Alcohol use among women is up…by a lot. According to a study conducted by JAMA Psychiatry rates of alcohol use, high risk alcohol use, and alcohol use disorder have all increased considerably among women from 2001-2002 to 2012-2013. The study also noted considerable increases in alcohol use among minorities and older adults.

While there has been a recent spotlight on opioid and prescription drug use, alcohol use has quietly been climbing and deaths attributed to alcohol continue to rival any other substance. High risk drinking, which was defined in the study as women consuming more than 4 drinks per day or men consuming more than 5 drinks per day increased by 30% between 2001-2002 to 2012-2013. Among women specifically, high risk drinking increased by nearly 60%.

When looking at problem drinking, which is defined as alcohol abuse that causes recurrent problems in daily life or alcohol dependence, rates among women increased by an alarming 84% within the ten-year time span. While men are still more likely to be problem drinkers than women, women are quickly catching up.

Binge drinking among women, which per The National Institute on Alcohol Abuse and Alcoholism (NIAA), is defined as 4 drinks or more in a two-hour period has also increased considerably- especially among older women. From 1997-2014 rates of binge drinking among men over 60 have stayed fairly steady, while rates for women over 60 have increased an average of 4% each year.

Women are known to be more sensitive to the damaging effects of alcohol. Aside from having generally a smaller stature than men, women also tend to have more body fat and less water (which dissolves alcohol) in their bodies compared to men, and tend to have less alcohol dehydrogenase- an important enzyme that helps our bodies break down alcohol.

The Centers for Disease Control defines heavy drinking as being more than 15 alcoholic drinks for a man per week or 8 drinks per week for a woman. Excessive alcohol use among women has been associated to cancer, heart disease, high blood pressure, stroke, gastrointestinal distress, liver damage, and brain atrophy among other health problems.

Researchers have theorized that with more women entering the work force and confronting demands of work-life balance, alcohol may be a way of coping with increased stress loads. Additionally, women can be faced with sexism, lower wages, job uncertainty, and exposure to trauma.

Throughout the media, heavy drinking among women has been normalized and in many cases associated with attractiveness, likability, and humor. There is less shame or guilt around alcohol use compared to other substances. Alcohol use is often socially acceptable and at times, even expected. A woman’s sobriety at the bachelorette party or girl’s night out may be critiqued more so than if she were to get buzzed or intoxicated.

As Oregonians and even more so, as Central Oregonians, it is hard to ignore the booze culture as trendy breweries seem to be popping up all around us. Booze tourism is serious business and the allure of what’s next on the horizon can be in all senses of the word, intoxicating. For many it is hard to contemplate fun or social outings without alcohol in the equation. It is easy to become desensitized to consequences and long-term implications.

Ultimately, while brew cycles and craft beers can be enjoyed responsibly, it is important that we maintain a realistic and frank dialogue about the very real dangers alcohol encompasses. If you or a loved on is struggling with alcohol know that there is help and certainly, know that you are not alone.

As always, thanks for listening everyone!

Wishing you health and vitality.

With gratitude,

Audry Van Houweling, PMHNP-BC, Owner & Founder She Soars Psychiatry, LLC

541-595-8337/Sisters & Silverton, Oregon/ www.shesoarspsych.com

 

 

 

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

Oh hormones…it seems you are my worst enemy and my best friend depending on the day. Sometimes you make me happy, sometimes you make me sad, and sometimes you make my husband fear you. Ladies, I think we can all relate.

How many times have people accused you of being “hormonal”? Feels a bit sexist, right? Was it your significant other as is often typical? I think it’s about time as women that we take this term back- reclaim it. My response is, “Well yes, I am hormonal and in fact, my hormones probably made you attracted to me in the first place. Thank you very much”.

As women we experience dynamic hormone transitions throughout our lives. Whether it is our monthly cycle that may be predictable or highly unpredictable, pregnancy, lactation, and/or menopause, we have all experienced the force of our body’s messengers. Sometimes these changes and transitions are rejuvenating, sometimes just tolerable, sometimes comical, but sometimes they can cause serious disruptions in our mood and overall vitality.

In conventional psychiatry, there is an acknowledgment that hormones may play a role in emotional wellness, yet it remains rare that hormone levels and function are actually tested for and considered with making treatment decisions. Unfortunately, too often psychotropic medications such as antidepressants or mood stabilizers are prescribed without a second thought to addressing hormone balance. Clients may meet every criterion for clinical major depressive disorder and per recommendations, would be a “good candidate” for an antidepressant, and yet lab tests may reveal significant hormone imbalances such as thyroid dysfunction, which when corrected remedies the depressive symptoms. Go figure!

At She Soars Psychiatry, we focus on hormones that we feel are most implicated in influencing your emotional wellness.

For the sake of maintaining your focus, I will not get too wordy with the science, but if there is a take home message, please consider getting your hormones checked before jumping to the conclusion that you have a “mood disorder”. Here are some noteworthy hormones worth consideration.

Noteworthy hormones for women:

Thyroid: Thyroid function is critical to maintaining emotional wellness. Dysfunction may be caused by multiple mechanisms including autoimmune disease. Hyperthyroidism (producing too much thyroid hormone) can cause insomnia, panic attacks, irritability, heat intolerance, and more. Hypothyroidism (producing too little thyroid hormone) can cause fatigue, depression, cold intolerance, weight gain, and foggy thinking. Women can be particularly susceptible to thyroid dysfunction following childbirth, which needs to be considered if postpartum mood symptoms are experienced.

 

Sex hormones: An imbalance between estrogen and progesterone can lead to multiple mood symptoms. Estrogen dominance or excess can cause symptoms of both depression and anxiety along with progesterone deficiency (the two often go hand in hand). Testosterone is also important for women and plays a role in facilitating motivation, sex drive, and energy levels. Our environment is full of xenoestrogens (estrogen mimicking compounds), which can cause further hormone disruption. Sex hormone balance should be particularly considered in women on oral contraceptives, women experiencing pre-menstrual mood changes, women with endometriosis, polycystic ovarian syndrome, uterine fibroids, and women in the peri-menopause and menopause stages.

 

Adrenals & HPA axis function: This is a big topic and one we will explore further in detail. Essentially, your adrenals and HPA (hypothalamic-pituitary-adrenal axis) are an intimate part of your stress response. It all starts in your brain with the hypothalamus, which assesses internal and external information and then communicates with another very important part of your brain, the pituitary gland. When stressed, the adrenal glands (which sit on top of your kidneys) release both norepinephrine/epinephrine and glucocorticoids (cortisol). Many of you may have heard of cortisol and how chronically elevated levels of cortisol may be associated with inflammation, blood sugar instability, weight gain, and depression. In cases where stress is not alleviated such as post-traumatic stress disorder, cortisol levels may actually be depleted and cause symptoms of burn out, chronic fatigue, a lack of motivation, and even autoimmune conditions.

 

 

The good news is that many of these hormones can be tested and there are practical and non-invasive steps you can take to restore hormone balance and vitality!

In the end, our hormones are amazing, yet delicate messengers that deserve the utmost respect for how they keep us feeling motivated, passionate, desirable, confident, and strong. They allow us to birth children, feed our children, run from danger, sleep well at night, and get up the next day ready to go at it again. So, no matter many times they have been your scapegoat or nemesis, they do deserve our praise.

 

 

 

Wishing you balance and dynamism!

With gratitude,

Audry Van Houweling, PMHNP-BC, HNFM certified, DONA trained postpartum doula

Owner & Founder She Soars Psychiatry, LLC. Holistic Psychiatry & Wellness for Women & Girls. 

www.shesoarspsych.com