Getting enough protein as a vegetarian or vegan

This video talks about how vegetarians and vegans can get enough protein and be at their best.

• 0:00 Intro

• 0:21 How much protein do I need? (here’s a link to the Huberman Lab podcast referenced)

• 1:39 Challenges with getting enough protein

• 4:43 Sources of protein

• 6:37 Protein powders

• 7:10 Sample menu

• 8:22 Glucose curves with different types of food

• 9:16 Continuous Glucose Monitors as a tool

We're working on creating short educational videos this year and would love your feedback and topic suggestions!

Continuous Glucose Monitors and Mood

This video talks about how glucose levels impact mood, focus, and fatigue - and shows an example of what hypoglycemia looks like on a continuous glucose monitor. Learn more at KristenAllott.com

We're working on short videos this year and would love your feedback and suggestions for topics!

Jill’s Story: Filling Up the Hole

A young woman name Jill stuck her head through the clinic doorway.  Instantly, I thought: Lady, what big, brown eyes you have.  It wasn’t just the size of her eyes that struck me; it was also their intensity.  Those dark brown, doe-like eyes darted about taking in the details of the space and me, as if to check out whether she fit here or not.  Would it be a safe place for her?

Like many women from challenging childhoods, Jill had seen therapists off and on concerning depression and anxiety for quite a while.  After initially getting acquainted, she turned the conversation. “I’ve been diagnosed with post traumatic stress disorder.  I had a pretty miserable childhood.  I was never quite perfect enough for my parents, whose parenting skills were limited to lots of criticism and hours of my being sent to my room alone.”   

I was impressed with the results of the work Jill had found in therapy.  It had not been an easy journey.  Yet, with the support of her therapist, she mostly lives a good life with a loving husband and several precious children.  It sounds as if she is a great mom!

Five years ago, her primary care physician started encouraging her to change her diet and lose weight.  She said that it was true that she had gained an additional five to ten pounds yearly. Three years later, her doctor informed her she was diabetic.  That diagnosis of diabetes spun her back to the cruelty and neglect of her childhood. The cycle of depression and anxiety kicked into gear once more.

“Suddenly, I am scared again!  My children are young.  My husband and I have plans!  And, there are so many things we still want and must do for each other and our children without having to deal with diabetes. I shared the diagnosis with my therapist and she referred me here to you.”  

Through lab work and analysis of her existing diet, Jill and I discovered that she had nutritional deficiencies that were resulting in her on-going feelings of fatigue and mental fogginess.  I reviewed how food and exercise contribute to her “feeling good“ daily.  These things seemed to motivate Jill to eat better and expand her exercise routine, which in turn meant Jill was thinking more clearly.

While I helped her feel better in the present by addressing her body’s needs, Jill and her therapist became aware that no one had ever taught her how to really care for her body. For example, Jill’s secret binge eating at night after everyone else in the home was asleep — although comforting to her in that moment — was one of her more dangerous behaviors.  She decided the bowl of chocolate ice cream and crunchy chips (her favorite late night fill up) had to change.  She tried numerous times unsuccessfully.

What we worked on together in this next phase was developing skills to eat in a way that resulted in her actually feeling better in the moment and the next day.  For example, rather than trying to stop the evening binge eating, we became determined to make the eating healthier.  In no time cottage cheese with pecans, scooped with corn chips became the nightly replacement.

Weeks later when Jill returned one evening to eating ice cream.  She could hardly function the next day.  Her body ached; her muscles stiffened; her head felt as if it were stuffed with cotton.  On the other side of that experience, the cottage cheese and pecan option seemed like self-care rather than a doctor allowing her permission to cheat.  Over time, with compassion and skill building, Jill made autonomous choices previously denied her in childhood.  She came up with her own ways of feeding herself that were helpful rather than harmful.  Her current choices became hers because of what her experiences taught her and how her body responded.

A year has passed since Jill first stood in my sun-filled doorway.  Her diabetes markers are vastly improved.  She understands diabetes and obesity are in part a result of an abused childhood.  Additionally, a poorly nourished body played an important part in her depression and anxiety cycle.  Her own self-inflicted coping methods, such as the binge eating, compounded an already poor situation. She now takes pride in how she cares for herself and her family, instilling the importance of honoring ourselves through the expression of our emotions, real food choices, and exercise.

Once in a while and as her body’s needs change, Jill and I check-in with each other, concerning her diet.  She and her therapist continue to explore her past and re-create a life-giving story for her.  These various threads of care come together now and support her, as Jill embraces totally the fullness of her days.  She thrives.

Washington’s state flower

Once Upon a Time...

There lived a 42-year old woman.  For the benefit of the story, I’ll call her Martha.  Three years ago, Martha’s husband died in a tragic head-on auto accident.  The death of her husband and father of two teenagers came so abruptly and finally that Martha and her children didn’t have a moment to prepare for living without him.

In the numbing aftermath, Martha has managed to downsize the family’s housing and increase her income a little bit, while dealing with her own and her children’s grief and anger.  With her daughter and son in their beds most evenings, Martha’s “my time” ritual of drinking a glass or two of wine seemed to have momentarily eased the stress and the emptiness, giving her a time to just be alone.

Now, three years later, Martha has gained 40 pounds and has begun taking anti-depressant medication prescribed to her by a therapist that she has been seeing since her husband’s death.  She is restless.  Because she was tired of “just getting” by on multiple fronts of her life, her therapist referred Martha to me.  In the introduction conversation we shared, Martha confessed that she was no longer active.  She had not continued cycling, which she and her husband loved doing together. “I’m too young to just shut down my life!”

The first thing that Martha and I did was to review what’s happening with her physically.  She rated her energy as 3-4 on a 10-point scale.

Secondly, we found that she was not sleeping through the night.  Frequently, she reported waking up every two hours, worrying about the future, and regretting the past over and over again.

Thirdly, we explored incidents of anxiety.  Martha repeatedly became anxious while doing things she has done in the past.  At the same time, she couldn’t seem to make herself volunteer for new projects at work. Realizing that fact, she worries about keeping her job.

Fourthly, she also brought up the disappointment in herself for gaining those 40 pounds.  She began eating only two meals daily, thinking that would help her lose weight.  I explained how important it is for her to eat small frequent meals to curb her brain’s anxiety.

After I informed Martha about how the brain and body function and how food choices contribute to fatigue, insomnia, and weight gain, we created achievable changes in her food routine. The next time we rated her energy on that 10-point scale, she rated it at 7!  New foods and eating habits brought about less anxiety and sleeping through the night for Martha.  Now we had a basic foundation from which to build.

Next, we did a robust blood panel, more thorough than her primary physician had done.  This step allowed me to check for nutrient intake, asking the question: Does Martha eat enough of the right things to make healthy quantities of dopamine and serotonin in the body?  Are there minerals and vitamins present that make dopamine and serotonin?  I used strict standards of health to evaluate for nutritional deficiencies.  With that analysis, I recommended options for Martha’s continued health improvement and prevention of long-term diseases, such as diabetes and cardiovascular disease.

Several months into the process, I couldn’t help but notice that Martha started more new things in her life than I suggested — things such as participating in outdoor activities and joining E-Harmony.  Now that Martha possesses more energy and less anxiety, she has the will to explore new possibilities and to begin another chapter of her life. 

Personal details of Martha’s story have been altered to protect the confidentiality of the patient.  The story is nonetheless true.  Fatigue, insomnia, anxiety and weight gain are common to many patients, who come to see me.  But, life doesn’t have to be lived that way.  Individual evaluations of nutritional health, screenings, and personal care plans can make an enormous difference in one’s quality and fullness of life.

Pandemic Fatigue Fix

Self-Care moves you into a brighter moment. Image by John Hain from Pixabay

Are you or someone you know struggling more in the last 45 days?

What I am seeing is the following:

• Fatigue

• Insomnia

• Increased anxiety

• Increased maladaptive emotional coping tools: alcohol, cannabinoids, sugar, binging on Netflix, to name a few…

We are exhausted from the pandemic. This makes sense, there are messages:

• Hope and disaster

• Relief and don’t change your behavior

• Grief and longing, as well as excitement

• Plus, we still don’t know the rules. Sigh…

A year ago, I wrote a blog on the importance of self-care to keep our immune systems functioning. If you are experiencing pandemic fatigue, I would encourage you to focus on self-care again. This time it will help your brain and body to have the energy to process the enormous changes that are about to come and find a stable platform to stand on.

Rather than focusing on what we’re doing wrong and then punishing ourselves for it, let’s do a 30-day experiment as a community, or with our family, friends, or clients, to see if we can each do a small compassionate act of self-care and see if we can have more energy and mental clarity as we move into May?

Here is a worksheet to help you commit to the 30-day challenge and track your progress.

In the next year, we’re going to create a new world together. I want us each to change what Kristen Neff has found in her research. After the pandemic, I want her to find that we are more self-compassionate and that we prioritize self-care because we understand that self-care is not self-indulgence. It is the one thing in the research that leads to better physical and mental health, less implicit bias, more connections to community, and more bandwidth to deal with change.  

“I found in my research that the biggest reason people aren't more self-compassionate is that they are afraid they’ll become self-indulgent. They believe self-criticism is what keeps them in line. Most people have gotten it wrong because our culture says being hard on yourself is the way to be.”

- Kristen Neff (Self-Compassion.org)

We created a form for you to let us know what activity you're experimenting with for the Challenge, and to rate your beginning energy level or "power supply". If you’d like, you can check back through the form weekly to track your progress. This form is completely anonymous, but will give us a generalized picture of the community-wide experiment that we can then share back with you.

My New Favorite Book to Increase Anxiety Tolerance: “Breath” by James Nestor

I am so excited about a new book, Breath: The New Science of a Lost Art, by James Nestor.

Ok, I will admit that I am a little late to the party for the importance of breathing. Not that I was against breathing. I enjoy doing it every 5 to 10 seconds, but it has never been a therapy that I emphasize.

I’ve seen two challenges with breathing practices:

1. In the past, it has always been presented as either a mindfulness practice or an ecstatic practice. In these trainings, no one explained how to breathe in general.

2. When I explained to breathing practitioners that breathing practices increased anxiety in my patients with histories of trauma, no one had an explanation and they recommended that my patients ‘just hang in there'. 

The challenge that people with complex trauma share is that focusing on slowing or controlling their breathing can create more anxiety, and then they feel like they are "failing" at breathing. Instead of a breathing practice,

Instead, I often have my patients name 3-5 colors that they can see around them. This allows the prefrontal cortex and the visual cortex to sit on the amygdala and slow the inner dialog, effectively lowering their anxiety. I thought that naming colors was the same neurological idea of breathing - just a different modality. Plus, I like being able to explain the neurophysiology: vision is at least 30% of our brain.

As a student of psychophysiology, I keep lists of physiology that cause mental health symptoms. When thinking about what can create the physical sensation of fear, independent from present or past emotional causes, I think about:

1. The amygdala being activated by the adrenaline released when the body needs to increase glucose, such as in hypoglycemia.

2. Nutrient deficiencies, such as protein, iron, and B vitamins. 

3. The Vegas Nerve being mechanical pinched at the first and second cervical vertebrae (See Stanley Rosenburg's Book: Accessing the Healing Power of the Vagus Nerve: Self-Help Exercises for Anxiety, Depression, Trauma, and Autism.)

Now, I have a fourth item on my list: Carbon dioxide intolerance caused by survival breathing. 

After reading Breath, I now think very differently about breathing as a tool for healing anxiety. James discusses how people can develop a narrow window of tolerance to carbon dioxide. He shares an example where a woman had no functional amygdala – so no fear responses to spiders, snakes, dangerous people... However, when she inhaled an air mixture with an increased carbon dioxide content, she had a full blow panic attack, and would NOT repeat the experiment.

What I had not appreciated, until reading this book, is that we have chemoreceptors in our brain and in our arteries that are monitoring for carbon dioxide and pH. As carbon dioxide builds up in our bloodstream, it triggers anxiety – sometimes high enough to create a full-blown panic attack.

But, if we don't have enough carbon dioxide in our systems, we can't properly oxygenate our bodies. With breathing patterns that keep carbon dioxide low, our tissues (muscles, digestive system, and brain) suffer from low oxygen states. We can develop fatigue, insomnia, sleep apnea, hypertension, cardiovascular disease, depression, anxiety, inflammation, auto-immune disease and have a weakened immune system. To be physically and mentally healthy, we need to have a range of carbon dioxide that we can tolerate. Studies indicate that people with anxiety have a very narrow range of carbon dioxide levels that they can handle (see links below). 

When we breathe through our mouths, we bring 20% less oxygen into our lungs. Breathing through our noses prepares the oxygen to be absorbed by the lungs into the red blood cells by removing bacteria, viruses, and particulates, increasing the humidity, and slowing the velocity of the molecules so that they can be absorbed into the capillaries carrying the red blood cells.

We need carbon dioxide present in the capillaries of the lungs so that it can exchange places with the oxygen in red blood cells. When we are intolerant of variations in carbon dioxide levels, we tend to breathe through our mouths. This lowers the carbon dioxide levels in our lungs and thereby lowers our oxygen absorption capacity. When we have lower oxygen levels in our bodies, we increase our bodies' stress, which increases our stress-related diseases. 

However, what I was seeing when my patients focused on slowing their breathing was the impact of the increased levels carbon dioxide in their bloodstreams, causing an increased physical sense of anxiety (anxiety not caused by what is externally around them).

Now that I understand the physiological mechanism through which carbon dioxide can increase anxiety, I can more closely screen patients for behaviors that indicate that they may be avoiding the sensation anxiety created by carbon dioxide intolerance. These include: 

• Mouth breathing, while awake or while sleeping

• Poor forward posture, often created by sitting in front of the computer

• Hyperventilation (respiratory rates greater than 10 breaths per minute)

For the people with complex trauma, who often refuse to consider breathing techniques for their anxiety, I now start by explaining that they are not failing at breathing, but rather that they need to develop a slightly larger range of carbon dioxide tolerance. And that when they can tolerate more carbon dioxide, more oxygen will be available to their body, which will help them have more energy and mental clarity. Their brains will begin to wire in that higher levels of carbon dioxide is safe. 

You might be wondering why we, as a species, are so hyper-vigilant to carbon dioxide when it’s so helpful in oxygenating our bodies. The carbon dioxide receptor is one of the oldest receptors found in most life forms. The earliest life forms on the planet were more concerned about getting into a space that was low in oxygen and high in carbon dioxide. This was a safety mechanism to stay alive, which was helpful in the past but not so helpful in our modern life.

Here are the steps that I am using to work with my patients around carbon dioxide intolerance;

1. Ask them to observe if they breathe through their mouths or noses. Times to observe are at work (particularly when working on a keyboard), watching screens, sleeping, and working out.

2. Ask them to focus on lightly closing their mouths when they can. This mindfulness practice will help them be aware of how they breath. When doing this, the patient might notice that they naturally breathe more deeply, using their whole rib cage. Suggesting that they place one hand on their chest and one hand on their belly is another way to help them see what muscles create their inhalation and exhalation. They might notice that they yawn more. I encourage focusing on their breath for at least 3 days, paying attention to what happens to their levels of energy and mental clarity. If they get anxious, they can breathe through their mouths for a time and then go back to breathing through their nose. 

3. Even if they have a stuffy nose, still encourage them to try breathing through their noses. James Nestor, who suffered from allergies, a deviated septum, and often developed pneumonia, found that learning to breath through his nose actually improved these symptoms.

4. Ask if they are willing to lightly tape their mouths shut while sleeping, using a small piece of medical tape or KT tape – about the size of a postage stamp. It’s still easy to open their mouths if they need to, but it’s enough to remind them to keep their mouths shut and to breath through their noses. This decreases snoring and mild sleep apnea, and increases the oxygenation of their tissues.

5. Ask them to try keeping their mouths shut when working out. This will likely be uncomfortable at first, but if they persevere it can increase performance, endurance and recovery.

6. Lastly, ask them to think of breathing as a moment-to-moment practice that can take a lifetime to truly appreciate.  

I hope this summary is helpful to you. Please feel free to email your questions. Your curiosity helps me learn to articulate the science in a usable fashion. Also feel free to share your own stories of breathing by commenting on this post below.

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Related references:

• Here a podcast interview with James Nestor, “How to Fix Your Breathing to Improve Your Health,” at Art of Manliness Podcast with Brett McKay #638 (46 minutes).

• I listened to Breath on Audible. It was a fun book to listen with lots of stories and listening always make the science easier to hear for me. 

• Scientific Papers:

  • “Panic Attacks as a Problem of pH” by By Richard Maddock, May 18, 2010 in Scientific American

  • “The physiological effects of slow breathing in the healthy human”. by MA Russo, Santarelli DM, and O'Rourke D. in Breathe (Sheff). 2017;13(4):298-309.

Key Labs To Rule Out Physical Causes Of Anxiety, Depression and Fatigue

I am so excited to be a part of Dr. Mariza Snyder's podcast, Essentially You. Mariza has spent the last 2 years creating something incredibly valuable to help reinvent your health with safer, more effective natural solutions and powerful lifestyle changes.

As you know, I believe that lab testing is the way to get the inside scoop on what’s really going on in your body and what could be causing your symptoms.

For so long, anxiety, depression, and fatigue have been completely separated from your nutrition, hormones, and physical health. But by understanding what’s going on under the surface, you can take simple steps to heal your mind and body and restore your energy.

Having the right nutrients and balance of hormones in your body can create a mental, physical, and emotional shift that will help you get back to your energized self faster.

Tune in to this episode today to hear me and Mariza talk about exactly what labs to request, how to interpret them, and which nutrients you can start adding to your routines today to experience relief!

Here’s a short video of what you’ll hear on the podcast!

I’m honored to be part of Essentially You!

Eye exercises to improve brain fatigue after Zoom meetings

Dr. Kristen Allott and Natasha Duarte interviewed Jennifer Nerio of Taiso Fitness in Tacoma, WA about Z Health eye exercises to reduce eye and brain fatigue when spending too much time in front of a computer.

What can be learned in therapy, with Dr. Jane Tornatore

The Connectors Group
When I work with an individual on improving their energy and mental clarity while also addressing other mental and physical health challenges, I often ask if they have done therapy and, if so, what they learned from it.

Often the response is that they told someone their story of childhood, loss, challenges... This, of course, is important, but what did they learn?

For myself, I has seen several therapists over time. With each therapist, I was mostly unclear about what I was learning at the time; I just wanted to feel better. In retrospect, I can see that I was learning:

• to tell my story and not edit out the uncomfortable moments

• how to have an observational self that is not the internal critic

• how to trust myself and trust others

• how to set boundaries for myself and others

• how to learn from my mistakes

• how to talk small steps forward, rather than try to leap into what I have not experienced before

• how to have hope

Recently, I was talking to my friend and colleague Dr. Jane Tornatore, who is one of the therapists that I refer out to when someone is struggling and is looking for more than “just talking” about what’s going on. I realized that part of why I enjoy referring to Jane is that she’s clear about what skills people need to learn to help their brains better integrate their experiences. Neuroscience supports that it’s this integration that helps people feel more stable and engaged in their lives.

This is a recording of the live webinar with Dr. Jane Tornatore, Dr. Kristen Allott, and Natasha Duarte..

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Meet Dr. Jane Tornatore:

Dr. Jane Tornatore is a therapist, speaker and author based in Seattle, WA. She has been in private practice for 15 years. Her style incorporates compassion, curiosity, deep listening, and heartfelt optimism, along with powerful shots of playfulness. Jane has dedicated her career and her life to helping people love themselves and have self-compassion. She received a Master’s degree at the University of Illinois, and a PhD at the University of Minnesota. Before going into private practice, she spent two decades working in the field of Alzheimer’s, including research and working for the Alzheimer’s Association. She has authored over 20 articles and just published a book—Everything is Perfect, Just Not ME! A Roadmap for Self-Acceptance. Learn more about Jane at: doctortornatore.com

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The Connectors Group consists of a wide range of individuals who are in positions to help other people navigate their lives better: mental health therapists, executive coaches, psychiatric nurse practitioners, supervisors and project managers, lawyers, teachers, and community organizers.

Dealing with Fatigue or Depression

In the United States, 33.7 million people live with some type of mental health issue. Studies show that prolonged fatigue is linked with anxiety and depression and all too often we assume that these symptoms emotionally driven without taking the time to rule out potential physical triggers, such as hypoglycemia, anemia or even possible drug interactions.

In part, this is because differentiating fatigue from anxiety and depression is hard to do and those suffering often don’t know what questions to ask.

I always recommend that people begin by describing their symptoms to their primary healthcare providers as fatigue rather than anxiety or depression.  The medical questions around fatigue can be answered with a number of blood tests. Be sure to ask for the following labs:

• CBC rules out overt anemia.
• Comprehensive metabolic panel rules out liver and kidney problems and identifies issues with glucose regulation (prediabetes and diabetes directly affect brain function).
• CRP is a metabolic marker implicated in cardiovascular disease, diabetes, obesity, and depression.
• Ferritin levels below 50 correlate with increased fatigue, especially in women.
• Hemoglobin A-1 C is a marker for diabetes. Studies have shown that diabetes predicts depression and depression predicts diabetes. A1C should be below 5.7 to be considered normal.
• Homocysteine levels (a Vitamin B marker) greater than 12 indicate a 70% increase in risk of depression.
• Lipid panel is important in diagnosing cardiovascular disease. Additionally, when total cholesterol is below 120, suicidal ideation increases.
• TSH rules out hypothyroidism or hyperthyroidism.

While there is a cost for running these labs, the cost of treating fatigue strictly as an emotional symptom is even higher. A recent article in Money magazine states that the treatment costs for mental disorders is more expensive than treatment of diabetes or hypertension– and that the cost falls mostly to the patients. Insurance companies put up road blocks for receiving mental health treatment, finding in-network care can be challenging and, if you do, the cost of prescribed medications is high. Very often, mental healthcare is a budget buster. Particularly if the primary care provider, prescriber, or therapist have not addressed the true problem – Fatigue. Nutritional studies are showing that poor nutrition and dysfunctional physiology cause 50% of the symptoms of fatigue.

I've created a sample letter requesting the above blood work from your primary care physician that you can use to help start this discussion.

In addition to asking your healthcare provider for the lab work, I have seen the following self-care steps help in relieving fatigue:

1. Walk outside everyday – move your body for at least 10 minutes.
2. Be in bed for 8 hours a night – even if you’re not sleeping, the rest is helpful.
3. Eat protein with every meal.

If these steps feel hard, ask yourself what you can do to make it happen. Don’t think of it as a lifestyle change, but consider it an experiment. Start with one of the above steps and commit to doing it for at least 3 days to see if it helps.

If there was one solution for fatigue, everyone would be doing it. Ask your provider to rule out the most common causes of fatigue/depression. It may not be all in your head ─ it may be that your body needs help.

References:

• Money magazine: The High Cost of Coping
• Lifestyle factors in preventing mental health disorders: an interview with Felice Jacka