Episode 60 | Nov 30, 2023

Can Health Coaching Improve Cognitive Decline?

Discover groundbreaking developments in health coaching research! In this week’s episode, Dr. Sandi presents new findings exploring the profound impact health coaching can have on preventing and treating cognitive decline. She also shares research highlighting the potential of adopting a systems biology approach, revealing how addressing nutrient deficiencies can improve or even eliminate various symptoms. Lastly, Dr. Sandi unveils a compelling report that spans nearly two decades of research, evaluating the overall effectiveness of health coaching.

We encourage you to watch the accompanying video (coming soon) which features informative slides. You’ll also find valuable links to these resources below.

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Episode Transcript

Dr. Sandi: Hello, everybody, and welcome back to another episode of Health Coach Talk. I am your host, Dr. Sandra Scheinbaum. And today it’s just me. It’s another solo episode. We’re going to be talking about a groundbreaking research study as well as a new report that came out on the effectiveness of coaching. They look back on all of the research reports going back to 2005. And finally I’m going to share a position paper that was written by a colleague, Dr. Ramona Wallace, that talks about physician training and nutrition, and I think there’s applicability there for the health coaching profession. If you are watching this on YouTube, then you can see these slides. And if you are listening, I suggest you may want to head over to YouTube, check out our YouTube channel, and you can see these slides as well.

So, this is groundbreaking, I believe. Get this. personalized coaching decreases cognitive decline in early stage Alzheimer’s disease patients. Now, this is so significant because we all know, at the current time, there are no medications that are effective for this population. And the numbers of people diagnosed with Alzheimer’s just are growing and growing as baby boomers like me are aging and are beginning to experience cognitive decline. So, what if we had a treatment that is accessible, that is affordable, and is doable with the help of a health coach? This is groundbreaking.

So, the study is really significant. And it is coming from the Institute for Systems Biology. This is Leroy Hood, and they have been doing marvelous work for many years. I got to meet some of the leaders through Dr. Jeffery Bland, his Personalized Lifestyle Medicine Institute, Nathan Price, who is someone who I’ve interviewed as well and followed the career of Leroy Hood, who is involved with this study. So, its title is a “A Remotely Coached Multimodal Lifestyle Intervention for Alzheimer’s Disease Ameliorates Functional and Cognitive Outcomes.” And it’s not published yet at the time of this recording, but it will be in the Journal of Alzheimer’s Disease. So, this is one you really want to make note of.

So, again, as we all know, there is no good treatment. The only thing we’ve had up to date is pharmacological treatments and managing the existing medical conditions accompanying Alzheimer’s not really effective. And so the authors say personalized multimodal therapies are needed to best prevent and treat Alzheimer’s disease. So, let’s look into this study.

It’s called the COCOA trial. Now, we’re not talking about giving these people chocolate. It stands for the Coaching for Cognition in Alzheimer’s trial. And it was a prospective randomized controlled trial, that’s the gold standard, peer reviewed randomized controlled trial to test the hypotheses that remotely coached, that means online, multimodal lifestyle intervention would improve early-stage Alzheimer’s disease.

So, who were these people? Well, they found participants. They were in early-stage Alzheimer’s disease, and they were randomized into two groups. So, that means the people, they didn’t know what they were getting, so there’s no possibility of this placebo effect. So, first, the control group got the usual standard of care. What might that be? Well, maybe it was medications, regular checkups, for example. But they were not getting lifestyle intervention, not working with a health coach, and they were using a telephonic personalized coaching sessions for multiple lifestyle interventions. And they were testing the hypotheses that the memory performance index would change over time, that it would be better in the intervention group than in the control group that was just getting treatment as usual. So what is this? The memory performance index is a standardized test of memory. It’s a computerized test. And you get a score on this test, and any change in the right direction would be very significant. So, this is a test that is easy, it’s quick to use, and it’s commonly used in research.

So, the personalized care, you might be wondering, “Well, what would that consist of?” Well, we’re talking dietary changes. They were giving them guidance on food choices as well as exercise and also cognitive training. The article that I have access to doesn’t get into the specifics. Again, this is pre-publication, but they did have some exercises that were testing or that were meant to challenge your memory and looking at playing these game, perhaps puzzles, and there’s a company called BrainHQ, which I actually personally have a membership, and I use those as sessions to test my memory and hopefully improve my memory. So, it could have been something like that. That’s a well-researched measure that is showing people that you can make gains in your memory. You get a score, and the more you practice, the better you get. And they’re looking at visual memory, and nonverbal memory, spatial orientation, lots of things go into it.

So what happened? Well, this is highly significant. Drum roll, please. The intervention arm ameliorated 2.1 MPI points, and this was statistically significant. So, what does this mean? Over two years, these people got better when they were tested on this memory performance index. And of course, because we know [inaudible 00:07:05] lifestyle intervention, there aren’t going to be adverse events most likely. And so sure enough, there were no adverse events or side effects. That is really huge when you think of the adverse reactions and side effects with medications.

So, what is the conclusion? Well, multimodal lifestyle interventions are effective for ameliorating cognitive decline and have a larger effect size than pharmacological interventions. Okay, that’s a quote, and I’m going to repeat it. Multimodal means they didn’t just focus on diet or exercise. It was a lot of things that they were emphasizing. So, it would be the lifestyle factors, nutrition, and exercise, probably stress. And because it was cognitive decline, they were also focusing on improving cognitive performance. So, cognitive exercises were thrown in as well. So, multimodal lifestyle interventions are effective for ameliorating cognitive decline and have a larger effect size than pharmacological interventions. They go on to say, and I’m quoting here, dietary changes and exercise are likely to be beneficial components of multimodal interventions in many individuals.

And here’s another thing to take into account. This was remote, and remote coaching is an effective intervention for early-stage Alzheimer’s disease. And of note here is that this was going on…they were doing this research during the pandemic. So, think about the stress that these people were undergoing as well during this period of time, and they were still able to make these very substantial gains.

So, I was just so excited to see this research because this is an area where coaches can be of such use to this population who are faced with this grim diagnosis and a very poor prognosis. And we have no pharmacological treatments that are effective at the present time, but this is something that is effective. So, I will be awaiting the publication of this research, and I hope that you will check it out as well in the Journal of Alzheimer’s. And this is something that you can specialize in if you… We have many people at FMCA who are specialists in this area, and let me tell you it is really rewarding work. So, it was a pleasure to see this study, and I look forward to its publication.

So, I’m going to go on to something else that I think is very significant. This is the power of health and wellness coaching. This is a comprehensive analysis. This is really very close to my heart because they’re asking, is health coaching effective for people with chronic illnesses? So, let me share a little detail about this study. It is called “The impact of health and wellness coaching on patient-important outcomes in chronic illness care: A systematic review and meta-analysis.”

Now, the difference here between this study and the previous one, the COCOA trial was an intervention trial. So, they had two groups, those who got the intervention, which was the lifestyle change, and those who just got standard of care. And they were comparing the differences between the two groups that the researchers were actively engaging. They were doing an intervention and studying it to see if it was statistically significant, if it had an impact. And, in the case, it did on the memory performance index. This is another type of study design. There’s no intervention. They’re just looking back over records to see, “Hmm, was health coaching effective in helping people with chronic illness?” It’s a commonly asked question. You are a health coach and you are interviewing for a job. You want to be armed with data that shows, “Yeah, this works. Health coaching is very effective,” which is why I am bringing this study to your attention.

So, this is looking at multiple databases. So, they went way, way back here. They started reviewing research back in 2005. Now, this was many years before the National Board for Health & Wellness Coaching, the very early days of coaching. So, there wasn’t a lot of research back then. And lately in the past couple of years, there’s been an explosion of research. Hardly a day goes by when I don’t see another study about coaching for all different types of chronic conditions. And many of those I will be highlighting on these solo podcast episodes.

So, they compared health coaching with the standard of care. Same old word, standard care. Well, what would that be? Regular office checkups, perhaps medication, but not lifestyle. And again, there were significant improvements. And this is what they were looking at. They were looking at improving quality of life, self-efficacy. What’s self-efficacy? Well, it’s a belief in your own ability to create changes and meet your goals. And then I also even looked at, get this, mental health conditions like depression and anxiety. And guess what? They found that health coaching does indeed make a remarkable difference. And just within three months, people were reporting a better quality of life. So, the quality of life, and it doesn’t say in the med report, but there is a standardized quality of life inventory, that’s a standardized test, and my hunch is that’s what they used because you can see data, but they may have been pulling records from other assessments, other studies as well, or it could be an aggregate result because it was just a general review of research.

So, in just three months, people were reporting better quality of life. In a little over a month, get this, they were reporting increased self-efficacy. And this is not surprising. Just about every research study that I come across where they’re looking at self-efficacy, they see an improvement time and time again. In our own research at FMCA, we found this as well. So, it’s one of the key variables that changes significantly. And it’s so significant because, in order to have a better quality of life, in order to get healthier, to make the kind of habit changes that are going to result in better physical and emotional health, you better believe that you have the ability to make these changes, that you can reach your goals because that’s where it all starts from, self-efficacy.

And then even on measures of depression, they were finding improvement 3, 6, and 12 months. And the conclusion was this is a long-term sustainable strategy. That is really significant because, as you probably know, we have a severe shortage of mental health professionals, and it is getting worse. And if somebody is struggling with anxiety or depression, it’s really hard to find a therapist to get counseling, to get those needs met. And health coaches, they’re not doing psychotherapy. They don’t make that diagnosis of depression or anxiety, for example, or administer treatment. They support people for emotional health. And as people are eating better, they’re moving throughout the day, they’re addressing stress, health coaches can help them with all of those things as well as validate that what they’re feeling might be normal. They’re asking questions like what’s strong with you, not what’s wrong with you, using positive psychology. That goes a long way in helping people with behavioral disorders. So, really significant improvements here.

Now, because this was just a review of research, it wasn’t an intervention, we don’t want to get too excited because they did note, of course, that some of the evidence was weak. Maybe it was a very small sample size. Maybe how they measured change wasn’t the gold standard like the randomized controlled trial, but it’s promising. And they concluded, of course, we need more research and we need to have perhaps more consistency across research sites so that we can be more confident in the results. But the conclusions are sure really eye opening and important to know that health coaching is effective. And although we do need, as I said, standardized reporting, longer follow-ups and studies, but HWC, that’s health and wellness coaching, improves quality of life, self-efficacy, and depression scores across chronic illness populations. So, really significant.

And finally, I’m going to share with you the main themes of a paper that came out. It was written by Dr. Ramona Wallace. She is someone that I got to know. She is from Western Michigan University’s medical school, and she is bringing functional medicine to the medical school curriculum. And the theme here is that I’m calling your doctor may not mention nutrition, but your health coach will. Why would I call it that? So, before we get into the details, let me just tell you the exact name of this report. It is “Embracing systems biology: a paradigm shift in modern medicine for identifying and treating nutritional deficiencies.”

So, I just realized this, as I looked at the title, we’ve come full circle, and it is very fitting that we are ending with this report because where we started was the groundbreaking COCOA trial that was from the Institute for Systems Biology. And here we have Dr. Wallace talking about embracing systems biology. Think functional medicine whenever you hear systems biology. That is the idea that you intervene in one area, and you’re going to see results in all the organ systems, that they’re all talking to one another. It’s a big matrix rather than what conventional approaches do, which is diagnose in a silo each organ system on its own and just find the treatment there as opposed to taking into account all of the interconnective pathways and all of these systems talking to one another and the importance of lifestyle change. At the end of the day, it is most likely the root cause of chronic illness.

This paper is published in the British Medical Journal of Nutrition, Prevention & Health. So, the bottom line here is that doctors often overlook nutrient deficiencies, and there’s several reasons for that. And despite the fact that they’re common and can cause a whole range of symptoms and be contributing to the development and the ongoing chronic illness, it’s very important to address nutritional deficiencies. However, in medical school, nutrition, to this day, is still not taught. I was with somebody who was affiliated with a very large medical hospital system in Chicago, and they have a medical school that is attached or affiliated. And they have tried to introduce some things regarding nutrition, and they even got some complaints from the medical students. Do we really need…? We have so much to learn that’s really important. And why are we getting this part of the curriculum? Of course, many are embracing it. So, this is coming. And I was at a program where there were people on the panel that were all advocating for more nutrition education in medical school curriculum.

So, coaches can educate on nutrition, and they can fill in the gap left by nutritional medical training because what doctors get in medical school is just a fraction of the whole curriculum. And so they’re ill-prepared. They don’t have the facts. It’s not on their radar, but there are also logistical reasons why they are not addressing this during a medical consult. First of all, they don’t have the time. They are often given very short amounts of time for each encounter. Seven minutes, 8 minutes, 10, 15 minutes might be a long visit. They’re often told you can only address one thing. They have so much paperwork with the EMR, the complexities. They have to make sure that everything is entered appropriately for party overviews often. So, they want to talk about it, but they don’t have time. And again, even if they had the time, they don’t feel confident. Maybe they have not had the background or training. So, this is very important that these are addressed.

I want to emphasize that health coaches are not dietitians or nutritionists, so they do not diagnose a nutrient deficiency. They would not run a lab test where you identify these nutrient deficiencies and advise people on the specifics for their individual medical condition. And it is highly personalized. But they can educate and they can increase awareness. They can help people to see, for example, that it could be they would ask questions of that individual, “Have you ever had your vitamin D levels checked?” And they could help them to see what is optimal, and then guide them in the right direction in terms of advising a nutritional consultation or helping them choose the right way to get that nutrient because that can be overwhelming. And most people get their nutrition education from the salesperson at a vitamin shop or to the vitamin section at the drug store or their local Whole Foods. And often they’re getting it from companies that cut corners. They’re using discounts. They’re getting it over Amazon and you just don’t know what might be adulterated. So, health coaches can provide all that great education.

And of course, these are preventive measures. You can catch a nutrition deficiency and then in the long run, that’s going to prevent a worsening chronic illness or developing in the first place. And then what does that mean? Well, you can be reducing healthcare costs as well and much better patient outcomes. So, this is something that should be on the radar of health coaches and helping the medical community out by saying, “We can take the load off. We can work in this area. We can help people work collaboratively with the nutrition professionals so that people can get these nutrient deficiencies addressed.”

For example, in this paper, she gives the example of a deficiency in vitamin D that can manifest as chronic pain, fatigue, or depression. These are common complaints that people go to the doctor about, and unfortunately, these doctors are not well-versed. It’s not on their radar, and so it’s probably not going to come up if they’re talking about depression. Most likely that person is going to leave with a prescription for an antidepressant.

So, what is the impactful quote here from Dr. Wallace? She says, as we move forward, let us remember that food is indeed medicine. And who’s better to guide you through this nutritional landscape than a health coach? Again, they don’t diagnose nutritional deficiencies. They don’t tell you what to eat, but they are going to be your guide, your educator, and they’re going to inspire you to create better health, because at the end of the day, it is all about taking control of your health.

Well, that’s it for another episode of “Health Coach Talk.” I hope that you found the studies that I commented on informative. And I just want you to know that we are moving forward in this health coaching profession at a lightning speed to see the studies, this groundbreaking trial, the COCOA trial, where they’re looking at…you can actually see the effectiveness of telephonic remote health coaching for Alzheimer’s disease and that they can look back at the research going many years back and see that this is very effective. So, this is just growing and will become more and more accessible to more people. So, it is a wonderful time to be a coach, to get into the profession. So, that’s it for now. Bye, everybody.