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Happiness by Removing “Second Darts”

5/25/2017

We’ve all been there before…sitting at the airport…patiently waiting at the gate for our flight to board…excited to kick off our “much needed” vacation…then the announcement…

“This flight has been DELAYED”

Of course, just as soon as you hear the word “Delayed” a series of negative reactions ensue:

"I told her to book the earlier flight, why did she not listen and book this one!"
"This always happens to me!"
"Who is responsible for this!?"
"There goes my vacation!"
[sound familiar?]

These reactions are referred to as Second Darts. Second darts most often serve no real purpose and disproportionately harm us compared to the inevitable first darts. Simply, they are a result of the mind reacting negatively to the experience.

When first darts don’t even exist
One of the saddest parts of all is that many first darts don’t even exist — they are entirely drummed up in our mind.

Have you ever thought about the scenario of your boss calling you into their office to tell you that you’ve been laid off. Perhaps you’ve been called out in meetings the past few weeks and are feeling less than comfortable about your work product. On top of that, you’ve heard rumors circulating around the office that layoffs are coming soon! So what do you do???
Naturally, you fire off a first dart → I’m going to get laid off. Then, the second darts ensue….

"How am I going to pay for my son’s school!?"
"We are going to have to move in with my parents because I can’t afford our mortgage!"
"The market is terrible, how the heck am I going to find a job!?"
"My wife is going to think I’m a failure!"

Wait. Wait. Wait. You are now thinking about moving in with your parents (which is more than likely depressing you and affecting your current mood) based of an entirely hypothetical situation — getting laid off. Doesn’t this seem crazy?

Negative reactions to positive events
Sometimes we actually react negatively to situations that are inherently positive in nature. Think about a time whenever something that was supposed to be great for you actually resulted in you thinking about it in a negative light.

So your boss just offered you a great opportunity at work to step up and take on a bigger role → you can’t stop thinking about whether or not you’ll fail and disappoint (second dart)…

"What if I look dumb in a meeting with Executives?"
"I’m not supposed to be in charge of something this important?"
Am I even smart enough to do this?
"So what’s happening in the brain"

It is extremely important to realize that even just thinking about a first dart kicks off a series of effects on the body. To paint the picture a bit more, here is the chain of events that occur once a first dart is set off in the untrained mind.

First Dart: Getting laid off from work…

The thalmus (this is the “relay station” in the middle of your brain) sends an alert signal to your brain stem — causing a release of norepinephrine throughout your brain.
The sympathetic nervous system (SNS) sends signals to your major organs and muscle groups preparing them to“fight or flight”.
The hypothalamus (the brain’s main regulator of the endocrine system) prompts the pituitary gland to signal the adrenal glands to release epinephrine (adrenaline) and cortisol — better known as the “stress hormones”.

How to avoid second darts
The good thing about all of this is that with a little bit of self-awareness and positive filtering of your thoughts, you can save your body and mind from the negative physiological and psychological impacts.Here are a few ways:

Accept the inevitable (first darts) — no use crying over spilled milk. Pain and heartache are some terrible aspects of life, but are outweighed by the greatness of it all.
Look on the bright side — find the positive side of what just happened. Your flight got delayed…go walk around the airport and get some exercise before you have to sit for 4hrs. You are getting laid off…finally you get a chance to find a job you actually want!
Be mindful of your thoughts — start by noticing when a second dart (or hypothetical first dart) arises and just acknowledge that it’s there. Over time, you’ll notice the second darts won’t try to come in anymore because they know you won’t grasp on to them. Try MeditateBot to start forming a daily meditation practice.
Practice makes perfect — your brain is a muscle and needs to be trained. The more you act or believe a certain way those neural pathways are strengthened.
Think about what’s happening in the brain — just knowing that these negative thoughts are sending signals to your body and causing unnecessary stress is sometimes all you need to catch them before you start.
Relax your body and breathe slow — by doing this you will activate the calming part of your nervous system and halt the fight-or-flight area.
Understand second darts are unnecessary — our brains have an evolutionary bias to focus on the negative. This was of course back when we roamed with deadly lions and bears and needed to focus our attention on what might harms us.

“There is only one way to happiness,” Epictetus taught the Romans, “and that is to cease worrying about things which are beyond the power of our will.”
― Dale Carnegie, How to Stop Worrying and Start Living

Eric Rems
Co-founder, The Mindful Tech Lab - Check out all of our amazing apps to help improve your life here

The Most Effective Over-The-Counter Medication to Treat Your Cold

5/8/2017

There are over 200 different types of viruses that can cause the common cold, and you are much more likely to be infected with a virus than bacteria. Unfortunately, antibiotics do not work on viruses and your cold will just have to run its course. That being said, there are certainly many things you can take to make yourself feel better.

Here is a list of the most common cold symptoms I hear in practice and what to look for at the pharmacy to make you feel better.

1. “My nose won’t stop running”
This is one of the most common symptoms associated with a cold, and can be incredibly annoying to be constantly grabbing for a tissue. Start taking a first generation histamine blocker, the most common is diphenhydramine (aka Benadryl) – yes these are marketed as allergy medication, but a side effect of these drugs is that they dry you out and will dry up that snot coming out of your nose and down your throat. Unfortunately, first generation anti-histamines can make you drowsy so best to take only at night time. Note that second generation anti-histamines ( i.e. Claritin, Allegra) do not have as much of a drying effect, but can take these during the day for possible relief.

2.“I am so stuffed up and congested”
Hands-down, most effective medication for this is pseudoephedrine (aka Sudafed) . Pseudoephedrine restricts blood vessels in your nassal passages, in effect reducing the pressure of your sinuses. Unfortunately, this constriction happens to all vessels in your body and can make your blood pressure go up a couple of points and may make you feel jittery because of this - so do not take if you already have high blood pressure and also do not take right before you want to go to bed. Another effective medication for sinus pressure is a nasal steroid such as Flonase. Note that nasal steroids take about a week to see full effect, so you are unlikely to get as much of a response compared to Sudafed.

Important note: Do not buy a product with phenylephrine (aka Sudafed PE), you will see this ingredient listed in any product that markets itself as a decongestant. This is the “Sudafed” that you see on the shelf that you can just walk out with without showing your ID. Phenylephrine has shown to be no more effective then placebo – and yes it will also raise your blood pressure, so not a good alternative for anyone

3. “My ears feel full”
This is an extension of your inflamed sinuses - your ears feel full because your sinuses are blocked, so how do you clear your ears? Clear your sinuses. As stated above, take pseudoephedrine and/or Flonase to help clear this congestion.

4. “I have a cold and the worst part is the cough”
There are a couple of different remedies for this.The American Academy of Chest Physicians recommends a combination of a first generation anti-histamine (i.e. diphenhydramine or Benadryl) PLUS a decongestant (pseudoephedrine or nasal decongestants such as Flonase).

Another popular ingredient for cough is dextromethorphan which you will as the main component in Robitussin DM or Delsym. Dextromethorphan theoretically works to make you stop coughing by blocking the cough reflex in the brain. Studies have shown this to be marginally effective, and I’ve had mixed results in practice as well. Read more about this here.

5. “My cold is gone, but I still have a cough”
AKA “post-infectious cough” can last up to 8 weeks after your cold goes away – 8 weeks! You can try one of the above remedies for cough, but if the cough is very irritating probably best to see your provider for an inhaler or prednisone which should make it go away quicker. Note that if it has been over 8 weeks your cough is likely due to some other cause and you should make an appointment to see your practitioner for evaluation.

6. “I'm coughing up thick phlegm”
For thick gunky mucus, Guaifenesin (aka Mucinex) is the ingredient you should look for to help with this. Note that this medication needs fluids to be able to work, so you must be hydrating yourself properly. Another potential benefit of taking this medication is that is has been shown to work as an anti-cough agent. Studies have shown this medication to be possibly effective for the above, this is another medication I've had mixed results with in practice.

7. “I have body aches”
Take nothing. Try light exercise, stretching, and avoid taking pain relievers. Body aches are a side effect of interferons, which are released in the presence of an infection, and whose job is to fight off the invader making you sick. In other words, body aches are a good sign because this means your body is trying to fight off the infection, let it be. Avoid taking ibuprofen because ibuprofen will block production of these virus killing cells - meaning longer duration and severity of cold symptoms for you.

8. “I had a fever of 102 this morning”
Take nothing. Plenty of fluids. A fever is a normal physiologic defense mechanism by your body to kill the pathogen making you sick - the American Academy of Pediatrics stresses that fever has beneficial effects and no evidence that a fever prolongs illness or causes any neurologic effect in the future. How does a fever work to help you? The increased body temperature stimulates production of your white blood cells (ie your immune system which functions to get rid of the bug making you sick), it lowers viral replication rate, (meaning less virus in your system), and high temperatures are toxic for some of the most virulent bacteria - such as those that cause pneumonia. Bottom line, let your body do its job and avoid taking fever reducers like acetaminophen or ibuprofen.

9. “I need to get better ASAP”
If you want to cut back on the length of your cold, start taking zinc gluconate now. Many studies have shown that zinc can decrease the length of your cold by 4-7 days – that’s like a 50% reduction in the length of your symptoms! If you are going to take anything for your cold, take zinc and take zinc gluconate specifically as it has shown to be the most absorbable formulation - the zinc needs to coat the throat where the virus normally lies. Also make sure to take in lozenge form as pills or drinks with zinc are less effective. Read more about this here.

Honorable mention: Vitamin C has also shown to be able to shorten the length of your cold, but there are limited studies on this, and the studies that do show a positive effect show only a ½ day reduction in the length of your cold when you take Vitamin C.

Sarah-Kate Rems, NP
Co-founder, The Mindful Tech Lab - Check out all of our amazing apps to help improve your life here

The Supplements You Should Be Taking Daily

5/1/2017

There are thousands of different supplements in the market today, and the efficacy is questionable for at least half of them. Let me start this first by saying that I believe diet and lifestyle are always best, but in cases where this is not enough, taking a supplement can certainly be beneficial.

Here is a list of supplements that I get the most questions about - and which I actually recommend you take on a daily basis. I recommend after reading this post you check out Labdoor which is a company that ranks brands based on efficacy, safety, and label accuracy.

1. Omega-3 DHA/EPA
Just about everyone could benefit from taking an omega-3 DHA/EPA supplement because most are not getting enough from the diet. There are many benefits with taking DHA/EPA, the most notable being that it decreases your overall risk of cardiovascular disease (think decreased risk of stroke, heart attack, etc) because it decreases systemic inflammation, lowers triglyceride cholesterol, and decreases blood pressure . Make sure your supplement contains at least 1,000mg combined DHA/EPA.

Dietary sources: Fatty fish (salmon, sardines, mackerel) are best. Other sources include fortified foods, most notably eggs - just note that this is highly dependent on what the chickens eat. So if chickens are fed flax, this means you are not getting DHA/EPA omega-3, but instead ALA omega-3. More on this below.

Note: The most common and easily absorbable forms of omega 3 are DHA/EPA. Plant based sources of Omega-3 contain ALA and not DHA or EPA. ALA must be converted to DHA/EPA which your body has a hard time doing. So yes, flax and chia are a "good source of omega-3," but this is highly deceiving because your body has a hard time absorbing any of it.

2. Magnesium
One of the most important minerals, magnesium is essential for bone formation and adequate vitamin D absorption. Magnesium can help with many ailments, but the most common everyday uses include prevention of headaches and migraines, constipation, pre-menstrual syndrome, and muscle aches. If you suffer from any of the above, a 400mg daily magnesium supplement may help, I recommend magnesium citrate.

Dietary sources: Almonds, sesame seeds, black beans, leafy greens, and cashews.

Note: There are many different types of magnesium and most are readily absorbable, but a few that you should avoid include magnesium oxide – this formulation is not easily absorbable by the body and unlikely to give you any benefit. Also avoid magnesium glutamate and aspartate which are linked to the artificial sweetener aspartame.

3. Vitamin D
Vitamin D also promotes calcium absorption and is therefore a necessary factor for keeping bones strong. Very few foods contain much Vitamin D, so the best way to get is from UV light – which most of us will not get especially with the winter and with the use of sunscreen. Low levels of vitamin D are linked to headaches, depression, dizziness, and fatigue. Make sure you take Vitamin D3 and not Vitamin D2 because Vitamin D3 is much more absorbable by your body. Take at least 1,000mg per day and make sure to take with a fatty meal because Vitamin D is a fat soluble vitamin and needs fat to be absorbed.

Dietary sources: Fatty fish contain the highest amount. Other foods that contain minimal amounts include eggs, cheese, and beef liver.

4. Biotin
For those of you who want strong, healthy hair and nails (who doesn't?) this is a supplement worth trying. Studies have shown that getting adequate biotin helps brittle nails become stronger and firmer and makes hair stronger thereby preventing hair loss.

Dietary sources: Eggs, fatty fish, meat, almonds, and beans.

5. Folate
If you are a woman of child bearing age and there is a chance you could become pregnant make sure you are taking at least 600mg of folate daily. Folate protects against major birth defects (i.e. neural tube defects) because it is essential for proper brain and spine development of a growing fetus - additionally it helps protect you from developing a folate induced anemia.

Folate (aka L-methlyfolate, L-5-Methyltetrahydrofolate) is the natural form found in foods and is preferred over folic acid. Folic acid is a synthetic version of folate and it must be broken down via several different steps into a compound that can be absorbed (aka its active form). This means when you take folic acid rather than folate there is a higher risk of buildup of folic acid derivatives and less vitamin being absorbed. Read more about this here.

Dietary sources: Eggs, green leafy vegetables, beef liver, and fortified foods.

Note: If you have the MTHFR mutation you should definitely be taking folate rather than folic acid, because this mutation means that you cannot fully break folic acid down to its absorbable form and this can lead to dangerous buildup of folic acid derivatives.

6. Probiotics
There are many benefits of taking a probiotic, but the most common everyday benefits include decreasing chronic gas, bloating, diarrhea, constipation, as well as improving immune function, absorbing nutrients, and for a healthy weight.

Fun fact: Microbes in your gut will eat up some that food you put into your system meaning this prevents you from absorbing calories – another reason to skip antibiotics if you can.

Your gut has trillions of bacteria so aim to get a probiotic that has at least 5 billion CFU (ideally 30-50 billion), because anything less is not going to do much for you . I recommend Ultimate Flora by Renew Life.

Dietary sources: Kimchi, kombucha, sauerkraut, pickles, and miso.

Note: I always recommend taking a probiotic when taking antibiotics, just keep in mind there is a chance of the antibiotic deactivating the probiotic when taken together. To prevent this from happening, take your probiotic on an empty stomach and make sure it has been a couple hours since you took your antibiotic or are going to take it.

7. Lysine
If you are someone who gets cold sores regularly, this may be a good option for you. Studies have shown that taking 500-1000mg of lysine daily can decrease cold sore outbreaks as well as decrease severity and duration of the outbreak. I've heard great success from many patients who take lysine, and I recommend trying if you get cold sores regularly.

Dietary sources: Eggs, beans, meat, cheese, fish, and nuts.

Note: At the first sign of a cold sore, contact your provider immediately to get a prescription of anti-viral medication. Prescription anti-virals, such as Valtrex, work best when taken within the first 24-48 hours of an outbreak.

Sarah-Kate Rems, NP
Co-founder, The Mindful Tech Lab - Check out all of our amazing apps to help improve your life here

Happiness by Removing “Second Darts”

The Most Effective Over-The-Counter Medication to Treat Your Cold

The Supplements You Should Be Taking Daily

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