Lifestyle medicine

Very interesting post that highlights the complexity of wellness care. As a non-physician provider of wellness care (exercise, nutrition, lifestyle geared to the needs of the individual), I think there is a need for cooperation between physicians and wellness care providers. Physicians do not have the time to personalize programs for their patients, nor to motivate patients to follow through, but they do have the credibility needed to help patients realize that improving nutrition and lifestyle can actually make a big difference to their health. Furthermore, physicians can frequently do the kinds of testing that is needed for targeted wellness care, that non-physicians are not permitted to do. For example, I would like to be able to order circadian rhythm adrenal profile testing (saliva), candida albicans testing, parasite testing, heavy metals testing, mucosal barrier testing, food sensitivity testing, vitamin D and iron level testing etc., in addition to blood-sugar testing, and the other usual health markers. The results of the testing would make it much easier for me to know what is top priority for the patient, and the kind of diet and lifestyle changes that would be most effective for that particular individual. In this way, a partnership between wellness practitioners and physicians can be very effective. The problem of course, is that as of yet, there is no “standard” or licensing with respect to the training of wellness practitioners, which is why the move to have physicians do the work.

I do think that there would be a huge market for physicians that want to open a wellness practice, but that is a completely different kind of practice than typical sick care. It would be more about functional medicine than anything else. Like what Biohealth in San Diego does.

The problem with the idea of physicians counselling patients on nutrition and exercise is that one size does not fit all. There is no one diet that works for everyone, no one exercise program that works for all, and therefore physicians, unless they are working in a wellness practice, don’t have the time to figure out what is suitable for the individual. Really, the only thing a physician can tell a patient to do and do no harm, is to lower sugar, transfats and processed food intake. As for appropriate amounts of carbs, fats and protein, they will vary with the individual, and the individual must be tested to learn what is appropriate. If a patient is not healthy, they will not tolerate a vigorous (sympathetic) exercise program, which will simply run them further into the ground. Unwell people need parasympathetic exercise, like yoga, tai chi or qi gong.

Anyway, my 2 cents worth. Thanks for the post,

Vreni Gurd
Health and Vitality Coach
Corrective Holistic Exercise Kinesiologist 3
Holistic Lifestyle Consultant 2
B. PhE.

It is stuff like that that gives wellness care a bad name. In my opinion, wellness care is NOT about pushing vitamins down people’s throats. All that does is sucker people into creating expensive pee. Proper wellness care is not about vitamins at all, but about helping the patient eat nutrient-dense foods appropriate for their biochemical individuality, exercise appropriately for their health status, and improve sleep and hydration habits.

I do agree with you though that supplement and protein-shake pushing is HUGE business. I sure wish they weren’t classified under wellness care.

Vreni Gurd
Health and Vitality coach
Corrective Holistic Exercise Kinesiologist 3
Holistic Lifestyle Consultant 2
B. PhE.

The next step will be refusing treatment (or insurance companies refusing to pay for treatment) to patients who don’t agree to ‘lifestyle” changes which will be prescriptions for specific behaviors developed by bureaucratic “experts”.

I am not a ‘population’ or a certain ‘group’. I’m an individual whose body is unique in so many ways, as is everyone else’s. There is no way for committees of ‘experts’ to determine the most healthful lifestyle for me. Basic guidelines are great, but not as absolute prescriptions for every person.

Another thing: the lives and ‘lifestyles’ of the ‘experts’ are carefully non-transparent, but they, no more than any other human being, have no bad habits, use no substances known to be detrimental to their health (even if also sometimes good), engage in no behaviors that put them at risk , etc, etc. Human beings are that way. Probably why we survived as a species — because there have always been too many of us who ignored current ‘experts’ who got it wrong but hey! They’ll come up with something new tomorrow.

I’ve put a lot of effort, money and time into discovering what keeps me healthy, and it’s working very well. I’ve lived nearly seven decades having worked at developing healthy (for me) habits of mind and body (and having escaped the lures (even possible benefits) of alcohol, drugs (legal and not) and tobacco — but not caffeine). But my habits would not fit for every other person. It isn’t genetics; heart disease, diabetes and cancer is rife in my family. Any of those may be what fells me ultimately but in the meantime I enjoy being as healthy as possible. And I’m smart enough to do the research to learn how. And committed enough to do the work, including exercising.

Isn’t it ironic that in a time when information, good information, is so readily available and at the same time, every aspect of our culture encourages rejection of personal responsibility for a healthy mind and body? And talking about lifestyles! Lawyers, pharmaceutical pushers and even some doctors live very high indeed off the miserable health of so many.

Well, it’s good that all the ‘experts’ can’t agree on exactly what we should be eating and doing to stay healthy. I think the time to worry will be when they all do agree. At least now, there’s still some acknowledgment that the scientists don’t yet know everything. I appreciate all the research and make use of it, but I also pay attention to how it’s done, who’s paying for it, etc.

I am especially grateful that we have so many good doctors. They are always going to be needed.

talented people, free to do what they believe is right, and highly educated to know, must operate on a cash basis. ‘lifestyle management’ smells like ‘olor de marketing’, but some good heads are involved, folks with the balls to oppose the evil machine, with a track record of doing so. that said, you can’t teach CHARISMA. patient trust develops non-verbally, and is the basic requirement for the successful transfer of didactic info as well as some notion of what a human with ‘X” diagnoses is reasonably expected to be able to do in the interest of improving health and vitality(not getting ready for the olympics). mounting health costs is the grand lie, for where does the money go? we are pissing away our economic future at the moment, and the quality keeps going down(yes i’ve been in practice 29 yrs). which of you is getting rich? define ‘rich’. you are economically disadvantaged compared to a mechanic if you count school costs, spiritually downtrodden by the constant oppressive lies, and physically exhausted by the late nights. you are one phone call away from a medicare audit (life-changing event). HARD TO SELL THE PATIENT ON LIFESTYLE CHANGES WHEN YOU LOOK LIKE YOU NEED SOME. nor will you attract patients who are interested in such. WAKE UP AND DROP OUT. practice your own brand of medicine, that best utilizes your talents. call it what ever you like. good luck. seymour

There is a need for Lifestyle Medicine to become an established specialty for the following reasons:
– The body of scientific literature regarding health behavior change in general and specific lifestyle interventions in particular is too large for the average physician to master. Specific residency training is necessary to create lifestyle medicine physicians with the skills necessary to help patients who need more intensive lifestyle intervention.
– Most physicians who commonly treat lifestyle diseases are not currently adequately trained in lifestyle intervention. An organization such as the American College of Lifestyle Medicine (ACLM) is needed to review the literature and current training to make recommendations for medical, post-graduate curriculum, and continuing medical education.
– It is true that there is a lot of confusion about what lifestyle interventions are evidence-based and under which circumstances different lifestyle interventions should be used. To bring order and sound recommendations the field of Lifestyle Medicine needs to be established and guided by a specialty organization such as ACLM.
– Clearly establishing Lifestyle Medicine as a defined specialty within allopathic medicine will help separate evidence-based lifestyle interventions from other interventions which are either not lifestyle or non-evidence-based. This may help allopathic physicians feel more comfortable in incorporating lifestyle medicine in their practices.
– There is currently insufficient provision and funding of lifestyle medicine even in circumstances where lifestyle intervention has been proven to be more effective than other interventions. By establishing this field health care organizations, insurers, and govenment entities will have a respected entity to base their policies on.
– Most of all, the health of many patients unnecessarily deteriorates because their physicians and health care systems are not set up to provide the more effective lifestyle intervention that they need. Studies show that coronary artery disease, diabetes type 2, obesity, hypertension, etc can be remarkably improved with appropriate lifestyle intervention.

Regarding the need to tell patients how to live…as with any intervention it would only be provided with patient consent. Do some patients need to have their lifestyles managed by clinicians? Absolutely! Changing one’s lifestyle can be difficult and one can use all the help one can get.

If you are a clinician and want to support the establishment of this field, I would invite you to joing ACLM. http://www.aclm.net

Doug Plata, MD, MPH
ACLM member