Thomas Pisello 0:11
My guest today is Dr. Kristen Carter. She’s co-founder and internal medicine physician at Grace medical home, and grace medical home, they help address over 200,000 uninsured in Orange County, Florida. They’ve taken care of over 5000 patients over the past decade. And she does just an amazing job of taking care of those who are kind of left behind by our our systems in place to get them the medical care they need, as well as mental health counselors diet care, and also spiritual care as well, which is a big part of Kirsten’s practice, from her experiences, experiences at Grace medical home, and her extensive experience in primary care functional medicine. Dr. Carter, well, she’s here to talk about stress, how it impacts our bodies as widowers and how we can leverage the right medicine, the right self care, the right activities and the right faith to dramatically advance our healing and growth. Dr. Carter, welcome.
Dr Kirsten Carter, MD 1:52
Welcome, Tom. It’s so great to be with you
Tom 1:55
Many widowers that I talked to, and this included me, have suffered from stress, suffered from trauma through the process. Some of this is short term, intense experiences of stress and trauma, usually triggered by things like special occasions, places, gosh, songs a lot of times And for other widowers this stress has been long term. A lot of the stress starts even before our spouse has passed away, going through the disease battle, right, and that grieving period, Talk about stress and the impacts this has on our bodies?
Kirsten 2:40
Well, you know, Tom, stress has a lot of levels. There’s emotional stress, and then physical stress, where our thoughts become our emotions, which become our behavioral actions, which also become how our body reacts to everything.
Because we are three things where our body, mind and spirit are all tightly woven, and people will underestimate how much stress impacts those three strands together, and each individually.
In the acute setting it’s obvious, where people lack sleep, where cortisol is elevated, and it does a lot more in our body than just the fight or flight response. Cortisol affects our immune system, how our GI tract works, even down to our epigenetics, that’s with regards to how our DNA gets transcribed. So in the short and long term, there are massive effects.
Tom 3:49
So let’s talk short term and dive a little bit deeper in that if you wouldn’t mind.
So short term, you experience stress, you’re triggered by something as an example, that song comes on, and all of a sudden, there’s uncontrollable crying, or you’ve curled up in a ball or maybe are experiencing uncontrollable anger. I know some people act out that way.
What’s going on? Our amygdala reacts, right, so there’s an alarm system, and then, what happens after that, the physiological process that we go through?
Kirsten 4:23
So the whole stress response, which is triggered by these emotions, our mind and body perceives these emotional responses as reality. Our body does not differentiate between a stress based on being really emotionally upset right now compared to actually experiencing a physical threat or challenge.
Because I’m thinking about the loss of my loved one, or I’m really angry right now. Those emotions all get translated very similarly to the same response of our body going, “Oh my gosh, this is dangerous and I’m being chased by a lion”. So in the very immediate aspects, and those things that people see,the statement “I am so mad, I could see red” rings true. That’s because, the epinephrine goes up, our blood pressure goes up, our heart rate goes up. Some people feel facial flushing. And then there is dry mouth. You’ll see when people speak, get an emotional reaction, and a lot of times they want a water bottle, it has to do with the stress of the acute aspect of your epinephrine going up.
And in that same way, in that whole, parasympathetic and sympathetic response, it also alters how our GI tract works. So now, you’re not absorbing your nutrients. Because now the your body goes to prioritizing everything that’s important. But not everything is important, like your digestion right this moment compared to your survival. That’s not important right now.
So things like digestion, those functions slow down. The stomach actually ends up getting its blood flow shunted away, so as a result, some people get GI distress because of this, whether it’s diarrhea, or cramping, And people get malnourished in the acute setting. The body says we’re putting this function on hold, we’re putting that on the side. So even things like good fingernail function, it can alter men’s with their sexual health.
And so in the acute setting, those usually reverse quickly where someone says, okay, I’m really upset and when they kind of walk themselves through it, it lasts minutes, hours, but it’s not a day long event or a day’s event. Because the day’s events accumulate and that’s where we really start getting into major bigger problems.
Tom 7:06
Yeah, focusing on the short term. I know for me, I get a severe kind of venal vagus nerve response, and I can tell when my breathing changes, my throatcloses up.
How do you get yourself out of that short term reaction? What’s are some of the techniques that you recommend people use to do that, so that it doesn’t impact and get into the acute phase?
Kirsten 7:36
So one of my favorite things to do, for myself is I pause. And that’s where I come back to becoming present and mindful. Where am I on my own two feet. My feet are on the floor. I’m sitting in this chair. What am I thinking and feeling? I’m in fear about the future since losing my spouse, causing financial issues …
So then you start thinking about what’s the “Why” you got triggered? What’s the Why, and then you go back to is it real? Is it? Is it something I can go to just honor myself and my thoughts? You know, I really do miss my wife, Judy, and I loved her so much. And you get to honor that part of yourself. But then you get to walk yourself through it, as opposed to jumping down the rabbit hole and doing the deep dive into anxiety. And next thing, you know, you are calmed.
Tom 8:42
You do have that fallback, right from the alarm system. So the amygdala is going off, it’s going into fight, flight, freeze and fawn response mode, and you have to get the alarm shut off first.
And then when you do this, it will quell the limbic system from the epinephrine and all of the other hormones that are being released, that are then firing up the rest of the systems through your body to react.
And one of the ways that I do this Kirstin, you mentioned a few of them, right? There’s a mind- body connection. So if you can get yourself back out of your imagination, which even though it seems real, and these worries seem like their reality, it isn’t reality and isn’t in “the now”. So getting yourself into the now is really important, and doing anything physical at that point, like you said, tapping your feet on the floor, maybe tapping your chest, there’s tapping that is used in PTSD treatment to reconnect mind and body in the “now”.
Kirstin 9:40
You can do frontal tapping, by tapping the sternum, and this tapping is very strong at quelling reactions..
Tom 9:47
Yes, that’s one that I use because I feel the Venal Vegas response occurring, which for me feels like it occurs right down the sternum. So to me, if I can get the tapping and mind-body connection where the response is occurring, that’s usually a great way to calm it down.
The other technique is breathing. Meditation at work So what I do is a quick breathe in twice through your nose, and then once out through your mouth. I always do this before speaking. I do this when I feel I’m being triggered in grief. And it really helps to get back control.
So basically, the first there’s 4 “T-s” that I like to use to kind of get out of this mode. And the first two were there to kind of calm the alarm system, the first is Transition. So you leverage the physical action, or breathing or both to get you to transition from your alarm system, emotional and limbic system reaction, to get back into your prefrontal cortex and get you back to your thinking, your logical brain. And then the second is Think, which you indicated is: “I’m here, I’m present. I’m not thinking about the future and concerned about that, or I’m not reminiscing about the loss. And going back in time, I am in the now”.
Kirsten 11:05
So my pneumonic that I love to use is PAWS. Through my children growing up, we always had a lot of animals around which we can use as another coping mechanism, to work through the grief trigger and become present.
Because all of our emotional responses actually come from what we’re thinking, sometimes consciously and many times unconsciously. How am I going to change that? The first part of the acronym addresses this, with Present Awareness, getting your mind and body connected and into the present. Into the Now.
And then I do the W and S, which is now I become Willing to Surrender, and I put up my challenges – the trigger, the loss, the sadness, the regrets, the guilt, the anxiety – all to God, Because acceptance and surrender are the keys to all of our answers.
Referring to your other techniques, I do the breathing, I’m a three in three out, just because it’s three and easy to remember. And I always try to make the exhale longer than the inhale, breathing in my nose, breathing out long, twice as long as the inspiration. Standard box breath.
And if that doesn’t work, I’m a huge fan of moving muscles to quell runaway thoughts. Getting up and walking for five minutes can transform what you’re thinking and feeling and altering that physiologic response. Because sometimes your thoughts have gotten a little bit ahead of you. So your body needs to reset. So using that exercise to reconnect mind and body, and also to use up those stress hormones, to walk them out.
Tom 12:52
Love that. Now, let’s talk a little bit about long term impacts. Before I want to circle back to the faith aspect, which you mentioned, which is an important part of the 4-Ts as well.
Long term, I see many widowers suffer from lack of sleep. What’s physiologically going on, that’s preventing widowers in grief from sleeping?
Kirsten 13:23
So chronic sleep deprivation is huge. And it really does take a massive toll on our body, because that’s when our brain resets, that’s when our body resets. And many times it’s just the fact that, and the sounds almost paradoxical, that they have been up so long and so preoccupied with caring for their loved one on their exit, that now there’s this empty space, and they don’t even know how to fill it. So that empty space can be a problem.
And it’s usually always a thinking thing rather than a physiologic thing. And this is a time when you don’t have to be a hero. This is a time when even something like Benadryl helps sleeping to get you back into your sleep cycles. And daily exercise is a phenomenal treatment of insomnia.
Tom 14:21
Yeah, like you said, try to use up that stress energy and all those related hormones that are getting released by the alarm system throughout the day. If you’re not exhausting them, exhausting your body, then you may not be able to sleep.
And these hormones, they may indeed be keeping you up, right? Because cortisol will act to keep you awake. Is that correct?
Kirsten 14:44
Well it is because when you’re on alert, you have to be awake so you can be aware and ready to respond to a survival related threat. The cortisol can go up via upset as when you are really sad from this big loss, and this secretes the cortisol and then cascades and changes all of your other hormones, including melatonin, norepinephrine, dopamine, all your GABA and several others. I like to say it’s like your snow globe gets all shook up.The little flakes haven’t settled down, so you can’t see the little village.
Tom 15:27
The dopamine, this is our reward hormone, and that inhibits or stops being produced. Along with your serotonin. So that in turn can lead to a lot of the sadness, longer term sadness can come from this.
The melatonin gets inhibited, which is your sleep hormone, right? So no wonder why not only are you on alert with one hormone, but the melatonin itself can often get depressed. And so you don’t have that sleep antagonist that’s present? And do you recommend taking melatonin and supplementing?
Kirsten 16:06
I definitely do. Because this is when you need to reset. The chronic cortisol is really one of the biggest robbers of sleep.
And there are very complex neuronal pathways, our brain is just amazing in how it works. And so when you are in stress, you’re in different parts of your brain, you’ve got your frontal lobe, and you’re talking about your amygdala, your limbic system, all of these really have to have a homeostasis.
And that chronic stress, we really weren’t made for that whatsoever. So things like small glands, like the pineal gland, which secretes the melatonin and produces serotonin as well, it shuts down. So this is where we need those things to start supplementing things like melatonin until the brain gets a chance to reset itself.
Tom 16:54
Got it? So from a mindset standpoint, how do we cope with and mitigate this stress? What are some of the things that we need to do in our minds to maybe handle this a little bit better. Even though we can’t eliminate our grief, here may be things that we could do with our mind that can kind of help quell that stress and some of these reactions to the grief.
Kirsten 17:24
Absolutely. And you know, self care is key. And this starts from the beginning of the day, to the end of the day.
Maybe start with journaling as an amazing outlet for grief. This can be your opportunity to start seeing and teasing out what you’re thinking and feeling and perhaps what’s triggering you.
A lot of folks really presume it’s just the loss of the individual. But sometimes loss of their loved one can trigger other loss, it turns out that that loss can trigger another unresolved and unaddressed previous loss, which then triggered the divorce when the parents were young, which triggered you losing your grandmother too, and you start teasing out all of these losses and hurts so you can deal with them individually.
The journaling and dealing with the past losses and hurts, it gives you this opportunity in the “now” space to think and feel that loss and the unresolved hurts. So the rest of your day can be released from that unresolved emotional tax. You have this kind of a brain dump. that emotional dump that allows you to get through the feelings because denial is never going to work. Our body keeps score, and we have to address the past losses and hurts and release them.
And this is where exercise really is key. Whether you walk, bike, run, swim, yoga, do pilates, it doesn’t matter. Your exercise journey, doing this with someone is key to getting accountability.
Most of us, finding a friend and neighbor, a loved one to say, “come and walk with me five minutes a day”. Usually people really want to be of service in these times of loss. And instead of bringing a meal, “Would you come walk with me?”. You’ll find it fascinating. Alot of times it’s another opportunity, while you’re walking to say “Listen, would you talk with me while we’re walking? Would you share some of your favorite memories about Judy and we could celebrate her”. And this gives you an opportunity to also emotionally process, while walking keeps that emotional response in check, while you’re also emotionally connecting. Isolation is where the devil finds you. Isolation is an ugly place to be.
So there’s so many things you can do. It starts with the beginning of the day, where you’ve got to find some exercise. You really have to start caring about and perhaps changing how you eat and make sure if you’re not eating you need to be eating, and if you’re eating too much, you need to cut down. But it’s also what you’re eating. The quality and quantity of food you eat really does affect your psyche. There’s a 100% gut to brain connection. And what you eat will change how you think and feel.
Tom 20:29
Yeah, the gut is now being called the second brain, and the gut biome is connected directly to the human brain via the venal vagus nerve. The gut biome can affect your moods and your emotions. In fact, there’s more bacterial DNA in our body than human DNA. And what you eat can reinforce bacteria that are good for our bodies and our mind, or do the opposite, foster production and blooming of bacteria that has a negative impact on our body, like fostering inflammation, and on our moods in response.
So you’re totally right about that, and what happens if we’re eating things like heavy carbs. So I’m feeling bad Kirsten, and I don’t care about myself maybe as much as I should. And I’m going to drive over and grab that fast food burger and those fries and that Coke, what happens at that point in our bodies, that makes that a negative perhaps?
Kirsten 21:05
Well, this is a time when emotional eating really is part of that downward spiral. Because when we eat, especially the complex carbs, and in particular, the crappy carbs, we are not nourishing ourselves, and worse with high cortisol levels, you now just changed your blood glucose levels exponentially. This can trigger a greater insulin release, which puts you further into this spiral, and you’ve got these high cortisol levels. It is a setup for illness, inflammation, without your throughout your body, which also affects how we think and feel…, these things: the inflammation, elevated glucose … our brain uses a ton of glucose, but it doesn’t like this high glucose environment. It changes where we are and our and our thinking.
You know, people used to talk about the brain fog you can get after certain meals. It’s a real event. It also alters where your stomach blood flow goes. Once again, everyone likes to talk about after Thanksgiving, everyone thinks it’s the tryptophan and that Turkey that makes everybody sleepy, but it’s really usually has to do a lot more with the what they ate and how much they ate.
Even though the emotional eating makes you feel better in that second long term, it really becomes problematic.
Tom 22:35
Another challenge, alcohol, some use, right? Talk about that. I mean, that obviously can keep you in that stress state and that depressed state.
Kirsten 22:48
Well, it really does, you know, people start self medicating from their emotional distress. You know, whether you’re irritable or restless, discontent, whatever it is, they start self medicating, whether it be with alcohol, marijuana, there’s all kinds of opportunities. And sometimes people self medicate with other things. You know, too much Netflix, pornography, whatever it is.
But those things, especially alcohol, because it’s socially acceptable, most of the time, number one, it does not address what we’re thinking and feeling. It just covers it up. Those emotions are still there, and they will come out one way or another. Number two is the alcohol. It is a toxin. When we talk about being intoxicated we’re taking in toxins and have to process these in our bodies. These toxins suppress most of our cortical thinking. When on alcohol, we are not at our best regarding our decision making ability. Alcohol is a major cause of inflammation.
No one ever thought they’ve made their best decisions while being impaired. Hangovers, this helps no one. And it’s also an immunosuppressant. And we’re now triggering more of that cascade. And it’s a depressant… I can go on.
Tom 24:08
For me, I would also overeat when consuming alcohol. I could add workouts but between processing the alcohol and the extra food, it did no good. And I am convinced that once I got off the alcohol, my gut biome improved dramatically. It helped me be in a better mood, and helped boost my energy and metabolism.
If you’re having those few drinks every night to self medicate that’s where the issue is. A little social drinking is normally acceptable. For me, I definitely had to go completely the other way and just say that’s it. I’m never having another drink again. It immediately helped gain benefits in my workouts. I immediately began losing weight (60+ pounds), and the effects were just so positive.
And I was lucid to deal with the grief, which I think you should do. Because like you said, If all you’re doing is suppressing it, covering it up, there’s an analogy of that being a dragon, your grief. And if you just put that dragon in a closet, suppressing and covering it up, and you’re feeding it with the alcohol, it’ll just get bigger and bigger and bigger, and it will never go away. And it’s going to be there. And it’s going to come out of the closet at the most inappropriate or worst time in your life. And so definitely, one of the biggest things to my personal healing process and improving my grief journey, was giving up alcohol.
Kirsten 25:30
Well, it really is, because you’re covering up the grief, that will not go away. So not only do we have the toxic effects of alcohol, and how it’s going to alter our physiology, our thinking, etc, just as you said, Tom, the emotional problem that we’re trying to escape from is there, and then not getting any smaller.
Tom 25:56
Yeah, and so you really do have to gain sobriety, and then deal and address things for that ultimate healing and curing to occur. We mentioned faith and the 4-Ts when you’re stressed. When your alarm system goes off, you’ve got to transition from the limbic system, into your thinking brain, get that alarm turned off, get your thoughts back. Transition and Think.
And then the two others that I added to it, which align perfectly with the second portion of your PAWS method is Thank and Transcend.
As bad as everything gets in your loss and your grief, there are still amazing things to be thankful for. You know, even though I lost Judy, I have two beautiful, amazing daughters in Sophia and Alaina, I still have my health, I still have amazing friends. I still had people that I was thankful that were around me, that were part of my team. And so I think part of it is, when you do think about the things that are causing you trouble, you can then take a moment and say, “Thank you, God, thank you for all of the things that I still do have in my life”.
And then from a Transcend standpoint, everything on this earth is fleeting. Everything will rust. Everything will fade away. There will be another loss. You lost your wife, but now your Mom might pass if she hasn’t yet. Your dad might pass. You know, there are going to be other losses, with friends, family that are going to pass. Everything is temporary in this world. And so if you don’t transcend upwards, to a higher belief in God and his unending love, I think you will always be susceptible to these additional losses.
We’re living in a broken world where everything does rust and fade away, making it vital that you Transcend your thoughts from this broken world, to a different dimension and plane.
Talk about that and the importance of faith in the healing process and some of these elements of the 4-Ts like Thank and Transcend?
Kirsten 28:02
Well, I do want to mention gratitude. Gratitude is actually an overriding neuronal pathway.
When we look at when someone’s anxious or depressed, there’s certain aspects of the pathways. We have done this with functional MRIs, when someone, even in the thick of their emotional distress whatever the source it is, when they go back to Gratitude, which is at least “I’m grateful that I’m sitting here”, “I actually have my health, I’m alive, I have air in my lungs, I food today”.
There is always something to be grateful for. Always. And when we do that, practice gratitude, you can actually see on functional MRIs where the neuronal pathways jump, they actually jump from a pattern of anxiety and sadness to healthy. The reaction to Gratitude in the brain is more potent than benzodiazepines in changing anxiety and grief. And it’s fascinating.
And we all can find something to be grateful for because we’re alive. We’re sitting here. We’re watching or listening to this podcast, We most likely had a meal in the last few hours. There’s always something to be grateful for.
That’s actually one of the great things also treatments for insomnia is to make a gratitude list before you go to bed. It’s amazing how that actually changes neuronal pathways towards improvement.
Tom 29:35
Using it first thing in the morning, making entries in my gratitude journal, and giving thanks. And it got my day starting from a point of thankfulness as opposed to a point of loss and sadness.
I love your advice as well of doing it at the end of the day because of the resetting that it’s doing in the brain and those pathways just before sleep. Calming it down so you can sleep. So keep going, please.
Kirsten 29:59
So I know, for me, faith is the answer to all of it. And acceptance and surrender is the answer to all of our problems, it is surrender to His will and acceptance to His will.
For me, I believe in God. I believe that there is a divine creator, and he had a plan for me all along. You know, Tom, you mentioned there are certain facts of life, and one of them is that it’s hard. And that we will experience loss on some level at some point. And that is just a fact of life. And if it’s not, at this moment, it will be at some point.
So going back to acceptance, which is kind of a starting step a little higher up. When you’re thinking about your situations, I like to think about it as, if I can have an eternal perspective to really think about, what I think and feel, this echoes in eternity. With that perspective, of eternity, everything I think and feel now, in this moment, it looks very different. It makes me really come back to a bigger place to think about: What I’m stressing about? What I’m anxious about? On the timeline of eternity, is it really impossible, impactful, relevant?
And when I allow the light of the Holy Spirit to come down upon me in that moment, it always thinks and feels differently. So for me, one of my best treatments for insomnia, also for me is a podcast that I listened to, or actually it’s an app, where if I can’t sleep, it will play the Bible to me.
And for me, that is actually the best treatment of insomnia I’ve ever had. I’ve recommended it to a lot of patients. And it’s funny, because a lot of them will say to me, I’m atheist, agnostic, Muslim, whatever. And I said, it’s fascinating. Just try it. Because there’s a lot of apps out there a lot of free apps. And some of them, because they are so frustrated with their insomnia, will choose to do so. because sleep is so important. And it’s amazing the success rate. So that’s also just one of those things that really makes a difference.
Tom 32:09
From a scientific standpoint, Kirsten, because your a doctor, talk about Blue Zones a little bit and what they found there with regard to the importance of faith, because I think this is really fascinating.
Kirsten 32:24
So I had the opportunity to talk to a large group of physicians at the national level, where we got to talk about epigenetics and telomeres. So now we’re getting to the dorky part.
So the telomeres, our DNA is a little crosshatch x and the telomeres are the tips, almost like the end caps of a shoelace. You know, we all have that little plastic tip at the end of the shoelace. So we know that from inflammation, cancer, all the diseases. These actually come when those telomeres get either snipped off or frayed, kind of like when the end cap of your shoelace gets damaged. You can’t spread it through the little eyelet any longer. But when our telomeres get damaged, that’s what precipitates disease. So we have now figured out that the key to good health and longevity is to either keeping your telomeres strong or lengthening them.
We’ve done a lot of studies into Blue Zones. Blue Zones are these areas of populations that are found around the globe that have neem found to have the highest number of people living the longest years, and living the healthiest. So the lowest morbidity and the lowest mortality rates.
And these Blue Zones, they have a large number of people and an older age, but they’re a very healthy older age. So what we’ve been doing is studying them to see what they do right? Because it’s not just one outlier, there are these groups of people. So what did they do differently? What was their secret sauce?
And so one of the things they noticed was regardless of the actual faith, whether it was Christian, Hindu, whatever, these populations that had a very strong faith, they lived longer and lived healthier. Using that information. We actually have had a chance to do several studies, large studies where we do PCR, everyone knows what PCR now is polymerase chain analysis of white blood cells in people’s bodies, when we were looking at things that would lengthen your telomeres or keep them strong and faith. Faith was the number one prognostic factor that kept people’s telomeres long and strong.
So when I say that surrender and acceptance to a higher power for me, that’s God. I’m not in everyone’s face regarding your path. It is your path to choose. But that really not only makes us think and feel different, but it even changes our DNA. And that to me, is just amazing.
Tom 35:15
And Kirsten, to take this a little bit further, when we are stressed and when we’re grieving, that too is having an impact on our DNA. Right? It is affecting the telomeres. Is that correct?
Kirsten 35:30
Yes, it is actually fraying them off. So we found that when there are severe environmental stressors, meaning smoking, those kinds of things, things we all know about, you get fraying. But emotional stressors are strong in their impact as well, and almost equivalent to smoking when it comes to damaging our DNA.
Tom 35:51
And so your cure, we mentioned a few things that are good habits to have. But the real cure, I think might be the secret power here, is faith… I think that’s what you’re trying to get across, right?
Kirsten 36:07
Actually, it IS the secret power. You know, “The joy of the Lord is our strength” is what it says in Nehemiah. Joy is a choice. It’s how we’re going to choose to think, and this also comes back to our gratitude.
Faith, It’s our strength. It’s our superpower. So when we come back to those places of “What am I going to think and feel” because we do have complete control over those thoughts and feelings, and we will ourselves to walk in the light of the Holy Spirit. Everything, even big loss, looks and feels differently, even down to our DNA, through the lens of Faith.
Tom 36:44
Faith. It affects the brain positively. It can get you out of that stress mode into a much more relaxed mode. It can help you to sleep more. And it will prevent disease and long term impacts because it will help to keep the sneaker nubs, the telomeres intact.
What’s the one thing you’d like to make sure our widowers, our growth warriors take away from today’s discussion?
Kirsten 37:17
Loss and stress is huge. You do have control over it. And even though yesterday and right now may not feel good, you can change each moment.
Each moment we really do have control over how we think and feel, and the biggest part of control is in the Surrender.
Tom 37:40
I love that. It seems almost paradoxical. That, in order to gain control, you actually have to Surrender. Wise words Kirsten. Thank you so much for participating with us here today.
Kirsten 38:00
Thank you, Tom. As always, it’s a joy. It’s a joy doing this journey with you.
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