May 15, 2020

Dr. Nave now works with queens through her virtual practice Hormonal Balance.  Today she talks to us about hormones and how they affect our mental health, including the baby blues and postpartum depression.  You can listen to this complete podcast episode on iTunes or SoundCloud.

Alyssa:  Hi.  Welcome to Ask the Doulas Podcast.  I am Alyssa Veneklase, co-owner of Gold Coast Doulas, and today, I’m excited to talk to Dr. Gaynel Nave, MD, and she works at Hormonal Balance.  Hi, Dr. Nave.

Dr. Nave:  Hi, Alyssa.  Thanks for having me.

Alyssa:  Yeah.  It’s been a while since we’ve talked, but we were emailing a while ago, and we realized that it’s Mental Health Awareness Month in May, and then this week is Women’s Health Week.  So you wanted to talk about baby blues and postpartum depression.  So before we get into that, why don’t you tell us a little bit more about Hormonal Balance because last time you talked with us, you worked for — you were at a different place.  So tell us what you’re doing now.

Dr. Nave:  Okay.  Awesome.  So as of this year, I’m in my own practice, as you said.  The name of it is Hormonal Balance.  And so I am an Arizona licensed naturopathic physician, and here in Grand Rapids, I operate as a naturopathic educator and consultant to women, with all gender identities, to basically reconnect to their — who they are and directing their own health, hormonal health concerns.  And that’s the reason why I went with Hormonal Balance, because our hormones affect almost every single aspect of our health, including when we wake up, our mood, our sexual health, all of it.  And for us who are women or female-identifying, the medical community sometimes doesn’t listen to our concerns or minimizes our experience, and so I want to be a part of changing that and, you know, helping women be advocates for themselves and learn more about their bodies, basically.

Alyssa:  Yes.  Awesome.  I love it.  And then you can do — so even though you’re here in Grand Rapids, Michigan, you can do virtual visits, so technically, you can work with anybody anywhere?

Dr. Nave:  Yep, yep, yep.

Alyssa:  Cool.  Well, we’ll tell people how to find you at the end, but let’s talk a little bit about the mental health aspect of, you know, bringing some awareness to it this month.  And then, obviously, you know, baby blues and postpartum depression is something that we deal with on a regular with our clients.  So how do you help your patients?

Dr. Nave:  I call them clients.

Alyssa:  Clients?  Oh, you do?

Dr. Nave:  Yeah, because here in Michigan, because my — there is no regulation for naturopathic physicians, even though I have my license.  I function more as a consultant, so I call the people that I work with “clients.”  And so the way in which I assist them is basically gathering information about their concerns as in-depth as possible because I’m not just going to look at you from the perspective of, oh, I’m experiencing this particular symptom, because nothing occurs in a vacuum.  And so looking at you as a whole, how does what you’re experiencing affect you mentally, emotionally, and physically.  And so we do the full assessment, and then a part of that is talking about and educating you on labs that are pertinent to you.  So there are different types of hormonal labs that are available.  There’s salivary.  There’s urine.  There’s blood.  And so, like, making sure that the one that’s best and indicated specifically for you is what we talk about.  It’s very individualized because each person has a different experience, even if we have the same diagnosis.  Does that make sense?

Alyssa:  Right.  So you’re saying if somebody comes in, you do a pretty thorough — kind of like with my sleep clients, I do an intake form.  Right?  There’s no, like — you’re saying there’s no one blood lab for — oh, there goes my dog.  I should have mentioned that we’re recording at home on speakerphone, and — okay.  So what I was saying is with my sleep consults, I do an intake form because there’s no right answer for every family, so if somebody comes in and needs blood work done or — well, like you said, labs.  Blood work might not be the right lab for them?

Dr. Nave:  Yeah, because there’s — let’s talk about female hormones, for example.  So the female sex hormones — and when I say female, I’m using the medical terminology for it, not like — so, like birth sex.  You have ovaries — versus the gender identify.  I’m still working through how to talk about these medical things and still be cognizant and respectful of the different gender identifies, so please forgive me if I say anything that’s offensive.  So the female sex hormones — estrogen and progesterone — but these hormones don’t just occur in women.  They also occur in men.  So all gender identifies have these hormones involved, but specifically for those who can give birth, estrogen is involved in the building up of the uterine lining of the uterus so that implantation of a fertilized egg can happen.  Progesterone is important for maintaining that uterine lining as well as maintaining healthy pregnancy so that you don’t lose the baby.  Obviously, there are a lot more factors involved.  These hormones, based on how the body breaks down balance specifically as it pertains to estrogen — we have three different types of estrogen, so it’s not just one form that’s in the body, and depending on what lab is done, you’re able to verify all three at the same time.  The one that I’m thinking of right now is the urine test called DUTCH test.  I really enjoy that one.  I’m not promoting it right now, but I’m just explaining why I like it.  So that particular type of analysis looks at all three of those types of estrogen in the body as well as how the body breaks them down.  Is it able to get rid of it effectively, which gives information on the metabolic pathways.  So there’s a lot more information that can be gleaned from — depending on what type of lab is utilized and depending on your specific concern and the way in which your symptoms are presenting; a more investigative or information-bent lab analysis might be indicated, and so being able to speak with someone like myself who is well-versed on the different approaches and all the different options can be really beneficial because then you don’t end up having to do multiple tests, you know, all that kind of fun stuff, or having to get blood drawn if you don’t have to.

Alyssa:  Right.  So what hormones are you looking for when somebody comes in and says, gosh, I think I have postpartum depression?  Is it just hormonal, or do I really have — I guess, where do you as a naturopathic doctor, say, “I think I can help you with hormones,” versus, “I think you need to see a therapist”?  Or do you do both?

Dr. Nave:  So I will probably tell them to do both because postpartum depression, as with any mental health condition, is on a spectrum.  So you have mild, moderate, and severe.  Before we go into that, I think it would be important for us to define a couple things.  Baby blues is feeling down or feeling a shift in your mood, like feeling more weepy, more exhausted, after giving birth, and this can last anywhere from a couple days up to two weeks.  If it extends beyond that time or it’s interfering with your ability to function, then it would be classified as postpartum depression, and postpartum depression can occur in that same time frame as the baby blues, like soon after childbirth, within three to five days, up to a year after giving birth.  And I’m going to read a couple of stats, so bear with me.

Alyssa:  Go for it.

Dr. Nave:  Just for a frame of reference.  So postpartum depression affects up to 15% of mothers, and shifting to 85% of moms is that they get the postpartum blues, so that — these statistics may provide some form of comfort that you’re not alone.  Please don’t suffer alone.  If you’re feeling more down and you need more assistance from your family and friends, please reach out.  If you’re a single mom, I’m sure that there are different groups, like single moms groups, or talking to your doctor or your friends who can be there to provide some emotional support for you during that time.  Please, reach out to people.  It’s not anything to be ashamed of.  A lot of women go through it because our hormones, as I said previously, affect a lot of things, including our mood.

Alyssa:  Right.  I feel like mothers are getting a little bit more comfortable talking about how hard it can be and how maybe bad they feel or these thoughts that they’re having.  You know, you talk to the older generations, like our mothers and grandmothers, who said, well, we didn’t talk about those things or we didn’t need help.  And we’re slowly getting to the point where we’re seeing more and more families look for and seek out postpartum support, which is one of my favorite services we offer because they can work day and night.  When a mom is suffering from any sort of perinatal mood disorder, having that in-home support that’s judgment-free can just be crucial to healing.

Dr. Nave:  I totally agree with you.  I’ve seen it in practice and the research back it up.  Just being pregnant, much less giving birth, is hugely taxing on our body and increased your risk for feeling down.  Some of it has to do with the hormonal changes.  I’m going to go really science-heavy because I’m a nerd and I think it’s fun and interesting…

Alyssa:  Do it!  Teach us!

Dr. Nave:  As I said, estrogen is responsible for the building up of the uterine lining, but it also affects things like our serotonin production, which you might know as the neurotransmitter involved in depression.  Like, if you have low serotonin, then you might get depression.  So the thing with estrogen is that it increases the production of serotonin by affecting a particular enzyme called tryptophan hydroxylase that is responsible for processing an amino acid that we get from our food called tryptophan into serotonin.

Alyssa:  Isn’t tryptophan the one that makes us sleepy?

Dr. Nave:  No.

Alyssa:  Tryptophan isn’t the thing that we eat that makes us sleepy?  What am I thinking?  It’s in turkey and stuff?

Dr. Nave:  Tryptophan is in turkey.  Serotonin and melatonin have the same precursor in terms of amino acid but the thing about their bodies is they use similar substrates or building blocks to make stuff, and just because we have the same building blocks doesn’t mean that we’ll get that particular product.  Does that make sense?

Alyssa:  Kind of, I guess.  In my sleep work, I talk about serotonin and melatonin a lot just for, you know, sleep cycles and feeling alert and then feeling sleepy, but I didn’t realize that a lack of serotonin can cause depression.  I’m trying to, in my brain, you know, the science of sleep, then — it makes sense, then, that people who are depressed sleep a lot, right?  Am I going down the right path here?  Because if you don’t have enough serotonin to make those hormones makes you feel awake and alert — sorry, I’m getting you totally off track by asking these questions.  Sorry!

Dr. Nave:  No, no, no.  I don’t think you’re going off track because sleep is very much an important part of the postpartum depression process.  If Mom isn’t sleeping, she’s at a greater risk for experiencing postpartum depression, and we know that the hormonal changes affect our sleep.  Also having a baby, a newborn baby — if the baby’s up crying, and they’re getting their sleep regulated; you’re adjusting to waking up and feeding the baby, feeling exhausted during the day, and your sleep is thrown off in terms of it not going or being matched up to when the sun rises and the sun goes down.  You’re more trying to sync to the baby, and that can lead to fatigue, which then exacerbates your mood, which makes you then more susceptible to feeling more down.  And then it’s like — one of the things that they mentioned is that babies who have a hard time sleeping — there seems to be a relationship between moms who have postpartum depression — so the baby isn’t sleeping; Mom tends to have a higher likelihood of having postpartum depression, but then the opposite is also true.  So if Mom has postpartum depression, it seems that the baby also as a result has a hard time regulating their moods and being more colicky and all these other things.  So taking care of yourself also helps the baby; it’s important to support Mom, which is why I’m so grateful that you guys have the postpartum doulas, and you guys do a lot of work with supporting moms post-baby.  Sometimes people focus so much on the baby that they forget the mother.

Alyssa:  Oh, absolutely.  It’s all about the baby.

Dr. Nave:  Yeah.  Yeah, yeah, yeah.  So the hormonal mood connection is very complex, and it’s not just A + B = C, you know, because, yes, estrogen influences serotonin production, but there are other factors that then influence, you know, the mood.  Does that make sense?  Specifically, when it comes to the mood changes or the hormonal changes in early pregnancy and postpartum – early pregnancy, we see the estrogen or progesterone levels are shifting because you’re now pregnant, so the body doesn’t have to produce as much of those hormones.  And when we have lower estrogen, which is what happens when you get pregnant, and since estrogen is responsible — or, rather, plays an important role in serotonin, which helps you feel calm when it’s at the normal level — if it’s particularly high, it can lead to anxiety-type symptoms.  If it’s really low, depression-type symptoms.  During those times when the estrogen is lower, there’s this lower mood that can also be accompanied by it.  Are you tracking?

Alyssa:  Yeah.

Dr. Nave:  Yeah.  So that’s the estrogen portion.  So estrogen affects serotonin production and also directly affects the neural networks in your brain.  Now, we have progesterone.  So progesterone: I like to think of it as our calm, happy hormone.  And so when you’re just about to have your period, usually it helps you sleep.  It helps you remain calm.  But if it’s really low, that can lead to insomnia, feeling really agitated and grumpy, and those kind of symptoms can also happen postpartum and early pregnancy.  And so that’s how the hormonal fluctuations can then manifest with the depression.  For the reason, at least in the postpartum stage, that these hormones might drop is that you give birth.  There’s a huge change because the body doesn’t have to maintain the hormones to keep the baby inside.  The baby is now outside of you.  And it really drops off really quickly, and that huge shift can then lead to the baby blues.  Then if it prolongs, your body having a hard time regulating, then that’s when we shift from the blues to the depression.  In terms of what I would do, I would assess what exactly is going on for you.  Do you have physical and emotional support?  Do you have a history of depression or any mental health condition prior to being pregnant?  Have you had postpartum depression before?  How is your sleep?  You know, sleep is really important.  If we can get you sleeping, I think that goes a long way.  Good quality sleep.

Alyssa:  You’re preaching to the choir here.  I think it’s one of the most important things!

Dr. Nave:  The other thing that they mention, the American College of Obstetricians and Gynecologists, is that if Mom has any feelings of doubt about pregnancy, that can also influence her feeling depressed because it can get, like, amplified during that time.

Alyssa:  So you’re saying, like, maybe doubting if they wanted to become pregnant?

Dr. Nave:  Maybe, or doubt that she’s capable of being a good mom, because there’s a lot of pressures on moms, you know?  Like, oh, someone will mention, like, oh, my baby’s sleeping through the night, or my baby — you know, they started eating at this time.  So there’s a lot of pressure to meet certain milestones that are from society, and that can amplify feelings of inadequacy that Mom might have had prior to becoming pregnant.  And so addressing that piece with a therapist or someone like myself will be a very important part of supporting her with the postpartum depression and getting her out of the state.  For some women, medication might be what they need to do, and their healthcare provider will be able to assess that.  But it’s not the only thing that’s available.  There’s therapists; there’s hormonal intervention, because if it’s a hormonal issue, if you address imbalance, then women get relief pretty quickly.  There’s having a doula, if that’s something that’s accessible to you, or if you have family members who are close by, asking them to help out some more.  Having people provide meals for you so then you don’t have to cook; having your partner be a part of taking care of the baby and asking them to step up some more to give you additional support.  Basically, asking for what you need is — I know it can be really vulnerable and scary if you’re not used to asking for help, but that can really be important in terms of getting what it is that you need because no one is in your exact position and knows exactly how you need to be supported.  Does that make sense?  Because I can talk about, like, a doula and a therapist and a naturopathic doctor, but you know what you need, and I want you to trust yourself in that knowledge.  You know what you need!  And here are all these different options to provide that.

Alyssa:  So you mentioned something a bit ago, and I don’t know what made me think of this, but how — let’s say a mother came to you pregnant and had postpartum depression before and knew that she — you know, her hormones are all over the place.  How much can you actually do in regard to hormones while pregnant?  Is there any risk to Baby?  You know, risk of miscarriage?  What does that look like for a mom who’s pregnant but knows she needs some help from you?

Dr. Nave:  So in terms of working with me specifically, I wouldn’t want to mess with her hormones during that time.  I would employ other tools, one of which is homeopathy, which basically supports the body’s own ability to heal and regulate itself.  As well as putting a plan in place — basically, working alongside her other healthcare providers to create a plan to support her and make sure that the transition is as smooth as possible.  What does she do if she notices that she’s trending from green and happy, healthy, thriving, into, I’m not doing so hot — what are the resources available to me when I’m at that place?  Who do I reach out to?  Who do I talk to?  What supplemental intervention needs to happen?  Do I need to talk to my doctor about starting me on medication?  There are so many different options, and prevention is always better than cure.  We would talk about what her issues — so she’s coming and she’s had it before — we would talk about what was her previous pregnancy like; when did the symptoms start to occur; what did they look like; what sort of things — what sort of red flags occurred during that time; what was the intervention utilized at that time; what were her hormone levels like?  What else; what were any medications that she was on; what medications is she on presently?  And, basically, maybe even talk about how that pregnancy is different than this pregnancy.  Like, does she feel more supported now?  What were the things that weren’t present in the previous one that she does have presently?  You know?  And basically coming up with a plan.

Alyssa:  Yeah, I like that.  So it’s kind of like what we do, you know, throughout birth.  It’s talking about all those what-if scenarios and what plans do you have in place for if any of these happen.  And then, like you said, once Baby comes home, nobody plans for that.  They’re so worried about the pregnancy and the labor and delivery part that they come home and go, oh, shoot.  What do I do now?  So it sounds like that’s a really healthy way to plan during pregnancy, if you do have any sort of mood disorder, to find a professional like yourself to sit down and say, hey, let’s go over all these things and put a plan in place, and then I’ll be here for you postpartum.  And then we’ll talk about what we can do then.  I like that.

Dr. Nave:  Right, because, as I said, there’s so many different options.  For one woman, maybe hormones, just giving her the hormones, is what she needs, and then I would, you know, work with her other — because I can’t prescribe hormones at the level that would be therapeutic, but I would be able to recommend, okay, that’s what you need.  Let’s talk to your doc.  Hey, Doc.  This is the plan.  If this happens, this is what we’re going to do so that she doesn’t have to suffer.  You know?  Or maybe it’s something else.  Just being able to work with someone who — again, like myself — who is savvy on that in terms of knowing — yeah, it definitely needs a collaborative approach, which is what I’m about.  In my head, in my dream, everyone would have a health team, you know?  People, health professionals, who are all in communication with each other who are just there to support you and help you thrive.  But I think to wrap up, it would be sleep, health, get your hormones evaluated.  If you’re thinking of getting pregnant and you have any mood disorders or any mental emotional concerns, as part of your pregnancy plan, you should be working — ideally, you would be working with a mental health professional as well, just to insure that you have the support that you need and you’re processing stuff effectively, because those concerns, those mental health concerns, can be substantially amplified once you become pregnant, as well as after giving birth.  If you have a mental health condition or if you’ve had postpartum depression before, you are at significant risk for developing it again.  And this applies to — postpartum depression can also occur if you have a loss of a baby, so it’s not just if you’ve given birth, but any form of baby loss can also result in postpartum depression.

Alyssa:  Yeah, I can imagine it would probably be even amplified with that because you still have the hormonal shift, that drastic hormonal shift, and then grief on top of it.  So it probably takes it to a whole new level.  Well, thank you for all of your expertise.  I always love talking to you.  I would love for people to know how to find you at Hormonal Balance, if they want to reach out.

Dr. Nave:  Yeah.  I am on Instagram and on Facebook as @drgaynelnave.  I’m in the process of getting my website up, so I’ll update you on that afterwards, or you can call my clinic at 616-275-0049.  If you have any hormonal or mental health concerns and you want to optimize your health team, you want a second opinion, or you just want some additional support — that’s what I do!

Alyssa:  Thank you!  During this Covid pandemic, can you see people in person, or are you choosing to do virtual only right now?

Dr. Nave:  I’m choosing to do only virtual at this point.  I see clients virtually most of the time Wednesdays through Fridays, actually, from 8:00 to 5:00 p.m., and in person at 1324 Lake Drive Southeast, Suite 7, Grand Rapids, Michigan 49506.

Alyssa:  So once the stay at home order lifts and things get a little bit more back to normal, you’ll be seeing people in person again?

Dr. Nave:  In person, yes.  But for now, we will see each other virtually!

Alyssa:  Thanks for your time!  Hopefully we’ll talk to you again soon!