Creating Healthcare, Not Sickcare

If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.
— Hippocrates

“Eww, Mom got whole wheat bread again?” I remember thinking after school one day in grade school. My family had always been health conscious, but recently my mom, a nurse, had gone to a health conference to learn about healthy lifestyle behaviors and got trained to teach a community program. This reflected on the food she bought for us. She never forced us to eat healthier, but she always encouraged us to.

Back then, I was the child dreading to eat cardboard flavored whole wheat bread instead of more refined bread, surviving on pre-packaged food and watching far too much TV. Now I am a recreational endurance athlete not only doing everything he can to eat healthy, but planning on spending a career in medicine helping others to find the same joy in healthy behaviors. How did that happen?

Once I reached high school, I started running a couple of times a week, mostly to stay fit for our mile runs in PE class. Eventually I started to notice that what I ate had a huge impact on how I felt during my runs. When I ate unhealthy foods, especially highly processed foods, I would feel slow and heavy during my runs and would often get side cramps.  When I had been eating mostly the healthy foods my mom would make for a while, I flew! This lead to me making the decision: I was going all in.

I started to eat only the food my mom made around the house, cutting out all of the highly processed foods I could. Within days, I noticed that I had way more energy, could focus better in school, and my acne even went away to this day. But my favorite part was that running was way more enjoyable, and my mile times improved dramatically!

I would often go with my mom after school to the community programs she taught, and would see people completely turn around their lives over the course of the program. These people were reversing their type II diabetes, getting off most or all of their medications, losing weight, and regaining their vitality. At the class alumni reunion, they had only improved more! This is when I was first introduced to lifestyle medicine. Lifestyle medicine is described as “a branch of evidence-based medicine in which comprehensive lifestyle changes (including nutrition, physical activity, stress management, social support and environmental exposures) are used to prevent, treat and reverse the progression of chronic diseases by addressing their underlying causes.”1

But I didn’t really think much of this at the time. It wasn’t until I got to college and took an Anatomy and Physiology class, and learned about the amazing ways our bodies work, as well as some of the ways they can go wrong and get disease that I realized the significance of what lifestyle medicine can do. Many of the ways the human body can go wrong that we heard about in class, including diabetes, heart disease, and some cancers were largely considered by the public as diseases of aging and genetic misfortune, sentences to a lifetime of medications. Something just didn’t click when I looked back and remembered the amazing power over their health that the people taking my mom’s class about lifestyle change had. This resulted in an obsessive search for how this disconnect could be such a major problem in our society. I quickly realized that there are some things our healthcare system is great at treating, and others that it doesn’t really treat at all.

The modern healthcare system is excellent at treating acute illnesses. If you have an infection, antibacterial treatment can save your life and get rid of the infection in a matter of weeks or days. If you get in a traumatic car crash, highly skilled and knowledgeable physicians can stabilize your body and get you on the track to recovery in no time.

The problem with this is that the same philosophy of healthcare with pills and procedures is applied to everything else as well, with far less effectiveness. The major problem we are dealing with in the U.S is what causes 7 in every 10 deaths: lifestyle related chronic diseases.2 Not just in the U.S, but worldwide, the most common cause of death is no longer infectious disease and childhood illnesses, but now chronic diseases related to increasing over nutrition and decreasing physical activity.3 If a person develops a chronic disease such as diabetes, there will be an abundance of insulin to buy to keep their blood sugars down to a safe level. If someone has atherosclerotic plaque built up in their arteries, they can have a stent placed or have a bypass surgery to stave off an event such as a heart attack.

However, this is not the ultimate solution. These patients will always need to come back for more treatment, as their problem has not been fixed at all; they have only treated the symptoms of their disease and never actually treated the disease itself. A major problem with the medical system today is that it focuses mainly on treating the symptoms of people’s lifestyle choices, such as high blood pressure, high blood cholesterol levels, or even atherosclerotic plaque, but many times will ignore the cause of these symptoms altogether. Dr. Denis Burkitt put it best when he said it is like mopping up the floor under an overflowing sink, when in reality the best option is to reach up and turn off the faucet.8

Our healthcare system’s inability to effectively treat chronic diseases is having a financial burden on our country as well, as Americans spent over $3 trillion on healthcare in 2014, the average cost per person was $9,523, and those numbers rise by about 5% a year.4 Most of this is spent on chronic diseases. In fact, 78% is spent on these diseases, which are mostly preventable and reversible.5

The more I learned of the diseases that plague Americans, the more I realized that they all have far too much in common. Americans are suffering from diseases of which all have the same root problem: we’re living in an unnatural environment which we have not had the time to adapt to. Instead of using our bodies to actively seek out fresh, whole foods, we are living lives barely moving at all while we eat foods our bodies are not designed to eat. The result of this is our body not functioning properly and fighting back through inflammation, which underlies most chronic diseases and disease risk factors.1

An excellent example is cardiovascular disease, not only the leading cause of death (when this occurs in the arteries supplying blood to the heart), but also causing many other devastating and often deadly conditions. When the vessels supplying our bodies do not function properly and are damaged, leading to blockages which limit blood supply, we can get anything from erectile dysfunction to stroke. This same disease process manifests itself in different locations in the body, and can lead to a variety of diseases which plague millions of Americans every year. And cardiovascular disease as well as many of the top killers in the U.S are largely caused by the choices we make, and mainly by the food we eat.16

It has been documented for decades that populations that consume a diet centered around minimally processed plant foods and are more physically active, have virtually none of the major diseases that burden our country today6,7,8 even when matched for age and gender.9 Unfortunately, when those same disease free people move to a western country such as the U.S, they take on some of our lifestyle habits and begin to develop the western diseases that we succumb to.24 On a positive note, when Americans take on some of the same healthy lifestyle behaviors these healthy populations have, most can prevent and halt the progression of these diseases. In many cases, they can even reverse the progression of the disease altogether, allowing them to avoid costly procedures and lifelong prescription medications.21 This is perhaps most notably seen with the effective reversal of the number one cause of death in the U.S: heart disease. Whereas procedures such as stents or bypass surgeries extend life in less than 5% of people who receive them10, lifestyle changes are estimated to prevent at least 90% of all heart disease.13 And the reversal of atherosclerotic plaque through lifestyle change alone has been documented in major medical journals for decades as being not only possible, but widely achievable23 and sustainable over a long period of time,11 and may result in not needing a surgical intervention.12 These results are far greater than pharmaceutical or surgical intervention alone25, however are also far less profitable.

It’s not hard to see that our healthcare system desperately needs a new approach, and Americans are suffering as a result of the way modern medicine is being practiced. Could lifestyle medicine be the answer? Institutions such as the Pritikin Longevity Center have been practicing the same model as lifestyle medicine for decades, with extraordinary results. Hundreds of studies have been conducted to document these results.14 Through immersing patients in an environment where they eat a mostly whole food plant based diet, increase physical activity and reduce stress, they are able to lower blood pressure to normal levels, taking patients off their medications; promote healthy, long-term weight loss; reduce insulin dependence for type I diabetes and cure type II diabetes; and much more.

These results are found on a larger scale as well. One large scale study, the EPIC study, followed 23,000 individuals who followed four simple behaviors: not smoking, exercising three and a half hours per week, eating a healthy diet of mostly whole plant foods (beans, nuts, seeds, whole grains, fruits, vegetables, and very small amounts of meat), and maintaining a healthy weight (BMI<30). They found that 93 percent of diabetes, 81 percent of heart attacks, 50 percent of strokes, and 36 percent of all cancers were prevented.15 The evidence for this eating pattern being ideal for health and longevity is rapidly growing.21

As I begin my unsettlingly long educational path towards becoming a practicing physician, I begin to realize that the medical system is not exactly set up to make it easy for me to practice in this way. To start, most medical students have little to no nutrition education during their medical training, despite poor nutrition being the number one cause of death and disability in the U.S.16 Second, the median doctor's visit is only about 15.7 minutes17, and only about 19% of patients actually stick to their doctor’s lifestyle recommendations.18 It seems like there is barely enough time to fully understand a patient’s problems and prescribe the right treatment for their problems, much less try to change the way they live their life.

If I do manage to practice lifestyle medicine despite these barriers, it will be the less profitable option. Most medical organizations run by a “fee-for-service” model, which pays physicians for the amount of care given, such as various procedures or prescriptions, incentivizing them to give more care, rather than better quality care. Thankfully, our healthcare system has recently been shifting more towards a “pay for performance” model, where physicians are paid for the quality of care given and are incentivized to create better health outcomes.

This trend towards incentivizing good health outcomes will make it even easier for future healthcare workers such as myself to follow in the footsteps of the pioneers of lifestyle medicine, who have found ways to effectively use lifestyle medicine to change people’s lives, and even implement it into the current medical system. From what I have learned, here is what we need to do:

We need to create a coordinated and comprehensive lifestyle approach to treatment in which healthcare workers get involved in the community working directly with their patients on a long-term basis, where we do not just tell them what to do, we educate them on why these lifestyle changes are important and show them how to implement this knowledge into their life.

These patients will come back in on a regular basis to track progress, continue education, and be held accountable for their efforts. This is the only way that these people will reliably keep these lifestyle changes long enough for them to become habits. When they see for themselves the amazing control that they have over their own health, their chances for sustaining these healthy habits will increase exponentially.

We can do this several ways. One way is a shared medical appointment, where physicians are able to meet with multiple patients at one time and spend much more time than the traditional visit, giving the opportunity to educate and counsel the patients as a group, and even give individualized medical treatment or recommendations to each patient during the visit. This format is already being used in many medical groups to educate patients about the power they have over their health.

The program my mom has been directing in my area called CHIP, first started in British Columbia in 1988.  It has since been documented in medical literature not only as being quite effective in cessation and reversal of chronic disease during the 30 days of the program19, but also in sustaining or even improving these results over four years after the program.20 Both shared medical appointments and CHIP are possible to be partially or completely covered by insurance. The CHIP program is hosted both in a community setting, as well as by some medical groups.

None of this is possible without physicians being knowledgeable on the subject. Eventually, I believe that the medical education needs to be renovated to emphasize nutrition and lifestyle intervention. However, in the meantime, it is essential that healthcare providers are aware of the potential of lifestyle medicine to heal their patients. Some options for physicians include continuing education offered by the American College of Lifestyle Medicine, resources offered by Kaiser Permanente22 (who is its own insurance company, and therefore runs by a “pay for performance” model), as well as many other online resources available to guide physicians and laypeople alike to an understanding of how to implement evidence based lifestyle choices into your life.

Great introductory material for both groups include documentaries such as Forks Over Knives, and books such as How Not to Die or Prevent and Reverse Heart Disease. Among the most informative websites is NutritionFacts.org, which discusses the latest in evidence-based nutrition research in short and easy to understand, yet detailed videos.

As we have been introduced to today, the current medical system, although constantly gaining new knowledge and high-tech treatment options, is not effectively treating what is killing us the most. Thankfully, I am not the only person in my generation catching on to this desperate need for change, as some of my classmates are beginning to see the incredible potential that simple lifestyle behaviors can have to drastically improve the health and longevity of our country. Through the increased implementation of a “pay for performance” model of healthcare, incentivizing physicians to use their newfound understanding of the power of lifestyle medicine, and the continued implementation of a comprehensive community based lifestyle approach into medical practice, our healthcare system can much more effectively ensure the health and longevity of Americans. As lifestyle medicine pioneer Dr. Hans Diehl says, “[the goal of lifestyle medicine is to] help you die younger…as late as possible”!

SOURCES: Creating Healthcare, NOT Sickcare

 

Forrest Sheperd
Pre-Medicine Walla Walla University
Email: forrestshep@gmail.com
Social Media: LinkedIn, Facebook: Forrest Sheperd