COVID-19 Update: Anxiety in a Time of Global Pandemic

Good morning, everybody. So today's topic is going to be a little bit different than usual and we'll talk about anxiety. I've been getting a lot of questions about anxiety, how to deal with it, and so I want to address those. It's not just about facts and figures. It's not just about talking about ways to boost your immune system or tracking the spread or flattening the curve and all those things, but how to, how to, how do individuals who are boots on the ground who are dealing with the stress and anxiety of this worldwide pandemic, how do we make it through? So basically this is an answer to a question. Please continue to ask questions, post them, post comments on social media, Facebook and Instagram, I guess YouTube as well and Vimeo, if that's possible. That just gives me a launching ground, know what you all are wanting to know and to be able to answer some questions and deal with some topics that I might not typically talk about. So anyway, what is anxiety? Why do we have it, what makes it worse and what can we do to deal with it? Anxiety is actually a natural response. It's a natural stress response. It's actually quite important. It's a survival thing. If you don't get anxious when something bad's about to happen, you happen. You don't have your heart rate increase, you don't have your adrenaline increase, you don't have your muscle strength increase. So anxiety is actually a natural, healthy response. Your mind sharpens, you become more aware, more hyper aware sometimes about what's going on in your environment. The issue is that when anxiety becomes a chronic thing, it goes from acute, oh my gosh, there's a big guy coming towards me. To a chronic low grade gnawing, almost like Chinese torture, where you have the drop, drop, dropping on your head and over time it literally makes you mad. That's the kind of anxiety that most of us deal with in the West. It's the chronic drip, drip anxiety thing. I actually have a podcast that's going to deal with this in more length coming out hopefully this week. A lot of our podcasting educational things we usually put out have been delayed due to the COVID 19. So be looking for that. Sign up for our podcast on your podcast vendor. That way it comes out, you'll be, you'll have it. So, but anyway, back to anxiety. So what anxiety, the purpose is basically survival. It becomes pathologic or disease causing when it's an ongoing chronic thing. So there's two parts of our immune system, there's our neurological system, there's our sympathetic nervous system and our parasympathetic nervous system. That's our fight or flight and our weed and feed. So you want to spend about 99.99% of your life in parasympathetic, relax, digest, hang out with the friends, contemplation kind of stuff. And you only want to spend a very small amount of your existence in the sympathetic nervous system. Overdrive. When you're eating food and you're anxious, it slows digestion of your food. You have less digestive enzymes produced, you have less blood to your GI tract, so you don't digest your food as well. And you're more prone to GI tract issues. When you have chronic sympathetic overdrive, you don't sleep quite as well. You won't get deep, restful sleep. The patterns of sleep. Again, another podcast coming on that get disrupted. So chronic stress can actually affect every aspect of your body. Elevated cortisol over time. We've known about some Cortisol with the COVID 19 with prednisone. While taking prednisone actually increases your risk for dying. If you get COVID 19, elevated cortisol over time can suppress your immune system, make you more prone to different kinds of autoimmune issues, and ultimately affect your overall health. So lots of things, again, I don't want to spend too much time on that, but just the concept. So what causes anxiety for us in the United States, in the West? There's a lot of interesting literature on technology exposure and blue lights. Okay, blue lights are very activating. They disrupt your sleep, wake cycles. Technology, technology exposure, graphic user interface, how much computer time you have, how much iPhone time you have. There's a direct correlation with anxiety in kids with exposure to computers. There's a direct correlation with anxiety in adults to graphic user interface exposures. And news feeds is another thing. Very interesting. Hmm. There's a direct correlation with news feeds, seeing the news and anxiety. So now we're in a time where everybody's online. I mean, as it. It takes my wife about three hours to download one of these videos and get them on all the things. Because so many people online right now, kind of crazy to think about taking three hours to get a 15 minute video downloaded. But that's kind of the numbers right now for us because so many people are using technology right now watching news feeds. So I would expect there to be a lot of anxiety and just uncertainty, the lack of control. As humans, we like to have control. We like to feel like we're in control of things. Right now, no one's in control. It seems like the government has no idea what's going on. Numbers are changing all the time. Physicians are kind of like, what should we do? Who's really in control right now? And that combination is giving people a lot of anxiety, a lot of stress. So what can you do to deal with this? This is nuts and bolts real quick. What can you do to deal with this? Probably one of the most important things, and I'm going to go through this in order of my, you know what I think is important? 1, 2, 3, 4, 5. First is sleep. We actually did a blog post on sleep back in June 20, 2017. So if you want some more information about how to work on your sleep, just refer to that on our website, richmondfunctionalmedicine.com but sleep is super, super important. Sleep is when you're sympathetic and parasympathetic nervous system rewinds. Sleep is when your body's detoxification ramps up. Sleep is when memories actually become fomented, become solidified in your brain. So sleep is super important for your immune system. That's, you know, animals when they get sick, humans when they get sick, what do you want to do? You want to go sleep, right? So there's different parts of sleep, the sleep initiation, their sleep maintenance and their sleep efficiency. So sleep initiation is how do you get to sleep? That's when your mind's racing. You have mind chatter at night. You can't really kind of focus on stuff. Things I typically use to calm down the mind shadow are things like L Theanine. L theanine is a green tea extract that actually increases alpha wave activity, but also helps slow that mind chatter down a little bit. Anywhere from 100 to 500 milligrams, 30 to 45 minutes before sleep. GABA is another thing. A lot of people use GABA to help calm their brains down. Sometimes GABA can be a little activating if you have a leaky brain. Increased blood, brain barrier issues as well. Sleep initiation can be helped with melatonin. Some people use melatonin 1-3mg. I will use up to 10mg. Short term melatonin is also an anti inflammatory. It helps boost your immune system. There's some interesting data with melatonin as a nutrient to help boost your immune system fight. Covid19 I don't use super high doses. In Germany they'll use up to 20 milligrams if you're treating breast cancer. But for acute sleep, I'll use maybe up to 10 milligrams. Chronic sleep 1 to 3, maybe up to 5 milligrams of melatonin. Glycine is another great thing. Glycine actually turns into Gaba in your brain. It's kind of like the Zyn amino acid. I'm doing anywhere from 1,000 to 3,000 to 5,000 milligrams of glycine. My particularly, I personally use a product called magnesium bisglycinate. Magnesium is another great nutrient. Just help calm your brain down, help you get into sleep, help initiate that sleep. Actually Thorne I think is the best manufacturer for this. It's a scoop. It's about 2,000 milligrams. Well, it's 400 milligrams of magnesium, but ends up being about 2,000 of the glycine mixed in there. Last thing to think about, magnesium. Epsom salt baths. Another way to kind of calm your brain down for that sleep initiation. You can use up to six scoops of Epsom salts in a bathtub. Put some lavender oil in there just to kind of calm your brain down. You want to just get in the space and you want to be able to initiate sleep and go to bed. Those are all ideas to help calm your brain down, to get your cortisol to come down so you can go to sleep. Now with sleep maintenance you might get to sleep, but that's when you wake up in the middle of the night. That's when you kind of wake up at 1 or 2 in the morning. Your brain is racing and you're like oh my Gosh, it's like 2am and my brain thinks it's 6. That phenomenon is where it is referred to as the daytime intruding into the night. Your body gets the sleep. Wake cycles are kind of messed up. So the things I typically recommend for sleep for sleep on maintenance, you can lose long acting melatonin. There are some products that actually the melatonin will last a little longer. Calming herbs, adaptogenic herbs. That's where your Magnolia philodendron, there's a product called Relora that actually works great for the daytime for cortisol lowering. It can also keep the spikes at night. Then that's Relora. Other calming herbs, Ashwagandha, astragalus, lavender, lemon balm, hops. These are all things that just kind of, these calming herbs just kind of help keep your brain chill so you don't have those peaks in the middle of the night. Other things with sleep, well, we'll get to that in a second here. The sleep efficiency sleep Efficiency is you wake up in the morning and you're like, I am still tired. I slept eight hours. And dysfunctional sleep efficiency is a bigger concern. That's telling me you're not getting deep sleep. That can be related to sleep apnea. That could be related to restless leg syndrome, nutritional deficiencies, iron deficiency. Sleep efficiency is a little harder enough to crack, so to speak. So I'd recommend you work with a practitioner that can help you kind of figure out that one. Snoring, your background noises. And if you're under, if you're sympathetic, nervous system is so wired that you can't actually relax enough to let your body won't go into that. That vulnerable state of getting that deep sleep where your body's paralyzed. That can be an issue as well. There are other things that can help with that as I'll go through here in a second on our, on our website. This is just a resource. I put a lot of resources on our website. One thing I've done on Fullscripts, which is my nutritional dispensary, I've actually set up a category on there and if you sign up on Fullscripts, just look at it. It's free information I put there. Actually. I personally use it as my own kind of pharmacy because sometimes I forget things. And so it's filled full of way too much stuff actually. But if you sign on to that and go into this under the sleep category, you'll see a lot of things like the glycine, like the botanical, other products just to kind of calm your brain down. They'll give you an idea of when your own personal research as well, like how to go with that. And that's a resource anybody can. You don't have to purchase anything there. It's just a resource to look at different categories. When I talk about adaptogenic herbs, I tend to put those under the endocrine and hormone categories. But just to give you an idea what there's what some of the things out there that people are using to help calm their brain get. And that's on our website under the full script. That's our nutritional resource for patients. Exercise. Okay, that's okay. The next big thing is exercise. So what are we not doing a lot of right now? Exercise. Everybody is trapped indoors and everybody is stuck inside. Exercise does so many things. It is probably the best anti anxiety, antidepressant medication. It works better than Prozac, Paxil or any of the SSRIs. Exercise helps improve sleep. It helps wire your brain for sleep. It helps Lower cortisol helps regulate your sympathetic and parasympathetic nervous system. Balance helps improve your metabolism. If you're having problems with sleep efficiency. Okay, that was the last one I was talking about. Exercise is great for that. I don't know if you all, any of y' all have kids. The kids. You know what's one of the best ways to make sure your kid gets a good night's rest? You wear them out the day before, right? You go to the park, you play outside, you run around, and then 7 o' clock comes around and they're zonked, right? Same thing for you. If you want really great sleep efficiency, get outside, do something. It can be anything, any movement. It doesn't have to be a gym. It could just be walking, it can be push ups, it could be bike riding. A lot of us just are stuck indoors right now. We're not doing things physically. And that by itself can affect our sleep. So exercise is the number two thing. My number three is mind. Mindfulness. Regardless of your personal belief system, we're all naturally wired to seek out and be a part of something bigger and greater than ourselves. For some people, this is religion. For some people, this is a cause greater than ourselves. Some people, it's family, it's culture, whatever. But this concept of mindfulness is really, really huge with our general sense of well being and our state of wholeness. If you don't feel in control, if you're not part of something greater, if you don't feel like there's any control out there, it's going to give you a general sense of dis. Ease and anxiety. The idea that you were created for purpose and meaning is huge. Do you feel like that right now? Are you so overwhelmed with disorder you can't really center yourself? And in chaos, we tend to fall apart. So that's kind of where mindfulness comes into play. It helps ground us and get back to, back to our roots, so to speak. It can be prayer, meditation. Those are the foundational ones that pretty much every culture and society has. You know, if you don't have a personal prayer and meditation practice, now's a great time to, to start one. Other things that can help you center in mindfulness is nature. Just being in nature. In Japan, there's this field of study called nature medicine, where literally you go out in nature and your cortisol goes down. A lot of patients I have will draw birds, will draw flowers, go in nature, look at a tree and you don't have to be able to draw very well. Just the act of observing something in detail, focusing your attention on a bird, closing your eyes. This is something that we do with our kids and we do our home, home education. We work on guided imagery. Look at a painting, look at a Monet, look at some beautiful work of art, a tree, a flower. My son and I, on this past weekend, I was working this week and still working. Now I got my scrubs on. We were swinging and just looking at the ground, looking at ants. And he was talking about the ants and I started talking about how small the ants are and how they pick up really big things and how be like me picking up a house with my mouth. That's how strong ants are. We just talked about it and it was just so relaxing for me just to sit there and look at the grass and look at the detail of the leaves. Just look at nature and be awed by it. And then this past Saturday night, we all went outside, laid on the driveway and looked at the stars and we all found the North Star. We found the Big Dipper. We talked about the moon and how it looked like an egg. It was kind of flat, wasn't quite perfectly round, and it was really, really relaxing. People have done that for millennia. Get outside and just observe the beauty around you. Right now, our apple trees are blossoming right now. Look at the dogwoods, they're blossoming. Look at the flowers, how beautiful they are. Smell them. Just experience the world around you. Because right now it's spring, it's really gorgeous. Outside activities. And that's where you can combine activities with these things, whether it's nature, journaling, drawing, etc. We've talked about that. Another thing, number three is meaningful relationships. This one is really, really hard right now. We are all in this together, alone. I've heard people say that we're all in this together, alone. And that is so true. Like, you're not talking to me right now, you're watching a video, you know, yes, we're together. I'm talking with you to feel like you know me a little bit. We're alone. And that's just kind of crazy. How can we get some togetherness with others through Facebook, doing group sessions, meeting, FaceTime, group meetings. I don't have the answer for this one because I haven't really figured it out myself, but something to think about. Diet, the foods we eat. This is always, always, always a big deal. I've been surprised by how many of my patients are just using this is just using this as an example or time to eat sugary foods. Really unhealthy foods. I mean sugar, processed, starchy foods are bad for your brain. Give your kids some sugar, give them something red right now, red, you know, Gatorade. Give them some candy, cake, whatever, and see what happens to them. They go crazy, they go bonkers. Their sugar levels shoot up, their insulin shoots up. Then their insulin, their sugar shoot down. That results in the cortisol shooting up, their norepinephrine shoots up, their epinephrine shoots up. And that's where you get that four hour later, that hangry kind of jittery, kind of crappy feeling that's not good for your brain, that's going to make you anxious, that's going to drive dysregulation of your sympathetic and parasympathetic nervous system. Fats in your diet, the trans fats, they really muck up your brain, literally. There's an FDA approved fat that's official to treat anxiety and adhd. There's so many nutritional things you can do to help with brain health, to help deal with what's going on that will regulate your sugar, that will regulate metabolism. On our website we have some nutritional tabs. The energy food plan is probably my favorite for this kind of stuff. There's also a detox food plan. If you're feeling kind of icky and sick because your diet's been kind of bad. If you react with foods, you get bloating and gassy and you rash. There's an elimination diet there. Maybe use this as a time to reset your diet in a healthy way to healthy affect your brain. You are what you eat and what you eat is going to affect your ability to tolerate anxiety and resiliency. And resiliency is term we talk about a lot in functional medicine that we're talking about more now. How can you be the most resilient you you can be? Technologies. There's lots of cool technologies out there. Unfortunately we don't have access to them. Alpha stem sensory deprivation, far infrared saunas. There's a lot of really cool, cool things. Unfortunately I'm not going to go into detail I do on the podcast, but because we can't really do them right now. Nutritionals, I've talked about nutritionals, adaptogenic herbs, things that help regulate cortisol. Lots of things out there I've already mentioned on our website. Again, on the full script, if you go under the sleep and then the endocrine, you'll see a bunch of different ideas, but just these are natural substances that come from nature that help your metabolism and your body regulate itself. Ideally, you want to use food for this. If you're eating a lot of junk food, I don't think you'll be able to take enough astragalus or andrographis or eleutherococcus or Siberian ginseng or whatever to regulate your anxiety. Or magnesium, ruthenium, whatever. If you're. If you're not sleeping and your diet's terrible, supplements, just supplement. So you need to focus on the main things. Finally, last but not least, medications. I am a medical doctor and some people do need medications. Some people need who have high cortisol, anxiety or depression need an ssri. Some people who just can't sleep need something to help break their spiral and get them sleeping again. If that's you see your practitioner, lots of offices are open. We're off, we're open. We're doing virtual visits right now. But if you're someone who's tried a lot of things and nothing's helped, maybe you need something to break that cycle. That's where medication working with your primary provider can be super, super helpful. Ultimately, you are a complete whole person, and you need a complete whole person response that's individualized to you. It's not just one thing or two things. It's multiple things like we've talked about right now. And think about this, work through things. We can get through this together. On the back end of things, life will be different, but it will go back to a new normal. But it will be the normal nonetheless. Hopefully this was helpful. Hope you have a great day and stay safe and be well. Take care.