Betsy Blazek-O’Neill, MDAllegheny General HospitalIntegrative Medicine Program

INTEGRATIVE HEALTH AND LIFESTYLE PROGRAMMING

Hippocrates: 3rd century B.C.

•“The natural force within each one of us is the greatest healer of disease.”

Voltaire: 18th century

•“The art of medicine consists of amusing the patient while nature cures the disease.”

Modern medicine: 2014•“The art of medicine consists of waiting until the patient is as sick as possible and then devising every possible method of preventing the body from healing itself.”

What do people believe about health?

•My health is determined by genetics.• I will get certain diseases because they run in my family.

•Getting an illness is just bad luck.• If I get sick, there is a medicine for that.•Humans live longer now than ever before, so we must be healthier than ever.

•Medical technology is so good now that we can treat anything.

What are realities about the current state of health in Americans?• Most illnesses are caused by unhealthy lifestyle choices that people make.

• Many illnesses are inadequately treated by available medical advances.

• Many health problems are caused by the treatments that people undergo for other health problems.

• Many people spend a significant portion of the latter portion of their lives in a debilitated condition, unable to enjoy activities they previously enjoyed, and often requiring assistance for activities of daily living.

• Length of life does not always translate into quality of life.

Three biggest killers:

•HEART DISEASE•CANCER•STROKE•All largely preventable!!!!!

Tobacco = BAD

Let’s look at the data…• A sedentary lifestyle is one of the top risk factors for heart disease

• We’ve known this since the 1960s and multiple studies have confirmed this finding

• Exercise also reduces obesity and the incidence of diabetes, both of which are separate risk factors for heart disease

• Effects on circulation and metabolism

Let’s look at the data…

• Moderate and high levels of physical activity are associated with reduced risk of total, ischemic, and hemorrhagic strokes

• 25 to 27% reduction of stroke

Let’s look at the data…• Summary of research by

National Cancer Institute:• Physical activity is a critical

component of energy balance (how weight, diet and physical activity influence health)

• Strong evidence that physical activity is linked to reduced risk of colon and breast cancer

• Several studies demonstrate links between physical activity and reduced risk of uterine, lung and prostate cancers

Let’s look at the data…

• Regular exercise reduces the risk of developing lung disease

• Moderate to high levels of regular physical activity are associated with reduced lung function decline and COPD risk among smokers

Let’s look at the data…• Research shows that many of

the changes attributed to aging are actually caused in large part by disuse.

• Dallas Bedrest and Training Study: Healthy 20 year old volunteers placed on bedrest for 3 weeks developed physical characteristics of elderly men

• Endurance training regimen reversed these effects

• 30 years later, when they had developed age-related physical changes, exercise training reversed 100% of the 30-year age-related decline in aerobic power

Let’s look at the data…• Researchers from the London School of Economics, Harvard Medical School and Stanford University School of Medicine found in 2013 that exercise was as effective as medication for treating diabetes, heart disease, and stroke

Let’s look at the data…• High intakes of processed

meats, eggs, red meats, and high-fat dairy products associated with biomarkers of heart disease risk

• Greater dietary fiber intake is associated with a lower risk of both cardiovascular disease and coronary heart disease

• For both fruit fiber and grain fiber, risk of heart disease inversely proportional to intake (the more you eat, the lower your risk)

Let’s look at the data…

• A recent Harvard University study concluded that eating five daily servings of fruits and vegetables can lower your stroke risk by 30 percent. Citrus fruits and vegetables such as broccoli or cauliflower are particularly beneficial

Let’s look at the data…

• Research is discovering that intake of fruits, vegetables, and cereal grains may interfere with the process of developing cancer of the oral cavity, larynx, esophagus, stomach, colon, lung, prostate, and rectum

Let’s look at the data…

• There is also evidence that total fat intake of greater than 30 percent of total calories can increase the risk of developing some cancers. This is especially true when total fat intake includes saturated fat and possibly polyunsaturated fat

Let’s look at the data…

• Evidence suggests that some components of food may play a role in decreasing the risk of developing cancer, including phytochemicals, antioxidants, and omega-3 fatty acids

• These substances are found in things like fruits and vegetables, green tea, oily fish, nuts

Let’s look at the data…

• The Arthritis Foundation and other groups and experts recommend following an “anti-inflammatory diet” to reduce arthritis and pain symptoms

• (In fact, inflammation related to most disease processes…)

Let’s look at the data…• High stress levels has been associated with increased risk of upper respiratory infections

• Highly stressed individuals are less likely to respond to vaccination

• Stressed individuals have lower levels of natural killer cells important in preventing illness

Let’s look at the data…

• Studies have shown that women with breast cancer who participate in a stress management program are about 50% less likely to get recurrent cancer and about 60% less likely to die of cancer

Exercise, healthy diet, stress reduction

• Human bodies are built for movement

• Human bodies are built to run on healthy fuels

• Human bodies are designed to handle SHORT periods of stress

• Inadequate exercise and improper nutrition lead to problems with insulin metabolism

• Problems with insulin metabolism lead to unchecked inflammation

• Unchecked inflammation causes most disease processes

• Chronic stress impairs immune system function

• Newer research also ties chronic stress to inflammatory pathways

So what now?• Most people know they

should eat better, exercise more but they don’t

• Most people don’t know about the link between stress and health and the need for regular relaxation practices

• Doctors AND patients find it easier to prescribe and take pills than to promote or adopt healthier lifestyle habits

Long-term benefits…• Our culture has difficulty making short-term changes when the benefit is perceived of as a long way off

• People think of healthy eating, regular exercise and regular stress management practices as just more stuff they have to do

The default position…

Compare and contrast:

How do we change behaviors?• We have to educate our patients and the public about the importance of healthy lifestyle behaviors: Why is this important?

• Patients need COACHING: practical, doable steps that promote confidence and well-being; encouragement to build on small successes

The coaching model:• Meet the patients where they are

• Serve as a role model• Small steps that are seen as improvements in life, not onerous chores

• Individualized programming

• Frequent visits or follow-up

• Teach skills: how to cook healthy food, how to read a label, relaxation techniques, how to use a pedometer

Innovative approaches:• Acupuncture, relaxation techniques to support tobacco cessation, weight loss, stress management

• Yoga, tai chi for exercise AND relaxation

• Cognitive behavioral therapy, dialectical behavior therapy, mindfulness training

• Many others!

Epidemic of substance abuse

• As a nation we are massively over-medicated

• It will take everything we can muster to to dig the American public out of the black hole of over-reliance on medications

On a larger scale:• We have to serve as role models for the community

• We have to help develop systems that make lifestyle modification counseling and coaching accessible for patients and the public

• We have to work toward a culture that promotes health instead of illness

On a larger scale:

•We have to change the way health care occurs for everyone

As a nation, we need:• Non-industrialized food sources

• Work schedules that allow people time to exercise, prepare healthy foods, and relax

• Opportunities to connect with others

• Opportunities for spiritual growth and connection

Affordable Care Act

• Moving toward a system in which providers are paid based on OUTCOMES, rather than just for providing services

• Current difficulty is in getting from present fee-for-service model to a new paradigm based on outcomes (no road map)

• We can help show them how to do it…

Mahatma Ghandi

•“Be the change you want to see.”