by Nicole Berardoni M.D., Tory McJunkin M.D., and Paul Lynch M.D.

The need for exercise and nutritional counseling has increased dramatically recently with the emerging evidence of effectiveness in treating many chronic conditions, both physical and emotional. Most people are not aware of the daily stressors that their bodies endure and therefore do not know how to eliminate certain stressors from their life. For example, caffeine found in coffee, soda, and energy drinks acts as a stimulant, causing an increase in heart rate, alertness, blood pressure, and possibly pain. However, when the caffeine wears off, there is a period of decreased energy. Also, people who drink caffeinated beverages tend to become mildly dehydrated because it increases the need to urinate by acting as a diuretic. Caffeine can also aggravate heart problems and anxiety disorders and should be avoided in patients with these conditions.

Nicotine is another commonly used substance that has negative effects, including increasing the heart rate and blood pressure, and stressing the body. Excessive sugar intake and overeating can also raise energy levels in the short term. This causes large amounts of insulin to be released, increasing the fat deposition and eventually causing low blood sugar and a decrease in energy.

Some of the common conditions that can benefit from exercise and nutritional counseling include:

  • Chronic pain
  • Diabetes
  • Kidney disease
  • Cardiovascular disease
  • Gastrointestinal disorders (irritable bowel syndrome, Crohn’s disease, ulcerative colitis, celiac sprue)
  • Hypertension
  • Hypercholesterolemia
  • Hypertriglyceridemia
  • Obesity (adult and pediatric)
  • Osteoarthritis
  • Depression


Obesity causes serious medical complications and impairs the quality of life in many people across the globe. In older people, obesity can exacerbate the age-related decline in physical function and leads to weakness and frailty. Obesity in the United States is an epidemic, and 45% of adults over the age of 60 are obese. Recent statistics reveal that only 13% of those over the age of 65 engage in vigorous physical activity three or more days a week. Physical activity has been shown to help prevent chronic disease and improve quality of life, yet few adults of any age exercise consistently (Rosenbloom 2006). The American Society for Nutrition and The Obesity Society reviewed the clinical issues related to obesity in older people in order to guide health professionals with weight-management guidelines for obese patients and reported that weight-loss therapy by diet and exercise improves physical function, quality of life, and the medical complications associated with obesity in older persons. Weight-loss therapy that minimizes muscle and bone loss is recommended for people who are obese and those who have functional impairments or medical disorders (Villareal 2005).

A recent study conducted in 2004 compared health outcomes in obese adults who underwent a 12-week exercise counseling program with or without dietary counseling. The results showed that exercise counseling for 12 weeks in obese adults improves some body fat composition, whereas the addition of dietary counseling increases improvements in body fat composition, lipid profiles, and several psychological parameters (Melanson 2004).

Cardiovascular Disease

Cardiovascular disease is a generalized term referring to many different diseases affecting the heart and vascular circulation, including myocardial infarction (heart attack), stroke, coronary artery disease, and hypertension (high blood pressure). With the increasing prevalence of cardiovascular disease, it has become the leading cause of death in the United States.

Cardiovascular disease is a process that typically occurs gradually and causes decreased flow of blood from the heart to your organs (brain, kidneys etc). The risk factors for the development of cardiovascular disease are high cholesterol, high triglycerides (fats), obesity, age, diabetes, and smoking. Except for age, many of the other major risk factors for this disease process are modifiable by diet and exercise. The American Heart Association published in July 2007 that they believe drinking more than one soft drink daily, regular or diet, may be associated with an increased risk of developing cardiovascular disease (Dhingra 2007). With the emerging evidence that cardiovascular disease can be prevented by a healthy diet and lifestyle, a prevention program in primary healthcare with a focus on physical activity and diet counseling are extremely important. With the proper nutritional and exercise counseling and close follow-up care, you can favorably influence several risk factors for cardiovascular diseases and your quality of life (Eriksson 2006).


Diabetes can be broken down into two main types: Type 1: insulin dependent and Type 2: non-insulin dependent diabetes mellitus. Over time, Type II DM patients may become insulin-dependent but are still labeled Type 2. Type 1 is seen most commonly in children and is due to a possible immunological cause, whereas Type 2 is caused by an acquired insulin resistance. Type 2 DM is frequently seen in obese patients and results when their bodies become resistant to their own insulin (hormone that controls your blood sugar). Patients with Type 2 DM must be educated about the types of foods that affect their blood sugars. By eating well-balanced foods in the correct amounts, you may be able to maintain your blood sugar levels close to normal and reduce the risk of the many detrimental consequences of diabetes.

Exercise is also extremely important in patients with diabetes. When a person exercises, their muscles use sugar for energy. With strenuous exercise, the body breaks down sugar for energy and blood sugar levels decrease. Exercise can also increase your sensitivity to insulin. The first-line treatment in patients with newly diagnosed diabetes Type 2 is diet, exercise, and weight loss because this may prevent the need for pharmacologic medication. When a person cannot control their blood sugar through diet and exercise, then medications are required. Diabetes is a severe risk factor for cardiovascular disease, peripheral neuropathy, kidney disease, and retinopathy (affecting the eyes), so strict blood sugar control is crucial for preventing these and other diabetes-related complications.

Postmenopausal Women

Women going through menopause experience emotional and well as physical changes. Some of the commonly reported occurrences in women going through menopause are weight gain, osteoporosis, hot flashes, and mood swings. In healthy women, weight gain and increased waist circumference during and after menopause can be prevented with long-term lifestyle dietary and physical activity interventions (Simkin 2003). Exercise, diet, and vitamin supplements are crucial in preventing the development of osteoporosis that is frequent in postmenopausal women. Exercise keeps the bones strong and diets rich in calcium and vitamin D help to provide the building blocks for your bones and may prevent fractures. A medical study in 2007 reported that not only does diet and exercise have a favorable impact on women’s body composition and physical condition, but it also improves health-related quality of life (Lemoine 2007).


Depression is a mental illness that affects many people of all different ages. Depression is thought to result from a chemical imbalance of serotonin within the brain. Serotonin is the chemical in the brain that controls a person’s mood and is frequently decreased in patients suffering from depression. Therefore, many of the therapies for depression aim at trying to raise serotonin levels in your brain. A vitamin supplement sometimes used in the treatment of depression is vitamin B6. This vitamin is eventually made into serotonin and therefore theoretically increases your serotonin level. Tryptophan is the chemical that vitamin B6 is broken down to before becoming serotonin. Tryptophan is naturally found in many foods and, by increasing consumption of these foods, you may indirectly increase the levels of serotonin produced. Nutritional counseling is very important in patients with depression because the types of food you eat may have a direct effect on your mood.

A regular exercise regimen should also be added to the treatment plan in patients with depression because it has been shown to increase the endorphins in your brain and increase self confidence.

A large survey among 173 physicians in 26 different departments, programs, and centers was conducted, and there was strong interest in offering several specific therapies for patient well-being. Among the physicians surveyed, 77% believed therapeutic exercise and 84% believed nutritional counseling were essential in patient care. Other parameters measured were expert consultation about herbs and dietary supplements (69%), massage (66%), pain management (84%), obesity/healthy lifestyle promotion (80%), and biofeedback (73%). Therefore, the survey concluded that there is strong interest among clinicians that comprehensive, integrated services for pain, obesity, diabetes, fitness, nutrition, and stress management should be involved in patient care (Kemper 2007).

At Arizona Pain, our goal is to relieve your pain and improve function to increase your quality of life.
Give us a call today at 480-563-6400.


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