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

Adrenal Fatigue - And The 4 Main Stressors On Our Body

Do you ever wonder what actually happens to our body and adrenal glands with chronic stress? Are you experiencing more than one main stressor leading to "adrenal fatigue" aka HPA dysfunction? More studies are showing negative long term side effects from chronic stress so lets get to the bottom of it and heal the body.

Ever heard the term "adrenal fatigue"? The adrenal glands sit on top of your kidneys and one of their main functions is to produce and secrete a hormone called cortisol. It is stimulated by the hypothalamus and pituitary signals, hence HPA axis. There are many receptors throughout our body that respond to cortisol to stimulate a "fight or flight" response - aka helping us run from that dangerous tiger. However due to four main reasons, our bodies may constantly be running from the tiger when it isn't even there! This of course takes a toll on us. 

Common symptoms of HPA dysfunction:

• fatigue
• insomnia
• brain fog
• anxiety, depression
• chronic colds and flus
• weight gain
• shakiness 
• PMS
• fibromyalgia
• diabetes 
• hypothyroidism
• eczema 

How is your body responding to the stress?

The more I practice, the more I realize the importance of discovering the underlying cause and response of these symptoms for each individual and treating it accordingly. For example, if one patient has more anxiety due to an inability to clear free cortisol effectively due to poor liver or thyroid function, I would treat this much differently than with a patient who is fatigued and depressed due to a down-regulated response in the HPA axis leading to low metabolized cortisol. 

Metabolized vs free cortisol what?? A DUTCH lab test, that I do in my practice and find very valuable, can actually differentiate these hormones and how they are broken down and metabolized. For example free cortisol is how much active cortisol is on our body, representing only 3-5% of our body's cortisol, and metabolized cortisol is what our adrenal glands actually produce, representing around 80%. Blood and salivary tests only test free cortisol, which is not the full representation of what is going on! 

(The DUTCH test actually test test SO MUCH MORE than cortisol, including sex hormones and their metabolites, melatonin and liver detoxification function...all so helpful to see!)

So what is actually causing this HPA axis dysfunction? It typically is not only the day to day stress we experience at our job or due to our daily schedule. If we can decrease these triggers the normal feedback systems within our bodies will recover and symptoms will improve.

Four triggers of HPA dysfunction:

1. Perceived Stress - This is the main trigger of cortisol dysfunction. Whether it be our go-go-go lifestyle preventing us from resting and recovering, or financial, job or relationship stress. Everyone perceives stress differently and some people may be less resilient than others. That trendy word mindfulness comes in here as well as simply taking time for yourself to recovery. 
2. Inflammation - This means ANY type of inflammation, including any autoimmune condition, an inflammatory diet full of sugar and inflammatory foods, gut issues, obesity, or chronic sickness. Inflammation of any kind up-regulates the HPA feedback system to put out the fire. 
3. Blood Sugar Dysregulation - High or low blood sugar affects insulin levels, which ultimately disrupts the HPA axis. This is why is it important to eat a low sugar diet with adequate protein, fat and fibre to slow down absorption of sugar and keep you full for longer. Look for foods with less than 7g of sugar, with full fat and good quality protein. Are you experiencing an energy crash in the afternoon? This means your blood sugar is not regulated! The first thing I suggest is changing your breakfast to include a protein and fat. 
4. Circadian Rhythm Disruption - I say it time and time again that our body LOVES routine. Too much exposure to light in the evenings, aka staring at a screen all evening, and not enough sun exposure during the day, aka too much time in an office and no sunshine, can affect the hormone cycles. Your cortisol can therefore be spiking at the wrong time. 

Once we establish your main triggers and how your body is actually responding to those triggers, several Naturopathic treatment options can help along the road to recovery. I love adaptogenic or nervine herbs to calm or support the HPA axis (more to come on the difference). IV therapy can help to support the immune system and adrenals (still discounted for the month of August!). Addressing the pillars of health of diet and lifestyle are always important as well. 

Questions about what was mentioned here or curious where your hormones lie? Come in for a visit!  I am always here to help. 

In health & happiness, 

Dr. Karen

Insomnia Got Your Down? Tips For A Better Quality Sleep

With the longer days in the summer we tend to go to bed a little later and wake up with the sun a little earlier. That doesn’t mean that the time you do sleep has to be compromised! A good quality sleep is essential to maintaining good health. Take it from Kirk Parsley in this TED Talk. Sleep is when we do a lot of detoxifying, when our stress hormone cortisol decreases, when we repair our tissues and so much more. We are more productive and alert after a good night sleep therefore more effective throughout the day. 

So how do we get more sleep? Here are some simple tips to help you. 

Lifestyle Tips:

1. Stick with a routine - I say it time after time that our body loves routine. We end up with a better quality sleep when our body knows around when to shut down and when to wake up. There are several sleep cycles we go through during a night and with a good routine our body will naturally come out of the sleep cycle when needed, instead of jolting awake in the middle of a deep sleep. 
2. Bedtime routine - Melatonin production increases in the evening to help you fall asleep. Blue light from screens (ie. TVs, iPads, cell phones) block melatonin production therefore impeding the onset of sleep. Try to turn off all electronics a half hour before bed or if really necessary use an app such as f.lux to eliminate the blue light. Do a little reading right before bed, spend time with your partner or take a bath with some calming essential oils such as lavender. 
3. Leave the bedroom for sleep and sex - Are you working in bed up until you go to sleep? Watching tv? Is your bed a playground for pets and children? If you struggle with sleep try to maintain your bedroom as a sort of sanctuary and don’t bring in things you don’t need. Leave your phone outside the room, light a candle before bed, and try to avoid distractions in bed such as pets crawling around. 

Food as Medicine:

1. Avoid coffee in the afternoon - Caffeine has a half life of about 6 hours. Therefore the extra coffee to get you through the afternoon slump may affect your sleep later on. That goes for pop and caffeinated tea as well. 
2. Have a tsp of raw honey before bed - Raw or unpasteurized honey is a great source of tryptophan. The tryptophan then gets converted to serotonin and melatonin in the brain to help calm the mind and trigger sleep. It also helps maintain liver glycogen levels which the brain relies on throughout the night for energy. If you wake up around 1-3am your liver may be struggling to provide glycogen therefore this may be a good trick for you. 

Supplements/Herbs:

1. Magnesium - This is a very common deficiency as it is difficult to get a lot from our diet. Magnesium has been shown to have a calming effect on our nervous system and relaxes our muscles priming us to relax. I recommend 200-400mg of magnesium bis-glycinate to start before bed. 
2. Nervine herbs - Some of my favourite calming herbs are chamomile, passionflower and valerian. Combined in a sleepy-time tea is a great tool to use if you struggle with sleep and something I often do for my patients.
3. Melatonin - As your cortisol decreases throughout the day, melatonin starts to increase peaking during the night. It is more likely helpful for those who have low melatonin levels (something that can be tested for). I recommend starting with 0.5-3mg a half hour before bed. Many people find lower doses more sedating than higher doses and cause less dependence. 

If you are struggling with sleep, start with these simple tips but I am always here to help to discover the root cause of your sleep issues! 

In health & happiness, 

Dr. Karen

PMS: Recognizing the Signs and Calming the Craziness

Do you feel like you could snap at anyone who looks at you some days? Or some days do you feel like you could burst into tears at any moment? I get it…I’ve been there! You aren't crazy. These emotions might seem out of the blue, however if you are tracking your menstrual cycle they may actually happen at the same time every month. You’ve got it…this is the dreaded premenstrual syndrome or PMS. 

I see this often in practice and believe it is important to note that even though symptoms of PMS are incredibly common this is not a normal response. There is usually a reason behind these feelings and symptoms and things that can be done to mitigate them, besides jump to the birth control pill. 

Common symptoms of PMS:

• Very emotional - angry, teary, irritable
• Fatigue
• Breast tenderness
• Cramps
• Bloating
• Food cravings
• Back pain
• Acne

What is causing PMS:

Throughout the month your hormones have a cycle and rhythm (See the graph to the right). There is a monthly increase and decrease of both estrogen and progesterone, but they happen at different times. We need proper nutrients, a low stress level, proper blood sugar balance and healthy liver detoxification for these cycles to happen properly. If your body, especially your liver, is not able to metabolism estrogen well an imbalance in the estrogen-progesterone occurs and the above PMS symptoms occur. If you pituitary gland, one of the control centres for your hormones, is not stimulated properly signals to your ovaries aren’t regular, again causing an imbalance in hormones. 

Natural Approaches to PMS:

There are many interventions to decrease PMS symptoms however these are some of my favourites to start with. 

Going with the Flow

By tracking your menstrual cycle you become aware of how your body is responding to these hormone cycles and what symptoms or emotions can be contributed to your cycle. Recognizing this may help you get through it more easily and understand why you may be feeling a little crazy at times. Take time for yourself before your period, take a nice bath, go for a massage or get a good sweat on. 

Magnesium and B6

The birth control pill actually depletes our body of both magnesium and B6. Both of these are vital to hormone regularity, therefore both helpful to decrease symptoms of PMS. Talk to your Naturopathic Doctor about the proper dose for you. 

Broccoli Sprouts

In chinese medicine it is believed that PMS is due to “liver qi stagnation.” This means there is stagnation, or a lack of movement, in the liver. Broccoli sprouts, or in particular sulporophane, up regulates an enzyme in phase II liver detoxification important in excreting excess estrogen. Basically, it gets things moving. Adding broccoli sprouts to a salad, smoothie or as a snack is a good addition to your diet. More liver support may be necessary, including turmeric, I-3-C or DIM depending on the severity of symptoms. 

Seed & Oil Cycling

Since there is natural ebb and flow to our hormones throughout the month, creating a similar cycle in our food helps to produce the proper hormones at the proper time. The seeds and oils carry certain oils, vitamins, and nutrients that can help support the body’s production, release, and metabolism of hormones. Some of the seeds used in seed rotation are flax and pumpkin for the first half of your cycle and sesame and sunflower in the second half. We also add omega 3 and evening primrose oil to the rotation. Adding seeds to smoothies, oatmeal or roll them into energy balls are some ideas to eat them daily. There is the most evidence on the benefits of flax to balance hormones and omega 3s to decrease inflammation. 

Acupuncture

Acupuncture is able to address "liver qi stagnation" specifically with certain acupuncture points. There are several studies supporting the use of acupuncture for improving menstrual function and reducing symptoms of PMS. "One study found that acupuncture was as effective as NSAID therapy for dysmenorrhea, a cycle with severe PMS symptoms, especially cramping."(1) I find this a very helpful adjunctive treatment for both myself and my patients. 

Again, these are some interventions I like to to start with for PMS. If your symptoms are causing you a lot of distress, please reach out to myself or your local ND for further support. Testing may be necessary to assess hormone levels, or look for any concurrent issues such as PCOS, endometriosis or fibroids. 

In health & happiness, 

Dr. Karen