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Lifestyle Medicine

2020 is rapidly accelerating many of the awful trends that plague our overall health. Our sedentary society has never sat around more. Our unhealthy eating habits have taken a turn for the worst. We are no longer using our brains as we sit around watching television. Isolation has often times been mandated. As a result, our bodies and minds are becoming weak. On top of this, mental illness and stress are reaching epidemic proportions.

I am especially fearful for our children, whose developing brains are not getting the knowledge that will allow them to excel in life. Children missing out on education while their brains are nimble and plastic will perhaps be the most devastating long term consequence of the Covid19 pandemic. It has become very clear to me that our society places no value on developing our future generations. We are literally feeding our children trash food and neglecting to educate them. The health of our children is in serious jeopardy!

I am seeing these awful health trends play out in my hospital practice every day. As many of you know, I take care of sick patients in rural hospitals as well as patients at Wander Medicine clinic in Boise, Idaho. Just this week, I have diagnosed type 2 diabetes in a new, formerly undiagnosed patient, every single day. Blood pressures are skyrocketing! People are coming in with systolic blood pressures in the 180 to 200 mmHg range (normal systolic blood pressure: 120 mmHg). Complaints of chest pain have been out of control as well. Chest pain is a red flag word in medicine. We worry about a heart attack in this situation. However, it is more often due to other problems, including anxiety. The number of patients in their 20s and 30s coming in with chest pain has been unprecedented. All of these conditions share one common etiology: a sedentary, unhealthy lifestyle, that lacks purpose, and meaningful relationships. So how is our society responding to this crisis?

We are currently in the age of pharmaceuticals, or pills. I predict that future generations will look back on this age with laughter. I have no doubt that founding fathers like Benjamin Franklin and Thomas Jefferson, would be simply appalled. This is because the way we are caring for chronic diseases is a joke. While our pharmaceuticals drugs can cure some diseases, most notably infections, they are mostly just temporizing measures. They help the symptoms of disease so long as they are taken. However, they provide no cure and when they are stopped, their benefits most often stop with them.

Let’s take a look at type 2 diabetes as an example.

All of the medications we use for diabetes, lower a lab called hemoglobin A1c. This lab measures the amount of sugar molecules attached to red blood cells. As red blood cells live about 3 months, the lab tells us about the average blood sugar over the last 3 months. Lowering hemoglobin A1c is a good thing. It prevents heart and kidney problems, helps things like erectile dysfunction, prevents blindness, and loss of limb. As a result, I use medications like metformin and insulin, which are known to lower A1c all the time in my clinical practice. Using these medications has and continues to help many of my patients.

However, the most powerful, and often curative, treatment for type 2 diabetes is lifestyle changes. Eating less sugar and processed foods along with vigorous exercise can cure diabetes type 2 along with all its co-morbid conditions. So many doctors spend so little time talking with their patients about this. They say things like, "People never change their behavior,"and that "It is a waste of time to spend much time talking about this." To me, this idea is both sad and negligent.

Diabetes has risen to epidemic levels along with the obesity pandemic. Drug companies have taken note and have rolled out numerous new diabetes medicines. Classes of drugs like GLP-1 agonists and SGLT2 inhibitors now flood our medical journals and advertisements. Underwhelmingly, like most new pharmaceutical drugs, these medications provide only a marginal or equal benefit over the medications already in existence. But while metformin usually costs about $2 a month, these new drugs can cost $500 to $1000 a month. Sadly, through programs like Medicare and Medicaid, all of us our collectively paying these obscene prices. We are paying as much as $40,000 a year to treat type 2 diabetes in patients that refuse to make meaningful changes in their life. This is just obscene.

Why would we pay these huge sums of money, for marginal benefits, for people that are unwilling to make lifestyle changes that could potentially cure their disease and all subsequent co-morbidities? Moreover, why are we asking the general public to pay for this?

People talk about how expensive healthy food is. They talk about the barriers to accessing healthy food. The reality is that a very healthy diet and a gym membership should cost < $800/month/person, and that is on the high end. Why are we giving people $40,000 worth of drugs just for their diabetes, every year, that will never fix them. Especially when we have a cheaper cure readily available. One reason is because pharmaceutical companies have profound control over our medical system, our physicians, and our government. But the real answer is our society has lost its way.

When we all pull our heads out of our butts, we will realize that until people start engaging in their own health, they will never get any better. Many doctors say they spend so little time on lifestyle measures because of poor adherence. The reality is that adherence to medication therapies is generally very bad as well, especially insulin! So, why not spend time on the potentially curative less expensive, and long-lasting treatment? I am not saying don’t treat diabetes with medication! What I am saying is stop paying obscene prices for a marginal benefit and let’s shift our focus to lifestyle. Ideally, let’s do it before we are all blind, impotent, legless, and bankrupt. No pun intended if you caught that!

So, what is lifestyle medicine? Well, the idea is very simple. Cut out addictive behaviors that interfere with the positive parts of the rest of your life. Make the majority of your diet healthy, plant-based foods. Stop eating processed foods, fast food, and stop drinking sugar sweetened beverages. Exercise vigorously and regularly. Combine cardiovascular aerobic exercise with resistance or strength training programs. Exercise your brain by constantly learning and challenging yourself. Build healthy relationships with other people, have a purpose, and contribute to society. Lifestyle medicine centers around good food, good relationships, pleasure in moderation, exercising the body, the mind, and purpose. Heart disease, mental health problems, chronic pain, autoimmune diseases, and many other issues can all be helped and sometimes even cured by the above! Change your life today and you will reap the benefits for years to come.

The best healthcare providers make lifestyle and preventative medicine the foundation of their care. When needed, a good practitioner will utilize medications. In some chronic disease states, pharmaceutical drugs can be lifesaving. In acute diseases, medications are often the best course of action. When you combine these things with disease prevention screenings and curative interventions like immunizations, you get Wander Medicine clinic.

At Wander Medicine clinic in Boise, Idaho we try and tie it all together. We combine western acute care and preventative medicine with lifestyle based holistic medicine. We practice evidenced based medicine. This means we use scientific research to support our decisions regarding your care. Good evidence does not just come from western medicine though. These days, alternative medicine disciplines like naturopathy, functional medicine, traditional healing philosophies, and many more health genres also have good studies supporting certain parts of their practices. Wander Medicine seeks to combine the best of every medical discipline, to bring you a holistic approach, grounded in science!

Good food, vigorous exercise, active learning, pleasure in moderation, and purpose all require more explanation. If you would like to learn more about these topics, check out the Wander Medicine blog.

Rise above the health issues preventing you from living the life you want to live! As time is our most precious resource, I recommend starting immediately.

Thanks for reading!

Bill Brandenburg, MD

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