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"REDUCING STRESS" Hey EP’s! A few weeks back, I shared with you that many people will receive the advice from their health care practitioners at some point in their health journey to “reduce stress”. But what does that actually mean, to “reduce stress”? Is it just saying sayonara to our lives as we know them, moving to an island, and never looking back? For some of us, maybe! But for many of us, it will look more like changing the WAY in which we RELATE to the life we are living, right here, right now. Thankfully, there are many tools that can help us do just that! As we discussed last week our bodies fight or flight response is a complex cascade of events that involves many of our organs, glands, and hormones! It begins in the brain; more specifically, processing the perception of threat begins in the “limbic” region of the brain, which is heavily involved in emotional processing and memory formation. This is important, because we are habitual creatures, so if we remember something to be stressful, we continue to create that pattern and relate to it in that way. CHANGING STRESS PATTERNS The good news is that our neuropathways, the pathways in our brains that translate into our thoughts, behaviors, and experiences, are actually quite PLASTIC- meaning they are malleable. What this means is that, when we begin to intervene via becoming aware of and changing the way we think about something, the way we act about something, or set an intention to experience something from a new perspective, our neural pathways respond. It can take some time (CONSISTENCY IS ESSENTIAL) to build and strengthen these new pathways. One way that I’ve heard it explained is like sledding in fresh snow. The first time you go down the hill, there’s no pathway, so whatever is beneath the surface: rocks, uneven ground, and ice, may make for a bumpy ride. As you look back after that first ride, though, you can see a slight pathway forming. And if you trudge up to the top of the hill, and go down that same pathway again, a groove begins to form, its a bit smoother, and you slide down with greater speed and ease. This is actually a pretty good analogy for shifting the patterning in our brain, and how we experience both the pull of old habits and the clunkiness of new habits as a result. But if you’ve ever made a dedicated change, whether that be getting up at a certain time every morning, drinking a certain amount of water, making dietary, exercise, or self-care changes, you’ve likely already played this out. At first, you may ride the waves of newness and motivation, so it feels really good. Then, as the newness wears off, it may begin to feel hard, heavy, or more effortful (as the neural pathway to the old habit is still stronger than the new). Yet, if you stay the course, and stay consistent, the activity likely becomes less effortful, physically, emotionally, and mentally, and you may (or may not) look back a few months later to realize that it has now just become a part of your routine. If you’ve never done so, PAUSE READING THIS AND SAVOR A MOMENT OF RECOGNIZING THAT YOU TOTALLY CHANGED THAT HABIT AND THE NEURAL PATHWAY IN YOUR BRAIN! HOW COOL! DEFINING "STRESS" & CHANGING BEHAVIOR Ok, now how does this relate to reducing stress? Well, first, let’s take a look at a definition of “stress”; for our purposes, let’s define it as anything that is currently triggering your sympathetic nervous system to stay on, chronically, or with a consistent frequency. This could include physical stressors: foods that are inflammatory to your system, or create drastic shifts in your blood sugar (see last week’s episode for more on this), over or under-exercising, exposure to toxins in your home/work/commute environment, lack of time spent in nature, or lack of quality sleep. This could also include emotional stressors: finances, relationships, major life transitions, illnesses in you or those you care about, caring/providing for others. Then there are mental stressors: the way we think about and relate to the other stressors, for example, feeling stuck, like a victim, helpless to changing our circumstances. My own definition of stress also includes spiritual stressors, such as misalignment of daily life with core values, beliefs, and worldviews, as well as the meaning we ascribe to the events of our lives. So our first step then, is to set aside some time and space for ourselves to become aware of the stressors we might be experiencing currently in each of these areas. YOU’RE ALREADY HERE, SO WHY NOT DO IT NOW:
That’s it, really. That is the process for shifting our experience. That is the process for getting the body out of sympathetic dominance and into parasympathetic dominance. That is the process for creating new neural pathways in our brain that make our desired way of responding our DEFAULT! And I can tell you from research, from my own practice, and from working with clients, the scale of the behavior is not the key. It doesn’t have to be a big, grand, sweeping behavior change, and at first, it’s likely best if it’s not. If it makes sense, you may even opt to break down your top stressor into smaller chunks, and address one chunk at a time in the way described above. EXAMINING WHAT'S GETTING IN THE WAY Living in the “pill for every ill” society that we have created, this may not resonate for you. You may even notice resistance coming up: “I’m really sick! I have a real disease/illness. This won’t work for me. I’ve tried this already and it doesn’t work!”. If you are feeling this, I completely understand. Feeling unwell gets old fast; it’s painful and scary and brings up a whole lot of uncertainty and change. It takes mega bravery and self-compassion to stay open, to FEEL what you are feeling, and to try something new without knowing what sort of impact it will have. We can be such habitual beings as humans that sometimes, it feels easier to opt for the painful but familiar way of being, rather than risking change that may translate into even bigger change and letting go and stepping into. Trying something new also often brings up perfectionistic tendencies and along with it, our desire to be in control; we risk being seen as “not having it all together” or “being at our best” and that is uncomfortable for many of us (I know it is for me!). Finally, staying stuck in “sick mode” may be affording us certain niceties (e.g., love, care, and affection from others) that we may fear we will lose if/when we get better. When we can’t hide behind our illness anymore, it’s just us. And we have to take full responsibility for it. And that can feel really, really scary. When it’s no longer the scapegoat, we actually have to ask for what we need, set boundaries, and say “no” because it simply doesn’t work for us.
So believe me when I say, I KNOW THAT BEHAVIOR CHANGE IS BIG WORK. It’s the biggest work. It has the potential to impact everything about us and the way we experience our lives. The good news is that YOU ARE IN THE DRIVER’S SEAT. You call the shots. You decide the pace and intensity. IT’S YOUR LIFE VISION, and you can create and re-create what you want it to look and feel like. The perhaps less comfortable news is that you can’t stay standing right where you are to get to where you want to be. And if you’d like to receive SUPPORT on that journey, if you’d like some help sifting through your stressors, the way you relate to them, and creating a vision and action plan for the life vision you hold, PLEASE REACH OUT! I currently have one open spot in my private coaching program, and I would love for it to be you! You can schedule a FREE 30 minute discovery call with me here: to see if we are a good fit for beginning this work together. Either way, I so honor you for showing up and doing the work rather than remaining on autopilot. Thank you! Jadi
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“I’ve noticed that when I eat sugar in the evenings, I wake up in the middle of the night feeling anxious, and I have more nightmares; is that a thing?” This is a question I received from a friend recently when talking about the impact of the foods that we eat on our system. And by the way, the answer I gave is “YES!” But before I get into the “WHY”, allow me to explain the “HOW”. BASICS OF METABOLISM: A REVIEW As I’ve discussed in previous posts, when we eat a meal or a snack, our blood glucose levels rise, and as they do, insulin is secreted from the pancreas and ‘unlocks’ cell membranes to allow this glucose to be shuttled into the tissues where it can be utilized. If there is a greater amount available than what can be used immediately, the body, being efficient and survival-focused, finds a way to store the extra energy for future use (i.e. as glycogen in our liver and muscle tissue and as triglycerides in our adipose tissue). As the time passes since our last meal, our blood glucose levels begin to decline until they reach a threshold that signals to the body “we need fuel!” If glucose is not made readily available (by eating a meal or snack), the body will tap into its stores of glycogen first (in the liver and muscle tissue), and then the energy stored in adipose tissue. Additionally, different macronutrients (i.e. carbohydrates, dietary fats, proteins) break down into readily usable fuel at different rates, with carbohydrates breaking down the quickest; the more refined the source of carbohydrate, the more rapid spike AND subsequent decline in blood glucose levels (with refined white sugar being one of the quickest). This is a very basic description of the mechanics of metabolism; my hope is that it will be helpful for building on the conversation of stabilizing blood glucose, especially when experiencing chronic stress and adrenal dysregulation. ADRENAL FATIGUE AND CORTISOL What we commonly call “Adrenal Fatigue” is actually a complex composition of symptoms that can include: fatigue, lowered immunity, lowered stress resilience, increased digestive distress and food/chemical sensitivities and allergies, feeling increasingly overwhelmed, brain fog, weight gain (especially around the midsection), feeling “tired but wired”, relying increasingly on sugar and caffeine for energy throughout the day, cravings for sugar and salt, experiencing energy “crashes” throughout the day (especially around 10am and 3pm), feeling more awake in the later evening hours, and the list goes on! Sound like you? It’s not uncommon! In his book “Adrenal Fatigue: The 21st Century Stress Syndrome”, Dr. James Wilson offers rates as high as 80% in describing who will experience some degree of adrenal dysregulation due to stressors at some point in the their lifetime. So what do heavy stress loads and blood sugar instability have in common? The answer is CORTISOL! You’ve likely heard of cortisol as it relates to stress and also “stubborn belly fat” (not my words; it’s often stated this way in the media), but it is SO MUCH MORE. Cortisol is a complex and essential hormone that is primarily excreted from the outer portion (cortex) of the adrenal glands (we have two; they sit atop the kidneys and are about the size of a walnut), and is responsible for many essential functions within the body, including (see Wilson, p. 3423 [kindle edition]):
Ok, now that we’ve seen that cortisol is not the bane of our existence, and actually serves as a life-enhancing regulator and modulator of homeostasis, let’s get into the effects of chronic stress on cortisol output and how this affects blood sugar stability. CORTISOL AND BLOOD SUGAR STABILITY When our brain (specifically the amygdala and then hypothalamus; Wikipedia) receives a signal that there is a perceived threat to our survival (ranging from walking down a dark alley alone to a hostile work environment to reliving or creating a stressful experience in our minds), it releases a chemical cascade to allow our bodies gear up to either FIGHT or FLEE. The adrenal glands are heavily involved in this: immediately, the adrenal medulla (inner portion of the gland) releases adrenaline, the jolt of energy we feel that gives us superhuman speed and strength to escape the threat. Shortly thereafter (and long-term if stress becomes chronic), cortisol is released, increasing blood pressure, as well as blood sugar, the latter of which works in concert with insulin from the pancreas to mobilize stored sources of energy for use. While in the short-term, this response is brilliant in giving us the energy and functionality to survive, long-term, it becomes debilitating and toxic. The body’s primary goal is always to maintain homeostasis to the best of its ability. And a chronic state of limbic brain activation, heightened cortisol release, and increased inflammation is counter to this. So, the brain begins to downregulate cortisol production. Our system becomes LESS responsive. The hypothalamus (the area of the brain responsible for regulating cortisol output) may begin to signal less output of cortisol, the tissues may become less responsive to cortisol and the receptor sites less sensitive or cortisol resistant (in theory, similar to insulin resistance). Additionally, the kidneys have the ability to switch between cortisol (active form of the hormone) and cortisone (inactive form of the hormone); so one way to downregulate cortisol is to convert it into its inactive form, cortisone. I say this because in most cases, the body does NOT lose its ABILITY to produce cortisol, so the glands haven’t really become ‘fatigued’. The body has simply ADAPTED to its environment as best as possible, and made these modifications to do so. (Side note: often, cortisol is tested via saliva. Saliva tests “free cortisol” which accounts for only 3-5% of total cortisol in the body; Kresser, 2017) But as we reviewed above, cortisol is involved in many regulatory functions in the body, so with this down-regulation of cortisol, we feel TIRED in the morning, we feel less resilient to stress, our immune system becomes overactive, our brains and thinking become foggy, our blood pressure plummets and we crave salt, our blood sugar drops and we crave sugar and quick sources of energy. As it relates to blood sugar stability more specifically, this down-regulation of cortisol makes us less able to mobilize our stored reserves of fuel to provide all of our tissues and systems with the energy they need, as cortisol is required for this conversion. As cortisol also pumps the brakes on insulin so that a slow steady release of glucose moves into the cells, a deficiency allows insulin to rapidly unlock the doors to the cells so that the glucose is released much more quickly, and as a result, we are left with low blood glucose and may experience the effects of hypoglycemia (Cherney & Pietrangelo, n.d.):
I know this is a lot of information, and it can sound pretty serious and dire! While it is serious, luckily, there are MANY lifestyle changes we can make to help our bodies decrease stress, and reactivate cortisol in a balanced and functional way. LIFESTYLE MODIFICATIONS TO STABILIZE BLOOD SUGAR One of these is to make sure that we are FEEDING OUR BODIES ENOUGH FUEL, and feeding it the fuel that creates STABLE ENERGY across long periods of time. For many people, this includes INCREASING DIETARY FAT and PROTEIN, ESPECIALLY AT BREAKFAST! Why? Because, as I mentioned at the beginning of this article, dietary fat and protein take longer to breakdown, creating a slow steady rise in blood glucose, rather than a quick sharp rise and fall (crash). We want to create a steady ebb and flow, which MASSIVELY reduces the metabolic stress load on the body. This doesn’t mean ELIMINATE CARBOHYDRATES. Carbohydrates are often an essential component to healing adrenal fatigue as well; what matters is the QUALITY. Eating whole, nutrient-dense, minimally processed forms of carbohydrate such as sweet potato, squash, starchy vegetables, and soaked and properly prepared grains/legumes (if tolerated) WITH quality sources of dietary fat and protein is ideal. Eating highly refined sources of carbohydrate such as breads, pastries, energy bars, and cereals, especially on an empty stomach without the blood-sugar-stabilizing effects of high quality dietary fat and proteins, can send our body’s on a blood sugar roller coaster that creates further depletion. So if you are experiencing the effects of cortisol insufficiency, including blood sugar disregulation and hypoglycemia, be sure to EAT BREAKFAST! Don’t skip it! Don’t skip lunch or dinner either! Eat a balanced meal of whole, nutrient-dense foods at each meal, including dietary fat and protein. Eat enough to keep your body satiated for 4-5 hours. You may find that your body requires smaller, regular meals throughout the day, or snacks between meals, especially at first. HONOR THAT. A handful of raw or roasted nuts or a tablespoon of nut butter (no sugar!) can be great as can be grass-fed jerky or some veggies with guacamole. You can even have a smaller portion of a meal as a snack. Keep in mind that cortisol demand goes up each time we eat and when chronically stressed, our digestive function may be compromised, so try to avoid “grazing” while PRIORITIZING EATING ENOUGH! Alright! That's all for now! I hope that you found this deep dive into the roles of chronic stress and cortisol on blood sugar regulation helpful! All the love, Jadi RESOURCES: Cherney, K., & Pietrangelo, A. (n.d.). The effect of low blood sugar on your body. Healthline. Retrieved from: https://www.healthline.com/health/low-blood-sugar-effects-on-body#1 Kresser, C. (2017). RHR: The myth of adrenal fatigue. Chris Kresser: Let's take back your health - starting now. Retrieved from: https://chriskresser.com/myth-of-adrenal-fatigue/ "Fight or flight response". (n.d.). Wikipedia. Retrieved from: https://en.wikipedia.org/wiki/Fight-or-flight_response Wilson, J.L., N.D., D.C., Ph.D. (2001). Adrenal fatigue: The 21st century stress syndrome. Smart Publications: Petaluma, CA. If this is really hitting home for you, and you’d like more tips, sign up HERE to receive my free PDF on 7 TIPS TO ELIMINATE EXHAUSTION NOW! Additionally, if you’re feeling in the weeds with Adrenal Fatigue or chronic stress recovery, and you’d like guidance and support through it, I WOULD LOVE TO SUPPORT YOU! I currently have ONE open spot in my 1-on-1 coaching practice. You can schedule a FREE discovery call with me HERE to see if we are a good fit for working together on your health vision. ***PLEASE NOTE THAT ALL INFORMATION PROVIDED ON THIS WEBSITE IS FOR INFORMATIONAL PURPOSES ONLY; PLEASE SPEAK WITH YOUR HEALTH PRACTITIONER BEFORE INCORPORATING ANY CHANGES.*** For the past three nights, I’ve been waking up at the same time, heart racing, and feeling anxious. It has been awhile since this has happened, so the first night it caught me a bit off guard; I simply sat (or laid in bed) with it, resisted the urge to look at the time on my phone, turned inward and focused on deep breathing (link) until my system calmed down and I was able to return to sleep. The morning after the second night, I got curious:
Noticing the dark chocolate/caffeine connection, I decided to keep it to lunchtime or before 2p, which I did, but the third morning, I remembered something else:
The latter is called the “Body Clock” and is explained by Traditional Chinese Medicine.  Photo credit: Chalkboard Magazine Within this and many alternative medicine practices, it is acknowledged that our body undergoes a system-wide detox throughout the day, and so paying attention to our symptoms and whether they have a time-of-day occurrence can be a helpful tool in understanding which organ/system is feeling overburdened. As many of our organs of detoxification are being cleansed at night, it is often recommended we be in bed by 10:30 pm and asleep by 11:00 pm so that deep detoxification can take place. With a schedule roughly close to this, our bodies move first into gallbladder detoxification, where bile is released and cellular repair is enacted. Between 1-3 am, the LIVER begins to detoxify. Next, the body focuses on the lungs, and this is also a place where deep sleep and dreams take place ( anyone else’s wakeup time fall during a dream!?). As 7 am approaches, the body is focused on the stomach; this is a good time to eat breakfast! And the cycle continues.
So as you can see, for me, the organ feeling challenged/overburdened is the liver. This isn’t hard for me to believe, as the liver is one of our PRIMARY organs of detoxification- food, alcohol, caffeine, supplements, antibiotics, birth control medications, metabolic byproducts- all of these and more require the support of a high-functioning liver. As many of us have incur AT LEAST one of these daily, if you ARE experiencing middle-of-the-night waking, or increased anger/frustration/irritation (the emotional component to the liver), it can be helpful to support the liver function. Thankfully, there are ways to do this in our very own kitchen! The liver LOVES cruciferous and leafy green veggies. So one way to support the liver and detoxification is to include more of these into your meals:
Another simple way to help the liver flush first thing in the morning is to drink a full glass (at least 16 oz) of room temperature water with lemon (vitamin C), sea salt (mineral/electrolyte balance), and a splash of Apple Cider Vinegar (balances blood sugar; boosts metabolic function). Finally, if it feels like a good fit for you, after speaking with your health care provider, you may opt to add in a supplement for extra liver support. Two potent (and usually safe) ones include Milk Thistle and NAC (N-Acetyl Cysteine). That’s it for today! I hope you found this information helpful! As always, I LOVE To hear from you! Please share if/how you would like to incorporate the Body Clock and liver support into your health routine below! Additionally, I have space to take on TWO PRIVATE COACHING CLIENTS right now! If you are a women who is in the throes of burnout, exhaustion, overwhelm, and is experiencing hormonal imbalances, digestive distress, and blood sugar dysregulation, I would LOVE To connect with you to see if we are a good fit for working together! CLICK HERE To schedule a FREE 30 minute coaching call with me. All the love, Jadi Our last deep dive into the ketogenic diet was a big topic, and this one is too- you guys know how to pick ‘em! Thank you! After taking a deep dive into the available research and clinical opinion on food sensitivity testing, the results are… mixed; I found them to be surprisingly uncertain! Like many topics in the health/nutrition field, there are full-on advocates for it, and those that are completely against their use. Before we get into all of that, let’s first cover some basic definitions: DEFINING FOOD ALLERGIES AND SENSITIVITIES: Food allergies, intolerances, and sensitivities are becoming an increasingly experienced, and therefore, investigated health issue. According to one report, food allergies impact 220 million people worldwide and approximately 14 million people in the United States (1), and even greater numbers are affected by the broader category of food hypersensitivities. A food allergy is defined as “an immune system reaction that occurs soon after eating a certain food.” (2) With an allergy, one can react to even microscopic amounts of the allergen, with symptoms that range from being slightly uncomfortable to severe and even life-threatening. These can include forms of skin irritations such as hives and eczema, swelling of the face, lips, and throat, gastrointestinal discomfort, lightheadedness and fainting, and on the severe end, anaphylaxis and death (2). Food intolerances can be experienced soon after ingesting a food, and are thought to be caused by difficulty in digesting certain foods (3); this may be due to a lack of enzyme production (as in the case of lactose intolerance), and though the reaction may be extremely uncomfortable and involve a wide array of GI symptomatology, including: cramping, painful bloat, constipation, diarrhea, nausea, and vomiting, the side effects are not typically life-threatening (19). The term food sensitivity is less universally defined and is often used interchangeably with the term food intolerance; however, as it is tested, it generally involves a reaction to a food protein that elicits an immune response that is distinct to food allergies (20). The underlying mechanism maybe that of leaky gut, gut dysbiosis, or the inability to assimilate a nutrient. Like food intolerances, symptoms can include digestive upset (3), but they may also present as delayed onset allergic reactions (19), a flare in autoimmune symptoms (4),or as weight gain, pain, and fatigue (5) . Because our immune and digestive systems are incredibly complex, the methods of testing for food allergies and sensitivities are of a wide variety as well. Let’s start with the more standard implementation of food allergy testing. TESTING FOOD ALLERGIES: Traditionally, testing for a particular food allergy begins with a clinical history to get a clear picture of the patient’s symptoms, severity, and onset (which are often quite immediate)(1). The age of the patient is considered, along with consistency of reaction, and the type of food implicated, as up to 90% of food allergies are encompassed within just a few food categories: eggs, milk, wheat, soy, fish, shellfish, nuts, and peanuts (1). Next, tests may be performed to confirm the patient account, such as Skin Prick Tests (SPT), in which a tiny amount of the food protein or extract is exposed to the skin via a grid (e.g., on the back of the patient) and then observed for a reaction (e.g., red, swollen skin). At this point, a bit of immunology is required! The skin contains one specific immune antibody, called immunoglobulin E (IgE) that SPTs test for. Allergic reactions are often described as being IgE mediated, while sensitivities are portrayed as being mediated by other immune antibody classes (e.g., IgA, IgG, IgM, IgD), and intolerances by non-immune related digestive challenges. As skin tests can only detect the presence or absence of an IgE mediated reaction (1), if the food sample is scratched onto or injected beneath the skin and the skin responds with redness, swelling, and blistering, shortly thereafter, there is likely a reaction happening in the body with that food substance (5, 1) (although the purity of the food extract and clinical history should be considered before drawing conclusions). However, there are many other immunoglobulins (contained in the gut for example) implicated in food reactions that the skin DOES NOT contain (5). Therefore, a non-reactive skin test result does NOT mean that the body is not reacting negatively to that food/substance, it simply means that the IgE pathway is not activated, by the amount given in the sample (5). Additionally, skin sensitivity varies, and so the amount of redness and swelling should not be taken to be indicative of the clinical reaction to the food/substance (1). Beyond SPTs, serum IgE tests can be done, and are usually best with specific suspected allergens indicated in the patient’s history, due to the risk of false positives and unnecessary food eliminations (especially in pediatric populations), as well as false negatives and the potential for severe side effects (1). Thus, the “gold standard” for detecting an allergy remains an “oral challenge” test, where the Physician can supervise the response and administer appropriate precautions (6). As you can see, allergy testing is not as clear cut as we might think. And often, if someone has a true allergy to a specific substance that is easy to tease out (e.g., a specific food or environmental allergen), they are aware of it and avoid it, with or without a test. What becomes more tricky is when reactions are delayed in onset, and more subtle and variable. How do we know what we are reacting too? How do we test for it? Let’s take a look! TESTING FOR FOOD INTOLERANCES & SENSITIVITIES: When it comes to testing for these more variable reactions, there are MANY approaches, from pulse testing, to muscle tests, to testing for various immune antibodies and other mediators of reaction (5). The reason that there are so many variations of tests available is likely because our immune systems are amazingly complex and changing all of the time, and no one test or theory of food sensitivity has been able to pinpoint all forms of reactivity. For these reasons, some researchers have concluded that multiple forms of food sensitivity testing in combination with a physician-guided lifestyle modifications (such as elimination and reintroduction diets) may be the best way to work with food reactivity, as no one test appears to be able to detect all reactions conclusively (7). Perhaps one of the more common ways to test for non-allergy food reactions, especially delayed hypersensitivity reactions, is IgG testing (especially IgG substrate 4) via the ELISA (enzyme-linked immunosorbent assay) method. This test measures the size of an immune antibody reaction to specific food proteins (20). The idea is that, of all the immune antibodies, the concentration of IgG is the highest. IgG has four substrates, with IgG1 being the highest, and IgG4 being the lowest under normal “healthy” physiological conditions (11). However, the concentration of IgG4 rises dramatically when one is reacting to an antigen (e.g., food protein). Therefore, if there is a strong IgG4 response to a substance, there is likely an inflammatory reaction to it. The way that this is most often measured is via a blood test, which is sent to a lab, where technicians place droplets of the patient’s blood into (usually, depending on the test) hundreds of different food samples/extract solutions, and the degree of IgG antibody binding to each food particle sample is monitored (8). The greater the binding or clotting noted, the greater the patient is thought to react to that food. The patient is often then presented with a handout of the various reactive foods and is told to avoid them for a certain length of time or altogether, and may work with the physician to devise a diet plan around them. Although this is an increasingly common method of food sensitivity testing, it entails many challenges. For example, because IgG has been observed in both non-reactive and reactive patients, it may be that the presence of IgG after ingesting a food is a normal physiological response; one that may even indicate tolerance for a food (8). Additionally, unlike IgE antibody reactions, which the immune system keeps long-term memory of in allergies, if the patient has already cut a food out of the diet for a period of time (e.g., 3 months to 2 years), the body will have likely stopped producing antibodies to it, even if it is a reactive food for them (12). Another large problem is the actual reliability of the tests being utilized. A common way to test the reliability of these tests, is to take two samples from the same patient at the same time, and send them into the same lab (or a different lab that runs the same test). If the test is reliable, there should be no greater than about a 10% discrepancy between the two tests (indicating a split sample reliability of 90%). However, the variance between tests is often much higher, with reports as high as 73% (which is less than chance!) (9), although certain labs have reported higher rates of reliability through consistent testing (10). Additional concerns include variables in the testing process, such as whether the food extracts are raw or cooked, organic and fresh or not, free of additives that the body might independently react to, and whether the testing solutions have been purified so they aren’t the cause of the reaction (12). Also of note, many tests report for whole foods or even broad categories (e.g., dairy, milk, yogurt) when a patient’s immune system may be reacting to a specific component of that food (e.g., casein or whey). Despite these flaws, there appears to be a place for their use. Two respectable Functional Physicians, Dr. Chris Kresser and Dr. Alan Christianson, both report utilization of food sensitivity testing in their work with patients (12; 5), albeit careful and hesitant. Dr. Kresser utilizes different Cyrex arrays in specific cases as there tests are quite extensive and account for variables such as both raw and cooked foods, and solution purity (13). Dr. Christianson reports that through conducting his own experiments with split sample reliability, he has found the KMBO FIT test, USBiotek, and Meridian valley labs most useful (5). Another functional practitioner, Dr. Michael Ruscio, finds that sensitivity tests are too unreliable, expensive and potentially restrictive to be of best use for his patients; he prefers to start with a whole foods elimination diet approach (14). Utilizing a professionally supervised elimination and challenge/reintroduction diet has been reported as a practice gold standard by others as well (4, 20). Beyond IgG and single immune antibody food testing, are theories that posit that multiple mediators (e.g., many different white blood cells, cytokines, histamines, prostaglandins) released during a reaction are actually what cause the negative effects we experience with a food sensitivity, such as the MRT test offered by Oxford Biomedical Technologies (15). The creator of this and the previous ALCAT mediator test, Immunologist Mark J. Pasula, PhD, explains in a 2014 Towsend Letter, “The inflammatory process associated with food sensitivities is significantly more complex than IgE-mediated food allergies. Multiple triggering mechanisms and pathways, multiple classes of reacting white cells, a vast number of pro-inflammatory mediators, and a wide array of symptoms and conditions make sensitivities a highly complex category of adverse food reactions.” (16; {see diagram 1}). Like the IgG and single immune complex tests, a blood draw is completed in a lab, and a specific amount of the patient’s blood is placed into each vial (e.g. 140 vials of specific foods and chemical additives are tested with the MRT). Next the vials are observed for reactions by technicians at specific time intervals via changes in the solution, which are comprised of the patient’s blood cells and plasma. According to this immunological theory, if there is a reaction, mediators from within the many different immune cells will be released; the cells then become smaller in size while the plasma remains the same (15). Significant changes to the total volume of the cells indicate a significant reaction, while modest changes indicate a low reactive substance. Patients then receive a print out of all substances tested with a reactivity bar of green (low reactivity), yellow (moderate reactivity), or red (high reactivity), and can make dietary adjustments accordingly. Although the mechanism of the food reaction is measured differently than immune antibody (e.g., IgG) tests, it is noted in these tests too that in some cases degree of reactivity may not correlate with clinical reactivity, and while it is recommended that one avoid all high and moderate reactivity foods, that low reactivity is likely “safe” IF that food has been consumed regularly before testing (taken from my own MRT printout). So similar to IgG testing, these tests must be interpreted and dietary modifications implemented with careful consideration of patient history. Beyond the pretty dated research available on Oxford Biomedical’s website, I found it challenging to locate updated information on the MRT III proprietary testing method (e.g., are the food extracts raw or cooked?). Similar to the procedure with IgG testing, I looked for indications of how reliable the test results actually are. It has been referenced by clinicians that split sample reliability is consistently greater than 90% (e.g., 17), and a research poster on Oxford Biomedical’s website (15) as well as one report I was able to locate (18) confirm this. Functional practitioners views of this form of testing are mixed (5;12; 17). PERSONAL OPINIONS AND ADDITIONAL CONSIDERATIONS: There is no doubt opportunity to go into even greater depth on each of the food reaction test methods mentioned, and many more. I myself, after examining all the research and available options, found that, much like embarking upon any approach to health, the right tool must be chosen carefully for the right person. My views also align with other practitioners (5; 7; 12; 14; 20;) in finding that a comprehensive approach to food sensitivity is one that may involve a hypo-allergenic or therapeutic food menu implemented for a certain period of time, along with additional testing (if and where it feels aligned), all under the guidance of a skilled practitioner. I think that as a consumer it is important to be aware of the clinical limitations of each of these tests, and I hope that you have a greater view into these through reading this article. Personally, I have quite a bit of experience with different elimination and reintroduction diets and have found them to be extremely helpful and informative; when it comes to testing, I have experience only with the MRT test, and what follows about it is purely anecdotal. This was the test my practitioner and I chose, along with stool testing, after experiencing a GI flare a few months ago, as a part of informing our approach to a gut healing protocol. After spending the past few years really invested in system wide healing, I feel like I am able to receive pretty clear messages from my body as far as what food, forms of movement, and social interactions feel really good (which changes throughout the month and life events). Prior to receiving test results back, there were a few foods that didn’t particularly feel great in my system, including coffee, green peppers, and bananas. Interestingly enough (even though I hadn’t consumed any of them for a month or longer), the test results showed them to be reactive foods in my system. However, there are other foods that also seem to elicit a particular response in my body; for example, my body has a higher tendency toward bloating, joint aches, eczema flares and skin rashes when I am regularly consuming grains. And when I eat dairy (in any form besides butter and including sheep’s, goat’s, and cow’s milk forms), I notice after three days worth that I feel sinus pressure, my ears drain, my throat hurts, my eyes water and burn, and my chest feels heavy. For these reasons, I have for the greater part of the last few years, kept them out of my diet. Interestingly, all forms of dairy and most grains tested came back in the ‘green’. Because of this, I tried reincorporating them, and just didn’t feel good! I talked to my practitioner about this and she basically said what I tell my clients which is TRUST YOURSELF and your body’s feedback. What I also found interesting and what became a key part of my healing protocol was the fact that many of the foods in the seafood and meats/poultry sections came back reactive. Looking at my history (which includes periods of food and caloric restriction, chronic stress, over-exercise, and higher alcohol, caffeine, and sugar consumption than my body prefers), it became clear that part of the root cause to the GI distress was low stomach acid (which declines with age and can be affected by each of the life markers mentioned above). So in addition to the nurturing food preparations and mindful eating practices that became priority, we added in digestive and stomach acid support. So, much like other health practitioners have found with their clients, my experience with this test was mixed. I am grateful for (and fascinated by) the testing options available and the researches behind them working to improve understanding, methodology, and reliability. I do think that they have a place and can be helpful in developing healing protocols, as long as their limitations are acknowledged, and the patient’s history and experience is given equal consideration. Whew! That was a biggie, and I hope that you found it helpful! **PLEASE NOTE, ALL INFORMATION PROVIDED HERE IS INTENDED FOR EDUCATIONAL PURPOSES ONLY; PLEASE CONSULT WITH YOUR HEALTH CARE PROVIDER BEFORE MAKING ANY CHANGES.*** *** Are you currently struggling with chronic burnout? I understand and would LOVE to support you on getting out of burnout and into THRIVING! Please click here to schedule a FREE call with me to learn more! Resources
I received this question last week, and with the many 30-day programs that have cropped up over the past few years and the greater interest in them, thought it would make a great EP topic!
So the question/comment was: “I am on the last week of a 30-day reset, and once it finishes, I’m not sure what to do.” This is a great question, and in my experience, and a very common place to land finishing a reset/plan/elimination diet. Often times, there are pretty specific rules offered along with these, and perhaps even daily meal plans. This can be great starting out, because it takes the guesswork out of everything; which can be a valuable asset when making changes or trying something new. If not instructed or guided though, I find it can also take the INTUITION and INNER TRUST out of the experience as well. So to answer this question, I am going to offer a question, or a few questions to consider throughout this process, as the answer for one person will likely differ from the next. Question 1: What was your intention in undertaking the reset?
Question 2: What have you noticed throughout the process? (write it down!)
Question 3: What is important to you NOW?
This may feel like a lot to consider (and a little deep!), and IT IS. Food IS deep. It is one of the first and the longest relationships we’ve had throughout life. Food is often with us in the highest of highs and lowest of lows. People have created tribes and cultures around food, and staked a lot of identity on it, too. And often, in the food and diet industry, along with the meal plan is an implicit promise: this is THE thing that will get you everything you want- love, belonging, beauty, health, harmonious relationships, confidence, and full self expression. This is an impossible promise because no one and nothing can give this to you unconditionally except for yourself. YOU get to decide that you are worthy of love, compassion, patience, caring, success, and health, and you decide the TERMS, too. If you decide that your life can only be lived at its best when you are X pounds, then you make it so. Conversely, if you decide that you are UNCONDITIONALLY worthy of love, and are willing to BE THAT SOURCE OF LOVE for yourself, always, nothing can stop you, and from this space decisions can be made with unwavering love for yourself. That unwavering love may lead you to undertake a reset or cleanse or any number of health changes that, from the outside, may look the same, but will FEEL very different than coming at it from a place of not good enough, and needing this thing (and then the next and the next) to make you whole and complete. From this space, what feel important to you, right now? Many elimination/reset diets are enacted with the guidance of health practitioners for the purposes of providing the widest amount of food variety with the greatest amount of health, energy, and vitality to be channeled into all the areas of life. So as one comes near the end of a reset, I would encourage taking note of all of the changes mentioned above, and then slowly begin to re-incorporate the food/s that were eliminated that you’d like to re-incorporate. That may be all foods, that may be some. There may be a few foods that you feel better without, most of the time; that’s great awareness, too! If you are interested in re-incorporating foods that may be connected with symptoms you’ve experienced in the past, I would recommend working with a health practitioner, who can guide you on when/how to re-incorporate foods in a way that works best for you. Commonly, this includes reincorporation of one food at a time, for at least three days, taking note of your experience, and then adding in another food, sticking with it for three days, taking note, and so on. One of the beautiful opportunities of closing out a reset, is that often the body has a greater sensitivity. What this means is people often find that when incorporating a food or beverage back in, they know pretty quickly whether it feels good in their system or not. This is not always the case, and not with every food. But it is my hope that if you are embarking on or closing out a reset of some sort, whether it be with food, exercise, or technology, that you’ve set a clear intention for why it is that you are taking the action, that you’ve given yourself space to check in and be with what you are noticing, and that you come away with greater awareness of yourself and confidence in what works well for you and where your threshold lies with things. If you are not feeling that way, if you feel worse, or feel even more confused about what foods are “healthy” for you, please ask for support. I am a practicing Health Coach and I specialize in helping women who feel lost confused, or stuck on their health journeys to get very clear on which diet and lifestyle patterns will serve them best right now, and how to navigate that change in a way that feels BALANCED. I would love to support you, so if it feels aligned, please reach out to jadiengels@gmail.com with the subject line: "I’d Love to Receive Support!" As always, hoping that this conversation serves you, and if you have a specific topic you’d like to see covered on the Empowered Patient, please comment below! Thank you and sending you so much love, Jadi  From butter coffee popping up on local coffee shop menus, to bacon- covered everything, I think it’s safe to say that a Keto craze has hit! Perhaps you’ve seen individual stories of men or women starting a keto diet and losing a ton of weight, or their chronic conditions resolving, or their energy and focus and athletic performance skyrocketing! Intriguing, right? While the internet can make it seem as though a Keto diet is the new magic approach to healing all that ails us, ketogenesis as a healing mechanism is not new… in fact is VERY, VERY old, perhaps even Biblical (1)! But the ketogenic approach I am referencing began as something much different than we think of it today; it began via therapeutic fasting. Utilizing fasting to heal illness within the body is referenced as a healing modality in Hippocratic texts (cite)! As we look at various cultural and religious practices across history, we see that many, if not most of them, include a dedicated time of fasting! However, long-term fasting is pretty intense, as far as therapeutic interventions go, and most often must be supervised by a healthcare team. The body needs fuel to survive, and it will do some pretty nasty things to keep that train rolling- like breaking down our muscle tissue for fuel- yes, our body will literally start eating itself if we don’t provide a fuel source. So the conundrum of healthcare practitioners in our history was this: how can we attain the benefits (primarily the reduced and even completely eliminated occurrence of seizures) of fasting in a way that is sustainable, long-term? Enter the 1921 research paper of Dr. Rollin Woodyatt, who discovered that the same byproducts we can see in fasting or starvation- beta hydroxybutyric acid, acetic acid, and acetone (collectively known as Ketone Bodies), can also be seen in diets that contain “too low a proportion of carbohydrate and too high a proportion of fat” (1). Another practitioner, Dr. Widler took this information and ran with it - or more accurately- began to experiment with it in pediatric epileptic patients at the Mayo Clinic. Side note: One of the challenge points of understanding the benefits of the ketogenic diet is macronutrient ratios. While broadly, it is described as a diet in which a high proportion of daily calories come from fat sources, minimal amounts from carbohydrate, and moderate amounts of protein, the exact ratios set out in the research vary. Our responses to carbohydrate quantity vary greatly, as do our responses to individual sources of carbohydrate (e.g., one person may tolerate sweet potato well but not mango, while another may tolerate lentils well, but not white potato!). However, the original “ketogenic diet” consisted of 1 kg/pound of body weight, 10-15 g of carbohydrate, and the rest of calories being consumed in the form of dietary fat, most often via Long Chain Fatty Acid sources. (1). And in looking at the research and clinical accounts of applying this dietary intervention in epileptic patients, it appears to be a very potent intervention (2, 3). Seizure episodes were significantly reduced in severity and frequency, and some eliminated altogether. This was true even in samples whose epilepsy had been resistant to medication. And so this form of intervention continued to be explored and applied throughout the first half of the 20th century. Despite its efficacy, the ketogenic diet, applied in this way with these patients does not come without side effects, some of which include: gastrointestinal distress, mineral deficiencies, stunted growth, osteopenia, increased bruising, increased risk of infection, decreased cardiovascular health, and even death (3). I feel it important to note that this rather rigorous and perhaps risky intervention continued to be used because other methods had not proven effective in the samples studied. On a lighter note, it was discovered in the 1960’s that the inclusion of Medium Chain Fatty Acids (e.g., MCT oil) more readily produced ketones in the body and as a result, patients were able to increase the amount of protein that they consumed as well as experienced greater flexibility with carbohydrates while their bodies remained in a ketogenic state (4). In more modern renditions, this is often why it is recommended when applying a ketogenic diet to include MCT oil or exogenous ketones as part of the approach. As time went on, new anticonvulsant medications came onto the scene that had more widespread application with epileptic patients, and so the ketogenic diet as an intervention began to have less utility. It wasn’t until the 1990’s when a prominent Hollywood producer shared the story of his son’s medication resistant epilepsy, and his astounding success with the ketogenic diet, which eliminated all seizure activity and allowed normal growth and development to continue (1), that clinical interest in the ketogenic diet as a therapeutic intervention was revived. It was also around this time that the Atkin’s Diet became a popular approach to weight loss and metabolic regulation. Since that time, much research has been conducted on a low-carb, ketogenic diet as an approach to weight loss, metabolic regulation, and cardiovascular health (2, 3). (I’d like to add that there are burgeoning fields of research exploring the therapeutic application of a ketogenic diet for many neurological disorders, cognitive decline, mood disorders, cancer, and PCOS, too; [see 2]). And it appears that, at least initially, especially in samples labeled “overweight/obese” (as measured by Body Mass Index) that a low-carbohydrate ketogenic diet was able to produce weight loss, fat loss, reduced fasting blood glucose and hemoglobin A1c, and improved blood lipid markers (2,3); although in some cases glucose tolerance was reduced and results were variable (3). So, is the state of ketogenesis magical? Does it have unique properties that melt weight and fat away? First, let me explain, albeit briefly and simply, what happens in the body when we eat food, and (beyond fasting) how a ketogenic state is produced in our bodies:
I hope from this you can see that physiological ketosis is actually a naturally produced state in the body; a built-in backup mechanism to keep us alive in times of food/fuel scarcity. It can be an intentional dietary intervention, yes, but it can also be induced in everyday situations such as during sleep (in some individuals), and after a period of intensive exercise (if glycogen stores are depleted) (5). But just because we can use ketones as fuel, does it mean we should...keep our bodies in ketosis...perpetually? Ultimately it comes down to considering your health goals and what works best for you. For managing a debilitating chronic health condition, like medication-resistant epilepsy, keeping the body in ketosis may be a more long-term endeavor that requires medical supervision. For general health and the desire to shed 10 or 15 pounds, it may not be necessary, and may even induce some unintended negative consequences (e.g., beyond the brain and red blood cells, glucose is required to convert thyroid hormone into its active form). Even experts who advocate a ketogenic approach suggest that there are many individual considerations that will determine if and how it can support you. For example, Leanne Vogel, author of The Keto Diet: The Complete Guide to a High Fat Diet, describes how when she tried to apply a ketogenic diet as classically described, she would engage in binge episodes; however, she found that these binges actually lead to improvements in body composition, leading her to incorporate what she calls “carb-ups”: meals where dietary carbohydrates are increased and dietary fat decreased (6). She shares that she has found that with women in particular, as well as those who are dealing with thyroid and other hormone imbalances, adrenal fatigue, stress, anxiety, and menstrual irregularities, and weight loss plateaus, incorporating some carbohydrate may be beneficial (6). How much, and what kind is also a journey of self-discovery, and if you are intent on keeping the body in a ketogenic state for therapeutic or other reasons, testing via a blood ketone glucose meter maybe a helpful resource in determining this, at least initially. While I support individuals becoming educated on the ever-changing health trends, and remaining an active participant in their health care journey, I also see the contagion of fads and the desire for one thing to fix everything. And for most people, a ketogenic diet, and in fact, no diet, is that one magic pill. Personally, I the view of author of The Primal Blueprint, Mark Sisson, who says, “ketosis isn’t magic- it doesn’t melt away body fat. Instead, it works for many of the same reasons a standard low-carb Primal way of eating works: by reducing insulin, increasing mobilization of stored body fat, and decreasing appetite” (5). In fact, he discusses the idea of finding a zone, or a range of carbohydrate that works best for you as an individual, a range that can vary greatly (e.g. from 20-120 g of daily carbohydrate, and for some, even more). He also says that (of course in “healthy” individuals), once our bodies are off of the blood sugar rollercoaster commonly seen in the Standard American Diet, by getting back to eating a variety of properly prepared whole foods, we can probably relax a little and just trust our bodies! When you’re craving more carbohydrates, eat them (and you’re body will use the glucose efficiently)! When you’re not, don’t ! When you are physically hungry, eat! When you’re not, don’t (and your body will use ketones)! Feels pretty...simple, right? It can be! Of course, it isn’t always. But when focusing on general health, energy, and vitality, eating whole foods prepared in a way that you enjoy and listening to your body can go a LONG way, in conjunction with proper rest, movement, stress coping strategies, and support systems. As ancestral diets from across the globe show us, health is dependent upon so much more than macronutrient ratios, which by the way vary widely, and include both high fat and high carb approaches (7)! This topic is, like many that spark controversy, big and complex. It is my hope that you come away feeling a bit more informed, and empowered to make the choices that will serve YOUR best health. Your partner in health advocacy, Jadi As always, if this topic sparked something for you, PLEASE, share about it in the comments below! If you're feeling lost on your own health journey, and you'd like to receive support, please contact jadiengels@gmail.com for more information. RESOURCES: 1. Wheless, J.W. (2004). History and Origin of the Ketogenic Diet. In C.E. Safstrom and J.M. Rho (Eds.), Epilepsy and the Ketogenic Diet (pp. 31-50). Totowa, NJ: Humana Press. 2. Paoli, A., Rubini, A., Volek, J.S., & Grimaldi, K.S. (2013). Beyond weight loss: a review of the therapeutic uses of a very low-carbohydrate-(ketogenic) diets. European Journal of Clinical Nutrition, 67(8), 789-796. doi: 10.1038/ejcn.2013.116 3. Ballantyne, S., Ph.D., & Minger, D. (2015). Ketogenic diet literature review. Retrieved from: https://www.thepaleomom.com/wp-content/uploads/2015/05/Ketogenic-Diet-Literature-Review.pdf 4. Huttenlocher, P.R., M.D., Wilbourn, A.J., M.D., & Signore, J.M., B.S. (1971). Medium-chain triglycerides as therapy for intractable childhood epilepsy. Neurology, 21(11). doi: https://doi.org/10.1212/WNL.21.11.1097 5. Sisson, M. (June 7, 2017). The Definitive Guide to Keto. Mark’s Daily Apple. Retrieved from: https://www.marksdailyapple.com/the-definitive-guide-to-keto/ 6. Vogel, L. (2017). The Keto Diet: The Complete Guide to A High-Fat Diet. Las Vegas, NV: Victory Bell Publishing Inc. 7. Kresser, C. (April 10, 2018). Why Quality Trumps Quantity When it Comes to Diet. Retrieved from: https://chriskresser.com/why-quality-trumps-quantity-when-it-comes-to-diet/ ***All of the information provided here is intended for informational purposes only; please consult with your health support team before making any diet and lifestyle changes. Over the past decade, with the rise in Positive Psychology as a field of study, gratitude has become an increasingly studied are of interest. Why? Well, proponents of gratitude have said that it can improve mood, health, comradery, relationship bonds, increase altruism, and potentially even part of a clinical intervention for depression! Gratitude has been on my radar for a few years now, and a practice I have incorporated into my life in varying levels of intensity. But recently, I saw a post where someone shared that their psoriasis had actually diminished and that they hadn’t had a flare in 6 months since picking up a daily gratitude practice! Wow! That’s powerful I thought, and away I went, diving into what research actually has to say about the positive, negative, and neutral when it comes to gratitude. DEFINING GRATITUDE:First, it is important to acknowledge that there is not one universally accepted definition of gratitude and this can cause some confusion in researching it. Is it an attitude? A personality trait? An emotion? A reaction to a kind act? A behavior? A coping mechanism? A life orientation? It has actually been studied as all of the above and is likely implicated in the variation in outcomes of studies exploring gratitude! To keep things broad at the beginning, let’s start where other reviewers of the literature have landed in saying, “Gratitude is a life orientation toward recognizing and appreciating the good; that is, a thankfulness for what is valuable and meaningful to you.” (Gratitude: Defined; Sansone & Sansone, 2010). In embodied practice, Dr. Robert Emmons (see What good is gratitude? Online Lecture), a leading expert on the topic, says that gratitude:
Sounds pretty powerful, right? But what does the available research actually say about gratitude when it comes to our health and wellbeing? Let’s take a look: Research on gratitude:Gratitude is consistently related to subjective/perceived well being and life satisfaction (Wood, Froh, & Geraghty, 2010; Sansone et al, 2010). As a construct, it appears to be related to but separate from similar markers of well being such as optimism and hope (Wood et al, 2010). It is (as we might expect) multifaceted, and includes aspects such as: individual differences in grateful affect, appreciation of others, a focus on what one has, feelings of awe in the presence of beauty, expressive behaviors, appreciation for the fact that life is short, a focus on the positive in the present moment, and positive social comparisons (Wood et al, 2010). One comprehensive review of the literature surmises that trait gratitude is made up of all of these factors, and the extent to which one experiences them with consistency, frequency, and intensity (Wood et al, 2010). This life orientation approach to understanding gratitude appears to account for the variety ways people recount experiencing it, not simply thankfulness for being on the receiving end of a favor, which, in fact, might actually detract from well-being by encouraging a feelings of indebtedness and an external orientation to life’s events. The available research on gratitude consistently links it with positive, adaptive personality traits, including: emotional warmth; greater openness to feelings, ideas, and values; altruism; dutifulness; and achievement striving, and inversely relates to anger, hostility, and depression (as defined by Costa & McCrae). As mentioned above, studies have consistently positively linked gratitude with subjective and psychological (eudaemonic) well being. Beyond individual wellbeing, a large and growing body of evidence suggests that gratitude is strongly related to the factors implicated in relationship development and maintenance (Wood et al, 2010). The relationship between health and gratitude is relatively understudied; yet the available research suggests that gratitude is related to decreased stress and may be especially important in sleep quality; both of which we KNOW are strongly implicated in health and thriving. In one study, gratitude was related to total sleep quality, duration, latency, subjective quality, and daytime dysfunction (Wood, Joseph, Lloyd, & Atkins, 2009). Each of the aforementioned were specifically linked to gratitude via pre-sleep thought patterns (i.e., pre-sleep positive thinking). In addition to these lifestyle factors, there appear to be many clinical implications. For example, one study (Kashdan, Uswatte,& Julian, 2006) examined gratitude in war veterans with and without PTSD. The results suggested that those experiencing PTSD had lower dispositional gratitude; and dispositional gratitude was significantly predictive of many aspects of well-being in those with PTSD over and above symptomatology and positive and negative affect. Additionally, in both groups, a daily practice of gratitude was uniquely related to each of the aspects of wellbeing measured. Many studies have examined these and similar constructs (e.g., thankfulness; eudaemonic wellbeing) in the context of epidemiological cohort studies and have found these traits to be predictive of significantly lower risk of depression, anxiety, and substance dependence and abuse later in life (Wood et al, 2010). Thus, gratitude as a life orientation and as a practice shows promise as an intervention for many clinical conditions, as well as a method of cultivating increased resiliency from them. Limitations to consider:Gratitude as a construct in wellbeing is again a relatively new topic of research; thus there is much room for further research and greater understanding. Currently, much of the research is observational (meaning we cannot draw causal conclusions) and cross-sectional (which only gives us a small snapshot of a particular population at one specific point in time). Gratitude shares a lot of overlap with other traits, although much of the research that has controlled for overlap shows that gratitude has a unique relationship with well being (e.g. above and beyond general positive affect). It is also unclear whether wellbeing causes gratitude or gratitude causes wellbeing; although here again, the experimental and longitudinal research that has explored this has demonstrated that it is gratitude that increases well being. Great, so if gratitude appears to increase wellbeing, both immediately and over time, and is positively implicated in relationships, health, and thriving, how do we cultivate it? Can we? What’s the best way? Let explore that! Gratitude interventions:There are a number of different ways to approach gratitude interventions, including:
Of these, daily gratitude lists are the most commonly reported in the literature, and appear to be comparable in effective as clinical interventions for certain conditions (e.g., body dissatisfaction; excessive worry), and with less attrition than traditional clinical interventions; they me also have a more lasting effect than other gratitude interventions (see Wood et al 2010). Grateful contemplation and writing and delivering a gratitude letter appear to have a more immediate positive effect on mood (see Wood et al 2010 for review). Their effectiveness must be tempered with the acknowledgement that many of these studies did not include a “true” control group (i.e., many of the control groups completed an activity that could have skewed the results in some way); yet, another review of the literature (Sansone et al 2010) cited a study where this was accounted for and the gratitude group showed increased well being as compared to the controls. So, to be clear, the research is a bit like braving the wilderness; there is still much to be discovered. Yet what is available suggests that gratitude is consistently positively linked with many aspects of well being, is readily applicable in simple but effective exercises like a gratitude list, and stands to foster greater positive affect, health, relationships, and resiliency, across many ages and groups in society. So, are there any groups for which gratitude could be counterproductive? Actually, yes!! And Final topic of discussion! When gratitude is counterproductive:As you might suspect, this section is brief, but I feel, equally important to cover. Gratitude can backfire when:
Alright, there you have it! The deep dive on gratitude! Now I’d LOVE to hear from you! PLEASE SHARE YOUR GRATITUDE AHA'S BELOW! If you’d like to receive my support, please reach out to jadiengels@gmail.com or we can chat by scheduling a free discovery call, HERE *The information on this website is intended for educational purposes only. Please consult with your health care team before making any lifestyle changes. RESOURCES:
EPISODE 2 is HERE!!
This week is a brief follow up to last week's deep dive! We discuss: "What if I KNOW my tolerance is LOW/sensitivity is HIGH, but I still want to drink caffeinated Coffee/Tea for PURE ENJOYMENT of it?" First, let me just say "YES!" to that. It's simply a CHOICE. There aren't RIGHT/WRONG's here. Simply making a CHOICE, feeling into it's after effect, and choosing again, in alignment with what is most important to us. And ENJOYMENT can be an IMPORTANT CHOICE! Here are the resources discussed: 1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5445139/ 2. https://www.thepaleomom.com/genes-know-caffeine-metabolism/ 3. https://chriskresser.com/all-about-coffee/ 4. https://blog.paleohacks.com/9-easy-ways-to-make-your-coffee-healthier/# 5. https://adrenalfatiguesolution.com/matcha-vs-coffee/ 6. https://adrenalfatigue.org/three-easy-and-inexpensive-ways-to-relieve-stress-that-actually-work/ Nervous system feeling depleted by stress? Would you like to receive support? Schedule a FREE discovery call with me: https://bit.ly/2kRWjgB *All of the information provided in this video is meant for educational purposes only; it is NOT meant to be a replacement or substitute for medical advice. Please consult with your practitioner before making any changes. Caffeine is the most widely consumed psychoactive substance in the world (1), whose rate is steadily increasing. According to one source (2), daily consumption has risen from 9% in 1999 to 41% in 2017- and that’s just in specialty coffee! More broadly, it is reported that over 85% of American adults consume caffeine daily, in the amount of 180 mg, which is akin to about two cups of coffee (1). So what’s the buzz? Is caffeine a productivity superpower or an adrenal draining ultra-drug? While many studies have been conducted on the benefits and health consequences of caffeine, the data remain inconclusive. How is this possible? Well, the effects of caffeine are HIGHLY individual, and depend on potential factors such as brain receptor sensitivity, and the presence or absence of certain genes and metabolic enzymes, which can be further influenced by certain medications, health conditions, and other lifestyle factors such as stress, gut health, and activity level! So let’s dive into the available research and information on caffeine, and empower YOU to determine your ideal caffeine intake. READY TO DIVE IN? Caffeine: the basicsCaffeine, or to be scientific, 1,3,7 trimethylxantine, is a naturally occurring substance found in coffee beans, tea leaves, the shrub seeds of yerba mate and gurana, the kola nut, and cocoa (3). In more recent years, it has increasingly been added artificially to foods, beverages, beauty products, and over-the-counter medications (1). It is most commonly ingested, and because it is both water and lipid soluble, it easily crosses the blood-brain barrier, is rapidly absorbed by the small intestine and can be found in most bodily fluids, including: saliva, semen, breast milk, amniotic fluid, and cerebrospinal fluid (1; 4). Most report feeling the effects of ingested caffeine within 10 minutes of consumption, with its peak effect of focus, concentration, alertness (and depending upon sensitivity, perhaps heart palpitations, breathlessness, and anxiety) occurring within 30 to 45 minutes (4). Caffeine is clinically recognized as an addictive substance (Kresser), with corresponding withdrawal symptoms (1). It is recommended that one wean down or off caffeine slowly over time if trying to decrease intake (e.g., 5; 6). While many feel and enjoy the “buzz” from consuming caffeine, purely defined, caffeine is not actually a stimulant. So how does it do what it does? Read on! Caffeine: molecular structureThe molecular structure of caffeine is quite similar to that of another neurotransmitter: adenosine. Adenosine concentrations parallel neuronal activity (i.e., the more neuronal activity the higher the concentration of adenosine) (7; 8). Once adenosine reaches a certain threshold, it will begin to bind with adenosine receptors, creating a calming, sleepiness effect. That is, unless caffeine comes in! Upon intake, caffeine will bind to the adenosine receptors, blocking the adenosine and thus its calming, sedative effects: vasodilation, lowered heart rate and blood pressure (8; 3). In fact, caffeine’s counteraction of vasoconstriction along with its anti-inflammatory properties is what makes it an effective addition to OTC and prescription pain medications (1). FUN FACT: - we have adenosine receptors NOT ONLY in the central and peripheral nervous system, but in various organs too (1)- including the kidneys and colon- when caffeine binds to these receptors it triggers the urge to use the restroom (4). Speaking of restroom- caffeine is a diuretic (it makes ya pee!), and this expedited passing of urine can also increase the release of vitamins and minerals from the body (e.g., potassium, magnesium, zinc, calcium, vitamin c, and the b vitamins) which can increase the risk of deficiency and related symptomatology (e.g, anxiety, panic, mood swings, and fatigue) (9). Caffeine has a half-life of approximately six hours (again, it depends on individual factors), which means it takes about six hours for the original concentration of caffeine in the body to reach half of that amount. This is one of the reasons people may reach for another cup throughout the day. This is ALSO why drinking caffeine late into the afternoon may be a hindrance to quality sleep later that evening! Ok, now that we’ve got the basics down, let’s dig deeper into the pro’s, con’s, and most importantly some of the individual factors to consider in your empowered choice to consume caffeine! Because if its popularity among consumer’s, many of us have already been exposed to the benefits of coffee and caffeine. For thoroughness, let’s briefly review: caffeine: potential benefits
While there appear to be beneficial relationships between caffeine consumption and reduced risk of decline and disease, the studies are often limited to being of an observational nature with specific population details and thus we cannot conclude causation (i.e., a direct effect) or generalize to all people (including ourselves!). There are also certain populations for whom the literature would suggest caffeine could be harmful. Let’s take a look: caffeine: potential risks
Ok, so there’s a snapshot of the big picture when it comes to current research on the benefits and potential harms in consuming caffeine. Feeling any closer to what’s best for you? If so, great! If not, I completely understand and my hope is that you feel more informed. Research in this fashion can give us an idea of TRENDS as well as potential benefits and harms in CERTAIN POPULATIONS that don’t readily generalize to us as individuals. So, what’s an Empowered Patient to do? Be aware of the research and become your own health detective! What I mean by that is, most likely, we will be best served by honing in on our own current health, lifestyle factors, and tolerance levels to determine the type and amount of caffeine that is best for us right now! Let’s take a look at tolerance and sensitivity: caffeine: Tolerance & sensitivityOn average, for “healthy” adults, a daily intake of 200-400 mg (i.e. two to four cups/day) is considered to be “safe” in that it is not associated with adverse health effects (1; 13). FUN FACT: according to one study (14), the heritability of coffee consumption is estimated to be 50%; there may be a small percentage of the population that carry a gene linked to higher caffeine intake with no adverse risks (i.e. caffeine hyposensitivity). On the other side of the spectrum, those with caffeine hypersensitivity may experience adverse effects after consuming only a relatively small amount (e.g., 30-50 mg or less) of caffeine. This reaction, which can include symptoms such as heart palpitations, sweating, jitteriness, increased anxiety, insomnia, muscle tension, restlessness, and blood sugar dysregulation (5; 9; 13) is separate from a caffeine allergy (which can be tested and diagnosed). The later is often more severe, and can include: sneezing, hives, itching and hoarseness of the throat, swelling of face, mouth, and throat, eczema, pain in the chest, hyperventilation, confusion, inability to focus, dizziness, mood swings, paranoia, and hallucinations (9). What are you gathering as you read this? Are you feeling like you have a pretty good idea of where you fall on the spectrum generally with caffeine tolerance? Keep in mind that life events such as periods of ongoing stress, chronic illness, HPA axis disregulation (i.e. adrenal fatigue), gut health issues, sleep deprivation, over-training, and the use of certain medications change that! In addition to lifestyle factors, there are certain genetic and metabolic factors that can influence our caffeine tolerance. Additionally, there are specific genetic and metabolic factors to consider: Caffeine: genetic & metabolic considerationsThe CYP1A2 is the gene that codes for the enzyme primarily responsible for metabolism of caffeine in the liver (1;5). This gene appears to have a large genetic variability (1;14); it is reported that approximately 50% of the population has a variant of the CYP1A2 that leads to slower metabolism of caffeine (5). It may be that those who feel hypersensitive to caffeine consumption produce less copies of the gene that clears caffeine from the system and therefore, experience heightened, prolonged, and adverse effects (5; 6; 8; 13), although some of the adverse effects have been reported in slow metabolizers (5). FUN FACT: the CYP1A2 gene is expressed in a circadian rhythm (and thus caffeine will have a different impact at different points in the day), and is the same enzyme that metabolizes steroid hormones (1). The impact is that steroid hormones SLOW the metabolism of caffeine; this is why the half-life of caffeine increases in pregnant women (up to 16 hrs longer!) and in women taking oral contraceptives (it tends to DOUBLE!). If you are interested in learning more about your genetic variations as they relate to caffeine consumption, there are tests available (i.e. 23andme). So we've taken a pretty extensive look at CAFFEINE... but what about those of us who know we are sensitive/prefer to consume DECAF? Here are just a FEW Things to consider: caffeine: decaf!If it is an issue of caffeine sensitivity, decaf may be the way to go (with approximately 2 mg per serving in coffee)- opt for Swiss-water-processed decaf if you can! Keep in mind, with coffee, that even decaf retains its diuretic properties, the proteins that often cross-react with gluten, and acids that can alter cortisol and thus blood sugar regulation (6). Again, this is not true for everyone, just data that can ground your own experience. Alright, that’s it for now! As you can see, there is A TON of available and sometimes conflicting information out there on caffeine and coffee consumption. As an Empowered Patient, it really comes down to awareness and paying attention to our own experience over time.
Now, I’d love to HEAR FROM YOU! How was your journey through this information? What did you learn? Are you a hyper-responder? Hypo-responder? Land somewhere in-between? What aspects are you most interested in? Have you taken genetic/other tests? Did you find them helpful/informative? How are you going to consume caffeine going forward? PLEASE SHARE YOUR COMMENTS BELOW!! Here to support you along the way! Your Health Advocate, Jadi P.S. If you have a question or would like a deep dive on a specific health/wellness topic and would like me to cover it in this series, please email me at : jadiengels@gmail.com |
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