A Zombie Story Imagine for a moment that massive numbers of people have been reported to be senselessly walking off cliffs around the country. In desperation, ever larger hospitals with massive emergency rooms are built at the bottom of the cliffs. If this story was from a grade B zombie movie, you would have little to worry about. Unfortunately, lifestyle is effectively setting up many Americans for an analogous end of life scenario. In this imaginary story, a national response could be public education about the dangers inherent in walking along cliffs and perhaps fences for especially dangerous locations. In America today, the cliff people are walking off of goes by the name heart disease, cancer or stroke. Just as in the grade B movie, the solution promoted today is more hospitals, more emergency rooms, and more healthcare workers, along with more insurance options to pay for the growing cost. While it’s unlikely that expected changes in public policy will improve this situation for the average person, there is hope for those willing to educate themselves about the merits of an evidence-based lifestyle. Sadly many will miss this vital message in the tidal wave of daily misinformation. Valid scientific evidence usually gets garbled by the news media or intentionally misrepresented by vested interest. Even more unfortunate is the extent to which the media and government are compromised by influence from the agribusiness industry. The 2014 movie Fed-Up is recommended to anyone having doubts about why the Government’s attempts to provide better guidance routinely buckles under food industry pressure. Many are not aware that as far back at 1977 Congress held hearings and proposed legislation to combat lifestyle-related conditions like heart disease, cancers, stroke, high blood pressure, obesity, diabetes, and arteriosclerosis. The recommendations in the select committee’s report at that time suggested less cholesterol, less refined and processed sugars, and more complex carbohydrates, and fiber. The recommended way of accomplishing this was to eat more fruits, vegetables, and whole grains, and less high-fat meat, egg, and dairy products. The committee's recommendations triggered strong negative reactions from the cattle, dairy, egg, and sugar industries. The result was predictable. Valid scientific recommendations were swept under the rug and for each year since 1977, there has been an increase in diet-related diseases. The movie Fed-Up provides much of the story and is available at the local library. If looking for a movie that can help your family get motivated to change diet, Fed- Up and Forks Over Knives both make good choices. When I began my career, the path I chose was one that taught the skills needed for dealing with acute care needs. Like most other doctors, I learned the skills needed to help when a person was suffering. Like most other of physicians, I received little lifestyle education in medical school. When we did study a lifestyle subject like nutrition it was focused on the classic nutrition deficiency diseases (rickets, scurvy, beriberi, pellagra, etc.) that most doctors never see outside of an undeveloped country faced by starvation. The standard of care was to recommend a balanced diet and to provide medications to alleviate symptoms as people aged. Today, the problem most people face has shifted to diseases with lifestyle as their root cause. In a world of plenty where no one misses a meal, snack foods are in abundance, and hardly anyone walks a mile, expanding waistlines and metabolic syndrome have become the norm. Unfortunately, the dissemination of valid evidence-based information, public education and public policy have not stayed abreast of these changes. Companies that sell food want their customers to eat more. As masters of the art, they know quite a lot about how to do it. By taking a page out of strategies used to hook people on tobacco, the food industry has mastered quite a few food addiction skills. With the aid of added, sugar, salt, oil, flavorings and hundreds of other additives the saying “You can’t eat just one” isn’t just a nice jingle, it’s a scientific fact. Out of about 600,000 foods available in America, over 80% have added sugar. Unfortunately, on food labels, the sugar content is still difficult to determine due to very successful industry lobbying efforts. Next time you read a food label, notice that the percent of sugar is not listed. You may thank the food industry lobbies for that oversight. It’s disappointing that, until about one and half years ago the best nutritional advice I could offer most patients was to eat less fat, avoid too much salt, and eat more fruits and vegetables. While this was generally good advice, I had no knowledge that other diets could prevent and even reverse many common chronic diseases. In fairness to older doctors, much of the data behind the newer recommendations remained controversial until recent years. Efforts over the last 15 years by the American College of Lifestyle Medicine to disseminate evidence-based information is making a difference. To pioneers like Dr. Ornish, Dr. Campbell and Dr. Esselstyne that persisted in publishing their research, I am grateful. When I talk with my patients (you) it’s not unusual to hear about parents or grandparents that died in their 40s or 50s from a heart attack. I also hear about those that survived with severe disabilities. In the past, this genetic history was usually a reason for fear that trouble lay ahead. Today we know that most of the inherited genetics that manifest as a chronic disease has a strong correlation with lifestyle. Habits passed from generation to generation are often what activate a genetic characteristic that otherwise would have remained dormant. There is some truth to the saying, “It’s not that heart disease runs in your family it’s that nobody in your family runs.” While running is not necessarily the missing element, we know with certainty that movement is a significant factor in determining quality of life and longevity. Until recently there were very few medical schools that promoted the importance of exercise and nutrition. Making matters worse, most doctors that had the good fortune of attending the few schools that offered lifestyle education later found the insurance reimbursement system was unlikely to pay for the time needed to educate patients. Today, this remains the situation for most doctors. Personally, I found this an unacceptable situation that guided my decision to make changes that would allow me to provide time for meaningful medical care. Not wanting to wait for my medical profession to catch up with the advances available I chose to become board certified in the emerging medical specialty called lifestyle medicine. If there was a defining moment in my decision to change how I practice medicine, it was probably at a conference I attended along with other doctors from Loma Linda University’s medical school. Before that, my suspicion had been peeked by patients that had made remarkable improvements. Patients using food as medicine for relief from GERD, hypertension, diabetes, sleep apnea, migraines and more were anecdotal but still compelling. It’s hard not to be impressed when a patient loses 50 pounds and no longer has GERD. Equally remarkable are patients with diabetes that can give up insulin. For those accustomed to the more traditional passive medical model that seldom requires effort beyond opening a prescription bottle, active participation in their healing often seems revolutionary. Still, I appreciate that change takes time and for many progress can only take place in small steps. For these patients, I remind you that progress is the goal, not perfection. I try to honor the need that each person has to make my recommendations work within the constraints of their ongoing lives. Today, for a person considering a recommendation for a non-urgent procedure from a specialist, I often recommend first trying a lifestyle change. Fortunately, each year there is a few more specialists being trained in lifestyle alternatives. The change has been slow but encouraging. In reference to why he follows a plant-based whole food diet, Dr. Kim Williams, President of the American College of Cardiology said, “I don’t mind dying, I just don’t want it to be my fault.” Case studies of patients avoiding stents and open heart surgery through lifestyle change are becoming more common. I now urge patients facing these issues to read “Prevent and Reverse Heart Disease” by Dr. Caldwell Esselstyn and if still not convinced to schedule an appointment with his clinic for an evaluation. Even more encouraging are patients that also report recovery from hypertension, arthritis, and sleep apnea. For many, this is accompanied by a reduction or elimination of medications. I still encounter resistance to change and appreciate that long practiced habits take time to change. For those needing more confirmation, I suggest books from my lending library or from books that are often available from the local library. Interestingly, I still find some that can’t believe disease reversal is possible by simply changing their lifestyle. Granted, for those having lived with the belief that genetics is destiny, it’s quite a concept to digest. As I get better at motivational counseling I hope to bring around even those most challenged by changes. With luck, only patients with unstable life-threatening conditions will be left for the surgeons. One goal I have is a mentoring program supported by volunteers that help people ready for change make smart plant-based whole food selections. Many need help understanding the basic concepts, reading food labels, new ways of cooking and with the challenge of a pantry makeover. It’s not just abandoning old habits, it’s about knowing which foods are nutritious, how to engage the family in the transition, and how to prepare food using new recipes. Ultimately, the goal is to avoid illness rather than working to restore health. I look forward to a day when all medical service providers are trained to provide lifestyle medicine as an option for the first line of therapy. Management of chronic diseases without addressing the root causes is not making America healthier. Despite many successes in alleviating symptoms, the most common treatments for chronic conditions are not being cured. Compounded by two-thirds of Americans now being overweight, the national healthcare burden is projected to exceed available resources in future years. Fortunately, the opportunity for positive change remains if public policy can be focused on the root cause. While my one voice can’t change public policy, I can teach what I know to those that will listen. Each day, I’m delighted to find more of you encouraged by the possibilities. I am even more delighted by the results I have been seeing. Nancy Neighbors, MD Huntsville, Alabama |