Lifestyle medicine is the use of daily activities to improve health and quality of life rather than relying on drugs and medical procedures. My emphasis is on diet but I have also addressed exercise in past blogs. Another well documented approach is meditation.

Commonly used meditation techniques come from either the Vedic (Hindu) or Buddhist traditions. Buddhist approaches include mindfulness and focusing on something constant like breathing. The Vedic tradition uses a mantra, either aloud or just in thought. Both approaches have millions of devotees and millennia of history with successful application. I have tried both approaches over the past many decades but have never developed a long term regular practice.

In the early 1980’s I took the Transcendental Meditation(TM) course and I used that technique regularly for six months or so but drifted away from regular practice. Our next door neighbors in Kauai are both long time TM teachers and one of them recently gave me a refresher session on TM practice and suggested a book, Super Mind, which I’ve read and will discuss in a subsequent blog.

I recently received an email from a friend who was overweight, probably technically obese:

“At the beginning of the year, I was overweight, I was feeling bad ,I knew I had to do something . even though i was doing excercise , my blood pressure remained high and my glucose level was out of normal range, I was struggling to loose weight.
I read your blogs taking about your son John, losing weight with fasting, so i kept reading all your blogs about health and diet.

This is what I did :

I changed my diet, I incorporated more vegetables, cut back on sugar and carbs, no sodas, I started reading more about
fasting and prediabetes, so i started doing intermitent fasting, excercising regurlarly, since i have my electric bike, makes it more easy to do it.

these are my results :

In the last 4 months I have lost almost 30 pounds, my blood pressure is back to normal (120/80) and my glucose levels in normal range .
I have 20 more to go.
I read in many articles that fasting can put your body into self healing and self repair, my biggest miracle that i experienced is the partial recovery of hearing on my left ear,
it has been dead for the last 6 years, now i can hear better, perhaps 50 % .”

Recovery of hearing may surprise many people but this is not unusual for someone who is eating a terrible diet and corrects to healthy food. Microvascular disease is the result of poor blood vessel health and capillaries constantly clogged with fat globules. If blood is drawn after a high animal fat meal, and it is centrifuged to measure the hematocrit, the naked eye can see a big clump of fat on top of the red cells. The effect in capillaries can be seen with a microscope in living animals and people. Red cells clump together and blood flow slows to a small fraction of normal, depriving tissues of oxygen and other nutrients. Common effects include vision loss, hearing loss, vertigo, and impotence which can be permanent after a while.

I’m not into gifts for myself, Christmas presents included, but this email was one I really liked.

Happy Holidays to all and Mele Kalikimaka from Deb and me.

Deb and I are in the middle of two months on Kauai where we are enjoying the weather, scenery and long walks through beautiful countryside, mountains and beach. People are healthier here because of an outdoor lifestyle providing lots of vitamin D and many easy, pleasant opportunities for exercise. Many also eat well- lots of local fruits and vegetables, more fish than meat.

Sadly, native Hawaiians are behind the curve, still relishing Spam and other unhealthy foods that replaced their traditional diet after western colonization. Obesity and resultant diabetes, heart disease, stroke, cancer and orthopedic problems abound because they have not embraced Hawaii lifestyle, their birthright. Westernization has meant short lives and poor health as well as loss of power and land for Hawaii’s natives. Hawaiian leaders have finally recognized the major lifestyle issues decimating their people. Several Hawaiian politicians, suffering from obesity and diabetes themselves, publicly embraced a return to a vegan diet comprised mainly of taro and other Hawaiian foods. They’ve lost weight and their diabetes and proclaimed it to their constituents and pacific islanders everywhere. Eric Adams, the African-American borough president of Brooklyn, has done the same but eating whole plant foods available in Brooklyn rather than Hawaii. He’s publicized his reclaimed health and energy, encouraging his constituents to do likewise. Westernized black and asian peoples suffer from the same health problems as Hawaiians as they abandon traditional foods for the rich western diet. Their genetics often make them much more susceptible to the diabetes now ravaging third world countries as they become wealthier and more westernized.

Schools here now emphasize healthy foods and many have programs teaching gardening skills at a school garden. Local community centers have programs in planning and preparing healthy meals. Community gardens are also flourishing, providing information, skills and access to produce which would otherwise be prohibitively expensive in a place where most food is imported in spite of huge tracts of unused farmland and a perfect climate for growing most things.

Cafes, coffee houses, fast food chains and food trucks provide moderately priced meals for locals and tourists. Most of this is still the garbage which addicts to fat, sugar, salt and destroys health.

New York Times obituaries have been an important source of information for me over the years. The writings of Jiddu Krishnamurti, an Indian philosopher and teacher, have provided me with a new way of looking at the world after I learned about him and his work in a NYT obituary. I discovered that the proprietor of a small Scottish country inn, a laird whose family had been local nobility for centuries and who kindly gave me some of the scotch whiskey he had distilled, then taught me the correct way to drink and enjoy its flavor, was the model for James Bond because of his daring WW II feats as a spy. The Times did some soul searching this past year as more and more stories of abuse of women surfaced. They concluded that women who had accomplished significant things had often been ignored in their obituaries section ever since the paper was established. Recently an amazing woman who died in 2017 was honored with a long obituary.

Lisa Schwartz was a professor of medicine who, with her husband, was co-director of the Center for Medicine and Media at the Dartmouth Institute for Health Policy and Clinical Practice, part of Dartmouth College’s Geisel School of Medicine. There they trained hundreds of journalists to become more skeptical about claimed scientific breakthroughs and miracle cures, and to better communicate the benefits and risks of medical tests and treatment. They concluded that medicine has become a huge business where the dominant people, physicians, are well trained in procedures and prescribing but not in appropriateness, side effects and alternatives, especially lifestyle medicine. Her work was endorsed and supported by the NIH and other authorities.

A link to her obituary:

A Utah orthopedic surgeon, Thomas Rosenberg, is a well-known inventor of widely used orthopedic devices, but his passion is long distance running. 15 years ago he developed knee pain which limited his running. X-rays and MRI confirmed degenerative changes with joint space narrowing and bony spurs. Rosenberg wondered if diet was a possible cause since it has been well shown to precipitate chronic inflammation and disease elsewhere in the body. He switched to a whole food plant based diet and his symptoms gradually abated even though he continued running. Over the years his radiographic changes have remained stable- his joint disease is not progressing, and his nutritious anti-inflammatory diet eliminated his pain.

Since then Dr. Rosenberg has advocated dietary change to all his patients and has started an organization, Plant-Based Utah, to spread the word about the miraculous effects of diet for most chronic diseases including chronic spine and joint disease.

Some of his patients listened and changed eating habits. In a recent presentation he showed images and videos of dramatic improvement. As chronic inflammation subsided and blood flow improved with a healthy diet, CRP, blood sugar and cholesterol dropped; MRI evidence of bony metaphyseal inflammation disappeared. Patients with severe pain associated with bone-on-bone arthritis (evidence of no remaining protective cartilage) often became asymptomatic. Those who required joint replacement healed faster and better. Chronic osteoarthritis can still occur after injury or severe malalignment but most can be prevented by a healthy diet. Symptoms are often improved or eliminated.

Rosenberg recognized that carpal tunnel syndrome is also associated with chronic inflammatory changes leading him to try diet change in these patients. They got better without surgery!

He uses the carotenoid index to demonstrate to patients how low their intake of healthy foods is, and he finds it helps to convince them to eat whole plant foods. He also notes that, unfortunately, obese patients who undergo gastric bypass surgery can no longer raise their carotenoid index after switching to a healthy diet. In addition to lowering calorie absorption, this surgery also blocks absorption of critical vitamins, minerals and micro-nutrients.

Healthy bones and joints are totally dependent on a nutritious diet which gives them a good blood supply and protection from chronic inflammation. In addition, regular load bearing exercise and an adequate intake of vitamins D, K and C plus calcium and magnesium are critical. Vegans typically have excellent blood supply and low chronic inflammation as shown by low CRP levels, but not uncommonly they have weak bones due lack of exercise or one or more critical vitamins or minerals.

Reviews of the degenerative diseases, spinal disc herniation and osteoarthritis, show some interesting correlations. Those often cited are obesity, genetics, prior injury, overuse and certain drugs. But there are other clues that something else is going on.

Patients with these conditions often have high blood sugar; high CRP (C-reactive protein, a marker for chronic inflammation); a low carotenoid index (measure of amount of healthy whole fruits and vegetables eaten.) MRI of joints in these patients show inflammatory changes in metaphysical bone (the bone adjacent to joints.) Anthropological studies show little evidence of these diseases in people from prior times, but few lived into old age. Studies of current primitive societies and third world populations show little chronic joint disease even in older people.

Those with sciatica or spinal disc disease typically have much higher rates of vascular disease and high cholesterol. Discs and spinal nerves are very sensitive to poor blood supply and chronic inflammation. Blocked spinal arteries lead to degeneration, disc rupture and pain. In western societies this vascular disease now starts in childhood as does early disc degeneration.

Patients with joint pain who have an MRI are typically shown to have cartilage loss and irregularity, sometimes a torn meniscus. An obvious approach has been arthroscopic repair of a meniscus or cartilage irregularity. Some improved but results were disappointing. Then science intervened after hundreds of thousands of these procedures. A group of patients with these MRI diagnoses were randomized to arthroscopic repair or a sham procedure where the patient had an incision and some probing but no repair. Surprise– no difference in results. The patients’ pain was not due to an arthroscopically correctable cause of joint disease. In spite of this surgeons continue to perform these procedures often citing personal experience to justify an expensive procedure which has been proven to be ineffective. The apparent answer then is analgesics, anti-inflammatory drugs, don’t use the joint, or “suck it up and live with it” until you have the joint replaced. But that’s wrong!

In past blogs I have discussed auto-immune diseases including some of the arthritides like rheumatoid and psoriatic, but the large bulk of chronic skeletal disease is the so-called degenerative variety including osteoarthritis and spinal disc disease. This group of diseases is a major cause of disability, surgery and medical expenses, currently at 20% of medical costs but increasing rapidly in our aging population. Projections of need for hip and knee replacement are staggering, and these procedures are expensive, typically a total cost of $50,000.

Joint replacement has a high success rate but many do need modification or even repeat replacement. Spine surgery for disc disease has a very high failure rate. In fact, a leading cause of spine surgery is prior spine surgery. Altered biomechanics after surgery leads to failure of adjacent discs and need for more surgery.

Reasons cited for this explosion of degenerative joint diseases are: more older people; more inactivity; more obesity. All are true but there’s much more, and it’s something amenable to remedial action as I’ll discuss in a future blog.

The press loves medical “miracles,” often due to a new drug or elaborate new procedure which trumpets the power of modern medical science. Sometimes these are wonderful advances; more often they affect a few people at great expense, frequently with devastating side effects.

In recent years I’ve seen hundreds of medical miracles which would have been described by the press in glowing detail were they due to a new drug or procedure, not because of a simple, cost free change of diet. Unlike miracle drug cures of chronic disease, effective response to diet is the rule, almost without fail, for many life threatening or disabling diseases. While working my whole career in university medical centers I had never seen these miracles, or even been aware that they were common in the field of lifestyle medicine.

Our society is greatly influenced by physician advice and behavior. Only when hospitals banned smoking in the early 1990’s did smoking rates start to plummet nationally. The medical profession has to lead in health matters.

Our medical education model is over 100 years old and many commentators have declared it outmoded and sub-optimal. We concentrate on curing disease, not producing health, and the drug industry provides most of the funding med school professors use for their research and career advancement. In recent years big pharma has increased their dominance of medical education by designing a system which enriches researchers and academic leaders. The recent exposure of pay-offs to the top people at Sloan-Kettering in New York (one of the leading cancer research, training and patient care hospitals in the world) is just the tip of the iceberg. The same is true at virtually every research and training institution in the United States. Since over 80% of health care dollars go to treatment of chronic disease a medical system which prevents and treats these diseases through lifestyle is totally unacceptable to big pharma and the leading academic physicians. The Hippocratic oath’s “prevention is preferable to cure” is totally ignored.

The result is medical training where:

      71% of incoming medical students think nutrition is important but only 46% of those graduating do.

      Cardiology training requires no education in nutrition even though the only proven way to prevent and cure atherosclerosis, the cause of heart attacks, is with diet.

      Medical licensure exams have no questions on nutrition.

      Most medical schools ignore the minimal requirement of 25 hours of nutrition training; those that do offer nutrition usually offer irrelevant material.

      94% of practicing physicians now (at last) believe nutrition is important for health but only 14% feel they have any ability to help patients in this regard.

What a mess! If patients seek out practitioners of lifestyle medicine our model will change. Supply and demand works in our system even if the monied interests of drug and other businesses are paying off institutional leaders.

Saray Stancic is an MD internist who had to learn about treating chronic disease the hard way. While a senior resident, age 28, she was diagnosed as having multiple sclerosis with severe symptoms. The top doctors at her university medical center took over her care, treating her with multiple drugs which were very expensive and had terrible side effects. After eight years her disease was progressive so that she needed crutches to get around in spite of her ten medications which were tormenting her with side effects. She came across an article in a little read medical journal which reported a group of MS patients who felt much better if they ate blueberries daily. Desperate, she searched the medical literature for connections between diet and her disease. She was shocked to find quite a few, including research published decades earlier in a top journal, The New England Journal of Medicine, which showed a strong correlation between diet and MS (the work of Dr. Roy Swank which I have reviewed in an earlier blog.) Her literature search discovered other work confirming this strong relationship between lifestyle, especially diet, and development and progression of MS. Armed with this, she went to her kindly, paternal neurologist who told her that MS was genetic and she was wasting her time searching for miracles. Dr. Stancic returned to research done on MS to find that only 14-33% of monozygotic (identical) twins got MS if the other twin had it despite identical genes.

What’s happening? As with all genetically caused chronic disease including cancer, epigenetics, the environment the genes are bathed in, determines if the genes are expressed and the disease actually occurs, progresses or improves.

Dr. Stancic stopped all her medications, changed to a totally whole food plant based diet, stopped working extra long hours, and slowly added exercise (she had been told not to exercise) as she could tolerate it. Very gradually she got better and was able to run a marathon seven years later. She changed her specialty from infectious disease to lifestyle medicine and was one of the first physicians board certified in this new field. She continues symptom free and healthy treating patients and teaching at her local medical school. Proper treatment of their own chronic disease is difficult for physicians since, even more than most Americans, they have been taught that all disease, chronic or acute, is best treated by pills and surgery.