Save your brain with the Mediterranean diet?

According to Gad A. Marshall, MD (Instructor in Neurology, Harvard Medical School, and Associate Neurologist, Center for Alzheimer Research and Treatment, Brigham and Women's Hospital, Boston) two recent studies demonstrate a reduction in the risk of mental decline in people who follow a Mediterranean diet. In a study in New York City, risk this showed up as a decline in the risk of Alzheimer's dementia in those who followed a Mediterranean diet, exercised regularly, or both. The hazard ratios were 0.6, 0.67, and 0.64 respectively. The study was large, well controlled of confounding factors and followed people for over 5 years. It would appear that in this population the diet reduced the risk of dementia by about 30-40%! A similar study in France, which was smaller, showed reduced cognitive decline (better maintained brain function) but not reduced risk of dementia. This study may not have been powerful enough to show benefit in preventing Alzheimer's, but results are still encouraging.

It seems to me the more we learn about diet and exercise, the more benefits we find. Perhaps Hippocrates was on to something when he recommended healthy (presumably Mediterranean given his location) diet, fresh air and exercise!

An example of good parenting!

I was sitting on our front porch this evening because it was warm and beautiful. Lots of people were walking by, walking dogs, riding bikes etc. A mother with a boy about 4-5 years old passed. He was riding a bike which hit a bump and he went sprawling hands first onto the sidewalk. It almost looked like he leaped forward. He rolled over onto his butt and was clearly unhurt. He looked up at "Mom" for a reaction. I would expect to see her concern, maybe some sympathy, even offering a cookie or treat. Many times I've seen the "Oh, oh are you OK" response which usually just make the child cry. This Mom remained smiling. Her response was "So, did you catch the rabbit?" How inspired! He did look a lot like my beagle when she tries to jump something, only difference is no howl from the kid! I couldn't tell the mother what a good job she did, and I doubt she will ever read this, but at least I can tell someone. Hope it helps you keep your stumbles in perspective. May you "catch the rabbit!"

Wholistic, holistic or integrative?

There are a lot of terms around to describe the attempt to integrate body mind and spirit into health. Some of the more common terms are integrative, functional, mind-body, holistic and wholistic. None of these terms yet conveys anything very specific about the practitioner or style of practice. I'd say this is in development, but if so it has been for a long time! When I first became interested in "wholistic" medicine it was spelled with a "W" and done mostly in church basements. The "holistic" moniker has often been used by chiropractors and often includes nutrition, supplements and the like as well as manipulation. Integrative and functional are more recent terms used by a variety of practioner types, including a few of us bolder MD's. It implies bringing together multiple disciplines to improve health and/or treating function rather than disease.

As I reflect on my preferences, I find myself gravitating toward the older "Wholistic" for a few reasons. The concept of "whole" including multiple aspects of body, mind and spirit. I know the actual root of "holistic" is "hol," the same root as Holy. It seems to imply more focus on the spiritual. Although this emphasis is not a bad idea given the subordinate position the spirit is usually given, a more even emphasis is more to my liking. I think as a wholistic practitioner I should be willing to address body mind and spirit in any combination and not value one above another.

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What is a doctor?

The mind body expo this weekend in Minneapolis gave me a different perspective on my title. If I said I was a "doctor" or a "physician" I got constant requests for clarification! The only unambiguous title was "MD" but this was not always a welcome one. Considering insurance companies now insist on calling me a "provider" (which I always thought was something I helped do for my family, being one of only two) I'm beginning to wonder if society has a role for people like me. Surely the education, study and practice of the past 30 years are of value. I know my skills are helpful to people and believe in my own worth independent of titles, but they do help people understand roles. I am not really ready to given them up either to generalization from "physicians" who have had much less training, or to be downgraded by insurance to a generic cog in the wheel- the role is only to see patients and generate revenue.

This brings me to what I should call the people who come to me for care. For decades I have used the term "patient" (and many of them have been VERY PATIENT with me, especially in the early years!) but I am coming to prefer the more modern term of client. This puts us on more of an equal footing which I do like. We are really collaborators in health.

Once the relationship is established, I don't think it matters as much what we call each other, but names do have implications.

Where am I today?

My decision to act this time resulted in a shorter delay than initially! I started our program Jan 1st, 2010 and have lost 20 pounds already! Although fully aware of the importance of proper balance in my diet and the need for regular exercise, I still struggle. Schedule changes have made my old positive patterns more difficult regarding exercise, and the cycle of splurging on carbs is hard to break! Focusing on developing new patterns seems to be working better than "getting back" to my old ones, since it is now clear that my old patterns are not possible.

Spirituality and centernedness are the cornerstones of the patterns I am now trying to develop. I can do daily Yoga before I even leave the house and focus on being centered when I eat. Lent is a good time to focus on spirituality and face one's darker side. Repentance is turning away in a Wholistic sense, body mind and spirit. Perhaps this will be a useful and inspiring concept for me over the next several weeks.

What is Wholistic Health?

As a starting place, for a practitioner to be "wholistic" there must be a genuine acknowledgement of Body, Mind and Spirit as related. My belief is that they are inseparable aspects of the same reality. To use the theological concept, a trinity. This is a multi-directional webwork of relationships. What affects the body affects the spirit and affects the mind. This is true of any permutation you can imagine. At Sage, each of our staff from reception to physician buys into this concept.

There needs to be a willingness to address each of these major areas in more than a superficial way. A complex web does not lend itself to a single program or a uni-directional approach. There needs to be an understanding that relationships are multi-directional and what affects one aspect will affect others in often unforeseen ways. Each strand has intrinsic value and a contribution to make. At Sage we have collected providers of as many different modalities to address as many different aspects as possible. (See our website: www.sageweightandwellness.com) We are open to others as availability and need present themselves.

Wholistic medicine is also integrative. It in not just a collection of different practitioners under one roof. To be wholistic, the model itself must be integrated. At Sage, we talk with each other, have a common record, share information and ideas and act as collaborators with our clients in their transformation to health. At a very real level we have a common mind, common body and common spirit.

These concepts need, themselves, to be more than mental constructs! They need to be integrated into the hearts and souls of those who would serve others. At Sage Weight and Wellness we have recruited an entire staff who not only acknowledge this but put it into practice in their own lives as well as their relationship with our clients.

I do not mean to imply that the "medical model" has no value. It is very valuable but is only one strand. As a strand, its values must be respected, including: the scientific method, "evidence based medicine," technology, and pharmacology among others. Wholistic Medicine is not simply discarding Western Medicine for other "alternatives" which may or may not be superior in a given situation. At Sage, we get this. You will not hear us badmouthing doctors or discounting science. We ARE aware, however, that Western Medicine is only ONE perspective.

Although as an entity, Sage Weight and Wellness has only existed for four years, our staff has been involved for decades. As a physician, my initial choice of Family Practice was heavily influenced by the fact that it recognizes relationships and family systems as important to health. It was the closest thing to wholistic or integrative medicine that existed 30 years ago! I have not abandoned this approach, but only expanded and deepened it. My recent Bush Fellowship, in Traditional and Alternative Treatments for Obesity, my experience and explorations into meditation, yoga, exercise and many other disciplines are evidence not just of an interest but a commitment.

My work with the Episcopal Church Pension Fund through CREDO has further broadened my understanding to include financial, and vocational aspects of health as well as physical and spiritual. Our other staff also have long journeys in wellness which need to be respected, but which I will not detail here.

I welcome questions or comments. Come and see for yourself! I'd love to show you around!