All blog posts from Dr. Allott are provided for educational and informational purposes only. As Dr. Allott is also a licensed medical practitioner, we must make it clear that nothing on the blog is intended to constitute medical advice, consultation, recommendation, diagnosis, or treatment. If you are concerned about your health, please seek appropriate care in your area.
This video quickly and clearly explains the impact of blood glucose levels on sleep, why it often triggers waking up around 2 or 3 AM, and how to use a simple snack to get your sleep back on track.
We're working on creating short educational videos this year and would love your feedback and topic suggestions!
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!
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!
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:
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.
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:
The amygdala being activated by the adrenaline released when the body needs to increase glucose, such as in hypoglycemia.
Nutrient deficiencies, such as protein, iron, and B vitamins.
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;
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.
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.
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.
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.
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.
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.
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.
A Lizard Brain Treat is a key intervention to help you feel better now.
When you’re feeling on the edge and having a hard time with acute anxiety and worry, it’s hard to remember what you can do in the moment to help yourself.
If you are experiencing any of the below, try a Lizard Brain Treat! Even though you may not feel hungry, fueling your brain will help you reduce your anxiety and symptoms.
Are you having a panic attack?
Are you uncomfortably anxious or irritated?
Are you waking at 3am in the morning, with your mind racing?
Are you overly or underly emotional for the situation?
Have you not eaten for more than 3 hours?
Do you want to feel better in 10-15 minutes?
A Lizard Brain Treat is a snack of sugar (a quick fuel) and protein (a longer lasting fuel). You want the quick fuel to get to your brain almost immediately, which will start to reduce the adrenalin causing you to be in your reactive lizard brain. Following this with protein extends the amount of time you’re in your responsive cortex brain, before needing to re-fuel. Choose one quick fuel and one protein from the lists below – or from your favorite foods.
¼ cup of juice
1 piece of hard candy
¼ cup of soda
Honey stick
1 tbl of jelly
¼ cup of nuts
¼ cup of nuts
A stick of jerky
¼ cup of cottage cheese
2 tbl of peanut (or other nut) butter
½ cup of a protein shake
Protein bar
½ a PB&J sandwich
Generally speaking, your anxiety will drop by 10-20% within 10-15 minutes.
Download this information as a handout and post it on your fridge or keep it near your desk.
It’s summer and a great time to start new sleep habits. With the sun out longer and the weather warmer, I find that I’m more interested in moving my body, being outside, and socializing… and not watching a screen. Is it the same for you? Some people are the opposite, and that’s ok. Summer is still a good to time to reset our sleep patterns. The beauty of improving your sleep habits is that you will have a new you!
First - are you and your family members getting enough sleep? If your home has little ones, check out the table below to learn how many hours they need to sleep. When developing brains (and adult brains) get enough downtime, they have more ability to learn, better memory, more balanced moods, and less anxiety.
Recommended Sleep Hours form the National Sleep Foundation
Newborns (0-3 months): 14-17 hours each day
Infants (4-11 months): 12-15 hours
Toddlers (1-2 years): 11-14 hours
Preschoolers (3-5): 10-13 hours
School-aged children (6-13): 9-11 hours
Teenagers (14-17): 8-10 hours
Younger adults (18-25): 7-9 hours
Adults (26-64): 7-9 hours
Older adults (65+): 7-8 hours
When trying to get enough sleep, it’s helpful to anchor one end or the other of your sleep time. If you are a night owl try, to always get up about the same time. Yes, it will hurt the first few mornings, but if you prioritize sleep your body will be happy to go to bed earlier. If you are a morning person, don’t get out of bed until it is time to get up. I’m a morning person and my brain will wake me at 5 am because the sun is up. I encourage my thinking self to stay quiet and stay in bed until 6am. Otherwise I can’t complete sentences after 8:30pm .
Since the sun is out and the weather is nice, turn off the screens. Turning off the screen at least 30 minutes before bed helps with falling asleep and having restful sleep. Develop a list of what else to do before going to bed. Here are some ideas:
Play board games or cards
Paint, draw, sketch
Listen to music, play music
Sit outside and actively notice colors, sounds, plants, growth, seeds
Play with pets
Walk around the block
Listen to a non-emotionally charged podcast or a calming story
Knit, bead, sort
Stretch, yoga, walk
Remember that your brain encodes what you do right before bed. So if you are reading or watching stories with psychopaths killing people… your brain is going to deeply encode that. A few years ago, I noticed that I was watching NCIS before bed. Almost all the stories included someone getting killed. I decided to take the summer off from reminding my brain that people get murdered. Three weeks after stopping fear-based entertainment, I had about 3 days of intense nightmares - all of them, in part, from NCSI story lines. After the purging of fear, I found that I was more curious about people and their stories outside my office. Maybe my survival brain was a little more interested in people because I was not consistently reminding myself that people are going to get killed in the next episode. Over the years, science and experience suggest that our brain does not separate stories from life. So maybe we should monitor what we tell ourselves about the world, particularly before sleep.
In summary, three things we can do to improve our sleep and the sleep of the people we are connected to are:
First, be in bed for the time that is appropriate for your age.
Second, move screen time away from bedtime and don’t use it while in bed.
Third, develop a robust list of activities that you can do before bed that supports your happiness.
You or someone you know may not be eating breakfast. "I’m just not hungry." Or you have breakfast when you get to work – 2 hours later. Just to be clear, breakfast is the meal that breaks the sleep fast, and your body expects to receive food within one hour of waking.
Why would someone not be hungry in the morning? It’s not because you ate a big meal in the evening. I know when I have my Thanksgiving meal at noon; I am hungry again before bed.
So why don’t you feel hungry when you wake up? If your glucose (brain fuel) level dropped too low while you were sleeping, your liver would have already received the signal to deliver a cocktail of hormones that tells the body to make fuel for the brain – and part of the cocktail is adrenaline. When adrenaline is in the system, we tend not to feel hungry. Historically, adrenaline signaled that someone or something was trying to hurt us and we should run; running and eating are not tightly wired together.
Clinically, the short-term consequences of skipping breakfast happen about 8 hours later. You might be fatigued, and your lizard brain takes charge. This increases the likelihood that you will overeat, have more alcohol before or at dinner than planned, and have passive evenings.
What are the long-term consequences of skipping breakfast? When we skip breakfast, we set up a cascade of stress hormones that are working to maintain our fuel supply. The most recent studies suggest that not eating breakfast causes:
increased calorie intake during the day,
Increased stress/inflammatory hormones, such as cortisol and insulin,
increased weight gain and adipose tissue/body fat,
increased cholesterol and blood pressure, and
increased cardiovascular disease.
What to do about the fact that you just don’t feel hungry? Typically, a quarter cup of fruit juice or some other quick-acting sugar, such as a teaspoon of honey, will get your body to send the hunger signal within 20 minutes. Then, you can have breakfast. For the people who are not eating because they are jumping out of bed to go to work, try putting a protein shake in the refrigerator the night before so you can grab it on your way out in the morning. If you do this for about a week, you might find that your hunger signal kicks in more easily in the mornings.
Do you skip breakfast? Try the experiment of starting your day with food that has protein (14-20 grams) + carbs + fiber + fat. This Shortcuts post has some ideas for breakfast. Observe the following changes:
less anxiety, irritation, and agitation in the mornings
more energy and mental clarity in the day
less overdoing intake of sugar, alcohol, or snacking 8 hours after waking
better sleep
increased ability to participate in after-work activities that are important to you.
Tell us about your experience on the Dynamic Paths Facebook page or add a comment to our blog.
For years, I had a consistent dream of a bear chasing me. I would wake with my heart racing. I didn’t want to go back to sleep for fear of the bear returning.
How do I fix a problem when I am not even conscious for the event? I started to look for patterns.
I noticed that when I went out with friends and had a drink with dinner, the bear would predictably visit. I noticed that when I had a late dinner with lots of protein and no alcohol, the bear was absent. I moved into a new apartment in the summer and it was hot, so I left the bedroom door open for a cross breeze. No bear. It cooled down and I closed the bedroom door while I slept…bear. Open door, less likely bear. I started a list of what seemed to make a difference. Open door, protein at night, limit alcohol at night: the bear dream was more manageable.
I started seeing a therapist to address some anxiety about being dyslexic and in medical school. When my therapist showed me how turn into my anxiety instead of trying to ignore it or avoid it, my dream changed. One night, instead of running from the bear, I turned to face it and said “What?!” The bear just stopped and sat down in front of me. I had a sense that I had found a new best friend. Now, I can trust my anxiety to tell me when something is off, and I can look with curiosity until I understand my discomfort.
Later as I started to study the physiology of mental health and how the brain works, I could see why my observations helped. Not getting random hits of adrenaline due to dropping blood glucose from alcohol or not eating protein is helpful.
We all have ancient brains that will scan our environment for safety and make sure we are not being approach by lions (or bears). We all need to figure out what our bodies and brains need to feel safe., especially while asleep. Nightmares and night waking are a chance to listen deeply for what we need, observe our patterns, and do experiments to learn more about what the body and brain need. Please read the Short Cuts post for more ideas about how to improve sleep.
There is a spectrum of sleep disturbances that can affect us: such as nightmares, anxiety dreams, sleep terrors, fitful sleeping, awake in the early morning for two hours (“3AM Committee Meetings"). If you suffer from having your brain wake you up or sleep through horrible stories, you may have tried various prescription medications only to find that maybe you don’t remember not sleeping well but still feel tired and groggy.
I suggest trying an experiment to prevent hypoglycemia and keep you brain oriented to the safety of today. This might help you reduce your medications or prevent the use of medications.
Let’s create check list of things that are likely to decrease sleep disturbances:
If the above list is basically being adhered to and sleep disturbances still occur, try the following experiments:
Sleep patterns are challenging to change because for the most part our conscious observer mind is asleep and is only receiving partial information. So when deciding to do a sleep experiment be sure to try it for at least 5 to 7 days. If the experiment works, try to be consistent for at least 6 months to rewire the new sleep habit.
This month we are discussing how to improve sleep. Eating protein before bed can help with nightmares, night terrors and night waking.
But what kind of protein and how much?
If we look at the Optimizing Brains Chart (page 2), we see that 3 ounces (about the size of a deck of cards) of any kind of meat or fish is about 20 grams of protein, which is roughly what a person can absorb and muscle can use in an hour.
For sleep we may not need that much. I suggest starting with 2 ounces (not quite a deck of cards), or 10-12 grams of meat or fish protein. I usually just have people have meat without anything else. For vegetarian sources, 2 tablespoons of nut butter, or ½ cup of quinoa or cottage cheese often does the trick.
Kristen Allott is dedicated to optimizing brains and bodies for better decision making, creativity and health.
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