213: Leveraging Lifestyle Medicine for Mental Health Equity with Dr. Alyssa Vela

[00:00:00] The stress of experiencing racism, of having less access to resources, of having less generational wealth, of experiencing stigma in healthcare, of systemic mistrust, of the healthcare care system, which I think is generally pretty valid and pretty reasonable in most cases, all kind of come together and can really influence how folks interact with and experience the healthcare system. This is the Healthy Lifestyle Solutions Podcast, and I'm your host, Maya Acosta. If you're willing to go with me, together we can discover how simple lifestyle choices can help improve our quality of life. Let's get started. Mental health symptoms and disorders are pervasive, accounting for 30% of disability and 20% of years of life lost due to disability in the United States and resulting in reduced quality of life for millions. 

[00:00:59] Racism, discrimination, acculturative stress, and trauma are only some of the factors that have been inextricably linked with mental health and wellbeing, with greater internalized racism and greater acculturative stress both associated with worse mental health. Further, significant gaps in access to culturally tailored and prevention oriented treatment exist, and disproportionately affect traditionally marginalized groups. My next guest, Dr. Alyssa Vela, is a health psychologist and assistant professor of surgery in psychiatry and Behavioral Sciences at Northwestern Feinberg School of Medicine. She's one of the speakers for the upcoming Lifestyle Medicine conference in Orlando, Florida, and her lecture is titled leveraging Lifestyle Medicine for Mental Health Equity. 

[00:01:50] As always, the full bio and the links for each of my guests can be found on the website healthylifestylesolutions.org. And are you following me on Instagram? If not, here is my handle at Maya podcast, and I hope that you enjoy this episode. Thank you, Maya. I'm so happy to be here with you today. 

[00:02:11] Yeah, well, I'm happy that you are able to be here to get our listeners excited about what they can expect for anyone who's interested in going to the Lifestyle Medicine conference. But even if you cannot go to the conference, were going to learn today a little bit about what you specialize in, or at least what you're passionate about when it comes to health equity. I did say that for us here on the podcast, mental health is such an important topic, but also just in general, health equity, making some of these lifestyle interventions available to people who could not otherwise afford, for example, health care. And so the lecture that you're going to give you have two things going on at the conference, but one of them that really piqued my interest is titled Leveraging Lifestyle Medicine for Mental Health Equity. Would you like to tell us a little bit about that and then we can talk about yourself and how you got interested in psychology in general? 

[00:03:10] Sure, absolutely. Yeah. I'm really excited for November to fingers crossed to be back in person. It's just such a rich experience to be face to face and interacting with folks. I'm really excited to be there and hopefully meet a whole bunch of new people at my talk and just at the conference in general. 

[00:03:30] So, the background is really that as a clinical health psychologist and based on my training, I have been interested and studied for many years. At this point, the intersection between physical health and mental health, which most of us know is important but tends to be a little underattended to. And since getting involved in the lifestyle medicine space, several of us who are trained mental health professionals have really been advocating for the need to think about and include mental health within lifestyle medicine. And how I like to conceptualize it, is that mental health and all aspects of lifestyle, all of the pillars as they're known within the American College of Lifestyle Medicine space, so sleep and diet and physical activity relationships, stress, substance use, all of those things have a bi-directional relationship with mental health, right? So, getting enough sleep can be incredibly supportive of mental health. 

[00:04:35] And poor sleep, insufficient sleep can certainly be a risk factor for mental illness. So, I think incorporating mental health across the board is incredibly important. And that sparked some of the work that myself and some of my colleagues and collaborators have done in this space over the past couple of years. And as I continue to get involved and just think about my own work that I'm doing at Northwestern. The courses I'm teaching in Diversity in Psychological Science and practice. 

[00:05:06] I'm also really interested in how can we use this emerging area of lifestyle medicine that is immensely impactful in people's lives and thinking about quality of life to really address the mental health crisis that is happening in the United States and really globally. And while many people are struggling with their mental health. And we've seen huge increases in anxiety and depression and trauma-related disorders. After covet and after many of the events of the last couple of years. The murder of George Floyd. 

[00:05:41] Shootings so many things over the course of this time. We tend to see mental illness underdiagnosed and undertreated across the spectrum from depression to eating disorders. So on and so forth. In underserved communities. Whether that's under-resourced or what's historically been known as minority or minoritized communities. 

[00:06:04] Black or African American communities. Latinx communities. So on and so forth. And so I'm just really excited about starting to have some conversations that are really kind of connecting health equity, mental health equity, in particular lifestyle medicine and lifestyle approaches to care and mental health, and just really starting to move forward to connect all of these concepts and create some change. Absolutely. 

[00:06:29] I'm also happy that we're finally able to be a little bit more open about these things that you hear more and more people comfortably saying suffer with anxiety and what does that mean and what are the resources that can help with anxiety? So hopefully we'll address some of those, helping people feel comfortable when it comes to sort of admitting that there's suffering and you just address that. The health crisis, the mental health crisis that we've seen in the last couple of years as a result of the pandemic has really caused many people to go back probably to having more anxiety, more depression. I wonder if later in the conversation you can speak with us about how we can develop kind of emotional resilience, if that is the right word for that, how we can begin to cope. What are some of the things that we can do to cope with mental health issues? 

[00:07:27] And you'll talk about that with lifestyle medicine as well, I believe so. Can we learn a little bit more about you, Doctor Vela? Why did you choose psychology? What led you to that path? Sure. 

[00:07:40] So, like so many others, I went to college thinking I was going to go to medical school. That was kind of a game plan. Since I was a little kid, always wanted to be a doctor. I was kind of the weird person who didn't mind being in hospitals and medical settings. I was just always really interested in health and well-being. 

[00:08:01] And as I got a little bit older in high school and into my college years, I just became really more interested in lifestyle approaches. I certainly didn't know lifestyle medicine was a thing at that time, and I think it probably didn't have that label back then anyway. But based on my own background as a Latina who grew up with grandparents that navigated the health care system without the best English language and without necessarily being able to find Spanish speaking providers or culturally sensitive providers and having many family members with serious and chronic health conditions, I became increasingly interested in the mental health and physical health connection or the mind-body connection. More simply. I took a class in college that was about health psychology and that just really clicked for me. 

[00:08:59] It was much more in alignment with my perspective on health, which is really focused on utilizing lifestyle and health behaviors for prevention and treatment. That's what I've always been interested in and passionate about. And I was also a collegiate athlete, and so I really saw in myself and in my teammates how thinking and emotion and mental health showed up quite literally in the pool every weekend that we had a competition. And so throughout college, that just became more and more evident that that was sort of my path and my interest. So, I kind of switched gears and decided to pursue health psychology very specifically with a clinical concentration because I was interested in working with patients and had the opportunity to interview with Dr. 

[00:09:51] Fari Kashlan who was at the University of North Carolina at Charlotte at the time and was really an expert in developing and testing lifestyle interventions for binge eating disorder among Latina women and meeting with her and hearing about her work and having the opportunity to work with her just really aligned with my background and my areas of passion. And that's sort of how landed un in this field. Fascinating that it was in many ways. You were always interested in health and wellness. 

[00:10:23] You wanted to be a doctor, and I think I've even heard you explain your degree, because there are people that have psychology, background in psychology that are also medical doctors, and then there are the people that have the PhD. So, yours is it's a great question. Most people have no idea what I am and what I do, including people I work with, probably. So, not uncommon where health psychologists are not super common, unfortunately. So, I have a PhD in health psychology, and then I did a clinical concentration, meaning that I did all of the training, the Residency Fellowship, to become a licensed psychologist. 

[00:11:04] But I really have specialized training in working with folks who have serious and chronic medical conditions, and particularly in medical settings and as part of interdisciplinary team. So it's a different language to communicate with physicians, MDS, do, registered dietitians, social workers, and to really come together as a team. And so I've worked with folks with diabetes in primary care. I've worked in oncology I've trained kind of all over the spectrum in terms of health, and that's really what I do as a clinical health psychologist. Okay. 

[00:11:46] Yes. Thank you. And hopefully we can touch a little bit on how you work in the cardiac setting in helping people to create change as they continue to hopefully improve their health. But also I've heard you say that you have to kind of help them make the change to optimize their health, just to even have a procedure. So much to talk about. 

[00:12:08] Dr. Vela, your interest in working with Latina women who have suffered with disordered eating is really interesting to me. I myself am an immigrant, even though I don't have an accent. We came when we were very young. But there are a couple of things that I think really affected us when it comes to mental health which I'm not going the other one is that a hold of my own family, and so you have.

[00:12:29] One of them is living in fear, which I'm not going to focus on too much, but just as an immigrant living in fear in this country and how that can affect your long term, that's part of the trauma. The other one is that we come as a culture, at least with my own family and my extended family that eventually also came here, is seeing the diet culture really taking hold of my own family. I don't remember dieting when we lived in Mexico. But you come here and you eat like the kings and queens of old, like John McDougall says, and so you have access to a lot of different foods. And so, like many people think if you can eat steak every night, it's a good thing. 

[00:13:13] And then you start to see the women gain weight. It's usually always the women. And then, I started to see dieting, which led me to develop disordered eating. And I went the other way in terms of restricting. I do speak about anorexia and bulimia from time to time here on the podcast because I want to continue to support women. 

[00:13:34] I want to continue to talk about this. Many of the health coaches that come on, even other specialists, come on, and they'll say that at some point in their lives, they also had disordered eating. Why is it so prevalent just in general? And what did you learn having worked with Latino women? Those are great questions. 

[00:13:54] I really appreciate you bringing up this topic. I think it's immensely important and really underappreciated and I mean, even having a pretty good sense of the scientific literature, there's more research that's coming out, but there's really just not enough attention to this topic, let alone in groups such as Latinas. I think this is so common for a variety of reasons. Number one is I think there's a lot of attention on food. When we think about diet culture and dietary recommendations from medical providers and even guidelines and stuff like that, there's so much attention to food, and there's so little attention to eating. 

[00:14:40] And nutrition is not just about what we eat, but it's about how we eat and stress that might come along with eating restriction food environment, right? I think one of the challenges for folks who are immigrants can even be some of the kind of societal lifestyle factors. So thinking about in Latin culture of Mexican descent and Italian descent. So it's very culturally normative in my family to eat as a family, to sit down and eat at the table. And that's surprisingly not entirely common in the US. 

[00:15:22] Right? And so with lifestyle changes come changes in eating behaviors. And I think it's the behaviors as well as some of the thinking related to things that you touched on the food environment, access to food, what it means to be successful in terms of the food that we have access to or have the opportunity to eat, all play really important roles. And the other thing that comes to mind that we paid a lot of attention to in my research and something I still think about now and is relevant to my current work is the role of acculturation and acculturative stress as well as generational status. So when somebody moves from another country to the United States, for example, or really anywhere else, they are assimilating to a new culture. 

[00:16:11] There might be some major distinctions between where they lived previously and where they live now that can actually happen within the United States as well. Somebody might move from Chicago, where I am, to down south or vice versa, or from an urban area to a rural area and vice versa. And so when we move from one culture and way of life to another, there's a lot of opportunity for a cultural stress. The stress that comes around along with those changes and the internal psychological conflict between maintaining one's original culture and assimilating or adjusting to the new culture. And those things can really come in conflict and cause an immense amount of distress and anxiety and low mood and be really difficult. 

[00:17:02] And within a household, within a family, potentially, there can also be different degrees of acculturative stress. And there's a lot of research looking at generational differences, particularly for families who immigrate. And so that's kind of the tip of the iceberg. But I think a lot of those things come together and can really influence eating behaviors and how people think about food and feel about food over the course of time and in some of those contexts. Excellent answer. 

[00:17:34] Wow. It really helps me to understand, and it makes sense. The way that you explained it is relocating, whether it's from one country to another or from one state to another. comes that added stress period. Moving in general is very stressful, but then coming into another culture that is not your own. And yeah, I mean, I remember the first few years that we were in this country, it was just us, my immediate family. 

[00:18:03] We didn't have a support system. We didn't have another family to invite over for dinner. And then you begin to learn about the fast food and the frozen foods and just things that make it easy as you're adjusting to your surroundings. And that's exactly what happened with us. Certain foods that we never ate. 

[00:18:22] I remember there was a time five years into us being here when an uncle of mine came from Mexico, and he was wanting to prepare a meal, and he said, Where's your food? And we're like, in the freezer. And he was shocked. He couldn't believe we were eating these foods because where my family is, they still shopped right there in the street. When the market sets up, you're eating fresh fruits and vegetables. 

[00:18:47] And frozen foods were not as common, at least back then. So gosh, that really helps a lot, the way that you explained it. I'd like for our listeners to understand once again what it means to have racism in healthcare and to have these disparities in general in health care. I will say that as this became even more apparent during the pandemic, that the people that were the most effective are the people that have the least amount of resources. Can you tell us more about what that looks like in health care and just mental health equity? 

[00:19:21] What are we talking about when you say that? Yeah, absolutely. I think we've known that racism is an issue in healthcare and medicine pretty much forever from the foundations. It's actually really interesting to learn about kind of the history of medicine, particularly fields such as obstetrics and gynecology and how women were treated and how enslaved women were inappropriately and really horrifically. I don't even know what language you utilized, for lack of a better word, to study, to study obstetrics. 

[00:20:03] So, there's an immense history of racism in medicine, and I think it's only recently that we're starting to that the field is starting to acknowledge this more directly and have more explicit conversations. So, certainly we have a long, long way to go. There is a paper, and I'm sure there are others that came out in 2020, I believe, in the journal The Lancet, that the title essentially said racism, not a race, drives inequality across the COVID-19 continuum. And there have been other papers and other statements saying a similar thing that we tend to over-attribute race to some of these disparities that we see, whether it's in covert outcomes or heart disease or diabetes or whatever it is. And it's not really racing because we know that genetic variation between race-ethnicity, which is also a social construct, but that's an aside for perhaps another conversation that genetic differences are incredibly minimal. 

[00:21:13] So, yes. There is some variation in predisposition. But we also know that the stress of experiencing racism. Of having less access to resources. Of having less generational wealth. 

[00:21:26] Of experiencing stigma in healthcare. 

[00:21:31] Of systemic mistrust of the healthcare system. Which I think is generally pretty valid and pretty reasonable in most cases. All kinds of come together and can really influence how folks interact with and experience the healthcare system. And I would be remiss not to mention intersectionality and the work that's really focusing on intersectionality originating from Kimberlé Crenshaw’s work and thinking about how a factor such as an individual factors such as race or ethnicity intersects with other aspects of identity, whether that's gender, which is where the work originated, or sexual orientation and so on and so forth. And that folks with multiple marginalized identities are even more likely to experience stigma and discrimination in health care and interest in general in the world. 

[00:22:27] And we do see that showing up in research. And again, there's more and more work happening in this space and more and more research funding, which is really important. But we have so much work to do and we do continue to see disparities. We've known for decades that black or African American individuals, women in particular, receive less pain medication than white individuals, particularly white men. And we've known for decades and decades that this happens and we really haven't seen that change. 

[00:22:58] And we know that comes from racism and implicit bias. But again, it hasn't really been addressed. And so we can continue to see this show up and that affects outcomes and quality of life and experiences of healthcare systems and relationships with providers and lifespan and so much more. It seems like there are so many factors that play a role in people's mental health. So one, like you said, is the disparities in general, maybe even not even having access to these resources but I wonder also just the culture itself not being so open. 

[00:23:38] Some families are not open to that. So how do you outreach, how do you work in trying to provide mental health equity when, say, some people may not be interested? Yeah, I think you're touching on some really important themes here. Absolutely. That's a common concern. 

[00:23:57] And there's certain cultures and certain groups and families that are less inclined to seeking mental health care, less inclined to engaging in treatment. I think I could probably say the same about my own family. So, maybe that is or isn't why I became a psychologist. Who knows? 

[00:24:18] I think professionally, it's about meeting people where they're at. And I think I have a fortunate opportunity as a health psychologist specifically and perhaps thinking back, that's even what sparked my interest in health psych versus kind of more general mental health clinical work is, I think it's sometimes easier to come in from the physical health perspective. So I work with folks who have cardiovascular conditions, particularly heart failure. And we know that among populations with cardiovascular disease and again, heart failure in particular, that we have much higher than general population rates of anxiety, of depression. We know that stress, personality characteristics, all of those things can certainly increase risk for cardiovascular events, for cardiovascular disease. 

[00:25:16] And so I think sometimes it's about coming in from more of that medical side and that physical health side and appreciating what are people's goals and what are their values, what do they care about? And how can we provide education as a baseline to help people understand that mental health and physical health are intimately related and bidirectional, and then also we have behavioral health, right? So it's not just mental 

health, but it's also thinking about lifestyle and behavioral interventions. And many of the interventions that we utilize for physical health are the exact same things that we utilize for mental health, physical activity and dietary changes and stress management. There's a ton of overlap. 

[00:26:05] So I think that's certainly only a small portion of what you're touching on. I think this is a much bigger issue. One of the things we're also seeing more of and I expect will continue to grow as primary care mental health integration. So having psychologists and social workers and counselors, other types of trained and licensed mental health professionals who are located within primary care offices and offering either therapy within the office but also offering truly integrated care. This is something I did quite a bit as a trainee when I was a resident and then a fellow, where I would see folks before, during or after they visit with their primary care doctor. 

[00:26:54] I might screen them. We might work on symptoms of anxiety or quitting smoking or anything kind of or disordered eating, anything within that realm. And when it's normalized and not because something is wrong or bad or they're quote unquote crazy and it's just readily available, just like every other aspect of their care. I think that can be really helpful and important, and I hope and expect that we will continue to shift in that direction and normalize systemically. Exactly. 

[00:27:29] That's an excellent point. It's something that would be wonderful if our primary care physicians have the time to kind of address some of these concerns. You might know Dr. Alyssa Vela. She is in California and she went back to school. 

[00:27:45] She's a primary care physician, but she went back to get some additional training in psychology and mental health. And part of the thing that she's very passionate about is screening for depression when she first meets her patients. And that's what you're talking about. That's having the tools for a primary care physician to kind of not only look at the health, because, like you said, taking it from a physical health could be the path towards addressing mental health issues or at least seeing what else is going on with the individual. So, yeah, this is excellent. 

[00:28:21] Now, we talked about what if people are not open to these modalities, but let's talk about the individuals that we can outreach to. And this is very important to me in general, not just with the Latinx community, but just in general, outreaching to people. I had an individual and I'm going to throw this in it's not related to mental health, but I had an individual who has a foundation in Santa Cruz, and she outreaches to farm worker families who only speak Spanish. And she put together she fundraises to provide Community RX, which is an educational program about eating plant based foods. And one of the things that she did, she reached out to me to see if I knew any Spanish speaking chefs or people trained in the field of nutrition. 

[00:29:12] And then, so she brought Spanish speaking experts with culturally appropriate recipes and really just started outreaching to the Spanish speaking community. And what I said at the end of the episode is, if you're in a situation where you have limited resources, which also probably means limited access, not knowing where you can obtain this information, but you're dealing with health issues and you have someone who's coming to you and providing these resources, it's like a wonderful thing, but not everybody does that. How do we teach this to people who are interested and at the same time, have limited resources? Yeah, I think that's just what an amazing program and what a beautiful example of providing people with information and resources that is really relevant to their needs and their lived experiences. I think having resources available in one's native language is incredibly important. 

[00:30:11] And being respectful of language is a really important aspect. And I actually think that's incredibly related to mental health. We know that what we eat impacts our mental health. And again, that acculturated stress and not being pushed by providers to eat something that's totally different than what is your native or culturally bound food. Asking people from Mexico, like my family, to never eat a tortilla again is not going to work. 

[00:30:40] That's not an appropriate recommendation. Tortillas have a place, of course. And so I think that's really interesting and just really exciting to hear about. I think part of this effort for myself and several others in the lifestyle medicine space is to really be thinking about, again, the intersection of mental health and lifestyle medicine and health behavior change, which is really what I do. I'm passionate about as a health psychologist. And how can we leave that into everything that we do? 

[00:31:16] How can we educate all different types of providers who are working in healthcare or outside of healthcare and nonprofits across the board about some of these things and how they intersect, how food can be so important, not just physiologically, but psychologically as well. Right food is more than just the nutrition. It also brings up memories and emotions and all of these other sorts of things that are just as important as the nutrients themselves. And so I think that sounds like a really creative approach. 

[00:31:53] And I also think that we have to be very thoughtful about social determinants of health and resources and barriers and all of these things as we're developing programs. And I think that's where some of the cultural sensitivity or cultural humility or even adaptation comes into play as being really aware of that and then thinking about, again, how can we make recommendations that are thoughtful and sensitive? The example always like to give when people say that the plant predominant eating is too expensive, because I think sometimes the conception is a very whole food, high end sort of approach to eating is that beans are really good for you. They have lots of fiber, they will fill you up. They have protein, and they're super affordable, right? 

[00:32:42] And most cultures eat some type of bean or legume or something like that. So it's about figuring out what those things are and then getting people excited. And this is a very long winded answer, but I think the last thing I'll add that I haven't touched on, that I think a lot about is that part of helping people change their lifestyle or their health behaviors is getting a sense of their why maybe I didn't mention this earlier their values. What do they care about? People don't make changes because somebody else told them to or for no reason whatsoever. 

[00:33:19] And if you start to make a change for an unclear or unsolved reason, it will probably not stick. It's probably not going to go super well or be able to be maintained. So having that sense of why, what drives people, what is important to an individual or community is immensely important when we're thinking about both individual and systemic lifestyle changes. People don't make a change until they have a health crisis, unfortunately. And so. 

[00:33:49] In your work. Then at cardiac rehab, you work with patients who kind of have it sounds like advanced chronic disease. Can you paint a picture for us of what that looks like? We touched a little bit about how you sort of prepared them to make those changes so that they can be ready for a procedure. What exactly does that look like? 

[00:34:09] Yeah, so I actually work in cardiac surgery, so I'm kind of on the front end of where people might even get to rehab and then hopefully continue to focus on that rehabilitation process physically. So, let me make that distinction. Thank you. Because in my mind, and I'm glad you bring it up, this is very important. When I think of cardiac rehab, I think of a team based approach outside of, like you said, in a separate setting. 

[00:34:36] So, the individual may or may not have had procedures, but probably has chronic disease. That individual is supported by a physician, a dietitian, perhaps an exercise physiologist, depending on the setting, maybe a registered nurse in different modalities so that in the programs could be extended I don't know how many weeks. But the person is learning how to implement lifestyle medicine into their lives by exercising, by eating healthier. Sometimes, like in cardiac rehab, they offer food demos. So, this setting supports the individual towards making changes that hopefully are sustained throughout their lives. 

[00:35:17] So, that's what I was thinking in my mind. What does cardiac surgery look like? Sure. And I would just add that I think you're describing, best case scenario, cardiac rehab. Like the Ornish program, for example. 

[00:35:31] I don't think unfortunately, all cardiac rehab is like that. I think most cardiac rehab is really focused on that physical rehabilitation after surgery or after a cardiac event. There are certainly I have several psychological psychologist colleagues that work or do research in cardiac rehab, doing mental health and lifestyle intervention work. Unfortunately, I don't think that's normal or typical, if you will, which again, kind of speaks to health disparities and access. And people who have more resources, are more able to travel, are more likely to access those programs that have a greater variety of resources. 

[00:36:17] Excellent point. I'm so glad you bring that up too, because when I was thinking about this, as we've done research on what cardiac rehab looks like you're right. In order to enter one of those programs, I think the insurance has to be approved, like if it's an Ornish program, unless you're in a comfortable situation and have the time to go to cardiac rehab. You're right. There is, again, an example of where some disparities can be very obvious. 

[00:36:45] Most folks are probably either acutely or chronically ill. So again, they would meet criteria after a cardiac event, like a heart attack or after some type of cardiac surgery. So there so they're either maybe we're already on long term disability or just generally unemployed, or might be on a more short term disability or time away from work because of this cardiac incidental surgery. Thank you for clarifying that. And so, what does cardiac surgery look like? 

[00:37:15] Sure. I'm actually based in cardiac surgery, which is interesting. So that's why I'm an assistant professor of surgery, which is like, kind of hilarious. And I'm not a surgeon, but great too. It's fun and interesting to be able to bring my lens as a health psychologist to the surgical world. 

[00:37:34] So I clinically primarily work with the advanced heart failure team at this time. I do a whole bunch of different things, mostly on the inpatient side in the hospital, some outpatient as well. And I primarily work with folks who have heart failure and need advanced heart failure treatment, such as a heart transplant or an LVAD, which is a left ventricular assist device, a form of mechanical circulatory support, which essentially pumps for the left ventricle of the heart for folks who are in heart failure. So, as you can imagine, these are major surgeries with major recovery and significant lifestyle changes. And so in the process of meeting with people to assess some of the psychosocial factors that can set them up for success or be detrimental to their success after surgery, I am really focusing on really the whole spectrum of lifestyle medicine or the Pillar. 

[00:38:37] So social support, what they're eating, how active they are, extensive mental health history, how they handle stress, how they cope. A lot of these folks are in the hospital for weeks to month, so their ability to cope with stress is really important. Social support is actually a requirement to move forward with any of these types of treatments. And then there are some other things that we sometimes have to address. For example, folks have to go at least six months without smoking, smoking anything, cigarettes, marijuana, whatever, cigars, because of the surgical risk and the risk to the lungs that comes along with that. 

[00:39:18] So helping people quit smoking, maintain abstinence from smoking or alcohol or marijuana, et cetera, all of those factors. So helping them really prepare for a big surgery and a big lifestyle change, again, in terms of lifestyle health behaviors and psychologically or really trying to maintain mental health for people who don't have a history of mental illness or mental disorder, again, it's pretty taxing to be hospitalized. And we know that, as I mentioned earlier, there are much higher rates of anxiety and depression after cardiac surgery. There's a lot of physiological factors that come into play inflammation in the body, blood flow, the insufficient blood flow, and somebody has heart failure. It obviously affects the whole body, including the brain. 

[00:40:11] And so there's that risk of symptoms of depression, anxiety, cognitive symptoms and deficits, et cetera. So it's really working with these folks and with their families to help them get through a really big surgery and then really thrive after. So I help people prepare, I help people cope while they're in the hospital and then I help them, depending on individual needs, recover after. So that might be managing their medications, managing stress, adjusting to not being able to work. And that's really important. 

[00:40:49] And we have sometimes people who went from pretty healthy and then all of a sudden they need a heart transplant and they were like working and have young kids and that's a huge lifestyle change. So really helping people recover from pretty intensive surgery, they recover usually takes at least about a year and really move towards thriving and living their best lives. I like to say nobody gets a heart transplant for a good time. They do it for reasons. That's where that why comes into play and really helping people move towards whatever it is that they want to be doing with their lives after surgery. 

00:41:29] That's excellent what you do. That's incredible that you can offer this sort of support. I bet not everybody has access to a health psychologist. That is, unfortunately true. I knew an individual who had a triple bypass procedure and you would think, well, you sort of have like a new heart, you're going to feel better, you're going to have more energy, your health will be optimized as a result of this. 

[00:41:55] And I was shocked to see the individual depressed and regretting, I should not have had this procedure. Almost like the individual loss their will to live and did have depression for about one or two years after the procedure. It sounds like what you do is you continue to offer that support because you know that there might be a prevalence for depression and anxiety and that added stress that comes as a result of having, for example, a heart transplant. That's huge. Yeah, absolutely. 

[00:42:28] I'm sorry to hear about this person and their experience. I think it is unfortunate that that's actually rather common and most people just aren't aware of that or don't have that expectation going in. And I think the challenge too is we're talking about major, major surgery and then folks have to sort of go home and figure it out, right? They may or may not have access to cardiac rehab, to transportation, to cardiac rehab. They may or may not have a good relationship with their medical providers, with any of their doctors, access to a psychologist or registered dietitian, etc. 

[00:43:02] And as we think about these lifestyle pieces too, right, you'd think if somebody needs a triple bypass, there'd be a lot of attention to diet and thinking about how they can address their diet and their eating behaviors to really support their quality of life and well being postoperatively and long term. Again, I think oftentimes the time and attention and resources aren't there to really intensely think about lifestyle and mental health. I guess that's why in many ways we try to work on the preventative end of all of this. I think you said a little while ago that you support the individual, but also families. 

[00:43:43] Yeah, absolutely. And you know, what you're sharing also makes me think about almost a sort of learned helplessness mindset that I think sometimes comes with chronic health conditions. And I'm like you very interested in primary and secondary prevention of cardiometabolic health, which is cardiovascular disease, weight, diabetes, and kind of how those all come together. So blood sugar, body habitat, etc, etc. That's really, really interesting and important to me. 

[00:44:21] And secondary prevention is really the prevention of complications related to a condition. So if somebody is just diagnosed with diabetes, type two diabetes, for example, what can we do to support them to improve their blood glucose stability so that they don't end up with retinopathy or neuropathy, et cetera, cardiovascular disease, all of those sorts of things. And I think, unfortunately, there's a lot of misconception. And we see this clinically and in the research, even more commonly among certain groups and populations, particularly black and Latino families, that there's this kind of belief of what, everybody in my family has diabetes, everybody in my family has heart disease. It's inevitable for me. 

TO0:45:141 And we know that while there is absolutely genetic risk, that lifestyle really accounts for about 70% to 80% of things. And so I think it's unfortunate, this misconception, that we have no control over our outcomes when we actually have a lot of control and I think kind of taking back the power and empowering ourselves to focus on what we can control instead of feeling entirely helpless. So there are certainly factors and degrees of this outside of our control is really important and important intergenerationally too. Right? So if we're thinking about making changes that can impact our children and our parents and vice versa. 

[00:45:58] And there's just a really important opportunity to think about quality of life and outcomes over the course of multiple generations. Yes. Excellent information going back to the conference and the lecture that you'll provide is really touching on these topics that we've been speaking about. So leveraging lifestyle medicine for mental health equity. I plan on attending that lecture. 

[00:46:25] Oh, God. I look forward to meeting you in person. And I want to remind our listeners that specialists, healthcare professionals, attend these conferences the last time Edison conference. And so the goal is what you're doing with your lecture is educating other specialists, other individuals that work closely with patients and understanding what mental health equity looks like. And is there anything else you'd like to tell us about that lecture that you'll be giving? 

[00:46:56] Yeah, I mean, I think we've talked about a lot that really falls within that. I guess I would go back to what I shared at the beginning, that I think we need to be paying more attention and having more conversations both in the medical community and in the general population about the relationship between mental health and physical health. And I'm so excited about the field of lifestyle medicine and the growth of the field as a psychologist. I think lifestyle medicine and health psych or behavioral medicine overlap quite a bit, and I think there have been a lot of folks in the behavioral medicine space doing this type of work for decades and decades. It's so exciting to see and hear other medical professionals doing this work too and having similar thinking. And that just makes me so excited for the opportunities to continue to grow and as you have touched on earlier, maya provide access and improve equity just in terms of access to care and in a variety of levels. 

[00:48:04] And so I really just want to emphasize how mental health and lifestyle are connected and how we can use this opportunity of the growth of lifestyle medicine to really move the needle when it comes to mental health in a really thoughtful and sensitive way and using again. A lot of the same approaches and attention to these lifestyle factors to support mental health and as you can probably tell. Quality of life and people living the life that they want to live in a way that's important to them. Which is sort of my mo. If you will. 

[00:48:39] Yes, I think your field is so important and we need more individuals as health psychologists trained in lifestyle medicine and I'm just so honored and excited and I can't wait to meet you in person. Thank you. Same to you. Do you have just for our listeners who may not attend the conference but may want to know a couple of things that they can do to improve their mental health? Yeah, I mean, so much, so many of these resources and approaches are free and accessible and sort of the low hanging fruit. 

[00:49:14] So, I think as I touched on, the first and foremost thing is always figuring out what's important to you, what are your values, what do you care about? And trying to figure out am I living in a way that is consistent with these values and what I care about, right? Am I eating, am I exercising, am I taking care of myself in a way that aligns with what I care about, showing up as a spouse or a clinician or whatever else, a family member, a sister, all of those sorts of things. So I think just spending some time reflecting on that can be really useful. 

[00:49:51] They say exercise is the best medicine and that is true for mental health just as it is for physical health. So activity can make a huge impact on mental health, even in a very quick sort of way. And I think I see where people get stuck and I have been impacted by this myself. Of course, this line of thinking is feeling like they need to do so much for it, for it to count. And I think moving away from that and recognizing that that's a really common pattern of thinking that doesn't necessarily serve us. 

[00:50:28] So the example would be that oftentimes people won't exercise because they're like, well, I can't go to the gym for a whole hour and do this intense workout, and so why bother? And we know from the science that exercise, quote unquote, counts after only ten minutes. So a ten minute walk is exercise and is amazing, and it's also cumulative. So if your goal is 30 minutes of exercise a day, three to ten minute walks is the exact same as a 30 minutes walk in terms of the outcomes that we see. And if you can't do 310 minutes walks, a ten minute walk, a five minute walk is amazing. 

[00:51:07] So exercising not to lose weight or to change our body, but just because of how it makes us feel and the energy it gives us, and our mental health, I think is really important and really underutilized. This has been wonderful. I can't tell you how valuable this has been for me. I feel like you need to come back on and talk more about all of this. Like I said, yeah, we will definitely stay in touch. 

[00:51:33] Again, thank you for being with us today. Thank you so much for having me. It was so fun to talk to you. And you certainly have me hyped up for the conference in November, and I really look forward to hearing the feedback from our conversation. What a wonderful conversation I just had with Dr. 

[00:51:48] Vela, and I wanted to summarize some of her key points that we had during our conversation. I asked Dr. Vela why diet, culture and disordered eating is so common within the Latino community. She mentioned that we pay so much attention to food but very little attention to actually eating. Nutrition is not just about what we eat, but it's also about how we eat as a culture. 

[00:52:14] We've lost that family setting that was once important to us, and we've pulled away from some of our original foods that were mainly plant-based. Environment plays a huge role. So, we spoke about the role of acculturation. There's the added stress that comes from relocating from one culture to another while living with an internal psychological conflict of trying to maintain one's own culture while adjusting to a new one. So basically, assimilating. 

[00:52:44] But this doesn't have to happen from one country to another. It can happen from just one state to another, where you suddenly find yourself having to adapt and adjust to a new culture. We spoke about the stress of experiencing racism and stigma in healthcare. There's a systemic mistrust of the health system which can influence how people interact with the health system. Dr. 

[00:53:07] Vela believes that coming from a physical health perspective, in other words, addressing a patient's health issues, offering lesson medicine modifications can help lead to improve overall wellness and improve mental health. When patients discover what is truly valuable to them, they are more likely to make long term changes. I hope that you consider going to the Lifestyle Medicine conference. This is an example of the great knowledge that you will receive as a result. Head on over to my voicemail that's SpeakPipe. 

[00:53:41] Comhlf and let me know what you thought about this episode. Did you find some value in it? Have you ever faced systemic racism? Please let me know. You've been listening to the Healthy Lifestyle Solutions Podcast with your host, Maya Acosta. 

[00:53:57] If you've enjoyed this podcast, do us a favor and share with one friend who can benefit from this episode. Feel free to leave an honest review as well at rateispodcast. comhs. This helps us to spread our message. Know, as always, thank you for being a listener. 

[00:54:17] Bye.