By Sarah LoBisco, ND


Since the beginning of my medical career, there existed within me an internal prodding to explore and find the missing link between holistic patient care and the fragmented approach of modern medicine in place today. Although, the US has a beautiful system in place for acute care, surgery, and disease management, the statistics for our health model is quite lacking. This may in part be due that the assessment of health tools themselves is lacking. According to article in this winter’s edition of Holistic Primary Care:

Citing new data on the country’s 2010 drug utilization, recently published by the IMS Institute for Healthcare Informatics (, Dr. Guarneri noted that last year, the country spent $13.6 billion on statin therapies alone. Despite the nation’s exorbitant expenditures on surgical interventions and drugs, 2,200 Americans die from CVD each day, and coronary disease still causes 1 in 6 deaths. “Statins do not cure CVD.”

Psychotic, Depressed, Dyspeptic

The IMS data indicate that Americans spent $308 billion on pharmaceuticals last year; collectively, we consume 47% of all pharmaceuticals by the drug categories with the biggest total expenditures, one can conclude that, “the US is psychotic, depressed, has hyperlipidemia and heartburn!” Dr. Guarneri joked. But it’s really not a joke. It’s a frightening reality, one that’s economically unsustainable.

Like many clinicians involved with Bravewell, Dr. Guarneri believes that a fundamental shift from disease-based interventions to wellness focused care has tremendous potential to save lives and save money.

“We have the tools. We know that for every dollar we spend on, say, the Ornish lifestyle based programs for CVD, we save $6. We have the research. We need to apply it.” Last year, Dr. Guarneri co-authored a review paper entitled The Efficacy and Cost- Effectiveness of Integrative Medicine, documenting the actual real-world outcomes and savings from application of integrative principles and practices in treatment of heart disease, stroke, cancer, diabetes and depression.

It is not my intention to suggest that our current model is not needed, rather that I’ve found it to be lacking and not in resonance to this idealized prevention and wellness model in my mind. To me, health is more than the absence of symptoms; it is about thriving and the ability to participate in life with full vitality and joy! This is why I continue to study Naturopathic and Functional medicine. This is also why most of my blogs continue to stress the importance of a holistic and systems biology approach to medicine.

Environmental medicine is one example that highlights how preventing and maintaining health is not just about looking at the individualized pathology of one system, but in evaluating the interaction between the patient and his or her surroundings. This approach exhibits that factors such as the quality of food and environmental toxicity can no longer be ignored and must become an integral part to the solution. (Be sure to see a great example of this in my Naturopathic Fun Facts this week!)

Last week, I gave you two baby steps to take to move forward in creating a strong foundation for a holistic and integrated approach to health. This week, I’ll continue with two more infant footies by encouraging you to:

1. Plan on food and you first, especially when stress rears its ugly head

2. Make your way safely through the grocery store aisles—with a very famous doctor!

Choosing Food First- The importance of Planning

Stress, it’s a major obstacle to choosing wisely, regarding any decision. It creates an overdrive into flight and fight and reactive urgency over relaxation and setting priority. In other words, the emotional brain is over-driving the executive functions of the prefrontal cortex. These emotional cues trigger various biochemical changes in response patterns, including food choices. An article in Vital Choice explored this connection between stress and food decisions:

The stress-food-fat connection

Five years ago, UCSF psychologist Elissa Epel, Ph.D., and a colleague reviewed the evidence available at that time, and saw likely connections between chronic excess stress and overeating.  As they wrote, “… it appears the obesity epidemic may be exacerbated by the preponderance of chronic stress, unsuccessful attempts at food restriction, and their independent and possibly synergistic effects on increasing the reward value of highly palatable food.” (Adam TC, Epel ES 2007)

Prior studies in rodents showed that abdominal obesity resulted when chronic stress caused chronic secretion of glucocorticoid hormones, such as cortisol. Fat cells are among the direct targets for cortisol and other glucocorticoid hormones. In comparison to subcutaneous fat cells – ones located just under the skin – abdominal fat cells have more glucocorticoid receptors to capture the hormones.

After putting on more belly fat, the rats’ cortisol secretion becomes blunted in response to acute stress, and their day-to-day glucocorticoid secretion goes down as well. The hormone system that controls cortisol secretion, known as the hypothalamic-pituitary-adrenal (HPA) axis, was turned down. “The rats appeared to be self medicating,” Epel said. “Their stress eating in turn dampened their HPA-axis activity. We wanted to know if this happened in people as well.” (UCSF 2011)

The researchers found that women who were the most stressed out were the most likely to report that they eat more in response to emotional upsets. And these highly stressed women had significantly more abdominal fat, on average, in comparison to women who did not experience such a high degree of chronic stress. Among women who ranked in the top quarter for chronic life stress, having more abdominal fat was associated with lower daily cortisol secretion, and with less hormone secretion in response to acute stress.

This leads us to baby step #3 in this series on using food as a foundation for health. It is is to remove the obstacles that causes you to reach for candy over carrots from that Christmas credit card bill or a work mandated overtime. For dietary emergencies like these, the power is in planning in advance for these times. It’s a hard balance act to do in this hyperactive society, but a critical component in preventative medicine.

Even for myself, I have to admit, it can be tough. I often catch myself popping supplements and grabbing something quick while doing charts vs. sitting down to a nice, nurturing lunch. Thank goodness, I have healthy bars and nuts and seeds on hand for such occasions. (I learned in Arizona, eating nuts can help with blood lipid profiles, are anti-inflammatory, nutrient dense, and balance blood sugar, and as we know cortisol cause a spike in blood sugar).

Dr. Hyman’s blog discusses the importance of food planning:

  1. Plan, plan, plan: You wouldn’t take a trip to climb a mountain or take a vacation to France without planning first. It is THE most essential activity you can do to create health. Plan your day, your week, your month and schedule in time for the things in your life that support health—food, fun, sleep, exercise, friends or whatever else puts deposits in your health bank account.
  2. Think of food first: Most of us are opportunistic eaters—when the opportunity comes, or when we get hungry we eat whatever’s in our path. In our culture that means junk food, fast food and vending machine “food like substances.” We live in a vast nutritional wasteland, a food desert. Every week plan where you are going to get all your meals. Think ahead; don’t end up in a food emergency where the only thing open is a fast food restaurant or convenience store. Think breakfast, lunch, dinner, and snacks. It will become a habit. Plan, shop, prepare, eat. Create an emergency food pack and buy quick-to-cook meals or make whole foods at home.
  3. Design fun and play into life: MacDonald’s was good for something—it gave us the ditty—“you deserve a break today.” Think of your day as a canvas and think of how you can paint yourself some fun. Learn new things—try yoga, dance, or learn a new sport. I like to get my exercise by having fun and playing not by going to the gym.

I’d also like to add that there are many ways to manage stress and prevent this cortisol rush. One big tip is to remember to be kind to ourselves as we make the transition from stress eating to nurturing behavior.

Surviving the Grocery Store Enticement

High fructose corn syrup, trans-fats, and claims of “health foods” which are actually loaded with sugar, are lurking on even the kindest grocers’ shelves. Like everything else, with food, awareness is the key to change. Now that we’ve planned what to eat, we need to follow through and actually grab the right things for our body, and bypass that endcap of HoHos and Peeps (I used to love the pink chicks).

Therefore, to guide you in step four- follow through with the plan, here is a link to a video commentary with Dr. Hyman and Tanya Amen. In this 20 minute video, these pioneers in true medicine show us how to avoid harmful foods and survive your next grocery store trip with little to no temptation. How fun! You can actually take a shopping trip with two of the most well-known and educated integrative physicians in the world! Whoo-hooo…..


Goldman, Eric. Bravewell Collaborative Honors Guarneri, Celebrates a Decade of Progress. Holistic Primary Care Winter Edition 2011.

Hyman, M. Six Ways I changed My Life and How You Can Change Yours. December 31, 2011.

Wetherby, C. Stress Fuels Overeating, Simple Solutions Found. Vital Choice. January 6, 2011.,b1h0JlRD

Hyman, M. Avoid the Bad. Accessed December 31, 2011.

Be sure to check out my informational blog on which includes:
1. Naturopathic Philosophy Highlight… Fun Facts:

  • Is Your Birth Control Hurting your Partner?
  • Saw Palmetto & Prostate Cancer
  • Nature’s Antifungal as Good as Rx Drug?
  • Genetic Differences in Detox highlight Negative Drug Reactions- Functional Medicine to the Rescue!

2. Happenings:

Upcoming Essential Oils Workshops with Terry Quigley at the Healing Garden. Contact Terry at 518-831-9469

Trader Joe’s is Coming! It’s True. Thanks Bruce Roter and the Crew.

PATIENTS: Please review follow ups and cancellation policy on my website

Time for a symptom re-evaluation?

All patients can now download the symptom survey done at the original visit online. If you haven’t re-evaluated your symptoms in a year or more, it may be a good time to fill out the form again and bring it in to your next visit. (Please add the numbers in every section when you return it).


3. Radio For Your Body-Mind-Soul Radio For Your Body-Mind-Soul: Marcelle Pick

January 11, 2012 Are You Fizzling Instead of Sizzling in the New Year? Has the hustle and bustle of year end activities taken its toll on you? Are you finding getting out of bed in the morning to be harder than usual? Is your energy dipping earlier in the day? Listen in today as Marcelle talks about getting your energy back!

4. Book of the week:  Manifesto for Medicine: Your Guide to Healing Partnerships & the Wise Use of Alternative Therapies. By James Gordon

Learn from a leader and pioneer in the importance of self-care and how mind-body and science unite for truly holistic medical system.

5. Don’t miss out:

  • The Rest of Fun Facts on my blog.
  • Listen to my colleagues and other experts as they discuss solutions to menopausal issues on a show dedicated just for women in mid-life! Here is a link from my interview on 360menopause Radio Show on Panic Attacks and Menopause and a list of archived shows.
  • Check out my latest answer on Dr. Oz’s Sharecare:The side effects of Birth Control Pills
  • View the Updated Link Resources on my homepage