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.
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.
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.
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!
Many people have high total cortisol when experiencing what has commonly been called adrenal fatigue.
The term HPA axis (hypothalamus, pituitary, adrenal) dysfunction or maladaptation is a more accurate description due to the complex interdependence of glands, cells and the brain. Furthermore research and statistics show it is usually not a case of low output by the adrenals at all.
Why is this so important?
Cortisol has an impact on inflammatory response, thyroid function, glucose levels and the list goes on. Studies show that early life events can set up a life long pattern that affects the HPA Axis and cortisol production. This maladaptation also can occur when there is decreased output by the pituitary gland. Receptor sensitivity is yet another way in which cortisol signalling can get disrupted. Lastly reduced bioavailability can happen at the tissue level by way of the binding globulin in the blood, conversion of cortisol to cortisone or cellular transcription. The point is that the HPA axis is much more nuanced than the concept of adrenal fatigue lets on.
Research and Testing
Much of the research on cortisol has been done based on saliva tests which only show free cortisol. Free cortisol levels can be very different, even opposite from total cortiso. Improper treatment can easily result. Looking more closely can lead to early detection of thyroid disease, diabetes, leptin resistance and even certain cancers.
Pregnenolone and DHEA
Chronic stress leads to lowered DHEA, an important steroid hormone. There is a common misconception that this is because cortisol is stealing from the precursor pregnenolone. Physiologically there is no evidence of this. Both pregnalone and DHEA are produced in mitochondria but in different tissues. Cortisol is actually regulated outside of the adrenals. Also the amount of cortisol produced is significantly more than DHEA. Location and function both debunk the myth that stress hormones ‘steal’ from sex hormones. This is news to me as and not commonly understood in the medical community. One way that this new theory can be proven is by looking at how supplementing pregnenolone will have no effect on DHEA.
Three ways of looking at Cortisol:
1. Is total cortisol low or high? Looking into other factors that are present and that will be influenced by this. Leptin and insulin resistance can be involved.
2. Is there a disrupted diurnal rhythm? It is important testing is done properly because the morning cortisol curve happens in the first hour of waking. Some tests are not specific enough by leaving a window of two hours. This creates misleading results.
3. Is there impaired cortisol metabolism? When there is more cortisone present this could indicate thyroid involvement.
Evolutionary medicine reminds us that being human means that we are really good at adapting to our environment. This includes learning to ride the wave of positive stressors that move us forward in our lives. Noticing when we dip into too much stress and backing off is a skill that requires constant refinement. I teach a course on the HPA axis so please take advantage of this information. Stress is by far the number one factor influencing health today. The HPA axis is what allows us to regulate stress appropriately. We all have times when stress becomes too much. Knowing which tools to engage and how to recover is key to resiliency.
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.
“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.
“But I don’t feel stressed!” I hear this a lot from patients when their body is telling me otherwise either through lab work, radial pulse or other clinical factors. Explaining that there are many physiological causes of stress often is helpful. Financial or relationship stress is just part of the picture when it comes to cortisol.
1. Gut Health
For example, a gut infection is a major stressor to the body and when we resolve this a lot of energy is freed up. The next step is to rebalance the HPA Axis after a year of living with a parasite.
Dietary factors like consuming pro-inflammatory omega 6’s or restricting calories, nutrients and protein can raise cortisol. Increasing certain nutrients like magnesium does the opposite. Similarly, intake of the vitamin A in its bioavailable form regulates the HPA axis.
3. Lifestyle Factors
Commuting and posture are some of the factors that can raise your stress response. Running too much is another common one along with caffeine. Frequent marijuana use affects both cortisol and prolactin.
4. Sleep, Sleep, Sleep
- Reduced Sleep – A loss of sleep for just one night leads to higher cortisol levels the next evening.
- Poor quality sleep – Poor quality sleep activates the stress response.
- Staying up late – Cortisol goes up when we are awake during normal sleep times.
5. Other Hormones
- Thyroid: “The effect of thyroid hormones on the adrenal axis was not secondary to changes in the level of circulating corticosteroids.”
- Estrogen: Estradiol regulates the CRH (corticotropin releasing hormone) which is “best known for its role in activation of the mammalian stress response.”
- Leptin: This study looks at CRH in relation to adiposity and leptin. Furthermore, “the modulatory role of glucocorticoids could be altered in obesity.”
I was working with a patient the other day and a noise I didn’t notice outside was causing her to feel unsettled. It reminded me of how we all respond differently to stressors. Noise can be a significant one for many people.
7. Toxic exposure
This study looks specifically at heavy metals following an oil spill and the affect on the cortisol. This links back to how there can be physiological stressors that affect our endocrine system and stress response past its limit without us knowing.
I have a couple questionnaires I use to help assess both the stress we know about and the stress we don’t know about. Applying more than one method to figure out what is going on at the root is key to successful treatment.
Sleep is a big deal
Especially when two-thirds of adults don’t get the minimum required to meet basic physiological requirements. In fact, less than 7 hours per night can shorten lifespan significantly. Inflammation increases when we miss a night of good sleep. Other sleep research shows up to 29% lower sperm count in men who sleep poorly vs those who regularly get enough rest. Athletes performance drops 10-30%.
Why Parents are Crazy
As a parent of a young child I can vouch for how difficult it can be to get enough sleep. When your infant finally starts sleeping through the night your cortisol and melatonin production is so confused insomnia becomes a thing. Catching up is not actually possible especially as a single parent. Through trial and error I’ve discovered the ridiculous reality of living in a state of constant sleep deprivation. Caffeine stops working. You think everyone hates you and life is out to get you. This is the real reason parents are crazy a lot of the time! Anyone doing shift work or work late at night can be included in those who suffer the most.
Adults really do require 7-9 hours of sleep
- Newborns (0-3 months): 14-17 hrs
- Infants (4-11 months): 12-15 hrs
- Toddlers (1-2 years): 11-14 hr
- Preschoolers (3-5): 10-13 hours
- Elementary school age (6-13): 9-11 hrs
- Teens (14-17): 8-10 hrs
- Adults (18-64): 7-9 hrs
- Older adults (65+): 7-8 hrs
Sleep Hygiene: Focus on What to Do
1. Be consistent with your sleep schedule
Set a realistic bedtime. Train your brain to develop a regular circadian rhythm by going to bed at the same time most of the time.
2. Establish a bedtime routine
This can include a warm but not hot bath or shower. Journaling in a book, meditating, stretching gently or reading are all appropriate activities. Dim your lights and listen to relaxing music to unwind from your day.
3. Your bedroom needs to be quiet, cool and comfortable
Sleep is better when your room is cool rather than warm. You can keep a door or window cracked for circulation and to avoid stuffiness. Keep all lights off, including night lights, and lights from electronic devices. Sleep on a comfortable mattress. Turn off the extraneous noise. A white noise machine is fine. If your pets wake you up, keep them in another part of the house.
4. Turn off electronic devices in the evening
This allows for more connection, better digestion and a general parasympathetic or relaxed environment where you can reconnect and let go of the day. Electronic devices emit blue light which stimulates the brain. Cortisol and melatonin get confused and these hormones play a huge role in insomnia.
5. Exercise during the day
Exercise promotes continuous sleep. Its also great stress relief. Avoid intense exercise in the evening as this can interfere with deep sleep. Stress management is crucial to sleeping well.
6. Eat enough during the day
Blood sugar dysregulation causes spikes in cortisol and makes it more difficult to rest later on. In fact, having enough carbohydrates during your evening meal has been shown to support better sleep. Choose root veggies and unprocessed, gluten free options. Often times food reactions cause an internal stress response that we aren’t aware of.
7. Use caffeine with caution
We know that 50% of people don’t metabolize caffeine. This means it stays in the body for much longer and therefore amount matters. Cut down on caffeine and avoid it after noon entirely. This includes chocolate. Uncooked cacoa is easier on you. Matcha has a longer burn than coffee and many health benefits. Find alternatives like peppermint or dandelion tea. Golden tea is a delicious alternative as well. I know its not easy to change this habit especially when you are sleep deprived but it can be done. It may be the most important change you can make.
8. Get out of bed if you aren’t sleeping
Do a guided meditation or find another relaxing activity until you feel sleepy. This is part of training your body that bed is for sleep. Have a comfortable chair in your room and make a cup of sleepy tea. Simple rituals like this work.
9. Avoid large meals later at night
A small protein rich snack before bed can help with night hunger but large meals late at night create a burden for the liver. Finish meals a few hours before bedtime. The liver kicks into gear at 11pm so being asleep by then is ideal.
10. Reduce fluids before bedtime
I’m training my son to drink more during the day so he won’t need pull-ups at night. Just pretend you are 5 years old! My mom has sage advice for parents. Ask yourself if getting your kid up to pee in the night is more of a priority than your sleep.
11. Nap or no nap?
I teach meditation to my patients. I find if someone calms their nervous system for 5-20min during the afternoon it can support a deeper sleep later. People may or may not nap as part of the practice. I don’t see any problem with this however long naps may inhibit sleep later on.
12. Avoid these because we know they interfere with sleep
Alcohol raises our body temperature and requires that the liver clear it. Ever wake up between 1am and 3am after having a drink? Cigarettes and some medications also make sleep more elusive.
13. Black out your room, hide the clock and wake naturally if possible
This is basic but an incredibly important game-changer. Buy black-out curtains. Don’t use night-lights except in the bathroom. Turn your digital clock away from your bed while you sleep. Don’t wake to an alarm as much as possible.
14. Creat an extended sleep schedule
For anyone who has suffered from sleep problems an extended sleep schedule can support getting more sleep. Research shows that allowing a longer period of time in bed does increase the amount of sleep people get.
15. Only use your bedroom for sleep and sex
Train your body to expect only rest and pleasure in this space by creating this. Bedrooms ought to be a place of sanctuary from the world.
An Important Ally: Your Morning Awakening Response
Its best to get up when you first wake up. By exposing your eyes to bright full-spectrum light you are stimulating the cortisol awakening response (CAR). This accounts for half or more of our daily cortisol secretion. Remember the cortisol is anti-inflammatory and an important hormone that works synergistically with melatonin. Doing any kind of movement first thing supports morning cortisol. This could be carrying a child, going upstairs, walking your dog or going for a run. Daylight stimulates cortisol release, and darkness stimulates melatonin.
Blue light boxes improve sleep and depression simply by stimulating this early morning response during the winter for those who have to get up before dawn or who can’t go outside first thing in the morning. Beginning to notice this response and working with it can help repair your sleep-wake cycle if its been disrupted.
HPA-D is not Adrenal Fatigue
I’ve written extensively on this topic and the reason I bring it up is because you’ll see a bunch of recommended supplements for adrenal fatigue. Insomnia is a symptom of a much more complex disorder called HPA-D. (hypothalamus pituitary adrenal dysregulation). By testing cortisol thoroughly we can see that pattern of dysfunction and supplement accordingly. Giving adaptogens to everyone is not the answer. Nervine herbs on the other hand are safe and interestingly ashwaghandha is both an adaptogen and a nervine. Some of my other favourites include skullcap, passion flower and camomile. Anything that makes you feel groggy upon awakening is inhibiting the cortisol awakening response so avoid this. Be careful using licorice as this potent herb increases cortisol. L-theanine is an amino acid that is safe to use for anyone.
Certain patterns of HPA-D require increasing cortisol at certain times of day or decreasing it. Often there’s an issue with hormone clearance pointing to excess inflammation, inhibited liver function or thyroid issues. The testing I do looks at both free circulating cortisol and total metabolized cortisol. These are not always the same. In many cases only free cortisol is tested resulting in treatment that is not neccessarily exact.
CBD is both anti-inflammatory and promotes sleep. This is why standardized extracts need to made available. For those experiencing recalitrant pain CBD can bring down the pain where other pain medications won’t. A patient of mine with insomnia and endometreosis began using CBD. Once her pain came down she was able to sleep and could start making decisions about her health. She had been unable to work for many months. I’ve seen this with backpain as well.
Thorough blood work including iron, blood sugar, thyroid and inflammatory markers is required to see a full picture and get a sense of what is going on. A gut work-up is also important. Neurotransmitters play a role in HPA-D through the gut-brain axis. Healing the gut so its producing neurotransmitters again and absorbing nutrients is the key in some patients. Supplementing with precursors like 5HTP are helpful in these patterns during treatment. You may be noticing that it can take time to get to the root cause of insomnia. Often we are also addressing trauma during treatment. When we find out what works and are sleeping more, people report feeling that they got their life back.
First things first: Birth control is NOT the only solution for heavy cycles! In fact, when it comes right down to it, birth control is more of a band-aid than a solution. Are you someone who wants to understand what actually going on? Underneath there are several possible imbalances at play and we always want to know which it is.
Technically the medical term used to describe heavy cycles is menorrhagia. It’s not a disease but it sure sounds like one. The problem is that it can be very depleting and generally difficult to live with each month. A cycle that lasts more than 7 days or a blood loss around 80 ml is considered heavy. A tampon or pad can hold about 5 ml. If you use a Diva cup you can calculate this accordingly. In comparison a normal cycle is 35 ml or less per month and lasts between 3-7 days.
Every woman is different so determining your own normal is key. Track your cycle to see how many days and ml yours is. If you are soaking around 16 pads or tampons in one cycle it’s definitely heavy.
A Few More Guidelines
Take note if it comes in less than 25 days or more than 35 days
Changing your pad/tampon or emptying your diva cup every 2 hours
Your ability to work, exercise or engage in other activities due to fear of leakage
Having to get up in the night to change
A diagnosis of anemia
Feeling fatigued, short of breath or depressed
What’s Happening to Cause this?
Heavy cycles happen when estrogen is higher in relation to progesterone. This commonly occurs at the beginning or ending of reproductive age. Teens and peri-menopausal women are affected the most. This is because the part of the endocrine system that communicates with the ovaries is either revving up or slowing down. It’s the hypothalamus that triggers ovulation and progesterone production follows ovulation.
Keep in mind that estrogen has many positive effects in the body. It’s anti-inflammatory, and supports the immune system. Its also anti-oxidant and regulates enzymes, gene expression and metabolic function. Estrogen is critical to brain development and decreases the incidence of strokes. Women may live longer than men due to estrogen. It is also protective. For example estrogens support gut health. It also reduces the incidence of prostate and breast cancer.
Related Patterns of Hormone Imbalance
- Heavy clots indicate more estrogen in relation to progesterone. Estrogen causes proliferation so more uterine lining, swollen breasts, weight gain, skin issues, PMS and headaches can involve a pattern called Estrogen Dominance.
- Poor thyroid function is another major factor. Subclinical hypothyroid is more common than we think and is poorly diagnosed. It causes poor clearance of estrogen from the body as well as limits the amount of progesterone produced.
- Fibroids are also caused by a e-dominant pattern. One type of fibroids can actually cause heavy bleeding but this is not common.
- Post pregnancy including miscarriage, abortion or full-term birth. Blood loss of this variety is due to deficiency.
- Birth control like the copper IUD and depo provera shot can cause heavy cycles.
- A bleeding disorder known as coagulopathy affects 20% of teenagers with heavy cycles.
- Inflammatory disease of the pelvis, liver or kidney
Steps You Can Take
Rule out anything serious by getting your routine pelvic exam. Request an ultrasound to check for fibroids and to see the thickness of your endometrial lining.
Blood work needs to include a full thyroid panel and a complete blood count to check for anemia. Regular STI checks and pap smears are also important.
Birth control is commonly prescribed for heavy cycles especially the oral birth control pill and the Mirena IUD. D & C ‘s are used to remove uterine lining temporarily or an endometrial ablation or hysterectomy are permanent interventions.
A Functional Medicine Approach
I focus on nutrient intake first. Vitamin A from cod liver oil has been shown to reduce heavy cycles significantly. B vitamins can reduce excess estrogens by supporting liver function and therefore estrogen metabolism. With b vitamins quality and bioavailability is important. I use Seeking Health because of this. Buffered Vitamin C at doses around 3000mg per day has been shown to reduce heavy bleeding and improve the absorption of iron. There is a cycle of blood loss, anemia and fatigue that requires some lifestyle adaptations as well as diet changes.
Real rest and meditation help cortisol regulation. Cortisol is upstream of all sex hormones and usually plays a significant role in hormone imbalance. I do thorough testing to see what is actually going on prior to treatment that includes free and total cortisol, its daily rhythm and all of the sex hormones plus their metabolites.
Every Woman is Unique
No two bodies are the same so getting to know yours is the most powerful step in this journey. We are always changing so this is a process we do again and again. Send me your questions. This post came out of multiple patients asking what caused their cycles to change and what could be done other than birth control.
What is Mindfulness really?
What strikes me as I emerge from another week of meditation retreat is the fundamental shift I witnessed in both myself and the others who committed to the journey. This transformation is unique. I see people physically change and become more themselves. What is happening and is this mindfulness?
Relaxation and Stability
Mindfulness is a word that is being used a lot these days. Usually it is referring to what occurs in the first step of meditation. This step brings about relaxation and creates stability. It involves focusing on one thing like the breath entering and exiting the body. When we are calm we are able to witness our thoughts and begin to see how much power we give them. This is an important first step. A lot gets lost if we stop here.
Meditation is an effective tool for lowering cortisol. The amount of medical research on mindfulness and meditation is impressive. Both topics receive nearly 5000 hits each in PubMed. Nearly all is focused on step one of meditation. So what’s step two?
Once a certain amount of stability has been established our lives begin to show up full force. Its as though the volume gets turned up and our capacity to meet it grows. I like to think about this in terms of human development. Each stage creates the foundation for the next. As we grow we reach a point that is beyond our reach and get destabilized. With meditation we have tools to work with this without shutting it down and thereby allowing growth to continue.
People change quickly when they meditate in a way that is not just about relaxation and certainly the opposite of suppressing life. Meditation provokes life to come at us full tilt. It increases our capacity to include everything especially those parts that we previously were not able to look at.
Ego is a cocoon. Our DNA is wired so that we can grow beyond this self-centred way of being. The caterpillar becomes the butterfly because this is what is meant to happen. As humans we need to train because we are easily distracted from what wants to emerge in us.
Learning to relax into the intensity of life is the real point of meditation. What comes through as we practice is an innate intelligence, a warmth and generosity. These qualities are what naturally arise because they are who we really are. It’s a natural part of human development for them to express. It brings about joy and happiness.
Meditation retreat is by far the most important thing on my to-do list. I attribute the major growth spurts of my life to meditation. Its not because these were on an agenda I made up. Life was able to come through more strongly because meditation gives life room to happen. Without practice our minds tend to manipulate, take over and even destroy the beauty that just is who we are.
Due to the amount of neural tissue found in the digestive system many now refer to the gut as the second brain. Intuition, gut feeling and butterflies in the stomach all describe this.
Neurons don’t divide or regenerate. We begin losing them as soon as we are born. Slowing down this process is our goal because we can’t stop it. Brain plasticity describes how neurons can communicate and pass along information before its lost.
Lowered Brain Function Causing Digestive Distress
Most of the brain’s output occurs through the lower part of the brain stem, the pontomedullary. The vague nerve is also in this area and is responsible for innervating the whole digestive tract. When there is decreased activity in this area, there is also lower production of hydrochloric acid, pancreatic enzymes and bile. This lead to poor gut function overall including motility issues leading to constipation or diarrhea. Lower blood flow in the GI tract means weakened immune function and increases the risk of infection by pathogens and bacterial overgrowth.
How does IBS lead to Leaky Brain?
What we are talking about here is irritable bowel syndrome or leaky gut. Chronic low grade infection increases inflammatory cytokines affecting the brain’s microglial cells. Do you see a vicious cycle? The brain’s microglia can’t turn down the inflammation the way other cells in the body can. Leaky brain contributes to leaky gut and vice versa. Around we go.
Gut Motility, Immunity and Mood
Studies show constipation and depression are linked. The enteric nervous system in the gut is made of autonomic nervous tissue, intestinal microglia and lymphatic tissue. As mentioned earlier the vagal nerve stimulates peristalsis. Slower motility occurs when communication in impeded. For those suffering from IBS with chronic diarrhea report recurrent anxiety.
The Journal of Clinical Psychiatry made the connection in 2001. They found 50-90% of IBS patients reported psychiatric disorders including panic, anxiety, social phobia, PTSD and major depressive disorder. The immune cytokine model of depression has a lot of support. Basically it describes how inflammation is the root cause of most depression.
Brain Health on the Decline
IBS is the second cause of missed work after the common cold. Depression is on the rise 20% each year. Anxiety in young people is on the rise. Leaky brain leads to cognitive decline manifesting as memory problems, and not just in the elderly. More and more young people are being affected.
The brain requires oxygen and glucose. Alzheimer’s, Parkinson’s and other neurological conditions are being called diabetes of the brain. Chronic stress literally atrophies the brain. The link between cortisol and blood sugar confirms this. Blood flow to the brain means oxygen and glucose deliverability. In a stressed state this is inhibited.
A disrupted gut microbiome increases cortisol, inflammation, pain and brain-fog. It reduces your ability to feel pleasure, leads to depression and causes memory problems.
Functional Medicine Looks Deeper
Irritable bowel syndrome is not a real diagnosis. Testing the gut microbiome through SIBO and H.Pylori breath tests, stool tests and blood work give us an idea of what’s actually going on. Anticonvulsant drugs or antidepressants will never treat the underlying infection but conventional medicine isn’t getting it yet. In fact patients hear that it’s all in their head which is true in another sense.
Healthy Gut equals Happy Neurotransmitters
80% of Serotonin is produced in a healthy gut. Those with low serotonin experience cravings, impulsive behaviour and pain at four times the strength of those with normal levels.
SSRI’s are some of the most common antidepressants prescribed. They affect cortisol levels without looking at cortisol levels which is likely why they are only effective in some people.
Dopamine is what we feel when we eat a good meal that is satiating and take the time to enjoy it. This has been known as the root of health in many cultures for centuries.
Acupuncture and movement move blood, help inflammation and feel good. Enjoying food, expressing joy, and training your instincts are all ways to tend to brain health.
A growing body of evidence supports treating the gut when anxiety or depression.https://www.ncbi.nlm.nih.gov/pubmed/25882912
Probiotics have been shown to decrease anxiety and help emotional processing. https://www.ncbi.nlm.nih.gov/pubmed/19338686
Decreased stress is found in those who feed the good bacteria through fermented foods and prebiotics. After 3 weeks cortisol levels were lower. Anxiety was lower.http://www.sciencedirect.com/science/article/pii/S0889159110005295