Improving Health and Wellness Across the Life Span

By Roxanne B. Sukol, MD, MS

Recent statistics count 29 million Americans as diabetic, with almost 28 percent of these cases undiagnosed. And the stats worsen with advancing age, with just over a quarter of those over age 65 now counted as diabetic. The news is grim, with 86 million Americans — over one-third of the adult population — meeting the criteria for prediabetes, and a startling 90 percent of these cases undiagnosed. Elevated blood sugar is a major risk factor for vascular dementia and other forms of cognitive dysfunction.

I encourage patients to think of wellness as a pyramid with three pillars: eating patterns, activity patterns, and rest and relaxation patterns. There is tremendous synergy among these three pillars. Go for a great walk and you sleep better that night; get a lousy night’s sleep and you’re more likely to snack on junk food the next day; too much junk food makes it hard to get up and go for a walk. And so on.

The take-home message for our patients is that we can leverage this synergy so that small improvements on all fronts can make them “feel like a million bucks.” While mobility can be limited by arthritis pain, cardiovascular compromise or pulmonary disease, many obstacles can be overcome with small adjustments. For example, pain medication can improve range of motion and endurance, and therapeutic yoga or chair-based exercises can be effective interventions for patients with underlying heart or lung disease.

Furthermore, exercise is a powerful mood stabilizer. I encourage physicians to discuss these interventions with all of their patients. Patients need reassurance that it is never too late to adopt new habits, to improve one’s health and wellness or to see things differently than they once did. All of us are capable of change. In fact, it is inevitable.

Taking Control

Prior to medical school, in a former career in environmental engineering consulting, I learned that it makes a lot more sense to prevent trouble than to chase it. The Wellness Institute at Cleveland Clinic is developing a diverse and thriving series of programs to highlight the benefits of nourishing food, increased activity, and strategies for managing stress.

All patients, young and old, will benefit from hearing that it’s not diabetes that’s the problem; but rather it is uncontrolled blood sugar. In other words, it doesn’t matter what you call it as long as your sugar reading is normal — or at least within reason. Individuals who involve their minds and bodies in the process, and who learn strategies to conserve insulin, are likely to see improvements that serve to reinforce further efforts. Patients know that I’ll continue to work with them to find ways to control their blood sugar.

Recommendations for Patients

Patients (as well as doctors) can increase their intake of local and seasonal fruits and vegetables, whether from a local farmers market or supermarket. They can find a local community, recreation or senior center to try yoga and exercise classes for improved fitness and/or relaxation. And, depending on patients’ home locations, opportunities may exist to enroll in shared medical appointments (SMAs) for brain health and wellness, weight management, breast and prostate cancer prevention, pain control and stress management. Group settings can provide elderly participants with opportunities to support one another as they work through difficulties. The social interaction component, essential to all of these activities, also promotes improvements in mood and quality of life. We need to gently guide our patients in this direction.

Goals to Achieve Better Health

As doctors we have many goals for our patients with diabetes. We want average blood sugars under 125, triglycerides under 150, and low-density lipoproteins (LDLs) below 100 or even 70. We want to see blood pressures below 135/85 mm Hg, normal kidney function, strong peripheral pulses, and expert foot and eye care. And it is important to share and encourage these goals, particularly with motivated patients. But patients’ goals are somewhat different.

It helps to remember that individual goals are always relevant and often inspiring. And it’s important to start helping patients to understand the difference between nourishing fats — like those in avocados, olive oil, deep sea fish, dark chocolate, nuts and nut butters — and the processed, manufactured fats like soybean, cottonseed, corn and “vegetable” oils, which are strongly pro-inflammatory owing to their high levels of omega-6 fatty acids. Discussing the impact of processed items helps patients to better understand the adverse effects of what they eat. We, as physicians, can start these conversations and then offer the services of a registered dietitian to supplement the information we provide.

I teach patients to conserve their endogenous insulin by shifting their diets in the direction of intact, whole carbohydrates — vegetables, beans, fruits and whole grains only. I also encourage patients to increase daily activity levels, even if they start with just five minutes a day of walking. I continue to offer positive reinforcement for small improvements, but the most sustainable reinforcement almost always comes from patients’ own pride on seeing improvements in their blood sugars and energy levels.

About Shared Medical Appointments

At Cleveland Clinic, Dr. Sukol leads a Brain Health and Wellness shared medical appointment (SMA) program. At six separate appointments over two to three months, patients learn how to improve cognitive function and to identify and address risk factors for cerebrovascular disease, such as diabetes, hypertension, hyperlipidemia, prior chemotherapy, hypothyroidism, sedentary lifestyle, vitamin B12 deficiency, family history, stress, depression and anxiety. Developed by physicians from Cleveland Clinic’s Wellness and Neurological institutes, staffing for the SMAs rotates among preventive medicine, behavioral and occupational therapists, dietitians, and yoga and meditation specialists.

Dr. Sukol sees patients in the Department of Executive Health and Preventive Medicine at Cleveland Clinic’s Wellness Institute.