Optimizing Metabolism

by Ingrid Kohlstadt, MD, MPH

Spirituality as an Age-Well Strategy

I liked the pulse of the 2015 Healthy Aging Summit in Washington, DC. It presented a mix of research, clinical and advocacy which I wrote about in my November 2015 Townsend Letter column. With this month’s theme of men’s health in aging I write about something the conference didn’t cover: a role for spirituality in supporting the aging process.

Attendees weren’t afraid to look chronologic aging squarely in the eyes. They weren’t going to give an inch to the ageist attitudes of our youth obsessed culture. One outspoken person said that he disagreed with the conference introduction video where the elderly stated their age as “years young.” “What’s wrong with being old?” he asked. “We should feel proud of the age we’ve achieved.” Attendees bandied phrases such as “Don’t sugarcoat age,” “Sweet-talk adds to discrimination,” and “Sixty-five is the new 65.” Even the opening talk was about achieving potential. My favorite was, “We should have a Peace Corps for older people. We do. It’s called the Peace Corps.” What I didn’t hear in the “age well” messaging was the spiritual aspect of vibrant health.

The Healer

As a medical student, I was taught that health is not the absence of disease but the presence of physical, mental, and social well-being. The only shortcoming I saw to the WHO definition of health is that it seemed static – an answer for standardized tests, not one for the ER in the midst of a medical crisis. Or so I thought.

Imagine my surprise when that static definition helped me save lives on three continents. Working in a hospital in the headwaters of the Amazon, I was on a medical team to stem the outbreak of yellow fever. Using the jungle’s rivers like roads, we canoed to distant villages. At each site we had to first meet with the traditional healer to receive permission to screen and immunize the villagers.

Later during a humanitarian mission in the Horn of Africa, I waited on giving a blood transfusion to a young man until his village’s healer could speak with me. In a remote Native American community the night before I was to serve as their doctor, there was a knock at my door. I was asked to join members of the community at their sweat lodge. During the sweat they prayed for me to be blessed and guided while serving as their doctor.

Not only did the WHO definition of health help me tailor my medical services to diverse communities, as I tried to integrate I changed. The image of the medical doctor whom I wanted to be had become more organic, connected with humanity, and tuned to the invisible forces of healing.

Spirituality for Life

The largest body of published medical literature for spirituality in medicine is focused on end-of-life care. But spirituality can help people live to their potential, too, empowering them to make healthful choices.

I’m very interested in how spirituality can inspire us to be vibrant. I’ve watched spirituality help people get off the couch and out of the junk-food aisles. Another struggle common among those with excess weight is feeling judged or blamed, as if their figure is fully due to them personally. Can spirituality help them receive grace, mercy, and self-acceptance? Can the social networks that we form around our spiritual beliefs help us become more informed about the health effects of certain foods and medications? And what about the silver lining, can spirituality help patients find purpose in their journey through illness and harness their experience to come alongside others?

Most cultures around the globe and across time have harmonized the spiritual with the physical. The explanations may not have been scientifically sound, which was obviously detrimental to the patient. But that doesn’t mean that the method by which health care was provided was not effective. In contrast, the US system offers a fragmented form of health care. The scientific advances may have bigger impact if we can reunite them with the spiritual aspects that have withstood the test of time.

Is Spirituality Necessary?

I asked my colleagues attending the conference if they had heard discussions about the connection between spiritual and physical well-being. They hadn’t, but they were interested in engaging in the topic.

For example, I spoke with the physician scientist who invented a clinical criterion for cognitive decline. His criteria didn’t include spirituality, but in his opinion, preserving someone’s mental functioning so they can experience their spiritual beliefs is very important, and personally very satisfying to him.

One plenary speaker explained how our parents’ aging process influences our own perception of aging. When she reached the young age at which her mother had died, it was emotional. The milestone was one that she clearly felt deeply and she reached deep inside to work through it.

The most common response from attendees was that the question of spirituality in healing was interesting, but was it really necessary?

“Necessary for what?” I asked. If health care were a ship, the captain would call all hands on deck, because of the widespread chronic diseases. Spiritual beliefs can inspire people toward nourishing choices, regular exercise and stress reduction. So in a utilitarian way, spirituality is necessary.

Spirituality is part of how we define ourselves, even in a secular society. Secular means that all spiritual beliefs should be respected. In my opinion, suggesting that patients check their beliefs at the clinic entrance, alongside muddy boots and wet umbrellas, falls short of that respect.

Is Spirituality Politicized?

One day I accidentally became the envy of lobbyists. I had been a state page and a congressional intern, so when invited to be “doctor of the day,” I returned to the central nerve of politics with a Tanita brand bioimpedance scale. I set it up at the first aid station and offered legislators personalized printouts of their body composition. The scale works best when metal is removed. I didn’t hesitate to use white-coat authority to say, “Senator, empty your pockets. You can hand me your wallet.”

While I got laughs, I didn’t get funding. I returned the wallets, and my moment in politics ended as abruptly as it started.

I can be lighthearted about politics but I couldn’t feel the same way about my scientific research. What if new jargon or catchphrases changed my research funding? That’s the challenge that some of my colleagues faced. In the Bush era, public health funding was tied to faith communities. The 2015 Healthy Aging Summit’s phrase was “social networks.” There was no funding or mention of faith communities.

Whatever we call them, new health programs are often most effective when they build on existing social networks such as faith communities. Faith communities, the social networks arising from our spiritual beliefs, have shown themselves effective in promoting health. Examples include social gatherings for physical activity, intergenerational activities, and civic engagement.

Summary

Although spirituality got short shrift at a leading health and wellness forum that I attended in Washington, DC, attendees were interested in engaging in the topic. Enduring despite political tides, spiritual aspects of health can help us better understand what it means to be human. In practical public health and preventive medicine, spirituality can help patients towards more healthful ways of being.

Ingrid Kohlstadt, MD, MPH, FACPM, FACN

Faculty Associate, Johns Hopkins Bloomberg School of Public Health

Executive Director, NutriBee National Nutrition Competition Inc.

Editor, Advancing Medicine with Food and Nutrients (CRC Press; 2013)