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All too often the field of physical therapy is an afterthought in healthcare, but PTs have a real opportunity to be the most powerful health profession in the world. Physical therapists just need the right tools to transform the health of our patients and our communities. Dr. Ginger Garner recently sat down with Dr. Elizabeth Dean, a physical therapist and global educator, who has been a leader in the field of integrative and lifestyle medicine for many years.
Dr. Dean co-authored the Orthopedics chapter in the book, Integrative and Lifestyle Medicine in Physical Therapy, which was co-edited and co-authored by Dr. Ginger Garner and Dr. Joe Tatta. They all saw a need for our profession to treat in a more holistic way. They realized that empowering physical therapists with the knowledge and the tools of integrative and lifestyle could powerfully impact our society as a whole.
All too often, physical therapists feel limited to simply perform manual therapy and physical exercise to improve function, reduce pain, or enhance a person’s quality of life. But the research shows that we need to do so much more…and our professional scope supports it.
Physical therapists are uniquely positioned in healthcare. We spend much more time with our patients than nearly any other healthcare provider. This allows us the opportunity to foster meaningful relationships. With these relationships, we then have a greater opportunity to guide and support each person through beneficial lifestyle changes.
There are so many gems of knowledge in this podcast and interview, but here is one of my favorites,
Okay. We’re committed to evidence-based practice. Okay. We’re committed to ethical practice. Well, when you connect the dots, we should be the leading health professional because the things that will prevent and potentially reverse these conditions is staring us in the face and yet we’re doing something other.
Dr. Elizabeth Dean.
Now that you know you should be using Integrative and Lifestyle Medicine with your patients….don’t you want to know how? Help physical therapy become the most powerful health profession, not for us, but for our patients!
Check out the book for more details!
Dr. Dean’s scholarly work focuses on bridging the ultimate knowledge translation gap between what is known about the causes of and factors contributing to lifestyle-related non-communicable diseases (heart disease, smoking-related conditions, cancer, hypertension and stroke, obesity, diabetes, and osteoporosis) and physical therapy practice. She has particular interest in their epidemiology and cross cultural means of maximizing outcomes of health education and interventions such as physical activity. She conducts research in the Middle East and Asia as well as multicultural Canada, and works with international teams to capacity build with respect to health-focused physical therapy practice. Dr. Dean has conducted extensive work on the management of chronic poliomyelitis based on a model of health and consideration of cultural factors. Currently, she is focusing on effective knowledge translation of existing and new knowledge by physical therapists to meet the priority health care needs of people globally in the 21st century, specifically non-communicable diseases.
00:03 Dr. Ginger Garner: Hello everyone and welcome. I am here with Dr. Elizabeth Dean and I’m so honored that she has agreed to speak with me and spend some time with us today talking about Integrative and Lifestyle Medicine practices in physical therapy. Part of what we’re gathering for is because she contributed the orthopedic chapter in Integrative and Lifestyle Medicine in Physical Therapy Practice. And I am just honored that you’re here.
I would like to introduce you a little bit. So give me a moment to tell you a little bit about Dr. Dean. Her work focuses on bridging the knowledge translation gap between what is known about the causes of and factors contributing to lifestyle related non-communicable diseases. All the things that we know about heart disease, osteoporosis, smoking related conditions, cancer, hypertension, stroke, obesity, diabetes, and physical therapy practice. So she’s particular interest in epidemiology and cross-cultural means of maximizing outcomes of health education and interventions, such as physical activity.
She conducts research in the Middle East and Asia, as well as multicultural Canada, and works with international teams to capacity build with respect to health focused physical therapy practice. Dr. Dean has conducted extensive work on the management of chronic poliomyelitis based on a model of health and consideration of cultural factors. Currently, she’s focusing on effective knowledge translation of existing and new knowledge by PTs to meet the priority health needs of people globally in this 21st century, specifically non-communicable diseases. Welcome Dr. Dean.
02:03 Dr. Elizabeth Dean: Thank you very much, Ginger. It’s really a pleasure. And it was a pleasure to have contributed to the book. It’s an excellent product. Yeah.
02:09 Dr. Ginger Garner: Yet we are so pleased at the outcome of the book and your contribution to the chapter. I wanted to start out with a really simple question because I think that stories move people. Stories are valuable and each of us has our own individual story. So I was wondering, what’s your story and how did you come to even choose physical therapy?
02:39 Dr. Elizabeth Dean: Well, you know, it was wonderful to be able to have a chance to actually reflect on my journey, because I actually never really, you know, as a grade school kid ever sort of imagined that I end up at a world class university as a physical therapist, as a practitioner, researcher, educator, and knowledge translator, which I probably these days really relate to most. But I think the beginning I grew up, I was born and grew up in Birmingham, England. And I came from a medical family, and my father wanted to get out of family practice. At that day and age, patients could call you in the middle of the night, you’d have to respond, and out he’d go.
But he really thought that his impact would be much bigger at a public health population health level. So that’s what took him to Canada. And of course, so these ideas were put into this little head very early on about public health, taking care of the population. Rather, I mean individual levels important, the bigger picture. And my mother was also a professional and academic, but she was knowledgeable about nutrition, even though people didn’t talk about it a great deal. She understood the basics very well. So having these little influences in my head. And I would have to say that even though my father trained at the University of Edinburgh, you know, at that time was a world class medical school, probably still is. But he was the most non-interventionistic physician, you could ever know. Drugs and surgery were bottom of the barrel. And that made a huge impression on me.
And then we came to Canada because he interned here and then we lived in Canada, went back to the UK but came back to Canada. But that was I think the first indications where my path might lead me and the word physical therapy kind of crept in, and that I related to. Because I was very interested in the people aspect. So my first degree was actually in psychology, then physical therapy. And then when I did my master’s at the University of Southern California I was able to bring my interests to align.
So that’s really how it started. But curiously and I’m sure we’ll get into this, the way things unfolded, the first half of my career, believe it or not, was in intensive care, which seems a zillion miles away from working with patients and programs for health behavior change. But it’s not such a big leap, and I’ll address that as we proceed with the questions.
05:40 Dr. Ginger Garner: Well, kudos to your parents for their courage, because their courage definitely wore off on you, because I remember reading some of your first papers, and you’ve got a massive list of the things that you’ve published, but I was so encouraged when I first read your work, because I almost left physical therapy when I first started out 25 years ago. This year is year 25, which doesn’t seem like it. It seems like five, not 25, because I was so disenfranchised as a PT. Everything was, and I didn’t know it at the time, but I had gotten dropped into kind of the epicenter of the opioid epidemic in a really hard-hit county.
And I knew that what I learned about the curative side of PT wasn’t enough. It wasn’t meeting my patients where they were. It wasn’t about fixing the ACL, you know, after the reconstruction. It was about so much more than that. But at the time, when I went to PT school, there were no classes in health and wellness, health promotion, population health. It didn’t exist. So I had to leave PT school and go to the School of Public Health. But that was still like an arm wrestling match, you know, to do that. It was like, oh, here’s Ginger, here’s the weirdo who wants to go to public health and she’s not just satisfied with PT school.
But so when I read your first papers, I was like, oh, I’m not homeless. Somebody is paving the way and that has really largely influenced my career. So thanks to your parents for that. Yeah, I did not know that. That’s a wonderful beginning.
What would you say over your years of practice and research, what’s been, I know it’s hard to pick out a favorite thing, but what’s a favorite thing about being a PT?
07:55 Dr. Elizabeth Dean: I think that I now appreciate that it really aligns with my values. Like you, I totally felt like a fish out of water because I was thinking that psychology and physical therapy, what a natural blend, but it was biomedical, totally biomedical. The only thing they needed was like first year university psychology, which is very far removed from psychological principles of patients. So I think, as I appreciate it, that it aligns with my values, and what I mean by that is that I, when I realized the role that we could play, given non-infectious diseases, and that most of us living in Western countries, industrialized countries, we’re all carrying around risk factors and or manifestations for these nasty conditions, Ginger, that are largely preventable.
We know heart disease, many cancers, hypertension, diabetes, stroke, gastrointestinal diseases, Alzheimer’s. These are large problems, we know, we have the knowledge. And I think my value of non-pharmacologic and reading the literature and see, we need some profession to take the bull by the horns and say non-pharmacologic, non-surgical is superior to drugs and surgery. Now, at least in the chronic, certainly if you’re in hypotensive crisis or you’re coming in with a life-threatening heart attack, of course, you gotta do those interventionistic things.
But when you look at the literature, and actually I have to say, I’m surprised that more class action lawsuits have not been brought up against so-called health professionals because we talk about, we talk about and say that we value evidence-based care, but we’re not putting it in to practice. We just keep saying, oh, well, yeah, you might change your diet a little bit. Oh, you might not smoke. But here is your prescription. I’ve spent eight years in medical school, so I can write you a prescription for this perfectly mostly preventable and/or reversible condition. What is ethical about that?
So I wrestle with things at a personal level, I’m calling myself a health professional. The definition, when you go, we’ve looked at the four physical therapy summits, global summits on total health that we’ve conducted. In the first one, we said, okay, what we went around the world, look at the five world physiotherapy regions in the world and ask, what are your leading problems? And we got them all, we got all the data. Mostly lifestyle related conditions.
And in those, like Africa and some parts of Asia where still a lot of infectious disease rages, those non-communicable diseases are coming up on the leading causes of death.
And so we said, well, okay, these are the leading problems, what role does physical therapy have?
So we have to go and look at 100 definitions of physical therapy, believe it or not, there’s quite a few. And it says, well, it says that we’re committed to non-pharmacological care mostly, and non-surgical care, that we want to exploit those. Okay. We’re committed to evidence-based practice. Okay. We’re committed to ethical practice. Well, when you connect the dots, we should be the leading health professional because the things that will prevent and potentially reverse these conditions is staring us in the face and yet we’re doing something other.
So when you asked me about the favorite thing or what I value most is that this profession that we have so much to offer and we need to, and it’s texts like this that hopefully will ignite. And I’m hoping actually that in a few editions, Ginger, you go out of print and that nobody buys it because this becomes the foundation for physical therapy practice in every patient. And I mean, adults and children because your heart attack and your stroke doesn’t happen at six years, seven, or 80. It starts when you’re a baby and somebody is putting a French fry in you. That’s right. A palette for those things that are so deleterious to us. So that’s what lights my fire. And I have other interests in life but this keeps drawing me back because something needs to be done.
12:40 Dr. Ginger Garner: Absolutely. You mentioned something earlier. It was in a question format, I think in our exchange of emails where you said, why would you not want to be in the most powerful health profession in the world?
And that really speaks to what physical therapy is. And it’s so, it felt so dissonant to be launched. I went to school at University of North Carolina at Chapel Hill to be launched out into the world, idealistic and loving what I do and to land inside a broken system whose values don’t match what we embody and what we wanna manifest. And I think that’s what it’s all about.
13:23 Dr. Elizabeth Dean: Oh, well, I totally agree. I mean, it can be totally disenchanting. And I think sometimes it’s ourselves who we have to hold responsible, I talk a little later about the system that we’re in, but ourselves, because you know you get questions like, well, you were with physical therapy. Well, in fact, the physical part is not going to work well. You know, the most fundamental thing you have to do to reduce impairment and maximize life quality is through these basic things that come out in the book. Smoking, good nutrition, weight control, sitting less, moving more, sleeping better, stress control. And you know, we’re living in an environment that is actually toxic in that it creates these issues and we have to look at the environment. So, not only from the then setting the role models for patients, being crack a jack and healthy ways of change, but also like you, influencers who are going to go, and we need people at the policy level as well. Because- Okay.
14:33 Dr. Ginger Garner: Absolutely. Absolutely. You know, one of the things that I think that in PT school, we probably, I know I didn’t get it. I didn’t get it until I decided to get into policy creation and to begin to understand where we came from as a profession. And you know, the advent of physical therapy happened around the same time as the advent of the first fast food chains in the United States where we didn’t have chronic disease. We had acute disease. It was things like polio that we were created to help with. And then at the turn of the, towards the 21st century, we no longer had those things. And now all of a sudden we are bombarded with epidemic chronic disease. That leads me to ask the question to you. I loved your story about how you came into PT. How did you make that transition then? Because you grew up with it. But how did you make that transition towards integrative lifestyle, being concerned about what we take in environmentally? What helped you really make that shift?
15:39 Dr. Elizabeth Dean: Couple of things. I, as I mentioned, first half of my career, I was all into intensive care. I love the problem solving. I love the teamwork, our research, because we shifted the thinking from just sort of airway clearance stuff to oxygen transport, to moving oxygen throughout the body, and all that monitoring you have to do to position the patient safely. And I’ve had the privilege of speaking in 40 countries and some multiple times. I remember half way through my career I was invited, it was a return visit to Singapore. And Singapore at that time had one of the largest hospitals in the world, over a thousand beds. And we did rounds in 12 different dedicated ICUs. Huge, state of the art, fabulous.
And I had this epiphany. Most of the people in which I’m sharing and doing these rounds, most of these patients should not be there. Should not be there. Yeah all the bells and whistles, the fanciest stuff, the level of interventionistic care was second to none, but most patients should not have been there.
And that was the beginning of this series of physical therapy summits. So, now, number one, what are the problems? So we looked at all the diseases in the, you know, all the countries that were member countries of world physical therapy which was 119 at the time, we looked at the definition of physical therapy, we looked at the evidence that non pharmacological interventions not surgical interventions, had on non communicative diseases, it was a no brainer for us.
You know, we need to be front row center and leaders in addressing the serious societal issue. And I like to make the point, I do refer to these as diseases because that’s in the common parlance, but they’re not diseases. They’re normal responses to adverse cellular environments. They’re normal responses. We can expect this in the majority of people.
You can predict it. You can give me a baby and I can rig the lifestyle to create high blood pressure, you want heart disease. So we have to change our brain with weapons. These are the normal responses to adverse conditions, to adverse cellular environments. And if that’s so, how can we change the cellular environment?
Just from the information in this book, you can change the setting of an environment. And it was Dean Ornish who published an article that should have actually changed the direction of cardiovascular care, because it was on cardiovascular health. He objectively showed, and geographically, you can objectively unblock and remove atherosclerotic plaques.
You know, it wasn’t overnight, yes, it took months, but that randomized controlled clinical trial came out and was published in 1990 or 1991. It’s been over 30 years. And we kind of said, well, yeah, well, change your diet a little bit, but here’s your drugs and here’s your surgery. And yet, that the remarkable benefit these patients had with, yeah, it was a strict, you know, vegetarian, low fat, and yes, there was exercise, but nutrition was a singularly important component.
And the other thing I’ll mention there is that our bodies are self-healing machines. You know, we injure it every day. We create all this oxidative stress with all the stuff we’re doing to it. We’re injuring it every day, and then it tries to heal, and then we injure it some more. You remove that, and the healing begins. You can, you know, within days, people’s blood pressure can come down. Within days, their blood sugars can be corrected, and it may take months for atherosclerosis, you know, to revert to varying degrees, but in a very large proportion of patients.
And weight control will take care of itself. You know, we only, to our patients, we only talk nutrition. We scrap weight control. You know, if you have good nutrition, if you look at Michael Greger’s work on How Not to Die and How Not to Die, brilliant, brilliant. And everything is evidence-based. How Not to Die has over 2,600 solid references. So how can we keep selectively heal? Well, I do have the answer to that question.
20:22 Dr. Ginger Garner: Yes, yes, I have, I love having my library of books and I have a private practice in pelvic health and orthopedics and I keep those books on the shelf so that I can say, look, you know, here, here’s your reference along with your lifestyle program because I use a software program to, to talk to them about their lifestyle changes, but to be able to pull out those books and say, you know, these are amazing references like How Not to Die for them to pick up and casually read because it’s about that subtle shift in their choices and learning how to influence behavioral change by not being preachy, but just saying sometimes it’s relating to them. Like I had that problem too, you know, but to, to help them come up with the reasons that they need to change because we could tell them all day long and that doesn’t land so well sometimes.
21:22 Dr. Elizabeth Dean: Yeah, health equity issues as well and marginalized populations and the whole BIPOC populations and unfortunately corporations have gotten in there, and have selectively targeted these low income, very vulnerable populations. Where is the ethics of them? So, we need our governments to disengage from corporate influence because it’s not working and they were left to their own devices to say, well you know you might think about this so what it’s up to you, you corporations you know to voluntarily make some changes in these, well, it didn’t work. It absolutely has failed. And we see that these conditions are continuing to escalate. So, something needs to be done and our profession needs to support organizations such as the Physicians Committee for Responsible Medicine and the Globally Nonprofit nutritionfacts.org, which is Michael Greger’s nonprofit website. We’ve got to disengage these interests of corporate influence. And governments are there to support public health and corporations are there for sales and profit. They can’t, they’re not they can’t work together, you know, they’re not going to.
22:40 Dr. Ginger Garner: Absolutely. Early on in my practice, I had always had an interest in public policy, but it just felt overwhelming, like it does for a lot of people. Oh, there’s so many problems. How can we even begin to, I can’t make a difference, so I’ll do nothing, is what a lot of people end up doing. And they just accept the status quo. But when I started to look at, I think this is a quote from Archbishop Desmond Tutu, who said, “at some point, we have to stop pulling bodies out of the river. We have to go upstream and see who’s throwing them in.” Why are they falling in? Who’s pushing them in? And oftentimes, it’s exactly what you’re saying. It’s a systemic policy problem. There’s health equity issues. There’s healthcare justice issues. There’s all kinds of things that swirl around it.
So I think that another good question to move towards is, out of all those problems that we know exist. I remember looking at when I was going to speak at when World Congress was in South Africa, and we were doing the Rapid Five presentations on research, and our group was looking at the global mortality, maternal mortality crisis, and how many formula manufacturers had moved into the continent of Africa, and then how maternal mortality, infant health had obviously shifted as they were sold a bill of goods for formula instead of breastfeeding, for example. So as we look at the challenges that are facing physical therapists, what do you see as the greatest challenge to our profession today?
24:28 Dr. Elizabeth Dean: I can answer that in two parts. One is ourselves. We really have changes to be made, it has to start from within, and I so relate to your saying. Well, you look at public health issues and society and all the levels. So what I have basically come down to is that if we’re going to make, so we can do lots based on the book and lots of interventions, lots of things that we can do with our patients, and then I think we need to provide service role model, because the literature shows that if you’re healthy yourself, you’re more likely as a practitioner to support health promotion in your patients, and your patients view you as being more credible. So that’s one level.
The other level is, and I think about this a lot, well, how can we change, you know, what’s available in those supermarkets? You know, that’s the level we need to be thinking of. And what I’ve come to, and it’s been a challenge getting this published, because it doesn’t really even get beyond the editor, you know, Alan Jenny disregarded it, you know, and that was an Academy of Plant-based Physical Therapy. Yes, all the things we talked about in the book, smoking, less sitting, more sleep, less stress, yes, but nutrition is the backbone. Nutrition is absolutely the backbone of health.
And so, Academy of plant-based physical therapy will give voice and provide a legitimate professional representation to that group. And it may be small because, you know, we all know long enough, patients will never change and we create these barriers for ourselves. And how am I going to make money doing that? And so they put blinders on.
An academy of plant based physical therapists gives legitimacy, and it will give them representation on important health policy committees. You know we need movers and shakers, who aren’t afraid to roll up their sleeves and get in there and, and be uncomfortable. And I think other, like the Physicians Committee for Responsible Medicine, we had our 35th anniversary a year ago last December. They’re established their respected, in fact, they’re going to be in Congress the day that I speak in Alabama, and challenging the new food guidelines, which themselves are inherently racist and contribute to health inequity because they promote dairy and actually, well-known animal sourced foods, whether people like it or not. And I’m going to be speaking in the barbecue belt of the US.
Well, like it or not.
Dr. Ginger Garner: I live in the middle of it. [Laughter]
27:24 Dr. Elizabeth Dean: You know, we are, I can talk about sleep, I can talk about sitting less, moving more. But when it comes to nutrition. Wow. The barriers go up, and the literature is so clear. We don’t want to hear it, we do not want to hear. But we are not. We’re not even omnivores let alone carnivores.
When we look at a Emma and Milton Mills happens to be an African American physician who is, he runs a nonprofit, I think it’s Planet Nation or something. And he did a very detailed review of 18 dimensions and compared carnivores, omnivores, herbivores, and in terms of their characteristics on 18 dimensions. And then he looked at humans and our characteristics were perfectly in line with herbivores, not omnivores, as we behaviorally and culturally have come to accept that we are designed to eat animal sourced foods when we are in the wild. So that is a huge contributor to our issues, but we don’t want to hear it. We don’t want to go there. So I think we do need this group, this academy of plant-based physical therapists who say this, yes, we appreciate people’s discomfort. We appreciate, but they need to know. You know, if people do not know, if they still to choose to eat that, the Standard American Diet, then it becomes more of a conscious choice. Right now, they’re not given all the facts. You know, you are not given all the facts. How many physicians would, or even cardiologists know that we are being by their side?
29:21 Dr. Ginger Garner: We, I had multiple experiences, as you might imagine, with healthcare providers over the years who were either misinformed, uninformed, or hadn’t read a peer-reviewed paper in 20 years. But I remember hearing things from my pediatrician, I would just, I had to choose my battles, but because my oldest never had dairy. I breastfed as long as I could, World Health Organization, you know, and abiding by what they’re talking about.
But I heard my pediatrician say to me, now how much milk are they drinking a day? Because if they’re not drinking milk, they can’t get any calcium. And I was just like, what?
I couldn’t choose that battle for the day because they’d probably upcharge me to a complex patient, charge my insurance company more money. But it’s things like that that are so concerning that this person is out there giving advice that drinking milk is the only way to get calcium and it’s just flat out wrong. To that end, you’re mentioning the plant-based providers and we just regionally started a group. Our acronym is PLANT.
Which is good, and I can’t remember the acronym because we just created the group, but it’s an interdisciplinary group named PLANT. That it’s all, we’re gathering together as plant-based providers. So we have OBGYNs, other types of physicians, we have mental health providers, certainly PTs, obviously registered dietitians, et cetera, that support, you know, predominantly plant-based diet. So there’s, that was, you know, part of the impetus of the book too is because it’s so many things that PTs don’t understand are within their scope, which is why your work is so encouraging. And it’s a catalyst because it is within our professional scope, that PTs may confuse professional scope with personal scope and think, oh, I don’t know anything about nutrition. Well, then now’s the time to go get the education on it because it is within our professional scope, but maybe it’s not yet within their personal scope. And that’s okay. That’s where we learn most of what we know and practice outside of PT school anyway.
31:47 Dr. Elizabeth Dean: Well, I think you framed it beautifully, you know, making that distinction. And I think it gives people sort of a way to park their own personal beliefs and values and, and then to recognize that there is a bigger picture to this as well. You know, some professions, I’m our nutritionists aren’t doing it, our dieticians aren’t doing it. It’s nice that you’ve got a group going there.
But mostly, yeah, I think why not physical therapists, let them lead. But it’s interesting that the roadblocks went up. And I wrote to all the editorial board members, not as a disgruntled author, whose work would be rejected, that was secondary. What troubled me was that if we could stimulate or influence even a small group of physical therapists who were committed to doing what I think is the right thing, based on the literature, then that could make a difference, even if Alan Jette and the editorial board have no interest, they want to, you know, to meet the status quo.
But at least give those within the profession, who are not only pro individual health, community health, environmental health, climate health, you know, not killing animals is a very significant contributor to reducing climate change. So and I described four pillars, what they how they can advise clinicians, how they can advise educators, how we can get nutrition into physical therapy programs, how we can advise researchers to include a nutrition component, or at least do post hoc analyses to see, well, did patients respond to physical therapy interventions differently if they had this kind of a diet as opposed to that, because we know that, you know, the Western diet is pro inflammatory. And then also to be good on their feet, we need people in that academy who can speak and represent the nutrition side, and support groups, like the Physicians Committee for Responsible Medicine.
So there are existing groups, we don’t have to do it all, we can’t do it all, but at least put our support behind those well established organizations and committees that are doing so much. And creating a literature to healthcare as opposed to endless care.
34:11 Dr. Ginger Garner: Yes, creating those alliances are so important. And I think that if that’s one charge that I could give to APTA right now, it would be that. So if someone ends up listening from APTA and leadership to this interview, that would be one of the things I think should be a catalyst as we move forward is to establish more alliances with existing organizations so that our values can be heard in a much more powerful way than they are now.
Especially if we’re only representing, let’s just say in the United States, American Physical Therapy Association, CPA, to align our values, particularly if I can speak to our Congress in the United States. That if in APTA we’re only, we go to Congress and we’re only representing 20% of PTs because we don’t have that membership, I think that that’s an encouraging, it’s a discouraging fact, but we can encourage, whether you’re in Canada, wherever you are, to join your physiotherapy, your physical therapy association so that we can create stronger alliances because the only way we’re going to be heard to create policy change is if we have the presence to be there. And if we’re one small voice, it’s hard to be heard. But you mentioned a quote that has always been one of my favorites by Margaret Mead. Yes. And for those of you who don’t know it, it is, “a small group of committed citizens can change the world. In fact, it’s the only thing that ever has.”
So reflecting back on what we have just been talking about, for example, predominantly plant-based and plant-based organizations, like we started this tiny little one in Guilford County here in the Stroke Belt in Greensboro, North Carolina, that it could be an inspiration for other providers to do that, because if they only change a little bit of their diet, that could make the difference between having back pain and not having back pain. Or their neurodegenerative disease course not going as well as it should if they just make those slight shifts.
I am motivated by my own upbringing because I didn’t have that background of family members in health care. I had the opposite. I saw family members dying of diseases and suffering from long-standing chronic pain, and that’s what motivated me to go in this direction because I knew they didn’t have to. Just like you said, your patients didn’t have to be in ICU. My family members didn’t have to be suffering in the way that they were, and they weren’t getting the advice that was evidence-based when they were going in, still. So I get lots of phone calls from family members these days. “I was told this. Is that right?” “Or they want me to take this med. What should we do?” And we always circle back to integrative and lifestyle medicine because there’s such a massive evidence base that supports it.
37:34 Dr. Elizabeth Dean: Well, absolutely. And it’s irrefutable. I think that’s the thing getting back to one of your original questions about, you know, what gives me the buzz. Well, there may be little tweaks over the years but the overarching evidence is so clear.
To know that it’s right. Look at the blue zones, people living well into 100 with very little end of life illness. And what you look to see, well, what are they eating? Well, it’s legumes, fruit, vegetables, and little to no meats. Foods! Now that should tell you something. Another thing that I, I’ve got a wonderful slide showing how we looked up to about 1950 to early years after the war. Beautiful pictures, black and white, beautiful pictures, multiracial, you know, but this is how we look, which is so different.
And people didn’t obsess about their nutrition then or about how much exercise they did. They got on with their lives. And I’m not saying it was a perfect world. There were a lot of problems. But if you couple all the advantages that we have today with that, not wanting to think about what we eat every minute, not having to think about, are we exercising today? Getting on with our lives, being with our loved ones, having fun.
And yet now we’ve become this obsessive culture. And because corporate interests have succeeded with their smoke and mirrors and casting doubts about public health messaging, which I have to say is so influenced, it’s very disillusioning to me. Because I used to publish the pyramid, the food guide pyramid in our textbook. And I looked at that for a number of editions and then started to, I don’t know if you know Marion Nestle’s work, who did very important work on food politics in the United States and how the food guidelines were influenced. Oh.
And I thought, well that could never happen in Canada. And lo and behold, we were not as strongly, but our lobby groups were influencing not only what was included, but the wording. Like they spent hours talking about, well, no, you can’t use the corporate interest, that you can’t use a void. Say limited, say limited, limited.
39:55 Dr. Ginger Garner: Yes, and for those who are listening who have not been exposed to that research, I remember reading the first bits and pieces of this in 19, oh goodness, in the 90s, when Fast Food Nation came out, I believe. And that was all the way back to environmentally, you know, how animals were treated, how food is produced, how people, members of the, you know, the dairy industry were sitting on boards which influenced what went on the food pyramid, and that it wasn’t based on the evidence base. And it’s clearly out there.
There are groups in the United States that are third party, doing third party research, Environmental Working Group was one of those where you can read all the things that we’re talking about now and get a solid history and background on what happened to the food industry in the United States and how, you know, what Dr. Dean is talking about with the malalignment of corporate interests and government policy have skewed public health information that gets disseminated, essentially.
And so, the take home message for this, for listeners, is that you have to do your homework. And one of the reasons that we, you can’t take things necessarily at face value. So, one, and one of the purposes in this book, in Integrative and Lifestyle Medicine in PT, was to write from the physical therapy perspective to let, not just physical therapists know, but to empower them with the information that they are qualified to be discussing these things across the lifespan with every single, you know, patient, type of patient population.
Because I think the public, and you can speak on this a lot, I know, the public may not necessarily understand this is part of what we do. I was told starting out, I would, “never get paid to work in health promotion and to talk about wellness and prevention.” “That’s nice, but you’ll never get paid,” was what I was told. And of course now, we have a whole book on it. I’ve, you know, I’ve established my whole career around it. I teach continuing education on it, and I’m motivated, inspired by researchers and clinicians like yourself. So I just want to offer people encouragement. If you’re listening and you’re not a physical therapist, physical therapists can help you a great deal with what you’re doing with nutrition and sleep and stress management.
It’s not just about physical movement, although mindfulness and movement are very important as well. If you’re listening as a PT, I’m sure there are a few take-home messages that we wanna share with you. And one of those is the question about, is a question about your chapter. For
a PT reading your chapter, what’s the one thing that you would want them to take away from reading your chapter on orthopedics?
43:06 Dr. Elizabeth Dean: And that, I think, initially we thought about health behavior change within the people with cardiovascular, respiratory issues. We thought those are the ones that really needed attention to not smoke anymore, you know, good blood lipids and good blood sugar, and so on. But because of the prevalence of our lifestyle, which is injurious, and because of the prevalence of the lifestyle conditions, these non-communicable diseases, that a patient comes in with back pain, they may even be a perfectly normal weight, but we have a responsibility to address because their lifestyle is inflammatory. So let’s address, nutrition is one component, a non-Western diet, particularly that’s plant-based is anti-inflammatory. And in addition to addressing the problems for which they have the orthopedic issues they’ve come to see the physical therapist for.
We are also, we also say that we’re interested in the patient’s health overall. So yes, we want to make them comfortable. I want every one of my patients to leave and be more comfortable. But the fact is I have a responsibility to that patient over and beyond that presenting complaint. And it’s not Elizabeth Dean saying, I’ve gone, we’ve gone, my international teams and I have gone to our professional websites, globally and nationally, and it clearly says there that we have a commitment to the overall health of the patient and to the overall health of society. These just can’t be words. These have to be operationalized. That means that we really have a responsibility to affect these in our practices.
And so the other calculation that we made Ginger was on average, of course, practice patterns differ, but on average, if a physical therapist over the course of their career will interface with a quarter of a million people over the course of a normal career from graduation to the retirement age.
And in addition, those, you know, you’re going to impact and we impact we want to engage families, not just that individual but hopefully what we tell and work with patients on the information that you transmitted to their families. That’s a lot of people. So not to underestimate your responsibilities and the far reach of your practice. That’s what we take pride in. And that is the one thing. So yes, you can do all your traditional physical therapy things for that bad back, but you are doing so much more. Actually, that bad back is the little problem. It’s the little problem when you look at the big picture.
So we talked about we have done detailed health and health behavior inventories with our patients for years, and we use the health improvement guid. Sorry the health, the modified the health improvement card from the World Health Professions Alliance, and we modified that. We’re just getting now approval for the modifications that we’ve included, because they include sleep and stress management, and it’s kept down to two pages. It’s a color coded like a traffic light system. You’ve got their biometrics on scorecard on one side and their health behaviors on the other side. So, wonderful. Just to get, they’ve agreed in principle, but they haven’t actually seen the final product.
46:50 Dr. Ginger Garner: I’m very excited about that.
You said something that was really important and I think that a lot of therapists get stuck in tunnel vision.
I trained as an athletic trainer prior, so it was all about sports and sports medicine. And then I came to PT school and, um…one of the things that, I think no matter where you are in the continuum, but especially in orthopedics, because that’s where I was born and raised, right? It was in orthopedics. I that we can get tunnel vision and focus on a diagnosis. And so the thing that you said, which is so important, and it’s what I teach my students every day, is to back up and look at the whole picture.
You’ve mentioned low back pain is a tiny part of the problem. And I think that if more people, not just PTs, but if more people understood that their low back pain is not necessarily the driver, it is secondary, tertiary, and far down the line that it is one more thing you said, which I’ve been telling patients for a while. It’s not just about an anti-inflammatory diet, although very important, it’s about an anti-inflammatory lifestyle.
It’s the lifestyle. And if we would back up and not get obsessed about low back pain, and if we would back up and not just say anti-inflammatory diet, but it is how we think. Do you have anti-inflammatory relationships? You know? It is our social structure. What household cleaners are you using? You know, is that contributing to an altered state of your gut microbiome? Or in my case, the vaginal microbiome can influence the way people perceive pain. Those things are so important.
48:4 3Dr. Elizabeth Dean: Mm-hmm, mm-hmm. Oh, I absolutely agree. And I think alerting and arming our patients with this information is critical so they can better understand the holistic picture. And at one point, when you mentioned you had your beginnings in athletic training related areas and orthopedics. When you look at athletic training, I’ve got a whole book on plant-based athletes.
And you can be sure, like all those guys in the Super Bowl, Boy, they were, they had dietitians, and many of them are plant based, they’ll have psychologists, they’ll have people who are experts on sleep, and rest, and recovery. And, and yet we realize these, and not smoking, I mean, that’s totally not even said. And we do this with our athletes and recreational athletes, of which I am myself. And yet for patients.
What is that? You know, we can do this with the select group because we know how powerful they are. But a wonderful book recently on the campaign. And yet for our patients, don’t we want the same for them? Don’t we want them to be, they may not be athletes and they have a hard time getting down the block, but don’t we want them to be at their peak level in order to do what they do? Maybe that one block with all these changes will become three blocks.
50:20 Dr. Ginger Garner:Mmm -hmm. I have a short story and experience on that because I think we can convey the power of a concept so much better through a story. But one of my patients, who was also a dear friend, was diagnosed with lymphoma. And he has since passed away. He did not win his battle with lymphoma, but he is so fondly remembered in my heart, but his son said something to him and I know this will resonate deeply with you because he had gone to start his treatment at an integrative oncology center, which will remain unnamed.
And the physician in charge of his care told him that what he ate had nothing to do with his health outcomes for his cancer. And that patient’s son knows enough to know that the doc was wrong, was obviously wrong. And he said this to his dad. He said, dad, you have to eat like you’re training for a marathon or an ultra marathon. You’re going through significant cancer treatment. It could take you from us in a short amount of time. Eat like your life depends on it, because it does.
51:45 Dr. Elizabeth Dean: And that had to come from a non-health professional. And then he had the wisdom to see that that was so good. It’s a wonderful story.
51:59 Dr. Ginger Garner: It is. I wish we all had advocates like that. I wish all our family members had advocates like that because most don’t. Most will listen to what the doctor said, which is, oh eat any fast food junk you want. It doesn’t matter you know with your treatment because maybe it could have saved him, if he had taken that advice and known about it early enough.
So, goodness, I have one more question. I don’t want to take up too much of your time. Based on stories like that, and people live through this all the time, they get information that isn’t necessarily accurate. We know that sleep, stress, movement, nutrition, and environmental influences, they all matter to contribute to our longevity. So if a patient is feeling overwhelmed, right? Like with smoking use, alcohol consumption, optimizing weight, physical activity, sleep, nutrition. Where would you say is the best place to start for them if they needed to make a change?
53:08 Dr. Elizabeth Dean: I think Michael Greger’s work as to, you know, I mean, it’s, it’s, yes he’ll overwhelm you with literature but his, his videos are very short, all evidence based, I think, very, you know, for the average person in society they would get a lot out of that, you know, you don’t have to be a health professional they’re really targeted at, at the general public, and because it is terribly confusing for the average person.
I’m afraid, I’m not conspiracy theorists, but I have to say, corporate interests have created so much in the way of smoke and mirrors. And the fact that there’s you know, paleo diets and ketogenic diets. All these terribly injurious variants are really detracting and messing them up in terms of what they are nourishing in themselves. And I do come back to nutrition because you get that part right, you’ll sleep better, your cognition is better, you lose weight, you’ll be about a healthy weight. You know, it impacts all those other dimensions, and tremendously. So, as a resource, I would say that would be the place to start. Nutritionfacts.org – totally non commercial nonprofit, and you go can go down a very nice website, people can target if its weight control they’re very interested in, cancer, and How Not do Die. it’s a brilliantly written book and you mentioned about, you know, how not to die from cancer. You know we’re all firing. We’re killing cancer cells in our body every single day. But our, you know our defense system is strengthened and it can take care of that. So we have to make sure that we are strengthening that part of our immune system so it can immunomodulate effectively as it should.
But, you know, cancer is a leading cause of death in the US and it rivals heart disease. And it doesn’t need to be. Let’s get a grip on this.
And I think that we are perfectly positioned to do this. You just need to ignite more energy and energetic colleagues to take on the challenge.
55:33 Dr. Ginger Garner: Yes, absolutely. The power of epigenetics cannot be underestimated. I like to tell patients that if a single breath can change your respiratory rate, your blood pressure, your heart rate, a single meal can change the quality of your gut microbiome and how you perceive pain and how you perceive stress. A single bout of exercise can be an antidepressant for people. We don’t have to take these things and do them forever and ever in order to be able to see a benefit. Sometimes it’s one meal, it’s one breath, it’s one moment of mindfulness that kicks you off in the right direction and once you feel good, you don’t go back. Once you get that little bit.
56:21Dr. Elizabeth Dean: And so with that, there are a few documentaries that I would highly recommend for the listeners.
Gamechangers
Milked – White Lies from Dairy Land
Cowspiracy
People on the road to Extinction
About how actually we’re extinguishing ourselves. These are not flamboyant, unsupported, unsubstantiated rhetoric. These are experts in the field, scholars who are commenting on these topics and I think for the general public, I’ve screened those documentaries many times and would highly recommend them. Some you have to rent, one you have the option of renting or buying but you can’t get it free because they so believe in spreading the word. So kudos to them but it’s you know for a few bucks it’s worth your health and that of your patients.
57:24 Dr. Ginger Garner: It is, and that’s one of the first things that helped me really make that shift into ILM is just reading the science on it. So thank you for those suggestions. And Dr. Dean, thank you for your time. Thank you for your passion and your commitment. You’ve long been an inspiration to me, and it’s just been an honor and a pleasure to speak with you and spend time with you today.
57:49 Dr. Elizabeth Dean: Thank you for the opportunity, Ginger. Thank you.
57:52 Dr. Ginger Garner: Thank you.
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