The Art and Science of Lifestyle Changes in Naturopathic Medicine

Maya Nicole Baylac N.D.

Hawaii Naturopathic Retreat Center

A healthy body + an open heart + a positive and creative mind = a happy spirit!

Lifestyle Change Model for Physical and Mental Health

awareness

mental

emotional

physicalNutrition &

Exercise

Psychotherapy

Philosophy

Meditation Liberate

Educate

Motivate

Behavioral Changes

The American Heart Association Study: Heart Health and Lifestyle

The incidence of blood clots were compared in:

30,000 + adultsAged 45 / older

Followed 4.6 years

They were then divided into 3 groups rated according to their adherence to Life’s Simple 7. The groups were:

Inadequate Average Optimum

Results of Study The America Heart Association Study: Life’s Simple 7 and CVD

38 % lower risk

44 % lower risk

Optimum Health

Average Health

Risk of Blood Clots Compared to Inadequate Group:

Inadequate Health

high risk

HOW EASY IS IT TO MAKE THESE LIFESTYLE CHANGES?

NORMAL WEIGHTNORMAL

CHOLESTEROLNORMAL BLOOD

PRESSURENORMAL BLOOD

SUGAR

Stop Smoking

Start Exercising

Eat a Healthy

Diet

Obesity Rates Continue to Climb

2000 2008 201027.00%28.00%29.00%30.00%31.00%32.00%33.00%34.00%35.00%36.00%37.00%

Obesity Rates

Obesity Rates

30.5%

33.7%

35.7%

Journal of American Medical Association

Increase of 5.7% from 2000 to 2010 in the United States

Obesity is defined by exceeding the BMI of 30kg/m2

Dieting is the Most Common Method Used to Lose Weight

55% of the total adult population, nearly 116 million adults are dieting at any given time.

Roughly 25 million men and 43 million women are dieting to lose weight.

Another 21 million men and 26 million women are dieting to maintain weight.

91% of women surveyed on a college campus in the mid-90s had attempted to control their weight through dieting.

Long-term Failure of Weight Loss Dieting

Source: Long-term weight-loss maintenance: a meta-analysis of US studies 1,2,3 James W Anderson, Elizabeth C Konz, Robert C Frederich, and Constance L Wood © 2001 American Society for Clinical Nutrition

Meta-analysis reviewed 29 research reports of long-term weight loss maintenance after a structured weight loss program involving various diets.

Results: 3.2 % sustained weight loss maintenance, averaging 3.0 kg, 5 years later.

Why this Failure of Calorie Restriction and Public Education?

Obesity and overweight is treated as a simple metabolic disorder.

Obesity is a complex bio-psychosocial phenomenon involving the adaptation of our brain to our modern environment: high food availability and palatability, which hijacks the brain reward system, and reorganizes the brain around addiction rather than around a homeostatic function.

The Hijacking of the Brain Reward Centers by the Food Industry

As a result, the brain adapts to the environment, and a maladaptive addictive behavior follows

The modern environment exerts an unprecedented pressure-manipulation on people’s mind to consume more food

The Problem Today:The nature of the homeostatic feeding system

low energy requirements

abundance versus

scarcity

high reward for extremely

palatable foods

The system has evolved to guarantee survival in a nutrient scarce environment

And this system rewards with pleasure the eating of fatty sugary food

Food in the Restrictive Natural Pre-industrial Environment

Food in the Abundant Artificial Modern Environment

From stomach hunger to cravings

Today the environment has created a shift from a

homeostatic feeding behavior, to a hedonistic feeding

behavior.

Stomach Hunger: Homeostatic Regulation

Brain Cortical and Sub Cortical Centers

Stomach Hunger Homeostatic Regulation by Dopamine in the Hypothalamus

The Hijacking of the Brain by the Food Industry: Stomach Hunger and Brain Hunger

This homeostatic mechanism is normally primed by:

HUNGER[hunger: the mental translation of a physiological state of need for food to create energy]

This homeostatic mechanism can also be primed

independently of hunger by external cues such as:

SMELLS SIGHTS STRESSORS

It can also be primed by internal mental cues:

MEMORIES OF PAST PLEASURABLE EXPERIENCES

BOREDOM OR SADNESS

EXTERNAL CUES / INTERNAL EMOTIONAL STATES CAN OVERRIDE HUNGER

Cravings, Sensitization and the Brain Reward System

Stimulus Fatty, Sugary

Foods

Sight and Smell

Cravings

Eat Liking

Hedonic ResponsePleasure

Memory Created

Sensitization

↑ OpioidsPOMC (1)

RepeatingBehavior

↑ Dopamine

PathwaysReinforcement

(1) Pro-opiomelano cortin (POMC)

Desire To Eat

Features of an Addiction: Psychological and Behavioral

Psychological dependence:

Need

Emotional eating

Compulsive eating

Loss of control

Binge eating

Overeating

DietingWithdrawal symptoms in the absence of the

substance

Relapsing

The Making of Fat:

Neil Bernard, M.D., in his book Breaking the Food Seduction: The

Hidden Reasons Behind Food Cravings—and 7 Steps to End Them Naturally, summarizes the scientific research demonstrating that there

are selective foods which break down into addictive ingredients and

do the same thing to a person’s brain as cocaine does.

DOES THE SAME THING TO A PERSON’S BRAIN AS COCAINE DOES

Various other chemical preservatives found in processed junk food

Refined salt

Hydrogenated oils

Monosodium glutamate (MSG)

High-fructose corn syrup (HFCS)

Addictive Properties of Certain Foods

The Making of Fat

Highly stimulating processed foods play

into the brain preferences for

concentrated food.

Low nutrients in processed foods do not

stimulate adequate amount of leptin the

satiety hormone, unless large quantities are

ingested.

low nutrients in snack foods give our taste buds a supernormal stimulus,

while withholding the nutrition that has always

gone along with that stimulus in evolutionary

time. “Snack food” is designed to make us fat

Addiction Reorganizes the Brain

Brain imaging evidence shows that the brain’s “cortex changes with overeating and obesity so that the mouth and tongue increase in geographical area,” Gold

Thoughts, desires, cues, feelings trigger the hunger pathways independently, creating learnt pathological reward pathways

With every use, the enabling circuits become stronger and more compelling creating an addiction

Reversing food addiction is not just a matter of giving up something pleasurable, the obese person has undergone a reorganization of the brain. Treating obesity requires dealing with every aspect of this reorganization.

Addiction Reorganizes the Brain:

Subcortical and irrational, versus cortical and rational

When the obsessive or addictive thought occurs, obsessive or addictive action follows.

The prefrontal area is weaker than subcortical systems or,

Subcortical systems are stronger than prefrontal area

The experience of cravings is irrational and there is a deficit of prefrontal inhibitory control over subcortical systems that mediate incentive appetite responses and automated unconscious response.

How do we Heal the Addicted Brain?

Physical level

Nutrition

Whole Food Diet Not Calorie Restriction

Sleep

8 Hours per Night

Exercise

Start Small

Nutrition

Weight-loss dieting, by definition, requires lowering food intake below the amount the body needs to maintain its present form. So, in a valiant attempt to regain homeostasis, the dieter's stomach-hunger system lowers levels of the satiety signals leptin and insulin and pumps the hunger hormone ghrelin into the bloodstream.

Any kind of weight loss diet sets you up for biochemical warfare with stomach hunger. The body does not know when it is overweight it only knows when it is in jeopardy of losing weight.

Whole Food Diet rather than Calorie Restriction

How Do We Heal the Addicted Brain?

Creating New Pathways

Education and psychotherapy

Stimulate and support motivation for change

Education: How to Overcome the Power of the Addicted Brain

Why will power does not work

The brain and the palate

Properties of addictive foods

How dieting sets them up for bingeing

How to prepare food and shop

Alternatives to food for pleasure

Avoidance of triggers

Psychotherapy Methods:

Cognitive Behavioral Therapy

Cognitive Behavioral Therapy has shown good results when combined with a dietary approach

Hypnosis Research shows that hypnosis is efficacious. Benefits of hypnosis increase over time. Journal of Consulting and Clinical Psychology (1996).

Motivate: Motivational Interview

Miller and Rollnick (1991) developed this method to be applied to the field of addictions.

The motivational interview empowers patients to change their behavior by presenting the discrepancies between their current behaviors and their larger life goals.

This technique forces patients to identify reasons for change on their own and can be a powerful motivator for those who are ambivalent.

Motivate: Support the Desire for Change

Know what stage the

patient is at

Group: Overeaters Anonymous

Be an inspiring model

Eliminate social network which support the addiction

Psychology of Change: The Trans-Theoretical Model of Change

Move from contemplation

to action.

Know where your patient is on the stages

of change.This model involves five stages through which a person will pass on the way to

eliminating a behavior.

Prochaska and DiClemente (1992). The trans-theoretical model of change.

The 5 stages of Changes : Prochaska and Di Clemente (212 L. Joranby et al.)

First stage Pre-contemplation The person does not recognize the behavior as a problem

Second stage Contemplation The person can recognize the behavior but maintains ambivalence about changing

Third stage Preparation stage The person wants to change the behavior but is unsure of how to go about change

Fourth stage Action stage Now actual change takes place

Fifth stage Maintenance stage Focuses on maintaining the new behaviors and avoiding regression into the old behaviors

Liberate:

MINDFUL AWARENESS

What is Mindfulness?

Mindfulness is a state of heightened awareness. It orinates from the Buddhist tradition of meditation.

Mindfulness has been defined as “bringing one’s complete attention to the present experience on a moment-to-moment basis” (Marlatt & Kristeller, 1999, p. 68).

Mindfulness brings about separation of the observer (the witness) from the contents of awareness (thoughts).

Mindfulness allows the meditator to monitor her/his thoughts as they arise in the present time, rather than be victimized by them.

Why Mindful Awareness? The addicted brain cannot cure itself.

Fighting the unconscious with will power gives more energy to unconscious patterns.

It is a self-reliant method and can be used in daily life when the addicted behavior is triggered.

Cravings are automatic, pre-attentive, involuntary, emotional, impulsive and irrational with a sub cortical base and avoidance would be aware, attentive, voluntary, cognitive, planned and rational (control) with a cortical base.

Mindfulness and Addiction

Promotes understanding and compassion rather than judgment and conflict with the addicted self.

It allows the unconscious patterns to emerge to the conscious mind.

It provides the opportunity for the rational mind to evaluate thoughts and dis-identify from them.

It can create a window where the witness has the power to make a conscious decision.

It has been used efficiently to break the cycle of addiction and compulsive behavior.

Mindfulness and Addiction

Mindfulness does not reinforce the addiction pathways.

Gives the opportunity to fully experience the desire as it arises and release it.

Brings dis-identification with the desire to binge or eat compulsively.

Allows the opportunity to commit to higher values.

Mindfulness and Addiction:

Bring awareness when the desire

arises

Pause (Find a place to sit)

Breathe

Witness, or be mindful of the

thoughts (can write them)

Go through the Advantages of not

acting on the cravings

Connect with higher self and reconnect

with determination and decision to quit

DO NOT ACT (last stage of change)

Indulge consciously or Choose an

alternative (first stage of change)

How to use mindful awareness to break the automatic subcortical response to cravings. Dr. Baylac’s method.

Diagram: Mindful Awareness and Cravings

Wants Desires Cravings

Fatty Sugary Foods

Conscious Avoidance

Conscious Awareness

Mindful Contemplation

Unconscious Automatic Response

Compulsive Eating Binge Eating

Alternative ChoicesAbstinence

Level 1

Level 2

Four Steps Conscious Attention by Dr. Schwartz for OCD

Brain lock: stuck neurological gear that causes thoughts to be acted out before the action can be stopped.

4 step self-treatment method of conscious attention to transform the automatic mind and its physiological substrates in the brain in the treatment of OCD, UCLA school of medicine. Dr. Jeffrey Schwartz.

5 steps self-treatment by Dr. Gabor Mate, adapted from Dr. Schwartz OCD treatment to behavioral and substance addiction (5th step added).

Five Step Mindfulness Method for Addictive Behavior

Step 1 Relabel: “False belief” rather than “Need”. I do not need to have a piece of chocolate right now.

Step 2 Reattribute: Blame the brain “This is my brain sending me a false message”

Step 3 Refocus:Buy time knowing that the desire is

impermanent. Find something else pleasurable to do.

Step 4 Revalue: What this addictive urge has done for me, my friends, husband children

Step 5 Recreate: My Life has been created by automatic

mechanisms, it is now time for me to create my life.

Excerpts from “In the Realm of Hungry Ghosts” North Atlantic Books Berkeley, CA

Research on Mindfulness and Binge Eating Disorder

Pilot research involving 18 obese women, (1999).

Findings:

Reduced bingeing episodes and symptoms of anxiety and depression.

Increased self-acceptance and self-control around food.

Kristeller and Quillian-Wolever are now replicating the pilot study with about 150 men and women with binge-eating disorder and who weigh on average 240 pounds.

Dr. Kristeller and Killan-Wolever

How to Cultivate Mindfulness

Conscious eating

Conscious walking

Sitting meditation

Lifestyle Change Model for Physical and Mental Health

awareness

mental

emotional

physicalNutrition &

Exercise

Psychotherapy

Philosophy

Meditation Liberate

Educate

Motivate

Behavioral Changes

Naturopathic Doctor Tools: LOC and Groups

Listen

Observe

Compassion

Develop Team

Treatment Work

Refer Patient to Support

Groups

For More InformationMaya Nicole Baylac N.D.

Hawaii Naturopathic Retreat Center, Inc.

www.HawaiiNaturopathicRetreat.com

www.RawDetox.org

www.MindYourBody.info

contact2013@hawaiinaturopathicretreat.com

1-808-933-4400 (U.S.)

239 Haili St.

Hilo, HI 96720