How Can Integrative Medicine Make You Healthier?

When you live with an illness, any illness, you immediately look for ways to feel better. If you have a headache you take an aspirin. If you have high cholesterol you take a statin. But sometimes there aren’t simple solutions to alleviate your symptoms.

What do you do when you're desperate to step outside the box of conventional medicine to feel better?

One doctor in Colorado has been guiding patients to jump outside that box for years. His name is Dr. Allen Bowling and he's an internationally renowned neurologist and MS specialist.

He's also a leading authority on complementary and alternative medicine (CAM) as applied to Multiple Sclerosis.

Photo Credit: NeurologyCare.net

Dr. Bowling entered my radar years ago when I was newly diagnosed and looking for ways to live healthier. The diets I found at the time fell short of what I was looking for. Roy Swank touted his extremely low in saturated fat diet and John McDougall offered a fad diet.

They weren’t for me.

I knew I didn’t want to rely solely on solumedrol (the only option at the time) whenever I had a flareup. I wondered if diet, exercise and a holistic health approach combined with traditional medicine would provide a healthier way of life.

Loyal readers know I became a follower of Dr. Andrew Weil's advice soon after my diagnosis. Weil is the (now) celebrity doctor who focuses on holistic health and integrative medicine. I clung to him in the beginning of my MS journey.

But I needed more answers. That's when I discovered Allen Bowling.

At the recent Consortium of Multiple Sclerosis Center's annual meeting I had an opportunity to attend a symposium focusing on lifestyle factors where Dr. Bowling presented his topic “Expanding the MS Toolkit: Integrating Lifestyle Factors and Unconventional Medicine Into MS Clinical Care.” It fascinated me.

It’s a subject Dr. Bowling is passionate about.Thank goodness for all of us.

Bowling’s newest book “Optimal Health with Multiple Sclerosis: A Guide to Integrating Lifestyle, Alternative, and Conventional Medicine” synthesizes his decades of important research, writing and caring about the MS community. I use it as a guide for healthy living.

For those living with MS - and even for those without - it's a reference book you can depend on time and time again. It is a bible for better health.

(NOTE: I love that one of my heroes, Dr. Oliver Sacks, highly recommended Dr. Bowling’s book. "This book is full of wise and balanced information. It provides a valuable service to patient and health care provider alike."--Dr. Oliver Sacks, author of Awakenings)

Dr. Bowling was kind enough to answer a few questions of interest for anyone searching for a healthier way of life. If you're looking for the key to mind, body and spirit working in harmony Dr. Bowling can help you open that door.

How did you first become interested in integrative medicine? When did you decide to share your interest with the MS community?

I first became interested in integrative medicine when I went into practice 20 years ago and realized that most of my patients were interested in this type of approach, yet I had received no education and training in this approach. Once I collected a small amount of evidence-based information in this area (a few months of work 20 years ago), I began writing and speaking on the topic. I also began to incorporate it into my clinical practice.

What was the first concept that caught your eye to learn more about integrative medicine?

What caught my eye about this approach (and was actually quite shocking!) is that this approach actually leads to a higher quality of care but it is not the standard of care. It provides a higher quality of care because it includes conventional medicine, addresses lifestyle factors that may prevent many diseases and may be beneficial for MS and many other conditions, and provides evidence-based information about “alternative” approaches.

Were you influenced by anyone’s work in integrative medicine to help you make the decision to go in that direction?

Early in my work, there were very few professionals who were truly using an evidence-based approach in this area—most of the information that was available was excessively negative or positive and did not include much evidence. In the 1990s, I was influenced by the work of Dr Edzard Ernst in the United Kingdom. My patients generally did not find either of these extreme, non-evidence-based approaches helpful—they wanted the “real deal” information without spin and without sugar-coating.

How do you explain integrative medicine to patients and why they’d benefit from incorporating it into their own lives?

I explain to patients that there is evidence that conventional MS medications have benefit for modifying MS disease course and treating MS symptoms, but there is also evidence that exercise, diet, emotional health, tobacco use, alcohol, and other medical conditions have important effects on MS and general health and therefore MUST be incorporated into the treatment plan.

In your experience does any one “type” of MS benefit more from integrative medicine than another?

I think all types of MS may benefit from this approach. In the specific case of progressive MS, for which many feel the treatment options are limited, I would argue that there are many therapies, especially integrative, that are available and should be used.

What has been the biggest game changer in the way patients view integrative medicine?

I think the biggest game changer is that people with MS and professionals are more open to this approach and also that more and more evidence is available to support the use of these approaches in a safe and effective manner.

What diet(s) do you suggest for the MS community?

I doubt there will ever be one best diet for MS—I think we may find one diet that’s the worst for MS…the standard American diet. For diet, I recommend:

A generally healthy diet—in keeping with Michael Pollan’s quotation, “Eat food. Not too much. Mostly plants.” Specific diets that are consistent with this include DASH, MIND, TLC, Weight Watchers, and vegetarian.
Consider Vitamin D and B12 supplements if blood levels of these nutrients are low.
Avoid or cautiously use most supplements---there are more than 200 supplements that raise concern for people with MS.
Limit calorie intake so as to maintain a healthy body weight.

How much exercise do you recommend to patients?

For exercise, I also think that it is unlikely we will ever find the one best program for people with MS. What I recommend is a personalized program that is enjoyable and generally has these features:

3-4 sessions per week with each session lasting 30-60 minutes.
2:1 ratio of aerobic:conditioning.
Balance, stretching, and some type of relaxation during or at the end of exercise is fun!
For people with any type of disability, the exercise program should be put together in conjunction with a physical therapist.

Please explain your integrative model in MS and the new paradigm in MS care.

The new paradigm of care that I discuss is this integrative model applied to MS. I discuss in detail in my recent book, Optimal Health with MS. This approach utilizes conventional medicine as well as unconventional medicine and lifestyle approaches to treat MS but also to treat other medical conditions and maintain whole body health. This approach has seven steps:

Disease-modifying medication
Symptomatic treatment—with conventional, unconventional, and lifestyle medicine
Exercise
Diet
Personal and social well-being
Tobacco and alcohol use
Treatment and prevention of other medical conditions

What are your thoughts on medical marijuana for MS patients?

I think marijuana use needs to be thought through carefully for people with MS. As with any drug, one should weigh the risks and benefits of marijuana. There are multiple studies in MS that show that marijuana products may improve pain and one’s sense of muscle stiffness (spasticity). Unfortunately, the products that have been used in these studies are not available in the US—this leads to a challenge with relating these studies to day-to-day practice with products that are available in the US. Marijuana may interact with prescription medications and has possible adverse effects, such as addiction, motor vehicle accidents, dizziness, impaired balance.

Tell us what you’re currently working on.

My current focus is on how to truly use an integrative approach in day-to-day clinical care for those with MS. That is a large and complex task. As a clinician, this requires a true “mindshift” and a significant fund of knowledge and clinical experience. There is also a logistical challenge to provide this type of care within the confines of the US healthcare system.

Here's a bit more about Dr. Bowling’s book from the Yale School of Medicine's website:

When he returned to his native Colorado 20 years ago to treat people with multiple sclerosis, Allen C. Bowling, M.D. ’88, Ph.D. ’88, believed he was well prepared. After earning a medical degree and a doctorate in pharmacology at Yale, he completed his neurology residency at the University of California, San Francisco, and spent three years as a fellow at Harvard.

“I was thinking, ‘Wow! I have such a great toolbox for doing clinical practice at a high level.’ ” Before long, however, Bowling recognized gaps in his knowledge. “There’s so much I don’t know, so much I didn’t get, in more than a decade of training.”

This realization grew out of the nature of multiple sclerosis (MS): this disease of the central nervous system is incurable and unpredictable and causes a constellation of symptoms. Although his patients generally took conventional medications for MS, Bowling discovered that most were interested in how such lifestyle issues as diet and exercise affect the disease. More than half pursued strategies not dreamed of in the medical school curriculum: reflexology, removal of dental fillings, marijuana, magnets, pressurized oxygen, and prayer. However, at that time, there were not any reliable sources of MS-specific information in these areas.

“I realized that the quality of MS care could be improved by providing objective information about the safety and efficacy of these lifestyle and unconventional approaches to people with MS and also to health professionals.

Click here to read the rest of this article.

For more information on lifestyle and unconventional therapies take a look at Dr. Bowling’s website, Neurology Care.

It's Time To Get Back On Track With Wellness

It’s been quite a year at the Chester House. I’m not going to go into any lengthy, boring details but we’ve weathered quite a few storms since January. Yet through it all I feel grateful that it’s brought my family closer together.

The bad news is it derailed any exercise routine I had and gave me an "excuse" to do some emotional eating. That is not a healthy combination.

This was me before the first time I began Jenny. I still hate scales.

I never step on the scale. Ever. Except under complete duress at the doctor’s office when the nurses force me to step on, kicking and screaming all the way. Then they roll their eyes after hearing (for what is probably the millionth time that day) why a woman hates being weighed.

I don’t bother taking off my shoes, earrings, rings, coat, sweater or socks to squeeze extra ounces off my body. What's the point?

I can feel I'm gaining weight by the way my clothes fit. If I can’t breathe with my blue jeans on, or the buttons on my preppy buttoned-down blouse doesn't close properly I know I’m in trouble.

Re-enter Jenny Craig.

When I called my friends at Jenny there were no questions asked. No comments about gaining weight or falling off the wagon. Their focus is on wellness and feeling good about yourself. And I quite agree.

The Jenny Craig consultants are wonderful.

So I’m taking control of my health by jumping back into Jenny Craig. It's my wellness gift to myself.

Jenny Craig offers nearly 100 premium food choices to help us lose weight, and they're properly portioned and nutritious by balancing protein, carbohydrates, fiber and healthy fats.

They’re also delicious. They really are. When I wasn’t on the plan I craved their triple chocolate cheesecake. They're amazing!

I love the attention you get at the weekly Jenny one-on-one consultations. All of my questions are answered, and the professional advice I receive from my consultant helps me lose weight by offering tips and tricks to stay on course and also ideas on making time to fit in exercise.

I’m excited to be getting back on track and more than ready to feel and look better.

Here we go!

DISCLOSURE: I was provided a free trial program and discount on the Jenny Craig meals. As always all opinions expressed here are entirely my own.

Offer: Join today & get $50 off* Jenny Craig’s Best Program + $50 in food savings**
Disclaimer:
**$50 food discount to be used in $10 increments with minimum weekly food purchase of $90 US/$95 CAN. Discounts valid at participating centers and at Jenny Craig Anywhere for new members enrolling in the Jenny Craig All Access program, other restrictions may apply, details available at participating centers. Additional costs include monthly membership fee, cost of food, and cost of shipping if applicable. Not valid to purchase food at jennycraig.com. No cash value. Offer ends 10/30/2015.

Offer: $25 off Jenny Craig food for each referral (limited time only)*
Disclaimer: *Offer requires minimum food purchase of $90 US/ $95 CAN. Referring member discount available on visit after referral enrolls on Jenny Craig program. Membership required at time of redemption. Valid at participating centers and Jenny Craig Anywhere only. Not valid at jennycraig.com. No cash value. Not valid for shipping costs. Not valid with any other offer or discount. One offer per person. Not transferable. Guest Code: NGE. Referring Client Code: GRD. Restrictions apply.

How Technology And Exercise May Help Patients Live A Better Quality Of Life

It’s a new world. When I grew up getting exercise meant riding my bike all over town or, as I got older, signing up for an aerobics class. Today, technology is changing the face of exercise by reaching a wider audience; people who either don't make time for it or don't know how to use their abilities for physical activities. This is good news for everyone, but it’s particularly exciting for the disability community. (See my post on how FitBit and FaceTime are keeping people fit.)

Patients living with Multiple Sclerosis know it’s a disease where no two people have it exactly alike, but they also know what’s overwhelmingly prevalent: fatigue and depression.

Traditionally MS specialists prescribe a myriad of medications for patients to try and combat their fatigue and depression. It’s been my experience that none of these work. So for years I’ve looked high and low for holistic ways to address these issues. What I’ve found is something we’ve known all along.

Physical activity makes a difference in more ways than one.

According to the Cleveland Clinic, “A number of studies have shown that regular exercise, usually with some aerobic (cardiovascular) component, helps with MS-related fatigue. Regular exercise is also good for balance, endurance, weight loss, and well-being.”

Well, then all we have to do is go out and (yes, I’m going to say it) just do it, right? Not so fast.

If you’re like me, someone who doesn’t exercise nearly enough, and you also happen to live with a chronic illness, getting daily exercise is not as easy as it sounds. The thought of walking, biking, lifting weights or dancing while battling fatigue can feel overwhelming. So I sit in the comfort of my chair promising myself that tomorrow I’ll get some exercise.

But tomorrow never comes.

What we need is a buddy, a mentor, or a friend to simultaneously inspire and hold us accountable to an exercise routine.

Coincidentally as I was deciding on my next topic to write about, from the hundreds of presentations offered at the recent CMSC Annual Meeting, I found myself leafing through abstracts in The International Journal of MS Care (the official publication of The Consortium of Multiple Sclerosis Centers) to help me decide.

One particular study seemed to jump off the pages.

It was a study done at The University of Washington called “Improving Fatigue and Depression in Individuals with Multiple Sclerosis Using Telephone-Administered Physical Activity Counseling” performed by Aaron Turner, Ph.D. and Alicia Sloan, MPH, MSW, LICSC, at their Multiple Sclerosis Center of Excellence.

Aaron Turner and Alicia Sloan performed a study on 64 veterans to see if fatigue and depression were affected by exercise

Its objective was to evaluate the impact of physical activity to improve fatigue and depression in patients with MS. After going through a screening process, sixty-four veterans became part of the study, receiving either telephone counseling (TC) or self-directed physical activity education (EC).

TC included mailed graphic feedback, six telephone counseling sessions that used motivational interviewing and telehealth home monitoring (including telephones, computerized ankle step monitors and home telehealth monitors) and a way to track progress on exercise goals.

EC consisted of advice and a DVD that was produced by the VA called “Get Fit for Life” which provided examples of in-home exercises. The activities included exercises for multiple physical abilities.

There was a three and six month follow-up.

What were the results? Go ahead and take a guess. I’ll give you a moment to think.

Are you thinking?

Almost done?

Your time is up! What was your guess? If you thought the veterans receiving telephone counseling fared better you were right. Give yourself a nice walk around the block as your prize!

The TC group showed significant increases in physical activity because they were monitored, and they also were found to have a reduced amount of depression and fatigue!

I find these results extremely promising.

I thought I'd reach out to Aaron Turner and Alicia Sloan to ask a few questions about their study. I wanted to learn a bit more and find out if they’re planning a larger study to reach a wider patient population.

CC: What is motivational interviewing?

AT/AS: Motivational interviewing (MI) is a form of brief psychosocial counseling and has been shown to help initiate and sustain behavior changes from across many health domains. MI encourages behavior change by contrasting current behavior, such as physical inactivity, with desired goals and values, such as physical fitness, good self-care, and quality of life, in a manner that is empathetic, evocative, and collaborative and intended to promote self-efficacy (Miller & Rollnick, 2012).

There is some specific evidence to suggest that MI-based counseling may be effective in promoting physical activity among individuals with MS (Bombardier et al., 2013) which led us to design this study.

CC: What exercises did the patients perform at home? What DVD’s did you use?

AT/AS: Exercise goals were self-selected. It was emphasized that the exercise tools chosen would be home-based or accessible to the participant (health club, class, etc.) with an emphasis on short-term goals specific and achievable based on the study participant’s abilities.

Exercises could be found on the DVD or on other personal interests.

In the counseling sessions the study therapist used Motivational Interviewing and other goal setting exercises to help the participant figure out specific goals for walking. Later they either chose yoga at home or at a community center. Others chose the “Get Fit for Life” DVD as a home based exercise plan.

The study therapist helped them figure out which exercises made sense for their abilities. Many of the participants used to participate in the activities they chose to do for the study, but stopped because of fatigue and other MS symptoms.

The DVD had veterans participating in various ability levels of exercise by an exercise coach. It is a great DVD that has a motivating, patriotic spirit that veterans could relate to.

CC: What's your next step with the findings of this study?

AT/AC: The next step is research of an intervention focused on health promotion more broadly that includes physical activity, but other health behaviors as well. It is likely the intervention will be delivered in a similar manner.

The ultimate goal is to develop a service that could be brought to people in their homes at low cost wherever they receive care.

The findings of this study suggest that telephone-based counseling (Motivational Interviewing) combined with home monitoring is a promising means of improving physical activity and treating fatigue and depression for people with MS. Providers could implement this kind of program into their practice with people with MS.

My sincere thanks to:

Aaron Turner (Principal Investigator), Ph.D., ABPP (RP), Director, Rehabilitation Psychology, Rehabilitation Care Services, Associate Director of Research, Multiple Sclerosis Center of Excellence (MSCoE) West,VA Puget Sound Health Care System,Seattle, Associate Professor, Department of Rehabilitation Medicine, University of Washington

Alicia Sloan, MPH, MSW, LICSW (Study Coordinator and Study Therapist), Clinical Research & Special Projects Coordinator, Multiple Sclerosis Center of Excellence (MSCoE) West ,VA Puget Sound Health Care System, Seattle, WA

Your continued interest in providing patients living with Multiple Sclerosis a better quality of life is sincerely appreciated. I thank you for all of your hard work, and for the opportunity to speak with you on this promising study.

How FitBit And FaceTime Use Technology To Make Exercise More Accessible

I have friends who say they love breaking a sweat when they work out. To me breaking a sweat means I’m having another hot flash.

I’ve never been good about sticking to any exercise program; instead I’ve wasted a lot of time and money on gym memberships that I never renewed. In my early twenties I religiously worked out at home with Jane Fonda in our respective leg warmers and headbands. That didn't last long.

When I was 26 I was diagnosed with Multiple Sclerosis and quickly began living my “new normal” that included permanent numbness, loss of balance and heavy bouts of fatigue. I focused on getting through my days as best as I could without feeling deep pangs of guilt that I wasn’t getting any exercise.

I became a mother at 34 and knew it’d take all of my inner strength and physical energy to be the best mother I could be. Once again, exercise took a back seat.

Looking back I regret not being more committed to an exercise regimen. I wish I had the means to hire a personal trainer because that's what I needed; someone who would make me accountable to a weekly workout.

Now that I’m in my fifties I know there’s a strong relationship between exercise and good health. It can improve strength, provide better cardiovascular fitness, help with fatigue and depression, and contribute toward maintaining an overall positive attitude. (Read this article about exercise from The National Multiple Sclerosis Society.)

So when I ran into my former neurologist, Dr. Mary Ann Picone, Medical Director of the Multiple Sclerosis Comprehensive Care Center at Holy Name Hospital when I was attending The Consortium of Multiple Sclerosis Center’s Annual Meeting, I was excited to learn about a new study she’s working on that could help people with MS adhere to an exercise program.

In her study, funded by FCMSC (Foundation for the Consortium of Multiple Sclerosis Centers), she used technology (a Fitbit and FaceTime) for patients who received an individualized workout program and were then monitored using FaceTime.

How simple and brilliant is that?

I asked Dr. Picone to explain her study further for us, because it's my belief that the results have the potential of making a tremendous difference for many in the disability community.

Dr. Mary Ann Picone and Dr. Hunter Vincent presenting their poster at CMSC about utilizing technology to improve patient adherence to exercise programs

CC: What made you decide there was a need to conduct a program to monitor patients at home with an exercise program?

MAP: Everyone knows how important exercise is and how helpful physical therapy can be in improving function. However, it is often difficult for some patients to get to therapy because of lack of transportation and/or lack of insurance coverage.

Another problem is adhering to an exercise program once it is started.

Since technology can be so helpful these days we thought we’d try to utilize it to allow patients access to physical therapy and at-home monitoring that they would not have been able to get otherwise.

Having the ability to FaceTime would allow us to track patients and adjust their exercise regimen as needed, and provide encouragement to maintain the program.

Use of the FitBit was another way to help motivate patients to do more. By using an iPad and having a physical therapist devise an individualized rehabilitation program for each person, then using FaceTime, a Fit Bit and reassessing each person at the end of 12 weeks, we could see if this was feasible, if patients liked it, and most importantly if we saw signs of improvement at the end of 12 weeks.

Jason Kavountzis, Head of the Physical Therapy Department at Holy Name, assessed each patient initially and videoed a program for them on an iPad.

Each person took them home, and Hunter Vincent (then a fourth year medical student at Touro University Medical School who was working with me at the Holy Name MS Center saw the challenges that patients faced. He applied for a Student Research grant from CMSC) also assessed the patient and did FaceTime to monitor them every two weeks throughout the course of the trial.

CC: How did you decide which patients qualified for your study? What types of MS did the patients have? Can patients with progressive MS take part?

MAP: Anyone diagnosed with MS who needed rehabilitation, was having difficulty accessing care, and had Wifi capabilities at home was able to qualify. We were looking for a variety of patients with various levels of disability.

We were able to have 8 patients in the trial ranging from having mild lower extremity weakness but primarily with balance problems to patients using a cane either occasionally or all the time to someone who needed a walker for ambulation.

One person who entered the trial had never been involved in a formal exercise program. Patients with either relapsing or progressive MS could take part. There were 7 women and one man in the study. We wanted to see if this program would work for patients with various levels of ability.

CC: What were the results of your study?

MAP: Each patient in the trial was assessed initially and had baseline testing to evaluate various measures such as fatigue, quality of life scales, time to walk 25 feet and a balance test called Tinetti Balance, and how quickly they could get up from a sitting position.

Several patients had not used an iPad before so they needed to learn how to use it and FaceTime. Everyone learned the technology.

Patients showed improvement in their walking, balance and overall quality of life at the end of the 12 weeks. Having to check in every two weeks was very helpful for support and adjustment of routine if necessary.

It improved everyone's confidence level. Several patients who had been very anxious about using the iPad, Wifi and the FitBit were thrilled about the knowledge they gained.

We presented this study at CMSC in Indianapolis and Hunter won First Prize for Best Platform in Patient and Family Education!

CC: How will these results be used? What is the next step?

MAP: Although there was improvement at the end of the 12 weeks, the next challenge is whether these benefits can be maintained. Twelve weeks may not be long enough to produce long-term change in lifestyle. We think six months is needed.

We would like to do a six-month study, look at FaceTime monitoring every two weeks, and include both a nutritional component to looking at improving a patient's diet and a psychological component that would help with trying to overcome any obstacles to maintaining a healthy diet and exercise program.

The next step is to also compare this to inpatient rehabilitation.

CC: How do you envision the study’s results to be used down the road for more patients in need?

MAP: I would like to see this technology expanded to allow more patients access to an individualized rehabilitation program that they can do at home with remote supervision and occasional inpatient visits for patients who would not otherwise be able to have rehabilitation.

This could even be used globally. I have a patient from Egypt who comes to the center and is using the iPad exercises for at home rehab program!

We want to enable patients to overcome obstacles to care.

CC: Who was involved in your study?

MAP: As stated above, Jason Kavountzis, Head of the Physical Therapy Department at Holy Name Medical Center, Dr. Hunter Vincent who was a fourth year medical student and interested in improving the care of patients with MS (and will be entering Physical Medicine and Rehabilitation Residency), Dr. Fred Foley, Head of Neuropsychology at the MS Center who helped with the statistics and me, Dr. Mary Ann Picone, as the faculty mentor for the study.

CC: Any other thoughts?

MAP: We are grateful to the Foundation of the CMSC for supporting medical student research initiatives.

Our goal is to find ways to improve the lives of patients living with MS and to encourage smart, enthusiastic medical students to become interns, residents and physicians who will continue to improve care in MS.

END NOTE: At the CMSC event in Indianapolis Dr. Hunter Vincent received the award for The Best Platform in Patient and Family Education. He was also designated as the June Halper Medical Student Research Scholar by FCMSC's selection committee. Congratulations Hunter!