Lifestyle strategies and alternative medicine

When he returned to his native Colorado 20 years ago to treat people with multiple sclerosis, Allen C. Bowling, M.D. ’88, Ph.D. ’88, believed he was well prepared. After earning a medical degree and a doctorate in pharmacology at Yale, he completed his neurology residency at the University of California, San Francisco, and spent three years as a fellow at Harvard.

“I was thinking, ‘Wow! I have such a great toolbox for doing clinical practice at a high level.’ ” Before long, however, Bowling recognized gaps in his knowledge. “There’s so much I don’t know, so much I didn’t get, in more than a decade of training.”

This realization grew out of the nature of multiple sclerosis (MS): this disease of the central nervous system is incurable and unpredictable and causes a constellation of symptoms. Although his patients generally took conventional medications for MS, Bowling discovered that most were interested in how such lifestyle issues as diet and exercise affect the disease. More than half pursued strategies not dreamed of in the medical school curriculum: reflexology, removal of dental fillings, marijuana, magnets, pressurized oxygen, and prayer. However, at that time, there were not any reliable sources of MS-specific information in these areas.

“I realized that the quality of MS care could be improved by providing objective information about the safety and efficacy of these lifestyle and unconventional approaches to people with MS and also to health professionals.

“My patients were immersed in these therapies that clearly were important to them—whether there was evidence that they worked or not.” Even physicians and scientists who were patients used unconventional therapies and were interested in lifestyle approaches, said Bowling, who runs an MS practice affiliated with the Colorado Neurological Institute and is a clinical professor of neurology at the University of Colorado.

Bowling set out to evaluate these unconventional and lifestyle strategies. His approach is to critically review articles on a topic related to lifestyle or alternative medicine and distill them into a form that’ user-friendly for clinicians and people with MS, he said.

The result is Optimal Health with Multiple Sclerosis: A Guide to Integrating Life-style, Alternative, and Conventional Medicine. For each of the main manifestations of MS, the book briefly describes potential therapies and lifestyle modifications. Under “walking problems,” Bowling mentions the standard medications and then lists 10 other “possibly effective lifestyle and unconventional therapies,” including cooling, tai chi, and therapeutic horseback riding. Much of the book is given over to Bowling’ elaboration on 49 approaches from acupuncture to yoga. For each, Bowling discusses effectiveness, possible interactions with standard care, hazards, and side effects. He cites studies and recommends further reading. Lifestyle, alternative, and conventional medicine strategies are integrated into a seven-step approach that may be easily followed by patients and professionals.

“I encourage my patients to explore things and extract what’s helpful to them,” said Bowling. He has tried much of what his patients pursue, both to understand his patients’ experiences and for his own well-being.

For instance, he now eats a vegetarian diet on week-days and has worked to understand his psychological makeup, aided by “a few decades of free psychotherapy at home” thanks to his psychologist-wife, Diana S. Bowling, Ph.D.

Bowling provides information about lifestyle and unconventional therapies on his website, neurologycare.net/CAM