Friday, September 18, 2015

yin and yang

Hot and Cold, Anger and Calm, Adrenaline and Serotonin......there are extreme opposites that exist to emphasize and support each other.  Can't have one exist if there weren't the other.  So if you think about the majority of reasons people show up to the ER being linked to the stress response it would be valid that teaching the relaxation response would keep our ER's empty!!!  Ah but no one learns this relaxation response until catastrophe occurs and then the mad scramble to find a healthy lifestyle.  Granted there are the few who I meet in yoga class/at a retreat/on the trail/in sanctuary/watching a sunrise a beach sunset that were blessed to have experienced the Serotonin High (click for link) at a young age and continue to chase the feeling for a lifetime.  You know when you meet the lucky ones, just seems like they are so magnetic, at peace, and just living and enjoying-(downright enviable!)  And here's the cool thing; human brains are hardwired to be attracted to people, events and circumstances that emulate this.  Genetics decided that the species will survive with love as a group so it is built into the DNA to feel very "on top of the world" when you accidentally place your "experiential toe" in the pool of happiness.

It's the ego that we entertain in youth (and sometimes into adulthood), that convinces the brain that the experiential thing that pulls us to share/smile/do things for others - isn't as important as getting something and keeping it, not giving back or contributing.  It's the ego that contemplates that you are the center and all things happy are placed on earth to serve you.  This self serving tendency makes you want to accumulate and horde, you are separate from others, "you are number one", "you deserve a break today", "this Bud's for you".....but the pseudo-rush-feeling one attains from the Adrenaline High is very fleeting and usually leaves you feeling kinda charged but at the same time- kinda needing to get recharged or more as the feeling isn't fulfilling for long.

This is the difference between material happiness and experiential happiness.  Both will work to trigger an emotional wave but usually the experiential thing (like me hitting the summit of Half Dome (click for link) will far outlast the purchase of a sports car or a big screen tv.  In fact there is something called the Hedonic Treadmill where you accumulate more "things" to keep the happy only to find the "thing" you purchased doesn't reward your DNA for long- resulting in a temporary fix making this unsatisfied spiritual nomad seek out another material thing.  Even in economics, the Easterlin Paradox says increased income does not correlate with increased happiness.

I believe that those who haven't tasted the nectar of the serotonin high will go for the next best short term easy emotion that even a child can cultivate....anger/stress.  I think deep inside most Americans will seek out terrifying news, "jump scare scenes" in horror movies, big noise, flashy lights...shock value stuff that is hard to look away from.  There is a definite rush associated with reckless behavior-but again....fleeting.   And to extend this concept to food, people who want fast emotional reward will also find it comes easily with smell and taste.  Processed food will usually give the same rush as shock tv  = rapid emotional turn on followed by a feeling of empty and the need for another "hit".

The built in "lysine contingency" (from Jurassic Park) to humans is -if the individual is exposed to an environment of continuous stress/anguish/hostility/poor calories....the species' DNA says surroundings are not supportive for prosperity so the individual will develop disease and die early.
(Please see my last post The Walking Dead -click here)

Has stated in the title, both extremes have to exist.  The Adrenalin Rush is a useful thing,  but not sustainable ......and for a good reason in that the species can use it to fight off saber tooth tigers, run from fire, seek shelter in thunder, move away from spiders.  Fast and furious response, then off.  In contrast, the Serotonin High makes people come together (literally) help others, provide service ........everyone gets a lump in the throat and a sheds a tear when watching young kids get reunited with parents that have been away a long time.   Having an act of kindness done to you generates massive amounts of serotonin and oxytocin.  Even witnessing the previous act of kindness will make you generate serotonin.  Ever wonder why a person coming home from vacation or a retreat is on cloud 9 for a long time after the experience has finished.  It is hardwired into our genetic code to to seek serotonin inducing activities and places that will allow the best odds for the species to survive.

So why don't we teach this to people as a form of "preventive medicine"?  China did this centuries ago in the form of large industry stating everyone that has a job must practice a form of serotonin inducing activity during the work day-Qi Gong/Tai Chi!!!  The end result was to have a more peaceful work environment, efficient workforce, healthy employees-less sick leave!   That was along time ago but if you even pass by an Asian household now, you may be witness to a grandparent doing some type of "swimming in the air" movement while standing in the driveway.  That is the old Asian guy getting his daily dose of serotonin!  Because he was blessed in younger years to experience the Serotonin High, he continues practice well into his 70's and 80's.  It makes him feel good most of the day, its easy to do, no side effects and requires no copay.

So is it worth carrying high adrenalin levels and suffering the side effects of the reflux medicine, the blood pressure medicine, the anxiety medicine, the palpation medicine, the IBS medicine, the headache medicine?  NO! ..NO!..NO!

More importantly, is it worth keeping daily serotonin at a therapeutic level using refreshing sleep, yoga, qi gong, meditation, hiking, exercise, laughter, healthy food?    Yes! ..Yes!.. Yes!    

Saturday, September 5, 2015

When is it too late to begin a healthy lifestyle change?

I gave a talk today to try and inspire some of my patients onto a healthier lifestyle.   I remember communicating with Steven Devries, an integrative cardiologist who tries to get his pre-cardiac stent patients to make a lifestyle change before going to bypass.  I used to think the concept of integrative preventive medicine was only limited to primary care doctors since my specialty couldn't bill for hospital based procedures -thus the only tool at our disposal was prescription medicine or life-coaching.  With the 15 minute visit not being adequate time to educate .....our only go to was the prescription pad.  Fast, powerful, easy to swallow and most important......paid for by insurance!!! But wait.....what if a patient asks about diet and exercise?  "Well John, I can send you to a registered dietitian for 60minutes of education, design, empowerment.....oh.....but your diagnosis of increase weight, high cholesterol, high blood pressure and prediabetes doesn't cover the visit with her".  We have to wait until your heart attack occurs or you are a full blown diabetic before giving you the education to reverse disease.  Doesn't make sense!!!  But has a hired doctor for a large corporation, I have to be productive compared to other docs.

Or do I?

I thought instead of seeing different patients individually then repeating the same answers.....why not have them all come at the same time!!!!   (of course they have to kinda resemble each other as far as type of medical disease)  But aren't the most common diagnosis all rooted in the same problems-nutrition/stress/immobility?  I decided to see a group of patients at the same time, teach healthy eating and "fire off" answers to the questions that resonated from the group - How to Design the Change in Life and Where to Start.  At the fellowship of Integrative Medicine with Andy Weil, doctors are essentially given the permission to spend 2 years reading and learning about using nutrition, mind body medicine, and parts of ancient whole healing systems (like yoga an Chinese medicine) to take care of the imbalances most people are suffering from.  These imbalances are driving the per capita spending from $5000.00 per person about 5 yrs ago to $8000.00 more recently. So I was able to get some good education across (I think?) and design good take home points that all could use for their individual medical problems.  I called it Weight Loss and Lowering Cholesterol.  I should have called it Weight Loss/Lowering Cholesterol/Reversing Prediabetes/Improving Obesity/Reducing Blood Pressure Medicine/Helping Menopause/Caring for Metabolic Syndrome/Fighting Cancer.  That wouldn't fit on the first slide.  Not only was I able to give more in depth info, I was able to introduce a personal trainer/nutritionist to our group and have her chime in additional "real world" pointers to each person in attendance!

Pouring this information into someones cup will only work if the cup is held with the open side up.  If I have someone that doesn't want a "refill", I don't give it.  Since taking over this primary care practice in Jan 2015, I have found most people didn't want to change getting their refills every 4-6months and some were not ready or willing to start experimenting with cooking more, buying from the farmers market, going gluten-free, enrolling in an exercise place.  In fact some people got angry and offended that I would suggest conservative options instead of medicines (see the angry review on  This is because the trusted way people have been interpreting "being healthy"- is to take a prescription.  Their thinking is if I suggest exercise, counseling and food prep then take the prescription drugs away and ......that would bring on disease!!!  I feel that other doctors are DISEMPOWERING patients by puffing up the value of prescription fixes and not mentioning natural ways to reverse disease with eating and movement.  So back to my original intention....I used to think it was just the primary care doctors role to advise lifestyle change since we had no procedure training and couldn't do stents or bypass or irradiation of tumors or insulin pump insertion.....but....I heard Steven Devries speak of Dark Leafy Greens and exercise and the diet used during the Lyon Heart Study.  Now it isn't just primary care, the concept of healthy lifestyle and evidence based change has trickled down into the specialists fields!!!  (there's hope after all....)

One of my old patients (an open heart surgery patient) came to the group visit today.  He and his wife are living proof of lifestyle change leading to positive results.  He was told by his cardiologist if he didn't have another surgical procedure, he would be dead in 4 years.  (-threat incentive)   I remember seeing his cardiac numbers a few yrs ago and was a bit worried that going conservative may not reverse his disease in time.   We pushed on, I watched him while his cardiologist continued to give the obligatory  finger pointing saying that once the heart muscle is damaged it can never be retrained to beat healthy.  First we did supplements to feel better, then supplements to fix deficiencies on blood testing, then exercise to take advantage of the supplement positive effects, then nutrition to remove the need for supplements.  Now at 72, he has been deemed a miracle according to the cardiologist, he inspires people 1/2 his age (and out-exercises a lot of them!!!)  He has dropped down to a healthy weight even lower than what he was in high school.   I asked to see muscle size and this is what this 72 yr old open heart patient showed me:

Even at the age of 72 where some people are accepting death, John is making changes to live a healthy life, has thrown away all his cardiac medicines and (....the clincher) avoided the high risk procedure he was told would get him past the 3 yr deadline given by cardiologist.  He looks good, feels good, is helping his wife get healthy and is living proof that change is worth's never too late.