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Melanie Cole, MS (Host): Expert Insights is an ongoing medical education podcast. The Carle division of continuing education designates that each episode of this enduring material is worth a maximum of .25 AMA PRA Category 1 credit. To collect credit, please click on the link and complete the episode’s post-test.

Healthcare providers are taught about how to treat illness, but not necessarily taught to effectively help patients, and themselves, to prevent and reverse chronic disease through lifestyle. Here to tell us about lifestyle medicine is Kiley Owen. She’s a physician assistant in the clinical decisions unit with the Carle Foundation Hospital. Kiley, what’s the current state of disease today? How is it related to our unhealthy behaviors?

Kiley Owen, PA (Guest): Well, thank you so much for having me on here Melanie. It’s great to be here. So today we know that, well the CDC wells us that about six out of ten U.S adults have a chronic disease. About four in ten have multiple chronic diseases. And we know that chronic disease is the leading cause of death and disability in the United States, and it’s what the vast majority of healthcare money is spent on. But we also know that if we could just do a better job on the lifestyle front, it’s estimated that nearly 80% of the chronic disease burden could be prevented.

Host: Kiley when I was in school- I'm an exercise physiologist-- our concentration was on that, lifestyle modifications and the physiology and the profound effect that exercise has. Do you feel—and this is your opinion—that medical professionals are getting that education now that they may not have been getting 20 years ago? Do you think the medical community is kind of catching up in the education department?

Kiley: I do. I think you’re really starting to see a shift in this direction, and I think that that is exciting. You're starting to see a lot of healthcare institutions, medical schools developing innovative programs that go more in-depth into a lot of these lifestyle areas taking a more holistic approach to care. I think that’s really, really exciting.

Host: I do too. I also think that so many aspects of that kind of care are all coming together. Whether it’s acupuncture, chiropractic, physical therapy, nutrition, dietetics. They seem to all be kind of coming together, as you say, to treat the whole person. Tell us what lifestyle medicine is and how is it typically practiced?

Kiley: So, lifestyle medicine is the evidence based lifestyle therapeutic approaches to prevent, treat, and reverse chronic disease. So that includes things like healthy diet, regular physical activity, adequate sleep, stress management, avoiding substance abuse, and healthy relationships. You might be thinking—or at least I did when I first heard this term lifestyle medicine—I thought well gosh. It kind of sounds like common sense. I mean it kind of just makes sense that we should do these things for good health. Even though this may be common knowledge to some extent, it is not commonly practiced. As we touched on before, the result is plain and simple chronic disease. Lots and lots of chronic disease.

What lifestyle medicine does is really look to address the root cause of a lot of these chronic illnesses to take a deeper dive into behavioral change and to really focus on getting the lifestyle healthier so that we can minimize the need for medications and procedures. So instead of adding more medications to the mix, the goal is to actually help patients off of some of these medications or to prevent them from ever needing them in the first place.

Host: What are some of the basic principle of lifestyle medicine? When we’re thinking about it, people hear lifestyle medicine and they might think alternative medicine or eastern medicine or complimentary medicine. What’s the difference between some of those and integrative medicine and lifestyle medicine?

Kiley: That’s a good question. I do think you're starting to see more and more of a mix between western practices and eastern practices, and just really more of an open mind in general about what health and healing is. I guess what my answer would be would be that lifestyle really focuses on the actions that we can take in our everyday life and tries to not focus so much on external things to make us well. So, it’s less about supplements and things like that. It’s more about how we are leading our life.

Host: That’s so interesting. People think as medicine as a way to treat a disease or treat a condition. But this is a little bit different because we’re trying to not only prevent the condition but treat the person with a healthier lifestyle. Tell us some of the challenges of practicing this type of medicine when you can't always get to the person before. People don’t tend to go see a doctor if they don’t feel sick. So, what are some of the challenges? How do you get to people?

Kiley: Right. That’s the thing. It’s one of those things that we—I think if you asked anybody they would say yeah. Health is important. But it’s also one of those things that can easily be pushed to the backburner if we’re not directly seeing the results of that. So, unfortunately, we’re taking care of these other urgent matters in our life that are maybe not as important, but they are more urgent. Time goes on and we keep pushing it to the backburner, pushing it to the backburner until eventually it does become a hot problem that we can to take care of. So, unfortunately, that happens a lot.

I think that, for one thing, education to help patients understand the trajectory that they may be on even though they may not be seeing some of the results of that yet, what those complications are. For those who are already running into some problems, for example, with chronic diseases, understanding lifestyle is very potent. It works. When patients do it, it works, and it works pretty quickly. So, I think it’s a message of hope saying that yes, we do need to put you on this medication today. However, depending on how motivated you are to make changes, this may not always be the case for you.

Host: True. I think one of the changes that people think about—I mean we hear about smoking, exercise, all of these things, but stress management, sleep quality. Some of those kinds of things, right? Those are the ones that we’re seeing so many more links to diabetes and obesity and heart disease. Stress. Kiley speak about how you would go about helping somebody because we’re all feeling it. Whether you're a healthcare provider or a regular person, we’re all feeling that stress. As you say, we have to work on our own situations before we can put the mask on those that we love or our patients. So how do we work on the stress whether it’s on ourselves or with patients?

Kiley: Exactly. That’s a very good conversation point. So, we know from the American Psychological Association, the APA, that the majority of Americans are suffering from moderate to high stress. The problem with stress is that stress, in itself, is very bad for your health. It leads to a whole bunch of different physical conditions. Everything from ulcers to heart attacks to chronic pain to all sorts of things. The unique problem with stress is that often instead of managing stress in healthy ways, we’re often indulging in unhealthy behaviors. So, it further complicates the problem. So that’s when you start getting into substance abuse or self-medication with food or whatever else is kind of taking away the problems that are brought on by stress. So, I hear you. That is a big one.

The other thing is just understanding that our bodies have a lot of self-healing mechanisms in place, but we need to give our bodies the right conditions to be able to function well. Keeping stress at bay is a huge, huge part of that. I think a lot of it has to do with our culture. We live in a culture where we’re doing more and more in less time and just packing a lot in. There’s just not a lot of time for rest and recovery. I think just a lot of it has to do with the frantic pace of life that we keep. So, a big part of that, I think it’s individual to individual. Just trying to look into our own life to see where can we perhaps say no to some things. Where can we perhaps change our priorities and realize where our values really are and where we want to place more focus.

Host: Kiley, when you're working with patients, because I think that maybe one of the things that people wonder about with lifestyle medicine or some of the other forms of complimentary medicine are the training that you have. It’s always been sort of a bane for personal trainers to give nutrition advice or nutritionists to give exercise advice. You know that crossover where maybe the qualifications are not there. What would you like other providers to know about the training that you have in lifestyle medicine? Or when they’re recommending a practitioner in that form of medicine, the training involved to be able to give that very important nutritional advice and exercise and looking at stress and sleep and all those other factors.

Kiley: I think ideally—and hopefully we start seeing more and more of this in healthcare—ideally you have a model or care where the patient is in the middle and you do have these experts in different areas that work together to get this patient better. So, you have that person who’s really good when it comes to the exercise. You have that person who’s really good when it comes to the nutrition. You’ve got this other person who’s really, really good when it comes to mind/body. Now most of us, granted, are not working in that kind of environment, but maybe one day that’s much more the norm.

I do think that there are things that we can do right now in our current practices, whatever that may be. Whether that be in patient or whether that be as a primary care provider to just do a better job of understanding some of these things and how we might address these things a little bit better. But it’s also understanding too that I may not be the best person to go over a particular topic, but if I know who to refer that patient too then that’s going to be helpful.

Host: As we wrap up, tell us your vision for lifestyle medicine and what you want other providers to know about how the more we focus on lifestyle medicine with patients, the better we get at practicing what we preach. Something certainly that many healthcare providers deal with on a daily basis, but what would you like them to know about this form of medicine and helping their patients with it?

Kiley: I think that the more we dig into this area of lifestyle and the more we try to get better at it with patients, I think in my own experience it’s a lot of fun, it’s very rewarding. I think that there’s a lot of enjoyment there. I can think of five things right off the bat that have changed in my own practice over the last few years that I think has made a big difference. If you’d like, I can go into those.

Host: Sure, do that.

Kiley: So, one thing, I think, number one, I think we need to change our definition of medicine. We need to realize that medicine does not have to come in a bottle. That food is medicine, movement is medicine. Sleep, fresh air, healthy relationships. All of these things are medicine. The other thing to keep in mind is that iatrogenic illness is the third leading cause of death in the United States. So, when it comes to medications, sometimes less really is more. We need to really think hard before we throw another medication into the mix and think what is going to be in the best interest of the patient.

The second thing I would say is that—and this is a little bit tough love—but sometimes we need to be brutally honest with ourselves and we need to say, “Hey. How good of a job am I doing in this area?” A few years ago, I did this myself and sometimes the truth hurts. When I looked at my own life, I was eating junk all the time. I was not exercising. I wasn’t getting good sleep. I was stressed out all the time and running on caffeine. How can I really relate to a patient if I'm not doing those things in my own life? So, I think when we take a deeper dive into those things with our own life, not only can we help patients more in that way, it’s also improving our own quality of life.

The third thing I would—which is huge, this has been a game changer for me—is to learn motivational interviewing. This is kind of a counseling technique, but it’s much less about lecturing and giving advice. It’s much more about listening, asking questions, and helping patients to find answers that are going to work in their own life. So that’s something that can be really, really helpful. The fourth thing I would say is that we need to educate ourselves better on nutrition in particular because this is something that hasn’t traditionally been focused on in medical education. In fact, only about a quarter of medical schools offer a single course in nutrition. I don’t know the stats on PA schools, but I would imagine they're pretty similar. So, we need to be diving in to some of this nutritional research and realizing that food is medicine.

Then fifth, I would just say this is an opportunity where we can really give hope to people, where we can really empower patients. It can be a lot of fun and it can really help to make our work meaningful and enjoyable.

Host: I couldn’t agree more. What a great segment. Kiley, thank you so much for coming on. Really such an interesting topic and the way that so many healthcare providers today, as we all come together, really should be practicing medicine. Thank you, again, for coming on with us. You're listening to Expert Insights with the Carle Foundation Hospital. For a listing of Carle providers and to view Carle sponsored educational activities, please visit carleconnect.com. That’s carleconnect.com. We hope the information gained will be applicable to your work and life, and I certainly think this segment will. This is Melanie Cole. Thanks for tuning in.