The power of a collaborative approach in Functional Medicine

"It is the long history of humankind (and animal kind, too) that those who learned to collaborate and improvise most effectively have prevailed." – Charles Darwin

An exceptional collaboration is based on unique contributions from all parties involved. Why do many professional sports teams have a group of coaches and special teams? Because it takes each persons unique contribution to create the whole package.

In functional medicine (FM) the triad of provider, dietitian and health coach is the trifecta. Critical components from each of these disciplines come together to provide comprehensive results for clients . The FM provider or practitioner is creating the timeline, looking at the core clinical imbalances as they relate to the patients lifestyle, doing lab work and developing recommendations to address the root cause. They spend a significant amount of time with the patient, usually an hour or slightly more gathering all of the information needed to create the best plan forward. The provider does not have the time to review and adjust the diet and walk the patient through that extensive process.

In walks the dietitian and the collaboration begins. Dietitians spend an amazing amount of time learning the intricacies of phytonutrients, macronutrients, balanced meals, how to connect symptoms with food intake and generally improve diet to support health in any number of ways. They are experts in helping patients achieve a workable nutrition plan that serves the patients health needs and also supports the social aspects of food and connection.

Often, in my clinical work, the dietitian will come back from meeting with a patient and say “I referred this patient to you, she really needs some coaching”. The dietitian is excellent at creating a plan for whole body nutrition but not equipped to help a patient through managing stress with hands on tools that will prevent, for example, the next SIBO (small intestinal bacterial overgrowth) event. It’s all tied together!! Stress can be the factor that throws everything off track so that it almost doesn’t matter what you are eating unless the stress is managed.

In walks the health coach. The provider and dietitian have critical roles, they have set the stage but they are not the ones to spend the time really delving into the patients daily life to see where behavior changes can be made and support patients through the changes that they are willing to address. If the patient is not quite ready to make the full changes, the health coach can expertly lead them into stages of change so they are ready and they made the decision, not someone else. At times a health coach can see a patient every week to establish new behaviors, mindset shifts and problem solve through all the areas of the providers recommendations and support. Stress management, relationships, exercise, mindset shift, sleep, personal and professional development, detox protocols, supplement regimens... All of these areas weave into a dynamic health journey for the functional medicine patient that ultimately provides an experience that both heals and allows the patient to be empowered to take care of their own health. When I have patients who are just seeing me as a health coach, we have the conversation within the first few visits about connecting with a functional medicine provider and dietitian. As a Functional Medicine Health Coach I can’t do blood work to determine nutrient deficiencies, potential heavy metal poisoning, high levels of environmental toxins or even mold or lyme infections. Yet, these may be some of the reasons a patient has energy deficits or any number of symptoms. Working with a patient for several weeks and getting them ready for the FM provider visit is a key component to getting the most out that visit and the recommendations, and then the journey progresses.

The collaborative process between these three disciplines, the provider, dietitian and health coach is a powerful and effective way to achieve the patient outcomes that move our collective society ahead toward health and prosperity.

Alone we can do so little; together we can do so much. —Helen Keller

Genetics outsmarted...my quest to avoid a heart attack.

For as long as I can remember heart disease and impending heart attacks were ever present in my family's life.  You see...my father had his first heart attack at age 36.  When I was just 4 years old.  It became deeply embedded in my mind and my body that heart disease could be my fate.  In my early 20's I started to work in healthcare and see the chronic illnesses that were linked on some level to lifestyle choices.  At that time we thought our genetic makeup had more of an influence on our physical bodies expression of health.  We now know it really only represents about 30% of what happens to us.  The world of epigenetic's helps us to understand that we have more control over what happens in our bodies that we ever thought before.  Epigenetics can simply be defined as the bodies ability to turn on or off our genes based on our lifestyle choices, what we expose ourselves to.  If you are interested in a more scholarly article about the word and history of epigentics read this article.

So… needless to say the way we live our lives and the choices we make have a significant impact on our health outcomes. In one way this is very empowering , to realize that we have more control than we once thought. On the other hand it now makes us responsible for living day to day in a way that supports our health and addressing habits they may not be in our best interest. That is not easy right? Behavior change and habit change even if we know it is in our best interest long term is THE hardest part of life.

For many years when coworkers or friends would ask me things like “do you actually like what you’re eating or are you eating it because it’s healthy?” many times my response would be “I’m just trying to avoid a heart attack”. To make light of it and not to get into a philosophical argument about my eating habits or any other habit of mine. As time went on and I became more convinced of the importance and the significant research supporting healthy habits in terms of avoiding chronic illness I would say “it’s a little bit of both in reality”. I like what I am eating and I feel good about the fact that I am doing something good for my body.

The reality is that at this point in my life after a good 25 years of focusing on healthy habits (and a few unhealthy things sprinkled into the mix as well because none of us are perfect right?) I have no evidence of heart disease. My cholesterol has always been at a good level, my cardiac calcium score (read here if you want to know more about this very important test)is “0” which means no detectable calcification in any of the three major arteries leading to my heart and BP is always at a great “lower than average” level. I’m not telling you this to brag, quite the opposite, but to provide an example of someone who could have been at risk for a cardiac event at my current age of 51, who has no evidence of heart disease. I am genetically and feature- wise very similar to my father. I look like him, my body type is more consistent with his. Now, you can argue that maybe my genetics are more similar to my mothers and she didn’t have her heart attack until she was 69. Yet, if she had a CT for her calcification score in her 50’s you would have likely started to see some plaque build up that could have led to arterial blockage that was the cause of her heart attack and subsequent bypass surgery.

Here is the message…. HEART DISEASE, DIABETES, OBESITY, NON-ALCOHOLIC FATTY LIVER DISEASE…I could go on…are all preventable with lifestyle changes. You don’t have to suffer with these chronic illnesses. Even more than that, many symptoms and illnesses are preventable by taking control and changing things one step at a time.

If all you do after reading this is start to get out and move a bit more, drink more water and eat more vegetables you’ve started to make a shift. Every little action on a daily basis is a vote for the person you want to be.

Who do you want to be?

It's not about the black dress

Here we are...the end of 2017.    So it happens.  Every year.  Everyone makes resolutions and goals in January and somewhere along March or April or maybe even sooner they are forgotten about or abandoned.  Why is that?  What is going on in the collective human psyche that prevents the majority of people from achieving and sustaining these goals?

Simply stated, we set goals that are unobtainable, short sighted and not in line with our values.  Many people will set goals to lose weight, go to a gym, follow a diet, run a marathon.  All of these goals are admirable to say the least but they are short sighted.  The true goal, if I even want to use the word goal, is to make small incremental changes daily that lead to true behavior change, a shift in your way of living and your mindset every day..  a lifestyle change.  I'm not saying that having something to work toward isn't helpful but these large goals often lead to failure and abandonment..

"The smarter approach is to learn to embrace the process.  Too often we approach our lives’ biggest hurdles with dread, execute them with anxiety, and leave them with regret,” says Amy Cuddy , Social Psychologist and Associate Professor at Harvard's business school, in her book, Presence: Bringing Your Boldest Self to Your Biggest Challenges.

“Instead, we need to nudge ourselves, moment by moment, by tweaking our body language, behaviour, and mind-set in our day-to-day lives.”

On the surface, that may seem counter-productive, like you aren't addressing the bigger picture, but Cuddy emphasizes the power of using long-term thinking for short-term planning. "You won't lose all the weight overnight, so your best option is to focus on making each day the best it can be. Look at the big goal as a string of daily or weekly goals that are easier to accomplish."

"A lot of research is showing us that we do much better when we focus on incremental change, on little bits of improvement," Cuddy say

Let's take the goal of losing weight for the purpose of our discussion.  It's the number one self-reported goal for the new year.  If you want to lose weight ask yourself "why?".  Why is losing weight so important to me?  Is it about wearing that little black dress or is it about something much deeper and inherently more important.

IT'S NOT ABOUT THE BLACK DRESS.  It may seem like that would be a good motivator but it quickly dissipates because it is not intrinsically motivated.  Losing weight to wear the black dress to your reunion or New Years Eve is about impressing others...but what is it really about?

To dig a bit deeper to the core of the issue ask yourself some of these questions:

1. What does being overweight mean to you?  

2. What do you feel like you are missing out on?  

3. How does the weight make you feel?  

4. Where does it limit you?

5. What are some words that describe the extra weight you are carrying? 

Now, ask yourself this question..."What would I feel like in 2-3 years if I actually embraced a healthier lifestyle and as a result gradually lost weight?"  and  "What would I feel like if absolutely nothing changed from today?"  

These are the questions that dig deep in order to affect lasting change in any area of life.  These questions and the conversation that it stimulates will connect you to the values that drive your behavior and thus effect behavior change and lifestyle change.

One of the first things you can do to move yourself forward on the path of true lasting lifestyle change is to expunge the word "diet" from your vocabulary, you will be better off immediately.  The negative connotations from this word start you off on the wrong path immediately.  Diet implies a short term sort of deprivation in most people's minds, instead think of it as making a choice every minute of every day to live healthier, your food choices are just part of that.  Start slowly but keep moving forward.

If we move our thoughts and actions to small changes or tweaks every day all throughout the day before we know it we've made a significant lifestyle change.   It's a mindset shift that needs to take place but it begins with small behavior changes and changing the way we talk to ourselves.

When you start by asking yourself what's important to you and why you want to lose weight or get healthy it becomes easier to be intentional with your daily behaviors.  Each day your actions need to be aligned with your overall values and if they aren't you need to ask yourself "why not?".   

So what is the real reason most people want to be healthier and lose weight?  Is it about being able to run around with your kids or grandkids?  Is it about not getting winded when you walk down the driveway to get the mail or up the stairs?  Is it about going to the doctor's and feeling confidant that you are finally taking charge of your health?  Is it about booking a flight to your next vacation without worrying about being cramped in the seat because you are too big?  Is it about finally feeling good about yourself and not hiding behind the weight? 

Connecting to your values and what's important to you makes this a lifestyle change.  Setting small achievable goals for every day and taking it one day at a time.  "Just for this morning I can make time for myself to eat a healthy breakfast and pack a snack".  This in turn affects how you deal with stress at work, you don't overeat lunch because you took the time to pack a healthy snack for 10 a.m.  

When you start taking care of yourself in one area of your health it becomes a cascade affect and celebrating these small achievements brings an internal level of satisfaction that goes a long way.

Connect to your values, nudge yourself daily, moment to moment and celebrate your success.  And lastly...find yourself a good health coach that can support and  guide you through this process.  Most people who achieve goals consistently have a coach or a mentor, it may be time for you to enlist a health coach and I know just the person...wink wink.  

How I became an Integrative Health Coach

Challenging myself is an inherent part of my make-up. I once had a friend ask me "Why do you always have to do everything differently than everyone else...do you do that on purpose?".  Yes...actually I do.  I am always seeking something new to learn and challenge my brain and body.  Anything from running races, rowing competitively, treating my speech patients in a very "outside of the box sort of way" to use an overused phrase, to really asking myself the hard question of "why am I doing this?  Is what I am doing making a difference in a positive way?".   I am easily bored but if I am challenged and have a purpose that is in alignment with my beliefs then I am happy.  So it's surprising that my chosen profession, Medical Speech Pathology, has kept me engaged for 25 years...almost. Not surprising in that it wasn't challenging or purposeful in the beginning, it certainly has been,  but 25 years??  We all change so much in 25 years...at least if you are living a life of awareness and willing to challenge your potentially long held beliefs.

As my views on healthy living evolved my involvement in traditional healthcare seemed less authentic.  I became more mindful,  More aware of what I do on a daily basis. I wasn't oblivious before but I had reached a point of mastery where I could really take more time to think about how it all fit within my values and beliefs.   A good portion of my practice as a speech pathologist has involved the treatment of swallowing disorders.  Many of my patients were unable to swallow for various reasons and required tube feedings.  My evaluation's frequently recommended non-oral feedings which were necessary to avoid aspiration pneumonia.  When I thought about the source of nutrition that I was recommending and the fact that I often told them "this is nutritionally sound and you will get all the vitamins and nutrients you need" I realized that I actually didn't believe that.  Sure...I knew that they would be avoiding pneumonia and that was paramount.  I still believe that...however, the nutrition they would be receiving from my point of view was not truly going to promote healing.  I also hadn't really incorporated the "choice" aspect of a hospitalization.  These patients had a choice to accept or decline my recommendations and I was really the only one who had the expertise to fully explain and offer that to them. That became a standard part of my practice quite a few years ago but still,  I had a crisis of consciousness.  I floundered and felt disengaged and thought where do I go from here?  It's really like jumping off a cliff to say you no longer feel in alignment with the practice you have been cultivating for over 20 years.  

Don't get me wrong...there are many aspects I have LOVED about being a speech pathologist and really felt like I've made a difference in lives all over the country. Yet I've also spent many years treating those who have the rubber stamp diagnosis of hypertension, diabetes, coronary heart disease and at times a plethora of other largely lifestyle induced diseases.  These are so common with every person who enters our healthcare system that we are more surprised when these aren't on their list of diagnosis.  It should be the other way around.   I felt complicit. 

 I was so comfortable in a hospital setting, I could evaluate and treat easily and efficiently, younger therapist's came to me for answers...but I knew something wasn't right. I felt a distinct disconnection with the way our healthcare system functioned and my personal beliefs about healthy living.  I knew I needed to be on the other end of the spectrum empowering people to take control of their health and happiness and living on purpose.  I discovered Integrative Health Coaching through Duke Universities Integrative Medicine Program and never looked back.  This was my tribe, my place.  I finally felt that I could be part of the solution.

We often live very unconsciously going from day to day not considering the routine things we do until they don't work anymore or we are just numb.  We don't have to wait until something goes wrong to start living a healthy, fulfilling and passionate life.  My personal journey of health and happiness began long ago and has evolved over the years as I learn and grow. My training at Duke Integrative Medicine made all the difference.   In my work as an Integrative Health Coach I am so energized when I bring clients to sit comfortably with the ideas of empowerment, purpose, taking small steps and living their best life.  This feels right.  

These ideas are grounded in mindful behavior on a daily basis.  It's been a daily practice for me to live more mindfully, pausing to consider my actions and behaviors before engaging for some time now.  Not perfectly but on the journey.  This is the basis of Integrative Health Coaching and my work as I see it.  It starts with a meditation practice which then filters into your daily life as more purposeful, mindful moments.  Nurturing mind-body awareness leads to long lasting sustainable change and living on purpose.  Using these principles has allowed me to live a more peaceful, balanced life.  Using my energy where it suits me best and gives back to others in a profound way.  I am charged up about bringing this way of living to more people and increasing the collective consciousness of compassionate, healthy living.  Put your oxygen mask on first before assisting others my friends.

 You only have one life...start living it the way you want to .