April 2016 - Non-Medicated Life
A call to
By Paul E. Lemanski, MD, MS, FACP
Editor’s Note: This is the 70th in a series on optimal diet and lifestyle to help prevent and treat disease. Any planned change in diet, exercise or treatment should be discussed with and approved by your personal physician before implementation. The help of a registered dietitian in the implementation of dietary changes is strongly recommended.
Medicines are a mainstay of American life and the healthcare system not only because they are perceived to work by the individual taking them, but also because their benefit may be shown by the objective assessment of scientific study. Clinical research trials have shown that some of the medicines of Western science may reduce the risk of heart attacks, strokes and cardiovascular death while others may reduce certain types of cancer.
In the first 69 installments of the Non-Medicated Life, informed diet and lifestyle have been shown to accomplish naturally for the majority of individuals, many, if not most of the benefits of medications in the prevention and treatment of chronic medical conditions. When implemented by an individual, informed diet and lifestyle as a medical intervention may accomplish such benefits at lower risk for side effects, may reduce the number and amount of medications, and result in a more naturally arrived at robust health.
When implemented by a population, however, especially when maintained for several years, such an approach can transform healthcare. A healthier population costs less to care for, has fewer heart attacks and strokes, requires less medication use, and has a smaller proportion of the population requiring nursing home placement and long term care due to frailty and dementia. While a more affordable healthcare may result, the major benefit for the health of the individual and the population is the paradigm shift in perspective that would be engendered.
We could move from the current state of dependency – in which we look to others to keep us healthy in spite of our own unhealthy habits – to a state of personal responsibility and empowerment. We would understand how it is both possible and necessary to keep ourselves healthy through our own efforts and then decide to practice this approach daily in the way we live our lives. We also would better understand that dollars alone do not assure health.
A case in point is diabetes prevention. It turns out that a drug called metformin, when given to a person at risk for diabetes, can reduce new diabetes cases by 30%. However, for those at risk for diabetes who are overweight or obese, a lifestyle change resulting in weight loss of 10 to 20 pounds has been shown in a clinical trial to decrease new cases by 57%! Literally, how we choose to live our lives can prevent diabetes and prevent the increase in heart attacks, strokes, kidney failure, and blindness that can result.
But urgent action is needed. Without a change in lifestyle, each year 11% of the 85 million individuals at risk for diabetes will become diabetic. Indeed, the federal government, realizing the power of lifestyle change to reduce new cases and lower the cost of healthcare, recently announced expanding Medicare to cover lifestyle programs to prevent diabetes.
But can such a lifestyle approach work outside of a clinical trial? Let’s look to a model that already exists – one in which people are healthy on the basis of lifestyle rather than the number of medications they take, or the number of surgical procedures they have undergone, or the number of dollars spent on their healthcare.
The people of Okinawa Island, Japan offer such a model. Okinawa has a greater proportion of people who reach 100 years old than any other country in the world. Moreover, these people, by and large, reach old age not in nursing homes but as active members of society. As a population Okinawans exercise daily, eat a predominately plant based diet and avoid excess body weight, through behaviors and habits handed down from generation to generation – an Okinawan lifestyle. Moreover, this lifestyle is practiced as a group and reinforced by the social mores and “peer pressure” of the group.
At the dinner table, Okinawans practice a Confucian teaching called “hara hachi bu,” that instructs people to eat only until they are 80% full. Thus, not only are second helpings discouraged in Okinawa but also eating to satiety is discouraged. Needless to say, this type of group habit has a powerful effect on individual behavior, even when you are alone. It moderates the total number of calories consumed per day.
Moreover, when combined with a habit of daily walking – not only for exercise, but also as a means of practical transportation – lifestyle alone can engender robust health. It can hold down body weight, reduce blood pressure and the risk for diabetes, heart disease and other chronic diseases – all without medications or high cost procedures.
Americans, unfortunately, do not grow up eating only to 80% of full. We do not have social mores that limit our calories and encourage daily exercise. However, we can use some of the benefits of such group dynamics by joining groups that practice healthy behaviors. For example, joining a group of walkers or runners who exercise four to five times a week, will encourage our behavior to do so.
Befriending those who eat a vegan diet and sharing meals can teach us much about the benefits of this way of eating. It may make our own diet healthier, and predominately plant-based, even if we don’t become vegan. Joining healthy groups and health-focused communities offer a way to change behaviors and maintain behaviors that alone we would find to difficult to accomplish.
In summary, informed diet and lifestyle can for the majority of individual keep us healthy and reduce the cost of care. For populations, such an approach offers the possibility of transforming healthcare, making it not only affordable, but also changing the collective perspective from dependency to responsibility and empowerment. But collective action is needed!
Employing informed diet and lifestyle in a group or community that reinforces and encourages healthy behaviors, may allow you to achieve a level of robust health more easily than going it alone. In so doing we avoid the proverbial bottle of pills and may truly achieve the Non-Medicated Life.
Paul E. Lemanski, MD, MS, FACP (firstname.lastname@example.org) is a board certified internist at the Center for Preventive Medicine, CapitalCare Medical Group in Albany. He is medical director of the Department of Community Medicine and Population Health at CapitalCare Medical Group. Paul has a master’s degree in human nutrition; he is an assistant clinical professor of medicine at Albany Medical College and a fellow of the American College of Physicians.