good evening i’m cliff steiner i’m a pa
here at the maxwell clinic
uh you may have seen me from a few of
these other group visits before i really
enjoy doing these and
i don’t know if you guys know but we get
to pick our topics so
usually
my topic is going to be around either
something i’ve been helping patients a
lot with lately or something that’s just
really been on my heart or my mind um
something that i feel like is an
important topic and that’s the case for
this evening we’re going to be talking
about
anxiety through a functional medicine
winds
so just a couple of housekeeping things
please i would encourage you to
write me a question and then at the end
of this then i’ll go through those
questions and make sure that i
i answer those before we finish up
other than that i think that’s about it
so let’s get started
so today’s goal
really is curiosity
so we all know what anxiety feels like
even if we can’t clearly define it
either philosophically or even
neurobiologically which is what we’re
going to talk about this evening even if
we can’t get that definition just right
we know what it feels like
so what i’m hoping is that at the end of
today
that you’ll be able to be curious
about anxiety when you feel like stress
is really bearing down and it feels
overwhelming
be curious as to what could be leading
to that and then that can lead us to
what we can do to help resolve it now
the idea is not to resolve all of our
stress or all of our anxiety
if you heard me talk about stress before
and inflammation those are actually good
things for the body we need those to
keep moving to keep living to keep
breathing to
grow stronger
both in our emotional relationships and
in our own bodies so we’re not trying to
totally get rid of anxiety but we do
want to prevent it from overwhelming us
so anxiety defined
so
as you see here we’ve got a few
different pictures
so often
we’ll talk about anxiety and we may hear
something about plates right we may say
i have too much on my plate
right and so we can see here um that
picture in the lower left there’s
definitely a lot on that plate right uh
not all that healthy i might add but hey
that’s neither here or there
in the end there’s just a lot of the
then in plate
middle here you see a plate that has
very little on it
so
you know
when we talk about having too much on
our plate there’s actually two things
going on here
so there’s the amount of things that we
actually have to think about right that
we have going on in our life so maybe we
have a job
we’ve got family uh family issues and
things that we are responsible for maybe
we have stuff going on in the community
that we’re responsible for it could be a
number of other things and all of those
different things could be what’s on our
plate
we could also think of it as the size of
our plate
right maybe we don’t have a whole lot of
things on our plate but we still feel
overwhelmed
maybe it’s because our plate is too
small
you ever thought of that
it’s kind of an interesting idea right
that maybe it’s not that there’s too
many things maybe my plate’s just too
small so in functional medicine we can
actually work and we’re going to be
talking about this evening how can we
make our plate bigger
so another way to talk about the same
idea that you may hear about in therapy
or in the counseling realm would be a
window of tolerance
so we all have a window of tolerance
like how much can we handle and
sometimes that window of tolerance we
may come up if we’re talking about
maybe conflict with a spouse and if we
have a small window of tolerance it
means we can handle very little conflict
before we’re overwhelmed
and once we reach a sense of being
overwhelmed
there’s really no use in continuing the
conversation it would be best to
take a breath step back
go think through it go take a few
breaths before we re-engage that because
once we get outside of our window of
tolerance we’re no longer thinking with
our frontal cortex we’re no longer able
to reason appropriately
and we all know what that can look like
once we get outside of that window of
tolerance
so another way to think about anxiety is
neurobiologically
so that is looking at the limbic system
and the limbic system is what i have
have here illustrated so it includes the
hippocampus which are these two blue
areas of the brain right here that go up
and around
and then you’ve got the amygdala
and so the amygdala you see it right
here and right here
so the amygdala is what i really want to
focus on the sea this evening this is
the part of the limbic system that
remembers
so this is emotions memories and arousal
all come from the amygdala
so
let’s say that in your past
you have a traumatic or very anxiety
inducing experience
your amygdala remembers
that
and so even though you may be going
through something now where you think
like oh this is not that big of a deal
like i should be able to get over this
or i should be able to move past that
well i want to encourage you that it’s
not your fault
rather it’s your past
because
let’s say that
you know in your past
you have an experience of being chased
by a lion
so now it may be that every time you see
a picture of a lion or you see somebody
running they could be running from a
lion
or you hear a roar or even a loud noise
your amygdala remembers
that life
threatening situation
in which you were in
and to keep you alive
it sends signals to the rest of your
body to react
exactly how you reacted when you were
being chased by a lion
the way that you needed to react
in order
to live
so this is not a problem this is not a
broken system this is a system to
protect you
and it could be that that system is sort
of stuck
in overdrive
and if that’s the case then that’s
something that needs to be explored
that’s something that needs to be to be
dealt with and there’s going to be
multiple ways in which you can you can
engage that you can do that and we’ll
we’ll talk about those a little bit
later but i just want to introduce
everyone to this idea
that when we feel anxiety
it’s not necessarily about what is
happening in the present moment
but it can be rooted in our past
and that’s something that needs to be
engaged with it needs to be dealt with
effectively
so that we can live in the present
moment in balance
so
five
strategies uh that work together
in order to help control or decrease our
anxiety
these five strategies they may look
familiar right these are the lifestyle
factors
that we talk about in functional
medicine
so normally if you’ve seen the matrix
the functional medicine matrix then
you’re gonna see these lifestyle factors
at the bottom
so nutrition let’s talk about how
nutrition can impact our
anxiety
so if we are highly inflamed or if there
is a significant amount of oxidative
stress in our body
then this increased inflammation is
going to sensitize our nerves
and make it more likely that we’re going
to feel a sense of anxiety or be very
easily triggered into an anxious state
so we can decrease that
oxidative stress
those free radicals we can decrease that
by doing something called eating the
rainbow
so we talk about a rainbow because we’re
talking about food and we’re talking
about eating multi-colored food so i’m
not talking about skittles even though i
guess there’s a good argument that that
could decrease anxiety at least
momentarily right but uh but i’m not
talking about skittles i’m talking about
uh swiss chard
i’m talking about um
red onions i’m talking about green
onions i’m talking about yellow peppers
i’m talking about all of these different
foods that have all of these different
colors
what’s so cool about the colors and the
pigments in our food
is that they correlate to these
antioxidants these chemicals that our
bodies crave in order to lower
inflammation
another way that we can use nutrition as
a way to moderate our stress is by
increasing fats and proteins
so increasing fats and proteins in our
diet helps to stabilize our insulin
levels
increased insulin and fluctuating sugar
are a sure way
to increase our anxiety
and we know this right we know this
already sometimes we even see it in
children right we say like oh wow they
must have had a lot of sugar because
they’re kind of bouncing all over the
place
and so what for children may look like
bouncing all over the place it’s a great
time we’re having so much fun
when we bounce all over the place we we
don’t have so much fun right and we
sometimes feel that as anxiety
so that’s one of the things that we can
do is to
increase our fats and proteins the other
thing that we can do is balance our
carbohydrates
so this doesn’t mean
only fats and proteins and no
carbohydrates so we’re not talking about
a keto diet specifically
but i am talking about eating healthy
carbohydrates carbohydrates that are
made from whole grains that are going to
metabolize slower we’re going to release
sugar slower into the body
we’re also talking about carbohydrates
from root vegetables
and so carbohydrates that are also
served with fats and proteins
so anything that we can do to slow down
that stream of sugar into our
bloodstream that’s going to prevent that
insulin spike from occurring
which can trigger feelings of anxiety
it’s also a good idea when it comes to
nutrition
to
eat
to eat in a rhythm in a healthy rhythm
so sometimes if we are too busy you know
maybe we’re not eating enough we can’t
remember to eat meals
so that can cause anxiety when the body
goes into starvation mode
sometimes if we’ve had dysregulated
glucose right maybe we had pre-diabetes
or even have diabetes then actually
fasting
might be a good way to decrease anxiety
there is some cool research being done
about intermittent fasting and anxiety
so i would encourage you to take a look
at that or
talk to your clinician because um that
could be something that that could help
you
so going counterclockwise now let’s talk
about stress
so moderating stress of course is going
to decrease our anxiety
so a few different ways that we could do
that we could lower the amount of things
on our plate now many of us
aren’t going to go to that one first
right we we may think that’s the easiest
thing to do right if i could take some
of these things off of my plate
then i would be less anxious
there may be a lot of truth to that
but if uh family life is one of the
things driving stress it may not be so
easy just to move that off of your plate
right if it’s your job that’s causing
you stress it’s not always easy to just
quit
or to go get another job right sometimes
there are things in our life that bring
us anxiety or stress
that we’re not going to just get rid of
but rather we’re going to work around
them we’re going to prioritize
the things that are most important to
our lives the things that bring us joy
and we’re going to work to make our
plate bigger so that we can handle the
things that are already on our plate
so one of my favorite ways to measure
stress is by measuring heart rate
variability so that’s something that we
do here in the clinic usually at our
first visit we’re going to use a company
called heart math
to give us an idea of heart rate
variability so let’s talk just for a
moment about it just so i can give you
an idea of why it’s important to measure
so heart rate variability lets us look
at the sympathetic and the
parasympathetic nervous system
so that’s the fight flight freeze
response
and then also the response in our
nervous system that allows us to digest
and controls our sleep patterns
so looking at those two things can give
us a really good idea of how you deal
with anxiety on a day-to-day basis are
you stuck in fight flight or freeze
many of us actually are
many of us are constantly feeling like
we’re being chased by that lion
so being able to look at that
objectively
through a measure of heart rate
variability can give me an idea of
what’s going on in my body
and then what i can do to make changes
and then we can measure that over time i
like to measure it every three months
sometimes we’ll measure it sooner
sometimes later just depends on the
individual patient but i do think it’s
something important that we can look at
there are also a lot of apps that you
can use so
the apple watch for instance has heart
rate variability settings uh whoop if
you’ve heard of that w-h-o-o-p
they have a great platform um it is a
subscription so sometimes that can be a
little annoying but even if you just get
it for three to six months and just
track heart rate variability and sleep
it can be really helpful for seeing what
is making you anxious or stressful and
the things that are also helping to
bring down that anxiety
so there’s other things that we can do
to help with stress such as meditation
or prayer
and when we’re talking about prayer i
mean a lot of times people
will use prayer
sort of like um sort of like a fireman
right like we just feel like our world
is burning down and now is the time that
i need to to pray and seek centeredness
and while i’m never going to discourage
people from praying right i’m never
going to discourage people from
meditating from taking a time out i
would encourage you that in prayer we’re
seeking relationship right and in
meditation we’re seeking centeredness
and i would encourage you that those be
done as an exercise
rather than just as sort of a fire alarm
so if we take a daily
quiet time where we can
meditate
where we can find our center
in our being in our creator
then that can be a great way to sort of
reset our mind and our limbic system and
prepare us for what the day brings
there’s a lot more to be said about that
and i would like to talk about um prayer
and meditation you know in another group
visit
but just for the sake of time
i will leave it i will leave it at that
now let’s come up and uh or let’s go
around let’s continue around
counterclockwise and talk about
relationship
so our relationships and you may
remember this from our first time
together we talked about community
relationship is vital
to our well-being
and specifically to bring down our
anxiety
so there’s this very interesting idea
it’s called attachment theory
and i think it is so helpful for
understanding how relationships
help impact
and can help improve our feelings of
anxiety
so a healthy attachment
is going to be attachment to another
person a french
friendship this could be um hey well
when we started out like when we were
born and very very young it would have
been with our primary caregivers
but these are people in our lives
who help us to feel
seen
as in they know us they know who we are
they understand our struggles they know
what makes us happy
they recognize that
and they show us that they recognize
that
these are people who are going to help
us to feel soothed
people that you go to
that hear you and they understand the
pain that you’re going through the
anxiety you feel
and they recognize what it takes to help
to help you feel better to know what you
need to hear to feel soothed
they also help you to feel secure
so a secure attachment and a safe
attachment may sound similar but
security is something that happens over
time right this is not really a one-time
event but being in a secure relationship
is somebody that you can trust
or a group of friends or a community in
which you can trust
the reason why trust is so important is
because it allows us to be vulnerable
it allows us to share
the things that we may be ashamed of the
things that we’re proud of the things
that we want other people to know about
us the things that we need other people
in our lives to help us to figure out
that can only happen in a secure
relationship
and then safety safety has to do with in
the moment
right in the moment am i going to get
hit by a car
is somebody going to punch me
is
somebody going to say bad things about
me and hurt my feelings
hopefully the answer to those things is
all no right and that that has to do
with our environment a safe environment
because it’s only in a safe environment
over time
can we feel secure
so we need individuals
who we are helpfully attached to and we
also need community
in which we find healthy attachments
and it is in those areas that we are
then going to be able to let our guard
down
so that we can be less than anxious
so moving up now we’ll talk about
movement
so movement
consists of
exercise
and so this could be exercise like hit
training high intensity interval
training
which can be really good as long as it’s
moderated
i will sometimes see in patients who
have been anxious or have really high
cortisol levels for a really long time
that hit training is not necessarily the
best for them
so if your adrenal glands have already
been maxed out due to inflammation or
emotional stress or anxiety
for a long period i mean years then
taxing them with high intensity interval
training is not always the best
so it could be hiking it could be
walking it could be rowing i mean it
could be any a number of things
but the best studies that show that when
you combine exercise with being outside
in nature
that we’re able to
we’re able to really
reset that limbic system remember we
talked about the amygdala now the
amygdala can be revved up right and when
the amygdala is revved up
then there’s really no other option than
anxiety
so movement in that way can really help
to to bring that down
to decrease
the activity in the limbic system
and then last would be rest
so rest is so important
rest is going to be sleep
so you’re trying to get about eight
hours of sleep some of us need a little
less not much less but a little less and
some of us need a little more not much
more but a little more so if you find
yourself
operating on four to five hours of sleep
consistently over months to years
and you feel like that’s enough
it may be
that your body is just compensated
but on the other side if you feel like
you consistently need nine to ten hours
of sleep
something’s going on there your body is
trying to tell you something
and i would encourage you to listen
to get that checked out to get
investigated
it could be that you’re not sleeping
well at night maybe due to sleep apnea
maybe due
to other issues that are not allowing
you to get into a deep sleep or or not
getting enough rem sleep
so maybe you need a sleep study
it could be that your magnesium levels
are off so it could be any number of
different nutrients that are causing
that issue
so if if you’re not sleeping well
or you feel like you’re sleeping too
long i would definitely encourage you to
get that investigated
then the other thing is recovery
so recovery when i’m talking about this
i’m talking about from exercise
so when it comes to you know a sprained
ankle we understand recovery right we
understand that if i’m spraying my ankle
it’s swollen it’s red it’s hot that i’m
going to need to recover i’m going to
need to heal
well exercise is micro tears and micro
sprains
all over the different muscle groups
that we’ve used
including the ligaments intended that
we’ve that we’ve worked and it’s
important to allow your body to recover
well so that we’re not stuck in a state
of inflammation because being stuck
chronically in a state of inflammation
due to under recovery will increase the
sensitivity of the nerves like i
mentioned earlier and can cause us to
feel anxious
so making sure that you are sleeping
well and making sure that you’re
recovering well
are going to help you deal with anxiety
so i mentioned heart rate variability
before
so i just love all the things that i’ve
already mentioned about heart rate
variability but also it can be a tracker
of our recovery
so by looking at our heart rate
variability by measuring it on something
like the woop or on a fitbit you can get
an idea the day after exercise on how
well recovered you are
and you may need
two days or three days before you can
exercise at the same intensity again
if it seems like you’re exercising and
it takes two to three days to really
recover
then you might want to just be careful
because this could be a situation in
where you’re really pushing your body
too hard
now
if you’re an athlete a professional or
you know an olympic athlete then like
there could be a really good reason why
you’re pushing yourself that hard and
that’s understandable
um but if if you have other things that
are going on maybe you’re not you know
maybe being an athlete is not your job
um
but rather your job is being a mom
or a dad
or your job is in an office somewhere or
you’ve got other things that you’re
doing for the community that you need to
be well-rested for
then pushing your body to that extreme
where it takes two to three days to
recover is going to mean that it takes
two to three days of you being kind of
foggy-headed
maybe feeling a little bit of fatigue
and not being on your game
and that could really hurt long-term
whether it be in your job or in the work
you’re doing in the community or with
your family or with your own creativity
so in the end i want to make sure that
no matter what you’re doing for exercise
that you are recovering well
so hopefully talking about these five
key strategies of these lifestyle
modifiers
that these can help trigger some ideas
that you could talk to your clinician
about or maybe that’s me and i would
encourage us to have that conversation
and see if there’s something in these
areas or maybe all of these areas that
we need to focus on to deal with your
anxiety
or maybe it’s an overactive limbic
system because of anxieties or trauma
that you’ve experienced in the past
and i would encourage you to investigate
that
and we could do that through
neurofeedback we could get a brain map
and then we could recommend neural
feedback based on that brain map to try
and dig in to see what what is that
underlying
issues that are going on with your brain
where it might be stuck
in hyperactive or consider seeing a
therapist or both
we often see that neurofeedback and
therapy whether with a counselor
or a psychologist work hand in hand
often those things work well together so
i would encourage you to investigate
that a little
more and that brings us to the end
of my presentation
does anybody have any questions i don’t
see any questions yet but i want to give
you guys a couple minutes
to ask if there if there are any
uh let’s see
check that
okay
all right
i don’t see any questions so i hope you
guys have a great evening i hope you
found this helpful and again if this
brought up any questions anything that
you should that you’re curious about
that i would encourage you to bring it
up with your clinician and go from there
have a great evening
oh i do have a question oh it’s just a
thank you you’re welcome it was a
pleasure bye guys
