Calm for the holidays

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Are you heading home for the holidays, hosting relatives, or throwing parties? A strong dose of calm can help you enjoy yourself more and stress less. Here are a few ways to take holiday stress down a notch and invoke your calmest self.

Find your calm

Breathe deep: When your emotions run high, breathing speeds up, too. Deliberately slowing your breathing relaxes tense muscles, bringing shoulders down from ears, calms roiling emotions, and helps disarm the hormonal cascade within the body that feeds anxiety.

Try this: close your eyes and breathe in deeply through your nose while counting upward. Hold for a few seconds. Breathe out slowly through your nose while counting downward. Make each out-breath a few counts longer than each in-breath. Repeat for five minutes.

Or try a calming yoga breath, such as alternate nostril breath, described in a blog post by Marilyn Wei, MD.

A wide world of mindfulness apps for smartphones or tablets can show you many more ways to breathe deep and seek calm. Some are available for a one-time fee or by monthly subscription. Others allow you to tap samples for free.

Move fast: Investing time and effort in regular exercise helps people manage anxiety. A systematic review of 15 randomized, controlled trials found that regular aerobic exercise successfully reduced anxiety in people who had been diagnosed with anxiety disorders and people with raised scores when tested for anxiety. Those who engaged in high-intensity exercise (such as jogging) gained more relief than those who did low intensity exercise (such as walking), although both approaches had positive effects.

Can’t find the energy or time to exercise regularly? Even so, the distraction factor and chance to burn off anxiety through bursts of activity can help you feel calmer. Run in place, sprint up and down stairs, do jumping jacks, or take yourself out of the mix for a while and go for a walk outside.

Change the conversation

Defuse charged conversations: Let’s say you have family members whose conversations or actions reliably raise your blood pressure. Are polar-opposite politics are the root of the problem? Angry Uncle Bot, an interactive chat program published in the New York Times, offers ideas on ways to change the script this year. Or maybe it’s more than just politics that you and your family wrestle over. If so, try these simple tips to help promote peace among relatives from Melissa Brodrick, ombudsperson at Harvard Medical School.

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Gut feelings: How food affects your mood

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The human microbiome, or gut environment, is a community of different bacteria that has co-evolved with humans to be beneficial to both a person and the bacteria. Researchers agree that a person’s unique microbiome is created within the first 1,000 days of life, but there are things you can do to alter your gut environment throughout your life.

Ultra-processed foods and gut health

What we eat, especially foods that contain chemical additives and ultra-processed foods, affects our gut environment and increases our risk of diseases. Ultra-processed foods contain substances extracted from food (such as sugar and starch), added from food constituents (hydrogenated fats), or made in a laboratory (flavor enhancers, food colorings). It’s important to know that ultra-processed foods such as fast foods are manufactured to be extra tasty by the use of such ingredients or additives, and are cost effective to the consumer. These foods are very common in the typical Western diet. Some examples of processed foods are canned foods, sugar-coated dried fruits, and salted meat products. Some examples of ultra-processed foods are soda, sugary or savory packaged snack foods, packaged breads, buns and pastries, fish or chicken nuggets, and instant noodle soups.

Researchers recommend “fixing the food first” (in other words, what we eat) before trying gut modifying-therapies (probiotics, prebiotics) to improve how we feel. They suggest eating whole foods and avoiding processed and ultra-processed foods that we know cause inflammation and disease.

But what does my gut have to do with my mood?

When we consider the connection between the brain and the gut, it’s important to know that 90% of serotonin receptors are located in the gut. In the relatively new field of nutritional psychiatry we help patients understand how gut health and diet can positively or negatively affect their mood. When someone is prescribed an antidepressant such as a selective serotonin reuptake inhibitor (SSRI), the most common side effects are gut-related, and many people temporarily experience nausea, diarrhea, or gastrointestinal problems. There is anatomical and physiologic two-way communication between the gut and brain via the vagus nerve. The gut-brain axis offers us a greater understanding of the connection between diet and disease, including depression and anxiety.

When the balance between the good and bad bacteria is disrupted, diseases may occur. Examples of such diseases include: irritable bowel disease (IBD), asthma, obesity, metabolic syndrome, diabetes, and cognitive and mood problems. For example, IBD is caused by dysfunction in the interactions between microbes (bacteria), the gut lining, and the immune system.

Diet and depression

A recent study suggests that eating a healthy, balanced diet such as the Mediterranean diet and avoiding inflammation-producing foods may be protective against depression. Another study outlines an Antidepressant Food Scale, which lists 12 antidepressant nutrients related to the prevention and treatment of depression. Some of the foods containing these nutrients are oysters, mussels, salmon, watercress, spinach, romaine lettuce, cauliflower, and strawberries.

A better diet can help, but it’s only one part of treatment. It’s important to note that just like you cannot exercise out of a bad diet, you also cannot eat your way out of feeling depressed or anxious.

We should be careful about using food as the only treatment for mood, and when we talk about mood problems we are referring to mild and moderate forms of depression and anxiety. In other words, food is not going to impact serious forms of depression and thoughts of suicide, and it is important to seek treatment in an emergency room or contact your doctor if you are experiencing thoughts about harming yourself.

Suggestions for a healthier gut and improved mood Eat whole foods and avoid packaged or processed foods, which are high in unwanted food additives and preservatives that disrupt the healthy bacteria in the gut Instead of vegetable or fruit juice, consider increasing your intake of fresh fruits and vegetables. Frozen fruits without added sugars/additives are a good choice too. Eat enough fiber and include whole grains and legumes in your diet. Include probiotic-rich foods such as plain yogurt without added sugars. To reduce sugar intake at breakfast, add cinnamon to plain yogurt with berries, or to oatmeal or chia pudding. Adding fermented foods such as kefir (unsweetened), sauerkraut, or kimchi can be helpful to maintain a healthy gut. Eat a balance of seafoods and lean poultry, and less red meat each week. Add a range of colorful fresh fruits and vegetables to your diet, and consider choosing certain organic produce.

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Creating recovery-friendly workplaces

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People who work in manual labor have higher rates of injury and overdose

Our country’s ongoing opioid crisis has many faces, from teenagers on Cape Cod to middle-aged parents in West Virginia. A recent report from the Massachusetts Department of Public Health provides another demographic affected by opioids: people who work in the trade industries, namely construction. The report broke down overdose deaths by industry, and construction workers were involved in almost a quarter of overdose deaths recorded in the state over five years. Farming, forestry, and hunting, along with fishing, are the next most dangerous industries. And there are relatively high overdose death rates for women working within health care support and food services.

This research supports what we have seen in our own work treating patients for substance use disorders who work in manual labor jobs. On-the-job hazards and related injuries are common, and pain medications of all kinds tend to be readily available as workers informally share and sell them on worksites.

The need for recovery-friendly workplaces

A recent National Safety Council report found that 70% of surveyed employers have been impacted by prescription drug misuse, but fewer than 20% feel extremely prepared to deal with it. The financial cost to employers in lost productivity is significant: in Massachusetts alone, opioid addiction cost businesses $2.5 billion annually from employees who aren’t functioning at full capacity, and $5.9 billion in lost productivity from people who can’t join the workforce due to addiction. Opioid use disorder has kept nearly 33,000 people in Massachusetts from participating in the labor force each year, on average, over the past five years.

But what could a recovery-friendly workplace look like? Drawing inspiration from models like Supported Employment, an evidence-based intervention for individuals with serious mental illness, and recovery high schools, we describe five key features of a recovery-friendly workplace:

Available counseling for scheduled and on-demand recovery support. Manual labor workers with varying schedules often have trouble making appointments in traditional healthcare settings, which tend to be offered only during normal business hours. Missed work equals lost income, which is harmful to workers and employers alike. An onsite counselor for large worksites or availability of remote telehealth counseling on-demand during work breaks could encourage participation in these programs.

Peer support groups built into the daily schedule. Like individual appointments, therapy groups often occur during the business day. Open and safe discussions with crewmates who are also in recovery can help build a culture of mutual support. Onsite peer support by recovery coaches in the industry might be particularly impactful.

A supervisor who understands the challenges and needs of people in recovery. Slip-ups are part of the recovery process, and a positive drug test should signal the need for more counseling support and closer monitoring, not automatic termination of employment.

Support for medication-assisted treatment. We’ve heard anecdotally about certain union health insurance plans that deny coverage of buprenorphine (Suboxone), a medication for opioid use disorder that calms cravings and halves the risk of overdose death. This kind of discrimination is a federal crime, and for good reason — imagine employer-based health insurance refusing to pay for insulin for workers who have diabetes. Unfortunately, stigma and fear of retribution may keep union workers from speaking out to claim their rights.

Onsite drug testing (where appropriate) and telepsychiatry. Regular drug testing could help make construction sites safer and indicate when people need more support. Crews often share transportation to and from worksites, making it hard for an individual to leave in the middle of the day for a medication appointment or to provide required toxicology testing for their program. Telepsychiatry visits in a secure room on a worksite could allow people to get assessed more regularly and prevent missed doses of recovery medications like buprenorphine.

Recovery-friendly workplaces may lower healthcare costs

Employers in all kinds of industries should consider how establishing recovery-friendly workplaces may help them access an underutilized workforce while addressing a vital social need. People in recovery from opioid use disorder commonly describe their core recovery goals as needing to keep busy, to achieve financial self-sufficiency, and to recapture the dignity of being a working member of society. Our clinical work can go only so far in supporting our patients’ recovery, but with the right kinds of partnership across sectors, we can make great strides together.

Given the high prevalence of substance use disorders in certain sectors, investing in supported employment with recovery support and medication-assisted treatment might reduce costs associated with missed work as well as employee hiring and retraining, improving overall work quality while also lowering overall healthcare costs. Finally, substance use is rampant on construction and manual labor worksites, so investing in recovery support and treatment might improve the relationship of workers with management and unions and reduce risk for accidental injuries in the future.

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