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