Rosetto Effect: Application in Integrative Medicine

In the early 1960s, a small town in eastern Pennsylvania came to the attention of two researchers. Roseto, founded by Italian immigrants, is a town of fewer than 2,000 residents located in the foothills of the Appalachian Mountains. Stewart Wolf, a medical doctor, and sociologist John G. Bruhn became interested in Roseto when they discovered that the male death rate from heart attack was less than half that of neighboring towns. Intrigued, the researchers set out to discover why.

At first, it was thought that perhaps their Mediterranean diet played a role. Did they exercise more? Smoke less? Inherit great genes? Residents underwent physical exams. They completed family surveys. Dietitians observed their food shopping and eating habits. Surprisingly, the results showed that people in Roseto ate the same animal fats as other Americans, smoked as much, exercised as little, and suffered from hypertension and diabetes at the same rate as their counterparts in the region. The researchers were stumped, until they began to notice that the town possessed certain characteristics that were not in evidence elsewhere. The population was very homogenous and tightly knit. Most families lived in multi-generational households. People supported and looked out for one another with a sense of community and solidarity. Their sense of identity and cohesion was reinforced by shared religion, culture, history, and traditions.

As Wolf and Bruhn noted in their retrospective, The Power of Clan, “What seems to have been learned is an old but often forgotten conviction that mutual respect and cooperation contribute to the health and welfare of a community and its inhabitants, and that self-indulgence and lack of concern for others exert opposite influences.”

Over time, as the town grew more heterogeneous, younger residents became more integrated into the world outside Roseto and began to move away from the ways of their parents and grandparents, living independently and abandoning old-world traditions. Deaths by heart attack started to climb correspondingly until they reached the same levels as in surrounding towns. The “Roseto effect” disappeared.

As Americans, we value diversity, so we are not looking to replicate a physical Roseto, with its notable homogeneity. Americans also move around more than any other people in the world, so our neighborhoods are often in flux. How then, do we create the kind of community the people of Roseto enjoyed for generations? That is what we are attempting at Georgia Integrative Medicine. We want to create an atmosphere that provides the kind of support, encouragement, and nurturing that can have a Roseto-like effect on people’s physical and emotional well-being. We want Rosetto effect for our patients as well as for ourselves.

One of the reasons why I created Georgia Integrative Medicine was to create a community of healers.  After a decade, we have dedicated team members, volunteers, and patients that creates an extraordinary healing environment.  This effect was partly inspired by my reading about Rosetto effect while studying with Dr. Andrew Weil at University of Arizona.

from Dr. Kim's book - Tao of Healing: A Story of Georgia Integrative Medicine

Yoon Hang "John" Kim, M.D., M.P.H.

Georgia Integrative Medicine

Clinic 678.814.1333

Mobile 678.373.8034

Home 678.519.0822

Blog: www.mindfulwise.com

Facebook: https://www.facebook.com/georgiaintegrative

Twitter:    @GAIntegrativMed

Author: Tao of Healing: A Story of Georgia Integrative Medicine

Instructor: 2015 Winter Integrative Health Studies e-course

Enhancing Your Immune System This Winter

This year promises to be a difficult flu season.  

Below are some of practical ways to enhance your immune system:

• Self Care Program:
  • Sleep early and wake up early (8 hours)
  • Use food as medicine - Optimize your biochemistry through your choice of food - fresh vegetables and fruits can provide with many of micronutrients such as vitamins.  High quality protein and fat are also important.
  • Deep breathing - I do this first thing in the morning - easier to do when everyone else in the house is still sleeping (see first step - sleep early and wake up early)
  • Walk under the sun 10 - 20 minutes three times a day
• Supplements:
  • For myself, I take a daily anti-inflammatory detox containing essential vitamins using WellJourney Clear.
  • In addition, I take medicinal mushrooms (WellJourney Defend) daily.
  • I also take a Chinese herbal formula containing astralagus when I am giving care to patients with respiratory infection - Bu Zhong Yi Qi Tang.

Please remember that supplements work best in addition to your self-care program.  Be well this Winter.

Yoon Hang "John" Kim, M.D., M.P.H.

Georgia Integrative Medicine

678.814.1333

 

Blog: www.mindfulwise.com

Facebook: facebook.com/georgiaintegrative

Twitter:    @GAIntegrativMed

 

Author: Tao of Healing: A Story of Georgia Integrative Medicine

Instructor: 2015 Winter Integrative Health Studies e-course

___________________________________

Treating Depression with Integrative Medicine: An Evidence-Based Approach

Yoon Hang John Kim* MD MPH and **Jeanne Bowers LAPC

Georgia Integrative Medicine

www.georgiaintegrativemedicine.com

What is Depression?

Depression is a state of low mood and aversion to activity that can affect a person's thoughts, behavior, feelings and sense of wellbeing(1). Depressed people can feel sad, anxious, empty, hopeless, helpless, worthless, guilty, irritable and/or restless. They may lose interest in activities that were once pleasurable, experience either loss of appetite or overeat, have problems concentrating, have difficulty remembering details or making decisions, and may contemplate, attempt or commit suicide. Insomnia, excessive sleeping, fatigue, aches, pains, digestive problems or reduced energy may also be present. (2)

According to the CDC, about 9% of Americans report they are depressed at least occasionally, and 3.4% suffer from major depression.(3) The analysis, part of the CDC’s Morbidity and Mortality Weekly Report(MMWR) for Oct. 1, was based on a survey of 235,067 people aged 18 and older in 45 states, Washington, D.C., Puerto Rico, and the Virgin Islands.

Depressed mood may not require any professional treatment, and may be a normal reaction to certain life events, a symptom of some medical conditions, or a side effect of some drugs or medical treatments. A prolonged depressed mood, especially in combination with other symptoms, may lead to a diagnosis of a psychiatric or medical condition, e.g., of a mood disorder, which may benefit from treatment. (4)

What is Integrative Medicine?

Integrative medicine is healing-oriented medicine that takes into account the whole person. In integrative medicine, an examination of the whole extends to exploring a patient’s spirituality, emotional state, relationships, and behaviors as they relate to health and wellness.  Integrative medicine draws from conventional as well as complementary and alternative medicine, and offers an array of treatment and care options from each field that may be used alone or in combination. (5)

Integrative medicine utilizes the strengths of conventional medicine and the wisdom of complementary and alternative healing modalities. Alternative modalities include acupuncture, Chinese herbs, and supplements (5).

Evidenced Based Medicine & Cochrane Library

Evidence-based medicine emphasizes the use of evidence from well-designed and conducted research in healthcare decision-making. The term “evidence-based medicine” was originally used to describe an approach to teaching the practice of medicine and improving decisions by individual physicians (6).

Cochrane Reviews, a database of systematic reviews and meta-analyses which summarize and interpret the results of medical research. The Cochrane Library aims to make the results of well-conducted controlled trials readily available and is a key resource in evidence-based medicine (7).

Evaluation of Integrative Medicine Modalities to Treat Depression:

Music therapy for depression
Authors’ concluded that the findings from individual randomized trials suggest that music is accepted by people with depression and is associated with improvements in mood. However, the authors express concern due to small number and low methodological quality of studies (8).

Exercise for depression
Authors concluded that exercise is moderately effective for reducing symptoms of depression, but methodologically robust trials only shows a small effect.  When compared to psychological or pharmacological therapies, exercise appears to be no more effective, though this conclusion is based on a few small trials (9).

St. Johns-wort-for-treating-depression
Authors concluded that the hypericum extracts tested in the included trials a) are superior to in patients with major depression; b) are similarly effective as standard antidepressants; c) and have fewer side effects than standard antidepressants (10).

Light Treatment for Non-SAD Depression
Authors concluded that for patients suffering from non-seasonal depression, light offers modest though promising anti-depressive effect , especially when administered during the first week of treatment, in the morning. Authors caution that due to limited and of studies these results need to be interpreted with caution. (11)

Discussion:

The art of practicing medicine is based on science of medicine.  However, the art goes further and deeper than what the current evidence provides the practitioners.  For example, in addition to music therapy, exercise, light treatment, and St. John’s Wort, I have seen impressive results with acupuncture with electrical stimulation.  In addition, Chinese herbs can also provide a valuable additional tool for treating depression.  Lastly, counseling allows patients to experience growth and healing in a time of great suffering.

Conclusion: 

A current review of evidence indicates that music therapy, exercise, St. John’s Wort, and light therapy all have positive anti-depressive effect.  However, the number of studies are small and the quality of the studies are low.

Caution:

If you have symptoms of severe depression or suicidal ideations, you need to seek out an experienced integrative medicine physician, psychiatrist, or counselor.

References:

1. Salmans, Sandra (1997). Depression: Questions You Have – Answers You Need. People's Medical Society. ISBN 978-1-882606-14-6.
2. "NIMH · Depression". nimh.nih.gov. Retrieved 15 October 2012.
3. http://www.cdc.gov/mmwr/pdf/wk/mm5938.pdf
4. Cheog J et al. for PsychCentral.com. Last reviewed August 26, 2010. Frequently Asked Questions About Depression Accessed May 11, 2013
5. http://www.georgiaintegrativemedicine.com/Integrative_Medicine.html
6. Evidence-Based Medicine Working Group (November 1992). "Evidence-based medicine. A new approach to teaching the practice of medicine". JAMA 268 (17): 2420–5.
7. http://en.wikipedia.org/wiki/Cochrane_Library
8. Maratos A, Gold C, Wang X, Crawford M. Music therapy for depression. Cochrane Database of Systematic Reviews 2008, Issue 1. Art. No.: CD004517. DOI: 10.1002/14651858.CD004517.pub2.
9.Cooney GM, Dwan K, Greig CA, Lawlor DA, Rimer J, Waugh FR, McMurdo M, Mead GE. Exercise for depression. Cochrane Database of Systematic Reviews 2013, Issue 9. Art. No.: CD004366. DOI: 10.1002/14651858.CD004366.pub6 - See more at: http://summaries.cochrane.org/CD004366/DEPRESSN_exercise-for-depression#sthash.DrCaPbSh.dpuf
10. Linde K, Berner MM, Kriston L. St John's wort for major depression. Cochrane Database of Systematic Reviews 2008, Issue 4. Art. No.: CD000448. DOI: 10.1002/14651858.CD000448.pub3

11. Tuunainen A, Kripke DF, Endo T. Light therapy for non-seasonal depression. Cochrane Database of Systematic Reviews 2004, Issue 2. Art. No.: CD004050. DOI: 10.1002/14651858.CD004050.pub2.

* Yoon Hang John Kim, Director, Georgia Integrative Medicine. E-mail: drkim@georgiaintegrative.com

** Jeanne Bowers, Counselor, Georgia Integrative Medicine. E-mail: jeanne@georgiaintegrative.coms

Insured, but Bankrupted by Health Crises

http://www.nytimes.com/2009/07/01/business/01meddebt.html?ref=business

Above is a link about the U.S. healthcare problems faced by millions of Americans.
As health care fix is being investigated by the Obama administration, I hope that it will consider the suffering of its people and come up with a viable solution.

How Safeway Is Cutting Health-Care Costs

http://online.wsj.com/article/SB124476804026308603.html

Above is an article published by the Wall Street Journal written by the CEO of Safeway.

By all accounts, our health care is in deep trouble. The US spends the most of money in health care only to claim 37th in the world right after Costa Rica. There are growing population of the US, more than 48 million people, who does not have insurance. More and more businesses are not able to afford providing insurance to the employees.

The article points out how we can learn from the auto industry. Provide financial incentives for health associated behaviors and provide financial disincentives for illness associated behaviors. It's pretty simple really. When people realize preventive measurements such as blood pressure, cholesterol, and weight result in increased premiums, they have a tendency to want to self correct the behavior.

Safeway implemented this policy and found that they can save 40%. Perhaps, the rest of the U.S. can learn from this experience.

Cost-Effective Ways to Fight Insomnia

http://www.nytimes.com/2009/06/06/health/06patient.html?_r=1&scp=1&sq=insomnia&st=cse

Dalai Lama said "Sleep is best meditation." I agree.
Lack of sleep can easily account for many of the chronic illnesses in the U.S. While, I cannot say that lack of sleep or chronic sleep deprivation causes illnesses, it can contribute to the ill effects of chronic illnesses.

I find that sleeping problems are often the most sensitive indicator of overall health and wellness. Often times, sleep disturbances will precede an episode of illness or a bout of depression or anxiety.

A good sleep resets our body and mind and renews our spirit. I find good sleep to be most cost effective ways for wellness. Integrative Medicine is a wonderful asset to help people to restore a good sleep.

Dr. Rubin Naiman, a faculty at Dr. Weil's faculty, suggest below suggestions for improving sleep:

Recommended Lifestyle Changes for Insomnia Treatment:

from Dr. Weil's website: http://www.drweil.com/drw/u/ART02004/insomnia

The following are some of the best possible insomnia remedies:

• Establish a consistent bedtime routine. This is one of the most important factors in insomnia treatment and maintaining good sleeping habits. Routines may include taking a warm bath or a relaxing walk in the evening, or practicing meditation/relaxation exercises as part of your regular nighttime routine.
• Try to go to bed at the same time every night, and get up at the same time each morning. This includes weekends.
• Get plenty of exercise during the day. Studies have shown that people who are physically active sleep better than those who are sedentary. The more energy you expend during the day, the sleepier you will feel at bedtime. Just be sure not to engage in vigorous exercise too close to bedtime as that can make it more difficult to fall asleep.
• Reduce your intake of caffeine, particularly in the evening.
• Avoid stimulants like caffeine and limit alcohol. Both, even when consumed early in the day, can affect sleep and inhibit insomnia treatment.
• Use your bed only for sleeping and sex. Don’t use it to do work or watch TV.
• Avoid large meals late in the evening.
• If you can’t fall asleep within half an hour of going to bed, get up and read or do something calming until you feel sleepy.
• Learn and use a relaxation technique regularly.Breathing exercises, meditation and yoga are not insomnia cures, but do lead to a state conducive to sleep.
• Use “white noise” devices to block out surrounding environmental noise.
• Take a hot bath before bedtime. Try a few drops of relaxing oil of lavender in the water.
• Short naps are good. Try to get into the habit of napping for insomnia treatment: ten to twenty minutes in the afternoon, preferably lying down in a darkened room.
• Spend some time outdoors as often as you can to get exposure to bright, natural light. If you are concerned about harmful effects of solar radiation, do it before ten in the morning or after three in the afternoon or use sunscreen.
• Try to give yourself some time - up to an hour - in dim light before you go to sleep at night. Lower the lighting in your house and bedroom and if other members of the household object, wear sunglasses.
• The two best natural sleep aids are valerian and melatonin. Valerian is a sedative herb, used for centuries. You can find standardized extracts in health food stores and pharmacies. Take one to two capsules a half hour before bedtime. Melatonin is a hormone that regulates the wake/sleep cycle and other daily biorhythms. Try sublingual tablets (to be placed under the tongue and allowed to dissolve); take 2.5 mg at bedtime as an occasional dose, making sure that your bedroom is completely dark. A much lower dose, 0.25 to 0.3 mg, is more effective for regular use.
• Don’t obsess about not sleeping. Not surprisingly, studies have shown that individuals who worry about falling asleep have greater trouble dropping off. It may help to remind yourself that while sleeplessness is troublesome, it isn’t life-threatening and there are insomnia remedies.

If All Doctors Had More Time to Listen

http://www.nytimes.com/2009/06/07/health/07health.html?_r=1&em

Above is an article in NY Times on If All Doctors Had More Time to Listen.

I feel priviledged to be part of the team at Georgia Integrative Medicine. We make the time to listen to our patients. Patients have ready access to Dr. Kim. Patients spend about one hour being treated for each visit. For complex patients, we spend up to four hours performing a comprehensive evaluation known as the team visit.

We have patients who are choosing us over their regular physicians and over other integrative medicine physicians because we choose to listen to our patients. Even our growth is managed to ensure that our existing patients have a ready access to Dr. Kim.

At Georgia Integrative Medicine, we understand that our patients are the experts on their bodies and in order to help, we have to listen and understand to their healing journey. Carl Rogers was a humanistic psychologist who understood the importance of "client-centered" therapy. He understood the importance of listening mindfully to what his clients had to say. At Georgia Integrative Medicine, we honor the Rogerian tradition and perform that mindful listening to the best of our ability.

Jeanne Bowers
Clinic Manager