functional medicine and nutritional genomics - American Association ...

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AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS hours a night. Alternately listless and agitated, Theresa’s been unable to concentrate at work. She leaves her office late—feeling guilty for what she hasn’t done and anxious that she will have to make up for it the next day. While she used to go dancing with friends in the evenings, now she tells them she’s tired. At home, she watches TV and eats frozen dinners. Sometimes she measures her wine in bottles, not glasses. She is feeling increasingly hopeless. Theresa is clearly clinically depressed and her internist and psychotherapist have already urged her to take antidepressants. But she doesn’t want to. She has come to me to find ‚a better way.‛ Theresa already knows I view depression differently than her doctor and therapist do-- ‚Depression is not a disease,‛ as I explained to her on the phone when she called to make an appointment. ‚It’s a wake up call, potentially the start of a journey that can help us become whole and happy, a journey that can change and transform our lives.‛ Before any patients visit my office or pay me a fee, I make sure to speak on the phone with them, let them know who I am, what my perspective is, how I work, and make sure they want to participate in what I have to offer. I also usually suggest that before the first appointment, they read something I’ve written about my practice, get to know a little more about the meditative, eclectic, active and engaged ‚Unstuck‛ approach I will offer. This kind of conversation feels respectful, clears up misunderstandings and helps ensure that our future time together will be used well. The congruence, the fit between what I’m offering and what my patient is hoping for, will be the springboard for all our work. It will provide the shared vision on which we can draw in the difficult and challenging times that may come in any therapy. Finally, commitment to an integrative approach – and the urgency that may fuel that commitment - help provide the energy which sustains us in meeting the challenges of our work together. I begin, as any therapist would, by asking Theresa what happened a month ago right before her 108 depression. She says that she has just ended another relationship and reminds me that at almost 40, she still doesn’t have a man who loves her or a child. I listen carefully as Theresa describes the inhibition and despondency that shadowed her childhood--the recent break up with her boyfriend has plunged her into the same kind of hopeless darkness she remembers from that time. A thousand miles away, she tells me, her mother’s arthritis has slowed her to irritated immobility and her father’s sight and vigor are fading. Theresa feels she should be with them, but doesn’t want to, and she feels guilty about that. ‚I carry my whole organization on my back, too‛ she says ruefully, ‚women’s rights for everybody except this woman.‛ As I take in what Theresa is telling me, I encourage her to see herself as a student and adventurer, an active participant in our work together. Indeed, she is the one primarily responsible, with my guidance, for helping herself. ‚Self-care,‛ I often tell clients, ‚is the true primary care.‛ From our first session, I convey to her my belief that she has within her the resources for her own healing. Indeed, I begin to help her recognize what she is already doing that is helpful to her. In Theresa’s case, the morning yoga she still sometimes does gives her energy; and phone calls or visits with her best friend, Barbara, dispel, at least for a while, her deepening loneliness. I write these activities down on a prescription pad, as another physician might an antidepressant drug—crafting ‚a Prescription for Self-Care‛ at the end of the first session. I also teach Theresa (and virtually all of my patients), a simple, meditation technique called ‚Soft Belly,‛ involving slow deep breathing in through the nose, out through the mouth, with the belly soft and relaxed. I encourage Theresa to close her eyes as she breathes in order to remove distracting stimuli. I suggest that she say to herself, ‚soft‛ as she breathes in through her nose and ‚belly‛ as she breathes out through her mouth. If thoughts come, I say, let them come, and let them go. 2012
AAPI’S NUTRITION GUIDE TO OPTIMAL HEALTH: USING PRINCIPLES OF FUNCTIONAL MEDICINE AND NUTRITIONAL GENOMICS ‚Soft belly‛ is, I explain, an antidote to the fight or flight and stress responses, which figure prominently in the development and deepening of depression. Soft belly brings more oxygen to the lungs and stimulates the vagus nerve, which is central to relaxation. Slowly, I tell Theresa, the relaxation of the belly will spread to the other muscle groups as well. I explain to Theresa that though the research studies are most often done on 30-40 minutes a day of meditation, just a few minutes several times a day will help balance her physiologically, slow her anxious, pressured thought patterns, and give her a little more perspective on her life. Equally important, as she sees she has the capacity to help herself, she will be overcoming the helplessness and hopelessness that are hallmarks of depression. I add ‚Soft Belly 3-5 minutes, 3-5 times a day‛ to Theresa’s Prescription for Self-Care. I do Soft Belly along with Theresa and with all my patients. It’s of course helpful for me to be as relaxed and open as possible in my sessions. It also conveys an important message to my patients: We are on this journey together. I’m not an observer. I’m here with you, learning as well as teaching, experiencing life, and dealing with my own stress along with you. Dealing with depression and its challenges and with stress, generally is, I am recognizing and admitting, not separate from our lives- an extraordinary response to a pathological situation - but an ordinary and ongoing part of them. We speak in the weeks ahead about the historical context of Theresa’s depression- her mother’s coldness; her isolation as a young black girl in a still segregated, white southern community; her tendency to take responsibility for the emotional lives of others-- her parents first, then her employees and lovers. Still, I am continually bringing our focus back to what is happening right now - how present feelings reflect past disappointments, and how she can relax with, learn from, and move through them. If she were to ask, I would explain that this is a meditative, present-oriented approach to psychotherapy. 109 Theresa, significantly more relaxed as well as reassured after our first session, felt encouraged and supported by the Prescription for Self-Care. Each week, I ask her about her progress and express appreciation for what she is doing well, while not being dismayed by what has been too difficult, or what she's ignored or neglected. Our work is not about her ‚good‛ or ‚poor‛ compliance-what an ugly, condescending word - but about what she can learn from difficulties, avoidance, and defeats as well as from ‚success.‛ Sometimes patients who seem originally committed to this Unstuck approach grow discouraged and are reluctant to pursue it. Nagging doubts remain about whether antidepressants might be the best and easiest answer, after all, or at least a necessary precondition for improvement and therapy. I respond with information on the most recent meta-analyses of drug research, which show that when unpublished negative studies are included along with positive, published ones, drugs are little if any better than placebos. I tell patients that I’m not ‚against‛ the drugs—I just see them, with their uncertain benefits, significant side effects and potential for habituation, as a last resort, not a first choice. Like many depressed people, expecting to get a prescription but not much more in the way of attention, Theresa is afraid of being ‚left alone‛ with her depression. I assure her that I myself have been on the journey through and beyond depression and that I will be there with her at every step of her journey. I make sure she understands we’ll have regular appointments - a usual feature of psychotherapy, but a significant departure for people who are used to seldom seen, drug-prescribing physicians. I also tell my patients they can call me anytime--and find that this reassurance is itself powerful medicine: Knowing they can call me, that I am always there, almost no one does. I also begin, in our first or second session, to directly address the comprehensive biological dimensions of depression. ‚Depression is not a disease,‛ I say, ‚but diseases of a variety of kinds, and imbalances in biochemistry and nutrition 2012
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