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The Secret I Tell All My Patients

Alex McDonald, MD

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June 30, 2021

When I meet a new patient, I often take a moment to get to know them, and I tell them about myself and my personal and professional philosophy and guiding principles as their new family physician. As part of this initial visit, I always tell them, "I have a medical secret. It might not quite be a fountain of youth, but it will do more for you than any pill or medical procedure ever could."

Patients often give me an inquisitive (or maybe skeptical) look as if I'm about to sell them some crazy pyramid scheme. Or maybe they think I must be getting a kickback from a company that produces some amazing new treatment. I allow the suspense to build for a moment, and then I say, "Lifestyle medicine — a healthy, plant-based diet; 30 minutes a day of physical activity; daily stress reduction; and 8 hours sleep each night — will do more for you than any medication or treatment in the world."

At this moment, any tension is released, and often there are smiles and even laughter. From this moment forward, not only have I developed a great rapport with my new patients, but they also understand the foundation that underpins virtually all of my medical decision-making and advice.

Don't get me wrong. I certainly prescribe traditional medication when indicated. However, I also tell patients that if they make the right changes, they may be able to stop taking insulin or blood pressure medication.

I often tell them the story of my patent, J.D., a 65-year-old man with hypertension, prediabetes, obesity, hyperlipidemia, and sleep apnea. He used a continuous positive airway pressure, or CPAP, device nightly, which he hated, as well as five different medications. After we discussed lifestyle medicine and how it could help him, he started walking 60-90 minutes daily. He also stopped eating bread and other processed foods. During the course of a year, he lost more than 50 pounds and was able to stop taking most of his medications and stop using the CPAP.

So, what exactly is lifestyle medicine? Lifestyle medicine centers on a whole-food, plant-based diet; physical activity; adequate rest and recovery; and stress management and social connection to not only promote health but also to treat and reverse disease.

Most medical students and the general public have a poor understanding of these as core principles to prevent and treat disease. Part of the problem is that we do not have a healthcare industry in this nation; we have a disease care industry. Our patients are inundated with direct-to-consumer drug advertisements for the latest blockbuster drug, and we have a traditional medical school curriculum that spends an inadequate amount of time educating future physicians on the importance of lifestyle — not only for their patients' health but for their own as well.

From an economic point of view, our focus on high-tech procedures and the latest pills is literally breaking our country's (and individuals') piggy bank. Yet, what do we have to show for it? Some of the worst health outcomes among members of the Organization for Economic Co-operation and Development, with astronomical rates of obesity and type 2 diabetes.

Health spending is on an unsustainable trajectory, and we are headed for disaster unless the incentives and messaging aimed at patients dramatically changes. This is where I see lifestyle medicine as part of the solution.

According to the American College of Lifestyle Medicine, at least 80% of healthcare spending in the United States is tied to treating chronic disease such as heart disease, stroke, type 2 diabetes, obesity, osteoporosis, and several cancers, all of which may be rooted in poor lifestyle choices. The key is to treat the underlying cause of disease rather than just symptoms. Furthermore, there is an expanding body of peer-reviewed literature that supports lifestyle medicine as evidenced-based.   

There are huge structural and institutional hurdles to overcome to achieve ideal lifestyles for all. Individual counseling and motivational interviewing are important; however, we ultimately need health and institutional policies that make the healthy choice the easy choice. For example, we could design buildings — and even communities — in a way that would encourage physical activity such as walking or taking the stairs.

We should also think about the way our federal government subsidizes the food industry. Why do we offer farmers subsidies for corn — resulting in cheap, highly processed, and carbohydrate-dense foods that contribute to obesity and diabetes — when we could be making healthy fruits and vegetables more accessible and affordable?

Those are just two examples, but the point is that we need to think big picture and long term to truly move the needle.

The AAFP has a growing lifestyle medicine member interest group where family doctors can share ideas as well as learn from others who are passionate about ways to incorporate lifestyle medicine into practice.

My favorite part of lifestyle medicine is that it is truly patient-centered. It puts the ball in patients' court to truly take ownership of their health. Lifestyle medicine is not a panacea and it's not a replacement for all medications or procedures. However, it can get us a lot closer to the triple aim of improved health, reduced costs, and improved patient satisfaction.

I guess my secret is out. Feel free to pass it on.

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About Dr Alex McDonald
Alex McDonald, MD, is a former professional triathlete and a family and sports medicine physician. His professional interests include exercise and physical activity, point-of-care ultrasound, health policy, and preventive medicine.
McDonald holds degrees from Connecticut College, the University of Vermont Larner College of Medicine, and Duke University.
He has three children and two dogs. He enjoys running, riding his bike, cooking, coffee, and 8 PM dance parties with his kids. Connect with him on Twitter: @alexmmtri

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