In my early years as a family practice doctor, it became clear that many of my patients struggled with health issues that had lifestyle as their root cause. Even for many that outwardly appeared healthy, I could see biomarkers resulting from their lifestyle that predicted health issues in future years. While many of my concerns were news to patients, this was old news to longevity researchers. We now know that over 85% of patients seeking help from a physician have a lifestyle health issue as the root cause of their failing health.
Before turning to lifestyle medicine, the dilemma I found myself confronted by was that I had an abundance of treatments that alleviated symptoms but very little to offer that could stop or reverse diseases. This realization led me to a medical specialty that placed more emphasis on the causes of disease.
Having an alternative to the traditional standard care was liberating. Supported by medical research, I could safely make recommendations that could have previously put me at odds with the standard of care offered by the traditional practice of medicine. While this may sound odd, imagine a heart surgeon deciding one day to try a knee replacement. Similarly, most primary care doctors also work within limits specified by the type of training they have been certified for. Although it limits the number of practitioners, it is a safeguard that assures patients that their doctor will stay within limits of what they are trained for and what their peers would find reasonable. The important point is that when a doctor is trained and issued a license, what they can and can’t do is pretty much defined by a standard of care required by the medical specialty they hold credentials in.
Given that lifestyle medicine is new to most patients and even most doctors in America, there are many questions I’m called on to answer. While I’m always glad that people ask questions, I know there are many more that have the same questions. In the event you have one of those many questions on your mind, I’ve collected a list of commonly asked questions along with answers that may provide what you’ve wondered about but didn’t ask.
How many doctors in Alabama have training in lifestyle medicine?
Primary care doctors that are dual board-certified in lifestyle medicine are still rare in Alabama. At last count (September 2019), there were ten doctors dual board-certified in lifestyle medicine in the state. Given that the specialty of lifestyle medicine is currently the fastest-growing medical specialty, you can expect more doctors with lifestyle training in future years. Given that states in the southeast have a far higher incidence of lifestyle diseases than most other states, it may take several decades before the supply of adequately trained lifestyle doctors meets the need.
How does a doctor become board certified in lifestyle medicine?
To assure that a doctor has a sound background in science and medicine, they must first be certified in a traditional medical specialty like family medicine, internal medicine, or cardiology. Only then can a doctor apply for and train in lifestyle medicine as a second board-certification. This two-step process assures that doctors practicing lifestyle medicine are first trained to understand and use traditional evidence-based medicine as appropriate. A similar approach to certifying doctors in lifestyle medicine has long been used in many other developed countries. In this regard, America is just now catching up with some of the best practices that have long been a part of medicine in countries like Germany, France, and Russia.
Why should I choose a doctor with training in lifestyle medicine?
Lifestyle medicine turns the traditional model of healthcare upside down. Rather than seeking a first line of therapy that addresses symptoms with pills and procedures, the goal is to find a lifestyle change that can address the root cause of the illness.
The traditional medical model is based on a patient-doctor relationship in which the patient presents a problem, and the doctor solves the problem with medicines or procedures. In essence, the patient often remains a passive part of the cure.
While lifestyle medicine frequently deals with chronic conditions, ideally it’s a practice of preventative medicine. Often the improvements offered are better than with traditional treatments. Depending on the patient’s needs and willingness to participate in their recovery, lifestyle medicine can be used alone or in conjunction with conventional therapies.
Is the lifestyle medicine approach worth the extra effort?
Think about it this way. Most people in America today will accumulate several lifestyle-related illnesses long before the usual retirement age. For myself, I would call that a bleak future. Imagine working a lifetime only to end up spending your retirement years with a diminished quality of life, budget-busting deductibles, and with your major event of the week being an appointment with one of your many medical specialists.
Diabetes is the poster child for what many will face without lifestyle changes. The average person with diabetes spends almost $14,000 per year on doctor’s appointments, medical equipment, and medication. Granted, some of that cost is usually paid by insurance coverage, the ‘invisible cost’ everyone pays. For more about this invisible cost, read the article, “Tragedy of the Commons.”
In addition to lost quality of life, there can be lost wages during periods of recovery. There is also the emotional cost from low energy, painful limbs, blurry vision, poor digestion, inflamed tissues, and more. These are cost that can be greatly minimized for most with lifestyle-related diseases like Type-2 diabetes. For those with Type-1 diabetes, lifestyle change still tops the list when it comes to improving quality of life. One fellow I particularly admire had the unfortunate experience of developing Type-1 diabetes in his early 20s. After changing to a plant-based whole food diet, he reduced his insulin requirements by 50%. Today, he functions with a better overall quality of life than most people that have never had diabetes. For those unable or unwilling to make lifestyle changes, I have many medications that can relieve symptoms, and in some cases, improve function. What I don’t have in my medical kit are long term solutions that match what is usually possible with lifestyle changes.
How long does it take to get results when using a blend of lifestyle medicine and traditional medicine?
For diseases that have not passed the point of no return, this can be a 2-3 year journey. Every person is different. Attitudes and habits learned over a lifetime can be challenging to change. The rate of progress varies. It’s not unusual for the journey to frequently take two steps forward and one step back. What I look for is progress, not perfection. For the most dedicated, I sometimes see positive results within 90 days.
Does lifestyle medicine work for everyone?
There are conditions that lifestyle medicine has no evidence for helping. For example, congenital heart conditions and some types of cancer do not respond. I have yet to encounter a patient that was a candidate for lifestyle intervention that did not see some improvement after following my advice. As a bonus, patients often begin reducing the use of medications they have taken for many years. It’s not unusual for some patients to discontinue all medications.
Does this program require eating a special diet?
I usually recommend a plant-based whole food diet. However, I recognize that diet is an individual matter and work within the constraints that a patient feels comfortable. My goal is to educate, support, and inspire you to follow a diet supported by research for longevity and quality of life.
What else distinguishes your practice?
For unexpected needs, I try to be available by phone just in case care is needed outside of office hours or while patients are on travel. The best part is that when patients have access to the best of both traditional and lifestyle medicine, good things begin to happen.
While my goal is to be available whenever a medical need arises, there are a few times when you may find yourself needing an emergency room or urgent care service. For suspected heart attacks, strokes or other sudden life-threatening situations, the emergency room at the hospital is the first place to go. When on vacation or temporary work assignments, you may have no alternative other than the use of an urgent care clinic. Regardless of the service you find yourself using, I need to know what is being prescribed. Often doctors seeing you for the first time will need information from me before recommending the best possible treatment.
Taking the time to understand a patient’s life constraints and further counsel about how to adopt a lifestyle change requires time. Understandably, this can rarely be addressed in the limited time most doctors are afforded for routine appointments. Solely advising a patient to follow a particular diet is rarely enough to initiate lasting change. It is essential that patients understand and internalize what caused their disease and why a lifestyle change may be their best prescription. Only then, is the patient empowered to change their habits.
In a recent survey of cardiologists, it was discovered that less than 3 minutes were spent discussing nutrition during an average patient appointment despite evidence that, for most, this would be the best medicine. Similar studies have shown that doctors in a hospital setting are similarly constrained by time. The result, of course, is that even the most motivated doctor will lack time for thorough patient counseling. Complicating matters, health insurance companies rarely reimburse for lifestyle counseling. It doesn’t help that popular TV shows dramatize passive medicine where the patient is miraculously transformed by popping a pill or use of an amazing high tech procedure.
While the subject of nutrition is a hotbed of misinformation, it’s hardly unique in that distinction. Stem cell therapy is another fad that of late has distracted many from taking an active part in their health. It’s an appealing thought. Get a simple low-risk injection, and you re healed. No argument, sometimes it seems to work. What more often produces positive results is the lifestyle counseling that accompanies the injection that includes diet, physical therapy, or an exercise program. Just know that few would be pleased to discover that spending between five and twenty thousand dollars not covered by insurance for a ‘miracle injection’ was, in reality, a rather expensive sideshow to the lifestyle changes that accompanied the injection.
While there is much I can offer by way of personal advice; most find the transition to a healthier lifestyle easier if they take upon themselves a little bibliotherapy. Almost any book or video by renowned experts like Dean Ornish, MD; Neal Barnard, MD; Joel Furman, MD, or Caldwell B. Esselstyn Jr, MD, will be educational and motivational. For more ideas, visit my blog at www.DocNeighbors.org and use the search option for more about books by one of the physicians previously mentioned.
There is hope for positive lifestyle change in America. Although still relatively small in numbers, doctors from the American College of Lifestyle Medicine, are having an impact. Their educational resources, classes, and mentoring opportunities for doctors are slowly working their way into medical school textbooks. With organizations like the American College of Lifestyle Medicine pushing for change, there is hope. For now, influencing public policy for change and reeducating a million doctors remains a formidable challenge.
Our wellbeing is inextricably connected to our lifestyle. To deny this or ignore it has health consequences. For now, corporate America largely controls what the public believes about nutrition through advertizing and contributions to political parties. This approach to influencing consumers isn’t the solution needed. To keep America great, the health of the country needs to be great. This change will have to begin by addressing the root causes of our deteriorating national health.
Perhaps you have other questions. Just send them along, and I’ll make sure they get answered.
Nancy Neighbors, MD
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