childbirth, labor, oxytocin, pregnancy

Pitocin Is Not Oxytocin

Pitocin-Is-Not-Oxytocin
The role of hormones in our body are so vast and dynamic!  Here is a quick article looking at only one of the hormones that help regulate us.

BY KELLY BROGAN MD

“The Love Hormone”.  Sounds important, no? Turns out that we know very little about the hormone oxytocin, beyond that it is incredibly relevant to multiple metabolic, behavioral, and endocrine functions. In a compelling review entitled Beyond Labor: The Role of Natural and Synthetic Oxytocin in the Transition to Motherhood, Bell et al explore the literature suggesting that, once again, we cannot outsmart, outdo, or circumvent nature with pharmaceutical products.

What is Oxytocin?

One of the known roles of oxytocin is in the complex physiology of labor and birth. Perceived by the obstetrical establishment to be a “contraction chemical”, oxytocin’s effects are bodywide, and most notably, brain-based. During pregnancy, oxytocin receptors increase in areas of the maternal brain related to mood, stress, and attachment behavior. Specifically, its activity has been studied in the hypothalamus, lateral septal nucleus, periaqueductal grey, Broca’s area, nucleus basalis of Meynert, locus coeruleus, vagus, solitary tract, trigeminal nerve, and lateral reticular formation. It is secreted continuously in the brain and in a pulsatile manner to the body through the posterior pituitary. Despite efforts, the brain-blood ratio has not been well-elucidated leaving major gaps in our understanding. When it comes to hormones, the production and release of the hormone is critical, but so is the receptor activity – the action of the baseball in the catchers mitt, and receptor sensitivity varies from person to person based on genetics and adaptation to experience.

What is Pitocin?

So, when we manufacture a synthetic version of this hormone and commandeer a woman’s labor physiology, it should come as no surprise that there are unintended and poorly understood consequences. Pitocin®  or “Pit” as it’s called on the floors, is the obstetrician’s whip. They snap this whip when your baby is not conforming to their non-evidenced-based schedules. When your due date is wrong, when you’re forced to birth in highly artificial circumstances, or when your physiology has been hijacked by an epidural.

Bell et al discuss a number of concerns related to the administration of synthetic oxytocin:

  • Because of its hydrophilic (fat-loving) nature and molecular size,Pitocin®  is unlikely to cross the blood brain barrier. But maternal oxytocin is very active in the brain, inducing secretion of other hormones including endorphins (buffering fear and pain). It is also active in the fetalbrain, protecting receptors such as GABA, from potential hypoxia of birth.
  • If, in fact, synthetic oxytocin does reach the maternal brain (because of barrier permeability or active transport of some kind), the authors state:

    “Whether the maternal brain will reliably respond to exogenous oxytocin by decreasing or increasing the synthesis or release of endogenous oxytocin is unknown.”

What about after labor is over?

Women are struggling to breastfeed in proportions likely never seen in human history. Bell et al reference a powerful study that implicates Pitocin in this phenomenon.

“Compared to all other study groups, women exposed to Pitocin® in labor combined with an epidural demonstrated significantly lower oxytocin levels during breastfeeding. Overall, the total quantity of synthetic oxytocin administered during parturition was negatively correlated to levels of oxytocin in plasma two days following birth.”

This may be related to the effects of a pharmaceutical-grade agonist stimulating the oxytocin receptor and causing modeling changes at the membrane level. When receptors are overstimulated, they are internalized and downregulated through changes in gene transcription. Bell et al reference a study demonstrating that:

Participants with oxytocin-induced labor had a 300-fold down-regulation of the OTR gene in uterine muscle, when compared to receptor availability in spontaneous labor.

The role of oxytocin in the HPA axis (hypothalamic-pituitary-adrenal) may explain why:

“Lactating women show increased vagal tone, decreased blood pressure and decreased heart rate when compared to non-lactating women, especially in response to a stressor.”

Data analyzing the role of oxytocin in response to postpartum stress suggests that it is a buffer to the negative effects of the experience. When this buffering effect is inadequate, we may see the emergence of postpartum depressive symptoms. One study found that bottle feeding women had lower levels of oxytocin, higher heart rates, and higher cortisol, but that breastfeeding depressed women shared this profile, implicating low oxytocin levels in depression.

Amazingly, some of oxytocin’s effects may actually be mediated by gut bacteria (is there anything the microbiome doesn’t manage?) as was demonstrated in this study showing a lactic acid bacteria accelerated (doubled) wound healing in rodents by increasing oxytocin levels. In psychiatry, there is sparse literature supporting the use of intranasal oxytocin in autism, schizophrenia, OCD, social phobia, depression/postpartum depression, and anorexia but notable theoretical underpinnings for consideration in these cases and minimal risk.

While we attempt to understand the variables contributing to altered oxytocin response in the body, deliberately interfering with this feedback system through the use of synthetic hormone should be exposed for what it really is: a dangerous fix for the problems of a medicalized birth.

Advertisements
Standard
cultivate, express, happiness, hood river midwife, hood river naturopath, journal, mental health, naturopath, write

Keep a One-Sentence Journal, Be Happier

UnknownEver since I can remember, my grandma has kept a daily journal. Not a “Dear Diary,” emotion-filled journal — just a couple of lines jotting down what she did that day and whom she was with. Often, when the family is together, she’ll dig out one of her old journals and tell us what she and various other family members were doing on a random day, in, say, 1994. I’ve always been amazed at how interesting these little moments are in retrospect.So this morning, as I listened to the newest episode of Gretchen Rubin’s “Happier” podcast, I was intrigued to hear her urge her listeners to adopt the habit my grandma has been following for years. Rubin calls it a one-sentence journal, and she herself has kept one for nearly a decade now. On her show, she talked about how she believes that reliving those daily moments has helped make her happier.

There’s even some research backing up Rubin (and my grandma) on this: Last year, Ting Zhang at Harvard Business School published a paper in Psychological Science outlining a series of experiments testing how much people appreciate memories of the day-to-day moments from their lives. She asked people, for example, to write about a recent conversation, and then to rate whether the chat was ordinary or extraordinary; they then guessed how much they’d appreciate reading their written account of the chat in the future.

Seven months later, Zhang contacted participants, asked them to read the memory they’d written down, and then to tell her how much they enjoyed it. Not only did most participants enjoy rediscovering the written record of the months-old conversation more than they’d anticipated, but those who’d written about an ordinary conversation were particularly likely to underestimate how much they’d appreciate reliving the memory.

What seems like an ordinary moment today, in other words, could become a little more special with time. As one participant in Zhang’s study said, “Re-reading this event of doing mundane stuff with my daughter has certainly brightened my day. I’m glad I chose that event to write about because of the incredible joy it gives me at this moment.”

Standard
breastfeeding, frenulum, inants, newborn, pregnancy, tongue tie

The Basics of Tongue and Lip Tie: Related Issues, Assessment and Treatment

By Melissa Cole, IBCLC, RLC and Bobby Ghaheri, MD., Portland OR.

“Tongue-tie” has become quite a buzz word in some circles and is still quite unknown in others.  Tongue-tie, professionally known as ankyloglossia, is a congenital condition in which the lingual (tongue) or labial (lip) frenulum is too tight, causing restrictions in movement that can cause significant difficulty with breastfeeding and, in some instances, other health concerns like dental, digestive and speech issues.  Mothers of infants dealing with feeding challenges are often desperate to find solutions; as awareness increases about tongue and lip tie, some mothers wonder if this is something their baby may be coping with.

Parents often want to know what some typical signs of tongue/lip tie are.  Each mother/baby dyad is very unique and therefore tongue/lip tie issues can present differently for everyone.  Some common symptoms that may point to the infant being tongue/ lip tied include: poor latch/inability to latch, sliding off the nipple, fatigue during feeds ,sleepy feeds, poor weight gain, clicking during a feed , maternal nipple pain/damage (can feel like the infant is compressing, chewing, gumming, pinching, scraping the nipple, etc), increased maternal nipple/breast infections, compromised maternal milk supply, dribbling milk at the breast/bottle, digestive issues (increased gassiness, reflux, etc due to extra are being swallowed and poor control of the milk during a swallow), and various other feeding related challenges. Some mothers and babies may cope with some of these issues, all of these issues or even none of these issues when a tongue/lip tie presents. We must keep in mind having a frenulum is not the problem; compromised tongue mobility and functionality that cause problems for the mother and/or baby are the problem!

Mothers are tech-savvy and often turn to the computer first to research what might be causing their feeding concerns. When moms go online, they will most likely encounter some discussion about how tongue and/or lip ties can cause feeding issues.  If parents suspect a tongue/ lip tie then families will often want to see a provider in-person to have their baby evaluated and treated.  Sometimes families are lucky enough to have a local provider well-versed in evaluating and treating oral restrictions like tongue and lip tie.  However, many mothers may not have access to this expertise in their local communities. If you suspect that your infant may have a tongue or lip tie and you’re not able to find a provider in your community to evaluate and treat this condition, consider connecting with a local international board certified lactation consultant (IBCLC) that should be able to help connect you with additional resources. Another resource is the website for the International Affiliation of Tongue-Tie Professionals (IATP) (please note that the website is just about to be launched and may or may not be live at present, do check back if needed).

Tongue and lip ties come in various shapes and sizes and can present uniquely in every baby.  Many providers have only been trained to look for very prominent, classic tongue ties that often create a heart-shaped tongue.  However, tongue ties can be sneaky and restrictions that are more posterior (toward the base of the tongue) cannot be easily visualized.  Proper assessment and evaluation are key when identifying these types of ties because they can easily be missed at first glance.  Not all providers know how to properly assess for all types of tongue and lip restrictions.  While there are various assessment tools and tongue-tied classification scales that have been published, there is still no universally accepted standard of assessment and care when it comes to tongue and lip tie.  This fluctuation in assessment and treatment standards can be extremely frustrating for parents trying to seek evaluation and care for their potentially tongue and lip tied infant.  If you are unsure of whether or not your provider is adept at assessing or treating various types of tongue and lip tie you may want to ask your provider the following questions:

  • How do you assess for tongue/lip tie?
  • How often do you treat tongue/lip tie in your practice?
  • Do you treat posterior tongue ties?
  • How do you perform the procedure?
  • What type of follow-up care to recommend after the procedure?

Providers that routinely assess and treat babies for tongue and lip tie should be able to easily answer these questions and provide parents with enough information so that they can make an informed decision.  Providers that may not be the best to assess or treat your baby include ones that rarely assess or treat for this condition, tell parents that the tongue tie will stretch or that it’s not a big deal, tell parents that they have never heard of it posterior tongue tie, or tell parents that this must be done under general anesthesia.  Parents should always feel empowered to seek additional opinions and advocate for the needs of their child if they are struggling to find a provider that understands and treat oral restrictions.

If a tongue or lip tie is present and parents wish to seek treatment, what can parents expect?  Various types of providers treat tongue and lip tie including: ear nose throat doctors (ENTs), pediatric dentist, oral surgeons, pediatricians, naturopathic physicians, and others qualified to do minor surgery.  In most all cases, releasing the frenulum for infants is an in-office procedure, with no sedation needed.  In some rare cases, or in cases with older children, sometimes light sedation is used if the parents or provider feel that the older child would be too stressed while alert, but in infants this is usually not necessary at all.  Some providers release the frenulum with sterile scissors, others use laser technology. The availability and types of providers in any given community will vary as will the course of treatment.  In general, this is what we tell parents coming to our practice to expect (please note that other providers may perform the treatment slightly different ways):

What to expect when your baby needs a frenotomy/frenectomy:

In general, the procedure is very well tolerated by babies.  We take every measure to ensure that pain is minimized.

1)    For a typical frenotomy (an incision of the frenulum), a topical numbing gel is applied once or twice and occasionally, if a frenectomy (frenulum tissue is removed) is needed, a small amount of local anesthetic is injected.  Often, ice chips are applied directly to the area before (and sometimes after), as this helps numb the area.

2)    Crying and fussiness are quite common, and most children lose only a small amount of blood.  They will frequently drool afterwards until the numbing medicine wears off.

3)    Pressure and ice are held to help minimize any bleeding, and the child will be returned back to you, where you have the option of immediate breastfeeding, bottle feeding or soothing depending on your preference.

4)    Tylenol may be used afterwards but is often not even needed.

5)    You may notice some dark brown stools or spit-ups afterwards as some blood may get swallowed after the procedure.

There is very little risk involved with the frenotomy/frenectomy procedure.  The biggest risk of the procedure is the potential for re-attachment to occur.  In order to prevent this from happening, we work with the patient’s in our practice to keep the newly-released area open and healing well by encouraging specific mouth-work after the procedure.  We encourage gently massaging/stretching the incised area, targeted oral motor work to help the tongue and mouth learning patterns, supportive bodywork, and other complementary healing modalities.  By incorporating this type of gentle aftercare, we do see a reduction in reattachment and better progress overall.

Over the decades, it is no doubt that many breastfeeding relationships have probably suffered greatly due to undiagnosed tongue or lip restrictions.  While more providers and parents are becoming educated about ties, we must be mindful not to think that every feeding challenge is created by a tongue or lip tie or that releasing restrictions will immediately improve the feeding situation.  Sometimes there is immediate improvement after the procedure and sometimes it is a gradual process as the tongue is supported in moving in new ways.  Feeding challenges can be complex and involve layers of issues.  In addition, tongue/lip tie can create other issues that may need to be proactively addressed.  Infants and mothers may cope with muscular tightness, nipple damage/pain, milk supply issues, infant weight gain concerns, etc. that need further support before and after a tongue/lip tie is evaluated and treated.  Working with a qualified, experienced board certified lactation consultant or other care providers that are familiar with oral restrictions is highly suggested.  Coping with feeding challenges in a tongue/lip tied infant can be an emotional and physical roller coaster for families.  It is our goal in writing this article that all mothers and babies receive the care they need and that awareness in regards to tongue/lip tie issues will continue to increase worldwide.

For additional resources on tongue and lip tie, please visit Luna Lactation’s website resource page and scroll down to the tongue tie section.

Standard
exercise, hood river naturopath, women's health

The Underground Guide To Planning Your Exercise Around Your Menstruation Cycle.

BG ArticleIntroduction

With adult women making up such a large percentage of people at the gym and out pounding the pavement, coaches and trainers (regardless of their sport) must educate themselves on the complexities of the menstrual cycle.

Ever heard of the pregnenolone steal?

That the luteal phase of menstruation lowers your insulin sensitivity while at the same time giving you an increase in metabolism?

Progesterone depletion?

You may not be familiar with all these terms, or how to use knowledge of them to your advantage or your clients’ advantage for exercise, so continue reading to figure out how you can help educate yourself or your clients on factors to track during menstruation.

And trust me, don’t stop reading if you’re a guy! Us men will benefit greatly from knowing how our partners, spouses, mothers, wives, daughters, sisters and clients can plan their exercise more intelligently. But before learning ways to plan training during menstruation, let’s dive into the basics of the menstrual cycle.

The Start Of Menstruation

The menstruation cycle starts at Day 1 after the unfertilized egg causes the uterus lining to break down.  A menstrual cycle lasts around 28 days but can vary depending on many factors.  For simplicity, in this article I will use a 28 day cycle as the example to cover the phase variances. Body-wide fluctuations occur during this time, but we’ll pay extra attention to levels of estrogen, progesterone, and insulin sensitivity.

BG Fitness

——————————

Follicular Phase

The follicular phase comes first (lasting roughly from Day 1 to Day 14) and occurs when the ovary releases an egg. At this point, estrogen increases, while progesterone and body temperature stays the same (See diagram below).  This first phase is a time where the female body is primed to hit intense workouts that are of an anaerobic nature.  Increased insulin sensitivity, along with an increase in pain tolerance, can explain this capability.

An article from The Globe and Mail by Alex Hutchinson stated that carbohydrate loading the day before an endurance competition is more important during this phase.  Later in the article, Hutchinson interviewed a scientist that stated that the metabolic effects during each phase can be negated with purposeful nutrition.  For example, if competition falls on this phase, carb loading during this phase is more important than other periods of the menstruation cycle. Hutchinson also found that performance during menstruation is highly variable. Supposedly, this whole carbohydrate need is due to the body’s ability to better dip into intense glycolytic efforts during the follicular phase, although it would be interesting to see if women who follow a high-fat diet have quite as high a need for carbohydrates during this phase. Regardless, you may want to try to adjust carb intake slightly up during your follicular phase, while at the same time planning your more intense, glycolytic workouts during this phase.

Some women perform unaffected, and others have phases that hinder performance if left unattended.  During training in the follicular phase, coupling intense workouts with refeed meals should be utilized, preferably including carbohydrate sources such as sweet potatoes, yams, rice, or starchy vegetables such as carrots, parsnips and beets.

The American Journal of Nutrition stated that basal metabolic rate decreases at the beginning of menstruation and reaches the lowest point a week before ovulation.  Doing more intense workouts and including metabolism-boosting post-workout meals in the follicular phase will help counteract this slower metabolism, says Shannon Clark in this T-nation article.

Ovulation

Ovulation occurs around Day 14.  Estrogen has peaked and begins a decline, while progesterone surges.  It is normal during ovulation for a woman to feel warmer for the remainder of the cycle. Clark stated in her T-nation article cited earlier that metabolism will start to climb, while insulin sensitivity will begin to decline.

As progesterone surges, a slight decrease in serotonin can happen, and since carbs can boost serotonin, food cravings can often occur at this time. You can use some of these tips to avoid giving into the serotonin boosting carbohydrate gluttony. During ovulation, estrogen and overall strength is peaked, so heavier weight training can be appropriate during this phase (rather than the more difficult cardiovascular anaerobic efforts of the follicular phase) – however, the American Journal of Sports Medicine found that due to joint laxity and estrogen-induced changes in collagen structure, ACL tears are four to eight times more likely to happen during this phase.

Consider supplementing with a tablespoon of collagen in your morning smoothie, place more emphasis on your warm-up, include recovery sessions, and be aware of fatigue and proper form.  More applicable recommendations that you can use for yourself or female clients will be listed below, but let’s finish the details of the menstruation cycle, shall we?

Snipping Pics for Articles2

Luteal Phase

Next is the luteal phase, which begins on ovulation day, for which we will say is happening on approximately Day 14.  During this phase, your body is not primed to workout at very high intensities, the body will prefer fat as its primary fuel source instead of glycogen, and you might retain more water at this time due to PMS symptoms. This might cause discomfort during short burst exercise – plan for lack of motivation here, and stick to aerobic activities as your primary exercise.

Fat burning workouts should be emphasized during the luteal phase.  If you are doing a workout that is strength or glycolytic, note that the luteal phase is not ideal for these domains and you may not perform to your usual capabilities. This is the time of the phase to plan things like aerobic trail runs, flat bike rides, easy swims and other aerobic activities that are at a slightly conversational pace.

After the luteal phase, the transition back to he menstrual phase, will bring metabolism, insulin sensitivity, body temperature, and water retention back to a slightly more “normal” feeling.  For a graphic representation, you can reference the first picture posted under “The Start of Menstruation” above to better understand phases.

Snipping Pics for Articles

Eight Recommendations For Planning Exercise Around Your Menstrual Cycle

So now that you have your head wrapped around the menstrual cycles, let’s jump into even more practical advice. What considerations should you take for programming for females? Here are some of my top tips.

1) Achieve Nervous System Balance.

Every week must include a slow, long distance workout of around an one hour of conversational paced work.  This will help women have smoother cycles because their body won’t feel as much stress in the sympathetic nervous system.  Not only will this help increase your heart stroke volume, stimulate parasympathetic nervous system growth, but it will also provide a nice active recovery for your body allowing your body to flush out lactic acid from muscle tissue. Going for an unplugged trek can be therapeutic and help build a more robust cardiovascular system.  Mothers and wives – this is also a good chance to bring your family along!

2) Know Where You’re At.

Begin tracking performance during each phase for your entire menstruation cycle.  Take notes on sleep, macronutrient consumption, and exercise intensity.  Communicate these notes with your coach. Try the “Flow” app to make tracking your cycle easier.

3) Moderate Stimulants.

Another important stressor to monitor includes avoiding dependence on caffeine as a stimulant. Allow your sensitization to caffeine to recover after drinking caffeinated coffee by following Ben Greenfield’s habit of alternating three weeks of caffeine with at least one week of decaf, including a variety of nourishing teasguayausachinese adaptogenic herbs, etc.

4) Eliminate Soy.

Along with regulating caffeine intake, eliminating commercial soy sources such as tofu and soy milk can help some women avoid estrogen dominance, which can lead to menstrual cycle irregularities.

5) Use Supplements.

To reverse the effects of estrogen dominance, Beyond Training by Ben Greenfield asks you to consider drinking 2-3 cups of organic green tea powder, consuming more fiber, supplementing with a Vitamin B/antioxidant complex, and many more found in Chapter 14 of his book.

6) Keep Moving No Matter What.

Movement (not necessarily a daily Crossfit WOD!) will help relieve cramping and headaches.  The release of endorphins will help reduce crankiness.  Movement can also help put you to sleep and resist cravings, as long as macronutrient needs are met depending on exercise intensity and the given phase of menstruation. But if you have cramps, excessive flow, or have a poor reading on your HRV that morning, take that day off from structured exercise or hard workouts.  Now, this is not an excuse to sit on the couch all day, so don’t get too excited!  Instead, try techniques like ‘greasing the groove’*, using a standing desk, reading a book, working on your mobility (especially your lower body mobility), spending some time on a rumble roller, and ensure you have proper foods prepared for the next couple days.

*Popular movements to ‘grease the groove’ include: jumping jacks, band pull-aparts, strict pull-ups, bodyweight squats, lunges, or something as simple as going up and down the stairs a few times, refilling your water bottle, and holding a few stretches.  Movement throughout the day is very important for overall health because GLUT-4 will shuttle more glucose into the body and lipoprotein lipase will be produced by muscle tissue when leg muscles are being flexed.  A lack of lipoprotein lipase is associated with many heart problems, including heart disease, so please get an adjustable standing desk.

7) Know Your Fat Burning Zone.

Know your fat burning zone for that luteal phase! Superhuman-approved example fat burning workouts, most especially for the luteal phase of a cycle, are a great way to shred fat at a time where your body is primed to do just that.  For example, you can perform 8 sets of 5 minutes at 60-70% of your VO2 max of running, biking, swimming, rowing, hiking, brisk walking or elliptical, with 3 minutes of easy movement between each bout (as opposed to a follicular phase workout, which might be something like 20 sets of 1 minute bursts at the same pace with 30 seconds of recovery in between, or an ovulatory phase workout, which might be a 5×5 style weight training routine).

How do you find your fat burning zone? Many tests exist to approximate your VO2 max, but the one Superhuman Network coaches use is a 20-30 minute run at a maximum sustainable pace while wearing a heart rate monitor and taking the average heart rate that you had, then subtracting 20 beats for your fat burning zone (more details here). Even though these are easy, fat-burnign workouts, you should not perform these or any workouts without following up with proper post workout nutrition if you have a history of missing your period.

8) Go Beyond Training.

A few more lifestyle basic tips from Ben’s book would include: do not skip meals, consume a high protein breakfast on your harder workout days, eat a diet high in ancestral meats such as liver and bone broth, consume a high amount of healthy fats, get proper quantity and quality of sleep, and track your HRV. These are all small ways to enhance your performance and can also lead to a more consistent menstrual cycle, along with better exercise sessions and better recovery. Maintaining low energy movements throughout the day, eating enough carbohydrate to fuel workouts as well as support menstruation (e.g. timing your carbohydrates to happen in conjunction with your workouts – here are some good post workout nutrition ideas for endurance and strength athletes.),  consuming fat from healthy nut butters or MCT oil, and performing no more than three very intense workouts (like Crossfit wods, Tabata sets, longer track sessions, etc.) per week can also be helpful, especially if you tend to miss periods.

Check out the podacst:  the podcast episode “#310: The Menstrual Cycle And Athletic Performance, How To Get Kids To Grow Taller, Fueling For Soccer Matches & More!”, I

Standard
add/adhd, mental health, pediatrics

Can Attention Deficit Drugs ‘Normalize’ a Child’s Brain?

Recent research that says that A.D.H.D. pills like Adderall, above, can “normalize” a child’s brain over time has drawn criticism.

By KATHERINE ELLISON Credit Elizabeth D. Herman for The New York Times

Recent research says that A.D.H.D. pills like Adderall, can “normalize” a child’s brain over time has drawn criticism. What are your opinions and what has worked for you?  As a naturopathic physician, I believe by balancing neurotransmitters, and discovering the root, initial insult that led to any developmental imbalance is key to finding health.   Where can energies be channeled, how can brain’s truly be ‘normalized’?  Consult your local naturopath or learn more at http://www.gorgenaturalmedicine.com

________________________________________________________________

The Pleasantville, N.Y., developmental pediatrician won’t allow drug marketers in his office, and says he doesn’t always prescribe medication for children diagnosed with attention deficit hyperactivity disorder. Yet Dr. Bertin has recently changed the way he talks about medication, offering parents a powerful argument. Recent research, he says, suggests the pills may “normalize” the child’s brain over time, rewiring neural connections so that a child would feel more focused and in control, long after the last pill was taken.

“There might be quite a profound neurological benefit,” he said in an interview.

A growing number of doctors who treat the estimated 6.4 million American children diagnosed with A.D.H.D. are hearing that stimulant medications not only help treat the disorder but may actually be good for their patients’ brains. In an interview last spring with Psych Congress Network, an Internet news site for mental health professionals, Dr. Timothy Wilens, chief of child and adolescent psychiatry at Massachusetts General Hospital, said “we have enough data to say they’re actually neuroprotective.” The pills, he said, help “normalize” the function and structure of brains in children with A.D.H.D., so that, “over years, they turn out to look more like non-A.D.H.D. kids.”

Medication is already by far the most common treatment for A.D.H.D., with roughly 4 million American children taking the pills — mostly stimulants, such as amphetamines and methylphenidate. Yet the decision can be anguishing for parents who worry about both short-term and long-term side effects. If the pills can truly produce long-lasting benefits, more parents might be encouraged to start their children on these medications early and continue them for longer.

Leading A.D.H.D. experts, however, warn the jury is still out.

“Sometimes wishful thinking gives us hope that the impressive short-term relative benefits of medication over other treatments will persist beyond childhood, but I haven’t seen it,” said James Swanson, director of the Child Development Center at the University of California at Irvine. Dr. Swanson, a co-author of a landmark federally funded study, the Multimodal Treatment of Attention Deficit Hyperactivity Disorder, said that follow-up research found overall improvement but no greater long-term benefits after three years for children who were treated with medication compared to those who weren’t. One possible reason, as the report noted, was that many children refuse to continue taking medication after a year or so, something most parentsof such children well know.

Research has shown that the brains of people with A.D.H.D. on average look and function differently than those who don’t have the disorder, particularly when it comes to processing two important neurotransmitters: dopamine and norepinephrine. For most people with A.D.H.D., stimulants can temporarily boost focus, motivation and self-control by increasing the availability of these chemical messengers. The question is whether these effects can last once the drugs have left the bloodstream.

In arguing for “normalization,” Dr. Wilens cited a major review in the Journal of Clinical Psychiatry in late 2013, which looked at 29 brain-scan studies. Although the studies had different methods and goals, the authors said that, together, they suggested that stimulants “are associated with attenuation of abnormalities in brain structure, function, and biochemistry in subjects with A.D.H.D.”

But other A.D.H.D. experts challenge this conclusion. Dr. F. Xavier Castellanos, director of research at the New York University Child Study Center, called assertions that stimulants are neuroprotective “exaggerated,” adding: “The best inference is that there is no evidence of harm from medications – normalization is a possibility, but far from demonstrated.”

A.D.H.D. is an exceptionally controversial diagnosis, with particular controversy zeroing in on researchers, including Dr. Wilens himself and some of the authors of the 2013 report he cited who have received financial support from pharmaceutical firms. In an email, Dr. Wilens said he had not received “any personal income” from the pharmaceutical industry since 2009.

As several experts noted, a major impediment to determining the long-term impacts of A.D.H.D. medication is that a “gold-standard” study would require researchers to assign children randomly to groups that either received medication or didn’t. Such a practice has been deemed unethical due to the widespread belief that the medication can help struggling children, at least in the short-term.

And other research has raised new concerns. One peer-reviewed 2013 study co-authored by Dr. Swanson suggested that the stimulants may change the brain over time so as to undermine the long-term response to the medication and even exacerbate symptoms when people aren’t taking them.

Dr. Peter Jensen, the former associate director of child and adolescent research at the National Institute of Mental Health, cautioned that parents should not try to force children with A.D.H.D. to take medication when they don’t want to, adding that “most kids don’t want to.”

Dr. Jensen, who now heads the REACH Institute, a national nonprofit organization concerned with children’s mental health, once surveyed 100 parents of sons and daughters in their 20s who had been diagnosed with A.D.H.D., asking what made the most difference.

“Eighty percent of them said ‘Love your child. Help him or her advocate for themselves, and find a doc who’ll work with you through thick or thin whether you medicate or not,” Dr. Jensen said. “Only a minority of these parents mentioned medication.”

Katherine Ellison is a Pulitzer Prize-winning former foreign correspondent and author and co-author of seven books, including the forthcoming “What Everyone Needs to Know about A.D.H.D.” (Oxford University Press), co-authored with Stephen Hinshaw, Vice-Chair for Psychology, Department of Psychiatry, University of California, San Francisco.

Standard
sleep, sunlight, vitamin d, well-being

The Meaning of Light

Screen Shot 2015-01-28 at 1.59.28 PM

Photographs by Uta Barth

Having trouble sleeping?  Have you been battling insomnia and other health concerns?  This article highlights some of the growing discoveries that are being made regarding the importance of our bodies natural rhythms and finding ways to sync with them.  For further support finding your balance consult with your local naturopath or make a visit today in Hood River with Dr. Katherine Walker.

  Words by Georgia Frances King

The daily rise and fall of the sun is one of the few reliable occurrence in our lives.  Despite this simple cycle controlling the happenings of our planet, we don’t pay much attention to sunlight’s effect on our physical and mental health.  And as some neuroscientists are beginning to discover, harnessing its radiant power could provide phenomenal benefits to our well-being. 

Every day presents us with all kinds of decisions to make about our lifestyles, and there are plenty of self-diagnosis websites, new age books and mothers-in-law ready to indisputably instruct us on the correct choices we should make. In an attempt to better ourselves, we try to obey their mantras: We sleep eight hours a night; we opt for whole grains instead of white flour; we drag our reluctant bodies on a quick jog; we choose not to open the second bottle of cabernet. But what if there was a more vital factor affecting our health? One that predates gluten alternatives and spin classes?

For the past few billion years, the sun has reliably risen every morning and set every evening. Our bodies have therefore come to expect its daily spiral through the sky, and most of our biological systems work on the assumption that we’ll follow along with its sunlight-based sequence. But now instead of waking with dawn, we have snooze buttons. Instead of dozing at dusk, we have Netflix.

Sunlight plays an intrinsic role in our lives and has a profound effect on the way we think and how our bodies function. Through its role guiding our circadian rhythms—the internal clocks that keep us regulated—sunlight can control everything from our sleeping habits to our wintertime melted cheese cravings. Regardless of the thought we put toward our well-being, it’s becoming apparent that the sun could actually be the ironically inconspicuous guru we should be following.

Despite the sun’s omnipresent nature, the effects of light on our mental and physical health are only just beginning to be examined. Two people who are working together to pioneer this exploration are an artist and a neuroscientist: Stephen Auger, a Santa Fe–based artist with an academic background in neuroscience who works at the intersection of science and art, and Dr. Benjamin Smarr, a doctor of neurobiology at UC Berkeley whose studies focus on the long-term effects of circadian rhythms on our physical and mental health. “A lot of people haven’t heard of light’s importance as ‘a thing,’ even though it seems very intuitive once you hear about it,” Benjamin says. “I’d love to see much more attention paid to it. It’s of absolutely central importance.”

But how did we lose our connection to sunlight in the first place? Were we complicit in our demise into dimness? When Thomas Edison popularized the lightbulb some 135 years ago, he was unwittingly ending our close relationship with natural light. “The part of our DNA that responds to light is so primal,” Stephen says. “It existed when we were a one-celled organism in the primordial ooze long before we became a human species.” But now, thanks to the humble lightbulb, we can work graveyard shifts and salsa until dawn. As Stephen puts it, “We’ve objectified light.” Convenience glowed brighter than our biological clocks, and we’ve been slowly letting them fall out of sync ever since.

In order to fathom light’s consequence on our well-being, we first need to understand circadian rhythms. Our bodies are hungry for sunlight and have come to trust it to tell us when we should eat, socialize and sleep. “Your circadian rhythm is the body’s anticipation of the 24-hour cycle of sunlight and darkness,” Benjamin explains. “The sun has arced through the sky every 24 hours for all of life, so life forms have evolved to assume it’s not just going to suddenly stop.”

“Every single cell in your body has a clock that’s trying to guess what time of day it is to get ahead of the game,” he continues. “If my body knows that I get up and eat breakfast at 8 a.m. every day, then my liver, stomach and pancreas don’t have to wait until there’s food in my stomach to go, ‘Oh shoot! We should be doing something about that.’” However, this preemptive response is only effective if we maintain a consistent routine based on the sun’s movement—one that isn’t influenced by impromptu midnight movie screenings and urgent deadlines. Technology and our desire to mingle have muted our biological reasoning, meaning our circadian rhythms’ pleas for predictable schedules are often ignored. “People are generally dissociated with their connection to the environment,” Stephen says. “And I wouldn’t be the only person to say that a great deal of that has to do with light.”

Thanks to everything from caffeine to night shifts, it’s pretty easy to confuse our bodies’ internal clocks, and this is especially common on the weekends. After five days of creating a semistructured morning routine, sometimes Saturday sleep-ins can leave us more tired than 6 a.m. starts. That feeling has a name: social jet lag. “It’s a real thing and has a real effect, as your body is dumbly anticipating you’ll get up at the same time as you did yesterday, because that’s how it worked for the past four billion years,” Benjamin says. This is also why Mondays can be such a drag—after two days of sleeping in, suddenly setting the alarm for dawn can shock our systems. “Your body’s network has no mechanism to deal with alarm clocks or wanting to stay up to watch a movie,” Benjamin says.

The act of taking care of ourselves via an awareness of sunlight’s patterns is part of what Stephen and Benjamin call “sensory well-being.” In addition to the other life choices we make to benefit our health, “Light is another piece of that puzzle we can now add to our lifestyles that’s going to make a huge difference,” Stephen says.

Improving our relationship with the sun could help both our personal well-being and society overall: If we learn how to look after ourselves through environmental adjustments, we’d free up the medical profession to concentrate on bigger problems. “Doctors shouldn’t have to focus on the maintenance work—you wouldn’t take your car to the mechanic every time it runs out of gas, right? That’s a part of your daily maintenance,” Benjamin explains. “But right now we don’t really know a lot about how to maintain our bodies. And because we lack that maintenance, we therefore run into problems and need to go to the mechanic more often, which becomes a burden on the mechanics.” By synchronizing ourselves with the sunlight’s quirks, we may be able to help tune ourselves up the natural way.

Here are some quick ways to fine-tune your light-related habits:

Set a routine
In order for our bodies to operate smoothly, all of our organs and systems are dependent on their clocks being wound to the same time. “They’re not all able to look at each other’s wristwatches though,” Benjamin says. “You have to give them a routine to let them line up and coordinate.” Getting up and going to bed at the same time every day allows our bodies to sync to a schedule, and we’d benefit even more by regulating the timing of meals too, like making oatmeal at the same time each morning.

Sleep with a mask
Sleeping eight hours per night is beneficial, but not if our bodies think it’s daytime. Switching on the bathroom light or checking emails in a bout of insomnia might not be the biggest problem: The most disruptive factor may be ambient light pollution drifting in through the curtains. “Most bedrooms aren’t well blacked-out, which often leaves them light enough that your brain registers the light all night long—especially in cities,” Benjamin says. “Something as simple as wearing a sleeping mask can have a profound effect.”

Observe dawn and dusk
While a lot is left to discover, it’s beginning to appear that these times might be the most important parts of the day to be out and about: The light quality is changing rapidly and the direction of that change serves as a biological cue for whether it’s early or late, thereby orienting our cells to wake up or wind down. “The subtle movement of light is an absolutely essential component to orient us to our circadian rhythms,” Stephen says. This could be as simple as getting up 20 minutes earlier to walk the dog at dawn or having an excuse to snack on charcuterie while watching the sunset.

Get some real rays
They say that people who live in glass houses shouldn’t throw stones, but they should throw open a window: Just like sunscreen helpfully blocks our skin from certain harmful light frequencies, the glass in windows deflects some other frequencies our bodies need to trigger biological responses. It’s helpful that we don’t burn while sitting in a sunlit office all day, but the fact we don’t scorch is a clue that we’re not getting all that the sun has to offer. It’s best to bask during the times of day when dangerous ultraviolet wavelengths are less prevalent, such as the first and last couple hours of sunlight. “My doctor tells me I should lie out in the sun completely buck naked for 20 minutes a day. And I’m like, ‘I like that doctor!’ ” Stephen says, laughing. In order to trigger vitamin D production, direct sunlight needs to shine on our bare, unprotected skin.

Circadian rhythms aside, vitamin D can also play a vital role in our sensory well-being. Our bodies naturally produce this small molecule when our skin absorbs certain helpful frequencies of ultraviolet light, causing a whole series of enzymatic responses in our cellular structure that help support a healthy immune system and balance our mood. Without its presence in our bodies, our defenses to nasty bugs weaken and our happiness also seems to nosedive.

So why natural light, and not just more lightbulbs? It’s all to do with wavelengths: Just as we think of rainbows as color spectrums from violet to red, the same can be described in light wavelengths. The sun gives off white light made of all the wavelengths combined, but lightbulbs only give off a few (think of how a crystal swinging on someone’s porch produces a rainbow when hit at the right angle, or Pink Floyd’s Dark Side of the Moon album cover). Different wavelengths have different energies, so depending on the height of the sun in the sky, the rays that hit earth have different intensities—that’s why it’s a lot harder to get sunburned at 9 a.m. than at high noon. These wavelengths and intensities also have different effects on our bodies, from the tumor-causing overdoses of ultraviolet rays to the more positive ones that stimulate vitamin D production.

Experts are still trying to understand the complicated role vitamin D plays in our well-being, and mixed messages abound: A medical professional might tell us to wear 50+ sunscreen to protect us from cancer-triggering ultraviolet light and in the same breath instruct us to sit unprotected in the sun to kindle vitamin D production. “I don’t want people to think if they hose themselves with vitamin D that all of their problems will be solved,” Benjamin says. “It’s one piece in a complex system that we’re still understanding.” Now that many of us spend our days within enclosed walls instead of outside in the wild, vitamin D deficiency has become fairly common. This is especially true in the winter when there are fewer sunlit hours in the day and therefore even less time to absorb the correct wavelengths we need to stimulate its production.

In the darker months, the combination of vitamin D deficiency and our disrupted circadian rhythms play a crucial part in Seasonal Affective Disorder, a.k.a. the aptly acronym-ed SAD. While some still consider this condition an imaginary excuse for not getting out of bed when it’s dark, it is an actual emotional disorder brought on by chemical reactions in your body. It’s often defined as when the natural traits that typify winter—the extra sleeping, the extra eating, the lack of desire to get out of the house and be social—are involuntarily taken to excess, which interferes with our ability to operate at our optimal level of mental health.

Our bodies anticipate seasons just like they do 24-hour days, so short instances of this stoic existence are a perfectly standard response to winter’s lower light levels and dipping temperatures. For example, we’re legitimately wired to crave carbs and fatty substances during the time leading up to the cold season to help us put on a nice layer of natural insulation—an evolved excuse for baking a second batch of mac and cheese. Except that where this was once a biological reaction that preempted a lack of winter produce, we now have all the food we hanker for available to us to consume year round.

“Historically it was great that my body craved cheese in October in anticipation of a cold snap,” Benjamin says. “But here I am in Berkeley, in summer, where I can go out and spend a hundred dollars on cheddar and wolf it down, but that’s probably not what my body intended.” This is another example of how we’ve lost touch with what our bodies are geared to crave, and cues from sunlight might be one of the best natural ways to resolidify those missed connections.

The best ways to ward off the winter blues and be kind to your sensory well-being are the same year round: Set a routine to keep your circadian rhythms ticking, try to be outside with your skin exposed during daylight hours for as long as your frosty epidermis can bear it, and don’t always reach for the wheel of Brie when the slightest cheese craving gurgles within you (only give in on some days).

But often the people most affected by SAD live in areas where they don’t have the choice to bask in the sun, even if they wanted to. For the residents of the world’s northernmost communities who don’t experience a sunrise for months during winter, or night-shift workers who have to be awake during nocturnal hours, no amount of positivity and goodwill can tilt the earth on its axis to grab some more rays. Without normal hours of natural light, how can these populations possibly set any semblance of a steady circadian rhythm or produce enough vitamin D to stay healthy?

That’s where artificial light starts to shine. Through a project that fuses art with science, Stephen has helped create an artificial light with the ability to replicate the movement of specific wavelengths of sunlight, potentially opening up a whole can of glowing worms for light-starved people around the world.

The technology was invented as part of The Twilight Array, an art exhibition that will take place at Gary Snyder Gallery in New York City this winter. For this project, Stephen collaborated with many esteemed experts (including neurobiologist Dr. Margaret Livingstone, founder of the Livingstone Lab at Harvard University and author of Vision and Art: The Biology of Seeing) to create a series of works that explore the subtleties of twilight perception. His paintings will be illuminated by a light that replicates the movement and wavelengths of twilight, sending the viewer’s mind into an entirely simulated biological state akin to watching a sunset. “Something really critical in my work is engaging someone’s sense of wonder, and we have that when we’re looking at a sunset or sunrise,” he says. The interplay of his canvases and the specialized light will allow him to emulate what your body feels when watching a Tahitian sunset while standing in a windowless gallery high above the streets of Manhattan.

Working with a series of optical engineers, Stephen and Benjamin have developed a highly sensitive dimmer that can artificially imitate multitude wavelengths and the changes in sunlight’s movement. Instead of walking into a room and flipping a simple on/off switch, owners of the dimmer will be able to download many different light sequences so they can have a romantic twilit dinner in a Moroccan dusk or wake up to the same wavelengths seen in the Scottish Isles. His team is currently measuring the light wavelengths around the world everywhere from Alberta, Canada, to Tasmania, Australia.

Aside from the romanticism of your body thinking it’s waking up in the foothills of Nepal or the Italian Riviera, this artificial lamp could also be used to benefit those who don’t have the privilege of experiencing a normal pattern of sunlight. “If you work until 3 a.m. and wake up at 10 a.m., there’s no reason why you can’t push your circadian rhythm back and program a dawn sequence for 9 a.m. and then turn your twilight mode on at 11 p.m.,” Stephen explains. The same could be said for northern populations who never see the sun at all: By regulating their circadian rhythms and stimulating vitamin D production with these lights, it might help stave off SAD.

“It’s absolutely the case that sunlight can be mimicked with the right technology; it’s just that it hasn’t been up until now. Our grandchildren are going to say, ‘What do you mean the lights were either on or off? That’s crazy!’ ” Benjamin says, laughing. “Once the technology is in place to control your light environment, it’s going to be huge. It’s such a fundamental quality of life issue that it’s impossible to imagine a future where it’s not part of the technological milieu.”

As it turns out, our eyes don’t really mind if light comes from a halogen lamp or the sun, as long as it provides them with the wavelengths they want, when they want. “If you’re able to replicate a light spectrum, physiologically there will be no difference between the experience of that in nature or in a space with an artificial light source,” Stephen says.

Stephen is by no means suggesting that we can have a happy lifestyle sitting in a room with a lamp that mimics light curves, but artificial lights could help us in times when nature’s benefits aren’t easily accessible. “I’m humbled by our innate relationship to nature, so I’ve always been suspicious of a technology claiming to replace the magnificence that nature provides,” he says. “It took me some time to stop romanticizing, but I’ve begun to demystify light and look at it empirically: It’s a spectrum, it’s a curve.” The dimmer may be artificial, but it can bring us back to a baseline from which we can build a healthy emotional and physical state.

The irony of the artificial-versus-real-light dichotomy lies in the fact that we’ve become so hooked on the freedoms technology has afforded us that we might also need to use technology to set us right again. While it would be idealistic to suggest that we live by the light like we did for eons, rising and retiring with twilight and eating our granola at the same time every morning for the rest of eternity, what kind of existence would that be? Like most things in life, employing a little give and take will often lead us to optimal gratification (and will certainly be easier to uphold). Inventions such as Stephen’s may allow us to reap sunlight’s health benefits while still taking advantage of the joys that contemporary society allows us. We’re never going to beat our bodies’ yearning for routine and sunlight, but we can learn to work with them instead of against them. “We have trouble enough accepting that we turn into our parents, right?” Benjamin explains. “With circadian biology, we have four billion years of ancestry that we have to come to terms with.”

The most important factor to consider when it comes to sensory well-being is figuring out what works best for you. Whether it’s sleeping with a mask to help all your body’s clocks align or programming an artificial dimmer to simulate a 6 a.m. dawn sequence in the depths of winter, even the act of being conscious about sunlight is a step in the right direction. As time goes on and the sun continues to rise and set every day until it flickers out, humans will continue to learn how to have a better relationship with it. There is still so much to discover, but at least we’re beginning to see the light.

Standard