​Imagine standing in the grocery store aisle, staring at a colorful package of your favorite snack: a bag of chips or a box of cookies that’s been your go-to comfort for years. But lately, you’ve heard a lot about “ultra-processed foods” and how they might not be the best for you. Your mind starts racing, Is this bad? Should I avoid it? and suddenly, what used to be a simple joy feels heavy with guilt. Sound familiar? If you’ve ever struggled with a difficult relationship with food or are recovering from an eating disorder, moments like this can feel especially overwhelming. I have been there too. But here is the thing: food isn’t the enemy, and neither are you. So, let’s take a deep breath and unpack this together.

The food label is a maze of numbers and words and can be complicated and stressful for anyone to navigate, but especially those who might be dealing with an eating disorder or a difficult relationship with food. Is this okay to eat? Am I making the right choice? If you have ever felt this way, you are not alone and you are in the right place. This blog won’t be a lecture or a list of rules. We’re here to have a conversation about finding a kinder, gentler way to navigate food choices, especially when it comes to ultra-processed foods and those tricky labels.

Ultra-processed foods (UPFs) are food and drink products that are mostly or entirely made from ingredients that come from food but are not whole foods themselves. Instead of using fresh or simple ingredients, these foods are typically produced using ingredients like refined oils, sugars, fats, and starches. They also often include additives like artificial colors, flavors, stabilizers, and emulsifiers to make them taste, look, or feel more appealing(1,2). Think of snacks, sodas, packaged baked goods, and ready-to-eat meals foods that usually don’t look like anything you would make from scratch at home(1,3,4,5).

UPFs are designed for convenience, attractiveness, and accessibility(6,7). However, these foods are often characterized by high added sugar, saturated fat, and sodium content, while fiber, protein, and micronutrient content tends to be low. The high palatability, convenience, shelf-stability, and aggressive marketing of UPFs have contributed to their widespread consumption among children and adolescents(6,7,8,9).

Many UPFs do have more sugar, salt, fats, and undesirable food additives, but here’s a truth worth holding onto: they’re not inherently “bad.” In some cases, they can be nutritious, quick, affordable, or even a source of joy or comfort. For example, some whole wheat breads, most plant-based milks, granola bars, and flavored Greek yogurts found in superstores/groceries can technically be labeled UPFs due to the additives and preservatives they contain, yet some of them can also be nutrient-dense choices, as well. Healthy eating isn’t about banishing these foods from your life; it’s about finding balance in a way that feels good for you and learning what feels good for your body.

Instead of labeling foods as “good” or “bad,” try asking yourself a few gentle questions:

• How does this make me feel?
• Does it give me energy?
• Does it bring me a little happiness?

Your answers matter more than any food rule ever could. And if that bag of chips brings you joy, it has a place in your story.

Now, let’s talk about those food labels. Imagine them as a friendly guide, not a stern judge. Here’s how you can approach them with curiosity instead of fear:

• The Ingredients List: Think of this as a peek behind the curtain. Ingredients are listed from most to least, so you can see what’s playing the lead role. If it is a UPF, you might spot some unfamiliar additives that are not readily available in the regular kitchen, but don’t panic. This isn’t about judgment; it’s about getting to know your food a little better.
• Nutrition Facts: These include information on calories, macronutrients, and vitamins. But if numbers feel overwhelming or triggering, permit yourself to skip them. Focus on how the food feels in your body. Does it satisfy you? Does it spark a little joy? That’s the real treasure.
• Health Claims: Phrases like “low-fat,” “all-natural,” or “zero-sugar” are regulated by the FDA and must meet specific criteria but that doesn’t always mean the product is as healthy as it sounds. These claims can be used as marketing tools and may give a false sense of health. That’s why it’s important to look beyond the buzzwords and check the ingredient list and nutrition facts panel for the full picture. Trust your instincts over the hype. You know your body and your needs better than any label does.  

Sometimes, you just need that quick snack or frozen meal, and that’s perfectly valid. Again, healthy eating isn’t about cutting things out, it’s about adding in what makes you feel good. Here’s how you can embrace these foods with a little extra love:

• Add, Don’t Subtract: Instead of worrying about what to avoid, think about what you can add. Pair your favorite snack with a juicy piece of fruit or a handful of nuts. It’s about nourishment, not restriction.
• Savor the Moment: When you eat, take a second to slow down. Notice the flavors, the crunch, the way it makes you feel. This isn’t about control; it’s about enjoying the experience.
• Celebrate the Wins: Tried a new food? Swapped a soda for water or added a veggie to your plate? Those are big steps worth cheering for. No win is too small.

For anyone with an eating disorder, food labels can feel like a battlefield. Here’s a fresh way to look at them:

• Curiosity Over Criticism: Approach labels with wonder, not worry. What’s in here? How could this fit into my day? There’s no wrong choice, just information to explore.
• Focus on Feeling Good: If certain ingredients leave you feeling energized and content, that’s wonderful! If not, that’s okay too. Your body is unique, and it deserves to be heard.
• Let Go of Perfection: You don’t need to decode every label or eat “perfectly.” Recovery is about progress, not perfection. Be gentle with yourself along the way.

Here’s the heart of it: food isn’t your foe, it’s a source of energy, joy, and connection. UPFs and food labels are just part of today’s food landscape, but they don’t have to control your story. By approaching them with curiosity, kindness, and a focus on what feels right for you, you’re reclaiming your power and making choices that lift you up.

Have you found a way to make peace with food labels or ultra-processed foods? Share your story in the comments below. Your journey could be the light someone else needs. And if you’re looking for more support, join our community of folks navigating recovery with heart and hope.
 
References:
1. Monteiro, C. A., Cannon, G., Moubarac, J.-C., Levy, R. B., Louzada, M. L. C., & Jaime, P. C. (2018). The UN Decade of Nutrition, the NOVA food classification and the trouble with ultra-processing. Public Health Nutrition, 21(1), 5–17. https://doi.org/10.1017/S1368980017000234
2. Monteiro, C. A., Cannon, G., Levy, R. B., Moubarac, J.-C., Louzada, M. L., Rauber, F., Khandpur, N., Cediel, G., Neri, D., Martinez-Steele, E., Baraldi, L. G., & Jaime, P. C. (2019). Ultra-processed foods: What they are and how to identify them. Public Health Nutrition, 22(5), 936–941. https://doi.org/10.1017/S1368980018003762
3. Louzada, M. L. da C., Ricardo, C. Z., Steele, E. M., Levy, R. B., Cannon, G., & Monteiro, C. A. (2018). The share of ultra-processed foods determines the overall nutritional quality of diets in Brazil. Public Health Nutrition, 21(1), 94–102. https://doi.org/10.1017/S1368980017001434
4. Martini, D., Godos, J., Bonaccio, M., Vitaglione, P., & Grosso, G. (2021). Ultra-Processed Foods and Nutritional Dietary Profile: A Meta-Analysis of Nationally Representative Samples. Nutrients, 13(10). cmedm. https://doi.org/10.3390/nu13103390
5. Monteiro. (2009). Nutrition and health. The issue is not food, nor nutrients, so much as processing. Public Health Nutrition, 12(5), 729–731. https://doi.org/10.1017/S1368980009005291
6. Monteiro, C. A. (2009). Nutrition and health. The issue is not food, nor nutrients, so much as processing. Public Health Nutrition, 12(5), 729-731.
7. Monteiro, Cannon, G., Levy, R., Moubarac, J.-C., Jaime, P., Martins, A. P., Canella, D., Louzada, M., & Parra, D. (2016). NOVA. The star shines bright. World Nutrition, 7(1–3), Article 1–3.
8. Moubarac, J.-C., Martins, A. P. B., Claro, R. M., Levy, R. B., Cannon, G., & Monteiro, C. A. (2013). Consumption of ultra-processed foods and likely impact on human health. Evidence from Canada. Public Health Nutrition, 16(12), 2240–2248. https://doi.org/10.1017/S1368980012005009
9. Norman. (2016). The Impact of Marketing and Advertising on Food Behaviours: Evaluating the Evidence for a Causal Relationship. Current Nutrition Reports. https://link.springer.com/article/10.1007/s13668-016-0166-6

Ingredients
8 oz uncooked pasta (such as Barilla Protein Plus angel hair pasta or chickpea thin spaghetti)
1 pound leftover cooked salmon, flaked into 1-inch pieces
Salt and pepper (to taste)
1 Tbsp olive oil
1 Tbsp butter
1 red or yellow bell pepper
1 shallot, chopped
1 lb asparagus, trimmed and chopped into 1-inch pieces
2 cloves garlic, crushed and minced
Several handfuls of organic baby spinach, roughly chopped
8 oz cherry tomatoes, halved
1/3 cup pesto
Grated parmesan cheese (optional topping)
Freshly squeezed lemon juice (optional topping – skip if your pesto already has lemon in it!)
 
Directions

1. Boil a salted pot of water for your pasta and cook it al dente according to package directions.
2. Heat olive oil and butter in a large pan over medium heat. Add bell pepper, shallot, and asparagus and cook, stirring frequently to prevent burning. Season with salt and pepper.
3. Add garlic, spinach, cherry tomatoes, and cooked salmon. Cook until garlic is fragrant and spinach is just wilted.
4. Add cooked and drained pasta and pesto; toss everything together and add more pesto if needed to coat everything.
5. Serve topped with parmesan cheese and lemon juice (if desired). Enjoy!

Want more recipes like this, with functional ingredients for brain and mental health? I have a whole 7-day meal plan included in my nutrition for depression course, complete with recipes that I love. Check out the full course and watch the first module for free here.

Stress hormones
The stress hormones include epinephrine (AKA adrenaline), norepinephrine (AKA noradrenaline), and cortisol. All three of these hormones are present in low, stable levels in your body all the time to do things like keep you awake when you're supposed to be awake and keep your blood pressure from bottoming out. When you're stressed, if things are functioning as they should be, levels ramp up, and then ease back down when the stressor is gone. 

But we see problems with mood and depression whether levels of these stress hormones are high or low. Often, it's a problem of balance--levels of cortisol being chronically high instead of coming down after the stress passes, or levels being chronically low because of long-term traumatic stress exposure. 

Sex hormones
Testosterone in men and estrogen in women play significant roles in stabilizing serotonin levels. When estrogen levels fluctuate during the menstrual cycle, menopause, or around pregnancy and childbirth, serotonin levels can go wonky, too. Testosterone seems to play a similar role in men of regulating serotonin levels.

Thyroid hormones
The thyroid gland is one of the first places to look when depression is present--not because it's always the trigger, but because when it is, it's vital to treat. Plus, it's a simple blood test that can be ordered by just about any primary care provider or functional dietitian. 

When the thyroid gland isn't functioning optimally and becomes underactive (AKA hypothyroidism), fatigue, lethargy, and depression are some of the primary symptoms. Individuals with hyperactive thyroid (AKA hyperthyroidism) can also see some major mood impacts, as well, including anxiety, insomnia, irritability, and sometimes depression, as well.

Sleep hormone
The major hormone involved in sleep, melatonin, is one that many of us know well. But did you know that it is also implicated in depression? Melatonin levels tend to be imbalanced in many people with depression, and with the prevalence of sleep disturbances in depression, this makes perfect sense. Many factors can lead to a melatonin dysfunction, but getting back into alignment with your circadian rhythm is a vital piece of restoring proper melatonin balance.

Hormone health
All of these hormones are vital in mental health, and all of them are impacted by how well you nourish your body and the self-care habits you put in place. This means that over time, making small changes like practicing better sleep hygiene, learning specific, practical tools to manage stress levels and complete the stress cycle, moving your body gently (not excessively), eating more nourishing, colorful plant foods, repairing protein, and omega-3 fatty acids, and replenishing any nutrient deficiencies can help to improve hormone health.

Hormones can be slow to change, and certainly other co-existing diseases and genetic factors can get in the way. But in general, even though these are things happening deep inside your body and outside of your direct control, there are ways that you can have a real impact on your hormone health through your nutrition and lifestyle.

Want to learn more about hormone health and depression? Check out my brand-new course Nourish Your Mind depression course for a super-deep dive into this and many other related topics relevant to living life with depression.

If you want to walk through personalized nutritional strategies for mental health with me, I'm currently accepting new patients. You can send me a message or schedule a discovery call with me to learn more.

Today, I want to share something really simple: my favorite granola recipe. 

I've always loved cereal, but honestly, it's hard to find cereal that is actually nutrient-dense. Most cereal options don't contain much protein, are way too high in added sugar, and don't give enough healthy fats or fiber to keep you satisfied and keep your blood sugar stable for long.

When I first started my own journey of buying less processed foods and making more from scratch, cereal was one of the things I knew I'd have to tackle! I've been making and tweaking this granola recipe for a couple years now, and trust me, it will be one of the most filling, satisfying, and nourishing things you've ever eaten for breakfast or for a snack.

I like to eat it with fresh berries and plain Greek yogurt, and pair it with quick egg scrambled with some greens. I hope you love it as much as I do!

Homemade Granola
Ingredients
3 cups rolled oats (preferably organic; gluten-free if necessary)
1 cup quinoa flakes*
1 ½ cups raw nuts (I like a combination of pepitas and pecans; walnuts, sliced almonds, or sunflower seeds would be great too!)
¾ tsp salt
1 tsp ground cinnamon
2 Tbsp hemp hearts
½ extra-virgin olive oil** (or melted coconut oil)
½ cup maple syrup or honey
1 tsp vanilla extract
¼ cup unsweetened coconut flakes (optional)
2/3 cup dried or freeze-dried fruit (optional) (I like tart cherries or freeze-dried strawberries)


Directions

1. Preheat oven to 350. Line a large baking sheet with parchment paper.
2. In a large mixing bowl, combine dry ingredients except dried fruit and coconut flakes. Then add the oil, honey, and vanilla, and mix well.
3. Pour the granola onto the pan and spread into an even layer.
4. Bake until lightly golden, 20-25 minutes, stirring half-way through baking (and adding coconut flakes, if using). 
5. Let cool undisturbed for at least 45 minutes, then break into pieces. Mix in dried or freeze-dried fruit if using immediately (within 1-2 weeks stored in an airtight container at room temperature); if freezing, leave the dried fruit un-mixed and just add it in as you eat it. I often leave the dried fruit out entirely and use fresh fruit instead.

Flavor options

• Chocolate Cherry Granola: add cacao nibs and use tart cherries for the fruit. 
• Tropical Granola: use dried pineapple for the dried fruit and don't skip the coconut!
• Peanut Butter Chocolate Granola: add cacao nibs after baking. Use raw peanuts for the nut, and add 1-2 Tablespoons of PB2 peanut butter powder. (I suggest skipping the cinnamon for this variation.) 
• Savory Granola: swap out the liquid sweetener for one egg white. Instead of the cinnamon and vanilla, add 1 Tbsp nutritional yeast, 1/2 tsp ground thyme, and 1/4 tsp each garlic and onion powder. Skip the coconut flakes and the fruit (obviously). I recommend sunflower seeds, cashews, and pumpkin seeds in this flavor variation. Use it as a crunchy topping on salads or soups, or just eat it by the handful!
• Low-FODMAP Granola: use walnuts, pecans, pepitas, or macadamia nuts for the raw nuts. Use maple syrup instead of honey. Use freeze-dried blueberries for the dried fruit (or serve with fresh blueberries). The recipe should be low-FODMAP at a standard 1/2 cup serving.

Notes
* Quinoa flakes: this is a great way to up the protein in your granola recipe. I find mine at Natural Grocers where I live, but it's available in the health foods section of many grocery stores. If you can't find it, you can always just substitute another cup of oats.
** Olive oil: yes, olive oil does bring with it some lovely savory flavor. If this bothers you, you can absolutely substitute melted coconut oil or another mild-tasting oil of choice. Personally, I use olive oil in all kinds of baking, both sweet and savory!

Affiliate links
I've provided links to some of my favorite products to use for this granola. These are all products that I personally use, love, and recommend as food-as-medicine to my patients. 

Recipe adapted from Cookie and Kate 

Enjoy, and let me know what you think and what creative flavor options you come up with!

If you're just joining us, I highly recommend you start by reading Part 1 and Part 2 before jumping back into this post!

If you've followed along with parts 1 and 2, let's recap: so far we've talked about what postpartum depression is, how it is impacted by lifestyle factors (like untreated mental illnesses in pregnancy, physical activity, sleep, social isolation, stress, and skin-to-skin care), how hormonal changes impact mood (including estrogen, progesterone, thyroid, and cortisol, all of which change dramatically during pregnancy and postpartum), and some of the nutritional factors at play (including omega-3s, vitamin D, choline, zinc, iron, and amino acids). 

Today, we're going to tackle one of the weirdest parts of the story--the gut microbiome--and something that comes up so often these days that you're probably actually sick of talking about it--inflammation.

And then, because this is going to be our last post in this series, we'll take a few moments to try to put it all together into a dietary pattern that you can actually follow. (Hint: it's about adding things, NOT about restricting.)

The gut microbiome
I’ve been nerding out on the gut microbiome for years now, and I’m constantly amazed by how much we’re learning about it and how much we really just don’t know about it. (If anyone tells you that they really understand the gut microbiome, they’re spinning a yarn.)

One thing that we do know is that it’s not static. It’s always changing and adjusting.

During pregnancy and in the postpartum period, recent research has found some interesting changes which may be linked to postpartum depression. Stress, changes in hormone levels, and changes in diet are just a few of the factors that might lead to changes in the gut microbiome, which in some cases could be substantial enough to create dysbiosis—an imbalance of healthy/harmless and pathogenic gut bugs. Dysbiosis, then, can lead to changes in the way that we process the nutrients we eat.

• For example, dysbiosis can change production of neurotransmitters like serotonin and melatonin.
• Dysbiosis can lead to increased inflammation, both in the gut itself and in the brain.
• We also know that the gut microbiome produces compounds called short-chain fatty acids when the microbes break down certain food components like fiber. Butyrate, for example, is an anti-inflammatory compound important to the health of our gut lining integrity. Some research suggests that having fewer butyrate-producing bacteria in our guts may be associated with more mental health symptoms like anxiety and depression.
• The gut microbiome also seems to play a regulatory role with adrenal function and cortisol, the stress hormone we discussed before. Dysbiosis could lead to overproduction or underproduction of cortisol, either of which could be detrimental to our mental health.
• And lastly, the gut microbiome plays a role in modulating estrogen and progesterone levels, which could be really helpful in that postpartum period of plummeting estrogen levels.

To treat an unhealthy or imbalanced gut microbiome postpartum, throwing probiotic supplements at the problem could be slightly helpful, but doesn’t have a ton of supportive evidence yet. On the other hand, eating a varied diet with lots of colorful plant foods and fibers to feed your gut bugs, and consuming probiotic foods such as kimchi, sauerkraut, kefir, natto, and tempeh, has a potential to benefit you even more broadly.

Inflammation and neuroinflammation (and gestational diabetes)
Let’s move on to talk about inflammation. It’s important to note that levels of inflammation fluctuate a LOT during pregnancy and in the early postpartum period. The first and second trimesters are largely anti-inflammatory, but then the third trimester, childbirth and early postpartum are generally pro-inflammatory.

While studies aren’t conclusive, there is some early evidence that postpartum depression, like certain forms of major depressive disorder, may be more likely to occur in individuals with higher levels of inflammation postpartum. If that does bear out, it makes a lot of sense that some of those anti-inflammatory nutrients we discussed before (like vitamin D, fish oil, and zinc) would be some of the most helpful nutritional interventions. It also brings the relationship between the gut microbiome and gastrointestinal inflammation into a new light, and sheds some light on the relationship between gestational diabetes and postpartum depression, as well.

Having gestational diabetes during pregnancy is linked to an increased risk of postpartum depression. At the same time, having a history of depression makes you more likely to experience gestational diabetes during pregnancy. These two conditions are very interrelated.

There are higher levels of inflammatory compounds in the blood of women with gestational diabetes. Plus, the abnormal processing of sugar that occurs in women with gestational diabetes can lead to elevated stress hormone levels and so to mood symptoms. All that on top of the sense of psychological stress that women may feel due to the pressures and challenges of dealing with a disease like gestational diabetes.

So if we use what we know about preventing gestational diabetes as a jumping-off point for preventing postpartum depression, how do we prevent and manage gestational diabetes?

• Lifestyle factors are certainly important, like quitting smoking and getting enough physical activity.
• Eating an anti-inflammatory, perhaps Mediterranean-style, low-glycemic index diet with lots of plants (fruits, vegetables, nuts, seeds, pulses, and healthful oils) and some carefully-selected animal foods.
• Preventing deficiencies (especially B12, folate, vitamin D, and iodine).
• Inositol, perhaps? Once known as vitamin B8, inositol was demoted from its status as a B vitamin once we discovered that our bodies produce it from glucose. It’s also widely available in food, as well as supplemental form. However, it is still hugely important in metabolic health and can help with hormone regulation and anxiety. When pregnant women eat low-fiber, plant-deficient diets, they’re also eating diets that are low in inositol. So this is perhaps yet another reason to eat more plants, to help boost inositol intake and improve glucose metabolism in the body. Studies looking at supplementing inositol have found some reduction in risk of gestational diabetes, especially for women in larger bodies.

Putting the pieces together
We’ve covered a lot of ground in this series of articles together, from gut health to inflammation to nutritional adequacy to hormones to lifestyle. So what kind of eating pattern would help us the most with all of these factors we’ve discussed?

The list is nothing earth-shattering:

• Vegetables,
• Fruit,
• Fish (especially cold-water, low-mercury fatty fish) and sea vegetables (and/or taking an EPA+DHA supplement),
• Eggs,
• Minimally processed meat,
• Nuts and seeds,
• Pulses (lentils, beans, peas),
• Whole grains,
• Olive oil (and perhaps other anti-inflammatory oils such as unadulterated avocado oil, minimally processed rapeseed oil, etc.),
• Fermented foods, including fermented vegetables/beans and fermented dairy (like yogurts and kefirs) if tolerated, and
• Spices and herbs.

Alongside this nutrient-dense and flavorful food, we’re aiming for a healthy and enjoyable relationship with our food, and focusing on rhythms rather than rules and restrictions. We’re aiming for a lifestyle that is active, but also well-rested (again, as much as is possible during these phases of life) and social support that helps us get time for self-care and nurturing relationships. These are, in many cases, the truly difficult things. I’m here to try to make the eating part as simple as possible—to support you as you work to support your body and mind with healing and nourishing food.

If you’ve learned something from this article series, I’d love to hear about it! If you’d like to learn more about working with me, click here for details and to book a free discovery call, or shoot me an email. 

This is Part 2 of my Nutrition and Postpartum Depression series. If you're just joining us, please start with Part 1 here!

In Part 1 of this series, we talked about what postpartum depression is and how it is impacted by lifestyle factors like untreated mental illnesses in pregnancy, physical activity, sleep, social isolation, stress, and skin-to-skin care.

Today, we're going to move on to talk about two other important factors: hormones and nutritional factors (including deficiencies and insufficiencies).

​Hormones
A woman’s hormones are constantly in flux, but there is nothing that changes them quite so dramatically and quickly as pregnancy and childbirth. Many different types of hormones are suspected to play a role here, from adrenal hormones (like cortisol) to placental hormones (like the estrogens and progesterone), thyroid hormones, and peptide hormones (like oxytocin and prolactin).

• Levels of the hormones estrogen and progesterone decrease suddenly and dramatically after childbirth. This by itself is linked to changes in mood because of the impacts on serotonin levels, and this is likely one of the causes of the Baby Blues. Estrogen and progesterone levels can take 3-12 months to return to normal after childbirth.
• Thyroid hormone levels increase during pregnancy, and then decrease following childbirth. Sometimes levels can decrease too much postpartum, which can lead to changes in mood, as well.
• Levels of cortisol, a primary stress hormone, are naturally higher in pregnant women, but should start to decrease gradually after childbirth. However, abnormal or excessively high cortisol levels can happen during pregnancy for some women, or can crop up in the postpartum period, maybe due to trauma, stress, sleeplessness—or maybe causing those things.

Hormone balancing is often going to take time, but a lot of the same lifestyle factors we discussed in the first post actually may be able to modify some of these hormone levels. Some important things to consider include:

• Gentle exercise,
• Stress reduction and adequate sleep,
• Keeping an eye on thyroid hormone levels (this is standard to check during pregnancy, but you might want to talk with your doctor about getting it checked if you are already postpartum).
• And consuming a varied diet with adequate levels of the nutrients we need to produce hormones, which we’ll address next.

Nutrients
Everyone is aware that nutrition is exceptionally important in pregnancy—but sometimes we focus on Baby’s nutritional needs (both during pregnancy and after birth) so much that we might forget about our own nutritional needs in the postpartum period.

Of course, if some women are not meeting their increased nutritional needs during pregnancy, they may have lingering deficiencies that persist into the postpartum period. But we also know that there are substantial changes that occur in mom’s nutrient status because of childbirth itself, the healing process, breastfeeding, stopping the prenatal vitamin (as many women do immediately after childbirth), and poorer dietary quality in the struggle that is postpartum life.

Some nutrients that I primarily focus on with my clients are:

• Omega-3s. You hear a lot about DHA, a specific type of omega-3 found in fish oil, during pregnancy because it’s vital for Baby’s brain development and mental health, and many women aren’t getting enough. Supplementing DHA is often necessary, especially when mamas have been told to avoid fish because of concerns about mercury. However, for mom, another type of omega-3 fatty acid called EPA might be missing if we’re just relying on DHA supplements for our omega-3s—and often, again, postpartum women stop these supplements altogether. Both EPA and DHA are important during pregnancy and postpartum, and EPA seems to be a standout nutrient when we’re thinking about preventing postpartum depression.
• Vitamin D. Vitamin D is an incredibly important vitamin and hormone in neurological and mental health. We know that one of the signs of vitamin D deficiency can be low mood, and we also know that it’s important in preventing neuroinflammation and supporting neuroplasticity, which is incredibly important in adjusting to postpartum life!
• Zinc. Higher zinc intake seems to buffer the effects of stress, and is also really helpful in managing the inflammation that happens postpartum!
• Choline. You may know that choline is vital for baby’s brain development, but it’s also essential for brain health in mom, as well. On a population scale, higher dietary choline intake is linked to a lower risk of depression, but we do need more research in pregnancy and postpartum. I don’t recommend going out and taking large doses of choline on a daily basis, but SO MANY women aren’t getting enough (some studies suggest 89% of pregnant women aren’t meeting their choline needs), so this is a really important nutrient for us to be aware of.
• Iron. Iron deficiency can cause symptoms of depression in anyone, and anemia both late in pregnancy and postpartum are associated with postpartum depression. However, if you’re already postpartum, this is one to ask your doctor or dietitian to test with a blood draw before starting a supplement, since overconsuming iron supplements can be problematic.
• Amino acids. Most people know that protein is important for their health and are trying to eat enough of it. However, many people on the Standard American Diet get their protein from lower-quality sources, such as high-fat processed meats and refined grains (which contain significantly less protein than whole grains). Add to that the fact that protein digestion and absorption can be impaired for all sorts of reasons, from gastrointestinal issues to acid-blocking medications to stress, not to mention increased protein needs for wound healing postpartum and possibly for lactation… and you can start to see why I do worry about amino acids, the building blocks of protein, in my clients’ diets. To give one important example, in the early postpartum period, there seems to be an especially high need for tryptophan and tyrosine, and if moms aren’t getting enough, it’s possible they may not make enough of certain mood-stabilizing neurotransmitters like serotonin and dopamine.

Obviously, there are a lot of factors to consider here. Diversity in the diet and a balanced, mindful lifestyle can make a big difference in both risk and ability to manage postpartum depression. But there are even MORE factors to consider here.

In our next post, we'll talk about the gut microbiome and inflammation, and how these two factors can play into postpartum depression--and then we'll try to wrap all these bits and pieces of information up into an actionable, doable package.

If you're comfortable sharing with this community, I'd love to hear from you in the comments. Have you ever struggled with postpartum depression, or are you struggling now? What was the most important step you took to help manage your symptoms? 

Postpartum depression is shockingly common for how infrequently it actually gets talked about. Sure, we’ve all done the screening questionnaires in the hospital, and those are very important. But many women are shamed into feeling that the way they feel is a sign that they are bad mothers or that something is wrong with their ability to love their babies.

But more than one in 10 women experience postpartum depression. It’s the most common postpartum mood disorder—and if you’re wondering why there even is a most common postpartum mood disorder, why this is such a sensitive time period in a woman’s life, I hope to partially answer that question in this series.

But also, along with telling you about why postpartum is SO HARD (you already knew it was, I’m just going to give you even more reasons why it’s hard), my goal is also to give you hope—that maybe there is more you can do about it, more that is actually within your locus of control, than you might have thought.

What is postpartum depression?
Postpartum depression is a depressive episode that occurs during pregnancy or within a year of giving birth. The symptoms in general are a lot like those of major depressive disorder (MDD), but these symptoms will look different, and perhaps in some cases more pronounced, because of the context in which they are occurring. Common symptoms include difficulty with self-care, changes in appetite, sleep, energy, motivation, and concentration, low self-esteem, guilt, and feelings of worthlessness. In some cases, women may also experience suicidal thoughts or thoughts of harming baby.​

Unlike the “baby blues” (which are experienced by up to 85% of women postpartum), postpartum depression is much more debilitating, lasts much longer, has a much more substantial impact on a woman’s ability to care for herself and for baby, and requires treatment. It’s so important that women recognize that care is available, and that they don’t have to “go it alone.”

Screening for postpartum depression
If you’re thinking that some of these symptoms sound familiar and want to dig a little deeper, a lot of physicians, psychologists, psychiatrists, and OB-GYNs use a screening form called the PHQ-9. You can take it on your own and bring it to your next appointment to discuss with your provider.

Why postpartum?
The period from conception to childbirth to the months following the birth (or loss) of a baby is filled with change—lifestyle changes, hormonal changes, inflammatory changes, dietary changes, and microbiome changes, just to name a few. This is an incredibly sensitive period in a woman’s life, including her physical, mental, and spiritual life.

Some of these factors are easy to understand but difficult to address. Some are difficult to understand in layman’s terms and still difficult to address. There’s nothing really easy about mental health in general. But we’ll start today by zooming in on some of the specifics, and then end by zooming out to what implementation of these specifics might look like in simple but broad sweeps.

In this series of articles, we’ll cover lifestyle factors, hormones, nutrients, inflammation, and the gut microbiome in a deep dive into preventing postpartum depression and promoting postpartum mental well-being.

Lifestyle factors
We’ll start with the lifestyle factors, because in some ways these are the most important—and in some ways also the most challenging to address.

• Untreated mental illness during pregnancy. Many women stop psychiatric medications when they become pregnant because of fear of the impact on Baby. While the impacts of many psychiatric medications in pregnancy aren’t completely understood, this is a really important conversation to have with a trained mental health professional such as a psychiatrist so that you can fully understand the risks and benefits involved. If you do choose to stop your meds, it’s vital that you replace the medication with something (therapy, for example). Allowing mental illness to go untreated during pregnancy and breastfeeding has the potential to cause much greater harm to both you and your baby over the long term.
• Physical activity! We also know that physical activity is incredibly important both during pregnancy and in the postpartum period, though of course tailoring exercise to your physical ability with an eye toward safety is of utmost importance. Most of all, just remembering the healing potential that movement has both physically and psychologically. There is a lot of very solid evidence that physical activity is protective against depression, and that it has powerful antidepressant effect! According to a 2023 review looking at exercise and mental health, pregnant and postpartum women were actually some of the groups to see the largest reduction in mental health symptoms from engaging in exercise. Higher intensity exercise seemed to have the greatest benefit for reducing depression and anxiety, but ALL types of physical activity were beneficial, including walking, Pilates and yoga (which are often great for some of the physical issues women are dealing with postpartum, as well).
• Sleep. Sleep is one of the most challenging areas to address, especially on your own. When you have a tiny baby who needs you constantly, you need support from others to be able to get rest. You need to feel safe, and you need to know that your rest is an absolute priority when it comes to your own health AND the health of your baby.
• Social isolation. We all know this is really difficult to avoid in the haze of postpartum life, but research shows that the more isolated a woman is postpartum, the higher her risk of postpartum depression. This is another thing that we obviously can’t do on our own—but if you feel that you don’t have the level of social support you need, during pregnancy is a great time to start seeking out support groups, cultivating friendships, and becoming part of a community.
• Stress. Stress obviously has a tendency to ramp up pretty dramatically in the period just before and for several months (or years) after the birth of a child. If you’re stressed, there’s nothing that stresses you out more than hearing that you need to stop being stressed because it’s harming your health. I plan to do a whole article on this in the future, but I want you to hear me for a moment on this here: stress is not always bad. You do not have to live a fully anxiety-free life in order to be healthy or even to prevent postpartum depression. Stress can actually be a remarkably positive thing when it has 1) a purpose and 2) an end. Like inflammation, when stress becomes chronic, generalized, and purposeless, that’s where it harms us. Do you know how to complete the stress cycle? To recognize when the purpose of a particular anxiety has passed, metabolize it, and get back to steady, calm, and stable?
• Skin-to-skin time with Baby. Thankfully, this is a much more common practice in hospitals and birthing centers today, but it hasn’t always been, and it certainly still isn’t accessible to everyone, especially in cases of traumatic or emergency births. However, when it’s possible, skin-to-skin care is hugely important for Baby’s health as well as for your health. Studies on postpartum depression risk have shown that mom is significantly more likely to deal with postpartum mood disorders if she is not given the skin-to-skin time she needs with her baby, activating that oxytocin release and reducing stress and anxiety. Whether you’re due next week or you had the baby three months ago, it’s not too early or too late to start thinking about what this might look like for you. It’s not too late to reap some big benefits from the power of touch.

No one is going to have all of these things all the time in perfect balance. But if there is a specific item in the list that you know is a real struggle for you, maybe that's the growth area to focus on first--even if the only thing you can actually do is share with someone else that you need their help and support.

In the next couple of posts (Part 2 and Part 3), we'll cover hormone changes, nutritional changes, changes in the gut microbiome, and inflammation, and how these factors can also have significant implications for postpartum mental health. 

In the meantime, let me know how I can support you in your journey. Postpartum is hard! But it's easier together.

If you’ve struggled with irritable bowel syndrome (IBS), inflammatory bowel disease (IBD) like Crohn’s disease, ulcerative colitis, or microscopic colitis, or if you just have a sensitive gut and deal with uncomfortable symptoms such as bloating, abdominal pain, diarrhea, or constipation, you have likely noticed at least some connection with food and symptoms. This can cause some people to fear food, which is completely understandable!

But as a registered dietitian working with individuals with gastrointestinal issues, I have some really important news for you: your gut needs fuel to work properly. It needs to be fed and nourished regularly, and it also needs breaks between meals and snacks to digest food and move it through.

The other encouraging piece of news I want to share with you is that some types of food can actually help to alleviate symptoms, rather than worsen them! Some foods, and some ingredients in food, can be triggers for some people; other foods can be soothing and healing. Whenever possible, I love to talk about what to increase than what to decrease or eliminate, so let’s talk about ten of my personal favorite gentle foods for a sensitive, irritated, or inflamed gut.

1. Kiwi. Low in fermentable fibers and sugars called FODMAPs, and packed with vitamins and gentle fiber, kiwis have been shown to help individuals with chronic constipation improve the regularity of their bowel movements, but without causing abdominal pain, bloating, or loose stools.
2. Cilantro. If you think you need to cut back on flavor or eat a bland diet because of GI issues, think again! Cilantro is an amazing gut-healing leafy vegetable with great flavor as well. (Unless you’re one of those unfortunate individuals who think it tastes like soap… what a bummer!)
3. Rolled oats. They’re an oldie, but a goodie: oats are high in soluble fiber, which means that they can help soothe the gut and slow the movement of food through the intestines to a more manageable rate. I would encourage the less-processed groats or rolled oats rather than the quick-cooking version, for a lower FODMAP load and a slower glycemic response.
4. Blueberries. Blueberries are probably one of my favorite things to recommend for just about anyone, anytime, from neurological and mental health to heart health. The phytochemicals (the chemicals that give plants color) in blueberries nourish the gut microbiome, and the fiber they contain is gentle on the gut, plus they’re packed with antioxidants that help to reduce inflammation both in the gut and throughout the body.
5. Okra. Okra is a mucilaginous vegetable, meaning that it swells and gels in water, and can use those properties to soothe irritated tissues, like the gut lining. In a reasonable serving size (about 7 pods), okra is low in FODMAPs and can help to soften and bulk stool, as well as protect your gut from toxins and infectious pathogens.
6. Flaxseed. Flax is an amazing source of plant-based omega-3 fatty acids and gentle fiber. Flax meal can help to improve stool consistency and reduce constipation, and it’s easy to add to hot cereals, baked goods, smoothies, homemade nut butters, etc. Try increasing your intake gradually to find the best daily amount for your body.
7. Parsnips. They might just look like white, weird carrots, but parsnips are a delicious addition to soups and stews, as well as being low in FODMAPs and high in soothing soluble fiber (a relatively rare thing in a vegetable).
8. Millet. While some grains can be tough on a sensitive gut and are often high in fermentable fibers (causing gas and stomach pain for some people), millet is low in FODMAPs that are known to cause GI discomfort, while also containing prebiotic fibers that help feed the gut microbiome. It’s also safe for people on a gluten-free diet.
9. Plantain. Plantains aren’t eaten raw, but can be delicious baked, boiled, fried, grilled, or steamed. They are great sources of resistant starch, a type of fiber that is great for your gut and for your blood sugar, while also being gentle enough for most people to eat without unpleasant side effects—as long as you go easy on the deep-fried version! Remember that foods with lots of added fats can sometimes cause digestive distress, so I would recommend cooking plantains with less oil to reap the benefits without the potential drawbacks!
10. Pressed tofu. As opposed to silken tofu, pressed tofu has a lower FODMAP content while still being high in fiber, essential amino acids, vitamins, and minerals. For vegetarians and vegans trying to manage gut symptoms while getting enough protein, pressed tofu can be a very helpful addition to the diet.

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Looking for more personalized assistance with your gut symptoms? I’m here to help. Feel free to send me a message or schedule an appointment so we can get to the bottom of your issues and get you feeling better.

You probably know that sunshine can boost vitamin D levels. But did you know that getting enough sunshine, especially in the morning, can also help with sleep and mental health?

It seems simple, but many of our schedules don’t automatically make time for it: a morning walk through the grass in the sunshine, 15 minutes on the patio while eating your breakfast, or even (for those who live in areas where it’s frequently still dark or cloudy in the morning) using an indoor UV sun-mimicking lamp. Now that it’s wintertime, it’s even more challenging for many who live in cold and cloudy climates to get the sunshine their bodies need.

Sunrise, sunset

Yes, sunshine is our primary natural “source” of vitamin D. (The UV-B rays of the sun actually activate a complicated chain of events in the skin that causes our bodies to produce vitamin D. While you make the most vitamin D when you’re outside when the sun is highest in the sky, early morning sunshine is considered the best for skin health, including reducing the risk of the damage that can lead to sunburn and skin cancer.) But getting out in the early morning rays is about more than just vitamin D production.  

And conversely, those recommendations to avoid artificial light and especially screens late at night is about more than just melatonin production (though that is hugely important).

Our bodies and minds are made to operate on a “clock,” meaning that we operate on 24-hour cycles that are set by exposure to the cycle of day and night, sunshine and darkness.

Here are a few of the systems and tissues in the body that function on a circadian rhythm—many of them even independently from the brain and central nervous system:

• The suprachiasmatic nucleus. (Now wasn’t that fun to say?) This one’s a big one, the “master clock” in the brain. It’s activated by blue light, the type that we see from daytime sunlight. Over the span of a 24-hour cycle, the expression of different genes change, creating a cascade of effects that help us to be awake and alert during the day, and restful and (hopefully) asleep during the night.
• The stomach. Its circadian rhythm seems to be set primarily by intake of food.
• The skin. What?! I know. Things like cell reproduction in the top layer of the skin happen in conjunction with the light and dark cycles of the day.
• The liver. Even though it doesn’t have any direct contact with light, it turns on and off according to the light and dark cycle, so that it’s ready to start digesting food and turning glucose (sugar) into energy during the day.
• The skeletal muscles. Their circadian clock is based around how much we’re using them – how much we’re moving.
• The adrenal glands. This is really important because the hormones they secrete help regulate your metabolism, immune system, blood pressure, response to stress, and more. For obvious reasons, we don’t want them to be producing lots of adrenaline in the middle of the night.
• …And literally every cell of the body. Yep, they all have their own individual little watches keeping time, but they can be overruled and have their watches synchronized by the major clocks above.

How does this apply to mental health?

I think we’ve established that our bodies operate in a rhythm, a daily 24-hour cycle that is fueled by the sunlight. So what does this have to do with our mental health?

The connection between sleep disturbance, circadian rhythm dysfunction, and depression is well-established. Sometimes sleep disturbances happen as a result of mental illness; other times they may cause it, and perhaps most of the time, it’s going both ways.

People with major depressive disorder have different body rhythms than people who don’t have the diagnosis. For example, our body temperature changes on a 24-hour cycle, with lower core temperatures at night. For someone with MDD, their body temperature doesn’t decrease as much. Their melatonin and cortisol levels don’t change as much in the course of the day, so they might not produce enough melatonin for quality sleep or enough cortisol to get through the activities of the day. The degree of misalignment between the internal clock and the timing of actually being able to fall asleep seems to correlate with the degree of severity of symptoms of depression.

Plus, there’s all sorts of other impacts that sleep disturbance can have on mental health. Insomnia increases levels of inflammation in the body, which (as we’ve discussed in other posts) can be correlated with depressive disorders. In the long term, sleep deprivation can also decrease the production of some really important brain proteins that support brain growth, elasticity, and resilience. There’s even a weakening of the blood-brain barrier, the “wall” that keeps stuff from the rest of the body away from the fragile tissue of the brain. This can let in all kinds of neurotoxic substances, leading to more inflammation.

Others dealing with depression may have the opposite experience, where rather than insomnia, they find themselves sleeping too much. This is also potentially linked to circadian rhythm dysfunction, imbalance of melatonin and cortisol, and poor-quality sleep (which is very common in depressive disorders).

So what can we do about it?

Nothing in biology is ever quite as simple as the word “reset” makes it sound. Recalibrating or resynchronizing your body’s clocks is not as quick and easy as resetting your Wi-Fi router. But there are some fairly simple steps we can take to try to get back on track, improve our sleep, and improve our mental health.

Many of these tips won’t be new to you, but hopefully you now have a deeper appreciation for their importance, and for specifically how they might improve not just your sleep, but pretty much everything else that happens in your body, as well.

• Get some sunshine as early in the day as possible. Whether you’re sitting in a sunroom, walking in the park, or even sitting by a UV lamp in a living room in northern Alaska, the goal is to get exposure to that morning sun to almost literally wake up your cells, from your eyes to your skin to your liver.
• Move your body. Combine this morning sunshine exposure with morning movement, when possible. Remember the importance of movement in calibrating the circadian “clocks” of the muscles. Morning exercise is also likely a lot better for supporting good sleep rather than doing high-intensity exercise late in the afternoon or evening, when we could make falling asleep more difficult for ourselves. Walking, yoga, and stretching are great anytime of day.
• Eat in the morning. I’m a big proponent of breakfast within roughly two hours of getting up in the morning. We are all busy people with a lot to do, but I think most of us will do those things much more effectively and efficiently if we’re properly nourished in the morning.
  I often get push-back on this one because of intermittent fasting. I know a lot of people like the idea of an intermittent fasting schedule shifted later in the day to allow eating dinner socially. Eating meals with others is really important to me, too. But from a circadian rhythm perspective, the goal of intermittent fasting is not just to limit the number of hours that you can eat, but rather, to place your eating window in the optimal time frame to align with the “clocks” in your digestive system. So maybe this means that your eating window, if you do intermittent fasting, is a little wider. Maybe it’s worth experimenting with.

• Eat your polyphenols. Along with all the other things they do for us, the anti-inflammatory colorful compounds in things like green tea, citrus zest, and red grapes have also been shown to help re-align the circadian rhythm. So cool.
• Dim the lights and avoid screens during your evening wind-down time. Research shows that melatonin production is delayed substantially by being in room light – maybe even up to an hour and a half, according to some research. That is potentially problematic when you’re trying to fall asleep, but I would argue perhaps more sneakily problematic when we’re thinking about sleeping well and waking up feeling well-rested.
• Keep to a schedule. A lot of our evening and nighttime habits might feel relaxing, but they might also lead us to stay up later than we intend to and then end up eating later at night than we intend to. (And often also consuming things that aren’t really helpful for supporting good sleep, like alcohol and sugar.) Conversely, we might sometimes stay up late trying to “get things done,” which raises our nighttime stress and cortisol levels. I’m speaking to myself here as much as to anyone else: Just go to bed.

Remember: it's all about starting small, incremental, gentle. Be kind to yourself. Choose one thing you can do today. Notice how little changes can have big impacts, especially when they are done mindfully and with self-compassion.
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Sources:

• https://www.embopress.org/doi/full/10.15252/embr.202152412
• https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7182033/
• https://pubmed.ncbi.nlm.nih.gov/19524304/
• https://academic.oup.com/jcem/article/96/3/E463/2597236?login=false
• https://pubmed.ncbi.nlm.nih.gov/22542179/
• https://www.cell.com/cell/fulltext/S0092-8674(19)30507-0

One of the goals of mindful eating is developing an increased awareness of sensations within the body, including knowing when one is “hungry” and when one is “full.” But while this may sound simple, hunger and fullness can actually be a lot more challenging to identify.

That’s partly because hunger is not binary. Meaning, it’s not just either-or: either hungry, or full. Hunger and fullness exist on a continuum. Often, figuring out where exactly we are on that continuum takes more attention than we tend to pay to anything going on internally.

In the process of learning to tell when to start and when to stop eating, it can be helpful to put numbers on that continuum.

While the sensations of hunger and fullness aren’t the same for every person, here’s an example of what that might look like on a one-to-ten scale:
1 – Starving! I have severe hunger pangs and feel shaky and weak. I am obsessing over food.
2 – Ravenous. I am really hungry, but it’s not yet intolerable. I am thinking about food constantly.
3 – Hungry. I have slight hunger pains, but it’s not uncomfortable. I know what I could eat and feel satisfied.
4 – Mild hunger. My stomach is growling, I know I will want to eat soon.
5 – Neutral. Not hungry, not full.
6 – Mild fullness. I am filling up, but I could eat a bit more to feel totally satisfied. I feel energized by what I have eaten.
7 – Full. I am totally satisfied and feel no hunger. My energy level has been topped off and I feel like I won’t be hungry for hours.
8 – Slightly overfull. I should have stopped eating a few bites ago. Stomach feels a bit swollen.
9 – Overfull. I am overfull and bloated, uncomfortable and sleepy.
10 – Stuffed. I am full to the point of feeling stuffed. Extremely uncomfortable. I have eaten much more than what was good for my body. I have no energy. I feel like I could be physically ill to relieve the discomfort.
(source: whatsforeats.com.au)

On the scale above, you would probably want to keep yourself between a 3 and a 7 most of the time. While there are always going to be exceptions in either direction—it’s a totally normal part of normal eating to sometimes be a bit too hungry and sometimes be a bit too full—our body and mind tend to work best within that comfortable zone between the extremes.

Getting below a 2 or 3 on the hunger scale can make it difficult to focus on other tasks and can lead to overeating when you do eat. It may make it difficult for some people to get enough energy and nutrients over the course of a day. It may also lead to slower thinking and decision-making and cause you to not move your body as much. The bottom line: there is a reason why our bodies tell us that we are hungry, and it’s important to our health that we listen.
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Routinely eating past a 7 or 8 is uncomfortable and, for some people, can lead to stomach and digestive problems (such as acid reflux or diarrhea). The feeling of fullness often does increase slightly over a few minutes after you’ve finished eating, which is why slowing down the process of eating can be helpful if you tend to be a quick eater. The bottom line: if you’re routinely eating past fullness, stop and ask yourself why. Is there another reason besides hunger that you’re eating? (This is not necessarily a bad thing, but helpful to be aware of.) Are you eating too fast? Do you set your fork down, chew thoroughly and taste your food, take sips of water, and take the time to smile? Are you always in a rush, eating on the go, or anxious about the food you’re eating or the environment in which you’re eating?

Try stopping yourself routinely throughout a meal to think, how hungry am I? If I stopped now, would I have the energy I needed to be active and stay focused for the next few hours? If I took a few more bites, would I feel better, or worse?

As a mindfulness practice, you may want to try to figure out your just-noticeable-difference—the number of bites it takes to make a discernible difference in your level of hunger/fullness.

Above all, don’t let mindful eating become stressful or make your mealtime less enjoyable. Use it to help you get the most out of your meals and snacks, enjoying them to the fullest and ensuring that they give you energy to live your life and feel well.
 
 
Note: Mindful eating can be very helpful for some, but not for all. There are several groups of people for whom I tend to avoid recommending mindful eating, at least early on in our work together.
For example, if you are dealing with disordered eating that leads you to feel very anxious about food, you may need to start with a more structured approach towards eating rather than with mindfulness in the initial stages of treatment. Additionally, some patients with functional bowel disorders may deal with an excessive focus on internal sensations (this is known as visceral hypersensitivity) and trying to increase focus on the sensations of hunger and fullness may not be appropriate initially.

If you’re wondering whether practicing eating mindfully would be helpful for you, I encourage you to talk to a dietitian or counselor. If food is of particular concern, try starting out with practicing mindfulness in other areas of life first—mindful movement or mindful walking might be a lovely place to start.

I've been quiet on my website for a few months taking care of my new baby girl. It's hard to believe how much she's grown and changed in the past 6 months.

She's amazing, she's beautiful, she's everything.

It's been a busy time, but having a daughter has helped spur me to think even more deeply about the world I want her to grow up in, and how I can be a part of building it.

This one's for the clinicians out there. Let me tell you something that I think is vital for all of us to know. 

Whether or not you work in the mental health space, like I do, you work with clients with mental health concerns. You work with clients with trauma. We all do. Trauma is so unfortunately common that it's impossible not to. We all want to do right by our patients, and truly help them.

But have you ever been in an appointment with a medical professional where you felt uncomfortable? Where you felt they didn't understand your emotional and psychological needs? Have you ever experienced a physical exam where you felt you were not being touched appropriately? Ever felt like terms were used that were either too medical-ized or too personal?

It's unfortunate, but it is true: re-traumatization happens often in healthcare. We want to be part of the solution, but if we're not careful, we can be part of the problem. And there is precious little training available to dietitians and nutritionists who want to grow in this area.

I want to build a world where everyone in healthcare is knowledgeable about trauma and prepared to treat every patient in a trauma-informed way. 

I've started teaching and doing trainings on trauma-informed care to try to fill this gap. I'm working on creating content and courses for providers to help you build your skills, so be on the lookout for more content, including:

• an upcoming CEU book through Skelly Skills (planned to be available in September 2023) that includes an entire research-backed chapter on trauma-informed care,
• a free webinar (follow me on Instagram or Facebook to get updates about this--no, I don't post much on social media but I try to make it worth both of our time when I do! :) ), and
• a more extensive training course for dietitians and nutritionists, planned in the future!

How can I help support you in learning about trauma-informed care? Let me know in the comments below or feel free to send me an email at [email protected].

Magnesium is one of my "all-star" nutrients for both gut health and mental health. Today, let's talk all things magnesium - why I love it, and when and how I recommend my patients use it!

What does magnesium do?
Magnesium is an essential mineral, and it is important for a bunch of different systems and functions in the body:

• Heart and cardiovascular health
• Metabolic health
• Muscle health
• Gastrointestinal health
• Hormonal and nervous system health
• Sleep hygiene 
• Electrolyte balance

What causes magnesium deficiency?
Magnesium deficiency or insufficiency is unfortunately pretty common, considering all the important roles it plays in the body. Low magnesium levels can be caused by:

• Low intake of magnesium from the diet
• Inadequate absorption
• Magnesium-depleting medications (such as oral contraceptives, diuretics, PPIs, and H2 blockers)
• Stress (which might increase your body's need for magnesium)
• Insulin resistance (which can cause increased excretion of magnesium in the urine)

How is magnesium involved in anxiety and depression? 
Magnesium is intricately involved in mental health. Low magnesium levels are linked to increased inflammation, circadian rhythm dysfunction (i.e., sleep issues), and poor tolerance to stress. We have discussed in previous posts the connection between inflammation and depression. Poor sleep is often a factor in worsening mental health, as well. Plus, magnesium is involved in balancing neurotransmitter function to promote CALM.

How can I get enough magnesium?
There are lots of dietary sources of magnesium, but they are mostly whole foods - which unfortunately are under-consumed by most Americans! Green leafy vegetables, whole grains, fish, nuts, and seeds are all great sources. When foods are processed and refined, magnesium content is sometimes lost, and Americans tend to eat a lot of processed and refined foods, which may partially explain why rates of deficiency and insufficiency are so high. 

We get varied levels of magnesium from drinking water, depending on the source (mineral water and well water tend to be higher, but exact levels vary). 

The Recommended Daily Allowance (RDA) for magnesium is 310-320 mg/day for women and 400-420 mg/day for men. (For reference, one of the highest-magnesium foods is pumpkin seeds, which contain 168 mg magnesium per ounce. Most other nuts, seeds, whole grains, and beans contain more like 30-60 mg per servings.)

If you're concerned you might not be getting enough, or you want to see whether additional magnesium might help some of your symptoms, magnesium supplements are also generally quite safe and effective. (But, it is always a good idea to check with your doctor or dietitian before you start a new supplement.) 

Your healthcare provider can check the magnesium levels in your blood, but those levels might not be very useful. The amount of magnesium in your red blood cells (RBC Magnesium) might be a better test. But even then, the level of magnesium in your brain is what's most important for mental health. Low magnesium in the brain is associated with depression and neuroinflammation.

How might magnesium supplements help?
Increasing magnesium intake and/or supplementing with magnesium might help with:

• Managing depression, especially as an adjunctive treatment (alongside other treatments, including mental health medications when they're needed)
• Reducing symptoms of anxiety
• Improving sleep (including both sleep quality and duration)
• Preventing migraine headaches
• Improving insulin resistance and blood sugar control
• Managing constipation

What type of magnesium supplement is best?
There are lots of different options for magnesium supplementation. Depending on what symptoms you're looking to treat with magnesium, the optimal choice of supplement will vary. 

If you are frequently constipated, the standard formulations of magnesium will probably help with this (such as magnesium sulfate, oxide, citrate, or chloride). It's a good idea to take the supplement at night to give it time to work - and that's the best time to take it for its sleep benefits, anyway.

On the other hand, magnesium glycinate and magnesium taurinate have both been used with good results in people with depression and anxiety, and seem to have fewer unwanted gastrointestinal side effects (for those who don't struggle with constipation at baseline). A newer supplement option, magnesium L-threonate, actually crosses the blood-brain barrier and boosts magnesium levels in the brain, which might make it an ideal choice to take advantage of the neurological and mental health benefits of magnesium.

If you’re interested in learning more about how to improve your mental health and gut health through the power of nutrition, contact us or schedule a virtual telehealth appointment with me!

Note: This post may contain affiliate links. I only recommend products I love!

One of the most central topics within the gut-brain axis is the vagus nerve. Here’s why you should care about your vagus nerve, how to improve vagal nerve function, and why “toning” the vagus nerve is an important part of supporting good mental health and gut health.

The vagus nerve is the longest cranial nerve in the body. It travels all the way from the brainstem to wrap around and run alongside organs throughout the abdomen, including the lungs, the esophagus, the heart, the liver, the stomach, and the large and small intestines (just to name a few).

It both carries signals from the brain down to the heart and the digestive organs (motor signals, telling those parts of the body what to do) and carries signals back up to the brain from those organs (sensory signals, telling the brain what’s going on in your midsection). It’s mostly in control of autonomic functions – the things your body does without you having to think about it, like pumping your heart, breathing, and digesting your food.
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However, stress and anxiety affect the function of the vagus nerve pretty dramatically. When you’re in fight-or-flight mode, your heart rate and breathing speed up, and digestion slows way down. This makes good sense, since when your life is in imminent danger, you want to have adequate blood flow and plenty of oxygen to fuel your muscles, and you don’t really want to be thinking about finding a restroom.

But what about the chronic, constant day-to-day anxiety of our lives today? What about people with anxiety disorders?

In these cases, the vagus nerve’s function is thrown off balance. As a result, our heart and lungs will spend most of their time on high alert, working too hard, and our digestive system may become sluggish, leading to things like low stomach acid, gastroparesis (slow stomach emptying), acid reflux (also known as GERD), and poor digestion. Along with anxiety, this imbalance has been linked with depression, and with gut disorders such as IBS and IBD.

If you’ve struggled with chronic anxiety or an anxiety disorder, you might resonate with some of these symptoms. Perhaps your appetite tends to be poor when you are stressed, or if you try to eat you feel like the food sits in your stomach like a rock, or you develop heartburn after eating.

(On the other hand, you may have had the opposite experience, where anxiety causes your appetite to increase. This tends to be more of a learned self-soothing behavior, but doesn’t rule out having some of the same side effects of decreased vagus nerve functioning noted above.)

The important question, then, is: what can we do about this?

You may have been told by a well-meaning doctor, psychiatrist, or loved one in the past that you need to “reduce stress” or just “stop being so anxious.” These recommendations tend to be quite unhelpful and frustrating.

But there are some truly actionable ways to help close the loop of the stress cycle and harness the power of the mind-body connection to decrease anxiety.

Let’s start with the breath.

I mentioned that most of the functions of the vagus nerve are “autonomic” – meaning that they happen automatically without us having to think about them. This is true for digestion, certainly, and thankfully your heart keeps beating even if you’re not thinking about it. But breathing is different. It can and does happen automatically most of the time, but you also can control it, if you so choose.

Take a moment right now to notice the rate of your breathing. Is it fast or slow? Are you breathing through your mouth or through your nose? Are you holding your breath?

Now take a conscious, deep inhale through your nose, feeling your belly expand like a balloon as you breathe in. Count to four as you inhale; one, two, three, four. Hold it here for a count of seven; one, two, three, four, five, six, seven. And now breathe out through your mouth slowly, for a count of eight; one, two, three, four, five, six, seven, eight.

Repeat this at least four or five more times on your own, perhaps even with your eyes closed. You may notice that this is a much-needed moment of peace and stillness, and spend a few more minutes here on your own. By all means, please do.

When you have finished this short breathing practice, notice what’s going on inside your body. Has your heart rate slowed? Is your breathing a little calmer than it was when you first tuned into it?

Deep breathing, or diaphragmatic breathing, is one of the simplest ways to tap into and change the functioning of your vagus nerve. While I feel like this term is a bit too simplistic, some call it “resetting” your vagus nerve. Whatever you call it, doing breathing practices like this one regularly, you can actually strengthen its function, which is why this is called building “vagal tone.”

This can help improve heart rate variability, the ability of your cardiovascular system to respond to increases and decreases in stress levels appropriately – speeding up and slowing down to match the needs of the moment.

A lot of research is being done on VNS devices implanted to stimulate the vagus nerve for depression, PTSD, and epilepsy, among other things. However, there are some less-invasive methods you can try today.

Here are some of the other practices and tools that have been touted for improving vagal tone:

• Yoga (and other mind-body practices, like qi gong)
• Brief cold water immersion or cold showers
• Biofeedback
• Humming and singing
• Gargling
• Alternate nostril breathing (nadi shodhana pranayama)
• Acupuncture
• Massage
• Tapping
• Joyful movement
• Laughter
• A healthy diet (full of nutrient-dense foods, high in omega-3s, and with added probiotics such as from fermented foods)

Some of these practices are better researched than others. My personal favorites are eating a nourishing diet, laughter, singing along to your favorite music, and moving the body in any way that feels stress-relieving to you!

So the next time you’re feeling anxious, give your vagus nerve some love! Over time, by regularly working on toning your vagus nerve, you might find it gradually get easier to move through the stressful fight-or-flight mode and get back to resting and digesting. 

​If you’re interested in learning more about the gut-brain connection and how to improve your mental health and gut health through the power of nutrition and lifestyle, contact us or schedule a virtual telehealth appointment with Erica, a mental health dietitian! 

Note: This post may contain affiliate links. I only recommend products I love!

In part 1 of this series on coffee and the brain, we discussed how daily consumption of coffee might help protect against dementia, stroke, and Parkinson’s disease. In this part we’re going to discuss how caffeine impacts mental health, including anxiety, depression, and ADHD.

Our mental health not only affects how we think, but also our views on life and how we handle situations and emotions. In recent years with the COVID pandemic, there has been a sharp increase in anxiety and depression. This may be linked to the social isolation of the pandemic.

Depression is characterized by low mood. It affects sleep, appetite, emotions, and can even cause physical symptoms in the body, including fatigue and headaches. On the other hand, anxiety disorders are characterized by a persistent and intense worry and fear. It can lead to social withdrawal, and includes symptoms like sweating, having trouble concentrating, constant unrest or nervousness, and an increased heart rate.

Caffeine and Anxiety
As previously discussed, caffeine is a stimulant that increases energy and alertness. It blocks a neurotransmitter (a chemical messenger that relays messages to the brain and body through the nervous system) called GABA. GABA plays a role in calming nerve cell activity, meaning that it helps us relax.

By blocking GABA, caffeine can increase cognitive functioning, but can also increase anxiety. People with anxiety tend to have a lower tolerance to caffeine and are more sensitive to the effects. If you or someone you know has anxiety or gets anxious easily, decreasing caffeine intake can help. Similarly, with bipolar disorders, high caffeine intake can induce a manic episode. It’s recommended that those with bipolar disorder avoid consuming large amounts of caffeine.

Caffeine and Depression
For those with depressive disorders, studies have shown that caffeine tends to elevate mood. Since it acts as a stimulant, there’s a boost in brain functioning and energy levels. This can help with the fatigue commonly associated with depression.

Even for those without a diagnosis of depressive disorder, the mood and energy boosting effects of caffeine are probably some of the main reasons its use is so common. It’s something people joke about (but are probably being serious). For instance, the “don’t talk to me until I’ve had my coffee,” or think about how coffee shops have become a hot spot for social settings. It’s easier to socialize when you have an energy- and mood-boosting drink in your hand. Studies have also shown that a moderate consumption of caffeine is associated with reduced risk of depression and suicide, as well as an elevated mood.

Caffeine and ADHD
ADHD is another disorder that can be impacted by caffeine intake. Symptoms include a short attention span, impulsivity, and hyperactivity. People are often unable to sit still, have difficulty concentrating, interrupt frequently, and have excessive movements.

Interestingly, caffeine has been shown to help manage these ADHD symptoms by increasing focus and alertness. However, it’s important to talk with your doctor or psychiatrist before combining caffeine with other ADHD medications, and certainly do not stop taking ADHD meds without talking with your doctor first.

In Practice...
It's important to note the overlap between a lot of these conditions. Many people struggle with both depression and anxiety, or both ADHD and anxiety, for example. In these cases, it’s wise to be cautious about caffeine intake. When you drink coffee, how is your mood? Your sleep? Your stress levels? Your energy levels? It may be helpful to do a self-experiment, gradually decreasing your caffeine intake and then seeing how you feel without caffeine for a couple of weeks before reintroducing it and noticing the results.

You might also consider other beverages besides coffee that contain a smaller, more manageable amount of caffeine, such as tea. The L-theanine in tea (and especially green tea) has a calming effect, while the relatively low caffeine content can still have a positive impact on focus and alertness.

Caffeine primarily affects cognitive functioning. As we discussed earlier, it interacts with our nervous system and brain. It increases working memory, attention, alertness, reaction times, and, as we discussed today, it can improve mood. However, too much caffeine can lead to anxiety, paranoia, mood instability, and dependence on caffeine. Stopping or decreasing caffeine consumption can be challenging because of its withdrawal symptoms, like tiredness, headaches, and mood changes.

​Caffeine isn’t for everyone, and can intensify anxiety and bipolar disorder, but it can also help improve mood and might help manage depression and ADHD.

I hope this two-part series was informational and useful. Thank you for reading!

Main research article for more information: https://www.mdpi.com/851178
Chart for caffeine intake in foods/beverages: https://www.cspinet.org/caffeine-chart

If you’re interested in learning more about how your dietary choices influence your mental and neurological health, reach out or schedule a virtual telehealth appointment with Erica, a mental health dietitian! 

Coffee, tea, soda, and energy drinks. These are some of the everyday beverages we consume. Especially when we have long nights and early mornings, or a never-ending workday. Maybe even kids that wake you up in the middle of the night, or exams and homework that just need to get done. Sometimes we just need that boost that coffee gives us, a little pick-me-up to start the day or to just keep going.

All those drinks have caffeine in them, something that most of us are very familiar with. On average, Americans consume 179 mg of caffeine a day. But what does caffeine even do? How does it impact our brain and mental health?

Caffeine is a stimulant. It plays a role in reducing drowsiness (which is why the morning cup of coffee is a go-to for many people). It has also been shown to increase concentration, motor coordination, and alertness. There is also an effect on learning and memory. Depending on genetics, people react to and breakdown caffeine differently. Some people are more sensitive to caffeine, so it takes longer to metabolize and its effects will last longer.

On average, caffeine will reach its peak effectiveness 30-60 minutes after consumption. Half of the caffeine consumed will break down within 2-10 hours—this wide range is a testament to how differently each person experiences caffeine!

Be wary—stimulants such as caffeine can be addictive. People also build up a tolerance, so they’ll consume more and more caffeine to feel the same effects that they did before. The problem is that your body is taking in a lot more caffeine. This can lead to sleep problems, jitters, increased heart rate, and overstimulation.

So, what does caffeine do to our brain? How does it impact different neurological disorders? Does it affect men and women differently in these disorders? We’re going to talk about caffeine and how it impacts our brain and mental health over two parts. In this first part, we will focus on neurological disorders. The second part will discuss caffeine’s impact on mental health.

There are theories that coffee plays a protective role when it comes to some neurological diseases, including stroke, dementia, and Parkinson’s disease. Looking at research studies, people who drank at least 3 cups of coffee a day had a reduced risk of stroke. With dementia, women (more so than men) had a reduced risk of developing dementia. In Parkinson’s disease, high caffeine intake has been associated with having a protective effect, including decreased rates of Parkinson’s disease in men. (In women the correlation is a lot smaller).

It’s also important to note that caffeine may help reduce the risk of developing these disorders, but once the disorder is present there is not a lot of research to suggest that caffeine will reduce the severity of the disorder.

What does this mean for us? More research needs to be done in further understanding and interpreting these connections. According to the USDA guidelines, the recommendation for a safe level of caffeine intake is less than 400 mg per day (or about four 8-oz cups of coffee). If you’re curious how much caffeine you are consuming every day, check out this chart with a wide variety of common food and beverages and their caffeine amount.

We’ve seen that some benefits of regular caffeine intake include protection against dementia and stroke more strongly in women, and protection against Parkinson’s disease in men.

Based on these research findings, caffeine intake seems to help decrease the risk of the development of neurological disorders such as dementia, stroke, and Parkinson’s disease for some people. This doesn’t mean that it is wise to drink a ton of caffeine every day, but—good news for coffee-lovers—a moderate amount daily might be helpful in maintaining good brain health.

If you’re interested in finding out how caffeine impacts risk of mental health disorders, stay tuned for part 2!
​
Main research article for more information: https://www.mdpi.com/851178
Chart for caffeine intake in foods/beverages: https://www.cspinet.org/caffeine-chart

If you’re interested in learning more about how your dietary choices influence your mental and neurological health, reach out or schedule a virtual telehealth appointment with Erica Golden, RDN, LD, IFNCP. She specializes in nutrition for mental and cognitive health.

You know how kids get hyped up on sugar and then crash? Boy, aren’t you so glad that all of us grow out of that when we grow up?
​
Yes, that’s tongue-in-cheek. We might get better at managing our moods as we get older, and our emotions and energy levels are a bit more within our scope of control. This allows us to keep focused at work even when we’re hungry and eat an ice cream cone and not run around the living room yelling at the top of our lungs.

But truth be told, the same metabolic processes are still going on in our bodies, the same changes in our blood sugar, the same changes in energy level coursing throughout our muscles and brains. Just because we’re better at appearing stable doesn’t mean things are actually stable inside.

For example, have you ever seen the study that looked at the differences in decisions Israeli judges passed on similar cases, merely based on whether the hearing was held before or after their morning snack or lunch break? Even the best and most well-trained of us still get hangry.

Let’s say you get up in the morning and you’re in a rush. You pour yourself a cup of coffee with sugar and French vanilla creamer and head out. By the time you get to work, the coffee is gone, and your hunger is staved off for a while. But 10AM hits and you start to feel fatigued and restless again. You go for a second cup of coffee from the communal coffee pot, and grab a donut from the box someone brought in.

For lunch, you stop by the local sandwich shop to get a hoagie, some chips, and a soda. After lunch, you’re feeling pretty good and really getting stuff done, until about 2:30PM when the afternoon slump begins. You peruse the vending machine in the hall and grab a candy bar (just for today, because that big deadline is coming up and you need to be productive). By the time you get finished with your work, it’s 6PM and you’re exhausted.

You finally head home, ready to crash, only to find the house is a mess and no one has thought about dinner. You’re irritated and snappish. You head to the freezer, find a couple of frozen pizzas to throw in the oven, and snack on some corn chips while you wait for it to heat up. After the kids go to bed, it’s a glass of port wine, a big bowl of ice cream, and some TV to help you wind down. Then, around 11PM, you head to bed for some poor-quality sleep, only to wake up and do it again the next day.

Look, work and family life are tough enough on their own. You don’t need your diet to just be making things more difficult for you to handle. Between meals or snacks when you’re feeling sluggish, hangry, irritated, and bummed out, it’s very possible that your mood is low because your blood sugar is low.
On the opposite end of the spectrum, the low blood sugars tend to trigger us to crave sugar, in the body’s attempt to fix the problem. Once we’ve eaten something sweet, our blood sugar spikes and we feel much better – usually. But for some people, elevated blood sugar can feel more like anxiety or just the uncomfortable sensation of feeling “wired.”

So what do we do to stop this vicious cycle?

Obviously, the Standard American Diet (nicknamed the “SAD” diet for good reason) isn’t doing us much good with an average added sugar intake of 17 teaspoons per day, most of it from ultra-processed food.

Cutting back on the added sugar in your diet is the simplest and, honestly, the most important step in breaking the hangry-anxious-hangry cycle. Consider all the sources – even the “healthier” choices like honey, maple syrup. Consider artificial sweeteners, as well, as they can trick your body’s hormones into spiking (like insulin, the hormone that brings sugar from the bloodstream into your cells where it can be used as energy) – and so they might cause some of the same symptoms, even without the calories or actual sugar content.

Once you’ve done that, if you’re still feeling some symptoms, it might be time to consider balancing the nutrients in your meals and snacks, and decreasing the glycemic load of your meals and snacks.
By “balance,” I mean trying to eat foods or combinations of foods that have a variety of nutrients. For example, I really like my clients to eat protein and fiber pairings for snacks, as these combinations are very satisfying, slow-digesting, and provide a longer-term source of energy (and thus a more stable mood). Some common examples of this might be plain Greek yogurt with blueberries, cucumbers with hummus, a boiled egg and a sliced kiwi, or carrot sticks with almond butter.

Glycemic index (GI) is a measurement that ranks foods from 0-100 based on their impact on blood sugar, with pure glucose being 100. This can be very useful information to know if you’re trying to keep your blood sugar from spiking, but it’s only really useful in combination with the glycemic load (GL), which takes into account the amount of carbs per serving of the food. For example, watermelon and cantaloupe are technically high-GI foods, but since their digestible carb content per serving is relatively low, their GL is considered low. Your blood sugar probably won’t spike much after eating a serving of melon.

In general, eating a lower-glycemic load diet follows pretty well along with our general idea of what a healthy diet looks like. Foods that have lower glycemic load will usually be the foods that are:

1. Low in added sugar
2. Less processed
3. High in fiber
4. Appropriate serving sizes
5. Nutrient-dense (often packed with vitamins and minerals, all of which are also healthy for your brain and mood!)

 
If you’re interested in learning more about how a healthy diet can boost your mood, reach out or schedule an appointment! I provide virtual telehealth nutrition care services in Colorado, California, Texas, Oklahoma, Indiana, Michigan, Virginia, Arizona, Alaska, Pennsylvania, New York, Connecticut, Washington, and Oregon, and I’d love to work with you!

Autism spectrum disorder, or ASD, is a neurodevelopmental disorder that leads to challenges with social interactions and communication, as well as repetitive behaviors. While these are the three core symptoms that lead to the diagnosis of ASD in children, there is also a very strong association between autism and gut symptoms (especially diarrhea, constipation, and acid reflux, or heartburn).

More and better research studies are still needed to tease out the impact of diet on autism, and what gut symptoms are related to the disease itself versus the dietary patterns and preferences of people with ASD. However, there has already been some fascinating research on ASD and the gut microbiota, as well as the potential impact of dietary changes on neurological symptoms.

Autism and the Microbiome

Altered levels of gut bacteria have been strongly associated with ASD. The average healthy child’s microbiome becomes fairly diverse as they eat an increasing variety of solid foods. However, kids with autism tend to have a much less diverse diet, which seems to lead to a sub-optimal gut microbiome.

Though actual gut microbiome composition varies widely, some bacterial families, like Clostridium (known for C. difficile, a common gut infection, but actually a common and generally harmless bacterial family in the gut), Firmicutes, and Proteobacteria tend to be increased in kids with ASD. The types of bacteria of which these kids have an abundance seem to produce too much of a type of short-chain fatty acid called propionic acid, and they have less of the beneficial bacteria that produce butyrate, a short-chain fatty acid with lots of positive effects on mental health and inflammation.

There are a few case reports of treatments with antibiotics have sometimes helped to reduce anxiety and improve some behavioral measures in kids with autism, which is another fascinating sign that the gut microbiome is involved in their neurological symptoms. However, treatment with antibiotics is (and should only be) short-term – and even short-term use can have negative consequences – so this seems unlikely to become a universal solution.

But probiotics and prebiotics – essentially live bacteria and their food – have a strong potential as a much safer treatment with far fewer side effects or risks.

Prebiotics and Probiotics

For example, a study combining an autism exclusion diet with the prebiotic supplement GOS, a type of prebiotic fiber found in dairy products, beans, and root vegetables, found significant improvements in abdominal pain and bowel habits with the exclusion diet, and additional improvements in anti-social behavior with 6 weeks of supplementation with GOS.

Other studies have looked at a variety of probiotics, including single, highly specialized strains such as L. Plantarum WCSF1, or broad-spectrum probiotic supplements containing multiple different strains (mostly in the Bifidobacterium and Lactobacillus families).

While a person with ASD may see benefits from a standard probiotic, strains and combinations of strains specifically studied for the particular condition you’re looking to treat are much more likely to be effective. Some significant improvements in both gut health and behavioral symptoms were seen with the probiotic blend delPRO in one study (though the study did not have a control group with which to compare the experimental group’s results) and with a blend of L. acidophilus, L. rhamnosus, and B. longum in a different study.

Restrictive and Elimination Diets
Lots of different restrictive diets have been proposed for people with autism, and in some cases they may be very helpful. Artificial colors have been linked to behavior disturbances in kids, and there are also concerns about contamination with toxins and heavy metals (though the FDA does require that all artificial colors be tested for lead, mercury, and arsenic).

Gluten-free and casein-free diets are commonly tried. While there are theories about how and why they work, there isn’t enough evidence to say whether they’re generally useful for people with ASD. Proponents feel that the studies that have been done on the GF-CF diet are too short-term to show much impact.

Some people with ASD may have other issues with gluten- and casein-containing foods, such as lactose intolerance, Celiac disease, or non-Celiac wheat sensitivity contributing to their GI symptoms. Others may have IBS, and may see improvements from a low-FODMAP diet (always followed by a re-introduction phase).

However, the more complex the diet, and the more difficult it is for the whole family to follow, the less likely it is to be feasible. Plus, for those with texture issues or those who have more difficulty eating enough variety as it is, it can be difficult to plan a diet that will give enough nutrition to meet their needs. It’s always a good idea to seek the guidance of your pediatrician, neurologist, or dietitian to discuss the pros and cons of restrictive and elimination-style diets, and how to plan them in a way that makes them nutritionally adequate and feasible for the whole family.

Adding to the Diet Instead of Taking Away?

For people with ASD, the diet is often already quite restricted based on personal preferences and aversions. Difficulties with food based on texture, color, and taste are common. Kids may also recognize that certain foods cause tummy pain, and refuse to eat these foods, even if they can’t verbalize this.

It’s important not to make mealtime a fight. Try to stay calm and don’t allow a power struggle to arise over certain foods. We all deserve the right to choose what foods to eat and what foods not to eat, and a person with autism is no exception. However, it may be helpful to try new foods in combination (such as finely chopped mushrooms sautéed and added to spaghetti sauce) or in different forms to make the texture easier to tolerate (such as peeled and crushed tomatoes in a salsa).

As much as possible, involve your child in the food preparation, and try to make it fun. Get your hands dirty together and allow your kids to acclimate to new foods outside of mealtimes to help decrease anxiety during mealtimes.

Very often, it’s more about what we add to the diet than what we take away. Eating more fruits, vegetables, beans and legumes, and whole grains can increase intake of those healthy, gut-nourishing prebiotic fibers that can then feed the gut microbiome, promote more butyrate production, and improve bowel health and GI symptoms.

Eating fermented foods when possible, such as yogurt with live and active cultures, can introduce probiotic “travelers” which can have a positive impact on the gut microbiome, as well.

Eating a greater variety of foods makes it more likely that the diet will have enough protein, vitamins, minerals, essential fats, and polyphenols to promote a healthy brain, gut, skin, immune system, etc.
And besides all that, focusing on food as the hero rather than the enemy can help to foster a healthier relationship with food, less fear of food, and possibly even less reactivity to it. We are all heavily influenced by our expectations, and people with autism are no exception to this, either.

Take-aways

The subject of neurological and developmental disorders and diet is a hotly debated topic, and one that is quite difficult to study. It’s also essential that it be individualized to the needs of the person with autism and their community or family.

If you’re interested in developing a supportive relationship with a dietitian who can assist with making some of these difficult decisions in a non-judgmental environment, and with helping make some of these recommendations more feasible for your family, please reach out to me or schedule an appointment.

​I provide virtual nutrition care services to caregivers and parents living with people with autism, as well as directly to adults with ASD, throughout Colorado, California, Michigan, Arizona, Alaska, and Virginia. 

IBS is incredibly common in the US – somewhere between 10-20% of people suffer from it. But it’s incredibly more common in people with mood and anxiety disorders such as generalized anxiety disorder, schizophrenia, major depression, and panic disorder.

Let’s be clear: IBS is not always IBS. Sometimes there are other issues going on that medical professionals can miss, especially since IBS is often a “diagnosis of exclusion” (meaning, “we’ve ruled out everything else we can think of, so it must be IBS”). It’s always important to see a provider with a specialty in gut disorders to make sure that you get the correct diagnosis.

But let’s assume that the diagnosis is correct. What is going on in the gut that makes things so wonky in the brain? Or what’s going on in the brain that makes things so wonky in the gut?

Since the connection between the gut and the brain goes both ways (primarily via the vagus nerve, hormones, and the immune system), problems with either one can affect the other. And that means that there is a long list of factors that can impact the gut-brain axis and trigger mood disturbances, anxiety disorders, and IBS.

Dietary changes are often needed to calm an “irritated” gut, improve the composition and health of the gut microbiome, heal an intestinal barrier that has become too permeable (or “leaky”), provide adequate vitamins and minerals and amino acids to produce neurotransmitters necessary for mood stability, and more. Dietary changes sometimes include increasing fiber intake, eating more probiotic foods, eating a greater variety of foods, or, on the other hand, restricting certain foods that are common triggers (and then re-introducing them in a planned and careful way).

Lifestyle changes are often needed to calm an over-worked or over-stressed mind. We all have stress, and stress is not inherently bad or harmful, but often can be when we are dealing with it in an unhealthy way or when the stress is chronic and when we aren’t good at resting and relaxing in a healing way. CBT (cognitive behavioral therapy) has been helpful for many people with IBS, which is testament to the importance of managing this disorder from both a gut and a brain perspective. Yoga, stretching, and other forms of gentle movement are also helpful for some people.

Probiotic supplements, fiber supplements, and herbal supplements such as natural anti-microbials, demulcents, digestive bitters, and peppermint can be helpful for some people, but I would always recommend getting advice from a trained professional such as a gastroenterologist or dietitian before starting such supplements, as they need to be carefully selected and tailored to your needs.

Managing disorders of the gut-brain axis, like IBS, can be very challenging. You don’t have to go it alone. If you’re interested in working with a gut health dietitian, schedule a virtual telehealth nutritionist appointment with me or send me a message today.

PS - I was recently interviewed about this topic for DeliveryRank. You can read the interview here.

After several months of trying to work fulltime and see patients on the side in my private practice, I'm excited to share that I'm finally jumping in for "real" with many more bookable hours and lots more energy to put into sharing my passion with all of you through blogs and other resources.

Have you dealt with mental health or digestive issues for months or years without finding successful treatments? Are you seeking to manage mental health symptoms with fewer medications? Do you deal with disordered eating or a relationship with food that you wish you could improve? Has your diet been gradually becoming more and more restrictive over the years because of gut health issues like IBS or IBD and you're starting to feel like food is the enemy?

Please don't just keep dealing with these issues alone. Your struggles are real, and I'm here to listen and help. It's what I do, and what I love to do.

Please reach out to me or book a virtual dietitian appointment with me if you're interested in finding out more about what we can accomplish together. I work with clients in many states across the US via telehealth, including Colorado, California, Texas, Oklahoma, Indiana, Michigan, Virginia, Arizona, Alaska, Pennsylvania, New York, Connecticut, Washington, and Oregon, and I'd love to work with you.

Move over smoothies, this is my new favorite way to eat kefir. 

I preach about fermented foods all the time, but I know it can sometimes be hard to find practical ways to fit them into your day. I home-make my own kefir (not as hard as it sounds), so I always have lots on hand and I love to experiment with new ways to eat and love it. This one is too good not to share! So here you go, friends. Enjoy!


Ingredients:

• ½ cup rolled oats
• 1 cup liquid (start with ¼ cup kefir + ¾ cup milk of choice; gradually increase kefir each time you make it until you reach your preferred flavor)
• ½ large banana
• 1 pitted date, chopped (optional)
• 1 tsp cinnamon
• 1 ½ Tbsp ground flaxseed
• ½ cup blueberries
• 2 Tbsp chopped pecans or walnuts

 
Instructions:

1. Mash the ½ banana in a bowl. Add oats, kefir, milk, and chopped prune or date. Mix the ingredients, cover, and place in the refrigerator at least 4 hours or (preferably) overnight.
2. Top with cinnamon, flaxseed, berries, and nuts. Stir to mix and enjoy!

 
Variations:

• Apple cinnamon overnight oats: replace berries with ½ chopped apple and increase cinnamon to 2 tsp.
• Strawberry chia overnight oats: replace blueberries with ½ cup chopped strawberries and flaxseed with chia seeds. Add the chia seeds with the oats the night before.
• Peanut butter chocolate overnight oats: a great dessert! Warm 1-2 Tbsp peanut butter for a few seconds in the microwave and drizzle over the fermented oats. Top with shaved dark chocolate. Yummmmmmm.
• Carrot cake overnight oats: replace berries with shredded carrot and use extra walnuts if desired. Add a sprinkle of brown sugar if needed. 

***Note: If you're wondering, "What's the deal with kefir anyway?" --let me tell you about it. Kefir is an amazing source of probiotics that, like yogurt, has been around for a very, very long time. It's sometimes called the "champagne of dairy" because of the bubbly, drinkable texture. It's a great source of Lactobacillus bacteria, which are one of the best-studied probiotics for gut health and mental health, as well as Saccharomyces cerevisiae, which is a probiotic yeast. Kefir has been shown in some studies to have benefits such as reducing constipation, reducing bloating, and improving mood--just to name a few. 

Got a favorite way to eat or drink your kefir? Share it with us below!

Interested in scheduling an appointment with a gut health dietitian? I'm a virtual telehealth dietitian, and I love to make my clients amazing meal plans with recipes like this one! Reach out to me or schedule a 15-minute discovery call to learn more.

If you've ever tried mindful eating, you know it's much harder than it sounds. It's easy to get sucked into checking your phone or turning on the TV if you're eating alone. If you're eating with others, it's easy to stop paying attention to the food you're eating.

Every meal and snack doesn't have to be 100% focused. Start with just one occasion per day.

Remember that anything else you try to do at the same time as eating will usually steal your focus. We're really good at eating - we've been doing it our entire lives - so we can do it on auto-pilot, and our attention naturally goes to any other activity that we're try to multi-task with.

Notice your hunger at the beginning of the meal and periodically as you eat.

Observe all 5 senses - eating is one of the few activities that uses all of our senses, and I think that might be part of why we enjoy it so much.

Put down your fork between bites. Savor. Smile. 🙂

How does eating mindful make you feel? Is it stressful? Does it make you feel unproductive, or bored? The way you feel when you eat mindfully tells you a lot about your relationship with food, and what work you might need to do to improve it.

One of my clients calls me her "food therapist." I love that. We all have a relationship with food - but is the relationship nourishing us, or is it harming us?

Eating more mindfully is the first step in uncovering what that relationship looks like - and what it COULD look like.
​
Want to learn more? Comment below or send me a message. If you'd like more personalized guidance, schedule an appointment or a free 15-minute discovery call with me. I'd love to work with you.