I recently had the opportunity to chat with fellow fitness enthusiast and naturopathic doctor, Alison Chen, about some issues that I see coming up over and over again in the Fit Thrive Member Community. So many of us struggle with digestive issues ranging from bloating to constipation and it's a common complaint that these issues are more prevalent during certain times of our menstrual cycle. As a naturopathic doctor, Alison has a great deal of knowledge in restoring internal vitality so I'm excited to share our convo here today and I hope these tips will be helpful if you are anyone you know is experiencing digestive discomfort.
Kellie: Hey Fit Thrive community! I'm really excited to interview Dr. Alison Chen who is a Toronto-based board certified and licensed naturopathic doctor. If you live in Toronto you can always schedule a visit with Alison and work with her in person; she's fabulous.
She also has some online services that she offers. She specializes in preventative, acute, and long term care, helping her patients with several conditions such as pain management, sleep disturbances, gastrointestinal conditions, weight management, irregular menses, and much, much more.
So at the end, I will let her tell you where you can find her and I want to go ahead and dig right in.
She recently authored a book called say What Your Poo Says About You, which is a children's book but it definitely addresses issues that we deal with as adults as well. So Alison, it's a delight to share your expertise with our FT community and welcome.
Alison: Thank you so much Kellie, I'm so happy to be here. Thanks for inviting me here.
Kellie: Absolutely. I gave just a broad umbrella of what you do but can you tell us a little bit about your background and what got you into naturopathic medicine?
Alison: So I guess it started off when I was a wee little one and I did gymnastics. I did competitive gymnastics for about 10-years of my life and so from a kid until about 4 until high school, I was a competitive gymnast at the national level, so obviously had lots of injuries and needed to keep my body in high performance shape throughout the year and I was introduced to a lot of alternative methods including chiropractic, physit, massage, acupuncture, and even just herbal and supplemental forms of therapies. And that's kind of where my interests stemmed in treating the body, helping it maintain, recover, and heal properly. Also nutrition was such a big part of my life and my mom was amazing. She always cooked our family dinners, and made our lunches, so it was really important that nutrition was high quality and supporting our bodies. I personally had a low immune system as a child, I got sick often and through various means of therapies I was able to strengthen my immune system, my gut flora and my gut/intestine general. I just kind of fell into this field and it was always something that interested me.
Kellie: Wonderful. I love that this has sort of been a life long process for you and skills that were adopted by you and your family when you were young. I also love that you talked about your gut flora and how that helped strengthen your immune system. That's so huge and that's a lot of why we are having you on today. Again and again we see topics come up in my community (Fit Thrive) regarding digestive health and it seems to be something that we all deal with in different ways but some of us have more prevalent digestive issues than others, regardless of how healthy we think we are.
So I really want to dive in to how digestion gives you clues into overall health and what are some signs that we can look for as far as how our digestion is correlating with other health issues?
Alison: Right. This is such a broad topic because your digestive system is considered your second brain. There's lots of different reasons why you have digestive issues and there's even more signs and symptoms that you have digestive issues. It doesn't have to be local to the gut. It doesn't have to be gas, or diarrhea, it could be systemic. It could be headaches, achy joints, trouble sleeping so it's such a broad topic that most people aren't aware of in terms of how in depth it can go. It's so important in terms of what we are eating but also our nervous system plays a role. The stress levels we have in our day effects our endocrine system, so all of things play a role - not just food.
The symptoms can vary so much. To give you just a brief idea: the stomach has 3 layers and this is including any mucosal membranes from your mouth to your stomach and into your intestines. There's several layers. In the stomach there's the inner most layer, which has what look like finger like projections called villi and even smaller projections called micro villi.
These increases surface area so you can absorb as much nutrients as possible. This also creates a barrier so that things can't pass that aren't supposed to. Then the second is the layer sub mucosal layer. This the layer that has the blood vessels and it's literally a freeway to all the parts of your body, including your muscles, nervous system, immune system like your spleen, blood marrow, thymus, lymphatics.
If something gets into that blood stream from your stomach, it can travel to anywhere in your body, limited to some parts of your brain because there is a blood-brain barrier. Some things can pass through but not everything. Which is why you don't have [a lethal reaction] when you eat a toxin or something that is a parasite or pathogen. But it can affect your whole body and the ones that I get asked about most are usually the differences in food sensitivities and intolerances and allergies.
I can talk a little bit more about what you are experiencing in terms of things you are eating.
Kellie: Okay, interesting. I love that you said that it's not necessarily direct digestive issues but other issues can tell you whether or not having problems with digestion and that's often things that we don't think about where overall health symptoms can tell us there's something going on in our guts. A lot of the questions that we really get regarding digestion is based around the menstrual cycle. Some women notice during the luteal phase of their menstrual cycle they tend to get a lot of outward symptoms such as bloating, gas, constipation, diarrhea, and I was just wondering if you find correlation between the menstrual cycle and digestive health or if the other way around.
Alison: Yes, there is correlation both ways. Anytime you have anything to do with hormones...the ovaries secreting estrogen, progesterone, luteinizing hormone at that stage, all of those will interact with hormone secreting glands. Your adrenals, your thyroid, your pituitary gland, so all of these things will interact with one another and those things can affect the digestion and vice versa.
Many women find not only that there's specific PMS type symptoms in that beginning luteal phase but also accented experience of other symptoms that they already currently have. Some maybe they have IBS and it becomes heightened during that luteal phase.
I'm going to briefly explain the follicular phase. The follicular phase is when the follicle, the egg, is developing in the follicle in the ovaries. That usually happens between day 1 and day 14 and day 1 is that first day that you get bleeding on your period.
Then luteal phase happens after the follicular phase and typically there will be a surge which kind of indicates that you are going to be ovulating. When you start in the follicular phase, you have estrogen that's steadily rising up and when you get to the luteal phase, the progesterone rises and becomes more dominant than the estrogen.
From the luteal phase, pretty much day 14-ish, until you start your period again that whole time period has a dominance of progesterone. This is what makes people have changes in symptoms. Whether it's feeling a bit more moody, craving food, or being more hungry, maybe more sensitive.
But basically estrogen makes a woman more insulin sensitive while progesterone - it acts in opposition to insulin so it makes it more insulin resistant. Both of them can help with cortisol management. So rogesterone and estrogen have a huge impact on your mood, but also digestion because low estrogen will cause more sugar cravings, more intolerance to starches which means when you are in that luteal phase you have to be a bit more careful in terms of giving into those cravings for sugars and carbs and all those yummy, feel good foods.
So when we are in premenstrual cycle, the estrogen and progesterone has an impact on your brain chemistry because there's receptors in your brain and so we can have a lowered serotonin, GABA, and dopamine effects -which they increase your cravings for sweets and starchy foods because it gives you that instantaneous reward feeling - and that's what those hormones do in your brain.
Those are the tricky parts with having those digestive concerns during the luteal phase is that your craving these things but it also makes you feel worse if you do give into them. Obviously serotonin, dopamine, GABA, they can be balanced in other ways rather than food. You can get a reward symptom doing something you love - dancing or swimming or whatever it is that makes you feel good. It doesn't have to be a food reward. But food is often one of those easy, go-to things to get.
In terms of helping with regulating those digestive symptoms during the luteal phase, the PMS feelings, just try to avoid high starchy, high carbohydrate, easy to break down into sugar type of carbohydrates and foods. You can have your normal caloric intake but just focus on the more nutritious foods, veggies, etc.
If you are going to have some sugars, have fruit so you are getting nutrition from that. Two things that I got from Dr. J T, who is also an MD, he talks about cocoa, and BCAA's (Branch Chain Amino Acids) that can help balance dopamine, serotonin, and also help with the cravings and things like that.
Those are two things that you can look into if you are finding that you really are craving something to eat, maybe you should go for a chocolate protein shake that has those things in them: cocoa and BCAA's. And then also you're decreasing those things that usually make crave more sugars and yummy foods like salt, alcohol, caffeine, dairy, and those kind of things.
Kellie: Awesome. Those are great, great tips. I like how you mention, too, finding other reward systems. Often I find when that helps cure, not necessarily cure but taper off, emotional eating or boredom eating. When you start feeling that urge and you know that you're not necessarily hungry-- have a go-to, have something else that you do that distracts you. Once you do that go-to if you come back and you are still hungry then maybe you should eat but if it goes away, if it was satisfied by another mean, then you know that was definitely a trigger for comfort food or boredom eating.
Alison: Right. That's so true. I just want to also mention that there are some other treatments that you if you go see a naturopathic doctor, they can also do some supplemental things because sometimes it's not just mind over cravings. Sometimes there is physiological imbalances in your body, especially if you are on birth control or taking some sort of medication that depletes nutrients in your body or maybe you have poor digestion and poor absorption of foods so you could be eating a super healthy diet but if you are not absorbing all your nutrients then you're still going to be deficient and maybe [malnourished].
It's one of strange circumstances that we live in now-a-days that we have so much obesity but we also have so much malnutrition too. It's ironic in that sense.
Some things to look into: maybe Vitamin B6, that really helps in serotonin and GABA production, Vitamin B, Vitamin D often helps with muscle pains and PMS symptoms. Magnesium has been huge, huge, huge for muscle pains and bloating. Calcium is something most people don't think of but it has shown in studies to help reduce PMS symptoms overall, especially with cravings.
And then something called EPO - I don't know if this is something that you are familiar with, Evening Primrose Oil - and this increases your body's natural production of prostaglandin E and so this can also help with bloating, PMS, irritability symptoms. One herb that is often recommended for anyone with either abnormal menses - so cycles that are not regular or having a lot of that bloating and craving and PMS'ing is something called Vitex Agnus Castus and this is helpful in increasing secretion of luteinizing hormone and helping to regulate your cycles because it can favor progesterone release.
Other things that naturopathic doctors do often is acupuncture or doing some digestive teas that help to soothe and relax the guts, so peppermint ginger, things like that can help to temporarily soothe the stomach.
Kellie: Wonderful. The vitamins and minerals that you mentioned, do you recommend taking a multivitamin or would you prefer people take them as individual supplements?
Alison: Most multivitamins are one of these 1-a-day support/balance your general health and to be honest, most of them don't have a high enough amount of each vitamin to have a therapeutic effect. So often these 1-a-days, they don't do very much. You'd have to take several a day to actually have enough of that nutrients to make an impact on your body.
Some of the professional brands that have higher amounts of the nutrients in them, they would be great, but I find most of them are not great. You might not need all of the nutrients. You might just need a select few. So why not focus on the ones your body actually needs? I always try to do my treatments kind of step by step, one thing at a time so that you can really identify what supplement and what nutrient is missing in your body. So that if it ever comes back you know where to target.
Kellie: Perfect. And then you mention that there probably is a point if you've tried every method that's out there possible and nothing seems to help - how does somebody know that they are dealing with issues that they need to seek treatment for? What stage or what part of the process should they have it evaluated by a naturopathic doctor?
Alison: Anytime you are uncomfortable and you haven't been able to get any relief, that's the time to come in. Even prior to having any symptoms, you can always optimize your body even more. You don't know what your best is until you do something that makes you feel more productive, more focused, more energized. People have their 1 out of 10 scale, but what if they could feel 15? And they just don't know it. It's never too early to see a naturopathic doctor but in terms of specifically needing more support?
If you've changed your diet and you've cleaned up any processed foods or food sensitivities or things that often aggravate your stomach and you do that for a month and you see no change - that's probably a good time to go in and kind of reevaluate what is going on because it might not be digestive specific. It might be your nervous system is just on fire, your vagus nerve is going crazy and it's causing digestive issues because you are in a sympathetic state and you can't digest and absorb nutrients properly when you are in that sympathetic nervous state.
But also more specifically, if you have any sharp pains, bleeding, black coffee ground stool, if you're extremely fatigued or have an unintentional weight loss or things like anemia, these are the signs that you need immediate attention and these are your red flags to get help right away. You shouldn't wait on these.
Kellie: Absolutely. I agree. And we're all so good at ignoring red flags. Because we don't want to stop what we are doing in our day to take care of our bodies. I love that you mention we could be doing everything that we think that is right - eating well, staying away from processed foods, taking our supplements, yet we still have all these symptoms and a lot of time it has to do with nerves. So if you sit there and look at your day and how much stress you place on yourself, that can have a direct effect.
How often is that pretty common? Our daily stress? Especially as working mothers - [it affects our overall health], especially our digestive health.
Alison: It's pretty critical in terms of western society. There's always low grade, chronic stress that most people experience. Stress is not bad. I always explain it like stress is important to strengthen the body. So getting a virus or bacteria infection actually strengthens your body because it builds resistance, it builds antibodies to try and recognize those bacteria and mount a response so that you don't get sick again or you don't get it as extreme.
In terms of fitness, putting resistance on the muscles and on the bones is really healthy. So if you have no stress on your joints and muscles, you are not going to get stronger. Stress is actually a very positive thing if it's acute and if you give yourself time to manage it properly.
Having a big workout and then taking a day or the afternoon to rest is great because your body is building resistance, getting stronger and you are able to heal properly so you can do it again. But if you're non-stop constantly stressed and constantly on the go and you're not giving yourself me-time or self-care or time to reflect and feel gratitude and feel grounded then it's going to affect your nervous and it's going to affect your endocrine system. Like I said, the cortisol, the adrenals are going to be affecting your thyroid, your pituitary, the gonads.
Men and women are both affected by low, chronic stress release. You need to take that time out of your day to be with yourself and reevaluate what's going on. The autonomic nervous system has two main states. It's the sympathetic nervous state and the parasympathetic nervous state.
When we talk about the two, the sympathetic is like imagine running from a bear. So you are not thinking about digesting food. You are thinking about getting the heck out of there and running for your life. Whereas the parasympathetic state is when you are in a relaxed state, when you are sleeping or when you are eating, going to the washroom. This is the state where you can heal.
Your body can heal. Even if you are sleeping, say 7-8 hours a night, it's not always restive or restorative. You still might not be allowing your body to rest and recover and heal because you are in this constant low-grade stress state. Where you are anxious about the next day, or having negative dreams or something that is worrying you constantly and as moms especially, if you are getting up in in the middle of the night to feed your little ones or to calm them down when crying, you know your sleep is getting interrupted so that parasympathetic state is not really able to kick in fully. So making sure you rest and recover is very, very important.
Kellie: Absolutely. You made me think about how many people bring their phones with them when they go to the bathroom or they are constantly engaged and accessible all the time. We have such a hard time saying 'no' so that when we think that we are resting, when we think that we are idle and not doing anything, we're really not. We're almost fooling ourselves. How many of us wake up after 8-hours of sleep completely exhausted? So I agree that it's not just going through the motion of relaxation but actually experiencing it and allowing yourself to be in that state. I love that you bring that up because we are so good at tricking ourselves into thinking we are relaxing when we're really not.
Alison: Yeah, and you talk about bringing the phone to the toilet. Going to the washroom is a parasympathetic state and if you're looking at Facebook, or anxiously reading about something, you're probably going to have more problem with constipation, trapped gas, more bloating. You're probably not excreting all your waste properly because of that. Eating as well. Some people eat and work at the same time and imagine that chaos in your digestive system if your vagal nerve is always activated and you're trying to absorb nutrients. That's probably not going to happen well and your stomach is going to have some issues.
Kellie: Absolutely. I definitely have been creating more awareness around eating, especially with my clients, and being mindful and being present with your food and actually tasting your food. How many meals have we had that we don't even taste what we eat? I love that you bring up that it's just little moments throughout your day that you go into this state. It doesn't necessarily have to be a set aside time to meditate or do yoga. Those are all beautiful things if you can do it, but just going into those little moments in our day and really taking time to be present with ourselves. IThey are quick fixes. It's just creating more awareness around them.
Alison: And it's these day to day things that will add up. You can do small things every day. It's more impactful that one big cleanse a year. And one trick that I like to do is anytime you are sitting down to eat, going to the toilet, or going to bed. If you can just take 3-5 slow, deep breaths before you do those activities, you'll give your body a chance to switch into parasympathetic mode and into digest/absorb/rest and recover.
Kellie: Wow. I love that. That's so important. I do that when I go to bed. I meditate before bed but I definitely never think of that before eating or going to the washroom or anything. Great, great tips, I really appreciate it, Alison. I'm going to go ahead and let you get back to your busy day. Can you give us information on where my community can find you? Any books or products you want plug? We'd love to learn more from you so let us have it.
Alison: Sure, my website is www.dralisonchen.com and for anybody who's a naturopathic doctor or holistic practitioner and I also run the the naturopathic doctor development center and you can find that at www.thenddc.com and then I have a bunch of Facebook groups that I'm starting and I'm actually just about to start a website for mummies, and that's coming out probably in November of 2016. I'm sure your community will love that because you're awesome, entrepreneurial, health focused, health conscience moms and this is going to be a site for high quality, great, reliable resources from certified health practitioners so this is something that I'm developing and growing and if you are interested or you are an expert in that field, I'll give Kellie the links so that you can add yourself to the group because it's going to be an awesome, awesome project.
Kellie: That sounds amazing. I have lots and lots of moms and expecting moms and moms trying to conceive so we've definitely our eye on that.
Well thank you so much for your time, Alison. It's always fun to talking to you and we'll catch up soon.
Resources from Doctor Alison Chen:
Cocoa (raise both dopamine and serotonin)
BCAA (minimize any muscle loss, lower cortisol, and also raise the brain chemicals GABA and glutamate to aid cravings)
Vit B6 (alleviating anxiety, depression and pain perception building block for serotonin and GABA
Vit D (can improve PMS symptoms, and muscle pain)
Magnesium (during entire cycle, or during luteal phase) can reduce mood fluctuations, bloating and headaches.
Calcium (Study shows in an 18% overall reduction in PMS from baseline – helps mood, affect, water retention, food craving and pain)
EPO- evening primrose oil (helps relieve irritability, bloating and breast tenderness)
Vitex agnus castus (inhibitory to prolactin, secretion of LH, and can favour progesterone; Generally regulates HPO axis- Hypothalamus pituitary)
Peppermint, ginger tea helps calm down the stomach
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