Abstract
Cleveland Clinic's Center for Integrative & Lifestyle Medicine is a leader in providing comprehensive integrative and lifestyle medicine. Established in 2004, the 10,000 ft2 Center in Lyndhurst, Ohio, houses myriad treatments and expertise, and even provides virtual visits for people around the world. The Center seeks to help people address the physical, emotional, lifestyle, and spiritual aspects of healing and, during a time of escalating chronic disease, emphasizes the importance of an integrative approach to chronic disease management.
Brenda Powell, MD, co-medical director of the Center, believes that any person with chronic disease should have a component of integrative management in their treatment plan. She commented that people with chronic pain in particular need integrative management. She stated: “Right now, integrative care is the gold standard for chronic pain management. Many medical societies are creating position statements promoting integrative medicine as the way to treat people with chronic pain and to avoid the use of opiates.”
Powell, who completed her medical education and training at Duke University School of Medicine, Durham, North Carolina, stated that medical conditions associated with chronic inflammation in general respond well to an integrative and lifestyle approach. Among the most common reasons people make a visit to the Center include irritable bowel syndrome (IBS), fibromyalgia, neuropathy, fatigue, menopausal symptoms, and a desire for weight loss. Powell commented: “The biggest successes I have seen in my integrative clinical practice include the resolution of digestive disorders and bowel symptoms with return to normal function, clearing of dermatological conditions such as eczema and acne, a reduction or resolution of pain from fibromyalgia and arthritis, and allowing people to return to activities they had given up.” She added, “We, at the Center, also help people avoid new diagnoses with simple lifestyle and supplement interventions.”
The Center offers a wide range of therapeutic services that support the holistic approach to healthcare, including acupuncture, Chinese herbal therapy, nutritional/nutrigenomics counseling, holistic psychotherapy, massage, guided imagery, chiropractic, yoga, and more. Integrative modalities are also offered through an inpatient program called Healing Services. Scott Katsikas, department administrator of the Center, said, “As the body of evidence for alternative medicine grows, we are committed to providing the most updated education and practices for our patients.”
Katsikas stated that in 2005 there were 1,489 visits for integrative medicine. By 2014, that number increased significantly to nearly 25,000 annual visits. Today, there are approximately 41,000 visits per year. Katsikas said, “We have expanded our services throughout the region with eight locations, and access to schedule appointments generally range from same-day to next-day.” Many of the services provided at the Center are covered by insurance, with some exceptions, and a staff of Patient Financial Advocates helps patients navigate coverage issues, according to Katsikas.
A typical patient visit to the Center includes an initial comprehensive assessment by a physician, lab testing as required, recommendation for diet, possible recommendation of supplements to take, and a referral to acupuncture, holistic psychotherapy, or one of the shared medical appointments (SMA). Unique aspects of the Center include a Chinese herbal therapy clinic, extensive nutritional offerings including culinary medicine and nutrigenomics, as well as SMAs. In the SMA setting, multiple patients are seen as a group (8–14 people) with a common focus. These visits provide an interactive setting in which patients have access to their physician, the benefit of counseling with additional members of a healthcare team, and the ability to share advice and experiences with other people suffering from the same or similar conditions, according to Katsikas. SMAs provided through the Center include: Living Well after Breast Cancer, Living Well after Prostate Cancer, Integrative Pain Management, Brain Health and Wellness, Trim Life, Acupuncture, Integrative Management of Anxiety, Stress and Insomnia, and others.
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Lifestyle Medicine
Mladen Golubic, MD, PhD, the first Cleveland Clinic physician certified in Lifestyle Medicine and medical director for the Center for Lifestyle Medicine, has an extensive research background in the areas of molecular biology, cancer, and integrative medicine, and also emphasized the need for improved chronic disease management. He stated: “Widely accepted and well-established chronic disease practice guidelines uniformly call for lifestyle change as the first line of therapy for conditions such as high blood pressure, diabetes and lipid disorders.”
Cancer is another condition for which inroads are being made for more comprehensive care. Golubic commented: “The critical importance of expanding cancer treatment to include the promotion of overall long-term health is emphasized by the Institute of Medicine of the National Academy of Sciences and professional cancer organizations to deliver high quality oncology care. These organizations encourage the development of partnerships between oncology providers, primary care providers and experts in nutrition, exercise science, and behavior change to help positively orient cancer patients toward longer and healthier lives.” Golubic added, “We, at the Center, also believe that Culinary Medicine, for example, is critical because it is often not enough just to give a patient a recipe and explain which foods to eat. People need instructions and education on how to prepare the foods to be used as medicine and to consume food that tastes great.”
As clinicians, we must adapt our perspective to see Lifestyle Medicine as the prescription for our time, according to Golubic. For example, we must view food as medicine, exercise as medicine, and/or relaxation as medicine. Numerous studies have shown the powerful impact that Lifestyle Medicine can have in an individual's life as part of an integrative approach. Golubic reported, “Studies have shown that diet plus exercise is twice as effective as medication in preventing the progression of pre-diabetes to type 2 diabetes, and lifestyle therapies can reverse type 2 diabetes.” In addition, studies suggest that relapse and survival rates in breast cancer survivors, for example, may be improved by following a diet low in animal fat and high in vegetables, and maintaining high levels of exercise, according to Golubic.
To that end, a Lifestyle Medicine consultation at the Center is a one-hour appointment with three clinician objectives in mind. Golubic said, “First, we learn details about the patient's current lifestyle behaviors. Second, we provide education about lifestyle influences on the chronic diseases the patient may be experiencing. Finally, in partnership with the patient, we develop a specific healthy lifestyle self-care plan.” To integrate lifestyle prescription fully into patients' daily lives in a sustainable fashion, patients often need to return for subsequent 30-minute follow-up visits, or they enroll in the appropriate SMAs, or receive personal one-on-one instructions from professionals on the Lifestyle Medicine team such as a chef, yoga therapist, behavioral health specialist, or exercise physiologist.
Compelling and clear evidence supports the idea that a large percentage of diseases could be prevented by lifestyle modifications, including, for example, an 80% reduction in coronary artery disease and a 90% reduction in type 2 diabetes, according to Golubic. He commented: “How can we achieve this? It is not rocket science. We simply need to: (1) eat a prudent, predominantly plant-based diet that is low in saturated and trans-fats and low in refined grain products and sugars; (2) not smoke; (3) spend at least 30 minutes daily in moderate physical activities; and (4) maintain a healthy body weight (Body Mass Index [BMI] below 25). Yet, it has been reported that less than 3% of all U.S. adults had all four of these healthy lifestyle characteristics.” Golubic added: “So many diseases of this century are fully avoidable and preventable with lifestyle changes that almost anyone can implement. We have a lot of room for improvement.”
Conclusion
In terms of the future, the Center hopes to continue growing regionally and infuse integrative and lifestyle medicine into every patient's care path, according to Katsikas. Powell stated: “We would like to be utilized by more primary care physicians both regionally and nationally for management of their chronic-disease patients and to assist primary care physicians when they identify a patient at risk for new onset disease, such as diabetes, hypertension or cardiovascular disease. Additionally, we would like to partner with specialty clinics in pain management, rheumatology, hematology/oncology and gastroenterology to provide evidence-based integrative care for their patients.”
Golubic concluded, “I envision the day when the most collaborative department in any medical center/hospital will be the one of Integrative and Lifestyle Medicine. Each patient will have access to teaching kitchens where they will learn how to prepare delicious and healthy meals. Patients also will have access to yoga, meditation and fitness studios because of the important role they play in facilitating behavior changes in a healthy and sustainable direction.” ▪