106: Be Medicine: Lifestyle Medicine Psychiatrist Dr. Kristen Gialo

Dr. Kristen Gialo  00:00

That's essentially what happened with me where I was thinking, you know, there's just so many more tools we have in our toolbox besides medication. And often patients are unsatisfied with medications. So many people are very hesitant to take them or they're on a slew of meds and they're like, I just don't want to take these anymore. And in fact,

Narrator  00:18

Welcome to the Plant Based DFW Podcast weekly show with Dr. Riz and Maya, a show broadcasted from the Dallas Fort Worth area that focuses on lifestyle medicine. This is the use of evidence based lifestyle therapeutic approaches, such as a whole food plant based diet, regular physical exercise, adequate sleep, and stress management to treat, prevent, and oftentimes reverse lifestyle related chronic diseases that are all too prevalent. Every week, They feature a guest who speaks on one of these lifestyle medicine pillars. This show is for you, the person who is seeking to improve your overall wellness and quality of life. So whether you are driving, walking, or relaxing at home, we hope this show will provide you one more tool for your wellness toolbox. Let's meet today's podcast guest.

Maya Acosta  01:10

Dr. Kristen Gialo completed medical school training at Philadelphia College of Osteopathic Medicine in Philadelphia, Pennsylvania. She went on to complete residency training in Psychiatry at University of Maryland Medical Center and Sheppard Pratt Hospital. She was executive chief resident during residency and then worked at Sheppard Pratt hospital specializing in working with patients with psychotic disorders, bipolar disorders, depressive disorders, anxiety disorders and developmental delays. She was a faculty member for the University of Maryland Medical Center residency program and taught residents and medical students. She often work with patients that not only had chronic mental illness, but also chronic medical illnesses that plague their everyday lives and served as an obstacle to their goals and happiness. There comes a point as a physician when you recognize that medications alone are not the answer, and that health is so much more than just pills. Eighty percent of chronic medical illnesses in the United States are a result of lifestyle concerns such as diet, exercise, stress, lack of social connection, difficulty sleeping and substance use. As a result of this continued observation. Dr. Gialo went on to become a Certified Lifestyle Medicine Physician with the American Board of Lifestyle Medicine. She's also a RYT - 200 certified yoga instructor, as well as a yoga scope certified instructor. She incorporates her knowledge of yoga and mindfulness into her therapeutic practice. With her combined training in psychiatry and lifestyle medicine. She is uniquely equipped to help individuals suffering from not only mental health concerns, but also chronic medical illnesses. Make sure to visit her website BeMedicine.org. And I hope that you enjoyed this episode. So welcome, Dr. Gialo.

Dr. Kristen Gialo  03:00

Thank you. Thank you so much for having me. My I'm glad to be here.

Maya Acosta  03:03

Well, I am very excited to have you. You know, I often have mentioned on the show that mental health is a topic that I really want to begin to kind of address there seems to be so much polarity, so much division in our world. And I'm hoping that our listeners can kind of walk away with some tools. So how they can cope with life a little bit better. Before we get started on what you do your specialty, can we learn a little bit about you, where you from? And how did you decide that you wanted to go into psychiatry.

Dr. Kristen Gialo  03:33

So I'm a psychiatrist from Maryland, and I am certified in psychiatry, obviously. And then also lifestyle medicine. I went on to become more board certified in that as well. So I practice in the state of Maryland. I really lived a lot of places though. And right now though, I'm settled here. I essentially ended up in Maryland because I did my psychiatry training at University of Maryland Medical Center, which is kind of close by the back to Riz. I was reading he went to Johns Hopkins. So I was like, oh, Baltimore, similar town. How I ended up in psychiatry is actually a little bit of an interesting story. It wasn't really where I was anticipating to be. You know, after college, I actually had done research in cancer at Memorial Sloan Kettering up in New York City. So I actually thought I was going to be an oncologist, a cancer doctor. And you know, the way medical school set up the first two years are bookwork you know, it's not very patient centered. It isn't until your third year of medical school that you actually get experience with patients. And so I was really excited for my first rotation in internal medicine thinking, I'm going to be an oncologist, I'm going to be working with cancer, it's gonna be great. And I absolutely hated it. I hated rotation. It wasn't what I thought we barely interacted with patients. We were just kind of looking at labs. We were ordering treatments. We were not, you know, speaking to people very much and that left me feeling pretty unsatisfied and actually my last core rotation of third year what I'm in psychiatry, and I loved it. You know, I was kind of fascinated by the illnesses on the inpatient unit, and then seeing people with a wide array of issues. And I just loved how much time we got to spend and talk with people to really get to the root of maybe what's going on in someone's life. But even after that, I wasn't convinced I was going to be a psychiatrist, right? Because this, my story kind of brings me a little bit to the whole normalizing of mental health stuff. Because even me, I didn't necessarily think of psychiatry as like a real specialty. Right? So I was thinking of things like medicine and these procedures and all of that and thinking, well, is psychiatry for me, right. So it took me almost all the way until match right before match, because I had actually applied to psychiatry and pediatrics. And I had ranked my specialties piece by piece it because I recently ambivalent myself, right? And it wasn't until the night before I had to submit my list so that I was like, What am I doing, you know, let me do psychiatry. That's what I want. That's what I'm passionate about. And I, you know, ranked it accordingly and got my first choice and ended up there. And I think to myself, or reflect back on that time. And I think, you know, what was I doing? I would have been miserable anywhere else. Right. So I think that that is something that I think is prevalent. When you think about that view of psychiatry in a way unfortunately, amongst my peers, right. So most people you work with in the hospital setting and such. And then if it's like that with us, you know, you can imagine it's not. It has a ways to go in the public and with people we treat, you know. So that's my story a little bit long winded, but definitely didn't expect it. But I'm so happy that I'm here.

Maya Acosta  06:48

We're lucky as well, because not only now do you have that understanding of what really Western medicine can be you kind of kind of got a taste of it early on. And then of course, now you understand the component of this of mental health and also how lifestyle medicine plays a huge role. I recently had a conversation with an internist who is going back to school and also studying psychiatry, because she now understands the importance of mental health. And she kind of talked about how depression has to be has happens to be very prevalent among some of her patients and how she feels that that actually can be under diagnosed by primary care physicians. So maybe we can talk about that as well. So for our listeners, can you tell us the difference between a psychologist, a therapist and a psychiatrist?

Dr. Kristen Gialo  07:37

Yeah, no, I think it's a great question because I get that too. You know, it's hard. What do you mean when you see therapist? So, you know, so a psychiatrist, they have a medical background, they're a medical doctor, they went to medical school, they can prescribe medications. And they can do other forms of procedures and psychiatry, things like ECT's that's electroconvulsive therapy, they can do TMS, which is trans magnetic stimulation, other things like that. And they can also do therapy, which is great, because as a resident, you get trained in therapeutic modalities, which is really important. So then there's a psychologist, and there's actually two different types of psychologists, there's PhD psychologist, so those individuals that go to grad school, that they really focus a lot on research, you know, a lot of psychological research, even though they are focused on that they can still do therapy, because they get trained in that as well. And or they can be a Psy D society, someone that isn't really doing research as much or really more focused on the clinical aspect of things. And then lastly, someone who might be considered a clinical therapist might have gone to school for social work, but they got a like big kind of got extra training and their letters are lcswc, so that the licensed clinical social worker were like a specialty counseling, so they would have received extra training in that. So there's many people to choose from, when you're looking for a therapist.

Maya Acosta  09:03

Well, that actually is very helpful for you to kind of describe the difference because I don't know how many people actually know that as a psychiatrist, you are a doctor, you are you are a physician, who is then equipped to prescribe medicine as needed as well.

Dr. Kristen Gialo  09:18

One, I think it's also really important distinction too, because going back to your friend who's an internal medicine physician going on psychiatry, there's a lot of medical reasons why we may also have mental health concerns, whether it's kind of vitamin deficiencies, or thyroid abnormalities, nutrient concern, dementia, like a lot of other issues that can manifest in certain ways. You have to have kind of a diligence and observant eye and the background knowledge to pick these things, pick these things out.

Maya Acosta  09:49

So when you initially work with patients to you, I know it's kind of a rare question. But do you have have them kind of do run some labs to kind of see where they are physically in terms of their health?

Dr. Kristen Gialo  10:02

Yes, definitely. So I always do a set of labs, when patients come in. I can go through those if you want. I'm telling you kind of things, but my order and reasons why.

Maya Acosta  10:14

Yeah, definitely I'd like to know because, you know, we talked about, for example, vitamin D deficiency and depression and how that can affect us. What kind of labs do you request and then what sort of things do you see as a result?

Dr. Kristen Gialo  10:27

Sure. So so in an outpatient setting, I tend to order like something called a CMP. That's a comprehensive metabolic panel. And I like to look at that because I just like to see patients electrolytes, but I also like to look at their kidney function. Because if I am going to prescribe medications, I want to make sure their kidney and liver are doing well. And I also do that too, because some of our medications, which we'll get into probably later in our chat can have metabolic side effects and cause weight gain and lipid troubles. And so I want to make sure I have a baseline if we were needing to prescribe any of those meds. I also order a thyroid study, because if someone has hypothyroidism in that they have a low functioning thyroid, they can suffer from low mood, low energy, fatigue, difficulty concentrating, decreased libido, and all these things are very similar to someone struggling with depression, right? So we can, if that is the issue, which I've had patients a number of times, and we prescribe some thyroid medication rather than an antidepressant, and then people feel better. And also someone has an overactive thyroid. And that can sometimes be called graves disease, or things like that, they might have maybe more symptoms of anxiety, elevated heart rate, they might be losing weight. They also could have other types of mood changes. And so that is really important to notice, too. I get a lipid panel, like I said, because one in lifestyle medicine. So I like to make sure that I'm keeping track of how people are doing in that arena to decrease their risk for other types of issues. But also, because unfortunately, again, some of our medications can change those numbers, which really, really stinks. And so I like to make sure that I'm really keeping a close eye on that. And then we look at vitamin levels. So vitamin D, is very important. And actually I've only had one patient that I've ever done a vitamin D level on where it wasn't low. So we are all struggling with low vitamin D, because we kind of stay inside all day. I mean, and it makes sense. That's how our life is now outside enough getting that wonderful sunlight. And so so that can affect people's mood can affect pain, cognition. Then I also get vitamin B 12, which is kind of a fascinating vitamin really, that is very involved with cognition, attention, nerves, sensations, right. So I kind of, you know, I have a fascinating story from a patient I had treated back when I worked in the hospital setting. She was a woman who couldn't walk, couldn't walk in her late 50s. And she was diagnosed as being schizophrenic, very cute, confusing, don't know why that diagnosis ended up, they did all kinds of stuff for this woman, we had her coming into the hospital, we did our normal admission labs, and she had a vitamin B 12, zero, nothing. And that is significant. And she had a history of that in the past, you know, people weren't paying attention. And we just had to supplement her with B 12. Her mood improved, she wasn't feeling depressed, and she could walk again, like that's how significant these vitamins can be. And then lastly, I for young women, female patients, I get a pregnancy test, you know, because that's something we want to make sure we're being mindful of if we have to prescribe medication. So I don't think I'm missing anything but but that those are the labs that I most commonly check if you're in the inpatient setting, though, you might do other things like an HIV test. Because sometimes people can be struggling with HIV, dementia or cognitive issues or a syphilis test. That's something else that is commonly tested because people can have manifestations in that way. 

Maya Acosta  14:05

Wow, I have no idea. That's pretty interesting. You just mentioned the hospital work that you did. And I found that interesting, because you kind of have had two experiences, the work that you did the hospital and now you're in private practice. And we'll talk more about that. Can you tell us about that work that you did at the hospital? And what sort of mental illness Did you see? 

Dr. Kristen Gialo  14:26

Sure. No, thank you for that question. Yeah, so I used to work first at at Sheppard Pratt, that's a freestanding psychiatric hospital section. The last one, the oldest one that used to be many more, but they kind of closed down and so now they're still there. And I worked on, specifically on with psychotic disorders. So people with schizophrenia, bipolar disorder, and then sometimes what happens in that mix as well as you might get people with dementia like, who end up having psychotic symptoms, or developmental delays and sometimes people with significant personality disorders. And from there, I ended up kind of moving more into a state hospital setting. And so many people are probably not familiar with what that means. So, state hospitals now can differ from state to state, you know, based on their rules and regulations and laws. But it's for forensic population of people. And what that means is someone who may have committed a crime when they weren't in their, quote, unquote, right state of mind. And so those can be people who might be suffering from delusions or psychosis, hearing voices, and not being able to necessarily be in the reality of what is going around them. And being in our own experience, we can also see that, again, like I said, with people with dementia and other types of illnesses, where it really can affect their mental state, and unfortunately, then they may end up doing something that they would otherwise normally do, they can be a smallest trespassing, you know, a lot of people might be trespassing, they don't realize they're not supposed to be certain places, to as big as, you know, harming someone in a significant way. And so it's a very, very interesting place to work. So the really cool thing, actually, about being able to be in a state hospital setting is you get to work with people for a really long time. So the average length of stay is, like a couple of months, you know, I had patients that I saw for years, and you see them every day. And it's a relationship that probably no other doctor gets to have with someone, you know. And so it's really, really unique. And you can have such a profound effect on someone. And that is something really special. And often individuals in this type of setting. You know, they are not, they might be not given the benefit of doubt, because many of the times the people I was working with, were truly good people

Maya Acosta  16:55

Interesting that you get to work with them a little bit longer. And then during that time, are you then say regulating their medication, and also to you in the hospital setting have control in terms of the foods that your patients eat?

Dr. Kristen Gialo  17:07

Yeah, so that's an excellent question. And that actually brings, that's actually one of the reasons why I ended up going into my own private practice. So the unfortunate thing about psychiatric medications, which I mentioned a few times is that they can cause weight gain and something we call metabolic syndrome. And you may have talked about this kind of thing on your podcast in the past that metabolic syndrome is, constitutes five different things, you know, an increasing an abdominal obesity, meaning like weight gain around the stomach area, increase in triglyceride levels, decrease in HDL, which is a type of cholesterol that we generally find favorable, an increase in blood pressure and increase in fasting blood sugars. And unfortunately, medications like anti psychotic, and mood stabilizers can have a negative effect on that. And so I think we often think of psychiatry is not necessarily being a field where nutrition matters, kind of similar to maybe the OB GYN person you saw, right, the nutrition doesn't seem to be important. But to me, if we're having medications that significantly cause weight gain, nutrition should be in the forefront of our mind and helping people mitigate and manage the symptoms, because for some people, this is all they have this option, they can't not take medications, they need to take it because they want to stay safe, you know, and they want to be able to function.

Maya Acosta  18:23

That's the frustrating part of when patients actually decide to do something about a condition that they've been dealing with, so they decide to go to the physician, the physician prescribes medication and then, like you said, there are a host of other things that happen side effects like weight gain, and things like that, that then affect the gut, right? Like the medications. Now I understand that the medications can affect the gut and the microbiome, but I didn't know that back then. But when a physician just prescribes the medication, and you go home, and you're gaining weight and feeling worse than before, it's so discouraging.

Dr. Kristen Gialo  18:55

So I love that you brought that up the guts stuff and and to connect that, you know, often the way it was thought with the weekend before is that, you know, the medications just caused you to be more hungry. And so you're the one you're really the one that's causing the issue, you're just more hungry, it's kind of in your head, right. And this is a theme of something I notice a lot, you know, in medicine, and often if we can't explain something, it becomes in your head, right. And so you're and so with that with the weight gain, what we've actually found with actually, this even brings me to something so I used to work with residents, medical students, physicians is the students, I have them with me. And a student actually said to me, you know, a doctor they had worked with in the past that medications can't cause you to gain weight because they don't have any calories. And so any patient that's coming to you that says that is mistaken. And so that frustrated me. I said, Well, that's wrong. But, you know, we have much more knowledge now right about the microbiome and something I'm very passionate about. And one of the studies again, a lot of the work has been done. On at the bench like in mice, you know, and they're really starting to branch out into more work and more setting in humans. But studies have they they did do in mice showed that when patients or mice were on antipsychotics, their resting metabolic rate was decreased by 16%. So that means that their ability to burn calories dropped by 16%, which is very significant. And it was within days. And actually, what they also had done was they just took stool from a mouse that received that med and injected into another mouse just the tool, and it decreased the resting metabolic rate by 16%. And so it shows you that there's something going on there, that is affecting your ability to burn calories, and it happens very quickly.

Maya Acosta  20:51

Okay, that one was new to me as well, I'm so glad that you're mentioning these things, because our listeners can then be more aware, you know, it's not solely their fault. It's the role that medications are playing in their anatomy based on before we talk about your practice, because I would love to hear all that you're doing now. But based on your experience in the hospital, would you say that there are some mental illnesses that are more severe than others? And how are those typically treated?

Dr. Kristen Gialo  21:22

So that's a great question. And to just make sure people understand that the people that were staying there for a month like that, that was in a forensic setting. So those settings are much different like that, that path is for people, instead of maybe going to jail or to prison, they end up in this these hospital systems. Because a typical inpatient stay for someone who might be depressed, if you know, if they were just going to, you know, your regular Community Hospital is typically only a couple of days up to a week. So those days are much different. But don't want people to get nervous that if you do have to go to the hospital, you will not be in a place for months and months. Because that's often a reason why that people people stop this, they really need help, they're worried about that. But yes, so there is definitely a spectrum of mental illness. And some illnesses are more severe than others. But also, even within the illness, there's a range. So like, for example, people who suffer from schizophrenia, you know, we kind of say the rule of thirds, so about a third of people who suffer from schizophrenia will be able to take medications and their symptoms almost completely go away, and they're able to function in the in the world as if those symptoms weren't there. Then about a third is the meds, okay? You know, they're okay, and they help, but they're not getting rid of everything. And they're not helping people maybe resume their normal life 100%. And then there's a third of individuals that, you know, the meds, they're, they're helping, maybe a touch, but really not enough. And that there was those individuals are still really struggling. And so, you know, to me, some of these things in in psychiatry, there's, there's a lot left to be desired, right, there's a lot left to know about these illnesses. And, and because, you know, our treatments are not able to help every single person that comes through the door. And so that can be really difficult. So that's an example of that. And, like bipolar disorder, same thing, you can have individuals that are more of a mild case, and individuals that are a bit more of a severe case with depression, with anxiety, there's just such a spectrum. And, and it depends, you can have someone with really severe anxiety that's having trouble leaving the house, whereas you can have someone with a mild schizophrenia that's out working and having children and things like that. So it really depends on where on the spectrum individuals is falling. Now, the one thing too is that people sometimes fear that like, because it's uncertain, you know, and how will it manifest in me? And I want to give people reassurance. So there are a lot of good tools out there a lot of good physicians, a lot of good therapists, that we help support people every day with all kinds of troubles, and that there's always hope and an ability to get through what things that you're struggling with.

Maya Acosta  24:03

I'm glad that you mentioned that as well that to kind of give our listeners some reassurance, because one of my questions actually goes along the lines of how does one decide that they need help?

Dr. Kristen Gialo  24:15

That's a great, great question. Because there's also this idea that if you're not, like, you know, struggling to the the point of being to the max that like you don't need to reach out. And, you know, I think everyone could benefit from a therapist and talking things out, you know, that there's so much kind of struggling and suffering that everyone has to go through and every in every day of your life, that it's just helpful to have that support. And so you don't have to have, you know, a very significant diagnosis like schizophrenia or bipolar or depression to seek out help. You can just be an everyday person who's in the midst of COVID and can't leave your house and can't see your loved ones and that can be enough to feel like new are You know, just not in a good place. And so I say, if you are feeling any sense of that reach out, there's so many services out there now. And it's so the one thing that COVID has allowed us is accessible telehealth, which, you know, you can just talk to someone from the comfort of your own bed, I mean, some people I talk to you, because most of my services now are telehealth. They're just sitting on their couch cuddled in the blanket, talking, and they're very comfortable. So, you know, it makes it very accessible, very approachable. And the other thing I tell people is, one of the most important thing in therapy is the relationship you develop with your therapist, your doctor, whomever it is, and you may meet with someone, and you meet a couple times, and you think, I don't know, I don't know about this, this person doesn't seem like they see me they're not getting me. They're meeting me not offering me what I'm looking for. And then you just say, Okay, this person, not for me, I'm going to try someone else, it doesn't mean that therapy is not for you, it just means that maybe the relationship wasn't there. And that's okay, therapists will not take offense to that, because they understand that 50% or more of the success that happens in therapy is just based on the relationship, it's based on the fact that you feel trusted, trust their support, and you feel like you can be vulnerable with someone that you feel that they're gonna listen to you and not judge you. And that it's a safe space. And that is more than half of the Battle of getting through what we're struggling with. So it's important to keep that in mind not to give up, and that someone is out there, that's going to be the perfect person to help you through your trouble.

Maya Acosta  26:30

That's a great point that you bring up. Most of us are not used to kind of shopping around or interviewing our specialists, our physicians. And so to the idea that okay, well, this therapist, or this psychiatrist didn't quite work out, let's see if there's a better match. So Dr. Gallo, can you tell us about BeMedicine? That's your private practice.

Dr. Kristen Gialo  26:51

Yeah, so BeMedicine is my private practice now. It's where I combine lifestyle medicine with mental health. You know, I try to approach patients and meet them wherever they're at. And I kind of started this because one, you know, being in a hospital setting is very restrictive, you have to fall into the way they're doing things. And it's really hard to change things and to help kind of get new messages out. So that's the first thing.

Maya Acosta  27:19

There are limitations when you're working at certain certain settings where for someone else?

Dr. Kristen Gialo  27:25

Well, yeah, it's true. There are and I actually, I was listening to a bunch of your episodes. And you know, I think Dr. Yami. And also you, your husband, Dr. Riz had had pointed these two things out one is Dr. Riz is saying, he is the only plant based vascular surgeon and people look at you like you're a nut quote, unquote, Your A Health Nut, and and so people think, and even your colleagues, but like, that seems like something that just seems silly. And so it's kind of hard to have the confidence sometimes to really talk about those things, because you don't have the support there. Even though you have the research, you know, even though it makes logical sense. You don't, you don't have the support. And then I think Dr. Yami has mentioned that you don't want to step on anyone's toes. And when you're in like a structured environment, again, it can feel very difficult to to offer advice that might be going counter, you know, so you You're, you're very constrained. And so that can make you want to kind of go your own path. And that's essentially what what happened with me where I was thinking, you know, there's just so many more tools we have in our toolbox besides medication. And often patients are unsatisfied with medications. So many people are very hesitant to take them or they're on a slew of meds. And they're like, I just don't want to take these anymore. And in fact, there was a study, I can't remember the exact percentages but but a significant amount of patients in all specialties aren't taking their meds, they come and they tell you, oh, I'm taking it, I'm taking it. But then you get a call from the pharmacy three months later, and why do you keep prescribing this medication, this patient hasn't picked it up ever. Right. So there's a lot of pressure that patients feel to to please the doctor to please the system. And to not feel like a disappointment and and you know, we have to be listening, we have to be paying attention to what our patients are trying to tell us and see if we can meet them with some other strategies and other solutions that they may feel more comfortable with and maybe just as effective, because they're actually going to engage and do them. So that's where my mind goes with that.

Maya Acosta  29:26

So when a patient comes to see you then that we talked about it a little bit earlier, but you'll order some labs, check how they're doing in terms of their vitamins and other things like that. And then you move on to probably asking about exercise, physical activity, and then relationships and stressors stressors that they may be facing?

Dr. Kristen Gialo  29:47

Yes. So So basically, my initial visit is about 75 to 90 minutes. And that's often not even enough time. okay to talk about things and part of the issue here with the prescribing medications thing is that the way the healthcare system is delivered now, is we don't have enough time, so often doctors are forced into these short visits where the only solution they can provide is to take a pill, because it takes time and listening to figure out what is going on with someone and what is maybe preventing them from being able to be at a place they want to be, whether that's with their blood pressure, whether that's with their cholesterol, or with their moods, you know, why are they not feeling those, they have the energy to get out of bed. And yeah, sometimes, all they need is an SSRI, like an antidepressant. And that could help but often, there's so much more going on in someone's life that is contributing to any health problem they're dealing with. And so that's usually my goal is to kind of do some investigation, some digging, some learning and some understanding about what is going on in someone's life. So I asked about, you know, standard psychiatric questions, kind of thinking about mood and energy and sleep history, if they've been in-patient before, have they seen doctors before. But I also want to know about their life, I want to know about their living situation, their relationships, you know, I want to know how life was growing up for them, how easy were things, how difficult were things? Where do they go to school, like, I want to know about all that stuff. And it's important, it's relevant, because we all have a story to tell. And that usually informs us until why they're coming to me today. And so just giving a pill, it may be one part of the piece, you know, but maybe they're really struggling in their marriage, or maybe their child's just got diagnosed with some sort of developmental delay, like, there's just so much going on. And so I asked about life. And then I also say, Well, okay, well, what's going on in your in your routine? Are you able to get out and about? Are you able to have time for yourself? Have you ever tried meditation? Have you ever how often are you in nature? So there's so many different things that we can focus on. And that's how I look at health and, and the other reason why I started my, my clinic, as well. And what I tried to try to focus on is behavior change is hard. 80% of the illnesses people deal with today are a result of lifestyle choices. That's a core fact that we learn right in our lifestyle medicine, training, whether it's, you know, kind of difficulties with weight, high blood pressure, high cholesterol. And then when we talk about even mood concerns, there are things going on around us that are contributing to how we are feeling. And so when a doctor says to you, and your 10 minutes is it, you need to lose weight and stop smoking, oh, and you need to get more sleep, okay by those three things are probably the hardest, most difficult thing you're going to tell someone to do. You didn't sit down, you didn't listen, you didn't hear why it's been difficult to begin with and you didn't offer any concrete advice about how to tackle those problems. And to me psychiatry is the perfect specialty to do that, because that's what we do. We're listeners, we're empathizers. And we help to make a plan to help people make those changes that they want to see in their life. And so that's how I put all that together.

Maya Acosta  33:04

So some issues, maybe there might be a genetic component, but the other could be just environment and things that are happening in our surroundings. And so now I think of like what many people are living, not only in our country, but just in the world nowadays, where we're disconnected from our loved ones, our support system, many people have lost jobs, or are now dealing with financial hardships, or maybe now the, you know, the marriages or relationships are falling apart because of the stressors. So I was hoping that as we're talking more about that, what are some of the things that we can do to kind of manage or get through some of these things that can be, you know, causing anxiety, you know, we're feeling overwhelmed.

Dr. Kristen Gialo  33:49

No, I think that's a really good point. And I'm by no means like against medication at all, I think it's definitely can be a very important thing. And I think often it can get people through a very tough time. Because when you are dealing with a lot of things like you mentioned, you know, difficulties with a transition, a life transition, moving, not having the social support that you need, you know, trying out a new a new portion of your life, sometimes it can get to the point where you're not able to function. And that's when medications can be really important, they get you over the hump, and they help to get you through. So then when you look back, you're able to kind of catch those things and see those things and maybe make a change or something that can help you then in the future. But one of the most important things I find is is the social support part, the need for connection, you know, people are our social species, you know, we need other people and yes, there's a division of introvert and extrovert, but just because you're an introvert doesn't mean you don't need people around you. And that, you know, I think with COVID people really, you know, embraced the importance of that the fact that when we're isolated And when we don't have a good network of people we can go to or even when we just can't see our family and give them a hug, you know, the significance of that is strong. And and that's one of the one of the questions I always ask my patients is about their social support network. And that's one of the things that group therapy, like you mentioned, can really bring because, you know, we need, sometimes we need those people around us that might have had similar experiences, or even if they haven't had similar experiences, people who are willing to listen, willing to support willing to help get us through a difficult time and group can really provide such a, like amazing space, to conquer challenges. And especially for individuals who don't have that support in their life. Even if it's just for that specific issue, like let's say it's like for weight loss, or if it's for grief, or something that's very specific, you may not have people in your life that can truly understand that challenge. And so kind of finding that these groups can be very powerful. So social support is, is really in my mind, in test I had passed in social support when I think of that, because, you know, there's such a special relationship, we can form with animals that really helps get people through difficult times, and even just joyous time. So I think support is incredibly important.

Maya Acosta  36:24

I've actually have seen in my neighborhood, so many new puppies. So you were talking about the need for connection. So that's one component, what about when individuals just have health problems overall, all of those things must really then affect a person's sense of power, or, you know, and also self esteem, and maybe feeling like they're losing control of their life. I mean, there's got to be a component when we're just physically ill, that can then affect our mental health and even how we perceive life.

Dr. Kristen Gialo  36:53

Oh, yeah, no, no, you're exactly right. I mean, physical illnesses, whenever we can't function, how we want to function, it's a challenge that you know, and it's a struggle. And if we are not able to do what we used to do, that's usually where the challenge is, whether it's mental illness, or whether whether it's physical illness, often it's because someone is, is not able to do what they desire and not with depression, you can't get out of bed, you'd have no energy, you're having difficulty sleeping, you can't then function in your daily life, you can't do what you enjoy, exercise, work, go to work. You know, same thing with physical illness, if you're stuck in that and dialysis three times a week, you're not, it's taking away from your joy from the things you want to be doing. And that's not an easy problem to solve. You know, in some ways, medications can help us, you know, like I said, like, get over that hump. But with certain physical illnesses, it can be a real challenge, you know, but just because it's a challenge doesn't mean that we can't find things that make us happy, and ways to make our life work for us. But sometimes, that just means that we got to sit down and we got to think it through, we got to talk it through and figure it out. You know, I think laughter is I have to look at their job as a problem solver, you know, and not just necessarily with a problem right in front of us, we got to expand our mind a little bit and think of ways of being creative to really help individuals get to the place they're trying to go and get to the wellness they're trying to have. 

Maya Acosta  38:22

And that's exactly why when I mentioned earlier, the internist that I had mentioned, that's now also studying psychiatry, I think that was what she was also noticing is there's that emotional part, the mental health aspect that sometimes gets I don't know, if you would say under diagnosed or overlooked when one is dealing with a primary physician, for example,

Dr. Kristen Gialo  38:44

When you said about the internist who kind of looking more to work in the in the psychiatry and that kind of depression gets under diagnosed and things like that. And, and a part of the reason, I think that happens is that emotions are uncomfortable. You know, depression can sometimes be uncomfortable to doctors, you know, they don't know what to do when someone brings strong emotion to you. And so, when we are uncomfortable with something, I think we just tried to shy away from it, or we tried to like fix it and give a pill and try to make everyone feel better. And sometimes just part of being a listener, part of being a doctor is sitting with uncomfortable information and just being willing to tolerate it because when you are allowing your patient, you're telling them It's okay. You know, and I think that that is something that is so powerful to do that. And you know, I think sometimes when doctors also don't know what to do, or don't know what's wrong, they will like to push it into the psychiatry box you know, that Oh, it must be in your head or It must be something that you know, we don't we can't explain it so you must be x y&z.

Maya Acosta  39:53

That's a good explanation. I'm so glad that you said that. They may want to help the patient but not know how. And so I often wonder, I other physicians impacted. And also I, I wondered, do psychiatrists also see psychiatrists? Or do you already have the tools to sort of manage yourself kind of self care and create boundaries to protect your own mental health?

Dr. Kristen Gialo  40:13

That is a wonderful question. And and there's so many important elements in that. So one, yes, doctors are affected, you know, and nurses are affected techs are affected. I think that there's all different ways that people deal with that and some of its denial, some of its giving the cold shoulder because they can't take it on because they can't handle it, you know, and that it's, you know, it's lots of different ways that manifests. And I think also, there's this idea that doctors, you know, and nurses are supposed to be tough, you know, and that you can't really show emotion, or that kind of shows a weakness, or that you can't handle your job. Like there's all of these different stereotypes that kind of go into it. So I think you put on this brave face, but things impact you and it is a tough job. I can't tell you how many people patients who have mine that are healthcare workers. And yes, psychiatrists see therapist, you know, therapist, the therapist, because you know, emotional work is taxing and it it can, it takes a lot. So being an empath listening to someone struggles, you can can take that on, it's hard not to we're humans, you know, we want to relate to people. And and when you when you empathize with someone, you can feel that. And so that that is something that you have to be aware of, and make sure you're taking self care, so you can stay, keep yourself together in order to keep giving that energy to others that they need. So it's just we're just kind of cycles of energy giving and taking and trying to support, you know, so boundaries is very important. And it's something that we get trained on as Petra psychologists all the time. Because, you know, a therapeutic relationship is a strange relationship. And this is sometimes comes up with patients, right, because they are telling me things they've never told anyone, right, and they're telling me they're things, things in life verse I don't share much they don't know much about me. So what, what friendships Have you ever had, where, you know, it's just, you know, one person divulging and the other person not saying anything. So it's kind of a strange dynamic. And that is one that in the history of therapy, psychiatry has been exploited in the past. So it's something that's very important to keep in mind. You know, so you want to make sure that you are being mindful of the potential, like, power issues that can exist in that. But at the same time, you know, you're a person and people, you have to be relatable, you have to be someone that's approachable because if you're just the stone cold wall that's just absorbing information from someone, people are going to clam up, they're going to close down. So it's a delicate balance that can only be really perfected with experience, you know, the more people you see the more things you you know, see the kind of people feel comfortable with or work with, you know, then you kind of start developing that. But yeah, so boundaries is is a tricky thing. But something that is very important to be mindful of. Yeah,

Maya Acosta  43:04

Great. Awesome. So we were going to touch on yoga, and I actually wonder if you can tell us how yoga can help with mental health?

Dr. Kristen Gialo  43:12

Yes, so Yoga is a wonderful thing. I became an instructor just because I love yoga. And it helped me, you know, really experienced mindfulness when I've been introduced to mindfulness a couple of times in the past. And I thought it was kind of silly. I was like, yeah, this isn't for me. And it wasn't until I really got into yoga that, wow, mindfulness is amazing. Why didn't I see this before. And that's just kind of a metaphor for things need to hit you at the right time, no matter what. And so Yoga is good, because it's a physical activity. So it's movement and our bodies need movement, they crave movement and movement helps to decrease anxiety helps decrease depression, it obviously helps with all kinds of health issues. But the unique thing about yoga is, it really ties in our thoughts and our breath, and helps to bring that into the room and working out. So it's less mindless, and more kind of focused. And I just always loved in yoga, kind of the intentions that you would focus in class, it really gave me something to think about something to focus on for half an hour, 60 minutes, whatever the class is, and that is so important for you're not just exercising your body, you're exercising your mind. And and I loved that combination of things. And so I bring that into my you know, I've done yoga with my patients. When I used to work at the state hospital, I did a yoga class with staff and with patients because I just, you know, people like it, you know, they like to experience different ways of wellness. And that's one of them.

Maya Acosta  44:45

You kind of mentioned that there's sort of a process of how you work with patients. So when you diagnose an individual that you work with, you kind of work with them where they are, and then bring different modalities or different tools to help them And so you necessarily wouldn't start with yoga?

Dr. Kristen Gialo  45:02

Yeah, no, I think it's a great question, I understand exactly what you're saying. So, yeah, there's all different types of of methods you can use to help people, right? through therapy, there's all different types. There's like cognitive behavioral therapy, and they've heard of that before like CBT, or dialectical behavior therapy, that's DBT, psychodynamic, motivational interviewing all these different types. And so some psychologists out there, therapists, they might say, Oh, one CBT therapist, and they just focus on the strategy of CBT. Or I just do motivational interviewing. And to me, I started off working with someone by just listening and meeting them where they are, because I'm not going to know what type of therapies actually going to benefit them. And typically, it's a combination of all those things, and, and yoga and mindfulness too like, So typically, I listen first, and then fit in things later to figure out okay, well, what's going to work and sometimes you may try something and try modality, and it's not hitting home. And so then you got to be able to shift. So I don't like to lock myself into one way of being, I like to try to utilize as many ways as I can, to help. I guess, meet them where they are. But like, like I just pointed out, mindfulness didn't hit me until times three, you know, so I had, you know, if you have to try different things, until they stick, and it really resonates with someone. 

Maya Acosta  46:19

The yoga and the mindfulness came later for me as well. So what is the first step for someone who might be interested in getting help? 

Dr. Kristen Gialo  46:26

The first step can sometimes be asking, Well, two ways, if you have a trusted friend, or someone that you feel comfortable enough asking, I think it's a good idea to ask them if they are in therapy, or have a therapist or have ever worked with someone in the past. And if there's someone they recommend, I would say, that's a great way to get a referral if you're interested in seeing a therapist yourself, because there's nothing like word of mouth, you know. And then another resource that can be good is something called Psychology Today, it's a website. And they are available in all 50 states, you put in your zip code, and psychiatrists and therapists in the area will show up. And you can read about them, they have like usually little blurbs and BIOS and ways of contacting them or you access to their website. And you can investigate and see if there's anyone that looks like it might be a good match. So those are that's kind of the two best ways I think are good getting help or at least starting the process.

Maya Acosta  47:19

And so you're practicing right now you're licensed in the state of Maryland, and you're also offering telehealth there. Do you take patients from anywhere else in the country?

Dr. Kristen Gialo  47:29

No, unfortunately, I'm only practicing in Maryland, I only have a license there. But I'm hoping to get licensed more licenses over the next year. So I'll be able to offer services. elsewhere. On my website, I have yoga videos, so anyone is able to watch those and participate in those if they're interested. And then, you know, I am available for like speaking engagements, or anyone who's kind of interested in just hearing more about this, whether it's at their like Community Health Fair, or at their own hospital, or their place of work. I've given talks like that before, as well as like academic chat that I've done, I usually lecture University of Maryland and other places like that, how to manage your own mental health and and also actually like how to incorporate kind of lifestyle elements into health and happiness and ways of being.

Maya Acosta  48:14

What do you think about self care? And do you have some tips for our listeners as to what they can do right now just to kind of be aware of how they're managing their stress and when they're not necessarily taking care of themselves?

Dr. Kristen Gialo  48:29

Yeah, I think that that's a great question. self care, super important. And there's all different ways to do that. Like you mentioned, journaling is a great, you know, meditation, I often say I should be a sponsor for the calm app, because I recommend it to every patient I work with if they can afford it. It's calm. It's a wonderful app that helps to introduce you to mindfulness, they have sleep stories, and all kinds of things that help with sleep in and kind of just being present. And when we think about eating nutritiously as well, I think I mentioned before, but just that we don't think of nutrition, and psychiatry is going together. But one of the things I often mentioned to patients is actually, you know, we think about serotonin as being the happiness hormone and we think about backwards, that's what our drugs work on, they work on serotonin up in the mind, but actually, about 90% of serotonin is actually produced in the gut produced in the intestines, and that's where 90% of the serotonin receptors even exist there. Serotonin has so much more function than just in the brain. And so we know that actually what we eat affects our bacteria, and that having certain bacteria increases our own internal percent of their accounting. So if we're eating right, and we're you're eating nutritious food, especially fibers, especially fiber that will help boost our levels of serotonin in the body, and so Yes, eating and nutrition and feeling good. You know, you mentioned kind of just changing diet to help you feel light and feel invigorated. That's the thing. It's not in your mind. That's a real thing. And so I often tell people to increase fiber and that and the other thing I, we talked about social connection, but the other important thing is being out in nature, you know, we're not outside enough. And just kind of being present with the world around us with the sun with breathing in fresh air. There's something so powerful about that. There's actually a psychiatrist who wrote a book last year, she's the British psychiatry, it's called The Well Gardened Mind. And it's about gardening. It's like, the positive effect, just that that can have on our body and even our microbes, right? There's the hygiene idea, we're always constant cleaning, we're not really coming in contact with with microbes, and 80 to 80% of microbes are actually beneficial to us. You know, we look at them as so scary. And some of them really are. Most of them are actually very nice to us, and they help us and so being out there in the dirt, and in in the world around us is just incredibly important.

Maya Acosta  51:10

Yes, I'm so glad you mentioned that, too. I feel like I talked so much about nature therapy. And I've been a little bit stressed. And so this weekend, we're going camping, and I'm just so excited, because I just want to be in nature and disconnect from everything. So is there anything else that you'd like our listeners to know that perhaps we didn't touch on?

Dr. Kristen Gialo  51:30

Just something I always leave with at least kind of the students and the residents than I used to work with was, and something I like to live by too is this to be inquisitive in life? Be curious, you know, there's so much we don't know about ourselves right about ourselves, it's important to look inward and become a little bit more aware of ourselves and people around us, but also about science and health, you know, and I think just coming from a place of curiosity, whether we're a doctor with our patients, or whether we're just looking at how we can improve our own health is such a great place to start.

Maya Acosta  52:04

Dr. Gailo, what's the best way that people can reach you, your website, your social media, so that they can learn more about your work?

Dr. Kristen Gialo  52:10

Sure. So my website is www be medicine, so be  medicine, that org. And so you can find more information about me I have a contact form, whether it's for a speaking, engagement or just you know, become a potential patient of mine, you can email or reach out through the contact form there. And then also, I have an Instagram account. It's just at B E dot medicine. And so you can follow me there as well just for little tips on the kind of health and wellness.

Maya Acosta  52:40

Dr. Gialo it's been a pleasure having you thank you so much for talking to us about mental health and giving us some tips. Thank you again.

Dr. Kristen Gialo  52:48

No, thank you so much Maya I had a blast. And I'm really glad that we're able to have this chat today.

Maya Acosta  52:54

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