In the past few weeks this column has been devoted to the “pillars of health”. We’ve covered the first three pillars: Nutrition, Exercise, and Care of Mind and Spirit. The fourth pillar, Personalized Medical Care, brings it all together in a practical way to enhance health and minimize disease, improving our overall wellness. Each of us has a unique combination of food preferences (nutrition), activity capabilities (exercise), and attitudes and beliefs (care of mind and spirit). We require a health care system which applies proven best practices and understands and builds on our uniqueness.
The nationwide average amount of “face time” with your doctor is only seven minutes per visit. This results in a one-size-fits-all cookie-cutter approach to your care. A few physicians are breaking away from this inadequate approach, embracing Personalized Medicine. By devoting the time it takes to really listen, ask the right questions, and thoroughly review your history, appropriate tests can be done to find the root cause of your symptoms. Then the best therapies are recommended, going beyond prescription meds to include lifestyle therapies. Our team approach includes regular consultations with our Health Coach to support you.
Let’s take the example of a 65-year old patient in our practice. She came to us frustrated and demoralized because she felt drained of energy, had chronic pain in her back and shoulder, and felt out of breath with even mild exertion. After seeing multiple specialists, she was on prescription meds for chronic pain, hypertension, cholesterol, depression, and sleep. No cause for her shortness of breath had been found, and she was worried.
My office gathered the records from the specialists she’d seen and the tests she’d had for my review. Careful questioning revealed that a decade ago she was a regular hiker and swimmer. She had given up swimming because of a shoulder injury that never fully recovered after surgery. During that period she started having lower back pain that further restricted her. As her pain became chronic, her mood worsened and her sleep became disrupted. She had gained some weight but had a high-normal BMI, meaning that according to the guidelines she was at a healthy weight for her height. After our initial visit I walked her down the hall for a Lifestyle and Fitness Evaluation with our Health Coach. Body Composition Testing revealed that in spite of her normal BMI, she had a profound deficit of muscle mass. Inactivity and normal aging had caused her muscles to shrink and body fat to increase. Her normal BMI had hidden this. Also, her years of calorie-restriction dieting without careful attention to nutrition had starved her muscles of protein. Without healthy muscles to stabilize her joints she had chronic pain. And her shortness of breath came from having so little muscle to move herself around. Our Health Coach designed a nutrition, exercise, and stress management program for her. Gradually she regained muscle, strength, clarity, sleep, and a return to a sense of well-being. Two years later she has returned to good health, is off most of the prescription meds and on a regular program of water exercise and walking with friends. When the four pillars are all strong and in balance, life is good! This is the power of Personalized Medicine – the fourth pillar of good health.
When we talk about “good health” we are really talking about a state of physical and emotional well-being. You are able to actively participate in your life’s activities, following a path of purpose and finding joy in it. You have inner resources to help cope when things go wrong and resilience when faced with changes beyond your control. These qualities are essential to good health, and comprise the third pillar we will discuss today.
We all need to cultivate attitudes and beliefs that build rest, relaxation, renewal, and relationships into our daily lives. Without these key elements we are vulnerable to a variety of disorders that erode our health. These include hypertension, arterial diseases like heart attacks and strokes, diseases of the gut like gastritis and colitis, anxiety, depression, chronic pain, headaches, sleep disturbance, immune disorders, and even asthma and blood sugar problems.
Fortunately, there are concrete steps you can take to strengthen the third pillar:
Learn to relax your mind and body. There are a variety of relaxation techniques and tools to help. Dr. Dean Ornish’s book The Spectrum includes a DVD with a variety of guided meditations. Try the free cell phone app Insight Timer for both guided and breath meditations. RespeRate is an FDA-approved device that develops the relaxing power of breathing to lower blood pressure (and reduce stress). For a simple sequenced relaxation, lie down and starting with your toes, relax them fully, releasing tension with each breath. Move your attention up your legs, belly, chest and back, arms, neck, and head. Then focus on your nostrils, feeling the breath going in and out without effort until you are ready to slowly return to a sitting position.
Prioritize sleep. Learn the elements of sleep hygiene and practice them regularly.
Practice prayer/meditation regularly. Cultivate an attitude of gratitude. Learn about mindfulness and compassion and integrate them into your daily activities.
Spend time in nature. Our connection with nature is innate and profound; this is called biophilia. Draw from it by spending time outdoors, or even looking at images of the natural world. Just having views of natural features (like trees and shrubs) leads to reductions of stress and mental fatigue in students. Exercise in outdoor natural environments provides all-around health benefits, including stress reduction and improvement in mood and sense of worth.
Find a purpose, something that reminds you that you’re not the center of the universe. Something that brings you joy and that you share with others.
Be of service.
Nurture human relationships, including taking care of yourself.
The evidence that exercise is essential to good health is mounting: Those of us who exercise regularly live longer and enjoy better quality lives. Studies from just the last decade have shown that exercisers reduce their risks for heart disease, hypertension, stroke, insulin resistance, type 2 diabetes, breast and colon cancers, adverse blood lipid profiles, weight problems, osteoporosis, fall-related injuries, and sleep disorders . . . to name a few! A physically active lifestyle results in higher levels of cardiovascular and muscular fitness along with neurochemical changes to the brain and hormonal systems. These beneficial effects improve memory, cognition, overall mood, and functional wellness. So what kinds and types of exercise are needed to get results? According to the American College of Sports Medicine and the Centers for Disease Control and Prevention (CDC), here are the standard guidelines for optimal fitness in apparently healthy adults and older adults: Aerobic activity: 3-5 days a week
Moderate intensity - power walking, hiking, or water aerobics for 150 minutes a week, or
Vigorous intensity – Indoor cycling, dancing, swimming laps for 75 minutes a week, or
A combination of moderate and vigorous aerobic activity.
Activity must be done for at least 10 minutes at a time.
Want to know how hard you should be exercising? The CDC uses a scale of 0-10, zero being at complete rest and ten being maximum exertion. Moderate intensity is on the scale at 5-6, meaning the heart is beating fast and you are breathing harder. You can talk but not sing. Vigorous exercise has higher increase in heart rate, breathing is more rapid, and talking is reduced to only a few words at a time. Strength Training: 2-3 non-consecutive days a week, working every major muscle group in the body. Two to four sets of each exercise are recommended.
8-12 repetitions improve strength and power.
10-15 repetitions improve strength in middle-aged and older persons starting exercise.
15-20 repetitions improve muscular endurance.
Flexibility and Neuromotor Exercise: At least 2 days a week
Static stretching is the most common type of flexibility exercise; hold a stretch around 30 - 60 seconds per muscle group. You should stretch when the muscles are already warmed up.
Yoga and Tai Chi help with flexibility, strength, balance, and coordination.
The challenge today is to act on all this good news about the benefits of exercise. Why wait until a disease is full blown and needs prescription medications? Detect the early stages and root causes of disease and reverse them through lifestyle changes before prescriptions are needed! Using lifestyle therapies for disease management can minimize or even eliminate the need for prescription meds. This lifestyle medicine takes more time and more staff, including a Health Coach with the training and tools necessary to help you achieve and maintain your optimal health. Let’s do it!
Learning the principles of healthy eating can seem overwhelming. There are books and blogs and websites and articles and experts spouting advice everywhere you look. It's not surprise most people don't even know where to start. Michael Pollan, in his book Food Rules lists some easy-to-follow (and fun!) tips that can help. Here a few of our favorites:
Don’t Eat Anything Your Great-Grandmother Wouldn’t Recognize as Food.
Shop the Peripheries of the Supermarket; Stay Out of the Middle.
Avoid Food Products That Have More Than Five Ingredients, or Ingredients a Third-Grader Can’t Pronounce.
If It Came From a Plant, Eat It; If It Was Made In a Plant, Don’t.
The Fewer the Feet, the Better the Meat. (Fish = no feet, Chickens = two feet, Pigs & Cows = four feet; Think of Plants as one-footed.)
Eat Your Colors, and Serve the Vegetables First.
Treat Meat as a Flavoring or Special Occasion Food.
If You’re Not Hungry Enough to Eat an Apple, then You’re Probably Not Hungry.
Eat When You’re Hungry, Not When You’re Bored.
Treat Treats as Treats.
No matter what approach you take, whether it’s Dr. Fuhrman’s Nutritarian eating, USDA MyPlate, low-carb, Paleo, or a plan of your own, focus on these practices:
Crowd your plate with brightly colored vegetables and fruits that are packed with phytochemicals and micronutrients.
Have some protein – preferably plant-sourced – with every meal.
Sit at the table when you eat. Not at your desk, not in your car, not standing in the kitchen. Turn off the TV and the radio. Focus on and enjoy your meal.
Avoid processed foods (like refined flours, pastas, sugars, and sugary drinks) that are packed with empty calories and spike your blood sugar.
Eat fruits, vegetables, and proteins for your snacks.
Drink a glass of water with and between every meal, and also when you exercise.
When you eat real food you’ll need fewer rules. And when your fork meets your plate, remember Michael Pollan’s guiding principle, seven simple words:
With over 50,000 nutrition books and countless “experts” out there, learning about nutrition can be overwhelming. The good news is that the basics are actually pretty simple - so here we go!
Protein Proteins are present throughout our bodies and integral to all our bodily functions. They are large, complex molecules made from only twenty-one different types of amino acids. Enzymes, hormones, neurotransmitters, structural components, immune functions, transport molecules, alternative fuel . . . proteins do it all!
Since protein is not stored in the body, a healthy diet should provide protein with every meal. Shoot for around 30 – 45 grams per meal, depending on your size and activity level. If you exercise a lot, especially muscle-building, your daily total should be one gram for every pound of your ideal body weight.
Don’t limit yourself to animal proteins! Beans, peas, nuts, grains, and many vegetables are excellent protein sources and can provide all the amino acids we need.
Carbohydrates Carbohydrates are basically fuel or fiber. There are two basic types:
Simple: Think table sugar, milk sugar, honey, nectar, maple and fruit syrups, jams, ripe fruits, sugary drinks, and candies. The simple carbs are single or paired sugar molecules that break down easily into the body’s core fuel – glucose.
Complex: These include starches and fibers, long and complex chains of sugars. Some of these - refined grains and flours, highly processed foods, and some starchy vegetables like potatoes - are metabolized quickly into sugars, so avoid them. Stick with the healthier carbs found in whole grains, most vegetables, beans, peas, and other legumes. These are rich in micronutrients and fiber that contribute to good health.
Fat With fats, the amount and types you eat really matter. Less than a third of your total daily calories should come from fats.
Go for the Good Fats (mono and polyunsaturated fats) that come from plant sources like nuts, seeds, grains, olives, avocados, corn and soy, and also fish. These are rich in omega-3 and omega-6 essential fatty acids.
Cut back on the Bad Fats (saturated fats) found in animal products. With animal-sourced foods, the lower the fat content the better.
Don’t eat the Really Bad Fats - the trans fats used in processed foods to increase their shelf life. Look for the words hydrogenated or partially hydrogenated on labels.
Water Water is an essential nutrient. As you age, your thirst diminishes so you’ll have to make a conscious effort to stay hydrated. The recommended amount is two to three liters a day, but that can vary depending on individual circumstances. Please note that with some medical conditions water consumption may be restricted, so check with your doctor.
Some tips to stay hydrated:
Drink a glass of water with each meal and also between meals
Drink water before, during and after exercise
You’ll see many diet plans that tout more energy, better sleep, and weight loss, but it’s important to consider your unique genetics, health history, body type, lifestyle, and environment in finding a plan that works for you. Nutrition is one of the four pillars of good health – it’s important to get it right!