Did you know that one-third of all cardiovascular outcomes are related to mental health, whether it’s social isolation, anger, depression or anxiety, etc.? Depression rates are three times higher in patients with heart disease.
That’s why it’s so important to take a proactive strategy to managing your mental health and well-being as part of a heart-healthy lifestyle.
Prescriptions from the Expert
Dr. Courtney Baechler serves as program director for the Minneapolis Heart Institute Foundation’s emerging science centers, including the Nolan Family Center for Cardiovascular Health, Penny Anderson Women’s Cardiovascular Center, and Global Outreach. She is a general cardiologist at Minneapolis Heart Institute® who is passionate about a healthy state of wellbeing — body, mind and spirit — and is a national leader in integrative medicine and wellness.
In the blogs below, Dr. Baechler shares practical tips, inspiration, and some of her personal practices and experiences. Originally written during the initial months of the COVID-19 pandemic, the information she shares remains critically important for all of us and our overall health and well-being, no matter what’s happening in our lives and the world.
Have you ever tried aromatherapy? It’s something cheap and easy to understand that you could easily order online today! One of the ways that our bodies learn to feel calm is by our senses. Our sense of smell is often one we forget to tap into. Our sense of smell is connected to the nervous system, which helps regulate our limbic system and ultimately helps to control our emotions.
Depending on the smell that is used, it can be a way to help calm you, control anxiety quickly, or improve nausea. It can also be stimulating and activating. Aromatherapy is something we routinely use at Abbott Northwestern Hospital.
Lavender is perhaps the most widely used scent to help calm. I prefer using an inhaler for aromatherapy, but you can also simply place some lavender oil on a cotton ball and place it on your pajamas using a safety pin to help with sleep.
Peppermint aromatherapy is something I often use in the afternoon when I feel I need something to help me feel more “alert” if you hit a 3 p.m. slump. There are lots of videos available online to help you understand how to safely use the aromatherapy option you choose.
Just like aromatherapy, we’re again talking about the power of the senses! What we hear makes a huge difference in our sense of well-being. Have you noticed when we leave the news on in the background all day long you feel a bit on edge? Here’s what we know about music:
- Music is a core function in our brain. Our bodies entrain to rhythm.
- We have a physiologic response to music. Music taps into our emotions.
- Music helps improve our attention skills.
- Music enhances learning.
- Music taps into our memories.
- Music is a social experience.
- Music is predictable, structured and organized, and our brains love that!
- Try changing what you are hearing and see how your mood changes.
This is what my day looks like for music: I have a monthly subscription to Pandora, but Spotify or others will also work. I start out with the “Chill Station Radio” or the “Coffeehouse Radio” and it makes me feel like I’m doing my work in a coffeehouse in Europe, which brings back great memories for me.
As the day moves on and I move to exercise outside, I often switch to a “hip hop station,” which for me motivates me, energizes me and makes me feel alive inside. While I’m preparing my dinner, I usually listen to “cool jazz radio.” All of these make me feel calm throughout the day and they are just there in the background helping to remind me, it’s all going to be OK.
I would emphasize this is very personal, so finding out what music is best for you is part of the fun … maybe it’s classical, alternative or punk. What matters is that it enhances your state of mind and doesn’t detract from it.
Have you ever noticed how your problems seem to melt away when you go outside? There is something about nature and its ability to recognize what’s bigger than all of us individually. This is a time where it can be ideal to take off headphones and head outside. Hear the wind, notice the signs of the season, listen to the birds, feel the crisp air, or enjoy a moment of strong sunshine.
All of these things remind us that the world is continuing to spin, that the sun is rising each day and setting each night and it truly sets an inner calm for our body. For those of you who have mobility issues or face other challenges that prevent you from getting outside on your own, move a chair into the area in your house with the most sunshine and open up a window. Even if this requires you to grab a blanket, it’s so important for our bodies.
During times of increased uncertainty and changes occurring at rapid speed, it is normal to feel slightly anxious, on edge, perhaps somewhat depressed. It’s helpful to have tools at your fingertips to help influence your mood and overall well-being. Meditation is another one of my favorites. Meditation has been shown to soothe anxiety, upgrade attention, improve mood, increase compassion, reduce stress effects, slow aging, lower pain, support mental health, manage cancer, and boost immunity.
I remember when I first started to think about a meditation practice, and it was quite overwhelming. My thoughts are busy in my head and the idea of simply being quiet and still seemed impossible. I discovered some apps like “Headspace,” which are usually five-minute meditations led by an instructor that help guide your thoughts and meditations for busy minds. Headspace has a trial period that is completely free, as well as portion of the platform that is always free.
“Calm” is another meditation app that I love. It also has a free trial period and has shorter meditations available as you begin to “train your mind.” Speaking of training, it turns out our brains are muscles, just like our quads and biceps, that need to be exercised to build up to larger endurance training. Start small — research shows that as little as five minutes of meditation can yield the effects that are listed above.
It turns out most of us are hardwired to see the world as “half empty” or “half full.” But you can actually rewire your brain to be more optimistic; it just takes some practice. This is what we call neuroplasticity — defined as the ability of the brain to form and reorganize synaptic connections, especially in response to learning, experience or following injury. By simply thinking of three things you are grateful for, and either writing them down or saying them out loud, you can actually start to rewire your brain to think differently.
My first child, Sophia, seemed to take the world and all of its problems much more seriously than her younger brother, Will. It wasn’t even a bad thing, but it was clear she was a sponge for sadness, people’s feelings, and troubles in the world. During this time, I was reading the work of psychologist Martin Seligman and his books Positive Psychology and Flourish. We started a gratitude practice at dinner each night as a family. Since Sophia was only four at the time, there was often lots of silly answers, but that’s what is so neat about gratitude — it doesn’t matter what you say or how deep it is. It’s more about the practice of reframing things.
Even during a pandemic or other crisis, practicing gratitude helps our brains produce neurohormones that keep us happy and calm. For me, it’s easiest to do a gratitude practice right before a meal because it doesn’t seem like another thing I have to do, and instead feels more like a conversation starter. Try it out and see how you feel, especially after an extra-crazy day. It only takes a few moments to help your brain realize that even in chaos, we have a lot to be grateful for.
Talking about the importance of social connection is an important area to address as we consider the best way to stay well — in body, mind and spirit. It’s not uncommon for me to “prescribe” to my patients the need to see your friends! Similar to how it may be critical for you to take your statin to lower your cholesterol, it’s equally important for us as human beings to stay socially connected, particularly through relationships where we feel comfortable being our authentic self. The former surgeon general, Dr. Vivek Murthy, said, “Loneliness and weak social connections are associated with a reduction in lifespan similar to that caused by smoking 15 cigarettes a day.”
Some of you may be familiar with Dan Buettner’s book The Blue Zones, which describes the areas in the world with the most people who lived over the age of 100. One of those areas is Okinawa, Japan. They believe one of the main reasons the people live so long and with such high quality of life is “Moai,” which is Japanese for a group of lifelong friends; a social support group that forms in order to provide varying support from social, financial, health or spiritual interests. In Okinawa, these groups start in childhood and extend into their 100s! The way they describe them is friends meeting for a “common purpose” — to gossip, experience life, share advice and even financial assistance when needed.
So … just how do we make that happen? Well, prior to the pandemic, that meant scheduling regular monthly dates with a group of high school friends, neighbors, college roommates or whoever you can be vulnerable with and let your guard down. The trick is to identify people who don’t have an ulterior motive. That’s to say – no one who secretly wants you to respond a certain way or do something for them. Find people that fill your soul from the time you have together. Just a little secret: this group usually does not include direct family members, not because you don’t love them, but because they don’t fill this specific role for you.
During a pandemic and with all the current events going on in our world, this is more important than ever. We have to be aware that everyone’s individual risk and comfort level is different depending on age, existing health conditions, beliefs, state rules, etc. But, the need to connect remains the same. This might be done through a virtual meeting, a Facetime call, a group of five people gathered in your backyard or a walk around a lake with a friend.
One of my favorite statements I saw over the summer of 2020 was “silence is violence.” Indeed, this is so much of what we saw in the peaceful protests — our need as human beings to be connected, seen, valued and heard. So pick up the phone, set a date (or two) on your calendar and make sure you make time for that group that has your back no matter what.
As we continue to strive for balance during times of distress, I can’t help but think of the role that laughter plays. After the death of my daughter, Sophia, I thought to myself, “I’ll never laugh again.” How could I possibly laugh after experiencing my biggest fear — the death of one of my children?
It was truly only two nights later and I found myself with a group of dear high school and college friends who had come to check in. As tears poured down my face with reflections of Sophia and the tragedy that had occurred, someone told a funny story from our college years and I found myself laughing. I thought to myself, “How could I possibly be laughing at the exact same time as I’m drowning in tears?” And there it was — the reality that you truly can experience both sadness and joy at the exact same moment.
Laughter has been shown to decrease stress hormones and increase immune cells and infection-fighting antibodies. By way of releasing endorphins, laughter has been shown to decrease physical pain. Laughter has also been shown to temporarily increase your heart rate and subsequently decrease your heart rate (what in medical speak we call “heart rate variability”), and subsequently result in a decrease in your blood pressure. We’re talking about something that is free and causes a boost in your immunity and improvement in your cardiovascular risk profile; I’m going to call that a win!
In Dan Buettner’s book The Blue Zones, describing the areas of the world with the most people who lived to be 100, Monterrey, Mexico was one of the areas highlighted. One of the reasons believed to be linked to Monterrey residents’ longer life span is laughter and their sense of humor.
Humor, happiness and a sense of well-being are critically interconnected. What does that mean from a practical perspective? Especially amid stressful, serious times while we all want to have the latest information, data and expert opinions on the world’s affairs, it’s also important to incorporate some moments of relief and laughter. If you have a friend who is funny and gives you belly laughs, it’s time to connect with them! Give yourself permission to enjoy humor! Add this into your health scaffolding: friends, shows, books, comedy online, even silly Tik Tok dances. Today’s prescription is for humor.
In the summer of 2020, I asked to be part of a panel on behalf of the MN chapter of the American Heart Association on “COVID-19 Community Conversations — Mental Health and Well-being” (you can watch the video here). My area was specifically focusing on mental health’s connection to heart health. I couldn’t help but think of how truly imperative information on managing our mental health is, now more than ever. In a poll done by the Washington Post at the time, 77 percent of people noted that their lives had been disrupted a lot by COVID-19, and 70 percent of people said the virus had been a source of stress for them.
Studies have shown that 32 percent of coronary artery disease is caused from depression, stress, anxiety, anger and social isolation. The Centers for Disease Control (CDC) put out this slide:
What’s most interesting to me about this figure is the idea that we aren’t always sure what causes what. That is to say, if you have ongoing mental health challenges, you are at higher risk of developing cardiac issues; meanwhile, if you have a cardiac event such a heart attack or stroke, you are also more likely to experience depression or anxiety. It truly is the phenomenon of which came first – the chicken or the egg?
Many of you might recognize my favorite phrase, “An ounce of prevention is worth a pound of cure.” As a preventive cardiologist, I think our best medicine is understanding what we are up against and mitigating risk by being aggressive with prevention. That begins with being aggressive about taking our mental health seriously and not being afraid to get help. As part of the prevention effort I’ve mentioned, it’s important that we figure out our own personal needs and don’t let any stigma stop us from getting the help we need.
After my daughter passed away, I was trying to figure out if my son, who was 5 at the time, would need to see a therapist. He seemed to be doing just fine, but a few weeks later he came home from school to tell me he went into the bathroom to cry because he didn’t know what else to do. It was at that time that he started to see an amazing children’s grief therapist.
Four years later, in the fall of 2019, he asked me what a therapist was. I told him, “That’s someone who helps your brain stay healthy, just like Mrs. Kara.” He told me all he did was play games, draw, have candy and chat and that it definitely wasn’t any of that. When we look back at some of the best tools it took to survive something “unknown,” recognizing when to get help was critical to ultimately finding joy and thriving. During any period of uncertainty, my ask to you is to be honest if you want a little help.
Feeling Calm in the Moment
I came across an article on COVID stress and the impact that it’s having on our body and I just couldn’t help but think about these messages and how we change this paradigm. COVID, unfortunately, appears to be continuing on somewhat of a course of its own. As I continue to see patients who come in with new symptoms, worsening symptoms, and concerns about both their mental health and heart health, I think, “How do we put all of this together and change our trajectory going forward?”
There’s a lot in the literature about American health compared to other countries that have the same wealth, but have greater health. In fact, compared to other countries our size and wealth, we have the lowest life expectancy at birth. Many of you might know that for the first time ever, our children are expected to have shorter life spans than us. I certainly like to see the positive sides in situations, so my suggestion for us is to commit to some actions on how we do this during COVID times to create the change we are all seeking.
I’m going to give you some strategies that I have been trying to put into play. Without having as many commutes to work, we have a little more time in our days. For me, that has given me the opportunity to eat breakfast sitting down (rather than in my car) and to start dinner a little earlier, which allows me to cook more often than before. Even my parents, who love going to dinner and supporting the restaurant business, seem to enjoy having some relaxed time at home to hide extra broccoli in meals (my dad actually told my mom he might be turning green). So, maybe you commit to trying a plant-based meal once a week? You might find that afterward you feel a sense of calm from chopping, preparing and eating such a nourishing meal.
Other friends have noted the joy they feel in seeing their kids over the lunch hour. Many have told me they are able to effectively meet their demands at work, and the opportunity for a 15-minute break seeing their kids or heading on a quick walk together has brought some additional calm and joy. Turns out those connections really add up to helping us feel positive about our day.
I have also heard and experienced people exploring Minnesota in new ways with changes in travel plans. After living near Minnehaha Creek for more than six years, I tubed the creek with my son for the first time. I saw new areas in my own backyard and got to have a fun, first experience with my son without leaving the state.
We know new experiences, optimism, purpose and nourishing foods all help create a sense of calm in a chaotic environment. I have learned the hard way that we have much less control than we think we do, but these ideas help us feel calm in the moment. Peace does not mean to be in a place where there is no noise, trouble, or hard work. It means to be in the midst of all those things and still be calm in your heart. My question to all of you: What can you do today to change this trajectory going forward, not just for COVID times, but for generations to come?
Finally, the right step for you might be to ask for help. Why is it so hard for us to do that even when it’s about our health? I want to remind you that there are more ways then ever to get help from professionals (over the phone, over video, and in-person).
As they say on the airplanes, remember to put your oxygen mask on first before you assist others. Taking care of yourself first gives you the opportunity to take care of all those you love. I’m looking forward to the day when we see an article run about the positive change in U.S. life expectancy and I hope you will join me on this journey.
A Recipe for Good Sleep
As we continue to settle into this potential “new normal” I have had my friends and patients discussing how much their sleep has been disrupted by this pandemic. It’s fairly common that many of my patients who experience palpitations (or irregular heart beats) will tell me that they find themselves waking up between 3 and 5 in the morning with this irregularity in their chest. I would be lying if I didn’t admit that I have found myself up in these early hours more frequently than before, thinking about what lies ahead.
As I have brushed off my own best practices for disturbed sleep, I thought it might be good to share some perspective on sleep.
In case you are doubting how powerful therapeutic sleep is, let’s remind ourselves of the tremendous value of good sleep. Ample sleep increases our immunity, improves our mood, lowers our stress levels and improves our blood pressure. These minimize our chance of ever contracting COVID-19 or if we do, this also helps to maximize our chance of a good outcome. It’s OK to feel like you might need a little tune-up to help with sleep. In times like this, none of us should be surprised if our sleep is a little “off.” High stress, changes in daytime schedules, and more sedentary lifestyles are all a recipe to decrease good sleep.
Here are some tips that I use myself:
- Non-addictive sleep promoters can be helpful. L-theanine is a natural supplement that I often use with patients. While it’s always best to check with your doctor, for most people, 100 mg twice a day of L-theanine helps the body calm, decreases anxiety without harmful side effects, and promotes good sleep.
- Sleepy time tea is also a great ritual to help give the body natural herbs that promote sleep and relaxation, as well as creating some time for your body to calm.
- Lavender aromatherapy can also be helpful. Putting this on a pillow or simply using a diffuser prior to sleep can help promote calm.
- Keeping a pad of paper by your pillow just in case you wake up with a “to-do” that you find yourself trying to remember can also be helpful. The goal here is to help your mind relax and let go of anything you are trying to commit to memory.
- If you do find yourself awake in the middle of the night, try not to look at a clock or reach for your phone. The blue light that is emitted will stimulate your senses further and promote awakening. Try to take 10 deep breaths; this works best for me. By the time I get to 3 or 4, I usually fall back asleep. If you have a meditation practice, this can also be helpful to get you back into sleep.
- Finally, it’s not a bad idea to invest in some new bedding, sheets, or pillows. Sometimes, if you feel like you are in a sleeping rut, creating a new sanctuary is the way to go to help your body erase bad habits.
Find Your Escape
As someone who loves travel, COVID has been challenging for me; I often use travel as my “escape.” I enjoy the life I have created, but sometimes leaving my usual routine allows me to break free from habits I have created in my day-to-day life.
My favorite adventures are to far-away places I have yet to explore. I love smaller cities that have a town center with a few restaurants, pubs, bakeries, and shops where you can get an idea of what the culture is like after a week or so of exploring. During the pandemic, there seems to be more time for introspection into why I enjoy it so much. Much like being a doctor, what I like about travel is learning how different people live, imagining what it would be like to live in that location, comparing it to how I live, and thinking about what things I might want to try and incorporate into my own life.
Recently, I traveled to a tiny town in Wisconsin to do just this. In general, when I have the opportunity to get on a plane and travel, I wouldn’t have expected a weekend in Wisconsin to deliver the escape that I experienced. I found it fascinating to learn that generations of families have been coming to a small lake I visited for nearly 100 years! It wasn’t fancy and there weren’t a lot of places “to go,” but it truly offered an escape. The kids spent hours swimming and playing king or queen on the floating dock. Adults went for walks, greeting everyone we encountered – any age, any political party – realizing that we all shared love for this beautiful space.
We stopped at a café in a tiny town on the way home. While it wasn’t a European city, I found I was having the same reflections and thinking about how this little café was able to make it during COVID. I thought about all the steps they were taking to be safe and how similar this time is for all of us despite the vast difference in lifestyles. I was pleasantly surprised at how much this weekend filled that needed “escape” for me in a safe way during this pandemic.
For those of you seeking something similar, I would encourage you to think about all the potential day trips or weekend trips that can safely be done during this time in Minnesota or our neighboring states. I have heard from many friends who have had the opportunity to do the same, that perhaps the best part of this “escape” is feeling normal in a time where everything feels different. Here’s to the adventures ahead!