What can Lifestyle Changes do to improve your Health?

---

Transcript

Chrissy Billau:

Welcome to Prescribed Listening from the University of Toledo Medical Center. On this podcast, we interview our experts to get the answers you need and can trust. I'm your host, Chrissy Billau. If you started a New Year's resolution and it has slowly not become a priority anymore, or you're struggling to even set a health goal, we have all been there.

And today, we're talking with psychologist and dietitian Dr. Julie Brennan and independent clinical and sports counselor Dr. Angele McGrady at UTMC about healthy habits to help you reach your body's health goals and how lifestyle changes can impact your overall health. Thank you, Dr. Brennan and Dr. McGrady, for joining me today.

Dr. Julie Brennan:

Thank you so much for having us.

Chrissy Billau:

So let's just jump right in and ask the experts. In some earlier episodes, we had Dr. Kevin Phelps on the podcast and we had a big discussion about lifestyle medicine. So to recap for any new listeners to this episode, would you please tell us what lifestyle medicine is and what we have been doing with it at UTMC?

Dr. Julie Brennan:

Absolutely. We'd love to talk about that. Lifestyle medicine is a medical specialty that uses therapeutic lifestyle changes. It's a primary modality to prevent, treat, reverse chronic diseases, including, but not limited to, cardiovascular disease, type 2 diabetes, obesity. So the main components of lifestyle medicine are, one, it's evidence based; two, it is lifestyle intervention-focused. So we are here to address the underlying causes or root causes of chronic diseases, not just the symptoms.

We've also become part of the ACLM, and that's American College of Lifestyle Medicine Health Systems Council. It's a collaborative learning community of health systems within the United States, and we've been learning from other health systems how to integrate lifestyle medicine and also been able to share what we are doing at UTMC. And so, we are hoping to continue to change our community and our culture here at UT that lifestyle medicine is the primary modality of our care.

Chrissy Billau:

So this is my first dumb question of the day. When you say lifestyle medicine, does it mean no medication?

Dr. Julie Brennan:

No. We want lifestyle medicine to be the primary modality, but medicine is, absolutely, it's a complement to it. We want to be able to be servicing our community with how do you first behave in healthy ways, through food, through sleep, through exercise, through stress management, through avoiding risky substances, all of those, and having positive connections. But certainly, medicine is part of the picture and can be part of the picture, but if it doesn't have to be, in certain cases, that's better.

Chrissy Billau:

I remember my dad always told me like, "Try to avoid taking medications, so try to do a lot of these things right." So when we talk about a lot of these things, what are the pillars of lifestyle medicine?

Dr. Julie Brennan:

So exactly what I just said. It is that whole-food, plant-predominant diet. It's sleep. It's physical activity. It's stress management, avoidance of risky substances, and then most people forget this piece, and that's positive social connections, which is so critical.

Chrissy Billau:

And I think during the pandemic, that became a very big thing that we all paid a little bit more attention to. So I'd like to look at each pillar individually and break things down with any tips you have for each one. So I don't know who wants to take the first one. The first pillar is whole-food, plant-based diet.

Dr. Julie Brennan:

All right.

Chrissy Billau:

You'd like?

Dr. Julie Brennan:

Sure.

Chrissy Billau:

So what are you looking for when it comes to a whole-food, plant-based diet?

Dr. Julie Brennan:

Well, let's break it down. So what is whole food? It is food that has not been processed or refined, so pretty simple there, and plant-based consists of anything that is non-animal-based, right? So we're talking about minimally processed foods, fruits, vegetables, whole grains, nuts, seeds, legumes, herbs, spices, all of that.

Chrissy Billau:

There are some people who might be listening and think, "I really struggle to just eat healthy, and figuring out a meal around being healthy is just simply hard with everything else going on." And you have practices to get to and work to get to and all the things. What would you recommend to help them?

Dr. Julie Brennan:

So big question. So first thing is just appreciate it that it sounds like eating healthier is important to them, which is a great first step. And then we're going to assess like, what do they know about eating healthy? What have they tried? What were the barriers they faced? And what are they ready for? It's important to remember for anyone that no step is too small. So I would want to explore what's the most difficult part of what's going on with what makes it difficult, and then if they have any ideas of what they'd like to do differently.

For some people, it may seem really big to change how one eats in general, and people just don't know where to start. So you've heard of SMART goals before. So, again, thinking about specific, what specifically are you going to do? Measure it. How can you measure a specific goal? Attainable. Is it realistic? Also, relevant. Why are you setting it? This is so important. What is important about this goal? And then timely, making sure that you have some way to be able to create a time perspective on it.

So when we think about this, we might think about adding one more vegetable at dinner. Right? Each day for one week might be one great place to start, or perhaps replacing a dessert with a fruit and doing that again for one week. Others might benefit from starting just with one meal, thinking about a particular meal perhaps that they find that they eat less healthy, so, for instance, breakfast or something, and how they could transform that meal to something more healthy.

So, for instance, maybe they're having two packets of flavored oatmeal with orange juice and thinking about, "How could I just modify that where it's not too much of a difference?" But maybe steel-cut oats and having an orange, or overnight oats to prevent that time in the morning to cook. So this is going to be a small change, but significantly decrease the sugar, increase nutrients, particularly fiber, right? Americans aren't eating enough fiber. We're deficient in fiber, so we always want opportunities to be able to increase our fiber.

Chrissy Billau:

When you say fiber, that is one of the recurring things that we have heard throughout, no matter what specialist we're talking to. It's fiber, fiber, fiber. What is some examples of some fiber that you can throw into your-

Dr. Julie Brennan:

Yeah. So any fruits, vegetables, whole grains, all of that. Right? So you want to put as much of that as possible. Again, we're back to that whole-food, plant-based diet. And if you're eating a whole-food, plant-based diet, you will not be deficient in fiber. Right? So it's getting all of that and adding small pieces, and every piece counts.

So I think it also can be helpful for some people who have low self-efficacy, low confidence on, "How do I eat better?" is to kind of get a sense of what does that look like, and maybe a meal plan or being able to look at, what does a whole-food, plant-based diet look like for breakfast? What would it look like for lunch or snacks, for dinner? Can be very helpful. We want to teach people how to eat healthy. We don't want them to be on this rigid plan, but that can sometimes help them to realize, "Ah, this is how I might do it," and be able to create some recipes that will work for them or their family.

Chrissy Billau:

I remember one thing that helped. I watched my sister-in-law, how she put her plate together. She lives out of town. She put her salad on her main plate, which reduced the size of some of the other stuff. I was like, "That is brilliant." That was life-changing for me.

Dr. Julie Brennan:

That's awesome. Yeah. That's a plate method, right? Half of that plate you want of fruits and veggies. And again, that's going to increase that fiber, a fourth full of those whole grains and then another fourth of that protein, particularly plant-based protein. And we're going to have a great fiber-filled plate if we can do that.

Chrissy Billau:

So what about dietary plans, like vegetarians or vegans and avoiding gluten and lactose?

Dr. Julie Brennan:

Yeah. So there's a lot of confusion about specific diets like that, and some people might confuse vegan or vegetarian with whole-food, plant-based nutrition. I don't know if you've ever heard of junk food vegans, but this is a thing that just because you've taken animal products out of your diet, doesn't mean that you're eating a healthy diet. You can easily get into eating processed or ultra-processed foods that are very unhealthy, and the studies are very clear that eating plant-based, processed, and ultra-processed foods do not benefit you, is the same kind of impact as the American diet, standard American diet. We need to be eating that whole-food, plant-based, and that's why lifestyle medicine focuses on that.

Chrissy Billau:

Food prices, especially as we're still in a season of high inflation at the grocery store. How can you stay on budget without sacrificing, without going to the highly processed stuff?

Dr. Julie Brennan:

Yeah. So food prices certainly are, on average, getting much higher, 10% or more, certain foods a lot more than that, but we can have a win-win at the grocery store by increasing our meatless meals. So if we think about meat and the expense of that and transform that into beans or lentils, you are going to save some bucks, and that is fantastic to be getting that benefit of healthy food as well as in your pocket.

In addition, other things could be eating more frozen vegetables or fruits, which don't go bad, so you're at less risk of wasting, as long as they do not have sauces or other additives, which you would want to check on that label and look at the ingredient list, and also look at the sodium to make sure that there's not higher sodium. Frozen vegetables and fruits can be a really healthy way to go. Of course, you can do those strategies we've all heard of, right? Buy generic, use coupons, buy in bulk when it's appropriate. Certainly, looking at that price tag can be helpful.

Chrissy Billau:

Well, no, this one is kind of a weird one, but how can you tell what plant-based things are worth the hype or the investment in? And for this one, where it comes from, at least from my perspective, is the plant-based meat. When I see that at the grocery store, I'm like, "I don't know what to do here."

Dr. Julie Brennan:

Yeah. So great question. So a lot of the plant-based meats, it's processed or ultra-processed. And if you look at the label and look at the total and particularly saturated fat, you want that saturated fat to be low as possible. So things like the Impossible Burger have just as much total and saturated fat as can be of a beef hamburger. And so, it also contains sodium, and so you want to look at that sodium as well, and some plant-based alternatives do have a higher sodium than you would find actually in meats as well. So you really want to look at that food label, look at that ingredient list, and see what you're actually putting into your body.

Chrissy Billau:

Okay. Yeah.

Dr. Angele McGrady:

One of the things that's important to realize is that you start with small steps. Most people cannot do an entire life change quickly with everything else that they have going on, all their responsibilities, but what they will find is that even a small change will affect their mood and how they feel. So that's the reward. And I think that once somebody experiences feeling better, a little bit of increase in mood, a little bit of improvement in mood, maybe less sad, maybe less anxious, and then I think that motivates them to go further. So I think we really have to emphasize that, that we're really talking about small changes.

Chrissy Billau:

Make it achievable so you're not constantly failing and then quit overall.

Dr. Angele McGrady:

And that is in the SMART goal, but many times, what's recommended is an entire change for the person. And some people can do that, but they really need close supervision. So if somebody has had a cardiovascular event and they meet with a nutritionist, they go to cardiac rehab, and then they're told, "Well, you really need to change your diet." And if the person agrees, they're not going to be able to do it on their own.

So I think we have to define these things as what the person's going to be able to do on their own and what's going to be part of a whole life change program because they've had an event. They've had a situation that is medically... It's a medical necessity for them to make these changes.

Dr. Julie Brennan:

And support is so critical. Support at home, sometimes getting coaching, sometimes getting your doctor obviously involved as well, and also maybe a nutritionist or another healthcare provider.

Chrissy Billau:

Well, and your family too, because, hopefully, they'll go along and do this with you, your kids, your spouse, so you're not in it alone. Yeah.

Dr. Julie Brennan:

Definitely easier when you don't do it alone. There are some times where there can be sabotagers, and it's just good to identify that and be aware of that.

Chrissy Billau:

Okay. All right. We're going to jump to the second pillar. The next pillar of lifestyle medicine is physical activity. Dr. Brennan, what are you looking for in a person's physical activity?

Dr. Julie Brennan:

Yeah. So when we think of what is physical activity, it means all movement, right? During leisure time, transport to and getting from places, a person's work, all of that. And the key is, any physical activity is better than none and has health benefits. So moving more, sitting less is important. And we are finding in studies that that decrease in sedentary behavior is associated with so many positive health outcomes, decreased risk of heart disease, high blood pressure, all-cause mortality.

Chrissy Billau:

And so, you're talking about moving, like just walking from your car to your office or carrying your groceries, things like that. But when we're talking about working out, where that is your sole focus of what you're doing for maybe a half hour or an hour you set up your life, how often should the average person be working out a week?

Dr. Julie Brennan:

Yeah. So there are some recent guidelines for physical activity, and for adults, it is 150 minutes at a minimum to 300 minutes of moderate-intensity physical activity. We can think of moderate-intensity physical activity as like brisk walking. We can think about, you could not sing, but you could carry on a conversation, or you could be engaging in 75 minutes of vigorous activity, where it is difficult to carry on a conversation and sing, and that would be jogging or running or things like that. So that is the aerobic part of the guideline, and then the other piece of the guideline is being able to do some weight-bearing exercises, strength training two times a week as well for adults.

Chrissy Billau:

Okay. Okay. So that 150 to 300 is for a week?

Dr. Julie Brennan:

A week, minimum, and that's a minimum. And there is a piece in that guideline that suggests that 300 minutes may be necessary for weight control for many people and beneficial additional benefits. But the other thing is, I don't want to minimize the importance of the things you were talking about, which is just daily life, increasing your steps, increasing your physical activity, increasing your movement. Right? That matters. It matters. So parking at the end of the other side matters. Yeah. Absolutely. Taking that walk at work every few hours or even every hour to just go to your drinking fountain, go to the bathroom matters. Standing up instead of sitting matters. So any increase in physical activity is important.

Chrissy Billau:

Do you have any tips or suggestions on improving exercise? I know magazines are launched with this question in mind. Any tips or tricks work for you or your patients?

Dr. Julie Brennan:

There are tricks and tips, but no miracle cure. The first thing is, you need to just understand where is your current activity level and how ready are you to increase your physical activity? How important is it to you? So we're talking about a lot of changes here, and we need to say, "What are we ready for?" Right? And finding ways to first maybe how do we reduce sitting behavior. So, again, can you get up from your desk or your couch at home during commercials? Can you take a two-minute walk around the office? Just general activity increases.

I think it's also really important to explore like, what do you like to do if you want to increase your physical activity? We know if you are saying, "I'm going to run. I'm going to train for a 5K," but hate running. It's unlikely to go well, and you're punishing yourself in the meantime. So find something you enjoy doing and figure out if you enjoy doing it alone or maybe you enjoy having a group. Maybe a class is important. Particularly, some people find it to be important to have a goal, like a 5K or some type of bike ride or just to finish something. It can be really helpful to pair physical activity with some other habit that you already have going on in your life.

So, for instance, in the morning, if you think, "Gosh, physical activity in the morning is when I have the most energy," maybe not for some of us, but maybe it is. And so, then you say, "Ah, I'm going to pair that with my coffee. So when I drink coffee, then I'm going to go for a 15-minute walk," or "When I brush my teeth, then I'm going to do some stretches or some yoga moves." Right? And so, being able to pair it with some activity that you already have established is called stacking and can increase our ability to stick with a habit. Right?

It can also be really important to schedule the physical activity. So a lot of us make goals, like, A, an outcome goal. I'm going to be active for 150 minutes, but that's all we go. We don't think about our plan. We don't think of how it's going to happen, when it's going to happen in the day. What are the barriers? And so, being able to spend some time on all of the planning and how behaviorally this is going to look is so important.

Chrissy Billau:

If I set my workout clothes out before I go to bed, I know I will work out in the morning.

Dr. Julie Brennan:

I love that. That's the cue. Right? So we know environment matters, having cues matter, and that's exactly what that is. So, again, cues are very important in behavior change, and I love that you have that. So you see that. It's less of a barrier in the morning, figuring out what you're going to wear. Right? And so, our environment matters. That environment matters for exercise. It also matters for nutrition.

Chrissy Billau:

Well, Dr. McGrady, you want to add to this one?

Dr. Angele McGrady:

Yeah. The assessment of a person's physical activity, I think, needs to be really down-to-earth. The provider needs to recognize what that person's situation actually is, because so often, walk around the neighborhood is recommended, but the person may not feel safe in their neighborhood, or maybe they're working a different shift and the only time they are able to get out might be during the night, and then where are they going to go? So I think you always have to assess the person's actual situation.

And in a practice like family medicine, the physician knows the patient, and that background information is so important before you make any recommendations, particularly for physical activity, where there's going to be really the most barriers. The things that are going to keep a person from being physically active are the neighborhood, the finances, and also whether they feel safe and if they have pain. So if you recommend physical activity to somebody who already has a pain condition, that has to be taken into consideration, and the plan always has to be modified for the individual.

Chrissy Billau:

The next pillar is a biggie, sleep. Now, Dr. McGrady, what are you looking for with a person's sleep?

Dr. Angele McGrady:

Those questions are part of the initial evaluation of a patient in the Department of Psychiatry and many other departments as well. So we ask a number of questions to assess the sleep health of that person. The first one would be hours of sleep. The second one would be, how long does it take you to fall asleep? The third one would be, how many times do you wake up during the night? And the fourth one would be, how do you feel in the morning?

Chrissy Billau:

Yeah. You don't necessarily need all the watches or all the apps. You can just assess how you feel.

Dr. Angele McGrady:

Well, that's the first step, and then you get the data to support that. So if the person says, "Well, it takes me an hour and a half to fall asleep," then that's outside the guidelines. The guidelines state 30 minutes to fall asleep, and then sleep efficiency, what's called sleep efficiency, should be at 90%. So that is the number of hours asleep based on the number of hours in bed.

Chrissy Billau:

Is this how you know how you're struggling with sleep? The overview of how many times you get up?

Dr. Angele McGrady:

Well, sure. You get the data and then you ask the person, "How do you feel in the morning?" And there's lots of different answers to that. So if they say, "Well, yeah. I wake up several times during the night." How do you feel in the morning? "Yeah, I feel pretty good. I feel rested and I'm ready for the day." All right. Then the wake-ups are not going to be a big factor.

Chrissy Billau:

But if somebody is just tired all the time during the day, then that is a big red flag?

Dr. Angele McGrady:

Well, we hear that all the time, but there's many, many different reasons why the person could be tired. Right? So sleep disruption and insufficient sleep is certainly one of the reasons for that, but there will be other indicators. If the person is sleep-deprived, there's going to be other indicators of that, like irritability. It's problems concentrating, not being efficient in your work. All right? Things slow down when you haven't had enough sleep and you won't feel well, and there's also, people become accident-prone.

And with serious sleep disruption, the person may fall asleep when they're not really aware that they've gone to sleep, and this is called a microsleep, and then you're in the danger zone. It's like a 30-second sleep, a 60-second sleep, but the brain will take over if the person is seriously sleep-deprived, pretty much no matter what they're doing.

Chrissy Billau:

Can that happen when you're driving?

Dr. Angele McGrady:

Yes. So one of the very common assessment tools is called the Epworth Sleepiness Scale, and it asks the person to identify when they're most likely to fall asleep. So some of them are very low risk, like, "Oh, you're sitting on the couch. You're watching TV. How likely are you to fall asleep when you're reading a book, you're sitting in class?" And then as you go down the list, then there's one that says, "How likely are you to fall asleep when you're at a stoplight as the driver of the vehicle?" So if the physician sees that that answer is yes, they need to do a further assessment right then and there because they are at risk.

Chrissy Billau:

How much sleep do you really need?

Dr. Angele McGrady:

Okay. So that is a trick question, because you'll read the averages that people, adults between the ages of over 18 up to, let's say, 60, 65 will need eight hours of sleep a night. That's the official recommendation, but that does not apply to everybody. Some people need more sleep than that, depending on their physical condition. Somebody struggling with a medical condition, somebody recovering from an illness, they're going to need more sleep. Lots of folks say that, "I don't need that much sleep. I'm great with six hours. I'm great with five hours." So what the research shows is that there's not that many people that are really good with six hours of sleep.

Chrissy Billau:

I remember when I was pregnant, that was the first time it really hit me of, "I'm going to take all the sleep I want," because I couldn't stay awake anyways. You're exhausted. I was that person who said, "Oh, six hours, I'm fine. I can make it." And not anymore. Never again.

Dr. Angele McGrady:

Yeah. So I think the assessment of sleep is really important and it fits in with all these other things, because there's reasons why people can't fall asleep or why they don't stay asleep. Lots of reasons, caffeine, eating, eating a larger meal just an hour or two before bedtime, and then the safety issue. The person has to feel safe in order to be able to go to sleep. It has to be quiet, and the routine is critical. So often, it's like, "I just got done studying for three hours for my big exam tomorrow. Now I got to go to bed," and they expect that they're going to fall asleep. Well, it's not going to happen.

Chrissy Billau:

So the routine, anything you should be including in your sleep routine or not including?

Dr. Angele McGrady:

Well, the sleep routine can be individualized to each person. Usually say that a half an hour before bedtime, you should start winding down, winding down in time for bed, and then do the same thing every single night. You brush your teeth. You get into your sleepwear, turn off the TV, turn off the phone, turn off the iPad, dim the lights, and they maybe listen to a meditation app. One of the apps is very available, very common. It's called the Calm app, and they actually have sleep stories in there.

So you can download that. And some of them are free, but some of them cost, so I don't want to recommend something that costs. This is just an example of getting that uploaded, and then they kind of tell you a story, and it may be a little wind or sound of a breeze in the background, something that just helps you wind down and be ready for sleep.

Chrissy Billau:

Okay. Did you want to add anything about sleep?

Dr. Julie Brennan:

So I think one of the things that many patients do is, when they are awake in the middle of the night, they think, "Gosh, I got to just go to sleep," and they look at their clock and say, "I'm going to stay here. I'm going to fall asleep," and they stay in bed. And so, one of the myths is, that is what you're supposed to do, is just stay in bed and try to fall asleep. And actually, that often works to the person's disadvantage.

And so, a big strategy that can be very helpful is, once you're agitated in bed or you just have been in bed for 15, 30 minutes, can't fall asleep, it's get up, but get up and do something very boring. Keep the lights low, don't move, and do a meditation. Just like Dr. McGrady said, go on that Calm app or read a book that's really boring. This is not the time to go on Facebook. This is not the time to put your murder mystery movie on or read the murder mystery, but rather do something boring. And then when you feel tired, go back to bed. And you may need to do that a couple times, but that is always going to give you that best response to be able to train your brain that that bed is for sleep and sex. Sleep and sex. That's it.

Chrissy Billau:

The next pillar of lifestyle medicine is stress management. So what are you looking for within a person's stress levels when it comes to lifestyle medicine?

Dr. Angele McGrady:

Well, when we do our assessment of a new patient, there's many questions that relate to this. So there's lots of different types of stress. There is acute stress, which is something that's happening within the past few weeks or a month that is likely to go away and resolve. Then there are chronic stressors, things that the people are dealing with on a daily basis, and this can be a mild chronic stress, can be something that you wouldn't think, "Well, what's the big deal about that?" But when it happens six months in a row, then it starts to have an effect on the person. There are also very severe stressors that will have an impact on the person for a long time.

So how do we assess that? Well, there are questionnaires to assess that, and there's also a lot of information about biology and physiology that will help to provide or assess the level of stress that the person's on, or in rather. So this would be like muscle tension. The physical exam done by the physician then will highlight that. "Oh, gee, we have a lot of tension back here. Gee, can you turn your head from side to side? Do you have headaches? And then how much do you worry? How much do you feel nervous?"

And so often, after that assessment, things will be highlighted, say, "Oh, yes. Well, you're under a lot of stress." Okay. Then what? Okay? So the stress could be located in an area of the body where it's actually starting to do damage. So the person could be a gut responder and have a lot of gastrointestinal symptoms related to stress. They could be a muscle responder, which means that they could have chronic back pain. They could have stiffness. They could have jaw tension. They could have TMJ. They could be a cardiac responder. So all these different types of physiological responders are unique to the individual, and that has to be assessed.

And then there's the psychological part of it, which is the worry, excessive worry. Could be lower mood, could be depression, could be anger responses, could be the person's always mad. So after you do the assessment, well, then what? And so often, it's like, "Well, you have to decrease the stress in your life." And so, the person is left with that. All right? So that's where, again, there needs to be follow-up. "Well, doc, easier said than done. Doc, are you decreasing the stress in your life? You just got done telling me that you don't get home till 8:30 at night and then you're doing notes till 10:00 PM." Yeah. Some of our patients, they ask these questions, and rightfully so. Rightfully so.

Chrissy Billau:

Well, they want to trust you and know that you're giving them advice that you follow.

Dr. Angele McGrady:

Yes. Yes. So it's not possible for most people to decrease the stress in their life. So then what are they going to do? Well, we can help them build skills to decrease the reactions to stress. So learn slow breathing, learn relaxation, learn imagery, learn meditation techniques. And these other things, like physical activity, will also help decrease the stress response. All right? Then there also is medication management, and some people need some help in terms of an antianxiety agent or an antidepressant. So there's nothing wrong with that. All right? That medicine helps them to be able to work through things in therapy.

So if a person is so anxious that their thoughts are continuously rapid thinking, overreactions, and then they try to institute slow breathing, sit still, well, they may not be able to do it. All right? And so, you're better off making recommendation for medication management, and then the medication makes the brain field more adaptable so that they can do these things on their own. All right? And the medication doesn't have to be forever. But certainly, in our patients that we see in psychiatry, most of them are on a medication regimen and they're also doing stress management. They're doing therapy.

Chrissy Billau:

That was the best explanation I've ever heard of. I never understood when people said, "Well, how do you carry your stress?" I never understood the question. I didn't know everybody. It could be in my muscles. It could be in my breathing. I didn't know that, so I thank you.

Dr. Angele McGrady:

All right. You're welcome.

Dr. Julie Brennan:

Do we want to say anything about optimal functioning?

Dr. Angele McGrady:

So I do some work with athletes. I've worked with some college athletes, some high school athletes, and they're always interested in, "How can I be at my best?" Right? And this is also applicable to the person who's not a college athlete or not a professional athlete, but knowing yourself, so awareness, doing an honest self-assessment of where you are, what you need to be at your best. And there's plenty of articles that say that a person needs to sleep to be at their best, and then they can't be over-reactive. Right? So they have to be able to manage their stress, because certainly, competition and trying to be at your best in the office setting or wherever you are requires a lot of energy. And so, it depends what you call it.

Okay? So people call everything stress, but instead, one of the things that Dr. Brennan and I are always emphasizing is that pay attention to your language. So if you want to be at your best, functioning optimally, you need to change your language. So instead of saying, "This is going to be so stressful," so we did that on the way over here. Yeah. I say, "Well, we're going to be on TV." And they say, "No, I don't think so." I say, "Oh, okay." Well, she's like, "I'm glad I'm not on TV." I'm like, "I want to be on TV."

So we modified our language. All right? This is going to be fun. Okay? This is a challenge. This is exciting. We teach our patients to change their language, and that makes a huge difference, because then that person's mind hears that and it puts it in a different box. Right? So instead of putting it into the stress box, it puts it into the, "Oh, okay. Well, I better perk up because this is exciting. I'm going to do my best. I'm going out there in that basketball court and I'm giving it my all."

Chrissy Billau:

Well, the fifth pillar is avoiding risky substances. So, Dr. Brennan, what do you consider a risky substance under lifestyle medicine?

Dr. Julie Brennan:

Yeah. Risky substances are any substances that increase our risk for addiction, injury, accidents, health problems, sleep issues, increased mortality. These could be alcohol, drugs, like tobacco, vaping, opioids, inhaled, ingested substances, but lifestyle medicine typically focuses mostly on the alcohol and the nicotine.

Chrissy Billau:

We'll start with drinks, but how many drinks a week is considered okay?

Dr. Julie Brennan:

So that's an interesting question because it depends. Right? So the World Health Organization published a statement just this year in January that there is no safe amount of alcohol that does not affect our health, and alcohol has been classified for many years as a Group 1 carcinogen by the International Agency of Research on Cancer. Really, in this statement, they recognize that there's really no studies that demonstrate that the potential beneficial effects of alcohol or light drinking on cardiovascular or type 2 diabetes really outweigh the risks of cancer at that same level.

So what is really much more clear is that the more you drink, the more harmful it is, and the less you drink, the safer it is. So in the United States, there are dietary guidelines for Americans, as many people are aware. And so, in those dietary guidelines for 2020-25 years, the guideline states that women are to drink one drink or less per day, and men, two drinks or less per day. 14 for a week for men and seven for women.

Interesting enough, I was in the progression of making these guidelines and following it, and they had decreased it to one for men, and they changed it to two at the end. I'm not sure exactly what that was all about. I did read perhaps because maybe men would not be happy with that, but it was a shift right at the end.

Chrissy Billau:

Well, and it's so interesting, because through the years, they do those studies and they say, "One glass of wine a night. It's good for your heart." And then now, over time, like, "No. No, it's not. Not at all. Don't do it."

Dr. Julie Brennan:

And I think, so some of it is that it may benefit certain people cardiovascularly. But again, when we think of the risk and the benefit profile, it gets to be a little bit more complex of a picture.

Chrissy Billau:

Is nicotine the same? Just avoid it?

Dr. Julie Brennan:

Nicotine is absolutely much more clear. Yeah.

Chrissy Billau:

Yeah. Zero.

Dr. Julie Brennan:

And vaping for sure as well, which is unfortunately rising, especially in that high school adolescent group.

Chrissy Billau:

Well, some people who think they're vaping think they're, "Oh, I'm doing this, but I'm not doing that, so it's better."

Dr. Julie Brennan:

Correct. Right. Not the case for vaping, and we are just in the beginnings of the research for vaping. And so, I would not recommend that for anyone.

Chrissy Billau:

Oh, yeah. No. And it's interesting how a lot of the pillars are connected, because when it comes with alcohol, that impacts-

Dr. Julie Brennan:

Correct.

Chrissy Billau:

... your sleep, like just having to get up to go to the bathroom in the middle of the night, but it's also, your body has to change what it's working on instead of focusing on sleep. So it's interesting how these are all connected too. Positive connections is the last pillar of lifestyle medicine. So what are you looking for here with people's relationships?

Dr. Angele McGrady:

Well, in terms of positive connections, it's very important to assess that when you're first dealing with a patient, because there is a growing body of literature that supports the fact that people who are isolated tend to be loners and they're unhappy loners. Not everybody who is alone is lonely, but some are. But certainly, the research supports the fact that being connected to other people in some ways, in lots of different ways to maintain that connection, to build that connection is very important for physical health.

So we're not only talking about mental health, but also physical health, that people who are isolated, who don't feel that they have anybody to talk to, who, if they were in trouble, wouldn't have anybody to call, if they needed a ride somewhere, they wouldn't know where to go, who to ask. So there's certainly a relationship between that kind of isolation and physical and emotional health.

So most often, as people get older, they start to lose friends. Okay? Now, they lose friends in different ways. Their friends can move out of town. So the person that they were walking with three times a week says, "We're thinking about moving to Florida," or there's illness or there's death. The kids move away. Right? And so, mom and dad see that their world is shrinking.

So that's a question I commonly ask patients when we get into this topic. I said, "Well, at this stage of life, now, you retired a year ago. You retired two years ago. Do you feel that your world has shrunk or has your world expanded?" And some of them say, "Well, I go to the senior center. I got hooked up with some things at the library. I do some volunteer work. I'm in a walking group." Right? So connecting those pillars, and others will say, "My world has shrunk. Definitely, my world has shrunk. The neighbors moved away."

And so, then they say, "Well, there's nothing I can do about that. My friends are sick, and I can't go walking anymore because I don't want to go by myself." And so, that's where the provider really has to be creative and really try to empower that person, first really by presenting the evidence. People respond to that. Say, "Well, did you know that social connections are related to your physical health?" "No, I didn't really know that." "Well, it is, and here's an article that you can read or here's a website that you can go to." And then say, "Well, how can we make that happen? How can I help you make that happen?"

Chrissy Billau:

Is this a case where quality over quantity can apply when it comes to friends? As long as you have two people, you might be okay?

Dr. Angele McGrady:

Two close friends, two people that you can really talk to just about anything, yes. But there's also, according to the literature, it's like, even the casual relationships, people that you might see at the senior center once a week, that's at least something. So talking to other people and kind of feeling like, "I belong someplace." It's more than social connections. It's this sense of belonging, because people that retire after many years, that job was part of their identity, and sometimes a really big part of our identity.

And we see a lot of people who come to psychiatry with various symptoms, "I'm very anxious," or "I became depressed." Well, when did it start? "Well, I retired and these are supposed to be the golden years, but the golden years aren't so golden." And so, trying to help them make that transition and to develop some of their sense of belonging.

Chrissy Billau:

Okay. So we're going to now move to the point... We're beyond the pillars. We've gone through all the pillars. Dr. Brennan, Dr. McGrady, we ask all of our podcast guests the same question, so we're going to do that for you. What is the most common question you get from patients and what is your answer? We'll start with you, Dr. Brennan.

Dr. Julie Brennan:

So often, I hear patients say, "How do I lose weight?" That's thick. And so, of course, your BMI can be important, but it's really beyond that. And so, when a patient asks me that question, we talk about what's underneath that, and that's really important. I want to hear that. And we don't necessarily push that goal aside, but we look at, what's the most relevant goal right now here? And let's look at not only that as an outcome goal, but we need to say, "What's a process goal? How are you going to get there? What's the behaviors? What's important that's going to matter in your life? And what do we have control over and focus?" Because there's a lot of factors, so many factors, that affect our weight, sometimes we don't have control over.

And so, what are those behaviors that we do have control of that even if that weight didn't go down, you're going to benefit your health in so many different ways? The other piece is that a lot of people get ultra-focused on that weight and then think, "Gosh, I set a goal to lose 15 pounds and it's not happening, and I'm a failure, and I'm just not trying anymore." And so, really being able to notice what you say to yourself matters, and that a lot of times, I might say, "So I'm wondering, what have you done to work on improving your health, losing weight?" And they're like, "Ah, not much." And it's like, "Well, wait a second. If you don't put any time into it, it's not just going to happen."

And people can get so hard on themselves thinking that they're a failure when they're like, "Oh, shucks, that's right. I didn't really have a great plan. Oh, shucks, I didn't put a lot of time." So we'll use an example of, if you want to get better at basketball, thinking about, "I'm just going to be an awesome basketball player. I'm just going to do it." And even imagining that is not getting you better at basketball, right? You have to have a plan. You have to say, "I'm going to do that work. I'm going to practice." And it's hard work, right? But really being kind to yourself about that, looking at the full picture, not just getting ultra-focused on something and focusing on those processes and behavioral goals.

Chrissy Billau:

Okay. And, Dr. McGrady, what is the most common question you get from patients and what is your answer?

Dr. Angele McGrady:

Okay. I think I'm going to pick two.

Chrissy Billau:

Okay.

Dr. Angele McGrady:

The first one would be, "How do I get rid of my stress?" Okay? And then my answer is, "Well, we have to assess what's going on. What are the sources of stress?" And then, "Yes, I can help you not get rid of your stress, but cope with your stress more efficiently by building skills." Second most common question is, "You mean that learning how to breathe is going to help me get rid of my headaches or it's going to lower my blood pressure?" to which I say, "Yes. Learning how to relax will help you get rid of your headaches," assuming that they are nonorganic, because these things are not cures, but learning how to slow-breathe, learning relaxation techniques decreases the tension in the body, and most tension headaches are related to tension in the body.

And so, the person is reacting to stress by tensing up, getting ready to react in the primitive, prehistoric way. All right? Most of our stress these days is mental stress. It's not physical stress, but yet the body responds in exactly the same way because that's how we're wired, and that part is never going to go away, because we need it in case something drastic happens and we do have to run, fight, and so forth.

Chrissy Billau:

Mm-hmm. Okay. Well, thank you. How can people schedule an appointment with your offices?

Dr. Julie Brennan:

So in Family Medicine, you can call 419-383-5555 to schedule an appointment with our primary care, family medicine physicians. And in that, you would just want a new appointment, and some of this lifestyle medicine will definitely come up.

Chrissy Billau:

Great.

Dr. Julie Brennan:

All right.

Dr. Angele McGrady:

And for the Department of Psychiatry, the main number is 419-383-5695. So the intake person there will ask the person what are they specifically looking for. Some are looking for stress management. Some are looking for therapy. Some are looking for medication management. So they'll be asked those questions. And then if they're looking for stress management or psychotherapy, then within that context, these lifestyle issues will all come up.

Chrissy Billau:

Okay. All right. Well, thank you, Dr. McGrady and Dr. Brennan, for answering all of my questions today, and that's all for this episode of Prescribed Listening. Tune in next time and subscribe for more on Apple Podcasts and Spotify.