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Lifestyle Medicine: Treating the Causes of Disease

If doctors can eliminate some of our leading killers by treating the underlying causes of chronic disease better than nearly any other medical intervention, why don’t more doctors do it?

November 4, 2013 |
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Acknowledgements

Images thanks to mikebaird, Philocrites, hegarty_david and puuikibeach via Flickr. Thanks to Dan Piraro for his kind generosity to use his amazing work.

Transcript

Though I was trained as a general practitioner, my chosen specialty is lifestyle medicine. Yes, most of the reasons people go see their doctors is for diseases that could have been prevented, but Lifestyle medicine is not just about preventing chronic disease—it’s also about treating it. And not just treating the disease, it's treating the causes of disease.

 If people just did 4 simple things—not smoking, exercising a half hour a day, eating a diet that emphasizes whole plant foods, and not becoming obese--they may prevent most cases of diabetes and heart attacks, half of strokes, and a third of cancers. Even modest changes may be more effective in reducing cardiovascular disease, high blood pressure, heart failure, stroke, cancer, diabetes, and all-cause mortality than almost any other medical intervention.

The key difference between conventional medicine and lifestyle medicine is instead of just treating risk factors we treat the underlying causes of disease, as described in this landmark editorial. See, typically doctors treat "risk factors" for disease such as giving a lifetime's worth of medications to lower high blood pressure, elevated blood sugar, and high cholesterol. But think about it. High blood pressure is just a symptom of diseased dysfunctional arteries. Yes, you can artificially lower blood pressure with drugs, but that's not treating the underlying cause, which often comes down to things like diet and exercise, the penicillin of lifestyle medicine.

 "Disregarding the underlying causes and treating only risk factors is somewhat like mopping up the floor around an over-flowing sink instead of turning off the faucet, which is why medications usually have to be taken for a lifetime. If a floor is flooded as a result of a dripping tap, it is of little use to mop up the floor unless the tap is turned off. The water from the tap represents the cost of disease, the flooded floor, the diseases filling our hospital beds. Medical students learn far more about methods of floor mopping than about turning off taps and doctors who are specialists in mops and brushes can earn infinitely more money than those dedicated to shutting off taps. And the drug companies sell rolls of paper towel, so patients can buy a new roll every day for the rest of their lives. Paraphrasing Ogden Nash, modern medicine is making great progress, but just headed in the wrong direction.

 Preventive medicine, is, frankly, bad for business….

 When the underlying lifestyle causes are addressed, patients often are able to stop taking medication or avoid surgery. We spend billions cracking people's chests open, but only rarely does it actually prolong anyone's life. In contrast, how about wiping out at least 90% of heart disease?

 Think about it… heart disease accounts for more premature deaths than any other illness and is almost completely preventable simply by changing diet and lifestyle. Those same changes can prevent or reverse many other chronic diseases as well—the same dietary changes. So why don't more doctors do it? Well, one reason is doctors don't get paid for it. No one profits from lifestyle medicine, so it is not part of medical education or practice. Presently physicians lack training and financial incentives… so they continue to do what they know how to do: prescribe medication and perform surgery.

 After Dean Ornish proved you could reverse our #1 cause of death, heart disease, open up arteries without drugs, without surgery, just with a plant-based diet and other healthy lifestyle changes, he thought that his studies would have a meaningful effect on the practice of mainstream cardiology. After all, a cure for our #1 killler! But, he admits, he was mistaken. Physician reimbursement, he realized, is a much more powerful determinant of medical practice than research.

Reimbursement more than research. Salary over science. Wealth versus health. Not a very flattering portrayal of the healing profession, but hey if docs won't do it without getting paid, let's get them paid.

So Dr. Ornish went to Washington arguing that look, "If we train and pay for doctors to learn how to help patients address the real causes of disease with lifestyle medicine and not just treat disease risk factors we could save trillions, and that's just talking heart disease, diabetes, prostate and breast cancer.” The Take Back Your Health Act was introduced in the U.S. Senate to induce doctors to learn and practice lifestyle medicine not only because it works better but here's the critical factor: physicians will be paid to do it. The bill died, just like the millions of Americans will continue to do with reversible chronic diseases.

To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video. This is just an approximation of the audio contributed by Ariel Levitsky.

To help out on the site please email volunteer@nutritionfacts.org.

Dr. Michael Greger

Doctor's Note

By treating the root causes of diseases with plants not pills, we can also avoid the adverse side effects of prescription drugs that kill more than 100,000 Americans every year, making them a leading cause of death. See my live presentation Uprooting the Leading Causes of Death.

For those surprised that policy makers wouldn’t support such a common sense notion as preventive health, check out my video The McGovern Report. What about medical associations? Medical Associations Oppose Bill to Mandate Nutrition Training.

For those unfamiliar with Dr. Dean Ornish’s landmark work, watch the story about my grandmother in my videos Resuscitating Medicare and Our Number One Killer Can Be Stopped.

There is another reason that may explain why the medical profession remains so entrenched. See my video The Tomato Effect.

If you haven't yet, you can subscribe to my videos for free by clicking here.

  • BeetsBeansButts

    I’m not exactly sure, but the Affordable Healthcare Act does give better reimbursement for preventative medicine, so things are changing for the better, right?

    There is a big difference between a physician telling her patient to stop smoking, and a physician effectively counseling a patient.

    As an greenhorn medical student I think I have an ok understanding of lifestyle factors on health, but I totally lack confidence in counseling patients on lifestyle interventions.

    • http://nutritionfacts.org/ Michael Greger M.D.

      Things are definitely getting better! And I totally understand what you’re saying about the skills, not just the knowledge. Check out videos like http://www.youtube.com/watch?v=dm-rJJPCuTE that explore motivational interviewing techniques. I’m so glad you’re psyched about prevention–we need more good doctors like you!

      • Adrien

        Thanks for all of this Michael. Your work is priceless.

      • BeetsBeansButts

        Thanks for sharing Dr. G. I am at an infantile state in my training busting through an Anatomy course. It’s nice to reminded about the importance of clinically relevant skills.

    • HereHere

      I’m in an allied health profession, and the link to motivational interviewing is valuable. I’m not allowed to prescribe dietary interventions in my scope of practice, so I have to do work-arounds. Maybe I can look at our profession changing this regulation; in the meantime, the best I can usually do is refer patients to a dietitian or ask motivational questions. I can have literature in my office, so I should see if I can print out useful, readable, and credible documentation.

      • FreeRadical

        I went to medical school to have choices. I would refuse to practice in that environment. The purpose is to help the patient. It’s already hard enough but to be bound and gagged is ridiculous. I encourage you to consider seeking work elsewhere. Consider the ramifications that your contractual obligations have on your liability, your patient outcomes and your overall happiness

    • Joe

      The “Affordable Health Care Act” is a control grid that centralizes all decision making and processes through the central government and insurance industry mega corporations. It takes from those who are proactive, who eliminate risks from processed foods, GMO food sedentary lifestyles and self destructive behaviors and forces them to pay for those who do not do the same. The most affordable health care is to take care of yourself, eat God’s food, not man’s food and take God’s medicine, not man’s medicine. This is a corporate-government takeover that has at its core the control of your life and your money.

  • Sara

    Dr. Greger, are there any jobs/careers out there for nurses in the lifestyle medicine field? I currently work in a surgical/transplant/trauma ICU and although is it way less depressing than when I worked in the medical ICU, I find myself becoming burned out by the level of distress my patients (and families) are in and disillusioned by the attitudes toward health and treatment that my coworkers all hold. I love learning about nutrition and would love to somehow find a nursing job that incorporates that, but have yet to find anything when I have tried searching. Any input you have would be greatly welcomed. Thank you so much for the work you do. It has literally changed my life :)

    • http://nutritionfacts.org/ Michael Greger M.D.

      You should totally check out the next American College of Lifestyle Medicine conference. I think it’s on the west coast next year. Great place to make these kinds of connections. Let’s keep people out of the ICU in the first place!

      • Kathy McLaughlin

        Dr. Greger, I live on the West Coast in Portland Oregon. I would love to see a Lifestyle Medicine Dr. How can we find out where these Drs are?

    • Mona Sigal

      Sara, I do not know where you are (geographically), but I am a Board certified EM MD, who is now practicing (plant based) nutrition and lifestyle medicine on the East Coast. Check out my website http://www.NHWFFL.com. If you are in the vicinity, let’s talk.

      • Sara

        Hi Mona, I’m actually in central Mass :) I would love to talk. Can I contact you through your website?

  • Laloofah

    The dripping faucet/floor mopping analogy is brilliant!

  • Bill Misner PhD

    Reality sets in…what you conclude is true, sad, with a hint of brilliance!

  • Kathie

    You list 4 simple things to do to prevent disease; not smoking, exercise 1/2 per day, eat a plant based diet, and not becoming obese. So… I got the first three down pat, and am struggling with obesity. I cannot lose weight. Any thoughts?

    • Wild4Stars
      • Kathie

        Thank you for the recommendation. I just ordered the book and will get it Wed.

    • JenniferM

      Kathie. I also have been plant-based for 2 years and although I feel great, I have not lost weight. I have recently started replacing 2 meals per day with juicing fresh fruits/vegetables and watching out for oil, and go to the gym 3 times per week and I have now started to lose weight. Juicing is great and you can drink as many as you want, very nutritious and filling! I have lost 10 lbs and Im in my 3rd week. So far so good.

      • Kathie

        Thank you for your comment JenniferM. Good luck to you. i am not so sure juicing is a good option for me.

    • b00mer

      Hi Kathie,

      This is a great presentation by Dr. Doug Lisle, a psychologist who was featured in Forks Over Knives and works with the McDougall programs. It is an hour long, but very much worth watching if you can find the time.

      “How to Lose Weight Without Losing Your Mind”:
      http://www.youtube.com/watch?v=xAdqLB6bTuQ

      • Kathie

        Thanks for the tip.
        I really like the cookbook ‘Forks Over Knives’ !

      • Blanster

        Boomer, this was FANTASTIC! Thanks for sharing it, I”m sending it to several friends.

        • b00mer

          Glad to hear you liked it! I recommend this one as much as I recommend Dr. Greger’s hour-long presentations.

    • Marcel Cattin

      Check out the informative book by Dr. Robert Morse THE DETOX MIRACLE SOURCEBOOK. It contains a lot of information in a language taht is easy to understand.

  • M85

    This situation is ABSOLUTE MADNESS! Seriously, what is wrong with these people?

    • Adrien

      I would say, what is wrong with our economic system, because that is – I believe – the real cause of all of this.

  • http://www.naturallifeenergy.com/ Aqiyl Aniys

    AWESOME!!!

  • Eli

    I’m on the pre-med track and was fortunate to land an internship at our local free medical (and dental) clinic. As a “Diabetes Education Intern”, I follow the approach modelled in the video Dr. Greger posted. Patients who come to the clinic, already aware they have diabetes–or who are diagnosed there, are invited to find out about our education program.

    If they are interested, either I or my fellow intern who is bilingual in Spanish give them a brief overview of the program, which involves an initial in-person consultation, which first entails finding out what the patient already knows about the “treatment” of the disease, filling in any gaps (covers diet, exercise, and foot checks), and setting a very specific goal that the patient deems is achievable by rating it between 7 and 10 on the scale mentioned in the video. “Achievability” tends to be based on the patient noting not only what he/she wants to change in diet or exercise regimen–but when (days of the week, and time/mealtime) and quantity (e.g., how long a brisk walk will be, or how much of the plate will be devoted to produce). With that goal established, we interns then make weekly calls for 10 weeks to see how things are progressing. During each call (done at an agreed upon day and time), we ask them for their thoughts on their progress in achieving the goal–and may “tweak” it to make it more achievable or, if achieved, either keep with the goal or add to it.

    I love the idea of this approach–but it’s not always smooth sailing. Some people won’t take calls, some people report doing well but their tone suggests otherwise, some people lose interest, some people didn’t grow up with the “on a scale from 1-10″ model so are alienated by that mechanism to pin down or adjust a goal, etc. I think so much of the problem stems from having been “brainwashed” by industry (Most everyone is middle-aged) and not necessarily believing what a plant-centric eating regimen can do for them, having established certain foods as comfort foods, and not having the structure of having weight, blood sugar levels, blood pressure, etc. measured by their physician throughout the 10 weeks. There are definitely successes, but I am eager to find out how to strengthen this model.

  • Adrien

    I think it’s more deeper than that. Adressing the root cause of this problem will send us down to the core – the very fabric – of our economic system. After all, feeding cheap food to lifestock to produce meat, the incentive behind this is the profit motive. And this generate poor health in the mean time. But guess what, more profits can be generate from sick people. And at every step of this process – animal and human suffer – but it generate growth, which our economy cannot function without. And every year it has to be more growth than the year before. NO WONDER that the low-carb is all of rage and that the mcgovern report wasn’t take into account. Our economy requiere infinite growth. This mean more ressource taken, used and trashed, more hamburgers, more obese that eat more and more, more drugs, more surgery, more stent, and more bypass to generate GDP, and low carb gurus are there to make us swallow the pills. It doesn’t take rocket science to figure this out, a finite world cannot support an infinite economic growth. One day or another, all of this will come to an end. All the question is: will we still be there to see it ?

  • Ilana

    I think the illusion of compliance is a factor as well. For example, I was watching a CME presentation about hemmorroids. There are 4 stages, 4 being the worst. The doctor was saying that most patients with stage 1 and 2 could be cured will fiber treatment (ie taking metamucil), but patient compliance is difficult. I don’t know how much is perceived vs real, but it appears many people would prefer to go under the knife than add a fiber supplement! Though i do not know if patients did not comply or were not told of that option. This was discussed in Essylstein’s book too, that patients are not told they can reverse heart disease with a vegan diet because they think they will not comply, but are all gungho to put them under the knife!

  • Plantstrongdoc M.D.

    The problem is complex. Reimbursement is definitely a part of the problem, but probably to a lesser degree in some parts of the world – northern Europe – where healthcare to a lesser degree is buisness, but still the focus is on drugs and hi-tech procedures. There are national guidelines you have to follow, so if you prescribe broccoli and brussel sprouts to a heart attack patient instead of aspirin, statin, candesartan and an elektive stent, you will be in serious trouble, even though you will save government-money (and your salary will be the same). So the problem is also lack of knowledge at a higher level. I do not underestimate patients, but a lot of patients wants the easy solution – a pill, a procedure – a have spent hours trying to convince some close relatives to change their diet and habits instead of popping pills for their lifestyle diseases, but without any luck at all. I have a very skilled colleague with newly diagnosed type 2 DM (obese) and even though he totally agrees, he doesnt have the belly ( :-) ) to change his habits and diet.

  • Dan

    In medical school long ago (17 years?), we learned an ancient Chinese adage, which went something like this:

    “To administer medicines to diseases which have already developed is comparable to the behavior of those persons who begin to dig a well after they have become thirsty.”

  • Karen Harris

    I was surprised only half of all strokes could be prevented with the 4 lifestyle changes. Why not more?

    • Plantstrongdoc M.D.

      Karen,
      That is a very good result. NNT (Number needed to treat ) is 2. No medication can match that. Diet an exercise is a (big ) part of the equation, but it will not cure or prevent everything

    • BenK

      Also, if you have ever heard a presentation by Dr. Joel Fuhrman, you will note that hemorrhagic strokes actually increase with vegan diets a lot of the time because people do not decrease their sodium intake when they cut out high fat foods. This leaves their smaller arteries and veins weak in their defense against blood pressure spikes. It could be worth checking into if you are still interested!

  • george jacobs

    i love the leaking faucet/paper towels analogy. thx -george

  • Frank X. Harris

    I have been a ‘good’ vegan for almost three years now and exercise every day. At first I lost some weight, but have since gained it back and then some. Also, my insulin use as a type 2 diabetic is up.

    In the past three decades I have lost and gained substantial weight in excess of ten times, and will not do so again. I am counting on the health effects of the food choices and daily exercise.

    It seems to me that it is time to give up the ‘diet’ mentality when discussing obesity. It has never worked for more than 2% of the population. Further, it does not explain the reason that Dr. Greger does not have millions of subscribers and lots of financial support, or that the findings about diet aren’t government policy in a country going bankrupt.

    My experience in successful weight loss has to do with ‘stress’ in its broadest meaning. The more I reduce my stress, the less I weight. Today I weight 245 lbs. but spent most of my life over 300 lbs. Of
    most importance, I am healthy, mobile, and very alive at age 65.

    Thank you Dr. Greger for your large part in making it happen!

  • Dan

    Always the same beginner mistake: Saving trillions is good for a corporation, but for a nation it means lower GDP – and that’s BAD.

  • Alicia Townsend

    As always, another great article. Thanks! My Ph.D. is in Health Psychology and Behavioral Medicine. We learned about Dr. Ornish’s work in grad school. I’m always happy to hear people talk about him, because I don’t think he gets enough recognition for his groundbreaking work. Also, I’m happy to be one of the lucky ones who makes a living by helping people address the source of their issues, and manage their health without medication and surgery in most cases! However, insurance still is a problem, because it often won’t reimburse for these services.

  • Kefir Boy

    Doesn’t “cure” everyone. I still need antihypertensives but my blood pressure is much easier to control and a minimal dose. No type of food is going to improve upon my low HDL cholesterol. So while there can be dramatic improvement, I wouldn’t sell this as a cure all.

  • bob luhrs

    I think doctors today are treating the lifestyle, not the person. Maybe for some people that is exactly what they want for awhile.
    But it is another thing to convince them that there’s nothing that change of lifestyle (and/or diet) would make any difference. That is where the criminality of it all starts.

  • FilterGuys

    How do you get doctors to do lifestyle medicine for someone already dealing with a chronic disease like cancer ? You have a GI cancer, you test negative for Celiac’s and you have Hashimoto’s, yet no doctor is telling you to avoid gluten? Is there a connection to these or all coincidental ? Why don’t doctors look at lifestyle and make connections and give patient directions?

  • sharonmc

    I have a deep respect for the work done by Dr. Greger and
    the NF team, however I have some ambivalence about this video describing the virtues of lifestyle medicine.

    To preface, I am in complete agreement that the best medicine involves prevention rather than cure. Our biggest health burdens would be very much tempered by preventive approaches to care, and it would be an absolute delight to see the reliance on pharmaceutical and biotech industries dismantled. However, the most common chronic diseases in
    North America are distributed disproportionally among those of lower
    socioeconomic status. The Whitehall studies, and the prolific research built upon the foundations of the Whitehall findings clearly highlight the inextricable link between socioeconomic position and health; the “social gradient”. Indeed, previous comments to this video have already alluded to broader issues contributing to health, such as access to affordable care and chronic stress. (Adrien makes some very compelling observations!) Our current economic situation sees a growing income disparity, time poverty, the expansion of food deserts in urban centres, environmental decay, and the commercialization of public green space…all detrimental to health and health related behaviours.

    It would be a shame if lifestyle medicine, in its disregard
    for the broader ecological influences on health, is accused of taking a blame the victim approach toward those burdened by cancer, heart disease, or type 2 diabetes.

    While I think behavioural change is virtuous and those that adhere to a clinical model of lifestyle education should be commended, I nonetheless
    have certain reservations about behavioural models for lifestyle change as a whole:

    Behaviour and lifestyle choices are strongly influenced by
    normative values; the decisions and actions of others in one’s cultural,
    physical, and social sphere strongly affect personal decisions regarding
    lifestyle. Additionally, we assume that by providing adequate information, people can—and will—make decisions about their health in a way we have predetermined as rational. We often fail to situate intrapersonal decision-making within a broader framework that includes, for example, psychological support and physical resources.

    What lifestyle medicine appears to assume is that the
    resources that enable healthy lifestyles are readily available: access to
    affordable and nutritious food, the precious time to prepare it, the safe
    places to go outdoors for exercise, the time and energy to engage in leisure activity, the social support by others that share the same lifestyle values, and the sense of self-efficacy or empowerment required for personal change. In other words, lifestyle medicine makes the assumption that all have access to lifestyle choices optimal for health.

    I hypothesize that when we look beyond intrapersonal failures
    and consider social failures for the maldistribution of poor health in North
    America, epidemiological outcomes will be much more inspiring.

    • b00mer

      This is an important perspective that is all too often left out of the conversation. Most of us are familiar with all of the recommendations on how to make a plant based diet affordable: bulk dry beans, frozen veggies, etc, but in making those suggestions we are exposing our own privilege by assuming even those basic foods are accessible. So unfortunately we have food deserts and a lack of information/outreach centered smack dab on the populations suffering the greatest from lifestyle-based disease. What to do? I genuinely don’t know. I’m no social scholar.

      I would love to see Dr. Greger or any of the other plant docs team up with someone like Ron Finley or Will Allen for a nationwide tour, focusing on venues in communities that need it the most.

  • Karl Young

    Geez, how un-American can you get Dr. Greger !? Eating large quantities of chicken fried streak (and chicken fired chicken…) and getting on a cocktail of heart and cholesterol meds, oils the wheels of commerce that we all depend on !

  • PS

    I’m a pre-med student but I really love the field of lifestyle medicine and prevention-focused care. Do you know if there are specific medical schools that focus on this, or a certain type of medicine that would be best to bridge me into this field for my career? Thank you!

  • Dan

    You are of course correct Dr Greger. It is so much easier to prescribe a statin and dismiss a patient than to level with them and coach them to adopt a plant-based diet. The former takes less than 5 minutes, the latter usually 30-40 minutes and serial sessions. We need to change the reimbursement scheme for lifestyle-oriented medicine so that lifestyle once again becomes foundational, rather than drugs. I say this as a clinical pharmacologist.

  • Derrek

    Dr. Greger, how did you set up your computer to your treadmill? Also can you write while walking? I have a lot of school
    Work to do usually.

  • Guy Hibbins

    There was recently a case in Australia where a patient successfully sued their general practitioner for failing to ensure that they had weight loss surgery. Apparently making an appointment with a weight loss surgeon was not enough. This judgement was appealed all the way to the High Court of Australia before it was finally overturned.

    See http://www.abc.net.au/news/2013-08-26/overweight-man-luis-almario-legal-battle-prompts-obesity-warning/4913292

    I wonder what would happen if a patient sued their doctor for not making them eat a healthy diet?

  • una

    Dr Greger , I learn so much from you. We need more doctors like you. Prevention in the key not bills. .

  • Francis Fong

    Any studies on papaya leaf extract helping increase platelet counts?

  • ruth

    o dear dr gregor!!! just please keep ringing the bell and more and more you and we are getting heard, its a slow change but still saving lives along the way! bravo to you!!!!

  • Ruby

    Un buleevable. But you know what? In my 30 yrs in the health field (alternative) that is exactly the feedback I got and why I was happy to reinvent myself when the economy changed. . . healing yourself is more work than is worth the trouble. . . As my father (a neurologist) said of his obese dog, riddled with tumerous, oozing, lumps and barely able to walk, laying next to him with his spoon and half gallon of ice cream, while addressing that maybe he should not feed the por dog so much when she never leaves the house for so much as a walk – his reply, “but what else has she got to live for but her food?”. . . . Nuff said. I come from an entire family in the med profession, with as little interest in health, when money and status are the real richness in life, and indulgence and gluttony the entitled reward.. . . Well, there are those really seeking who you can touch. Folks still believe in the med profession blindly, so the coat and letters help in your favor. . . . I was just a voice in the wind of howels of diet and propaganda. . . . I love what you are doing. Makes me proud to be human and that’s something I don’t think I’ve ever said. :)