Nature as Medicine:
An Evidence-Based Foundation for Healthcare Wellbeing

Transforming Healthcare Coaching Podcast — Episode 81: Nature as a Foundation for Health with The Doctor Outdoors. Host: Lillian Liang Emlet, MD MS CHSE CPC ELI-MP. Guest: Melissa Sundermann, DO, DipABLM, FACLM.

81. Nature as a Foundation for Health with The Doctor Outdoors Melissa Sundermann, DO, DipABLM, FACLM

Lillian Emlet: So I'm super excited for our guest today, Dr. Melissa Sunderman, who is Medical Director of Lifestyle Medicine at Corwell Health System. Founding chair of the American College of Lifestyle Medicine's Nature as Medicine Committee. Also chair of the Lifestyle Medicine Initiative at the Global Wellness Institute. for those of you runners out there about to run her 13th Boston Marathon this spring. And so thank you so much Dr. Sunderman for being here on our podcast today.

Melissa Sundermann, DO, DipABLM, FACLM: Thanks for inviting me for this conversation. I'm excited

Lillian Emlet: Yeah, and I think I also forgot to mention that you are the doctor outdoors.

Melissa Sundermann, DO, DipABLM, FACLM: Do

Lillian Emlet: Dr. If it's okay to start, tell us about your origin story.

Like when did the doctor outdoors begin?

Melissa Sundermann, DO, DipABLM, FACLM: A long time ago, I think I've, you know, I grew up, I'm 55 years young. I grew up in the seventies, so nature was my playground, right? This is what we did. We were pretty much kicked out of our houses and we just, I rode my banana. Bike, fantasy bike, Schwinn all around. We climbed trees. I had tree forts.

We'd dig for worms, catch fireflies, catch butterflies, and just really connected to nature. And then I just kept that up and really where I was able to find a. Voice to this was I became board certified in lifestyle medicine in 2019. Prior to that, I had done a faculty scholars program in integrative medicine at the University of Michigan way back in like 2007.

And then I did a, a professional training program, mind Body Medicine through the Center of Mind Body Medicine, outta DC like 2008. And so I was always interested in. Other modalities of healing and beyond pills and procedures that we were taught in medical school. And when I started asking myself the question of what are the ingredients to my own health and wellbeing, I really was able to say, wow.

It's the fact that I try to get outdoors each and every day someplace, any place. That's my little tagline that I always say, and I said, why this must have something to do with it. And I started digging into the research and uncovered all of this research that backed why I was feeling good. So in 2022, the American College of Lifestyle Medicine has an annual conference.

Our annual conference is coming up. It's a fabulous conference, always sells out about 2,500 attendees in person, and then another thousand or 2000 virtually. And I submitted an abstract proposal and I wanted to talk about nature's nurture and share some evidence, and it's very competitive to get a session accepted at the American College of Lifestyle Medicine.

I'm on the planning committee now. See how many proposals we get. They're all excellent, but I got accepted. When I got the agenda and saw, you know, where am I gonna be speaking? What time, what day? I saw I was on the big stage. I thought, oh my goodness, okay, pressure's on. And then I looked at who was speaking before me, and it was Dr.

Dean Ornish and Dr. T Colin Campbell. So some of the biggest luminaries in lifestyle medicine. I said, okay, well. I better show up and at least I'll have a packed audience 'cause everyone's coming to see them. So I got up on stage and I started talking about all this evidence and I always when I'm speaking to any audience and, and then particularly clinicians, I always start the, the talk by saying, who out in the audience raise of hands intentionally spends at least 20 to 30 minutes outside every day.

And I get some raise of hands and then I back it up with. Raise of hands if you're a clinician, forward facing to see clients or patients raise of hands who is prescribing nature. And usually just a few hands go up and I say, okay, I'm gonna go through this talk and I'm gonna come back to those same questions, and I'm hoping I'm gonna see all of your hands go up.

So then I went into my presentation and then afterwards. I had like a line of people like wanting to talk to me and ask more questions. And it was something that I had never experienced before and people kept reaching out and they had learned so much. They had no idea about these benefits. They had no idea about the evidence they were changing, the way they were engaging with nature.

They were changing the way that they were thinking about prescribing nature. So I said, let's get a group together and let's learn from each other and really promote this. So that's what was the impetus. To form the Natures Medicine Committee for the American College of Lifestyle Medicine. We meet once a month.

We've been going strong for about two and a half years. We have guest speakers from all over the world. I get attendees from all over the world that's a benefit of Zoom platform and it has been a complete blast. And as I was into this journey, a good friend of ours said, well, Melissa, duh, your, your DO degree stands for Doctor Outdoors.

And I'm like. You're absolutely right. How serendipitous is that? So no offense to any of my MD colleagues out there, but I think that Doctor Outdoors has a, a great, you know, reason for my do degree. So yeah, it's been fantastic. I, you know, get to work with people and speak to people and, and share this and hopefully empower people to just get outdoors each and every day.

Lillian Emlet: Below that somewhere, anywhere,

Melissa Sundermann, DO, DipABLM, FACLM: Yes.

Lillian Emlet: have the opportunity to do that. I think you really have been bringing to the forefront, things that I've also been seeing in terms of the using nature as like the mother of all coaching, right? So it's like the way to get to where you want to be because there's such great wisdom when we just get outside, when we start to move our bodies.

Melissa Sundermann, DO, DipABLM, FACLM: Yeah.

Lillian Emlet: And so I'm curious could you share a little bit about the evidence that you were saying, like a little bit, some of those things that you were talking about that you presented at the conference? So our audience gets

Melissa Sundermann, DO, DipABLM, FACLM: Yeah.

Lillian Emlet: a little bit today.

Melissa Sundermann, DO, DipABLM, FACLM: Absolutely. Well, I think some of the original studies were you know, back in the, in the 1980s and originated in Japan. And Dr. King Lee, who is one of the most prolific researchers, he is still publishing research and he really looked into the concept of Shinran Yoku and Shinran. Yoku translates to forest.

Bathing and he was really particularly interested in could nature reduce stress? And then we know that stress can inhibit immune function. And so he wondered if getting out into nature if that could actually. Benefit our immune system and boost our immune system. So his original studies were really looking at natural killer cell activity and we know that natural killer cell activity is involved in, you know, fighting off infections and inflammation.

And also, there's a inverse correlation with cancer incidents and natural killer cell activity. So what he did was he took people into the forest for two days and. They measure natural killer cell activity at baseline and then at day one and day two in the forest. And they saw this boost in natural killer cell activity.

So they said, well, maybe it's just that we're taking people away from their homes. They don't have to, you know, do chores and do homework and go to work. Maybe it's just this like relaxation state. So they took that same group and instead of going to a forest environment, they brought them into a urban environment, a big city, lots of big buildings and concrete, same thing.

Measure natural killer cell activity at baseline. Day one, day two. This time no boost, like flatline, no benefits. So they thought, okay, something truly is happening in the forest. And what's really neat is that they wanted to see what the halflife of this exposure is. And we talk about halflife in our medications.

And as a clinician, primary care physician, most of the medications I prescribed have to be taken every day. Sometimes twice a day, sometimes three times a day, like very few medications have a long half-life of once a week or once a month. Most of them have a very short half-life. So these subjects that went into the forest that they saw that natural killer cell activity, then they went back home.

They measure natural killer cell activity one week out and one month out. And even at one week and one month, they still saw an elevation from baseline of natural killer cell activity. So just going outside today can benefit your immune system for the entire month to come, which is amazing. So yeah, so those were some of the original studies and then they would take, larger studies where they'd go across, you know, several, forests and measure different outcomes or different biomarkers. So they the next big study was looking at salivary cortisol, so looking at stress hormone, looking at heart rate and blood pressure. And what they did in these subjects were, they had them, crossover. So they would go to the forest environment for a couple of days, then they would cross over and go to an urban environment, and urban then would go to forest. They measured the salivary cortisol, the blood pressure and heart rate. And they had them both do like gentle walking, so not like trail running but just gentle walking for 15 minutes.

And then they also had them just sit and just be in that environment for 15 minutes across salivary, cortisol, heart rate, and blood pressure. Like all of them decreased being in that forest environment. So there is something that's engaging that parasympathetic, that relaxation state and one of the mechanisms.

At, at least for the immune system is something called phytoncides So Phyton meets plant, and as a lifestyle medicine physician, I'm always talking about the benefits of phytonutrients. So plant nutrients and sidal means, sterilizing or antibacterial. So. Anything that is living in green. So our trees, our shrubs, our plants are emitting these organic volatile compounds called phytoncides And the reason why they produce these is to protect themselves from getting sick so that they can be vibrant and have lots of vitality. Well, the good news is when we are around these green, what we'll call green spaces. We actually inhale those fighting sides and they get into our own system and help to boo boost our own immune system.

So that is one of the mechanisms and that Dr. King Lee did a study. It was very small study. It was only 12 subjects, but it was really fascinating study. And each subject they're all in a hotel. Each subject had their own room and half of the rooms, so six of the rooms they rigged up. To vaporize phytoncides So basically they had hinoki cypress trees. They had essential oils from these trees being emitted into the hotel rooms. And then the other rooms were rigged to emit like o to nothing. And they measured natural killer selectivity at baseline. And then after three days of being in these hotel rooms and they saw that there was a 20% increase in natural killer cell activity.

In the rooms of the people who were inhaling those fight inside and they also reported feeling more refreshed and and less fatigued. So the take home point there is to try to get around green spaces and also if you can't get outdoors or you don't have like green spaces near you, get house plants in like, you know, balconies if you live in a big city and you can get some plants on those balconies, but even inside your house of just being surrounded by plants and then you can get those benefits of those phytoncides

Lillian Emlet: This morning I just went to a local coffee shop that it's, it sells lots of plants and it has tons of plants, all of them for sale. And so now you just made me another excuse to go to my favorite coffee shop a

Melissa Sundermann, DO, DipABLM, FACLM: Absolutely.

Lillian Emlet: And it

Melissa Sundermann, DO, DipABLM, FACLM: Yeah.

makes

Lillian Emlet: me feel very sad that I'm a very bad plant mom. I am really hard on my plants.

And now I it's interesting to see the both the benefits, right? There's a biological biochemical reason and also, potentially a mental health kind of reason too, to be out and about in nature. So that, that's really an amazing review of the evidence.

Melissa Sundermann, DO, DipABLM, FACLM: Yeah. Yeah.

Lillian Emlet: I'm curious then, know, especially for the urban people, it's really hard to get out. I think now, I think the reality is the best gift you can give someone is to give a plant as many plants as possible. Indoors is probably why I would say. Is that a correct conclusion?

Melissa Sundermann, DO, DipABLM, FACLM: Absolutely. And then there's also studies really looking at big cities and urban planning and a big initiative and push to, to plant more trees. And Barcelona right now has a. Huge initiative through 2030 to plant like thousands of trees all around Barcelona. Just to get treeline streets that can help to bring down the temperature in these big cities.

Also helps with air pollution. Because of the carbon dioxide sequestration, we know that there is an increased risk of strokes associated with air pollution. So when people have closer proximity to treeline streets closer proximity to parks and green spaces, we actually see a lowering in the, in the rate of strokes.

About 19% lower. Also in this country, in Louisville, they have a project called Greenheart Louisville. And what they did was they went into like inner city and they decided to plant several hundred trees in sort of the study area. That's the only thing that changed. Like they just planted trees.

They followed the people who lived kind of at closest proximity to those trees and then further out, these patients did not, or these sub subjects did not start eating healthier. They did not start exercising. They did not start meditating. They didn't start tracking their sleep. All that happened were trees were planted and.

One of the biomarkers that they tracked was C reactive protein and C reactive protein. For some of your listeners who maybe aren't clinicians, is a very sensitive marker of inflammation. Now, it's not specific, doesn't tell you where it's coming from, but it means that there's inflammation in your body.

So that could be, yeah, you've got like an achy joint, but it also could be systemic inflammation. That could be insulin resistance, coronary artery disease, obesity, chronic kidney disease, autoimmune diseases. The subjects that lived in closest proximity to those trees being planted had a 19% lower C reactive protein than people who were on the outskirts and not with those trees.

So just by planting trees. So so if you live in a big city and you can even just go on treeline streets. And then I'm always talking about in big cities of finding local parks. So obviously in New York City we've got Central Park and Boston, the, the Boston Garden and the Boston Common. But definitely getting, you know, plants into your living space or in your balcony.

And then the research that we have that just listening to nature. So maybe you live in a the air quality is poor or you don't live in a safe area or you have a disability and you can't get out. Maybe you could, you could open your windows and listen to. Hopefully more Bird song. There's actually a study that looked at sound bites, six minute sound bites of either listening to birds song or listening to loud traffic sounds and listening to Bird song actually lowered feelings of anxiety and paranoia, whereas listening to those loud, honking and people yelling and sirens actually worsen feelings of depression.

So if you've got like. YouTube or you know, put on your earphones. Just listening to nature sounds could help with mental health and wellbeing too.

Lillian Emlet: Wow, this has been an incredible amount of evidence you've just shared with us. And it's also pretty incredible just the whole being, living near a park, just even just

Melissa Sundermann, DO, DipABLM, FACLM: Yeah.

Lillian Emlet: With no other change. They did nothing different. That's actually pretty incredible. You make me wanna go out and buy a tree right now.

It's. So I guess the hard thing I can easily see now the pushback for some of, I, I work in critical care, so that's those are 12 hour shifts for most of the people who work there. So if you're a hospitalist or a critical care or a hospital based specialty, you're often working 12 hour days.

You're exhausted when you come home with a one hour commute on either side. Do you have any ideas for how you can make little prescriptions for busy clinicians?

Melissa Sundermann, DO, DipABLM, FACLM: Yeah, well I live in Ann Arbor, Michigan, and I at one time worked for the University of Michigan. I don't anymore. However an example of what health systems can do and are starting to do is University of Michigan has three of what they call recharge rooms. And these are exclusively for staff, so for nursing staff, for residents, for medical, staff, and.

You go into these rooms and the company that set this up is called Studio elsewhere and they create these rooms in healthcare facilities and healing buildings, and it's virtual reality nature. So it's a huge wall and you can select, I think there was eight different. Sites you could go visit. So you were either on a mountaintop, you were either at a beach, you were looking across a field of flowers, and then there's music that goes along with it.

And these rooms they have like comfortable chairs and blankets and they can't have real candles. So they have those sort of vol of electric candles. But just a really serene setting. And so when I've gone to visit these, it's been incredible and I've stayed long enough to see some staff members come in and during their break, you know, as a hospitalist, I, I was a hospitalist before I remember those days, but perhaps you have, like, you've finished, you know, morning rounds and you got a little bit of time maybe grabbing a cup of tea and going into something like these recharge rooms and just really.

Being able to deactivate the amygdala. We have you know, studies to show that, getting into that parasympathetic. Another thing is like, sometimes we have courtyards, right, of just having nature within a healthcare system of a courtyard. That if it's not raining or snowing or super cold, that you can just go outside, be within close proximity of your beepers, still working, of even like a labyrinth that you can just get some some movement.

One of the hospitals during COVID, when I was redeployed, actually had wonderful trails right around the hospital again, that I was within beeper notice and could just, you know, pop outside for even, you know, 10 or 15 minutes just to move my body, get some fresh air. Those shifts are really long, really stressful, and just to, to, you know, get that cognition.

And we have studies that being out in nature and moving our bodies in nature. Doing cognitive tests, like they've done studies where they do the Stroop test. And the stroop test is where like a word will be written in a color, a different color, but then you have to like, it tries to mess with different areas of your brain and actually people after taking a walk in nature perform better on that and more other studies that hooked up mobile EEGs and looked at brain patterns and brainwaves and, and improvement after taking a walk.

So just integrating and the importance of when we design healthcare systems or redesign them. Of trying to integrate nature. And then, one of the hospitals that I was at during COVID, they, it was a courtyard, but it was an indoor courtyard, but still it was like super high ceilings. It felt just very airy.

They had birdsong going on and nature songs and they had some fountains and you would just go in there and just, you'd be able to take a deep breath, right? And just even for a couple minutes, just be able to, to recharge.

Lillian Emlet: Yes. Those are really wonderful tips. I often tell my the clients that I work with, that, even though you think you're blocked for that 12 hour shifts inside that 12 hour shift, there are micro moments and that's five or 10 minutes that you have to intentionally go out and find it.

Melissa Sundermann, DO, DipABLM, FACLM: Yeah.

Lillian Emlet: now you've actually, I've not been to our restore room, even though they built it for us. I now need to go check out to see they have, if they have this wall, because

Melissa Sundermann, DO, DipABLM, FACLM: Yeah.

Lillian Emlet: have the chairs, but I

Melissa Sundermann, DO, DipABLM, FACLM: Okay.

Lillian Emlet: have the wall now.

Melissa Sundermann, DO, DipABLM, FACLM: Well, if they don't, you bring that up. So studio elsewhere. And another person who's doing amazing work is, his name is Louis Schwartzberg and he is a cinematographer producer. There's, there was a really popular Netflix docuseries or documentary that came out called Fantastic Fungi.

It was all about mushrooms. Totally fascinating. He was the cinematographer for that, but he also does something called Time Lapse Nature photography. It's incredible. So he's been working with healthcare systems and has been integrating some of his work, in there. So like Andrew Weil, who is really the, Luminary of, of integrative medicine. He has done some work with integrating some of his time-lapse photography and cinematography into those clinics just so that when people are in waiting rooms or they're getting treatments that they are just surrounded by nature and, and the serenity of that.

Lillian Emlet: Yeah, so you're really pointing out the, A work environment is not so much, even just the things that we do or the computers that we work with was really just even the architectural design and how we think about how we move through the space being really important. And so it is exciting times for. Are many people who are involved in the hospital and healthcare design to integrate all of these things,

Melissa Sundermann, DO, DipABLM, FACLM: Yeah. And one simple thing, one of I had one of my guest speakers at the, our Nature as Medicine Committee two months ago. Ian Siderits and he's a professor, I can't remember which university. And so he was like. Let's look at the healthcare system of how we can integrate nature. And he's like, let's look at scrubs.

So we had all of these different scrubs and he's like, what if we had scrubs that had flowers, that had trees, that had butterflies? You know, instead of like, we all have those scrubs that are just the, that pale green, right? Just boring. So what could we do just to get people thinking about nature and connecting with nature and, and maybe just changing our scrubs.

Could be be one small step that we could do.

Lillian Emlet: Yeah. No, that's wonderful. I always, it's like the only room that gets to have those nice things are the pediatric rooms,

Melissa Sundermann, DO, DipABLM, FACLM: Right,

Lillian Emlet: MRI, the.

Melissa Sundermann, DO, DipABLM, FACLM: right.

Lillian Emlet: they get the ocean, they get like some other part of the world. But the rest of us we're stuck in concrete and boring paint, but. So I guess it leads naturally into the next, question of there's so many chief wellness officers now, and many healthcare, big healthcare systems, and they have a huge, initiatives to try to figure out what is the most bang for your buck to help as many people. And it's very challenging as a chief wellness officer.

And you yourself also have led larger size programs with both many larger organizations. I guess what kind of simple starter suggestions in terms of like relatively low cost or maybe even high cost, but worth of investment? What would be a playbook for our chief wellness officers listening?

Melissa Sundermann, DO, DipABLM, FACLM: So I'm gonna. So I wear my hat as Dr. Outdoors, but I also wear my hat as medical director for lifestyle medicine for a large healthcare system. Actually, the Corwell Health is the largest healthcare system in the state of Michigan. We have about 66,000 employees, 23 hospitals, and what we would love to see for.

Employee health is access to our lifestyle medicine service offerings. So, so that this is a covered benefit because we know that 80 to 90% of chronic diseases are actually lifestyle driven. So food is medicine, sleep as medicine, movement, connection. And I'm gonna put that connection pillar with connection to self, that sense of purpose, connection to community and connection to environment nature.

Talking about street sleep and stress management. So. I would love to see more of a shift to you know, really if we have lifestyle medicine programs in your healthcare system, that this would be a covered benefit for you know, all of our employees as, as a first step. Second step is just, I think, realizing there's so many people when I give these talks.

Wherever I am, and I spoke to Kaiser Permanente they had a wonderful lifestyle medicine two day symposium, and so this was just two internal Kaiser physicians and there were people who were aware or interested in lifestyle medicine and even within that group, very, very few people were aware of. This, the evidence and how to prescribe nature.

So I would love to see more education to our clinicians because this can cause a ripple effect. Like I think that once we start doing it ourself, we're more apt to prescribe it. We already have studies that show that clinicians. When they exercise, they're more likely to prescribe exercise. So my goal is to really educate our clinicians about the benefits, get them utilizing this themselves, and then they're more apt to prescribe that.

So I think education these opportunities for our own employees and staff, and then. Making this easy. Because as busy clinicians, all we can think of is, you want me to do one more thing? Like seriously, like I am already so full plate, like there's so much going on. We have a, a real issue with physician and clinician burnout.

So we don't want this to feel like another lift. So what I've found within lifestyle medicine is. What's rewarding is that I actually feel like I'm helping my patients, right? I'm actually seeing not only disease reversal, disease treatment, but sorry, not only disease prevention, disease treatment, but also disease reversal.

And so the easiest way to do that is to embed things into EMRs and electronic health records. We are on Epic platform. We're starting to see nature being. Integrated into that and nature prescribing. There's Park Rx America, Dr. Robert Czar and Dr. Stacy St. Dryer who had this up. I just got to spend the weekend with Dr.

Stacy St. Dryer and it's really, you sign up as a clinician and it's like any regular prescription. And what's really neat about it is wherever you are, I'm an Ann Arbor, I could. Pull up where my patient lives and then it populates with parks and areas around that area. And I can prescribe it just like any other prescription, and I can be very create a smart goal.

So we know that smart goals specific, measurable, attainable, relevant, time bound are really what drives behavior change. So I can say, you know. Tuesdays and Thursdays you'll go to Huron Meadows Metro Park and walk for 30 minutes. And then they get email reminders, they get text reminders. So really treating this like a prescription.

So I think embedding some of these prescriptions to make it easy, give us tools so it doesn't feel as much as a lift as it feels like, Hey, I'm actually. Giving something actionable that can, can make a huge difference in our patients', lives. And, so I think getting leadership on board is huge, right?

So getting our leaders to believe in this and practice it themselves then they're going to be more apt to support it. And, and I'm really fortunate in Corwell Health. We have a wonderful CEO who believes and knows the power of lifestyle medicine, and that's made our work that much better and be able to, you know, elevate that and become one of the top healthcare systems for lifestyle medicine.

Lillian Emlet: Yeah. I think what's really amazing also too about having integration, like you're saying that e every specialty can benefit. From lifestyle medicine, and especially from the healthcare professional's perspective like that, we should have access and know that as that's a benefit that you sh like you, you're gonna be employee here.

We're a healthy workforce and we will slowly change the culture where we just normalize talking about these types of things. No matter, with your groups your peer groups, right? Because a lot of is peer support. If you don't wanna be the one odd person who doesn't get, doesn't do the plant forward and doesn't. Really talk about your mental health and wellbeing and doesn't think about moving and Hey, why don't we all just go take a walk, like on rounds, right? Like you can do it as a group, even if you wanted

Melissa Sundermann, DO, DipABLM, FACLM: Absolutely. Yeah. If you normalize it as a culture, like when I'm in clinic, I do both virtual and in person. Our front desk, our patient service representative, and one of our health coaches, like as soon as there's a break in between patients, they do, they're like, ready for our lapse. Yep. Ready for our lapse and.

It's just what we do. It's like, Hey, that's good for you. It's, you're gonna be going to show up and be nicer to the, the patients coming in because you're gonna be your best self. And it develops camaraderie and a lot of times when we're just taking a walk like, you're, you're, you know, I'm just less stressed and you'll just talk about, and I think just even getting to know each other outside of the office or outside of the hospital rounds is, is really beneficial.

Lillian Emlet: And so really having that exposure, because you're right, I think it's surprising to me that 20 plus years into the creation of lifestyle medicine with its own boards and organization, that's still even, for the last couple years we've incorporated into our wellbeing curriculum at least a lecture just to explain what it is. That's still, it's the penetration still not the, not there yet in terms of coming from primary residency into fellowship. That's 'cause I, trained fellows, it's still not a hundred percent across all primary residencies, which is surprising to me because there are so many things that you can prescribe, especially for, emergency medicine, discharge, clinic discharge, those EMRs it's just, if you have a pull down menu of things you could.

Melissa Sundermann, DO, DipABLM, FACLM: Yeah.

Lillian Emlet: like you're

Melissa Sundermann, DO, DipABLM, FACLM: Yeah. And

Lillian Emlet: all and

Melissa Sundermann, DO, DipABLM, FACLM: right.

Lillian Emlet: about them, you could still prescribe them.

Melissa Sundermann, DO, DipABLM, FACLM: Absolutely. And I think that coming from traditional primary care for 25 years, you know, our in primary care we're productivity is, is where we make our money. Is how many, you know, rvu and how much, how many patients you can see? Well, if you've got 15 to 20 minutes per patient, like there's no way that you can take a deep dive into nutrition, exercise, sleep.

And to be perfectly honest, like I thought. I, I, I counsel my patients in this. And it wasn't until I studied for my lifestyle medicine boards, I was like, I thought I was doing, you know, lifestyle counseling by saying, eat a Mediterranean diet and exercise, you know? And that's all I really had time for. And really, that's the depth of my knowledge.

So to now. Really focus on just behavior change. And I am just a cog on the wheel. Like as a physician, I could not be successful. Our program could not be successful without utilizing. We have nutritionists that are trained are board CER certified by the by ACLM American College of Lifestyle Medicine.

Health coaches. Health coaches. Health coaches are really behavior change because so often individuals, including myself, know what I should be doing. I know why I should do it. It's the how, right? It's how do you create behavior change. And so health coaches serve as educators, accountability partners and cheerleaders, and really great.

And then we leverage shared medical appointments. So this is covered by insurance, where we can bring people either virtually or in person. In groups and we have different topic areas for our shared medical appointments. We have a robust teaching kitchen that has seven teaching stations, televisions, everything like that.

So we've got a cooking for health shared medical appointment where they get 45 minutes of didactic, maybe it's like cooking with natural sweeteners or healthy fats. And then they actually learn how to cook. They try new recipes. They get recipe cards, they eat together. We have a fasting for health where we take people through fasting, mimicking, you know, dietary, ProLon is what we use.

So we've got different topics, and again, developing community, making this accessible because we can build through insurances. So really trying to you know, implement sustainable lifestyle changes, right? Not just quick fixes, not things that feel restrictive. We're just really trying to, not only prolong lifespan, but more importantly, healthspan and WellSpan.

Lillian Emlet: I love that. And if hospitals treated nature as a core wellbeing what do you think could change? Are there things about the. Schedules or the environment. Are there things that you would track as an intermediary measure for if, if we could, okay. Let's say there's someone out there listening that's yes, I got this.

We should do this. I can do this tomorrow with my EMR. We're gonna prescribe nature for our patients and our clinicians. What are the intermediary things that they should be looking for to see any kind of improvement? 'cause you're not gonna go into their NK killer cells.

Melissa Sundermann, DO, DipABLM, FACLM: Yeah, right. Probably not. Well, even like I am talking about you know, when I'm going through the pillars of lifestyle medicine and trying to get outdoors, we talk about moving our bodies outdoors. So I've got. So many patients that you know, we talked about, okay, you have a dog, let's take the dog for a walk.

Let's just get outdoors and do you have kids that you can go, you know, walking with or your kids are in sports practice? Can you take loops around the soccer field? And so, you know, one thing, I mean. Thing that everyone wants to see is, is BMI if, if it you have, if someone has an elevated BMI, if we start getting people out into, to nature, moving their bodies, and I'm always talking about just so many ways to move our bodies outdoors, whether that's walking, jogging, bird watching playing pickle ball, going for a swim, riding our bike.

Gardening, just being outdoors and gardening. So just making this inclusive and a really wide array of things that you can do and, and finding groups to be able to do this with because community is so important. So VMI is an obvious one because it's checked on everyone as part of a biometric.

I think that we see also with GAD and PQS of a mental health wellbeing of just we've got studies of. Early morning sunlight exposure. So that means like getting outside before nine or 10:00 AM without wearing any glasses. Not you don't have to look up to the sun, but you're just getting those infrared light rays into your retina, into that super chiasma nucleus into the pineal gland that translates to elevated serotonin levels and alignment of our circadian rhythms.

So just some of these. Small shifts and changes, I believe can really, you know, slowly over time, optimize several of our, our biometrics. And then I think if you're offering these programs and building a culture where we. We really care about our staff and, our employees and our patients. So we have courtyards, we have, you know, signage that says, you know, this trail around, you know, the hospital if is this many steps or, you know, this many miles or blue spaces.

I never wanna forget about blue spaces. And so ponds and you know, just fountains and things like that. I think that you would. See better retainment recruitment you know, productivity, less absenteeism. So those ROIs that the, the bean counters like to see, like they wanna, you know, see that biometrics are growing down.

But also in terms of ROI as an employer how we're, we're cost savings. And actually there was, maybe I can find it if you have show notes. In Becker's Healthcare, a couple months ago, they actually did translate ROI with hospital systems that really integrated nature into that. And they did see those, those ROIs of recruitment retainment better productivity, less absenteeism.

So they were able to, to put that into, to numbers.

Lillian Emlet: Let's say absenteeism is huge in

Melissa Sundermann, DO, DipABLM, FACLM: Yes.

Lillian Emlet: of just, having 'cause I think that's half the stressor, right? In terms of people showing, not showing up or having to get pulled. And, nurses especially are always affected by that. And just having a place where they know that they have. where you can decompress in the middle of a shift really makes a huge difference. And as part of, I think why COVID was so stressful in the ICU is that we didn't have a place to go and many of these centers and many of these rooms were built after with the pandemic. And in some ways I think there was a heightened reality and heightened speed to be able to help healthcare professionals after the pandemic.

And now the good thing is that we have so much data and literature like you're suggesting to support that is this is worth investing

Melissa Sundermann, DO, DipABLM, FACLM: Absolutely. And this is not healthcare related, but I was so tickled by this. So both of my kids now live in Denver and recently I was coming back from seeing them and my flight kept getting delayed and delayed and delayed. And I was like, oh, this, you're just trapped, right? You're just trapped. Denver Airport, one of their terminals is brand new at the end of the terminal, they have an outside space.

'cause like usually you can go outside, but once you get through security, I feel like I'm trapped, right? I'm trapped.

And beautiful like comfy chairs. And of course, I mean in Denver is great 'cause I could actually see the mountains off in the background. But I thought this, I am not no longer feeling angry that I am delayed.

I got my book, I was out in nature, I had fresh air, I had the sunlight on my face. So that was game changing for me to have an airport that really had a space for nature.

Lillian Emlet: Oh my goodness. Now I have to go fly through Denver.

Melissa Sundermann, DO, DipABLM, FACLM: Exactly.

Lillian Emlet: So I guess that sort of wraps up, in terms of the, you have given us a whirlwind of lots of things to think about, and especially for the wellbeing side of things. How in our own groups and practices will you take this back home?

And it's pretty clear that getting out and moving every single day and seeing natural sunlight and being with nature related, plants animals sounds, is really important to grounding ourselves both from a mental health perspective, but more importantly also from a biological perspective. So thank you so much for all of the things you've shared with us today.

Melissa Sundermann, DO, DipABLM, FACLM: Well, thanks for the opportunity to share.

Lillian Emlet: Yeah. And so I guess I'm our fun last question is, what are you reading and listening to right now? Or what kind of new adventure do you have coming up?

Melissa Sundermann, DO, DipABLM, FACLM: Well, new adventure. I actually I'm heading to Chicago this weekend to speak at a big conference. It's ACRM American College of Rehabilitation Medicine. And. I'm going there because they are actually integrating one day, a pre-conference day of lifestyle medicine. So I'm on a panel with three other lifestyle medicine clinicians.

We'll be talking about food as medicine. So this is a bunch of pm and r, physical medicine and rehabilitation, clinicians. So. It's starting to get into all of these specialties, which is really exciting. And then from there, I'm flying to Geneva, Switzerland, and I'm speaking at the Global Longevity Summit.

It's the first year they're having this. And, lots of really, really smart people speaking and researchers. And they asked me to speak on nutrition, fasting and metabolism for longevity. And I'm gonna be putting on my clinician's hat since I don't really do research other than collecting data for outcomes.

And I'll be talking about how we are able to implement lifestyle medicine on the ground to population health and the outcomes that we're having. And then as far as what I'm reading, well, you know, I'm reading my, my new book,

Lillian Emlet: You go.

Melissa Sundermann, DO, DipABLM, FACLM: Outdoors Guide to Nature and Lifestyle Medicine but also the other book that I've been reading and I've heard him, on podcast, it's Eric Topel who wrote Super Ages, and I really love his approach because longevity medicine is a growing field and there's lots of fancy shiny objects out there in longevity. Coming from lifestyle medicine clinician and, and doctor outdoors, I feel like. Get the low hanging fruit, right, which shift about 90% of our, our health, wellbeing and longevity.

And that's nature, food movement, sleep connection. And Eric Topol is a brilliant, brilliant research scientist and physician, and I think he's a physician. Yeah, he's a physician. And he, he really ascribes to all of that too. And so he's great. I've learned a lot from him and his book is fantastic.

So yeah. So that's what I'm up to.

Lillian Emlet: That's wonderful. I I'll have to go out and get that. I watch, I read his substack and it's it's really that's a great, that's a great thing. And so yes, for all of you listening, we'll put all of the different links in our show notes below, and we'll also put a link for how you can get Dr. Sundermann's book on prescribing nature specifically. And I agree with you, it's the most beautiful thing we have around the planet, and it's not costly. And if you just go out and go find it you'd be surprised like what is actually near you and, or you can just nurture a plant in your own house as a way at least to get closer towards nature.

Melissa Sundermann, DO, DipABLM, FACLM: Absolute.

Lillian Emlet: and so we're really excited too also to announce the fact that Melissa, along with many other guests that we have will be a part of a virtual summit in December called MedThriving We're trying to bring together lifestyle medicine, nutrition, and people here at Transforming Healthcare Coaching to bring you things that will help the foundation of wellbeing for healthcare professionals. I can tell you coaching with leadership and wellbeing all of our clients that.

Melissa Sundermann, DO, DipABLM, FACLM: step

Lillian Emlet: number one is first, making sure your house is in order. Oftentimes, when people come to us because they're stressed about. I dunno, whatever problem they have at work. The reality is underneath that is that their own house is on shaky ground.

They're not sleeping well, that there's a lot of other things going on with their family. And that you need to really make sure that all the pillars of lifestyle medicine are well in order to be able to execute for your team and your organizations. And so we are bringing on medthriving Feel free to gift it to a friend or a colleague and or. Think about purchasing a ticket for yourself. Tickets will only start at $20. So we feel like this is in a really affordable way just to get a bunch of information. Dr. Sundermann is one of our speakers, and so we're looking forward and there's a couple other speakers who I'm not gonna tell you all the others.

Yes, you have to go check out our website and see who else is speaking. So

Melissa Sundermann, DO, DipABLM, FACLM: I'm excited for this. Is gonna be great.

Lillian Emlet: Yeah. thank you everyone for listening, and feel free to reach out to us at podcast@transforminghealthcarecoaching.com for any questions you might have or advice on what else we should talk about next time. We'll see you then.