Rethinking Fat in the Diet

With all the hype surrounding statin medications this past week (see http://www.nytimes.com/2012/03/05/opinion/the-diabetes-dilemma-for-statin-users.html), it’s a perfect opportunity to take a step back and discuss some basic diet fundamentals.  For the past 40 or more years, the “benefits” of low-fat diets have been ingrained in our consciousness, and advocated by a majority of the medical community.  The thinking behind this was simple: high fat in the diet must lead to a buildup of fat and plaque in the arteries, so the less fat you eat, the better.  In recent years, research evidence has overwhelmingly refuted this concept, yet it continues to be the mainstream recommendation for preventing heart disease.  Even the “Dairy” section in the USDA’s “My Plate” emphasizes low or non-fat sources of dairy.

A scientific analysis of 21 earlier studies showed “no significant evidence” that saturated fat in the diet is associated with an increased risk of coronary heart disease.  In fact, the dietary evidence collected from these thousands of participants found no difference in the risk of coronary heart disease, stroke, or coronary vascular disease between those individuals with the lowest and highest intakes of saturated fat.  The bigger issue appears to be the added amounts of sweeteners and carbohydrates that people are eating instead of fats.  More and more evidence is suggesting that it’s this continuous increase in carbohydrate consumption that is truly responsible for an increased risk in diabetes and coronary artery disease.

I think the main take-away message from this information is that you don’t have to be afraid of good quality sources of saturated fat.  We’ve been so trained to be suspicious of it for so long that it becomes difficult to change our perception of how healthy it can be.  Now, does this mean you should be eating nothing but cheese, bacon, and beef for the rest of your life?  Of course not!  If you’re already consuming low-fat sources of dairy (skim milk, low-fat yogurt, etc.), switch to organic whole milk sources, and use butter instead of margarine or other processed forms of fat.  In general, try to limit your saturated fat intake to 10% of your total diet, while discontinuing the consumption of hydrogenated oils, artificial sweeteners, and high-glycemic carbohydrates.  By doing this, and continuing to emphasize fruits and vegetables as a mainstay, you’ll be much better off in the long run!

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ADHD and Essential Fatty Acids

In an observational study involving 810 children between the ages of 5 and 12 years of age who were referred for medical advice for “attention deficit hyperactivity disorder” (ADHD), supplementation with a combination of omega-3 and omega-6 fatty acids in combination with zinc and magnesium for a period of 3 months was found to be reduce symptoms of ADHD, as assessed via the SNAP-IV, reduce emotional problems, and reduce problems falling asleep. The authors conclude, “…considering the behavioural benefit in combination with the low risk due to a good safety profile, the dietary supplementation with PUFA in combination with zinc and magnesium can be recommended,” to children labeled as having “ADHD.”

With ADHD, there are also more extensive testing options available to assess nutritional and neurotransmitter status, allowing for more specific treatment options, and ultimately not having to depend on pharmaceutical interventions. The bottom line is that many “alternative” treatment options have been proven effective in the management of ADHD, and that medications aren’t the only option out there.

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Neuropathy and Natural Medicine

Neuropathy, whether it’s diabetic or idiopathic, is often challenging to treat, with any modality. However, I do find that the combination of acupuncture and naturopathic interventions tend to be much more successful than the “standard” protocol (which usually includes gabapentin and various cocktails of prescription painkillers). A recent study from the journal Diabetes Care (2011 July 25) discovered that 600 mg/day of the nutrient alpha-lipoic acid lead to a clinically significant improvement in patients with diabetic neuropathy. Clinically, I’ve also found that other forms of neuropathy often respond well to alpha-lipoic acid therapy as well. Other treatments that help to enhance peripheral circulation and restore nutrition to damaged nerves, such as acetyl-l-carnitine, mixed bioflavonoids, and B-vitamins, can also be beneficial in the treatment of peripheral neuropathy.

It’s not uncommon for people to be kept on medications for life when trying to deal with peripheral neuropathy pain, with the resulting relief being minimal at best. If this is something you have suffered from, don’t be afraid to seek alternatives, as there is enough clinical and research evidence to support the benefits.
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Cell Phones and Cancer

This is a reprint of an article from the Journal of Naturopathic Medicine that was a response to a recent study published in JAMA (Volkow N, Tomasi D, Wang G-J, et al. Effect of cell phone radiofrequency signal exposure on brain glucose metabolism. JAMA. 2011;305(8):808-813).
The bottom line is that cell phone use does indeed appear to enhance brain activity, which can potentially pose risks for cancer or other neurological complications. There are still many unanswered questions with respect to cell phone use and cancer, but this study is further evidence that this issue needs to be addressed and payed attention to:

For years, medical experts and scientists have voiced concerns regarding
the questionable safety of cell phone use, but even with the evidence
mounting, this alluring technology is hard to resist. Humankind’s
increasing use of cell phones, 5 billion users worldwide, necessitates a
thorough, unbiased look at the risks.

The JAMA study documents that cell phone exposure affects the
brain by increasing brain glucose, a known measure of increased brain
activity. Though the study does not offer an explanation of the
underlying mechanism, we do know that in other biological systems of the
body, chronic increase in glucose can have a significant effect on the
local tissues, altering cell and gene function. Notably, the study
refutes the longstanding claim by both the Federal Communications
Commission and the cell phone industry that there are no biological
effects from non-thermal levels of cell phone radiation.

The studies published on cell phone use and the possible health risks (including tumors of the brain, as well as male infertility)
are numerous, and many repudiate any risks. Among the catalogue of
studies, often funded in part by the cell phone industry, a
meta-analysis published in the Journal of Clinical Oncology in 2006, involving 23 case-controlled studies and almost 38,000 participants, concluded there are increased health risks.
Recently a branch of the World Health Organization called The
International Agency for Research on Cancer (IARC) convened 31
scientists from 14 countries, including the United States, and evaluated
peer-reviewed studies regarding the safety of cell phones and issued a
statement that puts exposure to radiofrequency electromagnetic fields
from cell phone use in the same category as lead and car exhaust:
possibly carcinogenic. At what point do we acknowledge that precautions need to be taken? Our
current safety standards regarding cell phones are based on obsolete
research. They certainly don’t take into account the dramatic increase
in number of users, the increase in amount of time spent in use, and the
rise of cell phone use by young people. There not only needs to be
continued investigation into the effects on brain tissues, but also the
consequences of both heavy use and long-term exposure–parameters not yet
studied.

The concept of the precautionary principle encourages policy makers to
make decisions that protect the public from a policy or action that may
be harmful, in the absence of definitive data. In looking at the health
impacts of electromagnetic radiofrequencies from cell phones, the public
needs to be protected from the harm that may be caused by their use. It
calls to mind our history regarding tobacco, when medical professionals
awaited definitive trial data for decades, while millions of
individuals suffered predictable health consequences. By refusing to
acknowledge the possible health risks of cell phone use now, we may be
harming generations to come.

While we continue to gather information, we can counsel our patients on
the many ways to reduce overall electromagnetic radiation exposure:

  • Turn cell phones off when not in use. Cell phone emissions are
    occurring whenever the phone is on, whether it is being used or not.
  • Avoid cell phone use when the signal is weak. Emissions increase while the phone is searching for a tower.
  • Store cell phones away from the body in a purse, backpack, or briefcase.
  • Use a protective headset that puts distance between the phone and the brain, with corded earphones if possible.
  • Engage in texting in lieu of phone calls.

We can assume there will be continued development of the technology,
including safer phones and safer designs for towers. Ultimately, curbing
cell phone use–using our cell phones for truly important communications
and turning them off when they are not needed–may be the key to
reducing risk.

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Small Intestinal Bowel Overgrowth and IBS

I’m posting a link here that explains in detail the symptoms of Small Intestinal Bowel Overgrowth (SIBO), and how it is often an underlying cause of IBS. In my clinic, I’ve diagnosed this several times, even after people have already consulted with their gastroenterologist, which indicates that SIBO is not “mainstream” enough for most doctors to pursue the appropriate testing. All that is required is a simple breath test-Once diagnosed, this condition is easily treatable, so talk to your doctor about performing the test if you’re experiencing recurring digestive symptoms, or have been diagnosed with IBS. 

http://www.medicinenet.com/small_intestinal_bacterial_overgrowth/article.htm

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IBS and “Mindfulness”

A therapy that combines mindfulness meditation and gentle yoga may help soothe symptoms of irritable bowel syndrome, a small clinical trial suggests.

In a study of 75 women with the digestive disorder, researchers found that those assigned to “mindfulness training” saw a bigger improvement in their symptoms over three months than women who were assigned to a support group.

The findings, they say, suggest that the mindfulness technique should be an option for treating irritable bowel syndrome (IBS).

A doctor not involved in the study agreed.

“I think people with IBS should learn mindfulness skills,” said Dr. Delia Chiaramonte, director of education for the University of Maryland’s Center for Integrative Medicine in Baltimore.

Learning such skills, she said in an interview, is “100 percent safe,” and it could offer people a way to help manage IBS symptoms on their own, long term.

People with IBS have repeated bouts of abdominal cramps, bloating, constipation and diarrhea. The typical treatment includes diet changes, as well as anti-diarrhea medication and, for constipation, laxatives or fiber supplements. There’s also some evidence that regular, moderate exercise helps.

The exact cause of IBS is unknown, but anxiety and less-than-ideal coping strategies — like avoiding going out because of your symptoms — are thought to make IBS worse for many people.

Because of that, psychological counseling is sometimes used. The best-studied form is cognitive behavioral therapy, which tries to change the unhealthy thinking patterns and behaviors that contribute to people’s health problems.

For the new study, Susan A. Gaylord and colleagues at the University of North Carolina, Chapel Hill, looked at a different approach to managing the “brain-gut” connection — known as mindfulness-based stress reduction.

The researchers randomly assigned 75 women with IBS to either undergo the mindfulness training or attend an IBS support group once a week for eight weeks.

The training included lessons on meditation, gentle yoga postures and “body scanning,” in which people focus their attention on one body area at a time to detect muscle tension and other sensations.

Gaylord’s team found that three months after the therapy ended, women who’d undergone mindfulness training were faring better than the support group.

On average, their scores on a standard 500-point IBS symptom questionnaire fell by more than 100 points, with a 50-point drop considered a “clinically significant” improvement.

In contrast, women in the support group averaged a 30-point decline, according to results in the American Journal of Gastroenterology.

Chiaramonte said the trial was “tremendously well-designed,” and set up to address the common criticisms of studies of mind-body therapies. Testing mindfulness training against a support group, for example, helps control for the fact that people involved in any form of therapy may simply expect to get better — and, therefore, do.

In surveys, the researchers found that women in the support group were as likely to expect benefits as those in the mindfulness group.

“And still, the mindfulness group did better,” Chiaramonte said. “So it’s not just the contact with another human being, or not just that they expected to get better.”

It also makes sense that mindfulness training would help people with IBS, according to Chiaramonte. “Part of the problem in IBS,” she explained, “is the attention people give to the physical discomfort, and what the mind then does with that.”

With mindfulness training, the goal is to help people become aware of what they are feeling, but then “let it go” instead of ruminating, and potentially making the physical symptoms worse.

Of course, naturopathic medicine automatically takes “mindfulness” into account, so this is nothing new from my perspective. By always assessing people’s mental/emotional state, along with implementing diet and lifestyle changes, it’s not uncommon for me to see people’s IBS symptoms improve dramatically. It’s unfortunate to see so many patients who come to me after undergoing multiple symptomatic treatments (steroids, anti-spasmodics, etc.), only left to be feeling worse. 

Once again, this study demonstrates what naturopathic med
icine already practices-The impact of the mind on physical health cannot be avoided!

SOURCE: http://bit.ly/lfYimf American Journal of Gastroenterology, online June 21, 2011.

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Doctors and Drugs

U.S. doctors are too quick to reach for their prescription pads, according to a new report urging them to think more about side effects and non-drug alternatives.

“Instead of the latest and greatest, we want fewer and more time-tested drugs,” said Dr. Gordon Schiff, associate director of the Center for Patient Safety Research and Practice at Brigham and Women’s Hospital in Boston, a non-profit organization that studies ways to improve safe practices in healthcare.

“We are really trying to promote a different way of thinking about practicing,” added Schiff, whose report appears in the Archives of Internal Medicine.

Nearly half of all Americans have used at least one prescription drug in the past month, according to the Centers for Disease Control and Prevention, and experts say overprescribing is rampant.

By definition, that means people are being exposed to side effects, sometimes fatal, without the benefits that would justify those risks.

“Often what is really bothering them is not cured with a pill, but rather through exercise, physical therapy, or diet changes,” Schiff told Reuters Health.

Yet many doctors are quick to prescribe a drug, partly because they have limited time to deal with individual patients or because they and their patients have been bombarded with ads from the pharmaceutical industry.

As for prevention and non-drug alternatives, Schiff said, “there are no drug reps coming to my office pushing that.”

In an editorial in the same journal, researchers describe how opioid painkillers like Vicodin and Percocet have become increasingly common without good evidence that they help patients in the long run.

The evidence of harm, on the other hand, is clear, write Dr. Deborah Grady of the University of California, San Francisco, and her colleagues.

In 2007 alone, for instance, there were nearly 11,500 deaths related to prescription opioids — “a number greater than that of the combination of deaths from heroin and cocaine,” according to the researchers.

Some four million prescriptions for long-acting opioids are written every year, with side effects ranging from addiction to constipation to sleepiness.

To counter some of this overprescribing, Schiff and colleagues urge doctors to think beyond drugs and to prescribe new ones much more cautiously.

When it first hits the market, new medicine has usually only been tested in a few thousand patients, often healthier and younger than the ones doctors see in their offices.

That leaves a lot of questions about safety, especially since patients often are taking several drugs at the same time. More than a third of people over 60 take five or more drugs, for instance, and the number of prescriptions continues to rise.

But Dr. Lisa Schwartz and her husband Dr. Steven Woloshin, both of Dartmouth Medical School in Hanover, New Hampshire, told Reuters Health it’s difficult for doctors to get unbiased information about new drugs.

“We need to be making this information much more easily accessible to doctors,” said Schwartz, an expert in risk communication. “There are billions of dollars being spent on new drugs with unproven benefits.”

Schwartz and Woloshin said one way to do this would be to have the U.S. Food and Drugs Administration, which approves new drugs, send out simple summaries about the medications.

They also emphasized that overprescribing, while real, goes hand in hand with underprescribing of drugs to high-risk patients.

“We have both problems in this country,” Schwartz told Reuters Health.

According to Schiff, patients also have a role to play.

“Patients need to ask critical and skeptical questions, too,” he said. “They really should learn about the side effects of the drugs they are taking and be on the lookout for them.”

Schiff’s “Principles of Conservative
Prescribing” study was funded by government grants supporting consumer healthcare education and healthcare quality research.

SOURCE: http://bit.ly/lwuNm0 Archives of Internal Medicine, June 13, 2011.

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Understanding Chronic Sinusitis

Once again, time has proven naturopathic medicine to be way ahead of the game when it comes to effectively treating a condition before modern medicine finally acknowledges the truth. In this case, we’re talking about chronic sinusitis. As long as I’ve been practicing, we’ve always addressed this largely as an inflammatory condition. By removing underlying triggers of inflammation (food and environmental allergens in particular), and using natural anti-inflammatory treatments, along with treatments to help facilitate sinus drainage, patients almost universally have long-lasting relief. Now, modern medicine is recognizing that chronic sinusitis is indeed an inflammatory issue, rather than having a whole lot to do with infectious causes. If you’re stuck in a cycle of repeated antibiotics for recurring sinus infections, definitely consult with a naturopath for treatment advice. 

As a reference, please visit the following article: http://www.nytimes.com/ref/health/healthguide/esn-sinusitis-ess.html
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Eczema and Kids

The discovery that DHA (docosahexaenoic acid) from breast milk promotes healthy brain, eye, and nervous system development was an important step towards understanding why breast milk is a perfect first food for babies. DHA is now commonly added to infant formulas, but it’s not the only fatty acid that is important for developing babies. A new study shows that other fatty acids in breast milk may protect them from allergies.

The sharp rise in allergic diseases like asthma, eczema, food allergies, and hay fever might be explained in part by a shift in the fatty acid balance in our diets. The widespread use of vegetable oils and the comparatively low intake of omega-3 fatty acids (mostly from fish) have tipped the scales in favor of omega-6 fatty acids, which contribute to inflammation in the body.

Does breast milk affect eczema?

As part of the KOALA Birth Cohort Study, scientists investigated the composition of breast milk and its relationship to eczema and allergy development in 310 infant-mother pairs. Based on earlier findings that organic dairy seems to protect against eczema during the first two years, some of the women included led “alternative lifestyles,” meaning that they ate organic foods and breast-fed for an extended period. Researchers were interested to see how the fatty acid composition of their breast milk compared with that of moms who ate a more conventional diet.

Information related to breast-feeding, eczema, and other allergic diseases was gathered from the women while they were pregnant and during the first two years after birth. Blood samples were taken from the babies at one and two years to determine the presence of allergies to things like hen’s eggs, cow’s milk, peanut, tree and grass pollen, dust mites, and cats and dogs.

Babies benefit from fatty acid combo

Compared with the conventional diet group, the breast milk of moms with alternative lifestyles had somewhat higher concentrations of the omega-3 fatty acids EPA (eicosapentaenoic acid), DPA (docosapentaenoic acid), and DHA. The breast milk from this group was also higher in ruminant fatty acids (those derived primarily from dairy fat), including the immune-enhancing fatty acid, CLA (conjugated linoleic acid).

“Differences in fatty acid status between mothers may modify the protective effect of breastfeeding,” said Dr. Carel Thijs, lead author of the study from the Department of Epidemiology at Maastricht University in the Netherlands. “This may explain inconsistencies between studies in different populations with different intakes of fish, ruminant fats, and trans fatty acids from other sources.”

More interesting results:

By age two, 31% of the babies had parent-reported eczema, and 42% of the children with eczema also had allergies as determined by blood tests.

The risk of eczema and allergies at one year was lowest among babies whose mothers’ milk was highest in omega-3 fatty acids.

The risk of eczema and allergies also decreased with increasing concentrations of ruminant fatty acids, independent of the effect of the omega-3 fatty acids.

“Ruminant fatty acids deserve further investigations for their role in early immune development and are potential candidates to explain the protective effects of dairy fat as well as organic dairy and possibly unpasteurized farm milk on the development of atopic (allergic) conditions in early life,” the researchers concluded.

How to protect your baby from eczema

Breast-feed, if you can. For some women breast-feeding isn’t feasible, but it’s worth it for your baby’s health if you’re able to.

Eat more fatty fish. This is important during pregnancy and while breastfeeding. Avoid high-mercury fish including swordfish, shark, albacore tuna, king mackerel, tile fish, grouper, marlin, and orange roughy.

Make it creamy. The latest study adds to a growing body of evidence of the inflammation-fighting potential of full-fat dairy products.

(The study comes from Allergy 2011;66:58-67)

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The Definition of Holistic Medicine

I’m posting an article written by Dr. David Katz, as I think it is a fantastic summary of what I strive for in my own practice, which is to emphasize healing by relying on both clinical intuition and scientific research, as too much focus on one or the other is not in the best interest of the patient. 

 

Holistic Medicine: How To Define It

 

We are probably all familiar with things that are tough to define,
but that we recognize when we see them. No, I’m not planning on talking
about that one

The term I have in mind is: holistic.

I practice holistic medicine. Specifically, for the past decade, I have directed a rather unique clinic that provides what we call ‘evidence-based integrative care.’ We have published and presented details of the model.

People tend to have a strong sense of what holistic means, whether or not they can actually define it. Detractors see it as an indication of quackery
without looking past the label. Proponents embrace it as an emblem of
virtuous humanism. Holistic is good, and all else … less so.

But if that is really true — if holistic care is better (I’m among
those who believes it is) — then a workable definition is important.
First, so that people who want to sign up for holistic care — to give
it, or receive it — know what they are signing up for, exactly. And
second, and more importantly, because you can’t practice what you can’t
define. Unless we can say just what holistic care is, it can’t be
taught, tested, replicated, or improved.

The medical version of TheFreeDictionary tells
us that holistic care is: “a system of comprehensive or total patient
care that considers the physical, emotional, social, economic, and
spiritual needs of the person; his or her response to illness; and the
effect of the illness on the ability to meet self-care needs.”

I am comfortable with this in theory, but not in practice. In
practice, it begs the question: how, exactly, do you do that? What does
considering ‘physical, emotional, social, economic, and spiritual needs’
look like in a doctor/patient encounter? What is a clinician actually
supposed to do in a room with a patient so that the care that transpires
between them is holistically concordant with this definition?

Let’s acknowledge that platitudes don’t really help. Of course, a
holistic practitioner looks beyond a battered body part to the whole
body; looks beyond the body to the mind and spirit; looks beyond the
individual to the body politic of which they are an intimate part; and,
if responsible, looks at the body of pertinent scientific evidence as
well.

But a devotion to holism does not impart mystical prowess to
clinician, or patient. No one gets a magic wand that allows for a
complex array of medical problems to be fixed all at once. Holistic
care is, in fact, most important when it’s hardest to do — when there
is a lot that needs fixing. I suppose there may be a holistic way to
suture the finger of a healthy, young person lacerated while dicing
zucchini, but I doubt it would matter much. It does, however, matter a
great deal in complex cases of chronic illness, attendant despair,
social isolation, and hopelessness. And at such times, it’s really hard!

Here’s an illustration, based on any number of patients we’ve treated
over the years. Consider a woman of roughly 70, who comes to the
clinic ostensibly to get dietary advice because she wants to lose
weight. She is, indeed, obese — with a body mass index of 32. She has
high blood pressure and type 2 diabetes, and is on medication for these.
Her husband passed away 4 years ago, and she lives alone. She is
lonely, tends toward sadness, and is always tired. She sleeps poorly.

She eats in part because she is often hungry, in part to get
gratification she doesn’t get from other sources. She does not exercise
because she has arthritis that makes even walking painful. Her arthritis
has worsened as her weight has gone up, putting more strain on already
taxed hips and knees. Medication for her joint pains irritates her
stomach, and worsens her hypertension. There’s more, but you get the
idea.

I regret to say that medical practice propagates its own uncouth
vernacular, resorted to in part to relieve the pressure of 30 hour
shifts and life and death crises. Much of the slang is too shameful to
share, but one term is especially germane to a case such as the one
above: circling the drain. A complex array of medical, emotional and
social problems really can resemble a cascade in which each malady
worsens another, and the net effect is a downward spiral into despondent
disability. Circling the drain is crude, but apt.

I present the term here because it actually has hidden utility. If
you can descend one degenerating spiral at a time, you can reverse
engineer the process — and ascend the same way! In my view, that is
what holistic care — in its practical details — needs to be.

For the hypothetical case in question, and innumerable real people
like her, reversing a descent begins with one well prioritized move in
the other direction. So, for instance, it is likely that this woman has
markedly impaired sleep, due perhaps to sleep apnea. A test and
intervention to address this effectively may be the best first move for a
number of reasons.

Poor sleep can cause, and/or compound
depression; poor sleep invariably lowers pain thresholds, making things
hurt that otherwise might not, and things that would hurt anyway, hurt
more; poor sleep leads to unrestrained and emotional eating; poor sleep
leads to hormonal imbalances that foster hypertension, insulin
resistance, and weight gain; and poor sleep saps energy that might
otherwise be used for everything from social interactions, to exercise.

Whether a focus on sleep is the right first step will vary with the
patient, of course. But let’s imagine that in this case it is a good
choice, as I have found it to be on a number of occasions. So, we
intervene accordingly — just to improve sleep. So far, this doesn’t
sound defensibly holistic. But it does sound like something the patient
might be able to tolerate.

But as soon as sleep does improve, the benefits start to accrue. Ms.
Patient has a bit less pain, a bit more energy, and a slightly more
hopeful outlook. So now that she has some more resources, we ask more of
her. We now need her to invest these benefits back into herself! Let’s
use that energy to start a gentle exercise regimen (water-based if need
be to avoid joint strain); initiate some social activity of interest to
get some stimulation and purpose reintroduced; and perhaps begin the
process of dietary improvements to address the weight loss goals
initially espoused. We might also start a course of massage therapy or
acupuncture to further alleviate joint pain, now that Ms. P believes
feeling better is possible.

A little exercise further improves energy, and sleep, and
self-esteem; and actually helps ease joint pain. Less pain further
improves energy, sleep — and willingness to exercise. Social engagement
— perhaps a church or civic group — confers gratification that no
longer needs to come from food. Hormonal rebalancing that occurs with
restoration of circadian rhythms alleviates constant hunger. Diet
improves. Medication doses are dialed down. Helpful supplements may be
started.

Weight loss starts. Energy goes up. Joint pain improves some more.
Physical activity becomes less and less problematic, and increases
incrementally. Energy and sleep improve further, weight loss picks up.
With more hope, and more opportunity to get out, Ms. P establishes, or
reestablishes social contacts that restore friendship and love to their
rightful place in her life. Her spirit rises, and with it, the energy
she has to invest back into her own vitality.

And so on — with many time consuming details left out, of course.
This may sound like wishful thinking — but it’s a rewarding reality I
have been privileged to help choreograph innumerable times over the past
decade.

If the erosion of health is a degenerating spiral, then its reclamation is a spiral staircase.
Which leads to the good news, and bad, about holistic care, practically
— and practicably — defined. The good news is that with real
dedication and a commitment to one another and the process, almost every
clinician and patient can find a way to ascend at least some distance
toward the heights of holistic vitality. The bad news is that I’ve yet
to see a helicopter fly in to get anyone there in one fell swoop. We all
need to be realistic. The climb is made one step at a time.

Dr. David L. Katz; www.davidkatzmd.com

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