Because of the war, I have health problems — I feel bad physically and psychologically. Why did this happen? What to do with it? How to help myself? A very large manual from “Babel”

War can affect health directly and indirectly. Direct impact is, for example, when you were injured. If you are not in the zone of hostilities or missile strikes, the impact will still be there, but in a different way — as a stress, sleep disturbances, increased anxiety. Prolonged war and terrorism affect mental health, stress from a constant threat can cause PTSD, physical symptoms, disorders of the reproductive system, of metabolism, problems with the digestive system. However, the current war is unique for humanity — for the first time, combat operations can be followed online and around the clock. Therefore, we donʼt yet know how exactly this war will affect our health, but you can notice this impact now and take care of yourself. Together with Daryna Dmytriievska, Daria Ozerna, Olha Maslova, Tetyana Konrad and Lesya Vaskivska, we explain what to pay attention to and how to support yourself.Here at “Babel” we understand that this topic may not be relevant for most Englsh-speaking readers in the world. Though, to the very least, you will feel better what Ukrainians are going through now.

How to understand that something is wrong with the body because of the war? Maybe I should pay attention to the condition of the hair or skin?

It doesnʼt quite work that way. There are no specific markers by which you can see the impact of war on the body. You need to pay attention to whether something has changed in your body. It can be a headache, muscle pain, digestive problems, constant fatigue. Only a doctor will help determine whether this symptom is related to experiences youʼve been through. In addition, due to stress, sleep or nutrition may deteriorate, and this also affects your condition. Therefore, pay attention to changes — and for this it is important to know how you feel in your usual state.

But first of all, you should focus not on the symptoms, but on your lifestyle. Do you sleep enough, eat plant-based food, how much do you move and are you not glued to your gadgets? If you are not yet bothered by unpleasant symptoms, this does not mean that everything is fine. For example, if you donʼt sleep well, over time you will become irritable, your heart will hurt, you will start eating more sweets, which can increase the risk of developing type 2 diabetes, cardiovascular diseases, etc.

Because of the war, there are risks that are less obvious than stress: disruption of the supply of medicines, the absence of a family doctor, behavioral correction. A checkup wonʼt help if you donʼt take the necessary medications now, ignore scheduled checkups, or donʼt know if you have chronic illnesses.

Can chronic diseases be exacerbated by stress? Can hereditary diseases appear now?

Any stress increases the likelihood of exacerbation of chronic diseases — for example, hypertension or heart problems. This is normal, because the body is now actively using its resources, and diseases develop faster. On the other hand, due to adrenaline, some symptoms of chronic diseases may not appear, and when you stabilize your condition, they will return.

As for diseases to which you have a hereditary predisposition — for example, hypertension, diabetes, cancer — then they will not necessarily manifest themselves. You just need to be attentive to your own body to notice the first changes. And if you find yourself in another city or country, find out about doctors and medical facilities in advance.

After February 24, I canʼt sleep properly. Why?

This is the impact of war that almost everyone feels, but it manifests itself in different ways. The normal duration of sleep is 7-9 hours. Someone canʼt fall asleep, someone wakes up in the middle of the night and has a shallow sleep, someone sleeps more than before. Someone is in a manic phase — gets a lot done, but sleeps little, and someone, on the contrary, is in a depressive phase. It depends on the neurotransmitters and their receptors.

Now there are several sleep disorders. The first is a direct violation, when a person is conditionally in the basement, and shells and rockets are above him/her. The second is when a person is in a conditionally safe place, but regularly hears an air alarm.

Each of us has a biological clock, which seems to consist of two factors: the internal rhythm of cells and the external astronomical rhythm. That is, the body must understand how lighting and temperature change during the day and year in order to be aware of where it is and how to work normally in these conditions. And when strong stimuli appear, the brain tries to understand what to do with it, but it cannot, so, relatively speaking, it is in shock — and the rhythm of the body goes astray. This hurts.

That is why the air alarm in the early hours of the morning — from three in the morning to five in the morning — is a part of psychological warfare. After all, sleep disturbances during this period have the most negative effect on the body.

What should be done to improve sleep even during war?

Specific actions depend on where you are at night. If you spend the night or generally live in a shelter, then you need to make the lighting similar to natural. When possible, go outside. Choose the lamps so that you turn on a brighter light in the morning, and make it dim in the evening. It should be pitch black at night, so sleep with a mask or just cover your eyes with a cloth.

Those who wake up during alarms and take shelter should turn on the lights as little as possible. To do this, fold the emergency backpack ahead of time and put it next to the bed. While walking, illuminate the path with your phone — then there is a chance that the brain will not fully wake up and you will be able to continue sleeping in the shelter.

If you decide not to respond to the air alarm and you are sure that the place where you are is safe (although we still do not recommend this), you can buy earplugs to block out the sound.

And do not force yourself to sleep less if the sleep lasts more than 9 hours. In "peaceful" times, this could be an indicator of illness, but now itʼs normal — the brain does not want to wake up and see everything that is happening.

Iʼm abroad, but I still donʼt sleep well. What shall I do?

You need to consult a psychologist to work with anxiety. You can independently meditate before going to bed, ventilate the room and take a hot bath 2-3 hours before going to bed, if you have no contraindications. A hot bath helps to cool down faster afterwards, and this is important, because during sleep the temperature of the environment and the body should decrease. You can also take sleeping pills after consulting a doctor — but people in Ukraine should not do this, because such drugs dull the sense of danger.

Now I eat worse, eat less healthy food, even when I have the opportunity. Why does this happen?

Stress exhausts the body, because all resources are mobilized for survival. There was a high level of stress in Ukraine before, but now it has increased even more. Added to this is disrupted sleep patterns, and in the short term this leads to anxiety and eating disorders. A person wants something sweet and fatty — and this is a normal reaction, because the body wants quick calories and energy. Evolutionarily, the body is configured in such a way that sweet and fatty foods make it happy, because they provide calories for the functioning of the brain. And now this mechanism is turned on, overpowering the idea of a balanced diet. If too much glucose enters the blood, it must be "hidden" in fat to reduce its concentration — then the brain receives a signal that glucose is allegedly lacking, and "forces" us to take the cake again. It is better not to fall into this vicious circle.

Another type of eating disorder is when you refuse to eat. On a strong adrenaline rush, it happens to soldiers, paramedics, volunteers — and so it was to civilians in the first weeks of a full-scale invasion.

And what if I still want sweet and unhealthy food?

The simplest but most effective advice is not to keep sweets at home. If you want something sweet after reading the news, read less of it and limit yourself to reliable sources. This will free up time and energy for action. Then you can, for example, if we are talking about sweets, bake cookies and give them to volunteers. Sharing food is an evolutionary mechanism that allows us to feel better: you occupied your hands with something, reduced anxiety, did not get caught up in the news, and the brain received satisfaction for a good deed.

Why is poor nutrition harmful if the brain likes sweets?

Junk food affects the intestinal microflora. For example, sausage instead of baked meat, burger instead of salad, cola instead of water. The intestinal microbiota is sensitive to what we eat and is involved in the processes of the immune system, glucose absorption, slow inflammatory processes, and even affects the brain. So when we eat too much sugar and fat instead of plant-based food, the microbiota gets out of dynamic equilibrium — the number of some bacteria increases and the number of others decreases. This cannot be changed with probiotics because they stop working as soon as we stop taking them. Therefore, the only way is a healthy diet.

Okay, that sounds convincing. And how to start eating right?

Treat it like a medicine. Even if you want a cake with coffee, eat a salad. Relatively speaking, eat a bowl of salad forcibly several times — and later you will already want it. Because healthy people want vegetables, buckwheat or soup. If you make a salad of vegetables, canned tuna and eggs, you will get enough protein and fiber in one plate. Pay attention to the fact that there are enough plant foods, proteins, slow carbohydrates and healthy fats in each meal.

Slow carbohydrates are rolled oats, for example, which should be boiled, not poured with boiling water. It is inexpensive. Seasonal berries and flax seeds can be added to it. If zucchini or cucumbers are pickled, they will become more useful — bacteria and yeast will "add" lactic acid, B vitamins to the vegetables, useful compounds will be more available through fermentation. You can do the same with apples. And in general, now it is worth eating everything that is in season. Cherries, zucchini, cucumbers, tomatoes — whatever you grow or can buy.

Potatoes can also be useful if you bake or boil them. For puree, you need to mash it in the water in which the potatoes were boiled. Similarly, pasta can be useful if it is prepared correctly — do not cook it to the end, but let it cook in a sauce with a ratio of 50 to 50. It can be meat, tomatoes, vegetables, fish, cheese, greens. The main thing is the proportion. With the right one you will get a useful amount of slow carbohydrates. Also, it is normal during physical exercises.

As for cereals, you should avoid couscous and soft oatmeal, but it is useful to eat wheat, barley, corn, buckwheat groats, millet and bulgur. It is also useful to eat chickpeas, beans, green peas, if they do not give you a stomach ache. It is cheaper and healthier than meat, for example. For an adult under the age of 65, it is enough to eat meat twice a week, as well as fish. You can eat mackerel to compensate for the need for unsaturated fatty acids. In fact, healthy eating is not as expensive as it may seem. The main thing is balance and proportions.

I had an operation planned, but it seems not urgent. Does it make sense to intervene so much in the body now? What about vaccinations?

Vaccinations must be done, because chronic stress weakens immunity and the course of viral diseases can be complicated.

As for operations, consider their nature and level of danger. If your hospital is under fire, itʼs better to wait, of course. Pay attention to the occupation of surgeons — perhaps they are involved in helping in critical situations. If acute stress has a positive effect on the bodyʼs ability to recover, then chronic stress can weaken it. But if you have the opportunity not to postpone the planned operation in a safe city, it is better to do it. The situation with COVID-19 may repeat itself, when people died not only from the disease itself, but also from the fact that they stopped going to doctors with other problems.

Can war affect the condition of teeth?

Yes, of course, and this influence is only negative. Firstly, many people clench their teeth due to stress — because of this, the tooth enamel cracks, causing a headache, because the strong muscles of the jaws are constantly tense. Secondly, chronic inflammatory processes are getting enhanced. Thirdly, due to "eating" stress, an increase in the amount of sweets in the diet and food such as chips, a plaque forms on the teeth, where it is "convenient" for bacteria to multiply — later, because of this, tooth decay develops. This applies even to previously healthy teeth. In addition, during the war, people pay less attention to dental hygiene and regular visits to the dentist.

I plan to get braces, but Iʼm afraid I wonʼt be able to take care of them due to a possible evacuation. What shall I do?

Orthodontics is something that can be postponed now, although problems with the teeth usually should not be delayed. But the fact is that due to going abroad, it will really be more difficult to take care of the braces, and it will not be easy to find an orthodontist who will continue the work that someone has already started. In addition, it will be very expensive.

How to understand that I need to see a dentist?

The first sign is tooth sensitivity when you eat something cold or sweet. The second is pain when biting, which indicates that chronic inflammation is worsening. For example, a cyst develops asymptomatically, and pain may mean that the process is worsening. Also, teeth can become brittle due to a lack of calcium in the body, but this can be determined by a doctor based on tests, so you should not take drugs yourself — because if there is too much calcium, sand or stones can form in the kidneys. If you have bleeding gums, you need to do a simple brushing — it could be plaque or tartar. It also means that you are not brushing your teeth effectively and you should probably change your toothbrush.

How can war affect my reproductive system? How to notice these changes?

Chronic stress affects the reproductive system at the level of sex hormones. In women, the duration and regularity of the cycle may change, the cycles may be anovulatory. A delay of 9 days is a reason to consult a doctor. And in general, one should not forget about standard examinations by a gynecologist and a mammologist, Pap tests for the risks of malignant neoplasms of the cervix, and palposcopy. The exact effect of stress on your reproductive system can only be determined by a doctor, but for example, in case of women stress produces more male sex hormones, and an imbalance can alter the insulin resistance system. This manifests itself in weight gain, for example.

As for the impact of stress on civilian men, volunteers who have significant physical exertion are at risk. This can cause varicose veins in the scrotum, and then, if the man already had a deterioration in the spermogram, it can worsen the situation. However, if the indicators were normal, the impact of stress will be insignificant.

My previous anxieties and fears intensified and I was once again alone with problems that seemed to have been solved. Is it because of the war?

Yes. We are now faced with a very big threat, and in such a situation the psyche falls back to previously tested behavioral strategies. The world becomes black and white, where simple questions require “yes or no” answers. But it is possible to return to the previous, more stable level — it just takes time. This is the reverse process.

I plan to go to a psychologist. Is this a good moment?

Now is not the best time to work deeply with a psychologist or psychotherapist. The main task is to contain emotions and stabilize a person. Thatʼs why support groups that are not psychotherapy but run by psychologists work very well. There, a person can put together a broken world again and find support.

I donʼt want to join a support group. Are there any exercises I can do on my own?

Yes. For example, the breathing exercise "one" — you need to sit or stand so that you rest firmly on your feet, and make each inhalation twice as short as exhalation.

You can take any thing and with closed eyes determine its shape, texture, weight, temperature, smell.

There is a classic exercise "5-4-3-2-1". You need to name five things that you see around you, four sounds that you hear now, three different surfaces, two smells and one taste. In the same way, you can make a list of pleasant things for each sense organ and be guided by it, doing something for yourself every day.

Another version of this exercise is to ask yourself the questions "who am I?", "where am I?", "what am I doing?".

You can make to-do lists and cross off what you have done, go for a walk, take care of your nutrition, take a bath if you have the opportunity, observe nature by choosing a specific plant near the entrance, for example. This allows you to return to reality and see life nearby.

Maybe I should take anti-depressants or something to calm me down?

Without a doctorʼs appointment — no, you shouldnʼt. Medicines should be prescribed by a psychiatrist after consultation. He or she will be able to choose the drug and dosage. Correct dosage is very important — stress can affect, for example, the kidneys, and a too strong drug will additionally burden them.

If you do not have the funds to visit a doctor, you can apply for a free consultation online.

And if you can now get a prescription for yourself, then taking medicine is a good idea. Our task is not just to survive, but to endure this marathon. It is important not to pretend to be a hero. So we should be more healthy both physically and mentally.

I donʼt remember well and I canʼt think as fast as I used to. Is this how war affects? Is it forever?

Yes, because of the war, the cognitive abilities of most people have deteriorated. But we donʼt know what the long-term impact will be because we havenʼt had situations like this before. Now we are all watching a war online and our brains are convinced that it is happening nearby. The process involves the oxytocin system, which, relatively speaking, is responsible for empathy, the stress response system, and the overall psychosocial experience of a person. In addition, some feel the additional impact of post-covid, which has also impaired cognitive abilities.

What else, apart from memory, could be affected?

First of all, the memory itself can suffer in different ways: someone cannot remember a past life, and someone immediately forgets what was for breakfast. The ability to concentrate has decreased — many people had problems with this before, but now the situation has worsened. This is natural — you canʼt look at scary images for a long time, the brain tries to "turn them over" as quickly as possible, and over time this strategy spreads to everything.

The ability to be creative, as well as to learn languages, has deteriorated, the active vocabulary may decrease, uncharacteristic banal mistakes in writing appear.

There is no single mechanism for these processes, but in general this happens due to the fact that resources from the "young" prefrontal cortex are drawn to the evolutionarily "older" departments responsible for survival.

Are there any exercises or tests to determine the level of problems with memory or concentration of attention?

There is no selection of such exercises at home, but if you are reading this text and it seems to you that it applies to you, it probably is true. Sometimes it is enough for people to learn about such conditions in order to recognize them in themselves. Remember what you could do before, but now it has become more difficult. For example, you learned languages, but now new lessons are more tiring, and words are forgotten.

Okay, I guess this is about me. How to help myself?

You can limit the number of channels or accounts where you get news. Choose a few reliable sources and donʼt read those that try to beat the emotions out of you with headlines like "Russians are killing our children". This is already known, there is no need to open the wounds.

But in general, you can follow the advice to prevent dementia. First, have an enriched environment. This means that you must interact with a wide variety of sensory stimuli — auditory, visual, gustatory. Then the brain has a reason to work. Here, nature can become a magic pill: walk barefoot, touch the leaves, walk near water bodies, watch animals. And donʼt forget about social interaction.

Secondly, it is useful to meditate. It is not about religious practice — it is necessary to teach the brain not to generate thoughts, to calm it down. It is difficult, but if you meditate once a day, it will help to cleanse yourself of emotional overdose.

The third suggestion is to use fine motor skills. And also do sports that bring you pleasure.

For the human brain, a situation where there is both novelty and routine is perfect. You have to maintain this balance, so if you can get new experiences and at the same time do not forget about safe rituals — thatʼs great. The ritual can be drinking from your favorite cup, sniffing your favorite essential oil, walking with your dog. If you are not at home, create your own corner.

It is also advised to keep a diary, but rewriting memories can be further traumatizing. So focus on your own feelings — if you feel comfortable recording your experiences, do it. If not, itʼs better not to. The brain can "turn off" memory for protection.

Maybe sports or physical activity will help me?

Yes, absolutely. It improves both physical and mental health. Physical activity is a mandatory component of anxiety treatment. Therefore, find an activity that you like. Working with a psychologist or therapist will also help you deal with stress.

Itʼs summer, but maybe itʼs worth drinking vitamins?

No, you should not do this without consulting a doctor. Even vitamin D, which is lacking in most of Ukraine, must be taken as prescribed in order to choose the right dose. As for other vitamins, you need to take tests. If you were under occupation and were starving, you should take them only under the supervision of a doctor. And if you eat normally, most vitamins get with food and additional ones are not needed. Too many vitamins also cause diseases — for example, they harm the kidneys or liver.

Which doctors should I make an appointment with and which tests should I take?

Donʼt take tests — a general blood test, determination of hormone levels or any other — just because you want to. They should be prescribed by a doctor according to your condition and then he or she will interpret the results. So, to begin with, contact your family doctor, who will examine you, interview you and determine what exactly to submit. Your family doctor should become your primary health care partner.

Translated from Ukrainian by Anton Semyzhenko.

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