To find health should be the object of the doctor.
Anyone can find disease.
—Andrew T. Still, M.D., Founder of Osteopathy 1
1. What Brings You Here?
“WHAT BRINGS YOU HERE?” This is the question I use to begin every consultation, so it’s the question with which I begin our time together in this book. If you were sitting across from me in my office, we would try to get to the bottom of the following questions: Why have you come to me? Are you suffering from a particular condition or ailment? Are you trying to understand why you’re feeling a certain way? Are you frustrated with the contradictory information and limited guidance you’ve been receiving from others? Have you gotten too much information, and has that confused you about where to begin? With all that you read and are told by others, do you really understand what it means to be healthy? Unlike most doctors, I am a doctor of slow medicine, meaning I really want to spend time on your questions. They show me where you are on the road to health.
Are you asking good, skillful questions? Think of it this way: you might have the intention to get to New York City from rural Pennsylvania, but by asking for directions to “the big city with all the buildings,” you might very well wind up in Philadelphia. Philly’s a good town, but it’s not where you intended to go. Similarly, if you don’t know where you are right now, it will be impossible to find the right road to where you want to go.
The fact is, you probably don’t need to think too hard about what’s bothering you right now, but you do need to refine your questions in order to reveal the path to true health. So, we start our consultation together with a series of intelligent questions. In general, they can be answered yes or no. This first one, for obvious reasons, is different. As you gain more insight by asking and answering these questions, you’ll get a glimpse of a much more optimistic framework for living your life—on a much more interesting journey, I might add. Ultimately, you’ll find a more sensible path toward healing.
I’ve spent a long time walking and studying that path. I’ll tell you more about my journey later. For now, I want to get straight to you. Why have you come to me? Like millions of us, you’ve probably got some health “issues,” and some of them might seriously diminish your quality of life. You might suffer from diabetes, hypertension, cancer, arthritis, headaches, ulcers, back pain, or a host of other very common and very unpleasant chronic conditions. You’re not alone. According to the Centers for Disease Control and Prevention, more than 133 million Americans (one in every two adults) suffers from at least one chronic illness. The percentage of children and adolescents with a chronic illness has more than quadrupled since the 1960s. And chronic diseases cause seven in ten deaths in the United States each year.2 You’ve probably tried a lot of solutions: several doctors, several specialists, several drugs, several “alternative cures,” and maybe even several invasive procedures or even surgeries. If you’ve been suffering for years, you’re probably like the vast majority of Americans—a whopping 72 percent—who believe the health care system in America is facing both “crisis and major problems”3 in part because it can’t seem to help you and those other millions.
In any case, if you’re dealing daily with chronic conditions, you don’t need much in the way of reminders and statistics. What’s wrong with this picture? How is it possible that we live in the most technologically advanced period in history, in the richest nation in history, where research, science, and the quest for health and longevity reign supreme—yet so many of us go on suffering needlessly with nasty conditions that are largely within our control? Is it really okay that 16 percent of our country’s wealth is spent on medical care—more than any other nation—yet there’s precious little evidence that our extra spending makes us healthier?4 Indeed, we rank only average or below average for health among highly industrialized nations! Why is it okay that so many new drugs were approved by the FDA in the past several years, billions were spent on medical research, doctors got supposedly better and better educations, but the rates of chronic ailments like diabetes and obesity are dramatically rising rather than falling?5 I’m trying not to sound shrill here, but it’s hard. The system is not serving us well, and it’s on the brink of collapse.
Meantime, you’re still sick, and that’s the most important thing. There are several reasons you’re sick and why conventional medicine hasn’t helped you get well. But I want to focus on a major one that’s in your sphere of control: the slow medicine notion that we need to address all the aspects of your life, rather than just trying to “fix a broken part,” in order to create the best health possible.
2. Are You Free of All Aches, Pains, and Chronic Diseases?
THE BIG 8 AND THEIR COMMON CULPRIT
So what does bring you here? Are you free of all aches, pains, ailments, and chronic diseases? This is the first of the yes-or-no questions designed to get you thinking about the bigger picture of health. I hope you’re free of all these maladies—but that’s not likely.
When we first meet, I encourage each patient to tell me the answer to this question about themselves, their health, and their life. In part, this is to help me understand your history, the particular circumstances of your baseline state of health, and your needs. But it has another, perhaps even more important function: to help you better understand yourself and your state of health. Obviously, this particular function is critical in my relationship with you, the reader, because I’m guiding you through a process you’re doing at home.
Your health is complex and multifaceted. Symptoms and syndromes are part of a whole web of body and life aspects we’ll explore in this book. But let’s start at the beginning, on a purely physical (symptom-based) level. Most people first come to me with a concern about a physical problem. The most common presenting complaints fall into one of eight broad categories. Chances are your immediate and initial health concern falls into one of these broad groups, too, some of which overlap:
1.Chronic pain. Headaches, migraines, arthritis, backaches, joint pain, muscle pain, neurological pain, menstrual pain, and various other kinds of long-term and debilitating pain
2.Fatigue. Lethargy, malaise, sleeplessness, chronic fatigue syndrome, and other low-energy states
3.Digestive tract issues. Irritable bowel syndrome, gastroenteritis, colitis, diverticulitis, inflammatory bowel disease, ulcers, and indigestion
4.Vascular disease. Heart and circulatory issues along with their frequent partners: obesity, high blood pressure, diabetes, and high cholesterol
5.Respiratory problems. Asthma, allergies, frequent bronchitis, emphysema, and chronic obstructive pulmonary disease (COPD)
6.Mood disturbances. Depression, anxiety, and other dysthymic conditions
7.Immune system disorders. Rheumatoid arthritis, lupus, and other chronic infections and autoimmune syndromes
8.Cancer.
3. Do You Understand the Causes of Your Chronic Physical Conditions?
You might have other ailments—and don’t worry, I’ll address as many as I can throughout this book. But the list above encompasses the main complaints. And this is a very interesting list of symptoms and conditions, from a medical point of view. Can you tell what the common denominator is for essentially all of these?
If you guessed inflammation, you’re right! It might not be the sole cause, but I can tell you from long experience and solid science there’s a good chance that some form of inflammation is at the root of all these physical challenges. It’s even implicated in Alzheimer’s disease and aging itself.
Inflammation happens to be one of the body’s natural protective healing processes. Inflammation is an automatic reaction to an injury or a disease state that precedes it. So a conventional doctor might be satisfied that inflammation in the colon (colitis), for example, has some physical cause, such as a blockage or infection in or around the colon. When they see colitis, they go in search of this cause: What’s attacking the colon, causing the inflammation? Notice that their search will focus on the physical cause. In an acute state of inflammation, there often is a physical cause. But the inflammation can persist for a long time without the original insult being present anymore. This is a chronic state of inflammation, during which some internal imbalance in the body keeps the inflammation going despite the absence of the original physical insult.
It’s also important to note that in many cases of chronic inflammation, some X factor—often outside the involved organ, and maybe even outside the body in some other aspect of the patient’s life—supports and maintains the inflammation in the system, settling in the colon, in this example. I’d call this secondary inflammation, but it’s inflammation nonetheless.
Either way, when I see colitis as a symptom, I will, of course, like your doctor, look for evidence of injury, underlying disease, infection, and so on—but then I will go beyond, using a holistic approach that is helpful for all the inflammatory conditions on the Big 8 list. If you’re reading this, it’s likely that the primary approach you’ve experienced in conventional medicine has not done the trick.
Indeed, it’s this holistic approach to inflammatory conditions that’s really instructive as a model for the way slow medicine works. Inflammation is likely to be at the root of many health problems, but the wisest and best approach for treating it must take into consideration that these conditions will defy straightforward, physical remedies in isolation. The patient needs to work on reducing inflammation with a comprehensive plan. In other words, as a rule, “Take two ibuprofen and call me in the morning” is not going to be enough. While that treatment plan might help mask symptoms of acute inflammation, it will fall far short of getting to the bottom of the chronic condition and its causes. If you have colitis, we’re going to have to address the inflammatory processes both in your colon and in the rest of your life.
Before we get to that, though, let’s look more closely at the standard of care in conventional medicine. How do most doctors deal with these kinds of conditions, and why do so many patients feel they’re not being helped?
DOCTORS WITH MYOPIA
In my practice, the most common answer to Question 1, “What brings you here?” is: “The doctor I’ve been seeing really isn’t helping me.” It’s remarkable, but almost every patient says something along those lines. They often add, “I don’t think my doctor really gets it.” Part of the reason for this is that your doctor doesn’t believe you can change. Dr. Tracy Orleans, a health psychologist at the Fox Chase Cancer Control Center in Philadelphia, found in his research that two out of three physicians were pessimistic about their patients’ ability to change. That’s perhaps because of poor “compliance” by patients in the past. The doctor tells you to quit smoking and you don’t. The doctor tells you to lose weight, yet you “refuse” to change your diet and start moving. Dr. Orleans writes, “This pessimism is the single biggest obstacle to getting physicians to help their patients with their health problems.” Yet studies show that if doctors took preventive medicine more seriously, they could double the number of patients with better results, like quitting smoking.6 That’s remarkable and disturbing, isn’t it?
My doctor isn’t really helping me. I don’t think he gets it. What you usually mean by that is that your doctor isn’t asking you the right questions or guiding you to ask yourself the right questions. Like many frustrated patients, you have an intuitive sense that you need to develop a broader, more comprehensive and holistic treatment plan—but the system doesn’t have a lot of room for that. The fact is, you’ve been trained to be satisfied with the prescription of a pill that might or might not reduce your symptoms temporarily. But your problems come back, and you come back to your doctor time and time again, until you find someone like me or finally figure out that so much of your health is under your control. We’ll discuss this dilemma and how to resolve it throughout the book.
MEDICAL EVOLUTION AND REVOLUTION
Pretty early in my career, frustrated with conventional medicine, I stopped feeling anxious about the number of patients in the waiting room, and I engaged the patients in my exam room for as long as I needed to. I asked them about their experiences, their disappointments, and their hopes regarding their health and their health care. I talked to dozens of my colleagues. I read a lot. I launched a personal quest to be the best healer and teacher I could be, and vowed to use whatever tools necessary to get me there, whether or not they fit neatly into the pantheon of conventional Western medicine. I studied and fine-tuned what many health industry vanguards like Dr. Andrew Weil and Deepak Chopra before me had begun.
Soon, I found myself feeling more comfortable as I began to embrace my role as a teacher rather than a mere medical mechanic, as many of my colleagues saw themselves—and as the system regarded us doctors. I stopped concentrating on individual symptoms like stomach pain or infertility, and I began to focus much more on the relationships I developed with my patients and all the ways I could help them think more deeply about the whole of their lives. I began to ask them more and more about their joys and traumas, their childhoods and parenthoods, their vocations and avocations, missions and dreams. I incorporated into my “treatment” plans much of what I had learned by studying various healing philosophies, both ancient and modern, Western, Eastern, and beyond. I felt I had gained a broader perspective on our lives as multifaceted constellations with many stars, all of which together form a living universe—us.
Gradually, I began to develop effective techniques to help my patients understand how the numerous and seemingly diverse aspects of their lives—things like the quality of their personal relationships and the passion they feel for their life’s purpose—are inextricably tied to their sense of health and, indeed, how well they felt. We did this together, through asking and attempting to answer the right kind of questions about ourselves. When we did this, something stunning and miraculous happened, which had happened less frequently in my years practicing the standard of care: my patients felt better! Empirical evidence proved they actually got healthier. They told me, time and again, that they felt listened to and understood for the first time in their experience with doctors. They felt like someone really cared—that someone actually “gave a crap,” in the language they most frequently used. But their success had a lot more to do with their taking the wheel into their own, skillful hands.
Ultimately, through expanding and honing a series of Skillful Questions about all the aspects of our lives—not just our physical symptoms—I came to understand what many great and influential philosophers and medicine men (both men and women!) did before me: it’s all connected. Now, I trained as a scientist. I believe in testing hypotheses and carefully reviewing data. I didn’t want to judge the efficacy of the slow medicine methodology just by the happy-looking patients piling up outside my office. This is what I found: for gauging a sense of overall health and well-being, factors that might seem “out there” to the average doctor and patient—such as the extent to which we’ve found a soul mate—seemed to matter just as much as how well we eat and whether we don’t abuse drugs and alcohol. This is at once awesomely revolutionary and totally, intuitively obvious.
In this model of understanding health, your conditions, their causes, and the place they hold in your overall life are all part of one whole being worth exploring and treating as such. In other words, just as the body is a dynamic system that must remain in balance to maintain health—the hip bone is connected to the thigh bone, and so on—so, too, is the body just a part of a greater gathering of forces. To achieve real health, the body must work in tandem with the mind, the soul, and the spirit. And that assemblage of all the portions of us that make us us, in turn needs to exist in equilibrium with even greater forces beyond ourselves. Our marriages and families. Our careers. Nature and the world around us. Universal cycles and rhythms like that of the moon and the sun. A higher power that many people refer to as God. To uncover the extent to which all these complex systems are functioning smoothly and in harmony, I continued to polish the slow medicine approach, incorporating concepts, insights, ideas, and images I gleaned from my patients, the wisdom of the ages, the best insights of modern medicine, and the counsel of many intelligent and helpful colleagues, whom you can read about in the acknowledgments section of this book.
4. Are You Taking More Medicines Than You Would Like?
AND ONE PILL MAKES YOU SMALL . . .
Maybe you’re wondering, Why do we need to redefine health when we’ve got so many great drugs out there? Couldn’t I just find the right pill for my problem? Drugs have their place. I’ve prescribed them, of course. Some drugs, such as insulin, have literally saved millions of lives. Let’s be clear, though. If you lose your pancreatic insulin-making function through trauma, infection, or cancer, you will die. So I’m going to prescribe insulin to type 1 diabetics. But what percentage of all diabetics have type 1, insulin-dependent diabetes? About 5 percent.7 For everyone else—for literally millions of type 2 diabetics—insulin is overprescribed and overused as a quick fix for the poor lifestyle choices the patient makes, and which, by the way, insulin makes so much more convenient. Here, as elsewhere, the so-called solution is in fact a huge part of the problem, not only ignoring the cause of the initial condition and merely masking its symptoms, but substantively contributing to the problem, as well as causing untold other health problems to boot (because insulin is a growth hormone, it stores fat and contributes to weight gain, making the patient less sensitive to the drug while at the same time increasing his need for the drug). Not to mention what’s happening psychologically, which is that so many people get “hooked” on the drug, using it to “chase” bad food choices, or wind up feeling depressed that they’re dependent on a drug in the first place. If you take a huge shot of insulin after a dozen doughnuts, your blood sugar will look perfectly normal. The long-term cost of this on the body, on the families of diabetics, and on the health care system is unacceptably high.
It’s not just insulin. According to the National Center for Health Statistics, half of all Americans take at least one prescription drug, and over the last ten years, this percentage has risen by 10 percent. The use of two or more drugs has increased by about 30 percent. And the number of people who take five or more drugs has nearly doubled—accounting for more than 40 percent of older Americans. There’s no doubt we’re reliant on pharmacology. One out of five children and nine out of ten older Americans are using at least one prescription drug. In the United States, we spend more than $234 billion a year on medicine—more than double what we spent in 1999.8 Are we getting better because of all these colorful miracle drugs? Or worse?
I understand that it’s possible your condition has progressed to the point where you feel you need medicine just to get through your day. Take our common problem of inflammation. Putting aside for the moment the not insignificant potential side effects and risks (like ulcers, kidney failure, overdose, and dependency), anti-inflammatory medications probably provide you with a measure of temporary relief. If you take steroids for bronchitis, for example, the reduced inflammation in your lungs can help you breath better. If you take a nonsteroidal anti-inflammatory drug (NSAID) for joint pain, you might experience a fleeting reduction in inflammation and pain that can help you cope with daily challenges like work and shopping. But opting for the drug-only solution has four inherent problems:
1.Most drugs prescribed for inflammation only mask symptoms—they don’t address the underlying problem. What’s causing your inflammation in the first place? Without addressing this question, the problem probably won’t get better.
2.The body adapts to such drugs and builds up a tolerance that will eventually mean you’ll need more or stronger medications to cope.
3.Relying on drugs with no other plan for overall healing reinforces our broken system of searching for Band-Aids when we need prevention and sustainable lifestyle treatments that incorporate our whole beings.
Even the best drugs come with potentially dire consequences. Just listen to the TV commercials advertising the latest medicine. Have you noticed that the list of potential side effects takes much longer to recite than the list of potential benefits? A well-advertised anti-depressant drug recently listed 22 side effects, including “depression” (yes, as a side-effect of an anti-depression drug), “suicidal thoughts and behaviors” (and you thought depression was bad), “decreases in white blood cells” (your infection-fighting cells), “seizures or convulsions,” and “increases in blood sugar levels [hyperglycemia], in some cases serious and associated with coma or death.”9 It’s no joke. And that’s just if you get the dosages and mixtures right. Fatal medication errors increased sixfold in one recent twenty-year period. From 1983 to 2004, more than 200,000 people died from accidental medication mistakes.10 That’s the population of Des Moines, Iowa.
Still, even the most caring and well-intentioned doctors are inclined to prescribe the quick fix of pharmaceuticals or surgery, for conditions that need more thoughtful, individualized, and long-term care. That’s because doctors have been trained to be overly reliant on external indicators of illness or wellness, and most are further constrained by the limitations of a profit-driven and largely inefficient health care system. Unfortunately, while quick fixes may temporarily mask symptoms or eliminate the immediate threat, they typically fail to get at the root of an issue, especially in the case of chronic illness. Many health challenges, in fact, stem from an imbalance, and quick fixes often add imbalance, thereby exacerbating the original problem and causing a slew of complications.
Throughout this book, I’ll talk about the very effective slow medicine alternatives. Not only does slow medicine have zero negative side effects, it’s packed with a litany of positive side effects as well, and it is the kind of medicine you can practice on yourself—identifying the root cause of your health challenges, then creating a thoughtful, step-by-step, and long-term response to them. I’ll guide you every step of the way, and together, we will transform you into your strongest advocate, your own best doctor, and your best friend. You will learn how to bring yourself back into balance and not only resolve your primary complaints, but also to benefit elsewhere in your life, as a natural byproduct of the steps you take.
Paradoxically, if the situation is approached mindfully, illness can serve as a catalyst for a new and improved life. Indeed, getting healthy does not need to be a chore; instead, it can be an adventure.
AN ANTI-INFLAMMATORY LIFE
In the meantime, at the least, I’ll recommend working on some ways to reduce your dependence on drug solutions. If we ask the question “What brings you here?” and part of your answer includes “pain” or one of the many other Big 8 conditions based in part on inflammation, then why don’t we start with implementing Phase 1 of an anti-inflammatory lifestyle—instead of just an anti-inflammatory drug? We can begin with the straightforward, physical steps you could take, starting today:
•Increase anti-inflammatory foods. The more plant-based your diet is, the less inflamed you will be. A balanced mix of whole fruits, vegetables, whole grains, and legumes provides you with solid nutrition, including all the protein you need and an abundance of antioxidants and phytochemicals that battle free radicals and other inflammatory molecules.
•Reduce inflammatory foods. Now that you’ve added all of these healthy and filling foods, it’s easier to consider eliminating some of the inflammatory foods you’re probably consuming in excess. These include most animal products, including meat, fowl, fish, and dairy. I understand this might take some getting used to. You don’t necessarily have to stop eating all meat, but at least start by making it a side to a main course of plant-based foods. To begin with, try cutting animal products by at least half. Also reduce processed foods, such as food made from flour or milled grains; once metabolized, they quickly become sugar and, in excess, are stored as fat, which contributes significantly to inflammation. Alcohol is also inflammatory and should be limited, as are foods that contain a lot of simple sugar, even if they are natural and whole, such as large quantities of fruit in one sitting. Even diet beverages or foods with artificial sweeteners can be inflammatory. The phosphoric acid in carbonated beverages promotes inflammation by adding acid to your system. The same can be said for excess protein in general, which is another reason why large quantities of animal products are problematic. Then there are foods that you might have a particular sensitivity to, whether you’re truly allergic or not. In either case, your immune system reacts to some element in these foods, producing damaging free radicals and other inflammatory molecules. Common foods that do this are wheat, dairy, soy, nuts, and chocolate. If you continue to consume the foods to which you are sensitive, in a way you’re saying “I want to be in pain,” which I know is not really true. You just need better information and better guidance to see how important all this is. The fact is, you can’t expect to avoid inflammatory symptoms like pain if you keep putting into your body the things that cause painful inflammation.
•Start moving more and get outside. Stagnation is a setup for inflammation. To the extent that you can, get moving to increase circulation and improve your body’s ability to release accumulated toxins, work your joints and muscles, lower blood sugar and blood pressure, lose weight, increase peace and balance, and decrease pain and inflammation overall. You don’t have to run marathons, but you probably have to do more than you’re doing. Haven’t you ever wondered why so many of those “tough old birds” of yesteryear managed to live into old age even though they smoked, drank, caroused, and ate a pound of eggs, butter, and bacon every morning? Just look at your couch for an answer. Those people got outside and moved—they were in touch with nature. Most of them were gardeners in one way or another. They lived more connected to the earth in some meaningful way.
•Get enough water and sleep. Proper hydration and adequate sleep allow our body’s physiological process on a cellular level to work optimally, and ultimately are both necessary to reduce inflammation. Addressing dehydration and sleep deprivation alone might be the single most important step toward the health that has been eluding you.
•Unload your toxins. Think about toxins (such as lead, mercury, pesticides) in your home, workplace, and greater environment. Are you exercising too strenuously and producing even more free radicals? Are the bacteria that live in your gut helping you or hurting you? The fact is, we need to “empty the garbage” now and then. While our body does have natural mechanisms to do this, given all that we are exposed to—in the food we eat, the air we breathe, and the water we drink, not to mention the other chemicals that we come in contact with every day—we need to pay special attention to this matter. Clearly, it helps to avoid toxins to begin with, but there are ways to help your body release them once they wind up inside of you. All of the measures mentioned above will help you here. And there are others that you might consider, such as cleansing juices and select periods of fasting.
These steps will all make a very good start, and they will certainly make a dent—often a big one—in the most common health challenges. A random, destructive diet and a couch-potato lifestyle are some of the main causes of inflammation in the body, which in turn contributes substantially to most major health problems, with diabetes and heart issues at the top of the Big 8 list.
But an anti-inflammatory life goes deeper than diet and physical activity. Chances are, when I ask the question “What brings you here?” and your answer reveals an underlying inflammatory condition, a few follow-up questions will reveal some deeper issues. What’s going on in your life? Your marriage? Your job? Your school? Your plans for the future? Well, now we often discover some rather inflammatory situations worth investigating. Are you fighting tooth and nail with your kids? Are you in the middle of an acrimonious divorce? Are you stressed about money? Do you work in a hostile environment? Are you getting sued? Are your parents ratcheting up the pressure on you? Are you trying—and trying and trying—to get pregnant? Doesn’t it make sense that if you began to work on those deeper “inflammatory” and “painful” challenges, the physical manifestations of the inflammation and pain might begin to abate? If it doesn’t make sense, I wish you and the medical establishment would humor me and try it. Try working on even one of those situations that’s ostensibly outside the realm of your physical health, and see if it doesn’t improve your physical health, too, and soon. I can tell you I’ve done this in my own life, read hundreds of studies that back it up, and seen thousands of my own patients prove it. It might not be a panacea, but it’s a hell of a lot more beneficial than popping pills every four hours.
I’m relieved to find that many doctors are slowly coming to believe that it is these “outside” issues that are the root of most common ailments. That’s especially true of inflammatory conditions. Let’s take one of the most common, persistent, and incapacitating conditions: back pain. Dr. John Sarno, professor of clinical rehabilitation medicine at the New York University School of Medicine, has studied back pain for decades and has treated celebrities like Howard Stern, Anne Bancroft, and John Stossel, who’ve all praised his work. He argues:
Neck, shoulder, and back pain are not a mechanical problem to be cured by mechanical means. It has to do with people’s feelings, their personalities and the vicissitudes of life. Above all, back pain is a reflection of temperament, which is undoubtedly why back pain is so common. Americans are a nation of doers and workers. We take life seriously and responsibly. As our lives become more complex, we generate more and more tension. This is the basis for most back pain.11
Sarno believes the same goes for gastrointestinal troubles, skin disorders, and a number of other common inflammatory conditions, and I agree. So let’s take this idea even further. Let’s say you’re totally committed to doing everything in your power to create a life that’s as free as possible from inflammatory situations. Your goal is to free yourself of back pain and the rest of the Big 8 by reducing inflammation across all aspects of your life. Here’s what you could do for a Phase 2 of the anti-inflammatory lifestyle:
•Avoid arguing. Find other ways to release the energy (talking it out, mediation, forgiveness, leaving unsalvageable relationships and hostile jobs, turning the other cheek, getting couples counseling, etc.).
•Avoid seething. Practice ways to let go of inner pain and turmoil (from loss, from the perceived hurts of others, from regret, and so on). Therapy often works. Faith. Meditation. The help of a spiritual adviser. Walking and other physical activity. Pets. Volunteering. Sewing, tinkering, gardening, or any other benign and unstrenuous physical activity.
•Try to resolve ongoing relationship/work problems. Make a plan to tackle the parts of your life that cause you the most aggravation (another word for inflammation). If you experience peace and harmony in your everyday life, your body will respond in kind. You won’t find perfect solutions, so don’t even try. You can’t control your toddler, your teenager, your boss, that talk-show host of the “other” party, or anyone else for that matter. All you can control is your reactions to them. Don’t let others “inflame” your rage, regret, or fear.
•Seek peace. Find a peaceful place to meditate or relax regularly. Listen to music and watch movies that bring you joy and a sense of calm and serenity. Go out into nature and listen to the birds. At least watch the fish in your fish tank. Play with your dog or cat more often. Find regular relief from work, family, money, and other potential stressors. If you have to, carve out time and earmark energy for peace-seeking activities like gentle hiking, watching the sun set, and sex with someone you love.
•Avoid inflammatory media. Consciously avoid aggravating and incendiary movies and music. This is tough nowadays. Practice a news embargo at least one day a week. Bad news and violent films and lyrics provide fuel to the fire of an already inflamed body.
All these suggestions might fall under the more familiar tent of “reducing stress.” As you know, stress is complicated, but at its core, it raises blood levels of hormones like cortisol, which are likely agents of inflammation and therefore of all the Big 8 conditions—including certain kinds of cancer—that we associate with inflammation. I posit that if you start seriously practicing both phases of the anti-inflammatory lifestyle plan, you’ll get some relief from your condition in as little as a week.
Perhaps you’re skeptical that following this plan could improve your long-term chronic ailment. Can you at least see that you would feel much better if you made even moderate improvements in these areas of your life? If you can’t see that yet, stick with me, and I’ll go into far more detail later. Suffice to say here that the answer to Question 3—Do you understand the causes of your chronic physical conditions?—should lead you to investigate both physiological causes and what we might loosely call “metaphysical” contributors—the things in the rest of your life that tend to resonate in your physical body.
5. Do You Feel a Strong Sense of Purpose in Life?
SOMETHING TO LIVE FOR
This is a big question, obviously, to which I’ve been alluding throughout the introduction and this first chapter. It comes down to a very simple principle, however: What do you have to live for? What would you use your good health for if it was returned to you? If you’re feeling unconnected to the world around you; if you’re floating through jobs, relationships, and homes; if you still don’t know what you want to do with your life or why you’re even here on Earth, then it’s going to be a tough task to maximize your health and well-being. Ask yourself, Who am I? What’s my purpose? Who and what do I value in this life—and why? These are meaningful, powerful questions that are bound to bring up strong emotions. Believe it or not, the vast majority of us in modern Western culture never ask such questions, much less attempt to answer them. This is paradoxical, considering many of us can afford the luxury of such introspection.
In short, most of us now have the ability—the time, the expertise, the resources—to organize our lives around a quest for extraordinary health that incorporates a sense of purpose. Extraordinary health is the achievement of a state of wholeness, living a good life in a state of awareness and harmony with those around us and with the greater universe. Ultimately, health is more than just living well, but is marked by peace and tranquillity throughout your life. To be in this state requires the cultivation of mindfulness; identifying and following your passions and purpose; and the recognition of, and ability to express, your essential authentic self. Yes, it’s true that many (if not most) of the world’s population still seems bound by desperate imperatives like staying alive and subsisting, preventing them from fully exploring such an ideal. But is that true in your life? Can you not afford to take care of yourself? Can you not find the time, the energy, or the tools you need to live skillfully—for as long as possible, in the best health possible, with the best attitude about your health? I think you probably can. And if you truly can’t, it would obviously be essential for you first to work diligently on those real obstacles to your achieving health.
However, as a wise early goal, regardless of your relative freedom to expand your health, it’s good to think about your purpose in life. For example, at this point in my life, I have come to realize that it’s my life’s purpose to join and guide others in their quest, and help them achieve the health and happiness they seek. That’s why I find it so distressing to see people wandering aimlessly, living without clarity and a higher purpose, and suffering needless physical and psychic pain. The direction of our lives is not predetermined, but when we walk the path into the unknown with purpose and intention, we can grow at every turn. I think you probably get this idea. Thirty million of you read Rick Warren’s The Purpose Driven Life,12 which has been credited with stopping crimes and saving lives.13
So what’s your purpose? I’ve heard others answer in the following ways, in case you’re looking for ideas:
•To experience life fearlessly to its fullest, in all its iterations
•To raise a family I can be proud of
•To contribute meaningfully to the field of poetry and literature
•To serve God
•To never stop learning
•To live up to the gift of my consciousness and the blessing of my senses
•To see as much of the world as possible before I die
•To educate children
•To experience joy, dancing, singing, and bliss as much as possible
You might notice from this list that one’s purpose can take two forms: what spiritual teacher Eckhart Tolle calls an “outer purpose,” and a corresponding “inner purpose.”14 An outer purpose is what you do (“My purpose is to dance professionally in the vanguard of new African American choreography”). From the point of view of your health, this is central. Indeed, as Rick Foster, Greg Hicks, and Jen Seda write in their book Choosing Brilliant Health,“You must make central to your life the things you love by acting on them.”15 Health researchers Foster and Hicks conducted years of study on how we find and maintain happiness and good health. One of their central conclusions is that when we go out of our way to engage in activities that uplift and stimulate us emotionally, we get happier. That makes intuitive sense. But they also cite colleagues’ studies to prove that “doing what we love increases our satisfaction levels, which correlates strongly with greater longevity.”16
Think back to your symptoms again. Not too long ago, my nineteen-year-old son, Malcolm, was suffering from a series of sore throats. In my mind, the pressure of final exams during the spring of his freshman year at a competitive college was affecting his immune system and causing inflammation, which settled into a vulnerable area—the throat. It wasn’t really important to me whether his sore throats were infectious or not. I knew that he’d recover when his exams were over. But to my surprise, he got better sooner. Why? Because his favorite band, Phish, had just announced its summer tour schedule, and he and some friends made plans to attend an epic six shows in a three-week span. A miracle Phish cure? No. Just a reflection of the healing power of passion. My son’s outer purpose was his commitment as a fan to this talented group of musicians. Their music made him happy, made him dance, made his spirit rise—and made him healthier. This has been going on since long before Phish and the Grateful Dead and even the lyre was heard over the hills, all the way back to drum circles and catgut strings that mimic the rhythms of nature.
The inner purpose is different and quite a bit deeper, although it’s helpful for it to be aligned with the outer purpose. While Tolle insists that we should all have the same exact inner purpose—to “awaken” and share that awakening with others—I think there’s a lot more room for individual development in this area. I believe you should think of your inner purpose not so much in terms of what you do (teach, sing, travel, raise kids) but rather in who you are, which can extend past the apparent limitations of “teacher,” “singer,” “traveler,” or “parent,” if you consider those designations creatively, into something more sublime and perhaps harder to put your finger on at first. It’s the thing that makes you you, the thing at your core that makes your life worth living, preserving, protecting, and celebrating.
THE HEALING EFFECTS OF PURPOSE
The Japanese have a word for this sense of purpose, which loosely translates to “something to live for”: ikigai. It’s a very old tradition, with some very new science to back up its efficacy for health. In three recent Japanese studies, people with ikigai fared better—in some cases much better—than their counterparts without ikigai when it came to surviving heart attacks and strokes.17 You’ve all heard stories of people who lost their life mates, got sick, and just “gave up” or “willed themselves to die.” It really happens; I’ve seen it many times. But it’s proof that you can also will yourself to live. It’s obviously much, much easier to find your ikigai when you believe in your heart that you have something to live for.
Do you think you’re too old to develop a life purpose? It’s never too late! Finding a purpose is, in fact, not typically the province of the young. But it can help you live a longer and happier life, even when you adopt it late in life. Research conducted by Ageing International synthesized more than seventy prior studies on the effects of a purpose-driven life on the body, and found that a personal sense of purpose in life led to better long-term health through middle age and into old age. A lack of purpose was found to be associated with boredom, hopelessness, depression, and the loss of the will to live. More than half of individuals who have a sense of purpose in life have above-average health.18 It works the other way around, too. Another recent study found that the risk for Alzheimer’s disease in the elderly increased when the patients did not have a strong sense of purpose. Those who had a strong sense of purpose were twice as likely to remain free of the disease than those with a low sense of purpose. The results suggest that deriving meaning from life’s experiences, and having a goal-oriented mind-set, substantially reduces the rate of cognitive decline in old age.19 Other studies back up these findings relative to Alzheimer’s and related conditions.20
This sense of purpose can lower the risk of ailments as banal as the common cold and as brutal as the most aggressive forms of cancer.21 Dr. Martin Seligman, a pioneer in the study of health and happiness, reviewed eighty-three studies on the effects of pessimism and optimism on mortality from all causes, mortality from cardiovascular disease, immune function, and cancer, and found statistically robust results. He looked at eighteen studies on cancer, including a Women’s Health Initiative Study involving 97,252 patients, and concluded that, controlling for other risk factors for cancer, negative mental states like pessimism and hostility are significant predictors of cancer.22 Bottom line: optimistic patients, including those who have a strong sense of purpose, fare better.23
DISCERNING PURPOSE: SOME KEY POINTS
In your quest to divine and develop your own, unique life purpose, keep a few things in mind. You should write your purpose down and solidify it. Keep it short. If you can get it to one or two sentences, great. If you can further distill it to one or two words, even better. It helps, too, to think in images and metaphors. Bring your written purpose out once in a while to tweak or to remind yourself what you’re all about when you’re feeling lost, misdirected, or kicked around, Nixon-style, by life. Below are some features an ideal purpose would comprise, with some examples of others’ purposes to stir your creativity. Your purpose should be:
•Consistent with your values, morals, and ethics. It’s the essence of who you are and what you do; it’s the attribute of which you’re proudest; it reflects your core beliefs. It’s honest and true to you and only you. You’ve chosen it of your own free will. It’s how you want others to think about you; what you want them to say about you at your funeral, or to carve on your tombstone along with your name.
The piper: “My purpose is to find joy and share joy for myself and others through music, whether from my instrument, my voice, or the rhythms and harmonies of the universe.”
•True to universally embraced principles. It isn’t incompatible with our shared sense of right and wrong (i.e., it doesn’t infringe on the rights of others); it doesn’t upend the natural and intuitively “right” balance of values, by placing, for example, a selfish value like greed above a generous one like altruism.
The scholar: “My purpose is to learn wherever, whenever, however, and from whomever I can; to always find opportunities for growth and development of my mind through sharing the wisdom of others and the earth, and to pass on what I’ve learned to others through my writings and teachings without ever succumbing to didacticism.”
•Satisfying and bliss-producing. It really gets your juices flowing. It makes you happy to think about it, plan it, learn it, do it, teach it, dream about it, and remember it after it’s done. If it’s the last thing you’re thinking, believing, or doing when you die, it’ll be, as the Native Americans say, a good day to die.
The healer: “My purpose is to learn and practice natural, holistic ways to heal my body and my psyche, then share them with others through the confluence of medicine and spirituality, wherever I’m needed most, and to ensure I take proper care of myself so I can be there to help heal others for as long as possible.”
•Varied enough to hedge against boredom. It has sufficient variety to keep you on your toes; to keep teaching you new things; to prick up your creative ears; to sustain you during dark times; to encompass your multiple interests, talents, and beliefs.
The leader: “My purpose is to seek and carry out various ways to bring my community and other communities together in pursuit of peace and positive change that raises the least among us to the highest.”
•Resonant throughout all facets of your life. It reflects both what you do and who you are; it provides a metaphor for the whole way you live your life and interact with others and the environment.
The warrior: “My purpose is to stand up and fight for justice and fairness wherever it needs an advocate, and to do what’s necessary to uphold those principles, especially for those who cannot fight for themselves.”
•Meaningful, contributory, and legacy-building. It’s important enough in the grand scheme of things to matter beyond selfish and transitory desires. It—you—will leave a positive legacy long after you’re gone, either on individuals, society, or the world as a whole.
The philosopher: “My purpose is to strive to use my mind and encourage others to use their mental faculties to think deeply about the betterment of our collective, human future, and to execute courses of action to promote wise, sustaining principles.”
•Healthful. It works in accord with your good health and the good health of others; it doesn’t flout the natural laws of health by endorsing dangerous or irresponsible behavior. Its practice promotes longevity, vitality, and strength.
The ecologist: “My purpose is to do my part and beyond to respect, uphold, and help restore the natural environment around me, including all nonhuman creatures, and to do whatever I can to leave the world in the same or better shape than it was before I entered it.”
This exercise should not be stressful—“Oh my God, what the hell am I doing with my life? I have to find a purpose by eight thirty!”—but rather meditative, contemplative, and restorative. It will probably take some time, and it might require some counsel from people you trust and love. It’s amazing how quickly your loved ones can identify what they think you’re all about, even when you have no idea, and it’s amazing how close they get sometimes to what you believe but haven’t yet articulated. One of my patients, for example, asked her husband what he thought her purpose was. He said, “Look around!” All over their kitchen were the six dogs they’d recently rescued from a hurricane. “Oh, yeah,” she said.
A note: if you’re experiencing a serious depression, it can be very painful and very difficult to contemplate, no less articulate, a life purpose. Which comes first here, the chicken or the egg? Are you depressed because you’re purposeless—or purposeless because you’re depressed? These are questions that get to the very heart of integrative medicine, though I don’t think the answer per se particularly matters. What matters is restoring balance and achieving health in the larger context we’ve been discussing. If you’re suffering, know that you do have a purpose underneath the pain. I want you to keep reading.
6. Do You Believe It’s Posssible to Achieve Genuine, Extraordinary Health?
HOW GOOD CAN YOUR HEALTH GET?
If I asked you whether you thought you could ever be truly healthy, there’s a good possibility that your knee-jerk response would be “No way. I’m too sick. I’m too fat. I’m hurting too much. My genetics work against me. It’s too late.” While some of these details might be true, your opinion about their implication is a reflection of what you have been taught and the society in which you live: your conclusions might still be false.
So as you embark on this journey, I urge you to look in the mirror and understand the basis for your current belief system. You might realize that the things you have until now accepted as truth are not absolute, but full of gray areas. In fact, every day we see new ideas, experiences, arguments, and studies challenging even centuries-old beliefs and assumptions. Recently, the very foundations of Christianity were shaken by the discovery of the Book of Allogenes, which scholars now recognize as the only known surviving copy of the Gospel of Judas. Judas! Now there’s an alternate perspective on long-accepted “truth.” In the field of medicine, which generates so much of the “expert advice” about health, new information and discoveries show us that some of the most time-honored medical practices are simply off the mark.
Remember, the truth, as we have come to know it, can change at any moment, and just might shake our foundation to the core. Therefore, modesty and humility are a necessary part of this new awareness. It’s critical to accept and embrace the idea that there might be another way of looking at things. The good news is that even if you’ve been told you’ll never get healthy, you can.
To live skillfully, you might need to shift perspective and alter your course. For some, this could entail nothing more than going to bed an hour earlier. Others might discover that a major shift is in order, such as switching careers or reassessing a marriage. You know now that adopting a new framework for living is not strictly about our physical bodies—avoiding disease or losing weight, looking better and simply living longer—but using personal challenges and obstacles to help find the path to a richer, more authentic existence.
I want you to stop reading at this point and just reflect. Think about the possibilities that are out there for you, health-wise. Believe—really believe and incorporate that belief into your daily thinking process—that you can, that you will, achieve genuine, brilliant health. It may not have worked yet, I know. But why not? Because you’ve probably been going about it the wrong way, thanks to decades of conditioning. There’s an old adage, popular in recovery programs, and attributed variously to two of the smartest guys of the past few hundred years, Ben Franklin and Albert Einstein: Doing the same thing again and again and expecting different results is the very definition of insanity.
Stick with this. Start the next chapter with verve and excitement about the new life you can make for yourself, about the extraordinary health that awaits you on the sane side of the street.
Throughout this book, I’m going to offer you some “bonus materials.” These will take two forms. The first will be further, practical exercises (but I’m a doctor, so I’m going to call them “prescriptions” instead) designed to get you thinking and moving forward. They will require some action on your part. Please set aside some time in your life to really give these Practical Prescriptions the time and energy they demand. You won’t regret it. The second will be bonus questions for further reflection, which I hope you will endeavor to answer for yourself; these are largely self-explanatory.
PRACTICAL PRESCRIPTION 1: WHAT ARE MY SYMPTOMS OF HEALTH?
Most of us are so habituated to looking for disease that we rarely pay attention to the health we already possess. We live in a culture where the complaint is king—where we expect things to be a certain way and where we have a meltdown or simply give up when they are not. What might our lives be like if we “celebrate instead of complain,” in the words of motivational speaker Donna Hartley, who survived a fatal plane crash, stage III melanoma skin cancer, and open-heart surgery?
Indeed, there are few experiences more humbling than speaking with young and wounded soldiers recently back from war. They tend to define “health” not in clinical, symptom-based terms but rather in terms of spirit, courage, inner strength, conviction, hope, problem-solving ability, proactivity, and camaraderie. While they have endured loss, they are vividly aware that they could have lost so much more. As a result, they live in appreciation of what they do have.
When struggling with our health challenges, it is helpful to learn about others who have transcended their own limitations. From professional dancers without legs, who move with wheelchairs and prosthetics more gracefully than most of us use our feet, to health and wellness leaders who thrive despite their own “diseases,” examples abound. What mindset empowers these individuals to transcend their limitations, and how can we adopt this mindset, to shift from surviving to thriving?
So this first Practical Prescription asks you to turn the complaint habit on its head. Ask yourself: What’s working about my health? Look for symptoms of well-being. Frame these questions in the positive. Write them down. I encourage you to come back and add to your list as you progress through this book. As you become more skilled at finding health, your list should get longer, and the items more indicative of expanding health. The following are just examples, not benchmarks to strive for. Your health is your own. Give yourself credit for any health achievement, no matter how small you think it is, because it’s all relative. And don’t forget that extraordinary health extends well beyond the physical:
•I can play catch with my dog for ten minutes before getting winded
•I can pick up my granddaughter
•I can breathe and appreciate the scent of my garden
•I can dance to the first three tracks on the new Lady Gaga album
•I can get up and down the stairs
•I can appreciate the beautiful scenery
•I can hike all day if it’s flat ground
•I can shovel my neighbor’s driveway
•I can feel grace and blessings when I look at my family
•I can bowl two games in a row
•I can use all four of my limbs to get through my day
•I can finish a marathon in eight hours
•I can be grateful for my wonderful career as a nurse
•I can wheel myself to the store without my arms getting tired
•I can think, pray, believe, hope, remember, wonder, and plot my future
QUESTIONS FOR FURTHER REFLECTION
7. Do You See an Alignment Between Your Personal and Professional Goals?
8. Does Your Job Use All of Your Greatest Talents, and Is It Enjoyable and Fulfilling?
It’s simple: The more you get to do what you love, the less it feels like a job, and the more it feels like a healthy, rewarding, and balanced life. We spend so many hours either at work or thinking about our career that it’s ideal if we don’t compartmentalize it, but rather integrate it into our overall health plan.