Reversing Chronic Disease with Lifestyle Medicine with Erika Blank, M.D.

Many chronic diseases can be prevented and even reversed by making healthy changes to your diet, exercise routine, sleep habits, and stress levels. In this episode, Dr. Erika Blank, an MUSC Health physician, talks about how evidence-based, lifestyle medicine is changing the lives of MUSC Health patients.

"People have a hard time letting go of what they're used to, of what they're used to eating, how they're used to socializing. I don't like to focus on what someone is giving up, but on what they're adding and how they feel when they do."

– Erika Blank, M.D.

Topics Covered in This Show

• Lifestyle medicine began as a field in the early 2000s and has been growing exponentially. It is an evidence-based practice that treats illness and disease with lifestyle changes based on diet, exercise, sleep, social connections, and stress management.
• Blank was an internist for almost 20 years before shifting gears in 2016 to also become board certified in lifestyle medicine. After years of treating chronic disease with medication and seeing patients continually feeling unwell, she decided to begin training in lifestyle medicine.
• There is a lot of solid evidence that a predominantly plant-based diet supports good health. This means eating primarily whole foods such as vegetables, fruits, whole grains, nuts, and seeds, with only a minimal amount of meat, especially red meat.
• Exercise and physical activity, especially aerobic exercise, is recommended. At least 150 to 300 minutes of aerobic exercise per week is ideal and can be as simple as a brisk walk. Strength training is also very important, as it is hard to maintain muscle mass with aging. Avoiding being sedentary is also crucial.
• Sleep is perhaps the most important pillar of a healthy lifestyle. Poor sleep creates conditions for disease, especially Alzheimer’s. Blank recommends setting an alarm for bedtime to remind you when to go to sleep. If you have insomnia, cognitive behavioral therapy can help.
• Good stress can be motivating and energizing, but chronic low-level stress can cause inflammation and disease. One way to counter this is to strengthen the parasympathetic nervous system – for example, practicing mindfulness.
• Blank states that stress is about 10% of what is happening and 90% of how we react to it.
• There is an evidence-based correlation between social connection and longevity. Even talking to strangers can be beneficial.
• Blank has seen patients reverse diabetes with a healthy lifestyle. She has also seen patients lower both blood pressure as well as cholesterol.
• It can be overwhelming to make so many lifestyle changes at once. Blank suggests starting small at first. Focus on the main priorities and slowly build up over time.
• MUSC offers a holistic mental health program called Modern Minds. MUSC's new Health and Wellness Institute can also help support those who are making lifestyle changes.

Read the Show Transcript

Erin Spain, MS [00:00:04] Welcome to Advance with MUSC Health. I'm your host, Erin Spain. This show's mission is to help you find ways to preserve and optimize your health and get the care you need to live well. Many chronic diseases can be prevented and even reversed by making healthy changes to your diet, exercise, routine sleep habits, and stress levels. Dr. Erika Blank an MUSC Health physician who is board-certified in both internal and lifestyle medicine, is here to talk about how lifestyle medicine is changing the lives of MUSC Health patients. Welcome to the show, Dr. Blank.

Erika Blank, M.D. [00:00:44] Thank you. Thanks for having me.

Erin Spain, MS [00:00:47] Tell me, what is lifestyle medicine? Some folks may have never heard of this term before. What is it and what makes it distinct from, say, internal medicine?

Erika Blank, M.D. [00:00:55] That's a good question. The field probably started in the early 2000s and has really been growing exponentially, especially in the last few years. So, internal medicine is general adult medicine. We learn about all the chronic diseases and we treat them. And lifestyle medicine has an emphasis on really preventing diseases and treating diseases with lifestyle changes. It's very evidence-based. We don't recommend anything that we don't have a lot of good evidence for. And the main pillars focus on diet, exercise, sleep, social connections, and stress management. So, it's really that extra time talking to patients about all of those behaviors where there's the difference. Truly, every doctor should be practicing lifestyle medicine as part of practicing medicine, but there's just not enough time.

Erin Spain, MS [00:01:46] So, you are board-certified in lifestyle medicine. What made you want to take this extra step and really immerse yourself into this practice?

Erika Blank, M.D. [00:01:56] Yeah, it just kind of happened naturally. I was living in New Hampshire at the time and I did a CME in Boston on lifestyle medicine. That was probably 2016 and something just spoke to me. At that point, I'd been a doctor for 20 years and probably practicing for 17, and I realized that all I was doing was treating patients for a lot of chronic diseases, prescribing a lot of medicines, and the patients didn't feel well, they weren't happy. It was just sort of frustrating to see the same thing over and over. So many people had diabetes and high blood pressure and heart disease and then for each one of those, they were taking a few medicines. The lifestyle medicine course came around at the right time, and then after doing that, I got notified that there was going to be a board certification, and I took it the very first year in 2017, and I'm actually number 22 of all the people certified in lifestyle medicine.

Erin Spain, MS [00:02:53] What do your patients say when you talk to them about, hey, let's try some of these changes and you let them know that there's a chance that they may be able to reduce or even get off of some of their medications. How do people respond to that?

Erika Blank, M.D. [00:03:07] The response is variable. Some people are excited. Some people I don't even need to tell them a lot. They go home and they make changes. And then I'm getting a phone call a week later that they're lightheaded because their blood pressure so low because they changed their diet. I think that generally there's some interest and I think that the difficulty is that making changes is hard. I think that's really the meat of the matter is helping people with those behavior changes. And then, of course, there are the people that I get the response, just give me the pill, doc. I start talking and then I get responses. Like I like to eat what I like to eat. And then, you know, they're not ready to hear that and that's okay.

Erin Spain, MS [00:03:47] You mentioned these pillars and you mentioned diet and eat, mostly plant based. Can you go through these different pillars for me? You know what you do recommend that patients do to embrace lifestyle medicine? Let's start with diet.

Erika Blank, M.D. [00:04:00] Yeah, there's a lot of evidence for a plant-predominant diet. And I don't want to scare anyone into thinking that I want them to become a vegan and that's the only thing they can do. Any shift toward eating more plant foods is good. So it's eating a diet of whole foods. So vegetables, fruits, whole grains, beans, nuts, seeds as the base of the diet. If a patient is having some small amounts of of meat with their diet and that's what they're comfortable with, I think that's okay. And really eliminating all of the popular foods in Western culture, like the sugar-sweetened beverages and the refined carbohydrates and all the processed food that we have in the middle of the grocery store and the boxes and really limiting the red meat so it's really simple. And I think that we probably all know what to do. We probably all know that soda and chips and candies and lots of cookies, cakes, ice cream can't be a regular part of the diet. I think people are often scared to let go of what they're used to, so I don't want them to think they could never eat something that they enjoy or some family traditional food, but really to focus on making healthy choices most of the time.

Erin Spain, MS [00:05:18] Exercise, physical activity is also a pillar.

Erika Blank, M.D. [00:05:21] Yet there's a few aspects of physical activity. There is getting in enough aerobic exercise. I recommend, and the American College of Sports Medicine, recommends at least 150 to 300 minutes of aerobic exercise per week, and it can be broken up any which way. It could be 30 minutes five days a week, can be as simple as a brisk walk. It doesn't have to be speed running, just something to get the heart rate up. So you're you're breathing a little heavy. The aerobic part is one thing. And then strength training and that is what I find most people are not doing is the strength training. It's so important, especially as people get older, it's harder to maintain your muscle mass as you get older. You didn't have to think about it when you were younger, but you have to make a conscious effort to do that. So twice a week to hit all the major muscle groups in whatever way somebody will do that, whether it's a gym, whether they prefer to do it at home. The pandemic affected things in certain ways, but we seem to be coming out of that. So really, I end up talking about strength training a lot because everybody knows they should be doing it, but they're not. And it's really important. And then the other aspect of exercise is to not be sedentary, to really be moving most of the day. So whether it's getting up or I took the dogs for that walk today, I like doing my own yard work on the weekends, so I stay more active. If you can walk to a store or meet somebody to walk and be moving instead of sitting still. Those are the three parts of exercise that are important.

Erin Spain, MS [00:06:53] And then sleep. Sleep is something that at least a lot of Americans seem to struggle with. How critical is sleep?

Erika Blank, M.D. [00:07:00] It may be most important, you can't do anything without good sleep. It's harder to keep up all of those other habits if you're not getting healthy sleep, and poor sleep really sets you up for chronic diseases. The most scary to me is Alzheimer's disease and there is evidence for that. I think that we don't make sleep a priority. Start with making it a priority. And people talk about instead of setting the alarm for when you wake up to set an alarm, to go to bed, to make sure you're getting to bed on time and leaving enough time to sleep. Most people need 7 to 9 hours of sleep, so leaving the time to sleep, creating a good bedtime routine. There's a lot of sleep hygiene that most of us have looked up at one point or another. If people are still struggling, then the best option is something called cognitive behavioral therapy for insomnia. It's difficult and it takes time. It's not an immediate fix, but it's really the best way to to treat a chronic sleep issue. And then, of course, if there's a medical issue like sleep apnea, I highly encourage anyone who suspects that they or a partner has that to have that evaluated, because that really puts a strain on the heart and can really lead to chronic diseases, arrhythmias, and it'll affect somebody's ability to lose weight. So I can't emphasize enough how prioritizing sleep, leaving enough time for it, creating a good routine, sleeping the same hours every day, not sleeping in on the weekends, just staying consistent with it.

Erin Spain, MS [00:08:35] Minimizing stress. It's been a stressful time for a lot of people in the recent years, and a lot of folks may not know that stress can impact things like blood sugar. Tell me about how stress can impact health and why it's so important to minimize it.

Erika Blank, M.D. [00:08:52] Yeah, we have a very strong mind-body connection and we might not even realize how stress is affecting us. And a lot of times a patient will come in with certain symptoms, whether it's abdominal pain or headache. After teasing everything out, it turns out that's what is affecting them. You know, it's very important to find that out and address it, you know, because chronic stress, there's good stress and bad stress: the good stress of your flight and fight response when something happens and you need to respond and flee or something like that. And that's one thing. But having this chronic low level stress affecting your body can cause inflammation. It puts you at risk for all of those chronic conditions like diabetes and blood pressure and even inflammatory diseases. One way to combat that is to really try to strengthen the parasympathetic nervous system. The sympathetic nervous system is your flight and flight response. If you've ever even felt anxious or you might know that increase in heart rate that you feel an increase in respirations. So the parasympathetic nervous system kind of slows everything down. And one way to access that is to practice mindfulness just to sit quietly and observe. And the more you do that, the more you strengthen that muscle and can get there more quickly and more often and decrease that chronic stress response that is is going on in your body. There's one saying that that stuck with me. That stress is probably about 10% of what is happening and 90% of how you're reacting to it, really learning how to stop, stay in the moment, calm down, can really help fight that stress response.

Erin Spain, MS [00:10:37] And then there's a social component and staying connected with people. How important is that to overall health?

Erika Blank, M.D. [00:10:45] I think it's really important. There's just that nice, positive feeling you get when you have a social connection, even with a stranger, if you are in line in a store and start up a conversation. That was something that was really challenging during the pandemic because a lot of people were isolating themselves intentionally because they were afraid of getting a virus. But on the other hand, they were really affecting their mental health by doing that. So yeah, social connections are really important. Also being, you know, part of a group, whether it's religious or just your community. If you look at the blue zones, blue zones are areas where people live a long time. A National Geographic journalist wrote this book. He worked with a bunch of demographers and they found the areas of the most longevity where they had the highest percent of centenarians. And one important feature in all of those areas was the social connections that people had. So we know that will help people live longer based on that observational evidence.

Erin Spain, MS [00:11:50] Tell me about some of the diseases that you have seen be completely reversed in some patients that you've helped and who've embraced lifestyle medicine?

Erika Blank, M.D. [00:11:59] Definitely diabetes. If somebody hasn't had it for that long, it is very possible to reverse it. So I have seen hemoglobin A1Cs, which is one of the measurements that we use to diagnose and monitor diabetes. I've seen that come down to normal levels. Cholesterol numbers are always fun to follow because you can trend them and see the results. I've had a lot of patients really lower their cholesterol And then blood pressure also. I think that those are the the main things. People dealing with anxiety or stress just there's not a number that you can follow, but just more of a general sense of well-being that the patients feel.

Erin Spain, MS [00:12:38] While these seem like simple changes that can be overwhelming for people to change their diet, start new exercise routines, work on stress. How do you approach this with your patients? How do you get them started with lifestyle medicine?

Erika Blank, M.D. [00:12:53] I think that it's important to prioritize where the the main issue is also to think about what changes you can make easily so that people will feel some positive reinforcement from being able to do something instead of aiming to do too much and feeling like they failed often, or leave it up to them to decide where they think they need to focus on and what they think they could do, even just to start small. I'm going to go to bed at 10:00 every night, and if they do that, they'll feel good about that. They'll have a lot of self-efficacy and they'll feel confident that they can make changes and then will do something else. You know, it comes up a lot with the diet that I have to ask people what they think they can do, what works with their family and work situation. So I really just let them lead me in that.

Erin Spain, MS [00:13:44] What resources are available to people through MUSC Health to start tackling some of these pillars?

Erika Blank, M.D. [00:13:51] There's an excellent mental health program downtown called Modern Minds, and I really like them because they approach mental health in a holistic manner. So they focus on everything, you know, the sleep and stress and diet and exercise and meditation. That's one great resource for people. MUSC is also starting a new Health and Wellness Institute, and they have nutritionists and health coaches and exercise physiologists there to help people. It's an excellent resource that attacks most of these pillars. Probably the combination of the two would cover everything.

Erin Spain, MS [00:14:29] If you could leave listeners today with a couple of pieces of advice, if they're interested in getting started and treating some of these conditions that they may have through lifestyle modifications. What advice would you give to them?

Erika Blank, M.D. [00:14:41] I think that what I see is that people have a hard time letting go of what they're used to do, of what they're used to eating, of how they're used to socializing, whether that's drinking beer on the weekends. So, I don't like to focus on what somebody is giving up. But what they're adding and how they'll feel when they do that — it's just that letting go aspect. I used to eat this, I eat meat, I do this. And I'm not saying you can never do that again, but just try some meatless meals, add another vegetable, maybe try not to drink alcohol for a short time and see how you feel. Inevitably people feel better. That would be the biggest part, I think just to focus on on what you're adding, not what you're giving up and not necessarily giving up forever.

Erin Spain, MS [00:15:33] What do you do to optimize your health and live?

Erika Blank, M.D. [00:15:36] Well, I try to practice all of this. None of us are perfect and I think that patients need to know that and they don't need to strive for that themselves. What I do is I do eat a mostly plant-based diet. I try to limit my eating hours to stop definitely by eight. I am doing a boot camp five or six days a week and I do yoga on the seventh and try to move as much as possible. I leave myself 8 hours to sleep. I try to read a book before I go to bed to relax. I sort of created rules for myself that I don't drink on school nights so it doesn't affect my sleep and I can perform well at work. And I do look forward to relaxing on Friday and meeting with friends and having a glass of wine.

Erin Spain, MS [00:16:27] Well, thank you so much, Dr. Erica Blank, for coming on the podcast and sharing these tips.

Erika Blank, M.D. [00:16:33] Thank you is really a pleasure.

Erin Spain, MS [00:16:39] For more information on this podcast, check out Advance.muschealth.org.