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The actions we take on a day to day basis decides our future and shape who we become. A significant aspect of how I work with clients is understanding behaviour science and using coaching tools to support clients with building new habits they wish to establish in order to work towards their health goals. In my first two years of practice as a naturopath and nutritionist, I realised that having the knowledge of WHAT clients needed to do to work towards their health goals was not enough. I needed to learn how to better support HOW they were going to do this. I've spent the last year and a half doing a deep dive in behaviour science and am really excited to share what I've learned with my clients. Let's first start by understanding what habits are... Habits make up a huge proportion of our daily lives A habit is an established/frequent behaviour often performed in the same setting and same way. It is guided by a cue or trigger and does not require much thought or attention (e.g. more ‘automatic’). Once formed, habits actually shift to a more primitive part of the brain, freeing up more cognitive space - this is why once formed, habits can be difficult to change. There is a HUGE gulf between the intention of doing something and actually doing it. In behaviour science, this is called the ‘Intention-Action gap’. For example, most adults know that exercise is good for them and would like to do more, yet studies suggest that between 36% to 55% of people never manage to convert intention into action. How habits are formed: Cue/Trigger - Some context that is stable. For example, making coffee might be cued by a particular time of day (waking up/morning), the kettle, or being in an environment as a whole (cafe), a preceding behaviour (switching on the kettle), or even a person or sound (alarm clock). Setting up your environment can be really helpful for developing a new habit - perhaps having your running shoes by the door or a gym bag ready. Repetition - for a behaviour to become a habit, it needs to be performed frequently and repeated many times. Assuming that a behaviour is performed regularly - at least a few times a week. Research suggests anywhere between 18 days and 254 days to embed a new habit - it varies! Rewards - all behaviour is functional and serves some sort of purpose - rewarding us in some way - rewards can be intrinsic or extrinsic, conscious or subconscious, physical or physiological, short term or long term, cumulative. Six Strategies for building habits: 1. Ensure a stable, supportive environment - perhaps having your gym shoes visible by the door and a packed gym bag. Having a water bottle on counter. Stocking your fridge with veggies and emptying your pantry to cue eating more fresh food. 2. Leverage the context - this strategy is about using natural opportunities already existing. It can include - stacking/piggybacking on an existing habit or utilising a bold change in context like moving or a new life stage. 3. MAKE IT EASY TO DO - sooooo many of us jump into all or nothing thinking and often bite off more than we can chew leading to burn out. Identify and remove barriers - choose an action that is easy to do. For example, if wanting to do more exercise, you might start with wearing sport shoes and walking to work or even getting off a bus stop one or two stops earlier. 4. Develop cues and rewards - Develop a simple “If….then”….for example, if I wear my sport shoes and pack my work shoes, I can walk to and from work”. Having a mix of rewards is essential - immediate (you could have a tracking chart for example), long term (how will you celebrate this at the end of week/month? ) 5. Practice and repeat and EXPECT resistance - new behaviours take time and to start, require more cognitive energy - therefore, it can be tiring and be met with resistance. This is normal. Planning and preparing for how you will respond to resistance is helpful. Knowing that you will have set backs is helpful. 6. Build meaning - knowing your why behind wanting to develop a new behaviour is important - it cultivates meaning and purpose. Building new habits take time and can be challenging for all of us. Finding a support system is really important. Surround yourself with people that support your values, the habits you want to build, and the person you want to become. If you feel you need more support, find a coach to support you.

When people talk about their health and fitness goals, generally, they say things like: ⚖️ I want to lose 20 pounds. 🧘🏻 I want to be less stressed. 🏃🏾‍♀️ I want to run a sub 30-minute 5K. These are all examples of outcome-based goals—goals that focus on a desired outcome or result.  It’s fine to frame goals like this… in casual conversation. But it’s not so great for actually improving or progressing toward that goal. That’s because wanting an outcome isn’t enough. (Even if you really, really, REALLY want it.) Why? Because we (usually) can’t control outcomes. You can have crystal clear vision of your goal—plus all the motivation in the world—but then: You get slammed with work. Your kid goes through a mental health crisis. Your gym closes for, like, TWO YEARS.  You develop problems sleeping. Your knee decides it hates running. And poof!  There goes your goal—up in smoke. Staring at the ashes of your former goals can feel like a personal failure.  However, you might’ve had little to do with your goal not working out. It’s just that things beyond your control—work, other people, your biology—didn’t cooperate.  But if results are out of your hands… how are you supposed to improve at anything??? Meet: Behavior-based goals. Behavior-based goals are centered on the ACTIONS you take, like eating slowly at every meal, practicing a daily meditation session, or doing some type of training or active recovery most days of the week. Because you have MUCH more control over your behaviors, behavior-based goals are more effective—and more empowering.  Here are a few examples of turning outcome goals into behavior goals: EXAMPLE 1 Outcome goal:  Lower blood sugar Behavior goal:  Take a 20-minute daily walk EXAMPLE 2 Outcome goal:  Sleep 8 hours a night  Behavior goal: Create a calming bedtime routine and start it 30 minutes before bedtime EXAMPLE 3 Outcome goal:  Improve relationship with partner Behavior goal:  Have a date night once a week  How to set a behavior goal—TODAY. What to Do ► Write down the outcome you want. (Let’s say it’s, “Lose 20 pounds.”) ► Then, write down some skills you think you’ll need to get that outcome. (For example, one might be “meal prep.”) ► Next, write down a behavior you can do today that’ll help build those skills. (“Buy and wash blueberries, and put them in a container that’s easily accessible.) ► Try to do the behavior consistently. (In the example above, maybe you prep a bunch of fruit each Sunday so you have healthy snacks available all week.)  You may not always follow through, and that’s okay. Progress is almost never a straight line in the direction you want to head.  But by focusing on the behavior and not just “lose 20 pounds,” you keep your attention on the part you can control.  That’s truly how you achieve amazing things over time.

Naturopathic Medicine is a form of Systems and Preventative Medicine Systems medicine takes an integrative and holistic approach to understanding the body - understanding that there is a deep connection between the different systems within the body and also between the body and external factors (e.g. environment, relationships, resources, etc). This approach aims to improve our understanding, prevention, and treatment of health concerns. The way medicine is often practiced is reductionist - seeing systems operating in silos without consideration for contributing variables. This leads to treatments that often only treat symptoms and do not go up stream enough to find the root cause nor addressing the likely contributing factors. Recently I read an article in The Washington Post about a women who had spent nearly two decades in a catatonic state of psychosis. She was institutionalised and diagnosed with schizophrenia. Years later, when a systems approach was taken, doctors found that she also had n autoimmune disease, lupus and that this was likely causing neuroinflammation. Understanding the connection between neuroinflammation and mental health presentations, doctors began to treat her with immune therapy. Within months, she improved and she is now living independently and able to function. Trichana et al. (2018) state that the body is made up of a ‘networks of networks’; organ networks, cellular networks, molecular networks, genetic networks. Naturopathy understands this in addition to spiritual networks, mental networks, socioeconomic networks, community and family networks, and environmental networks.The body is resilient and is always trying to maintain balance within and between these networks - this is called homeostasis. When healthy, we are resilient to perturbations. As practitioners, we may work with someone whose networks are unable to maintain homeostasis - which lowers vitality and may put them at risk for developing chronic diseases. Things that might signal this include: Metabolic dysregulation (e.g. lipid dysregulation, glucose/insulin dysregulation) Chronic stress Poor sleep patterns Recurrent infections Hormone imbalance Chronic pain and inflammation Digestive concerns Mood fluctuations Low energy Taking thorough case takes is critically important when trying to understand what is happening holistically. This takes time - in my practice, an initial consultation is 90 minutes. I also work on the case for several hours after that, looking at lab results and further processing all the the information I’ve gathered. Because we look at every system of the body during an initial consultation we can able to identify relationships and connections. These are common presentations now shown in research to have significant connections: - gut issues with mental health presentations (Connection: Gut-Brain Axis) - Stress and all health presentations (Connection: HPA axis influences all other networks) - metabolic issues (e.g. prediabetes/diabetes) and mental health presentations as well as hormone presentations (Connection: metabolic system influences hormones and cognitive function) - Gut issues and hormone presentations (connection: any digestive concerns can impact hormones) - Nutrient deficiencies/inflammatory diet and inflammation, low energy, mood concerns, hormone imbalance (connections: are you seeing a pattern? it's all connected). Catching destabilisation early as well as understanding the deep connections between systems is a key aspect of what we aim to do as Naturopaths. We think deeply about which systems are out of balance internally and externally. From there, we look at how we can support and restore these systems and their connections. Stabilising the networks so that they can maintain homeostasis is the goal. Support might look like: lifestyle and nutrition medicine suggestions referrals to see other practitioners if necessary (integrated/multidisciplinary approaches enhance systems medicine) Nutrient supplementation and/or herbal medicine where relevant and warranted Myers and Vgar (2019) completed a systematic scoping review and found that a whole-systems naturopathic approach was positively associated with the health outcomes and quality of life for many chronic diseases including metabolic disease, depression, PCOS, cardiovascular disease, and anxiety. I believe that PREVENTION is CURE and that a systems medicine approach to health is important. DOI: 10.1161/CIRCRESAHA.117.310999 10.1089/acm.2018.0340

(AANMC, 2023 (adapted from Zeff et al., 2013) This hierarchy demonstrates our focus as naturopaths, which is on disease prevention and health promotion. Reducing the cost of health care and increasing the individuals agency over personal health promotion is paramount. In my practice, a significant area of focus is coaching clients to develop strong conditions for health with lifestyle and nutrition medicine. This involves identifying and removing barriers as well as education and collaboration on small achievable goals to build back a foundation of health. There are some misconceptions about what we do as naturopaths and it is understandable because, unfortunately in New Zealand, it remains an unregulated profession. Until we are recognised, it is important that the public knows how to find a qualified and credible practitioner. Try and look for a degree-qualified or a diploma-certified practitioner who is registered with a reputable professional association such as NMHNZ. NOTE: NMHNZ is now only allowing degree-qualified practitioners to be registered. This ensures that they are held to professional standards (which are aligned with international standards set out by the world naturopathic foundation), maintain continued professional education, and are aware of their clear scope of practice. In my practice, to further uphold the safety and health of a client, a client can consent to a shared-care approach where I work collaboratively with their primary health practitioners and/or other practitioners such as psychologists. I believe that a shared care approach is the best way we can support a person's health and wellbeing. Based on the Naturopathic Therapeutic Order (Zeff et al., 2013), the foundation to health is establishing the conditions required to maintain health. This involves assessing and establishing foundational and social determinants of health as well as removing factors that disturb them. The determinants that we look at include: 1. nutrition 2. sleep 3. exercise 4. stress 5. trauma 6. lifestyle factors 7. Psycho-emotional factors 8. Socioeconomic factors 9. Environmental factors This is the most important aspect of my clinical practice as it is the foundation to whole-person preventative medicine. It is also the most challenging. It requires systems thinking, that recognises the interconnections between the different aspects and how these connections can be supported. It also involves working with the Transtheoretical Behavioural Change Model, which appreciates the stages of behavioural change and how an individual can be supported through these changes. In addition to my Naturopathic qualifications, I am currently completing a certificate in health coaching with Prekure, which is increasing my understanding and practice of behavioural medicine and coaching with regard to the above determinants. I am on a mission to promote preventative medicine and health. I am on a mission to do this collaboratively, in a person-centred way and with an integrated, shared-care approach. I believe our health care system can be better and I want to be part of the solution. Ngā mihi nui, Melissa References: AANMC, 2023 NZNMH, 2023

Maintaining a behaviour change Change is not a linear process - it is messy. How many of us have reached a health goal we set only to slip back into old habits? (All hands up including mine) The Transtheoretical Model of Change suggests that behaviour change involves moving between these stages: Precontemplation - not engaged, with no intention of starting any health promoting behaviours. Contemplation - not engaged but considering incorporating health-promoting behaviours into their life. Preparedness - Seriously considering starting to change their behaviours. This could include researching options or connecting with some form of support (e.g. practitioner). Action - Actively engaged in a health-promoting behaviour for 6 months. Maintainance - Consistently engaged in a health-promoting behaviour beyond 6 months. We could add a sixth stage, relapse, to this. This involves back-tracking to any point 1-5 above. Depending on where an individual is at (e.g. motivation, resource) as well as environmental context factors (e.g. One systematic review identified the following key themes relevant to maintaining behaviour change: Motives - are you feeling satisfied with outcomes; enjoying the new behaviour; is the behaviour aligned with your identity, beliefs, values. Knowing your why is important. Getting to the root of 'why' you want to change helps you really get to the heart and depth of what you want. Self-regulation - are you monitoring and regulating your behaviour (e.g. tracking and adapting when needed); do you have strategies to overcome barriers? Is your behaviour change EASY to implement? Resource - do you have the psychological, emotional, and physical resources to maintain this behaviour? Habit - has the behaviour become a habit; in other words, is it automatic and responsive to certain cues? Environmental and Social - do you have a supportive environment and community around you? Remember, behaviour change is not-linear and often messy. Life happens and we need to adapt. Remembering why you are doing what you are doing is important. Does it align with the holistically well person you want to become? Is it realistic? Working with a coach or practitioner to help you through this can be valuable. DOI - 10.1080/17437199.2016.1151372

There are 30-50 million traumatic brain injuries (TBI) a year world wide (most of which are classified as mild in nature) and 1 in 5 individuals will have symptoms persisting beyond 1 month. Acute trauma requires immediate medical attention by a primary health practitioner. Your GP or emergency care team are able to provide necessary screening, investigations to ascertain the severity of your injury and treatment required. Most individuals will recover within 1-3 months. Post-concussion symptoms may include: - Headache - Dizziness - Fatigue - Irritability and distress - Forgetfulness - Vision disturbances - Sleep disturbances - In general any new or worsened physical, emotion, and/or cognitive symptoms There are ways that you can support your recovery: - Eat an anti-inflammatory wholefoods diet - Avoid alcohol - Ensure you are eating a good amount of polyunsaturated fats (omega 3) - Ensure you getting enough sleep - Address any nutrient deficiency (e.g. vitamin D) - Manage and limit stress - Move regularly but at graded intensity - Ensure you have positive social support and especially, people you feel safe and comfortable sharing your process with Nutrients and herbs that have some compelling research:** - Lions mane - Choline - Creatine - Magnesium - N-acetyl cysteine - Omega 3 fatty acids **when taking supplements or herbs it is important to speak with a qualified health practitioner. DOI: 10.1016/j.apmr.2019.10.179 DOI: 10.3389/fnut.2022.977728 DOI: 10.3390/ijms222111313

This may not be a fan favourite topic but we need to look at the the implications alcohol has on brain health and overall wellbeing Most understand that large chronic consumption is associated with negative health outcomes, however, little is understand or discussed about the implications of regular light to moderate consumption. Research shows that alcohol acts as a neurotoxin and even light to moderate consumption on a regular basis (e.g. 1-2 standard drinks a day or 7-14 standard drinks per week) has negative impacts on our brain health: - Lowers a person’s physiological and psychological bandwidth for stress. - Can reduce and restructure both grey and white brain matter in such a way that it increases vulnerability and perhaps rate of cognitive decline/disease - Significantly reduces sleep quality. - Exacerbates depression and anxiety This is not to create panic or an expectation that all should refrain from consuming any alcohol at all. We may, however, need to reflect on the patterning and normalisation of regular alcohol consumption in our lives. Alcohol is deeply engrained in our culture. If we truly want to support the mental health of our communities, we need to look at alcohol as significant contributing factor. Some suggestions to change your relationship with alcohol: - Take some time off - break the REGULAR patterning. - Be a good mate - offer non-alcoholic drinks at social functions in addition to your alcoholic beverages of choice. If someone is not drinking please do not pressure them to drink. If a mate is struggling with mental health - avoid offering to take them out for ‘drinks’. - Consume when you are feeling most resilient and well - not using it as a coping tool for stress. - Normalise alcohol-free behaviour DOI: 10.1038/s41467-022-28735-5 DOI: 10.1001/jamanetworkopen.2019.10319 DOI: 10.3389/fcvm.2021.681627

Metabolic dysregulation is associated with cognitive decline. This is when you are not sensitive to insulin signalling and therefore, do not regulate glucose levels well. Excessive blood glucose promotes oxidative stress. Risk factors for metabolic dysregulation include: - Dyslipidemia - Hypertension - Diabetes - Increased central body adiposity - Poor gut health - Systemic inflammation - Excessive Western Food Diet intake (e.g refined grains, processed foods, low fibre, human modulated fats) Other contributing factors to metabolic dysregulation: - Significant hormone change (e.g. menopause) - Stress - Poor sleep patterns - Nutrient deficits - Poor gut health - Alcohol - Sedentary lifestyle Improving your metabolic health is an important way to protect your brain and overall cognitive function. Strategies to explore when needing to improve and/or wanting to maintain metabolic health: Anti-inflammatory, nutrient-dense nutrition: - 5+ serves of colourful fruit and vegetables - Whole grains and other complex carbs - Increased intake of omega-3 fatty acids (e.g. oily fish) - Unprocessed animal and plant-based protein - Fermented foods Key nutrients best found in wholefoods identified above for both metabolic and brain health: - Choline - B vitamins - Folate - Iron - Polyunsaturated fats - Antioxidants and phytonutrients - Vitamin D - Vitamin E - Vitamin C - Zinc - Pre and probiotics - Magnesium Lifestyle Advice - A regular and consistent exercise/movement practice - Stress management practices - Improved sleep quality - getting outside in natural light If you have metabolic syndrome or diabetes it is important to continue to see a trusted health care practitioner for more support and individualised planning to meet your needs. References (Sarris & Wardle, 2019) (Hechtman, 2019) DOI: 10.3390/nu14020333 DOI: 10.3390/nu12113367

Studies have shown that a balanced and healthy diet can have a positive impact on mental health by improving mood, reducing anxiety, and supporting cognitive function. Here are some ways that nutrition can support mental health: 1. Balancing blood sugar levels: A diet high in sugar and refined carbohydrates can lead to spikes in blood sugar levels, which can contribute to mood swings, irritability, and fatigue. A balanced diet that includes complex carbohydrates, protein, and healthy fats can help to regulate blood sugar levels, which can promote stable moods and energy levels. 2. Supporting gut health: The gut-brain axis refers to the connection between the digestive system and the brain. Research has shown that the health of the gut microbiome can impact mental health. A diet high in fiber, fruits, and vegetables can support gut health by promoting the growth of beneficial bacteria, which can have a positive impact on mood and cognition. 3. Boosting neurotransmitter production: Neurotransmitters are chemicals in the brain that regulate mood and behavior. Certain nutrients, such as amino acids, vitamins, and minerals, are required for neurotransmitter production. For example, the amino acid tryptophan is necessary for the production of serotonin, a neurotransmitter that plays a role in regulating mood. Foods high in tryptophan include turkey, chicken, eggs, and nuts. 4. Reducing inflammation: Chronic inflammation has been linked to several mental health conditions, including depression and anxiety. A diet high in anti-inflammatory foods, such as fruits, vegetables, nuts, and fatty fish, can help to reduce inflammation in the body and support mental health. 4. Supporting cognitive function: The brain requires a steady supply of nutrients to support cognitive function, including memory, attention, and learning. A diet that includes omega-3 fatty acids, antioxidants, and B vitamins can support cognitive function and may reduce the risk of cognitive decline. A balanced and healthy diet that includes a variety of nutrient-dense foods can help to regulate mood, reduce anxiety, and support cognitive function.

Chronic stress has been associated with negative consequences for brain health. Research shows that chronic stress may reduce neuroplasticity (needed for learning and memory) and neuroprotective factors such as BDNF, as well as increase connectivity within the limbic system (a region associated with anxiety and fear). Chronic stress can contribute to low mood, anxiety, poor mental performance, and fatigue. It can lead to burnout. Managing our stress response so that we can down regulate our nervous system after a heightened response keeps our nervous system in balance. Evidence-based strategies to reduce stress: Nutrition Advice: - Nutrient-dense, anti-inflammatory foods most of the time - Adequate non-processed protein - non-human modified healthy fatty acids - colourful veggies and fruit - Moderated caffeine and sugar intake - Addressing key nutrient deficiencies Key Nutrients best found in wholefoods that help with stress: - B vitamins - Omega-3 fatty acids - Vitamin C - Coenzyme Q10 - Amino acids - Glutamine - Zinc - Iron - Folate - Magnesium - electrolytes Lifestyle advice - Adequate sleep quantity and quality - Regular movement/exercise that is moderated for your needs - Mindfulness practice (e.g. meditation) - Having boundaries - Slow breathing practice (e.g. box breathing) - Spending time in nature and natural light - Building positive supportive social connections - Avoiding or minimising alcohol intake - alcohol is a common tool used to ‘reduce stress’, however, evidence shows that it actually lowers your psychological and physiological resilience to stress in the long run. - Seeking professional help from a counsellor or clinical psychologist to address underlying trauma and/or cognitive patterning that may be contributing to your stress response. - Addressing digestive disturbances There are also some herbs that can help with stress. **Please see your primary medical healthcare practitioner and a qualified medical herbalist before taking herbal medicine as they may be contraindicated and/or interact with some medications. References: (Sarris & Wardle, 2019) DOI: 10.1016/bs.irn.2020.01.001 DOI: 10.1038/s41380-019-0615-x

“Connection is the energy that exists between people when they feel seen, heard and valued; when they can give and receive without judgement; and when they derive sustenance and strength from the relationship.” ~ Brene Brown Social connection is associated with numerous physical and mental health outcomes as well as longevity and health-span overall (Lutz, 2021) (Holt-Lunstad, 2022). Lack of social connection is associated with premature mortality and diminished well-being of older adults (Suragarn et al., 2021). It serves as a critical public health role and one that has suffered over the last few years due to the pandemic. Humans are fundamentally a social species and connection is vital for development and survival (Holt-Lunstad, 2022). Social connection is an important pillar found in every Blue Zone (areas in the world with the highest population of centenarians). Lock, Churra, & Barracka, 2017 reported that maintaining positive social connection not only increases one’s perceived sense of wellbeing and quality of life but also their brain health overall. As we age, it is common for our social networks to change and often grow smaller. Maintaining close, positive relationships where we feel valued and engaged is critical. Physical contact like hand holding and hugging has been found to reduce levels of stress by reducing cortisol and increasing oxytocin (Lock, Churra, & Barracka, 2017). Neighbourhood/community social cohesion adds another layer of social support found in literature to be important (Lock, Churra, & Barracka, 2017). It can be described as a perceived degree of connection and belonging among neighbours or a community with an increased willingness to intervene for the common good. Let's make sure we are connected with a positive community and take care of those around us. Our health and wellbeing depends on it.

Micronutrient deficiencies have been associated with poor mental health outcomes (Hechtman, 2019) (Rucklidge, 2018). Some key nutrients I commonly see deficiencies with in the clinic include: Omega-3 fatty acids (EPA>DHA) reduces neuro-inflammation and may influence serotonergic neurotransmission B vitamins - needed for synthesis of neurotransmitters and energy production. Some of these vitamins also support brain's ability to utilise glucose for energy. These vitamins can have a profound impact on mood and cognition. Vitamin C - is needed for neurotransmitter synthesis and acts as a neuro-protective agent. It may also attenuate cortisol and, therefore, reduce physiological impact of stress Iron - main function is to facilitate oxygen transport and storage. Deficiency is associated with fatigue and lethargy. Vitamin D - essential for brain development and homeostasis. It may also modulate several neurotransmitters such as serotonin. Zinc - studies have shown an inverse relationship between zinc status and depression. Zinc is believed to support healthy neurotransmission, reduce neuro-inflammation, as well as modulate neurotransmitters. Another special mention: Magnesium - needed for almost every biological process in the body. It helps with energy production and nerve conduction, therefore supporting the nervous system. It may be especially helpful with sleep as well as PMS mood fluctuations. (Braun & Cohen, 2015)(Hechtman, 2019) (Sarris & Wardle, 2019) (Blampied et al., 2019) Eating a diverse range of nutrient-dense whole-foods is the best way to ensure you are getting a balance of nutrients. Sometimes, supplementation is beneficial, especially if you restrict foods. Talk to your health care practitioner about how you can ensure that you are getting the micronutrients you need.