Dear Stress, Let's Break Up

The Merriam-Webster dictionary defines stress as a physical, chemical, or emotional factor that causes bodily or mental tension and may be a factor in disease causation.  Most of us, particularly my fellow healthcare professionals, have an intimate knowledge of stress and do not need a formal definition.  Some level of stress has been our constant companion as we have acquired both formal and practical life education over the years.  Now that we have moved past school and training into the world of careers and parenthood, the sources of stress have changed but the level remains constant if not increased.  Since the reality of life stressors is not going away any time soon, the important thing is to learn techniques to deal with stress effectively.

Stress is not always a bad thing.  The body’s reaction to acute stress leads to what we know as the flight or fight response.  In the short term, this makes us more alert and prepared to take on necessary survival functions.  The type of stress that causes problems is chronic stress.  The same chemicals that allow one to be ready for oncoming danger in a crisis situation can cause a breakdown in the body’s maintenance activities when present for too long. 

Many times the effects of chronic stress are so insidious they are not recognized immediately.  Most of us are so perpetually wound up we do not realize this is not a healthy state of being until some medical professional indicates we have a hypertensive disorder.  The physical manifestations of stress can include headache, chest pain, fatigue, musculoskeletal pain, and dysfunction of the gastrointestinal tract.  The psychosocial ramifications can be sleep disturbance, anxiety, depression, irritability, rage, disordered eating, isolation behavior, lack of focus and substance abuse.  The best way to counter these effects is to identify sources of stress and develop methods to manage it.

The National Institute of Mental Health (NIMH) website suggests the following tips for coping with stress:

o   Note what you have accomplished at the end of the day rather than what you have been unable to do

o   Set priorities for what must get done now and what can wait

o   Recognize signs of your body’s response to stress

o   Stay in touch with supportive people (family, friends, community groups, religious organizations)

o   Avoid dwelling on problems

o   Look into stress coping programs

o   Have regularly scheduled healthy and relaxing activities

o   Exercise regularly

o   Get proper health care for existing or new health problems

o   Seek help from a qualified mental health professional if you feel overwhelmed and unable to cope without using drugs or alcohol

             

Managing stress is important part of being well.  Finding balance in life helps modify stress.  Work/life balance is a popular 21^st century phrase.  However, it implies there are only two aspects of being that need to be considered to achieve wellness.  It conjures the image of a scale where work has to be balanced with everything else on the other side.  True life balance involves putting work, kids, partners, finances, emotional health, physical health, and spirituality all in their proper places.  I think of it more like a hanging mobile where some items have to occupy a higher location or a larger space in order for everything to keep spinning.  Figuring out for ourselves where everything goes on that mobile is the first step in stress management and overall wellness.

No More Tired Than Usual

Last week I had the privilege of being in Kampala, Uganda with the non-profit organization World Children’s Initiative (WCI).  WCI was working with the pediatric cardiology staff of the Uganda Heart Institute to enable them to be self-sufficient in their treatment of congenital heart disease.  I was there in a non-clinical capacity but it was still very rewarding work.  One thing I realized about being out of my normal routine on the other side of the world was the test it put on my health behaviors.  One of the main habits being compromised was adequate sleep.

I know many people have lives where control over how much sleep they get is not completely their own.  A lot of parents of children under 5 years of age (and many times even older) have not experienced more than 6 hours of consecutive rest in years.  Also, on-call physicians cannot dictate the number of times during the night a nurse or patient may awaken them for issues of varying importance.  We are all extremely busy with work and family and it is hard to fit everything into the day.  Despite that being the case, we need to prioritize getting enough rest when it is possible.

Data shows most adults should get 7 to 9 hours of sleep every night.  However, it seems a lot of Americans do not abide by those recommendations.  The 2009 Behavioral Risk Factor Surveillance System (BRFSS) showed that 35.3% of adults get less than 7 hours of sleep during a typical 24 hour period.  I know that I have prided myself in the past for my ability to “function” on little to no sleep.  That is definitely a beneficial skill if necessary.  The problem is sometimes we just get in the habit of not sleeping, so we don’t even when we can.

As I think about my own life I recognize that one large contributor to inadequate sleep over the years has been poor time management.  Despite every intention of getting to bed at a decent time it doesn’t quite work out.  Here are some things to consider about managing time and getting enough rest.

Make a schedule of things that need to be done during the day.  Instead of just making a list, I ascribe a particular amount of time to complete each task.  One thing it has made me realize is some activities take way longer to complete than I would have thought.  This is how it gets to be 10 pm before you know it and you still have 5 things to do before you go to bed.  Giving one’s self a time limit also curbs the dillydallying to which we all fall prey at times.

Become an enemy of live television programming.  TV is quite a time suck.  God has given us DVR to help deal with our hectic lives.  Saving up shows and watching them when you have free time just makes sense.  Never getting around to watching the shows stored up on the recorder is just more evidence the hours you would have spent in prime time would have been a waste.  Sports are among the few televised events whose enjoyment is improved by watching live.  Pretty much everything else can be recorded.

If there is an opportunity, sleep when you are sleepy.  This is one of the most important things I learned when I was working as an ob/gyn.  You might feel lame going to bed early but your body will thank you.  When given the choice of staying awake to inefficiently complete a non-urgent project or getting rest in order to be productive for the next day, pick sleep.  Life is filled with instances when all you want to do is sleep and that is not a viable option.  If you actually have a choice, do yourself a favor and take a nap.   

Recognize that being sleepy all the time is not okay.  Normalizing chronic fatigue makes it easy for people to ignore it as a problem.  Living with a perpetual sleep deficit distorts the perception of tiredness.  The 2009 BRFSS also reported 37.9% of adults fell asleep unintentionally during the day at least once in the previous month.  Most of those individuals probably did not think they were overly tired because they felt that way every day.  No matter how well you think you are coping without sleep, it is impossible for me to express how much better you will feel when adequately rested.

Sleep isn’t the most obvious component of healthy living but it does contribute to overall well-being.  In order to function at a decent level, humans need to be well-rested.  You are better able to tolerate the irritations of life without participating in negative habits when you are not sleep-deprived.  Similarly, you are better energized to exercise and to prepare healthy meals when you are well-rested.  Even if your life legitimately makes it impossible to get more than 7 hours of sleep per night, try to get as much rest as you can.  For those who have sleep issues or want to learn more about sleep and health let me direct you to the CDC page on sleep, http://www.cdc.gov/sleep/.  Have a restful week.

  

I’M REALLY NOT A VEGETARIAN

A common misconception about me is that I am a vegetarian.  The funny thing is I am quite a carnivore.  I do well when I travel internationally because I don’t really discriminate against any type of meat.  I have always said if it is seasoned up right I’ll try almost anything.  The confusion for most people comes from the fact I really like vegetables also.  So many people have seen me consuming grilled brussel sprouts and quinoa veggie salad they think I have beef with beef.  I will admit I made a decision a few years ago to limit my intake of animal fats in order to decrease my risk for coronary heart disease, stroke, diabetes, obesity and certain types of cancer.  Since I like a challenge, I started this endeavor by spending a month being a vegetarian.  It just so happened it was Vegetarian Awareness Month at the time so that may be where the confusion began. 

For me, it really was not that difficult to use black beans, eggs and quinoa as my main sources of protein.  My daily diet did not have to change that much.  I learned how to prepare tasty, satisfying vegetarian and even vegan meals.  At the end of my trial run as a vegetarian I determined I still wanted to eat hamburgers and Buffalo wings, but I could live without them.  Although I have allowed meat back into my meals, I still try to center my diet around foods grown from the earth. 

Many of us could benefit from cutting back meat in our diets to decrease consumption of saturated fats.  This does not have to be a radical event where you throw out all the bacon in your house.  Thankfully, if you are not already suffering from hypertension, diabetes or the like drastic measures are not yet necessary.  Also, you likely will be more successful with a change your diet if you make it gradually and of your own volition.  That tends to feel more autonomous than because someone else told you to do it so you don’t die.  With that in mind, you may want to try these ways to bump up the fruits, vegetables and grains in your diet.

Start having one meat-free day per week.  You can test out vegetarian dishes and see what you find tasty and filling.  If you are starving without meat you may need to add more protein to the mix.  Black beans and quinoa are my go-to sources of meat-free protein.  For the sake of full disclosure, let me confess I am not a tofu fan.  As an omnivore, when I want a burger I don’t want soy.  However, some people like the idea of meat substitutes that behave kind of like real meat such as tofu, tempeh, and seitan.  Figure out what works for you.  If nothing else, you’ll learn you can enjoy a meal without meat. 

Eat actual vegetables on the days you don’t eat meat.  My friend uses the term “pasta-tarian” for people who don’t eat meat, but never actually consume vegetables.  One of the benefits of decreasing meat consumption is it allows more space in your diet for vegetables.  This is negated when your meatless day is spent eating grilled cheese sandwiches and spaghetti.  Every once in awhile it is good to ingest something that came off a stalk.  There are so many systems in your body that will thank you.

Don’t deep fry the nutrition out of your vegetables.  Living in the South for eight years taught me anything can be battered and fried.  In all honesty, many of those items are delicious.  However, for maximum health benefits, you actually want to taste the food you are eating.  I once heard a dietitian say you want to avoid food that is shiny.  If there is so much batter, sauce or oil on your vegetables as to make the taste unrecognizable, you may have cooked the healthy right out of it. 

Try cold water fish as your meat.  Salmon, tuna, mackerel, sardines and herring are great sources of omega-three fatty acids.  Omega-3s are the “healthy” fats that help prevent heart disease and high blood pressure.  Regardless of what some pescatarians would have you believe, this is still eating meat.  However, the effects on cholesterol are quite the opposite of that of a ribeye steak.  Of course, nothing is a panacea so you have to make sure you consume these fish in moderation due to potential mercury exposure. 

Limit the size of your meat portions.  When you do incorporate terrestrial meats into your meals, make sure the size is no larger than the palm of your hand.  Fred Flintstone should not be our patron saint of portion size.  Most American food portions are too large.  By decreasing your meat portions, you’ll have more coveted plate space for those healthy whole grains and vegetables.

Those who know me well know I am a stickler for semantics.  Maybe that is why, even though most of my meals are plant-based, I refuse to call myself some version of a vegetarian.  I am simply an omnivore who chooses vegetables more often than meat.  For the sake of your health, you may want to do the same.