The Progress and Perception of Integrative Health with Helene Langevin, MD

[00:00:00] Dr. Helene Langevin: You should not be using complementary therapy to treat, uh, cancer, for example. However, if somebody is undergoing cancer treatments, complementary therapies can be very useful to help deal with stress, for example, those kinds of things, and that can help in the recovery. So, you know, really understanding the, the role of, of therapies.Uh, in, in conjunction with conventional treatments is really important for people to understand.

[00:00:26] Dr. Melinda Ring: This is Next Level Health. I'm your host, Dr. Melinda Ring, Director of the Osher Center for Integrative Health at Northwestern University. On this show, we explore ways to take actionable steps towards optimizing our health with leaders in the integrative, functional, and lifestyle medicine fields who believe in science backed and time tested approaches to well being. Let's take your health to the next level. Hello, my guest today, Dr. Helene Langevin is a visionary leader in the field of integrative health. As the current director of the National Center for Complementary and Integrative Health at the NIH, she is at the forefront of the U. S. government's effort to research the science, safety, and effectiveness of integrative health approaches.Before taking on this pivotal role, she led, At our sister center, the Osher Center for Integrative Medicine at Brigham and Women's Hospital and Harvard Medical School, and served as a professor of medicine at Harvard. Beyond her leadership, Elaine is an expert in fascia, hearing a lot about fascia, the connective tissue in the human body plays a critical role in movement and pain perception and overall health. Her research focuses on how fascia based therapies like acupuncture or myofascial release could enhance patient outcomes. And I'm so thrilled to have my long term friend and colleague here on the show today to discuss the drive to bring safe and effective integrative health to people across the country and explore how we can all reach next level health. Welcome. Thank you so much for joining me today.

[00:02:10] Dr. Helene Langevin: Well, it's a great pleasure and honor. Thank you very much for inviting me.

[00:02:14] Dr. Melinda Ring: Like me, you did internal medicine, and then you did endocrinology, I believe, and you've been really involved, as long as I've known you, in integrative medicine and research. What initially drew you into medicine, and particularly integrative medicine?

[00:02:31] Dr. Helene Langevin: Well, it's funny, I was thinking about that the other day. I think from the start, I was always interested in the mind and body connection. I did a fellowship after medical school. On the hypothalamus, which is a really interesting part of the brain that connects essentially the brain with pretty much all the major autonomic functions, all the endocrine functions, but also things like sleep, appetite, you know, all these really important things, right? That was kind of the beginning of my really start thinking about integrative processes, physiological processes, but also. As our thinking evolved in, in health, in, in, in how to be healthier. And that we need to pay attention to all of these things, and especially that mind and body connection. So that's kind of what got me started along this path.

[00:03:20] Dr. Melinda Ring: How do you feel like things have evolved back from, you know, the 1970s when it was alternative medicine, to now where it is in maybe the soup that's happening of integrative and preventive and lifestyle and functional? It's really interesting, as you say,

[00:03:37] Dr. Helene Langevin: how it's evolved. Because what was happening back when At the beginning of, of our understanding of, of the important grassroots movement, right, of people, patients, for example, individuals going and seeking treatment outside of the conventional medicine. And this was the seminal paper by David Eisenberg, right, in 1993, I believe, that kind of revealed that. How often and how much This was a real thing that I could say, I believe it was 43 percent or something, people who were seeking some kind of, at the time we were calling them alternative therapies, and the idea that, well, what were people after?A lot of people would describe, That they, what they enjoyed about that was the, the, the patient provider interaction, that was a big part of it, people, uh, but also I think there was some ingredient of integration that so many of these therapies were not just looking at one part of the person. They were really looking at the whole person. And I think instinctively people like that. They sensed that there was something important there. Acupuncture, for example, traditional Chinese medicine. It's really integrative. It's holistic. I mean, that's a word that people use, right? Increasingly, we started thinking about it as really thinking about in terms of whole person health, that that's another aspect of integrative health that really looks at the whole person. And that theme of whole person health. Kind of started developing that while I was at the Osher Center, and then now it's really becomes pretty central to what we do at NCCIH.

[00:05:13] Dr. Melinda Ring: Sure, and at the VA also, obviously with their initiative with Whole Health. Yeah. So since you're bringing that up, I know that recently there was this launch of this new NCCIH coalition for whole person health. I'm part of some of the organizations that that um, are I think some of the leading initial members of it, like the Academic Consortium for Integrative Medicine and Health, like the Institute for Functional Medicine, Lifestyle Medicine. What is the purpose behind this new coalition? Like what are you really hoping that it's going to accomplish?

[00:05:53] Dr. Helene Langevin: Yeah, we're very excited about this coalition. The history behind it is that At NIH, a lot of the institutes and, and, and centers have what people call either friends groups or coalitions, or these are organizations of stakeholders, essentially. These are outside organizations. They're not part of NIH, but they, they're really a group of, uh, usually non profit organizations that, that are really dedicated to, to, um, supporting the work of the institute or the center of promoting it. Uh, and, and raising awareness of the importance of the work that the, that the Institute or Center does. Now, at NCCIH, we typically didn't have a coalition like that. The, the stakeholders that had an interest in integrative health or complementary medicine, complementary therapies, they were kind of fragmented, right? Yes. The professional organizations, you know, you had, for example, acupuncture organizations or chiropractic organizations, or, you know, yoga or massage therapists, or, you know, They were, they all had their own sort of constituencies and, and whatever they wanted to, to promote. We thought, well, what about whole person health? Like, is this something that everybody could get behind? We started that as an experiment as, and then in addition to that, there's all these other organizations that, that you mentioned, Lifestyle Medicine, for example, Functional Medicine, all of these organizations that already in their DNA, right? Okay. Have this integrative focus of and so pretty quickly we started realizing that this is a big group and we had a meeting Last year where we had Close to a I believe close to a hundred different representatives of different organizations that came and it was very very successful and so This year we, we decided to launch a, a coalition that really is, the purpose of this is, is to continue that work.

[00:07:55] Dr. Melinda Ring: People want to get away from the silos of this doctor deals with my heart, this doctor deals with my endocrine system, this one deals with my, my heart. Orthopedic issues. They want Buffalo connected. But then, which makes you think, oh, integrative medicine puts it all together. It sees the whole person. But like you said, within the field, I think it has been a real issue that there have been these silos and almost turf wars about who owns integrative medicine. Um, and there's some really, really valid issues around things like appropriation of practices, um, that have been part of cultures for millennia, and things like that, that absolutely are. valid and need to be taken into consideration. But you know, like you're saying, it is part of the DNA of all of those that we're all looking at the whole person, all recognizing the value of lifestyle. And we have more in common than we do differently. So what can we do together that we couldn't do separately? The other thing.

[00:09:04] Dr. Helene Langevin: That has been fun is connecting what we are, the insights that we're getting from integrative health into the rest of NIH. And that has been really, really interesting and challenging and rewarding. Because you know, there, there are people throughout NIH that recognize the importance of this. We are in the middle of launching actually a new, uh, program on whole person research that right now we have, uh, partners throughout and we have 18 institutes off offices and centers and offices that are participating in this funding opportunity. It's all about creating a framework for doing research on whole person. People have been very receptive to this, and so that has been really, really very challenging and rewarding at the same time. 

[00:10:02] Dr. Melinda Ring: So does that mean, for example, the NCCIH, the Integrative Health researchers or grants will be offered in collaboration with, say, Heart, Lung Institute, you know, like, there's going to be collaborations across the different institutes.

[00:10:20] Dr. Helene Langevin: All of these institutes are contributing funds towards this program, and we have experts from all of those different 18 institute centers and offices that have contributed to creating this funding opportunity. We had a workshop, uh, two, uh, couple years ago on the need to develop methods to study whole person health. That's not simple. Um, you know, it's a lot easier to study the effect of a pill on one molecule in your lung or something, right? I mean, that's hard enough, but imagine trying to understand the effect of a complex intervention, such as You know, a mind and body intervention combined with a nutritional, uh, you know, interventions and perhaps combined with exercise, right? Because we all know that it's, you really need multi component interventions for somebody to be well. It's not just one thing. And how do you study that? And how do you measure, uh, the effects of a complex multi component intervention on the whole person? Uh, it's easier said than done, obviously. And so we realized that we needed to go back. Back to, you know, start at the beginning and create a foundation for this kind of research. You can speak more to this than

[00:11:40] Dr. Melinda Ring: I can, but I think that, that has been a barrier to researching things like the traditional Chinese medicine, where it is so personalized to the patients and their needs. And So, you know, ten people who came in with heartburn with reflux might get ten completely different treatments.Because they're being looked at through a different lens of how health and disease occur. And that's so different from, What's become the gold standard, the, you know, double blind placebo controlled trial where, like you said, there's only a single variable that's tested. It doesn't always fit with studying integrative medicine, complementary medicine practices.You did mention that there have been maybe some challenges. Is, is that around the actual implementation or study of complementary therapies or herbs or other types of things? Like what, what have been some of the challenges that you've come across?

[00:12:45] Dr. Helene Langevin: Oh, no. I mean, the challenges have not been around specific therapies. It's more around the sheer complexity of it. Yes. You know. And, but fortunately, Absolutely. I think we're ready for that. And the reason for that is because, say, if we had tried to do this, you know, 10, 15 years ago, I don't think we would have been very successful. But right now, we're in the middle of a essential explosion of understanding how to study complex systems. I mean, we are so much better at this than we were, you know, not long ago, because we are understanding how to deal with Both complex systems, complex data sets, uh, we have methods now where we can analyze dynamic processes going on simultaneously in multiple different parts of the body and organs and systems and we're there, I mean, there's a, there's a wonderful program, uh, that is funded by the NIH Common Fund. Uh, this is a program that is, uh, an overarching program, uh, throughout all of NIH is, uh, And, uh, NCCIH, we participate in that program and we're funding, it's called Bridge to AI. It's about collecting, uh, datasets that are, uh, annotated correctly and ethically sourced so that you can perform artificial intelligence analyses of these complex, um, uh, problems, for example. One of the, the projects that is funded by this, uh, program is called Salutogenesis and it's about processes. Yeah, you'll recognize the term. The processes that, uh, that happen when somebody returns from a less healthy state to a healthier state and involve, you know, the whole, the whole person, essentially, and that's what they, they are studying in this, in this, um, in this program. So you can see how, once we understand how to do this, uh, we'll be able to really confidently, uh, Um, you know, address these kinds of problems, you know, with, with methods that are statistically correct and that really incorporate everything that we know that we're starting to understand about using big data.

[00:15:00] Dr. Melinda Ring: One of the things NCCIH does besides, uh, support the research, building the evidence base, helping us figure out what works and what doesn't work, is delivering education to the public. Uh, you know, again, I, I get these. Great handouts. I'll use them with patients. Um, that review the latest information on yoga, the latest information on meditation, uh, herbal medicine. Is this trying to balance out the stuff, like, with social media? Because you keep seeing these different things that are on TikTok that are being promoted, you know, and I get asked to, you know, comment on them. Like the latest one I was asked about was this naval polling with castor oil, you know, this is I guess the hottest new trend on TikTok, um, which comes from an Ayurvedic, but you know, the, the claims that you're going to lose 20 pounds if you do this and things like that are just, you know, out there and people go to their doctors and then the doctors like dismisses everything that comes from integrative medicine because of some bad publicity that we're getting. Any, any thoughts on what we should be doing?

[00:16:13] Dr. Helene Langevin: Well, part of it is, and you're doing this at your center and we're doing it at NIH, is really educating people, providing educational materials that are carefully written, that, that really guide people. And, you know, it's not necessarily easy. You know, you have to really help people do that. And also making sure that, you know, combat some popular misconceptions. For example, One thing that we talk a lot about at NGCIH is natural does not necessarily mean safe, right? There are some natural products that are downright dangerous and poisonous, right? I mean, so not everything that's in nature is is is something that you should just all put in your mouth. It's also important to understand that complementary therapies are not alternatives. should not be using complementary therapy to treat cancer, for example. However, if somebody is undergoing cancer treatments, complementary therapies can be very useful to help deal with stress, for example, those kinds of things, and that can help in the recovery. So, you know, really understanding the role of therapies. Uh, in, in conjunction with conventional treatments is really important for people to understand. Making sure that care is really integrated, that people talk with their, uh, healthcare providers of all types, you know, and inform, uh, the, the, their providers of what other types of treatments that they are undergoing. And it goes two ways. It goes both ways. Uh, if somebody goes and sees an acupuncturist. They should inform the acupuncturist as to what kind of medications they might be taking or what kinds of treatments they're having. So it goes both ways. They could also show their physicians that they're seeing an acupuncturist.

[00:18:05] Dr. Melinda Ring: Our center, the Osher Center, you know, is really, focuses also on training the next generation of providers so that whether they're doing it or not. In the context of their own specialty practice, like a rheumatologist who at least understands integrative medicine and can counsel a patient or, you know, more of what I do, which is act as an integrative medicine coach, consult doc who can help navigate, uh, and talk to their doctor if necessary and really help them do things that are safe. So let, let's talk about fascia. Some people may not know what fascia is. Tell us about what fascia is and, um, how did you get into this? Is it just because it's a connector?

[00:18:55] Dr. Helene Langevin: Well, fascia is fascinating. I mean, it's a part of the body that has been neglected for so long. I mean, you recall, right, in medical school, you're essentially cutting through that stuff in order to, when you're studying anatomy, in order to get to the organs and the muscles, and nobody cared about all the sort of grey stuff that was kind of in between everything and everything else. I And it was not until recently, I would say 20 so years ago, maybe a little more, that people started really paying attention to it and realizing, the first thing that was realized is, oh my goodness, there's sensory nerve endings in there. It's not inert. You know, we have sensations from this and there was a lot of interest at the beginning on possibly fascia being places that can hurt, you know, when, when part of your body, when you have musculoskeletal pain, part of this pain may be actually coming from your fascia. We knew absolutely nothing about it. The other part of fascia that's really, really interesting is its network nature, right? It connects literally every part of the body with every other part. And this is where the possible kind of analogy and correspondence to perhaps the idea of acupuncture meridians came. That's not proven, you know, but what we have found is that there's a lot of clues that acupuncture may actually meet, the needling may actually, um, interact with. What we call the interstitium, which is the loose connective tissue in between the fascial layers. And when you put an acupuncture needle and you move the acupuncture needle around, it, it stimulates that part. Now, of course, it also stimulates sensory nerves that are within the fascia. The part, the connective tissue that you stimulate, right? So it's not just the fascia and it's not just the nervous system, it's both.

[00:20:54] Dr. Melinda Ring: Is there a way that you suggest we take care of our fascia? 

[00:20:58] Dr. Helene Langevin: A really important thing to understand is that fascia and muscles, for example, and we're talking about the musculoskeletal system here, cannot separate them, right? They're really integrated there. And so, um, when we talk about being flexible. What we're really talking about is the interfaces, right? That's how fascia moves, but fascia is organized in layers, and the layers of fascia that are around the muscles need to be able to glide like this, glide past one another. And also the little, smaller and smaller and smaller pieces of fascia that are even inside the muscle need to also have some degree of motion. Otherwise, the muscles are just in one stiff, Mass, right? In order for the muscle to be able to function properly, the fascia within it and around it needs to be, um, healthy. Now, what does that mean in terms of movement? Well, it's not necessarily that more movement is necessarily better. There are people who are actually hypermobile, right? Yeah. Whose fascia? is actually, uh, overly loose and doesn't support their, their, their bones, their ligaments, their, their, their tendons. And these people are very prone to injuries. So it's, it's not simply as simple as saying people should be as flexible as possible. But at the same time, you have a lot of, a lot of individuals who tend to have fascia that is what I call kind of glued, you know, together where the, there's not a lot of movement. And that these fascia can become adherent, such that when one muscle contracts, that force gets kind of transmitted to the muscle next to it too much. We know there's some amount of myofascial force transmission, but we don't want all the muscles to be stuck in one, you know, kind of big mass. So, there is This is what we don't know yet how to measure very well.

[00:22:57] Dr. Melinda Ring: Yeah, that's what I was gonna say. You know, there's exactly, how do you know, how do you know you can, people can do body composition tests. Yeah. Like with a DEXA scan or a scale, and you can do strength measures. How, how do we, how do we measurable value needs? How do we know if our fascists

[00:23:12] Dr. Helene Langevin: Exactly. So this is where, um, fortunately what we've managed to be able to do. In the last two years, we, we have been collaborating with what's called the HEAL Initiative, which is a big initiative at NIH funded to address the opioid crisis. It's about, it's about opioid use disorder, but also about pain. And within the HEAL Initiative is a program called, Uh, developing measurements and markers of myofascial tissues. And so we have funded several awards now that are aimed at developing tools to measure the quality and the composition of fascia, but also how mobile it is, and in people, individuals with and without, you know, muscle myofascial pains, and also how it can be influenced by different types of treatments, such as acupuncture or manual therapy. So, hopefully, with those new tools, we'll be better able to understand exactly what's going on in fascia when people have pain. Is it because their fascia is stuck together? Is it because there's inflammation in there? Is it because there are, there's this new concept now called densification, where the hyaluronic acid or the glycosaminoglycans within the fascia have lost some of their Um, water carrying capacity and so they've become more congealed or dense and that means the fascia becomes more viscous. There's some thought that that might be something that we could address with manual therapies for example. So one of the techniques that we're going to, um, that people are going to use to look at this is a form of MRI imaging called T1 row imaging that actually quantifies the amount of free water in tissues. So, you know, all things like that, there's other techniques that are going to look at the interfaces using either ultrasound or, um, MRI elastography to look at the, uh, the stiffness of the tissues. But I think that, you know, right now, a lot of how people assess fascia is by, with their hands, you know, a manual therapist will palpate and feel. Yeah. Uh, the, the those, so they're able to.

[00:25:22] Dr. Melinda Ring: Yeah, because you know, they're, I know, I know in their training, one of, uh, when I was getting a massage and we were talking and she was telling me like, oh yeah. In our training, you know, they would put one hair underneath a bunch of pages. Uh, and you had to just be able to feel, I'm like, you know, I just do not have that level of sensitivity of touch. Yeah. Um, so you're saying that that a well-trained manual therapist. can just on a physical exam be able to assess somebody's fascia?

[00:25:53] Dr. Helene Langevin: Yeah, that's how it's done now, but then how do you do research on that, right? Right. So what we're trying to do now is develop methods that can correlate with what a practitioner feels with their hands. And very importantly, these new studies are going to be informed by the practitioners who are going to palpate, And, and describe what they feel and then see how that corresponds to what the image, you know, shows or the measurement shows. So it's really important that we, we take full advantage of the experience of the practitioners in, in doing this, this research.

[00:26:30] Dr. Melinda Ring: You mentioned hyaluronic acid. You know, of course, this is available as a supplement, there's collagen, there's all these different, is there any value for your fascia to using those sorts of supplements, or do we just not know yet?

[00:26:44] Dr. Helene Langevin: We don't know yet. I mean, this is what these measurement tools are going to allow us to now start to test. The experiments with hyaluronic acid, the ones that have been the most, you know, revealing have been, uh, experiments where, uh, these are not treatments, but they're experiments using hyaluronidase, so it's an enzyme that breaks down hyaluronic acid, and you can see when you administer Uh, hyaluronidase in a muscle, that it really changes the viscosity and, and the mechanical characteristics of the muscle. People have done that in patients, uh, after they've had strokes, uh, you know, when somebody has had a stroke, their muscles become more stiff. And we generally assume that this is spasticity. Right? But when you administer hyaluronidase in these post stroke patients, the muscles become much more pliable and movable. So some of this stiffness is not Just spasticity. Some of it is due to connective tissue.

[00:27:43] Dr. Melinda Ring: Okay, so people should not run out to buy supplements that are purported to help their fascia at this point. You know, we don't know.

[00:27:52] Dr. Helene Langevin: right? We don't have the data.

[00:27:53] Dr. Melinda Ring: yet. But, you know, hopefully soon. Okay. Um, so, Thank you so much for all your wisdom. Just to close, we like to leave with, uh, you know, a take home point for what we should all be doing. Um, so what, what, based on your personal and professional, you know, wisdom would you share with our listeners that will help them reach their own next level of health?

[00:28:19] Dr. Helene Langevin: Well, I think there's a couple of just general principles that I think apply across the board to a lot of things. And first of all, I think we have to be, be kind to ourselves, right? And at the same time, we have to push ourselves a little bit out of our comfort zones. And I think that that applies to many things. Um, it's good to challenge ourselves, but to also understand, for example, and somebody who is, is, spends a lot of time sitting, for example. To get off the chair. To walk around. That's good. And, but to understand also that all of this is highly individual. It's not a competition. And, you know, it, it's, each person should really move at their own pace. The three legged legs of the stool, right, that we talk about is, is really, you know, physical activity, uh, good nutrition, and also stress management and sleep. These are the, really the, the, the cornerstone, right, of, of whole person. And a lot of times, and I would say, uh, sometimes sleep can actually be the one thing that can help with all the other things. Oh, great. Um, so, you know, it's, it's really trying to see and, and, and for people to start with not try to do everything at once, you know, start, start with what the one thing, their, their diet or their physical activity or, or, or their, or managing their stress that they feel that they get, they want to start with and then gradually move on to other things, you know? So that it's not overwhelming.

[00:29:52] Dr. Melinda Ring: Alright, so one step at a time, but don't be complacent. It's okay to push yourself a little bit. Yeah. Just, uh, be kind to yourself. Exactly. All right, great message. Well, it was so great to get to reconnect with you. So thank you for taking the time to be here. I'm just so excited to see what's going to happen with the whole health coalition and with the all of the amazing research that you're helping push forward at the NIH.

[00:30:23] Dr. Helene Langevin: Well, thank you for all you're doing. I mean, you've really been an inspiration, uh, to me and a lot of people, you know, in what you're doing at your center. And, uh, so, um, yeah, I mean, it's, we're all in this together, right? We are

[00:30:36] Dr. Melinda Ring: all in this together. Thank you for joining me on this episode of Next Level Health. I hope you found some inspiration and practical insights to enhance your wellness journey. Don't forget to leave a comment on YouTube or review on Apple Podcasts. I'd love to hear your thoughts and suggestions for future topics or speakers. Be sure to follow Next Level Health with me, Dr. Melinda Ring, as we continue exploring the path to healthier, happier lives, together.