Welcome, everyone. I'm Kathleen Manillo, the Executive Director of the International Hearing Society. Today is our first ever virtual half day CE webinar event. It's also the first time the IHS staff has ever produced a webinar, not at the IHS office in our control room. So today we're all at home across Metro Detroit, hoping that technology is going to be helpful for us today. So stick with us. You know, with so many stay-at-home orders being prevalent and face-to-face events being canceled, so many of you, our members and customers, have reached out to us with a need for continuing education, for licensure renewal, for board certification, but also for your own professional development, for a sense of normalcy during this uncertain time. And we hope this event will meet this need for you. I want to send a big thank you to CareCredit for sponsoring this event so that we can provide CE credits to everyone complimentary. There's 500 people registered for this event today. And as of about an hour ago, I was informed that there's 415 people on a wait list to receive a link to the recording once it's rendered. That's a lot of CEs. So thank you so much CareCredit for putting such a high value on hearing healthcare professionals, just like we do at IHS. Additionally, IHS has made a resource center for you on our webpage about all things COVID-related and business-related during this time. If you go to ihsinfo.org, you'll see it right at the top of the page. There's links to other pages in there, as well as tons of information and applications. Additionally, IHS's staff member, Tara Douglas, has been able to negotiate exclusive pricing for PPE, personal protection equipment for IHS members. You can find this information by going onto the hub and looking for the threads by Tara. These are also linked from the COVID resource page. And if you're not a member, I invite you to join. There's a link right on our homepage. And as you can see, we put our members first and we're always looking to add value and resources to them. So I invite you to join the society. That's it for my announcements today. So with that, I'm gonna hand it over to IHS's Associate Director of Marketing, Diana. Diana. Thanks, Kathleen. Like you mentioned, thanks everybody for joining us today. Our first session is called the cortisol effect, how the stress response can play a role in physical and mental health, as well as hearing. The body's stress response has been shown to impact nearly every system in the body, as well as influence motivation, emotional health, and even hearing abilities. So what's that mean for the hearing healthcare profession? To share more about this, I'd like to introduce our speaker, Gina Warfel. Gina Warfel is a registered dietitian, master of human nutrition, speaker, and author. Gina practices at the world-renowned destination spa, Cala V. She became passionate about behavior repatterning after seeing so many people frustrated with their self-sabotaging habits and repeatedly failing to stick to the nutrition program. This led to the development of her published book, Mastering Mindfulness, and a method that has been presented at conferences nationwide. Gina's work involves optimizing metabolism, hormone balance, gut health, brain function, and your biochemistry to give a science-based and personalized program that will take your health to the next level. We're so excited to have Gina as our presenter today, but before we get started, a few housekeeping items to keep in mind. Note that we are recording today's presentation so that we may offer it on demand to the IHS website in the future. Also, as mentioned, this webinar is available for one free CE credit. To earn that continuing education credit, you will have to take and pass a quiz online. You'll find a link to today's quiz on this slide, the bit.ly link right here. If you take it and pass with a 70% or higher, IHS will process and send you a certificate of completion. The links and instructions for the quiz are also found in a downloadable handout found in the handout section of the webinar dashboard. You may access it at any time. And for a copy of today's presentation, that can also be found in the handout section of the webinar dashboard. That can also be downloaded now, too. Links for the quiz, more information about receiving CE credit, and today's presentation are also on our website, ihsinfo.org. Click on the webinar banner on the homepage or choose webinars from the navigation menu to access all of that. And lastly, tomorrow, you will receive an email with a link to a survey about this webinar. It's brief, and your feedback will help us create valuable content for you moving forward. So please do engage with that. Okay, so let's get started. Today, we're going to be covering how the stress response impacts physical and mental health, techniques to manage stress, and understanding nutrition factors that can impact hearing. Afterwards, we'll move on to the Q&A session. You can send a question for Gina at any time by entering your question in the question box on your webinar dashboard, usually located to the right or top of your webinar screen. We'll take as many questions as we can in the time we have available, so don't be shy. And now I'm going to turn it over to Gina, who's going to take us through today's presentation. Gina? All right, thank you. So let's jump in on how stress affects our physical body and mental health, and then also how does it affect hearing. And some things that might be coming up for you right now is, okay, I'm trying to make the connection. You're a dietician, you talk about nutrition, and I'm a hearing professional. What does stress really have to do with it? Is it really a big deal or a part of what we deal with, or is it something that we just know that there's some stress and we refer out? And I just want to give a little background on my experience and how it really changed my practice quite significantly. When I first became a dietician, I was so excited to learn all of the science and the physiology and how to create these perfect nutrition plans for my clients. And so when they started coming in, I opened up a practice and they started coming in, and I put together these perfect plans for them, and I was so excited to get them on their way but what I found was that they kept coming back and they weren't really sticking to the information that I was giving them. They were sabotaging their diet, they weren't really quite sticking to it, and there was actually a really big disconnect between me and my client. So when they were coming in, I was really trying to develop this rapport and reassure them that they were going to have a great nutrition plan, and there was just such a big disconnect. And so I knew that this was not the best way for me to run my practice, but I couldn't quite figure it out. So it really didn't come down to having the best knowledge and the best tools to make them successful. So it really changed where I started becoming interested in what is happening, how are they feeling right now when they're coming in to see me? How can I connect with them on a deeper level? And I started to understand how when they're feeling stressed, it really takes over the mind and talk about and how it creates this fight or flight state. And because of this, they weren't really in control of their emotions and they were sabotaging their diet and they weren't really sticking to their goals and they were really feeling not understood by me. And so we really had this big disconnect, but when I started to understand how they were feeling and what that meant when stress was taking over their bodies and it was taking control over their health and they came in to see me, I could start to approach it from a different way. And we were really starting to connect a lot deeper and actually right away, I was seeing a huge difference. So I really changed the focus of my practice towards understanding how do things like stress, whether it's physical or emotional, impact our health and how they're feeling about feeling comfortable working with a health professional. So I started teaching on this topic. I got really excited and I started talking about how the mind and stress was actually causing self-sabotage, how it was affecting their health and people actually really started responding to it. So when I, instead of just talking about nutrition, people started becoming curious and they're like, wait a second, that's me. You understand me, you get me. And it became so much easier to connect and develop relationships with my clients. So it really became the cornerstone of my work and where I developed a program called Mastering Mindfulness and I published a book on it. And it's become the best way for me to connect with my patients or my clients when I understood how they were feeling and how that influences their health. And then they became empowered at such a deeper level. So I'm not the 100% expert on stress management, but it's made a huge difference in my practice in developing relationships. So I'm going to share with you some of my experience on how I was able to connect with them deeper and then also how nutrition can impact their hearing and getting in control over their health more. So just putting yourself into your patient's shoes when they first come in, how might they be feeling about their health? It's so easy to get excited about our knowledge and what we know and wanting to change their lives. And it made such a big difference for me to really step back and say, instead of being the leader right now, how are they feeling? And I'm sure some of your patients might be feeling frustrated that their hearing hasn't maybe been optimal. Maybe they've been feeling lonely and even the people around them might be feeling some of those same feelings, frustration, loneliness. And when it comes to their hearing and their health, when they first find out that it's not optimal, they might be feeling that it's out of their control. At this point, it's too late. They might even be thinking about things that they should have done years ago for their health so that they didn't get themselves in that place. So they might be feeling a little bit helpless. And when just looking at how prevalent stress is, there was one study where they found that tinnitus is two and a half times more prevalent in people who are under long-term stress. So we do see that with stress, hearing problems are a lot more prevalent. There was another study that looked at women with high levels of emotional exhaustion and they found that they were much more sensitive to sound after this, so that it could be really important for us to start including emotional exhaustion into part of diagnosing and treating hearing problems. And this is just a few, this is two of many studies that I had found out there showing that when stress is occurring, the likelihood of developing hearing problems is much greater. And there was also another study where they just wanted to know how are people feeling when hearing loss is diagnosed? What are the feelings that are coming up? They found that there's emotional reactions such as loneliness, isolation, depression, anxiety, frustration. They even see behavioral reactions and cognitive reactions like confusion. Sometimes they have decreased self-esteem, not the greatest communication at that time. And so because of this, this could be really exacerbating their health conditions and their disease. So this is just something to consider that if these emotions are so prevalent in this population, what would it be like if we really understood them on this level, how much it could really help them? Thinking about if you had these intense emotions coming up, it's hard to wrap your head around logically, what should I be doing for my health? It's hard to think about being strategic and excited when you're feeling all of these emotions and maybe they're not feeling like they've gotten any support right now or maybe ever in their life or how they're feeling and being understood. So taking a deeper dive, now that we know how prevalent the stress is, let's take a deeper dive into how does stress affect the body? Is it really that big of a deal? So what's interesting is stress is bi-directional. We're still understanding when I was digging into the research on how stress affects hearing loss, there are some really interesting mechanisms that we're gonna talk about, but what they did establish is that there is a bi-directional correlation. So a stressful event can contribute to hearing loss and hearing loss can definitely contribute to stress. So it's kind of like the chicken or the egg, which one came first? We don't really know for sure, but we do think that it is both, that stress can cause hearing loss and hearing loss can cause stress. So let's talk about stress. What is actually happening when you feel stress? So let's say you get a stress to your body and this could be any type of stress. It could be physical, it could be emotional. So maybe they're just feeling a little bit frustrated. That triggers a stress response. Or maybe they're feeling a little bit lonely or bored. Even boredom is actually a stress to the body. It's just a lack of stimulation and it can actually create a stress. Even being tired is a stress. Even things like loud noises. So loud noises are actually a stress to the body. So whenever the brain gets this incoming signal, whether it's an emotion or a physical stress, whenever that comes in as a signal to the brain, to the hypothalamus, it takes in that information. And just like back in the caveman days, it changes our body to be in this fight or flight state. So your brain is receiving that information as an alarm. And then what it does is it sends a signal down to your adrenal glands. And that's that tiny little gland, it sits right, there's two, one on each kidney, sits right above the kidneys. And so whenever the adrenals get the signal, we are under stress, we're in fight or flight mode. It releases our stress hormone cortisol. And that's why this presentation is on the cortisol effect. Because what happens next is it shifts the whole body's physiology. So instead of being in a relaxed, you know, rest and relaxation, or rest and digest where we feel safe and calm, anytime it gets this signal that there's something happening, it creates this fight or flight switch. So now all of a sudden our body is in like the survival state. And that really changes your body's entire physiology. So everything goes on shutdown and you go into survival mode. So what might happen is blood pressure increases and the heart starts racing. And if you ever needed to run from a wild animal, if you were under stress, what it does is it breaks down stored glycogen and put sugar into the bloodstream. So you have a quick source of energy in case you have to run from a wild animal. And so all of these things that are happening are in that fight or flight state is if you were in survival mode. But think about how many of your patients might have trouble controlling their diabetes or their blood sugar. And every time the stress response is triggered, the body's breaking down glycogen and putting sugar into the bloodstream. It makes it really, really tough to control blood sugar. So those are things they might be coming to you saying is I'm having trouble getting my blood sugar under control or my blood pressure is just shooting through the roof and I just can't get it under control. And I want to get off of my blood pressure medication, but I just can't. And every time they're in that survival state, that's what's happening. Even something like a good metabolism is really important, really for anybody. Of course, we all want a good metabolism. But even for this population, as metabolism is going down, if you're in a fight or flight state, it wouldn't be good for you to be losing weight and have a good metabolism. The body is going to be storing and holding on to this fat as protection. And the same thing with our reproductive hormones. I'm sure that having enough of these good rev up hormones is something that's really important in this population. And what happens is it shuts that down. So it wouldn't be a good survival mechanism to have good hormones for reproduction at that time. It's not time to be having babies and it's actually time to just survive and look out for yourself. So it's really shutting down just about everything. Another big one is the digestive tract shuts down. Our digestion, we're not in rest and digest, we're in fight or flight. So those who are suffering from gut issues, they're getting bloating, they're feeling constipated, all of that happens in that fight or flight state because it wouldn't be safe to be in rest and digest. We also know that it can affect our mood, like it creates this risk for depression, anxiety. Overall, this stress hormone is our wear and tear hormone. So when we look at it, it really affects nearly every system in the body. We can see all the way from the brain, we can get headaches, increased risk of depression. Cortisol can even break down that brain tissue being a risk for Alzheimer's and dementia. The digestive tract we talked about creating, if it's shutting down that rest and digest, we get things like acid reflux and bloating and constipation. Blood pressure goes up, it's hard to sleep, that cortisol is so stimulating it can keep you awake at night. So for those who are having trouble sleeping. So I'm sure a lot of these things going on in the body are things that a lot of your patients are experiencing from that stress response. And when we see that the prevalence of stress is so high, a lot of them are probably experiencing some of these symptoms. And imagine when they come in to see you, if we can't make these connections, it might be hard to connect with them. But if they feel like you understand where the source of a lot of this is coming from, and you can actually have really simple tools that they can use right away when they go home, wow, they could feel so supported and so understood and feel like they're in such good hands from somebody who can actually take a look at how the stress affects their whole body and actually give them some really cool tools that they can take with them right away. So this was a really interesting study. It's called the Emotional Ear in Stress. And what they found is that there's multiple interactions between this nervous and neuroendocrine system. So that would be the cortisol fight or flight system, that fight or flight response. So there's an actual interaction between that fight or flight response, between the nervous system, the neuroendocrine system, and it definitely can contribute to these inner ear dysfunctions, such as tinnitus, vertigo, and hearing losses. So there's a really strong connection there. And so this is, I'm gonna break this down because it's really interesting. So I know you're like, what is that? This is a picture of the inner ear. And those red dots that you see are glucocorticoid receptors, which means it's a receptor right in the inner ear for cortisol. So what one study found is that in the inner ear, cortisol has a direct action directly on the ear. So that can actually, that stress hormone can actually directly affect the inner ear structure. And over time, that's our wear and tear hormone. So over time, it can actually affect that structure. What else it found is that it can express genes inside the inner ear. So when it binds on, it can actually affect gene expression, which could be beneficial or actually create breakdown and wear and tear on the inner ear. So we're also going to talk about nutritionally how we can influence this gene expression. But this was so interesting because this review actually showed how cortisol can affect gene expression in the ear and just directly affect the structure of our ear. So we might be thinking our stress hormones are far away when we're experiencing an emotional stress or we're feeling lonely or frustrated. We might feel like what does that emotion have to do with our ear? And here they're actually finding these cortisol receptors directly in the ear. And originally what's interesting is cortisol, some cortisone has actually been used to help with hearing challenges. And what happens is during this fight or flight state is at first cortisol is really high and it's really revved up. You could think of it as really revving up a car engine and cortisol is that wear and tear hormone. Over time that cortisol can start to be blunted and create even more problems by being low and blunted. So it's kind of like that car if you're constantly revving the engine, constantly kicking out cortisol, over time that car might get some wear and tear and break down a network as well as it should. So initially that cortisol causes wear and tear and then eventually can be blunted and create problems by even being low. So what they found was that if we continue to make progress in the domain, we might actually start integrating stress into clinical management with inner ear pathologies. So this is right on the horizon of some great new information. Now, when they were looking at this study and how, when they were looking at studies on how cortisol influences gene expression, some of them are mice studies, but this is, we can see that this is the direction of what we're learning about and where this is going. So if we could be ahead on this trend of using stress management to help with inner ear pathologies, this could be really great information and just another tool to your tool belt. So how can we actually empower these patients? Well, let's think about how they might be feeling. They could be feeling helpless and that there isn't really a whole lot that they can do at this point. And there actually is. So stress management and nutrition can make a significant impact on their hearing and their overall quality of life. So of course, as a hearing professional, you're making a huge impact on their life already giving them these tools. And these are just some more tools that you can add to your tool belt. So you can give them this hearing technology that is going to make a huge impact, just like I was so excited to give them this nutrition program that was going to be the tool to really change their life and then take it to the next step of really personalizing it around how do they feel, what are they experiencing and what is really going to motivate them to take charge over their health and creating a lasting relationship between the two of us. So just taking a minute to let yourself sink into that of what does empowerment feel like. And I think of people in my life who have maybe held me to a higher standard or given me the tools of what I needed to maybe take charge of just my health or my life or what I really wanted out of my life. So just letting that feeling sink into your heart for a minute. What does it feel like when you felt maybe a little bit helpless and you met with somebody, whether it's a health professional or a teacher or somebody who really took you under their wing and let you feel really understood and they didn't just give you what you needed, but they gave you the tools to also empower yourself. And how much that developed so much trust and creating that relationship, what was that relationship really like? So thinking about how this could influence your practice, you could really be that differentiator between just a transactional sale or really having a meaningful impactful experience that has a lasting relationship. And I had such a wonderful opportunity to interview a hearing professional on her experience who just has a really beautiful thriving practice. And one of the things that I asked her was, what do you think sets it apart from somebody who goes into a practice as a hearing professional? And I'm sure that some of the patients coming from a place of where they're feeling stressed and maybe really frustrated, it might be really hard to connect. What do you think is the difference from having lasting relationships and having a really thriving practice that you get referrals and you have a great relationship versus those who might be struggling to really connect and with their patients and get referrals? And she said, they really feel understood and they feel welcomed and warm and we just have an experience together in such a lasting relationship. And I think that this is one way that it could really be done. And I love this by Zig Ziglar. If you think about how this can impact your practice, is that you can have everything in life that you want if you will just help other people get what they want. So what do they want? They really wanna feel supported and understood. They probably wanna feel proactive and that they can be in control of their health. And they wanna know that their best years are still ahead and you're gonna be the one that guides them there and leads them. So what a different feeling that they could have when you understand where they're coming from, you can let their guard down, you can really open them up and let them know we've got some exciting things ahead, some really exciting tools. And when you're feeling frustrated or you're feeling stressed, here's some things that you can do. So this is what I do to help empower my clients. I always check in on their experience. So even when I'm teaching, if I'm teaching something nutrition or giving them an eating strategy, I actually check in with them and ask them, what's coming up for you right now? What is your experience like right now? And just being open and curious. It doesn't have to be a direct spotlighted question of how are you feeling? And they feel interrogated, but I like to let them know that it's a safe space. And I know that this time is really challenging. Maybe they're going through a lot of things. Maybe some fears are coming up. I just like to leave it as an open floor for however they're feeling and let them know that I understand that a lot of my clients, when they first come in, they might be feeling some fears, they might be feeling nervous, they might be feeling discouraged because they've had a really hard time the last few years and they don't know if this will really help them or not. So I like to give them a safe space. And originally I wondered, is it okay to just bluntly ask people who I don't really know, how are you feeling right now? What is your experience? Because I know that it's probably a lot of uncomfortable feelings. So I wasn't really sure if I should be treading lightly on those feelings and emotions. Could I just bulldoze through that and maybe put them on the spot? And what I found is that at first, some people are a little uncomfortable because they don't expect to be talking about their emotions. But as soon as they do and they feel safe, they actually unfold and they feel so seen and they feel so heard. And they may not have ever felt that way maybe in a long time or maybe a long time. So giving them that floor, all of a sudden it's like taking a deep breath. They've been able to exhale and they haven't been able to in a long time. And they're like, thank you. I'm actually being seen right now. So I just like to check it along the way as I'm teaching things, when I meet them, and just asking them, what are things like for you right now? What kind of things are coming up? Are you feeling nervous? Any apprehensions? What has your experience been like? And the next thing I like to ask is, what is really important to you? We know that deep down, if they are coming to see you, maybe they've been feeling discouraged for a while, or they may have lost some things that they've been passionate about. And this is something that was huge for me to check in with my clients and ask them, what is really important to them in their life? And it helped me connect with them on such a deeper level. I understood them so much better. What types of things were important? Because we all have a certain purpose or we live with passion. And sometimes that can start to dwindle away. And that can be a really cool tool for you to ask them, what is really important to them? What is keeping them thriving? For you to connect with them and see maybe where, what areas of their life has been lacking, and you can encourage to fill in those blanks. And I just love this quote by Matthew Kelly, that without purpose, we lead life in quiet desperation. So maybe you can be the one to encourage, to nudge their whole health, their mental health, towards a good direction, back into the things that they love to do. So this is just some really easy key strategies that I use. If they're feeling stressed, let's say they tell you, you know, I'm feeling a lot of anxiety, or maybe I'm just feeling stressed, or they might even express it to you as far as symptoms go. Maybe they tell you, sometimes I just, I get frustrated and it's hard to breathe, or I feel my blood pressure grow up, or I can't sleep at night. Maybe you can hear for these signs of stress. And there's actually a lot of research that shows that taking deep breaths, immediately drops the stress hormone cortisol. And not only is this a really good strategy for your patients, it's a great strategy for anybody. My clients have said that this is the number one tool in their tool belt, when they're getting cravings, food cravings, when they feel frustrated, when whenever they're struggling and having a hard time. So maybe if you notice that stress might be something that's an issue for your clients, giving them this strategy, they will feel an immediate difference. So by taking three deep breaths, there's a way to do it where they're filling up their lungs all the way down by their diaphragm. And three deep breaths is what brings you out of that fight or flight state. So I know even as healthcare professionals, we go through times of stress too. And this can be a great strategy for you to use if you're ever feeling like you're in that fight or flight state, those deep breaths immediately drop that stress hormone cortisol. Maybe they're feeling a little bit hopeless and they haven't been able to take charge of their health in a while. Another strategy that my clients like to use at first, they're like, what are you telling me to do? At first they thought I was crazy when I showed them this. And once they tried it for the first time, they use it right on the spot all the time. And what you do is you just take your hand and you just bring it to your chest and you can close your eyes. And if you're listening right now, you can even try this and notice what it feels like to reconnect with your body. It's basically giving you that reconnection when you're stuck up in your head and those thoughts are swirling through your mind. It gives you that immediate reconnection to your body and lets you know, hey, I'm still here and I'm listening to whatever emotions or feelings are coming up. Some people like to use a gratitude list when they're just feeling frustrated or maybe they're not in the best mindset. You could even talk to them about, hey, a lot of my patients like to do some gratitude journaling where they just list things that they're grateful for and it shifts them into a different way of thinking. Or maybe you can see that there's some frustration and they don't really know how they're feeling or what it's about. This is another one that a lot of my clients thought I was crazy when I told them to start doing some journaling. They really did, they were like, I journal about my feelings or my thoughts or what's coming up. But when I encourage them and let them know that it was actually a tool that my patients use a lot and they gave it a try, now all of them are doing it where when they're not sure how they're feeling or what emotions are coming up, they just freehand write down some things that come up and they listen and they learn so much about themselves. So these are just some strategies that if you notice, obviously if their stress is at a significant level, that's maybe where you draw the line and you refer out that I know that if my clients are handling some really deep emotional issues, that's of course out of my scope. I'm never their therapist or their psychologist. I'll always refer out if it's something that is beyond just helping them cope with stress. So that could be a really great opportunity to get to know some psychologists or therapists in the area so that you have that in your tool belt as well, where you can just easily refer out and make sure that you have that good team support. This was really cool. It was, there's a lot of studies that show the effect of breathing on cortisol. So if it sounds a little bit woo-woo meditative breathing and helping with stress, there are actually a lot of studies that show how this breathing can bring down that stress hormone cortisol. So what they did is they took two different groups. They had a breathing intervention group, which is that solid line on that chart. And then they just had the control group that wasn't doing the deep diaphragm breathing. And that is the dotted line. And what they had them do is just 20 different sessions of deep breathing. And what they found from this result, what they had found was that the breathing group had significant drops in the stress hormone cortisol. Where the control group who was just regularly breathing, they weren't giving them these deep breathing strategies. They didn't really see much of a change. And in fact, you can see that it actually went up a little bit in that time of cortisol concentrations. So there are a lot of studies that show by doing this deep breathing, you can have actually immediate effects on that stress hormone cortisol. So that could have an effect on mood. It could have an effect on digestion, blood pressure, all these things that they may be concerned about. So to do this, you could just put your hands on your rib cage. So right where the diaphragm is, and you can just take a big inhale and feel your breath, just expand those lungs and then letting it out. And three of those deep breaths can actually make improvements in that stress hormone cortisol. So if some of the journaling and the hand to heart doesn't quite resonate with your patients, you can tell them from a science perspective. We can see that when we do this deep breath, it actually helps that stress response. So those are ways that you can emotionally empower them. And another thing is think about when you felt that you could be in control of your health. There are certain foods that can actually help with hearing. And I thought this was so fascinating as I started to research the connection between certain foods, compounds, vitamins, and minerals that can actually make a difference. So maybe they're not going to all of a sudden magically change and they can hear without a hearing aid, but just to know that they're in control over their health and that it's making a difference can be so empowering and could really give you some tools in your tool belt to really make you shine and make such a difference between them just going and buying a hearing aid and getting a transactional experience. So there's a lot of information on how nutrition and food can impact hearing and stress. So I really had to try to prioritize and break it down into three different topics that I thought would be the most impactful. I could do a whole nother talk just on nutrition and how that impacts hearing alone. But these are some main ones that I thought would really make a difference and resonate with your patients a lot. So it was hard for me to pick and choose. But number one is having healthy blood vessels. I'm sure a lot of your patients have things, one common concern is things like high blood pressure, dementia, diabetes, cardiovascular disease. We can see that there's a connection between those health conditions and hearing loss. So having healthy blood vessels probably applies to a lot of your patients. And one really easy thing to remember is just the three Bs of having healthy blood vessels. We can see that these tiny little capillaries travel all throughout the insides of the ear, in the inner ear. So if we have healthy blood vessels, we can deliver nutrients and protect the ears and everything can function ideally as it should. But if those little tiny blood vessels, if those little blood vessels get damaged, we're not delivering the nutrients and the oxygen and the hydration to all of those tiny little structures. So there are three Bs that I think of to help improve the health of those little capillaries. One of them is beets. Beets is one of the best foods, beets are one of the best foods to create nitric oxide in the body, which opens up the blood vessels and gets the blood flowing. So for any type of cardiovascular health, beets are a great food for just opening up the blood vessels, getting that blood flowing. It actually works in a similar mechanism to Viagra. This may or may not resonate with your patients, but you can let them know that it opens up those blood vessels, gets the blood flowing. So it can be great for delivering nutrients to those tiny little capillaries. Another food that has been really well studied are berries. So that would be like your blueberries, your blackberries, your strawberries. They have these compounds, these antioxidant compounds that really protects those blood vessels and they're one of the lower sugar fruits. So for those who are having trouble controlling their blood sugar, maybe they have high blood sugar or diabetes, berries are a lower sugar fruit, but have these really powerful compounds that protect the cardiovascular system. And body movement. So things like walking, yoga, picking up weights, getting that blood pumping is really important to deliver the nutrients and get that blood flowing to those tiny little capillaries. So this was really interesting. This was a study on the neuroprotective effects of berry fruits on neurodegenerative diseases. And hearing loss can be a neurodegenerative disease. So they looked at things like hearing loss, Alzheimer's, dementia, and they found that these antioxidants, these antioxidants from berries actually protected the neurons. So it was really interesting just to prevent neurodegenerative diseases and have that neuroprotective effect. So maybe you could say, you don't have to explain these mechanisms, but you could say that we see that things like berries are really great for ear health and the protection of our ears and our hearing and our brain and our cardiovascular system, this would be a great food for you to work in. Another one is vitamin status. Vitamin status alone is something that I could talk about for an hour. But just to give you a summary, there are a lot of nutritional factors that are associated with hearing loss. So this was published in the Journal of Nutrients in February, 2019. So it's actually a pretty recent study. And they found that a lack of vitamins and minerals, you can see vitamin A, B, C, D, E, zinc, magnesium, selenium, iron, iodine, and our macronutrients can really affect hearing status. So again, we don't have to go through and dive into all the mechanisms of how each vitamin affects hearing loss, but you could maybe take your practice to the next level and talk to them about maybe how is their vitamin status or are there multivitamins that you would recommend? Maybe you could keep a high quality multivitamin. And if they're not taking one, it could be something that you could work in as part of your recommendation. Or if you're not comfortable with that, even just ask, have you considered adding a good multivitamin and mineral? Because we see that some of these nutrients are so important to protect the hearing function and protect from hearing loss. And this one is very fascinating. I didn't expect to come across this, but prebiotics can actually have an effect on our hearing. And you might be wondering, what is a prebiotic? Maybe you have or have not heard of them. And what's the difference between a probiotic and prebiotic? So a probiotic, you could think of your whole digestive tract. Let's say your digestive tract is like a fish tank. The probiotic is like your little fish. Those are the bacteria in your gut. Now a prebiotic is the food for the fish. So the fiber that we eat is a prebiotic. Our bodies don't do much with fiber. We don't really get nutrition out of it. We don't really get calories or nutrients. That fiber that we eat feeds the bacteria in our gut. So I know this looks like a lot, but let me just break it down because it's really interesting. So on the far left, we have dietary fiber. So that comes from certain vegetables. So that's your prebiotic. So when you eat those fibers, it goes into your gut and there's your probiotics, the gut bacteria. They love to eat the fiber. They eat that fiber and it creates what's called a short-chain fatty acid. Once it ferments, it creates this little product. It's called a short-chain fatty acid in the gut. Short-chain fatty acids are incredibly important for everybody's health. So important. That's why eating fiber is incredibly important because this short-chain fatty acid is a signaling molecule inside of our bodies. It travels, it signals up the vagus nerve and completely has a really strong effect on our brain. So it can actually influence neuron development. It can influence inflammation in our bodies. It can influence our cell growth. It's really important for neurotransmitter production, both in our gut and in the brain. So these short-chain fatty acids play a really big role in depression, anxiety. It's such an important part for mediating stress in our bodies. So you would probably never think that eating vegetables could affect the amount of stress that you have in your body and how well you cope with stress, but also your brain health, depression, anxiety, inflammation in the body. You've also found that short-chain fatty acids have an effect on diabetes control and how well insulin regulates blood sugar and preventing Alzheimer's, dementia. So this is actually huge for this population. And this study in particular showed that when people ate prebiotic, sorry, not people, this was actually done in mice. When mice ate these prebiotic fibers, it created short-chain fatty acids. And when it did that, it goes up to the inner ear to influence gene expression on these different genes that are really important for spiral ganglion neuron production. So it actually prolonged the survival of these neurons in the inner ear. So it influences gene expression and they had better ear function and ear quality. So again, this was done on mice. So maybe you're like, well, as a human, I'm not a mouse, what is the effect? So some of these studies are really new. Again, these are new studies, but very fascinating information. And so maybe this is something that you start asking them, hey, did you know that there are certain foods that have fibers that are really great for controlling diabetes, great for cardiovascular health, great for brain function, preventing Alzheimer's, but also has a really direct impact on ear function just in itself. So this is kind of a summary of how can we really support our patients, both from a stress perspective and a nutrition perspective. So maybe you're checking off, do they need something like deep breathing? Is this the kind of patient who is feeling a little tender and emotional and maybe they need, hey, have you tried this strategy? Hand to heart. Maybe they're feeling a little frustrated and misunderstood or they don't know how to do it. Or some things that might resonate that they've heard of before could be things like walking, stretching, meditation, asking them what types of things have been important to them in the past and are they still doing those things? And they might be really surprised that you're more than just a hearing professional, you're like a support, really such a leader for them to take back control of their health. We could be recommending that we're introducing certain foods that we know have an effect on their cardiovascular health, their brain health, and then also just preventing hearing loss from progressing and maybe that it could really have an effect on their hearing abilities. They may or may not notice a difference, but just for them to feel like they're being in control and proactive over their health, what that could really feel like. So that's a summary of what we're looking at. What that could really feel like. So this here, this slide is an overview summary. And soon we have a patient guide that will be developed. It will be provided through the International Hearing Society. We'll be providing it for everybody. That's a patient guide that you'll be able to use. So maybe if you don't feel comfortable just yet really implementing these strategies, but you see things coming up, maybe you have an intake form that you're asking them about their mental, emotional health or their nutrition. And you see that they're not scoring so well on that intake or it is something that just hasn't been a part of their life and you think it could be a good support. We'll have a patient guide that you can just give to them and say, here's some more resources that might help you. And they can feel supported at least that way. If you don't feel really comfortable just yet fully implementing some of the things that we really talked about today. So there's a summary. I also wanted to provide references from these journal articles. They're very fascinating. In case you're interested in digging into some of these research studies that I was looking at. Very fascinating, interesting stuff on how nutrition and stress management can both impact hearing. So we do have some time here for some questions. Thank you so much, Gina for a great presentation. We've got over 300 people on the line today that have joined us so far and this is amazing. So we appreciate the information you've shared. As Gina mentioned, we're gonna dive into some Q&A right now. As a friendly reminder, if you do have any questions for our presenter here, please go ahead and enter it into the question box on your webinar dashboard. So with that, Gina, first question here is from Mark. Mark is wondering if you can explain what happens if patients feel bloated from eating fiber rich veggies? Yeah, that's a really great question. I know that in a lot of this population, you might be recommending some of these fibers and they might not do so well with some of those fibers. Some of those fibers that create those short chain fatty acids. So a couple of things to recommend is that the stress response and bloating is directly connected, directly connected. So that might be something that when they say, oh, I'd love to eat some of those fibrous vegetables, but I can't, I don't digest them well and I get gassy or I get bloated. They might mention that. One thing to consider is that if they're feeling stressed, ask them how they're eating. They may need to take a few deep breaths before eating to get their body out of that fight or flight state and actually turn the switch to rest and digest. So you could actually recommend that they practice what I call mindful eating, where they're taking a few deep breaths to get out of that fight or flight and more into a rest and digest state so that their body switches over and digestion starts working, food digests better. And then some of my patients who need help digesting some of those fibers, especially in like an older population, sometimes a digestive enzyme is a supplement that they can take to help break down some of those fibers and help digest them a little bit easier so they're not having too many digestive troubles. Something that is a little bit newer, some people who really don't do well with those fibers can actually supplement with short chain fatty acids. So they're skipping all that fermentation and they're still giving that health benefit of the short chain fatty acid. I know that might be something a little bit out of what you're comfortable with, but even just starting with making sure that their body is in a rest and digest state can help them kickstart that digestion and break down the food better so they're not getting all this fermentation and bloating. And also letting them know that there are benefits to even very small amounts. So just starting off with a little bit where they don't have to start eating tons of these fiber-rich foods. That's super interesting. We have another question here from Melissa. And Melissa wants to know if you've seen any research that indicates a reversal of hearing loss through lowering stress and good nutrition. That's a great question too. So the one research article I saw was, it was not with humans, but it was with mice, where they found that when they did, when they did use the short chain fatty acids to stimulate this gene expression, what happened is that it increased certain genes such as BDNF, and that's brain-derived neurotrophic factor. And that's actually really important for developing more neurons. So yes and no. So we see that there can be development of some of these components inside the ear that can improve hearing loss. But the ones that I have seen were done with mice. And so it's not like I have seen them with humans and they actually saw a difference in hearing loss. So these are all really thought-provoking research studies on how we can possibly make improvements or reverse hearing loss. So far what I have come across, it hasn't, I haven't seen it in humans and actually where they actually significantly notice a difference. But hopefully that would be some new research ahead. Right now, a lot of the new research that's come out is being done in mice. Okay, great. We've got another question here from Nisha and she's curious about your thoughts regarding hydration and hearing. Can you share anything about that? Yeah, of course. So hydration is really important to keep up our blood pressure, to keep up blood flow. And lack of hydration is actually the number one cause of fatigue because blood pressure drops. And as soon as that blood pressure drops, it actually puts a strain on your heart to make your heart actually pump harder to keep that blood volume up. So hydration is really important for cardiovascular health and to get that blood flowing to be able to deliver nutrients. And we saw all those tiny little capillaries in the ears. So if we're not getting that good delivery of blood flow, that's where we deliver oxygen. That's where we deliver nutrients. So absolutely, I would say hydration is so, so important. Thank you. Our next question here is from Granville and Granville is asking, the COVID-19 pandemic has exacerbated the tinnitus level in patients. Is there anything that they can do to reduce stress when restricted to their home? Yeah, absolutely. So immunity is, viral things are definitely a stress on the body if somebody is actually diagnosed. But even just the stress of being stuck in their homes, and I know mental health is such a big issue right now. What a lot of people are doing is noticing what emotions are coming up right now. So a lot of us are being triggered, our stress is being triggered because we're having these emotional responses. And a way that I actually like to help my clients work through some of those emotions that are coming up while they're stressed, stuck at home, is actually instead of trying to fight them away, I ask them to lean into it and listen to what that emotion is. And so then that's where they can find a little bit of relief. And if anxiety is coming up, what is it trying to teach me right now? If I've been feeling a little bit bored, if I've been feeling a little bit lonely, and when they actually listen to that emotion that's coming up, then they can figure out what is it that they need to support themselves. It's hard to know how to support yourself and cope with that anxiety or stress if you're not really sure what that emotion is or where it's coming from. So really getting close to understanding like what is it that's coming up for me? Am I feeling some loneliness? Am I feeling boredom? Am I feeling fear that my health could be an issue or I might not be able to get out of the house much? And feeling into like, what is that stress that's happening? And then of course, getting excited about maybe some things that they haven't done in a long time or new things. But just being at home, I know a lot of my clients use tools like meditation or deep breathing. Any outlets that feel really good to them to help get connected to their body, listen a little bit better and that maybe feels good. Things like meditations and breathing exercises or doing some journaling, some reading. I really think it comes back to giving yourself the ability to check in instead of always checking out. There's nothing wrong with things like TV or being on the computer or games and reading. None of those are bad things, but we kind of check out for a minute. We kind of disconnect. So it's good to have tools when they're at home to check in and see what our emotions are coming up and how do they need to love on those emotions and nurture them. I love that. I love the idea of just loving on your emotions and nurturing them. I mean, it's so important to stay connected to your insides and yourself. So that's great. We've got another question here and we've got only a couple minutes left. So I'm gonna ask from Dave, does caffeine intake affect the blood flow to the ears? Well, caffeine definitely affects cortisol and can increase blood pressure. So caffeine is a stimulant. It does make the heart race. So for somebody like with high blood pressure, probably wouldn't be the best thing. Also, I would imagine that caffeine could impact hearing because caffeine does influence cortisol release in the body. So for somebody who has high or low cortisol, caffeine is not really a great thing for that. So indirectly, I think that it would probably change cortisol levels. And we see that with cortisol being dysregulated, cortisol dysregulation can directly impact tinnitus and vertigo and all these other hearing dysfunctions. I would think so. It could be a good opportunity that if a patient is drinking coffee, maybe you ask and see if they could go down to tea, where tea, something like green tea has less caffeine, or maybe just cutting back the amount. I think it definitely could make an impact. I don't know if I've seen a study directly on caffeine causing hearing issues, but there's definitely the connection between caffeine affecting cortisol imbalances. Got it. Yeah, it's so crazy. There's so much information out there and in these increasingly stressful times, I think it's really relevant to hear all this information. I mean, we've got tons of questions from our audience, but unfortunately we can only go for so long. So we are gonna wrap it up for today's webinar. Thank you, Gina, for such an excellent presentation. I'm hoping, I'm thinking that a lot of people are gonna walk away with great stuff to share with their clients. Thank all of you for joining us today on the IHS webinar, The Cortisol Effect, How the Stress Response Can Play a Role in Physical and Mental Health as Well as Hearing. If you'd like to get in touch with Gina, you can do so at gwarfel at gmail.com or visiting her website at ginawarfel.com. As a reminder, to receive a continuing education credit for this webinar through IHS, be sure to take and pass the quiz online by following the URL right here on your screen or accessing it from the downloadable handout in your handout section of the dashboard. You'll also find links to the quiz, more info about CE credit, and today's presentation on our website, ihsinfo.org. Click on the webinar banner on our homepage or choose webinars from the navigation menu. And please keep an eye out for the feedback survey that you're going to receive tomorrow via email. We ask that you take just a few moments to answer some brief questions about the quality of today's presentation. And now with that, I'm gonna turn it over to Kathleen to close this out. Thank you, Diana. And thank you, Gina, once again, for sharing this important research and information for us. It was certainly an excellent presentation. And before we close out our first webinar, I wanna once again thank our sponsor, Care Credit. Without them, today's complimentary CEs would not be possible. Be sure to visit them by clicking the link in the presentation or visiting carecredit.com forward slash sound strategies. Now we're gonna take a 15 minute break before our second speaker of the day. If you're already on for that event or you plan to join us, don't go anywhere. Just stay logged in, stretch your legs and we'll be back at 115 Eastern time with IHS's own Alyssa Parity. Thank you.

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