De-Stressing the Holiday Celebrations: How to enjoy and navigate the Thanksgiving to New Year's Holidays with the least stress

Dr. Joel’s Health and Wellness Catalyst Blog for November

While everyone’s challenges and stresses may differ during the holiday season, the approaches to having the most enjoyment and fun, and the least stress during this time can be priceless.  Between the work that is needed to prepare food and buy presents, and the challenges of potentially difficult family members (perhaps with opposing political views), lots of junk food calling out and/or the stress of ongoing work, home and/or other to do lists, we can often feel overwhelmed.  Drawing on lessons from past experiences and our current resources, as well as planning ahead can make all the difference.

What are your biggest challenges or stressors?

Identifying these at the beginning can be most important.  We also have strengths and weaknesses, enjoyable and torturesome tasks to do, and circumstances that push our buttons, so be present to these situations, and see if there are more effective or manageable ways to get them done.  Talk with family members or friends to make decisions that work best for you and your family, and develop a plan that hopefully finds the right balance.

Remember the true meaning of the Holidays?

Thanksgiving just finished – what a great holiday (definitely one of my favorites), and a chance to spend time with family and/or friends to reflect on all that we have to be truly thankful for and/or to be in action or think of others who may not have as much to be thankful for.  It is also a wonderful time to get some needed rest and relaxation, fun, and possibly plan for and prepare for the Holidays in December.  In addition to gratitude, consideration of loving kindness, service, mindfulness and peace for ourselves, our families and our communities, these all can provide the meaning and themes for this time of the year.

Take steps to manage the stress or plan for the framework of steps:

1.     Keep up with regular exercise – even if it is less than usual, do what you can and it will make a difference especially if you can do some others below

2.     Find the right balance that you need of healthy foods and other foods that are not as healthy but may be important for you to enjoy the holidays.  Set guidelines for holiday meals, parties, and foods that are kept at work or at home that might be tempting but also might cause you to feel tired, upset your stomach, give you a headache or just cause you to gain weight

3.     Continue your regular practice of relaxation techniques – mindfulness, meditation, prayer, breathing exercises and other approaches.  Again, even if you are not able to do as much as you usually do, whatever you can do will be helpful and help to balance the stress

4.     Ask for help – who can you go to if you need assistance to get things done

5.     Contact your go to people – who can you go see or call to talk about how you are feeling or the challenges or problems that you are dealing with

6.     Seek assistance or connect with your counselor, psychologist or social worker – this is why you have a practitioner as part of your healthcare team (or if it would be helpful, find someone), since this is also an opportunity to work through relationships or developmental issues that will tend to reappear until we fully address them, find completion and/or find peace with it/them

7.     If you are trying to lose weight, you may want to consider a different goal to maintain your weight during this time and start fresh again after the New Year to lose weight – not necessary for some but very important for others

Other Considerations

1.     Plan some of your favorite rituals to connect with the true meaning and joy of the holiday – this can be so many things from decorating for the holidays, to favorite or funny movies, to cultural activities, to sing-alongs, other musical performances and sporting events

2.     Take breaks or set aside time to do nothing or check in with how everything is going

Have a very Happy and Healthy Holiday Season!!

Managing the Winter Blues: Specific information and approaches to help control Seasonal Depression (Seasonal Affective Disorder - SAD) and the more mild and common form, winter blues

The Health and Wellness Catalyst:  October, 2016

This past year I have worked on a corporate wellness project for a healthcare system and it has been a revelation to me how common seasonal depression is, and how important it is to understand its influence on mood so that it can be managed effectively.   What I found was that about 20 percent of the participants that I worked with had this seasonal depression or winter blues, which I thought was surprisingly high – it also was important for me as their health coach to support them with information and/or approaches that would help them to address it.  In this way they could be more aware of their seasonal and yearly tendencies, and take specific steps to clarify, adjust and/or sustain their health and well-being goals.

I therefore went to one of the best resources:  Winter Blues: Everything you need to know to beat seasonal affective disorder, by Norman E. Rosenthal, MD, 4^th edition, Guilford Press, NY, 2013.  Dr. Rosenthal is a psychiatrist and one of the leading practitioners who has developed, researched and educated the public (and the healthcare field) about seasonal depression.  I also heard an interview with him (I think on Voices in the Family with Dan Gottlieb, PhD on NPR) and he is a truly caring physician who has made an important contribution to mental health and to those who see him as a health practitioner.

Anyway, Dr. Rosenthal states in his book that about 5 percent of the US population has SAD and another 14 percent have winter blues – which is about what I observed in my health coaching project.  Interestingly, some people start to feel the changes in the fall when days start to get shorter, while others commonly feel it starting in the coldest winter months of January and February.  SAD and winter blues can be felt by experiencing one or more of the following symptoms: feeling down or depressed, having difficulty focusing on work or in relationships, snacking more (especially on carbs and/or sugar), feeling more tired, sleeping more, difficulty waking up in the morning and many other possible symptoms.

What to do if you feel like you may have SAD or winter blues:

1.     Learn more about SAD and winter blues – look at information provided by reliable sources online or get Dr. Rosenthal’s book.  Also, discuss it with your primary care doctor and/or counselor or psychologist to help determine whether it is having an important effect and what steps should be considered.

2.     Look at your lifestyle to see how well you are doing with your nutrition (diet and targeted nutritional supplementation), exercise and fitness (are you consistent?), and your stress level and relaxation techniques (are you balancing the stress enough with exercise, relaxation/mindfulness/ meditation and time for yourself?)

3.     Light therapy – research suggests that it is very helpful for season depression and newer research suggests that it may also be helpful for non-seasonal or unipolar depression also.  Make sure you get a good light box that has been approved for SAD or winter blues and make sure you spend time each day in front of it to get the light that you need to feel better.

4.     Consider seeing a psychologist, social worker or counselor to get more specific assistance and support, and if necessary, consider if anti-depressant medication may be needed.

5.     Regular exercise is helpful for managing both stress and mild to moderate depression – is your program helpful? Are you following through with it? Do adjustments need to be made?

6.     Good nutrition is important - the foundation should be a natural, healthy diet, which could be a Mediterranean type diet or a lower/moderate carbohydrate diet.  Targeted supplements could be added also such as B complex, vitamin D, fish oil, magnesium, chromium and/or others.

7.     Meditation, mindfulness and stress management techniques such as yoga, tai chi, chi gong, and others can help – again do you have a good program? Are you following through? Are adjustments or new approaches needed?

8.     As with all symptoms or disorders, it is important to identify the most important and unique effects for you (for example, knowing when symptoms tend to start), what approaches are most important for you and getting support from the practitioners who are part of your healthcare team and/or family and friends who are part of your support network.   

As this discussion shows, there are many options for effectively managing SAD and winter blues, but half of the challenge is realizing that this may be a problem for you, and then the other half is to get into action by learning about it and finally getting any help that you need to manage it.

Know Your D Level: Although not a miracle nutrient, vitamin D is essential for helping to prevent many health problems including heart disease, cancer, depression and memory loss

Dr. Joel’s Health and Wellness Catalyst Blog:  September, 2016

Know Your D Level: Although not a miracle nutrient, vitamin D is extremely important for many health issues such as heart disease, cancer, depression and memory

The list of vitamin D related health issues seems to grow almost on a monthly basis – bone health, heart disease, blood sugar regulation and insulin resistance, depression, susceptibility to common cancers and auto-immune diseases, memory, pain, etc.  How can this be, you say – well, it turns out that vitamin D helps to regulate and is a co-factor for 10-20 % of all genetic activity, which is a huge amount and central to almost all of our bodily functions. 

**  Everyone should know what their blood level is and be taking it unless they have at least a level of 40 mg/dL.

A good example of the importance of vitamin D comes from a recent study looking at its important effect in memory and cognition.  What was most interesting to me was that not only was higher level of vitamin D at the beginning of the study associated with better memory or cognition level, but it was also associated with the amount of cognitive decline that occurred over time (lower vitamin D level was associated with greater change or worsening of cognitive measures over the four year period in which the participants were followed).

Research has tied vitamin D to variety of functions and influences within the brain that may be important for maintaining healthy functioning.  These include the vitamin D receptors found in many parts of the brain that affect brain activity and vitamin D’s promotion of anti-oxidant function which protects tissues from aging or ‘rust’ damage (very important for maintaining nerve cell function and overall nervous system activities).

Vitamin D and vitamin D blood levels are also important for the two leading causes of death in the United States – cancer and heart disease.  Benefits of higher levels of vitamin D have been shown in certain types of cancer - one study from Norway found that higher levels of vitamin D were associated with longer length of survival in breast, colon and lung cancer, as well as in lymphoma (Tretli S, et al, 2012).  With regard to heart disease, vitamin D level may be a marker of and/or contributor to high blood pressure, heart failure, stroke, peripheral vascular disease, irregular heart beat disorders and/or overall death or mortality – lower vitamin D levels increase risk.

I have also wondered why so many people are vitamin D deficient and I thought that it might relate to environmental chemicals (in addition to using so much sun screen and other influences – sun helps to make the active form of vitamin D) because many of these chemicals are hormone or endocrine disrupters and vitamin D is also a hormone.  A recent study has found a link between the intake of Bisphenol A - BPA (found in some food can linings and plastic water bottles) and phthalates (found in some plastics and cosmetics) and vitamin D blood levels (Johns LE et al, 2016).

It is therefore important to know your vitamin D level (25 hydroxy vitamin D),  take extra vitamin D if you need it (vitamin D3 – 1000 to 5000 IUs per day) and make sure that your overall nutrition and lifestyle program is effective for your health history and current health issues.

1. Wilson VK, et al.  Relationship between 25 hydroxyvitamin D and cognitive function in older adults: the Health ABC study J Am Geriatr Soc 2014;62:3839-53.

2.  Tretli S, et al.  Serum levels of 25 hydroyvitamin D and survival in Norwegian patients with cancer of the breast, colon, lung and lymphoma: a population based study.  Cancer Causes Control  2012;23:363-70.

3.  Lugg ST, et al.  Optimal vitamin D levels for cardiovascular disease protection.  Dis Markers  Sept 8, 2015; epublication.

4.  Johns LE, et al.  Relationships between urinary phthalate metabolite and bisphenol A concentrations and vitamin D levels in US adults: NHANES, 2005-2010.  J Clin Endocrinol Metab 2016 Sep 20 (epublication).

International Congress of Integrative Medicine and Health: Meeting in Las Vegas, May 17-20: Update and Highlights

International Congress of Integrative Medicine and Health:  Meeting in Las Vegas, May 17-20:  Update and Highlights

Welcome to the May issue of the Health and Wellness Catalyst Blog

I recently got back from this educational and enjoyable meeting and wanted to give you an update on what I found:

1.     First, it was a gathering of almost 800 people – physicians, psychologists, nutritionists, acupuncturists, naturopaths and other similar practitioners, and other stakeholders - from all over the world.  Most of the attendees are members of the Academic Consortium For Integrative Medicine and Health, composed of over 60 member university hospitals and/or medical schools from North America – to get more info on them or to find a local member organization, go to www.imconsortium.com. 

2.     The research on integrative medical and health approaches to many diseases and conditions is expanding quite rapidly – that is an important step forward since this model of care and research of integrative care will help in the understanding of both practitioners and clients, resulting in more integrative approaches to common conditions and diseases.

3.     I presented three posters at the conference, which all were received well – these included:

a.     A research poster: Perceived stress in patients with common gastrointestinal disorders:  Associations with quality of life, symptoms and disease management

b.     An Integrative Nutrition Consultation Practice in a Suburban Philadelphia Counseling and Therapeutic Center

c.      Targeted Cancer Coaching for Cancer Survivors:  Individual and Group Programs to go From Surviving to Thriving

I also want to summarize a couple of keynote presentations that were very interesting and inspiring:

I.               Well-Being is a Skill:  Perspectives from Affective and Contemplative Neuroscience, by Richard Davidson, PhD, Center for Investigating Healthy Minds, University of Wisconsin.

This was a really interesting talk by the researcher who has been visited about ten times by the Dali Llama and challenged by him to focus on health and well-being, and happiness, as opposed to disease.  He described four constituents of Well-being including: (a) Resilience; (b) Positivity; (c) Attention-presence (he said that a “wandering mind is an unhappy mind;” and (d) Generosity.  The last, generosity is not as well validated as he would like to see.

He also talked about compassion training – it does not take a lot of practice to see brain activity changes using scanning techniques.  Positive effects were shown for adults who did the training for 30 minutes per day for two weeks.

II.             Pain and the Brain: Conceptual and Clinical Considerations, by Lorimer Moseley, PhD, University of South Australia.

This was a fascinating discussion of pain and neuroscience, which he developed and is continuing to research.  His basic premise, if I understand it correctly, is that we have a tissue tolerance level of pain and that we continually ‘protect ourselves’ from pain.  However, if we are continually protecting ourselves we are reacting significantly or over-reacting to pain when we don’t really need to.  He therefore suggests that we acknowledge pain but identify when it hurts but that we are safe and not needing to react so much or over-react. 

Another interesting story which he described and illustrates the power of  the mind-body connection or interaction involved reported pain and swelling in a study – it showed that people who looked through binoculars that enlarged their swollen hand reported more pain and swelling than those who looked through it and saw a smaller and less swollen hand – cool experiment!

His books that describe his approaches to pain and people with pain are, The Explain Pain Handbook Protectomer, 2015; and Painful Yarns: metaphors and stories to help understand the biology of pain, 2007.

I also had some fun meeting new people at the conference and did get into Las Vegas one evening to enjoy a great Italian meal at the Venetian Casino – it was painful to not be able to take home leftovers!  So all in all, it was a really good conference and trip, enjoyable, and helpful to promote some of my current research and activities that will move forward.

Nutritional and Holistic Keys to Maintaining Effective Memory:  New research suggests combined benefits from B complex vitamins and omega 3 fatty acids (fish oil)

Welcome to the April issue of the Health and Wellness Catalyst Blog

It has been known for some time that B complex vitamins such as vitamin B12, folate, and vitamin B6, and omega 3 fatty acids are important for healthy nervous system functioning and good  memory.  This has been attributed to the importance of B complex vitamins in producing specific neurotransmitters in the brain, which help to transmit messages or signals between nerve cells.  Omega 3 fatty acids are more important in nerve cell membrane function because they help to keep these cells more flexible and therefore function better.  It should be remembered that there are several minerals that are also important for producing neurotransmitters, and magnesium and zinc are most helpful.  Finally, vitamin D is another nutrient that can influence brain function and memory.

Research studies that were part of my doctorate in Nutrition Science

My research for my doctorate in nutrition, assisting Dr. Iris Bell, showed combined effects of vitamin B12 and folate on memory in patients in the geriatric psychiatric unit at McLean Hospital, Harvard’s psychiatric hospital.  One of the most interesting aspects of this work was that they were not deficient levels of vitamins but below average or below median levels of both B vitamins.  This suggested that even low normal levels of nutrients are important because they interact in ways that are vulnerable to ineffective function.

Recent research in the Journal of Alzheimer’s Disease

In the research that I am focusing on this month, 266 participants with mild cognitive impairment (MCI), who were also over 70 years old, were given the combination of vitamin B12, folic acid and vitamin B6 for two years, or they were given a placebo (a dummy pill with no vitamins).  After the study was completed, it was found that the B complex vitamins were helpful for decreasing the cognitive function decline, but only when the levels of the omega 3 fatty acids were in the upper end of the normal range.  Also, DHA seemed to have more of an effect than EPA, suggesting that fish oil supplements have both DHA and EPA or more DHA than EPA.

Holistic approaches to good memory

There are several factors that research suggests are known to improve or maintain good memory with aging.  These include:

1.     Regular exercise – some research has shown that the size and function of the hippocampus, the primary part of the brain associated with memory, is increased and improved;

2.     Relaxation techniques – stress is well known to decrease the size of the hippocampus and impair memory while relaxation techniques have been found to be helpful for preserving memory;

3.     Challenging your brain function with puzzles and other activities such as art work or playing music is also good for memory – they are thought to increase the number of connections and functioning or interconnectedness of nerve cells (this is known as neuroplasticity);

4.     Good social networks – research has shown that the better our relationships are and the larger our social network is the less likely we are to have memory decline with aging (this is also associated with longer life).

Conclusions and bottom line:

1.     Both B complex vitamins and fish oil or omega 3 fatty acids are important for brain function and memory, whereas benefits may not be seen if the nutritional status of either is not adequate;

2.     Healthy diet is always the foundation for good nutrition but targeted nutritional supplements are also important to achieve therapeutic benefits;

3.     Lifestyle is also essential to address and research supports the importance of exercise and physical fitness, stress management and relaxation techniques, brain exercise from puzzles, artwork, music and other activities, and having a  good support network and close relationships.

References:

1.     Abderrahim O, Jerneren F, Resum H, et al. Omega 3 fatty acid status enhances the preention of cognitive decline by B vitamins in mild cognitive impairment.  J Alzheimer’s Disease 2016;50:547-57.

2.     Bell IR, Edman JS, Marby DW, et al.  Vitamin B12 and folate status in acute geropsychiatric inpatients: affective and cognitive characteristics of a vitamin non-deficient population.  Biological Psychiatry  1990;27:125-37.

Healing Your Gut: Nutrition and lifestyle approaches for IBS, GERD and inflammatory bowel disease

Welcome to the March issue of the Health and Wellness Catalyst Blog 

This month's blog is about my long and effective personal and professional experience with stomach and intestinal symptoms and problems - I have seen more GI disorders in my professional career than anything else and I help people get very good if not great results when I work with clients and patients in my clinical practice.

It is important to realize that everyone's circumstances are different, so that the nutritional (diet and targeted nutritional supplements), stretching, fitness and exercise, and stress management or relaxation techniques, need to be individually and effectively designed.  In holistic terms, these approaches address physical, emotional and spiritual well-being.  Without including all of these approaches, it may be difficult to get the results that you may want, particularly when the symptoms may have been present for a long time.

Dietary approaches and guidelines:
As with most chronic and/or complex disorders that I see in clinical practice, sugar, dairy and wheat are the most common offenders and needed to be avoided or rotated (1-2 times per week), at least for a period of time, to see how much they may be contributing to current symptoms.  However, many people need to follow a more comprehensive elimination diet (also restricts or rotates corn, citrus, coffee, peanuts, other gluten grains - rye and barley, eggs, and other allergenic or frequently included foods or beverages).  I have worked with many people who feel that they no longer know what to eat and we have to begin with well tolerated proteins (poultry, fish, etc), cooked low carbohydrate veggies, and starchy vegetables and rice.  Again, it must be remembered that the best diet may not get results unless targeted nutritional supplements, exercise and relaxation techniques are also addressed.

Targeted nutritional supplements:
In my experience, a good probiotic and a digestive enzyme are the two most important supplements to take, although others can be helpful if symptoms continue .  As I have previously written in this blog, and before that my newsletter, the microbiome project will significantly change and improve gastrointestinal care because we will know in each of the GI disorders what bacteria is normal and abnormal for each condition.  There will also be information and understanding for gut bacteria as it relates to autoimmune disorders (eg. MS, rheumatoid arthritis, Hashimoto's thyroiditis, and many others), neuropsychological problems, asthma and allergies, colon cancer and many more medical diagnoses and symptoms.  For right now, we know that lactobacillus and bifidobacteria species are most important and healthy, and that it is important to have a good diversity of different bacteria in the gut (by eating more naturally grown organic foods which have not been exposed to so many pesticides, herbicides and other chemicals).

Stress management techniques:
1. Stretching, fitness and exercise - exercise is a great stress management technique and has an important effect on the 'second brain' or nervous that is in the GI tract.  Again this should be individualized to make sure that you like your work out program and will continue it over the long term.  It generally would include aerobic exercise, some weight training and some more meditative exercises like yoga, tai chi or chi gong.  There are so many options here that I will just suggest that you find what works best for you and if you are having any difficulties, you should get assistance from the current practitioners that you are working with.

2.  Mind-body and relaxation techniques - again, there are many options here including mindfulness, meditation, guided imagery, biofeedback, counseling, others that overlap with exercise (yoga, tai chi and chi gong), and many other approaches.  The important point is that stress often has a tremendous effect on not only quality of life but also disease management - in the near future I will post my lead author abstract supporting this relationship, which I will presenting as a poster at the International Congress on Integrative Medicine and Health in Las Vegas, May, 2016.  I am also submitting the article for consideration of publication in a peer reviewed journal - I will let you know when and where that article will be published as soon as I can get that published.

Conclusions and Bottom Line:
1. Stomach and intestinal problems can be effectively managed through natural approaches, although medication can be necessary for some people.
2. Developing the right dietary approach is essential by avoiding or limiting sugar, dairy, wheat and/or other foods to which you may be intolerant.
3. Targeted nutritional supplements such as a probiotic and digestive enzyme are often important and helpful.
4. Exercise and stress management techniques are essential for the effective management of symptoms for most people.
5. Find the right practitioner or practitioners that will help you heal your gut.

Health Coaching for Breast Cancer Survivors: Going from Surviving to Thriving

Integrative Health Coaching for Breast Cancer Survivors:  Creating lasting lifestyle changes to live your best life

Introduction

Health coaching is a relatively new approach to lifestyle and lifestyle change that can be very beneficial – these lifestyle factors are primarily nutritional guidelines, physical fitness or exercise, and stress management or relaxation techniques.  Most people actually know what healthy lifestyle behaviors are, but can have a very difficult time making or sustaining the necessary changes.  Therefore, health coaching after a breast cancer diagnosis, can be very important because it will help to promote an optimal quality of life and healing, as well as help to prevent a possible cancer recurrence.

What is Health Coaching?

Health coaching can be defined as the process of helping clients and patients gain the knowledge, skills, tools and confidence to become active participants and owners in their care, so that they reach their self-identified health-related goals.  During this process, there are a number of techniques that are used, but two of the most important are positive psychology and mindfulness.  Some of the central characteristics of this health coaching process also include client or patient centered care, self-discovery, a learning or educational process, supportive relationships, drawing on all important resources and accountability. 

Another key feature of health coaching is creating a health and wellness vision, as well as three-month goals and weekly or biweekly goals.  Health coaches are most often nurses, nutritionists, mental health professionals, physical therapists or exercise physiologists, or have other similar health related backgrounds.

Positive psychology is an important cornerstone of health coaching because it helps to draw on people’s strengths and successful experiences.  Our healthcare system has really been more of a disease care system, and as we have seen, has not been very successful at promoting health and wellbeing or creating effective lifestyle changes.  Positive psychology brings other beneficial approaches as well, such as a positivity ratio of 3:1 (ratio of positive to negative thoughts and comments), which has been found to be associated with happier people, and a 5:1 ratio for happier marriages – research suggested that 80 % of people have a positivity ratio below 3:1.  This is important because happier people are more flexible and creative, and more importantly for breast cancer survivors, tend to be healthier and have greater longevity.

Mindfulness is another cornerstone of health coaching, for both the client and the coach.  Mindfulness is important for stress management and sets the tone for a coaching process that is most helpful for clients to achieve their health-related goals and for health coaches to most effectively support clients in this process.  With both clients and coaches being fully present in a non-judgmental and mindful environment, it becomes a safe place to explore any thoughts or feelings that arise.  This can be a sacred place, where health-promoting and healing steps can occur, by discussing a variety of concerns or issues that range from the practical to the spiritual – one example would be to put the right healthcare team in place, that could include a good primary care physician, oncologist, counselor or psychologist,  physical therapist, nutritionist, health coach and/or any other needed or desired practitioners.  Another example would be to talk about fears, losses or other painful experiences and insure a connection with a counselor, psychologist or other practitioner who can more thoroughly and effectively process these feelings. 

As we know, cancer survivorship often puts the most severe stresses and strains on people who may need to make important decisions about their care and lifestyle, or may be facing their mortality.  In addition, the cancer experience can have a profound impact on relationships with spouses, and with family members and friends, vital to a healthy, loving and healing social support system.

Positive Study Results for Health Coaching for Cancer Survivors

One cancer survivor study of mostly women with breast cancer found that wellness coaching significantly improved depression, anxiety, and quality of life (QOL- see reference).  Also, participant self-reports suggested improvement in vegetable and fruit consumption, as well as weight and body-mass index (BMI).

Practical Steps to Get Health Coaching

Now that we have defined and described health coaching, this next section will more specifically give examples and scenarios of who would benefit most from health coaching, how it is done and what the process would look like.

Although health coaching is most helpful for people who have completed active treatment (most commonly, surgery, chemotherapy and/or radiation therapy), health coaching during treatment can also be beneficial.  For those who have completed treatment, the focus can be totally on healing physically, emotionally and spiritually.   As many people have experienced however, the cancer survivorship journey with ongoing treatment can often feel like a roller coaster so health coaching can be a helpful and a useful tool as part of an overall program that addresses a range of symptoms, side effects and other issues that may develop.

Who would be helped most by health coaching?

    Women who need to lose weight (decreasing insulin resistance and the risk of a cancer recurrence)

    Those who still have fatigue and/or brain fog

    Those who may still feel some depression and/or anxiety (these women  also need to be seeing a counselor or other mental health practitioner)

    Those who are having a difficult time putting their lives and lifestyles back together after treatment is completed

    Those who feel like there is little coordination of aftercare

    Those who still feel that they need to heal more and/or feel overwhelmed

Creating a Health and Wellness Vision, Three Month Goals and Weekly or Biweekly Goals

Clients begin coaching by puting together a meaningful health vision that can be inspiring and motivating, as well as three month and weekly goals that help them focus their actions to help them achieve their health vision.  The developed goals are S.M.A.R.T. goals – specific, measurable, actionable, realistic, and timely.  When the goals are reached, great results occur, however, when they are not met or are only partially met, there are lessons to be learned.  The coach then discusses with the client any insights gained from the process, and can provide reflections, feedback, problem-solving tips, when they are invited to do so.  Coaches cooperate with clients to better understand challenges or barriers and develop approaches that may help clients to move forward more effectively and be more successful.   This also helps to develop trust, respect and rapport.

Other benefits of Health Coaching for Cancer Survivors

Experienced health coaches, who also have significant expertise working with cancer survivors, can help support the development of healthy lifestyles, as well as help to sort through differences of opinion regarding healthy dietary guidelines, nutritional supplementation, physical fitness/exercise programs, and emotional and spiritual well-being.  Creating this healthy lifestyle is essential for feeling comfortable and confident with your lifestyle program, as well as optimizing your physical and emotional health and well-being.

Coaching experiences – these come more from my general coaching practice since I am currently adapting my programs for cancer survivors and building that part of my coaching practice

Wendy* – I had met Wendy originally to provide nutritional counseling to help her lose weight.  She did well for a while (lost 15 pounds) and then gained it all back.  We reconnected after I got my coaching certification and worked together using the health coaching structure.  What we found is that she would do well until she came to challenging issues related to her diet or maintaining her lifestyle program when she had so much other work to do (she was the Director of a non-profit organization in Philadelphia).  What she discovered is that she was much better taking care of others and her work responsibilities, which often prevented her from taking the time that she needed for herself.   Secondly, we found that when she got to points where she was unsure about what steps to take, she gave up.  In her Director role however, she would face many similar business and related decisions that needed to be made and was very good at doing that - so she had the ability, but just needed to stay focused and follow through, supported by our coaching relationship.

Jack* – was about 50 pounds overweight and had diabetes when we first started to work together.  He was very good with his exercise regimen but had much more difficulty controlling his eating because he was a good cook, and truly enjoyed food and the company of family and friends that often went with it.  With my weekly or biweekly support and encouragement, we designed a framework that allowed him to lose 40 pounds and help his blood sugar return to normal levels.  We are now working on a clear and easy framework that promotes weight maintenance and well-being

Group coaching experience

I have just started to do group health coaching for cancer survivors - this is a good way to provide lifestyle information and coaching, within a group format that can take advantage of group dynamics and be less costly.  The first group that I ran was a smaller group of 3 cancer survivors but they all reported that they got good information, insights and suggestions about nutrition, fitness and stress management. They also felt that the coaching format, along with the ability to look at all of these issues together, was very helpful.   

Steps to finding the right health coach:

1.    Ask your healthcare providers to recommend someone or look at other reliable sources for health coaches.

2.    See what training, experience and certification they have – check their website or ask them about these.

3.    Talk with them, and ask them some questions to make sure you feel comfortable with their responses/approaches – it should be a good fit.

Concluding Thoughts and Future Directions

Health coaching is an exciting and new approach to healthy lifestyle and well-being for cancer survivors.   It is another potentially important part of an overall team of practitioners and approaches that can help to maximize quality of life and cancer survivorship outcomes when support is needed most.  Accumulating experiences and research will hopefully create greater awareness, acceptance and use of the health coaching framework and approaches in private practices, cancer centers and academic oncology departments.

References and Other Resources

Galantino ML, Schmid P, Milos A, et al.  Longitudinal benefits of wellness coaching interventions for cancer survivors.  Inter J Interdisciplinary Soc Sci  2009;4:42-57.

Positivity: Top-notch research reveals the upward spiral that will change your life, Barbara L. Fredrickson, PhD, Crown Publishing Group, New York, 2009.

Full Catastrophe Living (revised edition): Using the wisdom of your body and mind to face stress, pain and illness, John Kabat Zinn, Bantom Books, New York, 2013.

The gifts of imperfection: let go of who you think you’re supposed to be and embrace who you are, Brene Brown, Hazelden Books, Minnesota, 2010.

Changing for good: a revolutionary six-stage program for overcoming bad habits and moving your life forward.  James O. Prochaska, John C. Norcross and Carlo C. DiClemente.  HarperCollins Publishers, New York, 2006.

Health and Wellness Catalyst Newsletter Archive: Fall, 2014

Health and Wellness Catalyst Newsletter Archive:  Fall, 2014

Welcome to the Fall edition of the Health and Wellness Catalyst.  I hope everyone is doing well.  This newsletter will primarily be from the International Research Congress in Integrative Medicine and Health held in Miami, May 13^th - 16th.  It was a great conference to reconnect with colleagues, meet new people and hear inspiring talks on a range of topics.  All of the articles come from the conference and they are: (1) Nutrition – New information about probiotics, the gut microbiome and the nervous system; (2) Health coaching – An update and description of the field of health coaching – a vital part of behavioral change in the emerging healthcare system; and (3) Integrative medicine – New research describing the incredible and measurable biological effects of relaxation techniques such as mindfulness, yoga and tai chi.

Nutrition:  New information about probiotics, the gut microbiome and influences on the nervous system

This session was led my John Bienenstock, PhD, of McMaster University and Kristen Tillisch, MD of UCLA.  John described his work with colleagues and a series of studies that showed that the specific mechanisms of feedback from the ‘gut brain’ to the central nervous system were via the vagus nerve and biomolecules produced from the bowel flora that interact with sensory neurons.  One study that he described was in mice who were supplemented with Lactobacillus rhamnosus which produced the following effects: (1) region specific effects on GABA receptors (increased in some regions and decreased in others); and (2) reduced stress-induced corticosterone, and anxiety and depressive behavior.  An associated study showed that these effects were not seen in vagotomized mice, suggesting that the major communication pathway was via the vagus nerve.

Kristen described some of her research that has looked at predominantly plant-based or carbohydrate eaters, who had a significant presence of Prevotella species in their guts, in comparison to carnivores who have a significant presence of Bacteroides species in their GI tract.  It was the next study that was most interesting, in which she looked at women with different microbiota predominant organisms and found that they had different nervous system activity patterns.  She went on to say that there is still a tremendous amount of work to do because we still don’t have good information on 70-80 % of the gut microorganisms.  The focus of ongoing research is what is normal flora, how does it interact with the nervous system and what probiotics can be most helpful for the range of GI problems, nervous system or emotional symptoms/disorders and a range of other potentially related diseases.

Comment:  This is exciting and emerging research in animals and humans describing the interrelationships between the gut, and the nervous system/emotional well-being.  As we understand more about normal gut flora and its influences, we will be able to target probiotics that improve emotional and nervous system function in addition to stomach and intestinal function.

Health Coaching:  An update and description of the field of health coaching – a vital part of behavioral change in the emerging healthcare system

This was a concurrent session focusing on health coaching led by Karen Lawson, MD, Director of Integrative Health Coaching, University of Minnesota, and Ruth

Wolever, PhD, Director of Research, Duke Integrative Medicine (she also helped establish Duke’s integrative health coaching training program).   Ruth started out by talking about her research on the definition of health coaching – this shows you how health coaching research is truly in its infancy.  She also encouraged support of the non-profit organization which is working on certification criteria for health coaching, a must for the field to move forward – www.ncchwc.org  (National Consortium for Credentialing Health and Wellness Coaches) – with input and/or financing.  Ruth defined coaching as a process that brings together about 80 years of psychology research that combines the best approaches to how adults learn, motivational tools for creating lifestyle changes and sustaining change - this is all also put into the context of a client-centered approach, client determined agenda, self-discovery, accountability and a strong relationship.  Finally, Ruth described the best study to date showing a significant return on investment of 4:1 from a large study of over 174,000 people (stratified, randomized study to usual care or enhanced support), who were working with an insurance carrier from Portland, ME – subjects had chronic diseases and high healthcare costs (Wennberg DE, et al, NEJM, 2010 see ref below).

Karen described their program’s 4 pillars of health coaching practice as mindful presence, self-awareness, safe/sacred place and authentic communication.  She also described a study that she conducted with an insurance company in high-risk clients that showed significant changes in behavior and return on investment.

I also want to mention a presentation by Meg Jordan, PhD, RN of California Institute of Integral Studies – she presented some very interesting and inspiring work done with a homeless population in San Francisco.  While they found that these folks needed to have lodging security before they could effectively engage in a coaching process, it was inspiring to see how the work of coaching and empowerment can be used in a broad range of endeavors.

Comment:  Health coaching is poised to be the major vehicle for behavioral change in the healthcare system in the next 5-10 years, filling a vital and gaping hole in healthcare that will promote effective health outcomes.  On a personal note, I have found health coaching to be very helpful both personally and professionally, and I am excited about building up my health coaching practice with its whole-hearted and respectful approach to interpersonal relationships and personal transformation.

Integrative Medicine:  New research describing incredible and measurable biological effects of the relaxation techniques, mindfulness, yoga and tai chi.

This information came from plenary sessions presented by Steven Cole, PhD, from UCLA, “Social and Psychological Influences on Gene Expression;” Elissa Epel, PhD, from UCSF, “Mind, Body and Cellular Aging;” and a concurrent session, “Transforming the Understanding of Mind-Body Interventions: The Genomics of Stress and Resiliency,” in which the primary presenters, leaders in the field, were Michael Irwin, PhD, of UCLA, and Michael Antoni, PhD, of the University of Miami.

Steven spoke about a range of studies that have shown that psychological symptoms such as anxiety, loneliness and depression cause specific genetic activity that

increases inflammation and decreases immune resistance to viruses.  This has also been correlated with social loss, cancer diagnosis and lower SES.  From a mechanistic standpoint, mediating factors include stimulation of the HPA axis and the sympathetic nervous system, decreases in the number and activity of monocytes and dendritic cells.  He also described a range of other related research, too much to mention here.

Elissa spoke mostly about telemeres and telomerase activity which has been shown to correlate with longevity in that stresses have been shown to decrease telomere length (and decrease telemorase activity), where as stress reduction approaches such as membership in support groups (close and supportive relationships) have been shown to increase telomere length (and telemorase activity).  She has also looked at meditation effects, which are beneficial,  and in specific circumstances such as daily stress experience, autistic kids, anger and cancer survivorship.

Michael Irwin and Michael Antoni also added to the presented information by describing tai chi effects on viral immune responses, sleep quality, inflammation (and decreasing the cytokine NFKB) – the same effects were seen with yoga although not as much research was presented on yoga.  Michael Antoni focused on a cognitive behavioral stress management technique that improves coping and resiliency, particularly in cancer survivorship, and decreases pro-metastatic mechanisms.

Comment:  It was just incredible to see the degree to which we now have research that describes changes in genetic activity, brain activity, immune response, cytokine production, telomere length/telomerase activity and others that can have significant benefits in individuals with cancer and a range of there complex or chronic diseases, or more ‘simple’ stress related symptoms.

Cookbook Recommendation:  The Omni Diet, by Tana Amen, BSN, RN.  St. Martin’s Griffin, NY, 2013.  There are tasty recipes here for people who include

healthy proteins (vegetarian and animal products) and healthy plant-based foods.  Like many books on nutrition, some controversies discussed but overall very good.

References

Bravo JA, Forsythe P, Chew MV, et al.  Ingestion of Lactobacillus strain regulated emotional behavior and central GABA receptor expression in a mouse via the vagus nerve.  Proc Nat Acad Sci 2011;108:16050-5.

Bienenstock J, Gibson G, Klaenhammer TR, et al. New insights into probiotic mehanisms: a harvest from functional and metagenomic studies.  Gut Microbes 2013:4:94-100.

Tillisch K. The effects of gut microbiota on CNS function in humans.  Gut Microbes 2014;5:3 epub.

Wennberg DE, Marr A, Lang L, et al. A randomized trial of a telephone care-management strategy.  N Engl J Med  2010;363:1245-55.

Epel E, Lithgow GJ.  Stress biology and aging mechanisms: toward understanding the deep connection between adaptation to stress and longevity.  J Geronotol A Biol Sci Med Sci  2014;69S1:S10-16.   She also has multiple papers on a range of effects!

Vargas S, Antoni M, Carver CS, et al.  Sleep quality and fatigue after a stress management intervention for women with early-stage breast cancer in southern florida.  Int J Behav Med  2013;epub.

Hoyt MA, Stanton AL, … Irwin MR.  Inflammatory biomarkers and emotional approach coping in men with prostate cancer.  Brain Behav Immun  2013;32:173-9.