When it comes to lifestyle change, there’s no such thing as “excuses”, only stages of change.

ross-findon-mG28olYFgHI-unsplash.jpg

We’re always supposed to be ready to change aren’t we? What’s so magical about January 1 in terms of starting a new exercise routine, anyway (Truth bomb: It’s not - 80% of New Year’s resolutions have been forgotten by February)? Our healthcare system makes the poor assumption that when your doctor tells you, for instance, that you need to eat better and move more, that, starting tomorrow, you are going to implement her recommendations. Never mind that you have already known this for years and haven’t done it on your own yet, but now? Now’s supposed to be the time. Rely on your willpower, they say. You can do it! And six months later at your follow up visit, you dread even going because feel guilty for not implementing said recommendations yet.

What all of these well-meaning people, and maybe you, don’t realize is that we’re not always ready to make big changes yet. I know that sounds like a no-brainer, but here’s the surprising part: there is actually a process that we must go through before we’re ready to take action on a change. And the process doesn’t involve action on a behavior until way down the line of readiness. One must progress through each stage of change for the change to actually stick.

Now, I’m not giving you a copout to say, “Well, Doc, I read that there’s this process for change and I’m just not ready for action yet, so I’m going to wait until that time comes.” No, but what I will do is help you see two things: 1) it is OK to be in whatever stage of change you’re in currently and 2) there are things that you can do to move from one stage of change to the next. Well, ok, maybe three things, 3) it’s completely normal to cycle back to a stage from time to time, but more on that later.

So, I’m not giving you permission to rest forever on your contemplation around changing your diet, for instance. I’m empowering you to be aware of your contemplation and start taking steps to help move you forward slowly, but surely, eventually progressing into the next stage of change toward greater readiness, and then eventually action. Sound reasonable? Great, keep on reading…

So what are these stages of change? I’m glad you asked. James Prochaska developed the Transtheoretical Model of behavior change using decades of research evaluating and measuring behavior change for various health behaviors. This is the framework we can use to effect self-change in areas of our health that are important to us. And, it helps us understand how and when new behaviors might be adopted and sustained. The process goes like this: we go from not thinking about change, to consciously thinking about a change, on to planning for the change, taking action on the change and then sustaining the change. Prematurely, advancing to a later stage will not translate into sustainable change, so knowing this model offers insight and understanding into why we may have struggled in the past or quit altogether. It also offers hope that we can be successful working through each step.

It’s important to recognize that you may be in various stages of change for different behaviors. For instance, your eating habits may be on point and in the maintenance phase, but perhaps your physical activity is still in the contemplation phase. Interestingly, success with achieving maintenance in one area increases the likelihood that you can also achieve progress in another area. Always start building a new habit based on the behavior that is farthest along on the readiness spectrum. Success breeds success.

So with that, let’s dive into each of the stages of change:

Pre-Contemplation (“I won’t” or “I can’t”)

In pre-contemplation, you’re not yet thinking of adopting a healthy behavior. This occurs for one of two reasons:

  1. “I won’t”: You’re not interested in changing because you do not believe you have a problem.

  2. “I can’t”: You would like to change, but you don’t believe it’s possible for you. Perhaps it’s too complicated. Or, perhaps you’ve tried and tried and not seen success.

So, if you find yourself in pre-contemplation, what should you do? Here are a few thoughts to explore. You can journal about each of these, or simply just think about how might respond to each of these:

  • Accept that you feel like “you won’t” or “you can’t.” Don’t fight against it. It’s OK and it’s normal. Show some compassion toward yourself. I promise you are not the only person who is at this stage of change for at least one health behavior. Know that you have full control of your life- change or not.

  • If “you won’t,” where is this feeling coming from? Is it perhaps from other people nagging you about what you “should” do? Do you want to make the change for yourself and not be changed because of the opinions of others? If so, good. This change is only for you, not anyone else! You’re in control of your future. You get to make the call.

  • If “you can’t,” think about other areas of your life where you may have felt like you couldn’t do something in the past, but you did it despite that feeling. Or perhaps you’ve tried time and time again, but each time, you feel as though you fail. How did that process work for you? What helped you initiate change at that time? What strengths did you use during that time? What worked well then? What may not have worked so well?

  • Regardless of whether you feel like “you won’t” or “you can’t,” what barriers exist for yourself? Are they real or perceived? Do they feel large or unable to be overcome? Is there fear involved? Can you reframe any of these thoughts or feelings to be more positive or self-accepting? At this point, just notice and become aware of the barriers. There’s no need to strategize about working through them, removing them or fixing them.

  • What are your positive sources of motivation for you in other areas of your life? What is going well for you? How did it get to be that way?

  • Explore what’s most important to you in your life. Why do you wake up every day? What’s your greatest priority in this life?

  • Identify your greatest source of strength. Do you find strength in solitude, in company with others, in prayer or meditation, or perhaps another way? How do you rely on this source of strength on a daily basis?

  • Are there other health behaviors that you feel more ready to change right now? If so, what stage of change are you in with it? Perhaps you’re not considering quitting smoking anytime soon, but you are interested in changing your diet. Focus first on the change that you are furthest along with on the readiness spectrum. This experience can drive your confidence to eventually tackle the ones where you’re earlier on the change spectrum.

Contemplation (“I may”)

When you’re in the contemplation stage, you’re thinking “I may” change. You’re thinking about changing either unhealthy behaviors or perhaps, adopting new healthy behaviors. You still have a fair amount of ambivalence though. You know you need to change and you want to change, but you’re just not sure how or even if it’s possible for you. You’re on the fence, so to speak. But you’re hoping to take some form of action in the next six months.

If you’re in contemplation, give some thought to or even journal about the following:

  • Recognize that you will have ambivalence about this particular change. It may feel like it will be incredibly difficult, even impossible to succeed with it. And that is completely normal at this point in the change process. You’re allowed to see both sides of the change. In fact, seeing both sides helps you strengthen your motivation to change.

  • How long have you been thinking about the change? Sometimes, people find themselves stuck in contemplation for years. If this sounds like you, know that you may just not know how to change yet. And that’s the point of this article. I want to help free you from chronic contemplation and show you that progress is possible.

  • Explore the pros and cons of change. What are the reasons to change? What are the reasons to stay the same? Are the pros and the cons equally balanced, or not? In order to move forward, eventually the pros of making the change will have to outweigh the reasons for staying the same. But know that this takes time!

  • In order to continue considering reasons for change, can you think of your very best experience with change? Can you imagine yourself after you’ve made the change? What would that look like or feel like? What are reasons that would compel you to behave in the way you desire in the future? What are values you hold deeply and how might this change align with those values? What strengths do you have that you can leverage with this change? What are your hopes for the future and how would this change factor into those hopes? Why is this important to you? The point here is to connect the dots between the exciting possibilities that exist for you and how this change benefits that future.

  • Create a strong vision for your future based on what you do want for yourself, as opposed to what you don’t want. Revisit your positive vision for health regularly and watch it grow and change over time.

  • Learn about or connect with people who have made the same change you hope to make. What is their story and what can you learn from it? What worked for them may not work for you, but what could work after hearing from several people who have made the change? What are the gold nuggets you can take away from their experience to contribute to your own? Why reinvent the wheel? Learn from their mistakes too. What would they have done differently if they could do it all over again?

  • What are the scientific facts about the health benefits of the change you’re trying to make? I assure you, there’s plenty of research out there on any number of lifestyle changes whether related to quitting smoking, eating, movement, sleep, stress or most other health-related behaviors. Good sources of reliable, evidence-based health information are the CDC, Healthy People 2020, Mayo Clinic and Harvard Health.

  • Goals at this stage can include reading, learning, listening, thinking, talking, discovering and deciding about your intended change.

  • A stepwise approach can be an incredibly useful in establishing micro-goals in this stage too. For instance, if your goal is to start exercising, but you’re still in contemplation about meeting the exercise recommendations of 150 minutes per week, you may find that building in a 5-minute walk each day or even a few minutes of stretching is totally do-able and builds your confidence to scale up from there later. You may not be ready to tackle the whole goal as envisioned right away, but you can start small. Small successes, with consistency, lead to large victories over time!

Preparation (“I will”)

In the preparation stage, you’re thinking “I will” make this change. You’re committed and are within 1 month from initiating the intended behavior. At this point, you have largely worked through any remaining ambivalence and you see the benefits of making the change very clearly in relation to the “future you.” You’ve identified your sources of strength and your primary motivators. You have grown and strengthened your motivation from the “thinking” phase of contemplation into creating your own, unique plan.

In the preparation phase:

  • Experiment with some possible solutions. Try it on for size and see how it works for you. If it works, great! Keep it. But if not, throw it away quickly and try another approach. There are no failures during this process, only learning. You’re learning what may work and you’re uncovering what’s not going to be a good fit for you.

  • Once you’ve discovered some potential solutions, develop your plan. It’s incredibly helpful to structure your plan as SMART goals during the preparation phase. SMART stands for Specific, Measurable, Attainable, Realistic and Time-Bound. What specifically will you do and how often, how will you know when you’ve reached your goal, is it realistic, yet aggressive enough to stretch you, and when will you start/stop? A smart goal might be structured this way: “I want to walk twice a day 3 times per week. I will walk for 15 minutes each of these mornings at 7:00am and evenings at 7:30pm, starting on the first of October.”

  • You are aware of your barriers and have considered some ways to navigate either through or around them. Make sure to develop contingency plans to address these during the preparation phase. Think about situations that could be problematic and get a plan in place right now for how you might deal with it. For instance, using the goal above, what if it rains for a week straight? Clearly, this is something you cannot control, but it would interfere significantly with your goal. So your contingency plan might be “If it rains or it’s too hot to be outside, I will go to the mall or to the YMCA inside track instead.”

  • Your goal may not be quite where it needs to be. You may have underestimated what you’re actually capable of or you may have overshot the time that you actually have available to work on your goal. Not to worry, goals can be fluid and change over time. Don’t lock yourself into something that’s not going to work. Readjust and keep moving forward.

  • Remember that you’re going to have obstacles. One of my favorite quotes from Ryan Holiday is “the obstacle is the way”. If we want to avoid obstacles, we’ll never meet our goals, but in order to be successful, you have to deal with the obstacles as they arise. It’s an absolutely vital part of the journey toward your goal. Overcoming obstacles helps us build resilience, confidence and self-efficacy, the exact attributes that will make sustaining your goal for the long-term even more likely.

Action (“I am”)

When you’re in the action stage you’re practicing your new behavior consistently. This stage of change generally lasts for 6 months or more because not only are you practicing the new behavior, you’re also creating a new mindset and building a new habit. You’re in the “I am” stage, as in, I am doing it!

You may have to focus very intently on your new behavior in the beginning. You’re likely going to consciously make the choice to do it each and every time. What you’re actually doing by consciously and intentionally making the choice though, is building your brain chemistry to support your habit. Each time you make the choice, the neurons in your brain fire. The more they fire, they eventually wire together to create a new neuronal pathway in your brain to support this new choice. Over time your behavior will become more and more automatic, until eventually it’s your new normal. Your brain can support the change you want to see. Oh, and great news on that front, your brain is capable of growing and changing our entire lives, so it’s never too late to start. Just ask the 60+ year old group of research volunteers who integrated 1 hour of exercise three times per week for 8 weeks in a research study and whose brains actually grew in volume!

  • What can you do consistently right now? Once you’re consistent doing your chosen behavior, for instance, 2 days per week, you can eventually move to 3 days a week and then up to your target of 5. Start small and build from there. Rome wasn’t built in a day. Research shows that it takes at least 66 days to start to build a habit.

  • Revisit the section above under Preparation on SMART goals. Refine your SMART goal. You can even make it SMART-ER by continually Evaluating and Readjusting it. You don't have to stay locked into a goal that’s not working for you. When you learn new approaches that work better, use them! Refine your goals. It’s not only OK, it’s ideal to consider how your goals can be structured better than they already are!

  • Don’t rely on your willpower to ensure that you’re engaging in your new behavior. As Benjamin Hardy, PhD so aptly says in the title of his book, “Willpower Doesn’t Work”, he explains, through a great deal of supporting research, that, rather, restructuring your environment ensures your success. So, if you’re goal is to eat a whole food diet, relying on your willpower to keep from eating the potato chips you see every time you open your pantry, will not work. Eventually, you’re going to have a rough day, feel that salt/fat craving coming on, and BOOM, there goes the rest of the bag. Restructure your environment instead. Don’t even buy potato chips and store them in your pantry. Better yet, place some raw almonds in the place where the potato chips used to sit for a wholesome alternative.

  • Keep your values, your strengths and most importantly, your vision for health at the forefront of your mind during this time. This helps you to remember your why; why you’re doing this in the first place, as well how you can stay on track using the strengths that come naturally to you. Keeping your values top of mind can also help you realize when you get off track. You might start to feel friction between your path and your values. If that occurs, it might be time to re-evaluate your approach.

  • Engage in or create new supportive relationships with people who share your values and goals. Research shows that we pick up behaviors from the people we spend the most time with, so ensure you’re creating an environment of success by choosing your company wisely.

  • Leverage self-compassion. Make sure your self-talk sounds like something you would say to a good friend who’s in the same boat. There will be times where you slip up, when things don’t go as planned or you fall off of the wagon altogether. Lapses happen and will continue to occur. Be understanding with yourself, identify what you can learn from it and start back strong tomorrow. There is no such thing as failure. Ever. There is never a time where you can throw your hands up in the air and give up. This is too important to you. Just dust yourself off and start back strong tomorrow. Consistency over time is what matters when it comes to any healthy behavior.

  • Perhaps you could benefit from a planned lapse to practice getting back on the horse? Maybe you could schedule a day to go off of your eating plan or a couple of days off of exercise routine? This can help you build new mental strength and practice how you might deal with an actual lapse.

  • Develop your relapse-prevention plan. What specifically will you do when the time comes that you experience a lapse in your new behavior? Write it down. Put it somewhere for safe keeping. The moment you become aware of a lapse, pull it out and put your plan into motion. Lapses can be physical, emotional, and mental. Your relapse-prevention plan should take each of these areas into account. As part of your relapse-prevention plan, make sure to continue to envision yourself in the future having established this new behavior. This is your best self. What are the rewards and benefits you envision? Reconnect to your original vision for health and your why.

Maintenance (“I still am”)

The maintenance stage begins when your new behavior becomes a habit and is done automatically, without thinking about it. In most cases, this is approximately 6 months after beginning the action phase. Your confidence in maintaining your habit is solidified and your motivation is sustained and self-reinforcing.

Lapses can still occur at this point in the process and are quite common, so it’s important to continue to refine and engage your relapse-prevention plan when necessary. Many times in the maintenance stage, lapses can be brought about simply by boredom. Expansion of your view of maintenance can sometimes be beneficial. Luckily, lapses during the maintenance phase, when addressed early, generally do not cause significant changes to health or fitness levels long-term.

  • What have you discovered about yourself during this time of change? What are things that have excited you or encouraged you? On the flip side, what has caused either boredom or discouragement? Why are each of these important to the process and how have you navigated them during this time of sustaining your habit?

  • What are ways that you’ve developed to stay engaged in your new habit? How have these ways been helpful or not helpful? How can you mix up your routine to add newness and novelty to your behaviors? How can you expand this behavior to either encompass new areas or even other areas of your life?

  • Who are you a role model to? What do you think this person sees in you that perhaps you don't see in yourself? Why is being a role model important to you?

  • How have you learned to hold yourself accountable to your relapse-prevention plan? What have you learned about the times that you may have started to lapse, but engaged your plan to stay the course? How can you leverage this learning for future moments where you might sense a lapse coming on?

  • To reverse a relapse, even if you’ve moved into a previous stage of change during the lapse, revisit your vision for wellness, your strengths, goals, values and the many personal resources you have at your disposal to get back on track. More than anything remember to use self-compassion and kindness, not judging yourself for the for the lapse. Lapses are normal. Learning to identify it and reverse it is the key.

Sometimes, you may need external support to help you see blind spots or identify patterns of behavior that are not serving you. You may need quite a bit of support navigating through each stage of change, particularly if you’ve tried before and not experienced success yet. Health coaches can be an especially important ally to engage for further support, as they are experts in the behavior change process and can support you to navigate through each phase in a way that works best for you. A health coach can help you create your goals, stay accountable and provide the support that’s missing from many of the lifestyle change prescriptions that are given by healthcare providers.

Counselors can be especially helpful if you identify patterns of behavior that hinder you from achieving success in multiple areas or if you are concerned about your mental health. Mental health is a priority when embarking on a lifestyle change program. Sometimes, mental health treatment and behavior change can be done concurrently; however, do check in with your physician or mental health provider on their recommendations in this regard. Coaching can be initiated once you feel as though you have adequate support for your mental health.

Always seek the professional advice from a licensed healthcare provider before engaging in any form of lifestyle change whether eating habits, exercise, relaxation, stress management, sleep, or any other form of lifestyle change.

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...

leonard-von-bibra-182682.jpg

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.