Fear and Health Cannot Coexist

Photo by  Paul Csogi  on  Unsplash

Photo by Paul Csogi on Unsplash

“Helplessness weakens the body; mastery strengthens the body.” Martin Seligman

Fear will never feed health. Fear feeds disease. We cannot fear our food, for our bodies sense our belief that it harms us and it will in turn respond to that belief. We cannot fear our environment, for our bodies sense the stress related to the effect of the environment upon our body and it responds in turn to our belief. We cannot fear our genes, for they will express the biology of fear. Fear becomes a self-fulfilling prophecy in our attempts to improve our health. Fear cannot and will not drive health.

Our beliefs drive our bodies to respond in kind. If you fear what might be in your food, in your environment, in your body, you are certainly human and you are a conscientious being. You care. You’re concerned. It matters to you. Make your cares count though. Help your concerns drive a different, and better outcome for you.

It is said that love and fear cannot coexist. Love is a primary driver of health and wellbeing; therefore, I say too that health and fear cannot not stand together.

You are an intricately complex entity with thoughts, emotions and feelings. We know now that our negative thoughts and our toxic emotions and past trauma that we’ve not healed or let go of can pervade our biology and create disease. Yet, if these things pervade our biology and create disease, can we not look at the other side of the coin?

Can we not infuse our biology with hope and trust, safety, love and confidence that our choices matter. Our choice that we will thrive from our food. Our choice to move well and immerse ourselves in nature. Our choice to be still and hear the call on our lives. Our desire to live and live fully.

We can trust and believe that the things we do each and every day feed our health, for our bodies will respond in kind. We can choose to believe that when we make the decision to eat more plants that they will promote happiness within our minds, an outward glow upon our skin, healing throughout our body, and positive genetic expression toward health. When we decide to move more, we can choose to believe that the steps we’re taking will lengthen our lives, strengthen our hearts, build our muscles, and create serenity and peace in our minds.

When we fill our lives with meaning and purpose, our biology responds. For the human organism was designed in the image of God and He has a place for you, and only you. You are here to shine your light. Shining your light outwardly also shines it inwardly. Your biology responds to light, much like a plant leans in the direction of the sun. Your biology craves fresh air, green spaces and the sounds of nature. It loves when we move this amazing body we’ve been given, for everything in our biology aligns with our movement and it affects how our incredible body is meant to work. We fulfill the balance that is intended within us.

You are wonderfully made. Remember always that you’ve been given the gift of creation. Not only all of creation to enjoy and appreciate. But also, creation of your own. You, too, are a creator. You can create your beliefs, your thoughts, your actions, and therefore, your reality. God has bestowed upon you the gift to create something that matters. For you. For others. And it starts with a belief. Will your beliefs feed your biology? Will they feed your genetic expression, your optimal health and your way forward? They can, and it starts with just one choice. Believe. Believe that you’re being nourished, that you’re continually immersed in love and care, and forever abounding in vitality. Because you are.

An Open Letter to our Healthcare System

Dear Those Who Care So Well for Patients,

You know it as well as anyone does: you can’t cheat time. You can’t cheat it with processes. You can’t cheat it with technology. You can’t even cheat it with a prescription or a surgical procedure. You deal with this challenge in and day out and recognize that there is just not enough time in the day to do the things that need to be done. You just, simply, cannot cheat time.

Patients in our healthcare system need time and they need more of it than ever before. And doctors do not have the time. Many primary care physicians see upwards of 25 patients per day in their practices. They usually don’t have more than about 10-15 minutes per patient. And it is, unfortunately, nothing that they can control. Their services are in high demand. Nurses don’t have the time either because they’re supporting those same doctors with the needs of those 25+ patients. Nor do mid-level providers. They’re doing the same work as doctors in primary care. As caring and well-equipped as all of these providers are, there is absolutely no more time to give to patients within the walls of our current healthcare system.

The technology that was supposed to save the healthcare provider team time has exponentially increased the amount of time spent away from the patient and re-directed it into administrative functions. Electronic Medical Record (EMR) technology has added time that healthcare providers didn’t have to begin with, so now they’re working extra hours to fulfill their administrative responsibilities. Healthcare providers didn’t sign up for administrative work, they signed up to care for patients. And they’re becoming increasingly burned out. Estimates show that burnout rates among some specialities are higher than 60% and many healthcare providers are considering leaving the field altogether.

Patients need time. But with the structure of our healthcare system, they don’t get the time they need to talk about the things that matter most to them. This is the heart of healthCARE for any patient.

Guess who has the time to dedicate to patients? Health and Wellness Coaches. But they are vastly underutilized in our healthcare system because Health and Wellness Coaching is not yet reimbursed by insurance and is not delivered by a licensed healthcare provider. Guess what? Training your nurses on the coach approach and hiring “Nurse Coaches” is amazing, but if there’s no more time to dedicate to patients than the 10-15 minutes that they’re given, the coach approach cannot deliver the full value of what health and wellness coaching is capable of delivering, no matter who delivers it. Patients will continue to feel unheard and will continue to be sick until the necessary time is dedicated to each of them.

Sixty percent of Americans have at least one chronic condition, usually requiring any number of prescription medications. It is well-established that many chronic conditions, particularly diabetes, hypertension and high cholesterol are not only preventable, but completely reversible with intensive lifestyle changes. Yes, reversible. As in “go off of prescription medications” reversible (under a healthcare provider’s direction and supervision, of course). Health and Wellness Coaches have not only been trained to provide the support necessary to help patients integrate these lifestyle changes, but they dedicate the time necessary in supporting someone to make them. And they keep the patient’s healthcare provider into the loop on their progress and work together with both the patient’s goals and the provider’s goals.

There is an army of Health and Wellness Coaches at the ready, waiting to dedicate their time to support patients on the lifestyle and behavior change that has been prescribed by their healthcare provider. There is even an army of Nationally-Board Certified Health and Wellness Coaches certified by the National Board of Medical Examiners (NBME) and the International Consortium of Health and Wellness Coaching (ICHWC) that is nearly 2000 strong and growing by the year. These highly qualified Health and Wellness Coaches have struggled to find their way into the healthcare system because they are not “licensed healthcare providers”. But, we are uniquely qualified to serve your patients in this absolutely necessary capacity of behavior change toward a healthier lifestyle alongside the rest of the care team. We dedicate our time to guide them through the readiness to change process and help them achieve their personal vision of wellness, in their own personal way and on their own timeline.

When they make the lifestyle changes you’ve prescribed, your job becomes infinitely more fulfilling and rewarding because you start to see the outcomes that are aligned with your recommendations. They’re eating better, moving more, less stressed, more relaxed, sleeping better, more socially-connected and hopeful of the future. And their blood pressures are improving, their blood sugars are decreasing, their cholesterol is dropping and soon, they start decreasing medication dosages and might even eliminate some of them. And you benefit because you can deliver care without ever increasing your time or your team’s time. You leverage those professionals in your own community who are fueled by the work of behavior change and it matters to all of us.

Yes, there is a cost to patients for this service and it is not yet recognized by most insurers (although this is likely coming in the future). Some medical savings accounts reimburse health and wellness coaching. Among the many well-qualified coaches in your area, you will find that many are very reasonably priced, some using a sliding scale to accommodate lower-income patients. Most health and wellness coach’s services range anywhere from $30-150 per hour. Meeting with a coach once or twice per month for half an hour for a period of months is usually sufficient to see significant results. There is immense long-term value to a patient investing in a Health and Wellness Coach in the pursuit of greater health and well-being, as well as potential savings in future personal healthcare costs.

I beg you, on behalf of the many thousands of Health and Wellness Coaches around our country who are ready and willing to serve you and your patients, please find one near you and start sharing this amazing, meaningful resource with your patients. Your patients will love the support, the care and concern, and most of all, the time, that a Health and Wellness Coach will give them.

You can find a National Board-Certified Health and Wellness Coach near you at https://ichwc.org/nbchwc-directory/#!directory/map.

Alzheimer's May Not Be Exactly What We Thought...


Many of the early years of my career was spent conducting clinical trials on Alzheimer's disease therapies. The medications we were studying were thought to potentially slow the progression of the disease. I enrolled countless patients and caregivers into these trials with one common thread between all of them: hope that their participation would make a difference in the course of Alzheimer's research; if not for them, then for future generations. I'm thankful for the many clinical research participants and caregivers who have volunteered to participate in research for Alzheimer's because their participation has mattered greatly in the development of our knowledge about this devastating disease. We have learned so much about the disease in the last two decades, all of which is guiding our path forward on lessening the impact of Alzheimer's. The potential impact of the disease in the coming years is significant, but thankfully, our hope in lessening the burden of the disease is even greater. 

Alzheimer's disease currently impacts 5.2 million Americans, two-thirds of which are women. It is the sixth leading cause of death in the United States. We now know that 45 million Americans hold a gene called ApoE4, which can increase your risk of developing Alzheimer's disease anywhere between 30-90%. The disease is projected to affect between 13.8 to 16 million people in the U.S. by 2050. Pretty concerning. 

And sadly, even after decades of research on new therapies, we are no closer to either a cure or even an modestly, effective treatment. In fact, of the six medications that have been FDA-approved (one of which was discontinued for safety issues) for Alzheimer's disease, each of them only temporarily reduces the symptoms of the disease for a period of 6-12 months. A new Alzheimer's drug has not been approved since 2003. Alzheimer's is the ONLY one of the nation's 10 most common causes of death for which there is no effective treatment. Yes, there are many new drugs in the pipeline for Alzheimer's disease research as well, but interestingly, each only targets one specific mechanism in the body that we think contributes to Alzheimer's. 

Emerging research is demonstrating that cognitive decline (including Alzheimer's disease) may not actually be caused by one specific mechanism, as once thought. Rather, it seems that cognitive decline can develop based on any combination of 36 different mechanisms. So, while taking a drug that targets one or two of these mechanisms can make a difference, according to Dale Bredesen, MD, whose team has discovered and documented these mechanisms, "it's like trying to plug a roof with 36 different holes." Dr. Bredesen's work is focused on not only what drugs can make an impact on as many of these different mechanisms as possible, but also what lifestyle factors can make a difference in Alzheimer's disease as well. His work is exciting and more research is ongoing. You can learn more about Dr. Bredesen's work in his book entitled "The End of Alzheimer's." 

We know that in individuals with Alzheimer's disease, there is an accumulation of amyloid-beta in the brain. Amyloid-beta is a protein fragment that forms sticky plaques which build up in the spaces between nerve cells. The disease also features neurofibrillary tangles made from another protein called tau that builds up inside of cells. Additionally, neuroinflammation (inflammation in the brain) seems to be the key trigger that causes someone to exhibit symptoms of cognitive decline. In fact, brains of the elderly without cognitive decline were examined after their death and were found to also contain plaques and tangles, but without neuroinflammation, symptoms of cognitive decline were not displayed. 

According to Dr. Bredesen's research, they are finding that production of amyloid beta is actually a normal defense mechanism of the brain to injury, infection or some other type of assault. These assaults can be from inflammation, lack of nutrients or even toxic exposures. Also, the disease process starts decades before someone starts to show symptoms of cognitive decline. In fact, this process can start as early as age 40 in someone with high genetic susceptibility to the disease (those with the ApoE gene, for instance). So early intervention is key in reducing the likelihood of developing the disease. 

So what can we do about Alzheimer's disease? I'm glad you asked because the one thing we can do is focus on the things that we can control. We may not be able to control the time it takes to research new therapies. We also may not be able to control our genetic risk for the disease. But we can begin to impact our approach to Alzheimer's disease by changing our mindset and therefore our approach to risk. First, our genes don't have to necessarily be our destiny. We know that our genes are influenced greatly by our environment, so even if your mother had Alzheimer's disease, steps you take now could impact your ability to prevent the disease. Additionally, we have learned that our brains can change and grow throughout our lifetime, so new behaviors you take on can grow your brain and the networks within it. 

So what do experts recommend that we do to prevent Alzheimer's disease? Change your lifestyle through simple steps that can make a big difference. Ensure 8 hours of quality sleep each night with consistent sleep and wake times. Handle stress in your life- better yet, embrace any stress in your life because it's a reaction to something that you care about deeply. Be engaged with others in community- do all that you can to avoid feeling isolated. Move your body. Our bodies were designed to chase animals for food and walk miles and miles each day foraging. Continue learning new things- read books, learn a new language, hobby, etc. And finally, eat real food. The Mediterranean diet has shown great promise in reducing the risk of cognitive decline, and even improving memory in aging populations. Plus, it's a great way to eat with a focus on fresh, local food around family and friends and with a nice glass of red wine every now and then. 

Interested in leaning more about how you can reduce your risk of cognitive decline? Stepwise Health is offering a new program starting in Spring of 2018 that will guide you through each step of the risk reduction process. You will learn the latest science on how to prevent cognitive decline, learn how our brains are capable of changing and growing throughout our lives and build new habits that will contribute to optimal brain health, energy and longevity. For more information, please contact us directly. We are planning to offer individual and group programs in the local Winston-Salem community. If you live outside of Winston-Salem, we also have a Telehealth option so you can engage in the program from the comfort of home. 


The Evolution of Primary Care


In the next five years, expect your primary care visits to look very different than they do now. Your primary care experience will likely involve more time and attention from your healthcare team. In today's healthcare climate, that seems to be wishful thinking, but there are several drivers that I believe will contribute to this unexpected trend. Several key areas are fueling the need for a much more robust and meaningful primary care experience:

The Rise of Chronic Disease

We have seen volume in our healthcare system increase exponentially over the years because of the rise of more and more chronic disease in our society. "Chronic diseases and conditions—such as heart disease, stroke, cancer, type 2 diabetes, obesity, and arthritis—are among the most common, costly, and preventable of all health problems. As of 2012, about half of all adults—117 million people—had one or more chronic health conditions", according to the Centers for Disease Control (CDC). Health risk behaviors are behaviors that contribute to disease that you can change. Four of these health risk behaviors—lack of exercise or physical activity, poor nutrition, tobacco use, and drinking too much alcohol—cause much of the illness, suffering, and early death related to chronic diseases and conditions, per the CDC. In fact, they note that eighty-six percent of the nation’s $2.7 trillion annual health care expenditures are for people with chronic and mental health conditions. The current model of treating chronic disease is too costly and too little time is available in primary care visits to address the lifestyle factors that are driving disease. Telling patients what they need to do is not enough. Sharing the consequences of not changing lifestyle is demotivating and demoralizing to many patients. Change is extremely hard without adequate support.

Patient-Centered Care

Intuitively, everyone in healthcare knows that patients are the most important part of the equation of care. But, as patients, do we always feel that our wellbeing is a focal point of our care? I greatly value and appreciate the time I spend with my healthcare providers. I'm thankful for their expertise, their insight and their compassion. I appreciate that my provider takes a personal interest in what's wrong with me. And as expected, generally, my visits focus around just that- what's wrong with me. And I'm thankful that when something is wrong, I can reach out to my provider for their help. But who can help me ensure that I'm doing the right things for my health day-to-day? That I'm doing the things that minimize my health risk. Clearly, there is a missing link with what actually happens on the many days, weeks and months between primary care visits. Many of those decisions fall within my own sphere of influence, not my provider's. And honestly, I don't think those should fall within my provider's sphere of influence because he or she needs to attend to other patients who have things wrong that need to be fixed immediately. 

Time Constraints and Healthcare Provider Burnout

Which leads me to my next point- a provider's time is much more limited now. So much has changed in terms of administrative, management and leadership responsibilities for providers in the last 10 years. This challenge became especially apparent with the inception of the electronic health record (EHR). For providers, this adds an administrative layer to their responsibilities that is not only time-consuming, but also has providers scratching their heads as to how to get it all done. Do they park their computer between them and their patient to collect the EHR on the spot and risk the ever-present physical barrier to patient care? Or, do they spend 10+ additional hours a week at home catching up on patient records, when they really want to be with their families? I, for one, don't prefer either scenario. I want a provider who is thriving. When he or she thrives in their life, their patients will thrive too. I want a provider who is present during my visit, but also one who is present for the things that matter to them when they're away from their work. Current estimates show that burnout affects over 60% of primary care physicians according to the American Medical Association.  Healthcare provider burnout is a growing problem that affects the quality, safety and efficiency of patient care. Providers need greater support in the clinical setting to accomplish the excellent care of the patient. 

A New Breed of Healthcare Professional

There is a new type of healthcare professional that is evolving and rising up to help meet the chronic disease challenge. Meet the professional Health and Wellness Coach- the new face you will begin to see as part of your healthcare team within the next five years. According to the International Consortium for Health and Wellness Coaches (ICHWC), Health and Wellness Coaches partner with clients seeking self-directed, lasting changes, aligned with their values, which promote health and wellness and, thereby, enhance well-being. In the course of their work, Health and Wellness Coaches display unconditional positive regard for their clients and a belief in their capacity for change, and honoring that each client is an expert on his or her life, while ensuring that all interactions are respectful and non-judgmental. ICHWC is ensuring a new standard of professionalism and competency with professional Health and Wellness Coaches through a new credentialing process that now recognizes a coach as a National Board Certified Health and Wellness Coach.

When you reach out to see a primary care doctor in the future, you will most likely be connected early on in that process to a professional Health and Wellness Coach who will work with you to, first and foremost, co-create your health and wellness goals based on your unique vision for health. They may even conduct much of the new patient intake process at the practice. You will most likely see your Health and Wellness Coach at each of your primary care appointments, and even stay connected with them even between your visits through phone, video chat or instant messaging. Your Coach will have the time to support you in changing your lifestyle, because that is their primary purpose. They will celebrate your accomplishments with you and inspire you to use your strengths to reach your full vision for health. Your Coach will connect you with the resources you might need to make the changes you desire. Your Coach will focus on what's right with you, while your doctor focuses his/her expertise on fixing what might be wrong when those times come. 

And from a cost standpoint, the entire healthcare system wins because Coaches are a much more affordable option for contributing to the overall management of chronic disease. Coaches support a primary care practice in many ways that can reduce burden on other providers- from scheduling, new patient intake, medical records, education and follow up. And finally, because chronic disease is fueled by lifestyle factors which require sustained behavior change, Health and Wellness Coaches represent one missing link in the chronic disease care equation. They are the experts who have the skill, time and knowledge to support this behavior change process. Research also shows that Health and Wellness Coaches, as part of the healthcare team facilitate greater trust between patients and their providers. 

Early outcomes for research on integrating Health and Wellness Coaches in primary care models are promising, demonstrating the value of health coaching in terms of improved clinical outcomes, which persisted one year after the completion of the health coaching intervention. The study's author encourages primary care clinics to hire Health and Wellness Coaches to equip and encourage patients to self-manage their chronic diseases. 

So, prepare to meet your new Health and Wellness Coach during a future visit to your primary care provider and get ready to create your very best health yet!