Nutrition and Lifestyle to Support C-PTSD
Everything is connected. A statement I repeat often in my teachings, while working with others, as well as to myself in reflecting on my own health. There is a continually expanding field of study, born in the 1970s, which explores this concept. Psycho-neuro-endocrine-immunology, or PNEI, studies how each of these internal systems influence, communicate and affect one another. This establishes the foundation for understanding C-PTSD, or Complex Post Traumatic Stress Disorder.
Although not a recognized diagnosis in the DSM-5-TR, it is widely acknowledged among clinicians. C-PTSD is thought to have myriad causes, be it developmental trauma, where a little one with a developing nervous system experiences ongoing traumatic events, or attachment injuries without adequate support for repair. It may also occur later in life, when there are repeated traumatic experiences without adequate internal or external resources to support processing and repair. In developmental trauma, this alters the development of the nervous system, in theory leading to changes in stress tolerance as well as relational interactions down the road. Dr.’s Vincent Felitti and Robert Anda under the CDC and Kaiser Permanente conducted a study, namely the Adverse Childhood Experiences Study (ACEs), from 1995-1997. The outcome indicated that individuals with a higher ACE score, as in a higher occurrence of developmental trauma, were at higher risk for chronic health issues as adults. This has contributed to the implementation of trauma-informed care in many settings and has also inspired additional research.
C-PTSD can occur in both adults and children.
The field of PNEI and the connections made in the ACEs research are transparently clear in that our mental, emotional, and physical health are all interwoven. Tending the nervous system is as important as doing so for the cardiovascular system, or the gut. All of our body’s systems are in communication with one another, and notably, they all take orders from the nervous system. The interaction specifically between the nervous and the endocrine systems impacts hormone production, neurotransmitter production, and multiple glands and organs.
In 2020, I engaged on a project to explore how trauma healing could occur across communities, in places where resources might be limited, or perhaps mental health needs are stigmatized. Although I am confident there are many more methods, I landed on four cornerstones which I found consistent evidence for: time in or access to nature, community/meaningful connection, creative expression, and food. Interesting, but ultimately not surprising, was the insight that not only are these things the medicine, but their absence creates a higher susceptibility to trauma taking hold. Additionally, there is overlap among them. The food that helps heal is food from nature, anti-inflammatory and free of chemicals and synthetic ingredients that irritate the gut, nervous system and the brain. The act of choosing vegetables and fruits and taking them home to prepare them is both creative, and a profound act of healing. In communities where a community garden or farmers’ market is accessible, there is opportunity for access to nature, and connection. The act of sharing a meal with someone you feel a safe and strong connection with is regulating for the nervous system, reducing the production of stress hormones and aiding nutrient absorption.
In my work in functional health, I have often seen the impacts of trauma in an individual’s physical health. In my mental health work, I have witnessed the shouting of symptoms in the physical body impeding someone’s ability to heal mentally and emotionally. Healing and recovering from a traumatic event(s) is a layered and nuanced process that requires safety and support. Inherently making recovery more accessible, bringing the body into balance widens the window of tolerance, thus creating the space to tolerate the discomfort of healing. It is a pillar of recovery I find needing more acknowledgement.
Symptoms of C-PTSD may include:
● Flashbacks
● Exaggerated startle response
● Intrusive thoughts
● Nightmares
● Anxiety / Chronic Fear
● Depression / Sadness / Despair
● Challenges in relationships
● Heightened emotional responses
● Negative self-concept / Feelings of worthlessness
● Memory Lapses
● A persistent sense of current threat / hypervigilance
● Shame
● Dissociation
● Sleep disruption / Nightmares
● Self-Harm / Self-Destructive Behaviors
● BODY – Headaches (migraines), dizziness, chronic pain, body dysmorphia, eating disorder behaviors (restricting, binging, ARFID, orthorexia), digestive issues, stomach pain, nausea, fatigue, insomnia, brain fog, heart palpitations or racing/pounding heart, reactive hypoglycemia/blood sugar instability, over or underweight, metabolic resistance, cravings, aversions, air hunger, difficulty regulating body temperature, skin flare-ups, hormone disruption.
Symptoms are a way the body attempts to get your attention in the hopes a pivot toward health is possible. The symptoms above suggest identifiable, underlying imbalance. C-PTSD alters the systemic immune (histamine, cytokine, mast cell etc.) response, subsequently contributing to behavioral and cognitive changes. This happens by way of inflammatory response chemicals, transmitted via their corresponding nervous system response in the prefrontal cortex and limbic brain areas, as well as endocrine changes in cortisol production, among others. This contributes to alterations in the hypothalamus, pituitary, adrenal and thyroid axis, cortisol dysregulation, circadian rhythm dysregulation, cellular dehydration due to adrenal depletion, gut-brain connection and microbiome disruption, and systemic inflammation.
Approaching C-PTSD through the lens of functional nutrition means adopting a whole food, anti-inflammatory diet and lifestyle (?) most of the time. Prioritizing a predictable rhythm to your mealtimes assures your nervous system that all is well, reducing the physiological need for hypervigilance.
What makes it worse?
Food –
● Chemicals – artificial flavors, artificial colors, artificial sweeteners, agricultural chemicals, mold/mycotoxins, processed foods
● Excitotoxins – chemical substances (glutamate and aspartate are examples) that overstimulate neuron receptors in the brain. They can contribute to Alzheimer’s and Parkinson’s, and can be very damaging to developing brains. Common sources are: MSG, hydrolyzed vegetable protein, soy protein isolate, hydrolyzed oat flour, aspartame (often in gum, diet sodas – Equal)
● Inflammatory Foods – sugar, high fructose corn syrup, peanuts, corn, soy, wheat, gluten, shellfish, unhealthy fat (and insufficient intake of good fats), dairy, canola oil, sunflower oil, safflower oil
● Environmental toxins in foods – agricultural chemicals, PFAS, microplastics, metals, mold
● Overmedication without sufficient detoxification – need to support detox pathways. Hydration, healthy bowel motility, sweating and movement are all helpful here.
● Too much caffeine – dehydration, demineralization, thins the gut lining, offends the gut microbiota, stresses the adrenals
Supplements –
● Poor quality supplements
● Not organic protein powders and other powders
● Energy drinks
Behaviors –
● Not prioritizing sleep
● No stress management
● No time outside
● Loneliness / Isolation
● Excessive screens
● Substance use
What helps?
Food / Hydration –
● Whole foods
● Proteins – pastured, organic (affects fatty acid and vitamin D levels) – beef, poultry, fish (wild caught), eggs, protein powders are okay if they are clean
● Proteins deliver amino acids necessary for building and maintaining muscle (including organs), energy metabolism, blood sugar stability , brain function, repair
● Fats – cook with avocado oil, coconut oil or ghee. Use extra virgin olive oil, hemp seed oil, flax oil as dressing, eat seeds more than nuts – (buy them raw), fatty fish (salmon, sardines, mackerel)
● Fats are essential for brain and nervous system function. The brain is made up of 60% fat. The myelin sheath of the nervous system needs healthy fats. Healthy fats are necessary for joint mobility and health, and for permeability of cell membranes.
● Carbohydrates – all non-starchy vegetables, beans, legumes, whole grains, fruits.
● Carbohydrates provide necessary antioxidants, vitamins, minerals, and phytonutrients.
● Starches – Resistant starches – cooked and cooled white potato, cassava, green banana
● Fiber should be contained in the carbohydrates consumed. Fiber assists with blood sugar stability, cholesterol management, bowel motility, detoxification.
● Liquids – water, herbal teas (tulsi, licorice, ginger, turmeric, ccf, peppermint, chamomile), broths, mineral water with lemon or a little unsweetened fruit juice
● Quick fix/hacks – rx bars, boiled eggs, turkey bacon, baby carrots, dried fruit instead of sweets, switch table salt to pink/celtic/real salt, almond butter and jam sandwich on GF bread
● Omegas
● Magnesium
● Vitamin D
● B Complex
● Multimineral + Multivitamin
● High quality electrolytes
Behaviors
Eat to:
● Nourish cells, tissues and organs
● Heal the gut / Support optimal digestion – no multitasking and eating, no screens and eating, be relaxed, chew – mindful omnivores
● Eat for the gut brain axis/connection – This is a bidirectional communication network linking the central nervous system (brain) with the enteric nervous system (gut) that uses nerves, hormones and immune signals. It contains 100+million neurons, more nerve endings than in your spine. Communication occurs by way of the vagus nerve. 90% or more of our serotonin is produced in your gut. Sufficient healthy bacteria are needed, as microbiota synthesize all B vitamins which are necessary for methylation (neurotransmitter and hormone production). Aiming for 90% beneficial bacteria.
● Reduce inflammation
● Feed your brain and nervous system – Nervous system is your inner child
● Balance blood sugar – Eat within 60-90 minutes of being awake and every 3-4 hours thereafter. Fat, fiber, protein and green every time.
● No intermittent fasting unless HPAT (adrenal / nervous system regulation) is balanced and healthy. A 12/12 is okay for most people on a daily basis.
● Sleep regulation
● Morning sunshine
● Balanced movement – not too much, not too little
● Time in nature
● Intermittent fast your devices
● Hydrate, hydrate, hydrate
● Meaningful connection
● Creative outlet
● Downregulate the nervous system daily and broaden your toolkit
● Mindful eating (not intuitive) – put fork down between bites
● Make your kitchen a place you want to inhabit (flowers, music, color palette etc.)
● Meal plans
● Batch cooking
● Walking after eating
● Prayer / Gratitude before meals
● Support detox pathways by: Ensuring at least 1 bowel movement per day (bowel motility is essential for detox), adequate hydration – kidneys, bladder, bowel, skin, dry brush or hot towel scrub- lymphatic, walking – lymphatic, jumping up and down – lymphatic, breathing practices – lymphatic, lungs, nervous system and digestion, sweat daily - skin
*Treat your nervous system like it is your inner child. Try moving through one day imagining a little one moving through your routines with you. How would you change the timing of your meals, bedtime etc? Do you notice when you are pushing your body versus supporting it? Are you able to hear the messages your body is sending you?
Recommended Reading:
The Body Keeps the Score by Bessel van der Kolk
When the Body says No by Gabor Mate
The Complex PTSD Workbook by Arielle Schwartz, Maryann Sullivan, et al.
**A note – What is offered here does not constitute medical advice or replace the importance of medical treatment. C-PTSD may impact individuals in a variety of ways, and at different intensities over the course of a lifetime. I am a strong advocate for seeking the professional support of a provider if you are struggling. Please explore the SAMHSA website, or call/text 988 for support.
Sweet Chickpea Stew
Ingredients
· 3 chickpeas, cooked
· 3 carrots, chopped
· 1 onion, chopped
· ½ c. celery, chopped
· 11/2 c. diced tomatoes
· 2 kabocha or acorn squash, seeded, skinned, and chopped in quarters.
· 3 cloves garlic, minced
· 2 tsp. garam masala
· 1 tsp. cumin powder
· 2 in. fresh, minced gingere
· 2 c. green cabbage
· 2 Tb. avocado oil
· 1 c. organic veggie or bone broth
· Fresh cilantro for garnish
Himalayan pink or Celtic sea salt & pepper to taste
Preparation
· Sauté onions on medium heat in large saucepan for about 5 minutes or until onions are translucent.
· Add garlic, carrots, ginger, celery, and tomato. Sauté 3-5 minutes.
· Add squash, cabbage, garam masala, cumin, beans, broth and salt. Simmer about 20 minutes.
· Carefully scoop meat out of squash and put back into pot. Discard skins.
· Serve.
