Tag Archives: Anxiety

The Child & Youth Mental Health Epidemic

Healing Complex SystemsMaybe we all have a reason to be here.

If I have a mission for my time on earth, it’s about healing.

Supporting the healing capacity of complex systems~.

That’s what I’m attempting with this blog. It’s what I try to do in my personal life. And it’s the primary emphasis of my career.

In my work, I coordinate a Collective Impact initiative called the Child & Youth Health Network.

A principal concern of all our partners in that initiative, across sectors & cultures, is the current mental health epidemic among children and youth.

We are hearing from our school district partners that our schools are overwhelmed, starting in Kindergarten.

Anxiety and depression rates are increasing. As are diagnoses of ADHD, autism and behavioral disorders.

Our kids are suffering.

We know from our government and non-profit organizations, as well as from youth and parents, that mental health services are insufficient and outdated. And the waitlists for those services are ridiculously long.

Youth who struggle with metal health issues have told us that the current mental health system is like Mordor. As in: “Even if you can get in, you’re still screwed”.

Even if you can get in...

Some data on youth mental health from my corner of the planet:

  • Among Southern Vancouver Island youth who attended secondary schools in 2013, 8% of males and 15% of females seriously thought about killing themselves in the past year (that’s over 1 in 10). And 4% of males and 7% of females reported attempting suicide in the past year.
  • In 2013, 8% of males and 22% of females who attended secondary schools on Southern Vancouver Island also reported cutting or intentionally injuring themselves in the past year.
  • Rates of problematic mental health for youth who are not engaged in secondary school are even higher, as often it is mental health issues, compounded with other risk factors, that result in disengagement from the education system. For example, 68% of homeless and street-involved youth in British Columbia (62% of males & 72% of females) reported having at least one specific mental health condition in 2015.

As I have Collective Impact conversations with diverse cross-sectoral partners who genuinely want to figure out how to reverse this alarming trend, I have to decide (over and over again) how much I am going to share about what I understand about the origin of this epidemic.

About the origin of illness.

Because saying that the Canada Food Guide is part of the problem is still considered a fringe perspective. Not supported by evidence.

The paradigm is changing, but it hasn’t shifted sufficiently yet to enable us to consider some of the primary contributing factors to this serious population-level health problem. Doctors are still dismissive of the role of diet in health.

So instead, we all get together and talk earnestly about better arrangements for the deck chairs on the Titanic. As the saying goes.

Even though we are coming together because we all acknowledge that such a serious health problem is going to require that we work together in innovative ways and try new approaches.

The Healing CapacityI know the system isn’t ready until it’s ready.

I know that because I have devoted my life to system-level work.

Supporting the healing capacity of complex systems.

It’s my thing~.

I know that I can influence systems by nurturing the conditions that will lead to a tipping point, but no one can force a system to do anything it isn’t ready to do. Or, more accurately, the resources required to try to instigate that kind of change make those efforts extremely wasteful and low leverage.

The Complex Origins of Mental Health Issues

I know, from experience, that mental health issues have complex origins.

I have worked with children, youth and families who live with conditions of complex risk for over 20 years. And I struggled with depression and anxiety for over 30 years, from the time I was 10 until a few years ago.

I still need to stick very close to my optimization protocol to be emotionally and spiritually well.

I know that my own mental health is impacted by a combination of:

  1. My personal history of connection and trauma (& the way my brain is wired as a result);
  2. My biological health;
  3. My spiritual health; &
  4. Epigenetic factors: the impacts of my experiences and my environment on the way my genes express themselves.

As is yours.

Through my own n=1 experiments I am working to address these four factors.

In my experience, it is the elements of the Microbiome Protocol that have had the most profound impact on my mental health, specifically through an intentional return to ancestral patterns of living, combined with continual monitoring of my well-being through biohacking methodologies.

I can’t say that out loud in my work.

Very often.

But I feel tremendous urgency.

Because I know that our young people are suffering. Really suffering. Right now.

And the impacts of the origin of the mental health epidemic become harder to reverse as time goes on.

beach youthWhen these children and youth become adults, how many of them will continue to struggle with their mental health?

How many will develop autoimmune conditions?

Because it seems that the origin of these illnesses, in many cases, is the same.

I believe the health of our young people is a pretty good indicator of the health of our society.

How much of this epidemic is preventable?

And when can we talk about it?

4 Comments

Filed under Uncategorized

The Origin of Illness (the Microbiome~)

My understanding of the microbiome is evolving.

New research is surfacing almost every day. Some of it I don’t fully comprehend.

Most recently, I’ve been reading David Perlmutter’s Brain Maker, which simplifies things enormously.

Here’s a step-by-step (with diagrams~) of my current understanding of the origin of illness. As ever, I welcome your thoughts.

The Origin of Illness

Both health and illness begin in the microbiome.

Here’s the basic idea:

Microbiome 1

My initial understanding involved a 3-step process:

  1. Inflammatory food upsets the balance of the bacteria in the gut, resulting in intestinal permeability.
  2. This allows foreign particles to leak into the body, causing systemic inflammation.
  3. Inflammation causes disease.

The connection between diet and gut health is the foundation of the nutritional elements of the Autoimmune Protocol as outlined in The Paleo Approach by Sarah Ballantyne, (as well as all other evidence-based healing protocols like the The Wahls Protocol and The Bulletproof Diet).

But not only autoimmune conditions are caused by an unhealthy imbalance in the microbiome: it seems that most illnesses are.

The notion that most chronic health conditions are at least partly caused by inflammation is, in itself, a radical departure from the previous, mechanistic understanding of health. But this story gets way more interesting:

Microbiome 2

Inflammation isn’t the only cause of health problems.

We also need to consider genes & environment. Which leads us to…

Epigenetics

Epigenetics is the study of the interaction between genes & environment. It’s partly this interplay that determines whether or not a genetic predisposition to a particular disease gets activated in response to systemic inflammation.

And helps explain why one person might get Psoriasis while another one gets Multiple Sclerosis.

Here’s a cute overview on Epigenetics:

The Origin of Gut Dysbiosis

Gut dysbiosis is an unhealthy imbalance in the microbiome and as mentioned, it is this imbalance that is a primary culprit in illness.

What causes an imbalance?

In addition to an unhealthy diet, chemicals (like chlorine); environmental factors (like excessive hygiene); side effects from drugs (including antibiotics); Caesarean birth and formula or bottle feeding all contribute to dysbiosis.

Before we are born, we have a minimal microbiome. We begin to acquire a robust one at birth. A vaginal birth followed by breastfeeding is the best possible way to get a healthy and protective microbiome started.

Interestingly, Dr Natasha Campbell-McBride suggests that a newborn receives microbiota from both the mother and the father (or the mother’s other sexual partners) during vaginal delivery. Which gives a whole new meaning to the term ‘dirty sex’~!

Stress

Stress is a really big deal.

Not only does ongoing stress contribute to gut dysbiosis through elevated cortisol levels, but gut dysbiosis causes stress.

And because chronically elevated cortisol levels contribute directly to intestinal permeability and inflammation, stress creates a nasty reinforcing loop of disease-provoking conditions in the body.

What causes stress?

Modern life.

We just weren’t designed for living this way.

Microbiome 3

 Toxins in the Brain

We used to think that the blood-brain barrier protected the brain from toxins. According to David Perlmutter in Brain Maker, that isn’t so.

Intestinal permeability allows toxins into the body and some of these travel up to the brain.

This is one explanation for the mental health epidemic we are now experiencing, including widespread depression and anxiety.

Remarkably, toxins can stress the brain into perceiving threat, which automatically triggers a neurological takeover by the limbic system.

The limbic system does a great job of protecting us from old-school hazards like predators, but is incapable of higher reasoning or anything approaching enlightenment, and simply can’t navigate the complexity of modern life.

So these toxins not only provoke depression and anxiety, but can render us incapable of making good decisions.

The Collateral Damage of Chronic Health Conditions

Compounding the problem, people who end up with chronic health conditions end up dealing with a host of other factors that contribute to stress, including pain, financial impacts and negative effects on relationships, which add add to the stress fest that help create their illness in the first place.

Microbiome 4

Mental Health

Obviously, the presence of toxins in the brain isn’t the only cause of mental health issues. The whole point of creating a convoluted spaghetti diagram like this one is that the origin of illness is complex.

In addition to epigenetics (genes & environment), trauma & brain architecture are significant factors to consider when thinking about our mental health.

I haven’t seen any reference to the connection between microbiome research and neurological development research in the literature, but it’s highly relevant.

(Still with me? We’re almost done~!)

Toxic Stress & Brain Architecture

Neurological research over the past 20 years has demonstrated that toxic stress in childhood changes the architecture of the brain.

The Harvard Centre on the Developing Child is a wonderful repository for this research.

The basic idea is that all children experience stress, but prolonged stress without the support of a caring adult is toxic to early brain development and permanently impairs executive functioning.

The ability to handle stress, fascinatingly, is wired into the same part of the brain as executive function skills, so that reduced executive function capacity also results in reduced ability to handle stress throughout the lifespan.

Executive function skills are also exactly what become impaired in an adult who experiences brain fog as a symptom of systemic inflammation.

Trauma & Nervous System Dysregulation

Finally, trauma, whether it occurs during childhood or adulthood, can result in nervous system dysregulation, which also impairs the body’s ability to manage stress.

So there it is.

My current (& no doubt flawed & incomplete) understanding of the origin of illness.

Next up: what we can do about it~!

25 Comments

Filed under Uncategorized

A Paleo New Year

April seems to be my paleo new year.BeforeandAfter

Two years ago in April I went Paleo and lost 75 lbs in 5 months.

Soon after that I realized all 9 of my health issues had disappeared.

At the time I thought I’d ‘made it’. After all, I’d achieved even more than I’d set out to do.

I didn’t realize I was still only in the foothills of health and I’d taken just the first baby steps in my paleo experiments.

What I’ve experienced since then, as my food has become increasingly pure and my gut has continued to heal, is previously unimagined levels of well-being.

As someone who struggled with depression and anxiety every day in my pre-paleo life, I’m still astounded by the feeling of psychological well-being. And the impact psychological health has had on all aspects of my life, including my career.

Levelling Up

During my first paleo year I only ate fish & poultry, which was obviously sufficient for weight loss & initial healing. As a recovering vegetarian, I wasn’t prepared to eat mammals at first, but it became apparent that I needed to reduce my reliance on fowl as a protein source.

So last April, I had my first bite of steak.

And this April, after 3½ months on the Autoimmune Protocol, I went ketogenic on the Wahls Paleo Plus.

As April seems to be my Paleo new year, I’m going to make a resolution.

This year I’m going to level up to organ meat.

I’ve been recalcitrant on the offal front. I actually don’t even want to change (that’s sort of the definition of recalcitrant). But I know it’s the next step.

And one year from now I will no doubt wonder why I stayed offal-obstinate for so long.

Maybe it was because I started with lamb kidney.

Started and ended with lamb kidney.

I know it’s politically incorrect to say so, because in paleo-land we’re all just supposed to start salivating & shouting hallelujah the moment we see a pile of fresh organs in the butcher’s display case, but lamb kidney tastes like urine and the taste stays in your mouth for a long time, even if you brush your teeth (& your tongue) repeatedly.

I’m an offal wimp.

I just had to get that off my chest.

According to the Paleo PI, kidney is intermediate offal. Tongue & heart is the place to start.

I actually think chicken liver might be the way to edge in for me.

In any case, I’m celebrating my new year with offal.

Celebrate with me!

 

 

29 Comments

Filed under Uncategorized

Ideating about paleo

I have some friends who are ideating about paleo.

They have misgivings.

Talking to them has reminded me that I actually once went through a grief process about letting go of my favorite bakery pizza.

I also remember that during my first paleo workweek I was profoundly anxious about how I’d handle stressful meetings if I couldn’t eat starches for courage beforehand. That was actually my #1 fear.

Seems so weird, now.

I asked my friends if they would write down their fears about embarking on paleo.

Here’s what one wrote:

Fears about going in–my primary one is that I will get exhausted, and have no way of getting through my demanding days without the odd sugar hit or piece of toast to boost me up. This is partially because I’m anemic, and have been since March of this year. My iron stores are low, and I’m taking iron supplements, as well as increasing the meat in my diet. But I get so freakin’ wiped, and midday naps are mostly not an option–definitely not during the week.

I’m also afraid of wanting [my partner] and [kid]’s food–because they are not giving up their breadstuffs and ice cream, yet–no way. 

And I’m afraid of backsliding in a crisis–which is exactly why I’m here at the heaviest I’ve ever been, again, after losing 17 lbs in 2011. How can I keep eating the way I want, instead of the default way of eating, when the shit hits the fan–bad days at work, family member ill or in crisis, etc. etc. How do I keep looking after myself and not have that be one more thing on the enormous to-do list? How do I look at that as especially important, and NOT look at saying “oh, fuck it all, I’m eating this donut” as the relaxing/kind/letting-myself-off-the-hook option.

And another:

For me, when considering the idea of fully switching to the paleo diet I encounter two obvious hurtles:

1. Food prep time with a busy life (and especially when caring for [my kid])
2. The addiction

I could probably face the addiction part more easily if I was able to free my house of any temptations that seem to raise their voices when I’m feeling weak…

I’m feeling really insecure in my field of work right now because it provides very little job security. The anxiety I feel about this is toxic and is clearly undermining other aspects of my life. Although I’m not in a crisis mode by any means, I’m experiencing first hand right now how anxiety operates to diminish a person. I’m afraid that if I let go and actually embrace the reality that at the moment I have no clue how I’m going to make a living in the future, that I will spend the little reserve money I have and be in a worse position. I’ve got some abstract ideas about an ideal career but don’t have a road map for getting there. Anyways, there’s a downward spiral that happens with carbo crutches in times like this. Ironically, I can see how embracing paleo and not focusing on the rest may actually be the way out because my mental fog will dissipate and I’ll have more energy and courage to tackle this new phase.

Reading these actually made me cry a little bit. Because they describe how complicated it can be to find your way through the labyrinth to health.

That’s why I’m writing this blog. Because I wasn’t seeing anyone else addressing how complex and multi-layered the process was for me. Wound up with trauma and anxiety and destructive self-fulfilling feedback loops. For many of us, it’s not as simple as sanctifying the pantry and googling some recipes.

We are unfathomably complicated creatures engaging in a whole-self renovation.

And at the same time, we can also be pretty predictable and a lot simpler than we like to think.

As described by a 3rd friend:

Some of my fears/trepidations/concerns include:

1. I’M LAZY!!!

That’s it.

Ha!

4 Comments

Filed under Uncategorized

Yog-Sothoth: the small dependent mammal

I’m not big on small dependent mammals.

Nevertheless, three years ago we adopted two rescue kitties from the SPCA. My #3 kid and I went to the kitty shelter every weekend for a month waiting to meet our perfect cats. We saw lots of pretty young cats come & go, and lots of old cats that will probably stay in the shelter for the rest of their lives. We seriously considered adopting one of these oldsters. And we really thought about the fellow who had been so severely abused that he’d had a front and a back leg amputated when he arrived. But he got adopted by a rich old lady who promptly went out to buy him $500 in kitty toys, so we figured he was going to do better with her than with us.

My stepson joined us (my #4 bonus kid!) on the big day and as soon as he walked into the kitty room, a black cat climbed out from under the bank of cages and looked lovingly into his face. They gazed at each other like two very old friends.

So that was obvious.

And then I saw Allie peering out at me from behind the piece of paper that was taped to the front of her cage. She’d been there every time we had, and for a couple of months before that. She had a paper barrier between her and the world because she got so distressed whenever people came near. Allie was another cat who had been severely abused. Pure white, with crik in her short tail where it had been broken. And she was looking at me.

I opened her cage door and she sniffed my hand.

Of course, I’d told the kids they could each pick a cat, but I wanted to recant. I had to have her. Luckily, my #3 kid was just as impressed, and Allie came home with us.

I did try very hard to get Matthew and the kids to agree to change her name to Yog-Sothoth, but we couldn’t get consensus on that. Allie was the name they’d given her at the SPCA, and Allie it stayed, though I do sometimes call her Alligator for short. We all agreed that Sebastian was a perfect name for a handsome black gentleman with such frightfully tattered ears.

Allie spent most of the first six months crammed in the tiniest crevices she could find. But over time her crevices became less tiny. Then sometimes she’d let a paw stray out while she slept. If you pulled on it, she’d suck it back in, like a snail recoiling to its shell. Then she started hanging out when just the family was home. And then she started skulking in corners when visitors were over. Sniffing them, even. Giving their pant legs a little lean, but disappearing before she could be touched.

Allie’s a comparatively well-adjusted cat now, but she still bolts if you move quickly. If you close the door to the room she is in, she leaps up from a dead sleep and wants out now. I’m pretty sure she will always be like that, even though she knows that she is safe with us. Her early trauma is stuck in her body. Her flight response is on a hair trigger.

Turns out Sebastian is quite a vocal cat. He’s a meowler. He’s hungry? Meowl! Wants’ out? Meowl! Wants love? Meowl! Not sure what he wants but he thinks maybe you should do something about it? Meowl!

I have talked to kitty experts who have said that this can happen to abandoned cats. Seb was discarded and as a result he meowls, irritatingly.

Sebastien meowls and Alligator startles.

And the only solution is love, patience & compassion.

Image

Love, patience & compassion~

What does this have to do with being paleo?

I think that a lot of us are stuck in meowling and startling; fighting & flighting; and are in the habit of trying to regulate our disordered nervous systems with simple carbohydrates.

Unresolved trauma results in a disregulated nervous system, for mammals of all kinds. In humans it can lead to addiction in an attempt to numb the discomfort and get the nervous system back in balance. Not everyone becomes a meth-head or an alcoholic. A lot of us become starch & sugar addicts, because it’s legal & cheap & socially acceptable & our fix is available at every corner store. In fact, I think we might be a whole society of SAD starch & sugar addicts.

And it is really, profoundly, and utterly hard to quell this addiction.

That’s the reason I’m writing this blog. To address the complexity of making the change to paleo. It’s not as simple as sanctifying your pantry and downloading some recipes. It’s healing work. But unlike Alligator and Seb, we can make choices.

If you still need your tiny crevice, or your sugars and starches, to be safe: choose them.

Know that healing is a process. Work on creating a safer environment so you can put first a paw, and then your whole self, into the change you want to be.

2 Comments

Filed under Uncategorized

Paleo Nerd Fitness (Part 2)

PaleoNerd

I was at my yoga studio getting something sorted with my membership last week when one of the owners came up to welcome me and to ask how I was liking the studio so far.

To which I responded, I have been coming here for 3 years.

She was mortified. I know she prides herself on knowing the yogis who flock to her studio, but she didn’t even recognize me.

I’m a full-blown introvert who can pass for socially normal, but I prefer to remain unseen. Being more visible since I’ve been paleo has been tricky for me.

But in all honesty, it wasn’t just my stealth maneuvers that were at work with the studio owner. Though I’ve observed her hundreds of times as I’ve slipped through the studio, I don’t haunt her classes. Not because she’s not a great teacher, but because she once played Bob Marley for an entire 75 minutes, and I’ve been wary ever since. But that’s an aside.

For introverts who have not perfected the art of furtiveness, venturing into any social setting, including most fitness situations, is so stressful that they just don’t.

I started thinking about nerdiness and fitness when I read that introverts are less likely to exercise in Susan Cain’s book Quiet. Think about nerds. Renowned for their physical prowess? Not so much. Why is that?

My guess is it starts early.

Flashback to 1978

I didn’t hate gym class until grade 3 when we started to play team sports. I found baseball and soccer so traumatic that I would do almost anything to get out of gym. They were stressful not only because I’m an introvert whose brain partially shuts down if I’m forced onto a team, but also because I didn’t know the rules, and couldn’t seem to learn them what with my brain:

a)    mostly shut down;

b)    otherwise absorbed with devising strategies to avoid gym.

I had concluded, at age seven, that I wasn’t good at sports, and as everyone else concurred I started directing all my nerdy powers into avoiding physical activity.

But when I think back, I loved moving my body.

I went to a two-room school. It had been a one-room school only a year or two before, but the population increased when a bunch of hippies bought up all the cheap land thereabouts. With them came packs of feral hippie children, of which I was one. A portable was added beside the original schoolhouse to house us, and as the years went on and more hippie kids were generated, more portables arrived.

But in the seventies it was still a two-room school, and in the absence of adventure playgrounds, all the kids still played rip-roaring games together at recess. I loved these games, especially Horses.

The rules of Horses were simple: the girls were horses and the boys were horse catchers. When a horse got caught she was put in the corral until recess was over or she managed to escape. I only got caught once (& it was terrifying) but that was not because I was a fast runner. It was because I was a nerd. I would run around being a horse deep in the woods all by myself where the boys would almost never find me. That’s the kind of game an introvert likes. Solitary while still vaguely connected.

I still love moving my body. And I still abhor team sports. Running & yoga work for me. Even though yoga classes are full of people, I can ignore them. It is perfectly acceptable to practice mat-by-mat without any social interaction at all.

I’m still happy to be vaguely connected, but unseen.

Which is why I wasn’t offended that the studio owner didn’t recognize me. I was more like Yes! My invisibility spell has been working! But that is difficult to explain to an extrovert, who assumes that we all aspire to be noticed.

So I’m calling all Paleo Nerds! Let’s not unite, but stay separate and vaguely connected! We don’t have to reflexively avoid exercise because we avoid people!

It’s a rallying cry!

See Paleo Nerd Fitness (Part 1) for a geeky fitness graph.

 

7 Comments

Filed under Uncategorized

Health 9; Problems 0;

Image
Health issues that have resolved since being paleo: 9
Health issues that remain: 0

I know some people are dealing with much more serious health stuff, but I felt like my body was disintegrating. And I was only 41. How was I going to make it to 50?

My 9 pre-paleo health issues:

  1. Chronic neck pain that no amount of chiro, massage or acupuncture could assuage;
  2. Carpal tunnel that required a wrist brace with steel supports so I could sleep;
  3. Plantar fasciitis that necessitated orthotic arch supports for my shoes, making it difficult to walk any distances. I even had to stop wearing flip flops, which was actually (I know this sounds overwrought) heart-breaking;
  4. Obesity;
  5. Depression;
  6. Anxiety. And it’s good buddy Ativan;
  7. Periods so heavy we could have made a slasher movie;
  8. One wiry black hair that grew out my chin. I joked that it was my beard (but only to Matthew, because I was actually quite self-conscious about it);
  9. Insomnia. I took increasingly large doses of ‘sleep vitamins’ every night for years;

Wow. Writing that list I’ve just been struck by how much less work my daily life is now that I’m no longer managing a dilapidated body. And how much money I’m not spending on supplements, drugs and therapies. And people critique paleo for being time consuming and expensive!

Actually, being unhealthy is time-consuming and expensive.

My health changes didn’t happen immediately, but they’re old news now and I’m not yet 43, so in retrospect it was pretty rapid.

After a while I realized that I’d been peering at my chin for weeks, tweezers in hand, ready to pluck my lone black chin hair, but it just wasn’t growing back.

Over time I noticed my neck, wrist and foot pain was gone. So I got rid of my wrist brace and orthotic shoe inserts. I wore flip flops all summer this year and I’m still wearing them (sometimes) in November, here on Vancouver Island. I’m euphoric about that.

Some issues healed gradually and others transformed overnight. After 7 months of paleo life I was at work one morning when I noticed an odd feeling. And it wasn’t the familiar pre-paleo mid-morning feeling: I need coffee and a muffin stat! so I don’t perish right here on my keyboard. It was an absence of fuzziness or a lack of greyness, sort of like I’d misplaced an itchy sweater I had become accustomed to wearing. It was an unsettling sensation until I realized that what I was experiencing was well-being. For the first time since I was ten (31 long years) I didn’t feel depressed.

That’s when I understood that pre-paleo my depression had become so much a part of me that it didn’t even register unless it got severe enough that I had to hide in my bed. If I could force myself out of bed and keeping rolling the gigantic boulder that was my life uphill, no matter how slowly or ineffectively, then my awareness of my depression faded. That was my normal. Over the next few weeks I rummaged around in the cupboards of my psyche looking for my misplaced depression but I couldn’t find it anywhere. I think it’s just gone.

And I haven’t taken anything to help me sleep since July.

And my Ativan has fallen into disuse at the back of my underwear drawer.

But it does take time. 30 days isn’t enough. The more complex and severe your health problems, the more time they might take to heal or abate.

I’m not suggesting paleo is a cure-all. Many of my health issues resolved because I lost weight. But I lost that weight, and have maintained my new weight, by being paleo. It’s a stormy Saturday morning in November and I’m about to go out for a 10k run in the rain and there is nothing I would rather do. That’s an indicator of wellness I just never experienced before.

So I’m feeling pretty fantastic. Better all the time, actually. 17 months into this paleo experiment I’m feeling finer than I ever have before.

Suprahuman.

14 Comments

Filed under Uncategorized