G3. Relaxation & Stress

Positive stress or "Eustress" can be less of a negative for health and happiness and instead be the challenge that keeps someone going and gets them out of bed in the morning excited to greet each new day.

• See the article What is Positive Stress? for more information and a link to a business related article with more information about making a business environment support an employee's sense of purpose and ownership of their work. Having "autonomy" over some aspect of your job can help provide a sense of purpose and value even when the work is repetitious or boring. (12.21)

Self-reported mindfulness was found to be associated with more self-esteem and an orientation for autonomy - feeling the ability to be self-directed. The research authors suggest mindfulness can be innate but which is also a skill that can be developed over time and improved with practice. Having an autonomy orientation has also been associated with more prosocial behavior - helping others, volunteering or other positive activities - and more to the point for a guide about writing policy for guiding behavior - autonomy support was associated with lower volunteer turnover. (12.23) 

     A sense of autonomy refers to feeling that you are in control over your actions instead of having your every action be micromanaged with excessively controlling policies. For "Autonomy support," try investing in the workers with training and career planning resources. Effective managers and leaders aren’t born, they are trained and mentored, and opportunities for resume building projects may have been handed to them through networking. 

     “Whatever Happened to Assertiveness Training?” asks a psychiatrist in an article focused on the need for assertiveness training for physicians. (G7.6) David M. Allen shares his concern that the changes in the health insurance coverage and managed care industry have left physicians more stressed and rushed than is healthy for them or their patients - potentially. 

     The solution that has been offered is mindfulness training, to help cope with stress. He makes the point that it is not a solution that would help protect patients or the physician's time and stress caused as a direct result of having ineffective conversations with managed care or insurance company representatives; who in turn may be rude or abrupt, or who may just be a human trying to do their job, but one who is having to enforce annoying, unrealistic policies that may even be life threatening. And oh, yes, the physician might be pressed for time as well. Mr. Allen recommends assertiveness training for the physicians to help them directly reduce stress by giving them better tools for managing the real underlying cause of some of the stress - having to perform a job that has unrealistic demands on their time, and their patience and professional need to prevent harm to their patients. (G7.6)     

     While everyone needs a livable wage, younger workers today may value a sense of purpose and autonomy more than a pay raise or monetary bonus. Assertiveness training is about effective communication which can help with negotiating a project or a pay raise. Workers today are more likely to switch jobs many times in comparison to workers of previous generations.

• Read more: Forget work perks, millennial employees value engagement. (12.26)

Leaders and managers can be the role models for purposeful behavior and smooth the way for employees to seek out a purpose they find stimulating. Guiding the selection of projects and helping the team collaborate can also give younger workers a chance at leadership roles which can add experience to their work record and resume.

     Recent research suggests workers are more engaged when their manager or business leadership shows a sense of purpose. The team of researchers suggest that organizations can promote purposeful and ethical leadership in their management staff with several key strategies: adopting relevant policies; providing leadership role-modeling; having a core vision for the business; providing training and development for staff; and providing an organizational culture.

• See Why Leaders With A Moral Purpose Have More Engaged Workers: (11.70)

An organizational culture that would be more supportive of purposeful leadership would promote positive interpersonal relationships and support the staff who are demonstrating the values of the core vision of the business.         

     A purposeful leader incorporates the values of a moral self, with vision and commitment to stakeholders according to a report by Chartered Institute of Personnel and Development, CIPD, and a purposeful organisation would have the attributes of societal responsibility, values, and ethics. The full report is available for download: Purposeful leadership: What is it, what causes it, and does it matter?, CIPD.co.uk: (12.31)

     Advocacy for causes that support society in general or at a local level or even for the employee who needs a new car to get to work are all serving a “moral purpose.” Advocacy can be very challenging and trying to help can sometimes end up being harmful instead. 

     Guidance is available, a free ebook, "The Complete Guide to Advocacy," might help make speaking up for the environment and for human rights less stressful: (12.32.thecampaignworkshop.com) 

Chronic stress can damage brain cell health. Neuroplasticity refers to the connections and pathways that form between brain cells. Long term habits develop as routine nerve pathways between brain cells where an initial action may stimulate the rest of the routine habit. Having routines embedded in our memories may help to save us time when we're performing routine activities like household chores or driving home from work but it may interfere when trying to replace an old habit with a new habit. Routines may save energy for the mind to wander to other thoughts while the familiar chore is being performed.

     The ability to form new pathways in the brain may also help to reduce the negative effects of stress. (G3.1) Games that are designed to boost brain plasticity may simply be boosting our ability to take tests.

     When habits become an automatic part of life they can save energy by reducing the need to make minor decisions. Every decision or use of willpower that we perform throughout the day can deplete our mental energy and reduce our ability to resist making impulsive decisions. Isaiah Hankel describes a way to make habits that last by making smaller changes and attaching them to a routine that already exists. If you always brush your teeth each morning and want to be better about taking a vitamin supplement or medication every day attach the new habit to the old one by linking them consistently. Older research suggested it can take three weeks of consistency to build a new habit while more recent research suggests it may take closer to two months. For more information see Chapter 8: Automaticity, Scaling, and the Rise of Mental Loops, in the book by Isaiah Hankel, Ph.D. called The Science of Intelligent Achievement, (pp 52-58, G3.123). 

     More research is needed to better understand neuroplasticity and how we can change old habits by changing the old neural pathways. (G3.2) In the meantime learning new words has been found to stimulate reward pathways in the brain. And it was found that people with stronger connections between the two regions of the brain involved in the reward pathways were able to learn more words than people with weaker connections. (G3.3) Poetry may activate the brain similarly to music by helping increase brain connectivity in a similar way to what occurs when someone is listening to or composing music. (G2.1)
 

Meditation & Mindfulness Training can help an overanxious brain.

Mindfulness Training can help increase awareness of the issues that may be exciting or infuriating, but at a wordless subconscious level so they may go unnoticed and lead to behaviors that don’t seem to have a obvious reason or cause: How Mindfulness Helped a Workplace Diversity Exercise: (12.22)

     And other research suggests that meditation and having a sense of purpose in life may help reduce some of the negative effects of stress which include cellular changes associated with aging. (G3.4)

 Communication or Assertiveness Training may help reduce stress by improving effectiveness of conversation and by increasing the likelihood of having pleasant exchanges rather than difficult ones.

     Communication difficulties can lead to direct stress effects on the body that occur during the conversation, lack of oxygen itself from tensely holding the breath, talking too fast or crying, might also add to negative effects of oxidative stress.  Stress might also occur over time from the resulting lack of progress on the topic that was being discussed with difficulty instead of with clear exchange of each person’s priorities, concerns, and goals.

     Issues from our childhood with communication problems we observed in our parent's or other caregiver's conversation may show up in our own behaviors. Role playing in a group may help reveal where other people's typical responses are different than what you might have responded yourself. Role playing can help provide a safe place to practice new communication techniques with people who understand the technique and that it is practice. The strategy is used in Family Therapy but power struggles can be part of many types of relationships not just within families.

     Training materials about equality within a conversation or within a relationship were developed for helping victims of domestic violence and batterers learn how to recognize problem behaviors within their communication and actions. The handouts may be helpful for most age groups as emotional manipulation or abuse of power and control can occur in many types of relationships not just between couples. Discussing the difference between equal exchanges in a conversation and unequal ones in a calm neutral setting may be helpful to prevent a difficult exchange from ever happening in the first place. 

• Power and Control and Equality Wheels:  The Power and Control Wheel (I.21) was developed by the Domestic Abuse Intervention Programs (DAIP). (I.22) Manipulative behaviors are grouped into eight categories in the model. An additional Equality Wheel (I.23) was developed to help guide batterers and victims of emotional or physical abuse towards healthier ways to interact. It is grouped into eight equivalent categories with examples of healthier ways to interact with each other. Problems frequently can involve communication issues by both people in a relationship.

Crisis Hotlines and Resources:

• U.S. National Suicide Prevention Hotline: Call 1-800-273-8255, Available 24 hours everyday. (I.16.suicidepreventionlifeline.org)
• National Helpline: Substance Abuse and Mental Health Services Administration: "SAMHSA’s National Helpline, 1-800-662-HELP (4357), (also known as the Treatment Referral Routing Service), is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders."  (I.17.samhsa.org)
• Rape, Abuse and Incest National Network, RAINN Hotline: 1-800-656-HOPE, (I.18.RAINN.org)
• National Domestic Violence Hotline: 24/7 confidential support at 1−800−799−7233 or TTY 1−800−787−3224. (I.19.thehotline.org)
• Child Welfare Information Gateway: a variety of toll-free hotline numbers for concerns involving the safety of children. (I.20)

See a healthcare provider for medical advice, diagnosis or treatment.

• Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.
• The Academy of Nutrition and Dietetics has a service for locating a nutrition counselor near you at the website eatright.org: (eatright.org/find-an-expert)

Stressful times can make fear and anxiety more likely as our body's instincts expect to either run from danger or to freeze in position, possibly in the hopes of not being noticed by a predator. 

Who’s more at risk to experience stress with a negative fear response? 

     Who is more at risk to experience a challenge with a negative fight, flight, or freeze stress response? (G3.10) Instead of having their body or mind perceive a stressor as a positive challenge and an exciting reason to get up each morning ready to say “Carpe diem"? 

   Who is more at risk to experience stress as a negative stress response instead of perceiving it as a positive challenge and an exciting reason to get up each morning?

• Answer: many groups are more at risk for having their bodies respond to an event with more of a negative stress response than the average person.     

People more vulnerable to the negative health effects of stress include:

• older adults;
• mothers and especially working mothers;
• less educated individuals;
• divorced or widowed individuals;
• people with financial concerns or lack of health insurance;
• isolated or lonely people;
• people who are targets of racial or sexual discrimination;
• people who live in cities,
• and people with a history of childhood trauma can be more risk to feeling stress.
• Summarized from "Stress": (G3.5), University of Maryland Medical Center.

Antioxidant foods can help protect against negative effects from stress.

     Eating antioxidant rich foods can help protect the body from negative effects that can occur due the waste chemicals produced during normal metabolism and increased during situations that cause more oxidative stress from  either emotional or physical reasons. Angry and tense due to having to hold in your temper at work, or angry and tense because the traffic was so physically dangerous to navigate simply to get to work in the first place; - both can increase the amount of oxidative stress occurring throughout the body. 

     Social contact with caring people can also help the body physically detoxify negative chemicals produced during stress or produce less of them in the first place, that will be discussed more in the next section. (G3.10)  

     The stress response produces chemicals which can cause other inflammatory reactions throughout the body. Having extra antioxidant rich fruits and vegetables and assuring adequate omega 3 fatty acids was shown to help reduce inflammation in autoimmune Celiac sprue. (G3.6)

     Dark chocolate has also been shown to be beneficial antioxidant source. Forty grams (1.3 ounces approximately) per day of chocolate was found beneficial with a college student population. (G3.7) That is quite a bit of chocolate for someone with limited room for the empty calories from sugar. Sesame seeds would provide antioxidants with no added sugar.

     Eating sesame seeds as part of the daily diet has been shown in sports research to help reduce oxidative stress. The trial subjects ate 2 tablespoons per day of the seeds. See: Effects of Sesame (Sesamum indicum L.) Supplementation on Creatine Kinase, Lactate Dehydrogenase, Oxidative Stress Markers, and Aerobic Capacity in Semi-Professional Soccer Players. (G3.8)

     Using tahini in the diet regularly would have similar health benefits.  Raw oil or seed butter products may have the most antioxidant content. Look for the phrase "unroasted" on a seed or nut butter product or "cold pressed" on the label of an oil or coconut oil product. Tahini is a sesame paste similar to peanut butter except it has different flavor.  The flavor is stronger and to my taste does not go well with sweet jams or jellies like peanut butter or sunflower seed butter. 

     I have found daily use of tahini to be more beneficial to my health then sunflower butter as a substitute for peanut butter - which I have to avoid. I have many dietary restrictions because I feel better without the foods, due to intestinal sensitivities and the autoimmune inflammatory reactions that can occur when I have even very small amounts of some things. My easy answer to fueling my body so I can get back to what I like doing - reading and writing - is simply tahini spread on rice cakes. I'm used to it now and eat it plain but when I first started eating it I would drizzle a small amount of blackstrap molasses on as a sweetener with a stronger flavor and a good supply of iron and trace nutrients. Or more often I would sprinkle ginger powder on for a zingy accent that provides pain killing anti-inflammatory chemicals. Later in this section on oxidative stress TRP channels will be discussed and their unfortunate sensitivity to many common foods - including ginger. Sadly for my diet and inflammatory condition, I no longer can use ginger due to the intestinal overactivity of TRP channels - presumably, more on that in a later section - however it may take a while, note the abrupt change in the next footnote number, there is some stuff in between the beginning and the end of the footnote list: 

     Chocolate and antioxidant foods and herbs found helpful for stress are discussed in more detail with references on a UCLA webpage providing information about integrating Eastern medical philosophies and treatments with Western medical methods. (G3.112)

      To provide sustenance for the journey and a way to add chocolate to your diet for anyone who can't think of any, see my antioxidant rich recipe for chocolate chip cookies. See the third version on this page of recipes and information about gluten free food sensitivity and autoimmune sensitivity for an egg free, butter free, gluten free cookie recipe. It is still a treat with calories and fat, but with fewer ingredients that contain inflammatory chemicals and more ingredients that are very good sources of antioxidants or healthy types of fats: G8.Chocolate Chip Cookies.    

      Regarding TRP channels - cinnamon is a spice that can activate a type of the membrane gates to allow nerve signals or other actions to occur. The spice has been to help reduce blood glucose levels for patients with diabetes. About one quarter to one half teaspoon per day was found helpful. (G3.124) A half teaspoon of cinnamon powder is a large amount. Some people enjoy it stirred into a bowl of hot cereal in the morning. It could also be added in smaller amounts to a few cups of hot tea throughout the day, or an evening cup of hot cocoa. Cinnamon is a spice that I avoid due to migraines, it may be causative as a TRPA1 channel agonist. More is included in later sections on TRP channels and the foods that may cause problems for some people such as those with a tendency towards migraines or Irritable Bowel Syndrome or concerns with chronic itch or skin problems such as psoriasis or eczema.The science regarding cinnamon and blood glucose is complex, some of these terms and chemicals will be discussed in more detail later, this is an introduction to the topic of oxidative stress and TRP channels:

     Cinnamaldehyde is a phytonutrient found in cinnamon. It activates ion channels (TRPA1) found in membranes of nerve cells in the tongue and throughout the body. Activating the TRPA1 ion channels causes a release of proteins called peptides from the nerve cells. The nerve cells carry pain sensations and also supply nerve signals to blood vessels. Blood vessel and cardiovascular functions can be beneficially affected by the peptides (including "calcitonin gene-related peptide, (CGRP), and Substance P, (SP)") and activation of the TRPA1 channels within nerve cells of the gastrointestinal tract can also signal satiety centers in the brain (satiety is the sense of fullness, and hunger signals stop). Cinnamon use by patients with Type 2 diabetes has been found to help decrease blood glucose levels. Release of insulin promoting hormones ("glucose-dependent insulinotropic hormone (GIP) and GLP-1") by the TRPA1 ion channels may be the reason for the decrease in insulin levels with the use of cinnamon. (page 1118, G3.113) 

     How much cinnamon, what type? Cinnamon that included another phytonutrient called linolool was found to be helpful to lower blood glucose levels in an animal-based study at doses of 12.5 or 25 mg/kg of body weight, and more was not better. Doses of 50 mg/kg no longer had the beneficial effect. (G3.124) For a human who weighs 150 pounds/68 kilograms, that might be a serving size of 850-1700 milligrams, which might be roughly ¼ to ½ teaspoon per day – and one teaspoon, 50 mg/kg, would not be more helpful. Many nutrients and other activities in life are good in moderation but may be not helpful or even harmful in larger amounts. Too much of the peptide Substance P may increase oxidative stress and pain or other inflammatory symptoms. 

     TRP ion channels will be discussed more later in this section and also in G5. Preeclamspia & TRP channels.

People and other species are social creatures whose survival may have been dependent on being part of a group rather than being isolated. Loneliness has been associated with increased inflammation and a reduced resistance to infection by viral diseases. Genetic changes have been found to occur in isolated individuals that lead to the increased inflammatory response in comparison to individuals who have more social support. Genes can be temporarily turned on or off depending on the environment.

     Our instincts have developed to trust that being part of a group increases our chance of survival. Having a role that fulfills a valued purpose for the group is associated with an increased sense of happiness. Read more: A Better Kind of Happiness, by Will Storr, (G3.9).

     Fitting into groups well can require social skills that need to be nurtured from birth. Infants learn body language at an early age by interacting with a parent who responds to the baby's cues. If the baby smiles the mother smiles back and the baby learns to smile more readily. If the baby has a mother that doesn't notice body language though, then the infant may stop smiling as often.

     Infants and children depend on their caregivers for everything and try to please with their smiles, eye contact, or baby coos. If the infant isn't receiving eye contact in return however they may stop trying or are scolded they may learn to look away and to avoid eye contact.

     Children ideally need emotional support in order to develop trust in themselves and in others. Parents who have limited skills in understanding and accepting their own emotions may not be able to teach their children what they don't understand themselves. Children who have some role model in their lives who understands emotional skills may cope better than children who don't.     

• The topic is discussed in more detail in the book Adult Children of Emotionally Immature Parents: How to Heal from Distant, Rejecting, or Self-Involved Parents, by Lindsay C. Gibson, PsyD, (New Harbinger Pub., Inc., 2015, Oakland, CA) (G3.10) (This book is not a twelve step book and is not affiliated with the Adult Children of Alcoholic or Dysfunctional Parents twelve step group.) 
• On page eight the author discusses the importance of emotional connection for humans and other mammals for responding less negatively to stress. Stephen Porges published work in 2011 suggesting that mammals evolved a way in which we can get additional soothing during fear situations when we are in touch physically or possibly even mentally - thinking about them during times of need. It involves vagus nerve pathways that can be inhibited to reduce the fight, flight, or freeze stress reaction. (G3.10)

So a sense of connection to others can help reduce the negative inflammatory effects of the stress response. Some stress can be healthy to help get us moving to meet whatever challenge has occurred. Stress may become more overwhelming however if the person is isolated or never learned social skills or developed enough trust in others to ask for help or seek out help.

     Children in situations with emotionally immature caregivers may learn that people around them can't be trusted or that trying doesn't lead to success so why bother trying - they can learn a sense of helplessness and hopelessness and not even try to seek help because they are unfamiliar with finding strength or support from others.

     In the book Adult Children of Emotionally Immature Parents: How to Heal from Distant, Rejecting, or Self-Involved Parents, by Lindsay C. Gibson (G3.10) four different types of emotionally immature caregivers are described and how growing up with them might affect children. Solutions are also provided in the form of techniques for how, as an adult, a person might overcome the lessons they learned as a child once they discover that emotions aren't dangerous things to never be discussed or worse - that one might be punished for exhibiting them.

     Some emotionally immature people may feel threatened by strong emotions and may react negatively to children who are simply being children. The child in that situation learns to not trust themselves and may not learn that emotions are normal rather than upsetting or frightening.

     Severe childhood trauma can lead to changes in the brain that cause ongoing symptoms of Post Traumatic Stress Disorder (PTSD). A new strategy for treating PTSD has been developed which involves electrical stimulation of the vagus nerve called Vagal Nerve Stimulation (VNS). 

     The summary from the book Adult Children of Emotionally Immature Parents (G3.10) regarding the research by Stephen Porges suggests that the vagal nerve is the nerve pathway that naturally is stimulated when social contact is sought by mammals who are enduring a stressful situation. (G3.11) (G3.12)

     Whether you are a parent or a teen or an adult learning more about emotional maturity and immaturity can help understand your own emotions and others. Whatever we grow up with will seem normal to us and as adults we tend to seek out similar relationships to those we were familiar with as children - but sometimes what seems normal to some people isn't normal for everyone else and there is no need to continue living in abusive situations just because it seemed like a normal part of life as a child.

     Lack of emotional skills may increase the risk of acting inappropriately when under severe stress. People need the support of people to help reduce negative effects of stress and increase a sense of connection and purpose. People need to learn emotional skills from people who have emotional skills  - or sometimes from a book, Adult Children of Emotionally Immature Parents: How to Heal from Distant, Rejecting, or Self-Involved Parents, by Lindsay C. Gibson: (G3.10)

Attachment Theory and parenting styles are discussed in section 8. Trust is learned early. The descriptions in this section suggest the inconsistent parenting of the Disorganized style or a parent that switches between Avoidant and Anxious-Resistant styles. A more trusting Secure style can be achieved with the help of Cognitive Therapy techniques and practice ; but it is a lot of work to change core values, or more realistically - attempt to modify slightly, core values that remain from early childhood. Art Therapy or EMDR therapy can help access nonverbal feelings and events that may have occurred during the preverbal years of childhood. Dialectical Behavior Therapy can help when there are cognitive and physical issues underlying mood symptoms.

Our bodies don't have specific receptors just for sensing "pain." Pain is a sign that something is wrong in the body and is sensed in a variety of ways. In medical terminology there are two main types of "pain." 

• Nociceptive pain is associated with physical damage to the body or by sensations of pressure or heat or extreme cold. It might be due to pressure from a cancer tumor. Nociceptive pain might be described as "sharp, aching or throbbing." 
• Neuropathic pain is caused by physical damage or pressure on nerves. It might also be due to a cancer tumor but one that is pressing on a nerve. Nerve damage can also be due to some nutrient deficiencies such as vitamin B12, (G3.13), or other "Nutritional imbalance, alcoholism, toxins, infections or auto-immunity." Neuropathic pain often is described as "a burning or heavy sensation, or numbness along the path of the affected nerve." (G3.14)

Some types of pain such as migraine headaches may involve both nociceptive pain due to the pressure of inflammation or dilation of blood vessels an neuropathic pain from pressure on nerves by dilated or inflamed blood vessels.

     The next part gets complicated, some background information:

• Calcitonin is a hormone released by the thyroid that promotes lower blood calcium levels by reducing bone resorption, (G3.15) (Bone resorption: breakdown of the bone and release of minerals, (G3.16)).
• Calcitonin Gene-Related Peptide 1 and 2 (CGRP 1: (G3.17) and CGRP 2: (G3.18)) cause dilation of blood vessels in the heart and brain and throughout the body. Its prevalence in the Central Nervous System (CNS) also suggests that it may also have a neurotransmitter or neuromodulator role.

CGRP is produced by nerve cells in the brain and throughout the body. The protein has a role in sensations of pain. It is a member of the calcitonin family of proteins and exerts its effects at receptors that are formed from two other types of receptors.

     The CGRP protein has two commonly found forms, one helps reduce pain and one helps increase it - luck of the draw. The alpha form of the protein may help reduce pain while the beta form is associated with migraine, temporomandibular joint (TMJ) pain, psoriasis and irritable bowel syndrome (IBS). The beta form is largely produced in keratinocytes found in the epidermis layer of skin. The alpha form is the type produced more within sensory nerves. (G3.19) (Psoriasis is an eczema-like condition believed to be autoimmune in nature.)

     After a physical injury like a bump on the shin, inflammation causes an increased output of the Calcitonin Gene-Related Peptide (CGRP) and an inflammatory protein that is called Substance P, possibly for peptide, which is another word for protein. The release of the peptides follows shortly after an inflammatory event and shortly the chemicals are released there is  edema and plasma leakage in the surrounding area. (G3.20) The inflammatory peptides are also released in increased amounts during migraine headaches. (G3.21) The peptides increase the dilation of blood vessels and cause increased leakage from blood vessels (edema) and “degranulation of mast cells.” (G3.19) (G3.21)

     Levels of CGRP increase in people who suffer from migraines and a type of prescription medication, called sumatriptan, which has been found helpful to stop migraine pain, has also been found to inhibit the release of CGRP in migraine patients. The medication may be inhibiting the release of CGRP by increasing intracellular levels of calcium. The “cytokine TNF-α” may be involved in migraine pain. (G3.21)
    That was the background - the bottom line - magnesium deficiency can make the body more susceptible to the negative effects of CGRP, Substance P and chronic stress. And a chronic stress situation combined with chronic magnesium deficiency may lead to the development of inflammatory conditions like migraines, fibromyalgia, PTSD, or Irritable Bowel Syndrome. The magnesium deficiency associated with the inflammatory peptides CRGP and Substance P may be causing an increase in the level of the cytokine TNF as early as two days after a deficient diet was begun in a research study with lab animals. (G3.22) 

     So an Epsom salt bath or foot soak may relieve itch by providing the body with a form of magnesium that can be absorbed through the skin bypassing any GI problems that might underlie a chronic magnesium deficiency. It isn’t uncommon to have a diet low in magnesium but it is also not uncommon in the food supply. Problems with poor absorption or increased kidney or bowel loss are common causes of chronic magnesium deficiency.

     A variety of tips for reducing Substance P levels are included in the article Trichodynia, Pain, and Substance P. Exercise, hobbies that use repetitive motions of the hands, and stretching exercises may help reduce excess levels of the inflammatory chemical according to the article on the website drwardbond.com, see the article for more details: (G3.23)

Genetic differences in more than 70 genes have been associated with increased itchiness, see summary at the end of this section. (G3.24) Calcium and serotonin levels may be involved in increased itch or arthritis pain signals being sent or perceived. (G3.25) Scratching an itch is considered rude and a chronic itch is often considered funny however it isn’t fun. 

Some background information:

     Too much or too little calcium and magnesium can affect pain, itching, and mood. The minerals are both electrically active, and provide energy for ion channels which control the transport of messenger chemicals like serotonin across cell membranes - such as nerve cell membranes which might feel like a sensation of itchiness or pain.

     Excess serotonin may be involved, (G3.26, G3.27), and scratching an itch can make the urge to scratch more intense, even worse afterwards, even though there may be a temporary feeling of relief while scratching. (G3.28) Adequate magnesium is essential for reducing pain in arthritis or at least may help reduce pain levels. (G3.27) An antihistamine may help for some types of itching related to genetic conditions. (G3.29)

     Excess dopamine levels can also be a cause of an overwhelming urge to scratch - see “grooming behavior” in section 7. When to Report?. The solution there is to figure out why dopamine levels are that elevated. Elevated dopamine can be a symptom of hyperthyroidism but it can also be associated with other conditions.

• An Itch You Just Can't Scratch; NIH-funded study identifies proteins that may cause chronic itch. Summary points: The HTR7 gene was found most closely associated with chronic itch in an animal based study, however over 70 genes were found to be more expressed, more active in lab animals with chronic itch. The gene expression of the HTR7 gene was most active in the mice with the worst symptoms of scratching compared to the mice with the least sensitivity. The activity of the TRP1 receptor was also increased in animals with more symptoms. (G3.24) 
• Transient receptor potential ankyrin 1 (TRPA1) receptor is involved in chronic arthritis: in vivo study using TRPA1-deficient mice. Summary points: The TRPA1 receptor is directly activated by calcium levels inside of the cell, and a variety of toxins or “noxious” (irritating) substances that are produced as a normal part of “oxidative stress” otherwise known as “inflammation” including, “4-hydroxy-2-nonenal, hydrogen peroxide, hypochloride, hydrogen sulphide, 15-delta prostaglandin J2 [25–28].” and irritants from the environment or diet can also activate the TRPA1 receptor, 1.“mustard oil (allyl isothiocyanate: AITC) [29], 2. cinnamaldehyde [30, 31], 3. allicin [32, 33] and 4. formalin [34]...”. Serotonin and other  “Inflammatory mediators, such as bradykinin...[19, 35]” can make the receptors more sensitive which can lead to increased responsiveness of nerve endings - more pain or itch. (G3.25)  

*People with over active TRPA1 channels may be sensitive to: 

1. Mustard:  "mustard oil"
2. Cinnamon:  "cinnamaldehyde'" (G3.43) ); 
3. Onion or Garlic: "allicin," (G3.41) 
4. Formaldehyde: "formalin," chemically the two are very similar: (G3.42) and formaldehyde is found in the environmental and as a metabolite of some alternative sweeteners and other dietary. sources. (G3.56) Environmental sources include which would include first and second hand smoke, poorly ventilated air or smog, especially when there is brand new flooring or other new plastic or vinyl  material in the living area, it  can release volatile chemicals including formaldehyde at levels that can make a sensitive person feel ill. Metabolites of the breakdown of the alternative sweetener aspartame and Neotame include menthol and formaldehyde. (G3.44)  Older packages of fruit juice also may contain increasing amounts of formaldehyde as the product ages, more of the chemical is produced from other chemicals.

Magnesium, opioids, and neuropathic pain.

     This list and this section got much longer actually, and eventually led me back to a topic I've written about in 2011, and which is one of the underlying causes of overactive TRP channels. Fortunately it also has a simple solution, (G3.101), unfortunately - it is so simple a solution that it isn't profitable - unfortunately for individual patient's health and quality of life and unfortunately for the economic health of individuals and nations and businesses who are being overcharged by the medical industry for ineffective healthcare. 

     It is so effective a solution for improving mood and pain and muscle cramp type symptoms that I've been sharing the information online since at least 2011 and the article I shared was research from 2009, (G3.101), - so the clock is ticking on how soon the evidence based medical research will reach the individual patient who is in pain. The racers at the starting line are the physicians and nurse practitioners and other health professionals who make recommendations for opioid medications in an attempt to block pain instead of trying to find and resolve the cause of the pain. 

What is a nerve signal? "Pain" or "no pain"? or "on" and "off"?

     Pain, however, should not just be blocked without trying to understand the cause. It is a message from the body desperately asking for help but it is not always a clear message. Pain in one area of the body may have to do with an issue in another area of the body. Instead of blocking the pain signals we need to listen to them more carefully and try to figure out what the pain signals mean and how to resolve the underlying cause of the pain. Something might be missing and need to be added back into the diet or something might be happening in excess either in the diet or lifestyle habits and need to be stopped or moderated. 

     Nerve signals are not specific to send the brain a message of "pain" that exclusively means "pain;" a nerve signal is more of an "on" or "off" and might indicate a variety of extremes: too hot or too cold, or too rough or too light (ticklish), or too hot peppery, (capsaicin,  (G3.100), more on that later), or too mustard oily. The nerve signal is simply telling the brain that "something" happened - figure it out captain of the ship - and fix it - such as remembering to wear gardening gloves before handling wild mustard weeds, especially if you have diabetic hypersensitivity. 

     The TRP channels are the bridge between the world and the nerve signal. There are many types and they can respond to specific temperatures, so some might activate when it is very cold and some might activate when it is very hot. Some might react to the hot pepper and some might react to the mustard oil. They would all tell the same nerve - "something" extreme happened.

     Mustard oil can cause an extremely itchy reaction. It is used to induce "hypersensitivity" in lab animals to study the condition in relation to diabetic hypersensitivity. This will be discussed in the next section in more detail. (G3.96) Wearing gloves may be advisable when pulling a patch of wild mustard if you tend to have sensitive skin or allergic reactions.  (p124, G3.97)

Antihistamines taken daily can be helpful if excess histidine is a problem. 

     Antihistamines taken as a daily precaution may be helpful for people with overly sensitive skin if the sensitivity is related to a tendency to overproduce histidine. (G3.29) If that is an issue, then taking an antihistamine medication daily may also help for some types of chronic pain as well, more will be included in the next section. Acupuncture is a traditional therapy that may help reduce the overactivity of TRPV channels and reduce the production of the inflammatory peptide Substance P and other cytokines. Acupuncture can affect both the opioid and the cannabinoid receptors - but without needing the prescription or having to experience the side effects! (G3.104) 

Formaldehyde is a chemical that can be produced within the body as part of metabolism, it is toxic however and the body would continue to break it down further for removal from the body in conditions of normal health. Formaldehyde is found in the environment from a variety of sources and is produced in the body or in food products as a metabolite (a chemical produced from the digestion/metabolism of a larger chemical) of some alternative sweeteners (G3.48) and other dietary sources including fruit juices and artificial and natural flavorings. ((G3.49, (p476, G3.50)) (G3.56)  "Formalin" is chemically very similar and may cause similar health symptoms. (G3.42) (G3.25) Formalin is used to induce pain in lab animals for experimental purposes and it was determined that the pain was due to activation of the TRPA1 channels. (G3.86)

1. First and second hand smoke, (G3.44); The formaldehyde content of some types of E-Cigarette preparations used for “vaping” instead of smoking the volatile gases have been found to vary significantly. Skipping to the last point on this list may provide the explanation - fruit flavoring based on fruit juice and essential oils from fruit and other artificial “flavorings” are frequently chemicals from a group of chemicals called aldehydes. They can break down over time into smaller chemicals which can include formaldehyde or other toxic types of aldehydes. (G3.49) So if you are “vaping” in order to avoid toxins in cigarette smoke then it may be advisable to skip the “chocolate or fruit flavoring” and use an E-Cigarette product that just has the natural tobacco flavor instead. (Yes, tobacco is an herb and it has a flavor and nicotine can have some health benefits, however formaldehyde does not. The nicotine patch provides a steady dose of nicotine without any volatile toxins.)
2. Poorly ventilated air or smog; (G3.45)
3. Vinyl and PVC plastic products off-gas formaldehyde and other volatile chemicals at levels that can make a sensitive person feel ill. (G3.45). A poorly ventilated room would increase the risk of the gases accumulating to more toxic levels. The wax refinishing treatments used to clean and shine vinyl flooring are also sources of formaldehyde and other toxic gases. One re-waxing session can produce as much volatile chemicals from the chemical products that are used to strip off the old layer of wax polish and add a new layer, as the vinyl floor itself would off-gas throughout all the years of its installation. So making a choice about which type of flooring to install is also making a choice about the  type of cleaning products that will be needed to maintain the floor. (G3.46) A Cleaning Product Fact Sheet is available from the California Environmental Protection Agency Air Resources Board: (G3.47). Types of flooring and other building materials are discussed in extensive detail in a review article regarding sources of Formaldehyde in the Indoor Environment: (G3.45).
4. Metabolites of the breakdown of the alternative sweetener aspartame and Neotame include menthol and formaldehyde. (G3.48)  
5. Older packages of fruit juice also may contain formaldehyde in amounts that can continue to increase as the product ages. The formaldehyde is produced as other chemicals become unstable over time and metabolically breakdown into a variety of smaller chemicals which include formaldehyde. The food preservative method of ionizing radiation has been found to increase the chemical breakdown of larger aldehydes in apple juice into formaldehyde and other chemicals with toxic properties. (p476, G3.50) 
6. Before leaving the topic of formaldehyde, the symptoms of toxicity with workplace exposure to formaldehyde have been reported to include allergic type symptoms including: "sneezing/airways-related symptoms, itching and watery eyes." (G3.51) Formaldehyde exposure may also be a cause of systemic allergic contact dermatitis, (G3.52, G3.53, G3.54), possibly even with symptoms of rash occurring on the eyelids.(G3.55) A diet designed to avoid formaldehyde intake may be helpful for alleviating the eczema like rash. (G3.52)

A summary, in reverse order;

• Workplace exposure; Workers more at risk might include health professionals, (G3.51); and hair stylists or nail salon technicians, (G3.58); and funeral directors may be more at risk for developing the paralyzing chronic disease ALS, (G3.59); some industries such as the garment and textile industry may have formaldehyde exposure, (G3.63);
• Aseptically packaged juices, the amount may collect in older packages as the product ages, ionizing radiation methods of food preservation have been found to increase the amount of toxic aldehydes including formaldehyde and therefore is not a recommended technique for the juice industry, (p476, G3.50);
• Nutrasweet (aspartame) and Neotame, alternative sweeteners. (G3..48) 
• Vinyl flooring, cleaning products, and other PVC type of plastic products. (G3.45, G3.46, G3.47);
• Poorly ventilated air or smog. (G3.45); *Note, lighting large numbers of decorative candles may be increasing volatile chemicals in your air supply. Also air fresheners and cleaning products may contain chemicals that break down into formaldehyde. (G3.60) Lifestyle choices besides smoking cigarettes can negatively affect health. Try a fern for air freshening instead; give it a nickname and you might get some emotional benefits in addition to other physical health benefits. Plants can be useful household decorations because some types can clean the air of formaldehyde and other toxins. The original research was by a NASA scientist for use in keeping the air fresh in living environments for astronauts. For the most effective air cleaning ability, the plant does need to be watered and misted as its particular type requires, because the chemical removal of formaldehyde from the air is dependent on the roots and leaves access to water. (G3.61); a mechanical problem with the furnace or water heater and ventilation system may be leaking toxic chemicals into the building’s air supply; increased efficiency of insulation and other building materials have created rooms and buildings that are too good at preventing air circulation, which makes maintenance and cleaning of ventilation systems and fans important - otherwise everyone working or living in the space might start feeling some symptoms of “sick building syndrome.” (G3.62)
• Smoking cigarettes or other products, and flavorings in “vaped” E-Cigarettes may also be a source of formaldehyde. (G3.44, G3.49)

• The Centers for Disease Control provides a fact sheet for further guidance regarding risks and precautions regarding formaldehyde: What You Should Know About Formaldehyde, (G3.57)
• The Environmental Protection Agency provides a fact sheet on sick building syndrome: Fact Sheet: Sick Building Syndrome, (G3.62) 
• The Cleaning Products Fact Sheet, by the California Environmental Protection Agency's Air Resources Board provides guidance regarding safer cleaning products: (G3.47)
• The National Cancer Institute’s Fact Sheet: Formaldehyde and Cancer Risk includes research on occupations that may be at risk for formaldehyde exposure and provides a list of organizations that might have more information or other help to offer. (G3.63)

Sick Building Syndrome: Symptoms that may occur due to breathing air that contains too much formaldehyde may include sore throat, cough, scratchy eyes, and nosebleeds according to the fact sheet by the Centers for Disease Control. (G3.57) So if everyone working in a building, or many workers or family members are all experiencing allergies or a slight cold that just doesn’t seem to want to go away - then bad air may be a problem. See the fact sheet on Sick Building Syndrome by the EPA for more information. (G3.62) 

Eczema: The eczema symptoms reported in medical research may occur with more chronic long-term exposure to formaldehyde and/or in individuals who also have more difficulties metabolically with detoxifiying formaldehyde - we don’t know all the answers. I have personally experienced skin rashes off and on all my life and was startled to develop it on my eyelids in my more recent past - and then was more startled, or more relieved to learn of the possible cause - formaldehyde exposure (G3.55) and systemic allergic contact dermatitis, (G3.52, G3.53, G3.54) Poor air quality was a problem at the time in part due to water heater mechanical problems, and also first and secondhand smoke were contaminants in my air supply - I cleaned up and changed habits somewhat and my eyelid rash got better - yeah science! To me that seems like an example of effective self care and effective use of evidence-based medical research even if I had to read it on my own.

Other health risks include cancer and neurological conditions: The link between cancer and formaldehyde may be less strong than for neurological disorders such as ALS in funeral home directors, (G3.59), or autism in a child whose mother had prenatal exposure to formaldehyde, (G3.56), however research has found some cancers associated with occupational exposure to formaldehyde. The National Cancer Institute also has a fact sheet on the topic of formaldehyde and it includes a convenient list of addresses and websites for organizations that might have more information for workers concerned about exposure risks such as OSHA, the Occupational Safety and Health Administration,. (G3.64) See the National Cancer Institute’s Fact Sheet: Formaldehyde and Cancer Risk for more information and resources regarding formaldehyde and occupational safety: (G3.63)

If you are looking for a hair salon that is likely to have less formaldehyde and other volatile toxins in the air then look for one with lots of healthy ferns and other tropical low light houseplants. (G3.61)

    If you are a hair salon or other business owner interested in improving the air quality in your establishment with the help of ferns and other houseplants, then hire a staff member who knows and loves plants because they do require some consistent care that can vary quite a bit depending on the type of plant - or buy the book by the NASA research scientist and have an employee learn how to care for your indoor air-cleaning garden. 

     The scientist, B. C. Wolverton, organized what he learned to help astronauts in an easy to use plant guide that lists the species of plants which were found most effective at cleaning air. The book, How to Grow Fresh Air: 50 Houseplants that Purify Your Home or Office, includes guidance for caring for each species and also lists them by the types of volatile chemicals that they were able to remove from the air. (G3.66)     

     Large urban areas may have office plant services available where a greenhouse or florist shop supplies and maintains lovely office plants for a subscription or rental type of payment. An employee of the plant business has a route of subscribing businesses to visit each week in order to water, mist, and trim plants of any dead leaves, even a healthy plant will look sad if it is covered in a layer of dust and has a few dead leaves. Plants that are sick are simply returned to the greenhouse for care or recycling and the empty spot is filled with a replacement by the plant business employee. 

     Ambius is an example of an office-plant company with service locations available in many urban areas in both Canada and the United States. See the Ambius website for more information and service locations: Ambius.com.

    I'm convinced, but I also already own the book; To do list: Buy a new fern to replace the one from years ago that is no longer around. 

     Ferns, in particular, do need a certain humidity level and require misting in addition to being watered instead of being over watered whenever the fronds look dry. A room environment comfortable for humans is not the rain forest or a temperate zone. The tips of the fern leaves will turn brown even though the plant has water in its pot. The fern and other plants able to detoxify volatile chemicals from the air require most leaves and roots in order to be able to do so. Watering a fern about once a week and misting it with water thoroughly at the same time may be sufficient, or it may prefer to be misted again occasionally in between needing water added to the soil. Over watering a plant in a container can be bad for the root structure and lead to the plant dying from being unable to take up nutrients through the damaged roots. 

• The book by B. C. Wolverton includes care instructions for the species that are listed in the book How to Grow Fresh Air: 50 Houseplants that Purify Your Home or Office. (G3.66)

Before leaving the topic of “getting to know your TRP channels,” I’d like to introduce the vanilloid family. They were among the first TRP channels to be identified with lab techniques. This is all very tiny stuff, difficult to work with compared to a craft or construction project in the full size world we can see without a microscope. It is easy, however, to see when someone is scratching or wincing from pain, so the lab technicians and research scientists are to be commended for their fine eye for microscopic detail. Vanillin or vanilloid receptors can have a calming effect on the body - baked goods with vanilla have a little extra besides love soothing the body. However some types of TRVP channels can also be stimulated by hot pepper due to its capsaicin content. (G3.99) 

     Capsaicin is the active phytochemical that causes a feeling of “hot” when hot peppers are eaten - because it activated a TRPV channel which activates a nerve to send a signal to the brain that is most likely to be interpreted as “hot” although some people learn to enjoy the feeling, or may be genetically different and experiencing slightly differently than other people who couldn’t imagine eating very hot, hot peppers (G3.100)

     The aroma of vanilla can lead to an emotional feeling of comfort even without eating a food containing the phytochemical that can activate the TRPV channels. “Aroma” does involve nerves being activated in response to a chemical in the air that enters the nostrils. Tiny amounts of “vanilla” aroma are entering the nose and physically activating TRPV channels which physically activate nerve signals that tell the brain “something” happened. This time it wouldn’t be as obviously “hot” as the capsaicin though, the vanilla is activating a different TRP channel which would activate a different nerve. If hot peppers had been experienced before the memory of them would be strong enough to remember not to eat them or touch them again. Making “noxious” chemicals, irritants or toxins, is a plant defense mechanism to encourage animals to not eat the plant unless it is ready for the seeds to be spread. A delicious fruit smells delicious when it is ripe and the seeds are ready to be “planted” somewhere other than right where the plant is growing. Some plants make seed pods that catch the wind or have burrs and attach to animal fur as animals walk by, and other plants make delicious fruit or other nutritious seeds to encourage animals to eat them, and carry the seeds elsewhere to be “planted” later (whenever the animal defecates). Nature is amazing.      

     Vanilla is a delicious smelling seed pod so the plant must want its seeds to be eaten. For delicious history and recipe information see Primer: Vanilla Part One and Two, by Jasmine, a culinary blogger.  (G3.102, G3..103) .

     We learn from previous experiences when to avoid something and when to reach for a second helping. If the brain had experienced home baked cookies in the past, then the scent of them baking any time in the future might set off an expectation of delicious food and activate saliva glands in addition to causing a calm or pleasant emotional response to the aroma of vanilla or a comforting memory from childhood. Aromas can also be tied to emotional responses that were learned in childhood or at any time in a trauma situation. Positive memories associated with an aroma may be triggered by re-experiencing the favorite fragrance or negative memories might also be triggered by a reminder of something associated with the trauma.

     Cancer treatments can be so nauseating that patients are counseled to avoid favorite foods during the first few days after the treatment in order to prevent negative associations of nausea being linked to their favorite food.  When feeling “under the weather” there is a natural instinct to want to tempt the appetite with a comfort food - but if it is most likely going to be thrown up and the hope is that a few nutrients get absorbed before that happens then a bowl of oatmeal or a entree from an expensive restaurant would be equally unappealing on the way back up and the unusual meal might be more likely to cause memories of the experience. So - the common sense recommendation from dietetics eat the oatmeal while feeling sick or something neutral and save the favorites for later.

TRP channels - what were they again? 

• Physiology and Pharmacology of the Vanilloid Receptor, (G3.98) Excerpt: “In addition to the contribution of the vanilloid receptor as a target of the neurogenic inflammation underlying different diseases, TRPV1 is gaining interest for the treatment of neuropathic, postoperative and chronic pain and, recently, for the therapy of epithelial disorders [epithelial = skin or membrane]. Thus, for instance, topical capsaicin or resiniferotoxin have been used in postherpetic neuralgia, diabetic neuropathy, postmastectomy pain and arthritis [64,103]. Recently, TRPV1 has been clearly validated as a key target for management of chronic pain in bone cancer [42]. As a result, the development of specific TRPV1 antagonists is a central focus of current drug discovery.” (G3.98) 

To review: magnesium is the ion that is needed inside of the cell to power the TRP or ion channel’s ability to stop some chemicals from entering the cell’s interior while allowing other chemicals to enter. Magnesium is the soldier at the gate with the energy to stand sentry all day and night - if present. If there is magnesium deficiency, the sentry with energy to keep the gate shut is gone and any chemical floating around in the fluid outside of the cell that is small enough to fit through the open ion channel is able to  flow through the unguarded gates. The capsaicin that can treat pain when used topically is over stimulating the receptors to the point where they are no longer sending any pain signals. When there is a magnesium deficiency then calcium itself can be a cause of pain. 

     Inside the interior of the cell calcium can activate the cell function and cause it to overwork to the point of cell death similarly to the “excitotoxins” such as glutamate or aspartic acid, both used in the food supply as flavorings - they also excite the tongue’s taste buds. MSG, aspartame and Neotame were included in the list of chemicals that might activate TRPA1 receptors which are associated with several chronic pain and chronic itch conditions. 

     Calcium signals the cell to overwork, which leads to inflammation and signals of pain. Nerve signals are activated by inflammatory chemicals which are also “pain” signals as perceived by the brain - inflammation hurts because it is activating “pain” nerves. “Inflammation,” “oxidative stress,” and “pain” are all experienced as the same thing to the brain. So if someone at work is annoying you and you just can’t stop thinking about it - you might be physically hurting yourself, consider taking a walk in nature or buying a fern instead. 

• The research team suspect that “calcitonin gene related peptide (CGRP)” is involved in producing changes underlying the condition of “pain” and “inflammation” for the condition of arthritis at least. Inflammatory chemicals produced in one area of the body could travel and send nerve signals that led to inflammatory pain symptoms being felt in other areas of the body - so over-thinking can hurt? Read more: New Study Proves that Pain is Not a Symptom of Arthritis, Pain Causes Arthritis. Newsroom, University of Rochester Medical Center, urmc.rochester.edu, Sept. 29, 2008, (G3.109)

However CGRP has also been found to be involved in helping to suppress severity of symptoms in autoimmune diabetes. Providing CGRP therapy in an animal based research study helped reduce oxidative stress chemicals and the damage they can cause to pancreas cells that can eventually lead to developing autoimmune diabetes. (G3.114) Researchers working with human patients who have diabetes theorize that those people with a reduced response to stress are the people who seem to progress to diabetes most quickly. (page 19, G3.115)  Chemicals similar to CGRP have also been tested therapeutically for heart disease patients and has been found to have some benefits for reducing hypertension, cardiac hypertrophy, and heart failure. (G3.116) 

     As a dietitian the question I next ask when I learn about a chemical in the body that seems to promote health is how do we make it for ourselves? How can we better assist patients to make it for themselves rather than being dependent on a daily medication? What does a person need to make CGRP ?

     Drumroll - an answer does already exist in medical research, and it is inexpensive and readily available in the diet if well absorbed or is available topically via magnesium chloride or magnesium sulfate foot soaks or baths - magnesium. Providing magnesium directly to an area of bone with a fracture in need of healing, was found to effectively promote increased bone healing - possibly due to a measured increase in levels of CGRP.  (G3.117, G3.118)  

     So would you rather have a medical professional provide you a daily medication at a profit to the medical system - or be informed of ways to change your diet and lifestyle so that you could make the life saving chemical naturally the way healthy people do, everyday?

     Like most things in life - too much CGRP isn't good either. Genetic differences may be involved in  risk for migraine as elevated levels of CGRP have been found in patients with migraines. Attempts to block the chemical Substance P were found to be ineffective but use of CGRP agonists/blockers were found to help patients with migraine. (G3.119) 

     And sugar is something that is a negative when eaten in excess. Too much sugar in the diet typically also means fewer nutrients are being consumed as refined sugar has no additional B vitamins or magnesium, while a piece of bread or fruit would provide some nutrients in addition to the naturally found sugars. Excess sugar in the bloodstream leads to an increased loss of magnesium by the kidneys because the mineral is necessary in order to remove the excess sugar from the blood and add it to the urinary waste stream. (G3.120) 

 B vitamins are needed in order for the body to be able to break down the molecules of sugar so the stored energy is released. Smaller waste chemicals are produced from the larger sugar molecule that will also need to be excreted by the body as a normal part of metabolism (metabolism is roughly equal to all of the body's many chemical, energy and digestive cycles). A diet with excess refined sugar has also been associated with heart disease risk. (G3.121) 

Evidence based clinical research from 2009 could have helped save many lives lost to the opioid epidemic if patients were being told and treated with the discovery. (G3.101) Patients with diabetes and chronic pain often don’t experience much if any relief from the use of opioid medications, however that is the standard pain medication that is provided for chronic pain so it is often prescribed to diabetic patients anyway, just a prescription pad after all not a patient (not true). The research study provided magnesium to the diabetic patients as a pretreatment before providing the opioid or along with an IV drip of the medication, and not only was the pain reduced for patients who received magnesium, but the pain level was reduced for several days for the fortunate patients. And some trials of the experimental treatment didn’t provide the opioid medication and yet pain relief was felt by the diabetic patients.

      Well that is exciting and it leads me to say - why even bother giving an opioid medication then, if it won’t help to relieve pain that is actually being caused by a magnesium deficiency?  Because there is profit to be made by prescribing opioid medications but there isn’t profit to be made writing a magnesium prescription? Pondering is a waste of time for someone in pain.

     The research discussion seemed to focus on using 30 mg of magnesium with IVs of morphine or other opioid medication for better pain control, but didn't address or stress the fact that the 300 mg dose of magnesium had reduced pain levels for patients on its own, without any opioid medication having been given along with the nutrient. Pain control without needing an addictive drug that can cause death if overdosed?

    Common sense can be inexpensive - consider the benefits of resolving a problem instead of treating symptoms and ignoring the underlying cause. (Magnesium can also be deadly in overdoses, but that really isn’t as common a cause of death as opioid overdoses.) 

• Read more: Magnesium ions and opioid agonists in vincristine-induced neuropathy, (G3.101).
• A more recent study found a significant difference between magnesium levels between the patients with diabetes and the control group. Significantly lower levels of magnesium were also noted in association with insulin resistance factors although not with fasting blood sugar levels. Read more: Association of Serum Magnesium Deficiency with Insulin Resistance in Type 2 Diabetes Mellitus, (G3.122)

Trying to replace a natural function with a patented medication is using patient's pain for the purposes of profit.  

     Calcium channel blocker medications (PPIs for example) are trying to close the gates and keep the calcium out - and magnesium would be delighted to do that as nature intended if enough of the mineral were being absorbed from the intestines. However many issues with our modern food supply and the contaminants it may contain that  may be leading to poor absorption of magnesium and increased loss by the kidneys, (too much active hormone D3 can cause increased calcium absorption and loss of magnesium). Note the frequent use of the word “may” - more research is needed, in the meantime an Epsom salt bath or foot soak or use of a topical magnesium chloride product could bypass poor intestinal absorption problems. The magnesium sulfate used in Epsom salt would also provide sulfate which may also be beneficial due to possible contaminants in our modern food supply. 

     Talking about doing things “traditionally” is nice but our children are not growing up in the same chemical environment that we did, and we didn’t get to experience the food supply that our grandparents enjoyed. 

     Calcium channel blocker medications make a large profit for the pharmaceutical company - magnesium cannot be patented.

     Now that it is clear that emotions and environmental triggers can cause inflammation, which at the same time is a cause of feeling "pain," it is easy to see why childhood trauma or severe traumatic experiences or ongoing trauma can lead to developing inflammatory conditions such as inflammatory bowel conditions or fibromyalgia and migraine pain. The next section moves into psychological conditions that can be due to emotional trauma but may cause physical symptoms as well as mental symptoms.

A more frequent problem than is recognized is a milder form of a dissociative condition called Depersonalization/Derealization Disorder, commonly known as “work burnout,” than the more well-known but rare “Multiple Personality Disorder.” That name has been changed to Dissociative Identity Disorder (DID).  

     Symptoms of the milder Depersonalization Disorder (Work burnout) may include depersonalization and/or derealization without the presence of other psychosis or memory and identity disturbances. It is one of the Dissociative Disorders which also include Dissociative Amnesia  and Dissociative Fugue and Dissociative Disorder Not Otherwise Specified, in addition to the more severe DID, Dissociative Identity Disorder. The disorders may be under-diagnosed or misdiagnosed even though symptoms consistent with the Dissociative Disorders are often reported by people with psychiatric illness who also have a history of having experienced trauma.   (G3.30) 

• Read more: Stress and Trauma: Psychotherapy and Pharmacotherapy for Depersonalization/Derealization Disorder. (G3.30) 

Techniques that help patients reach a deeply relaxed state can help reach the nonverbal emotions and memories from early childhood that may not have been stored as “words.” Art therapy, journaling or poetry, music and movement and meditation can all help access or nonverbal memories. EMDR therapy incorporates rapid eye movement or hearing a sound that switches from the right to the left side of the brain rapidly. The stimulation in a rhythmic pattern helps reach a relaxed meditative state that is not as deep as hypnosis but might be somewhat similar. The therapist then guides the patient with some questions about a traumatic event or memory in order to try to reframe the issue from an adult’s perspective, in order to help the little child within the patient understand the issue from a more adult perspective. Forgiveness for parents who didn’t know better might be part of reviewing a traumatic childhood from the viewpoint of an adult. Parents may have just been young and foolish once too. 

• Eye Movement Desensitization and Reprocessing, EMDR Therapy: Using EMDR to Find Your ‘Safe Place’ in Trauma Recovery. (G3.31)

Dissociative Identity Disorder (DID) is a mental health disorder that can result when there was severe child abuse and/or neglect. Colin A. Ross, M.D. is a specialist in the treatment of DID, see his book Dissociative Identity Disorder: Diagnosis, Clinical Features, and Treatment of Multiple Personality for more information. (G3.32) 

     The author provides an example script he developed for patients to describe what cognitive therapy is and how it might help them. The script begins with lines that suggest that our feelings are sometimes affected by what we think and that if that is true then changing how we think may be the best way to change how we feel. He describes cognitive therapy as a method for helping the patient to learn what not to do rather than focusing on teaching them what to do.(p 339,  G3.32)

     Incorrect beliefs can develop during childhood that may have been helpful to the child at the time but may cause problems later in life. The author discusses false assumptions commonly believed by DID patients and he describes a few cognitive therapy techniques which he found helpful for challenging the old beliefs and guiding the patients to new beliefs. Counseling strategies and false assumptions are discussed within the section titled Cognitive Restructuring Techniques (pp 338-345,  G3.32)

The false assumptions are discussed in the book Dissociative Identity Disorder: Diagnosis, Clinical Features, and Treatment of Multiple Personality within the section titled Cognitive Restructuring Techniques (pp 338-345, G3.32) I found the ideas helpful and combined the false beliefs into a list, with notes summarized from my understanding of the text, words in italics are quotes from the text:

1. "Different parts of the self are separate selves." - Which can lead to the false belief that different parts of the self (alters) actually have different bodies and cognitive therapy may address the risk of one alter causing physical harm to the host (primary personality) by tackling the alters' false belief that there are two or more separate bodies.
2. "The victim is responsible for the abuse."  This false belief may occur during developmental stages in early childhood when the child believes that what happens in the world is caused by the child's actions. Cognitive therapy  can challenge the underlying belief that "I must be bad."
3. "The abuse happened because I am bad." Children can't just leave their caregivers and the need to love and feel love is also strong so it can be a common false assumption that whatever is happening is right and the child is wrong or deserving of the mistreatment. Cognitive therapy can discuss the differences between a child's and an adult's responsibilities in life and whether traumatic events are something other children could cause to occur or that they deserve instead of normal love and affection.
4. "It is wrong to show anger." Cognitive therapy can help teach what healthy anger is and how to control it. Underlying false beliefs can be challenged by asking: "Who says anger is bad? How do you know that?"
5. "The primary personality can't handle the memories." Cognitive therapy can help the DID patient to recognize that as an adult the primary personality is older and may have more ability to cope with painful memories. (paraphrased from the book Dissociative Identity Disorder: Diagnosis, Clinical Features, and Treatment of Multiple Personality, section Cognitive Restructuring Techniques, (pp 338-345, G3.32))

• The first and last of the assumptions listed above are more specific to DID in that amnesia is involved; the memory of the trauma is blocked from the primary personality. However a child in a trauma situation might also develop the last assumption about other people in their lives. They might feel a need to protect family or others from information that the child might fear is too disturbing in some way or had been told by someone else to keep secret.
• Less severe cases of childhood trauma may result in the child growing up believing false assumptions similar to those listed in number 2, 3, and 4 without the child also developing amnesiac memory blocks or feeling like there are parts of the self that are separate from each other.

Dissociation can be a normal coping strategy but in DID it can become disruptive for the adult even though it may have helped the child survive traumatic events. Cognitive therapy strategies can help the patient recognize that the beliefs they had developed as a child are not necessarily true at all or they are not true now that the child is really an adult. Initial recognition of false assumptions can help change old beliefs and related behaviors quickly, but it can also take months or years repeating the new beliefs to replace the old childhood beliefs.

Information provided in the book Dissociative Identity Disorder: Diagnosis, Clinical Features, and Treatment of Multiple Personality regarding the cost effectiveness of therapy for DID suggests that accurate diagnosis and treatment could be very cost effective and save years of ineffective therapy for the patient and the clinician. 

     Clinicians have reported stable integration in children with DID in as few as 5 to 10 office visits. The shortest reported integration for a child patient occurred in just one session and the longest treatment reportedly took 30 sessions over five months. The point is made however, that it wouldn't be ethical to treat a child with DID while they are still experiencing abuse because the therapy would be taking away the child's coping strategies.(p 256, G3.32)

     Adults with DID have been reported to have spent as long as twenty years in ineffective therapy before the diagnosis of DID was made. Twenty years of therapy can cost $500,000. Research that examined the treatment of fifteen women found that it took an average of 8.1 years in therapy before a diagnosis of DID was even made, at an average cost of $166,786.97 each. In comparison the average length of treatment once a diagnosis of DID was given was 2.6 years.(p 257, G3.32) Two to five years of therapy before reaching integration is typical for patients with DID. (G3.32)

     The diagnosis of DID became controversial in the past as some practitioners over diagnosed and may have led some patients to false memories during sessions. However it is a real condition that is not very common.

• A narrative “dramatized” description of a patient with DID and her therapy is available in the book Jennifer and Her Selves. written by the patient’s psychotherapist: (G3.33) 
• A patient with the condition shared her own story and "survival tips" for others with Dissociative Identity Disorder. At the time she wrote her book the condition was still called Multiple Personality Disorder. The next section includes more of Sandra J. Hocking and Company's story in their book, Living With Your Selves: A Survival Manual for People With Multiple Personalities, (G3.34) . Sandra wrote the book along with some of her "alters", the other sides of her personality that were formed at different stages of her childhood or life.

More severe dissociative disorders like Dissociative Identity Disorder (DID) (formerly known as Multiple Personality Disorder, MPD) have occurred in some cases of extreme childhood trauma. A strong alter character may develop in the child's mind that takes over during scary times as a defense strategy. 

     The child or adult may be left with no memories of what happened while the alter personality was in charge.  A person with the condition describes "multiplicity" as being like a bus that has a variety of passengers who may take over driving occasionally, and go and do things without asking, and the bus may not remember it. The "host" or main personality is not the bus driver but is the whole bus.

     The full description is in the book, Living with Your Selves, by Sandra J. Hocking and Company;  (G3.34) , some of the author's alters helped write parts of the book. The author would like people to understand that the condition can be coped with and that it isn't possession by any external force. The alters were all protectors at some stage of the host's difficult life.

     The main difference between DID and less severe forms of dissociative disorders is that memory is suppressed in DID in order to protect the core child personlaity from whatever trauma is or was going on in the child/former child's life.

     My own feelings of disconnection as a child or as an over-worked adult have never included missing blocks of time or forgetting whole days, which can be symptoms of DID. 

     Seeing bad memories from above as if watching oneself from the ceiling can be a symptom of milder forms of dissociation. Conversations that you aren't part of or other voices taking place inside the head may be symptoms of DID. Sandra Hocking mentions that hearing voices externally from inanimate objects like a bicycle would be a symptom of a different type of mental health problem and she encourages talking to someone (other than the bicycle) if any odd voices are being heard.

     Recent research has shown that the "voices" that people with schizophrenia symptoms "hear" are actually their own internal sub-vocalizations - their own inner thoughts - but that some disconnection occurred in the brain that seems to make them unable to recognize the "voice" or "voices" as their own thoughts or memories.

     Hearing voices may be a symptom that is due to many possible reasons rather than being due to "schizophrenia" - it may be more of a set of symptoms that all resemble "schizophrenia-like symptoms." Several different nutrient deficiencies may cause a symptoms of "hearing voices". If a person was deficient in all of the nutrients, which is not uncommon in malnutrition, then supplementing only one of the nutrients would be unlikely to show much improvement in the schizophrenia-like symptoms even though it might have been helping somewhat. All of the nutrients are important for health.

• The voices heard by patients with these symptoms have been found to be the patient's own internal monologue but the patient no longer recognizes the voices as their own thoughts or memories from their past.  See:  "When People With Schizophrenia Hear Voices, They’re Really Hearing Their Own Subvocal Speech, Unlike most people, they just can’t tell it’s themselves." By Eliezer Sternberg  (G3.35) 

•  Folate and vitamin B12 deficiencies can cause schizophrenia like symptoms; possibly due to an increase in levels of c-reactive protein. Folate and vitamins B6 and B12 are needed to breakdown c-reactive protein. (G3.36)  
• Genetic differences in metabolism can affect the risk of deficiency in folate and vitamin B12. Genetic screening for methylation cycle differences can help clarify whether extra supplements of the more bioactive methylated forms would be more helpful than standard supplements.
• And a zinc deficiency and/or copper excess is more common for patients with schizophrenia; so pyroluria, a condition also thought to be due to genetic differences may be an issue. (G3.37)
• A zinc deficiency prenatally may be linked to schizophrenia later in life: (ncbi.nlm.nih.gov/1491625) (G3.38)   
• Vitamin D deficiency is more common in people diagnosed with schizophrenia. (G3.39) 

Health isn't easy on a good day for someone of average age and average metabolism. Seeking help from mental health counselors and other healthcare professionals can help provide care for a variety of topics that may not fit easily in  visit with the family physician.

      A specialist in research explains the oxidative stress chemical process in the background section of a review paper regarding the possible connection between psychiatric disorders and oxidative stress. (G3.110) The short story on the chemistry is about balance between the waste produced when burning energy for use in metabolism and antioxidants available to neutralize the oxidizing chemicals produced as waste. The oxidizing waste chemicals are smaller parts of what was once the larger molecule of sugar, glucose. We do need to be able to use the stored energy from glucose, so having plenty of colorful fruits and vegetables in the diet gives the balance of antioxidants necessary to neutralize the “free radical” waste products. They are like the ions of calcium or magnesium in the way they are “free” to donate or take energy from other molecules, which may leave them in disrepair.An excerpt gives a summary of oxidative stress and the potential link to psychiatric disorders, (G3.110)

• “Hence, oxidative stress can be considered as a state where the level of oxidants [hydrogen peroxide, superoxide, nitric oxide, etc.] produced by biological reactions exceeds the oxidants scavenging capacity of the cells. These oxidants modify cellular macromolecules [proteins, DNA, lipids] and alter cellular functions [19] resulting in apoptosis or necrosis [20-22].” (Apoptosis or necrosis = cell death)
• “The brain with its extensive capacity to consume large amounts of oxygen and production of free radicals, is considered especially sensitive to oxidative damage [12, 23]. Therefore, it is not surprising that oxidative stress is implicated in several disorders of the brain including neurodegenerative disorders [23-26], psychiatric ailments [27], and anxiety [28]. This association is largely due to the high vulnerability of brain to oxidative load [27].”, 
• Read more: Oxidative Stress and Psychological Disorders, (G3.110).

The topic of psychiatric disorders, TRP channels, oxidative stress, infertility and pre-eclampsia is more complex than I've led you to believe in this overview and this page is already long so the discussion will be continued on a separate page focused more on TRP channels - they are an exciting topic, see G. Pre-eclampsia &TRP Channels.

So speak nicely to yourself, you might be listening. And it turns out that words can hurt after all, due to oxidative stress, not just sticks and stones. 

     A book called What to Say When You Talk to Yourself, by Shad Helmstetter, goes into more detail about the emotional impact that can occur due to how and what we think to ourselves. How we phrase our thoughts and goals can affect our success and enjoyment in life; that seems like a no-brainer, but maybe not to the nervous toddler who is still trying to stand up in the adult sized shoes - a little wobbly but trying. (G.111)

The glossary section G. Fear & the Inner Child has more information and resources about early childhood experiences and emotional development and the possible creative benefits of dissociation. The section G. Autoimmune Disease & Vitamin D continues the medical discussion of oxidative stress, magnesium deficiency, and why an Epsom salt foot soak or bath might help an autoimmune condition in addition to improving a bad mood and soothing a muscle cramp and sore back - one stop shopping, now that is efficiency.
 

See a healthcare provider for medical advice, diagnosis or treatment.

• Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes. 
• The Academy of Nutrition and Dietetics has a service for locating a nutrition counselor near you at the website eatright.org: (eatright.org/find-an-expert)

 Crisis Hotlines and Resources:

• U.S. National Suicide Prevention Hotline: Call 1-800-273-8255, Available 24 hours everyday. (I.suicidepreventionlifeline.org)
• National Helpline: Substance Abuse and Mental Health Services Administration: "SAMHSA’s National Helpline, 1-800-662-HELP (4357), (also known as the Treatment Referral Routing Service), is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders."  (I.samhsa.org)
• Rape, Abuse and Incest National Network, RAINN Hotline: 1-800-656-HOPE, (I.RAINN.org)
• Child Welfare Information Gateway: a variety of toll-free hotline numbers for concerns involving the safety of children. (11.18)
• Power and Control and Equality Wheels  The following training materials are for helping victims of domestic violence and batterers learn how to recognize problem behaviors but emotional manipulation or abuse of power and control can occur in many types of relationships not just between couples.The Power and Control Wheel (11.15) was developed by the Domestic Abuse Intervention Programs (DAIP). (11.16) Manipulative behaviors are grouped into eight categories in the model. An additional Equality Wheel (11.17) was developed to help guide batterers and victims of emotional or physical abuse towards healthier ways to interact. It is grouped into eight equivalent categories with examples of healthier ways to interact with each other. Problems frequently can involve communication issues by both people in a relationship.