Are you giving yourself the TLC you deserve?

Tender Loving Care does share the same acronym with the TLCs I will be talking about, but for our purposes, TLCs stands for Therapeutic Lifestyle Changes. And, it is these TLCs that need to be adhered to in order for you to achieve optimal health. When thinking about what it is to be healthy, in both body and mind, I look at how I can help my patients achieve this. I pride myself in helping my patients achieve their optimal physical health, but what about mental health.

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The week that just passed, May 5-11 2014, was Mental Health Week and the Canadian Mental Health Association (CMAH) sees mental health as more than the absence of mental illness, but rather a state of well being. And, how do we achieve this?

What if I told you that all it takes to reach a state of well-being are 8 simple steps? And these steps are lifestyle changes that can benefit other aspects of your life as well. But, don't take my word for it, especially since I am not an expert in mental health, but a lot of research has been done on this subject and in 2011, Dr. Roger Walsh MD, PhD, DHL, a professor of psychiatry, philosophy, and anthropology, as well as professor in the religious studies program at the University of California at Irvine published an article titled Lifestyle and Mental Health in American Psychologist. When I first read this article, I thought, "Here is a great synopsis on how to truly get the most out of life and be able to ascertain true health as it encompasses more than just the mental component of health."

Dr. Walsh states that these TLCs are not only effective on their own, but also cost-effective when considering healthcare costs in that some TLCs — for example the use of exercise for depression or the use of fish oils to prevent psychosis in high-risk youth — may be as effective as pharmacotherapy or psychotherapy.

It is however important that I emphasize that TLCs are not only about mental health, they also offer secondary benefits such as improvements in physical health, self-esteem, and quality of life. And some TLCs, such as exercise, diet, and meditation — may also be neuro-protective and reduce the risk of subsequent age-related cognitive losses and corresponding neural shrinkage. Something that is important to most of as we age.

The 8 Therapeutic Lifestyle Changes

The 8 TLCs have been identified as regular exercise, good nutrition and a proper diet, spending time in nature, good relationships, participating in recreational activities, relaxation and stress management, religious or spiritual involvement, and service to others.

1. Exercise

My monthly newsletter is titled Movement is Your Medicine for a reason, because movement is key to both physical and mental health and when done properly and continuously it leads to optimal health. Anyone in pain or that is unable to move can attest to the fact that it is not a pleasant or desired experience. And, that is why I continue to see new patients and help people get back to moving so that they can enjoy their life to its fullest.

Exercise offers benefits that encompass many body systems and are more than just physical. Yes, we become leaner and fitter, and less likely to develop deadly diseases such as diabetes, obesity, high blood pressure and cancer, but it has also been shown to reduce chronic pain, age-related cognitive decline, the severity of Alzheimer’s disease, and some symptoms of schizophrenia.

It has been hypothesized that exercise helps to positively improve serotonin metabolism, improved sleep, as well as release endorphins that make you feel euphoric, those of us that run or cycle have definitely felt this “runner’s high.”

People who exercise regularly have been shown to have enhanced self-efficacy and self-esteem, interruption of negative thoughts and a breakdown of chronic psycho-somatic muscle tension.

What exercise does to the nervous system is absolutely amazing. Exercise has been shown to increase brain size, improve blood and oxygen flow to the brain and with time create new blood vessels (vascularity) in the brain which further increases blood flow. All this allows your brain cells to live longer sprout new connections and develop new neural pathways, something called positive neural plasticity (I look forward to adding this to my website soon). When looking at some animal studies, there is a correlation between exercise and positive effects to the brain similar to that seen with how antidepressants work, it is just naturally produced. When looking at the research it has been shown that regular exercise is associated with enhanced academic performance in youth, helps with stroke recovery, reduces age-related memory loss and the risk of both Alzheimer’s and non-Alzheimer’s dementia in the elderly.

So, which exercise is best? There is no best, when you talking about movement, but rather how much exercise. You can participate in brisk walking, gardening, playing a sport, or working out in the gym. However, it needs to be done at least three times a week and for 30 minutes at a time. It has been shown that while 30 minutes provides valuable for physical health, it does little for cognitive gains. It has been suggested that if you want to be smarter, that is experience cognitive benefits, that this only happens with more strenuous activity and by combining strength training with aerobics.

If you would like a simple but effective exercise session, try and perform eight rounds of Sun Salutations, it may be enough to get your mind and body going.

That being said, it is very important to ensure that you can safely engage in regular vigorous exercise and if any aches, pains or movement dysfunctions are present, they are addressed before starting. What I often see in clinic is people thinking they are young again or think they can pick up where they left off in terms of physical activity after taking a few years or decades off. That only leads your body vulnerable to injury and you end up in my office. So, if you have any injuries or have questions about if you are ready to get back into regular physical activity, ask me, Dr. Nick, and I will help you attain optimal health.

You will see benefits within a month of regular physical activity and over the long term, you'll not only feel happier, healthier, and more energetic, but you'll also have the satisfaction of knowing you're doing something for your body, your brain, your mind, and wellbeing.

2. Nutrition

One of the basic necessities for life is proper nutrition; it is what drives us to do pretty much everything we do as humans. Even when you binge on “junk food” you are striving to achieve good nutrition, that is why you eat a lot, however, “junk food” is called that for a reason, it is full of junk, like artificial and processed sugars with non-nutrient rich calories arguing that a calorie is not a calorie and when participating in a “diet” you should not only look at calories, but rather nutritional content of the foods you are consuming. What is a good diet for your brain and nervous system? Researchers have produced hundreds of studies, but their findings can be reduced to several simple principles. These are to eat:

Eat predominantly multicolored fruits and vegetables.
Reduce calorie consumption, especially empty calories.
Eat fish, such as cold deep-seawater fish (e.g., salmon – wild preferably – how healthy do you think a farm raised salmon is?), which are high in beneficial omega-3 fish oils, while avoiding the four species with high mercury levels (shark, swordfish, king mackerel, and tilefish). For those who don’t eat fish regularly, it can be worthwhile to supplement with fish oil

When patients ask about supplementation, I always say there are a few items that everyone should consume. They are a multi-vitamin/mineral, anti-oxidants, probiotics, essential fatty acids (EFAs) and Vitamin D. In future, I will be discussing this in more detail, but for now and when dealing with brain health, lets focus on EFAs and Vitamin D.

Fish and fish oil are especially important for mental health as they contain EFAs. They supply essential omega-3 fatty acids, especially EPA (eicosapentaenoic acid) and DHA (docosahexaenoic acid), which are essential to neural function. Omega-3s have been shown to have an anti-inflammatory effect, counteracting the pro-inflammatory effects of omega-6 fatty acids, and are protective to many different areas of the body. But how much is enough? Many studies have been done, and the consensus is that a dose of 1,000 mg of EPA daily is ideal. However, risks are always present for all supplements and some recommended doses may be too great as they can induce some mild gastrointestinal symptoms. There are other exceptions as well, for example it is not suggested to take these dosages if you are on anticoagulants or have bleeding disorders, because fish oils can slow blood clotting. If you know that you suffer from this, you need to be monitored by your family physician.

It is believed that omega-3s modify genetic expression and as such are part of a new field of therapy called “psychonutrigenomics.” Nutrigenomics uses nutrients to modify genetic expression and is a growing field, a topic that I will speak to in a future article.

Vitamin D is a multipurpose hormone with multiple neural functions, including neurotropic effects (nerve growing), acts as an antioxidant, and has anti-inflammatory effects. There have been several studies that have indicated the association between Vitamin D and cognitive impairment, depression, bipolar disorder, and schizophrenia, often seen when you do not consume enough Vitamin D. Therefore, mental health professionals are beginning to work with physicians in recommending routine supplementation (usually 600 IUs per day) and, where indicated, testing patients’ Vitamin D blood levels and modifying supplement levels accordingly.

For more information about how to eat right and what supplements are the best, feel free to contact me, or Ask Dr. Nick your questions.

3. Time in Nature

For thousands of years, humans lived intimately with nature until the rise of the industrial revolution and large urban centers became commonplace. With the advent of modern technology humans seem to be moving further and further away from nature spending more time in front of a computer, tablet or phone. But this is not always the case when you are looking for mind calming or reflection. Lately many corporation will send their top executives to a wilderness retreat to re-gain their mind set and throughout the ages we have heard of sages, shamans, yogis, and indigenous people seeking the wilderness for sources of healing and wisdom.

After walking through a park, don’t you often feel relieved and at peace with yourself? Many experts have shown that nature reduces the symptoms of stress, depression and attention deficit disorders. The physical and mental benefits are seen with greater cognition, emotional, spiritual and subjective well-being. It has been thought of as a mode of healing. In hospital rooms that offer views of natural settings, patients experience less pain and stress, have better mood and postsurgical outcomes, and are able to leave the hospital sooner.

Living in Toronto, we are blessed that we have a lot of green space and a walking through a park or ravine system is much easier than many think. Take the time, to perhaps combine some of these TLCs together with a brisk nature walk and some reflective meditation.

4. Relationships

There is a lot of research that supports a very ancient assertion that good relationships are paramount to physical and mental well-being. The quality of a relationship is considered to be the most important of all lifestyle factors in determining the quality of our life.

It has been shown that good relationships lower the risk of diseases ranging from the common cold to heart disease as well as strokes and depression. Good relationships are also associated with greater health and happiness as well as better intellectual and work performance. But, how does this happen?

Recent research in social neuroscience indicates that humans are wired for empathy and intimacy. Our brains actually resonate with one another like tuning forks, picking up subtle emotional and social cures, enabling us to empathize with others, and to literally feel what they feel. We essentially create an intimate brain-to-brain link-up. This neural link allows us to feel, be affected and affects the brain function of everyone we meet.

Have you ever thought why some people that spend a lot of time together start to look alike, Well, there is an actual effect that occurs between people and it is called the Michelangelo Phenomenon. Essentially, people in relationships (professional, intimate or social) can mold one another both psychologically and physically. Not surprisingly, good relationships are very important. There have been multiple studies showing that even doctor-patient relationships benefit more when there is a connection rather than looking at the doctor’s qualifications alone – this is often referred to as a good “bedside manner” and often results in effective therapy, especially when there is an open and honest relationship.

So, be careful of the company you keep, they may just make you healthier.

5. Recreation and Enjoyable Activities

If you manage your time wisely, you can combine a few TLCs, together, such as recreation, exercise, time in nature, and social interaction. For example participating in a Soccer (Football), Ultimate Frisbee or Beach Volleyball league around the city that plays in open fields or at a beach can help reduce defensiveness, enhance well-being, foster social skills as well as aid in the maturation in children.

Research indicates that recreation, often synonymous with play is something that is hardwired in our biology. Playing has been shown to enhance learning and social growth. It teaches children how to live together, how to compete and cooperate, make friends and acquire necessary social skills. This is why I often recommend to parents that they enroll their children in some sore of team sport that is outdoors – my favorite is soccer as it allows both girls and boys to play together when they are at a young age and improves their physical stamina and overall coordination.

Recreation and play is not however limited to the young. Adults can also benefit from play. Many of my patients cannot stop talking about how relaxed they feel after their dance class, volleyball tournament or cricket match. All of which have been shown to reduce painful emotions such as anxiety and worry, and foster feelings of happiness and joy.

It is important to understand that recreational activities do not exclude art and other aesthetic pleasures, which have long been employed for self-healing. I remember when I was a student speaking to a then 94-year-old chiropractor, Dr. Herbert Lee, and I asked him for the secret of health and he answered “have a hobby and be physically active.” When I asked him about longevity, he said, “Choose your parents wisely.” So, it is clear that how long you live may be more of a genetic factor, but perhaps how well you live is something that you may be able to control with some participation is recreational activities.

6. Relaxation and Stress Management

Stress is not always bad. It is usually good as it pushes our body to adapt and become stronger. It is only when the stress becomes too great and our bodies are unable to adapt that it becomes a bad thing. In another article, I will discuss stress in more detail and you will be able to print off a Stress Management Booklet as well (it will be available in the June 2014 Movement is Your Medicine Newsletter).

Some simple stress management strategies often overlap with some of the other TLCs, such as exercise, recreation, relationships, and religious or spiritual involvement

Movement is used as a great stress management strategy. However, when used for stress management, movement should be rhythmic in nature, and when performed slowly it often provides greater benefit. Examples of these are Tai Chi, Qui Gong or certain types of Yoga. Other movement based relaxation and stress management methods are muscle relaxation therapies, which require you to systematically tighten and then relax major muscle groups. Some good research has shown that muscle relaxation skills are used beneficially in the treatment of anxiety disorders (panic and generalized anxiety).

Yoga is great as it offers both somatic and contemplative strategies. It along with meditation has been shown to enhance various psychological capacities, health, and maturity. If you would like to try some simple yoga, you may be interested to check out the Sun Salutations article on my site.

7. Religious and Spiritual Involvement

Religion and spirituality are very important to most people. It is estimated that approximately 90% of the world population participates in some form of religious and spiritual practice. People call on their religion when faced with illness as well as emotional and physical stress for help and support. It has been shown that people that participate in religious activities are less likely to suffer from anxiety, depression or drug and alcohol abuse. Increased resilience, better relationships and marriages are also attributed to regular religious and spiritual involvement.

The health benefits are seen in mind and body. Decreased blood pressure and better physical shape overall has also been shown to occur with religious participation. The most amazing result of regular religious involvement seems to be that there is a benefit to life span. It has been shown that people that attend religious services at least weekly will live approximately SEVEN YEARS LONGER than those who do not, even when baseline health and health behaviours have been statistically controlled.

It is however important to understand that the type of religious involvement makes a big difference. When people are involved in a religious community that focuses on love and forgiveness, people are most likely to be happier and healthier. When themes of guilt, sin and punishment are considered in a religion, then the benefits to your health are not seen. Again asserting the fact that positive thoughts bring positive practices, which bring positive habits.

8. Contribution and Service

Giving back is not purely one sided. Service and contribution to others has been regarded as a virtue and can benefit both the giver and receiver. It is a very ancient tradition and has been considered a means towards happiness, mental health and spiritual maturity. Altruistic behaviours are thought to reduce greed, jealousy and egocentricity while enhancing love, joy and generosity.

In various studies it has been shown that people who volunteer more are psychologically happier and healthier and may even live longer. When looking at elderly volunteers who assisted students having trouble at school ended up feeling better and showed improved intellectual abilities and better brain function. The same benefits can be experienced through undertaking meaningful paid work. At the end of the day, I believe it is all about having a meaningful affect on society and this often parlays into a healthier and happier life.

If you would like to learn more about the 8 ways to wellbeing, I recommend you visit 8 Ways To Well Being.

If you wish to read more about Dr. Roger Walsh feel free to visit the following two sites:

References: Walsh, R. (2011, January 17). Lifestyle and Mental Health. American Psychologist. Advance online publication. doi: 10.1037/a0021769

8 Ways to Achieve Optimal Health