Lifestyle medicine: a new medical specialty?

Thanks for publishing such a thought-provoking article which I thoroughly enjoyed. Hippocrates said so eloquently long before we made medicine a science and business.

“If you are not your own doctor, you are a fool.” Hippocrates

I think we have a desperate need to accept that the current model of medicine will neither be sufficient nor sustainable in years to come. If we have the freedom to utilize the health care system then we should have a responsibility to promote healthy behavior and try to sustain it lifelong. The healthcare system should be used when lifestyle interventions seem to be failing. By medicalising conditions, we foster a false hope that lifestyle diseases can and should be treated at any stage. The government should encourage healthy behaviors and reward champions to drive the message across. No amount of statins can undo the effects of an unhealthy lifestyle without side effects and incurring cost to the taxpayer.

Finland had one of the highest ischemic heart disease-related deaths in the world. Dr Pekka Puska and his team orchestrated a multi-pronged, community-wide approach starting with North Karelia, and within five years it spread to all of Finland. Now the country has witnessed over 75% reduction in the last four decades by dramatically controlling risk factors like high blood pressure, high cholesterol, and smoking.

We as human beings, whether a doctor or a patient, have an obligation to actively seek what is healthy, pursue what is wholesome and get help when we fall short or get sick.

Healthcare is hell. The more we get, the worse we feel. There are 24 medical specialties and 88 sub-specialties. How can we choose, afford, or survive so much healthcare?

There are three kinds of healthcare: traditional medicine, alternative medicine, and complementary medicine. Complementary medicine (integrative medicine) combines traditional medicine with alternative medicine. All three kinds of healthcare use drugs.

Traditional medicine uses prescription drugs, such as antibiotics, tranquilizers, vaccines, and chemotherapy. Alternative medicine uses over-the-counter drugs, such as vitamins, minerals, herbs, and enzymes. Complementary medicine uses both prescription and over-the-counter drugs. So all healthcare uses drugs, and patients have no real alternatives.

Drugs are a mixed blessing. They prolong life, but they also shorten it. This is because drugs are toxins and addictions that fool and block our body's biochemistry. This is why drugs have so many serious side effects and adverse reactions. In contrast, nutritious food, which is free of toxins and addictions, fuels and builds our body’s biochemistry. This is why food is live medicine, but medicine is dead food. So healthcare needs selfcare.

I am writing as one of the first cohort of physicians to sit the Lifestyle Medicine examination in Edinburgh earlier this year, after years of study and practice of lifestyle medicine principles. In my opinion, although lifestyle and nutrition is listed as the initial step in guideline algorithms, it receives, at best, lip service. I believe that part of the reason for this is that physicians themselves are unaware of the profound benefits that can be achieved with profound lifestyle changes, and that part of this unawareness stems from the guidelines lagging behind the literature.

As an example, most physician colleagues who I communicate with are unaware that research showing the reversal of coronary artery disease has been published in top peer reviewed journals for literally decades. One need only google the names of Dr Esselstyn and Dr Ornish to see that this is so. Yet many busy doctors are not inclined to go to primary literature and are satisfied with reliance on guidelines. This is understandable but unfortunately if we as doctors are not informed, we will not be able to offer our patients real choice as to how to prevent or treat the conditions that cause the most morbidity and mortality.

I believe this is an ethical issue for the profession and especially for creators of guidelines and for educators. We should not be leaving motivated patients at the mercy of the internet which is full of unsubstantiated claims regarding nutrition, and we should not abandon less motivated patients because we do not believe they will make changes. I hope all physicians but first and foremost, GPs, will regard the field of Lifestyle Medicine as a natural extension of the evolution of our advice about smoking. We know that it is bad, and we know we have to tell people, and continue to develop ways to shape the environment to encourage choices which promote human health, and to assist patients to move towards making their own educated healthy choices whether by big steps or small. In addition, since all physicians are also patients, or potential patients, we should examine how we can promote our own health through example and never consider that there is an 'us and them' situation. We are them.

In response to the question of whether the field of Lifestyle Medicine should be separate, or integrated into medicine in general, I would like to bring an analogy to Palliative Medicine, which started out as a separate endeavour but which is widely practised within General Practice and becoming integrated into other specialities. Yet, some situations will always require specialist palliative care expertise, there is no contradiction here.