Combatting postpartum depression

The paradigm of depression being a disease/disorder has evolved around the concept that neurotransmitters are primarily the root cause.

Yet, dysregulation in this field could very well be a symptom, coping mechanism and signal from a multitude of different issues ranging from inside, as well as outside of the body (as explained in my previous post).

The association of depression solely being linked to low levels of norepinephrine and serotonin is flawed throughout studies. There are many other variables that can result in this outcome.

Several studies indicate that as few as 25% of depressed patients have low levels of neurotransmitters, while paradoxically, some patients have abnormally high levels of neurotransmitters with no history of them ever being low.

Does the placement of depression into the category of disease/disorder attach a greater overwhelming thought process to the word than if we were to label it as a symptom?

One could argue that generally speaking, symptoms are alleviated with greater ease when compared with the disease.

It is easy to allow our identity to be taken hostage by adopting the ownership of depression and succumb to its depths.

Yet when we shift our thinking to understand that depression does not embody us as individuals, nor does it yield an element involved in modeling our identity, we shift our thoughts to a greater sense of self-empowerment.

We can overcome the ‘depression vs self’ mentality by accepting that depression is an adaptive and protective mechanism from the human body, accompanied with respect for the opportunity it brings forth to gain further insight into what needs nurturing.

I understand this is a challenging and delicate shift to take, yet the perception of the experience is paramount to one’s thoughts.

Could we disempower the shackling chains of emotional paralysis, gain buoyancy in the swamp of thoughts and restore vitality into one’s behaviour when depression is approached in the light of a symptom?

Can we utilise it as foresight with direction to what may require attention and care within our body and how we live?

This paradigm shift allows more of a harmonious level of awareness with the experience of depression and what possibilities it may bring.

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References:

1. Asberg M, et al. Arch Gen Psychiatry. 1976
2. Mol Psychiatry. 2010 March
3. Della FP, et al. Pharmacol Biochem Behav. 2012
4. Della FP, et al. Behav Brain Res. 2012
5. Della FP, et al. Metab Brain Dis. 2013

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PMS is characterised by a collection of physical and emotional symptoms that occur in the day before menstruation.

(Awanish Kumar Pandey, et al. 2013) indicated that 100% of girls tested showed a prevalence of at least one symptom of PMS, with 42.5% showing more than five symptoms.

Some of the most common psychological symptoms ranged from:

• Lethargy (83%)
• Anger and hypersomnia (74%)
• Anxiety (68.5%)
• Feeling overwhelmed (62.5%)
• Hopelessness (50%)
• Difficulty in concentrating (33.5%)
• Tearfulness (26.5%)
• Insomnia (26%)

Some of the most common physical symptoms ranged from:

• Joint or muscle pain (77.5%)
• Headaches (67%)
• Weight gain (58%)
• Backache (57.5%)
• Bloating (41%)
• Breast tenderness (31%)
• Acne (*16.5%)

*16.5% may seem low when compared with some of the other figures mentioned above, however, this still equates to 1/6 women suffering from acne every single month around their menstruation.

The conventional approach for addressing PMS uses SSRI’s, which numbs the individual along with increasing the likelihood of suicide ideation, risks post-SSRI-sexual-dysfunction and depletes melatonin.

This complex condition likely has multiple causes, with fluctuations in hormone levels and nutritional deficiencies playing key roles.

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OESTROGEN

One of the possible reasons for PMS has been associated with the excess of oestrogen relative to progesterone.

High oestrogen has also been found to increase thyroid-binding-globulin, which will reduce the activity of the thyroid hormones, further leading to apathy and a lack of energy. Ensuring oestrogen’s efficient metabolism through the correct pathways and supporting elimination from the body is paramount.

In short, this requires a range of nutrients from cruciferous vegetables, flaxseed and possibly grapefruit (grapefruit does have the ability to inhibit CYP3A4 enzyme which will decrease the metabolism of medication. Therefore grapefruit should be avoided to prevent medical complications).

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PROGESTERONE

Progesterone is also at its lowest during the time of PMS. Progesterone acts on GABA receptors in the brain to produce a calming effect along with supporting thyroid conversion, thus assisting with energy.

The consumption of Wild Yams supports progesterone.

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MAGNESIUM

Magnesium deficiencies may be causing or aggravating symptoms of PMS. Magnesium is essential for nerve, muscle function and the ability for the muscles to relax, all of which can be affected in PMS. (Iran J Nurs Midwifery Res. 2010 Dec).

A decrease of 12.42% in serum magnesium levels have been found in the follicular phase when compared to the menstruation with magnesium levels elevating a further 7% in the luteal phase. These fluctuations portray the role of magnesium in accordance with menstruation. Magnesium can be obtained through the consumption of dark chocolate or almonds.

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IRON

In a meta-analysis, eating an iron-rich diet was linked to a 31% lower risk of developing premenstrual syndrome (Am J Epidemiol. 2013 May). Iron will be depleted during menses, thus further depleting levels. Iron is essential for energy regulation, along with being an essential a cofactor for the enzyme tryptophan hydroxylase, which catalyses the conversion of tryptophan into 5-hydroxytryptophan, a precursor for serotonin (the neurotransmitter associated with mood and happiness).

Iron obtained from plants is likely to have reduced bioavailability within the body. It is often accompanied by phytic acid and oxolates, both of which bind with the iron to prevent absorption.

Another factor to take into account when seeking to optimise iron levels within the body is stomach acid (HCl). HCl is essential to break iron down from food for assimilation within the body.

One can complete the baking soda challenge test for indication of whether their HCl is low or not, by drinking 250ml of water mixed with 1/4tsp of baking soda first thing in the morning. If the individual belches after the 3-minute mark, this would correlate to low HCl and therefore a likelihood that the individual will have poor digestion and assimilation of iron within their body.

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ZINC

Women have a 24%–29% lower risk of PMS when in the top 2 quintiles of zinc to copper ratios (Am J Clin Nutr. 1995). Zinc deficiency is associated with depression while copper up-regulates the CYP19A1 enzyme, which leads to aromatisation of androgens to oestrogen (estradiol) while enhancing estradiol binding affinity to the oestrogen receptors, which amplifies its action.

Below are my preferred dietary sources of zinc per 100g:

• Oysters – 61mg
• Beef – 11mg
• Hemp Seeds – 10mg

Zinc is another micronutrient which requires HCl for its assimilation, therefore assessing HCl status could also correlate with the potential zinc status within the individual.

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VITAMIN B6

The effectiveness of Vitamin B6 in the treatment of PMS dates back over 40 years. Results were noted such as ‘significant decreases in all symptoms’ (Goei and Abraham, 1983), ’70% reporting good or partial response’ (Brush, 1988) and an ‘improvement in 63% of patients on pyridoxine’ (Day, 1979). The dose used within these studies ranged from 40-200mg (with possible risk of toxicity at 200mg).

Only one patient of the 940 participating in these trials indicated the presence of any side effects that could be attributed to the neuropathy associated with pyridoxine toxicity (London RS, et al. 1991).

Obtaining this level of Vitamin B6 effectively through food will be extremely difficult as these dosages are 29-115 times that of the recommended daily allowance.

Below are my preferred dietary sources of Vitamin B6 per 100g:

• Organic liver – 0.6mg
• Pistachios – 1.7mg
• Salmon – 0.9mg

Above is just an example of how proper nutrition can support and mitigate against PMS.

What is the Lymphatic System?

The lymphatic system is becoming increasingly more talked about but is still, in my opinion, one of the least appreciated and under-utilised systems in the restoration of movement dysfunctions and chronic health complaints.

Everybody, including health practitioners and those in the fitness industry, could benefit from understanding and implementing lymphatic techniques. You can consider that a homeostatic balance of the internal environment can be a true measure of health.

Lymphatic techniques can, therefore, aid the body in moving towards more of an internal state of homeostasis.

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How does the lymphatic system function?

The lymphatic system is, in essence, the sewage system of the body.

It has the incredible ability to trap nearly all soluble antigens, roughly 99%, with its role in waste removal. This is significantly important for the other body systems to not become overwhelmed and develop issues as well.

The lymphatic system contains the thymus, an endocrine organ which is responsible for the development of T-lymphocytes, immune cells that are involved in fighting infection through the process of cell-mediated immunity.

The spleen plays a key role in the lymphatic system as the largest lymphatic organ, having a vital role in a host of detox processes, such as:

• Filtering blood
• Removing old dead red blood cells
• The maturation of lymphocytes and macrophages to aid in fighting infection

The splenic communication of the tenth cranial nerve, the Vagus nerve, is crucial in reducing inflammatory cytokine production.

The tonsils also form part of the structure of the lymphatic system. With the tonsils formed of lymphatic tissue, housing lymphocytes and macrophages, they protect the digestive system and lungs from pathogens entering through the nose or mouth.

There is also a deep association with the gastrointestinal system through gut associated lymphoid tissues (GALT) known as Peyers Patches, with the role of the gastrointestinal system intrinsically linked to the immune system. Estimates suggest that roughly 70-80% of immune function is beholden to gastrointestinal health.

This amazing system also comprises millions of lymphatic vessels which, if placed end to end in a continuous line, would circle the earth four times! Alongside these vessels there are over seven hundred lymph nodes within the body, with the most populated areas being the neck, skin and the intestines.

This mass of lymphatic vessels works in uniform direction towards the heart, with valves interspersed to prevent any backflow from occurring. This one-way system is aided by the structure of the vessels which allow fluids to flow in the direction of clearance, but with numerous valves preventing backflow. Allowing the system to be cleared, very much how a filtration device on a fish tank would work.

The ability to regulate fluid homeostasis is a key aspect of the lymphatic system. The body contains fifteen litres of lymphatic fluid, predominantly of water, and roughly 10% of proteins, hormones and waste products. Comparing this to the five litres of circulating blood that we have, the body wouldn’t contain three times more lymphatic fluid than blood if it wasn’t a critical component of our survival!

From the five litres of circulating blood, over the course of a day, three litres of plasma leaks out into the interstitial space.

If not appropriately removed through the lymphatic system this can lead to swelling outside of the cellular space due to the increased fluid concentration and alterations in pressure.

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Without effective drainage this can create stagnation in the fluids;
Let’s go back to the fish tank analogy above, we know that stagnation of fluids is detrimental to the ecosystem, the same being the case for our health.

In a system with appropriately functioning lymphatics, this plasma is removed from the interstitial space into the lymphatics system and circulated upwards towards the subclavian vein. This is where it flows into the venous system, before returning to the liver, detoxifying and purifying the blood.

Taking a deeper look into the pathway of the lymphatic vessels will give an understanding into the application of treating the lymphatic system.

As a one way system drains into the venous system at the bilateral sites of the subclavian veins, all lymphatic vessels are required to flow in this direction. The right upper quadrant of the body drains through the right lymphatic duct and into the right subclavian vein, whilst the remainder of the body drains through the thoracic duct into the left subclavian vein.

The thoracic duct is responsible for the majority of lymphatic flow and also houses the largest lymph node, the cisterna chyli, which is a major site of drainage for the liver. It’s crucial to keep this node functioning well as between 25-50% of the returning lymphatic fluid through the thoracic duct is returned from the liver.

There is an important bidirectional relationship between the cisterna chyli and the liver, with an overburdened liver that can’t move or function optimally placing more load on the cisterna chyli. Having a lymphatic system that can’t drain well, especially at the cisterna chyli, increases the potential to create stagnation around the liver. A lymphatic vessel that is unable to drain will not be able to receive fresh supply creating this backlog.

A fairly recent discovery reveals that the lymphatic system also continues up into the central nervous system through the glymphatics, more commonly known as the glymphatic system.

The glymphatic system has the same role as the lymphatic system, however it is only situated in the brain. This helps to reduce inflammation and drive the removal of waste products which is essential for overall brain health. Additionally, the protective benefits of this system helps to distribute fuel sources and various other vital components around the brain.