Well taking care of ourselves, or ‘self-care’, is super important. I too enjoy a bit of late-night TV vegetation and find I’m much more centred when I find time for yoga or meditation. However, as a Clinical Psychologist what I really wish people knew more about – especially when it comes to our mental health, burn out or stress – is the importance of self-compassion, and that it is actually quite different than self-care.

Self-compassion refers to the ability to be kind and caring to one’s self at times of suffering or failure. Since it was first introduced to the psychological literature in 2003 by Kristin Neff, research into the subject has grown exponentially. Today it seems clear that higher levels of self-compassion are associated with significantly lower levels of depression, anxiety, stress, self-criticism, perfection and a whole range of other mental health issues. Increasing self-compassion has also been shown to improve romantic and non-romantic relationships, leadership outcomes, confidence, parenting, care-giving, burn out and even physical health and recovery.

Given the somewhat overuse and similarity of the term ‘self-care’ with self-compassion you would be forgiven for confusing the two. However, there is actually a very big difference between them. Self-care refers to taking particular behaviours or actions that are regenerative and help us to relax and unwind. Self-compassion is much more complex and involves both thoughts, feelings and behaviours. It goes back to our childhood and involves things like ‘mindfulness’, ‘common humanity’ and is an emotional regulation skill set that reflects our schemas and mental maps.

Unfortunately, increasing our self-compassion is not that easy. It is actually very common and normal to have a resistance to being kind to ourselves. More adults than not today were raised in a ‘tough-love’ culture. We may have learnt that being compassionate to ourselves (or others) is soft, weak or self-indulgent. These are misconceptions that can be hard to break or even sneaky to notice when they creep in. Improving our self-compassion takes time and focus, but it can pay dividends for our well-being and mental health.

I discovered self-compassion through my own personal journey with well-being and conducted my first research study in self-compassion in 2013 as part of my psychology Honours thesis. Today I teach self-compassion to my clients through 1:1 psychological therapy alongside some of the main interventions such as Cognitive Behavioural Therapy, Schema Therapy and EMDR (Eye Movement Desensitisation and Reprocessing). Now I’m excited to bring this important concept to even more people through in person and online self-compassion workshops. For more information on the next workshop or 1:1 treatment check out my website at: www.thinkfulpsychology.com.

The post Self-Compassion – It’s just self-care right? – by Felicity Jefferson, Clinical Psychologist appeared first on Performance in Health.

The concerning trend is the number of individuals I am supporting who are starting the year already feeling burnt out and fatigued.  How can that be?  Normally, I see this trend starting in October.  Well, I definitely have some thoughts on this to share.

One would expect that after a long Christmas break which occurs for many people in Australia, that people would greet the new year feeling restored,  motivation levels replenished with a positive attitude.  This is not what I am finding.

Now one might say that as a naturopath, I am not going to have people come to see me who are feeling restored, motivated and energetic and that is true.  However, what I am experiencing is a huge increase in the number of people booking naturopathic consultations who are completely exhausted weeks into the new year.

I have a great educational blog on dealing with Burn out that of course will be helpful for most sufferers and discusses impact of lack of sleep, stress, an unhealthy diet and more – READ HERE.

So, we have had several years now where we dealt with covid and all that came with it, now it is inflation, less people to fill important jobs and rising interest rates as we see the world in chaos with war and natural disasters.  Christmas holidays are often full of activity, catching up with family, getting on long flights and for many amongst you, whilst you had a break from work, the time you had off was a far cry from being a restorative holiday where you jumped into 2023 fully energized with a skip in your step.

It is my assessment that many of us are absolutely exhausted from the last three years or so and more is needed to restore oneself back to a healthy state of motivation, good mood and energy.

Strategies that may have worked in the past probably need a re vamp.

In high demand people

So many of us I put in the category of being “in high demand” people and I know from clinical experience that this has more far reaching impacts than you may think on your health.

What does “in high demand” really mean?  I am referring to those of us who in our 24/7 society are juggling excessive amounts of daily responsibilities with little time left in the day to rest, relax, wind down and simply be still.

Does this sound like you?   Maybe you are what I term a “Superwoman”, juggling career, running busy households, trying to fit in daily exercise, dutifully visiting parents and friends on weekends, cooking after work each day, nurturing your children, partners or fur babies whilst having minimal down-time for yourself?

Maybe you are a mum at home with young children who require your undivided attention day in day out with no time for your own needs?  In my prior life where I advised senior women on important career decisions, it was abundantly clear that one of the most difficult jobs for them was being a stay-at-home mother with many describing their “work job” as much easier and much more appreciated! 

Maybe you are a father supporting your family in whatever way you can during challenging times, maybe you are in a constant state of worry about job stability, are building a new business or maybe you live on your own with no support, building your career and relying on yourself to make ends meet.

Whatever type of “in high demand” person you are, functioning in this way is stress as far as the biochemistry of your body is concerned.

Many of you may say “But I don’t feel stressed” or “this is my normal and has been for many years”.

But you see, what the body sees as stress may in fact surprise you.  Simply being in a constant “state of go” is a signal that your body automatically reacts to.

The body senses this “go state” as stress, just as if you were running from a swerving car, swimming from a shark or protecting your child from danger and it responds by producing chemicals such as adrenaline and cortisol to “fight or flight” this perceived threat.   From a biochemistry point of view, your body does not know the difference between the swerving car or you being in your natural, every day “go state”.  It is one in the same as far as your body is concerned.

In short bursts, stress acts to sharpen your focus and give you the extra strength and endurance needed to face an immediate issue or danger head on.  But when that threat is gone this reaction shuts down and normality returns.

The problem is that in modern society this cortisol and adrenaline production never turns off because your “go state” never turns off.  This leads to consistently elevated levels of these chemicals in your body and these chemicals do a lot of things.  Let me list a few:

•          Weight gain:  high cortisol tells your body to release sugar into your blood stream for your muscles to have the energy to “run from the threat”, but you are not running anywhere so this excess sugar sits in your blood.  Because excess sugar in the blood is dangerous, your body quickly stores this sugar as fat.  And it is mostly around the abdominal area too!   In addition, cortisol is a chemical that increases your appetite meaning you crave more carbs & sugar.

•          Reduced function of important body processes:  Whilst cortisol signals your body to increase muscle strength and blood sugar levels to run from that swerving car, it actually needs to shut down or inhibit other functions to do this.  Whilst facing this threat the body rightly determines that certain processes are less important.    Unfortunately, this means reduced digestion, immune strength and reproductive functions.  This is why being in the “go state” constantly will give rise to digestive issues, increased colds and flu and problems with fertility.

•          Reduced thyroid function: stress hormones reduce the level of thyroid hormones in your body.  This can lead to weight gain, fatigue, hormone related issues and infertility to name a few.

•          Anxiety & depression: cortisol is a very greedy chemical in your body, and it uses up a lot of nutrients that are also required to make “feel good” hormones and neurotransmitters.  There is simply not enough of these nutrients to go around when cortisol is being made by the body at such high levels and mood disorders can appear.

•          High blood pressure:  to run quickly from that swerving car for example, your body needs to be fast and strong immediately.  Again, cortisol and adrenaline come to the party and activate physiological changes to push blood to your muscles, heart and vital organs.  Your blood vessels quickly tighten and your blood pressure increases so that blood can get to these places quickly.  Being in a constant “go state” means that this is happening to you all of the time.

It is therefore incredibly important not to underestimate the powerful impact that stress may be having on your mental and physical well-being.  Daily rituals to switch off this “go state” is important for your happiness and future.  Daily moderate and enjoyable exercise, sunshine, getting into a good sleep routine, breathing exercises, a warm bath and a nutritious diet are some ideas that you could consider.

But it needs to be more than daily rituals especially if you have already reached a position of “burn out”.  Reviewing all home tasks, planning restoration holidays and hand balling tasks where possible is critical so that you can have an “alt control delete” and reboot your computer.

High performance self-care strategies

I made this term up as I see so many successful people, performing in their jobs, gym sessions each week, performing in their finances, performing in their studies, looking after everyone else however self-care and restoration strategies go by the way-side.  It is mostly because self-care is never really put on the list of performance KPI’s or in business plans and I am here to say that it damn well should be.

Burn out is very dangerous.  It leads to depression, anxiety and a body that can start to break down and get ill.

Preventing it by prioritizing self-care is critical.  So, what are some high-performance self-care strategies I recommend:

• A complete overhaul of activities at home including cleaning, school pick up, who cooks dinner when, grocery shopping.  Do you and your partner do some tasks together? Can they be separated so you get more you time? Can you get food delivered?  Can meal preparation be allocated amongst people in the house? Is it possible for a grandparent or someone else to drop kids off to school?  Can you afford a cleaner?  Can you work one day from home or can you reduce your hours or buy more leave from your employer or allocate more time if self-employed? Look closely at what is not negotiable here and what actually can be done to release time for self and give you less to do.
• 10-day relaxing holiday every year by yourself, with partner, close friend or immediate family; caveat is that it should be taken as a preventative and not once you have already reached burn out.  Now, these types of breaks don’t need to be expensive.  There are lots of lovely spots out of most cities or there is lots to do even if you stay at home.
• Put as much emphasis on relaxation as you do on fitness; add a weekly restorative yoga or meditation class to the schedule.
• Three hours a week – time just for you.  Could be a Saturday walk, could be a Thai foot massage and reading a book under a tree in the park.  In my household, I work from home on a Monday for half a day and then have the other half to myself and my husband is banned from working from home that day – it is mine (and my cat).  I work on Saturdays and so my husband has his solitude time.  It is healthy and we both really look forward to our own space.  There is a lot to be said about solitude.
• In your entertainment budget: people always make allocations for dinners, alcohol, movies.  Add self-care massage, long weekend at Airbnb, drive out of city into nature and quiet café onto the list.
• Last but certainly not least is to honor the commitments you make to yourself so that consistent restoration is a priority for thriving in life and patterns repeated year after year are finally ceased.

This list could be endless.  You may need the support of a counsellor to help you put in place life strategies that work for you so that your prevent burn out and the anguish that comes with it.

So, that is my thought piece for today.   I hope that the trend of early year exhaustion is not a sign of things to come and I hope if you are reading this that you make it a huge priority to preserve energy, nurture self-rejuvenation and KPI self-care in your life goals.

For additional support if you have reached burn-out or what support on managing a hectic life so that you prevent burnout, here are some additional blogs to support you https://www.performanceinhealth.com.au/2022/04/21/anxiety-depression-and-burnout-support https://www.performanceinhealth.com.au/2020/05/14/effects-of-daily-stress/.  Please book an initial naturopathic consultation with me via the contact tab here.

Founder, Naturopath

Tanya Edwards

Performance In Health

The post Reclaiming your energy and motivation appeared first on Performance in Health.

I also focus on digestive issues and IBS as a naturopath, and it is certainly an area of health that I am passionate about.  I find that irritable bowel syndrome (IBS) is a diagnosis often via exclusion and once other health conditions have been excluded, IBS is the diagnosis given.    This basically means that the actual cause of your gut distress is not known.  It is important to exclude other causes which is always part of my treatment plan when working with gut related issues. 

When I am supporting someone with an IBS diagnosis, I always consider anxiety as a cause.  In saying this, I always assess for chronic constipation as the cause, slow gut motility, Post Infectious IBS, endometriosis on the colon, bacterial overgrowth in the small and/or large intestine, bacterial dysbiosis, food intolerances & malabsorption conditions and thyroid disease.  I often recommend functional testing to delve more deeply into what is happening for my clients.  Often Inflammatory Bowel Disease, GERD, H Pylori or more may have been excluded by a gastroenterologist. 

I also find that it may be several health-related issues that may create the “perfect storm” of Chronic IBS.

What I do know without a shadow of a doubt is that in approximately 70% of case gut issues drive anxiety and in approximately 30% of cases anxiety drives gut issues however no matter where it starts, one drives the other so you end up in a gut – anxiety – gut- anxiety circuit and treatment must also focus on both for successful outcomes.

Let’s talk statistics about Anxiety Driven IBS.

Both IBS and anxiety are common health issues for adults in Australia. IBS affects around 1 in 5 of us, whilst 1 in 6 will experience an anxiety disorder in their lifetimes. It’s becoming increasingly well established that our mood and our gut health are intrinsically linked and, anecdotally, many of us are all-too-familiar with the gut-churning effect anxiety and stress can have on our bodies. We’ve previously discussed on the blog about the link between gut health and low mood issues such as depression. But what about other mental health conditions? Do these also affect our gut health? Today we look at anxiety and how it can drive IBS – the mechanisms behind this, as well as some simple strategies to help you manage your anxiety symptoms to improve your gut health.

IBS

Irritable bowel syndrome, also known as IBS, is a really common gastrointestinal condition, affecting around 15% of the general population.  IBS is a chronic functional disorder, characterized by recurrent symptoms of abdominal pain and bloating, as well as constipation, diarrhea, or both.  Despite being common, it’s a complex condition that involves a complicated interplay between gut microbiota, diet, pain receptor dysregulation, and mental health. It’s very common for people with IBS to have concurrent mental health conditions, such as anxiety and depression – up to 90% of people with IBS also have one or more mental health conditions. What’s more, IBS symptoms often worsen during periods of acute stress or exacerbations of existing mental health conditions, and treatment for mental health can lead to reduced IBS symptoms. Recent studies suggest that IBS is actually a disorder of a breakdown in gut-brain communication, rather than being a strictly gastrointestinal health condition.

Anxiety and the Gut

Have you ever been anxious about an event and found you suddenly had to go to the bathroom? Or, if you experience an anxiety disorder, do you find that gastrointestinal symptoms are an issue for you? You’re not alone. Anxiety is one of the most common mental health conditions in Australia; many of us have experienced an anxiety disorder ourselves or have seen a loved one go through it. Anxiety causes both psychological and physical symptoms, with gastrointestinal symptoms being some of the most common issues for those with anxiety. Whilst typical symptoms might include shortness of breath, sweaty palms, and palpitations, acute anxiety can also look like:

• Diarrhoea, constipation, or both
• Abdominal cramping or pain
• Nausea, indigestion, or heartburn
• Loss of appetite, or increased appetite

So, what is going on here? There are a few reasons why these symptoms occur.

1. The Enteric Nervous System and The Gut-Brain Axis

The first reason for this link between anxiety and the gut is because both the gut and brain are connected via a system of nerves called the enteric nervous system (ENS), which is also known as the “second brain”, or the “gut-brain axis”. The enteric nervous system controls aspects of communication between the gut and the brain regarding functions such as digestion and gut motility. In fact, the vital functions of the gastrointestinal tract are almost entirely dependent on the enteric nervous system and things quickly fall apart if it is not working properly. Researchers have also found that the ENS may be responsible for some of the mood changes associated with gastrointestinal conditions like IBS. The ENS and gut-brain axis connects the emotional and cognitive centers of the brain with the gut. It is through this link that our thoughts and feelings affect our digestion and vice-versa.

2. The Physiology of Anxiety and Neurotransmitters

The second reason why anxiety and IBS are linked has to do with the chemical changes that occur in the body in anxiety. Physiologically, anxiety is essentially an overactivation of the fight or flight response, also known as the HPA axis or sympathetic nervous system. This means anxiety, like stress, puts our body into fight or flight mode. When the body is in fight or flight mode, “non-essential” functions such as digestion and immune function are suppressed. People with anxiety often aren’t digesting and absorbing their food adequately, particularly when symptoms are bad. What’s more, anxiety leads to altered levels of many important neurotransmitters, which are the chemicals the nervous system uses to send messages throughout the body. When neurotransmitter levels become altered, communication within the nervous system is compromised, as is communication between the brain and the gut via the ENS. Some of the neurotransmitters that are affected include noradrenaline, GABA, and acetylcholine, among others.

Noradrenaline

Noradrenaline, also known as norepinephrine, is a key neurotransmitter in the sympathetic nervous system (the fight or flight mode). It helps us to feel awake and alert and plays important roles in regulating our behaviour, memory, and learning. Anxiety typically causes noradrenaline levels to be higher than normal, which causes a fast heart right, high blood pressure, suppressed digestion, and slow bowels (meaning constipation). However, in periods of acute stress or anxiety, high noradrenaline can actually stimulate the bowels and trigger diarrhoea. In addition, noradrenaline can also cause alterations to the gut microbiota, leading to dysbiosis, which can make IBS symptoms even worse.

GABA

Gamma-aminobutyric acid (GABA) is our main calming neurotransmitter. Not only does it help us to feel calm, it is also important for helping with physical movement and cognitive function. Low GABA levels are typical in anxiety. Unfortunately, low GABA levels causes an increased sensitivity to pain in the gut, one of the most common symptoms in IBS. Low GABA levels can also negatively affect gut motility and the gut’s immune function, too.

Acetylcholine

Acetylcholine is another important neurotransmitter that is altered in both anxiety and IBS. Acute stress and anxiety cause low levels of acetylcholine in the gut and the brain, which leads to inflammation and increased gut motility, causing diarrhoea.

The Role of Gut Bacteria

Of course, we can’t discuss the gut without also discussing the gut microbiota. The gut microbiota is essential for the health of both the central nervous system (brain) and the ENS, because of the important neurotransmitters these bacteria produce, which are utilized by our nervous system. Bacteria in the gut produce not only serotonin, but also GABA, acetylcholine, and even melatonin. Animal studies show that changing the gut microbiota can trigger anxiety disorders and other mental health conditions, further highlighting how important our microbiota balance is. Gut bacteria directly affect the gut-brain axis, too. Bacteria communicate with nerve cells in the gastrointestinal tract, as well as communicating with the brain via the neurotransmitters they produce.

A Self-Perpetuating Cycle

It’s easy to see how the link between gut health and anxiety can lead to a self-perpetuating cycle for those with anxiety disorders and conditions like IBS. Once you are caught in this cycle, it will continue until both the anxiety and the gut aspects of your health are addressed. This is where as a naturopath I often make a significant difference in Anxiety Driven IBS through guiding you towards treatments that will help to address both the anxiety and the gut, to help make sure you are healing both parts of the issue.

Calming Your Anxiety for Better Gut Health

The good news is there are many ways you can start to gain control of your gut health by addressing your anxiety, and vice versa. Below are some great tips for helping to regain your health.

Herbal Medicines for Anxiety

Each person is unique and for this reason there are many herbs that I use for my KPI of Calm energy. This may also include herbs for more restorative sleep as sleep is critical for reducing next day anxiety.  Some of my favourite herbs include kava, withania, rhodiola, passionflower, lavender and more.

Gut calming herbs

Again, this is dependent on medications and what is unique to each client however some of the herbs I may prescribe include chamomile, lemon balm, peppermint.

Use a Quality Probiotic when indicated

Prescribing a probiotic when someone actually has a bacterial overgrowth can worsen their symptoms when working with IBS.  Once an overgrowth has been excluded and reasons for a lack of healthy gut bacteria has been identified then specific probiotics may be prescribed.

A good quality probiotic can be incredibly valuable in re-establishing a healthy gut microbiota for certain people. Certain specific microbial strains, such as Lactobacillius reuteri, have been found to improve gut motility and reduce pain perception in the gut, demonstrating good potential for use in IBS. However, remember that probiotic supplementation does need to be paired with prebiotics and a healthy, plant food-rich diet to ensure sufficient substrate available for bacterial populations to thrive. Unfortunately, many probiotics available on the market are of inferior quality or don’t contain therapeutic doses of specific bacterial strains that are beneficial for conditions like IBS. If you are interested in taking a probiotic, speak with your naturopath to find the right probiotic supplement for you.

Specific prebiotics

Many prebiotics can produce excess gas that worsen symptoms such as bloating and pain however proper prebiotic prescriptions made in line with symptoms can make a huge difference for symptoms and support good bacterial populations to grow.

Vitamin deficiencies and additional needs

Again, each person has different nutrient requirements depending on levels of stress in their lives including career, family, past history and more (which uses up nutrients), diet, lifestyle, and medications.  Important nutrients for anxiety include magnesium, Zinc, Vitamin B, Vitamin C and more.  The wrong magnesium at the wrong dose can worsen looser stools so be careful.

Blood sugar balancing

When supporting my clients with anxiety, a focus is always made around balancing blood sugar levels throughout the day and night as fluctuations can trigger and worsen anxiety.  Having good energy levels throughout the day is also important as fatigue is a trigger for anxiety in many people.

Manage Your Stress

Finding ways to reduce your stress and improve your stress-coping skills can really help with anxiety. Stress management can be as simple as a daily 30-minute walk or starting a mindfulness practice.

Talk it Out

If you experience anxiety, having a professional you can talk to makes a big difference. If you don’t already, consider booking yourself in to see a psychologist, counsellor, or therapist, who can listen to your experiences and help direct you towards helpful strategies to manage your anxiety.  Performance in Health Wellbeing clinic in Sydney’s Inner West have a team of well qualified professionals to help you.

Book in to see me (Tanya Edwards) for Naturopathic support

If you’re struggling to understand where to start, getting some professional guidance is key.  A naturopathic consultation is an extremely thorough investigation which can help you to better understand your symptom picture and overall health as we work together to develop a holistic strategy to help you regain your health.

Treatment will look at what needs to be excluded.  I may recommend a low FODMAP as a temporary measure to reduce gut symptoms as we figure out what is happening for you and herbs to reduce anxiety and gut issues at the same time.  To find out more, contact Performance in Health today.

References

Annahazi, A., & Schemann, M. (2020). The enteric nervous system: “A little brain in the gut.” Neuroforum, 26(1).

Bercik, P. (2020). The brain-gut-microbiome axis and irritable bowel syndrome. Gastroenterology & Hepatology, 16(6), 322–324.

Carabotti, M., Scirocco, A., Maselli, M. A., & Severi, C. (2015). The gut-brain axis: Interactions between enteric microbiota, central and enteric nervous systems. Annals of Gastroenterology, 28(2).

Cherpak, C. E. (2019). Mindful eating: A review of how the stress-digestion-mindfulness triad may modulate and improve gastrointestinal and digestive function. Integrative Medicine: A Clinician’s Journal, 18(4), 48–53.

Gros, M., Gros, B., Mesonero, J. E., & Latorre, E. (2021). Neurotransmitter dysfunction in irritable bowel syndrome: Emerging approaches for management. Journal of Clinical Medicine, 10(15).

Hadjivasilis, A., Tsioutis, C., MIchalinos, A., Ntourakis, D., Christodoulou, D. K., & Agouridis, A. P. (2019). New insights into irritable bowel syndrome: From pathophysiology to treatment. Annals of Gastroenterology, 32(6), 554–564.

Jerndal, P., Ringstrom, G., Agerforz, P., Karpefors, M., Akkermans, L. M., Bayati, A., & Simren, M. (2010). Gastrointestinal-specific anxiety: An important factor for severity of GI symptoms and quality of life in IBS. Neurogastroenterology & Motility, 22(6).

Lee, S., Wu, J., Ma, Y. L., Tsang, A., Guo, W.-J., & Sung, J. (2009). Irritable bowel syndrome is strongly associated with generalized anxiety disorder: A community study. Alimentary Pharmacology and Therapeutics, 30(6), 643–651.

Niesler, B., Kuerten, S., Demir, I. E., & Schafer, K.-H. (2021). Disorders of the enteric nervous system—A holistic view. Nature Reviews Gastroenterology & Hepatology, 18, 393–410.

Popa, S.-L., & Dumitrascu, D. L. (2015). Anxiety and IBS revisited: Ten years later. Clujul Medical, 88(3).

Shrestha, B., Patel, D., Shah, H., Hanna, K. S., Kaur, H., Alazzeh, M. S., Thandavaram, A., Channar, A., Purohit, A., & Venugopal, S. (2022). The role of gut-microbiota in the pathophysiology and therapy of irritable bowel syndrome: A systematic review. Cureus, 14(8).

Windgassen, S., Moss-Morris, R., Goldsmith, K., & Chalder, T. (2019). Key mechanisms of cognitive behavioural therapy in irritable bowel syndrome: The importance of gastrointestinal related cognitions, behaviours and general anxiety. Journal of Psychosomatic Research, 118, 73–82.

The post Is Anxiety Driving your IBS? appeared first on Performance in Health.

Mental Health 101 – What Does a Healthy Nervous System Look Like?

Before addressing the issues that contribute to poor mental health, it can be helpful to understand some of the physiological processes that happen in the body every day that determine our mental health and our resilience to stress.

Neurotransmitters

These are chemicals that send messages to the brain and other parts of the body and can affect our mental state, sleep, and more. The majority of these are produced in the brain itself, but they are also produced in other parts of the body too, such as the adrenal glands and even the gut. When our nervous system is healthy, our neurotransmitters are in balance – not too much of the stimulating chemicals and not too much of the relaxing chemicals. Some of the important neurotransmitters for mental health include:

Serotonin – AKA the “feel good” chemical. Interestingly, whilst many think of serotonin in terms of its production in the brain, a whopping 90% of our serotonin is actually produced in the gut by our gut bacteria!

GABA – AKA gamma aminobutyric acid. This chemical helps us to feel calm. If GABA is too low, we can experience symptoms of anxiety, such as feeling stressed, overwhelmed, and feeling unable to relax.

Noradrenaline – helps us to be focused and alert. If noradrenaline is out of balance, we can feel restless and anxious, and may have trouble with memory and concentration.

Adrenaline – also affects our concentration. Adrenaline levels rise during periods of stress and is associated with being in “fight or flight” mode. If our adrenaline levels are too high for long, we can crash, leading to fatigue and burnout.

Acetylcholine – is one of the chemicals used by brain cells to communicate with each other and is involved in memory and learning. It also plays a role in regulating our mood. If acetylcholine levels are too high, we may feel depressed.

Dopamine – is involved in feelings of motivation and reward. Low dopamine might make us feel unmotivated and down.

Cortisol – our “get up and go” hormone. Cortisol levels fluctuate over 24 hours and should be higher in the morning (typically peak at around 8am) and then gradually reduce over the course of the day until it is lowest at night. Cortisol and melatonin (below) directly affect one another. If one is high, the other one is low.

Melatonin – our sleep hormone. If cortisol levels are too high, or peak too late in the day, melatonin production can be impacted and it may be more difficult to fall asleep, as the build up in melatonin at night is partly responsible for us being able to fall asleep.

What Can Disrupt Neurotransmitter Balance?

Mental health conditions, and especially depression, are often put down to simply being a “chemical imbalance”. But what is causing this imbalance? Many different things can disrupt the delicate balance of our neurotransmitters, including:

• Hormonal imbalance due to hormones such as thyroid hormones, oestrogen, or testosterone
• Chronic stress (see below)
• Dietary insufficiencies or poor digestion – not enough of the building blocks are being absorbed for the body to make neurotransmitters. This includes protein but also many different vitamins and minerals, such as B vitamins, zinc, and magnesium
• Genetic factors, which can increase the body’s requirements of nutrients like B vitamins (a common one is MTHFR)

Other Factors that Contribute to Anxiety, Depression, and Burnout

• Overwork and overcommitment
• Lack of sleep and insufficient rest or downtime
• Psychological trauma
• Lack of social connection
• Underlying health conditions, such as thyroid autoimmunity
• Inflammation, which can disrupt normal neuronal functioning
• Toxicity and detoxification issues, including exposure to heavy metals, or poor liver clearance of toxins
• Chronic illness
• Blood sugar issues – hypoglycaemia can trigger symptoms of anxiety
• Nutrient deficiencies – deficiencies in important nutrients such as omega 3 fatty acids, vitamin D, zinc, and vitamin B12 are well documented as playing a role in mental health disorders, including depression and anxiety.

The Effects of Chronic Stress

Our bodies aren’t designed to cope with chronic stress. In times gone by, stress was an acute issue – a sabretooth tiger was chasing you and either you outran it, hid from it, or were eaten by it. In any case, the stressor was a sudden, acute situation and was completely resolved very quickly. Contrasted with today’s modern stressors, there is a huge difference in the types of stress we are encountering, and how completely we are able to resolve stress, too. Instead of spending our days hunting, foraging and seeking shelter, we are instead bombarded with high stress work demands, constant advertising, global news of war and devastation both here and in faraway countries, over which we have little control.

The issue is that our bodies cope with stress in the same way, whether that stress be a short- or long-term issue. In the early phases of the stressful situation, we move from the parasympathetic nervous system (AKA the “rest and digest” phase) into the sympathetic nervous system (AKA “fight or flight”). The digestive system, immune system and any other “non-essential” bodily functions at that time are put on the back burner and their function is reduced.  The body also releases high amounts of adrenaline and cortisol, ready to cope with the issue at hand. We are ready to physically outrun or fight the threat. However, when it comes to chronic stress, this response isn’t really very helpful as there is no need to run or flight. As time goes by and we aren’t able to outrun the stressful situation, our bodies become depleted, and we begin to feel burnt out. Fatigue sets in, we are unable to concentrate, and yet we find it impossible to relax or sleep. Our immune system and digestion suffer, too, and we become more susceptible to issues such as recurrent infections or even IBS.

Gut Health and Mood

Our gut is more heavily linked to our mood than you might think. As mentioned above, 90% of serotonin is produced in the gut, but our gastrointestinal tract is also involved in regulating our mood in other ways, too. Special nerve cells in the gut form what is known as the enteric nervous system – it is also known as “the second brain”. This system, along with communication from our gut bacteria, communicates with the brain to control physical processes such as blood flow to the gut and the production of digestive secretions, but is also involved in emotional regulation. A good example of the enteric nervous system in action is the feeling of butterflies in your stomach that occurs when stressed or nervous. It can also be seen in the very real relationship between mood and symptoms in sufferers of IBS. For more information on the link between the gut and the brain, head to our website here and check out the blog post “Is your gut affecting your mood?”.

Treatment Strategies for Coping with Anxiety, Depression and Burnout

Dietary Changes

Foods to Avoid

Processed Foods

Processed foods containing trans fats and refined grains, as well as food and drinks with added sugar, cause rapid increases in blood sugar and insulin levels. This can lead to reactive hypoglycaemia (low blood sugar), triggering symptoms of anxiety. It can also negatively impact our body’s ability to maintain energy throughout the day, which can be a big issue with suffering with burnout and depression.

Examples of processed foods to avoid include:

• Refined carbohydrates – white bread, white rice, cakes, muffins, crackers, cookies, potato crisps
• Processed meats – bacon, salami, sausages, pastrami
• Foods with added or concentrated sugar – sweetened popcorn, ice cream, chocolate, fruit juices, soft drinks, cordial
• Foods containing trans fats – fried foods, pastries, hot chips

Food Intolerances/ Sensitivities

Foods that you are sensitive or intolerant to, can exacerbate fatigue and mental health symptoms, because they increase inflammation in the body, causing high cortisol levels. The digestive issues that these foods can cause will further exacerbate neurotransmitter imbalances in the long term, by impacting your body’s ability to absorb important building blocks for making neurotransmitters. Whilst sometimes it can be easy to identify food intolerances due to obvious symptoms after exposure (e.g. digestive issues after eating dairy), some intolerances and sensitivities can lead to vague or delayed symptoms. Using a food and symptom diary can help to identify trigger foods that are impacting your health and need to be eliminated.

Caffeine

The brain cleanses and replenishes itself while we sleep, so prioritising quality, restful sleep is incredibly important for looking after mental health. Caffeine can unfortunately significantly impact on our sleep. Caffeine has a long half-life of up to 12 hours, which means that 12 hours after consuming a cup of coffee, half of that caffeine is still circulating through your body and affecting you. This means that a cup of coffee at 3pm will certainly still be affecting you at 10pm when you are trying to sleep. Multiple cups of coffee (or consuming caffeine from multiple sources) further worsens the issue. If you do need to drink coffee, stick to one cup per day (preferably a good quality espresso), and make sure you have it before 10am. Be mindful of hidden sources of caffeine to ensure you aren’t mistakenly consuming too much.

Sources of caffeine include:

• Coffee and coffee-flavoured foods
• Tea (including black, green, rooibos, and flavoured tea varieties) – Note: herbal teas are generally caffeine-free, unless it is a blend that includes tea in it
• Energy drinks
• Chocolate

Alcohol

Alcohol is a no-go when it comes to managing anxiety, depression, and burnout. Alcohol worsens inflammation, reduces serotonin levels, and impacts sleep by preventing us from entering restorative REM sleep. As a depressant, it can also negatively affect our emotional state and be detrimental to improving mental health.

Foods to Include

Fresh Vegetables and Fruits

Choose a variety of vegetables and fruits in different colours and textures – this is the easiest way to ensure you are eating a wide variety of nutrients. Raw, steamed, baked, and cooked into stews and soups are great ways to prepare vegetables and fruits to maintain optimal nutritional benefits. For added fibre, keep the skin on foods such as carrots, potatoes, sweet potatoes, and apples (but be sure to give them a good scrub before preparing/ eating). Vegetables and fruits are also a great source of B vitamins, and many contain good amounts of magnesium, which are crucial for neurotransmitter production. Where possible, look for fruits and vegetables that are currently in season. Aim for 5 or more serves of vegetables and 2 serves of fruit each day. Below are some vegetables and fruits to include:

• Non-starchy vegetables: broccoli, cauliflower, green beans, eggplant, tomato, cucumber, zucchini, artichoke, asparagus, pumpkin, Brussels sprouts, onions, cabbage, kale, spinach, peas, celery, silver beet
• Starchy vegetables: potato, carrot, sweet potato
• Fruits: apples, pears, oranges, mandarins, tangerines, apricots, plums, bananas, mangoes, strawberries, blueberries, mulberries, blackberries, raspberries, cherries, watermelon, rockmelon, honeydew melon, pineapple, coconut, feijoa, grapefruit, grapes, jackfruit, lemons, kiwifruit, lychee, nectarines, papaya, passionfruit

Note: dried fruits can have very concentrated amounts of sugar in them, which cause big fluctuations in blood sugar and can worsen anxiety symptoms and feelings of burnout. Keep consumption to a minimum and combine them with a source of protein and fat (such as a few nuts) to slow down the sugar absorption.

Fresh Herbs and Spices

Use fresh herbs and spices in your cooking to add flavour to meals. They can also be added raw to salads! Herbs and spices can add extra antioxidants, vitamins, and minerals to your meals.

Some examples of herbs and spices to use include basil, coriander, rosemary, dill, parsley, oregano, garlic, ginger, mint, chives, sage, tarragon, thyme.

Protein

Protein should be a part of every single meal, as it provides the building blocks needed to make serotonin and other neurotransmitters. Having protein with every meal will also help to keep blood sugar levels balanced. Lean meats, preferably organic and pasture-raised are great additions to your diet. Beef, kangaroo, chicken, turkey, fish, and lamb are all good options, as are free-range eggs. Fish is a particularly good option as it provides omega-3 fatty acids, which are helpful for mental health. Remember not to overdo it, however – a palm-size portion is plenty, and red meats in particular should be limited to only a few times per week. Grill, bake or lightly sauté, rather than frying.  For plant based proteins, this website blog has some excellent recommendations click here

Remember to also include vegetarian proteins in some meals to avoid overeating meats. These foods are rich in fibre, vitamins, and minerals as well. Some examples of vegetarian proteins include:

• Lentils
• Beans – kidney, black, cannellini, pinto, lima
• Chickpeas
• Tofu, tempeh, and edamame
• Nuts – almonds, cashews, walnuts, Brazil nuts
• Seeds – pumpkin, sunflower, sesame, chia, hemp

Whole Grains and Unprocessed Carbohydrates

Carbohydrates are an essential part of our diet, but the type of carbohydrates you consume can either help or hinder your mental wellbeing and physical health. As discussed above, “white”, processed carbohydrates aren’t good for blood sugar balance or insulin levels and can worsen anxiety and burnout issues. Instead, it is best to opt for minimally processed whole grains or other, unprocessed carbohydrate sources, such as starchy vegetables (listed above) and never let carbohydrates be the main event of your plate by always adding a quality protein and healthy fat. Options for whole grains include:

• Brown rice
• Quinoa
• Rolled or steel cut oats
• Whole grain and sourdough breads
• Buckwheat

Fats

Whilst we need to avoid trans fats (as discussed above), “good” fats are essential for healthy cells and hormones. Fatty acids are essential for neuronal cells to function properly, and omega-3 fatty acids in particular have great outcomes on mental health issues including depression.

Polyunsaturated fats, including omega 3 fats, can be found in:

• Oily fish, such as salmon, tuna, sardines, and mackerel
• Walnuts
• Hemp seeds, chia seeds, pumpkin seeds, flax seeds, and sunflower seeds and other raw nuts

Monounsaturated fats can be found in:

• Vegetables such as avocado, Brussels sprouts, olives
• Extra virgin olive oil
• Almonds, cashews, pecans, hazelnuts
• Pumpkin seeds, sesame seeds

Remember that we only need quite small amounts of fat, and a little goes a long way – a serve of almonds, for example, is about 30g, which is only 20 almonds.

Micronutrients

B Vitamins

B vitamins are needed to support neurotransmitter production and are also vital for energy, too. Vitamin B12 is a particularly important nutrient for mental health that is found only in meats and fortified foods, so vegans and vegetarians must supplement this vitamin to avoid deficiency. B vitamins are found in a wide range of foods, particularly fruits, vegetables, and whole grains. Choosing nutrient dense whole foods helps to ensure you are getting plenty of these nutrients in your diet, however supplementation may still be required.

Magnesium

Magnesium regulates the production of neurotransmitters such as serotonin, as well as being involved in over 300 processes in the body. During times of stress, magnesium is quickly depleted from the body, and many of us don’t get enough from our diet to avoid insufficiency. Dietary sources of magnesium include almonds, pumpkin seeds, sunflower seeds, and dark green leafy vegetables. Using Epsom salts in the bath can also help to increase magnesium levels, as some of the magnesium in Epsom salts can be absorbed through the skin. Supplementation may still be necessary, however, especially if you have been dealing with chronic stress in your life.

Support proper digestion and absorption

If you have been stressed and burnt out for a while, your body probably isn’t digesting and absorbing nutrients very well. One way we can help to improve digestion and absorption is by ensuring we are entering into the cephalic phase of digestion before we begin eating. This is the phase of digestion that precedes actually eating – when the look, smell, and thought of food primes our body by stimulating digestive secretions (saliva, gastric juices, and bile). We can help our bodies along by doing the following:

• Boost digestive enzyme production by drinking some lemon in warm water about 10 minutes before main meals
• Sit at the table to eat
• Put down the phone and turn off screens to eat. Avoiding distractions at the table means we are more engaged with our food, which helps us to digest and absorb more. Not scrolling on your phone also prevents us from feeling stressed while we eat, which worsens digestion and absorption.

Lifestyle Strategies

Exercise

Whilst exercising when your mental health isn’t good can feel difficult, it is so important to move your body each day. In addition to boosting your mental health, exercise is important for improving sleep quality, heart health, and for maintaining muscle and bone health. On difficult days, walking is a great choice which can seem less daunting. Start with 20 minutes per day and build up slowly to one hour per day. Walk quickly enough that you break a sweat. When you feel ready, challenge yourself with more vigorous exercise at least once or twice per week. Solo options include gym workouts or classes, bike riding, jogging, or swimming. You could also use exercise as a social outlet and try group-based exercises such as team sports or rock climbing.

Sleep

Sleep is so vital not just for physical health but also for mental health. When we are asleep our brains repair and renew themselves, dealing with inflammation and clearing away toxins and metabolic waste products. Without adequate sleep, these processes can’t be properly done, which can worsen mental health symptoms and fatigue. Below are just a few methods for helping you to prioritise quality sleep.

• Get yourself outdoors for some sun exposure each morning, sometime between 8am and 10am. This triggers your body to release cortisol (our awake and alert hormone) in the morning when it is needed and allows plenty of time for cortisol to decrease in the evening and allow melatonin levels to rise in time for sleep. Sunlight exposure is also important for vitamin D production, which is a crucial nutrient when it comes to mental health.
  
  Note: bright fluorescent lights in the office don’t cut it! The sun is 10,000 times brighter and is needed in order to have the positive effect on cortisol regulation.
  
  
• Create the right environment for melatonin production in the evenings by improving your dark exposure:
  – No overhead lights – use low-light lamps only (salt lamps work well for this, or switch the bulbs in your lamps to warm, low-light types)
  – Have at least 1 hour of screen-free time before bed (that means no TV, computer, laptop, tablet, or phone).
  – Use blue-light blocking glasses in the evenings – these help to reduce the cortisol-rising effects of blue light and promote better melatonin release before bed.

Digital Hygiene

As discussed above, screen-based technology can have a significant impact on sleep and mental wellbeing by adding stress and anxiety to our lives. There’s even a term for it – doom scrolling. Limit your screen use as much as possible by utilising timers and parent-lock apps to keep you off your phone if required. It can also be worthwhile setting yourself a schedule of when to engage in news reading and social media to limit your consumption of these, particularly if they can be a source of stress for you.

Social Connection and Support Networks

Social connection and support networks are vital for lasting mental wellbeing. We are social creatures and need to have that connection in our lives. Friends and family that have a positive influence in your life and make you feel good about yourself are a great source of connection. We can also seek community in other places, such as hobby groups, social sports, and local religious community groups. Volunteer groups such as SES and Landcare (among others) are also a great place to find meaningful social connection, while also offering an opportunity to give back to the community.

Find a Counsellor or Therapist You can Connect With

If you don’t already have a regular counsellor or Psychologist, it is worthwhile pursuing this. Having someone you can speak to about stressors in your life can make a huge impact on you mental wellbeing. A qualified counsellor or psychologist can help with facilitating lasting lifestyle changes, identifying patterns of behaviour that need to be released, and finding underlying issues and roadblocks that may be limiting your healing journey.   Performance in Health Wellbeing clinic not only has myself as Naturopath to support clients on strategies of diet, lifestyle and nutrient deficiencies – we also have a team of highly qualified mental health specialists to make sure that your whole person is supported.

Practice Mindfulness

Mindfulness meditation and meditative movement are excellent additions to your daily life when healing from mental health issues and burnout. Research shows that these practices can greatly improve mental wellbeing in both the short and long term, by bringing us out of fight or flight mode, reducing cortisol levels, and helping us to build resilience to stress. Even ten minutes of daily mindfulness meditation can help reduce feelings of stress. Meditation studios offer both in-person and online classes, or you can use an app such as “insight timer” for access to thousands of guided meditations for free. Meditative movement practices such as yoga, tai chi, or Qi gong are also helpful. As with meditation, there are many studios out there that offer regular classes. There are also many apps available online, or you can try YouTube for free videos – “Yoga with Adrienne” is a popular YouTube channel with dozens of free videos to use.

Prioritise rest

Especially when recovering from burnout, prioritising rest and downtime is vital. It can be helpful to remember that we do not need to be productive during every waking hour! Taking time out to rest and be calm outside of sleeping hours is an important part of living a balanced life and supporting your mental health. Set aside one hour for down time each evening – the hour before you go to sleep is an ideal time. Use this hour to practice self-care (a bath or shower is a great idea), or to otherwise nourish yourself. This might mean reading a book, listening to some music (or playing an instrument), engaging in a hobby, practicing yoga, or simply spending quality, screen-free time with a loved one. Taking time out for yourself each day can help to improve your feelings about the day and helps you to move out of fight or flight mode.

Herbal Medicines for Mental Health

There are many wonderful herbs that are fantastic for supporting mental health and for recovering from burnout. Here are just some of the herbs that can be used:

• St John’s Wort, which has anti-depressant properties and works to increase serotonin levels
• Saffron, which increases serotonin as well as GABA
• Chamomile, well-known for its calming properties, can help with anxiety and improve sleep, too
• Passionflower, which can reduce anxiety and increases GABA
• Ashwaghandha, which is known as an adaptogen – helps to increase our resilience to stress
• Liquorice, which can help to balance cortisol levels
• Kava, which increases GABA and helps with anxiety
• Nettle, which promotes calm and is also a highly nutritive herb with lots of magnesium and other micronutrients for neurotransmitter production
• Oats seed, which helps to nourish the nervous system overall to help with healing

You may also be on anti-depressant medication and it is important that a fully trained herbalist/naturopath investigates which herbs and supplements work well alongside these medications as some can be contraindicated.

Sample Daily Eating Plan – No Dietary Exclusions

Breakfast: 2 free-range eggs, scrambled, with lightly wilted spinach, grilled tomato and sautéed mushrooms

Snack: 20 grams of organic walnuts with 1 cup blueberries

Lunch: Palm-sized serve of chicken breast with quinoa and salad (tomatoes, lettuce, cucumber, red cabbage) and a a drizzle of extra-virgin olive oil

Snack: carrot sticks with ¼ cup of tahini or hummus

Dinner: Grilled salmon fillet with a small serve of brown rice and steamed broccoli, asparagus and green beans, topped with freshly chopped parsley or dill.

Sample Daily Eating Plan – Vegan

Breakfast: 1/3 cup scrambled tofu cooked in freshly grated turmeric, with a grilled tomato and one cup wilted spinach on the side

Snack: ½ cup homemade chia pudding with 1 cup strawberries

Lunch: Grilled eggplant and chickpea salad with cherry tomatoes, red onion, capsicum, and fresh chopped parsley, with ¼ cup hummus

Snack: An apple and 30g walnuts

Dinner: vegan burrito bowl – kidney beans cooked in cumin and paprika, with mixed leaf lettuce, capsicum, tomato, cucumber, and corn, ½ an avocado, freshly chopped coriander and chilli

The post Anxiety, Depression and Burnout Support appeared first on Performance in Health.

Constipation is such a common issue among both adults and children, but often goes under treated or ignored. Constipation can greatly impact on quality of life and can also exacerbate other health conditions, so getting to the root cause of the issue is important for overall health. If constipation is an issue for you, read on to discover some of the most common root causes, as well as naturopathic strategies to help improve your digestive health.

What is Constipation?

Constipation means you are either not having a bowel movement or are finding it difficult to pass a bowel movement (or both). Ideally, we should be opening our bowels daily and stools shouldn’t be difficult to pass – that is, we shouldn’t need to strain or spend long periods of time on the toilet to get things happening.

Medically speaking, chronic constipation generally means fewer than 3 bowel movements per week. In reality, however, we should ideally be opening our bowels every single day. Why? Because our bowels are one of our major channels of elimination for getting rid of toxins and waste products that the body doesn’t need. If we aren’t opening our bowels often enough, these waste products sit stagnant in the bowel, causing inflammation. They may even be reabsorbed by the bowel and re-enter circulation, increasing the toxic burden on the body and creating additional stress on organs such as the liver, who need to process these waste products all over again.

Symptoms of Constipation:

• Stools are difficult to pass: Straining or extended periods of time sitting on the toilet are required
• You feel as though your bowel movement was “incomplete” after evacuating (as if there is more to pass but you are unable to pass anything more)
• Stools are hard and may be smaller than usual
• Abdominal pains from trapped gas can also occur

What Causes Constipation?

There are many, many different causes of constipation and for many people their constipation will be due to a combination of causes. Below are some of the major causes of chronic constipation.

Insufficient water intake

Stools are made up of a high percentage of water, which is what keeps the stools soft enough to move through the digestive tract efficiently. If you aren’t drinking enough water, your stools can end up being too dry and hard, which slows down their transit in the bowel.

Insufficient fibre in the diet

Fibre (undigestible carbohydrates in the diet) is found in foods such as vegetables, fruits and legumes. It is vital for healthy bowel movements, as it makes up the “bulk” of the stool, as well as being a food source for the bacteria in the gut, which play a role in normal stool formation and gut function. Having sufficient bulk in the stool triggers the gut to rhythmically contract (a process called peristalsis), moving the stool through the digestive tract ready for excretion. Too little fibre means this process doesn’t occur properly, leading to slower transit time.

Low physical activity

Physical activity also helps to stimulate the bowel to move stools through the digestive tract.

Certain medications and nutritional supplements

Certain medications, including some pain-killers, antacids and anti-depressant medications, are known to increase the risk of constipation. Nutritional supplements containing iron or calcium can also lead to constipation.

Stress and anxiety

The gut-brain connection is a powerful regulator of our health. Stress and anxiety activate our body’s fight-or-flight response, putting us into a state known as parasympathetic dominance. When in this state, our body down-regulates certain biological functions, including digestion, so that it is ready to respond to perceived imminent threats. This means impaired digestion and, as a result, constipation.

Dysbiosis

The bacteria in our guts are important for so many aspects of our health, and it’s not surprising that they play a role here, too. Our gut bacteria are the biggest producers of serotonin in the body, which is not only our “happiness” molecule, but is also important in maintaining normal gastrointestinal function. Dysbiosis and reduced intestinal serotonin levels can lead to poor gut motility and contributes to chronic constipation.

Pregnancy

Hormonal changes in pregnancy lead to the slowing down of the gastrointestinal tract, which aids in absorbing additional nutrients from food as it passes through. The downside, however, is that this slower transit time can lead to constipation.

Pelvic Floor Dysfunction

A weakened pelvic flood may mean there is insufficient muscle tone for you to properly expel the stool.

Other causes:

• Ignoring the urge to pass stools
• Over-use of laxatives – this can lead to reliance on laxatives in order to have a bowel movement
• Medical conditions such as IBS, food intolerances, diabetes, Parkinson’s disease or multiple sclerosis

Constipation in Kids

Constipation is also a common issue for children, particularly between the ages of 2 and 4 when potty training begins. Whilst some children may experience constipation due to slow bowel transit, up to 95% of chronic constipation in children is due to withholding behaviour, sometimes triggered by a previous painful bowel movement. Withholding and ignoring signals to open their bowels means the stool remains in the large intestine for too long and becomes dry and hard, making it more difficult to pass and further exacerbating the issue.

Health Consequences of Chronic Constipation

­Haemorrhoids

Haemorrhoids are swollen, distended veins which can occur inside or outside the rectum as a result of straining to open your bowels. Haemorrhoids can be painful which can worsen constipation by leading to hesitancy and resisting the urge to open your bowels.

Dysbiosis

Dysbiosis (changes to the normal microflora balance in your gut) may be a cause or an effect of constipation. To learn more about the importance of a healthy microbiome and the health consequences of dysbiosis, click here.

Waste Product Reabsorption

As discussed above, when stools sit in the large intestine for too long, the body begins to reabsorb some of the waste products that are meant to be eliminated. This can lead to issues with other health conditions such as hormonal issues like PMS, as excess oestrogen that would otherwise have been neutralised and eliminated from the body re-enters circulation, contributing to continued oestrogen dominance. The recirculation of waste products also puts additional strain on the liver, which may lead to fatigue, headaches and other issues. 

Combating Constipation, the Naturopathic Way

Fortunately, there are many effective strategies for combatting chronic constipation without resorting to harsh laxatives. Check out the tips below from Sydney naturopath Performance in Health for some of the common effective strategies to beat constipation.

Dietary Strategies

Increase your fibre intake:

• Fibre is the undigestible portion of carbohydrates which are important for healthy bowel movements.
• Include a variety of fibre-rich foods.
• Fruits and vegetables of different colours and textures (consider leaving the skin on vegetables such as potatoes and carrots for added fibre, but be sure to thoroughly wash before preparing).
• Legumes, nuts and seeds are also good sources of fibre, as well as being protein-rich foods.
• Fibre supplements, such as flaxseed meal and slippery elm powder can also be used, however they must be taken with sufficient water, or else they may exacerbate the issue. It’s best to discuss this with your naturopath before using.
• If you need to increase your fibre intake, it’s best to increase it slowly over a period of time to prevent bloating and gas issues.

Increase water intake:

• As a rule of thumb, around 2-2.5L of water per day is required for an adult, and more if you’re physically active.
• Increase prebiotic foods.
• Prebiotic foods feed the beneficial bacteria that support healthy bowel movements.
• Foods such as apples, garlic, onions, and legumes are all excellent sources of prebiotics.
• Reduce your intake of low-fibre foods such as meats, eggs, dairy and highly processed foods like white bread, cakes – reducing your intake of these foods makes way in your diet for high fibre foods.
• Lemon juice in warm water before meals stimulates digestion and can help with constipation.
• Eat “bitters” before main meals.
• Bitter foods such as rocket, or even herbal bitters such as gentian, can help to improve overall digestive function.
• If you do wish to try herbal bitters, speak to your naturopath first.

Supplements

Probiotics:

• A variety of probiotics have been shown to help improve bowel function in constipation sufferers.
• Probiotics have also been shown to be helpful for children with chronic constipation.

Magnesium:

• Some magnesium supplements depending on the type have been shown to help in chronic constipation by acting as an osmotic laxative, stimulating the intestines to draw additional water into the bowels.

Herbal medicines:

• Depending on the cause of your constipation which must be understood first, some safe and effective herbs can help to improve constipation alongside other treatment strategies.  It is important that a trained herbalist prescribes these herbs as they must be used appropriately.  Herbs such as Dandelion root, Globe artichoke, Senna, Yellow Dock, Rhubarb, Magnolia, Ginger and Licorice are some of the herbs prescribed.

Lifestyle Strategies

Daily physical activity:

• Aim for 20-30 minutes of moderate intensity exercise every day – a brisk walk (fast enough to break a sweat) is a great place to start.
• Bowel “re-training”.
• Sitting on the toilet at the same time each morning (for example, after breakfast) can help to “retrain” your brain to associate a certain time of day with opening your bowels, helping you to initiate a regular bowel movement. After a main meal is an ideal time for this, as it takes advantage of the body’s reflex system to increase peristalsis when the stomach is full.
• Bowel “retraining” can be a particularly important strategy for assisting in constipation in children, who should be encouraged to sit on the toilet for 5 minutes after each main meal and try to open their bowels.
• Ensuring optimal posture for bowel movements is equally important. A relaxed posture with feet comfortably supported on a foot stool optimises posture for bowel movements – a “squatting” type position is ideal.
• For children with functional constipation, using a reward system and even a daily diary can also be beneficial.
• Don’t ignore the urge to go! Even if you are unsuccessful in opening your bowels, responding to bowel movement queues by sitting on the toilet helps to retrain your brain to respond appropriately to these queues in future.

What About Over the Counter Laxatives?

Over the counter laxatives are often the first port of call for constipation sufferers, however, as discussed above, frequent use of laxatives to initiate a bowel movement can lead to your body relying on these for every bowel movement. Instead, think of laxatives (even “healthy” and “natural” ones) as being for short-term use only. Once the initial constipation is relieved, it’s best to focus on longer term strategies and addressing the root cause of the issue, to prevent constipation from recurring.

To find out more, contact Performance in Health today for an initial appointment.

References

Cao, H., Liu, X., An, Y., Zhou, G., Liu, Y., Xu, M., Dong, W., Wang, S., Yan, F., Jiang, K., & Wang, B. (2017). Dysbiosis contributes to chronic constipation development via regulation of serotonin transporter in the intestine. Scientific Reports, 7.

Dimidi, E., Christodoulides, S., Scott, S. M., & Whelan, K. (2017). Mechanisms of action of probiotics and the gastrointestinal microbiota on gut motility and constipation. Advances in Nutrition, 8(3), 484–494.

Forootan, M., Bagheri, N., & Darvishi, M. (2018). Chronic constipation: A review of the literature. Medicine (Baltimore), 97(20).

Hechtman, L. (2012). Clinical naturopathic medicine. Elsevier Australia.

Koppen, I. J. N., Lammers, L. A., Benninga, M. A., & Tabbers, M. M. (2015). Management of functional constipation in children: Therapy in practice. Pediatric Drugs, 17, 349–360.

Levy, E. I., Lemmens, R., Vandenplas, Y., & Devreker, T. (2017). Functional constipation in children: Challenges and solutions. Pediatric Health, Medicine and Therapeutics, 8, 19–27.

Mori, S., Tomita, T., Fujimura, K., Asano, H., Ogawa, T., Yamasaki, T., Kondo, T., Kono, T., Tozawa, K., Oshima, T., Fukui, H., Kimura, T., Watari, J., & Miwa, H. (2019). A randomized double-blind placebo-controlled trial on the effect of magnesium oxide in patients with chronic constipation. Journal of Neurogastroenterology and Motility, 25(4).

The post Living with Chronic Constipation: a Naturopathic approach to healing appeared first on Performance in Health.

Introduction

Mental health is an incredibly important issue affecting a significant number of Australians – nearly 1 in 2 Australians will experience a mental health disorder in their lifetime. Whilst external factors such as stress and environment of course contribute to poor mental health, Changes in our physical health can also impact our mood and may even contribute to or worsen mental health conditions. The importance of our gut microbiome for gastrointestinal health is something that is well established – many of us are aware of the benefits of probiotics for supporting healthy digestion. But how does our microbiome affect other areas of our health, such as our mood? There is growing evidence to support an important link between our microbiome and our mood – the microbiome may have an important role to play in not only helping us to feel happier, but even for helping to support those with mental health conditions such as depression, insomnia, and anxiety. In this blog, we examine the link between our gut, microbiome, and mood, and look at ways to support a healthy gut from a naturopathic perspective.

The Microbiome and The Gut-Brain Axis

The term “microbiome” or “gut microbiota” refers to the trillions of bacteria and other microorganisms that naturally live inside our intestines. We each have around 100 trillion bacteria, made up of approximately 100 different species, living inside our intestinal tract. The exact composition of each of our microbiomes is individual and depends on a range of factors, including genetics, geographic location, diet, and the use of medications, such as antibiotics.

One of the key connections between our microbiome and our mental health is through the gut-brain axis, a two-way communication pathway between our brains and our intestinal tract. This communication highway is mediated by the Vagus nerve, a large nerve that runs up through the centre of the abdomen. Microbes are able to send signals to the brain by directly and indirectly stimulating the Vagus nerve in various ways, but particularly through their ability to produce chemical messengers that send signals to the brain via this nerve. Certain bacteria inside our intestines produce significant amounts of neurotransmitters that are important for our mental health, including serotonin (the “happiness” molecule). In fact, 90% of our body’s circulating serotonin is produced not in the brain, but in our guts by intestinal bacteria, so microbes are playing a bigger role in your mood than you might think! Other important neurotransmitters such as dopamine, noradrenaline, GABA, and acetylcholine, can also be produced by intestinal bacteria. These chemicals play important roles in regulating our mood, anxiety, and even cognitive function.

Our intestinal microbes also influence inflammation levels inside the gut, as well as maintaining normal intestinal wall integrity (i.e. they help to prevent “leaky gut”). This is important, because both inflammation and leaky gut syndrome have been associated with mental illnesses such as depression. Changes in the make-up of the microbiome can lead to an increase in the production and release of inflammatory molecules called lipopolysaccharides. These and other inflammatory molecules send signals via the Vagus nerve up to the brain, causing changes in the brain that can induce symptoms of depression and anxiety.

So, how is the microbiome involved in specific mental health conditions?

Microbiome and Stress

Our microbiome influences how we perceive and react to stress in our lives. Stress leads to changes in the microbiome and can contribute to “dysbiosis” (an unhealthy imbalance of microbes in the gut). Animal studies have shown that a healthy gut microbiome actually helps to regulate our fight-or-flight response (also known as the HPA axis), meaning we are better able to cope with stressors in our lives when our microbiome is healthy.

Microbiome and Depression/ Anxiety

Inflammatory chemical messengers from bacteria have been shown to trigger symptoms of both depression and anxiety. Several studies have found that the types of intestinal bacteria present in the guts of people with major depressive disorder differs to that of the general population. However, there currently isn’t any consensus on any single bacteria that may be causing this link.

Microbiome and Insomnia

Recent research suggests that changes to the microbiome may play a role in insomnia, too. Studies have shown that interfering with normal sleep patterns (such as during shift work) can trigger changes to the intestinal microbiome. Another interesting role of the microbiome in influencing our sleep is in relation to our circadian rhythm, the internal clock that helps us to be awake and alert in the day, and sleepy at night. Studies on the microbiome show that the microbes within our intestines also follow a day-night pattern, fulfilling different functions depending on the time of day or night.

Supporting Your Mood and Your Gut Health

What can you do to help improve your mood and support your gut health? The following provides some tips on supporting both your mental wellbeing and your microbiome.

Eat a healthy diet:

• Certain dietary patterns, such as the Mediterranean Diet, have been shown to improve mental health and also provide lots of the types of foods that are good for supporting a healthy microbiome, too
• Reduce your intake of foods that preferentially feed unhealthy bacteria species – these foods include high sugar foods like cakes, lollies, and soft drinks, as well as foods high in trans fatty acids such as deep-fried foods
• Eat plenty of fibre-rich foods such as fruits, vegetables and wholegrains – Our “good” bacteria feed off of the complex carbohydrates found in these foods
• Our blog on feeding and nourishing your microbiome might also provide important tips https://www.performanceinhealth.com.au/2020/06/11/microbiome-family-gut-health/

Supplement with a high-quality probiotic:

• If you have recently taken medications such as antibiotics, have had a digestive issue such as diarrhoea, or have been through a period of significant stress, your microbiome may well benefit from a boost with a probiotic supplement
• Studies show that supplementing with probiotics can help to improve your mental health. Probiotics have been shown to increase serotonin levels, and clinical trials have shown that just 8 weeks of supplementation can cause marked improvement in symptoms of patients with depression. Other studies show that they are even effective when used in combination with prescribed anti-depressant medications
• The quality of probiotic supplements available on the market varies significantly, so it’s a good idea to discuss your needs with a naturopathic practitioner before beginning supplementation. Naturopaths are able to make recommendations to suit your individual health needs and ensure you are using a quality supplement that will benefit your health due to their extensive studies in this particular field.

Reduce your stress levels:

• As we’ve seen above, stress can affect our microbiome and our mental health, so reducing stress levels where possible is an important strategy for supporting mental wellbeing.
• Regular meditative practices such as yoga and mindfulness are well known for their stress-relieving abilities – check out your local yoga studio, or look into the many free apps that are available if you’d prefer to practice solo
• 20-30 minutes of daily exercise (such as a brisk walk through the neighbourhood) can also help to reduce stress
• Consider seeking the help of a counsellor or psychologist if you feel your stress would be better managed through talk therapy

Consider using herbal medicines:

• Bitter herbs such as gentian can be used before main meals to help improve your digestion and improve the pH in your intestines, which will help to help keep good bacteria happy
• Depending on your specific health needs, herbs such as liquorice, calendula, and chamomile might be beneficial by helping to soothe and heal any inflammatory damage in the intestines caused by dysbiosis
• As always, it is important to seek expert guidance from naturopathic practitioners before using herbal medicines. As a trained herbalist, a naturopath can assess your needs and create a unique blend that will work to best support your healing journey

It is important to remember that everyone’s digestion is unique.  In working with many individuals with Irritable Bowel Syndrome (IBS), strategies to build a balanced microbiome may be more complicated initially and may require a restriction on certain prebiotic foods and low FODMAP food sources.  For this reason, seeking one on one guidance is always recommended.

References

Australian Institute of Health and Welfare. (2021). Mental health. https://www.aihw.gov.au/reports/australias-health/mental-health

Bravo, J. A., Forsythe, P., Chew, M. V., Escaravage, E., Savignac, H. M., Dinan, T. G., Bienenstock, J., & Cryan, J. F. (2011). Ingestion of Lactobacillus strain regulates emotional behaviour and central GABA receptor expression in a mouse via the vagus nerve. PNAS, 108(38), 16050–16055. https://doi.org/10.1073/pnas.1102999108

Clapp, M., Aurora, N., Herrera, L., Bhatia, M., Wilen, E., & Wakefield, S. (2017). Gut microbiota’s effect on mental health: The gut-brain axis. Clinics and Practice, 7(987).

Desbonnet, L., Garrett, L., Clarke, G., Bienenstock, J., & Dinan, T. G. (2008). The probiotic Bifidobacteria infantis: An assessment of potential antidepressant properties in the rat. Journal of Psychiatric Research, 43(2), 167–174. https://doi.org/10.1016/j.jpsychires.2008.03.009

Du, Y., Gao, X.-R., Peng, L., & Ge, J.-F. (2020). Crosstalk between the microbiota-gut-brain axis and depression. Heliyon, 6. https://doi.org/10.1016/j.heliyon.2020.e04097

Hechtman, L. (2012). Clinical naturopathic medicine. Elsevier Australia.

Li, Y., Hao, Y., Fan, F., & Zhang, B. (2018). The role of microbiome in insomnia, circadian disturbance and depression. Frontiers in Psychiatry, 9.

Li, Y., Zhang, B., Zhou, Y., Wang, D., Liu, X., Li, L., Wang, T., Zhang, Y., Jiang, M., Tang, H., Amsel, L. V., Fan, F., & Hoven, C. W. (2020). Gut microbiota changes and their relationship with inflammation in patients with acute and chronic insomnia. Nature and Science of Sleep, 12, 895–905.

Limbana, T., Khan, F., & Eskander, N. (2020). Gut microbiome and depression: How microbes affect the way we think. Cureus, 12(8). https://doi.org/10.7759/cureus.9966

Liskiewicz, P., Kaczmarczyk, M., Misiak, B., Wronski, M., Baba-Kubis, A., Skonieczna-Zydecka, K., Marlicz, W., Bienkowski, P., Misera, A., Pela-Wysiecka, J., Kucharska-Mazur, J., Konopka, A., Loniewski, I., & Samochowiec, J. (n.d.). Analysis of gut microbiota and intestinal integrity markers of inpatients with major depressive disorder. Progress in Neuropsychopharmacology & Biological Psychiatry. https://doi.org/10.1016/j.pnpbp.2020.110076

Morkl, S., Wagner-Skacel, J., Lahousen, T., Lackner, S., Holasek, S. J., Bengesser, S. A., Painold, A., Holl, A. K., & Reininghaus, E. (2020). The role of nutrition and the gut-brain axis in psychiatry: A review of the literature. Neuropsychobiology, 79, 80–88.

Nikolova, V., Zaidi, S. Y., Young, A. H., Cleare, A. J., & Stone, J. M. (2019). Gut feeling: Randomized controlled trials of probiotics for the treatment of clinical depression: Systematic review and meta-analysis. Therapeutic Advances in Psychopharmacology, 9.

The post Is your gut affecting your mood? appeared first on Performance in Health.

As someone that has personally experienced a back injury in sport, managing pain is something I sadly live with especially when I have let go of my daily preventative routine of walking, stretching and massage.

This blog was devised as I sat nursing an injury flare after several non-stretching days combined with moving furniture and lifting in a way that someone with my condition should never do.  My injury affects both nerves and muscles so the pain down one leg as it follows the nerve is the worst part of this acute flare. 

But there are many types of pain conditions whether by past injuries or other health issues that present the sufferer with chronic daily pain or acute flare-ups or a combination of both.

Chronic pain is Complex

Chronic pain is a common, complex issue that affects millions of Australians – nearly 1 in 5 Australians aged 45 and over are affected by chronic pain. It is a different life when pain is constantly by your side and it can significantly affect a person’s life, impacting quality of life and daily functioning, mental health, sleep, and can even increase the risk of smoking and self-medication through alcohol use. Whilst conventional medical treatment strategies can be powerful during times of acute pain relying on conventional pharmaceuticals such as opioids and other pain killers when managing chronic pain for days and years can carry significant risk of side effects when used long term.

The prescription of opioid medications such as oxycodone is on the rise in Australia for the management of chronic pain conditions. Whilst short term use is often helpful, long term use of opioid medications carries risks such as dependence and addiction, but can also lead to drowsiness, constipation, reduced immune function and even hormonal issues. Even NSAIDs (non-steroidal anti-inflammatory drugs) such as paracetamol carry risks when used long term, including increased risk of gastrointestinal bleeding and blood pressure issues. The risks of long-term use of these pain killers highlights the need for holistic and integrative approaches to help with chronic pain conditions.

This blog post looks at the underlying mechanisms involved in chronic pain, as well as some of the naturopathic strategies that can help sufferers with managing chronic pain symptoms in a more natural way.

What is Chronic Pain?

Chronic pain is complex, and there is no one definition of what constitutes chronic pain. There are many conditions that fall under the umbrella of chronic pain, including fibromyalgia, headache/ migraine, arthritis, inflammatory bowel disease, irritable bowel syndrome, and multiple sclerosis, but chronic pain can also be considered a condition in its own right – it is any pain that persists after recovery from an illness or injury.

The pathophysiology of chronic pain is complicated and involves interactions between both biological and psychosocial factors. Physical (biological) factors include physical injury and tissue damage, as well as changes to nerve cell functioning with contributes to ongoing pain even after the body has healed from the initial injury. In addition to these biological mechanisms, chronic pain is also impacted by issues such as emotional trauma, stress, and even fear of pain, which can worsen chronic pain symptoms.

There are three types of pain associated with chronic pain – nociceptive, neuropathic and centralised pain/ central sensitization.

• Nociceptive pain: this is the type of pain that arises from tissue damage, such as that caused by physical trauma. This type of pain involves inflammation of bodily tissues, which triggers the release of chemicals that alert nerves to send pain signals to the brain. Long-term nociceptive pain can lead to changes in both peripheral nerves and the central nervous system (brain). This is the main type of pain seen in chronic inflammatory conditions such as osteoarthritis, rheumatoid arthritis and inflammatory bowel disease, and injuries such as tendinitis.
• Neuropathic pain: This type of pain is caused by direct damage to sensory nerves. This damage causes alterations to the way nerves send signals to the brain, as the damaged nerves no longer function the way they should. This type of pain might be experienced as feeling like “electric shocks”, burning, or tingling sensations. Neuropathic pain is associated with conditions such as diabetic neuropathy, multiple sclerosis, and Parkinson’s disease.
• Central sensitization: this type of pain occurs when there is a change in pain perception without any underlying nerve activation due to physical injury or tissue damage. The brain’s pain receptor pathways have become rewired to sense pain even when they shouldn’t. This type of pain is associated with conditions such as chronic fatigue syndrome, fibromyalgia, temporomandibular joint disease, and irritable bowel syndrome. Central sensitization may be associated with widespread pain, as well as changes in mood, sleep and energy.

Treating Chronic Pain with Naturopathy

Treating chronic pain naturopathically requires a holistic approach, as each person’s experience with chronic pain, the underlying factors contributing to their condition, as well as the triggers for acute pain flares, are unique to that person. Because of this, it is always imperative to seek a qualified naturopathic practitioner for guidance when it comes to managing chronic pain with complementary medicines, to make sure you are getting the treatment that is right for you. No two manifestations of chronic pain are the same, so ensuring your treatment strategies, dosing and lifestyle changes are best suited to your individual needs will help to ensure the best outcomes for your health. This is particularly important if your condition involves acute flares, such as in fibromyalgia. Treatment during acute flare periods is very different to the treatment required during ongoing chronic pain management. A naturopath will be able to guide you with regards to best practice for managing your acute flares using strategic dosing to help keep acute pain in check when it arises. Dosing for an acute flare of pain is often quite different to any preventative dosing.  Below are some examples of naturopathic treatments used to help manage chronic pain.

Turmeric

Turmeric is a herb that is becoming increasingly well-known as a herbal medicine, particularly for its anti-inflammatory properties from its main compound called curcumin. Studies have shown these anti-inflammatory effects to be effective in reducing pain in patients with rheumatoid & osteo arthritis, a type of chronic pain condition and other neurodegenerative conditions.  Many forms of turmeric are notable to be absorbed so it is important that products are prescribed that ensure optimal bioavailability.

Devil’s Claw

Devil’s claw is an anti-inflammatory and analgesic herb that is commonly used to help ease pain in arthritic conditions. Devil’s claw is also used for other pain conditions such as headaches, back pain and tendinitis. Studies have also shown Devil’s claw to be useful during acute pain flares in chronic pain conditions.

St John’s Wort

Whilst St John’s wort is most famous for its use as an anti-depressant herb, it is also a powerful analgesic and is particularly helpful with nerve pain. Studies have shown St John’s wort to be beneficial in managing a number of different chronic pain conditions, including sciatica, neuralgia and diabetic neuropathy.

Other Herbal Medicines

Depending on your unique pain condition and unique health picture, a naturopath may use a range of different types of herbal medicines to help you cope with your chronic or acute pain. Some favourites are Corydalis, Willowbark, Ginger, Boswellia, Jamaican Dogwood and more.  Herbs such as Withania can help with improving your resistance to stress, while herbs such as California poppy, Kava and Passionflower can help improve sleep when it is impacted by pain.  The beauty of liquid herbal medicine is that a naturopathic herbal prescription can be made up unique to your individual needs.

Magnesium

Magnesium is an essential mineral in the body involved in hundreds of different bodily processes, particularly in the nervous system, where it is involved in maintaining normal nerve transmission. Magnesium’s normalising effect on nerve cell signalling can help to reduce pain perception. Studies have found Magnesium to be beneficial in reducing pain symptoms in a number of chronic pain conditions, including diabetic neuropathy, migraine and post-injury chronic pain.

Palmitoylethanolamide (PEA)

PEA is a type of fatty acid molecule found naturally in foods such as eggs and peanuts, which can be used in supplemental form for a range of conditions, including chronic pain. PEA reduces inflammation around nerves at the site of injury and has been shown to be effective in reducing chronic neuropathic pain.  Often in an acute flare the inflammation presses against nerves and PEA can be very helpful in reducing the nerve pain caused by this.

Diet and Lifestyle Strategies

In addition to physical medicines, lifestyle strategies can also help to improve outcomes for patients with chronic pain. Mindfulness-based activities such as meditation and yoga can help to reduce pain levels and improve physical functioning and can even reduce the risk of mental health issues such as anxiety and depression. Dietary changes can also be a valuable tool in managing chronic pain, by helping to reduce oxidative stress and provide anti-inflammatory nutrients needed for tissue repair and nerve healing. Multiple studies have found plant-based diets to reduce chronic pain symptoms in as little as 8 weeks. The Mediterranean diet, which is also rich in anti-inflammatory fruits and vegetables and omega 3’s has seen similarly positive effects.

Because chronic pain is so complex, effective management of pain symptoms often benefits from an integrative approach to treatment. Naturopaths work collaboratively with other health professionals to help you better manage chronic pain and reduce its impact on your daily life – acupuncture, remedial massage, physiotherapy, osteopathy, psychology and more may all be beneficial. A naturopath can help to point you in the right direction and may even be able to refer you to practitioners of these modalities.

If you’d like to learn more about naturopathic treatments for chronic pain or other health conditions, book your appointment to see Tanya now.

References

Alshelh, Z., Mills, E. P., Kosanovic, D., Di Pietro, F., Macey, P. M., Vickers, E. R., & Henderson, L. A. (2019). Effects of the glial modulator palmitoylethanolamide on chronic pain intensity and brain function. Journal of Pain Research, 12, 2427–2439.

Australian Institute of Health and Welfare. (2021). Chronic pain in Australia. https://www.aihw.gov.au/reports/chronic-disease/chronic-pain-in-australia/contents/summary

Baldini, A., Von Korff, M., & Lin, E. H. B. (2012). A review of potential adverse effects of long-term opioid therapy: A practitioner’s guide. Primary Care Companion for CNS Disorders, 14(3).

Chen, L., & Michalsen, A. (2017). Management of chronic pain using complementary and integrative medicine. BMJ, 357.

Clauw, D. J., Noyes Essex, M., Pitman, V., & Jones, K. D. (2019). Reframing chronic pain as a disease, not a symptom: Rationale and implications for pain management. Postgraduate Medicine.

Dimou, T., Spanomanoli, A., & MIchelis, S. (2019). ESRA19-0249 The use of palmitoylethanolamide (PEA) in FBSS for chronic pain management. Regional Anesthesia and Pain Medicine.

Gagnier, J. J., Chrubasik, S., & Manheimer, E. (2004). Harpagophytum procumbens for osteoarthritis and low back pain: A systematic review. BMC Complementary and Alternative Medicine, 4.

Galeotti, N. (2017). Hypericum perforatum (St John’s wort) beyond depression: A therapeutic perspective for pain conditions. Journal of Ethnopharmacology, 200, 136–146.

Grant, L., McBean, D. E., Fyfe, L., & Warnock, A. M. (2007). A review of the biological and potential therapeutic actions of Harpagophytum procumbens. Phytotherapy Research, 21(3), 199–209.

Kaushik, A. S., Strath, L. J., & Sorge, R. E. (2020). Dietary interventions for treatment of chronic pain: Oxidative stress and inflammation. Pain and Therapy, 9, 487–498.

Kirkland, A. E., Sarlo, G. L., & Holton, K. L. (2018). The role of magnesium in neurological disorders. Nutrients, 10(6).

Majeed, M. H., Ali, A. A., & Sudak, D. M. (2018). Mindfulness-based interventions for chronic pain: Evidence and applications. Asian Journal of Psychiatry, 32, 79–83.

McCrae, J. C., MacIntyre, I. M., Dear, J. W., & Webb, D. J. (2018). Long-term adverse effects of paracetamol—A review. British Journal of Clinical Pharmacology, 84(10), 2218–2230.

Mills, S. E. E., Nicolson, K. P., & Smith, B. H. (2019). Chronic pain: A review of its epidemiology and associated factors in population-based studies. British Journal of Anaesthesia, 123(2), 273–283.

Park, R., Ho, A. M. H., Pickering, G., Arendt-Nielsen, L., Mohiuddin, M., & Gilron, I. (2020). Efficacy and safety of magnesium for the management of chronic pain in adults: A systematic review. Anesthesia and Analgesia, 131(3).

Roxburgh, A., Bruno, R., Larance, B., & Burns, L. (2011). Prescription of opioid analgesics and related harms in Australia. The Medical Journal of Australia, 195(5), 280–284.

Towery, P., Guffey, J. S., Doerflein, C., Stroup, K., Saucedo, S., & Taylor, J. (2018). Chronic musculoskeletal pain and function improve with a plant-based diet. Complementary Therapies in Medicine, 40, 64–69.

The post Treating Chronic Pain with Naturopathy appeared first on Performance in Health.

Premenstrual Dysphoric Disorder (PMDD) is a severe cyclic mental health condition that can significantly impact women’s quality of life. But, what exactly is it? In this blog post we will discuss what PMDD is, how it is more than just “bad PMS”, as well as some of the naturopathic treatments that are available to help.

What is PMDD and How is it Different to PMS?

PMS is a very common condition, with estimates that it affects anywhere from 30% up to 85% of menstruating women. Symptoms of PMS are varied, but often include physical symptoms such as cramping, bloating and breast pain, as well as some mood symptoms like mood swings and irritability. PMDD on the other hand, is a much less common condition, affecting just 3-5% of women. PMDD is significantly more severe in its symptomatology, and is much more heavily related to mood symptoms, particularly anxiety, depression and even panic attacks. Along with mood symptoms, women with PMDD also experience an increased sensitivity to stress. Symptoms are worse during the luteal phase of the menstrual cycle, which is the 2 weeks leading up to a menstrual bleed. Symptoms then ease again within a few days of menstruation starting. Unfortunately, as with many other female hormonal conditions, diagnosis of PMDD is often significantly delayed; diagnosis for Australian women with PMDD takes an average of 12 years!

What are the Causes of PMDD?

PMDD is a complex condition and there are several different theories regarding the underlying cause of the condition. It can be hereditary, and mutations to specific genes have been identified in some studies on the condition. One of the most interesting things about PMDD is that although it is a hormonal condition, it actually isn’t associated with a hormonal imbalance per se – testing has shown that women with PMDD have the same levels of ovarian hormones pre-menstrually as women without PMDD. Symptoms of PMDD appear to be more to do with the brain’s sensitivity to these hormones, as well as changes to other chemical messengers relating to mood and stress. Below are some of the common underlying causes of PMDD symptoms:

Sensitivity to Allopregnanolone in the Brain

One of the leading theories of the cause of PMDD is that it is a sensitivity of the brain to the normal hormonal changes that occur during the menstrual cycle. One hormone metabolite in particular has been implicated – a progesterone metabolite known as allopregnanolone, or ALLO. Women with PMDD have higher than normal levels of ALLO during the luteal phase, and also have a paradoxical reaction to it. ALLO normally acts to activate GABA receptors in the brain to produce a calming, anti-anxiety effect, particularly during periods of high stress. However, in women with PMDD, ALLO can lead to increased feelings of anxiety and mood disturbance. Researchers have identified alterations in a specific gene, known as the oestrogen receptor alpha gene (ESR1) in women with PMDD, which is linked to changes in the brain’s reactivity to both progesterone and oestrogen.

Altered Brain Activity During the Luteal Phase

MRI studies have shown that women with PMDD have different brain activity during the luteal phase, particularly when it comes to emotional regulation.

Neurotransmitter Abnormalities

Neurotransmitters are important chemical messengers that work throughout the nervous system and elsewhere in the body and are strongly associated with emotional regulation and mental health. Studies have shown that both serotonin and GABA, two important neurotransmitters for mental wellbeing and anxiety, are lower than normal during the luteal phase in women with PMDD. Lower levels of these neurotransmitters would contribute to feelings of low mood, irritability and anxiety.

High Cortisol and HPA Axis Dysregulation

The HPA Axis is our “fight or flight” response. It is how our brain responds to stressors in our life by increasing cortisol, creating feelings of alertness and readiness to act. In PMDD, women experience increased sensitivity to stress because their HPA axis does not function the way it normally would. A study from 2019 found a link between high cortisol levels in women with PMDD and also showed that women with PMDD did not experience the same daily cortisol rhythm (higher cortisol in the morning and lower cortisol in the evening) compared to women without PMDD. Part of the reason for this increased stress response is because of the brain’s altered reactivity to ALLO, which normally helps to create a feeling of calmness during periods of stress.

Managing PMDD Naturally

There are several naturopathic therapeutics that can be helpful in managing PMDD symptoms, along with dietary and lifestyle measures to help improve your mental health throughout your cycle. Below are some of the more commonly utilised treatments, however your naturopath will formulate a treatment plan that suits your specific needs.

Vitamin B6

Vitamin B6 is a vital mental health nutrient because it is involved in the production of key mood-regulating neurotransmitters including serotonin, which is low in PMDD. Boost your intake of vitamin B6 with foods such as chicken, turkey, oats, banana, avocado and sweet potato. Your naturopath may also prescribe a vitamin B6 supplement if it is required.

Tryptophan

Tryptophan, an amino acid, is the precursor for making serotonin in the body. It’s vital to ensure we are consuming enough tryptophan, in order to ensure our bodies are able to produce sufficient levels of serotonin. Your can help to boost your serotonin levels by eating foods high in tryptophan, including chicken, turkey, salmon, pumpkin seeds, oats and eggs.

St John’s Wort

St John’s Wort is one of the most well-known herbs for managing mental health conditions, and research shows it can be beneficial in PMDD. St John’s Wort acts like a herbal anti-depressant, boosting our serotonin levels in the brain. It is important to speak with your naturopath before using St John’s Wort, as it can react with certain medications.

Saffron

Saffron (yes, that beautiful yellow spice) is a promising herbal anti-depressant that is becoming more and more popular for managing mental health conditions. In addition to its mood-boosting actions, saffron is also known for its powerful anti-anxiety effects. Saffron works similarly to St John’s Wort in that it helps to increase serotonin levels, but it also helps to boost other important neurotransmitters such as dopamine and can even bind to the GABA receptors in the brain that help us to feel calm. This means it could help to reduce some of the effects caused by the brain’s sensitivity to ALLO. Research backs this up – a study from 2020 found saffron to be an effective treatment for PMDD.

Vitex

Vitex is a popular herbal medicine for helping with PMDD symptoms, however it is important that your unique hormonal situation is reviewed before this is prescribed.

If you are looking to find relief from PMDD symptoms, book in with Tanya to find out how to start feeling better soon.

References

Beddig, T., Reinhard, I., & Kuehner, C. (2019). Stress, mood, and cortisol during daily life in women with premenstrual dysphoric disorder (PMDD). Psychoneuroendocrinology, 109.

Comasco, E., Hahn, A., Ganger, S., Gingnell, M., Bannbers, E., Oreland, L., Wikstrom, J., Epperson, C. N., Lanzenberger, R., & Sundstrom-Poromaa, I. (2014). Emotional fronto-cingulate cortex activation and brain derived neurotrophic factor polymorphism in premenstrual dysphoric disorder. Human Brain Mapping, 35(9), 4450–4458.

Girdler, S. S., Straneva, P. A., Light, K. C., Pederson, C. A., & Morrow, A. L. (2001). Allopregnanolone levels and reactivity to mental stress in premenstrual dysphoric disorder. Biological Psychiatry, 49(9), 788–797.

Hantsoo, L., & Epperson, N. (2020). Allopregnanolone in premenstrual dysphoric disorder (PMDD): Evidence for dysregulated sensitivity to GABA-A receptor modulating neuroactive steroids across the menstrual cycle. Neurobiology of Stress, 12.

Hechtman, L. (2012). Clinical naturopathic medicine. Elsevier Australia.

Huo, L., Straub, R. E., Roca, C., Schmidt, P. J., Shi, K., Vakkalanka, R., Weinberger, D. R., & Rubinow, D. R. (2007). Risk for premenstrual dysphoric disorder is associated with genetic variation in ESR1, the estrogen reeptor alpha gene. Biological Psychiatry, 62(8), 925–933.

IAPMD. (2019). What is PMDD? https://iapmd.org/about-pmdd

Lewin, E. (2019, October 8). “It’s not PMS”: Shining a light on premenstrual dysphoric disorder. https://www1.racgp.org.au/newsgp/clinical/it-s-not-pms-shining-a-light-on-premenstrual-dysph

Petersen, N., Ghahremani, D. G., Rapkin, A. J., Berman, S. M., Liang, L., & London, E. D. (2018). Brain activation during emotion regulation in women with premenstrual dysphoric disorder. Psychological Medicine, 48(11), 1795–1802.

Rajabi, F., Rahimi, M., Sharbafchizadeh, M. R., & Tarrahi, M. J. (2020). Saffron for the management of premenstrual dysphoric disorder: A randomized controlled trial. Advances in Biomedical Research, 9(60).

Steiner, M., & Pearlstein, T. (2000). Premenstrual dysphoria and the serotonin system: Pathophysiology and treatment. Journal of Clinical Psychiatry, 61.

The post Premenstrual Dysphoric Disorder –More than “Bad PMS” appeared first on Performance in Health.

But what exactly causes it, and how can we manage it? In this week’s blog post we take a deep dive into the underlying causes of PMS, and how we can use natural treatments to help reduce the toll of those monthly symptoms.

What is PMS and what causes it?

PMS is the name given to a group of symptoms that can occur in the 7-14 days leading up to the menstrual period. There is a wide range of symptoms that are included in this syndrome, including both physical and psychological symptoms. Symptoms vary from person to person and can range from mild to severe. Symptoms of PMS include:

Physical symptoms:

• Bloating and weight gain
• Cramps and abdominal pain
• Breast pain
• Headaches
• Back pain
• Changes to bowel habits
• Fatigue
• Food cravings

Psychological symptoms:

• Anxiety
• Depression
• Irritability
• Mood swings

So, what exactly causes it? Unfortunately, PMS is a complex issue that isn’t yet fully understood. There are many different theories to explain the causes of PMS, but in reality, it’s likely that there are many different factors at play, including complex interactions between different hormones and other chemicals in the body.

Possible contributing factors include:

• Hormonal imbalance: The 7-14 days before your period are known as the “luteal phase”, which begins after ovulation has occurred and continues up until you begin your menstrual period. During this phase, progesterone (and to a lesser extent, oestrogen) levels increase, before peaking just before your period. Excessively high oestrogen (also known as “oestrogen dominance”) or an imbalance between progesterone and oestrogen, may be a factor in PMS symptoms. Excess oestrogen can lead to bloating, weight gain, irritability, anxiety, breast pain and cramps, while a relative progesterone excess may lead to low libido, bloating, depression and low energy. Similarly, other hormones such as prostaglandins and prolactin may become imbalanced during this phase of the cycle.
• Altered neurotransmitter levels, particularly low serotonin and GABA, due to changes in oestrogen and progesterone
• Altered adrenal hormone levels, due to changes in the HPA axis (our “fight or flight” response)
• Altered aldosterone levels, the hormone responsible for regulating our body’s fluid balance, leading to water retention and bloating
• Nutritional deficiencies, particularly magnesium, vitamin B6, calcium and vitamin D
• Blood sugar dysregulation
• Environmental factors such as stress
• Excess histamine: unfortunately, too much estrogen can cause histamine intolerance.  A naturopath will assess symptoms of high histamine and may recommend lowering high histamine foods in your diet.

Naturopathic Treatments for PMS

So what can we do to help reduce symptoms? Just as there are many different underlying causes of PMS, there are a huge range of naturopathic treatments that can be useful. Naturopathy always aims to treat the underlying cause of health issues. Because of this, your naturopath will likely use a comprehensive case history and possibly even refer you for testing to assess for some of the factors that are contributing to your symptoms. Some of the more common treatment approaches for managing PMS symptoms are listed below.

Diet and Lifestyle

• Improving the health of your gut: this is critical for the healthy clearance of estrogen.
• Eat plenty of fruits and vegetables: Fresh fruits and vegetables can be a surprisingly valuable strategy for helping to manage one of the key underlying factors in PMS – excess oestrogen. Certain vegetables, such as broccoli, cauliflower, kale and Brussels sprouts, are particularly useful, as they contain liver-supporting nutrients that help our liver to function at its best. This is important because our liver is responsible for eliminating excess hormones in the body, including oestrogen. Similarly, the fibre from fruits and vegetables can also help our bodies to excrete excess hormones by binding up excess hormones in the bowels, keeping us regular and ensuring hormones are eliminated before our body reabsorbs them.

• Include healthy protein with your meals: This is particularly important for those with symptoms that might be due to a change in blood sugar regulation, such as food cravings. Including protein in your meals can help to slow the absorption of sugars, reducing excessive blood sugar spikes that trigger further cravings.
• Reduce your alcohol consumption: Drinking alcohol, and especially heavy alcohol consumption, can exacerbate PMS symptoms. Heavy alcohol consumption can affect our hormones as well as impact our serotonin levels, so it’s no wonder it can play a negative role when it comes to PMS. Reducing your alcohol intake throughout the month and avoiding binge drinking is best.
• Reduce your sodium intake: This one is particularly important if you suffer from pre-menstrual bloating and fluid retention, as excessive sodium in your diet can exacerbate this issue.
• Reduce your caffeine intake: High consumption of caffeine is associated with more severe PMS symptoms. Be mindful of your caffeine intake throughout your cycle and be aware that caffeine is found in many different foods and drinks aside from coffee, including tea, cola, energy drinks, cocoa and chocolate.
• Reduce your sugar intake: Sweet, sugary foods are often on the top of the list when it comes to premenstrual food cravings, however they can wreak havoc on your blood sugar levels, leading to further cravings as well as fatigue. Be mindful of your sugar intake and opt for healthier sweet foods when possible, such as fresh fruit.
• Engage in regular physical activity: Regular physical activity throughout the menstrual cycle can help to reduce the severity of your symptoms. Whilst any aerobic activity can help, yoga has been found to be particularly effective. A recent study found 40 minutes of yoga three times per week for just one month, was able to significantly reduce the intensity of PMS pain. Likewise, swimming has been found to help with a wide range of premenstrual syndromes, including cramps and pain, headaches, anxiety, depression and breast pain.

Specific Nutrients

• Calcium: Studies have shown that our calcium levels change throughout the menstrual cycle and are typically lower during the luteal phase. Women with PMS have been shown to have especially low levels of calcium during this phase of the menstrual cycle, and low calcium may be involved in symptoms such as irritability and cramps. You can boost your calcium intake with foods such as dairy products, dark green leafy vegetables including broccoli, kale and Brussels sprouts, and legumes.
• Vitamin D: Evidence suggests that our vitamin D levels can also change during the luteal phase of the menstrual cycle, because higher oestrogen can increase the break down of vitamin D by the liver, leaving us with less vitamin D than normal. Vitamin D is an important nutrient for maintaining our optimal calcium levels but is also involved in hormonal balance and even bloating. Studies have shown supplementation of both calcium and vitamin D to help reduce the severity of PMS symptoms. Vitamin D is best absorbed via sun exposure – even just 15 minutes per day can help to boost your vitamin D levels. Vitamin D can also be found in some foods, including salmon, sardines, red meats, and free-range eggs.

• Magnesium: Magnesium is vital for regulating muscle contraction and relaxation, as well as being involved in the function of important neurotransmitters such as serotonin. Studies have found magnesium to be useful in alleviating a range of different PMS symptoms, particularly anxiety and mood changes. Magnesium can be found in foods such as pumpkin seeds, almonds, spinach, cashews, lentils, eggs and lean meats.
• Vitamin B6: Vitamin B6 is an important nutrient when it comes to PMS, because it plays a role in balancing neurotransmitters such as serotonin and GABA, and also helps our body to utilise magnesium in our cells. Boost your vitamin B6 intake with foods such as chickpeas, salmon, tuna, chicken, dark leafy green vegetables, bananas, and oranges.

If you feel you may be suffering from nutrient deficiencies, it’s important to speak with your naturopath or other health care provider for professional advice before using supplements.

Herbs

There’s a wide range of herbal medicines that can be used to help relieve PMS symptoms. Your naturopath will be able to formulate a herbal mix that best suits your unique symptomatology.

Some herbs that are commonly used in PMS include:

• Vitex: Also known as chaste tree, vitex is one of the most commonly used herbs to help with PMS, with many studies demonstrating its effectiveness in reducing mild to moderate PMS symptoms. This herb works through a number of different mechanisms, including altering hormonal balance and also binding to opioid receptors in the body to reduce pain. Vitex has been shown to help with a range of PMS symptoms, including bloating, headache, irritability, breast pain and mood changes.
• St. John’s Wort: St. John’s Wort can be used to help particularly with psychological PMS symptoms such as anxiety and low mood. This herb is able to increase serotonin levels and has been shown to help with a range of PMS symptoms such as low mood, anxiety, food cravings, headaches and fatigue.
• White Peony: White peony is a traditional Chinese herb that can help to regulate hormonal balance and has shown promise in treating PMS symptoms, particularly premenstrual cramps.

Other herbs may be used to help manage specific symptoms:

• Liver herbs like dandelion root can help your body process and eliminate excess oestrogen
• Nervous system herbs such as ashwagandha to help with stress
• Anti-spasmodic herbs such as cramp bark to help with cramps and pain

While PMS may be common, it’s not something you need to put up with. Book your appointment with Tanya today – an award winning naturopath in Sydney – to learn more about PMS and develop a treatment strategy to help you feel better.

References

Abdi, F., Ozgoli, G., & Rahnemaie, F. S. (2019). A systematic review of the role of vitamin D and calcium in premenstrual syndrome. Obstetrics and Gynecology Science, 62(2), 73–86.

Cerquiera, R. O., Frey, B. N., Leclerc, E., & Brietzke, E. (2017). Vitex agnus castus for premenstrual syndrome and premenstrual dysphoric disorder: A systematic review. Archives of Women’s Mental Health, 20, 713–719.

Fernandez, M. del M., Saulyte, J., Inskip, H. M., & Takkouche, B. (2018). Premenstrual syndrome and alcohol consumption: A systematic review and meta-analysis. BMJ Open.

Hechtman, L. (2012). Clinical naturopathic medicine. Elsevier Australia.

Khademi, N., Abbassinya, H., Heshmat, F., Naafe, M., & Mohammadbeigi, A. (2020). Evaluation of the effect of perforan (Hypericum perforatum) on premenstrual syndrome severity of physical and behavioural symptoms in patients with premenstrual syndrome: A clinical randomised trial. Advances in Human Biology, 10(3), 110–114.

Maged, A. M., Abbassy, A. H., Sakr, H. R. S., Elsawah, H., Wagih, H., & Ogila, A. I. (2018). Effect of swimming exercise on premenstrual syndrome. Archives of Gynecology and Obstetrics, 297, 951–959.

Niroumand, M. C., Heydarpour, F., & Farzaei, M. H. (2018). Pharmacological and therapeutic effects of Vitex agnus-castus L.: A review. Pharmacognosy Review, 12, 103–114.

Shobeiri, F., Araste, F. E., Ebrahimi, R., Jenabi, E., & Nazari, M. (2017). Effect of calcium on premenstrual syndrome: A double-blind randomized clinical trial. Obstetrics and Gynecology Science, 60(1), 100–105.

Vaghela, N., Mishra, D., Sheth, M., & Dani, V. B. (2019). To compare the effects of aerobic exercise and yoga on premenstrual syndrome. Journal of Education and Health Promotion, 8(199).

The post Premenstrual Syndrome & Naturopathy appeared first on Performance in Health.

Sub-fertility is a significant issue in Australia – around 16% of Australian couples have trouble conceiving, with both male and female-related issues affecting fertility rates. Fertility and preconception is an area of health that can feel entirely foreign when you begin trying to conceive, and the jumble of information available online can feel overwhelming. If you’re having difficulty conceiving, or even if you’ve only just begun your preconception journey, this article about fertility naturopath treatment will help you to understand some of the key factors that might be impacting on your fertility, as well as provide tips to help you boost fertility and help you to conceive naturally.

Female Fertility 101

Before getting into the factors which disrupt female fertility, it’s important to have a brief look at how fertility in women works on an anatomical and biochemical level, to help us understand what we’re dealing with (and how we can help to improve fertility outcomes).

In a normal menstrual cycle, a woman releases one egg (also known as an ovum or oocyte) from one of her ovaries into the fallopian tube – the process known as ovulation. It is here that the egg is able to be fertilised by sperm, before travelling through the fallopian tube and into the uterus, where the newly fertilised egg, now known as an embryo, implants into the endometrial lining of the uterus. The release of a healthy egg from the ovaries, as well as the development of a healthy endometrial lining for the embryo to implant in, requires a balance of hormones such as oestrogen, follicle-stimulating hormone, luteinising hormone, and progesterone, as well as adequate nutrients for the development of a healthy egg, embryo and endometrium. The factors that can interrupt this process are varied, and may affect just one portion of the process, or may impact the process as a whole.

Image by FreePik

Factors Affecting Fertility

So, what factors can impact on female fertility and conception? You may have an idea of some of the major factors, such as age, but there are many physical and lifestyle factors that can contribute, and you may find there are multiple issues you need to address when it comes to improving your fertility. Some of the major factors are:

• Age
• Genetics
• Nutrition
• BMI
• Stress and lifestyle
• Chemical/ toxin exposure
• Pre-existing medical conditions

Some of these, such as age and genetics, we unfortunately aren’t able to change, but there are many factors here that we can address.

Below is a more detailed look at some of these issues, and what we can do to help mitigate their effects.

How Can Nutrition Affect Female Fertility?

Nutrition is a huge area of focus when it comes to preconception and fertility. The old adage “you are what you eat” is particularly true for fertility. A poorly balanced diet, or one with specific nutrient deficiencies, leaves you without the key building blocks needed for successful conception and healthy foetal growth. Certain micronutrients, such as zinc, selenium, iron, iodine, B vitamins (especially folate and B12), and vitamin C (among others!) all play important roles in conception and embryonic development. Likewise, a balanced intake of macronutrients (protein, carbohydrates and fats) from healthy sources is essential. For example, eating a diet with too many high glycaemic index (GI) carbohydrate foods has been shown to increase insulin levels, which can contribute to an increase in the body’s production of androgens (“male” type hormones), disrupting normal hormone balances needed for successful conception.

Antioxidants are another important nutritional consideration, as a diet low in antioxidants is considered a risk factor for reduced fertility. Normal bodily processes as well as exposure to harmful chemicals in daily life contribute to the development of free radicals within the body, which lead to oxidative stress. Our bodies counteract the damaging effects of free radicals with antioxidant compounds that work to neutralise free radicals. Certain vitamins, such as vitamins C and E, as well as other nutritional compounds like glutathione, lycopene, resveratrol, and coenzyme Q10 (CoQ10), all act as important antioxidants within the body. It is vital that we are eating sufficient levels of these nutrients in order to keep the body in balance, especially when trying to conceive.

In addition, high caffeine intake has been shown to increase the risk of early spontaneous pregnancy loss, and studies have shown it to increase the time it takes to conceive. With that in mind, it’s best to skip the second (or third, or fourth) cup of coffee!

Improving Nutrition During Preconception

• Eat a balanced diet high in nutrient-dense foods and ensure you are eating adequate amounts of key fertility-boosting nutrients
  • Plenty of fresh fruits and vegetables – aim for as much variety as possible, focusing on eating as many different colours of vegetables as you can each day (always be sure to wash your fruits and vegetables before consumption)
  • Opt for high quality protein sources, such as wild caught fish, legumes, grass-fed organic meats and free-range eggs. Reduce your intake of highly processed meats such as sausages, and deli meats like ham and pastrami.
  • Choose lower GI, wholegrain carbohydrates such as brown rice and wholegrain breads
• Boost your intake of key micronutrients for healthy conception
  • Zinc: Found in beef, eggs, milk, seafood, sunflower seeds, pumpkin seeds, blueberries, broccoli and capsicum
  • Selenium: Found in Brazil nuts, cashews, eggs, fish such as tuna, oysters and other seafood
  • Iodine: Found in fish, kelp, mushrooms, dairy products and sunflower seeds
  • Iron: Found in beef, chicken, eggs, spinach, tahini
  • B vitamins: Found in green leafy vegetables, lentils and other legumes, avocado, mushrooms, sunflower seeds
  • Vitamin C: Found in strawberries, oranges, broccoli, tomatoes, kiwi fruit, sweet potatoes
• Eat plenty of antioxidant-rich foods: fresh fruits and vegetables in plenty of different colours
• Reduce your caffeine intake, or avoid caffeine altogether

Can My BMI Affect My Fertility?

Being overweight or obese (BMI above 25), has been shown to reduce rates of conception and increase the risk of miscarriage. A high BMI is also associated with adverse pregnancy outcomes such as premature birth, hypertension, and gestational diabetes, further highlighting the importance of achieving and maintaining a healthy weight prior to conceiving.

Reducing the Effect of BMI on Fertility

The best way to approach this is to speak with your naturopath about a weight reduction plan appropriate to your needs. Remember that even a small reduction in body weight can help to improve ovulation and improve pregnancy outcomes.

 

Cigarette Smoking, Alcohol and Recreational Drugs

Cigarette smoking affects female fertility in a number of ways, including increasing the risk of spontaneous miscarriage and directly damaging eggs, reducing your ovarian reserve (i.e. the number and quality of eggs left in your ovaries).  Although alcohol only indirectly affects fertility, foetal alcohol spectrum disorder is a major consideration in the recommendations for women abstaining from alcohol altogether when trying to conceive. Marijuana use can also affect fertility. Cannabinoids within marijuana have been shown to disrupt hormonal regulation and ovarian function, leading to ineffective implantation.

Reducing their Effects on Fertility

It is vital to eliminate cigarettes, alcohol and recreational drugs from your lifestyle while trying to conceive and during pregnancy and breastfeeding. With regards to cigarette smoke, it is also important to avoid second-hand smoke exposure, which can also be dangerous.

Stress

Both psychological and physical stress can play a role in reduced fertility in women. Stress activates the body’s hypothalamic-pituitary-adrenal axis (HPA axis), also known as the “flight or fight response”, leading to elevated levels of hormones such as cortisol. Over time these stress hormones negatively affect fertility by altering the body’s secretion of important fertility hormones like oestrogen and luteinising hormone, and altering ovulation, fertilisation, and implantation. This stress might include a physically or psychologically demanding job, or other types of stress such as relationship and family issues, insecure housing or employment, or financial stress.

Reducing the Effects of Stress on Fertility

The good news is that stress management techniques have been shown to help improve fertility outcomes. There are a range of options available to help reduce the effects of stress, including:

• Regular physical activity – aim for 30 minutes of moderate intensity exercise on most days of the week
• Yoga, tai chi, or Qi Gong
• Meditation – if you find the thought of self-guided meditation daunting, there are many group classes available nowadays, both in-person and online
• Counselling and talk therapy

 

Chemical and Toxin Exposure

It’s no secret that our modern world is full of harmful chemicals and toxins, to which we are exposed daily. Some of these toxins are particularly worrisome when it comes to preconception and it is worth looking into how we can avoid exposure. One of the primary reasons these chemicals are concerning during preconception is because of they way they can act as endocrine disruptors (sometimes also known as xenoestrogens), affecting hormone balance and disrupting the body’s ability to regulate its own hormones. They may also lead to increases in oxidative stress within the body, affecting healthy egg production. Chemicals that may impact fertility are:

• Pesticides, including garden sprays and herbicides, insect sprays and rodent baits
• Heavy metals, including mercury and lead, which can be present in contaminated water and food, as well as air pollution
• Certain plastics, such as phthalates and bisphenol-A (BPA)
• Chemicals in your cleaning products at home plus perfumes, make-up, shampoo & conditioner, hairsprays, toothpaste, skincare, soaps, body washes, hair dyes and nail-polish. Our blog on estrogen dominance goes into these chemicals in more detail, you can check it out here.

Reducing their Effect on Fertility

The best way to reduce their effect on fertility is to reduce your exposure:

• Avoid exposure to pesticides
  • Choose organic gardening methods and avoid using Round-Up in your garden
  • Wash fruits and vegetables thoroughly before eating and choose organic where possible
• Avoid exposure to heavy metals
  • Use a water filter to reduce impurities and contaminants from tap water
  • Reduce consumption of foods which may be contaminated with heavy metals, particularly fish such as shark, swordfish and bluefin tuna – opt for lower mercury varieties such as sardines, mackerel and salmon
• Avoid exposure to BPA and other harmful xenoestrogens
  • Avoid plastic food containers and water bottles
  • Do not microwave food in plastic containers – reheat foods on the stove top or in the oven, or if you do choose to use a microwave, use microwave-safe glass containers

Image by University of Vienna

Pre-Existing Medical Conditions

There are a vast range of pre-existing medical conditions which can impact on fertility in women, whether as a result of the condition itself or through the medications and other treatments that may be used for the condition’s management. It’s beyond the scope of this post to list every condition that might affect female fertility, but a few of the major conditions, including female reproductive conditions, are listed below.

Some female reproductive conditions which may impact your fertility are:

• PCOS is a relatively common hormonal condition, affecting approximately 20% of women, which is associated with high levels of androgens (“male” hormones), which can disrupt ovulation, leading to “immature” eggs that don’t function as they should
• Endometriosis is a complicated hormonal condition that involves abnormal growth of the endometrium, which lines the uterus
• Uterine fibroids are a type of benign tumour within the uterus which cause a physical barrier to fertility. Depending on their exact location and manifestation, uterine fibroids may negatively affect implantation and increase the risk of miscarriage.

Other conditions to be aware of are:

• Infections, including sexually transmitted and genitourinal infections, may disrupt fertility in a number of ways. For example, sexually transmitted infections such as chlamydia can cause irreparable damage to the fallopian tubes, significantly impacting fertility. These infections can be asymptomatic, so it is important to speak to your GP about keeping up to date with STI screening.
• Thyroid disorders
• Diabetes
• Autoimmune conditions

 Reducing their Effects on Fertility

If you have concerns about a diagnosed health condition or prescribed medications and how it may affect your plans to conceive, always speak with your naturopath or GP for advice. With regards to female hormonal conditions, your naturopath may also be able to prescribe herbs, such as shatavari, white peony, or chaste tree, to help mitigate the effects of the condition and improve hormonal regulation and promote ovulation.

Find out more about how we can support you through fertility and contraception – we are an award winning naturopath in Sydney’s Inner West, so please make contact or book an appointment.

References

Conforti, A., Mascia, M., Cioffi, G., De Angelis, C., Coppola, G., De Rosa, P., Pivonello, R., Alviggi, C., & De Placido, G. (2018). Air pollution and female fertility: A systematic review of literature. Reproductive Biology and Endocrinology, 16(117). https://doi.org/10.1186/s12958-018-0433-z

Family Planning NSW. (n.d.). Infertility. Retrieved February 22, 2021, from https://www.fpnsw.org.au/factsheets/individuals/fertility-and-infertility/infertility

Hechtman, L. (2012). Clinical naturopathic medicine. Elsevier Australia.

Lisiecki, M., Paszkowski, M., & Wozniak, S. (2017). Fertility impairment associated with uterine fibroids: A review of the literature. Menopause Review, 16(4), 137–140. https://doi.org/DOI: https://doi.org/10.5114/pm.2017.72759

Palomba, S., Daolio, J., Romeo, S., Battaglia, F. A., Marci, R., & La Sala, G. B. (2018). Lifestyle and fertility: The influence of stress and quality of life on female fertility. Reproductive Biology and Endocrinology, 16(113). https://doi.org/10.1186/s12958-018-0434-y

Rattan, S., Zhou, C., Chiang, C., Mahalingam, S., Brehm, E., & Flaws, J. A. (2017). Exposure to endocrine disruptors during adulthood: Consequences for female fertility. Journal of Endocrinology, 233(3), R109–R129. https://doi.org/DOI: 10.1530/JOE-17-0023

Silvestris, E., Lovero, D., & Palmirotta, R. (2019). Nutrition and female fertility: An interdependent correlation. Frontiers in Endocrinology, 10(346). https://doi.org/10.3389/fendo.2019.00346

The post Barriers to Female Fertility and Conception appeared first on Performance in Health.