Authored by Dr. Aidanne

What is Acne?
Acne refers to the inflammation and irritation of the hair follicle that results in trapped oils (also known as “sebum”), skin cells, and various bacteria known as C. acnes that populate the skin surface. When trapped, this mix of materials can produce what we know as pimples that are characteristic of acne. Pimples can come in many forms and show as either white heads, black heads, raised bumps or cysts deep under the skin surface. They are commonly located on the face, arms, chest and back. Whether it is showing as a single pimple or more widespread, the pressure of a clogged follicle can become very painful and lead to scarring.

What Causes Acne?
I hear this question frequently in clinic, and there is no one catch all answer for everyone. Some people may have a single key root cause while others may have a combination of triggers. This is where blood work and functional lab testing are useful to guide proper management of acne.

As with most conditions, acne has both modifiable and unmodifiable risk factors. Modifiable factors are those that are within our control to change. Unmodifiable are those that are out of our control.

Here are some of the most common modifiable triggers for acne:

• Hormonal Changes (ie. estrogen, testosterone, DHT, DHEA, etc.)
• Diet & Food Sensitivities
• Blood Sugar Regulation (ie. Glucose, insulin)
• Stress (ie. Cortisol)
• Nutrient deficiencies

Here are some of the most common unmodifiable triggers for acne:

• Age
• Genetics / Family History

Hormones:
Androgens and androgen precursors are hormones that can lead to acne when elevated. These include testosterone, DHEA, and DHT. The latter has nearly four times the potency of testosterone. These hormones increase the amount of sebum that is produced, which can clog the pores more frequently leading to increased acne. Also, fluctuations in estrogen and progesterone throughout the menstrual cycle can also worsen acne.

Diet & Blood Sugar Regulation:
You may have experienced a pimple or two after eating a lot of baked goods or sugary foods. When we eat foods that are high on the glycemic index, our blood sugar levels go up. Given insulin’s main job is to remove sugars from the blood stream and send them to the tissues to be burned for fuel, a high blood sugar level causes insulin to rise. Elevated insulin levels can drive the production of androgens, thus leading to increased sebum production.

Whey is a protein found in dairy that can trigger acne for a couple of reasons. When consumed regularly, food sensitivities can result in GI related inflammation that weakens the skin barrier. Many people do not tolerate dairy well, and this is often due to either its lactose or whey content. Secondly, consuming whey leads the body to make a chemical called Insulin Like Growth Factor (IGF-1) which triggers cells to grow. What is one of the main hormones that causes tissue growth? Yet again, the answer is testosterone!

Stress:
When stressed, the body makes various hormones to drive the “fight or flight” response. The adrenal glands are the primary source of two key hormones in this process, DHEA and Cortisol. DHEA can be converted into testosterone in the body, and cortisol spikes increase circulating blood sugars so that the body has quick fuel if it needs to act quickly.

Adaptogens are a group of botanical medicines that help the body “adapt” to the stress response and improve stress resiliency. I often include an adaptogen as part of an acne protocol.

Nutrient Deficiencies:
Those living with acne have been found in the literature to be more likely to have low Vitamin A, Vitamin D, Vitamin E and zinc status compared to their counterparts. Where it’s hard to say whether these deficiencies are a main cause acne, their supplementation has been shown to improve the intensity of acne, reduce inflammation, and help skin cells heal.

Authored by Dr. Barrett

Authored by Dr. Aidanne

Up to 7% of women do not experience any symptoms but most women will present with cyclical or chronic pelvic pain, painful intercourse, intense menstrual cramps, fatigue, back pain, bloating, nausea, and infertility (nearly 50%). This pain can severely impact one’s quality of life, mood and sense of self. 

The inner lining of the uterus is meant to respond to estrogen with changes in the menstrual cycle. When found outside of the uterus, this endometrial tissue can wreak havoc on organs and systems due to both its physical presence as well as the inflammatory response it exerts on the local nerves when exposed to estrogen. Up to 7% of people do not experience any symptoms but most people will present with cyclical or chronic pelvic pain, painful intercourse, intense menstrual cramps, fatigue, back pain, bloating, nausea, and infertility (nearly 50%). This pain can severely impact one’s quality of life, mood and sense of self. 

The risk of endometriosis goes up if you have a family history, early onset of menstruation, late menopause, heavy and short menstrual cycles, or have never had a pregnancy. 

The goal of supporting a person with endometriosis is to support clearance of estrogens to lower their effect on the system, alleviate pain, and reduce inflammation. Often women are told that they simply have heavy periods, and they’ll have to either live with it or go on birth control. Although birth control can provide relief, there are other options available. Let’s dive in!

Diet:
​
As elevated sugar in the diet can increase our estrogen levels, minimizing excess carbohydrates and sugar is key in reducing pain symptoms of endometriosis. 

Since we eliminate hormone metabolites through our stool, ensuring that bowel movements are well-formed and easy to pass is important to avoid reabsorbing estrogen. Fibers such as those that come from ground flax seed can help with this and can also reduce estrogen in the blood stream by increasing the level of sex hormone binding globulin (SHBG). 

Antioxidants are needed to offset the oxidative stress that occurs with inflammation. Foods that had a mother and are colorful are typically antioxidant rich, such as green leafy veggies, berries, red onion, carrots, etc. 

Finally, the cruciferous family of veggies (ie. broccoli, cauliflower, Brussels sprouts, etc.) contain compounds in them called indol-3-carbinol (I3C) and diindolylmethane (DIM) which help metabolize estrogens to the lower potency, 2-hydroxyestrone form. 

Food is medicine!

Lifestyle:

The best lifestyle factors to improve symptoms of endometriosis include movement, reducing exposure to environmental estrogens also known as xenoextrogens, and using castor oil packs. 

Movement can have a positive impact on all body systems. In this case, it encourages the muscles to utilize the sugars within our blood stream. When blood glucose levels are reduced, so is the hormone needed to take them out of the blood stream known as insulin. High levels of insulin dampen our liver’s ability to produce SHBG which allows estrogen to roam more freely in the blood stream and exert its effect on bodily tissues. 

Xenoestrogens can come from various sources such as plastics (BPA, BPS), polychlorinated biphenyl (PCB), phthalates in cosmetic products, pesticides, cigarette smoke, exhaust, chemical pollutants, etc. These synthetic estrogen mimicking components can be reduced by:

• Switching to a stainless-steel water bottle
• Buying organic where possible
• Dusting & vacuuming regularly 
• Incorporating EWG approved unscented & phthalate free cosmetic products
• Cooking with cast iron
• Using glass storage containers vs. plastic and avoiding heating plastics

Although the mechanism is not fully clear, castor oil is known to have anti-inflammatory and analgesic effects when used topically. It can be applied to the abdomen or pelvis to alleviate pain symptoms. Talk to your naturopathic doctor to learn more! 

Botanicals & Nutritional Supplementation:

Botanical & nutritional medicines can be used to support the liver in clearing estrogens, bring blood sugars into balance, and alleviate pain by reducing inflammation. 

Common recommendations would include:

• Hormone Regulators – Chaste tree verry, 
• Antioxidants – Melatonin, Resveratrol, EGCg, Pycnogenol
• Anti-inflammatories – Turmeric, Cat’s Claw, Ginger, Garlic
• Liver Supporting – Milk thistle, NAC, Burdock

A placebo-controlled study from 2013 in Brazil showed that melatonin at a dose of 10mg nightly was able to reduce daily pain scores by nearly 40% when taken for 8-weeks. This affect was attributed to melatonin’s ability to decrease both reduce pain on its own and lower levels of a protein called brain-derived neurotrophic factor (BDNF) which makes the nerves more sensitive to pain. 

A 2021 randomized control trial conducted in Iran showed that 400mg of garlic extract taken daily for 1-3 months could improve pelvic pain, low back pain, heavy menstrual bleeding, and painful intercourse. This effect was attributed to garlic’s ability to support estrogen clearance in the liver and its anti-inflammatory Allicin content. 

Interested in learning more? Let’s chat!

References:

1. Schenken, RS. Endometriosis: Pathogenesis, epidemiology, and clinical impact. UpToDate. Updated: Feb 13, 2023. Accessed: Apr 6, 2023.
2. Endometriosis. World Health Organization. Accessed from this link. 
3. Prousky, J. Textbook of Integrative Clinical Nutrition. CCNM Press. 2013.
4. Daka B, Rosen T, Jansson PA, Råstam L, Larsson CA, Lindblad U. Inverse association between serum insulin and sex hormone-binding globulin in a population survey in Sweden. Endocr Connect. 2012;2(1):18-22.
5. Ilhan M, Dereli FTG, Akkol EK. Novel drug targets with traditional herbal medicines for overcoming endometriosis. Curr Drug Deliv. 2019;16(5):386-399.
6. Schwertner A, Conceição dos Santos CC, Costa GD, et al. Efficacy of melatonin in the treatment of endometriosis: A phase II, randomized, double-blind, placebo-controlled trial. Pain. 2013;154(6):874-881.
7. Amirsalari S, Behboodi Moghadam Z, Taghizadeh Z, Jafar Abadi MN, Sabaghzadeh Irani P, Goodarzi S, Ranjbar H. The Effect of Garlic Tablets on the Endometriosis-Related Pains: A Randomized Placebo-Controlled Clinical Trial. Evid Based Complement Alternat Med. 2021 Jul 20;2021:5547058. doi: 10.1155/2021/5547058. PMID: 34335819; PMCID: PMC8315864.

Authored by Dr. Barrett

Authored by Dr. Aidanne

Since the onset of the COVID19 pandemic, researchers and medical professionals have found that the SARs-CoV2 virus can both worsen outcomes for those living with pre-existing cardiovascular disease (CVD) risk factors and increase risk in of CVD outcomes in otherwise healthy individuals.

Those living with hypertension, arrhythmias, poor circulation, diabetes, and dyslipidemia are significantly more susceptible to blood clots, stroke, and inflammation of the heart (aka pericarditis) after infection with COVID19.

But how does the SARs-CoV2 virus exert this effect?

To thrive in a host environment, a virus must first find a molecule on the cell surface to hijack in order to gain entry to the cell. In the case of SARs-CoV2, it hijacks the ACE2 transporter which can be found in cells of our heart, lung, kidneys, nose, mouth, and intestines causing ACE2 enzyme levels to go down. Some major roles of the ACE2 enzyme include keeping our blood pressure tightly regulated and heart beating strongly. Low ACE2 levels can therefore contribute to weakened heart contractions, poor circulation to the heart’s ventricles, and worsened diastolic hypertension.

Once entry into the cell is achieved, the virus causes a cascade of inflammation which drives the production of reactive oxygen species (ROS). ROS can be damaging to the cells, and this is especially true for the cells that line our blood vessels. Injury to the blood vessel causes the vessel walls to constrict, leading blood pressure to go up. Clotting factors also become activated in an attempt to heal the injured tissue, and platelets are made in greater numbers to help fight off the infection. Both clotting factors and platelets thicken the blood and slow circulation with goal of forming a clot. On the skin surface this process would look like the formation of a scab. To coat and reinforce the damaged blood vessel itself, cholesterol and immune cells also come together to lay a fatty steak foundation that sets off the process of atherosclerosis and plaque formation. Together, these processes increase the risk of stroke and heart attack.

Finally, the heart cells themselves can become injured after infection which can be seen from testing markers of cardiac inflammation such as D-dimer, fibrinogen, prothrombin time, and troponin T levels.

Although most people recover once the infection is cleared, some have a hard time overcoming the inflammatory response. In the short term, inflammation plays a protective role to help us fight the virus and activate the immune system. But inflammation in the long term can become detrimental and shows in the cardiovascular system as hardening of the heart muscle, atherosclerosis, altered coordination of nerve signals that regulate the heart’s rhythm, or postural orthostatic tachycardia syndrome (PoTS). There is a lot we still need to learn about what leads one person to respond so differently than another to a SARs-CoV2 infection, so hopefully future research will be able to speak to these knowledge gaps.

In the meantime, naturopathic medicine has a major role to play in supporting and preventing cardiovascular risk factors by means of dietary counseling (especially around antioxidants!), lifestyle changes, use of botanical medicines, and targeted nutritional supplementation.

Interested in learning more? Let’s chat!

References:

1. Danilczyk U, Penninger JM. Angiotensin-converting enzyme ii in the heart and the kidney. Circulation Research. 2006;98(4):463-471.
2. ​Raisi-Estabragh Z, Cooper J, Salih A, et al. Cardiovascular disease and mortality sequelae of COVID-19 in the UK Biobank. Heart. 2023;109(2):119-126.
3. Cenko E, Badimon L, Bugiardini R, et al. Cardiovascular disease and covid-19: a consensus paper from the esc working group on coronary pathophysiology & microcirculation, esc working group on thrombosis and the association for acute cardiovascular care (Acvc), in collaboration with the european heart rhythm association(Ehra). Cardiovascular Research. 2021;117(14):2705-2729. – Picture

Authored by Dr. Barrett

The figure above highlights a few hypothesized mechanisms for developing long-COVID. Today we are going to talk about the relationship between autoimmunity and COVID-19.

Autoimmune disease develops when the immune system starts attacking your own tissues. In addition to genetic factors, environmental triggers including viruses, bacteria and other infectious agents play a major role in the development of autoimmune diseases. There are several mechanisms behind these triggers that include but are not limited to molecular mimicry, bystander activation and epitope spreading. In an oversimplified nutshell there can be cases of mistaken identity (molecular mimicry), our immune system getting overexcited (bystander activation), and chronic inflammation (epitope spreading). One major hypothesis regarding COVID-19  and autoimmune disease is that SARS-CoV-2 aggravates the immune system via molecular mimicry and bystander activation. 

There are several ways that autoimmune disease and COVID-19 are interrelated. COVID-19 may trigger new onset of autoimmune disease. Conversely, people with existing autoimmune disease may be at risk for complications from a COVID-19 infection. People who experience ‘long COVID’ have higher incidence of blood markers for autoimmune disease. 

COVID-19 may trigger the development of autoimmune diseases. One study looked at patients hospitalized with COVID-19 and measured their levels of autoantibodies. Autoantibodies are antibodies that attack our own tissues. They found that approximately 50% of patients hospitalized with COVID-19 generated autoantibodies compared to just 15% of non infected individuals. This indicates that SARS-CoV-2 causes development of new autoantibodies which correlates with an autoimmune response. (1)

Patients with autoimmune diseases specifically rheumatic, IBD, and multiple sclerosis appear to be more vulnerable to severe outcomes from COVID-19 infections. One important note is that all of these conditions increase the risk of cardiovascular disease. In many of the studies, once cardiovascular disease is taken into account, the association between autoimmune disease and severe outcomes from COVID-19 isn’t as statistically significant. In a nutshell, it could be not so much the autoimmune piece that increased the risk but the cardiovascular health of the patient (2). We need more research to understand why patients with autoimmune disease may be at a higher risk for complications and severe outcomes from COVID-19.

Patients with long-COVID syndrome exhibit immune characteristics that include higher predisposition to autoimmunity. ANA is a blood marker used to diagnose autoimmune diseases. One study looked at patients who had long-COVID for one year and found a positive ANA in a significant number of patients compared to controls (3). Interestingly these patients also had a poorer antibody response to SARS-CoV-2 and more chronic inflammation. 

It's important to note that while there is evidence suggesting a connection between COVID-19 and autoimmune disease, more research is needed to fully understand the mechanisms behind this association. 

In naturopathic medicine we work to reduce triggers to the immune system, lower systemic inflammation and bring more balance to an overactive immune system. We use a variety of tools including but not limited to nutrition, botanical medicine, microbiome support, mind body medicine, hormone balancing, lifestyle medicine and targeted supplementation. 


References: 

1. Chang SE, Feng A, Meng W, Apostolidis SA, Mack E, Artandi M, Barman L, Bennett K, Chakraborty S, Chang I, Cheung P, Chinthrajah S, Dhingra S, Do E, Finck A, Gaano A, Geßner R, Giannini HM, Gonzalez J, Greib S, Gündisch M, Hsu AR, Kuo A, Manohar M, Mao R, Neeli I, Neubauer A, Oniyide O, Powell AE, Puri R, Renz H, Schapiro J, Weidenbacher PA, Wittman R, Ahuja N, Chung HR, Jagannathan P, James JA, Kim PS, Meyer NJ, Nadeau KC, Radic M, Robinson WH, Singh U, Wang TT, Wherry EJ, Skevaki C, Luning Prak ET, Utz PJ. New-onset IgG autoantibodies in hospitalized patients with COVID-19. Nat Commun. 2021 Sep 14;12(1):5417. doi: 10.1038/s41467-021-25509-3. PMID: 34521836; PMCID: PMC8440763.
2. Winchester N, Calabrese C, Calabrese LH. The Intersection of COVID-19 and Autoimmunity: What is Our Current Understanding? Pathog Immun. 2021 Mar 8;6(1):31-54. doi: 10.20411/pai.v6i1.417. PMID: 33969248; PMCID: PMC8097827.
3. García-Abellán J, Fernández M, Padilla S, García JA, Agulló V, Lozano V, Ena N, García-Sánchez L, Gutiérrez F, Masiá M. Immunologic phenotype of patients with long-COVID syndrome of 1-year duration. Front Immunol. 2022 Aug 24;13:920627. doi: 10.3389/fimmu.2022.920627. PMID: 36090973; PMCID: PMC9451924.
4. Liu Y, Sawalha AH, Lu Q. COVID-19 and autoimmune diseases. Curr Opin Rheumatol. 2021 Mar 1;33(2):155-162. doi: 10.1097/BOR.0000000000000776. PMID: 33332890; PMCID: PMC7880581.
5. Castanares-Zapatero D, Chalon P, Kohn L, Dauvrin M, Detollenaere J, Maertens de Noordhout C, Primus-de Jong C, Cleemput I, Van den Heede K. Pathophysiology and mechanism of long COVID: a comprehensive review. Ann Med. 2022 Dec;54(1):1473-1487. doi: 10.1080/07853890.2022.2076901. PMID: 35594336; PMCID: PMC9132392.

Authored by Dr. Aidanne

Recovering from a COVID19 infection can be challenging enough, let alone living with long COVID symptoms after the infection clears. Digestive upset (ie. nausea, abdominal pain, vomiting) and bowel movement changes are among the more common long COVID symptoms. If you previously lived with a happy gut, this could significantly impact your new day to day life.


And why does it happen? How does the SARS-CoV2 virus affect gut and the microbiome.


To grasp this connection, we must first understand our biology. For those who may be new to this topic, the gut microbiome refers to the community of “flora” including bacteria, yeast, and viruses that colonize our intestines. They are meant to be there in a delicate balance and serve many beneficial purposes. They help us digest our foods, absorb nutrients, keep the intestinal lining healthy, fend off other invaders that may enter the system through our environment, lower inflammation, and make neurotransmitters such as serotonin that communicate with our brain.


This community keeps our bodies running smoothly but their balance is susceptible to damage from exposures in our environment such as infectious disease-causing organisms. We want a variety of beneficial species in the intestines with no one strain becoming dominant.


Various studies have shown that the stool samples of those who have contracted COVID-19 not only have a lower variety of beneficial microbes in their samples compared to a healthy counterpart but they also have a lower quantity of beneficial flora. If you think of the GI tract as a tube that only has so much space for microbes to fill, space that is left empty by the absence of beneficial flora will be filled with more problematic or opportunistic species (ie. Candida, Clostridium, Enterobacter, etc.).


Once these species seize the opportunity to establish themselves in the system, they wreak havoc by first inducing inflammation in the intestinal tissue. This inflammation then signals to the immune cells resting in the brush border of the intestine that we have something to fight off. To kill off these invaders, these local immune cells sound the alarm to their neighbors to make what are called cytokines. These are compounds that help guide the immune response but can further the inflammatory cycle if not kept in check.


Ultimately, the inflammation from this process wears down the protective mucus barrier to the brush border. It can also weaken the bonds called tight junctions that keep the cells of the GI tract close together, and weakened tight junctions contribute to intestinal hyperpermeability or “leaky gut”. If you think of a bucket with holes in it, you can expect that a lot of water will fall through. In a similar vein, if the intestinal lining is leaky we will not be able to digest our foods or absorb our nutrients well which can further contribute to imbalances in the local flora that are not prepared to pick up the leg work in feeding on undigested foods.


To cut this cycle and help the intestinal lining heal, naturopathic medicine offers a diverse set of tools including botanical medicines, probiotics, dietary counseling, and targeted nutritional supplementation.


Are you ready to start your journey? Let’s chat!

​
References:

1. Wang B, Zhang L, Wang Y, et al. Alterations in microbiota of patients with COVID-19: potential mechanisms and therapeutic interventions. Sig Transduct Target Ther. 2022;7(1):1-15.
2. Bernard-Raichon L, Venzon M, Klein J, et al. Gut microbiome dysbiosis in antibiotic-treated COVID-19 patients is associated with microbial translocation and bacteremia. Nat Commun. 2022;13(1):5926.

Authored by Dr. Aidanne

What does testing look like?
An advanced assessment includes testing lipid levels, lipoproteins (proteins that transport lipids in the blood stream), inflammatory markers and hormones.

1) Lipids:
Lipids are fats that our body uses to make hormones, keep our skin vibrant, absorb nutrients, etc. A basic lipid panel is often run as part of routine bloodwork to screen for elevated cholesterol. This includes total cholesterol, HDL, LDL, and triglycerides. Where this is an incredibly important screening measure, it is not comprehensive for assessing overall cardiovascular disease risk.

An NMR Lipo Profile is one example of an extended lipid profile that includes the number and size of each lipid molecule. This is important because smaller lipid molecules are more likely to penetrate an inflamed blood vessel and contribute to plaque.

This test also includes measures of very low-density lipoprotein (VLDL), Apolipoprotein-A and Apolipoprotein-B. VLDL and Apo-B are known to have a high plaque producing potential, where Apo-A is cardio-protective. (2)

2) Inflammatory Markers:
Inflammation plays a leading role in the development of atherosclerosis. (3) Once the inner muscular layer of a blood vessel is irritated and becomes inflamed, it is easier for immune cells and fats to accumulate and produce plaque.

C-reactive protein (CRP) is a protein our body produces in response to inflammation in general. Where it is not specific to the cardiovascular system, it can be a useful marker to track your progress with a treatment plan. (4)

Homocysteine (Hcy) is an inflammatory marker that is more specific to the cardiovascular system. It is the byproduct of protein breakdown that is cleared out of the system with the help of folic acid and other B-vitamins. When elevated, this can be a sign that either:

1. We are not eating enough green leafy vegetables rich in folic acid, OR
2. There is a gene mutation that does not allow the body to make the MTHFR enzyme needed to convert the folic acid we gain from our diet into the methylenetetrahydrofolate (MTHF) form needed for clearing homocysteine.

3) Hormones:
Our bodies make hormones to send signals and ensure the system is operating smoothly. This process can affect how they use fats and sugars. When elevated, thyroid stimulating hormone (TSH), cortisol (the main stress hormones responsible for signaling a fight or flight response in our bodies) and testosterone can cause total cholesterol and LDL levels to rise. (6,7) A similar effect can be seen in response to depleted estrogen levels as a woman experiences menopause.(8)
Insulin is the hormone responsible for drawing sugars out of the blood stream to be burned for fuel in the tissues. When insulin is elevated, this can be a sign that blood sugar levels have been high for a prolonged period which is a potential source of inflammation in the blood vessels.

Do you have a family history of cardiovascular diseases?

Why wait to screen for your cardiovascular status?

Connect with your naturopathic doctor today!


References:

1. CDC. Heart Disease Facts | cdc.gov. Centers for Disease Control and Prevention.
2. Emeasoba EU, Ibeson E, Nwosu I, Montemarano N, Shani J, Shetty VS. Clinical relevance of nuclear magnetic resonance lipoprofile. Front Nucl Med. 2022;2.
3. Malekmohammad K, Bezsonov EE, Rafieian-Kopaei M. Role of lipid accumulation and inflammation in atherosclerosis: focus on molecular and cellular mechanisms. Front Cardiovasc Med. 2021;8.
4. Nehring SM, Goyal A, Patel BC. C reactive protein. In: StatPearls. StatPearls Publishing; 2022.
5.  Maduka IC, Neboh EE, Ufelle SA. The relationship between serum cortisol, adrenaline, blood glucose and lipid profile of undergraduate students under examination stress. Afr Health Sci. 2015;15(1):131-136.
6. Kaur H, Werstuck GH. The effect of testosterone on cardiovascular disease and cardiovascular risk factors in men: a review of clinical and preclinical data. CJC Open. 2021;3(10):1238-1248.
7. Guetta V, Cannon RO. Cardiovascular effects of estrogen and lipid-lowering therapies in postmenopausal women. Circulation. 1996;93(10):1928-1937.

Authored by Dr. Aidanne

What is Gastritis?
Words that end in the Greek derived suffix “itis” indicate a condition that involves significant inflammation. Gastritis is specifically referring to inflammation of the stomach lining. Exposure to chronic irritation over time can cause damaging changes to the gastric tissue, which can eventually lead some to experience ulceration.

Where abdominal pain, heartburn, reflux, nausea, vomiting, anemia or dark stools may be signs of gastritis, not everyone experiences these symptoms. Ultimately, this is diagnosed based on imaging studies and biopsy of the stomach (also known as endoscopy) by a gastroenterologist. (1)

Where does it come from?
This inflammation can be rooted in a few sources, including but not limited to (1,2):

• H. pylori infection
• Bacterial, viral, parasitic, or fungal infections
• Acid reflux or heartburn (chronic)
• Autoimmunity and treatment, including Crohn’s disease
• Gallbladder disease
• Radiation
• Food allergies or intolerances
• Family history
  
  

As the digestive tract is a large tube that processes foods and other substances from the outside world, lifestyle factors that can aggravate the stomach tissue should also be ruled out. A few include:

• Smoking tobacco
• Moderate to excessive alcohol use
• Long term use of certain medications (ie. NSAIDs such as Ibuprophen, etc.)
• ​Significant psychological stress

​How can naturopathic medicine help?

Diet & Lifestyle Counseling:
A key goal in managing gastritis is to lessen the impact of stress on the system, whether that be identifying foods that are irritating to your GI tract or discussing a plan to offset the stress in your life.

When our stomach lining is inflamed, our ability to absorb nutrients properly goes down and deficiencies may result (Ie. Iron, B12, zinc, vitamin C, etc.). Once the inflammation is calmed, repleting these nutrients is key to supporting overall health, immune function, mood, sleep, and energy levels. (3)

Botanical Medicine:
Botanical medicines are a valuable modality when it comes to lowering inflammation in general, especially when it is rooted in the gastrointestinal tract.

1.) Licorice:
One of my favorite botanicals to use in gastritis is licorice because it (4):

• Directly eases irritation of the GI lining
• Has been shown to heal gastric ulcers (5)
• Supports the immune system
• Has antibacterial and antiadhesive effects against H. pylori (5)
• Acts as an adaptogen, which helps improve our resilience to the physical manifestations of stress

When used for this purpose, I typically recommend licorice in the form of de-glycyrrhizinated licorice (DGL). DGL this has the glycyrrhizin compound removed, which is responsible for the blood pressure raising effect of licorice.

2.) Marshmallow, Slippery Elm & Aloe vera:
When you think of marshmallows, a puffy white sugar cube likely comes to mind. Althea officinalis is the scientific name for the marshmallow root, which is rich in a gummy substance called mucilage. Other botanicals rich in mucilage include slippery elm and aloe vera which gives them a “demulcent” or soothing action. Akin to how you would rub Aloe vera on a sunburn to ease the pain, these botanicals can be consumed as an tea or mixed in water to ease the burning symptoms of gastritis. (6)

3.) Cranberry & Mastic Gum:
If H. pylori is identified as a contributing factor by either biopsy or non-invasive tests (Ie. breath, stool, or blood testing), then Cranberry and Mastic gum are two botanical medicines that would support conventional treatment in clearing these bacteria from the system. Cranberry helps to keep the bacteria from adhering to the lining of the stomach, and mastic gum has antibacterial, anti-inflammatory, and tissue healing properties. (7,8,9)

Ready to discuss which approaches are most appropriate for you? Schedule your complimentary discovery call today!

References:

1. Azer SA, Akhondi H. Gastritis. [Updated 2022 Jul 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK544250/
2. Feldman M, Jensen P. Gastritis: Etiology and diagnosis. UptoDate. Updated: July 29, 2022.
3. Gaby A. Nutritional Medicine. Second edition. Fritz Perlberg Publishing; 2017.
4. Murray MT. Glycyrrhiza glabra (Licorice). Textbook of Natural Medicine. 2020:641–647.e3. doi: 10.1016/B978-0-323-43044-9.00085-6. Epub 2020 Jul 10. PMCID: PMC7348626.
5. Wang Q, Yao C, Li Y, Luo L, Xie F, Xiong Q, Feng P. Effect of polyphenol compounds on Helicobacter pylori eradication: a systematic review with meta-analysis. BMJ Open. 2023 Jan 5;13(1):e062932. doi: 10.1136/bmjopen-2022-062932. PMID: 36604137; PMCID: PMC9827256.
6. Hoffman, D. Medical Herbalism: The science and practice of herbal medicine. Healing Arts Press; 2003.
7. Soulaidopoulos S, Tsiogka A, Chrysohoou C, Lazarou E, Aznaouridis K, Doundoulakis I, Tyrovola D, Tousoulis D, Tsioufis K, Vlachopoulos C, Lazaros G. Overview of Chios Mastic Gum (Pistacia lentiscus) Effects on Human Health. Nutrients. 2022 Jan 28;14(3):590. doi:​10.3390/nu14030590. PMID: 35276949; PMCID: PMC8838553.
8. Abdi S, Ataei S, Abroon M, Majma Sanaye P, Abbasinazari M, Farrokhian A. A Comprehensive Review of the Role of Complementary and Dietary Medicines in Eradicating Helicobacter pylori. Iran J Pharm Res. 2022 Jun 18;21(1):e127030. doi: 10.5812/ijpr-127030. PMID: 36060908; PMCID: PMC9420233.
9. Mastic: Pistacia lentiscus. Natural Medicines Database. Updated: 10/4/22. 

Authored by Dr. Aidanne

As iron is a key piece to the hemoglobin protein, low iron levels can result in symptoms of low tissue oxygen such as (1):

• Fatigue
• Shortness of breath
• Dizziness
• Headaches
• Pale skin
• Elevated heart rate
• Nail changes
• Low mood
• ​Brain fog

Where does it come from?
Risk factors for iron deficiency anemia include situations where the demand for iron is higher than the supply to the body. Common examples of this include chronic blood loss, inadequate intake of iron from the diet, poor absorption of iron through the GI tract, or all the above (1):

• Menstruation
• Pregnancy
• Gastrointestinal ulceration or bleeds
• Celiac disease
• Chronic Inflammation (i.e., Cancer, autoimmune conditions, IBD, HIV, etc.)
• Malnutrition in seniors

Testing:
If someone comes to me expressing low energy and any combination of the symptoms mentioned above, iron is high on my list of labs to order.

When assessing iron status, I like to run a complete blood count (CBC), iron panel & ferritin to get a robust picture of how the body is utilizing iron. Looking at an iron panel will show the direct level of iron in the blood stream as well as how efficiently hemoglobin is using it. If you have lived with chronically, over time a CBC will show changes in the size and shape of the red blood cells.

The human body has an incredible ability to heal and store nutrients needed for survival in times of hardship. Ferritin is the form of iron that we keep on reserves. If a CBC and iron panel look normal but the ferritin level is low, this is a warning sign that we are dipping into savings to keep our blood iron levels normal. In that case, our goal is to boost dietary iron intake and support absorption to prevent the progression to anemia.

Repleting our iron stores takes time. I often retest these values after 3-4 months of targeted dietary or supplemental efforts to ensure your body absorbs the iron properly.

Food Sources & Absorption:
Iron comes in two main forms: heme and non-heme. As “heme” is Greek for “blood,” this form of iron is found in foods that contain blood such as animal-based proteins. Non-heme refers to the iron contained in plants, which is not as easy to absorb as its counterpart. (2)
One way that we can improve the absorption of non-heme iron is by accompanying the plant with a source of Vitamin C. (2) Personally, I love to sauté chopped collards or kale and drizzle some lemon juice to garnish for dinners, or add a squeeze of lime juice to the black beans on my tacos. There are so many tasty ways to use food as medicine!

Foods rich in iron include, but are not limited to (3):

• Liver
• Fish, Lean poultry, beef, other meats
• Eggs
• Dark green, leafy vegetables
• Legumes
• Millet & Oatmeal
• Pumpkin seeds

If dietary restrictions prohibit you from eating these foods, supplementation is always an option, but should be coordinated with a health care provider to avoid side effects such as constipation , nausea, etc.

Ready to take back your energy levels? Let’s chat!
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​References:

1. Warner MJ, Kamran MT. Iron Deficiency Anemia. [Updated 2022 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448065/
2. Ems T, St Lucia K, Huecker MR. Biochemistry, Iron Absorption. [Updated 2022 Apr 21]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK448204/
3. https://ods.od.nih.gov/factsheets/Iron-HealthProfessional/ 

Authored by Lynn Salmon-Easter

Summertime brings thoughts of sunshine, carefree schedules, vacations and weekends away at the cabin. Is summer a season that replenishes and restores you? For some of us, summer simply is not a time of year that rejuvenates. As I continue to explore and deepen my understanding of being a highly sensitive person (HSP), I have come to realize summer is a season that holds challenges and triggers for me.

According to leading expert Elaine Aron’s bestselling book, “The Highly Sensitive Person," the highly sensitive trait impacts 15%-20% of the population. Being a highly sensitive person is a scientific personality trait also known as sensory processing sensitivity (SPS). HSPs are naturals when it comes to picking up on subtle cues or stimuli that other people miss. This is due to a nervous system and brain that process deeply and are more in tune with subtleties in the environment.  As a result, highly sensitive people do best with plenty of rest and downtime to regulate their nervous system and replenish their body and mind. 

Are you wondering if you might be a highly sensitive person? If so, you can take this sensitivity quiz developed by expert and sensitivity psychologist, Julie Bjelland. 

Unfortunately, it can be common for those of us that are highly sensitive to feel misunderstood and out of sync with the rhythms of mainstream society. For many years, I convinced myself summer is a season to relish and love. As I have gained greater knowledge about the genetic trait of high sensitivity, I have become more in tune with my personal needs and better acquainted with the environments that overstimulate my body, brain and nervous system. 

Last summer, I became acutely aware that heat, noise and disruptions to my daily routine are all things that stress and overwhelm my nervous system and body. With this realization, I have finally been able to make sense of the seasonal feelings of dread and anxiety that are ushered in with the season of summer for me each year. 

Personally, summer often feels like the odds are stacked against me, with high heat, humidity, noise from road construction and air conditioners plus longer days with fewer hours of sleep. These triggers can all add up to be a formula that challenges me physically and makes me feel like my mental wellness may come unhinged at any moment.

Not all highly sensitive people will find summer to be challenging. In fact, much of the population adores summer, which can make ‘summer blues’ that much more stifling. If summer makes you feel mostly miserable and everyone else seems so happy hanging out in the summer sunshine, it can can make you feel that much more isolated and out of sync with society. 

Specific symptoms of ‘summertime blues’ can look like:

• low moods 
• lack of energy or motivation
• Irritability 
• Anxiety

If your symptoms begin to include loss of appetite, weight loss, trouble sleeping, or you no longer have interest in hobbies or activities that usually excite you, please seek professional help. Summertime SAD (seasonal affective disorder) is a more serious form of ‘summertime blues’ and affects 1 out of 10 people that suffer from seasonal affective disorder.

If you struggle with low moods and lack energy during the summer months, below are some tips that have tamed my ‘summertime blues’ and blahs. I hope these tips might be helpful for you too.

Identify Your Summer Triggers 
It is not exactly known why individuals impacted by ‘summertime blues’ are affected, but it is thought increased heat, higher humidity, longer days and disruptions to routine and schedules may play a role. By identifying your personal summertime challenges, you can begin to develop a plan to manage your triggers in healthy and sustainable ways.

Create A Routine  
If you have struggled with low moods or depression personally, you will know that having a reliable routine is one of the best ways to keep depression symptoms at bay. Unfortunately, summer usually unmoors our daily rhythms and routines and can create chaos within even the most calm individuals and families. Following a consistent schedule each day of the week can assist in stabilizing your moods as well as your life.

Prioritize Sleep
With the longer days of summer, it can be challenging to get enough shut eye to stay feeling mentally well. Purchasing blackout shades or curtains can help create an environment that is conducive for sleeping more hours within a given night. For highly sensitive people, sleep is imperative and is one of the trusted ways to work through the increased information HSPs take in each day. Many sensitive individuals do best with 9-10 hours of sleep each night.

Commit to Self-Care
One of the greatest challenges highly sensitive people face is an overstimulated nervous system. As highly sensitive individuals, self-care is an essential part of our equilibrium and wellbeing. If you are highly sensitive and summer is a season that creates challenge and triggers for you, self-care practices will be imperative so you can get you through the warmer months with sanity and ease. Bodywork like massage, acupuncture, Reiki or any other type of service that nourishes you can be supportive and helpful in calming your nervous system and body. If finances limit your access to services, find creative low cost ways to support your sensitive soul. Here are a few ideas:

• Make herbal sun tea — try this lavender rooibos sun tea
• Place your feet in an ice bath 
• Keep moistened washcloths in the refrigerator or freezer to create your own chilled compresses. Add a few drops of your favorite essential oil to the washcloths before you refrigerate or freeze them. This simple addition of essential oil will elevate the experience and delight your senses.

Stay Cool
The increased heat and humidity of summer seems to inflame body, mind and emotions. Finding ways to stay cool can help temper irritability and any physical discomfort. Heading to the movies to sit in a cool dark theater can be a perfect remedy or take a dip in a natural lake or nearby swimming pool. Air conditioning can be a good option as well, but for those that are sensitive to noise, you will need to balance the benefits of being cool with the disruptive drone from the air conditioner. 

If the season of summer is not refreshing and replenishing for you, please know you are not alone. Focus on activities you enjoy during the summer and give yourself plenty of time for rest. Carve out space in your life and clear your calendar, so you can begin to naturally counteract the stimulus and triggers that overwhelm your nervous system. Continue to commit to simple acts of self care, so you can find relief from the sweltering summer moments. 

REFERENCES
Seasonal Affective Disorder by Mayo Clinic

5 Signs You Have The ‘Summer Blues’ by health enews Staff

Summertime Blues Really Are a Thing by UCI Health

Summertime Sadness: 11 Ways to Chase Away the Warm-Weather Blues 
By Michell Pugle and Medically Reviewed by Alison Young, MD

Summertime Sadness by Tala Ciatti

Being a Highly Sensitive Person Is a Scientific Personality Trait. Here’s What It Feels Like  by Juli Fraga

Authored by Olivia Beisler

Authored by Dr. Brittany Stamer

Let’s discuss how hormonal contraception works to prevent pregnancy. Normally, the two dominant sex hormones that are produced during a menstrual cycle are estrogen and progesterone. They are mostly produced by the ovaries, but also in smaller amounts by the adrenal glands and adipose tissue. These hormones ebb and flow throughout a cycle in order to mature a follicle and eventually ovulate.
​
Hormonal contraception such as birth control pills, hormonal IUDs (Mirena, Skyla, Kyleena, Liletta), implants, or the shot contain synthetic forms of progesterone and/or estrogen. Some types or brands of birth control will contain only synthetic progesterone while some will contain both synthetic progesterone and estrogen. Due to the route of administration and variations of hormones these types of hormonal contraception can each work a little differently, but the basics are similar. These synthetic versions of sex hormones do not act in the body the same way natural hormones do and because the body is receiving a synthetic form of these hormones it does not receive the signal to create it’s own estrogen and progesterone. Meaning hormonal contraception completely shuts down these entire hormonal pathways.

One of the most crucial ways hormonal contraception works is that it impedes ovulation from occurring. In a normal physiological state in relation to ovulation, the brain secretes hormones which then communicate to tell the ovaries to make estrogen and progesterone allowing people of reproductive age to ovulate and become pregnant if desired. When on birth control this entire communication between the brain and ovaries is non-existent. The body “thinks” it has natural estrogen and progesterone based on the synthetic hormones that are being consumed. This communication disruption does not allow ovulation to occur because the ovaries are now not receiving the signal to produce the hormones needed to develop and release a follicle. 

This lack of ovulation means that the bleed that occurs on oral birth control is not technically a menses. For a monthly bleed to be considered a menses there needs to be a flux of natural hormones and ovulation must have occurred. The bleed on oral birth control instead happens due to the withdrawal of synthetic hormones while taking the placebo/sugar pills. 

This lack of natural estrogen and progesterone also prevents pregnancy in many other ways besides inhibiting ovulation. 

Birth control also prevents pregnancy by making cervical fluid inhospitable to sperm. Cervical fluid is necessary to become pregnant. Fertile cervical fluid which looks watery or similar to egg-white occurs immediately before ovulation. It creates a safe haven for sperm to wait until ovulation occurs, creates a sperm ‘highway’ to help the sperm travel quicker and farther into the uterus, has nutrients to feed the sperm, protects and harbors them against the more acidic vaginal pH, and filters abnormal sperm out. Normally, estrogen would signal to the cervix to make this cervical fluid, but because hormonal contraception does not allow the natural influence of estrogen to occur cervical fluid becomes thicker and less functional therefore preventing pregnancy. 

While on birth control the endometrial/uterine lining of the uterus also becomes thinner. This is due to the minimal influence of natural estrogen and progesterone. As an analogy, estrogen will normally act as the bricks and progesterone acts as the mortar of the uterine lining thickening the lining throughout the course of the menstrual cycle. Without these natural influences the uterine lining is much thinner and this makes it very difficult for an embryo to implant and develop there. 

IUDs can prevent pregnancy in the previous ways mentioned, but in addition can create local inflammation in the uterus as well. This prevents pregnancy by making the uterus an inhospitable place for sperm and for fertilized eggs to implant. 

Hormonal contraception can also prevent pregnancy by lowering libido for some users, although this is not true for all. 

All of these reasons are why hormonal contraception is so effective! It works in multiple ways to prevent pregnancy. Most forms of hormonal contraception are above 99% effective with perfect use! 

Yet, for some this high level of effectiveness does not come without side effects. 

Hormonal contraception has been shown to decrease libido by lowering testosterone as previously mentioned. It also can decrease the size of the clitoris. It has been studied to decrease vitamins and minerals possibly contributing to mood changes. One study even revealed that 51% of women experienced a negative mood altering effect from hormonal contraception. It has been shown to cause a slight increase in breast, cervical, and liver cancer as well. The International Agency for Research on Caner (IARC) classifies combined oral contraceptives as a group one (I) carcinogen. It can also negatively affect gut health and thyroid function. While taking oral birth control a protein called sex hormone-binding globulin (SHBG) increases in the body. It is normally responsible for binding to sex hormones in the blood and renders sex hormones inactive while attached. If this SHBG is too high it can keep too large of an amount of sex hormones inactive which can cause significant hormonal dysfunction. SHBG can stay elevated for years after discontinuation.  

Also, another important side effect or result not often discussed is how hormonal contraception can be used as a ‘fix’ for issues like painful periods, endometriosis, fibroids, PCOS, or similar. But, often these conditions are not properly addressed and root causes are not treated before hormonal contraception is initiated. The first time some of these issues are addressed are when patients discontinue birth control and desire to become pregnant. I often see that because these hormonal imbalances had been masked for so long it can take a lot of time and effort to resolve, and this can be difficult when patients want to become pregnant right away. So, while hormonal birth control is a wonderful effective and widely accessible tool to help people plan their futures by preventing pregnancy, which is by far the biggest and best benefit, it absolutely does not cure hormonal issues. Hormonal contraception can actually hide hormonal issues, and the process that may be leading to these imbalances will likely go unaddressed for years until hormonal birth control is discontinued.
To learn more about what contraception choices are best for you and your life I recommend going to www.bedside.org/birth-control.com to explore hormonal and non-hormonal options. 

References 

1. “The Fifth Vital Sign” by Lisa Hendrickson-Jack
2. Bedsider.org 

Authored by Dr. Brittany Stamer

Ovulation is vital to the health of menstruating women. Ovulation is the only way women make a significant amount of progesterone. Progesterone is the hormone responsible for creating the relaxed feeling in the second half of the menstrual cycle, can promote better quality sleep, it can protect against certain cancers, and can reduce PMS or PMDD symptoms. It is also absolutely necessary to become pregnant and to maintain a pregnancy. 

But, it is not a given that every woman between the ages of menarche and menopause are ovulating. There are many reasons ovulation isn’t occurring and these reasons are worth discussing considering it is so important for overall health.  

A very normal reason ovulation may not be occurring is the time around menarche which the first menses. The average age of menarche is 11.9 years. What a time! I remember my mom brought me flowers and gave me a big hug, which basically led me to feel unbelievably mortified. In my older years I grew to appreciate my menses and my mom’s sweetness, but many women can relate to the initial shock I am sure! I digress. Menarche is a very normal time to not ovulate. You might have heard about young women having irregular cycles for a few cycles before them regulating. This could mean the body is not ovulating and is very common. When cycles start for the first time it can take the body some time to get into the rhythm of how the brain communicates with the ovaries. This should normalize within a few months, but if it doesn’t or any significant symptoms such as acne, cramps, mood issues, or otherwise come up it is a great idea to seek support from a holistic practitioner.

Another very normal reason ovulation does not take place is in perimenopause which means the time before menopause. The average age of menopause is 51 years old. As fertility normally decreases ovulation occurs less often as well. 

There are many other reasons that lead to lack of ovulation that should be addressed and treated. Some of the most common reasons are polycystic ovarian syndrome (PCOS), hypothalamic amenorrhea, thyroid disorders, primary ovarian insufficiency (POI), or hypothalamic or pituitary signaling issues. 

PCOS is one of the most common reasons for lack of ovulation, otherwise known as anovulation. There are many causes of PCOS but no matter the cause the underlying mechanism that leads to anovulation is the same. There are too high of androgens or male type hormones in the blood that interfere with the delicate hormone signaling between the brain and ovaries and ovulation cannot occur. Instead, multiple cysts develop on the ovaries revealing an attempt of the ovary to ovulate, but the inability to. PCOS has 4 main causes which include blood sugar dysregulation and insulin resistance, stress or adrenal PCOS as it is sometimes called, inflammatory PCOS which can occur from a host of issues including disrupted gut health or hidden infections, or post-birth control PCOS. 

Hypothalamic amenorrhea occurs when the body simply does not have enough energy to expend to ovulate. The communication from the brain to the ovaries is simply not occurring. This is due to overexercising, under-eating, or excessive stress. 

Thyroid disorders including both hypothyroidism and hyperthyroidism, can both lead to anovulation and can cause either shortened cycles or lengthened cycles respectively. 

Primary ovarian insufficiency (POI) occurs when a woman is headed towards menopause before 40 years old. This can occur due to genetics, radiation, endocrine issues, lack of blood supply to the ovaries, autoimmune conditions, infections, or environmental toxin exposures (heavy metals or mold). This can be slowed or reversed in some cases depending on the cause, if the assaulting factors are removed. 

Pituitary or hypothalamic signaling issues are another issue that can cause anovulation. The most common occurrence in this cause is actually when a woman is breastfeeding! Which is a very normal reason to not ovulate. To breastfeed, the pituitary releases a hormone called prolactin to stimulate the making of breast milk. When prolactin is high it suppresses the body’s ability to ovulate. This can also happen pathologically with something like a tumor in the pituitary which is called a prolactinoma. Prolactin is a common lab test completed when a woman, who is not breastfeeding, is not having a period. This is completed to ensure this more serious cause of anovulation is not part of the picture. 

Having what seems to be a normal and regular cycle does not mean that ovulation is occurring. Most of the time ovulation is occurring in these instances, but not always. There are multiple ways to evaluate if you are ovulating. Cycle charting by tracking cervical mucous and basal body temperature is my favorite way as it connects women to their bodies and allows them to be in tune with themselves. But, completing a blood draw for progesterone post-ovulation in the second half of your cycle can also confirm ovulation. Any value of progesterone above 5 ng/mL means ovulation occurred. 

As I have mentioned in my previous blog post “What is Ovulation Anyway?" a follicle undergoes its most robust development 120 days before being released. This means it can take a significant amount of time for hormones to change enough for ovulation to occur. When trying to correct some of the imbalances that lead to anovulation like PCOS or hypothalamic amenorrhea, patience can be difficult! Especially when it comes to possibly imbalanced hormones and the symptoms people can be experiencing, but these symptoms can improve, these conditions can be treated, and ovulation can happen. 

Even if ovulation is happening, having good egg quality is essential for becoming pregnant and maintaining a pregnancy. Good egg quality is a hard thing to measure unless the eggs are retrieved, as they are in in-vitro fertilization (IVF), and genetically analyzed. But, the level of progesterone in the body post-ovulation can give us a hint about egg quality. Usually higher progesterone means better egg quality. This can mean chances are higher for people to become pregnant.  

You can support ovulation and egg quality/adequate progesterone in many ways. Some of these recommendations can be different based upon what cause of lack of ovulation someone is prone to. But, some basic ways to support healthy ovulation include:

• Eat a well-balanced omnivore diet. I recommend a diet with at least some animal products as they are very nutrient dense, have a lot of protein, and fat. 
• Keep your blood sugar balanced. Eat protein and fat with every meal. 
• Don’t restrict calories. 
• Exercise regularly, but not too much. Overexercise is perceived as a stress on the body. I was a college athlete and had some friends lose their period temporarily from our exercise regimes. 
• Reduce stress. You can do this with anything you like including having fun with friends, laughing, doing a creative project you like, going to therapy, watching TV, reading, yoga, exercise, quitting something that isn’t serving you or your health, and many more things! 
• Sleep! I recommend at least 8 hours of sleep per night. 
• Reduce inflammation. This can mean SO many things. I recommend eating a healthful organic diet, exercising, laughing with loved ones, and reducing stress as the basics. Sometimes this is when testing can help identify the causes of inflammation as they can be hidden like with environmental toxins, heavy metals, mold, hidden infections, or gut health issues. 
• Avoid environmental toxins. Many of these environmental toxins act as synthetic hormones in the body. Avoiding most plastics in the house, getting rid of any products with fragrance, and using a water filter are all good places to start when trying to avoid these toxins. 

References 

1. “The Fifth Vital Sign” by Lisa Hendrickson-Jack 
2. "Trends and Patterns in Menarche in the United States: 1995 through 2013–2017” by National Health Statistics Reports. 
3. "Menopause" by the Mayo Clinic. 

Authored by ​Olivia Biesler, NBC-HWC

I sometimes ask my clients “what makes you happy?” Some people have an answer straight away: “my grandkids, painting, and traveling." Others take longer to answer or the list is quite short. Others, especially clients who struggle with depression, anxiety, and/or stress, seem taken aback by the question and can’t think of anything that currently brings them happiness. The answer is then usually phrased as “well, I used to do *insert activity here* but I haven’t in a long time." 

So what does help make you happy? If you google that phrase, you find a lot of lists that boil down to the same things: get outside, spend time with friends, meditate, volunteer, practice gratitude, exercise. And those are helpful. I wanted to create a different list, however, one that explains both the what and why of things we can do to cultivate happiness in our lives. 

But first, it’s important to clarify a few things about happiness. First, no one can be happy all the time. In fact, experiencing negative emotions or moods is key in being able to appreciate positive or neutral moods and emotions. Secondly, happiness is an individual feeling for people: what makes one person happy might not make another person happy. Thirdly and finally, you can decide whether cultivating happiness is important to you. It might not be and that’s ok. A wonderful article in the Guardian talks about why happiness is important (“Why Does Happiness Matter?”, 2014). In short, it says that happiness makes us healthier, more productive, nicer, and more altruistic, all of which have positive impacts on our community. 

So how can we cultivate happiness in our lives? The list below is a collection of ideas and practices I have pulled from articles, my own coaching, and my personal experiences. I hope they help spark some creative thinking in your own life!

1. Practice mindfulness. So often we only express appreciation for positive things when things are going badly. When I have a cold, for example, it makes me truly appreciate being able to breathe through my nose after my sinuses have cleared. Only after a week (or many weeks) of cloudy days does a day of sunshine make me realize how much I have missed seeing blue sky and felt the warmth of the sun through my office window. Remembering to be mindful of these wonderful things more often helps keep the happiness alive and fresh in my mind, which can help me sustain the feeling of happiness longer. 
2. Remember that happiness levels off. If something happens that brings us a burst of happiness, say a pay raise or a new house, we adjust to it fairly quickly. Mindfulness can help with this: it helps us appreciate the present and how we’ve arrived there. Expressing gratitude can help as well. Another thing that can help is to write down or journal how you feel during bursts of happiness so you can have a record to look back on and relive. I have a video of myself talking about an exciting moment in life and when I go back and watch it, I feel that same feeling again and again. 
3. Practice doing things that used to make you happy or might make you happy even if they don’t right now. Happiness is an emotional state. You can practice being happy just like any other skill. Things like positive affirmations, finding one positive for every negative, engaging in a hobby, talking to a friend, all can help you “learn” how to feel happy. With practice it becomes easier. How can you practice happiness in small ways during your day?
4. Switch the idea of “feeling happy” to “feeling valued”. This idea is encapsulated in the article “What It Means to Matter” by Dr. Isaac Prilleltensky. His idea is that when we both feel valued and add value to our community, we become happier and healthier. What does feeling valued look like for you?
5. Remember that circumstances matter. The old saying used to be “money can’t buy you happiness” and some older studies showed that after a certain amount of income, happiness plateaued. Newer studies, however, seem to contradict this. Having our basic needs met and being able to indulge in wonderful experiences does impact happiness. Circumstances aren’t everything though. As usual, it’s a balance of things: circumstances, personality, mindset, and practices. 
6. Happiness can be a mixture of emotions. For some it’s excitement, joy, and thrill, for others it’s contentment, fulfillment, and love. You can also experience different types of happiness: a burst of joy at unexpected news versus the prolonged contentment that things are going well for you. What does happiness feel like for you? Can you identify different types of happiness in your life? Do you tend to value some types of happiness over others? 
7. Identify things that bring you short-term happiness versus long-term happiness. These things look different: enjoying a latte vs putting money in your savings account. Hanging out with a friend vs exercising for your future health. Take stock of what your list looks like and how balanced it is. Pay attention to what percentages of each type support your mental and physical health. Do you need to do more short-term or long-term? What would it feel like?
8. Find activities, hobbies, and/or practices that get you into a “flow” state, also known as “being in the zone”. This article from Headspace articulates the benefits of flow well: “What is a flow state and what are its benefits?” Headspace defines flow as a “very active, moving meditation” and “it can leave us feeling ecstatic, motivated, and fulfilled”, all of which are emotions that are linked to happiness. 

​
We all are living with new stressors and rapid changes. Some clients of mine express guilt at seeking happiness while so many others are struggling. When we talk about finding happiness or work on adding more of it to our lives there needs to be an acknowledgement that we have the opportunity and privilege to do so. There is also the acknowledgement that small moments of happiness, flow etc keep us motivated, fulfilled, and able to move forward. Acknowledging these things and finding balance can be difficult, but is ultimately immensely satisfying. I hope this article allows you to spend some time thinking about what brings you happiness as well as the benefits it can add to your wellbeing. 

Authored by Dr. Brittany Stamer

Menstruating gets a lot of attention from people with uteruses, but ovulation is really the main event of the menstrual cycle. 

Ovulation is when an egg is released from one of the ovaries. It will then travel down the fallopian tube and into the uterus. It will either be fertilized by sperm, implanted into the lining of the uterus, and a pregnancy is underway or the egg is not fertilized and in approximately 12-16 days the uterine lining will be released and a menses will occur. 

This description of ovulation may lead us to believe that ovulation is only crucial for pregnancy, but that is absolutely not true! 

Let’s discuss the menstrual cycle a bit more to help understand why ovulation is so important and what it means for your overall health. 

A normal menstrual cycle is considered to be between 21-35 days, but I would consider an optimal menstrual cycle to be between 26-33 days. The reason why I think a shorter window is optimal is because this likely means you have a more ideal balance of estrogen and progesterone in the body, which paves the way for fewer negative hormonal symptoms. The menstrual cycle is divided into two sections, a follicular phase where estrogen is dominant and a luteal phase where progesterone is dominant. The first 3-7 days of a normal menstrual cycle is when the uterine lining sheds.

Now, for a little more about how these hormones connect to ovulation:

During the menses and for approximately the first half of the menstrual cycle (note: it is normal for this “half” to vary from month-to-month or person-to-person) estrogen is increasing more and more each day. This increase helps an egg (aka a "follicle") in the ovary to develop. While an egg speeds its development quickly during the menstrual cycle it is released in, it actually takes about 4 months (or 120 days) for an egg to become fully mature.

Estrogen produced in the first half of the cycle can make you glow, feel energized, motivated, and want more social interaction. When estrogen reaches its peak and that egg is developed enough this is when the ovary gets a signal from the brain to release the egg...ovulation! Ovulation often occurs from every other ovary, though this is not universally true. One month you will ovulate from your right ovary and the next month from your left. Even though ovaries are about the size of almonds and an egg is about the size of a period at the end of a sentence, some women can actually still feel the sensation of ovulation, called Mittelschmerz. 

Ovulation immediately makes progesterone, which for the first half of the cycle was extremely low in the body. Progesterone is made by the corpus luteum,  the portion of the follicle (aka egg) that gets left behind after ovulation. This phase of the menstrual cycle (the luteal phase), when progesterone dominates can make people feel relaxed and improve sleep. Progesterone can also protect against certain cancers. Without ovulation occurring a woman’s body makes almost no progesterone. Meaning ovulation is absolutely essential for progesterone production. 

Ovulation is important because having that proper balance of estrogen and progesterone in the body is crucial for overall health. 

Some women might think if they have a normal menstrual cycle within that 21-35 day window that they are ovulating, but in fact many women that have a normal menstrual cycle are actually not ovulating. You can imagine knowing this information is very important if you plan to become pregnant. But, ovulation is also so important for many other reasons that have nothing to do with pregnancy. Ovulation is a sign of good health. A sign that your hormones are in balance. This balance of hormones can help support a healthy mood, decrease or resolve acne, resolve a painful menses, stop heavy menstrual bleeding, protect from some hormonal cancers, build stronger bones, protect thyroid function, and even help with your digestive health! These are just some of the areas where your hormones play a role. So having balanced hormones - and specifically ovulating - can improve many facets of health. 

Even if you don’t plan to become pregnant now or even ever, ensuring you are ovulating is essential to protect your health. Most hormonal birth controls, with the exception of a hormonal IUD on occasion, halt any of this crucial hormonal fluctuation including ovulation. 

For my menstruating patients, I recommend tracking menstrual cycles with a symptothermal Fertility Awareness Method. It can take some practice to learn, but the connectedness and body awareness you gain from it is well worth the few months of practice.

The menstrual cycle, including the knowledge of if you are ovulating, is a key indicator of your overall health. Some would even consider the menstrual cycle as the fifth vital sign, with pulse, respiration, temperature, and blood pressure. Meaning the health of the menstrual cycle, including the main event of ovulation, is just as important as healthy blood pressure.
 

References 

1. “The Fifth Vital Sign” by Lisa Hendrickson-Jack 
2. Female Reproductive System via The Cleveland Clinic 

Authored by Olivia Biesler, NBC-HWC

Remember when the concept of hygge caught on in the US? In 2016 an article on hygge was published in the New York Times (“Move Over Marie Kondo: Make Way for the Hygge Hordes”) and many more came after it. Hygge is the concept of comfort or coziness that helps bring contentment and peace to your life/environment. It has an element of mindfulness to it: recognizing moments that are special and letting yourself relax and enjoy them. Hygge caught my attention then because I realized that those moments of mindfulness came when I allowed myself to look at winter (a prime time for hygge related coziness) as a time to prioritize rest and rejuvenation. 

We often think of summer vacation as the time to rest and relax, however, I can’t be alone in thinking that my summers are more packed and busy than my winters are. As an avid gardener, spring, summer, and fall are my busiest times. My schedule is filled with outdoor activities, nights out enjoying the warm weather, socializing, lake or cabin time, family get-togethers. Looking at my friends and family who have children, their summers are full of playdates, camps, trips, and finding ways to entertain their kids while they aren’t in school. There is something about the start of winter that allows me to breathe a sigh of contentment, knowing that I can hunker down for a season and turn my focus a bit more inward, or to projects I have not gotten to for many months. 

If we think about nature, winter is a time for hibernation, sleep, managing resources, and prioritizing basic needs like food and warmth. Plants die back and retreat underground. What would happen if we took that concept and translated it into our lives? What valuable lessons can we take from nature and use to bring contentment, stress-reduction, rest, and relaxation into our daily life and/or environment? 

Scaling Back
Taking our cue from plants and certain animals, we can see that scaling back is something that has many benefits. Many plants get rid of their above-ground parts, reducing themselves down to roots. Animals like bears, groundhogs, and fish either hibernate or slow their systems down. Winter can be a time of reducing things down to necessities and honing in on what’s important. 

How does that translate to humans? It can mean being more mindful of our energy output and input. This could mean saying “no” more, holding up our boundaries, taking a moment to ask our mind and body what it needs/wants before saying “yes” to something. It could be prioritizing time alone, relaxing activities like reading, and sleeping more or taking weekend naps. What would scaling back look like in your life? Some benefits you might see are less stress, more enjoyment of the present moment, more time for yourself, and feeling more rested and relaxed.

Getting Outside
Not all animals hibernate in the winter and not all plants die back. My bird feeders are full of chickadees, cardinals, and junkos and the squirrels are busy underneath them (and sometimes on them). Evergreen trees break up the gray and white vistas and remind us that spring will eventually come. Getting outside in the winter, if possible, is important. If you are able, simple winter walks are a wonderful way to get fresh air, move your body, and enjoy the unique beauty of the winter scenery. Even standing or sitting outside for five to ten minutes a day can have benefits. It can be a time to practice mindful breathing or mindful movement. It can be a time to practice gratitude for the warmth of the indoors, the coziness of our beds, and the sweetness of hot chocolate or tea. 
Getting outside can give our minds and bodies an important break from work or other activities and increase circulation, which can boost our mood, energy, and creativity, as well as provide health benefits for both mind and body. 

Coziness and Warmth
Prioritizing warmth and coziness during winter reminds me of squirrels curled up in leaf-lined tree hollows and little birds puffing up their feathers until their bodies are round. Prioritizing warmth and coziness for myself means intentionally creating a space of calm and softness in my house. This can include doing some cleaning, finding a blanket, some candles, and settling down with a craft. 
It also, however, means finding the time to use that space. The biggest barrier I see for clients and myself is not that we don’t have time. Rather, it’s convincing ourselves that spending time in that space is valuable and worthwhile. We can so often be sucked into the productivity mode that is the norm for Americans and see time for coziness and rest as being lazy or selfish. How can you prioritize rest this winter and take time to appreciate the benefits it provides? 

Internal Work
Perhaps because I end up doing so much outdoor work with gardening in the spring/summer/fall, I tend to take more time in the winter to do more internal work and self-care during the winter. If we look towards nature for inspiration we can see this too: it’s a time of turning inward and contemplation, a time to build up energy so when spring comes we have seeds to sow and ideas to plant. Winter can be a time to make plans for spring/summer, put in place habits of rest/relaxation before we get busy again, and enjoy creature comforts like hot soup, electric blankets, wool mittens, crunchy snow, fires, baths/saunas, cuddling with loved ones or pets, or whatever comes to mind when you think of cozy comfort. 

It can also be an amazing time to practice mindfulness along with those creature comforts. Practicing mindfulness while doing an activity you enjoy is a great way to train your brain in the habit of mindfulness and makes it easier for you to use mindfulness in situations that are perhaps less enjoyable, say in stressful situations or more emotional ones. 


What would prioritizing rest and relaxation over the winter look like in your life? What would be the benefits? Can you see yourself adding any of the above practices into your life? I encourage you to take 30 minutes one day and either write down or think about what you currently do to take advantage of the winter season and what you might want to add (or take away!). Remember, prioritizing rest and self-care is how we are able to refill our tank of energy so we can show up both for ourselves and the people and community around us.  

Authored by Olivia Biesler, NBC-HWC

It’s now 2022 (Happy New Year!) and, like many people, I’ve been thinking about goals and intentions I want to set for the new year. Things that come to mind personally are: exercising more, reducing screen time, developing a more consistent mindfulness practice, building my coaching practice. Things I’ve heard my clients say are: reduce stress, work less, move more, read more, all of which are valid and beautiful intentions to set going into a fresh year.

People like to start goals at the beginning of things: a new year, a new month, Mondays, your birthday etc. It gives you the feeling of a fresh start or a clean slate. People also experience an increase in motivation at these landmarks, which can increase the urge to start or restart a goal or intention. 

I’ve found that when my coaching clients want to start a new goal they fall into two categories: the schedulers and the adaptables. The schedulers pick the times, the days, the exact place they want to accomplish their goals, e.g. “I’m going to go to the gym Mon, Wed, Fri next week at 3pm and I’m putting it on my calendar.” The adaptables give themselves more room: “I plan to exercise 2-3 times this week, I have time either in the morning or in the evening so whichever one works better with my schedule I will do.”

The schedulers are using the SMART goal method: setting a goal that is Specific (go to the gym), Measurable (3x per week), Achievable (fits in their schedule, doesn’t involve a lot of change), Relevant (aligns with client’s values/goals), and Time-bound (has a start date). This way of starting a goal can be successful, especially for people who tend towards being scheduled in the first place. 

The adaptables are using aspects of the SMART goal method, but adding a few layers of flexibility to it. Instead of the specific action of going to the gym, they plan on “exercising”, which could mean many different things. They are giving themselves different options on time because they know they might feel more motivated at different times on different days, or last minute conflicts might pop up. They’re basically broadening the options out to cover for barriers that might come up. This way of starting a goal can also be successful! 

In the podcast Hidden Brain, host Shankar Vedantam interviewed researcher and writer Katy Milkman about her findings on goal setting and follow-through, how knowing our common pitfalls is important but not the sole solution, and  how making our goals malleable can help with our success rate. 

So what can you take away from this? Here are a six steps that can help you build a sustainable practice:

1.  Spend some time thinking about your goal and how it relates to your values and purpose. Are you wanting to start this because it’s truly important to you and based on intrinsic value? Or are you doing it because someone said you “should” be doing this? Goals that are based on your values and are intrinsically motivated are more likely to be successful. Goals not based on intrinsic motivation can still be successful, but they will probably require more support, reminders, and maintenance. 
   
   
2. Decide what approach is better for you: a true SMART goal or a more malleable approach. What fits better into your work/life schedule? What have you had success with in the past? 
   
   
3. Find a support person or two. This can look like someone who is doing the same new practice as you or simply someone you have talked to about starting a new practice and can check in with your progress. Think about what you need from them and let them know: encouragement, accountability, a listening ear, someone to ask questions, etc. 
   
   
4. Start small, much smaller than you think you need to. Do you want to exercise more? Start with a walk around the block a few days a week. Work out the kinks, see what feels good. Once you feel comfortable with that small step, add a little more time to it. Give yourself options and ask yourself what you need. In the book Atomic Habits by James Clear, he states “A habit must be established before it can be improved. If you can’t learn the basic skill of showing up, then you have little hope of mastering the finer details. Instead of trying to engineer a perfect habit from the start, do the easy thing on a more consistent basis. You have to standardize before you can optimize”.
   
   
5. Keep a journal or memo in your phone and jot down your experiences. Notice how you feel before and after your practice and make a note of it. This can be a good way to remind yourself that after your walk you feel more clear-headed or after meditating your anxiety has lessened. It can also help you to remember why this goal is important to you when you don’t feel like doing it. Bring a moment of mindfulness to your practice before and after and check in with your progress as your goal develops. 
   
   
6. Use that “fresh start” mentality to your advantage. If you skip a day, a week, or something stressful happens and you need to re-prioritize, remember that tomorrow is a new day and you can start anew. It’s natural that your new goal will have ups and downs. Just because you have a down day or week doesn’t mean you aren’t able to accomplish your goal. Scale the goal back down, focus on a fresh start tomorrow, and remind yourself why you want to do it. If you continue to struggle, return to step one and ask yourself some questions: what’s getting in your way? What’s not aligning with your values? Why might you be struggling? What other resources or support might you need?

Starting a new habit and working towards a goal takes time, energy, and patience. Hopefully the above steps can help you make a sustainable goal plan and work through the barriers that come up. If you want more support, I am holding a workshop to talk about New Year's Resolutions in February. The workshop will focus on your goals/habits for 2022 and how they are progressing, working on more support/resources, and making a plan to move forward. You can register here. I hope to see you there! 

Q: What are your interests in holistic medicine?
A: I'm currently completing my master's in holistic health studies from St. Catherine University (Graduating December 2021). My focus throughout the program was on mindfulness and nature, and in May 2021 my research team and I published our 200-page thesis on how people have used time in nature to heal their grief caused by COVID. We collected hundreds of photos and amazing stories about the healing power of nature from people all over the world.

I came to be interested in holistic health after discovering how important a regular meditation practice is for every aspect of my wellbeing - when I have a consistent mindfulness practice I feel better in my body, my inner dialog is more meaningful, and my relationships are healthier. A curiosity for other ways to holistically heal brought me to my graduate program, and to Wellness Minneapolis.

Q: What gets you out of bed in the morning?
A: Coffee, my animals (one dog and two cats), hugs, and my morning reading ritual.

Q: What are you currently working on in your life?
A: It took many years to realize that I will never be able to do just one thing. I live for hobbies, side hustles, part-time jobs, volunteering, random projects - anything to feed my constant curiosity. Currently:

• I have a mindfulness and sidewalk chalk project called CeMental Break (@cementalbreak)
• I teach group exercise classes at the YMCA and JCC (Zumba and water exercise are my favorites)
• I do triathlons with my husband, Peter.
• I work with entrepreneurs and small organizations on their logos, branding, and illustrations, and create fun illustrations for myself too (www.taylortinkham.com)
• I volunteer at People & Pets Together - a local pet food shelf with the mission of keeping animals and their humans together - because pets are family!
• I'm a Tree Care Advisor through University of Minnesota Extension.
• I garden, preserve and can food for winter, cook a lot, and I'm baking my way through the Dessert Person cookbook by Claire Saffitz.
  
  

***If you have a fun hobby, a unique skill, or a hidden talent you bet I want to hear all about it!***

Q: What is your favorite breakfast item/food/beverage/dish etc?
A: I love fried rice for breakfast - leftover rice, whatever fresh veggies I have around, an egg, and some hot sauce!

Authored by Lynn Salmon-Easter, Reiki Master

With the holiday season upon us, I want to reach out to those of you that identify with being highly sensitive and reassure you that you can create holidays that are calmer, brighter and more meaningful for you.

Many individuals find this time of year to be exhausting, but when you are highly sensitive, you are particularly vulnerable to overwhelm and becoming overstimulated. Busyness and the hustle of the holidays can leave sensitive people prone to burnout and depletion.  

When you are a highly sensitive person, your nervous system processes the world at a much deeper level than others. Being highly sensitive is completely normal and in fact, is a genetic trait that runs in families. Highly sensitive people (HSPs) make up 15-20 percent of the population. If you are wondering if you may be highly sensitive, you can take this free sensitivity quiz developed by leading expert and sensitivity psychotherapist, Julie Bjelland. 

One of the greatest challenges highly sensitive people face, is the amount of information taken in daily due to our highly attuned nervous system. This easily leads HSPs to feel frazzled and overwhelmed as well as stressed and anxious.

It can be downright hard attending numerous social engagements, being bombarded with noise from multiple stores and having your daily routine disrupted during the holidays. Your natural instinct may be to withdraw from holiday and family activities in order to preserve your own energy.

Working with highly sensitive people and being one myself, i have found one of the greatest ways to offset stress of the holidays (or any stressful event) is to give yourself permission to be true to who you are. This means learning to honor your own unique needs and then learning to communicate these needs to yourself, family and loved ones. 

Come back to what brings you joy and peace this holiday season, so you can create more calm and ease in your life. Below you can find ways I have found to make the holiday season calmer, brighter and more meaningful for myself. I hope these may bring you back to calm as well.

Find Meaning and Magic in the Season
What matters most to you this holiday season and what will bring meaning and joy to you at this time of year? I love twinkle lights, holiday decorations, handmade gifts, and candles. I enjoy the opportunity this time of year lends to attend intimate gatherings with close family and friends. Take time to ponder what events and activities bring your heart warmth and help ease holiday tension for you. 

If you are able to identify the most meaningful (and even magical parts) of the season for you, it can foster a greater sense of purpose and deeper connection with the activities and gatherings you attend. 

Finding both purpose and connection in life as highly sensitive people is incredibly important to us and helps us to feel a deeper meaning in our life. Identifying areas of purpose, meaning and connection in our lives will also allow us to feel more stable and settled as highly sensitive souls.

Awareness of Holiday Season Needs 
As highly sensitive people, we simply need more time, space and rest than the other 80% percent of the population. Time and space are what allow us to sort through all the information and emotions we take in day-to-day. When we learn to honor our deep need for alone time, reflection and rest our life begins to feel better. 

Consider how much quietude and time alone you really need to offset the level of activity you take in during this busy time of year. The more stimulation you have in your life, the more rest, space and quietude you will need to offset and bring your nervous system back into a calm and normal state once again.

Choose to engage in activities that soothe and calm your nervous system on a regular basis. Cooking, baking, taking baths, knitting, making art, journaling, sitting quietly or reading by a fire are just a few ideas. 

Make a list of activities that are settling to your body and nervous system and keep it nearby as you navigate these upcoming weeks. I recommend calming your body and nervous system at least once a day. You will find even more calm and benefit if you commit to activities that settle your body several times a day. 

Keep as close to your daily rituals and routines as possible. This will help to ease the strain of travel as well as offset the unsettling nature of interrupted schedules this time of year often brings. 

Limit Family and Social Gatherings
Highly sensitive people think deeply about things in life and we crave meaningful time together with the people we love. Take time to reflect on which events and social gatherings will be most meaningful for you to attend this holiday season. I encourage you to politely give a “no” for any events that will drain or overstimulate you. 

Spend time contemplating how many events you can sustainably attend in the weeks and months ahead. You can turn to the saying ‘quality over quantity’ to help you decide which events or gatherings to choose. Your body and nervous system will thank you for your discernment. 

Sometimes you don’t even need to skip a family or social event entirely to avoid overwhelm. Give yourself permission to leave gatherings or events early. This way you won’t miss out and you will also have time left for you.

Get Creative to Find Calm
Most highly sensitive people have a creative side as well aa a deep appreciation for nature, beauty, art and music. By carving space for creativity this holiday season, you can naturally nourish and support your body, mind and spirit.

One of the ways I offset the hustle of the holidays is to make handcrafted gifts for family and friends. I find knitting settles and soothes my body and slows me down. By choosing to create handmade gifts, I calm my body and nervous system on a regular basis while making meaningful gifts to boot. 

No worries if you don’t know how to knit. Get creative in ways that matter most to you. Take time to listen to music or appreciate art that soothes and settles your soul. 


During this holiday season, give yourself the gift of quietude, contemplation and rest as a way to keep your energy renewed. If you need guidance on how to come back to your heart this holiday season, I highly recommend Courtney Carver’s hands-on-heart practice. This activity takes only 5 minutes a day. Time with family and friends can be more enjoyable and fulfilling when you make space for your thoughts and heart along the way.

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Resources:

• How to Thrive During the Holidays as an Empath, According to a Psychiatrist by Dr. Judith Orloff, MD
• 8 Things All Highly Sensitive People Need to Survive the Holidays by Andre Solo 
• 25 Simple Ways to Care of Yourself Over the Holidays by Courtney Carver 
• Holiday Survival Plan for the Highly Sensitive Person by April Snow, LMFT