists of our brain, our spinal cord and all of our nerves. Nerves that go to and from different body organs and our nervous system is divided into the voluntary and the involuntary, or autonomic, nervous system and our autonomic nervous system is divided into the sympathetic and parasympathetic nervous systems. So our sympathetic nervous system is the “fight or flight” nervous system. This gets turned on when we sense an immediate danger and our body is primed to respond to that danger.

The parasympathetic nervous system is turned on when we’re sleeping and digesting, and when we’re a state of otherwise calm, when there is no danger around. You can think of these two systems as a seesaw. One gets turned on while the other gets turned off and our body should be able to toggle back and forth between these two arms of the autonomic nervous system easily and without getting stuck in either one and depending on the situation and what’s going on. So imagine that you’re walking through the forest, and you’re feeling calm, and you’re feeling at peace, and then you look down at what you think is a stick on the ground that starts to move, your autonomic nervous system is going to kick you into the sympathetic, fight or flight, response. In this response your body will be primed to either fight, flight, run away, or freeze. And these three responses are what will get us away from the danger or meet that impending danger and this is what our body will respond with in order to ensure our survival when there are dangerous situations that we’re faced with.

Once that danger’s gone, we’ve either fought, flown, or frozen and the danger has forgotten about us and left, we’ll return to the parasympathetic nervous system. We need the parasympathetic nervous system turned on when we’re eating and when we’re sleeping. If we have problems, so if we get stuck in that fight or flight response for too long, either because we perceive there to be danger, or our body simply can’t switch back into the parasympathetic state, we’re going to have problems with feeling relaxed, sleeping soundly, and digesting our food properly.

Those of us who are experiencing chronic stress, our nervous system is just taxed, and we’re in the sympathetic nervous response far longer than we should be, because we’re constantly facing deadlines, or we have a lot more responsibility and a lot less control, on our plate, we’re going to experience this feeling of chronic stress. This will exacerbate someone who’s already got a predisposition towards anxiety. There’s a hypothesis, or personality theorists hypothesize that some of us are just born with a higher level of neuroticism as part of our constitutional tendencies. So I see that a lot of anxiety will run in families, especially in female patients, many of them will have grown up with a mother who suffered from anxiety. So there’s definitely a nature component to the nature-nurture debate in terms of what causes anxiety. So, while we can’t really affect our nature, or our genetics, we can affect how those genes are expressed and we can look at the environmental factors that might trigger those genes to be expressed. So that’s what I’m here for. My goal as a naturopathic doctor is to take a full assessment, understand what someone’s symptoms of anxiety are, what the external factors, the environment of their life is like, and look for potential causes that might be exacerbating the anxiety, making it difficult for them to function and perform and live the life that they know they can live. Living a life that’s full of abundant health.

So, the first cause that I want to talk about is chronic stress. when we’re stressed out, like I described when we encounter that snake in the grass, our body will release hormones called norepinephrine and epinephrine. Those are our fight or flight hormones. Those are short-lived, and when those run out, our body starts to make cortisol. Cortisol is a more long-term stress hormone. However, when we’re stuck in that sympathetic state our body becomes, well a theory is that our body becomes unable to produce as much cortisol for long periods of time, that our adrenals get “fatigued”. Another theory is that our brain stops responding to cortisol and we develop a kind of cortisol resistance. And this we’ll see with a lot of brain fog, memory loss, difficulty concentrating, there’ll be a lot of weight gain, especially around the abdomen, and people will experience a lot of inflammatory symptoms, so that’s when we’ll see joint pain and muscle aches and, potentially, worsening of depression as cortisol can kind of motivate us and get us going, because, if you think about it, when we’re in a state of fight, flight or freeze, that’s an action-oriented state, once our body stops responding to that, we enter this kind of burnout and exhaustive phase.

What’s more, once our body stops responding to cortisol, in order to maintain that sympathetic tone, to stay in that fight or flight state, that for whatever reason our body is turned on to, we start to make those catecholamines, norepinephrine and epinephrine again and that contributes to those symptoms of anxiety. So essentially what anxiety is is a high cortisol, high norepinephrine state, where we have that racing heart, we have those tense muscles, we’re looking for danger and our body, for one reason or another, expects that there’s some kind of danger that it needs to defend itself against.

So, not all stress is bad stress. You think of a new mom, she’s full of love and all these feel-good hormones, but the lack of sleep, the added responsibility, all of the things that having a new baby might mean to her and her life, are going to contribute to more stress hormones going through her system. And so I’ll ask a lot of my patients if they’re stressed and, even though I’m kind of getting a sense of high stress from them in terms of their level of busyness, and their level of downtime and just the demands on them in their day-to-day life, a lot of them will say that they don’t feel stressed, that they love their job. So it’s not about whether you love your job, or whether or not you love the things that are, basically, getting piled onto your plate, it’s your body’s perception of those things. So, our body does well when it has enough down time, it has enough restful sleep, and it gets enough breaks. So that keeps that toggle from the sympathetic nervous system, to the parasympathetic nervous system, fluctuating in a healthy way, without getting in one or the other.

Another common cause of anxiety that I see, or definitely a factor that exacerbates anxiety symptoms, is blood sugar imbalance. So, when we wake up in the —a lot of us wake up in the morning and we have cereal, or we have those packaged oatmeals. So, in North America we eat high-carb, high-sugar breakfasts, or we skip breakfast, or we just eat a lot of carbs and sugar in general throughout the day. When you eat a food that’s high on the glycemic index, that contains a lot of easily digestible carbs or refined flours and sugar, we get this immediate spike in blood sugar, as those sugars are absorbed directly into our blood stream. When we get this high level of sugar, we might feel a lot of energy, we might feel really good, we get a lot of dopamine release, and it feels pretty awesome, we get a lot of immediate energy that our body can use. But then, because our body wants to maintain a certain level of blood sugar, what gets released next is a hormone called insulin. Insulin helps that glucose, that sugar, get inside of our cells, where we can use it for energy. If our blood sugar shoots up too high our body sends more insulin into the blood stream to lower that sugar. Sometimes it sends too much insulin and our blood sugar plummets, we get hypoglycaemia symptoms: dizziness, “hangry”, irritability, weakness, fatigue, you’d kill someone for a piece of toast kind of situation, and carb cravings, and we respond by eating more carbs and the cycle begins again. That can exacerbate anxiety because our energy levels are going to be rising really quickly and falling really quickly. Stress hormones are going to get triggered everytime we enter a hypoglycaemic state. And, because cortisol also releases sugar into the blood, so cortisol and insulin work together. Going through this eb and flow of blood sugar, basically riding the blood sugar rollercoaster, is going to exacerbate and mimic a lot of the anxiety symptoms that I described. So a lot of people I talk to, when they’re experiencing anxiety, oftentimes, during the day when they’re experiencing anxiety, it’s between meals, or it’s after a high carb, high sugar meal. And, so a big part of managing their anxiety, or at least creating a terrain where their mental health can function optimally, and their emotional wellness has a chance to function optimally, is to get their blood sugar nice and level. And this means adding protein and fat to every single meal, lowering those refined carbohydrates, beginning each day with a high-fat, and high-protein breakfast. Nutrient deficiency is another really big cause that I look for when it comes to anxiety. So, the happy hormone, serotonin, which is implicated in both depression and anxiety, that’s what the antidepressant and anti-anxiety drugs like cipralex or prozac act on, so those selective-serotonin re-uptake inhibitors. This is a hormone that gives us a feeling of satisfaction, it gives us a feeling of uplift, it’s often what tanks when we crave carbs, and so eating carbohydrates kind of perks our serotonin levels up. In order to make serotonin, we need an amino acid called tryptophan, which we get from protein, and we need the vitamins B6, magnesium, B12, and zinc, and iron. And those take tryptophan and turn it into another amino acid called 5HTP, which then gets turned into serotonin. And then, once we have enough serotonin, that gets turned into melatonin, which helps us sleep and regulates our circadian rhythms. So any break in either of those pathways is going to result is us having lower levels of serotonin and melatonin available to our nervous system for us to have proper mental and emotional regulation. When we’re stressed out, our demand for those nutrients goes up, because our adrenal glands are also sucking in a lot of those nutrients to make cortisol and the catecholamines. Protein is super important, not just for blood sugar regulation, but to give us the amino acids that we need to make the proper neurotransmitters. So, I mentioned serotonin, I also mentioned norepinephrine and epinephrine and other ones include dopamine, GABA, which is a nervous system calming neurotransmitter, glycine, another nervous system calming neurotransmitter, and a good source of glycine is collagen, or gelatin, which I’ve mentioned in other videos. See the “8 Foods for Mental Health”, and tyrosine, which makes dopamine and also makes the catecholamines. So we need tryptophan, which makes serotonin and melatonin, we need GABA, which makes GABA, and that calms our nervous system down, we need tyrosine, which makes dopamine, this is a feel-good hormone that helps us seek rewards and feel motivated, and energized, also tyrosine gets made into thyroid hormones, again, which helps us feel energized and keeps our energy levels stable and our metabolism revved up, and the catecholamines, norephinephrine and epinephrine, which we need for that fight or flight response and that we’re going to be burning through a lot more quickly when we’re in that fight or flight response. And then glycine, another nervous system-calming amino acid. And glycine also helps balance the nervous system. Typically we don’t suffer from protein deficiency in North America, but I see it more and more, especially low-quality sources of protein. So, chicken nuggets, yeah they have chicken in them, but they only have about 10 grams of protein and a ton of trans fats and a lot of processed carbohydrates. So, although we might be eating hamburgers and chicken fingers and omelettes on waffle, we’re not necessarily getting enough good sources of protein. So, ensuring protein from things like legumes, nuts and seeds, clean animal products, fish, like salmon, and white fish, are all really important and I often suggest people get 30 grams of protein per meal, so three times a day, but it depends on your weight, it depends on your energy demands and it depends on your lifestyle and how stressed out your are, because our demands for protein definitely go up during stress. It also depends on how level your blood sugar is and if you’re getting those hypoglycaemic symptoms, sometimes those people need to increase their protein, while decreasing some of the carbohydrates, especially those refined carbohydrates, and give their body more fibre-rich carbohydrates that the body has to work harder to extract and release into the bloodstream. Another really common cause, or contribution, or exacerbation to anxiety is iron deficiency. So I see this a lot in menstruating women. It’s not super common in young men to have iron deficiency, but women who are menstruating every month, especially women with heavy periods, and who are experiencing fatigue, definitely need to get their ferritin levels tested. So, ferritin, in our blood, will tell us what our iron stores are like. So, how much iron we have available to our tissues. Iron is useful for participating in lots of different chemical reactions in the body, as part of normal metabolism, but it’s also important for caring oxygen to our tissues and oxygen is what we need in a process called oxidative phosphorylation, which gives us energy. So, no oxygen, no energy. And what will happen is, if we lower levels of iron in our blood and lower levels of oxygen, our heart starts to beat faster in order to send more volumes of blood to our tissue. So, it figures, if, with each heartbeat, i’m not sending as much oxygen, if I just double up my heartbeats, I might send double the amount of oxygen and try to meet the demands of the tissues that I’m sending oxygen to. You can kind of figure out, then that quick heartbeat mimics those heart palpitation symptoms of anxiety and can trigger some anxiety symptoms. Iron’s also go this grounding affect. It gives us this nice, level energy. And there’s a very specific feeling to iron deficiency fatigue that a lot of women may have experienced. It’s not quite like a sleepiness, or a lethargy, it’s a very specific feeling of just depletion. So it’s important to get ferritin checked and then find a kind of iron that you can take every day to build your levels up, at least for a few months, and one that’s easily absorbed.

So, another reason why iron might be low is in the case of leaky gut, or malabsorption syndrome, so this can occur in somebody with inflammatory bowel disease, or celiac disease, where the intestinal cells are just not able to absorb as many nutrients, or somebody with IBS, so, just generally sluggish digestion, inefficient digestion, perhaps a lack of stomach acid, or a lack of those digestive enzymes that help us absorb our food. IBS and leaky gut are other common symptoms and causes of anxiety. So it’s kind of a chicken or an egg situation. Our gut bacteria produces serotonin, dopamine. We’ve got about 5 trillion in our gut, and that’s about 10x more cells than we have in our bodies. For the most part, when it comes to a cell-to-cell basis, we have 10x more gut bacteria than we have cells. So we’re more gut bacteria than us. Our gut bacteria, there’s good ones, there’s bad ones, we haven’t been able to isolate all of them, there’s very little, relatively, that we know about the microbiome, but a lot more research is coming out, especially in the area of mental health. We know that these gut bacteria can make their own neurotransmitters. They can even specifically ask for food, so a lot of people with sugar cravings have a dysbiosis going on where the gut bacteria need those refined carbohydrates and that sugar, in order for them to grow. And so they’re sending out ghrelin, or hunger-stimulating signals to try and get us to eat more sugary foods. Our gut bacteria also make most of the serotonin in the body and our gut cells also make most of the serotonin in the body. So if we have unhealthy gut cells, they’re not going to be able to regulate our nervous system. And if we have an imbalance in gut bacteria, again we won’t be able to regulate our nervous system, because we won’t be producing those neurotransmitters that we need to balance and to be able to toggle seamlessly between the parasympathetic and sympathetic nervous systems. The gut is also where a lot of our immunity lies. And our immune system is going to be the cause of low-levels of inflammation, especially if there’s a little bit of autoimmunity or food sensitivities, or allergies going on. Low levels of inflammation are going to affect our brain. So there is a hypothesis that depression is caused by low-grade inflammation in the brain. We don’t have pain receptors in our brains, so we ‘re not able to detect inflammation in the way you would with an inflamed knee. If you injured your knee or had arthritis in your knee, and you would notice that your knee was red, and swollen and it would hurt to touch and you wouldn’t be able to walk on it. We don’t get those symptoms in our brain because of the lack of pain receptors and so how brain inflammation might manifest is brain fog, difficulty concentrating, depression, anxiety, mental chatter, negative self-talk, negative thoughts, those symptoms that are really common, mental symptoms, in something like depression and anxiety.

There’s a lot more we need to research about this, but there’s something called LPS, lipopolysaccharide, that’s produced by some of the “bad” gut bacteria. When rats were injected with lipopolysaccharide, or when human volunteers were injected with lipopolysaccharide, we mimic the symptoms of depression. When those same patients and rats were given EPA, which is a very anti-inflammatory fatty acid that’s from fish, marine sources like salmon and sardines, the depression symptoms went away. There’s also some studies in depression with prednisone and corticosteroids, which lower inflammation really rapidly. They come with a host of side effects, so that they’re not that great of a remedy for depression, but they actually lowered depressive symptoms. There’s a lot of a connection, that we’re noticing, between inflammation and depression and anxiety and we’re just not sure to the extent that inflammation causes depression. I tend to think that, probably most cases of depression and anxiety have some kind of inflammation present, especially when we consider that just chronic, turned on, sympathetic nervous system and high levels of cortisol is going to contribute to a cortisol resistance in the brain and increase neuroinflammation, especially in the hypothalamus.

We also know, as I mentioned before that symptoms of anxiety and symptoms of IBS often go hand in hand. And so, a lot of the anxiety symptoms that people will get are looser bowels, bloating, loss of appetite, just difficulty digesting their food. And a lot of symptoms that people with IBS will get are anxiety. And one of the treatments for IBS are selective-serotonin re-uptake inhibitors, which, you guessed it, are also drugs that treat anxiety.

So another common cause that fits really well into my practice, my focus is on mental health and hormones, and these two areas overlap, probably more than they don’t overlap, it hormonal imbalance. So, especially in women, men have their own host of issues when it comes to hormonal imbalance, but women, because our hormones are cycling and going through different phases all month long, we’re more susceptible to problems with proper hormone regulation, especially in the face of female endocrine disorders such as PMS, PMDD, PCOS, all of the acronyms, endometriosis, fibrocystic breasts, and just dysmenorrhea, so painful and heavy menstruation, or irregular cycles. So all of these point to symptoms of hormonal imbalance. Estrogen and progesterone are the two female hormones and they do have effects, yes on the ovaries, and they control ovulation, they control building up of our uterine lining and shedding of the uterine lining, when those two hormones fall away, and that causes our period to occur, so they definitely control our fertility, but they also have affects on other tissues in the body. One of those tissues, one of those organs, is our brain, our nervous system, so estrogen can work a little bit like serotonin and, so what you might notice, right before your period when your estrogen levels drop, or women that are going through menopause and have a drop in estrogen levels, is you’ll get irritable, you’ll get depressed, and you’ll crave carbs like crazy. And a lot of women get something called premenstrual dysphoric disorder, where they have fluctuations in their estrogen levels. So, lowering of estrogen, or insufficient estrogen, may cause some of those more depressive anxiety symptoms, progesterone acts like a GABA agonist, which, I mentioned before, is a calming neurotransmitter. So, lower levels of progesterone, and I see this in a lot with women who have something called “estrogen dominance”, I have another video on this, and women with PCOS as well, and women who have high estrogen symptoms, or conditions such as endometriosis and fibroids, and fibrocystic breasts, and those kind of symptoms, or conditions where estrogen levels tend to be high, and progesterone levels tend to be low or deficient, they’ll often have anxiety with these symptoms. And lower levels of progesterone, especially premenstrually, often are related to low mood and anxiety, and cravings. So, looking at hormones, especially when the patient sitting across from me has a lot of menstrual issues, and irregular cycles and all of the other things I mentioned, I’ll definitely look into hormones and promote proper estrogen detoxification and building up of progesterone. A common cause of low progesterone is being in that fight or flight state. So, now I’m starting to reveal how this web interconnects, how everything is tangled together and how cortisol and blood sugar all relate to everything. So, cortisol, it uses the same precursor to make progesterone, and, when our body needs more cortisol, it will steal progesterone from the system to make cortisol. Because our body has to prioritize sometimes, and getting away from that snake in the grass, and saving our life is more important than making babies to our body in the short-term. So, we suffer in the long-term if that snake in the grass never goes away and we’re always kind of worried about juggling all the things in our lives. But a lot of women who are chronically stressed, or are in that sympathetic nervous state, will have lower levels of progesterone, so doing a lot of adrenal support is one of the ways that we help their bodies build up some progesterone.

And then, finally, I think I mentioned before, there’s a reason that we have anxiety, it’s not an irrational fear. A lot of the time when I sit across from patients, the things that they’re worried about are legit things to worry about. Maybe they’re out of work, or there’s financial worries, maybe there’s just so much on their plate that it’s difficult to find any time for themselves, or make ends meet, maybe they’re unhappy with their career, they’re relationship is in jeopardy. There’s all kinds of things that people deal with on a daily basis. And then, that being said, there’s also people who are just primed to be more neurotic than others, based on that spectrum of neuroticism in terms of personality and constitutional predisposition. And I think we know this, there’s some people who are just a little bit more anxious than others and that diversity in human personality probably helped us evolutionarily and so I think there was obviously an evolutionary advantage for someone who’s nervous system was a bit more responsive. Those people could get away from danger, they were expecting danger more often, and they probably ended up surviving and passing their genes on to their ancestors more readily than those who were way too laid back and didn’t think about danger and got themselves into risky situations.

So, those who are a little bit more neurotic may be predisposed to negative thinking, over-estimating the negative outcomes of certain events or maybe engaging in critical self-talk. Especially in the case of post-traumatic stress disorder, PTSD, there’s definitely a connection between early childhood trauma, or just trauma in adulthood, some of these experiences can teach us to turn our nervous system on, or to get triggered more easily as a way of surviving in the future. There’s different areas of psychotherapy that deal with these phenomena, and they term them different ways, but they can be called core beliefs, or certain mental schemas, so when our brain experiences very strong emotions, the amygdala wires those emotions down in implicit memories. They’re really tightly wired and those memories get triggered again whenever there’s a situation that reminds us of the situation that wired down those responses. It might be a certain smell, or a certain sound, or a certain song, something that activates those memories, that may not be conscious, because the amygdala is pre-verbal, will trigger those feelings of fear and prime our body to respond. And the problem is that we’re surrounded by potential stimuli all the time that can trigger that. And so, really understanding what triggers anxiety symptoms, where those triggers may have come from, and bringing those memories up to the cognitive, cerebral cortex and rational mind, so that we can help dissolve those memories, is a big part of psychotherapy and how we manage anxiety with psychotherapy. Especially if we think the cause of anxiety may be related back to some sort of childhood trauma or implicit memory that was consolidated.

Those are some root causes of anxiety that I would look for as a naturopathic doctor, among many others. What an intake will look like is a 90-minute conversation with the person in front of me where I get to know them, and understand the environment surrounding the phenomena of their symptoms, the symptoms themselves, and all of the other different factors that might be contributing to the anxiety that they’re displaying. So, I’ll ask about period health, I’ll ask about sleep, I’ll ask about their energy levels, I’ll ask about any other physical symptoms they might be experiencing, their digestion, what their stress levels are like. We’ll go through a review of systems, looking at every single organ system and trying to create a tabulation of how anxiety might be manifesting for them, and we may even explore what their core beliefs are, or implicit memories are in future visits. And we’ll talk about diet. And then I’ll make some recommendations as I begin to understand what those root causes of anxiety might be. So we’ll look at whether they may be experiencing nutrient deficiencies, leading to an imbalance in proper neuroendocrine production, if there might be some inflammation going on, if they may be experiencing some digestive issues, or some hormonal imbalances, or if there’s chronic stress going on in their life. And so what we’ll do is, once we find out the causes, we’ll engage in some psycho-education, so I really believe in empowering my patients to understand their bodies, to be able to notice when things are triggering them, to notice what exacerbates their anxiety, what makes it better, and to develop a self-care plan where we’re eating right, we’re thinking right, we’re exercising right and we’re getting enough rest, if possible.

So that’s the gist of it, that’s Root Causes of Anxiety, my name is Dr. Talia Marcheggiani, I work in Bloor West Village in Toronto.

Contrast Showers for Immunity, Inflammation, Mood, Pain and Weight Loss

I talk about contrast showers for boosting immunity, lowering inflammation, mood, pain and weight loss.

Hello everyone, my name is Dr. Talia Marcheggiani, I’m a naturopathic doctor and today I’m going to talk about hot and cold contrast showers. As naturopathic doctors, one of our modalities is hydrotherapy. Hydrotherapy comes from naturopathic medicine’s roots, using hot and cold water to make changes to circulation, hormonal functioning and immune functioning. I’m going to talk about some of the science behind hot and cold contrast showers.

This is something I recommend to my patients to increase their immune activation, decrease autoimmunity, improve mood and hormonal functioning, as well as increase circulation and there’s some evidence that it might help with weight loss as well.

So, firstly, things like exercise and hot and cold therapies induce a little bit of stress. There’s two kinds of stress: distress, which is sort of that chronic, cortisol-fuelled stress that a lot of people come in with, in a state of burnout that’s causing things like inflammation, and mental-emotional illness, and autoimmune issues, and dysbiosis, and then there’s something called eustress, which is more like exercise, cold therapy: short, small bursts of stress that actually up-regulate proteins and genes in our body to combat stress. These genes are involved in DNA repair, increase antioxidant synthesis, and the antioxidants that our body makes are far more powerful than the ones that you’re going to get from food or supplements.

So, by upregulating these genes, we can protect ourselves from cancer, neurodegenerative disease, and other chronic diseases. It’s really powerful stuff, this is called a “Hormetic” response, hormesis, where small stressors mount bigger responses by the body than is needed to deal with those stressors and overall we’re better off; there’s this net beneficial effect. This is one of the proposed mechanisms for some of the antioxidants or flavonoids in green leafy vegetables. It’s not that they provide us with antioxidants, it’s that they encourage our body to make antioxidants due to the small, toxic load that they present to us. And so there’s some evidence that getting short bursts, or longer bursts of cold, very cold, will increase a hormone called norepinephrine. Norepinephrine is involved in depression and mood. Norepinephrine is a catecholamine and it increases the sympathetic nervous system, which is that fight or flight nervous system. When boosted in small amounts, it can actually elevate mood and so a lot of anti-depressant medications also induce, or inhibit the reuptake of norepinephrine. So these are called SNRIs and they include things like Venlafaxine and Cymbalta. So there’s some evidence that norepinephrine increases 2-3 times after only 20 seconds of immersion in cold water. There’s a connection between norepinephrine lowering pain and inflammation and increasing metabolism and there’s some anecdotal evidence and one study, at least, was done to show that cold immersion therapy actually decreased symptoms of depression.

There’s also these things called hot and cold shock proteins, heat shock proteins and cold shock proteins. So, for example, one is called RBM3, which is a cold shock protein, and these proteins can actually help increase longevity and they can actually help decrease incidences of neurodegenerative diseases and neurodegeneration, so something like Alzeimer’s disease or Parkinson’s disease, which can help us with health longevity, so staying healthier into our later years.

We know that inflammation is one of the drivers of the aging process. Probably the primary driver of the aging process, and one of the main factors in chronic, debilitating disease, and, especially in my focus, mental health, there’s more and more researching coming out that inflammation, low levels of inflammation in the brain, is the main cause of mental health conditions, such as depression, and anxiety, bipolar disorder, OCD, ADHD. There’s these low levels of inflammation that contribute to the symptoms of low mood and by increasing norepinephrine, through small bursts of cold and increasing those cold shock proteins, we’re actually able to combat these mental health conditions. Norepinephrine decreases inflammation by decreasing a cytokine called TNF-a that is known to increase inflammation in the body and in the brain. TNF-a can cross the blood brain barrier and it can inhibit serotonin synthesis and it can actually also increase neuro-inflammation, causing symptoms of mental health disorders.

There’s some studies that cryotherapy, for rheumatoid arthritis actually decreased pain significantly. And there’s also some studies that being in cold water, that cold shock, can actually increase the immune system activation. It’s good to increase our immune system activation if our immune cells are behaving properly. If our immune cells are attacking ourselves, then we want to decrease the immune response. But having higher levels of lymphocytes, especially cytotoxic T lympthocytes that are involved in killing cancer cells, is a very positive thing and that’s been shown to increase in people that underwent cryotherapy, or really acute, short exposure to intense cold.

There’s also an ability to lose weight when exposed to cold, over the long term. There’s a man called Ray Cronise who lost over 80 lbs by just habitually exposing himself to mildly cold temperatures. And one of the mechanisms for this weight loss is through non-shivering thermogenesis, in which the cells in the mitochondria uncouple proteins that make energy and they dedicate all the stored energy in fat to making heat. Kind of like cutting your bike chain. So instead of biking, you’re not moving forward, but you’re generating energy and you’re generating heat. And so our body will do this when it’s slightly cold that it can increase heat. Our body is always striving to maintain constant temperature, between 1 or 2 degrees. This process is regulated by norepinephrine, which rises acutely as soon as we’re exposed to just a few seconds of cold. This can be 40-50 degree water. And then I already mentioned that short, cold exposure can increase the production of antioxidants. Our mitochondria are constantly creating reactive oxygen species and reactive nitrogen species. This is just a product of normal cell metabolism. These become toxic, though and damage DNA if our body doesn’t also produce anti-oxidants to clear out those reactive oxygen species and reactive nitrogen species. The cold induces a little bit of a stress that increases our metabolism that increases the reactive oxygen and nitrogen species in our mitochondria and therefore our body is incited to up-regulate the enzymes that create those powerful anti-oxidants that I talked about that are far more powerful than the ones that you can get from food: vegetables, fruits, vitamin C supplement. A couple of these enzymes are glutathione reductase and superoxide dismutase, which are very powerful to our cells.

There’s some evidence that hot and cold therapy can increase muscle mass, can increase muscular strength and aerobic endurance. So this is great for athletes post-workout to lower inflammation and improve muscle regensis. And then, it can also increase something called mitochondrial biogenesis, which is the production, or the replication of more mitochondria in the tissues, especially the muscle tissue. So our body will increase the mitochondria content, the mitochondrial mass, in muscle tissue under certain conditions. These conditions are mainly fasting, exercise, and hot and cold shock.

So, what I’ll recommend to my patients, somebody who’s suffering from low immunity, so they’re getting frequent colds and flus, or maybe autoimmunity, or maybe just general inflammation and pain, brain fog sluggishness adrenal fatigue, that kind of sluggish lethargy from depression. So it’s more the sluggish depression, I’ll recommend hot and cold showers.

So what you do is, in your shower, either during your shower, during your regular cleaning routine, or after your shower is done, and you’ve already washed your hair and everything, you’re going to turn the water on to a reasonably hot temperature, so not so hot that it’s scalding, and you’re going to leave that hot water on for 30 seconds to 1 minute. When that’s done, you’re going to turn the shower to as cold as you can tolerate. So with my patients I often coach them to start with a lukewarm temperature before going whole hog and doing cold. And this is just to coax the body into that stress response that we want, that short, quick stress response that’s going to do all those good things: up-regulate anti-oxidant production, increase norepinephrine, decrease inflammation, increase mitochondria synthesis, burn fat. So you’re going to try and make it as cold as possible, for 20 to 30 seconds, and then you’re going to cycle back and forth at least 5 to 10 times, always end on cold, and then, when you’re done, towel off and keep warm.

There’s some evidence that doing this before bed can actually increase REM sleep and help you sleep more soundly without waking up in the middle of the night. We all know that a good sound sleep is going to set the tone for the next day and your energy for the next day. And then there’s also some evidence that doing this in the morning can increase your energy and alertness throughout the day, so it’s almost like this same practice at different times of day impacts our circadian rhythms differently and can give us more of what we want: either more profound sleep or more daytime energy.

So, that was hot and cold showers, my name is Dr. Talia Marcheggiani and you can check out my website at taliand.com or contact me at connect@taliand.com . A lot of this research came from Dr. Rhonda Patrick at foundmyfitness.com .

 

8 Foods for Mental Health

I talk about 8 functional foods that can help calm inflammation, boost neurotransmitter synthesis and restore common nutrient deficiencies that might contribute to low mood and mental health conditions.

My name is Dr. Talia Marcheggiani. I’m a naturopathic doctor with a focus in mental health and emotional wellness as well as hormonal health and hormone balancing, and today I’m going to deliver a short video about some foods that you can add to your diet to help your mental health.

These are all medicinal foods that act like prescriptions, like anti-depressants, that you can just add to your diet. So, a lot of these foods are recommended based on the idea that depression is an inflammatory condition in the brain. There’s more and more research that shows that there’s low levels of inflammation in people who have depression and anxiety and other mental health conditions like bipolar disorder, schizophrenia, ADD, ADHD and even sub-diagnostic symptoms, such as brain fog and cognitive disruptions. So all of these are a result of some kind of inflammation in the brain. And so a lot of these foods are working to heal depression and anxiety with their ant-inflammatory properties.

And so the first thing that’s recommended to eat are lots of anti-inflammatory fats. These are omega 3 fatty acids such as fish oil. So you can either increase the amount of fish oil by having fatty fish three times a week. You can remember what a fatty fish is by the acronym SMASH. And SMASH stands for sardines, mackerel, anchovy, salmon and herring, and also trout, so SMASHT. And these kinds of fish are rich in the omega 3’s EPA and DHA. Our body can make EPA, but some of us have impaired ability to make it. And so supplementing is necessary for a lot of these people. If you’re looking for a fish oil, make sure you look for one that has a higher amount of EPA compared to DHA. This is very important, because studies on depression are very favourable for fish oil supplementation, but the ratio of EPA to DHA has to be at least 3:1 or higher, and the higher the ratio, the higher the amount of EPA relative to DHA, the better the anti-depressant effects, and the mood-regulating effects. So, fish oil actually showed positive outcomes treating bipolar disorder and schizophrenia, so there’s a mood-stabilizing effect as well. And we think because our brain is made up largely of DHA and EPA, but also the anti-inflammatory effects are very helpful for mood and emotional balancing and mood balancing.

Coconut oil is also another great oil you can add to your diet. Coconut oil is a saturated fat, but it’s rich in something called Medium Chain Triglycerides. So these are saturated fats that the body uses readily for energy. So they don’t go through the normal process of digestion that other fats have to go through. They’re absorbed in our lymphatic system. So we get those fats, the energy from those fats, right away.

Coconut oil is very anti-bacterial and anti-fungal, so it can help regulate bacterial balance in our gut and it can give you a boost of energy. There’s also some evidence that being in ketosis, so this means relying on fats for energy, as opposed to carbohydrates, and, to an extent, proteins. Being in ketosis, so burning fat for fuel: body fat or dietary fat, has a mood-stabilizing effect. And so you might read about intermittent fasting, Ketogenic diet. I wouldn’t recommend doing that without working with a functional medicine practitioner, nutritionist or a naturopath, because there are some negative downsides to doing those kinds of diets prolonged, without supervision, but there is some growing evidence for that. But one thing you can do is add coconut oil to a morning smoothie, or eat a couple of tablespoons in the morning, even looking at some Bulletproof coffee recipes, that can also help with keeping your mood steady or your energy high in the morning.

Staying on the topic of fats and nuts, something that is really great for mental health are Brazil nuts. And Brazil nuts are high in a nutrient called selenium, which our body needs to create an anti-oxidant, the main anti-oxidant in our body, glutathione. You may have heard me talk about n-acetyl cysteine, NAC, which is an amino acid that I often recommend for people with bipolar disorder, for schizophrenia and, to an extent, depression and anxiety, and especially personality disorders, like borderline personality. There can be a very strong mood-stabilizing effect with NAC. And that’s probably because—we’re not exactly sure why that is—but it’s probably because NAC is the precursor to what our body uses to make glutathione, but we can’t make glutathione without selenium. So two brazil nuts a day, and they’re really delicious and fun to eat, they’re big nuts—two brazil nuts a day gives you the 200 mcg of selenium that’s the therapeutic dose. It’s also helpful for thyroid health.

Another thing I tend to recommend and am recommending a lot more in my practice is collagen, specifically gelatin, but for the more health-food minded people, going with a collagen hydrosylate supplement from grass-fed meat is something that I often recommend. But, for most people and myself, I just throw some gelatin that you can buy at Bulk Barn, into a shake or into a seed bowl, or into something that I’m eating like oatmeal, or I’ll make jello out of it.

So, gelatin is really rich in collagen, so it’s made from the hooves of animals, and collagen has a gut-stabilizing effect, so it can help heal the gut. A lot of us suffer from something called “leaky gut” in which inflammation in the gut makes its way to the rest of our body and can affect our brain. Leaky gut can often result in “leaky brain”, resulting in inflammation in the brain and then mental health symptoms. So, collagen helps to repair the gut barrier and the blood-brain barrier. It’s also very anti-inflammatory because it’s high in an amino acid called glycine, which is a calming neurotransmitter as well as an amino acid. It can also help balance the immune system. So anyone that has a low level of autoimmunity, or maybe your immune system is on the sluggish side and you’re getting colds and flus and infections more readily than others, collagen is a great supplement for that. Because our main sources of protein: meat, legumes, whole grains, nuts and seeds, don’t contain a lot of glycine. We’re pretty glycine deficient in our society because we’re not eating that much gelatin, we’re not getting as much bone broth. And so you can get collagen from from making bone broth, from stewing bones and accessing that bone marrow, or you can get it from something like gelatin, which is from hooves, from the collagen-rich membranes, the cartilages, of animals. There’s also fish collagen for more pescatarian-oriented people.

Collagen is also really great for anti-aging, for treating hair loss, for skin and for cellulite. So, all aesthetic things that might bring someone in to my practice, but also really great for mood balancing. A good source of protein as well.

You can either just throw it into a shake, mix it into some water or make your own jello. And I make jello by boiling some fruit, about a cup of blueberries in water. I boil it until the blueberry juice is extracted, then I add a couple tablespoons of gelatin and then I put it in the fridge until it’s hard. And you have a natural jello you can serve to your kids. It’s pretty good.

Another great food to help balance your mood and mental health is turmeric. Turmeric, or curcumin, as it’s scientifically called, is a spice that is used mostly in India. It’s a yellow spice, it stains things yellow: your clothes, your counter, your intestines. It has very very strong anti-inflammatory benefits. It also helps the liver detoxify, it’s been shown to have anti-cancer properties, it’s a really powerful, nutrient-rich plant, root. So studies have shown that two grams per day of turmeric actually outperformed Prozac for treating depression and probably this is due to its anti-inflammatory properties in really lowering inflammation in the brain, which we know is really one of the underlying roots of depression. The way that we get to that inflammation is different in every person with depression, but there is this kind of common thread of inflammation that’s going on in every case of mental health condition, mental illness. So, adding turmeric to foods, or supplementing with turmeric, is a great way to combat that inflammation and keep moods balanced.

Some other foods you might want to add to your diet are foods that are rich in zinc. So, these are mainly things like pumpkin seeds. You’ve got to get around two cups, though, of pumpkin seeds, to get a decent therapeutic dose of zinc, or oysters. Or you can supplement with zinc. Zinc, again, is anti-inflammatory, it can help heal the gut. We need it to make neurotransmitters and enzymes that our brain needs to rebalance mood. And there’re also some studies that zinc increases something called BDNF. BDNF is a chemical in the brain that help with neurogenesis, this is the creation of new neurons in an area of the brain called the hippocampus. So you may have heard “you can’t teach and old dog new tricks” or that our neurons never regenerate once we reach a certain age, and this is not true because new research has shown that we do have neurogenesis, something called neurogenesis, that increases and changes and grows new neurons even as we age. And so anyone suffering from brain fog or really high amounts of cognitive stress, or mental illness, maybe benefit from zinc as that increases the neurogenic abilities of the brain. It’s also very anti-inflammatory and it can help with leaky gut and leaky brain situations. Vegetarians, unfortunately, are often deficient in zinc just because we get most of it from animal products and animal sources, but really upping your pumpkin seed intake might get you to a therapeutic level of zinc or you can supplement as well.

Another really great addition to your diet to help balance mood and to improve your mental and cognitive health are fermented foods. So, these include things like kefir, kombucha, kim chee, saurkraut, and yogurt, if you do dairy. These things, they contain probiotics, and studies show that it may be better to supplement or to add fermented foods to your diet rather than supplementing with a probiotic, and this is obviously an individualized recommendation that would have to be made by a doctor, but adding fermented foods to your diet, especially if you make them at home and ferment them at home, like you make your own kombucha or your own kefir, that can actually boost the probiotic capacity of your gut. Probiotics actually make neurotransmitters, they make things like serotonin, and the calming neurotransmitter GABA and they can help us digest our food, like gluten, as well as combat inflammation and regulate our entire immune system. It’s also important to feed those probiotics with something called resistant starch that you can find in carbohydrates that have been cooled to room temperature after they’ve been cooked, so, for example brown rice that’s after it’s been cooked as been cooled to room temperature, potato starch, green bananas, black beans, and jerusalem artichokes. These are all starches that bacteria feed on and that keeps them populated in the gut. Coconut oil tends to kill more pathogenic bacteria and therefore can promote a healthy bacterial balance.

And lastly, I’m going to talk about leafy greens. So, adding a cup of spinach, or two cups of spinach or chard to your diet will give you the amount of magnesium you need. Magnesium has a calming effect on the body. We need it to make the neurotransmitters like serotonin, dopamine and melatonin, to help with sleep. Magnesium also can help balance mood and help us with stress. A lot of us suffer from stress. It can also make our brain more resilient to stress, as stress is one of the major causes of neuro-inflammation in people with mental illness and this can be stress from a significant trauma, it can be psychosocial stress, interpersonal stress, the stress of being out of work, even long-term chronic stress or burnout from school and work and things like that. So, two cups of spinach gives you your daily magnesium serving. You can also get it from chocolate but you need to eat quite a bit of chocolate.

So, in boosting your mental health, or in promoting mental and emotional wellness, you can add all of these foods to your diet and balance your inflammation, feel good and nourish yourself.

5 Tools for Emotional Wellness and Mental Health

I talk about 5 essential tools for caring for your mental and emotional health. These are powerful self-care practices that can help balance your mind and emotions.

Hello, everybody, my name is Dr. Talia Marcheggiani. I am a naturopathic doctor with a focus in mental health and hormonal health.

Despite the increasing amount of research into mental health conditions and psychiatric conditions, and the increase in interventions and early recognition and pharmaceutical therapies that come with mental health diagnoses, we’re actually seeing more debility in mental health outcomes: more debility, more morbidity. So we’re seeing worsening of outcomes even though we’re applying more interventions.

So, how could this be? You expect that the better the drugs that we’re developing, the less disease we should encounter, if those drugs are actually working to counteract the disease process. We’re not seeing that in the realm of mental health, especially when it comes to the common conditions such as depression and anxiety.

And when it comes to disease in the west, we’re not really winning the war against disease. So, things like cardiovascular disease, cancer, hormone imbalances such as diabetes, hypothyroidism, mental health conditions such as depression and anxiety, ADD and ADHD, infertility, neurological disease such as MS and Parkinson’s, autoimmune disease, such as, again, MS and things like Hashimoto’s Thryoiditis and myasthenia gravis, and immunodeficiencies such as HIV. All of these diseases are on the rise, all of these chronic, lifelong diseases. And so, despite these advances in research and drug development, we’re not seeing an improvement in our ability to manage these diseases or prevent them.

And there is obviously not one simple solution to this problem, but one thing I want to point our attention to is this increase in stress and this connection to stress and the diseases that I mentioned. Obviously it’s not just one cause, that would simplify the entire system to an almost ludicrous degree, but there is an estimation that 75-90% of hospital visits are either directly or indirectly related to stress.

And some of the symptoms of stress, so chronic stress or even acute stress, are an increased heart rate, elevated blood pressure, elevated blood sugar, decreased memory and cognition, disrupted levels of serotonin, leading to depression and anxiety, disrupted levels of the other hormones such as dopamine and norepinephrine, and addiction to stress, so a chance in the opioid receptors and the brain structure, altered hormone synthesis, increased inflammation, altered gut flora, etc., etc., and a change in the immune system. So, basically, every system of the body is affected by stress. And being in a prolonged, acute state of stress is lethal to the body.

So, we can look at the rise of cardiovascular disease and diabetes and the fact that stress increases our heart rate and increases our blood pressure and increases our blood sugar. And we can make some of those connections between the symptoms of stress and the diseases that are increasing in our society.

When it comes to mental health, we see how our neurotransmitters and our brain structure and our gut and our immune systems are affected by chronic stress and we can infer that some mental health conditions are either caused by or aggravated by this chronic stress situation. And, so, by not addressing stress and by not looking into stress and finding healthy ways to manage it, we’re doing ourselves a disservice in the management of these diseases and the prevention of them,

So, there’s a few theories that connect—there’s that Monoamine Hypothesis when it comes to mental health, that people with depression and anxiety have this inherent brain imbalance. So they don’t make enough serotonin, or their brains for some reason aren’t responding to serotonin. Again, it’s a very reductionistic model because it reduces all of the experience of depression and anxiety and conditions such as ADD and ADHD and bipolar down to one single neurotransmitter and it oversimplifies the entire system and the entire constellation of symptoms that people can experience and the life situations surrounding these conditions and the fact that they’re comorbid with things like stress and poverty and childhood trauma and those kinds of things.

But there’s some other theories that we can look at, and some other kind of pieces of the puzzle that we can add to create a more inclusive narrative. So there’s a theory called the Mind-Body Theory and this kind of arises as a counteraction, or a counter-philosophy to what Descartes discovered or decided that he discovered, which was that the mind and body are separate entities—this dualistic hypothesis. We know absolutely that that’s not true but our mind and body are completely connected and that our mind probably doesn’t reside only in our brain because our nervous system extends throughout the entire body and our minds are also inter-relational, so they’re a product our environments and our relationships with other people as well.

We know that the gut is the second brain, for the amount of neurons that it inhabits and the neurotransmitters that influence its function. Our gut health affects our mood depending on how healthy it is. And we call this connection, another word for it, a more scientific word, is “Psychoneuroimmunology”. This is the connection between the immune system, the nervous system, and our psychology, our mood: our thoughts and emotions. So, we know that everything in the body is interconnected and you can’t prescribe an antibiotic and not expect that there’ll be sequelae or consequences, or side effects that affect a different body system. And we see that all the time now, but we have to understand how tugging on one thread in this interconnected web is going to affect another piece of it further down the line.

There’s also this Energetic Model of mental health, and that’s that the emotions have their own energy. There’s this theory that the emotions can manifest as physical symptoms and we see this in the work of Gabor Mate, who writes extensively about stress and addictions and mental health, in his book “The Body Says No”. He talks about how the health of our thoughts and emotions impact our physical stress. And so it’s not just that our thoughts and emotions can impact our mental health, but also our physical health and might set the stage for us to get conditions like cancer, or autoimmune disease, and all of the other diseases that I mentioned.

So, when it comes to stress and our mental health and emotional wellbeing, we need to take a proactive approach. Just like we do with getting vaccinations, and preventing colds and flus, and getting proper nutrition, and exercise and all of that, we need to be strategic about how we manage our stress.

The World Health Organization defines mental health as “A state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.” So, notice that this definition isn’t simply the absence of disease and it’s not necessarily a normalizing—being “happy” or not having a diagnosis. This definition is about realizing one’s potential and experiencing emotional “wellness”, for lack of a better word. So, an ability to cope with life’s stressors and to live a life of meaning and purpose.

So I want to talk about 5 tools that are really important for establishing a self-care and emotional wellness routine, for improving mental health. These strategies may not be sufficient enough for more serious psychiatric conditions, but I believe that they form the foundation of proper lifestyle strategies to help with increasing our emotional wellness and our ability to cope with life’s stressors.

So the first one I want to talk about is something called “Self-Care”, which is becoming kind of a buzzword in high-stress communities such as universities, and even some offices and corporations. So, one of the first things I want to talk about is the power of saying “No”. Sometimes saying No, especially for more agreeable individuals, and a lot of the time for women, saying no is a difficult thing for us to do.

When I give this presentation to a group I always ask them, “Why is it hard for you to say no? What would happen if you didn’t say no? Let’s say a friend invites you out and you’re just not feeling it, or you’re invited to a baby shower and it’s just more than you can handle and you wish you could say no, but you don’t.” And, one thing that everybody says is that they’d feel guilty, if they said no. This is sort of universal. And so I ask them, “What would happen if you didn’t say no? What would happen if you went along with it, even if you just didn’t have the energy to devote to this commitment?” And people say that they’d feel resentment. And so when it comes to deciding what things to take on and what things to discriminate against in terms of the tasks that we take on, the commitments that we make, we’re kind of stuck between this dichotomy between feeling guilt and resentment spectrum. One of my mentors, Gabor Mate, in his book “The Body Says No”, talks about when faced with this choice between guilt and resentment, especially when we’re more prone to guilt-avoidance by saying yes more often than maybe we should, he said “choose guilty every time”, because the feeling of guilt, and obviously this isn’t a hard or fast rule, but the feeling of guilt is more indicative that you’re taking care of yourself.

His theory as well is that resentment tends to build up in the body and contributes to the cause of more disease such as cancer and this cancer personality that he writes about is the woman that will say yes to things and is scared to say no out of guilt. So, resentment is far more damaging for the body and therefore, when trying to avoid guilt, maybe move towards guilt, especially when you know that you might be taking on more than you should. And also pay attention to the idea that when we say yes to things we’re saying no to other things. So, we’re always saying “no” and “yes”. We only have 24 hours in the day and so, by saying yes to that baby shower that you’d rather not go to, what are you saying no to? Are you saying no to doing a yoga class for you, or getting extra sleep, or saving your money for a family vacation? So, paying attention to those commitments that we make. There’s a great article online called “The Law of F- Yes! Or No.” And this law is, if you’re faced with a decision and you’re not feeling like this, “F- Yes!”, then say no and save that time and save those commitments for something else that you’re more enthusiastic about.

When it comes to self-care, there’s another great article that talks about the BACE method, so that’s BACE. And this stands for these 4 pillars of self-care. And the first one of body-care. So that’s making sure you have a healthy diet, that you’re supporting yourself nutritionally, that you’re getting movement in, that you’re sleeping enough. A is acceptance, just allowing the emotions, and that self-care, that self-love to come through. C is connection, so establishing those interpersonal relationships and prioritizing them, especially relationships that feel nurturing, where you can be your authentic self. And E is enjoyment, finding activities that are fun and cause a sense of enthusiasm and enjoyment in your life. And this is something that’s often a problem for a lot of adults with lots of responsibilities that, when I ask them to rate on a scale of 1 to 10 how much fun they have, or how satisfied they are with the amount of fun in their life, they often rate it pretty low.

A lecture that I attended, there was a woman who was talking about self-love and improving self-worth and recommends asking oneself this: “what would someone who loves themselves do? Or say?” and that can be pretty powerful for just examining how our internal dialogue is manifesting and how we’re talking to ourselves and treating ourselves. Would someone who loves themselves eat that? Or say that? Or do that activity or say yes to that commitment? And, you know, just sitting with that question can be really helpful for changing some behaviours, or adding perspective to our daily lives.

There’s also this, lastly in the realm of self-care, there’s this idea of Wu Wei, which is a Taoist idea, which is translated roughly into the art of “effortless action”. In our society we’re kind of educated to pair action with effort. So, we don’t feel like we deserve success unless our success was the result of a massive amount of effort that we’ve put in, and stress. And, according to wu wei, this idea that action is objective, we can measure it, but effort is subjective. So, you can see if you’re performing an action, but the perception of effort behind it is this kind of subjective and thought-based experience. So, we can do the laundry or DO the laundry. We can do laundry from a place of self-love and self-care, like “I want to care for my clothes, and to have nice clothes to wear tomorrow and I’m going to do this for myself and I’m going to be mindful as I do it”. And I’m going to do this out of necessity, but also out of a natural drive that’s coming from this place within. Or I can have laundry on my to-do list that’s causing me stress. So, sometimes even wu wei is about doing less and not feeling guilty for that.

The second tool for emotional wellness is journalling and writing. This is one of my favourites. So, journalling allows us to keep a record, to get creative, and to engage in self-expression. And when we write we engage both sides of our brains: the motor centres, the language centres, the centres that are involved in language perception and in language generation, also our visual centres. So, a lot of the brain is lit up in the act of writing and that can help integrate some of our deeper thought processes.

Writing down things leads to clarity and focus. We’re forced to deepen our thought processes and remove ourselves from some of the cognitive loops we might be engaged in. We can complete our thoughts and reach their inevitable, often ridiculous conclusions and this kind of comes from some core beliefs, or, we call them “automatic thoughts.” Like, “I’m a failure” or “I’m worthless”. Those kind of things that our brain generates based on past experiences that may not be relevant anymore to who we are now. Through writing we’re forced to look inside of ourselves, to causes and explanations for how we feel. We’re also able to express ourselves and rid the body of pent up emotions, such as anger and aggression and sadness, shame.

I often recommend that people write a letter. Especially if there’s someone in the past that’s done damage to them, or hurt them. Someone that they miss, sometimes remembering somebody through a letter: sometimes people wish that they could communicate with someone who’s passed away or is no longer in their life anymore and, through this letter-writing, you’re able to.

I also have people write letters to themselves from the perspective of their personality at age 80, and this can sometimes provide perspective for patients who are depressed and young, because it gives them an idea; it increases the perspective of their lives. And sometimes I have people personify and anthropomorphize their problems or addictions and write letters to that or write letters from that and through that process can learn a lot about the relationship between themselves and alcoholism, for example.

There’s another great activity I like called the “God Jar”, for people that have constant worries or wake themselves up at night and process things or who are anxious about the future—The God Jar or the Wish Jar. And so, you get a mason jar and little pieces of paper and you write things that you’re worried about or things that you’re anxious about or thinking about and you scrunch them up and throw them into this jar and, in essence, symbolically, you’re giving those problems to “God”, or to the universe or you’re just simply filing them away for later use. And this is sort of a subconscious, or conscious, dumping of your problems, especially if you don’t have immediate control over them. I mean, in the middle of the night you’re not going to be able to finish your taxes when you’re supposed to be sleeping, or solve a problem at work. And that can often worsen our problems, when we’re not getting enough sleep. Then I sometimes have people open up that jar 6 months later and take a look at some of the things they’ve written and that can also generate feelings of accomplishment and achievement and perspective when you find out that those things that you were so worried about 6 months ago are no longer even relevant and you barely remember them. So, it’s pretty powerful.

Another great exercise is something called a Gratitude Journal. And there’s a Ted Talk about this that, for 21 days, and I like to tell people to do this for a full month, 28 days. If you write 3 things that you’re grateful for at the end of the day for 21 days, it actually changes your brain structure and helps you see things in a more positive light and focus on the blessings, rather than the things that you lack. Our brains have a negative bias. So, they’re wired to pay attention to the things that we’re missing out on and that we’re lacking and when we focus on and acknowledge the things that are going right for us, it can sort of change our perspective. And, throughout the day, as you’re doing this exercise, you’re going to be paying attention to things that you’re going to have to write down later, so you’re paying attention to the things that went well, that you want to include in your gratitude journal. And this can have profound effects.

There’s some studies about journalling. And there was a study that showed that patients with HIV or AIDS, who wrote about their life for 30 minutes had an increased CD4 T cell count—and that’s the cells in the body that are affected by the HIV virus. So, by simply writing about their lives, something profound, it wasn’t just a grocery list. But writing something profound about their lives, such as sharing their life story, actually increased their immune system’s ability to function in the face of the HIV virus.

And then, similarly, there was another study in patient with rheumatoid arthritis—this is an autoimmune condition—they had these patients write for 20 minutes a day, for 3 days, and they found that their symptoms went down and their immunoreactivity went down. So we’re seeing these two studies, and we’re not exactly sure of the causal effect, these studies are a little bit correlative and very difficult to control for, because patients who are in the study, subjects know if they’re writing in their journal or not. But these studies were controlled against people who were just kind of mindlessly writing about grocery lists. So, it was writing about more profound concepts and sort of outlining a significant life event, or life story, or significant events that were happening in the day that had an emotional charge to them.

So, we find that engaging in journalling, even 20 or 30 minutes a day, can actually modulate the immune system. So, if you have a immunodeficiency issue, like HIV, it can increase immunoreactivity, and if you have an autoimmune disease like rheumatoid arthritis, or asthma, if can lower that immunoreactivity and inflammation. So there’s this evidence that journalling and our thoughts and emotions are directly impacting our immune system and our immune system’s ability to function and balance itself.

The third tool for mental and emotional wellness is interpersonal support. And, being a naturopathic doctor who does a lot of counselling in my practice, I tend to favour psychotherapy and counselling as a form of social support for people that don’t feel that they can be authentic or have that deep connection with people in their lives.

There’s evidence that loneliness is the new epidemic, especially in our society and, as social animals, connecting with others is part of our biology, part of who we are. Through therapy, what I really like about it, is it can help us reframe the past and our personal identity. We can start to identify some automatic thoughts and core beliefs, which are deep-seated beliefs that may not serve us anymore in the present and may actually be contributing to feelings of low mood or behaviours that are unwanted. It can also allow us to rewrite our life story, so, looking back on the past and reframing certain events, from the perspective of someone maybe with more resources and power. For example, someone with a history of trauma may have an idea of powerlessness and being victimized and, in every single story of trauma that I’ve encountered, people have always responded in some way. Either psychologically, mentally, emotionally, if not in action, and sometimes just recognizing these responses changes our whole perception of the event and our identities in the present, our ability to act in the present. So, there is evidence that stress is related to our perception of things that happen, not actually what happened. So, for example, imagine somebody that’s just broken up with their girlfriend and they were very in love. And you can image what their mental and emotional state would be like. Maybe the next day they don’t feel like getting out of bed, there’s clothes all over the floor, they haven’t brushed their teeth, they’re feeling extremely sad, and crying. And nothing has changed biologically in this person, but the situation surrounding their life has changed. Then imagine that this person wakes up the next day and they’re in this state of low mood and depression. And they get a phone call. And it’s their girlfriend saying, “you know, I’d like to get back together, I made a mistake, I’m in love with you and I don’t want to be broken up anymore.” So you can imagine that this person’s mood is going to change rapidly as the situation changes. And so, there is a change in their circumstances, but not in their physical biology.

And sometimes, in past events, there’s the story that our minds create around what happened, and then there’s the actual events that happened. So you might call your partner and they don’t pick up the phone, and we start to create a story about why that is. Maybe it’s because they don’t love us anymore, they want to break up with us, that we’re worthless, that no one’s ever loved us, that we’ll never find love, that we’ll always be alone. But, in actuality, we don’t know those things and the only thing that’s happening is they’re just not picking up the phone and there’s thousands of explanations for that.

We perceive situations based on our personal histories, our physical conditions, our state of minds, etc., and things that we’ve learned in the past and also our core beliefs. So, we filter our experiences through our perceptions and our identities and personalities and so, by understanding more about these things, we can understand why we pick out certain events and draw conclusions from the connection between those events rather than others. There’s some people that, when they fail a test, they just think, “Oh, it was a hard test, or maybe I didn’t study hard enough.” And there’s others that think “I’m a failure, I’ll never pass anything, there’s no point in trying, I’m dropping out of school.” And so it’s not just the event but our perception of the event that change our thoughts, mood and behaviours.

Another great thing that therapy and social support can do, is help us identify our passions and purpose in life. So there’s a psychological that I really like to listen to called Jordan Peterson that talks about how the purpose of life is not necessarily well-being and happiness, because happiness is a state that can be derived chemically, through doing things like cocaine, or substance abuse, and happiness might just be a disposition that certain people embody better than others and that life is suffering. And this is present in Buddhist philosophy that no matter how we live, we’re going to encounter events that are devastating for us, and that are hard for us to deal with. And so, in those situations, we’re not going to feel happy, so what’s going to drive us? What’s going to push us forward? What’s going to keep us going in those times and so his theory or idea is that we should look for what makes it worth it: what adds meaning to our life. What is our potential in life? What is our purpose? What gives us that sense of meaning such that, when we encounter these situations of suffering and hopelessness that we’re able to continue on. So, having a direction for our lives, and having a sense of identity and purpose that gets us up in the morning and makes us move forward, even when we’re not particularly feeling happy that day.

Therapy and social support are also great for just self-acceptance. So, having other people mirror back to us who we are and how we’re being in the world.

The 4th tool for emotional wellness is mindfulness and meditation, so very very powerful tools. It’s arguably very difficult to be healthy in this day and age without some form of mindfulness meditation, or meditation practice to combat the increase in stress that we encounter in our society. So, mindfulness is—there’s many different techniques, but the main tenant is just taking the perspective of the compassionate, detached observer to our thoughts, emotions and physical sensations. So, when we split our mind or watch our thoughts, we can get a better sense of awareness of how emotions and thoughts arise in our body, pass through our bodies, and how we’re not them—that there’s this observer role that we can also take, that we can watch ourselves from.

Mindfulness allows us to stay in the present and reframe certain situations and just slow time down so that we’re not victims to the whims of our biology, that we’re able to understand it a little bit more. And there’s a great resource on the internet called “Mindfulness-Based Stress Reduction” that’s a secular kind of meditation by a man in Massachusetts called Jon Kabat Zinn and you can download body scan meditations or take a course in MBSR in your town. I highly recommend them; they’re really great for developing mindfulness practice.

There’s also yoga, and qi gong and tai qi, and these kind of integrated, mindfulness-based and physical exercises that can help slow us down, bring us into the present and help us observe our minds and emotions a little bit better. And there’re amazing for managing stress. There’s good evidence building about them helping us deal with stress and manage our mental health conditions.

And the 5th tool for mental and emotional wellness is to look at that mind-body connection that I mentioned before. The mind-body theory sees our thoughts and emotions as energy that can impact our cellular biology, from that idea of psychoneuroimmunology. And there’s increasing evidence about this and how calming our thoughts down, doing some mindfulness meditation, can affect our heart-rate and can affect our blood pressure, and journalling can affect how our immune system responds.

There’s this idea that if our thoughts and emotions aren’t processed properly they can become trapped and stagnated in the body and contribute to disease. So, Gabor Mate mentioned that resentment can build up and lead to things like cancer. It’s one of his theories that he’s observed through working with patients.

We know that there’s this connection between physical manifestations of symptoms and physical conditions and certain emotional causes. In medicine we know this because every time a study is done, a randomized control trial, two groups need to be divided amongst the subjects. One is given a placebo, an inert pill. And this idea that someone who believes they’re taking medicine will notice a positive effect, is something that we just take for granted, but we build into every single study that we do, if it’s a good study. So, this idea that you can take a pill, believe it’s helping you, and actually physically notice a change in your body is really remarkable. And this just proves that there’s this connection between the mind and body, that we can further explore and exploit.

So, there’s things like herbal remedies that help our body increase our cells’ resilience to stress and help manage the stress hormone cortisol. And these are some herbs called adaptogens. So, they literally help us adapt to stress. And these are things like withania or ashwaghanda, rhodiola, ginseng, even nervine herbs like St. John’s Wort and skullcap can help balance our neurotransmitters and our stress hormones and lower inflammation in the body.

Doing self-care things like getting a massage, or getting acupuncture can help. And there’s a study that compares acupuncture to Prozac, so getting one acupuncture session a week for 6 weeks was actually comparable to Prozac for decreasing symptoms of depression and anxiety.

In my practice I always address diet and gut health and just make sure people are absorbing their nutrients, that they’re guts are producing the proper amounts of neurotransmitters, that there’s the proper bacterial balance, that there’s no inflammation being caused by a gut dysregulation. And we also want to remove those external stressors that can be contributing to an impaired digestive system. So, there is this saying that “we are what we eat,” but more accurately, we are what we absorb, because you can eat a lot of stuff, but, depending on how you’re digestion is functioning, we might not be absorbing all of it and incorporating it into our body, into our cells.

So, inflammation in the gut, caused by a bacterial imbalance, or food sensitivities can impact our health and we have some evidence that depression and anxiety can be caused by some latent levels of inflammation in the brain. And we know that there is an impact on gut health and increasing levels of inflammation and also stress. And really lowering that stress response, healing the gut, can have huge impacts on our mood. Establishing routine, and sleep are major pillars. So, I don’t think I’ve ever encountered a patient who felt mentally healthy when they had disrupted sleep. A lot of the time having a ritual around sleep and getting into a routine and waking up at the same time every day, really working on getting deep sleep—so avoiding electronic use before bedtime, trying to get as many hours before 12 am of sleep as possible, so preferably having a 10pm bedtime or winding down around 10 pm. Doing things like teas, or hot baths, or reading a book before bed or doing some yoga or stretches or meditation before bed to teach the body that it’s time to start relaxing is really important and has huge impacts on health, on our mood, on our emotional wellness, our ability to cope with stress, our ability to heal from stress, and our ability to balance inflammation and the immune system.

There’s evidence that exercise—I mean exercise is arguably the first-line therapy for someone with depression, especially someone under the age of 24. Instead of reaching for pharmaceutical interventions, such as selective-serotonin reuptake inhibitors, more psychiatrists are recommending exercise to young patients, which is wonderful. I’m so happy about that! And, so 30 minutes of a moderate to intense form of exercise such as weight training, or running or moving your body, can help release some of those trapped emotions, as well as boost those neurotransmitters and help our body increase its resilience against stress.

And then, finally, I just want to point out that making sure that we’re supporting our neurotransmitter synthesis through diet is really important. So, making sure that we’re getting enough magnesium, zinc and B vitamins, and proteins and amino acids, which are all helping us create the neurotransmitters like serotonin and dopamine that are going to impact our mood and mental health. So, we can journal, but we are physical beings, and we are a product of our biology. So, by supporting that biology through proper nutrition, we’re able to incorporate those nutrients and create the proper components of our body for proper mental and emotional wellness.

So, I also like to ask people this miracle question. So, this is the final thing that I’m just going to conclude on. The Miracle Question is from a modality called “Solution-Focused Therapy”. And this question is, “if you woke up tomorrow and all of your issues were completely gone, you woke up in an amazing 10 out of 10 state of energy and physical well-being and mental and emotional well-being, what would be possible for you? What would your day look like?” If you can stand in that place and sort of write down what you’re aiming at, what you’re aiming towards, it helps set the stage for taking the proper actions that preserve your mental and emotional wellness. And it also helps you stand in a new territory, one that’s not of disease or illness, but one of possibility.

And, finally, I was at this free meditation circle as we were talking about self-love, and we were talking about how difficult it can be to love oneself. Because, oftentimes we have these core beliefs that drive our psyches and oftentimes these core beliefs are negative. And so what was said was that it’s often hard to stand in a place of self-love when you’re intent on changing things and you’re not happy with where you are now. And so, he said, the person running the meditation said, “self-love is like a garden. So, you can nourish the soil and water the seeds, but you can’t actively force the garden to grow.” So what you can do is, you can take care of the things you love in yourself, all the things that you have in your right now, rather than trying to be somewhere that you’re not currently at. And this is kind of like when you have, for parents out there, if you have a child, you love your 4-year old child, and you don’t put expectations on them that you would a 25-year old. So, you’re loving your 4-year old at where they’re at, but also recognizing that this is somebody who is developing and so you’re loving their potential to develop, just as you’re loving their 4-year old incarnation, their 4-year old manifestation of their personalities. So you’re loving their potential to grow, just as you love the seeds that you’ve planted in your garden, but you’re also loving things where they’re at. And through that act of self-love and tending to the garden, or tending to your child, you’re encouraging that growth and development in the directions that you want.

My name is Dr. Talia Marcheggiani. I’m a naturopathic doctor and I work in Bloor West Village, in Toronto.

A Morning Smoothie Recipe for Mental Health

I often recommend smoothies as an easy way to manage mental health symptoms, balance blood sugar, reduce inflammation and increase energy. I discuss the types of foods I put into my morning smoothie and their benefits on the body and mind.

Hello, everyone. My name is Dr. Talia Marcheggiani, I’m a naturopathic doctor with a special focus in mental health and emotional wellness and today I’m going to talk to you about how to make one of my favourite breakfasts to recommend patients: the morning smoothie. I always recommend smoothies in the mornings because it’s a great way to take care of a lot of your daily recommended nutrients in terms of protein, vegetable, anti-oxidant-rich berries and a healthy source of fat.

I always recommend somewhere between 20-30 grams of protein in the morning for people with depression and anxiety as well as digestive issues, hormonal imbalances, anything like fatigue or chronic stress because when we wake up in the morning we’ve been fasting for at least 8 hours. Sometimes in healthier cases, it’s actually better to fast for 12 hours and so throughout the night our blood sugar hasn’t been stimulated, we haven’t been increasing our blood sugar throughout the night and so, when we start our morning with something like, in North America, like we usually start, with a piece of toast or some sugar-rich cereal, our blood sugar goes from the lowest point, since we’ve been fasting for so long, and spikes. And then around 10 am, a couple hours after we’ve had our breakfast, our blood sugar will drop again, causing symptoms of hypoglycemia, which can worsen stress, it can trigger cortisol release and cause fatigue, worsening of anxiety and depression. And then throughout the day our blood sugar’s going to go up and down as we start to crave sugar again and it’s more likely to throw us off our balanced state that we want to be in.

So I start by recommending 20-30 g of protein to my patients in the morning and they often ask me what they can eat. And I’ll recommend something like leftovers from the night before, like a chicken breast has about 30 g of protein. Other patients ask “can I eat eggs?” And eggs are wonderful to eat but in order to get 30 g of protein you need to eat about 5 or 6 eggs, which is not typical. We usually eat 1 or 2. Although eggs is a great addition. You can throw eggs into your smoothie as well.

It’s also important to get a nice source of fat in your smoothie. So this is something that we often leave out, we don’t put sources into smoothies and so I recommend something like ground flaxseed or coconut oil, olive oil if you have that lying around, avocado, you can even through your fish oil in, if you’re that kind of person.

And I always throw in a leafy green, which you can’t taste. A cup of something like spinach or kale is a source of leafy greens. It’s full of fat-soluble vitamins as well as things that help us detoxify the estrogens from our body and keep our hormones balanced. This is something I always recommend for women with irregular periods or heavy periods, or things like PCOS, Polycystic ovarian syndrome, endometriosis, infertility. Anything that causes estrogen to go off and if you’ve read some of my articles you know that a lot of us suffer from estrogen-dominance. This is just more estrogen than progesterone in the female body. Even men can suffer from this and that’s because we’re just exposed to so many things, so many toxins in our environment that are activating estrogen receptors. So by eating leafy greens, we allow our bodies to detoxify a lot of those xeno-estrogens, those toxic estrogens in our environment.

So all you need is a blender. I like to throw in some baby spinach, pre-washed. I just eye it and throw in a couple of handfuls. That amount. Just a couple servings of spinach. The nice thing about things like spinach is it blends really well. You don’t taste it and depending on how much other ingredients you throw in, your smoothie might not even be green, so you can also fool your kids by throwing some spinach in their smoothies.

I always throw in some frozen berries. You can put in blueberries or a berry medley. I get it from No Frills for about $11 for a bag. Frozen’s nice because your smoothie gets icey. It might not be the best for winter but the days are still warm our digestive fire is still strong enough to be able to digest things that are cold.

Today the fat I’m going to add is coconut oil. Coconut oil is a saturated fat, but it contains medium-chain triglycerides, which our body doesn’t need to convert into sugar to be used as energy so we can just use them right away as an energy source. It’s great for the skin and it’s great for gut-healing because of its anti-fungal properties. It’s also really good for balancing blood sugar and boosting our metabolism. 2 tablespoons, I put in.

Fats are great medicinal foods. You can throw in a couple tablespoons of olive oil if you have cholesterol issues, blood sugar issues. The right kinds of fats are very anti-inflammatory and we know that inflammation is implicated in things like digestive issues, depression and anxiety, stress and so, by making sure we’re getting the right balance of fats in our diet, you can start in your morning smoothie, by setting your fat balance on the right track, be able to balance inflammation and feel really good throughout the day.

This smoothie will also keep you full really long, well into the afternoon because of the source of fats in it. I like to throw in things like eggs as well, just raw eggs. It’s difficult for me to really recommend it universally to all my patients because there is, of course, the risk of salmonella in raw eggs. So, at your own risk you can try it out, but I find it really makes it taste nice and rich as well as give us a good source of cholesterol. And cholesterol’s a good thing, because we need cholesterol to make hormones. Especially in depression and anxiety. You don’t want to be sacrificing cholesterol or taking—of course this depends on your health history—but there’s a risk of depression in people who are taking statin drugs, cholesterol-lowering drugs that are lowing our cholesterol in the body because how are we making our hormones if we don’t have enough cholesterol.

You can also throw in something like an avocado, it makes it nice and thick and rich or some peanut butter or almond butter, or nut butter. I’m also going to throw in some ground flaxseed.

Flax has two really great medicinal benefits. I use it for hormone-balancing in a lot of my patients with things like period irregularities or amenorrhea, this is not getting your period, infertility. So what flax does is it activates estrogen receptors. But it activates them weakly so if you’ve too much estrogen, the flax competes for the estrogen by binding to receptors preventing those hyper-estrogenic effects and if you don’t have enough estrogen, so in the case of post-menopause or ovarian failure, flax binds to estrogen receptors and causes the estrogen effects that we really want, like libido and energy and the expression of female sex characteristics. It can also clear skin and it’s great for acne, it’s great for regulating periods. It’s great for balancing heavy periods, bringing periods back and making them more regular.

Flax is also great for constipation because it’s a good source of fibre and you need to grind the flax, it needs to be milled. And this is because our body can’t break down whole flaxseeds. So you might have seen breads or crackers where there’s whole flaxseeds and they advertise flax on the package, well it really doesn’t so us any good. It just passes right through the body. It’s not adding those fibres or medicinal fats.

Finally, this is a protein powder that I just got from Bulk Barn. I find that Bulk Barn is the cheapest in terms of protein powders. I use a vegan protein powder. So this is great is you’re vegan or vegetarian. Whey is the best absorbed protein, but personally I have a food sensitivity to whey, caseine and other dairy products, so I go with vegan protein, which is a mix of pea protein, hemp protein and rice protein. But you can also use whey. If you’re sensitive to dairy and not sure if you’re sensitive to whey, always go with a whey isolate, because whey isolate doesn’t contain caseine, which is the protein in milk that most people react to. So it’s just pure whey.

In my protein powder, I also mix gelatin. So gelatin is just a crystalized powder. I put in one scoop of protein powder for 30 grams of protein. So gelatin comes from the hooves of animals. It’s rich in collagen and it can actually increase the amount of collagen in the body. It’s an incomplete protein, so it has a lot of an amino acid called glycine, which most of us are deficient in because we don’t get a lot of glycine from the meat of animals. It’s actually located in the collagen. Glycine’s a really calming neurotransmitter. We use it to bind minerals, so if you’re my patient you might have been prescribed magnesium glycinate, which is an easier absorbed form of magnesium, also a source of glycine, to help calm the body. It activates those suppressive neurotransmitters, the GABA pathways in the brain so it’s great for calming anxiety and great for preparing us for sleep. But it doesn’t make you tired for the rest of the day. What’s great about getting a source of collagen is that it can help with gut healing. It can help with the integrity of the gut in leaky gut situations and it’s great for the skin and hair because we know our skin is made of collagen as well as our joints. So, if you have acne, acne scars, if you’re suffering from premature aging or sun damage, a couple tablespoons of gelatin or collagen hydrosylate is a great thing that you can do every morning.

So I’m just going to add in, as your liquid source you can add in something like water, I usually just use water or almond milk. I’m going to use coconut milk today because it’s delicious. I’m going to mix a little bit of coconut milk with water. Just tap water. I’m going to add some tap water. So how much water you add depends on how thick you want your smoothie and the quality of your blender. I filled it up to about 500 ml. I like to eat a lot in the mornings.

Put it into your blender. So this is my smoothie pre. And then you just pour your smoothie in a glass. Mine’s kind of on the watery side. It turns out purple, not green at all, so you can still fool the kids. If you want to make it sweeter, you can add in half a banana, or even some maple syrup. But it tastes pretty good. It tastes like berries.

So this is great because liquid is obviously, it’s pre-chewed, so it’s easier for our body to absorb the nutrients, which is nice in the morning, especially for people who aren’t really into breakfast. It’s also really portable you can put it in a mason jar or a glass container and take it to work. You can drink it half before leaving for work and half while in your in the car or commute or on the subway. A lot of your nutrition for the day is taken care of. So, even if you, have not-an-ideal lunch or dinner you’ve gotten a great source of highly-absorbable protein, you’ve gotten some gut-healing in in the form of gelatin. You’ve gotten some healthy fats and a serving of leafy greens and anti-oxidant-rich berries. So, you’re on your way for a healthy day.

The 6-2-6 Breath for Stress and Overwhelm

The 6-2-6 breath is a yogic breathing technique that can help calm the mind, benefitting feelings of anxiety and overwhelm.

Hello. My name is Dr. Talia Marcheggiani. I’m a naturopathic doctor and mental health professional. I focus my practice on mental health and emotional wellness. I’m just at home right now with my dog, Coco, and we’d like to show you a very quick meditation that you can do.

This is a great thing to do. It’s something I teach my patients to do when they’re feeling overwhelmed or stressed out at work. It’s a great way to combat anxiety and depression as well as a really great way to dive into a meditation practice if you don’t already have your own practice.

Encouraging patients to engage in mindful activities like meditation is indeed a valuable strategy for mitigating stress and promoting mental well-being. As individuals navigate the challenges of modern life, finding effective coping mechanisms becomes increasingly crucial in combating anxiety and depression. Moreover, incorporating meditation into daily routines not only offers a reprieve from stress but also serves as a gateway to cultivating a deeper sense of mindfulness and self-awareness.

For those seeking additional support in managing stress, exploring natural remedies such as CBD  presents a promising avenue for relaxation and stress relief. Whether used in conjunction with meditation or as a standalone remedy, CBD flower represents a natural alternative that aligns with the ethos of mindfulness and self-care. By embracing complementary strategies that prioritize mental well-being, individuals can embark on a journey towards greater resilience and balance in the face of life’s stressors.

I also find just spending 3 to 5 minutes a day to sit and focus on the breath, especially deepening the breath, is a great way to dive into meditation and establish your own meditation practice.

So all you have to do is start by either sitting in a chair with your back straight and your feet flat on the floor or in a cross-legged position. You can put your hands on your knees, but what I like to do is tell people to start with their hands on their lower abdomen. That way we can practice moving the breath into the lower abdomen, feel the abdomen rise and fall with the breath, and thereby ensure that we’re sending our breaths down into the belly as we breathe.

It’s called the 6-2-6 Breath. It’s very simple, so all you do is breathe in for a count of 6, hold the breath for a count of 2 and breathe out for the count of 6. By lengthening our inhales and exhales we’re able to stimulate the vagus nerve, which activates the parasympathetic nervous system. This is the “rest and digest” arm of the autonomic—think “automatic”—nervous system in the body. When we’re in a state of stress, overwhelm or depression, we’re usually in a sympathetic of “fight or flight” state and by calming and deepening the breath we’re also able to calm the body, establish a sense of safety within the body, and calm the mind and emotions.

So I want everyone to just close your eyes and breathe in. Start by deepening your breaths. You should feel your hands rise and fall as you breathe.

So when you’re ready let’s begin our inhale for the count of 6. So, inhale, 3, 4, 5, 6, and pause for 2, exhale 3, 4, 5, 6. Pause, 2. And inhale 3, 4, 5, 6. Pause, 2, and exhale, 3, 4, 5, 6. Pause, 2, inhale, 3, 4, 5, 6. Pause, 2, exhale, 3, 4, 5, 6. Pause, 2, inhale, 3, 4, 5, 6, pause, 2, exhale, 3, 4, 5, 6.

So you can continue doing this breath. I recommend spending 3 minutes just settling into the breath and body. You can do this while at work. You can do it at home, you can do it before bed to calm the body down, to help with a more restful sleep. I like how it helps us move out of the space of overwhelm, stress and anxiety, centre into our body and establish more possibilities for clarity and for ways to move forward in overwhelming situations.

Let me know what you think, try it yourself and leave your comments or questions below. You can also follow my blog at taliand.com.

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