In recent years, we’ve been hearing a lot about integrative medicine, sometimes referred to as complementary, or functional, or alternative medicine. Is it all the same? And how is it different from the health care we’ve grown up with in the U.S?
While attending the recent Scripps-sponsored Conference On Natural Supplements, I had an opportunity to talk Dr. Erminia (Mimi) Guarneri, a cardiologist and co-founder of the Scripps Center for Integrative Medicine in La Jolla, CA, where conventional and complementary medicine techniques are simultaneously used to treat (and prevent) disease and improve health. After years of surgically fixing hundreds of blocked arteries, Dr. Guarneri realized that there was much that could be done to help patients prevent the need for these interventions in the first place with proper nutrition and stress reduction techniques.
I asked her to explain the differences between integrative or “functional” medicine and the western approach to healing that we’re so accustomed to; which supplements and lifestyle modifications offer the most benefits for menopausal women; and finally, how to find a physician who is trained in natural medicine. Here’s a transcript of our conversation:
Wendy: Let’s start with a definition of integrative or “functional” medicine. How is it different from traditional, Western medicine that we are more accustomed to?
Dr. Guarneri: I always use a metaphor with my patients of a tree. In Western Medicine, if the fruit on the tree is sick, they’ll give you a drug, or cut the branch off, or bypass the branch. In integrative, functional, medicine, we say let’s look at the soil. If you’re overweight, or have hypertension, diabetes, if that’s your sick fruit, we ask, why do you have this? Why is someone diabetic? Is it because they’re eating too much sugar and simple carbs? Not exercising? Is their magnesium low? Are they under an enormous amount of stress that’s producing cortisol? Are they not sleeping well at night and that’s putting stress on their body?
Once the source of their problems is determined, we put together a mind-body and spirit program that’s going to address these underlying issues. We look at the food you’re putting into your body, what you’re craving. We recommend an exercise program that you can stick with, one that begins with small steps if you’ve been sedentary. If you have high levels of perceived stress we would recommend increasing your resiliency with meditation and other techniques. A personalized plan is outlined that includes lifestyle change, nutraceuticals and pharmaceuticals if necessary.
Wendy: Not everyone has a fabulous integrative medicine center such as Scripps near them, so are there certain supplements, and lifestyle modifications that you think are particularly beneficial for midlife women?
Dr. Guarneri: Generally, women should have their Vitamin D level checked and supplement as needed along with Calcium and Magnesium. I also like 1000 mg of EPA/DHA fish oil daily. Anti-oxidants are important especially if someone has inflammation. I like fiber as a supplement because it lowers blood sugar, keeps bowels regular and lowers cholesterol.
Of course, I like to personalize a program to what the individual needs. For example, if a woman has high blood pressure, I may suggest daily exercise, and a diet of less than 1500 mg of sodium. If she is under stress we will include programs like meditation, yoga and biofeedback. If she has elevated cholesterol, I may recommend fiber, red yeast rice or other cholesterol lowering supplements. If she’s having GI problems, such as gas and bloating, I will usually recommend probiotics and an elimination diet.
Wendy: Let’s talk about supplements. With so many competing health claims and contradictory research findings, how do we know what supplement research to believe?
Dr. Guarneri: What happens with supplement research, is that very frequently, the supplements are not personalized to the individual. For example, researchers might give a gram of Omega 3 (fish oil) and not look at how inflamed someone is or how much oxidative stress someone has. Today we can actually measure the omega index and determine more scientifically what someone needs. Frequently, we don’t even have an understanding of the population that is getting this so-called intervention. That’s the downside of a lot of the supplement research.
Wendy: Of course, most of us remember headlines and don’t have the time or inclination to review the original study.
Dr. Guarneri: When reading about supplement research, it’s important to go beyond the headline and read what went into determining the final conclusion. The recent reports about Calcium studies are a good example of this. The headlines said “Calcium Causes Heart Attacks.” But when you looked at the actual study, you see how flawed it was. The researchers asked women if they had taken Calcium 11 years ago. Then they extrapolated and concluded that the women who were taking Calcium did worse. The question is, who are these women? Are they diabetic, hypertensive, are they smoking? It’s important to be able to evaluate the literature critically.
Wendy: Unfortunately, most consumers have to rely on news reports about supplement use because our physicians don’t believe in them, or they brush us off with a comment like, “it can’t hurt.”
Dr. Guarneri: I think it’s important to find a practitioner that’s savvy in this world, and I think that some of the best people in this area are Naturopathic physicians and individuals trained in Integrative/Functional medicine. Western trained physicians were not educated in this area unless they have enhanced their career with programs in Integrative and Functional Medicine. Fortunately, this is changing with many medical schools offering courses in nutrition, nutraceuticals and mind-body medicine.
that I highly recommend. And finally, if you’d like to find an practitioner who specializes in integrative medicine, see the website of the American Board of Integrative Holistic Medicine (ABIHM), where you’ll find a searchable directory.
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