Let’s Look to the Best

“It was the best of times, it was the worst of times…” to quote Dickens. Nothing like a national emergency to help us sort the wheat from the chaff within our lives.

Times of trial bring opportunities for new reflections on our lives. For years, people have been living “busy” lives. Now, many people have been brought face-to-face with the reality of what the effects of their lifestyle priorities have produced, and some of the “best” include:

• Volunteers using their time, talent, and materials to make protective equipment for first responders and healthcare workers. (As a recipient, let me say thank you!)
• Researchers posting tasty recipes from 1930-depression-era cookbooks that require minimal ingredients.
• Family members exercising, dusting off and teaching the kids board games, defining and working on home projects, schooling, or just talking TOGETHER.
• Young people helping older folks with shopping, yard work, errands, and even pitching in from their own pockets when seniors come up short in paying at the grocery store.
• First responders and medical professionals with limited resources and an unknown enemy, swallowing their fear and finding their strength to attend the sick and dying.
• Truckers, grocers, utility workers, local government employees, waste disposal workers, order pickers shippers, and all the others who work to keep us fed and our households running because of their integrity and work ethic.

Most of us have not experienced loss from a distance, empty store shelves, empty wallets or stay-at-home orders. If you experience worsening depression, anxiety, substance use, hunger, suicidal thoughts or are a victim of abuse, please contact one of the national organizations for referral to resources local to your area.

  • For Emergencies 911
  • National Suicide Prevention Line 1-800-273-TALK (8255)
  • Disaster Distress Helpline 1-800-985-5990
  • Boys Town for kids, teens, and parents 1-800-448-3000
  • Veterans’ Crisis Line 1-800 273-8255
  • Boys Town for kids, teens, and parents 1-800-448-3000
  • National Alliance on Mental Illness 800-950-NAMI(6264)Nami.org
  • Substance Abuse and Mental Health Services Administration National Helpline 1-800-662-HELP (4357)
  • National Domestic Violence Hotline 1-800-799-7233 (SAFE) 1-800-787-3224 (TTY for the Deaf)
  • Feeding America FeedingAmerica.org
Photo by ELEVATE on Pexels.com

On the flip side, change may also reveal the negatives in our lives. Sometimes these are things that we may not have even noticed creeping in because there is a comfort and security with “routine.” While stress can bring out the good, it can also lead us to acknowledge dissatisfaction with the realities in our lives. Recent examples include:

• Parents report they don’t like their kids.
• Numbers of runaways are increasing. While some are due to domestic violence, many do so because they are mad, bored, or just want to see their friends.
• Some are complaining about anything and everything, although they still have a home, loved ones, a job, food, toilet paper, and other creature comforts
• Over consumption of processed food has led to weight gain and worsening diabetes and hypertension in others. Despite having time to cook, they chose this path because cooking is “hard and boring.”
• Many are reporting tales of incessant social media, Netflix binges, and 24-7 news programs (much of which is designed to arouse negative emotions) leading to lack of time to accomplish anything meaningful.

So, as with any challenge, there is also opportunity. As people are reporting feeling unmoored during this time, they believe there is nothing they can do to help themselves. This is far from the truth. Now is the time you can step up to the challenge and reclaim your life. This is not a time to become self-critical, but to become insightful. As humans, we make mistakes. Sometimes by choice, sometimes based on poor information, and sometimes because of what has been modeled for us as the “right” way. Don’t waste time on fault, and put aside blame and guilt. Instead, put your energy into evaluation and change.

To start, ask yourself what has been important in your life that has been stripped away or changed? What do you or did you like to spend your time on? Did it help or harm your health/relationships? Flesh out your responses with the five Ws—who, what, where, when, why, and don’t forget “how.” Some starting-point examples might be:

If you don’t like your children or your teen won’t stay home, who has been assuming the responsibility to raise them?
• What can’t or won’t you face at home that requires you to consistently want to escape?
• Where did your practice of disparaging others or blanketly excusing others come from?
• Why don’t you want to learn to cook?
• When did watching media become more important to you than a hobby, learning something new, interacting with family, etc.?

The common denominator here is EFFORT. Over the years, we have all brought “so” into our lives to justify our decisions. We wear it as a badge—I’m so busy, so tired, so discouraged, so important, so overextended, so indispensable, etc. No wonder there’s no time or energy for a mundane chore like, for example, cooking. (By the way, these folks likely eat many of their meals out and otherwise fill in with processed foods; eventually their health will reflect these poor choices.)

So, what about you? Now that some of the busy-ness has been stripped away from your days, take the time to reevaluate what needs to come back. Do you want to maintain the status quo with the possibility of chronic disease and chronic medication, or do you want to take this time to build a healthy infrastructure to your days and improve your physical and mental health along with your relationships?

Healthy relationships positively impact your health. Stress hormones increase your risk for several chronic diseases. If your relationship with your children is stressful, think about why. Have you unknowingly allowed teachers, coaches, music instructors, daycare workers, and others to usurp you as the parent? How can you better engage with your family and get to know each other as individuals?

Couples in supportive relationships have better health outcomes. Has this time together brought you closer to your significant other? Sometimes we use busy-ness to avoid looking at how things really are. Do you have a contentious relationship which has been ignored? Have you settled into a routine with very little support or interaction? Are you ready to make some decisions about how you want the relationship to move forward?

Helping others increases positive brain chemicals. Why do you find it hard to stay home? If you are a natural extrovert who thrives on interaction, try phone or video chat to check on others that may not have family available. What about a volunteer organization or even getting to know a neighbor who may need you to run an errand? Let’s put your strength as an extrovert to work and boost those brain chemicals.

Tidy environments reduce stress and improve sleep. Is your home or yard so out of control you don’t know where to start? Start with admitting there is a problem with where to begin. Maybe a peek at a website or a call to someone whose home/yard you admire can provide suggestions and motivation. But if push comes to shove, just pick up that sock and into the hamper it goes. Make the bed. Then fold that basket of clothes and put them away. Next, pull all those clothes off the pseudo clothes rack (i.e., exercise bike) and get them sorted and into the washing machine. One task at a time will lead to a much tidier room, and tidier rooms lead to a tidier home.

Reducing negative exposure reduces overall depression and anxiety. Limit news watching to no more than 30 minutes twice a day. Too much bad news increases your stress hormones driving up blood pressure and blood sugar. Counteract negative thoughts by recording a daily gratitude list and spend an equal amount of time (i.e, one hour) enjoying hobbies, music, etc.

Picking up a new healthy habit can reduce or prevent chronic diseases. Binge watching and eating junk food can result in weight gain and chronic diseases not limited to those of the brain like dementia or addiction. Let’s look at some healthy habits you can establish over time which support the brain or reduce the progression of debilitating disease.

• Get plenty of sleep; it builds neurons and restores the body.
• Learn to cook healthy meals; they contain the body’s building blocks which originate in unprocessed foods.
• Get moving. No need to join a gym; a 30-minute walk after a meal can decrease blood sugars and improve mood and sleep.
• Learn something new through a self-improvement program that teaches you to play an instrument, master a new language, explore your genealogy, pursue a new hobby or learn new skills related to an old one. You will be helping your body to build neurons, reducing stress, and maybe making new friends.

While none of us has asked for this challenge, let’s try to use it advantageously. It is an opportunity, so let’s come out of it on the other side better and brighter and filled with the hope of the “best of times.”

Lifestyle Medicine vs. Cancer

An illness may result in the loss of something of greatest value, namely some aspect of one’s health.  When considering cancer, you may think “I am at risk of losing my health and there is nothing to be done about it.”  But, is this really true?  According to research by Mingyang Song, MD, ScD and Edward Giovannucci, MD, ScD, “about 20-40% of cancer cases and about half of cancer deaths can be potentially prevented through lifestyle modification.”1  Yet, individuals continue to believe there is nothing preventative to be done under the mistaken notion that cancer is about non-modifiable—“nothing I can do about them”–risk factors such as genetics, age, or race.

Enter the good news, Lifestyle Medicine has evidence-based information on modifiable risk factors and the actions you can take to help counter them:

What you put in or on your body, and what you do for your body.

Someone is already thinking, “If that were true, then why do picture-of-heath individuals get cancer”?  Generally speaking, information about disease and its etiology, complications, etc., fill medical school libraries and is profoundly beyond the scope of this article.  Further, certain details of an individual’s life, e.g., childhood and workplace environmental exposures, may never be known and therefore impossible to factor into the individual’s equation.   However, it is generally agreed that 40% of cancer diagnoses are preventable with changes to lifestyle.  Before you write off lifestyle consider the following: 

EXPOSURE

Smoking has long been linked to lung cancer, sun exposure to melanoma, radiation to thyroid cancer, and Human Papilloma Virus (HPV) to cervical and other cancers.  And, have you seen the legal advertisements on TV with regard to asbestos exposure and Mesothelioma?  Most of us are aware of at least some cancer/exposure links.  Lesser known associations include alcohol’s link with six different kinds of cancer.  Another is Diethylstilbestrol (DES), a synthetic estrogen used during pregnancy between 1940-1971, which resulted in cancer in some of these women and their offspring.  Studies are now ongoing in their grandchildren.  So, the message here is avoidance of exposure to limit your risks.

IMMUNITY

White Blood Cells Attacking an Invader

Think of the immune system as your body’s own little army of “soldiers.”  A “foreign invader” such as bacteria, a virus, or even an abnormal cell forming inside the body sends the “soldiers” into action to prevent invasion, replication and dispersion.  But, as with certain illnesses like HIV/AIDS, impairment of the immune system can occur.  Transplant recipients require immunosuppressive medication to prevent the “soldier” cells from mistakenly attacking the new organ.  These “soldiers” also may not be able to destroy unrelated cancer-causing infections or cancer cells, hence the restrictions placed upon these patients regarding crowd exposure, etc.

INFLAMMATION

When an injury occurs, the body’s immune system sends white blood cells and chemicals to heal the area.  This will present as a warm, red area around the wound.  However, sometimes after the injury is healed, the inflammation remains.  It is even possible to have inflammation without an injury or infection; this chronic inflammation can damage healthy cells and weaken the immune system, leading to development and growth of cancer cells.

EXAMPLES FROM EACH OF THREE AREAS

Viruses, bacteria, and parasites are all part of the problem.  By exposure, they enter the body.  Some disrupt the cell communications; others weaken the immune system, decreasing the body’s ability to defend itself against other cancer-causing infections; and a few lead to chronic inflammation.  Some like H. pylori (best known as causing stomach ulcers) and Hepatitis C have treatments available.  Others such as Hepatitis B and HPV have vaccines available for prevention before exposure.  Your doctor will guide you regarding appropriateness of vaccines for yourself and your family.  When traveling, educate yourself about the geographic area and the preventive measures you can take to reduce exposure to pathogens.

SO, HOW TO AFFECT THESE AREAS

Every time you eat, it is an opportunity to put something into your body to make it function better.  Does this mean supplements?  No, real food!  Blueberries for example, are showing amazing potential in studies to not only prevent cancer from forming but to assist in cancer therapy by making the cancer cell more susceptible to treatment.  To see other ways foods can positively affect your health refer to the “The Nutrition Rainbow2.

So, what else can I do?  Shown below are other activities you can incorporate and their cancer-busting potential.

Hopefully, this article has given you a brief introduction to the relationship between lifestyle changes and their ability to perhaps lessen potential cancer risks, all presented in a way that is understandable to those not seated at the science nerd table.  Or, maybe you are still caught up in the “this is too much trouble; this is too unlikely; this is not do-able in a family of five; this isn’t going to mitigate the strong history of “x” cancer in my family,” etc. But, you read the article…all the way to the end.

In a nutshell, Motivational Interviewing, a counseling technique, defines five stages of change:

  • Pre-contemplation—“Leave me alone.”
  • Contemplation—“I’m thinking about it, but on the fence.”
  • Preparation—“I’m going to do it.”
  • Action—Do it.
  • Maintenance—Ongoing monitoring.

Remember, you read the article…all the way to the end, so you may well be at Stage 2 or even 3.  Continue to digest the information and maybe even look up some additional sources online or chat with your primary care doctor or Lifestyle Medicine physician.  Should you undertake to make changes, remember perfection isn’t expected or being broadcast on social media.  Any change, however small, you undertake to promote better health can only help.

References:

  1. Song M and Giovannucci E. JAMA Oncol. 2016;doi:10.1001/jamaoncol.2016.0843.
  2. “The Nutrition Rainbow” by The Physician’s Committee for Responsible Medicine. Link

Lifestyle Medicine

Reprint of my article as printed in Inside Medicine magazine August 2018 edition.

The old expression–”there is nothing new under the sun”— may indeed be true.   But, old ideas sometimes can be explained in a new way.

Many people are already aware that their habits can affect their health.  The news is full of “don’t eat this,” or a new study on exercise.  And, yet, we as a nation appear to be getting sicker.  It is difficult for doctors to discuss health given our current illness-based insurance model.  With genuinely caring physicians having such limited time with each patient, the recommendation for a one-size-fits-all diet and exercise approach is often the norm.

Fortunately, out of established research a new branch of medicine has emerged with the focus on helping people improve their health and prevent chronic diseases.  Based on improving six areas of health, Lifestyle Medicine uses many non-drug modalities to treat, improve, and sometimes even reverse chronic health conditions. Medication, while still used, becomes the supplement to these lifestyle changes.

These six areas are:

  1. Nutrition—getting vitamins, minerals, protein, fiber, phytonutrients, etc., from a predominately whole-food, plant-based diet
  2. Movement—consistent daily movement that works all the muscles, including the heart
  3. Sleep—improving the quality of rest
  4. Substance use—eliminating the use of tobacco and other potentially harmful substances
  5. Relationships—establishing and nurturing supportive social connections
  6. Stress management—leading to improved health and productivity

Why focus on so many things? In addition to the fact that individually each of these areas can produce health issues (e.g., tobacco and cancer), they also can affect each other. Improved sleep may assist in weight loss.  Moving may reduce stress. And, if you don’t fuel your body with a good quality diet, it’s little wonder you don’t feel like getting off the couch.

Would you like to feel better about your health? The process starts by deciding what your goal is and perhaps even writing it down.  Maybe you would like to run a 5K or simply be able to play on the floor with your grandchildren.  Next is to identify areas you are willing to change.  Maybe the coffee creamer will not be eliminated, but you will eat an extra serving of a green vegetable each day.   An earlier bedtime is not feasible, but you are willing to encourage deeper sleep by turning off your phone and leaving it in the kitchen overnight. Successes are celebrated and failures are put to good use as you learnto analyze, re-adjust, and overcome.

So, while the message is not new—your mother may have told you to eat your vegetables and get plenty of sleep—life has a way of intervening and sending us down another path.  Now is the time to learn how to manage that stress, get some quality rest, develop a strong emotional support system, avoid substance use, and become active while being mindful of your food choices.  It may just be exactly what the doctor ordered!

Elizabeth McCleskey, DO Board Certified Family and Lifestyle Medicine; Member, American College of Lifestyle Medicine; HealthStylesDr.com