February 2019 - NON-MEDICATED LIFE
Why I Practice Lifestyle Medicine
By Paul E. Lemanski, MD, MS, FACP
Medicines are a mainstay of American life and the healthcare system, not only because they are perceived to work by the individuals 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. With such benefits and relative ease of use, why would I as a physician look for effective, evidenced-based ways to avoid the use of medications, if possible? Why not just give another pill? My answer begins with a simple observation: people in our culture take a lot of medication. The average 60-year-old person is on five medications. The average nursing home patient is on seven medications. We have medications for almost every conceivable medical condition or life problem. Even my own patient would ask, “Doc, do I really need to take all this stuff?”
After a few years of prescribing pills, I realized that for some patients, medications were absolutely essential to disease free survival, but for many, if not most, patient’s medications simply allowed them to continue certain counter-productive behaviors with less health risk. Patients with hypertension could eat salted snacks, if they took their diuretic; those with high cholesterol could eat ice cream, hot dogs and hamburgers, if they took their cholesterol-lowering drug; and those with diabetes could drink some sugary sodas and overeat, if they took diabetes pills.
Along with my patients, I began to ask which medications might be “less” necessary or perhaps effective in smaller doses, provided those counterproductive behaviors were curtailed and replaced with more healthy behaviors or a so-called healthy lifestyle. This is not a trivial question. Medications are double-edged swords. They may address a given condition effectively, but they can produce side effects, especially in higher doses. Moreover, given the number of medications taken, drug interactions can be significant and cause both morbidity and mortality.
Finally, especially for those on fixed incomes or with limited drug coverage, the cost of medication can be prohibitive. For a society, concerned as we are with the rising cost of healthcare and having sufficient resources to cover everyone, the cost of possibly unnecessary medication becomes important. But before a physician can consider using lower doses of medication, or fewer medications in the treatment of any of a number of chronic medical problems, there must be evidence that substituting healthy behaviors for unhealthy ones could be effective in preventing the emergence of medical problems – and then also be effective treating those same problems.
This approach using lifestyle – including diet, exercise and certain behaviors – as a medical intervention would have to be held to the same rigor and scrutiny as medication interventions in order to be considered an evidenced-based alternative treatment. For those of us interested in the new field of Lifestyle Medicine, thankfully, that evidence exists and continues to grow. For example, large epidemiological studies (Seven Countries Study) first suggested that diet and heart disease were associated. Other epidemiological studies (The China Study) suggested that a whole food, predominantly plant-based diet was associated with a lower risk of heart disease and certain cancers.
Later, large, randomized, prospective clinical trials (the gold standard of medical science), established a causal relationship between diet and heart disease. For example, the Lyon Diet Heart Study established that a high omega-3 fatty acid Mediterranean diet could achieve a 70% reduction in fatal and non-fatal heart attack, as compared to a prudent Western diet. Perhaps most impressively, the Lifestyle Heart Trial proved that lifestyle changes alone – including a vegan diet, daily aerobic exercise and relaxation techniques – could slow, stop and actually reverse the progression of cholesterol plaques in the arteries of the heart. Such studies were pivotal in convincing me as a medical practitioner that patients needed to be informed of the power of Lifestyle Medicine as part of their informed consent prior to the use of medications.
Moreover, even those opting for a traditional use of medication should be encouraged to use the techniques and strategies of Lifestyle Medicine to maximize their risk reduction and then to consider – appropriate to their level of risk and with the input of their primary physician and subspecialist – possible reduction or elimination of certain medications.
I choose to practice Lifestyle Medicine because it empowers the patient to take charge of their own health and engage the natural healing processes of their own bodies. The patient not the pill is in control of their health. One dramatic example of such empowerment is when an individual with diabetes is able to achieve a normal blood sugar off all diabetes medication for one year. Such so-called remission of the patient’s diabetes is not accomplished with medication – indeed the patient’s diabetes medications must be stopped under the supervision of a physician. Rather, it is accomplished through the guidance of a Lifestyle Medicine practitioner with simple patient implemented changes including weight loss, changes in the composition of the diet, the use of intermittent fasting and exercise.
Indeed, the majority of the medical conditions I treat with medications as a practitioner of internal medicine – high blood pressure, elevated cholesterol, elevated blood sugar and diabetes, gastro-intestinal reflux, sleep apnea and obesity – I can treat effectively with a Lifestyle Medicine approach. Using this approach, I can also prevent problems from developing in the first place. If you have a family history of diabetes in a first-degree relative, have a slightly elevated blood sugar and are overweight, I can show you how to decrease the likelihood of developing diabetes by 57%. For a 5’1”, 200-pound patient at risk for diabetes, the loss of only 10 lbs. can prevent the development of diabetes – even if the patient is more than 50 pounds overweight. Compared to a 30% reduction of risk with a medication, the power of Lifestyle Medicine becomes clear.
In summary, I practice Lifestyle Medicine, because it is a natural, evidenced-based alternative to medication. It empowers and engages the patient and improves health outcome in measurable ways. Under the direction of a physician practicing Lifestyle Medicine, many if not most of the chronic medical problems that are treated with medication, may be treated more naturally and with equal efficacy, minimizing side effects, drug interactions and costs. As a practitioner, I regard this as a superior and preferred approach to simply pushing another pill.
Paul E. Lemanski, MD, MS, FACP (firstname.lastname@example.org) is a board-certified internist practicing internal medicine and lifestyle medicine in Albany. Paul has a master’s degree in human nutrition, he’s an assistant clinical professor of medicine at Albany Medical College, and a fellow of the American College of Physicians.