Chiropractic Care in Pregnancy
I have been under chiropractic wellness care for most of my life, but a few months after our most recent move I still hadn’t found a local chiropractor. I found out that I was pregnant, and I immediately made an appointment with a Webster certified chiropractor (I literally called around to chiropractors before calling OBGYNs). The Webster Technique is a specific analysis and adjustment utilized for pregnant women. The goal of the adjustment is to balance the bones, ligaments, and muscles of the pelvis which allows for optimal comfort within the mother.
Pregnant women can benefit from chiropractic adjustments even in the absence of back pain. Chiropractic care can aid in optimizing physiological function of both the mother and the baby throughout pregnancy and birth. According to the ICPA, chiropractic care during pregnancy can also affect labor. “During birth, pelvic imbalance can affect labor progression, leading to unnecessary intervention. Pelvic imbalance adversely affects uterine nerve function, the structure of the pelvis, and may hinder a baby’s ability to gain optimal positioning. These are the very causes of dystocia or difficult, stalled labor. The Webster Technique helps achieve a state of balance in the pelvis that may contribute to a safer, easier birth outcome.
I noticed an improvement in my own quality of life while pregnant when I received chiropractic adjustments. As a chiropractor myself, I have since become Webster Certified so that I can serve pregnant mamas in my community. As both a patient and a chiropractor, I highly recommend scheduling with a Webster certified doctor in your area throughout pregnancy!
Stress, Sleep, and Chronic Pain
There is nothing I hate more than being told to “destress” when discussing my chronic illness with healthcare providers. It sounds inherently dismissive, and if all of my issues could be fixed by doing yoga and taking bubble baths every day don’t you think I would have tried that by now?! Stress can be a component of chronic illness and pain, but it is not the singular cause or solution to most health conditions.
As a chiropractor, I have found that many patients say that stress does worsen their chronic pain symptoms. It turns out there is a scientific explanation for this! Stress increases a neurotransmitter in the body known as Substance P. Substance P is responsible for transmitting pain signals and producing the inflammatory response. In the simplest of terms, more Substance P results in more pain and inflammation. Therefore, an increase in stress can directly impact pain and inflammation.
Stress also plays a role in our “happy” emotions by decreasing serotonin. Many of us have heard of serotonin because of the growing popularity of SSRI antidepressants (Selective Serotonin Reuptake Inhibitors). Serotonin is the “feel-good” neurotransmitter- which is why SSRI’s aim to increase your levels of serotonin. HIgher levels of stress can make it harder to feel positive emotions because of the decrease in serotonin.
You may also have heard of melatonin supplements that people take before bed. Melatonin is responsible for your sleep wake cycle, and is actually produced within the body from serotonin. If you have noticed that stress also impacts your sleep, this is why. Stress has decreased the amount of serotonin in your body, reducing the amount that is available to be converted into melatonin. This can be a vicious cycle because proper sleep is often needed to get out of a period of high stress, but the stress itself can inhibit sleep. This can further the chronic pain response because sleep can also play a crucial role in the body’s healing processes.
This was a lot of scientific jargon, but the take-away here is that stress increases pain and inflammation, decreases “feel-good” emotions, and makes it harder to sleep. Knowing all of this can help us understand the importance of stress management, but please keep in mind that this is just one explanation as to how stress impacts chronic conditions. I will never be a healthcare provider that dismisses pain by saying it is “just stress,” but I may use stress management techniques as part of your care plan!
Can you Lose Weight without Dieting?
Obesity is a growing health concern, with over two-thirds of American adults qualifying as obese. Obesity is associated with numerous other health risks including type 2 diabetes, heart disease, stroke, cancer, and high blood pressure. As such, if you qualify as obese, you may be advised to reduce your body mass. Anybody who has ever tried to lose weight though, knows that this is often easier said than done. There are several medical options for weight loss under the supervision of a doctor including prescription drugs, such as Ozempic, and weight loss surgery. Both options are relatively risky and invasive, which is why the first option for weight loss is usually diet and exercise.
One common form of dieting for weight loss is calorie restriction. In this method, the calories you need to eat per day are calculated, and you then must aim to eat under that number of calories each day. There are several smartphone apps to help with this, including Lose It and My Fitness Pal. It is important to calculate the correct number of calories to avoid unnecessary health risks from malnutrition. Low calorie diets have been shown to result in weight loss and improved heart health. There is also evidence that calorie restriction can decrease inflammation and improve gut health.
Restricting calories in this way has been shown to have health benefits, but there is not yet much research on the long-term effects of low-calorie diets. Traditional diets are often unsustainable, with studies showing that up to 40% of people who lose weight eventually gain it back. The act of repeatedly losing and gaining weight is known as weight cycling. Weight cycling can be dangerous for your health and has been associated with poor heart health.
For this reason, another nutritional option known as intuitive eating has gained popularity. Intuitive eating is based on recognizing when you are hungry and when you are full to determine food choices. It also utilizes something known as gentle nutrition, which allows you to make food choices based on which foods will make you feel good. You can start this practice today by adding foods that your body needs, in addition to the foods that you are craving. For example, a brownie may sound good to you, but you are hungry and know that it won’t fill you up all the way. Therefore, you may opt to eat a small salad with protein and then finish with a small brownie so that you are satisfied both mentally and physically. Practice adding nourishing foods to meals in which you are eating the foods you are craving.
To begin an intuitive eating practice, you would buy groceries that you know will physically satisfy your body’s needs. High protein options to include in each meal include chicken breast, Greek yogurt, and lean beef. You can also buy a variety of fruits and vegetables that you enjoy, such as spinach, bananas, lettuce, kale, and berries. Produce such as this will include fiber, which when combined with protein can keep you full. To round out your meals, you can include a carb source such as brown rice or quinoa. These carbs give you energy. Finally, add food sources that will add enjoyment to your nourishing meals. I know that I enjoy a salad more if I include feta cheese, so I always buy feta in addition to my salad produce. In an intuitive eating practice, no foods are off limits. Feel free to buy dark chocolate, nuts, and even your favorite candies to consume in moderation. Serving sizes can also be useful when building your snacks and meals. Start with the servings size on the food label. If you finish the serving and find you are still hungry, it is okay to go back for more!
Mindfulness practices can also help you on your intuitive eating journey. Be present with your food and try to eat without any distractions, such as your phone or television. You can also practice breathwork before each meal. Headspace is a great app that you can download to help you out with this!
Research has shown that people who learn intuitive eating are far more likely to make long-term changes to their nutrition than people who are taught to diet with calorie restriction. Intuitive eating is based around body-acceptance, and weight loss is not an intended goal. However, intuitive eating behaviors have been associated with lower prevalence of obesity.
It has not yet been determined that intuitive eating has a positive impact of intuitive eating on physical health markers, such as cholesterol, heart health, and blood pressure. Therefore, your doctor may recommend a different nutrition intervention if they are concerned about these health markers. However, intuitive eating has been associated with positive mental health outcomes such as lower levels of depression, higher self-esteem, and higher body satisfaction. It has also been shown to lower the risk of disordered eating behaviors.
Overall, we need more research on intuitive eating to determine its effect on mental health, physical health, and weight status. However, it may be an option for you to improve your health, especially if you have a history of weight cycling and yo-yo dieting. Intuitive eating can be a great tool for sustainable, healthy nutrition habits especially when paired with regular exercise. For more information or to find an intuitive-eating counselor, you can visit intuitiveeating.org.
References
10 principles of intuitive eating. (n.d.). Intuitive Eating. Retrieved November 30, 2023, from https://www.intuitiveeating.org/10-principles-of-intuitive-eating/
Bacon, L., Stern, J. S., Van Loan, M. D., & Keim, N. L. (2005). Size acceptance and intuitive eating improve health for obese, female chronic dieters. Journal of the American Dietetic Association, 105(6), 929–936. https://doi.org/10.1016/j.jada.2005.03.011
Bray, G. A., & Ryan, D. H. (2021). Evidence‐based weight loss interventions: Individualized treatment options to maximize patient outcomes. Diabetes, Obesity and Metabolism, 23(S1), 50–62. https://doi.org/10.1111/dom.14200
Christoph, M., Järvelä-Reijonen, E., Hooper, L., Larson, N., Mason, S. M., & Neumark-Sztainer, D. (2021). Longitudinal associations between intuitive eating and weight-related behaviors in a population-based sample of young adults. Appetite, 160, 105093. https://doi.org/10.1016/j.appet.2021.105093
Funk, M. D., Lee, M., Vidoni, M. L., & Reininger, B. M. (2019). Weight loss and weight gain among participants in a community-based weight loss Challenge. BMC Obesity, 6(1), 2. https://doi.org/10.1186/s40608-018-0225-1
Ott, B., Skurk, T., Hastreiter, L., Lagkouvardos, I., Fischer, S., Büttner, J., Kellerer, T., Clavel, T., Rychlik, M., Haller, D., & Hauner, H. (2017). Effect of caloric restriction on gut permeability, inflammation markers, and fecal microbiota in obese women. Scientific Reports, 7(1), 11955. https://doi.org/10.1038/s41598-017-12109-9
Your Body Can Only Do You So Many Favors
I have a strong career interest in lifestyle medicine, but as a patient I can tell you that it can be quite overwhelming. My perfectionism makes me feel like I either have to make all of the lifestyle changes perfectly at 100%, or that I am a total failure. Through my own wellness journey, I have found that it actually works best to leverage the lifestyle categories I am best able to and leave the other ones alone. This is quite the opposite of being perfect, yet it is where I have personally seen the most progress.
I spent a year and a half of chiro school being incredibly sick and stressed. I had recurrent episodes of gut dysbiosis in which I would lose 15 pounds over the course of a few weeks, take an antibiotic that allowed me to eat normally again, overcompensate from not being able to eat, and then gain 25 pounds back. I went through several cycles of this and tried elimination diets, herbal remedies, and strict protocols. Then I started my coursework in functional medicine and realized that there were other areas of my life that I had far more capacity to tackle than focusing on foods alone. I set a sleep schedule and learned how to incorporate relaxation time into my everyday habits. I chose to exercise daily and make time for fun fiction books. Most importantly, though, I finally chose my health over my grades. After a few months of these relatively simple changes, I can finally eat normally again! I try my best to include whole foods, and limit caffeine and alcohol but I am no longer tied to strict protocols or lists of foods that I can’t tolerate.
I’ve learned that my body could only do me so many favors at a time. I was constantly stressed, not setting boundaries, eating poorly, drinking too much, and studying more than I was sleeping. It only makes sense that my body wasn’t able to keep up with all of this, and in my case, it led to my gut health crashing. Now I nourish my body where I am able to, and my body is able to handle the remaining stress (both mental and physical). If you are struggling with your health, look into the areas where you are most able to make changes. Some areas to begin with:
Sleep. Maybe you have kids who don’t sleep through the night or a second job that makes you get home later than you’d like. Is there any aspect of sleep within your control, though, that you can improve. Can you turn off all screens in the bedroom and try meditation instead of scrolling through Facebook before bed? Can you set a specific sleep schedule where you go to bed and wake up at the same time every day, even if you aren’t getting as many hours of sleep as would be ideal?
Relaxation. You might not have time to take a bubble bath every night, or you might not have the finances to get a massage every month. Can you carve out an hour per week to paint your nails while you watch your favorite show? Can you replace an hour of social media per week with an hour of reading a book that you enjoy? Can you listen to a podcast while driving or folding the laundry?
Hydration. It sounds like the simplest thing, but most of us are going through the day dehydrated, which makes it hard for the body to keep up with other crucial processes. Aim for half of your body weight in ounces of water per day (i.e. 200 lbs body weight = 100 oz of water daily). I help myself reach my water goal by making myself drink an entire water bottle (40 oz) before I have any fun drinks, including coffee. I also sprinkle LMNT into my water for taste and some added electrolytes.
Movement. A lot of us do not move our bodies enough, and in my case, this was because I didn’t have any forms of exercise I enjoyed. I have found that I really enjoy dance workouts, yoga, and taking walks while listening to a podcast. Chronic illness related fatigue has also made it difficult to commit to the same level of intense workouts that I used to do. However, movement does not have to be a structured workout that costs a ton of time and money. It can just be simple walking and stretching breaks throughout your day!
Nutrition. This is the one I struggle with the most, especially as a picky eater. I have found nutrition through addition to be my best friend. Instead of restricting foods, I eat the foods I love but I also add the foods I need. I still enjoy pasta regularly, but I will be sure to add vegetables to it. I still eat bagels, but I add Greek yogurt on the side for extra protein. In general, try to create most meals from whole foods (fruits, vegetables, lean protein sources, etc.), but it is okay to enjoy all foods in moderation.
Breastmilk and the Immune System
I recently came down with the flu, and several people asked if I switched my baby to formula during this time- thinking that my breastmilk would get my baby sick.
This is a very common myth, but in fact breastfeeding moms should do the exact opposite and make sure they are feeding their baby milk that was produced during illness.
Breastmilk contains antibodies, which are proteins that help fight off foreign substances such as viruses and bacteria. When a mom is sick, her body produces these antibodies against the illness. The antibodies are present in breastmilk and instantly help protect the baby from the infection.
Babies are born with immature immune systems, which is why it can be scary if they are exposed to illness. However, If a baby is exposed to germs the mom will automatically start producing immune factors against that illness- even if the mom isn’t sick.
Moms who are pumping are usually told to feed their baby the oldest milk first. However, in the event of illness it can be helpful to use the most recent milk instead, as it has immune factors to help the baby fight off the illness. Even though my baby was very exposed when I got the flu, he never did end up getting sick- a win that I attribute to breastmilk!
Should I Worry about my BMI?
A lot of us have complicated histories with the BMI chart, and I have heard several stories from women who have struggled with body image based on their BMI categorization. I have done some research on the history of the BMI chart, and I have some issues with it:
Weight and body fat can be significant health factors, but BMI may not be the best way to measure health. Body Mass Index (BMI) is a metric that is a "measure of body fat based on height and weight” according to the National Institutes of Health (NIH). The NIH says that BMI measures body fat, but body composition is not considered in the BMI calculations. BMI calculations are based solely on height and weight, without taking body fat or muscle mass into account. Thus, muscular people with healthy lifestyles have the potential to be considered “obese” according to the BMI.
Furthermore, the BMI was created by a statistician and was never meant to measure individual health. The initial purpose of the BMI chart was to estimate population data. It was initially based on white Western Europeans in the 1830s… and probably should not be generalized to everyone else.
For me, the final nail in the BMI coffin comes from a revision that occurred in 1998. The chart was revised in 1998 by the NIH, changing the cutoff line between “overweight” and “normal weight” from 27.8 (men) and 27.3 (women) to 24.9. This was pretty substantial. A 5’8 woman was considered “healthy” at 180 pounds before this change but afterward needed to be 164 pounds to fit within the confines of the new chart. Overnight, millions of Americans who were previously considered to be of healthy weight were told they needed to lose several pounds. Many panel members who made this change had ties to weight loss companies such as Weight Watchers and pharmaceutical companies with weight loss drugs on the market. Essentially, the people making this shift had something to gain by telling Americans they needed to lose weight.
My takeaway is that anybody pursuing better health should focus on healthy behaviors, not BMI metrics. Health-promoting behaviors include physical activity, consumption of fruits and vegetables, and sleeping 7+ hours per night. Obsessing about fitting into a chart category is not on this list.
Run the Dishwasher Twice
A while back there was a post circulating a Facebook (linked below) about running the dishwasher twice. The author didn’t have the energy to scrub her dishes prior to putting them in the dishwasher, so her therapist suggested that she simply run her dishwasher twice. This post resonated with me because at the time I was struggling with Oula. My perfectionism and all or nothing mindset had let me to stop dancing in 2020 when I felt I couldn’t go all in. Pre-covid I was taking Oula classes every chance I got and was dancing several times per week.
When covid hit, that all stopped for obvious reasons. Once we were able to do outdoor classes that summer, I started dancing regularly but once the fall hit and it got cold, I struggled again. I was in a season of being too emotionally exhausted to commit to anything “extra.” I was in my first trimester of grad school and working part time, and it felt daunting to come home from work, do homework, and find the energy to even change for a workout let alone commit to an hour. After reading the dishwasher post, I decided there were no rules for how I do Oula. I would take off my shoes, leave my work clothes on (often leggings anyway), and play a class that was only 30 min. I took out more jumps than I left in most days. Some days I felt extra good and chose the hour class but I told myself that I don’t have to commit if it’s too much (I always feel better once I start a class though, and usually I did complete it).
All of this rambling is to say that if anyone has similar struggles, I really encourage you to give yourself grace and move your body at whatever level you are able to right now. I really missed the community of in-person classes. I really missed having the energy to do 5 full hours of Oula a week. But when these were not options, I found that doing something was better for me than doing nothing. Allowing myself to practice Oula in an imperfect way really, really helped me to feel better mentally and physically. The mistake we make with fitness is feeling like we have to do it perfectly. We start intense workout programs and 90 day challenges, then quit them when we feel that we don’t have the energy to commit to the whole thing. It is okay to scale it back and meet yourself wherever you are at day to day. I think that your mind and your body will thank you for it.
Dishwasher article: https://www.upworthy.com/woman-shares-therapists-mental-health-tip-for-doing-dishes
The 1200 Calorie Myth
Many of us who have dieted in the past have aimed for 1200 daily calories at one point or another. It wasn’t until I took masters level nutrition courses that I realized this is literally the calorie needs of a toddler, not of an adult human!
In an effort to demonstrate demonstrate daily calorie needs, I am going to go over some terms and numbers below- hopefully without overwhelming y'all with math:
We need to start by finding basal metabolic rate, or BMR. Some of us have been told to eat at or below this number, but that is never the case! I read a magazine once that told me BMR is the number of calories I burn if I sit and watch TV all day (which tbh I am guilty of at times), and that to lose weight you need to eat 500 calories below that. This is not true, though, as BMR is literally the bare minimum calories your body needs to just survive.
Resting metabolic rate, or RMR, is your BMR plus the energy your body needs to maintain body heat, digest food, and do other complex things for survival. Therefore, this number is higher than your BMR. For this example let's use a 30 year old woman who is 5'5 and weighs 160 lbs. Her RMR is 1,447 calories. This is essentially how many calories she needs to maintain normal body function, and therefore it would not be recommended that she eat less than this amount. We can already see that her daily energy needs are more than 1200 calories!
The RMR is still not how many calories she burns in a day, though. That number would be Total Daily Energy Expenditure or TDEE. To get this calculation, we add RMR + physical activity + the amount of energy needed to digest and absorb food. This depends on activity level and dietary intake, but lets say our example here eats 2,000 calories a day and burns 500 daily active calories each day based on her apple watch. Her TDEE, or the number of calories she burns each day, is 2,147 calories.
Essentially, the person in this example would need to eat 2,147 calories per day to maintain her current body weight. She could decrease this number to lose weight, but 1200 calories would not be nearly enough!
Resources
Mifflin St Jeor Equation:
RMR (female) = 10 (weight in kg) + 6.25 (height in cm) - 5 (age in years) - 161
RMR (male) = 10 (weight in kg) + 6.25 (height in cm) - 5 (age in years) + 5
Total Daily Energy Expenditure equation:
TDEE= RMR + physical activity + TEF
Online calculator: https://www.leighpeele.com/mifflin-st-jeor-calculator
References
Lagerros, Ylva, (2006). Physical activity from the epidemiological perspective— measurement issues and health effects. retrieved from https://www.researchgate.net/publication/237547296_Physical_activity_from_the_epidemiological_perspective-measurement_issues_and_health_effects
Mifflin MD, St Jeor ST, Hill LA, Scott BJ, Daugherty SA, and Koh YO, (1990). A new predictive equation for resting energy expenditure in healthy individuals. The American Journal of Clinical Nutrition, 51(2):241-247.
*Please note that the information in this post is for educational use only. Contact your medical provider before adopting any dietary changes.
Are you Filling your Cup?
I read once that burnout is not caused by doing too much, but instead by not doing enough of the things you actually enjoy. This resonated and led to a theory of mine that everything you spend your time on has the potential to deplete your energy or refill it.
The activities that fill my cup include talking with good friends, writing, exercising in an enjoyable way, and reading a fun book. If you are experiencing burnout, it might be because you aren't including enough of these recharging activities.
Most of us experience energy depleting activities on a daily basis. After doing something that drains my energy, I intentionally plan to do something from above that will energize me. For example, there are certain continuing ed classes that deplete my energy. To counteract this, I plan a short outdoor walk after working on these.
I have also discovered that some activities are truly just neutral. Watching Netflix for hours doesn’t necessarily fill my cup or deplete it. For this reason, I have tried to replace these "neutral" activities with ones that truly re-energize me.
Being more mindful about how I spend my free time has been instrumental in my stress-management journey and has allowed me to overcome burnout. If I come home from a long day where my energy is depleted and scroll social media, I will go to bed feeling depleted. If I instead do a yoga class or Facetime a friend, I am able to truly recharge.
If you feel chronically stressed, try practicing intentional activities that truly fill your cup.
Moving Stress through your Body
Chronic stress has been one of my biggest obstacles to overcome. I am still working on it, but something that has really helped me has been finding ways to physically move the stress out of my nervous system through my body. Here are some examples of ways to do this:
1. Take a walk outside
Sunshine in itself has several benefits, and I’ve found walking to be a great way to relieve stress. I typically pair my walk with a fun podcast episode or a phone call with a friend for an added mood boost.
2. Engage in a mind-body fitness format
Exercise in any form releases endorphins and can be an excellent stress reliever. I have personally found even more benefit from mind-body formats that allow me to release my emotional stress through physical movement. My favorites are Yoga and Oula.
3. EFT tapping
Emotional Freedom Technique (EFT) is a great option for stress relief because you can perform it on yourself. The premise is that tapping on certain body points while focusing on painful emotions can reduce the distress signals in your brain and promote relaxation. Learn more at tappingsolutionfoundation.org.
4. Chiropractic care and massage therapy
I have found great stress relief from both chiropractic adjustments and massage therapy. While this may not be an active form of stress relief, I do believe it is a powerful tool to utilize in combination with the other ones listed.
5. Find an NET practitioner
Neuro Emotional Technique (NET) is based on the concept that unresolved emotional trauma is stored in the body. NET practitioners (such as chiropractors or psychologists) are trained in finding stress patterns and helping you to heal them. Learn more at onefoundation.org/net.