Herbal Supplements – Know the Facts

Herbal supplements are a leading consumer industry in the United States.  The notion that these are more natural products assures many people to feel a sense of comfort and security in taking the supplements themselves, or giving them to their children.  However, the reality is quite the contrary in many instances.

A standard medication will go through rigorous phases of safety and efficacy trials under FDA regulations before entering the market.  Manufacturers must follow strict protocols as well, ensuring correct dosing and labeling of medication packaging, along with adverse reaction warnings.

In contrast, herbal supplements have been marketed through a loophole in the system;  not claiming to be medications, but rather “dietary supplements”, they fall out of the regulatory constraints of the FDA and other agencies.   As a result, there are no requirements for proof of efficacy or safety, nor regulation to prevent contamination of ingredients with other substances, or inaccurate dosing or labeling by the manufacturer.  In essence, the consumer is picking up an unknown, unregulated drug off the shelf.

In reality, every medication – be it a pharmaceutical or homeopathic – are types of drugs made from chemicals found in nature.  One of the most potent cancer chemotherapeutic agents, Tamoxifen (Taxol), was derived from the Pacific Yew tree, and has become an essential treatment for breast cancer, despite its many side effects.  The advertisement of products as being more “natural’ and hence safer, is a misnomer.  Flip to the back ingredients label of many herbal cough and cold remedies, and one will find a list of several chemical components in the product.   Below is an example of one popular over the counter homeopathic remedy for children:

Hyland’s Cold ‘n Cough, Ingredients:


Allium Cepa 6X HPUS, Hepar Sulph Calc 12X HPUS, Hydrastis 6X HPUS, Natrum Muriaticum 6X HPUS, Pulsatilla 6X HPUS, Sulphur 12X HPUS. (Nighttime): Allium Cepa 6X HPUS, Chamomilla 6X HPUS, Coffea Cruda 6X HPUS, Hepar Sulph Calc 12X HPUS, Hydrastis 6X HPUS, Natrum Muriaticum 6X HPUS, Nux Vomica 6X HPUS, Phosphorus 12X HPUS, Pulsatilla 6X HPUS, Sulphur 12X HPUS


Moreover, the amount of active ingredient actually present in a given herbal supplement has been shown t be highly variable.  A large study in Canada tested 31 different melatonin supplements from 16 different brands.  They found that the actual melatonin content of those products ranged from 83% less to 478% more than the amount advertised on the label.  Many of these pills when tested contained contamination with serotonin as well.*

Similar findings have been noted for ginseng and other herbal supplements.

The primary question for the consumer when choosing between a standard medication and herbal supplement is not whether one is more natural than the other, but rather, whether one has been tested to be safe and effective.  Because of the lack of randomized controlled trials on homeopathic medicines before market, we do not have any way of knowing their risks or benefits.

So are all herbal supplements bad?

Herbs and spices have been used for centuries in the treatment of various illnesses.  And to this day there is known benefit of their use for health and wellness; the use of honey for cough, turmeric as an antioxidant, dill for GI issues, and ginger for anti-inflammatory effects, are some among many such benefits.  The key is understanding as an educated consumer the nature of products sold over the counter.  Moreover, it is important to be aware that all medications, both pharmaceutical and homeopathic, have the potential for serious interactions and adverse side effects.  For example, patients with underlying cardiac disease taking blood pressure or anticoagulant medication can suffer from fatal complications by taking a “natural” homeopathic supplement due to the chemical interactions involved.  The Cleveland Clinic has a good summary of the cardiac risks and interactions associated with some of these supplements.  Read more here.

Risks associated with herbal supplements:

Medication interaction, particularly cardiac complications

Lack of data proving efficacy (i.e. does it really work)

Lack of data proving safety

Lack of regulation of dosing during manufacturing, with some pills having little to no active ingredient advertised and others having 5 times the dose advertised – sometimes within the same bottle

Lack of regulation from contamination with other potentially harmful substances or chemicals


Just as with any medication, one should understand the risks and benefits associated with homeopathic and herbal supplements, and discuss these decisions with your doctor.  An educated consumer is a safe and healthy consumer.







Caring For Your Heart – A Conversation with Dr. Yasmeen Golzar

Is fat always bad for you?  Can you be at risk for early heart disease because of your parents?  What are good foods and lifestyle choices to reduce your risk of a heart attack or stroke?  

These are some of the topics we discuss with Dr. Yasmeen Golzar below, in our feature on your heart health.


Can you describe your clinical practice? 

I work at John H. Stroger, Jr. Hospital of Cook County in Chicago, IL, a public urban teaching hospital. I am a general cardiologist, director of non-invasive imaging at Stroger Hospital, and assistant professor of medicine at Rush Medical College.


What is the incidence of heart disease in America? Is it more prevalent in certain demographic groups? How about in women?

Heart disease is still, unfortunately, the leading cause of death in the U.S.—that is 1 in 4 deaths. This is true among most ethnicities. Heart disease affects men and women equally and is the leading cause of death in women. That being said, women tend to be underdiagnosed or there can be delays in diagnosis due to atypical presentations of heart disease.


Heart disease…is the leading cause of death in women, [yet] women tend to be underdiagnosed.


Let’s talk numbers – what is the ideal blood pressure and cholesterol level we should aim for as an average healthy adult?

Recent data suggests that the lower the blood pressure, the less the risk of stroke, heart attack, or death. Generally speaking, an average adult should have a goal blood pressure of around 120/80.

Cholesterol is made up of different types of cholesterol, including “good cholesterol” (HDL) and “bad cholesterol” (LDL and triglycerides). A high HDL (women > 55 mg/dL, men > 45 mg/dL) and a low LDL (< 100 mg/dL) are optimal.


What are some of the atypical symptoms of a heart attack that people may not be aware of?

This is a great question because not recognizing atypical symptoms is one of the most common causes of delays in seeking treatment for heart attacks, particularly in women. Many people, instead of typical symptoms of chest pain, may have left arm numbness, upper abdominal pain, or left-sided jaw or throat pain. Any symptoms which are new and limit exertion, such as shortness of breath or fatigue, are also concerning.


Selection of food that is good for the heart


Can you describe a balanced, heart healthy diet – and how important is it for us to start this as young adults? Any particular foods that are cardio-protective?

This is a topic which still sparks a lot of debate. Some of my colleagues support very restrictive regimens such as vegan diets while others argue that we put too much emphasis on diet in relation to heart health.

I am a big believer in moderation and looking at lifestyle rather than diet alone. When it comes to food, existing evidence points towards the fact that mostly plant-based diets with a healthy balance of whole grains and a modest consumption of fatty fish, such as tuna and salmon (2 or more servings per week), are the most heart-healthy. Food that is refined, highly processed, or high in sugar content should be avoided. One of my favorite rules comes from Michael Pollan, author of An Omnivore’s Dilemma—he said something to the effect of: If your grandmother would not recognize it as food, you shouldn’t be eating it. As an exercise, next time you are grocery shopping, think of this rule with every item that you pick up. Considering all of the additives we put in food and the highly processed foods we consume, you will be shocked by how little food actually passes this rule.

With the growing epidemic of childhood obesity and the early onset of conditions which we normally consider “adult” diseases, such as hypertension and diabetes, the development of coronary artery disease has been seen as early as the teenage years. We should start our children on healthy diets from the moment they begin to eat table food. Not only does this allow children to enjoy a healthy palette from childhood, they will continue to make good food choices through their lifetimes.


Young woman picking vegetables at farmer's market


Let’s talk about fat – I know that we should avoid saturated fats, but are there “good” fats we should try to include in our diet?

 Fat is the most misunderstood macronutrient. We used to think that limiting our fat intake was compatible with heart health, but over the past two decades, we have come to better understand how complex dietary fat is.

All fat is not created equal. For instance, trans fats, which are found in deep fried food or packaged snacks, are known to adversely affect heart health. This is also true for diets high in saturated fats which are found in red meats, dairy products, and tropical oils.

On the other hand, foods high in polyunsaturated fats, such as fatty fish, soybean, walnuts, and flaxseed, have proven to be beneficial for the heart. Increasing dietary intake of these foods may decrease LDL and triglycerides and help to increase HDL. In some trials, replacement of carbohydrates or saturated fats with consumption of polyunsaturated fats has been shown to be anti-inflammatory, decrease insulin resistance, and lower cardiovascular risk.

Fish oil is a type of polyunsaturated fat. Data has been very promising in showing the benefit of fish consumption on heart health. In fact, studies have shown that by regularly consuming non-fried oily fish, such as salmon and tuna, you can decrease your risk of dying from cardiovascular causes by up to 36%!


Do you have any opinion on the role of meat in our diet? I have heard some postulate a plant-based diet as a means for reducing heart disease?

Yes, when looking at existing study data as well as studying populations which have the lowest incidence of cardiovascular disease, a mostly plant-based diet with limited consumption of lean meats is the most heart healthy. We know that consumption of omega-3 fatty acids, which is found in fatty fish, is beneficial for heart health as well.

Though some individuals are willing to make drastic changes in their diet, most who enjoy an omnivorous diet would find that very difficult. Try to start off by keeping certain days of the week “meatless.” I, for example, bring very little meat in my home but allow myself to eat meat when I eat out. Again, the key here is moderation.


Selection of healthy food on rustic wooden background


If I am an otherwise healthy adult – non-smoker, normal cholesterol – do I have an increased risk of heart disease if my parents had CAD?

Unfortunately, yes. Genetics is a powerful player in the development of coronary artery disease. I had a patient who was a vegan marathon runner and had to have bypass surgery in his late 30s because, despite his extremely healthy lifestyle, he had developed severe coronary artery disease because of a very strong family history.

That being said, even though a genetic predisposition can put one at a higher risk of development of coronary artery disease, it is important to not add to that risk by additional risk factors that one can control, such as smoking, an unhealthy diet, or having a sedentary lifestyle.


Let’s talk exercise – I know that you value this in your own life, and ran a marathon last year. Can you describe some simple activities that are great for heart health?What about for older patients who may be limited in mobility – are there modified exercises you would suggest for them?

Exercise is such an important component of heart health. I tell my patients to participate in aerobic activity for at least 30-45 minutes, 3-4 times per week. Additionally, being more active in everyday activities is extremely important–take the stairs instead of the elevator, forego the closer parking spot so that you can walk further to the store, take a sunset walk as a stress-reliever and a lovely and meditative way to end your workday. These are easy ways to build in more exercise during the course of an average day.

For my elderly patients with limited mobility, getting as much activity they can get in with their activities of daily living is the goal. In addition to trying to be as independent as possible by doing their own laundry, cooking, etc., I encourage patients to walk around the house for 10 minutes during the morning, even if it is with the help of a walker or cane. While they are watching TV, I ask them to do bicep curls and arm extensions while holding soup cans. If they have access to a gym or a senior center which provides classes in water aerobics or senior dance classes, these are great activities to participate in which are easy on the joints.

Young man running during autumn, winter morning


For older patients, is there a certain age at which advanced screening measures should be implemented routinely to detect silent heart disease?

Our current guidelines do not support routine screening for coronary artery disease. We generally decide on further testing based on the development of symptoms.


What are some of the greatest barriers you see for Americans in preventing heart disease?

Unfortunately, our lifestyles are not very encouraging of heart health. The western diet is filled with processed and refined foods, we generally lead sedentary lives, and the stressors of a competitive and stress-filled work culture are all working against our health. As a society, we have become more cognizant of these detrimental factors, and there is a movement to incorporate more healthy lifestyle choices which I find encouraging. We have to make those choices as individuals and on a daily basis.


What do you find most rewarding about caring for your patients at County?

The rewards are so many! I care for a mostly underserved, under-resourced population. Many of my patients do not have health insurance or are underinsured; they come from all over the world and belong to a myriad of races, religions, and ethnicities. To be able to care for patients who otherwise may not have access to healthcare is so gratifying. I also have the opportunity to train future generations of physicians which keeps me energized and inspired.




Dr. Yasmeen Golzar is a cardiologist on staff at John H. Stroger, Jr. Hospital of Cook County in Chicago and director of non-invasive imaging.  She is also assistant professor of medicine at Rush Medical College.





Heart Healthy Cooking Oils

Replacing bad fats (saturated and trans) with healthier fats (monounsaturated and polyunsaturated) is better for your heart.

One way you can do this is by choosing healthier nontropical vegetable oils for cooking and preparing food.

Use these oils instead of solid fats (including butter, shortening, lard and hard stick margarine) and tropical oils (including palm and coconut oil), which can have a lot of saturated fat.

Here’s an alphabetical list of common cooking oils that contain more of the “better-for-you” fats and less saturated fat.

  • Canola
  • Corn
  • Olive
  • Peanut
  • Safflower
  • Soybean
  • Sunflower

Blends or combinations of these oils, often sold under the name “vegetable oil,” and cooking sprays made from these oils are also good choices. Some specialty oils, like avocado, grapeseed, rice bran and sesame, can be healthy choices but may cost a bit more or be harder to find.

In general, choose oils with less than 4 grams of saturated fat per tablespoon, and no partially hydrogenated oils or trans fats.

You may find that some oils have distinctive flavors, so try different types to discover which ones you like. Also, some oils are better for certain types of cooking than others, so you may want to have more than one type in your pantry.

You can usually use cooking oils just like solid cooking fats. For example, use them to:

  • Make your own salad dressings, marinades, dips and sauces.
  • Grill, sauté, stir fry, bake or roast foods.
  • Coat pans to keep food from sticking.
  • Spread or drizzle on foods for flavor.
  • “Season” cast-iron cookware.
  • Substitute for butter, margarine or solid fats in recipes.

Article copyright © 2016 American Heart Association. This recipe/article is brought to you by the American Heart Association’s Simple Cooking with Heart © Program. For more articles and simple, quick and affordable recipes, visit heart.org/simplecooking.


Insomnia – A Non-Medicated Approach to Getting Better Sleep

Insomnia and lack of sleep plague our modern society – over a third of Americans suffer from some form of sleep disturbance,  over 10 million use prescription sleep aids, and women are twice as likely as men to suffer from insomnia.  Often, prolonged sleep latency (difficulty falling sleep), or inability to sustain restful sleep can be signs of underlying anxiety, stress or depression.  The health implications of sleep deprivation are profound, including increased risk of heart disease and hypertension, cognitive impairment, a weakened immune response, and increased risk of weight gain, among others problems.  Approximately 60 percent of Americans have admitted to driving while sleep deprived, a significant risk for motor vehicle accidents.  According to research, being awake for 18 hrs leads to impairment equivalent to a blood alcohol level of 0.05, and after 24 hrs, of 0.10.   A blood alcohol level of 0.08 is commonly considered intoxication.

Over the counter sleep aids like melatonin, prescription drugs like zolpidem (Ambien) and others – while quick fixes – often lead to further masking of underlying sleep problems and some degree of daytime drowsiness.  While beneficial for short term needs, many Americans suffer from chronic sleep problems related to stress.  What are some alternative, healthy practices to restore restful sleep?  Here are a few healthy sleep habits:


  1. Maintain the same bedtime each day – a routine sleep schedule is key to healthy sleep, even on weekends.  Approximately 7-9 hrs of sleep is recommended for adults, and 10 hrs for school age children.  Often children who oversleep on holidays run into a cycle of inability to sleep at night, followed by daytime sleepiness.
  2. Turn off all electronic and other stimuli prior to sleep –  a good habit is to turn off the TV, tablets and phones about an hour before sleep.  Giving your body a chance to wind down, dimming the lights and transitioning to less mentally stimulating activities before sleep is key – both for adults and children.  The light emitted from most mobile devices also interferes with the natural rise in the body’s melatonin levels, making it harder to fall asleep.  Place your phone across the room if you are tempted to keep checking it at night.
  3. Visualization – there are many mindful visualization techniques that have been proven to reduce anxiety levels and relax the mind and body.  It can be as simple as visualizing a favorite, relaxing place, such as a beach, for five minutes.  Close your eyes and try to use all five senses to mentally place yourself in that location -visualize the ocean water, think of the sounds of the waves, the scent of salt in the air, and the feeling of  sand and sun on your skin.  For five minutes immerse yourself in that experience, and your body will began to relax while your mind refocuses.
  4. Writing – journaling, or simply writing down a to-do list on paper for 15 mins and then putting it away, can help off-load thoughts in your mind onto paper before sleep.
  5. Meditation & Mindfulness – one of the biggest challenges to falling asleep is often when we have too much on our mind – thinking about what we have to do the next day, worries about problems, etc.  Meditation and mindfulness is the process of being aware of one’s thoughts, and taking control of these thoughts in a healthy way.  Passively allowing our thoughts to take over our mind leads to increased anxiety and stress.  But similar to the visualization technique above, you can start with simple mindfulness exercises that redirect your thoughts to being present and aware of your body, breathing and surroundings.  Many studies have shown the cognitive benefits of meditation on the brain’s physiology and in reducing anxiety and depression.  It has a similar role in helping with insomnia.  Not sure how to practice mindful meditation?  Try this mobile app, Head Space , which offers 10 minute practical meditation exercises which you can incorporate into everyday life, including relaxation technique prior to sleep.
  6.  Cooling off – some studies have shown the benefit of cooler temperatures for falling asleep.  Try reducing your thermostat settings to 65-68 degrees at night.
  7. Cut the Caffeine – of course, limiting caffeinated beverages prior to sleep is a known element of good sleep hygiene.  If you are suffering from insomnia, try to eliminate any late afternoon coffee or soda runs as well.

For those who have other contributing medical factors affecting sleep, such as restless leg syndrome, snoring/sleep apnea, back pains, consult with your medical provider for further evaluation.  We hope you will try to implement some of these healthy sleep habits in your nightly routine.




10 Ways to Foster Kindness & Empathy in Kids

The Washington Post

Several kids had been targeting Beth for weeks. Beth was sweet, absent-minded, easygoing and resigned to being mistreated. Some of her fellow eighth-grade students were using social media to call her fat and stupid, and they would drop dirty tissues on her head as they passed her desk. As her school counselor, I wanted to help, but Beth would never call out the bullies. She worried she would make the situation worse, and she insisted she was fine.

Beth’s classmate Jenna, however, was so disturbed by the mean behavior that she brought me a handwritten list of the perpetrators and pleaded with me to make them stop. Jenna — a confident, popular student — barely knew Beth, but she couldn’t stand the cruelty. Her discomfort was the one positive in a bad situation. The Jennas are rare; I can’t recall another recent situation when a student so vehemently refused to be a bystander. I knew that it would be difficult to change the kids’ behavior, and that quick solutions, such as detentions and phone calls home, would only give Beth a short-term reprieve.

While some kids, like Jenna, seem to be hard-wired for empathy, we need strategies to reach those who are not. No one sets out to raise an unkind child. To teach kids to be kind, it’s critical to start young, when they can most easily absorb fundamental lessons. The stakes get higher as kids age. There is no easy program to follow, but parents and educators can take these steps to stack the deck in favor of raising a child who shows decorum and kindness.

Remember that apples don’t fall far from trees. Model compassion by treating friends, acquaintances and colleagues with kindness. Expending energy on caring, reciprocal relationships teaches children to prioritize friendship and positivity over popularity. Children hovering at the periphery of “alpha” groups often struggle the most. Constant maneuvering for position in the social hierarchy can lead to insecurity, envy, anxiety, or competitiveness, all of which promote meanness. Children with sensitive adult role models and gentle friends tend to behave similarly.

Keep it real. Being inauthentic damages credibility with kids. Kindness doesn’t require liking or speaking positively about everyone all of the time. Validate kids’ feelings when they accurately point out that someone has been mean-spirited. Take the opportunity to talk about why a specific action was mean, and remind children that it’s possible to make bad choices but still be a good person. You don’t need to pretend that they have to be friends with everyone, but you can teach them to be respectful and polite and to avoid burning bridges. Friendships often cycle in and out as kids change and mature. Promote this social growth by praising kids when they are considerate or altruistic, even as they outgrow some friendships and move on to others.
Stop the contagion. Anyone who has spent time in a toxic environment knows that behaviors such as gossip, jockeying for power and negativity spread rapidly. Being in a mean climate can alter individual behavior. This stuff matters, and adults help set the tone for everyone, including kids in their charge. In order to establish positive social norms, school and community leaders need to understand and target systemic problems, which may include insecurity, anxiety or a sense of powerlessness. These trained adults can identify kindness catalysts who can model positive behavior and take on roles such as playground buddies or new student welcome ambassadors. Through field trips, retreats and collaborative projects, leaders also can create opportunities for kids to venture beyond their usual social groups. Familiarity, comfort and shared experiences make it easier for children to establish core values and develop a culture of respect and cooperation.

Teach compassion through mindfulness. Mindfulness can enhance attention span and reduce stress, but now researchers are finding that it can also foster empathy. In a study at Northeastern University, participants took an eight-week meditation course. When they were then faced with the option of giving up their chair to a person in visible physical discomfort, they were far more likely than control group subjects to act beneficently. And when a middle school in a poor neighborhood in San Francisco started offering twice-daily meditation periods, suspensions decreased by 79 percent.

Explore both natural and fictional worlds. Dacher Keltner, a psychology professor at the University of California at Berkeley, notes that going out into nature and experiencing “feelings of awe” appears to heighten empathy. You can also build kids’ compassion by sending them to fictional universes. When children read books and become invested in characters’ plights, they can imagine themselves in other people’s shoes.

Be a coach, not a browbeater. To teach children how to rationally consider the consequences of their harmful actions, use logical reasoning. Keltner notes that simply telling kids what is right or wrong — or reacting with strong emotions or physical punishment — produces people who are less likely to want to alleviate others’ pain. By encouraging reflective discussion, you can help children learn how to actively listen and appreciate different perspectives.

Give back to the community. Meaningful volunteer engagement can widen children’s worldview, teach them gratitude and build their awareness of and sensitivity to others’ struggles. Placing children in unfamiliar settings or uncomfortable situations heightens their ability to empathize with anyone who feels like an outsider or lacks a sense of belonging. When families and schools prioritize this kind of service learning, children are more likely to be altruistic.
Talk about the importance of diversity. Teach children that their lives are enriched when they encounter and befriend people from different racial, ethnic or socioeconomic backgrounds, or who face different learning or physical challenges. Remind kids that everyone is an individual and that it is dehumanizing to label groups. When kids are self-aware and self-accepting, they are less likely to be judgmental or prejudiced. Promote self-discovery by sharing personal journeys and helping kids understand that everyone has a story.

Get moving. Researchers at the University of Michigan studied middle school children and found that those who were more physically active and involved in team sports scored highest in leadership skills and empathy. Exercise also can have a calming influence.

Impart the art of making amends. Everyone makes mistakes. Kids in particular are still learning, and developmentally they may be self-centered. Encourage children to do their best to behave kindly and ethically, but to recognize when their efforts fall short. Explain that there is tremendous power in an apology, even when the harm caused was unintentional.

In the end, Beth gave Jenna permission to confront the kids who were bothering her. Beth had resisted adult intervention, and her instincts were on the mark. Jenna’s forceful and self-assured approach stopped the tormentors. Beth felt enormously comforted by having a supportive ally. She also shared that Jenna’s rare and generous move had empowered her, and made her more likely to stand up for herself and others in the future. If meanness is like a tsunami, washing over and eroding a child’s self-image, kindness is like a molecule of water slowly rippling outward. That first drop may have a subtle effect, but with persistence, its force can become a current, strong enough to cut through steel, sculpt mountains and change lives.

Phyllis L. Fagell is a licensed clinical counselor at the Chrysalis Group and a school counselor in Bethesda. She tweets @pfagell.


Helping Kids Develop a Healthy Sense of Self – Esteem

How can we help our child develop a healthy sense of self-esteem? By definition, self-esteem is the way in which an individual perceives herself-in other words, her own thoughts and feelings about herself and her ability to achieve in ways that are important to her. This self-esteem is shaped not only by a child’s own perceptions and expectations, but also by the perceptions and expectations of significant people in her life-how she is thought of and treated by parents, teachers and friends. The closer her perceived self (how she sees herself) comes to her ideal self (how she would like to be), the higher her self-esteem.
For healthy self-esteem, children need to develop or acquire some or all of the following characteristics:

A sense of security.
Your child must feel secure about herself and her future. (“What will become of me?”)

A sense of belonging.
Your youngster needs to feel accepted and loved by others, beginning with the family and then extending to groups such as friends, schoolmates, sports teams, a church or temple and even a neighborhood or community. Without this acceptance or group identity, she may feel rejected, lonely, and adrift without a “home,” “family” or “group.”

A sense of purpose.
Your child should have goals that give her purpose and direction and an avenue for channeling her energy toward achievement and self-expression. If she lacks a sense of purpose, she may feel bored, aimless, even resentful at being pushed in certain directions by you or others.

A sense of personal competence and pride.
Your child should feel confident in her ability to meet the challenges in her life. This sense of personal power evolves from having successful life experiences in solving problems independently, being creative and getting results for her efforts. Setting appropriate expectations, not too low and not too high, is critical to developing competence and confidence. If you are overprotecting her, and if she is too dependent on you, or if expectations are so high she never succeeds, she may feel powerless and incapable of controlling the circumstances in her life.

A sense of trust.
Your child needs to feel trust in you and in herself. Toward this goal, you should keep promises, be supportive and give your child opportunities to be trustworthy. This means believing your child, and treating her as an honest person.

A sense of responsibility.
Give your child a chance to show what she is capable of doing. Allow her to take on tasks without being checked on all the time. This shows trust on your part, a sort of “letting go” with a sense of faith.

A sense of contribution.
Your child will develop a sense of importance and commitment if you give her opportunities to participate and contribute in a meaningful way to an activity. Let her know that she really counts.

A sense of making real choices and decisions.
Your child will feel empowered and in control of events when she is able to make or influence decisions that she considers important. These choices and decisions need to be appropriate for her age and abilities, and for the family’s values.

check up


A sense of self-discipline and self-control.
As your child is striving to achieve and gain more independence, she needs and wants to feel that she can make it on her own. Once you give her expectations, guidelines, and opportunities in which to test herself, she can reflect, reason, problem-solve and consider the consequences of the actions she may choose. This kind of self-awareness is critical for her future growth.

A sense of encouragement, support and reward.
Not only does your child need to achieve, but she also needs positive feedback and recognition – a real message that she is doing well, pleasing others and “making it.” Encourage and praise her, not only for achieving a set goal but also for her efforts, and for even small increments of change and improvement. (“I like the way you waited for your turn,” “Good try; you’re working harder,” “Good girl!”) Give her feedback as soon as possible to reinforce her self-esteem and to help her connect your comments to the activity involved.

A sense of accepting mistakes and failure.
Your child needs to feel comfortable, not defeated, when she makes mistakes or fails. Explain that these hurdles or setbacks are a normal part of living and learning, and that she can learn or benefit from them. Let your supportive, constructive feedback and your recognition of her effort overpower any sense of failure, guilt, or shame she might be feeling, giving her renewed motivation and hope. Again, make your feedback specific (“If you throw the ball like this, it might help”) and not negative and personal (“You are so clumsy,” “You’ll never make it”).

A sense of family self-esteem.
Your child’s self-esteem initially develops within the family and thus is influenced greatly by the feelings and perceptions that a family has of itself. Some of the preceding comments apply to the family in building its self-esteem. Also, bear in mind that family pride is essential to self-esteem and can be nourished and maintained in many ways, including participation or involvement in community activities, tracing a family’s heritage and ancestors, or caring for extended family members. Families fare better when members focus on each other’s strengths, avoid excessive criticism and stick up for one another outside the family setting. Family members believe in and trust each other, respect their individual differences and show their affection for each other. They make time for being together, whether to share holidays, special events or just to have fun.


Mental Health & Wellness – A Conversation with Dr. Ayesha Mian

We discuss ways to identify and manage stress, anxiety and depression with Dr. Ayesha Mian.

Can you tell us a bit about your clinical practice?

I am an adult psychiatrist and specialize in Addiction Medicine. I have been in practice for over 6 years. My patients are usually in different phases of their mental illness and/ or addiction disease. I help people get off alcohol and other drugs in a hospital and clinic setting. I also work with people who might be in a state of mental decompensation or seeking assistance to improve their mental health and well-being. I work at Fairfax County Community Services Board, Virginia Hospital Center and my private practice in Arlington, VA.

What are some of the most common mental health issues you see in the community?

Some of the most common issues I deal with are depression, anxiety and alcohol dependence. We live in the day and age of high stress, unrealistic expectations, limited social supports, social media frenzy, breakdown of family structure and abundance of reliance on alcohol and drugs. All these factors contribute to depression and anxiety and these are some of the most common issues I see in the community.

What are some early signs of depression, anxiety?

There are several signs to watch out for with depression- problems with sleep, that is sleeping too much or too little; problems with appetite, that is eating too much or too little resulting in weight loss or weight gain; problems with energy, focus and concentration. People might begin to lose interest in the things they normally find pleasure in, they might begin to isolate and may not be as talkative, they may start to call-in sick at work. Some times if the depression has gone on too long, people might start to feel that life is not worth living. Anxiety may or may not present with depression. When people are anxious, often times they complain of physical symptoms- feeling palpitations or a racing heart, shortness or breath, feeling ‘keyed up’ all the time, worrying constantly about mundane things, feeling overwhelmed etc. There is usually a spectrum of severity with these illnesses. You may only feel some of these symptoms and you may only have them at low intensity and they may progressively get worse. It is important to seek help if you or your loved one might be experiencing such symptoms.

Broken hearted woman is crying,silhouette,Valentines day concep

We live in a world filled with multiple stressors. How do you counsel patients about dealing with stress?

I tell people that it is normal to have some degree of ups and downs in your mood with the normal ups and downs of life. It is important to keep a healthy life style, which includes nutritious diet and exercise. 30-40 minutes of cardio 5 or more times a week improves anxiety and low grade depressive symptoms. Incorporating yoga, mindfulness and meditation helps decrease levels of stress as well.  Other ways of building resilience include reliance on social relationships, positive thinking and self-care. Human beings are social creatures and we should cultivate relationships in our life, spend quality time with family and friends and rely on our networks in times of need. Oftentimes we don’t reach out for help when we should. The power of positive thinking and having hope in the future are also important as coping skills. Self-care – taking the time out to treat ourself, read a good book, travel, any thing that makes one feel good – are important tools to improve one’s mental health. Eliminating negativity from our lives, decreasing use of social media, putting down our phones and having more meaningful conversations and relationships with people one on one are all coping strategies we can incorporate in our day to day lives.

Have you found a role for “mindfulness” and meditation in reducing stress? Can you talk a bit about that?

Definitely. Mindfulness, in short, is practicing being present in the moment and learning to accept without judgment. There are known benefits of meditation and mindfulness on mental health. Research shows evidence that mindfulness changes the brain. Studies show that the part of the brain called the Anterior Cingulate Cortex, which is associated with self-regulation of impulsivity and aggressive behavior, has higher activity in people who meditate. Meditators and people who practice mindfulness have greater self control and are less impulsive.

In addition, people in stress whether it is psychological or physiological, tend to have higher levels of the stress hormone called cortisol. Studies show that people who practice mindfulness or meditation tend to have thicker gray matter in the region of the brain called the hippocampus, which is involved in memory and emotion. This is the same region of the brain that has a lot of cortisol receptors and is found to be damaged in people with PTSD or depression. So, we actually see physiological benefits on the brain with practice of mindfulness and meditation and I absolutely recommend this to my patients.

There is a stigma in our society not only about mental illness, but also about seeking out counseling for issues like stress, family problems, anxiety etc. Many people are afraid they will be labeled as having a “mental problem” and hence shy away from these resources, or have tried it once and felt a disconnect. What would you advise about the importance of professional counseling and therapy?

Over 18% of the people in the US suffer from some form of mental illness each year. This is not a small number of people. It is important to address mental illness because it can very commonly get to a point where the person becomes dysfunctional in their life and / or it severely negatively impacts their relationships. It can also lead to suicidal or homicidal thoughts, which is considered a medical emergency. We see and hear about people completing suicide because they couldn’t tolerate the suffering and pain of their illness. Therapy and medications do help. You might have to see a few different therapists before you find the right fit, and it is definitely worth the time it takes to find the right person for you. It is important to have a therapist who is neutral (not a friend or family) and would be able to help guide you to discover things about you that you might not be able to otherwise.

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How do you approach medication initiation for patients suffering from depression or anxiety?

Depending on the severity and effect of depression or anxiety on a person’s level of functioning, I make a decision on whether a medication needs to be started or not. Some times, people come to me after being referred by their therapist or other doctors. I almost always recommend life style changes – including diet, exercise, limited caffeine intake, meditation, yoga, breathing exercises, therapy etc. Often times, by the time someone is referred to me, these recommendations alone are not enough and we may add a medication. But it really is a decision based on each person’s individual history. There is no one-size-fits-all. I have to assess each person’s medical history, family history, trauma history, genetic predispositions, psychological and social factors, etc. before I can make a recommendation regarding medications.

If I notice a friend or loved one having some serious mental health concerns – (e.g. extremely depressed, paranoid thoughts, irrational behavior) but they are unwilling to see a doctor, what resources are there to seek help?

I come across this a lot. Some times but not always, family and friends have leverage and can do an intervention to convince the person to see a doctor. One way to find a therapist is through your insurance company. Another option is http://www.psychologytoday.com where you can search for therapists in your zip code and your insurance carrier. Your primary care physician might also know a therapist or psychiatrist they work closely with. Also, all Virginia counties have Community Health Services Boards with emergency services for their county residents. It is hard to get someone to go to treatment against their will, but if someone is in danger of harming self or others, then call 911 or take the person to the nearest emergency room.

What do you think are the biggest barriers to seeking out mental health services – Stigma? Financial coverage? Education and awareness of resources?

All of the above. There is a long way to go in improving the challenge that we see with stigma associated with mental illness. We as health professionals have to continue to create awareness about mental illness as a way to counter the stigma. I also think people don’t know how to recognize mental illness and when they do want to seek help, they do not know where to go. Another barrier is the scarcity of mental health professionals which makes it hard to get an appointment with a psychiatrist in a reasonable amount of time. The hope is that access and availability improves over time and those who need mental health care receive it.