Flashback Friday: The Best Kept Secret in Medicine

Below is an approximation of this video’s audio content. To see any graphs, charts, graphics, images, and quotes to which Dr. Greger may be referring, watch the above video.

Even though the most widely accepted, well-established chronic disease practice guidelines uniformly call for lifestyle change as the first line of therapy, physicians often do not follow these guidelines. Yet lifestyle interventions are often more effective in reducing heart disease, hypertension, heart failure, stroke, cancer, diabetes, and deaths from all causes than almost any other medical intervention.

“Some useful lessons come from the war on tobacco,” Dr. Neal Barnard wrote in the American Medical Association’s Journal of Ethics. When he stopped smoking in the 80s, the lung cancer death rate was peaking in the U.S., but has since dropped, with dropping smoking rates. No longer were doctors telling patients to give their throat a vacation by smoking a fresh cigarette. Doctors realized they were more effective at counseling patients to quit smoking if they no longer had tobacco stains on their own fingers. In other words, doctors went from being bystanders—or even enablers—to leading the fight against smoking. And today, he says, plant-based diets are the nutritional equivalent of quitting smoking.

If we were to gather the world’s top unbiased nutrition scientists and experts, there would be very little debate about the essential properties of good nutrition. Unfortunately, most doctors are nutritionally illiterate. And worse, they don’t know how to use the most powerful medicine available to them: food.

Physician advice matters. When doctors told patients to improve their diets, which was defined as cutting down on meat, dairy, and fried foods, patients were more likely to make dietary changes when their doctors advised them to.  And it may work even better if doctors practice what they preach. Researchers at Emory randomized patients to watch one of two videos. In one video, a physician briefly explained her personal health, dietary, and exercise practices, and had a bike helmet and an apple visible on her desk. And in the other, she did not discuss her personal practices, and the apple and bike helmet were missing. For example, in both videos the doctor advised the patients to cut down on meat, to not usually have meat for breakfast, and have no meat for lunch or dinner at least half the time, as a simple place to start improving their diets. But in the disclosure video, the physician related that she had successfully cut down on meat herself, and perhaps not surprisingly, patients rated that physician to be more believable and motivating. So physicians who walk the walk—literally—and have healthier eating habits may not only tend to counsel more about diet and exercise, but also appear more credible and motivating when they do so.

It may make them better doctors. A randomized controlled interventional trial to clean up doctors’ diets, called Promoting Health by Self Experience, found that healthcare providers’ personal lifestyles were directly correlated with their clinical performance. Healthcare providers’ own improved well-being and lifestyle cascaded to the patients and clinics, suggesting an additional strategy to achieve successful health promotion.

Are you ready for the best-kept secret in medicine? The best-kept secret in medicine is that, given the right conditions, the body heals itself. Treating cardiovascular disease, for example, with appropriate dietary changes is good medicine, reducing mortality without any adverse effects. Yes, we should keep doing research, but educating physicians and patients alike about the existing knowledge about the power of nutrition as medicine may be the best investment we can make.

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• Stanford Research into the Impact of Tobacco Advertising
• M A Hyman. The ecology of eating: the power of the fork. Altern Ther Health Med. 2009 Jul-Aug;15(4):14-5.
• N D Barnard. The physician's role in nutrition-related disorders: from bystander to leader. Virtual Mentor. 2013 Apr 1;15(4):367-72. doi: 10.1001/virtualmentor.2013.15.4.oped1-1304.
• M A Hyman. The failure of risk factor treatment for primary prevention of chronic disease. Altern Ther Health Med. 2010 May-Jun;16(3):60-3.
• I Shai, D Erlich, A D Cohen, M Urbach, N Yosef, O Levy, D R Shahar. The effect of personal lifestyle intervention among health care providers on their patients and clinics; the Promoting Health by Self Experience (PHASE) randomized controlled intervention trial. Prev Med. 2012 Oct;55(4):285-91. doi: 10.1016/j.ypmed.2012.08.001.
• E Frank, J Breyan, L Elon. Physician disclosure of healthy personal behaviors improves credibility and ability to motivate. Arch Fam Med. 2000 Mar;9(3):287-90.
• M W Kreuter, S G Chheda, F C Bull. How does physician advice influence patient behavior? Evidence for a priming effect. Arch Fam Med. 2000 May;9(5):426-33.
• M A Kadoch. The power of nutrition as medicine. Prev Med. 2012 Jul;55(1):80. doi: 10.1016/j.ypmed.2012.04.013.
• L Lianov, M Johnson. Physician competencies for prescribing lifestyle medicine. JAMA. 2010 Jul 14;304(2):202-3. doi: 10.1001/jama.2010.903
• M Ezzati, E Riboli. Can noncommunicable diseases be prevented? Lessons from studies of populations and individuals. Science. 2012 Sep 21;337(6101):1482-7.

Images thanks to raedon via Pixabay.