I will never get annoyed at a patient’s “lack of compliance” again.
Health care is scary, even when you know what you’re doing. When it’s your own health, putting yourself in the hands of a professional is not easy.
Yesterday I had an initial consult for myself with a nutrition specialist. She’s well-known in her field, super-academic, in her 70s, and has published books and papers.
She knows her stuff. She’s also really helped a friend of mine and the referral came from him. I had every reason to trust her and feel good about putting myself in her hands.
However, I was nervous getting ready to see her. I filled out a diet diary… what would she think? What would she say about my blood work? Would she be nice? Would she be understanding? Would we get along?
Survival instincts kick in.
We talked about a few things in the first visit (which cost an arm and a leg, but will be worth it if I’m left feeling great) and she prescribed some supplements for me to take.
I left, kind of satisfied. Ready to get on with our journey, with a list of things to pick up, dosages to tweak, things to consider and instructions to book again in 3 to 4 weeks.
Ok.
I woke up this morning, in the early hours tossing and turning, thinking to myself, “I don’t want to take vitamin E!” And “Did she truly understand my concerns?” And “what are all these supplements treating?” and “did she really hear me out?” And, “is all this going to actually help?”
The impulse to not trust, to run and hide, to override her assessment and recommendations with my own were overwhelming. (And, of course, as someone who does what she does for a living, the struggle to overcome this is real, we’re “experts” on the body, but it’s nice to let someone else give direction for a change, especially someone with 30+ more years’ experience).
Still, trusting is hard.
Being aware of the impulse to run and avoid, while also resisting the impulse, is hard.
I have people who neglect booking a follow-up even when they know that we still have lots of work to do.
I have people who don’t fill out diet diaries for fear of actually taking a hard look at their food intake.
I have people who email me that “nothing is working” when in fact they haven’t started taking their nutrients and supplements yet.
And, guess what, as frustrating as that may be (because ultimately, I want people to have success! I want people to heal), I’m doing the same thing.
Jeez, being in the patient chair is mighty humbling.
I highly recommend it to all my health practitioner colleagues out there.
And, yes, now I’m taking vitamin E. I’ve decided to just trust. (But I’m still taking my own multi-vitamin… hey, doctors make the worst patients… amiright?)
Since publising the original article about the Mirena IUD on this blog, thousands of women have come out of the woodwork writing to me asking for help.
When I originally wrote the article, I was spurned on by my observations of the women in my practice who had experienced a rise in estrogen dominance and low progesterone after the insertion of their IUDs (which were often inserted to treat hormone imbalances!).
At that point I never imagined that so many women would be affected by the IUD, or that even more were suffering from so many hormonal symptoms that drastically affected their lives and health.
It makes sense: our society does not set us up for proper hormonal function.
Our diets are carbohydrate-heavy, promoting insulin resistance and blood sugar dysregulation, which impacts our ovaries’ ability to make estrogen properly.
An excess amount of body fat produces more estrogen in the body and acts as a reservoir for the toxic estrogens in our environment.
We lack many of the micronutrients necessary to process our hormones properly, such as vitamin D, B vitamins, magnesium, zinc, omega 3 fatty acids, glutathione, and amino acids.
Many of us have impaired or suboptimal liver function, or sluggish digestion, which keeps hormones in our bodies around longer than they should be.
A dysbiotic gut has the tendency to turn estrogen in the gut back “on”, putting it back into circulation when it was otherwise on its way out of the body.
Stress alters our hormonal function, including our ability to make progesterone, DHEA-S, convert thyroid hormones, and process estrogen properly.
Xenoestrogens in our food and environment, from plastics, fragrances, pesticides, and processed soy products, contribute to overall body burden of the hormones in our body, throwing off our delicate balance, and contributing to symptoms.
The result of all this is that many women suffer from hormonal imbalances.
10% of women have some form of PCOS, or Polycystic Ovarian Syndrome, characterized by the body’s inability to properly make progesterone or estrogen, instead making loads of male hormones, like testosterone. PCOS alters fertility, promotes weight gain, and causes things like unwanted facial hair growth, acne, and missed periods. PCOS is often connected to stress and insulin resistance.
Many women in my practice suffer from PMS or PMDD, experiencing often debilitating symptoms sometimes even two weeks before their periods begin. They might get migraines, intense cravings for sugar, and massive mood changes, such as anxiety, intense irritability, or devastating depression. Panic attacks can occur at this time as well. Many of them comment that their mood and personalities flip once their hormones levels reach a certain point, causing them to act like different people. This can jeopardize their relationships with spouses and children, coworkers, friends and family.
Tender and painful breasts, or breast lumps, are also common in many of these women.
Acne, weight gain, stress, fatigue, disrupted sleep, depression and anxiety are all symptoms I see in women with hormonal imbalances.
Many women have horrific cycles, experiencing painful and heavy periods that often cause them to miss days of work every month. Many of these women struggle to keep their iron levels in the optimal range, suffering from hair loss, fatigue and weakness.
Many women are diagnosed with fibroids, or endometriosis, or are concerned about their risk of female cancers like breast, ovarian, uterine and cervical cancer.
All of these symptoms are often linked to relatively higher levels of estrogens compared to progesterone, sometimes termed Estrogen Dominance by functional medical practitioners who look at the underlying causes of bodily imbalances.
I feel terrible that I can’t help more of the women who write to me. My license prevents me from giving advice to those who live abroad, especially to non-patients over the internet. It’s a shame, however, because oftentimes the solutions are relatively simple, despite how complicated many of these symptoms might seem.
I’m hoping that this article can provide some direction to many of the women who suffer.
Firstly, I want to state that I am not against birth control or even the Mirena IUD (or other IUDs, for that matter). The vast majority of women with the IUD tolerate it. For many women with debilitating heavy periods and endometriosis it can be the only viable solution that makes life tolerable.
In my social practice at Evergreen, many of the women I see experiencing homelessness, drug addiction, or PTSD from relationship trauma, rely on the efficacy of IUDs to prevent unwanted pregnancies. Their lives often don’t allow for them to remember to consistently take pills every month.
Many women don’t tolerate combination birth control because of a history of blood clots, female cancers, or migraine headaches associated with their periods, and therefore the Mirena IUD, which is progesterone only, is a safe alternative for preventing unwanted pregnancy.
That all being said, many women do suffer on the Mirena IUD (or other forms of birth control). They were perhaps put on the Mirena to deal with some of the above symptoms of hormonal imbalance, or for contraception. Many of them noticed that their symptoms became worse after insertion of the IUD.
How the Mirena IUD and Birth Control Works:
The Mirena works by secreting small amounts of progestins, a synthetic form of progesterone, into the uterus and surrounding tissues. While it is not fully known how the Mirena works, the end result is a suppression of ovulation. This results in either very light periods or a complete cessation of periods until the IUD is removed (after 5 years when its hormones run out).
It is important to say here that, while birth control can certainly treat the symptoms of hormonal imbalances, it does not correct them.
All forms of birth control, with their synthetic versions of the hormones estrogen and progesterone, simply induce further hormone imbalances in the body. They introduce versions of hormones that may suppress or alter symptoms (such as heavy and painful bleeding, or acne), but the versions of hormones are not fully recognized by the body and therefore don’t fully replace all the hormones’ important functions, such as mood regulation, immunity, or blood sugar balance.
The effects of both altering the body’s natural hormonal balance, while ignoring the underlying cause of hormonal issues, is often what causes symptoms to continue or worsen.
For example, women with PCOS are prescribed birth control to manage acne or promote monthly periods. However, when women with PCOS miss periods, it is because they are not ovulating. The missed periods are not the problem; the lack of ovulation is.
Despite that, many women with PCOS experiencing amenorrhea (or missed cycles) will be prescribed birth control. However, birth control does not address the underlying cause of amenorrhea. It simply further suppresses ovulation (because its main purpose is to prevent unwanted pregnancy).
The periods you get while on birth control are not periods. Periods from birth control are withdrawal bleeds. After 21 days of taking hormonal pills, pills are stopped or replaced with placebo pills. The withdrawal of hormones in the pills induces a bleed that resembles a period, but is not one.
Hormonal contraception does not correct hormonal imbalance, it imposes further hormonal imbalance to manage symptoms. This is not always bad!
But it is an important difference.
Many women do require symptom suppression, particularly if their symptoms are severe. Many individuals in my practice experience periods so heavy that the only way for them to get through the month is with an IUD. Genetic variability in how our bodies process hormones can make us susceptible to intense hormonal symptoms, through no fault of our own.
In my opinion, however, it is important to attempt to address the underlying cause and to set our bodies up for better hormonal regulation, making as many changes as our lifestyles will allow.
What You Can Do About It:
If you are like any of the people I described above who seek my help, there are a few things that you can do to get started on correcting hormones.
Working With a Professional:
The first thing I advise is finding a licensed naturopathic doctor or functional medicine practitioner who understands hormones, can order lab tests, and will address the underlying cause of your hormonal imbalances by taking the time to fully understand your body and lifestyle.
This practitioner might be a naturopathic doctor (you can find one in North America by looking one up at naturopathic.org), or a medical doctor, a chiropractor, or a highly skilled nutritionist or nurse practitioner. Research this person well, read their articles, and perhaps book in with them for a complimentary meet and greet.
Testing:
I often test patients using simple blood tests, on day 21 of their cycles (or about 7-9 days before they expect their next period).
I will test their blood, looking for anemia, will test iron and B12 levels, homocysteine (to gauge their ability to methylate), vitamin D, cholesterol (to see if their diets are promoting proper hormone synthesis), estradiol, estrone (the more toxic, problematic estrogen), progesterone, free testosterone, a thyroid panel, fasting glucose and fasting insulin (to calculate insulin resistance using something called the HOMA-IR), HbA1C (to look a long-term blood glucose control), FSH and LH (two hormones made in the brain that talk to the ovaries and orchestrate the menstrual cycle), DHEA-S, to name a few.
Some women will require more testing. Others will require less.
These labs are interpreted from a functional perspective. Even though you are in the “normal” ranges (which take into account the entire population, many of which are not healthy—they are seeing their doctors, after all!), these blood markers may not be optimally balanced, giving us an opportunity to correct things before they go further.
Testing allows us to match symptoms to underlying imbalances and to be able to properly direct treatment protocols. Women with estrogen dominance may be experiencing high levels of estrogen and normal progesterone, which indicates a body burden of estrogen or impaired liver and digestive system clearance. Other women may be experiencing normal levels of estrogen but low progesterone, indicating a failure of their bodies to ovulate, due to high stress, and PCOS (or the Mirena IUD and birth control pill).
Other options for hormonal testing are month-long salivary hormone testing, or DUTCH testing, which looks at hormone breakdown in the urine. I sometimes run these tests, but find that blood testing is useful, accurate, and more cost-effective.
Treatment:
Once you understand your individual hormonal situation through testing (and through working with a practitioner who is putting the testing together with your symptoms and health history), your practitioner may recommend a variety of treatments.
I personally combine diet and lifestyle with key herbal and nutritional supplements, to target what is going on under the surface with my particular patients.
These treatments may include herbs that boost ovulation, aid liver detoxification, or regulate the stress response. I might recommend nutraceuticals that encourage methylation, or aid in hormone production.
My treatments take into account the individual’s symptoms, labs, diet, lifestyle, and any other health issues she may be facing like fatigue, digestive disturbances, or poor sleep.
What You Can Do Today:
Barring more individualized assessment and advice, there are some best lifestyle practices that can help most women balance their hormones better, whether they are still using birth control to control and address their hormonal symptoms or prevent pregnancy.
Diet:
When it comes to diet and hormone support, we need to ensure that we are balancing blood sugar, boosting liver detoxification pathways, promoting hormone synthesis, and supporting digestion, especially if experiencing constipation.
Consume more leafy greens: kale, spinach, collards, beet greens, arugula, etc. Eat 1-2 cups of these foods every day. Leafy greens contain active folate, which boosts methylation and detoxification. They also contain magnesium which is essential for hormonal regulation as well as 300 other important biochemical reactions in the body that balance mood and hormones.
Consume more cruciferous vegetables: broccoli, cauliflower, brussel sprouts, cabbage, bok choy, etc. Eat 1-2 cups of these foods every day. Crucifates help the body make glutathione, and contain indole-3-carbinole, which helps eliminate excess estrogens from the body. Broccoli sprouts are potent players in these pathways. Consume them as often as possible.
Ensure adequate dietary fibre intake: I often recommend ground flaxseeds or chia seeds in smoothies, avocados, fruits and vegetables and legumes (if tolerated) to make sure that women are having regular bowel movements to clear excess estrogens out of the body. 2 tbs of ground flaxseed (or more) every day can help balance estrogen levels and promote daily bowel movements.
Balance blood sugar: consume protein, fat and fibre at every meal. Avoid refined starches and flours. Avoid all sugar, even natural sugar like maple syrup, coconut sugar, cane sugar, honey, agave, etc. Try stevia or avoid sweets. Limit carbs (grains, legumes, root vegetables like potatoes or sweet potatoes, to 1/2 cup to 1 cup per meal). Only consume whole grains like quinoa, buckwheat, steel cut oats, millet, and teff. Cook them yourself!
Avoid soy, particularly processed soy, like vegan burgers, or soy milk.
Consume omega 3 fatty acids in fatty fish like salmon and sardines, or nuts and seeds like flax and chia seeds, walnuts, and pumpkin seeds. Get 2-4 tablespoons of these nuts and seeds every day and 3-4 servings of fatty fish a week.
Consume animal products: eggs contain choline, which is essential for liver function, meat contains vitamins B6 and B12, which are essential for hormonal regulation and production. Cholesterol in animal products are the backbones of our sex hormones. Iodine, found in animal foods, regulates estrogen balance in the body. If possible, try to obtain organic animal products from pastured or free-range animals to boost omega 3 intake, to lower your impact on the environment, and to promote animal welfare.
Other Lifestyle Practices:
Boost progesterone production by managing stress:
Establish a self-care routine: plan regular vacations, even small outings, do meditation or yoga, take breaks from work, spend quality time with family, have a plan to get your work done on time, ask for help.
Sleep! Aim for at least 8 hours of sleep, and try to get to bed before 12am. Practice good sleep hygiene by avoiding electronics before bed, keeping the bedroom as dark as possible, and setting a bedtime and wake time, even on weekends. Body scan meditations and some key supplements can be helpful for resetting circadian rhythms. Regulating blood sugar can have a major impact on improving sleep. Talk to your functional medicine doctor or naturopathic doctor for individualized sleep solutions.
Eliminate exposure to toxic estrogens and boost estrogen clearance:
Avoid exposure to xenoestrogens: whenever possible use natural body products, deodorants and shampoos, or “edible” body products for face and hair. Avoid plastic water bottles and plastic food containers. Use natural cleaning products around the house. Avoid fragrances and processed foods, especially processed soy.
Encourage sweating: get regular exercise or engage in regular sauna therapy. If you don’t have access to a sauna, epsom salt baths can also work—anything that helps you sweat. Heat therapy has also been shown to benefit mood and the stress response.
Heal your digestion: make this a priority with your naturopathic doctor, so that you can absorb the nutrients from the foods you’re eating as well as encourage daily bowel movements and optimal microbiome balance.
Maintain a healthy weight: body fat is metabolically active and can increase overall estrogenic load. Work with your naturopathic doctor to manage your weight. We often attempt to lose weight to become healthy, however I find my patients have far more success (and fun!) getting healthy in order to lose weight. Healthy weight loss often involves managing stress, sleeping 8 hours a night, avoiding sugar and processed foods, and regulating blood sugar, as well as encouraging proper sweating and liver detoxification.
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I often get emails like this, “Dear Doctor, please tell me your favourite natural cure for anxiety”, to which I often reply:
Dear, Anxiety,
Imagine you are a gardener, tending to your garden. You are a skilled gardener: you tend lovingly to your plants every day and you care deeply for their welfare.
You are the perfect gardener in every way, except for one: for some reason you don’t know anything about soil.
No one has ever taught you about the damp, dark soot that envelopes the roots of your beloved plants, kindly offering to them its protection, water, and nutrients.
You are a gardener, but are innocently oblivious to the fact that soil must be nurtured by millions of microbes, and that nutrients in the soil must be replenished. You have no idea that the other plants sharing the soil with your garden form a complex network of give and take, depositing nutrients into it, while greedily sucking others away.
Now, as this soil-ignorant gardener, imagine your surprise when, despite your care and attention, the plants in your garden wither and die, bearing no flowers or fruit.
Imagine your frustration when your efforts to prop up tired stems fail. You apply water and fertilizer to buds, leaves and stems. You stand by, powerless, as your garden dies.
Notice the weeds taking over your garden, which you lop off at their stems, unaware that their roots reside deep inside the earth.
When the weeds pop up again and again, you slash at them, burn them, and you curse the skies.
“Why me?”
Why you, indeed.
You are unaware of root gardening, soil gardening, just as many of us are unaware of root medicine—soil medicine.
You see, Anxiety, there are many natural remedies that can help.
However, tossing natural pills at twitching nerves, imbalanced blood sugar, unregulated stress responses, and various nutrient deficiencies, might be as naive a practice as spray painting your roses while they wilt in sandy earth, beneath their red paint.
It might be akin to prescribing anxiety medication or a shot of vodka to calm your trembling mind; you might feel better for a time, propped up with good intentions, before collapsing in the dry soil encasing you.
With no one to tend to your roots you eventually crumple, anxiety still rampant.
“Why me?” You curse the skies.
Rather than asking, “Why me?” it might help to simply start asking, “Why?”
While it is important to understand the “What” of your condition—What disease is present? What is the best natural cure for anxiety?—naturopathic doctors are far more interested in the “Why”.
As Dr. Mark Hyman, functional medical doctor, asks:
Why are your symptoms occurring?
Why now?
And why in this way?
Naturopathic doctors prescribe natural remedies for conditions such as anxiety, it’s true. However, naturopathic medicine is a medicine that first tends to the soil.
Naturopathic doctors first look for and addresses the roots of symptoms, working with the relationships that exist between you and your body, your food, the people in your life, your society, your environment—your soil.
Healing involves taking a complete inventory of all the factors in your life that influence your mental, physical, and emotional wellness. It requires looking at the air, water, sunlight, nutrients, stressors, hormones, chemicals, microbes, thoughts and emotions that our cells bathe in each day.
Healing means looking closely at the soil that surrounds us. It requires asking, What are the roots that this condition stems from? And, What soil buries these roots? Does it nourish me?
Do I nourish it?
The causes of disease can be interconnected and complex. Very often, however, there are common root networks from which many modern-day chronic health conditions arise.
Starving Gut Bacteria.
It was Hippocrates, the father of medicine, who first proclaimed that “All disease begins in the gut.”
Our digestive systems are long, hollow tubes that extend from mouth to anus, and serve as our body’s connection to the outside world. What enters our digestive system does not fully become the body until the cells that line that digestive tract deem these nutrients worthy of entering.
Along their 9 metre-long, 50-hour journey, these nutrients are processed by digestive enzymes, broken down by trillions of beneficial bacteria, and sorted out by the immune cells that guard entrance to our vulnerable bodies.
Our immune cells make the judgement call between what sustains us, and what has that potential to kill us. For this reason, about 70% of our immune system is located along our digestive tract.
Our gut bacteria, containing an estimated 30 trillion cells, outnumber the cells in our body 3 to 1. Science has only just begun to write the love story between these tiny cells and our bodies. These bacteria are responsible for aiding in the digestion of our food, producing essential nutrients, such as B vitamins and fat-soluble vitamins, and keeping our intestines healthy.
However, this love story can turn tragic when these little romantics are not properly fed or nurtured, or when antagonists enter the story in the form of pathogenic bacteria or yeast.
Our microbiome may impact our health in various ways.
Studies are emerging showing that obese people have different gut profiles than those who are normal weight. Our gut bacteria have a role in producing the hormones that regulate hunger, mood, stress, circadian rhythms, metabolism, and inflammation. They regulate our immune system, playing a role in soothing autoimmune conditions, and improving our ability to fight off infections and cancer.
Psychological and physical stress, inflammation, medication use, and a diet consisting of processed food, can all conspire to negatively affect the health of our gut. This can lead to a plethora of diseases: mood disorders, psychiatric illness, insulin resistance, cardiovascular disease, chronic pain and inflammation, obesity, hormonal issues, such as endometriosis, autoimmune disease, and, of course, chronic digestive concerns such as IBS, among others.
As Hippocrates long knew, one doesn’t have to dig for long to uncover an unhappy gut microbiome as one of the primary roots of disease.
Our gut has the power to nurture us, to provide us with the fuel that keeps our mood bright and our energy high. However, if we fail it, out gut also has the power to plague our cells with chronic inflammation and disease.
To be fully healthy, we must tend to our gut like a careful gardener tends to her soil.
This involves eating a diet rich in fermented foods, like kefir, and dietary fibre, like leeks, Jerusalem artichokes, and black beans. It also means, consuming flavonoid-rich foods like green tea, and cocoa, and consuming a colourful tapestry of various fruits and vegetables.
Healing our gut requires avoiding foods it doesn’t like. These may include foods that feed pathogenic bacteria, mount an immune response, kill our good bacteria, trigger inflammation, or simply those processed foods that fail to nurture us.
To heal ourselves, first we must feed out gut.
Confused Circadian Rhythms.
For hundreds of thousands of years, all of humanity rose, hunted, ate, fasted, and slept according to the sun’s rhythms.
To align us with nature, our bodies contain internal clocks, a central one located in brain, the suprachiasmatic nucleus, which is susceptible to light from the sun, and peripheral clocks located in the liver and pancreas, which respond to our eating patterns.
Our gut bacteria also respond to and influence our body’s clocks.
However, the invention of electricity, night shifts, and 24-hour convenience stores, means that our bodies can no longer rely on the outside world to guide our waking and sleeping patterns. This can confuse our circadian rhythms, leading to digestive issues, insomnia, daytime fatigue, mood disorders, and problems with metabolism, appetite, and blood-sugar regulation.
Dr. Satchin Panda, PhD, a researcher at the Salk Institute in California, found that mice who ate a poor diet experienced altered circadian rhythms. However, he found that when these mice were fed the same diet in accordance with their natural rhythms, they weighed less, had lower incidences of diabetes and cardiovascular disease, had better cognitive health, and lived longer.
These findings indicate that perhaps it is not what we eat but when that may impact our health.
Perhaps it is that an unnatural diet disconnects us from nature, or that this disconnection tempts us to choose non-nutritive foods, but the research by Dr. Panda and his team reveals the importance of aligning our daily routines with our bodies’ natural rhythms in order to experience optimal health.
According to Dr. Panda’s findings, this involves eating during an 8 to 12-hour window, perhaps having breakfast at 7am and finishing dinner early, or simply avoiding nighttime snacking.
For many of us, this may involve making the effort to keep our sleep schedules consistent, even on weekends.
For most of us, it involves avoiding exposure to electronics (which emit circadian-confusing blue light) after the sun goes down, and exposing our eyes to natural sunlight as soon after waking as possible.
Nature Deficit Disorder.
Nature Deficit Disorder is a phrase, coined by Richard Louv, in the 2005 book, Last Child in the Woods.
According to Louv, a variety of childhood problems, especially mental health diagnoses like ADHD, are a direct result of our society’s tendency to increasingly alienate children from nature.
With most of humanity living in cities, nature has become a place we visit, rather than what immerses us. However much modernization might remove us from nature, our bodies, as well as the food, air, water, sunlight, and natural settings they require to thrive, are products of nature, and cannot be separated from it.
A Japanese practice called Shinrin-Yoku, or “Forest Bathing”,developed in the 1980’s toattempt to reconnect modern people with the healing benefits of spending time in a natural setting. There is an immediate reduction in stress hormones, blood pressure, and heart rate when people immerse themselves in natural environments, such as a forest.
Whether we like it or not, our roots need soil. It is possible that the components of this soil are too complex to manufacture. When we try to live without soil, essential elements that nourish us, and the various relationship between these elements are left out.
When we remove ourselves from nature, or ignore it fully, we become like gardeners oblivious to the deep dependency their plants have on the soil that enshrouds them.
Connecting with nature by spending time outside, retraining our circadian rhythms, connecting with our food sources, and consuming natural, whole foods, may be essential for balancing our minds, emotions, and physical bodies.
A Lack of Key Building Blocks.
Our bodies are like complex machines that need a variety of macro and micronutrients, which provide us with the fuel, building blocks, vitamins and minerals that we need to function.
As I child, I would play with Lego, putting together complex structures according to the blueprints in the box. When I discovered that a piece was missing, I would fret. It meant that my masterpiece would no longer look right, or work. If I was lucky, I might find a similar piece to replace it, but it wouldn’t be the same.
After looking long and hard for it, sometimes the missing piece would turn up. I’d locate it under the carpet, my brother’s bottom, or lodged in a dark corner of the box. Often our bodies don’t get that lucky.
Nutrients like vitamin B12, perhaps, or a specific essential amino acid, or a mineral like magnesium, help our body perform essential steps in its various biochemical pathways.
These pathways follow our innate blueprint for health. They dictate how we eat, sleep, breathe, and create and use energy. They control how our bones and hair grow. They control our mood and hormones. They form our immune systems. These pathways run us.
Our bodies carry out the complicated instructions in our DNA to will us into existence using the ingredients supplied from food. If our bodies are missing one or several of these ingredients—a vitamin or mineral—an important bodily task simply won’t get done.
Dr. Bruce Ames, PhD, theorized that when nutrient levels are suboptimal, the body triages what it has to cove tasks essential to our immediate survival, while compromising other jobs that are important, but less dire.
For example, a body may have enough vitamin C to repair wounds or keep the teeth in our mouths—warding off obvious signs of scurvy, a disease that results from severe vitamin C deficiency. However, it may not have enough to protect us from the free radicals generated in and outside of our bodies. This deficiency may eventually lead to chronic inflammation, and even cancer, years later.
According to Dr. Ames’ Triage Theory, mild to moderate nutrient deficiencies may manifest later in life, as diseases that arise from the deprivation of the building blocks needed to thrive.
In North America, despite an overconsumption of calories, nutrient deficiencies are surprisingly common.
25-50% of people don’t get enough iron, which is important for the transport of oxygen, the synthesis of neurotransmitters, and for proper thyroid function.
One third of the world’s population is deficient in iodine, which affects thyroid health and fertility.
Up to 82% of North Americans are vitamin D deficient. Vitamin D regulates the expression of over 1000 genes in the body, including those involved in mood regulation, bone health, immunity, and cancer prevention.
Vitamin B12 is commonly deficient in the elderly, vegans and vegetarians. It is important for lowering inflammation, creating mood-regulating neurotransmitters, and supporting nervous system health. Deficiency in vitamin B12 can result in fatigue. Severe deficiency can lead to irreversible nerve damage, dementia, and even seizures.
Magnesium is an essential mineral involved in over 300 chemical reactions, including mood and hormone pathways. Over 40% of North Americans do not consume enough magnesium, which is found in leafy green vegetables.
Our bodies have requirements for fats, which make up our brain mass and the backbone of our sex hormones, and protein, which makes up our enzymes, neurotransmitters and the structure of our body: bones, skin, hair, nails, and connective tissue.
Our gut microbiota require fibre.
Our cells need antioxidants to help protect us from the free radical damage from our own cells’ metabolism and our exposure to environmental toxins.
We certainly are what we eat, which means we can be magnificent structures with every piece in place, thriving with abundance and energy.
Despite reasonably good intentions, we can also suffer from nutrient scarcity, forced to triage essential nutrients to keep us from keeling over, while our immune health, mood, and overall vitality slowly erode.
A Body on Fire: Chronic Inflammation.
When we injure ourselves—banging a knee against the sharp edge of the coffee table, or slashing a thumb with a paring knife—our immune systems rally to the scene.
Our immune cells protect us against invaders that might take advantage of the broken skin to infect us. They mount an inflammatory response, with symptoms of pain, heat, redness, and swelling, in order to heal us. They recruit proteins to the scene to stop blood loss; they seal our skin back up, leaving behind only a small white scar—a clumsiness souvenir.
Our inflammatory response is truly amazing.
One the danger has been dealt with, the immune response is trained to turn off. However, when exposed to a stressor, bacteria, or toxin, for prolonged periods, our immune system may have trouble quieting. Chronic issues can contribute to chronic inflammation.
Scientists argue that an inflammatory response gone rogue may be the source of most chronic diseases, from heart disease, cancer, and diabetes, to schizophrenia and major depressive disorder.
The gut is often the source of chronic inflammation as it hosts about 70% of the immune system. When we eat something that our immune system doesn’t like, an inflammatory response is triggered. This can cause digestive issues such as inflammatory bowel disease, celiac disease, and the more common irritable bowel syndrome. It can also lead to more widespread issues like chronic pain, arthritis, migraines, and even mood disorders like Bipolar.
Ensuring optimal gut health through nurturing the gut microbiome, and eating a clean diet free of food sensitivities, is essential for keeping the body’s levels of inflammation low.
Constant Fighting and Fleeing.
Like inflammation, our stress response is essential to our survival.
When facing a predatory animal, our body is flooded with stress hormones that aim to remove us from the danger: either through fighting, fleeing, or freezing. Our stress response is affectionately called our “Fight or Flight” response.
However, like inflammation, problems arise when our stress response refuses to turn off. Traffic, exams, fights with in-laws, and other modern-day struggles, can be constant predators that keep us in a chronically stressed-out state.
Chronic stress has major implications for our health: it can affect the gut, damage our microbiome, alter our circadian rhythms, mess with mood and hormones, and contribute to chronic inflammation. Stress gets in the way of our ability to care for ourselves: it isolates us, encourages us to consume unhealthy foods, and buffer our emotions through food, alcohol, work, and drugs.
We also know that stress has a role in the development of virtually every disease. Like chronic inflammation, it has been found to contribute to chronic anxiety, depression, digestive concerns, weight gain, headaches, heart disease, insomnia, chronic pain, and problems with concentration and memory, among others.
Discomfort with Discomfort.
To assess its impact on health, it helps to determine between two key types of stress: distress, the chronic wear and tear of traffic, disease, and deadlines, and eustress.
Eustress is beneficial stress—the short-lived discomfort of intense exercise, the euphoric agony of emotional vulnerability, or the bitter nutrients of green vegetables—that makes the body more resilient to hardship.
Whenever I feel discomfort, I try to remember the ducks.
Several years ago, on a particularly frigid winter day, I was walking my dog. Bundled against the cold wind, we strolled along the semi-frozen lake, past tree branches beautifully preserved in glass cases of ice. Icebergs floated on the lake. So did a group of ducks, bobbing peacefully in the icy waters.
With nothing to protect their thin flippers from the sub-zero temperatures, they couldn’t have felt comfortable. There couldn’t have been even a part of them that felt warm, cozy, or fed.
There was no fire for them to retreat to, no dinner waiting for them at home, no slippers to stuff frozen, wet flippers into. This was it. The ducks were here, outside with us, withstanding the temperatures of the icy lake. A part of them must have been suffering. And yet, they were surviving.
Far from surviving, the ducks looked down-right content.
I think of the ducks and I think of the resilience of nature.
We humans are resilient too. Like the ducks, our bodies have survived temperature extremes. Our ancestors withstood famine, intense heat, biting cold, terrible injury, and the constant threat of attack and infection, for millenia. You were born a link on an unbroken chain of survivors, extending 10,000 generations long.
Our bodies have been honed, over these hundreds of thousands of years, to survive, even thrive, during the horrendous conditions that plagued most of our evolutionary history.
Investigations into the human genome have revealed genes that get turned on in periods of eustress: bursts of extreme heat or cold, fasting, and high-intensity exercise. When our body encounters one of these stressors, it activates a hormetic responseto overcome the stress. Often the response is greater than what is needed to neutralize the threat, resulting in a net benefit for our bodies.
These protective genes create new brain cells, boost mitochrondria function, lower inflammation, clear out damaged cells, boost the creation of stem cells, repair DNA, and create powerful antioxidants. Our bodies are flooded with hormones that increase our sense of well-being.
It’s like the old adage, “What doesn’t kill you makes you stronger.”
Our bodies were made for discomfort. In fact, we have entire genetic pathways waiting to kick in and heal us as soon as they experience hardship.
There are a growing number of studies on the healing power of small troubles. Fasting may have a role in treating autoimmune diseases, decreasing the signs of aging, and as an adjunct therapy for cancer; sauna therapy boosts detoxification and may prevent dementia; cryotherapy, or exposure to extreme cold, has the potential to heal arthritis and autoimmunity; and High Intensity Interval Training has been shown to boost cardiovascular health more than moderate-intensity exercise.
Plants may benefit us through flavonoids, which, rather than serving as nutrients, act as small toxins that boost these hormetic pathways, encouraging the body to make loads of its own, powerful antioxidants to combat these tiny toxins.
Mindfully embracing discomfort—the bitter taste of plants, the chilly night air, the deep growling hunger that occurs between meals—may be essential for letting our bodies express their full healing potential.
Not Minding Our Minds.
Our ability to withstand powerful emotions may have healing benefits.
Many of us avoid painful feelings, allowing them to fester within us. We buffer them with excess food, or drugs, leading to addictions. Mindfulness can help us learn to be with the discomfort of the emotions, thoughts and physical sensations that arise in the body as inevitable side effects of being alive.
Research has shown that mindfulness can help decrease rumination, and prevent depressive relapse. It also helps lower perceived stress. How we perceive the stressors in our lives can lower the damaging effects they have on us. Research shows that those who view their life stressors as challenges to overcome have lower stress hormone activation, and experience greater life satisfaction.
According to Cognitive Behaviour Therapy (CBT), our thoughts create our emotions. Becoming more aware of our thoughts, through CBT or mindfulness, allows us to identify which thoughts may be limiting us or exacerbating our reactions to stressful situations.
When we learn to observe our thoughts, we create some distance from them. We become less likely to see the dismal thoughts in our minds as absolute truths.
Practicing mindful meditation, CBT, or cultivating positive thoughts, such as engaging in a daily gratitude practice, may improve our resilience to chronic stress.
Inattention.
According to Stephen Cope, yoga teacher and author of The Great Work of Your Life, “You love what you know deeply. Get to know yourself deeply”. We get to know things deeply by paying attention to them.
Georgia O’Keefe’s admiration for flowers, or Monet’s adoration of landscapes, is apparent to anyone who sees their work. In order to commit images to canvas, the artists gets to know their subject matter deeply. Their art celebrates what they took the time to pay attention to, and eventually came to love.
As a naturopathic doctor, I believe that healing begins with attention. When we become aware of our bodies, we begin to know them deeply. Awareness allows us to respond to symptoms lovingly, the way a mother learns to skillfully attend to her baby’s distinct cries.
When I first meet a new patient, the first thing I have them do is start to pay attention.
We become curious about their symptoms, their food intake, their sleep patterns, their habits and routines, the physical sensations of their emotions, the thoughts that run through their heads.
Through paying attention, with non-judgmental curiosity, my patients start to understand their bodies in new ways. They learn how certain foods feel in their bodies, how certain sleep habits affect their energy levels the next day, and how specific thoughts contribute to their feelings.
Once we begin to open up this dialogue with our bodies, it becomes impossible not to answer them with love. It becomes hard not to eat, sleep, and move in ways that convey self-respect.
A gardener who pays deep attention cannot ignore the obvious—her plants have roots, embedded in soil. The gardener quickly learns, through careful observation, that the health of this soil is vital to the health of her plants.
And so, back to the original question, “What is your favourite natural cure for anxiety?”
My favourite remedy isn’t a bottle of pills we reach for, it’s a question we reach for from within:
“What do I need to heal?”
After asking the question, we wait.
We wait for the answer to emerge from some primal place within, just as a gardener waits for new buds to rise out of the mysterious depths of the dark, nutritious soil.
“I followed X, Y, Z (controversial) diet, and my doctor said my blood is fine!”
Firstly, what do we think doctors are testing our blood for? Most standard blood tests look at cholesterol, check for anemia, and to see if our kidneys are failing or not.
If you’re lucky, your doctor might test your iron levels, B12, and thyroid function (using one hormone measure, TSH, which often fails to pick up cases of under-active, or autoimmune, thyroid).
Your doctor is likely not looking at inflammation levels, vitamin levels, hormone levels, insulin resistance, or delving into the nuances of your cholesterol levels. Standard blood tests do not provide a comprehensive analysis of your health status. Rather, they rule out the presence of serious disease.
Your blood tests are “fine” because the markers that might actually be negatively (or positively) impacted by your diet and lifestyle are simply not tested for.
Secondly, let’s challenge the notion of “fine”.
For most practitioners, “fine” means, “You don’t qualify for a diagnosis of X disease, which would justify the prescription of Y medication.”
I meet a lot of patients whose B12 levels aren’t “fine”, or whose thyroid levels are certainly not “fine”.
Sure, they are not deficient to the point where they have dementia (from low B12), or where they need thyroid hormone replacement medication, but their bodies are not working optimally.
If we dig a bit below the surface, we find that they are insulin resistant, they have elevated anti-thyroid antibodies, their B12 and iron levels are suboptimal, or their ovaries are not making progesterone.
Someone with these lab markers may not get a disease diagnosis from their medical doctor, and they may not need medication yet, but they’re not “fine”.
Oftentimes your blood tests are fine for decades—until they’re not fine.
This is a classic problem for those who are diagnosed with diabetes. I believe that for many patients, if we had done some exploration of their symptoms and blood 15 to 20 years earlier, we could have detected insulin resistance simmering below the surface of the conventional lab tests. (https://www.ncbi.nlm.nih.gov/pubmed/16627374)
Perhaps we could have prevented their diabetes, and subsequent cellular and metabolic damage, altogether.
I love it when we can do more in-depth lab testing based on your individual signs, symptoms, and risk factors. We take a full inventory of your lifestyle and health history and really dive into the nitty-gritty when it comes to preventing the diseases that your doctor looks for when ordering lab tests.
With the right approach, we might be able to keep those lab tests looking “fine”.
Like many people I see, Sandra was experiencing debilitating exhaustion.
Completing her PhD, she was working all day and collapsing on the couch at 8 pm.
She stopped going out in the evening. She ceased spending time with friends, engaging in activities outside of her studies, exercising, and having sex.
Her motivation and zest for life were at all-time lows.
Her marriage, and her life, were being sidelined in the service of her fatigue.
Her family doctor met her complaints with a defeated shrug. “You’re just getting older,” he offered by way of explanation.
Sandra was 27.
My patient is not alone. At least 20% of patients approach their family doctors complaining of fatigue.
Lack of energy is a problem that can arise from any body system. Fatigue can be an early warning sign that something has been thrown off balance.
I frequently see fatigue in patients suffering from hormone imbalances, including suboptimal thyroid function, insulin resistance, and low estrogen, progesterone, or testosterone. But also in chronic stress, depression, and anxiety.
Fatigue is often connected to mental health conditions, digestive issues, lifestyle imbalances, chronic inflammation, chronic stress, and lack of restful sleep. It’s no wonder, then, that most of the people I work with experience some level of low energy.
Conversely, I see improvement in energy as one of the first signs that someone is moving towards more robust health. Some of the first signs of healing are a clear mind, bright mood, and vibrant, buoyant energy.
There are a few steps you and your naturopathic doctor can take to identify and remove the cause of fatigue, while optimizing your health and energy levels.
Differentiate between sleepiness and fatigue.
It is important to determine if low energy is fatigue or sleepiness.
Sleepiness is characterized by the tendency to fall asleep when engaging in non-stimulating activities like reading, watching TV, sitting in a meeting, commuting, or lying down.
Sleepiness:
Is often improved by exercise, at least in the short-term
Is improved with rest
Fatigue is characterized by a lack of energy, both physical and mental. Fatigue is often worsened by exertion.
Those who are fatigued:
Suffer from mental exhaustion
Experience muscle weakness
Have poor endurance
Typically feel worse after physical exercise and take longer to recover
Don’t feel restored after sleeping or napping
Might experience ease in initiating activities but progressively experience more weakness as they continue them (e.g.: engaging in social activities, movement, working, etc.)
To determine between sleepiness and fatigue, your naturopathic doctor will ask you a series of questions about the nature of your low energy.
2. Assess sleep.
Assessing and optimizing sleep is essential for beginning to treat all low energy and, in particular, sleepiness.
Assessing sleep involves looking at a variety of factors such as:
Bedtime and waking time
Sleep onset: how long it takes
Sleep routine and sleep hygiene habits
Sleep duration: how many times you wake up, how quickly you can fall back asleep after waking
Causes of interrupted sleep such as sleep apnea, chronic pain, frequent urination, children/pets/partners, etc.
Nap frequency and length
Ability to wake up in the morning
Perceived sleep quality: do you wake feeling rested?
The use of sleep aids
Exercise routines, how close to bedtime you eat or exercise.
And so on.
Using a sleep app or undergoing a sleep study are two additional tools for assessing the quality and duration of your sleep cycles that may be useful.
3. Address sleep issues.
Whether the cause of fatigue is sleepiness or not, restful sleep is essential to restoring our energy levels. Optimizing sleep is an important foundational treatment for all health conditions.
Restorative sleep regulates hormones and balances the stress response, called the hypothalamic-pituitary-adrenal axis (HPA axis). It improves cell repair, digestion, memory, and detoxification.
Mental and emotional stress, artificial light, blood sugar dysregulation, inflammation, and hormone imbalances can interfere with sleep.
To address issues with sleep, it is important to:
Maintain a strict sleep schedule. This means keeping bedtime and waking time consistent, even on weekends.
Practice good sleep hygiene by avoiding electronics at least an hour before bedtime, using blue light-blocking glasses if necessary, and keeping the bedroom as dark as possible.
Avoid stimulating activities like exercise in the hours before bed.
Keep the bedroom cool and dark.
Reserve the bed and bedroom for sleep and sex only.
Balance circadian rhythms by exposing your eyes to sunlight immediately upon waking and eating protein in the morning.
In addition to sleep hygiene and balancing circadian rhythms, sleep aids can be helpful. I start my patients with melatonin, a non-addictive antioxidant, to reset the sleep cycle and help with obtaining deeper, more restorative sleep.
It is important to take melatonin in a prolonged-release form a few hours before bedtime and to use it in addition to a dedicated sleep routine.
Determine whether the fatigue is secondary to an underlying medical condition.
Secondary fatigue is defined as low energy, lasting from 1 to 6 months, that is caused by an underlying health condition or medication.
With your medical or naturopathic doctor, be sure to rule out any issues with your immune system, kidneys, nervous system, liver, and heart, and to assess the side effects of any medications you’re taking.
Ruling out chronic infections, pregnancy, anemia, and cancer may be necessary, depending on other signs and symptoms that are present, your individual risk factors, and family history.
While the vast majority of fatigue is not caused by a serious health condition, ruling out more serious causes is an essential part of the diagnostic process.
Remember that this is not a job for Dr. Google! Because fatigue is a sign that something in the body is not functioning optimally, it can be implicated in virtually every health condition, alarmingly serious ones, but also more benign conditions as well.
Taking into account your entire health history, risk factors and particular symptoms, as well as assessing blood work is a complex job that a regulated health professional can assist you with.
Get blood work done.
Assessing blood work is necessary for ruling out common causes of fatigue.
Blood tests are used to rule out anemia, infections, suboptimal iron, B12, and folate levels, under-functioning thyroid, inflammation, insulin resistance, and hormonal imbalances.
To evaluate the cause of fatigue, your doctor will look at:
A complete blood count (CBC) that looks at your red and white blood cells.
inflammatory markers like ESR and hs-CRP
TSH, to assess thyroid function, and occasionally free thyroid hormones and thyroid antibodies, if further investigation is indicated
B12, iron and folate
Other tests such as fasting insulin, fasting blood glucose, liver enzymes, and hormones like estradiol, testosterone, estrone, LH, FSH, and progesterone, depending on the health history and the constellation of symptoms.
Your doctor may take further measures to assess your heart and lungs, or to rule out chronic infections.
6. Identify physiologic fatigue, or burnout.
Once sleepiness and any underlying health conditions have been ruled out, your doctor may determine whether you have physiologic fatigue.
Physiologic fatigue, also commonly called “burnout” or “adrenal fatigue”, is the result of an imbalance in sleep, exercise, nutrition intake, and rest.
It is by far the most common category of prolonged fatigue that I see in my practice. Two thirds of those experiencing fatigue for two weeks or longer are experiencing this type of fatigue.
Feeling a lack of motivation, low mood, and increased feelings of boredom and lethargy are characteristics of this kind of fatigue.
Physiologic fatigue can be confused with depression, leading to a diagnosis and subsequent antidepressant prescription, which may fail to uncover and address contributing lifestyle factors.
To tell if you might be experiencing physiologic fatigue, or burnout, see if you answer yes to any of the following questions, adopted from the Maslach Burnout Inventory:
I feel emotionally drained at the end of the day.
I feel frustrated with my job.
I feel I’m working too hard.
I feel fatigued when I have to face another day.
I have a hard time getting up in the morning on weekdays.
I feel less sympathetic and more impatient towards others.
I am more irritable and short-tempered with colleagues, my family, my kids.
I feel overwhelmed.
I have more work than I can reasonably do.
I feel rundown.
I have no one to talk to.
Fortunately, there are many solutions to improving low energy and mood caused by burnout.
Balance the HPA Axis
Balancing the stress response, otherwise known as the Hypothalamus-Pituitary-Adrenal (or HPA) axis, is an important component of treating physiologic fatigue.
Our HPA axis becomes activated in the morning when the hormone cortisol is released from the adrenal glands. Cortisol suppresses inflammation and gives us the motivated, focussed energy to go about our day.
Towards the end of the day, cortisol levels naturally fall. In the evening, cortisol is at its lowest, and melatonin, our sleep hormone, rises.
Those with HPA dysfunction have an imbalance in this healthy cortisol curve.
They commonly experience sluggishness in the mornings, a crash in the afternoon (around 2 to 4 pm), and restless sleep, often waking up at 2 to 4 am as a result of nighttime cortisol spikes and an impairment in melatonin release.
These individuals often experience cravings for salt and sugar. They may have low blood pressure and feelings of weakness.
It is common for those experiencing burnout to get sick when they finally take a break or experience prolonged healing time from common infections, likes colds and flu.
They may suffer from inflammatory conditions like chronic migraines, muscular tension, and report feeling depressed or anxious.
In this case, balancing the HPA axis is a treatment priority.
Treatment involves:
HPA axis balancing through adaptogenic herbs
Optimizing adrenal nutrient levels
Regulating blood sugar
Improving circadian rhythms
Reducing workload and perceived stress through addressing perfectionism, practicing setting boundaries, and developing mindfulness, among other skills.
Improving sleep
Engaging in regular, scheduled exercise
Reducing inflammation, improving digestion, or regulating hormones
Being proactive about mental health and emotional wellness
Improving self-care and stress resilience
Cognitive Behaviour Therapy can be used to teach healthy coping skills while balancing sleep and stress. Studies show it can be more effective than medication for the depression and anxiety related to physiologic fatigue.
Of course, from a holistic perspective, the above strategies are the foundations for improving general health and wellness for all fatigue-related conditions, regardless of whether the fatigue is due to sleepiness, secondary fatigue, physiologic fatigue, or chronic fatigue syndrome.
Talk to your naturopathic doctor about adaptogenic herbs.
Adaptogenic herbs are an important natural tool for improving mood and energy.
Adaptogens help the body “adapt” to stress. They up-regulate genes involved in boosting the body’s natural stress resilience.
Because of this, adaptogens not only improve energy and mental and physical endurance, they also improve attention and concentration, immune system function, and mental work capacity.
They can treat depression and anxiety, and regulate circadian rhythms.
Common adaptogens are withania (or ashwaghanda), rhodiola, holy basil, the ginsengs, like Siberian gingseng (or eleuthrococcus), schizandra, liquorice, and maca, among others.
My two favourite adaptogens are ashwaghanda and rhodiola, however your naturopathic doctor can work with you to pick the best herbal combination for your individualized needs.
9. Rule out Chronic Fatigue Syndrome.
Chronic fatigue syndrome (CFS) is characterized by fatigue that lasts 6 months or longer, is not improved by exercise and rest, is not related to an imbalance in lifestyle, and is not caused by a primary health condition.
Those with CFS often have signs of an activated immune system such as enlarged lymph nodes, a low-grade fever, or a sore, inflamed throat. Sufferers may experience generalized weakness and pain.
CFS can be an extremely debilitating condition that results in a 50% reduction of daily functioning.
The cause of CFS is not known, however balancing HPA axis function, improving nutrient status, reducing inflammation, healing the gut, reducing toxic burden, boosting mitochondrial functioning, and promoting self-care are all useful treatment strategies.
Our gut is the seat of the immune system, sampling foreign substances from the external environment and activating an immune response, if it finds any of those substances pose a threat to the health of the body.
If our immune system comes into contact with something doesn’t like, even if that something is a benign food substance, an inflammatory reaction can be triggered. Chronic inflammation can exacerbate fatigue.
To test for food sensitivities, your naturopathic doctor will either order a blood test, or recommend an elimination diet where suspicious food is removed from the diet, the gut is healed, and foods are later reintroduced.
Common foods to eliminate are gluten, dairy, sugar, eggs and soy. Stricter Autoimmune Paleo diets involve the removal of all dairy, eggs, grains, legumes, and nuts.
Mind your mitochondria.
Our mitochondria are the “powerhouses” of the cell, responsible for making ATP, our body’s energy currency, out of the carbs, protein, and fats from our food.
Research has shown a link between mitochondrial dysfunction and chronic fatigue.
The mitochondria need a variety of different nutrients to function optimally. These nutrients include B vitamins, magnesium, Coenzyme Q10, and certain amino acids.
When the mitochondria are unable to produce sufficient ATP, fatigue may result. Similarly, a problem with antioxidant production can result in the buildup of reactive oxygen and nitrogen species, otherwise termed “free radicals”, in the mitochondria.
Free radicals can trigger inflammation and immune system activation in the entire body, causing us to feel ill and fatigued.
B vitamins are also important for a process called “methylation” which is essential for energy and hormone production, immune function, detoxification, mitochondrial function, and DNA repair.
Balance your blood sugar.
Insulin resistance, hypoglycaemia, type II diabetes, and metabolic syndrome are all common conditions that reflect the body’s inability to regulate blood sugar.
All of these conditions can cause frequent energy crashes, fatigue after eating, brain fog, and lethargy.
Even those free of the above conditions may still struggle with blood sugar imbalances. Signs of blood sugar dysregulation are craving sweets, feeling hungry less than 3 hours after a meal, getting “hangry”, feeling weak and dizzy if missing meals, waking at night, and snacking at night.
Balancing blood sugar by eating enough fibre, fat and protein at every meal is essential to maintaining the endurance to get through the day.
Your naturopathic doctor can help you come up with a diet plan that keeps your blood sugar balanced and your energy levels stable throughout the day.
Support your immune function and eradicate chronic infections.
Chronic infections can result in prolonged activation of the immune system, resulting in chronic fatigue.
Viral infections, like mononucleosis and Epstein Barr, and gut bacteria imbalances, such as SIBO, C. Difficile, and candida overgrowth can be implicated in chronic fatigue.
Supporting the immune system with herbs, balancing the HPA axis, and using natural remedies to eradicate the infection are all courses of action you may take with your naturopathic doctor to eradicate infectious causes of fatigue.
Uncover and treat hormone imbalances.
Our hormones, the messengers of the body, regulate how our cells talk to each other.
Hormones are responsible for blood sugar control, the stress response, ovulation and fertility, sex drive, metabolism, and, of course, energy production and utilization.
It is possible that those who suffer from low energy have an imbalance in the hormones cortisol, insulin, estrogen, progesterone, DHEA, testosterone, or thyroid hormones. Directly addressing hormones is then the main treatment goal for improving energy.
Uncovering other signs of hormonal imbalance, such as the presence of PCOS, endometriosis, or symptoms of hypothyroidism, as well as ordering blood tests, can help reveal if an imbalance in hormones is the main cause of your fatigue.
Encourage detoxification.
Our body has the powerful ability to process and eliminate the 500 chemicals and toxic substances we come into contact with daily, as well as the hormone metabolites and immune complexes produced as a result of normal metabolic functioning.
Our livers, kidneys, colon, and skin regularly filter hundreds of harmful substances from our bodies. This process happens naturally without the aid of outside support.
However, it is possible that an increased toxic burden on the body paired with a sluggish liver and digestive system, can increase the body’s overall toxic load.
Toxic overload can contribute to fatigue by increasing inflammation and immune system activation, as well as impairing energy production pathways, and disrupting hormonal function.
Reducing contact with harmful toxins, while supporting kidney, liver and colon function can help restore optimal energy and health.
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Treating fatigue first involves developing a relationship with your healthcare provider: finding someone who takes your concerns seriously.
Conducting a thorough assessment of blood, lifestyle factors, sleep, hormones, and digestion, and as many other factors as possible, is essential to uncovering the cause of fatigue.
Treatment involves removing obstacles to healing, supporting energy production, balancing lifestyle, and using herbs to boost energy and stress resilience.
When we consider fatigue as an important sign that something in our body is functioning sub-optimally, we can use our energy levels are important indicators for health.
Is your multivitamin or B-complex making you sick?
Take a look at the label on your multivitamin or B-complex and see if it contains “folic acid”.
Folic acid is often used interchangeably with “folate”, which is a vitamin needed for DNA synthesis and repair.
Every time our bodies make new cells (which is all the time), we need folate to move that process along.
Because very few of us North Americans get enough folate from leafy greens, folic acid, a synthetic precursor to folate, has been added to grain products, to “fortify” them.
Folate deficiency in pregnant women can lead to neural tube defects. Therefore making sure that your body has enough folate, especially if you’re pregnant or planning to conceive, is essential.
However, folic acid, the synthetic vitamin is NOT the same as the folate (look at the bottom of the chart below, another word for folate is 5-methyltetrahydrafolate, or 5-MTHF) that our bodies use for cell division and DNA synthesis.
As you can see by the picture, folic acid needs to go through several stages of transformation before it can be of any use to the body.
All of us are really poor at converting folic acid to DHF (first step in the pathway). This step is faster in rats. In humans, it’s abysmally slow.
This means we take folic acid from supplements and fortified grains and slowly pass it through the narrow DHFR sieve that all of us are born with. This slowly transforms our synthetic folic acid into DHF.
The same DHFR enzyme must take DHF and turn it into THF. Two steps: folic acid –> DHF –> THF. So far, none of these products is useful.
3 steps and 2 enzymes later, our body makes a product called 5,10 methylene THF, or folinic acid, which can be used for DNA repair and synthesis.
After that, an enzyme called MTHFR turns folinic acid into folate (5-MTHF). And yes, MTHFR does remind you of the word you’re thinking of!
About 40-60% of us are poor at the last step, making 5-MTHF, which results from a slow or completely impaired MTHFR gene which has trouble producing a fully functioning MTHFR enzyme.
Slow enzymes mean very few of us are going to take the folic acid from foods and cheap vitamins, and turn them into methylfolate.
Methylfolate (remember, NOT folic acid), is needed for important chemical reactions called “methylation” reactions.
Methylation is needed for with detoxification, liver function, managing inflammation, hormone production and recycling, and producing neurotransmitters. Research is establishing a connection between MTHFR gene mutations and mental health conditions, autoimmune conditions and heart disease, among other common health complaints.
Folic acid, when added to supplements isn’t just useless, however.
When it can’t be broken down (and remember, all of us are slow at the first stop, some of us just plain can’t perform the last step), it builds up in tissues, and can block ACTUAL methylfolate action.
It can also trigger inflammatory reactions.
Not good.
Most multivitamin and B complex brands at health food stores contain cheaper forms of B vitamins. Companies use folic acid and a cheaper, synthetic form of B12, called cyanocoblamin, when making products to cut costs.
This doesn’t mean you have to shell out a lot of cash for quality B complex vitamins, it just means you need to be smart about the B-complexes you buy.
B-complex vitamins can be useful for those who experience inflammation, hormone imbalances and chronic stress. We tend to use more B-vitamins, which are water-soluble, when stressed, and when on certain medications, such as birth control pills. Supplementing in these cases can be extremely helpful for boosting energy and mood, while lowering symptoms of PMS and inflammation, among other things.
Most of the patients who come into my office already on a B complex are on a form that contains folic acid. At best, their body is working harder than needed to convert this synthetic vitamin into something useful. At worst, this product may be causing them harm.
The first thing you can do, is check your multivitamins and B-complex products and see if they contain “folic acid” or “cyanocobalamin”. If so, you can toss them.
You can also consider getting tested to see if you have an MTHFR mutation. Keep in mind that naturopathic doctors who are registered in Ontario, Canada cannot recommend or interpret genetic testing.
Next, you can reassess your diet. Folic acid is also added to enriched grains. Those who are particularly sensitive to folic acid, may experience a worsening of inflammatory symptoms and mental health issues when consuming high amounts of these foods.
Also, eat plenty of leafy green vegetables, which DO provide your body with a useable form of folate, among their many other health benefits.
Finally, if you’re considering getting pregnant, have a naturopathic doctor assess your prenatal vitamins to tell you if the form of folate you’re taking is appropriate for you.
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?
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:
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.
Snacks should contain protein to keep blood sugar steady (aim for about 10-20 g of protein, depending on the size of the snack).
Snacks should contain healthy fats.
Snacks should be nutrient-dense, containing essential vitamins and minerals that your body needs to keep its enzymes and chemical reactions and hormones buzzing.
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:
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
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.
ÏÏAround the same time that the American Heart Association published a paper warning the public that coconut oil contained saturated fat, supposedly leading to heart disease, Netflix released the vegan documentary What the Health, which declared diabetes to be a disease of fat buildup in the blood, among other completely unscientific claims.
It was no wonder that my inbox and social media were bombarded with comments from confused patients, family members and friends; their attempts at healthy eating were being called into question by this onslaught of confusing contradiction.
“But I’ve been adding coconut oil to my morning smoothies!” one person wrote.
“I’ve switched to a plant-based diet!” another triumphantly declared. She was currently seeing me for treatment for her long-standing anemia.
Don’t: Freak Out
It seems like every new nutrition-focused Yahoo! News article lifts the protective rock of certainty off the health-conscious, sending us scuttling frantically for cover like newly exposed garden grubs.
You can hardly blame us. As someone who studies health and nutrition for a living, even I find myself caught up in this health claim game of ping-pong. How could one claim be true if the complete opposite claim was being made? Was coconut oil the devil incarnate, or the next belly-fat blasting super food? Do vegan diets cure diabetes or cause it?
I take my eyes off the ping pong ball and stop to massage my neck.
Do: Understand the Power of Food
If there is one right diet for humans, then we certainly haven’t found it through modern-day nutritional research. One of the problems with finding a standardized “perfect” human diet is that humans are not gerbils: our food serves various functions.
A good diet fuels the body, prevents disease and promotes health, but also provides us with a source of pleasure, soothes emotional pain, gives us something to look forward to, serves as a reward (for ourselves, our loved ones, our children), takes centre stage during celebrations, supports social cohesion, and encourages meeting attendance, or blood donations.
Food allows us to wallow in the luxury of our senses, or to commune with the Divine. Eating and making food serve as hobbies, creative outlets, and so on.
Food holds a sacred place in virtually every human culture.
As a naturopathic doctor, I use food as a medicine; the food we eat has the power to reverse disease and promote health.
With conditions like cardiovascular disease, type II diabetes, and mental health conditions, on the rise, it becomes imperative that we make an effort to understand the health impact of our food choices.
Understanding the Do’s and Don’t’s of Nutrition can help us harness the power of food to heal the body and prevent disease.
Do: Be Critical of Nutrition Research
Nutritional research, while essential for separating the gluten-filled wheat from the chaff, is flawed in many regards.
Because well-controlled, long-term clinical trials on compliant humans are nearly impossible to do, much of the nutritional information we rely on comes from epidemiological studies, which establish relationships between two isolated variables, such as a food and a health outcome (red meat consumption and colon cancer incidence, for example).
When evaluating these studies it is important not to confuse correlation with causation. This is what happened in the 1950’s, when Ancel Keys published his famous Seven Countries Study that claimed to link saturated fat intake and coronary artery disease.
Keys’ findings led us to toss out our delicious bacon and egg breakfasts in lieu of spending the next 60 years munching fat-free yogurt and sugary cereal.
Keys assumed that because saturated fat, dietary cholesterol, and heart disease were linked (in the seven countries he included data for) that the relationship was causal. However, we know from current research that this is not true—correlation does not equal causation.
Other things that correlate with an increased incidence of heart disease are paying tax in Sweden and owning multiple TV sets. While paying taxes may certainly give you chest pain, avoiding them will probably not reduce your heart disease risk.
Nutrition researchers attempt to account for as many relevant lifestyle variables as possible, but there are many that they miss.
For example, studies may record whether the participants smoked, drank, or exercised, but important variables such as the status of their gut microbiome, or how they season their meat, are often left out. This can be problematic—when we fail to include everything, we’re bound to miss something.
While nutritional research is essential for understanding how food interacts in our bodies, we certainly need to take most studies with a grain of salt (which a new study shows has no impact on your blood pressure).
Do: Pay Attention to What Healthy Traditional Societies Ate
Speaking of salt, any human nutrition article wouldn’t be worth its weight in it without mentioning the work or Dr. Weston A. Price. Dr. Price was a Canadian dentist who lived at the turn of the 20th century, when food was becoming more industrialized.
Suspecting that the increase in tooth decay he was noting in his child patients was diet-related, Price set out on a 10-year journey in the 1930’s to find the “perfect diet” by analyzing what traditional human societies ate.
He studied populations in remote Swiss villages, in the Americas, African tribes, Australia and New Zealand, and the Melanesian and Polynesian South Sea Islanders. Dr. Price took meticulous notes, food samples for analysis, and many pictures, all of which he published in his book Nutrition and Physical Degeneration.
While many of the populations he studied had also begun to experience the creeping influence of an industrialized food economy, others had still managed to retain their native diets. Due to globalization and its effects on traditional communities, this type of study could never be done today.
Price found some of the populations exhibited incredible characteristics of robust health. They had decay-free, straight white teeth, flawless facial and jaw structures indicating healthy bones, and no diseases; cancer and autoimmune conditions were virtually nonexistent across generations in these populations.
Price noticed that, while the healthy populations’ diets consisted of a variety of foods and macronutrients, they all had very important commonalities.
Don’t: Consume Processed Foods:
First of all, Dr. Price found that the healthiest populations somehow managed to avoid the flood of industrial food products. They refrained from eating refined flours, sugars, food additives, and vegetable oils, and stuck to their native diets of meat, eggs, dairy, fish, fruits, and vegetables.
He noted that, once processed foods started to creep into a population’s diet, dental decay and degenerative diseases, such as cancers, tended to quickly follow.
Don’t: Eat Anything Your Grandmother Wouldn’t Recognize
Michael Pollen, author of The Omnivore’s Dilemma, reminds us of some simple food rules, such as his famous “Eat food. Not too much. Mostly plants.”
In his book, Pollen clearly differentiates between “food”, i.e.: something your grandmother would recognize, and something “made from a plant, not in one”, and “edible food-like products”, which tend to increasingly populate our grocery stores, kitchen cupboards, and bodies.
Refined sugars and vegetable oils have increased exponentially in the average diet in the past few decades. So have metabolic degenerative diseases such as cancer, diabetes, and heart disease.
It seems that the entire food industry, from the way grocery stores are set up, to the way that foods are marketed to consumers, to the promotion of a culture of snacking, is built around encouraging the consumption of processed, “edible food-like products” rather than real foods.
The book The Dorito Effect outlines how the food industry engineers processed foods to contain taste, textures and chemicals that override our body’s hunger and satiation signals in order to monopolize our cravings, leading us to overeat.
Steering clear of these packaged, processed and over-produced food-like products is essential for promoting health.
Do: Eat Whole Foods
Stick with consuming what Michael Pollen classifies as “food”: whole substances that come from plants and animals, that resemble how they are found in nature, and that usually exist in the periphery of the grocery store.
Prepare foods at home as much as possible. Avoid foods in packages that contain more than 5 ingredients, especially if the ingredients listed are unpronounceable, or something your average 5th grader wouldn’t recognize.
As early on as the 1930’s, Dr. Weston A. Price was already noting an increase in tooth decay and jaw malformation in children who were consuming the industrialized processed foods that were beginning to enter the North American diet.
Since then our consumption of processed foods, refined sugars, vegetable oils and flours has increased, and so have our incidences of chronic, lifestyle-related diseases.
Therefore: Eat Food. Not too much. Mostly plants (and animals).
Do: Consume Animal Products
Dr. Price found that every population he studied consumed some form of high-nutrient animal product. While some populations were vegetarian, consuming raw dairy products, none were vegan.
Every healthy population consumed some combination of fish, organ meats, insects, eggs and dairy from pastured animals. All animals consumed were obtained from nature and ate their natural diet; cows ate grass and poultry ate grass, grubs, and worms.
They consumed the entire animal, favouring nutrient-rich organs over muscle meat: liver was highly valued. They used bones to make gelatin, which provides a source of bone, skin and connective-tissue-building collagen.
Obtaining enough organ meats, fish, egg yolks and grass-fed beef and dairy allowed the healthiest populations to achieve ten times the dietary intake of the fat-soluble vitamins A, E, D and K than the typical North American.
Do: Consume Fat
The healthiest populations that Price studied consumed anywhere from 30 to 80 percent of their total calories from fat. Most of these fats were saturated, obtained from animal sources, and heart-healthy monounsaturated fatty acids, obtained from foods such as olives, avocados, and macadamia nuts. Only 4% of the fat they consumed came from the polyunsaturated fats that are found in vegetable oils, nuts, seeds, processed grains and legumes (like corn and soy), and fish.
Vilified for years in North America, fat is essential to the human diet: it builds our brains, nervous systems, hormones, and cell membranes. Fat is a fuel source for our brains. It aids our bodies in blood sugar regulation and the absorption of essential nutrients.
Contrary to what we’ve been told for the last few decades, a low-fat diet, rather than a high-fat one, is associated with increased risk of mortality.
A 2017 Lancet study that observed the diets and disease risk of 135,000 people found that total fat intake, including saturated fat, was not associated with any increase in cardiovascular disease or mortality. The study also found that when saturated fat intake increased the risk of stroke decreased.
Don’t: Consume Vegetable Oils
Polyunsaturated fats, or PUFAS, exist as omega 6 (found in processed vegetable oils like corn, soy or canola oil) and omega 3 fatty acids (found in fish, nuts and seeds).
Healthy human populations generally obtained a 1 to 1 ratio of omega 6 to omega 3 fatty acids. The increase in cheap vegetable oils in our diets has brought our inflammatory omega 6 fatty acid levels up substantially, to a ratio of 10 to 1. With this increase we see a rise in inflammatory health conditions: arthritis, diabetes, obesity, cardiovascular disease, mental health conditions, and autoimmune disease.
Vegetable oils like canola, corn and soya oil require intense chemical processing and are very unstable, becoming rancid quickly. Their high omega 6 content promotes inflammation.
Avoid these oils whenever possible by avoiding store-bought salad dressings, packaged foods, restaurant foods, and fried foods. Instead, cook from home whenever possible using the healthier oils from olives, coconut, and avocado, or using butter and ghee.
Do: Consume Fermented Foods
Our microbiome, the universe of trillions of bacteria that live inside our digestive tracts, has become the subject du jour of intense medical research. The health of our guts has been associated with virtually every disease, from our mental health to our risk of inflammatory, degenerative diseases, to our circadian rhythms and stress responses.
It is no wonder, then, that Weston A. Price, found in the 1930’s what modern science is now confirming: the healthiest human populations regularly consumed fermented foods, like kefir, that were rich in healthy probiotics.
These populations also soaked, fermented and sprouted their grains, seeds and legumes to neutralize their lectins and phytates. Lectins present in grains and legumes can cause inflammation and autoimmune reactions, while phytates act as anti-nutrients, preventing absorption of minerals in the digestive tract.
Fermentation supports the health of our gut bacteria and aids in the digestion of various foods.
Do: Personalize Your Diet
While the work of Weston A. Price and intuitive wisdom—avoid fake foods wherever possible—can serve us in our eating choices, there was a significant amount of variability among the foods consumed in healthy human diets.
How do we know what foods will help us thrive personally?
Eran Segal, in his popular Ted Talk, presents a variety of blood sugar responses to different types of carbohydrate-rich food.
When we eat food high in carbohydrates, our blood glucose levels rise as those carbs are broken down into simple sugars in the digestive tract and then absorbed. Constantly spiking blood sugar levels, when done repeatedly over time, is a recipe for fat-gain and increasing our risk of type II diabetes.
Segal and his team found that some foods, like bananas or white rice, caused a marked increase in blood sugar levels when some study participants ate them, while foods like cookies and ice cream had no effect, slowly raising blood glucose levels rather than dramatically spiking them.
There were other study participants, however, who experienced the opposite effect: a marked spike in blood sugar in response to sugary foods, like ice cream, and a more gradual increase (consistent with healthier blood-glucose control) in response to rice and cereal grains.
Segal found that an individual has a personalized blood sugar response to certain foods, which can be predicted by their genetics and microbiome, among other factors.
Segal’s team concluded that dietary guidelines are not one-size-fits-all. Each individual may have a specific set of foods on which they thrive.
Do: Find Your Perfect Diet
So, how do we find our perfect personalized diet?
Life coach, Brooke Castillo, of the Life Coach School Podcast has some useful guidelines. Castillo suggests four questions to ask yourself when eating a specific food to find out if that food is right for you:
1) Does this food taste good to me?
2) Does this food feel good in my body?
3) How is this food acting in my body?
4) Is this food helping me get me the health results that I want?
Do: Eat Food You Like
As a naturopathic doctor, I know: it doesn’t matter how good a particular food may be, if my patient doesn’t like it, he or she won’t eat it.
Finding the perfect diet for us involves eating a variety of unprocessed foods that provide us with fuel and that we look forward to eating. However, it can take a while to learn what real food tastes like if our palates have been manipulated by the chemically-enhanced flavours of processed foods.
Ayurveda, a 6000-year old medicine from India, identifies 6 tastes: sweet, sour, salty, spicy, astringent and pungent; a healthy diet consists of all 6 tastes.
The Standard American Diet contains mostly sweet taste, with some salty and sour (alcohol) added to the mix. Being relatively rare in nature, the human palate evolved to prefer these tastes over others (such as bitter taste, which is abundant in antioxidant-rich plants).
In order to balance our diets, we may need to make an effort to consume more bitter or astringent foods from micronutrient-rich leafy green vegetables. Training ourselves to appreciate a variety of tastes may be important for finding a diet that fuels us while also bringing us pleasure.
Do: Pay Attention to How Foods Feel in Your Body
If Eran Segal’s study subjects had had experience practicing mindful eating and body awareness, I wonder how many of them would have already known whether their bodies could better tolerate white rice or ice cream.
If they had been paying attention to their body’s cues, it’s possible that they already knew that white rice spiked their blood sugar, causing symptoms of shakiness, dizziness, brain fog and lethargy, or increased hunger and sugar cravings.
Whenever I see a new patient, I have him or her record their food intake for two weeks along with any symptoms experienced in their bodies. This exercise almost always proves useful in a variety of ways. Patients notice that certain foods make them feel bloated and lethargic, or cause headaches, while other foods reduce their cravings and provide them with level energy.
Paying attention to how our body feels immediately after eating or in the hours following, can provide us with invaluable information about the specific effects certain foods have on us.
Do: Consider Working With a Professional
To answer Brooke Castillo’s 3rd guideline question “How is this food acting in my body?” you may need to work with someone who understands nutritional biochemistry and physiology.
For example, you may love cheese and it may feel good in your body immediately after you eat it.
However, unbeknownst to you, cheese may be causing a delayed food sensitivity reaction that produces symptoms many hours to days later and contributes to your symptoms of hormone imbalance. Cheese may be encouraging mucus production, contributing to your chronic sinus congestion.
The way different foods interact with our hormones and immune systems may not be apparent immediately after we ingest them. The effects may be delayed or slowly accumulate over time. Gaining a professional’s view on the impact a food has on our complex bodily systems, including our personalized genetics and gut microbiome, can help us understand whether that food has a place in our ideal diet.
A professional combines his or her knowledge of the body with your knowledge of your own body, your health history, and blood tests, to help you identify which foods might not be right for you.
Do: Eat Food that Supports Your Health Goals
As Hippocrates once said, “Let food be thy medicine.” As a naturopathic doctor, I believe that nutrition has an important place in disease prevention and healing. Each bite of food we take can have the effect of moving us toward health or away from illness.
Our nutritional requirements will differ depending on our health goals. A 71-year old woman undergoing chemotherapy and radiation for stage 2 lung cancer will be eating a very different diet than her 24-year old bodybuilding grandson. A 42-year old woman who has polycystic ovaries and hopes to get pregnant in the next year will also have completely different dietary requirements and health goals.
You might love the food you eat. It might feel great in your body; you’re eating unprocessed, whole foods you prepare at home. However, you’re not feeling as amazing as you feel you should. Perhaps you feel tired, or struggle to lose weight. You might suffer from depression, diabetes, or daily digestive symptoms.
Depending on your health goals, a healthcare professional can work with you to find the ultimate nutrition do’s and don’ts for your body.
Do: Have Courage
Dipping our toes into the deep pool of human nutrition can be a daunting, yet essential act. Our dietary habits have the power to deeply influence our health. In the words of Ann Wigmore, “The food you eat can either be the safest and most powerful form of medicine, or the slowest form of poison.”
Removing processed foods from our kitchens, eating whole foods, cooking at home, eating enough of the right types of fats, developing awareness of how foods feel in our bodies, and considering working with a professional to help us reach our health goals through diet and lifestyle changes, can have a powerful impact on the quality of our lives.
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.
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.
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.”
In the past I used to suffer from “hanger”, feeling hungry and irritable if going more than a few hours without food. Now my body is adapted to fasting, going prolonged periods without food—and I feel all-the better for it.
When I was a kid, no one ever had to convince me to finish my dinner. Perpetually “hangry” (hungry and angry), I was the Tasmanian devil of snacking, vacuuming up whatever food substances crossed my path, leaving wrappers and crumbs in my wake. “Never get between Talia and her food,” my brother facetiously coined when, like a voracious bull, I would bully my way into the kitchen to fix myself an emergent after-school snack. From the moment I was born, it seems, going more than two hours without eating was a physical impossibility. “I’m sick with hunger,” I would complain whenever my blood sugar levels dipped.
Now I sit here writing this article, in my adult incarnation, comfortably having abstained from eating for more than 14 hours. Whereas before I couldn’t go more than 2 hours without some kind of sugary snack, my body is now adapted to thriving during prolonged periods without food—and I feel all-the better for it.
“Eat a snack every 2-3 hours to keep blood sugar stable and lose weight,” dieticians and nutritionists often advise . However, as we dig into the disease prevention, anti-aging and weight management research, we learn that there may be benefits to going without food for prolonged periods.
We humans spent much of our evolutionary history hunting and gathering with extended periods of food scarcity. Our bodies adapted to survive through, and perhaps even thrive and depend on, periodic fasts. We now live in a society that enjoys food abundance: with 24-hour convenience stores and fast food restaurants at our disposal, we rarely go hungry. This recent lifestyle change may contribute to the increase in the diseases of excess that afflict modern bodies.
Ancient healing systems like Ayurvedic medicine and Traditional Chinese Medicine have long recognized the benefits of fasting for purifying and healing the body. Today, a body of research is accumulating that suggests that fasting may help treat diseases like multiple sclerosis and cancer, reduce the risk of chronic metabolic diseases, such as diabetes, battle dementia and cardiovascular disease, and reverse the effects of aging, helping us live longer.
What Happens During Fasting:
Human physiology fluctuates between two modes: the fasted and the fed state. After eating, a hormone called insulin rises in response to the intake of dietary carbohydrates and, to a lesser extent, protein. Insulin allows glucose to enter cells where it can be used for energy. Insulin encourages the storage of body fat and glycogen—a molecule stored in the muscles and liver that can be broken down quickly for energy. Insulin is an anabolic hormone that promotes tissue building and growth.
Our bodies are in the fed state, or postprandial state, for up to 4 hours following a meal, when blood sugar and insulin levels rise and the body begins to store food energy. 4-6 hours after eating, our bodies enter the post-absorptive state. Insulin and blood sugar levels fall, and blood sugar is maintained through the breakdown of liver and muscle glycogen. At the 10-12 hour mark post-meal, the body enters the fasting state. At this stage, glycogen stores have been depleted and blood glucose is maintained through a process called gluconeogenesis: glucose is created from fat, lactate and protein. In the fasting state, the body taps into fat stores to create ketone bodies, which are used for fuel.
Approximately 24-48 hours after a meal, the body enters a state called autophagy (or self-eating). The body breaks down old, damaged cells into their proteins and reuses them to build new cells or for fuel, through gluconeogenesis. Autophagy has gained the attention of researchers who recognize its benefits for managing inflammation, slowing the effects of aging, and treating various chronic diseases, such as autoimmune disease and cancer—more on this later!
Fasting to Treat Cancer:
Valter Longo, PhD, at the Longevity Institute at the University of Southern California, examined the effects of 2 to 4-day fasts on patients with cancer who were undergoing chemotherapy. The study found that several days of fasting improved the efficacy of chemotherapy, while reducing its side effects, protecting healthy, non-cancerous cells. Healthy cells responded to the periods of food restriction by shutting down, protecting them from the toxicity of the chemotherapy. Cancer cells don’t have such a response, leaving them susceptible to the chemotherapy. “Cancer cells are dumb cells,” says Dr. Longo.
The fasting period not only improved the effects of cancer treatments, it stimulated the regeneration of the immune system through the creation of progenitor stem cells. Fasting cleared out damaged immune cells and cancer cells through autophagy and new cells were regenerated upon re-feeding. Dr. Longo and his team found that up to 40% of the immune system is rebuilt in mice after a fasting and re-feeding cycle.
Fasting Mimicking Diets:
Recognizing the difficulty in going 3 days without food, Dr. Longo developed a 5-day “Fasting Mimicking Diet” that allows for the consumption of about 700-1000 calories per day in the form of small snacks. The Fasting Mimicking Diet is low enough in calories, protein and carbohydrates to mimic the physiological conditions and benefits of fasting like autophagy, ketone body production, beneficial stress response, and cancer cell starvation.
Mice given the Fasting Mimicking Diet (FMD) lost 30% of their body weight through the breakdown of body fat and clearing away of old, damaged cells. When the mice were re-fed, their blood, brain and bone cells were rebuilt. The mice who underwent the Fasting Mimicking Diet had rejuvenated immune systems, decreased incidences of cancer, reduced body fat, improved cognitive performance, decreased inflammation, and increased lifespans.
Fasting to Treat Autoimmunity:
Research in mice showed promising results in using the Fasting Mimicking Diet to treat multiple sclerosis, a debilitating autoimmune condition that attacks the nervous system. When following the diet, immune cells that were attacking the brain and spinal cord were destroyed. Upon re-feeding, new progenitor stem cells were created that repopulated the immune systems of the affected mice, and aided in repairing the damage to the brain and spinal cord. The Fasting Mimicking Diet resulted in a 20% reduction in autoimmunity in mice with multiple sclerosis.
A study that examines the effects of the Fasting Mimicking Diet on humans with Crohn’s Disease, an autoimmune disease the affects the digestive system, are currently underway.
Fasting to Reverse Aging:
Autophagy, the process of removed and recycling old and damaged cells, is a new area of research for reversing the effects of aging. Autophagy alleviates the body burden of senescent cells that have stopped dividing but are still robbing the body of essential nutrients and energy.
When cells become senescent, they release inflammatory mediators, which can damage neighbouring cells and cause inflammation and disease. Cellular senescence is thought to be one of the primary mechanisms by which we age. As we age, more cells become senescent, causing age-related inflammation. A study found that inflammation is the primary factor that drives the aging process, damaging DNA and contributing to various diseases, such as cardiovascular disease, diabetes, arthritis, cancer, and autoimmunity.
The process of fasting and re-feeding stimulates the production of new, healthy progenitor stem cells in the immune system. Mice and human volunteers who underwent cycles of the Fasting Mimicking Diet had decreased numbers of myeloid cells, the inflammatory immune cells that become more numerous as we age, and increased numbers of cytotoxic T cells, which protect the body against viruses and cancer.
Fasting promotes longevity through its inhibition of Insulin-like Growth Factor -1 (IGF-1), a growth factor that promotes cellular growth, and prevents the death of senescent cells. Growth factors are important for growing babies and children, developing fetuses, boosting muscle, and growing new brain cells. However, growth factors like IGF-1 are negatively associated with longevity because of their potential to stimulate the growth of cancer and prevent autophagy. Mice whose growth factor-dependent genes were removed, or “knocked out”, lived 40-50% longer and suffered from less diseases as they aged. IGF-1 is stimulated by protein and carbohydrate intake; it is elevated in the fed state and inhibited when fasting.
Healthy humans who underwent cycles of the Fasting Mimicking Diet had lower risk factors that were associated with cardiovascular disease and diabetes, such as lowered blood pressure, reduced CRP (a marker of inflammation in the blood), and reduced fasting blood glucose levels. These markers remained improved even after the subjects returned to a normal diet, which indicates that fasting may help reduce the risk of chronic diseases, such as diabetes and heart disease, promoting health longevity and increased lifespan.
Fasting for Energy and Resilience to Stress:
Hormesis is the process in which the body’s response to a stressor like the slightly toxic flavonoids in plants, intense exercise, or extreme temperatures, benefits the body as a whole. Hormesis is one of the reasons that exercise and green leafy vegetables are so good for us; they impose minor stressors on the body, boosting its healing properties, and improving resilience.
Fasting, in addition to other positive stressors, up-regulates a stress-response gene called FOX03. When FOX03 is activated, it produces proteins that reduce inflammation, increase anti-oxidant production, repair DNA, and increase cellular energy production through the creation of new mitochondria. Humans with a more active version of the FOX03 gene have an almost 300% chance of living to be over 100 years old.
Fasting also promotes a process called mitophagy. Similar to autophagy, mitophagy involves removing and recycling damaged mitochondria that are no longer able to effectively produce energy. Through activation of the FOX03 gene, more mitochondria are created to replace the old, improving energy production. The creation of new mitochondria only occurs in response to exercise, extreme temperatures, and periods of fasting.
Fasting for Weight Loss:
It doesn’t take a researcher to figure out an obvious truth about fasting: when you don’t eat, you lose weight. Dr. Jason Fung, MD, a Toronto-based nephrologist, prescribes fasting to his obese and diabetic patients. In his book, The Obesity Code, Dr. Fung discusses how the old paradigm of restricting calories for weight loss—eating 1500 calories a day while burning 2000, for example—is out-dated and ineffective for keeping weight off longterm. Dr. Fung argues that fat storage and breakdown are not the result of a simple calories in minus calories out equation, but the performance of a hormonal orchestra conducted by insulin. Insulin stores fat and glycogen, while inhibiting the release of fat breakdown. The body only begins to tap into its glycogen and fat stores when insulin drops during the post-absorptive and fasting phases after a meal. Once it depletes its glycogen stores, the body burns fat as its main source of fuel as long as insulin levels remain low.
According to Dr. Fung, fasting is superior to caloric restriction diets because it keeps insulin levels low for long enough to allow the body to deplete its glycogen stores and tap into fat. Fasting also releases surges of growth hormone, which prevents muscle loss, and norepinephrine, which boosts energy and feelings of well-being. Unlike caloric restriction diets, studies have shown that metabolism increases during and after fasting, preventing weight regain. Dr. Fung argues that fasting can spare muscle, boost metabolism, increase energy, and increase feelings of well-being, making it an effective tool for lasting weight loss.
Ways to Fast:
While the health benefits may be numerous, fasting isn’t easy. The first time I tried a prolonged fast, all I could think about was food. Food was everywhere and the people around me seemed to be eating all the time. My body, accustomed to being constantly fed, wasn’t too happy with the sudden metabolic switch I was demanding from it. Many of our metabolisms have been trained to run on dietary carbohydrate and glycogen as their primary fuel sources, making the first few hours to days of fasting a challenge. However, there are many ways to ease into the practice of fasting. You can obtain Dr. Valter Longo’s Fasting Mimicking Diet kit from a healthcare provider through ProLon, or practice small intermittent fasts, such as Time-Restricted Feeding.
Time-Restricted Feeding:
A researcher at the Salk Institute in Califoronia, Dr. Sachin Panda, PhD, found that restricting eating time had amazing health benefits in mice. Mice were fed an unhealthy diet of lard and sugar. The mice, as you might expect, had shorter lifespans and a variety of health problems: diabetes, obesity, and heart disease. However—and this part is miraculous—when Dr. Panda and his team restricted the time the mice were fed the exact same crappy diet to 12 hours (instead of allowing them to eat whenever they wanted), none of the negative health benefits occurred; the Time-Restricted Fed mice were 70% leaner, lived longer and were free from diabetes or heart disease.
Further investigation revealed that restricting feeding time to 8-12 hours a day, resulted in mice that had less body fat, improved muscle mass, decreased inflammation, increased cardiovascular function, increased mitochondrial function, higher levels of ketone body production, increased cellular repair processes and anti-oxidant production, and increased aerobic endurance. It was when the mice ate, not what they ate, that conferred these health benefits.
North Americans, on average, eat on a 15-hour clock. We seem to eat constantly, stopping only to sleep. To study the effect of Time-Restricted Feeding on humans, Dr. Panda had human participants restrict their food intake to 12 hours a day; if the volunteers had their first sip of coffee at 7 am, they were told to cease all food intake by 7pm. After the completion of the 16-week study, the volunteers lost 3-5% of their body fat without making a conscious change to their diets. The participants reported sleeping better and feeling more energized in the morning. They noted that their overall calorie consumption decreased by about 20% without effort.
Research into Time-Restricted Feeding indicates that allotting at least 12 hours a day to fasting boosts the body’s repair mechanisms, improves digestive function and motility, provides time for the body to switch to ketone body production (which tends to happen 10-12 hours after a meal), improves blood sugar control, regulates appetite, and enhances stress resilience. Taking a break from eating allows the body to invest its energy into repair, rather than digestion. The best part about Dr. Sachin Panda’s research is its simplicity; to obtain all of the benefits, simply avoid after-dinner snacks!
Intermittent Fasting:
Similar to Time-Restricted Feeding, Intermittent Fasting plays with the ratio of fasted to fed hours. Proponents of Intermittent Fasting refrain from eating from 12 to 23 hours within a 24-hour period. A common ratio of fasted to fed time is 16 to 8 hours: fasting for 16 hours a day and eating within an 8-hour window. For example, if breakfast is at 8am, then those following a 16:8 intermittent fast stop eating by 4pm in the afternoon.
Alternate Daily Fasting or the 5:2 Diet:
Studies with mice and human subjects found that alternating daily food intake, or following a 23:1 fast (having just one meal a day) every second day, was effective for weight loss. The protocol is beautifully simple: every second day either fast completely or indulge in only one meal. While people tend to eat more on their “fed” days, they don’t seem to make up the calories that are lost on the fasting days, resulting in an overall reduction in calories and weight loss.
Water Fasts:
It’s estimated that we need to fast for at least 36 hours to get the autophagy benefits, which makes water fasting a powerful therapeutic and anti-aging practice. Water fasting is simple: withstand extended periods, usually 3 to 5 days, but often longer, only consuming water.
The longest recorded water fast was 382 days, performed in 1973 by a 27-year old male who weighed 456 lbs. During the months he fasted, the 27-year old consumed only water and a multivitamin and, according to the study published on him, experienced “no ill-effects”. While water fasts can have amazing therapeutic benefits, it is advised that they be medically supervised.
Ketogenic Diets:
Ketogenic diets are high-fat diets that restrict carbohydrates and limit protein, and can mimic the low-insulin conditions of fasting. Because carbohydrates and protein are restricted, the body is forced to turn dietary fat into ketone bodies, which it can use for energy.
Ketone bodies, especially beta-hydroxybutyrate, produced from either dietary or body fat, have important therapeutic uses. They provide more energy for the brain than glucose, which can have benefits for memory, mood, concentration and cognitive performance. Ketogenic diets have been recommended for treatment-resistant epilepsy, and diseases associated with cognitive decline like Alzeimer’s and Parkinson’s. More recently ketogenic diets have been recommended for mental health conditions, such as depression and anxiety.
Ketone bodies also help cells resist oxidative stress, preventing cellular damage, which makes ketogenic diets of interest to cancer researchers because or their ability to starve cancer cells of protein and carbohydrates, while fuelling healthy cells.
Ketogenic diets can deliver many of the benefits of fasting because of the low-insulin, low growth factor conditions they induce. When a person becomes “keto-adapted”, able to burn ketone bodies efficiently for fuel, the transition to fasting is easy. For this reason, ketogenic diets and fasting often go hand-in-hand.
Cautions:
While fasting can deliver many health benefits, it can impose a temporary stress on the body for those who haven’t adapted to ketosis or prolonged periods without food. Therefore, it’s important to fast under the supervision of a medical professional, especially if deciding to embark on an extended fast.
Before deciding to fast, the individual’s energy levels and vitality, health status, hormone regulation (those who are taking insulin should practice extreme caution when fasting), age, health history, and health goals, should all be considered. A woman of fertility age will have different health goals than a 72-year old woman with type II diabetes. The former may want to preserve body fat and promote fertility and ovulation, while the latter may want to reduce her insulin and growth factor levels, and lose weight in order to promote health longevity.
Fasting may not be appropriate for everyone. For example, those who are underweight, pregnant, breastfeeding or suffering from an eating disorder should not fast. Fasting in women of reproductive age has the potential to produce hormonal imbalances such as hypothalamic amenorrhea (irregular or absent menstrual cycle). Fasting can exacerbate or cause dysregulation in stress hormones, particularly cortisol, known as “adrenal fatigue”, and potentially effect thyroid function, as a result of the body’s starvation response. Fasting while under the pressure of chronic mental and emotional stress is probably not a good idea. Working with a professional and listening to your body are key elements to doing fasting right.
However, when used correctly, it can be a simple, free, powerful therapeutic tool for healing the body, treating chronic disease, and promoting longevity.
