Caregiver’s Resilience In Parkinson’s Care

Introduction and Guest Background 0:00

Welcome back to the Parkinson's Solutions Summit. I am your co-host, Dr. Sandra Scheinbaum And we have a very special guest today. Her name is Dr. Monisha Bhanote. And she has an incredible background, including being quintuple board certified as a physician. So welcome, Monisha. Thank you so much, Sandra. I'm looking forward to sharing with the Parkinson's community today. Thank you. Well, let's start. If you would, share your background with us. Yes. As you already mentioned, I'm a quintuple board certified medical doctor and people are always curious.

Well, what exactly does that mean? That means I have done a lot of studying in the last 30 years. And I started an internal medicine, which many people are really familiar with because they go to their internist to see for annual checkup. I then spent quite a bit of time in anatomic pathology, clinical pathology and cyto pathology, which is really the diagnoses of all diseases. So we are the doctor's doctor, meaning we have all the answers because we are looking at your body and tissues and I did advanced training and fellowships inside of pathology, looking at single cells at Cornell in New York City.

And then I also did bone breast and soft tissue cancers at the University of Rochester. And then I didn't stop just there because when you know about all these diseases and you're seeing people not getting better, the curiosity can get to some people. And it did to me. And I'm like, something doesn't make sense here. Patients are getting these diagnoses. We're giving them treatment, but their disease continues to progress. So when you look at it from that standpoint, it really came back to lifestyle.

And what do we do in our 24 hours of a day, seven days a week? And that's where I really spent quite a bit of time delving into integrative medicine at the Andrew Weil Center for Integrative Medicine and then culinary medicine. So I now combine a five different specialties into one and my practice where I'm really helping people connect their health issues that they're dealing with and address them from a lifestyle perspective. Wow, what a background. And you say your love of learning stands out.

You are so accomplished. So a term that's bandied about quite a bit is holistic health, but people may not know what that exactly is. Can you define explain the concept of holistic health and particularly how the interconnectedness of mind, body and the gut and how that may play a role in building resilience, particularly for caregivers of Parkinson's patients, as well as patients themselves? Absolutely. That's a great question, Sandra. So when you think of holistic health, I really want you to understand that it's both the understanding about health and well-being, not just in the absence of disease, but really building this balanced and integrated function of your body, your mind, your spirit, your whole body.

Right? So when we look at health care, we often go to the cardiologist for our heart disease or the neurologist for our are our cognitive things. Right? But at the end of the day, our body is closely intertwined. And one thing relies on another thing to be optimally functioning. So we need to really look at it in that aspect. Now, for a caregiver and both for Parkinson's patients. This interview connectedness of the mind, body and gut specifically. And the reason you'll hear me talking about the gut a lot and building resilience is because we eat every day, right?

And most people do not realize the impact of food on their body's ability to function or their mood. Right. So the way the brain functions. So building this gut health really builds your resilience as a caregiver, both emotionally and physically. Because the challenges of being a caregiver, it can get very

Holistic Health and Mind-Body-Gut Resilience 4:46

overwhelming, right? So if you're healthy, then you're able to manage this caregiving even better so that that's really where the concept comes from. But but, but it includes more than that because it's the mind body connection. It's what does gut health really mean in the body. And then, of course, that interconnect connectedness to build that resilience. Well, that makes a lot of sense. Getting into the specifics, what would be some evidence based mindfulness techniques that you think would be really helpful for caregivers that they can implement because there's so much stress.

So how could they implement these strategies? What are some of these strategies to improve their emotional well-being, and how would that also benefit the gut microbiome? Absolutely. So one of the things that I did not mention is that I am a mindfulness based stress reduction teacher, which means that I teach you how to be mindful and reduce stress. I also happen to be a yoga and meditation teacher. So combining all that together. So what are some of these evidence based techniques? Well, one of them definitely is mindfulness based stress reduction, and this is something that combines both being mindful and a mindful meditation and yoga.

And there have been studies done on individuals who go through an eight week NBSR type of experience that they can reduce stress and improve psychological well-being and therefore they enhance their coping strategies. So one would be NBSR, the next one would be I often use Pranayama, which is a breathing technique for individuals to help them really connect with their stress response. And sometimes having somebody sit and simply meditate when there's too much going on in their head is not going to work and actually will make them more stressed out.

So with these individuals, I might have them start with a simple 5, 7, 8 breath, which is a type of breathing technique that can activate the parasympathetic system, which is our rest and digest system rest and digest together, right. Therefore producing relaxation. So those are two I often can also employ a body scan, meditation. And this you can do more of like a guided you can listen to a body scan, audio recording and really see where are you holding your tension and allowing that to kind of resolve in your body and identifying it.

Part of the thing is we don't identify what's going on because we don't take the moment to sit back and go, Oh, wait a minute, I'm feeling like very tense and I need to take a moment just for myself as a caregiver. Loving kindness is another one. I love loving kindness because there is no doubt what you know, taking care of somebody else and and not really knowing if if they even know what's going on can be very frustrating not only for the patient but for the caregiver. Right. So having loving kindness both for yourself and what you're trying to do and for the patient.

Right. So this is just a type of meditation that allows you to increase your connection between your the person you might be caring for and yourself, of course. And then I often use progressive muscle relaxation, which is another one where this is a technique in where you are tensing and relaxing certain parts of the body. And I tend to start from the feet going all the way up to the body, you know, so from your feet to your calves to your thighs, all the way up. And then another one for evidence based is, of course, mindful eating.

One thing we don't think about is that we're taking all this time as caregivers to make sure that the individual is being fed and taken care of because they have their own dietary requirements. But also taking a moment to sit down and make sure we're nourishing ourselves. So those are just some evidence based ways to for techniques that caregivers can employ right away. And then, of course, whether it's the gut for the Parkinson's patient or the gut for the caregiver, both are important.

Mindfulness Techniques for Caregivers 9:42

Those are great suggestions. And I'm delighted to hear you talk about progressive muscle relaxation. So my background as a clinical psychologist, I focused on mind body medicine starting in the seventies, and I always used progressive muscle relaxation, which was developed by Edmund Jacobsen in the twenties, University of Chicago. It's a classic book that he wrote, but it's very simple. And for people who have difficulty with breathwork or get very anxious with meditation, just have them tense up and then relax.

And you could do that with a body scan where they can exaggerate the tension. And then when they let it go, they're letting it go as much as they exaggerated it. So it's a remarkably effective and I would just great to hear that you incorporate that in your arsenal as well as the just the use of that body scan and where you can catch something and then you follow it. Often for me, it's often my shoulders and heart at a lower level. You release the tension in my shoulders so constantly, Yes, throughout the day I'm doing that.

Now, that could be just so effective. So let's turn to nutrition. Can you share some nutritional strategies that caregivers could follow that could promote a balanced gut microbiome and would be very helpful both for them and for the individual with Parkinson's? What is your what are your tips for nutrition? Yeah, absolutely right. Because at the end of the day, digestion is how we are going to produce our energy. Digestion is how we are going to make our own cells function, right. So some nutritional strategies that you can do that I often like to incorporate specifically to keep your microbiome healthy, because if your microbiome is not healthy, at the end of the day, you will develop some kind of disease as you age and progress, right?

So the goal is always to love on our microbiome and give it what it needs. So for the caregiver, that might incorporate fiber rich foods, you know, most people don't incorporate enough fiber into their diet, and that would be things like whole grains, legumes, fruits, vegetables and that dietary fiber. What it's doing is actually food for your microbiome, right, for your gut bacteria. So think of yourself as you have your human cells, but you're actually a host to all these other organisms. There's microbiome, right?

So with that, we want to make sure we're giving it food, otherwise it's going to starve and get a little cranky. And what I call when the body is cranky and your cells aren't getting what they need, they create symptoms that you then experience, right? So we don't want angry cells in our body. So fiber rich foods for sure. How would that translate into the actual so for the caregiver fiber rich foods Now for the Parkinson's patient, fiber rich foods is also vital. So in this case, you might want to do soft high fiber foods because cooked foods as opposed to raw carrots, you might want to do cooked carrots, right?

Because this cooked food is going to be easier for them to consume. Next would be probiotic rich food. Right. So before you go grab your probiotic supplement, let's make sure we're incorporating the probiotic rich foods. And that would be things like sauerkraut, kefir, fermented foods like miso soup, kimchi kombucha, even as a drink that can help balance the gut microbiome. And these can be also quite easy to digest for Parkinson's patients. Like if you think of a yogurt or coffee or might be a good way to incorporate that for them, especially if they're having a challenging time with solid foods, right?

So it's something you can have and something they can have. And the whole goal is when you're in one household to make it as simple as possible, right then fiber rich probiotic next would be hydration. The number of people that forget to drink water during the day is surprise to me. We don't forget our coffee. I don't know anybody who's ever told me they forget to drink coffee. But coffee is dehydrating, right? So caffeinated drinks will dehydrate the body even more. So make sure you're hydrating.

One of the things that I always like to think about for hydration, the example that I use for hydration is if you think of your kitchen sponge and you haven't wash your dishes in a day or two and that kitchen sponge gets super crunchy and you put it under the kitchen sink faucet and the water rolls off it and then eventually it absorbs. All right. So that's kind of like your human cell. If you haven't drank water in adequate water in a day or two, when you drink a lot of water, what happens? You run to the bathroom because all it's doing is going out of your body right away.

That's why continuously saying hydrated, even if it's smaller sips, will be better for your cells. And when your cells are hydrated, they communicate better. Right. And when they communicate better, you feel better. So hydration is number three. The fourth one would be limiting sugary and processed foods. Yes, everybody knows that. No, not everybody does that. But they do impact your gut microbiome from the perspect of of causing inflammation in the body. So limiting that as much as possible to maintain gut health.

And then I'll like to focus on what should we be incorporating. Right. So we already talked about the fiber rich foods and the probiotic rich foods, healthy fats. Okay. So I don't remember when in the eighties everybody went low fat or no fat and everybody was so cranky in the world. Our body fat. Okay. And usually when that that low fat label is on there, it's been replaced by some other chemical ingredient that our body just does not identify or register very well. Right. So think of high quality fats.

These would be your things like omega three rich nuts and seeds and avocados. I always say eat an avocado every day, or at least a serving of an avocado every day and high quality olive oil, which is going to be great for gut health. It has also to be great for reducing inflammation in the body, and that can apply both for the caregiver and for the patient. Additionally, I would want the individual to consider polyphenol foods so polyphenol rich foods like berries. I and green tea can have great nutrients that can promote gut health, but can also promote brain health.

Right. And just make your function so much better and clearer. The easiest way to do this is really Roig Before

Nutrition for Gut Health and Energy 17:20

make Roig believe your new best friend, remember the colors of the rainbow. We always forget that. And when I'm preparing foods in my functional culinary medicine kitchen is really what I call it, is making sure as much as possible I am eating the colors of the rainbow every day, and I do not mean the Skittles rainbow. I mean real rainbow, right? So and then from the perspective of the patient, you know, you can take all these foods and what I often do is make sure we have a great smoothie on rotation and a great soup on rotation that's going to include all these fiber rich nutrients, these poly phenols, these different colors.

And the best part is you can prepare in advance in your functional culinary medicine kitchen and freeze them. That way you're not always like trying to figure out, Oh, what am I going to give my mother or what am I going to give my husband this week? Right? So these are just some small things to consider. Wow. Those are great things to consider. And I'm with you on Eating the Rainbow and and Mariah D I been hearing about can you have 30 different plants and we to be spices too. So when we think of a variety and we think of color, we'll think of spices and how that can add additional color and choices as well.

So great suggestions. You talk a lot about Resilience toolkit. Can you talk about what are some of these essential components that you would include in your Caregiver's Resilience Toolkit? Perhaps mindfulness practices, traditional guidelines and gut health tips. What would go in there? Yeah, absolutely. So this toolkit is I want you to think of this toolkit as your go to whenever you're feeling challenged or stressed, or you just you don't you don't know what to do. Right? So we've already talked about the mindfulness based practices for emotional resilience.

So just as a reminder. So those would be having your favorite basic breathing exercise, whether that's of course, seven, eight breath box breathing or simply a inhale and exhale, where your exhale is long held, longer than your inhalation. Right. To get into that parasympathetic state. And we take a moment and just for those who might not know what a four, seven, eight breath is and what a box breath is, can you perhaps demo those or show of what that what they are? Absolutely right. So a478 breath as you it's hard for me to do and talk at the same time so I'm going to try but you're basically inhaling for four, holding for seven and then with a swish sound if you can exhaling for eight.

The premise behind it is that you are inhaling and then at holding and then exhaling for a longer count to get into that parasympathetic state. Now a box breath is just it's a little bit different where it's like you inhale you maybe for a count of two, if that's all you can do, are you inhale for a kind of four hold and then you go across exhale and then you're kind of just continuing this pathway. I find that four, seven, eight is one of the easier ones to start with, and you really only need to do it four or five times.

So it takes you less than two, 3 minutes to really kind of recalibrate into that parasympathetic state. Yeah, And. Sleep as. Well. Yes, it's great for sleep. Right. So the other mindfulness based techniques we talked about was body scan. We talked about and BSR, we talked about loving kind, kindness, mindfulness while eating, but one that I did not mention, which I will give you, is singing. So even if you cannot sit and be quiet and do that, my goal is really for you to activate your parasympathetic nervous system, your relaxation system, and part of that is activating your vagus nerve.

All right. So what I often do is for individuals who are like, Doctor me, you're not going to get me to meditate. And I'm like, okay, tell me the things you like to do. And I often find that singing to your favorite song is on the top of the list, right? So just by singing your activating the voice box, which is closely connected to your vagus nerve, which is the nerve that participates in your relaxation response. So that's something you can do. I often give that to children to do because they just love singing.

Gargling can also have the same effect of activating that back side of that nerve. They're so that's just a just a little extra one. And then the other thing in the tool kit, so we talked about the mindfulness based practice. There's nutritional things that I want to make sure that you guys really have down, right? So the fiber focused foods, right? So make your list of the foods that you actually enjoy. The hardest thing is people pick foods that they're like, I don't like brussel sprouts, but now I need to eat brussel sprouts.

I think to put it in there, there's plenty of other vegetables that are rich in fiber that you can pick. I would just please ask you to try and do as much of the color of the rainbow as possible and limit your intake of white potatoes, because I really want you to have more nutrition. So more color equals more nutrition and more polyphenols and more phytonutrients, and then have your favorite probiotic and prebiotic rich foods. Right. Whether you are a coffee drinker or maybe you have your nightly cap of kombucha, have something and try if you can at every meal to have something hydration.

I know water gets super boring. I understand you. So I am a fan of doing ice cubes with different things in them. So I will do mint and lemon. I will do to meric ice cubes. I will do whatever fruit is going bad in my fridge. Great. Or I'll put that in ice cube trays. So just have an array of ice cubes ready. That way you're not having produce that's going in the garbage and you're also able to get some of the nutrients and a little bit of natural flavorings there. Number four would be that anti-inflammatory foods, right?

So limiting or avoiding anything processed fried fast food as much as possible would be a great thing for your gut and also for the Parkinson's gut and then incorporating those healthy fats. So those were your mindfulness, those were your nutritional guidelines. And then I think also having some resources for whether it's your favorite mindful app or maybe your favorite place you go to like do new recipes. This is also quite useful and be kind to yourself. If if you don't do it for a week, it's okay.

Just jump back on it the next day. We tend to be very critical of ourselves as if it's a failure. And I don't want you to see yourself in that way. And that's why I'm saying really like love on yourself, because there's going to be good at this and there's going to be bad days. But the beauty of what I really talk about for my patients is incorporating or incorporating rituals, because when when you go from something like habits or routine habits for me are always a negative connotation. Routines are what we do every day and really bore us.

But I want you to think of these things as rituals and things. You get to do in your life and have a blend of them for wherever you need them. If that makes a little bit of sense. That makes perfect sense. And I think that's particularly important for caregivers who may feel guilty taking time away from their caring responsibilities. And so taking time for themselves might be something that they feel guilty about. Whereas really this to be an effective caretaker, caring for yourself comes first.

So it is very important. So that's why know we are told to put on our oxygen masks first on an airplane and then attend to the others around us. So do you have any real life examples of landing or how effective it is to blend these mindfulness techniques, nutrition principles and caring for the gut microbiome so that you can be a better caretaker and have more resilience?

Caregiver Resilience Toolkit and Practical Rituals 26:38

Yeah, absolutely. I have many, many examples, but let me give you a couple, so maybe these will resonate with the people watching now. So one example would be Sarah. So Sarah is she's taking care of her husband who was diagnosed with Parkinson's and Sara is only 55 years old. So, you know, she's a younger woman and now she's juggling her part time job and taking care of her husband who has this new diagnosis. Right. And what she is experiencing is symptoms of basically caregiver burnout. Right. And what might caregiver burnout look like That might look like fatigue, irritability, like kind of like a little bit of a short fuze and then digestive issues, which she doesn't even connect that they're all related.

All right. So what was the intervention we did with her? Well, we did give her an eight week mindfulness based stress reduction strategy. So we walked her through that. And it was specifically tailored from the care of caregivers perspective. Right. We also helped her from her nutrition standpoint and how to create balanced meals for the gut and like. So she doesn't feel like she's preparing two sets of meals. That's the hardest thing in a household is when you prepare one for the person who has a health issue, then you're preparing another one for the children and then you're doing another one for the dog.

It gets very overwhelming, right? So we we streamlined that. So she's just kind of spending a limited amount of time doing that. And then, of course, we were making sure that she was getting her daily probiotic supplement and replacing her processed snacks with things that were going to give her more energy to really do what she needed to do and get through the day. So it was really helping her understand that the food she was eating was impacting whether or not she was able to have energy or if she was feeling fatigued.

That was impacting her irritability. Now, we didn't just stop there. Of course. We incorporated other things like making sure her sleep was addressed right, because sleep is a big part of it. We don't get enough sleep, we get cranky. Everybody knows that, right? So there were some other things that we incorporated there. And then the outcome was that really after about three months, she did have and none of these are overnight fixes. So please realize that everything we do builds upon each other.

But after about three months, her stress levels were decreased and her rate of anxiety, self scaled anxiety and depression scales were decreased. And she also found that her digestive issues improved and she had more energy and more focus, and that allowed her to be more patient and more present while addressing her husband's illness, which is important. Right. So that's that's one example. Is that what you would you would you want another one? We would love to hear another one if you have an example.

Okay, So I have another one. So I met my patient Mark, who is a young 35 year old, very active and in the prime of his career. However, he is the primary caregiver for his mother who was diagnosed with Parkinson's. Right. So now Mark, who's got this highly demanding career, has to now take care of his mother, was starting to experience anxiety attacks around the whole situation. All right. And so we started with him with ten minute body scans. All right. Because that that that's like somebody who's always on the go.

You know, he's at the gym, he's here. But he never took the moment to actually slow down and scan his body. So we we began using those. And then we also began doing meal prep every Sunday, because now, mind you, he's got a 9 to 5 job in addition to taking care of his mother. Right. So meal prep sundaes. I am a huge fan of meal prep.

Real-Life Caregiver Examples and Outcomes 31:08

When you're a busy individual going in the kitchen every day and trying to prepare, it can be overwhelming for anybody, whether you're taking care of somebody or not. So every Sunday, we would make sure that both him and his mother would have access to gut friendly and healthy food as opposed to picking something up on the drive on the drive home from work. So we did that and really incorporated simple recipes for him. And then in his perspective, we also added a prebiotic and probiotic after testing him.

I'm a big fan of testing. I don't guess because some individuals might not need a probiotic and they might need something to improve their digestion. So I always test individuals as we're we're putting our plan together. So for him, his outcome was his stress levels did decrease and what he felt good about was that he noticed both his and his mother's digestion improved, which at the end of the day led to better sleep. Right, rest and digest. Right. When you're digesting better, you rest better.

And then also led to less irritability for both of them. Right. And the best part was when he took his mom in for one of her doctors appointment that the doctor has felt that she was even doing better. So they're like, what are you doing with her? Right. So that makes you feel good as a caregiver that that's actually doing something right because you don't know if it is unless you're really paying attention. But then to also have the doctor say to you, well, you know, her mental state looks better and overall her stability feels better.

So that increased positive quality of life is shown and it feels good for you, too. So those are just two examples. Well, those are powerful examples, and I hope that those listening can take those examples and feel inspired to implement all of the strategies that you have talked about so that caregivers and patients can build resilience and get healthier. So this has been a delight to speak with you. And where can people find you? Dr. Bhanote Yeah, I'm super easy to find. I'm on all social media platforms Instagram, YouTube: @DrBhanote So it's just my name.

My website is drbhanote.com. So really easy. There's only one Dr. Bhanote

Where to Find Dr. Bhanote and Closing Gift 33:48

Well, thank you so much for participating in the Parkinson's Solutions Summit. Absolutely. And I have a great gift for them as well. So just, you know. Yeah, I do. I have a very simple cookbook. It's called the Self-care Plate. And what I have done is incorporated functional culinary medicine from a gut and brain health perspective, where we're thinking of foods a little bit in a more intentional way and incorporating nutrients. And all of these recipes have been tried and tested by people who don't cook in the kitchen and they love them and they are all plant based gluten free, so they are allergen free.

And I hope enjoy them. I'm sure that we will. Thank you. This will be a very popular gift. So thank you and thank you for participating. Thank you so much, Sandra.