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If you deal with depression, you're probably familiar with serotonin--the all-important mood-stabilizing neurotransmitter. Many antidepressant medications target it, and individuals with depressive disorders often seem to have lower levels. Serotonin is incredibly important.
But depression isn't just about serotonin. It's not just about neurotransmitters at all. Today, I want to talk a little bit about the role of hormones and how your hormone balance (or imbalance) can play a role in mood and depression.
But depression isn't just about serotonin. It's not just about neurotransmitters at all. Today, I want to talk a little bit about the role of hormones and how your hormone balance (or imbalance) can play a role in mood and depression.
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.
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.
- Published on
Can Good Nutrition Help Prevent Postpartum Depression? (Part 3: The Gut Microbiome and Inflammation)
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.
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?
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:
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.
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.
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.
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.
Erica Golden, RDN, IFNCP
Integrative and functional registered dietitian nutritionist.
Food therapist.
Nutritional psychiatrist.
Mama.
- Published on
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).
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:
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:
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?
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?
Erica Golden, RDN, IFNCP
Integrative and functional registered dietitian nutritionist.
Food therapist.
Nutritional psychiatrist.
Mama.
- Published on
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.
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.
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.
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.
Erica Golden, RDN, IFNCP
Registered Dietitian Nutritionist with a passion for helping people improve their mental health and gut health using integrative and holistic therapies.
- Published on
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 single 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:
- Low in added sugar
- Less processed
- High in fiber
- Appropriate serving sizes
- 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 several states throughout the US, and I’d love to work with you!
Erica Golden, RDN, LD, IFNCP
Mental Health, Eating Disorders, and Gut Health Functional Dietitian Nutritionist
- Published on
In the realm of nutritional psychiatry, some of the best evidence is for the ability of omega-3 fatty acids, and specifically fish oil (which contains fatty acids called EPA and DHA, among others) to help treat depression.
So what exactly is the evidence, and what do we do with it?
To start, let’s first define what we mean by fish oil. Out of all the different types of fats and oils, there are just a couple that are considered essential for our bodies – meaning that we can’t make them on our own. One of those essential fatty acids is ALA, or alpha linolenic acid, an omega-3 fatty acid. (The other is LA, or linoleic acid, an omega-6 fatty acid.) ALA is considered essential because it is the precursor to two very important fatty acids: DHA and EPA.
However, a relatively small percentage of ALA is actually converted to either of these in most people. So while we can certainly eat flax seed, chia seeds, and walnuts and get a fair amount of ALA from these foods, the most efficient way to get EPA and DHA is to eat fish, especially the cold water oily fish like salmon, sardines, anchovies, herring, and mackerel, or sea vegetables like nori (seaweed) or dulse (kelp).
The average healthy person can meet their needs for EPA and DHA by eating a serving of fish twice a week (preferably fish that is responsibly sourced and low in mercury).
But for some people, that may not actually be enough to meet their needs for optimal health. Some mental health conditions appear to make this list.
I want to preface by saying that a fish oil supplement is not for everyone. Decisions about supplements should always be made in discussion with a doctor or dietitian, because there may be interactions with other medications or concerns about other conditions that could actually make taking some supplements dangerous. For example, fish oil can increase bleeding risk and interact with some medications, like blood thinners. There also has been some evidence that for some people and some conditions, the risks can outweigh the benefits, so a conversation with a knowledgeable professional is always a good idea.
For major depressive disorder specifically, however, the evidence is mounting that routine supplementation with EPA can make a significant difference in depressive symptoms. There’s a good chance that one day soon, fish oil supplements may be standard of care either as a first-line therapy or an adjunctive treatment (meaning, alongside standard medication).
The dosages looked at in most studies is around 2 grams per day (for reference, you can get about 2 grams from a 4-ounce serving of salmon). Some of the mixed results in the research seem to come from varying amounts of EPA and DHA in the supplements the studies used. For major depression, most of the evidence seems to point to either pure EPA or at least a 2:1 ratio of EPA to DHA.
The link between omega-3s and depression seems to lie in the inflammatory nature of depression. Studies have shown that people with higher levels of chronic inflammation linked to depression are more likely to respond to treatment with EPA.
Again, before starting any new supplement, it's always prudent to talk to a health professional familiar with your personal needs and conditions, as well as with expertise in mental health treatment. It's often a good idea to use foods first to improve your nutritional status, rather than jumping straight into supplements. You might consider starting with increasing your intake of oily fish and trying sea vegetables first. If you do decide to take a supplement, collaborate with a healthcare professional to help you make an informed decision about which supplement type and brand to take.
Interested to learn more? If you have any questions, feel free to comment below or message me directly. 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.
So what exactly is the evidence, and what do we do with it?
To start, let’s first define what we mean by fish oil. Out of all the different types of fats and oils, there are just a couple that are considered essential for our bodies – meaning that we can’t make them on our own. One of those essential fatty acids is ALA, or alpha linolenic acid, an omega-3 fatty acid. (The other is LA, or linoleic acid, an omega-6 fatty acid.) ALA is considered essential because it is the precursor to two very important fatty acids: DHA and EPA.
However, a relatively small percentage of ALA is actually converted to either of these in most people. So while we can certainly eat flax seed, chia seeds, and walnuts and get a fair amount of ALA from these foods, the most efficient way to get EPA and DHA is to eat fish, especially the cold water oily fish like salmon, sardines, anchovies, herring, and mackerel, or sea vegetables like nori (seaweed) or dulse (kelp).
The average healthy person can meet their needs for EPA and DHA by eating a serving of fish twice a week (preferably fish that is responsibly sourced and low in mercury).
But for some people, that may not actually be enough to meet their needs for optimal health. Some mental health conditions appear to make this list.
I want to preface by saying that a fish oil supplement is not for everyone. Decisions about supplements should always be made in discussion with a doctor or dietitian, because there may be interactions with other medications or concerns about other conditions that could actually make taking some supplements dangerous. For example, fish oil can increase bleeding risk and interact with some medications, like blood thinners. There also has been some evidence that for some people and some conditions, the risks can outweigh the benefits, so a conversation with a knowledgeable professional is always a good idea.
For major depressive disorder specifically, however, the evidence is mounting that routine supplementation with EPA can make a significant difference in depressive symptoms. There’s a good chance that one day soon, fish oil supplements may be standard of care either as a first-line therapy or an adjunctive treatment (meaning, alongside standard medication).
The dosages looked at in most studies is around 2 grams per day (for reference, you can get about 2 grams from a 4-ounce serving of salmon). Some of the mixed results in the research seem to come from varying amounts of EPA and DHA in the supplements the studies used. For major depression, most of the evidence seems to point to either pure EPA or at least a 2:1 ratio of EPA to DHA.
The link between omega-3s and depression seems to lie in the inflammatory nature of depression. Studies have shown that people with higher levels of chronic inflammation linked to depression are more likely to respond to treatment with EPA.
Again, before starting any new supplement, it's always prudent to talk to a health professional familiar with your personal needs and conditions, as well as with expertise in mental health treatment. It's often a good idea to use foods first to improve your nutritional status, rather than jumping straight into supplements. You might consider starting with increasing your intake of oily fish and trying sea vegetables first. If you do decide to take a supplement, collaborate with a healthcare professional to help you make an informed decision about which supplement type and brand to take.
Interested to learn more? If you have any questions, feel free to comment below or message me directly. 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.
Erica Golden, RDN, LD, IFNCP
Mental health nutritionist / Eating disorder dietitian
@nourishedmindnutrition
- Published on
In order to talk about the gut-brain axis, we have to start with a basic understanding of the gut and of the brain.
(As an aside, I believe health literacy, or understanding what's going on inside your body, is so, so important in understanding when and why things go wrong, making educated decisions on how to manage things on your own, and knowing how and when to seek treatment when it's needed. So try to stick with me if you can!)
In case it's been a minute since biology class, let's start with a brief review of the process of digestion.
When you eat, food moves through your mouth, where the process of digestion starts, down your esophagus, and into your stomach.
While there, acidic digestive juices work on breaking it down chemically, while the rhythmic motions of your stomach work on breaking it down physically. When it's ready, it moves next into the small intestine.
The small intestine is narrow, but it's incredibly long (approximately 22 feet!) and covered in microvilli, small hair-like projections on the surface of the intestinal epithelial cells that make its surface area somewhere in the neighborhood of 2700 square feet. All this surface area is vital to getting as many nutrients as possible absorbed from your food into the blood, including broken-down carbohydrates (monosaccharides), amino acids, fatty acids, vitamins, and minerals.
What isn't absorbed in the small intestine keeps on moving and ends up in the large intestine - which is a comparatively measly foot-and-a-half in length, but much wider. In the large intestine, the body focuses on absorbing water and a few last nutrients, like electrolytes, biotin, and vitamin K.
Most of the digested food that enters the large intestine has been reduced to fiber, water, and waste products. Fiber is actually a type of carbohydrate that our bodies cannot digest.
Fortunately, our large intestines are filled with critters that can digest that fiber - our intestinal microbiota. Our bacterial friends ferment (break down) fibers from plant foods that we eat into energy for themselves, and into short-chain fatty acids (SCFAs) for us. These short-chain fatty acids, like butyrate, proprionate, and acetate, are things that we can't produce for ourselves, but that become the main source of energy for the cells lining our large intestines (among other important functions).
By the time the continued rhythmic movements throughout your intestines have brought the waste products to the end of the line, it's been a couple of days - approximately 5 hours in the stomach, 5 hours in the small intestine, and anywhere 10-70 hours in your large intestine.
While you are focused on chewing and swallowing, your body and brain are hard at work sending and receiving messages. Multiple hormones are released by the stomach, the small intestine, and the large intestine as the food you're eating moves through your digestive system. Other digestive organs, like the pancreas and liver, are activated, and send in enzymes to help with the process of breaking down foods into their nutrient components.
After you eat, the vagus nerve, the longest and most complex of all the cranial nerves, lights up with communication between your brain and your gut, as your digestive system reports back to the brain on the meal you are digesting.
The nutrients absorbed into the body, including vitamins, minerals, amino acids, glucose (sugar), short-chain fatty acids, etc., as well as the hormones produced in the gut, can also themselves send messages to the brain. Some nutrients are able to pass through the blood-brain barrier (the "wall" separating the brain from the rest of the body and protecting it from harmful substances) into the brain, directly impacting brain function (things like increasing or decreasing levels of different neurotransmitters, increasing or decreasing inflammation in the brain, increasing or decreasing different hormones... etc.).
Additionally, problems in the gut (such as irritation and inflammation) are communicated to the brain and can lead to some pretty dramatic shifts in mood, cognition, stress, and anxiety.
This connection between the gut and the brain is obviously very complex - much more so than we can address in this one blog. But the constant two-way communication happening between these two important body systems is part of why the gut has begun to be called the "second brain" or the "gut brain" - technically known as the enteric nervous system.
It's clear from the research that we have to stop thinking about mental illness as being "all in the brain." The gut-brain axis is just one example of how interconnected all of our body systems are.
Say it with me:
Mental health is HEALTH.
Want to learn more? Reach out. I'd love to work with you. And if you're interested in future posts, be sure to sign up for updates or check back soon for more to come on strategies for using our "gut brain" to improve the health of our "main brain."
(As an aside, I believe health literacy, or understanding what's going on inside your body, is so, so important in understanding when and why things go wrong, making educated decisions on how to manage things on your own, and knowing how and when to seek treatment when it's needed. So try to stick with me if you can!)
In case it's been a minute since biology class, let's start with a brief review of the process of digestion.
When you eat, food moves through your mouth, where the process of digestion starts, down your esophagus, and into your stomach.
While there, acidic digestive juices work on breaking it down chemically, while the rhythmic motions of your stomach work on breaking it down physically. When it's ready, it moves next into the small intestine.
The small intestine is narrow, but it's incredibly long (approximately 22 feet!) and covered in microvilli, small hair-like projections on the surface of the intestinal epithelial cells that make its surface area somewhere in the neighborhood of 2700 square feet. All this surface area is vital to getting as many nutrients as possible absorbed from your food into the blood, including broken-down carbohydrates (monosaccharides), amino acids, fatty acids, vitamins, and minerals.
What isn't absorbed in the small intestine keeps on moving and ends up in the large intestine - which is a comparatively measly foot-and-a-half in length, but much wider. In the large intestine, the body focuses on absorbing water and a few last nutrients, like electrolytes, biotin, and vitamin K.
Most of the digested food that enters the large intestine has been reduced to fiber, water, and waste products. Fiber is actually a type of carbohydrate that our bodies cannot digest.
Fortunately, our large intestines are filled with critters that can digest that fiber - our intestinal microbiota. Our bacterial friends ferment (break down) fibers from plant foods that we eat into energy for themselves, and into short-chain fatty acids (SCFAs) for us. These short-chain fatty acids, like butyrate, proprionate, and acetate, are things that we can't produce for ourselves, but that become the main source of energy for the cells lining our large intestines (among other important functions).
By the time the continued rhythmic movements throughout your intestines have brought the waste products to the end of the line, it's been a couple of days - approximately 5 hours in the stomach, 5 hours in the small intestine, and anywhere 10-70 hours in your large intestine.
While you are focused on chewing and swallowing, your body and brain are hard at work sending and receiving messages. Multiple hormones are released by the stomach, the small intestine, and the large intestine as the food you're eating moves through your digestive system. Other digestive organs, like the pancreas and liver, are activated, and send in enzymes to help with the process of breaking down foods into their nutrient components.
After you eat, the vagus nerve, the longest and most complex of all the cranial nerves, lights up with communication between your brain and your gut, as your digestive system reports back to the brain on the meal you are digesting.
The nutrients absorbed into the body, including vitamins, minerals, amino acids, glucose (sugar), short-chain fatty acids, etc., as well as the hormones produced in the gut, can also themselves send messages to the brain. Some nutrients are able to pass through the blood-brain barrier (the "wall" separating the brain from the rest of the body and protecting it from harmful substances) into the brain, directly impacting brain function (things like increasing or decreasing levels of different neurotransmitters, increasing or decreasing inflammation in the brain, increasing or decreasing different hormones... etc.).
Additionally, problems in the gut (such as irritation and inflammation) are communicated to the brain and can lead to some pretty dramatic shifts in mood, cognition, stress, and anxiety.
This connection between the gut and the brain is obviously very complex - much more so than we can address in this one blog. But the constant two-way communication happening between these two important body systems is part of why the gut has begun to be called the "second brain" or the "gut brain" - technically known as the enteric nervous system.
It's clear from the research that we have to stop thinking about mental illness as being "all in the brain." The gut-brain axis is just one example of how interconnected all of our body systems are.
Say it with me:
Mental health is HEALTH.
Want to learn more? Reach out. I'd love to work with you. And if you're interested in future posts, be sure to sign up for updates or check back soon for more to come on strategies for using our "gut brain" to improve the health of our "main brain."
Erica Golden, RDN, LD, IFNCP
Gut Health & Mental Health Dietitian
@nourishedmindnutrition
- Published on
Inflammation has become a buzz word in our modern health landscape. In the biochemical reality of our bodies, it's actually a pretty complex thing, but the benefit of thinking of things from an inflammation perspective is that we can see the relationships between many conditions and diseases that we never would have connected otherwise - from depression to diabetes to arthritis.
But let's start with the reason inflammation exists. It's actually a healthy process that happens in our bodies in response to injury or infection, for example. There's a trigger, an inflammatory cascade that usually involves redness, warmth, swelling, some loss of function, and some pain, and then resolving of those symptoms as the injury or infection is healed. Inflammation can be visible or invisible, on the surface of the skin or deep within the body. Either can be perfectly normal.
But too often, when the conditions are right, the inflammation happens at the wrong time and/or doesn't do anything productive and/or doesn't go away when it should. And that's what we call chronic inflammation.
Inflammation is often totally hidden from view unless you know where to look. I like to imagine chronic inflammation as a fire, smoldering throughout a person's body, showing up in all kinds of different places and ways. As time has gone by and more and more research has been done on inflammation, we've found it connected with all kinds of diseases we might never have imagined.
All the diseases that end with -itis (arthritis, bursitis, myelitis, hepatitis, sinusitis... you get the idea) are diseases of inflammation. But then there are diseases like heart disease, diabetes, allergies, COPD, chronic fatigue, depression, irritable bowel syndrome (IBS), Crohn's disease, fibromyalgia, and many, many more.
The symptoms of these disease are variable depending on the area that is affected first. But we see a lot of commonalities in them when we start to look inside the person. Just like acute inflammation causes pain, often, so too does chronic inflammation. It may be isolated to one area of the body, or it may be wide-spread. Just like acute inflammation causes loss of function, often, so too does chronic inflammation. Again, it is sometimes specific to one area of the body or brain, and other times to the body as a whole.
From an internal perspective, we often see metabolic abnormalities (changes in the way that energy is created and stored), hormonal imbalances, organ dysfunction, elevated stress indicators (such as cortisol), dysbiosis (imbalance of the bacteria living in the gut), changes in immune function, and changes in the permeability of some of the important membranes in the body (like the intestinal wall and the blood-brain barrier).
All of these diseases are caused by a complex network of triggers. Our genetics often plays a role, but is generally not our destiny. Sometimes, there is one major trigger that sets the whole body ablaze with inflammation. Often, it's a combination of multiple factors: genetics, prenatal and early life triggers, stress (including trauma), environmental triggers, dietary and lifestyle triggers, chronic infections, and more. That means that treating just one of these factors alone is usually not enough. We have to treat holistically (the whole person).
Modern medicine tends to treat the symptoms of all of these conditions, usually with medication. But trying to heal chronic inflammation by merely treating the symptoms of chronic inflammation is like trying to put out a campfire by blowing out your burning marshmallow. It often allows people to be able to function again, which is amazing and wonderful and totally not to be discounted. And medication certainly may be a part of a holistically-built long-term treatment plan. But often, it only masks the problem in one area of the body or mind, only to see it crop up again in another area.
A better approach?
Let's dig down and find the root causes of the chronic inflammation. Let's find the underlying imbalances in the body and mind. Let's treat those, with gentle, compassionate care.
But let's start with the reason inflammation exists. It's actually a healthy process that happens in our bodies in response to injury or infection, for example. There's a trigger, an inflammatory cascade that usually involves redness, warmth, swelling, some loss of function, and some pain, and then resolving of those symptoms as the injury or infection is healed. Inflammation can be visible or invisible, on the surface of the skin or deep within the body. Either can be perfectly normal.
But too often, when the conditions are right, the inflammation happens at the wrong time and/or doesn't do anything productive and/or doesn't go away when it should. And that's what we call chronic inflammation.
Inflammation is often totally hidden from view unless you know where to look. I like to imagine chronic inflammation as a fire, smoldering throughout a person's body, showing up in all kinds of different places and ways. As time has gone by and more and more research has been done on inflammation, we've found it connected with all kinds of diseases we might never have imagined.
All the diseases that end with -itis (arthritis, bursitis, myelitis, hepatitis, sinusitis... you get the idea) are diseases of inflammation. But then there are diseases like heart disease, diabetes, allergies, COPD, chronic fatigue, depression, irritable bowel syndrome (IBS), Crohn's disease, fibromyalgia, and many, many more.
The symptoms of these disease are variable depending on the area that is affected first. But we see a lot of commonalities in them when we start to look inside the person. Just like acute inflammation causes pain, often, so too does chronic inflammation. It may be isolated to one area of the body, or it may be wide-spread. Just like acute inflammation causes loss of function, often, so too does chronic inflammation. Again, it is sometimes specific to one area of the body or brain, and other times to the body as a whole.
From an internal perspective, we often see metabolic abnormalities (changes in the way that energy is created and stored), hormonal imbalances, organ dysfunction, elevated stress indicators (such as cortisol), dysbiosis (imbalance of the bacteria living in the gut), changes in immune function, and changes in the permeability of some of the important membranes in the body (like the intestinal wall and the blood-brain barrier).
All of these diseases are caused by a complex network of triggers. Our genetics often plays a role, but is generally not our destiny. Sometimes, there is one major trigger that sets the whole body ablaze with inflammation. Often, it's a combination of multiple factors: genetics, prenatal and early life triggers, stress (including trauma), environmental triggers, dietary and lifestyle triggers, chronic infections, and more. That means that treating just one of these factors alone is usually not enough. We have to treat holistically (the whole person).
Modern medicine tends to treat the symptoms of all of these conditions, usually with medication. But trying to heal chronic inflammation by merely treating the symptoms of chronic inflammation is like trying to put out a campfire by blowing out your burning marshmallow. It often allows people to be able to function again, which is amazing and wonderful and totally not to be discounted. And medication certainly may be a part of a holistically-built long-term treatment plan. But often, it only masks the problem in one area of the body or mind, only to see it crop up again in another area.
A better approach?
Let's dig down and find the root causes of the chronic inflammation. Let's find the underlying imbalances in the body and mind. Let's treat those, with gentle, compassionate care.
Erica Golden, RDN, LD, IFNCP
Gut Health & Mental Health Dietitian
@nourishedmindnutrition
- Published on
The brain is a complex and incredible thing.
When you think about everything it does, from keeping us breathing to playing the piano to swimming laps to doing complex calculus to learning languages to inventing new electronics to falling in love...
it's easy to imagine why some things go wrong. Why the brain needs so many different nutrients to do all the different things it does. Why it uses an incredible amount of energy to do its job. Why it is so sensitive to changes in the environment.
Nutritional psychiatry and its sister, nutritional psychology, are the new realms of research and clinical practice that are looking into how we can support brain function and treat mental illness with nutrition.
We know that some diet patterns can help to improve symptoms of mental illness, and that while there are some stand-out foods and nutrients, a whole-diet approach seems to be the best approach.
We also know that nutritional deficiencies are common in the US population in general, but that they seem to be even more common in those with mental health challenges.
We also know that the microbiota-gut-brain axis plays a huge role in our mental and emotional wellbeing and resilience.
I believe nutritional psychiatry works best in combination with therapy, exercise, and in some cases, mental health medications that work together with nutritional approaches to treat the mental illness. Because mental illness is often multifactorial in cause, we also need to use multiple modalities to treat it. However, nutrition is an incredibly powerful tool that can benefit everyone working on their mental and emotional wellness.
When you think about everything it does, from keeping us breathing to playing the piano to swimming laps to doing complex calculus to learning languages to inventing new electronics to falling in love...
it's easy to imagine why some things go wrong. Why the brain needs so many different nutrients to do all the different things it does. Why it uses an incredible amount of energy to do its job. Why it is so sensitive to changes in the environment.
Nutritional psychiatry and its sister, nutritional psychology, are the new realms of research and clinical practice that are looking into how we can support brain function and treat mental illness with nutrition.
We know that some diet patterns can help to improve symptoms of mental illness, and that while there are some stand-out foods and nutrients, a whole-diet approach seems to be the best approach.
We also know that nutritional deficiencies are common in the US population in general, but that they seem to be even more common in those with mental health challenges.
We also know that the microbiota-gut-brain axis plays a huge role in our mental and emotional wellbeing and resilience.
I believe nutritional psychiatry works best in combination with therapy, exercise, and in some cases, mental health medications that work together with nutritional approaches to treat the mental illness. Because mental illness is often multifactorial in cause, we also need to use multiple modalities to treat it. However, nutrition is an incredibly powerful tool that can benefit everyone working on their mental and emotional wellness.
Erica Golden, RDN, LD, IFNCP
Gut Health & Nutritional Psychiatry
@nourishedmindnutrition