Nutritional Therapy

Stay balanced in late winter with Self Massage: Abhyanga Step by Step

At a time of year when the weather tends to keep us indoors, it’s not uncommon to feel isolated and lonely.

winterIn the darkness of Winter, many people come in requesting massage just for the sake of being touched. Examining this a little more closely, we know that touch can help to soothe anxieties, relieve stress, and of course, help with pain and tension that the body holds.

Touch is fundamental to being human.

There are a multitude of studies that show that regularly receiving touch decreases violence, increases trust, promotes stronger immunity, and helps with overall wellbeing. How does this work?

High Resolution -98Massage, and touch in general, has been shown to increase production of oxytocin and serotonin, two of four neurotransmitters that are responsible for our happiness. Serotonin flows when you feel significant or important. Oxytocin creates feelings of trust, intimacy and builds healthy relationships and is essential for creating strong bonds and improved social interactions. Oxytocin, known as the cuddle hormone, can be released with something as simple as a hug.

While it’s not quite the same as receiving touch from another person, some of these same positive benefits can also be experienced through self massage.

Abhyanga (pronounced AhbYAWNga) is a form of self-massage that is derived from Ayurveda, the Indian system of medicine. Ayurveda has always included self massage as part of its daily regimen for promoting good health.

Performed daily, it can have the positive benefits of nourishing the entire body, lubricating the joints, increasing circulation and lymph flow, and promoting better sleep. It also gives you a chance to check in with your body and can soften, smooth and brighten your skin.

Traditionally, unrefined sesame oil is used to help warm the body. In the summer, an unrefined coconut oil can be used to help with excess heat in the body as it has a more cooling effect.

Self-Massage: Abhyanga Step by Step

oilinglassWarm approximately 1/4 cup of oil using a glass jar in a vessel of warm water or a mug warmer.

Make sure the room is warm and comfortable.

Starting with your feet, take some time to rub the sesame oil into the soles of your feet.

Work your way up your legs with long strokes toward your heart, taking time around the joints with circular strokes (knees, hips, elbows).

Massage the abdomen and chest in broad, clockwise circular strokes.

On the belly, follow the path of the large intestine, moving up the right side of the stomach, across under your ribs, and down the left side in circular motions.

Finish the massage spending time on your face ears and scalp.

Let the oil sit on your skin for 5-15 minutes. This is a great time to throw on some old pajamas and cultivate your meditation practice.

Enjoy a warm bath or shower. Avoid using soap on the skin except for the more strategic areas to allow the oils to continue to nourish your skin. Try to avoid vigorously soaping and rubbing your body.

Towel dry gently, blotting away the moisture instead of rubbing your body dry.

lavenderThe use of essential oils such as lavender or vanilla has been linked with the release of endorphins, which act to alleviate anxiety and depression.

Feel free to put a drop or two into your oil to enjoy the therapeutic benefits of these essential oils during your self-massage. Please take care getting in and out of the shower or bath with oil on your feet. You may want to use a warm washcloth to wipe your feet before bathing.

“The body of one who uses oil massage regularly does not become affected much even if subjected to accidental injuries, or strenuous work. By using oil massage daily, a person is endowed with pleasant touch, trimmed body parts and becomes strong, charming and least affected by old age”

Charaka Samhita Vol. 1, V: 88-89
(One of the Great ancient texts of Ayurveda)





A Holistic Approach to Shaking the Winter Blues

Here’s another installment in our Healthbooks series discussing the late winter energy and how it affects many of us. You can read the inaugural article here, dig into nutritional approaches to late winter health, hear more perspectives on SAD and learn about how movement – especially Qigong – might help during this sometimes challenging time. For now, enjoy the new article.

CrocusI’m in love with springtime in Portland.

Already the Daphne buds are beginning to open and purple crocuses are popping up out of the wet earth. The sweet smells and the long succession of flowers emerging fills me with relief and joy. It always seems like a miracle, this annual return of beauty, after a season of bare branches, dormant gardens, and cold, damp weather!

But this time of year in Portland is confusing too!

As soon as I see and smell these early flowers I think, Spring is here! The ordeal of Winter is over! And then it continues to be grey, wet, and cold for much of the next several months. This late-winter limbo can be hard to endure.

Do you notice that you experience a significant mood change during the winter months? During an extended period of reduced natural sunlight, some people suffer from Seasonal Affective Disorder or, SAD. It is a type of depression that comes on in the winter months and lifts in the spring or summer. Mental/emotional symptoms may include sadness, anxiety, hopelessness or pessimism, feelings of guilt and worthlessness, helplessness, irritability and restlessness, and/or a loss of interest in pleasurable activities you used to enjoy. One may also experience difficulty concentrating, remembering details or making decisions and even have thoughts of death or suicide. Physical symptoms may include fatigue and decreased energy, difficulty sleeping or oversleeping, changes in appetite and changes in weight.

Clearly, with symptoms like these that have such a huge impact on a person’s quality of life and well-being, it’s important to treat SAD.

There’s a lot you can do to shake off the winter blues!

naturewalkFirst of all, take yourself by the hand and get outside to take a walk through the neighborhood or in nature, or putter in a garden. Make sure that there is movement in your life (preferably something you love to do!).

Seek more sunlight, set up a light box, and take your vitamin D. Do your best to eat and sleep well, and to reach out to others. Consider massage or acupuncture. Talk to a doctor to rule out other causes of your symptoms and to customize a treatment for you. Get to know a new herb or two.

Here, I’ll outline how I work with patients to assess cases and give an idea of what a treatment plan might include.

First, I take the time to really get to know each patient. Of course, I‘ll ask about a person’s present symptoms, their medical history and family history and what medications and supplements they are taking or have taken in the past. I’ll also want to know about a person’s diet, physical activity, sleep, relationships, life-stressors, use of alcohol or recreational drugs and the ways they practice self-care.

I’ll usually order lab tests. When a person suffers with symptoms of depression, it’s wise to rule out physiologic causes like anemia, hypothyroid, blood sugar imbalances, or vitamin D or B vitamin deficiencies. In some cases I will also rule out other hormonal imbalances. All of this information helps me to evaluate and reach an accurate diagnosis and then tailor a treatment to a specific patient. 

A comprehensive treatment plan to treat SAD would begin with dietary recommendations to optimize nutrition and keep blood sugar balanced, along with a customized exercise plan. I would also address sleep problems and provide counseling pertaining to self-care and stress reduction.

I would prescribe dietary supplements that have been proven to be supportive, including a methylated B complex, vitamin D3, omega 3 fatty acids, and probiotics. I would also do acupuncture.

Acupuncture has also been shown to be very effective in treating depression.

Results have proven as effective as Prozac and appeared weeks earlier, without the side effects of the medication.

I would discuss light therapy. Research has shown light therapy can also perform as well as Prozac for SAD. I educate patients on what kind of light box they should get, as well as advise them on the positioning of the light and timing of treatments. Also, I would offer referral to counselors or psychiatrists as needed.

Herbal medicine is one of my favorite treatments. I love to create herbal formulas customized to each patient. I have found that herbs alone can keep some people from dipping into seasonal depression, and treat SAD and depression in cases that are mild.  There are two herbs that deserve special mention in treating SAD: St. John’s Wort and Lemon Balm.

The Latin name for St. John’s Wort is Hypericum perforatum. Hypericum comes from the Greek word hyperikon which combines the two words, hyper, meaning ‘over’ and eikon, meaning ‘image or apparition’, a reference to the belief that the herb could ward off evil spirits. Interesting, isn’t it, that today it’s used to ward off our inner demons of depression and dispel the darkness of seasonal affective disorder?

St. John’s Wort has a sunny yellow flower whose common name refers to the fact that it historically blooms on or near St. John’s Day, or Summer Solstice, also known as Midsummer. It blooms at the time of year when the sun is highest and the days are longest, and it seems that it also imparts the sun’s qualities of brightness and energy to us when we ingest it as well. St. John’s Wort has been studied extensively for the treatment of depression and anxiety, and for treating SAD.

St._John's_Wort_(5976542341)It has been found to be a safe and very effective treatment for these conditions.

It has been found to positively affect the neuroendocrine system in multiple ways, increasing serotonin, norepinephrine and dopamine, as well as influencing levels of glutamate and GABA. For an adult, the recommended dose of St. John’s wort is 300mg, three times per day. As a tincture, 20-30 drops, three times per day, is recommended.

Because St. John’s wort is so effective at increasing serotonin levels in the brain, it is not a safe treatment for people who are already on SSRI (selective serotonin re-uptake inhibiting) antidepressant medications, as together they could increase a person’s serotonin to a dangerous level. This is an herb where care should be taken if a patient is on ANY prescription medication.

St. John’s wort ‘up-regulates’ a couple of liver detoxification pathways, meaning it could cause the body to break down medications too quickly and reduce their effectiveness, including reducing the effectiveness of oral contraceptives. Take extra care with sun exposure while taking St. John’s wort, as it can increase sun sensitivity and sunburn.

St. John’s wort also has anti-inflammatory, antiviral and antibacterial effects. Research has also shown it to be helpful in treating symptoms of PMS, menopause, OCD and social phobia. It also can be used topically to help eczema and minor irritations and injuries to the skin.

Melissa_officinalis_Lemon_balmThe other herb that I love to use to treat SAD is lemon balm, Melissa officinalis. The Latin Melissa means ‘bee’, and indeed, bees are delighted by the unassuming but sweet-smelling Melissa flowers when they bloom. Part of the Laminacea, or mint family, lemon balm gets its common name because of it’s lemony scent and flavor. It’s leaves are full of fragrant essential oils, which rub off on your fingers and make lemon balm tea delicious. Ancient nicknames for lemon balm are ‘heart’s delight’ and ‘the gladdening herb’.

 An old Arabian proverb says that “balm makes the heart merry and joyful”.

It is an herb that is both uplifting and soothing to the spirits, and it was traditionally used to treat ‘melancholy’. Lemon balm is gentle and safe enough for babies and children, as well as adults. Used in combination with other herbs, it’s helpful in treating anxiety and insomnia due to nervousness.

Lemon balm can boast many other health benefits, such as it’s soothing effect on digestion, and it’s antiviral abilities. One caution with taking lemon balm is that it can have a thyroid-suppressing effect if taken in very large amounts. In fact it is used in some cases where the thyroid gland is overactive.

Tea-TimeAs I mentioned before, lemon balm makes a lovely tea. The ritual of preparing a pot of tea for oneself and stopping to sit and sip a fragrant, steaming cup adds to the healing. Pinch or snip off the tops of the fresh plant and add a large handful to a teapot or mason jar, fill with boiled water, and allow to steep, covered for at least 20 minutes. If using dried loose leaf lemon balm tea, add one tablespoon of herb per cup of hot water. Traditional Medicinals also makes an organic lemon balm tea in teabags that I recommend. Drink a cup 2-3 times a day.

St. John’s wort, however, is best taken as a tincture, which is an alcohol and water extraction, or encapsulated.

Whenever you take herbal medicine it’s critical to be aware of the source and quality of the herbs. Unfortunately, the supplement industry is so poorly regulated that herbal products often contain ineffective or dangerous ingredients, and often do not actually include the herb that is listed on the label. I usually recommend Herb Pharm as a source of good quality herbal medicine. With it’s bright orange labels, it’s easy to find in health food stores. I personally know the owner, and trust the expertise and integrity of this company completely. Vitanica, Oregon’s Wild Harvest, Gaia, Mountain Rose and Urban Moonshine are other excellent sources of herbs.

If you find yourself inspired to, you can also learn to make your own medicines. Both St. John’s wort and lemon balm grow happily and like weeds in the Pacific Northwest. You’re likely to spot lemon balm growing along the sidewalk as you walk through Portland’s older neighborhoods. You’re more likely to find St. John’s wort in an abandoned lot or field. They’re both distinctive enough to easily identify once you know their distinguishing features. They’re both abundant and easy to harvest for making into medicines for yourself.

Wishing you well. Hang in there. The days are getting longer, and the flowers are starting to open. This too shall pass.



What You Can Do To Combat Seasonal Affective Disorder

Many of us know the feeling of sadness that can descend when it is dark and grey outside. I grew up in a very sunny place and first experienced this feeling during my second winter in Portland. It was definitely a challenge at first to figure out the best way to deal with the lack of sunlight for so long, but I was told it was possible. I also fully understood what people meant when they talked about Seasonal Affective Disorder, or SAD. It certainly makes one sad, or worse.


If you are like me, you might find yourself wanting to stay home in the evenings, or even on weekends, out of the wind and rain. This is not an unreasonable thing to want to do. Not many of us really enjoy being cold and damp! However, it can serve to isolate during a time when one might already feel sad or isolated.

The fact that there is less sunlight is also a challenge. Our bodies thrive on sunlight. In the PNW, it isn’t just the lack of sunlight that can cause problems, but the angle of the sunlight. The angle is simply not allowing us to get the same benefit from what little sun we do get to see as we would in the summer.

Why does the lack of sunlight affect many of us this way?

Our biological clock and brain chemicals, or neurotransmitters, are very sensitive to sunlight, or the lack thereof. When there is less light, our circadian rhythms can shift causing our internal clock to get out of balance. This can lead to feelings of depression. Also melatonin production is thrown off due to the decrease in light. Our daily schedules have us getting up in the dark and going to bed in the dark. When our melatonin is not being produced properly, it can disrupt our sleeping patterns, making us sleepy or awake at inappropriate times. Additionally, serotonin, a neurotransmitter that lifts our mood, can drop during the winter due to a lack of sunlight.


SAD1As you can see, the sun is central to how we feel psychologically. It also can affect how we feel physically, which affects our moods, creating quite a circle of events.

Fear not, however

There are things that you can do during the winter to help reduce the symptoms of SAD. Future articles will spend more time on nutritional, naturopathic, physical, and chinese medicine solutions to the complex of disorders that can emerge during this time of year. I would like to focus on ways that you can support your mood mentally, spiritually, and socially.

One, very simple, option to support your health during this time is to invest in a light box. A light box simulates sunlight and can go a long way toward maintaining all of the brain functions that are affected by sunlight. It is easy to use and makes a big difference in the depression many of us feel during this time.

Another way for many of us to improve our moods is to be around other people. For extroverts, this will feel pretty obvious, but even introverts can benefit from social interaction with one or two close friends. Many of us prefer to stay home out of the cold and wet. If you have a strong support system of people who are going to stay home with you, this is a perfect time to consider doing fun indoor activities together.

Putting together a puzzle, playing games, cooking healthy and warming meals, or even talking to one another can be very supportive. These things will keep your mind engaged. The connections with others doing things you enjoy boosts your neurotransmitters, like serotonin, dopamine, and oxytocin, and improves your mood. If you live alone, or with people you don’t do fun things with, consider setting up meetings between friends to do fun things together. Again, this can be a big group or a small one, depending on your preferences.

Meditation is also a great way to support our brains during the dark time of the year.

Even if you do not have a formal meditation style, simply sitting quietly and taking deep breaths in the morning and evening can help to center your body and mind. Praying or using gratitude lists can also help us focus on positive things and let our brains take a break from feeling icky.

Mature woman relaxing with eyes closedIf you already see a counselor or therapist, this time of year is the perfect time to be proactive and make sure you are going regularly to talk. Adding an additional appointment or two to your normal schedule might be helpful. If you do not have someone professional to talk to, it is worth considering.

Talking to a therapist does not mean you are “crazy.” In fact, talking to a professional who can listen and offer helpful suggestions is a great way to handle the challenges we all face in life. When it comes to SAD, a counselor can help you come up with strategies to work through or cope healthily with depressive feelings.

If this is your first experience dealing with SAD, it might be scary and feel beyond your control. Making small changes and being kind to yourself will help you through this first winter. If you have dealt with SAD for years, remember that putting support into place in the summer and early fall is incredibly helpful. It might not in the forefront of your mind when you are floating on the river in the sunlight, but it can make a huge difference when the darkness comes.

Always remember that it is important to reach out to professionals for help when things seem overwhelming. The sunlight will return. I promise.


The Watershed Healthbooks project and working with the dregs of Winter

watershed wellness acupuncture winterI feel privileged to introduce you to a new initiative from Watershed Wellness. It’s something we’ve been planning for a long time, and now finally have the personnel and energy to get it going.

We are going to be creating something we call Watershed Healthbooks. These are team created, multi-disciplinary sources of information on health related topics that are highly relevant to you. We will be organizing ourselves around a particular seasonally appropriate theme, and sharing with you information on that theme from different perspectives available within the Watershed community of practitioners.

This will result in a rich, grounded and immediately useful nexus of background info, reflections, and action steps that you can use as you go about living your most vital life.

Logistically, we will be releasing a portion of each Healthbook about once per week in the form of a blog post. You can be notified of each post either through RSS, by watching our FacebookTwitter, and Instagram, or by subscribing to our newsletter. Since our newsletter only comes out once a month, if you want to be notified of each individual post, you’ll want to try one of the other methods.

We will take all of these individual blog posts and collect them together for you. That forms the guts of the Healthbook. But we’ll add even more engaging content, plus beautiful imagery and design, and generally make them the kind of thing you will want to look at over and over again.

We’ll offer these completed books in a digital format for free to our patients and newsletter subscribers when they are finished.

You can keep them on your computer or mobile device and begin to create a library of health information from the practitioners you know and love. Eventually, if there is enough interest, we may even print these as small booklets that you can keep around, give to friends and family, or whatever else you like.

We’ll be creating approximately 4-5 of these per year, and depending on the topic and our abilities, we may be adding multi media content like audio and video, and sometimes even creating live classes to support your exploration of the information within.

Our hope is that these Healthbooks will help you sink more fully into your wellness journey.

Seeing practitioners is wonderful, of course, and often the quickest way to healing. Still, that process can be significantly enhanced by information and tools for reflection and action that are hard to acquire in other ways. Eventually, we hope you’ll come to see the Watershed website and our clinic as a place where you can not just receive top quality healthcare, but also as a learning center that helps you come into greater balance. With a combination like that – how can you go wrong?

So – what’s our first topic?

For the next 8 weeks, we are going to be working with a problem that many people encounter – particularly those of us in the Northwestern US. Once the holiday season and optimism of the New Year’s celebration recedes, the reality of another couple of months (at least) of sometimes brutal and depressing winter weather begins to set in.

Even for a person like me, who loves our extended cold rainy season, I can begin to lose hope that days of picnics on the lawn and easy strolls without bundling up will ever come.

There are multiple factors at work here – of course! There are physiological realities, social aspects, problems related to the holidays, the lack of movement, and even end of year (and beginning of tax season) financial difficulties that can all contribute. For the most part, we are a heat seeking and sun loving species, with many cultural idiosyncrasies that interrupt an easy descent into the cold and dark.

If you struggle at times in the later winter months – know that you’re not alone.

Even more importantly – there are answers for the questions that vex you. Actually, even for those of us who have a generally easier time in the winter, it can be nice to learn ways to maximally adapt to the season. To take advantage of its positive qualities, to use the energy to help us to be healthier in every respect – these things are desirable and possible.

In the next several blog posts, you’ll become oriented around ways of looking at this special time from Chinese medicine, psycho-spiritual, movement, nutritional, bodywork and other perspectives. You’ll receive inspiration and information, sure, but also concrete action steps, resources for additional engagement, and encouragement to build a plan to help you work with the deep winter in a way that uplifts you.

We look forward to sharing and interacting – stay tuned!

The myth of the Body Mass Index (BMI)

doodle_magnifying_glassAlmost everyone has heard of the Body Mass Index (BMI). It is one of the common metrics doctors use when judging how healthy we are. Schools calculate it to identify children who are “obese.” You can find it commonly discussed in all kinds of media.

But, what exactly is the BMI and what does it mean to our health?

The BMI is a calculation of height and weight in relation to each other. The calculation is: weight / height². If using metrics (kilogram / meter²) it’s as simple as that. If you’re using English or Imperial measurements (pound / inches²) then you multiply your total by 703.

The range of values is categorized according to particular standards, and labels are given to the resulting categories.

Current guidelines are:

  • Underweight <18
  • Normal weight 18-25
  • Overweight 26-29
  • Obese 30+

First calculated by Adolphe Quetelet in 1830, a Belgian mathematician, to try to describe the “average man”, it was meant to be used as a statistical device, not as an individual health indicator.The main thing the BMI does not show is how healthy or unhealthy that person may be. For example, Tom Cruise has a BMI of about 26, in the overweight category, and Sylvester Stallone is considered obese with a BMI of 37. These two stars spend a lot of time and money to stay in shape and healthy – so we need to go beyond BMI to understand health, at least in these cases.

Weight is a combination of fat, bone, muscle, other tissues, and water.

The exact amounts of each are different from person to person and people of very different body compositions may have the same BMI. In other words, three different people may have the same BMI, but they may have different amounts of fat or muscle or be different heights or weights.

According to Linda Bacon in Body Respect, when she investigated why the United States lowered the BMI standards in 1998, in the absence of supporting research, she discovered:

“…that they got a lot of pressure to conform to international standards…the [World Health Organization] relied on the International Obesity Task Force (IOTF) to make the [BMI] recommendations. At the time, the two biggest funders of the IOTF were pharmaceutical companies that had only weight-loss drugs on the market.”

In the research, BMIs in the extreme ranges, very low or very high, are correlated with poorer health outcomes. Clear enough, right? Maybe not! Further analysis shows us that this simple correlation does not mean high BMIs themselves are the cause of poor health outcomes.  Fitness, for instance, is a huge indicator of positive health outcomes, regardless of BMI.

The fact that we continue to use BMI to gauge individual health is a travesty. Health outcomes would improve significantly if BMI was completely thrown out and a weight-neutral emphasis on healthy habits was employed by health professionals. This is one of the reasons I practice Health at Every Size®. In my practice, I’ve learned that focusing on healthy habits has a much greater chance of creating states of wellness than intense focus on weight loss.

What is Health at Every Size?

IMG_7756My biggest passion in medicine is definitely being an advocate for Health at Every Size® (HAES®), and generally looking at
health in a weight neutral way. I am so passionate about it this because I have observed that using weight loss as a goal actually creates a lower state of health and, ironically, more weight gain!

The reality is that using weight loss as the only goal enters people into an unhealthy cycle of weight loss and weight regain. This cycle can lead to poorer health in general, which, in turn, is blamed on the fatness, lack of willpower, or laziness.

I often hear:

“The idea of Health at Every Size® is great! Except if someone is very fat or very thin. Then, that person definitely needs to change their weight significantly to be healthy.”


“Health at Every Size® is great…except for me, because I need to lose a lot of weight to feel good in my body.”

I also hear:

 “I know this fat/skinny person who is really unhealthy…so HAES® doesn’t work.”

Here’s the thing about Health at Every Size®: it does not mean that everyone of every size IS healthy. It simply means that healthy habits can lead to good health, regardless of body size.

I’d like to share the basic tenets of HAES. Maybe this will help debunk some of these myths I so frequently hear. They are:

  • Eating in a flexible manner that values pleasure and honors internal cues of hunger, satiety, and appetite.
  • Finding the joy in moving one’s body and becoming more physically vital.
  • Accepting and respecting the natural diversity of body sizes and shapes.

Generally, healthy habits include what many people would consider lifestyle changes. These include moderate exercise, eating a variety of foods that include plenty of fruits and vegetables, staying well hydrated, reducing stress, getting sufficient sleep, and engaging in supportive, healthy relationships.

These are just a few things that have been shown to support health, regardless of weight change. In fact, according to a study published in the Journal of Nutrition, people who focus on healthy habits (as opposed to mere weight loss) continue those habits over the long term and, thus, have improved health outcomes. Those who focused more purely on weight loss may stop their habits when weight loss slows, stops or reverses.

To be clear, the decision to pursue, or not pursue, weight loss , or even health, is an individual decision.

That said, it does help to know as many of the facts as possible to make the most educated health decisions, regardless of your current weight. I hope to share more about HAES on the blog, as well as in events at Watershed. If you’re interested in learning more about those events, you can join us on Facebook, or check our Schedulicity class calendar (just log in as if you are making an appointment, and you can browse available events).

Always feel free to reach out to me by email!