Naturopathic Stress Management

I'm excited to be speaking at NSCC for their wellness day.

Since stress has the potential to negatively impact our health on so many levels, I thought it would be an important topic to discuss. Luckily, naturopathic medicine offers many options when it comes to managing stress.

Naturopathic Strategies for Stress Management 

What is stress?

Stress can be both positive and negative in nature, but either case, the way we respond to stressors both physically and emotionally can have a major impact on health. Finding ways to manage your stress is an important piece of any wellness plan. 

Physical stressors include dehydration, intense exercise, poor nutrition, lack of sleep - they can be considered stressors because of the way a body responds. All of those listed cause increase release of cortisol. Cortisol in the short term allows our bodies to adapt - some physical responses are increased heart and breathing rates, a heightened sense of awareness, dilated pupils. These responses prepare us for fight or flight (which come in very handy if you had to run from a lion or even with modern day triggers like giving a presentation). The problem with humans is that we often 'stress' over things that are not a direct threat. As explained by in 'Why Zebras Don't Get Ulcers', animals respond to stress when necessary but when the immediate stress is gone, they go back to calmly eating grass. 

Long-term stress can lead to many unwanted health concerns and has been associated with increased rates of heart disease and cancer, depression, anxiety, chronic pain, irritable bowel syndrome, and migraine headaches.

It is impossible and unwanted to completely eliminate stress, but finding strategies that help reduce the impact and eliminate unnecessary stress can be extremely beneficial.

Breathe and Meditate

Although an essential process for life, many of us do not know how to breathe and can learn to use our breath to positively influence our health and reduce stress. Breathing can be done in a formal setting such as a yoga class or while sitting in traffic or at your desk.

Many of the benefits of yoga are due to the focus on the breath. Yoga has been shown to modulate stress response systems resulting in lower heart rate and blood pressure.

A small but intriguing study characterized the effect of yoga on the stress response. In 2008, researchers at the University of Utah noted that people who have a poorly regulated response to stress are also more sensitive to pain. Using functional MRIs to monitor brain function, the researchers subjected participants to thumbnail pressure and found the lowest pain-related activity in yoga practitioners. 

Meditation is becoming increasingly popular as a way to moderate the impact of stress. Many people find that spending as little as 10 minutes a day in silence with their breathe has a positive impact on their ability to handle stress during the day. 

Naturopathic Rx: spend 10 minutes a day breathing. For more suggestions, see a handout called “Maintaining Life Balance” available at www.thepeartreeclinic.com.

2) Stay hydrated

Poor hydration is an immediate stressor that the body has many strategies to avoid (reduced urination, slowed breathing). Chronic low grade dehydration has been shown to cause fatigue, increased anxiety, and reduced cognitive function.

Water, like breathing, is essential for life - but expecting your body to run optimally on bare minimum is a lot to ask. You can make a huge difference in how you experience stress and recover from it by increasing your water intake. 

Naturopathic Rx: Aim for 1/2 of your body weight in ounces (180 pound person should drink 90 ounces of water, or about 11 cups). See my article on water for more detailed information on your body's signs for more water.

Some people are choosing flavoured water for the taste. The concern is that many of these waters are sweetened with sugar or artificial sweeteners. A better option is to flavour your own water. Soaking fruit overnight in a large pitcher and adding lemon juice and/or honey can add a ton of flavour and colour to make drinking water a bit more interesting. Cube or puree the fruit and herbs and soak 8-12 hrs refrigerated. Strain if desired before drinking. Try these combos: watermelon and mint, cucumber and basil, strawberry and lime.

3) Sleep

Getting enough sleep goes a long way at reducing the impact of stress and improving our response to it. Step one is to give yourself enough time - aim for 8 hours of sleep during a 24 hours period. 

Naturopathic Rx: If you find yourself having a hard time falling or staying asleep, consult your naturopathic doctor for sleep support such as acupuncture, melatonin, or sedating herbs such as valerian. 

4) Herbal Medicine 

Herbs are amazing, especially when it comes to support our stress glands, aka adrenals. Many herbs can be chosen based on their ability to increase or decrease cortisol levels, depending on a person’s needs. Known as “adaptogens” herbs such as eleutherococcus, licorice root, and rhodiola can do wonders at improving the body’s response to stress in the both the short and long term.

5) Exercise

Much research has shown the positive benefits of exercise. Regular exercise causes a release in endorphins, increases energy, improves sleep, lowers cortisol levels, and is an effective tool to manage depression and anxiety.

Naturopathic Rx: 30 minutes 5x/week of movement  

6) Work towards a positive outlook and self-compassion

"Without self-love, you cannot see your true self in the mirror and accept yourself as worth loving; you only see what's wrong.". B. Siegel, MD

Naturopathic Rx: Suggested Resources

Brene Brown

Book: “The Gifts of Imperfection: Let Go of Who You Think You’re Supposed to Be and Embrace Who You Are”

TED Talks: http://www.ted.com/talks/brene_brown_on_vulnerability.html

Dr. Gabor Maté, MD

Book: “When The Body Says No”

Bernie Siegel 

Book: “The Art of Healing”

Robert Sapolsky

Book: “Why Zebras Don’t Get Ulcers”

National Geographic Special: Stress, Portrait of a Killer 

Much of our response to stress is perception - working on a positive outlook and using healthy coping strategies to manage stress can make a huge difference in how your mind and body react to stress.

Rethinking Stomach Acid - A Naturopathic Approach to Digestive Health

"I am convinced that digestion is the great secret of life." Sidney Smith

With so many people taking acid inhibitors for digestive concerns such as reflux and heartburn, it's no wonder we've come to associate these health problems with too much stomach acid.

Generally however, most people do not produce enough stomach acid and the fact is stomach acid is essential to our digestion and therefore to our health.

Production of stomach acid, aka hydrochloric acid, decreases with age and as many as 8 in 10 adults over 60 have deficient levels. Other causes of low levels include antacid use, stress, infections, and long term vegetarian diets.

Optimal levels of stomach acid are determined using a tool know as the pH scale. This scale ranges from 0 to 14 with the more acidic substances landing lower on the scale (vinegar, lemon juice) and the more alkaline on the higher end (baking soda). A measurement of 7 is considered to be neutral. The ideal stomach environment functions at a pH of 2. Anything above 4 indicates low acid levels and can have serious health complications as a result.

Although not an enzyme itself, hydrochloric acid in the stomach acts as the signal for the release of all other digestive enzymes. In other words, stomach acid doesn't actually do any digesting but creates the optimal environment for the enzymes to do their work.

Symptoms of low stomach acid, or hypochlorhydria, include acid reflux, frequent belching after meals, indigestion, feeling of fullness, gas, constipation, diarrhea, undigested food in stool, and food sensitivities. Long term complications of hypochlorhydria can contribute to nutritional deficiencies, digestive disturbances, and gastrointestinal infections.

Testing

There are a number of tests available to determine your stomach acid levels.

Heidelberg - a state of here art test that involves swallowing a pH sensitive capsule which then transmits information about the stomach environment. The information is printed on a graph and it the gold standard for assessing acid levels.

Baking soda test - although the validity of this test is not supported by research, it can be worth a try, inexpensive, and done at home. Mix one quarter teaspoon of baking soda in a small glass of cold water and drink first thing in the morning before food. Time how long it takes before you burp. If you burp within the first 2 minutes, your levels are likely adequate. Anything between 2-5 minutes suggests low levels and more than five minutes suggests very low levels. It's a good idea to repeat this test three mornings in a row to get an average result and also to repeat after treatment to assess improvement.

HCL challenge - although not completely fool proof, taking a capsule of Betaine HCL midway thru a meal can help identify if your stomach acid levels are adequate or not. Any warmth or discomfort after the meal indicates your acid levels are sufficient. If you do not feel any differently, take 2 capsules at your next meal. Continue increasing with each meal until you feel warmth or reach 5 capsules with one meal. If you get up to 4 or more capsules without any signs of warmth or burning, it is likely that you have very low levels of stomach acid.

Naturopathic Solutions

Nutrition

• Apple cider vinegar with meals. To stimulate an optimal pH during digestion and improve overall function of the system, add 1-2 tablespoons of ACV to 1/4 cup room temperature water and drink before your meal.
• Whole foods diet. To get the most nutritional value from your food, avoid processed and refined foods that are nutrient depleted. Instead, choose foods that are easy to digest and nutrient dense. Consider smoothies, fresh juices, puréed vegetables and soups, and steamed vegetables.
• Identify and avoid food sensitivities. Food sensitivities can both be caused by and be the cause of low stomach acid. When proteins that would normally be digested pass thru a low stomach acid environment into the intestines, they create inflammation and trigger immune reactions. Continuing to consume these food triggers damages the lining of the digestive tract, impairing its ability to produce appropriate enzymes.  It becomes a viscous cycle. Food sensitivity testing is available at The Pear Tree and can identify foods that otherwise may be missed and continue to cause problems. Although challenging to follow, an elimination diet can also be an effective tool to identify food triggers.
• Fermented Foods. A source of probiotics, friendly gut bacteria, fermented foods support digestive function in many ways. Examples include raw sauerkraut, kombucha, miso, and kefir.

Lifestyle

• Chew. This may seem like a simple and obvious strategy, but many of us do not take full advantage of our mouths as part of the digestive process. Teeth and tongue help to breakdown food into smaller, more manageable food pieces. Keeping food in our mouths a little longer while chewing also exposes the food to enzymes in our saliva. It is a conscious effort to chew and ideally food should be chewed until almost in a liquid form (about 30 times per bite). Effectively chewing your food will help your entire digestive system work more effectively.
• Eat when relaxed. When we are rushed or feeling stressed, blood is diverted away from our digestive organs. We also have a stronger tendency to gobble down our food rather than chew it. Schedule time to eat and avoid eating on the run.
• Manage stress levels. Stress depletes digestive function. Manage your stress with healthy strategies such as yoga, meditation, counselling, journaling, and breathing exercises.
• Avoid consuming all your liquids with meals. Drinking larger amounts of water and other liquids with your meals dilutes stomach enzymes. Adding lemon juice or apple cider vinegar to your water helps reduce the impact, however a positive health strategy is to drink most of your daily fluid intake between meals.

Herbs

• Bitters. Various herbs support digestion. By stimulating the release of stomach acid, adequate bile flow and pancreatic enzymes, bitters such as gentian, dandelion, and rhubarb are especially helpful. Speak to your naturopathic doctor for appropriate dosing options.
• Demulcents. If there's been damage to the digestive tract from situations related to low stomach acid, such as reflux or food sensitivities, demulcent herbs may be useful. Demulcents are soothing and healing to the lining of the digestive tract. Aloe Vera can be very soothing for an irritated digestive tract. If you've experienced reflux or heartburn as a result of low stomach acid, Aloe Vera juice on an empty stomach will help reduce inflammation and soothe damage. Other options with similar effects are also available, including licorice root and slippery elm. Consult your naturopathic doctor to determine a herbal solution ideal for your health concerns.

Supplements

• Betaine HCL and Digestive Enzymes. There are cases which benefit from enzymes and hydrochloric acid in capsule form. These supplements provide the necessary amounts of hydrochloric acid and enzymes such as bile, pepsin, lipase, and amylase to support the digestive process. It is important to consult with a naturopathic doctor to ensure you are taking therapeutic doses. It is possible to take too much hydrochloric acid in supplement form and it is not recommended in cases of active ulcers or if you are taking anti inflammatory medications such as corticosteroids, aspirin, or ibuprofen which damage the protective lining of the stomach wall.
• Probiotics. Balancing the bacteria in your digestive tract leads to many positive health benefits. Although fermented foods are great sources of probiotics, occasionally higher doses are needed to rebalance the flora.
• Replace deficiencies. B vitamins, omega 3, fat soluble vitamins (A, D, E, K), minerals (iron, zinc, calcium) and other nutrient deficiencies are common in cases of low stomach acid. If stomach acid has been inadequate for some time, multiple nutritional deficiencies are likely. Blood and hair analysis tests are options which help determine nutritional status and if supplementation is necessary. These tests are available at The Pear Tree. It may be helpful to take a supplement to boost levels before maintaining with diet alone.

Conclusion

Although acid-reducing medications are a common recommendation to address digestive issues, adequate stomach acid levels are necessary for digestive health. Optimal digestion occurs when the stomach environment is at a highly acidic pH of 2. A more comprehensive approach to digestive concerns is to identify and treat the root cause. Often, this means supporting rather than suppressing your body's natural tendencies.

Healthy Bones

Healthy Bones with Naturopathic Medicine

According to The Osteoporosis Canada website, fractures from osteoporosis are more common than heart attack, stroke and breast cancer combined and consume more hospital beds than stroke, diabetes, or heart attack.

Osteoporosis can happen in both men and women, however women during menopause are particularly prone to bone loss. This is due to a decline in estrogen levels. As many as 50% of women and 25% of men over the age of 50 will have an osteoporosis-related fracture. It is estimated that almost 2 million Canadians have osteoporosis.

Osteoporosis is a common bone disease in North Americans that can be defined as a state of decreased bone mass. Since this correlates with bone strength, a low bone mass leads to increased fragility of the bone tissue and consequently an increased risk of fracture.

There are a number of factors that can contribute to the development of osteoporosis. Review the checklist below to note identify your level of risk:

o   Family history. Osteoporosis does tend to run in families. Although you may have an increased risk, there is an exciting field of medicine called epigenetics that studies our genes and the lifestyle components that determine whether or not these genes get “turned on” or activated. We can and do have some control over our DNA.

o   As mentioned, women more frequently suffer from osteoporosis than men, but both sexes are susceptible.

o   Poor lifestyle choices, including a diet high in refined and process foods, low physical activity, and excessive soda consumption. Bone mass peaks around the age of 30, so habits of our youth can increase our risk of osteoporosis.

o   Many over-the-counter and prescription drugs, particularly steroids.

o   Imbalance/low sex hormones – especially estrogen. This is the reason why menopausal women are at an increased risk, but deficiencies in these hormones can occur thru-out the life cycle.

o   Thyroid disease

o   Nutritional deficiencies. Deficiencies can occur due to low intake of nutrient dense foods or due to gastrointestinal diseases that interfere with absorption (such as celiac disease, food sensitivities, and inflammatory bowel disease).

o   Low vitamin D

o   55 + years old (although it can occur at any age).

o   Tobacco smoking.

o   Excess alcohol consumption (greater than three units/day).

One concern with the high rate of fractures is that osteoporosis is a “silent disease” and until a fracture occurs, often goes undiagnosed. Having the appropriate testing to assess the stage of bone loss will assist with developing an appropriate treatment plan.

Lab Tests

DEXA Scan

A bone mineral density test, such as a dual-energy x-ray absorptiometry (DEXA) scan, evaluates the stage of bone loss by assigning a T-score. A score of -2.5 is diagnostic for osteoporosis. Although not a good measure of actual fracture risk, DEHA scans provide a necessary piece of information, which you can discuss with your naturopathic doctor.

Serum Vitamin D (25-OH)

Low vitamin D is a major contributor to poor bone health. Optimal levels help prevent bone loss and stimulate new bone. Having a blood test helps determine the need and appropriate dosing. Other nutritional tests may also be useful, including hormone levels, iron & B12, thyroid function, and inflammatory markers.

How Naturopathic Medicine can Help

There are a number of naturopathic strategies to reduce your risk of osteoporosis and improve overall bone health.

Nutrition

A diet rich in whole foods is protective against most disease, including osteoporosis. Ensuring 4-6 servings a day of vegetables will help provide a wide array of necessary vitamins and minerals to support bone health. Avoiding foods that are processed and refined will also reduce the acidity of your diet. A diet that has an imbalance in acid/alkaline will leach minerals from the bones, leading to osteoporosis. Acid forming foods and high sodium foods include soda pop, sugar, processed meats, chips, and crackers. Most fruits and vegetables help alkalize the diet and support healthy bones.

Inflammation plays a critical role in bone health. Ensuring you have enough omega 3 in your diet helps reduce overall inflammation and promotes healthy bones. Rich omega 3 foods include wild fish, sardines, flaxseeds, walnuts, and hemp. Occasionally, when food is not enough, a supplement may be warranted. Consult your naturopathic doctor for a tailored suggestion to meet your needs.

Exercise

Exercise has been shown to significantly reduce the risk of osteoporosis by stimulating the bone forming cells known as osteoblasts. It is ideal to have a mix of aerobic and weight bearing exercises – such things as walking, playing sports, snowshoeing, dancing, and aerobic step classes provide both. Ideally, aim for 30 minutes or more of movement daily.

Supplements

Depending on your deficiencies and risk factors, supplements may be necessary to get the best results for your bones. Calcium, Vitamin D, Magnesium, Boron, and Vitamin K are all necessary components for healthy bones. Part of a supplement plan may include digestive support, if necessary. Enzymes and probiotics are necessary to ensure proper absorption and utilization of the bone building supplements. 

Work with your naturopathic doctor to assess and reduce your risk factors. Your ND can develop a medical plan that will address you needs to help prevent and treat osteoporosis for optimal bone health at any age.