Lifestyle is Medicine - Naturopathic Approach

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Imagine that you are or a loved one is recently diagnosed with a medical condition; let’s say hypertension. Since you are deeply concerned, a family physician is consulted, who prescribes an antihypertensive (e.g. lisinopril) and a statin to address elevated cholesterol levels that was found on bloodwork. Some time later, during a follow up-consult with a cardiologist, you are told that a bypass surgery is recommended due to a narrowed coronary artery (blood vessel nourishing the heart). Desperate to avoid surgery, you go to another doctor. This particular doctor has an interesting recommendation for you: He suggests that you shift your diet to a whole-foods, plant-based diet.

I have a question for you: In the above scenario, which of the three doctors gave you medicine? In most people’s minds, only two of the three: The one who prescribed the antihypertensive and the one who recommended surgery. Why? Because in the minds of most individuals, medicine is composed of pills, tablets, injections, and surgeries, whereas vegetables, fruits, dumbbells, and sleep are not. However, in this brief article, I want to argue that how we live our life is also medicine. Lifestyle is medicine.

Disease Burden Has Changed in the Past 200 Years

The year 2012 marked the 200-year anniversary for the New England Journal of Medicine (a very well-respected medical journal). To celebrate, the journal wanted to see how the content of the journal had evolved over the years. So, it compared changes in what scientists and doctors were writing about in the early 1800s, early 1900s, and in the 2000s. In the 1800s, they found that doctors were concerned about diseases like spina bifida, epilepsy, and rabies. They were also writing about fainting spells, gunshot wounds, and even cannonball injuries. Consumption, diarrhea, and pneumonia were major killers, but teething, worms, and even “drinking cold water” caused death as well back in those days.^[1] One hundred years later, in the early 1900s, the leading concerns were conditions like tuberculosis, gonorrhea, syphilis, diphtheria, measles, pneumonia, scarlet fever, and typhoid. Interestingly, Massachusetts still had a leper colony at the time as well.^[1] However, by the end of the 20th century, heart disease, cancer, diabetes, noninfectious airway diseases, etc., were center-stage in the medical journal.^[1] The authors of the report also noticed a shift in what was documented as the leading killers in America. The leading killers in 1900 were pneumonia, tuberculosis, and gastrointestinal infections, but in over 100 years later, in 2010, they were conditions like heart disease, cancer, noninfectious airway diseases, cerebrovascular diseases, Alzheimer’s, and diabetes.^[1] This is quite consistent with other data. In 2018, the Journal of the American Medical Association (JAMA) reported that the leading killers in America were diseases like ischemic heart disease, pulmonary cancers, chronic obstructive pulmonary disease, Alzheimer’s disease, colorectal cancer, diabetes, and stroke.^[2] Do you notice a shift, a change, in the nature of diseases over the past 200 years? The answer should be an absolute: “Yes.” Diseases have shifted from mostly infections to, now, those caused mainly by poor lifestyle habits such as how we are eating, sleeping, moving, and stressing. The leading risk factors are things like poor diet, tobacco use, high blood pressure, and high body-mass index, which are related to our lifestyles.^[2] In fact, the World Health Organization estimates that by the year 2020, two-thirds of all diseases will be the result of lifestyle choices.^[3]

Medications Still Our Primary Solution

Though the nature of diseases has shifted, the practice of medicine practice has not changed much. We used synthetic nostrums and concoctions in the past until more sophisticated pills, injections, and surgeries came along, and these have remained as our main modalities to this very day. In the United States, 68% of men and 82% of women in the 18–44 age bracket are using medications. This number jumps to 81% and 89% of midaged men and women. And among seniors, it is above 90%.^[4] 44% of male seniors and 57% of women seniors are on five or more drugs. More than one in ten are on 10+ drugs.^[4] This is a travesty. A report from the Canadian Medical Association Journal says that prescription drugs are placing a major burden on the public health system in Canada, amounting to billions of dollars. Do you want to take a guess which drugs are estimated to be the greatest cost to health-care in Canada? Number one are antihypertensive drugs, costing the health-care system about 1.4 billion dollars. Number two are cholesterol-lowering drugs. Number three are biologics for inflammatory conditions. Others on the top ten list are acid-lowering drugs, noninsulin diabetes drugs, insulin, antidepressants, antipsychotics, and opioids.^[5]

The Scales Are Not Tipping

Do you notice that most of the drugs mentioned above are used to address diseases caused by a poor lifestyle? Hypertension, diabetes, high cholesterol, etc. are, in most cases, caused by a poor lifestyle. This may explain why patients are not doing very well. You would think that, with all the money we are throwing at these diseases, people would be doing better, but that is simply not the case for many. On the contrary, the more common experience is one in which patients have more drugs added to their regimen, and many are told to take such drugs for life. Though we have a mountain of drugs to address heart disease, cancer, hypertension, and diabetes, these diseases and the burden they cause are still outweighing all our pills, tablets, injections, and surgeries, and may I add botanicals, vitamins, minerals, and all the other supplements that naturopathic doctors utilize as well.

Turn Off the Faucet

Why is this the case? It is because many of these medications do not address the root-cause of the disease. This can be understood in the context of an overflowing faucet. Imagine that, in your home, a faucet is running and the water is all over the floor. In this situation, would it be any good to mop the floor? Obviously not. Yet, this is precisely what our current medical system is doing. Many medications are merely mopping up the symptoms without turning off the faucet of poor lifestyle habits. Drs. Mark Hyman, Dean Ornish, and Michael Roizen stated it very well in their wonderful paper on lifestyle medicine when they said: “Disregarding the underlying causes and treating only risk factors is somewhat like mopping up the floor around an overflowing sink instead of turning off the faucet, which is why medications usually have to be taken for a lifetime.”^[6] This statement reminded me of the medical care given to my father. His physician told him to take statins for the rest of his life. Yet, he never talked to dad about changing his diet that still included of processed products, cheese, and animal-based foods. Such a diet can fuel elevated cholesterol, yet neglecting all of this, my father was simply told to take medications to deal with the symptom of elevated cholesterol. This is a prime example of mopping the floor without turning off the faucet. Numerous cases can be put forward to demonstrate this unfortunate state of affairs in the way many view medicine. Common examples are patients being told to take antihypertensives and glucose-lowering drugs for life without being given proper advice and counseling on shifting the diet away from processed, high-sugar, and animal-food diets to more whole foods, plant-based diets, and physical activity that meets the current Canadian physical activity guidelines of approximately 150 minutes of moderate-to-vigorous aerobic activity per week.^[7] If we continue to try fighting lifestyle-related diseases without addressing the underlying cause of a poor lifestyle, we as doctors—or worse yet: the patients themselves—will forever be kept mopping up the floor.

Conclusion

The landscape of diseases plaguing society is shifting, and thus a corresponding shift needs to take place in the way medicine is practiced. It is high time that we diffuse ourselves of this mindset that medicine consists only of pills, tablets, injections, and surgeries. The pharmaceutical companies should not get a monopoly on the term. So, going back to the original illustration we began with at the start of this paper, let us remember that pills, tablets, injections, and surgeries are indeed part of medicine, but let us never forget that lifestyle changes are also medicine as well. A great many of the diseases in our world are the result of lifestyle choices. If lifestyle is the cause, then certainly lifestyle must also be part of the medicine.