Awe-inspiring

Im significantFor Christmas I received a subscription to New Scientist. It is my favourite magazine and prior to getting my own copy each week I regularly pilfered my Mum’s copy (thanks for the present Mum). In a recent edition (Issue 3136) I read an article about the benefits of feeling small as a human when compared to nature, Earth, the sun, other planets and space itself. The article goes onto discuss the concept of awe, not just with things bigger than us but anything that truly inspires awe; a full moon rising, a stunning view, a beautiful piece of music, art or an idea.

The feeling of being awestruck has powerful effects not only our mind and body but also on our sense of self. True awe can dissolve our sense of self, allowing a greater sense of connection with others and nature. It can lower stress, boost creativity and even make us nicer people. So what is the feeling exactly? Researcher’s studying awe describe it as ‘an emotion that combines amazement with an edge of fear’, and is a feeling we get when ‘confronted with something vast, that transcends our frame of reference’.

Part of feeling awe is a move of focus away from our own self-interests and to a bigger picture, which has shown to help us feel happier, less stressed and even improves immune function by reducing inflammation. This effect doesn’t just last in the moment, if cultivated, awe can have lasting effects. It can also help switch us out of ‘fight or flight’ mode by stimulating parasympathetic nervous system responses (rest and digest mode).

Contemplating awe I thought back over recent history to moments that I identified with feelings of awe and a few came to mind; St Peter’s Basilica in Vatican City, a recent full moon rising that seemed to take up half the skyline, and every time I really think about what it would be like to be Dr Who’s companion in the Tardis (yep, I’m a fan and it’s a big concept!).

There are ways of cultivating awe on a regular basis. The article infers that we could stop looking at images of nature and space on our smart phones and starting looking at the real thing. Yes, yes we all say! Fortunately awe isn’t necessarily rare and can be manifested in more ways than just seeing amazing things. To do this we need to raise our expectations of feeling awe in the first place, and then think about what we individually find awe-inspiring, whatever that may be. Then we can make it part of the every day.

Feel free to comment below – what makes you feel awe?

Reference:

Marchant, Jo. Awesome Awe, New Scientist ISSUE 3136 | MAGAZINE COVER DATE: 29 July 2017

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Stress gets under the skin

From a health perspective, my skin is my vulnerable organ; for me everything shows up on the surface. Stress in particular is a ‘skin trigger’. I have changed my health significantly since the days of breakouts and chemical sensitivity so they aren’t issues anymore, but my skin still tends to be reactive in response to stress looking drier and flushing easily.

Skin Stress

Skin is one of the key defence systems of the body with the outermost layer providing a natural barrier to water loss and potential toxins or microbes. It is exposed to numerous daily stressors such as infections, toxic agents (artificial fragrances), allergens, UV light and mechanical damage and is usually well equipped to respond and protect from these environmental factors. However, in those with skin conditions such as psoriasis, chronic itching, eczema and rosacea, both environmental and psychological stress can be a trigger for acute flare-ups as well as sustaining chronic issues.

Stress impacts aren’t just about major life events. It is often the ongoing daily pressures of life that creates a chronic stress burden, eventually leading to less overall stress resilience. The depth of this impact is in part a reflection of genetics, but also of cumulative experiences over time. Of considerable influence are individual health behaviours such as sleep, hygiene, activity levels, diet and substance abuse (alcohol, excess sugar intake, recreational drugs, cigarettes etc). The more we move away from healthy practices such as enough sleep, regular exercise and a healthy diet, the more burden on the body and the more likely maladaptive stress responses will develop.

When stress is constant, individuals with skin conditions can lose resilience at a local skin level as well. As a consequence there is less innate ability to regulate immune and inflammatory responses within the skin. Essentially stress leads to increased inflammation and potentially worse disease severity.

The specific impacts of stress on skin include:

  • Reduced skin barrier leading to trans-epidermal water loss (TEWL) so skin looks and feels dry and dehydrated. Dry/dehydrated skin skin also becomes more sensitive to environmental stressors e.g. topical creams or temperature changes.
  • Reduced local antimicrobial defence leading to greater risk of infection from microbes residing on the skin e.g. staphylococcus aureus, a common cause of secondary infection in those with eczema.
  • A significant increase in pro-inflammatory chemicals in the skin contributing to both acute and chronic inflammatory responses – skin may present as more red, more reactive, itchier or with increased plaques in the case of psoriasis.
  • Delayed recovery time.

For example, the general psoriasis population is vulnerable to the exacerbation of inflammation such that a stressful event/s can significantly aggravate the course of the condition. Up to 80% of individuals with psoriasis report a stressful life event prior to a flare up and 45% prior to the onset of the disease.

Fortunately there are many positive skin benefits associated with improved stress resilience and while there is no doubting the benefit of enough sleep, a healthy diet and exercise, adding regular mindfulness practice to usual treatment can have significant benefit. For example, in a group of psoriasis patients’ regular mindfulness practice led to a 4 fold increased clearing rate of skin lesions. Mindfulness based practice has also been shown to reduce post-stress inflammatory responses and increase symptom relief following skin damage.

There are numerous ways to improve stress resilience using self care and mindfulness but I find while many may work in the short term, sustained practices are those that really make the difference…practices that, while they may take time and effort, really make you feel good. I find that implementing mindfulness and self-care is less prescriptive and more a journey of discovery, trying new techniques or remembering things you used to do regularly and enjoy. Many of the practices are quite simple:

  • Green therapy – a favourite of mind, which is spending time in nature
  • Mindful breathing practices
  • Meditation
  • Mindful walking – being present and observing your movement
  • Head to toe scanning to tap into body sensations
  • Regular magnesium baths or foot soaks
  • Journalling – thoughts, frustrations, things to be thankful for
  • Practicing gratitude
  • Reading for pleasure

I generally encourage patients to pick one and ‘try it on to see if it fits’. While it may take sustained effort something will feel good. The aim then is to make it part of a daily, weekly or regular practice and this is when the benefits will be felt, and seen on the skin.

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More benefits of Vitamin D

Memory and Vitamin D

In other memory related news (see previous post), a 2017 randomised trial in healthy adults showed that high levels of vitamin D improved visual and non-verbal memory, resulting in higher-level cognitive function. This trial was conducted in healthy adults so the mechanism isn’t necessarily about correcting disordered function related to a disease state. However, the impact of higher doses (4000iu daily) was greater in those with lower baseline levels of vitamin D (75 nmol/L). Interestingly most Australian pathology labs indicate that a vitamin D level between 50-100 nmol/L is sufficient. On this basis a proportion of adults that have ‘normal’ levels of vitamin D may benefit from increasing their level to the high-normal range.

Vitamin D, Sleep and Pain

I have previously discussed before the relationship between sleep, mood and pain (listen here or read here) but a recent paper (Oliveira D, et al, 2017) provides the possibility that vitamin D might provide an important interface between sleep and pain. Vitamin D shows sleep modulation effects and lower levels have been liked to sleep disorders. The link between vitamin D, sleep and pain may in part be the impact this nutrient has on shared brain neurotransmitter pathways. The anti-inflammatory impact of Vitamin D may also help reduce nociceptive (danger signals) input, which the brain interprets as pain.

sunshineI will add my usual caveat with vitamin D, which is to establish baseline serum levels before taking higher doses and it is worthwhile seeing a health care professional such as your naturopath or nutritionist to do so, particularly if you are having memory or pain-related issues. Sunshine can and vitamin D rich foods are also important for maintaining healthy levels.

References:

de Oliveira, D.L., Hirotsu, C., Tufik, S. and Andersen, M.L., 2017. The interfaces between vitamin D, sleep and pain. Journal of Endocrinology, 234(1), pp.R23-R36.

Pettersen, J.A., 2017. Does high dose vitamin D supplementation enhance cognition?: A randomized trial in healthy adults. Experimental gerontology, 90, pp.90-97.
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Memory enhancing EVOO

Olive-OilI am regularly regaled with the benefits of Coconut oil (predominantly a saturated fat) but personally I am not a fan. By all means moisturise with it, use it as a mouth cleanser, rub it through hair etc, but don’t eat too much of it. The purported health benefits just don’t stack up in the research. On the other hand Olive oil (a mono-unsaturated fat) has a bucket of research showing positive health benefits including this recent report indicating that extra-virgin olive oil (EVOO) protects memory and learning ability and further, decreases the risk of brain changes commonly associated with Alzheimer’s.

EVOO achieves these protective benefits by reducing brain inflammation and activating a process called autophagy, which clears old cells and toxins (garbage disposal) from the tissues. Researchers now think that the protective effects of the Mediterranean diet against dementia are equally from EVOO as they are the high intake of fresh fruit and vegetables. Go EVOO!

As it is the season for brussels sprouts (I love them!) I have included a recipe that includes them and lashings of lovely olive oil. I like to use Australian olive oil as the olive tree groves tend to be younger and thus richer in polyphenols and antioxidants, the important plant chemicals that contribute to the health benefits of EVOO.

Shaved brussels sprouts, olive oil, lemon and pecorino

Serves 4-6
450g brussels sprouts
5 tbsp extra virgin olive oil
½ tsp salt
3½ tbsp fresh lemon juice
½-1 tsp whole black peppercorns, crushed
115g pecorino cheese, grated or shaved

1 Rinse the sprouts, then pat dry with kitchen roll. Remove any discoloured outer leaves, then cut the sprouts in half, lengthways. Very thinly slice them the sprouts crossways, transferring to a large, shallow serving bowl as you go.

2 Drizzle the oil over the sprouts, sprinkle with salt and toss well. Add the lemon juice and pepper and toss again. Lay the cheese on the top of the salad and serve immediately.

Recipe from: The Perfectly Tossed Salad by Mindy Fox

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Gut-to-Brain or Brain-to-Gut?

Gut-Brain_AxisGut-to-Brain or Brain-to-Gut axis – terms I hear frequently when supervising student clinic and indeed I use in discussion with my own clients. While there is a common understanding that the brain-gut pathways are bi-directional, recent research indicates it might be important to clarify the impact of this bidirectional pathway. Does the brain have a stronger influence on the gut and creating, for example IBS-like symptoms or is the gut driving our brain, leading to anxiety, depression and mood changes? Importantly, whatever the case, does this impact on how we manage treatment?

Given the significant association with psychological conditions such as depression and anxiety, thinking has been that functional gastrointestinal disorders such as irritable bowel syndrome (IBS) and functional dyspepsia (FD) have originated in the brain and are modulated by stress pathways. That is, our thoughts and emotions drive physical stress responses, which then impact in various ways on our gut (brain to gut). However, there are inconsistencies with this understanding. For example the significant association between gastrointestinal infection and subsequent IBS points to at least a proportion of people have symptoms that originate in their gut, which can then impact on mood, leading to anxiety or depression.

Last year Australian researchers set out to determine how many people with IBS and FD have symptoms that originate in their gut (gut-to-brain) compared to those where symptoms first originated from psychological input (brain-to-gut). Findings showed that even though the pathway is bidirectional, “a major subset begin with gut symptoms first and only then psychological distress develops”, indicating that gut mechanisms are in many cases the primary starting point and cause of the gut and psychological symptoms (Koloksi, et al, 2016). The research showed that while the brain-to-gut pathway is relevant, the gut-to-brain pathway may in fact predominate and should not be overlooked during treatment planning.

Why is this important? From a naturopathic view, treatment is holistic however; the order of disease onset is significant when formulating a treatment plan. For those with a predominant brain-to-gut pathway centrally focused approaches along with psychological and mindfulness might feature strongly. Alternatively, those with a predominant gut-to-brain pathway, for example IBS that started with a gastrointestinal infection, may respond better to a focus on gut-directed interventions, with central/mood-focused approaches as supportive therapy.

Read more about mindfulness and gratitude

Read more about gut healing or constipation

If IBS or FD impact you personally and you want more information about the management of these conditions please book into make an appointment to see me or contact me here.

References:

Koloski, N.A., Jones, M. and Talley, N.J., 2016. Evidence that independent gut‐to‐brain and brain‐to‐gut pathways operate in the irritable bowel syndrome and functional dyspepsia: a 1‐year population‐based prospective study. Alimentary Pharmacology & Therapeutics, 44(6), pp.592-600.

 

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Practicing Gratitude

Working with mindfulness practices both for clients, and myself, I have become increasingly aware of its ‘sister’ gratitude practice. Over April I participated in ‘a month of gratitude’, a concept run by a Positive Psychology program I follow. The reason I took up this month long practice was that while I conceptually understood gratitude, I didn’t find myself feeling it as often as I could.

Gratitude practice can take many different forms such as gratitude meditation or contemplation, a gratitude journal, reading about gratitude, using a gratitude app, telling others how grateful you are and the list goes on. For more ideas check out this article, which lists 26 different exercises and activities.

Studies into both mindfulness and gratitude similarly show increased levels of well-being. Unsurprisingly, gratitude practice can lead to increased feeling of gratitude and as well as long term benefits, the results can be quite immediate, bringing with it all the benefits of gratitude. For some of my clients in particular this includes more effective pain management. Other benefits include:

  • It can make you more mindful, which then brings about positive benefits of mindfulness as well!
  • Gratitude can increase sleep quality (Jackowska, 2016).
  • A three-month gratitude journal trial found that participants found things to be grateful for and were able to express their gratitude more readily, both of which had positive impacts on wellbeing, mood and depression (O’Connell, O’Shea, & Gallagher, 2017).
  • Gratitude has also been shown to increase our self-esteem and positive emotions (Amin, 2014, Rash, Matsuba, & Prkachin, 2011)

I suspect that rather than a direct benefit, improvements in mood and sleep following gratitude practice is what actually brings about positive impacts on pain. Really though, improvements in any of those areas is a positive thing.

Initially to prompt myself to practice gratitude I followed Brianna Steinhilber of everup.com and wrote down why I felt grateful but by the end of the month I found I didn’t need to journal everyday. Rather I thought about gratitude, spent short periods of time contemplating how I felt grateful and practiced gratitude in practical ways, like thanking others and taking time to just enjoy moments – walking in the local reserve, having hugs with my dog, enjoying my morning coffee (oh so much!), delighting in catching up with my mum unexpectedly etc.

I have really relished the experience of feeling grateful more often and find I tune into to things to be grateful for more readily. I didn’t always find it easy and some days I was like ‘OMG what am I going to feel grateful for today’…but the feeling didn’t last long. Overall I know it has been a useful experience for me, and I plan to continue practicing and feeling gratitude on a regular basis.

Here are some of Brianna’s prompts you can use as a tool (I particularly like this one – When was the last time you laughed uncontrollably—relive the memory):

  • List five small ways that you can share your gratitude today.
  • Write about a person in your life that you’re especially grateful for and why.
  • What skills or abilities are you thankful to have? (You communicate well, you’re a good cook, you have an uncanny ability to dominate in Fantasy Football. Hey, it’s your journal).
  • What is there about a challenge you’re experiencing right now that you can be thankful for? (This is a tough one, but you have learned something or grown from the hardship—how?).
  • How is where you are in life today different than a year ago–and what positive changes are you thankful for?
  • What activities and hobbies would you miss if you were unable to do them?
  • List five body parts that you’re grateful for and why. (Those long legs help you reach items on the top shelf … don’t forget the little things).
  • What about the city you live in are you grateful for?
  • What are you taking for granted about your day to day that you can be thankful for? (Can’t think of any? Your alarm clock, your coffee machine, the paperboy who delivered your newspaper, your friendly neighbour who always says good morning … and that’s before you even leave the house).
  • List 5 people in your life who are hard to get along with—and write down at least one quality for each that you are grateful for.
  • What materialistic items are you most grateful for?
  • Write about the music you’re thankful to be able to listen to and why. (We couldn’t make it five minutes on the treadmill without our beats).
  • Who has done something this week to help you or make your life easier and how can you thank them?
  • What foods or meals are you most thankful for? (Bacon, egg and cheese on Monday morning, we’re looking at you).
  • What elements of nature are you grateful for and why? (The beach, a starry sky or one speckled with fluffy clouds, the sunset…).
  • What part of your morning routine are you most thankful for? (A big stretch before you get out of bed, that warm cup of coffee, a cuddle session with your pet…).
  • Write a letter to someone who has positively impacted your life, however big or small.
  • What is something you’re grateful to have learned this week?
  • When was the last time you laughed uncontrollably—relive the memory.
  • What aspects of your work environment are you thankful for? (Supportive co-workers, flexible hours, great snacks in the kitchen…) (Steinhilber, 2015)

For more inspiration check out this entire article, which has 10 different Ted Talks about gratitude and below I have put down a gratitude meditation:

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Negative expectations of pain

It might surprise you (or not!) to know that I was the only nutritionist/naturopath at the recent Australian Pain Society conference. The attendees were largely made up of pain researchers, physiotherapists and psychologists with some GPs thrown in to the mix. The attendees were representative of the biopsychosocial approach to chronic pain and accordingly within the conference presentations there was a focus on the significant psychological influences on chronic pain.

bps model

One conference presentation examined how negative expectations and learning processes can have physiological effects and impact on central pain processing i.e. negative expectations and associated behaviours can amplify pain responses. Negative expectations about chronic pain can be formed through verbal suggestions of heightened pain (a concerned family member, ‘Don’t do that, you will hurt yourself’), prior painful experiences (see example below), and observation of pain in others. An example of this is someone with irritable bowel syndrome (IBS) who feels anxious about going out with friends because last time they ate something that triggered their IBS symptoms. The anxiety then leads to worsening symptoms regardless of food triggers in that situation. Subsequently the IBS sufferer starts to avoid social situations, creating a situation where the symptoms and pain related to IBS start to control the individual’s life and lead to a degree of social isolation. This might seem like an extreme end point however it is not uncommon for people in chronic pain withdraw socially due to anxiety or fear of heightened pain.

In situations where negative expectations play a part in creating or heightening pain responses mindfulness, cognitive behavioural therapy and hypnosis can be helpful. I also add into the mix time in nature, with animals, friends that understand what you are going through and a supportive nutritionist/naturopath who can help you de-tangle when and where negative expectations are impacting and identify what resources might assist.

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