Body Positive Yoga and PCOS

Body positive yoga

All bodies are yoga bodies. Photo courtesy of Lydia Mann, Flickr Creative Commons.

Why Body Positive Yoga Matters

I wish I could write that all yoga programs are welcoming to all body shapes and sizes. The reality is, though, that many yoga programs cater to a thin body standard and narrow view of what constitutes health and wellness. And sometimes they do not offer the modifications or recommendations that help make all yoga poses comfortably accessible to larger bodies. Or they over-emphasize poses and, however well-intentioned, single out larger students for special assistance or treatment even if none is needed or desired. In short, not everyone feels comfortable in a conventional yoga class. If these words resonate with you, please read on:

Body Positive Yoga: recommended event and resources

As a body positive naturopathic physician, I want all my patients have access to yoga instructors whose teaching caters to their mind, body and spirit as they are, not as they should be. And when it comes to instruction and personal practice, nothing quite compares to being able to see a body that looks like your body do yoga.

This is why I am delighted to tell you about an upcoming event with body positive yoga instructor and author Jessamyn Stanley at the Seattle Central Library on April 21 from 7 – 8:30 pm. She will be discussing her body positive approach to yoga and her new book “Every Body Yoga”

“Jessamyn Stanley is known for combining a deep understanding of yoga with a willingness to share her personal struggles. Now she brings her body-positive, emotionally uplifting approach in a book that will help every reader discover the power of yoga. Jessamyn will appear in conversation with local writer and yoga instructor Nicole Tsong.

As an internationally recognized yoga teacher and Instagram star, Jessamyn Stanley conducts yoga workshops across the country, teaching students of all shapes, sizes, and colors how to make yoga a permanent part of their lives.”

If you have ever wondered whether yoga is for you, or if you have ever wanted to try a yoga class but were worried that you wouldn’t fit in or feel comfortable participating, please check out Jessamyn’s website and go see her speak in Seattle.

Where to find in-person or online body positive yoga instruction:

A benefit of living in or near Seattle is that we have some great body positive yoga studios for in-person classes and instruction. A benefit of the internet age is that it is increasingly easy to start a home yoga practice. Yoga instructors from around the world offer online videos and tutorials, many of them free or available by monthly subscription.

Here are several resources to get you started:

  • Whole Life Yoga: a Seattle-based body positive yoga studio located in the Greenwood neighborhood. They have drop in classes 7 days a week and regularly offers a Yoga for Round Bodies series of 4-6 classes.
  • Tiger Lily Yoga: a Seattle-based yoga body positive yoga studio located in the Columbia City neighborhood. They offer in-person classes 7 days a week, including pay-what-you-can donation based classes.
  • Curvy Yoga: online yoga videos that are searchable by length, energy level, pose type and body part. Free and paid memberships are available.
  • Body Positive Yoga: online yoga classes, tutorials for pose modifications. She also offers helpful advice for other yoga instructors on how to incorporate body positive language into their instruction and how to present pose modifications that keep students safe and prevent injury.

For writing on body positive yoga, I highly recommend Vancouver, BC-based Lisa Papez’s blog and manifesto. I took a workshop from her at the 2013 Realize Your Radiance conference in Seattle and was so inspired by her approach and instruction.

If you are a body positive yoga instructor or know of body positive yoga resources in Seattle or the Eastside, I would love to know about them!

Yoga, Body Positivity and PCOS:

80% of women with PCOS experience hormonal and metabolic dysregulation that leads to insulin resistance and weight gain, which can be closely tied to experiences of body dysmorphia, a challenging relationship with body image and anxiety.

A 2012 study of adolescents with PCOS showed that a 12 week holistic yoga program was better for reducing anxiety than a traditional physical exercise program. The teenage girls recruited for this study practiced yoga and meditation for 1 hour per day for 12 weeks, while their study counterparts in the control group participated in a 1 hour daily of traditional exercise (e.g. leg lifts and crunches) and group lectures on healthy diet and lifestyle. Researchers believe that the benefit that yoga had for reducing symptoms of anxiety was both neurological, by reducing activity of the sympathetic (fight-or-flight) nervous system, as well as psychological by enhancing mindfulness and stress resilience.

This same group of teenage girls with PCOS was also seen to have better glucose metabolism, measured by fasting insulin and fasting glucose, and lower cholesterol levels than their counterparts in traditional exercise programs.

About the author:

Hello, I’m Miranda Marti, ND, LAc, a body positive naturopathic physician and acupuncturist specializing in the holistic treatment of PCOS. I started doing yoga to support my stress resilience and stabilize my neck and back muscles to help alleviate my migraine headaches. What began as a very goal-oriented experiment (wildly successful, btw) with yoga has blossomed into a regular, self-sustaining practice.

Why Am I So Tired: Movement

From simple lifestyle habits to complex medical problems, why we lack energy can have many causes. In this series, I’m tackling some of the lifestyle factors associated with fatigue that lend themselves to home troubleshooting. This week’s topic is:

Movement: replenishing the energy that stress steals

Stress takes it toll on us in a number of ways, a major one being mental and physical exhaustion. Stress can rob us of the energy we need to do the things we need and want to do, and cause serious health problems such as cardiovascular disease, anxiety and depression.

One of our best ways to reclaim lost energy from stress is through exercise. This is illustrated in a 2015 article published in the peer-reviewed journal BMC Psychiatry. This 18-month study of individuals diagnosed with stress-related exhaustion found that increasing physical activity reduced symptoms of fatigue, burnout and depression .

Surprisingly, study participants did not need to meet the recommended guidelines for physical activity to report benefits. As long as they regularly increased their physical activity above their pre-treatment baseline,  they reporting feeling more energetic and experiencing a better mood compared to individuals in the study who maintained their sedentary habits.

How much movement do I need to fight stress?

Walking for 10 minutes improves stress levels and mental acuity. Image by Peter Blanchard.

The American College of Sports Medicine’s guideline for cardiorespiratory excise, which was used in the study referenced above, is 150 minutes of moderate intensity exercise per week.  Though remember that even people who didn’t meet this goal still reported significant improvement in their fatigue and burnout. All movement benefits the body and the brain!

Movement is more than just formal exercise. Any activity or movement that engages large muscle groups and raises the heart rate for at least 10 minutes at a time can help fight fatigue. In addition to formal exercise, this can include chores, sports, playing with kids or pets, gardening, physical labor, and walking.

Movement and Exercise guidelines for supporting mental and physical health:

  • 20-50 minutes of moderate intensity exercise 5 days per week
    • practical definition: you can talk but not sing while moving or exercising at this level
    • max heart-rate: 60-70%


  • 20-60 minutes of vigorous-intensity exercise 3 days per week
    • practical definition: you can string together 2-3 words  but not talk in full sentences while moving or exercising at this level
    • max heart-rate: 70-80

Max heart-rate is a commonly used measure of physical exertion, representing the upper limit of what a person’s cardiovascular system can handle. The basic formula for calculating your max heart rate is:  220 – (your age), or you can use this calculator.

In addition to the guidelines above, which treat exercise as an event, I also recommend a daily movement habit I call:

The  10 minute walk away from stress

What is a 10 minute walk going to do for stress? Reverse it.

Stress, particularly it’s chemical mediator adrenaline, decreases blood flow to our prefrontal cortex, the part of our brain most responsible for critical thinking. This leads us to more easily feel distracted, overwhelmed and prone to short-sighted or bad decision-making.

We can reverse this with 10 minutes of light-moderate exercise, such as walking, which increases blood flow to the prefrontal cortex.

Though stress often tricks our mind into thinking we can’t afford to step away from the problem we’re working, the reality is that 10 minute break will reward you with increased energy and motivation, improved concentration and a greater problem-solving capacity.

Words of motivation

My go-to inspiration for movement & exercise to benefit the mind and body.

As Dr. Ratey, a psychiatrist specializing in how exercise changes the brain, states in his excellent book Spark: The Revolutionary New Science of Exercise and the Brain: 

Exercise is the single most powerful tool you have to optimize brain function…When people ask me how much exercise they should do for their brain, I tell them the best advice is to get fit and then continue to challenge themselves. The prescription for how to do that will vary from person to person, but the research consistently shows that the more fit you are, the more resilient your brain becomes and bet better it functions both cognitively and psychologically….Does that mean I have to look like an underwear model to enjoy the brain benefits of exercise? Not at all. In fact, many of the most convincing studies use walking as the mode of exercise.

If you are looking for inspiration to start a new exercise practice or revive an old or tired one, I highly recommend reading Spark. It is my go-to reading every time I start to get a little bored with my movement habits or start to be swayed by that voice in my head that tells me I don’t have time for walking, yoga, running or whatever it is that I’m doing to keep my mind and body fit.

Want to know more?

This is the third of a series of blog posts providing the Whole Life Medicine community with reliable information about important health topics. Check back with use for future posts or follow our Facebook page.

About the author: Evaluating causes of fatigue affecting physical and mental health is a specialty of Miranda Marti, ND. For information about scheduling a free 15 minute consult or making an appointment, please contact us or call our front desk at 425-398-9355.

Why Am I So Tired: Nutrition

From simple lifestyle habits to complex medical problems, why we feel tired can have many causes. In this series, I’m tackling some of the lifestyle factors associated with fatigue that lend themselves to home troubleshooting. This week’s topic is:


What we eat is important. But even a diet made up of the best quality foods can leave us feeling tired if the timing and quantities of those foods is off.  This is because with rare exception, every cell in our body relies on glucose as it’s fuel to create energy. If our fuel supply is inadequate or disrupted throughout the day, that can leave use feeling tired.

Physical fatigue can feel like lethargy, muscle weakness, loss of stamina, the need to lay down and rest, or feeling drained by the day’s activities. Mental fatigue can be experienced as brain fog, irritability or mood swings, confusion, and feeling scattered, unmotivated or unfocused.

How much do I need to eat to avoid fatigue?

Flickr Creative Commons licensed for commercial use

Banana Berry Protein Smoothie by Amazing Almonds

There are a few nutritional guidelines that are worth trouble-shooting for anyone who feels tired.

  1. Am I eating an appropriate amount of protein throughout the day?
  2. Am I eating at least 150 grams of carbohydrate throughout the day?
  3. Do I eat frequently enough throughout the day?

It may require a little legwork to answer these questions, particularly reading the nutrition labels of prepared foods and looking up nutritional information for whole or fresh foods. But the answers are a worthwhile and necessary for ruling out simple nutritional oversights as a cause for fatigue.

Visit my Pinterest boards for snack and meal recipes that provide an energizing balance of protein and carbohydrates.

Protein Needs:

Generally speaking a healthy person’s protein need is based on their age, sex, body size and activity level.  Use this protein calculator to determine your protein needs per the American Dietetic Association (ADA) and Centers for Disease Control and Prevention (CDC) recommendations.  Once you have the appropriate protein range that you should be consuming, keep a diet diary for a few days to tally up how much protein you are eating throughout the day to find out if you are achieving your goal.

A person with health problems may require more or less protein than the  average healthy person, so consult your doctor or a nutritionist about individual health-related protein needs.

Carbohydrate Needs:

Unless you are specifically following a ketogenic diet, which forces the body’s cellular metabolism to use ketones rather than glucose as fuel by following an extremely low carb diet, your body may feel tired or overwhelmed when your carbohydrate intake drops below 150 grams per day.  

Even though we are constantly told Americans eat too many carbohydrates, it can be surprisingly easy to eat too few. It has been my experience that in an effort to be healthy,  many health-conscious people actually overshoot the low-carb mark.  I see this particularly often when patients are reporting overwhelmed by brain fog, irritability and mood swings.

Flckr Creative Commons licensed for commercial use

Photo courtesy of I_Nneska

Here is an example of a diet diary of someone who is unintentionally eating less that 150 gm carbohydrate per day:

  • 8 AM breakfast: an apple (25-30 gms), scrambled eggs, coffee with half & half
  • 10 AM snack: a handful of almonds (6 gms) and a tall soy latte (18 gms)
  • noon lunch: Trader Joe’s Harvest with Grilled Chicken (20 gms) and sparkling water
  • 4 PM snack: LemonZest Luna Bar (26 gms)
  • 7 PM dinner: chicken breast, 1/2 cup quinoa (20 gms), 1 cup steamed broccoli (6 gms)

While this example diet supplies an adequate amount of protein, it only delivers 126 grams of carbohydrate which is low enough to leave someone feeling tired, irritable or overwhelmed.

How often do I have to eat to avoid fatigue?

Even the best quality foods in the world have a limited time to provide us with energy. This is because our digestive system is in constant motion. For most people, food is on its way to becoming a bowel movement about 4 hours after it is eaten.

While some people thrive going longer times between meals, it is not a strategy that works for everyone. If you are routinely going more than 4 hours between snacks or meals, try experimenting over several days with increasing your snack and meal frequency to see how your energy improves.

Diet diaries help

To fully trouble-shoot these dietary causes of mental and physical fatigue, I recommend keeping a food diary. This involves taking a day or two to record the amount of proteins and carbohydrates you are eating throughout the day, as well as when you are eating them, to see if you are meeting your goals to keep your body fueled.

For prepared foods, you can simply look at the nutrition label for their protein and carbohydrate content.

For fresh or whole foods, like fruits and vegetables, grains or meats that you cook for yourself, you can look up the nutritional content using the USDA nutrient database. Some people also prefer to use food-tracking apps on their smartphone, such as LoseIt.

Want to know more?

This is the second of a series of blog posts providing the Whole Life Medicine community with reliable information about important health topics. Check back with use for future posts or follow our Facebook page.

About the author: Evaluating causes of fatigue affecting physical and mental health is a specialty of Miranda Marti, ND. For information about scheduling a free 15 minute consult or making an appointment, please contact us or call our front desk at 425-398-9355.

Why Am I So Tired: Hydration

From simple lifestyle habits to complex medical problems, why we feel tired can have many causes. In this series I’m tackling some of the lifestyle factors associated with fatigue that lend themselves to home-trouble shooting. This week’s topic is:


We know water is vital to life.

A small decrease in our hydration can lead to an outsized drop in our energy levels, including physical energy that leaves us feeling lethargic and tired, and mental energy that leaves us feeling scattered, unmotivated and unfocused.

But how much water do I need to drink?

And what if I don’t like to drink it?

How much water do I need to avoid feeling tired?

The short answer is: it’s hard to say. Seriously, there isn’t a precise scientific consensus on how much water a person needs to drink, as is discussed in an informative 2010 article in the journal of Nutrition Reviews: Water, Hydration and Health.

Generally speaking, though, here are hydration guidelines for adolescent and adult men and women:

  • Women: 80 – 90 ounces of water per day from fluid and food sources
  • Men: 110 – 120 ounces of water per day from fluid and food sources

You might noticed that drinking water isn’t the only source of hydration. If you are not a fan of plain water, please see the section below for alternative means of keeping yourself well hydrated!

Some practical recommendations of when to increase your hydration from water, caffeine-free and unsweetened beverages and fresh fruits and vegetables:

  • Hydrate when you are thirsty.
  • Hydrate when you are feeling mentally tired.  Signs of mental fatigue: brain fog, indecisiveness and low motivation
  • Hydrate if your urine is darker than pale yellow. If your pee is darker than the color of straw, that’s a sign of dehydration.
  • Hydrate when you’ve been sweating, particularly if it has been for 45 minutes or longer.

And remember: too much of anything, even plain water, can cause serious health problems. The risks for overhydration are greatest when people consume more than 30 ounces of water per hour, exceeding the rate that the kidneys can adequately filter excess water into urine. If you want to read more, here is an interesting and well-researched article on the dangers of overhydration.

What if I don’t like drinking plain water?

Hydration doesn’t come from drinking plain water alone. Plenty of foods, especially fresh fruits and vegetables, contain enough water to be great sources of hydration. Hydrating through food is bladder-healthy because it slows the rate of water absorption, minimizing the chance you’ll experience the urge to pee shortly after drinking. And hydrating through food is muscle-healthy because it combines the water with electrolytes, natural sugars and vitamins that help muscles recover after activity and workouts.

  • Foods that are 90-99% water
    • strawberries, watermelon, cantaloupe, lettuce, spinach, cucumber, zucchini, tomato, celery, cauliflower, radish, cabbage, pickles, peppers, squash (cooked)
  • Foods that are 80-89% water
    • apples, pears, apricots, blueberries, plums, grapes, oranges, pineapple, carrots, peas, broccoli, yogurt
  • Foods that are 70-79% water
    • bananas, avocados, baked potatoes & sweet potatoes, cooked corn, cottage cheese, ricotta cheese

Other hydrating alternatives to plain water:

use via Flickr Creative Commons commercial license

Pitcher by Simon Pearce

  • caffeine-free herbal teas
  • decaffeinated black and green teas
  • infused water with mint, cucumber, lemons, limes, berries or other cut fruit
  • mineral waters and seltzers such as Talking Rain, La Croix and Spindrift

Want to know more?

This is the first in a series of blog posts proving the Whole Life Medicine community with reliable information about important health topics. Check back with us for future posts or follow our Facebook page.

About the author: Evaluating causes of fatigue affecting physical and mental health is a specialty of Miranda Marti, ND. For information about scheduling a free 15 minute consult or making an appointment, please contact us or call our front desk at 425-398-9355.

Outsmarting the Weight Loss Paradoxes

It is no secret that weight loss is challenging for many people. Why?  The short answer is our brain and behaviors tend to form paradoxes in the face of most weight loss attempts. Paradox #1 concerns some of the intentional and habitual behaviors that affect short-term weight loss, while paradox #2 concerns behaviors, hormones, and mindsets that affect long-term weight loss or weight maintenance.

Paradox #1:

Set points for energy intake and output can be hard to change.

The physics of weight loss is dependent on a discrepancy between calories consumed and calories burned but it is nearly impossible to consciously control how many calories are consumed or burned in a given day. This is because the majority of our behaviors during the day are not driven by conscious intentions but by habit, and habit is geared to maintain homeostasis.

  1. We eat more than we realize when we are intentionally trying to limit our food intake. For example: plate portions can grow a little larger than usual, we “don’t count” the extra snack or bit of food we eat in passing between tasks.
  2. We reduce our energy expenditure in small ways when our energy intake goes down. For example: you might fidget less during the day or perform fewer household tasks or shorten the length of time you spend walking the dog; even while you may be consciously trying to increase your physical activity through intentional exercise like going to the gym or a yoga class. A 2012 study published in JAMA showed this effect in groups of adolescents following low-fat, low-glycemic or low-carb diets to achieve a 10-15% weight loss. Interestingly, in this study resting energy expenditure was most negatively affected by the low-fat diet.

Paradox #2:

In order to lose weight, one must have a healthy brain that maintains a balance between the limbic system, which houses the pleasure-reward pathway and is responsible for the generation of cravings in response to stress or need, and the prefrontal cortex, which houses our conscious decision-making, long-term planning and inhibition control (the ability to say no to something or ignore a craving). But the ability to maintain this balance is easily and quickly compromised by stress, including the stress of deprivation and starvation.

  1. The pleasure and reward circuitry of the brain. Image courtesy of the NIH.

    Most dieting attempts are inherently stressful to the body because they rely on reducing food intake to the point that the body’s stress response is activated. Even the best quality food will only provide blood sugar to keep your body fueled for about 3-4 hours, then other hormonal mechanisms take over to manage the delivery of blood sugar to tissues. Those other hormones include adrenaline and cortisol, both of which can compromise the brain’s ability to manage decision-making and the ability to keep denying oneself food or the comfort derived from food.

  2. Stress, particularly adrenaline stimulated by falling blood sugar levels and starvation, reduces the blood flow to the prefrontal cortex where conscious decision-making and inhibition control come from. This means that an unintended consequence of many weight loss attempts is that they actually leave us more vulnerable to food cravings by decreasing our inhibition control.
    • Different people will have different susceptibilities to this particularly mechanism. Genetics, the degree of stress a person is under, from both physical and emotional causes, and the diversity of an individual’s ability to manage their stress (e.g. those who use food as a primary coping mechanism will be more vulnerable than those who have experience and confidence using an array of stress coping mechanisms).

      Sugar is more than just sweet, it’s stress-relieving. Photo by Moyan Brenn.

  3. Sugar is not just a “treat” for many people. Sugar biochemically decreases the degree to which cortisol, one the stress hormones, affects this brain as was seen in a recent study published in the Journal of Clinical Endocrinology and Metabolism. This is a probable reason sugar and sweet things are used as a stress coping mechanism and why people crave sweets when they experience stress.  It can, quite literally, be a form of self-medication and stress management.
    • If an attempt at weight loss removes this coping mechanism, then not only may the individual attempting to lose weight experience more stress due to the nature of their weight loss strategy, but they will experience that stress more acutely and powerfully because one of the tools they had previously used to blunt the effect of stress on their brain is unavailable. And that in turn can set them up for sugar and food cravings.

So how do we outsmart the paradoxes?

Outsmarting Paradox #1

Awareness, planning and feedback

Awareness: Knowing that our habitual behaviors drives us towards homeostasis, keeping things just they way they are, it’s helpful to find ways to keep our decisions about food and what we eat in the sight of our conscious attention. Plenty of studies show that keeping track of what you eat with a food journal helps people lose weight and maintain weight loss more successfully than just winging it. This is because it enforces awareness about the choices you are making throughout the day and allows you to be accountable to yourself and others, if you are sharing this information with someone else who is supporting you in your weight loss efforts. And research suggests that using online food journals or apps is as effective as more traditional handwritten journals.

A trip to the library can do wonders for meal-planning inspiration. Photo by Lauren Friedman.

Planning: Knowing that our ability to make decisions supporting our long-term goals rather than our short-term cravings is compromised by hunger and deprivation, it’s beneficial to minimize the number of decisions you need to make about what to eat. This is where meal planning comes in. If you know what and when you are going to eat ahead of time, you will feel more secure exercising your inhibition control when a craving arises and have fewer opportunities for making spontaneous stress-driven decisions that are at odds with your weight loss goal.  For low-glycemic recipes and meal-planning ideas geared towards supporting brain health and decision-making visit my Pinterest boards.

A fitbit can track the number of steps taken throughout the day. Photo by Ian Dick.

Feedback: Knowing that we can subconsciously decrease our daily activity levels in response to decreased energy intake, it is helpful to have a way of measuring what our daily activity levels are on a regular basis. This way our efforts to increase our physical activity, such as going to the gym, are not in vain. One simple way to do this is to use a pedometer to keep track of your daily step count to make sure it is not subtly falling over time. It can also be helpful to log other types of small activities, such as gardening or housework, that might not be well captured by a pedometer.

Tips for the busy person: Programs that provide specific eating plans, or even provide specific meals and snacks, can be a reasonable strategy for out-smarting this paradox, at least in the short term. If you don’t feel as though you have the time and energy to create your own meal plans and do daily journaling, there are a number of programs that can do some of that work for you to get your started. These can be particularly helpful for people who feel overwhelmed by decision-making or do not feel they have a good instinctual sense of how to create and then follow a specific meal plan.

Outsmarting Paradox #2

Pushing the boundaries of pleasure, strengthening your stress response, and tackling trauma

Pushing the boundaries of pleasure:  people use food to reward themselves on a regular basis, whether it’s at certain times of day, like a 2 PM cookie to get you through an afternoon of work, or in response to certain events, like watching a favorite show on TV or celebrating a birthday. The pleasure-reward pathway in the brain is schedule- and event-driven, you can’t just take away rewards or alter your reward schedule and expect this part of the brain not to notice.  For long-term weight loss  the brain needs to be experienced in receiving pleasure from a variety of activities. We are reward-driven beings; it is part of our nature.  And developing a sense of reward from activities can take practice. That might sound odd, because it seems that rewarding behaviors are inherently rewarding. But the truth is the more we practice something, the better we like it. So if you are shifting your reliance on reward for food, you need to develop a schedule or program for building reward in other areas of your life.

  1. One big mistake people make when they substitute food rewards for other rewards during a weight loss program is that they withhold their new reward from themselves until they meet a particular weight loss goal. For example, someone might decide the will use an hour-long massage as a reward for losing 5 lbs.  This is a mistake because that’s not how the old reward system worked, instead it’s doubling down on depravation: you can’t have the thing you want (massage) until you finish denying yourself the other things you want (food rewards). The only thing this reinforces is that deprivation is hard and ultimately untenable. That’s not the lesson most people are meaning to teach themselves.

    Scheduling rewards is essential. Photo courtesy of Oliver Symens.

  2. The key to learning to experience more pleasure is to practice often. If you like massage, for example, practice receiving it on a regular schedule so that it supports your reward center on a regular basis and keeps you from feeling acute deprivation from your changing behaviors around your food rewards. That is how you teach your brain that there is an abundance of ways to be nourished and rewarded outside of food.

Strengthening your stress response: this similar to the concept of strengthening your reward pathways. In fact, many of the reward activities can become stress response activities. A stress response activity is something  you know will help you feel better in the face of stress.  You know it will because you have practiced it enough to know it provides pleasure under normal circumstances, and then practiced it more while under stress until it becomes a reflexive response to stress, something that your body craves to make you feel better.

  1. Walking for 5-10 minutes is enough to improve stress levels and reduce cravings. Image by Peter Blanchard.

    One of my favorite examples of this is exercise.  I make myself get up and take a 10 minute walk when I’m feeling a little stressed at least once a day, even if I don’t necessarily feel so stressed that I need to (or necessarily want to) take a break from work. Why? Because habitually walking when I experience a little trains my brain to make a connection between walking and stress relief. And the consequence of that is that later on, when something really stressful happens, my reflex response is to want to move to release the stress. How do I know this works? One, because my body has done this type of training before with chocolate and I successfully (and unintentionally) trained myself to want chocolate when I am stressed. And because I know intellectually that there are multitudes of ways that exercise improves mood and attenuates stress. If you are interested in knowing more about the ways that exercise benefits the brain, I cannot recommend the book Spark by John Ratey, MD highly enough.  Dr. Ratey is a psychiatrist whose practice and research focuses on how exercise supports mental health. Anytime I need motivation to move or exercise more, I can read a chapter and then next thing I know I absolutely cannot wait to exercise again. You can listen here to a free reading of the audiobook.

  2. Biofeedback is another powerful tool for redirecting how your nervous system responds to stress. Over a series of 4 – 8 visits you can learn to use your breathing and your posture to send calming signals to your brain, which can keep your long-term plans in sight even when events around you are stressful. Check out our biofeedback page for more information.

Tackling trauma: There is a complex relationship between trauma and weight gain, some of which is mediated the brain’s relationship to stress and food detailed above. One of the most important studies to shed light on this relationship is the ACES study. It’s received a lot of attention in the media for providing insight into the relationship between adverse childhood experiences, including common events such as the loss of a parent through death or divorce/separation, and health concerns later in life. The ACES study was started after clinicians running a weight loss program realized that an unexpectedly high number of participants started dropping out of the trial after successfully losing weight and wanted to find out why.  If you are interested in knowing more about the ACES study or seeing what your ACES score is, I recommend reading the ACES Too High News.

Miranda Marti is a naturopathic physician who specializes in the mind-body relationship and supporting long-term recovery from chemical and behavioral addictions, including complicated relationships with food and eating.  She is an advocate for body positivity and believes in health at every size.

The Hormonal Poetry of Sex and Love

Photo courtesy of the Orange County Archives.

The hormones most directly related to love, bonding, romance and sexual arousal can be remembered through the apt acronym POET: prolactin, oxytocin, estrogen and testosterone.

While both men and women respond to these hormones, they do so in different ways and with different results.  There is currently a great article on Medscape on the topic, Miriam E. Tucker. Hormonal ‘POETry’ Key to Valentine’s Day Romance. Medscape. Feb 13, 2014 (note: to access the full article a medscape log in is required, but an account is free to set up and open to anyone over the age of 18).

If you don’t have time for the log-in, however, here is a quick run-down of the role these hormones can play in men and women.


Prolactin “generally has no effect on libido in normally cycling women, but it can suppress sexual desire when levels are too high, such as in women who are breastfeeding, have prolactin-producing tumors, or are taking medications that affect dopamine pathways.”

Oxytocin, “the ‘cuddly hormone,’ induces uterine contractions and facilitates milk ejection after childbirth. Elevated levels appear during orgasm, but its role in female sexual desire isn’t as clear as it is with men.”

Estrogen “directly affects vaginal engorgement and lubrication, and it regulates female genital tissues’ “receptivity” to sexual activity.”

Testosterone ” also correlates with female sexual desire and satisfaction.”


Prolactin  “likely is responsible for the immediate decline in sexual desire and the onset of sleepiness following orgasm” and may be an indicator of satiety.

Oxytocin “recent studies suggest that oxytocin in men increases their empathy for and speed of response to facial expression cues; increases activity in brain areas associated with arousal, reward, memory, and social bonding ; and increases their willingness to share emotions.”

Testosterone, contrary to popular belief “high testosterone levels do not correlate with sexual function. However…small decreases in testosterone can affect sexual desire and satisfaction, as can visual cues and relationship issues.”

This blog post comes courtesy of Dr. Serena McKenzie.

Which Exercises Improve Major Depression?

Photo by USAG-Humphreys

News we’ve been waiting for years to hear is finally in! A study in the May Journal of Psychiatric Practice has pinpointed what type of exercises are best for improving symptoms of major depression.

Exercise is seen to improve the symptoms of depression, such as low mood and sleep and appetite changes, both as a solo therapy or as an augmentation to other treatments, like counseling, nutrients or medications.

Here is a summary of the findings on using exercise to alleviate depression:

  • Aerobic and resistance (e.g. weight training) exercises are both beneficial, though aerobic exercise was found to be MOST helpful for alleviating depressive symptoms
  • Aerobic intensity needs to reach 50% to 85% of the maximum heart rate, and in resistance training, patients need to do 80% of one repetition maximum, the maximum weight that can be lifted at a single time.
  • Three to five exercise sessions weekly for 10 weeks are needed.
  • Each session should be 45 to 60 minutes.

Keeping an exercise journal can be a great way to keep track of your progress and keep you motivated until you cross that 10 week (or 1350 – 3000 minute) threshold for improvement.

Bear in mind that these findings are specific to the diagnosis of major depression and may not apply to all types of low mood and depression. While this study is provides helpful guidance for type of exercises, and length and duration of use for alleviating symptoms of major depression, it should not be extrapolated that exercise is a panacea or silver bullet for treating all depressive symptoms; response to exercise as a treatment for depression may be variable. If you have depressive symptoms or low mood or a diagnosis of major depression, please talk with your doctor and/or mental health provider about how exercise might fit into your individualized treatment plan.

This blog post is courtesy of Dr. Miranda Marti. She has a strong interest in the mind-body connection and the organic (physical and biochemical) contributors to mental health and well-being.

Unmanageable periods? Could be endometriosis.

March is Endometriosis Awareness Month.

Common sites of endometriosis in the pelvis and abdomen.

Do you know someone whose life becomes unmanageable around the time of her period due to intense pain or strange symptoms, like allergic reactions, digestive problems or fatigue? The problem could be endometriosis.

Endometriosis is a painful condition that can cause digestive symptoms, abnormal menstruation and infertility. It occurs when the tissue that lines the uterus, the endometrium, starts growing elsewhere in the body. This most often occurs within the pelvis around the ovaries, but can happen anywhere – even the brain!

Pain that is suggestive of endometriosis includes pelvic and lower abdominal pain or low back pain that occurs:

  • during menses that does not feel better with the use of anti-inflammatories, like ibuprofen, or other types of conservative pain control, like heating pads
  • between periods but feels likes menstrual cramps
  • before, during or after sex
  • with bowel movements and urination, especially during menses

Other unusual symptoms of endometriosis are:

  • allergies, migraines or fatigue that are worse during menses
  • difficult bowel movements or alternating constipation and diarrhea that does not respond to standard IBS treatment or dietary changes
  • bloating, nausea and vomiting during menses

The pain and other symptoms associated with endometriosis have a reputation of being hard to diagnose and treat through conventional medicine alone. That’s why all of our physicians are trained to view the body holistically and treat not just the symptoms of endometriosis, but the underlying cause of hormonal imbalance and inflammation.

One of the major reasons endometriosis occurs is due to an imbalance of estrogen levels in the body. Many doctors address this imbalance primarily through the use of additional hormones, such as birth control pills, and pain management medications. This treats the symptoms of endometriosis, but it doesn’t treat the cause.

Estrogen Balance and Nutrition:

Broccoli and other members of the Brassica family of vegetables help promote healthy estrogen balance.

One important avenue for treating endometriosis is to focus on foods that support efficient hormone metabolism and avoiding non-organic vegetables. meats, dairy and other foods that may be a significant source of hormone exposure.

“It’s not just the hormones in the cows, but the pesticides on the fruits, vegetables and grains that can influence estrogen levels in endometriosis. You have to focus on the diet to treat the disease.” – Dr. Mary O’Connell, gynecologist

There are also a number of herbal protocols that can help the body balance estrogen and progesterone levels on its own to reduce symptoms and progression of endometriosis.

For pain management, our doctors provide guidance on how to develop an anti-inflammatory eating plan, how to effectively use supplemental anti-inflammatory oils and herbs for long-term pain management. Our clinic also has acupuncturists who are skilled in treating pelvic and low back pain.

If you know someone whose life becomes unmanageable around the time of their menses, share this blog post or have them schedule an appointment to evaluate their symptoms and assess their hormone balance.

This post is courtesy of Dr. Miranda Marti.

Picture of common sites of endometriosis courtesy of Tsaitgaist via the Creative Commons Attribution-Share Alike 3.0 Unported license.

Picture of broccoli courtesy of La Grande Farmers’ Market via Creative Commons Attribution 2.0Generic license.

January is Cervical Cancer Awareness Month

A Pap smear evaluates the cervix.
An annual exam evaluates the entire reproductive system.

Do you know when you’re due for your next annual exam?  Your next Pap smear?  Is your appointment already scheduled?

If you don’t know or aren’t sure:  call or email us today!

Phone: 425-398-9355

Email: you can use the contact form below or write to us at

When to screen for cervical cancer

Recommendations for how most women should be screened for cervical cancer have changed in the past year. For some women, this means getting a Pap screening every 2-5 years instead of every year.

But there are exceptions to every rule! Women who are at high risk for cervical cancer or have other health concerns may still require yearly screening. Contact your PCP or gynecologist to make sure you know which screening schedule you should follow.

Risk factors for cervical cancer include:

  • Early onset of sexual activity
  • Multiple sexual partners (2x risk with 2 partners, 3x risk with 6 or more partners)
  • Sex without condoms
  • Smoking
  • Personal history of  sexually transmitted infections: chlamydia, herpes, high-risk HPV
  • Low immune system function (e.g. HIV)
  • Family history of cervical cancer

Cervical cancer is the 3rd most commonly diagnosed cancer of the female reproductive system. The average age at time of diagnosis is 48. For detailed information about cervical cancer, check out this information from the National Cervical Cancer Coalition and Planned Parenthood.

 An annual exam covers much more than just a Pap screening!

Though Pap screening recommendations have changed, recommendations for annual exams and check-ups haven’t. Unless otherwise specified by your doctor, you should still have an annual screening with to evaluate other aspects of your reproductive health, such as the size of your uterus and ovaries, and to discuss other important preventative medicine topics related to hormones & reproductive health, like bone density.

This post is courtesy of Dr. Miranda Marti and Dr. Serena McKenzie from the offices of Balancing Health Integrative Medicine in Bothell, WA.

The Balancing Health Holiday Guide

Image by Mark Skrobola.

This post on navigating the holidays in health and happiness is courtesy of Dr. Miranda Marti and the rest of the staff at Balancing Health.

Between now and the New Year you’re likely to encounter many demands on your time and attention. With that in mind, here is a selection of local services you may find worthwhile to help you maintain a healthy balance between the joys and challenges of the holiday season.

Entertaining yourself, your kids or your guests

Fresh Picked Seattle is a fantastic day-by-day calendar of food and nature-related activities going on throughout the Seattle area. Best of all? Many of them are FREE!

We find Fresh-Picked Seattle to be an essential resource for finding fun, natural and affordable activities throughout the year, but particularly so during holidays when we have out-of-town guests or out-of-school kids to entertain.

From cooking classes for toddlers to jewelry making for teens to beer, wine, whisky and chocolate tasting for adults, Fresh-Picked Seattle has an option to keep everyone entertained and in good spirits.

Finding living trees, local and sustainably made gifts

Living tree image courtesy of Our Living Forest

Woodinville’s own Molbak’s Garden & Home is our favorite place to find living trees for seasonal indoor and outdoor decor. They also feature many local, sustainably made gifts, including hummingbird feeders, bamboo kitchenware, gardening gloves and ornaments.

One of our favorite living gift ideas are Molbak’s beautiful herbal topiaries that will keep in your kitchen during the holidays and can later be planted in your garden for year-round enjoyment.

Also check out the Chick N Coop Crafts Holiday Bazar and many other holiday events at Country Village, a collection of over 40 locally owned small businesses in Bothell.

Keeping your inner peace during the holidays

Do you have acupuncture or massage benefits that are due to expire at the end of the year? Now is the time to schedule in some self-care with acupuncturists Janna Rome and Miranda Marti. Acupuncture can do wonders for promoting relaxation, improving sleep and focusing energy.

Avoiding holiday weight gain

It’s not just the holidays themselves that tempt us with more alcohol and snacks, not to mention leftovers – it’s the entire holiday season from now until New Year’s. And for some of us, that can lead to an average 1-5 pounds permanent weight gain, according to the New England Journal of Medicine.

Join us on Tuesday, November 27th at 7 pm at the Balancing Health office for Dr. Mona’s Guide to Avoiding Holiday Weight Gain. Dr. Mona Fahoum provides advice and practical tips on how to avoid unintentional weight gain this holiday season while still enjoying a delicious holiday season. This event is free and open to the public. Please RSVP at 425-398-9355 or via email at

Finding a new balance point in the New Year

Yoga image courtesy of Tom Mooring.

Looking to find a new balance point in your life?  Need a positive antidote to the onslaught of body-shaming gym promotions that capitalize on the traditional New Year’s resolution to lose weight?

Come January, consider joining Insideout Yoga’s Realize Your Radiance Group for Women as an avenue for regaining or reinforcing a healthy mind-body balance after the holidays. Instructor Kim Trimmer offers yoga and meditation classes and workshops for individuals at any experience level in a body-positive environment.

Or if you’re looking to kick your yoga practice into high gear, consider signing up Balance Yoga Studio’s 30-Day Challenge: 30 classes in 30 days, starting January 2nd.