Why You May Want to Think Twice About Keto
People with metabolic insulin resistance or neurodegenerative conditions like Alzheimer’s and Parkinson’s can benefit enormously from a ketogenic diet. Others just want to have better focus, improve their game or stop eating processed foods.
Many of these people thrive with the shift but others don’t. So who doesn’t and why not?
Perhaps you have a friend who has tried a keto diet and done everything by the book but it hasn’t worked. This person may be feeling worse even after the initial adaptive phase.
When the HPA axis is stressed keto can make things worse. The body interprets this low carb diet as just another added stress to deal with. This’ll happen if cortisol, our primary stress hormone, is out of whack.
Symptoms of constant overwhelm, afternoon crashes, insomnia and poor waking energy indicate ‘adrenal fatigue’. The cause is chronic or acute stress that is more than the body can handle. Learning to regulate cortisol and recover from the stress has to come first. Otherwise switching to a ketogenic diet is unlikely to work. It may even make things worse.
It’s similar with thyroid health. Nearly every tissue in the body requires thyroid hormone. If you have a low body temperature, are losing hair and have thinning eyebrows you may want to have your thyroid checked. In fact, I screen all my patients for thyroid levels. This is because I see it so commonly missed and is essential to metabolism.
When it comes to keto or low carb diets caution make sense. Thyroid function requires consistent fuel. This fuel is most accessible through carbohydrate. Although the body can adapt it makes more sense to stabilize the thyroid first. The endocrine system as a whole has this check and balance system of negative feedback loops. The benefits of keto won’t roll out if thyroid health is not at a certain level of stability.
Often in clinic there is a dual presentation.This is why medicine is personal and individualized. As a practitioner I tease out what is possible. For example, a patient with a cortisol imbalance who has a family history of diabetes may benefit from keto if stress management is taken seriously. If this person’s life doesn’t allow space for meditation or good sleep hygiene then keto should be avoided.
Many people with adrenal or thyroid require specific nutrients. If symptoms flare on keto then electrolytes become even more important. Not enough electrolytes can cause cortisol to rise which interferes with the conversion of T4 to T3 which is the active form. Stay tuned because my next article is all about electrolytes.
Getting enough sleep, sunlight, movement and social contact optimizes our health in ways that diet doesn’t. Ignoring these aspects of health is common especially for anyone who likes to fixate. Experiment and keep a curious mind. For those with a history of disordered eating or addiction its important to notice if you are becoming neurotic about the details. After an initial phase switching to keto shouldn’t take too much thought.
Keep in mind that overeating is another stressor. It’s easier to eat less with keto because fat and protein is much more satiating than carbs are. You may have noticed feeling hungry if you have just a piece of fruit. If you add some nuts or cheese your snack last longer. This is a really simple example but it works. On keto cutting carbs down to less than 25% of your caloric intake means your body begins using fat as fuel. And we know healthy fats have benefits throughout the body from nourishing the joints, brain and gut.
Migraines are common and disabling to people. They make up 5% of hospitalizations, and 20% of neurology consultations. Women experience them twice as much as men. Those with chronic migraines can end up relying on strong pain medications.
Migraines are usually associated with other symptoms such as nausea, vomiting, dizziness, extreme sensitivity to lights, noises, and smells, lack of appetite, and disturbances of bowel function. I am seeing more people suffering with these extreme symptoms so I wanted to break-down the different causes, testing and treatment.
Premenstrual syndrome can be a trigger for migraines. Vitamin E is an effective treatment for menstrual migraines. It does this by lowering prostaglandins without any negative side-effects.
Use of an oral contraceptive pill or hormone replacement therapy can lead to too much estrogen and not enough progesterone. This is another hormonal imbalance that can lead to hormonal migraines in menstruating women or those in peri-menopause.
A whole-food, low-glycemic diet that is high in phytonutrients with plenty of organic flax, fermented soy, and cruciferous vegetables such as broccoli, cabbage, brussels sprouts and cauliflower can help. Avoid alcohol as it contributes to leaky gut. Caffeine, sugar, and refined carbohydrates should be removed as well. Exercise and stress reduction techniques are also key.
Mitochondria & Cellular Health
Along with migraines you may feel fatigue, muscle aches, and brain fog. This can be a methylation defect or simply poor cellular regeneration. Mitochondria are the powerhouses or batteries of our cells. Certain micronutrients like B vitamins (especially B2) and CoQ10 are essential for mitochondrial function. Other b vitamins, alpha lipoic acid and vitamin c are also important. An organic acids test lets us see the weak link.
Magnesium is also important for mitochondrial function. A deficiency can contribute to migraines, constipation, anxiety, insomnia and other stressors. Feeling of irritability, noise sensitivity, muscle cramps or twitching, and heart palpitations are possible symptoms. Magnesium glycinate is best for muscles whereas citrate targets constipation. Magnesium theonate is specific for brain health.
The connection between migraines, constipation and liver function is well understood in Functional Medicine. Our bodies filter chemicals and hormones the liver. They are released through the colon. If the liver detox capacity or digestion is impaired there is a build-up. This toxic load often ends up in the bloodstream where it can cross the blood-brain barrier. If you’ve heard the term ‘leaky brain’ this is what its referring to.
Chemical responses are also be triggered by certain foods. Processed-food diet including aspartame, MSG (monosodium glutamate), nitrates (in deli meats), sulfites (found in wine, dried fruit etc) are all common chemical triggers. Tyramine-containing foods like chocolate and cheese are also worth checking.
Digestion & Migraines
Brain fog, bloating, irritable bowel syndrome, joint or muscle pain, and sinus congestion can all indicate an imbalance of the microbiome. Whether its a food related trigger or not, an elimination diet is a good way to start. Remove gluten, dairy and eggs. Corn can also be a problem. Stool testing is used to assess possible pathogens or dysbiosis as well as inflammation and triggers. Urine testing is excellent for fungal yeast, mould or bacterial imbalances.
The Conventional Approach
A diagnosis of chronic migraines is given to those where over 15 days of the month are migraine days. Triggers are sometimes identified and a prescription of preventative medication can be taken daily. These medications all have side effects. None of them cure migraines. Some of them have a rebound effect, meaning when the medication wears off, a rebound headache occurs.
You may have heard the term fat-burner. By consuming limited carbohydrates, the body begins using fat for energy. This is a normal physiological process. Fat is more satiating so if keto is done properly people tend to need to eat less but feel full.
What I see often see in clinic is people who don’t eat enough protein. Keto tends to help with this because you start by tracking your protein intake. Protein has higher nutrient density than other foods. It also more satiating for this reason. When people are low in protein they are also low in essential micronutrients as well. This can cause cravings and a hunger that seems to never end.
Blood Sugar Dysregulation
Keto is stabilizing stabilizing for blood sugar. Those with insulin resistance or hyperglycemia can benefit from a ketogenic diet. Just to be clear, metabolic ketosis is what we are talking about. Don’t confuse this with ketoacidosis, an acute condition that can occur to diabetes.
Both conditions involve ketone production but the second happens because insulin is unavailable at the cellular level. This dangerous condition produces much higher levels of ketones and is a medical condition that looks much different than metabolic ketosis. Blood sugar dysregulation is very common. I see it almost daily in my practice.
If you have followed my work you’ll know how important blood sugar regulation is for maintaining physiological homeostasis ranging from hormones to brain health.
Epilepsy & Neurodegenerative Diseases
We have known for a long time that a ketogenic diet has excellent outcomes for certain conditions. Drug resistant epilepsy is one especially when used in children. The side effects of seizure drugs have some of the worst side effects. Using diet to avoid long-term use has changed the lives of epilepsy patients. Other neurodegenerative diseases like Alzheimer’s and Parkinson’s also show promising results.
This is an area that requires more research however we’ve know of anecdotal evidence where cancers disappear with extended metabolic ketosis. Interestingly the method used to detect cancer uses a radioactive form of glucose. This reflects the fact that cancers use more glucose than normal tissues.
Patients with recalcitrant gastrointestinal issues like SIBO (small intestine bacterial overgrowth) and IBD (like Crohn’s and Colitis) tend to benefit from a lower starch diet. In many cases keto or intermittent fasting provides symptom relief so people are doing this intuitively. Keep in mind that simpler sugars (monosaccharides) are sometimes easier for these people to tolerate. Fruit is a better source of simple sugar than processed foods which are what some people reach for when they are in pain but require energy. Energy from fat can be a good solution that is actually helping with recovery from the infection or inflammation.
Protein is the best place to start. Most organisms do not overeat protein. We have a hard-wired cut off point for protein because of how satisfying it is. If you don’t get enough protein, you’ll try to find nutrient minimums by eating larger amounts of other foods that likely don’t have as good a nutrient profile.
The next step is to limit carbs to 20-30 grams per day. There are tools to help you learn how to do this that I go into below. Once you get started it becomes just a new way of eating. In the long-term carb cycling can be better for gut health. This means choosing a day or two a week where you increase carbs. By including some of the resistant starches and prebiotic fibres you replenish the beneficial bacteria.
The last step is to fill the rest of your energy needs with healthy fats. For gut health use a variety of fats, not just saturated fats. I’ll talk more about who benefits from “a mediterranean keto diet’ in a follow-up article. Basically everyone benefits from consuming adequate amounts of EPA/DHA from fish and MUFA (monounsaturated fatty acids) from olive oil & nuts.
We know humans can thrive on any macro nutrient ratio. There is evidence of populations like the Inuit thriving on a fat-based diet. This is also true of a high protein or a high carbohydrate diet. We are highly adaptable! This is not one-size fits all, meaning any diet needs to be individualized & will change depending on activity levels, stage of life, lifestyle etc.
I’ve trialed a few different tools for tracking macronutrients. Initially these make it much easier to get a sense of what you are eating. MyFitnessPal is a popular one that many of my patients use. I prefer Cronometer. It give you a sense of your micro and macronutrients and is easy to use. Check it out and let me know what you think!
In the next couple articles I’ll address who should be cautious when trying a ketogenic diet and why electrolytes are so darn important!
Love Your Lifestyle
People who engage in regular movement or meditation are less likely to get sick during the winter months. Getting outside during daylight helps your circadian rhythm and vitamin D levels. Good sleep supports immunity and prevents colds. Here are 15 ways you can sleep better this season! Prevent getting sick so you can have more time with your loved ones.
Devour These Delicious Delicacies
This is the time of year to build your defences. Boost these in your diet. Enjoy this season more!
Colostrum: By providing immune cells directly, colostrum encourages the body’s resilience to external viruses. Milk that comes from mammals during the first 72 hrs of their baby’s life that is particularly high in antibodies.
Ginger: There is plenty of scientific research supporting the use of ginger in several pathogenic conditions. This is one of the most used herbs world-wide,
Vitamin C: This powerful nutrient contributes to immune defence by supporting various cellular functions of both the innate and adaptive immune system. It protects against environmental oxidative stress. 42% of people do not eat enough Vitamin C.
Fish Oil: Much of your immune system is housed in your gut. Research indicates that DHA (docosahexaenoic acid) in fish oil helps gut immunity by supporting B cell function. DHA is also one of the major building blocks of the brain. This omega-3 fatty acid is critical at all ages of life for optimal brain health. It is preventative against SADD.
Probiotics: Probiotics are living microorganisms that are found in the gut. They play an important role in regulation of host immune response. We are learning everyday how to best target symptoms with strain specific probiotics that are more likely to adhere to the gut lining.
Zinc: This nutrient is well documented as a source of immune support. Foods that are highest in zinc include oysters, crab and red meat. Nuts, seeds, legumes, avocados, berries and apricots also have zinc.
Echinacea: The active substances that help support cellular immunity are phenols and alkylamides. You know you have a potent product if it makes your tongue tingle.
Mushrooms: These work as antioxidants and immunomodulatory. Mushrooms such as Reishi (Ganoderma lucidum), Shiitake (Lentinus edodes), and Turkey tail (Colorus versicolor) protect immune cells.
Vitamin D Deserves Special Recognition
Low vitamin D levels may be one of the key reasons why acute respiratory infections are common during winter and spring. According to a recent study published in the British Medical Journal, vitamin D plays a critical role in enhancing immunity against viral, acute respiratory infections. Cod liver oil is an excellent way to increase your family’s intake of vitamin D. For prevention of diabetes type I and type II it is essential to optimize your vitamin D levels. The blood marker you can ask for from your doctor is 25-OH-D.
And Finally My Favourite: Beta Glucans
Beta glucans are highly branched polysaccharides that are non-caloric and impart an immune benefit. These prebiotic foods are mainly found in fungi (mushrooms and yeast) and grains (oats).
One study showed that 9g of beta glucans from brewer’s yeast taken for 16 weeks was able to reduce the number of cold infections by 25% and the symptom score of those who got infected by 15% (1)
Fungal beta glucans have a stronger effect on immune response. Beta glucans from oats have a more potent anti-lipidemic effect. My store is nearly stocked with some of the best formulas for supporting your health long-term. Stay tuned for its launch soon!
In the last decade, oral contraceptive usage has dropped. This suggests a collective desire to regain control of our bodies and health. Many women report headaches, weight gain, mood issues and a host of other symptoms from taking the pill.
What is replacing the Pill?
Last time I visited a sexual health clinic I was pleasantly surprised to see the fertility awareness method (FAM) included on the intake form. FAM has not always been an accepted form of contraception. This was the first time I’ve seen it alongside the IUD and hormonal birth control.
I have never taken oral contraceptives. Not once although it seems like such an easy option. My mom told me how they work. This encouraged me to explore other options. When I asked about FAM and the IUD in my 20’s I was laughed at by clinicians. That’s putting it lightly. The sexual health clinics were somewhat coercive. If I wasn’t there to get the pill why had I come? I had read Taking Charge of Your Fertility and was getting to know my body.
Research,Technology & Men
Today there are a number of new books on the subject. There are also cycle-monitoring apps and social media groups devoted to fertility awareness. Packed with research, these offer accessible information. Learning what’s normal is a big deal. Then we can get support about what’s happening with our menstrual cycles.
In the 90’s, the intrauterine device (IUD) wasn’t offered to women prior to giving birth. Now women can choose the copper or Mirena IUD whether or not they have children. These devices can be disruptive in other ways but work well for some women who want to avoid the side effects that come with the pill. The Mirena has hormones and a woman may still lose her cycle. With the copper its important to monitor your zinc: copper balance. Some women also experience gall bladder issues or other pain along with a heavier cycle.
One of the most important changes that is occurring is men taking more of an active role in fertility and contraception. I presented at a conference a couple years ago and was speaking to this. A master herbalist was following me on stage. I invited him into the question and answer portion of my talk.
Supporting women’s menstrual cycle is a way to prevent unwanted pregnancy. He explained that he knew exactly when his wife was ovulating. Instead of showing his daughters what herbs prevent pregnancy, he shows them how to normalize and track their cycle. It is encouraging to have male allies in this important work. Men are getting on board with cycle tracking. This allows women to relax and enjoy their bodies more.
‘A Women’s Health Epidemic’
This shift comes at a time when our collective hormonal health seems to be getting worse. Experts know this is largely a result of our modern lifestyle. High stress, environmental toxins like xenoestrogens and a diet high in processed food are all factors. Then there is a lack of research and focus on women’s health. Conventional medicine rarely tests hormones. Invasive interventions are offered before gathering basic information that directly relate with women’s symptoms.
“I absolutely believe we are in a women’s health epidemic,” Nicole Jardim, a New York-based hormone expert. “I believe that there are a number of different reasons why that’s occurring right now. Most of them can be attributed to the fact we live in a crazy modern society. Women have super-human expectations of themselves. Other people have them too.” This creates a lot of pressure and stress.
Jardim is a nutritionist and holistic health coach specializing in hormonal and reproductive health. She says that electronic addiction and poor nutrition wreak havoc on women’s bodies.
“Combine that with the insane stress so much of us are under, our lack of sleep and I think we have a perfect storm for hormone imbalance,” she adds.
All the Same Root Cause
Ninety percent of women experience difficulty with PMS now. Polycystic ovarian syndrome, breast cancer and difficultly with menopause are not as separate as they first seem. Underlying all of them is a lifestyle and environment that is mismatched with our bodies.
We can shift this culture by learning to adapt and care for ourselves differently. Enough meditation and rest is important. Choosing medical marijuana instead of harmful pain medications is another step we can take. Getting thorough hormone testing is also very empowering.
Seasonal Affective Disorder is Real
Millions of people experience the winter blues. This type of depression is known as SADD. There are several interventions that can help and even reverse SADD. Winter is an excellent time to get extra support either from a therapist, a peer group or a functional medicine practitioner who can help optimize your health.
7 Tips You Can Begin Now
Let me know which of these helps you the most.
- Get outside between 10 am and 2 pm everyday. Bright light exposure triggers our brain and endocrine system creating a cascade that helps your body thrive. Aim for at least 20 – 30 minutes everyday. It doesn’t have to be sunny out to get the benefit of midday exposure to daylight.
- A lower carbohydrate diet makes sense in the winter because we generally slow down a bit. People who experience SADD tend to feel better when they focus on other foods in the winter. Simply focusing on microbiota accessible carbs (MAC’s) supports both gut health and mood. These come in the form of roots and tubers. They are the traditional foods we would gather in the fall and store in the winter.
- Eat Fish. The DHA in fish supports healthy brain function whereas the EPA keeps inflammation down. Research shows that consuming fish several times a week is better in the long-term than supplementing with fish oil. Just eat real food and take cod liver oil as an excellent source of Vitamin D.
- Tend to your gut health. The gut-brain axis is key. Brain-fog is usually caused by an imbalance in the gut. Eat fermentable fibers and avoid alcohol as it can increase intestinal permeability. This can set off an immune response and increase inflammation which contributes to depression.
- Neurotransmitters are produced in the gut. Depending on what kind of depression your experience you may benefit from specific dietary or supplement support while treating the gut. Melatonin is affected adversely by bright light at night. It works with serotonin to regulate the sleep/wake cycle.
- Get moving. Exercise feels good. Serotonin is one of the neurotransmitters that we know increases when we move. Choose activities that you enjoy and try new ones that are more suited for the season.
- Reflect. The winter is an excellent time to cultivate creativity and develop a gratitude or meditation practice. Enjoy warm drinks, cozy fires and enough social time to balance out the stillness.
Lab Tests Can Provide Important Insight for Treatment
For my patients, I want to see their vitamin D status especially if they have been supplementing. This is a standard blood test. Vitamin D can be problematic if too high or too low. I also like to see a urine organic acids test to see how neurotransmitter production is functioning. Basic gut testing always helps whether or not there are gut symptoms. Cortisol, melatonin and inflammatory markers like cross-reactive protein also give important insight when it comes to treating the root cause of depression.
Light Disrupts Sleep
Research shows that young children are adversely affected by indoor lighting at night. Just one hour of bright light exposure before bedtime suppressed the children’s melatonin by 88 percent. This study isn’t even looking at electronic use, and a significant negative response was found. We know the higher intensity blue light coming from screens causes even more disruption.
Bright artificial light exposure at night suppresses melatonin production. The negative health effects include fatigue, behaviour issues, compromised immunity and elevated blood sugar.
Serotonin is the precursor to melatonin. Both help regulate inflammation and pain. Chronic inflammatory disorders including depression may be influenced by low melatonin. Melatonin is also an important antioxidant.
Amber coloured light bulbs and side lighting can be used in the evening to support melatonin. Dimmer switches can help as well. Nightlights ought to be warm coloured and used in bathrooms as opposed to bedrooms. Digital alarm clocks, and other sources of artificial light should be removed from bedrooms. Blackout curtains may be necessary. Restricting children’s use of electronic use especially before bed is important.
Parents feel more distracted parenting when using their phones. Studies show this impairs their sense of connection with their children. The group of parents who did not use phones while parenting had an increased sense of meaning from this time.
Play as an Antidote to Anxiety
Screens take away from play time, interrupt time for reflection and time for boredom which is an important aspect of creativity.
The disappearance of play is a major contributor to the growth of anxiety disorders amongst adolescents. Play helps kids learn social and emotional skills. It also develops the ability to take risks and think abstractly.
Half of children will have a mood or behaviour disorder by the time they are 18. Anxiety affects 32% of young people. Time spent on social media means a decline in contribution to their home environment and in their communities.
Cultivating the 3 ‘C’s’
- Connection – cuddling, tickling, holding young children. Older children need the same connection although it may look different.
- Communication – asking questions, finding out how they feel and what they spend their time doing. Ask them how screen time feels different from other activities?
- Capability building – help them grow to be capable human beings who are learning skills to self-regulate.
Two references that may be of interest: The Good News About Bad Behavior & Playborhood
Optimizing methylation can help with depression, allergies and asthma. A recent meta analysis showed “consistently lower methylation levels observed at all associated loci across childhood from age 4 to 16 years in participants with asthma.” The findings of this meta analysis suggest that further investigation of epigenetics is warranted. This means a focus on how genes expressed.
Our health is not determined by our genes. Diet, environment and lifestyle are more important than we think.
I see women in clinic nearly everyday who are very low in specific nutrients. This can have far reaching effects on methylation. The cause is often a vegetarian or vegan diet that they are choosing because they believe it is more healthy.
Specific genetic variations or SNP’s (single nucleotide polymorphisms) can inhibit methylation. You may have heard of MTHFR. It’s one of the most commonly talked about gene mutations. It relates specifically to methyl folate. The enzyme needed to make this nutrient active is inhibited. Ensuring you have a folate rich diet is the epigenetic part. We need 2-3 servings at least. I say this because if you are a poor methylator you may benefit from more.
Chris Masterjohn, Phd has a handy phrase to help us remember where to find folate. The 3 L’s are Leafy greens, legumes and liver. One serving is 100 grams so we need between 200 and 300 grams per day of:
- Cooked vegetables. Fresh and local is important. Use the water that you cook them in.
- Double the amount if you are measuring raw vegetables.
- Wash veggies before cutting, blending.
- Folate degrades in frozen veggies so avoid any freezing or frozen products.
- Liver can be weighed before cooking.
- Legumes need to be soaked, rinsed and then cooked.
- Buying sprouted legumes and pressure cooking speeds the process.
- Some people can’t tolerate legumes even if they are prepared in these ways.
Methylation contributes to detoxification of foreign chemicals and heavy metals. The liver is where most of this happens. What is really fascinating is our cells are constantly adapting to the the demands of their environment. Methylation is one of the key players that assists with this process.
This explains why how some people exposed to certain toxins feel little effect while others may be debilitated.
Methylation & the Brain
Proper methylation helps keep your brain flexible and focused. It prevents negative thought patterns from taking over. Associations between poor methylation and alzheimers have been researched.
Decreased methyl folate production is common. There are up to 30 different kinds of MTHFR genetic variations making it difficult to convert folate into its active form,L-methylfolate. Mania, mental illness and depression are linked to some of these mutations.
Allergies & Histamine Intolerance
When you are methylating well your body is getting rid of histamines. At the root of most allergic reactions is an overload of histamine causing what some call a histamine response. In the scientific literature this is called mast cell activation syndrome (MCAT). Mast cells mediate immunity and inflammation. Methylating poorly contributes to MCAT. Triggers like chronic stress and trauma can be triggers for MCAT.
Eat these key nutrients
- Folate or Vitamin B9 requires 2 -3 servings per day of dark leafy greens, sprouted legumes or liver. This essential nutrient cannot by synthesized in the body so must be ingested. L-methylfolate is the active form that can cross the blood-brain barrier. One key function of folate is to help produce serotonin, dopamine and norepinephrine.
- B12 needs to eaten frequently. We can only absorb in a day what is required for that day. Aim for 4-8 grams of liver, 8 grams of clams/oysters, 375 grams of animal protein, 3 glasses of milk or 3 ounces of cheese. Research is being done to assess if nori and chantrelle/shitake mushrooms can provide B12 but this is not yet conclusive. In general vegans/vegetarians are at high risk for B12 deficiency. This is a serious health concern.
- Choline: Egg yolks are an excellent source of choline especially if they are soft. One egg yolk has the same amount of choline as 50 grams of liver or 200 grams of nuts. Two or three egg yolks per day meet our need but don’t eat 600 grams of nuts. Cruciferous veggies are another source as is lecithin. If you are supplementing try alpha GPC or TMJ.
- Glycine: I’ve written at length about glycine. Basically we need 1-2 grams of glycine rich collagen for every 150 grams of protein we eat. You can also supplement with gelatin or have a high protein bone broth as your source of glycine
Who is at higher risk?
Anyone over the age of 65 needs to monitor these nutrients. If you have a history of ulcers or gastritis you also are at higher risk for deficiency. Vegetarians and vegans also need to be careful. Poor absorption can indicate the need for supplementation but generally its best to get these essential nutrients from food.
Remember methylation can be the missing link in your health. I want you feeling your best.
Our brains adapt to early life experiences by creating imprints. We have many imprints both positive and negative that become part of how we see the world. The interesting part is our brains can change. The brain’s ability to reorganize and form new neural connections is called neuroplasticity. Our nerve cells can adjust their activities in response to new situations or to changes in the environment. Here’s what you need to know in order to do this.
Our brains are wired to remember the dangerous or overwhelming experiences. This is part of a mechanism to protect and help with survival. The term used to describe it is negativity bias.
Trauma is any event that we hold onto because at the time we weren’t able to integrate it. This happens to everyone. And yet we don’t need to live in a constant state of heightened stress because of it.
The idea of ‘positive thinking’ has always felt suspicious to me. Underneath there is often a simmering of unmet needs. How do we address this? Beginning with ourselves and experimenting with our own experience is what seems to work best.
Gender & Sexuality
Gender is a rich place to explore this topic of how the brain orients itself. Just yesterday a man dropped by to inquire about my work. As he was leaving he scanned my body in a way that is very familiar. We all look at each other all the time but there is a way that a man does this to a woman that is rude given the circumstances.
I’ve learned from transgendered friends that this type of gaze is well known. Being observed and questioned about their gender or sexuality can cause significant activation of the stress response. The ability to regulate and reduce the impact of our negativity bias becomes more difficult. Our culture needs to shift to allow more people to be at ease.
Neuroplasticity tells us that we can train the brain to regulate itself. It is possible. The cascade of positivity extends far beyond ourselves. I’ll explain how this happens.
Body-centred mindfulness training or loving self-compassion are the foundations. Knowing the body and training ourselves to notice when we begin to get overwhelmed is stage one.
Stage two is noticing what is not overwhelming. Seeing anything in the environment that is easy to integrate brings us into a different part of our brain. This part is deactivated. It sees more clearly and can enjoy the beauty of the world more.
Stage three is looking at other people from this appreciative lens. This part can happen spontaneously and we also can train to do it more often. A gaze that sees another person with curiousity is kind. This type of gaze only looks deeply at another when the foundation or motivation is heart-centred. What this means is the judging, critical or activated brain is not running the show.
We can attune better to others and know what is appropriate if we are regulated ourselves. We can also listen to another’s experience without overlaying our own. This is an innate response. I see kids do it all the time on their own. It certainly helps when it is modelled to them.
Glycine is the Amino Acid that Gives
Without knowing it, glycine is helping your body everyday 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. In terms of 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. In fact it is 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
Why I Love Collagen
Collagen helps to balance the branch chain amino acids in our bodies. This has far reaching effects. Many of you understand the importance of balancing healthy fats to ensure you get enough omega 3’s. There is a similar balance when it comes to amino acids. Most of us get too much methionine and not enough glycine. Glycine can be taken on its own or consumed in either bone broth or collagen.
The reason I love collagen is because of convenience. I make bone broth but not as often as I need to consume it. Collagen is convenient. It can be added to my morning matcha, power balls or an afternoon workout drink.
Grace & Beauty
Collagen nourishes all of our connective tissue. Its great for anyone who wants a faster recovery time post workout or is experiencing tendon or joint pain. Connective tissue includes skin, hair and nails. You may notice collagen being marketed as a beauty aid. Certainly when we are pain free and nourished, we have a healthy glow.
Adequate amounts of glycine also supports phase two of liver detoxification. This is often sluggish due to the modern lifestyle and the high stress that comes with it. We can talk about this from an evolutionary standpoint and it makes a lot of sense. We evolved eating a wide variety of foods that included some fish and animals. We valued these sources of nutrient dense food by eating everything. This gave us a balance of amino acids that nature provides.
Glycine is a neurotransmitter as well! It has the ability to be both excitatory and inhibitory, meaning it can function both to stimulate brain and nervous system activity, or to quiet it. Let’s put a few things together.
- Calms the brain
- Helps us sleep deeply to support repair
- Supports organ function especially the liver which cleans our blood at night
- Liver also regulates all emotions. When it’s not functioning optimally, we tend to feel frustrated or angry. When the liver is well we are able to grow in a direction that feels right
- Grace is a feeling of ease with how life is. This comes with a happy liver
Strong Bones Long Term
There is more collagen in our bones than calcium. Remember this applies also to our skin, joints, ligaments and hair. If you haven’t taken collagen before you can try taking it up to three times a day. Ideally we’d have 30% of our protein from collagen rich foods.
Blood Sugar & Hormones
Protein can stabilize blood sugar so collagen can be an excellent way to support a higher protein intake. Collagen is a great way to increase the cascade of dopamine first thing in the morning. Patients report a huge benefit from beginning their day with a warm, protein rich breakfast.
If you aren’t a breakfast person collagen in your hot morning drink can suffice. For hormone health this is a much better choice. I often see people using caffeine and fat to suppress their normal morning appetite. It works for awhile but then hormone and lipid markers start to go out of range. Symptoms can include afternoon crashes, late night hunger, brain fog, thyroid problems and insulin resistance.
Sleep is the cornerstone of health. Everything from immune function to mood & behaviour issues are all linked with poor sleep habits. Researchers are learning so much from experimenting with how sleep deprivation inhibits our ability to thrive.
Let’s get your sleep dialed so you can live well. Here are some of the facts that will help you do it.
Duration & Timing of Sleep
Duration is how long you sleep. Research shows that we need between 7-9 hours each night for optimal health. You’ll need to be in bed a little longer to achieve this because we all need transition time.
Timing is when you sleep. Sleeping during the day is very hard on the body. Natural light, temperature and seasonal changes all relate with timing.
The habits of three hunter-gatherer groups were recently studied. They went to bed, on average, 3.5 hours after sunset. Were they in front of screens during this time? Of course not. They were dancing, telling stories and singing. What’s very interesting is like us parents, they woke before sunrise. Why?
Temperature is a big deal when it comes to sleep
People wake up when temperature rises and this often happens prior to sunrise.
Having a hot bath before bed raises your temperature but when you get out you cool down rapidly. In fact your core temperature cools down and this can make you drowsy.
Alcohol raises your body temperature so you’ll often sleep worse after a drink. NSAIDs like tylenol drop temperature slightly but I don’t recommend using this as a sleep aid.
The Time You Spend in Bed
Allowing yourself a sleep period of 8 hours ensures that you’ll get the rest you need. How long we sleep varies but extending the time you have in bed means you’ll more likely get what you need. Keep in mind that recovery from a work out or an infection requires longer rest periods.
What is fascinating is that the tribes that were studied would be asleep for an average of 6 hours every night but in bed for 8 hours. So this brings us to why an extended sleep period is so effective for increasing sleep satisfaction.
This is the feeling of being rested, energetic and alert when you wake up. You may need even more sleep if you are using your brain a lot or want to optimize memory. This is why college students need almost as much as infants or toddlers.
The hunter-gatherer people who were studied were not affected by light exposure. Obviously this is because they have a consistent environment without artificial light. There is no jet lag and fewer changes in general.
Blue light at night, shifts in time zones and more stimulus at the wrong times all have an effect. Lack of daytime light exposure is a major contributor to circadian disruption. We all need at least 30 min of outdoor day light to set our clock. With people working indoors all day this is an important factor to address. In terms of productivity, cutting blue light during the day can be helpful. We are alerted constantly when exposed to blue light & don’t perform as well. Wearing orange tinted glasses is calming. It can help with focus. Take a walk outside at lunchtime will do the same thing.
Light is measured in lux. Although devices don’t have a high output most people hold their device too close. I’ve thought about how as a kid I never was allowed to sit that close to a television.
The intensity of light exposure is quadrupled if your device is a foot away versus two feet away. This is because of how directly the light penetrates into your eyes.
All Kindle type apps are now backlit. This can create a similar circadian disruption especially if you don’t get daytime light exposure & have your ebook lit up at bedtime.
Nature, distance & movement
Being in nature regularly is important too. Looking at a body of water, a field or the forest uses different parts of our eyes and brain. I was struck by how calming it is to look out at the mountains where I live.
Eye movement has a massive impact on learning and physicality. We know this from studying infants growth. I study this through a movement practice. I always sleep better after moving my body in different ways.
Chuck Czeisler’s has a Sleep Lab at Harvard University
Siobhan Banks is a researcher of sleep.
Dr. David Dinges is a psychiatrist who focuses on sleep and behaviour.
For glasses that block blue light check out: https://www.blublocker.com/
Addiction to Technology is a Real Problem
40% of North Americans suffer from addiction to technology whether its email, porn or games. By the age of 7 a child will have spent 1 whole year of life on devices. If we break down the average number of hours we are spending looking at screens it is shocking. Sleep is suffering.
Most people can’t imagine life without their phone. College age students check their device 82 times per day. Besides infants, this is the age group that requires more sleep than any other. Many report keeping their phone on throughout the night to answer texts at any hour.
The majority of adults spend 4 hours a day looking at their hand held device. How is this impacting health not to mention relationships, productivity, satisfaction and the environment?
Destroyers of Sleep
I was talking with my son yesterday. He’s 6 and was asking about caffeine. There is a local company opening a cafe to serve organic yerba mate. Part of the marketing strategy is to give away sweetened, canned drinks that are stimulating to young people at festivals. It works. Kids as young as my son are curious and want more.
Young people are marketed to heavily. For the first 5 years of his life my kid wasn’t on devices at all. This was supported by his preschool teachers and his uncle who works in marketing. As a single parent it wasn’t easy but I did it. He’s also never tasted coca cola but now he’s had canned yerba mate.
So we talked about what stimulating drinks do. I explained that I didn’t touch them until I was almost 30 years old. When I did I started to develop sleep issues. Asking him if he enjoys sleeping & feeling healthy made him consider what’s more important. He’s seen me grumpy and sleep deprived many times.
Caffeine has a good side of course. I love it in moderation. Morning is my best time and I don’t suggest not enjoying it especially for parents. But our kids…no way. We can protect them and teach them to self-regulate around stimulants.
In the centre of our brain, right above the optic nerve, is where light registers. Its called the suprachiasmatic nucleus. It’s part of the hypothalamus and is responsible for controlling circadian rhythms. Blue light at night disrupts sleep. Disrupted sleep means compromised health. Its that simple.
Inflammation & Sleep Deprivation
All chronic disease has an inflammatory quality. Research shows that one night of poor sleep increases inflammation. I’ve written on cortisol’s important anti-inflammatory quality. When your circadian rhythm is disrupted its quite likely that cortisol is not regulated. This means your inflammation will also not be regulated.
How to Fix it
✔Stop all notifications that aren’t essential
✔Uninstall all social media apps from hand held devices
✔Create phone-free areas in your house. The bedroom is number one and the dinner table is number two
✔Set up a regular tech free times perhaps daily (the morning or times with loved one) and weekly (ex. Sunday)
✔Plan a longer tech free time or digital detox at least once a year but more often
“What Do You Want to Pay Attention To?”
- Evaluate your usage: Moment (iOS), BreakFree (Android) AND Smartphone compulsion test.
- Cultivate behaviour change with mindfulness apps: Calm, Mindfulness or Headspace.
- Reduce your usage: “How to break up with your phone” by Catherine Price is a 30-day step-by-step plan for creating a healthier relationship with technology.
Sleep is an integral part of health. Over the next few weeks I’ll be offering a few challenges to help you meet your goals in terms of real rest & sleep.
September brings a natural change in routine. I encourage you to ride this wave. Join my FB group to receive support and have your questions answered each week. This begins the last week of August, 2018. Sign up now and begin feeling better soon!
Brain health is influenced by many factors and we know there are a few habits that support long term function.
The inflammatory cytokine model of depression shows the influence diet has on cognitive function. Omega 6 oils are linked to depression and are pro-inflammatory. One in four adults experience mental illness in the US and the standard American diet is high in omega 6 oils. (1) Depression is increasing at an alarming rate of 20% each year.
1. Protein and Fat
Supplementing with omega 3’s is an option, however quality is an issue. Keep in mind that grass-fed dairy, meat and pastured eggs all are high in omega 3’s whereas conventional varieties are much higher in omega 6’s. Cold water, fatty fish that is wild is an excellent source of omega 3 oils as well as the important fatty acids EPA and DHA. DHA has been shown to support brain function particularly in depression, bipolar disorder and ADHD . Comparatively, vegetarians and vegans ingest 30-60% less EPA and DHA.
Monounsaturated fats like cold pressed, extra virgin olive oil increase the production of ACTH which is an important neurotransmitter. All neurotransmitters are built from amino acids in the gut. Glycine, a component of bone broth, reduces psychotic episodes and improves cognition by acting as an inhibitory neurotransmitter. It will antagonize norepinephrine which helps regulate the stress response. Cholesterol nourishes the myelin sheath of the brain.
A staggering 30-40% of people do not respond to anti-depressants. One of the ways these function is to inhibit the stress response by lowering high cortisol levels. Although, it can’t be known if an individual has high, normal, or low cortisol without testing. As a result this may explain why so many don’t respond. Cortisol is anti-inflammatory and by lowering it without proper testing it could actually increase inflammation.
2. Caffeine has many benefits in moderation
Caffeine is known to exacerbate anxiety especially in the afternoon and evening. The resulting lack of sleep and improper light exposure disrupt circadian rhythm. Over 20% of people with insomnia develop depression. In addition, those at high risk are mother’s whose iron and fat intake is not optimal. Interestingly half the population are poor metabolizers of caffeine. There may be a link between those with a gluten intolerance.
3. Gut Health and Gluten
The number of people who have undetected celiac disease and non-celiac gluten sensitivity is growing. The connection between celiac disease and cognitive dysfunction has determined at least 22% of people are likely to experience both. An astonishing 57% of those with neurological dysfunction test positive for anti-gliadin antibodies. Clinically I’ve seen people who tested negative for gliadin which is the standard test and when I test other gluten specific antibodies they are positive. The disorders associated with gluten include: seizures, neuropathy, ADD, ADHD, autism, ataxia, anxiety, depression and schizophrenia.
Vegetarians and vegans are 68-83% deficient in B12. B12 deficiency is associated with alzheimer’s, dementia, cognitive decline, memory loss, depression, bipolar and psychosis. B12 absorption can be impaired by dysbiosis, leaky gut, inflammation, pernicious anemia which is autoimmune, alcohol, pharmaceuticals, low stomach acid and IBD.
Folate and B6 are needed for serotonin synthesis. Additionally, a deficiency of these also increases inflammatory homocysteine.
5. The Minerals: Zinc and Magnesium
Copper and zinc act as neurotransmitters in the brain. The ideal serum ratio is .7 copper – 1 zinc. Oxidative stress and inflammation reduce zinc and increase copper. Low zinc indicates inflammation.
Magnesium acts at the blood brain barrier to prevent stress hormones from entering the brain. Prevents anxiety and depression after a traumatic brain injury. Caffeine and stress in excess deplete magnesium. Too much calcium inhibits absorption. Calcium from food is enough for most people.
Magnesium is stored in our bones. Acid reflux, Crohn’s, colitis, kidney disease and alcoholism contribute to a deficiency. Proton pump inhibitors are used to treat reflux by masking the symptoms and these will also deplete the body of magnesium overtime.
The recommended dose between 500-700 mg/day. Food sources include: dark leafy greens, cacao, bananas, soaked nuts, seeds and legumes. Protein will be better absorbed with a diet higher in protein. Some pharaceuticals block absorption and create deficiency of magnesium including PPI’s, Lasix, digoxin, nitrofurantoin, anti-malaria drugs and bisphosphonates.
Symtoms and conditions associated with low levels include: muscle cramps, heart arrhythmias, tremors, headaches, acid reflux, increased risk of heart disease, hypertension, metabolic syndrome, type 2 diabetes, migraines, premenstrual tension syndrome, asthma and hypothyroidism.
I recommend magnesium gylcinate and suggest that people take one capsule at night along with eating a nutrient dense diet free of the phytates that bind magnesium. Loose stool results from too much and can be to help with occasional constipation. Taking magnesium before bed will help relax your muscles and supports good sleep.
An ancestral approach is much more than a diet. Let’s start with a handful of startling facts from the industrial world:
- 1 out of 6 children in the industrial world has a developmental delay
- an infant as young as 1 has been diagnosed and treated with an anti-psychotic medication
- depression is the number one disability in adult populations
- 40 million have an anxiety disorder
- 40 thousand suicides a year in the US alone
This is crazy! A disconnect has happened. It has led to an epidemic of chronic disease that is new. The effect on our children is most concerning. How we are living is undermining our health and particularly the ability of our brain function.
What are the solutions? I asked this many years ago as I watched a friend develop schizophrenia. Diet changes help him a lot but the medications he was on were debilitating. Unfortunately meds are given more weight than diet in conventional medicine. And yes they are crucial at certain points. Limiting them is also very important.
A new patient in my clinic today was told that stress, diet and lifestyle have no role in her fibroids. Since the medication she was given didn’t work surgery has been suggested. Unfortunately these are the only tools doctors have. Patients are left knowing that changes are needed but not knowing what to do.
Intuitively I knew what was needed when I became ill and it wasn’t medication. When I found my doctor and mentor he reminded me of what I already knew. This information is in our bones. He learned medicine in an oral tradition and so he shared his knowledge in this way. We need this kind of human connection. As a First Nations man he talked about how we are all indigenous. We all come from the same earth. Tuning into our bodies and the genetic wisdom etched in our DNA is what reconnects us. Its how we heal.
So yes, this is more than a diet. The ancestral approach includes how we relate to all aspects of being human. Most people have a nature deficit. A lack of intimacy, play and pleasure have been replaced with screen time. Light exposure is raising our stress levels while good stress like exercise, learning and new experiences are being put aside. We need these homeotic stressors to adapt.
“Cultivate strength of spirit.” Leni Wylliams
Leni Wylliams was one of my dance teachers when I was young. Do you remember the words of someone you looked up to? This phrase stayed with me. Physical training and art strengthen our spirit. Being immersed in nature helps us relax into being human. Meditation allows us to live with confidence and dignity. Anything that assists you in turning towards life, even the painful parts, is what keeps you well. Life is not about avoiding the storms, but about making sure we have the resiliency to endure them.
Noticing where we draw strength from is important. What in your early years taught you to trust life? Growing up on a farm and having a brilliant, stay-at-home mother gave me a good start. At the time infant formula was being pushed and she didn’t buy into it so I was breastfed. She taught me to honour the female body and to be skeptical of oral contraception. She’s fabulous. I pursued Functional Medicine because of how she raised me. Listening to women and children is another way we can revolutionize the medical system.
Six Essential Nutrients to Consider
Being taken seriously
The Gut-Brain Connection
Infections and other imbalances in the gut result in an inflammatory response in the brain. The inflammatory cytokine theory is well established in the scientific literature and is being embraced as the number one cause of depression.
But what about anxiety? (more…)
Smart Ways to Work and Play
We all know that sitting a lot isn’t good. You may have heard the phrase ‘sitting is the new smoking’. Its true that blood sugar and cardiovascular risks go up significantly for people who find themselves in sedentary jobs. How can we mitigate these health complications when life requires a certain amount of work at a desk?
Continual activity throughout the day is more beneficial for improving glycemic control than a single bout of structured exercise. Just meeting recommended levels of physical activity isn’t enough. By spending the rest of the day sedentary, people are still at risk for insulin resistance leading to diabetes and a disrupted gut microbiome. Here are a few tips to keep in mind:
- Avoid sitting for extended periods.
- Engage in frequent light activity breaks throughout the day.
- Set up a standing desk and alternate with sitting.
- Treadmill desks can improve focus and productivity.
- Ensure that your leisure activities do not involve screen time.
Skipping Meals, Caffeine and Stress
I love my work. When I have a lot to do I often can forget to stop and eat. This in combination with sitting at a desk increases my stress. On the weekend I have no trouble with blood sugar but this isn’t true when I’m sitting which confirms what the research is saying.
Packing enough of a lunch and starting my day with some movement helps tremendously. I go for a walk, a swim or do some resistance training. On my research days I also have a yoga mat out in my office so I can take creative breaks or do some push-ups. Putting on dance music can also inspire me when needed.
I hear this from many of my patients about how caffeine is a contributor to stress. The connection between memory loss, blood sugar dysregulation and caffeine addiction is very real for many people working in tech. The rise in young people with memory loss is not separate from the rise in diabetes.
Life is better when you move
Activity breaks can include taking a walk outside over the lunch hour, or simply getting up to walk to the water dispenser every hour. Include some social time as this helps to regulate our nervous system. Having a fun activity to look forward to does as well. This may be the most important part of your work day.
Of course activity breaks can’t be considered a replacement for other physical activity. Recent research recommends that activity breaks be used daily in the context of an overall healthy lifestyle. Aiming for 150 minutes per week of moderate to vigorous intensity exercise is essential as a baseline.
“Why do I have abdominal weight gain?” – This is a question I often get from patients.
Basically it’s an imbalance of hormones beginning with our stress hormones and involving insulin. You may have heard me talk about how cortisol is a glucocorticoid. Gluco meaning glucose or blood sugar. Cortisol meaning stress.
When we get stressed we either overeat or under-eat and this is why. Both make sense from an evolutionary standpoint. Overeating is a way of preparing for famine, and storing abdominal fat was how we did this. Under-eating prepares us to flee as in the flight response when the predator is on our tail. Keep in mind stress hormones are upstream from our sex hormones including testosterone, progesterone and estrogen. These often get out of balance when there has been prolonged stress either perceived, or internally caused by physiology. You may remember that cortisol, when functioning optimally, is an important anti-inflammatory.
One night of poor sleep can increase inflammation. The problem is that no one want to hear this because we are all not sleeping well, especially those who are parents with young children. What I notice when I miss lunch is I can’t rest at night. The combination of stress, no food, and insomnia creates a cluster of other problems. Simple changes at any one of these junctures goes a long way because all these systems are interdependent.
For example, the number one hormone imbalance affecting women and causing infertility is polycystic ovarian syndrome (PCOS). It is strongly associated with insulin resistance, inflammation, and HPA axis dysregulation (hypothalamus pituitary adrenal). Adrenal glands produce cortisol.
My doctor tells me to “Just lose some weight!”
This research suggests that high-intensity interval training (HIIT) is the most beneficial way for for women with PCOS to exercise. By improving insulin sensitivity, body composition, and endothelial function, HIIT targets several of the key components of PCOS. This can all happen in the absence of weight loss which is interesting. Often women with PCOS are told by their doctors to lose weight. I hear over and over how this is not helpful and I understand why. When a perfect storm is happening on a physiological level weight loss is not possible. A body that is stressed will not be adapted to lose weight no matter what. We also know most doctors don’t have the diet and lifestyle information to help. HIIT can be an adjunct to other interventions that support hormone balance including a stress management program and the right dietary approach. Many places offer HIIT classes, making this an accessible option.
HIIT improves insulin resistance. In this study thirty-one women were assigned to either high-intensity interval training, strength training, or a control group for 10 weeks. The HIIT group performed two weekly sessions with four minutes of exercise at 90 to 95 percent of maximum heart rate. This was separated by three-minute periods of moderate intensity exercise at 70 percent of their heart rate maximum . They also performed one weekly session of 10 bursts of maximal intensity HIIT separated by one minute of rest.
Strength Training vs Moderate Aerobic Exercise
In this study each woman chose her mode of exercise. They regularly used a treadmill, bicycled, ran, or walked outside. The strength training group performed eight weightlifting drills with progressively increasing weight on gym equipment three days per week. The control group performed 150 minutes of moderate-intensity exercise per week.
After the 10-week exercise intervention period, it was found that insulin resistance improved significantly only in the HIIT group. HIIT also increased HDL cholesterol, improved endothelial function, and decreased body fat percentage.
I wrote another article about how resistance training is the number one form of exercise to integrate into your lifestyle. The long term benefits outweigh all other forms and it is the antidote for our current culture. For anyone who hopes to age gracefully this is the ticket. However this memo has not made its way to the mainstream yet. Most medical research still focuses on aerobic exercise. This is why I was so excited to see this article pop up last month.
Lifestyle Medicine Your Liver
As it warms up its easier to get outside more and get moving. Discovering ways to stay active all year long is important for many reasons. Organ health is at the top of that list. Our livers do more for us than any other organ. Caring for it can be as easy as moving everyday. They love it when we are active for a few reasons:
- Movement gets blood flowing. Our liver stores and cleans our blood. Physical movement assists this.
- The liver is affected by stress. Exercise reduces this. Endorphins are released so we feel better & can focus.
- Digestion improves. When the liver is upset you won’t digest as well. Move and you’ll enjoy your downtime more!
- Late night eating interferes with the liver’s job of cleaning the blood. Exercise improves our daytime appetite and regulates blood sugar. Eating earlier means sleep is more restful.
- Excess hormones move through the liver as do toxins. We help this process along by moving our body.
Move to Improve Gut Health
This new research shows that regular exercise changes our gut flora independent of what we eat. Specifically, it increases levels of short-chain fatty acid-producing bacteria and SCFAs. SCFAs are bacterial metabolites that serve as fuel for epithelial or cells of the colon. They also modulate the inflammatory response, and improve insulin sensitivity.
Based on these effects, aerobic exercise may be a beneficial therapy for dysbiosis, insulin resistance, and diseases associated with chronic inflammation. Engage in aerobic exercise to optimize the composition of your gut microbiota and increase circulating levels of health-promoting SCFAs.
What about Anaerobic Exercise?
Resistance training is by far the most important kind of exercise to balance hormones, increase longevity and mobility. When we build up and break-down muscle fibre there is a cascade that occurs in the body. It will literally make you look and feel younger, stronger and more at ease with life.
Endurance exercise can raise cortisol and contribute to burn out in the long term. Weight lifting, on the other hand, triggers the human growth hormone and helps us adapt better to stress. It also makes us better fat burners while reducing our risk of insulin resistance. Other hormonal imbalances also start to level out. The good news is you need to train just a few times a week to get excellent health benefits. This time commitment is much less than most aerobic exercise regimes.
A Few Excellent Botanicals for the Liver
Chinese Thorax (bupleurum falcatum)
This herb supports both phases of liver detoxification. Its used for symptoms like depression, irritability, menstrual cramps, and headaches. More serious conditions like hepatitis C and cirrhosis also respond to schisandra partially because it also modulates the immune system. Good for those with autoimmunity.
Burdock root (arctium lappa)
Burdock is anti-inflammatory and detoxifying especially for the skin. Its used to treat skin conditions such as eczema, acne, and psoriasis. As a bitter, burdock stimulates the release of bile and digestive enzymes. It is can soothe the digestive tract and also act as a laxative in a higher dose.
Dandelion root (taraxacum officinale)
Dandelion root is similar to burdock root. It is specifically indicated to assist in resolving gallstones.
Milk Thistle (silybum marianum)
Milk thistle’s active compound is silymarin. This is protective and repairs liver tissue after exposure to environmental and food toxins. It is safe while breastfeeding, and also enhances the production of milk.
Schisandra (schisandra chinensis)
Schisandra has all 5 key flavours: sweet, salty, bitter, sour and pungent. It has been in used in China for thousands of years. Its protective and supports both of the two phases of liver detoxification so is also used in treatment of Hep C. Schisandra regulates blood glucose and cholesterol. It strengthens the immune system and calms the nervous system because of its adaptogenic properties. It’s also a cough suppressant.
Turmeric extract (curcuma longa)
Turmeric is anti-inflammatory and an anti-oxidant. It restores liver tissue, increases bile production, and has mild blood thinning properties. Ingesting it with a fat will enhance your body’s ability to absorb it. Turmeric’s active component is called curcumin. It is far more potent than the whole spice, and is widely used as a supplement for inflammatory conditions. Tumeric supports the liver, mood and cardiovascular health.
I see a patients every week with iron deficiency who don’t know it. Standard blood work isn’t enough. In this article I’ll explain why. There are several markers that help us understand why iron is low but again conventional medicine rarely tests these. Low iron can cause fatigue, anxiety, depression and insomnia just to name a few common symptoms.
“My doctor says its all in my head but I know it isn’t.”
Other symptoms of iron deficiency include palpitations, rapid heart rate, restless legs, infections, poor mental function brain fog and decreased tolerance for exercise. Athletic performance and capacity to work will be lower. This is because when iron is low it decreases oxygen availability and then myoglobin levels in muscle drops. Lactic acid builds up.
It can also be difficult to maintain proper body temperature. This can lead people to believe they have a thyroid problem. Brittle nails, sores around the mouth and loss of taste can occur. Iron deficiency happens prior to clinical anemia which is the final stage. Eight percent of premenopausal women are iron deficient but I’m guessing this number is more given the number of women I see who are undiagnosed. A quarter of those are anemic.
In clinic I listen carefully to my patients symptoms and teach them how to read their own signs. Iron deficiency is often visible in a person’s complexion, cuticles or tongue depending on what else is going on. Postural hypotension or feeling dizzy upon standing can be a tell-tale symptom.
Functional Medicine Solutions
That being said, I always want to see comprehensive lab work. This is the best way to know what is actually going on. Recently I suspected a patient to be low in iron but her lab work showed two parasitic infections with healthy iron stores. As we treated the gut infections, her complexion and energy changed rapidly.
Another patient had a chief complaint of anxiety and fatigue. This had been going on for 4 years, since the birth of her second child. Her ferritin was the lowest I’ve ever seen. She is in the final stage of iron deficiency and clinically anemic.
Why is ferritin not monitored more closely, especially in mothers?
In the final trimester before my son was born I was also anemic. My symptoms were so uncomfortable I would cry at night before bed knowing I faced another night without sleep and in pain. Restless legs and insomnia can be incredibly painful.
This could have been caught earlier and prevented. I was seeing a primary care provieder weekly so why was this missed? I trusted that my bloodwork was being monitored properly. My diet was excellent but at this stage more supplementation was needed. Once I began I felt better within a few days.
3 Stages of Iron Deficiency
There are three stages of iron deficiency. Iron stores are measured in ferritin. When ferritin is between 10 to 15 ng/mL there is deficiency but not exhaustion. During this stage, there may not be any symptoms that conventional medicine would recognize.
The difference in Functional Medicine is that we flag anything under 30 ng/mL. In this way we prevent stage two when iron stores become exhausted and ferritin drops below 10 ng/mL.
The final stage is when there is no iron in bone marrow stores. Red blood cell production and hemoglobin drop. Anemia is more obvious, and symptoms can become severe. Unfortunately, most clinicians in primary care settings don’t test iron or ferritin. They only look at hemoglobin, red blood cells, and MCV levels. This is why a lot of patients in stage one and stage two are being missed.
In fact, its fairly common that people are iron deficient for decades without knowing it. Iron deficiency affects 1.62 billion people worldwide. That’s 25% of our global population.
Functional medicine understands there is a connection between depression, anxiety, fatigue, insomnia and low iron. Observing a patient and feeling the pulse is often enough to suspect iron deficiency. This is part of my basic training.
We also know how to investigate the underlying cause. Is it simply lack of nutrient intake? How can we increase iron rich foods into the diet? What other lifestyle factors are contributing? Is there gut dysbiosis leading to malabsorption? Are there any infections that need to be cleared? Is the body shunting iron to protect from something more serious? Is heat masking some of the signs we check?
Ferritin is an acute-phase reactant that increases the inflammatory response much like C-reactive protein. This can be confusing and its why a comprehensive panel is important to have. This is especially when chronic pain or more complex conditions are present. So a patient can be iron deficient but their inflammation is raising ferritin. Seeing a normal value in the face of clinical anemia does happen. Functional testing catches this by looking deeper.
In many places people can order their own bloodwork but the interpretation is important. I ask patients to get copies of their labs so we can look over them together from a Functional perspective.
The spirit of ‘DIY’ or ‘do it yourself’ is a quality I admire in patients. I love working with people who are engaged in their health and want to understand what is at the root of what they are experiencing.