Living Better, Not Just Longer (with Shoshana Ungerleider, MD)

The decisions we make  on an individual basis do matter. Crossover’s Dr. Shoshana Ungerleider, a wellness expert, frequent media contributor,  and host of the TED Health Podcast joins Danielle to share the importance of receiving team-based care to optimize your “healthspan.” Find out how to improve your quality of life (hint: there’s no magic potion). 

Transcript

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Shoshana: 0:00

While life expectancy has increased by about three decades since the mid 20th century, healthspan has not people are able to live longer, but they aren't living better.

Crossover Health: 0:13

happiness, success, freedom, energy, fun, balance strength piece. It all stems from our physical and emotional well being. You're in the right place for a healthy discussion with experts to show you the way. This is B Well, a podcast from crossover health. Not sick is not enough. Being Well is a movement to get the most we want out of life. In each of our episodes, we pick a health or lifestyle topic, bring in one of our doctors from the frontlines and have a real conversation. Be well do good enjoy life.

Danielle: 0:56

What's up everyone this is Daniel Hughes Adele's health coach, Program Manager for crossover health and you are in right place for a healthy discussion. Just a reminder, the following presentation is for informational purposes only and is not intended nor implied to be a substitute for professional medical advice. Please do not apply any of this information without first speaking with your doctor. Today we have Dr. Shoshana Ungerleider acrosser physician here to speak about the topic of health span. Shawn is a physician, speaker, producer, writer and the host of the TED health podcast. She's the founder of endwell, a nonprofit media platform focused on making the end of life part of life. She works as an internist practicing medicine at crossover health in San Francisco. She received her medical degree from Oregon Health and Science University in Portland, Oregon, and completed residency at California Pacific Medical Center, where she serves on the executive board of the Foundation Board of Trustees. Welcome Shoshana is such a privilege to have you with us today.

Shoshana: 2:08

Oh, wow. Thank you so much for having me. This is gonna be so much fun. Agreed.

Danielle: 2:13

Agreed. So the topic is health span. I feel like our listeners may or may not know, or be familiar with that term. So how would you describe healthspan?

Shoshana: 2:28

Yeah, so it's, you know, not everybody agrees on a single definition. But one common definition I've seen out there is that health span is really the period of life spent in good health. So free from chronic disease, and what we would consider to be the disabilities of aging. The whole idea is is about looking at that not the number of years lived in life, but the quality of life that an individual experiences. And certainly that can be completely subjective, right? Because what is quality of life, for one may not be for another. And certainly people can live many, many years and live well with chronic disease, or even a disability of aging. But that was sort of the most widely accepted definition in the literature, although for sure it we don't want to exclude anybody who's living well with a chronic illness, or what we would consider to be a disability of aging specifically.

Danielle: 3:23

Absolutely. So thank you so much for clarifying that. So if we think about increasing the quality of our years, what are some of the things that we should take into consideration?

Shoshana: 3:40

Yeah, you know, this reminds me of a quote. And you know, when we talk about this concept of healthspan, Dr. Atul Gawande says we've been wrong about what our job is in medicine, we think our job is to ensure health and survival. But really, it's larger than that it is to enable well being. And I think that's from his book, being mortal, which is is really one of my favorites. And so I like this concept of well being, and we really want people to get the most out of life, while they're living it, improving quality of life, no matter where you're at, in that journey. And as I mentioned, you know, good health is and healthspan is not just about living longer, it's about living better, right. So I'm excited to kind of dig into that and think about in addition to our genetics, which we're sort of born with and have little control over, what are the things that we can control that contribute to healthspan? Right.

Danielle: 4:35

Well, actually, let's stick into that. So well, actually, maybe first let's talk about when we talk about well being. I think there's a lot of ways we can think about that. I think sometimes folks think about health strictly from a physical standpoint. But when we think about well being that can encompass that a lot more about how that person is, is living like their mental, emotional, spiritual well being. So I think it does paint a broader picture. Would you agree? What else do you feel like is maybe included in that broader sense of well being than just a physical health?

Shoshana: 5:17

Oh, gosh, absolutely. I think medicine and really our society in general has created an artificial distinction between the mind and the body. And I think the more and more that we learn, we realize that they're completely connected in very deep ways. So I think we really need to see mental health as health, and give it the attention it deserves. And certainly thinking about whole person care. And what that means for people, you know, I my hope, right, is that we can recognize mental well being as a really integral factor when we think about healthspan. And I have to just say, it's been so wonderful to practice within a model of care, at crossover where mental health is really 100% integrated into whole person care, it makes such a big difference when I as a as a physician, can easily turn to my colleagues and you know, and get a quick referral or bounce ideas off one another to take the best possible care of patients, because we know now more than ever, so many of us are grappling with, with mental health issues, and it's so hard to get the care that you need at the right time. So, you know, in addition to thinking about our mental health, as health, I mean, I think that we're gonna, we're going to dig a little deeper into into healthspan. But thinking about kind of getting back to basics, meaning that the things we have control over like quality, sleep, good nutrition, movement, and exercise, stress reduction, and then thinking about really community as a factor in well being. That's right,

Danielle: 6:51

you talked about, you know, genetics are one thing, and those you can't change, the focusing on what we can change. And as you mentioned, things like sleep and nutrition and movement and stress and the importance of connection, and community. Yeah, I think you're so right, like, those are the tangible things that we can do something about, can you talk a little bit, maybe just a touch on like each of those and how you see those playing a role into someone's greater well being?

Shoshana: 7:23

Yeah, absolutely. And I and I do think that we should take a pause, and certainly point out that genetics absolutely play a role in healthspan. That, again, those are things that, you know, we tend to be born with, or that happened throughout life that we really, for the most part have little control over. But it turns out, we have much more control of how well we live throughout life, by the decisions that we make every day. And by preventing illness, we can actually greatly affect how we live in terms of health into old age, and that quality of life peace. And and I do think it's also important to point out that while life expectancy has increased by about three decades, since the mid 20th, century, healthspan has not people are able to live longer, but they aren't living better. Most people, right, wow, most people live many years near the end of their lives with chronic illness, some degree of stability, and then, of course, for many a lack of independence. And so the idea is in my hope is that we need to close that gap. So there's certainly systemic factors at play within our healthcare system that contribute to that, but I think a lot of it can actually be mitigated by the things that are within our control. So, you know, getting back to your actual question, you know, again, this idea of evaluating things in our lives that we do have control over. Right, so thinking about quality sleep, and what does that mean that somewhere on the order of seven to nine hours a night of uninterrupted sleep, for which we can be in a dark, quiet place. And that's easier said than done, right and in modern life, but something that if we can, if we can strive for, we know, reduces the risk of, of chronic disease later in life, certainly nutrition, which I don't need to tell you about, I know all about. And again, we know that there are disparities and access to high quality food sources, but it is, you know, a big factor and it's not something that we learn a whole lot about in medical school is how to counsel people, and how to encourage or even prescribe good nutrition. And so it's, I am delighted to get to work alongside you know, health coaches and people who truly have a background in, in nutrition to be able to learn from y'all and, and help our patients and, you know, certainly movement and exercise that's getting out and moving every single day, doesn't mean you have to go out and run 10 Miles doesn't even mean you have to hop on a workout machine for 30 minutes even Just walking in and building in, you know, the those these small bits of exercise throughout the day can be hugely beneficial. And then, you know, the final two and from my perspective would be thinking about stress and where it comes into our lives and how to mitigate it, whether that's through meditation, or yoga, or prayer or journaling, or whatever works for you. And then certainly, community, we know that social isolation and loneliness are huge factors in contributing to chronic illness and early death, even. So the data is actually really staggering. And only just now starting to come out that, that the being lonely and isolated are just as detrimental to your health as smoking cigarettes, if you can imagine that. And so it's certainly something we've we've been dealing with throughout the pandemic, especially for older adults, but we need to continue to address this.

Danielle: 10:56

Absolutely agree. Now you had all of the the factors, although you did sort of sort of mentioned it in relation to loneliness, but smoking or stopping smoking is also another thing that can, that can, is something that we can control that can help us in terms of disease prevention, yeah, and I really liked the fact that you brought up hey, you know, your access to some of these things might vary for a number of reasons. But any little change to the positive is going to be something that can improve your health span. So again, if if it's just walking that you can do if it's dancing around around your living room, if it's increasing, just by one fruit or vegetable a day, I mean, those are things that, again, are going to make a positive step towards your improving your, your health span.

Shoshana: 11:48

And I think that the younger that people start to do this and and build this into your daily life, whether you're in your 20s 30s 40s 50s It's never it's never too late. Right. And and I think when we can build in healthy behaviors, we not only role model that to our our friends, our family members, our community, which is helpful, especially if you have little ones around. But then also it truly becomes a part of your life throughout life. And it actually does lead to much, much better health outcomes. If somebody continued to do those things over over a period of many years. Yeah,

Danielle: 12:23

it's very true. I mean, it's never too late cannot cannot stress that enough. It is never too late to start making changes in any of these areas. But yeah, the earlier you start, the more benefit, you're going to see if if you're keeping consistent with it, the more benefits you're going to see through your through your life. As we think about things that can be controlled, I think we also can talk about, also making sure that people are accessing the help that they need. And that can mean going and seeing a provider or multiple providers based on what your needs are like, you know, crossover we have like mental health providers, we have our primary care physicians, can you talk about it from a physician's perspective on how you can see the the discipline of medicine helping people with their health span?

Shoshana: 13:19

Oh, my goodness, so many ways. I mean, I think that what I can see is that many of my patients are kind of looking in the wrong places for for improving their their quality of life, right, their health span, the there's a big movement in the wellness industry for kind of life hacks and shortcuts. You know, the majority of them are not evidence based and may not be helpful. Unfortunately, there isn't a magic pill or potion. It's again about this idea of choosing health every single day, and making even tiny decisions around your diet and exercise and your mental well being and connection that we know make a difference. I think the the wellness industry likes to offer supplements or unproven interventions that are tend to be expensive and really, again, aren't proven to make a difference. And then sometimes can even cause harm. So a lot of the time I spend kind of teasing out what works and what doesn't with my patients, especially if they have a laundry list of, of supplements or other things that they're taking. It truly is I mean, we talked about getting back to basics, but it's the things that we've been talking about that are that are tried and true, that are extremely helpful for living a good a good life throughout life. So it's, it's It's the basic stuff and then certainly we know that all of our patients have different different circumstances in their lives. We know that there is on equal access to healthy food, quiet environments to get quality rest and relaxation, as well as environmental exposures right which occur more frequently in marginalized communities. So I think it's very, very important on the individual level, as well as a, as a society that we continue to assess what we call the social determinants of health in the care of our patients, when we think about long term well being, and I think this is only just now being talked about regularly, I certainly didn't learn about it in medical school, but from a public health perspective, and on the individual, you know, doctor patient relationship, as well as any kind of provider, right, this is so critically important to assess, we need to meet people where they are. Absolutely.

Danielle: 15:32

And I'm so glad you brought that up. Because from an individual provider perspective, we do need to account for what is happening with this individual? What are their social determinants of? Or how are the social determinants of health affecting them? And same, you know, when I went to nutrition school, didn't learn a thing about that. So really glad we're starting to talk about it now. Because it I mean, if you're giving advice to somebody, or you're giving education to somebody, and it, it doesn't apply to them, because of of barriers that they're confronting, it's it's not helpful. And I think it also can breed Miss trust. So, you know, I think what I'm hearing you say is providers, help a person find the most effective and right solutions, but that will work for them within kind of their individual circumstances.

Shoshana: 16:34

Yeah, that's absolutely right. And across a variety, we spent a good amount of time kind of doing that work. So for me, it's been super helpful to get that kind of training and know what are the right questions to be asking of people around housing, security, food security, things about, you know, making rent, or being worried about financial stability. I mean, again, these are things that we don't think of as a part of medicine, or people's health, but they make a huge difference, in addition to everything else, that's really, really important that we address. Yeah, absolutely.

Danielle: 17:06

Yep. And I think too, if you are running into a provider, that isn't acknowledging those things. So Kate, to find a new provider, if that option is open to you to seek out a second opinion to go and, and find somebody that is going to listen to you and your concerns.

Shoshana: 17:30

Absolutely, I couldn't agree more I do that when I'm looking for a doctor if it's not a good fit, for whatever reason. So I think that's really, really important. I want to anybody listening, empower, you know, patients, to ask questions to interview your provider, just as much as they're asking you questions to make sure it's a good fit, and they're recognizing, you know, who you are as a human being in the context of your life as you in order to form sort of a therapeutic bond? I guess, I would say that those those pieces need to be there.

Danielle: 18:01

Yeah, absolutely. And seeing somebody as an individual and not just you see, you know, not not just a number, we see this a lot with them. Coming from a nutrition and coaching aspect, we see people all the time who have been on the receiving end of a significant amount of weight stigma and bias and and being told to just sort of lose weight as the solution for everything. And that prepared that provider never asked, so how are you eating? How's your exercising? Have you feel about your weight? What is what's going on for you? And so again, you are well within your your rights to go find somebody else who is going to listen to you treat you as an individual not see you just as a number.

Shoshana: 18:51

Yep, I couldn't agree more. You know, one of my mentors, Dr. Tracy godet, who was was in her most recent role, I believe, was was at the the Veterans Administration, the VA Office of Patient centered care and cultural transformation. She since moved on to something else. But something she always said was really pivotal for me. And she said, it's critical that we ask people, what matters most to them, and then tailor our care based on the answer to that question. So I know from being you know, a health coaching perspective, that's, that's old hat, but in medicine, you know, it's, it's so critical. And, you know, for patients out there, it's really asking the question of yourself, you know, what am I living for? And how can my healthcare team focus my treatment on my priorities for living the best life? So I think, for clinicians, it's making sure that we're partnering with our patients to involve and engage them to ask those kinds of questions. And this is whether we're talking about treating high blood pressure or diabetes, or we're talking about the end of life. It's all so critically important. And so I just wanted to throw that out there as well.

Danielle: 19:58

Absolutely. What is ortant to that person that as cliche as sitting in front of you, and I love that you said, you know, as a, as a human, ask that question of yourself, right? What is most important and and that might be able to guide you through finding your right way to whatever your health span looks like. I know in coaching, you know, it's it's really important for us to ask folks, hey, what's behind this change? And if we're hearing answers, like my doctor told me, I had to do, oh, we're gonna need a little more than that for it to be sticky. Right? So or I, you know, I'm just the reasons that people will give you for wanting to change that are not in line with their values. And so in coaching is something that we really go into what do you value what, what's important to you so that we can connect these basics as you say, the sleep, the eating, the movement, the stress reduction, the community, we can tie them back to what somebody values, because that's when those changes become really sticky. It's also where people start to realize like, what in their life is out of alignment with their values?

Shoshana: 21:17

Yes, exactly. And gosh, I so wish that we were we were maybe we're now we're training medical students to do this a little bit more, but so much of what we do in the world of primary care, which is what I do, is that kind of thinking about this stuff, and, and encouraging people to kind of to jump in to their health had first and and so I think a lot of those kinds of questions are really, really critical. And, you know, I'm so lucky to get to work alongside health coaches. But for for providers who aren't my goodness, there's there's a lot to be done, and so much to be learned around, truly engaging our patients. And certainly, you know, again, empowering patients to ask the questions about about treatment options and diagnoses if those things come up. Because the more that I think we can empower patients to advocate for what they need, in case the clinician isn't asking those questions, I think I always encourage people to do that.

Danielle: 22:11

Totally agree. And you should have a provider that listens to you and addresses your concerns, what I wasn't thinking brought up earlier that, that I liked this, you know, when people come to us, and they do want some quick fixes, where they're sort of looking in the wrong place. That's, that should be an open and non judgmental conversation with your provider so that your provider can say, hey, I understand why you might want to seek this because it sounds great. But here's the reality of you know what this can and cannot do you and here are some things that actually can get you what you're looking for. So I love that you brought that up, because I do find that we do feel a lot of that, you know, like, what's the latest hack for this or that off more often than not, the evidence points us back towards those basics.

Shoshana: 23:01

Yeah, and in a world where you you know, there's there's a watch, or a wearable or some device and again, those some of those are actually really great to be able to track information. But it's sometimes we're in data overload of so much information that we can learn about our health, that it's important to kind of if you're interested in that stuff, bring it up with your physician or other primary care clinician and, and find out you know, what's helpful to think about in the context of, of your health and well being and what is the extra stuff that, you know, really is just is just clogging up space. So all of that so incredibly important. So really,

Danielle: 23:37

so if we can distill this down to a couple of takeaways for our listeners, about how to kind of get the most out of the years that they have? How would you distill it for them?

Shoshana: 23:57

Yeah, I mean, I guess I'll start with sleep, again, can't speak highly enough of this important period of our lives. A lot of times we you know, when we think about sleep, you think you think about this passive time where it's, it's hours wasted. Turns out, it's an incredibly active time for our body to be resting and rejuvenating, there's so much going on on the cellular level inside of our brains, the rest of our body, it's, it's really, really critical to prioritize sleep every single night as much as you possibly can. That's not to say if you get one night, a bad sleep that you know, all bets are off. But I mean, in terms of thinking about this over years of life, the ways that we can optimize sleep in quiet, cool, dark environments, with limited distractions, reducing screen time at night, reducing alcohol and caffeine intake, close to bedtime, all of these things make a huge difference. So I know that I spend a lot of time thinking about that for myself.

Danielle: 24:54

And it's foundational, I mean, they're, it's foundational to health for you Due to sleep, there's a reason why humans need to sleep. And we do. And I know in coaching we get, we'll get people who come in, who again feel like OH, Sleep isn't that that's just it's a waste of time, because there's so much to do. And they'll be like, Well, okay, but how can I hack my energy? Like, what's the supplements are the foods that I can eat? Like, you really just need to try to sleep because there's no other good replacement for it. And it is so foundational to our health. So definitely, in agreement on that being a biggie. Yeah, what else? What else would you say, is important for people to take away from this conversation?

Shoshana: 25:40

Yeah, I mean, getting out and moving, right. So any form of exercise, anything that you like doing, from my perspective, is what's gonna stick and this is not again, you don't have to go train for a marathon, you don't have to go swim 800 laps, I mean, this, these are little things like taking the stairs instead of the elevator, or parking a little further away. When you go to targets and walking those extra steps. Those things all add up throughout the day. For me, I try to get in at least an hour of exercise a day, that's not going to fit for everybody, in fact, probably for most people. But again, doing anything and moving your body is better than nothing. And building that in early in life so that it remains a habit, as we age is just critical.

Danielle: 26:22

Yep, absolutely. Anything else you'd like to share with our listeners as we end our conversation?

Shoshana: 26:30

Well, I think, you know, for me stress reduction in a time when the world is just crazier than ever, is, has been transformational. And I practice daily meditation, and I just can't speak highly enough about finding something where you can take the time just for yourself and not feel guilty about it. Sometimes I'll even hide in the bathroom and do and do a meditation for 10 or 20 minutes. It just goes a long way to staying centered and grounded and not sweating, the small stuff that kind of comes up throughout a normal day. And we know again, that that's a huge factor when we think about a healthy life and throughout life.

Danielle: 27:16

Absolutely. And there are so many ways is you said meditation might be your go to, for me, it's engaging in in a hobby. I'd love to so so to me, that's very meditative. When projects are going well, when they're not little less so, but still enjoyable. And so for some people it might be drawing, it might be just gratitude, it might just be going out for a walk in may be sitting in silence, it's finding those ways of, of taking the edge off of the stress and engaging in those consistently. So I think that's also part of it is not just when stress is ramping up, but just consistently engaging in stress management practices. And if you're able to seek out a mental health provider if if the stress is really unmanageable, and we know right now, for a lot of folks, it absolutely is. We get it. If you're able to seek out the help of a mental health therapist there, they can be pivotal and giving you the right tools to be able to manage your stress.

Shoshana: 28:25

I think consistency is the key with all this stuff. Right? It's building it in.

Danielle: 28:29

It is and again, it doesn't matter sort of where you're at with any of this there any little step forward is a positive step. So find what works for you what you're able to do. And yeah, get consistent with it. So before we go, I do have some rapid fire questions to help our audience get to know you just a little bit better. Are you ready for the rapid fire? I'm ready. Okay. Number one, what are you currently watching or listening to? Oh,

Shoshana: 29:07

I'm just finishing inventing Anna, on Netflix. I'm a big TV watcher, which I hate to say. But sometimes I do it while I'm working out so at least I'm building a healthy habit.

Danielle: 29:19

I am a massive pop culture TV watcher inventing and is absolutely on my list. So good. What's your go to snack?

Shoshana: 29:30

Great question. I'll put like peanut butter on a honey crisp apple. That's probably my most recent or grab like a go macro bar. Something that's, you know, maybe healthy. I don't know. But yeah, probably those delicious. And finally, what

Danielle: 29:47

is the one thing you do everyday to stay healthy?

Shoshana: 29:50

I exercise I am obsessive about it. It drives my family nuts, but I as I said exercise at least an hour a day. Whether it's walking Getting on the peloton doing the elliptical something I just have to move it's so impacts my the way I feel day to day it's been a huge part of my life probably since my my teens so exercise is where it's at.

Danielle: 30:16

Okay, so then one sidebar question how do you choose your peloton rides? Instructor Music What how do you filter your rides?

Shoshana: 30:27

Yeah Sometimes it depends on how much time I have. So that can certainly be a you know, a rate limiting step there but usually I filter my by instructor and Robin are sown and Cody Rigsby are my favorites for a high impact ride. And then Hannah Corbin for like a mellow kind of downtempo just chill ride are absolutely the best. Oh,

Danielle: 30:52

excellent, excellent choices. All right. Thank you so much, Shannon. This was wonderful. Thank you so much for joining us today.

Shoshana: 31:00

Oh, thank you so much for having

Crossover Health: 31:01

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