In the winter of 2019 I took a surfing lesson in Costa Rica. I fell in love–the sun and salt water on my skin, the beautiful view of the beach, the spray off the back of the waves, the loud crashing of translucent turquoise, and the feeling of power, ease, flow and grace as I stood on a board, using the energy of the earth to fly across water.
The problem was, however, I would be going home in a week to a landlocked part of the world that spends a lot of its months covered in ice.
It was depressing.
Then I met a girl from Toronto, a psychotherapist who worked at a clinic just down the street from my old one.
“You can surf in Toronto, you know”, she informed me.
Where? I thought, astounded.
“On the lakes!” She exclaimed.
I was flabbergasted–perhaps I could be a surfer after all. The beach bum lifestyle, the rock hard abs, the zinc oxide cheek bones, the chronically wet hair, watching the winds and tides and slipping out for a sun-soaked hour during a work break. Could this be true–could you surf the Great Lakes?
“The thing is,” she continued, “the surf season is from October to March”.
Oh.
Winter surfing.
It was still interested, though.
Back in Toronto, I waited for the next strong February East wind and headed to a surf spot I’d heard about on Lake Ontario. I was met with a crowd of black neoprene-clad surfers, soaked by water, wind and sleet. The elements were harsh. The stoke, however, was infectious.
Ok, I could do this, I thought.
My next stop was the surf shop. I purchased gear and the rest is history.
Not a lot of us are built to slip into near-freezing water during the frigid winter months to catch a few waves. Lake waves are harder to catch, the currents are strong, ice chunks are a thing to watch out for, and… it’s friggin’ cold! But, surfing is surfing. The lakes provide beautiful landscapes, just like the ocean, and the feeling of catching a wave and riding it is the same.
There’s also the benefit of body hardening.
We modern humans are very different from our hunter-gatherer ancestors. Our genes may be the same, but our lifestyles couldn’t be further apart. Down-filled jackets and central heating protect us from the discomfort of the elements. In a sense, our lives are temperature controlled.
However, our incidence of chronic degenerative disease has never been higher.
Body hardening practices involves exposure against natural stimuli, such as intense cold, that results in increased resilience–resistance to disease and improved health.
A 1998 study in QJM: an international journal of medicine looked at antioxidant production in German winter swimmers.
Winter swimming, just like winter surfing, is a thing. As of the 90s, there were 3000 Germans who participated in winter swimming clubs. They were known to experience a 40% reduction in respiratory diseases compared to the rest of the population, debunking the notion that if you exposure yourself to cold you’ll “catch a cold”.
The study looked at 23 male and 13 female who had been members of a Berlin winter swimming club for more than two years. On average they swam for 5 to 10 minutes on a weekly basis in water between 1 and 5 degrees celsius. Their blood levels of glutathione were compared with that of 28 healthy men and 12 healthy women who had never participated in cold-exposure body hardening therapies such as winter swimming.
Glutathione is our body’s main antioxidant. It protects us from free radicals (reactive oxygen and reactive nitrogen species, ROS and RNS, respectively) that are harmful to our cells. It is produced from three amino acids: glycine, cysteine, and glutamine.
Glutathione reduces oxidative stress produced by these free radicals that occur in cells as a result of their energy production, as well as toxins, pollutants and other stressors. A deficiency of glutathione is associated with an increased risk of cancer, accelerated aging, and other diseases, such as metabolic disease like diabetes and cognitive diseases like Parkinson’s. It decreases as a result of aging, chronic disease, toxin exposure, and chronic stress.
Elevating glutathione status has been shown to improve conditions like insulin resistance, autoimmune diseases, cognitive and mental health conditions, fatty liver and cirrhosis, autism, and respiratory diseases.
It was found that after cold water exposure, blood levels of antioxidants like glutathione decreases, indicating that cold water exposure induces oxidative stress on the body. However, after a period of time, glutathione levels rose higher than that of baseline.
Baseline blood levels of glutathione were higher in cold water swimmers, indicating that their bodies were more efficient at producing glutathione in response to the temporary oxidative stress imposed on them by the cold exposure.
In essence, “what doesn’t kill you makes you stronger”.
This is called hormesis: when temporary stress is imposed on our bodies, we respond with adaptive measures, such as increased glutathione production to combat that stress. However, our bodies are smart. They figure that if we’re exposed to some cold stress, there might be more coming. Therefore, it might be a good idea to invest energy into hardening, preparing for more of that same stress in the future and, in essence, becoming more resilient. And so, when exposed to a stressor, we often produce more antioxidant than is needed to simply overcome that stressor, and this results in an overall net benefit to our health and well-being.
Just like lifting weights makes us stronger for the next time we lift weights, we become stronger and more resilient at our baseline as we prepare for the next hit of cold, heat, exercise, or stress.
The 1998 study also revealed that cold water swimmers had more enzymes that combat free radicals such as superoxide dismutase, glutathione peroxidase, and catalase, meaning that their cells were better prepared to ramp up antioxidant production quickly and neutralize free radicals at a moment’s notice, if needed.
Cold water swimmers also produced four times more norepinephrine after their cold exposure. Norepinephrine is part of our fight or flight response, but is also associated with increased energy, mood, motivation and well-being. Imagine a hit of caffeine–that’s a bit what cold burst can do to you via norepinephrine. Heart race increases, and we’re filled with an excited euphoria.
Norepinephrine is part of the reason why cold therapy has been touted as a remedy for depression. Cold exposure provides a much-needed burst of mobilizing chemicals to kickstart feelings of well-being and motivation for people who are struggling with low mood and arousal.
Cold therapy also increases dopamine by 250%, according to a 2000 study in the European Journal of Applied Physiology. Dopamine gives us the sense of motivation and meaning in pursuing a goal. It fills us with purpose and drive. So many of us are starved of dopamine and therefore so much of our culture involves trying to increase dopamine: scrolling social media, consuming sugar, playing video games, and so on.
The problem with many of these attempts to boost dopamine is that they come with a cost. We get a hit of pleasure from consuming sugar, for example, followed by a dip in our baseline levels of dopamine. Overall, we’re left feeling empty, foggy, purposeless, and addicted. We experience cravings that need to be filled.
Even supplements like Macuna pruriens and l-tyrosine, designed to boost dopamine levels, result in crashes 30 to 45 minutes after they peak.
Cold exposure, however, gives us a hit of dopamine that remains elevated for hours without a resulting crash. This provides an intense boost to mood, motivation, cognitive function, concentration, focus, purpose and drive. Like norepinephrine this can also contribute to cold therapy’s anti-depressive effect.
It seems that if we engage in something hard and uncomfortable, something that requires effort–like cold exposure–our body rewards us with an increase in mood, motivation and drive through the enhancement of dopamine production in our brains.
Winter surfing has been an immense gift to my health and well-being. It’s given me purpose, community, exposure to nature, and a wonderful outlet for body hardening. If I go more than a week without a surf session I start to feel a bit of withdrawal. There is nothing more therapeutic than hours spent checking the forecast, and driving to chase waves in order to end up floating in the middle of a beautiful lake, surrounded by nature and friends.
With regular winter surfing I feel invigorated, energized and fit–the mood-lifting effects of the cold exposure is comparable to nothing else.
This winter my message to everyone is: get outside. Exposure yourself to cold. Expose yourself to nature. Use the elements and the changing seasons as tools to enhance your health.
There are incredible mood-elevating, immune system-boosting and anti-aging benefits to becoming more resilient. While it may be uncomfortable, cold adaptation is a sign of your improved vitality and disease resistance.
Nature’s harshness evolved us. Temperature extremes helped to shape our DNA. Our genes contain codes for amazing mental, emotional, and physical resilience. They are waiting to be turned on at a moment’s notice, if only they’re given a reason.
Cold exposure flips the on-switch to your body’s incredible superpowers. Let’s explore the potential of this beautiful vessel in which we all live.
References:
Šrámek, P., Šimečková, M., Janský, L. et al. Human physiological responses to immersion into water of different temperatures. Eur J Appl Physiol81, 436–442 (2000). https://doi.org/10.1007/s004210050065
W.G. Siems, R. Brenke, O. Sommerburg, T. Grune, Improved antioxidative protection in winter swimmers, QJM: An International Journal of Medicine, Volume 92, Issue 4, April 1999, Pages 193–198, https://doi.org/10.1093/qjmed/92.4.193
I talk with Dr. Kara and Dr. Dave of That Naturopathic Podcast, rated in the top 6 Canadian Medicine podcasts, about taming the tiger of anxiety. Click to learn about your HPA Axis, the stress response and how we can “tame the tiger” by providing our body and mind with the assurance that we’re safe. Listen on Spotify.
Hannah Hepworth, of the Anxiety Revolution Podcast, and I team up to discuss a natural and functional approach to managing anxiety.
In our talk, featured in her 2019 Anxiety Revolution Summit, a series of talks with integrative mental health practitioners and experts, we discuss circadian rhythms, the body’s stress response and the HPA (hypothalamic pituitary adrenal) axis, and blood sugar, and their role in anxiety.
Click the link to listen to this 30-minute interview. Let me know what you think!
Gorf is a man of his age, which, in his case, happens to be the Stone Age.
Yes, Gorf is a caveman.
And, perplexingly, Gorf suffers from insomnia.
Gorf wakes up sluggish, long after the sun has risen, wishing he had a snooze button to smash.
He struggles through the day, exhausted. In the early afternoon, he sucks glycogen from the raw meat of a fresh kill to get an extra blood sugar boost.
Gorf prays for someone to discover coffee and refined sugars so that he can join the ranks of modern zombies getting through their 3 pm slumps with artificial pick-me-ups.
When the sun sets, Gorf feels depleted, but also restless and wired. He frustratedly tosses on his bed of mammoth skins beside the dying embers of his campfire while his family snoozes on.
Wide awake at 2 am, Gorf knows that the next morning he’ll begin the cycle again, his body completely out of sync with the Earth’s rhythms. Such is the cursed life of a Prehistoric Insomniac.
If this story seems preposterous, it’s because it probably is. Whatever we imagine prehistoric humans to be, insomniacs is not high on the list.
Those of us who have spent a night outside—whether it was a weekend camping trip or longer—might remember how deeply we slept under the darkness of the starry night sky and how refreshed we woke when the sun began to warm our faces in the early morning.
The closer we get to nature, the better our bodies seem to align with the Earth’s light and dark rhythms.
Now, if we took poor Gorf, dressed him in a suit, and dumped him in a desk chair in an office building in any major modern city, we might believe his claim to insomnia.
Now that Gorf is one of us, his eyes are exposed to bright lights at night as he slogs away at his computer, answering emails, or surfing social media pages into the late hours.
During the day, Gorf now spends his time indoors, where light exposure is 400 times less than that of a bright sunny day.
On bright days when he has a chance to get outside, Gorf protects his fragile eyes with dark glasses.
Welcome to the modern industrial lifestyle, Gorf. Don’t forget to help yourself to the coffee and cookies.
Our Body’s Circadian Rhythms
Our body runs on a 24 hour clock, which is orchestrated by an area in the hypothalamus of the brain called the Suprachiasmatic Nucleus (which we will refer to as “the SCN” from now on).
Our organs, body tissues and cellular processes, from our digestive function, hormones, mood, body temperature, metabolism, sleepiness and wakefulness, cellular repair, to detoxification, among others, have different objectives for certain times of day. The SCN coordinates these functions with the Earth’s daily cycles.
The SCN runs without the aid of outside influence, however several zeitgebers, German for “time givers”, or environmental cues, tell our internal clock what time of day it is to sync our internal and external worlds. The most important zeitgeber is light, which directly activates the SCN through a pathway that connects the retina in our eyes to the hypothalamus (the retinohypothalamic tract).
In our bodies, timing is everything. The more we are able to sync our cycles with the environment, the better our body organs function. Working against circadian rhythms by engaging in activities like sleeping and eating at the wrong time of day can negatively affect our health, decrease our lifespan, and make us miserable (like poor, sad Gorf in his dimly lit office).
The digestive system, for example, is wired to break down, absorb and convert food energy into fuel during the day and repair and regenerate itself at night.
At night, the pineal gland, located in the brain, releases melatonin, a hormone produced in the absence of light, to help us sleep. However, exposure to bright lights before bed can impede the natural release of melatonin, preventing restful sleep.
Science shows that healthy circadian rhythms equal optimal metabolic health, cognitive function, weight, energy levels, cardiovascular health, immune function, digestive health, coordination and mental health. Regulating our circadian rhythms can increase our health-span.
Our Liver, Muscles and Adrenal Glands Also Have Clocks
While the SCN is the chief executive officer of the circadian cycle, other organs, such as the liver, muscle and adrenal glands, help regulate our body’s rhythms through peripheral clocks.
These clocks register cues from the environment and report back to the SCN.In turn, the SCN tells the organs what jobs they are supposed to be performing according to the time of day.
Dr. Satchin Panda, PhD, a researcher at the Salk Institute, is discovering how important our eating times are for setting our circadian clock.
The first bite of our breakfast tells our liver clock to start making the enzymes and hormones necessary to digest our food, regulate our metabolism, and use the food we eat throughout the day to fuel our cells.
A few hours later, our digestive system requires relief from food intake to invest its resources into repair rather than spending precious resources on digesting food.
Dr. Panda found that restricting a “feeding window” to 8 to 12 hours in mice and human participants (for example, eating breakfast at 7 am and finishing dinner no later than 7 pm), allowed the system to digest optimally, left time for the system to repair itself at night, and also acted as a powerful circadian regulator.
New research suggests that food is a potent zeitgeber, which has the power to regulate our circadian rhythms. This suggests that eating at the right time of day can heal our adrenal glands and sleep cycles.
Fasting for 10 to 16 hours at night, or “Time Restricted Eating”, helps optimize health and increase lifespan in mice. In human participants, it improves sleep and results in modest weight loss.
According to Dr. Panda, we become more insulin resistant at night, which means that late-night snacking makes us more likely to store the calories we consume as fat.
Consuming calories in a state of insulin resistance can also predispose use to metabolic syndrome and type II diabetes.
In addition to light and food intake, rest and movement are important zeitgebers. Therefore, engaging in these activities at the right time of day has the potential to promote physical and mental health.
Circadian Rhythms and the Stress Response are Tightly Connected.
If the internet is any indicator, it seems that everyone is suffering from the modern illness of “adrenal fatigue”, or HPA (Hypothalamic-Pituitary-Adrenal) axis dysfunction
Because of the stress of our modern lifestyles, our adrenal glands and brains are no longer able to regulate the stress response.
This leads to a host of symptoms that wreck havoc on the entire body: fatigue, anxiety, sugar cravings, and insomnia. It also negatively impacts digestion, hormone production, and mood.
Our adrenal glands make cortisol, the “stress hormone”, a hormone involved in long-term stress adaptation but also in wakefulness, motivation, reward, and memory.
Deficiencies in cortisol signalling can result in issues with inflammation and depression. Too much cortisol floating around in the body can cause weight gain, cardiovascular issues, such as hypertension, and metabolic syndrome.
Cortisol has a circadian rhythm of its own. Our cortisol levels rise within an hour of waking; 50% of the total cortisol for the day is released in the first 30 minutes after we open our eyes. This rise in cortisol wakes us up. It allows us to perform our daily activities in a state of alert wakefulness.
Cortisol levels decline steadily throughout the day, dipping in the evening when melatonin rises.
A flattened or delayed rise in morning cortisol results in grogginess, brain fog and altered HPA axis function throughout the day. Elevated cortisol in the evening cause us to feel “tired and wired” and affect sleep. Waking at night, especially in the early morning between 2 and 4 am can be due to cortisol spikes.
Our adrenal glands help regulate our circadian rhythms through the production of cortisol. Both the adrenals and the SCN communicate with each other as early as 2 in the morning to ready the system to generate the waking response a few hours later.
Psychiatrist Dr. Charles Raison, MD says, “The most stressful thing you do most days is get up in the morning. Your body prepares for it for a couple of hours [before waking by activating] the stress system. The reason more people die at dawn [than any other time] is because it’s really rough to get up.”
Waking up is a literal stress on the body.
However, we need the stress response to get through our day effectively and healthy HPA axis function and optimal mood and energy are a result of properly functioning circadian rhythms.
Without these rhythms functioning properly we feel tired, groggy, tense, and depressed. Like Gorf, we need sugar and caffeine to help us through the day.
Circadian Rhythms Affect Our Mental Health
In nearly everyone I work with who suffers from anxiety, depression, or other mental health disorders, I see disrupted circadian rhythms and HPA axises.
Many of my patients feel exhausted during the day and wired at night. They have trouble getting up in the morning (or stay in bed all day) and postpone their bedtime. Most of them skip breakfast due to lack of hunger, and crave sweets after dinner, which further throws off the circadian cycle.
Lack of sleep can disrupt circadian rhythms leading to obesity, depression, diabetes and cardiovascular disease. Even two nights of shortened sleep can affect cortisol production and the HPA axis, worsening mood and energy levels.
Depression severity on the Hamilton Depression Rating Scale (HDRS) falls by 6 full points when sleep is restored, which is enough to bring a patient from moderate/severe depression to mild. In comparison, the standard medication SSRIs, like cipralex, only drop the HDRS by 2.
Bipolar disorder is particularly affected by a misaligned circadian clock. In an interview, Dr. Raison claims that a single night of missed sleep has brought on episodes of mania in his bipolar patients. Their moods level once the sleep cycle is restored.
Our mood is tightly connected to our circadian rhythms and sleep.
Circadian Rhythms and Chinese Medicine
Thousands of years ago, the Chinese developed the Theory of Yin and Yang to describe the dynamics nature, including the cycles of night and day.
Yin and yang (symbolized by a black-and-white circle with dots) represent the process of change and transformation of everything in the universe.
Yang, represented by the white part of the circle, is present in things that are hot, light, awake, moving, exciting, changing, transforming and restless.
Yin is present in material that is cold, dark, soft, inhibited, slow, restful, conversative, and sustaining.
Yin and yang are dependent on each other. Yin feeds into yang, while yang feeds and transforms into yin. Everything in nature consists of a fluctuating combination of these two states.
The circadian cycle transforms the yin night into the yang of daytime.
Yang zeitgebers such as food, light, and physical and mental activity, help stimulate yang in the body, which helps us feel energized, light and motivated.
Before bed, yin zeitgebers like darkness, rest and relaxation help our bodies transition into the yin of night, so that we can sleep restfully.
Lack of sleep and relaxation can deplete our body’s yin energy, causing yin deficiency. Individuals with yin deficiency feel fatigued, anxious, and hot, experiencing night sweats, hot flashes, and flushed skin. Conventionally, yin deficiency can look like burnout compounded by anxiety, or peri-menopause.
Out-of-sync circadian rhythms can result in yang deficiency resulting in morning grogginess, an insufficient rise in morning cortisol, and a failure to activate yang energy throughout the day.
Yang deficiency is characterized by the build-up of phlegm in the body, leading to weight gain, feelings of sluggishness, slow digestion, bloating, weakness, and feeling foggy, pale and cold. Yang deficiency symptoms can look like depression, chronic fatigue syndrome, IBS, estrogen dominance, hypothyroidism, or obesity and metabolic syndrome.
In Chinese medicine, the organs have specific times of activity as well.
The stomach is most active from 7 to 9 am, when we eat our breakfast, the most important meal of the day according to Traditional Chinese doctors. The spleen (which in Traditional Chinese Medicine operates much like the Western pancreas) is active from 9 to 11 am, converting the food energy from breakfast into energy that can be utilized by the body.
According to the Chinese organ clock, the liver is active from 1 to 3 am. Individuals with chronic stress, insomnia and irritability, sometimes called “Liver Qi Stagnation”, frequently wake up restless during those early morning hours.
Entraining our circadian clock with environmental cues can help us remain vital by balancing the flow and transformation of yin and yang energies in the body.
Healing the Circadian Clock:
When I work with patients with depression, anxiety and other mental health conditions, or hormonal conditions such as HPA axis dysfunction, one of our goals is to heal circadian rhythms.
This involves coordinating our internal rhythms with the Earth’s night and dark cycle by setting up a series of routines that expose the body to specific zeitgebers at certain times of day.
How to Heal Your Circadian Rhythms
Morning Activities: Increasing Yang with movement, light and food:
1. Expose your eyes to bright light between the hours of 6 and 8 am. This stimulates the SCN and the adrenal glands to produce cortisol, which boosts mood, energy and wakefulness in the morning and can help reset the HPA axis.
2. Have a large breakfast high in protein and fat within an hour of waking. The intake of a meal that contains all of the macronutrients wakes up the liver clock. This activates our metabolism, digestive function, blood sugar regulation, and HPA axis.
Consider eating 3 eggs, spinach and an avocado in the morning. Or consume a smoothie with avocado, MCT oil, protein powder, berries and leafy greens.
Eating a breakfast that contains at least 20 grams of protein and a generous serving of fat will help stabilize blood sugar and mood throughout the day while obliterating night-time sugar cravings.
3. Move a little in the morning. Morning movement doesn’t necessarily have to come in the form of exercise, however, it’s important to get up and start your routine, perhaps making breakfast and tidying, or having an alternate hot and cold shower (1 minute hot bursts alternating with 30 seconds cold for 3 to 5 cycles).
Muscle movement triggers another important peripheral clock that helps entrain our circadian cycle with the day.
4. Turn on lights in the morning, especially in the winter time. Spend time outside during the day, and avoid using sunglasses unless absolutely necessary so that light can stimulate the SCN. Consider investing in a sunlamp for the winter, particularly if you suffer from seasonal affective disorder.
5. Consume most of your supplements in the morning, with breakfast. Taking adaptogens (herbs that help reset the HPA axis) and B vitamins can help promote daytime energy and rebalance our morning cortisol levels. This, of course, depends on why you’re naturopathic doctor has recommended specific supplements, so be sure to discuss supplement timing with her first.
Night Routine: Increasing Yin with dark and stillness:
1. Maintain a consistent sleep and wake time, even on the weekends. Retraining the cycles starts with creating a consistent routine to get your sleep cycle back on track.
2. Try to get to bed before 11pm. This allows the body to reach the deepest wave of sleep around 2 am. It also allows for 7 to 8 hours of continuous sleep when you expose your eyes to bright lights at 6 to 8 am, when cortisol naturally rises. Of course, this sleep routine will vary depending on personal preferences, lifestyles and genetics.
It’s important to first establish a routine that will allow you to get at least 6 hours of continuous sleep a night. If you suffer from chronic insomnia, working with a naturopathic doctor can help you reset your circadian cycle using techniques like Sleep Restriction Therapy to get your body back on track.
3. Avoid electronic use at least an hour before bed. Our smartphones, tablets, computers and TVs emit powerful blue light that activates our SCN, confusing all of our body’s clocks. Blue light also suppresses melatonin release, making us feel restless and unable to fall asleep.
For those of you who must absolutely be on electronics in the late hours of the evening, consider investing in blue light-blocking glasses, or installing an app that block blue light, such as F.lux, on your devices. These solutions are not as effective as simply turning off electronics and switching to more relaxing bedtime activities, but can be a significant form of harm reduction.
4. Fast for at least 2 to 3 hours before bed. Avoid late-night snacking to give the body a chance to rest and to signal to the peripheral digestive clocks, such as the liver clock, that it’s now time to rest and repair, rather than digestive and assimilate more food.
Avoiding food, especially carbohydrate-rich food, at night can also manage blood sugar. A drop in blood sugar is often a reason why people wake in the early hours of the morning, as blood sugar drops spike cortisol, which wake us up and off-set our entire circadian system.
5. Engage in relaxing activities in dim lighting. Turn off powerful overhead lights, perhaps lighting candles or dim reading lights, and engage in at least 30 minutes of an activity that feels restorative and relaxing to you. This might include taking an epsom salt bath, reading a book while enjoying an herbal tea, doing yoga or meditation, or cuddling with a partner.
Taking this time helps us step out of the busyness of the day and signals to the body and its clocks that it’s time to sleep.
6. Take nighttime supplements before bed. I often recommend sleep-promoting supplements like prolonged-release melatonin (which is a powerful circadian rhythm and HPA axis resetter), magnesium or phosphatidylserine, before bed to help my patients’ bodies entrain to the time of day. Talk to your ND about what supplements might be right for you.
If you suffer from chronic stress and mood disorders, do shift work, or are dealing with jet lag, you may need to engage in these routines diligently for a few months to get your circadian cycles back on track.
These practices can also be beneficial at certain times of year: daylight savings time, periods of stress and heightened mental work, and the transition of seasons, especially early Spring and Fall.
Finally, consider working with a naturopathic doctor to obtain and individual plan that can help you reset your body’s rhythms.
In order to make sense of the world, people create stories. It is our greatest gift and most fragile weakness.
Boy meets girl, they fall in love, they encounter difficulties that they eventually overcome. It brings them closer. They live happily ever after—the classic love story.
Stress has a classic story too: cortisol, the “stress” hormone, is released during stress. It wreaks havoc on the body. Lowering stress helps lower cortisol.
However, when it comes to human hormones, telling stories in a linear narrative is impossible.
Hormones are signalling molecules in the body. They are produced by endocrine organs, such as the adrenal glands, the brain, and the ovaries. They travel through the bloodstream to impact the expression of genes on distant tissues, which impacts how our bodies function.
Production of norepinephrine in the adrenal glands as a response to stress can make your heart race, your pupils dilate, your hands to shake, and your senses become hypervigilant—when a perceived threat or danger activates the release of this hormone, your entire body pulsates under its influence.
Hormonal stories are hard to fit the human desire for narratives. Their relationships with our genes, bodily systems, receptor binding sites, and each other make their actions too complicated to be described linearly. Instead they act like webs, or tangled networks of intricate connections.
When hormone levels rise in the body, beyond our delicate homeostatic balance, a phenomenon, called “resistance”, can occur. With resistance, cells reduce their responses to the hormones that interact with them.
When telemarketers keep interrupting your dinner at 6pm, eventually you stop answering the phone.
When certain hormones continue to call at the surface of cells, stressing the body’s capacity to respond, our cells simply stop answering.
Many of us ask, “what happens when I pull this thread here?” when learning about one hormone that we’ve blamed all our woes on. We tug the thread, without considering the entire web of connections, and our actions affect the entire system.
Our hormones exist in an ecosystem where everything hums and flows together, as a unit. It’s impossible to lay out explanations for their actions in a linear fashion.
Hormone stories flow like a Choose Your Own Adventure novel—a hallway with many doors that snake down long corridors and meet again, and interconnect.
Go through the door marked “estrogens”, and you encounter serotonin, cortisol, progesterone, insulin, thyroid hormones, leptin, BDNF, dopamine, norepinephrine, and many others.
Hormones are the conductors of your body’s personal orchestra, composed of thousands of musicians, a complex musical score, highly-trained arms, fingers, and mouths manipulating instruments: a million moving parts working together in harmony.
The best we can do to understand the entire interplay is to slow down the action, take a snapshot of it, and to try to understand why these symptoms are occurring in this individual.
Symptoms of Hormone Imbalances
Because hormones affect absolutely every system of our body, I am always attuned to the possibility of hormonal imbalances in my patients.
It helps to look at hormones in terms of their symptom patterns rather than how any one hormone affects us in particular.
Common signs of hormonal imbalance are:
Fatigue, low libido, restless sleep, depression and anxiety, waking at 2 to 4 am, a high-stress lifestyle, and brain fog might indicate cortisol imbalance.
PMS – and the more severe related condition, PMDD – infertility, fatigue and low libido, missed and irregular periods may be related to fluctuations in the hormones estrogen and progesterone, or low estrogen and progesterone levels. Many of these symptoms could also be related to estrogen dominance, in which estrogen is either high or normal, and progesterone is low.
Endometriosis, a family or personal history of female cancers, anxiety and panic attacks, heavy and painful periods, frequent miscarriages, infertility, fibroids, fibrocystic breasts and weight gain around the hips and thighs can indicate estrogen dominance.
High levels of male sex hormones like testosterone, irregular periods, weight gain, acne, and hair loss may indicate a female hormone condition called PCOS.
Fatigue, brain fog, difficulty losing weight, puffiness, constipation, dry skin and hair, and low body temperature can be signs of hypothyroidism.
Symptoms of reactive hypoglycemia, such as feeling dizzy, anxious and shaky between meals, sugar cravings, weight gain around the abdomen, difficulty losing weight, and low morning appetite, night-time carbohydrate cravings, and binge eating can all be related to insulin resistance and poor blood sugar control.
In my naturopathic practice, I see common patterns of symptoms that indicate certain hormonal imbalances.
These patterns often represent vicious cycles where our body is stressed beyond a capacity to balance these interconnected webs of chemical interactions, causing further imbalance.
Cortisol
Speaking of stories, here’s one I hear often.
You wake up in the morning, exhausted. Your brain is in a fog and you don’t feel alive until a cold shower or double espresso knock you out of your stupor.
Things get a bit better once you get moving, but you wonder why your energy never fully bounces back.
You used to play sports in university, you think to yourself. Now just thinking of sports makes you tired.
Is this what getting older feels like? You’re in your 30s.
The days at the office stretch on forever. Concentration and focus are difficult. You see a coworker whose name, you realize with horror, can’t be brought to mind.
You’ve known her for a year. Cynthia? Sylvia? Your brain hurts.
In the afternoon you think longingly of napping, but instead take your place in the long line for coffee and something carb-y like a cookie.
When it comes time for sleep you are either out like a light or find it hard to turn your mind off; you’re tired, as always, but also wired.
Sleep doesn’t feel restful, and you often wake up, sleepless, at 2-4am in the morning.
When your alarm rings a few hours later, the cycle begins again.
Cortisol, one of our stress hormones, has a circadian rhythm. Its levels are highest in the morning, about an hour after waking. Cortisol promotes energy, alertness and focus. It is also a potent anti-inflammatory hormone.
Cortisol is what makes us feel alive in the morning, bouncing out of bed like Shirley Temple and her curls.
Throughout the day our cortisol levels slowly dwindle (unless a major stressor causes them to spike abnormally). They are lowest in the evening, when melatonin, our sleep hormone begins to rise, inducing feelings of sleepiness, preparing us for a night of rest.
Our modern day society, however, calls on cortisol to perform more than its fair share of work. Cortisol is around when we’re hauling ourselves out of bed after an inadequate night of rest.
Cortisol fuels gym workouts, gets us to our meetings on time, allows us to meet deadlines, tolerates traffic jams, responds kindly to tyrannical bosses, and makes sure the kids get to all their after-school events.
Cortisol is made in the adrenal glands, two endocrine glands located on each kidney, in response to signals from the brain that perceive stress in our environments and bodies.
When stress hormones levels are too high we experience a “tired and wired” feeling. During this time we might feel we thrive better under stress: workouts boost our energy, we have a hard time quieting down and we rarely feel hungry.
We might still struggle with weight gain, however, especially the abdomen and face, where cortisol tends to encourage fat deposition.
We might feel tension—tight muscles and shoulders, and body pain, as muscles clench up, preparing to fight or flee.
Chronic stress is associated with high levels of cortisol. We work long hours, late into the night. We go, go, go. This may give us a “high” or it may feel exhausting and depleting.
Many of us can exist in this state for months and even years. Sometimes a compounded stressor such as a divorce, accident, or loss, can tip us over the edge into a depleted, burnt out state.
Burnout, often following a period of prolonged stress, can be associated with low cortisol signalling. Our bodies have simply stopped being able to produce the stress hormones necessary to meet the needs of our daily lives, or glucocorticoid receptors in the brain and body cells, have stopped responding to cortisol.
Just as cell can be become resistant to insulin, they can also become resistant to cortisol. Too much (or even too little) of a hormone can cause cells to start ignoring their signalling, resulting in symptoms of low levels of the hormone in some areas of the body and high levels of the hormone in others.
Cortisol is a complicated molecule. It both encourages the stress response, but also turns it off, when levels reach a certain point.
Often, cortisol levels that are too low result in an impaired stress response, preventing our fight or flight system from properly shutting off—cortisol resistance can lead to further stress hormone disruption.
The result of an imbalance in cortisol, otherwise termed Hypothalamic Pituitary Adrenal (HPA) Axis dysregulation is weight gain, fatigue and brain fog, inflammation and immune system activation, digestive issues, restlessness, impaired sleep, decreased cognitive function, and mental health conditions, such as anxiety and depression.
When cortisol levels are low, the body makes adrenaline and noradrenaline to meet our needs, which often leads to anxiety and feeling shaky and nervous, contributing to symptoms of anxiety.
Cortisol also influences the function of our sex hormones, thyroid hormones, and our blood sugar. Imbalances in any of these other hormonal systems can be a result of an impaired HPA axis.
Cortisol Testing
The two main ways to assess the body’s levels of cortisol are through serum (blood tests) and saliva.
A study found both tests were equal when it came to diagnosing Cushing’s disease, a condition of highly elevated cortisol.
One of the advantages to salivary cortisol testing is the ability to obtain multiple samples in one day to be able to view a patient’s cortisol curve, in which cortisol peaks approximately one hour after waking and declines throughout the day.
The cortisol curve is measured by assessing 4 samples of salivary cortisol taken at 4 key points during the course of one day. It measures free cortisol, which may only represent about 5% of total cortisol in the body.
While salivary cortisol levels can be a good starting point for assessing the cortisol curve, it doesn’t tell us everything about the health of the glucocorticoid receptors or HPA system as a whole.
High cortisol levels may be seen in patients with low cortisol signalling, such as depression, anxiety and chronic fatigue. Errors in obtaining salivary cortisol samples (such as not taking samples at the right time) can lead to falsely low cortisol readings.
In my opinion, this makes symptoms and health history the most valuable tools for properly assessing HPA axis function.
Cortisol and Melatonin
Melatonin, our sleep hormone, also operates on a circadian rhythm. It is released by the pineal gland in the brain and induces sleep. Its release corresponds to a drop in cortisol levels at the end of the day.
That release is impeded by artificial light exposure at night, lack of daytime sun exposure, alcohol, stress, and HPA axis disruption, among other lifestyle and environmental factors.
Melatonin, like other hormones, can be tested for in blood, urine and saliva, but I find more value in assessing for sleep quality and quantity by taking a thorough health history while also restoring a patient’s sleep hygiene and HPA axis regulation.
Many patients with sleep issues can benefit from a trial of supplemental melatonin to see if that helps their sleep. Taking it 2 to 3 hours before bedtime to coincide with the body’s natural melatonin surge and taking a prolonged-release version to promote sleep maintenance are two strategies I use for helping patients sleep better.
Working on sleep and circadian rhythms is also beneficial for restoring HPA axis functioning.
The “Female” Hormones: Estrogen and Progesterone
The most prevalent female sex hormones are estrogen and progesterone. These two hormones eb and flow in distinct ways throughout a woman’s monthly cycle.
Estrogen creates an “M” shape, rising at the beginning of the cycle to its first peak around ovulation, half-way through the cycle. At this time women typically experience their best mood, energy, and motivation, perhaps noticing a rise in libido.
After ovulation, estrogen dips a little bit and then rises, peaking again about a week before a woman’s menstrual cycle is due.
After this, estrogen takes a nosedive, reaching low levels around the time that menstruation begins: Day 1 of the menstrual cycle.
Progesterone, on the other hand is largely absent the first half of the cycle, before ovulation. Then, it begins a steady climb to peak with estrogen, about a week before the arrival of the next period.
After peaking, just like estrogen, progesterone then takes a dip, which stimulates the uterine lining to shed, resulting in menstruation, in which the entire cycle begins again.
PMS and PMDD
My practice is populated by women who experience various forms of grief at different stages of their monthly cycles.
Many of my patients experience PMS, and the more severe PMDD (Premenstrual Dysphoric Disorder)—which is characterized by intense mood swings, irritability, depression, or anxiety, panic attacks and psychosis in the most severe cases— up to two weeks before their periods.
The mood changes in PMS and PMDD are associated with fluctuations in the hormones estrogen and progesterone, which can wreak havoc on our brain chemistry.
Estrogen has a beneficial effect on mood, increasing dopamine and serotonin action in the brain. Dopamine and serotonin are two antidepressant, feel-good neurotransmitters.
Estrogen also increases something called Brain-Derived Neurotrophic Factor (BDNF) a chemical that stimulates the growth of brain cells. This can boost memory, concentration, and cognition, as well as positively influence mood.
Progesterone breaks down into a chemical called allo-pregnenolone, which acts like GABA, a calming neurotransmitter, in the brain. Bioidentical progesterone therapy is often used as a treatment for anxiety and insomnia.
When estrogen and progesterone levels surge and drop suddenly, drastic fluctuations in mood can occur. Cravings for sweets, crying, lack of motivation, or severe anxiety can all occur when hormones drop right before a period is due.
However, elevated levels of estrogen can also be problematic. Estrogen stimulates dopamine, which typically makes us feel good, gives us energy, and helps to motivate us. In genetically vulnerable women, elevated levels of dopamine can cause excess irritability, low stress tolerance, and even mania or psychosis.
Estrogen also slows the recycling of the stress hormones epinephrine and norepinephrine, which can lead to symptoms of acute stress and anxiety, when dysregulated.
This means that dramatic rises and falls in estrogen throughout a woman’s cycle can cause her to feel irritable and anxious one week and unmotivated and depressed the other.
Smoothing out hormonal ups and downs can be a key factor in regulating a woman’s menstrual cycles and soothing her mood and emotions throughout the month.
Perimenopause and Menopause
Perimenopause is characterized by a declining production of the ovarian hormones estrogen and progesterone.
Estrogen levels tend to rise and fall dramatically throughout a woman’s remaining cycles, while progesterone levels tend to stay low.
The result of these changes are symptoms like hot flashes, night sweats, brain fog, fatigue, and depression when estrogen levels suddenly tank, and increased stress and anxiety when estrogen levels abruptly spike.
During this time, cycles may become irregular. Some of my patients comment that their periods are incredibly light one month and the heaviest of their lives another.
Some get periods every few months and some notice increased frequency, even spotting between cycles, or have a full-blown period every two weeks in more extreme cases.
Weight gain tends to drift from the thighs and buttocks to the abdomen. Once pear and hourglass-shaped figures begin to resemble apples.
Fatigue is a common symptom. Women may experience poor sleep due to night sweats from estrogen deficiency, and anxiety from insufficient progesterone.
What a joy, right?
Many of these perimenopausal symptoms are a relatively modern phenomenon, stemming from a dysregulated HPA axis.
After cessation of periods, it’s the job of the adrenal glands to take over sex hormone production. However, if the HPA system is preoccupied with organizing a stress response, this can affect the production of other hormones.
Impaired Estrogen Clearance
Many women struggle with symptoms that are related to relatively high levels of estrogen, often caused by impaired estrogen clearance.
These conditions include heavy and painful periods, fibrocystic breasts, or conditions like fibroids or endometriosis.
Chronically elevated estrogen levels also include a risk of certain hormone-associated cancers, such as breast cancer.
These women may experience irritability and anxiety through estrogen’s interaction with stress hormones, and also from a relative deficiency in progesterone.
A relatively high level of estrogens compared to progesterone is termed “Estrogen Dominance”.
Estrogen is normally cleared through the digestive system: the liver and intestines.
A sluggish and congested liver causing a slower rate of hormonal clearance (think of it like a clogged drain), an increase in environmental toxin exposure, or an overconsumption of alcohol, can slow the liver’s ability to regulate estrogen levels in the body.
Constipation and a dysbiotic gut can also impair estrogen clearance.
Symptoms of estrogen dominance include stubborn weight gain, typically around the hips and thighs, heavy and painful periods, tender and painful breasts, fibrocystic breasts, endometriosis, uterine fibroids, acne, cyclical mood swings, especially premenstrual anxiety and panic attacks, and irregular menstrual cycles.
Low Progesterone
Aside from impaired estrogen clearance, another pattern of estrogen dominance is low progesterone.
In this case, estrogen levels are normal or even low (as in the case of menopausal or perimenopausal women). However, an even lower progesterone level still results in a pattern of relative estrogen dominance.
This can cause some of the same symptoms as excess estrogen (anxiety, irritability, heavy and painful periods, weight gain, PMS, fibroids, fibrocystic breasts, etc.).
Low progesterone can also be a culprit in unexplained infertility or early term miscarriage, as progesterone maintains the uterine lining in pregnancy.
Progesterone is released from the ovaries after ovulation. Lack of ovulation, therefore, is a primary reason for low progesterone levels. Anovulatory cycles can occur in women with polycystic ovarian syndrome, women with high levels of physical and emotional stress, or women entering menopause.
Some progesterone, however, is also made in the adrenal glands, where it can be eventually turned into cortisol, aldosterone (a steroid hormone involved in salt-water balance in the body) and androstenedione (a male sex hormone), eventually making testosterone and estrogen.
Women with high cortisol demands due to chronic stress may shunt the progesterone made in their adrenal glands to producing other hormones that support the stress response.
Not only can stress alter ovulation and fertility through various other mechanisms, it can also rob the body of progesterone, directing any progesterone made towards cortisol production.
Testing Estrogen and Progesterone
Estrogen and progesterone can be tested reliably in saliva, blood and urine.
Month long salivary hormone testing of estrogen and progesterone can be an easy and effective way to track the eb and flow of these hormones throughout a women’s menstrual cycles.
In this test, women obtain a saliva sample every 3 to 5 days for the duration of the month to track how estrogen levels corresponds with progesterone and how both hormones rise and fall.
In my practice, however, I often start by running blood tests. I test hormones on day 21 (of a 28-day cycle) to coincide with progesterone’s peak. This can help us calculate the progesterone to estrogen ratio and establish whether the cause of estrogen dominance symptoms is high estrogen or low progesterone.
Blood tests offer the option of looking at estrone, which is a more problematic form of estrogen, as well as estradiol (the most common, metabolically active estrogen in the body). In blood we can also look at LH and FSH, two hormones produced in the brain and ovaries that orchestrate ovulation.
FSH tends to be high in women in menopause or perimenopause, while LH tends to be elevated in women with Polycystic Ovarian Syndrome (PCOS).
Dried urinary metabolite testing, or DUTCH, is an effective way to understand how hormones are broken down and processed by the body. Looking at the entire hormone breakdown pathway provides a more in-depth look at the complexity of hormones in a woman’s cycle, and can guide treatment in specific, useful ways.
The “Male” Hormones: Testosterone
Polycystic Ovarian Syndrome (PCOS) is one of the most common causes of infertility (and the most common endocrine disorder) in women of reproductive age. It affects about 10% of menstruating women.
PCOS is a collection of various symptoms and complex hormonal causes. However, it is characterized by missed periods, anovulation, male-pattern facial hair growth, especially on the upper lip, chin, breasts and abdomen, and the presence of cysts on the ovaries.
Other common symptoms of PCOS are weight gain, estrogen dominance, male-pattern hair loss (on the crown of the head), insulin resistance, infertility, and acne, especially hormonal cystic acne on the jawline.
PCOS is characterized by elevated levels of testosterone, a male sex hormone, or “androgen”, on blood work.
Acne, weight gain, infertility, and hair loss are the main symptoms that bring women with PCOS into my office.
PCOS is a complex process that involves an overproduction of testosterone in the ovaries coupled with insulin resistance. Therefore, balancing blood sugar through diet and lifestyle can have a major impact on symptoms.
The conventional treatment for missed or absent periods is oral contraceptives, which of course doesn’t treat the underlying cause of anovulation. That’s why women with PCOS often seek naturopathic and functional medical solutions to treat the root cause.
Testing for PCOS
When I meet a new patient with PCOS, I often test her blood for estradiol and progesterone levels at Day 21 of her cycle. A very low progesterone level may indicate that she has not ovulated that cycle.
We also test LH and FSH. A high LH:FSH ratio can be indicative of PCOS even if cysts are not present on an ovarian ultrasound.
Other important tests that are often ordered are free testosterone and DHEA-S, another male hormone made in the adrenal glands.
Glucose control and insulin resistance can be assessed by looking at fasting blood glucose, fasting insulin and HbA1c (a marker that looks at long-term glucose control).
Prolactin, another hormone released by the pituitary gland, can sometimes be elevated in anovulatory women with PCOS.
A 4-point salivary cortisol test may be useful in women with PCOS who are also experiencing symptoms of cortisol dysregulation, which can contribute to insulin resistance and affect ovulation and hormone regulation, particularly progesterone production.
Prolactin
Prolactin is a hormone released by the pituitary gland to promote milk production after child birth.
However, some women will have elevated levels of prolactin in blood, despite not currently pregnant or breastfeeding.
Called hyperprolactinemia, elevated prolactin may be a cause of anovulation, mimicking some symptoms of PCOS and menopause, including hot flashes, absent or irregular periods, infertility and even milk discharge from the breasts.
Hyperprolactinemia may be caused by low calorie diets, liver issues, hypothyroidism, and issues with the pituitary gland itself.
Prolactin can be tested in blood. If levels are elevated, an MRI must be conducted to rule out a physical issue with the pituitary gland, such as a tumour.
Oxytocin
Oxytocin is a hormone produced in the brain and secreted by the pituitary. It aids in childbirth. Also termed the “love hormone,” it’s associated with feelings of intimacy and connection.
While high and low levels of blood oxytocin can be possible in men and women who are not pregnant or breastfeeding, the clinical applications of it are not fully known.
Thyroid Hormones
The thyroid, a butterfly-shaped gland on our neck, is the master thermostat of the body, controlling heat and metabolism. It pumps out thyroid hormones T4 and T3, which tell cells to burn fuel, creating energy and heat.
Because our thyroid hormones interact with the cells in every body system, symptoms of hypothyroidism, or low thyroid function, can be incredibly diverse.
Common symptoms of hypothyroidism are weight gain or inability to lose weight, fatigue and sluggishness, brain fog, hair loss, low body temperature, constipation, dry skin and hair, puffiness, infertility, and altered menstrual cycles, such as missed periods or heavy periods.
Aside from autoimmunity, other causes of low thyroid function can be HPA axis dysregulation and chronic stress, a very low calorie or very low carbohydrate diet, sudden weight loss, a deficiency in nutrients needed for thyroid function such as iron, zinc, iodine and selenium, and a body burden of environmental toxins such as heavy metals.
Testing Thyroid
To assess thyroid function, conventional doctors will test a hormone called Thyroid Stimulating Hormone, or TSH. TSH is not a thyroid hormone, but a hormone made in the brain that urges the thyroid to pump out the thyroid hormones T3 and T4. It gives doctors an indirect measure of thyroid regulation.
When TSH levels are high, this suggests that thyroid function is sluggish; the brain needs to send a louder signal to get an unresponsive thyroid to work.
However, TSH is only a periphery marker of total thyroid function, not giving us the whole picture. Also, TSH ranges on conventional lab tests may fail to pick up some cases of subclinical hypothyroidism or impending cases of autoimmune thyroid conditions, otherwise termed Hashimoto’s Thyroiditis, which is the most common cause of hypothyroidism.
To properly assess thyroid function in someone with symptoms of thyroid dysfunction, a slightly elevated TSH, or a family history of Hashimoto’s, I will order a thyroid panel: a blood test measuring TSH as well free thyroid hormone (T3 and T4) levels.
It’s also important to assess for autoimmune thyroid conditions by testing for anti-thyroglobulin and anti-thyroperoxidase antibodies. Both of these antibodies, when elevated, suggest the presence of an autoimmune thyroid condition.
Insulin
Some of the most common hormonal dysfunctions I see in my practice are insulin resistance and reactive hypoglycemia: blood sugar imbalance.
These issues often lie at the heart of other hormonal imbalance patterns, such as irregular menstrual cycles or HPA axis dysregulation.
When we eat, glucose enters our bloodstream, providing fuel for our cells. Insulin helps our cells access this hormone, spiking with each meal.
The higher the meal is on the glycemic index (i.e. the more sugar or refined carbohydrate it contains), the higher our post-meal blood sugar and insulin spikes will be.
Without insulin, we would slowly lose energy and die, unable to get precious glucose into our cells. Individuals with type I diabetes cannot make insulin. They must inject it daily to keep their cells fuelled and blood sugar stable.
For the rest of us who do make insulin, large blood sugar spikes after a meal can be problematic.
Insulin is a storage hormone. It helps energy get into cells, and it helps build muscle and brain cells, but it also blocks the breakdown of fat cells, blocking weight loss.
Insulin also drives down blood sugar levels. When blood sugar rises too quickly after a meal, a large insulin response can drop blood sugar levels too drastically, causing reactive hypoglycemia, or feeling “hangry” (hungry, angry, irritable, tired, light-headed, weak and dizzy) in between meals.
Individuals who experience hypoglycemia feel irritable, shaky, dizzy and anxious between meals. They often suffer from anxiety and panic attacks, and feel hungrier at night.
They may wake up in the middle of the night, as their bodies are unable to go 8 hours (the length of a decent night’s sleep) without food. This causes them to wake up, restless and perhaps anxious, in the early hours of the morning.
These individuals, paradoxically, rarely feel hungry at breakfast time.
I often see anxious patients wake from a restless sleep and toss back only a coffee in the morning, skipping breakfast due to slight morning nausea.
At 10 am, feeling ravenous and shaky, they might scarf down a high-glycemic bagel or croissant. Later on, they’ll enjoy a light lunch—maybe a sandwich—often feeling foggy and lightheaded after eating it.
At 2 to 4 pm, they may feel like an afternoon nap, instead indulging in a coffee and sweet treat to buy them some energy for the remaining hours of the work day.
Finally, after enjoying a larger dinner once they get home, they find themselves snacking all night long. Their bodies are finally urging them to ingest the nutrients they were lacking throughout the day.
They then fall into bed, feeling full, restless and wired, and the cycle begins again.
When our blood sugar falls, we not only feel hangry, weak, and crave processed carbs, our HPA axis also gets stimulated.
Cortisol, a glucocorticoid, can help our body control blood sugar, bringing it into the normal range after insulin sends it tanking too low.
This drop in blood sugar, therefore, needlessly triggers a stress response from the adrenal glands, which can further worsen anxiety, HPA axis dysregulation, and glucocorticoid resistance.
When blood sugar and insulin are spiked repeatedly for days, months, and years on end, cells stop responding attentively to insulin’s signal. Like our response to a pesky telemarketer, cells eventually stop picking up the phone when insulin calls.
However, cells still need insulin. More and more insulin must be released to trigger the same response from insulin resistant cells. This makes cells even more resistant, as they require even more insulin release the next time blood sugar rises to get glucose into the cell for fuel. And so the cycle becomes vicious.
Elevated insulin levels cause inflammation, fat gain, fatigue, depression, reactive hypoglycemia, and HPA axis dysregulation. The more resistant our cells become to insulin, the more cortisol must be called on to maintain blood sugar levels.
PCOS is also characterized by higher insulin levels. This prevents ovulation, causing infertility and female hormone imbalance.
When insulin resistance persists, type II diabetes, where the body is no longer able to keep blood sugar in a safe range, develops.
Type II diabetes is characterized by chronically high blood sugar—which poses a danger to small blood vessels, and is a potent inflammatory condition, increasing the risk of heart disease—and elevated insulin.
It affects almost 10% of the adult population and is the 7th leading underlying cause of death in North America, costing 350 billion dollars a year to manage in the United States alone.
Insulin-related weight gain can affect female hormones, as fat cells make estrogen in the body, leading to estrogen dominance.
Insulin also interacts with a hormone called leptin, which is created by fat cells in response to calorie intake. When body fat levels get too high, cells can become leptin resistant. The body no longer senses dietary calorie intake, leading to increased hunger. This exacerbates the problem of weight gain and insulin resistance.
Testing for Insulin Resistance
When I meet a patient who is presenting with stubborn weight gain, estrogen dominance and stress, I assess their blood for insulin resistance by looking at blood levels of fasting insulin and fasting glucose.
With these two values a calculation that measures insulin resistance, called the HOMA-IR, can be performed. This can give us a baseline measure of how well the body is compensating to control blood glucose.
I also run HbA1c, which looks at glucose levels over 3 months. I will often run a blood cholesterol panel, and inflammatory markers, such as CRP.
Insulin resistance often puts all of our hormones on a rollercoaster, which becomes very difficult to get off of unless we prioritize the diet and lifestyle interventions that address blood sugar control.
Assessing Hormones
When presented with a patient suffering from a complicated symptom pattern, I begin by taking a thorough health history in which we investigate:
Energy levels,
Sleep quantity and quality,
Mood and mental health history,
Period health history,
Family history,
Dietary intake and exercise,
Health risk factors like smoking, alcohol use, and past health history.
Depending on how clear the patient’s symptom picture presents, we may opt to make some changes before testing, to gauge their body’s response to an increase in nutrient intake.
Then, if necessary, I will order a comprehensive blood work.
Blood testing might include a thyroid hormone panel, and an in-depth look at female hormones, fasting insulin and fasting blood glucose, and other markers that help us assess health, such as cholesterol and inflammatory markers, or nutrient levels.
Patients requiring a more comprehensive view of their cycles may opt for month-long salivary testing. Others may opt for a dried urine test that looks at hormonal breakdown in the body.
A Sample Case
Jenny (name changed for privacy) came to me feeling fatigued and anxious.
She had suffered from anxiety periodically as a teen, but now at age 46 she was experiencing bimonthly panic attacks that seemed to occur cyclically; the panic would come around ovulation and premenstrually.
It was hard to tell, however, because Jenny also claimed that her periods were “all over the place”. One month they were heavy and painful, causing her to take time off work, crouched on the bathroom floor in agony. Other months she barely noticed them, experiencing some light spotting, if anything at all.
Very troubling to her was her major mood volatility, which she described like a “switch” that would suddenly flip on or off, causing her to breakdown at work or pick fights with her family.
Then, almost as suddenly, the cloud would lift and she would be her cheerful, friendly, loving self again.
It was maddening, both to her and those living with her during these darks times, she said.
She also noticed disrupted sleep and weight gain around the abdomen, which seemed to ignore her intense workouts and strict dietary regime.
Jenny was highly accomplished at her high-pressure job and commented that she thrived on being busy and achievement oriented.
I tested Jenny’s blood estradiol, estrone, progesterone, LH, and FSH levels one week before her next expected period, had her fill out a weekly diet diary, and gave her some recommendations about sleep and supplement intake.
Jenny’s blood revealed elevated FSH, indicative of impending menopause (FSH encourages the ovaries to ovulate, as TSH encourages the thyroid gland to make thyroid hormone). She also had low estradiol, and low progesterone, but elevated levels of estrone, the more problematic of the estrogens.
According to her labs and history, Jenny was experiencing estrogen dominance and perimenopause. Many of her symptoms were stemming from elevated estrone, low progesterone and a disrupted HPA axis.
Together, we worked on her diet to provide her body with the nutrients needed to make hormones and to support her brain, mood and adrenal glands.
We used herbs and dietary nutrients to promote liver estrogen clearance and to support Jenny’s adrenal glands.
We addressed the stress in her life, encouraged relaxation, and made sure her body was supported in its ability to make and respond to cortisol.
After a few months, Jenny reported a reduction in hot flashes, better sleep and feeling calmer. She had a reduction in her waist line and better energy and mood.
Our hormones, when imbalanced, can cause vicious cycles in the body that trap us in a state of worsening imbalance.
Through correctly assessing these common hormonal patterns through a health history and appropriate testing, and then making diet, lifestyle and supplement suggestions addressed at stopping these cycles, naturopathic doctors can address underlying hormonal issues that might be causing these complex and troublesome patterns of hormone disruption.
Since publising the original article about the Mirena IUD on this blog, thousands of women have come out of the woodwork writing to me asking for help.
When I originally wrote the article, I was spurned on by my observations of the women in my practice who had experienced a rise in estrogen dominance and low progesterone after the insertion of their IUDs (which were often inserted to treat hormone imbalances!).
At that point I never imagined that so many women would be affected by the IUD, or that even more were suffering from so many hormonal symptoms that drastically affected their lives and health.
It makes sense: our society does not set us up for proper hormonal function.
Our diets are carbohydrate-heavy, promoting insulin resistance and blood sugar dysregulation, which impacts our ovaries’ ability to make estrogen properly.
An excess amount of body fat produces more estrogen in the body and acts as a reservoir for the toxic estrogens in our environment.
We lack many of the micronutrients necessary to process our hormones properly, such as vitamin D, B vitamins, magnesium, zinc, omega 3 fatty acids, glutathione, and amino acids.
Many of us have impaired or suboptimal liver function, or sluggish digestion, which keeps hormones in our bodies around longer than they should be.
A dysbiotic gut has the tendency to turn estrogen in the gut back “on”, putting it back into circulation when it was otherwise on its way out of the body.
Stress alters our hormonal function, including our ability to make progesterone, DHEA-S, convert thyroid hormones, and process estrogen properly.
Xenoestrogens in our food and environment, from plastics, fragrances, pesticides, and processed soy products, contribute to overall body burden of the hormones in our body, throwing off our delicate balance, and contributing to symptoms.
The result of all this is that many women suffer from hormonal imbalances.
10% of women have some form of PCOS, or Polycystic Ovarian Syndrome, characterized by the body’s inability to properly make progesterone or estrogen, instead making loads of male hormones, like testosterone. PCOS alters fertility, promotes weight gain, and causes things like unwanted facial hair growth, acne, and missed periods. PCOS is often connected to stress and insulin resistance.
Many women in my practice suffer from PMS or PMDD, experiencing often debilitating symptoms sometimes even two weeks before their periods begin. They might get migraines, intense cravings for sugar, and massive mood changes, such as anxiety, intense irritability, or devastating depression. Panic attacks can occur at this time as well. Many of them comment that their mood and personalities flip once their hormones levels reach a certain point, causing them to act like different people. This can jeopardize their relationships with spouses and children, coworkers, friends and family.
Tender and painful breasts, or breast lumps, are also common in many of these women.
Acne, weight gain, stress, fatigue, disrupted sleep, depression and anxiety are all symptoms I see in women with hormonal imbalances.
Many women have horrific cycles, experiencing painful and heavy periods that often cause them to miss days of work every month. Many of these women struggle to keep their iron levels in the optimal range, suffering from hair loss, fatigue and weakness.
Many women are diagnosed with fibroids, or endometriosis, or are concerned about their risk of female cancers like breast, ovarian, uterine and cervical cancer.
All of these symptoms are often linked to relatively higher levels of estrogens compared to progesterone, sometimes termed Estrogen Dominance by functional medical practitioners who look at the underlying causes of bodily imbalances.
I feel terrible that I can’t help more of the women who write to me. My license prevents me from giving advice to those who live abroad, especially to non-patients over the internet. It’s a shame, however, because oftentimes the solutions are relatively simple, despite how complicated many of these symptoms might seem.
I’m hoping that this article can provide some direction to many of the women who suffer.
Firstly, I want to state that I am not against birth control or even the Mirena IUD (or other IUDs, for that matter). The vast majority of women with the IUD tolerate it. For many women with debilitating heavy periods and endometriosis it can be the only viable solution that makes life tolerable.
In my social practice at Evergreen, many of the women I see experiencing homelessness, drug addiction, or PTSD from relationship trauma, rely on the efficacy of IUDs to prevent unwanted pregnancies. Their lives often don’t allow for them to remember to consistently take pills every month.
Many women don’t tolerate combination birth control because of a history of blood clots, female cancers, or migraine headaches associated with their periods, and therefore the Mirena IUD, which is progesterone only, is a safe alternative for preventing unwanted pregnancy.
That all being said, many women do suffer on the Mirena IUD (or other forms of birth control). They were perhaps put on the Mirena to deal with some of the above symptoms of hormonal imbalance, or for contraception. Many of them noticed that their symptoms became worse after insertion of the IUD.
How the Mirena IUD and Birth Control Works:
The Mirena works by secreting small amounts of progestins, a synthetic form of progesterone, into the uterus and surrounding tissues. While it is not fully known how the Mirena works, the end result is a suppression of ovulation. This results in either very light periods or a complete cessation of periods until the IUD is removed (after 5 years when its hormones run out).
It is important to say here that, while birth control can certainly treat the symptoms of hormonal imbalances, it does not correct them.
All forms of birth control, with their synthetic versions of the hormones estrogen and progesterone, simply induce further hormone imbalances in the body. They introduce versions of hormones that may suppress or alter symptoms (such as heavy and painful bleeding, or acne), but the versions of hormones are not fully recognized by the body and therefore don’t fully replace all the hormones’ important functions, such as mood regulation, immunity, or blood sugar balance.
The effects of both altering the body’s natural hormonal balance, while ignoring the underlying cause of hormonal issues, is often what causes symptoms to continue or worsen.
For example, women with PCOS are prescribed birth control to manage acne or promote monthly periods. However, when women with PCOS miss periods, it is because they are not ovulating. The missed periods are not the problem; the lack of ovulation is.
Despite that, many women with PCOS experiencing amenorrhea (or missed cycles) will be prescribed birth control. However, birth control does not address the underlying cause of amenorrhea. It simply further suppresses ovulation (because its main purpose is to prevent unwanted pregnancy).
The periods you get while on birth control are not periods. Periods from birth control are withdrawal bleeds. After 21 days of taking hormonal pills, pills are stopped or replaced with placebo pills. The withdrawal of hormones in the pills induces a bleed that resembles a period, but is not one.
Hormonal contraception does not correct hormonal imbalance, it imposes further hormonal imbalance to manage symptoms. This is not always bad!
But it is an important difference.
Many women do require symptom suppression, particularly if their symptoms are severe. Many individuals in my practice experience periods so heavy that the only way for them to get through the month is with an IUD. Genetic variability in how our bodies process hormones can make us susceptible to intense hormonal symptoms, through no fault of our own.
In my opinion, however, it is important to attempt to address the underlying cause and to set our bodies up for better hormonal regulation, making as many changes as our lifestyles will allow.
What You Can Do About It:
If you are like any of the people I described above who seek my help, there are a few things that you can do to get started on correcting hormones.
Working With a Professional:
The first thing I advise is finding a licensed naturopathic doctor or functional medicine practitioner who understands hormones, can order lab tests, and will address the underlying cause of your hormonal imbalances by taking the time to fully understand your body and lifestyle.
This practitioner might be a naturopathic doctor (you can find one in North America by looking one up at naturopathic.org), or a medical doctor, a chiropractor, or a highly skilled nutritionist or nurse practitioner. Research this person well, read their articles, and perhaps book in with them for a complimentary meet and greet.
Testing:
I often test patients using simple blood tests, on day 21 of their cycles (or about 7-9 days before they expect their next period).
I will test their blood, looking for anemia, will test iron and B12 levels, homocysteine (to gauge their ability to methylate), vitamin D, cholesterol (to see if their diets are promoting proper hormone synthesis), estradiol, estrone (the more toxic, problematic estrogen), progesterone, free testosterone, a thyroid panel, fasting glucose and fasting insulin (to calculate insulin resistance using something called the HOMA-IR), HbA1C (to look a long-term blood glucose control), FSH and LH (two hormones made in the brain that talk to the ovaries and orchestrate the menstrual cycle), DHEA-S, to name a few.
Some women will require more testing. Others will require less.
These labs are interpreted from a functional perspective. Even though you are in the “normal” ranges (which take into account the entire population, many of which are not healthy—they are seeing their doctors, after all!), these blood markers may not be optimally balanced, giving us an opportunity to correct things before they go further.
Testing allows us to match symptoms to underlying imbalances and to be able to properly direct treatment protocols. Women with estrogen dominance may be experiencing high levels of estrogen and normal progesterone, which indicates a body burden of estrogen or impaired liver and digestive system clearance. Other women may be experiencing normal levels of estrogen but low progesterone, indicating a failure of their bodies to ovulate, due to high stress, and PCOS (or the Mirena IUD and birth control pill).
Other options for hormonal testing are month-long salivary hormone testing, or DUTCH testing, which looks at hormone breakdown in the urine. I sometimes run these tests, but find that blood testing is useful, accurate, and more cost-effective.
Treatment:
Once you understand your individual hormonal situation through testing (and through working with a practitioner who is putting the testing together with your symptoms and health history), your practitioner may recommend a variety of treatments.
I personally combine diet and lifestyle with key herbal and nutritional supplements, to target what is going on under the surface with my particular patients.
These treatments may include herbs that boost ovulation, aid liver detoxification, or regulate the stress response. I might recommend nutraceuticals that encourage methylation, or aid in hormone production.
My treatments take into account the individual’s symptoms, labs, diet, lifestyle, and any other health issues she may be facing like fatigue, digestive disturbances, or poor sleep.
What You Can Do Today:
Barring more individualized assessment and advice, there are some best lifestyle practices that can help most women balance their hormones better, whether they are still using birth control to control and address their hormonal symptoms or prevent pregnancy.
Diet:
When it comes to diet and hormone support, we need to ensure that we are balancing blood sugar, boosting liver detoxification pathways, promoting hormone synthesis, and supporting digestion, especially if experiencing constipation.
Consume more leafy greens: kale, spinach, collards, beet greens, arugula, etc. Eat 1-2 cups of these foods every day. Leafy greens contain active folate, which boosts methylation and detoxification. They also contain magnesium which is essential for hormonal regulation as well as 300 other important biochemical reactions in the body that balance mood and hormones.
Consume more cruciferous vegetables: broccoli, cauliflower, brussel sprouts, cabbage, bok choy, etc. Eat 1-2 cups of these foods every day. Crucifates help the body make glutathione, and contain indole-3-carbinole, which helps eliminate excess estrogens from the body. Broccoli sprouts are potent players in these pathways. Consume them as often as possible.
Ensure adequate dietary fibre intake: I often recommend ground flaxseeds or chia seeds in smoothies, avocados, fruits and vegetables and legumes (if tolerated) to make sure that women are having regular bowel movements to clear excess estrogens out of the body. 2 tbs of ground flaxseed (or more) every day can help balance estrogen levels and promote daily bowel movements.
Balance blood sugar: consume protein, fat and fibre at every meal. Avoid refined starches and flours. Avoid all sugar, even natural sugar like maple syrup, coconut sugar, cane sugar, honey, agave, etc. Try stevia or avoid sweets. Limit carbs (grains, legumes, root vegetables like potatoes or sweet potatoes, to 1/2 cup to 1 cup per meal). Only consume whole grains like quinoa, buckwheat, steel cut oats, millet, and teff. Cook them yourself!
Avoid soy, particularly processed soy, like vegan burgers, or soy milk.
Consume omega 3 fatty acids in fatty fish like salmon and sardines, or nuts and seeds like flax and chia seeds, walnuts, and pumpkin seeds. Get 2-4 tablespoons of these nuts and seeds every day and 3-4 servings of fatty fish a week.
Consume animal products: eggs contain choline, which is essential for liver function, meat contains vitamins B6 and B12, which are essential for hormonal regulation and production. Cholesterol in animal products are the backbones of our sex hormones. Iodine, found in animal foods, regulates estrogen balance in the body. If possible, try to obtain organic animal products from pastured or free-range animals to boost omega 3 intake, to lower your impact on the environment, and to promote animal welfare.
Other Lifestyle Practices:
Boost progesterone production by managing stress:
Establish a self-care routine: plan regular vacations, even small outings, do meditation or yoga, take breaks from work, spend quality time with family, have a plan to get your work done on time, ask for help.
Sleep! Aim for at least 8 hours of sleep, and try to get to bed before 12am. Practice good sleep hygiene by avoiding electronics before bed, keeping the bedroom as dark as possible, and setting a bedtime and wake time, even on weekends. Body scan meditations and some key supplements can be helpful for resetting circadian rhythms. Regulating blood sugar can have a major impact on improving sleep. Talk to your functional medicine doctor or naturopathic doctor for individualized sleep solutions.
Eliminate exposure to toxic estrogens and boost estrogen clearance:
Avoid exposure to xenoestrogens: whenever possible use natural body products, deodorants and shampoos, or “edible” body products for face and hair. Avoid plastic water bottles and plastic food containers. Use natural cleaning products around the house. Avoid fragrances and processed foods, especially processed soy.
Encourage sweating: get regular exercise or engage in regular sauna therapy. If you don’t have access to a sauna, epsom salt baths can also work—anything that helps you sweat. Heat therapy has also been shown to benefit mood and the stress response.
Heal your digestion: make this a priority with your naturopathic doctor, so that you can absorb the nutrients from the foods you’re eating as well as encourage daily bowel movements and optimal microbiome balance.
Maintain a healthy weight: body fat is metabolically active and can increase overall estrogenic load. Work with your naturopathic doctor to manage your weight. We often attempt to lose weight to become healthy, however I find my patients have far more success (and fun!) getting healthy in order to lose weight. Healthy weight loss often involves managing stress, sleeping 8 hours a night, avoiding sugar and processed foods, and regulating blood sugar, as well as encouraging proper sweating and liver detoxification.
Want to balance your hormones, energy and mood naturally? Check out my 6-week foundational membership program Good Mood Foundations. taliand.com/good-mood-learn
I often 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.
Humour me for a moment. Take a moment to imagine your “happy place”—the place you feel most at home. Where are you? What are you doing? Who is there with you?
What are the sights, sounds, smells, tastes, and sensations that fill the air and tickle your skin? What are the internal bodily sensations you notice when you find yourself here, in this place? What emotions do you feel?
I’ll venture some guesses: you feel calm, at peace, safe, energized, connected, and integrated. If you turn your attention to your breathing you probably notice that it’s slow, deep, restorative. That head cloud of frenzied thoughts and worries that you tend to spend your time in might have cleared. Your sense of “self” has probably moved out of your head and into your body.
Maybe, through doing this short exercise, you’ve come home to yourself, even just a little.
1) Understand what “self-care” means.
A friend recently shared a Collegehumor video with me depicting three women in a nail salon, bragging about what horrible things they’ve done, from eating 13 glazed donuts in a single sitting, to “enslaving the entire office”, in the name of their own self-care. Because, according to the video, “You can be terrible if you call it ‘Self-care’”.
Humorous? Perhaps. An accurate depiction of self-care? Well, no.
I asked followers of my Facebook page to tell me what the phrase “Self-Care” means to them. They enthusiastically replied:
“Silence. No social media, or anything electronic.”
“Floating in water—buoyant, effortless.”
“Being kind and gentle to myself.”
“Meditation and time to oneself.”
“Eating healthy foods.”
“Respecting your body.”
“Epsom salt baths.”
“Peace.”
“Rest.”
“Hygge.” (a Danish word that is roughly translated as “warm and cozy”)
“Yoga.”
“Commitment.”
“Masturbation.” (There’s one in every crowd.)
In essence, their responses boiled down to, “Self-care is feeling good, taking care of myself, and taking care of my body, by engaging in activities that feel nourishing while reducing external stress and overwhelm.”
Put even more simply, self-care is the act of practicing self-compassion, whatever that might look like to you.
2) Understand the impacts of stress.
The relationship between self-care and stress is important. According to The American Institute of Stress, about 75% of us have significant physical and psychological stress in our lives.
This stress takes a toll; it produces physical, mental and emotional symptoms, sending us into emergency rooms with panic attacks, and drugstores with prescriptions for pain, anxiety, or anti-hypertensive medications.
Stress lands us in doctor’s offices, pouring over junky magazines waiting to discuss our latest health complaint—digestive issues, mental health issues, fatigue, autoimmune disease, metabolic syndrome, chronic pain, weight gain, and so on.
Our bodies have a built-in stress response to save our lives when triggered by a life-threatening danger. Now, this fight-flight-freeze mechanism is chronically set off by the abundant stressors in our modern era—traffic, deadlines, relationship woes, artificial lighting, and in-laws.
When our body encounters a stressor, one of the hormones it releases is cortisol.
Cortisol affects every system in the body; it elevates blood sugar, heart rate, and blood pressure. It suppresses the immune system, redistributes fat, shrinks certain areas of our brain involved in learning and emotional regulation, causes painful muscle contraction, impairs digestion, and affects our sleep.
Managing stress involves two main goals: lowering external stressors, and managing internal perceived stress by boosting our physical, mental, and emotional resilience. Self-care is our armour against the internal and external stress we put up with daily.
3) Make a list of your nourishing and depleting daily activities.
Let’s try an exercise from Mindfulness-Based Cognitive Therapy. Write down a list of routine activities in your typical day: hauling yourself out of bed, brushing your teeth, eating breakfast, sitting in traffic, working, exercising, making dinner, and so on.
Decide if each activity is nourishing, depleting, or neutral. In other words, does this activity fill your cup or drain it?
For instance, I find that breakfast is nourishing, but less so when I scroll through Facebook feeds or answer emails while eating it. Coffee immediately feels nourishing to me but, hours later, caffeine-fuelled and wired, I often feel more depleted than if I had opted for an herbal tea, or hydrating water instead.
4) Find out what brings you pleasure or mastery.
To get a deeper understanding of your day, determine if the activities that nourish you provide you with pleasure, mastery, or both.
Pleasurable activities feel good in our bodies, and minds when we do them. They bring us positive emotions like safety, calm, peace, happiness, joy, excitement, gratitude, and awe. Sleeping, eating, laughing with friends, cuddling with my dog, and consuming art, are all activities that give me pleasure.
Activities of mastery give us a sense of accomplishment and achievement. We feel that we are developing ourselves and moving closer towards an important goal. When we engage in activities that give us a sense of mastery, we experience our lives to be rich in meaning. Checking things off a to-do list gives me a sense of accomplishment. So does making strides at work, and taking a course, or studying.
5) Make some changes to your list.
Oftentimes, patients recoil in horror when they realize that their lists contain only depleting and neutral activities. There are no activities in their day that nourish them: either through pleasure or self-development. I ask them:
Are there any depleting activities that you can stop doing?
Are there more nourishing activities that you can start doing?
How can you make a depleting activity feel more nourishing?
Self-care and self-compassion are the agents through which we answer these questions.
6) Set healthy boundaries.
Before we can reduce the invasion of depleting activities in our lives, we must learn to prioritize our needs. Many of us put others’ needs first. We ignore the advice of every flight attendant—we put on everyone else’s oxygen mask before our own. Before long, we run out of air.
In order to nourish ourselves, we need to learn to create healthy boundaries around our energy and time; we need to say “no.” Author Cheryl Strayed writes, “No is golden. No is the kind of power the good witch wields… [It involves] making an informed decision about an important event in your life in which you put yourself and your needs and your desires front and centre.” When we say no to the people, activities, commitments, and responsibilities that drain us, we say “yes” to ourselves.
Think of your list of depleting, nourishing and neutral activities. What activities, if you could just say “no” to them, would bring you immense relief? What would saying no to those activities allow you to say yes to instead?
7) Recognize perceived stress.
Whether or not external events elicit a stress response in our body depends on our perception. Stressful events are woven into how harmful and uncontrollable we perceive them to be, rather than their intrinsic capacity to cause us harm.
Our perception of stress can be influenced by biochemical factors, such as our levels of neurotransmitters, and hormones. It can also be influenced by our mindset, our capacity for resilience, and how far into burnout we’ve begun to drift.
Lowering our perception of stress requires that we practice the skill of mindfulness: being aware of how external situations affect our thoughts, emotions, body sensations, and behaviours. It also requires that we pay attention to our internal physiology: our hormones and circadian rhythms, and inflammation levels, to support our body’s physical capacity to deal with stress.
8) Practice Mindfulness.
A tarot reader friend of mine once said, “It is impossible to be healthy in this day and age without mindfulness.” She was probably right.
Mindfulness helps us lower our perception of stress. It is the act of bringing attention to the present moment, intentionally, without judgement. Through mindfulness we can be intentional about our behaviours: how often we exercise and what it feels like, what certain foods feel like in our bodies, and what activities we engage in.
Mindfulness also allow us to parse out our overwhelmed, worried, personalizing, catastrophizing, black-and-white, future-telling, and negative, thoughts from our body sensations and emotions. We realize that our thoughts are just that—thoughts. Thinking something doesn’t necessarily make it so.
Research shows that mindful meditation strengthens the connections between the rational brain and the emotional brain. It helps us develop awareness of our moment to moment experience. It connects us to our bodies and our emotional states.
There are many different mindfulness techniques. You can do sitting meditations, standing meditations, and walking meditations. You can do mindful yoga. You can wash the dishes mindfully.
However, the simplest way to begin a mindful practice is to sit or lie down in a comfortable position, with an relaxed and alert posture, and focus on the experience of breathing.
Focussing on the breath helps us practice bringing our awareness to the present moment. As we learn to ride the waves of our breathing, we eventually learn to ride the waves of stress that sometimes lap gently at our floating bodies, and other times rock us to our core.
With mindfulness we can begin to relax our resistance to the waves. As Jon Kabat Zinn says, “You can’t stop the waves, but you can learn to surf.” Mindfulness is the surfboard that carries you.
9) Practice self-soothing.
Self-soothing helps us regulate our emotions in the presence of external stressors. Dialectical Behaviour Therapy teaches self-soothing as a means of returning to the “Window of Tolerance”.
When we’re in the Window of Tolerance we’re not in fight, flight or freeze. We aren’t depleted, disconnected and dissociated. We feel relaxed and safe, but also alert and focussed. We are present, in control of our bodies. Self-soothing allows us to enter the window of tolerance by boosting the hormone oxytocin, which helps us feel calm, nurtured, and connected.
To boost oxytocin:
Lie or sit in a comfortable position, place your hands on your chest and breathe slowly and deeply.
Connect deeply with a trusted other: a person in your life, a pet, or an entity (God, your higher self, a deceased loved one, etc.).
Use body weights or heavy blankets on your body.
Recite believable affirmations of self-love.
Ask someone you trust for a hug.
Boost pleasure through engaging the senses: listen to soothing music, savour delicious food, look at beautiful images, touch soft fabrics, and use aromatherapy and calming essential oils, like lavender.
Poet Mary Oliver tells us, “You do not have to be good… You only have to let the soft animal of your body love what it loves.”
Self-soothing requires practicing mindful awareness to recognize if you’re slipping outside your Window of Tolerance. It also involves implementing nourishing rituals that “the soft animal of your body” loves, to release oxytocin, and return to feelings of calm.
10) Balance blood sugar to balance your mood.
Our blood sugar is complexly intertwined with our other hormones, like insulin and cortisol, but also our neurotransmitters, like serotonin, epinephrine and dopamine, which influence our mood.
More than 1 in 3 American adults has pre-diabetes. This indicates an impairment in our body’s ability to control blood sugar, which throws mood and hormones off balance.
One of the main life-saving actions of the body’s stress response is to regulate glucose in the blood. Fluctuations in blood sugar can trigger cortisol and stress hormone release. Stressful events can also wreak havoc on our body’s ability to control blood sugar. Regulating blood sugar, therefore becomes a priority for managing our body’s internal stress cues.
To balance blood sugar:
Eat a full 20 to 30 g serving of protein and healthy fat at each meal.
Eat a large, protein-rich breakfast that contains at least 200 calories’ worth of healthy fats: 1 avocado, a handful of nuts or seeds, coconut oil, full fat yogurt or kefir, 3 eggs, etc., within an hour of waking.
Eat snacks that contain 10-15 g of protein. A great snack for balancing blood sugar is a 1/4 cup of pepitas, or raw pumpkin seeds. Rich in protein, fibre and healthy fats, they also contain zinc and magnesium, two important minerals for balancing mood and supporting stress hormones.
Ensure that every meal contains gut-loving fibre: eat 2-3 cups of vegetables at every meal.
Avoid refined sugars and flours wherever possible.
Experiment with Time-Restricted Feeding, leaving at least 12 hours of the day open where you consume only water and herbal teas, to give the digestive system a rest. For example, if you have breakfast at 7am, finish your dinner by 7pm, to allow 12 hours of fasting every night.
11) Calm your stress response through healing your circadian rhythms.
The body’s stress response is tightly connected to our circadian rhythms. Cortisol, the stress hormone, follows a predictable daily pattern, rising within an hour of waking in the morning, and then falling throughout the day. Low cortisol levels at night coincide with the rise in melatonin, our sleep hormone.
Morning fatigue, afternoon crashes, and waking at night, all point to a flattened or altered stress response that has negatively impacted our body’s circadian rhythms. Sleep is also the greatest reset for the stress response. We build up our metabolic reserve and internal stress resilience every night when we rest.
To heal your circadian rhythms:
Expose yourself to bright, natural daylight soon after waking.
Eat a large, fat and protein-rich breakfast within an hour of waking.
Avoid exercising too close to bedtime.
Keep blood sugar stable.
Practice sleep hygiene: keep your bedroom dark and cool, and reserve your bed for sleep and sex.
Avoid blue light after 7 to 8 pm. Wear blue light-blocking glasses, use a blue light-blocking app on your devices, such as F.Lux, or simply avoid all electronics in the evening, switching to paper instead.
Try to get to bed before midnight, as the deepest sleep occurs around 2 am.
Talk to your naturopathic doctor or natural healthcare professional about melatonin supplementation or other natural remedies to help reset your sleep cycle.
12) Manage Inflammation and nurture your microbiome.
Cortisol, the stress hormone, is an important anti-inflammatory. High levels of inflammation have been associated with mental health conditions like depression and anxiety.
Keeping inflammation levels low not only reduces our need for stress-hormone-signalling, but keeps us healthy. Most chronic conditions, like cardiovascular disease and diabetes, are associated with inflammation.
To keep inflammation levels low:
Eat a variety of anti-inflammatory colourful fruits and vegetables.
Avoid processed oils like soy and corn oil, whose omega 6 fatty acids are known to contribute to inflammation.
Eat healthy fats from avocados, fish, coconut, olives, nuts, seeds and grass-fed animals.
Avoid processed foods and fried foods wherever possible.
Nurture your gut health by eating lots of fibre, and consuming fermented foods, like kefir and sauerkraut.
Our gut is the seat of the immune system. Keeping it healthy is a powerful preventive measure for keeping inflammation levels low. Our gut bacteria also play a role in our mood and stress-hormone regulation. Therefore, keeping them healthy and happy is essential for boosting our internal resilience against external stressors.
13) Recognize that balance doesn’t exist.
None of us are born cool and collected. Those of us who seem to “have it together” are simply quick to respond to life’s tendency to fall apart. Balance doesn’t exist; as soon as we feel like we have the details our lives lined up, a sharp gust of wind sends them tumbling in all directions. Therefore prioritizing self-care becomes an ever-evolving balancing act that we must commit ourselves to through nurturing our internal resilience.
A poem by Kelly Diels says it best, “when your love knocks you down or your weak ankles trip you up, stop worrying about balancing—‘cuz you’re not — and bounce.”
Estrogen levels in the brain and body affect our brain’s levels of dopamine and norepinephrine, two neurotransmitters that are implicated in mood disorders like depression, psychosis and anxiety.
Our brain has several built-in recycling processes to keep us level-headed. When neurotransmitters (brain chemicals that have mood-regulating effects) are finished with their tasks, enzymes recycle them, breaking them down into their chemical parts to be reused again at a later date. This process controls the level of chemical nervous system stimulation in our brains and keeps our moods regulated.
You’re at home, late a night, working on an important assignment, driven by the excitement of the topic at hand. Your brain is flooded with dopamine, a brain chemical that is connected to positive mood and motivation, pleasure and reward; dopamine pathways are activated when we’re engaged in a task that is pleasurable and rewarding, when our lives are flooded with meaning and we’re working towards a goal. Dopamine, however can also be connected to psychosis, conditions like schizophrenia and bipolar disorder, and also be linked to impulsive behaviour, aggression and irritability, when over-expressed.
Typing happily, you near the end of your assignment. Suddenly, your computer screen goes dark. Your heart begins to race, your skin prickles and you’re overtaken by anxiety, panic and fear. Your body is releasing norepinephrine, a chemical connected to stress, anxiety and the “Fight or Flight” response, but that also allows us to feel alert and energized. Your heart pounds as your reboot your computer. You are hyperaware of the sounds and smells around you. Your skin prickles and your breathing is loud and rapid.
You exhale with relief as your computer screen lights up again, revealing that your assignment is unharmed. Stress drains out of your body, and your norepinephrine levels fall. You begin to tire; it’s time for bed. You add some finishing touches to your work, hit “save” and turn in for the night. The stress and motivation you felt only hours before dwindle, as the neurotransmitters responsible for these responses are swept out of your synaptic clefts and recycled.
When our brains have had enough stimulation of dopamine (mood, reward, pleasure, but also aggression, irritability, impulsivity and psychosis) and norepinephrine (stress and anxiety, “Fight or Flight”, but also alertness and energy), both get recycled through COMT, which pulls them out of circulation, breaks them down into their chemical parts, and reassembles them for later use.
We all have variability in how fast our COMT enzyme works, based on the expression of the COMT genes in our DNA. Some of us have slower COMT genes, meaning that our brain levels of dopamine and norepinephrine tend to be higher than other people’s, as our ability to clean up and recycle these hormones is slowed. This might result in an individual (depending on other genetic and lifestyle factors) who is at a higher risk of mental health conditions like psychosis or bipolar disorder, or someone who is more irritable, prone to aggression, or stress intolerant.
Others have more COMT gene expression, resulting in a faster enzyme that clears dopamine and norepinephrine more quickly, resulting in lower brain levels of these neurotransmitters. If other factors are present, these individuals may be more at risk for mental health conditions such as depression, low mood, lack of motivation, or susceptible to addictions.
Beyond genetics, there are several environmental and biological factors that may affect the speed of the COMT enzyme. One of these factors is estrogen. Estrogen slows the COMT enzyme down by as much as 30%. This means that when estrogen levels are high (seen in many women around ovulation or premenstrually, or in women with generally high estrogen levels, termed “Estrogen Dominance”, COMT performs more slowly and dopamine and norepinephrine levels remain elevated.
Depending on the extent of the problem, women with high estrogen often experience anxiety and irritability and a low tolerance for stress. On the more severe end of the spectrum, some women experience conditions such as PMDD (Premenstrual Dysphoria Disorder) or PMS-induced psychosis, resulting from abnormally high brain levels of dopamine and norepinephrine due to high estrogen. These conditions probably result from a combination of high estrogen, slowed COMT and other genetic and lifestyle factors. Xenoestrogens from environmental toxins, or birth control pills may also slow COMT and further exacerbate some of the symptoms of estrogen dominance.
Conversely, women with lowered levels of estrogen, such as those with amenorrhea (missed menstrual cycles) from various causes—PCOS is one, so is the birth control pill, especially progestin-only pills, or hormonal IUDs—or women who are peri-menopausal or menopausal, will have a faster COMT enzyme. This means that dopamine and norepinephrine will be cleared from the brain more quickly. Low levels of these neurotransmitters may result in depression: low mood, low energy and lack of motivation. On the extreme end, low levels of dopamine in the brain may result in conditions like Parkinson’s. Currently, research is being done on estrogen-replacement therapy as a treatment for Parkinson’s because of its ability to increase brain dopamine levels through slowing COMT.
When it comes to birth control pills, which are combination of synthetic estrogen and synthetic progesterone (“progestins”), or just straight progestin, either in pill-form or in a hormonal IUD, effects can be unpredictable. There is evidence that oral contraceptive use, especially progestin-only contraception, can exacerbate anxiety and depression, especially in teens. The pill acts by suppressing ovulation and suppressing natural hormone production, which may result in low levels of naturally-occurring progesterone and estrogen, which can slow COMT. However, the synthetic estrogens from the pill may interact with COMT, speeding it up in some women. Therefore the effects of specific forms of birth control on individual women is hard to predict; if functional medicine and genetic research tells us anything, it’s that there is no one-size-fits-all when it comes to striking the right hormonal balance.
Estrogen also has effects on another enzyme, called MAO-A, that recycles serotonin, the “Happy Hormone”, often implicated in depression and anxiety. Like COMT, estrogen slows down MAO, reducing the speed at which the body breaks down serotonin, resulting in higher brain serotonin levels. Drops in estrogen around and before a woman’s period, or low estrogen levels, may result in feelings of depression. Many women report feeling depressed and craving carbs and sugar around their periods. This is often related to a drop in serotonin as estrogen levels fall right before menses. Drops in serotonin levels due to drops in estrogen levels after childbirth may explain postpartum depression, according to some researchers.
The link between estrogen and its effects on COMT and MAO hint at the complexities of the body and brain’s hormonal milieu and its implications for hormonal regulation and mental health. Mental wellness is a complex state involving a variety of factors: hormones, enzymes and neurochemical pathways that are affected by our environment, our genetics and our hormonal predispositions. This is why I believe in taking a functional approach to mental health, seeing our mental health symptoms for what they are: symptoms, and making efforts to uncover underlying causes rooted in lifestyle, genetics and our environment. I believe the way to address symptoms is to trace them back to their source.
For many women, treating depression, anxiety and stress-intolerance may involve balancing estrogen levels and healing the menstrual cycle. For others it may involve supporting genetic susceptibilities with lifestyle changes, finding a birth control method that balances (or coming off entirely), and reducing exposure to xenoestrogens, supporting estrogen detoxification pathways, and addressing women’s health conditions such as irregular menses, and conditions like PMS, fibroids, endometriosis and PCOS.
I talk about root causes of anxiety, the most common mental health condition, and what to do about it from a functional medicine perspective.
Hi, everybody, Dr. Talia Marcheggiani here. I’m a naturopathic doctor who practices in Bloor West Village, in Toronto and today I’m going to talk to you guys about the roots of anxiety.
Anxiety is the most common mental health condition. It affects about 18%of North Americans and it encompasses a wide range of different diagnoses including generalized anxiety disorder, panic disorder, OCD, phobias, PTSD and depression, and social anxiety. It’s a huge umbrella of different conditions. So the first thing I do when I meet my patients is try to understand how anxiety manifests for them. The word anxiety means very little to me. What I care about is how the symptoms are manifesting in my individual patient in front of me and how it affects their life. So, I’ll ask them what does it mean when you tell me that you have anxiety? Walk me through a situation when your anxiety gets triggered, tell me what it’s like to live inside your shoes, inside your head, what kind of things do you worry about? What goes on in your body? And, how do you know that you have anxiety? Did you decide that you had that diagnosis or did someone else give it to you and what do you feel or think about having that diagnosis? Do you agree with it? Do you disagree? Do you have any doubts? The symptoms of anxiety encompass the body because it affects our nervous system, every single bodily organ is affected, potentially, by anxiety and some people have some of the symptoms or all of them and sometimes very few, just the mental and emotional symptoms, and many of us don’t even identify with having chronic anxiety or anxiety disorders or anxiety symptoms.
First of all, we have the mental symptoms. People with anxiety will commonly experience worrisome thoughts, anticipatory anxiety, so, being worried about the immediate future or the distant future. They might feel irritable or excited, they may have depressed mood. A lot of the people I see with anxiety have this kind of “chilled out” demeanour because it’s very common for someone who’s got a high level of anxiety in their body to dissociate a little bit from those feelings and appear very calm. They kind of describe it as a duck on a pond. On the surface, you see this calm animal, just floating along, but when you look under the water you see the duck legs busily working away and so that’s how a lot of people will describe their mind. They say, on the surface I’m really calm, but once you look under the surface, you see that there’s a lot of mental activity and a lot of worry that’s happening.
There may be fears, such as specific fears, such as phobias, or just general fears, like in the case of generalized anxiety disorder, or fears may be triggered in certain situations like in the case of social anxiety. Insomnia is very common, an overactive and busy mind is very common, fatigue is another common symptom as well as difficulty concentrating, memory loss, brain fog. So all of these conditions that show that the person who’s experiencing anxiety and who is dealing with anxiety is distracted and focused on other things, rather than what’s right in front of them. So a lot of the time my patients will describe an inability to feel present and feel connected and enjoy the moment. Their mind is always on something else. Sometimes the anxiety is based around specific concerns and sometimes it’s just very general and it doesn’t really matter what’s going on in someone’s life, there’s this sense of impending doom that they’re dealing with on a daily basis. Anxiety and depression are very common, they’re comorbid mental health conditions, and it’s very difficult to tell the difference a lot of the time. There’s a hypothesis that they’re similar conditions, or the same condition, but one is a more extraverted, so that would be anxiety, version of depression, which is a more introverted and internalized manifestation of the same disease process. This is still a hypothesis, but it makes some sense and it resonates with a lot of people that I talk to.
Then we have the bodily symptoms of anxiety. A lot of people will experience muscle tension, aches and pains. This is typically in the shoulders where they carry their worries or they’ll find themselves tensing their muscles without being aware of it. They may experience twitching, and they experience pain from the tight muscles. There’s also sensory symptoms, such as ear ringing, hot and cold flushes, changes in vision, tingling, numbness, muscle cramps. It’s very common to have cardiovascular symptoms, such as a racing heart or heart palpitations and this often occurs in people who have panic attacks, which often sends them into the emergency room, because it can be difficulty breathing, racing heart, chest pains, sweating, all these kinds of autonomic symptoms that one might experience if they were having a cardiovascular event, can occur in someone with anxiety or panic disorder. It can be really frightening.
Then there’s gastrointestinal symptoms, so there’s definitely a connection between IBS and anxiety. And those of us who don’t necessarily suffer from anxiety but have experienced nervousness, which I’m sure we all have, will notice that our gut is definitely affected and we may have looser bowels, bloating, difficulty digesting, or we might not have an appetite or want to eat. And this all common in people who have chronic anxiety. Genitourinary symptoms, such as frequent urination, or frequent thirst, often leading people to think that they have diabetes. Also, there might be a delay in urination, so you feel like you have to go to the washroom, you go to the toilet and then there’s a moment where you can’t really go, and you’re trying to wrestle with yourself, which is really common. So urinary hesitancy, it’s called. And then we have the autonomic, so the symptoms that are related to the autonomic, or automatic, nervous system, such as a dry mouth, dilated pupils, sweating or flushing, and this also related to our GI symptoms.
So, these are just a few of the anxiety symptoms. And, as you can see, they affect pretty much every single system in the body. Our nervous system, which is what is affected in anxiety, consists of our brain, our spinal cord and all of our nerves. Nerves that go to and from different body organs and our nervous system is divided into the voluntary and the involuntary, or autonomic, nervous system and our autonomic nervous system is divided into the sympathetic and parasympathetic nervous systems. So our sympathetic nervous system is the “fight or flight” nervous system. This gets turned on when we sense an immediate danger and our body is primed to respond to that danger.
The parasympathetic nervous system is turned on when we’re sleeping and digesting, and when we’re a state of otherwise calm, when there is no danger around. You can think of these two systems as a seesaw. One gets turned on while the other gets turned off and our body should be able to toggle back and forth between these two arms of the autonomic nervous system easily and without getting stuck in either one and depending on the situation and what’s going on. So imagine that you’re walking through the forest, and you’re feeling calm, and you’re feeling at peace, and then you look down at what you think is a stick on the ground that starts to move, your autonomic nervous system is going to kick you into the sympathetic, fight or flight, response. In this response your body will be primed to either fight, flight, run away, or freeze. And these three responses are what will get us away from the danger or meet that impending danger and this is what our body will respond with in order to ensure our survival when there are dangerous situations that we’re faced with.
Once that danger’s gone, we’ve either fought, flown, or frozen and the danger has forgotten about us and left, we’ll return to the parasympathetic nervous system. We need the parasympathetic nervous system turned on when we’re eating and when we’re sleeping. If we have problems, so if we get stuck in that fight or flight response for too long, either because we perceive there to be danger, or our body simply can’t switch back into the parasympathetic state, we’re going to have problems with feeling relaxed, sleeping soundly, and digesting our food properly.
Those of us who are experiencing chronic stress, our nervous system is just taxed, and we’re in the sympathetic nervous response far longer than we should be, because we’re constantly facing deadlines, or we have a lot more responsibility and a lot less control, on our plate, we’re going to experience this feeling of chronic stress. This will exacerbate someone who’s already got a predisposition towards anxiety. There’s a hypothesis, or personality theorists hypothesize that some of us are just born with a higher level of neuroticism as part of our constitutional tendencies. So I see that a lot of anxiety will run in families, especially in female patients, many of them will have grown up with a mother who suffered from anxiety. So there’s definitely a nature component to the nature-nurture debate in terms of what causes anxiety. So, while we can’t really affect our nature, or our genetics, we can affect how those genes are expressed and we can look at the environmental factors that might trigger those genes to be expressed. So that’s what I’m here for. My goal as a naturopathic doctor is to take a full assessment, understand what someone’s symptoms of anxiety are, what the external factors, the environment of their life is like, and look for potential causes that might be exacerbating the anxiety, making it difficult for them to function and perform and live the life that they know they can live. Living a life that’s full of abundant health.
So, the first cause that I want to talk about is chronic stress. when we’re stressed out, like I described when we encounter that snake in the grass, our body will release hormones called norepinephrine and epinephrine. Those are our fight or flight hormones. Those are short-lived, and when those run out, our body starts to make cortisol. Cortisol is a more long-term stress hormone. However, when we’re stuck in that sympathetic state our body becomes, well a theory is that our body becomes unable to produce as much cortisol for long periods of time, that our adrenals get “fatigued”. Another theory is that our brain stops responding to cortisol and we develop a kind of cortisol resistance. And this we’ll see with a lot of brain fog, memory loss, difficulty concentrating, there’ll be a lot of weight gain, especially around the abdomen, and people will experience a lot of inflammatory symptoms, so that’s when we’ll see joint pain and muscle aches and, potentially, worsening of depression as cortisol can kind of motivate us and get us going, because, if you think about it, when we’re in a state of fight, flight or freeze, that’s an action-oriented state, once our body stops responding to that, we enter this kind of burnout and exhaustive phase.
What’s more, once our body stops responding to cortisol, in order to maintain that sympathetic tone, to stay in that fight or flight state, that for whatever reason our body is turned on to, we start to make those catecholamines, norepinephrine and epinephrine again and that contributes to those symptoms of anxiety. So essentially what anxiety is is a high cortisol, high norepinephrine state, where we have that racing heart, we have those tense muscles, we’re looking for danger and our body, for one reason or another, expects that there’s some kind of danger that it needs to defend itself against.
So, not all stress is bad stress. You think of a new mom, she’s full of love and all these feel-good hormones, but the lack of sleep, the added responsibility, all of the things that having a new baby might mean to her and her life, are going to contribute to more stress hormones going through her system. And so I’ll ask a lot of my patients if they’re stressed and, even though I’m kind of getting a sense of high stress from them in terms of their level of busyness, and their level of downtime and just the demands on them in their day-to-day life, a lot of them will say that they don’t feel stressed, that they love their job. So it’s not about whether you love your job, or whether or not you love the things that are, basically, getting piled onto your plate, it’s your body’s perception of those things. So, our body does well when it has enough down time, it has enough restful sleep, and it gets enough breaks. So that keeps that toggle from the sympathetic nervous system, to the parasympathetic nervous system, fluctuating in a healthy way, without getting in one or the other.
Another common cause of anxiety that I see, or definitely a factor that exacerbates anxiety symptoms, is blood sugar imbalance. So, when we wake up in the —a lot of us wake up in the morning and we have cereal, or we have those packaged oatmeals. So, in North America we eat high-carb, high-sugar breakfasts, or we skip breakfast, or we just eat a lot of carbs and sugar in general throughout the day. When you eat a food that’s high on the glycemic index, that contains a lot of easily digestible carbs or refined flours and sugar, we get this immediate spike in blood sugar, as those sugars are absorbed directly into our blood stream. When we get this high level of sugar, we might feel a lot of energy, we might feel really good, we get a lot of dopamine release, and it feels pretty awesome, we get a lot of immediate energy that our body can use. But then, because our body wants to maintain a certain level of blood sugar, what gets released next is a hormone called insulin. Insulin helps that glucose, that sugar, get inside of our cells, where we can use it for energy. If our blood sugar shoots up too high our body sends more insulin into the blood stream to lower that sugar. Sometimes it sends too much insulin and our blood sugar plummets, we get hypoglycaemia symptoms: dizziness, “hangry”, irritability, weakness, fatigue, you’d kill someone for a piece of toast kind of situation, and carb cravings, and we respond by eating more carbs and the cycle begins again. That can exacerbate anxiety because our energy levels are going to be rising really quickly and falling really quickly. Stress hormones are going to get triggered everytime we enter a hypoglycaemic state. And, because cortisol also releases sugar into the blood, so cortisol and insulin work together. Going through this eb and flow of blood sugar, basically riding the blood sugar rollercoaster, is going to exacerbate and mimic a lot of the anxiety symptoms that I described. So a lot of people I talk to, when they’re experiencing anxiety, oftentimes, during the day when they’re experiencing anxiety, it’s between meals, or it’s after a high carb, high sugar meal. And, so a big part of managing their anxiety, or at least creating a terrain where their mental health can function optimally, and their emotional wellness has a chance to function optimally, is to get their blood sugar nice and level. And this means adding protein and fat to every single meal, lowering those refined carbohydrates, beginning each day with a high-fat, and high-protein breakfast. Nutrient deficiency is another really big cause that I look for when it comes to anxiety. So, the happy hormone, serotonin, which is implicated in both depression and anxiety, that’s what the antidepressant and anti-anxiety drugs like cipralex or prozac act on, so those selective-serotonin re-uptake inhibitors. This is a hormone that gives us a feeling of satisfaction, it gives us a feeling of uplift, it’s often what tanks when we crave carbs, and so eating carbohydrates kind of perks our serotonin levels up. In order to make serotonin, we need an amino acid called tryptophan, which we get from protein, and we need the vitamins B6, magnesium, B12, and zinc, and iron. And those take tryptophan and turn it into another amino acid called 5HTP, which then gets turned into serotonin. And then, once we have enough serotonin, that gets turned into melatonin, which helps us sleep and regulates our circadian rhythms. So any break in either of those pathways is going to result is us having lower levels of serotonin and melatonin available to our nervous system for us to have proper mental and emotional regulation. When we’re stressed out, our demand for those nutrients goes up, because our adrenal glands are also sucking in a lot of those nutrients to make cortisol and the catecholamines. Protein is super important, not just for blood sugar regulation, but to give us the amino acids that we need to make the proper neurotransmitters. So, I mentioned serotonin, I also mentioned norepinephrine and epinephrine and other ones include dopamine, GABA, which is a nervous system calming neurotransmitter, glycine, another nervous system calming neurotransmitter, and a good source of glycine is collagen, or gelatin, which I’ve mentioned in other videos. See the “8 Foods for Mental Health”, and tyrosine, which makes dopamine and also makes the catecholamines. So we need tryptophan, which makes serotonin and melatonin, we need GABA, which makes GABA, and that calms our nervous system down, we need tyrosine, which makes dopamine, this is a feel-good hormone that helps us seek rewards and feel motivated, and energized, also tyrosine gets made into thyroid hormones, again, which helps us feel energized and keeps our energy levels stable and our metabolism revved up, and the catecholamines, norephinephrine and epinephrine, which we need for that fight or flight response and that we’re going to be burning through a lot more quickly when we’re in that fight or flight response. And then glycine, another nervous system-calming amino acid. And glycine also helps balance the nervous system. Typically we don’t suffer from protein deficiency in North America, but I see it more and more, especially low-quality sources of protein. So, chicken nuggets, yeah they have chicken in them, but they only have about 10 grams of protein and a ton of trans fats and a lot of processed carbohydrates. So, although we might be eating hamburgers and chicken fingers and omelettes on waffle, we’re not necessarily getting enough good sources of protein. So, ensuring protein from things like legumes, nuts and seeds, clean animal products, fish, like salmon, and white fish, are all really important and I often suggest people get 30 grams of protein per meal, so three times a day, but it depends on your weight, it depends on your energy demands and it depends on your lifestyle and how stressed out your are, because our demands for protein definitely go up during stress. It also depends on how level your blood sugar is and if you’re getting those hypoglycaemic symptoms, sometimes those people need to increase their protein, while decreasing some of the carbohydrates, especially those refined carbohydrates, and give their body more fibre-rich carbohydrates that the body has to work harder to extract and release into the bloodstream. Another really common cause, or contribution, or exacerbation to anxiety is iron deficiency. So I see this a lot in menstruating women. It’s not super common in young men to have iron deficiency, but women who are menstruating every month, especially women with heavy periods, and who are experiencing fatigue, definitely need to get their ferritin levels tested. So, ferritin, in our blood, will tell us what our iron stores are like. So, how much iron we have available to our tissues. Iron is useful for participating in lots of different chemical reactions in the body, as part of normal metabolism, but it’s also important for caring oxygen to our tissues and oxygen is what we need in a process called oxidative phosphorylation, which gives us energy. So, no oxygen, no energy. And what will happen is, if we lower levels of iron in our blood and lower levels of oxygen, our heart starts to beat faster in order to send more volumes of blood to our tissue. So, it figures, if, with each heartbeat, i’m not sending as much oxygen, if I just double up my heartbeats, I might send double the amount of oxygen and try to meet the demands of the tissues that I’m sending oxygen to. You can kind of figure out, then that quick heartbeat mimics those heart palpitation symptoms of anxiety and can trigger some anxiety symptoms. Iron’s also go this grounding affect. It gives us this nice, level energy. And there’s a very specific feeling to iron deficiency fatigue that a lot of women may have experienced. It’s not quite like a sleepiness, or a lethargy, it’s a very specific feeling of just depletion. So it’s important to get ferritin checked and then find a kind of iron that you can take every day to build your levels up, at least for a few months, and one that’s easily absorbed.
So, another reason why iron might be low is in the case of leaky gut, or malabsorption syndrome, so this can occur in somebody with inflammatory bowel disease, or celiac disease, where the intestinal cells are just not able to absorb as many nutrients, or somebody with IBS, so, just generally sluggish digestion, inefficient digestion, perhaps a lack of stomach acid, or a lack of those digestive enzymes that help us absorb our food. IBS and leaky gut are other common symptoms and causes of anxiety. So it’s kind of a chicken or an egg situation. Our gut bacteria produces serotonin, dopamine. We’ve got about 5 trillion in our gut, and that’s about 10x more cells than we have in our bodies. For the most part, when it comes to a cell-to-cell basis, we have 10x more gut bacteria than we have cells. So we’re more gut bacteria than us. Our gut bacteria, there’s good ones, there’s bad ones, we haven’t been able to isolate all of them, there’s very little, relatively, that we know about the microbiome, but a lot more research is coming out, especially in the area of mental health. We know that these gut bacteria can make their own neurotransmitters. They can even specifically ask for food, so a lot of people with sugar cravings have a dysbiosis going on where the gut bacteria need those refined carbohydrates and that sugar, in order for them to grow. And so they’re sending out ghrelin, or hunger-stimulating signals to try and get us to eat more sugary foods. Our gut bacteria also make most of the serotonin in the body and our gut cells also make most of the serotonin in the body. So if we have unhealthy gut cells, they’re not going to be able to regulate our nervous system. And if we have an imbalance in gut bacteria, again we won’t be able to regulate our nervous system, because we won’t be producing those neurotransmitters that we need to balance and to be able to toggle seamlessly between the parasympathetic and sympathetic nervous systems. The gut is also where a lot of our immunity lies. And our immune system is going to be the cause of low-levels of inflammation, especially if there’s a little bit of autoimmunity or food sensitivities, or allergies going on. Low levels of inflammation are going to affect our brain. So there is a hypothesis that depression is caused by low-grade inflammation in the brain. We don’t have pain receptors in our brains, so we ‘re not able to detect inflammation in the way you would with an inflamed knee. If you injured your knee or had arthritis in your knee, and you would notice that your knee was red, and swollen and it would hurt to touch and you wouldn’t be able to walk on it. We don’t get those symptoms in our brain because of the lack of pain receptors and so how brain inflammation might manifest is brain fog, difficulty concentrating, depression, anxiety, mental chatter, negative self-talk, negative thoughts, those symptoms that are really common, mental symptoms, in something like depression and anxiety.
There’s a lot more we need to research about this, but there’s something called LPS, lipopolysaccharide, that’s produced by some of the “bad” gut bacteria. When rats were injected with lipopolysaccharide, or when human volunteers were injected with lipopolysaccharide, we mimic the symptoms of depression. When those same patients and rats were given EPA, which is a very anti-inflammatory fatty acid that’s from fish, marine sources like salmon and sardines, the depression symptoms went away. There’s also some studies in depression with prednisone and corticosteroids, which lower inflammation really rapidly. They come with a host of side effects, so that they’re not that great of a remedy for depression, but they actually lowered depressive symptoms. There’s a lot of a connection, that we’re noticing, between inflammation and depression and anxiety and we’re just not sure to the extent that inflammation causes depression. I tend to think that, probably most cases of depression and anxiety have some kind of inflammation present, especially when we consider that just chronic, turned on, sympathetic nervous system and high levels of cortisol is going to contribute to a cortisol resistance in the brain and increase neuroinflammation, especially in the hypothalamus.
We also know, as I mentioned before that symptoms of anxiety and symptoms of IBS often go hand in hand. And so, a lot of the anxiety symptoms that people will get are looser bowels, bloating, loss of appetite, just difficulty digesting their food. And a lot of symptoms that people with IBS will get are anxiety. And one of the treatments for IBS are selective-serotonin re-uptake inhibitors, which, you guessed it, are also drugs that treat anxiety.
So another common cause that fits really well into my practice, my focus is on mental health and hormones, and these two areas overlap, probably more than they don’t overlap, it hormonal imbalance. So, especially in women, men have their own host of issues when it comes to hormonal imbalance, but women, because our hormones are cycling and going through different phases all month long, we’re more susceptible to problems with proper hormone regulation, especially in the face of female endocrine disorders such as PMS, PMDD, PCOS, all of the acronyms, endometriosis, fibrocystic breasts, and just dysmenorrhea, so painful and heavy menstruation, or irregular cycles. So all of these point to symptoms of hormonal imbalance. Estrogen and progesterone are the two female hormones and they do have effects, yes on the ovaries, and they control ovulation, they control building up of our uterine lining and shedding of the uterine lining, when those two hormones fall away, and that causes our period to occur, so they definitely control our fertility, but they also have affects on other tissues in the body. One of those tissues, one of those organs, is our brain, our nervous system, so estrogen can work a little bit like serotonin and, so what you might notice, right before your period when your estrogen levels drop, or women that are going through menopause and have a drop in estrogen levels, is you’ll get irritable, you’ll get depressed, and you’ll crave carbs like crazy. And a lot of women get something called premenstrual dysphoric disorder, where they have fluctuations in their estrogen levels. So, lowering of estrogen, or insufficient estrogen, may cause some of those more depressive anxiety symptoms, progesterone acts like a GABA agonist, which, I mentioned before, is a calming neurotransmitter. So, lower levels of progesterone, and I see this in a lot with women who have something called “estrogen dominance”, I have another video on this, and women with PCOS as well, and women who have high estrogen symptoms, or conditions such as endometriosis and fibroids, and fibrocystic breasts, and those kind of symptoms, or conditions where estrogen levels tend to be high, and progesterone levels tend to be low or deficient, they’ll often have anxiety with these symptoms. And lower levels of progesterone, especially premenstrually, often are related to low mood and anxiety, and cravings. So, looking at hormones, especially when the patient sitting across from me has a lot of menstrual issues, and irregular cycles and all of the other things I mentioned, I’ll definitely look into hormones and promote proper estrogen detoxification and building up of progesterone. A common cause of low progesterone is being in that fight or flight state. So, now I’m starting to reveal how this web interconnects, how everything is tangled together and how cortisol and blood sugar all relate to everything. So, cortisol, it uses the same precursor to make progesterone, and, when our body needs more cortisol, it will steal progesterone from the system to make cortisol. Because our body has to prioritize sometimes, and getting away from that snake in the grass, and saving our life is more important than making babies to our body in the short-term. So, we suffer in the long-term if that snake in the grass never goes away and we’re always kind of worried about juggling all the things in our lives. But a lot of women who are chronically stressed, or are in that sympathetic nervous state, will have lower levels of progesterone, so doing a lot of adrenal support is one of the ways that we help their bodies build up some progesterone.
And then, finally, I think I mentioned before, there’s a reason that we have anxiety, it’s not an irrational fear. A lot of the time when I sit across from patients, the things that they’re worried about are legit things to worry about. Maybe they’re out of work, or there’s financial worries, maybe there’s just so much on their plate that it’s difficult to find any time for themselves, or make ends meet, maybe they’re unhappy with their career, they’re relationship is in jeopardy. There’s all kinds of things that people deal with on a daily basis. And then, that being said, there’s also people who are just primed to be more neurotic than others, based on that spectrum of neuroticism in terms of personality and constitutional predisposition. And I think we know this, there’s some people who are just a little bit more anxious than others and that diversity in human personality probably helped us evolutionarily and so I think there was obviously an evolutionary advantage for someone who’s nervous system was a bit more responsive. Those people could get away from danger, they were expecting danger more often, and they probably ended up surviving and passing their genes on to their ancestors more readily than those who were way too laid back and didn’t think about danger and got themselves into risky situations.
So, those who are a little bit more neurotic may be predisposed to negative thinking, over-estimating the negative outcomes of certain events or maybe engaging in critical self-talk. Especially in the case of post-traumatic stress disorder, PTSD, there’s definitely a connection between early childhood trauma, or just trauma in adulthood, some of these experiences can teach us to turn our nervous system on, or to get triggered more easily as a way of surviving in the future. There’s different areas of psychotherapy that deal with these phenomena, and they term them different ways, but they can be called core beliefs, or certain mental schemas, so when our brain experiences very strong emotions, the amygdala wires those emotions down in implicit memories. They’re really tightly wired and those memories get triggered again whenever there’s a situation that reminds us of the situation that wired down those responses. It might be a certain smell, or a certain sound, or a certain song, something that activates those memories, that may not be conscious, because the amygdala is pre-verbal, will trigger those feelings of fear and prime our body to respond. And the problem is that we’re surrounded by potential stimuli all the time that can trigger that. And so, really understanding what triggers anxiety symptoms, where those triggers may have come from, and bringing those memories up to the cognitive, cerebral cortex and rational mind, so that we can help dissolve those memories, is a big part of psychotherapy and how we manage anxiety with psychotherapy. Especially if we think the cause of anxiety may be related back to some sort of childhood trauma or implicit memory that was consolidated.
Those are some root causes of anxiety that I would look for as a naturopathic doctor, among many others. What an intake will look like is a 90-minute conversation with the person in front of me where I get to know them, and understand the environment surrounding the phenomena of their symptoms, the symptoms themselves, and all of the other different factors that might be contributing to the anxiety that they’re displaying. So, I’ll ask about period health, I’ll ask about sleep, I’ll ask about their energy levels, I’ll ask about any other physical symptoms they might be experiencing, their digestion, what their stress levels are like. We’ll go through a review of systems, looking at every single organ system and trying to create a tabulation of how anxiety might be manifesting for them, and we may even explore what their core beliefs are, or implicit memories are in future visits. And we’ll talk about diet. And then I’ll make some recommendations as I begin to understand what those root causes of anxiety might be. So we’ll look at whether they may be experiencing nutrient deficiencies, leading to an imbalance in proper neuroendocrine production, if there might be some inflammation going on, if they may be experiencing some digestive issues, or some hormonal imbalances, or if there’s chronic stress going on in their life. And so what we’ll do is, once we find out the causes, we’ll engage in some psycho-education, so I really believe in empowering my patients to understand their bodies, to be able to notice when things are triggering them, to notice what exacerbates their anxiety, what makes it better, and to develop a self-care plan where we’re eating right, we’re thinking right, we’re exercising right and we’re getting enough rest, if possible.
So that’s the gist of it, that’s Root Causes of Anxiety, my name is Dr. Talia Marcheggiani, I work in Bloor West Village in Toronto.
