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.

​
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.
​
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.

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!