What you need to know about Estrogen Detoxification

What you need to know about Estrogen Detoxification

Symptoms like breast tenderness, heavy or clotted cycles and fibroids are linked with excess estrogen in the body.  In men, this can look like weight gain, erectile dysfunction, breast development or moodiness.

So where does your estrogen go once your body is done using it?  Estrogen does a lot of great things for our bodies, like protect us from cardiovascular disease for example.  Problems arise  when our body isn’t able to get rid of it properly and it recirculates.

Where Your Estrogens Go

The short answer is that you detox your estrogen based on two main factors.  Lifestyle and genetics.  These influence one another.  Now as we begin to dig in, keep in mind that there are three parts to detoxification & this is a process your body is undergoing all the time.  Gently supporting your overall health supports this process.  Doing fast, hard cleanses does not.

First, the Liver!

In phase one of detoxification your estrogens get turned into 3 different kinds of metabolites.  The metabolites are called 2-OH, 4-OH and 16-OH.  The 2-OH is the protective pathway but even too much of this can inhibit neurotransmitter production.  What we are looking for a a ratio that prefers the 2-OH pathway.  Broccoli, kale, cauliflower, broccoli sprouts, and brussels sprouts encourage this pathway.  There are supplements as well but please do not start using them unless you know it’s phase one that needs support.  I’ll explain why.

If you begin taking DIM when its actually your phase two that is sluggish then you will feel worse.  Both phases need to be optimal in order for the symptoms of PMS, heavy cycles or painful cycles to let up.  Supplementing without testing can also lower estrogen levels overall.  If they aren’t high then this can cause other problems.  With hormones it really is about the balance.

Next, Packaged Up! 

Keep in mind that in phase one, all of these metabolites are reactive to oxygen meaning they have the potential to damage DNA.  The goal of phase two is to neutralize the 2-OH and the 4-OH in a process called methylation.  Basically this process makes the metabolites water soluble so that they are in a form that can be safely excreted.  Magnesium helps the enzyme COMT in this process.  If excretion doesn’t happen then the reactive metabolites will recirculate and end up in the 4-OH pathway.  Magnesium is a safe to supplement for most people.

With testing we can see if you methylate your estrogens well or not.  Nutrients like SAMe, methionine, choline, tri-methyl-glycine (TMG) and methylated B vitamins support methylation.  Having food with a balance of amino acids is a good start.  Before supplementing testing is ideal.  To support phase two check your make-up, skincare and household cleaners for chemicals. Avoid pesticides & herbicides.  Reduce alcohol.

Last, Move ‘Em Out!

Interestingly, we need to begin treatment with this last phase in most cases.  Phase three is all about how we excrete these estrogens once they are ready to go.  This happens in the gut.  If you colon isn’t working properly then recirculation will occur.  Inflammation can inhibit this phase.  Flavonoids like those found in broccoli sprouts, dark chocolate & green tea support phase three.

If your gut bacteria is disrupted and you are producing too much of an enzyme called beta glucaronidase then phase three won’t work.  This is because this enzyme can take the estrogens that are ready for excretion and push them back into circulation.  You can be estrogen dominant because your gut health and microbiome causes reabsorption where the 4-OH pathway is likely to be preferred.  Good gut testing will show if beta glucaronidase is elevated. If it is then we can help with a supplement called calcium d-glucarate.  But again, do not take this without testing.

What you can do is eat a whole food diet with plenty of prebiotic fibres and fermented foods.  Drink two litres of water a day and avoid environmental toxins as much as possible.  We know that by simply living a lifestyle that is cleaner can expand your lifespan by 13 years.  Quality of life improves as well.

Why Estrogen Gets a Bad Reputation

Often women share with me that they are concerned about breast cancer because of a family history.  By looking at the metabolite pathways some of these fears are alleviated.  When it comes to hormones we really can’t guess where the imbalance is because there are so many factors.  By optimizing the detoxification pathways and preventing recirculation we can take steps to decrease the proliferative estrogens.  4-OH is why estrogens get a bad reputation.  16-OH is weaker but also can contribute to symptoms.

None of this is an alternative to cancer treatment.  A friend whose wife recently fought breast cancer shared what he learned.  She had a family history and was screened regularly so it was caught early.  They treated immediately.  He noticed that the women who were diagnosed at the same time and who waited did not have good outcomes.

Going back to how lifestyle and genetics work hand-in-hand allows us to feel empowered.  It is also what evidence-based medicine knows.  The choices we make do have a major influence in how our genetics get expressed in this lifetime.  This doesn’t mean that when someone is diagnosed it is somehow their fault.  It’s shocking that this cruel idea even exists but it does.  Please enjoy this precious life and be kind to those who are up against cancer.  Touching into our mortality can fuel our love for the time we have and align us with how best to spend it.

Orgasms for Health & Humanity

Orgasms for Health & Humanity

Women’s Health, Human Rights & Orgasms

Years ago a patient asked me, in a sincere way, how she could have more orgasms.  At the time, I worked in a busy community clinic.  I didn’t have time to answer her question but it stayed with me.

Yesterday a patient told me her antidepressant caused her libido to disappear.  Switching to a keto diet helped bump it back up.  She is also ready to taper off her medication with the right support.  She began the SSRI (selective serotonin reuptake inhibitor) when housing for herself and her child was impossible to find.  Her labs showed how this medication had a major impact on cortisol and testoterone.

Stable housing is a basic human right and she now has this covered.  With the current housing crisis, there are many whose health is compromised.  Women, people of colour, elders and children are vulnerable.

Birth Control, Bone Health & Antidepressants

Many women are asking me about alternatives to hormonal birth control.  This is because they are simply not happy with the side effects of taking synthetic hormones.  One of my colleagues spoke about the birth control pill recently calling it a gateway drug to antidepressants.

Another colleague shared her experience of seeing a specialist who said, “If you don’t take birth control, you will be in a nursing home because of osteoporosis.”  Using birth control to prevent osteoporosis, or any other health condition for that matter, is problematic. It’s a band-aid.

Within two years of changing her diet and lifestyle, this woman reversed her osteopenia.  She focused on strength training, K2 and other interventions like meditation for stress management.  I have seen these changes work.  These women have a much higher quality of life.

Transgendered Happiness

Synthetic hormones are necessary at times but over-medication all too common.  This past weekend I bumped into an old friend.  He looked happier than I had ever seen him.  When i asked what changed, he said he had stopped his psychiatric medications with the help of a progressive psychiatrist.  This doctor suggested using micro doses of psilocyin or ‘magic’ mushrooms to replace his antidepressants.  Along with this therapy, this trans friend went grain-free and ended up feeling much more like himself than he had in years.

What I noticed is he had energy to play with the kids which was beautiful.  He was more connected with his long time partner & able to talk about his experience of being trans openly with my son when asked.  He noted the non-judgemental quality that children naturally have.  Curiousity that is refreshing and healing.  My son often gets mistaken for a girl because he grows his hair long.  So he understood. Also,  transgender came up and was discussed in his grade one class.

It was incredible to listen to my friend’s story.  He felt his personality was lost with the drugs.  Seeing how he reclaimed his life is remarkable.  He will continue hormonal therapy but the overall reduction in medication has freed up a lot of health and wellness.

What are Orgasms good for?

It turns out that orgasms support immune health and help people recover from autoimmune flares.  They release oxytocin which is the number one bonding hormone.  This keeps us connected and strong in our close relationships.  Oxytocin lowers cortisol, connects us with our intuitive or gut feeling and keeps us vibrant.  Female orgasms in particular are a key factor why humans have survived through the ages.  It is the strength of our communities or tribes that allowed us to survive.  Women have always been at the center of these.  Oxytocin increases significantly with child birth and breast feeding.  Hugs also stimulate oxytocin release.  Father’s experience increased oxytocin from connecting too.

Did you know that an astonishing 43% of women today report sexual dysfunction?  This includes an inability to enjoy sexual arousal or orgasm.  Yikes!  Why is this?  A German study concluded that “women using contraception, especially hormonal contraception, had lower sexual functioning scores.”  Stress and relationship were other variables that factored in.  In short, regular orgasms can help you live longer, sleep better, reduce autoimmunity, headaches and PMS.  Another study that used MRI’s to see if there was a difference between orgasm from self-stimulation or partner stimulation saw no difference.

 

How to have more orgasms?

 

  1.  Heal your gut!  Your gut produces neurotransmitters when its healthy.  Oral birth control, pain killers and other medication wreak havoc on the lining of your gut.  This inhibits production of these smart vehicles that determine much of our behaviour and mood.
  2. Kick Hormonal Birth Control can mess with how you connect with your own body and your partner.  Pill bleeds are not menstrual cycles.  You do not get the orchestra of hormonal changes and you gut health is paying the price.  Both antidepressants, like SSRI’s, and oral contraceptives lower testosterone and therefore libido can be impaired. Instead, get to know your cycle using technologies available.
  3. Stabilize blood sugar.  Ask your doctor for a hemoglobin A1C as it is the most accurate marker of blood sugar.  You want this marker to be 5.0 or lower.  Get a glucometer and track your blood sugar before and after meals.  Get to know how you respond to different foods.  This is important because blood sugar has a huge downstream effect on hormones and mood.
  4. Meditate, enjoy your food and move your body.  Stress management is as important as diet.  Cortisol, our main stress hormone, works with insulin.  Meditation is the best way to regulate both.  And its free!  Tapping into the parasympathetic nervous system allows us to connect more easily.  Strength training is an excellent way to support hormonal health, stimulate appetite and calm yourself.
  5. Seek pleasure: the 3 C’s.  Notice what you enjoy and do more of this.  Experiment with all forms of pleasure including food, masturbation, social connection, dancing and anything else that floats your boat.  We can entrain ourselves to enjoy life more by being curious and connected.  And always remember the clitoris!  Curious, connected, clitoris.  C isn’t just for cookie!
Glycine or Collagen?

Glycine or Collagen?

Glycine is the Amino Acid that Gives

Without knowing it, glycine is helping your body every day with muscle repair, cognitive function, metabolic health, and immunity. This amino acid assists in breaking down glycogen, fat and other nutrients to be used as energy at the cellular level.  When it comes to aging gracefully it plays a role with the important antioxidant glutathione as well as the human growth hormone.

In the brain glycine acts as neurotransmitter in a similar way to GABA. It is in fact released with GABA to calm or inhibit parts of the central nervous system.  Glycine modulates excitatory neurotransmissions as well, meaning that it can go both ways. This unique neurotransmitter helps with sleep, memory, mental performance, stress, anxiety and even severe mental illness. As a preventative measure for everything from fatigue to stroke this is a powerful supplement.

For stabilizing blood sugar research shows a significant benefit with 5 grams of glycine before each meal so 15 grams per day.  This amount would be difficult to get in either bone broth or collagen.  You’d need two full servings of collagen to get 5 grams of glycine.  With metabolic issues sky rocketing glycine can be an excellent therapeutic aid.

Anyone who over methylates can benefit from glycine because it buffers excess methyl groups.  Methylation is a biochemical process that has an impact on B vitamin status.  Without adequate B vitamins the body will generate less glycine.  Another problem that can happen is that glycine can produce oxalates instead.  This causes a different kind of pain in the joints and can lead to kidney stones.

By restoring gut health you also support immunity.  This is one of the far reaching benefits of glycine.  Given that digestive disorders and autoimmune conditions have reached epidemic proportions it’s worth ensuring you are getting enough glycine.

Where to Get Your Glycine

I mentioned above a few reasons to take glycine in its free form and how it can be difficult to get a therapeutic dose otherwise.  Collagen loading is one way to bring up the balance in the body.  This means taking high doses for a few weeks.

One of the reasons bone broth has finally received so much attention is due to this amino acid along with proline and arginine. However its difficult to know what dose you are getting when you make bone broth yourself.  If you purchase both broth and the label tells how much protein there is per serving then the amount of glycine is a 3:10 ration.  So you get 3 grams of glycine per 10 grams of protein.

Both collagen and bone broth can be taken for maintenance.  Testing B vitamins, metabolism and neurotransmitters through organic acids testing will let you know what is needed.

Types of Collagen: How to choose?  

Grass-fed, bovine sources of collagen provide both type 1 and 3.  What this means is that it targets muscle growth as well as the joints, skin, hair and nails.  This is because Type 3 has proline which supports creatine production.

The parts of the animal that are often wasted are used to make collagen. Grass-fed, pasture raised animals supports a healthy ecosystem in ways that industrial agriculture can’t.  The benefits to humans consuming small amounts of ethically raised animal products is well known.  This is especially key for those with compromised digestive health or autoimmunity.  For recovery from injury, surgery or to alleviate the damaging side effects of some medications it can be considered medicine.  Women who are pregnant, breastfeeding and caring for small children benefit as well.

Collagen harvested from fish can also be very nourishing and done ethically.  However marine collagen has a higher price point.  If its not then likely this is because the source is farmed fish.  The bioavailability will therefore be compromised as the molecules are larger and therefore less absorbable.  Well sourced marine collagen contains only Type 1 collagen which is the most bioavailable and often marketed for beauty reasons.

Type 2 collagen from chicken sources is especially rich in cartilage.  For anyone taking MSM and glucosamine this may be a replacement especially if you try a higher dose.

Optimal Health & Hormones

I mentioned the human growth hormone (HGH).  By building up and breaking down muscle we actually stimulate a cascade of positive physiological responses in the body that keep us feeling and looking great.  I like to think of collagen and glycine as supporting an active lifestyle and optimal health.  The liver loves glycine and the liver is what helps balance other hormones.

Here are all the ways that glycine supports your to feel your best:

  • Energizes:  whether you suffer from chronic fatigue or are an athlete this nutrient improves energy
  • Metabolism:  balancing blood sugar is key to metabolic health and weight maintenance
  • Muscle growth: for those who have lost muscle mass from illness or are enjoying the benefits of strength training
  • Sleep and Nerves: glycine has a positive, regulating effect on the central nervous system
  • Digestion: helps repair the gut by helping form the two key elements required for this which are gelatin and collagen
  • Aging: as a powerful antioxidant it prevents cellular damage and can slow the various ways that aging shows up
  • Immunity: by improving gut health we improve immunity
  • Injury repair:  this includes post-birth or surgery, joint or ligament injuries and harmful side-effects of medications

 

 

Your Gall Bladder & Gut Health

Your Gall Bladder & Gut Health

Cholecystectomy is the removal of the gallbladder.  In the later stages surgery is necessary but I’ll talk about how to avoid this and why.  A few years ago my dad had symptoms of a serious gall bladder attack.  I urged him to call the ambulance immediately.  I know how dangerous it can be if left untreated.  He was living out of town and was unable to drive because of the pain.

Surgery Doesn’t Treat the Underlying Cause

Surgery keeps people alive which I am so grateful for.  Now that his gallbladder is gone, bile flows from my dad’s liver to his small intestine via the common bile duct.  The liver continues to produce bile but an accumulation can still occur. Bile secretion directly into the small intestine has been shown to effect the microbiome and function of the gut negatively (1).  Also, those who have had a cholecystectomy can still have  gallstone issues if the underlying cause has not been addressed (2).

Gall Bladder Physiology

Bile is produced in the liver and travels via the common bile duct to the gallbladder. When dietary fats enter the small intestine, the gall bladder contracts to release bile. Bile is made up of mostly water, with only 3 percent consisting of a mixture of bile acids, cholesterol, phospholipids, bilirubin, inorganic salts, and trace minerals. Bile acids act like a detergent, helping to emulsify lipids in food. Without bile, these lipids go undigested, resulting in fatty stools. Bile is also crucial for proper absorption of cholesterol and the fat-soluble vitamins A, D, E, and K.

Gallbladder symptoms vary.  Initially pain in the upper abdomen that radiates into the back is common especially on the right side.  Nocturnal onset along with jaundice or yellowing of the skin, nausea and vomiting usually are involved (3).

Gallbladder diseases include:

  • Cholestasis: the backup of bile flow in the liver or in the biliary ducts.
  • Gallstones: stones form from the components of bile. 10-15% of adults are affected (4).
  • Cholesystitis: prolonged cholestasis characterized by inflammation of the gallbladder. 6 to 11% of patients with gallstones develop Cholecystitis (5).
  • Cholangitis: a complication where the flow of bile is blocked. The infection can also spread to the liver, so quick diagnosis and treatment are very important (6).

Leaky Gut

The connection between leaky gut and gall bladder problems is largely missed in conventional medicine. However, studies demonstrate a clear link between gluten intolerance (both celiac disease and in non-celiac wheat sensitivity) and inflammation of the gallbladder. Gluten damages the intestinal lining compromising the intestinal barrier function.  Largely this is due to zonulin.  Gluten increases this toxin resulting in a break down of the tight junctions.  Microbes and dietary proteins from the gut then ‘leak’ into the bloodstream (7).  The immune system sees these microbes and their microbial products as foreign invaders, and launches an immune response. The biliary system is affected by this inflammatory signaling. It has been shown to alter the gene expression and bile secretion in the liver (8).

Sure enough, research has linked gluten intolerance and celiac disease to increased prevalence of gallstones and biliary cirrhosis (9,10). Patients with autoimmune hepatitis are often also celiac (11). A study found that 42 percent of adults with celiac disease had abnormal levels of liver enzymes and I certainly see this in my practice. A gluten-free diet normalized liver enzyme levels in 95 percent of these patients (12).

Treating the gallbladder functionally

A low-fat diet may alleviate symptoms over the short term which is what conventional doctors often suggest.  But a long-term reduction of fat intake prevents gallbladder contractions which leads to more sluggishness and an increased risk of gallstones. Interestingly, a higher fat diet has been shown to protect against gallstone formation. Use it or lose it applies.

Gallbladder flushes are recommended by some natural health stores.  I learned long ago these have the potential to be dangerous as the bile duct can become obstructed. I typically stay away from extreme approaches that lack scientific evidence. I have yet to find a clinical trial on gall bladder flushes. I focus on treating the root cause.

Testing: markers like ALT, AST, bilirubin, LDH, GGT, ALP, and 5ʹ-nucleotidase can help discern what is going on.

Diet:  removing inflammatory foods like gluten, processed foods, and sugar are a great starting place.

Gut:  beak the cycle of gut inflammation leading to biliary stasis and lack of bile causing more gut inflammation.

Stimulate bile: with bitters like dandelion, milk thistle, and curcumin.

Reduce gallstones: with beet root, taurine, phosphatidylcholine, lemon, peppermint, and vitamin C.

Take bile: if you are having trouble with digestion of fats supplement with ox bile for a therapeutic period.

 

Do you have Candida? Or is it SIFO?

Do you have Candida? Or is it SIFO?

What’s the Difference?

Symptoms like chronic yeast infections, brain fog and sugar cravings can indicate dysbiosis or an imbalance in the gut microbiome. About 20 years ago candida albicans began receiving a lot of attention. Some said to cause a long list of ailments. We’ve learned a lot since then and continue to learn more all the time. Endoscopies are not perfect but can show fungal overgrowth occurring in the small intestine. (SIFO).   In out patient settings, we test the gut using stool and breath tests.

Candida albicans is one strain of bacteria residing in the colon and is part of a healthy colon when in balance. It can get out of balance. This can happen when there is a dybiosis of insufficiency meaning a lack of other bacteria. Often it occurs after antibiotics used especially if several rounds were used.

Keep in mind that high stress, poor diet and reactions to foods also trigger an imbalance in gut flora. Similarly a parasitic infection like giardia can trigger the onset of Celiac disease and non-celiac gluten sensitivity. This is why people go traveling and say their gut was never the same afterwards.

So what causes SIFO?

If you are on a very limited diet to manage symptoms that appear to be fungal overgrowth but your labs come out looking good we have to consider SIFO. There isn’t a breath test available for SIFO and it won’t show on stool tests. Certain antibodies can be used to detect it but this is not yet widely used. An organic acids test has markers that are more telling. This is what I end up using because it has a variety of other markers that are helpful for assessing the patient’s health status in general. Knowing what triggered the symptoms is important so reinfection can be avoided. There is a strong correlation between long-term use of proton pump inhibitors and SIFO.   Low stomach acid means more pathogens make it into the small intestine.

Treatment can include both pharmaceuticals and botanicals.   As far as botanicals go I use monolaurin, a concentrate of coconut oil, oregon grape root, berberines, caprylic acid or allicin and biofilm disruptors like NAC or Interfase Plus. Cycling antibiotics followed antifungals is what gastroenterologist Dr. Satish Rao suggests. This is because onset of fungal infection occurs after the good bacteria is killed off whether its in the small intestine or the colon.

Can diet help?

A lower carb diet rich in nutrients is a good starting place. There is some indication in the research that ketones can feed the overgrowth so use caution with this approach. Often people will know what triggers symptoms and these need to be avoided. Following treatment a period of rebuilding is key to ensure that the colon is functioning optimally. A prokinectic like 5-HTP or bitters encourage the migrating motor complex to prevent reinfection in the small intestine. If the ileocecal valve between the two bowels is inflamed we want to address this. Bacteria collect around these valves and take up residence where they shouldn’t. So inflammation and any immune issues also need to be addressed.

Keep in mind that candida albicans is different than candidiasis, which is a serious condition occurring in immune compromised people. Candidiasis requires immediate medical intervention.

15 Sleep Solutions You Can Do

15 Sleep Solutions You Can Do

Sleep is a big deal  

Especially when two-thirds of adults don’t get the minimum required to meet basic physiological requirements.  In fact, less than 7 hours per night can shorten lifespan significantly.  Inflammation increases when we miss a night of good sleep.  Other sleep research shows up to 29% lower sperm count in men who sleep poorly vs those who regularly get enough rest.  Athletes performance drops 10-30%.

Why Parents are Crazy

As a parent of a young child I can vouch for how difficult it can be to get enough sleep.  When your infant finally starts sleeping through the night your cortisol and melatonin production is so confused insomnia becomes a thing. Catching up is not actually possible especially as a single parent.  Through trial and error I’ve discovered the ridiculous reality of living in a state of constant sleep deprivation.  Caffeine stops working.  You think everyone hates you and life is out to get you.  This is the real reason parents are crazy a lot of the time!  Anyone doing shift work or work late at night can be included in those who suffer the most.


Adults really do require 7-9 hours of sleep

  • Newborns (0-3 months): 14-17 hrs
  • Infants (4-11 months): 12-15 hrs
  • Toddlers (1-2 years): 11-14 hr
  • Preschoolers (3-5): 10-13 hours
  • Elementary school age (6-13): 9-11 hrs
  • Teens (14-17): 8-10 hrs
  • Adults (18-64): 7-9 hrs
  • Older adults (65+): 7-8 hrs

 

Sleep Hygiene: Focus on What to Do

1. Be consistent with your sleep schedule 

Set a realistic bedtime.  Train your brain to develop a regular circadian rhythm by going to bed at the same time most of the time.  

2.  Establish a bedtime routine

This can include a warm but not hot bath or shower.  Journaling in a book, meditating, stretching gently or reading are all appropriate activities.  Dim your lights and listen to relaxing music to unwind from your day.  

3.  Your bedroom needs to be quiet, cool and comfortable

Sleep is better when your room is cool rather than warm. You can keep a door or window cracked for circulation and to avoid stuffiness. Keep all lights off, including night lights, and lights from electronic devices. Sleep on a comfortable mattress.  Turn off the extraneous noise. A white noise machine is fine. If your pets wake you up, keep them in another part of the house. 

4. Turn off electronic devices in the evening

This allows for more connection, better digestion and a general parasympathetic or relaxed environment where you can reconnect and let go of the day.  Electronic devices emit blue light which stimulates the brain.  Cortisol and melatonin get confused and these hormones play a huge role in insomnia.

5. Exercise during the day

Exercise promotes continuous sleep.  Its also great stress relief.  Avoid intense exercise in the evening as this can interfere with deep sleep.  Stress management is crucial to sleeping well.

6.  Eat enough during the day

Blood sugar dysregulation causes spikes in cortisol and makes it more difficult to rest later on.  In fact, having enough carbohydrates during your evening meal has been shown to support better sleep.  Choose root veggies and unprocessed, gluten free options.  Often times food reactions cause an internal stress response that we aren’t aware of.

7. Use caffeine with caution

We know that 50% of people don’t metabolize caffeine.  This means it stays in the body for much longer and therefore amount matters.  Cut down on caffeine and avoid it after noon entirely.  This includes chocolate. Uncooked cacoa is easier on you.  Matcha has a longer burn than coffee and many health benefits.  Find alternatives like peppermint or dandelion tea. Golden tea is a delicious alternative as well.  I know its not easy to change this habit especially when you are sleep deprived but it can be done.  It may be the most important change you can make.

8. Get out of bed if you aren’t sleeping

Do a guided meditation or find another relaxing activity until you feel sleepy.  This is part of training your body that bed is for sleep.  Have a comfortable chair in your room and make a cup of sleepy tea.  Simple rituals like this work.

9. Avoid large meals later at night

A small protein rich snack before bed can help with night hunger but large meals late at night create a burden for the liver.  Finish meals a few hours before bedtime.  The liver kicks into gear at 11pm so being asleep by then is ideal.

10. Reduce fluids before bedtime

I’m training my son to drink more during the day so he won’t need pull-ups at night.  Just pretend you are 5 years old!  My mom has sage advice for parents.  Ask yourself if getting your kid up to pee in the night is more of a priority than your sleep.

11.  Nap or no nap?

I teach meditation to my patients.  I find if someone calms their nervous system for 5-20min during the afternoon it can support a deeper sleep later.  People may or may not nap as part of the practice. I don’t see any problem with this however long naps may inhibit sleep later on.

12. Avoid these because we know they interfere with sleep

Alcohol raises our body temperature and requires that the liver clear it.  Ever wake up between 1am and 3am after having a drink?  Cigarettes and some medications also make sleep more elusive.

13. Black out your room, hide the clock and wake naturally if possible

This is basic but an incredibly important game-changer.  Buy black-out curtains.  Don’t use night-lights except in the bathroom.  Turn your digital clock away from your bed while you sleep.  Don’t wake to an alarm as much as possible.

14. Creat an extended sleep schedule

For anyone who has suffered from sleep problems an extended sleep schedule can support getting more sleep.  Research shows that allowing a longer period of time in bed does increase the amount of sleep people get.

15. Only use your bedroom for sleep and sex

Train your body to expect only rest and pleasure in this space by creating this.  Bedrooms ought to be a place of sanctuary from the world.


 

An Important Ally: Your Morning Awakening Response

Its best to get up when you first wake up.  By exposing your eyes to bright full-spectrum light you are stimulating the cortisol awakening response (CAR).  This accounts for half or more of our daily cortisol secretion.  Remember the cortisol is anti-inflammatory and an important hormone that works synergistically with melatonin. Doing any kind of movement first thing supports morning cortisol.  This could be carrying a child, going upstairs, walking your dog or going for a run. Daylight stimulates cortisol release, and darkness stimulates melatonin.

Blue light boxes improve sleep and depression simply by stimulating this early morning response during the winter for those who have to get up before dawn or who can’t go outside first thing in the morning.  Beginning to notice this response and working with it can help repair your sleep-wake cycle if its been disrupted.

HPA-D is not Adrenal Fatigue

I’ve written extensively on this topic and the reason I bring it up is because you’ll see a bunch of recommended supplements for adrenal fatigue.  Insomnia is a symptom of a much more complex disorder called HPA-D.  (hypothalamus pituitary adrenal dysregulation).  By testing cortisol thoroughly we can see that pattern of dysfunction and supplement accordingly.  Giving adaptogens to everyone is not the answer.  Nervine herbs on the other hand are safe and interestingly ashwaghandha is both an adaptogen and a nervine.  Some of my other favourites include skullcap, passion flower and camomile.  Anything that makes you feel groggy upon awakening is inhibiting the cortisol awakening response so avoid this. Be careful using licorice as this potent herb increases cortisol.  L-theanine is an amino acid that is safe to use for anyone.

Certain patterns of HPA-D require increasing cortisol at certain times of day or decreasing it. Often there’s an issue with hormone clearance pointing to excess inflammation, inhibited liver function or thyroid issues.  The testing I do looks at both free circulating cortisol and total metabolized cortisol.  These are not always the same.  In many cases only free cortisol is tested resulting in treatment that is not neccessarily exact.

CBD is both anti-inflammatory and promotes sleep.  This is why standardized extracts need to made available.  For those experiencing recalitrant pain CBD can bring down the pain where other pain medications won’t.  A patient of mine with insomnia and endometreosis began using CBD.  Once her pain came down she was able to sleep and could start making decisions about her health.  She had been unable to work for many months.  I’ve seen this with backpain as well.

Thorough blood work including iron, blood sugar, thyroid and inflammatory markers is required to see a full picture and get a sense of what is going on.  A gut work-up is also important. Neurotransmitters play a role in HPA-D through the gut-brain axis.  Healing the gut so its producing neurotransmitters again and absorbing nutrients is the key in some patients. Supplementing with precursors like 5HTP are helpful in these patterns during treatment.  You may be noticing that it can take time to get to the root cause of insomnia.  Often we are also addressing trauma during treatment.  When we find out what works and are sleeping more, people report feeling that they got their life back.

 

 

 

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