false
Catalog
56th Walter J. Zeiter Lecture: Lifestyle Medicine ...
Session Recording
Session Recording
Back to course
[Please upgrade your browser to play this video content]
Video Transcription
As they're leaving, I'd like to introduce today's Zeider lecturer. The Walter Zeider Lectureship is an academy tradition that honors the qualities of statesmanship, scholarship, executive leadership, and warm friendship of Dr. Walter Zeider, past executive director of AAPMNR and ACMRM. The lectureship honors a broader spectrum of leaders who share Dr. Zeider's admirable qualities. I'm excited to introduce this year's Zeider lecturer, Dr. Elizabeth Pegg Fradies. Dr. Fradies is a pioneer in lifestyle medicine education, an award-winning teacher at Harvard, and currently works with patients to help them adopt and sustain healthy habits. Dr. Fradies completed a residency in the Department of Physical Medicine and Rehabilitation at Harvard Medical School, where she served as chief resident. After residency, Dr. Fradies focused on stroke, with an emphasis on stroke prevention. Fascinated by empowering people to adopt healthy habits, Dr. Fradies pursued further training in behavior change through health and wellness coaching programs, as well as motivational interviewing training. Despite her extensive work as a public figure in lifestyle medicine, Dr. Fradies continues to work closely with individuals and groups seeking to implement healthy behavioral changes. Please join me in welcoming Dr. Beth Fradies as she discusses lifestyle medicine for patients and providers. Thank you. Thank you so much. It is a huge honor to be on this stage today, especially after Dr. Walter Frontera received his Lifetime Achievement Award. He's a major mentor of mine, and when I was a resident in PM&R at Spalding Rehab Hospital in the Harvard Department of Physical Medicine Rehab, he was the chair. And he has inspired me to do what I've done in my career, so I'm so delighted to share it today on stage with all of you, and I thank your president, Dr. D.J. Kennedy, for inviting me here. I have some disclosures. I no longer serve on the Scientific Advisory Board of Jenny Craig or the Medical Advisory Board of Obvious Solutions or Clearing.com, but I did, and I also have my own private practice in lifestyle medicine and health and wellness coaching. Today, together, in our 45 minutes that we have to share, I am going to cover three main areas. First of all, I will introduce to you the six pillars of lifestyle medicine and the science behind them. Quick question. How many of you are familiar with the six pillars? Okay. So there are some in the audience. I know we do have some people who are joining us virtually, so there were a few hands raised. That's terrific. What I love about this talk and what I'm going to share with you today is that this is pertinent for you and for your patients. How many of you in this audience have a primary care physician? Yay. That is excellent. So we are providers and we are patients. I generally like to ask that question, but that question has gotten really important to me as one of my dear colleagues did neglect his own health and was recently diagnosed with stage four prostate cancer. So taking care of yourself is really important, and these pillars that I'm going to share with you are critical. I'm going to highlight the role of each one of these pillars for a healthy body, as well as a peaceful mind and joyful heart. This is mental health and physical health. And I really hope that when you leave today, maybe you have some idea as to what you can do to enhance your own well-being and maybe some things that you'll be able to speak to patients about when you return on Monday. So let's get to the basics. What is lifestyle medicine? I served as president of the American College of Lifestyle Medicine for the past two years. We have 14K members in this organization, half are physicians and half are allied health professionals. It was in 2022 that we updated our definition that I'm going to share with you today. Lifestyle medicine is a medical specialty that uses therapeutic lifestyle interventions as primary modality to treat chronic conditions, including but not limited to our number one killer, cardiovascular disease, type 2 diabetes, and obesity. The key thing about that part of the definition is we are a medical specialty. So if you look at AAMC and medical students who I know are in the room, if you're looking for a specialty, you will be able to find it in AAMC now. Second part of the definition, lifestyle medicine certified clinicians. So I've been in this field since 2006. And actually, again, back to my residency days in PMNR, Dr. Eddie Phillips, after I wrote a book on how to prevent a second stroke with Dr. Julie Silver and Dr. Joel Stein, who were in our department, he came up to me and said, hey, Beth, you're doing lifestyle medicine in your book. You talk about exercise, nutrition, stress resiliency. So it was at that time I started on this voyage and journey in lifestyle medicine. And I wanted to tell you that 11 years later, in 2017, I was called upon to write the examination with three other item writers for board certification in lifestyle medicine. So now we do have about 4,000 physicians in the U.S. who are board certified in lifestyle medicine. I think there are some in this room now. If you are board certified, could you just raise your hand? Yes, I see. Thank you. Terrific. Okay. So lifestyle medicine certified clinicians are trained to apply evidence-based whole person prescriptive lifestyle change to treat and when used intensively, often reverse such conditions. So someone who has a diagnosis of high blood pressure or the diagnosis of diabetes can lower their hemoglobin A1C, can lower their blood pressure, and then no longer carry that diagnosis with proper lifestyle medicine prescriptions in the six pillars. What are the six pillars? A whole food plant predominant eating pattern, physical activity, very familiar with that in this specialty, restorative sleep, stress management, avoidance of risky substances, and a focus on positive social connections. This also provides the effective treatment for chronic conditions as well as prevention of chronic conditions. Okay. Talked about definitions. Let's talk about a patient. Anyone in this room recognize this patient? Okay. There's one person, so you can't participate in the questions. Anybody else for sure know who this is? Two people. Okay. Everybody else can participate. All right. I'm going to tell you about this gentleman. He's 72 in this photograph, but I want to bring you back to a time when he was 52 years old, overweight, overstressed, New York City businessman who was also overworked. Anyone from New York? Okay. Anyone been to New York? Yes. Okay. So imagine this man walking fast, talking fast, eating fast, perhaps all three at the same time. Can you see it? Thank you. So he is racing around New York City going to his business that his father started, and he's taking it over, and stress is high. Life revolves around making this business last a second generation. He's married, has kids, but the priority is work, and when he's home, he's not present, if you know what I mean. His body's there, but his mind's at work. When we think about his diet, I already told you, fast food, he had hard candies in his middle drawer at work, loved Oreo cookies, potato chips, highly processed foods. You get that? Stress reduction techniques were eating the hard candies, really stress eating, maybe a little yelling. Sleep, it was nonexistent, not true exactly. He would sleep maybe two hours, three hours from 12 to 2 or 12 to 3 a.m., then go to the kitchen, have some ice cream, candy, cookies, go make a to-do list, go back to sleep, wake up at 6 a.m. to catch the first train into New York City. So I've done and covered many of the pillars, except I didn't share the one he's doing really well in at this time, which is he doesn't smoke, doesn't drink. There's one other pillar I haven't gotten into. Which one is it? Somebody is listening, I know. Social connection, good. He has very limited social connection, except for that at work. But I was thinking of a different pillar I didn't touch on yet. Exercise, I heard it over here on the right, yes, exercise. Despite the fact that this gentleman was an outstanding athlete, third base in baseball, forward in soccer, basketball, point guard, at this time in his life, he was sedentary. He did one thing, one thing, sporadically. Can anyone guess what that one thing is? I do have a prize if anyone gets it. Racketball, good try, New York City guy, good try, no. Pickleball, good try, no. Golf, everyone says that, no, that would be good. Walking, that would also be fantastic, no. Rowing, gosh, that would be wonderful, wouldn't it, no. Cycling, again, so great. I wish you all had been there for him when he was sedentary. These are great ideas, no. Swimming, no. Dancing would have been fun, no. All right, so let's, do you want a clue? There is a prize at stake. I'm just saying, do you want a clue? Clue, hint, one. It would happen at the exact same time of the day, but you never knew which day. Medical student had to say that, always the medical students. If you're on Zoom, I'll repeat what the medical student said. They said sex, I'm not quite sure about that part for this gentleman, sorry. And were you a medical student? The person who said it, yes, no, no, it was not a medical student, it was a young person. All right, anyway, okay, do you want another hint? Do you want the time this occurred? Did that help? Okay. 11.07 p.m. Walk the dog, that would be lovely. He didn't have a dog, nor did he walk, okay, next. What? Stretching, that's also, see, again, that would be good. And you know that stretching releases endorphins, did you know that? I learned that in lifestyle medicine. Most people run, I'm a runner, I get endorphin rush from running, but stretching can also get an endorphin rush. He didn't do that. Anyone else? Walking up the stairs coming home from work. Really great idea. I really wanted to give a book to someone who could get this. Most people don't, say it again? You get a book. I don't know where it came from, oh, over here, in white, I got it. There's a book right there, Abby, do you mind, just grab that book right there, it's in my bag, yeah, thank you, Abby. So this man would run for the train at 1107PM, 101 Park Avenue was his office location, he knew exactly how much time it would take to get to the train. On one of these train rides, ooh, little pressure, no pain, no gain, this gentleman forged forward, made the train, half hour ride to Scarsdale, New York, where he lived, his wife, a teacher, no idea about anything medical, but took one look at him after the half hour train ride, diaphoretic, pale, short of breath, she said, you need to go to the ER. Thank goodness, she took him to the ER, where he completed his massive myocardial infarction, and then subsequent right middle cerebral artery infarct, leaving him paralyzed on the left side. Many of you are stroke physicians and probably have heard a similar story, anybody, yes, a lot of yeses, okay. The good news is, this gentleman, this occurred in 1986, this gentleman researched options and found Pritikin, intensive cardiac rehab, anyone know Pritikin? A few, yes, a few do, okay, Nathan Pritikin actually received the Lifestyle Medicine Lifetime Achievement Award at the American College of Lifestyle Medicine this past year, Nathan Pritikin, passed away, but the Pritikin community received the award, anyway, back to this gentleman, he went for 14 days to an inpatient rehab setting, where he learned about healthy eating, so vegetables appeared on his plate, he followed pretty much the healthy eating plate offered by Walter Willett at Harvard Medical School, half fruits and vegetables, a quarter whole grain and a quarter protein, he learned about exercise, and they eased him into exercise, he religiously was on that exercise bike for one half hour, five days a week, that is the guidelines for physical activity, as you probably know, 150 minutes of moderate intensity physical activity each week, he hit that, he learned about stress resiliency, he reprioritized, he stopped working crazy hours, pulled back on that, learned how to get good sleep, and lived the best 27 years of his life after that health setback. I know this story really well, like many of us know our patients very well, but I knew about the hard candy in the middle drawer and lots of other interesting details, except for some of the ones that were mentioned, one of them, anyway, I know that because this man is my dear old dad. That happened when I was 18, it's the reason I changed from economics major at Harvard College to a premed, because I was going to be the third generation to take over that business for my grandpa, for my dad, but I changed course. And then, thank goodness, found Dr. Walter Frontera and the Department of Physical Medicine Rehab at Harvard and at Spaulding. And through the years, as I mentioned, Dr. Eddie Phillips helped me define lifestyle medicine and this has been what I've devoted the past, basically, almost 20 years to. So the six pillars, you know them well, exercise, nutrition, sleep, stress management, social connection, substance use, moderation, elimination. Would you like to play a game? Yay. I knew the physiatrist would want to play a game. Not everybody wants to, but actually most. Okay, anyway, let's play the game. It's an invitation, no one has to do anything, right? This is an invitation. How we're going to play the game is we're, first of all, we have to agree that there's no judgment in the room. We're not going to look at each other and judge each other, okay? All right. We're going to talk about sedentary physiology, which is unhealthy, and I'll tell you why. So I'm going to invite you to stand if you would like, it's part of the game. If you would like to stand, you can. We're going to be voting. The people who are standing can say yes to the question. If you can't say yes to the question, you're invited to sit down. Now listen, some people may sit down because they want to. It may not be related to the question. So don't judge. No one's judging. Some people's legs get tired. Some the shoes are tight. We don't know. We're not in their shoes. So let's just pay attention to ourselves. We're going to go through the six pillars and I'm going to share with you the evidence based guidelines that come from, for example, the United States Health and Human Services. That's for physical activity. 2008, we got guidelines from the United States Health and Human Services. So you're invited to remain standing if you can answer yes to this question. Are you accumulating 150 minutes of moderate intensity physical activity each week? In general, not, no, this week I wasn't because I was at the meeting. No, none of that, none of that. In general, are you accumulating 150 minutes of moderate intensity? I know you're a physiatrist, so you know that means you can talk but not sing. If you can sing, that's at a low level. Some of you I know do vigorous intensity. Amy West, who was a medical student in Harvard Medical School and is incredible and I'm sure she is here. If you are doing vigorous intensity like someone similar to Amy West, then you only have to do 75 minutes of activity in the week. This is a physiatry conference. I love this. A lot of times people pop right down. Now this one might be tricky for everyone. Strength training twice a week. If you're doing that, you're invited to remain standing. If you're not strength training routinely twice a week, your legs may be tired and you want to take a break. It's up to you. I don't know. Anyway, by the way, with Dr. Stein, Scott Abramson, Mike Shuffley and some other residents, we did a study back in 1999. It turns out physicians who exercise, counsel on it. Physicians who do aerobic activity, counsel on it. Physicians who strength train, counsel on it. Okay. I digress. Nutrition. You're invited to stand if you can say yes. I enjoy. I see someone just sat down when I said nutrition. Like literally, I'm not going to look in the room at the place it occurred. I don't know who it was, but when I said nutrition, I saw them just sit. Okay. At any rate, we're going on. Are you consuming? I was going to say enjoying, but that could be debatable. Are you consuming five fruits and vegetables combined? Not five fruit and five vegetables, a combination of five fruits and vegetables each day in the week routinely? Yeah. I lose a lot of people there. Yeah. Okay. We're going to talk about why that's important now. I know a lot of your legs are tired at this point, but you're invited to stand if you sleep routinely. Not when you're on call. Come on, guys. If you sleep routinely, seven to nine hours each night, you're invited. Yeah. I know. I lose so many there. You should see the surgeons. I work with the Department of Surgery at MGH, so I've been invited to a lot of surgery conferences. I always feel like starting with that one, but I don't because I get them real excited like they're going to win. Then I say, and if you sleep seven to nine hours ... Okay, but we're not done. Stress. Do you have ... If you can answer yes, stay standing. A stress resiliency technique that you use routinely? Lost a few, not many. Okay. Now let's do social connection. Do you connect with at least one person each day or perhaps a total of seven in the week times that you're connecting with someone that you're close to and you can have a supportive relationship with? Are you enjoying that at least daily, but maybe you're away, so again, at least seven times in a week. Social connection. Okay. Last one. If you are not smoking, you're invited to stay standing. If you are not ... Okay, there's a couple things to this one. If you do not drink, you remain standing. If you drink at the AHA level, which is for a woman zero to one drinks per 24 hour period, for a man zero to two drinks per 24 hour period, then you're invited to stay standing. Now I always have to clarify, are there Europeans in the room? Because I always have to clarify this. So it's not lunch and dinner, that doesn't ... No, it's the whole 24 hour period, just to clarify. Okay. Wow, this is very impressive. I know that ... I'm not sure you can see this if you're online, but we have several physiatrists, people attending AAPM are standing. Okay. That's amazing. Great. So, now we're going to go through some of the science, okay? Apple doesn't fall far from the tree. Talk fast, walk fast. Okay, so I'm going to talk a little bit quickly here, but you're physiatrists, you can stay with me. Let's go to the first exercise pillar. So at Stanford Medical School, where I attended from 91 to 96, we did learn a little bit about exercise. Raise your hand if you learned about exercise in medical school. Yeah, we learned a bit. And of course, as physiatrists, we can master this one. We know it helps prevent cardiac disease and stroke, helps reduce blood pressure, controls blood glucose by increasing insulin sensitivity, controls weight, helps prevent obesity, helps prevent bone loss. You know all this. Can increase self-esteem, energy, improve mood, and decrease stress. Then I like to look at the mental health model. I think it's interesting what's emphasized. Improves sleep, better endurance, stress relief, improvement of mood, increase energy and stamina, reduce tiredness, and can increase mental alertness, weight reduction, reduce cholesterol, improved cardiovascular fitness. Is the reason you exercise on this list? Raise your hand. Anyone have a reason that's not on this list? Yes, please tell me. So you can eat, okay. That's interesting. We're going to get to that in a minute. Thank you. It's like you're a plant. Anything else? Enjoy it. Okay, joy. You exercise because you enjoy it. Anything else? Personal time. It's like me time. Okay. Anything else? Community. Cognitive health. Like a plant. Nice. Okay. We're going to get right into that. So I actually exercise, and I was going to see if anyone else exercised for this reason, to increase nitric oxide for my endothelial cells. Now that you know me, you understand why, because I've had this risk factor since 18, so I've been on this for a long time. But most people, most audiences, from middle school to Naples retirees, the brain, the brain. Cognitive function. That's what people are really focused in on. Dopamine is released. You all know this. Improving motivation, focus, and learning. Serotonin is released. Increasing mood. Do you know about the SMILE Study? Raise your hand if you know the SMILE Study. Okay. A couple people. This is from 2014. It's been replicated many times. If you take a serotonin reuptake inhibitor at dose for four weeks, if you are at dose for physical activity, 150 minutes. Mindfulness. Okay. If you are at dose for physical activity, 150 minutes, moderate intensity physical activity each week, both at dose. You wait four weeks. Serotonin goes up the same in those two, and depressive symptoms go down the same. I'm not saying get rid of your antidepressants. No way. But I'm saying, hey, let's think a little bit about movement as an antidepressant. Endorphins, we talked about. Norepinephrine. People have ADHD. When you exercise, norepinephrine increases, improves attention, perception, and motivation. Anybody know BDNF? Just raise your hand if you know BDNF. It's a physiatry group, so we do have some hands mostly. I don't see hands when I do this in CME. Brain-derived neurotrophic factor, neurogenesis for the brain. That increases with exercise. Then the hippocampus, consolidating memories. We have MRI studies now that show when we exercise, you can increase the volume of your hippocampus. More reasons to exercise. Here's some more. Did you know and do you know the myokine irisin? Anybody know it? Yeah. Not well known, but it's amazing. I'm going to introduce you to irisin, and I hope you love irisin now. Look at irisin. So it's a cytokine. It comes from our muscles. It increases when we exercise. It has an impact on muscles, adipose tissue, pancreas, bone, brain, and liver. And this is released when we exercise. Specifically, think about diabetes. Irisin's impact on the pancreas is to increase beta cell regeneration function and survival. We know when we have patients who have diabetes, we want to counsel them on movement. The brain. Irisin has an impact on appetite regulation. Adipose tissue. Irisin brown, going from white adipose tissue to brown adipose tissue. Irisin plays a role in this. Now, I love lifestyle medicine and the science behind it. We're always learning new things. This is from Stanford in June 2022. N-lactoylphenylalanine. Anyone heard of it? No. LACFI. Some people call it because they don't like N-lactoylphenylalanine. LACFI. No. Metabolite as a molecular effector associated with physical activity across multiple activity modalities and mammalian species. This too is associated with suppressing feeding and lowering the incidence of obesity. Talked about sedentary physiology. Fortunately, you all stood because you know sitting is the new smoking. You've heard that before? Sitting is the new smoking. No, not many, but okay. So fortunately, you already stood. Every hour you're meant to stand. If somebody has diabetes, they stand every half hour for their health. According to the American Diabetes Association, we have patients who have diabetes, many. So we need to know this. And why is this important? Because we have known for a long time there's something called sedentary physiology. Lipoprotein lipase decreases. Why do you care? Because that allows triglycerides to increase. And you know why that's bad. Also, sedentary physiology is associated with HDL lowering and glucose control disruption. Exercise and nutrition. Exercise reduces the urges for sugary snacks and attenuates the urges in response to the stress situation and cue in overweight people. You know why this may happen. Just told you. Irisin or N-lactoyl phenylalanine, LACF. Let's talk about nutrition. It's big. It's a big topic. I spend hours. In fact, there is a course you could take that's 14 hours or so on nutrition. But let's clarify some things early on here. Dr. David Katz, he's a past president of the American College of Lifestyle Medicine. He actually won the president's award this year at the American College of Lifestyle Medicine annual meeting. He's a very good friend. He was at Yale for many years. I admire him. He is an organized thinker. He put this together. There's all the different dietary patterns. One might call them diets. I like to think about eating patterns. Low carbohydrate rate, low fat, vegetarian, vegan, low glycemic, Mediterranean, mixed balance. That's a DASH diet. Dietary approaches to stop hypertension. Or paleolithic. Oh, or is that also Atkins? Or is it keto? Wait. Keto can also be vegan. There are health benefits to all those eating patterns. So he says, and I like to also convey, let's look at the healthy benefits that all those patterns have in common. Limited refined starches. Limited added sugars. Limited processed foods. Limiting the intake of trans fats, saturated fats. Emphasis on whole plant foods with or without lean meats, fish, poultry, seafood. Anybody know who said eat food, not too much, mostly plants? Anybody know? Yes. Michael Pollan. Nice. All right. This is where the focus is. If you heard the hearings in D.C., the White House hearings three weeks ago, you heard a lot about the importance of reducing ultra processed foods. And that's from the research. We know that for each additional serving of ultra processed food, all cause mortality increases by 18%. That is something we can help our patients with. This is non-disputable. There's no one in nutrition that is going to dispute this one. Now, the food industry, that's a little different. But in nutrition, we know that we need to eat whole foods and go away from these processed foods. Everything I told you my dad ate in the beginning of this talk, everything. He just was Mr. Ultra processed food. Oreo Double Stuffs was his go-to, if you're curious. Now, what is a serving? Whatever it says on the package. One cookie, a quarter of a cookie, it can be deceiving, as you know. And then when we think about chips, one ounce or 18 chips, who do you know opens up a bag of chips and counts out 18 and only eats 18? Never. It's the whole bag. But this doesn't happen with a bag of, hmm, spinach or kale. No. No one's eating all that bag. But we want to emphasize the importance of the spinach and the kale. Why? Vegetables and fruits. Dad has been around for a long time. Meta-analysis of cohort studies following about half a million participants found that a higher intake of fruits and vegetables is associated with a reduced risk of death from CVD. An average reduction in risk of 4% for each additional serving per day of fruit and vegetable. Nurses study. You're well aware of this one. Compared with those in the lowest category of fruit and vegetable intake, less than 1.5 servings a day. Those who averaged 8 or more servings a day were 30% less likely to have a heart attack or stroke. So you know that I strive for not five, but eight every day. Individuals who ate more than five servings of fruit and vegetables per day had roughly a 20% lower risk of coronary heart disease and stroke compared with individuals who ate less than three servings per day. So some is better than none. Five is better than three. Eight is better than five. Why though? Antioxidants, vitamins, minerals, yes, absolutely. Also fiber. We are a fiber deficient nation and no one's talking about it. WHO recommends 25 to 29 grams of fiber each day. How many people, just look down, no need to see in the room. How many people are consuming that amount of fiber each day, 25 to 29 grams of fiber? We're a fiber deficient organization. Oh, it's okay though. We're learning this and we know that we can make a difference. We can put this on our goal setting. Now why though? Why do we want fiber? That's always the interesting thing. It's the why. Why, why, why? Why exercise? What's going on? Why want fiber? Because of the microbiome. So when we eat fiber, the microbiome ferments the fiber. It creates short chain fatty acids called acetate, propionate, and butyrate. People are familiar with acetate, propionate, and butyrate. No, these are very important short chain fatty acids. They go through the L cell in our gut and they have an influence on GLP-1, PYY, and other factors. Why do you care about this? Because this plays a role in lipid metabolism, glucose metabolism, immunity, our risk for cancer, these short chain fatty acids, and this fermentation process. So we need fiber to be healthy. This says it all. Everyone gets excited about this slide now because you can see the dietary fiber. You can then see the gut microbiome, the short chain fatty acids, as I told you, and then they're going through the L cell. And you see GLP-1 increase. What did I suggest? GLP-1 increase. Everyone goes, what's that? How? Yeah, through fiber. But here's the thing. It only lasts two to three minutes. This is our natural physiology, GLP-1. Still, if you eat three meals a day, you can get a little bump in your GLP-1, your PYY. And it's really important you have these short chain fatty acids so that you can regulate energy, glucose, lipid, you reduce your inflammation, you increase your ability to fight infection with your immunity, and you decrease your chances for cancer through fiber. So here's that healthy eating plate I mentioned to you in full color, Dr. Walter Willett. He's been a great mentor of mine at the Harvard T.H. Chan School of Public Health for years. Now we have Dr. Frank Hugh, great friend also now, who took over as chair of the Department of Nutrition at the Harvard T.H. Chan School of Public Health. Walter Willett also put together the Eat Lancet plate. You can see it follows very closely the Eat Healthy plate. This is healthy people, healthy planet on the left. All right. People always say to me, that's nice, Beth, Dr. Freedies, but what about people in under-resourced areas? Yes. At Lifestyle Medicine, we are very much concerned with people in under-resourced areas. We have Eating on a Budget in Spanish here and in different languages from the American College of Lifestyle Medicine website pre-available to you and to patients. This is one way that Dietary Spectrum on the right handout to help people go from the SAD diet, Standard American Diet, to the whole food plant predominant diet. Rice is inexpensive, beans are inexpensive, and one thing we really have to understand is that frozen fruits and vegetables are healthy. The phytonutrients are in there. The fiber is in there. Yes, I have the ability to get farm-fresh fruits and vegetables. Not everybody does. In my freezer, if you looked right now, you'd see frozen broccoli, cauliflower, peas, streamed beans. I have the means to get the other, but I like the convenience of having that plus my frozen berries. Food and mood. Higher intake of fruit and vegetables associated with decreased incidence of depression. Multiple studies show this. People generally know they need to eat fruits and vegetables. They don't do it, so we need to help people with cooking skills. We need to help them use herbs, spices to make this nutritious and delicious. But how are healthy eating patterns disrupted? Anyone give a guess. It's the next pillar I'm going to cover. Time. Stress. Stress. Stress can increase the desire for hyperpalatable foods, foods high in fat, sugar, or both, felt to be likely due to the high cortisol levels. I don't need to tell this audience about stress. You can recognize stress in other people, animals, and in yourself. Some stress is good. You stress. That's called flow. So when we are in flow, or we have a little bit of stress, where our skills match the challenge at hand, we're in flow, fully engaged, and we lose track of time. That's a good thing. Too much stress is considered distress, and that's what we're talking about when we're talking about the problems with stress. And guess what? The hippocampus comes back up, because there are studies, multiple, that show chronic increased distress can show changes in our hippocampus. Degeneration, negative changes in the hippocampus. But don't get stressed, because how can you help yourself increase the volume of your hippocampus? Somebody. Yes. Yes. You're listening. Thank you so much. Exercise. Yes. Okay. So we also know about stress as physiatrists. We're well aware that we experience it through the brain. What happens is our cortex then gives signals, hypothalamus, pituitary goes to the HPA axis, hypothalamic, pituitary, adrenal axis. We actually release cortisol, release epinephrine. You can see that this can increase inflammation, decrease immunosurveillance. Then look on the right-hand side of the slide. We also know that stress has an impact on behavioral changes. It can, through this epinephrine release in the circulation, increase hypertension, through increased cortisol, increase insulin resistance and adiposity, creating cardiometabolic changes that lead to chronic conditions. Here's an example of how psychological stress can have an impact on one of our epidemics we have in the U.S. of diabetes. You can see the HPA axis, the increased cortisol, subclinical hypercortisolemia, increased intra-abdominal fat, increased waist circumference. Then, of course, the autonomic nervous system, increased epinephrine, norepinephrine. Then we have insulin resistance, increased hemoglobin A1c, increased triglycerides, decrease HDL. And then inflammation. IL-6 increases, C-reactive protein increases. Then there's the endothelial cells. Endothelial dysfunction. This can all lead to type 2 diabetes. So here's the good news. You want the good news. The good news is there are several evidence-based stress reduction techniques. Getting out in nature. Forest bathing. Exercise. Mindfulness. Mindfulness-based stress reduction. Anyone familiar with that? Some of you. John Kabat-Zinn in UMass Worcester. I took a five-day CME in this. It changed my life. Mindfulness-based stress reduction. Take online classes now for eight weeks. For patients and providers. Meditation. Sarah Lazar's work at Mass General Hospital shows that prefrontal cortex is actually thicker than people who meditate. Kind of the reason I went I went towards meditation. Playing with your pet. Cat or dog, furry. You pet it, oxytocin is released. Taking your vacation. How many of you take your vacation? Okay, a few. Yay. Good. When you take your vacation, you come back. Research shows you're more productive. Taking deep breaths. How many of you use your breath to relax? One, two. Okay, a few more. Good. Yeah. It is your switch. You have with you and it is free. Anytime of the day or night. Deep breath in. Long exhalation out. Can turn off the sympathetic system and get into parasympathetic. Still more. Still more good news. Music. What kind of music? Any kind you like. My brother likes Led Zeppelin. No, that's not, that's going to stress me out. I like classical. It's whatever you like. Practicing yoga. Laughing. Love that one. Expressive writing. Chewing gum. Pretty simple. Checking email less frequently. Less simple. But important. Now let's get into the next pillar, sleep. We had a lot of people sitting down on that. So seven to nine hours National Sleep Foundation. You can nap best before 3 p.m. and only for 20 minutes so it doesn't disrupt your nighttime sleep. Circadian rhythm. Same time to bed, same wake up. Monday through Monday. Now when you're on call, of course, it's all different. But when you can control your own schedule. This routine is important. Why? Cardiovascular disease. Yet again, the research shows that's why these recommendations are in place. Sleep duration is on your x-axis. Y-axis has a ratio for incident CBDs. Look at the nadir. Seven to nine hours. What can sleep deprivation do to you? Here's where I think you should all start really paying attention, okay? Increase your high blood pressure. Increase your blood pressure to make it high. It has a correlation with heart disease, obesity, and diabetes. Insufficient sleep. People don't realize this. We are counseling diet people with diabetes and we are not talking about sleep. We should be. Five nights of sleep restricted to four hours per night results in, get ready, 24% decrease in insulin sensitivity. 30% decrease in the acute insulin response to intravenous glucose. And here's the thing. This has been replicated and it was shown to us years ago. We need to take this seriously. Now this sleep and mood, similar graph that you saw for cardiovascular disease. Same nadir. Seven to nine hours. This will get you. People that were having trouble or their legs were getting weak when I asked about sleep and they sat down. Ready? Reaction time. This is an interesting study. Driving while drowsy. Sleep deprivation, blood alcohol levels. This was done in Australia. Reaction time of those that were sleep deprived was compared to the reaction time of those who had been consuming alcohol. Being awake 18 hours, similar reaction time to someone who has a blood alcohol of 0.05. Being awake 24 hours, reaction time similar to someone who has a blood alcohol of 0.10. You know that 0.08 is considered legally drunk. I'm sorry to have to report this. I don't know who else can raise their hand on this. It is not something to be proud of. It's pretty embarrassing but I've been with you almost 45 minutes so I'm going to be authentic and vulnerable now and tell you that when I was on my surgery rotation at Santa at San Jose, Santa Clara Valley Medical Center in San Jose as a Stanford medical student, I was trying to impress the surgeons and staying up all night checking this, checking that and then rounds were over and I felt exhausted. It's almost like when you're dealing with someone who's drunk, they say no I can have the keys. You say no don't take the keys. I said I shouldn't drive. I should sleep. Then I said no I can't have the keys. No take the key. I took the keys. I went in the car and I fell asleep at the wheel. Anybody fall asleep? So dangerous. Thank God. I just woke up in a place. I don't know how I got there. No one was hurt. I wasn't hurt but I honor sleep and hope that everyone here can honor sleep. Residents take Ubers home. Residents at MGH and surgery, we really have to protect our trainees. So how do we have proper sleep hygiene? Make your bedroom like a cave. So quiet, cool and dark. Ear plugs. If you need white noise, pink noise depending on where you live, cool. 67 degrees is a sweet spot for sleep because a drop in body temperature is a signal for sleep. Another signal for sleep is a release of melatonin. Well that's not going to happen if you're looking at your screen or any screen. Your phone, your tablet, your computer because blue wavelength light gets into your retina and it blocks the pineal gland from releasing melatonin. So put on the app. You say well I have to I have to use my computer. I have to do my work. Well put on the app that blocks the blue wavelength light or get blue wavelength blocking glasses but be cognizant of this and if you can turn it all off two to three hours before bed. Now let's talk about caffeine. What receptor does caffeine bind to? We learn all about pharmacology in medical school. What receptor does caffeine bind to? Yes, adenosine. Why does that matter? Adenosine builds up throughout the day. We use ATP. Adenosine builds up throughout the day, reaches a peak usually around 11 p.m. That helps us fall asleep. Adenosine does. But wait, caffeine binds to the same receptor. So if caffeine is bound to that receptor, uh-oh, we're gonna have the opposite reaction. And guess what? What's the half-life of caffeine? Four to six hours. So people often go for the caffeine around 3 p.m. but what happens at 9 p.m. when they're getting ready for sleep? Half of it's in their system so it's hard to fall asleep. Then they may have a drink of alcohol. We'll talk about that later. Sleep deprivation and the impact on food. I told you these pillars are connected. Sleep insufficiency is associated with a significant increase in the desire for weight gain promoting high calorie food items following sleep loss, magnitude of which is proportional to the subjective severity of sleep loss across participants. So when people are sleep deprived, are they going for the bag of chips? Yeah, not the bag of kale. And we know specifically volunteers who slept four hours, ate 300 extra calories compared to those who got nine hours of rest. Now poor sleep can impact our mood, outlook, productivity, creativity, sociability, relationships. Matthew Walker and his Why We Sleep book and his research has shown that you are what percent more likely to have an amygdala flare if you're sleep deprived? Anyone know? Anyone know what amygdala flare is? So your amygdala, as you know, threat center, you feel threatened, get into fight-or-flight. Often that person is irrational, just talking from their amygdala, no prefrontal cortex available. It's irrational talk. None of you have had one but maybe somebody has had an amygdala flare in front of you when they're just crazy and they're talking irrationally to you and they're not stopping. Even if you say that doesn't make sense, can we think of it a different way? They're not thinking because they're having an amygdala flare. If you're sleep deprived, you're 30% more likely to have one. So all of the people that their legs got weak, I want you to think about this when you're thinking about sleep. When you sat down, when I asked about seven to nine hours, think about prioritizing your sleep. Okay, we only have two more pillars and they're gonna go quickly. Ready? Maslow's hierarchy of needs. Who studied this? Psychology class. Okay, a few people. Physiologic needs. Water. Food. Shelter needs. Then love and belongingness right after that. Right after that. It's a physiologic need. Psychologic need. Now, this is the landmark study from Lisa Berkman and Leonard Syme. This was in Alameda County, 1965 to 1974. They looked prospectively over nine years at men and women in different age groups. The different age groups represented on the X-axis, you've got 30 to 49, 50 to 59, 60 to 69. Y-axis is the percent that died from all causes in age groups. The different age groups over those nine years. Then it's a bar graph, so those that have the least connections are the ones with the diagonal lines. As you can see, in all age groups, both men, men are on the left, women are on the right. Both age groups, those that were the most likely to die had the least connections. It's time to take it seriously, social connection. Vivek Murthy said, we have an epidemic of isolation. So, of loneliness. An epidemic of loneliness. And what's this doing to our patients? Well, when we have low quality and quantity of social ties linked with development, progression of cardiovascular disease, recurrent heart attack, atherosclerosis, high blood pressure, cancer, delayed cancer recovery, and slower wound healing. When was the last time you asked a patient if they were lonely? It's a question. One question that you can ask. Robert Waldinger at MGH, he's been studying the adult development study. He's the third director of this study. He's been working with the research. 80-year follow-up, longest study of adult development. They studied participants' health trajectories, broader lives, their triumphs and failures, careers, marriage. Findings produced startling lessons. Surprising findings that our relationships and how happy we are in our relationships has a powerful influence on our health. This is Robert Waldinger. And what I want to emphasize here, taking care of your body is important, but tending to your relationships is a form of self-care too. And that's the revelation Bob Waldinger puts forward in his book, The Good Life. So what gets in the way of social connections? Substance use disorder, certainly. And we know that went up with the pandemic. Why? Increased stress, increased alcohol availability, boredom. And this has to do with patients and physicians. If you don't know the YouTube video by Carrie Leibovitz at MGH, surgeon, she shares authentically and vulnerably about her issues around alcohol and mental health. It will certainly move you. So quit smoking and monitor alcohol use. We already went through this. You know, the American Heart Association guidelines. But do you know what a drink is? Twelve ounces of beer, five ounces of wine, 1.5 ounces of distilled spirits. Here I am the messenger. OK, this is the message from the CDC, the AHA and also the American Cancer Society. For cancer prevention, there is no safe amount of alcohol. You can look at the studies. Take that information and do what you will with it. Alcohol and the other pillars, alcohol disrupts sleep. Most people think alcohol helps them fall asleep. But the research shows is that you may fall asleep quicker, but you will wake up in the middle of the night. You will certainly have less REM sleep. We're all worried about our memories, consolidating our memories. We want REM sleep. Also, people who consume alcohol with dinner may end up eating more food than they normally would, staying up later than they normally would, and perhaps saying things that they normally would not, which leads to trouble in our social connection. So I'm just going to end by telling you that this is about you. It is about your patients. I've been doing this a long time, as you heard, at Harvard Medical School, at Spaulding and at Mass General. And now I'm doing group coaching in this with physicians and surgeons from both Mass General and the Brigham for their own health. You can actually continue your journey with me if you'd like and learn more about these six pillars of lifestyle medicine for free for this CME course from Spaulding and Mass General Hospital Department of Surgery. And we can continue our journey together. I am available. I will stay after for any questions and any comments. I just want to tell you that it was a delight and a real honor to be able to be on the stage with you today. I thank you for your attention, your engagement, and I wish you the best on your journeys in lifestyle medicine. Thank you so much.
Video Summary
At the Zeider Lectureship, Dr. Elizabeth Pegg Fradies, a leading figure in lifestyle medicine, shared her insights with an audience that included both in-person and virtual attendees. Dr. Fradies, a Harvard educator and practitioner, detailed the six pillars of lifestyle medicine: a whole-food, plant-predominant diet, physical activity, restorative sleep, stress management, avoiding risky substances, and nurturing social connections. These pillars not only boost physical health but also support mental well-being.<br /><br />Dr. Fradies emphasized the transformative power of these practices in treating and potentially reversing chronic diseases like cardiovascular disease and diabetes. She illustrated this through her personal narrative about her father, who recovered significantly from a major health setback by implementing these lifestyle changes.<br /><br />Throughout her talk, Dr. Fradies engaged the audience in interactive exercises to highlight the importance of these lifestyle interventions. She touched on the profound impact of physical activity on mental health, the role of fiber in the diet, the effects of stress, the essential nature of quality sleep, and the critical role of social connections.<br /><br />In closing, Dr. Fradies invited attendees to consider how they might personally enhance their health and apply these strategies with their patients.
Keywords
lifestyle medicine
Elizabeth Pegg Fradies
six pillars
chronic diseases
physical health
mental well-being
interactive exercises
diet and nutrition
social connections
×
Please select your language
1
English