Podcast: Supporting Your Mind Through Diet & Exercise

Jenn talks to Dr. Marni Chanoff about the impact of diet and exercise on our mind. Marni shares how sleep can affect our mental and physical health and provides tips to involve everyone in the family in healthier routines without feeling overwhelmed by new habits.

Marni Chanoff, MD, is an integrative psychiatrist combining Western psychiatry practices, Eastern approaches, nutritional psychiatry, and culinary and lifestyle medicine. Dr. Chanoff founded and directs the integrative wellness group at McLean OnTrack, where she is also a clinical associate. In addition, she has a clinical and consulting private practice in Cambridge, Massachusetts, and writes and lectures nationally on bipolar disorder, anxiety, and depression.

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Episode Transcript

Jenn: Welcome to Mindful Things.

The Mindful Things podcast is brought to you by the Deconstructing Stigma team at McLean Hospital. You can help us change attitudes about mental health by visiting deconstructingstigma.org. Now on to the show.

Hi folks. So good morning, good afternoon, good evening to you wherever you’re joining us from in the world, whatever time it is, whatever the weather looks like there. Thank you for joining to talk all about “Supporting a Healthy Mind Through Diet & Exercise” and sleep. I’m Jenn Kearney, I’m a digital communications manager for McLean Hospital.

I’m joined today by Dr. Marni Chanoff, who is just a ray of sunshine in a very cold Boston winter so far. For a lot of folks that are tuning in, I’m sure that you have heard that diet, sleep, and exercise have been referred to by a lot of clinicians as the pillars of mental health. And they’re really not wrong.

Sleeping well, moving regularly, eating healthily. Those can all contribute to overall better wellbeing, and it could also lead to better lifelong habits if they’re practiced by young adults and even fully grown adults.

But I am really excited to have Marni here to talk with me all about the impact of diet and exercise and sleep on our minds, ways that we can be healthier without getting really overwhelmed by new habits, ‘cause that can happen pretty quickly and some strategies to get everybody in the family on board with being healthier.

So if you are unfamiliar with Marni Chanoff, I have the distinct pleasure of introducing you to her. And I am so excited to do so. So Marni Chanoff, MD, is an integrative psychiatrist that combines Western psychiatry practices, Eastern approaches, nutritional psychiatry, and culinary and lifestyle medicine.

In addition, she has a clinical and consulting private practice in Cambridge, Massachusetts, also writes and lectures nationally on bipolar disorder, anxiety, and depression. And as if she doesn’t already do enough in a day, she also founded and directs the integrative wellness group at McLean OnTrack, where she’s a clinical associate.

So Marni, I’m so excited to have you back. I know we’re recording this in early 2022, but so I haven’t seen you since last year, and it’s nice to see you. I wanted to get started just by asking, what are the benefits of having healthy dietary habits, exercise, good sleep hygiene, not just on our mental health, but our overall health?

Marni: So, we’re in a pretty great place right now in terms of having research to support these recommendations that we all should be moving and eating well and sleeping well to support our mental health. And there is science out there now supporting these basic lifestyle recommendations.

It’s always important for me to sort of pause when I say that, because, in the modern kind of medical and mental health world, we sort of look at this as like, wow, this is exciting and well actually, people have known this for thousands of years and food and diet and sleep and exercise have been the pillars of good mental, since the beginning of time.

But now we have enough research out there to actually say, so now it’s validated by our own standards in Western medicine, but these are not new concepts. Since the beginning of time we have, we are designed and we function best when we are eating well and moving and sleeping well.

So finding time, because now we have all this research and people are sort of willing to get behind it, to start recommending it along with the other, more sort of modern medications and other therapies we have.

But it is clear that diet impacts mood and can have a positive role in turning around the regular dips in mood, or even low-lying depression or more significant major depression. And it is also clear that exercise, aerobic exercise can be a very good contributor to anxiety and depression and stress and insomnia, and it goes on and on and on.

So if we go back in time, the data is there, and if we look at our current body of research, the data is also there. This is really significant.

Jenn: So can you elaborate on some of that evidence about specific foods or nutrients lessening some of the symptoms, or I would say improving some of the symptoms of some mental health conditions like I know you had mentioned depression and anxiety. Can you elaborate on that a little more?

Marni: Yeah, so I get a little hesitant to start putting out very specific recommendations for this nutrient and that nutrient.

What I think is actually very important for people to understand is that the evidence supports a whole foods diet, much aligned with the Mediterranean diet, but it’s actually not a diet, it’s a pattern of eating, over a long period of time that is sustainable.

That is what’s most important. So I want to just make from the beginning, a distinction between a pattern of eating and a way of living compared to a diet or specific nutrients or specific supplements.

The data shows through recent studies over the last few years, that if you can follow something that is most aligned with the Mediterranean diet, you have a good chance of turning around depressive symptoms. And so what is that? What are we talking about?

We’re talking about a diet that is plant forward. You don’t have to be a vegetarian. You don’t have to be vegan, but you’re getting a lot of your nutrients from vegetables and fruit. You can also eat meat and actually having some meat in many people’s diets is actually very helpful.

So that’s always a very important distinction to make. You want to have a lot of leafy greens. You want to have enough protein to support a healthy physical body. That’s very important, so it’s, if you are vegetarian, then you have to think about where you’re getting your proteins in the form of beans and legumes and seeds and things like that. But meat is okay. And fish, fish is actually great.

So if you can have fish at least once, maybe a few times a week, that will support a good mental health diet. The other thing, is you want to get really good healthy fats in your diet. So we have moved away from the fat-free diet.

We have moved away from even, you need to have a low-fat diet. It’s less about how much fat you’re eating, it’s more about what kinds of fats you’re eating. And if you can get in healthy fats, healthy oils like olive oil, avocado, nuts, seeds, things like that.

Then those are going to be healthy fats to get in the diet. So fruits, vegetables, lean proteins, fish, seafood. Seafood is actually at the top of the list, believe it or not.

So there have been psychiatrist, Dr. Drew Ramsey and his colleague, Dr. LaChance who did a study. And they put together a list of foods that seem to have antidepressant effects and at the top of their list, were actually seafood and at the top of that list were oysters.

So not everyone eats oysters, not everyone likes oysters, not everyone can afford to eat oysters, but you get the idea. If you can have lots of good healthy seafood, fish in your diet, lean proteins, lots of fruits and vegetables, healthy fats, nuts and seeds. You’re in pretty good shape.

Jenn: One thing that I can’t help, but think of as we’re recording the session, it’s right around the new year. And most people will make resolutions of I’m going to go on a diet.

I’m going to get, this is the year I’m going to clean up my eating. I’m just going to do better, but why are diets overall just so difficult for us to mentally adhere to? ‘Cause every time I think of one, I’m like, oh God, this is my Everest, I just want some french fries.

Marni: Yeah, because we seek comfort and we need to be satisfied. And if we’re going to do something for the long run, which is really what we’re talking about, we’re talking about creating sustainable change. We have to feel satisfied. We have to feel nourished. We have to enjoy what we’re eating.

Food should be delicious. Food is such a wonderful part of our lives and it should not be a source of deprivation. And I think, I mean, that’s the nice thing about this way of eating. It’s actually, it’s delicious in my opinion.

And I think most people who slowly move in this direction realize there’s lots of things that they can find or make simply that are actually very, very flavorful, very tasty, very satisfying.

We have to decondition ourselves away from, the marketing campaigns around junk food and around processed food and around like eating processed food and fast food is one of the greatest ways to enjoy life, or as a source of happiness.

It doesn’t have to be, sure if you want your french fries once in a while, enjoy them, but make sure you really enjoy them. Like eat them slowly, make sure you turn your screens off. Don’t eat them while you’re like trying to get some emails out, like really be with those french fries.

And then if you have kind of experience, it’s like, well, how often do you need the french fries? Maybe having french fries every once in a while is more celebratory or a real treat rather than day-to-day sustenance. And that’s the biggest distinction.

So when you’re thinking about a way of eating, you want to set yourself up right. And so the way I like to think about this is, do your research come up with your list of foods that feel like I can do this.

Like this doesn’t feel like it would be depriving to me, or like, I’m interested in this, let me try one thing or two at a time and slowly, slowly make the changes and slowly integrate them into your way of life. And keep it simple. The more simple it is, the more likely you’re going to be able to keep it up.

Jenn: So thinking about if what we eat can affect our mental health, how can we encourage if say like a partner or a child is a picky eater, how can we encourage them to either try new things or just simply be a little bit more open-minded about what they’re eating.

I wanted to ask this question of you, because I know you’re a therapist, you have a clinical practice. I’m sure that when you’re trying to incorporate the nutrition aspect into it, you probably get pushback from some of your patients, right?

Marni: Yeah. Yeah. And certainly even my own kids. My kids are like “No more soup.” “No more,” since I love especially this time of year, just to throw things in a pot and lentil soup and all kinds of and they’re like, “No more soup.”

So I get lots of pushback and I get it, I get it. It’s not exactly what they’re sort of hearing from their friends that they’re eating. If I hear what their friends are bringing to lunch, it’s like, okay, well then I have to explain why they’re not bringing that to lunch and not that those foods are bad, not an everyday kind of go to.

So there’s a difference. And I actually liked this concept that the years, and it really resonated with me and I like to share it with people and the concept is that there’s a difference between everyday eating, like what you eat Monday through Friday, to get you through your breakfast and your lunch and your dinner and your very busy, busy, busy lives.

Or when you’re not feeling like cooking. And you’re not feeling like shopping. Just to get you through. And then there’s the idea of celebratory foods. What are your favorite foods? What are your comfort foods?

What are the foods that remind you of your family, your culture, your traditions that really fill you up with joy and satisfaction and nourishment, not just nourishment in the belly, but nourishment in the heart and soul and mind?

And to think about the difference, like how often do you need those celebratory foods? Can you save them for real celebratory occasions and then to make a distinction between that way of eating and your day to day nourishment and grabbing things when you are really busy and on the go? To me, I don’t know if that resonates with you like it did with me, but it really makes sense to me.

Jenn: So I want to talk, I know we talked a lot about diet so far. I want to talk about exercise. We’ll transition into talking about sleep because it all culminates into, the 360 impact on your mental health, but chemically, how does exercise actually improve our mood?

I’m a distance runner. I have heard people talk about the runners high. I’ve never achieved that. So for me, I feel like there’s a little bit of myth behind it, but chemically, there’s got to be some explanation. People are happier when they exercise that seems like it’s not an urban myth.

Marni: Well, it seems that the exercise will increase the circulation in the body. It increases circulation to the mind and it interacts with our stress response system. And so it can help really decrease that kind of stress response that a lot of us are walking around with or sitting in front of our computers with a lot of the time.

So that increase in cortisol that chronic stress level, which can actually...anxiety and in a chronic way, if it’s not really reversed, it can lead to depletion and depression.

So interacting with that stress response system, and it’s decreasing that stress response system, it’s increasing the circulation to the brain. It’s increasing all of those good chemicals in the brain to allow you to be more resilient. It also, exercise is known to have a real impact on your sleep and your quality of sleep.

So, and we know the impact of sleep on mood. It’s one of the pillars, as you said. So you’re getting a lot of benefit, whether it’s directly through the chemicals in the brain or the kind of the ripple effect of what exercise can do in both ways you’re getting benefit.

Jenn: So ideally how much exercise should we be getting a week? I know that there’s been rules of thumb that say 10,000 steps a day. For me, I’m a little short that ends up being about six miles a day.

It seems like a lot when you’re working full time, 30 minutes a day is a doctor prescribed. What are your thoughts on what would be an adequate amount of exercise to be doing on a regular basis?

Marni: So if you can get 30 minutes of aerobic exercise in a few days a week, like four days, four to five days a week, you’re in pretty good shape. And that’s for the mental health part of it. You also want to get good resistance training in.

As you get older, you lose more and more muscle mass. So you really want to get that resistance training, to keep up your muscle in the body, to help you feel strong and fit and capable. And it increases bone density and all of that.

But the recommendation that I like to use comes from the CDC, and this is not just for mental health, but this is for overall health. And that is that we do best if we can get 150 minutes a week of moderate exercise, and that can come in small little chunks, it can come in larger chunks.

You have freedom in how you get to your 150, but it does average out to the recommendation for mental health, which is about, let’s call it five 30 minute sessions a week. And the moderate part means that it’s aerobic.

So what do we say? So there’s the moderate meaning that if you are jogging or you’re walking briskly, you can still have a conversation, but you’re walking at a high enough rate where it would be hard to sing, that’s moderate.

If you are a runner like yourself and you can get to vigorous exercise, then you actually cut that requirement in half. And the recommendation is 75 minutes a week of vigorous exercise. And what does vigorous mean?

Vigorous is thought to be that you can’t sing just like in moderate exercise, but you also can’t talk. You’re like huffing and puffing enough where you are working it. And it would be really hard to have a conversation at the same time.

They also recommend at least two days a week of resistance training or strength training to go along with the aerobic exercise. And the aerobic exercise can come in all kinds of forms. It can come, whatever you like best it can come in brisk walking, jogging, or running, it can come in rowing.

There are some people who like to do more moderate forms of yoga or Pilates and things like that. As long as you are feeling like your kind of your heart rate is up, you’re breathing heavier and you’re in that range, then you do what you love ‘cause the more you love it, the more you’ll do it.

Jenn: I wanted to ask you about, I know we’ve talked about ways to incorporate better eating habits into our lives, start small. Does the same principle apply to incorporating exercise?

And I know it’s easy for folks to get overwhelmed because powering through a bowl of broccoli is a little bit different than getting through 20 minutes of weightlifting and then you hurt for three days after. So do you have any advice for the folks who are just starting off on their fitness journeys?

Marni: Definitely like any change, I think recognizing that, putting something new into place is hard. It’s very challenging to change our routines and our rhythms, and to give yourself lots of space and grace, as you start to make these changes, start small.

You go for a walk around the block, you go for a 10 minute moderate, moderately paced walk, go to somewhere where you love. If you can take a walk and be around nature, even if it’s winter time, even better, make it enjoyable. Sometimes that’s not motivating enough for people to get out and put their clothes on and move.

So one of the tricks is to try to incorporate walking into your weekly rhythm. So that could mean if you’re taking the train to work, you get off two stops earlier and add in a 10 minute walk. If you’re going to the grocery store, try just parking instead of the closest parking spot you can find at the store, parking all the way in the back of the lot.

Add in a 10 minute walk there, see how that feels. Keep it small, keep it sweet. Know that it’s going to take practice, know that it’s not going to go swimmingly well in the beginning and just give yourself space and time to try new things until you figure out the thing that works for you, which is going to be different than the thing that works for other people around you and that’s okay.

Jenn: Is there any suggested time of day that folks should be working out? Should they be doing it in the morning is it better to do it in the afternoon, the evening? What are your thoughts or are you familiar with any evidence about when people should exercise?

Marni: So there is evidence looking at morning exercise as like a really great goal. And traditionally people did get up with the sun or before the sun and got their exercise in first thing in the morning.

One of the things that I’ve studied in practice is ayurvedic medicine, which is a 5,000 year old medicine from India. And the recommendation, is to get your exercise in, in the morning.

There are not many people I know who wake up at 5:00 am or 5:30 or 6:00 am and get in their exercise before they have to get their house ready, their kids ready, get in the shower, eat their breakfast, have a healthy breakfast, pack a lunch, all of that thing and get to work on time.

Now, of course, with COVID, everything is mixed up. And so a lot of us are trying to find new routines or maybe they’re not so new anymore. I say, just do it. If it works for you, when are you most likely to do it?

Like we don’t have to be so specific, especially in the beginning, just do it when you’re going to remember, and when you’re most likely to be successful and that’s when you should exercise. And it could be any point in time.

Jenn: One of the things that I know that refers to a lot of healthy eating is making sure that you’re being really aware of what’s going in your body. So not watching TV, not playing on your phone, just really being attuned to what you’re eating is the same principle applicable to exercise?

Or is that something that if we want to be texting a friend while we’re doing it or catching up on emails, that doesn’t actually really detract from what we’re getting out of the exercise regimen.

Marni: So if you’re on a treadmill watching your favorite show and that show and that’s, the only time of day that you can watch that show and that show makes you super happy and makes you really motivated to keep moving on the treadmill, fine.

Are you getting all the benefits in terms of having a very mindful experience in the body, being in the body, listening to your body, enjoying the movement and being kind of enamored with how the body works and all of those amazing things, or paying really attention, good attention to your breath cycle and how good it feels to be taking in that oxygen and really breathing deeply while you’re exercising?

You’re going to miss out on a lot of that. Is that essential for getting all of the heart health, mental health benefits of aerobic activity? I don’t think so. Is it the gravy? Yes.

But if you’re not going to go out there for that walk we’re talking about where you’re looking at the trees and you’re taking a nature and you’re breathing and you’re like loving life in that body of yours and that mind of yours, do what works for you because the most important thing is to do it.

Jenn: I want to talk a little bit about some of the Eastern medicine practices as well. Are you familiar with any impacts of acupuncture on mental health conditions or just improving overall health?

Marni: I am not an expert on acupuncture. So I’m going to decline to answer that. I don’t want to answer it incorrectly. My understanding is acupuncture can help with stress and insomnia. Have I reviewed that data on depression and anxiety? I have not.

Jenn: Good enough answer. We definitely don’t want you to be telling tales out of school. Can you talk a little bit about the mental health benefits of meditation? Is that something that you’re very fluent in?

Marni: Meditation can be very helpful for, again, working with the stress response. So there is a term called the relaxation response. I don’t know if this is something we’ve talked about before in some of our other conversations. The relaxation response--

Jenn: We have.

Marni: We have. Yeah.

Jenn: I think so, but I think any refresher course I will gladly take at this point.

Marni: So the relaxation response, it was, a term coined in the seventies by Herbert Benson. And what he did was he took these age old practices that are in traditional medicine, like meditation, some forms of yoga that people have been doing for thousands of years to relax and calm the mind and calm the body and focus and concentrate.

And he took it to the lab and studied it in the lab. And what he saw was that these, if you’re able to stick with the practice and focus on your breath, for instance, as one option, that you actually have the ability to tap into your autonomic nervous system, and you have the ability to tap into your own rest and digest or parasympathetic nervous system.

You have the ability to decrease your heart rate and decrease your blood pressure and overall have a sense of wellbeing. And that can come from meditation that can come from various breathing exercises, that can come with a mindful walk, that can come with practicing mindfulness, but not meditating.

There’s different ways that you can get to that point. But the really cool concept is if you can train yourself, to just be able to sit calmly or walk calmly. Some people can’t sit no matter what, they’re like “I just don’t sit.”

So for you, I don’t know what your experience is, but you might actually do much better with just a nice rhythmic, slow walking meditation. And for you that might look like more like just feeling what it feels like to have your feet touch the ground. And one of them great mindfulness tools is to just tap into your different senses.

And this is a form of meditation too. What are, are there three things that on your mindful walk that you can see and you’re like focusing on your vision, are there three things that you can hear? Are there three things that you can smell?

You can, even if you’re not smelling something and that you can take something because the more you can engage your sensory system, the less active, these very, very busy, busy, busy parts of our mind are, the ruminating, the obsessions, the preoccupation, the mood, the strategizing, the organizing, all of those things that make us humans and make us totally high functioning people.

We need to figure out when we need that to be on. And when we need to really decrease that so that we could be more calm, relaxed in the body. And if you can get to that place, it can be very, very beneficial for both mental and physical health.

Jenn: I’m sure there are a hefty amount of folks tuning in that just can’t get their minds to quiet down. There’s a lot going on all the time. We feel like we always need to be connected and engaged. How do we get started on that shutting our brains off process, starting to incorporate meditation into a part of a daily wellness practice?

Marni: Well, I think you have to first start to get a little bit more used to not being stimulated all the time, which is really challenging right now. So shutting things down, shutting down the screens, shutting down the phones, shutting all of that high, high, high stimulation that you’re taking in all day, all the time and slowly de kind of stimulating the mind.

And again, it’s like the change with exercise and diet. If you go cold turkey, people are going to be walking around the house jonesing for their next fix, their next screen fix. And that’s what happens.

So you slowly want to move towards more of a daily routine and a weekly routine that you’re taking breaks from those things. And just by doing that, your brain will start to settle.

Then if you can start to, increase that time in quiet, maybe dimming the lights, focusing on the breath, focusing on being in the body, focusing on the sensory system, then you’re going to really slowly, slowly start to give yourself the various sort of inputs to counteract that high, high, high stimulation that we’re so used to.

Jenn: I want to talk some about sleep. We had somebody write in saying that their child exercises daily and practices meditation, but dreads going to bed due to the fact that they have a racing mind. Do you have any recommendations for an anxious teen who struggles to sleep due to these racing negative thoughts at night?

Marni: Well, I think, you know, thinking about, why the teen has these racing, negative thoughts. I mean, there’s so many reasons right now that teens are struggling, but even before this pandemic, teens also, struggled and to think about what’s going on for the teen. Is there something that hasn’t been diagnosed that needs to be better understood?

Is there a depression? Depression can lead to negative racing thoughts. Is there anxiety? Which can also lead to that. So really, as a psychiatrist, I have to think first about what is this? Is this regular stress? Is this something else that needs to be addressed by a professional?

That can be hard to distinguish one from the other, but after you’ve done that, and you’re assuming that this is more something that needs to be addressed behaviorally, it could be that distracting the mind before sleep would be much better for that particular person than just going to bed in the dark and then having to lie there with their negative racing thoughts.

So is there a way to help them ease into the night? Reading something can be very helpful to distract the mind from the negative racing thoughts. And it’s not a screen, not reading on a screen, but actually reading a book, that kind of thing, a dim light, a book or a magazine, something that is not so, so high content to start helping to relax the mind.

If they’re not a reader, going to sleep with soft music can be a way to focus the mind on the music and not on the negative racing thoughts. Making sure that they’re doing that good sleep hygiene of shutting all their screens down at least an hour. I find two hours before bed is even more effective than one hour.

I don’t know if that’s possible for most people, especially teens. If the teen is up worrying a lot around schoolwork or friends or social pressures to really have a diversion from that, if you can shut that down earlier in the evening and have them focus on things that are lighter or less angst producing way before they try to go to sleep, that would be very helpful.

Sometimes engaging the body like with a hot bath or a hot shower can really be very calming. So you want to work with the mind and the body for people who are very agitated, feeling, not just restless in the mind, but also feeling restless in the body.

Working with the body at night can be very helpful. A hot bath, a hot shower, sleep yoga can be helpful. Listening to a meditation and audio track can be helpful. There’s actually a form of meditation that comes from the yoga tradition called yoga nidra, and that’s you’ll get sleep.

So that’s a way to not just say, go to bed, shut off your screens, turn out your lights and just lie there with your thoughts, but you’re giving them other things to pay attention to. And slowly, slowly decrease the racing negative thoughts.

Jenn: I know you had mentioned trying to get off a phone or a screen an hour or two before going to bed. What are some ways that you have found to be helpful for doing that? Because I know every time I’ve tried to do it, it’s I reach for it. I text somebody, I check my email. It seems like it’s a habit. It’s one of the hardest habits to break in my opinion.

Marni: Yeah, no I’m with you. Totally. I think it’s just figuring it out for yourself, putting it in a different room, learning how to pick up books again and not reading the newspaper and all about the COVID data right before bed, not reading the headlines are really hard to read right now.

If you’re consuming that news right before you go to bed, that’s tough stuff to digest and you might be waking up in the middle of the night, thinking about what you just consumed, because what I find and what I think a lot of people know to be true is like, as you’re taking in all of the stimulation during the day, you need time to process that the mind needs time to process, to digest, to compartmentalize.

And you have to give it that time. If I don’t give myself that time in the evening, before I try to go to sleep, I’m up at 3:00 am processing. So the only way I know how to live is just, I need to be able to process and digest all of the things I’m thinking about and doing during the day. And so if you can think about ways you do that.

So whether it’s taking a bath, taking a walk, journaling, reading, listening to music, playing a game of cards with your partner or your family member, just keep trying, doing a puzzle in the evening. And if you need to check your phone here and there, because you can’t like, that’s a part of us.

That’s going to take time and you don’t want to beat yourself up over it, but that’s different than sitting there and scrolling and scrolling and scrolling or reading headlines, headlines, headlines, and then being like, oh, it’s 10:30 time to go to sleep. It’s a different thing.

Jenn: So what does regularly disrupted sleep do to our mental health over time? And how can we improve our sleeping habits? I know it’s technically two questions rolled into one, but felt they were related.

Marni: How can we improve our sleeping habits? Well, the A number one thing that comes out of the sleep hygiene literature is you want to be really consistent with your, the timing of your sleep. So you want to get into a really good sleep routine.

You want to go to bed at the same time every night. You want to do the same things every night before you turn the lights out. You really want to get very serious about your sleep rhythm and routine. You want to set the alarm for the same time every morning.

On weekends, okay, fine, these things we want to give ourselves some give on the weekends, but you know how it is. If you sleep till noon on Sunday, your normal sleep time at 10:00 pm or 10:30 Sunday night, isn’t going to, you’re not going to be ready to go to sleep.

So even on the weekends, if you can stick to somewhat of that same routine, you’re going to really do well. So sleep routine, sleep rhythm’s huge. All the things we talked about will help.

The other thing is people find that, if they’re drinking alcohol like that glass of wine with dinner, or going out with friends to the bar or whatever, alcohol can really impact the quality of sleep.

And that is unfortunately something that people learn the hard way and can take years to accept and give up, especially when you get older in your forties and you’re like, oh my gosh.

But people get there and they’re like, I just know that if I’m going to have two drinks at dinner or after I’m just not going to sleep well, and then you have to do that calculation for yourself, of how important that is for you that particular night or whatever.

So those things are the big ones. I actually, I don’t know how old, what the demographics are of our audience today, but I will say that as you get older, you also want to take care of your bladder.

So, people tend to forget to hydrate during the day and then they’re making up for it at night and people will tell me, but I’m so thirsty at night. I was like, well, how much water did you drink that morning? How many glasses have you had before 6:00 pm? You, of course, you’re thirsty. People are like, I have only had coffee today. Like, well, of course thirsty.

So, but if you start loading on your hydration in the evening, you’re going to relieve your bladder in the middle of the night. So I think that this is often one that’s a little overlooked especially for older people, where I say front load your water.

When you wake up in the morning, have a glass, maybe two glasses of water, get it in. Then you’re replenishing your hydration from the whole night of not drinking. And then get your eight glasses in if you can, in the afternoon into the evening and then try not to have anything to drink after dinner time.

And if you can just take sips of water, if you take meds at night, just take sips, try not to do the gulping, because you will have to wake up in the middle of the night. And if you have to wake up in the middle of the night to relieve your bladder, and you’re already in an anxious state or depressed state, it’s going to be much harder for you to fall back asleep.

Jenn: So we had someone write in saying, I’m a provider that works with many clients who regularly use caffeine and alcohol, both of which affect moods and their ability to fall asleep and stay asleep like you’ve mentioned.

Any suggestions for the provider to help their clients better understand the roles that both substances are playing in their wellness?

Marni: Well, I think we have to do a good job of being direct and just giving people the data, like the data is clear. Like these caffeine will absolutely affect your ability to sleep well at night.

Don’t take it away from them, like for most people, like maybe one cup of coffee in the morning, but again, be with that cup of coffee, like really enjoy, like wake up a good 15, 20 minutes early, so you can really just sit with your nice cup of coffee.

Encourage that, but try to keep it to one, maybe two, and then you’re done. And then you can find other ways of soothing yourself throughout the day besides the caffeine. And of course the alcohol can be hard or even harder for people to start to move away from.

So I think, we have to do a good job of as providers of giving the evidence, not sugarcoating it, being direct. And at the same time, recognizing how hard it is for people to give these things up.

People are very much attached to their coffee and very much attached and in some ways dependent on caffeine and alcohol. And so you have to be aware that just lecturing someone and being like, you shouldn’t do that, isn’t going to work.

So we take kind of motivational interviewing approach, taking an approach of curiosity. I’m really interested to hear what is your current relationship with coffee? Like, tell me about it. What do you love about it? What does it help you with? What do you perceive it? What are the perceived benefits of your coffee?

And validate that and make plenty of space for how wonderful coffee is and then you also make space for. So, and what are the ways that you think it’s actually not serving you?

Are there any, there may be not, maybe you think that’s like a hundred percent great, but maybe there’s a couple that you can imagine and some people are reluctant to say anything, but many people will be like, oh yeah I get that jittery feeling.

feel really like racy or I feel a little agitated and I know when I’ve had too much and, oh, that’s so interesting. How do you know when it’s been too much? What are your cues? Tell me about that.

And this is kind of the problem in medicine right now is like, people don’t necessarily have time to do these deeper dives into people’s habits and routines and decisions, but that’s really what it takes, because then you can reflect that back and say, well, okay, so let me, so this is what you just told me.

I’m hearing that this helps you become really, really productive during the day and you’re afraid you’re not going to be able to do your job without it. But I’m also hearing that you’re agitated and you have to get up and pace throughout the day, at least every 15 minutes.

So can we look at those two things and you’re really engaging them in a process of curiosity and openness, and you don’t want to do the shame game because it just shuts it all down and people leave feeling bad and humiliated. How do you keep them engaging and keep coming back to the conversation?

And then I like to ask people to become their own mad scientist. What would it be like if you just had two cups instead of three cups, can you try that? What would it be like for you to try that? How ready are you to make that kind of change? And can we talk about it next time? I’m really curious to hear how that works for you.

Jenn: I only started laughing in the middle of your explanation because I felt like I was having motivational interviewing done to me. Like I thought you were actually speaking what I was thinking.

So I have a very unhealthy relationship with how much I love coffee, but I am actively working on it in 2022. We did have someone write in asking, what does drinking water do for our health and that they always feel better after drinking water, but they really only get thirsty if they’ve been exercising?

Marni: They don’t feel thirst unless they’ve exercised. Well, so what does water do? Water rehydrates the body, water rehydrates every cell of the body, water it’s, we are made of water, we need water to function.

Water just helps the body function. And it just does and on every level, we just need to be hydrated. Why is it that some people feel more thirsty without consuming much water? I’m not sure I have like a scientific answer for that.

But what I can say is that if you’re not used to tuning into your experience of thirst, then you may be missing all of the bodily cues that tell you, you are thirsty. Like right now, if I really pay attention to what’s happening, maybe Jenn you can do it too.

You really pay attention and again, this is that mindfulness and you focus your mind away from the computer screen, and you just really focus on what’s happening in the mouth. You actually can start to pay attention to the nuances and you realize, actually that does feel a little dry, and then you can experiment.

Well, what does it feel like if I have, like a half a cup of water, and then you’re like, oh, that feel really, really good. And if you can train your mind to distract from all of the distractions and stimulations throughout the day, and instead focus on what’s happening internally, in this case, in the mouth, then you might be a little bit more cued into what your body actually needs.

Jenn: Someone did write in saying, no matter what they do, they can’t get enough water in a day. Do you have any foolproof ways to get more ounces of water in, on a regular basis?

Marni: So like I said, I like to start my day and this actually came again from my ayurveda training is when I wake up in the morning, I get a full glass of water and sometimes I’ll take two. And then I’m like, I know I’ve gotten that a good head start for the day. I like to have a water bottle.

And I think that if you know, how many ounces are in that bottle and you know how that compares to like the eight to 10 glasses a day, quantifying how many bottles you need to drink a day can be very helpful.

Instead of keeping track of eight to 10 units throughout the day, you’re keeping track of maybe two to three and you know that you keep it by your desk or you keep it in the car or you keep it in your backpack. And you are just in relationship with your water bottle. And you’re also paying attention to your cues.

You’re making sure that you’re drinking after your meals. If you’re known to not drink much, maybe making a larger glass of water rather than a cup. The other thing I will say is that when it’s really cold out, it can be really hard to drink these icy ice cold drinks that people are conditioned to drink.

I have switched to drinking warm water in the winter and in the colder months. And I find it really soothing. It actually replaces the desire for coffee and caffeine. That’s associated with holding that hot, luscious cup of coffee. Now I can hold a hot cup of water and it’s like soothing and hydrating and warming. And it really works for me.

So getting creative with your water. So one, keeping track of it through a water bottle, some people like to buy the water bottles that have lines on them and they’re really recording, but then, the other thing that can be nice is having fun with like, at the end of the day, some people will grab a glass of wine.

You can grab like a glass of seltzer and put a splash of juice in it and so that counts. Hot tea, bubble tea, something that isn’t so dehydrating with a lot of caffeine that counts. So really figuring out what makes you happy, what makes you feel good and diversifying, and then keeping track of the commodity with a water bottle would be great.

Jenn: We have a bunch of questions about kids, teens, family members, and good exercise and diet habits. So I want to jump into those before we run out of time. First and foremost, what are the benefits to having our kids eating well and exercising regularly?

Marni: What are the benefits? Well, there are mental benefits. So we’ve talked about depression and anxiety and stress and resilience. There are cognitive benefits of exercise helps kids with cognition.

There is a positive association with feeling like if I’m exercising and using my body, I associate my body with health rather than I associate this body of mine with all of the social media input of its imperfections and why I don’t look like that person or that person or that, or that it’s associating the body with strength and movement and how well it functions.

And it can be a real source of confidence for kids to have that relationship. And I think if kids can get in the routine of connecting with their body in these positive ways and looking at it as a source of strength and fascination with the body, if possible, that will set the stage for a good relationship moving forward and for good routines going forward.

Kids who engage in sports and athletics, or even just walking, taking walks with their friends or with their dog, then as they grow older, they will have that built into their already relationship. They don’t have to re-establish that as adults.

Jenn: Someone wrote in, I know we’ve talked about the Mediterranean diet a bit through this conversation, but a parent admitted it can be hard to make these items appeal to kids and that’s totally understandable.

They want to know, do we follow the Mediterranean diet, but mix in less healthy foods now, and then, or do you know any other methods of approaching getting kids to eat healthy without dealing with that constant struggle of them not enjoying meals that are better for them?

Marni: Yeah, so I think, so one of the tricks is just to get them when they’re really hungry. So if you can, like, before you serve a meal, if you can chop up a bunch of veggies and even serve it with like a dip that they like, peanut butter or hummus, or even ranch dressing, or my daughter likes to put apple cider vinegar on everything and it’s like she just does.

So whatever they like, and you can just put out a bunch of chopped veggies before dinner, when they’re really hungry. You’ll see that they’re more open to trying these things. But I think we have to be really realistic and not set our kids up for real rigidity around what is okay and not okay to eat.

You know, so being flexible, I think, is really important and being realistic ‘cause they’re getting so many cues from the school, from their peers, from marketing, from social media, around all these other foods, you don’t want to set them up for like, that is bad and you can’t have that.

But like, maybe, can you get your veggies in first and then have something after, it’s really important to make room for that. The other thing that can be very helpful for kids and especially younger ones is to eat the rainbow.

Have you heard this? And so, putting a variety of colors out and talking about like, if you can eat the rainbow, you’re getting in a variety of nutrients and phytonutrients, let’s just eat the rainbow. It doesn’t matter what you’re eating. Let’s just try to get as many colors. And if not today, then this week, and then you can make that a fun thing.

The other thing that I like to use is there’s something called my plate and it’s a plate that divides the plate into four or actually three different sections. And half of it is actually fruits and vegetables, a quarter of it are grains, and a quarter of it is protein.

And that’s a kind of reversal of what kids kind of, or what we think we’re supposed to be serving. And so you can even buy these and serve them for younger kids. Like this is actually what’s recommended and get people used to eating in that different way where you don’t have a little bit of broccoli on the side, but you mix broccoli in with your protein and that’s your main dish, that kind of thing.

And really showing them that like, these things can be you trying different sauces and techniques and being really creative with them can be really helpful.

Jenn: We had a parent write in saying that, my clinically depressed tween got 30 minutes of moderate exercise per day for a week, which is a big accomplishment for her.

So congratulations to her, first of all, but now she’s sore and she’s really tired. So how can the parents keep their tween motivated?

Marni: Well, I mean, I think if that could be just a chance for what we call kind of a cognitive reframe, like you’re sore, why do you think you’re sore? Like you’re sore because your muscles, you gave your muscles, the workout that they really need, and they’re telling you that they have gotten what they need.

And so if you can do a reframe on the soreness, okay, so you’re sore. That means that you actually accomplished a lot and that’s just your body telling you that it got what it needed and the more you do it, the less sore you’ll be. And to try to find the language for that particular kid that’s going to resonate with them.

Maybe trying to find an example, like what would be a good example of how, when something doesn’t feel good, it’s a sign that it’s working. I don’t know. I can’t think right off the top of my head around that, but like try to work with them. Like, so you’re sore, it’s uncomfortable in the moment, but what, is there another way that we can look at soreness in a less negative way?

Jenn: Alright. My last question for you is how can I enroll a family member who is pretty disengaged on a journey to better overall health?

Marni: Yeah, that’s really hard. I’ve been there. The thing about all of this is, unless someone is really ready to make change, it can be very, very difficult to convince them that they should. And I don’t have a great answer for people how to change people who aren’t really ready to change.

It can be so, so hard and frustrating. But I think if I were to try to come up with a couple of things, I think it’s like small little nuggets and the more we try, oftentimes the more people who don’t want to change, kind of like dig their heels into not changing.

So it’s more about like small little nuggets, maybe sending them some sort of soft kind of touches. Maybe send them something and be like, I know, I know you don’t want to hear from me, but I thought this one might be interesting.

Like if there’s an article or something, I think that the other approach could just be making just a lot of space for the reasons not to change and how hard it can be. And just to practice that real compassion and empathy for why it’s so difficult for that particular to engage.

If it’s a family member, what, so, why? Help me understand. Instead of being shaming and blaming, just engaging them in a conversation about not wanting to change might be the first step in actually helping them realize that there’s not that much loss in thinking about change.

Jenn: This is actually a perfect time to end the session. I know I had you for an hour. We’re basically right at the hour. So Marni, thank you. This has been so fun. You have so much knowledge about so many things that it’s just, I can’t appreciate how much insight you gave to a cornucopia of questions.

So thank you tremendously. And to anybody who tuned in, thank you for joining us. This concludes the session. Until next time, be nice to one another. Be nice to yourself and drink water even when you’re not thirsty. So thank you again, Marni, and thanks for joining folks. Have a great day.

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Don’t forget, mental health is everyone’s responsibility. If you or a loved one are in crisis, the Samaritans are available 24 hours a day at 877.870.4673. Again, that’s 877.870.4673.

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The McLean Hospital podcast Mindful Things is intended to provide general information and to help listeners learn about mental health, educational opportunities, and research initiatives. This podcast is not an attempt to practice medicine or to provide specific medical advice.

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