I, like most of my colleagues became a naturopathic doctor because of my own extremely disempowering experiences with the healthcare system.
In my late teens and early 20s I was suffering from what I now know were a series of metabolic and hormonal issues and I, like almost all of my patients and colleagues experienced confusion, gaslighting, frustration and a complete lack of answers for what I was dealing with. I tell my story more in depth in other places, but I was told to “stop eating so much”. I was told everything was normal in bloodwork (or simply not called back). I was weighed incessantly. I was chastised for doing my own research (I had to–no one would tell me anything). I was interrupted, cut off and dismissed.
And so, I did what most of my colleagues do–I got educated. I went to school. First for biomedical sciences and then, when that degree left me with more knowledge gaps than answers (and no one who would indulge, let alone answer, my questions), I became a naturopathic doctor.
Throughout my 8 years as a practicing ND, I have encountered thousands of similar stories of disempowerment and confusion and frustration. We patients are trained to see our doctors when we feel depressed, fatigued, or debilitated by PMS, menstrual pain, headaches, and mood issues. Most of us don’t care what answer we get–fine, if it’s a medication I need, I’ll take it! But if we experience lack of benefit from the solutions and a lack of answers, then what? I’ve heard this story over and over.
And so, like many of my colleagues I use the privilege of my education to help me navigate the system. I ice a sore foot for 2 days and then get an x-ray (picking a non-busy time to visit the ER). I take the orthopaedic surgeon’s advice with a grain of salt and implement my own strategies for bone healing. I ask for the bloodwork I need (and know my doctor will agree that I need) and pay for the rest out of pocket. I know my doctor’s training and I understand her point of view and I don’t get frustrated when diet and nutrition or lifestyle are never mentioned. I don’t get upset if my doctor doesn’t have an explanation for symptoms that I now know are related to functioning and not disease, and that it is disease which she is trained to diagnose and prescribe for.
And thankfully, my experience with the healthcare system has been quite limited as I’m able to treat most things I experience at home and practice prevention.
My good friend, who is a naturopath as well, and who has given me permission to share her story, had the same experience up until this summer. She too used the healthcare system quite judiciously and limitedly until a series of stressors and traumas landed her in in-patient psychiatric care (i.e.: a psychiatric hospital) for a psychotic episode–her first.
…And until she started experiencing debilitating gastroesophageal symptoms that were beyond what one might consider “normal.”
And in both cases she sought help from the medical system. She told me recently that her experience was quite different from the ones she’d had in her 20s when her long-standing parasite was misdiagnosed as IBS and she was repeatedly dismissed by doctors. She told me “I’ve been having great experiences with the healthcare system. It’s not like it was before. My doctors have listened to me. They’ve been helpful. Yes, they’ve recommended drugs but when I tell them that I don’t want to take the medications because I know what they do and how they work and don’t think I need them, they respect that. They treat me like I’m a real person. They’re all our age, too. The procedures are more state-of-the-art. The facilities are pleasant. Something has changed in healthcare.”
I know that my friend’s experience might be different from yours. I’m not saying her experience is universal. In fact, if I reflect on my interactions with the fracture clinic in St. Joe’s hospital in Toronto, I had a fairly good experience as well (except for long wait times and booking errors). Sometimes medical trauma can blind us to reality–sometimes we aren’t willing to re-evaluate our assumptions until someone points out a piece of reality that is hard to deny. I actually haven’t had a direct negative experience with healthcare in years– and yet I had chalked that up to the fact I rarely need to use it.
But my friend had had two quite intense experiences and came away from them feeling positive about the care she received. I wondered what was different. Here are my thoughts.
Medical care has evolved. It is inevitable that this happens. Sometimes we might have just had a bad doctor, or someone who was having a bad day or maybe was triggered by our experience. I sometimes think not knowing how to help triggers doctors—I think this might have been the case with the doc who told me to eat less. She might have felt helpless and incompetent at not being able to help me and projected those feelings onto me as a “difficult patient”.
Ultimately health professionals got into their field to “help people”. If you’re not helping people you might feel triggered. But then, if you’re a competent professional, and I believe most are, you look for new ways to help. You open your mind to other practitioners, like NDs. You might not understand why or how what they do works, but “whatever works.”
Doctors are increasingly open to new studies on nutrition. They recognize treatment gaps in their care and in medical knowledge and guidelines. Nutrition and alternative practices are entering mainstream and are dismissed as “woo woo” less and less, particularly by doctors who embrace science and research.
With the evolving landscape of medical care, doctors and health professionals are adapting to new perspectives and approaches to help their patients effectively. Acknowledging that some past encounters might have been influenced by various factors, professionals are increasingly open to alternative practices and unconventional methods. They are embracing the significance of research and scientific advancements, often exploring innovative solutions such as the MAS Test to bridge treatment gaps and enhance patient care. By incorporating cutting-edge tools like the MAS Test, doctors are demonstrating a commitment to understanding diverse approaches, ensuring they provide comprehensive and personalized healthcare solutions to their patients. This openness to holistic methods and ongoing research not only enriches medical knowledge but also fosters a more inclusive and effective healthcare system for everyone.
I always say, when picking a doctor pick one that listens, that is curious and that is humble. I strive to be these things, although it’s not easy. Practicing medicine is as much an art as it is a science–we need to be able to not only admit but carry with us the absolute truth that we do not know everything. It is literally impossible to know everything. The body and nature will constantly present us with mysteries on a daily basis, but the gift of being a clinician is that we are constantly learning.
“I don’t know, but I will try to find out” should be every doctor’s mantra (along with Do No Harm).
In a busy and overloaded system we need to help healthcare workers help us. This means being informed. My friend is highly informed and educated in healthcare. I believe her healthcare providers could sense this. She was respectful in denying medications and wasn’t pushed (because she had informed reasons that the healthcare practitioners ultimately agreed with, “no, you shouldn’t go on a PPI long-term, that’s right” “yes, anti-psychotics do have a lot of side effects, and taking them is a personal choice”).
A significant element of my medical trauma was the feeling of disempowerment. I was completely in someone else’s hands and they were not communicating with or educating me. I was left feeling lost and hopeless. Empowerment is everything. It allows you to communicate and make decisions and weigh options. You know what healthcare can offer you and what it can’t.
Of course we can’t always be empowered, especially when we’re very sick and when we’re suffering. In this case, having advocates in your corner are essential. Perhaps it’s having an ND who can help you navigate the system, think clearly and help you weigh your options.
I also recognize that it is hard to be empowered in emergencies. Fortunately, modern medicine handles emergencies exceptionally well. Still, in this case, having an advocate: friend, practitioner or family member, is an incredible asset.
Physicians are burned out. Patients are burned out. I believe this is because of responsibility. Neither the medical system nor the individual can possibly be solely responsible for your health. I believe that responsibility is better when shared. We need help. We can’t do things alone: we need someone’s 8+ years of education, diagnostic testing, clinical experience and compassion. We also need our own sense of empowerment so that doctor’s don’t succumb to the immense pressure of having to fix everyone and everything.
My sister in law is an ER nurse and once remarked (when asked if the ER was busy and chaotic) “people need to learn self-care”. She didn’t mean self-care as in bubble baths. She meant: learning how to manage a fever at home, when a cut needs stitches or how to determine if a sore ankle is a sprain, strain or break. A lot of people were coming in with colds—self-limiting, non-serious infections that could easily be treated at home. This was burning her out. Of course, she meant, go to the ER if you’re not sure. But, there are many non-grey areas in which we can feel empowered to manage self-limiting, non-serious health conditions as long as we know how to identify them or who to go to for answers.
Education is power. In a past life (before becoming an ND and while studying to become one) I was a teacher. I am still a teacher and in fact the Latin root of the word doctor, docere, means “to teach.” Healthcare is teaching. No doctor should say “just take this and call me in the morning” and no patient should accept this as an answer. We have the right to ask, “what will this pill do? When can I stop taking it? How does it work?” This is called Informed consent: the right to know the risks and benefits of every single treatment you’re taking and the right to respectfully refuse any treatment on any grounds.
You have the right to a second opinion. You have the right to say, “Can I think about this? I’d like to read more about it.” You have every right. You have the right to bring a hard question to your doctor, like “do I really need this statin? A study in Nature found that the optimal cholesterol level for reduced all-cause mortality is around 5.2 mmol/L, which is much higher than mine. Do I really need to be on something that lowers my cholesterol?”
If we can’t speak to our doctors, we turn to Google. Being a good researcher is a skill. This is what I was trained to do at naturopathic medical school and in undergrad. How can you tell if a study is a good study? Does the conclusion match the results? What does this piece of research mean for me and my body? Your doctor should be able to look at you and answer your questions to your satisfaction. This is basic respect.
You deserve to access the results of your blood tests and be walked through the results, even if everything is “normal”. Even a normal test result tells a story. We deserve transparency.
I was once told in a business training for healthcare practitioners (NDs, actually) that “people don’t want all the information. They don’t want to know how something works. They just want you to tell them what to do.”
Now, I sincerely disagree with this. In my experience, patients listen vividly when I walk them through bloodwork, explain what I think is happening to them and try to describe my thought process for the recommendations I’m making. I’m sure a lot of what I say is overwhelming–and then I try to put it differently, and open the conversation up to questions to ensure I’m being understood. Again, doctor as teacher, is a mantra we should all live by. There are few things more interesting than learning how our bodies work. In my experience, patients want to know!
When our bodies occur as a mystery, we are bound to live in fear. We are bound to feel coerced and pressured into taking things that our intuition is telling us to wait on, or seek a second opinion for. When we are scared to ask our doctors questions or take up their time, we end up having to deal with our concerns on our own. When we are dismissed we end up confused and doubting ourselves. We end up disconnected from our bodies. We are anxious. We catastrophise. We give away our power to strangers.
Empowerment is everything. It helps us connect to our bodies. It strengthens our intuition. We know where to go or who to go to for answers (or at least a second or third, opinion). We can move ahead with decisions. (i.e.: “I’m going to take this for 8 weeks and if I don’t like the side effects, I will tell my doctor that I want to wean off or ask for another solution”). We are aware of the effects and side effects of medications. We are aware of our options. We know if something isn’t right for us. We can make food and life style choices in an informed and empowered way. We can feel in our bodies who is trustworthy. We can trust ourselves and our bodies.
When patients are empowered, I believe doctors experience less burnout. The responsibility is shared evenly among patients, friends, family and a circle of care of helpers. No one faces the entirety of the weight of their health alone. No one should.
Empowerment and health don’t mean that you’ll be completely free of disease, or that your body will never get sick, or that you will be pain and suffering free. We all get sick. However, empowerment can help you notice something is off. Increased awareness helps you advocate for yourself to get the care you need in a timely fashion. It helps you take necessary steps, even if you’re afraid. You might be less afraid when you have more information. You might have more hope when you know all your options.
Empowerment in healthcare is everything. And here’s the thing: your doctor wants you to be empowered. Empowered patients are fun to work with. They ask good questions. They are respectful. They are open. They give us practitioners an opportunity to learn. My friend experienced this. I’m sure she was a joy of a patient to work with because she was knowledgeable, alert and present. She maintained her own power. She asked questions when she was unsure. She knew what questions to ask. She knew where to go for answers on her own time. She knew which information was relevant for her practitioners to know. She knew how to ask for time and space before making a decision. She knew how to maintain her sense of autonomy. Most of all, empowerment gives us the strength to find a new practitioner if the therapeutic relationship we’re in isn’t respectful or supportive.
I believe we get into the helping professions to help–to heal, to learn and to alleviate suffering. We all swore an oath to “do no harm”.
What do you think? How has health empowerment helped you navigate your own healthcare?
Brett Weinstein and Heather Heying have a t-shirt that says “Welcome to Complex Systems” on it.
Indeed.
Many patients and biological reductionism want to know what caused my anxiety, depression, hormonal issues, and autoimmune disease? What did I do wrong, or that went wrong for me? What was the food I failed to eat, the ingredient I was missing or the thing that caused the house of cards that represented my health to topple?
I think it’s appropriate to answer, “welcome to complex systems.”
Like everything else in nature, your body, your mental health is a complex system. This means that it consists of many factors, many of which have yet to be identified, virtually all that have yet to be correctly understood, that drive its function—even seeing health as an absence of disease, which is essentially how our medical system is organized, is a product of biological reductionism. Biological (or rather mechanical reductionism), the attempt to identify the loose screw or the spring that’s out of place, works for your car, but it doesn’t work for your brain, body, mental or physical health.
Understanding health might be better done using the Biopsychosocial Model, a framework for understanding where we sit today in terms of our health from the context of our biology, psychology, and social environment. Further, the biology part of the biopsychosocial factors that drive our health can be considered triggers and drivers rather than cause and effect.
Say you are feeling terrible. You’re feeling exhausted and agitated, and you’re constipated, and your hair is falling out. You see your doctor, and they tell you everything is great. You push for some bloodwork. Your doctor says your thyroid is slightly off, but it’s likely nothing.
So you take the bloodwork to your naturopathic doctor, who tells you your stimulating thyroid hormone, or TSH, is out of range, indicating that your thyroid seems to be under-functioning. They order more testing to understand what else lies under the hood and find your anti-thyroid antibodies are sky-high. It turns out you might have Hashimoto’s thyroiditis or a condition of under-functioning thyroid driven by autoimmunity.
You also have celiac and a family history of multiple sclerosis, thyroid issues, and other autoimmune diseases. How did this happen?
For months you were dealing with a ton of stress. You also haven’t been eating the greatest. But you haven’t been sleeping well either, and it’s hard to eat well when you’re so darn tired. You’ve been working a lot, dealing with a global pandemic and all, and things haven’t been great. But this is compounded by the fact that you’re not feeling great, which makes it harder to deal with the stress, making the condition worse–a vicious cycle.
At least now you know that something is going on, and it’s not all in your head, but what caused this?
We want to know the exact cause of something to find the specific treatment. This is biological reductionism. Something is missing; we’ve identified the thing, so here’s the magic bullet that will target the exact issue and either replace it or weed it out.
The problem with complex systems is that when we pull one thread on this ball of yarn that is your health, a knot gets tightened somewhere else. Like the post on Chesterton’s fence, complex systems are difficult to understand. So we must assume we don’t fully understand them, and therefore I believe we should exercise humility when it comes to tugging on pieces of yarn that comprise the whole operation.
For example, the side effects of drugs aren’t side effects; they’re effects. Some of these effects are wanted. But all the other effects that happen, such as weight gain, agitation, or migraines from anti-anxiety medication, are unwanted. And they are still effects of the drug. Side effects of drugs are indications that we have failed to understand the implications of messing with complex systems entirely.
Sometimes this might be warranted. The system might be so far out of bounds that it could kill you unless we intervene. Sometimes the drug is more specific–if you don’t have a thyroid, you need thyroid hormone. However, does the thyroid have a role beyond simply producing T4 (thyroid medication)? While thyroid hormone medication might be indicated or necessary, is it fully completing the thyroid’s function in the complex system? What about T3? (or T1 and T2)? What about iodine? What about the driver contributing to thyroid dysfunction? Is it still driving disease? Might it start to create other symptoms elsewhere in the body?
In other words, have we entirely dealt with the problem when we reduce thyroid dysfunction down to deficiency of a single hormone?
So, I explain to my patient; there isn’t a cause of autoimmune disease or a thyroid condition. There are drivers, such as chronic inflammation (which might be triggered by a specific food your immune system doesn’t like). There might be a driver like chronic stress triggered by a more stressful event. Genes can be drivers or susceptibilities triggered by environmental factors, such as nutrient deficiencies. So, it’s not gluten that caused your thyroid issue, but it might start or driveimmune system overactivation and chronic inflammation, contributing to the problem.
So what does this mean for treatment? It means we need to look at the ball of yarn respectfully. We need to appreciate how many symptoms are a healthy response and compensation by the body. If we randomly attack a symptom like fatigue with a stimulant, we might further drive the inflammation, nutrient deficiencies, or stress that underly that symptom. We need to understand what the body lacks (what’s it deficient in?) and when it might have too many environmental toxins, allergens, chronic stress, blue light, etc.
We need to look at the system and help it re-establish its equilibrium. Cleaning up garbage in a pond is likely a good idea–it probably shouldn’t be there in the first place. The pond didn’t create the trash. But what about something else we don’t want, like an algae overgrowth? But if we throw an algaecide in the water, what unseen harm might we be doing to the pond’s ecosystem if we mess with it? Has the pond created algae for the reason that currently escapes us, but wouldn’t if we looked a little deeper?
Why doesn’t our modern medical model treat our bodies as complex systems? I’m not sure. A few guesses, though. Complex systems are complicated, if not impossible, to understand. They require time to unravel. They need patience and education. They require effort on the part of the patient to try to shift their environment to eliminate or adjust possible triggers. They are impossibly hard to market and profit from.
Getting our concept of a complex system “right” can take time. It might take trial and error, collecting information, curiosity, and a willingness to try. It might take admitting that our culture has many aspects to it that are inherently unhealthy.
We might have to find a mini culture where people get sun, eat well, move, and sleep early to support our health. We might have to be “stricter” than the people around us. These people may have similar drivers working below the surface, but their symptoms may look different. They do not display symptoms like fatigue or anxiety until their systems have completely shifted beyond balance.
We are all a manifestation of complex systems. Laini Taylor says, “Inside each of us, there is a world that no one else can ever know or see or visit.”
About a month ago I fractured my right 5th metatarsal (an avulsion fracture, aka “The Dancer’s Fracture” or a “Pseudo-Jones Fracture”).
As soon as I laid eyes on the x-ray and the ER doctor declared, “Ms. Marcheggiani,” (actually, it’s doctor, but ok) “you broke your foot!” things changed.
I have never broken anything before, but if you have you know what it’s like. In a matter of seconds I couldn’t drive. I could barely put weight on it. I was given an Aircast boot to hobble around in, and told to ice and use anti-inflammatories sparingly. My activities: surfing, skateboarding, yoga, even my daily walks, came to a startling halt.
I spent the first few days on the couch, my foot alternating between being elevated in the boot and immersed in an ice bath. I took a tincture with herbs like Solomon’s Seal, mullein, comfrey, and boneset to help heal the bone faster. I was adding about 6 tbs of collagen to oats in the morning. I was taking a bone supplement with microcrystalline hydroxyapatite, pellets of homeopathic symphytum, zinc, and vitamin D.
We call this “treatment stacking”: throwing everything but the kitchen sink at something to give the body as many resources as possible that it may use to heal.
My brother’s wedding came and went. I was the emcee, and the best man. I bedazzled my boot and hobbled around during set-up, photos, presentations, and even tried shaking and shimmying, one-legged on the dance floor. The next few days I sat on the couch with my leg up.
I watched the Olympics and skateboarding videos. I read The Master and the Margarita and Infinite Jest. I got back into painting and created some pen drawings, trying to keep my mind busy.
I slept long hours–an amount that I would have previously assumed to be incapable. The sleep felt necessary and healing. I was taking melatonin to deepen it further.
I closed down social media apps on my phone to deal with the immense FOMO and stop mindlessly scrolling. I journaled instead, turning my focus from the outside world to my inner one.
It was a painful process, and not necessarily physically.
I was confined to my immediate surroundings–not able to walk far or drive. I was at the mercy of friends and family to help me grocery shop. The last year and a half has made many of us grow accustomed to social isolation and a lot of my social routines from years prior had fallen by the wayside.
My world, like the worlds of many, had gotten smaller over the last 18 months. With a broken foot, my world shrunk even further.
The loneliness was excruciating.
It would come in waves.
One moment I would relish the time spent idle and unproductive. The next I would be left stranded by my dopamine receptors, aimless, sobbing, grieving something… anything… from my previous life. And perhaps not just the life I had enjoyed pre-broken foot, but maybe a life before society had “broken”, or even before my heart had.
I thought I would be more mentally productive and buckle down on work projects but it became painfully obvious that my mental health and general productivity are tightly linked to my activity levels. And so I spent a lot of the weeks letting my bone heal in a state of waiting energy.
My best friend left me a voicemail that said, “Yes… you’re in that waiting energy. But, you know, something will come out of it. Don’t be hard on yourself. Try to enjoy things… watch George Carlin…”
During the moments where I feel completely useless and unproductive, waiting for life to begin, I was reminded of this quote by Cheryl Strayed. This quote speaks to me through the blurry, grey haze of boredom and the existential urgency of wasting time.
It says,
“The useless days will add up to something. The shitty waitressing jobs. The hours writing in your journal. The long meandering walks. The hours reading poetry and story collections and novels and dead people’s diaries and wondering about sex and God and whether you should shave under your arms or not. These things are your becoming.”
These things are your becoming.
Something will come out of it.
When I did a 10-Day Vipassana (silent meditation) retreat in the summer of 2018, I learned about pain.
It was Day 3 or 4 and we had been instructed to sit for an entire hour without moving. The pain was excruciating. The resistance was intense. I was at war with myself and then, when the gong went off and there was nothing to push against, I noticed a complete relief of tension. I was fine.
The next time I sat to meditate (another hour after a 10 minute break), I observed the resistance and released it. It’s hard to describe exactly what I did. It was something like, letting the sensations of pain flow through me like leaves on a river, rather than trying to cup my hands around them, or understand or making meaning out of them.
The sensations ebbed and flowed. Some might have been called “unpleasant” but I wasn’t in a space to judge them while I was just a casual observer, watching them flow by. They just were.
And when I have intense feelings of loneliness, boredom or heart-break I try to remember the experience I had with pain and discomfort on my meditation cushion. I try to allow them.
“This too shall pass”.
When I have a craving to jump off my couch and surf, or an intense restlessness in the rest of my body, the parts that aren’t broken, I try to let those sensations move through me.
I notice how my foot feels. How while apparently still, beneath my external flesh my body is busy: it’s in a process. It’s becoming something different than it was before. It’s becoming more than a foot that is unbroken. It’s becoming callused and perhaps stronger.
Maybe my spirit is in such a process as well.
The antidote to boredom and loneliness very often is a process of letting them move through, of observing the sensations and stepped back, out of the river to watch them flow by. A patience. Letting go.
I can’t surf today. But, it is the nature of waves that there will always be more.
Pima Chodron in her book When Things Fall Apart also references physical pain and restless in meditation while speaking of loneliness.
She writes,
“Usually we regard loneliness as the enemy. Heartache is not something we choose to invite in. It’s restless and pregnant and hot with desire to escape and find something or someone to keep us company. When we can rest in the middle, we begin to have a nonthreatening relationship with loneliness, a relaxing and cooling loneliness that completely turns our usual fearful patterns upside down.”
She continues,
“When you wake up in the morning and out of nowhere comes the heartache of alienation and loneliness, could you use that as a golden opportunity? Rather than persecuting yourself or feeling that something terribly wrong is happening, right there in the moment of sadness and longing, could you relax and touch the limitless space of the human heart?
“The next time you get a chance, experiment with this.”
It’s mulberry season, which means while walking through my neighbourhood I can snack, picking food right off the trees growing behind fences or on people’s front lawns whenever I walk by a berry-stained sidewalk.
There’s something therapeutic about entering into the flow state of berry-eating from a tree (or a bush? they’re massive bushes. The act of eating becomes a ritual. It demands presence and attention. It becomes like a game, the objective is looking for rich colour, ripeness, size, and strategizing how to access the delicious, prized morsel you’ve laid your eyes on, then savouring the experience of having attained it, before beginning the process again.
It’s impossible to binge-eat this way.
I remember at my friend’s cottage last Septemeber it was blueberry season and we spent the weekend casually hanging out in the middle of blueberry patches. I would find an abundant bush, settle down in the midst of it and graze. I must have eaten 5 cups of blueberries each day and yet it took me the entire day to do it.
What better way to spend a day?
The best part of it was: I met my food.
I was listening to Paul Saladino of the Fundamental Health Podcast interview Daniel Vitalis from the Rewilding Podcast. The subject came up about foraging, and hunting and meeting your food.
“Some people have never seen a bass,” Daniel Vitalis commented.
“Maybe not in the wild, maybe not in a zoo. They don’t know how big it is, what colour it is, what kind of lakes it lives in, what it looks like.
“And, more importantly, even if someone fishes for bass or knows what they look like, if they eat bass in a restaurant or from a frozen filet they’ve bought at the grocery store, they most likely haven’t met that bass.
“There’s a massive disconnect in our society between us and the food we eat.”
In almost every other culture we would have shared an intimate relationship with food.
When I was eating blueberries I took the time to settle down in a patch of bushes and linger. The act of eating was immersed in a ritualistic past-time. I was connecting with the specific plant whose food I was borrowing. I was visiting her home–her environment.
When you fish for bass, or hunt a deer, you enter that animal’s setting. You meet it alive. You witness it living. You witness it dying.
The animal’s fate intertwines with yours.
Your survival and his become like a seesaw. Yesterday it was your turn. Today it’s mine.
I suppose the fish filet’s fate is also intertwined with yours: he may have been destined to end up in the freezer section of the local Costco, but somehow… it seems radically different, largely impersonal. Colder.
This is why we obsess over food sometimes: where was the bass made? Was it caught or farmed? Is it organic? Where was it processed? Eating animals is wrong—I’m going to go vegan. And so on.
I believe that this neurosis becomes our remedy for disconnect, for the disembodiment we experience. Eating becomes an intellectual task. We need to read labels, visit websites, and do research, rather than just experiencing our food first in its living form, before engaging in the eating of it.
Hunter gatherers don’t read labels. They don’t diet.
The Hadza from Tanzania don’t have food rules, restrictions ,or even mental, nutritional concepts about food. That’s a Western thing.
The Hadza, like many other cultures more connected to their food sources, simply possess the raw biological desire to eat whatever and however much they like that they can get, whenever they can get it. They are guided by taste and hunger.
Their lives revolve around hunting and gathering food. They simply immerse themselves in their food environments and eat.
We are also immersed in a food environment: the packaged, fried, doctored foodstuffs packed into grocery stores, fast food restaurants, gas stations, and convenience stores. These foods connect with our hunger cues and communicate with our tastebuds but offer none of the impact of “real” food on our physiology. They don’t nourish us.
They don’t connect us to the natural world. They don’t encourage ritualistic eating. What happened to that wheat sheaf or corn blade for it to become refined flour or hydrogenated oil? Could I participate in the making of it? Or do I lack the chemicals and technology to process this food to make these potato chips, bread, or cookies?
Our food environment encourages our disconnect and this encourages our neurosis around food and nutrition. In order to thrive in this environment we need to think about food. We need to read labels and make choices and abstain from certain foods, and make an effort to change our environment so that it becomes one more conducive to human nourishment.
We need to refuse foods served to us at events, or buy separate groceries, and make separate meals for our partners or children.
We create a food “island” for ourselves, in the midst of our community.
And this becomes impossible.
You are only as healthy as the group and environment you find yourself in.
So what can we do? Perhaps we can start with community. Where do the healthy people shop? Where do you feel most connected to your food? Is it in your garden? Is it visiting a farm? Hunting or buying meat from a hunter, or a farm? Can you meet your meat before you buy it? Can you develop a relationship with those who grow or process your food?
Perhaps it means more at-home food preparation. Visiting more farmer’s markets. Talking with the people selling you your eggs. Perhaps it means developing a connection with a local farm where you source your food. Perhaps it means you pick your apples in season, or you grow your own herbs. Maybe you bake bread with your children, or can your own tomatoes.
Maybe you develop your own food and eating rituals and you practice them as a family or as a community.
Maybe you ask some questions about your food–what does this bass look like? How did this cow live?
Food has always been so central to human culture.
When we connect with the rituals of picking, hunting, growing, processing, and consuming our food, we learn what it is to be truly human.
“I don’t believe in diseases anymore, I treat stories.
“…No other medical system in the world ever believed in diseases. They all treat everybody as if, you know it’s whether it’s the ancestors or meridians–it’s none of this rheumatoid arthritis, strep throat kind of thing. That’s just this construct that we kind of… made up.”
– Dr. Thomas Cowan, MD
Dr. Cowan is admittedly a (deliciously) controversial figure. His statement, I’m sure, is controversial. But that’s why it intrigues me.
In naturopathic medicine, one of our core philosophies, with which I adhere very strongly, is “treat the person, not the disease”.
And, in the words of Sir William Osler, MD, “It is much more important to know what sort of person has a disease, than to know what sort of disease a person has”.
And, I guess it’s relevant to ask, what is disease in the first place?
I see disease as an non-hard end point, a state that our biological body enters into. On the continuum between perfect health (which may be an abstract and theoretical construct) and death, disease I believe is near the far end of the spectrum.
Disease happens when the body’s proteins, cells, tissues, or organs begin to malfunction in a way that threatens our survival and disrupts our ability to function in the world. For example, a collection of cells grows into a tumour, or the immune system attacks the pancreas and causes type I diabetes.
But, of course there is always more to the story.
What causes disease?
I have heard biological disease boiled down to two main causes: nutrient deficiencies and toxicities. And, I’m not sure how strongly I agree with this, but on a certain level I find this idea important to consider.
However, it is definitely not how Western Medicine views the cause of disease!
Diseases, as they are defined, seem to be biological (as opposed to mental or emotional). They have clinical signs and symptoms, certain blood test results, or imaging findings, and they can be observed looking at cells under a microscope.
Medical textbooks have lists of diseases. Medicine is largely about memorizing the characteristics of these diseases, differentiating one from another, diagnosing them, and prescribing the treatment for them.
As a naturopathic doctor, I see a myriad of patients who don’t have a “disease”, even though they feel awful and are having difficulty functioning. These patients seem to be moving along the disease spectrum, but their doctors are unable to diagnose them with anything concrete–they have not yet crossed the threshold between “feeling off” and “disease”.
Their blood tests are “normal” (supposedly), their imaging (x-rays, MRIs, ultrasounds, etc.) are negative or inconclusive, and their symptoms don’t point to any of the diseases in the medical school textbooks.
And yet they feel terrible.
And now they feel invalidated.
Often they are told, “You haven’t crossed the disease threshold yet, but once you reach the point where you’re feeling terrible and our tests pick it up too, come back and we’ll have a drug for you”.
Obviously not in so many words, but often that is the implication.
Our narrow paradigm of disease fails to account for true health.
Even the World Health Organization states that health is not the mere absence of disease.
So if someone does not have health (according to their own personal definition, values, dreams, goals, and responsibilities), but they don’t have disease, what do they have?
They have a story.
And I don’t mean that what they’re dealing with is psychological or mental or emotional instead, and that their issues are just “all in their head”. Many many times these imbalances are very biological, having a physical location in the body.
Subclinical hypothyroidism, insulin resistance, nutrient deficiencies, chronic HPA axis dysfunction, and intestinal dysbiosis are all examples of this. In these cases we can use physical testing, and physical signs to help us identify these patterns.
An aside: I believe the categories of biological, mental, environmental, and emotional, are false.
Can we have minds without biology? Can we have emotions without minds or physical bodies? How do we even interface with an environment out there if we don’t have a body or self in here?
Aren’t they all connected?
Ok, back to the flow of this piece:
Your story matters.
This is why it takes me 90 minutes to get started with a new patient.
It’s why I recommend symptom and lifestyle habit tracking: so that we can start to pay attention.
It’s why I’m curious and combine ancient philosophies, research (because yes, research is useful, there’s no doubt–we should be testing out our hypotheses), and my own intuition and skills for pattern-recognition, and my matching my felt-sense of what might be going on for a patient with their felt sense of what they feel is going on for them.
Attunement.
I write about stories a lot. And I don’t mean “story” in a woo way, like you talk about your problems and they go away.
No. What I mean is that you are an individual with a unique perspective and a body that is interconnected but also uniquely experienced. And my goal is to get a sense of what it’s like to be you. What your current experience is like. What “feeling like something’s wrong” feels like. What “getting better” feels like.
And all of that information is located within story.
Your body tells us a story too. The story shows up in your emotions, in your physical sensations, in your behaviours (that might be performed automatically or unconsciously), in your thoughts, in your energy, and in the palpation of your body.
No two cases of rheumatoid arthritis are the same. They may have similar presentations in some ways (enough to fit the category in the medical textbooks), but the two cases of rheumatoid arthritis in two separate people differ in more way than they are the same.
And that is important.
We’re so used to 15 minute insurance-covered visits where we’re given a quick diagnosis and a simple solution. We’re conditioned to believe that that’s all there is to health and that the doctors and scientists and researchers know pretty much everything there is to know about the human body and human experience.
And that if we don’t know about something, it means that it doesn’t exist.
When we’re told “nothing is wrong” we are taught to accept it. And perhaps conclude that something is wrong with us instead.
When we’re told that we have something wrong and the solution is in a pill, we are taught to accept that too. And perhaps conclude that something is wrong with our bodies.
But, you know what a story does?
It connects the dots.
It locates a relevant beginning, and weaves together the characters, themes, plot lines, conflicts, heroes, and myths that captivate us and teach us about the world.
A story combines your indigestion, mental health, microbiome, and your childhood trauma.
A story tells me about your shame, your skin inflammation, your anxiety, and your divorce.
Maybe you don’t have a disease, even if you’ve been given a diagnosis.
Imagine that you’re stuck in the middle of the Amazon forest. You have no idea where you are. You’re terrified and hungry.
All of a sudden a man (or a woman) emerges from the bushes. They tell you, “I can help you get out of here. I can help you find your way home”. With relief, you follow them.
They slash through the bush with a certain confidence. They feel comfortable to be around. But after some time, doubt fills your mind.
A little while later you, still following this guide, but mind racing with doubt, both come upon someone else, coming from the other direction.
“That’s not the way out,” this new person exclaims, once you’ve greeted one another, “Follow me, I know how to get you out of here.” And there’s something about their scent or voice, you’re not sure what, but you like them better than the other guide, or maybe the same, you don’t know, but for whatever reason you choose to follow them.
And so you leave the first guide, thank them for their help (they really were helpful after all, but this new guide, well they’re really something) and all, and say, “My heart says I should follow this new guide”. And now you’re off, travelling in an entirely different direction, on what you hope is your way out of the jungle.
The truth is, every way is the way out. Perhaps some ways are faster than others, but one thing is certain, if you continue to travel in any one direction for a long enough period of time, you will eventually leave the dark woods.
What will keep you in the jungle, however, is switching direction, switching guides. Imagine you’re almost out of there: a few hundred metres away, and you find a new guide, turn around and immediately follow them further into the bush.
So it is with healing.
Sometimes we need to pick someone–a therapist, doctor, teacher, mentor, sometimes for no better reason than we like their voice or their website or we resonate with something they’re sharing from the heart–and we need to choose them and let them guide us.
No, we don’t need to do everything they say. We don’t need to follow them blindly. We can follow them with a sense of integrity and skepticism, of course, but if we choose their guidance, and their path towards healing, perhaps we need to see it through.
I find that, as it’s often the case with anxious patients, we constantly feel the need to reach for the new solution, the new single ingredient that will make us healthy and whole. That extra thing. That missing thing. That shiny new theory, or condition, or treatment.
“Perhaps I have histamine intolerance”
“Maybe I’m eating too many lectins”
“I think I need to test my oxalates”
“Maybe I’m zinc deficient”
“Maybe it’s my estrogen dominance”
It could be any one of those things, but if you find your wheels spinning, flipping from one therapist to another, and preventing any one of them from really getting a sense of who you are or what you need then I suggest you… stay.
Who do you stay with?
Stay with the one who listens.
If anyone is offering you a simple solution, a one-trick fix (and if any one is a one-trick pony, you know them, the ones who apply their theory to everyone they work with), then please run.
Your health and wellness does not boil down to one thing, one practice, one supplement, one root cause.
Stay with the one who listens. The one who repeats back to you what you said and adds more to it. The one who synthesizes and summarizes your problem in a way that clicks something into place.
Stay with the one who talks to you, not their team of followers.
The one who has your case information, not the yoga instructor you chat with after class while you’re putting your shoes back on, not the supplements salesperson who said “It’s probably your hormones” and hands you a bottle of 15 ingredients, not the documentary you watched on Netflix that applies one-size-fits-all diet advice to you and 6 billion others without even knowing your name.
Or, maybe stick with them… but stick with one of them. See their advice through to the end.
Maybe stick with the one who says, “Hm, this sounds like…” and proceeds to connect the dots for you, in front of your eyes. Who seeks to educate you. Who thinks about your case between visits. Who says things like “I consulted with my colleagues about your case to ask and…” and things like “I was thinking about/reviewing your case the other day and thought about…”
Stay with the one who refers you to other practitioners. Stay with the one who answers your pointed health questions with “It depends” or “Normally yes, but in your case…” or “A lot of the time no, but it’s possible that in your case…”
Psychoanalyst Francis Weller urges us to practice restraint. To pause. To reflect on our needs. He urges us to practice humility.
I love working with patients who show up humble, kneeling at the alter of their own healing, saying, “I found your website” or “My friend referred you” and then proceed to tell their stories, and receive my assessment.
They help me practice humility as well. To receive their cases with humility (not with my already always listening). To receive them with patience. To take my time. To do my research. To check in: “How does this sound…”.
I kneel at the alter of healing beside them.
We set an intention of working together–walking together—out of this wilderness.
I often get emails like this, “Dear Doctor, please tell me your favourite natural cure for anxiety”, to which I often reply:
Dear, Anxiety,
Imagine you are a gardener, tending to your garden. You are a skilled gardener: you tend lovingly to your plants every day and you care deeply for their welfare.
You are the perfect gardener in every way, except for one: for some reason you don’t know anything about soil.
No one has ever taught you about the damp, dark soot that envelopes the roots of your beloved plants, kindly offering to them its protection, water, and nutrients.
You are a gardener, but are innocently oblivious to the fact that soil must be nurtured by millions of microbes, and that nutrients in the soil must be replenished. You have no idea that the other plants sharing the soil with your garden form a complex network of give and take, depositing nutrients into it, while greedily sucking others away.
Now, as this soil-ignorant gardener, imagine your surprise when, despite your care and attention, the plants in your garden wither and die, bearing no flowers or fruit.
Imagine your frustration when your efforts to prop up tired stems fail. You apply water and fertilizer to buds, leaves and stems. You stand by, powerless, as your garden dies.
Notice the weeds taking over your garden, which you lop off at their stems, unaware that their roots reside deep inside the earth.
When the weeds pop up again and again, you slash at them, burn them, and you curse the skies.
“Why me?”
Why you, indeed.
You are unaware of root gardening, soil gardening, just as many of us are unaware of root medicine—soil medicine.
You see, Anxiety, there are many natural remedies that can help.
However, tossing natural pills at twitching nerves, imbalanced blood sugar, unregulated stress responses, and various nutrient deficiencies, might be as naive a practice as spray painting your roses while they wilt in sandy earth, beneath their red paint.
It might be akin to prescribing anxiety medication or a shot of vodka to calm your trembling mind; you might feel better for a time, propped up with good intentions, before collapsing in the dry soil encasing you.
With no one to tend to your roots you eventually crumple, anxiety still rampant.
“Why me?” You curse the skies.
Rather than asking, “Why me?” it might help to simply start asking, “Why?”
While it is important to understand the “What” of your condition—What disease is present? What is the best natural cure for anxiety?—naturopathic doctors are far more interested in the “Why”.
As Dr. Mark Hyman, functional medical doctor, asks:
Why are your symptoms occurring?
Why now?
And why in this way?
Naturopathic doctors prescribe natural remedies for conditions such as anxiety, it’s true. However, naturopathic medicine is a medicine that first tends to the soil.
Naturopathic doctors first look for and addresses the roots of symptoms, working with the relationships that exist between you and your body, your food, the people in your life, your society, your environment—your soil.
Healing involves taking a complete inventory of all the factors in your life that influence your mental, physical, and emotional wellness. It requires looking at the air, water, sunlight, nutrients, stressors, hormones, chemicals, microbes, thoughts and emotions that our cells bathe in each day.
Healing means looking closely at the soil that surrounds us. It requires asking, What are the roots that this condition stems from? And, What soil buries these roots? Does it nourish me?
Do I nourish it?
The causes of disease can be interconnected and complex. Very often, however, there are common root networks from which many modern-day chronic health conditions arise.
Starving Gut Bacteria.
It was Hippocrates, the father of medicine, who first proclaimed that “All disease begins in the gut.”
Our digestive systems are long, hollow tubes that extend from mouth to anus, and serve as our body’s connection to the outside world. What enters our digestive system does not fully become the body until the cells that line that digestive tract deem these nutrients worthy of entering.
Along their 9 metre-long, 50-hour journey, these nutrients are processed by digestive enzymes, broken down by trillions of beneficial bacteria, and sorted out by the immune cells that guard entrance to our vulnerable bodies.
Our immune cells make the judgement call between what sustains us, and what has that potential to kill us. For this reason, about 70% of our immune system is located along our digestive tract.
Our gut bacteria, containing an estimated 30 trillion cells, outnumber the cells in our body 3 to 1. Science has only just begun to write the love story between these tiny cells and our bodies. These bacteria are responsible for aiding in the digestion of our food, producing essential nutrients, such as B vitamins and fat-soluble vitamins, and keeping our intestines healthy.
However, this love story can turn tragic when these little romantics are not properly fed or nurtured, or when antagonists enter the story in the form of pathogenic bacteria or yeast.
Our microbiome may impact our health in various ways.
Studies are emerging showing that obese people have different gut profiles than those who are normal weight. Our gut bacteria have a role in producing the hormones that regulate hunger, mood, stress, circadian rhythms, metabolism, and inflammation. They regulate our immune system, playing a role in soothing autoimmune conditions, and improving our ability to fight off infections and cancer.
Psychological and physical stress, inflammation, medication use, and a diet consisting of processed food, can all conspire to negatively affect the health of our gut. This can lead to a plethora of diseases: mood disorders, psychiatric illness, insulin resistance, cardiovascular disease, chronic pain and inflammation, obesity, hormonal issues, such as endometriosis, autoimmune disease, and, of course, chronic digestive concerns such as IBS, among others.
As Hippocrates long knew, one doesn’t have to dig for long to uncover an unhappy gut microbiome as one of the primary roots of disease.
Our gut has the power to nurture us, to provide us with the fuel that keeps our mood bright and our energy high. However, if we fail it, out gut also has the power to plague our cells with chronic inflammation and disease.
To be fully healthy, we must tend to our gut like a careful gardener tends to her soil.
This involves eating a diet rich in fermented foods, like kefir, and dietary fibre, like leeks, Jerusalem artichokes, and black beans. It also means, consuming flavonoid-rich foods like green tea, and cocoa, and consuming a colourful tapestry of various fruits and vegetables.
Healing our gut requires avoiding foods it doesn’t like. These may include foods that feed pathogenic bacteria, mount an immune response, kill our good bacteria, trigger inflammation, or simply those processed foods that fail to nurture us.
To heal ourselves, first we must feed out gut.
Confused Circadian Rhythms.
For hundreds of thousands of years, all of humanity rose, hunted, ate, fasted, and slept according to the sun’s rhythms.
To align us with nature, our bodies contain internal clocks, a central one located in brain, the suprachiasmatic nucleus, which is susceptible to light from the sun, and peripheral clocks located in the liver and pancreas, which respond to our eating patterns.
Our gut bacteria also respond to and influence our body’s clocks.
However, the invention of electricity, night shifts, and 24-hour convenience stores, means that our bodies can no longer rely on the outside world to guide our waking and sleeping patterns. This can confuse our circadian rhythms, leading to digestive issues, insomnia, daytime fatigue, mood disorders, and problems with metabolism, appetite, and blood-sugar regulation.
Dr. Satchin Panda, PhD, a researcher at the Salk Institute in California, found that mice who ate a poor diet experienced altered circadian rhythms. However, he found that when these mice were fed the same diet in accordance with their natural rhythms, they weighed less, had lower incidences of diabetes and cardiovascular disease, had better cognitive health, and lived longer.
These findings indicate that perhaps it is not what we eat but when that may impact our health.
Perhaps it is that an unnatural diet disconnects us from nature, or that this disconnection tempts us to choose non-nutritive foods, but the research by Dr. Panda and his team reveals the importance of aligning our daily routines with our bodies’ natural rhythms in order to experience optimal health.
According to Dr. Panda’s findings, this involves eating during an 8 to 12-hour window, perhaps having breakfast at 7am and finishing dinner early, or simply avoiding nighttime snacking.
For many of us, this may involve making the effort to keep our sleep schedules consistent, even on weekends.
For most of us, it involves avoiding exposure to electronics (which emit circadian-confusing blue light) after the sun goes down, and exposing our eyes to natural sunlight as soon after waking as possible.
Nature Deficit Disorder.
Nature Deficit Disorder is a phrase, coined by Richard Louv, in the 2005 book, Last Child in the Woods.
According to Louv, a variety of childhood problems, especially mental health diagnoses like ADHD, are a direct result of our society’s tendency to increasingly alienate children from nature.
With most of humanity living in cities, nature has become a place we visit, rather than what immerses us. However much modernization might remove us from nature, our bodies, as well as the food, air, water, sunlight, and natural settings they require to thrive, are products of nature, and cannot be separated from it.
A Japanese practice called Shinrin-Yoku, or “Forest Bathing”,developed in the 1980’s toattempt to reconnect modern people with the healing benefits of spending time in a natural setting. There is an immediate reduction in stress hormones, blood pressure, and heart rate when people immerse themselves in natural environments, such as a forest.
Whether we like it or not, our roots need soil. It is possible that the components of this soil are too complex to manufacture. When we try to live without soil, essential elements that nourish us, and the various relationship between these elements are left out.
When we remove ourselves from nature, or ignore it fully, we become like gardeners oblivious to the deep dependency their plants have on the soil that enshrouds them.
Connecting with nature by spending time outside, retraining our circadian rhythms, connecting with our food sources, and consuming natural, whole foods, may be essential for balancing our minds, emotions, and physical bodies.
A Lack of Key Building Blocks.
Our bodies are like complex machines that need a variety of macro and micronutrients, which provide us with the fuel, building blocks, vitamins and minerals that we need to function.
As I child, I would play with Lego, putting together complex structures according to the blueprints in the box. When I discovered that a piece was missing, I would fret. It meant that my masterpiece would no longer look right, or work. If I was lucky, I might find a similar piece to replace it, but it wouldn’t be the same.
After looking long and hard for it, sometimes the missing piece would turn up. I’d locate it under the carpet, my brother’s bottom, or lodged in a dark corner of the box. Often our bodies don’t get that lucky.
Nutrients like vitamin B12, perhaps, or a specific essential amino acid, or a mineral like magnesium, help our body perform essential steps in its various biochemical pathways.
These pathways follow our innate blueprint for health. They dictate how we eat, sleep, breathe, and create and use energy. They control how our bones and hair grow. They control our mood and hormones. They form our immune systems. These pathways run us.
Our bodies carry out the complicated instructions in our DNA to will us into existence using the ingredients supplied from food. If our bodies are missing one or several of these ingredients—a vitamin or mineral—an important bodily task simply won’t get done.
Dr. Bruce Ames, PhD, theorized that when nutrient levels are suboptimal, the body triages what it has to cove tasks essential to our immediate survival, while compromising other jobs that are important, but less dire.
For example, a body may have enough vitamin C to repair wounds or keep the teeth in our mouths—warding off obvious signs of scurvy, a disease that results from severe vitamin C deficiency. However, it may not have enough to protect us from the free radicals generated in and outside of our bodies. This deficiency may eventually lead to chronic inflammation, and even cancer, years later.
According to Dr. Ames’ Triage Theory, mild to moderate nutrient deficiencies may manifest later in life, as diseases that arise from the deprivation of the building blocks needed to thrive.
In North America, despite an overconsumption of calories, nutrient deficiencies are surprisingly common.
25-50% of people don’t get enough iron, which is important for the transport of oxygen, the synthesis of neurotransmitters, and for proper thyroid function.
One third of the world’s population is deficient in iodine, which affects thyroid health and fertility.
Up to 82% of North Americans are vitamin D deficient. Vitamin D regulates the expression of over 1000 genes in the body, including those involved in mood regulation, bone health, immunity, and cancer prevention.
Vitamin B12 is commonly deficient in the elderly, vegans and vegetarians. It is important for lowering inflammation, creating mood-regulating neurotransmitters, and supporting nervous system health. Deficiency in vitamin B12 can result in fatigue. Severe deficiency can lead to irreversible nerve damage, dementia, and even seizures.
Magnesium is an essential mineral involved in over 300 chemical reactions, including mood and hormone pathways. Over 40% of North Americans do not consume enough magnesium, which is found in leafy green vegetables.
Our bodies have requirements for fats, which make up our brain mass and the backbone of our sex hormones, and protein, which makes up our enzymes, neurotransmitters and the structure of our body: bones, skin, hair, nails, and connective tissue.
Our gut microbiota require fibre.
Our cells need antioxidants to help protect us from the free radical damage from our own cells’ metabolism and our exposure to environmental toxins.
We certainly are what we eat, which means we can be magnificent structures with every piece in place, thriving with abundance and energy.
Despite reasonably good intentions, we can also suffer from nutrient scarcity, forced to triage essential nutrients to keep us from keeling over, while our immune health, mood, and overall vitality slowly erode.
A Body on Fire: Chronic Inflammation.
When we injure ourselves—banging a knee against the sharp edge of the coffee table, or slashing a thumb with a paring knife—our immune systems rally to the scene.
Our immune cells protect us against invaders that might take advantage of the broken skin to infect us. They mount an inflammatory response, with symptoms of pain, heat, redness, and swelling, in order to heal us. They recruit proteins to the scene to stop blood loss; they seal our skin back up, leaving behind only a small white scar—a clumsiness souvenir.
Our inflammatory response is truly amazing.
One the danger has been dealt with, the immune response is trained to turn off. However, when exposed to a stressor, bacteria, or toxin, for prolonged periods, our immune system may have trouble quieting. Chronic issues can contribute to chronic inflammation.
Scientists argue that an inflammatory response gone rogue may be the source of most chronic diseases, from heart disease, cancer, and diabetes, to schizophrenia and major depressive disorder.
The gut is often the source of chronic inflammation as it hosts about 70% of the immune system. When we eat something that our immune system doesn’t like, an inflammatory response is triggered. This can cause digestive issues such as inflammatory bowel disease, celiac disease, and the more common irritable bowel syndrome. It can also lead to more widespread issues like chronic pain, arthritis, migraines, and even mood disorders like Bipolar.
Ensuring optimal gut health through nurturing the gut microbiome, and eating a clean diet free of food sensitivities, is essential for keeping the body’s levels of inflammation low.
Constant Fighting and Fleeing.
Like inflammation, our stress response is essential to our survival.
When facing a predatory animal, our body is flooded with stress hormones that aim to remove us from the danger: either through fighting, fleeing, or freezing. Our stress response is affectionately called our “Fight or Flight” response.
However, like inflammation, problems arise when our stress response refuses to turn off. Traffic, exams, fights with in-laws, and other modern-day struggles, can be constant predators that keep us in a chronically stressed-out state.
Chronic stress has major implications for our health: it can affect the gut, damage our microbiome, alter our circadian rhythms, mess with mood and hormones, and contribute to chronic inflammation. Stress gets in the way of our ability to care for ourselves: it isolates us, encourages us to consume unhealthy foods, and buffer our emotions through food, alcohol, work, and drugs.
We also know that stress has a role in the development of virtually every disease. Like chronic inflammation, it has been found to contribute to chronic anxiety, depression, digestive concerns, weight gain, headaches, heart disease, insomnia, chronic pain, and problems with concentration and memory, among others.
Discomfort with Discomfort.
To assess its impact on health, it helps to determine between two key types of stress: distress, the chronic wear and tear of traffic, disease, and deadlines, and eustress.
Eustress is beneficial stress—the short-lived discomfort of intense exercise, the euphoric agony of emotional vulnerability, or the bitter nutrients of green vegetables—that makes the body more resilient to hardship.
Whenever I feel discomfort, I try to remember the ducks.
Several years ago, on a particularly frigid winter day, I was walking my dog. Bundled against the cold wind, we strolled along the semi-frozen lake, past tree branches beautifully preserved in glass cases of ice. Icebergs floated on the lake. So did a group of ducks, bobbing peacefully in the icy waters.
With nothing to protect their thin flippers from the sub-zero temperatures, they couldn’t have felt comfortable. There couldn’t have been even a part of them that felt warm, cozy, or fed.
There was no fire for them to retreat to, no dinner waiting for them at home, no slippers to stuff frozen, wet flippers into. This was it. The ducks were here, outside with us, withstanding the temperatures of the icy lake. A part of them must have been suffering. And yet, they were surviving.
Far from surviving, the ducks looked down-right content.
I think of the ducks and I think of the resilience of nature.
We humans are resilient too. Like the ducks, our bodies have survived temperature extremes. Our ancestors withstood famine, intense heat, biting cold, terrible injury, and the constant threat of attack and infection, for millenia. You were born a link on an unbroken chain of survivors, extending 10,000 generations long.
Our bodies have been honed, over these hundreds of thousands of years, to survive, even thrive, during the horrendous conditions that plagued most of our evolutionary history.
Investigations into the human genome have revealed genes that get turned on in periods of eustress: bursts of extreme heat or cold, fasting, and high-intensity exercise. When our body encounters one of these stressors, it activates a hormetic responseto overcome the stress. Often the response is greater than what is needed to neutralize the threat, resulting in a net benefit for our bodies.
These protective genes create new brain cells, boost mitochrondria function, lower inflammation, clear out damaged cells, boost the creation of stem cells, repair DNA, and create powerful antioxidants. Our bodies are flooded with hormones that increase our sense of well-being.
It’s like the old adage, “What doesn’t kill you makes you stronger.”
Our bodies were made for discomfort. In fact, we have entire genetic pathways waiting to kick in and heal us as soon as they experience hardship.
There are a growing number of studies on the healing power of small troubles. Fasting may have a role in treating autoimmune diseases, decreasing the signs of aging, and as an adjunct therapy for cancer; sauna therapy boosts detoxification and may prevent dementia; cryotherapy, or exposure to extreme cold, has the potential to heal arthritis and autoimmunity; and High Intensity Interval Training has been shown to boost cardiovascular health more than moderate-intensity exercise.
Plants may benefit us through flavonoids, which, rather than serving as nutrients, act as small toxins that boost these hormetic pathways, encouraging the body to make loads of its own, powerful antioxidants to combat these tiny toxins.
Mindfully embracing discomfort—the bitter taste of plants, the chilly night air, the deep growling hunger that occurs between meals—may be essential for letting our bodies express their full healing potential.
Not Minding Our Minds.
Our ability to withstand powerful emotions may have healing benefits.
Many of us avoid painful feelings, allowing them to fester within us. We buffer them with excess food, or drugs, leading to addictions. Mindfulness can help us learn to be with the discomfort of the emotions, thoughts and physical sensations that arise in the body as inevitable side effects of being alive.
Research has shown that mindfulness can help decrease rumination, and prevent depressive relapse. It also helps lower perceived stress. How we perceive the stressors in our lives can lower the damaging effects they have on us. Research shows that those who view their life stressors as challenges to overcome have lower stress hormone activation, and experience greater life satisfaction.
According to Cognitive Behaviour Therapy (CBT), our thoughts create our emotions. Becoming more aware of our thoughts, through CBT or mindfulness, allows us to identify which thoughts may be limiting us or exacerbating our reactions to stressful situations.
When we learn to observe our thoughts, we create some distance from them. We become less likely to see the dismal thoughts in our minds as absolute truths.
Practicing mindful meditation, CBT, or cultivating positive thoughts, such as engaging in a daily gratitude practice, may improve our resilience to chronic stress.
Inattention.
According to Stephen Cope, yoga teacher and author of The Great Work of Your Life, “You love what you know deeply. Get to know yourself deeply”. We get to know things deeply by paying attention to them.
Georgia O’Keefe’s admiration for flowers, or Monet’s adoration of landscapes, is apparent to anyone who sees their work. In order to commit images to canvas, the artists gets to know their subject matter deeply. Their art celebrates what they took the time to pay attention to, and eventually came to love.
As a naturopathic doctor, I believe that healing begins with attention. When we become aware of our bodies, we begin to know them deeply. Awareness allows us to respond to symptoms lovingly, the way a mother learns to skillfully attend to her baby’s distinct cries.
When I first meet a new patient, the first thing I have them do is start to pay attention.
We become curious about their symptoms, their food intake, their sleep patterns, their habits and routines, the physical sensations of their emotions, the thoughts that run through their heads.
Through paying attention, with non-judgmental curiosity, my patients start to understand their bodies in new ways. They learn how certain foods feel in their bodies, how certain sleep habits affect their energy levels the next day, and how specific thoughts contribute to their feelings.
Once we begin to open up this dialogue with our bodies, it becomes impossible not to answer them with love. It becomes hard not to eat, sleep, and move in ways that convey self-respect.
A gardener who pays deep attention cannot ignore the obvious—her plants have roots, embedded in soil. The gardener quickly learns, through careful observation, that the health of this soil is vital to the health of her plants.
And so, back to the original question, “What is your favourite natural cure for anxiety?”
My favourite remedy isn’t a bottle of pills we reach for, it’s a question we reach for from within:
“What do I need to heal?”
After asking the question, we wait.
We wait for the answer to emerge from some primal place within, just as a gardener waits for new buds to rise out of the mysterious depths of the dark, nutritious soil.
The Therapeutic Order is a tool that helps guide naturopathic treatment approaches. I explain how naturopathic doctors’ healing philosophy might differ from the conventional medical model.
Hi, guys, I’m Dr. Talia Marcheggiani and I’m recording to you guys from my clinic in Bloor West Village and today I’m going to talk about some myths about naturopathic medicine, especially regarding our relationship with conventional medicine and medications and, in order to talk to you about that, I want to talk to you about something called the Therapeutic Order. So the therapeutic order is from our traditional roots in the formation of the profession of naturopathic medicine. This is one of our philosophical ideas about how to treat somebody that comes in our door and how people should be treated in terms of the medicine that we practice. And this is a 7-step process, or a hierarchy, of what our treatment goals are for seeing somebody. And the reason that I’m relating the Therapeutic Order to medications is because one of the steps in this hierarchy of the Therapeutic Order is pharmaceutical medication. And so I feel that, in naturopathic medicine, most of us, and certainly in our philosophy, in regards to medication, it’s not that we don’t agree with medication or surgery or conventional treatments, it’s our agreement about when they’re implemented and it’s also about our efforts to treat patients before the need for surgery or medications arises. And so, the Therapeutic Order is a system of interventions and we go from lower-force interventions to higher force interventions and the first step in the Therapeutic Order is to remove obstacles to health.
So, anytime someone walks into my office, and is displaying certain symptoms, I’m always looking for, what are the obstacles that their body is facing when it’s trying to achieve its optimal state of health and wellness. Our bodies have evolved over 300 billion years, from whatever our common ancestor was, that first created life, we’re this result of a lineage of survivors, if we’re here on the planet today. And so our bodies have evolved amazing mechanisms to preserve our health and well-being to ensure that our genes are carried on to future generations. So when somebody is coming in in the initial stages of disease, and so this may manifest for you as just this subclinical feeling of “imbalance”, for lack of a better word, there’s often an obstacle in the way. And a big obstacle that often presents itself in my patients’ lives is stress. That’s one that’s huge and that’s the reason that I talk about it so often. Another is toxic burden from our environment. Things like pesticides, plastics, smog pollutants in our air, in our water, in our food, that can also cause an obstacle to health or just give our bodies some extra things it has to deal with that divert it from its job of making us feel and look our best. And another thing, of course, is diet that’s inadequate, that’s not providing us the nutrients that we need or a diet that’s providing us with anti-nutrients, so it’s preventing us from absorbing the vitamins, the minerals and the macronutrients that we need to function optimally.
And some naturopathic doctors will focus on the energetic aspect, the spiritual aspect. So, is the person in front of them pursuing a meaningful life, do they feel satisfied with their work, are they satisfied with their relationships. So, anytime one of these major pillars of our health is lacking that can also present an obstacle to us feeling our best. And oftentimes the obstacle is a mental-emotional one, even if the symptoms that are manifesting are physical.
So, another video that explains this is my wheel of balance video in talking about stress and when I work with mental health, a stage to mental health promotion is emotional wellness, which is why I use that term so often, rather than focusing on eradicating or eliminating or managing symptoms of mental “illness”—and I prefer to say mental health conditions, rather than mental illness—how can we improve our emotional wellness, how can we improve our mental wellness, as opposed to focusing on disease.
Most naturopathic doctors will focus on this level, this will be inherent in our philosophy we’re always going to be looking for what the obstacles are that are in the way of our patients’ achieving symptom-free lives or a life of low or no symptoms, and a life of abundant wellness and energy, and healthy weight management and healthy mood and all of the things that indicate robust health. This will always be inherent in our philosophy.
The second step in the Therapeutic Order is to stimulate the Vis, so this is the “vis medicatrix naturae”, which is Latin for the healing power of nature, which may seem a little bit woo woo to some people, but you can think of the Vis as metabolism or homeostasis, and this is the idea that our body is primed for optimal health, and our body is always striving to maintain balance. And there’s this idea in naturopathic philosophy that sometimes this inherent energetic mechanism that causes life and all living beings, that sometimes it needs to be stimulated and oftentimes the therapies to do this are more in the energetic realm. So things like homeopathy and acupuncture and hydrotherapy as well, so using water and various temperatures to increase metabolism, hormonal balance, homeostatic balance and blood flow, so those are all scientific terms for what I think the Vis attempts to describe.
So, I tend also to use diet in this realm and herbs. I believe that herbs, and there’s some research for this, some evidence that herbs are modulating, that herbs, as opposed to drugs, kind of seek where things are lacking and they balance our hormonal milieu, our hormonal landscape, more than a medication, which is man-made and an example of this is that some people supplementing with straight vitamin A experienced some negative outcomes in large studies that were done. But if you eat foods that are high in vitamin A, those negative symptoms from vitamin A supplementation seem to balance themselves out and that’s because there are some nutrients present in vitamin and nutrient-rich foods that we haven’t discovered yet and that seem to act synergistically with other chemicals, natural chemicals, that are present in those foods. And so, by taking nature into our bodies through forest bathing, so physically being in nature, or through the consumption of plants and natural substances, I believe that we receive some of those messages from nature. And I can get into this in future videos. I find that herbs have intelligence behind them. And that’s not necessarily woo-woo or pseudoscientific, there’s some research for sure that show that herbs modulate through their anti-inflammatory effects, their anti-oxidant effects, and their hormone-balancing effects, in ways that pharmaceuticals don’t do to the same extent.
So, these two stages, when patients are coming in and we’re focusing our treatment, we’re removing obstacles and stimulating the body’s capacity to heal and you can think about this. If you break a bone, we’re definitely going to remove the obstacle, which is whatever broke the bone in the first place, and then we’re going to promote the body’s ability to heal. It’s not conventional medicine that heals the bone, we simply align the bone so that it can fuse together. It’s the body that heals it. So, we’d be promoting the healing of that tissue with some of the nutrients that the body needs. So this can be applied no matter how serious the medical condition, but definitely it will always be implicit in our treatment plans and how we look at the body. And sometimes that’s enough, if somebody is just coming in with a general feeling of imbalance or, you know, someone who’s coming in with a good state of health, without a loss of apparent symptoms that just wants to manage their health in general, then we’ll kind of stop there, but we might teach you some ways to detoxify, to encourage a healthy diet, and the healthy consumption of health-promoting foods and we’ll let you sort of maintain that on your own.
But what often happens is that people are coming in, because we’ve been taught in our culture in North America and Canada, especially, to come in and seek medical care when we’re feeling ill, a lot of the time people will come in with some kind of issue, so some specific symptoms, and oftentimes these symptoms are apparent or located within one organ system. And so the third step in the Therapeutic Order is to strengthen weakened systems. So this might be somebody who’s coming in a liver issue and this may be a diagnosed issue, or based on their symptoms, we’re noticing some impairment in the liver in general. And so we take treatment a step further and we start to focus on actually repairing the tissues that are present in the liver and so we’ll be using some, perhaps, liver detoxification, some more intense diets, so diets that are geared more to therapeutics, and using some herbs and nutrients to clean out the liver.
We can also use some of our energetics, at this stage, acupuncture, homeopathy, hydrotherapy, self-care practices, and we’ll definitely be removing obstacles to cure, so high-sugar diets, or overconsumption of alcohol, or a high toxic burden. We’ll be looking at those things as well, but we’re also taking it a step further and specifically focusing on the liver in this case.
And this is something that I see most of in my practice, is people coming in with hormonal imbalance, with a mental health condition, with digestive issues, skin issues, hair falling out, and so we’re ordering labs, we’re targeting specific organ systems, and we’re, maybe not necessarily putting these symptoms into a diagnostic category, that would be diagnosed by a conventional doctor, so sometimes these are still subclinical, but there’s definitely symptoms present, people are suffering and they’re noticing a change and they’re probably have already sought help with their medical doctor and maybe were told everything was fine, or maybe they received a diagnosis.
The 4th stage in the Therapeutic Order is to correct structural integrity. So, if our posture, if our alignment is off, then our health is not going to work properly, there’s not going to be proper nerve conduction, there won’t be proper circulation, there won’t be proper functioning of our organ systems. If our rib cage is collapsed, we won’t be breathing properly and we won’t be oxygenating our tissues. If our pelvis is out of alignment we won’t experience proper digestion and digestive regulation. And I often refer out for this stage, I might refer to an osteopath or a chiropractor, or a physiotherapist or massage therapist. I might so some acupuncture myself, but typically for structural correction, I’ll refer to another practitioner and I myself see a massage therapist, chiropractor, osteopath and do quite a bit of hydrotherapy and work on aligning my body through yoga and things like that because of its importance and just general health maintenance.
While this is the 4th stage in the Therapeutic Order, I often recommend that it be implemented as some kind of healthcare strategy that focuses on structural integrity be implemented early on or as a maintenance, especially because we’re so sedentary and we spend so much time in front of our computers and often engage in repetitive exercise. Working on structural integrity management is so important.
The 5th stage in the Therapeutic Order is the use of natural substances to restore and regenerate. And so this is a little bit like symptom management, if you can imagine that. The objective of naturopathic medicine is not necessarily to fix a specific disease, which is often confusing, because we have a very disease-focused healthcare system, not necessarily a health-focused one. And so we’re sort of indoctrinated into this view that if you don’t have a diagnosis that you’re healthy, or that health is the absence of symptoms, which is certainly not the philosophy of the world health organization who believes that health is a mixture of our mental and spiritual and emotional and physical wellbeing and not simply the absence of disease, however we do have a sickcare system rather than a healthcare system, and so we’re educated not to go to the emergency room or your family doctor unless you feel like it’s serious enough to warrant a diagnosis and, if it’s not, then you’re often sent home and told everything’s fine. And patients will always come in having told me that their labs are fine. And they are, they’re fine in the framework of not requiring a diagnosis, or pointing to necessary pathology, but they’re certainly not fine in the sense that not things that we can improve on and that are not giving us warning signals of what could come in the future.
We often focus on disease prevention and healing the body rather than focusing on the symptoms or the pathology. We’re looking for the underlying cause. However, sometimes we get far enough along that we do need to manage symptoms, otherwise people aren’t going to notice benefit. And, so, further along the disease process, further along the naturopathic order we need to reach. To manage the diseases. These are a little bit higher-force interventions, rather than sort of encouraging tissue repair, like we were doing in the 3rd stage of the Therapeutic Order, now we’re focusing more on managing symptoms, managing inflammation through herbs that are going to calm it down quickly, and detoxify quickly, and we’re going to manage headaches with herbs, that are just generally anti-inflammatory. So we’re going to be looking at symptom-management. And so a lot of the time we’ll do that in conjunction with the other 4 stages of the Therapeutic Order, but this time there is a heavy focus on keeping symptoms under control for better quality of life and to move the needle further.
And the 6th step of the Therapeutic Order is similar to the 5th, except we’re using pharmacological devices and so it’s not that we’re against pharmacology and medications in naturopathic medicine, at all, we simply want to encourage patients to come and see us before things get to the point where you require medications and I certainly believe and I think even many conventional practitioners agree with me on this, that medications are probably too widely prescribed or over-prescribed. And this may be that there are no other solutions and, as a clinician, you want to help the person sitting in front of you and aren’t really sure how to go about that. So somebody comes in to your office who has depression and you’re going to reach for the selective-serotonin reuptake inhibitor, the SSRI, the Prozac or Cipralex, you’re not going to tend to risk using herbs or focusing on diet or digestion or those kind of things, you’re going to use this “proven method” and you’re going to implement that right away, whereas my philosophy would be to, depending on how serious the case is, to implement other interventions and make sure that our terrain is being treated, that we’ve removed some obstacles to cure, we’ve encouraged spiritual and life-meaning pursuits and we’re stimulating the body’s own healing mechanisms and anti-inflammatory mechanisms, and that maybe we’re directly targeting the brain with some nutrients and some vitamins and that we’re making sure structural integrity is there, and that we’re even using some herbs to manage depression because we know that St. John’s Wort works very similarly to an anti-depressant in terms of its efficacy. And then, if those things are not working or not having enough of an impact, then we might talk about an SSRI, depending on how severe the case is.
And I say this not to create a stigma around medication use at all. Every single body is different and everybody’s going to need a different treatment concoction and it’s never going to be just one treatment or very rarely will it just be one panacea, no matter how much we wish that there were, it’s going to be a few things that we need to implement to help manage our own health, so that’s when we’ll reach for the pharmaceuticals, when the natural treatments are not having enough of an impact, or the disease process has progressed far enough.
And then the last is the use of high-force interventions, so surgery, radiation and chemotherapy. When you’re diagnosed with cancer, then it’s definitely appropriate to do radiation and chemo or to excise the tumour, or if there’s joint degeneration to the extent that it can’t further be repaired, and you can’t sort of prevent it any longer, because you’ve reached the point where the cartilage in your joint is damaged, then a joint replacement is appropriate. It’s not that we’re against these things either, it’s that we believe in trying as hard as we can to prevent them from being necessary. But when appropriate, they’re definitely a gift that we have in our culture and the time that we live in that we can use these kinds of things to improve our quality of life and to get us back on track in terms of our health. And so very rarely will I see somebody who requires this stage of intervention, even naturopaths that work with cancer, their focus is not to treat cancer with natural therapies but to support the whole patient and to improve the outcomes of the high-force interventions, often an obstacle to healing from cancer is that patients aren’t able to finish their course of chemo due to the side effects, and so a lot of the natural therapies can help boost the efficacy of the medication and reduce the side effects and make patients feel better, so that they’re able to complete their treatment and then have better outcomes. So, at these two, the last two stages, where we’re using medications and high-force interventions, natural medicine is working to support the terrain and to support the body, through the therapies, through the side effects and to also encourage the therapies to work better.
And just to recap, the stages of the Therapeutic Order are first, number one, remove the obstacles to health, number two, stimulate the Vis Medicatrix Naturae, or stimulate homeostasis, improve our body’s self-healing mechanisms through applying nutrients, or looking at energetics, or using herbs to balance our systems and promote proper hormone balance. And the third is to strengthen weakened organ systems, focusing on one organ that may be the culprit in causing symptoms in particular, and really using nutrients that target that organ and the tissues that that organ has. Number four is to correct structural integrity, creating proper alignment and healing the musculoskeletal system through things like chiropractic medicine, osteopathy, massage therapy, even hydrotherapy and acupuncture, doing exercise like yoga as well fits under there. And number five is to use natural substances to restore and regenerate, so this is using natural substances to work directly with symptoms, to promote healing, but in patients that are further along the road to pathology and maybe already have a diagnosis of some health condition. And number six is to use pharmaco-substances to halt progressive pathology, so these are palliating, they’re stopping disease, they’re treating somebody who is either not responding enough or whose disease has progressed far enough that natural therapies are no longer strong enough. And then the seventh stage of the Therapeutic Order is to use high-force invasive modalities, such as surgery, radiation and chemotherapy and, again, these are removing the disease. Often that stage is usually life or death situations, we’re working to remove what’s causing a danger to our body and to our ability to survive. And so naturopathic medicine cover this whole spectrum. We have therapies that cover the whole spectrum of these stages and we’re working to treat the whole person not focusing on the disease or the symptoms, but looking at the person in front of us, and taking into account their lifestyle their preferences, their unique individuality and genetic expression and individual expression. My name is Dr. Talia Marcheggiani, I’m a naturopathic doctor and I work at Bloor West Wellness in Bloor West Village in Toronto. Take care.
In this video I give an education talk to a group of seniors at the Bernard Betel Centre about naturopathic medicine. I discuss our philosophy, education, what kinds of conditions we treat and answer some questions along the way.
“I was born with an imbalance in my brain,” my patient explains to me, “The medication corrects it—Since I started taking Cipralex, I wake up feeling like a normal person again.”
It is estimated that about 10% of adults in North America are taking a medication to help them cope with anxiety and depression. Many people swear by these substances, others claim that they worsen depression, cause uncomfortable side effects and fail to treat the root cause of symptoms, numbing us to the experience and cause of our emotional pain and physical symptoms. The reality is, however, that prescriptions for these medications is increasing.
What are anti-depressants?
Most anti-depressant medication falls into the pharmaceutical category of SSRI, or Selective-Serotonin Re-uptake Inhibitors, like Prozac or Cipralex. These medications prevent the body from mopping up the “happy hormone”, serotonin, in the brain, making its feel-good effects last longer. The result is thought to be more serotonin in the brain and, therefore, increased feelings of happiness and euphoria. Other drugs work on preventing the re-uptake of other neurotransmitters, brain chemicals dopamine and norepinephrine, which also cause feelings of happiness, pleasure and reward, and give us energy.
The Monoamine Theory of Depression:
The leading theory of depression for decades, the Monoamine Theory, states that in people who suffer from depression, there is an imbalance in serotonin production and signalling in the brain—a “serotonin deficiency”—which SSRI medication corrects. Because this is how anti-depressant medication works, this has taken over as the prevailing theory of depression. However, there has never been a published study that proves that people who suffer from depression or anxiety have issues with brain serotonin production or metabolism. It almost seems that pharmaceutical companies have “reasoned backwards” creating a theory in order to support anti-depressant use.
As patients, we want to believe that the medicine our doctors give us is just that, medicine—something that treats the root cause of disease and makes us healthier, rather than covering up our symptoms while the underlying problem continues to worsen. However, most medications don’t work that way. While Advil may alleviate a headache, we intuitively know that our headache was not caused by an Advil deficiency. Likewise, alcohol may calm down those plagued by social anxiety, but we know that alcohol isn’t a cure for social anxiety; it is a drug that can temporarily help symptoms and relying on it will only cause further health problems down the line. We know that for most health conditions, while a drug may help temporarily, something else is going on inside our bodies that warrants attention.
While the percentage of people who are medicated for depression has increased in recent years, the rate of disability from mental health conditions is steadily on the rise. This is perplexing, especially if these drugs are doing what they’re “supposed to”, which is curing a brain chemical imbalance. Shouldn’t medicating patients with depression result in a cure, or at least a declining rate of disability for mental health concerns? Clearly, something else is going on.
Harnessing the Placebo Effect:
Many patients report the fact that anti-depressant medications saved their lives, radically turning around serious and debilitating symptoms. I’ve heard quite a few stories from individuals who couldn’t get out of bed until they found the right SSRI for their body.
The data shows that SSRI medication has the ability to reduce depressive symptoms by 30% in individuals, a modest reduction at best, but still significant. But, do these medications work as well as the studies claim? A glance at the entire body of research casts doubt on the efficacy of anti-depressant medication:
Firstly, there is a large body of unpublished negative studies. This means that studies that show there is no difference in anti-depressant medication and placebo is left out of the body of literature, favouring a bias for positive publications, publications that find anti-depressants work. Medical research draws conclusions by producing studies over and over again. When the results of several studies are combined, doctors and researchers are able to draw conclusions about whether a medication works or not. When only positive research is published, without negative research to balance it out, it casts medications in a favourable light that they may not necessarily deserve. This is an unfortunate phenomenon in medical science as a whole, and often skews the evidence in favour of drugs that may not be as effective as we hope.
Secondly, the gold standard for evidence, the Randomized Control Trial (RCT) may have design flaws due to the nature of the medications being tested. In RCTs, patients are randomized into two groups. One group is given placebo and the other the active drug that is being tested. The subjects and the people evaluating them are both blinded—neither knows which group is given the drug and which is given the placebo. This reduces the possibility of bias in reporting and observing the effects of the medication. The idea is because an inert pill, or “placebo” may be able to exert the effects of a drug, providing about 30% benefit, according to some sources. However, when patients who are in the active group experience side effects of the medication: gastric symptoms, nausea, headaches, altered sleep and appetite, they quickly become alert to the that fact that they are in the medication group, leaving room for the placebo effect to occur. This is termed the “Active Placebo Effect”. When SSRIs are compared with active placebos—placebos that don’t act as medicine but produce the same side effects—we found their effects rapidly diminished, perhaps because the placebo effect was not taking effect anymore.
What about the people who SSRIs help?
To cast doubt on the efficacy of anti-depressants does not in any way invalidate those who have felt the medications helped them. Every body is different and I believe that it is not for us to say how someone should or shouldn’t be reacting to a medication or therapy. The mysteries of our bodies are vast and there is only so much that we’re aware of in the world of medicine and health. Furthermore, the placebo effect, while often being used to dismiss therapies (“oh, it’s probably just a placebo effect”) should really be viewed as an amazing miracle of medicine and evidence of how powerful our bodies and minds are. The placebo effect shows us that, according to our beliefs, we have the power to heal ourselves. We believe that we’re getting treatment, we believe the treatment will help us, and the very nature of those beliefs heals our physical bodies.
This does not mean that the people who were suffering before taking the medication were “faking it” or should have been able to just snap out of it—that’s not how the placebo effect works. The placebo effect is based on changing our beliefs, which, as you may know, is not something we can simply will ourselves to do. However, the fact that our beliefs hold this kind of healing power, I find, frankly, is amazing. The placebo effect shows us evidence of an almost magical ability of the mind-body connection to heal ourselves, without side effects, and I believe it is something that we should harness and celebrate.
What’s the problem, then?
While anti-depressants may be harnessing the placebo effect to help individuals heal, there are downsides to them as well.
Firstly, SSRI medications have a long list of side effects, from weight gain and fatigue to sexual dysfunction and vitamin deficiencies, being on these medications over the long-term can be unpleasant for some and seriously affect quality of life for others.
Secondly, anti-depressant medications are notoriously difficult to get off of. I have assisted many patients in getting off their medication, with the help of their medical team, but it’s never easy and must always be done slowly and responsibly. Getting off medication involves a slow wean over months with support of natural therapies, psychotherapy and lifestyle changes. Because these drugs force the brain to adapt, causing a very real chemical imbalance, oftentimes the withdrawal effects are so intolerable that patients are not able to come off.
Most patients who decide to try anti-depressant medications are not aware how difficult it will be to stop taking the medication, if they should eventually choose to do so. This is unfortunate, as I believe that full informed consent should be applied to patients so that they may make appropriate decisions about their health—patients should be made aware that they are expected to stay on the medication for life and that weaning will be very difficult and, in some cases, not possible.
Finally, there is a growing body of evidence showing that patients who do not receive medication, but other forms of help such as diet and lifestyle changes, psychotherapy and stress management, do better, have higher rates of remission and less relapse than those who are medicated. As we see with the studies that show that more medication is correlated with more disability from mental health concerns, it is possible that medicating depression is only worsening the problem for most people.
So, what causes anxiety and depression?
Scientists and clinicians are not sure what the cause of depression is. However, the Cytokine Theory of Depression and the Gut-Brain Connection are two areas that are gaining increasing interest from researchers. These theories state that depression may be a cause of inflammation in the body that affects the brain, and that imbalances in gut health, especially with gut bacteria may offset mental health, respectively. Naturopathic doctors also notice a clinical correlation between burnout or “adrenal fatigue” and mental health symptoms.
Healing the mind and body, however, starts with creating a therapeutic relationship with a professional that you trust. After that, I find that healing the gut, correcting inflammation and nutrient deficiencies while addressing harmful core beliefs and stress can have wonderful results for healing depression and anxiety.
Depression is a symptom:
Psychiatry would have us believe that depression and anxiety are conditions that we are born with. Conventional medicine states that perhaps we have a familiar tendency to develop these conditions, perhaps we’ve had them since childhood, but, and in this case it is clear, depression and anxiety are not things that you heal from; they are things you simply manage.
I disagree. I don’t believe that depression and anxiety stand on their own as diseases, but symptoms of a deeper imbalance. Like any symptom, I believe mental health concerns are trying to tell us something. Our bodies have no other way of communicating with us other than through the symptoms they produce: lack of motivation, sore muscles, bloating and diarrhea, headache, joint pain, brain fog, fatigue and so on. As naturopathic doctors, we are trained to listen, not just to our patients, but the messages their bodies are signalling to us through symptoms.
This means that, when I start seeing a patient with depression, whether they are on medication or not, we develop a full work-up, asking in-depth questions about sleep, diet, exercise, digestion, mental status, mood, energy, reproductive health and so on. I connect these symptoms together to find out what is going on beyond what may be immediately visible.
Depression and anxiety often have a root cause. The cause may be stress, childhood trauma, leaky gut, adrenal fatigue, inflammation or even medication and drug use itself. Through uncovering the root of the issue, we are able to treat it, helping the body restore itself to balance and health.
My philosophy of healing is that, sometimes, illness can be a gift, especially if it encourages us to delve deep into our lives and values and make the necessary changes for healing ourselves. Sometimes depression and mental health challenges can be the beginning of a grand and fulfilling journey where we learn to connect more deeply to our bodies, discover our life purpose and a greater sense of happiness and life satisfaction.
