Phase Two - The Follicular Phase

Yin Rising

The second phase of the menstrual cycle is all about yin essence in Chinese Medicine. The feminine, cool, moistening energy.
It is when the follicles are growing, oestrogen is being produced and the endometrial lining is slowly thickening, getting ready to receive an embryo in the luteal phase of the cycle.

It is interesting to stop and think about the process that is happening at this point. As we all know women are born with a set number of eggs. These eggs reside in individual ovarian follicles which, when 'initiated', will grow over the course of about a year until they are mature enough to be selected for ovulation. Each menstrual cycle approximately 5-7 follicles are recruited to compete for the honour of being released at ovulation. The first follicle to reach a certain stage of development will become dominant,  the rest die away leaving the dominant follicle to mature and release its egg into a fallopian tube where it will hopefully be met by healthy sperm and create an embryo.

As you get closer to ovulation cervical mucus starts to be produced, reducing the naturally acidic or 'hostile' environment of the cervix, providing a safe pathway up to the fallopian tubes. Cervical mucus is the clear stretchy 'egg white' vaginal discharge many women experience for up to a week before ovulation occurs. It aids in lubrication during intercourse and contains the nutrients  and trace elements needed to keep sperm alive for days while they wait for the egg to enter the fallopian tubes.

If we want good quality eggs at ovulation we must nourish the environment the follicles are developing in. In Chinese Medicine terms this means nourishing the Yin and fluids.

Yin nourishing foods include pork, eggs, honey, tofu, seaweeds, apples, pineapple, kidney beans and black sesame seeds. Blood nourishing foods will also continue to be beneficial at this time so don't forget the bone broths, soups and stews. As we need extra hydration to help produce the slippery cervical mucus soups and stews are fabulous  meal choices.

Here is a link to a ham hock soup that ticks all the boxes for the follicular phase of the cycle:
http://thedesignfiles.net/2013/06/tasty-tuesday-smoked-ham-hock-rye-and-cavolo-nero-soup/

For the vegetarians floridix is a beneficial supplement during the whole of the follicular phase, while spirulina smoothies can be a great addition during these summer months for those with strong digestive systems. Miso soup is another great option, fill it up with plenty of tofu, nori and buckwheat noodles for a nourishing meal.

Heres a bit of a treat recipe from River Cottage. Its an apple crumble with the added goodness of walnuts and almonds: http://www.rivercottage.net/recipes/apple-and-walnut-crumble/
 
Heat tends to dry Yin up, as such anything that creates too much heat in the body is worth avoiding. This includes things like coffee, alcohol, chilli, greasy foods, smoking, emotional and physical stress that is not released and of course 'burning the candle'. So while warmth is super important, heat will reduce the amount of cervical mucus and potential cause an early ovulation with an immature egg.

To sum all this up, if you want your egg to be the best quality it can you need to nourish in the days leading up to ovulation. Look after yourself, do things that make you feel happy 'open the heart' and the rest will follow.

Phase 1 - The Menstrual Flow

Going With The Flow

The menstrual flow speaks volumes about the state of our reproductive health.  It is a concept that is simple to grasp, in fact you would think it was almost an unnecessary statement, however it is something we vary rarely stop to think about.  It varies wildly from woman to woman, and so too do ideas of what is normal.  However, whether it’s a non-event or a debilitating monthly occurrence, the state of the flow gives us an indication of what your fertile health is like. 

Ideally we are looking for a period that is something like this:

·      The flow starts during the night of the 27th day, or the morning of the 28th day (although a cycle between 26 and 30 days is considered normal providing it is regular). 

·      The menstrual blood starts fresh red (the same as if you had cut your hand and were bleeding) at a moderate flow (needing to change a light sanitary napkin/tampon every 4 hours).

·      The flow continues to get heavier until a regular sanitary napkin/ tampon needs to be changed approximately every 3 hours. 

·      The heavy flow is present for 1-2 days then tapers off and finishes cleanly, still fresh red in colour on day 4 or 5.

Clots, pain, bloating, mood changes, sore breasts, changes in bowl movements, headaches or fatigue before, during or after could be considered normal due to the fact that many people have them, but these symptoms are not ideal for optimum menstrual health.

Any deviation from the ideal will show us where we need to focus our attention.  For example, if there are large clots and/or pain, the endometrial lining is unlikely to be smooth, potentially causing implantation issues if you are trying to conceive.  A very light flow can indicate that the lining is too thin, again potentially causing implantation issues; while an extremely heavy flow can indicate a structural problem (eg fibroids) or an energetic imbalance.

During the period, there is a natural tendency to withdraw and take it easy.  Pain and emotions aside, it is the perfect time to sit and meditate, reflecting on the month that has past.  Take a break from your usual exercise routine and do some gentle yoga.  Sakshin Ghatastha www.muktiyoga.com.au and Iyengar yoga both have a lovely menstrual sequence.  It involves sitting on the floor in gentle forward bends and back bends, encouraging the body to open and allowing the blood to flow. Getting into nature with a slow walk through a park, by the creek or ocean can do wonders too.  Just remember to stay warm!  Cold naturally constricts and can cause a world of pain.

In Chinese Medicine there is a great analogy comparing the endometrium to being like a garden bed.  We need to nurture the soil, ensuring that it is rich and fertile, balanced in its nutrients.  Diet, plus our wonderful Chinese herbs and acupuncture, are the best way to achieve this.

At the beginning of the menstrual flow it is important to encourage the blood to flow.  This is where light exercise and acupuncture can be really beneficial.

Eggplant, turmeric, spring onions, leeks and crab are all examples of blood moving foods.

As the blood flow starts to taper off its important to start replenishing blood and fluids.  Organic red meat and soups made from bone stock are the most efficient way to do this.  Slow cooked meals such as osso bucco, lamb shanks and stews are the best option as the meat is easy to digest and the nutrients are “locked into” the sauce.  Here is a link to an aubergine and lamb recipe by Jamie Oliver, perfect for both nourishing and moving blood: http://www.jamieoliver.com/recipes/lamb-recipes/roast-leg-of-lamb-with-aubergines-and-onions.

In addition, here is a link to Sarah Wilson’s recipe for “Bone Broth”. It comes with a long list of why it’s so good for you and a clear and easy “how to”.   If you want to go a little more hard-core Chinese Medicine with this we’d be happy to give you some blood moving and nourishing herbs to put in towards the end of the cooking process, just to give the whole thing even more oomph!

http://www.sarahwilson.com.au/2012/01/how-to-make-bone-broth-and-why-you-should/

If this is a bit much, then chicken stock is a good alternative. (Back to Sarah Wilson again for this one!) http://www.sarahwilson.com.au/2013/04/my-crispy-roast-chicken-5-reasons-why-its-the-smartest-way-to-eat-a-chook/

If you’re not so big on the whole meat thing, then it is even more important to be aware of replenishing your blood energy.  Beetroot is the king vegetable with which to do this.  Tempeh, kidney beans, eggs and seaweeds are also considered good blood nourishing foods, as are any fruits or vegetables that are good sources of iron.  Here is a link to Maggie Beer’s wonderful Beetroot Risotto. She has a bit of bacon in the recipe, but it’s easy to leave out if you want.  I love to serve it with some Meredith’s Goats Cheese and a side of sautéed silver beet.

http://www.maggiebeer.com.au/recipes/beetroot-risotto

Regardless of whether you are trying to conceive or not, having an awareness of your cycle, embracing the monthly flow and looking after your menstrual health will serve you well for years to come - and by this I mean menopause, but that’s for another post! 

Six Weeks in Walcha

Spending six weeks practicing in a different environment, has given me a strong reminder of a great strength of Chinese Medicine; the notion that we are always at one with our environment. Our surroundings – the climate, the land, the air, the seasons, the other people and animals, the plants and microbes, the dust, the sunshine… – might as well be considered just a much a part of us as our own left elbow. I found that this is more obvious in the countryside, where the people are truly connected to their land.

I’ve been living at Bergen Op Zoom, a beautiful slice of farmland just outside of Walcha, a small town in NSW, roughly one hour drive from both Armidale and Tamworth. Armidale claims to be the highest altitude city in Australia, and Walcha is a ‘town built in a hole’ nearby, where the land dips down into a shallow valley, upon the New England plateau. The drive down-mountain to Port Macquarie, extremely popular with motorcyclists seeking the thrill and fresh air of a windy forest road, takes you down more than a thousand metres of altitude in a few hours, landing you at sea level nearby some of the most beautiful beaches I have ever visited. The first time I drove back up the mountain, was when I truly realized the remarkable difference in climate. And the climate is not the only thing that changes. “Mountain people are much different from coastal people,” says Hamish Brown, my Chinese Medicine friend, and Kungfu master, for whom I was stepping in for at ‘The Way of Water’ Chinese Medicine clinic, in both Walcha and Armidale. Hamish is a true mountain man. Whilst although I had a thoroughly enjoyable experience of the New England folk, and the landscape, I think I’ll always be a coastal girl. I’m a saltwater girl from way back. But there is ‘a great mob of people in Walcha’, as Phillip Brown says, and I agree, 100%.

Walcha is a cold, dry place. In six weeks there, the skies opened up only twice. Initially I found it more difficult to breathe, especially when I’d break into a jog down the red gravelly farm road. The air is colder, drier, and carries less oxygen, so I am quite sure I’ve come home with a few extra red blood cells in my system. In town, the air is smoky, from the abundance of wood-fires. My skin has become drier, my lips drier, and I’ve barely had to wash my hair. At the clinic, common presentations included asthma, eczema, menopausal hot flushes, arthritis, and aches and pains of all sorts. All of these conditions, in Chinese Medicine, can be a result of exposure to too much cold, and not enough moisture.

Since back practicing in Melbourne town, I’ve been observant to see if any patterns start to shine through more strongly, through my eyes that now envision a slightly different perspective. What are the strongest environmental forces in the Melbourne climate? The cold weather, wind, and pollens dominate through winter and spring, but the effects are not as widespread, or ingrained, across the population. This must be because we can escape it more in the city, with more time spent indoors, amongst our higher density of housing, masses of concrete, and generally highly modified landscape. The people I meet in Melbourne come from all over the globe, whereas in Walcha, most families seemed to have been there for generations. Or if they were ‘new’ to town, I’d hear things like “Nah, I’m no local yet. Only been ‘ere fifty years!”.

We are much less connected to the land in the cities, and it seems this disconnection comes with both benefits and downfalls. Whilst imbalances with our surrounding environment can be the cause of disease, a disconnection with this other part of our whole, has its own consequences. The forces of nature have powerful healing ability as well. Bob, the farmer at Bergen Op Zoom, a passionate advocator of the buteyko breathing technique, and a man who says he is so connected to the land, that he will never leave it, is truly living as one with his surroundings. During my six weeks in Walcha, I felt connected to the land in a way that I have only ever felt more strongly during a multi-day hike through the wilderness, my time spent ‘WWOOFing’, or by spending a lot of time in the ocean. Perhaps farming’s the way to go, if this connection is what you want for long-term. Bob and I killed a sheep the other day. And the next morning I ate it’s liver for breakfast.

I have brought home from this experience a pocketful of new acupuncture techniques, experience with different acupuncture needles, exposure to a broad range of diseases and conditions, and a deeper understanding of many herbal formulas. I also feel stronger, in both body and mind, after training under Hamish Brown and Matt Starr alongside a wonderful, dedicated group of Taichi and Kungfu students. The dedication and discipline I have witnessed, although not yet developed within myself, has been inspirational.

For this experience, I would like to thank Hamish, his caring family, and all of the people I have worked with in the Chinese medicine clinics. I’d also like to thank all of my fellow practitioners at Quiescence, for allowing me to disappear for a while, and for taking such good care of my patients in my absence. To Hamish, I thank you for welcoming me, and entrusting me into your home and clinic, and for all that I have learnt from you. To the patients, I have appreciated your open-mindedness, and commitment to improving your health. I also feel incredibly grateful for all the friendship and support I have received, especially from Camilla Fontanella, Bob Waugh, the Kungfu crew, Phillip and Katie, and any of my patients who have helped me out, whilst I have helped them. Exchange and sharing is always a wonderful thing. I also hope that my presence has had positive impact on the lives of those I have met.

And finally, I would like to thank the New England landscape, for welcoming me into your grasp, and becoming a part of me.

Steph x

The Menstrual Cycle - An Overview

The Yin and Yang of the Menstrual Cycle

It's surprising how may of us women have very little idea of how the menstrual cycle works. Although after years on the pill and being told "if you have unprotected sex, you will get pregnant" maybe its not so surprising after all...

In Chinese Medicine we break the menstrual cycle down into two halves and four phases.

The two halves of the cycle are as in western medicine, i.e. from the first day of bleeding (day 1) until ovulation is known as the follicular phase and is said to be the Yin half of the cycle.  Yin essence is the feminine, cool, moistening energy in the body. It's incredibly important in creating the slippery fluids involved in conception, nourishing the developing follicles and keeping the sperm alive on their journey to the egg.
From ovulation until the following day 1 is the luteal phase and is said to be the the yang half of the cycle. Yang essence is the masculine, warming strengthening energy in the body. It has the same function as progesterone in the sense that it keeps the body's temperatures high, creating the perfect incubator for the developing embryo and secures the uterus preventing miscarriage.

These halves are further broken down into 4 phases.

Phase One is all about blood. It's when the sloughing off of the emdometrium occurs, the period itself.  This is where the body is clearing out the old to make way for the new, where the Yin essence is starting to build.

Phase Two is the continuation of Yin essence building. It's where the endometrium regenerates and the follicles develop. At the end of this phase we should start to see the cervical mucus become more fertile (clear and stretchy).

Phase Three is the switch from Yin to Yang, ovulation. The Yin essence reaches is maximum (positive OPK test), ovulation occurs and the Yang essence takes over.
If you are trying to conceive ideally there would be lots of healthy sperm waiting for the released egg to enter the fallopian tube, conception occurs and the newly formed embryo makes its way down the fallopian tube to the uterus.

Phase Four is the continuation of Yang essence building. If you are trying to conceive implantation  occurs sometime at the beginning of this phase and the warm yang energy nourishes and supports conception.

Ideally this happens over a 28 day cycle. Phase one being day 1-4, phase two being day 5-11, phase 3 being day 12-16 and phase four being day 17-28. Please note if you do not have a 27-29 day cycle the days will need to be adjusted to fit your cycle.

Over the next few posts we will go into more detail of each of the phases with things to look out for and a few diet and lifestyle suggestions.

Nourishing Life

Nourishing Life, and Fertility

Yang Sheng, in Chinese, means to ‘nourish life’. The principles are based on the preservation of health, not just the treatment of disease. The way we choose to care for our health now will impact not only on the quality of our health in later years but also that of our children, and children’s children, for many generations to come.

At Quiescence we do a lot of work assisting couples to conceive. As a result men’s and women’s health in general has become the dominating focus of our practice, whether you are trying to conceive or not. It has become obvious that optimal health equates to optimal fertility. We feel this concept is especially important because it is this state of health that is carried forward into the future. From a ‘Yang Sheng’ perspective it’s not just about having babies, but also about having healthy, constitutionally strong babies who grow into happy, healthy kids.Over the next few posts we will be writing about the various stages of the menstrual cycle, linking the Chinese Medicine to the western medicine and hopefully giving you a better understanding of how this whole thing works. But for now please, take a second and think about this: How nourishing is my lifestyle really.

• How much of my food comes from a packet? 

• How much exercise am I getting? 

• How much sleep am I getting? 

• How much stress am I under? 

• Is trying to conceive becoming an obsession?

If you're not happy with your answer to any of these questions talk about it with your partner, and with us. If our lives are well nourished then we can support the growth and development of new life, happily and healthily.

Fish, omega 3's, mercury and pregnancy

The question of eating fish while trying to conceive and during pregnancy seems to come up a lot. On one hand we need the essential fatty acids that fish offers for the health and development of the baby's eyes, brain and nervous system. Not to mention mum's immune system and hormones that are involved in the growth of the placenta. On the other hand what about the mercury content and issues with over fishing?

The good news is that there are fish that are OK to eat and the ones to avoid are easy.

Ideally a serve of fish 3 times per week is recommended plus a daily dose of good quality fish oils.

The following fish are low in mercury and  high in omega 3's. They are also considered a better choice by the Australian Marine  Conservation Society. http://www.marineconservation.org.au

Mackerel
Wild Australian Salmon and tinned salmon
Herrings
Sardines

The following fish are low in mercury but not as high in omega 3's (while still being a good environmental choice) are as follows:

Squid and octopus
Whiting
Wild Trevally
Mullet
Bream

A word about farmed fish:

In the past fish farming has been loosely regulated allowing for poor practises to develop. Some of these practises include overcrowding, the use of wild fisheries to supply feed and overuse of antibiotics to treat disease. With tighter regulations and pressure from the public many fisheries are improving their farming practises. If you are choosing farmed fish, its worth looking a bit further into the farm and how it does things.

A word about tinned tuna:

There are several species of tuna, all with varying levels of mercury and degrees of over fishing. Greenpeace has put together a website ranking tinned tuna from a sustainable perspective, but doesn't take into consideration the mercury content. http://www.greenpeace.org/australia/en/what-we-do/oceans/Take-action/canned-tuna-guide/
Fortunately Skipjack seems to be both lower in mercury and generally "pole caught", therefor better environmentally. Based on Greenpeace's ranking Fish 4 Ever, Safcol and Greenseas are the top three.
White Ablacore is higher in mercury while yellowfin is at risk of overfishing.

Fish to avoid:

Shark (flake)
Orange Roughy
Swordfish
Ling
Marlin

Yoga Is Truly Awesome

I’ve just completed my first yoga class in a long while and I feel fabulous.

I was a regular yoga goer for many years until the birth of my son, then it just seemed impossible to find the time. I forgot just how good it could make you feel and "getting back to the mat" slowly stopped being a priority.

It’s been three super busy years but finally a little bit of balance is creeping back in,  so again I find myself on the mat, happily practising Sakshin Ghatastha Yoga.

 This wonderful form of yoga has a flowing almost dance like quality to it and can be practiced by anyone. One of the best things about Ghatastha Yoga is the personal tuition option.  These are classes where, while you share the room with other students, you get personally taught a sequence. These sequences are organized in grades and can be adjusted to fit any health requirements, they even have a sequence especially for menstruation. Its perfect if you have an injury, are pregnant or are trying to get pregnant.  Once you’ve learnt a sequence you can practice anywhere, anytime. It just up to you to do it!

Teachers of Sakshin Ghatastha Yoga can be found either

1) in the city at the Yoga Arts Academy www.yogaarts.com.au

2) in Preston with Lisa Farinosi  www.muktiyoga.com.au

3) in the city with Jasmine Johnston at www.studiocirq.com.au

If just making you feel physically great isn’t enough, some of the other health benefits yoga can give include lowering anxiety, stress and depression while increasing antioxidant status.

A recent study measured gene expression after a yoga session and it showed a positive effect on circulating immune cells. If you’d like to read more about this study have a look here: http://www.plosone.org/article/info%3Adoi%2F10.1371%2Fjournal.pone.0061910

Lisa in Garudasana