Integrative Medicine for Brain Health: Why Neurologists Should Care

Kathrin LaFaver, MD


June 02, 2021

The field of integrative medicine is gaining a steadily growing interest base among patients and healthcare professionals alike. Defined as healing-oriented practice with a focus on lifestyle interventions, offering patient-centered care addressing physical, mental, and spiritual well-being, it can fill the gaps that many perceive in our traditional healthcare environment.

With the rapid increase in chronic neurodegenerative conditions including Alzheimer's and Parkinson's diseases, there is a clear interest in lifestyle factors for prevention and treatment of brain disorders, although many physicians rightfully voice skepticism about unregulated supplements and treatments with potential harm.

The first virtual Integrative Medicine Summit, organized by the Andrew Weil Center for Integrative Medicine at the University of Arizona, provided an excellent opportunity to get up-to-date about current trends and practices.

The conference opened with a full day dedicated to the immune system and infectious diseases, followed by day 2, covering topics related to brain health, and wrapping up with hot-topic discussions on day 3. Watching the summit with a neurologist's lens, I left impressed by the depth and commitment to scientific rigor by the majority of presenters.

One of the keynote lectures was delivered by Dr Laurie Mischley on Parkinson's disease (PD), presenting data from her Complementary & Alternative Medicine Care in PD study. After analysis of survey responses from over 1500 patients, the strongest predictor associated with PD progression turned out to be loneliness, proving a better marker for quality of life than motor symptoms such as tremor.

In terms of lifestyle factors associated with reduced self-reported symptom severity over time, higher consumption of fresh vegetables, fruits, nuts, and seeds, as well as exercise on at least 3 days per week, had favorable effects.

Mischley also decidedly spoke out against "levodopa phobia," the fear that treatment with carbidopa/levodopa may hasten progression of PD. Although this claim has repeatedly been shown to be unfounded, it is still a reason for some practitioners to unnecessarily delay pharmacologic treatment.

Another highlight was the talk by Donna Jackson Nakazawa, an award-winning science journalist and author of the book Childhood Disrupted, on the often underrecognized connections between physical and mental health. She spoke about the impact of adverse childhood experiences on the immune system, especially microglia function, with potentially wide-ranging negative downstream effects on brain health and disease.

Pertinent to the COVID-19 pandemic, the experience of isolation, uncertainty, and trauma, combined with an activated immune system, provides fertile ground for a growing mental health crisis for years to come. Importantly, many already available therapies, including different psychotherapy modalities, mindful meditation, biofeedback, and expressive writing, can be harnessed to improve emotional regulation and stress response.

As another proponent of overcoming mind-body dualism, Dr Howard Schubiner delineated the role of emotional processing in chronic pain and presented outcomes of pain reprocessing therapy for patients with fibromyalgia and other pain syndromes.

Conceptualizing chronic pain as a neural circuit disorder with faulty predictive coding as a core feature, he delineated a pathway to new treatment approaches that may be helpful in a wide range of conditions, ranging from fibromyalgia, chronic fatigue, and insomnia to mood disorders.

A few presenters promoted dietary supplements based on small case series that left me questioning their clinical value, but the commitment to good science as the basis for good medicine was a stated goal by the summit organizers and will hopefully continue to be pushed forward in future conferences.

As a leading example, Dr Weil himself took a strong stance in favor of the COVID-19 vaccine, a positive signal among an often vaccine-hesitant atmosphere in the complementary and alternative medicine world.

For those looking for more information, there are now close to 3000 peer-reviewed scientific papers on the topic of integrative medicine and neurology, with recent reviews on common diagnoses including headaches, dementia, and neuromuscular disorders.

Furthermore, the first edition of the textbook Integrative Neurology was published in September 2020, edited by Dr John W. McBurney and Dr Ilene S. Ruhoy, both graduates of the integrative medicine fellowship at the University of Arizona under Dr Weil's leadership.

Finally, a growing number of medical schools and residency programs offer formal education and elective rotations in integrative medicine. Additional education for practicing neurologists and neurology trainees will undoubtedly help us to more fully meet the needs of patients with neurologic disorders and inspire physician scientists to conduct additional, much-needed research in this important area.

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About Dr Kathrin LaFaver
Kathrin LaFaver, MD, is a neurologist and movement disorders specialist with a focus on integrating mental and physical aspects of health. After training at the Mayo Clinic and the National Institutes of Health, and practicing neurology for over 10 years, she believes in lifestyle medicine as a foundation for prevention and treatment of brain disorders. She is co-founder of the Women Neurologists Group and is passionate about the arts and being in nature. Follow her on Twitter @LaFaverMD


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