Katie Pickworth, ND, MS

01/11/2021

Check out this blog post I wrote on moving away from the BMI and weight as indicators of health! :)

Facebook Twitter Google+ Pinterest We’re finally on the other side of 2020! And with the new year comes the same old-school messaging: “Isn’t time for you to set a new year’s resolution, and shouldn’t you start the new year by trying to lose weight?” This is the time of year when we’re...

10/30/2020

It’s no secret that stress and anxiety go hand in hand. Anxiety often becomes more problematic or pathological when it disrupts daily activities or doesn’t feel appropriate given our stress level. For example, we might experience anxiety in our day-to-day life even if we aren’t that stressed, or our anxiety response to a normal, minimal stressor could be super-duper high when it doesn’t need to be. 😖🤬😱

This boils down to dysregulation of our hypothalamus-pituitary-adrenal (HPA) axis, which is responsible for our stress response that gets us into fight or flight mode. The critical hormone/regulator of this is cortisol, which can easily become imbalanced or overactive when we experience prolonged stress. Studies have shown that repeated, prolonged, or very severe stress can cause over-activation of this axis and contribute to anxiety. The details of this relationship have yet to be determined by the research, but I know that I have seen many patients with clear HPA axis dysfunction that impacts their mood, including anxiety. This also often impacts sleep patterns, especially when someone is up ruminating late at night or is waking in the middle of the night unable to go back to sleep. I suspect that traumatic experiences and trauma-triggers play a key role here, but I haven’t seen the clinical trial just yet!

HPA axis dysfunction is a state of being that responds to more natural and lifestyle intervention than pharmaceuticals; in fact, there aren’t a ton of conventional options to get our HPA axis back in harmony. Good news is that your friendly neighborhood naturopathic physician has a lot of tools for supporting this system and improving your stress response AND anxiety. ✨🌿🥰

PMID: 19716990
📸: Portland, Oregon October 2020

10/23/2020

Anxiety is a state of mental and physical discomfort that has many possible underlying causes. One of the most-talked-about but perhaps least understood aspects of anxiety is the role that neurotransmitters play in our experience of it. I think of them as one critical way we understand the mind-body connection; these little friends mediate much of our internal experience!

Neurotransmitters are the proteins responsible for sending messages between cells in our brain. Dysregulation or dysfunction of the neurotransmitters responsible for mood and emotions is one cause of anxious mood. This happens one of two ways: there is too much of a stimulating neurotransmitter or too little of a calming neurotransmitter. Most research has found that the neurotransmitter GABA, which is our brains’ go-to for calming down, becomes dysfunctional. This can happen either because the receptors in the brain have become less common or because there isn’t enough GABA to go around.

Serotonin, which plays a larger role in depression because it’s the “feel good” or “happy” neurotransmitter, also has some evidence of dysfunction in some people with anxiety; this is more likely to be the case when someone has a mix of depression and anxiety.

Medications and natural supplements, including some herbs, often act on these two neurotransmitters or their receptors, increasing their ability to bind in the brain and have the desired positive, calming impact. There are even some fancy ways to test the activity and availability of your own neurotransmitters (though those tests are sometimes without great scientific evidence to back them). Regardless, this is a very common place to start when it comes to medical treatment options for anxiety - but it’s rarely the whole picture.

Neurotransmitter function is important for brain health, of course! Where things get really interesting is when we dig into the relationship between these fun molecules and their protein brethren, our hormones (especially stress hormones). More about the relationship between neurotransmitters and hormones coming next! ✨🤗

PMID: 19716990
📸: Arch Cape, Oregon October 2020

10/21/2020

When I start working with a patient who reports anxiety, I always try to identify the root cause of their distress or dysfunction - this is one of the cornerstones of naturopathic medical thinking and decision-making. 🤓

From my standpoint, anxiety is rarely a result of just one thing, nor is it likely the result of brain regions gone awry or just “chemical imbalance.” The reality is that I often find that individuals with anxiety have endured difficult life events or trauma; anxiety rarely presents without some kind of emotional or physical disturbance in someone’s childhood or youth. More on that later!

There are several areas of the brain that have been linked to anxiety, and one scientific perspective on anxiety is that it results from an imbalance in the activity of different brain centers that control mood, emotions, and executive function (like how we think, plan, and choose to act). 🤔🤪🤗

One critical brain structure here is the amygdala, which is responsible for our fear response. If the amgydala gets input from regions of the brain responsible for mood and executive functioning, it can cause increases in heart rte and blood pressure, feelings of hyper-vigilance, more of a startle response, and triggering of our stress hormones. All of this is intended to help us fight or flee a threat, but the amygdala can fire even when there isn’t a “real” threat - just a perceived one. 😫😖😰

People with anxiety are more likely to have larger amygdalas, likely due to the amygdala being “used” so much over time that it grows to meet demand. People with anxiety also have more brain activity in their prefrontal cortex, which is responsible for sending signals to the amygdala.

The circuitry of the brain goes on overdrive when we have anxiety, especially chronic anxiety. This is one of the reasons to treat anxiety sooner rather than later to improve long-term mental health! ☺️✨🧠

📚PMID: 19716990
📸: Brookings, Oregon August 2020

10/19/2020

It’s no secret (and no joke) that this year has been incredibly tough on the mental health of many people. One report from the CDC presented substance use/abuse statistics and mental health statistics for United States adults at the end of June; the report indicates that 40% of adults are struggling with mental health or substance use concerns with 31% of adults experiencing anxiety or depression symptoms. That is no small number and definitely something to be alarmed about.

It seems like the topic of anxiety is coming up more and more with my patients as the year goes on (especially with some critical impending political events), so I want to take the next month to highlight the naturopathic approach to anxiety, demystifying and destigmatizing the experience of anxiety along the way. That means I’m going to briefly explain how we understand anxiety physiologically and then follow it up with brief descriptions of evidence-based ways that we can manage anxiety with conventional options, natural options, and lifestyle options.

It’s a really big topic and one that I imagine I’ll return to again on social media, so I can’t claim that this will be the end-all, be-all, of anxiety management. BUT, I do have a lot of experience in how to get people through anxious moments and how to reduce and prevent anxiety from happening in the first place.

I love working with patients to identify the root cause of their anxiety (physiologically or psychologically), so the first thing I want to address in this series is the physiology of anxious moods. Stay tuned for that information this week! 🤓✨🧠

What do you want to know about anxiety? Have you ever successfully managed anxiety yourself at home? Let me know below.

Reference - DOI: http://dx.doi.org/10.15585/mmwr.mm6932a1

10/16/2020

Very compelling essay by Marquisele Mercedes, a current PhD candidate at Brown, about the problematic nature of certain voices within the anti-diet space.

HAES, fat positive, weight neutral, and intuitive eating work is inherently intersectional and should always acknowledge its roots in the marginalization and limitation of BIPOC voices.

These white female dietitians have helped steal and monetize the body positive movement. And I’m sick of it.

10/13/2020

October 10th was World Mental Health Day!

Fostering an internal sense of mental wellness is an admirable goal and something that several of our providers love to participate in. Mental health is more important now than ever - and it's about a lot more than how quarantine and isolation impacts us.

A new study published in JAMA Network Open highlighted that having a psychiatric illness increased some patients' risk of mortality from COVID-19. The study looked at a sample of COVID patients hospitalized in the Yale University hospital system between February and April 2020, and results showed that patients with a psychiatric illness had increased risk of mortality compared to those without a psychiatric diagnosis. The authors of the study didn't look at which types of conditions presented the most risk, how long the patients had that diagnosis, or why people with psychiatric illnesses might increase risk.

What do we do with this information? A few thoughts:

1. Don't freak out! Science is imperfect and doesn't look at each individual but rather looks at trends in big samples.
2. Acknowledge to yourself, family/friends, and your doctor if you feel like you have an undiagnosed or uncontrolled mental illness. We're here to support you.
3. Prevention is the best medicine! Continue to follow state guidelines about mask wearing to prevent the spread of COVID-19.

If you need more support around your mental health this month or any month, schedule an appointment with one of our specialists at NWIM! We can work together toward mental wellness even in this trying time.

With hope and love,

Dr. Katie
Katie Pickworth, ND, MS

10/13/2020

This post coming to you all the way from my second year of residency, which started last week at Northwest Integrative Medicine in Tualatin, OR.

My first year of residency was all about self-development in the end: learning how to process change, accepting the things I can’t control, and sitting with my own goals and resilience. I paused my Instagram and Facebook content to make this inner work happen. I also experienced many moments of self-doubt and worry that I didn’t have much of value to add to the digital conversation. I’ve accepted that the Internet is a vast place that can trick you into thinking you’re less important than you are (and vice versa).

There’s so much that I’m always learning in my journey towards being the best doctor I can be. If I can spread the love, knowledge, growth, positive psychology, etc - that’s enough for me.

Looking forward to chatting about my favorite things on this platform: mental health, musculoskeletal health, hormone health. HAES, weight neutral, and body positive care. Social justice for BIPOC and LGBTQ+ patients, colleagues, and community members. Integrative approaches that see the whole person from head to toe, from cell to spirit. And whatever other magic comes up the pipeline. ✨🌱

📸: Crater Lake, Oregon, August 2020