AMEN 2019: Christ in You

Breakout Session A

Plenary

Amarachi Nwankpah

Allen Lloyd

Adventist Medical Evangelism Network (AMEN)

Hormones and Emotional Intelligence

The title of this presentation has to do with hormones and emotional intelligence.

And of course, the emotional part is something that we deal with on a regular basis as we run residential depression and anxiety recovery programs.

And by the time they get to us, it's their last stop.

They have been going to usually a lot of other places, and they've had a lot of workup done here and there.

But we want to leave no stone unturned and so we can understand everything that's going on biochemically with them, as well as relationally and in other ways.

And so since this is their last stop, and many of those individuals will tell us this, you know, it's kind of no pressure on us when they say, if this doesn't work, I'll just go home and kill myself.

But we've had that happen, we've had that said multiple times, and of course if it didn't work we wouldn't let them go home and kill themselves.

But it is, It is something that's been gratifying to be able to see a number of positive changes made as a result of hormonal influences on emotional health.

First of all, emotional intelligence, what is it?

It's understanding your emotions and the emotions of others and responding to those emotions how?

It's a chemical transmitter produced by a gland or cells of the body and transported by the bloodstream to the cells and organs on which it has a specific effect.

And oversupply or undersupply results in multiple unwanted symptoms.

And of course, either 1 of these can result in significant issues.

And Many hormonal problems result in emotional challenges and difficulties.

1 of the relationships that I have thought about is the influence of hormones on the system, potentially in a way in regards to the influence of the spirit of God on the entire system, including the spiritual health.

You know, 1 of the prerequisites to getting an entire outpouring of the Holy Spirit of God, we're told, is to be prepared for it.

And there's a number of preparation aspects that we've been told in regards to this.

But there's a statement, and I was trying to find it right before I came.

I know it's, I'm doing something right now, it started January 1, but I'm reading through 10 pages a day of the entire 9 volume of the testimony series.

And I've never read it from cover to cover but I know it's in 1 of the previous testimony ones and I couldn't quite find it to see the quote here but she actually states that God actually could pour out his spirit on us without having the prerequisites.

You think, wow, that would be pretty amazing.

But she says it would result in confusion.

It would result in animation and all sorts of things, but it would actually not be consistent with truth, not be consistent with complete self-sacrificing love, and there's a reason why he withholds his spirit from us.

And I was thinking this is kind of what happens when our hormones are in excess.

It can result in a lot of animation and things, but it can result in actually unwanted consequences for that.

So in his mercy, he limits the pouring out of his spirit because we're not quite ready for it.

And this is of course something in our daily life.

Hope if you stay for session 2 this afternoon, I think we'll be talking about how in this whole process of, we're speaking about physician burnout and dental burnout this afternoon, but 1 of the solutions of that burnout is actually being prepared fully for the outpouring of the Spirit of God.

So there is a parallel of the Holy Spirit and hormones, and of course if we don't have enough of the Holy Spirit, it's like not having enough hormones either, and we're going to have problems of the undersupply, and we're lacking a lot more of the undersupply in our spiritual life, obviously, than the oversupply, particularly since he prohibits the oversupply of it if we're not ready.

So common hormonal and emotional intelligence issues, hypothyroidism, of course, can produce some significant mental health issues.

And this is 1 of the things that I think every psychiatrist is clear about.

I remember even years ago before I learned about all the different causes of depression and anxiety, It wasn't my focus at the time.

It was more of the internal medicine, adult diseases.

But when I was shadowing psychiatrists, when I wanted to learn a lot more about the psychiatric field, they always mentioned that they ruled out thyroid issues when I was asking about causes.

And this, of course, can produce some emotional problems.

Hyperthyroidism also produces its own set of emotional problems.

And of course, diabetes and even prediabetes can produce emotional issues.

And of course, low testosterone, hypogonadism, premenstrual syndrome, menopause itself, and adrenal issues, and of course low growth hormone or excess growth hormone.

We had an individual in our program just this last year that had some hormonal issues related to severe growth, excess in growth hormone, and acromegaly, and some of those issues that Resulted and she had had this going on for about 5 years before it was diagnosed by of all people a nurse practitioner And I'm thinking wow she had been to doctors and it took a nurse practitioner to do the right tests to find this out.

Of course, as soon as it was found out, she was referred away from the nurse practitioner to the proper specialist to get the treatment.

But the treatment had to be so significant that then she experienced a lot of hormone deficits as a result of what was being done to the pituitary gland on multiple aspects and ended up with a almost near panhypopituitarism.

So let's take a look at some of these causes of the adrenal issues.

Autoimmune disease or Hashimoto's thyroiditis can, of course, produce hypothyroidism.

And hyperthyroidism treatment is 1 of the major causes of hypothyroidism as well.

The radiation that might destroy the gland from Graves' disease or surgery and other forms of treatment.

And of course, there can be medication causes, such as lithium and pituitary disorders, or a secondary hypothyroidism, pregnancy, iodine deficiency as well.

Of course, we know TSH is the most sensitive test.

It takes 6 weeks to begin to notice a change after proper treatment.

But T4 and T3, both the full as well as the free, can be helpful.

But when these are normal despite a high TSH, of course, we call this subclinical hypothyroidism.

And a TSH greater than 3 may mean more antithyroid antibodies.

There's been studies showing the correlation there, and a greater chance to develop full hypothyroidism.

Even though the TSH, you know, of 4 or 5 might be producing more thyroid, it's not enough, and that's why it's subclinical hypothyroidism.

So early Hashimoto's is common, but this is often an overlooked aspect of subclinical hypothyroidism is chronic stress.

We have a lot of individuals come through our program that have TSHs of 4, 5, 6, 7, 8.

First time, you know, it's been diagnosed as subclinical hypothyroidism, but it is having its effect emotionally.

And interestingly, there are some natural therapies that can help with this.

Supplementation with tyrosine, which is something that actually we need to make thyroid hormone, it's tyrosine and iodine, can increase norepinephrine in the brain.

Of course tyrosine also has other effects.

Tyrosine actually gets turned into 2 different neurotransmitters that are very important in our brain, dopamine and norepinephrine.

And by increasing norepinephrine in the brain, it can induce thyrotropin-releasing hormone neurons to release more thyrotropin-releasing hormone, which acts on the hypothesis to release more thyroid-stimulating hormone.

And as a result, synthesis and release of thyroid hormones can actually increase.

So sometimes it's just a matter of getting them enough L-tyrosine.

And of course, L-tyrosine into the brain is where we need to get this.

And a lot of people are getting tyrosine in their diet, but not into their brain because of the blood-brain barrier.

This almost steel pipe requires, when it's a large neutral amino acid like tryptophan or tyrosine, it requires carriers to get it across the blood-brain barrier, and it's an insulin-mediated mechanism to get it across, meaning that we have to have carbs.

This is why the high-protein, high-fat diet is not very good as far as getting tyrosine into the brain, or tryptophan for that matter, and we ended up having brain problems from these, you know, even paleo diets or these ketosis diets that have become so popular today, and 1 of the reasons why they're not sustainable long-term.

In summary, chronic stress causes behavioral changes and disorders in the neuroendocrine network, and L-tyrosine can relieve or inhibit these changes.

We could go over some of them with you, where we'll see a TSH of 8.

We actually will put them first on L-tyrosine, and then 6 weeks later, their TSHs are less than 3, and they're doing much better.

Other treatments for subclinical hypothyroidism, this was actually a study that we did years ago at the Lifestyle Center of America, where we randomized 3 groups of community members to either continue their non-exercise routine or get on an aerobic exercise fitness program or an IT fitness program.

And the intermittent training fitness program individuals ended up having a nice, healthy drop in their TSH as compared with even the other 2 groups.

And so there's something about intermittent training or interval training that produces benefits as far as subclinical hypothyroidism.

Of course, there's other foods that are often recommended, like kelp with its iodine.

Of course, too much iodine can cause the thyroid gland to shut down, and too little can be problematic.

It's actually quite rare that iodine, with today the salt being supplemented with it is an issue, although it may be worthwhile to check.

We've had some individuals that avoid salt in any food or don't eat any prepared food and avoid it like the plague, and they might have an iodine issue.

And they wouldn't necessarily need to take iodine supplements, but even sea plants and seafood are gonna be high in it, and green leafy vegetables and strawberries and cranberries.

And then, of course, other treatments can be the actual medication, which is actually bioidentical in regards to the T4 and T3, of course, the active hormone being a T3, but T4 converts over to T3.

So because of our time limitation, I didn't cover all of the aspects of thyroid.

I could have also — I have a whole section on hyperthyroidism as well and some of those things.

If you have some questions afterwards, after I have a chance to present this material, feel free and we may be able to talk about more of those aspects.

But it's primarily exercise and the L-tyrosine treatment that a lot of people are unaware of in regards to natural therapies for thyroid.

Diabetes, of course, is also an endocrine issue and a hormonal issue.

And of course, there's been another term coined for it, diapression, because it often comes with depression.

And 1 of the reasons is the most common form of diabetes is type 2 diabetes, which is insulin resistance.

And as I just mentioned, it requires an insulin-mediated mechanism to get enough tryptophan and tyrosine into the brain.

So if we are insulin resistant, that can also be an issue in regards to brain chemistry and emotional health.

Metabolic syndrome, of course, is prediabetes.

Hemoglobin A1C is less than 6.5, But they're still having a metabolic effect, and we will see higher rates of depression, well documented even in the pre-diabetes stage.

And of course, the risk factors for type 2 diabetes are obesity and a decrease in physical exercise.

Essentially, you're getting more calories in than calories out.

And of course, you have the gene as well that's associated with it.

Six Words Every Physician Should Know

Dear Lord, we thank you so much for this day that you've given us.

Thank you for this time and thank you for this conference, Lord.

I just pray that you may be seen, felt, and heard in every word that I speak and every action of my life, Lord.

I humbly ask that we may come away from this meeting knowing you more and understanding more of the calling you have for each 1 of us.

I thank you for all that you have done and all that you're doing, all that you will do today and through this conference.

And I ask all these things in Jesus' name, amen.

Does anyone have a guess on what maybe these 6 words are?

Or maybe in your own practice, 6 words that you use or a motto that you live by that you remember every day when dealing with your patients.

This is interactive, you had to talk to me, that's why I asked the question.

No 1 guessed what the 6 words that I'm going to present on are, so this will be exciting.

But those were all great, so let's get into the presentation.

So this is a CME activity, so there are no disclosures that I have.

But the objectives are that by the conclusion of this CME activity, the learner would be better able to understand the barriers that hamper, destroy a provider's effectiveness in patient care, recognize that spirituality is a core patient need and its beneficial influences on health, and also understand the role spirituality can play in their professional growth, promotion of personal happiness, and the basis of their calling as a health care provider.

So in 2019, a study was conducted by the National Coalition for Cancer Survivorship, where patients and physicians were asked about some physician behaviors that can have a negative impact on effective communication between the healthcare provider and the patient.

So some reasons given by the patient were that the provider withholds information or provides this information in a cold and tactless manner.

The physician sometimes talks down to patients or use terms that are unfamiliar to patients or that the provider has body language or behavior that signals that they're really too busy to give the time that the patient may need.

Physicians also noted some barriers, mostly centered around not understanding the subject matter and thus not being able to teach it, and then also being afraid or ashamed to admit that they don't understand the subject matter.

And then also doubt in certain treatment options due to unfamiliarity of the method.

So, these barriers not only made it more likely for a patient to be non-compliant, but with the lack of empathy perceived, trust, and the lack of concern perceived, the patient is likely not to return to the provider to receive the care they need.

So interestingly enough, these barriers not only exist in communication of physical diagnosis and treatment, but also in spiritual health care as well.

In 2016, the AMA, the American Medical Association, conducted a survey and found that 41% of patients want to discuss religious or spiritual concerns in the healthcare setting, but less than half reported being offered the opportunity to receive such care.

In 2003, a survey was conducted in primary care clinics at 6 academic medical centers.

A total of 456 patients participated in the study, and 65% of these patients felt that the physician should be aware of their religious preferences, while 35% preferred that the physician ask them about their beliefs.

The study also showed that the patient's desire for spiritual interaction with their physician increased with the severity of their illness.

Other studies have shown that as many as 83% of patients would want their physician to inquire about their beliefs and Studies even indicate that integrating spiritual care into patient care significantly enhances patient satisfaction.

Patients surveyed said that when spiritual care is not integrated into their health care that their satisfaction levels are actually decreased.

So the effect of spirituality on health is really an active area of research.

Typically studies on this topic tend to fall into 3 major categories, either mortality, coping, or recovery.

Some observational studies suggest that people who have regular spiritual practices tend to live longer because religious commitment may offer richer social support and the strength of personal values and moral view.

So patients who are spiritual may utilize their beliefs in coping with illness and pain and life stresses.

Interestingly, a study of heart transplant patients showed that those who participated in religious activities complied better with follow-up treatment and had improved outcomes at the 12-month follow-up visit.

So these studies highlight the importance of assessing spiritual needs and having a conversation about spiritual health with every patient.

Yet few providers actually do this, thus creating a gap in a patient's health care.

Also, when a prior does address spiritual health, many patients observe the same barriers that we just discussed and are non-compliant with the recommendations or do not return to the subject in subsequent visits.

When physicians were specifically surveyed about addressing spiritual care and the barriers that may be present, they said similar things.

Lack of time, lack of knowledge and interest in spiritual things, and they didn't want to make people feel uncomfortable and they felt uncomfortable themselves.

So an understanding of the impact of spirituality on overall health is really essential and although challenging, consistently addressing the matters with every patient is as important, if not more important, than addressing their physical and emotional needs.

So I'd like to demonstrate these points in 3 unique cases.

She's a 61 year old woman who had poorly controlled hypertension and obesity.

When she came to me she was already on 3 different blood pressure medications and despite this her blood pressure was consistently in the 180s to 190s over 90 to 100 range.

She was complying with all her medication, so as I talked with her, I thought that really the most likely cause of her elevated blood pressure was because she didn't have a great lifestyle regimen.

So as every good Adventist physician does, I started talking about lifestyle with an acronym.

First, nutrition and exercise and water, sunlight, temperance, fresh air, rest.

And then when I got to the last tea, I looked at my clock and I realized, don't have time for this.

So, I told her, you know, we'll follow up, we'll talk about the rest on our next visit, but I felt a little guilty.

So in order to make myself feel a little bit better, I kind of rambled off something to the tune of, you know, health is really important and it includes spiritual, physical, and emotional needs.

And, you know, we talked a lot about physical health today and spiritual health is really important as well.

And some of my patients like to talk about spiritual health and so they even like to include spiritual practices such as prayer.

So is this something you'd be interested?

And she was pretty confused at that point, not really knowing where that came from.

So she declined and she left the office with a note from me that she brought to the checkout counter saying, follow up for blood pressure in 2 weeks.

So, the way my office was structured, in order to make more availability at my schedule and also to decrease the wait time for patients for straightforward visits, her repeat blood pressure check was actually scheduled with my medical assistant.

And so I knew that it was going to be a long time before I actually saw her.

And so, you know, at that visit I felt that I had missed the mark.

I felt that I should have done more, but then I consoled myself saying, I do have a busy schedule, it wouldn't be fair for other people to wait longer, and I did talk about lifestyle, right, check, and I did offer prayer, check, And she was really the 1 who refused to talk about spiritual health.

2 weeks later, my medical assistant knocks on my door, and she reports that Zizi has returned.

And she checked her blood pressure 3 times, and the best reading that she got was 180 over 100.

So besides this, Zizi was crying because her blood pressure was still not controlled despite compliance with all the medication and lifestyle recommendations.

So at this point, remember I said that she was on my medical assistant schedule, so she wasn't on my schedule.

So I had a full schedule, patient set to arrive any minute.

And I had also discussed with her at a previous visit that if her blood pressure still wasn't controlled, we might need to add a fourth antihypertensive to help control her blood pressure.

I said, you know, I have a busy schedule.

Let her know that we're just going to add that other blood pressure medication, and then she can see me back in the office.

My medical assistant returned soon after saying, the patient wants to speak with you.

I checked her blood pressure myself with a manual cuff, and the reading was 186 over 94.

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Presenter

Amarachi Nwankpah

2 Teachings

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Hormones and Emotional Intelligence

59m

Six Words Every Physician Should Know

28m

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Hormones and Emotional Intelligence

59m

Six Words Every Physician Should Know

28m

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Series

Breakout Session A

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4 parts

Series

Plenary

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7 parts

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Oct 31 – Dec 1, 2019

AMEN 2019: Christ in You

5 series

Sound Doctrine