SURGEON GENERAL’S RX FOR STRESS IN AMERICA

The National Institutes of Health (NIH) has put itself firmly on record as being deeply concerned about our national epidemic of stress at the individual, organizational and societal levels. NIH’s National Center for Complementary and Integrative Health (NCCIH) broadcast on September 7th its annual Stephen E. Straus Distinguished Lecture in the Science of Complementary Therapies. The lecture was titled A Nation Under Pressure: The Public Health Consequences of Stress in America.

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PROMOTING RESILIENCE WITH OPTIMISM AND MINDFULNESS

The American Psychological Association (APA) recently documented a worrisome increase in stress in the U.S. population (Stress in America https://www.apa.org/news/press/releases/stress). Uncontrolled stress can cause or worsen anxiety, depression, PTSD and a wide range of clinical conditions affecting every organ system. Medical students, residents and practicing physicians experience higher levels of stress than their age-matched counterparts at all levels of medical training....

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ALLOWING AWE IN MEDICINE

Of all the sciences, medicine uniquely combines all domains of the human condition-biological, cognitive, emotional, environmental, interpersonal and transpersonal. The more we learn about the benefits of the interpersonal and transpersonal dimensions of health, disease and medical practice, the more we seek to populate medical schools with well-rounded students and humanize medical training and the healthcare workplace.

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and cravings as nothing more than thoughts and allow them to simply come and go like any other thoughts - without eating ‘just one more.


Mindfulness is the world’s leading behavioral, mind-body practice for promoting health, managing stress-related chronic conditions and enriching your experience of being alive. Mindful eating and food preparation can be an important ingredient in your overall practice of mindful living and enhance your overall relationship with food- its production, distribution, preparation and consumption. Those with eating-related conditions such as overweight, obesity, anorexia nervosa, bulimia, binge-eating disorders, body image disorders and night-eating syndrome can also benefit by including mindful eating in an overall treatment plan.


Eating mindfully

Mindful eating is a basic mindfulness skill. Bringing attention to the act of eating can transform an ordinary activity into a health-supporting, life-affirming practice. It can be a physician’s ally in assisting a patient in adhering to dietary guidelines for chronic disease management. Mindful eating can also be part of a preventive, behavioral, lifestyle program to promote health and prevent disease. Simply changing how we eat can transform our relationship with ourselves, our body, our weight, our medical treatment plan and our overall health. Mindfulness practices can help manage the stress that may contribute to overeating and help with weight management without actually ‘dieting.’


Seven kinds of hunger

A useful review of the various ways to conceive of hunger is offered by pediatrician Jan Chozen Bays in her book Mindful Eating–A Guide to Rediscovering a Healthy and Joyful Relationship with Food. Based on her work as a physician and mindfulness meditation teacher, she helps patients and families re-connect with health-promoting, physiologically based hunger signals and avoid the temptation of false appetites. Bays describes seven types of hunger. She suggests that we bring our attention to these seven types of hunger on purpose rather than being hijacked and victimized by their often unconscious influence over our eating habits. Observing your eating experience this way can put you in charge of your food consumption and your health.


  1. Eye hunger: To avoid over-eating and to satisfy eye hunger, intentionally appreciate the visual appearance of your food as you begin to eat.
  2. Nose hunger: Much of your sense of taste comes from your sense of smell rather than your taste buds. Honor this aspect of your eating experience by focusing on the smell of the food you are about to eat.
  3. Mouth hunger: So many of your preferred tastes are socially conditioned from your family and acquired eating habits. Can you eat with curiosity, openness and experimentation as you add more or less of different spices and seasonings?
  4. Stomach hunger: Abdominal rumbling, growling and dyspepsia may suggest hunger when the body doesn’t really need to eat. These sensations may reflect stress, anxiety or an artificial eating schedule you may have developed out of social convenience more than physiological need. Listen to overall hunger cues before trusting stomach hunger.
  5. Cellular hunger: This is the underlying physiological need being addressed by hunger and eating. Becoming more attuned to your body through body scan meditation and other mindfulness practices can put you back in touch with this deeply physiological ‘true’ hunger.
  6. Mind hunger: Your food choices may sometimes be driven more by advertising and fad diets than your true body needs. Pay attention to your food as you eat. Avoid eating while watching television. Eat some meals alone and really tune in to the full experience - physical, mental and emotional.
  7. Heart hunger: Your eating choices may sometimes be driven by a desire for comfort foods and feeding emotional needs that you can address in a healthier way. A hot bath with candlelight, journaling, talking with a good friend or walking in nature are low calorie/high nutrition options for feeding heart hunger.       


Practical, ancient meditation practices and modern lifestyle medicine can be combined to help physicians and their patients achieve overall health goals through mindful eating.


Resources


This new patient was a desperate, mid-career physician, referred to me by his cardiologist for mindfulness training and stress-reduction. He confessed to regularly eating as much as 5,000 calories in a single meal. His facial expression and body language spoke of his hopelessness and exhaustion. In a telling example of the crucial importance of body awareness, he consistently expressed difficulty feeling physical sensations in his body during body scan meditation. He was literally out of touch with himself. I was concerned and deeply saddened by the plight of this fellow physician- a man who worked fulltime addressing his patients’ health while dangerously neglecting his own. I feared the worst and, indeed, his words were tragically prophetic. He died 2 months later from cardiac complications of emergency abdominal surgery.


His son later told me that his father had actively embraced mindful eating and other mindfulness-based stress reduction practices he had learned in our two meetings together- an initial individual consultation and a follow-up group class. He began to realize that he rarely knew whether he was actually hungry. He simply ate and ate and ate. He also began to realize he didn’t always taste his food. His growing awareness of his relationship with food gave him a glimmer of hope. He only wished he had begun this important, potentially life-saving, self-care skill much earlier in the course of his chronic morbid obesity, hypertension, diabetes, venous insufficiency, heart failure, renal failure and depression.



BY JOHN A. PATTERSON MD, MSPH, FAAFP

Where is your attention when you eat?

Do you love the pleasure of eating so much that you overeat from sheer enjoyment rather than from physiologic hunger cues? Do you overeat as a self-soothing antidote for emotional stress, anxiety or depression? Or do you consider eating a necessary but boring interruption in your busy day at home and work and overeat while reading, viewing screens, driving or talking? If either of these eating patterns describes you, the power of your attention is being used unskillfully. Your health could suffer simply because of misplaced attention.


What is mindfulness?

Mindfulness is defined as paying attention to present moment experiences, intentionally and nonjudgmentally with openness and curiosity. Mindful eating means paying complete attention to this plate, this bite, this sip, in this moment. It means paying more attention to the food itself and less attention to the distractions all around you and inside your mind.


In particular, the regular practice of body scan meditation increases the capacity for mindful eating, accurate assessment of hunger cues and successful weight management. With practice, you can train yourself to experience your food desires

JOHN A. PATTERSON MD, MSPH, FAAFP

Dr Patterson chairs the Lexington Medical

Senator Alvarado earned his bachelor's degree in biology from Loma Linda University (California) in 1990, and then went on to receive his Doctorate in Medicine in 1994. He completed his medical residency in Internal Medicine and Pediatrics at the University of Kentucky in 1998. Society's Physician Wellness Commission and is certified in Physician Coaching. He is on the family practice faculty UK College of Medicine and teaches nationally for Saybrook School of Integrative Medicine and Health Sciences (San Francisco) and the Center for Mind Body Medicine (Washington, DC). After 30 years in private family practice in Irvine KY, he now operates the Mind Body Studio in Lexington, where he offers integrative mind-body medicine consultations specializing in mindfulness-based approaches to stress-related chronic conditions and burnout prevention for helping professionals. He can be reached through his website at www.mindbodystudio.org