Been to the doctor lately? Likely you have had the typical patient experience- sat in the waiting room past the time of your scheduled appointment, then were ushered back to the exam room, sat probably a bit longer waiting for the provider to actually be ready to see you, and when the provider finally arrives, you rush through your concerns perhaps at the insistence of the provider who might be typing away making only brief eye contact, and then you are handed a prescription 5-10 minutes later, told to rest, drink lots of fluids, and maybe just maybe, to eat healthy and exercise.

Sound familiar? Let me tell you, many of these providers have the very best intentions, but are pressured by multiple factors that may not be readily apparent as you are sitting in front of them trying to feel heard. Providers are pressured to be more and more productive as insurance reimbursements are insufficient and employers struggle to stay afloat. They are pressured to fill their schedule to the max. They feel pressured to have a solution for you, even if it is more of a band-aid. Many of them know the value of preventative medicine. Many of them wish they had more time to foster an actual relationship with you. And sadly, many providers are simply burnt out.

In part, it is why I chose to pursue functional medicine as it allowed me an opportunity to practice medicine in a way that honors the whole context in which symptoms were occurring- physiologically, psychologically, spiritually. It allows me time to develop relationships and time to discuss root causes and the foundations of wellness that are often missed in conventional medicine. Even while working in mental health where more time is allotted compared to primary care, I myself was labeled primarily as a prescriber and thus, clients came to expect a prescription at the end of the session when that may not be what is most appropriate.

With all the hustle and bustle, conventional medicine misses the opportunity to ask WHY when it comes to your concerns. In the business world asking WHY is important and more commonly known as a root cause analysis. A root cause analysis essentially demands asking WHY about the WHY about the WHY. The “5-WHY” model is a commonly used strategy.

Here’s an example with a car that won’t start:

Can you imagine if this were done in medicine? Let’s just use the hypothetical example of anxiety- something that is typically addressed by prescribing an anxiolytic medications in the conventional setting. 

• Anxiety (WHY)
  • WHY #1: Patient states they feel overwhelmed.
    • WHY #2: Patient states they worry about finances and their marriage.
      • WHY #3: Patient states they have been arguing a lot with their spouse and working harder than they should, but still living paycheck to paycheck.
        • WHY #4: Patient states they have a tense relationship with their boss. It is difficult to ask for a raise. A lot of their work-related stress is projected on their spouse.
          • WHY #5: Patient states their boss is intimidating. Patient states they feel taken advantage of.

While medication may mask or numb symptoms from the anxiety, given this example, might it be more sustainable to instead work on empowering the patient to confront their boss or perhaps it is time to look for a new job? Many times, patients know what might be driving their stress, but giving themselves permission to act is another ballgame.

Ready for another example? Let’s take on Type II diabetes- one of our most troubling epidemic.

Here we go:

• Type II Diabetes (WHY)
  • WHY #1: HbgA1C 7.2, fasting blood sugar 200
    • WHY #2: Patient is classified as obese.
      • WHY #3: Patient feels overwhelmed with trying to exercise and eat healthy.
        • WHY #4: Patient is on food stamps and struggles to afford healthy foods. Patient cannot afford a gym membership and lives in an unsafe neighborhood- so they are uncomfortable exercising outside. Patient is also prescribed medication that increases weight gain.
          • WHY #5: Patient has been on disability for schizophrenia since age 20. Patient has been unable to work, has little support, and has poor self-esteem.

 

There you have it. It goes back to social reforms, social justice, and addressing the pre-determinants of health & wellness (safety, shelter, food, environment, social connection). Clearly, we cannot expect providers to solve these problems in the course of a 10 minute appointment, but we must try harder to encourage upstream rather than downstream models of healthcare. Providers must also be emboldened to pause, take a step back, reevaluate, and acknowledge the WHY’s with their patients and also with themselves! And remember, providers are not saviors…so if you can do a little root analysis on yourself- you might be surprised what you come up with!

With gratitude,

Audry Van Houweling, Owner & Founder, She Soars Psychiatry, LLC

www.shesoarspsych.com

 

 

They say your gut is your second brain. We all get “gut feelings” or “butterflies in our tummy”. It is not a surprise that there is often a synchronicity between our feelings and our insides.

For a good introduction of how your gut and brain are connected, watch the below TED talk

Pretty interesting stuff, right?

At She Soars Psychiatry, your gut function is a major focus of restoring your emotional wellness. Your gut and brain are in constant communication with one another.

Depression, anxiety, poor focus, mood instability, autism, and fatigue have all been previously linked to a higher susceptibility to gastrointestinal disorders such as irritable bowel syndrome (IBS), food allergies, ulcerative colitis, and inflammatory bowel diseases.

Your gastrointestinal track houses the enteric nervous system (ENS)- made up of over 100 million nerves in your gut that release neurotransmitters, hormones, and intersect with your immune function. And by the way, your gut plays the starring role in your immune system as it is the primary site where your immune system meets invading organisms. 80% of the immune cells reside in your gut!

Supporting both your gastrointestinal health and emotional wellness is your gut’s microbiome. Your microbiome is essentially the makeup of bacteria in your gut- of which we all have trillions! Did you know your microbiome is estimated to weigh 3lbs? And, we have far more bacteria compared to the cells that our actually our own!

Certain bacteria is known to be more beneficial such as Lactobacilli and Bifidobacterium strains. Other bacteria such as C.difficile, H. Pylori, and E.coli can be more harmful. When there is an imbalance between harmful vs helpful bacteria or a lack of bacterial diversity, dysbiosis can occur. Dysbiosis can also be triggered by stress, environmental toxicity, nutrition, medications, and illness among other factors.

While mechanisms behind how exactly the microbiome supports emotional wellness are not entirely clear, it is clear that they are intimately connected be it through the vagus nerve, hormones, and/or immune responses. Your gut is also a major producer of neurotransmitters. Bifidobacterium strains for example help produce tryptophan- a precursor to serotonin. Did you know that your gut produces between 90-95% of your body’s serotonin? Certainly, if this went awry, depression and anxiety could be possible consequences.

A remarkable study demonstrated that when a fecal transplant of a depressed mouse was given to an “undepressed” mouse, the “undepressed” mouse began exhibiting depressive symptoms including lack of interest and anxiety suggesting a direct connection between your gut’s microbiome and your mood.

Your gut’s microbiome is always fluctuating and is never stagnate. You are born with a sterile gut. Babies born vaginally are exposed to their mother’s microbiota in the birth canal, which is also transferred via breast feeding. It has been shown that individuals born caesarean or who were not breast fed may be more susceptible to dysbiosis, obesity, and immune deficiencies. Much of what we do, eat, and are exposed to can either be helpful or harmful to our gut’s microbiome.

Practical ways to support your gut’s microbiome & emotional wellness:

1. Minimize refined sugars & processed foods– Sugar is quickly absorbed in the small intestine and can leave the bacteria feeling deprived so that they then start consuming the cells that line your gut, which can lead to intestinal permeability of leaky gut syndrome.
2. Eat a lot of colorful plants- especially organic vegetables and low glycemic (low sugar) fruits. Plants can supply the gut with helpful bacteria and also act as prebiotics, which are food to the healthy bacteria. Try getting most of your carbohydrates from plants.
3. Enjoy fermented foods that include an array of helpful bacteria such as kefir, sauerkraut, unprocessed yogurt, and kimchi.
4. Consider an elimination diet. At least try avoiding grains and dairy for 2-4 weeks. You might notice significant improvements! Corn, soy, eggs, and legumes can also be problematic for some folks. Taking a food first approach to restoring emotional wellness is one of the least invasive, most sustainable, and most affordable strategies!
5. Consider taking a probiotic (a good one that is). Taking a high-quality probiotic can help repopulate your gut with healthy bacteria. Probiotics can help improve your digestion, mood, immune function, and energy levels.
6. Try avoiding antibiotics when possible. Certainly, antibiotics have their place, but excess use can cause havoc for the microbiome as healthy bacteria may be compromised and diversity of bacteria lessened.
7. Support your digestion! Make sure to drink lots of water and consume fibrous foods. Antacids or proton-pump-inhibitors (PPIs) can deplete stomach acid, which is an important part of supporting your microbiome. Digestive enzymes and glutamine- the primary amino acid support your gut lining can also be helpful.
8. Practice mindfulness, gratitude, & meditation. Chronic stress can perpetuate chronic inflammation and the release of inflammatory cytokines in the gut. Getting a handle on our stress can help slow the inflammatory cascade and allow our gut to heal.

Restoring emotional wellness & gut function go hand in hand. We look forward to helping you navigate this journey at She Soars Psychiatry.

May you be well!

With gratitude,

Audry Van Houweling, Owner & Founder, She Soars Psychiatry, LLC