Note: The Psychiatrist reviews this Health Promotion Educational Package with each patient.
The patient is encouraged to consult with the members of the Treatment Teams to clarify the contents of the Package and develop the necessary skills to incorporate the recommendations in their personal recovery program to accrue the best results during the 52 weeks In-home treatment offered by Aware Recovery Program.VM
Aware Recovery care
“Recover where you live”
Title: Health Literacy promoting Recommendations of Dr. Velandy Manohar, MD- Medical Director of Aware Recovery Care.
Purpose: Is to inform and urge every individual client to play an active role in promoting their own health during treatment of Medical disorders [including Psychiatric Illness] and during the challenging trajectory of recovery from Alcohol and or other Drug Dependencies.
Why are we doing this?
Here is the rationale:
- Per the CDC- [11 27 16- Hartford Courant] 2/3rds of all deaths in the USA of people under 80 are caused by five disease states: Cardiac disorders, Cancer, Stroke, COPD and Accidental deaths and Overdoses. All these deaths are preventable. [Data from 2010-2014]
- Sadly, and tragically Deaths from Accidental Deaths and Overdoses increased by 23%, [see below] COPD only by 1%. On the other hand, deaths from Cancer dropped by 25% thanks to a 12% age adjusted decrease in deaths due to Lung Cancer presumably due to the drop-in cigarette smoking. Heart disease has dropped by 4% and Stroke by 11%.
- Overall Heart Disease: 30% is preventable, Cancer: 15% preventable, Stroke: 30% preventable, COPD: 35% preventable, Accidental Deaths and Overdoses 45% are preventable.
- Social Determinants of Health: Our genes, biology, and health behaviors together account for about 25% of population health. Social determinants of health represent the remaining three categories of social environment, physical environment/total ecology, and health services/medical care. [75%] These social determinants of health also interact with and influence individual behaviors as well. More specifically, social determinants of health refer to the set of factors that contribute to the social patterning of health, disease, and illness. CDC-SDoH
- Adverse Childhood Experiences: [10 Core Experiences] Childhood trauma isn’t something you just get over as you grow up. Pediatrician Nadine Burke Harris explains [in TED TALK on 02 17 2015] that the repeated stress of abuse, neglect and parents struggling with mental health or substance abuse issues has real, tangible effects on the development of the brain. This unfolds across a lifetime, to the point where those who’ve experienced high levels of trauma are at triple the risk for heart disease and lung cancer. In the Mid 90s Kaiser Permanente discovered an exposure that dramatically increased the risk of seven of the ten leading causes of death in the US. In high doses, it affects brain development, the immune system, hormonal systems and the way DNA is read and transcribed. Folks who are exposed very high doses have TRIPLE lifetime risk of heart disease and Lung Cancer and a 20-year difference in life expectancy. The most important thing to remember is that the ACE score is meant as a guideline: If you experienced other types of toxic stress over months or years, then those would likely increase your risk of health consequences.
- : The Biology of Stress and the Science of Hope - Film Screening and Discussion- The Body Remembers. Bessel Van Der Kolk- Childhood Trauma- Body Keeps Score. Paper Tigers of Educational Reform.
Contextual frame for the recommendations:
It is increasingly accepted by the Medical Community and the public that these two organ systems the Brain [and Nervous System] and the Bowel influence each other in many ways. Stress and Bidirectional Neural Immune interactions involving these Organ Systems play significant roles in the development of Obesity, Heart Disease, Cancer, Depression and Type II Diabetes by affecting the Pancreas.
There are Bi-Directional Neural and Immune system interactions between the Bowel and the Brain and components of the Immune System. There 100,000 nerve connection in the Abdomen. The Vagus nerve [ Sensory and Motor branches as well as the Sympathetic Nervous system affect the type and intensity as well as consequences of our responses to Stress and inflammatory Cytokines e.g., TNF Alpha, IL1Beta and IL 6.
In addition, it is important to consider the fact that Adipocytes and the Bowel Biota are packed with more genes than the ones packed into our 23 pairs of Chromosomes we inherit form our parents which greatly magnifies its impact on our health and wellbeing. From birth humans, must contend with and find ways of coexisting with micro-organisms all over the body especially with the Gut microbiota. There are far more Gut Micro-organisms than there are cells in the Human Body- which number 13 trillion.”
In the light of this, it is reasonable to questions whether the Genes of the Microbiome in the Gut might play a greater role in Health than do Human genes. Recent evidence suggests that the Microbiome may affect the probability of many Major Diseases including Obesity and Diabetes – A.L. Komaroff- JAMA 24/31, 2017, Vol 317 #4
For most people, what they consume - eat, drink, inhale, chew affects their Emotions, Behavioral patterns and Thinking faculties in real time and over longer spans of their lives.
We are not powerless. What I am advocating with respect to health promotion such as components of SENSS [Item 10] can be a great start to engage and empower our staff and patients to take personal responsibility to achieve and stay optimally healthy while building the resilient foundations of sustainable growth and personally fulfilling Recovery.
Here are a series of 10 tasks you can commit to making these activities part of your life starting today and play an active role in promoting your health and do what you can with the assistance of your family to reduce the risk of Accidental Deaths and Overdoses, Heart Disease, Cancer, Stroke COPD. [See above]
- It is vital to stay clean and sober one day at a time while in Recovery. It is just as important to work the first three steps as diligently and sincerely as you can bring yourself to do on any given day and reach out whether you can or cannot meet a challenge along the way. Enhanced social connectivity is the indispensable life line that sustain health and adds life to years not just years to life [ that is when one tries to push forward while attempting to endure white knuckled, tight lipped and clenched jaw sobriety- usually by one’s lonely self.
- Diet and nutritional status: Establishing good dietary habits in recovery is very important to repair the body and replenish Vitamin stores that are lost during active addiction. For suggested diet composition, please refer to https://www.choosemyplate.gov. A good first step is to reduce or eliminate consumption of processed foods, which contain additives and unnecessary sugars to our diets. The recommendations have helped to change two habits: the eating habit and the grocery shopping habits. It is prudent to keep this in mind- what goes into the shopping cart will go into the belly and grease the wheels that take us on a nutritional downward spiral that is hard to exit. The plate is figuratively divided into four quadrants. Each quadrant is for:
a] fruits,
b] Vegetables,
c] Whole grain,
d] Protein source. There is room for the fifth component which dairy.
I recommend yogurt containing the six specific healthful bacteria to ensure optimum energy equilibrium, health and well- being. {please see item 7 and 8]
- Plant Sterols: Plant sterols are a group of substances made in plants. Plant sterols are found in the highest amounts in foods like vegetable oils, nuts, and seeds. Plant sterols are used as medicine in combination with Cholesterol lowering drugs and Fat lowering diets. When taken in people who are also following a low-fat or cholesterol-lowering diet, plant sterols can reduce total and "bad" low-density lipoprotein (LDL) cholesterol more than the diet alone. Plant sterols don't decrease blood fats called triglycerides or increase "good" high-density lipoprotein (HDL) cholesterol levels.
Adults: By mouth:
For reducing cholesterol levels in adults with an inherited tendency toward high cholesterol (familial hypercholesterolemia): 1.6-1.8 grams of plant sterols per day for 8-26 weeks have been used.
For high cholesterol: 200 mg to 9 grams of plant sterols per day have been tried. However, doses above 2-3 grams per day don't seem to work any better than 2-3 grams per day.
Children: By mouth:
For reducing cholesterol levels in children with an inherited tendency toward high cholesterol (familial hypercholesterolemia): 1.6-2.3 grams of plant sterols per day have been used in children 6-16 years-old.
Plant sterols are usually taken along with a low-fat diet.
- Eat Cold water fish, such as wild caught Salmon, Haddock, Haddock, Halibut, sardines, Cod, Anchovies or Pollock 2-3 times a week. Choose a fish to contribute the 3-4 ozs of the protein source that is part of the recommended Choose my plate meal. These are good sources of Omega 3 fatty acids. If you going to take supplemental Omega 3 it is vital to keep a ratio of at least 20:1 between Omega 6 and Omega 3 Fatty acids to sustain the immune system and prevent Omega 3 from inhibiting the healthful inflammatory processes.
- Exercise for 30 minutes per day. Choose and stick with whatever exercise works for you. This may include walking. Dancing, jogging, cycling, swimming or any other form of exercise. The most cost effective and healthful investment is to set aside time for walking- A total of 30 minutes a day every day throughout your life. I advise people who have jobs that require being seated at desks to use the portable elevate able tables for your computer devices and do the work standing up. In addition, take breaks every 3-4 hours to push away from the desk and walk around- go up and down stairs for fifteen minutes throughout the day. Or walk to your colleague at work instead of dashing an e-mail out. Get out of the seat as much you can. This can help you to defeat the chemical forces by the fat cells in your belly around the organs and the toxic products form your belly bacteria from harming your Pancreas and blood vessels, joints and muscles. Furthermore exercising, walking, running or performing Tai Chi in the Sunlight between 6-8AM can be health promoting measures. Please see Item 10. [Please see more on Exercise and Depression PS #2]
- Start a meditation, Deep Breathing, Yoga, Tai Chi [Movement based Therapy] or any other meditative practice including silent or audible prayer or listening to for instance the Gregorian chants or Chants of any other faith tradition. I found listening to the Quran with my earphones on an Emirates, Buddhist and Hindu Chants during the 20 plus hours’ flight to India was very soothing and erased the effects of the confined space. I combined this with walking around the cabin and other feet exercises to avoid blood clots. Choose to set this time aside every day for promoting your health and strengthening your recovery. You may recall that the 11th Step of Alcoholic Anonymous recommends the practice of meditation, prayer and reflection to round out one’s rough edges during healthful recovery [ sharp elbows, sharper tongues] I presume that got exposed when the drugs and alcohol which were both the facilitators of erratic, disruptive behavior and inhibitors of timely social outreach to stay in balance.
- Probiotic bacteria/ Yogurt. Most of us suffer from the fact we have unhealthy micro-organisms in our Bowel. One of the most important causes is the rampant use of antibiotics for all types of disorders and the other is the consumptions of food stuffs that have been exposed to antibiotics, pesticides and other environmental toxins. Over time our healthy bacteria are replaced by unhealthy microorganisms resulting in the development of inflammatory processes that affect our health and mood. Susceptible people often develop the “leaky Gut Syndrome” and other immune disorders. E.g. Heart disease, Depression, Stroke Cancer, Obesity, Diabetes, Bowel, Joint and muscle and nerve disorders. Dairy is the fifth component of Choose my plate. Gov recommendations. To improve our digestive health and reduce the risk of adverse health consequences of the Leaky Gut Syndrome and unhealthy two-way Brain- Gut linkages [chemical and neural] it is necessary to introduce healthy bacteria into our gut. A convenient and effective strategy to achieve this is to introduce yogurt [ see item 2 above] as the fifth component of the daily diet. Look for yogurts- unsweetened and low fat that contain minimum of these six live cultures of healthful bacteria. The ones to look for are: a] L. Acidophilus, b] L. Casei, c] L. Thermophillus, d] L Bifido-Bacteria, e] BB12, f. L. Bulgarigus.
You may remember the CDC reported a good chunk of the deaths caused by the five-major diseases that kill the most people in America are preventable. These measures can be helpful over time to achieve the reduction of deaths due to these five diseases. These health- promoting Micro-Organisms and the Turmeric can contribute synergistically to reduce pro-inflammatory actions of substances like Interleukin [IL]1 Beta, IL6, TNF Alpha [Tumor Necrosis Factor] NF KB, Cox 2. [Please refer to PS #3 on Inflammatory Biomarkers and PS #4 on Pro-Inflammatory Diets and depressions]
Study finds high-fiber diet brings significant changes to human gut microbiome | MDLinx
Dietary fiber consists of resistant carbohydrates found in fruits, vegetables and whole grains. Fiber persists in our digestion system, and while not digestible by humans, our gut bacteria can metabolize fiber into short-chain fatty acids and other byproducts critical to human health
- Turmeric [Curcumin with Bioperine]1000mg in Capsule form twice a day acts as an anti-infectant in the Bowel helps to reduce the leakage of Toxins and unhealthy Bacteria from the bowel into the capillaries and into all the organs of the body. [Look for USP or GMP Stamp on the Label] This can be beneficial if combined with the dietary changes in 2,3, and 6 to the overall health by reducing the impact of inflammatory substances including cytokines on the Brain, Heart, Blood Vessels, Pancreas, Adipocytes. Curcumin blocks NF KB [Kappa Beta] a very powerful Inflammatory humor and COX 2 as well. Besides affecting the absorption of the inflammatory products produced by unhealthy micro-organisms in the Colon and destroys the types of unhealthy micro-organisms in the Colon that produces the pro-inflammatory products without harming the Probiotic micro-organisms. These micro- organisms are part of the human Microbiome which has powerful impact on the health and wellbeing of human beings and perhaps even the directions and success of certain developmental trends in Human Evolution [Both adverse and beneficial] The beneficial effects of Dietary including use of suitable Yogurt and Turmeric and Exercise recommendation can reverse Epigenetic aging and shortening of the Telomeres over time. [Please refer to PS #3 on inflammatory Biomarkers and PS#4 on Pro- Inlammatory Diet]
- L – Methyl Folate is one of the B- Vitamins. This formulation is readily absorbed into Brain Cells. Deplin [trade name] 15mg/day can contribute to the heathy functioning of neurons in the Brain by increasing the capacity of specific enzymes that synthesize Dopamine, Serotonin and Nor-Epinephrine and replenishing a Critical substance NAD that is involved in RNA repair and through other chemicals like SIRT 1 and SIRT 3 influence the efficiency of the Mitochondria which are important to healthy and robust functioning of cells.
10. The best results will follow if the specific food stuffs in the proportions cited in My Plate.Gov, plus, Turmeric, L Methyl Folate, Plant sterols/Stanols and Yogurt with the six healthful bugs are integrated into these five components of a long-term approach to achieve and maintain good health. One day while thinking about and discussing these strategies I came to my senses and decided to use SENSS as a mnemonic and acronym for my core strategy to promote personal accountability to restore and maintain optimum health
S: Social connections with people who provide warm wafting wind beneath your wings. [a: below]
E: Exercise: three types/ options: stretching, strengthening, walking running, swimming. Total time minimum 150 minutes a week: Different physical activity 'cocktails' have similar health benefits | MDLinx "Getting 30 minutes of physical activity per day, or 150 minutes per week, is what's currently recommended, but you still have the potential to undo all that good work if you sit too long.
A cocktail formula of 3 to 1 is best.
The researchers found that getting (3) three minutes of moderate-to-vigorous activity or 12 minutes of light activity per hour of sitting was optimal for improving health and reducing the risk of early death.
Although the researchers found that replacing sedentary time with just two minutes of moderate-to-vigorous exercise is more efficient than replacing it with light physical activity—two minutes of moderate-to-vigorous exercise is equivalent to four to 12 minutes of light physical activity—But both have value.
Using this basic formula, the study found that multiple combinations of activities reduced the risk of early death by 30%:
N: Nutrition: Consider adopting the diet from My Plate.Gov plus the Yogurt with the six healthy bacteria. Diabetes remission diet also lowers blood pressure Published on: 1 June 2021. Our study shows that, in addition to possible remission from type 2 diabetes, there are other very important health benefits, as weight loss is a very effective treatment for hypertension and its associated serious health risks
The DiRECT trial was done entirely in primary care. The evidence shows that GPs can safely offer an evidence-based intensive weight management intervention, aiming for substantial weight loss and remission of type 2 diabetes. The study further highlights the links between diet, weight, type 2 diabetes and hypertension, and how long-term support to maintain weight loss is vital.”
https://www.cnn.com/2021/09/27/health/uncontrolled-high-blood-pressure-wellness/index.html Nearly half of all Americans live with high blood pressure, a key contributor to diabetes, heart disease, kidney disease, stroke and serious complications from Covid-19, according to the American Heart Association. “But there is something people with stubbornly high blood pressure can do -- and it's more than just pop another pill. In what authors are calling the first study of its kind, people were able to reduce resistant high blood pressure with a combination of diet, exercise and reducing salt intake. The study published Monday in the AHA's journal Circulation. The DASH diet[Stands for Dietary Approaches to Stop Hypertension.] An award-winning eating plan, DASH has a simple premise: Eat more veggies, fruits and low-fat dairy foods; limit foods high in saturated fat; and limit your intake of sodium to 2,300 milligrams a day -- that's about 1 teaspoon of table salt.
The DASH meal plan includes four to six servings of vegetables and another four to six servings of fruit; three servings of whole-grain products; two to four servings of fat-free or low-fat products; and several servings each of lean meats and nuts, seeds and legumes each day. THE SENSS approach also emphasizes Exercise and Nutrition. VM
S: Stress management: Deep breathing, Yoga, Meditation, Metta – Loving Kindness prayer, Tai Chi etc..
Please review Stress Resources PS #5 on Page 12.Please review also Immune System and Inflammation Resources PS #6 on Page 12
S: Self- Care/Self -Compassion can be experienced by adopting and practicing various Buddhist chants, and meditations from other faith traditions including Christianity e.g. Gregorian Chants as well as Hindu, Jain, Muslim and Sikh prayers, massage, healthy Sleep hygiene while eschewing smoking Tobacco, Alcohol, other drugs of abuse with the use of specific formulations of Cannabis- derived Alkaloids for medical reasons being an exception that I have come to accept. I leave it up to my readers to make their own informed decisions on this Drug. [b: below]
I have added one study as PS on the important matter of Social Connectedness and another on Self-Compassion.
We must bear in mind the profound effects of Social Determinants of Health SDoH and the grinding Long term effects of the Social Gradient on Longevity, Wellness and Health Outcomes. The Social Gradient demonstrated by Sir Michael Marmot in the UK and since then in many other locales, in social, vocational environments the pernicious effects of the crushing social gradient have been demonstrated.
The most devastating demonstration of the main components of the impact of the Social Gradient in the USA is on the Map especially when we advance the death rates from 1980 forwards. We can see the devastating story of widening gap between the counties with highest death rates along the lower Mississippi valley KY and WV and lower death rate counties in northern tier.
A generation and a half has been hollowed out the health status is getting worse in these communities in whole counties, states and regions. The declining longevity in the USA will result in Mexico life expectancy catching and perhaps surpassing the USA in 2030.
In parts of Appalachia, more people are dying of heart disease now than were in 1980, despite rapid improvements in medical technology.
Poverty and its associated struggles, such as depression, stress, and poor nutrition, are also clearly playing a role.
There's no sign of the gap closing. In fact, it appears to be widening. Between 1980 and 2014, the gap between the highest and lowest life spans increased by about two years.
A pair of new studies suggest Americans are sicker than people in other rich countries, and in some states, progress on stemming the tide of basic diseases like diabetes has stalled or even reversed. The studies suggest so-called “despair deaths”—alcoholism, drugs, and suicide—are a big part of the problem, but so is obesity, poverty, and social isolation.
"Therefore, the poor recent and projected U.S. performance is at least partly due to high and inequitable mortality from chronic diseases and violence, and insufficient and inequitable health care."
“We might be seeing the drag that decades of stagnant wages, growing inequality, and the associated behavioral (e.g. smoking, diet, activity) and psychosocial (e.g. chronic stress, depression) factors have on eventual mortality,” said Michael Kramer, a professor of epidemiology at Emory University, via e-mail. Americans are hit harder than other rich countries are by these forces, he posits, both because of our skimpy preventive health care and because “the U.S. has higher income inequality and less comprehensive social safety net, so the ill-effects of poverty may take an undue toll.”
One paper published this month suggested that Americans would live nearly four years longer if the U.S. had a safety net as generous as those of European countries.
Perceived social status is related to physical and mental health (Adler, Espel, Castellazzo, & Ickovics, 2000). Perceived social status is typically measured using objective measures of socioeconomic status (SES) such as income and education. The relationship between perceived social status and health has been called the social gradient, because for each increase in SES there is a corresponding increase in health (Adler, Boyce, Chesney, Cohen, Folkman, Kahm & Syme, 1994).
While this model appears to be valid among the population of the United States generally, it is not valid among Hispanic immigrants in the United States, for whom lower objective SES is related to better health when compared to those living in the US (Vega, Kolody, Aguilar-Gaxiola, Alderete, Catalano & Caraveo-Anduaga, 1998; Wei, Valdez, Mitchell, Haffner, Stern & Hazuda, 1996). This reversed social gradient has been called the Hispanic Paradox because it represents a reverse to the typical social gradient found in Western societies (Scribner, 1996).
The social gradient of health is generally accepted as a well-established relationship.
However, the reason why health disparities get larger as difference in SES increase is not entirely understood.
[The Social Gradient of Health: do Emotions Play a Role? Maaike Schols (242547) In this paper the role of emotions, as highlighted by Gallo & Matthews (2003), were of interest as mediating variable to the social gradient of health.
It was predicted that, based on the resource-based view of the “Reserve Capacity Model”, negative emotions are less common among people with a higher socio-economic status and that the indirect effect from negative emotions to health outcomes partly explains the relationship between socio-economic status and health.
For positive emotions the prediction ran the other way: people with higher socio-economic status experience more positive emotions, and through the indirect effect from positive emotions to health the relationship between socio-economic status and health outcomes gets partly explained.
First, it was demonstrated that in fact there is a mediation path of negative emotions on the social gradient of health.
About 27% of the total effect of socio-economic status on health outcomes is accounted for by negative emotions.
It indicates that differences in socio-economic status do influence the extent to which people experience negative emotions. This result is thus in concordance with the predictions based on the “Reserve Capacity Model”.
Thus, Social Connectivity, Stress Management Self- Compassion/Self-care are very significant components of the health promoting life sustaining recommendations provided to persons in treatment
- Exposure to Sun light and Sun Lamps. Many Individuals often find their moods darken when days get shorter. This experience is associated in many instances with increased fatigue-ability, daytime somnolence, dysattention, slowed thinking and impaired concentration, weigh gain and in some instances overeating. This resembles the reactions of individuals to elevated circulating levels of Cytokines. [CRP, TNF alpha, IL6, IL1] The Light therapy used for treating Skin diseases e.g. Psoriasis is very different form light sources used for treating Mood disorders. The Light source for Depression should have UV and Blue light blocked as much as possible. It is vitally important to design your individualized game plan starting now before the need arises for active treatment with medications or other interventions for depression. Check with your Psychiatrist, or Mental Health APRN or PCP about the initiation of intervention by exposure to specific therapeutic Light Boxes. The Light therapy used for treating Skin diseases e.g. Psoriasis is very different form light sources used for treating Mood disorders. The Light source for Depression should have UV and blue light blocked as much as possible. The Light Box exposure treatment can be part of a basket of strategies including components listed above. Everyone must take the initiative to design an effective combination of counter- measures to avoid emotional, behavioral and cognitive disorders. It may be possible to reduce doses of anti-depressants if the daily exposure to 10,000 Lux light at 24 inches begins to take effect and improve concentration, cognitions, sleepiness, Low energy and mood.
- Strengthening Vagal Tone to augment recovery and improves quality of life. The Vagus nerve is the prime component of the parasympathetic nervous system which regulates the “rest-and-digest” or “tend-and-befriend” responses. On the flip side, to maintain homeostasis, the sympathetic nervous system drives the “fight-or-flight” response. Healthy Vagal Tone Is Part of a Feedback Loop Linked to Positive Emotions.
Healthy vagal tone is indicated by a slight increase of heart rate when you inhale, and a decrease of heart rate when you exhale. Deep diaphragmatic breathing—with a long, slow exhale—is key to stimulating the Vagus nerve and slowing heart rate and blood pressure, especially in times of performance anxiety A higher vagal tone index is linked to physical and psychological well-being. Conversely, a low vagal tone index is associated with inflammation, Depression, negative moods, loneliness, heart attacks, and stroke. Clinical and experimental studies indicate that Stress and Depression are associated with the up-regulation of the immune system, including increased production of pro-inflammatory Cytokines. When administered to patients or laboratory animals, cytokines have been found to induce typical symptoms of depression. Therefore some cases of low mood, low energy, and lack of motivation may be due to elevated levels of cytokine proteins. The Vagus nerve can inhibit the production of these Cytokines by directly influencing the function of T cells in the Spleen.
- A 2010 study, “How Positive Emotions Build Physical Health: Perceived Positive Social Connections Account for the Upward Spiral Between Positive Emotions and Vagal Tone,” was published in Psychological Science. Barbara Fredrickson and Bethany Kok honed in on the Vagus nerve and discovered that a high Vagal tone index was part of a feedback loop between positive emotions, physical health, and positive social connections. Their research suggests that positive emotions, robust social connections, and physical health influence one another in a self-sustaining upward spiral dynamic and feedback loop that scientists are just beginning to understand.
- Healthy vagal tone is indicated by a slight increase of heart rate when you inhale, and a decrease of heart rate when you exhale. Deep diaphragmatic breathing—with a long, slow exhale—is key to stimulating the Vagus nerve and slowing heart rate and blood pressure, especially in times of performance anxiety. Frederickson and Kok used a Loving-Kindness Meditation (LKM) technique to help participants become better at self-generating positive emotions. However, they also found that simply reflecting on positive social connections and working to improve close-knit human bonds also caused improvements in Vagal tone.
Thus, we return to the Contextual frame of reference upon which these Ten recommendations are founded. It is increasingly accepted by the Medical Community and the public that these two organ systems the Brain [and Nervous System] and the Bowel influence each other in many ways. Stress and Bidirectional Neural Immune interactions involving these Organ Systems play significant roles in the development of Obesity, Heart Disease, Cancer, Depression and Type II Diabetes by affecting the Pancreas.
For most people, what they consume - eat, drink, inhale, chew affects their Emotions, Behavioral patterns and Thinking faculties in real time and over longer spans of their lives. Therefore, we are offering a health promoting protocol consisting of 10 tasks you can commit to making these activities part of your life starting today and play an active role in promoting your health and do what you can with the assistance of your family to reduce the risk of Accidental Deaths and Overdoses, Heart Disease, Cancer, Stroke COPD. [See above]
Velandy Manohar, MD
PS: #1
[a]: The future of mental health care: peer-to-peer support and social media
- J. A. Naslund, K. A. Aschbrenner, L. A. Marsch, S. J. Bartels
- Journal: Epidemiology and Psychiatric Sciences / Volume 25 / Issue 2 / April 2016
- https://doi.org/10.1017/S2045796015001067
- Published online: 08 January 2016, pp. 113-122
In this commentary, we take the perspective that when an individual with serious mental illness decides to connect with similar others online it represents a critical point in their illness experience. We propose a conceptual model to illustrate how online peer-to-peer connections may afford opportunities for individuals with serious mental illness to challenge stigma, increase consumer activation and access online interventions for mental and physical wellbeing.
People with serious mental illness report benefits from interacting with peers online from greater social connectedness, feelings of group belonging and by sharing personal stories and strategies for coping with day-to-day challenges of living with a mental illness. Within online communities, individuals with serious mental illness could challenge stigma through personal empowerment and providing hope. By learning from peers online, these individuals may gain insight about important health care decisions, which could promote mental health care seeking behaviours. These individuals could also access interventions for mental and physical wellbeing delivered through social media that could incorporate mutual support between peers, help promote treatment engagement and reach a wider demographic. Unforeseen risks may include exposure to misleading information, facing hostile or derogatory comments from others, or feeling more uncertain about one's health condition. However, given the evidence to date, the benefits of online peer-to-peer support appear to outweigh the potential risks.
[b] Embodying self-compassion within virtual reality and its effects on patients with depression
- Caroline J. Falconer, Aitor Rovira, John A. King, Paul Gilbert, Angus Antley, Pasco Fearon, Neil Ralph, Mel Slater, Chris R. Brewin
- Journal: BJPsych Open / Volume 2 / Issue 1 / January 2016
- https://doi.org/10.1192/bjpo.bp.115.002147
Self-criticism is a ubiquitous feature of psychopathology and can be combatted by increasing levels of self-compassion. However, some patients are resistant to self-compassion.
To investigate whether the effects of self-identification with virtual bodies within immersive virtual reality could be exploited to increase self-compassion in patients with depression.
We developed an 8-minute scenario in which 15 patients practiced delivering compassion in one virtual body and then experienced receiving it from themselves in another virtual body.
In an open trial, three repetitions of this scenario led to significant reductions in depression severity and self-criticism, as well as to a significant increase in self-compassion, from baseline to 4-week follow-up. Four patients showed clinically significant improvement.
The results indicate that interventions using immersive virtual reality may have considerable clinical potential and that further development of these methods preparatory to a controlled trial is now warranted.
PS #2 http://www.psychiatrictimes.com/major-depressive-disorder/april-research-update-major-depressive-disorder?rememberme=1&elq_mid=1096&elq_cid=1250186
Psychiatric Times: April Research Update: Major Depressive Disorder by Mark L. Fuerst Apr 17, 2018
Ceasing regular exercise increases depressive symptoms in healthy adults, more so in women than men. A literature review found six studies of 152 adults who exercised for at least 30 minutes, three times a week, for a minimum of three months.
In some cases, ceasing this amount of exercise induced significant increases in depressive symptoms after just three days. Other studies showed that depressive symptoms increased after the first one or two weeks. Female participants had significantly more depressive symptoms after stopping exercise than male participants.
Clinical Implications for Study 2: “For now, it is important that people understand the potential impact on their mental well-being when they suddenly cease regular exercise,” said senior author Bernhard Baune, MD, Head of Psychiatry at the University of Adelaide. He noted the depressive symptoms arising from stopping exercise occurred in the absence of the typical biological markers commonly involved with depressive symptoms. “This suggests some kind of novel effect in these cases, although we should add some caution here, as the number of people included in the studies we examined was small. Such findings would need to be replicated in additional trials,” said Baune.
Source: Morgan JA et al. Does ceasing exercise induce depressive symptoms? A systematic review of experimental trials including immunological and neurogenic markers. J Affect Disord. 2018;234:180-192.
PS #3 Psychiatric Times: April Research Update: Major Depressive Disorder by Mark L. Fuerst Apr 17, 2018
Study 3
Levels of interleukin-6 (IL-6) and C-reactive protein (CRP) may be useful in identifying treatment-resistant depressed patients most likely to benefit from ECT treatment.
A study included 29 patients who had a current MDD episode and were scheduled to undergo ECT. Their levels of IL-6, CRP, IL-8, and tumor necrosis factor-α and severity of depressive symptoms were prospectively evaluated before ECT treatment, after the second ECT session, and again at the completion of the index treatment series.
In multivariate analyses, higher levels of IL-6 at baseline, but not other inflammatory markers or clinical variables, were associated with lower end-of-treatment depression rating scores. When stratified by sex, IL-6 remained a significant predictor of end-of-treatment depression for women, but not for men, and CRP emerged as a significant predictor for women, but not men.
Clinical Implications for Study 3: “Assessment of pretreatment inflammatory biomarkers, especially in women, might be useful in guiding treatment decision-making in treatment-resistant depression,” stated the researchers, led by Jennifer L. Kruse, MD of the Cousins Center for Psychoneuroimmunology at the University of California Los Angeles.
Source: Kruse JL, et al. Inflammation and Improvement of Depression Following Electroconvulsive Therapy in Treatment-Resistant Depression. J Clin Psychiatry. 2018;79:17m11597, 10.4088/JCP.17m11597 http://www.psychiatrist.com/JCP/article/Pages/2018/v79n02/17m11597.aspx
PS #4
A pro-inflammatory diet may be associated with higher incidence of depressive symptoms in a cohort of older Americans, according to a recent study.
Therefore, transitioning to a more anti-inflammatory diet may reduce depression risk.
This longitudinal study, with a follow-up of 8 years, included 3,648 participants (1,577 males, 2,071 females; mean age: 60.6 years) with/at risk of knee Osteoarthritis.. Researchers found:
- In total, 837 individuals (310 men and 527 women) developed incident depressive symptoms over the course of 8 years.
- Participants in the most pro-inflammatory group (quartile 4) had approximately 24% higher risk of developing depressive symptoms compared to subjects with the most anti-inflammatory diet.
PS #5 Stress Resources.
a. https://www.verywellmind.com/stress-relief-activities-you-should-try-3144614?utm_campaign=list_stress&utm_medium=email&utm_source=cn_nl&utm_content=16492887&utm_term= Top 10 Stress Relievers You Should Try
b. Signs You’re Mentally Exhausted (webmd.com)
- How to Feel Better and Practice Self-Care in Less Than 15 Minutes (webmd.com)
- Life event, stress and illness - PubMed (nih.gov)
- https://www.frontiersin.org/articles/10.3389/fphys.2018.01487/full
- Mitochondria, Oxidative Stress and Innate Immunity - PubMed (nih.gov)
- General Adaptation Syndrome Stages, Phases & Model - Sanesco (sanescohealth.com) full article below.
- https://medical-dictionary.thefreedictionary.com/general+adaptation+syndrome
- https://www.medicalnewstoday.com/articles/320172#what-is-gas
- https://www.healthline.com/health/general-adaptation-syndrome#model
PS #6
- Immune System Resources
- Immune System Problems: Signs and Symptoms (webmd.com)
- What Doctors Do to Boost Their Immune Systems (webmd.com)
- Most Common Infectious Diseases in the U.S. in Pictures (webmd.com)
- The Human Immune System Explained (webmd.com)
- Inflammation Resources
- Top 5 Blood Tests For Inflammation - DrJockers.com
5 Ways To Reduce Inflammation Quickly - DrJockers.com
- 5 Ways To Reduce Inflammation Quickly.
NB
Illustrates the interconnections between various system in the brain, neuro chemical systems and immune systems.
Scan_Pic 0004 Illustrates the connections between the brain, Immune system and endocrine glands.
illustrates the impact of underlying Inflammation I have spoken about in my Health literacy promoting and recovery supporting educational materials
illustrates my concept of how the treatment approach I have developed and recommended can over time reduce the levels of depression, lower the levels of the Inflammatory Cytokines and improves the Telomerase length, Telomerase level, Reduces the discrepancy between Epigenetic Age and Chronological age by reducing DNA methylation and increase the Level of Brain derived Neurotropic Factor BDNF.
I use these charts for a quick review of the text and remind people of what we spoke about their role in getting better and staying well.
Over a period during the 52 weeks of continuous streamlined treatment I expect the underlying inflammatory processes to mitigate and the following changes to occur coterminous with the interventions and self -adopted changes in Nutrition, Exercise, Stress management and more effective self-management:
I have produced two graphs based on the hand- written illustration Scan_Pic0006:
A. 1. Telomerase increase 2. Telomere length increase 3. BDNF increase, 4. DNA Methylation - Epigenetic age is improved so it is less than 5 years more than chronological age and perhaps equal to chronological age [Graph 2]
B. I Reduction progressively of CRP, Interleukin 1Beta, 6, TNF Alpha and Total scores on PHQ 9, score on Q9 and Disease burden of the Depression Symptoms assessed by PHQ 9 [Graph1]
Velandy Manohar, MD
Distinguished Life Fellow, American Psychiatric Association
President–In-Home Addiction Treatment, PC
Medical Director–Aware Recovery Care, CT [I have developed health promoting treatment recommendations that has holistic orientation – attaching documents]
CT. State Medical Society- Quality of Care Committee
CT. State Medical Society- Disaster Preparedness Committee
Steering Committee, National Physician Alliance, CT
Older Age Behavioral Health Work Group, CT This is the group I represented at the Stand Down Event [09 14 18.]
CT. Multicultural Health Partnership- Nancy Berger Award winner.
CT State Innovation Model–Community Advisory Board 2017
Primary Care Modernization–Genomic Medicine Design Work Group, CT 2018
Primary Care Modernization–Behavioral Health Integration Design Work Group, CT 2018
Primary Care Modernization- Consumer Advisory Discussion Group, CT 2018
Founding Member–Community Resilience Collaborative of Mx. County, CT 2018