Clinician’s Corner: Healthy Choices and Improving Your Health Outcomes

white hair man and woman meditating - Clinician's Corner

By Dr. Jason Doescher, Minnesota Epilepsy Group

Be good to yourself, invest in your health and wellness

Such a simple comment is easy to agree with but can be challenging to accomplish. While the basic ingredients of health are straightforward, our busy lives often influence choices to meet short-term needs at the expense of long-term health. The Epilepsy Foundation’s mission to foster a full and productive life to the best of an individual’s ability, focuses attention, support, and resources towards lifelong healthy habits.

The Wellness Institute, a program of the Epilepsy Foundation, champions whole-person health with a focus on serving individuals with epilepsy and the well-being of caregivers. It identifies eight areas of wellness:

  • Emotional health
  • Stress management
  • Sleep
  • Diet and nutrition
  • Physical activity
  • Independent living
  • Social relationships
  • Education and employment.

The Wellness Institute offers a Wellness Toolkit, videos, and referral networks to support healthy and effective behavioral change.

This article is the first in a three-part series highlighting overall wellness. Part one outlines general wellness areas, identifies choices within each area, and emphasizes how consistent habits define a person’s health outcomes.

The second part of the series focuses on wellness for people with epilepsy and how each area might impact their health. The third article focuses on the health and well-being of caregivers, recognizing the challenges for self-care they face. Additionally, in 2021, the Epilepsy Foundation of Minnesota (EFMN) is offering a webinar series that reviews these wellness areas and shares local resources.

Wellness means different things to different people

An individual’s sense of health and wellness is influenced by their life experiences, abilities, resources, and social and cultural norms. Past experiences, present conditions, and personal goals all impact someone’s confidence and ability in managing healthy outcomes. 

Wellness success is not a checklist of accomplishments, nor a manual of step-by-step actions, but rather an understanding that health requires active maintenance with more good choices and habits than bad. Healthy choices take attention, time, and resources, which are too often felt to be limited in our American culture.

Progress toward a healthier state includes positive strides and periodic setbacks. Personal motivation and a willingness to change are necessary to move from thinking about getting healthier toward the action that results in being healthier. Accepting challenges and change is empowering. Healthier choices feel good and are reinforced by a sense of reward and accomplishment. Partnering with others and sharing the journey develops external rewards and provides accountability.

Routines, reminders, and replacing unhealthy habits (candy bars) with healthier choices (apples) are parts of behavioral change. Behavioral change is hard and healthy choices can require more effort than the unhealthy choice. Picking one area at a time to improve makes challenges less intimidating. Success in one area provides motivation to focus and improve in another area. Instead of completely overhauling your behavior, chose a starting point and let the momentum of each success carry you forward.       

Wellness is an outcome of healthy behaviors

Behavioral change starts by understanding what a person is doing and why. Stopping to recognize the present behavior allows someone to see their daily choices. People have reasons for doing what they do as well as alternatives to most choices. Priorities shape a person’s choices as do needs and responsibilities. People are motivated by avoiding near term discomfort. 

Consider the power and motivation of hunger. Many people structure their days around meals; their actions are often consistent routines, either good or bad. A person’s nutrition is influenced by time, money, access, skill, and preference. People often trade convenience to meet a short-term goal, like avoiding hunger or saving time, even if it results in a less healthy choice. 

Healthy routines catch the simple choices, make health-conscious decisions, and adapt habits to create lasting outcomes. Such an example includes exchanging an unhealthy snack (candy bar) for a healthy one (apple). Supportive behavior includes keeping nutritious snacks in the kitchen, office, or car and decreasing access to junk food and fast food. Daily choices make up our habits and result in our overall wellness. 

A comprehensive approach to health recognizes how a person eats, moves, and sleeps, and acknowledges the person’s motivations, feelings, and interactions with the community.

Emotional health is the “appropriate awareness and self-control to experience a range of feelings.” Feelings influence behavior, communication, and comfort. They’re often signals, communicating warnings or needs. A range of emotions, good and bad, is normal and healthy. 

People can influence, but do not have control over other people or their external environment (school, work, family, neighbors). Interactions with others naturally results in a range of positive or negative feelings. Being able to restore emotional balance, awareness, and self-control provides a sense of feeling grounded and comfortable. Feeling comfortable leads to a more positive perspective.

Resilience is a strength that’s exercised through finding a sense of courage and hope during times of fear and threat. Focusing on and appreciating what an individual has rather than what is missing or lost, with a willingness to accept challenges, is an opportunity for growth. Emotional health can be strengthened by increasing social support networks (trusted friends and mentors), taking time for self-care (hobbies or things that feel good), and doing activities that contribute to others such as community service or volunteering.

While emotional health relates to the inner self, stress management relates to navigating the external world. Day-to-day activities, and meeting basic needs, are commonly challenged by limited time, energy, and resources.

Stress is often described as a feeling of discomfort. It can present as muscle aches, an upset stomach, headaches, racing heartbeats, and feelings similar to fear. Stress takes attention and focus from work, relationships, and self-care. However, it’s not always bad.

Sometimes stress motivates important changes or leads to a sense of accomplishment through completed challenges. Healthy actions include identifying the issue and why it’s uncomfortable. Next, it’s finding options to improve the situation by gathering information and support. Turn to friends and mentors. To help others and be helped are key elements in being healthy on the individual and community level. Developing a plan provides an empowered sense and potential for making the situation better. Choose to be active in making things better and embracing challenges.  

Sleep is important to health and wellness

Sleep offers rest and restoration, both neurologically and throughout the body. The goal is to get an adequate quantity and quality of sleep. The majority of people feel rested with 7-9 hours of uninterrupted sleep. Some can function well on less, and others require more. 

Insomnia is the inability to fall or maintain sleep throughout the night, which may be influenced by stress, surrounding noises or temperatures, and medication side effects. Sleep hygiene techniques and night-time routines help. Examples include keeping bedroom temperatures cooler, avoiding entertainment in bed (reading or watching TV), and practicing calming behaviors like journaling, meditating, or making ‘to-do’ lists prior to sleep. 

Healthy diets, daily activity, and avoiding alcohol also contribute to quality sleep. Sleep disordered breathing, which includes sleep apnea, disrupt both the quantity and quality of sleep, and is a common cause of fatigue. Failing to resolve sleep disordered breathing can complicate treatment of other chronic conditions such as obesity, depression, and hypertension. Sleep deprivation may lower an individual’s seizure threshold, therefor increasing seizure frequency.

We are as healthy as the food we eat

Food provides the resources for a body’s energy, growth, and restoration. Food is also part of a person’s social and self-care routines. What, how, when, and with whom a person eats, all matters. Lifestyle medicine shows the connection between nutrition and chronic disease noting food’s role in inflammation, gastrointestinal micro-flora and impact on neuroscience.  Healthy whole-food, vegetable-based diets reduce or prevent common chronic illness such as cardiovascular disease, dementia, diabetes, and cancer. 

Despite the benefits, changing diets is a significant challenge. Behavioral change requires avoiding unhealthy choices and normalizing healthier decisions. This may require new skills, recipes, and shopping patterns. 

“Whole foods” often means cooking from basic ingredients which takes time and money. “Pre-made” foods are often less expensive, easier to make, and involve less time. Kitchens can be a social hub of the home and a place to share, support, and grow new skills. Investing in nutrition is often time well spent. 

Photo by Gabby K

Physical activity is important to overall health 

Being active is an all-day event, from lifting, walking, and working throughout. The duration and intensity of each activity adds up and benefits the heart, lungs, muscles, and joints. Physical activity also impacts metabolism, sleep, mood, and stress reduction. Fitness includes cardiovascular exercise focusing on distance and duration, such as walking, jogging, biking, and swimming. Strength training and muscle development are important too, as are balance and flexibility. 

The Center for Disease Control and Prevention (CDC) recommends getting 150-300 minutes (2.5-5 hours) of moderate activity per week with a mixture of endurance exercise, strength training, and stretching.

Exercise such as walking is a wonderful social and supportive activity. Physical activity can be adaptive and requires attention to safety, supervision, tolerance, and collaboration with a medical team. Simple actions like tracking daily steps and setting gradual higher targets is a common way to incorporate exercise into a routine and create healthy habits. 

The Wellness Institute recognizes the value of personal growth, independence, and healthy social relationships. Self-management is rarely easy, and efforts to build confidence, competence, and skills lead to a more secure and safe level of independence. When experiencing a chronic illness such as epilepsy, challenges are unique to each person and family, and goals should reflect this.

The Wellness Institute focuses on maximizing development and overall quality of life through skill development, resource direction, and opportunity. It often takes help from others for each individual to grow and thrive. Relationships and sense of community are key elements of health and wellness. Isolation and loneliness, far too common in America, have a negative impact on health. Identifying trusted relationships, investing time and attention in them, and making personal friendships a priority are major contributors to well being. 

Being active in organizations with opportunities to meet others, be present with spirit, appreciate common interests, as well as respect differences are habits that make individuals healthy and communities resilient. These activities are available through school, church, community centers, and special interest groups, such as EFMN activities like Connect Groups. 

Making time for self-care, as well as time with others, is as important as healthy diets and regular exercise. Mixing these elements of food, activity, and social support can be as simple as dinner and a walk with friends.    

An often overlooked opportunity involves smart use of medications and resources. Despite the best attempts at healthy habits, many people need additional support like therapy, medications, systems to measure progress, adaptive technology, education, and professional expertise. The key is measuring progress to show if actions are making a positive difference. 

Too often people do things but don’t see a clear benefit. It’s important to try new strategies and improve problematic situations. Informed and thoughtful change is good. If the current therapy is not effective, explore opportunities to make changes and minimize side effect or expense. Asking experts (doctors, pharmacists, nurses, dietitians, fitness trainers, teachers, financial planners, social workers) in each area and building a treatment team typically yields meaningful and positive results. 

Progress starts by making one small change consistently

Make health a priority. Change starts by dedicating time and attention to a focused area of health. Make positive, informed choices. Work toward a goal and measure the outcomes. Simple additions or changes to an old habit help. Make regular adjustments to make greater progress. When a goal is met, celebrate! Change is hard to accomplish. Never stop being good to yourself and feel better along the way. 

Resources and References

  1. Widmer RJ, Flammer AJ, Lerman LO, Lerman A. The Mediterranean diet, its components, and cardiovascular disease. Am J Med. 2015 Mar;128(3):229-38. doi: 10.1016/j.amjmed.2014.10.014. Epub 2014 Oct 15. PMID: 25447615; PMCID: PMC4339461.
  2. Andreu-Reinón ME, Chirlaque MD, Gavrila D, Amiano P, Mar J, Tainta M, Ardanaz E, Larumbe R, Colorado-Yohar SM, Navarro-Mateu F, Navarro C, Huerta JM. Mediterranean Diet and Risk of Dementia and Alzheimer’s Disease in the EPIC-Spain Dementia Cohort Study. Nutrients. 2021; 13(2):700. https://doi.org/10.3390/nu13020700
  3. Mentella MC, Scaldaferri F, Ricci C, Gasbarrini A, Miggiano GAD. Cancer and Mediterranean Diet: A Review. Nutrients. 2019; 11(9):2059. https://doi.org/10.3390/nu11092059
  4. The Harvard Healthy Eating Plate and Pyramid. https://www.hsph.harvard.edu/nutritionsource/healthy-eating-plate/

Treatment Options

Some of the most common treatment options for epilepsy include medication, surgery, implant devices, and alternative therapies.

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