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by William Cone, Ph.D. One of the most recognizable characters in movie history is One Flew over the Cuckoo's Nest's Nurse Rached. Cold, uncaring, and focused on the rules, she does her job by the book. No administrator would find fault with her dedication, responsibility, and adherence to policy and procedure. But we come way from watching her with little appreciation for these things. Instead, her lack of compassion and callous disregard for other people's feelings appall us. In the years that I have spent training hospital and long-term care staffs, I have seen many com-passionate caregivers, but unfortunately I have also run into Racheds. They didn(t start that way; they began with a passion for helping and an intense desire to give. But eventually, like the contemptible Rached, they burnt out. WHAT IS BURNOUT? Burnout is a physical and emotional reaction to an unrelenting, intense involvement with people over a long period of time. Working with the frail, the ill and the elderly takes its toll. Burnout occurs when you sense that your energy is gone, your expectations are never to be met, and your ability to help others is depleted. Why healthcare? Healthcare workers are bombarded each daily with people's feelings of helplessness, dependence, fear and despair. We are repeatedly exposed to frequent, highly charged emotional situations. We spend most of our days with people in pain. This can give us a dim view of the word. In one of my training seminars, a nurse said to me, "Working in this place has made me intensely afraid to get old." This statement shows a loss of perspective, and the beginning of the negative expectations that lead to burnout. By immersing herself in the absolute worst aspects of aging, she lost sight of the fact that most people are healthy, and that for the vast majority, life satisfaction actually increases with age. This error is a common one, when all we see is problems day after day, it is easy to lose sight of the fact that most people enjoy their lives. Who flames the fastest? Although all of us in healthcare are prone to burnout, what kind of helping we do has an effect on who burns out. For example, nurses who work in intensive care units burn out faster that those working in less stressful circumstances. As a group, intensive care nurses have higher turnover, more sick days, less job satisfaction and more physical and emotional complaints. They are also the most likely to undergo a deterioration in interpersonal skills and a loss of empathy. It seems that one reason for burnout is that the people with the least amount of training get the most work Studies show that RNs have a significantly lower degree of burnout compared to nurses' aides and LPNs. Subjective and objective overload (which we will talk about below) in the LPNs and nurses' aides play an important part in their higher burnout rate.. Similarly, mental health practitioners who work with chronically mentally ill patients have many more interpersonal problems and a higher burnout rate than those who work with less disturbed patients. Nurses, caregivers, and healthcare practitioners working with seriously ill people have a high probability of seeing themselves as failing The common factor in these groups is high demand tied to lack of control. Nurses, caregivers, and mental health practitioners working with seriously ill people have a high probability of seeing themselves as failing. Many of the patients do not get well. In fact, despite their best efforts, many people in healthcare see the people they work with get steadily worse, and some die. Unfortunately, several studies show that for many of us, the longer we work in the helping professions, the less we enjoy what we do. Even before we are conscious of this we begin to compensate by minimizing our contact with patients. We become more maintenance oriented, rather than patient-centered, and this makes us more rule-conscious than people-conscious (remember Rached?). The component that is lost here is that of clinical empathy - the ability to sustain compassion while maintaining boundaries and keeping power in perspective. The ability to care without taking our patient's problems home with us is what keeps us effective. Why is clinical empathy important? A recent study compared levels of empathy, burnout and attitudes among different categories of nursing staff. Of the people in the study, 27.4% were considered to be at high risk for burnout (that's more than one out of four, folks). All of the staff members showed moderately levels of clinical empathy, but the RNs showed the highest, and the fact that they had the most positive attitudes towards their patients and the highest level of empathy gave them the lowest degree of burnout. The authors concluded that burnout begins with loss of empathy. Failure to thrive Of course, this loss of empathy affects the patients as well as the staff. Many years ago Rene Spitz discovered that babies do not survive if only their physical needs were met. Spitz studied children in a foundling home who were fed and changed, but given little comfort or solace. Most of these children wasted away and died, a condition called failure to thrive. I can(t help but think about Spitz when I walk in certain nursing homes. Sure, everyone is fed, clothed, and kept clean, but the com-passion is missing, and the people look lost and lonely. A colleague of mine once described a facility she was working in as "a warehouse for wrinkled skin." This to me is tragic, and I believe this attitude is due largely to caregiver burnout. Furthermore it's been shown that the more conflict there is within the staff of a facility, the more agitation and aggression there is in the patients. This feeds an endless cycle of burnout aggravating patients, patients getting more resistant and creating more work, and more work leading to higher levels of burnout. THE THREE CAUSES OF BURNOUT Unrealistic Goals Health care workers have a high degree of burnout because they tend to go into the profession with high levels of motivation, high expectations, and a strong desire to help others. But after a time, they discover that not all people can be helped, and that many of the people they attempt to help are not appreciative of their efforts. In addition admin-istrative, economic, and bureaucratic pressures often make it difficult if not impossible to provide adequate services, resulting in frustration and helplessness. Unrealistic Expectations Having lofty expectations of yourself and others is not a bad thing, but those expectations must be realistic. For example, in the real world, the expectation that everyone should treat you fairly is going to leave you severely disappointed. Health care workers have a high degree of burnout because they tend to go into the profession with high levels of motivation, Despite your best efforts, people are often rude, unreasonable and unappreciative of your efforts. If you take this personally, you are headed for burnout. The belief that dedication and hard work gets results and rewards will not always serve you well. The greatest reward you can give yourself is knowing that you have done your best, regardless of the outcome. Unrealistic Demands In certain health care facilities, economic pressures and licensing issues cause a great deal of stress. You may be called upon to do things that have no apparent purpose. You may feel caught between unreasonable demands and the need to do your job well. You may disagree with your superiors and yet feel unable to express your dissatisfaction for fear of losing your job. At times, you may even feel that you must violate procedures in order to get your job done. This type of atmosphere can lead to feelings of inadequacy, perfectionism, and increased effort. Wanting to feel competent, you tackle unreachable goals with more and more effort, until you are exhausted. This increased demand also causes confusion in organizational structure. Administrators and program directors become confused about the roles of others, and may make demands that you are ill equipped to satisfy. In many of the facilities where I consult, staffs are being asked to do double-duty. With cost cutbacks and decreasing reimbursements, staff members are being asked to do things that were never in their job descriptions. When this happens, both the person and those working with them become unsure about the responsibilities of their job. In addition, many and may lack the training to do what is asked of them. This results in their delivering second-rate ser-vices, and consequently everyone feels frustrated. SYMPTOMS OF BURNOUT Emotional Problems In any line of work it's normal to become frustrated, overwhelmed, angry, resentful, and dissatisfied at times. We all occasionally get assignments that we don't like, and we all have had thoughts that things would go better if everyone would just listen to our opinions. However, burnout begins when you experience these negative emotions more and more, until they become so frequent that find yourself getting ready for work with relentless dread, convinced that you're about to have a bad experience. This negative expectation causes you to feel chronic, emotional fatigue. As burnout progresses, you begin to feel sustained negative emotions. You become, irritable, short-tempered and quick to anger. You become hostile to your co-workers and to your patients. You may actually begin to have contempt for the people you have pledged to help. You see them as demanding, whining and needy. But more importantly, you come to believe these things are beyond your control, and that they will never change. You begin to feel that you can no longer help the people you work with because you have nothing left to give. In this regard, burnout could be described as externally triggered depression. It includes the feelings of helplessness and hopelessness, the two major components of depressive disorders. People problems With all this, you may still be oblivious to the fact that you are burning out. Instead, you can't understand why people around you think you "have an attitude". Burnout impairs your tolerance for frustration. As you continue to become emotionally exhausted every problem looks larger. You become short tempered. When conflicts occur, you overreact. You might even find yourself "going off" (having sudden uncontrollable emotional outburst). You may begin to feel bouts of intense hostility towards your coworkers, patients, or clients. Your cranky condition leads you to dealing with people as bothersome, and to avoid these episodes you find yourself withdrawing socially (the less time you spend with people, the less likely you will lose your temper. Instead, you begin to sit alone. You watch more and more television, trying to numb yourself into oblivion. You find yourself thinking, "what's the use?" The enthusiasm you once felt is now turning to cynicism. Your efforts seem pointless, and you begin to dehumanize the people you once pledged to help. (This is one of the reasons for the so called "black humor" in healthcare facilities (the use of morbid or callous jokes about the people you care for distances you from their suffering.) Dehumanization is the decreased awareness of our common bonds with others - the loss of interpersonal attachment. This distancing behavior is found quite frequently in helping professions such as nursing, where human contact is intimate, intense, and often negative. After years of being berated by irritable and ungrateful patients, you may become callous and uncaring about the people you are paid to care for. You stop seeing others as having feelings and thoughts, and eliminate the shared sameness of humanity. The more burnout progresses, the more you begin see your patients as completely different from you. Once this happens, patients are seen as problems, rather than people. Physical Problems Negative expectations and negative emotions are stressful, and eventually lead to physical exhaustion. Exhaustion itself is not always a negative feeling - a long-distance runner may be completely exhausted at the end of a run, but she will also experience a great feeling accomplishment. However, in burnout, the exhaustion comes without accomplishment. Instead it is often paired with the feeling of having wasted your time. As your boundaries crumble, the stress of the day rides home with you. You slam the door and kick the dog. You eat a pint of Ben & Jerry's. Although you're exhausted, you cannot sleep. Instead, you toss and turn, obsessing about what went wrong, about the people with whom you are angry, and what you are going to have to face tomorrow. Instead of feeling that tomorrow will be better, you find yourself plotting revenge. Insomnia causes you to face the morning already fatigued, and you hit the highway with frazzled nerves and a short fuse. They cycle repeats itself and you enter and endless, downward spiral towards depression. You may begin to have headaches, backaches, or stomach pains. You may find yourself smoking or drinking more in an attempt to unwind. Some victims of burnout may begin to have panic attacks, and consequently develop a phobia of going to their facility. FACTORS LEADING TO BURNOUT Personal Factors Personal worth Self-esteem comes from the knowledge that you are both lovable and worthy. Being told you are appreciated helps build lovabilty, while feeling productive results in feeling worthy. In other words lovability and worth are the internal components of value and productivity. The lower your sense of self-esteem when you enter the world of healthcare, the more likely it is that you will begin to feel wounded and worthless. Although you seem to expend more and more effort, you feel no sense of accomplishment. This further lowers your sense of worth. As you begin to feel unappreciated, you lose your sense of lovability. Without these two things, life seems pointless. As father Freud once said, to be healthy is to be able to love and work, and you can't seem to do either one. While a person with a strong sense of self may be able to cope with these problems and still keep things in perspective, those who rely on external supplies for a sense of self can be severely damaged. My work with caregiving staffs has shown me that many people enter this profession because they need the sense of being of use to someone. They enter this profession because they think that helping others will help them feel better about themselves. Although these people are often the most dedicated, they are also the most vulnerable and more prone to burnout. Denial As mentioned earlier, in the beginning stages of burnout, the tendency is to do more. Despite the feelings of fatigue and the sense of failure, you feel that if you just try harder, everything will get better. This, of course, doesn’t work. It only results in further exhaustion. Many people are so reluctant to admit they are burning out that they work to the point of collapse. In the past, we used to call this a nervous breakdown, but now we call it burnout. Personal Proficiency The root cause of burnout is having more to do than you can cope with. It is a sense of overload. Objective overload is the actual overloading a person with work. In many of the long-term care facilities where I have worked, staffs are asked to do more than is physically possible. There is no way they will ever get everything done. But this is not the only reason people get overwhelmed. Subjective overload is your perception that you can't meet the demands placed upon you. While we've seen that in some cases this may be true, there are times when the demands placed on you are difficult but reasonable. In these cases it may be your skill-level that is lacking. To gain some perspective on this, take an inventory of your industry. Do others with the same job description do these things? Is this task within your job description? If the answer to these questions is "yes" you need to seek training. Organizational Factors Top-down control Research shows clearly that lack of control and meaningless work are the two most potent contributors to burnout in the workplace. Large, rigid companies that are multi-layered, centralized, and take a top-down decision-making attitude give workers little control and often demand redundant and unnecessary tasks, just because "it's always been done that way." This management style causes more burnout than a total quality approach. Poor Team Spirit In companies where management plays favorites and breeds competition, co workers soon learn to undermine one another. When people compete instead of cooperate, they learn to vie for recognition by making others look bad. Hierarchies do not work nearly as well as teams. Lack of Recognition Some companies feel that paying people for their effort is reward enough. Nevertheless, research shows that money has never been the primary motivator in work. One of my clients once told me, "If I all I cared about was money, I'd be a hit man. The pay's good , the hours are great, and if my clients die, I feel successful." Reward and recognition are the two most powerful things a company can provide to prevent burnout. These things also build team spirit, increase loyalty, and improve quality. Management that doesn't take the time to make their people feel special can expect increased turnover, employee theft, and sabotage. BEATING BURNOUT Organizational Remedies Companies can do many things to prevent burnout problems among its staff. As mentioned above, in order for people to feel satisfied in her work, they must feel valuable, productive, and appreciated. For work to be gratifying it must posses certain factors - clear goals, participation in decisions that affect the worker, accurate con-structive feedback on progress and performance, and recognition for achievement. Organizations that incorporate these components into their management style find employees feel more satisfied. Overload must be addressed. Steps should be taken to assess the ability of the staff to meet the demands put upon them. Benchmarking can help define what a reasonable workload is. Objective overload can be overcome by decreasing workload or increasing staff, while subjective overload can be overcome by staff training. Increase availability of time-out Provide the staff with a comfortable, pleasant place where they can take breaks and unwind. Designate times and places to relax, but acknowledge special needs and special circumstances. If the day has been unusually hard, give the staff time to regroup. Limit hours of stressful work Cross-training the staff so that all employees can share the burden of high-stress tasks makes everyone's job a little easier, while at the same time building a sense of camaraderie in the staff. Flexibility Flexibility in an organization is the ability to change when it's for the best. Rules become secondary to reality. When the work situation changes to the degree that the rules are impossible, change the rules not the people. Of course, I'm not suggesting that you break any laws or violate regulations. There is no sense of accomplishment without growth, and there is no growth without change. An organization that fails to heed the needs of its members soon loses the best it has (a fact that has escaped managed care). Offer staff training in burnout Health-care organizations have always been prone to teach procedural, not emotional, skills. However, the healthcare professions are highly emotionally charged. Teaching the staff how to recognize and cope with their own emotions and those of others will do much to increase the quality of the workday. A seminar on emotional intelligence can do a lot to improve a workforce. Personal Remedies Acknowledge the problem The first step in beating burnout is to admit that it is happening. If you found yourself in the paragraphs above, there is little doubt you are burning out. The next step is to take action. Make a commitment to do something about it. Define your difficulties The solution to any problem begins with defining it in concrete terms. Be specific about what is bothering you. "I'm overwhelmed," may sound descriptive but it is too vague to tackle. A better statement would be, "I am being asked to do a task that I don't feel competent to do," or, "I am working overtime three times a week." These are statements that you can do something about. Change your attitude I'm not suggesting that you transform yourself from a burned out hulk to a Pollyanna on Prozac, but work on being positive. Learned helplessness, the idea that you are powerless to change your situation, will drag you into the ditch of depression. Tackle your problems. Let others know what you they are. Form a committee to reduce burnout in your workplace. Problem solve Become an expert problem solver. Learn to focus on your desired goal, not your feelings. For example, when you become angry with someone, your first impulse may be to yell at him. A better approach would be to wait until you have calmed down, and then discuss to problem and offer a solution. Take a workshop or read a book about problem solving. Always ask yourself, "How do I want this situation to end?" Define your boundaries Keep clear boundaries. If you are feeling burnt out, you might take a boundary inventory. Do you find it difficult to say no? Do you take on the work of others? Do you often feel victimized? One of the difficulties in healthcare is the people who choose it as careers do so because of their desire to help. This predisposes them to come to the aid of others. Because of this, you must maintain realistic limits of what you can do. If you have difficulty saying "no," practice. Let others know that your schedule is full. Schedule time for yourself. Make a list of you problems and then rephrase them into new goals. Keeping your boundaries will help you maintain your clinical empathy. Seek social support Numerous studies show that you can estimate a person's mental health by looking at the size of their social support system. Right now, write down the names of five people that you can count on to give you emotional support. If you can't think of five names, make some new friends. Write down some of your frustrations and talk about what's wrong. Friends can often thing of solutions that you would not see because you are too close to the problem. Hone your skills Continuous education and skill improvement is mandatory. Expose yourself to new methods, ideas, and innovations. This will keep you competent and allow you to be more effective. "This is the way I've always done it" is an attitude that will lead you down the path to ashes. In addition, acquire skills in something that has nothing to do with your job. Pick a field of knowledge that you have always been interested in, but know little about. Get a hobby, go to school or join a group that shares this interest. This will put some excitement and satisfactions back in your life. Change your environment Redecorate your workspace. Surround yourself with pleasant objects. Change the way you drive to work. Find new places to have lunch. In general change your routine as much as possible. This will break old thought patterns and allow you to approach your day in a different way. Leave When all else fails, consider a job change. No job is worth your health, and if you are truly burnt out, you will help your patients most by not being there.
REFERENCES William Cone, PhD Although most minerals are found in very small concentrations in the body, they play a vitally important role in maintaining good health and sound memory. Here are some examples. Boron Boron is a trace mineral that is necessary for the proper absorption and utilization of calcium. Recent studies on boron indicate that it may help prevent postmenopausal osteoporosis, or loss of bone mass. In a study of postmenopausal women aged 48 to 82, those taking 3mg of boron per day retained higher levels of dietary calcium, magnesium, and phosphorus. Although I have seen no definitive research linking boron with dementia prevention, deficiencies of boron, potassium, and selenium have been found in people with Alzheimer's disease. Five separate studies conducted by J. G. Penland at the Grand Forks Human Nutrition Research Center showed that boron deprivation resulted in decreased brain electrical activity similar to that seen in malnutrition. Assessments of cognitive function in boron deficient subjects revealed impaired performance in motor speed and dexterity, attention, and short-term memory. Researchers have found that boron significantly increases production of estrogen and testosterone. Supplementation of boron has doubled the level of estrogen in some patients. These findings suggest the possibility that boron could have a preventive effect on dementia, as it is known that estrogen therapy does reduce dementia risk, and testosterone replacement can be an effective antidepressant in both men and women. The recommended daily allowance for boron has not been established. Nutritionists states that the optimal range of intake is from 1.5 mg to 6.0 mg per day. Dietary sources of boron include alfalfa, cabbage, lettuce, peas, snap beans, soy beans, sweet clover and leafy vegetables. Fruits rich in boron include prunes, grapes, raisins, apples, dates, and pears. Nuts containing boron include almonds, hazel nuts, and peanuts. Stinging nettle is an herb rich in boron. Boron supplements are also available in capsule form. Boron is also needed to help vitamin D stimulate the absorption and utilization of calcium. Calcium Over half of all Americans don’t get enough calcium. Calcium is a major component of bone and tooth material, and about 20 percent of an adult's bone calcium is replaced every year, making calcium one of the most important minerals in our diet. But although it’s well-known that calcium helps keep bones and teeth strong, it also plays a vital role in other body systems. For example, over 50 million Americans suffer from high blood pressure. Left untreated, even mildly elevated blood pressure can reduce the life expectancy of a 35-year-old by several years. Studies suggest that in some people, increased calcium consumption can help control blood pressure without medication. The results of a thirteen-year survey by the National Center for Health Statistics showed that people who consumed 1300mg of calcium per day were 12 percent less likely to develop high blood pressure than those consuming 300mg per day. Those under age 40 had a 25 percent reduction in risk. For this reason, it may be prudent for those with hypertension to increase their calcium intake. Several studies suggest that calcium may also lower cholesterol. In a study at the Center for Human Nutrition at the University of Texas, three men with moderately high cholesterol levels were given a low calcium diet (410mg per day) for ten days. Then, for another ten days, the men were given 2,200mg of calcium daily. The results showed that the high-calcium levels reduced the level of total cholesterol by 6 percent and lowered LDL cholesterol (the bad cholesterol) by 11 percent, while HDL (good cholesterol) levels stayed the same. Physical exercise can reduce blood pressure and cholesterol, but evidence suggests that this is may be mediated by increased serum calcium levels. Exercise also enhances calcium transport to the brain. This rise in calcium enhances the neurotransmitter dopamine, which seems to be the most important neurotransmitter for neurons involved in working memory. The Recommended Daily Allowance for Calcium in adults over 50 is 1200mg per day for women and 1,200mg per day for men. Food sources include milk, cheese, eggs, sardines, almonds, leafy green vegetables, and tofu. Magnesium While magnesium has not been directly connected with Alzheimer’s disease, it is known that aluminum The fourth most abundant mineral in the human body, magnesium participates in over 300 biochemical reactions. It is required for the growth and formation of human bones and muscle tissues. About 50% is of the magnesium in your body can be found in your bones. The remainder resides in blood, body fluids, organs and tissue cells, where it helps to convert carbohydrates, fats, and proteins into energy. Glucose (blood sugar) and oxygen are essential for proper brain function. Your brain uses ten times more glucose and oxygen than any other organ in your body. Changes in these nutrients can impair brain function. Magnesium helps regulate blood sugar levels. Any blood sugar volatility—hypo- or hyperglycemia—stresses the brain. Over time, dips and spikes in blood sugar can cause permanent damage to the blood vessels in the brain, and consequently damage brain tissue. Magnesium metabolism is very important to insulin sensitivity, and magnesium deficiency is common in individuals with diabetes. Heart disorders and high blood pressure are significant risk factors for dementia. Magnesium promotes normal blood pressure, and therefore reduces the risk of vascular damage in he brain. But most importantly, magnesium, in concert with calcium, maintains normal nerve function, which regulates heart rhythm. Inadequate magnesium causes muscle tissues to cramp. Since the heart is a muscle, inadequate magnesium can prevent the heart from going through a complete relaxation phase causing the next contraction to begin before the relaxation is complete. Surveys have associated higher blood levels of magnesium with lower risk of heart disease. There is also evidence that a higher magnesium intake may reduce the risk of stroke. Oxygen supply is also vital to memory function. According to a study in England, adults taking an average of 38mg of magnesium per day showed increased lung function. This increase was present in smokers as well as non-smokers. Magnesium absorption is inhibited by consuming foods high in oxalic acid, such as cocoa, spinach, and tea. Some medicines may also result in magnesium deficiency, including certain diuretics, antibiotics, and cancer medications. The use of alcohol, a diet high in fats, and large doses of zinc and vitamin D all increase the body’s need for magnesium. In addition, problems such as Crohn's disease, gluten sensitive enteropathy, regional enteritis, and intestinal surgery may impair magnesium stores. Excessive calcium intake can also cause a magnesium deficiency. Symptoms of magnesium deficiency resemble symptoms of thyroid disease, especially hyperthyroidism. Minor deficiency symptoms include irritability, anorexia, fatigue, insomnia, muscle twitching, memory deficits, apathy, confusion, and impaired ability to learn new information. Moderate deficiency symptoms include rapid or irregular heartbeat. Severe deficiency may cause tingling, numbness, involuntary contraction of muscles, hallucinations, delirium, and personality changes. The Recommended Daily Allowance for magnesium in adults is 400 mg per day. Most adults in the United States don’t consume enough magnesium, and magnesium intake is significantly lower in the elderly. Magnesium deficiency can also occur because it refined out of many foods during processing. Foods high in magnesium include dairy products, fish, whole grains, lean meats, seeds, and vegetables. Green vegetables such as spinach and kale are good sources of magnesium because the center of the chlorophyll molecule (which gives green vegetables their color) contains magnesium. Some legumes (beans and peas), nuts and seeds, and whole, unrefined grains are also good sources of magnesium Tap water can also be a significant source of magnesium, but the amount varies according the source of your water supply. Water that naturally contains more minerals is called hard water. Hardness is defined as the amount of calcium and magnesium dissolved in the water. Therefore hard water contains more magnesium than soft water. Hard water is better for you, and tastes better, than soft water. But hard water is less desirable because it requires more soap for effective cleansing, forms scum and curd, causes yellowing of fabrics, toughens vegetables during cooking. Most common types of commercial water softeners replace the calcium and magnesium ions with sodium. Therefore drinking soft water lowers calcium and magnesium intake. In Finland researchers found a significant relationship between water hardness and cardiovascular disease. For every unit of increase of water harness the risk of heart attack decreased by one percent. Chromium Chromium is necessary for proper metabolism of sugar, and is useful to people with diabetes and hypoglycemia. Glucose Tolerance Factor is an organic complex of chromium, niacin, and glutathione. It is a dietary compound that has been linked with the maintenance of glucose regulation. Without adequate supplies of chromium, insulin is less effective in stabilizing blood glucose. Chromium is also essential in the manufacture of trypsin, a digestive enzyme which is necessary for the absorption of other nutrients. It is important too in the metabolizing of cholesterol. Proper levels of chromium prevent the accumulation of deposits on the arterial walls, thus reducing the risk of arteriosclerosis. The average American eats too much refined sugar, which depletes the body of chromium. Consequently, many people today are low in both red blood cell and intercellular chromium. Lack of chromium can cause headaches, mood swings, fatigue and sweating. Studies on nutrition and the elderly show that about 70 percent of people over 65 are chromium deficient. In addition, 40 percent of people over 40 have abnormal glucose-tolerance test results, which suggest chromium deficiency. The Recommended Daily Allowance for chromium is 25mcg/day for women and 35mcg/day for men. Foods sources for chromium include molasses, egg yolks, yeast, shellfish, cheese, and whole wheat products. But the most popular source of chromium today is chromium picolinate. This nutritional supplement has been shown to be useful in stabilizing blood sugar, increasing energy, and maintaining weight loss. Germanium Germanium is found in minute quantities in many medicinal herbs, including garlic, ginseng and chlorella. Technically, germanium is a trace element found in the earth’s crust. Germanium has been considered to be a memory enhancer since the 1980s. It increases the body’s ability to accept oxygen and therefore increases brain function. Germanium also has the ability to capture heavy metal toxins in your body and to remove them within twenty-four hours. Research suggests that germanium also stimulates the immune system and has a positive effect against tumors, cancer, and several viruses. The recommended dosage is 30mg daily, while some nutritionists recommend 60mg per day. Common natural sources of germanium are garlic, onions, aloe vera, watercress, barley, the herbs comfrey, ginseng, angelica, and suma, shiitake and reishi mushrooms. Iron The average human body contains about four grams of iron, 70 percent of which is found in the blood inside a molecule called hemoglobin. Another 5 percent is found in myoglobin, the material which makes up muscle. Still another 5 percent is located in special respiratory enzymes, and 20 percent is used in the manufacturing and storage areas of the bone marrow, the liver, and the spleen. A tiny amount of iron (about four milligrams) is not bound to hemoglobin, but floats free in the bloodstream. This is recycled iron that the body actually salvages from old red blood cells, recirculates it in the blood as free iron salts and transports it to the bone marrow where it is used to make new blood cells. Iron deficiency is common in women. About one in ten pre-menopausal women is low in iron. Harold Hanstead at the University of Texas found that women given 30mg of iron a day improved their scores on memory tests by 15 to 20 percent. Iron appears to improve verbal recall, the ability to repeat what you have heard. Iron is important to the left hemisphere of the brain (in right-handed people), and affects word fluency. For some reason not yet fully understood, low iron impairs thinking and word finding in women, but not in men. Because memories are stored during sleep, any sleep disruption can impair memory. Restless legs syndrome (RLS) is a sleep disorder that plagues many older adults. Recently the Department of Geriatric Medicine of the Royal Liverpool University in Liverpool, U.K. found that the RLS improved significantly with increased blood levels of iron. Researchers have discovered that low levels of iron were correlated with a condition called akathisia, from the Greek word which means can't sit still. This is a common side effect of antidepressants. Recently some studies have suggested that too much iron in the diet can increase the risk of heart attack in men. More than 100 mg of iron are per day increases infection risk. For these reasons, iron supplements are not recommended in males unless they have a diagnosed clinical deficiency. One cause of iron deficiency is undiagnosed gastrointestinal bleeding, often caused by ulcers or the use of aspirin. Iron deficiency symptoms include breathing difficulties, brittle nails, anemia and constipation. The recommended daily allowance for iron is 15 mg per day. Food sources of iron are bananas, whole rye, black molasses, prunes, raisins, walnuts, kelp, lentils, and oysters. Manganese Manganese is important for normal central nervous system function. Like chromium, a manganese deficiency can lower your glucose tolerance, and exacerbate a diabetic condition. Manganese is also involved in the metabolism of vitamin C and the nutrient choline. While there is no recommended daily allowance for manganese, most nutritionists recommend between 2 and 9mg per day. Dietary sources of manganese include blueberries, seaweed, dried peas, avocados, nuts and seeds, egg yolks, legumes, whole grains, especially buckwheat and green leafy vegetables. Potassium Potassium plays an important role in regulating heart rhythms and in the transmission of messages though the central nervous system. It is also involved in helping nutrients to be absorbed and metabolized by the cells. More importantly for our needs here, potassium helps to maintain the body’s water balance and the regulation of blood pressure, and may also prevent strokes. Extended use of laxatives or diuretic drugs can cause potassium deficiency. Deficiencies can also be caused by frequent vomiting, diabetic acidosis, kidney disease, and chronic diarrhea. Low levels of potassium can lead to weakness, mental confusion, and general apathy. Extreme deficiency can cause heart failure, dehydration, and death. The minimum daily requirement for potassium is about 500mg The average American already consumes about 1200mg of this mineral each day, so supplementation is rarely necessary. Foods high in potassium include dairy products, fish, apricots, avocados, bananas, molasses, brewers yeast, brown rice, raisins, potatoes, legumes, meat, poultry, vegetables and whole grains. Selenium Selenium is one of the most poisonous substances known to man. It is also absolutely necessary for our survival. Selenium is a trace element, which means it is present in extremely small quantities in the body. As well as being an antioxidant, selenium increases the effectiveness of vitamin E, and has been shown to be an anti-carcinogen. Several studies show that selenium can reduce cancer in animals. Other studies suggest that there is a relationship between low selenium levels and heart attack. Selenium also helps remove toxic metals such as mercury and lead from the body. The recommended daily allowance of selenium is 70 mcg a day. Foods high in selenium include garlic, liver, brewer’s yeast, brown rice, and eggs. It is also available in multivitamins and in tablet form, combined with vitamin E. Silicon Silicon is used in the body in the formation of collagen and connective tissues, and in hair and nails. This mineral is important in that it reduces the effect of aluminum on the body, and therefore may play a role in delaying the onset of Alzheimer’s disease. There are conflicting opinions about silicon’s involvement in cardiovascular disease. Although it is known that the substance is necessary for maintaining flexible arteries, many people with atherosclerosis have been found to have high serum levels. There is no recommended daily allowance for silicon. Because silicon is found in abundance in the average American diet, deficiencies are rare. The main dietary sources are alfalfa, beets, bell peppers, beans, cereals, whole grain breads and peas. Zinc Many older people do not get enough zinc in their diet because they can’t afford the foods (such as meat and seafood) that contain it. Low zinc causes loss of taste and smell, which lessens appetite. Mari Golub from U.C. Davis studied the effects of dietary zinc using Rhesus monkeys. One group was given one hundred parts per million and the other group four parts per million in their daily diet. The low zinc animals took three times longer to learn the difference between a circle and a cross. Other studies also suggest that zinc improves associative memory. Clinical studies have linked low blood-zinc levels in the body to depression and anxiety. Although clinical trails involving zinc supplementation in depressed patients are pending, data suggest that zinc may have an anti-depressant effect in humans, and improves the outcome in those currently taking anti-depressants. In a recent government hearing, reports were given indicating that thirty-two states now have zinc-deficient soil. This makes it possible that many of us are zinc deficient. On the other hand, too much zinc can be dangerous. Some researchers believe that zinc can increase the amount of toxic amyloid (a protein that plays an important role in causing Alzheimer’s) that is deposited in the brain. Investigators at Massachusetts General Hospital found that an increase in zinc caused the amyloid molecules to clump together within only two minutes. In addition, dietary zinc has been shown to markedly decrease mental functioning in people with Alzheimer’s. Although the results are preliminary, there is enough evidence to warn against taking megadoses of zinc. This is important in light of the fact that zinc has become a popular cold remedy. 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