EATING CAN HEAL. EATING CAN KILL.

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.

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LIFE IS SHORT - LIVE ACCORDINGLY

Neena Thomas-Eapen, MD is a family practice physician in the UK Department of Family and Community Medicine. She has completed the University of Arizona’s fellowship in integrative medicine and brings that broader perspective to the department’s faculty, staff and residents. Growing up in India, she liked biology and always thought she would be a teacher. She had seen the poor conditions in Indian government hospitals and didn’t initially consider medicine as a career.

….FULL ARTICLE

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.

….FULL ARTICLE

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the importance of diet and non-smoking to optimum health and we need to take emotional well-being just as seriously.


Murthy explained that not all stress is bad. Short-term, acute stress can be adaptive enhancing physiologic healing, test-taking and performance. The problem arises from sustained, prolonged, chronic stress- increasing inflammation throughout the body, increasing the risk of cardiovascular disease, cancer, anxiety, depression and many other chronic conditions.


The widespread increase in perceived stress and stress-related illness is partly due to changes in workplace culture in which a 9-5 workday has been replaced by a 24/7 availability due to constant connectivity and increasing productivity expectations.


Importance of exercise

Murthy explained that regular physical exercise has been shown to relieve stress and have an anti-depressant effect for many people. Exercise-related increases in endorphins play a role in this positive emotional side-benefit of exercise. Happily, the choice of physical activity can be highly personal. Choosing an activity one enjoys increases the likelihood of regular practice and long-term commitment. Yoga, gardening, aerobics and walking illustrate the wide range from which one can choose to reduce stress and promote resilience.


Importance of social connections

Despite widespread electronic social networks, many people feel isolated, even in densely populated housing and major cities. 20% of adults in the U.S. reported feeling lonely in the 1980s. That number today is 40%. Murthy said “a quarter say they do not have anyone in whom to confide about a personal problem.” Clearly, the availability of online social networks is not the kind of support required to combat emotional isolation and its widespread adverse health effects.


Importance of sleep

The “iron man culture” of today’s medical training and practice, as well as society overall, is sadly dismissive of the need to get a healthy quantity and quality of sleep. Murthy said “sleep is when our brain regenerates, we form new memories and neural connections. It’s when the body heals.” Sleep loss impairs decision-making, creativity, learning and health. Hormonal disturbances related to sleep loss may explain the association between sleep loss and obesity, diabetes, hypertension and other chronic diseases. Children who loose sleep can have behavioral and emotional problems and trouble paying attention in class.


Importance of meditation

NIH Director Collins specifically asked Murthy to address meditation as an intervention, explaining that this was an area of intense research at NCCIH. Murthy explained that while “meditation has a serious branding problem… we have known for a long time, meditation can be a powerful tool for inducing the relaxation response,” explaining that it is now being used at the VA for treating PTSD. School-based meditation programs are increasing student performance while reducing teacher absenteeism and student behavioral issues, including violence. Murthy visited a school in a troubled neighborhood that had reduced student suspensions by 45% in the first year and 75% after two years of a meditation intervention. Entering its third year, 95% of the children had signed up for this voluntary program, requiring parental permission.


This experience was so compelling to Murthy that he offered meditation to his entire Surgeon General staff. They often meditated together at work. It reduced their workplace stress and enhanced their worksite collegial relationships. While rejecting exaggerated claims that mindfulness meditation or Transcendental Meditation are cure-alls, he is impressed by the research suggesting they both can reduce stress, promote resilience and help prevent and manage many stress- related chronic conditions.


A change in culture is needed

Murthy compares our current lack of widespread prioritization of stress management and emotional well-being to the tobacco issue. Eventually, a widespread coalition of health advocates, parents, farmers and policy-makers came together around the protection of children and adults from the harmful effects of tobacco. That same type of coalition is needed to raise awareness and drive research to reduce the harmful health effects of stress. Supportive relationships, exercise, sleep and meditation can benefit children, adults, workplaces, homes, schools, public health and medical providers and their patients.


Health professional training must emphasize the importance of self-care, stress management and resiliency training. We have enough research to justify this shift already and more is needed to weave emotional well-being into the curriculum and patient care in hospitals and clinics. Dr. Collins explained that NIH is leading by example. Their Clinical Center was recently rated #1 among 426 major healthcare delivery centers in terms of patient-reported satisfaction with institutional attention to emotional well-being.


Speaking to Collins, Murthy said “the fact that you are sitting here as the head of NIH addressing stress sends a powerful signal through NIH that stress is not evidence of weakness or a personal failure but that it is a reality of life and we have to collectively figure out how to address it.”


We’re all in this together

Murthy passionately and articulately argued for a societal, public health perspective on stress and emotional well-being. He closed by saying “we need to be concerned not just about our stress but the stress that people around us are experiencing. When someone has a great deal of stress and does not have the tools to deal with that and it results in acts of violence, that affects us all. When we have stress and emotional discord that prevent us from coming together and talking about solutions to big problems as a country, that affects us all… We know from data that people who say they have a best friend at work are much more likely to stay in that job, be productive and not burn out… I believe we can build a country that is more compassionate and that is more kind- a country that recognizes that our emotions, when properly cultivated, are our greatest source of strength.


”May we all heed this message for the former Surgeon General and the Director of NIH.


Recommended reading

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.


This article is based on that lecture.


Stress research at NIH

To intentionally highlight the importance of the topic of stress, NIH Director Francis Collins, the physician-geneticist noted for his discoveries of disease genes and his leadership of the Human Genome Project, was the interviewer. His interviewee was Vivek Murthy MD, who was U.S. Surgeon General from December 2014-April 2017. He released a landmark report on drug and alcohol addiction in November 2016, the first report on the topic by a Surgeon General, stating that dependency on opioids and other substances should not be viewed as a "character flaw.” His focus in this interview was the role played by stress as a contributing factor in many medical conditions and societal ills.


Stress and resilience are major research topics at NCCIH. Several NIH centers, including NCCIH, are partnering with the Veterans Administration and the Department of Defense in creating a research network seeking non-pharmaco- logic approaches to chronic

BY JOHN A. PATTERSON MD, MSPH, FAAFP

pain and PTSD among active duty military and veterans. Mind-body approaches are prominent among the interventions to be studied.


Stress epidemic across America

Murthy began his tenure as Surgeon General with a ‘listening tour,’ traveling extensively to large U.S. cities and small towns and was struck by a common theme. He saw people in pain everywhere - pain from medical conditions, financial uncertainty, violence, stress of daily life and work - and the pain and grief of loosing children to the opioid crisis. Regardless of geography, urban or rural residence, race, age, beliefs, background or political party, there was universal recognition that stress was overwhelming Americans’ ability to cope. Among lawmakers and citizens alike, the desire for emotional well-being was the one issue people everywhere agreed upon. He ended his tour convinced that addressing stress and emotional well-being is critical to maintaining our individual health and the health of our society.


Murthy compared today’s lack of physician training in stress management and emotional well-being to the historic lack of nutrition education and the mid-20th century commercial depictions of physicians smoking cigarettes. We have learned

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