Melanie Cole, MS (Host): Welcome to Back to Health, your source for the latest in health, wellness, and medical care, keeping you informed so you can make informed healthcare choices for yourself and your whole family. Back to Health features conversations about trending health topics and medical breakthroughs from our team of world-renowned physicians at Weill Cornell Medicine.

I'm Melanie Cole. And today, we're learning about Integrative Medicine and Lifestyle Medicine guidance for women as we age. Joining me is Dr. Michelle Loy. She's an Assistant Attending Physician at New York-Presbyterian Hospital Weill Cornell Medical Center, and an Assistant Professor of Pediatrics in Clinical Medicine at Weill Cornell Medical College Cornell university.

Dr. Loy, thank you so much for joining us. I'd like you to start by telling us about Integrative Medicine and Lifestyle Medicine. What are they and how have they come onto the scene and changed the way that we look at wellness and the whole person?

Michelle Loy, MD: Thanks for having me, Melanie. Of course. Let me start off with what Integrative Medicine is, and then I will cover what Lifestyle Medicine is. So, Integrative Medicine is a rapidly evolving field. It combines and blends in a coordinated fashion, both conventional care, things like medication, surgery, radiation, with evidence-based complimentary therapies. And the goal is to treat the whole person physically, mentally, and emotionally.

The key thing is that it should be under the coordinating care of a dually trained board-certified physician specialist. Now, some of the key components include things like nutrition, food as medicine, culinary medicine, mind-body practices, herbal medicine, manual therapies like massage or osteopathy, whole medical systems, Ayurveda; traditional Chinese medicine, including acupuncture, Tai Chi, Qi Gong; social connection, purpose and lifestyle modifications in clinical care. And we emphasize the roles of these tools in preventative care to promote resilience, manage chronic conditions and support overall well-being in all ages, from children, adolescents, to adults.

Some of the other key components in Integrative Medicine is that it affirms the importance of the relationship between the practitioner and the patient. It's informed by evidence, and it makes use of all appropriate therapeutic approaches, healthcare professionals and disciplines to achieve optimal health and healing.

People often ask me, "Well, what's the difference between Integrative Medicine and Lifestyle Medicine?" I think of Integrative Medicine as Lifestyle Medicine plus. So, Lifestyle Medicine focuses on several pillars: nutrition, sleep, exercise, stress management, healthy relationships, and avoidance of risky substances, both for the prevention and the treatment of chronic disease. Then, people ask me, "Well, what's Functional Medicine?" Functional Medicine is a systems-based approach that focuses on disease roots and prevention, but it has a pretty heavy emphasis on laboratory testing and supplements. So, I think of Integrative Medicine as being the overall umbrella with other aspects like lifestyle, medicine or functional medicine, included in that. Neither Integrative Medicine or Lifestyle Medicine are alternative medicine, and I define that as non-evidence based therapies used in place of conventional care. So, we are not using any non-evidence based therapies and we are not replacing conventional medical care. I hope that was helpful.

Melanie Cole, MS: That was helpful. What a great explanation, Dr. Loy. And I love the way that you put that, evidence-based medicine. Because nowadays, there's so much misinformation that goes all around, both in the media and on the internet, and people don't know what to believe. So, thank you so much for stressing the differences there.

Now, as women, I'm in my 60s, which is ridiculous for me to say, how do our health concerns change as we women age and some of the most common women's health issues that you have come across in your career? Just what are some of the things that we need to look out for?

Michelle Loy, MD: Sure. So, I'm going to start with the pediatric and adolescent population, and then I'll move through. So, I think of it, three buckets of common reasons for consultations in the pediatric adolescent population: physical ones, things like functional abdominal pain, irritable bowel, sometimes we'll see some migraines, chronic fatigue, frequent illnesses. And as we move into the adolescent years: dysmenorrhea, irregular menses, sometimes some PCOS. Of course, metabolic issues, whether it's over or underweight. We are seeing some diabetes and hyperlipidemia. And then, also things like chronic pain, juvenile, rheumatoid arthritis, fibromyalgia. These are some physical reasons. Emotionally, common reasons for consultation include things like anxiety, depression, OCD, tics, disordered eating, emotional dysregulation and even sometimes some substance abuse, including cannabis hyperemesis. Cognitive reasons might be things like ADHD, executive functioning concerns or developmental learning disabilities.

When we move into the young adult age group, we see a lot more things like PCOS autoimmune conditions like Hashimoto's; again, dysmenorrhea, irregular menses; still ADHD, anxiety, depression, chronic pain. And then, maybe we start to have concerns about fertility.

Then, when we get into the perimenopausal age group, after the fertile pregnancy years, then we have concerns about weight, memory, mood, cancer, not just the breast, ovarian, uterine, cervical, but we're also at risk for other non-female-specific organ cancers like colon, skin, lung cancer. This is a time where many women have perhaps launched their children. They've become empty nesters. They are the sandwich generation, taking care of parents, and the time where they may not be taking time to go to their screening. So, this is a very important time to focus on their own health as well.

And then, postmenopausal, common concerns are bone health, brain health. We have a number of group visits I've started on these topics. And one thing I tell my patients is there's ample evidence that exercise in midlife really protects cognition later in life. It's also good for the heart. And then, there's this wonderful Ornish trial that showed lifestyle interventions being able to reverse mild cognitive impairment.

So, those are some of the conditions that we often get consultations for across the female lifespan. And then, I wanted to add another one that's across the board is the neurodivergent conditions. And regardless of age, I find in particular the tool of genomics can be very helpful in those conditions, in guiding lifestyle integrative recommendations, knowing which vitamins and supplements and interventions that are most likely to help.

Melanie Cole, MS: This is so interesting. What a cool field you're in, Dr. Loy. And as we look at our teenagers and in the teen years, mental health, especially right now, there's a mental health epidemic with our youth and it's scary and it's sad to see. And as we see these anxiety disorders, eating disorders, we think, "What can we do to help them?" Speak about screening for these and what you want young women to know about taking charge of their mental health, because this epidemic is just really all around right now.

Michelle Loy, MD: Yes, it is. And I'm glad you brought this up. So actually, disordered eating is common in teens, but I've seen it in my practice throughout the female lifespan. I have patients in their 70s and 80s that struggle with this. So, I ask every one of my patients, regardless of age, in the course of my intake, if there is a history of disordered eating. And as integrative and Lifestyle Medicine physicians, I feel like it is even more important to identify such patients because sometimes clinicians may inadvertently cause more harm by introducing, for example, a therapeutic elimination diet or suggesting a data tracking device like a continuous glucose monitor or a food log in such patients. So, we need to have a very healthy awareness.

Now, as far as what we can do, in my practice and as a pediatrician with pediatric training, I'm big on emphasizing developing a healthy relationship with food and body image from the youngest of children. I wrote a piece, in Contemporary Pediatrics, about how to talk to children about weight. And I cannot emphasize the importance of family meals, positive times around the table, a time for connection. I love using food as medicine, culinary medicine, gardening, cooking together with children, recipe development, even doing little fun activities like the Chopped reality TV show where you provide different nutritious foods and have the children come up with their own dish. It allows them to explore different foods and putting them together. And if they come up with the recipe and cook it, they're much more likely to try it. Doing physical activity together, hiking, walking together, emphasizing health and strength and well-being rather than body size. These are things that I think are very important to implement at all ages.

And then, I will emphasize with the adolescent population, there are studies showing, even the use of protein, creatine and dieting supplements among adolescents being associated with eating disorder risk factors and changing the types of sports participation. And then, there's the other condition of relative energy deficiency in sports where this is something that affects both male and female athletes. And so, when I talk to teens, it's important to emphasize, I think, the healthy behaviors, training, nutrition, sleep, and recovery first. And when they ask about supplements, this is when I like to tell them that that's sort of like the cherry on top. If there's an actual vitamin deficiency, by all means, yes. But be aware that supplements can carry potential risks, and it's something that they need to speak to their healthcare provider about.

Melanie Cole, MS: So, that leads us well into the next question here, because there's an exploding interest on social media for these supplements. And as you talked about disordered eating and kids are looking towards these things, can you help us identify those science-based therapies that show what ones are safe and effective and concordant with the perspectives that we're looking for, with the answers that we're looking for? Because it's dizzying, Dr. Loy.

Michelle Loy, MD: It absolutely is, and that is why I think a major take-home from this piece is that you do need to work with a well-trained Integrative Medicine, Lifestyle Medicine practitioner to wade through all of these confusing questions. So, any practitioner, whether it's acupuncturist or massage therapist, you need to look for practitioners who are formally trained and professionally licensed, right? So as you mentioned, there is an exploding interest on social media for supplements, even peptides, all manner of weight loss, muscle building, longevity hacks. And more than ever, it is so crucial especially with this increased distrust in science, it is so crucial that patients and families work with credibly trained practitioners who can identify these evidence-based therapies that are safe, effective, and concordant with the perspectives, beliefs, and cultural values of our patients.

I am particularly concerned about a growing trend among young preteen girls, the Sephora kids, and this non-medical term that's come up called dermorexia, which basically describes compulsive skincare routines around anti-aging and acne prevention. And they're often thought of as being harmless or cute, but they can really confer very serious dermatologic consequences, especially in children that have preexisting risk or barrier-defective skin. Children are not little adults. They have thinner stratum cornea. They have more water loss across the skin. They have a much more vulnerable lipid matrix. And so, if you can combine that with these adult-formulated creams and things that can be a perfect storm for irritant or allergic contact dermatitis. And more and more, we are seeing very serious rapidly progressing rashes from these creams that don't even respond to like a steroid.

The other concern I have is over a lot of popular teen supplements. Many times, they can be tainted with weight loss or bodybuilding prescription-drug ingredients or even caffeine-containing herbs that can cause life-threatening arrhythmias. Many of these supplements are not tested on children, and the side effects can be different from adults. There's a lot of misinformation and potentially harmful supplements that are provided to teens by retailers. This actually has been published and things like creatine supplements, which people use it to enhance their strength or muscle mass endurance. But these can also have side effects. So, these need to be discussed with your healthcare provider.

And finally, I would say it's not just the teens. This peptide craze using off-label and non-FDA approved peptides with these putative anti-aging effects or other unsubstantiated health claims endorsed by many wellness influencers and celebrities, many of these do not have evidence for benefits in humans using randomized controlled trials. And some are even banned by the world Anti-Doping Agency, things like BPC-157. And there is concern for, for example, potential risk of cancer and acceleration of, for example, dormant tumor growth. We don't know the proper dose purity, the potential contaminants, the long-term impact. And of course, the FDA approved GLP-1s, 12% of Americans are estimated to be taking it. But they also do have some side effects that have to be considered from GI effects to loss of muscle mass, to even potential mood changes.

So, there is an interest in wellness, longevity. There is a lot of marketing around with or without oversight. And it's very important more than ever that patients and families discuss these with trained healthcare providers.

Melanie Cole, MS: Wow, you're giving us so much great information. Dr. Loy, give us some strategies briefly that women can use to put our own health higher on our priority list, because the thing is that we need to put our own masks on before we can put on the masks of our loved ones. If we don't take care of ourselves, we cannot take care of the ones that we love.

Michelle Loy, MD: Yes, absolutely. So, I'd say make time to exercise. Make time to sleep. Prepare nourishing food that is easy to prepare, delicious and healthy. If you can link your purpose-- we call it in the Blue Zones Ikigai or your Plan DaVita, if you can link your purpose to the above health behaviors, that helps a lot.

I would say surround yourself with health-minded buddies, whether it's group visits, Walk with a Doc. There are YMCAs and JCCs and faith-based community groups. Those are all really helpful, and that's also why we started so many different group visits because it really helps patients. And then, prioritize your screenings and checkups just as much as you do for your own children.

Melanie Cole, MS: Now, what about food as medicine? We're talking about nutrition a lot in these discussions that we're having, and really we've heard more and more about food as medicine. Can you tell us what you feel are the most important things to consider when we're trying to eat healthy?

Michelle Loy, MD: So it's very simple. Eat real foods, focus on vegetables, fruits, whole grains, legumes, nuts, seeds, herbs, spices, prepared simply and maybe with traditional ways, things like fermentation; probiotic-rich foods. Don't be distracted by the food fads and all the winds of change that come up every few decades.

 If you look at the data, the Mediterranean diet, the DASH diet, the Diabetes Prevention diet, the portfolio diet, the whole food plant-based, these all have very similar commonalities, and that is they all focus on the whole unprocessed foods. They have varying amounts of fat. Mediterranean is more like 30%, whole food plant-based is more like 10%. But the commonalities are that they focus on whole unprocessed foods.

Don't be distracted by-- unless you have celiac-- gluten-free or sea oils versus tallow or grass-fed, don't get distracted by all of that. Focus on the unprocessed real foods. Stay away from processed snacks and sugar-sweetened beverages, and you're most of the way there.

And the last thing I would say is try exploring different types of cuisines, different traditional cuisines. Try out the different types of produce, the different spices and herbs. They all have very strong health benefits.

Melanie Cole, MS: Now, we're thinking about our reproductive years. Do you have some advice on important preconception health concerns? Everything you've said basically falls into that category.

Michelle Loy, MD: Yes. So, preconception and fertility is an excellent area for integrative and lifestyle interventions. And we work with women who are trying to conceive naturally or with assisted reproduction. So, the prenatal diet, prenatal vitamin is very important; an anti-inflammatory diet for both parents. Reducing stress is a big one. Things like acupuncture are so important for fertility, both for natural and assisted, really helps with the outcomes. And even sometimes I'll use certain vitamins or supplements and probiotics. But I think the biggest thing is reduction of stress.

I'm actually starting a Healthy Mother, Healthy Baby group visit, which is a four-week group visit, which will address nutrition, microbiome, environmental factors, everything that we can do to enhance prenatal and postnatal health outcomes, focusing on these crucial 1000 days of life. And so, we'll talk about how prenatal and perinatal feeding practices can help with adventurous eating, reduce allergy risk, support healthy weight, and nurture healthy relationship with food. We'll talk about how you can use nutrition and environmental practices to optimize a healthy immune system, reduce allergy risk, reduce obesity risk, and support maternal breast health. We'll talk about how you optimize the baby's brain development, the language, memory, attention, reduce the risk for neurodevelopmental conditions, and then the role of toxin exposure reduction and the Clean Label food laws. And then, we'll also cover birth, perinatal and postpartum integrative support. So, these are some of the areas where patients can receive help.

Melanie Cole, MS: Dr. Loy, I think that listeners are going to have to listen through twice because you are just a wealth of amazing information, science-based information, expertise that is blowing me away here. You're giving us so much to think about. And weight management being such a huge one for women from, boy, our tween years, and we're seeing an obesity epidemic all across the spectrum for women and for everybody really. What would you like us to know about weight management? It's one of the most difficult things that we think about.

Michelle Loy, MD: It sure is. And people think it's about cutting calories or increasing cardio, but in my experience, they're often missing out on some other key components. They may actually be surprised that part of the reason may be we find that they're not eating enough. We find this throughout these body composition and metabolic tests that they may be cutting calories too much, slowing down metabolic rate. And so, they need to work with our team to work on proper nutrition and build muscle.

Another surprising area is the microbiome. There is a lot more emerging data on certain strains that may be promising for metabolism. One I'm thinking of is akkermansia. It's a strain that loves feeding on polyphenols that are plentiful in things like pomegranates and red grapes.

And then, another surprising point is learning how to have a balanced relationship with data. I started a dopamine reset group visit on building healthy habits and helping patients get freed from behavioral addictions. And in this world of Fitbit and Oura Rings and CGMs and sleep trackers and calorie trackers, there are some patients for which more data can be crippling, more anxiety-provoking and interfere with sleep. And sometimes patients will be surprised to learn that it wasn't the ice cream or the banana, but the interrupted sleep or the stressful argument or the fasted workout that they did that spikes their glucose. So, I think we have to learn also to have a balanced relationship with data, especially when we're dealing with weight management.

Melanie Cole, MS: Wow. That is so true, and it's so much to think about. And as we wrap up here, I'd like you to speak about women as being our own best health advocate at any age. Because if we don't speak up, if we're afraid to mention a concern to our physician, then it doesn't necessarily get addressed. And I know teens can be hesitant to discuss things, whether they're worried about sexual practices and safety or supplements or weight management, and we can sometimes be hesitant to bring these things up. I'd like you to give us your best advice about speaking with our physicians, voicing our concerns, and taking care of ourselves.

Michelle Loy, MD: I would say never be afraid to speak up about any concerns. Never be afraid to get a second or third opinion. Remember, you and your healthcare provider are on the same team. And you also know your body the best.

What's very interesting is these days some of my patients will divulge, that they go to Dr. Google or like what I call Dr. AI with their medical questions. And I personally appreciate my patients who are frank and they feel comfortable confiding that they're doing their ChatGPT research. But this is what I say, we can engage in shared decision-making where I can share with them my clinical experience and training and we can fold that into their lived experience. Patients don't follow AI algorithms and I personally wouldn't want to trust my health decisions to AI. I think patients can bring up their concerns, take charge of their health by. Speaking to the healthcare providers about any complimentary health approach they're using or considering. This is a great time to ask questions about non-pharmacological and lifestyle Integrative Medicine tools to approach things like weight or menopausal symptoms in conjunction or not, with things like GLP-1s or HRT, this is the time to talk to your healthcare provider about all of these concerns. These are, obviously, very complicated and nuanced conversations that require openness and mutual respect. But I think that together we can make very shared and well-informed decisions and help patients uplift their health in the best way.

Melanie Cole, MS: Rock on, Dr. Loy. What a great guest you are. This was so informative and educational. Wow! I could talk to you for hours about all of these things. Thank you so much for sharing your incredible expertise on Lifestyle Medicine and Integrative Medicine. This has been a fascinating discussion.

And Weill Cornell Medicine continues to see our patients in person as well as through video visits, and you can be confident of the safety of your appointments at Weill Cornell Medicine. That concludes today's episode of Back to health. We'd like to invite our audience to download, subscribe, rate, and review Back to Health on Apple Podcast, Spotify, iHeart, and Pandora. And for more health tips, go to weillcornell.org and search podcasts and parents. Don't forget to check out our Kids Health Cast. There's so many great podcasts there. Thank you so much for joining us today. I'm Melanie Cole.

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