While our basic human physiology is largely unchanged, never in history have we collectively contended with as many unremitting and insidious insults to our wellbeing and vibrancy as we do today.
This is my first post for 2017 and I thought what better way to kick off than with some musings to do with a talk I did late last year, under the auspices of the Ancestral Health Society of NZ (AHSNZ). This talk was part of a women's wellness event with two other presenters that I lucked out and got to see talk, Dr Lara Briden and Dr Anastasia Boulais. I presented on my current favourite topic: the psychological expression of physical excesses and deficiencies. Here is part one of my summary of how that talk went including an important question raised by a member of the audience.
First, check out this quote I like, from the book Psychological Masquerade:
"Psychological symptoms are not always best explained psychologically." ~ Robert Taylor
It's true. They also may not always be best explained by other reasons that are accepted by the masses at the time. For example, when you look at some of the proposed causal understandings of female physical/psychological suffering over time, they include sexual and reproductive organ issues (and lack of sex/orgasms), possession and black magic (with exorcism and execution), and penis envy (thanks Freud). 'Hysteria' was the first known descriptor of what are now termed "psychosomatic" disorders, and was originally applied to women and defined as "the conversion of psychological stress into physical symptoms".
Things progressed post-world wars however, after men returned home with the physical and psychological effects of prolonged or acute stress and trauma. There was a shift to obtaining a greater scientific understanding of such experiences, as well as effective treatments for the debilitating effects (Van der Kolk, 2014). This eventually led into well-known biological models that have been generally accepted until recently, including catecholamine dysfunction as the explanation for depressive and anxiety disorders (e.g., low serotonin, dopamine, GABA), with psychiatric medications widely used as treatments (e.g., selective-serotonin re-uptake inhibitors - SSRI's). Under a medical model, binary or dualistic concepts of mind and body relationships became the focus within clinical practice rather than integrative, as per NZ based mind-body expert Dr Brian Broom (Broom, Booth, & Schubert, 2012). More recently though, there has been discussion on the limitations of both dualistic and catecholamine models, as we've seen an emergence in research on the gut-brain axis (see below). Concerns have also been raised around rising rates of mental disorder despite the commonality of psychiatric medication use (e.g., as per 2015 NZ Pharmac data 1/6 women used an SSRI).
The gut-brain axis involves the complex interaction of our gut microbiome (the array of microorganisms in our gut which require balance), the hypothalamic-pituitary-adrenal axis (the cortisol and adrenaline producing stress response), the vagus nerve (gut-brain/two-way communication line), and the immune and neuroendocrine systems, among other things. How our modern diet and lifestyle jeopardise the harmony of the gut-brain axis, and how to repair this harmony, is a promising area of research within many fields, including mental health. Problems within the gut-brain axis explain overlapping physiologic and mental symptoms such as those seen in 'psychosomatic' disorders (Greenblatt & Brogan, 2015). For example, anxiety, panic attacks, emotional lability or flatness, cognitive changes, and insomnia can arise with physical food allergies/intolerances, nutrient depletion, insidious hormonal problems including thyroid, sex hormone, or adrenal dysregulation, and autoimmunity. This brings us around to how modern excesses and deficiencies affect the gut-brain axis and contribute to these phenomena.
Excesses & Deficiencies
When I talk about 21st century excesses I include this non-exhaustive list of modern factors that were absent or minimal at earlier times in history:
- processed food and food intolerances/sensitivities
- device notifications and screen time (especially in the evening)
- mindlessness (chronic "automatic pilot")
- perceived stress, rushing, and being "busy"
- toxicant exposure (pesticides etc.)
- social media/self-focus and the 'imaginary audience'
- intrusive sensationalist media of many forms
Then there are the deficiencies of things that our ancestors likely had more ready exposure to:
- adequate nutrients (e.g., vitamins, minerals, macronutrients)
- true relaxation
- movement/physical strength
- time in nature
- deep quality sleep
- meaningful connection and community
- hands-on childrearing support
- environmental intuition (respecting the wisdom and rhythm of nature)
In just one example of the physical/psychological overlap, the slide below contrasts various symptoms of suboptimal nutritional intake (arising from a combination of the excesses and deficiencies listed above) with the common symptoms of a depressive episode (Note: a diagnosis of depression also requires other factors like ruling out other explanations, symptom duration, and degree of impairment to functioning).
That is a large overlap, right? Yet broad nutrient insufficiency is often not delved into and worked with, and so people are frequently not aware of how much their diet and lifestyle may be impacting psychologically. To have the nutritional foundation for mental and emotional wellbeing, the brain requires individually sufficient macronutrients (healthful fat, protein, and complex carbs) and all the various micronutrients that are abundant in food as designed by nature (e.g., optimal B vitamins, Iron, Folate, zinc, Magnesium, Vitamin D etc.). Our heavily processed and highly carbohydrate based modern diet does not provide these adequately, plus, when there are additional insults from the lists above (and let's face it, we all have some), they use up extra nutrients, make absorption difficult, and place strain on the gut-brain axis.
Here are what I consider to be other common key deficiencies from a psychological perspective:
- secure attachment
- compassion (for self/others/world)
- aligning our behaviour with our values
- a sense of meaning and purpose
- and allowing difficult emotional experiences
Stress and Balance
Of course, the concept of excesses and deficiencies is an oversimplification, as these usually interact together and cause a vicious cycle (e.g., overlooking early signals that rest is needed = evening screen time = low melatonin production = poor sleep = caffeine = increased stress response = chronic cortisol production = depleting nutrients and damage to gut = neurotransmitter impairment, possible immune response, neuroendocrine changes = physical symptoms, low mood, memory impairment, anxiety, and so forth). However, the uniting feature of either excesses or deficiencies is that they cause or contribute to perpetuating a stress response in the human body. There was a whole book recently written on this in relation to depression and integrative treatments for it that is a very worthwhile read for any clinician (Greenblatt & Brogan, 2015). While humans generally thrive with short-term stress that can be switched on and off quickly (e.g. jumping out of the path of an oncoming car), the presence of unremitting stress is detrimental. To a point, we are physiologically primed to adapt to maintain homeostasis/balance for our survival (McEwen, 2005; 2008). But as tolerance to stress increases and a certain threshold is reached, the body will eventually find a way to protect itself from further stress with implications for the gut-brain axis and our health.
It must also be noted that we may have a different degree of drive towards excess and deficiency in the first place, arising from:
- our individual (epi)genetic makeup
- how stressful our early life events were (Cirulli, 2017)
- our early attachment, which shapes our self-control, emotion regulation, self-expectations, capacity for healthy connections with others, plus more
- the degree of social support and connection we have vs loneliness
- the availability, affordability, production, and marketing of food
- political influences
- knowledge and beliefs about health and wellbeing
- and various norms within our society (e.g., coffee culture, wine o'clock, sedentary living, having 'treats', wearing 'I'm so busy' like a badge of honour)
Importantly, developmental stress researcher Dr Bruce McEwen acknowledges that "the brain is the key organ of the stress response because it determines what is threatening" (2008, p.4). Thus, our values, unique expectations and judgements of our self, perceptions of others, and perspectives of things that happen in our life interplay with the stressors in our environment. Once in an established pattern, the stress response itself can also maintain the drive to continue habitual behaviours, as we are then in survival mode (McEwen, 2008). There are also withdrawal and metabolic effects from some of the excesses, which require us to seek them out just to function. If you can't open your eyes without coffee, find yourself chasing afternoon sugar to think straight, or crave the evening swill or sleeping pill to unwind from the cortisol of the day, this might be you.
The Crux of the Issue
One question from the audience that was asked at this talk has remained with me since, from someone brave who probably said what others often think - "it's all very well to hear about all this information and to know what I "should" be doing for my recovery, but how on earth do I actually do it?" To me this is the crux of the issue. Once the penny has dropped and we wish (or need) to live a balanced life more in accordance with our physiological design, how do we each do it? Members of the audience had their own answers for this question with apt suggestions such as - you need to find your likeminded and supportive people, just take it one step at a time, and they reiterated a message I'd carefully fed into my talk "avoid striving for perfectionism in the quest for health, as this can also maintain ill health".
"Strive for progress not perfection". ~ Unknown
How do We do It?
How to do it is something I grapple with daily as I work alongside people to figure this out, and I now consider recovery from gut-brain axis dysfunction much like an intricate jigsaw puzzle. Helping others to do it is why I studied clinical psychology originally, and now why I study other integrative or holistic approaches. It is why I think-tank regularly with colleagues from a variety of different disciplines other than my own, and is why I was so thrilled to discover and join up with the AHSNZ. This is a wider NZ platform of likeminded people bringing together an understanding of our evolutionary past with the modern advances we continue to develop. This group are fascinated with finding ways to function optimally in the 21st century and to share this knowledge with New Zealanders. Learning about ancestral health is a helpful approach to the "how do we do it" question, but being able to translate this information into practice often requires assistance to navigate, as the audience member's question highlighted. Watch out for answers to this question in the second half of this summary that I'll share next: Addressing 21st Century Excesses and Deficiencies. This will include information on the prevention and treatment of gut-brain axis dysfunction, how to optimise vitality and functioning, as well as resources I recommend from the integrative realm.
McEwen, B. S. (2008). Central effects of stress hormones in health and disease: Understanding the protective and damaging effects of stress and stress mediators. European journal of pharmacology, 583(2), 174-185.