By Amy Locke, M.D.
Part of the curriculum in Integrative Medicine at the University of Michigan is to get students to think beyond the paradigm of making a diagnosis and then matching the right drug or surgery to the problem. Unfortunately, many physicians, as well as many medical consumers, have fallen into this trap. With medical visits crunched by time and society trained to look for the quick fix, using pharmaceuticals is often the go-to treatment for a particular condition.
It isn't that physicians and patients don’t know about the benefits of lifestyle and preventive measures. It is common knowledge that a good diet, physical activity, adequate sleep, good mental health and a connection with the community, or something larger than ourselves, builds a solid foundation for a long healthy life. It is just physicians often don’t know how to effect changes that lead to better health.
Physicians are generally fantastic at the diagnosis of disease. They are good at getting people back from the brink to average health. We are not as effective at going further along the continuum to fantastic health. We need to help the physicians of tomorrow learn how to help individuals take good health and create optimal wellness. Imperative to this is the understanding that this transformation is not easy.
In my Integrative Medicine practice, it is not uncommon for people to come in not wanting to take medication for their medical problems. Although the majority of people in my practice are motivated to make lifestyle change, I still see a significant group of individuals who would like to use integrative techniques in the same way they would have used medications. They would rather take a supplement or herbal product than a medication. They aren't so interested in making other changes. Unfortunately, this is often not much better than using a pharmaceutical. To deal with any chronic problem or to prevent ongoing problems from developing, a multi-faceted approach is essential. It isn't that medication, supplements, or herbs are inherently bad, but when used in isolation there are often multiple missed opportunities to improve health and prevent disease. They also run the risk of creating even more symptoms that require even more treatments to address.
With almost any medical problem there are a multitude of ways to improve a person’s symptoms and prognosis. One of the examples that came up in a recent teaching session with our fellow was around migraines.
The standard treatment of migraines is to use medication to acutely treat a headache, or if the headaches occur commonly, longer term preventive medications. Acute medications can be over-the- counter pain relievers or prescriptions. Some of these prescriptions increase the risk of heart attacks and can’t be used in high risk people. If acute medications are used too frequently, they result in rebound headaches. Many, but not all, people with migraine also know that there are certain foods that commonly can trigger headaches, such as MSG, sulfites, or foods that contain the amino acid tyramine (like aged cheeses). That list only scratches the surface of foods that can trigger migraine. A careful history and diet tracking, perhaps with the use of elimination diets, can be much more precise in finding triggers for an individual person.
In addition to nutrition, the person’s physical activity, sleep, and stress levels are key to managing migraine frequency and intensity. Tension in the neck and head can also trigger migraines so looking at the person’s work space and daily habits can be informative.
Beyond lifestyle, there are a number of therapies that can help, including supplements such as b-vitamins, magnesium, Co-Q10 and botanicals, such as butterbur and feverfew. For women with menstrual or menopausal migraines, an assessment of their hormones can identify underlying triggers. Mind-body techniques, acupuncture, massage and other body work are a few of the other strategies that can be helpful.
To adequately address the complex nature of non-pharmacologic treatments and to best understand what will work for a particular person, it takes time. It is almost always easier to just give a quick prescription and move on. When we talk with students about integrative medicine, we stress that it is more than choosing an herb or supplement or modality to fix the problem in front of you. It is about looking at the big picture, about understanding what forces have come to play in creating the symptoms of an individual. That often starts with the time to address each issue adequately.
In addition to our work in the medical school, we will continue to do Continuing Medical Education conferences to help providers already in practice learn how to provide this type of medicine and network with other practitioners outside of conventional medicine. For more information, check out https://integrativehealthinprimarycare.wordpress.com/
My hope is that we can empower future physicians to think beyond the prescription pad, demand the time required to adequately look at a problem and develop the skills to help individuals make necessary lifestyle changes.
Amy B. Locke, M.D., is Assistant Professor and Director of Integrative Medicine, Department of Family Medicine, Director of the University of Michigan Integrative Medicine Fellowship, Integrative Family Medicine Clinic. She has been on the faculty at the UM since 2002 and has practiced at the Integrative Medicine Wellness Clinic since 2007.