Welcome to Paging Dr. Gupta. This is the show where I get to answer your health questions. I really appreciate you sending so many in. My producer, Andrea, is with us today. Who do we have up first?

Hi Sanjay. We've gotten quite a few questions about just how hygienic it is to wear shoes inside the home. Where do you stand on the issue?

Should you wear shoes in the home? I have a lot of strong thoughts on this. We'll step into that debate right after this short break.

'Welcome back to Paging Dr. Gupta. So, shoes on or off in the home? Especially when it comes to thinking about hygiene. First of all, let me say this. In some cultures, it is just customary to take off your shoes when you enter an indoor space. Japan, Korea, China, some Muslim countries, as well as countries in Northern and Eastern Europe. I was just in Denmark. People take their shoes off when they enter the home. The reasons for this can vary greatly. Some of it is to honor religious and spiritual traditions. Sometimes it's just a sign of respect, a cultural norm or a custom to protect the floors. Simple as that. For comfort, you're signifying that you're home now and you can relax and unwind. And then yes, for hygiene and cleanliness. And when it comes to this last point, it's not even close. Hands down, not wearing shoes in your living space is much cleaner, much more hygienic. Look, the soles of your shoes. They track in a wide range of contaminants, some of them potentially harmful: bacteria and viruses, including drug-resistant pathogens, especially, for example, if the shoe wearer, like me, was visiting a hospital. Now, there was this one famous or perhaps infamous experiment conducted in 2008. It was done by this microbiologist at the University of Arizona, and they found after two weeks of wearing shoes, 10 participants were found to carry 421,000 units of bacteria. Per square centimeter. That's a problem. You also have things like pesticides and herbicides and other chemicals from lawns or dry cleaners or worksites or even just asphalt can carry those things. Heavy metals and of course even things like animal waste. So you might not just come into physical contact with something unpleasant, but those things that I just mentioned could impact your air quality as well. So it's not just the ground but the air that's impacted by wearing shoes in the house. People spend up to 90% of their time indoors. And according to a pair of environmental chemists, 30% of the matter that builds up in an indoor space is imported from the outside. Let's say you've got a hermetically sealed home. If you're going in and out of that house, especially with your shoes on, you're importing a lot of the air that builds in that indoor space. And a lot that can be coming from your shoes. Now, I did say at the start that it's not even close, whether removing your shoes is more hygienic. It is more hygenic, that is true. But to be clear and to be fair, experts do point out that the amount of quote unquote "stuff" that you track in on the bottom of your shoes is probably not enough to make a healthy adult sick. There are plenty of other sources of germs, both in and outside your home that you come in contact with. Your kitchen sponge, for example, your smartphone, your pets, things like that. But, if you have young children and they're still crawling around, if you have someone in your household who's immune compromised or you're immune compromised; if you are a guest at a no shoes home; or you simply want less debris in your own space, whatever it might be, it's probably worth just kicking off your shoes before entering the home. We do that in our household. It is pretty natural. When people come over to our house, they pretty much take off their shoes. We don't always require it like we did when the kids were very young, but it is sort of customary in our house to do so. So it might be worth kicking off your shoes before entering your home or the home of someone else. All right, now when we come back, we're gonna talk about navigating a tricky balance. How to stay informed with all that is happening in the world today while also managing your mental health. How to do both right after the break.

Hey everyone, welcome back to Paging Dr. Gupta. I know coping with the news cycle can be tough and particularly tough lately. So I thought it would be good to rewind to a previous episode where I talked with a psychiatrist, Dr. Gail Saltz, about how to prioritize our mental health and that of our children while still staying informed. As a journalist, I'm so proud of the work we get to do on the ground. It's important, it matters. But, I've got to be honest. That news can also be hard to absorb, to take in and experience. As a dad in moments like these, I can't help but worry about what my kids are seeing and what they're hearing. And you, if you're feeling burnt out or overwhelmed or burdened by what you're seeing or hearing on your screen or social media feed, I want to tell you this, I'm feeling it too. A lot of people are. Right now, I think it's important to talk about what we can all do to take care ourselves, to take care of our brains and our minds. And to take care of those we love.

And I'm not saying, hey, crawl under a rock and have no idea what's going on. I'm, not advocating for that, but I am advocating for perhaps not scrolling through on the social media where there's no trigger warning, there's no warning, it's just a constant diet of really upsetting images.

That's Dr. Gail Saltz. She's a clinical associate professor of psychiatry at the New York Presbyterian Hospital and Weill Cornell Medical College. She's also host of the podcast, How Can I Help? So I have three children, you have three children, I have 3 girls. And I'm curious with regard to what's happening in the Middle East right now, should I be bringing this up with them? Should I wait for them to ask me questions? How do you approach it?

Yeah, I also have three girls who are a little bit older. This is really, I would say, the rule of thumb. Unfortunately, because there is so much social media and so much discussion and so on, it chances are your child has absolutely heard something already. If your child is over 10, I would to say to you, you want to open up this conversation because you wanna be the trusted source and you want them to be able to talk to you about it. And you do that by basically saying, what have you heard? What do you know? What do feel about what you've heard and what you know, and let them tell you. Then let them ask you questions that you should answer honestly. You don't have to be super graphic to answer honestly, and sometimes the answer is I don't know. The answer is, I don't know. You say, you know what? But I'm gonna try to find some answers. But the idea is that you want them to know that you're always available to talk to them about their feelings. And I would talk to your kids who are over 10 about limiting what they're seeing because it will be better for them and you need to explain it that way. Hey, look, I'm very aware, seeing all this all the time, it's not good for your mental health. And we have to prioritize our mental health, so for the next week, let's just say, we can check in after that. Let's just remove the TikTok or let's remove certain things. And take a vacation from that while this is so disturbing and going to disturb you. Because if it would help, great, but it's actually not gonna help. And then that's another thing to do with kids is sort of talk about, can we think about helping? Helping for adults and kids is a great defense mechanism. It really, you know, it helps people to feel better when they are feeling scared and helpless and so on. So, that's how I would tackle it. When your kid is under 10, it's going to be very difficult for them to understand a lot of these things. So again, I would listen for any evidence that they've heard anything about anything going on. And then obviously, if they have, you want to ask them similar questions.

'You are a psychiatrist, and you're well-informed. So how do you sort of balance being well-informed while also being really diligent about your own mental health?

I do practice what I preach and I will limit what I'm looking at. I will limit it either by, you know, saying like, okay, that app, I'm not opening that anymore. I'm going to look at my headline in the morning. I might look again in the afternoon and say like, where are things? And I'll read as opposed to looking at images. And if I feel that I'm being particularly stoked, I might increase the coping tools that I do personally find are helpful for me, because I know that bringing down my body's physiologic sympathetic nervous system response will bring down the thoughts in my mind as well. You know, Joseph LeDoux at NYU, brilliant researcher, and the one who really let us know so much about the amygdala and fear, also really helped us to understand that anxiety often once it's started, is happening first in the body. And then our frontal lobe says, well, wait a minute, let me come up with a thought that makes this make sense, that I'm having this physiologic anxiety. So it always feels to us like we thought a thought and then our body had this response, but often it's the other way around, but it happens so quickly, so quickly that it doesn't feel that way. When you really ground and relax your body and try to bring up your parasympathetic response, it helps your mind as well. And so I do things that help me to do that.

This does feel like an inflection point. There are horrible things we've already heard and seen, but as you point out, Dr. Saltz, it's going to continue for a while, and there's gonna be really, really tragic stories that we continue to hear and images that we see. So if someone does, is in your office and you want as part of their treatment to help them, talk them through relaxation, what are some of those things? I wonder if you can talk us through that.

Sure, so paced deep breathing is really quite simple. You know, you would put your hand on your chest.

I'm gonna do this as you're describing it.

Sure. You're gonna put your hands on your chests because you would like to inhale and have your chest, upper chest expand and not your belly. That is sort of to help you have a deep diaphragmatic breath. And you would breathe in through your nose with your, hopefully your hand, your chest rising to a count of five, a slow count of five. And then you would breathe out through your mouth to a slow count of seven, a little longer exhale than an inhale. And the reason is we know on that long extra exhale is what slows your heart rate just a little bit. And that helps bring down, you know, bring the anxiety down. So doing that slow deep breathing, close your eyes, be in a very relaxed position, sitting down, things shouldn't be tensed up, you, you. And doing that for about five minutes, 10 minutes, should leave you afterwards feeling more physiologically relaxed. Alternatively, progressive muscle relaxation is tightening a muscle group to a count of five, holding the muscle group very, very tight to a account of five and then releasing it. You would start with your feet, flexing your feet, holding that very tightly for a count of five and then releasing, tightening your calves to a count five and releasing. You would work your way up your legs. Then you would do your arms, you know, to a a count of five. I'm not counting to five, but it would be longer than this obviously. And then releasing and you would that with your shoulders, with your neck. And then at the end, scrunching your face to a count of five, and then releasing. So when you get basically to the top of your head, you should be more relaxed.

'Now again, that was a clip from a previous episode that originally aired in October of 2023, but in so many ways it feels as, if not more relevant than ever before. I really recommend you listen to the whole conversation about how to cope with the news with psychiatrist and podcast host, Dr. Gail Saltz. I think the bottom line is that it's important that we take the time to check in on how we're feeling with our kids, our friends, and ourselves. That's all the time we have for today, thanks for tuning in this week, and please keep calling in and sending questions. If there's something health-related you've been wondering about, record a voice memo and email it to pagingdrgupta@cnn.com. That's pagingdrgupta@cnn.com, or give us a call at 470-396-0832 and leave a message. Thanks so much for listening.