Jan E. Patterson, MD is an integrative medicine and infectious diseases physician who has practiced and taught medicine for more than 30 years. She believes in using all the tools in the toolbox for better health and works to integrate holistic therapies with conventional ones. She is a professor of medicine at UT Health San Antonio Long School of Medicine. Dr. Patterson is medical director for the Integrative Medicine Program at University Health. She trained at University of Texas, Vanderbilt, Yale and the Andrew Weil Center for Integrative Medicine at University of Arizona.
Q: What was your motivation behind writing Breath For the Soul?
A: I’ve practiced and taught medicine for more than 30 years, and I’ve had personal experience as a cancer survivor and a survivor of personal losses, including the loss of a son. I realized that while conventional medicine is very helpful and can do wonderful things, it is not all that is needed for coping with the difficulties in life—such as stress, anxiety, depression and grief.
Through my training in integrative medicine, I learned simple yet effective things that people can do for their own self-care. These are empowering and should be widely used. Among these practices are intentional breathing, movement, nutrition and spirituality. So, I wrote the book so that more people can learn about these self-care practices.
Q: How does chronic stress affect the body?
A: When our body detects a physical or emotional threat, there is a stress reaction. Our brain and autonomic (automatic) nervous system respond and send messages to the adrenal gland, which produces cortisol (our body’s natural steroid hormone) and adrenaline. These act to increase alertness, heart rate, blood pressure and focus our attention on the threat. Functions such as digestion, sleep, growth, pleasure and development are put on hold until the perceived threat is over.
Decades ago, Dr. Hans Selye researched the effects of chronic stress. The body adapts with the physiological changes outlined above—increased heart rate, blood pressure, alertness. But eventually, exhaustion and adverse effects occur. Continual stress is harmful physically and mentally. It increases inflammation in our body and increases our risk for heart disease, diabetes, high blood pressure, indigestion, pain, anxiety, infertility, sleep disorders and more. It can also cause us to overeat, plan poorly, make bad decisions, and lose compassion for ourselves and others.
While there have been many refinements in Dr. Selye’s work since his initial studies, we know chronic stress is harmful. A quote from Dr. Selye is “It’s not stress that kills us; it is our reaction to it.”
Q: What is intentional breathing and how is it beneficial?
A: We breathe without thinking as an involuntary action, but breathing can also be voluntary and intentional. Focusing our mind on our breath and using intentional breathing to breath more slowly, deeply and regularly, can help change our stress response to a relaxation response.
This simple strategy tells our autonomic nervous system and brain, via the vagus nerve, that it is okay to turn off the stress response and relax. The term vagus comes from the Latin word for wandering. The vagus nerves takes a wandering path from the brain to many organs in the body, including the lungs, heart and gastrointestinal tract.
As we control our breathing intentional by deep, slow, regular breathing using our abdomen and not just our chest, the vagus nerve directs our body to respond by slowing the heart rate and lowering the blood pressure. We think more clearly, make better decisions, treat people more kindly.
Consider the quote from Dr. Andrew Weil: “The single most effective relaxation technique I know is the conscious regulation of breath.”
Q: In the book, you talk about how movement and exercise are ways to help reduce stress, anxiety and depression. Can you explain why and what movement/exercises do you recommend?
A: There is an increasing amount of evidence that moderate or vigorous activity reduces stress and anxiety and can help to relieve depression. Current recommendations are for 75 minutes of vigorous activity a week, or 150 minutes of moderate activity a week. Vigorous activity includes running, cycling hills, swimming or power walking. Moderate activity would be walking, gardening or cycling on flat roads. Strength training is recommended twice weekly.
While heart rate and blood pressure increase during exercise, the overall effect
of regular exercise is decreased blood pressure and heart rate, decreased inflammation in the body and less risk for heart disease, diabetes and even many types of cancer. Vigorous activity can result in the release of endorphins, the body’s own “feel good” hormones. Strength training improves muscle function and tone as well as bone density.
Meditation movements, such as yoga, tai chi and qi gong, are also helpful. These movements emphasize intentional breathing as well as muscle training and core strength. The meditation aspects of the practices can be beneficial in relieving stress, anxiety and even chronic pain.
Yoga has been shown to relieve depression and increase levels of gamma aminobutyric acid (GABA), a calming neurotransmitter in the thalamus, a part of the brain that influences mood. A deficit of this neurotransmitter is thought to contribute to mood disorders like depression.
Q: Food choice is mentioned throughout the book and the links it has with either relieving or exacerbating stress, anxiety and depression. What effects does nutrition (or the lack thereof) have?
A: Chronic stress produces cortisol, which can lead to increased appetite and weight gain. When we are stressed, we tend to favor foods high in sugar and/or fat. While these make us feel better in the short term, this leads to a spike of insulin which stores
glucose and causes blood sugar levels to crash. The brain and body then feel deprived, and cravings start again.
A way to stop the cycle of cravings is to eat lower glycemic-index foods, that is foods that take longer to digest and/or contain fiber. Examples are fruits such as berries, apples, pears, vegetables, whole grains, chickpeas, nuts such as almonds and walnuts, sweet potatoes and oatmeal (non-instant).
A concept for choosing healthy food is to “eat the rainbow.” Choose natural foods of many colors to include a variety of phytonutrients. Foods that are good sources of magnesium help to calm the autonomic nervous system and relieve psychological stress. These include dark leafy greens, nuts and even dark chocolate (> 70 percent cocoa).
Including omega-3 essential fatty acids in the diet, through foods such as cold-water fish, walnuts, chia seeds and flax seeds can benefit the brain by preserving brain-cell membrane integrity and decreasing inflammation.
Herbal teas, such as chamomile, peppermint or lemon balm, can be calming. Green tea contains some caffeine, although less than coffee, but it also contains L-theanine, a compound with a calming effect.
The Mediterranean Diet and Dr. Weil’s Anti-Inflammatory Diet are two good examples of eating lifestyles to follow that are largely plant-based and include fruits and vegetables, whole grains, nuts and healthy fats such as olive oil.
There is an increasing amount of evidence that eating a healthy diet as described above is beneficial for mental health as well as physical health. Studies have shown improved mood and decreased risk of depression when eating this way.
Q: Is there anything else you would like to add?
A: An important point that my co-author of Breath for the Soul: Self-Care Steps to Wellness, Phyllis Clark Nichols (www.phyllisclarknichols.com), and I want to get across is that practices, such as intentional breathing, use of essential oils, movement, healthy nutrition and spirituality are simple, effective, empowering ways to take good care of yourself. Sometimes it is much easier for us to have compassion for others than to have compassion for ourselves, but self-care is important for living our best lives and being of service to others.