April 19, 2022

Ep. 12 How Emotions can Contribute to Disease

Do We Have Any Control?

Health by design the podcast where we explore your brilliant biology, current research and successful traditions to give you the health of your life.

So often there are emotional and spiritual reasons for illness and the next two episodes, we'll dig into these more and I've brought in somebody valuable to help. Our emotions are such a valuable part of who we are yet wounds and pain that we internalize can create physical challenges that we need to be aware of in order to heal fully and enjoy the health of our life. Today, I have the privilege of interviewing Marissa

I'm so excited to have you here Marissa. Thank you. This is really a blessing. Marissa has a master's in public health and she's a registered dietician specializing in oncology and has been working as a frontline worker at a level one trauma hospital in Southern California throughout COVID during the last two and a half years.

She's young, intelligent. Beautiful and has important insight that I am privileged to share with you today. So with that, Marissa, I wanted to ask you some questions. And I just want to start with what is emotional health?

That is a very good question. So thank you so much for having me here, Cynthia. I actually just wanted to. Define health the way the world health organization defines health, because I think it gives us a very good holistic understanding of what health is and how our emotions play a role in our health.

So the world health organization defines health as a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity for them. They say there is no health without mental health. Instead of separating emotional health as a separate definition, it is just all one, one definition for us.

Yeah. And I think as a medical practitioner, I like to practice with


concept in mind. So I think a lot of our medical field right now, especially in America views the human body as just a body, just a physical body, but I practice with a whole person care model. So I like to view a person as a body, soul spirit, as a whole person where emotions and physical health.

Everything is tied together.

That's really part of the reason I wanted you here 'cause I know that about you.

Thank you. Yeah, I'm really excited to be here. And I'm so excited to talk about this because it's something that we see regularly all the time. It's so practically part of my daily practice, that it's almost impossible not to talk about.

So for example, in the hospital, I see a wide variety of patients. We, since we're a level one trauma hospital, we see people who have been sick for a long time. We see people who get hit by a car and have an immediate trauma. so any given day I can be seeing a patient who is on a ventilator sedated, and I'm putting formula through a tube and calculating their needs and making sure we're meeting their needs.

I don't talk to them, but I could also. You know, five minutes later, go and see a different patient who just got a heart attack, brand new, diagnosis, never knew they had heart issues and I'm supposed to talk to them about what is life going to look like going forward? How can we prevent this from happening again?

So for example, just the other day, Maybe a few months ago. I saw a patient who had a new diagnosis. He just got a heart attack. He was a 60 year old man, generally pretty healthy. and he came in and I was supposed to talk to him about, well first, just assess and make sure everything nutrition is looking good.

His numbers looking good in his life. He's not malnourished, you know, anything just physical. but then I also wanted to equip him for when he went home. And so, so often, you know, people would just say, okay, do some education. Let me give you a piece of paper with a meal plan, you know, and let's talk about heart healthy diet, you know, cutting down on saturated bat, cutting down on salt, you know, all these different things, right?

High fiber, maybe some omega three fatty acids. What happens often is you get in there. So I'm getting in the room with this man, and it turns out he has, he's very healthy. Overall. He has a huge knowledge base on healthy diet. he was working out regularly, you know, prior he had a very healthy pattern of living and eating.

And then he told me I got married.


no, we're talking about marriage. And then he told me he's 62 and he married a 27 year old girl who moved here from the Philippines. After they got married, he said he got stressed. She bought all this stress on him and they had a new baby and she wants to learn how to drive. And she wants to go back to school and he's like, and now I worked so hard to get her by working out and eating healthy, being this fit guy.

You know, and now it's, I got married. I've lost some of that because I want to, she takes up all my time and energy. I have no time to take care of myself and our marriage is so stressful. It was so interesting because I come in talking to them about nutrition. What do you know about nutrition? Let's talk about a heart healthy diet for when you go home.

And here we are actually, what are we talking about? His marriage and his marital problems. You had a lot of built-up emotions, you was expressing a lot of overwhelmed, anxiety, anger, resentment, just stress pressure. what we ended up talking about was how he felt as a man in his home. We ended up talking about his relationship with his wife, and how all of those played together to create a picture of an unhealthy lifestyle that he's been living. He doesn't have time to work out. He doesn't have time to eat healthy meals. She cooks this kind of food where he was eating this kind of food, you know, so we ended up having a much larger conversation and at the end, Of the day, what we came away with was talking about his identity as a man, how he can reclaim that in his family so that he can create ownership over his life again, in order to actually have motivation to live a healthy life.

And we talked about having to find something outside of himself to keep him motivated and strong enough to carry that identity in his marriage. And then practically, what are you talking about for nutrition? The one thing we took away was he was going to go on a walk with his wife after every meal for 10 minutes, or at least after dinner, he was home because he was working from home at that point.

But I said, you're not doing any exercise and you and your wife have to all this tension. So why don't you put the baby in the stroller. Can you just walk for 10 minutes around the neighborhood right after you eat, because it actually lowers your blood sugar. It lowers your blood pressure, which is what caused for his heart issues in the first place.

And it gets you moving and it also can help with the stress, the tension that you and your ever having to get you out of the house, do something physical together. Yeah. And I said, in that 10 minutes, you're not allowed to talk about any conflicts you have. You're not allowed to talk about the baby.

Only if the baby had some things, you could talk about the baby, you know, but I was like, there is some frame, like something just 10 minutes of something funds. And then you were looking forward to something that made you smile that day. Like things you're grateful for those 10 minutes are reserved for just that.

And that was our major takeaway. And then I just gave him a packet on heart healthy diet that you was going to review later. He already knew all that stuff. You knew it. He just had

Wasn't the diet that brought him in.

It wasn't the diet! It wasn't the lifestyle that he had all that knowledge, but it was really a bigger context of who this man was, his life, his family, his marriage, and all of the emotions he carried because of the circumstances.

Wow. It's amazing how that impacts us.

It really, it really does. It's all tied together. So I can't just say. Let's just talk, that's it. You know, let's just talk about your blood markers. Like we have to talk about all this other things. Otherwise it will be no change in that life. There will be no health overall health.

Like the world health organization said it's not merely an absence of disease. It's a social wellbeing. It's an emotional wellbeing that we're really looking for. And that affects our physical health. Wow.

Amazing story to explain it. And so true. So a lot of times do you find that you're dealing with.

Emotions more than diet or is it always emotions more than


I wouldn't say all ways, but I would say they go hand in hand. I think our food is a very much of a relationship. Our food plays a role in our life as much as a parent or as much as a friend like food, because we interact with it so much.

We both need it, but we also find pleasure in it. You know, there's just so many ways that we interact with food, that it actually creates a lot of emotion within us as well. And so sometimes we're talking about diet, but I think there's a lot of interplay. And I would say it's both and. I don't, I don't want to, it's always about emotions and feelings, but I think that always plays a role.

That's really a beautiful way to put it.. I mean, sometimes I ponder about, okay, we, we have to eat a certain number of times per day. And as a mom, we're preparing meals for our family, a certain number of times per day. And there are time for celebrations when we prepare for people to come over and we've got so much is involved with our food, but I don't think that I ever understood.

You brought me to another level here with explaining it the way that you did. Yeah. That we have emotions tied to our food.

We have emotions tied to our food. Definitely. So for example, If you're constantly telling your child, I actually think it's interesting. You bring it up as a mom, because the way that we attach to food is often the way that we're taught to attach.

Subconsciously by the way our parents feed us. And a lot of times as children, food becomes a reward or the way the parent interacts with food is the way the child will learn to interact with the food. So, for example, if you say, if you're a good boy, I will give you ice cream for dessert. If it's different, then I'll give you ice cream, we're happy and we're going to eat ice cream.

So that child is going to associate ice cream constantly with happy being good, positive emotions, positive, happy pleasant, memories, celebrations. And so when they tried to self-soothe or cope later on in life, often, people want to talk to me about Benji, hog and dogs, ice cream or whatever. I can't stop, you know, whatever, some sort of addiction to food or something like that.

Often just tie to something as simple as the way that they were brought up. Yeah. There was a man that came in who was morbidly obese. And I found out that his mom, whenever he cried, when he was a child, his mom would either stick a bottle in his mouth or give them food just being chewing. They never talked about things that made him upset.

They never had any sort of conversation. She would just feed him when he was upset, she would just feed him. And so as he got older, that was the coping mechanism you learned to, to get him through any part of life, if college was stressful and he would feed himself, if a relationship was stressful, if he felt unhappy he'd feed himself.

And so it just created this pattern for him. That was so almost subconscious.

This is another tangent and it's kind of related. When we first got married, I had seen modeled for me, anger right before dinner. And I found myself finding reasons to get mad as I'm making dinner or about to serve my husband.

And it took me a little. Understanding before I realized that I was bringing something that didn't belong there and, you know, we've stopped that pattern long ago, but interesting how it affects so many parts of our lives.

And then if you tie that into your physical health, when you're under high stress, different people eat food differently and they crave different types of food.

So that could even affect your food consumption at dinner, how you eat, how much you eat, maybe if you're going to eat little and then eat a huge snack in later in the evening, like all of that plays a role. It may be your long-term health or your husband's long-term health because of just the pattern and how it's affecting your meals, which is actually like a piece of nourishment for your body as well.

Wow. So it's really, yeah. That's, that is amazing that you caught that pattern because I think a lot of people it's so subconscious. It was just something you didn't even realize this there is. It's amazing that you caught that.

Thank you. I'm grateful. Very grateful. So we've talked a little bit about how your emotions affect your physical health.

Obviously that man had an issue of the heart really? That was manifested as a heart attack.

one was caused from emotional stress. Tell me a little bit more about that. What do you, how do you see emotions playing out in health?

Yeah, that link between the emotions and the physical health. Yeah. And I know we have talked about this a little bit to give some grounding to that. My master's is in public health and, for four years I managed research projects.

One of my projects was in a low income community, that had high rates of incarceration. High rates of chronic disease, high rates of crime, high rates of drug use. And I was asked to come in to research why this is happening and how can we stop that cycle for the next generation.

So really looking at the kids to really stop that cycle for the kids. What I discovered was a key piece of research that I think explains this connection really well. So in 1998, a research study was published and it was called relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults.

The adverse childhood experiences study.

It's a lot. So to break that down, it was probably one of the most important pieces of research that helped me connect some of the pieces here. Basically adverse childhood experiences are exactly what it sounds like. Horrible traumatic experiences that can happen to children, but also to adults. And they study seven specific categories of that, which have now evolved into 10 because this piece of research blew up.

I mean the medical community, just research, just test taking it to another level. So those include abuse that can be physical, emotional, or verbal as sexual. Neglect. So emotional neglect or actual physical neglect, and then household dysfunction. And that can include a parent with a mental illness or an immediate family member in the home with a mental illness, a mother experiencing violence, an immediate family member who's incarcerated, divorce, or drug use in the home.

Let me just make sure I think drug use.

So these seven to 10 qualities were directly related to adult chronic illness, unhealthy or risky behaviors and ultimately premature death. Which is a huge outcome. That sounds kind of scary, but everything leads to premature death if you're involved with risky behaviors..

So what they found...


sound like risky behaviors that you're not in as much control of,

right? Yes. As in, they could be subconsciously playing out, like becoming angry before meals, even though you weren't trying to be angry before meals. Right. So that's, that's a really good point. It is. definitely a correlation that we want to research because people are acting out of learned habits that have ingrained to them.

What they found in the study is that 50% of the respondents. And there were up to 13,000 respondents that were researched, had at least one point, at least one ACE exposure and, 25% reported, two or more. And then one out of every five adults had, three or more exposures. and. In 1998. So I don't know how much our society has changed because these kind of re youth kind of ACE scores are intergenerational.

So if you have three or more exposures, the likelihood of you perpetrating that onto the next generation is higher. So that. Your next generation might have even more exposures. So what they found is that there is a graded relationship between the ACE scores, the number of ACE scores and risky behaviors, as well as chronic disease.

What that means is that the higher, the number of ACE scores that you have, the higher, the risk of developing chronic illness and showing risky behaviors. So quoting from the research persons who had experienced four or more categories of childhood exposure, compared to those who had experienced none had four to 12 fold increase in health risks for alcoholism, drug abuse, depression, and suicide attempts.

Those are part of ACE scores for the next generation. If you're an adult. with depression drug abuse, suicide. That's an ACE score for your kid. A two to four fold increase in smoking core self rated health and having more than 50 sexual partners or a STD and a 1.4 to 1.6, fold increase in physical inactivity and obesity, which is directly tied to chronic illness.

So other chronic illnesses that were tied in the original study were ischemic heart disease, cancer, chronic lung disease, skeletal fractures, and liver disease. But what we find is that the ACE study was so groundbreaking that more studies were done and it's just blown up all of our research. So further studies have really showed us that.

Auto-immune disease cancer, asthma, heart disease, chronic physical and mental illness. And like we said before, premature deaths are directly related to ACE scores. And I just wanted to focus on a study on autoimmune disease because I found it just really fascinating and also like diabetes, rheumatoid arthritis, just very common diseases are actually autoimmune.

So it's very much relevant to a lot of the diseases pervaded by society and our population. What they found is as a score exposure increases. So does our risk for auto-immune disease. And what that looks like is for every one point increase in ACE scores, we see a 20%. Increase risk for auto-immune disease.

Oh my

goodness. That's a huge difference.

Yeah. And, and so with every point, if there's four points, I mean that risk has increased exponentially. They also found that even a low, a score of two. So let's say you got to pick up your parents divorced and your mom, maybe your mom who you live with couldn't handle the divorce.

Well, she developed anxiety and depression. So that's two different aCE scores can increase your chance of being hospitalized for auto-immune disease by 80%.

Oh my goodness. That feels so hopeless. That feels like, what can you do? Because how many of us, I mean, isn't the divorce rate in this country? Something in the seventies?

Right, right.

So now we're seeing that divorce. Mental health issues. They're not in a silo. They affect and ripple down through the generations, not just inside, but externally that Seth is going to manifest in our body and our physical health. And that's, that's true. Talking about hope. I think that's something that we really want to talk about on this podcast.

Yes. Thank you. I really do. I feel like. One of the reasons that I was motivated to do this podcast in the first place is that I felt like feeling control over your health or hope was something that a lot of people didn't have getting a disease was something that you either got. Or you didn't and you didn't have any control over it.

And I feel like God has designed us to have some measure of control. Although obviously there are circumstances in our life that we don't have control of that contribute. So I'm really excited to pursue this.

Yeah. Actually part of my research with this specific study. So when I was doing the four years of research in that community with these kids, one, groundbreaking research that I discovered with the ACE scores, but another was actually hope scores.

So there's been a lot of research on hope with children who have everything going against them. High ACE scores, low SES, social economic status. Everything going against that, maybe their neighborhood, their school district, you know, situations in life.

They created a scale to measure hope and that measuring hope scores But what they found is that hope actually disrupt any sort of cyclical pattern and that children who have everything going against them, but have high hope scores actually overcome and result in different outcomes as in they result in getting through education, getting degrees. We see them having stable jobs, making more than the poverty line, which is breaking a cycle for their family and even having stable relationships in the future. actually research on hope specifically. What is an emotion!

That's amazing. I mean, I'm not surprised cause I know hope is critical.

Like we've spoken about it. Where you need to have a dream. Like I see drugs, for example, street drugs can give some, or even pharmaceutical drugs can take away the hope that someone has or the dream or the thought of the future. And when you have that hope, it just makes all the difference.

It really does.

And that part of research, I think. It's just, it's just funny to say. It gives us hope, why we do research, why we do research in order to, to step into communities and step into people's lives and, feel agency over even our own lives. Like we are never victims of our lives. We have agency and the development of hope in us I think it's going to be a. Important and curious part of our podcasts either today or in the future.

Can we continue on this? I seriously let, can we talk about hope and how we get it? Yes.

Awesome. I'm super excited to do that.

I think that would be an amazing part of our, yeah, our next podcast

I would love that. Thank you.

Yeah, I think that we, we never, and I know for you, this podcast is about showing it, like you said, people that. Control, there is some sort of control and agency and hope.

And, I think this will be a fundamental part of our discussion. Yeah. Thank

you so much. Marissa I am so grateful that you've taken the time to share with us. <TAG>

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Ep. 12 How Emotions can Contribute to Disease

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Ep. 12 How Emotions can Contribute to Disease

Ep. 12 How Emotions can Contribute to Disease


Helping you enjoy REAL Health.

Cynthia Cruz

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