Consiousness Based Medicine Treatment Protocol for Type 2 Diabetes: A Case Study Rea E. TarnavaCalifornia Institute for Human ScienceSpring 2018Consiousness Based Medicine Treatment Protocol for Type 2 Diabetes: A Case Study IntroductionJohn was diagnosed at the age of 45 with Type 2 Diabetes (T2D). On December 2, 2016, John was rushed to hospital with a high fever, nausea, and delirium.
Emergency testing revealed a dangerously high blood glucose level and sepsis from a wound on John’s toe. While in the hospital, John thought about the symptoms he had been experiencing in the 12 months leading up to this crisis. Extreme thirst, frequent urination, lack of energy, headaches, rashes on his lower legs, and an infection in his big toe that just would not heal.
It was a devastating diagnosis for John. With other family members having this condition, he knew the impact diabetes would have on his life long term. John was treated for the blood infection with intravenous antibiotics and released after ten days with little information on what to do moving forward with his new diagnosis. The day John left the hospital, he attended an appointment with his family physician to discuss the protocol he would need to follow in order to manage the diabetes. After a short discussion with the doctor, he was prescribed two drugs: metformin and an insulin injection at bedtime. The doctor taught him how to use a blood glucose meter to record his blood-sugar levels in a journal three times a day. She went through all of the potential risks associated with his diagnosis including heart disease, cardiovascular disease, renal disease, vision problems, headaches, nerve damage, fatigue and depression.
She handed John a copy of the American Diabetes Association’s food guide and told him to carefully follow it. John returned home and followed her instructions to the letter. Within the first week, he experienced side effects from the metformin including headaches, nausea, abdominal cramping and constipation. The insulin greatly affected his mood and energy levels, and the injection sites burned. Already 55 pounds overweight, John noticed he was gaining even more weight from following the food guide she provided.
He returned to his doctor and was given gabapentin to help address the abdominal pain but after a week of taking the new drug, he noted it did not help. She told him to continue following the food guide as well. After two more weeks of suffering, he returned again and she replaced the metformin with Onglyza and Farxiga once daily. She also added repaglinide to help the pancreas squeeze out more insulin. This combination was still not working for John, so he returned to his doctor for a fourth visit and was given Jardiance to replace the Farxiga. She told him this change was due to better cardiovascular protection by the Jardiance. John wondered why he was given Farxiga in the first place then.
In between all of these visits to the family doctor, John was also attending appointments with an endocrinologist, internal medicine specialist and a diabetic pharmacist to address his concerns and additional side effects. The abdominal pain continued to increase, as did John’s weight. Now he was also experiencing very cold feet with some numbness and tingling. John was depressed, demotivated and defeated. After six months of following the physician’s recommendations and feeling that his health was in steady decline, John was completely disappointed with the conventional medical system.
He decided it was time to seek an alternative, more wholistic treatment plan that better met his needs. In the city where John lives, an innovative new integrated health and healing clinic had opened that incorporated treatment protocols which followed the consciousness-based medicine philosophy. John contacted the clinic and scheduled an appointment. BackgroundType 2 diabetes or insulin-resistant diabetes is a metabolic disorder that develops when the insulin produced by the pancreas does not get used efficiently in the body (Campbell, 2011). A combination of these factors can cause insulin resistance, whereby your body doesn’t use insulin as well as it should. Insulin resistance, is the most common cause of type 2 diabetes, is known to develop more gradually than type 1 and is believed to have some relationship to obesity, low level of exercise and a family history of the disease (Campbell, 2011). The hormone insulin is produced in the pancreas and regulates glucose storage to provide energy to fuel the body’s cells es and the metabolites such as glucose, protein, and fats(Campbell, 2011).
. When insulin synthesissynthesis of insulin is inadequate,not sufficient the , it cannot metabolize the carbohydrates , proteins and fats in food cannot be properly metabolized leading to and the other metabolites. This leads to a high glucose levels accumulation in the blood (Campbell, 2011(Laaksonen & Atalay, 2002). The glucose is later excreted in the urine due to an inability to be utilized by the cells which results in depleted cellular energy (Campbell, 2011). Diabetes is a chronic debilitating medical condition that affects an estimated 30.3 million individuals in the United States, of which 30.2 million are adults aged 18 years or older, representing 12.
2% of all U.S. adults (National Diabetes Statistics Report, 2017).
Diabetes is linked towith significant morbidity and mortality and is the leadingleading cause cause of amputations of the lower extremities, end-stage kidney disease, and vision loss in persons aged 20–74 years (Egede, Ye, Zheng, & Silverstein, 2002). FurthermoreAdditionally, diabetes may impose a financial burden on individuals with the disease. The annual medical cost associated with diabetes is 327 billion dollars, including direct and indirect medical costs and lost productivity (American Diabetes Association, 2018). T2D continues to be a prominent and devastating condition even though there are vast treatment options being used in conventional medical care. Recently, an alternative medical model termed consciousness-based medicine was proposed to approach illness and disease in a different way. Consciousness-based medicine (CBM) is a term given to a form of medical treatment that works by direct appeal to the consciousness of the patient (Edwards, 2010).
The accepted belief in CBM is that disease manifests when our consciousness becomes overwhelmed existing in the particle state, instead of the preferred wave state of being (Edwards, 2010). Edwards defines this particle state as being out of the flow, in protection mode or the stress response: it is when you are existing in fear (Edwards, 2010). The wave state is defined as the relaxation response, healing response, growth mode or being in the flow: it is the love response (Edwards, 2010). At any given time, we exist in proportions of wave and particle states, with the ideal to be more in the wave state than the particle state on average in order to maintain a healthy balance (Edwards, 2010). The treatment model for consciousness-based medicine as proposed by Randy Fauver, Ph.D.
comprises The Seven Layers of Healing, and is a “top-down approach to treatment, bringing all dimensions of the human experience into active engagement for the maximum benefit of the patient” (Fauver, 2018, p.1). The Seven Layers of Healing are as follows: spirit, mind, body, touch, herbs and supplements, pharmacological agents and, as a last resort, surgery (Fauver, 2018). Treatment ProtocolJohn met with Beth, a CBM program director at the CARES Centre For Healing. After completing a lengthy interview process where she collected data on John’s relationships, work life, home environment, exercise regime, support system, diet, and spiritual/religious beliefs, Beth proposed a healing protocol that incorporated the first five levels of the CBM model to address John’s diabetes. The protocol used a whole person approach which respected his desire to incorporate more holistic treatment methods. The specific course of treatment was selected based on efficacy in providing the most improvement to the disease, secondary diseases and symptoms.
Level 1: SpiritLevel 1 interventions in CBM encompass involvement at the spirit level and include grace, prayer, meditation, mindfulness practice, spiritual guidance and spiritual engagement at a community level (Fauver, 2018). Spirituality is an increasingly important aspect of healthcare and health professionals are beginning to recognize that addressing patients’ spiritual needs are an essential part of patient-centered care (Parsian ; Dunning, 2009). Spirituality and a sense of meaning in suffering bring people with chronic health conditions to the process of transformation, helping them to know their strengths through finding their inner self and achieving wellbeing (McSherry ; Cash, 2004).
John is a very spiritual person, attending church with his family and friends every Sunday, and conveyed this importance to Beth. She decided to incorporate a deeper connection with spirit for John by suggesting he get more involved and perhaps volunteer at his church. She explained the relationship of spirit through self-actualization, relationships, connectedness with the universe, finding meaning in suffering, spiritual practice, self-awareness and spiritual beliefs leading to the transformation of inner peace (Parsian ; Dunning, 2009).
John found the courage to start a support group at the church for others living with diabetes. HThe found over time the connections he made with the other parishioners, and the discussions they had incorporating their faith, indeed lifted his spirit. John no longer felt so alone in his diagnosis. Level 2: MindLevel 2 interventions in CBM encompass involvement at the level of the mind and include individual and group psychotherapy, psychoeducation, training in skillful communication, and social engagement (Fauver, 2018). Psychological disorders such as depression are a problem for people with diabetes, in addition to less serious issues of frustration and being overwhelmed by the demands of the disease (Huffman, DuBois, Millstein, Celano, ; Wexler, 2015). A key to effectively treating diabetes-related distress is found in enhancing the patients coping skills (Peyrot ; Rubin, 2007).
As part of his treatment plan, John agreed to incorporate daily mindfulness-based stress reduction (MBSR) to help improve symptoms from depression and anxiety, as well as to improve his A1C, which is a test showing the overall average blood sugar level over a three-month period (Rosenzweig et al., 2006). The core of MBSR involves training in mindfulness meditation, a practice of self-regulating attention that lowers reactivity to stress triggers (Kabat-Zinn, 1990).
In only eight weeks, John had improvement with his feelings of depression and anxiety related to dealing with his illness. When he went for his next A1C blood test three months later, he also found positive improvement in the lab results. The second part of John’s level 2 treatment protocol included positive psychological interventions (PP).
PP is a branch of clinical interventions that uses systematic exercises (i.e. gratitude letters, acts of kindness, etc.) to target positive cognitive and emotional states (Seligman et al.
, 2005). PP interventions have been used in over 4000 mostly healthy subjects and have been found to increase well-being and decrease depression (Bolier et al., 2013), with effect sizes comparable to other psychological interventions (Cuijpers et al., 2011). PP was chosen because John could easily incorporate the exercises into his work and church life. He started volunteering his time as a greeter at the front of the church, doing odd jobs and repairs, and visiting sick parishioners in hospital. John’s depression improved and he felt a sense of joy, gratitude and pride through engaging in new positive activities.
He also found these additional activities tied in well with his level one intervention of hosting a support group for others with T2D. Level 3: BodyJohn was gaining weight and he was feeling fatigued. He had never been a very active man and due to the pain and tingling in his feet, he was not too keen on starting. Beth decided, as a part of the treatment plan, to ask John if he would be willing to incorporate yoga as a form of exercise into his weekly routine, explaining that it had benefits for not only his weight and fatigue, but also may improve his glucose levels.
John would be taught pranayama which is a breathing technique, and yoga-asanas which are different postures and poses, by a qualified yoga teacher. He would need to go to class initially for five days straight and then once every week for 45 minutes every day for a total of 45 days (Singh, Kyizom, Singh, Tandon, ; Madhu, 2008). Beth noted he may experience a reduction in the blood sugar, lower his body mass index (BMI), improve glucose metabolism and reduce the amount of prescription drugs need with this yoga program (Singh et al. 2008). Excited to continue on his healing journey, John agreed to complete the full yoga program as recommended by Beth. At first, he felt awkward and a bit self-conscious.
He was not used to group exercise activities but decided to persist. After a few weeks, John got into the flow of the yoga and began to enjoy how peaceful and centered it made him feel. John made several friends in the class which was also helped with his anxiety and depression. Most of all, his blood sugar levels, taken daily on his glucose monitor, continued to improve. An added bonus was that the Yoga was helping him to lose some weight as well. He could see that each level of healing complemented and supported the next level. To address the concerns about his diet and support the weight reduction happening though his yoga program, Beth introduced John to a ketogenic diet, low in carbohydrates and high in good fats like olive oil and avocados (Westman, Yancy, Mavropoulos, Marquart, ; McDuffie, 2008).
The diet plan included restricting carbohydrates to 20 grams per day maximum without restricting calories (Vernon ; Eberstein, 2004). John was told his daily intake could include unlimited lean meats and seafood, 4 oz of hard cheese, 2 ounces of ricotta or cottage cheese, 2 cups of salad and 1 cup of non-starchy vegetables (Westman et al., 2008).
Beth asked John to drink plenty of water and recommended for the first two weeks that John should drink beef or chicken broth 2 to 3 times a day to help with the hunger, until his body could adapt to the change (Westman et al., 2008). Beth further suggested that the American Diabetes Association’s food guide may not be his best choice, as it is heavy in carbohydrates such as bread and white rice, low in lean protein and healthy fats, and also much too low in recommended fiber intake. Beth relayed to John a study she had read on how embracing a ketogenic diet could lead to a reduced A1C glucose blood level, reduction or potentially the elimination of insulin and hypoglycemic medications, lower blood pressure, higher HDL cholesterol and significant weight loss (Westman et al., 2008). Finally, she encouraged John to take daily probiotics noting they would help to restore vital microbes back into his intestines offsetting the negative effects of antibiotics given in hospital.
John made the necessary changes to his diet, and immediately began to see a reduction in his body fat. Over the course of 12 months, John lost 55 pounds. He felt lighter both outside and in.
His thinking about his diagnosis began to shift and he was more motivated than ever to continue on with Beth’s treatment plan. Level 4: TouchJohn had discussed the numbness and tingling in his feet with Beth in their initial meeting and she immediately wondered whether he was beginning to experience peripheral neuropathy. Of the secondary health issues found in patients with T2D, peripheral neuropathy (PN) is one that causes significant pain and distress. Nerve damage to the extremities, or PN, occurs when small blood vessels in the hands and feet are damaged by high glucose levels in the blood causing symptoms such as numbness, tingling, burning and muscle weakness (Campbell, 2011). Beth decided upon acupuncture as a mode of treatment for John’s pain to reduce the need for harmful pain-killing drugs knowing that John had a goal of dropping as many medications as possible.
There was also the benefit of improved mood and overall well-being. Beth further explained that acupuncture is one of the main forms of treatment in Traditional Chinese Medicine (TCM) and involves the use of fine needles that are inserted into the body at very specific points (Thambirajah, 2011). The acupuncture points are selected based on clinical presentation, symptoms, appearance, and emotional state (Thambirajah, 2011). In TCM, it is believed that correcting the imbalances in energy flow, or qi, in the meridians is the essence of restoring health through the use of acupuncture (Thambirajah, 2011). John accepted her recommendation and began seeing an acupuncturist at CARES Clinic.
The treatment protocol included needling 25 acupuncture points related to blood stasis, phlegm and severe numbness of the hands and feet (Zhang, Ma, & Yan, 2010). The needles were placed in each of the specific acupuncture points, lifted and twirled, and then left in the skin for 25 minutes. The manipulations were then repeated a second time. (Zhang et al., 2010).
The treatment consisted of 14 sessions, once a day with a four-day break after every two weeks, totaling 70 treatments (Zhang et al., 2010). John noted significant improvement after the first two weeks. Once he completed the recommended protocol, he was able to eliminate all pharmaceutical pain medications. He still experienced occasional tingling and thus decided to continue with the acupuncture once a month for maintenance.
Level 5: SupplementsOf all of John’s issues associated with his diabetes, it was his greatest desire to improve his blood glucose levels and eliminate as many of the medications as possible. Beth shared with John a study which looked at the beneficial effects of using a chromium picolinate supplement twice daily to lower glucose, reduce total cholesterol and improve insulin resistance (Anderson et al., 1997).
She asked John to take 500 micrograms twice daily for four months and then she would have him repeat his bloodwork. Beth based the value of this intervention in providing an opportunity for John to further reduce pharmacological medications including insulin, while lowering glucose levels more naturally through the use of the chromium picolinate. Using a supplement instead of prescription medications would provide greater overall health benefits and may even improve the overall outlook for the progression of the disease once John’s glucose levels were more effectively controlled. John was thrilled and agreed to immediately incorporate the chromium picolinate as per her recommendations. After the four months, John’s A1C results had come back much lower than he expected.
He was able to discontinue the use of insulin all together after 12 months and felt a great sense of accomplishment and joy. ResultsEighteen months ago, John was fighting for his life. He was taken to emergency by ambulance and treated in hospital for sepsis, finding out the underlying cause was type 2 diabetes. Today, with the help of a clinic following the consciousness-based medicine treatment protocol, John’s life has improved. He practices meditation and yoga, incorporates daily positive psychological exercises, takes chromium supplements, and follows a low-carb ketogenic diet. John receives acupuncture once a month now for his neuropathy and has eliminated the need for insulin and other drugs due to achieving glucose levels that fall within the normal range. He is feeling better overall, has lost 55 pounds, spends quality time with family and friends, and has learned how to reduce stress.
John continues to go to church and enjoys facilitating a support group for others living with T2D. John, who was once overwhelmed with a T2D diagnosis, has now come to realize this disease saved his life. It was the wake-up call he needed to address spiritual, mental and physical issues he had been avoiding. The individualized treatment plan Beth designed incorporated interventions at five levels of the CBM treatment protocol. They were implemented incrementally in order of the CBM model, with each successive level aiding in supporting the former level.
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