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ReMARKS
Integrative Medicine
Helping patients achieve wellness through compassionate education and individual
lifestyle plans.
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As long as I can remember, I have had an interest in aspects of mind-body
interactions in the form of meditation and study of the interconnectedness of
various cultural similarities and differences as they apply to wellness. In the
early '90s, while a general surgery resident, I began to explore Ashtanga Yoga
as a method through which I could achieve physical fitness and stress
management. During this time, mostly on my own, I became increasingly
interested in the spiritual aspects of this ancient tradition. Having been
raised in Western medicine this came slowly, but I began to notice a deep
wisdom in this approach which I found lacking in the typical American approach
to health care. These observations combined with a long term interest in
promoting wellness—rather than controlling or intervening in illness—have led me to consider integrative medicine, the inclusion of alternative or
complimentary medical approaches, into my current general surgery practice.
Specifically, my practice is expanding to include dietary counseling,
acupuncture, massage, and other physical and spiritual modalities including
yoga and meditation. I have employed many of these modalities in my own life and personally
understand how these methods can help guide others in their quest to improve
the quality of their lives.
Integrative medicine, defined
In common medical terms, integrative medicine refers to the blending of
mainstream medicine with alternative or complimentary interventions which
typically are not included in the curricula of Western medical schools.
Examples of integrative medicine include
various dietary modifications; herbal and homeopathic remedies; spiritual
practices; chiropractic; and acupuncture. In a study from the CDC in 2004, it
was estimated that 62 percent of Americans 18 and older had used some form of
alternative medicine over the course of a year (CDC Advance Data No.343).
Integrative Medicine programs have become more available over the last decade
most notably those of Andrew Weil, MD, in Arizona. In addition, at Columbia
University, Mehmet Oz, MD, as the director of the integrative medicine program,
has been instrumental in incorporating alternative and complimentary techniques
into the hospital as well as his cardiothoracic surgery practice.
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Many of these [integrative] approaches have been used for centuries, but we have
lost sight of them in many cases, due to the influence of an excessively
profit-driven food industry and perhaps a medical establishment which focuses
on crisis intervention rather that prevention.
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Among the range of exotic to routine interventions which could be employed,
perhaps the most important is dietary—which will be my initial integrative focus. The obesity epidemic in the United
States has led to the conclusion that the current generation of young people
will be the first in our nation's history to have a shorter life expectancy
than their parents as outlined in a 2005 study in the New England Journal of
Medicine (volume 352, pp1138-1145). Our food options, while plentiful, are
often of poor nutritional value. The introduction of processed food, an excess
of hormone and chemically enhanced food and the ubiquitous use of high fructose
corn syrup among other additives has led to a diversion from the more natural
healthy diet of our ancestors. Unfortunately, often the approach of our current
health care system is to compensate for this by adding additional medications
such as cholesterol lowering agents and weight loss medications or, in an
increasing number of cases, prescribing weight reduction surgery. The medical
community has seen liver damage from the cholesterol lowering agents and
valvular heart disease from the diet pills. Weight reduction surgery retains a
very high morbidity and mortality rate, as it has in the past, although this
has been improved somewhat by current laparoscopic techniques. It would not be
at all surprising to see in coming years an excess of complications from these
surgeries analogous to the myriad complications that followed weight reduction
surgery procedures of the past.
Helping the patient
By changing the interventional philosophy to an integrative one, many of these
problems can be averted. While it seems on the surface to be a simple matter,
in an age of fast food restaurants on every corner and a mesmerizing array of
packaged food in the grocery store, it would appear to be beyond the ability of
many people to make well informed choices. They need help.
An integrative approach to nutrition must be individualized: Many approaches
exist ranging from the mundane to much more esoteric. Many of these approaches
have been used for centuries or millennia, but we have lost sight of them in
many cases, due to the influence of an excessively profit-driven food industry
and perhaps a medical establishment which focuses on crisis intervention rather
that prevention.
One of the most obvious schools of thought is macrobiotics (large or long life).
This was first proposed by Hippocrates and Galen (5th century Greeks) to
describe a lifestyle which included a simple balanced diet promoting wellness
and longevity. Macrobiotics was employed by most long-lived ancient cultures
such as the Incas and Han Chinese, but in modern times traces its popularity to
the work of George Ohsawa, who introduced the approach to the United States and
Europe in the 1950s. Macrobiotics emphasizes locally grown whole grains, beans,
fruits and vegetables, and soy products, which are combined in certain ways to
balance them and promote health and longevity. Such balance generally involves
adjusting the composition of the dishes according to the season, level of
activity, climate, gender, age and health conditions. While macrobiotics does
not necessarily mandate a vegetarian lifestyle, it does incorporate many of the
same food combining principles. Also, somewhat related to this approach, is Wu
Xing (five element) of traditional Chinese philosophy in which many aspects of
health are related to the five elements of fire, water, earth, air, and metal—all of which are thought to influence health. Modification of these elements by
dietary modification is believed by its practitioners to produce significant
physical and mental changes. Another interesting approach is that of Ayurveda (“knowledge of life”) originating in traditional Indian medicine. There are eight branches of
Ayurveda encompassing many of the branches of traditional Western medicine.
These include surgery; internal medicine; ears, eyes, nose and throat;
pediatrics; toxicology; purification of the generative organs; health and
longevity; and spiritual healing/psychiatry. However, in the United States it
generally is limited to dietary advice and herbal remedies. The central theory
of this modality is the Tridosha system in which health is maintained by the
balance of the three doshsas, or constitutions, present in all individuals and
that imbalance of these produce illness. These doshas are Vata, Pitta, and
Kapha which correspond in many ways to combinations of the elements of
traditional Chinese medicine. Interventions are aimed at balancing these
factors by dietary manipulation and herbal therapies. These therapies have been
promoted most in the West by Deepak Chopra, Vasant Lad, and John Douillard.
Douillard has advocated various dietary and exercise regimens in his books The
3 Season Diet and Body, Mind and Sport and has removed much of the mysticism,
thereby making it somewhat more approachable by a Western population.
Clearing up confusion
Many of these theories have allegedly been employed for centuries or perhaps
millennia but modern additions to the fray are myriad and endlessly confusing,
to the average person without a background in nutrition. These include such
topics as the popular Zone Diet, Atkins Diet, and South Beach Diet. All of
these probably have some validity for individual people, but obviously one diet
plan cannot work for everyone. To truly integrate these philosophies and
practices into practical application, most people need help to separate truth
from fiction.
Aside from dietary intervention, which I count as perhaps the most important,
individuals must not forget physical conditioning and spiritual matters. Again,
to a great extent I believe that people want to affect their health from these
perspectives but are often at a loss as to how to begin. The perceived enormity
of losing 50 pounds or decreasing their cholesterol can be overwhelming, and
too many people are just looking for a quick fix. We are now live in boxes that
we call our homes, often separated from nature; work in the boxes of our
workplace where it is eternal daylight; drive between them in our polluting
gasoline-consuming vehicles; and obtain many of our meals from a drive through
windows. The thought of walking out in nature is often seen as an anomaly. This
is how we have been conditioned. An integrative approach recognizes the
plurality of our lives and affords us the opportunity of providing either
directly or indirectly through partnerships with other entities an alternative
to "our boxes" by recommending or offering physical therapy, fitness training,
yoga, tai chi, acupuncture and perhaps meditation and other coping mechanisms
to overcome the stresses of life, which often lead to suboptimal health. It is
my hope that I can begin to provide these possibilities with sensitivity to the
cultural and religious lives of my future clients.
UO
James Holleman, MD a board certified general surgeon in Columbus, NC.
The comments in Remarks are solely those of the author and may or may not be
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