Guest Post – Postpartum Depression

Pregnancy, child birth, and the postpartum period place high demands on a woman’s physical, emotional, and spiritual health. Although welcoming a new life into the world comes with strong feelings of happiness, the postpartum period is a fragile time during which many women struggle with depression.

In this article, naturopathic doctor and CCNM clinic resident, Lauren Quinn, looks at the difference between postpartum ‘baby blues’ and postpartum depression, and ways to prevent postpartum depression.

There are ups and downs during the postpartum period. Lack of sleep, initiation of breastfeeding, variable support networks, hormonal changes, and physical symptoms after birth can all take a toll on a mother’s mood.

Postpartum blues
During the postpartum period there is a shift in hormones; estrogen & progesterone levels drop and prolactin levels rise. Postpartum blues can affect up to 75% of mothers, and the onset is usually within the first 3-5 days postpartum and can last for 24-48 hours. Symptoms include: anxiety, mood swings, fatigue, and feeling tearful and overwhelmed. There is no treatment required for the baby blues; however, support, nutrition, and rest will assist with coping with these changes.1

Postpartum depression (PPD)
In Canada, the prevalence of major postpartum depression is 8.69%, while that of minor/major (moderate) PPD is 8.49%. Symptoms typically appear by 2-4 weeks postpartum, and are longer lasting and more severe than the baby blues. Symptoms can be the same as any other depressive episode and can include: anxiety about infant, guilt, insomnia, severe fatigue, and inability to care for self or family. Some risk factors for developing PPD are a prior history of depression, lack of social support, adolescent mothers, and mothers who experience high levels of stress during pregnancy.1

Stress and Inflammation:
Preventing and treating postpartum depression should include decreasing stress and inflammation. Research in the area of psychoneuroimmunology is investigating the relationship between stress, inflammation, and depression; mental and/or physical stress can lead to increased inflammation which is a major underlying risk factor for depression. Pro-inflammatory cytokines increase during the final trimester of pregnancy, and they increase even more when affected by sleep disturbances, pain, and other stressors in the postpartum period.2

Lifestyle support:
1) Breastfeeding
Successful breastfeeding has been shown to be associated with more positive mood and decreased stress.3 Initiation of lactation and having infants properly latch can be very a challenging for new mothers. Seeking out some of the following resources during pregnancy could be a helpful way to prepare for breastfeeding:
-Dr. Jack Neman- Dr. Newman is a medical doctor who runs the International Breastfeeding Clinic in Toronto. He has a book called Dr. Jack Newman’s Guide to Breastfeeding, handouts and resources on the website http://www.nbci.ca, as well as a Facebook group (Dr. Jack Newman) for online support.
-Lactation Consultant- Find a board certified lactation consultant for hands-on clinical support with breastfeeding, and any breastfeeding-related problems.
-La Leche League- A mother-to-mother support group set up in cities all around the world. Visit http://www.groups.LLLC.ca to find one close to you.

2) Exercise
Exercise can be a helpful way to decrease depressive symptoms postpartum.4 Meeting up with other mothers to walk while pushing a stroller, or finding a mom-and-baby yoga class can be ways for new mom’s to get out, socialize, and get some exercise with baby in-tow.

3) Infant massage classes
Postpartum depression can negatively impact the mother-infant relationship. Infant massage classes have been shown to facilitate mother-infant interaction, and decrease depression scores in mother’s with postpartum depression.5 Infant massages are not only great for bonding, but can be a calming addition to bed-time routine.

Nutritional support:
The link between nutrient deficiencies and mood has been reported for folate, vitamin B12, calcium, iron, selenium, zinc, and omega-3 fatty acids. Several studies have reported inadequate intake of omega-3s, folate, B vitamins, iron, and calcium in pregnant women.6 Combine that with the fact that pregnancy and lactation are major nutritional stressors on the body, it makes sense to utilize nutrition in the prevention of postpartum depression.7
1) Fish oil
Omega-3 fatty acids, including intake during the perinatal period, can help decrease pro-inflammatory cytokines, thus decreasing the risk for depression.2,8 A combined EPA/DHA supplement (with at least 400mg/day DHA) is best to help support mom’s mood, and also ensure baby is getting the proper fatty acids for brain and vision development.

2) Vitamin D
Low vitamin D levels during pregnancy can increase the risk for developing low mood and depressive symptoms during the postpartum period.9 Supplementing with at least 1,000 IU of vitamin D per day during pregnancy and the postpartum period can help in achieving adequate levels.

3) Tryptophan
The amino acid tryptophan is a precursor to the neurotransmitter serotonin, and decreased serotonin levels are associated with depression. There is a transient decrease in tryptophan during the postpartum period which could contribute to low mood.10 The most common sources of tryptophan are protein-based foods such as nuts, seeds, tofu, cheese, red meat, chicken, turkey, beans, lentils, and eggs. A whole foods diet with lots of veggies and fruit, along with plentiful intake of these protein-rich foods, can help support mood.

4) Iron
A combination of increased need for iron during pregnancy and blood-loss during birth can put new mother’s at risk for anemia. The recommended daily allowance of iron for pregnant women is 27mg/day, and that for breastfeeding women is 9mg/day. It is important to have iron levels checked because postpartum anemia is associated with increased fatigue, emotional instability, and depression.11,12

Thyroid
Testing thyroid function and treating accordingly is something that should not be overlooked in new mom’s, as there is a positive association between decreased thyroid function at delivery and depressive symptoms at 6 months postpartum.13

Additional naturopathic therapies can be used to address the cause of the issue, as well as to help alleviate the symptoms associated with low mood and depression. These include, but are not limited to the following modalities: lifestyle and nutritional support, nutraceutical supplement, botanical medicine, and acupuncture.14 It is important to have a thorough assessment done by your healthcare provider, and this article should not replace the advice of your naturopathic doctor or family physician.

References:
1. Lanes et al. Prevalence and characteristics of Postpartum Depression symptomatology among Canadian women: a cross-sectional study. BMC Public Health. (2011); 11: 302.
2. Kendall- Tackett, Kathleen. A new paradigm for depression in new mothers: the central role of inflammation and how breastfeeding and anti-inflammatory treatments protect maternal mental health. International Breastfeeding Journal. 2007; 2: 6.
3. Groer MW. Differences between exclusive breastfeeders, formula-feeders, and controls: a study of stress, mood, and endocrine variables. Biol Res Nurs. 2005; 7(2): 106-17.
4. Armstrong and Edwards. The effects of exercise and social support on mothers reporting depressive symptoms: A pilot randomized controlled trial. International journal of mental health nursing. 2003; 12: 130-138.
5. Onozawa K et al. Infant massage improves mother-infant interaction for mothers with postnatal depression. J Affect Disord. 2001; 63(1-3): 201-207.
6. Leung BM and Kaplan BJ. Perinatal depression: prevalence, risks, and the nutrition link–a review of the literature. Journal of the American Dietetic Association. 2009; 109(9): 1566-1575.
7. Bodnar and Wisner. Nutrition and Depression: Implications for Improving Mental Health Among Childbearing-Aged Women. Biologyical Psychiatry. 2005; 58(9): 679-685.
8. De Vriese et al. Lowered serum n-3 polyunsaturated fatty acid (PUFA) levels predict the occurrence of postpartum depression: further evidence that lowered n-PUFAs are related to major depression. Life Sciences. 2003; 73(25): 31831-3187.
9. Robinson et al. Low maternal serum vitamin D during pregnancy and the risk for postpartum depression symptoms. Archives Women’s mental health. 2014; 17(3): 213-219.
10. Bailara et al. Decreased brain tryptophan availability as a partial determinant of post-partum blues. Psychoneuroendocrinology. 2006; 31(3): 407-413.
11. Milman N. Postpartum anemia I: definition, prevalence, causes, and consequences. Annals of Hematology. 2011; 90(11): 1247-1253.
12. Albacar et al. An association between plasma ferritin concentrations measured 48 h after delivery and postpartum depression. Journal of affective disorders. 2011; 131(1-3): 136-142.
13. Sylven et al. Thyroid function tests at delivery and risk for postpartum depressive symptoms. Psychoneuroendocrinology. 2013; 38(7): 1007-1013.
14. Manber et al. Acupuncture: a promising treatment for depression during pregnancy. Journal of affective disorders. (2004)l 83(1): 89-95.

Seriously Boost Mood with Food

It may be nice to know certain foods are high in specific nutrients and have been proven to positively benefit mood. Especially if depression, anxiety, or blueness are concerns for you, nutrition is a powerful tool that can help you stay or get well.

Here are 4 nutrients you can increase in your diet to seriously boost your mood.

1) Omega 3s

There is much research proving the benefit of omega 3s in the treatment of depression and other mood disorders. Omega 3s provide necessary brain nutrients, including EPA and DHA. Examples of fish high in omega-3s include sardines, salmon, herring, trout and canned white tuna. Shellfish, including mussels and oysters, also contain omega-3s. Other sources include flaxoil, chia seeds, and walnuts.

2) B Vitamins

More accurately these vitamins should be known as Hap-B vitamins. These water soluble vitamins are mood and energy boosting and are very effective at addressing symptoms of mood imbalance, including anxiety and depression.
Food processing destroys naturally occurring B vitamins, so the best way to increase Bs in your diet is to fill your refrigerator and pantry with raw, organic fruits and vegetables. Beans and lentils, as well as whole grain are also high in B vitamins.

3) Protein

Protein is made up of amino acid building blocks. These tiny nutrients are essential for building muscle, energy, and mood. One amino acid that particularly benefits mood is tryptophan. Found in turkey, barley, and beans, tryptophan supports the mood boosting serotonin.

4) Antioxidants

Antioxidants which could help to fight anxiety and stress are found in foods that have high beta-carotene level as well as those rich with vitamins C and E. One way to ensure your diet is rich in antioxidants is to eat a rainbow everyday. Encourage variety and colour in your diet as a means of boosting your mood. To go for colour choose fruits such as pomegranate, pineapple, grapefruit, berries; vegetables like beets, peppers, kale and spinach; as well as legumes and nuts and seeds especially walnuts, pecans and sunflower seeds.

There are many fantastic recipes you can try using foods rich in the above nutrients. One of my favourite website to visit for nutritious meal ideas is http://www.nourishingmeals.com.

Isn’t it wonderful to know that you have a significant amount of control when it comes to using food to power your mood?

An Attitude of Gratitude

“There are only two ways to live your life. One is as though nothing is a miracle.The other is as though everything is.” – Albert Einstein

In the past, the main focus psychology has been on conditions that contribute to dis-ease (such as anxiety and depression) and how to treat these states. There was little to no emphasis on ways to enhance the average person’s wellbeing. Positive physchology is a relatively new area of research that aims to figure out what makes people flourish. Repeatedly, it has been shown that expressing gratitude is an effective way to increase happiness.

Being grateful isn’t just about the warm and fuzzy feeling you get when reflecting upon the positives in your life (although it is a wonderful side effect). Practicing gratitude on a daily basis has been shown to influence every area of human life.

Did you know that practicing gratitude for 5 minutes everyday will increase your level of happiness by 10% – it’s as much benefit on happiness as doubling your income! Better yet, gratitude lends to consistent, long term elevated levels while the high from other happiness boosting events (such as a pay raise, winning the lottery, or a new relationship) eventually plateau as we become accustomed to this new normal.

Did you also know that gratitude benefits our physical health? People who make it a practice to count their blessings spend, on average, more time exercising, are more social, have better quality sleep, and experience less pain than people who do not.

If you need the science to back up these claims, feel good knowing there are dozens of research articles proving the many benefits of gratitude. The changes that can happen by practicing gratitude include improved health, better relationships, and increased resilience – all helping to boost overall levels of happiness.

Just like anything else that we know is good for us – the benefits come with time and the practice becomes more than just a habit – it becomes a lifestyle, an ATTITUDE. That’s how it works with gratitude.

I can say it’s definitely rubbing off on me! Since making a conscious effort to express gratitude on a daily basis, there have been several moments that I may normally not have handled so well. To be honest, I don’t remember what those situations were – I only remember that I felt calm and grounded and looked for the positive in the situation.

Still not a believer? Take the challenge! Spend 5 minutes a day writing down 2 or 3 things you are grateful for for 21 days. Notice how you start looking for things to be grateful for?

Here’s to making gratitude an attitude!

The Golden Child

Turmeric is by far my favourite spice and why pretty much everything I cook ends up being a shade of yellow.

With so many benefits, I’d be crazy not to cook with it!

http://www.mynewroots.org is a wonderful food blog by holistic nutritionist, Sarah Britton. Here’s what she has to say about turmeric.

“Turmeric: The Golden Child (original post from January 10, 2014)

Let’s make a New Years resolution together: eat more turmeric! Why? Because this humble little rhizome is a super food with serious superpowers.

Turmeric is a rhizome that comes from the Curcuma longa plant, with brown skin and shockingly bright orange flesh. It’s this pigment that gives curry powder its distinctive hue, and ballpark mustard that famous yellow glow. Curcumin, the primary ingredient in turmeric that is responsible for its golden colour, has important antioxidant, anti-inflammatory, and healing properties. It protects the liver form toxins and congestion, lowers cholesterol, reduces menstrual pain, and even helps soothe an upset tummy by aiding digestion and ridding the system of gas and distention.

Turmeric also speeds up the healing of wounds, both on the inside and out! To make an effective pain killer and cut healer, simply mix one teaspoon of ground turmeric powder with enough ghee, olive oil or coconut oil to make a paste and spread over the cut. Adding grated ginger to the paste will help decrease pain and increase its ability to heal. Turmeric is wonderful on burns as well, which I know from my days working in a professional kitchen! Mix one teaspoon ground turmeric powder with one teaspoon fresh aloe vera gel, apply to the burnt area and keep open to the air. Reapply as needed.

The flavour of turmeric is relatively mild – warm, slightly bitter and peppery with notes of orange and ginger. I find that it is delicious in everything from savoury stews and dressings, to sweet smoothies and raw desserts! Seriously. The fresh root is much more delicious than the dried version, simply because it has more depth and character. Finding fresh turmeric may be difficult however if you do not live near an ethnic market, but the dried powder is widely available. If possible, get your hands on freshly ground turmeric that hasn’t been sitting on your grocery store’s shelf for months on end.

To store fresh turmeric, wrap tightly in plastic wrap and keep for one week in the refrigerator. To store dried turmeric, keep powder in a tightly sealed glass container away from heat and light – not right next to the stove for example. This will preserve the flavour and medicinal qualities, which I know you’re interested in now!”

Fitting in Fermented Foods

Jarsoffermentedfood

We’ve heard it before, the importance of good bugs in a healthy digestive tract. Much of our immune system resides in the digestive tract and a balanced level of beneficial bacteria has been linked to reduce allergies and fewer colds, along with overall reduced digestive distress (such as gas, bloating, constipation, etc). More recent research is connecting positive gut environment with improvements in mental health, such as reduced levels of anxiety as in this study. http://www.huffingtonpost.com/2015/01/04/gut-bacteria-mental-healt_n_6391014.html
For more detailed information on the benefits of balanced gut bacteria, check out a past post: “Let Them Eat Dirt”

Incorporating fermented and cultured foods in your diet is one of the best ways to promote good bacteria.

What exactly are fermented foods and how do they contribute to healthy gut flora? According to Sandor Katz, author of The Art of Fermentation, fermented foods are “the flavourful space between fresh and rotten.” Nice, eh? During the fermentation process, beneficial bacteria digest sugars and starches in the food and release lactic acid. It’s the lactic acid that prevents any unwanted organisms from growing. Just a few days of fermenting, et voila! A bacteria rich, health promoting food that also tastes great!

Common examples of fermented or cultured foods include sauerkraut, miso (soybean paste), Kombucha tea, natural yogurt, aged cheeses, and kefir.

Another wonderful thing about fermented foods is that it doesn’t take much to reap the benefits. As little as a few tablespoons of sauerkraut, 1/2-1 cup of kefir, or 2 cups of kombucha tea provide therapeutic benefits.

There are many resources on how you can make your own fermented foods, but if you’re not into fermenting food at home, many quality products are available for purchase online or at local health food stores.

Not all fermented foods are created equal. When purchasing fermented foods, be sure to follow these guidelines offered by Dr. Frank Lipman, MD:

Be a Smart Shopper – In Five Steps
To get the most active cultures be on the look-out for:
KEEP COOL: Fermented foods are full of live organisms that must be kept cool to survive, so buy only fermented items in the refrigerated section of the store

IT IS WHAT IT IS: Fermented foods will, not surprisingly, have the phrase “fermented” printed somewhere on the label, so make sure it says so.

PUT IT OUT TO PASTURE: Be sure the label does not say “pasteurized” – because the pasteurization process wipes out the cultures you need to help fortify your gut.

FERMENTED AND PICKLED ARE TWO DIFFERENT THINGS: …So don’t confuse the two – they’re not interchangeable. Pickled foods are exactly that – they’re pickled in liquids like vinegar or brine, but not fermented (unless it says otherwise on the label).

BUY ORGANIC: Look for fermented foods that are made from the best raw materials possible, namely those made from organic, non-GM or locally farmed produce. (Dr. Blake’s note: especially SOY products such as Tempeh and Miso)

Aside from promoting a healthy environment in the digestive tract, fermented foods are rich in antioxidants like vitamin C, have anti-cancer benefits, and support healthy blood sugar levels. This article details the benefits of sauerkraut. http://vitalitymagazine.com/article/ten-reasons-to-eat-fresh-unpasteurized-sauerkraut/

Adding a dose of fermented foods to your daily routine will go a long way in promoting a flourishing life.

A few of my favourite resources:

Fermented Veggie Recipes & Websites:
http://www.culturesforhealth.com/how-to-naturally-culture-ferment-vegetables
http://www.nourishingmeals.com/2012/02/how-to-make-lacto-fermented-vegetables.html
http://phickle.com (an entire site about fermenting!)

Yogurts and Cream (can be non-dairy)
http://www.nourishingmeals.com/2014/01/homemade-dairy-free-sour-cream-nut-free.html

Books:
Fermented foods For Health by Deirdre Rawlings
Delicious Probiotic Drinks by Julia Mueller
The Whole Life Nutrition Cookbook (features an entire chapter on cultured foods) by Tom Malterre & Alissa Segersten

Products:
Kartheins Unpasteurized Kimchi and Sauerkraut
Yogi Kombucha Green Tea

Not to be a party-pooper but….

My not-totally-sugar-free tiger!
My not-totally-sugar-free tiger!

This Halloween was the first that I’ve had where my daughter was actually able to participate with awareness and, it’s official, I’m not a fan. In truth, I’ve never been a big fan of the event and my involvement has been minimal. Other than attending a costume party with friends, we were the house with the lights off. As a Naturopathic Doctor it just didn’t feel right to hand out sugar loaded treats to young children during the peak of cold and flu season and my interest level wasn’t high enough to put an effort into healthier alternatives (and risk the egg throwing that may come afterwards).

I didn’t see any costume this Halloween season that is scarier than a concerning health trend: diabetes. It bugs me that we as a society continue to promote trick or treating while kids (and our health care system) are suffering because of it.

Normally, when we consume food, our bodies digest the food items into their most simple forms. In the case of carbohydrates the end result is glucose. Once glucose is absorbed into the blood stream, the pancreas produces a hormone known as insulin. Insulin is the signal for cells in the body to open their doors to glucose. Our cells use glucose as energy.

Type 1 diabetes occurs when the pancreas does not produce insulin. This causes a build up of glucose in the blood. High levels of glucose in the blood stream can damage a number of body tissues, especially brain, kidney, and eyes. Type 1 diabetics require diet/lifestyle modifications as well as medication to treat their disease. The specific cause of Type 1 diabetes is unclear, however, it is not linked to lifestyle and diet factors in the same way as Type 2.

In Type 2 diabetes, the same process happens – glucose is not getting in to the cells like it should. However, the reasons are different. Type 2 diabetes is progressive and preventable. In the beginning, it is usually the result of too high blood sugar too often. The pancreas “burns out” and slows its production of insulin. The cells also become immune to the insulin message and begin to ignore the signal. The pancreas becomes overstressed and eventually stops working.

Type 2 diabetes was once considered an adult disease, hardly ever occurring in children. Today however, the number of adolescent and childhood cases of Type 2 diabetes is growing. Recent research suggests that one in every three children born in North America after 2000 will be diagnosed with diabetes in their lifetime. Even more alarming is that in the next 15 years, it is anticipated that the global incidence of type 2 diabetes in children will increase by up to 50 percent! For a disease that was once only seen in adults, these statistics are scary.

The development of type 2 diabetes is closely related to obesity; about 95 per cent of children with type 2 diabetes are overweight at diagnosis. Given that the proportion of Canadian children who are overweight has tripled in the last 30 years (now approx. 1 in 4 kids under 17 are overweight), it is not surprising that incidence of type 2 diabetes among youth is rising. The exciting news is that Type 2 diabetes is preventable! With basic lifestyle and diet modifications, we have the ability to change these statistics.

Follow the steps below to reduce your risk of Type 2 diabetes:
1) Get moving. Exercise prevents obesity and helps lower blood sugar levels. Kids need exercise as much as (and maybe more than) adults. Ensure 1 hour of activity every day.

2) Get adequate Vitamin D. Low vitamin D levels are linked to Type 2 diabetes and insulin resistance. If it’s not possible to get your dose from sunshine, ask your Naturopathic Doctor on how best to supplement this essential vitamin.

3) Reduce sugar intake. Try to avoid all refined sugar (candy, pop, chocolate bars). Sweeten with applesauce and other fruits or use honey in moderation.

4) Add blood sugar regulating foods to your diet. Cinnamon sprinkled in yogurt or added to a smoothie, apple cider vinegar used in salad dressing, and blueberries on your oatmeal are helpful at reduce blood sugar levels.

5) Choose whole foods and refer to the glycemic index (a tool used to identify how quickly foods turns to sugar in your body). http://www.glycemicindex.com

I’m not saying that Halloween can’t be fun or that the occasional candy is going to cause diabetes. I just think we need to come together and make some changes – give your children and trick-or-treaters healthier options (www.nourishingmeals.com is a great resource) OR plan a fun activity (bobbing for apples, pumpkin carving, costume party) that is unrelated to food. Treats don’t always have to come in packages.
Dr. Melissa Blake is a licensed Naturopathic Doctor with a family practice at The Pear Tree Naturopathic Clinic in Dieppe, NB. She is passionate about educating her patients so they are able to make informed decisions about their health and wellness. She is a member of the Canadian Association of Naturopathic Doctors and Vice President of the New Brunswick Association of Naturopathic Doctors. She can be reached at 506-857-1300 or by email: thepeartreenaturopathicclinic@gmail.com . She also maintains a wellness blog: http://drmblake-nd.blogspot.ca