Betsy Blazek-O’neill MD Staff Physican with Integrative Medicine Program at Allegheny General Hospital and Allegheny Health Network

1. Betsy Blazek-O’Neill, MD
Allegheny General Hospital
Integrative Medicine Program
INTEGRATIVE HEALTH
AND LIFESTYLE
PROGRAMMING

2. Hippocrates: 3rd century B.C.
•“The natural force
within each one of
us is the greatest
healer of disease.”

3. Voltaire: 18th century
•“The art of medicine
consists of amusing
the patient while
nature cures the
disease.”

4. Modern medicine: 2014
•“The art of medicine
consists of waiting
until the patient is as
sick as possible and
then devising every
possible method of
preventing the body
from healing itself.”

5. What do people believe about health?
•My health is determined by genetics.
•I will get certain diseases because they run in my
family.
•Getting an illness is just bad luck.
•If I get sick, there is a medicine for that.
•Humans live longer now than ever before, so we
must be healthier than ever.
•Medical technology is so good now that we can treat
anything.

6. What are realities about the current state of
health in Americans?
• Most illnesses are caused by unhealthy lifestyle choices that
people make.
• Many illnesses are inadequately treated by available medical
advances.
• Many health problems are caused by the treatments that
people undergo for other health problems.
• Many people spend a significant portion of the latter portion
of their lives in a debilitated condition, unable to enjoy
activities they previously enjoyed, and often requiring
assistance for activities of daily living.
• Length of life does not always translate into quality of life.

7. Three biggest killers:
•HEART DISEASE
•CANCER
•STROKE
•All largely
preventable!!!!!

8. Tobacco = BAD

9. Let’s look at the data…
• A sedentary lifestyle is one of the
top risk factors for heart disease
• We’ve known this since the
1960s and multiple studies have
confirmed this finding
• Exercise also reduces obesity
and the incidence of diabetes,
both of which are separate risk
factors for heart disease
• Effects on circulation and
metabolism

10. Let’s look at the data…
• Moderate and high levels of
physical activity are
associated with reduced risk
of total, ischemic, and
hemorrhagic strokes
• 25 to 27% reduction of stroke

11. Let’s look at the data…
• Summary of research by National
Cancer Institute:
• Physical activity is a critical
component of energy balance
(how weight, diet and physical
activity influence health)
• Strong evidence that physical
activity is linked to reduced risk of
colon and breast cancer
• Several studies demonstrate links
between physical activity and
reduced risk of uterine, lung and
prostate cancers

12. Let’s look at the data…
• Regular exercise reduces the risk
of developing lung disease
• Moderate to high levels of regular
physical activity are associated
with reduced lung function decline
and COPD risk among smokers

13. Let’s look at the data…
• Research shows that many of the
changes attributed to aging are
actually caused in large part by
disuse.
• Dallas Bedrest and Training
Study: Healthy 20 year old
volunteers placed on bedrest for
3 weeks developed physical
characteristics of elderly men
• Endurance training regimen
reversed these effects
• 30 years later, when they had
developed age-related physical
changes, exercise training
reversed 100% of the 30-year age-
related decline in aerobic power

14. Let’s look at the data…
• Researchers from the
London School of Economics,
Harvard Medical School
and Stanford University
School of Medicine found in
2013 that exercise was as
effective as medication for
treating diabetes, heart
disease, and stroke

15. Let’s look at the data…
• High intakes of processed meats,
eggs, red meats, and high-fat
dairy products associated with
biomarkers of heart disease risk
• Greater dietary fiber intake is
associated with a lower risk of
both cardiovascular disease and
coronary heart disease
• For both fruit fiber and grain fiber,
risk of heart disease inversely
proportional to intake (the more
you eat, the lower your risk)

16. Let’s look at the data…
• A recent Harvard University
study concluded that eating
five daily servings of fruits
and vegetables can lower
your stroke risk by 30
percent. Citrus fruits and
vegetables such as broccoli
or cauliflower are particularly
beneficial

17. Let’s look at the data…
• Research is discovering that
intake of fruits, vegetables,
and cereal grains may
interfere with the process of
developing cancer of the oral
cavity, larynx, esophagus,
stomach, colon, lung,
prostate, and rectum

18. Let’s look at the data…
• There is also evidence that
total fat intake of greater
than 30 percent of total
calories can increase the risk
of developing some cancers.
This is especially true when
total fat intake includes
saturated fat and possibly
polyunsaturated fat

19. Let’s look at the data…
• Evidence suggests that some
components of food may play a
role in decreasing the risk of
developing cancer, including
phytochemicals, antioxidants,
and omega-3 fatty acids
• These substances are found in
things like fruits and vegetables,
green tea, oily fish, nuts

20. Let’s look at the data…
• The Arthritis Foundation and
other groups and experts
recommend following an
“anti-inflammatory diet” to
reduce arthritis and pain
symptoms
• (In fact, inflammation related
to most disease processes…)

21. Let’s look at the data…
• High stress levels has been
associated with increased
risk of upper respiratory
infections
• Highly stressed individuals
are less likely to respond to
vaccination
• Stressed individuals have
lower levels of natural killer
cells important in preventing
illness

22. Let’s look at the data…
• Studies have shown that
women with breast cancer
who participate in a stress
management program are
about 50% less likely to get
recurrent cancer and about
60% less likely to die of
cancer

23. Exercise, healthy diet, stress reduction
• Human bodies are built for
movement
• Human bodies are built to run on
healthy fuels
• Human bodies are designed to
handle SHORT periods of stress
• Inadequate exercise and improper
nutrition lead to problems with
insulin metabolism
• Problems with insulin metabolism
lead to unchecked inflammation
• Unchecked inflammation causes
most disease processes
• Chronic stress impairs immune
system function
• Newer research also ties chronic
stress to inflammatory pathways

24. So what now?
• Most people know they should eat
better, exercise more but they
don’t
• Most people don’t know about the
link between stress and health and
the need for regular relaxation
practices
• Doctors AND patients find it easier
to prescribe and take pills than to
promote or adopt healthier
lifestyle habits

25. Long-term benefits…
• Our culture has difficulty
making short-term changes
when the benefit is
perceived of as a long way
off
• People think of healthy
eating, regular exercise and
regular stress management
practices as just more stuff
they have to do

26. The default position…

27. Compare and contrast:

28. How do we change behaviors?
• We have to educate our
patients and the public about
the importance of healthy
lifestyle behaviors: Why is
this important?
• Patients need COACHING:
practical, doable steps that
promote confidence and
well-being; encouragement
to build on small successes

29. The coaching model:
• Meet the patients where
they are
• Serve as a role model
• Small steps that are seen as
improvements in life, not
onerous chores
• Individualized programming
• Frequent visits or follow-up
• Teach skills: how to cook
healthy food, how to read a
label, relaxation techniques,
how to use a pedometer

30. Innovative approaches:
• Acupuncture, relaxation
techniques to support
tobacco cessation, weight
loss, stress management
• Yoga, tai chi for exercise
AND relaxation
• Cognitive behavioral therapy,
dialectical behavior therapy,
mindfulness training
• Many others!

31. Epidemic of substance abuse
• As a nation we are massively
over-medicated
• It will take everything we can
muster to to dig the
American public out of the
black hole of over-reliance on
medications

32. On a larger scale:
• We have to serve as role
models for the community
• We have to help develop
systems that make lifestyle
modification counseling and
coaching accessible for
patients and the public
• We have to work toward a
culture that promotes health
instead of illness

33. On a larger scale:
•We have to change
the way health care
occurs for everyone

34. As a nation, we need:
• Non-industrialized food
sources
• Work schedules that allow
people time to exercise,
prepare healthy foods, and
relax
• Opportunities to connect
with others
• Opportunities for spiritual
growth and connection

35. Affordable Care Act
• Moving toward a system in which providers are paid based on
OUTCOMES, rather than just for providing services
• Current difficulty is in getting from present fee-for-service
model to a new paradigm based on outcomes (no road map)
• We can help show them how to do it…

36. Mahatma Ghandi
•“Be the change you
want to see.”