What is Wellness?

I heard someone recently say you know, like alternative med, complementary, functional lifestyle, etc. “Oh no,” I thought, “they aren’t all the same!” There are so many new definitions in health recently though, I can certainly understand the confusion. In fact, it’s hard to keep up myself. I thought that this might be a good time for me to review what’s what, define them for all of you and to help you all understand why what we are creating is different.

I was with a friend recently, who asked me “what exactly is Doctor of Living into? Is it functional medicine?” I answered, “No, it’s not functional medicine.” “So what is functional medicine, then?” he asked. The Institute of Functional Medicine defines “functional medicine as a systems biology-based approach that focuses on identifying and addressing the root cause of disease.”[1] In the case of functional medicine, you need to start with a disease. This means, you have been funneled through the diagnostic process and been labeled with a problem. Typically, functional medicine looks at lots of very detailed labs, nutrients, amino acids, electrolytes, etc. and gives you a sense of why you might have the problem that you have. Doctor of Living is not interested in diagnosis of any problem. In fact, we use very few labs or biometric tests at all. William Osler once said, “It is much more important to know what sort of a patient has a disease than what sort of a disease a patient has.” Yes, understanding the functional biology behind disease is important, but understanding why someone has the functional biology they have is even more important. Personally, I choose not to have the fatalistic view that we are nothing more than a function of our genes and biology, but rather a dynamic metaphysical being that requires more than data points and genetics to truly understand.

My friend then asked, is it alternative or complementary medicine? “No,” I said, “Doctor of Living is NOT alternative medicine.” Alternative medicine is also known as fringe medicine, pseudo medicine or even questionable medicine. Wikipedia says that it’s the “promotion or use of practices which are unproven, disproven, impossible to prove, or excessively harmful in relation to the effect-in the attempt to achieve the healing effects of medicine.” We will never endorse practices that are unproven. In fact, one of the key elements of at Doctor of Living is that we demand data prior to presenting the information. Sometimes, there is promise in new knowledge that is yet to be proven and so the establishment may call it fringe. The physicians who endorse or present this knowledge have even been called quacks. The problem is that this is a relative term, as what’s considered fringe and mainstream may change overnight with a good study. In addition, what’s considered mainstream may become fringe, like blood-letting from the old days. Alternative medicine is applied to various forms of medical practice and is consumed by 40% of Americans.[2]

“Ok,” my friend asks, “so it’s like integrative medicine then?” I answered, “yes and no.” According to Duke’s Integrative Medicine page, “Integrative medicine is an approach to care that puts the patient at the center and addresses the full range of physical, emotional, social, spiritual and environmental influences that affect a person’s health.” In this way, we are integrative medicine, but the page goes onto say, “The patient and practitioner are partners in the healing process.” Another website says that “integrative medicine is the blending of complementary and alternative medicine (CAM) therapies with conventional care for the prevention and treatment of health conditions and the pursuit of wellness.” By this definition, it would appear that integrative medicine is a blending of the traditional approach and the new approach. In this case, Doctor of Living differs, there is no traditional medicine here at all.

So, what exactly are we doing then. At Doctor of Living, we are starting something totally new. Totally unique. We are a wellness company. I know it’s sounds generic and even “old school,” but it’s not. I would argue that there are very few true wellness companies out there. We use several models to help create wellness in people’s lives. We are patient centered, but we are so much more. Definitions matter not just for you, but to us. We are defining a new role for a physician, not as a practicing physician in a new specialty or field, but as a Doctor of Living.

Ok, so we have talked about what we aren’t, now let’s start talking about what we are. Wellness is defined in a Google Search as “the state of being in good health, especially as an actively pursued goal.” It was virtually unused until the 1950s. Now, it’s everywhere.

Women showing wellness through yoga

WELLNESS

Wikipedia says that “Wellness is generally used to mean a state beyond absence of illness but rather aims to optimize well-being. It is an umbrella term for pseudoscientific health interventions.” Oops, here’s the pseudoscientific piece of definition, we heard from the alternative medicine definition. It’s being clumped together and it’s not the same.

The term was “initially brought to use in the US in the 1950s by Halbert Dunn MD, Phd. Dr. Dunn was the Chief of the National Office of Vital Statistics and discussed “high level wellness,” which he defined as an “integrated method of functioning, which is oriented toward maximizing the potential of which the individual is capable.””[3] I find it interesting, because we just talked about integrative medicine and functional medicine. Both would appear to stem, in part, from this definition, but neither fully reflect the true nature of wellness.  

The constitution of the World Health Organization states that “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”[4]

Here’s the major challenge. How do you define what a “state of complete physical, mental and social well-being” is? Dr. Dunn believed that it included “well-being within the family and within the community life. And, it certainly includes a compatible work interest. Complete well-being calls for all of these states to happen together-wellness of the body, of the mind, and of the environment.” He goes on, “Your body should be eager for activity. Your mind should sparkle with interest. For maximum wellness, the environment should be such as to encourage you to live life to the very full.”[5]

Dr. Dunn additionally comments, “I cannot help but ask myself the question: Why is it that doctors and nurses and health workers so frequently forget the meaning of this definition? For even while they quote the words, they tend to focus upon disease, disability, and death, to the exclusion of other factors. Perhaps this is because their training has been oriented toward disease rather than toward positive wellness; and they therefore find disease more interesting than wellness. Also it’s easier to fight against sickness than to fight for a condition of greater wellness.” He used a term called “high-level wellness,” which helps us understand the spectrum of wellness. He said that “High-level wellness for the individual is defined as an integrated method of functioning which is oriented toward maximizing the potential of which the individual is capable. It requires the that the individual maintain a continuum of balance and purposeful direction within the environment where he or she is functioning.”

Dr. Dunn helped us to understand what wellness is and why it’s important. He also defined a high-level wellness, which is not a fixed or static destination, but a vision for “ever-higher potential” of functioning. This vision is unique to each of us and carries no set definition. We are NOT machines and as such there is no one level of functioning for each of us that is best. This element of wellness, comes in stark contrast to many of the above practices. There is no perfect number, threshold or diagnosis that must be met, helped or created. In fact, we are all unique beings and because of this, we must have a personal approach.

Dr. Dunn’s vision for wellness is invaluable. Adopted by other leaders in wellness, like Dr. John Travis, the movement gained some steam, but it hasn’t overhauled our system clearly to this point. His ideas came out in the 1960s and I am sure that most have heard the term wellness, just perhaps not in the capacity that Dr. Dunn envisioned it or that you are hearing here. The term wellness has even been somewhat abused. It’s a great word really, but you can find it on virtually anything these days. Not that there isn’t cross-disciplinary value, but the truth is that it was created with a specific purpose in mind and, as a physician, I don’t think the term has fully lived up to its potential.

Yes, wellness is everywhere, but in some ways, it’s nowhere. Don’t believe me. Let’s look at where we find ourselves today. As a group, family and community we are obese, overweight, sedentary, emotionally unstable, and generally unhealthy. If our mindset were that of wellness from the childhood onwards, we wouldn’t have ended up in this state. While there isn’t a fixed destination, we can’t argue that we are all functioning at our highest level. Wellness just simply is not part of the American culture.

Reductionism

“If ain’t broke, don’t fix it.” I love this expression in some ways, because it minimizes the necessity of potentially unnecessary testing and treatment. Many well-intended physicians will attempt to fix something to avoid discomfort, misfortune, prolong life and even prevent death. This speaks, in part, to the unyielding desire of humanity to embrace life itself. This bias opens up the door for innumerable potential treatments. In other ways, however, it speaks to the culture in the United States of waiting for a problem to occur. Once the problem occurs, we can diagnose what that problem is, based on the symptoms and come up with a solution. Whether that solution is integrative medicine, functional medicine, alternative or complementary medicine, or traditional medicine they all are potential solutions to your problem. Many of those therapies and even criteria for diagnosis change over time, based on “science.” It’s up to you to choose what works best for you. Often, people start with one approach and work their way through numerous approaches, until they have found something that works. All of these approaches have 1 thing in common. Wait for a problem and FIX it. Physicians and healthcare, in general, make a living on fixing your problem.

Wellness check

Part of the problem is science itself. Science utilizes reductionism to accomplish understanding. Wikipedia has a fascinating article about reductionism. Here’s what it says, “Ever since the Industrial Revolution, Western society has benefited from science, logic, and reductionism over intuition and holism.”[6] The article goes on, “It’s almost irresistible to blame something or someone else, to shift responsibility away from ourselves, and to look for the control knob, the product, the pill, the technical fix that will make a problem go away. Serious problems have been solved by focusing on external agents like preventing smallpox…”[7]

Reductionism works when you want to understand something. It would be like wanting to become a mechanic on a car. First, you have to take it all a part. Then, you can learn to put it back together. Reductionism has defined the last 100 years, in our understanding of each part of the human being. Now, it’s time to start putting everything back together. We have to start viewing the human being, not as a sum of its parts, but rather a complex mental, physical and spiritual being. When we do this, we can achieve true health- a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.[8]

When’s the last time you did something that you knew was unhealthy, just because it felt good? For me, I don’t have to think long. If you have ever done something, ate something, or even thought about something unhealthy, you can now understand why reductionism doesn’t work for the whole being. Even just a thought, spurious and unacted upon, can create a sense of anxiety, fear, and depression that can altered our hormonal state and lead to physical symptoms. If you go to see the doctor and you explain these symptoms, do you think that doctor, even the most brilliant of all, can possibly diagnose your thought! No. Of course, not. We understand this, yet we seek out solutions from outside ourselves.

Diagnosis in the above example becomes almost an effort in futility. There are innumerable examples of this in medicine. We are so focused on treatment, because that’s what pays. We have reduced the body to parts and apply our treatments to the different parts, closely observing its impact, but not fully understanding the interweaving or overlapping complexity of human existence, when we fail, most of the time we haven’t even started, as the problem itself wasn’t fully addressed or understood.

Learning from cars

I said before that we are NOT machines. So, this will sound conflicting, but here it goes. When I was in school, I learned about a great man named Dr. W. Edwards Deming. Dr. Deming was a brilliant engineer behind the Toyota Method of Quality. For those that don’t know where I am going with this, hang tight. Dr. Deming was an American who went over to post-WWII Japan. He started working with Toyota.

He helped Toyota to understand several important points. The first is that you can’t build a quality car with junk parts. “But with process controls that your engineers are learning about-consumer research, redesign of products- you can.”[9] He was referring what most of us know in our jobs today as process improvement. Build quality into the system, rather than wait for the end result and then trash it.

How does that relate to health? As I explained before, our current model is wait for a problem and then treat it. If we applied Dr. Deming’s philosophy to our health, we would use checks and balances along the way to reduce the end result of bad health. If we have waited for bad health to occur, then we have waited too long. This doesn’t mean that we need to diagnosis the pathway to bad health. After all, I just pointed out that diagnosing without understanding the complex mental, physical and spiritual being is an effort of futility. Building quality into the system, then isn’t just about early detection of a problem, but reduction of the small problems and errors that cause the problems in the first place. There is a role for early detection of disease and certainly early detection of cancer, for example can lead to more successful treatment, but why did the cancer happen in the first place? We have blamed this on external factors for far too long.

Nearly every day, I hear someone talking about how they “got sick.” You didn’t get sick, you became sick. Your body succumbed to an ailment. It may be that most others you know succumbed to it or it may be that no one you know succumbed to it. In this way, the quality of your system did not work.

Another important point from Dr. W Edwards Deming is that the “The consumer is the most important part of the production line.” He was referring to sales in this case. If you sell the customer junk, they won’t buy from you again. We are all customers, in the healthcare sense. We purchase whether directly or indirectly our health from healthcare facilities. We are not always receiving the quality we seek. In part, that’s because our health isn’t necessarily the goal. We are being sold a treatment for our symptoms and the diagnosis that the healthcare system bestows upon us. We are not walking away with health, so much as we are walking away with a solution, external, for a likely internally generated problem.

In another way, we are our own customers. Our minds and souls, depend on the body for their physical existence. When we build quality into our own healthy living system, we reap what we sow. We become the satisfied customers of our own process improvement process. We are now aligned with our own goals, but had to recognize that we are both mind body and soul independently but also mind, body and soul inseparable and whole.

Wellness rules

Most of us need rules. For Judeo-Christians, we have rules from God. For Muslims, they have rules from Allah. We have rules at school. We have rules in the courtroom. We have rules at work. We have rules in the home. We need rules.

Wellness again is the “integrated method of functioning, which is oriented toward maximizing the potential of which the individual is capable.”[10]

We all define what we are capable of and this definition is dynamic, meaning it is ever-changing. We may have established capability when we are young, which changes when we are older. When Dr. Dunn was talking about integrative functioning, he was referring to integrating wellness into our very being. The integration of wellness requires some rules.

I like to think about this example. Imagine yourself living in a bubble. No one could survive. The first thing you would need is air. Air has the oxygen you need to breathe. If that air is contaminated, then you will get sick. Then, you need water to drink. If that water is contaminated, then you will get sick. Then you need food to eat. If that food is contaminated, then you will get sick. These exposures are called toxic exposures and they lead to disease. We need to avoid toxins not just to avoid disease, but to maximize our potential capability.

Next, you get hungry in your bubble. Imagine you eat foods that are rich in animal products and develop heart disease, stroke, diabetes, obesity. You have become diseased and are no longer capable of maximizing your potential as an individual.

Living in a bubble means you can’t move. You are sedentary. You develop obesity, blood clots, muscle wasting, and emotional lability. If you start moving, you will reduce the incidence of these diseases. You are now able to maximize your potential as an individual.

Because you live in a bubble, you have no human contact. No touch. We know from experiments years ago on monkeys, which were quickly deemed unethical that if you take a monkey away from its mother during infancy it will die, not because it isn’t nourished physically, but because social isolation alone can kill it. We need a state of emotional wellness to maximize our potential capacity.

Finally, spiritual disconnection from the world around us, lack of purpose in our bubble, and lack of love will all lead to despair that no nutrition or physical activity can overcome. This despair will lead to disease, hormonal imbalance and eventually death. We need spiritual connections with one another in the form of community, a personal relationship with God, and a connection with our environment to maximize our potential capacity.

These 5 rules of wellness are known as Doctor of Living’s 5 Pillars of Health.™ We can glean some insights about minimizing our potential through lifestyle. Our lifestyle is both a reflection of our potential, as well as the cause of our current state. When our lifestyle is balanced, healthy and based on scientific evidence, then not only do we avoid to disease, but we take it another step further, we functionally integrate these rules above into achieving our purpose-driven and God-granted maximal potential capacity.  

We can learn more about lifestyles associated with avoiding disease to functionally integrate this into our own mind, bodies and souls through the American College of Lifestyle Medicine. The ACLM says that Lifestyle Medicine involves the use of evidence-based lifestyle therapeutic approaches, such as a predominantly whole food, plant-based diet, regular physical activity, adequate sleep, stress management, avoidance of risky substance use, and other non-drug modalities, to prevent, treat, and, oftentimes, reverse the lifestyle-related, chronic disease that’s all too prevalent.

We must integrate lifestyle medicine into our every day life, but this is not enough to high-level wellness. At Doctor of Living, we can help you develop your own process improvement process to build quality into your life and work towards high level wellness.

Thanks for joining me today. Doctor Jeremy signing off. Let’s seed wellness.


[1] https://www.ifm.org/functional-medicine/what-is-functional-medicine/

[2] https://www.webmd.com/balance/guide/what-is-alternative-medicine#1

[3] https://en.wikipedia.org/wiki/Wellness_(alternative_medicine). Accessed February 25th, 2019.

[4] https://www.who.int/about/mission/en/. Accessed 2/25/19.

[5] “High-level wellness is an integrated method of functioning…maximizing the potential of the individual…” Halbert Dunn, MD, PhD. Chief National Office of Vital Statistics. U.S. Public Health Service. High Level Wellness. 1961.

[6] https://en.wikiquote.org/wiki/Reductionism. Accessed february 25, 2019.

[7] https://en.wikiquote.org/wiki/Reductionism

[8] https://www.who.int/about/mission/en/. Accessed 2/25/19.

[9] The Deming Management Method. May Walton. Perigree Book. 1986.

[10] https://en.wikipedia.org/wiki/Wellness_(alternative_medicine). Accessed February 25th, 2019.

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