Hippocrates once said “all disease begins in the gut” and, even though as a naturopathic doctor I have internalized this to the utmost degree, I still forget from time to time.
So, when I was having an increase in histamine symptoms (itchy eyes, runny nose, inflammation, congestion, itchy skin, immune issues), dental issues (bad breath, swollen tongue, increase in plaque and bleeding gums), gut issues (bloating, constipation, sugar cravings) and mood issues (PMS, low motivation, fatigue, brain fog, lower mood, fatigue) as well as other random symptoms such as decreased stamina, cold intolerance and otherwise just feeling “blah”, it took me an embarrassingly long amount of time to connect all these symptoms to being caused by a gut microbial imbalance.
Our gut bacteria outnumber the cells of our body by 10 to 1. These little guys influence our digestion, mood and immune system. They affect our brain function. A recent study in Frontiers in Psychiatry (Nguyen et al., 2021) even connects the diversity of our microbiome with loneliness and wisdom.
Interestingly, loneliness and wisdom have been found to occur in inverse relationship with one another. In other words, the wiser you are, the less lonely. It’s important to note here that loneliness is not the same thing with isolation or being alone–sometimes alone time is necessary for the type of self-reflection that imbues wisdom.
Wisdom is a complex phenomenon that is made up of traits like compassion towards self and others, self-awareness and reflective thinking and deep knowledge about the world and the meaning of life events. From this description we can imagine how protective wisdom might be against mental illness and how it may lend to mental, emotional and physical wellness.
The wiser you are, the better able you may be to make meaning of and persevere through life’s difficulties and connect with others. Wisdom lends itself to an overarching view of self, life and humanity that may allow us to respond to life’s challenges with resilience.
Perhaps a wise person who is alone may also be aware that they are also part of an interconnected ecosystem that includes self and others. They may be aware of their place within the fabric of existence. In this way, they are never really alone.
Further, the meaning they may derive from states of aloneness may protect them against the feelings of social isolation that are characterized by loneliness. Imagine a wise figure. Perhaps they are alone, but would you say they are lonely?
Our gut is sometimes called “the second brain” and forms part of the microbiota-gut-brain axis in which our gut bugs influence the health of our intestines and thus influence our nervous system, immune system and brain (Cryan & Dinan, 2012). Our gut microbiome can even influence personality traits such as agreeableness, openness and even neuroticisim (Kim et al,m 2018). Interestingly, unhealthy gut bacteria like proteobacteria (associated with SIBO) were associated with low conscientiousness and high neuroticisim (Kim et al., 2018).
Does this mean that diet can influence our tendency to hand things in on time and keep our rooms clean? hmm…
It’s interesting to think that we all have a sense of our personalities and who we are as people. We imagine ourselves to be introverted or extraverted, artistic, creative, liberal or conversative. We might consider ourselves kind or trustworthy, blunt or afraid of conflict. We may identify as people who make healthy eating choices and enjoy exercising or who have sweet tooths (teeth?).
Amidst this self-discovery, the exploration of mbti personalities seamlessly weaves into the fabric of our understanding, adding another layer to the rich and diverse mosaic of human characteristics. Delving into the realm of MBTI personalities opens a door to a nuanced comprehension of ourselves and those around us. The Myers-Briggs Type Indicator, with its sixteen distinctive personality types, provides a structured framework to decipher the intricacies of our individuality. This insightful exploration not only enhances self-awareness but also fosters a greater appreciation for the diverse ways in which personalities interlace and contribute to the vibrant mosaic of the human experience.
But what if we are less in control of our behaviour and even personality than we think? The truth is the bacteria in our gut produce chemicals that influence our behaviour: what we crave and eat and even how we act and think. In turn, this influences the composition of our gut.
Prosocial behaviour is associated with more gut biodiversity, and people who are more social tend to have microbiomes that are more diverse (Johnson, 2020). This makes sense if you think about it. If you’re exposed to a variety of people and environments, you’re likely exposed to a variety of bacteria and viruses as well. These microbes are ingested and incorporate themselves into our bodies.
When we visit different environments we consume foods in those environments. When we socialize with various people, we often share food. This increase in food diversity will also influence gut microbial diversity.
As I write this, I wonder about the effects of social isolation of the past 2-3 years. During Covid, our social circles decreased. Currently we are seeing a rise in infections: colds, flus and other illnesses (RSV, hand food and mouth disease, pink eye and so on), particularly in children. I wonder if this lack of socialization has affected our microbiomes and thus our individual and collective immunity. A hypothesis worth exploring, perhaps…
Further, the hypersanitization may also have contributed to shifting the health of our microbiome. It still remains to be seen.
We know that a lack of gut diversity can affect our immune system and is associated with obesity, inflammatory bowel disease and major depressive disorder (Jiang et al., 2015). In mice, the health of the microbiome is essential for their social development (Desbonnet et al., 2014)!
So, what does this mean practically and clinically?
Throughout my studies and years practicing as a naturopathic doctor, a clear-cut path towards improving microbiobial health of the gut is still unclear to me. We know that increasing the amounts of plants and fibre in the diet can support gut diversity. But we also know that fibre can cause constipation and bloating in some individuals and aggravate their digestion and that there are many indiviudals who at least anecdotally seem to thrive on diets that reduce fibre, such as the Carnivore Diet or an Animal-Based Diet (which, by the way, I’m not necessarily recommending here).
For me, gut health has largely been about paying attention and noticing when things have gone astray and then (and this part is harder than it sounds) correctly attributing what has gone astray to a shift in the health of my microbiome.
This has been years in the making. Our gut produces pain in response to stretch (i.e.: from gases in the intestines). We don’t necessarily feel pain in our gut if we’re experiencing intestinal permeabilty (leaky gut) or dysbiosis. This means that there is not a lot of feedback from our body that tells us about the state of our gut. Our gut doesn’t always hurt if it’s inflamed or imbalanced in the way your shoulder might. We need to look for other signs and symptoms that alert us to the state of health of our guts.
For me symptoms of gut imbalance often correlate with symptoms of candida overgrowth (something I, like many, am prone to). Candida, a species of yeast, tends to flourish in my body if my overall gut ecosystem is failing to keep it in check. Sometimes this can occur due to stress, and increase of sugar in my diet and other factors.
Symptoms I notice are:
– A change in oral health: more plaque on my teeth, bad breath, tongue coating, bleeding gums, and so on. – A change in mood and mental functioning: symptoms of depression or dysthymia such as apathy, low motivation and lethargy. Brain fog, difficulty concentration, poorer executive function (particularly initiating tasks or increased procrastination). – A change in digestion: persistent bloating, more constipation (involving not just frequency but stool quality. They might be stickier or harder to pass). – A change in immune function: more mucus production and congestion. Allergy symptoms. Trouble breathing,. – A change in energy and metabolism: reduced stamina despite exercising. Weight gain. Water retention. Fatigue. Feeling cold. – A change in cravings: wanting more sugar, binge-eating and overeating. Obsessing about food. Cravings for sugar after meals. Feeling “hangry” more often. Difficulty feeling full. Mental hunger (hunger despite feeling the presence of food in the stomach). – A change in hormonal health: changes to libido, vaginal flora. heavier periods, irregular periods. Increased PMS.
And so on. If this seems like virtually every system in the body is affected, I remind us all that Hippocrates said it first (or at least most famously): “all disease begins in the gut”.
What is the solution? Like recognizing the cause, the solution is often subtle. For me it was focusing attention to gut health and slowly steering the ship back to healthier habits.
The problem with dysbiosis is it often maintains itself. Low energy leads to less socialization and less motivation to cook healthy meals. More cravings lends to poorer food choices. These are just some examples of what you can imagine to be a variety of maintenance processes that are caused by and serve to perpetuate dysbiosis.
Therefore for me, the solution is not to make drastic changes but to identify and shift these patterns in support my microbiome.
1) I took sugar out of my diet. For me this involved shifting away from my 3 fruits a day to starchy vegetables (like squashes, etc.) I thrive on a Paleo-like diet (a whole foods diet that emphasizes fruit, vegetables and animal protein) and subtly shifted back to one.
I didn’t completely eliminate fruit sugar as I don’t believe there is a need. However, I recognized that I was likely overconsuming sweet foods as a response to dysbiosis and this wasn’t serving me.
2) I got on a comprehensive and broad-spectrum probiotic. I often tell my patients that probiotic prescribing is more of an art than a science and involves some trial-and-error. I typically look for one that has 8+ strains and a high CFU (colony forming unit) count. I took Colon Care 90 Billion by New Roots. This is certainly not the only good one and it might not be the right one for you, but it’s one I selected for myself based on a variety of factors I was looking for that supported my individualized assessment of my gut health.
For me probiotics can be highly effective, but they take time to work. They often can aggravate symptoms initially. The first symptoms I notice that indicate improvement are an improvement in oral health.
3) I supported my digestion in general. This involves for me supporting the liver and gallbladder, which influence gut motility, bile flow (which helps keep the small bowel free of bacteria) and fat digestion (which prevents growth of more pathogenic microbes and stabilizes blood sugar).
4) I consumed anti-candida, antimicrobial foods that work for me (again, this is after much trial and error). Raw garlic, coconut oil, apple cider vinegar and oregano oil. I also started on a candida herbal supplement that incorporates cloves, black walnut and other anti-microbial herbs that selectively kill pathogenic microbes while typically preserving healthy ones.
5) I supported my microbiome by integrated back into nature: getting outside more, reducing chemical exposure (soaps, fragrances, plastics, pesticides, etc.) and getting more sunlight. Camping outside in the cold, sleeping on the ground and brushing my teeth in a natural brook in Nova Scotia also likely contributed to shifting the diversity of my microbiome through encouraging the exchange of my microbes with those of the earth.
6) I supported the body’s stress response by getting more sleep. When I’m awake I try to get as much sun exposure as possible. Our microbiome and our Circadian Rhythms are intricately connected. Supporting one can support the health of the other (Bishehsari et al., 2020). Regarding this, I wonder if Daylight Savings Time made some of us more susceptible for microbial imbalances in our guts? Hm…
Getting off track is a holistic multi-facted process. We all know our own vices and susceptibilities if we look deep enough.
Therefore, getting on track is an equally holisitic and comprehensive process. It involves wisdom (which, conveniently, increases as your microbial health increases). I can help you figure things out if you’re new to this process.
After implementing these strategies and paying a bit more attention for a few weeks I slowly and surely notice myself feeling more like myself. Getting back on track: more energy, better mood, better cold tolerance (this is a big one!) and better gut health. My appetite has regulated incredibly. I feel like a different person. But the shifts have been slow and sometimes subtle (as is often the case with shifting an entire ecosystem) and paying attention to them is a very important part of the process.
Wisdom.
It’s not just diet. It’s not just supplements. It involves looking at the relevant factors and gently moving back in the right direction with patience and persistence. Maybe your main point of focus needs to be eating regular meals and meal planning. Maybe you need more strength-training. Maybe you need to start socializing more, getting out in public (knitting circle, anyone? I’ve been hearing so much about knitting circles these days, haha–a sign from the universe?).
Maybe it’s time to look at emotional eating with a pair of fresh eyes (perhaps through the lens of your microbiota). Maybe you need to take a walk outside today. Everyday. Breathe fresh air. Take a probiotic.
Contact me if you need support! I’m here for you.
What else do you do for your gut microbiome?
References:
Bishehsari, F., Voigt, R. M., & Keshavarzian, A. (2020). Circadian rhythms and the gut microbiota: From the metabolic syndrome to cancer. Nature Reviews Endocrinology, 16(12), 731–739. https://doi.org/10.1038/s41574-020-00427-4
Cryan, J. F., & Dinan, T. G. (2012). Mind-altering microorganisms: the impact of the gut microbiota on brain and behaviour. Nature reviews. Neuroscience, 13(10), 701–712. https://doi.org/10.1038/nrn3346
Desbonnet, L., Clarke, G., Shanahan, F., Dinan, T. G., & Cryan, J. F. (2014). Microbiota is essential for social development in the mouse. Molecular psychiatry, 19(2), 146–148. https://doi.org/10.1038/mp.2013.65
Jiang, H., Ling, Z., Zhang, Y., Mao, H., Ma, Z., Yin, Y., Wang, W., Tang, W., Tan, Z., Shi, J., Li, L., & Ruan, B. (2015). Altered fecal microbiota composition in patients with major depressive disorder. Brain, behavior, and immunity, 48, 186–194. https://doi.org/10.1016/j.bbi.2015.03.016
Johnson, K. V. A. (2020). Gut microbiome composition and diversity are related to human personality traits. Human Microbiome Journal, 15, 100069.
Kim, H. N., Yun, Y., Ryu, S., Chang, Y., Kwon, M. J., Cho, J., Shin, H., & Kim, H. L. (2018). Correlation between gut microbiota and personality in adults: A cross-sectional study. Brain, behavior, and immunity, 69, 374–385. https://doi.org/10.1016/j.bbi.2017.12.012
Nguyen, T. T., Zhang, X., Wu, T.-C., Liu, J., Le, C., Tu, X. M., Knight, R., & Jeste, D. V. (2021). Association of loneliness and wisdom with gut microbial diversity and composition: An exploratory study. Frontiers in Psychiatry, 12. https://doi.org/10.3389/fpsyt.2021.648475
What is your favourite season? Normally Fall is mine. Perhaps it’s because I’ve spent so many years as a perennial student, but the wool scarves, crisp leaves and fresh air (and pumpkin spice!) has always held a special place in my heart.
However, this year fall hit hard. It seems like within a weekend, the temps here in Southern Ontario dropped 10 degrees (celsius) and then within another weekend dropped another 10. We went from shorts weather to winter coats within a few short weeks. As an internet meme stated, “Summer left like it owed someone money” (haha!).
This rapid change can put pressure on our Spleens.
Now, what does the Spleen have to do with fall or temperature, you ask? In Western Medicine, nothing.
Anatomically, our spleen (located on the left side of the abdomen) is a reservoir for blood.
In Traditional Chinese Medicine (TCM), however the Spleen is an incredibly interesting and special organ.
The Spleen in TCM works more like a pancreas. It’s job is to take digested food and turn it into energy, or Qi, for the body to use. The spleen helps transition the body during the change of seasons, particularly from summer to fall.
The Spleen regulates digestion, moving food Qi (the energy the food we eat) into energy that can be used by the body (think of how the pancreas’ job is to release insulin and digestive enzymes to incorporate sugars into cells to be used for energy.
It governs the flesh and muscles (supporting muscle growth from the food we eat).
It governs thought, memory and learning. An overactive or dysfunctional spleen can lead to rumination (overdigestion of thoughts). Digesting and incorporating too many thoughts can overload the spleen (think studying or ingesting large amounts of information—note the analogy to digesting food here!)
The spleen manages blood (moving energy and substance around the body to nourish the skin and hair).
It also supports immune function (or Wei Qi)
It gives us mental and physical energy
The spleen regulates our intellect and spirit as well as emotions (enthusiasm, sadness and worry).
During the change of season our Spleens are workinghard. Deficient Spleen Qi (or energy) can lead to an accumulation of mucus, digestive issues (bloating, constipation, diarrhea), fatigue, depression, muscle weakness, bruising and bleeding disorders.
Cravings for sweet can damage the Spleen (but also be a result of Spleen Qi deficiency). Phlegm and dampness (another word for weight gain in Chinese Medicine) can accumulate if the spleen is congested and having trouble cleanly converting energy from our food into energy from the body.
So think of typical fall symptoms (particularly if we consider that Fall is the time we are ingesting more information and mentally busier with back-to-school for students): congestion, susceptibility to colds and flus, fatigue, sluggishness, lower mood.
Spleen Qi deficiency can also cause dry skin and lips, a swollen tongue, feelings of sadness, rumination and worry. Prolonged spleen qi deficiency can lead to Spleen Yang Deficiency (feelings of deep fatigue, coldness, swelling and weight gain).
How do we support Spleen Qi?
Regulating our consumption of sugar (avoiding refined sugar and consuming natural sugars from starchy vegetables and fruit instead).
Taking time to rest the mind (meditation, yoga, prioritizing sleep)
Protecting the “windgate” or back of the neck using scarves to protect our immune system (the wind gate is where “cold” gets into the body).
Consuming nourishing and easy-to-digest foods that are warm and slow-cooked. Think soups and stews, bone broths, congee, root veggies, beef and chicken, warming spices like ginger, cardamom, cinnamon, etc. (hello, pumpkin spice!)
Consuming warm drinks like herbal teas like President’s Choice “feeling soothed” or “feeling revitalized” or “feeling energized” (all containing herbal combos that support Spleen and adrenal health).
Considering taking adaptogenic herbs like schisandra, astragalus, codonopsis, goji, Lycii and wild yam (some of which are ingredients in change of season soup) which support our adrenals and immune system.
Supporting the emotions, engaging in laughter, cuddles, and play more often to take the focus off the mind and thoughts and support deeper, spleen-y emotions like enthusiasm and child-like play.
Because fall hit so hard, I didn’t have time to get into my Spleen routines. I went from cold smoothies in the morning and lots of coffee to feeling tired, sluggish and congested–ugh!
Now that we’re well into October and Canadian Thanksgiving has past, I am remembering my Spleen practices. These involve spending time in the kitchen to create warm stews (cooking beef and vegetables with curry spices) and bone broths. I’ve given up coffee and started consuming copious amounts of green and herbal tea.
I’ve started taking herbs to support gut health like oregano and ginger.
I’ve gotten back into taking a probiotic.
And, finally, I’ve started taking my cod liver oil to get a healthy dose of vitamin D and vitamin A to support immunity and mood.
It’s also important to spend as much time outside as possible. Days are getting shorter and our exposure to mood-elevating and stimulating sunlight is getting sparser and sparser. We’re spending more time inside as we work on sedentary projects that tax the mind but leave the body unattended to.
While many patients state that they find it hard to get outside when the days cool off, I urge you to consider that cold exposure is the single most important thing you can do to prepare your mind and immune system for winter.
Get outside daily (without sunglasses–if appropriate for you) and go for a walk. Enjoy the fall colours. Protect your windgate. Breathe in the fresh air.
Cold exposure increases your body’s ability to create antioxidants. It also “hardens” the body for cold resilience making the transition to winter much more enjoyable.
And, of course, remember to tend to your spleen as the days get colder and shorter.
“There exists in such a case a certain institution or law; let us say, for the sake of simplicity, a fence or gate erected across a road. The more modern type of reformer goes gaily up to it and says, “I don’t see the use of this; let us clear it away.” To which the more intelligent type of reformer will do well to answer: “If you don’t see the use of it, I certainly won’t let you clear it away. Go away and think. Then, when you can come back and tell me that you do see the use of it, I may allow you to destroy it.”
In other words, beware of tearing down structures until you fully understand their benefit.
Chesterton’s Fence can also be thought of as the Precautionary Principle. Not following this principle led to scientific practices like frontal lobotomies or removing the entire large intestine because doctors didn’t understand the benefits of these structures or the consequences of removing them.
A narrow range of focus, i.e., this organ is causing a problem, or we don’t know why it’s here, led to drastic action that resulted in unforeseen, disastrous consequences.
I believe that such is the case with our stomach acid.
The stomach is essentially a lined bag filled with acid. Stomach pH is from 1.5 to 3.5, acidic enough to burn a hole in your shoe. However, the mucus layer of the stomach protects it from being destroyed by the acid. The acid in the stomach helps dissolve and digest the food chewed up by the teeth and swallowed.
Stomach pH is needed for breaking down proteins. Stomach acid also plays a role in absorbing minerals such as calcium, zinc, manganese, magnesium, copper, phosphorus and iron. It activates intrinsic factor, which is needed for B12 absorption in the small intestine.
Stomach acid regulates the rate of gastric emptying, preventing acid reflux.
Fast-forward to a condition called gastric esophageal reflux disease, or GERD. GERD affects about 20% of Western countries, characterized by high esophageal pH and reflux of the stomach acid and stomach contents into the esophagus. While the stomach is designed to handle a shallow pH environment, the esophagus is not. A doorway called the lower esophageal sphincter, or LES, keeps stomach contents where they should be–in the stomach.
In GERD, the tone of the LES is weak, resulting in a backflow of stomach contents. This can damage the esophagus, causing heartburn, pain, bad breath, coughing and even problems like ear pain, sore throat, and mucus in the throat. Silent reflux occurs when these symptoms occur without burning.
The symptoms occur from the stomach’s acidic contents irritating the more delicate tissues of the esophagus. So, rather than treat the root problem, i.e., the reflux, drugs like proton pump inhibitors (PPIs), H2 blockers, and buffers like Tums are recommended to reduce the stomach’s acidity.
Essentially, with GERD, we are tearing down Chesterton’s Fence to pave a road without taking even a moment to consider why the fence might be there in the first place.
About 12% of people are prescribed PPIs. They are given for GERD, gastritis, and IBS symptoms like bloating and stomach pain. Most of my patients are prescribed them for virtually any stomach complaint. PPIs, it seems, are the hammers wielded by many GPs, and so every digestive concern must look like a nail. Most people are put on them inevitably, without a plan to end the use and address the root cause of symptoms, which in most GERD cases are low LES tone.
PPIs raise stomach pH, disrupting stomach function. This causes issues with mineral absorption and protein digestion. Their use results in B12, vitamin C, calcium, iron, and magnesium deficiencies. Many of these deficiencies, like magnesium deficiency, can’t be tested and therefore might show up sub-clinically in tight muscles, headaches, painful periods, disrupted sleep and anxiety, and constipation. Therefore they fly under the radar of most primary care doctors.
No one connects someone’s heartburn medication with their recent onset of muscle tightness and anxiety.
Many of my patients report difficulties digesting meat and feeling bloated and tired after eating, particularly when consuming a protein-rich meal. They conclude that the meat isn’t good for them. The problem, however, is not meat but that stomach acid that is too diluted to break down the protein in their meal, leading to gas and bloating as the larger protein fragments enter the small intestine.
Many digestive problems result from this malabsorption and deficiency in stomach acid, not too much. Zinc is required for stomach acid production, and one of the best sources of zinc is red meat (zinc is notoriously lacking from plant foods). I have recently been prescribing lots of digestive enzymes and zinc to work my patients’ digestive gears.
Therefore, beware of tearing down a fence without understanding why it’s there. Stomach acid is essential for digesting our food, and regulating blood sugar and building muscle mass through protein digestion.
It is necessary for mineral absorption and B12 digestion. Our stomachs were designed to contain an extremely low pH. They evolved over millennia to do this. Stomach acid is low for a reason. It’s highly unlikely that our bodies made a mistake when it comes to stomach acid.
Therefore, beware of messing with it.
Consider that our bodies know what they’re doing. Consider the importance of finding and treating the actual root cause, not one factor that, if mitigated, can suppress symptoms while causing a host of other problems.
Don’t block your stomach acid.
As Hippocrates said, “All disease begins in the gut.”
It is the boundary between us and the outside world, the border where our body carefully navigates what can come in and nourish us and what should stay outside of us: our fence. Beware of tearing it down.
References:
Antunes C, Aleem A, Curtis SA. Gastroesophageal Reflux Disease. [Updated 2021 Jul 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK441938/
Daniels B, Pearson SA, Buckley NA, Bruno C, Zoega H. Long-term use of proton-pump inhibitors: whole-of-population patterns in Australia 2013-2016. Therap Adv Gastroenterol. 2020;13:1756284820913743. Published 2020 Mar 19. doi:10.1177/1756284820913743
Heidelbaugh JJ. Proton pump inhibitors and risk of vitamin and mineral deficiency: evidence and clinical implications. Ther Adv Drug Saf. 2013;4(3):125-133. doi:10.1177/2042098613482484
You know how you just want the recipe and yet you have to scroll through someone’s long story about their cat and their grandma and a blistery winter day?
Forget all that. I made this curry.
Here’s the recipe (you’re welcome 😜 ):
Ingredients:
1 can coconut milk (full fat, Arroy-D)
2 heads broccoli, chop off the florets into small pieces
2 large bell peppers, chopped into slices
1/2 jar of Thai Kitchen red curry paste (nice, clean, delicious, free of seed oils 👍 )
4 large chicken breasts
Salt, pepper, olive oil.
Directions:
Preheat oven to 350 degrees (you can also do all this in the air fryer). Add chopped chicken breast to a baking pan, add broccoli and peppers, drizzle with olive oil. Cook for 45 minutes (or until everything is cooked).
In a large stir-fry pan, add cooked vegetables and chicken, add red curry paste and coconut milk.
You can serve on rice, but you don’t have to.
Filling, rich in protein and veggies. Delicious, warming. I love Thai curries on snowy days.
It’s day one of my period and I’ve been healing a broken foot for 6 weeks. The weather is overcast, thick, humid and rainy.
My body feels thick and heavy. Clothing leaves an imprint on my skin–socks leave deep indentations in my ankles. My face and foot is swollen. My tongue feels heavy. My mind feels dull, achey, and foggy. It’s hard to put coherent words together.
I feel cloudy and sleepy. Small frustrations magnify. It’s hard to maintain perspective.
My muscles ache. My joints throb slightly. They feel stiffer and creakier.
This feeling is transient. The first few days of the menstrual cycle are characterized by an increase in prostaglandins that stimulate menstrual flow and so many women experience an aggravation of inflammatory symptoms like depression, arthritis, or autoimmune conditions around this time. You might get. a cold sore outbreak, or a migraine headache around this time of month. The phenomenon can be exaggerated with heavy, humid weather, and chronic inflammation–such as the prolonged healing process of mending a broken bone.
Inflammation.
It’s our body’s beautiful healing response, bringing water, nutrients, and immune cells to an area of injury or attack. The area involved swells, heats up, becomes red, and might radiate pain. And then, within a matter of days, weeks, or months, the pathogen is neutralized, the wound heals and the inflammatory process turns off, like a switch.
However, inflammation can be low-grade and chronic. Many chronic health conditions such as diabetes, arthritis, PMS or PMDD, depression, anxiety, migraines, even bowel and digestive issues, have an inflammatory component.
In the quest to manage chronic inflammation, people often explore various avenues, including dietary supplements. One such natural option gaining attention is OrganicCBDNugs. Derived from the hemp plant, CBD, or cannabidiol, is believed to possess anti-inflammatory properties, potentially offering relief to those struggling with conditions like arthritis, anxiety, or migraines.
This organic supplement, with its purported ability to interact with the body’s endocannabinoid system, might provide a holistic approach to tackling inflammation-related issues. As we navigate the complexities of our bodies and the ebb and flow of inflammation, exploring natural remedies like Organic CBD could be a step toward finding equilibrium and promoting overall well-being.
As I telly my patients. Inflammation is “everything that makes you feel bad”. Therefore anti-inflammatory practices make you feel good.
Many of us don’t realize how good we can feel because low-grade inflammation is our norm.
We just know that things could be better: we could feel more energy, more lightness of being and body, more uplifted, optimistic mood, clearer thinking and cognitive functioning, better focus, less stiffness and less swelling.
Obesity and weight gain are likely inflammatory processes. Insulin resistance and metabolic syndrome are inflammatory in nature. It’s hard to distinguish between chronic swelling and water retention due to underlying low-grade chronic inflammation and actual fat gain, and the two can be closely intertwined.
It’s unfortunate then, that weight loss is often prescribed as a treatment plan for things like hormonal imbalances, or other conditions caused by metabolic imbalance. Not only has the individual probably already made several attempts to lose weight, the unwanted weight gain is most likely a symptom, rather than a cause, of their chronic health complaint. (Learn how to get to the root of this with my course You Weigh Less on the Moon).
Both the main complaint (the migraines, the PMS, the endometriosis, the depression, the arthritis, etc.) and the weight gain, are likely due to an inflammatory process occurring in the body.
To simply try to cut calories, or eat less, or exercise more (which can be helpful for inflammation or aggravate it, depending on the level of stress someone is under), can only exacerbate the process by creating more stress and inflammation and do nothing to relieve the root cause of the issues at hand.
Even anti-inflammatory over the counter medications like Advil, prescription ones like naproxen, or natural supplements like turmeric (curcumin) have limiting effects. They work wonderfully if the inflammation is self-limiting: a day or two of terrible period cramps, or a migraine headache. However, they do little to resolve chronic low-grade inflammation. If anything they only succeed at temporarily suppressing it only to have it come back with a vengeance.
The issue then, is to uncover the root of the inflammation, and if the specific root can’t be found (like the piece of glass in your foot causing foot pain), then applying a general anti-inflammatory lifestyle is key.
The first place to start is with the gut and nutrition.
Nutrition is at once a complex, confusing, contradictory science and a very simple endeavour. Nutrition was the simplest thing for hundreds of thousands of years: we simply ate what tasted good. We ate meat, fish and all the parts of animals. We ate ripe fruit and vegetables and other plant matter that could be broken down with minimal processing.
That’s it.
We didn’t eat red dye #3, and artificial sweeteners, and heavily modified grains sprayed with glyphosate, and heavily processed flours, and seed oils that require several steps of solvent extraction. We didn’t eat modified corn products, or high fructose corn syrup, or carbonated drinks that are artificially coloured and taste like chemicals.
We knew our food—we knew it intimately because it was grown, raised, or hunted by us or someone we knew—and we knew where it came from.
Now we have no clue. And this onslaught of random food stuffs can wreck havoc on our systems over time. Our bodies are resilient and you probably know someone who apparently thrives on a diet full of random edible food-like products, who’s never touched a vegetable and eats waffles for lunch.
However, our capacity to heal and live without optimal nutrition, regular meals that nourish us and heal us rather than impose another adversity to overcome, can diminish when we start adding in environmental chemicals and toxins, mental and emotional stress, a lack of sleep, and invasion of blue light at all hours of the day, bodies that are prevented from experiencing their full range of motion, and so on.
And so to reduce inflammation, we have to start living more naturally. We need to reduce the inflammation in our environments. We need to put ourselves against a natural backdrop–go for a soothing walk in nature at least once a week.
We need to eat natural foods. Eat meats, natural sustainably raised and regeneratively farmed animal products, fruits and vegetables. Cook your own grains and legumes (i.e.: process your food yourself). Avoid random ingredients (take a look at your oat and almond milk–what’s in the ingredients list? Can you pronounce all the ingredients in those foods? Can you guess what plant or animal each of those ingredients came from? Have you ever seen a carageenan tree?).
Moving to a more natural diet can be hard. Sometimes results are felt immediately. Sometimes our partners notice a change in us before we notice in ourselves (“Hon, every time you have gluten and sugar, don’t you notice you’re snappier the next day, or are more likely to have a meltdown?”).
It often takes making a plan–grocery shopping, making a list of foods you’re going to eat and maybe foods you’re not going to eat, coming up with some recipes, developing a few systems for rushed nights and take-out and snacks–and patience.
Often we don’t feel better right away–it takes inflammation a while to resolve and it takes the gut time to heal. I notice that a lot of my patients are addicted to certain chemicals or ingredients in processed foods and, particularly if they’re suffering from the pain of gut inflammation, it can tempting to go back to the chemicals before that helped numb the pain and delivered the dopamine hit of pleasure that comes from dealing with an addiction. It might help to remember your why. Stick it on the fridge beside your smoothie recipe.
We need to sleep, and experience darkness. If you can’t get your bedroom 100%-can’t see you hand in front of your face-dark, then use an eye mask when sleeping. Give your body enough time for sleep. Less than 7 hours isn’t enough.
We need to move in all sorts of ways. Dance. Walk. Swim. Move in 3D. Do yoga to experience the full range of motion of your joints. Practice a sport that requires your body and mind, that challenges your skills and coordination. Learn balance both in your body and in your mind.
We need to manage our emotional life. Feeling our emotions, paying attention to the body sensations that arise in our bodies—what does hunger feel like? What does the need for a bowel movement feel like? How does thirst arise in your body? Can you recognize those feelings? What about your emotions? What sensations does anger produce? Can you feel anxiety building? What do you do with these emotions once they arise? Are you afraid of them? Do you try to push them back down? Do you let them arise and “meet them at the door laughing” as Rumi says in his poem The Guest House?
Journalling, meditation, mindfulness, hypnosis, breath-work, art, therapy, etc. can all be helpful tools for understanding the emotional life and understanding the role chronic stress (and how it arises, builds, and falls in the body) and toxic thoughts play in perpetuating inflammation.
Detox. No, I don’t mean go on some weird cleanse or drinks teas that keep you on the toilet all day. What I mean is: remove the gunk and clutter from your physical, mental, spiritual, and emotional plumbing. This might look like taking a tech break. Or going off into the woods for a weekend. Eating animals and plants for a couple of months, cutting out alcohol, or coffee or processed foods for a time.
It might involve cleaning your house with vinegar and detergents that are mostly natural ingredients, dumping the fragrances from your cosmetics and cleaning products, storing food in steel and glass, rather than plastic. It might mean a beach clean-up. Or a purging of your closet–sometimes cleaning up the chaos in our living environments is the needed thing for reducing inflammation. It’s likely why Marie Kondo-ing and the Minimalist Movement gained so much popularity–our stuff can add extra gunk to our mental, emotional, and spiritual lives.
Finally, connect with your community. Loneliness is inflammatory. And this past year and a half have been very difficult, particularly for those of you who live alone, who are in transition, who aren’t in the place you’d like to be, or with the person or people you’d like to be–your soul family.
It takes work to find a soul family. I think the first steps are to connect and attune to oneself, to truly understand who you are and move toward that and in that way people can slowly trickle in.
We often need to take care of ourselves first, thereby establishing the boundaries and self-awareness needed to call in the people who will respect and inspire us the most. It’s about self-worth. How do you treat yourself as someone worthy of love and belonging?
Perhaps it first comes with removing the sources of inflammation from our lives, so we can address the deeper layers of our feelings and body sensations and relieve the foggy heaviness and depression and toxic thoughts that might keep us feeling stuck.
Once we clear up our minds and bodies, and cool the fires of inflammation, we start to see better—the fog lifts. We start to think more clearly. We know who we are. Our cravings subside. We can begin to process our shame, anger and sadness.
We start to crave nourishing things: the walk in nature, the quiet afternoon writing poetry, the phone call with a friend, the stewed apples with cinnamon (real sweetness). We free up our dopamine receptors for wholesome endeavours. We start to move in the direction of our own authenticity. I think this process naturally attracts people to us. And naturally attracts us to the people who have the capacity to love and accept us the way we deserve.
Once we start to build community, especially an anti-inflammatory community—you know, a non-toxic, nourishing, wholesome group of people who make your soul sing, the path becomes easier.
You see, when you are surrounded by people who live life the way you do–with a respect for nature, of which our bodies are apart–who prioritize sleep, natural nutrition, mental health, movement, emotional expression, and self-exploration, it becomes more natural to do these things. It no longer becomes a program or a plan, or a process you’re in. It becomes a way of life–why would anyone do it any other way?
The best way to overcome the toxicity of a sick society is to create a parallel one.
When you’re surrounded by people who share your values. You no longer need to spend as much energy fighting cravings, going against the grain, or succumbing to self-sabotage, feeling isolated if your stray from the herb and eat vegetables and go to sleep early.
You are part of a culture now. A culture in which caring for yourself and living according to your nature is, well… normal and natural.
There’s nothing to push against or detox from. You can simply rest in healing, because healing is the most natural thing there is.
Whenever I sit with a new patient for an initial intake, I ask about cravings.
From my many conversations about food, appetite and cravings, the most common responses are cravings for salt, or sugar, with many people falling on one end of the preference than the other: “I’m a salt craver” or “I’ve got a sweet tooth”.
However, cravings are so much more than that.
I believe that they are a beautifully intricate process, in which our body is trying to speak to us about what it needs.
Our bodies have developed taste receptors to detect quality nutrients from the environment. While these days sugar is abundant wherever you turn, during our hunter-gatherer times, it was a relatively scarce and highly sought after taste–the taste of ripe fruit, rich with nutrients, the taste of quality calories from carbohydrates, which may have been scarce in times of food shortage or famine.
Salt or “savoury” or umami cravings, often represent a need for more protein. Unfortunately, many of my patients who crave salt (and often calories) find themselves the bottom of a bag of chips, rather than grilling up a chicken breast.
Our modern environment doesn’t necessarily set us up to adequately translate and respond properly to certain cravings. Salted chips were probably not a thing in a natural environment and the only way to satisfy a salt and savoury craving would have been through hunting, consuming meat, or eggs and poultry.
When I was travelling in Colombia I was obsessed with broccoli–it was like I couldn’t get enough of it.
The same thing happened on a month-long trip to Brazil in 2019. Broccoli is rich in vitamin C, sulphur, and certain amino acids. It’s also a decent source of calcium. I’m not sure what nutrient I may have been lacking on my travels, but it’s possible that those cravings meant something for my body. And so I honoured them–I sought out broccoli like it was a magic elixir of health and ate as much of it as I could.
After developing significant iron deficiency after spending a few years as a vegetarian, I became suddenly attracted by the smell of roasting chicken from a local Korean restaurant I was passing by while walking the streets of Toronto.
The wafting smell of roasting poultry was majestic and impossible to ignore. It didn’t smell like sin, or temptation–my body betraying my moral sensibilities or whatever else we often accuse our cravings of—it smelt… like health.
There was no doubt in my mind as the delicious fumes touched my nostrils that I needed to honour my body and start eating meat again. I did and my health and nutrient status has never been better.
Patients will report craving carbs and chocolate the week before their period. The eb and flow of estrogen can affect serotonin levels. A large dose of carbs allows tryptophan, the amino acid that forms the backbone of serotonin, to freely enter the brain. This explains the effect “comfort foods” like starchy warm bread and pasta have on us, creating that warm, after-Thanksgiving dinner glow.
Chocolate is rich in magnesium, a nutrient in which many of us are deficient, that is in higher demand throughout the luteal phase of our cycle, or our premenstrual week.
Cravings are not just nagging, annoying vices, thrust in the path to greater health and iron discipline. They’re complex, intuitive and beautiful. They may be important landmarks on the path to true health and wellness.
Disciplines like Intuitive Eating and Mindful Eating have based themselves on the idea that our bodies hold intuitive wisdom and our tastes, cravings and appetites may be essential for guiding us on a road to health. Through removing restriction and paying more attention to the experience of food, we may be better guided to choose what foods are right for us.
The book The Dorito Effect outlines how our taste cues have been hijacked by Big Food. Like having a sham translator, processed foods stand between essential nutrients and the signals our bodies use to guide us to them. A craving for sweet that might have led you to ripe fruit, now leads you to a bag of nutrient-devoid candy that actually robs you of magnesium, and other nutrients in order to process the chemicals. A craving for salt and umami, or hunger for calories leads you to polish off a bag of chips, which are protein-devoid and laden with inflammatory fats, and only trigger more cravings, and shame.
It’s no wonder that we don’t trust our cravings– we live in a world that exploits them at every turn.
Clara Davis in 1939 was curious about the instintual nature of human cravings and devised a study that was published in the Canadian Medical Assoication Journal (CMAJ). The study was called Self-Selection of Diets by Young Children.
Clara gathered together 15 orphaned infants between 6 to 11 months of age who were weaning from breast-feeding and ready to receive solid food for the first time. These infants, before the study had never tried solid food or supplements. They were studied ongoing for a period of 6 years, with the main study process was conducted over a period of months.
The babies were sat at a table with a selection of simple, whole foods–33 to be exact. The foods contained no added sugars or salt. They were minimally cooked. Not all 33 were presented to each baby at each meal, however the babies were offered an opportunity to try everything.
The foods they were offered were water, sweet milk, sour (lactic) milk, sea salt, apples, bananas, orange juice, pineapple, peaches, tomatoes, beets, carrots, peas, turnips, cauliflower, cabbage, spinach, potato, lettuce, oatmeal, wheat, corn meal, barley, Ry-krisp (a kind of cereal), beef, lamb, bone marrow, bone jelly, chicken, sweetbreads, brains, liver, kidneys, eggs, and fish (haddock).
The nurses who were involved in running the study were instructed to sit in front of the infants with a spoon and wait for them to point at foods that they wanted. The nurses were not to comment on the choices or foods in any way, but wordlessly comply with the infants’ wishes and offer them a spoonful of the chosen foodstuff.
Throughout the study Davis noted that all the infants had hearty appetites and enjoyed eating.
At first, the babies showed no instinct for food choices, selecting things at random, and exploring the various foods presented to them. All of them tried everything at least once (two babies never tried lettuce and one never explored spinach). The most variety of food choices occurred during the first two weeks of the study when they were presumably in their experimentation phase.
Their tastes also changed from time to time, perhaps reflecting some hidden, internal mechanism, growth spurt or nutritional need. Sometimes a child would have orange juice and liver for breakfast (liver is a source of iron, and vitamin C from the orange juice aids in its absorption), and dinner could be something like eggs, bananas, and milk.
Many infants began the study in a state of malnourishment. Four were underweight and five suffered from Rickets a condition caused by extremely low vitamin D. One of the babies with severe Rickets was offered cod liver oil in addition to the other food options. Cod liver oil is a rich source of vitamin D.
The infant selected cod liver oil often for a while, after which his vitamin D, phosphorus and calcium blood levels all returned to normal range, and x-rays showed that his Ricket’s healed.
It is often thought by parents that children, if left to their own devices will eat themselves nutrient-deficient. While that may be true in todays’ landscape of processed frankenfoods, the infants in Davis’ study consumed a diet that was balanced and high in variety. They got 17% of their calories from protein, 35% from fat and 48% from carbohydrates and intake depended on their activity levels.
During the 6 years in which the infants’ eating habits were under observation, they rarely suffered from health issues. They had no digestive issues, like constipation. If they came down with a cold it would last no more than 3 days before they were fully recovered.
In the 6 years, they became ill with a fever only once, an outbreak that affected all of the infants in the orphanage. The researchers noticed their appetites change in response to the illness.
During the initial stages of the fever, they had lower appetites. And, once the fevers began to resolve, their appetites came back with a vengeance. They ate voraciously, and it was interesting that most of them showed an increased preference for raw carrots, beef and beets–which may indicate a need for vitamin A, iron and protein, which are needed for immune system function and recovery.
The habits of the infants to crave and select medicinal foods during times of fever and nutrient deficiency is such compelling evidence of Clara Davis’ craving wisdom hypothesis—were their bodies telling them what they needed to heal?
The self-selected, whole foods diets seems to have a positive impact on the mood and behaviours of the babies, all of whom were living full-time at the orphanage.
A psychiatrist, Dr. Joseph Brennemann wrote an article on them entitled “Psychologic Aspects of Nutrition” in the Journal of Pediatrics on their mood, behaviour and affect, “I saw them on a number of occasions and they were the finest group of specimens from the physical and behaviour standpoint that I have even seen in children of that age.”
In our world we often try to mentalize our food choices: going vegan or low-fat, counting calories, or reducing carbs. We time our eating windows, fast, or try to exert discipline and will over our bodies’ inherent desires.
So often my patients need to be coached through food eliminations, or given meal plans and templates. The art of listening to the body: properly identifying hunger, thirst, fatigue, inflammation, and even emotions like boredom, anxiety, sadness, anger, and hurt, can be a long process.
And yet, I wonder if we clear our palates and offer them a variety of whole, unprocessed, fresh foods, if our bodies will settle into their own grooves–perhaps our health will optimize, our bodies will be able to more readily communicate what they need, our taste receptors and cravings will adjust, and our cravings and appetite will serve the purpose they were meant to–to tell us what we need more of and what need less of or not at all.
I wonder if we listen, what our bodies will tell us.
I wonder if we let them, if our bodies will exhibit the pure instinctual wisdom of nature and the quest for harmony and homeostasis that lies at the heart of our natural world.
The Low Carb, High Fat or “Ketogenic” Diet has been touted as a health solution for weight loss, mental health, hormonal health, as well as a treatment for insulin resistance, diabetes, childhood seizures, migraines, and dementia.
It consists of eating foods like meat, fish, and non-starchy vegetables, and plenty of healthy fats from avocados, coconut, olives, nuts and seeds, while avoiding starchy foods like grains, legumes, fruit and root vegetables.
Our bodies and brains can use two main types of fuel: sugar and fat.
In this 21-day challenge we will teach our bodies to burn fat for fuel.
Some argue that fat is a “cleaner” fuel source than carbohydrates.
Ketone bodies, produced from fat have been shown to decrease inflammation, improve mitochondrial function—our cells’ power supply—and boost cognition. Ketone bodies also keep us full for longer, our brain sharp and focussed, and our energy abundant and sustained.
Many are introduced to low carb diets through their weight loss journeys. When we restrict carbohydrates, our bodies burn dietary fat and body fat for energy. Furthermore, less dietary carbohydrates means less insulin release. Insulin is our storage hormone, that prevents our bodies from breaking down fat, possibly impeding weight loss. When we cut out carbs we reduce our insulin levels, helping to heal insulin resistance, and helping our bodies shed fat.
To be perfectly honest, I don’t believe in diets,
particularly trendy diets that have names and followers, like groupies at a rock concert.
I believe that how we eat has a LOT to do with our individual biochemistry, our genes, our gut bacteria, our culture, our preferences, our job, our family, our free time, our individual health goals and health challenges.
Diet (or since diet is often a trigger word, but honestly all I mean by it is “way of eating”, or daily nutritional practice), is highly individualized. There is no one-size-fits-all diet.
HOWEVER, I do believe in resets.
I believe all adults could do well with a dedicated amount of time: 14 days, 20 days, 30 days, etc.: in which we really examine our relationship with food. In which we strip our diets down to the bare bones and examine our blood sugar, food sensitivities, food addictions, tendencies to emotionally eat, taste buds, etc.
After all, the human “diet” is essentially meat and vegetables. What happens when we strip all the fluff away? What might we discover about our bodies and minds? About our habits? About ourselves?
This way of eating restores metabolic flexibility, gets us burning fat for fuel (in addition to carbs when you add them back in after the 21 days). It helps us manage blood sugar, which is implicated in chronic stress, acne, diabetes, and hormonal disruption to name a few conditions and symptoms.
Obviously this challenge is not for those who struggle emotionally with food and need more one-on-one focused support, but it is an excellent way to be held accountable, to take on a challenge in which you’re given all the tools you need to do the discovery work.
You might discover that this is the best eating style for you.
You might restore your insulin sensitivity but discover that you need some carbs, or certain carbs, to feel your best.
You might discover hidden food sensitivities that have been plaguing you with inflammation for years.
In order to make sense of the world, people create stories. It is our greatest gift and most fragile weakness.
Boy meets girl, they fall in love, they encounter difficulties that they eventually overcome. It brings them closer. They live happily ever after—the classic love story.
Stress has a classic story too: cortisol, the “stress” hormone, is released during stress. It wreaks havoc on the body. Lowering stress helps lower cortisol.
However, when it comes to human hormones, telling stories in a linear narrative is impossible.
Hormones are signalling molecules in the body. They are produced by endocrine organs, such as the adrenal glands, the brain, and the ovaries. They travel through the bloodstream to impact the expression of genes on distant tissues, which impacts how our bodies function.
Production of norepinephrine in the adrenal glands as a response to stress can make your heart race, your pupils dilate, your hands to shake, and your senses become hypervigilant—when a perceived threat or danger activates the release of this hormone, your entire body pulsates under its influence.
Hormonal stories are hard to fit the human desire for narratives. Their relationships with our genes, bodily systems, receptor binding sites, and each other make their actions too complicated to be described linearly. Instead they act like webs, or tangled networks of intricate connections.
When hormone levels rise in the body, beyond our delicate homeostatic balance, a phenomenon, called “resistance”, can occur. With resistance, cells reduce their responses to the hormones that interact with them.
When telemarketers keep interrupting your dinner at 6pm, eventually you stop answering the phone.
When certain hormones continue to call at the surface of cells, stressing the body’s capacity to respond, our cells simply stop answering.
Many of us ask, “what happens when I pull this thread here?” when learning about one hormone that we’ve blamed all our woes on. We tug the thread, without considering the entire web of connections, and our actions affect the entire system.
Our hormones exist in an ecosystem where everything hums and flows together, as a unit. It’s impossible to lay out explanations for their actions in a linear fashion.
Hormone stories flow like a Choose Your Own Adventure novel—a hallway with many doors that snake down long corridors and meet again, and interconnect.
Go through the door marked “estrogens”, and you encounter serotonin, cortisol, progesterone, insulin, thyroid hormones, leptin, BDNF, dopamine, norepinephrine, and many others.
Hormones are the conductors of your body’s personal orchestra, composed of thousands of musicians, a complex musical score, highly-trained arms, fingers, and mouths manipulating instruments: a million moving parts working together in harmony.
The best we can do to understand the entire interplay is to slow down the action, take a snapshot of it, and to try to understand why these symptoms are occurring in this individual.
Symptoms of Hormone Imbalances
Because hormones affect absolutely every system of our body, I am always attuned to the possibility of hormonal imbalances in my patients.
It helps to look at hormones in terms of their symptom patterns rather than how any one hormone affects us in particular.
Common signs of hormonal imbalance are:
Fatigue, low libido, restless sleep, depression and anxiety, waking at 2 to 4 am, a high-stress lifestyle, and brain fog might indicate cortisol imbalance.
PMS – and the more severe related condition, PMDD – infertility, fatigue and low libido, missed and irregular periods may be related to fluctuations in the hormones estrogen and progesterone, or low estrogen and progesterone levels. Many of these symptoms could also be related to estrogen dominance, in which estrogen is either high or normal, and progesterone is low.
Endometriosis, a family or personal history of female cancers, anxiety and panic attacks, heavy and painful periods, frequent miscarriages, infertility, fibroids, fibrocystic breasts and weight gain around the hips and thighs can indicate estrogen dominance.
High levels of male sex hormones like testosterone, irregular periods, weight gain, acne, and hair loss may indicate a female hormone condition called PCOS.
Fatigue, brain fog, difficulty losing weight, puffiness, constipation, dry skin and hair, and low body temperature can be signs of hypothyroidism.
Symptoms of reactive hypoglycemia, such as feeling dizzy, anxious and shaky between meals, sugar cravings, weight gain around the abdomen, difficulty losing weight, and low morning appetite, night-time carbohydrate cravings, and binge eating can all be related to insulin resistance and poor blood sugar control.
In my naturopathic practice, I see common patterns of symptoms that indicate certain hormonal imbalances.
These patterns often represent vicious cycles where our body is stressed beyond a capacity to balance these interconnected webs of chemical interactions, causing further imbalance.
Cortisol
Speaking of stories, here’s one I hear often.
You wake up in the morning, exhausted. Your brain is in a fog and you don’t feel alive until a cold shower or double espresso knock you out of your stupor.
Things get a bit better once you get moving, but you wonder why your energy never fully bounces back.
You used to play sports in university, you think to yourself. Now just thinking of sports makes you tired.
Is this what getting older feels like? You’re in your 30s.
The days at the office stretch on forever. Concentration and focus are difficult. You see a coworker whose name, you realize with horror, can’t be brought to mind.
You’ve known her for a year. Cynthia? Sylvia? Your brain hurts.
In the afternoon you think longingly of napping, but instead take your place in the long line for coffee and something carb-y like a cookie.
When it comes time for sleep you are either out like a light or find it hard to turn your mind off; you’re tired, as always, but also wired.
Sleep doesn’t feel restful, and you often wake up, sleepless, at 2-4am in the morning.
When your alarm rings a few hours later, the cycle begins again.
Cortisol, one of our stress hormones, has a circadian rhythm. Its levels are highest in the morning, about an hour after waking. Cortisol promotes energy, alertness and focus. It is also a potent anti-inflammatory hormone.
Cortisol is what makes us feel alive in the morning, bouncing out of bed like Shirley Temple and her curls.
Throughout the day our cortisol levels slowly dwindle (unless a major stressor causes them to spike abnormally). They are lowest in the evening, when melatonin, our sleep hormone begins to rise, inducing feelings of sleepiness, preparing us for a night of rest.
Our modern day society, however, calls on cortisol to perform more than its fair share of work. Cortisol is around when we’re hauling ourselves out of bed after an inadequate night of rest.
Cortisol fuels gym workouts, gets us to our meetings on time, allows us to meet deadlines, tolerates traffic jams, responds kindly to tyrannical bosses, and makes sure the kids get to all their after-school events.
Cortisol is made in the adrenal glands, two endocrine glands located on each kidney, in response to signals from the brain that perceive stress in our environments and bodies.
When stress hormones levels are too high we experience a “tired and wired” feeling. During this time we might feel we thrive better under stress: workouts boost our energy, we have a hard time quieting down and we rarely feel hungry.
We might still struggle with weight gain, however, especially the abdomen and face, where cortisol tends to encourage fat deposition.
We might feel tension—tight muscles and shoulders, and body pain, as muscles clench up, preparing to fight or flee.
Chronic stress is associated with high levels of cortisol. We work long hours, late into the night. We go, go, go. This may give us a “high” or it may feel exhausting and depleting.
Many of us can exist in this state for months and even years. Sometimes a compounded stressor such as a divorce, accident, or loss, can tip us over the edge into a depleted, burnt out state.
Burnout, often following a period of prolonged stress, can be associated with low cortisol signalling. Our bodies have simply stopped being able to produce the stress hormones necessary to meet the needs of our daily lives, or glucocorticoid receptors in the brain and body cells, have stopped responding to cortisol.
Just as cell can be become resistant to insulin, they can also become resistant to cortisol. Too much (or even too little) of a hormone can cause cells to start ignoring their signalling, resulting in symptoms of low levels of the hormone in some areas of the body and high levels of the hormone in others.
Cortisol is a complicated molecule. It both encourages the stress response, but also turns it off, when levels reach a certain point.
Often, cortisol levels that are too low result in an impaired stress response, preventing our fight or flight system from properly shutting off—cortisol resistance can lead to further stress hormone disruption.
The result of an imbalance in cortisol, otherwise termed Hypothalamic Pituitary Adrenal (HPA) Axis dysregulation is weight gain, fatigue and brain fog, inflammation and immune system activation, digestive issues, restlessness, impaired sleep, decreased cognitive function, and mental health conditions, such as anxiety and depression.
When cortisol levels are low, the body makes adrenaline and noradrenaline to meet our needs, which often leads to anxiety and feeling shaky and nervous, contributing to symptoms of anxiety.
Cortisol also influences the function of our sex hormones, thyroid hormones, and our blood sugar. Imbalances in any of these other hormonal systems can be a result of an impaired HPA axis.
Cortisol Testing
The two main ways to assess the body’s levels of cortisol are through serum (blood tests) and saliva.
A study found both tests were equal when it came to diagnosing Cushing’s disease, a condition of highly elevated cortisol.
One of the advantages to salivary cortisol testing is the ability to obtain multiple samples in one day to be able to view a patient’s cortisol curve, in which cortisol peaks approximately one hour after waking and declines throughout the day.
The cortisol curve is measured by assessing 4 samples of salivary cortisol taken at 4 key points during the course of one day. It measures free cortisol, which may only represent about 5% of total cortisol in the body.
While salivary cortisol levels can be a good starting point for assessing the cortisol curve, it doesn’t tell us everything about the health of the glucocorticoid receptors or HPA system as a whole.
High cortisol levels may be seen in patients with low cortisol signalling, such as depression, anxiety and chronic fatigue. Errors in obtaining salivary cortisol samples (such as not taking samples at the right time) can lead to falsely low cortisol readings.
In my opinion, this makes symptoms and health history the most valuable tools for properly assessing HPA axis function.
Cortisol and Melatonin
Melatonin, our sleep hormone, also operates on a circadian rhythm. It is released by the pineal gland in the brain and induces sleep. Its release corresponds to a drop in cortisol levels at the end of the day.
That release is impeded by artificial light exposure at night, lack of daytime sun exposure, alcohol, stress, and HPA axis disruption, among other lifestyle and environmental factors.
Melatonin, like other hormones, can be tested for in blood, urine and saliva, but I find more value in assessing for sleep quality and quantity by taking a thorough health history while also restoring a patient’s sleep hygiene and HPA axis regulation.
Many patients with sleep issues can benefit from a trial of supplemental melatonin to see if that helps their sleep. Taking it 2 to 3 hours before bedtime to coincide with the body’s natural melatonin surge and taking a prolonged-release version to promote sleep maintenance are two strategies I use for helping patients sleep better.
Working on sleep and circadian rhythms is also beneficial for restoring HPA axis functioning.
The “Female” Hormones: Estrogen and Progesterone
The most prevalent female sex hormones are estrogen and progesterone. These two hormones eb and flow in distinct ways throughout a woman’s monthly cycle.
Estrogen creates an “M” shape, rising at the beginning of the cycle to its first peak around ovulation, half-way through the cycle. At this time women typically experience their best mood, energy, and motivation, perhaps noticing a rise in libido.
After ovulation, estrogen dips a little bit and then rises, peaking again about a week before a woman’s menstrual cycle is due.
After this, estrogen takes a nosedive, reaching low levels around the time that menstruation begins: Day 1 of the menstrual cycle.
Progesterone, on the other hand is largely absent the first half of the cycle, before ovulation. Then, it begins a steady climb to peak with estrogen, about a week before the arrival of the next period.
After peaking, just like estrogen, progesterone then takes a dip, which stimulates the uterine lining to shed, resulting in menstruation, in which the entire cycle begins again.
PMS and PMDD
My practice is populated by women who experience various forms of grief at different stages of their monthly cycles.
Many of my patients experience PMS, and the more severe PMDD (Premenstrual Dysphoric Disorder)—which is characterized by intense mood swings, irritability, depression, or anxiety, panic attacks and psychosis in the most severe cases— up to two weeks before their periods.
The mood changes in PMS and PMDD are associated with fluctuations in the hormones estrogen and progesterone, which can wreak havoc on our brain chemistry.
Estrogen has a beneficial effect on mood, increasing dopamine and serotonin action in the brain. Dopamine and serotonin are two antidepressant, feel-good neurotransmitters.
Estrogen also increases something called Brain-Derived Neurotrophic Factor (BDNF) a chemical that stimulates the growth of brain cells. This can boost memory, concentration, and cognition, as well as positively influence mood.
Progesterone breaks down into a chemical called allo-pregnenolone, which acts like GABA, a calming neurotransmitter, in the brain. Bioidentical progesterone therapy is often used as a treatment for anxiety and insomnia.
When estrogen and progesterone levels surge and drop suddenly, drastic fluctuations in mood can occur. Cravings for sweets, crying, lack of motivation, or severe anxiety can all occur when hormones drop right before a period is due.
However, elevated levels of estrogen can also be problematic. Estrogen stimulates dopamine, which typically makes us feel good, gives us energy, and helps to motivate us. In genetically vulnerable women, elevated levels of dopamine can cause excess irritability, low stress tolerance, and even mania or psychosis.
Estrogen also slows the recycling of the stress hormones epinephrine and norepinephrine, which can lead to symptoms of acute stress and anxiety, when dysregulated.
This means that dramatic rises and falls in estrogen throughout a woman’s cycle can cause her to feel irritable and anxious one week and unmotivated and depressed the other.
Smoothing out hormonal ups and downs can be a key factor in regulating a woman’s menstrual cycles and soothing her mood and emotions throughout the month.
Perimenopause and Menopause
Perimenopause is characterized by a declining production of the ovarian hormones estrogen and progesterone.
Estrogen levels tend to rise and fall dramatically throughout a woman’s remaining cycles, while progesterone levels tend to stay low.
The result of these changes are symptoms like hot flashes, night sweats, brain fog, fatigue, and depression when estrogen levels suddenly tank, and increased stress and anxiety when estrogen levels abruptly spike.
During this time, cycles may become irregular. Some of my patients comment that their periods are incredibly light one month and the heaviest of their lives another.
Some get periods every few months and some notice increased frequency, even spotting between cycles, or have a full-blown period every two weeks in more extreme cases.
Weight gain tends to drift from the thighs and buttocks to the abdomen. Once pear and hourglass-shaped figures begin to resemble apples.
Fatigue is a common symptom. Women may experience poor sleep due to night sweats from estrogen deficiency, and anxiety from insufficient progesterone.
What a joy, right?
Many of these perimenopausal symptoms are a relatively modern phenomenon, stemming from a dysregulated HPA axis.
After cessation of periods, it’s the job of the adrenal glands to take over sex hormone production. However, if the HPA system is preoccupied with organizing a stress response, this can affect the production of other hormones.
Impaired Estrogen Clearance
Many women struggle with symptoms that are related to relatively high levels of estrogen, often caused by impaired estrogen clearance.
These conditions include heavy and painful periods, fibrocystic breasts, or conditions like fibroids or endometriosis.
Chronically elevated estrogen levels also include a risk of certain hormone-associated cancers, such as breast cancer.
These women may experience irritability and anxiety through estrogen’s interaction with stress hormones, and also from a relative deficiency in progesterone.
A relatively high level of estrogens compared to progesterone is termed “Estrogen Dominance”.
Estrogen is normally cleared through the digestive system: the liver and intestines.
A sluggish and congested liver causing a slower rate of hormonal clearance (think of it like a clogged drain), an increase in environmental toxin exposure, or an overconsumption of alcohol, can slow the liver’s ability to regulate estrogen levels in the body.
Constipation and a dysbiotic gut can also impair estrogen clearance.
Symptoms of estrogen dominance include stubborn weight gain, typically around the hips and thighs, heavy and painful periods, tender and painful breasts, fibrocystic breasts, endometriosis, uterine fibroids, acne, cyclical mood swings, especially premenstrual anxiety and panic attacks, and irregular menstrual cycles.
Low Progesterone
Aside from impaired estrogen clearance, another pattern of estrogen dominance is low progesterone.
In this case, estrogen levels are normal or even low (as in the case of menopausal or perimenopausal women). However, an even lower progesterone level still results in a pattern of relative estrogen dominance.
This can cause some of the same symptoms as excess estrogen (anxiety, irritability, heavy and painful periods, weight gain, PMS, fibroids, fibrocystic breasts, etc.).
Low progesterone can also be a culprit in unexplained infertility or early term miscarriage, as progesterone maintains the uterine lining in pregnancy.
Progesterone is released from the ovaries after ovulation. Lack of ovulation, therefore, is a primary reason for low progesterone levels. Anovulatory cycles can occur in women with polycystic ovarian syndrome, women with high levels of physical and emotional stress, or women entering menopause.
Some progesterone, however, is also made in the adrenal glands, where it can be eventually turned into cortisol, aldosterone (a steroid hormone involved in salt-water balance in the body) and androstenedione (a male sex hormone), eventually making testosterone and estrogen.
Women with high cortisol demands due to chronic stress may shunt the progesterone made in their adrenal glands to producing other hormones that support the stress response.
Not only can stress alter ovulation and fertility through various other mechanisms, it can also rob the body of progesterone, directing any progesterone made towards cortisol production.
Testing Estrogen and Progesterone
Estrogen and progesterone can be tested reliably in saliva, blood and urine.
Month long salivary hormone testing of estrogen and progesterone can be an easy and effective way to track the eb and flow of these hormones throughout a women’s menstrual cycles.
In this test, women obtain a saliva sample every 3 to 5 days for the duration of the month to track how estrogen levels corresponds with progesterone and how both hormones rise and fall.
In my practice, however, I often start by running blood tests. I test hormones on day 21 (of a 28-day cycle) to coincide with progesterone’s peak. This can help us calculate the progesterone to estrogen ratio and establish whether the cause of estrogen dominance symptoms is high estrogen or low progesterone.
Blood tests offer the option of looking at estrone, which is a more problematic form of estrogen, as well as estradiol (the most common, metabolically active estrogen in the body). In blood we can also look at LH and FSH, two hormones produced in the brain and ovaries that orchestrate ovulation.
FSH tends to be high in women in menopause or perimenopause, while LH tends to be elevated in women with Polycystic Ovarian Syndrome (PCOS).
Dried urinary metabolite testing, or DUTCH, is an effective way to understand how hormones are broken down and processed by the body. Looking at the entire hormone breakdown pathway provides a more in-depth look at the complexity of hormones in a woman’s cycle, and can guide treatment in specific, useful ways.
The “Male” Hormones: Testosterone
Polycystic Ovarian Syndrome (PCOS) is one of the most common causes of infertility (and the most common endocrine disorder) in women of reproductive age. It affects about 10% of menstruating women.
PCOS is a collection of various symptoms and complex hormonal causes. However, it is characterized by missed periods, anovulation, male-pattern facial hair growth, especially on the upper lip, chin, breasts and abdomen, and the presence of cysts on the ovaries.
Other common symptoms of PCOS are weight gain, estrogen dominance, male-pattern hair loss (on the crown of the head), insulin resistance, infertility, and acne, especially hormonal cystic acne on the jawline.
PCOS is characterized by elevated levels of testosterone, a male sex hormone, or “androgen”, on blood work.
Acne, weight gain, infertility, and hair loss are the main symptoms that bring women with PCOS into my office.
PCOS is a complex process that involves an overproduction of testosterone in the ovaries coupled with insulin resistance. Therefore, balancing blood sugar through diet and lifestyle can have a major impact on symptoms.
The conventional treatment for missed or absent periods is oral contraceptives, which of course doesn’t treat the underlying cause of anovulation. That’s why women with PCOS often seek naturopathic and functional medical solutions to treat the root cause.
Testing for PCOS
When I meet a new patient with PCOS, I often test her blood for estradiol and progesterone levels at Day 21 of her cycle. A very low progesterone level may indicate that she has not ovulated that cycle.
We also test LH and FSH. A high LH:FSH ratio can be indicative of PCOS even if cysts are not present on an ovarian ultrasound.
Other important tests that are often ordered are free testosterone and DHEA-S, another male hormone made in the adrenal glands.
Glucose control and insulin resistance can be assessed by looking at fasting blood glucose, fasting insulin and HbA1c (a marker that looks at long-term glucose control).
Prolactin, another hormone released by the pituitary gland, can sometimes be elevated in anovulatory women with PCOS.
A 4-point salivary cortisol test may be useful in women with PCOS who are also experiencing symptoms of cortisol dysregulation, which can contribute to insulin resistance and affect ovulation and hormone regulation, particularly progesterone production.
Prolactin
Prolactin is a hormone released by the pituitary gland to promote milk production after child birth.
However, some women will have elevated levels of prolactin in blood, despite not currently pregnant or breastfeeding.
Called hyperprolactinemia, elevated prolactin may be a cause of anovulation, mimicking some symptoms of PCOS and menopause, including hot flashes, absent or irregular periods, infertility and even milk discharge from the breasts.
Hyperprolactinemia may be caused by low calorie diets, liver issues, hypothyroidism, and issues with the pituitary gland itself.
Prolactin can be tested in blood. If levels are elevated, an MRI must be conducted to rule out a physical issue with the pituitary gland, such as a tumour.
Oxytocin
Oxytocin is a hormone produced in the brain and secreted by the pituitary. It aids in childbirth. Also termed the “love hormone,” it’s associated with feelings of intimacy and connection.
While high and low levels of blood oxytocin can be possible in men and women who are not pregnant or breastfeeding, the clinical applications of it are not fully known.
Thyroid Hormones
The thyroid, a butterfly-shaped gland on our neck, is the master thermostat of the body, controlling heat and metabolism. It pumps out thyroid hormones T4 and T3, which tell cells to burn fuel, creating energy and heat.
Because our thyroid hormones interact with the cells in every body system, symptoms of hypothyroidism, or low thyroid function, can be incredibly diverse.
Common symptoms of hypothyroidism are weight gain or inability to lose weight, fatigue and sluggishness, brain fog, hair loss, low body temperature, constipation, dry skin and hair, puffiness, infertility, and altered menstrual cycles, such as missed periods or heavy periods.
Aside from autoimmunity, other causes of low thyroid function can be HPA axis dysregulation and chronic stress, a very low calorie or very low carbohydrate diet, sudden weight loss, a deficiency in nutrients needed for thyroid function such as iron, zinc, iodine and selenium, and a body burden of environmental toxins such as heavy metals.
Testing Thyroid
To assess thyroid function, conventional doctors will test a hormone called Thyroid Stimulating Hormone, or TSH. TSH is not a thyroid hormone, but a hormone made in the brain that urges the thyroid to pump out the thyroid hormones T3 and T4. It gives doctors an indirect measure of thyroid regulation.
When TSH levels are high, this suggests that thyroid function is sluggish; the brain needs to send a louder signal to get an unresponsive thyroid to work.
However, TSH is only a periphery marker of total thyroid function, not giving us the whole picture. Also, TSH ranges on conventional lab tests may fail to pick up some cases of subclinical hypothyroidism or impending cases of autoimmune thyroid conditions, otherwise termed Hashimoto’s Thyroiditis, which is the most common cause of hypothyroidism.
To properly assess thyroid function in someone with symptoms of thyroid dysfunction, a slightly elevated TSH, or a family history of Hashimoto’s, I will order a thyroid panel: a blood test measuring TSH as well free thyroid hormone (T3 and T4) levels.
It’s also important to assess for autoimmune thyroid conditions by testing for anti-thyroglobulin and anti-thyroperoxidase antibodies. Both of these antibodies, when elevated, suggest the presence of an autoimmune thyroid condition.
Insulin
Some of the most common hormonal dysfunctions I see in my practice are insulin resistance and reactive hypoglycemia: blood sugar imbalance.
These issues often lie at the heart of other hormonal imbalance patterns, such as irregular menstrual cycles or HPA axis dysregulation.
When we eat, glucose enters our bloodstream, providing fuel for our cells. Insulin helps our cells access this hormone, spiking with each meal.
The higher the meal is on the glycemic index (i.e. the more sugar or refined carbohydrate it contains), the higher our post-meal blood sugar and insulin spikes will be.
Without insulin, we would slowly lose energy and die, unable to get precious glucose into our cells. Individuals with type I diabetes cannot make insulin. They must inject it daily to keep their cells fuelled and blood sugar stable.
For the rest of us who do make insulin, large blood sugar spikes after a meal can be problematic.
Insulin is a storage hormone. It helps energy get into cells, and it helps build muscle and brain cells, but it also blocks the breakdown of fat cells, blocking weight loss.
Insulin also drives down blood sugar levels. When blood sugar rises too quickly after a meal, a large insulin response can drop blood sugar levels too drastically, causing reactive hypoglycemia, or feeling “hangry” (hungry, angry, irritable, tired, light-headed, weak and dizzy) in between meals.
Individuals who experience hypoglycemia feel irritable, shaky, dizzy and anxious between meals. They often suffer from anxiety and panic attacks, and feel hungrier at night.
They may wake up in the middle of the night, as their bodies are unable to go 8 hours (the length of a decent night’s sleep) without food. This causes them to wake up, restless and perhaps anxious, in the early hours of the morning.
These individuals, paradoxically, rarely feel hungry at breakfast time.
I often see anxious patients wake from a restless sleep and toss back only a coffee in the morning, skipping breakfast due to slight morning nausea.
At 10 am, feeling ravenous and shaky, they might scarf down a high-glycemic bagel or croissant. Later on, they’ll enjoy a light lunch—maybe a sandwich—often feeling foggy and lightheaded after eating it.
At 2 to 4 pm, they may feel like an afternoon nap, instead indulging in a coffee and sweet treat to buy them some energy for the remaining hours of the work day.
Finally, after enjoying a larger dinner once they get home, they find themselves snacking all night long. Their bodies are finally urging them to ingest the nutrients they were lacking throughout the day.
They then fall into bed, feeling full, restless and wired, and the cycle begins again.
When our blood sugar falls, we not only feel hangry, weak, and crave processed carbs, our HPA axis also gets stimulated.
Cortisol, a glucocorticoid, can help our body control blood sugar, bringing it into the normal range after insulin sends it tanking too low.
This drop in blood sugar, therefore, needlessly triggers a stress response from the adrenal glands, which can further worsen anxiety, HPA axis dysregulation, and glucocorticoid resistance.
When blood sugar and insulin are spiked repeatedly for days, months, and years on end, cells stop responding attentively to insulin’s signal. Like our response to a pesky telemarketer, cells eventually stop picking up the phone when insulin calls.
However, cells still need insulin. More and more insulin must be released to trigger the same response from insulin resistant cells. This makes cells even more resistant, as they require even more insulin release the next time blood sugar rises to get glucose into the cell for fuel. And so the cycle becomes vicious.
Elevated insulin levels cause inflammation, fat gain, fatigue, depression, reactive hypoglycemia, and HPA axis dysregulation. The more resistant our cells become to insulin, the more cortisol must be called on to maintain blood sugar levels.
PCOS is also characterized by higher insulin levels. This prevents ovulation, causing infertility and female hormone imbalance.
When insulin resistance persists, type II diabetes, where the body is no longer able to keep blood sugar in a safe range, develops.
Type II diabetes is characterized by chronically high blood sugar—which poses a danger to small blood vessels, and is a potent inflammatory condition, increasing the risk of heart disease—and elevated insulin.
It affects almost 10% of the adult population and is the 7th leading underlying cause of death in North America, costing 350 billion dollars a year to manage in the United States alone.
Insulin-related weight gain can affect female hormones, as fat cells make estrogen in the body, leading to estrogen dominance.
Insulin also interacts with a hormone called leptin, which is created by fat cells in response to calorie intake. When body fat levels get too high, cells can become leptin resistant. The body no longer senses dietary calorie intake, leading to increased hunger. This exacerbates the problem of weight gain and insulin resistance.
Testing for Insulin Resistance
When I meet a patient who is presenting with stubborn weight gain, estrogen dominance and stress, I assess their blood for insulin resistance by looking at blood levels of fasting insulin and fasting glucose.
With these two values a calculation that measures insulin resistance, called the HOMA-IR, can be performed. This can give us a baseline measure of how well the body is compensating to control blood glucose.
I also run HbA1c, which looks at glucose levels over 3 months. I will often run a blood cholesterol panel, and inflammatory markers, such as CRP.
Insulin resistance often puts all of our hormones on a rollercoaster, which becomes very difficult to get off of unless we prioritize the diet and lifestyle interventions that address blood sugar control.
Assessing Hormones
When presented with a patient suffering from a complicated symptom pattern, I begin by taking a thorough health history in which we investigate:
Energy levels,
Sleep quantity and quality,
Mood and mental health history,
Period health history,
Family history,
Dietary intake and exercise,
Health risk factors like smoking, alcohol use, and past health history.
Depending on how clear the patient’s symptom picture presents, we may opt to make some changes before testing, to gauge their body’s response to an increase in nutrient intake.
Then, if necessary, I will order a comprehensive blood work.
Blood testing might include a thyroid hormone panel, and an in-depth look at female hormones, fasting insulin and fasting blood glucose, and other markers that help us assess health, such as cholesterol and inflammatory markers, or nutrient levels.
Patients requiring a more comprehensive view of their cycles may opt for month-long salivary testing. Others may opt for a dried urine test that looks at hormonal breakdown in the body.
A Sample Case
Jenny (name changed for privacy) came to me feeling fatigued and anxious.
She had suffered from anxiety periodically as a teen, but now at age 46 she was experiencing bimonthly panic attacks that seemed to occur cyclically; the panic would come around ovulation and premenstrually.
It was hard to tell, however, because Jenny also claimed that her periods were “all over the place”. One month they were heavy and painful, causing her to take time off work, crouched on the bathroom floor in agony. Other months she barely noticed them, experiencing some light spotting, if anything at all.
Very troubling to her was her major mood volatility, which she described like a “switch” that would suddenly flip on or off, causing her to breakdown at work or pick fights with her family.
Then, almost as suddenly, the cloud would lift and she would be her cheerful, friendly, loving self again.
It was maddening, both to her and those living with her during these darks times, she said.
She also noticed disrupted sleep and weight gain around the abdomen, which seemed to ignore her intense workouts and strict dietary regime.
Jenny was highly accomplished at her high-pressure job and commented that she thrived on being busy and achievement oriented.
I tested Jenny’s blood estradiol, estrone, progesterone, LH, and FSH levels one week before her next expected period, had her fill out a weekly diet diary, and gave her some recommendations about sleep and supplement intake.
Jenny’s blood revealed elevated FSH, indicative of impending menopause (FSH encourages the ovaries to ovulate, as TSH encourages the thyroid gland to make thyroid hormone). She also had low estradiol, and low progesterone, but elevated levels of estrone, the more problematic of the estrogens.
According to her labs and history, Jenny was experiencing estrogen dominance and perimenopause. Many of her symptoms were stemming from elevated estrone, low progesterone and a disrupted HPA axis.
Together, we worked on her diet to provide her body with the nutrients needed to make hormones and to support her brain, mood and adrenal glands.
We used herbs and dietary nutrients to promote liver estrogen clearance and to support Jenny’s adrenal glands.
We addressed the stress in her life, encouraged relaxation, and made sure her body was supported in its ability to make and respond to cortisol.
After a few months, Jenny reported a reduction in hot flashes, better sleep and feeling calmer. She had a reduction in her waist line and better energy and mood.
Our hormones, when imbalanced, can cause vicious cycles in the body that trap us in a state of worsening imbalance.
Through correctly assessing these common hormonal patterns through a health history and appropriate testing, and then making diet, lifestyle and supplement suggestions addressed at stopping these cycles, naturopathic doctors can address underlying hormonal issues that might be causing these complex and troublesome patterns of hormone disruption.
I review my adventurous year of living on the Low Carb High Fat Ketogenic Diet.
I’ve always had a sweet tooth.
I remember binging on Halloween candy as a kid, stuffing one tiny chocolate bar after another into my mouth, as fast as my little fingers could unwrap them, trapped in some kind of sugar-filled trance.
“Never get between Talia and her food!” My family would joke when my blood sugar would crash between meals and I’d rage towards the fridge for a snack to keep me sane.
I remember digging into the little bags of cheese popcorn reserved for school lunches, finishing off one after another and then hiding the wrappers in their big Costco box so that it would look like it was still full, the way rebellious teens top up empty vodka bottles with water.
I can gain weight with the drop of a hat (but also put on muscle fairly easily), and it takes concentrated effort and dedication to take it off.
After a period of temporary stress and bagel-related weight gain, I decided to embark on a bit of experimentation. Work was getting busy and I wanted to supply my brain with constant energy without having to take snack breaks every few hours. Also enticed by anecdotes of shattered weight loss plateaus, I decided to “go Keto”.
I like experimenting with diet. Like many health-conscious people, finding the right nutrition regime for me has been a process. In my teens I started controlling portions and switching out white breads for whole grain rye and Jolly Ranchers for carrot sticks. In my early 20’s, I was vegetarian. I tried being vegan for a while before deciding it was a disaster for my health when I began to experience nutrient deficiencies, weight gain, and hormonal issues.
Later on, I followed my naturopathic school classmates to a modified Paleo diet (keeping in some gluten-free grains and legumes), then moved to a more traditional Paleo diet (taking out the grains and legumes), before going back to the modified version (which is probably the best eating style for me—more on that later).
For the most part, my diet is comprised of whole foods, with lots of vegetables, but in the Fall of 2016, when this all began, I was in a pretty Standard North American place when it came to food intake. At the time I was suffering from IBS, some issues related to subclinical PCOS, and fatigue. I was also starting to see some signs of impaired glucose control.I wasn’t feeling good and I was in need of a kind of reset of sorts.
I was interested in seeing how relying on ketone bodies for fuel would help my body, mental performance, and improve my blood glucose control and symptoms. I have a family history of type II diabetes and I wanted to do what I could to prevent insulin resistance and metabolic syndrome. Drastic times call for drastic measures, I thought.
Ergo, The Ketogenic Diet.
About the Diet:
The Classic Ketogenic Diet was first developed in the 1920’s to treat children with medication-resistant epilepsy.
When our brains are starved of glucose, their preferred fuel source (our brains use up 60% of the body’s glucose), the liver creates ketone bodies from stored or dietary fat that the brain can use as a substitute source of energy.
One of these ketone bodies, beta-hydroxybutyrate, is thought to be a particularly therapeutic molecule for the brain, conveying anti-convulsive benefits, thereby helping to reduce the incidence of seizures in children who don’t respond to medication.
However, the original Ketogenic diet is more extreme than the general health and weight loss-aimed diet we see described in recipe books these days. The Classic Ketogenic diet consists of about 90% of calories coming from fat. In order to achieve that, followers need to severely restrict their protein intake, and virtually eliminate all dietary sources of carbohydrate, which drastically limits their nutrition choices.
Since, the benefits of beta-hydroxybutyrate are being studied for other neurological disorders, such as Parkinson’s disease, dementia, migraine headaches and narcolepsy. It’s being looked at as a potential treatment for mental health conditions, like autism and depression, and metabolic disorders such as type II diabetes, and even to increase the efficacy of chemotherapy and radiation treatments in cancer. Other studies are looking at its role in improving cognitive function in mice and humans.
Some research shows that beta-hydroxybutyrate can expand lifespan by interacting with genes that slow aging. It is also shown to confer anti-inflammatory and antioxidant benefits.
In the 1970’s, Dr. Atkins responded to the high-carbohydrate, low-fat dogma of the nutrition world at the time, by bringing a modified Ketogenic diet into vogue. Restricting all forms of carbohydrates and encouraging a consumption of the still-vilified high-fat foods like bacon, eggs and cheese, Atkins affirmed that people could lose weight by eating fat, as long as they restricted carbohydrates at the same time.
The modern version of the Ketogenic Diet is slightly more health-conscious, promoting a higher intake of vegetables. The current diet restricts carbohydrates to under 20 to 50 grams per day, and encourages a high fat intake and a moderate protein intake, in order to encourage the body to turn to fat as its primary source of fuel. The current version of “Keto” is less strict than it’s initial epilepsy-treating incarnation, with anywhere from 60-85% of its calories coming from fat.
My Version of Keto:
I started the whole journey by tracking my food intake (using My Fitness Pal). My aim was to consume 20 grams of net carbs, or less, per day to push my body into using fat-turned-to-ketone bodies as a its primary fuel source.
Net carbs are calculated by subtracting dietary fibre from total grams of carbohydrates. For example, 1 cup of raw broccoli contains 6 grams of carbs. 2.5 of those are fibre. Therefore, the net carbs in broccoli are 3.5, which would count towards my net carb goal of 20 grams per day.
This isn’t easy. Take a look at any package of food you regularly consume. 1 cup of cooked oatmeal contains 23 grams of net carbs: 3 grams over my entire daily allotment. Therefore all high-carb foods like grains, legumes, starchy nuts, all fruits, and some starchier vegetables, were off limits.
Many people opt to test their blood, breath or urine for ketone bodies to determine whether or not their bodies are in ketosis. I dabbled in this, using the urinalysis strips in my clinic to test for urinary ketones. However, even though I was sticking to the diet, the strips would mostly turn up negative for ketones.
There are a few reasons why ketone strips may not be a reliable marker for ketosis. Firstly, the don’t test for beta-hydroxybutyrate, which is the main ketone body utilized by the brain, but acetoacetate, another ketone body produced in the liver.
Secondly, urinalysis strips only test for urine ketone spillover. They don’t necessarily reflect blood levels, and they won’t pick up the ketones that are being utilized as fuel by the body. If cells are absorbing all the ketones the liver produces, urine testing may not be positive.
The most accurate, albeit more expensive, method for testing ketone bodies is through a skin-prick test that analyzes blood levels of beta-hydroxybutyrate.
While I knew that the urine strips weren’t highly accurate, not having my state of ketosis validated was discouraging. I was often left in doubt over whether things were “working”. I wondered if there was some other mechanism going on. Was my body finding carbohydrates from someplace else? Did I have Small Intestinal Bacteria Overgrowth that was digesting my fibre and allowing me to absorb it somehow? Were my blood ketones being used up somewhere else (by the yeast in my gut, for instance)?
I did have signs of being in ketosis that I could watch for, however. When I avoid carbs, or fast for a few days, I start to develop a metallic taste on the tip of my tongue. It’s not a common sign of ketosis, a more common sign is a “nail polish” or “paint thinner” taste in the back of the throat, but still a symptom that some people report.
Keto Flu:
During the first few days of switching to Low Carb High Fat, I had to white knuckle through a phase realistically termed the “Keto or Low Carb Flu”. This horrible phenomenon is thought to be a result of the body switching from burning glucose as its primary fuel source to adapting to ketone body production. There is often a painful adjustment period for brains that have to learn how to rely on ketones for their main fuel source after a lifetime of glucose abundance.
It was nasty. I felt intense hunger and sugar cravings, nausea, dizziness, and weakness—it truly was a “flu”.
I knew that I had spent most, if not all, of my life as a sugar burner. Before Keto, I would crave food even just two hours after a full meal. I would often feel “hangry”: dizzy and shaky in between meals, and irritable if made to wait for food for too long. I had been existing between carb-dense meals, experiencing insanity-inducing reactive hypoglycemia between my regular sugar fixes.
The more I read about others’ experiences, the more I was assured that the keto flu symptoms were actually a sign of my body healing. I was becoming adapted to other fuel sources, which was a good thing, I thought.
So, I muscled through and followed the online advice: I consumed more fat to provide more fuel to my brain, including medium chain triglyceride (MCT) oil, which is quickly absorbed by the lymphatic system and turned into ketones by the liver, and I consumed electrolytes, which are more rapidly excreted from the bodies of low carb dieters.
For some people, Keto flu can last for days, for others it lasts weeks. For me, the Keto flu thankfully only lasted two days, after which my body began to adjust and my cravings for sugar went down. I began to feel more energy, which felt encouraging.
Daily Meal Plan:
For breakfast, I would typically eat a high-fat smoothie containing coconut milk yogurt, gelatin, and avocado, and topped with pumpkin seeds and cacao. Sometimes I’d make fat bombs or homemade unsweetened chocolate.
I’d have my second meal of the day in the mid-afternoon, around 2 to 3 pm, for which I’d consume a few cups of cruciferous vegetables, like broccoli or cabbage, with a fatty cut of meat like ground beef, chicken thighs, or salmon, all topped with liberal amounts of fat from coconut, olives, avocados, or grass-fed ghee. I made a lot of batch-cooked grain-free curries and stews.
If I had a third meal or snack in the day, it would be another serving of fat: a handful of macadamia nuts or a hunk of creamed coconut.
Eating this way made me feel like Obama and his grey suits—I didn’t have to plan my meals too carefully. All I had to do was eat fat. My food was so calorie dense and my blood sugar so stable that I didn’t need to eat often. This meant that I didn’t need to worry about bringing food with me everywhere I went; one meal could satiate me for half the day. Hunger was never an emergency situation, as it had been in the past. Hunger would come on very slowly, and it would never be “hanger”; my already low blood sugar had nowhere to dip to. If I needed more food, I could always wait until I got home to eat.
More Benefits:
Within a few days, my PCOS- related cystic acne cleared. I also felt slimmer as some water retention deflated. This felt good. Our body stores carbohydrate in the form of glycogen in the liver and muscles. Glycogen stores retain water.
When glycogen stores are used up, a rapid 5 or more pound drop in weight can occur. This is the “water weight” that people talk about losing when they first begin some kind of nutrition plan.
It’s also common to notice a drop in water weight from a decrease in inflammation, when embarking on a new eating plan. I know that I am sensitive to certain carbs and dairy and, because those things were out of my diet overall (although Keto can certainly include high-fat dairy products for those who can tolerate them), the water retention caused by chronic inflammation seemed to clear.
Although it seems to attract people primarily for its hip-slimming potential, the Ketogenic diet probably does not cause weight loss in and of itself. Instead, the diet encourages a passive reduction in calories by stabilizing blood sugar and insulin levels, while promoting the intake of highly satiating foods containing protein and fat. Ketone bodies also have appetite-suppressing effects. Therefore, it’s probably a calorie deficit that causes the weight loss, rather than any specific biochemistry in the diet itself.
I didn’t lose much more weight than the water weight. However, my mood was brighter. I would wake up in the morning looking forward to the day, which often doesn’t happen in the winter. I felt more sustained energy throughout the day, and really enjoyed the decreased appetite, which led to more productivity.
I felt fine consuming two meals a day, able to get through hours of back-to-back patient visits without needing a snack or a break. It was actually incredible to need so few meals; it was like becoming another person, one no longer ruled by sugar cravings. I was like a camel, switching to stored fuel when the fat from my last meal had run out, and the transition was seamless. There was no wall to hit, and no hypoglcyemic crash to be seen.
I also noticed less bloating and digestive issues, probably from the lack of fermentation in my gut and the reduction in foods that tend to aggravate IBS, like certain vegetables, fruit, and legumes.
However, all was not roses on the Keto diet. While the first few months were dreamy, the longer I stayed on it the more I started to notice changes in my body that indicated the honeymoon period I was enjoying wasn’t going to last.
The Microbiome:
The research is in: human beings probably need 10 servings of fruits and vegetables a day (roughly 5 cups), or 800 g, a day to get the most heart disease, stroke and cancer-preventing benefits that diet can afford us. The International Journal of Epidemiology concluded that, if the correlations found in their February 2017 study were causal, almost 8 million lives might have been saved in 2013 if everyone in the world had simply consumed their fruits and veggies.
It’s one thing all diets, even the faddy ones, agree on—from the Paleo Peeps, to Plant-Based Hippies, to Raw Macrobiotic Sun Worshippers, to Whole Foods Michael Pollen Omnivores, to the dejected nagged-at husband pushing brusselsprouts around on his plate—fruit and vegetables are good for you. You should eat them. If you’re a typical North American, you should probably eat more than you’re eating. The health value of everything else we eat seems to be up for debate: red meat, saturated fat, soy, bread, coffee. The benefits of eating enough fruits and vegetables, however? There’s no contest.
It’s hard to pick one way in which fruits and vegetables are so health protective. It could be because of their high concentrations of micronutrients, reducing the risk of common nutrient deficiencies, like magnesium and vitamin C. It could be because, if you’re filling your body with a kilogram of fruits and vegetables a day, you probably aren’t scarfing down an entire medium-sized pizza and supersized orange pop as well—there just isn’t room. It could also be the antioxidants they contain that protect cells against free radical damage, protecting DNA. Or perhaps its the fermentable fibres present in fruits and vegetables that feed our invaluable microbiome.
The problem with keeping net carbs under 20 grams a day was that I needed to restrict my fruit and vegetable intake. I was eating no fruit at all, and staying away from the starchier veggies, like carrots and beets. I still stuck to my beloved leafy greens and crucifates, but even eating 2 to 3 cups of those guys a day would push me to the upper limits of my carbohydrate intake, which meant I couldn’t eat them as liberally as I had been.
Getting enough vegetables and (any) fruits on the keto diet is hard, if not impossible. This can impact our ability to get the micronutrients we need, but also enough fermentable fibres from vegetables like garlic, onions, yams, Jerusalem artichokes, and legumes, which provide food for our microbiome.
Feeding our gut bugs is important. They benefit us in numerous ways, from digesting out food, to calming inflammation, to fuelling gut cells by producing a short-chain fatty acid called butyrate. They help our immune systems function optimally. They produce neurotransmitters for our brains to work. They balance our stress responses and our circadian rhythms.
Jeff Leach, at the Human Microbiome Project speculates that the lack of dietary fibre in most low-carb diets may impact the health of the microbiome in negative ways by depriving the gut bacteria of their preferred food sources, as well as altering the acidity of the colon and intestines. He cites this article, in which obese subjects on a high-protein and low-carb diet had lower levels of butyrate in their bodies and intestines, likely due to decreased diversity in their guts.
There are, however, some studies that suggest that a Ketogenic diet can improve the microbiome in children with epilepsy, and autism, and some speculation by the researchers that that may be how the diets treat these conditions. However, since these studies are not done in “healthy” children, with an already healthy microbiota, it’s hard to extrapolate the findings to the healthy adult population.
Then there’s the fact that most studies that look at high fat diets and their impact on the microbiome are mostly done in rats. Of course, rats aren’t humans, despite there being relative genetic similarities. In these animal studies, researchers refer to “a high fat diet” when in fact they mean a high fat, high sugar diet. The sources of fat in these “high fat” mouse diets are often corn, margarine, or soy oil, which we know are highly inflammatory and offer few if any health benefits.
In other words, many studies on “high fat” diets are not looking at a relatively balanced Ketogenic diet that consists of vegetables, proteins, and healthy sources of fats from avocados, coconut, fish, olives, nuts and seeds and grass-fed meats.
Context is important as well. Is it the high fat diet that causes a reduction in gut diversity or the absence of fibre? This one mouse study showed that simply providing the mice with fibre in addition to their high fat diets decreased their risk of obesity.
I felt that my gut initially improved in the first few months on Keto: the diet was low in foods that aggravate me: namely refined carbs, sugar, gluten and dairy, as well as some of the fermentable fibres that can aggravate IBS. However, it never fully healed. After a few months, I started to notice the symptoms of bloating and digestive irregularities coming back.
Candida, a yeast that resides in the gut and can overgrow in the intestines in some people, especially the immunocompromised, causing symptoms of fatigue, IBS, and weight gain, among a variety of other symptoms, can survive on ketone bodies. Yeasts have mitochondria of their own. Some species of gut bacteria can consume protein, bile salts and even fats.
Contrary to what many claim, a Ketogenic diet doesn’t necessarily “starve out” the bad gut bugs. Combined with the lack of fibre to feed the beneficial gut bacteria and promote more bacterial diversity, a prolonged Ketogenic diet may be a recipe for gut dysbiosis.
Hormones:
Throughout my year spent in ketosis, I definitely noticed an improvement in my insulin signalling and glucose control, especially in the first few months. Looking at my blood work in March, after about a year of the Ketogenic diet (and then having been off it for a few months), my fasting insulin was very low and fasting blood glucose levels were in the low-optimal range. HOMA-IR, a calculation that is used as a marker of insulin resistance, was also low, indicating good insulin sensitivity.
I personally believe that this means that my risk for getting metabolic syndrome or type II diabetes is low, as long as I maintain this level of insulin sensitivity by watching the glycemic load of my diet and my stress levels.
The metabolic flexibility awarded to me from my year in ketosis also proved to be invaluable. Now, I no longer fear fasting and I can survive on other fuel sources besides sugar. My brain knows how to tap into stored and dietary fat more efficiently, and use those for energy. Even when not following any sort of low-carb diet, I noticed that I could survive between meals while travelling in Southeast Asia for two months, whereas normally I would have had to exist on unhealthy, sugary snacks.
However, after a few months on the diet, I began to notice a decline in my menstrual health. My cycles began to get longer, and soon I started missing periods. I noticed more hair falling out in the shower and more cystic acne developing on my chin. When I ran my blood estrogen and progesterone levels, I was surprised to see that their levels were very low.
We know that insulin, while often vilified as a “fat storage” hormone is actually responsible for storing everything, including nutrients. It also correlates with estrogen levels and the conversion of T4, one of our thyroid hormones, to its active friend, T3, which runs our metabolism. Insulin builds muscle, bone and brain cells. Very low insulin levels, in my case, were contributing to amenorrhea and a disruption in my sex hormones.
This wasn’t good.
While not quite the same as Intermittent Fasting (IF), Keto is often grouped into the same category because of its similar impact on blood glucose and insulin. The difference is that Intermittent Fasting induces ketosis through periodic food restriction, as opposed to carb restriction. Keto and IF often go hand in hand, however. The reduced hunger and high-nutrient density of the foods eaten on a Ketogenic diet often lend well to practicing intermittent fasting. It did in my case—I was only eating two main meals a day.
I always found it interesting, however, that most proponents of intermittent fasting are men. The male body appears to thrive in the fasted state, getting a boost of growth hormone and norepinephrine, both of which provide men with energy, motivation, and an improved sense of well-being.
This hormonal change may be a remnant of our ancestral hunter-gatherer days where it would be an advantage to feel motivated and energized to go out and hunt during periods of food scarcity.
I don’t think female bodies experience exactly the same effect. Some preliminary animal research tends to suggest that as well.
A few rat studies indicate that fasting may impair female insulin sensitivity, and induce amenorrhea, or missed periods. Female bodies rely on a consistent influx of calories and carbohydrates to stimulate insulin, which plays a role in stimulating thyroid hormones and estrogen, to continue to ovulate. Another study showed that fasting tended to “masculinize” female rats, lowering their female hormones, and increasing their levels of androgens, the male sex hormones, like testosterone.
Of course, these studies were done on fasted rats, which cannot be fully translated to the effects of Intermittent Fasting and Ketogenic diets on women. However, some of these findings did validate my experience, which certainly wasn’t being validated in the podcasts and blog posts I was exposed to, largely written and followed by men.
I did experience positive hormonal effects: the increased insulin sensitivity and lowered blood glucose. However, I was not happy about my irregular cycles and estrogen deficiency.
Therefore, I decided to increase my carbohydrate intake, returning to a more moderate Paleo diet that consists of some fruit, starchier vegetables and legumes. After a few months, my periods returned to normal, my skin cleared up, my hair stopped falling out, and my thyroid hormones, estrogen and progesterone levels all returned to their optimal ranges.
I have still have low fasting insulin levels, suggesting that the Ketogenic diet did help to reset my insulin sensitivity and that this effect may be lasting.
Metabolic Health:
After a year of doing the Ketogenic diet, and then a few months of returning to a moderate-carb paleo diet, I tested my cholesterol levels and inflammatory markers. My HDL cholesterol (the “good” cholesterol, to put it very simply) was high, my triglycerides (a risk factor for heart disease) were very low, and my LDL cholesterol (the “bad” cholesterol that statin drugs target) was also low. My inflammatory markers: C-Reactive Protein (CRP) and erythrocyte sedimentation rate (ESR), were also low.
While it is typically the monounsaturated fats, like olive oils and avocados, that are associated with increased levels of the heart-protective HDL cholesterol, even saturated fats from coconut oil can raise HDL. LDL is often lowered by these healthy monounsaturated fats, however saturated fats, even healthy ones, can raise LDL in certain individuals.
All else being equal, higher levels of LDL may not be as big of a problem as we think. Especially in the context of low risk factors, like low inflammation, absence of smoking and a healthy body weight. What’s more, the triglycerides and cholesterol/HDL ratio may be more important factors for determining heart disease risk. Further, assessing LDL particle size may also provide those concerned about their LDL levels with more information concerning their cardiovascular health. That being said, it is important to be aware that some of the fats present in a Ketogenic diet have the potential to raise blood levels of LDL in certain susceptible individuals, and that not everyone’s blood lipid results will look like mine.
Triglyceride levels are associated with liver function, and generally reflect dietary sugar, fructose and refined carbohydrate intake, rather than fat intake. Reducing refined dietary carbohydrates like white grains, flours and sugars is a good strategy for reducing triglyceride levels and reducing heart disease risk.
Some individuals can experience elevated levels of inflammation on a Ketogenic diet, depending on the quality of foods consumed. A Ketogenic diet low in fibre that fails to feed the microbiome; high in foods that a person may have an individualized sensitivity to (such as dairy, eggs, nuts or soy); or high in inflammatory fats like trans fats, and industrial oils like canola and corn oil, may all contribute to increased inflammation.
That being said, certain ketone bodies like beta-hydroxybutyrate may have anti-inflammatory properties. Many of the fats consumed in a mindful, whole foods Ketogenic diet, such as olives, avocados, seeds, salmon, and coconut, are also anti-inflammatory.
I found my blood markers a good indicator of the power of a high-fat, low-carb diet to, at least in my case, improve HDL cholesterol and lower triglycerides, fasting insulin and fasting glucose levels. Whether I needed an entire year in ketosis, or whether I even needed to actually enter ketosis to receive these benefits, isn’t clear. Perhaps I could have gotten the same results by moderately lowering my carb intake while increasing my dietary intake of healthy fats.
Modified Ketogenic Diets:
While I do think I benefitted from entering into ketosis, I would not necessarily recommend a Ketogenic diet to patients unless to achieve some sort of therapeutic goal, such as improved insulin resistance, or for adjunct cancer care, to reduce inflammation, or to improve severe depression, migraines, or narcolepsy.
However, there may be a benefit to cyclical Ketogenic diets for memory and cognition, and increased life span in mice. Cyclical Ketogenic diets involve entering ketosis on alternate weeks. On the other weeks, participants return to a normal, whole foods diet that contains higher amounts of carbohydrates. In this case, individuals gets the benefits of beta-hydroxybutyrate production and increased metabolic flexibility on their weeks on, while also being able to eat a high amount of fermentable carbs and fibres on their weeks off, essentially getting the best of both worlds.
Adding medium chain triglycerides to food may also confer health benefits, similar to being on a Ketogenic diet. One study showed that adding MCT oil to a high-carb breakfast (pasta), reduced appetite in men. This is likely because, after burning through the glucose in the pasta, the men’s brains were able to access the ketone bodies that were made readily available by burning the MCT oil. This kept their brains fuelled and their bodies satiated for longer.
The men eating pasta and MCT oil in the study had a ketone blood level of 0.3, which is similar to that obtained from a diet that derives 10% of its calories from carbohydrates, which is an essentially a very low-carb, if not Ketogenic, diet. This may indicate that simply adding MCT oil to a moderate to low-carbohydrate diet, may confer some of the benefits of having a slightly higher rate of circulating ketone bodies without having to follow a strict diet. Again, following this strategy, you can get the best of both worlds: consume a diet high in fibre, while also getting a steady flow of ketone bodies to the brain.
Other interesting areas of research are the use of supplemental, or exogenous, ketones for therapeutic use, however the area is new and not something I currently recommend in my practice (although this may change when more research begins to emerge and better supplements enter the market).
My Plan Moving Forward?
I’m happy that I gave the Ketogenic diet a try, but now I’m back to my more modified Paleo diet, aimed at promoting gut health, optimizing my micronutrient intake, regulating hormones, and supporting my energy levels. I now consume berries and apples, legumes, starchier vegetables and lean proteins more often and aim to get 10 servings of fruits and vegetables a day, with 8 to 9 of servings coming from vegetables, as opposed to fruit.
I currently start my day with a smoothie with berries, an avocado, spinach and protein powder. For lunch I have some sort of protein, fat, and tons of veggies. I eat more often than when I was in ketosis: about 3 meals a day with a vegetable and fat as a snack, or no snack at all in between, depending on my schedule.
My total daily carbohydrate intake falls around 100 grams a day with a net carb intake between 50 to 70 grams a day, depending on the fibre content of the vegetables, seeds, and legumes I’ve eaten that day. I try to get upwards of 30 grams of dietary fibre per day.
I avoid all sugar, including sweeter fruits like tropical fruits, and dried fruits, like dates. I especially stay away from refined sugars, even “natural” coconut sugars and agave. I avoid processed carbohydrates and flours. I mostly avoid grains, except when travelling or visiting someone’s house, getting my carbs from starchy vegetables and tubers, legumes and berries. I continue to avoid dairy (which I’m sensitive to), gluten, and processed industrial oils like canola, corn, and soy oil.
Right now, rather than focussing on macronutrient ratios, I’m directing my food intake towards obtaining the Recommended Daily Allowances of the micronutrients that run all of our cellular reactions, and the fibres that feed a healthy gut microbiota. I use an app called Cronometer to track this.
I definitely eat more fat than before, adding MCT oil to my morning smoothie, especially on days when I need to stay full and focused for longer. I also aim to do at least 12 hours of fasting a day, trying to get in 16-18 hour fasts where I can, ending dinner at 4pm, for example. I no longer do regular long bouts of Intermittent Fasting, particularly not when I’m feeling stressed and burnt out.
Would I Recommend the Ketogenic Diet to Patients?
One of the main tenants of Naturopathic Medicine is “Do no harm”. While it may seem like making diet and lifestyle recommendations are relatively benign therapies, I believe that they do have the potential to do physical and psychological harm, particularly if they are strict recommendations.
Following a strict diet may have health benefits, but it also may isolate us from friends and family, frustrate us and restrict our intake of certain nutrients, like fibre, vitamins and minerals. This is one of the reasons I do not ever advocate a Vegan diet, although if patients are following one already, I believe in guiding them to optimize their nutrient intake.
Furthermore, at least in my personal experience, the cure was stronger than the disease. I probably didn’t need to do the Ketogenic diet for so long; this was evidenced by the hormonal imbalances that I began to experience towards the end of my year on the diet.
However, particularly for patients who are suffering from metabolic syndrome, type II diabetes and insulin resistance or PCOS, there may be some powerful benefits to entering ketosis in order to dramatically reverse metabolic dysfunction. In this case, a modified regime combining Intermittent Fasting and cyclical Ketogenic diets could be beneficial.
Of course, it all depends on where patients are at in their nutrition journeys. Sometimes I meet patients who require, and respond well to, more heroic lifestyle interventions. Other times I meet patients relying on several sugary treats a day to get them through. In these cases, simply tweaking their diet in small ways, using baby steps may also have powerful disease-risk-reversing effects.
Since publising the original article about the Mirena IUD on this blog, thousands of women have come out of the woodwork writing to me asking for help.
When I originally wrote the article, I was spurned on by my observations of the women in my practice who had experienced a rise in estrogen dominance and low progesterone after the insertion of their IUDs (which were often inserted to treat hormone imbalances!).
At that point I never imagined that so many women would be affected by the IUD, or that even more were suffering from so many hormonal symptoms that drastically affected their lives and health.
It makes sense: our society does not set us up for proper hormonal function.
Our diets are carbohydrate-heavy, promoting insulin resistance and blood sugar dysregulation, which impacts our ovaries’ ability to make estrogen properly.
An excess amount of body fat produces more estrogen in the body and acts as a reservoir for the toxic estrogens in our environment.
We lack many of the micronutrients necessary to process our hormones properly, such as vitamin D, B vitamins, magnesium, zinc, omega 3 fatty acids, glutathione, and amino acids.
Many of us have impaired or suboptimal liver function, or sluggish digestion, which keeps hormones in our bodies around longer than they should be.
A dysbiotic gut has the tendency to turn estrogen in the gut back “on”, putting it back into circulation when it was otherwise on its way out of the body.
Stress alters our hormonal function, including our ability to make progesterone, DHEA-S, convert thyroid hormones, and process estrogen properly.
Xenoestrogens in our food and environment, from plastics, fragrances, pesticides, and processed soy products, contribute to overall body burden of the hormones in our body, throwing off our delicate balance, and contributing to symptoms.
The result of all this is that many women suffer from hormonal imbalances.
10% of women have some form of PCOS, or Polycystic Ovarian Syndrome, characterized by the body’s inability to properly make progesterone or estrogen, instead making loads of male hormones, like testosterone. PCOS alters fertility, promotes weight gain, and causes things like unwanted facial hair growth, acne, and missed periods. PCOS is often connected to stress and insulin resistance.
Many women in my practice suffer from PMS or PMDD, experiencing often debilitating symptoms sometimes even two weeks before their periods begin. They might get migraines, intense cravings for sugar, and massive mood changes, such as anxiety, intense irritability, or devastating depression. Panic attacks can occur at this time as well. Many of them comment that their mood and personalities flip once their hormones levels reach a certain point, causing them to act like different people. This can jeopardize their relationships with spouses and children, coworkers, friends and family.
Tender and painful breasts, or breast lumps, are also common in many of these women.
Acne, weight gain, stress, fatigue, disrupted sleep, depression and anxiety are all symptoms I see in women with hormonal imbalances.
Many women have horrific cycles, experiencing painful and heavy periods that often cause them to miss days of work every month. Many of these women struggle to keep their iron levels in the optimal range, suffering from hair loss, fatigue and weakness.
Many women are diagnosed with fibroids, or endometriosis, or are concerned about their risk of female cancers like breast, ovarian, uterine and cervical cancer.
All of these symptoms are often linked to relatively higher levels of estrogens compared to progesterone, sometimes termed Estrogen Dominance by functional medical practitioners who look at the underlying causes of bodily imbalances.
I feel terrible that I can’t help more of the women who write to me. My license prevents me from giving advice to those who live abroad, especially to non-patients over the internet. It’s a shame, however, because oftentimes the solutions are relatively simple, despite how complicated many of these symptoms might seem.
I’m hoping that this article can provide some direction to many of the women who suffer.
Firstly, I want to state that I am not against birth control or even the Mirena IUD (or other IUDs, for that matter). The vast majority of women with the IUD tolerate it. For many women with debilitating heavy periods and endometriosis it can be the only viable solution that makes life tolerable.
In my social practice at Evergreen, many of the women I see experiencing homelessness, drug addiction, or PTSD from relationship trauma, rely on the efficacy of IUDs to prevent unwanted pregnancies. Their lives often don’t allow for them to remember to consistently take pills every month.
Many women don’t tolerate combination birth control because of a history of blood clots, female cancers, or migraine headaches associated with their periods, and therefore the Mirena IUD, which is progesterone only, is a safe alternative for preventing unwanted pregnancy.
That all being said, many women do suffer on the Mirena IUD (or other forms of birth control). They were perhaps put on the Mirena to deal with some of the above symptoms of hormonal imbalance, or for contraception. Many of them noticed that their symptoms became worse after insertion of the IUD.
How the Mirena IUD and Birth Control Works:
The Mirena works by secreting small amounts of progestins, a synthetic form of progesterone, into the uterus and surrounding tissues. While it is not fully known how the Mirena works, the end result is a suppression of ovulation. This results in either very light periods or a complete cessation of periods until the IUD is removed (after 5 years when its hormones run out).
It is important to say here that, while birth control can certainly treat the symptoms of hormonal imbalances, it does not correct them.
All forms of birth control, with their synthetic versions of the hormones estrogen and progesterone, simply induce further hormone imbalances in the body. They introduce versions of hormones that may suppress or alter symptoms (such as heavy and painful bleeding, or acne), but the versions of hormones are not fully recognized by the body and therefore don’t fully replace all the hormones’ important functions, such as mood regulation, immunity, or blood sugar balance.
The effects of both altering the body’s natural hormonal balance, while ignoring the underlying cause of hormonal issues, is often what causes symptoms to continue or worsen.
For example, women with PCOS are prescribed birth control to manage acne or promote monthly periods. However, when women with PCOS miss periods, it is because they are not ovulating. The missed periods are not the problem; the lack of ovulation is.
Despite that, many women with PCOS experiencing amenorrhea (or missed cycles) will be prescribed birth control. However, birth control does not address the underlying cause of amenorrhea. It simply further suppresses ovulation (because its main purpose is to prevent unwanted pregnancy).
The periods you get while on birth control are not periods. Periods from birth control are withdrawal bleeds. After 21 days of taking hormonal pills, pills are stopped or replaced with placebo pills. The withdrawal of hormones in the pills induces a bleed that resembles a period, but is not one.
Hormonal contraception does not correct hormonal imbalance, it imposes further hormonal imbalance to manage symptoms. This is not always bad!
But it is an important difference.
Many women do require symptom suppression, particularly if their symptoms are severe. Many individuals in my practice experience periods so heavy that the only way for them to get through the month is with an IUD. Genetic variability in how our bodies process hormones can make us susceptible to intense hormonal symptoms, through no fault of our own.
In my opinion, however, it is important to attempt to address the underlying cause and to set our bodies up for better hormonal regulation, making as many changes as our lifestyles will allow.
What You Can Do About It:
If you are like any of the people I described above who seek my help, there are a few things that you can do to get started on correcting hormones.
Working With a Professional:
The first thing I advise is finding a licensed naturopathic doctor or functional medicine practitioner who understands hormones, can order lab tests, and will address the underlying cause of your hormonal imbalances by taking the time to fully understand your body and lifestyle.
This practitioner might be a naturopathic doctor (you can find one in North America by looking one up at naturopathic.org), or a medical doctor, a chiropractor, or a highly skilled nutritionist or nurse practitioner. Research this person well, read their articles, and perhaps book in with them for a complimentary meet and greet.
Testing:
I often test patients using simple blood tests, on day 21 of their cycles (or about 7-9 days before they expect their next period).
I will test their blood, looking for anemia, will test iron and B12 levels, homocysteine (to gauge their ability to methylate), vitamin D, cholesterol (to see if their diets are promoting proper hormone synthesis), estradiol, estrone (the more toxic, problematic estrogen), progesterone, free testosterone, a thyroid panel, fasting glucose and fasting insulin (to calculate insulin resistance using something called the HOMA-IR), HbA1C (to look a long-term blood glucose control), FSH and LH (two hormones made in the brain that talk to the ovaries and orchestrate the menstrual cycle), DHEA-S, to name a few.
Some women will require more testing. Others will require less.
These labs are interpreted from a functional perspective. Even though you are in the “normal” ranges (which take into account the entire population, many of which are not healthy—they are seeing their doctors, after all!), these blood markers may not be optimally balanced, giving us an opportunity to correct things before they go further.
Testing allows us to match symptoms to underlying imbalances and to be able to properly direct treatment protocols. Women with estrogen dominance may be experiencing high levels of estrogen and normal progesterone, which indicates a body burden of estrogen or impaired liver and digestive system clearance. Other women may be experiencing normal levels of estrogen but low progesterone, indicating a failure of their bodies to ovulate, due to high stress, and PCOS (or the Mirena IUD and birth control pill).
Other options for hormonal testing are month-long salivary hormone testing, or DUTCH testing, which looks at hormone breakdown in the urine. I sometimes run these tests, but find that blood testing is useful, accurate, and more cost-effective.
Treatment:
Once you understand your individual hormonal situation through testing (and through working with a practitioner who is putting the testing together with your symptoms and health history), your practitioner may recommend a variety of treatments.
I personally combine diet and lifestyle with key herbal and nutritional supplements, to target what is going on under the surface with my particular patients.
These treatments may include herbs that boost ovulation, aid liver detoxification, or regulate the stress response. I might recommend nutraceuticals that encourage methylation, or aid in hormone production.
My treatments take into account the individual’s symptoms, labs, diet, lifestyle, and any other health issues she may be facing like fatigue, digestive disturbances, or poor sleep.
What You Can Do Today:
Barring more individualized assessment and advice, there are some best lifestyle practices that can help most women balance their hormones better, whether they are still using birth control to control and address their hormonal symptoms or prevent pregnancy.
Diet:
When it comes to diet and hormone support, we need to ensure that we are balancing blood sugar, boosting liver detoxification pathways, promoting hormone synthesis, and supporting digestion, especially if experiencing constipation.
Consume more leafy greens: kale, spinach, collards, beet greens, arugula, etc. Eat 1-2 cups of these foods every day. Leafy greens contain active folate, which boosts methylation and detoxification. They also contain magnesium which is essential for hormonal regulation as well as 300 other important biochemical reactions in the body that balance mood and hormones.
Consume more cruciferous vegetables: broccoli, cauliflower, brussel sprouts, cabbage, bok choy, etc. Eat 1-2 cups of these foods every day. Crucifates help the body make glutathione, and contain indole-3-carbinole, which helps eliminate excess estrogens from the body. Broccoli sprouts are potent players in these pathways. Consume them as often as possible.
Ensure adequate dietary fibre intake: I often recommend ground flaxseeds or chia seeds in smoothies, avocados, fruits and vegetables and legumes (if tolerated) to make sure that women are having regular bowel movements to clear excess estrogens out of the body. 2 tbs of ground flaxseed (or more) every day can help balance estrogen levels and promote daily bowel movements.
Balance blood sugar: consume protein, fat and fibre at every meal. Avoid refined starches and flours. Avoid all sugar, even natural sugar like maple syrup, coconut sugar, cane sugar, honey, agave, etc. Try stevia or avoid sweets. Limit carbs (grains, legumes, root vegetables like potatoes or sweet potatoes, to 1/2 cup to 1 cup per meal). Only consume whole grains like quinoa, buckwheat, steel cut oats, millet, and teff. Cook them yourself!
Avoid soy, particularly processed soy, like vegan burgers, or soy milk.
Consume omega 3 fatty acids in fatty fish like salmon and sardines, or nuts and seeds like flax and chia seeds, walnuts, and pumpkin seeds. Get 2-4 tablespoons of these nuts and seeds every day and 3-4 servings of fatty fish a week.
Consume animal products: eggs contain choline, which is essential for liver function, meat contains vitamins B6 and B12, which are essential for hormonal regulation and production. Cholesterol in animal products are the backbones of our sex hormones. Iodine, found in animal foods, regulates estrogen balance in the body. If possible, try to obtain organic animal products from pastured or free-range animals to boost omega 3 intake, to lower your impact on the environment, and to promote animal welfare.
Other Lifestyle Practices:
Boost progesterone production by managing stress:
Establish a self-care routine: plan regular vacations, even small outings, do meditation or yoga, take breaks from work, spend quality time with family, have a plan to get your work done on time, ask for help.
Sleep! Aim for at least 8 hours of sleep, and try to get to bed before 12am. Practice good sleep hygiene by avoiding electronics before bed, keeping the bedroom as dark as possible, and setting a bedtime and wake time, even on weekends. Body scan meditations and some key supplements can be helpful for resetting circadian rhythms. Regulating blood sugar can have a major impact on improving sleep. Talk to your functional medicine doctor or naturopathic doctor for individualized sleep solutions.
Eliminate exposure to toxic estrogens and boost estrogen clearance:
Avoid exposure to xenoestrogens: whenever possible use natural body products, deodorants and shampoos, or “edible” body products for face and hair. Avoid plastic water bottles and plastic food containers. Use natural cleaning products around the house. Avoid fragrances and processed foods, especially processed soy.
Encourage sweating: get regular exercise or engage in regular sauna therapy. If you don’t have access to a sauna, epsom salt baths can also work—anything that helps you sweat. Heat therapy has also been shown to benefit mood and the stress response.
Heal your digestion: make this a priority with your naturopathic doctor, so that you can absorb the nutrients from the foods you’re eating as well as encourage daily bowel movements and optimal microbiome balance.
Maintain a healthy weight: body fat is metabolically active and can increase overall estrogenic load. Work with your naturopathic doctor to manage your weight. We often attempt to lose weight to become healthy, however I find my patients have far more success (and fun!) getting healthy in order to lose weight. Healthy weight loss often involves managing stress, sleeping 8 hours a night, avoiding sugar and processed foods, and regulating blood sugar, as well as encouraging proper sweating and liver detoxification.
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For breakfast, I would typically eat a high-fat smoothie containing coconut milk yogurt, gelatin, and avocado, and topped with pumpkin seeds and cacao. Sometimes I’d make fat bombs or homemade unsweetened chocolate.
