Clearing the Haze: Naturopathic Approaches to Addressing Postpartum Brain Fog

The journey from pregnancy to parenthood is a transformative experience, filled with joy, challenges, and profound changes within the body. During pregnancy and the postpartum period, the body undergoes significant hormonal changes that affect neurotransmitter levels within the body. Estrogen is a hormone that is known to influence our serotonin levels (ie. the natural “feel-good” chemical), which affects mood and cognition. Throughout pregnancy, estrogen levels are at an all-time high; during the postpartum period estrogen levels decrease, which leads to mood swings, symptoms of anxiety, and cognitive difficulties…commonly referred to as postpartum brain fog. However, other factors can contribute to a decrease in cognitive function (hello, sleep deprivation and stress!), so it is important to keep things in perspective.

As naturopathic doctors, we look at the intricate web of factors contributing to the postpartum brain fog phenomenon and offer holistic approaches to support cognitive function and overall wellbeing during this important time. One of our main goals is to address the root cause and support overall health through personalized, comprehensive care. Here are some ways we can help:

Addressing Hormonal Imbalances

This is a fundamental aspect of naturopathic medicine and care. Hormonal imbalances can include things like decreased estrogen levels, but also things like thyroid dysfunction or adrenal fatigue. It is important to discern where the impairment in cognitive function stems from so that an appropriate treatment plan can be formulated for your individualized needs. NDs can run functional lab testing to pinpoint the root causes of your brain fog; as well, we are also able to requisition common (and naturopathic-specific) blood tests to dig deeper and get a clearer picture of what is going on in your body.

Nutritional Support

Ensuring proper nutritional intake is essential to both maternal and child health during the pregnancy and postpartum period. Proper nutrition also plays a vital role in supporting cognitive function. When discussing nutrition for cognitive health we want to emphasize an anti-inflammatory diet and increase the consumption of whole grains, fruits, vegetables, and healthy fats to lower inflammation levels within the body. Omega-3 fatty acids (found in fish oil and flax seed) are particularly important for maintaining healthy neurotransmitter levels.

Lifestyle Changes

Cortisol is a stress hormone released by the adrenal glands and helps your body deal with stressful situations. Cortisol levels within the body tend to decrease during the postpartum period due to sleep deprivation and an increase in stress levels, so we want to find that sweet spot where you can function optimally without living in “fight-or-flight” mode.

• Practicing mindfulness and stress reduction techniques such as deep breathing exercises or meditation can help manage the mental load of parenting.

• Engaging in regular physical activity (with your medical provider’s clearance) can also help enhance mood levels and cognitive function by increasing blood flow to the brain. It doesn’t have to be complicated – walking, yoga, and impromptu dance parties are good for the body AND the spirit!

• Aiming to establish a sleep routine and seeking support from family and friends can also alleviate the burden of sleep deprivation and stress. Sleep during this period is undoubtedly unpredictable, so any measures you can take to create good sleep hygiene is essential for success. Harvard’s Stress and Development Lab has a useful checklist you can use to help set up better habits.

Parenthood is a very exciting and joyful time for most people, but it can also be a stressful and disheartening experience. We understand the underlying factors of postpartum brain fog and employ holistic approaches to help support new parents in reclaiming their cognitive function and enhance their overall well-being. In the simplest terms – we are here to help you survive AND thrive.

Yours in good health,

Dr. Sami Leung, ND

1. Aparicio, E., Jardí, C., Bedmar, C., Pallejà, M., Basora, J., & Arija, V. (2020). Nutrient Intake During Pregnancy and Post-Partum: ECLIPSES Study. Nutrients, 12(5), 1325. https://doi.org/10.3390/nu12051325

2. Ball, L., De Jersey, S., Parkinson, J., Vincze, L., & Wilkinson, S. (2022). Postpartum Nutrition: Guidance for General Practitioners to Support High-Quality Care. Australian Journal of General Practice, 51(3), 123–128. https://doi.org/10.31128/ajgp-09-21-6151

3. Barba-Müller, E., Craddock, S., Carmona, S., & Hoekzema, E. (2018). Brain Plasticity in Pregnancy and the Postpartum Period: Links to Maternal Caregiving and Mental Health. Archives of Women’s Mental Health, 22(2), 289–299. https://doi.org/10.1007/s00737-018-0889-z

4. Buckwalter, J. G., Buckwalter, D. K., Bluestein, B. W., & Stanczyk, F. Z. (2001). Chapter 22 Pregnancy and Postpartum: Changes in Cognition and Mood. Progress in Brain Research, 303–319. https://doi.org/10.1016/s0079-6123(01)33023-6

5. Deems, N. P., & Leuner, B. (2020). Pregnancy, Postpartum and Parity: Resilience and Vulnerability in Brain Health and Disease. Frontiers in Neuroendocrinology, 57, 100820. https://doi.org/10.1016/j.yfrne.2020.100820

6. Guo, Y., Kehoe, P., Pimentel, P., Rousseau, J., Axelin, A., Rahmani, A. M., & Dutt, N. (2021). Exercise and Stress in At-Risk Women During Pregnancy and Postpartum. MCN: The American Journal of Maternal/Child Nursing, 46(4), 217–222. https://doi.org/10.1097/nmc.0000000000000722

7. McGrattan, A. M., McGuinness, B., McKinley, M. C., Kee, F., Passmore, P., Woodside, J. V., & McEvoy, C. T. (2019). Diet and Inflammation in Cognitive Ageing and Alzheimer’s Disease. Current Nutrition Reports, 8(2), 53–65. https://doi.org/10.1007/s13668-019-0271-4

8. Qiu, T., Wen, H., Liu, Z.-X., Pan, X.-P., & Zeng, T. (2021). Investigation Regarding Early Cognitive Function of Women in the Postpartum Period and the Analysis of Influencing Factors. Risk Management and Healthcare Policy, Volume 14, 3747–3754. https://doi.org/10.2147/rmhp.s309553

Recipes For Happiness

The foods we eat give us the nutrients necessary for good health. Our body runs on biochemical machinery (like the engine of a car) which requires the right fuel for optimal function. The neurotransmitters in our brain that contribute to our well-being and happiness require the right nutrient raw materials for their synthesis and conversion to help us stay happy, calm, and motivated to live our best lives.

We’ve gathered some recipes for happiness that have all the right nutrients to support these neurotransmitters and keep you fueled for wellness and success!

serotonin

Serotonin contributes to well-being and happiness, and helps with sleep cycles and digestive system regulation. Serotonin is made from the amino acid tryptophan, which can be found in high amounts in chia seeds, whole milk, sesame seeds, yogurt, pumpkin seeds, prunes, spirulina, raw cacao, wheat bread, and edamame beans.

Image source - Oh She Glows website

(Happy) health chia seed pudding:

https://ohsheglows.com/healthy-chocolate-chia-pudding/

*This recipe is made with chia seeds and cacao, which are both rich in tryptophan. Chia seeds have 202mg of tryptophan per ounce, and cacao has 18mg per ounce. Top with pumpkin seeds (121mg/oz) and sesame seeds (189mg/oz) for a tryptophan-packed snack when you need a serotonin boost!

dopamine

Dopamine is associated with feelings of pleasure and motivation; people tend to repeat behaviours that lead to dopamine release, so it is also associated with addiction. Dopamine is made from the amino acid tyrosine (which our bodies are able to make), but they require another amino acid - phenylalanine - in order to do so. Phenylalanine is an amino acid our bodies don’t make, so we need to obtain it through diet. Phenylalanine is found in high amounts in many high-protein animal products such as chicken, beef, eggs, fatty fish, dairy products, legumes, nuts, seeds, and spinach.

Image source - Against All Grain website

(dopamine-driven) healthy chicken parmesan

https://againstallgrain.com/2011/04/21/chicken-parmesan-with-spaghetti-squash/

*This recipe is made with chicken (1310mg of phenylalanine per 100g) and parmesan cheese (1870mg/100g). Add in some spinach and get ready to take on the day!

GABA

GABA is the calming neurotransmitter. GABA is made from the amino acid glutamate, which is excitatory and can actually increase feelings of anxiety. Vitamin B6 is necessary in the conversion of glutamate (excitatory) to GABA (calming) to help you maintain a relaxed and balanced mood.

Inage source - Nadia’s Healthy Kitchen website

crunchy (calm) pistachio bars

https://nadiashealthykitchen.com/5-ingredient-crunchy-pistachio-bars/

*This recipe is made with pistachios, which have 2.1mg per cup, which is the highest amount of Vitamin B6 per 100g - even compared to animal products. With a bit of serotonin-promoting chocolate, this is a happy snack!

Happy, healthy eating!

Dr. Jacalyn Sieben, ND

resources:

1. Mosconi, L. (2018). Brain Food.

2. https://ohsheglows.com/healthy-chocolate-chia-pudding/

3. https://againstallgrain.com/2011/04/21/chicken-parmesan-with-spaghetti-squash/

4. https://nadiashealthykitchen.com/5-ingredient-crunchy-pistachio-bars/

Don’t Settle For Just “Getting By”

understanding and addressing depression

Now that spring is well on its way, is your mood picking up? If you’re still feeling the “blahs” – low energy, persistent sadness, changes in appetite or sleep patterns, and a loss of interest in activities you once enjoyed – this might be more than the winter blues.

While Seasonal Affective Disorder (SAD) is a well-known culprit for winter blues, it’s crucial not to overlook other underlying issues that may contribute to depressive symptoms. Booking an appointment with your ND can provide valuable insights into your mental and physical well-being. During your visit, we can explore various factors contributing to depression, including hormonal imbalances, nutritional deficiencies, lifestyle habits, and environmental stressors.

By taking a comprehensive approach, we can tailor a treatment plan to address your unique needs. This may include a combination of dietary adjustments, supplementation, herbal remedies, lifestyle modifications, and acupuncture. Additionally, we will work collaboratively with you to uncover any potential root causes and develop strategies for long-term wellness.

Here a few tips to consider as we hop into spring…

Protein

Foods that are rich in protein contain amino acids that help produce neurotransmitters like dopamine and serotonin. If your protein intake is low, you may experience low mood. Most adults require 1g of protein per kilogram of body weight. Fortunately, it is easy to increase your protein intake – here are some easy ideas to snack on:

• A handful of unsalted almonds, walnuts, and/or pecans

• A hard-boiled egg

• No-bake energy balls

• An apple with 2 tbsp nut butter of your choice

• Sausage sticks or jerky (aim for ones with no fillers)

• Edamame

Mediterranean Diet

The Mediterranean Diet is a diet high in fish, legumes, whole grains, vegetables, fruits, seeds, and olive oil. It is low in high fat meats and dairy products. Following the Mediterranean Diet has been shown to be protective against depression at all ages throughout a person’s lifespan. For more information, check out our past blog post.

Exercise

Adults (including seniors) should get at least 150 minutes of moderate to vigorous physical activity per week[i]. Think that’s a stretch? Here are some ways to incorporate more movement into your day:

• Do squats or lunges while you brush your teeth

• Park farther away from stores or work

• Take the stairs

• Spontaneous dancing (at home OR in public 😊)

• Deep clean something

• Get up and move your body during commercial breaks – marching in place, jumping jacks, walking lunges across the room…be creative!

Sunshine

Exposure to sunlight increases serotonin levels in the brain. While you may be taking a Vitamin D supplement to keep your levels up, being in the sunshine is the best source of natural Vitamin D[ii]. In order to optimize your exposure, we recommend spending anywhere between 5-30 minutes each day outside[iii] – and while you’re out there, why don’t you get in that little extra bit of exercise and take a walk around the block?

Did you know that Vitamin D is not typically tested when you have bloodwork completed by your physician? Many people may be deficient in this important vitamin and not even know it. If this is something you are concerned about or would like to know more, bring it up with your naturopathic doctor - it may be worth investigating!

Don’t forget…

You don’t have to navigate depression alone. Your mental health matters every day and every season of the year.

[i] https://www.canada.ca/en/public-health/services/publications/healthy-living/physical-activity-tips-adults-18-64-years.html

[ii] Raymond-Lezman JR, Riskin SI. Benefits and Risks of Sun Exposure to Maintain Adequate Vitamin D Levels. Cureus. 2023 May 5;15(5):e38578. doi: 10.7759/cureus.38578. PMID: 37284402; PMCID: PMC10239563.

[iii] Srivastava SB. Vitamin D: Do We Need More Than Sunshine? Am J Lifestyle Med. 2021 Apr 3;15(4):397-401. doi: 10.1177/15598276211005689. PMID: 34366736; PMCID: PMC8299926.

Probiotics, Your Microbiome and Your Mood

Have you ever noticed that what you eat impacts your mood? Have you felt worse after binging on junk food or after a night of drinking? There is compelling research suggesting that it may not be just the guilt talking - your microbiome may be contributing in a large way to the conversation.  

What is the microbiome?  

There are 10- to 100-trillion symbiotic microbes of various species existing in and around the human body, collectively referred to as the microbiome [1]. These friendly microbes outnumber your own human cells and have recently become popularized for the growing body of evidence detailing the vast impacts they have on human physiology and behaviour. 

The microbes in your intestines make vitamins, amino acids, hormones, neurotransmitters and other signaling molecules that impact the way your brain and body function [2], [3]. They also produce short-chain fatty acids as byproducts that your intestinal cells use for energy, which contributes to healthy gut function [3].  

These microbes live in our digestive tract and survive off the foods that we eat. Just like any other living organism, their health (and therefore ours) depends on consuming a healthy diet. It has been shown that dietary changes (e.g. from animal-based to plant-based), as well as any significant systemic stress and inflammation can alter the composition (i.e. diversity and abundance of species) of your microbiome within just 24 hours [3].  

Altered microbiome composition has been associated with many conditions, such as inflammatory bowel disease (IBD), psoriasis, atopic dermatitis, autoimmune arthritis, type 2 diabetes, obesity, and atherosclerosis [3]. This is not surprising given the significant role these organisms have in regulating metabolism and immunity. In fact, researchers are finding that the microbiome composition in a given disease seem to have a different complement of microbes associated with it. For example, an IBD microbiome has less diversity (fewer species of healthy microbes), and lower numbers of good bacterial species. Therefore, it has lower short-chain fatty acid production [3]. Short-chain fatty acids (SCFAs) are essential to the health of your intestinal cells and are also thought to be anti-inflammatory in the gut [3]. 

The Microbiome’s Effect on Mood & Behaviour  

Gut microbes relay messages to the brain via various direct and indirect mechanisms - bacterial metabolites, metabolic precursors, immune signalling, vagus nerve signalling, and Hypothalamic Pituitary-Adrenal axis activation [4], [5]. It is through these mechanisms that neurodevelopment or neurodegeneration are influenced [5]. A significant portion of the microbiome influence on the brain comes via the gut-brain axis: a bi-directional pathway connecting the nervous system in your digestive tract to the central nervous system (your brain) [4], [5]. As shown in the graphic below, your gut and your brain communicate directly via nerves that transmit different signals and molecules, which can have a profound effect both ways to both systems [6].

Photo credit: https://fhs.mcmaster.ca/forsythe-lab/microbiota_gut_brain_axis.html 

Considering the gut-brain axis and the physical manifestations that different microbiome composition can produce, it should be no surprise that there are mental/emotional implications as well. Many psychiatric and neurological pathologies have gastrointestinal co-morbidities, including schizophrenia, autism, neurodegenerative diseases, anxiety, and depression [7]. As noted above, different pathologies have different microbiome composition. This extends to mood and neurodegenerative disorders, such as major depressive disorder, schizophrenia, Parkinson’s disease, and autism spectrum disorder [2], [5], [8]. There is also data suggesting that alterations in the microbiome from addictions (e.g. alcohol, cocaine) may be associated with substance cravings and increased risk of developing associated psychiatric disorders, such as anxiety and depression [9], [10]. 

Probiotics & Your Mood 

Probiotics are supplements that contain healthy microbes that ,when ingested, influence the health of your microbiome. Probiotics used to benefit mood and cognition have been coined “psychobiotics,” and are a burgeoning new area of interest in research. A study by Tillisch et al. used brain scans (functional magnetic resonance imaging) to demonstrate the ability of probiotics to alter brain activity in areas associated with processing emotion and sensation, and to reduce negative thinking associated with sad mood [4], [7], [11], [12]. While most studies indicate that further research in this area is needed, associations between specific strains of microbial species and their benefits on various conditions are rapidly emerging [7], [13][14]. A recent human clinical trial of adjunctive probiotic intervention for Major Depressive Disorder (MDD) showed that compared with placebo, probiotic intervention exhibited greater improvement in depressive symptoms [15]. Participants who received the probiotic intervention experienced reductions in both depression and anxiety, and the probiotics were well-tolerated, prompting the authors to suggest probiotics as an acceptable adjunctive intervention for adults with MDD [15]. 

How Can I Support My Microbiome? 

Lifestyle 

A healthy lifestyle goes a long way in supporting your microbiome, and healthy eating is just one part of it. As mentioned earlier, dietary changes, significant systemic stress, and inflammation can alter your microbiome within just 24 hours. There are many different types of stress - physical, mental and emotional - that can lead to physiologic changes that can alter the microbiome. Practicing stress management through self-care, meditation, social connection, thoughtful schedule planning, getting adequate sleep, and setting appropriate boundaries with people and responsibilities will help you be more resilient in dealing with stress. The better you are at managing stress, the less likely it will spill over into added physical or mood-related symptoms.  

Digestive Supports 

Probiotics are a great start to improving your gut health and mood, though quality and potency matter!  Our naturopathic doctors are here to assess if and which type of probiotics are most suitable for you, as well as to review if any further testing or treatments are indicated to optimize your digestive and mental health.  

We are here to help, so reach out if you are looking for professional guidance! 

In Health,  

Dr. Jacalyn Sieben, ND 

[1] Ursell, L.K. et al. (2012). Defining the human microbiome. Nutrition Reviews. Vol. 70 (Suppl. 1):S38- S44. doi:10.1111/j.1753-4887.2012.00493.x

[2] Dinan, T.G. & Cryan, J.F. Mood by microbe: Towards clinical translation. Genome Medicine. 8:36. DOI  10.1186/s13073-016-0292-1

[3] Corfe, B.M. et al. (2015). The multifactorial interplay of diet, the microbiome, and appetite control:  current knowledge and future challenges. Proceedings of the Nutrition Society. 74, 235-244.  doi:10.1017/S0029665114001670

[4] Dinan, T.G., Stilling, R.M., Stanton, C., Cryan, J.F. (2015). Collective unconscious: How gut microbes shape human behavior. Journal of Psychiatric Research. 63:1-9. http://dx.doi.org/10.1016/ j.jpsychires.2015.02.021

[5] Sharon, G. et al. (2016). The central nervous system and the gut microbiome. Cell. 167. http:// dx.doi.org/10.1016/j.cell.2016.10.027

[6] McMaster University. (2019). The microbiota-gut-brain axis. [Digital Image] Retrieved from: https:// fhs.mcmaster.ca/forsythe-lab/microbiota_gut_brain_axis.html

[7] Sampson, T.R. & Mazmanian, S.K. (2015). Control of brain development, function, and behavior by the microbiome. Cell Host & Microbe. http://dx.doi.org/10.1016/j.chom.2015.04.011

[8] Jiang, H. et al. (2015). Altered fecal microbiota composition in patients with major depressive disorder. Brain, Behavior, and Immunity. 48:186-194. http://dx.doi.org/10.1016/j.bbi.2015.03.016

[9] Hillemacher, T., et al. (2018). Alcohol, microbiome, and their effect on psychiatric disorders. Progress in Neuro-Psychopharmacology and Biological Psychiatry. Volume 85, Pages 105-115. https://doi.org/ 10.1016/j.pnpbp.2018.04.015

[10] Kiraly, D.D. et al. (2016). Alterations of the host microbiome affect behavioral responses to cocaine. Scientific Reports. 6:35455. DOI: 10.1038/srep35455

[11] Rea, K., Dinan, T.G., Cryan, J.F. (2016). The microbiome: A key regulator of stress and neuroinflammation. Neurobiology of Stress. 23-33. http://dx.doi.org/10.1016/j.ynstr.2016.03.001

[12] Tillisch, K., Labus, J., Kilpatrick, L., Jiang, Z., Stains, J., Ebrat, B., Guyonnet, D., Legrain-Raspaud, S., Trotin, B., Naliboff, B., et al. (2013). Consumption of fermented milk product with probiotic modulates brain activity. Gastroenter- ology 144, 1394–1401. DOI: https://doi.org/10.1053/j.gastro.2013.02.043

[13] Foster, J.A., Rinaman, L., & Cryan, J.F. (2017). Stress & the gut-brain axis: Regulation by the microbiome. Neurobiology of Stress. 124-136. http://dx.doi.org/10.1016/j.ynstr.2017.03.0 01

[14] Sarkar, A. et al. (2016). Psychobiotics and the manipulation of bacteria-gut-brain signals. Trends in Neurosciences. Vol 39, No. 11. http://dx.doi.org/10.1016/j.tins.2016.09.002

[15] Nikolova VL, Cleare AJ, Young AH, Stone JM. (2023). Acceptability, Tolerability, and Estimates of Putative Treatment Effects of Probiotics as Adjunctive Treatment in Patients with Depression: A Randomized Clinical Trial. JAMA Psychiatry. doi:10.1001/jamapsychiatry.2023.1817