How are you? No, but for real. Uncovering anxiety and depression.

How many times have you asked that question yet are not quite ready to hear the full answer? Are you asking to be polite or out of habit or are you truly there to listen. Of course no one is being rude when they ask that question out of habit. Sometimes this question can open up a can of worms and in my opinion, this is where the good comes. This question, "How are you?", if you have more than a second to listen, or more importantly to answer, is a time to get real, to allow those feelings and emotions to come boiling up instead of being suppressed, which can eventually cause physical or mental health issues.

There was a recent study that showed the connection between Alzheimers and stress. This proves, yet again, the connection between the mind and the body. We also hear heart-wrenching stories of those taking their life due to depression, when no one around them knew they were suffering.  I see this mind-body connection every week, both personally and professionally. 

Professionally I ask the question “How are you?", usually hoping for more detail, to figure out if there is an emotional connection to the root of my patients concern. Time and time again there is! Because I understand the mind body connection I ask these questions first before doing any extra testing or giving supplements. I love taking the time to listen. Most people aren’t given that time or space and it can be very therapeutic. 

Personally, building a practice and understanding how to structure it to best suit my needs is hard. I have learned this since I started and still struggle to find the right balance. I can suffer health wise myself because of stress and worry. No job is perfect but being the perfectionist that I am I can’t seem to settle for anything else. I want to help you, I want you to heal, I want to give you that space and be open to truly listening to your answer when I ask how you are. In order to do that I need to find time to answer that question myself, to breath, to meditate, to talk. Practice what I preach. 

Are you feeling overwhelmed, anxious or depressed? Don’t hide it. Find people that can support you. That could be family and friends or it could be someone with an unbiased approach or simply a sounding board; a counsellor, a therapist or me, an ND. We are all happy to listen and to help. It’s time to talk.  

In health & happiness,

Dr. Karen

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The Winter Blues: 5 Ways to Beat Seasonal Affective Disorder and Depression

It always surprises me after the time change in November how dark it can get in the evenings. Every year around this time I have to check in with myself and how I am feeling and every year I realize, after a gentle reminder from those around me, that the darker days do affect my mood. Living in Vancouver for 4 years, where it is raining most of the winter, I would forgot how much happier people were with the sun out, until the skies opened and you get a glimpse again of sunny summer days. The same goes for most of Canada however. When a patient comes to me concerned about their mood, I always ask whether they notice a more depressed mood in the winter...most say yes! 

An important point is that there could be a easy explanation as to why you are feeling depressed and ruling these out first is key. There are a few common reasons I see in my practice, for why people feel depressed. They are vitamin D deficiency, adrenal fatigue, hormone imbalances, hypothyroidism and food allergies/sensitivities. Simple blood work, a health history and/or elimination diet can help decipher if your mood is affected by one of these issues.  However these simple tips can make a drastic change in your mood.

1. Light Exposure:

As the day shorten our circadian rhythm adapts and melatonin production increases. This in turn decreases serotonin production. Unfortunately this combination doesn’t improve sleep. Getting some light exposure in the morning, helps to keep our circadian rhythms in check. Suggestions for this are going for a 20 minute walk in the morning when it is brighter out, in nature is an added bonus, or investing in a sunlamp. I recently learned that the Public Libraries around HRM have these on loan!

2. Vitamin D3:

One of the first vitamins I think about when it comes to mood is vitamin D. It plays an important role in many things, including bone, skin and immune health, but it also contributes to improving mood. There are several studies that show an association with low vitamin D status and mood disorders, including seasonal affective disorder. 30 minutes of full-exposure to sunlight, without sunscreen, can provide between 10,000 to 20,000IU of vitamin D. In the winter, or if we work in an office all year, it is difficult to get enough D3, therefore we need to supplement. I suggest 2000-5000IU/day for mood disorders, however it is recommended to have your vitamin D levels checked to avoid toxicity. 

3. Increase Endorphins:

On these cold darker days we tend to sink into the couch. Exercise, even moderate amounts, have been proven to increase endorphins and serotonin production, ultimately improving your mood. Start by walking 20 minutes in the morning or at lunch if you are just getting back into it, or increase the intensity with HIIT workouts. Massage also has been studied to increase endorphins, or any physical touch for that matter! Our testosterone levels have been shown to increase in the winter so take advantage of the increased sex drive. 

4. B Vitamins:

These vitamins are also important to regulate mood. B vitamins are necessary for every energy reaction in your body, including the production of hormones and neurotransmitters mentioned above. Women on oral contraception become deficient in B6 (and magnesium), therefore it is even more important to supplement in these women. I recommend a multi-B vitamin, with higher amounts of certain Bs depending on the person. 

5. Decrease Sugar Intake:

When our blood sugar spikes then crashes it stimulates a stress response in our body. An increased cortisol level in turns affects other hormones and neurotransmitters and ultimately affects mood. If you are having energy crashes or bouts of fatigue or depression take inventory at how much sugar you are eating in a day. The recommendation is no more than 6g/day! Good quality protein, fat and fibre in the morning will set your day off right so you won’t be craving that 2pm sugary snack. 

As you can see there are many tools to consider to help with SAD and depression. There are other nutrients and botanicals that I would consider in my practice, depending on the person and if they are on medication or not. For a more individualized approach consider booking an appointment with me or your local ND.

In health & happiness,

Dr. Karen

p.s Check out these posts if interested - PMS: Recognizing the Signs, Anxiety: Tried & Tested Tools, Adrenal Fatigue

Anxiety: Tried and Tested Tools

As the concept of mindfulness becomes more recognized, anxiety and high stress seem to be more prevalent. Perhaps we are finally taking note of how our body feels and recognizing that there needs to be a shift, or perhaps we just keep piling on responsibilities.

There is an optimal level of stress, we would not get anything done if we had nothing to drive us (see graph below). However, it is easy to teeter over the edge! 

Finding ways to manage your anxiety so we are not always "on alert", is vital to our health. I have mentioned before that this is something I have struggled with over the years. I have never suffered from lack of sleep due to stress, unless it is the night before a big event, but my stomach and skin suffers and I notice it quickly. Everyone will have their own way anxiety and stress represents itself in their body and recognizing these signs is helpful. It is well documented that anxiety and high stress have many negative implications on our health.

• Does your mind race at night, preventing you from getting to sleep?
• Do you find it hard to concentrate at work?
• Do you find you are overly emotional before your period, or in general?
• Do you get palpitations or a racing heart?
• Do you feel bloated often?
• Is your skin breaking out in hives often?
• …just to name a few.

Tried and Tested Tools:

Over the years, there have been several natural “go-to’s” to manage my stress and anxiety and I wanted to share a few more with you:

1. Yoga: What I love about yoga is that it is for all levels and all body types. There are days I want to push myself and work up a sweat or try a new pose, and days I could sit in child’s pose or legs up the wall the whole time. Both are very nourishing at the right time. The movement is in tune with your breath, connecting mind to body. If you are beginner or would like something slower and nourishing check out www.yogawithadriene.com. If you are in Halifax, check out Shanti Hot Yoga, Rio or Breathing Space - to name a few. If you want a little more fire at home check out www.oneoeight.tv. 
2. Meditation: Start with playing your favourite song, like this one, sit comfortably on the floor and breath deeply, into your chest and belly, until it is over. It can be that simple! Or take 20 minutes a day to try Deepak Chopra’s 21 day mediation challenge - starting Monday. 
3. Rescue remedy: I love having this in my purse at all times for those acute stressors. Bach flowers are an amazing gentle form of medicine and this is a blend of a few. You can find it in any health food store, or the health food section of the grocery store. 
4. Time with friends and family: My friends and family are very important to me. Not only do they make me feel good in the moment, I will live longer because of them! There is a great study showing that social support is a better predictor of lifespan that BMI, pollution and even smoking. My weekends are typically filled with time with my loved ones, decreasing my cortisol levels and increasing oxytocin. 
5. Avoiding stimulants: Unless I am on a very relaxing vacation, I cannot drink coffee or any caffeine. I am a slow metabolizer of coffee, therefore a small amount makes me jittery and spikes my anxiety. I suggest taking a caffeine break for at least 2 weeks, to understand how your body reacts to it. Other options are chamomile or peppermint tea, or just plain water. 
6. Mind mapping: I have started about 3 journals, all with 1-3 entries in it. It is not my thing. However, when I am feeling overwhelmed, making a mind-map or vision board of my ideas helps to organize my thoughts and create a plan. 
7. To do lists: Lists are key to a stress free week. I was introduce to Toodledo by a friend and colleague and it has made life so much easier. I can make due dates, organize by importance, and I don’t have to re-write things over and over. Do you have a favourite To Do app?
8. Acupuncture: Is the tip of your tongue red? Do you have red dots over your tongue? These are clues that your body is “on alert.” Acupuncture addresses this pattern with powerful points like Yin tang or Ht 7. Consistency is key with acupuncture. 

I do take, and suggest, supplements when needed, and that is where a Naturopathic Doctor can help. Sometimes a little extra support is necessary, especially during times of acute anxiety. I also have mentioned before that anxiety could be due to a hidden cause and an ND can help decipher what that might be. 

What are your favourite anxiety busters? Let me know in the comments below 😃

In health & happiness, 

Dr. Karen

Anxiety - 6 Ways to Conquer Your Mind

Anxiety - It is a word heard more and more among people today, since the medical community is opening up more about mental health. It is not something we should shy away from, but support each other through. 

I have come to realize, over the years of being a perfectionist, studying in medical school, and starting a practice of my own, that I suffer from anxiety. I understand why people keep it to themselves, because it is actually a hard thing to admit, and a frustrating thing to live with. Because of my anxiety, at times I question whether or not I am are good enough, healthy enough and capable of achieving what I want. My mind gets in the way, even though I know it is irrational. My thoughts can take over, making me less productive. It makes only a few tasks seem like a million that I will never be able to wade through. But this doesn't always have to happen. Taking care of myself and following these steps help to push those anxious feelings aside and go on living a happy and healthy life. 

Types and Symptoms of Anxiety: 

• Generalized anxiety disorder (GAD) - Characterized by excessive anxiety and worry. These feelings are associated with 3 of the following: restlessness or feeling "on-edge", easily fatigued, difficulty concentrating, muscle tension, irritability and sleep disturbances. 
• Social anxiety - Fear of social or performance situations, to the extent that their ability to perform at work or school is impaired. Avoidance, anticipation or distress occurs. 
• Panic disorder - Feelings of terror or anxiety strike suddenly and repeated with no warning. A panic attack occurs, including sweating, palpitations, shaking, dizziness and difficulty breathing. They can last anywhere from 3 to 10 minutes. 
• Agoraphobia - Fear of places and situations that might cause panic, helplessness, or embarrassment. Usually results from a previous panic attack in a certain area or situation (eg. heights, public spaces, small spaces etc.)

*Remember, none of these types make you inadequate or imperfect, simply who you are. Anxiety also comes in all sorts of shapes and sizes so a diagnoses is not necessary in order to benefit from these steps. 

6 Steps to Take:

1. Routine - I'll say it time and time again, our bodies LOVE routine! Hormones, including cortisol and melatonin, have a rhythm to them and a lack of routine affects these rhythms, leading to issues with energy and mood. Often we press snooze upon waking, rush off to work without eating or pooping, and are on our phones until we hit the pillow. Have a dog? Follow their cues! Wake and eat at the same time, walk every day, cuddle something, drink water and go to sleep at the same time.
2. Deep breathing/meditation - When we are frightening we tend to breath in and hold our breath. This stimulates "fight or flight". Therefore exhaling is even more important, as it stimulates our sympathetic nervous system ("rest and digest"). Shallow breathing is also a common habit, stimulating anxious feelings. Focusing on deep breathing, expanding both your chest and belly for around a count of 6, in and out, is helpful. Start small - 5 minutes 2x/day. Or delve into mediation using apps such as Calm, Breathe or Headspace. Or join me on Deepak Chopra's 21 day meditation. This is one reason why I love yoga, because it connect the mind and the body through breath and meditation. 
3. Nourish with food - We are what we eat! A diet abundant in brain foods such as fish, nuts and seeds, avocado, fermented foods and healthy oils (coconut, EVOO, grapeseed) help to feed the brain. A diet with colourful vegetables and fruit, contribute necessary vitamins and minerals and good quality protein aids to build proper hormones and neurotransmitters. Try this delicious and quick salmon recipe. 
4. Sleep - With our busy lives, our sleep is something that usually suffers. It is an important part of our routine, in order to get enough stage 4 sleep. This is the healing phase, where tissue repair, detoxification and healing occurs. Without enough sleep, inflammation increasing, in turn increasing cortisol and feelings of anxiety and stress. Try lavender essential oil on your pillow or in a bath before bed to help calm your mind.
5. Open up - This can be either discussing how you feel with family or friends or putting it on paper. Holding in our emotions is a form of stress, which can translate into other symptoms over time (eg. eczema, bloating, headaches), so get it out! Naturopathic Doctors, Psychologist, or counsellors are available to listen and help wade through your limiting emotions.
6. Support with supplements - There are several great nutraceuticals and herbs, called nervines, available to help calm the mind. My favourites are L-theanine, schizandra berries, ashwaghanda, passionflower and oats. Specific dosing and herbs depend on the person and situation. Visit an ND to find the right supplement for you. 

Finally, anxiety may occur due to other issues such as poor digestion, nutrient deficiencies and thyroid issues. Naturopathic Doctors can help decipher what the root cause is. Remember, bad weeks happen, but what is important is knowing that you can get through it using these steps and with the support around you. 

Looking for support? I offer 15 minute complimentary consults to help answer any questions you have about Naturopathic Medicine or to see if it is the right fit. Visit Get In Touch to learn more. 

In health & happiness, 

Dr. Karen

(Photo credit: everythingedrecovery.com; pinterest)