Optimizing your sleep is one of the most important actions you can  take right now to improve your overall health, wellbeing and potential longevity.

What good sleep looks like?

We are learning more and more just how critical good consistent sleep really is for our health and wellbeing.    Sleep is absolutely fundamental for the proper functioning of all our physiologic systems.  It is the necessary reset, reboot, cleaning, maintenance and repair that our brain and body needs every day. All life on earth evolved to optimize function around the 24-hr day – night cycle.  This circadian rhythm is the rhythm of life.  The more that we are out of sync with our natural circadian rhythms, the more problems begin to show up (circadian dys-synchrony).  This new science called chronobiology has linked increased risk for diseases that impact the central nervous system, reproductive systems, metabolism, cardiovascular and endocrine functions to circadian disruption.

There 4 pillars of good sleep are: regularity, continuity, quantity and quality.  What defines the parameters for good sleep for one individual can be different than another but there are some general guide posts.  The following are characteristics of good sleep:  You can fall asleep without difficulty in less than 30 minutes.  You do not awaken more than once during the night and you can fall back asleep in less than 20 minutes.  You wake up feeling refreshed and energized, physically and psychologically and perform well throughout the day. Consistent sleep times and awakening times do seem to matter as our systems work better when there is a routine.  Research studies have found that optimal sleep quantity ranges from 7 – 9 hours.  However, the quality of sleep is as important if not more important than the quantity.  Sleep is a complex physiologic process where our brain cycles every 90 minutes  through REM and Non-REM stages.  You should spend roughly 75 percent of your night in non-REM sleep and 25 %in REM sleep.  Of this, approximately 25% of the total sleep should be in deep sleep.

 

Why sleep  matter’s to women’s’ health, well-being and longevity?

Regardless of sex, consistent, good quality of sleep over the course of one’s lifespan is a major protective factor in reducing the risk of many chronic diseases of aging including heart disease, metabolic conditions such as diabetes, neurodegenerative brain disorders including Alzheimers, depression and anxiety, as well as some forms of cancer including breast cancer. Good sleep is key to emotional well-being, healthy metabolism and weight, balanced hormones, optimal cognitive performance and optimal immune system function.

There have been a number of studies have suggested that women may be slightly more susceptible to and effected by circadian disruption.   Insomnia is reported at nearly twice the rate in women compared to men. This is invariably due to sex differences in hormones and how they change dynamically through a woman’s life.   There is substantial evidence of associations between circadian rhythm disorders and reproductive health  in female shift workers.  A 2014 meta-analysis of 15 studies with more than 100, 000 women subjects  found that shift workers had an 11% increase in infertility and a 16% increase in menstrual irregularities.[1]  Sleep disturbances during peri-menopause and menopause are common and are partially due to reduced levels of hormones like estrogen and progesterone which have sleep protective benefits.  However, the age-related decrease in melatonin is also a factor.  Additionally, it has been observed that a reduction in melatonin levels in women is associated with an increased risk of breast cancer. Night shift work appears to increase this risk possibly due to the melatonin suppression.

The key to longevity or more importantly “healthspan “which is defined by the number of years of life in good health is to avoid or to delay the onset of the major chronic diseases of aging.  These include the big four:  cardiovascular disease (heart attacks and strokes), disturbed metabolism (diabetes), neurodegenerative brain disorders (Alzheimers) and cancer.  The  root mechanisms for all of these conditions include a chronic inflammatory response, elevated sympathetic nervous system tone (stress response), impaired glucose metabolism (insulin resistance), oxidative stress. Impaired immune response and hormonal imbalances. Sleep is vital to regulation of these key physiologic processes.

If you want to live longer and healthier, make sleep a number one priority in your life.

 

Optimal sleep is non-negotiable in terms of overall health and well-being.

 

 

 

[1] Stocker LJ, Macklon NS, Cheong YC, Bewley SJ. Influence of shift work on early reproductive outcomes: a systematic review and meta-analysis. Obstet Gynecol. 2014; 124(1): 99-110. doi: 10.1097/AOG.0000000000000321[5]

 

Life on earth has survived through billions of years because of its ability to adapt to changes.  All living things today are the product of this evolutionary intelligence.  We wouldn’t be here reading this article if we didn’t have resilience engineered into our DNA. We are in fact wired to survive!

What is the definition of resilience?

Resilience can be defined as a process of adapting well in the face of adversity, trauma, threats, stress…

Resilience is a dynamic process and not a fixed trait.  Resilience is more a capacity and skill which we can continuously learn to build and grow – like a muscle.  It is an emergent property that arises from the complex interplay between your genes and environment over the course of your entire life span.  Your ability to deal with a current stressor depends on your capacity to respond (physical to psychological) which in turn is dependent on how you have learned to respond in the past to challenges.  These challenges can include anything from injury to infections, toxins, chronic stress – physical and emotional.  We can become more resilient as our systems learn to adapt to stressors over time as long as we able to continue to maintain a physiologic (homeostasis) and nervous system balance. We can learn to be resilient.

Stress is our lives is not inherently good or bad.  I have always liked this quote by Adyashanti, “Stress is what happens between the ears…everything else is just a situation”.  A stressful event doesn’t necessarily have to mean distress.  Distress is what causes a chronic unregulated flight or fright (sympathetic) nervous system state than can lead to negative health impacts.

Stress can actually be good for you.  Good stress which has been called ‘eustress” is an opportunity for growth and increasing resilience.  Hormesis is a physiologic concept that certain amounts of stress causes a favourable biologic response (exercise, fasting  are some examples).   Part of being resilient is not automatically equating a stressor as being bad and to recognize that how we perceive the stressor is critical. We have no control over most external events in our lives, but we do have much more control over the perception of these events than we think.

Why is resilience important?

Physical resilience means that you can withstand environmental stressors, threats, infections, recover quickly from injury and illness and continue to maintain normal functioning.  Emotional resilience allows you to recover in a positive way to set-backs, challenges and stresses.

Resilience on a body system level means that our cells, tissues and organ systems can maintain homeostasis when subject to changes in environment. Homeostasis is from the Greek roots “stable” and “same”.   A resilient living system is a system that can obtain all the necessary inputs for survival, maintain core physiological systems, be able to sense and appropriately respond to threats, repair damage and restore function and balance.

The levers that we can use to modulate these functions include our key lifestyle factors.  Our bodies ability to obtain nutrient rich, ideally chemically free whole foods, properly digest, absorb (digestion) and to utilize these key nutrients to drive our biochemistry is vital for growth, repair and cellular functioning.   Adequate sleep (7 – 8 hrs consistently) is non-negotiable in this regard as well.  Regular exercise which includes aerobic, resistance and stretching is key to a resilient physical body to maintain functional movement as well as optimizing our metabolism.  Given that our nervous system is what controls everything in our bodies, our ability to self-regulate our nervous system (distress tolerance) is a critical piece to being resilient.  Modern neuroscience is beginning to show us the power of awareness coupled with learned practices such as meditation, yoga, breath work etc. in terms of keeping a balanced and resilient nervous system.

A resilient body forms the basis of a resilient mind but this relationship is likely bi-directional.  A resilient mind is one that is flexible, adaptive, compassionate and integrated.  How we think and how we direct our attention has the power to create our awareness, consciousness and neural connections.  Once again, these are skills that we learn, practice, develop, reinforce and continually refine over time.

Ultimately, resilience is not just an individual attribute but an ecological/cultural construct.  Our resilience as an individual is inter-dependent of our social/community and ecological networks. We are not separate from each other or the planet and the recognition of this is key to our resilience as individuals and our survival as a species.

Resilience comes from deep inside us and from the support around us. It is a capacity that we can develop and nurture.  We can grow stronger, resist infections, heal from trauma, be more loving, compassionate, be more connected and find greater depth of meaning and appreciation in our lives through the challenges and adversities that find us along our journey.

 

Part One:  An Integrative perspective of Healthy Immunity

The function of the immune system to protect the organism from potential threats.  These threats can be external infectious agents such as pathogenic bacteria, viruses, other micro-organisms but also include environmental toxins and chemicals.  The immune system also provides a surveillance function to keep in check any cells replicating out of control which could lead to cancer and also helps to remove damaged cells that no longer function properly.   The immune system has a complicated  task of continually needing to evaluate whether a given molecule out of thousands of different molecular shapes is truly a threat or not. This speaks to the need for discernment on all levels – molecular to whole person.

The immune system needs to be sensitive, detective and defensive but also needs to know when to be tolerant of its own self tissues.  Healthy immunity is an internally regulated, balanced system that responds appropriately to the level of threat.  A deficient immune system will not be able to defend against an infection but on the other side, an excessive immune response can lead to allergy as well as an attack on own tissue (autoimmunity).

Immune responses need to be tightly controlled and actively resolved.  If not, an initially adaptive acute inflammatory (healing) response can turn into a chronic inflammatory response which causes tissue damage and can lead to disease. This leads to the strategy of decreasing the total inflammatory load on the body to allow the mechanisms of self-regulation to function properly.

The state of readiness and balance of one’s own immune system at a given point in time is a function of many factors which span through someone’s entire life-course.  Early factors including mode of delivery (C-section vs normal vaginal birth), breastfeeding, early antibiotic exposures, food and toxins can have significant effects on a child’s microbiome which appears to be involved with immune system programming and tolerance.

There exists a significant body of  research which has connected imbalances in gut microbiome, gut mucosal inflammation and increased intestinal permeability with an increased risk of immune dysregulation.  These imbalances may be the result of foods that can cause inflammation as well as on-going exposure of environmental toxins, chemicals, pathogens and possibly increased psychological/emotional stress.  The gut contains a large amount of our immune system cells.  This makes sense as out gut represents a large surface area in contact with the “outside” world.  This is our border, our interface which must be defended.  This is why gut health is a major key to healthy immunity.  This topic will be explored in further posts.

Healthy immunity is also restorative.  The immune helps to repair damaged tissues that results from injury or adversarial encounters.

Healthy immunity is tolerant. The system needs to be actively unresponsive to self antigens (own tissue), innocuous microbial, food and environmental antigens. An over-loaded system is more likely to lose tolerance and become dysregulated.  Anything that is a potential threat to the organism can increase this total stress load on the system.

Healthy immunity is ultimately about balance and can be significantly influenced by environmental / lifestyle factors including diet/nutrients, sleep, exercise, stress resilience and social connection.  We have much more influence on modulating our immune system than we think.

Finally, the science of psychoneuroimmunology has been elucidating the powerful connection between our psychological mind states, neurologic function and our immune system.  So, perhaps, how we “see” the world and how we interpret/perceive the signals we receive (threat vs non-threat) determines how we respond to the world and in turn influences how our immune system responds.

 

Any crisis presents a perfect opportunity to examine the nature of our mind.  Where is our attention going?  Are we ruminating on the latest news of COVID 19, not in any productive way but just becoming worried and anxious.  Are we being present and aware of  what is actually happening right now? The quality of our consciousness from one moment to the next is really what determines the quality of our experience.

I am sharing this from my perspective as a front-line ER doctor who is preparing for a potential tsunami of sick COVID patients here in Vancouver, Canada. In the past few weeks, I have found myself having trouble balancing the need to stay informed on all things related to the outbreak both from a professional and personal standpoint and being in the present moment.  This really hit me the other day as I was intensely reviewing case reports of severe cases in Italy and becoming more and more anxious but drawn to look outside the window by the sound of birdsong.  When I looked outside, the sun was shining, the sky was blue and birds were signing carefree just as any other amazing day.  The juxtaposition of the impending doom of what I was reading (experience in my head/thoughts) versus what was true in this present moment (warm sun shining through the window etc.) was remarkable.  Fortunately, I  was able to shift my attention and re-direct my experience.  I have been reflecting on the idea that we do always have the choice on how we direct our attention as long as we are reasonably aware of the tendencies of our own minds.  It is no doubt much more challenging when we are facing an unknown challenge, drowning in reports and sensationalized news bites that are delivered with ever increasing velocity to our devices non-stop.  This is why, during these times, it is even more important to be deliberate in developing tools and practices to focus our attention, regulate our nervous system and be empowered to determine the quality of our moment to moment experience.

Self-isolation, closure of all our usual entertainment options (restaurants, bars, gyms etc) is a real challenge for all of us who are so used to being productive, active, “busy”, occupied and distracted.  I am beginning to see how this is a gift in many ways beyond the benefits of “flattening the curve” of the pandemic.  What do we do with ourselves when our usual distractions and activities are removed?  Are we bored, miserable, irritable with our partners and family whom we have been forced to spend all day with now?  Are we afraid of our own thoughts?  Fortunately, the internet is still working and we still have endless options of distractions available to us at a single click.  The question is, can we take this opportunity to slow down, to be more mindful, to be more present?  I recall the stories from New York city when they had a prolonged power outage, when many New Yorkers recall this period  as a special time when they could  spend hours just talking with friends by candlelight or looking at the stars.  In a world of so many distractions, noise; retreat – either self-imposed or forced (like now) can be an invitation to being more present, embodied and having a deeper experience of who we are.

This is where meditation is one of the best tools for becoming more aware of the quality of our thoughts and regulating our nervous system.  It is pretty clear that our mind states have profound implications on all of our body system functions including our immune system.  A chronic stress response increases the chances that our immune system can become dysregulated (either under active – increasing susceptibility to infections or over-active – increasing risk of autoimmunity, allergy etc.).  This is why regulating our nervous system is so very important in the face maintaining a good defence system against infectious threats.

Social connection is also vitally important.  Although we are in the need to be physically self-isolating right now, we should do everything we can to connect with our family, friends, our community through technology.  We can still be outside connecting with nature while maintaining physical social distance.  I say physical social distance because in these times, we have the opportunity and need to be actually becoming closer together.

There are lots of amazing meditation apps (Waking Up, Headspace, 10% Happier), online videos, books etc. that can help us get started.  I try to find 20 minutes in the morning to “set-up” where my attention/consciousness lies as well as anchor the baseline of my nervous system before things get busy.  Ideally, I do the same thing before bed.

I will be going into the ER tomorrow for a shift.  I won’t lie, I have some anxieties about whether I will see a sick COVID19 patient who is crashing and who needs intubation.  Will I be able to save this person’s life, will I remember all the complicated steps of doning an doffing personal protective equipment, will be at risk of bringing something home to my family?  How do I deal with this uncertainty and risk which seems ever more present now?

The best thing I can do for myself and for patients apart from being prepared from a technical medical standpoint is to ground myself, be present, regulate my nervous system so that I am prepared to deal with what ever it is that I need to deal with tomorrow. At some point, we can only prepare as much as we can and just do the best we can.   Right now – the sun is shining and the birds are singing.

In health

Lawrence Cheng

 

Longevity is the big buzzword these days.  There is no end to humanity’s search for the magic elixir of prolonged life or even immortality.  With the continuing discoveries and exponential growth of life science technologies and fuelled by increasing computing power, we are hurtling headlong into the unknown of cracking the code of aging and death.  This is certainly not a bad thing but we do need to take pause and to ask the question of what is the point of life extension if  we are not living well, at our highest level of vitality!

What is health span?  Its difficult to define as everyone’s definition of health is not necessarily the same.  We can safely say that it is the period of one’s life that is free from any serious disease or debilitating illness that impacts our daily living. Its important to note that although we have made significant gains in life expectancy over the past century, we have not been that successful in delaying the onset of most of the common diseases of aging.  This means that although we are living longer, we living longer with disease.  In order for us to be truly compressing morbidity or increasing our relative amount of health span we are going to have to “delay” the physiologic aspects of aging.  This is going to require both major scientific breakthroughs but more importantly, implementing what we already know is true – which is that improving lifestyles, behaviours, communities and socioeconomic determinants of health can significantly increase both lifespan and healthspan.  Its easy to lose sight of the fundamentals in favour of new technology which we hope will save us.  This is shortsighted.  People are not living to their highest health or life potential not because they are lacking a pharmaceutical wonder drug (or natural  supplement for that matter) that slows down or turns off the aging process but because we haven’t optimized environmental conditions (internal and external) which allows optimal health to be the emergent property.

There are many determinants for what one would call health span.  In order to live well at our highest vitality, free of disease ideally, we need a body, a mind,  that has the functional capacity to do what we want it do – free of pain, but also a good level of stress resilience (to deal with what life has in store for us), sense of purpose and meaning, love and connection.  It is very difficult to live with a good quality of life without optimizing all those factors. This is the foundation.

To increase our health span relative to our lifespan we then need to delay the onset of the diseases of aging.  We are understanding much more about the molecular basis of lifespan and there is growing evidence that dietary nutrients (kind, quality and amount), caloric restriction/intermittent fasting, exercise and pharmacologic interventions  (metformin, rapamycin)  seem to be able to modulate key pathways involved in nutrient sensing (AMPK, mTOR), autophagy (cellular renewal), inflammation and senescence (cell death). Much of this science is very promising but still very new. Only time will tell.

I would say ultimately though, it is not about a longer lifespan or even health span that really matter but about living well in full vitality with a sense of purpose, love and connection.  This is what we call Whole human health.  Health ultimately is about wholeness at the deepest level – not just a perfectly functioning body and mind. This wholeness emerges from integration.   We have to integrate all these levels – from cellular biochemistry to the biologic networks of organ systems, to the way we perceive and process information, to the way we respond to our environment (consciously and unconsciously), to our relationship to ourselves, to the connection with others and to nature.  It all starts with awareness.

Join Dr. Christie and myself for a deep dive into these questions of what is true health and wellness as well as reviewing the latest scientific evidence for how we can live optimally well during our upcoming retreat Whole Human Health at the Hollyhock Retreat Centre on Cortes Island this September.

 

https://hollyhock.ca/p/919/whole-human-health-functional-medicine-2-0/

 

Ultimately, what is health?

The WHO (World Health Organization) defines it as the following:

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”

Health is not merely the absence of disease.  It is a positive asset that enables us to fulfill our human potential.  Without health – it is hard for us to reach the higher levels of Maslow’s hierarchy of needs.  It is the foundation of the pyramid upon which everything is built upon.

Health is wholeness – integrated at every level – from a cellular to whole being.  What constitutes cellular “well-being one might ask?  The cell is our basic unit of function.  It is actually like a computer that is constantly waiting for inputs/information.  Based on the information it receives, it responds by translating the DNA, making proteins, enzymes and other molecules to maintain homeostasis (balance).  The cell is constantly sensing and responding to the environment.  What happens at the cellular level happens at every level of the organism from a tissue, organ, organ system and finally whole person level.

So health is the ability to appropriately sense changes in the environment and make adaptive changes.  The ability for an organism to self-regulate is essential not only to survive but to thrive!  Sensing on every level is dependent on being able to have sufficient balanced sensitivity and being able to interpret/discern the message/information.  Too little sensitivity means that we will fail to pick up signals that might be important and too much sensitivity can result in over stimulation and usually increasing resistance.  This happens at the receptors within the cell, on the cell surface membrane, organ system sensing systems (for carbon dioxide, blood oxygen levels, blood glucose etc.) to nervous system (our senses), our immune system and how we process information from a psychological level as well.  What information, what messages are we inputting into our cellular computer, nervous system, whole person?  Are we conscious about the quality of this information that we expose ourselves to and the resultant downstream effects?

How do we balance our sensitivity set point so that we can pick up the signals from the noise but not be overwhelmed by the noise.  This is where the practices of mindfulness, meditation, yoga, Tai chi, Qi gong of the Eastern Wisdom traditions have much to teach us.  In this world of too much information,  too much sensory overload, being on-line all the time – our nervous systems are losing the ability to be sensitive and discerning at the same time.  This ‘noise’ is causing illness.  We need to balance this by consciously choosing to create space, to subtract, to distill, to edit what is truly important, to quiet down the mind/body noise to that we can connect to something deeper.

The science of epigenetics tells us that our phenotype (which is the observable composite of physical characteristics) is determined by the interaction between our genes and the environment.  What this tells us is that how we live each and every day – what we eat, how we move, how we sleep, ow we perceive the world affects our biochemistry at a DNA level.  The foundations of health need to address all of these.  Lifestyle medicine should always be the first treatment before any drugs or surgeries unless it is an acute illness that requires prompt intervention.  Precision medicine using “omic” molecular technologies (genomics, proteomics, metabolomics, microbiome) will help us understand our biochemistry and physiology like never before and promises truly personalized medicine. But this will not necessarily give you optimal, vital, radiant, exuberant health which is what we all want!

Health is much more than an optimal physiologic state.  Beyond the bottom part of the pyramid, we need safety, social connection, confidence, achievement and self-actualization.  Fundamental to this development is deep sense of knowing oneself and a radical self -acceptance of who we really are and the ability to compassionately observe our patterns of behavior, self-delusion and escape.  A recognition that we are already whole.  We are not broken.  Discomfort, illness, pain are pathways to lead us to observe and learn and ultimately to become more integrated selves.

Whole Human Health is firstly about recognizing our own innate radiant essence and our own innate body intelligence/wisdom.  These core beliefs than translate and manifest as our behaviors.  We cannot sustainably change behaviours without transforming the underlying core beliefs. The journey to health is all of this…

Health is about being in touch with this essence of being a human being.

Please join Dr. Christie and myself on an experiential journey of whole person health at Hollyhock in September 2019.

For more details: https://hollyhock.ca/programinfo/cheng-christie/

 

There is a revolution that is underfoot that is going to change how we understand our bodies, approach our health and how medicine will be practiced.

This coming revolution is being powered by a super-convergence of technology and empowered consumers.  Advances in biotechnology now allows us to sequence your genome in a few hours, analyze hundreds of proteins and metabolites from a drop of blood.  We can even describe the ecology of your of poop!  Coupling this with the exponential increases in computing power, data storage and wearable devices which can now measure real time physiologic variables and you have a convergence of technologies which are going to change medicine.

Precision Medicine is “an emerging approach for disease treatment and prevention that takes into account individual variability in genes, environment and lifestyle for each person” (https://ghr.nlm.nih.gov/primer/precisionmedicine/definition).  This is in contrast with the current  paradigm of “one-size-fits-all approach”.  We know now that every one is biochemically unique.  We need to move from medicine of the average to medicine for the individual.  Within each individual there are thousands of genetic and metabolic variations.  We are all mutants, outliers in some aspect.  This is actually good for the most part because because many of these mutations may confer some of biologic survival advantage.

 

“Medicine is for real people.  Statistical humans are of little interest” – Dr. Roger Williams.

The molecular you is the sum total of all the molecules in your body and how they interact with each other.  As we begin to map these out, we are essentially writing an operator’s manual for our body which as it turns out we never got.

The omic technologies of genomics, proteonomics, metabolomics and microbiomics are the foundations of understanding the molecular you.  Genomics is the study of our DNA – our blueprint you might say.  Proteonomics is the study of proteins that have been made from the translation of DNA.  We can now measure hundreds of proteins at once using mass spectrometry.  The complete array of proteins at a given point in time is a snapshot of how your DNA is being translated. Metabolomics is the science of the unique chemical fingerprints of cellular processes.  The power is in the combination of this multi-layered data set.  We have decoded the human genome a while ago now and it did not herald a massive transformation in healthcare.  The reason is because the DNA is only the blueprint.  It doesn’t tell us what is actually built or translated.

What is the promise of all of this information? It will tell us what diseases are you more at risk for and what we can do minimize our risk.  It will tell us how to correct imbalances before they manifest into disease.  It will tell us what medicines to take and which ones not to take.  It will tell us what we individually should eat or not eat.  It will tell us if certain lifestyle changes are changing our biochemistry or not.

Most of our current lab testing measures only a few markers that usually can only indicate disease when it is clinically evident (obvious symptoms).  Most chronic diseases which represents the biggest burden of illness certainly in the developed world have a long latency period.  It often takes many years from initiation of a condition before it manifests into obvious symptoms and detectable disease.  For example, atherosclerosis (hardening of the arteries which leads to heart disease and stroke) starts 10 – 20 years before someone has any symptoms.  The promise of molecular testing is that we can begin to detect patterns of system imbalances many years before and this will give us a head start to correct them.  If we are able to correct the imbalances far enough ahead, we may be able to avert getting the disease all together.  This is upstream medicine rather than downstream medicine when we treat disease at its end manifestations.

However, it is early days yet for this technology.  We have much to learn about how significant a particular molecular pattern or signature might be and what specifically we can do to change it.  We will need enough data from enough people to pick up the signals from the molecular noise.  For diagnosis, we will need ensure that the test is sensitive and specific enough to rule in or out disease without having too many false positive or falsely negative tests that will create anxiety and unnecessary testing, interventions and possible harm.

Ultimately, the ability to understand our bodies and mind at a molecular level is going to empower us to make better and better decisions about our health than we ever have been able to until now.  But the totality of a human being is much greater than the sum total of our measured molecules.  So, in order for this technology to truly transform our health, we will need to be able to translate molecular data into real actionable insights and to combine this with conscious awareness and a deep understanding of our inter-connectivity.

For more information about molecular testing:

http://www.molecularyou.com

 

Medicine is undergoing a major paradigm shift from a reactive, organ based diagnosis and disease management system to an engaged, proactive, molecular based systems approach.  This is being called “4P Medicine: Personalized, Predictive Preventive, Preventive and Participatory.
This new medicine is emerging from the rapidly growing new science of systems biology including the study and application of genomics, proteomics, metabolomics and the microbiome.
The super-convergence of  “omics”, new computational tools and an increasingly engaged and knowledgeable population who are using ever more sophisticated biometric tracking devices and learning from each other through social networks is fueling this revolution.

The promise of the new “omic” technology is nothing short of ushering in a whole scale revolution in medicine.  If you really think about it, we don’t really understand the underlying mechanism for many common diseases.  Take hypertension, diabetes, asthma, Alzheimer’s etc., do we really understand the underlying pathophysiologic mechanisms that are in play in a given individual?  Why does one person manifest a disease at a particular point in time and another not?  We are beginning to understand that it is the complex interactions between your genes and the environment that leads to a certain set of biochemistry/physiology which then translates to a given expression of functioning (phenotype).  This phenotype changes with changes in the environment (epigenetic influences).  Dr. Jeffrey Bland writes about this eloquently in his latest book “The Disease Delusion”.

You change your environment (which includes the sum total of what your mind/body/spirit is exposed to) and you change your DNA expression which changes who you are!

Using “omic” technology we are going to be able to better understand this complex gene-environment interaction as never before.  The ability to analyze your DNA for your genetic tendencies plus the resulting protein expression and downstream arrays of hundreds of metabolites, including an understanding how your micro biome (ecology of gut bacteria) might be influencing all this – will begin to give us a picture of what is really going on in a given individual.  This will in turn give us a better chance of correcting these imbalances at a root level to achieve more like what a cure is rather than symptom management.

We tend to have a never-ending fascination with technology (there is nothing wrong with this at all) but we should be wary about continuing down the reductionist rabbit hole and to not forget that the total is much greater than the sum of the different parts.  Even if we think we can measure everything there is to know about a human being, there will be infinitely more that we cannot quantify in terms or numbers, base codes of DNA etc.

What we need is a vision of the Future of Medicine that includes a balanced view of the new technology but calls us to remember that the “molecular/digital you” is not and never will be the same as the “human you”.  An integrative view includes an ecological whole person approach that understands that our health is not separate from anyone or anything else, but is part of an interconnected, interdependent web of relationships between all of us and our biosphere.

 

I will be speaking at next Integrative Health Care Symposium in Toronto on this topic:

http://www.ihsymposium.com/canada/session/the-future-of-medicine-an-integrative-4p-medicine/

The World Health Organization estimates that by between 2000 and 2050, the world’s population over 60 years of age will double from 11% to 22%.  This amounts to an increase from 605 million to 2 billion persons over the age of 60.

We as a society are woefully ill-prepared for this demographic tsunami.  Part of the problem is our perspective of aging in general  We are really not good are accepting the fact that we are all aging and many of us will have decreasing function and need supports.  It is inevitable, as much as our mortality is inevitable but we humans are good at deceiving ourselves from reality.  We view aging almost as a failure.  We don’t want to see our vulnerabilities in the last part of our lives.  We put are aged away in places where we don’t need to see them.

We need to view aging differently.  We need to view the twilight of life course as part of the bigger story – not just a number of losses towards the end.  This often tends to result in the over-medicalization of these latter years.  Countless visits to doctors, going for testing which can eventually consume a big portion of your day.  But to what meaningful outcome for the patient?  This is where culture comes in.  How do we view our elders, where do they belong in our communities and society.  When we begin to accept the realities of aging and our mortality, we will begin to understand how to live better lives and we will begin to understand how to care for some of the most vulnerable in our society.

We live in an increasingly noisy environment with countless distractions.  There is so much environmental noise, mental noise in our modern lifestyles that stillness, quiet and calm focus is become a rarity.  All this noise creates a low-level chronic stress on our physical and nervous systems.  Chronic stress is a major factor in chronic disease.

What we need more now than ever are tools to help us to be mindful of the present moment, to decrease our stress response and ultimately to be awake and alive to every experience.  The Buddhists have studied the nature of the mind for hundreds of years and calls the distracted mind – “the monkey mind”.  Meditation is one of those tools that can help us still the mind.  It is like a pond which when calm, perfectly reflects back its surroundings (the true nature of reality.  If the pond surface is disturbed, the ripples and fluctuations distort the reflection of the surroundings.

There is increasing evidence that meditation is beneficial for our health.  Research has shown that it reduces blood pressure, chronic pain, headaches, anxiety and depression.  It has also been shown to be effective in boosting immune function, brain function and productivity.  It costs nothing and has no side effects.

Scientific studies have shown clearly that something is happening to brain chemistry when people meditate.  Functional MRI scans on Buddhist monks have shown that meditation produces long-lasting changes in brain biochemistry in areas involved with attention, working memory, learning and conscious perception.

An article published in January JAMA Internal Medicine journal that reviewed 47 trials looking at the effects of medicine concluded that there was insufficient evidence to recommend meditation as a therapy. However the authors did state that they found moderate evidence that mindfulness meditation alleviates pain, anxiety and depression – the latter two to a similar degree as antidepressant therapy. I will say again – meditation costs nothing and has no side effects.  How much scientific evidence to you need for a therapy that has no side effects?  The only side effect of meditation is an increasing sense of connectedness, awareness and presence!

I truly believe that a type of meditative practice where we find time and space to be quiet, to observe our mind, to become more present, to reflect, to feel compassion and gratitude is absolutely essential for health and wellbeing.  Meditation should be a daily routine just like flossing our teeth!  Once you begin to practice, you will begin to feel the benefits.  The true evidence is the direct felt experience that you will have of feeling more alive!

There is a growing body of evidence that is showing the measurable benefits of meditation.

What is stress?  We all feel it, we can’t escape it, but what is it actually and how does it affect us?

Stress is the physiological response to the perception of a real or imagined threat to your body or self.  The key point here is perception.  An external event is not necessarily inherently stressful – it is how we interpret the signals and how it is processed in our mind and translated into our body.  The threat could be real (biking accident)  but it could be imagined (an assumption that someone was mad at us).  In either case – if we perceive the event as stressful, a cascade of patterned responses ensues.  Adrenaline, cortisol and other stress hormones are released from your brain and permeate every cell in your body. Every cell has receptors for these powerful chemical messengers (hormones).  When you “feel” stressed, your cells feel this stress.  When you feel joy, your cells feel joy so to speak.  The stress response activates the sympathetic response (flight or right) of the autonomic nervous system causing your heart rate, blood pressure to go up, blood more sticky,  increases your blood sugar levels to prepare you for emergency action. This is the right response if there is an acute stressful event that requires you to take action (run away from the sabre tooth tiger).  However, if we are chronically stressed, this adaptive stress response becomes maladaptive and it causes all kinds of problems on the body.  Stress has been identified as a major contributor of many chronic diseases – heart disease, high blood dress, thyroid dysfunction, mood disorders etc.

We are an incredible complex and resilient organism.  It never ceases to amaze me, how much stress, trauma and illness the body can handle, heal and triumph from.  We need to pay attention to what our body is saying to us.  The body communicates to us through symptoms.  What is our body trying to say to us?  It is telling us to slow down, to quit that job that we know we should done long ago but can’t quite make ourselves do it.  The body will say “No’  – if we can’t say “No.  Every symptom or illness should prompt an inquiry and reflection upon what is going on in our lives.

We are learning more and more that our choices we make each and every day contribute to our overall resilience to stress, dysfunction and illness.  Nourishing our bodies with nutrient dense, whole foods provide us with all the co-factors and molecules to ensure our systems are running well and have extra capacity.  Keeping our bodies strong, flexible, supple ensures that energy is flowing freely through our systems and stress is not getting trapped.  Ensuring consistent, restorative sleep is vital.  Learning how to breath – deeply and slowly have profound effects on our stress response.  Do Yoga – it is the best combination of movement, breath and meditation.  Understand our thinking patterns and begin to be aware of how we often make erroneous assumptions about situations and how this causes us stress.  Once we become more conscious and mindful about our perception and responses, we can then begin to re-pattern and re-wire how we respond.

Resilience is about having extra functional capacity so that we can handle increased stress without losing function.  We can all live healthy, happier lives once we begin to understand and shift how we perceive and respond to stress

In Health,

Dr. Lawrence Cheng

“It’s time to embrace lifestyle medicine” on the cover of the latest Time Magazine.

We are at a pivotal point in the evolution of medicine where we are beginning to truly appreciate both the incredible power of modern technological medicine but also its limits.  More than 70% of all chronic diseases which account for the majority of the burden of illness in Western countries is preventable by better lifestyle choices.  The US spends about 3 trillion dollars each year on healthcare – 86% of it on chronic disease that can preventable.  There is no end in sight for the rising cost of healthcare and increase demands for disease treatment.  We have barely begun to see the demographic bulge of the “Boomers” enter into their high health care needs.  I work in a busy downtown ER in Vancouver where we are gridlocked everyday.  We routinely treat 25 or more patients in the waiting room everyday that should be in a stretcher space.  There is no more room, there is no more money.  Continuing to treat downstream end organ disease without addressing the prevention side of the equation makes no sense whatsoever.  But in fact, that is what we have been doing.  Governments spend a relatively small percentage of health care money on prevention.  Third party insurers in the US are really beginning to invest in prevention because they realize that if they can prevent a disease, they will save costly payouts for treatments in the future.

Lifestyle medicine is based on epigenetics.  Epigenetics is showing us that the environment that we put ourselves in – what we eat, how we move, how we relate to ourselves and others has more effect in many cases than our disease risk from inheritance.  Genes are not our fate!  The DNA is the hardcode blueprint but the epigenome is the software that makes the whole thing run.  Disease results from the interaction between your genes and your environment.  By changing the environment – you can significantly alter your disease risk.

Dr. Dean Ornish has pioneered some of the key studies that have shown conclusively that lifestyle programs can reverse heart disease.  Lifestyle medicine incorporates proper nutrition, optimal exercise and movement, stress reduction, mind body therapies and understands the importance of healthy relationships with oneself, others and connection with community.  The research is all out there….

Lifestyle medicine should be in many if not most cases, the first line treatment for chronic diseases.  Only after we have optimized lifestyle factors as effectively as possible should we begin to incorporate pharmaceutical drugs or surgery.  Lifestyle interventions is not just for prevention but for treatment of disease.  Many chronic diseases arise from imbalances in our core functional systems.  Most drug therapy does not address these core imbalances, they treat downstream effects and symptoms

It is about time that lifestyle medicine truly is beginning to be seen as effective treatment for disease as well as prevention.  When we address lifestyle factors for real, the side-effect is that the disease fixes itself!

In Health,

Lawrence Cheng MD

There is no separation really between us and the environment. There is no separation between the quality of the air we breathe and the oxygen that flows through our lungs and into every cell of our body. There is no separation between the health of our water supply in our oceans and rivers and the health of our blood and fluids that course through our arteries and veins. There is no separation between the food we eat and health of the soil, plants and animals that we share this planet with. David Suzuki talks about this “Sacred Balance”. We cannot talk about human health separate from the health of the planet.

We are living in an increasingly toxic environment. Chemicals are everywhere: In our homes, in our workplaces, in products we put on our body and to the food-like substances that we eat.   It is estimated that there have been over 80,000 new chemicals introduced into the environment since World War II. There is a growing body of scientific evidence that links the exposure and accumulation of toxins with human disease. Many common conditions have been associated with toxicity: obesity, diabetes, thyroid disorders, asthma, chronic fatigue, autoimmune conditions and cancer to name a few.  In fact allergies, autoimmune conditions and cancer continue to become more prevalent despite improving living conditions and medical advances. Our genome (our DNA) has not had time to adapt to these new chemicals, as a result damage occurs and disease manifests.

Low dose exposure is not necessarily safe exposure. We really don’t know the long-term effects of most of the chemicals or drugs that we have produced. No evidence for harmful effects is not the same as “evidence of NO harm”. The only rational approach to this is to follow the precautionary principle which states that we have the duty to prevent harm when it is within our power (and institutions) to do so – even when the evidence is not in.

Furthermore, we are learning that one’s ability to detoxify (break down chemicals and render them harmless and eliminate them safely in our body) can be quite variable due to the individual’s genetic and biochemical uniqueness. What might be a ‘safe’ exposure for 90% of the population could cause significant disease in an individual who has impaired ability to detoxify certain compounds. Reducing exposure is the best advice and appreciating individual susceptibility.

One’s ability to detoxify substances to which he or she is exposed to is critical to overall health and prevention of disease.   How well our body detoxifies can be modified by our lifestyle.

The elements of a detoxification lifestyle is:

1. Avoid exposure to all known sources of toxicity as much as possible.
2. Optimize your nutrition by consuming a diet that is high in phytochemicals (beneficial compounds found in fruits and vegetables. Onions and garlic, cruciferous vegetables, citrus, green tea etc. all act in a complex, beneficial manner to improve our detoxification systems.
3. Regular moderate intensity exercise most days of the week helps increase antioxidant enzymes in your body, improves lymph drainage and increased elimination through sweating.
4. Restorative sleep, rest, relaxation and rejuvenating play are essential elements as well.
5. Finally, true detoxification includes eliminating toxic influences of all kinds that do not serve us – not just chemicals. This includes toxic self-limited beliefs about our selves, maladaptive patterns of behaviours, toxic relationships etc.

We have an incredible ability to withstand stresses from all kinds of toxins from environmental to emotional. This is the wisdom and intelligence of the body manifest but we need to give our bodies the best chance to do this by living a lifestyle that helps are body, mind and spirit be strong. How we live each and everyday makes all the difference.

In health,

Dr. A. Lawrence Cheng MD CCFP(EM), MPH

Why we need functional medicine?

“Problems cannot be solved by the same level of thinking that created them”.

Einstein

The most powerful question one can ask is “Why?” In medicine this translates to why did this particular person get this form illness at this particular point in time? This is the question we need to ask more in modern medicine.

We are facing an epidemic of chronic disease around the world. Over 70% of the disease burden now comes from chronic disease not infections or trauma. Despite all the money being spent on drugs, procedures and surgery, the incidence of chronic disease continues to rise.

We need more than ever a new paradigm in medicine that focuses on prevention and looks closely at the root causes of illness rather than just treating the end manifestations of end-organ disease.

We need a new medicine that looks at the person as an integrated whole – mind, body and spirit; appreciates our biochemical individuality; understands that most chronic disease arises from imbalances that result from a mismatch between our genes and the environment (Lifestyle).

We need a model that reflects the new science emerging from the genomic revolution – in particular epigenetics. What we are learning from epigenetics is that our genes are not our destiny – it is not a fixed blueprint. What actually manifests as structural components of your body and the biochemical machinery that runs everything depends largely on what genes get translated (what gets turned on or off). How your genes get translated is a result of interactions with the environment. This means – how you live each and every day (the food you eat, the way you move, breath, interact with the world) determines how your genes gets expressed. Your phenotype (the actual expressed genome) can be quite different than your genotype (DNA code).   This is an incredibly complex and brilliant system that allows the organism to adapt continuously to a changing environment.

We need to realize that the naming and classification system of diseases helps us match signs and symptoms to a diagnosis and then to a corresponding treatment but it doesn’t mean that we understand the root cause of the problem. In fact – we don’t know the root causes of many chronic diseases.

For acute illness caused by an acute infection or injury – the root cause is fairly clear. But the root causes of a disease that takes many years to develop –sometimes decades (long latency), result in myriad of symptoms in different organ systems is much more difficult to ascertain. Our current tools in our medicine toolbox are great for acute trauma and illness but not so good for long latency complex chronic disease.

The principles of functional medicine are as follows:

1. Functional medicine uses a systems based approach that looks for root causes of illness and imbalances in core physiological processes rather than focus on treating symptoms.
2. Functional medicine works “upstream” rather than “downstream” by looking for patterns of dysfunction before they manifest into disease if possible.
3. Looks at the person as an integrated whole – mind, body and spirit.
4. Recognizes that everyone is biochemically and physiologically unique. There is no one size fits all treatment. Treatment is personalized.
5. Recognizes that chronic disease arises from the interactions between our genome and environment. Uses lifestyle as prevention and treatment by focusing very carefully on nutrition, exercise, sleep, stress reduction and our relationship with ourselves, others and the world.
6. Integrating best practices from conventional biomedicine with other modalities like natural medicines, (Naturopathy), Traditional Chinese Medicine, Massage, Chiropractic, mind/body therapies (yoga, meditation) etc.

What we need is a new paradigm that understands that there we are inter -connected to everything – on both a physical and energetic level. Our cells are part of tissues, which are part of organs, which are part of organ systems, which work together to form our whole person, the person is part of a community, which is part of an ecosystem, which part of the biosphere. A holistic, deeply conscious systems based approach is really the only ways forward if you understand this.

It is my sincere hope that we continue moving in this direction. This is why Connect Health Centre for Integrative + Functional Medicine was created.

Happy New Year!

Wishing everyone radiant health!

Dr. Lawrence Cheng MD, CCFP (EM), MPH

Co-founder and Director

Connect Health Centre for Integrative + Functional Medicine