Many of my patients have undergone sleep studies with little result. It is difficult to sleep normally in a strange place with your body plugged into machines. Sleep tracking at home makes a lot more sense and companies like the Oura ring have really upped the game on this. Oura is using heart rate variability to go deeper with sleep. You learn what works because you see the patterns of your sleep everyday in your own environment. Getting this daily feedback makes it easy to see what changes work. This is really technology at it’s best.
the Calm, Cool Cycle
Your bedroom needs to be 18 degrees C or cooler in order to have optimal sleep. Sleep efficiency is tracked based on how you fall and stay asleep. Timing is one of the biggest factors in getting a good score. Most of your body’s essential regulatory processes happen in 24 hour cycles. Hunger, temperature and hormone release all contribute to the circadian rhythm. If we work with this our performance, health, sleep and recovery will be a lot easier than if we work against it. You want the midpoint of your sleep cycle to fall between midnight and 3am. Going to bed too late will interrupt this. Alcohol inhibits sleep by raising your body temperature. If you are going to have a drink do it earlier.
REM & Deep Sleep
Rapid eye movement (REM) sleep energizes your mind and body. It is associated with dreaming, memory consolidation, learning and creativity. Adults need approximately 1.5 – 2 hours of REM sleep per night. A regular sleep schedule supports this. Avoiding heavy food before bed does as well. Deep sleep is where muscle repair and growth happen. This is where your blood pressure drops. Your heart and breathing rates are regular. You experience deep, restorative rest. Adults get about 1 to 1.5 hours of deep sleep per night. Staying away from screens and caffeine in the evening supports deep sleep.
Heart Rate Variability
Your resting heart rate is the number of times your heart beats per minute at rest. It is an important contributor to your readiness for life. When your resting heart rate is below your average it is a sign of good recovery. Too high or low can indicate the need to ease off and do something restorative. The Oura ring tracks heart rate variability and gives you daily readiness scores so you can adjust in a way that’s smart. Timing your active times and workouts earlier in the day does increase your sleep score.
As many of you know, I am a strong advocate of meditation for health and happiness. Having trained and practiced for over 15 years in somatic meditation, I have experienced and witnessed the positive changes. Meditation can support your sleep in ways nothing else does with no negative side effects. I also use botanicals, labs and other lifestyle modifications to repair sleep. You can find my favourite sleep support here.
“HRV (heart rate variability) biofeedback shows that the sympathetic nervous system is counterbalanced by increased vagal tone, and autonomic balance is enhanced by meditation.”
Research on meditation improves homeostatic regulation of the autonomic nervous system and reduces cortisol. Attention and focus increase. Participants in a 6 week study reported a sense of happiness and calm that was new. The ability to emotionally regulate themselves and attune to others was highlighted as another positive outcome of regular meditation.
Every tissue in the body adores and wants some estrogen. Estrogen protects us from disease. It nourishes our brain and keeps our bones strong. And damn girl, estrogen is what makes women curvy! We build muscle in our legs and butts more readily than men because of this wonderful hormone. During a regular menstrual cycle estrogen will spike around ovulation giving us extra energy while suppressing our appetite. Estrogen doesn’t cause abdominal weight gain.
People get down on estrogen but it’s not estrogen’s fault! Environmental toxins and pharmaceuticals like birth control contain ‘bad’ estrogens which can accumulate in the body. These can be recirculated or metabolized down pathways that lead to problems. There is a trend to ‘detox estrogen’ as a way to lose weight. Please don’t fall for this! We need estrogen. We love estrogen. Estrogen is sexy. Treating your hormones without proper testing and guidance is not recommended. It can create more problems.
Progesterone Just Says ‘Eat!’
Seems like progesterone gets all the love. It’s true, progesterone is pretty awesome too. We need all of our hormones to work together. Progesterone spikes before your period. This is why you may feel extra hungry. It’s a good time to nourish yourself with iron rich foods so I don’t mind this cue. It makes sense. Progesterone doesn’t get a bad reputation the way estrogen does. Why is this? Is it because of how estrogen dominance and insulin resistance in men causes a certain type of weight gain? Well, women are quite different than men.
Progesterone can dip due to high stress. When this happens it can contribute to estrogen dominance in women. Estrogen might not even be high but the ratio is what matters. We have come to equate estrogen dominance with weight gain but it’s not that simple. The kind of weight that is concerning for women’s health has a specific pattern. It looks like higher testosterone paired with insulin resistance and an aggressive androgen metabolism.
Estrogen: the Move & Seek Hormone
Around ovulation women tend to have more energy. It’s a great time to test your limits in the gym or attend a social event. This phase has been coined ‘move and seek’ by researcher Martie Haselton. As estrogen is hitting its peak we tend to want to move our bodies more and seek more contact. This fertile window creates a surge of inspiration for moving and mating. Makes sense, doesn’t it?
A plant-based diet is good for the gut. Any diet high in plants offers a wide range of fibres, phytonutrients, antioxidants and other valuable micronutrients. However, plant-based does not mean avoiding foods and nutrients from other sources. It’s is all about what’s needed, for who and in what amount. Cravings, stress and sleep play an important role in our ability to make choices. Diet isn’t just about what food we take in. It’s also about what media, social contact & downtime we choose.
Keep It Simple
Simplifying life is an art. It is more about what we leave out, than what we take in. We are overloaded with choice. Overwhelm and anxiety are an epidemic. The amount of stress we have is compounded by each decision. My happiest times have been when I have one thing to do each day. I’ve talked about this in terms of success as well. People who can focus on what they love are more satisfied, healthier and happier.
So eat plants for carbohydrates. Enjoy a wide variety of locally grown vegetables. Include sea vegetables. Avoid anything that your body reacts and that is too processed. Make sure you are eating plants that grow below the ground. These nourish the microbiome. Cook these foods more. If you have trouble with your tummy then cook the plants that grow above the ground too. Summer is a better time to eat a little raw food like sprouts & cucumber. In the winter warming spices support your digestion.
Start your day with protein. This gives you a dopamine response. This means you will be satiated and have lasting energy. Then you can focus. Carbohydrates have been vilified lately. There are good reasons. The food industry sells highly palatable foods in combinations that make people insatiable to keep us buying more and more. If you stick to plants for carbs this won’t happen especially if you don’t buy packaged food. Cook at home. Keep stress down. Keep the marketing machine at bay. Satisfied people are less susceptible to being sold insanity. Cold, sweet breakfast cereal and pea protein powders with a million ingredients will hurt your metabolism & your tummy. Fruit is a great snack later in the day.
What is Right for You
What you need will change. Humans are omnivores. We can thrive on any macronutrient ratio. Get to know what makes you feel good. There is so much debate over what is healthy and not healthy. Don’t get too caught up in it. You can be plant-based and eat grass-fed meat. Fish is incredibly important for brain health so include it in your diet in a way that you enjoy and feel good about.
What we each need changes throughout our lives. Kids need more calories AND more nutrients. So do athletes and college students. So do mothers of small children. Pleasure is a big part of food. So is social connection. Keep this central to what you take in. Don’t ever forget it. Personally, I could order out more to ensure that I’m not a slave to my kitchen. Fasting is another way to take a break. Both are good options.
Cravings, Crashes & Sleep
Sleep is everything! Half of women lay awake in the past month because of stress. What does this have to do with cravings? Well it’s pretty simple. Our brain can’t function or make the best choices when it hasn’t had enough rest.
When stress is high your body will try to regulate itself. The quickest form of energy is glucose. Sweet means survival to our brain. A lot of sweet makes us crave salt. Stress causes our blood pressure to go up. Craving salt can be an attempt to regulate this. The crash that occurs after a stressful event can result in craving fat. This is natural because fat is replenishing after a crisis. But what if you are always in crisis?
High cortisol makes it harder to make good choices. It changes how the frontal cortex makes executive decisions. Cortisol increases how much pleasure we derive from salt and sugar. This is why I focus so much on stress management, even more so than what food you eat. It’s much easier to make good choices when our cortisol is regulated.
Calm Cortisol & Hunger
Abdominal fat is inflammatory that cortisol makes and stores when we are under chronically high stress. It changes grenlin and leptin which are hormones that play a role in hunger. Basically this type of fat makes you crave sugar and carbs to calm the stress. You’ll be more hungry as a result because there is such a low nutrient profile in most of these quick fix foods.
Remember that cortisol is one of our allies when it comes to inflammation but only if we manage our stress. Meditation is one of the best ways to do this. So is strength training. Both of these you can do at home or with a group depending on if you need more time alone or more social connection.
So why is plant-based good for the gut?
My mom would say a lot of this is common sense and I’ve written in detail on this before. It increases the diversity in our microbiome to avoid processed carbs and focus on plants. The brain & metabolism both respond better to these microbiota accessible carbs than other carbs. Add enough fats and proteins to nourish the lining of the gastrointestinal tract so you can absorb all that goodness.
A healthy gut produces neurotransmitters for the brain. The brain also loves healthy fats and protein from wild fish or grass fed meats. If you focus on getting enough rest you’ll be more able to choose these foods. You’ll stop having cravings and feel more calm. Hunger won’t come on like a tidal wave and your energy will be steady again.
Our brains are built to learn, adapt & grow for our entire lives. Research on neuroplasticity has opened the field of human potential and healing exponentially in recent years. Some say that understanding how the brain can change is one of the most important advances of our time. We can strengthen specific neural pathways and create new connections at any age. Applied to chronic illness is showing remarkable results.
Grow Good Neurons
It was a Canadian neuropsychologist named Donald Hebb who coined the phrase,”neurons that fire together, wire together.” Since then we’ve learned how to apply this concept to treat conditions like irritable bowel syndrome. Let’s talk about how this works.
“Neurons that fire together, wire together.”
Pathways in the brain form and are reinforced through repetition. When you become ill, the brain begins firing in a way that is not your normal. Illness that goes on for a long period of uses pathways that become the new normal. I often hear from patients, “I just don’t feel like myself.” A person who was once quite social and connected might start to isolate for example. Treatment needs to include reminding the brain of the pathways it used to use. With IBS we treat the infection as well as the brain because this is where the root cause of the illness originates.
We grow good neural pathway by remembering who we are. When authentic, positive moments occur we savour them. This allows the neural structures to strengthen healthy pathways that will be used again. Beneficial experiences occur in life. When they do, we can linger just a little in the joy or pleasure. Our nervous system will then remember this. Memory is a big part of rehabilitating ourselves after negative experiences.
Slow Down to Savour
A moment of feeling strong inside, of letting go, of feeling cared about or being skillful in relationship are all worth savouring. Slowing down allows these experiences to become part of your nervous system. When you slow down, you begin to hard-wire a feeling of safety and pleasure back into your body. Craving diminishes because your needs feel met and you know you have what you need. Growing pathways of contentment internally allows you to be happier, more resilient and less shaken by life. The ups and downs are a breeze instead of a storm.
The Root Cause
The reason this can be difficult to do this, at least at first. is because of an innate survival response that we all have. Our ancestors survived because they were paranoid and fussy. Amusing, yes and true. Our negativity bias and is well researched. This bias has allowed us to survive imminent death by helping us focus on what is most threatening. By further understanding this we can rewire our brain.
We give more attention to pain than to pleasure.
Dr. Rick Hanson outlines how this bias works. I have paraphrased his work in these 5 steps.
We tend to seek our environment and body for potential dangers or threats. This is how we stayed alive throughout our evolution. When we do this, it’s likely that we will find something that looks like bad news or actually is.
We then focus all our attention on it. Imagine a predator close to your home. I know I’d focus all my attention, even obsess over it until it was gone. We become over reactive to threats until we are able resolve the situation.
This is how and why we give more attention to pain than to pleasure.
This response gets fast tracked into our memory and becomes a somatic memory which will need to be resolved later. If you’ve ever seen a puppy shake or play out a chase during sleep, this is what I’m talking about.
A stressful event leaves us vulnerable to more stress. Cortisol is released and then crosses the blood-brain barrier. The amygdala, our alarm center, gets charged up. Meanwhile the calming action of the hippocampus is weakened by the excess cortisol. Cortisol then tells the hypothalamus to release more stress hormones causing a vicious cycle.
What Puppies Know that Humans Need
This vicious cycle can be curbed. We create more resiliency in our brain by simply extending those times when we feel relaxed, safe, connected, competent and understood. Let’s go back to the secret of puppies. Puppies know how to let go. Humans don’t because we let this brain of ours override our body. So don’t think your way out! Trying to override it with ‘positive thinking’ won’t work.
Our ancestors survived because they were paranoid and fussy.
What puppies do is relax and experience whatever is there. It’s called ‘being with your experience’. Not trying to get away from it with positive thoughts. Be with your body and it will work it out. It knows how to let go. This is why somatic meditation is so powerful.
Brain Function & Structure
Our nervous system has the capacity to change. Enduring changes in function result in structural changes. This how chronic illness can be resolved. For example, we know that the underlying cause of IBS is an infection in the small bowel that happens because the migrating motility complex isn’t being triggered in the brain.
The gut is basically a bundle of nerves. This is why we see a co-occurence of depression and anxiety with IBS. We see relapse with IBS or SIBO. Sometimes what is needed is rewiring of the nervous system. This will look different for each patient but generally requires training the brain to skillfully develop neural pathways that are new or haven’t been used in a while. Annie Hopper has developed a system for doing this. I spoke with her at a conference earlier this year. I encourage patients to access biodynamic cranio-sacral therapy or other somatic therapies.
Changing the Brain
A focus on gratitude, grit, self-compassion, confidence and self-worth begins to hard wire these attributes into the brain during treatment. It is very similar to muscle memory. Every person knows how to learn because we all learned to walk and talk. With over 200 billion cells and several hundred trillion synapses in our brain there are always new options for growth and learning. Making new connections and getting our neurotransmitters firing helps the prefrontal cortex to calm the part of the brain that fires the alarm.
Our brain can learn to be like velcro for beauty.
If we understand that our brains are like velcro for bad experience and teflon for good we are eons ahead. This wiring helped us when we were hunter-gatherers but we can adapt. That’s what humans are good at. Our current circumstances require that we savour our surroundings. Let the beauty of this world sink in a bit everyday. My functional medicine teacher explained that in his First Nations culture there is a word for this. It is about appreciating the world and embodying a state of wonder. We can cultivate this way of beauty.
Getting your bounce back is possible. Low libido has many causes ranging from low testosterone or iron to body image dysmorphia, chronic stress, and hormone imbalance.
The DUTCH Hormone Panel
Functional lab testing is thorough and shows what’s really going on. Hormone health can be complex. I see so many patients who are at the end of their rope. Why am I so tired? What makes my period heavy or irregular? My doctor wants to put me on the birth control pill and an anti-depressant. Is there anything else I can do? I want a natural approach. I don’t feel heard.
The Dutch test is different than the adrenals stress index and saliva tests that are typically done. Its the most comprehensive in that we see both the total and active forms of cortisol which can indicate patterns of metabolic or thyroid disease. We also see all the sex hormone metabolites which is helpful for treating and preventing a number of hormonal imbalances including PCOS, painful periods, irregular cycles, and yes: low libido.
Stress is Primary
Low libido and other hormone imbalances are likely to occur when stress is too high for too long. Cortisol is upstream of all of these other hormones.
Nutrient imbalances are another cause. Iron deficiency and other types of anemia play a role in low libido. Basic survival needs have to be covered in order for us to have the energy for sex. This makes sense from an evolutionary perspective because having children when there is famine or the threat of predators and war is not ideal. For many people today their physiology is telling them they are in a time of threat when in fact they have a shelter, food, and loved ones around. This can be due to trauma, gut infections, overwork or a difficult relationship. Recent research looked at the effects of being in a relationship that is not healthy. This situation actually affects the gut microbiome negatively as well as the mood.
Four Triggers to Keep in Check
Perceived stress: new, unpredictable & individual based on past experience, belief systems. Some new and unpredictable stress can be exciting. It can help us expand and grow but too much is not good.
Inflammation: purely a physiological thing which adds to our allostatic load or what we can handle.
Blood sugar dysregulation: which is an epidemic in our country, and also physiological.
Circadian disruption: too much exposure to artificial light at night and not enough exposure to natural light during the day. It’s only in the last 150 years where we’ve had significant amounts of light at night.
Pleasure and Play
Saying “no” and building in more downtime are great ways to manage stress and kick your libido into gear. The more we allow ourselves to do things we enjoy the more we wire our bodies for pleasure. Things like a meditation practice, yoga, deep relaxation or any other way you know to connect with your body are great. When we get real rest (meaning away from screens) then we have more energy to move, have fun and socialize. These are key for a full and happy life.
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
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).
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.
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.
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.