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is associated with perspective taking,
empathy and compassion; the brain stem
called the Pons, where many regulatory
neurotransmitters are produced; and
the amygdala, which is important for
anxiety, fear and stress.
Dr. Troneci says she’s personally noticed
changes in physicians who are long-time
meditators. One colleague, for example,
who often exhibited impulsive, angry
and irritable behavior, had become
almost unrecognizable as one who was
now “chill and collected.”
There also is ample research that shows
that meditation and mindfulness are
beneficial to another group – those
affected by psychiatric illnesses. This
includes those suffering from bipolar
disorder, borderline personality disorder,
attention deficit, and substance abuse.
Dr. Jeffrey Lazar, vice chairman of the
Department of Emergency Medicine
at SBH, is another proponent and
practitioner of meditation. He sees it as
a potential tool towards achieving the
hospital’s Quadruple Aim – specifically,
targeting the fourth tenet promoting
health care provider satisfaction and
wellness. “What I appreciate about
meditation is that it trains one to block
out noise, and focus on the moment,”
he says. “We have so much noise, both
literal and metaphorical, in medicine.
The skills called upon to focus and be
present during meditation can assist
providers in focusing on and being
present with their patients despite the
abundant distractions.”
He says he first became intrigued by
meditation after watching a TEDx talk
by Matthieu Ricard, a French molecular
biologist turned Buddhist monk, as well
as via a friend, a successful corporate
executive who incorporates meditation
into her life and who became a mentor
of sorts. This led him to taking regular
meditation classes near his home, and
developing his own practice.
“The more I do it, the more resilient
I feel,” he says. While he keeps a
meditation pillow – one filled with
buckwheat hulls – in his office, he admits
that a hectic administrative schedule has
limited him to meditating at the hospital
only a handful of times over the past six
months. This is why he tries to devote 20
minutes every morning to it before he
leaves for work.
He introduced the idea of meditation
to his Emergency Medicine interns
during their orientation week, in what
he characterized as a particularly intense
period for them. Meditation, he says,
can play an important role in a specialty
like emergency medicine that has a high
rate of burnout. Meditation programs, he
says, have been used by the U.S. military
for some Special Forces soldiers. “While
they may have different aims, there are
some similarities in the stresses shared
by working in an ER and going into
battle,” he says.
So, considering the extensive research
supporting and promoting meditation
and mindfulness as techniques to lessen
stress and burnout, why are physicians
resistant to embracing them? That’s a
question that is not easily answered.
“Why is it so hard to find a few minutes
to be with ourselves? To appreciate the
moment, to be mindful of our feelings,
to be empathic towards our tired and
stressed self?” asks Dr. Troneci. “Could
it be the invincibility we were trained to
develop? Just as the times have changed,
we must change. We need to change and
embrace our humane, vulnerable and
mindful I.”
T
he Centers for Disease
Control and Prevention
(CDC) estimates that as many as
11 percent of American children
between the ages of four and
17 suffer from Attention
Deficit Hyperactivity Disorder
(ADHD). It’s a condition that
can be perplexing to parents
whose children typically
show signs of inattention,
hyperactivity, and impulsivity.
This may manifest itself in a
range of behaviors, including
difficulty listening, having
trouble playing quietly, talking
excessively, aggression, lack of
restraint, being easily distracted
and/or not finishing tasks.
Guidelines from the American Academy
of Pediatrics (AAP) recommend
behavior therapy or medication as the
first line treatment for ADHD in young
children. While Dr. Paulo Pina, director
of ambulatory pediatrics at SBH Health
System, points to these as the only two
evidence-based therapies available for
children with ADHD, both of which
options he presents to parents, he
recommends that they also consider
a change in diet for their children.
“While changes in diet have not been
proven in any major studies, in a subset
of kids, sugar and processed foods can
make the condition worse,” says Dr. Pina.
“Studies have shown that some children
with ADHD have low levels of omega-3
fatty acids and iron, which is why we
recommend those nutrients.”
He acknowledges that changing a child’s
diet can be difficult, but believes these
foods can support better health for
children with ADHD as well as other
childhood conditions, like obesity.
He and the hospital’s other pediatricians
routinely distribute dietary information
to parents of young children who
have been diagnosed with ADHD.
Recommended are two to three servings
per week of foods that are good sources
of omega-3 fish oils, such as tuna,
salmon and cod. Omega-3 oils are also
found in flaxseed, cod liver oil, walnuts,
and spinach. Studies have found that
omega-3 may also help fight heart
disease, diabetes and breast cancer.
Dr. Pina also suggests serving foods
heavy in iron, which is commonly found
in beef, pork, chicken and eggs; beans
and lentils; dark leafy greens; and dried
fruits (such as raisins and apricots).
Finding healthy foods in the Bronx,
he says, can be a challenge. While he
prefers that parents serve these nutrients
in their natural form, he recommends
the use of supplements, especially if a
child won’t eat the recommended foods
or if they aren’t available. If a child can’t
or won’t swallow the supplements in
pill or capsule form, parents can buy
gel capsules and squeeze the contents
of the capsules into food. In addition to
avoiding processed foods and sugars, he
encourages parents to have their children
avoid foods with artificial colors and
flavors and preservatives. “If it’s a bright
orange potato chip or a drink that is
bright blue or purple, you can assume
it’s not natural, and so you should try
to avoid it,” he says.
Many parents are receptive to dietary
changes for their children, he says,
because they are motivated to do
whatever they can to avoid treating
with medications that can have such
side effects as reduced appetite, sleep
issues and abdominal pain.
“We go over the options with parents,
discussing the science behind medication
and behavior therapy, and talk about
diet, in making a shared decision,” Dr.
Pina states, adding that doctors need
to do a better job in teaching parents
how to read nutritional labels. “Having
a strong support system with patients
who are very engaged also plays a role in
helping these kids succeed.”
Change in Diet Benefits Children with ADHD
Paulo Pina, MD,
SBH’s director of ambulatory pediatrics, recommends diet as part of therapy
for children with ADHD.
HOLISTIC CARE
