References

Chapter 1: Refilling Your Cupboard

HOW YOUR CUPBOARD CAN BECOME BARE

Growing Demands upon You

If any nutrients were missing in the foods you ate, they were extracted from you and given to your child.

King, Janet C. “The Risk of Maternal Nutritional Depletion and Poor Outcomes Increases in Early or Closely Spaced Pregnancies.” Journal of Nutrition 133, no. 5 (2003): 1732S–1736S. https://doi.org/10.1093/jn/133.5.1732s.

Marshall, Nicole E., Barbara Abrams, Linda A. Barbour, Patrick Catalano, Parul Christian, Jacob E. Friedman, William W. Hay, et al. “The Importance of Nutrition in Pregnancy and Lactation: Lifelong Consequences.” American Journal of Obstetrics and Gynecology 226, no. 5 (2021): 607–32. https://doi.org/10.1016/j.ajog.2021.12.035.

If you breastfeed (about half of all mothers do—and we generally recommend it for its benefits for both you and your child)

CDC. “Breastfeeding Report Card.” Breastfeeding Data, 26 Aug. 2025, https://www.cdc.gov/breastfeeding-data/breastfeeding-report-card/index.html.

Purkiewicz, Aleksandra, Kamila J. Regin, Wajeeha Mumtaz, and Renata Pietrzak-Fiećko. “Breastfeeding: The Multifaceted Impact on Child Development and Maternal Well-Being.” Nutrients 17, no. 8 (2025): 1326.
https://doi.org/10.3390/nu17081326.

each day you burn up an extra 450–500 calories

“Breastfeeding Your Baby.” Accessed November 4, 2025.
https://www.acog.org/womens-health/faqs/breastfeeding-your-baby.

If you are not getting enough of these nutrients in your regular diet, and few moms with infants seem to have the time

Murphy, S, P., and B. F. Abrams. “Changes in Energy Intakes During Pregnancy and Lactation in a National Sample of US Women.” American Journal of Public Health 83, no. 8 (1993): 1161–63. https://doi.org/10.2105/AJPH.83.8.1161.

your bodily reserves are drained every time you nurse

For a general reference, see:

Kennedy, K. I. “Effects of Breastfeeding on Women’s Health.” International Journal of Gynecology & Obstetrics 47, no. Supplement (1994).
https://doi.org/10.1016/0020-7292(94)02230-V.

For studies on essential fatty acids, see:

Al, Monique D. M., Adriana C. van Houwelingen, and Gerard Hornstra. “Long-Chain Polyunsaturated Fatty Acids, Pregnancy, and Pregnancy Outcome.” American Journal of Clinical Nutrition 71, no. 1 (2000): 285S–291S.
https://doi.org/10.1093/ajcn/71.1.285S.

Holman, R. T., S. B. Johnson, and P. L. Ogburn. “Deficiency of Essential Fatty Acids and Membrane Fluidity During Pregnancy and Lactation.” Proceedings of the National Academy of Sciences 88, no. 11 (1991): 4835–39.
https://doi.org/10.1073/pnas.88.11.4835.

Hornstra, Gerard. “Essential Fatty Acids in Mothers and Their Neonates.” American Journal of Clinical Nutrition 71, no. 5 (2000): 1262S–1269S.
https://doi.org/10.1093/ajcn/71.5.1262s.

Otto, Suzie J., Adriana C. van Houwelingen, Anita Badart-Smook, and Gerard Hornstra. “Comparison of the Peripartum and Postpartum Phospholipid Polyunsaturated Fatty Acid Profiles of Lactating and Nonlactating Women.” American Journal of Clinical Nutrition 73, no. 6 (2001): 1074–79.
https://doi.org/10.1093/ajcn/73.6.1074.

Otto, Sj, Adriana C. van Houwelingen, M. Antal, et al. “Maternal and Neonatal Essential Fatty Acid Status in Phospholipids: An International Comparative Study.” European Journal of Clinical Nutrition 51, no. 4 (1997): 232–42.
https://doi.org/10.1038/sj.ejcn.1600390.

Zeijdner, E. E., A. C. van Houwelingen, A. D. M. Kester, and G. Hornstra. “Essential Fatty Acid Status in Plasma Phospholipids of Mother and Neonate After Multiple Pregnancy.” Prostaglandins, Leukotrienes and Essential Fatty Acids 56, no. 5 (1997): 395–401.
https://doi.org/10.1016/S0952-3278(97)90590-1.

For other research on nursing, particularly if nutrition is poor, see:

Adair, Linda S., and Barry M. Popkin. “Prolonged Lactation Contributes to Depletion of Maternal Energy Reserves in Filipino Women.” Journal of Nutrition 122, no. 8 (1992): 1643–55. https://doi.org/10.1093/jn/122.8.1643.

Besides being time-consuming, the work of mothers is uniquely stressful

Crnic, Keith A., and Mark T. Greenberg. “Minor Parenting Stresses with Young Children.” Child Development 61, no. 5 (1990): 1628.
https://doi.org/10.2307/1130770.

Tein, Jenn-Yun, Irwin N. Sandler, and Alex J. Zautra. “Stressful Life Events, Psychological Distress, Coping, and Parenting of Divorced Mothers: A Longitudinal Study.” Journal of Family Psychology 14, no. 1 (2000): 27–41.
https://doi.org/10.1037/0893-3200.14.1.27.

Breastfeeding rarely proceeds without one troublesome hitch or another, especially in the beginning.

Schmied, Virginia, and Lesley Barclay. “Connection and Pleasure, Disruption and Distress: Women’s Experience of Breastfeeding.” Journal of Human Lactation 15, no. 4 (1999): 325–34. https://doi.org/10.1177/089033449901500410.

Wambach, Karen A. “Maternal Fatigue in Breastfeeding Primiparae During the First Nine Weeks Postpartum.” Journal of Human Lactation 14, no. 3 (1998): 219–29. https://doi.org/10.1177/089033449801400311.

mothers consistently report more stress than fathers, or women not raising children

Campbell, Angus, Philip E. Converse, and Willard L. Rodgers. The Quality of American Life: Perceptions, Evaluations, and Satisfactions. Russell Sage Foundation, 1976.

Larson, Reed W., Maryse H. Richards, and Maureen Perry-Jenkins. “Divergent Worlds: The Daily Emotional Experience of Mothers and Fathers in the Domestic and Public Spheres.” Journal of Personality and Social Psychology 67, no. 6 (1994): 1034–46.
https://doi.org/10.1037/0022-3514.67.6.1034.

Luecken, Linda J., Edward C. Suarez, Cynthia M. Kuhn, et al. “Stress in Employed Women: Impact of Marital Status and Children at Home on Neurohormone Output and Home Strain.” Psychosomatic Medicine 59, no. 4 (1997): 352–59.
https://doi.org/10.1097/00006842-199707000-00003.

Skreden, Marianne, Hans Skari, Ulrik F. Malt, et al. “Parenting Stress and Emotional Wellbeing in Mothers and Fathers of Preschool Children.” Scandinavian Journal of Public Health 40, no. 7 (2012): 596–604.
https://doi.org/10.1177/1403494812460347.

especially if a child has any special needs, like colic

Beebe, Susan A., Rosemary Casey, and Jennifer Pinto-Martin. “Association of Reported Infant Crying and Maternal Parenting Stress.” Clinical Pediatrics 32, no. 1 (1993): 15–19. https://doi.org/10.1177/000992289303200103.

an illness

Almulla, Hebah, Ohoud Aljaloud, Halah Almulla, and Seema Nasser. “Caregiver Burden, Perceived Stress, and Social Support Among Parents of Chronically Ill Children in Saudi Arabia.” BMC Nursing 23, no. 1 (2024): 811.
https://doi.org/10.1186/s12912-024-02494-8.

Golfenshtein, Nadya, Alexandra L .Hanlon, Janet A. Deatrick, and Barbara Medoff-Cooper. “Maternal Parenting Stress Changes over the First Year of Life in Infants with Complex Cardiac Defects and in Healthy Infants.” Cardiology in the Young 32, no. 3 (2022): 383–89. https://doi.org/10.1017/S104795112100216X.

Hauenstein, Emily J. “The Experience of Distress in Parents of Chronically Ill Children: Potential or Likely Outcome?” Journal of Clinical Child Psychology 19, no. 4 (1990): 356–64. https://doi.org/10.1207/s15374424jccp1904_7.

a disability

Dumas, Jean E., Lucille C. Wolf, Sandra N. Fisman, and Annie Culligan. “Parenting Stress, Child Behavior Problems, and Dysphoria in Parents of Children with Autism, Down Syndrome, Behavior Disorders, and Normal Development.” Exceptionality 2, no. 2 (1991): 97–110. https://doi.org/10.1080/09362839109524770.

or a challenging temperament

Fischer, Mariellen. “Parenting Stress and the Child with Attention Deficit Hyperactivity Disorder.” Journal of Clinical Child Psychology 19, no. 4 (1990): 337–46. https://doi.org/10.1207/s15374424jccp1904_5.

Van Den Bloom, Dymphna C., and Jan B. Hoeksma. “The Effect of Infant Irritability on Mother-Infant Interaction: A Growth-Curve Analysis.” Developmental Psychology 30, no. 4 (1994): 581–90. https://doi.org/10.1037/0012-1649.30.4.581.

the more kids, the more work and stress

Lavee, Yoav, Shlomo Sharlin, and Ruth Katz. “The Effect of Parenting Stress on Marital Quality: An Integrated Mother-Father Model.” Journal of Family Issues 17, no. 1 (1996): 114–35. https://doi.org/10.1177/019251396017001007.

Over half of all mothers today will return to work before their baby’s first birthday

Han, Wen-Jui, Christopher J. Ruhm, Jane Waldfogel, and Elizabeth Washbrook. “The Timing of Mothers’ Employment After Childbirth.” Monthly Labor Review 131, no. 6 (2008): 15–27.

yet doing so while raising an infant increases their risk of health problems, especially if they’re already stretched, such as by being a single parent

Ali, J., and W. R. Avison. “Employment Transitions and Psychological Distress: The Contrasting Experiences of Single and Married Mothers.” Journal of Health and Social Behavior 38, no. 4 (1997): 345–62.

McGovern, Patricia, Bryan Dowd, Dwenda Gjerdingen, Ira Moscovice, Laura Kochevar, and William Lohman. “Time Off Work and the Postpartum Health of Employed Women:” Medical Care 35, no. 5 (1997): 507–21.
https://doi.org/10.1097/00005650-199705000-00007.

Walker, Lorraine O., and Mary Ann Best. “Well-Being of Mothers with Infant Children: A Preliminary Comparison of Employed Women and Homemakers.” Women & Health 17, no. 1 (1991): 71–89.
https://doi.org/10.1300/J013v17n01_05.

A Thin Soup of Resources

the typical mother of a young child gets about 6½ hours of sleep a day . . . plus she rarely gets a chance to sleep as deeply as she needs to

Kalil, Ariel, Rachel Dunifon, Danielle Crosby, and Jessica Houston Su. “Work Hours, Schedules, and Insufficient Sleep Among Mothers and Their Young Children.” Journal of Marriage and Family 76, no. 5 (2014): 891–904.
https://doi.org/10.1111/jomf.12142.

Lee, K. “Parity and Sleep Patterns During and After Pregnancy.” Obstetrics & Gynecology 95, no. 1 (2000): 14–18.
https://doi.org/10.1016/S0029-7844(99)00486-X.

Maas, James B. Power Sleep: The Revolutionary Program That Prepares Your Mind for Peak Performance. 1. ed., [Nachdr.]. HarperPerennial, 2000.

You’re probably not eating all that well, either

Mackey, Amy D., Mary Frances Picciano, Diane C. Mitchell, and Helen Smiciklas-Wright. “Self-Selected Diets of Lactating Women Often Fail to Meet Dietary Recommendations.” Journal of the American Dietetic Association 98, no. 3 (1998): 297–302.
https://doi.org/10.1016/S0002-8223(98)00070-4.

when you’ve got a young family, pleasures fall away, old friends drop out of your life, and you never seem to have any real time for yourself.

Even if you’re ill, you usually get little chance to rest.

Woods, Nancy Fugate, and Barbara Sorenson Hulka. “Symptom Reports and Illness Behavior Among Employed Women and Homemakers.” Journal of Community Health 5, no. 1 (1979): 36–45. https://doi.org/10.1007/BF01321569.

the average mom works about 20 hours more per week, altogether, than does her partner, regardless of whether she’s drawing a paycheck

Cowan, Ruth Schwartz. More Work for Mother: The Ironies of Household Technology from the Open Hearth to the Microwave. Repr. Basic Books, 2008.

Hess, Cynthia, Tanima Ahmed, and Jeff Hayes. “Providing Unpaid Household and Care Work in the United States: Uncovering Inequality.” Institute for Women’s Policy Research, January 2020. https://iwpr.org/wp-content/uploads/2020/01/IWPR-Providing-Unpaid-Household-and-Care-Work-in-the-United-States-Uncovering-Inequality.pdf.

Rexroat, Cynthia, and Constance Shehan. “The Family Life Cycle and Spouses’ Time in Housework.” Journal of Marriage and the Family 49, no. 4 (1987): 737.
https://doi.org/10.2307/351968.

You probably also handle more of the high-stress tasks, like dressing a resistant two-year-old, plus carry more of the “executive responsibility” for the family

For a general review:

Maushart, Susan. The Mask of Motherhood: How Becoming a Mother Changes Everything and Why We Pretend It Doesn’t. Penguin Books, 2000.

if you’re raising your children essentially alone, as do one in five mothers

Blankenhorn, David. Fatherless America: Confronting Our Most Urgent Social Problem. Basic Books, 1995.

the arrival of children commonly leads to a dramatic decrease in positive interactions and marital satisfaction—especially for mothers

Belsky, Jay, and John Kelly. The Transition to Parenthood: How a First Child Changes a Marriage: Why Some Couples Grow Closer and Others Apart. Dell Pub., 1995.

Cowan, Carolyn Pape, and Philip A. Cowan. When Partners Become Parents: The Big Life Change for Couples. Lawrence Erlbaum, 2000.

Kurdek, Lawrence A. “The Nature and Predictors of the Trajectory of Change in Marital Quality for Husbands and Wives over the First 10 Years of Marriage.” Developmental Psychology 35, no. 5 (1999): 1283–96.
https://doi.org/10.1037/0012-1649.35.5.1283.

Shapiro, Alyson Fearnley, John M. Gottman, and Sybil Carrère. “The Baby and the Marriage: Identifying Factors That Buffer Against Decline in Marital Satisfaction After the First Baby Arrives.” Journal of Family Psychology 14, no. 1 (2000): 59–70.
https://doi.org/10.1037/0893-3200.14.1.59.

couples with children report less satisfaction with their relationship than couples without kids

Children are meant to be raised within a strong community

Flinn, Mark V., and Barry G. England. “Social Economics of Childhood Glucocorticoid Stress Response and Health.” American Journal of Physical Anthropology 102, no. 1 (1997): 33–53. https://doi.org/10.1002/(SICI)1096-8644(199701)102:1<33::AID-AJPA4>3.0.CO;2-E.

Small, Meredith F. “Family Matters.” Discover , 2000. 21st ed.: 66-71.

the average adult is affiliated with just one community group as compared to five in our parents’ day

Putnam, Robert D. Bowling Alone: The Collapse and Revival of American Community. Simon & Schuster, 2001.

fathers have not entered the world of family to the extent that mothers have gone into the world of work

National Advisory Mental Health Council. “Basic Behavioral Science Research for Mental Health: Family Processes and Social Networks.” American Psychologist 51, no. 6 (1996): 622–30. https://doi.org/10.1037/0003-066X.51.6.622.

Carter, Betty. “Focusing Your Wide-Angle Lens.” The Family Therapy Networker, December 1995.

you’re likely to have much less of the social support that could have provided practical help, lowered your stress, and buttressed your health

Aspinwall, Lisa G., and Shelley E. Taylor. “A Stitch in Time: Self-Regulation and Proactive Coping.” Psychological Bulletin 121, no. 3 (1997): 417–36.
https://doi.org/10.1037/0033-2909.121.3.417.

Vulnerable Spots in Your Armor of Resilience

if you are even a little anemic when you enter motherhood‚ as up to 40 percent of women are

Alwan, Nisreen A., and Hanan Hamamy. “Maternal Iron Status in Pregnancy and Long-Term Health Outcomes in the Offspring.” Journal of Pediatric Genetics 4, no. 2 (2015): 111–23. https://doi.org/10.1055/s-0035-1556742.

In the last three decades, the birthrate of women over 30 has increased by about one-quarter, and the rate of first births for women over 35 has nearly doubled.

Driscoll, Anne K., and Brady E. Hamilton. Effects of Age-Specific Fertility Trends on Overall Fertility Trends: United States, 1990–2023.

National Center for Health Statistics. National Vital Statistics Reports. Hyattsville, MD: US Department of Health and Human Services, March 6, 2025. https://stacks.cdc.gov/view/cdc/174576.

Older mothers are typically less able to weather a pregnancy

Gilbert, W. “Childbearing beyond Age 40: Pregnancy Outcome in 24,032 Cases.” Obstetrics & Gynecology 93, no. 1 (1999): 9–14.
https://doi.org/10.1016/S0029-7844(98)00382-2.

Siega-Riz, A. M., and L. S. Adair. “Biological Determinants of Pregnancy Weight Gain in a Filipino Population.” American Journal of Clinical Nutrition 57, no. 3 (1993): 365–72. https://doi.org/10.1093/ajcn/57.3.365.

About nine mothers in ten have not consumed the US government recommended amounts of minerals and vitamins before conceiving their first child.

This figure is an estimate based on combining the low percentages of women who consume any one of the many nutrients for which there are RDAs. See:

Bendich, Adrianne. “Lifestyle and Environmental Factors That Can Adversely Affect Maternal Nutritional Status and Pregnancy Outcomes.” Annals of the New York Academy of Sciences 678, no. 1 (1993): 255–65.
https://doi.org/10.1111/j.1749-6632.1993.tb26127.x.

Block, Gladys, and Barbara Abrams. “Vitamin and Mineral Status of Women of Childbearing Potential.” Annals of the New York Academy of Sciences 678, no. 1 (1993): 244–54.
https://doi.org/10.1111/j.1749-6632.1993.tb26126.x.

Godfrey, Keith M., Philip Titcombe, Sarah El-Heis, et al. “Maternal B-Vitamin and Vitamin D Status Before, During, and After Pregnancy and the Influence of Supplementation Preconception and During Pregnancy: Prespecified Secondary Analysis of the NiPPeR Double-Blind Randomized Controlled Trial.” PLOS Medicine 20, no. 12 (2023): e1004260.
https://doi.org/10.1371/journal.pmed.1004260.

Jameson, Sten. “Zinc Status in Pregnancy: The Effect of Zinc Therapy on Perinatal Mortality, Prematurity, and Placental Ablation.” Annals of the New York Academy of Sciences 678, no. 1 (1993): 178–92.
https://doi.org/10.1111/j.1749-6632.1993.tb26121.x.

about a third of all pregnancies are unplanned

CDC. “Unintended Pregnancy.” Reproductive Health, January 31, 2025. https://www.cdc.gov/reproductive-health/hcp/unintended-pregnancy/index.html.

Hellerstedt, W. L., P. L. Pirie, H. A. Lando, et al. “Differences in Preconceptional and Prenatal Behaviors in Women with Intended and Unintended Pregnancies.” American Journal of Public Health 88, no. 4 (1998): 663–66.
https://doi.org/10.2105/AJPH.88.4.663.

even if you start taking supplements, it often takes months or years to restore healthy levels of nutrients in your body

Siega-Riz, Anna, Linda Adair, and Calvin Hobel. “Maternal Hematologic Changes During Pregnancy and the Effect of Iron Status on Preterm Delivery in a West Los Angeles Population.” American Journal of Perinatology 15, no. 09 (1998): 515–22.
https://doi.org/10.1055/s-2007-993976.

Your relatives may have had illnesses . . . that raise your risk for similar problems.

Burt, Vivien K., and Victoria C. Hendrick. Concise Guide to Women’s Mental Health. 2nd ed. American Psychiatric Pub., 2001.

Women are more likely than men to enter parenthood with preexisting gastrointestinal

Wolf, Jacqueline L. “Bowel Function.” In Primary Care of Women edited by Karen J. Carlson and Stephanie A. Eisenstat, 79. Mosby-Year Book, Inc., 1995.

hormonal

Burt, Vivien K., and Victoria C. Hendrick. Concise Guide to Women’s Mental Health. 2nd ed. American Psychiatric Pub., 2001.

or autoimmune conditions

Komaroff, A. L. “Fatigue and Chronic Fatigue Syndrome.” In Primary Care of Women edited by Karen J. Carlson and Stephanie A. Eisenstat, 452. Mosby-Year Book, Inc., 1995.

one mother in eight will have an episode of PPD

Bauman, Brenda L. “Vital Signs: Postpartum Depressive Symptoms and Provider Discussions About Perinatal Depression—United States, 2018.” MMWR. Morbidity and Mortality Weekly Report 69 (2020).
https://doi.org/10.15585/mmwr.mm6919a2.

Khadka, Nehaa, Michael J. Fassett, Yinka Oyelese, et al. “Trends in Postpartum Depression by Race, Ethnicity, and Prepregnancy Body Mass Index.” JAMA Network Open 7, no. 11 (2024): e2446486. https://doi.org/10.1001/jamanetworkopen.2024.46486.

And if you suffered from postpartum depression after your first baby, your chance triples of having PPD again with another child.

Munk-Olsen, Trine, Katja G. Ingstrup, Benedicte M. Johannsen, and Xiaoqin Liu. “Population-Based Assessment of the Recurrence Risk of Postpartum Mental Disorders: Will It Happen Again?” JAMA Psychiatry 77, no. 2 (2020): 213.
https://doi.org/10.1001/jamapsychiatry.2019.3208.

Some women have a tendency toward depression, and this can be intensified by the hormonal fluctuations of motherhood.

Schiller, Crystal Edler, Samantha Meltzer-Brody, and David R. Rubinow. “The Role of Reproductive Hormones in Postpartum Depression.” CNS Spectrums 20, no. 1 (2015): 48–59. https://doi.org/10.1017/S1092852914000480.

Also see Chapter 5.

Swimming Upstream

your life would have moved at the speed of a walk while you provided for your needs and fulfilled your ambitions with a child on your hip or nearby

See the work of Sarah Blaffer Hrdy, cited in:

Angier, Natalie, “Primate Expert Explores Motherhood’s Brutal Side,” New York Times, February 8, 2000,
https://www.nytimes.com/2000/02/08/science/scientist-work-sarah-blaffer-hrdy-primate-expert-explores-motherhood-s-brutal.html

we can’t help absorbing some of the billions of pounds of toxins released into the environment each year, which even leave traces in breast milk

Byczkowski, J. Z., J. M. Gearhart, and J. W. Fisher. “‘Occupational’ Exposure of Infants to Toxic Chemicals via Breast Milk.” Nutrition (Burbank, Los Angeles County, Calif.) 10, no. 1 (1994): 43–48.

Rogan, Walter J. “Pollutants in Breast Milk.” Archives of Pediatrics & Adolescent Medicine 150, no. 9 (1996): 981. https://doi.org/10.1001/archpedi.1996.02170340095018.

The Effects on a Mother’s Body

vitamin B6, which is critical for hormone balance and the production of serotonin, a neurotransmitter that helps regulate mood and digestion

See Chapter 5.

magnesium, which is essential for sleep, as well as taurine, an amino acid that helps a person feel both energized and relaxed

See Chapter 5.

Recognizing Depletion

For example, the body of a woman generally reacts more intensely to stress than a man’s does

Gallucci, William T., Andrew Baum, Louisa Laue, et al. “Sex Differences in Sensitivity of the Hypothalamic-Pituitary-Adrenal Axis.” Health Psychology 12, no. 5 (1993): 420–25. https://doi.org/10.1037/0278-6133.12.5.420.

chronic . . . stress relentlessly disturbs

For general reviews, see:

Sapolsky, Robert M. Why Zebras Don’t Get Ulcers. Third edition. St. Martin’s Griffin, 2004.

Regarding the gastrointestinal system, see:

Wolf, Jacqueline L. “Bowel Function.” In Primary Care of Women, edited by Karen J. Carlson and Stephanie A. Eisenstat, 79. Mosby-Year Book, Inc., 1995.

Regarding the nervous system, see:

Hamilton, J. A., and M. Jensvold. “Personality, Psychopathology, and Depressions in Women.” In Personality and Psychopathology: Feminist Reappraisals, edited by L. S. Brown and M. Ballou, 116–143. Guilford Press, 1992.

McEwen, Bruce S. “Neurobiological and Systemic Effects of Chronic Stress.” Chronic Stress 1 (February 2017).
https://doi.org/10.1177/2470547017692328.

Newcomer, J. W., G. Selke, A. K. Melson, et al. “Decreased Memory Performance in Healthy Humans Induced by Stress-Level Cortisol Treatment.” Archives of General Psychiatry 56, no. 6 (1999): 527–33.
https://doi.org/10.1001/archpsyc.56.6.527.

Regarding the endocrine system, see:

Juster, Robert-Paul, Bruce S. McEwen, and Sonia J. Lupien. “Allostatic Load Biomarkers of Chronic Stress and Impact on Health and Cognition.” Neuroscience & Biobehavioral Reviews 35, no. 1 (2010): 2–16.
https://doi.org/10.1016/j.neubiorev.2009.10.002.

Regarding the immune system, see:

Friedman, Howard S., and Stephanie Booth-Kewley. “The ‘Disease-Prone Personality’: A Meta-Analytic View of the Construct.” American Psychologist 42, no. 6 (1987): 539–55. https://doi.org/10.1037/0003-066X.42.6.539.

Kiecolt-Glaser, J. K., L. D. Fisher, P. Ogrocki, J. C. Stout, C. E. Speicher, and R. Glaser. “Marital Quality, Marital Disruption, and Immune Function.” Psychosomatic Medicine 49, no. 1 (1987): 13–34.
https://doi.org/10.1097/00006842-198701000-00002.

Kiecolt-Glaser, Janice K., Gayle G. Page, Phillip T. Marucha, Robert C. MacCallum, and Ronald Glaser. “Psychological Influences on Surgical Recovery: Perspectives from Psychoneuroimmunology.” American Psychologist 53, no. 11 (1998): 1209–18. https://doi.org/10.1037/0003-066X.53.11.1209.

Licinio, J., P. W. Gold, and M.-L. Wong. “A Molecular Mechanism for Stress-Induced Alterations in Susceptibility to Disease.” The Lancet 346, no. 8967 (1995): 104–6.
https://doi.org/10.1016/S0140-6736(95)92119-2.

Researchers have found signs of depletion in mothers from both middle-class American populations and low-income countries.

Lander, Rebecca L., K. Michael Hambidge, Jamie E. Westcott, et al. “Pregnant Women in Four Low-Middle Income Countries Have a High Prevalence of Inadequate Dietary Intakes That Are Improved by Dietary Diversity.” Nutrients 11, no. 7 (2019): 1560.
https://doi.org/10.3390/nu11071560.

Miller, Jane E. “Birth Intervals and Perinatal Health: An Investigation of Three Hypotheses.” Family Planning Perspectives 23, no. 2 (1991): 62-70.
https://doi.org/10.2307/2135451.

Merchant, K., and R. Martorell. “Frequent Reproductive Cycling: Does It Lead to Nutritional Depletion of Mothers?” Progress in Food & Nutrition Science 12, no. 4 (1988): 339–69.

Wild, Laura E., William B. Patterson, Roshonda B. Jones, et al. “Risk of Micronutrient Inadequacy Among Hispanic, Lactating Mothers: Preliminary Evidence from the Southern California Mother’s Milk Study.” Nutrients 13, no. 9 (2021): 3252.
https://doi.org/10.3390/nu13093252.

Winkvist, A., K. M. Rasmussen, and J. P. Habicht. “A New Definition of Maternal Depletion Syndrome.” American Journal of Public Health 82, no. 5 (1992): 691–94. https://doi.org/10.2105/AJPH.82.5.691.

the research on women’s health has lagged far behind that of men

Helmuth, Laura. “Reports See Progress, Problems, in Trials.” Science 288, no. 5471 (2000): 1562–63.
https://doi.org/10.1126/science.288.5471.1562.

raising a family is associated with generally poorer health in women, especially as the number of pregnancies increases

Dior, Uri P., Hagit Hochner, Yechiel Friedlander, et al. “Association Between Number of Children and Mortality of Mothers: Results of a 37-Year Follow-up Study.” Annals of Epidemiology 23, no. 1 (2013): 13–18.
https://doi.org/10.1016/j.annepidem.2012.10.005.

Kington, R., L. Lillard, and J. Rogowski. “Reproductive History, Socioeconomic Status, and Self-Reported Health Status of Women Aged 50 Years or Older.” American Journal of Public Health 87, no. 1 (1997): 33–37.
https://doi.org/10.2105/AJPH.87.1.33.

Wagener, D. K., J. Walstedt, L. Jenkins, C. Burnett, N. Lalich, and M. Fingerhut. “Women: Work and Health.” Vital & Health Statistics. Series 3, Analytical and Epidemiological Studies, no. 31 (December 1997): 1–91.

More specifically, studies have found that motherhood raises a woman’s risk for: fatigue

Henderson, Jane, Fiona Alderdice, and Maggie Redshaw. “Factors Associated with Maternal Postpartum Fatigue: An Observational Study.” BMJ Open 9, no. 7 (2019): e025927.
https://doi.org/10.1136/bmjopen-2018-025927.

nutritional deficits

King, Janet C. “The Risk of Maternal Nutritional Depletion and Poor Outcomes Increases in Early or Closely Spaced Pregnancies.” Journal of Nutrition 133, no. 5 (2003): 1732S-1736S. https://doi.org/10.1093/jn/133.5.1732S.

Merchant, K., and R. Martorell. “Frequent Reproductive Cycling: Does It Lead to Nutritional Depletion of Mothers?” Progress in Food & Nutrition Science 12, no. 4 (1988): 339–69.

Miller, Jane E. “Birth Intervals and Perinatal Health: An Investigation of Three Hypotheses.” Family Planning Perspectives 23, no. 2 (1991): 62.
https://doi.org/10.2307/2135451.

Oziegbe, Elizabeth O., and Lynne A. Schepartz. “Parity, Dental Caries and Implications for Maternal Depletion Syndrome in Northern Nigerian Hausa Women.” PLOS ONE 18, no. 3 (2023): e0281653. https://doi.org/10.1371/journal.pone.0281653.

diabetes

Lewis, C. E., E. Funkhouser, J. M. Raczynski, S. Sidney, D. E. Bild, and B. V. Howard. “Adverse Effect of Pregnancy on High Density Lipoprotein (HDL) Cholesterol in Young Adult Women: The CARDIA Study.” American Journal of Epidemiology 144, no. 3 (1996): 247–54. https://doi.org/10.1093/oxfordjournals.aje.a008919.

Moazzeni, Seyyed Saeed, Reyhane Hizomi Arani, Samaneh Asgari, Fereidoun Azizi, and Farzad Hadaegh. “The Association of Parity/Live Birth Number with Incident Type 2 Diabetes among Women: Over 15 Years of Follow-up in The Tehran Lipid and Glucose Study.” BMC Women’s Health 21, no. 1 (2021): 378.
https://doi.org/10.1186/s12905-021-01519-7.

Simmons, D. “Parity, Ethnic Group and the Prevalence of Type 2 Diabetes: The Coventry Diabetes Study.” Diabetic Medicine 9, no. 8 (1992): 706–9.
https://doi.org/10.1111/j.1464-5491.1992.tb01877.x.

gallbladder disease

Beral, V. “Long Term Effects of Childbearing on Health.” Journal of Epidemiology and Community Health 39, no. 4 (1985): 343–46.
https://doi.org/10.1136/jech.39.4.343.

Kritz-Silverstein, Donna, Elizabeth Barrett-Connor, and Deborah L. Wingard. “The Relationship Between Reproductive History and Cholecystectomy in Older Women.” Journal of Clinical Epidemiology 43, no. 7 (1990): 687–92.
https://doi.org/10.1016/0895-4356(90)90039-R.

Liu, B., V. Beral, A. Balkwill, and on behalf of the Million Women Study Collaborators. “Childbearing, Breastfeeding, Other Reproductive Factors and the Subsequent Risk of Hospitalization for Gallbladder Disease.” International Journal of Epidemiology 38, no. 1 (2009): 312–18.
https://doi.org/10.1093/ije/dyn174.

Scragg, R. K., A. J. McMichael, and R. F. Seamark. “Oral Contraceptives, Pregnancy, and Endogenous Oestrogen in Gall Stone Disease–a Case-Control Study.” BMJ 288, no. 6433 (1984): 1795–99.
https://doi.org/10.1136/bmj.288.6433.1795.

cardiovascular disease

Ness, Roberta B., Tamara Harris, Janet Cobb, et al. “Number of Pregnancies and the Subsequent Risk of Cardiovascular Disease.” New England Journal of Medicine 328, no. 21 (1993): 1528–33. https://doi.org/10.1056/NEJM199305273282104.

hormonal problems

Friedrich, Nele, Sabine Schwarz, Jens Thonack, Ulrich John, Henri Wallaschofski, and Henry Völzke. “Association Between Parity and Autoimmune Thyroiditis in a General Female Population.” Autoimmunity 41, no. 2 (2008): 174–80.
https://doi.org/10.1080/08916930701777629.

For example, greater parity (i.e., having more children) increases the risk of PMS, or increases the severity of preexisting PMS. See:

Freeman, E. W., S. J. Sondheimer, and K. Rickels. “Effects of Medical History Factors on Symptom Severity in Women Meeting Criteria for Premenstrual Syndrome.” Obstetrics and Gynecology 72, no. 2 (1988): 236–39.

Hsia, L., and M. Long. “Premenstrual Syndrome: Current Concepts in Diagnosis and Management.” Journal of Nurse-Midwifery 35, no. 6 (1990): 351–57.
https://doi.org/10.1016/S0091-2182(05)80017-5.

Lurie, Samuel, and Richard Borenstein. “The Premenstrual Syndrome:” Obstetrical & Gynecological Survey 45, no. 4 (1990): 220–28.
https://doi.org/10.1097/00006254-199004000-00003.

kidney disease

Sun, Kan, Diaozhu Lin, Qiling Feng, et al. “Parity Is Associated with Albuminuria and Chronic Kidney Disease: A Population-Based Study.” Aging 11, no. 23 (2019): 11030–39. https://doi.org/10.18632/aging.102507.

some kinds of cancer

Kvåle, Gunnar, Ivar Heuch, and Steiner Nilssen. “Parity in Relation to Mortality and Cancer Incidence: A Prospective Study of Norwegian Women.” International Journal of Epidemiology 23, no. 4 (1994): 691–99.
https://doi.org/10.1093/ije/23.4.691.

Mosgaard, Berit Jul, Øjvind Lidegaard, Susanne Krüger Kjaer, Geert Schou, and Anders Nyboe Andersen. “Infertility, Fertility Drugs, and Invasive Ovarian Cancer: A Case-Control Study.” Fertility and Sterility 67, no. 6 (1997): 1005–12.
https://doi.org/10.1016/S0015-0282(97)81431-8.

Platz, Elizabeth A., Maria Elena Martinez, Francine Grodstein, et al. “Parity and Other Reproductive Factors and Risk of Adenomatous Polyps of the Distal Colorectum (United States).” Cancer Causes & Control 8, no. 6 (1997): 894–903.
https://doi.org/10.1023/A:1018420513815.

a higher overall mortality rate

Xing, Zailing, Russell S. Kirby, Henian Chen, Mary Ashley Cain, and Amy C. Alman. “Associations Between Parity, Age at Childbirth, and Later-Life Mortality in Postmenopausal Women Mediated by Premature Menopause.” American Journal of Obstetrics and Gynecology 233, no. 5 (2025): 471.e1-471.e19.
https://doi.org/10.1016/j.ajog.2025.06.005.

Depleted Mother Syndrome

Every year, [depletion] impacts millions of American women

About 3.6 million women have a baby each year in the United States, 3 million of them for the first time, and about 20 million women are raising children age six or younger (“FastStats.” September 17, 2025. https://www.cdc.gov/nchs/fastats/births.htm). If at least one mother in ten goes through a period of measurable depletion lasting several months or longer, and if there typically are lingering effects of depletion on those mothers’ mental or physical health, or her intimate relationships, then past or present depletion is a factor in the lives of millions of American women.

and it probably leads to billions of dollars in health care expenses and lost productivity

O’Neil, Sasigant So, Isabel Platt, Divya Vohra, et al. “Societal Cost of Nine Selected Maternal Morbidities in the United States.” PloS One 17, no. 10 (2022): e0275656.
https://doi.org/10.1371/.

The Effects on a Mother’s Mind

Storms of Anger

like “ghosts in the nursery,” in the memorable phrase of Professor Selma Fraiberg

Fraiberg, Selma, Edna Adelson, and Vivian Shapiro. “Ghosts in the Nursery.” Journal of the American Academy of Child Psychiatry 14, no. 3 (1975): 387–421.
https://doi.org/10.1016/S0002-7138(09)61442-4.

Fears and Worries

The stresses of mothering can lead to panic attacks . . . a mother may become preoccupied with irrational worries, or compulsive about things she can control

Fairbrother, Nichole, Patricia Janssen, Martin M. Antony, Emma Tucker, and Allan H. Young. “Perinatal Anxiety Disorder Prevalence and Incidence.” Journal of Affective Disorders 200 (August 2016): 148–55.
https://doi.org/10.1016/j.jad.2015.12.082.

If her child has major health problems or is seriously injured, she could suffer the symptoms of acute stress disorder at the time . . . or posttraumatic stress disorder (PTSD) at a later point.

Lefkowitz, Debra S., Chiara Baxt, and Jacquelyn R. Evans. “Prevalence and Correlates of Posttraumatic Stress and Postpartum Depression in Parents of Infants in the Neonatal Intensive Care Unit (NICU).” Journal of Clinical Psychology in Medical Settings 17, no. 3 (2010): 230–37. https://doi.org/10.1007/s10880-010-9202-7.

Feeling Guilty or Inadequate

During the time you’re home with children, you lose a source of pride and status through accomplishments at work.

Baruch, Grace K., Lois Biener, and Rosalind C. Barnett. “Women and Gender in Research on Work and Family Stress.” American Psychologist 42, no. 2 (1987): 130–36.
https://doi.org/10.1037/0003-066X.42.2.130.

The way you think about all this makes a big difference in how you feel.

See any one of the numerous books on cognitive psychology, including:

Beck, Aaron T., A. John Rush, Brian F. Shaw, et al. Cognitive Therapy of Depression. Second edition. The Guilford Press, 2024.

Burns, David D. Feeling Good: The New Mood Therapy. Rev. and Updated. Avon, 1999.

Disturbed Mood

These knocks against self-esteem are just one of the many conditions faced by mothers known to cause depression.

The rest include: sleep deprivation

Johnson, Sheri L., and John E. Roberts. “Life Events and Bipolar Disorder: Implications from Biological Theories.” Psychological Bulletin 117, no. 3 (1995): 434–49. https://doi.org/10.1037/0033-2909.117.3.434.

stress

Kandel, Denise B., Mark Davies, and Victoria H. Raveis. “The Stressfulness of Daily Social Roles for Women: Marital, Occupational and Household Roles.” Journal of Health and Social Behavior 26, no. 1 (1985): 64.
https://doi.org/10.2307/2136727.

McGrath, Ellen, Gwendolyn Puryear Keita, Bonnie R. Strickland, and Nancy Felipe Russo, eds. Women and Depression: Risk Factors and Treatment Issues: Final Report of the American Psychological Association’s National Task Force on Women and Depression. American Psychological Association, 1990.
https://doi.org/10.1037/10074-000.

changes in physical appearance

Kling, Kristen C., Janet Shibley Hyde, Carolin J. Showers, and Brenda N. Buswell. “Gender Differences in Self-Esteem: A Meta-Analysis.” Psychological Bulletin 125, no. 4 (1999): 470–500. https://doi.org/10.1037/0033-2909.125.4.470.

ongoing issues with children

Woods, Nancy Fugate, and Barbara Sorenson Hulka. “Symptom Reports and Illness Behavior among Employed Women and Homemakers.” Journal of Community Health 5, no. 1 (1979): 36–45. https://doi.org/10.1007/BF01321569.

For a general discussion of how seemingly intractable issues can lead to depression, see:

Seligman, Martin E. P. Helplessness: On Depression, Development, and Death. Freeman, 2000.

health concerns

DeNeve, Kristina M., and Harris Cooper. “The Happy Personality: A Meta-Analysis of 137 Personality Traits and Subjective Well-Being.” Psychological Bulletin 124, no. 2 (1998): 197–229. https://doi.org/10.1037/0033-2909.124.2.197.

marital conflict, and social isolation

Brown, G. W., B. Andrews, T. Harris, Z. Adler, and L. Bridge. “Social Support, Self-Esteem and Depression.” Psychological Medicine 16, no. 4 (1986): 813–31. https://doi.org/10.1017/S0033291700011831.

Reiss, David, and Richard H. Price. “National Research Agenda for Prevention Research: The National Institute of Mental Health Report.” American Psychologist 51, no. 11 (1996): 1109–15. https://doi.org/10.1037/0003-066X.51.11.1109.

While raising children, you’ve got about a 50-50 chance of going through a period of depressed mood

Affonso, D. D., S. Lovett, S. Paul, et al. “Dysphoric Distress in Childbearing Women.” Journal of Perinatology: Official Journal of the California Perinatal Association 12, no. 4 (1992): 325–32.

Cowan, Carolyn Pape, and Philip A. Cowan. When Partners Become Parents: The Big Life Change for Couples. Lawrence Erlbaum, 2000.

Orr, S. T., S. A. James, B. J. Burns, and B. Thompson. “Chronic Stressors and Maternal Depression: Implications for Prevention.” American Journal of Public Health 79, no. 9 (1989): 1295–96. https://doi.org/10.2105/AJPH.79.9.1295.

depression wears more on a marriage than any other health problem

Bouras, N., P. Vanger, and P. K. Bridges. “Marital Problems in Chronically Depressed and Physically Ill Patients and Their Spouses.” Comprehensive Psychiatry 27, no. 2 (1986): 127–30. https://doi.org/10.1016/0010-440X(86)90021-0.

Whisman, Mark A. “Marital Distress and DSM-IV Psychiatric Disorders in a Population-Based National Survey.” Journal of Abnormal Psychology 116, no. 3 (2007): 638–43. https://doi.org/10.1037/0021-843X.116.3.638.

Getting the Weight Off Your Mind

Also, [her growing connections] probably increased the effectiveness of her immune system

See Chapter 5 and its references.

The Effects on a Mother’s Marriage

Eight Times as Many Arguments

Kids bring an intense need for teamwork

Belsky, Jay, and John Kelly. The Transition to Parenthood: How a First Child Changes a Marriage: Why Some Couples Grow Closer and Others Apart. Dell Pub., 1995.

Cowan, Carolyn Pape, and Philip A. Cowan. When Partners Become Parents: The Big Life Change for Couples. Lawrence Erlbaum, 2000.

but a mother and father often disagree about parenting practices or how to share the load fairly

Roberts, Paul, and Bill Moseley. “Father’s Time.” Psychology Today, May 1, 1996. https://www.psychologytoday.com/us/magazine/archive/1996/05.

the average couple has eight times as many arguments after children arrive . . . two couples in three report a sharp drop in satisfaction with their relationship once they become parents

John Gottman, quoted in Susan Wood, “Happily Married . . . with Children,” Parenting Magazine, February 2000, 134.

Shapiro, Alyson Fearnley, John M. Gottman, and Sybil Carrère. “The Baby and the Marriage: Identifying Factors That Buffer Against Decline in Marital Satisfaction after the First Baby Arrives.” Journal of Family Psychology 14, no. 1 (2000): 59–70.
https://doi.org/10.1037/0893-3200.14.1.59.

Struggles with your partner over childrearing are intensely distressing

Baruch, Grace K., and Rosalind Barnett. “Role Quality, Multiple Role Involvement, and Psychological Well-Being in Midlife Women.” Journal of Personality and Social Psychology 51, no. 3 (1986): 578–85.
https://doi.org/10.1037/0022-3514.51.3.578.

and can lead to psychological problems

Kessler, R. C., and J. A. McRae. “The Effect of Wives’ Employment on the Mental Health of Married Men and Women.” American Sociological Review 47, no. 2 (1982): 216–27.

these quarrels wear on your health

Coyne, James C., and Anita DeLongis. “Going Beyond Social Support: The Role of Social Relationships in Adaptation.” Journal of Consulting and Clinical Psychology 54, no. 4 (1986): 454–60.
https://doi.org/10.1037/0022-006X.54.4.454.

in part by increasing your blood pressure

Ewart, Craig K., Kent F. Burnett, and C. Barr Taylor. “Communication Behaviors That Affect Blood Pressure: An A-B-A-B Analysis of Marital Interaction.” Behavior Modification 7, no. 3 (1983): 331–44.
https://doi.org/10.1177/01454455830073003.

and weakening your immune system

Kiecolt-Glaser, J. K., L. D. Fisher, P. Ogrocki, J. C. Stout, C. E. Speicher, and R. Glaser. “Marital Quality, Marital Disruption, and Immune Function.:” Psychosomatic Medicine 49, no. 1 (1987): 13–34.
https://doi.org/10.1097/00006842-198701000-00002.

Burman, Bonnie, and Gayla Margolin. “Analysis of the Association Between Marital Relationships and Health Problems: An Interactional Perspective.” Psychological Bulletin 112, no. 1 (1992): 39–63. https://doi.org/10.1037/0033-2909.112.1.39.

Your Path Toward Well-Being, Health, and Support

Compared to women who haven’t had children, mothers are generally more stressed

Avery, Ally R., Siny Tsang, Edmund Y. W. Seto, and Glen E. Duncan. “Differences in Stress and Anxiety Among Women With and Without Children in the Household During the Early Months of the COVID-19 Pandemic.” Frontiers in Public Health 9 (September 2021): 688462. https://doi.org/10.3389/fpubh.2021.688462.

Campbell, Angus, Philip E. Converse, and Willard L. Rodgers. The Quality of American Life: Perceptions, Evaluations, and Satisfactions. Russell Sage Foundation, 1976.

more unhappy in their marriages

and more prone to illness

See references above for The Effects on a Mother’s Body.

greater support from your partner can boost your own physical and psychological health

Baumeister, Roy F., and Mark R. Leary. “The Need to Belong: Desire for Interpersonal Attachments as a Fundamental Human Motivation.” Psychological Bulletin 117, no. 3 (1995): 497–529. https://doi.org/10.1037/0033-2909.117.3.497.

Introduction to Part Two

raising children, taken as a whole, will probably be the most stressful experience of your life

Note the number of different stressors that apply to mothers in inventories of stress, such as the classic Life Change Unit Scale in:

Cline, David W. “A Prospective Study of Life Changes and Subsequent Health Changes.” Archives of General Psychiatry 27, no. 1 (1972): 51,
https://doi.org/10.1001/archpsyc.1972.01750250043005.

Chapter 2: Reducing Your Stress

Short-Term Stress Relief

Five-Minute Soothers

Listen to your favorite music.

De Witte, Martina, Anouk Spruit, Susan Van Hooren, Xavier Moonen, and Geert-Jan Stams. “Effects of Music Interventions on Stress-Related Outcomes: A Systematic Review and Two Meta-Analyses.” Health Psychology Review 14, no. 2 (2020): 294–324.
https://doi.org/10.1080/17437199.2019.1627897.

Long-Term Stress Relief

Releasing Emotions

feeling let down by your partner could be amplified by experiences in which important people were not there for you as a child

Atkinson, Brent J. “The Emotional Imperative Psychotherapists Cannot Afford to Ignore.” Family Therapy Networker, August 1999.

Liberating Insight

Many studies have found that this positive self-talk is one of the most powerful ways to cope with stress.

See the extensive literature on cognitive therapy.

Beliefs That Help Mothers Cope

Things could have gone much worse.

Research by Lawrence Senna, Ph.D. and colleagues reported in:

Chatterjee, Camille . “Your Secret Mood Booster.” Psychology Today, September 1, 1999. https://www.psychologytoday.com/gb/articles/199909/your-secret-mood-booster.

meditation . . . [is] a proven method of lowering blood pressure

Chen, Qiongshan, Hui Liu, and Shizheng Du. “Effect of Mindfulness-Based Interventions on People with Prehypertension or Hypertension: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.” BMC Cardiovascular Disorders 24, no. 1 (2024): 104.
https://doi.org/10.1186/s12872-024-03746-w.

Many of these sources lurk in the shadows, outside your conscious awareness.

Atkinson, Brent J. “The Emotional Imperative Psychotherapists Cannot Afford to Ignore.” Family Therapy Networker, August 1999.

Temperament and mood.

For a general review, see:

Rusting, Cheryl L. “Personality, Mood, and Cognitive Processing of Emotional Information: Three Conceptual Frameworks.” Psychological Bulletin 124, no. 2 (1998): 165–96. https://doi.org/10.1037/0033-2909.124.2.165.

Cultivating Positive Experiences

Studies have shown that one of the most powerful ways to reduce stress—especially for a woman—is to have the experience of feeling connected to another person.

Taylor, Shelley E., Laura Cousino Klein, Brian P. Lewis, Tara L. Gruenewald, Regan A. R. Gurung, and John A. Updegraff. “Biobehavioral Responses to Stress in Females: Tend-and-Befriend, Not Fight-or-Flight.” Psychological Review 107, no. 3 (2000): 411–29.
https://doi.org/10.1037/0033-295X.107.3.411.

Scheduling good times.

Folkman, Susan, and Judith Tedlie Moskowitz. “Positive Affect and the Other Side of Coping.” American Psychologist 55, no. 6 (2000): 647–54.
https://doi.org/10.1037/0003-066X.55.6.647.

Chapter 3: Transforming Painful Emotions

Turning Sadness into Contentment

approximately 10-12 percent [of mothers] will go through a clinical depression

Amer, Samar A., Nahla A. Zaitoun, Heba A. Abdelsalam, et al. “Exploring Predictors and Prevalence of Postpartum Depression Among Mothers: Multinational Study.” BMC Public Health 24, no. 1 (2024): 1308.
https://doi.org/10.1186/s12889-024-18502-0.

roughly half the mothers of young children will suffer many of the symptoms of “persistent depressive disorder”

Cowan, Carolyn Pape, and Philip A. Cowan. When Partners Become Parents: The Big Life Change for Couples. Lawrence Erlbaum, 2000.

Mourning Your Losses

For a general review of the psychological processes involved in loss, see the work of:

Neimeyer, Robert A. Meaning Reconstruction and the Experience of Loss. American Psychological Association, 2001.

Unlearning Helplessness

“learned helplessness,” a feeling of powerlessness and pessimism

Stajkovic, Alexander D., and Fred Luthans. “Self-Efficacy and Work-Related Performance: A Meta-Analysis.” Psychological Bulletin 124, no. 2 (1998): 240–61.
https://doi.org/10.1037/0033-2909.124.2.240.

learned helplessness is a powerful source of depression

Burns, Melanie O., and Martin E. Seligman. “Explanatory Style Across the Life Span: Evidence for Stability over 52 Years.” Journal of Personality and Social Psychology 56, no. 3 (1989): 471–77. https://doi.org/10.1037/0022-3514.56.3.471.

Seligman, Martin E. P. Learned Optimism: How to Change Your Mind and Your Life. Knopf Doubleday Publishing Group, 2011.

When you think there’s a fair chance you’ll succeed, you’re more willing to try.

Folkman, Susan, and Judith Tedlie Moskowitz. “Positive Affect and the Other Side of Coping.” American Psychologist 55, no. 6 (2000): 647–54.
https://doi.org/10.1037/0003-066X.55.6.647.

Also see research reported in

Azar, B. “Mom’s Stress May Affect Early Child Development.” APA Monitor, 1999.

try to pay attention every day to the good news about yourself

Folkman, Susan, and Judith Tedlie Moskowitz. “Positive Affect and the Other Side of Coping.” American Psychologist 55, no. 6 (2000): 647–54.
https://doi.org/10.1037/0003-066X.55.6.647.

The future: . . . When you’re active, rather than passive, you feel better and you keep learning how to be ever more skillful at coping.

Talking Back to Sadness

Extensive research has shown that talking back to negative thoughts can lift a sad or depressed mood.

Gloaguen, Valérie, Jean Cottraux, Michel Cucherat, and Ivy-Marie Blackburn. “A Meta-Analysis of the Effects of Cognitive Therapy in Depressed Patients.” Journal of Affective Disorders 49, no. 1 (1998): 59–72.
https://doi.org/10.1016/S0165-0327(97)00199-7.

Many Ways to Feel More Contented

“Top Ten Topics for Future Presentations at Our Mothers’ Club”

Adapted from a presentation given by the co-presidents:

“Top Ten Topics for Future Presentations at Our Mother’s Club.” Larkspur/Corte Madera Mother’s Club, California, 1996.

Shine a light

Norman Rosenthal, MD, quoted in:

Kearns, B. “Natural No-Fail Mood Boosters.” Good Housekeeping, March 2000.

Regular aerobic exercise . . . will increase the serotonin in your brain

Vogel, Gretchen. “New Brain Cells Prompt New Theory of Depression.” Science 290, no. 5490 (2000): 258–59.
https://doi.org/10.1126/science.290.5490.258.

and lift your mood

Babyak, Michael, James A. Blumenthal, Steve Herman, et al. “Exercise Treatment for Major Depression: Maintenance of Therapeutic Benefit at 10 Months:” Psychosomatic Medicine 62, no. 5 (2000): 633–38.
https://doi.org/10.1097/00006842-200009000-00006.

Clegg, Andrew J., et al. “Exercise for Depression.” Cochrane Database of Systematic Reviews, no. 1 (2026): CD004366.
https://doi.org/10.1002/14651858.CD004366.pub7.

Few things can lift your mood like the empathy, kindness, and emotional support of others

perceiving support is a key to alleviating mental and physical distress

Ozbay, Fatih, Douglas C. Johnson, Eleni Dimoulas, C. A. Morgan, Dennis Charney, and Steven Southwick. “Social Support and Resilience to Stress: From Neurobiology to Clinical Practice.” Psychiatry 4, no. 5 (2007): 35–40.

But by finding some form of community service . . . you’ll . . . even access a kind of self-nurturing source inside as you nurture others.

Thanks to Micheal Elkin for this suggestion, from:

The Family Therapy Networker, January/February 2000, 14.

Extremes of Mood

Persistent depressive disorder:It often coexists with anxiety, feelings of guilt or inadequacy, brooding about the past, or major depressive episodes.

Flett, Gordon L., Karel Vredenburg, and Lester Krames. “The Continuity of Depression in Clinical and Nonclinical Samples.” Psychological Bulletin 121, no. 3 (1997): 395–416. https://doi.org/10.1037/0033-2909.121.3.395.

Major depressive disorder:women worldwide are more burdened by depression than by any other health condition.

Dai, Fangyi, Yuzhou Cai, Min Chen, and Yong Dai. “Global Trends of Depressive Disorders Among Women of Reproductive Age from 1990 to 2021: A Systematic Analysis of Burden, Sociodemographic Disparities, and Health Workforce Correlations.” BMC Psychiatry 25, no. 1 (2025): 263.
https://doi.org/10.1186/s12888-025-06697-4.

Tang, Mingjie, Yinghong Li, Jun Shao, Shiwei Li, Jiqin Tang, and Zhaoming Chen. “Global, Regional, and National Burden and Trends of Depressive Disorders Among Women of Childbearing Age from 1990 to 2021: Insights from GBD 2021.” Frontiers in Psychology 16 (August 2025): 1594430.
https://doi.org/10.3389/fpsyg.2025.1594430.

About 10 percent of mothers are clinically depressed at any given time, and this rate jumps to 13 percent among women who have recently given birth.

Ertel, Karen A., Janet W. Rich-Edwards, and Karestan C. Koenen. “Maternal Depression in the United States: Nationally Representative Rates and Risks.” Journal of Women’s Health 20, no. 11 (2011): 1609–17.
https://doi.org/10.1089/jwh.2010.2657.

“Perinatal Mental Health.” Accessed November 10, 2025.
https://www.who.int/teams/mental-health-and-substance-use/promotion-prevention/maternal-mental-health.

Woody, C. A., A. J. Ferrari, D. J. Siskind, H. A. Whiteford, and M. G. Harris. “A Systematic Review and Meta-Regression of the Prevalence and Incidence of Perinatal Depression.” Journal of Affective Disorders 219 (September 2017): 86–92.
https://doi.org/10.1016/j.jad.2017.05.003.

Remember what worked the last time you were depressed; you probably found some things that helped, and there’s a good chance they’ll work this time, too.

Thanks to Jacqueline Sparks, PhD for this suggestion, from:

The Family Therapy Networker, January/February 2000, 13.

Your partner . . . can support you

Jacobson, Neil S., Amy Holtzworth-Munroe, and Karen B. Schmaling. “Marital Therapy and Spouse Involvement in the Treatment of Depression, Agoraphobia, and Alcoholism.” Journal of Consulting and Clinical Psychology 57, no. 1 (1989): 5–10.
https://doi.org/10.1037/0022-006X.57.1.5.

There is more evidence that psychological factors cause depression than biochemical ones

Seligman, Martin E. P. “President’s Column: Is Depression Biochemical.” APA Monitor, September 1998.

psychotherapy is as effective or better for many people than antidepressants

Breedvelt, Josefien J. F., Fiona C. Warren, Zindel Segal, Willem Kuyken, and Claudi L. Bockting. “Continuation of Antidepressants Versus Sequential Psychological Interventions to Prevent Relapse in Depression: An Individual Participant Data Meta-Analysis.” JAMA Psychiatry 78, no. 8 (2021): 868.
https://doi.org/10.1001/jamapsychiatry.2021.0823.

Keller, Martin B., James P. McCullough, Daniel N. Klein, et al. “A Comparison of Nefazodone, the Cognitive Behavioral-Analysis System of Psychotherapy, and Their Combination for the Treatment of Chronic Depression.” New England Journal of Medicine 342, no. 20 (2000): 1462–70. https://doi.org/10.1056/NEJM200005183422001.

Voderholzer, Ulrich, Barbara B. Barton, Matthias Favreau, et al. “Enduring Effects of Psychotherapy, Antidepressants and Their Combination for Depression: A Systematic Review and Meta-Analysis.” Frontiers in Psychiatry 15 (November 2024): 1415905. https://doi.org/10.3389/fpsyt.2024.1415905.

The size of the effects of psychotherapy also compare favorably to those of many medical interventions; see:

Rosenthal, Robert. “How Are We Doing in Soft Psychology?” American Psychologist 45, no. 6 (1990): 775–77.
https://doi.org/10.1037/0003-066X.45.6.775.

Depression is a common complication of insomnia, chronic pain, illness, or medications

Finan, Patrick H., and Michael T. Smith. “The Comorbidity of Insomnia, Chronic Pain, and Depression: Dopamine as a Putative Mechanism.” Sleep Medicine Reviews 17, no. 3 (2013): 173–83. https://doi.org/10.1016/j.smrv.2012.03.003.

Li, Julien, Yoann Zelmat, Wilhelm Storck, et al. “Drug-Induced Depressive Symptoms: An Update Through the WHO Pharmacovigilance Database.” Journal of Affective Disorders 350 (April 2024): 452–67.
https://doi.org/10.1016/j.jad.2024.01.119.

In general, depression should be addressed through a combination of . . . stress reduction

Finch, John F., Morris A. Okun, Gregory J. Pool, and Linda S. Ruehlman. “A Comparison of the Influence of Conflictual and Supportive Social Interactions on Psychological Distress.” Journal of Personality 67, no. 4 (1999): 581–621.
https://doi.org/10.1111/1467-6494.00066.

Vogel, Gretchen. “New Brain Cells Prompt New Theory of Depression.” Science 290, no. 5490 (2000): 258–59.
https://doi.org/10.1126/science.290.5490.258.

World Health Organization. mhGAP Intervention Guide for Mental, Neurological and Substance Use Disorders in Non-Specialized Health Settings: Mental Health Gap Action Programme (mhGAP). Version 2.0. With World Health Organization. World Health Organization, 2016.

Turning Anxiety into Security

anxiety that is over the top . . . wears on your body and mind

Retraining the Worry Impulse

[meditation] has been shown to be quite effective in lowering anxiety.

Kabat-Zinn, J, A. O. Massion, J. Kristeller, et al. “Effectiveness of a Meditation-Based Stress Reduction Program in the Treatment of Anxiety Disorders.” American Journal of Psychiatry 149, no. 7 (1992): 936–43.
https://doi.org/10.1176/ajp.149.7.936.

Massage . . . can reduce anxiety

Field, Tiffany M. “Massage Therapy Effects.” American Psychologist 53, no. 12 (1998): 1270–81. https://doi.org/10.1037/0003-066X.53.12.1270.

Dealing with Traumatic Stress

mothers whose children have had serious illnesses or traumatic experiences often experience intrusive and intense images or memories, problems concentrating or making decisions, a heightened reactivity, or physical symptoms

Chu, Xiangyuan, Xiu Dai, Ping Yuan, Guojia Qi, and Xiuquan Shi. “Epidemical Trends and Risk Factors of PTSD in Parents of Critically Ill Children: Evidence from Both Meta-Analysis and Subgroup Analysis.” Journal of Affective Disorders 344 (January 2024): 242–51.
https://doi.org/10.1016/j.jad.2023.10.032.

DeMier, R. L., M. T. Hynan, H. B. Harris, and R. L. Manniello. “Perinatal Stressors as Predictors of Symptoms of Posttraumatic Stress in Mothers of Infants at High Risk.” Journal of Perinatology: Official Journal of the California Perinatal Association 16, no. 4 (1996): 276–80.

Rodrigue, James R., Kathleen MacNaughton, Russell G. Hoffmann, et al. “Transplantation in Children: A Longitudinal Assessment of Mothers’ Stress, Coping, and Perceptions of Family Functioning.” Psychosomatics 38, no. 5 (1997): 478–86.
https://doi.org/10.1016/S0033-3182(97)71425-7.

Timmons-Mitchell, Jane, Dawn Chandler-Holtz, and William E. Semple. “Post-Traumatic Stress Symptoms in Mothers Following Children’s Reports of Sexual Abuse: An Exploratory Study.” American Journal of Orthopsychiatry 66, no. 3 (1996): 463–67.
https://doi.org/10.1037/h0080196.

Wilcoxon, Lucy A., Richard Meiser-Stedman, and Aaron Burgess. “Post-Traumatic Stress Disorder in Parents Following Their Child’s Single-Event Trauma: A Meta-Analysis of Prevalence Rates and Risk Factor Correlates.” Clinical Child and Family Psychology Review 24, no. 4 (2021): 725–43. https://doi.org/10.1007/s10567-021-00367-z.

Younger, Janet B., Mary Jean Kendell, and Rita H. Pickler. “Mastery of Stress in Mothers of Preterm Infants.” Journal for Specialists in Pediatric Nursing 2, no. 1 (1997): 29–35. https://doi.org/10.1111/j.1744-6155.1997.tb00197.x.

If traumatic stress is affecting you, here are some ways to help yourself cope:

General acknowledgments for many of these suggestions to

“Managing Traumatic Stress,” American Psychological Association, 1998.

talking about a traumatic experience can strengthen your immune system.

Pennebaker, James W., Janice K. Kiecolt-Glaser, and Ronald Glaser. “Disclosure of Traumas and Immune Function: Health Implications for Psychotherapy.” Journal of Consulting and Clinical Psychology 56, no. 2 (1988): 239–45.
https://doi.org/10.1037/0022-006X.56.2.239.

Both counseling and medication have been shown to be quite successful with traumatic stress and other forms of anxiety

See research reported in:

Clay, R. A. “Psychotherapy Is Cost-Effective.” Monitor on Psychology, January 2000.

Footnote: It is estimated that in the US one in four girls have been sexually molested, one in four women will be the victim of attempted or completed sexual assault, and 41 percent will be the victim of intimate partner violence.

Basile, Kathleen C., Sharon G. Smith, Marcie-jo Kresnow, Srijana Khatiwada, and Ruth W. Leemis. The National Intimate Partner and Sexual Violence Survey : 2016/2017 Report on Sexual Violence. National Center for Injury Prevention and Control (US). Division of Violence Prevention. CDC, 2022.
https://stacks.cdc.gov/view/cdc/124625.

CDC. “About Child Sexual Abuse.” Child Abuse and Neglect Prevention, July 10, 2025. https://www.cdc.gov/child-abuse-neglect/about/about-child-sexual-abuse.html.

CDC. “About Intimate Partner Violence.” Intimate Partner Violence Prevention, September 3, 2025. https://www.cdc.gov/intimate-partner-violence/about/index.html.

Turning Shame into a Sense of Worth

And motherhood can be isolating, further eroding the sense of worth that in the past was refueled through social connections.

and

Girls and women get many messages to put the wants of others first

and

Getting unfairly critical or angry with yourself worsens your well-being, makes it harder to cope

many studies have shown that going to babies when they cry helps make them more secure and confident when they’re older

Higley, Elizabeth, and Mary Dozier. “Nighttime Maternal Responsiveness and Infant Attachment at One Year.” Attachment & Human Development 11, no. 4 (2009): 347–63. https://doi.org/10.1080/14616730903016979.

Turning Anger into a Peaceful Heart

Studies have found that the more children a woman has, the more time she spends with them or doing housework, and the more hassles she has with childcare or her kids, the more angry she’s likely to be.

Aber, J. Lawrence, Jay Belsky, Arietta Slade, and Keith Crnic. “Stability and Change in Mothers’ Representations of Their Relationship with Their Toddlers.” Developmental Psychology 35, no. 4 (1999): 1038–47.
https://doi.org/10.1037/0012-1649.35.4.1038.

Andersson, Ewa, and Ingegerd Hildingsson. “Mother’s Postnatal Stress: An Investigation of Links to Various Factors During Pregnancy and Postpartum.” Scandinavian Journal of Caring Sciences 30, no. 4 (2016): 782–89.
https://doi.org/10.1111/scs.12305.

Ross, Catherine E., and Marieke Van Willigen. “Gender, Parenthood, and Anger.” Journal of Marriage and the Family 58, no. 3 (1996): 572.
https://doi.org/10.2307/353718.

Put On the Brakes

but no reputable professional thinks it’s fine for a parent to vent his or her anger through raging at or hitting a child.

Gershoff, Elizabeth T., and Andrew Grogan-Kaylor. “Spanking and Child Outcomes: Old Controversies and New Meta-Analyses.” Journal of Family Psychology 30, no. 4 (2016): 453–69. https://doi.org/10.1037/fam0000191.

we suggest you ask your heart

Acknowledgments to the Institute of HeartMath for this idea; it has developed effective, research-based techniques for using the innate wisdom of the heart to lower stress, boost the immune system, and improve well-being. You can find out more in:

Childre, Doc Lew, Howard Martin, Donna Beech, and Institute of HeartMath. The HeartMath Solution. HarperSanFrancisco, 1999.

Chapter 4: Staying Well

Getting Enough Sleep

When Your Children Are Little

Insufficient sleep can lead to: gastrointestinal troubles

Khanijow, V., P. Prakash, H. A. Emsellem, M. L. Borum, and D. B. Doman. (2015). “Sleep Dysfunction and Gastrointestinal Diseases.” Gastroenterology & Hepatology 11, no. 12 (2015): 817–25.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4849511/.

a weakened immune system

For a review, see Modofsky, H. “Sleep and the Immune System.” International Journal of Immunopharmacology 17, no. 8 (1995): 649–54.
https://pubmed.ncbi.nlm.nih.gov/8847159/.

and slow repair of strained or sore muscles

Vitale, K. C., R. Owens, S. R. Hopkins, and A. Malhotra. “Sleep Hygiene for Optimizing Recovery in Athletes: Review and Recommendations.” International Journal of Sports Medicine 40, no. 8 (2019): 535–43.
https://doi.org/10.1055/a-0905-3103.

It also causes: poor concentration and memory

Alhola, P., and P. Polo-Kantola. “Sleep Deprivation: Impact on Cognitive Performance.” Neuropsychiatric Disease and Treatment 3, no. 5 (2007): 553–67. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2656292/.

lowers mood, and shortens a person’s fuse

Triantafillou, S., S. Saeb, E. G. Lattie, D. C. Mohr, and K. P. Kording. “Relationship Between Sleep Quality and Mood: Ecological Momentary Assessment Study.” JMIR Mental Health 6, no. 3 (2019): e12613.
https://doi.org/10.2196/12613.

When Your Children Are Little

your hours spent in childrearing and homemaking are probably more stressful than his are

Rusu, P. P., O.-S. Candel, I. Bogdan, C. Ilciuc, A. Ursu, and I. R. Podina. “Parental Stress and Well-Being: A Meta-Analysis. Clinical Child and Family Psychology Review 28, no. 2 (2025): 255–74. https://doi.org/10.1007/s10567-025-00515-9.

When the Baby Is Sleeping but You’re Not

cortisol hormone normally rises in the morning to prepare you for the activities of the day, but with too much stress, this hormone will kick into gear extra early

Buckley, T. M., and A. F. Schatzberg. “On the Interactions of the Hypothalamic-Pituitary-Adrenal (HPA) Axis and Sleep: Normal HPA Axis Activity and Circadian Rhythm, Exemplary Sleep Disorders.” Journal of Clinical Endocrinology and Metabolism 90, no. 5 (2005): 3106–14. https://doi.org/10.1210/jc.2004-1056.

Vgontzas, A. N., C. Tsigos, E. O. Bixler, C. A. Stratakis, K. Zachman, A. Kales, A. Vela-Bueno, and G. P. Chrousos. “Chronic Insomnia and Activity of the Stress System: A Preliminary Study. Journal of Psychosomatic Research 45, no. 1 (1998): 21–31.
https://doi.org/10.1016/s0022-3999(97)00302-4.

Magnesium is needed for quality sleep

Ikonte, C. J., J. G. Mun, C. A. Reider, R. W. Grant, and S. H. Mitmesser. “Micronutrient Inadequacy in Short Sleep: Analysis of the NHANES 2005–2016.” Nutrients 11, no. 10 (2019): 2335. https://doi.org/10.3390/nu11102335.

Rondanelli, M., A. Opizzi, F. Monteferrario, N. Antoniello, R. Manni, and C. Klersy. “The Effect of Melatonin, Magnesium, and Zinc on Primary Insomnia in Long-Term Care Facility Residents in Italy: A Double-Blind, Placebo-Controlled Clinical Trial.” Journal of the American Geriatrics Society 59, no. 1 (2011): 82–90.
https://doi.org/10.1111/j.1532-5415.2010.03232.x.

[Magnesium’s] Daily Value (DV) is 320 mg per day (360 mg if you are pregnant)

National Institute of Health, Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/Magnesium-HealthProfessional/.

many busy people find it difficult to get even the DV of 320 mg [of magnesium] in their diet

Rosanoff, A., C. M. Weaver, and R. K. Rude. “Suboptimal Magnesium Status in the United States: Are the Health Consequences Underestimated?” Nutrition Reviews 70, no. 3 (2012): 153–64. https://doi.org/10.1111/j.1753-4887.2011.00465.x.

Calcium is another mineral that can help you sleep better.

[Calcium’s] DV is 1,000 mg

National Institute of Health, Office of Dietary Supplements. https://ods.od.nih.gov/factsheets/Calcium-Consumer/#h2.

Valerian . . . can help bring on or deepen sleep

Fugh-Berman, A., and J. M. Cott. “Dietary Supplements and Natural Products as Psychotherapeutic Agents.” Biopsychosocial Science and Medicine 61, no. 5 (1999): 712–28. https://doi.org/10.1097/00006842-199909000-00012.

the Chinese formula suan zao ren rang might aid your sleep

Ni, X., J. L. Shergis, A. L. Zhang, X. Guo, C. Lu, Y. Li, and C. C. Xue. “Traditional Use of Chinese Herbal Medicine for Insomnia and Priorities Setting of Future Clinical Research.” Journal of Alternative and Complementary Medicine 25, no. 1 (2019): 8–15. http://doi.org/10.1089/acm.2018.0249.

One way to increase serotonin for sleep is to take . . . tryptophan before bed

Nakazawa, Y., H. Hasuzawa, T. Kotorii, T. Ohkawa, H. Sakurada, K. Nonaka, and K. Dainoson. “Study on the Effects of L-5HTP on the Stages of Sleep in Man as Evaluated by Using Sleep Deprivation.” Folia Psychiatrica et Neurologica Japonica 34, no. 2 (1980): 83–7. http://doi.org/10.1111/j.1440-1819.1980.tb01516.x.

Satoh, S., H. Matsumura, T. Nakajima, H. Onoe, K. Sakai, T. Nakajima, M. Jouvet, and O. Hayaishi. “Promotion of Sleep by Prostaglandin D2 in Rats Made Insomniac by Pretreatment with Para-Chlorophenylalanine.” Neuroscience Research 21, no. 1 (1994): 41–50. http://doi.org/10.1016/0168-0102(94)90066-3.

For a general review, see Birdsall, T. C. “5-Hydroxytryptophan: A Clinically Effective Serotonin Precursor. Alternative Medicine Review 3, no. 4 (1998): 271–80. https://pubmed.ncbi.nlm.nih.gov/9727088/.

modern research has shown [acupuncture] to be helpful with many ailments, including pain, stroke, depression

For a general review, see Pelletier, K. “The Best Alternative Medicine: What Works? What Does Not? Simon and Schuster, 2000: 138–151.

and insomnia

Phillips, K. D., and W. D. Skelton. “Effects of Individualized Acupuncture on Sleep Quality in HIV Disease.” Journal of the Association of Nurses AIDS Care 12, no. 1 (2001): 27–39. http://doi.org/10.1016/S1055-3290(06)60168-4.

Montakab, H. [“Acupuncture and Insomnia”] [German]. Forschende Komplementarmedizin 6 (1999): 29–31.

Huang, K. C. “Acupuncture: The Past and the Present.” In Acupuncture in Internal Medicine. Vantage Press, 1996: 185–86.

Eating Right

Ingredient #1: Protein

studies have found that eggs do not increase the risk of heart disease, and in fact they may raise the level of HDL (“good”) cholesterol

Kritchevsky, S. B., and D. Kritchevsky. “Egg Consumption and Coronary Heart Disease: An Epidemiologic Overview.” Journal of the American College of Nutrition 19, no. 5 Supplement (2000): 549S–555S.
http://doi.org/10.1080/07315724.2000.10718979.

McNamara, D. J. “The Impact of Egg Limitations on Coronary Heart Disease Risk: Do the Numbers Add Up?” Journal of the American College of Nutrition 19, no. 5 Suppl (2000): 540S–548S. http://doi.org/10.1080/07315724.2000.10718978.

Weggemans, R. M., P. L. Zock, and M. B. Katan. “Dietary Cholesterol from Eggs Increases the Ratio of Total Cholesterol to High-Density Lipoprotein Cholesterol in Humans: A Meta-Analysis.” American Journal of Clinical Nutrition 73, no. 5 (2001): 885–91. http://doi.org/10.1093/ajcn/73.5.885.

Try to minimize fish at the top of the ocean food chain—like tuna, shark, or swordfish—because mercury and other toxins increase as you move up the chain

See FDA Guidelines: https://www.fda.gov/food/consumers/advice-about-eating-fish.

Ingredient #2: Vegetables

Vegetables . . . contain . . . phytoestrogens, hormone-like substances that seem to help balance estrogen

Bolt, H. M., P. Janning, H. Michna, and G. H. Degen. “Comparative Assessment of Endocrine Modulators with Oestrogenic Activity: I. Definition of a Hygiene-Based Margin of Safety (HBMOS) for Xeno-Oestrogens Against the Background of European Developments.” Archives of Toxicology 74, no. 11 (2001): 649–62.
http://doi.org/10.1007/s002040000178.

Bingham, S. A., C. Atkinson, J. Liggins, L. Bluck, and A. Coward. “Phyto-Oestrogens: Where Are We Now?” British Journal of Nutrition 79, no. 5 (1998): 393–406. http://doi.org/10.1079/bjn19980068.

Adlercreutz, H., and W. Mazur. “Phyto-Oestrogens and Western Diseases.” Annals of Medicine 29, no. 2 (1997): 95–120.
http://doi.org/10.3109/07853899709113696.

The US Department of Agriculture recommends that everyone have five servings a day

“Americans Still Can Meet Fruit and Vegetable Dietary Guidelines for $2.10–$2.60 per Day” (2019). Retrieved April 28, 2022, from https://www.ers.usda.gov/amber-waves/2019/june/americans-still-can-meet-fruit-and-vegetable-dietary-guidelines-for-2-10-2-60-per-day.

fresh vegetables . . . have more nutrients than ones that are canned, dried, or frozen

Appendix G, in Whitney, E. N., and S. R. Rolfes. Understanding Nutrition, 7th ed. West Publishing Company, 1996.

Ingredient #3: Unrefined oils and essential fatty acids

Essential fatty acids (EFAs) are “good fats” needed for the membranes of your cells and a healthy heart

Chang, C. Y., D. S. Ke, and J. Y. Chen. “Essential Fatty Acids and Human Brain.” Acta Neurologica Taiwanica 18, no. 4 (2009): 231–41.
https://pubmed.ncbi.nlm.nih.gov/20329590.

[Essential fatty acids] are often deficient in mothers since they are drawn on heavily to grow a baby during pregnancy and breast milk is loaded with them, and most women don’t have anywhere near enough to start with.

Simopoulos, A. P. “Essential Fatty Acids in Health and Chronic Disease.” American Journal of Clinical Nutrition 70, no. 3 Supplement (1999): 560S–569S. http://doi.org/10.1093/ajcn/70.3.560s.

Horrocks, L. A., and Y. K. Yeo. “Health Benefits of Docosahexaenoic Acid (DHA).” Pharmacological Research 40, no. 3 (1999): 211–25.
http://doi.org/10.1006/phrs.1999.0495.

Uauy, R., and D. R. Hoffman. “Essential Fat Requirements of Preterm Infants.” American Journal of Clinical Nutrition 71, no. 1 Supplement (2000): 245S–250S. http://doi.org/10.1093/ajcn/71.1.245S.

Holman, R. T., S. B. Johnson, and P. L. Ogburn. “Deficiency of Essential Fatty Acids and Membrane Fluidity During Pregnancy and Lactation.” Proceedings of the National Academy of Sciences USA 88, no. 11 (1991): 4835–39.
http://doi.org/10.1073/pnas.88.11.4835.

But today, the average is about 16:1 omega-6s to omega-3s!

Simopoulos, A. P. “The Importance of the Omega-6/Omega-3 Fatty Acid Ratio in Cardiovascular Disease and Other Chronic Diseases.” Experimental Biology and Medicine 233, no. 6 (2008): 674–88.
https://doi.org/10.3181/0711-MR-311.

and one of the results, for instance, is a greater tendency toward inflammation

Simopoulos, A. P. Essential Fatty Acids in Health and Chronic Disease.” American Journal of Clinical Nutrition 70, no. 3 Supplement (1999): 560S–569S. http://doi.org/10.1093/ajcn/70.3.560s.

to which mothers are already vulnerable

Due to autoimmune processes, and perhaps other factors; see chapter 5.

many of us lack some of the enzymes or c-factors needed to convert flax oil into the long-chain fatty acids the body needs

Erasmus, U. Fats That Heal, Fats That Kill. Alive Books, 1993: 261.

Ingredient #4: Unrefined, varied whole grains

[Grains] don’t need to dominate your plate

Harvard T. H. Chan School of Public Health, The Nutrition Source. 2025. “Healthy Eating Plate.” Last reviewed January 2023. Accessed October 24, 2025. https://nutritionsource.hsph.harvard.edu/healthy-eating-plate/

certain chemicals within grains called phytates can interfere with the absorption of minerals

Gibson, Rosalind S., Karl B. Bailey, Michelle Gibbs, and Elaine L. Ferguson. “A Review of Phytate, Iron, Zinc, and Calcium Concentrations in Plant-Based Complementary Foods Used in Low-Income Countries and Implications for Bioavailability.” Food and Nutrition Bulletin 31, no. 2 Supplement (2010): S134–46.
https://doi.org/10.1177/15648265100312S206.

Ingredient #5: Organic foods

Organic foods have fewer toxic molecules because they contain no pesticides or artificial fertilizers.

Crinnion, W. J. “Organic Foods Contain Higher Levels of Certain Nutrients, Lower Levels of Pesticides, and May Provide Health Benefits for the Consumer.” Alternative Medicine Review 15, no. 1 (2010): 4–12.
https://pubmed.ncbi.nlm.nih.gov/20359265/.

For example, see: Podwall, D., H. S. Dresner, J. Lipetz, and J. J. Steinberg. “Variation in the Deoxynucleotide Composition Between Organic and Nonorganic Strawberries.” Ecotoxicology and Environmental Safety 44, no. 3 (1999): 259–70.
https://doi.org/10.1006/eesa.1999.1832.

Organic foods also tend to have more nutritious molecules—especially minerals—because they come from richer soils.

Montgomery, David R., and Anne Biklé. “Soil Health and Nutrient Density: Beyond Organic Versus Conventional Farming.” Frontiers in Sustainable Food Systems 5 (2021). https://doi.org/10.3389/fsufs.2021.699147.

Worthington V. “Effect of Agricultural Methods on Nutritional Quality: A Comparison of Organic with Conventional Crops.” Alternative Therapies in Health and Medicine 4, no. 1 (1998): 58–69.

Doctor’s Data Lab, Journal of Applied Nutrition 45 (1993); cited in Haas, Elson, The Staying Healthy Shoppers Guide, Celestial Arts.

organic foods often taste better

Reganold, J. P., J. D. Glover, P. K. Andrews, and H. R. Hinman. “Sustainability of Three Apple Production Systems.” Nature 410 (2001): 926–30.
https://doi.org/10.1038/35073574.

Ingredient #6: Supplements

many women already have significant nutritional deficits when they start their first pregnancy

See Chapter 1.

the amount of vitamin C that prevents scurvy is less than that which brings the greatest cardiovascular health across a lifetime

Law, M. R., and J. K. Morris. “By How Much Does Fruit and Vegetable Consumption Reduce the Risk of Ischaemic Heart Disease?” European Journal of Clinical Nutrition 8 (1998): 54956. https://doi.org/10.1038/sj.ejcn.1600603.

Kendler, B. S. “Recent Nutritional Approaches to the Prevention and Therapy of Cardiovascular Disease.” Progress in Cardiovascular Nursing 12, no. 3 (1997): 3–23. https://pubmed.ncbi.nlm.nih.gov/9287363/.

A growing body of research has substantiated the benefits of above-DV levels of various nutrients for gastrointestinal dysfunction, depression, hormonal disturbances, and autoimmune diseases

See Chapter 5.

do not take more than 5,000 IU of vitamin A if you are pregnant

Committee Opinion. American College of Obstetricians and Gynecologists, #196, (1998).

[Vitamin] B5 enables the body to make adrenal hormones.

See Chapter 5.

Vitamin B6 helps balance the endocrine system

See Chapter 5.

Ingredient #7: Sugar

The average American today eats 60–70 pounds per year of refined sugars

According to the CDC: https://www.cdc.gov/nutrition/data-statistics/added-sugars.html.

High consumption of sugar (and the elevated levels of insulin that come with it) is associated with type 2 diabetes, weight gain, bloating, fatigue, arthritis, migraines, lowered immune function, gallstones, obesity, breast cancer, and cardiovascular disease. And sugar is depleting

For a general review, see: Crayhon, R. Nutrition Made Simple. M. Evans & Co., 1988: 54–55.

“Get the Facts: Added Sugars.” CDC Nutrition.
https://www.cdc.gov/nutrition/php/data-research/added-sugars.html.

Huang, Yin, Zeyu Chen, Bo Chen, Jinze Li, Xiang Yuan, Jin Li, Wen Wang, et al. “Dietary Sugar Consumption and Health: Umbrella Review.” BMJ 381 (2023): e071609. https://doi.org/10.1136/bmj-2022-071609.

DeChristopher, L. R., K. J. Auerbach, and M. D. Tucker. “Intake of High-Fructose Corn Syrup Sweetened Soft Drinks, Fruit Drinks and Apple Juice Is Associated with Prevalent Arthritis in US Adults, Aged 20–30 Years.” Nutrition and Diabetes 6, no. 3 (2016): e199. https://doi.org/10.1038/nutd.2016.7.

Gao, Xiang, Yujie Gao, Dongdong Zhang, Qiaoqiao Luo, and Menglu Zhao. “Exploring the Causal Relationship Between Lifestyle, Sleep, and Reproductive Factors and Migraine: A Mendelian Randomization Study.” Nutrients 17, no. 1 (2025): 135.
https://doi.org/10.3390/nu17010135.

Regarding breast cancer, see: Bruning P. F., J. M. Bonfrer, P. A. van Noord, A. A. Hart, M. de Jong-Bakker, and W. J. Nooijen. “Insulin Resistance and Breast-Cancer Risk.” International Journal of Cancer 52, no. 4 (1992): 511–6.
https://doi.org/10.1002/ijc.2910520402.

Sugar also feeds some of the microbes in the digestive tract, which can lead to impaired nutrient absorption, diarrhea, gas, or fatigue.

See Chapter 5.

And if you do keep dessert around, try to have only one kind, since we tend to eat more if there’s a variety.

Embling, Rochelle, Emma J. Boyland, Eric Robinson, and Jason C. G. Halford. “Effect of Food Variety on Intake of a Meal: A Systematic Review and Meta-Analysis.” The American Journal of Clinical Nutrition 113, no. 3 (2021): 716–741.
https://doi.org/10.1093/ajcn/nqaa352.

Exercising Regularly

exercise will improve your cardiovascular health, strengthen your immune system, and help prevent obesity and type 2 diabetes

LaFontaine, T., S. Dabney, R. Brownson, and C. Smith. “The Effect of Physical Activity on All Cause Mortality Compared to Cardiovascular Mortality: A Review of Research and Recommendations.” Missouri Medicine 91, no. 4 (1994): 188–94.
https://pubmed.ncbi.nlm.nih.gov/8202071/.

Smekal, G., R. Pokan, R. Baron, H. Tschan, and N. Bachl. [“Amount and Intensity of Physical Exercise in Primary Prevention”] [German]. Wiener Medizinische Wochenschrift 151, nos. 1–2 (2001): 7–12.

Ryan. A. S. “Insulin Resistance with Aging: Effects of Diet and Exercise.” Sports Medicine 30, no. 5 (2000): 327–46.
https://doi.org/10.2165/00007256-200030050-00002.

Regular Checkups

A postpartum depression triples the risk of another one

Munk-Olsen, Trine, Katja G. Ingstrup, Benedicte M. Johannsen, and Xiaoqin Liu. “Population-Based Assessment of the Recurrence Risk of Postpartum Mental Disorders: Will It Happen Again?” JAMA Psychiatry 77, no. 2 (2020): 213–14.
https://doi.org/10.1001/jamapsychiatry.2019.3208.

Chapter 5: What to Do If You’re Getting Depleted

Jan’s Story: “I’m Going to Get Better!”

Drains and Stresses

my gastrointestinal tract had already been disturbed by years of taking antibiotics

Catanzaro, John A., and Lisa Green. “Microbial Ecology and Dysbiosis in Human Medicine.” Alternative Medicine Review 2, no. 3 (1997): 202–9.
https://chiro.org/Graphics_Box_ALT-MED/Microbial_Ecology_and_Dysbiosis.pdf.

Garcia, Karina, et al. “Impact of Dietary Sugars on Gut Microbiota and Metabolic Health.” Diabetology 3, no. 4 (2022): 549–60.
https://doi.org/10.3390/diabetology3040042.

Van Zyl, Kristien Nel, et al. “The Effect of Antibiotics on the Human Microbiome: A Systematic Review.” International Journal of Antimicrobial Agents 59, no. 2 (2021): 106502. https://doi.org/10.1016/j.ijantimicag.2021.106502.

Vander, A. J., et al. Human Physiology: The Mechanisms of Body Function. McGraw-Hill, 2001: 728.

The Realization

Some also excrete toxic substances . . . mental fog.

Valles-Colomer, Mireia, et al. “The Neuroactive Potential of the Human Gut Microbiota in Quality of Life and Depression.” Nature Microbiology 4, no. 4 (2019): 623–32. https://doi.org/10.1038/s41564-018-0337-x.

Dubois, Thomas, et al. “Role of Gut Microbiota in the Interaction between Immunity and Psychiatry: A Literature Review.” Psychiatria Danubina 31, no. Supplement 3 (2019): 381–85. https://pubmed.ncbi.nlm.nih.gov/31488756/.

Spectrum of Care

Your Gastrointestinal System

the microbiome, home to vast populations of microorganisms living in your intestines

Gorman, Christine. “Healthy Germs.” Time, Dec. 28 1998: 197.

The beneficial microflora aid digestion, make essential vitamins

Marz, Russell B. Medical Nutrition from Marz. 2nd ed., Omni Press, 1997: 19.

What Can Disturb the Gastrointestinal System

(NSAID’s), such as aspirin or ibuprofen, can irritate and inflame the lining of the gut

Drini, Musa. “Peptic Ulcer Disease and Non-Steroidal Anti-Inflammatory Drugs.” Australian Prescriber 40, no. 3 (2017): 91–93.
https://doi.org/10.18773/austprescr.2017.037.

stress can disrupt the delicate balance of the microbial ecology in the digestive tract

Bailey, M. T., and C. L. Coe. “Maternal Separation Disrupts the Integrity of the Intestinal Microflora in Infant Rhesus Monkeys.” Developmental Psychobiology 35, no. 2 (1999): 146–55, https://pubmed.ncbi.nlm.nih.gov/10461128/.

Huis in ’t Veld , J. H. [“Gastrointestinal Flora and Health in Man and Animal”] [German]. Tijdschrift Voor Diergeneeskunde 116, no. 5 (1991): 232–39.
https://pubmed.ncbi.nlm.nih.gov/1901673/.

Kelly, G. S. “Nutritional and Botanical Interventions to Assist with the Adaptation to Stress.” Alternative Medicine Review 4, no. 4 (1999): 249–65. https://pubmed.ncbi.nlm.nih.gov/10468649/.

a mother’s reliance on quick and ultra-processed foods—which usually contain lots of white flour and sugar—can foster a population explosion of harmful microorganisms

Arnone, Djésia, et al. “Sugars and Gastrointestinal Health.” Clinical Gastroenterology and Hepatology 20, no. 9 (2021).
https://doi.org/10.1016/j.cgh.2021.12.011.

Numerous studies demonstrate this with regard to yeast. For a sampling, see:

Pizzo, G., et al. “Effect of Dietary Carbohydrates on the in Vitro Epithelial Adhesion of Candida Albicans, Candida Tropicalis, and Candida Krusei.” New Microbiologica 23, no. 1 (2000): 63–71. https://pubmed.ncbi.nlm.nih.gov/10946407/.

Weig, Michael, et al. “Limited Effect of Refined Carbohydrate Dietary Supplementation on Colonization of the Gastrointestinal Tract of Healthy Subjects by Candida Albicans.” American Journal of Clinical Nutrition 69, no. 6 (1999): 1170–73.
https://doi.org/10.1093/ajcn/69.6.1170.

[Note that this study gave extra carbohydrates for just one week; nonetheless, subjects who already had high levels of oral candida still showed in increase in yeast.]

Samaranayake, Y. H., et al. “The in Vitro Iysozyme Susceptibility of Candida Albicans Cultured in Carbohydrate-Supplemented Media.” Oral Microbiology and Immunology 8, no. 3 (1993): 177–81. https://doi.org/10.1111/j.1399-302x.1993.tb00662.x.

Samaranayake, Y. H., et al. “The in Vitro Lysozyme Susceptibility of Candida Species Cultured in Sucrose-Supplemented Media.” Microbios 74, no. 298 (1993): 23–28. https://pubmed.ncbi.nlm.nih.gov/8336552/.

Vargas, S. L., et al. “Modulating Effect of Dietary Carbohydrate Supplementation on Candida Albicans Colonization and Invasion in a Neutropenic Mouse Model.” Infection and Immunity 61, no. 2 (1993): 619–26.
https://doi.org/10.1128/iai.61.2.619-626.1993.

Nikawa, H., et al. “Modulation of the Anti-Candida Activity of Apo-Lactoferrin by Dietary Sucrose and Tunicamycin in Vitro.” Archives of Oral Biology 40, no. 6 (1995): 581–84, https://doi.org/10.1016/0003-9969(94)00195-h.

Note also that sugars and refined carbohydrates could promote yeast overgrowth by weakening the immune system; see:

Murray, Michael T., and Joseph E. Pizzorno. Encyclopedia of Natural Medicine. 2nd ed., Prima Pub, 1998: 151–52.

Dysbiosis has been linked to numerous GI symptoms, including constipation, diarrhea, cramping, and inflammation in the digestive tract

For example, see:

Neut, C., et al. [“Treatment of Diversion Colitis with Short-Chain Fatty Acids. Bacteriological Study”] [French]. Gastroenterologie Clinique et Biologique 19, no. 11 (1995): 871–75. https://pubmed.ncbi.nlm.nih.gov/8746044/.

Zoppi, G., et al. “The Intestinal Ecosystem in Chronic Functional Constipation.” Acta Paediatrica 87, no. 8 (1998): 836–41.
https://doi.org/10.1080/080352598750013590.

For a general review, see:

Catanzaro, John A., and Lisa Green. “Microbial Ecology and Dysbiosis in Human Medicine.” Alternative Medicine Review. 2, no. 3 (1997): 202–9.
https://chiro.org/Graphics_Box_ALT-MED/Microbial_Ecology_and_Dysbiosis.pdf.

these factors may, in turn, lead to what is called a food sensitivity

Ahmed, T., and G. J. Fuchs. “Gastrointestinal Allergy to Food: A Review.” Journal of Diarrhoeal Diseases Research 15, no. 4 (1997): 211–23.
https://pubmed.ncbi.nlm.nih.gov/9661317/.

Butkus, S. N., and L. K. Mahan. “Food Allergies: Immunological Reactions to Food.” Journal of the American Dietetic Association 86, no. 5 (1986): 601–8.
https://pubmed.ncbi.nlm.nih.gov/3517113/.

Proujansky, R., et al. “Gastrointestinal Syndromes Associated with Food Sensitivity.” Advances in Pediatrics 35 (1988): 219–37.
https://pubmed.ncbi.nlm.nih.gov/3055859/.

these oversized, only partially processed “macromolecules” could be a threat, so the body’s defenses are mobilized to protect you

For a review, see:

Miller, Alan. “The Pathogenesis, Clinical Implications, and Treatment of Intestinal Hyperpermeability.” Alternative Medicine Review 2 (1997): 330–45.
https://altmedrev.com/wp-content/uploads/2019/02/v2-5-330.pdf.

irregularities in thyroid hormones (more likely after children) can lead to constipation (low thyroid) or diarrhea (high thyroid)

Nolan, Thomas E. Chapter 9. Novak’s Gynecology. Edited by Jonathan S. Berek, 12th ed., Williams & Wilkins, 1996: 222.

Disturbances in neurotransmitters such as serotonin can trouble your digestive tract.

De Ponti, Fabrizio, and Marcello Tonini. “Irritable Bowel Syndrome.” Drugs 61, no. 3 (2001): 317–32.
https://doi.org/10.2165/00003495-200161030-00001.

Schmulson, M. J. “Brain-Gut Interaction in Irritable Bowel Syndrome: New Findings of a Multicomponent Disease Model.” Israel Medical Association Journal 3, no. 2 (2001): 104–10. https://pubmed.ncbi.nlm.nih.gov/11347592/.

Signs and Symptoms of Disturbance in the GI System

there is some evidence that food sensitivities can lead to an overactive immune system in general

Bozic, Carmen R., et al. “Neurogenic Amplification of Immune Complex Inflammation.” Science 273, no. 5282 (1996): 1722–25.
https://doi.org/10.1126/science.273.5282.1722.

Meggs, W. J. “Neurogenic Switching: A Hypothesis for a Mechanism for Shifting the Site of Inflammation in Allergy and Chemical Sensitivity.” Environmental Health Perspectives 103, no. 1 (1995): 54–56.
https://doi.org/10.1289/ehp.9510354.

an apparent association between vaginal yeast infections and an overgrowth of yeast in the digestive tract

Miles, M. R. “Recurrent Vaginal Candidiasis: Importance of an Intestinal Reservoir.” JAMA 238, no. 17 (1977): 1836–37.
https://doi.org/10.1001/jama.238.17.1836.

Nystatin Multicenter Study Group. “Therapy of Candidal Vaginitis: The Effect of Eliminating Intestinal Candida.” American Journal of Obstetrics and Gynecology 155, no. 3 (1986): 651–55. https://doi.org/10.1016/0002-9378(86)90297-8.

And the toxins excreted by pathogenic microbes may lead to fatigue, inflammation, depressed mood, or poor memory.

William, Shaw, et al. Biological Treatments for Autism and PDD. Great Plains Laboratory, 2008: 31–65, 105–7.

Gastrointestinal Assessment

Footnote: Yet high levels . . . [of yeast] can . . . cause diarrhea, increase the likelihood of vaginal infections, and produce microtoxins that can weaken your immune system.

Beaver, J. P., and P. Waring. “A Decrease in Intracellular Glutathione Concentration Precedes the Onset of Apoptosis in Murine Thymocytes.” European Journal of Cell Biology 68, no. 1 (1995): 47–54.
https://pubmed.ncbi.nlm.nih.gov/8549589/.

Sutton, P., et al. “In Vivo Immunosuppressive Activity of Gliotoxin, a Metabolite Produced by Human Pathogenic Fungi.” Infection and Immunity. 62, no. 4 (1994): 1192–98. https://doi.org/10.1128/iai.62.4.1192-1198.1994.

Talwar, P., et al. “Fungal Diarrhoea: Association of Different Fungi and Seasonal Variation in Their Incidence.” Mycopathologia 110, no. 2 (1990): 101–5.
https://doi.org/10.1007/bf00446998.

But for a caution on overestimating the impact of candida, see:

Odds, F. C. “Candida Infections: An Overview.” Critical Reviews in Microbiology 15, no. 1 (1987): 1–5.
https://doi.org/10.3109/10408418709104444.

Balancing Your Gastrointestinal System

Energetic: acupuncture could help balance your GI system

Li, Hui, et al. “Acupuncture and Regulation of Gastrointestinal Function.” World Journal of Gastroenterology 21, no. 27 (2015): 8304.
https://doi.org/10.3748/wjg.v21.i27.8304.

Dietary: you may be able to reduce problematic the microbes by eliminating sugar, refined carbohydrates, and alcohol

Try to consume about 25 grams of fiber each day.

USDA, and US Health and Human Service. Dietary Guidelines for Americans 2020 -2025: Make Every Bite Count with the Dietary Guidelines. Dec. 2020, www.dietaryguidelines.gov/sites/default/files/2021-03/Dietary_Guidelines_for_Americans_2020-2025.pdf.

fiber . . . supports beneficial bacteria

Schneeman, Barbara O. “Carbohydrates: Significance for Energy Balance and Gastrointestinal Function.” Journal of Nutrition 124, no. Supplement 9 (1994): 1747S1753S. https://doi.org/10.1093/jn/124.suppl_9.1747s.

the low-FODMAP diet

Monash University. Low FODMAP Diet: IBS Research at Monash University. 2019, https://www.monashfodmap.com/.

Supplements: essential fatty acids are needed for the walls of your intestines, plus they may help with serious GI disturbances, such as ulcerative colitis

Almallah, Y. Z., et al. “Distal Procto-Colitis, Natural Cytotoxicity, and Essential Fatty Acids.” American Journal of Gastroenterology 93, no. 5 (1998): 804–9.
https://doi.org/10.1111/j.1572-0241.1998.229_a.x.

[Intensive Daily Dose of] L-glutamine

Ziegler, T., et al. “Glutamine: From Basic Science to Clinical Applications.” Nutrition 12, no. 12 (1996): S68–70.
https://doi.org/10.1016/s0899-9007(96)00019-6.

licorice root . . . can reduce gastric pain and even help heal ulcers

Murray, Michael T., and Joseph E. Pizzorno. Encyclopedia of Natural Medicine. 2nd ed., Prima Pub, 1998: 85.

For overgrowth of microbes . . . several herbs can help reduce these populations, including garlic, goldenseal, and oregano

Birdsall, Timothy. “Gastrointestinal Candidiasis: Fact or Fiction?” Alternative Medicine Review 2, no. 5 (1997).
https://chiro.org/Graphics_Box_NUTRITION/Gastrointestinal_Candidiasis.pdf.

Hammer, K. A., et al. “Antimicrobial Activity of Essential Oils and Other Plant Extracts.” Journal of Applied Microbiology 86, no. 6 (1999): 985–90.
https://doi.org/10.1046/j.1365-2672.1999.00780.x.

Murray, Michael T., and Joseph E. Pizzorno. Encyclopedia of Natural Medicine. 2nd ed., Prima Pub, 1998: 85, 151–52.

Stiles, J. C., et al. “The Inhibition of Candida Albicans by Oregano.” Journal of Applied Nutrition 47 (1995): 96–102.

Probiotics: These beneficial microorganisms crowd out pathogenic ones

Goldin, B. R. “Health Benefits of Probiotics.” British Journal of Nutrition 80, no. 4 (1998): S203–7. https://pubmed.ncbi.nlm.nih.gov/9924285/.

Gorbach, S. “Probiotics and Gastrointestinal Health.” American Journal of Gastroenterology 95, no. 1 (2000): S2–4.
https://doi.org/10.1016/s0002-9270(99)00806-0.

Kopp-Hoolihan, L. “Prophylactic and Therapeutic Uses of Probiotics: A Review.” Journal of the American Dietetic Association 101, no. 2 (2001): 229–41.
https://doi.org/10.1016/S0002-8223(01)00060-8.

Pochapin, M. “The Effect of Probiotics on Clostridium Difficile Diarrhea.” American Journal of Gastroenterology 95, no. 1 (2000): S11–13.
https://doi.org/10.1016/s0002-9270(99)00809-6.

Vander, A. J., et al. Human Physiology: The Mechanisms of Body Function. McGraw-Hill, 2001: 703, 728.

lactobacillus GG has been clearly shown to decrease GI infection

Britton, Robert A., and James Versalovic. “Probiotics and Gastrointestinal Infections.” Interdisciplinary Perspectives on Infectious Diseases 2008 (2008). https://doi.org/10.1155/2008/290769.

Conventional medicine: The treatment options include antidiarrheal agents, antispasmodics, and low doses of antidepressants.

For example, for a review of approaches to irritable bowel syndrome, see:

Camilleri, Michael. “Management of the Irritable Bowel Syndrome.” Gastroenterology 120, no. 3 (2001): 652–68.
https://doi.org/10.1053/gast.2001.21908.

Wald, Arnold. “Irritable Bowel Syndrome.” Current Treatment Options in Gastroenterology 2, no. 1 (1999): 13–19.
https://doi.org/10.1007/s11938-999-0013-6.

Your Nervous System

What Can Disturb the Nervous System

Stresses . . . can change the balance of neurotransmitters in your brain and cause depressed mood

Orr, S. T., et al. “Chronic Stressors and Maternal Depression: Implications for Prevention.” American Journal of Public Health 79, no. 9 (1989): 1295–96. https://doi.org/10.2105/ajph.79.9.1295.

and poorer . . . memory

Newcomer, J. W. “Decreased Memory Performance in Healthy Humans Induced by Stress-Level Cortisol Treatment.” Archives of General Psychiatry 56, no. 6 (1999): 527–33. https://doi.org/10.1001/archpsyc.56.6.527.

there’s a high demand for [taurine] during breastfeeding

Braverman, Eric R. The Healing Nutrients Within. 2nd ed., Keats Publishing, 1997: 163.

fluctuations in estrogen or progesterone . . . can impact several neurotransmitter systems, leading to depression, anxiety, or a poorer memory

Fink, George, et al. “Estrogen Control of Central Neurotransmission: Effect on Mood, Mental State, and Memory.” Cellular and Molecular Neurobiology 16, no. 3 (1996): 325–44. https://doi.org/10.1007/bf02088099.

Archer, Johanna Suzanne. “Relationship Between Estrogen, Serotonin and Depression.” Menopause 4, no. 4 (1997): 288.
https://doi.org/10.1097/00042192-199704040-00147.

Gray, Jeffrey A. “Sex Differences in Emotional Behaviour in Mammals Including Man: Endocrine Bases.” Acta Psychologica 35, no. 1 (1971): 29–46.
https://doi.org/10.1016/0001-6918(71)90029-1.

Carpenter, Siri. “Does Estrogen Protect Memory?” Apa.org, Monitor on Psychology, 2001. https://www.apa.org/monitor/jan01/estrogen.

Thyroid dysregulation after childbirth or due to an autoimmune condition related to motherhood can lead to depression.

Minaldi, E., et al. “Thyroid Autoimmunity and Risk of Post-Partum Depression: A Systematic Review and Meta-Analysis of Longitudinal Studies.” Journal of Endocrinological Investigation 43, no. 3 (2019): 271–77.
https://doi.org/10.1007/s40618-019-01120-8.

as cortisol rises due to stress, DHEA tends to decline

Cacioppo, John T., et al. “Autonomic, Neuroendocrine, and Immune Responses to Psychological Stress: The Reactivity Hypothesisa.” Annals of the New York Academy of Sciences 840, no. 1 (1998): 664–73.
https://doi.org/10.1111/j.1749-6632.1998.tb09605.x.

Laughlin, G. A., et al. “Nutritional and Endocrine-Metabolic Aberrations in Women with Functional Hypothalamic Amenorrhea1.” Journal of Clinical Endocrinology & Metabolism, 83, no. 1 (1998): 25–32.
https://doi.org/10.1210/jcem.83.1.4502.

which has been linked to depressed mood

Barrett-Connor, Elizabeth, et al. “Endogenous Levels of Dehydroepiandrosterone Sulfate, but Not Other Sex Hormones, Are Associated with Depressed Mood in Older Women: The Rancho Bernardo Study.” Journal of the American Geriatrics Society 47, no. 6 (1999): 685–91. https://doi.org/10.1111/j.1532-5415.1999.tb01590.x.

Cawood, Elizabeth H. H., and John Bancroft. “Steroid Hormones, the Menopause, Sexuality and Well-Being of Women.” Psychological Medicine 26, no. 5 (1996): 925–36. https://doi.org/10.1017/s0033291700035261.

Michael, Albert, et al. “Altered Salivary Dehydroepiandrosterone Levels in Major Depression in Adults.” Biological Psychiatry 48, no. 10 (2000): 989–95.
https://doi.org/10.1016/s0006-3223(00)00955-0.

1. Takebayashi, et al. “Plasma Dehydroepiandrosterone Sulfate in Unipolar Major Depression.” Journal of Neural Transmission 105, no. 4 (1998): 537–37. https://doi.org/10.1007/s007020050077.

allergies and inflammation . . . can lower your mood

Bell, Iris R., et al. “Depression and Allergies: Survey of a Nonclinical Population.” Psychotherapy and Psychosomatics 55, no. 1 (1991): 24–31.
https://doi.org/10.1159/000288404.

Lu, Zhiyu, et al. “Allergic Disorders and Risk of Depression: A Systematic Review and Meta-Analysis of 51 Large-Scale Studies.” Annals of Allergy, Asthma & Immunology 120, no. 3 (2018): 310–317. https://doi.org/10.1016/j.anai.2017.12.011.

Gastrointestinal dysfunction due to maternal stress can have a similar effect.

Kumar, D., et al. “Role of Psychological Factors in the Irritable Bowel Syndrome.” Digestion 45, no. 2 (1990): 80–87.
https://doi.org/10.1159/000200227.

Masand, P. S., et al. “Major Depression and Irritable Bowel Syndrome: Is There a Relationship?” Journal of Clinical Psychiatry 56, no. 8 (1995): 363–67. https://pubmed.ncbi.nlm.nih.gov/7635853/.

Song, Ji-Yung, et al. “Anxiety and Depression in Patients with Abdominal Bloating.” Canadian Journal of Psychiatry 38, no. 7 (1993): 475–79.
https://doi.org/10.1177/070674379303800703.

Talley, Nicholas J., et al. “Impact of Functional Dyspepsia on Quality of Life.” Digestive Diseases and Sciences 40, no. 3 (1995): 584–89.
https://doi.org/10.1007/bf02064375.

Walker, Edward A., et al. “Comorbidity of Gastrointestinal Complaints, Depression, and Anxiety in the Epidemiologic Catchment Area (ECA) Study.” American Journal of Medicine 92, no. 1 (1992): S26–30.
https://doi.org/10.1016/0002-9343(92)90133-v.

Balancing the Neurotransmitters of Mood

Energetic: acupuncture can lift depressed mood.

Armour, Mike, et al. “Acupuncture for Depression: A Systematic Review and Meta-Analysis.” Journal of Clinical Medicine 8, no. 8 (2019): 1140.
https://doi.org/10.3390/jcm8081140.

Eich, H., et al. [“Acupuncture in Patients with Minor Depressive Episodes and Generalized Anxiety. Results of an Experimental Study”] [German]. Fortschritte der Neurologie Psychiatrie 68, no. 3 (2000): 137–44.
https://doi.org/10.1055/s-2000-11624.

Luo, Hechun, et al. “Clinical Research on the Therapeutic Effect of the Electro-Acupuncture Treatment in Patients with Depression.” Psychiatry and Clinical Neurosciences 52, no. S6 (1998): S338–40.
https://doi.org/10.1111/j.1440-1819.1998.tb03262.x.

Ulett, George A., et al. “Electroacupuncture: Mechanisms and Clinical Application.” Biological Psychiatry44, no. 2 (1998): 129–38.
https://doi.org/10.1016/s0006-3223(97)00394-6.

Musculoskeletal: Regular exercise . . . can help lift depressed mood, sometimes working as well as an antidepressant.

Clegg, Andrew J., et al. “Exercise for Depression.” Cochrane Database of Systematic Reviews, no. 1 (2026): CD004366.
https://doi.org/10.1002/14651858.CD004366.pub7.

Dietary: Be careful about a low-protein diet if you tend toward a depressed mood, since that would reduce amino acids needed for healthy brain chemistry.

Smith, K. A., et al. “Impaired Regulation of Brain Serotonin Function during Dieting in Women Recovered from Depression.” British Journal of Psychiatry 176, no. 1 (2000): 72–75. https://doi.org/10.1192/bjp.176.1.72.

eliminating sugar can improve mood

See studies reported in:

Werbach, Melvyn R. Nutritional Influences on Illness. 2nd ed., Third Line Press, 1996: 223.

Also see research by Dr. Kelly Kreitsch (1988) reported in:

Pelletier, Kenneth R. The Best Alternative Medicine: What Works? What Does Not? Simon & Schuster, 2000: 148.

Eliminating alcohol could help as well.

Werbach, Melvyn R. Nutritional Influences on Illness. 2nd ed., Third Line Press, 1996: 223–25.

Also see research by Dr. Kelly Kreitsch (1988) reported in:

Pelletier, Kenneth R. The Best Alternative Medicine: What Works? What Does Not? Simon & Schuster, 2000: 189.

Supplements: deficits in the[following] nutrients . . . are associated with depressed mood. . . . Supplementation . . . especially when there is a deficiency . . . could help lift your spirits.

Werbach, Melvyn R. Nutritional Influences on Illness. 2nd ed., Third Line Press, 1996: 223–73.

For vitamins, see:

Benton, D., et al. “Vitamin Supplementation for 1 Year Improves Mood.” Neuropsychobiology 32, no. 2 (1995): 98–105.
https://doi.org/10.1159/000119220.

For essential fatty acids, see:

Adams, Peter B., et al. “Arachidonic Acid to Eicosapentaenoic Acid Ratio in Blood Correlates Positively with Clinical Symptoms of Depression.” Lipids 31, no. 1 (1996): S157–61. https://doi.org/10.1007/bf02637069.

Bruinsma, K. A., and D. L. Taren. “Dieting, Essential Fatty Acid Intake, and Depression.” Nutrition Reviews 58, no. 4 (2000): 98–108.
https://doi.org/10.1111/j.1753-4887.2000.tb07539.x.

Maes, M., et al. “Fatty Acid Composition in Major Depression: Decreased Omega 3 Fractions in Cholesteryl Esters and Increased C20: 4 Omega 6/C20:5 Omega 3 Ratio in Cholesteryl Esters and Phospholipids.” Journal of Affective Disorders 38, no. 1 (1996): 35–46. https://doi.org/10.1016/0165-0327(95)00092-5.

Tryptophan is used to make serotonin

Richard, Dawn M., et al. “L-Tryptophan: Basic Metabolic Functions, Behavioral Research and Therapeutic Indications.” International Journal of Tryptophan Research 2, no. 2 (2009): S2129. https://doi.org/10.4137/ijtr.s2129.

supplementing [tryptophan] or 5-hydroxytryptophan . . . is often successful in the treatment of mild depression

Kikuchi, Asako M., et al. “A Systematic Review of the Effect of L-Tryptophan Supplementation on Mood and Emotional Functioning.” Journal of Dietary Supplements. 18, no. 3 (2020): 1–18. https://doi.org/10.1080/19390211.2020.1746725.

For a general review, see:

Meyers, S. “Use of Neurotransmitter Precursors for Treatment of Depression.” Alternative Medicine Review 5, no. 1 (2000): 64–71.
https://pubmed.ncbi.nlm.nih.gov/10696120/.

the dosage of 5-HTP commonly used in studies of depression is 200–300 mg/day

Murray, Michael T. 5-HTP: The Natural Way to Overcome Depression, Obesity, and Insomnia. Bantam Books, 1999.

do not take 5-HTP along with . . . antidepressants (especially MAO inhibitors)

Juarascio, Adrienne, et al. “Alternative Therapeutics for Sleep Disorders.” Elsevier EBooks (2011): 126–39.
https://doi.org/10.1016/b978-1-4377-1703-7.10009-x.

Tyrosine is the chemical basis for the neurotransmitters norepinephrine and dopamine, which are involved in the regulation of mood.

Meyers, S. “Use of Neurotransmitter Precursors for Treatment of Depression.” Alternative Medicine Review 5, no. 1 (2000): 64–71.
https://pubmed.ncbi.nlm.nih.gov/10696120/.

Young, Simon N. “Behavioral Effects of Dietary Neurotransmitter Precursors: Basic and Clinical Aspects.” Neuroscience & Biobehavioral Reviews 20, no. 2 (1996): 313–23. https://doi.org/10.1016/0149-7634(95)00022-4.

If you are deficient in tyrosine, or its amino acid precursor, phenylalanine, supplementing one of these may help improve your mood.

Leonard, B. E. “The Role of Noradrenaline in Depression: A Review.” Journal of Psychopharmacology 11, no. 4 Supplement (1997): S39-47. https://pubmed.ncbi.nlm.nih.gov/9438232/.

Leyton, M. “Effects on Mood of Acute Phenylalanine/Tyrosine Depletion in Healthy Women.” Neuropsychopharmacology 22, no. 1 (2000): 52–63.
https://doi.org/10.1016/s0893-133x(99)00086-x.

One well-controlled study found no benefit for tyrosine, but its participants were not screened for deficiency in the first place:

Gelenberg, Alan J., et al. “Tyrosine for Depression: A Double-Blind Trial.” Journal of Affective Disorders 19, no. 2 (1990): 125–32.
https://doi.org/10.1016/0165-0327(90)90017-3.

Another amino acid, taurine, may have a mild calming effect and help ease irritability

Through its inhibitory effects as a neurotransmitter, and through up-regulating intracellular magnesium.

Jakaria, Md, et al. “Taurine and Its Analogs in Neurological Disorders: Focus on Therapeutic Potential and Molecular Mechanisms.” Redox Biology 24, no. 101223 (2019): 101223. https://doi.org/10.1016/j.redox.2019.101223.

Low levels of SAMe are associated with depressed mood, and several well-controlled studies have found that supplementing SAMe is often quite effective in relieving depression

Bell, K. M., et al. “S-Adenosylmethionine Blood Levels in Major Depression: Changes with Drug Treatment.” Acta Neurologica Scandinavica 89, no. S154 (1994): 15–18. https://doi.org/10.1111/j.1600-0404.1994.tb05404.x.

Bressa, G. M. “S-Adenosyl-l-Methionine (SAMe) as Antidepressant: Meta-Analysis of Clinical Studies.” Acta Neurologica Scandinavica 89, no. S154 (1994): 7–14.
https://doi.org/10.1111/j.1600-0404.1994.tb05403.x.

Bottiglieri, T. “Homocysteine, Folate, Methylation, and Monoamine Metabolism in Depression.” Journal of Neurology, Neurosurgery & Psychiatry 69, no. 2 (2000): 228–32. https://doi.org/10.1136/jnnp.69.2.228.

Fugh-Berman, Adriane, and Jerry M. Cott. “Dietary Supplements and Natural Products as Psychotherapeutic Agents.” Psychosomatic Medicine 61, no. 5 (1999): 712–28. https://doi.org/10.1097/00006842-199909000-00012.

Kagan, B. L., et al. “Oral S-Adenosylmethionine in Depression: A Randomized, Double-Blind, Placebo-Controlled Trial.” American Journal of Psychiatry 147, no. 5 (1990): 591–95. https://doi.org/10.1176/ajp.147.5.591.

[SAMe] also seems helpful for joint pain

Soeken, Karen L., et al. “Safety and Efficacy of S-Adenosylmethionine (SAMe) for Osteoarthritis.” Journal of Family Practice 51, no. 5 (2002): 425–30.
https://pubmed.ncbi.nlm.nih.gov/12019049/.

The most commonly used daily dosage of SAMe is 400–800 mg. . . . We suggest starting at 200 mg—especially if you are sensitive to medications—or at 100 mg if you have a history of panic attacks; a person with bipolar disorder should take SAMe only under medical supervision.

Karas Kuželički, Nataša. “S-Adenosyl Methionine in the Therapy of Depression and Other Psychiatric Disorders.” Drug Development Research 77, no. 7 (2016): 346–56. https://doi.org/10.1002/ddr.21345.

Sarris, Jerome, et al. “Adjunctive Nutraceuticals for Depression: A Systematic Review and Meta-Analyses.” American Journal of Psychiatry 173, no. 6 (2016): 575–87. https://doi.org/10.1176/appi.ajp.2016.15091228.

Herbs: Studies have found [St. John’s wort] to be often helpful for mild depression

Ng, Qin Xiang, et al. “Clinical Use of Hypericum Perforatum (St John’s Wort) in Depression: A Meta-Analysis.” Journal of Affective Disorders 210 (2017): 211–21. https://doi.org/10.1016/j.jad.2016.12.048.

[St. John’s wort] does not appear to be an effective treatment for severe depression

Shelton, Richard C., et al. “Effectiveness of St John’s Wort in Major Depression.” JAMA 285, no. 15 (2001): 1978.
https://doi.org/10.1001/jama.285.15.1978.

About 2 to 20 percent of people taking St. John’s wort suffer side effects

Werbach, Melvyn R., and Michael T. Murray. Botanical Influences on Illness. Third Line Press, 1994: 251, 254–55.

Murray, Michael T., and Joseph E. Pizzorno. Encyclopedia of Natural Medicine. 2nd ed., Prima Pub, 1998: 396–97.

If you are on any prescription medication—in particular, for contraception, high blood pressure, or HIV—ask your doctor before trying St. John’s wort

Izzo, Angelo A., and Edzard Ernst. “Interactions between Herbal Medicines and Prescribed Drugs.” Drugs 69, no. 13 (2009): 1777–98.
https://doi.org/10.2165/11317010-000000000-00000.

Natural hormones: Supplementing DHEA may help lift a depressed mood, particularly if there is an adrenal insufficiency

Arlt, Wiebke, et al. “DHEA Replacement in Women with Adrenal Insufficiency—Pharmacokinetics, Bioconversion and Clinical Effects on Well-Being, Sexuality and Cognition.” Endocrine Research 26, no. 4 (2000): 505–11.
https://doi.org/10.3109/07435800009048561.

Arlt, Wiebke, et al. “Dehydroepiandrosterone Replacement in Women with Adrenal Insufficiency.” New England Journal of Medicine 341, no. 14 (1999): 1013–20. https://doi.org/10.1056/nejm199909303411401.

Bloch, Miki, et al. “Dehydroepiandrosterone Treatment of Midlife Dysthymia.” Biological Psychiatry 45, no. 12 (1999): 1533–41.
https://doi.org/10.1016/s0006-3223(99)00066-9.

Wolkowitz, Owen M., et al. “Double-Blind Treatment of Major Depression with Dehydroepiandrosterone.” American Journal of Psychiatry 156, no. 4 (1999): 646–49. https://doi.org/10.1176/ajp.156.4.646.

Conventional medicine: Antidepressant medications are one of the great medical success stories in the last century, and millions of people have used them to good effect

Quitkin, F. M. “Validity of Clinical Trials of Antidepressants.” American Journal of Psychiatry 157, no. 3 (2000): 327–37.
https://doi.org/10.1176/appi.ajp.157.3.327.

Pregnant or breastfeeding women need to be particularly careful about the use of antidepressants.

Misri, S., et al. “Are SSRIs Safe for Pregnant and Breastfeeding Women?” Canadian Family Physician 46 (2000): 626–28, 631–33.
https://pubmed.ncbi.nlm.nih.gov/10752001/.

Yoshida, K., et al. “Psychotropic Drugs in Mothers’ Milk: A Comprehensive Review of Assay Methods, Pharmacokinetics and of Safety of Breast-Feeding.” Journal of Psychopharmacology 13, no. 1 (1999): 64–80.
https://doi.org/10.1177/026988119901300108.

[antidepressants] don’t always work

Rush, A. John, et al. “Acute and Longer-Term Outcomes in Depressed Outpatients Requiring One or Several Treatment Steps: A STAR*D Report.” American Journal of Psychiatry 163, no. 11 (2006): 1905–17.
https://doi.org/10.1176/ajp.2006.163.11.1905.

Your Endocrine System

hormones affect memory

Birge, Stanley J. “Is There a Role for Estrogen Replacement Therapy in the Prevention and Treatment of Dementia?” Journal of the American Geriatrics Society 44, no. 7 (1996): 865–70. https://doi.org/10.1111/j.1532-5415.1996.tb03749.x.

self-control

Copeland, Larry J., and John F. Jarrell. Textbook of Gynecology. Saunders, 2000:. 661.

and mood

Altshuler, Lori L., et al. “Pharmacological Management of Premenstrual Disorder.” Harvard Review of Psychiatry 2, no. 5 (1995): 233–45.
https://doi.org/10.3109/10673229509017143.

Raymond, Natasha. “Hormones Got You Down?” Psychology Today, Sept. 1999, https://www.psychologytoday.com/us/articles/199909/hormones-got-you-down.

What Can Disturb the Endocrine System

progesterone and estrogen levels may end up settling down to somewhere other than an optimal point

For a general discussion, see:

Speroff, Leon, et al. Clinical Gynecologic Endocrinology and Infertility. Williams & Wilkins, 1994.

[Stress] tends to rattle your progesterone, estrogen, insulin, cortisol, and thyroid hormones.

Vander, A. J., et al. Human Physiology: The Mechanisms of Body Function. McgGaw-Hill, 2001: 753.

the risk of thyroid problems increases several times higher after having children

Struve, C. W., et al. “Influence of Frequency of Previous Pregnancies on the Prevalence of Thyroid Nodules in Women without Clinical Evidence of Thyroid Disease.” Thyroid 3, no. 1 (1993): 7–9. https://doi.org/10.1089/thy.1993.3.7.

about one woman in ten will develop an autoimmune disease of the thyroid gland in the postpartum period

Davies, Terry F. “The Thyroid Immunology of the Postpartum Period.” Thyroid 9, no. 7 (1999): 675–84.
https://doi.org/10.1089/thy.1999.9.675.

Naji Rad, Sara, and Linda Deluxe. “Postpartum Thyroiditis.” StatPearls Publishing, 2021. https://www.ncbi.nlm.nih.gov/books/NBK557646/.

But sometimes this restoration of normal cycling does not occur smoothly, especially if you were prone to menstrual irregularities, or are now eating poorly or are under a good deal of stress.

Copeland, Larry J., and John F. Jarrell. Textbook of Gynecology. Saunders, 2000.

Digestive imbalances can disturb the delicate rhythms of the hormonal dance

Qi, Xinyu, et al. “The Impact of the Gut Microbiota on the Reproductive and Metabolic Endocrine System.” Gut Microbes 13, no. 1 (2021): 1894070. https://doi.org/10.1080/19490976.2021.1894070.

deficiencies in key nutrients can weaken the dancers.

Werbach, Melvyn R. Nutritional Influences on Illness. 2nd ed., Third Line Press, 1996: 542–49.

ups and downs in the neurotransmitters that regulate your mood can change your hormones as well

Freeman, Ellen W., et al. “Differential Response to Antidepressants in Women with Premenstrual Syndrome/Premenstrual Dysphoric Disorder.” Archives of General Psychiatry 56, no. 10 (1999): 932–9.
https://doi.org/10.1001/archpsyc.56.10.932.

Park, S. B. G., et al. “Do the Endocrine and Subjective Effects of D-Fenfluramine Predict Response to Selective Serotonin Reuptake Inhibitors?” International Clinical Psychopharmacology 10, no. 4 (1995): 215–20.
https://doi.org/10.1097/00004850-199511000-00002.

Steinberg, Susanne, et al. “A Placebo-Controlled Clinical Trial of L-Tryptophan in Premenstrual Dysphoria.” Biological Psychiatry 45, no. 3 (1999): 313–20.
https://doi.org/10.1016/s0006-3223(98)00005-5.

disturbances in the immune system can trigger autoimmune reactions that attack endocrine glands such as the thyroid

Smith, D. A., and D. R. Germolec. “Introduction to Immunology and Autoimmunity.” Environmental Health Perspectives 107, no. Supplement 5 (1999): 661–65. https://doi.org/10.1289/ehp.99107s5661.

Whitacre, C. C. “Biomedicine:A Gender Gap in Autoimmunity.” Science 283, no. 5406 (1999): 1277–78.
https://doi.org/10.1126/science.283.5406.1277.

Signs and Symptoms of Disturbance in the Endocrine System

some symptoms that might indicate hormonal imbalances

For a general review, see:

Speroff, Leon, et al. Clinical Gynecologic Endocrinology and Infertility. Williams & Wilkins, 1994.

For the potential connection between depressed mood and low estrogen, see:

Agorastos, Agorastos, et al. “Morning Salivary Dehydroepiandrosterone (DHEA) Qualifies as the Only Neuroendocrine Biomarker Separating Depressed Patients with and without Prior History of Depression: An HPA Axis Challenge Study.” Journal of Psychiatric Research 161 (2023): 449–54. https://doi.org/10.1016/j.jpsychires.2023.04.003.

Raymond, Natasha. “Hormones Got You Down?” Psychology Today, Sept. 1999, https://www.psychologytoday.com/us/articles/199909/hormones-got-you-down.

Assessing the Endocrine System

there is a normal pattern of rising and falling levels of cortisol over the course of the day

Speroff, Leon, et al. Clinical Gynecologic Endocrinology and Infertility. Williams & Wilkins, 1994.

Balancing Your Menstrual Cycle

PMS has many different faces—and no single solution.

For general reviews, see:

Head, Kathleen. “Premenstrual Syndrome: Nutritional and Alternative Approaches.” Alternative Medicine Review 2, no. 1 (1997): 12–25.
https://altmedrev.com/wp-content/uploads/2019/02/v2-1-12.pdf.

Speroff, Leon, et al. Clinical Gynecologic Endocrinology and Infertility. Williams & Wilkins, 1994: 515–23.

The ways in which your body is using and metabolizing hormones probably play a role [in PMS]as well.

Speroff, Leon, et al. Clinical Gynecologic Endocrinology and Infertility. Williams & Wilkins, 1994: 515–23.

Further, imbalances in various neurotransmitters have been implicated in PMS.

Energetic: acupuncture can sometimes be quite helpful with PMS, perhaps through its general effects on a woman’s sex hormones.

Ko, Jade Heejae, and Seung-Nam Kim. “A Literature Review of Women’s Sex Hormone Changes by Acupuncture Treatment: Analysis of Human and Animal Studies.” Evidence-Based Complementary and Alternative Medicine (2018): 1–9.
https://doi.org/10.1155/2018/3752723.

Musculoskeletal: Regular exercise promotes production of carrier proteins

Kraemer, William J., et al. “The Effects of Short-Term Resistance Training on Endocrine Function in Men and Women.” European Journal of Applied Physiology 78, no. 1 (1998): 69–76. https://doi.org/10.1007/s004210050389.

Speroff, Leon, et al. Clinical Gynecologic Endocrinology and Infertility. Williams & Wilkins, 1994.

one study showed that women who participate in sports experience less PMS than those who don’t

Choi, Precilla Y. L., and Peter Salmon. “Symptom Changes Across the Menstrual Cycle in Competitive Sportswomen, Exercisers and Sedentary Women.” British Journal of Clinical Psychology 34, no. 3 (1995): 447–60.
https://doi.org/10.1111/j.2044-8260.1995.tb01479.x.

Pearce, Emma, et al. “Exercise for Premenstrual Syndrome: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.” BJGP Open 4, no. 3 (2020): 101032. https://doi.org/10.3399/bjgpopen20x101032.

Regular massages can help [PMS] as well

Hernandez-Reif, M., et al. “Premenstrual Symptoms Are Relieved by Massage Therapy.” Journal of Psychosomatic Obstetrics & Gynecology 21, no. 1 (2000): 9–15. https://doi.org/10.3109/01674820009075603.

Dietary: You are likely to have less PMS if you consume less (or no) sugar, salt, refined carbohydrates, caffeine, alcohol, and dairy products, and if you increase your intake of fruits, vegetables, and other fiber-rich complex carbohydrates.

Werbach, Melvyn R., and Michael T. Murray. Botanical Influences on Illness. Third Line Press, 1994: 540–42.

Murray, Michael T., and Joseph E. Pizzorno. Encyclopedia of Natural Medicine. 2nd ed., Prima Pub, 1998: 742–44.

cruciferous vegetables . . . have a compound called indole-3-carbinol (I3C), which has been shown to affect the metabolism of estrogen in a positive way

Michnovicz, J. J., et al. “Changes in Levels of Urinary Estrogen Metabolites after Oral Indole-3-Carbinol Treatment in Humans.” JNCI Journal of the National Cancer Institute 89, no. 10 (1997): 718–23.
https://doi.org/10.1093/jnci/89.10.718.

soy foods . . . seem to function like a very weak estrogen

Messina, Mark. “Soy Foods, Isoflavones, and the Health of Postmenopausal Women.” American Journal of Clinical Nutrition 100, no. Supplement 1 (2014): 423S430S. https://doi.org/10.3945/ajcn.113.071464.

If your estrogen levels were too high, the “competitive binding” of phytoestrogens to those receptors might gentle the impact of estrogen on your body.

Murray, Michael T., and Joseph E. Pizzorno. Encyclopedia of Natural Medicine. 2nd ed., Prima Pub, 1998: 744.

Supplements: the MSDV of . . . minerals (especially calcium)

Thys-Jacobs, Susan, et al. “Calcium Carbonate and the Premenstrual Syndrome: Effects on Premenstrual and Menstrual Symptoms.” American Journal of Obstetrics and Gynecology 179, no. 2 (1998): 444–52.
https://doi.org/10.1016/S0002-9378(98)70377-1.

supplementing the intensive daily dose (IDD) of one or more of the following nutrients may bring greater balance to your menstrual cycle, particularly if that nutrient is lacking in your body

Vitamin B6

Doll, H., et al. “Pyridoxine (Vitamin B6) and the Premenstrual Syndrome: A Randomized Crossover Trial.” Journal of the Royal College of General Practitioners 39, no. 326 (1989): 364–68. https://pubmed.ncbi.nlm.nih.gov/2558186/.

Kleijnen, Jos, et al. “Vitamin B6 in the Treatment of the Premenstrual Syndrome: A Review.” BJOG 97, no. 9 (1990): 847–52.
https://doi.org/10.1111/j.1471-0528.1990.tb02582.x.

De Souza, M. C., et al. “A Synergistic Effect of a Daily Supplement for 1 Month of 200 Mg Magnesium plus 50 Mg Vitamin B6 for the Relief of Anxiety-Related Premenstrual Symptoms: A Randomized, Double-Blind, Crossover Study.” Journal of Women’s Health & Gender-Based Medicine 9, no. 2 (2000): 131–39.
https://doi.org/10.1089/152460900318623.

Vitamin E

London, R. S., et al. “Efficacy of Alpha-Tocopherol in the Treatment of the Premenstrual Syndrome.” Journal of Reproductive Medicine 32, no. 6 (1987): 400–4. https://pubmed.ncbi.nlm.nih.gov/3302248/.

London, R. S., et al. “The Effect of Alpha-Tocopherol on Premenstrual Symptomatology: A Double-Blind Study.” Journal of the American College of Nutrition 2, no. 2 (1983): 115–22. https://doi.org/10.1080/07315724.1983.10719916.

Magnesium

Facchinetti, F., et al. “Oral Magnesium Successfully Relieves Premenstrual Mood Changes.” Obstetrics and Gynecology, 78, no. 2 (1991): 177–81.
https://pubmed.ncbi.nlm.nih.gov/2067759/.

Walker, Ann F., et al. “Magnesium Supplementation Alleviates Premenstrual Symptoms of Fluid Retention.” Journal of Women’s Health 7, no. 9 (1998): 1157–65. https://doi.org/10.1089/jwh.1998.7.1157.

For a general discussion, also see:

Head, Kathleen. “Premenstrual Syndrome: Nutritional and Alternative Approaches.” Alternative Medicine Review 2, no. 1 (1997):
https://altmedrev.com/wp-content/uploads/2019/02/v2-1-12.pdf.

Murray, Michael T., and Joseph E. Pizzorno. Encyclopedia of Natural Medicine. 2nd ed., Prima Pub, 1998: 744–49.

Herbs: The western herb Vitex agnus-castus (chasteberry) has been shown to be helpful for PMS

Schellenberg, R. “Treatment for the Premenstrual Syndrome with Agnus Castus Fruit Extract: Prospective, Randomised, Placebo Controlled Study.” BMJ 322, no. 7279 (2001): 134–37. https://doi.org/10.1136/bmj.322.7279.134.

Natural hormones: The research evidence is mixed for using progesterone to reduce PMS

Well-controlled studies that have found progesterone to be helpful include:

Baker, Elizabeth R., et al. “Efficacy of Progesterone Vaginal Suppositories in Alleviation of Nervous Symptoms in Patients with Premenstrual Syndrome.” Journal of Assisted Reproduction and Genetics, 12, no. 3 (1995): 205–9.
https://doi.org/10.1007/bf02211800.

Dennerstein, L., et al. “Progesterone and the Premenstrual Syndrome: A Double Blind Crossover Trial.” BMJ 290, no. 6482 (1985): 1617–21.
https://doi.org/10.1136/bmj.290.6482.1617.

Hellberg, D., et al. “Premenstrual Tension: A Placebo‐Controlled Efficacy Study with Spironolactone and Medroxyprogesterone Acetate.” International Journal of Gynecology & Obstetrics 34, no. 3 (1991): 243–48.
https://doi.org/10.1016/0020-7292(91)90357-b.

Magill, P. J. “Investigation of the Efficacy of Progesterone Pessaries in the Relief of Symptoms of Premenstrual Syndrome. Progesterone Study Group.” British Journal of General Practice 45, no. 400 (1995): 589–93.
https://pubmed.ncbi.nlm.nih.gov/8554838/.

Yet other solid studies have found no benefit greater than placebo, including:

Freeman, E. W., et al. “A Double-Blind Trial of Oral Progesterone, Alprazolam, and Placebo in Treatment of Severe Premenstrual Syndrome.” JAMA 274, no. 1 (1995): 51–57. https://pubmed.ncbi.nlm.nih.gov/7791258/.

Freeman, E., et al. “Ineffectiveness of Progesterone Suppository Treatment for Premenstrual Syndrome.” JAMA 264, no. 3 (1990): 349–53.
https://pubmed.ncbi.nlm.nih.gov/2194047/.

Conventional medicine: OCAs can impose an artificial balance on your menstrual cycle

Altshuler, Lori L., et al. “Pharmacological Management of Premenstrual Disorder.” Harvard Review of Psychiatry 2, no. 5 (1995): 233–45.
https://doi.org/10.3109/10673229509017143.

[OCA’s] also may interfere with the metabolism of some vitamins (including B6)

Bendich, A. “Lifestyle and Environmental Factors That Can Adversely Affect Maternal Nutritional Status and Pregnancy Outcomes.” Annals of the New York Academy of Sciences 678 (1993): 255–65.
https://doi.org/10.1111/j.1749-6632.1993.tb26127.x.

Blechman, Elaine A., and Kelly D. Brownell. Handbook of Behavioral Medicine for Women. Pergamon, 1988: 269–90.

antidepressants . . . may relieve the depressed mood some women have with PMS, and sometimes other discomfort as well

Dimmock, Paul W., et al. “Efficacy of Selective Serotonin-Reuptake Inhibitors in Premenstrual Syndrome: A Systematic Review.” The Lancet 356, no. 9236 (2000): 1131–36. https://doi.org/10.1016/s0140-6736(00)02754-9.

Pearlstein, T. B., et al. “Comparison of Fluoxetine, Bupropion, and Placebo in the Treatment of Premenstrual Dysphoric Disorder.” Journal of Clinical Psychopharmacology 17, no. 4 (1997): 261–66.
https://doi.org/10.1097/00004714-199708000-00004.

Steiner, Meir, et al. “The Efficacy of Fluoxetine in Improving Physical Symptoms Associated with Premenstrual Dysphoric Disorder.” BJOG 108, no. 5 (2001): 462–68.
https://doi.org/10.1111/j.1471-0528.2001.00120.x.

Balancing Thyroid Hormone

After children, it’s more common to see thyroid levels that are too low than too high

Premawardhana, Lakdasa, et al. “Postpartum Thyroiditis and Long-Term Thyroid Status: Prognostic Influence of Thyroid Peroxidase Antibodies and Ultrasound Echogenicity.” Journal of Endocrinology and Metabolism 85, no. 1 (2000): 71–75.
https://doi.org/10.1210/jcem.85.1.6227.

Supplements: deficits [in iodine] are increasingly widespread

Lieberman, Harris R., et al. “Iodine Inadequacy Is Prevalent and Has Continuously Increased from 2001 to 2018 in the United States.” Journal of Nutrition 155, no. 11 (2025): 3886–95. https://doi.org/10.1016/j.tjnut.2025.09.017.

150 mcg is the DV [of iodine], but some practitioners go as high as 600 mcg

Marz, Russell B. Medical Nutrition from Marz. 2nd ed., Omni Press, 1997: 142–43.

Selenium and zinc help activate thyroid hormone

Kelly, G. S. “Peripheral Metabolism of Thyroid Hormones: A Review.” Alternative Medicine Review 5, no. 4 (2000): 306–33.
https://pubmed.ncbi.nlm.nih.gov/10956378/.

Balancing Your Adrenal Hormones

Your hypothalamus and pituitary could become so used to high levels of stress hormones that it takes increasing amounts to get these glands to stop ordering the adrenals to release more cortisol, etc.

Holsboer, Florian, et al. “Steroid Effects on Central Neurons and Implications for Psychiatric and Neurological Disorders.” Annals of the New York Academy of Sciences, 746, no. 1 (1994): 345–59. https://doi.org/10.1111/j.1749-6632.1994.tb39255.x.

Footnote: These are simplified summaries of extremely complex processes that involve other aspects of the body as well, such as the hippocampus (a part of your brain).

Heuser, Isabella. “The Hypothalamic-Pituitary-Adrenal System in Depression.” Pharmacopsychiatry 31, no. 1 (1998): 10–13.
https://doi.org/10.1055/s-2007-979288.

Your adrenal glands could become desensitized or “exhausted,” so that they produce insufficient hormones even when the alarm bells are ringing

Heim, Christine, et al. “The Potential Role of Hypocortisolism in the Pathophysiology of Stress-Related Bodily Disorders.” Psychoneuroendocrinology 25, no. 1 (2000): 1–35. https://doi.org/10.1016/s0306-4530(99)00035-9.

Now it feels harder than ever to kick into gear, and you may be more prone to allergies and joint pain (since cortisol inhibits inflammation).

Jefferies, William McK. Safe Uses of Cortisol. Charles C. Thomas Pub. Limited, 1996: 37.

even one night of poor sleep leads to elevated cortisol levels the next day

Leproult, R., et al. “Sleep Loss Results in an Elevation of Cortisol Levels the Next Evening.” Sleep 20, no. 10 (1997): 865–70.
https://pubmed.ncbi.nlm.nih.gov/9415946/.

Energetic: acupuncture can affect the hypothalamic-pituitary-adrenal (HPA) axis

Liu, Z., et al. “Effect of Acupuncture on Weight Loss Evaluated by Adrenal Function.” Journal of Traditional Chinese Medicine 13, no. 3 (1993): 169–73. https://pubmed.ncbi.nlm.nih.gov/8246584/.

Yu, Jung-Sheng, et al. “Acupuncture Stimulation and Neuroendocrine Regulation.” International Review of Neurobiology 111 (2013): 125–40.
https://doi.org/10.1016/b978-0-12-411545-3.00006-7.

Musculoskeletal: Yoga is a well-researched and powerful method of stress relief that can have a specific impact on the adrenal hormones.

Pascoe, Michaela C., et al. “Yoga, Mindfulness-Based Stress Reduction and Stress-Related Physiological Measures: A Meta-Analysis.” Psychoneuroendocrinolog 86, no. 86 (2017): 152–68. https://doi.org/10.1016/j.psyneuen.2017.08.008.

Supplements: A deficiency of pantothenic acid—vitamin B5—can weaken the adrenal glands

Kelly, G. S. “Nutritional and Botanical Interventions to Assist with the Adaptation to Stress.” Alternative Medicine Review 4, no. 4 (1999): 249–65. https://pubmed.ncbi.nlm.nih.gov/10468649/.

Murray, Michael T., and Joseph E. Pizzorno. Encyclopedia of Natural Medicine. 2nd ed., Prima Pub, 1998: 186.

vitamin C . . . increases adrenal function

Kelly, G. S. “Nutritional and Botanical Interventions to Assist with the Adaptation to Stress.” Alternative Medicine Review 4, no. 4 (1999): 249–65. https://pubmed.ncbi.nlm.nih.gov/10468649/.

Chronic stress depletes vitamin C

Marz, Russell B. Medical Nutrition from Marz. 2nd ed., Omni Press, 1997: 236..

The amino acid, tyrosine, is the precursor to norepinephrine (as well as dopamine), and numerous studies have shown it to improve the adaptation to stress. . . . [Phosphatidylserine] could help balance the stress feedback system in your body. . . . If stress has thrown off your sleep clock, try methylcobalamin

Kelly, G. S. “Nutritional and Botanical Interventions to Assist with the Adaptation to Stress.” Alternative Medicine Review 4, no. 4 (1999): 249–65. https://pubmed.ncbi.nlm.nih.gov/10468649/.

Herbs: Both Panax and Siberian ginseng appear to have an “adaptogenic” effect on the adrenal glands . . . Licorice binds to the hormone receptors of cortisol, creating a cortisol-like effect. . . . In about a fifth of the population, high doses of licorice lead to hypertension

Kelly, G. S. “Nutritional and Botanical Interventions to Assist with the Adaptation to Stress.” Alternative Medicine Review 4, no. 4 (1999): 249–65. https://pubmed.ncbi.nlm.nih.gov/10468649/.

Natural hormones and conventional medicine: In cases of severe adrenal fatigue, hydrocortisone can be given

Jefferies, William McK. Safe Uses of Cortisol. Charles C. Thomas Pub Limited, 1996.

Your Immune System

What Can Disturb the Immune System

Stress

stress stimulates the release of corticosteroid hormones, and these suppress both arms of your immune system

Vander, A. J., et al. Human Physiology: The Mechanisms of Body Function. McGraw-Hill, 2001: 751–52.

a woman’s immune system is generally more active than a man’s is

Whitacre, C. C. “Biomedicine:A Gender Gap in Autoimmunity.” Science 283, no. 5406 (1999): 1277–78.
https://doi.org/10.1126/science.283.5406.1277.

an allergen that would once give you no more than a few sneezes for you could now lead to hives or asthma

Kay, A. B. “Allergy and Allergic Diseases.” New England Journal of Medicine 344, no. 1 (2001): 30–37.
https://doi.org/10.1056/nejm200101043440106.

Stress also seems to play a role in the development and severity of autoimmune illness

Porcelli, Brunetta, et al. “Association Between Stressful Life Events and Autoimmune Diseases: A Systematic Review and Meta-Analysis of Retrospective Case–Control Studies.” Autoimmunity Reviews 15, no. 4 (2016): 325–34.
https://doi.org/10.1016/j.autrev.2015.12.005.

Nutritional deficits: an activated B-cell will produce about a thousand antibodies per second before dying in a day or two

Vander, A. J., et al. Human Physiology: The Mechanisms of Body Function. McGraw-Hill, 2001.

a lack of protein

Vander, A. J., et al. Human Physiology: The Mechanisms of Body Function. McGraw-Hill, 2001: 725.

deficit in any one of numerous nutrients—such as vitamin C or zinc—will lower its resistance to disease

Murray, Michael T., and Joseph E. Pizzorno. Encyclopedia of Natural Medicine. 2nd ed., Prima Pub, 1998: 150–58.

Fetal tissue: It is possible that the immune system may interpret those fetal cells as “foreign,” putting it on red alert, now more likely to overreact and develop an autoimmune disease.

Nelson, J. Lee, et al. “Microchimerism and HLA-Compatible Relationships of Pregnancy in Scleroderma.” The Lancet 351, no. 9102 (1998): 559–62.
https://doi.org/10.1016/s0140-6736(97)08357-8.

Nelson, J. L. “Microchimerism and Scleroderma.” Current Rheumatology Reports 1, no. 1 (1999): 15–21.
https://doi.org/10.1007/s11926-999-0019-z.

Other systems of the body: Depression, for instance, is associated with a slower rate of recovery from illness and less effective white blood cell activity.

Foley, Éimear M., et al. “Peripheral Blood Cellular Immunophenotype in Depression: A Systematic Review and Meta-Analysis.” Molecular Psychiatry 28, no. 3 (2023): 1004–19. https://doi.org/10.1038/s41380-022-01919-7.

Reiche, Edna Maria Vissoci, et al. “Stress, Depression, the Immune System, and Cancer.” The Lancet Oncology 5, no. 10 (2004): 617–25.
https://doi.org/10.1016/s1470-2045(04)01597-9.

low estrogen can reduce the effectiveness of your immune system

Foo, Yong Zhi, et al. “The Effects of Sex Hormones on Immune Function: A Meta-Analysis.” Biological Reviews 92, no. 1 (2016): 551–71.
https://doi.org/10.1111/brv.12243.

healthy levels of estrogen, progesterone, oxytocin, and prolactin help control overzealous immune function

Wise, Phyllis M., et al. “Minireview: Neuroprotective Effects of Estrogen—New Insights into Mechanisms of Action.” Endocrinology 142, no. 3 (2001): 969–73. https://doi.org/10.1210/endo.142.3.8033.

Rapid fluctuations in these hormones—from stress, weaning, new pregnancies, etc.—can lead to hair-trigger immune responses, increasing the chance of an autoimmune disease.

Wilder, Ronald L. “Hormones, Pregnancy, and Autoimmune Diseases.” Annals of the New York Academy of Sciences 840, no. 1 (1998): 45–50.
https://doi.org/10.1111/j.1749-6632.1998.tb09547.x.

Signs and Symptoms of Disturbance in the Immune System

If your immune system is weakened, you would be more prone to frequent, severe, and lingering diseases, from the common cold to serious infections.

Vander, A. J., et al. Human Physiology: The Mechanisms of Body Function. McGraw-Hill, 2001.

Strengthening and Balancing Your Immune System

A positive outlook, social support, and low stress will nurture the healing powers of your body.

Bittman, B. B., et al. “Composite Effects of Group Drumming Music Therapy on Modulation of Neuroendocrine-Immune Parameters in Normal Subjects.” Alternative Therapies in Health and Medicine 7, no. 1 (2001).
https://pubmed.ncbi.nlm.nih.gov/11191041/.

Vollhardt, Lawrence T. “Psychoneuroimmunology: A Literature Review.” American Journal of Orthopsychiatry 61, no. 1 (1991): 35–47.
https://doi.org/10.1037/h0079226.

Vander, A. J., et al. Human Physiology: The Mechanisms of Body Function. McGraw-Hill, 2001: 725.

angry quarrels depress immune system function

Kiecolt-Glaser, Janice K., et al. “Marital Stress: Immunologic, Neuroendocrine, and Autonomic Correlatesa.” Annals of the New York Academy of Sciences 840, no. 1 (1998): 656–63. https://doi.org/10.1111/j.1749-6632.1998.tb09604.x.

try to get lots of deep sleep, since that’s when your brain and body produce several substances that enhance immune function

Moldofsky, Harvey. “Sleep and the Immune System.” International Journal of Immunopharmacology 17, no. 8 (1995): 649–54.
https://doi.org/10.1016/0192-0561(95)00051-3.

Energetic: Acupuncture can help restore and maintain a healthy homeostasis in the immune system.

Liu, Fengyi, et al. “Acupuncture and Its Ability to Restore and Maintain Immune Homeostasis.” QJM 117, no. 3 (2023).
https://doi.org/10.1093/qjmed/hcad134.

Musculoskeletal: Moderate exercise boosts the levels of several kinds of white blood cells, but strenuous exercise—like running a 10K race—briefly lowers lymphocytes, natural killer cells, and antibodies in your respiratory and digestive tracts.

Nielsen, Henning Bay. “Lymphocyte Responses to Maximal Exercise.” Sports Medicine 33, no. 11 (2003): 853–67.
https://doi.org/10.2165/00007256-200333110-00005.

Simpson, Richard J., et al. “Exercise and the Regulation of Immune Functions.” Progress in Molecular Biology and Translational Science 135 (2015): 355–80. https://doi.org/10.1016/bs.pmbts.2015.08.001.

massage and even affectionate touching have also been shown to increase immune system function

Field, Tiffany M. “Massage Therapy Effects.” American Psychologist 53, no. 12 (1998): 1270–81. https://doi.org/10.1037//0003-066x.53.12.1270.

Dietary: Lots of vegetables and a reasonable amount of fruit will give you immune-boosting carotenes and flavonoids.

Werbach, Melvyn R. Nutritional Influences on Illness. 2nd ed., Third Line Press, 1996: 363.

A solid serving of protein at every meal will also keep your immune system humming along.

Murray, Michael T., and Joseph E. Pizzorno. Encyclopedia of Natural Medicine. 2nd ed., Prima Pub, 1998: 151.

Werbach, Melvyn R. Nutritional Influences on Illness. 2nd ed., Third Line Press, 1996:. 354.

it’s critical to minimize sugar and refined flours: Besides wearing on your body and general and thus affecting the immune system indirectly

Recall our discussion of the effects of gastrointestinal problems, depressed mood, and hormonal gyrations on the immune system, all of which are increased with high sugar intake.

sugars have direct effects as well

Murray, Michael T., and Joseph E. Pizzorno. Encyclopedia of Natural Medicine. 2nd ed., Prima Pub, 1998: 151–52.

Marz, Russell B. Medical Nutrition from Marz. 2nd ed., Omni Press, 1997: 354–55.

consuming about two sodas’ worth of sugar knocked down the effectiveness of white blood cells

Murray, Michael T., and Joseph E. Pizzorno. Encyclopedia of Natural Medicine. 2nd ed., Prima Pub, 1998: 151.

a low-fat diet with minimal caffeine has also been shown to improve immune function

Marz, Russell B. Medical Nutrition from Marz. 2nd ed., Omni Press, 1997: 354–55.

Supplements: [Antioxidants] are generally most effective in combination with one another

Chen, Xuan, et al. “The Synergistic and Antagonistic Antioxidant Interactions of Dietary Phytochemical Combinations.” Critical Reviews in Food Science and Nutrition 62, no. 20 (2021): 5658–77.
https://doi.org/10.1080/10408398.2021.1888693.

Vitamin A . . . stimulates white blood cell activity and antibody response

Semba, R. D. “Vitamin A, Immunity, and Infection.” Clinical Infectious Diseases 19, no. 3 (1994): 489–99.
https://doi.org/10.1093/clinids/19.3.489.

Marz, Russell B. Medical Nutrition from Marz. 2nd ed., Omni Press, 1997: 171.

Vitamin C supports many aspects of the immune system

Marz, Russell B. Medical Nutrition from Marz. 2nd ed., Omni Press, 1997: 239–40.

Murray, Michael T., and Joseph E. Pizzorno. Encyclopedia of Natural Medicine. 2nd ed., Prima Pub, 1998: 155.

For maximum immune support, you could try the IDD

Marz, Russell B. Medical Nutrition from Marz. 2nd ed., Omni Press, 1997: 239–41.

Vitamin E . . . seems to help both antibody-related and cell-mediated aspects of the immune system

Meydani, S. N., et al. “Vitamin E Supplementation Enhances Cell-Mediated Immunity in Healthy Elderly Subjects.” American Journal of Clinical Nutrition 52, no. 3 (1990): 557–63. https://doi.org/10.1093/ajcn/52.3.557.

Werbach, Melvyn R. Nutritional Influences on Illness. 2nd ed., Third Line Press, 1996: 359.

the IDD of 800 IU

Murray, Michael T., and Joseph E. Pizzorno. Encyclopedia of Natural Medicine. 2nd ed., Prima Pub, 1998: 155–56.

high doses of beta-carotene alone may . . . be harmful

Jeon, Young-Jee, et al. “Effects of Beta-Carotene Supplements on Cancer Prevention: Meta-Analysis of Randomized Controlled Trials.” Nutrition and Cancer 63, no. 8 (2011): 1196–207. https://doi.org/10.1080/01635581.2011.607541.

A deficiency in nearly any B-vitamin will weaken the immune system

Werbach, Melvyn R. Nutritional Influences on Illness. 2nd ed., Third Line Press, 1996: 354, 357.

vitamin B6, vitamin B12, and folic acid are particularly important

Murray, Michael T., and Joseph E. Pizzorno. Encyclopedia of Natural Medicine. 2nd ed., Prima Pub, 1998: 156.

Iron deficiency (even when minimal) lessens the effectiveness of several parts of your immune system.

Beisel, William R. “Single-Nutrient Effects on Immunologic Functions.” JAMA 245, no. 1 (1981): 53. https://doi.org/10.1001/jama.1981.03310260031024.

Murray, Michael T., and Joseph E. Pizzorno. Encyclopedia of Natural Medicine. 2nd ed., Prima Pub, 1998: 156.

Werbach, Melvyn R. Nutritional Influences on Illness. 2nd ed., Third Line Press, 1996: 360.

Zoppi, G., et al. “The Intestinal Ecosystem in Chronic Functional Constipation.” Acta Paediatrica 87, no. 8 (1998): 836–41.
https://doi.org/10.1080/080352598750013590.

low iron levels are widespread among women in general, and mothers in particular can have a shortage of iron due to the lingering effects of pregnancy

Veena Sangkhae, et al. “Iron Homeostasis During Pregnancy: Maternal, Placental, and Fetal Regulatory Mechanisms.” Annual Review of Nutrition 43, no. 1 (2023): 279–300. https://doi.org/10.1146/annurev-nutr-061021-030404.

Selenium shortages weaken many aspects of the immune system.

Murray, Michael T., and Joseph E. Pizzorno. Encyclopedia of Natural Medicine. 2nd ed., Prima Pub, 1998: 157.

Werbach, Melvyn R. Nutritional Influences on Illness. 2nd ed., Third Line Press, 1996: 361.

Even when blood levels of selenium are normal, taking 200 mcg per day has been shown to help the immune response.

With 200 mcg of selenium, this study found an 118% increase in ability of lymphocytes to kill tumor cells and a 82.3 % increase in the activity of natural killer cells. See:

Roy, Martin, et al. “Supplementation with Selenium and Human Immune Cell Functions.” Biological Trace Element Research 41, nos. 1–2 (1994): 103–14. https://doi.org/10.1007/bf02917221.

Zinc deficiency has been found to decrease immune system activity, while supplementation has been shown to enhance it.

Godfrey, J. C., et al. “Zinc Gluconate and the Common Cold: A Controlled Clinical Study.” Journal of International Medical Research 20, no. 3 (1992): 234–46. https://doi.org/10.1177/030006059202000305.

Odeh, Majed. “The Role of Zinc in Acquired Immunodeficiency Syndrome.” Journal of Internal Medicine 231, no. 5 (1992): 463–69.
https://doi.org/10.1111/j.1365-2796.1992.tb00961.x.

one study found this dosing [of zinc] shortened the duration of colds by 64 percent

Eby, G. A., et al. “Reduction in Duration of Common Colds by Zinc Gluconate Lozenges in a Double-Blind Study.” Antimicrobial Agents and Chemotherapy 25, no. 1 (1984): 20–24. https://doi.org/10.1128/aac.25.1.20.

Herbs: Astragalus is used in Chinese medicine as a long-term immune tonic and for active viral infections

Chang, Hson-Mou, and Sih-Cheng Yao. Pharmacology and Applications of Chinese Materia Medica. World Scientific, 1987: 1941–46.

Chu, D. T., et al. “Immunotherapy with Chinese Medicinal Herbs. I. Immune Restoration of Local Xenogeneic Graft-Versus-Host Reaction in Cancer Patients by Fractionated Astragalus Membranaceus in Vitro.” Journal of Clinical & Laboratory Immunology 25, no. 3, (1988): 119–23. https://pubmed.ncbi.nlm.nih.gov/3260960/.

Pelletier, Kenneth R. The Best Alternative Medicine: What Works? What Does Not? Simon & Schuster, 2000: 340.

Echinacea has been shown to boost the immune system, particularly when used at the beginning of a cold, flu, or respiratory infection.

Braunig, B. “Echinacea Purpurea Radix for Strengthening the Immune Response in Flu-like Infections.” Z Phytother 13 (1992): 7–13.

Pelletier, Kenneth R. The Best Alternative Medicine: What Works? What Does Not? Simon & Schuster, 2000: 340.

Percival, S. S. “Use of Echinacea in Medicine.” Biochemical Pharmacology 60, no. 2 (2000): 155–58.
https://doi.org/10.1016/s0006-2952(99)00413-x.

Do not use [echinacea] if you are prone to allergies

Mullins, Raymond J., and Robert Heddle. “Adverse Reactions Associated with Echinacea: The Australian Experience.” Annals of Allergy, Asthma & Immunology 88, no. 1 (2002): 42–51. https://doi.org/10.1016/S1081-1206(10)63591-0.

or have an autoimmune disease

Pelletier, Kenneth R. The Best Alternative Medicine: What Works? What Does Not? Simon & Schuster, 2000: 340.

Probiotics: there are intriguing indications that certain probiotics, such as lactobacillus, can stimulate the innate immune system

Gura, T. “Innate Immunity: Ancient System Gets New Respect.” Science 291, no. 5511 (2001): 2068–71.
https://doi.org/10.1126/science.291.5511.2068.

Introduction to Part Four

quarrels increase blood pressure, wear down the immune system, and disturb your hormones

For a review, see:

Kiecolt-Glaser, Janice K., and Tamara L. Newton. “Marriage and Health: His and Hers.” Psychological Bulletin 127, no. 4 (2001): 472–503.
https://doi.org/10.1037/0033-2909.127.4.472.

an atmosphere of tension and emotional distance increases the risk that their children will feel insecure

Frosch, Cynthia A., et al. “Marital Behavior and the Security of Preschooler-Parent Attachment Relationships.” Journal of Family Psychology 14, no. 1 (2000): 144–61. https://doi.org/10.1037//0893-3200.14.1.144.

and develop psychological problems

Kelly, J. B. “Marital Conflict, Divorce, and Children’s Adjustment.” Child and Adolescent Psychiatric Clinics of North America 7, no. 2 (1998): 259–71, v–vi. https://pubmed.ncbi.nlm.nih.gov/9894063/.

Webster-Stratton, C., and M. Hammond. “Marital Conflict Management Skills, Parenting Style, and Early-Onset Conduct Problems: Processes and Pathways.” Journal of Child Psychology and Psychiatry, and Allied Disciplines 40, no. 6 (1999): 917–27. https://pubmed.ncbi.nlm.nih.gov/10509886/.

Chapter 6: Talking with Your Partner

A Civil Tongue

Thirty years of research have shown that the key to a loving and lasting relationship is how the two people interact with each other.

Levenson, Robert W., and John M. Gottman. “Marital Interaction: Physiological Linkage and Affective Exchange.” Journal of Personality and Social Psychology 45, no. 3 (1983): 587–97. https://doi.org/10.1037/0022-3514.45.3.587.

In strong couples, positive interactions really outnumber the negative ones.

Gottman, John, and Nan Silver. Why Marriages Succeed or Fail: And How You Can Make Yours Last. Simon & Schuster, 1995.

Besides feeling awful, negative interactions stress your body

An atmosphere of marital conflict . . . [is] a risk factor for [children] developing depression, anxiety, and behavior problems.

Davies, Patrick T., and E. Mark Cummings. “Marital Conflict and Child Adjustment: An Emotional Security Hypothesis.” Psychological Bulletin 116, no. 3 (1994): 387–411.
https://doi.org/10.1037/0033-2909.116.3.387.

Fendrich, Michael, Virginia Warner, and Myrna M. Weissman. “Family Risk Factors, Parental Depression, and Psychopathology in Offspring.” Developmental Psychology 26, no. 1 (1990): 40–50.
https://doi.org/10.1037/0012-1649.26.1.40.

Sternberg, Kathleen J., Michael E. Lamb, Charles Greenbaum, et al. “Effects of Domestic Violence on Children’s Behavior Problems and Depression.” Developmental Psychology 29, no. 1 (1993): 44–52.
https://doi.org/10.1037/0012-1649.29.1.44.

Frequent quarrels also wear down marital bonds.

Karney, Benjamin R., and Thomas N. Bradbury. “Neuroticism, Marital Interaction, and the Trajectory of Marital Satisfaction.” Journal of Personality and Social Psychology 72, no. 5 (1997): 1075–92.
https://doi.org/10.1037/0022-3514.72.5.1075.

Disagreements . . . usually increase after children.

See Chapter 1.

How to Make a Conversation Go Badly

Every communication contains two messages: the explicit content and an implicit statement about the relationship between the speaker and listener.

Tannen, Deborah. You Just Don’t Understand: Women and Men in Conversation. HarperCollins Publishers, 2007.

If People Are Getting Upset

About one woman in three will be seriously assaulted at least once by her partner

“Violence Against Women.” Accessed November 12, 2025.
https://www.who.int/news-room/fact-sheets/detail/violence-against-women.

the odds of this increase—sadder still—if there are children in the home

Peek-Asa, Corinne, Audrey F. Saftlas, Anne B. Wallis, Karisa Harland, and Penny Dickey. “Presence of Children in the Home and Intimate Partner Violence among Women Seeking Elective Pregnancy Termination.” PLOS ONE 12, no. 10 (2017): e0186389.
https://doi.org/10.1371/journal.pone.0186389.

Empathy

If you sense that another person really gets how it is for you—or is at least trying to—you’ll likely feel less stressed

Chapman, Heather A., Stevan E. Hobfoll, and Christian Ritter. “Partners’ Stress Underestimations Lead to Women’s Distress: A Study of Pregnant Inner-City Women.” Journal of Personality and Social Psychology 73, no. 2 (1997): 418–25.
https://doi.org/10.1037/0022-3514.73.2.418.

Receiving Empathy

Box: Research on Mothers

Mothers are more emotionally affected by parenthood than fathers.

Rocha, Sarah, Fernanda Staniscuaski, Marta F. Nudelman, et al. “The Impact of Parenthood on Mental Health Within the Academic Community: Highlighting Vulnerabilities and Identifying High-Risk Groups.” Humanities and Social Sciences Communications 12, no. 1 (2025): 893. https://doi.org/10.1057/s41599-025-05178-z.

Ross, Catherine E., and Marieke Van Willigen. “Gender, Parenthood, and Anger.” Journal of Marriage and the Family 58, no. 3 (1996): 572.
https://doi.org/10.2307/353718.

Childrearing and housework are mainly done by mothers, even when both parents work for pay.

Belsky, Jay, and Emily Pensky. “Marital Change Across the Transition to Parenthood.” Marriage & Family Review 12, nos. 3–4 (1988): 133–56.
https://doi.org/10.1300/J002v12n03_08.

The Free-Time Gender Gap How Unpaid Care and Household Labor Reinforces Women’s Inequality. Gender Equity Policy Institute, 2023.
https://thegepi.org/GEPI-Free-Time-Gender-Gap-Report.pdf.

Ruble, Diane N., Alison S. Fleming, Lisa S. Hackel, and Charles Stangor. “Changes in the Marital Relationship during the Transition to First Time Motherhood: Effects of Violated Expectations Concerning Division of Household Labor.” Journal of Personality and Social Psychology 55, no. 1 (1988): 78–87.
https://doi.org/10.1037/0022-3514.55.1.78.

The typical inequities in the total workload make mothers upset, angry, and even depressed.

Lennon, Mary Clare, Gail A. Wasserman, and Rhianon Allen. “Infant Care and Wives’ Depressive Symptoms.” Women & Health 17, no. 2 (1991): 1–23.
https://doi.org/10.1300/J013v17n02_01.

Ross, Catherine E., and Marieke Van Willigen. “Gender, Parenthood, and Anger.” Journal of Marriage and the Family 58, no. 3 (1996): 572.
https://doi.org/10.2307/353718.

Schwartzberg, Neala S., and Rita Scher Dytell. “Dual-Earner Families: The Importance of Work Stress and Family Stress for Psychological Well-Being.” Journal of Occupational Health Psychology 1, no. 2 (1996): 211–23.
https://doi.org/10.1037/1076-8998.1.2.211.

A mother often feels pulled in opposing directions by her partner and her children.

Barigozzi, Francesca, Pietro Biroli, Chiara Monfardini, Natalia Montinari, Elena Pisanelli, and Sveva Vitellozzi. “Beyond Time: Unveiling the Invisible Burden of Mental Load.” Preprint, arXiv, 2025. https://doi.org/10.48550/ARXIV.2505.11426.

Barnett, Rosalind C., and Grace K. Baruch. “Women’s Involvement in Multiple Roles and Psychological Distress.” Journal of Personality and Social Psychology 49, no. 1 (1985): 135–45. https://doi.org/10.1037/0022-3514.49.1.135.

Childcare hassles rattle mothers more than fathers

Lennon, Mary Clare, Gail A. Wasserman, and Rhianon Allen. “Infant Care and Wives’ Depressive Symptoms.” Women & Health 17, no. 2 (1991): 1–23.
https://doi.org/10.1300/J013v17n02_01.

working mothers experience more stress and overload from juggling both roles than their husbands do

Greenberger, Ellen, Wendy A. Goldberg, Sharon Hamill, Robin O’Neil, and Constance K. Payne. “Contributions of a Supportive Work Environment to Parents’ Well‐being and Orientation to Work.” American Journal of Community Psychology 17, no. 6 (1989): 755–83. https://doi.org/10.1007/BF00922737.

Lin, Katherine Y., and Sarah A. Burgard. “Working, Parenting and Work-Home Spillover: Gender Differences in the Work-Home Interface Across the Life Course.” Advances in Life Course Research 35 (March 2018): 24–36.
https://doi.org/10.1016/j.alcr.2017.12.003.

Olivieri, Rosalia, Alessandro Lo Presti, Sebastiano Costa, Lucia Ariemma, and Marco Fabbri. “Mothers Balancing Work and Family: The Associations with Emotional Well-Being, Sleep–Wake Problems and the Role of Basic Needs.” BMC Psychology 12, no. 1 (2024): 750.
https://doi.org/10.1186/s40359-024-02241-3.

A mother is typically more impacted by her husband’s job than he is by hers.

Crouter, Ann C., Matthew F. Bumpus, Mary C. Maguire, and Susan M. McHale. “Linking Parents’ Work Pressure and Adolescents’ Well Being: Insights into Dynamics in Dual Earner Families.” Developmental Psychology 35, no. 6 (1999): 1453–61.
https://doi.org/10.1037/0012-1649.35.6.1453.

On average, women experience a sharper drop in marital satisfaction after children than men do.

Kowal, Marta, Agata Groyecka-Bernard, Marta Kochan-Wójcik, and Piotr Sorokowski. “When and How Does the Number of Children Affect Marital Satisfaction? An International Survey.” PLOS ONE 16, no. 4 (2021): e0249516.
https://doi.org/10.1371/journal.pone.0249516.

women . . . usually place a higher value on relationships

Tannen, Deborah. You Just Don’t Understand: Women and Men in Conversation. HarperCollins Publishers, 2007.

and are more economically vulnerable to the impact of divorce

Harkness, Susan. “The Accumulation of Economic Disadvantage: The Influence of Childbirth and Divorce on the Income and Poverty Risk of Single Mothers.” Demography 59, no. 4 (2022): 1377–402.
https://doi.org/10.1215/00703370-10065784.

A woman is . . . and twice as likely to seek a divorce.

Parker, Gillian, Kristina M. Durante, Sarah E. Hill, and Martie G. Haselton. “Why Women Choose Divorce: An Evolutionary Perspective.” Current Opinion in Psychology 43 (February 2022): 300–306.
https://doi.org/10.1016/j.copsyc.2021.07.020.

you . . . are no longer a free agent, but nested now in a web of connections and obligations that tugs at your every move

Empathy for a Father

that could draw him into working longer hours

Diniz, Eva, Lígia Monteiro, and Manuela Veríssimo. “Work Gains and Strains on Father Involvement: The Mediating Role of Parenting Styles.” Children 10, no. 8 (2023): 1357. https://doi.org/10.3390/children10081357.

Research by Elaina Rose, PhD, reported in:

Psychology Today. December 2000.

The changing, unclear societal expectations about what it is to be a father make it harder to find his footing.

Škvařil, Václav, and Pavla Presslerová. “Becoming a Father: A Qualitative Study on the Journey to Fatherhood.” Health Psychology Report 12, no. 2 (2024): 97–111.
https://doi.org/10.5114/hpr/176082.

Speaking Your Mind

holding back your true feelings can . . . wear on your health.

Haynes, S. G., and M. Feinleib. “Women, Work and Coronary Heart Disease: Prospective Findings from the Framingham Heart Study.” American Journal of Public Health 70, no. 2 (1980): 133–41. https://doi.org/10.2105/AJPH.70.2.133.

you need to be able to openly address any issues in your partner—such as a drinking problem or depression—that affect him, you, or your children

Jacob, Theodore, Gloria L. Krahn, and Kenneth Leonard. “Parent-Child Interactions in Families with Alcoholic Fathers.” Journal of Consulting and Clinical Psychology 59, no. 1 (1991): 176–81. https://doi.org/10.1037/0022-006X.59.1.176.

Phares, Vicky, and Bruce E. Compas. “The Role of Fathers in Child and Adolescent Psychopathology: Make Room for Daddy.” Psychological Bulletin 111, no. 3 (1992): 387–412.
https://doi.org/10.1037/0033-2909.111.3.387.

Positive Support

researchers have found that receiving emotional support from one’s partner is a powerful way to reduce the stress of parenting

Deater-Deckard, Kirby, and Sandra Scarr. “Parenting Stress Among Dual-Earner Mothers and Fathers: Are There Gender Differences?” Journal of Family Psychology 10, no. 1 (1996): 45–59. https://doi.org/10.1037/0893-3200.10.1.45.

Martin, Rachel C. B., and Rebecca L. Brock. “The Importance of High-Quality Partner Support for Reducing Stress during Pregnancy and Postpartum Bonding Impairments.” Archives of Women’s Mental Health 26, no. 2 (2023): 201–9.
https://doi.org/10.1007/s00737-023-01299-z.

and increase personal well-being

Chapter 7: Partners in Parenthood

Parenting from the Same Page

conflicts about raising a family eat away at the bonds that hold a marriage together

Lavee, Yoav, Shalom Sharlin, and Ruth Katz. “The Effect of Parenting Stress on Marital Quality.” Journal of Family Issues 17, no. 1 (1996): 114–35.
https://doi.org/10.1177/019251396017001007.

Parents often have different values or styles in childrearing.

Belsky, Jay, and John Kelly. The Transition to Parenthood: How a First Child Changes a Marriage: Why Some Couples Grow Closer and Others Apart. New York: Dell Pub, 1995.

Carolyn Pape Cowan, and Philip A Cowan. When Partners Become Parents: The Big Life Change for Couples. Lawrence Erlbaum Associates, 2000.

Hastings, Paul D., and Joan E. Grusec. “Parenting Goals as Organizers of Responses to Parent-Child Disagreement.” Developmental Psychology 34, no. 3 (1998): 465–79. https://doi.org/10.1037//0012-1649.34.3.465.

Leaper, Campbell, Kristin J. Anderson, and Paul Sanders. “Moderators of Gender Effects on Parents’ Talk to Their Children: A Meta-Analysis.” Developmental Psychology 34, no. 1 (1998): 3–27. https://doi.org/10.1037/0012-1649.34.1.3.

Work out the details

people in conflict usually overestimate their differences

Thompson, Leigh. “‘They Saw a Negotiation’: Partisanship and Involvement.” Journal of Personality and Social Psychology 68, no. 5 (1995): 839–53.
https://doi.org/10.1037/0022-3514.68.5.839.

Talk About Misunderstandings or Broken Agreements

Fulfilling commitments is the basis of trust in any relationship.

For example, appraising one’s partner as undependable is associated with low satisfaction in marriage:

Rempel, John K., John G. Holmes, and Mark P. Zanna. “Trust in Close Relationships.” Journal of Personality and Social Psychology 49, no. 1 (1985): 95–112.
https://doi.org/10.1037/0022-3514.49.1.95.

Camanto, Omar J, and Lorne Campbell. “Trust in Close Relationships Revisited.” Journal of Social and Personal Relationships 42, no. 9 (2025).
https://doi.org/10.1177/02654075251346105.

Sharing the Load

On average, a mother is working one way or another many hours more each week than the father of her children, whether or not she is drawing a paycheck.

See Chapter 1.

Even when a mother makes as much money as or more than her husband

Syrda, Joanna. “Gendered Housework: Spousal Relative Income, Parenthood and Traditional Gender Identity Norms.” Work, Employment and Society 37, no. 3 (2002). https://doi.org/10.1177/09500170211069780.

tending to young children is more stressful than most jobs

See Chapter 1.

even if each of them spends about the same amount of time doing tasks, the mother typically does the high-stress ones

McDonnell, Cadhla, Nancy Luke, and Susan E. Short. “Happy Moms, Happier Dads: Gendered Caregiving and Parents’ Affect.” Journal of Family Issues 40, no. 17 (2019): 2553–81. https://doi.org/10.1177/0192513×19860179.

It is still usually Mom, not Dad, who does most of the planning, worrying, and problem-solving about the children.

Aviv, Elizabeth, Yael Waizman, Elizabeth Kim, Jasmine Liu, Eve Rodsky, and Darby Saxbe. “Cognitive Household Labor: Gender Disparities and Consequences for Maternal Mental Health and Wellbeing.” Archives of Women’s Mental Health 28 (July 2024): 5–14. https://doi.org/10.1007/s00737-024-01490-w.

Studies have shown that fathers who are less involved have kids who are less responsible, less able to solve problems

Sarkadi, Anna, Robert Kristiansson, Frank Oberklaid, and Sven Bremberg. “Fathers’ Involvement and Children’s Developmental Outcomes: A Systematic Review of Longitudinal Studies.” Acta Paediatrica 97, no. 2 (2008): 153–58.
https://doi.org/10.1111/j.1651-2227.2007.00572.x.

Yoon, Susan, Minjung Kim, Junyeong Yang, Joyce Y. Lee, Anika Latelle, Jingyi Wang, Yiran Zhang, and Sarah Schoppe-Sullivan. “Patterns of Father Involvement and Child Development among Families with Low Income.” Children 8, no. 12 (2021): 1164. https://doi.org/10.3390/children8121164.

Kume, Taisuke. “The Effect of Father Involvement in Childcare on the Psychological Well-being of Adolescents: A Cross-Cultural Study.” New Male Studies: An International Journal 4, no. 1 (2015): 38-51.
https://doi.org/10.13140/RG.2.2.11325.95202.

Inequities also eat away at a marriage, reducing the satisfaction of each spouse.

For wives: Deutsch, Francine M, Julianne B Lussier, and Laura J Servis. “Husbands at Home: Predictors of Paternal Participation in Childcare and Housework.” Journal of Personality and Social Psychology 65, no. 6 (1993): 1154–66.
https://doi.org/10.1037//0022-3514.65.6.1154.

For husbands: Blair, Sampson Lee, DeeAnn Wenk, and Constance Hardesty. “Marital Quality and Paternal Involvement: Interconnections of Men’s Spousal and Parental Roles.” Journal of Men’s Studies 2, no. 3 (1994): 221–37.
https://doi.org/10.3149/jms.0203.221.

they deplete a mother, increasing her stress

Avoiding the nitty-gritty tasks of tending to young children . . . can make a father feel less connected

Suzuki, Daichi, Yukiko Ohashi, Eriko Shinohara, Yuriko Usui, Fukiko Yamada, Noyuri Yamaji, Kiriko Sasayama, et al. “The Current Concept of Paternal Bonding: A Systematic Scoping Review.” Healthcare 10, no. 11 (2022): 2265.
https://doi.org/10.3390/healthcare10112265.

Clear Facts

many father feel they’re doing their fair share of childrearing

Pew Research Center. “Raising Kids and Running a Household: How Working Parents Share the Load.” November 4, 2015.
https://www.pewresearch.org/social-trends/2015/11/04/raising-kids-and-running-a-household-how-working-parents-share-the-load/.

Clear Principles

A father’s active involvement with childcare depends in part on . . . his beliefs about the importance of fathers to children

Trahan, Mark H. “Paternal Self-Efficacy and Father Involvement: A Bi-Directional Relationship.” Psychology of Men & Masculinity 19, no. 4 (2018): 624–34.
https://doi.org/10.1037/men0000130.

Schoppe-Sullivan, Sarah J., Kevin Shafer, Eric L. Olofson, and Claire M. Kamp Dush. “Fathers’ Parenting and Coparenting Behavior in Dual-Earner Families: Contributions of Traditional Masculinity, Father Nurturing Role Beliefs, and Maternal Gate Closing.” Psychology of Men & Masculinities 22, no. 3 (2021): 538–50.
https://doi.org/10.1037/men0000336.

The amounts and kinds of housework he does are shaped by his ideas about the fundamental equality of the sexes.

Carlson, Daniel L., and Jamie L. Lynch. “Housework: Cause and Consequence of Gender Ideology?” Social Science Research 42, no. 6 (2013): 1505–18. https://doi.org/10.1016/j.ssresearch.2013.07.003.

Your psychology influences him as well, through your expectations and willingness to assert yourself.

Egami, Sonoko. “The Relationship Between Wives’ Communication and Husbands’ Sharing of Housework and Childcare Duties.” Japanese Journal of International Society for Gender Studies 21 (2023): 82–101.
https://doi.org/10.32195/isgs.21.0_82.

But speaking your mind can be hard if you . . . Feel guilty about pursuing your own career and try to compensate by going overboard on childcare and housework.

Deutsch, Francine M., Julianne B. Lussier, and Laura J. Servis. “Husbands at Home: Predictors of Paternal Participation in Childcare and Housework.” Journal of Personality and Social Psychology 65, no. 6 (1993): 1154–66.
https://doi.org/10.1037//0022-3514.65.6.1154.

Biology plays a part as well.

For this paragraph and the one that follows, see

Geary, David C. “Evolution and Proximate Expression of Human Paternal Investment.” Psychological Bulletin 126, no. 1 (2000): 55–77.
https://doi.org/10.1037/0033-2909.126.1.55.

The balance of power in a father between mating effort and parental investment is greatly affected by social and psychological factors.

Silverstein, Louise B. “Primate Research, Family Politics, and Social Policy: Transforming ‘Cads’ into ‘Dads.’” Journal of Family Psychology 7, no. 3 (1993): 267–82.
https://doi.org/10.1037//0893-3200.7.3.267.

Clear Agreements

He might say that he’ll get more involved when the kids are older and it feels more “natural.”

Men are more likely than women to let their relationship with their children be affected by their feelings about their spouse.

Coiro, Mary Jo, and Robert E. Emery. “Do Marriage Problems Affect Fathering More than Mothering? A Quantitative and Qualitative Review.” Clinical Child and Family Psychology Review 1, no. 1 (1998): 23–40.
https://doi.org/10.1023/a:1021896231471.

it could also mean that you’re getting stuck with more than your share of the housework, which might feel boring, unpleasant

and even depressing

Glass, Jennifer, and Tetsushi Fujimoto. “Housework, Paid Work, and Depression among Husbands and Wives.” Journal of Health and Social Behavior 35, no. 2 (1994): 179. https://doi.org/10.2307/2137364.

[a] big, time-consuming job [could] be one way he fulfills his sense of responsibility to you and the children

Bonney, Jennifer F., Michelle L. Kelley, and Ronald F. Levant. “A Model of Fathers’ Behavioral Involvement in Child Care in Dual-Earner Families.” Journal of Family Psychology 13, no. 3 (1999): 401–15.
https://doi.org/10.1037/0893-3200.13.3.401.

Even with the best of motives, his big job is like an elephant in the living room, limiting the space that’s left for family.

Aldous, Joan, Gail M. Mulligan, and Thoroddur Bjarnason. “Fathering over Time: What Makes the Difference?” Journal of Marriage and the Family 60, no. 4 (1998): 809. https://doi.org/10.2307/353626.

Box: Your Values for Life and Money

Imagine that you have one year to live.

Levine, Stephen. A Year to Live. Macmillan Reference, 1998.

Chapter 8: Staying Intimate Friends After Children

it’s normal to be reluctant to get close . . . to someone you feel routinely let down by

Simpson, Jeffry A., and W. Steven Rholes. “Adult Attachment, Stress, and Romantic Relationships.” Current Opinion in Psychology 13 (February 2017): 19–24. https://doi.org/10.1016/j.copsyc.2016.04.006.

it’s a plain fact that most children suffer in a divorce, and many are injured psychologically as well

Amato, Paul R., and Bruce Keith. “Parental Divorce and the Well-Being of Children: A Meta-Analysis.” Psychological Bulletin 110, no. 1 (1991): 26–46.
https://doi.org/10.1037/0033-2909.110.1.26.

D’Onofrio, Brian, and Robert Emery. “Parental Divorce or Separation and Children’s Mental Health.” World Psychiatry 18, no. 1 (2019): 100–101.
https://doi.org/10.1002/wps.20590.

O’Connor, T. G., A. Caspi, J. C. DeFries, and R. Plomin. “Are Associations Between Parental Divorce and Children’s Adjustment Genetically Mediated? An Adoption Study.” Developmental Psychology 36, no. 4 (2000): 429–37.

The initial breakup is stressful for . . . parents

Bloom, B. L., S. J. Asher, and S. W. White. “Marital Disruption as a Stressor: A Review and Analysis.” Psychological Bulletin 85, no. 4 (1978): 867–94.

Weitoft, Gunilla Ringbäck, Bengt Haglund, and Måns Rosén. “Mortality Among Lone Mothers in Sweden: A Population Study.” The Lancet 355, no. 9211 (2000): 1215–19. https://doi.org/10.1016/S0140-6736(00)02087-0.

there’s usually a wound in the family that lasts for years; it can include more room to diverge in parenting practices

Maccoby, Eleanor E., Christy M. Buchanan, Robert H. Mnookin, and Sanford M. Dornbusch. “Postdivorce Roles of Mothers and Fathers in the Lives of Their Children.” Journal of Family Psychology 7, no. 1 (1993): 24–38.
https://doi.org/10.1037/0893-3200.7.1.24.

grappling with new partners or stepparents

Fine, Mark A., Patricia Voydanoff, and Brenda W. Donnelly. “Relations Between Parental Control and Warmth and Child Well-Being in Stepfamilies.” Journal of Family Psychology 7, no. 2 (1993): 222–32.
https://doi.org/10.1037/0893-3200.7.2.222.

single mothers tend to have worse physical and mental health than married ones

Benzeval, Michaela. “The Self-Reported Health Status of Lone Parents.” Social Science & Medicine 46, no. 10 (1998): 1337–53.
https://doi.org/10.1016/S0277-9536(97)10083-1.

Kim, Ga Eun, and Eui-Jung Kim. “Factors Affecting the Quality of Life of Single Mothers Compared to Married Mothers.” BMC Psychiatry 20, no. 1 (2020): 169.
https://doi.org/10.1186/s12888-020-02586-0.

Sex after Children

Will Change Diapers for Sex

It is normal for estrogen to be lower than usual for several months after childbirth (longer if you continue to nurse), and estrogen helps make women receptive to sexual advances.

Perelmuter, Sara, Ramzy Burns, Katie Shearer, et al. “Genitourinary Syndrome of Lactation: A New Perspective on Postpartum and Lactation-Related Genitourinary Symptoms.” Sexual Medicine Reviews 12, no. 3 (2024): 279–87.
https://doi.org/10.1093/sxmrev/qeae034.

Szöllősi, Katalin, Kinga Komka, and László Szabó. “Risk Factors for Sexual Dysfunction During the First Year Postpartum: A Prospective Study.” International Journal of Gynecology & Obstetrics 157, no. 2 (2022): 303–12.
https://doi.org/10.1002/ijgo.13892.

Making Room for Two When Baby Makes Three

Sex is boring:

To rekindle some zest, you could start by thinking about or writing down a list of things you would like to try or change in your sex life

Thanks to Anne Semans and Cathy Winks for this suggestion, in their helpful book:

Semans, Anne, and Cathy Winks. The Mother’s Guide to Sex: Enjoying Your Sexuality Through All Stages of Motherhood. Three Rivers Press, 2001.

Chapter 9: Juggling Motherhood and Work

Making Choices about Working

studies have found that mothers who work are healthier than mothers who do not

Frech, Adrianne, and Sarah Damaske. “The Relationships between Mothers’ Work Pathways and Physical and Mental Health.” Journal of Health and Social Behavior 53, no. 4 (2012): 396–412. https://doi.org/10.1177/0022146512453929.

Footnote

women who work are likely to be better educated

Crouter, Ann C., et al. “Parental Monitoring and Perceptions of Children’s School Performance and Conduct in Dual- and Single-Earner Families.” Developmental Psychology 26, no. 4 (1990): 649–657.
https://doi.org/10.1037/0012-1649.26.4.649.

which is associated with better health practices and less illness

Hofer, T. P., and S. J. Katz. “Healthy Behaviors among Women in the United States and Ontario: The Effect on Use of Preventive Care.” American Journal of Public Health 86, no. 12 (1996): 1755–1759.
https://doi.org/10.2105/ajph.86.12.1755.

van der Noordt, Maaike, et al. “Health Effects of Employment: A Systematic Review of Prospective Studies.” Occupational and Environmental Medicine 71, no. 10 (2014): 730–736. https://doi.org/10.1136/oemed-2013-101891.

They also tend to be more healthy in the first place, since ill people are less likely to seek work.

Burdorf, Alex, et al. “Health and Inclusive Labour Force Participation.” The Lancet 402, no. 10410 (2023): 1382–1392.
https://doi.org/10.1016/s0140-6736(23)00868-1.

For a discussion of the “healthy worker effect,” see:

Repetti, Rena L., et al. “Employment and Women’s Health: Effects of Paid Employment on Women’s Mental and Physical Health.” American Psychologist 44, no. 11 (1989): 1394–1401. https://doi.org/10.1037/0003-066x.44.11.1394.

Waldron, Ingrid, et al. “How Valid Are Self-Report Measures for Evaluating Relationships between Women’s Health and Labor Force Participation?” Women & Health 7, no. 2 (1982): 53–66. https://doi.org/10.1300/j013v07n02_06.

The Costs of Working for You

Physically demanding work . . . has been associated with poorer health in mothers, especially during the first year after giving birth.

Houston, B. Kent, et al. “Job Stress, Psychosocial Strain, and Physical Health Problems in Women Employed Full-Time Outside the Home and Homemakers.” Women & Health 19, no. 1 (1992): 1–26. https://doi.org/10.1300/j013v19n01_01.

MacDonald, Leslie A., et al. “Physical Job Demands in Pregnancy and Associated Musculoskeletal Health and Employment Outcomes: A Systematic Review.” American Journal of Obstetrics and Gynecology 230, no. 6 (2023).
https://doi.org/10.1016/j.ajog.2023.12.014.

McGovern, Patricia, et al. “Time off Work and the Postpartum Health of Employed Women.” Medical Care 35, no. 5 (1997): 507–521.
https://doi.org/10.1097/00005650-199705000-00007.

Rosenfeld, J. A. “Maternal Work Outside the Home and Its Effect on Women and Their Families.” Journal of the American Medical Women’s Association (1972) 47, no. 2 (1992): 47–53. pubmed.ncbi.nlm.nih.gov/1573149/.

Jobs that offer the employee little say . . . are a risk factor for cardiovascular problems in mothers.

Nriagu, Bede N., et al. “Occupations Associated with Poor Cardiovascular Health in Women.” Journal of Occupational & Environmental Medicine 63, no. 5 (2021): 387–394. https://doi.org/10.1097/jom.0000000000002135.

an employed mother typically sleeps about five or six hours a week less than a stay-at-home mom.

McGovern, Patricia, et al. “A Longitudinal Analysis of Total Workload and Women’s Health after Childbirth.” Journal of Occupational & Environmental Medicine 53, no. 5 (2011): 497–505. https://doi.org/10.1097/jom.0b013e318217197b.

the hassles of investigating, managing, or changing childcare usually land on you

Ciciolla, Lucia, and Suniya S. Luthar. “Invisible Household Labor and Ramifications for Adjustment: Mothers as Captains of Households.” Sex Roles 81, no. 7-8 (2019): 467–486. https://doi.org/10.1007/s11199-018-1001-x.

as the difficulty of arranging for childcare rises, a mother’s health tends to decline.

McGovern, Patricia, et al. “Time off Work and the Postpostpartum Health of Employed Women.” Medical Care 35, no. 5 (1997): 507–521.
https://doi.org/10.1097/00005650-199705000-00007.

Mistry, Ritesh, et al. “Parenting-Related Stressors and Self-Reported Mental Health of Mothers with Young Children.” American Journal of Public Health 97, no. 7 (2007): 1261–1268. https://doi.org/10.2105/ajph.2006.088161.

Nærde, Ane, et al. “Symptoms of Anxiety and Depression among Mothers of Pre-School Children: Effect of Chronic Strain Related to Children and Child Care-Taking.” Journal of Affective Disorders 58, no. 3 (2000): 181–199.
https://doi.org/10.1016/s0165-0327(99)00119-6.

if you are already heavily burdened . . . a job could be the proverbial straw that breaks your back.

Macran, Susan, et al. “Women’s Health: Dimensions and Differentials.” Social Science & Medicine 42, no. 9 (1996): 1203–1216.
https://doi.org/10.1016/0277-9536(95)00432-7.

full-time employed mothers of infants report greater stress than do full-time homemakers with infants, and they often neglect their own health to cope with their total workload.

Chatterji, Pinka, et al. “Effects of Early Maternal Employment on Maternal Health and Well-Being.” Journal of Population Economics 26, no. 1 (2012): 285–301.
https://doi.org/10.1007/s00148-012-0437-5.

Floderus, B., et al. “Work Status, Work Hours and Health in Women with and without Children.” Occupational and Environmental Medicine 66, no. 10 (2009): 704–710. https://doi.org/10.1136/oem.2008.044883.

The Costs of Working for Both You and Your Family

returning to work (especially full-time) usually leads a mother to wean earlier than she otherwise would

Dagher, Rada K., et al. “Determinants of Breastfeeding Initiation and Cessation among Employed Mothers: A Prospective Cohort Study.” BMC Pregnancy and Childbirth 16, no. 1 (2016). https://doi.org/10.1186/s12884-016-0965-1.

Fein, S. B., and B. Roe. “The Effect of Work Status on Initiation and Duration of Breast-Feeding.” American Journal of Public Health 88, no. 7 (1998): 1042–1046.
https://doi.org/10.2105/ajph.88.7.1042.

Visness, C. M., and K. I. Kennedy. “Maternal Employment and Breast-Feeding: Findings from the 1988 National Maternal and Infant Health Survey.” American Journal of Public Health 87, no. 6 (1997): 945–950.
https://doi.org/10.2105/ajph.87.6.945.

continuing to breastfeed seems to help shield you from the effects of stress.

Beery, Annaliese K., et al. “Acute Decrease in Mothers’ Cortisol Following Nursing and Milk Expression.” Hormones and Behavior 153, no. 105387 (2023): 105387–105387. https://doi.org/10.1016/j.yhbeh.2023.105387.

Taylor, Shelley E., et al. “Biobehavioral Responses to Stress in Females: Tend-And-Befriend, Not Fight-Or-Flight.” Psychological Review 107, no. 3 (2000): 411–429.
https://doi.org/10.1037/0033-295x.107.3.411.

the benefits [of breastfeeding] for children include a boost in IQ and fewer illnesses

Heinig, M. Jane. “Host Defense Benefits of Breastfeeding for the Infant.” Pediatric Clinics of North America 48, no. 1 (2001): 105–123.
https://doi.org/10.1016/s0031-3955(05)70288-1.

Lawrence, Ruth A. “Breastfeeding: Benefits, Risks and Alternatives.” Current Opinion in Obstetrics and Gynecology 12, no. 6 (2000): 519–524.
https://doi.org/10.1097/00001703-200012000-00011.

Meek, Joan Younger, and Lawrence Noble. “Technical Report: Breastfeeding and the Use of Human Milk.” Pediatrics 150, no. 1 (2022).
https://doi.org/10.1542/peds.2022-057989.

the American Academy of Pediatrics and the World Health Organization recommend exclusive breastfeeding for the first six months, and continued nursing for two years or longer if desired by both parent and child.

Meek, Joan Younger, and Lawrence Noble. “Technical Report: Breastfeeding and the Use of Human Milk.” Pediatrics 150, no. 1 (2022).
https://doi.org/10.1542/peds.2022-057989.

your kids . . . in childcare [are] more frequently ill from exposure to other children who are sick.

McGovern, Patricia, et al. “Time off Work and the Postpartum Health of Employed Women.” Medical Care 35, no. 5 (1997): 507–521.
https://doi.org/10.1097/00005650-199705000-00007.

Some research has found that moderate, high-quality childcare, especially past the first birthday, has – on average – some benefits for language development without disrupting the attachment relationship between a typical parent and child, though it does seem to make many kids somewhat more aggressive.

Huston, Aletha C., et al. “Time Spent in Child Care: How and Why Does It Affect Social Development?” Developmental Psychology 51, no. 5 (2015): 621–634. https://doi.org/10.1037/a0038951.

Luijk, M. P. C. M., et al. “Hours in Non-Parental Child Care Are Related to Language Development in a Longitudinal Cohort Study.” Child: Care, Health and Development 41, no. 6 (2015): 1188–1198. https://doi.org/10.1111/cch.12238.

For a major longitudinal study on the effect of childcare on the attachment relationships of children, see:

NICHD. “Child-Care and Family Predictors of Preschool Attachment and Stability from Infancy.” Developmental Psychology 37, no. 6 (2001): 847–862.
pubmed.ncbi.nlm.nih.gov/11699758/.

For more general reviews of this complex topic (though perhaps tilted a bit, in our view, toward deemphasizing the impacts of childcare on children and families – and the mothers themselves), see:

Scarr, Sandra. “American Child Care Today.” American Psychologist 53, no. 2 (1998). https://doi.org/10.1037//0003-066x.53.2.95.

Scarr, Sandra. “Working Mothers and Their Families.” American Psychologist 44, no. 11 (1989): 1402–1409.
https://doi.org/10.1037/0003-066x.44.11.1402.

Making It Work to Work

Working at home

Millions of employees now work remotely at least part-time—many of them mothers—and many other moms run home-based businesses. .

Borkowski, Connor, and Rifat Kaynas. “Telework Trends.” Bureau of Labor Statistics, March 25, 2025.
www.bls.gov/opub/btn/volume-14/telework-trends.htm.

Getting help from your husband

While fathers whose wives work tend to do more than fathers whose wives are full-time moms, working mothers still typically do more total household and childrearing work than their husbands.

Raley, Sara, et al. “When Do Fathers Care? Mothers’ Economic Contribution and Fathers’ Involvement in Child Care.” American Journal of Sociology 117, no. 5 (2012): 1422–1459. https://doi.org/10.1086/663354.

Yavorsky, Jill E., et al. “The Production of Inequality: The Gender Division of Labor across the Transition to Parenthood.” Journal of Marriage and Family 77, no. 3 (2015): 662–679. https://doi.org/10.1111/jomf.12189.

researchers have found that dads who help more with caring for children have greater well-being than dads who do not.

Bamishigbin, Olajide N., et al. “Father Involvement in Infant Parenting in an Ethnically Diverse Community Sample: Predicting Paternal Depressive Symptoms.” Frontiers in Psychiatry 11, no. 578688 (2020).
https://doi.org/10.3389/fpsyt.2020.578688.

Appendixes

Appendix A: Defining Depleted Mother Syndrome

Differential Diagnosis

Postpartum depression: 4

PPD. . . is a major depressive episode that begins within four weeks of delivery

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5-TR, American Psychiatric Association, 2013.

The “maternal depletion syndrome”: we found references to a “maternal depletion syndrome” suffered by malnourished women in Third World countries who commonly bear and breastfeed multiple children with short birth intervals

For a review of this construct, see:

Winikoff, B., and M. A. Castle. “Defining Maternal Depletion Syndrome.” American Journal of Public Health 83, no. 7 (1993): 1052–52.
https://doi.org/10.2105/ajph.83.7.1052.

Appendix C: A Mother’s Suggested Daily Values

MSDV Chart

Dr. Oscar Serrallach. The Postnatal Depletion Cure. Grand Central Life & Style, 2018.

National Institute of Health. “Nutrient Recommendations and Databases.” Ods.od.nih.gov, National Institutes of Health, 2021.
ods.od.nih.gov/HealthInformation/nutrientrecommendations.aspx.

‌“Vitamin K Benefits and Importance.” Thorne.com, 2020,
https://www.thorne.com/take-5-daily/article/the-importance-of-vitamin-k.

Appendix D

If you drag a net with a two-inch mesh through the sea, you will conclude there is no such thing as a fish that is shorter than two inches.

Arthur Eddington, PhD. This is a paraphrase by Rupert Sheldrakke, PhD, in Discover, August 2000: 65.

Appendix E: The Insider’s Guide

Four Guidelines for Navigating Within the Spectrum of Care

the majority of the practices used day to day in Western medicine have not yet been evaluated in multiple, high-quality studies

Angus, Derek C., et al. “The Integration of Clinical Trials with the Practice of Medicine: Repairing a House Divided.” JAMA 332, no. 2 (2024): 153–62.
https://doi.org/10.1001/jama.2024.4088.

Footnote: Unfortunately, many people have little choice about their health care professionals, usually for financial reasons.

Dickman, Samuel, et al. “Inequality and the Health-Care System in the USA.” The Lancet 389, no. 10077 (2017): 1431–41.
www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)30398-7/fulltext?code=lancet-site.

Footnote: the “placebo effect” . . . appears quite small in research studies

Hróbjartsson, Asbjørn. “The Uncontrollable Placebo Effect.” European Journal of Clinical Pharmacology 50, no. 5 (1996): 345–48.
https://doi.org/10.1007/s002280050120.

Making Sense of the Findings

Compared to what?

The “normal range” is typically set between the 2.5 to 97.5 percentiles

Doles, Nancy, et al. “Interpretating Normal Values and Reference Ranges for Laboratory Tests.” Journal of the American Board of Family Medicine 38, no. 1 (2025): 174–79. https://doi.org/10.3122/jabfm.2024.240224R1.

References for Quotations

Chapter 1

A baby is an inestimable blessing and bother.

Mark Twain. From Bartlett’s Familiar Quotations, 15th ed., 1980.

Improvements of the nutritional status of American women of childbearing age should be a national priority.

Gladys Block and Barbara Abrams. “Vitamin and Mineral Status of Women of Childbearing Potential.” Annals of the New York Academy of Sciences 678, no. 1 (1993): 251. https://doi.org/10.1111/j.1749-6632.1993.tb26126.x.

Evidence is accumulating that being a mother may be the most important source of stress in women’s lives.

Rosalind C. Barnett and Grace K. Baruch. “Women’s Involvement in Multiple Roles and Psychological Distress.” Journal of Personal and Social Psychology 49, no. 1 (1985): 137.

For many couples, the cascade toward divorce begins with the first decline in the wife’s marital satisfaction after the arrival of the first baby.

Alyson Fearnley Shapiro, John M. Gottman, and Sybil Carrere. “The Baby and the Marriage: Identifying Factors That Buffer Against Decline in Marital Satisfaction After the First Baby Arrives.” Journal of Family Psychology 14, no. 1 (2000): 59.
https://psycnet.apa.org/doi/10.1037/0893-3200.14.1.59.

Chapter 2

Helmer: First and foremost, you are a wife and mother.

Nora: That I don’t believe anymore. I believe that first and foremost I am an individual, just as much as you are.

Henrik Ibsen, A Doll’s House. From Bartlett’s Familiar Quotations, 15th ed., 1980.

When you are a mother, you are never really alone in your thoughts. A mother always has to think twice, once for herself and once for her child.

Sophia Loren. From For a Mother with Love, Garborg’s Heart’n Home (no date). Bloomington, MN.

The quickest way for a parent to get a child’s attention is to sit down and look comfortable.

Lane Olinghouse. From A Mother’s Journal: A Keepsake for Thoughts and Dreams, Running Press, 1985.

I see women’s spirits getting weaker and weaker when they don’t fill their pitchers up, when they don’t recharge.

Shoshana Bennett. Founder, Postpartum Assistance for Mothers. Personal communication, 2000.

There is no pleasure in having nothing to do; the fun is in having lots to do and not doing it.

Mary Little. From For a Mother with Love, Garborg’s Heart’n Home, Inc. (no date). Bloomington, MN.

I don’t think the quiet mind is very far away for anybody.

I don’t think the place of stillness is very far away for anybody.

It doesn’t matter whether you’re chopping wood or sitting on a meditation cushion.

It doesn’t matter whether you’re in an intensive retreat or you’re living a very creative and vital life.

What’s important is that your home is in stillness.

Christina Feldman, Spirit Rock Meditation Center Newsletter, February–August, 1998

Chapter 3

Insanity is hereditary— you get it from your children.

Sam Levenson. From The Pregnancy Journal: A Day-to-Day Guide to a Healthy and Happy Pregnancy by A. Christine Harris, PhD. Chronicle Books, 1996.

Parents are often so busy with the physical rearing of children that they miss the glory of parenthood, just as the grandeur of trees is lost when raking leaves.

Marceline Cox. From The Pregnancy Journal: A Day-to-Day Guide to a Healthy and Happy Pregnancy by A. Christine Harris, PhD. Chronicle Books, 1996.

It will be gone before you know it. The fingerprints on the wall appear higher and higher. Then suddenly they disappear.

Dorothy Evslin. From A Mother’s Journal: A Keepsake for Thoughts and Dreams, Running Press, 1985.

We are, perhaps, uniquely among the earth’s creatures, the worrying animal. We worry away our lives, fearing the future, discontent with the present, unable to take in the idea of dying, unable to sit still.

Lewis Thomas. From Bartlett’s Familiar Quotations, 15th ed., 1980.

Motherhood brings as much joy as ever, but it still brings boredom, exhaustion, and sorrow, too. Nothing else ever will make you as happy or as sad, as proud or as tired, for nothing is quite as hard as helping a person develop his own individuality—especially while you struggle to keep your own

Marguerite Kelly and Ella Parsons. From A Mother’s Journal: A Keepsake for Thoughts and Dreams, Running Press, 1985.

Chapter 4

Health is a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.

Platform for Action of the Fourth World Conference on Women in Beijing in September, 1995; quoted in Weisman, C. S., “Changing Definitions of Women’s Health: Implications for Health Care and Policy.” Maternal and Child Health Journal 1, no. 3 (1997): 183.

There was never a child so lovely but his mother was glad to get him asleep.

Ralph Waldo Emerson. From A Mother’s Journal: A Keepsake for Thoughts and Dreams, Running Press, 1985.

I often feel a spiritual communion with all the other mothers who are feeding their babies in the still of the night. Having a baby makes me feel a general closeness with humanity.

Simone Bloom. From A Mother’s Journal: A Keepsake for Thoughts and Dreams, Running Press, 1985.

A baby is God’s opinion that life should go on.

Carl Sandburg. From Remembrance Rock. Harcourt, Brace and Company, 1948.

I can resist everything except temptation

Oscar Wilde. From Bartlett’s Familiar Quotations, 15th ed., 1980.

The Tao is called the Great Mother:

empty yet inexhaustible,

it gives birth to infinite worlds.

Lao Tzu. Tao Te Ching: A New English Version. Translated by Stephen Mitchell. New York: Harper & Row, 1988.

Chapter 5

A . . . mother’s role is to deliver children obstetrically once, and by car forever after.

Peter De Vries. From The Tunnel of Love. Little, Brown, 1954.

Chapter 6

It is an amazing but true thing that practically the only people who ever say mean, insulting, wounding things to us are those of our own households.

Dorothea Dix, quoted in Gottman, John, Cliff Notarius, Jonni Gonso, and Howard Markman. A Couple’s Guide to Communication. Research Press, 1976.

Kind words can be short and easy to speak, but their echoes are truly endless.

Mother Teresa. From For a Mother with Love, Garborg’s Heart’n Home, Inc., (no date). Bloomington, MN.

Chapter 7

Before I got married I had six theories about bringing up children; now I have six children and no theories.

Lord Rochester. From A Mother’s Journal: A Keepsake for Thoughts and Dreams, Running Press, 1985.

If evolution works, how come mothers have only two hands?

Ed Dussault. From A Mother’s Journal: A Keepsake for Thoughts and Dreams, Running Press, 1985.

A rich child often sits in a poor mother’s lap.

Danish proverb. From For a Mother with Love, Garborg’s Heart’n Home, Inc., (no date). Bloomington, MN.

Chapter 8

We’re too busy being parents to be friends.

A mother. Anonymous woman, personal communication, 2000.

Helpful husbands are an aphrodisiac for their wives.

A mother. Anonymous woman, personal communication, 2000.

Chapter 9

The work world has evolved as if employees had no families.

Marcia Killien. “Childbearing Choices of Professional Women.” Health Care for Women International 8, nos. 2–3 (1987): 121–31.
https://doi.org/10.1080/07399338709515777.