What does an integrative medicine approach look like for diabetes and coronary heart disease?
I am often asked, "What is integrative medicine?"
While the terms "integrative medicine," "integrative health," and "functional medicine" are becoming better known by health care consumers, it remains unclear to many patients and health care professionals what an integrative health approach to disease recovery and healing looks like, for a common condition such as coronary heart disease.
I had written previously on the conceptual framework of whole-person healing at a fundamental level, in body and mind, and proposed that a paradigm shift in health care provision is much needed to fully realize the promise of 21st century medicine.
As is often the case in medical training, case histories offer relatable anecdotes that ground our understanding and learning. So, in this spirit, I illustrate here the case of a patient with diabetes and coronary heart disease, and compare and contrast what a treatment course might look like through a conventional medicine experience and through an integrative medicine experience. While this is a fictional case, it should immediately resonate with patients and health care providers as a commonly encountered scenario.
Case Example: Conventional Medicine
A 60-year-old man with a history of diabetes (for which he takes 2 diabetes medications) and recurrent chest pain with physical exertion is diagnosed with coronary artery disease, in which the blood vessels supplying his heart are clogged with plaques. His doctor prescribes an aspirin, a beta blocker (such metoprolol), and a "statin" medication, and advises him to eat a low-fat, low cholesterol diet and exercise regularly.
Three months later, his blood pressure remains high, and his doctor adds another medication, a calcium-channel blocker (such as amlodipine), to lower his blood pressure. Several months later, he comes back to his doctor, complaining of swelling in his legs, and his doctor prescribes a mild diuretic ("water pill") to help decrease the swelling in his legs.
A year later, while mowing his lawn, he suddenly develops a heart attack and was hospitalized. He underwent a cardiac catheterization and stent placement for a significant blockage in one of his coronary arteries, and the heart attack left him with a case of congestive heart failure.
He feels tired all the time, and is depressed because of his health condition and his inability to enjoy life with his family as he used to.
As a result, his exercise capacity is now significantly worse, and he can no longer take a stroll with his wife around his neighborhood without stopping to catch his breath. He was prescribed more "water pills," and his kidney function worsens (as a result of both the heart failure and the use of the "water pills"). His doctor now tells him that his kidney function is only 50% of normal.
Case Example: Integrative Medicine
We meet here the same patient as above. After being diagnosed with coronary artery disease, he decides to visit an integrative medicine doctor because he is very concerned about where his health is headed.
He comes in after having been prescribed the same 3 new medications. However, his doctor spends an hour with him exploring his lifestyle and his stressors, and discovered that after his son was fired from a job a year ago, he has been feeling very stressed. As a coping mechanism, he has started to eat more fatty, fried foods, more sugary, processed foods like cakes and ice creams, and drink more coffee and alcohol. He is not sleeping well and has low energy in the daytime.
His wife has also become depressed, so she has stopped cooking altogether, and they both eat mostly frozen dinners they buy from the supermarket, consisting of mostly meats or processed meats, and low amounts of fresh vegetables, whole grains, or beans. The doctor empathizes with this patient and refers him to an 8-week class of mindfulness-based stress reduction (MBSR). She counsels him extensively on the importance of a "food as medicine" approach in treating coronary artery disease, and refers him to an integrative nutritionist.
The patient follows up with the doctor 3 weeks after he and his wife had started the MBSR program, which has already helped him improve his mood and his insomnia. As a result, he is motivated to follow the advice of the integrative nutritionist on following a heart-healthy, whole-food, plant-centered food plan. He has even started taking cooking lessons at a teaching kitchen to better learn how to cook healthy meals.
Three months later, he is now enjoying cooking. His cholesterol and blood sugar levels are the best he has ever seen, and his inflammatory markers in the blood are normal. Over the next 6 months, his doctor gradually tapers off his diabetes medications and, in consultation with his cardiologist, cautiously tapers him off the "statin" (cholesterol) medication. After doing so, he notices that the vague, generalized muscle ache that he has had for a while is now all gone. On hindsight, he realizes that the muscle ache had started after he started taking the "statin" medication, but he did not attribute it to the medication at the time and never reported it to his doctor.
He is now exercising 30 minutes every day and walking with his wife daily. He feels full of energy, and his wife is no longer depressed. His integrative cardiologist arranges to have him repeat a test for his heart and finds that his coronary artery disease has been almost completely reversed as a result of the lifestyle change program he has undertaken for almost a year now.
After further discussions with his doctor and cardiologist and showing a strong determination to follow this healthy lifestyle, his doctors agree to have him discontinue his remaining 2 medications, while following up with him on a regular basis to check his blood pressure (which was actually made artificially a little bit too low when he was taking his medications) and his cholesterol levels.
While the above example is intentionally dramatic to illustrate the case, many integrative health practitioners can attest to witnessing such success stories on a regular basis.
And despite the fact that we intentionally still use terms such as "integrative medicine" and "good geriatric medicine," this is just, simply, "good medicine" (as Rakel and Weil tersely phrased). We can be sure that a new paradigm of medicine has dawned when this good medicine is the standard of care, and such terms as "integrative and functional medicine" are a thing of the past.
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Disclaimer: This blog only serves as general information. None of the information on this blog should be interpreted to constitute diagnosis or treatment recommendations. If you are looking for medical advice, please consult a physician. Do not discontinue any medications without consulting with your health care provider.