Health Connection - Summer 2020

Author: Ellen Doxey & Daniel Sadowski

The Dangers of the COVID-19 Doldrums

By: Rebecca Maxwell, LCSW, Director, Behavioral Health

When a sailboat is stuck at sea with no wind to get it moving, sailors call that the doldrums. Life during the coronavirus pandemic can be a bit like that. We feel isolated, anxious, and bored and it seems like there’s no end in sight. Weekdays blur into weekends. Those who live alone may feel lonely and those who live with family may long for more privacy and space. Add to that the stress of financial obligations and the fear that we, or our loved ones could contract COVID-19, and many of us are tempted to pour ourselves a glass of wine — or three.

There’s no doubt people are drinking more than usual, and way more than they should. Nationally, alcohol sales are up 54% since late March and by April, online sales had skyrocketed 500%. Restaurants are offering alcohol as a takeout order to help boost their shrinking margins. Zoom cocktail hours are all the rage, and folks don’t have to worry about driving home afterwards.

Here in the land of fine wine and craft beers, it’s especially important to remember the dangers of excessive drinking:

  • Over time, too much alcohol increases your risk of liver disease, obesity, breast cancer, hypertension, stroke, heart attack, atrial fibrillation, and high blood pressure.
  • Alcohol has harmful interactions with a variety of prescription drugs.
  • Alcohol interferes with brain function, judgement, memory, balance, thinking, and healthy sleep.
  • People who are alcohol-dependent have compromised immune systems, reducing the body's ability to fight off infection.
  • Those who smoke AND drink can have impaired lung function, a risk factor for poor outcomes if they contract COVID-19.

How much is too much?

The National Institute on Alcohol Abuse and Alcoholism defines one drink as 12 ounces of regular beer, 5 ounces of wine, or 1.5 ounces of distilled spirits. Federal dietary guidelines define "moderate" daily alcohol consumption as no more than one drink for women and one to two for men. Binge drinking is particularly dangerous and is generally defined as four or more drinks for women and five or more drinks for men in a two-hour period.

In addition to drinking too much, many of us are overindulging in our favorite foods. Smokers are smoking more, and some ex-smokers are tempted to start up again. Finding ways to get enough exercise takes a little more effort and creativity when the gyms are closed. Ultimately, the most effective ways to reduce stress come from within. Whether it’s spending more time on a hobby, meditating, walking in nature, taking an online yoga class, or reaching out to someone you haven’t talked to in a long time, seek activities that distract you from your anxieties and reduce your stress. And remember that getting enough good quality sleep will always help.

When to Worry

By now, most of us have at least a mild case of the pandemic blues. If you are using alcohol or other substances to cope, it’s time to scale back. If you need support to do so, look into the resources at the end of this article. However, if you think you (or someone you love) might be depressed, it’s important to get professional help. Symptoms of depression include:

  • Feeling empty, sad, and hopeless
  • Getting frustrated easily and feeling unusually irritable and quick to anger
  • Losing interest in topics and activities you previously enjoyed
  • Sleeping too much or too little
  • Fatigue and lack of energy
  • Eating too much or losing interest in eating
  • Sleep disturbances, including insomnia or sleeping too much
  • Fixating on past failures and loss and blaming yourself
  • Having problems with memory and concentration
  • Thinking about death or even suicide

If you are concerned that a loved one may be considering suicide, don’t hesitate to get involved. Giving them an opportunity to discuss their feelings may actually reduce their suicide risk.

Make sure they have the number for the National Suicide Prevention Lifeline (1-800-273-8255). If you are concerned about leaving them alone, stay with them or get a friend or relative to do so, and get professional help as soon as possible. For immediate care, call 911.

Keep in mind that the ongoing pandemic is affecting the emotional health of most people. Even if you aren’t drinking too much or experiencing the signs of depression, it’s still important to take steps to manage your mental health. Learn more about staying mentally and emotionally healthy during the pandemic with this short podcast.

Where to Get Help:

Sweet Dreams: Ten Tips for Better Sleep

We are a nation of insomniacs. According to the American Sleep Apnea Association, 25% of U.S. adults suffer from sleep deprivation at least 15 days or more each month, and insufficient sleep — less than six hours — is a nightly problem for 11%.

Stress and worry are the most common causes of poor sleep and in this time of COVID-19 and an uncertain economy, there’s plenty of both to go around. People with irregular work schedules may also suffer from sleep disruptions. There are also more than 80 medical conditions that affect sleep, from sleep apnea and narcolepsy to restless leg syndrome. If you’ve been dealing with sleep issues for more than a week or two, talk to your doctor, who may order a sleep study.

The one thing you shouldn’t do is ignore your sleep issues. Lack of adequate sleep can impact your judgment, mood, memory, and ability to retain information, as well as make you more accident prone — and that’s just in the short term. Over time, chronic sleep deprivation can lead to a host of health problems including obesity, diabetes, cardiovascular disease, depression, high blood pressure, a suppressed immune response, and even early mortality.

Sleeping Pills Are Not the Answer

Desperate for some shut eye, many people turn to prescription or over-the-counter sleep aids. Both types of medication should be used sparingly. Prescription sleeping pills, categorized as sedative-hypnotics, should only be used short-term (no longer than 30 days), in small doses, and under a doctor’s supervision. These drugs can have dangerous side effects and may also interact with other prescription medications. In addition, prescription sleeping pills can lead to physical and psychological dependency and cause withdrawal symptoms when you try to stop taking them. Long term use of over-the-counter sleep aids such as Benadryl and Tylenol PM are also dangerous. Over time, these drugs affect learning and memory and have even been linked to dementia in seniors.

Safe Solutions to Sleep Issues

Fortunately, there are some simple changes you can make to your lifestyle or routine that can have beneficial effects on sleep:

  1. Get some sun. Your circadian rhythm, or sleep/wake cycle, responds to light. Daily exposure to sunlight, or at least bright indoor lights, can reinforce your natural sleep rhythm. Try to get some natural light as soon as you wake up every morning.
  1. Avoid blue light. The light emitted by smartphones, TVs, and computers is fine during the day, but too much exposure at night can throw your circadian rhythm (your body’s internal clock) off balance. Try to avoid all screens for at least an hour before going to bed.
  1. Avoid caffeine after 3-4 pm. Caffeine stimulates your nervous system and stays in your blood for 6–8 hours, so forgo that after-dinner cup of coffee.
  1. Maintain consistent hours to get into a regular sleep/wake cycle. Try to wake up at a similar time every day, including on the weekend. If you must nap, keep it short. Naps longer than 30 minutes can put you into a deeper sleep, leave you feeling groggy and further disrupt your sleep cycle.
  1. Try melatonin or another natural supplement. Melatonin is a sleep hormone that signals the brain that it’s time to go to sleep. Start with a low dose to assess your tolerance and then increase it slowly as needed. For some people, plant extracts such as ginkgo biloba, valerian root, and lavender have a calming effect that helps promote sleep. Others find that magnesium or the amino acids glycine and L-theanine improve sleep quality. Do talk to your doctor before taking these, or any other supplements, and don’t take more than one at a time.
  1. Don’t drink alcohol before bed. Alcohol has a negative impact on the production of melatonin and increases the incidence of sleep apnea, snoring, and disrupted sleep patterns. It also blocks REM sleep which is thought to play a role in learning, memory, and mood. Drinking alcohol before bed also increases your chances of having to get up to use the bathroom in the middle of the night.
  1. Make your bedroom more restful. Reduce noise and light as much as possible and keep your room cool — 70° is optimum for most people. Make sure your pillow and mattress are comfortable. A poor-quality or worn mattress can contribute to chronic back pain and leave you tossing and turning all night, so plan to replace yours every 5-8 years.
  1. Find the right evening snacks. Walnuts, cherries and cherry juice, almonds, pistachios, bananas, and goji berries all contain melatonin, so consuming a modest amount before bedtime may help you sleep better. Hot liquids such as warm milk, chamomile tea, or caffeine-free green tea can help you relax but limit your intake to reduce middle-of-the-night trips to the bathroom.
  1. Try relaxation techniques such as listening to music, meditation, yin yoga, breathing exercises, or taking a hot bath or shower just before bed. And instead of picking up an electronic tablet or reader, try reading an actual book or magazine until you feel drowsy. Mindfulness meditation and guided relaxation are tools for reducing stress and improving sleep. Try this guided relaxation exercise.
  1. Exercise regularly — but not before bed. Exercise is one of the best ways to improve your sleep and health. Aim for a minimum of 30 minutes every day — ideally an hour. A walk after dinner is fine but avoid strenuous exercise in the evening because it increases alertness and boosts hormones like epinephrine and adrenaline.

Eating to Stay Well: Nutrition and Your Immune System

By Pamela Riggs, MS, RDN, CSOWM

The notoriously contagious COVID-19 virus has put a spotlight on the importance of the immune system — a complex network of organs, tissues and cells that work together to protect us from infection, injury and disease. While we still have a lot to learn about COVID-19, it is clear that people who are immunocompromised due to immunodeficiencies, cancer, and other conditions are especially vulnerable to the disease. There’s no replacement for our first line of defense from the coronavirus (masks, hand-washing, and social distancing) but boosting your immune system can help you stay healthier and more resilient.

Proper nutrition is essential to maintaining a healthy immune system. When your immune system senses a pathogen, it needs to ramp up production of cells, chemicals and proteins to carry out its functions. Lean sources of dietary protein, vitamins A, D, folate, B12, B6 and the minerals iron and zinc provide the biochemical building blocks and cofactors your body needs to mount an effective immune response.

When your immune system is fighting an infection, it produces byproducts called free radicals. These accumulate over time and can cause damage to healthy cells. Nutrients called antioxidants, such as vitamin C, vitamin E, iron, zinc, copper and selenium, help protect immune cells and reduce potential damage from free radicals. Many people don’t realize that inflammation is a normal immune response that serves to isolate an injury or infected area. The immune system can then deliver immune cells, chemical messengers and antibodies to that area. However, prolonged inflammation or the inability to stop inflammation leads to tissue damage and disease. Chronic inflammation is associated with heart disease, obesity, diabetes, cancer, arthritis, and other conditions. The good news is that a healthy diet can promote an anti-inflammatory response.

Omega 3 fatty acids (EPA and DHA) found in fish and fish oil can help keep inflammation in check. Consuming two servings of fish each week such as wild salmon, halibut and sardines is a good place to start. If you don’t like fish, a high-quality fish oil supplement containing both EPA and DHA can be your “Plan B”. To reduce inflammation, also avoid foods high in saturated fat, such as whole milk dairy products, butter, or fatty cuts of meat. Limit your consumption of sugar and refined carbohydrates found in foods such as soda, candy, white bread, cakes, cookies, and pastries. These foods also raise insulin levels which, over time, may lead to pre-diabetes and eventually, diabetes. Of course, eating too much sugar and fat isn’t good for your waistline either, and people who are overweight and obese have higher biomarkers for inflammation. What’s more, obese people who contract COVID-19 tend to stay in the hospital longer and require more intensive and prolonged oxygen treatment.

What should you eat for a healthier immune system? To make sure you’re getting the nutrients you need, eat a diet that emphasizes:

  • Protein: Seafood, poultry, eggs, beans, nuts, soy, seeds
  • Vitamin A: Eggs, carrots, sweet potatoes, apricots, spinach
  • Vitamin C: Sweet red bell pepper, kiwi, strawberries, oranges
  • Vitamin D: Pink salmon, sardines, fortified milk, supplements
  • Vitamin E: Almonds, sunflower seeds or oil, peanut butter
  • Folate: Lentils, spinach, enriched whole grain bread
  • B12: Clams, mackerel, beef
  • B6: Salmon, turkey, potato with skin
  • Zinc: Oysters, beef, yogurt, beans, nuts
  • Iron: Beef, tuna, lentils, iron fortified cereal
  • Copper: Oysters, cashew nuts, lentils
  • Selenium: Brazil nuts, tuna, pork, whole wheat bread
  • EPA/DHA: Wild salmon, sardines, herring, supplements

Learn more about nutrition counseling and how a registered dietitian can help you build a healthier diet.

Pamela Riggs is a Registered Dietitian Nutritionist at MarinHealth Medical Center.

Vaccines: Your Best Shot at Disease Protection

More than 200 years ago, the first vaccine was created and lead to the eventual eradication of smallpox, one of the most feared diseases in colonial America and around the world. Since then, vaccines have prevented innumerable cases of disease, spared countless people the sometimes-permanent health issues caused by contagious illnesses, and saved millions of lives. Though a COVID-19 vaccination is still a ways away, we can be inoculated against a host of other dangerous and often lethal pathogens, including polio, measles, diphtheria, pertussis, rubella (German measles), mumps, tetanus, rotavirus and Hemophilus influenzae type b (Hib).

Vaccination does more than just protect inoculated individuals. It keeps them from infecting others, including infants and young children, the elderly, and vulnerable people with chronic conditions or weakened immune systems. The greater the number of people vaccinated, the less opportunity a disease has to spread. Measles is a good example: worldwide, vaccination has resulted in a 73% drop in measles deaths—an estimated 23.2 million fatalities—between 2000 and 2018.

Myths and Misconceptions

Unfounded fears around vaccines have led to a drop in immunizations in recent years, fueling local disease outbreaks around the world. In fact, the World Health Organization (WHO) counts “vaccine hesitancy” as one of their top 10 threats to global health.

Anyone questioning the benefits of immunizations should read this cautionary tale. In 1974, 80% of Japanese children were getting the whooping cough (pertussis) vaccine. That year, there were only 393 cases of whooping cough in the entire country, and not a single child died. By 1979, people started getting complacent about the dangers of whooping cough and vaccination rates dropped to just 10%. As a result, whooping cough spread quickly, eventually affecting more than 13,000 people and killing 41 of them. Vaccinations resumed and infection rates dropped dramatically.

More recently, some parents have been hesitant to give their child the MMR vaccine, which protects against measles, mumps, rubella, and chickenpox, due to unfounded allegations that the vaccine causes autism. The Infectious Disease Society of America has been working to debunk some of the myths and misconceptions about the MMR and other vaccines. Here’s what parents need to know:

  • Despite an abundance of research on the subject, there is no evidence that the MMR vaccine causes autism. In fact, there exists a wealth of evidence that the vaccine is safe and does not cause autism.
  • The MMR vaccine does not cause measles and has caused no deaths in healthy children. The vaccine is not recommended for children who are immunocompromised.
  • The MMR vaccine, like all other vaccines given to children, does NOT contain mercury, or the compound thimerosal.

Your child’s pediatrician will provide guidance for scheduling vaccines, starting with Hepatitis B, given to infants at one month. In recent years, doctors have added the HPV vaccine to the recommended immunizations. This vaccine, which protects women from cervical cancer and prevents men from transmitting it, is given around age 11. Before you send your teen off to college, he or she should also be vaccinated against meningitis.

You can view the CDC’s recommended vaccine schedule for infants, children, and teens here.

Vaccines are not just for kids!

Vaccines are recommended for infants, children, teens, and adults based on a variety of factors including age, health, lifestyle, occupation, and travel. The protection from certain childhood vaccines dissipates over time, but your Primary Care Physician (PCP) will keep you up to date on any necessary boosters. General recommendations for adults include:

  • HPV vaccination for young adults (up to age 26) who did not get this vaccine as a tween or teen.
  • Tdap vaccine for adults who did not get one in their teens. In addition, women should get a Tdap vaccine with every pregnancy, preferably at 27-36 weeks of gestation.
  • Td (tetanus, diphtheria) booster shot every 10 years.
  • Yearly seasonal flu (influenza) vaccine. This is especially important for people with chronic health conditions, pregnant women, and older adults. This year, with COVID-19 still spreading around the world, a flu shot is especially critical for everyone over the age of 6 months. And despite what you may have heard, the vaccine is made from inactivated virus, so it can’t make you sick.
  • Shingles vaccine for healthy adults ages 50 and older.
  • Pneumococcal polysaccharide vaccine (PPSV23), which protects you from meningitis, bloodstream infections and other pneumococcal infections. This is recommended for all adults 65 and older, as well as for younger adults with certain health conditions.

Of course, the entire world is waiting for an effective vaccine against COVID-19, and one may be available within the next several months. Once a vaccine is approved, you can rest assured that it’s been thoroughly tested, proven to be safe and effective, and is our best bet for protecting ourselves and helping control the spread of COVID-19.

Listen to a MarinHealth podcast to learn more about the importance of vaccination.