671: What If It’s Not Depression? Your Guide to Finding Answers and Solutions With Dr. Achina Stein

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Katie: Hello, and welcome to the Wellness Mama Podcast. I’m Katie from wellnessmama.com, and this episode is all about: What if it’s NOT Depression? Your guide to finding answers and solutions with Dr. Achina Stein. This was such a fun episode. So not only is this woman incredible in her work that she does, but I found out at the beginning of this episode that she also plays and is going to Nationals in the Grand Masters League of Ultimate Frisbee, and that she can hold a plank for an hour, which are incredible in their own right.

But Dr. Achina is also an Amazon International bestselling author of What If It’s NOT Depression? Your guide to finding answers and solutions. She’s a Board Certified Psychiatrist and has been in practice for 25 plus years. And propelled by her son’s mental health crisis, in 2010, she found Functional Medicine, which resolved his issues as well as her own. And so she now does Functional Medicine Psychiatry. She is a certified practitioner of the Institute for Functional Medicine, a Distinguished Fellow of the American Psychiatric Association, an Azarias Energy Healer, and she was awarded many awards within the work that she does. And as a companion to her book, she offers programs to find and reverse all the root causes of depressive-like symptoms, which can be a great alternative to medication for people with chronic to mild to moderate depression symptoms that don’t respond well to medication.

She also offers a course on how to manage antidepressant withdrawal symptoms or taper off SSRIs. And we get to go deep in this episode about how she got into this particular field within her work, about her son’s journey and how she used this method with her own family. And we talk about things like the most common root causes of depression and anxiety, the five factors she looks at to determine the root cause, which she calls her shift protocol of stress, hormones, infections, food, and toxins, the most common food triggers that are linked to depression and anxiety. We talk about inflammation as a common root cause and how to address this in both the body and the brain. We talk about what the burp test is, how to identify if there are gut infections, the dealing with stress and sleep factors within all of this, and so much more. She’s very much a wealth of knowledge. And let’s join Dr. Achina. Dr. Achina, welcome. Thank you so much for being here.

Achina: Oh, thank you for having me. It’s my pleasure.

Katie: Well, I am really excited to chat with you, especially to go deep on the topic of depression and all of the subtopics within that. But before we jump into that, one thing I love to ask in the prep of interviews is for random or unknown facts about people, often because they’re just great icebreakers before we even hit record. But in your case, there’s two that I want to talk about right now because they’re so fascinating to me. The first one being that you play in the Grand Masters League of Ultimate Frisbee, and I think you might be the first guest who I’ve ever that I know of does that. So tell me about that and how you got into that.

Achina: Oh, wow. So I started playing ultimate. I think I was 40 or 41 years old. So I used to be a runner and ran track, cross-country, ran through college, and after having my first son, my hips just subluxed so I could not run anymore, at least not the distances. And so my husband was playing ultimate in grad school, and so I picked it up with him and I just went from there. And I love the sport. He and I have coached ultimate frisbee. All three of my kids play ultimate frisbee, and I play in like, three different leagues, so it’s a lot of fun. I’m going to be going to Nationals in July in the inaugural Great Grand Masters Ultimate Frisbee Tournament for women 47 and older. So I’m going to be turning 60 this year.

Katie: That’s incredible. And congratulations. I had a similar experience, but actually with what you used to do, I’m just now getting into track and field as an adult with my kids, being in high school sports now and coaching and then now trying my first pentathlon. So it’s a whole new world for me, too. I am by no means national level. That’s super impressive and somewhat dovetailing with that. The other fact I have about you is that you can hold a plank for an hour, which is total beast mode territory, and I would have guessed you were not even 40, so how did you even find out you could do a plank for an hour? Because that’s not a thing I’ve ever considered trying.

Achina: I don’t know. I actually did this with my son to see who could hold the plank longer, and I actually beat him. I have no idea. I’ve just had a really strong core from a very young age. People are always surprised about my flexibility and my strength and my core strength. I’m not doing anything special. I spend a lot of my time standing, and while I’m seeing patients, I’m doing leg lifts and all sorts of work, lower work. I’m doing it now, too. And maybe it’s like an antsy kind of thing, but I’m constantly moving. And it might be that, I’m not really sure, but I really don’t do anything special to be able to do that. And it was surprising to me myself, so yeah.

Katie: Well, that is like elite level of planking. So I’m super impressed. And I think that also, besides being an elite athlete, which you totally are, that’s impressive. A question I don’t normally ask, but I think is important for context for this episode is the mundane question of what do you do? I would guess some people listening are already familiar with you and your work. For people who aren’t, can you give us a background? Because I feel like you have a very unique area that you have extreme expertise in.

Achina: Yes, well, I’m a functional psychiatrist. That’s what I call myself now, but I was a traditional psychiatrist for a number of years, and I now practice functional psychiatry. And what that means is looking for the root causes of depression and anxiety and other mental health symptoms. And this occurred about, this started about 10, 11, I’m going to say eleven years ago. My son had a significant mental health crisis to the point of being very becoming acutely depressed and suicidal, ready to jump off a fifth floor of the building. And that was shocking to me when we were there, because the day before he was fine, even hours before he was fine and fine until we learned later.

But I went the traditional route in getting him help. And a couple of months later, and this is in 2010, he’s on four medications and not my son anymore. And so this was a crisis in faith in the system for sure for me, because I wasn’t getting any answers and didn’t know who to turn to. So I hit the books and learned what I could do. And I also found a functional medicine doctor who took care of him. And we found a number of issues that were underlying that was causing not only his mental health issues, but also explained his chronic severe eczema and chronic severe constipation.

And so when we started his treatment with initially dietary changes, the eczema and the constipation went away within a couple of months. And my son, who had been living with this for a long time, recognized like, wow, there’s something to this. And this was just through dietary change initially. So he was found to be malnourished. He was found to have celiac disease. There was all sorts of issues, gut symptoms, pathogens that needed to be taken care of. But long story short, eventually he came off of all four medications within a couple of years. And he’s had his ups and downs since then because once you learn how to manage these symptoms through lifestyle and dietary changes, you kind of have to maintain them. Of course, he hit college and that didn’t happen, but he knew what he needed to do. That’s the beauty of functional medicine.

You learn the tools that get you well, that you jump right back on the wagon again. And within six months, he was a lot better and back on the road again. Of course, seeing this happen with my son, I knew I couldn’t practice the same way. It was just not possible. And so I joined the practice that this doctor, Dr. Edward Levitan, who now has a practice called Five Journeys. At the time it was Visions Healthcare. I asked to join their practice and they happened to be looking for an integrative psychiatrist. And so it was perfect. The universe brought us together and I learned, I’ve been doing functional medicine since then. I still do psychotherapy with a handful of patients, but it’s mostly soup to nuts functional medicine or functional psychiatry.

Katie: That’s quite the incredible story. I’m glad to hear he’s doing so much better now. And I would guess that many parents listening might have they might be resonating with your journey in that the jokes abound and the memes abound about a concerned mom can do better research than the FBI. But I think it is true and certainly true with my experience. And I know many families who have gotten more interested in health in various ways because of either a parent’s own health struggle or more often a child’s struggle, which leads to a journey of understanding and trying to get to that root cause, which I now am so excited to hear talked about so much more. And I love that this is entering the conversation.

And I think I’ve said many times on here, at the end of the day, we are each our own primary health care provider and or for our children and that the best outcomes happen when we have people who are willing to do the research and who have a vested interest in the outcomes. Working with practitioners who have this specific knowledge and can help that journey in a less all-over-the-place fashion. And so I’d love to start going deep on that topic. You mentioned the root causes. What are some of now in your over ten years of experience in this specific area, some of the root causes that you see often when it comes to things like depression and anxiety.

Achina: Sure, yeah. I call it the SHIFT protocol, my SHIFT protocol. And it’s an easy way to remember at least the five major ones, root causes. One is stress, so S is for stress, H is for hormones, I is for infections, food. F is for food and T is for toxins. And so it’s stress, hormones, infections, foods, and toxins. But I don’t necessarily address these issues in that order. We always start with food. Food is medicine and food is poison. I’m sure people have heard that and it really is the truth. It’s amazing how much people don’t even realize how much food can affect them.

I had a patient this morning who knew that he was caffeine sensitive and had taken all the coffee out of his diet. And we went through everything that could possibly stimulate him, that could cause him to have insomnia. And we literally looked at all the ingredients of the supplements that he was taking and we found that his Garden of Life protein powder had caffeine in it. 14 milligrams. No, I think it was 28 milligrams of caffeine because he had two scoops of it and it had cocoa nibs in it as well, which can be stimulating for some people. And so it’s like you need to take those out, change over to vanilla flavor.

But it’s amazing how much food can really affect you. And so it’s important to look at that. And it’s not all about taking. A lot of times when people talk to functional medicine doctors, they’re going to take this away from me. And it’s not about taking away. You can start with adding. There’s a lot of things that people don’t eat enough of, so starting with adding. But part of the reason why we want to take some foods away is just to do an experiment. It’s really literally three weeks where you can see how your immune system responds to that, then you get information. And when you add that food back in, you can actually see how your body responds to it. The thing is, the brain is a little bit different in that it can take a little bit longer. Sometimes it’s right away, but sometimes it’s even longer.

So it’s a matter of doing what I call mini experiments and some people call it, oh, I cheated, oh, I cheated, or on the diet. And rather than calling it cheating and then feeling guilty about it, say, I’m going to do a conscious experiment and I’m going to make a choice about eating that dessert and knowing what the ingredients are, because I’m being conscious about it, and I’m going to see how I react, still do a little mini experiment and then enjoy the food and not feel guilty about it. Right? So when you make conscious choices and experiment, then you get information. So it’s all about initially getting information about how your body responds to food or reacts to food or lots of food. Like, oh, my body really loves that food, I’m going to have more of that. So paying attention and having more awareness on your body is really important.

So food is the initial thing that we start with, but again, it also depends on the person. So if a person has a lot of issues with food, if they have an eating disorder, I wouldn’t necessarily start with food. We’d start with other areas. So the next area we look at, because usually in the first couple of months while we’re working on food, we’ll get testing and then we focus on pathogens, chronic infections. So a lot of people don’t realize that an acute infection is what might cause an elevated white blood count or a fever, things like that. But chronic infections, it’s almost like the body comes to a stalemate. It’s like, okay, I see you over there, but you’re not getting any bigger and cause any more harm. But those pathogens absolutely can cause a lot of issues in the gut, which ultimately disrupts the process of making neurotransmitters in the gut, which your brain needs. And so it’s really important to look to see what pathogens are there.

And the top ones are the types that cause a gut dysbiosis. There’s H. pylori. There is candida, which is a yeast or a fungal fungus that can cause problems. So it’s a combination, usually looking for a combination of things that can disrupt the gut microbiome, which is your second brain, essentially. And so foods, infections, toxins. Everybody probably knows a lot about toxins on your audience, right? But there’s more and more research now that talks about alcohol as being almost you really kind of have to pull it out altogether. It’s like turpentine to your gut lining. And so it’s really important, especially women, it’s more important for women to cut back on the alcohol than men. But there’s toxins in our environment, there’s toxins in our foods.

And so it’s being aware of what foods to buy, how to avoid toxins in your environment or bringing them into your environment, like cleansers and air fresheners, anything that’s synthetic and stress, so a big one is stress that can cause you to be operating in fight/flight, in basically constant fight/flight. And that can cause a whole host of issues, but it may even start from a very young age. And people don’t realize how much, if they’ve had trauma in their childhood, whether it’s trauma with a big T or a little T, that can absolutely affect how your body reacts in the long run because that childhood stress causes adrenaline surges, chronic release of cortisol, which then affects and can cause directly multiple chronic diseases. There’s lots of research that supports that as well. So all of those things are what we look at. And it’s really fine-tuning our plan to where the patient’s at, at the moment and where they’re willing to begin.

Katie: Yeah. And it seems like it speaks to what I feel like it’s an emerging trend as well, where everybody is so individualized that I feel like that was my lesson over the last 15 years in health and wellness is that there’s so much to learn from every approach. But at the end of the day, we each have that responsibility of figuring out our own variables and the pieces that are going to actually make the big difference for us. And so I love that there’s so many people now to learn from and that approaching all of those different things with curiosity helps us to have a foundation to figure out and work within our own bodies and our own mental health constructs in a way that’s positive moving forward.

And to highlight a couple of things you said, I loved that approach of the mindset piece of that. Yes, often there’s a little bit of restriction in that it’s helpful to avoid things for at least a short time to see how we’re interacting with them. But it seems like your approach lines up with what I discovered the hard way as well, which is that if we approach it with a positive mindset in, how do I optimally nourish myself, how do I make sure I’m getting enough of the things my body needs and focus on that rather than what I can’t have, our psychology tends to respond better to that, or at least for me, I found that the case.

And I also love the idea of experiments. It seems like the human brain likes the idea of experiments versus like a long term restrictive model. So I think those both. I just wanted to highlight both of those. And I’m curious if there are common foods that seem to be often triggers that come up here or that are at least helpful to avoid in the short term if someone is experiencing depression or anxiety.

Achina: Yes, absolutely. So the biggest ones are gluten, dairy, sugar, processed foods, artificial flavors. Those are the top five right there. And generally when someone starts working with me, that’s usually what I try to do. But the way we do that is by adding foods first. But there are some people who are right on board and like, just show me the way, I’m going to do exactly what you say. And it really makes a difference if you’re able to make that shift right away because that tells me just how much it is food. The body responds pretty quickly. It’s important to look at the whole picture and and obviously fine tune it to what where that person’s at first because we don’t want to also scare people or make it a dreadful kind of experience.

We start with where a person can have some control over the situation and go at the pace that they need to go. So everybody’s different, right. But those are the top five gluten, dairy, sugar, artificial flavors, and processed foods to try to remove those out as quickly as possible. And a good diet for some people to start with. That kind of does that is the Whole30. The Whole30 is very cookbook kind of. There’s cookbooks for it. Right. So that’s a good place to start if someone wanted to start. But a Mediterranean diet, there’s lots of research that shows a Mediterranean diet as being very good for your health and mind. I think the things to add into your diet would be omega-3 fish oil, you know, foods that are high in omega-3s, foods that are high in B vitamins, the complex of Bs and fermented foods as well. So to feed that microbiome. Those also make a difference in terms of depression, anxiety.

The thing that I didn’t mention when I mentioned that SHIFT protocol is that these areas that are addressed from the functional medicine approach, they not only improve your mind, your brain, and your cognition and your mood and mental health symptoms, they fix lots of other things in your body. And the reason is because of inflammation. It’s inflammation that’s driving all of these symptoms. And what it does is it kind of clears the fog away in terms of how much might be due to acute stressors, like psychosocial stressors, which can impact inflammation. But then you’ll know how much you need in terms of psychotherapy to address specific things like in your thoughts or relationship issues, making decisions about your life, like leaving that toxic job. Then it kind of actually clears the air and gives you more courage and the ability to think through those processes. So it doesn’t fix everything, but it kind of just kind of clears the air, so to speak, and strengthens your resolve to move forward even in certain decisions.

I’ve had people actually move forward in their therapy after doing what I call this gut restoration, removing what’s causing inflammation, replacing what’s missing, re-inoculating the gut microbiome and repairing the gut lining. When we do those things, I’ve had patients where they’ve been in therapy for years stuck on the same loop. It’s always this thing, it’s always this thing. And then they move forward in their therapy because something gets unstuck on some level. And I’ve seen it happen over and over and over again that that’s what they really needed to make progress in certain areas of their life.

Katie: That makes sense. And the part to me that’s very encouraging in that is that the body and the brain are so connected that it seems like if they get in a negative feedback loop where you have inflammation and you have stress and then they both start compounding each other, that can definitely, of course, lead to a not great experience. But understanding that means it can also go in a positive feedback loop where when we’re supporting the body, it makes the mental health piece easier. And then we can deal with stress more easily, which also helps reduce the physical stress our body feels, and we can use that positive feedback loop to get better.

And just to echo what you said about the positive side of adding nutrients in as well, I experienced this very much firsthand, where I had been eating in a very restrictive way for a lot of years to try to deal with some of my physical symptoms. And I realized that from chronically undereating for so long, I had missed out probably on key nutrients. And I realized from my genes that I had a lot of choline-dependent genes and had been avoiding eggs for years. And when I made an effort to get things like choline and just more protein, which includes all those essential amino acids and B vitamins like you talked about, I noticed how drastically I felt so much more energy. I had much clearer thinking, and it was probably I was missing those nutrients without realizing it.

And so adding more food and adding more nutrients made a really positive difference for me personally. You also mentioned gut infections, and I think this is becoming, it seems like a bigger and bigger issue just because of all the factors you mentioned and what we’re exposed to. But I’m curious how you approach gut infections with people. And what are some of the steps that people can use to address gut infections if they identify that they have one?

Achina: Yes. Well, anybody who has diarrhea, constipation, bloating, gas, especially foul smelling gas, most likely have some sort of gut infection. And the reason people always wonder, like, well, how does that even happen? Right? Because I think people don’t realize just how much our food is contaminated. I mean, occasionally you’ll see these recalls of lettuce or some kind of produce on the news, but that’s because it’s extremely contaminated. But pretty much our food is contaminated from the get go. And we have this process of decontamination, washing it, cooking it, kills all the pathogens. There’s a way to decontaminate these things. But we also have this decontamination system in our body, and that is starting with our mouth. We have saliva that starts decontaminating and breaking down proteins and things. We have our stomach, this acid pit that it just dumps into that, decontaminates it, and then we have bile that squirt from our gallbladder into our small intestine. And that is a third layer of decontamination.

But believe it or not, there are pathogens that get past that. And then our immune system that is along our gut lining is overwhelmed by it. And if you have increased gut permeability, which is where the cells are, the gates are open between the cells that can be caused by lipopolysaccharides from certain types of gut pathogens, but also gluten. Gluten, which is in wheat, barley, and rye. And so that makes it another layer of immune inflammation or activation. So we want to make sure that we are salivating. Right? And how many people are taking medications that cause dry mouth? And why do they have cavities is because they have dry mouth.

There are people who have a gut infection that can cause a shutdown of acid, and that’s H. pylori. And so we want to test for that and make sure that you’re making enough acid. But another reason why some people don’t make enough acid is because they’re under stress. And if you’re on fight/flight, then you’re not going to be in rest and digest mode. And so we want to make enough acid and be in a rest and digest mode in order to digest your food. Right?

But if you have H. pylori, which is the gut infection that we look for in our testing. We want to treat that. So you make a normal amount of acid. There is some types of H. pylori species of H. pylori that have virulence factors that can cause a high amount of acid production. And that’s where the traditional doctors, conventional doctors look for. They don’t really associate H. pylori with low acid. It’s always associated with high acid causing gut ulcers and gastric cancer, gastric ulcers. And they want to give you proton pump inhibitors, or there’s medications that shut down your gastric acid production.

And so sometimes people have gallbladder problems. They have congested gallbladders that don’t efficiently eject enough bile salts. So it’s looking at all of those factors to make sure that your own internal system of decontaminating your food works. It’s really important. And also, those are the same things that actually digest your food. Your pancreas also releases digestive enzymes. And so all those things not only decontaminate your food, they also digest your food and breaking down into the particles small enough to cross over that gut barrier to assimilate into your body.

Katie: That makes sense. Are there positive steps we can take to support those various things, even in a foundational way, or even with our kids in hoping that they don’t develop some of these problems as they get older, like many of us potentially have? Like, I think back to when I was in my active healing phase, I just intuitively preferred cooked foods. And now I’m wondering if that was that an intuitive response from my body that that was easier to digest because it was already cooked. But I’m thinking through things like that. Are there things we can do and steps we can take to hopefully support all these various things that are happening within the body?

Achina: Absolutely. Yeah, there’s definitely things you can do. In terms of digestion, of releasing enough acid, you could do a test called a burp test to see if you are doing it. Those instructions are laid out in my book, and there are plenty of YouTube videos about how to do the burp test. But basically, you’re taking teaspoon of baking soda. And not everyone should do this, so make sure you’re doing this with a provider. But just to explain what that is, it’s taking a teaspoon of baking soda and mixing in water, drinking it on an empty stomach in the morning, and timing how long it takes for you to have a hearty burp.

And it’s basically doing a volcano experiment in your stomach. It’s sodium bicarbonate, which is the baking soda and hydrochloric acid, when they come together, create this gas. And so when you burp, okay, especially if it’s within two minutes, and it’s a hardy burp, not a little burp, and then you know you’re making enough acid. If it’s less than two minutes, it’s enough acid. If it’s two to five minutes, you’re making some acid, possibly not enough. And if it’s over five minutes or no burp, then you’re not making enough.

One strategy that you can try is, before having a meal, you’ll want to do some deep breathing and relaxation, and you’ll want to chew your food, smell your food, connect to your food. Right. I want everyone to think about, like, how often do you just vacuum that food down? You don’t even know what it tasted like. You only went for the sensation in your gut, that satiated feeling. But did you even feel the texture or taste what you were actually eating? Did you chew your food? Right? I’m always telling my kids this, chew your food. You’re usually the last person at the table eating.

But anyway, yeah, you want to relax, and you want to connect to your food, smell your food, chew your food, and connect with the people around you. And the other thing is, it’s important to set up rhythms in your body. So if a person eats breakfast, lunch, and dinner, whether it’s three meals or five meals, it doesn’t matter. But it’s important to signal to your body that you’re going to eat. And so just like you have a rhythm with your child eating, right. They cry at a certain moment, and that releases their own juices, and it also signals to you it’s time to eat. But our bodies, as adults, do the same thing. Shop opens. I would say shop opens to receive, then shop closes in the morning, and then at noon, shop opens to receive, and then it closes. And then at dinner time, shop opens to receive, and then it closes. So if you have missed that opportunity, then you kind of have to force your body consciously, almost, to release those juices efficiently.

And so that’s why sometimes people, if they’ve missed lunch and they had all these growling, it was waiting. Shop was open. It was growling, your stomach’s growling. You’re really, really hungry. And then you pass that moment. An hour later, you try to eat, and it feels like a brick in your gut. Right, because shops closed. Yeah. So it’s listening to your body and understanding that your body wants rhythms. Whether it’s three meals or five meals, it doesn’t matter. But it’s being consistent and listening to your body as to when it wants the food.

Same thing with bowel movements. Generally, people should have bowel movements. That’s a toxicity issue. Right. You want to put the garbage out. If we started accumulating all this garbage in our house and the sanitation department didn’t pick it up once a week, our garbage bags would start smelling and drawing flies and things like that. Right. How many times have you been in New York? I don’t know if you’ve been in New York City, but they have piles of garbage. It’s just like, oh, my gosh. But if you don’t take the trash out on a regular basis through bowel movements, at least one bowel moment a day, all those toxins do permeate into your other organs. They’re not in little plastic bags, they’re permeable bags. And so you really want to remove those toxins and that will make room for the next meal and that it facilitates the digestive process even more.

So to answer your question, it’s breathing before a meal, doing a little testing perhaps to see if you are actually burping and cooking your food is certainly, or pureeing, sometimes people need to puree their foods if they find it particularly hard to digest certain foods. And so making sauces, as opposed to eating whole vegetables, especially my trick for people who have trouble with vegetables at all is to take a lot of lot of different vegetables, a small amount of each one, and putting it into a blender and pureeing it, making in the sauce and adding it to tomato sauce. And you’re feeding your microbiome little bits of a variety of vegetables and that way it’s going to change your palate. Your palate is the way it is because of the microbiome that you’re feeding. Your microbiome tells your brain what it wants. But if you start eating small amounts of the foods that are healthier for you, you slowly change that microbiome and then your brain will want those healthier foods. That’s my hack for food.

Katie: And seems like a great tip with kids as well, especially a lot of younger kids don’t tend to naturally just gravitate towards certain vegetables. But it seems like you said if you can train the gut bacteria to want those things over time, then it’s not a battle with the kids to try to encourage that so much as their body learns to want it on their own. And I also feel like those tips are just valuable. And line up with the Mediterranean diet as well of like breathe and just get your nervous system in a good state before you eat so your body even knows food is on the way. And then chewing well, like you mentioned and you explained so well.

And then things like I know in a lot of blue zones, for instance, or in Mediterranean countries, they often walk home after dinner or go for a walk. And now there’s so much data with all these glucose monitors people are wearing on how even just a ten minute walk after a meal can improve blood sugar and digestion and so many other things related to our food.

And I hadn’t heard it explained so well either about the rhythms of food and digestion. But it makes sense. And I would guess many people listening have had that experience where they were so hungry and then later on food just didn’t feel right in their body. And it makes sense when we think of that. And I know that food is also a big signaling mechanism for circadian biology. We have light temperature in food as big signaling mechanisms. And so being aware of that it seems like we can use that to our advantage to also impact sleep, which is another big factor when it comes to mental health and gut health and all of these things as well. Do you have any other tips related to the sleep component? And then I also want to make sure we talk about stress. But I know sleep is a big issue, especially people with mental health issues can struggle with sleep and vice versa. Lack of sleep can lead to us feeling more anxious or depressed. So any tips for that that you often deal with, with your patients?

Achina: Oh, absolutely. So, I mean, there’s lots of information on the internet about sleep hygiene, right? Having a routine is important. Having a bedtime routine, even for adults. We have bedtime routines for our children. As parents, we do that for our kids, but then we don’t have our own bedtime routine. So it’s really important to do that.

A great way to wind down to sleep is to definitely not do this in front of a TV. So many people watch a TV show and then they expect themselves to go right to bed. What you’ll want to do is watch that TV show or news or whatever it is that you’re doing on TV or on your phone to do it downstairs out of your bedroom and go to bed and get ready for bed. And that might include a nice Epsom salt bath once in a while. I know some people who do that on a regular basis, actually.

But there’s so many things that you can do to sort of wind down. And it might be reading a real book, a paper book that’s not too stimulatory. If you’re one of those people that has a monkey mind thinking about the next day, you might want to write those down so it’s not constantly going through your mind and having it at your bedside and sort of closing that book and knowing that you can open it the next day and start from there. It’s looking at what are the things that are activating you. So I think about thoughts, emotions. Are you replaying a conversation or at a meeting that you had earlier in the day and you’re trying to resolve some kind of conflict and it’s a matter of just acknowledging those emotions. It’s like, okay, this is how I feel about it. You could journal about it, write it down, or just say, okay, I’m going to let this go. This is what happened. I’m going to let this and I’m going to put myself to bed so that I have energy in the morning to deal with it. Right. I’ll get rested, sleep on it, and feel rested enough to deal with this in the morning so that you’re not replaying these things in your mind.

But sometimes people think that they have to sleep through. It’s normal to wake up, turn over. It’s normal to wake up, maybe use the bathroom and come back. If you’re frequently using the bathroom, then it’s important to understand why that is. So are you drinking too much water? Do you have a chronic infection? There’s reasons why that might be happening, but it’s a matter of looking at you want to have at least the fewest number of wake up times as possible, but it’s okay to wake up, look at the clock, turn over, and go right back to sleep. And I think sometimes I’ve had some patients tell me that that was a sleep problem. It’s like, no, that’s kind of normal. It’s normal to do that.

And the key is to make sure that you’re feeling rested. That’s how you know that you’re getting good sleep. Are you waking up rested? And so sometimes people think that they have to have 8 hours of sleep, and they’re striving to get 8 hours. 8 hours, but it’s like, well, how many hours are you getting? 6 hours. But do you feel rested? As long as you’re feeling rested and you can get through the day and you’re doing well and you’re not feeling tired, like, so much so that you need a nap, then I think 6 hours is probably that’s normal for you. So it’s figuring out what is right for you and trying to think of some other tips.

I don’t know if you want me to talk about supplements, but I find that most people are very magnesium deficient. Magnesium is the easiest way to get someone sleeping, and it resolves so many issues, not just sleep. It helps people with sleep, helps people with anxiety, with depression, with constipation, stress. There’s lots of things that magnesium helps with.

I like to use a magnesium that has multiple types of magnesium, like magnesium glycinate, magnesium taurate. There is magnesium citrate. That’s more for the constipation, but a combination is really good, and it’s even something that you can give for your child by rubbing, getting like a magnesium oil and rubbing that into their feet, and that’ll help them to sleep. So if you have a child that has trouble sleeping, that’s a great way to get them to sleep without having to take pills. And it’s very well tolerated by most people. And if you get diarrhea, then you know to back off. The only people who shouldn’t take magnesium is people with kidney problems, so they ought to avoid that. I mean, I’m not saying it’s impossible to use it, but you should definitely be working with a practitioner in that regard. Magnesium is wonderful for these kinds of issues.

Katie: So many good tips wrapped up in that response.

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And another factor I want to make sure we get to delve into deeply is the stress piece, because you mentioned this already as part of your SHIFT protocol, and it seems like this might be the most elusive or potentially the toughest to dial in because there’s so much individuality here and stress can come from a variety of factors. Like you’ve mentioned all the physical stress factors that our body interprets as stress, even if we don’t mentally feel stress. And then of course, we have the mental and emotional stress that many people feel for any number of reasons.

And it seems like this one is often very multifaceted and could be the toughest to deal with. But also, I learned very much first hand how intricately connected that is to our physical health and to our biology. When I did all of the by the book physical things for years and didn’t really notice big results. And then when I dealt with my emotional trauma from high school, all of the physical stuff started resolving without me making any other big changes. And it just really showed me how important this is and how our body and our minds are so intricately connected. So how do you work people through the stress piece when they come to you?

Achina: Oh, wow, that’s a big question. You encapsulated it beautifully. I had so many things to say about sleep that I didn’t even know where to start. Now this is even a bigger topic, but it really starts with educating people about how stress impacts a person. Just the way you described is beautiful. And understanding that trauma can cause childhood trauma absolutely can cause a lot of physical health problems.

But some people don’t even realize how stressful like, there are people who love their jobs. They have great families, they’re multitaskers and just doing everything right. Boom, boom, boom, boom, boom. And they’re right on point inflow and don’t realize that their mind might be there energetically. They’re there and their mind is there, but their body is taking the toll. It’s almost like, come on body, let’s go! Some people think that the way it’s showing up in the body is the chronic disease, so to speak, where people assume that if the body was having a problem with it, that it would just get tired. That’s not necessarily the case. It just shows up differently for different people.

And so, yeah, it’s important to stop and slow down and think about what changed when this started, what happened that I started, what happened right before these changes occurred. Like, I have a patient who didn’t realize how much stress of her job caused her to have elevated blood sugars. Stress alone can cause diabetes. Stress alone can cause hyperlipidemia. And it doesn’t have to be a bad toxic stress. It could just be stress. So the key is to find places to rest. And so then that’s the other thing. I don’t know how to rest. I’ve been go, go, go going since I was a kid. I don’t even know what that feels like. And when they do feel that way, then they feel guilty if they try to rest, right? They feel guilt, they feel shame. But I’m not allowed to take care of myself. I’ve been taking care of everyone for so long that that has no meaning to me.

I just got off the phone before we started recording with a woman about that. She doesn’t even know the concept of resting was not even in her venue. Where do we start? We start where the patient’s at, right? We start where the person’s at and look at all of the variables that are getting in the way of taking care of oneself and getting to this place of rest. And then taking periods in your day to rest, to connect, to ground yourself, to show gratitude for yourself, for your life, for your connections, for the world. And it’s just being present and that in itself, just that, and you can do that for two minutes, can really snap you and reset you and get your body out of that stress mode. So just even adding two minutes every hour.

So sometimes I tell my patients to set their alarm or do it after a session, like if they have back to back Zoom sessions, take a break even for two minutes, just to reset. You know, sometimes doctors who are burned out, you know, before you go into the session, you know, put your hand on the knob before you open that door and just for 30 seconds breathe. And then it’s just finding ways to work that in into your everyday where you’re pausing and everyone has a different routine. So you kind of have to sort of think out of the box and figure out where it would work for them. And that’s where coaching comes in, right? Coaching and figuring that out for you.

Katie: Yeah, exactly. It seems like we talked about it very individualized, but that there are many multifaceted things that can help and I think it is at the end of the day, finding each of our own. So I never like to give exactly, “This is what I did…” because I don’t want someone to take it as, oh, I’m going to do the same thing and have the same results. But I feel like I tried many strategies and then anchored the ones that really helped me, which just for as a personal example, again, not prescriptive for me were things like morning sunlight really helped my stress level and which also, we know helps circadian rhythm and sleep, but also midday sunlight.

I realized I am blissfully happy in the sun, which makes sense when I understand my vitamin D receptors and that I convert vitamin D best from sunlight. And so making that a priority even for ten minutes a day was a big difference for me. And then gratitude for sure for me. I actually started keeping a gratitude journal and now I have several that are filled and slowly over time, I’ve seen this shift in my mindset. I actually have the words amor fati tattooed on my wrist now, which means love of fate or love what is. And that slow process of learning to shift not just from being grateful for the good things to being grateful for everything, and then to actually having a deep blissful love for all of the things. But that was a journey that I went on, not an overnight process. But one I like to just suggest because it was so helpful to me personally, I’d also love to delve into if I know we’re getting close on time, but into vagus nerve and how that comes into play and what vagal nerve stimulation can do when we speak of the stress component or other health aspects of this as well.

Achina: Oh, absolutely. There are a lot of people who have vagal nerve dysfunction and that can cause a lot of anxiety and even panic attacks to the point of panic attacks. So it’s being stuck in fight/flight and being in this constant sometimes people call it like an internal vibration, even, where they just cannot calm down, they don’t feel settled and they’ll be given a diagnosis of panic disorder or anxiety disorder. And medications really don’t do much for it. If a person goes from doctor to doctor and has tried all the different medications and none of them work, it’s probably because this is the issue and it’s probably not the only issue, but one of the issues.

So vagal nerve stimulation is basically the 10th cranial nerve and it’s a nerve that starts at the base of your brain and innervates practically every single organ in your chest area, all the way down through your abdomen to your tailbone. That is something that when you’re in fight/flight, you’re in sympathetic drive, you really want to stimulate the vagus nerve to put you in parasympathetic mode, and that is the rest and digest mode. So we talked earlier about breathing, so breath work is really important for that on a chronic basis. But there are things that you can do to get yourself out of fight/flight or to stimulate the vagus nerve, and those are things like gargling, singing, humming. So you’re stimulating the vagus nerve on the sides of your neck by doing those kinds of activities. Dr. says that you should gargle until your eyes tear, then you know that you’ve hit the right parts of the nerve. So when you have that tears reaction but there’s a whole host of ways to do that.

There’s books on it. Dr. Steve Porges wrote a book about, yes, I think that’s him and Dr. Habib has written books about different techniques. But those are the kinds of things that I would start with is gargling and singing, humming. I like to get people to sing, especially if they like to, so I’ll have them start with and if it’s been a while since they’ve sung, it’s also a great activity. Hearing music, it’s a relaxing kind of thing. So if someone is in alignment with singing and they haven’t done it for a while, I like to have people start there, but gargling and humming gargling is pretty hard to do and it’s not something that you can incorporate into your daily life throughout the day.

But breath work is really important for sure, and there’s different types of breath work. Box breathing is a very common place to start. There’s also the Wim Hof method, and so there’s so many different types of breathing. I don’t want to sort of box people into one type. I think it’s important to try all the different kinds and see what feels right to you. There’s no one way of doing things, so I try not to give one type of thing, but box breathing is the easiest place to start.

Katie: Yeah, great tip. And just purely anecdotally I love this singing tip because one thing that I noticed was after my trauma in high school, I had actually just become very quiet and people would say I was very soft spoken. And even at that point, I had never not that I think it would have been good to do, but I had never yelled at my kids. But I just realized for over ten years, I had never raised my voice or sung loudly or anything. And just anecdotally it lined up that I started taking voice lessons to get myself out of my comfort zone. And around the same time, I was doing all of this inner work.

But I had another guest say even the act of singing loudly also stimulates thyroid function because that’s also right there in the throat and I think between the vagus nerve side and the thyroid side, it lined up with my thyroid also getting a lot better. Not that that was necessarily causal, but I think it’s a really cool tip and one that we can all incorporate that also brings in an element of play and music and all those other things as well. So I love that you brought that up as a tip. And I know there’s so much more to all of this than we can cover ever in a 1 hour podcast episode, but that you have so many resources available for this. So where can people find you to keep learning from you and where can they find your book?

Achina: Oh, sure, people can find me on my website, www.fxnmind.com. My practice is called Functional Mind in Providence, Rhode Island. We just moved to a new place, 105 Wickenden Street in Providence, and it’s right in the heart of the city. And people can find me on Facebook, at my podcast. It’s ‘What if It’s Not Depression? With Dr. Achina Stein’ and I’m on Instagram @drachinastein. So I think that I gave you all that information on the show notes, and I’ve also written a book called What If It’s NOT Depression? It was published in 2020 about the very topic that we discussed today—topics that we discussed today—and people can get in detail.

Katie: I will put links to all of those in the show notes for anyone listening on the go that will all be at wellnessmama.fm. You can find that as well as all the notes I’ve been taking throughout this episode. And a last question that I love to ask because it’s personally fun for me to get new recommendations and that is if there is a book or a number of books that really have profoundly impacted you personally and if so, what they are and why.

Achina: Well, my favorite book that’s really impacted me is The Body Keeps the Score by Bessel van der Kolk. It really shows the research of how the body responds to emotions. And I think it really proves that when…it’s not all in your head, and that the body is connected to the mind. And it’s just really wonderful about how the body that’s been traumatized can express itself and manifest in disease, in suffering. And so I think it’s just was profound in terms of reading that and the information that provided.

Katie: I wholeheartedly second that recommendation. I will link to that in the show notes as well. And thank you so much for the time today. I’m very grateful for all the work that you’re doing and for you taking the time away from your patients to share with us today. So thank you for being here.

Achina: Oh, it’s my pleasure. It’s always been my pleasure. And you’ve been wonderful with all your questions and you’re so brilliant in how you connected all the dots right here on the show.

Katie: Thank you so much. And thanks, as always to all of you for listening and sharing your most valuable resources, your time, your energy, and your attention with us today. We’re both so grateful that you did, and I hope that you will join me again on the next episode of the Wellness Mama Podcast.

If you’re enjoying these interviews, would you please take two minutes to leave a rating or review on iTunes for me? Doing this helps more people to find the podcast, which means even more moms and families could benefit from the information. I really appreciate your time, and thanks as always for listening.