Dealing with Fatigue or Depression

In the United States, 33.7 million people live with some type of mental health issue. Studies show that prolonged fatigue is linked with anxiety and depression and all too often we assume that these symptoms emotionally driven without taking the time to rule out potential physical triggers, such as hypoglycemia, anemia or even possible drug interactions.

In part, this is because differentiating fatigue from anxiety and depression is hard to do and those suffering often don’t know what questions to ask.

I always recommend that people begin by describing their symptoms to their primary healthcare providers as fatigue rather than anxiety or depression.  The medical questions around fatigue can be answered with a number of blood tests. Be sure to ask for the following labs:

• CBC rules out overt anemia.
• Comprehensive metabolic panel rules out liver and kidney problems and identifies issues with glucose regulation (prediabetes and diabetes directly affect brain function).
• CRP is a metabolic marker implicated in cardiovascular disease, diabetes, obesity, and depression.
• Ferritin levels below 50 correlate with increased fatigue, especially in women.
• Hemoglobin A-1 C is a marker for diabetes. Studies have shown that diabetes predicts depression and depression predicts diabetes. A1C should be below 5.7 to be considered normal.
• Homocysteine levels (a Vitamin B marker) greater than 12 indicate a 70% increase in risk of depression.
• Lipid panel is important in diagnosing cardiovascular disease. Additionally, when total cholesterol is below 120, suicidal ideation increases.
• TSH rules out hypothyroidism or hyperthyroidism.

While there is a cost for running these labs, the cost of treating fatigue strictly as an emotional symptom is even higher. A recent article in Money magazine states that the treatment costs for mental disorders is more expensive than treatment of diabetes or hypertension– and that the cost falls mostly to the patients. Insurance companies put up road blocks for receiving mental health treatment, finding in-network care can be challenging and, if you do, the cost of prescribed medications is high. Very often, mental healthcare is a budget buster. Particularly if the primary care provider, prescriber, or therapist have not addressed the true problem – Fatigue. Nutritional studies are showing that poor nutrition and dysfunctional physiology cause 50% of the symptoms of fatigue.

I've created a sample letter requesting the above blood work from your primary care physician that you can use to help start this discussion.

In addition to asking your healthcare provider for the lab work, I have seen the following self-care steps help in relieving fatigue:

1. Walk outside everyday – move your body for at least 10 minutes.
2. Be in bed for 8 hours a night – even if you’re not sleeping, the rest is helpful.
3. Eat protein with every meal.

If these steps feel hard, ask yourself what you can do to make it happen. Don’t think of it as a lifestyle change, but consider it an experiment. Start with one of the above steps and commit to doing it for at least 3 days to see if it helps.

If there was one solution for fatigue, everyone would be doing it. Ask your provider to rule out the most common causes of fatigue/depression. It may not be all in your head ─ it may be that your body needs help.

References:

• Money magazine: The High Cost of Coping
• Lifestyle factors in preventing mental health disorders: an interview with Felice Jacka

Home Treatments for Colds and Flus

In the January Connectors Group we discussed how to prevent colds and flus and how to feel better quicker if you do get sick.

Winter is the season of stuffy noses, aching muscles, coughs and headaches. Common daily interactions, no matter how careful we are, lead to sharing viruses and bacteria. These invaders slow us down and can even wipe us out.  After the Connectors Group, Natasha and I recorded a podcast on the same topic. The game changers for me when I am treating my own colds are hot baths and rest. 

This accompanying free 4-page handout for you covers:

• 6 simple steps to feeling better quicker,
• 5 steps for prevention,
• A worksheet for a Plan to Get Better Faster, and
• Guidelines for when to see a Doctor and how to get the most out of that visit.

Remember to share it with the people in your life to help them feel better. 

In the the podcast,  I recommend some supplements (in addition to rest and hot baths) that help in preventing colds and flus:

• Carlson's 2000 IU of Vitamin D3 daily for adults and 400IU/day for children 6 years old or up to 140 pounds of weight. Vitamin D boosts the immune system and helps prevent autoimmune diseases
• Emergen-C is a great way to get 1000 mg of Vitamin C as a drink mix or chewables
• Airborne, or similar products, can also help boost the immune system and prevent a cold

Seattle Referral List

I am putting up this blog post to create a link for people who are looking for Seattle providers to help them with fatigue, depression, anxiety, and addictions.  I will encourage you to sign up for my newsletter. I will be creating online classes, podcasts, blogs and ultimately books on how to address the physical cause of mental health. By joining the newsletter, you can receive the educational material as it comes out. 

Here are the names of then Seattle providers I am sharing with my clients as I transition to a Tacoma office. 

Heather Coyle (halfmoonseattle.com) is an acupuncturist who specializes in muscle skeletal aches and pains in Fremont. As a life long student and teacher of martial arts, her practical get it fixed approach is helpful for the body and the mind. 

Amy Darling (amycdarling.com) is an acupuncturist and Zen practitioner in downtown Seattle. When we consult with each other, we are both seeking for our patients to be more gentle and more awake to themselves. 

Dr. Miranda Marti (wholelifemedicine.net) is a naturopathic physician, acupuncturist and bio-feedback practitioner in Kirkland. She specializes in women’s health, and the treatment of mental health and addictions.

Dr. W. Bruce Milliman (seattlehealingarts.com) is a naturopathic physician who is just a great diagnostician in Seattle. He is who I refer people to when I can’t figure it out. 

I think, at a child's birth, if a mother could ask a fairy godmother to endow it with the most useful gift, that gift should be curiosity. 
Eleanor Roosevelt 

Distraction and Anxiety

I am a semi-regular listener to the podcast, This Week in StartUps with Jason Calacanis. This podcast focuses on the startup world and Jason is a venture capitalist who supports new and innovative companies. Part of why I enjoy the podcast is that Jason brings on really interesting people who are looking deeply at how to effect human behavior mostly within the technology sector.

This week he interviewed Adam Gazzaley, the Director of Neuroscience Imaging Center at UCSF, about his new book The Distracted Mind: Ancient Brains in a High-Tech World. Adam and Jason have an interesting conversation about how we, as humans, are wired to have anxiety that stems from responding to the outer world and anxiety that is generated from the inner world. Wired into the system of being human is the competing goals of the Wizard brain and the Lizard brain. The Wizard brain is for accomplishing goals in a responsive manner and the Lizard brain is for survival, which is a reactive manner. What is new is our technology that is tapping into is our Lizard brain to get our reaction and attention. As we all know some of our anxiety is just from all the emails, texts, vibrations, pings, lights, etc. Adam points out that technology has trained us to not tolerate the boredom of standing in line or waiting at a stoplight. Studies are really clear that it is through these time gaps, when we have nothing to do, that we have more creativity and feel more alive. What I often think when I am bored is that at the end of this tunnel is something creatively new.

If your are interested listen to the podcast, you can find it here.  

If you want to do an experiment: Schedule times to be on technology and have times that are tech-free. How long can you go without your phone? Can you block time that you will be creating verse responding?  

Categories: Technology, Anxiety

Using the EcoCycle as a Tool to Plan for the New Year

Everyone has something that they want to change or start, but sometimes we get stuck because we want to get to the mature practice before we birth the change into our actual lives. We want perfection before we have process or we have a process that has become too ridged for dynamic change. In this webinar Dr. Allott shares a handout that has helped her and her clients better see where they are in the change cycle and take actionable steps to move forward.

Connectors Group Webinar November 11 2016

Download a pdf of the EcoCycle handout

Recommendations from the November 2016 Connector's Group

(1) If you have a robust inner critic and want more curiosity and creativity, check out this very thin but robust book called Zen Mind, Beginner's Mind by Shunryu Suzuki. It is a great book for learning to be in charge of the chatty brain. 

(2) Shannon Rude is a massage therapist in Seattle WA and a student of Kate Bowman, both of their websites are worth following. Shannon teaches individuals and group classes in the Seattle area. If you want a new way of relating to how your body moves, I suggest following their blogs and connect with Shannon when you are in Seattle. 

5-Step Eating Plan for Loving the Holidays

We are entering one of the seasons characteristically rich with gatherings, celebrations, gift giving and receiving, seeing old and new friends, good cheer, deadlines and stress.  That’s a great deal for any of us to handle, much less handle well.

Hopefully, a few fairly simple tips will ease the way for your greater enjoyment of this holiday season. It is certainly my intent to do away with the added pounds as well as the torture and guilt that frequently accompany unanticipated holiday eating.

Try following these tips and you’ll love the holidays even more than expected:

1. Take a few minutes to plan with your calendar of the scheduled holiday events in hand.  Mark those days with a star, where you anticipate higher than usual calorie eating. (We’ll call these Holly-days.)  Star your calendar. After every Holly-day, have 3 high protein, good nutrition days.

2. No matter how busy these days may get, make sure you get 7-8 hours of sleep daily. Four days of sleep deprivation will increase sugar cravings.

3. Walk at least 10 minutes a day, preferably in the mornings. Walk perhaps a few more minutes on the mornings you are anticipating the possibility of binge eating.

4. Throughout the holidays, focus on eating high-protein foods, not carbohydrates.

5. Post two full days of healthy and satisfying meals (2 breakfasts, 2 lunches and 2 dinner meals) in a prominent spot in your kitchen or on the refrigerator. Purchase the necessary ingredients so they are at your fingertips.

When life alters your plan, and it will, pick yourself up and move on, still loving the holidays. “Start overs” are allowed.

Dr. Allott's Favorite Protein Sources

I like protein bars to have about a 2:1 ratio of total carb to protein, real ingredients (meaning I can pronounce and recognize all of them), no artificial sweeteners (manitol, stevia, aspartame), and no gluten.

• Stinger Protein Bar - Protein 10 grams, Total carbs 18 grams,  Less than 2:1 Total carbs/protein ratio, Gluten free, Nut free, Real food ingredients, Has chocolate!
• Zing Bar - Protein 12-15 grams, Total carbs 21-24 grams, Less than 2:1 Total carbs/protein ratio, Gluten free, Real food ingredients, Has chocolate!
• Square Bar - Protein 12 grams, Total carbs 23 grams, Less than 2:1 Total carbs/protein ratio, Gluten free,  Soy free, Vegan, Real food ingredients, Has chocolate!
•  Krave Jerky - Protein 8 grams, Total carbs 12 grams, Less than 2:1 Total carbs/protein ratio in a serving, Gluten free,  Soy Real food ingredients.
• Trader Joes Nut Packs- Protein to Carb ratio will vary. Getting the individual pack will limit the sugar grazing and prevent eating a pound of nuts -- which can be done in a day. 

Note: I am not affiliated with these brands in any way.

The Art and Science of Food: Delicious and Nutritious

I love food. I love eating food. I love making food. I love thinking about food. I love learning about food. Ok, I am a little obsessed. However, for me it is about the quest. It is actually a little hard to experience food in a meaningful way. For me, good food needs to be tasty in the first and last bite, aromatic (smells good), satisfying (vs creating cravings), interesting, and diverse. In other words, a full sensory experience. Remember, it is your brain that registrars the senses and says "that is good."  Your lizard brain also believes that if you are nutrient deprived that it must be fats and carbs that you are missing. If you are eating a standard American diet you are probably missing some micronutrients. Although we get plenty of calories, they are not very nutrient dense. The lack of nutrients cause cravings for fat and carbs and can cause all sorts of health problems: fatigue, depression, weight gain, anxiety, diabetes, and cardiovascular disease. 

Recently, I listen to the Freakonomics podcast "Food + Science = Victory!" with Stephen Dubner. He interviewed J. Kenji Lopez-Alt who has a new book on the science of cooking,  The Food Lab: Better Home Cooking Through Science. The book is about the art and science of cooking. Simple tips on how to make food taste satisfying. The second person that Stephen interviewed was Jo Robinson, the author of Eating on the Wild Side,  who discusses why are food is missing key nutrients.

So if your interested in learning more about how to support your brain and body with delicious and nutritious foods you might want to check out this podcast Food + Science = Victory! A New Freakonomics Radio Episode

Wishing you the best!

HBR: Anxiety and Business Decisions

Check out the Editors Pick of the Week November 7, 2013 (17:09 -12:15 minutes)

The first article in the Harvard Business Review, HBR podcast is about seeking advice when anxious.  The article discusses how decisions can be influenced if we are anxious before we make a decision.  What I found most interesting is that the psychologist used a technique of watching a video that makes the subject anxious before they have to make a decision on a different subject. What the psychologists understand is that the brain retains the emotional tone even if the context changes.  Most important is that even we don’t feel like we are anxious, even when our brain is actually making slightly different decisions. 

The take-home for this business is when there are important decisions to be made, we should clear the decks and go do something that helps us get into a neutral state, such as playing a round of golf, sleeping on it, or doing another activity in which we have a great deal of confidence.  By getting our brain in a neutral state, our mind is better able to make the decisions we need to make.

Preventing CEO Burnout

John, the CEO of a mid-size family company, has been putting in 90-hour workweeks for 11 months.  Between the tight economy, an aggressive new competitor, and several family dramas, his taking a vacation now has been out of the question.  It is hard for John to get to sleep; it is even harder for him to stay asleep, and his brain turns off only after several cocktails before going to bed.  John knows that he can’t continue this pattern, but he doesn’t know how to stop, or frankly, what else to do.

One night recently, he woke up gasping for air.  John and his wife thought that he might be having a heart attack and frantically called 911.  As they waited for the ambulance’s arrival, several heavy thoughts registered in a back corner of John’s mind.  He was simultaneously afraid and relieved:  Afraid . . . This is it!  I’m going to die.  And yes, relieved:  Why, if I were to survive the heart attack, I might actually get a break!

At the ER, the medical team conducted blood tests and monitored his heart.  After several hours, the team informed John that he had experienced a panic attack.  He was given two prescriptions and encouraged to check in with his primary care physician as soon as possible. The first prescription was for four days worth of Clonazepam, a benzodiazepine that immediately quiets the brain, but is very addictive.  Also, the ER doctor prescribed Celexa, an antidepressant that aids in reducing anxiety.

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The experience stunned John.  “I’m not the sort of guy who has panic attacks!”  Then, dozens of other questions came:  What does this mean? . . .  Am I not cut out for this level of leadership? . . .  Am I failing and don’t know it? . . . How can I take care of the company and my family, if I am not a strong leader? . . .

After taking a couple of days off, “due to a family emergency,” John returned to work and to the stress that comes with being a man who has many people depending on him and great responsibilities.  Soon, getting access to another Clonazepam tablet became a daily matter for him - a disturbing and frightening concern because he has seen other family members struggle with addictions to prescription drugs.  He called his family physician whose only suggestion was to take time off.

On Tuesday, May 7, 2013. The Wall Street Journal published Leslie Kwoh’s article “When the CEO Burns Out.” She listed fatigue, resentment, and loneliness as causes for burnout.  She gave examples of well-known companies that have lost valuable leadership, when men and women took vacations and/or left to recover physically and mentally.   As remedies. she suggests time off and medications, as needed.

Wait a minute.  We can do better than that!  CEO and C-suite executives do not burn out.  Their brains and bodies do! These same brains and bodies begin to break down when they are exposed to chronic stress.  A common symptom of CEO breakdown caused by chronic stress is loss of a person’s ability to focus. 

In prudent organizations today, leaders understand that executive brains and their physical well-being are the most important assets of any venture.  Therefore, owners and boards of directors anticipate their organization’s needs; after all, they are used to essential scheduled maintenance on machines.  It’s required for all human assets too!

The idea is a sound one.  Therefore, it doesn’t take long for someone to ask: What should be included in an organization’s prevention plan for executive burnout?  At a minimum plans should include:

 1.    Instilling in your corporate culture the behaviors that increase the body’s ability to cope with stress.  These tenants are eight hours of sleep, 30 minutes of exercise daily, and at least three meals with protein and vegetables per day. 

 2.   Insisting on time away:  Our brains function better when we take time away from complexity and sameness.  Rest, relaxation, and discontinuous time and activities produce fresh perspectives - essential in thinking strategically.

 3.  Scheduling annual physical examinations with primary care physicians for C-suite executives.  Metrics of high blood pressure, high cholesterol, and weight gain are symptoms of a body not handling stress well.

Rather than being surprised and in crisis when an executive must step out or step down, which is extremely costly, why not create a preventive maintenance plan for key executives in your organization?