Are We Too Clean?

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Is our obsession with being clean, shunning dirt, and taking antibiotics every time our nose gets runny or we feel under the weather actually hurting us? Are we overdoing it with the anti-bacterial soap and the pill popping? Some expects in the field of medicine certainly think so.

I saw an article in The Economist not too long ago on the American Association for the Advancement of Science (AAAS) and its recent meeting, which discussed the hygiene hypothesis. The hygiene hypothesis tries to explain why some illnesses, such as asthma, eczema, and type-1 diabetes, have become more common in first world countries while, due to improvements in hygiene, many diseases have become much more rare.

My childhood was filled with endless days spent outside playing sports, walking through the creeks behind my house, helping my parents in the garden, and sampling the local honeysuckle bushes. My immune system was exposed to all sorts of bacteria and, as a result, had a lot of practice learning what bacteria was good and what was bad. Life was much different back then than it is now. Our obsession with unnatural cleanliness has only grown with time and neighborhood safety is much more on the front of parents’ minds (are kids even allowed to walk a mile to school anymore like I did?).

As discussed in the article, asthma is caused by an immune response resulting in chronic inflammation of the airways. Studies have shown that farm-raised children are less prone to it than city-raised ones, that children born by Caesarean section are more likely to develop it than children born naturally (children born vaginally get their first dose of bacteria as they pass through the birth canal), and that children treated more often with antibiotics are also more prone.

Why is this? Well it all comes down to the gut. A study in Canada found that infants deficient in four types of bacteria were 20 times more likely to manifest the predictive indicators of asthma. This same study was repeated in Ecuador where it was also found that gut bacteria in infants can predict susceptibility to asthma, though the particular bugs in this study were completely different than the ones from the Canada study.

Scientists are working on the why and the where we go from here, but I thought these findings were fascinating. Since being diagnosed with a gut imbalance myself, I have read a lot on gut health and learned that pretty much everything we eat and expose ourselves to on a daily basis impacts our microbiome. This includes what you eat, the quality of the food you eat, the lotions and makeup you put on your face and body, the vitamins, medications, and supplements you take, how much you exercise, and even your stress levels.

I took medication to treat acne for at least a solid 10 years of my life, which almost certainly contributed to the gut dysbiosis I am working hard to resolve today. While antibiotics kill bad bacteria, they also kill good ones that help our body to function optimally. I’m also a C-section baby, so possibly was more prone to gut imbalances from the beginning.

Regardless of your background and your current state of health, here are a few tips I have learned that are crucial to maintaining a healthy microbiome:

  1. Eat Real Food – A diet filled with processed food and artificial sugars will feed bad bacteria and yeasts, causing them to grow and multiply. Over time this leads to a less diverse microbiome. It has been found that microbiomes are less diverse in obese people.
  2. Eat Organic – Especially produce, meat, and dairy, if at all possible in your budget. Round-up, a common pesticide sprayed by farmers on crops, contains a herbicide called glyphosate, which is antimicrobial. It disrupts the normal gut flora and reduces the number of good bacteria when you eat foods that contain it. If you eat meat and dairy from animals treated with antibiotics, you absorb those antibiotics too.
  3. Avoid Hand Sanitizers – They have been linked to environmental allergies and atopic diseases (asthma, food allergies, atopic dermatitis).
  4. Use Antibiotics Only When Needed – A round of antibiotics can decimate your gut flora, including both the bad and good bacteria. Antibiotics also do not treat viral infections. If your doctor prescribes an antibiotic make sure you understand exactly why.
  5. Get Outside – Play in the garden, go puddle jumping, hike your favorite trail, play fetch at the dog park, or lay in the grass and read a book. Nature is filled with good microbes and your immune system may need a little bit of practice. What better way to celebrate Spring?

Oh, and Happy Earth Day folks.

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The Disconnect Between Healthcare and Public Health

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Recently my job and my passion for health and wellness came together for a brief moment in time and it was absolute magic. Not often does this happen to an accountant with a love for fitness and health, so let’s just say my inner nerd was really happy. While the actual event was not terribly exciting (I was taking an online continuing professional education course for my CPA license), the content, which covered our healthcare system, managing costs, and improving patient outcomes, was. Now that’s right up my alley!

Take a moment to imagine all the things in your life that impact your health on a daily basis. This list is pretty long right? It basically encompasses almost everything in your day, from how you sleep, when you wake up, what you eat, who you interact with, to how you feel and think throughout the day. It also encompasses the environment in which do you all of these things. These various aspects of our life are called social determinants, or more simply put, economic and social conditions that impact health.

They can be grouped in the following major buckets: where you live, what you eat (or don’t eat), access to transportation, education level, social network (family/friends), and employment and income. Studies have shown that approximately 80% of our health is determined by these factors. Makes sense right? In general, someone who is homeless and doesn’t have regular access to food, is relatively uneducated, and has no social support network will normally suffer from greater health issues than a middle class, educated individual who has a home, job, and family.

Here’s the catch. While social determinants account for 80% of our health, 88% of healthcare investment is in clinical care and doesn’t even consider these factors. This is a huge disconnect. As I have said before in my recent post on functional medicine, our medical system currently only treats the symptom, the clinical issue at hand. It does not take into account the other factors in a patient’s life that may be impacting their health in a big way, which are usually these social determinants.

Even if the system can treat an individual’s issue through care, who’s to say that it won’t come back again due to some other aspect in their personal life that is completely outside of the current realm of medicine? Maybe this person lives in a food desert and the only food they can afford and have access to is fast food. Maybe this person is super stressed out at their job and working long hours. Maybe this person is a single parent just trying to get by. The possibilities are endless and unique to each individual.

There are so many “ifs” and it is causing us money. In case you haven’t heard, we are a fairly unhealthy lot. We have the highest rate of of obesity among OECD countries (OECD stands for Organization for Economic Cooperation and Development). Obesity alone costs us about $245 billion a year. Add in cancer, heart disease, and Alzheimer’s and the numbers add up fast.

So what can we do about it? Focus on these social determinants. In my opinion, the best way to do this is through health coaches. Individuals who are trained in nutrition and healthy eating but also have an understanding of how all aspects of our lives impact our health.

Health coaches can work with doctors to implement a protocol based on each individual patient’s needs. Most importantly, coaches can provide ongoing help to individuals so that healthy changes are actually achieved, because we all know someone who’s gotten a recommendation from their doctor and never ended up following through on it. For those who need assistance with housing or other basic needs, they can team up with social workers and aid organizations.

I am imagining one big network of care that extends beyond the hospital or doctor’s office.

As I am a trained health coach I may be a little bit biased about how beneficial health coaches could be to the system, but the facts above really show that there is a need. Our current system is failing.

We are headed in this direction, slowly but surely. My health plan at work actually has monetary incentives that encourage you to speak to a coach about things such as stress, weight loss, and mental health. Maybe ten years from now health coaching will be an accepted thing that everyone uses and not just a niche thing for people with disposable income or a job that provides good benefits. I sure hope so, especially for those on the lower end of the income spectrum who sometimes need these services the most.

This post isn’t meant to be a sales pitch; I’m not actively practicing health coaching, nor do I really want to. It is meant to show the reality of where we are as a nation and where I think we are headed. That there are other avenues out there to achieving health besides going to the doctor and getting a prescription. Health coaches can assist you in finding health through areas that many doctors are not trained in, such as nutrition and exercise. They can be a great compliment to the work you do with your doctor.

If this intrigues you I strongly recommend you take a look at what coaching options are offered by your insurance plan and talk to your doctor to see if they have any recommendations. There are so many coaches out there that even a basic Google search will probably bring up a plethora of options.

Here’s to you achieving health in the way that works best for you!
Sources:  Deloitte Development LLC