"The Best Kept Secret in Medicine"
Even though the most widely accepted, well-established
chronic disease practice guidelines uniformly call for
lifestyle change as the first line of therapy,
physicians often do not follow these guidelines.
Yet lifestyle interventions are often more effective
in reducing heart disease, hypertension, heart failure,
stroke, cancer, diabetes, and deaths from all causes
than almost any other medical intervention.
Some useful lessons may come from the war on tobacco,
Dr. Neal Barnard wrote in the American Medical Association’s Journal of Ethics.
When he stopped smoking himself in the 80’s,
the lung cancer death rate was peaking in the U.S.,
but has since dropped, with dropping smoking rates.
No longer were doctors telling patients
to give their throat a vacation by smoking a fresh cigarette.
Doctors realized they were more effective at counseling patients
to quit smoking if they no longer had tobacco stains on their own fingers.
In other words, doctors went from being bystanders
—or even enablers—
to leading the fight against smoking.
And today, he says, plant-based diets
are the nutritional equivalent of quitting smoking.
If we were to gather the world’s top
unbiased nutrition scientists and experts,
there would be very little debate
about the essential properties of good nutrition.
Unfortunately, most doctors are nutritionally illiterate.
And worse, they don’t know how to use
the most powerful medicine available to them: food.
Physician advice matters.
When doctors told patients to improve their diet
which was defined as cutting down on meat, dairy, and fried foods,
patients were more likely to make dietary changes,
when their doctors advised them.
And it may work even better if doctors practice what they preach.
Researchers at Emory randomized patients
to watch one of two videos.
In one video, a physician briefly explained her personal
healthy dietary and exercise practices
and had a bike helmet and an apple visible on her desk,
and in the other, she did not discuss her personal practices
and the apple and bike helmet were missing.
For example, in both videos the doctor advised the patients
to cut down on meat, to not usually have meat for breakfast,
and having no meats for lunch or dinner at least half the time
as a simple place to start improving their diets,
but in the disclosure video, the physician related that she
had successfully cut down on meat herself,
and perhaps not surprisingly, patients rate that physician
to be more believable and motivating.
So physicians who walk the walk—literally—
and have healthier eating habits,
may not only tend to counsel more about diet and exercise,
but also appear more credible or motivating than when they do so.
It may even make them better doctors.
A randomized controlled intervention trial
to clean up doctors' diets called Promoting Health by Self Experience
found that healthcare providers’ personal lifestyles
were directly correlated with their clinical performance.
Healthcare providers' own improved wellbeing, and lifestyle
cascaded to the patients and clinics,
suggesting an additional strategy to achieve
successful health promotion.
Are you ready for the best kept secret in medicine?
given the right conditions, the body heals itself.
Treating cardiovascular disease, for example,
with appropriate dietary changes is good medicine,
reducing mortality without any adverse effects.
Yes we should keep doing research,
but educating physicians and patients alike
about the existing knowledge about the power of nutrition as medicine
may be the best investment we can make.