“Well now baby, when you’re born, you’re just set on a road, and that road is your medicine road,” recalled integrative medicine pioneer Tieraona Low Dog, MD, 57, midwife, herbalist, physician and author. It was her grandmother speaking. She was eight years old, riding shotgun in a Ford 150 pickup truck home from the annual pow-wow held at Medicine Lodge, Kansas.
“Everything you do affects you,” her grandmother continued, “and it affects the world around you—the way you eat, the way you treat other people, how you live your life, the way you move in the world. Everything you do is medicine, good or bad.”
Young Tieraona’s reaction at the time? “I had no idea what she was talking about,” she admitted. “I didn’t for a long time. But what she said kind of seeped into me, like an herb in water. I’ve come to realize as a primary care physician that what she was talking about is what today we call prevention and health promotion.”
In a recent wide-ranging keynote to an audience of doctors, Dr. Low Dog, now with more than 35 years of medical experience, told what she thinks really makes a healthy life. She had some provocative things to say about the difference between sleep and rest…the biggest nutrition mistake in a generation…why you sometimes need to say “no” to your friends…and much more.
THE BIG PICTURE
“Ninety-three percent of diabetes, 81% of heart attacks, 50% of strokes and 36% of all cancers could be prevented by a clean environment with limited or no exposure to toxic chemicals, no smoking, no or moderate alcohol consumption, healthy nutrition, a balance of exercise and rest, stress management and a healthy social network,” said Dr. Low Dog. We can’t achieve these dramatic improvements with pharmaceuticals, she added. “No one is saying we can prevent 93% of diabetes with metformin. It’s about the way we live our lives.”
WAGING PEACE IN THE NUTRITION WARS
“How can people be so confused about nutrition? Come on now! As if we could discover an entirely new way of eating! When we move away from traditional diets, the way people have eaten for hundreds of years, we suffer. If you want to improve your own health, it’s about cutting out the sugar-laden processed foods and eating more whole foods. Any traditional diet, whether it’s the Mediterranean or the Okinawan, doesn’t include all this sugar and processed foods.”
She admitted to misleading her own patients for years with advice that she now understands was wrongheaded. “If I had a nickel for every person who came into my office and I told to cut back on saturated fat, I’d be a millionaire. Sometimes science gets things wrong. In 1980, we told people to cut back on fat, and they started eating lots of carbs and loading up on the sugar.
“But the data is now swimming in one direction—saturated fat doesn’t impact heart disease in any meaningful way, and replacing saturated fat with polyunsaturated fat doesn’t reduce heart disease either. That’s not an excuse to start eating lots of fat—I’m not saying go out and eat a pig!—but fat is not our primary problem. Sugar is.
“It’s a relative newcomer in the world and in the American diet. We now consume about 80 pounds per person in added sugar each year. That’s about a pound every four days. No way has the human body evolved to handle that much sugar! The World Health Organization advises that we limit added sugar—not what’s in blueberries and strawberries but sugar added to processed foods—to 25 grams per person. That fat-free Greek yogurt? It might contain half your daily amount of added sugar! People have gotten heavier, and we’ve seen a tidal wave of nonalcoholic fatty liver disease, diabetes and heart disease.”
A few more nutrition pearls from her talk…
- On fake health foods: “You go to Whole Foods, and you buy something with agave nectar in it instead of high-fructose corn syrup. Really? That makes it a healthy food?”
- On giving up sugar: “I went on a sugar-free diet for a week—no foods with added sugar. That means no bread, too, since it has added sugar. By day three, I found myself wondering what store might be open in Santa Fe if I got in my car and drove an hour. I was dreaming of donuts—and I don’t even eat donuts! It took about six or seven days before the sugar cravings went away. I realized what my patients mean when they say they are addicted to sugar—I realized they mean what they say!”
- On eggs: “We told people to quit eating eggs, one of our best sources of protein.” The yolk is rich in choline, which is critically important during pregnancy and early childhood and also improves liver function. “If you go out to a diner and order an egg white omelet, I’d just say, ‘Why bother?’”
- On grains: “Remember when the food pyramid said to eat seven to nine servings of cereals and grains a day? That’s crazy! A couple of servings of whole grains a day, that’s enough for most of us.”
- On alcohol: “I lean to the moderate rather than the ‘no’ alcohol side—I like a glass of wine with dinner.”
- On nutrient deficiencies: “Ninety million Americans are deficient in vitamin D—and 30 million in vitamin B-6, which contributes to irritability, depression and poor cognition. Eighteen million have low B-12 levels—if you’re taking a proton pump inhibitor, your chance of having a B-12 deficiency goes up.” Many people who’ve cut back on salt or use non-iodized salt (such as sea salt) now have a borderline iodine deficiency, she added. “I’m not recommending that everyone start salting everything, but be mindful where you are getting iodine in your diet.” She takes a multivitamin/multimineral supplement almost every day.
MORE STOPS ON THE MEDICINE ROAD
Dr. Low Dog covered many more topics, including why we need friends for a healthy life but sometimes need to tell them to go away…
- On toxins: “Cut back on the cans, get rid of the plastics, no artificial fragrances.”
- On rest versus sleep: “The data isn’t so compelling about the actual number of hours you sleep. What we really need is rest. I don’t ask patients how many hours they sleep—I ask them, ‘When you wake up in the morning, do you feel rested?’ You could sleep 10 hours and still wake feeling tired.”
- On loneliness: “When people are socially isolated and alone, it’s as bad for their health as being a smoker, as being an alcoholic—and worse than being obese. It may be better to occasionally eat a Twinkie with your best friend than to eat a salad alone every night. One of the most important questions we can ask our patients is, ‘How many friends do you have? What are the names of four people who would drop everything to come be with you if you needed them to?’ Social networks matter.”
- On turning off technology—and friends: “The most difficult thing for me is to take one day off a week, including no cell phone or e-mails. It’s one of the keys to managing stress.” She illustrated her difficulty by recounting the story of a friend who planned to spend a weekend in Santa Fe, about an hour away from where she lives. She told her friend that she wasn’t available for dinner at a restaurant in the city, or breakfast, or even a visit to her ranch. “What are you doing this weekend?’” her friend asked. “I said, ‘nothing’—as if doing nothing was bad! I told my husband, ‘I’m trying to practice saying no, and it’s not working very well.’ But sometimes you have to create a space for solitude, a space where you can hear your own voice and not the chatter of the world.”
- On stress and depression: “Chronic stress drives much of the disease we see today, but better living through drugs isn’t the best answer. Nutrition and exercise make you more resilient in the face of stress. For milder forms of depression, however, antidepressants have not been shown to be better than placebo. For severe depression, these medications absolutely are effective and lifesaving. But how many people have I seen who started on antidepressants and were still taking them six years later—with no thought about weaning the dose or asking the opinion of a mental health specialist if the drug was still necessary? One thing is true—medications are often added but not often taken away.” Yet, an effective intervention is often ignored—exercise. “There are more than 90 studies that show that exercise can be effective for both preventing and treating depression and anxiety. One problem is that not enough doctors exercise. Doctors who exercise are more willing to tell their patients to exercise, too. When it comes to beating stress,” said Dr. Low Dog, who trained as a martial artist, “exercise wins every time.”
- On meditation: “It’s about making friends with your thoughts, not obsessing over your thoughts. Do it for 30 minutes for 30 days and you’ll change your brain for the better.”
- On healing: “I love this quote from Rachel Naomi Remen, MD, a family medicine professor at the UC San Francisco School of Medicine,” concluded Dr. Low Dog: Healing may not be so much about getting better as about letting go of everything that isn’t you—all of the expectations, all of the beliefs—and becoming who you are.
