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.

Launch of the Health and Wellness Catalyst Blog: Promoting Optimal Health and Well-being, and Transformation

Greetings and welcome to my new blog – which is actually a transition from a quarterly newsletter that I began in the Fall of 2014 and continued into the Winter of 2015.

I am Dr. Joel and I help people transform their health through health coaching, nutrition and integrative medicine.  You can get more information about my expertise in health coaching, nutrition and integrative medicine from my linked in profile, my google plus profile, and my website.

In this first post I wanted to provide a little background and then refer to my three newsletters which are available here (Winter, 2015 is below, and Fall 2014 is in a separate post that follows).  There are some interesting articles and comments on health coaching, nutritional issues such as probiotics, vitamin D (in relation to memory) and Coenzyme Q10 (and heart failure), and integrative medicine (relaxation technique influences on aging, multiple sclerosis treatment and hospital readmissions).

So again welcome and I look forward to providing interesting, insightful and practical posts in the coming months and years.

To your health,   Dr. Joel

Welcome to the Winter edition of the Health and Wellness Catalyst.  I hope everyone is doing well, having had a great Holiday and New Year.  I have been busy with several new projects and changes that I am excited about and will describe further in my newsletter section Edman Wellness Services Update.   The articles that I have included in this issue are: (1) Nutrition – The Effect of Coenzyme Q10 on Morbidity and Mortality in Chronic Heart Failure: Results from Q-Symbio – a Randomized Double-Blind Trial. Mortensen SA, et al.  J Am College Cardiology HF 2014 epub ahead of print ; (2) Health coaching – The Effectiveness of Wellness Coaching for Improving Quality of Life, Mayo Clinic Proc, Clark MM, et al. 2014 July 31 (Epub ahead of print); and (3) Integrative medicine – The topic is Hospital Readmissions and there are two articles, Strategies to Help Reduce Hospital Readmissions, J Family Practice, Snyderman D, et al. 2014;63:430-8; and Micronutrient Deficiencies: an Unmet Need in Heart Failure, J Am Coll Cardiol, Soukoulis V, et al. 2009;54:1660-73.

Nutrition: Relationship between 25-hydroxyvitamin D and cognitive function in older adults: the Health, Aging and Body Composition Study.

This study adds cognition and mental functioning to the long and growing list of disorders that deficient and/or insufficient vitamin D is known to be associated with, including cardiovascular disease, cancer, autoimmune disorders, diabetes, osteoporosis, depression, pain and possibly others.  What is most interesting to me is that the level of vitamin D at the beginning of the study was correlated with both the cognition level (higher vitamin D level was associated with better cognitive function) and the amount of cognitive decline (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 issues within the brain that may be important for maintaining healthy functioning.  These include the vitamin D receptors found in many parts of the brain, vitamin D’s potential mediating effect on anti-oxidant pathways (very important for maintaining nerve cell membrane fluidity and function) and its relationship to vitamin D receptor genetic polymorphisms (and the different functions and mediating effects that vitamin D has for the specific biochemical and metabolic pathways involved with each genetic polymorphism).

Comment:  This is important research in humans suggesting that not only should vitamin D levels be checked, but that higher levels may suggest better functioning and long-term influences.  Supplementation studies need to be done to confirm vitamin D’s importance in cognition and what the optimal vitamin D level is for a range of health conditions – there is definitely a lot to study and clarify.   It is notable, however, that these findings add to several studies suggesting that higher vitamin D levels correlate with ‘better functioning’ and greater length of survival in cancer patients.  One study from Norway found that higher levels of vitamin D were associated with longer survival in breast, colon and lung cancer, as well as in lymphoma (Tretli S, et al, 2012).  

  

Part of the importance of vitamin D level, and optimal range and function is that vitamin D regulates a significant amount (10-20 percent) of all genetic activity – it doesn’t get much more essential to have an optimal level (not ‘normal range’ or deficient level), so that more optimal functioning and health is achieved .

Health Coaching: The Effectiveness of Wellness Coaching for Improving Quality of Life, Mayo Clinic Proc, Clark MM, et al. 2014 July 31 (Epub ahead of print)

Although this was a pilot study, it is important because there are few published outcome studies showing the specific benefits of health coaching, and this study showed benefits over a broad range of psychosocial characteristics including depression, perceived stress and QOL.  This research examined 100 employees who participated in a 12-week wellness-coaching program - the primary outcome measures that improved were QOL (five specific domains and overall QOL), depressive symptoms and perceived stress.  Results showed significant improvements in all outcomes including QOL (for all domains and overall, p<.0001), reduced level of depressive symptoms (p<.0001) and reduced level of perceived stress (p<.001).  These improvements were also then maintained at the 24-week follow-up assessment suggesting some longer-term benefits.

This research was done to determine effect sizes for future QOL and psychosocial outcomes studies so that future randomized controlled trials (RCTs) can be effectively designed – the larger randomized studies are considered level 1 evidence or really strong evidence.  So these results helped to contribute to level 2 evidence for health coaching benefits and set the stage for larger RCTs to be done, which I am confident will show significant benefits and be cost effective.

Comment:  As mentioned in the last newsletter, 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 lifestyle changes and health outcomes.  Standardization in coaching certification is being worked on and the fields of health coaching and corporate wellness are evolving and growing so that it can become most effectively utilized in healthcare settings. It is also notable that it had a significant impact on perceived stress (in addition to depressive symptoms and QOL), because my published article in cancer survivors suggested that perceived stress correlates with many symptoms (eg. fatigue and pain) and QOL, so health coaching (and other interventions such as mindfulness, meditation, yoga, tai chi, and others) should be examined in cancer survivors for their ability to impact perceived stress, a range of symptoms and QOL.

Integrative Medicine: A Multimodal Intervention for Patients with Secondary Progressive Multiple Sclerosis: Feasibility and Effect on Fatigue, J Altern and Complement Med, Bisht B, et al. 2014;20:347-55.

For those of you who have seen the TED Talk by Terry Wahls, MD and/or her book, The Wahls Protocol: How I beat progressive MS using Paleo Principles and Functional Medicine (2014, Avery Publishing), this is an article that describes some pilot study data based on her experience and recommendations.  If you have not seen the TED talk, I highly recommend it – it is an extraordinary story of a physician from Iowa who was getting progressively worse with conventional or allopathic medical treatment, and when she pursued other options such as a Paleo diet and functional medicine (and other approaches), this led to a complete reversal and control of her MS.  It was actually fortunate that she had gone to the Mayo Clinic to have her diagnosis confirmed because critics and the conventional medical community would have claimed that she did not have MS to begin with.

The pilot study followed 10 of 13 participants whose adherence during a two week run-in phase was considered adequate, and then they were followed for one year.  The intervention included a modified paleo diet, nutritional supplements, stretching, strengthening exercises with electrical stimulation, meditation and massage.  In this small group the fatigue scores significantly decreased (p<.001) and there were not any reported side-effects suggesting that the protocol is safe.  Future research is warranted for these natural and integrative approaches to a chronic neurological disease such as MS.

Comment:  It has been interesting to see Terry Wahls describe and study an effective dietary and functional medicine approach to progressive MS, since neurologists are rarely open to integrative medicine and the potential benefit these approaches can have on disease management and QOL.  It is also unfortunate that the protocol that was effective for Dr. Wahls is being applied to everyone instead of understanding that this protocol should be individualized to each participant or person with progressive MS.  An illustration of this is that Terry Wahls has a food intolerance to eggs but that does not mean that everyone does or that eggs should be excluded from the dietary program.  However, this is still an important advance in the consideration of dietary, nutritional and integrative medical approaches for a chronic and complex disorder such as MS.  In fact, in one interview Terry Wahls reported that there were significant improvements for a few people who had Parkinson’s disease and were following the protocol, and they suggest that it could be beneficial for auto-immune diseases in general and well as other neuropsychological conditions. 

Cookbook Recommendation:  Kicking Cancer in the Kitchen by Annette Ramke and Kendall Scott.  Running Press Book Publishers, Philadelphia, 2012.  This book is written by two cancer survivors, whose ideas and recommendations may be helpful for all cancer survivors because they share their experiences, challenges and insights on the range of issues that they dealt with on their cancer journey.  In addition, they provide a range of healthy recipes for people to try so that they can add to their dietary recipe collection and overall resources.

Update from Edman Wellness Services:

My highlights and significant accomplishments from this Summer were:

1.     Changing my company name – to Edman Wellness Services from Edman Nutritional Services.  This reflects my expansion of services from nutrition and integrative health to include health coaching, behavioral change and wellness promotion;

2.     I have begun to work with Business Health Solutions, a corporate wellness company based in Baltimore – so far, I have given talks to corporate clients but hope to expand to other clinical and/or consulting activities in the near future;

3.     My first author article in the journal Integrative Cancer Therapies was published in hardcopy in their September issue – it is entitled, “Characteristics of Cancer Patients Presenting to an Integrative Medicine Practice-Based Research Network.” It found that perceived stress correlated with many physical and emotional factors, and should be measured and addressed in all cancer patients in the course of their treatment and post-treatment care.  Again, if you would like a copy of this, just send me an email and I will email it to you.

References

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

The Effectiveness of Wellness Coaching for Improving Quality of Life, Mayo Clinic Proc, Clark MM, et al. 2014 July 31 (Epub ahead of print).

A Multimodal Intervention for Patients with Secondary Progressive Multiple Sclerosis: Feasibility and Effect on Fatigue, J Altern and Complement Med, Bisht B, et al. 2014;20:347-55.

Wahls T: “The Wahls Protocol: how I beat progressive MS using Paleo principles and functional medicine.   A radical new way to treat all chronic autoimmune conditions.”  New York: Avery, Penguin Group, 2014.

Tretli S, et al.  Serum levels of 25-hydroxy vitamin 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.