Mental Health 2020: The Stats

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At this point, there have been no substantive studies of mental health resulting from either the pandemic or the political climate in the U.S. There are metrics that have been tracked via online survey since April; the surveys added modified questions that ask about factors related to the pandemic.

The results for symptoms of anxiety show that 30.8% of respondents indicated more symptoms in late April compared to 31.4% in late August although the percentage fluctuated as high as 36.0%. The results for symptoms of depression ranged from 23.5% in late April to 24.5% in late August with a percentage fluctuation as high as 28.8%.

What do the numbers mean in comparison with pre-pandemic times?
From January to June 2019, 8.2% of adults aged 18 and over had symptoms of anxiety disorder while 6.6% had symptoms of depressive disorder. The current surveys are not perfect and there’s no statistical analysis, but by all appearances we are more anxious and tend to exhibit more depressive symptoms.

I think what contributes to the anxiety is that there’s no simple solution. Humans like binary choices: this is right, that’s wrong. And that just doesn’t apply in this case. Could we be creating a population at risk for a form of posttraumatic stress disorder? Is there anything we can do about it? We’ll take a look at that on Saturday.

What are you prepared to do today?

        Dr. Chet

References:
1. https://www.cdc.gov/nchs/covid19/pulse/mental-health.htm
2. https://www.cdc.gov/nchs/fastats/depression.htm

Mental Health Update: Fall 2020

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As I write this, I just got back from working out. I went to my gym for the first time since it opened last Wednesday after closing in March. Everyone wore masks. Everyone cleaned up their equipment, but that’s the standard anyway so that wasn’t surprising. Nobody fainted from lack of oxygen. Everybody just worked out, cleaned up after themselves, and went on their way. No big deal.

But it’s a big deal to many people who have been anxious over the closures in their states, including their gym. That can lead to depressive symptoms. If you follow social media, that can hurt considerably: comments suggesting the virus is one big scam or people are too concerned. In fact neither is true; spending less time on social media might be the single best thing you could do for your mental health. I go back to what I wrote several months ago: don’t let yourself be immobilized by fear of this virus, but show it the proper respect.

On top of that, the political climate is a mess. There are no longer any discussions, just arguments that can be vicious. The anger is palpable. When you lose contact with family and friends you care about because of political differences, that also leads to anxiety and depression. Throw in unemployment, concern about finances, keeping a roof over your head, and more, and it seems our mental health is taking a beating.

But is it? I’ll take a look at the research this week.

Reminder for all Insiders: our monthly Conference Call is tomorrow night at 9 p.m. ET. One topic I’ll be discussing is a remarkable study done on COVID-19 and genetics by a supercomputer. You don’t want to miss it. If you’re not yet an Insider, you have until 8 p.m. to join and still participate live.

What are you prepared to do today?

        Dr. Chet

By Any Means Necessary

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Riley has finished his first week of in-classroom school. He seems to have adapted quite well, which is no surprise—he is the most social child I’ve ever known and makes friends with everyone.

Much like me, he’s not much of a morning eater. Occasionally I’ll eat breakfast but for the most part, it’s not going to happen until I’ve been awake for several hours. A cup of Joe isn’t going to work for Riley, so milk and water suffice. I gave him a fruit and vegetable pouch yesterday, but he wanted to take it for a snack at school. I talked him out of it; he ate about half and saved the rest for after school.

Riley is a choosy eater: he chooses to refuse many foods that most kids eat such as apples, oranges, and bananas. Until recently, he had a strong gag reflex that was triggered by many solid foods, so we’ve continued to use pouches as a nutritional stop-gap; we watch for sales and usually pay about a dollar per pouch.

The reason I hesitated to have him take it for snack was that I wasn’t sure kids who are five still use them, and I didn’t want him to get embarrassed among his new friends. Then my health brain kicked in. He’s gotten used to eating blueberries, raspberries, and grapes in small quantities, but that’s about it. Vegetables? Other than potatoes, carrots, and Grampa’s spaghetti sauce with hidden vegetables, it’s a tough sell. But in those pouches, he eats just about everything. What’s more important: eating the fruits and vegetables in whatever form or worrying about what people think? So if he wants to take pouches to school, he will because getting those fruits and veggies into him is more important by far.

Just as serious: how are you doing with your consumption of vegetables and fruit? If you don’t get your five to ten servings, check out the pouches. They contain one or two servings of pureed vegetables and fruits, organic with no additives, and include very interesting blends; some of Riley’s faves are in the illustration. I’ve tried them and if I didn’t like vegetables and fruits, I’d use them. Cold, they’re refreshing. They’re shelf stable, so you can keep them in your desk or locker or car for convenient, healthy snacks. It sure beats making or buying a smoothie every day, and they’re a better alternative than the doughnuts in the break room or whatever you find in the vending machine.

If you’re concerned about the ecological impact, the New York Times reports, “While the pouches are not recyclable through municipal services, they can be mailed to TerraCycle at a cost of at least $93 per shipment, except for a few brands that have set up free mail-in programs with the recycling company. Pouch caps are collected in some locations by Preserve, which manufactures goods like toothbrushes and razors from recycled plastic.”

If you know you’re never going to eat kale or spinach, try a pouch. As I said, get your fruits and vegetables by any means necessary.

What are you prepared to do today?

        Dr. Chet

Why Riley Went to School This Week

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Tuesday was Riley’s first day of kindergarten in the classroom. One of the reasons I haven’t written memos for two weeks is because Paula and I were attending online kindergarten with Riley four times a day; that gave Jamie some time to spend with her sister, who has a serious illness (and we’d appreciate your prayers for Nicki).

Riley’s school gave each child a Chromebook already loaded with all the apps they would need for class, and he figured it out in no time. (One day we were both dismayed and proud to find him watching a Sonic the Hedgehog movie, but Paula is still more proficient than he is and blocked a few sites.) Online school for people who can’t read was interesting to say the least. I thought getting adults to mute themselves was challenging! But it didn’t take long for most kids to get it and respect the teacher and other students in class.

While we’ve been anticipating getting Riley into a classroom, it’s slightly scary; we don’t want him to get sick or bring anything home to the rest of us. The district, staff, and teachers in his elementary school have done what they could to be safe: masks, hand-washing stations and sanitizer, and social distancing to the extent possible with five-year-olds. They’ve explained how people will look and what they will do to help students. The students know they will wear masks and that they should wash their hands to the ABC song. Everyone is ready, especially Riley, who was very eager to go to school after his pre-K days were cut short.

Riley needs this; he is the most social person I know. We think it will be easier to keep him focused when he’s surrounded by other students who are paying attention rather than just looking at a screen. He could continue online, but as a family we agreed it’s worth the risk, given the advantages versus the precautions taken; if he were several years older, we might have decided to stay online, as our neighbors with older children did. Our little people-person needs the interaction with his teachers and classmates for as long as it lasts. School districts in the state that opened with in-school classes lasted about a week. Let’s hope Kentwood Schools last longer.

I’ll keep you posted on how things are going. Oh, and don’t forget, while you’re washing your hands, sing the ABC song so you make sure you wash long enough to really get rid of those germs.

What are you prepared to do today?

        Dr. Chet

Phytonutrients: Diet or Supplements?

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The study that we looked at this week demonstrated that flavonoid intake is related to socioeconomic status. It also demonstrated that most of that difference comes from the consumption of tea. All well and good.

What stood out to me was the lack of phytonutrient intake. While there were some small differences in the other flavonoids besides flavan-3-ols, the total intake of flavonoids was low. Even though we’re talking about just one class of phytonutrients, the total flavonoid intake minus the flavonoids from tea was about 140 milligrams per day. That’s reflective of a poor diet that does not include as many sources of phytonutrients as it should: not enough vegetables, fruit, beans, nuts, and others. And it hasn’t changed in the six years of the study. Most people still don’t eat enough plant-based foods to do themselves any good.

Supplements: An Insurance Plan

The study demonstrated the need for the regular use of supplements containing plant concentrates. A plant concentrate is the plant or its fruit or its root or its leaves, minus the water and the fiber. It should also have been harvested at the peak of nutrition, not the peak of flavor and taste. The plant concentrates contain all the phytonutrients that are contained within the plant, and that includes not only the flavonoids that were the subject of this study, but all of the other types of phytonutrients that we need on a regular basis.

The plant concentrates may be found in multivitamin-minerals, as part of a fruit-and-vegetable concentration, or maybe even as a stand-alone. We’re not talking about treating diseases with these supplements; we’re talking about getting the nutrition that you’re supposed to be getting from the foods that you eat (but you’re not). To me, this study pretty much proves that everyone needs to take supplements with plant concentrates every day. They provide good backup while you work on improving your diet.

The Bottom Line

If you want the best chance at preventing degenerative diseases, you need optimal nutrition. That starts with what you eat, including all those phytonutrient-containing vegetables, fruits, beans, grains, and aromatic herbs used to season your food. As a backup, take supplements that contain plant concentrates to complement your diet. It’s not either/or; it’s using them both to get to better health.

Paula and I will be taking some time off to work on more jobs around the house. We’ll be back after a short break.

What are you prepared to do today?

        Dr. Chet

Reference: J Nutr 2020;150:2147–2155.

Flavonoid Intake Varies by Demographic

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Besides the flavonoid intake, another purpose of this study was to find out if there were any socioeconomic differences between high and low flavonoid intake. Before I get to that, here are some of the results of this study.

The age group with the highest flavonoid intake was adults 51–70 with 293 mg/day. As education increased, so did flavonoid intake from 201 mg/day for those not completing high school to 251 mg/day for those with some college. Finally, the flavonoid intake remained the same throughout all three cycles of the study.

Socioeconomic status was correlated with flavonoid intake as well; the higher the status, the higher the flavonoid intake. Race, income, and education were all included in the analysis. But not all flavonoids—just flavan-3-ols. By nature of the analysis, flavan-3-ol intake was directly attributed to tea consumption. (If you want to try to increase your tea consumption, try making Paula’s Sugar-Free Sweet Tea; find the directions in the Recipe section of my Health Info page.)

The researchers were satisfied they had found a link to phytonutrient intake, specifically flavonoids, and non-nutritive factors. To me, it meant something entirely different and I’ll cover that on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: J Nutr 2020;150:2147–2155.

Getting Acquainted with Flavonoids

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Every vegetable, fruit, and spice we consume in the foods we eat and many substances that we drink contain phytonutrients. Just to make the subject even more complicated, there are different categories of phytonutrients including flavonoids, which are the most prevalent in our diet. Flavonoid intake is linked to reduction of diseases such as cardiovascular disease and cancer.

Here’s an example: turmeric is a spice and one of many plants that contain beneficial phytonutrients. Many of us use a turmeric supplement because it may help reduce pain and inflammation. Turmeric contains three major phytonutrients known as curcuminoids; curcumin is the most familiar.

Researchers wanted to check the flavonoid intake from subjects over nine years old who had completed two 24-hour recalls in two of three NHANES study cycles during 2011–16. Of all the dietary intake techniques in use, the 24-hour recall is the second most accurate available (food diaries are first). They used the dietary data to estimate the flavonoid intake of all subjects. The food or drink consumed with the most flavonoids: tea, although they found that nine year olds don’t drink much of it. But that’s not all they discovered, and I’ll cover that in Thursday’s Memo.

What are you prepared to do today?

        Dr. Chet

References:
1. J Nutr 2020;150:2147–2155.
2. https://www.ars.usda.gov/ARSUserFiles/80400525/Data/Flav/Flav_R03-1.pdf

Exercise vs. Meditation? The Winner Is…

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As a trained exercise physiologist, if I were asked the question, “Which would prevent acute respiratory tract infections?” I would have picked exercise over meditation every time. The only reason I would choose meditation is that nagging voice in the back of my brain that says, “If they’re asking the question, maybe there were surprise results.” Science says to ask the question, so the researchers did; let’s take a look at the results.

When Meditation Tops Exercise

There were distinct differences between the exercise and stress-reduction groups versus the controls. When compared to the control group, the exercise group had fewer acute respiratory infections. The mindfulness-based stress reduction program also had fewer acute respiratory infections than did the controls, but when looking at other variables such as absenteeism and lost days of work, the stress-reduction program did slightly better than exercise.

When Exercise Beats Meditation

The researchers also examined the total number of infections, and the exercise group did better. In this study, which was completed well before the current pandemic, the exercise group had no coronavirus infections (the common cold) while the meditation and control groups both did; the difference was that the meditation-trained group handled the infections much better than did the controls.

It would have been great if they had one more group that both exercised and used the stress-reduction techniques. It would have been interesting to see if there were additive or even multiplicative benefits, or maybe there would have been no differences or even negative results. We can’t assume that it would have made the immune system function better; the “stress” of doing both might have compromised immune function.

The Bottom Line

Even though this study was done eight years ago, it’s the only study I could find that examined the benefits of exercise related to any type of upper respiratory infection. That the study also included stress reduction/meditative techniques was a bonus. What we know now, based on this study, is that moderate exercise as well as stress reduction will both reduce our risk of serious infection from many types of virus, and we may have milder symptoms if we do catch one. Whether this will serve us well during this pandemic is uncertain, but even a little protection to reduce the most severe symptoms would be worth the effort. That’s great news for people who don’t have the physical capacity to exercise and for those who don’t have the patience for meditation: either one will work. Just do something.

What are you prepared to do today?

        Dr. Chet

Reference: Ann Fam Med 2012;10:337-346. doi:10.1370/afm.1376.

Immune System Training: Exercise vs. Meditation

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What’s going to work better to prevent acute respiratory infections: moderate exercise training or meditation training? Have you predicted which would be more effective without looking at the article? Or do you not have enough information yet? Let’s take a look at what each group did.

The moderate exercise group met for 2.5 hours each week with personnel trained in exercise physiology. The time was broken up into education about exercise and time practicing on different forms of equipment such as treadmills, exercise bikes, etc. The rest of the week, they exercised for 45 minutes per day. Most subjects used walking or jogging as their home modality of exercise. The subjects were trained to exercise at a moderate level based on the Borg perceived-exertion scale; once trained in assessing exertion, it matches up quite well with the effort people are actually performing during exercise.

The meditation group met with personnel trained in mindfulness-based stress reduction techniques for 2.5 hours a week. This program “is based on the idea that an increased awareness of physical, emotional, and cognitive manifestations of stress may lead to a healthier mind-body response to stress.” The subjects were also to practice the stress reduction techniques for 45 minutes every day at home.

The control group did not do either of the techniques. The training lasted for eight weeks. The variables I mentioned in Tuesday’s memo were collected before, during, and after completion of the eight weeks training. What were the results? I’ll give you a little more time to think about it and give you the answer on Saturday.

What are you prepared to do today?

        Dr. Chet

Reference: Ann Fam Med 2012;10:337-346. doi:10.1370/afm.1376.

Boosting Immune Function: Exercise vs. Meditation

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Every once in a while, I come across some research that’s just so interesting and unique, I have to share it with you. In this case, it’s directly related to boosting the immune system, which is what a lot of people are trying to do right now. In this case, researchers tested whether an eight-week program of either moderate exercise or meditation would reduce the variables associated with an acute respiratory infection such as time lost from work.

Researchers recruited subjects who did not get a flu vaccination and also did not exercise or meditate; they used just about every survey related to health that was available. They also took samples from nasal rinses after subjects had acquired an acute respiratory infection of any type and tested for markers of immune function in the rinses.

The mean age of the subjects was 59 years old. The subjects were randomly assigned to one of three groups: the control group who agreed to do nothing during the eight weeks; a group who would exercise at a moderate level; and a group who would participate in a specific type of meditation.

On Thursday, I’ll talk about the training programs. Looking ahead, short of looking up the paper itself, what do you think will be more effective: exercise or meditation to boost the immune system?

Insider Conference Call

Tomorrow night is the August Insider conference call. I’m going to do a COVID-19 update focusing on the recent spate of doctors plugging hydroxychloroquine as well as answering Insider questions. If you become an Insider by 8 p.m. ET, you can participate live!

What are you prepared to do today?

        Dr. Chet

Reference: Ann Fam Med 2012;10:337-346. doi:10.1370/afm.1376.