Lifestyle Medicine’s Indisputable Foundation of Health and Access

I’ve been professionally engaged with the integrative health and medicine field for the better part of a decade and, as a 28-year cancer ‘thriver’ of a so-called incurable malignancy, I’ve watched this movement up close and personal half my life.

Through FON, I’ve consulted hundreds of clinics, businesses, and organizations; participated in chronicling The Rise of Integrative Medicine; and written on the various names and nomenclature—and the numerous tents that comprise one, albeit loose-knit camp of mostly well-intentioned organizations, passionately aligned in service of health creation.

What I absolutely know is that ours is an inexorable movement: a fledgling field consistently finding firmer footings; and yes, it continues to show its value in cost-effectiveness, while fueling a vibrant industry with significant and growing economic impact. The foundation for all of this activity and growth has been…

Lifestyle Medicine: The Common Denominator

The underpinning for integrative health, and all that falls under its umbrella, has always been the fundamentals of lifestyle medicine.

Functional. Integrative. Ayurvedic. Naturopathic. Traditional Chinese. Preventive.

None of these systems and practices—and the often repeatable, sustainable, and quality-directed clinical outcomes achieved—are possible without the full participation of patients willing to change their behavior through  lifestyle modification.  

I am a proponent of, and personally utilize, judiciously, functional testing to inform well-placed, high-quality nutraceuticals. I support complementary and even alternative approaches, as appropriate, for a number of conditions, including pain, nausea, anxiety, and depression. But the core of my personal health program, captured in the literature, has always been lifestyle medicine.

I’m also a realist. Though positive observed clinical outcomes often suggest correlation—correlation does not prove causation. The high bar to irrefutably prove causality for natural products alone—or, with diet and complementary therapies, to prevent or reverse disease burden—remains elusive. This is largely because the requisite quality and volume (trial design and number of subjects) for comprehensive scientific inquiry of non-reductionist, whole systems research is typically cost-prohibitive.

Significant commercial interest and commitment through investment is critical. However, there is limited commercial appeal in developing natural products. It is difficult to securely protect novel procedures or product ‘discoveries’ as intellectual property; the vast majority of interventions specific to lifestyle medicine, not unlike integrative health as a whole, are high-touch, low-tech, and low margin as compared to, say, service lines such as radiation oncology, surgery (and pharmaceutical prescriptions) which are low-touch, high-tech, and high margin.

Let me be clear. I am not suggesting we halt the discovery process. I am just being honest. High quality science is what continues, albeit slowly, to move us forward. This is where limited funding still remains from NIH, through NCCIH and OCCAM.

However, the double-blind RCT paradigm invented for drugs and medical devices is largely ineffective for non-reductionist, multi-modality, whole systems integrative health clinical studies.

What keeps integrative health and medicine products, program, and clinical services growing in demand, stature, and relevancy, in economic terms, is largely based upon clinical outcomes: repeatable observations from providers and patients alike. Many health consumers are healing with these approaches—many of whom were unsuccessful before turning to integrative health modalities.

Science Supporting Lifestyle Medicine is Irrefutable

A plethora of literature incontrovertibly proves the power of lifestyle medicine to prevent the bulk of chronic disease that has plagued a large swath of the U.S., and much of the industrialized world, for the better part of the last half century. We are talking about several types of largely lifestyle-driven malignancies (think: colorectal and prostate cancers), most heart disease, hypertension, and type 2 diabetes. It’s important to mention that we have also seen the reversal of certain conditions and pathology utilizing lifestyle medicine alone, including Dr. Dean Ornish’s work—small studies looking at heart disease and indolent prostate cancer. 

Core Tenets of Lifestyle Medicine

At the heart of lifestyle approaches to health creation are:

• nutrition (predominantly plant-based);
• physical activity;
• stress reduction;
• restorative sleep;
• elimination of smoking, alcohol;
• awareness of toxic environmental exposure: air, water quality.

Integrative health practitioners, and the greater field at large, go further than their lifestyle medicine brethren by also supporting sensible, if not all irrefutably scientifically proven, approaches to prevention and treatment of chronic disease via:

• well-placed, high quality dietary supplements informed by functional labs and additional testing;
• complementary therapies such as yoga, acupuncture, massage, and mind-body work;
• elimination of deeper toxic environmental exposure in cosmetics, toiletries, household products (including cleaning agents) and lawn care products;
• social connectedness and community.

The above is not meant to be a comprehensive list.

Skeptics of Integrative Health

More than ever, we need skeptics and cynics to uncover bad actors and purveyors of so-called alternative medical treatments that are at best worthless and expensive, and at worst can cause real harm, even death.

This is especially true when charlatans hawk various products or clinical services in lieu of proven standard of care given with curative intent. Cancer care provides a prime example of this. Hucksters and quacks abound. Dr. Google lays bare countless frauds that lay in wait to pounce on unsuspecting and often desperate people: victims whose sole goal is to find relief from what ails them. We need gatekeepers brave enough to protect us from malfeasance.

Notwithstanding the bad clinical actors and the purveyors of inferior so-called natural products—and the very real threat of many unproven alternative cancer therapies and ‘cures’—integrative health naysayers are on the wrong side of history. The critics’ endless breath and vigor, conflating all integrative health approaches into a catchall category of ‘unproven, unhelpful, harmful’, dilutes their impact and effectiveness as a bulwark against quackery. It erodes the trust they otherwise might earn.

Lifestyle Medicine is Not (Yet) Standard of Care

The skeptics like to say the integrative health community has conflated its practice by co-opting lifestyle medicine. But lifestyle medicine has always been at the heart of integrative medicine, and therefore integrative health and wellness practices.

Naysayers also like to say that lifestyle medicine is now standard of care across the land, so it does not belong to integrative health; it’s simply good medicine. Lifestyle medicine is certainly headed that way: just look at the explosive growth and activities of the American College of Lifestyle Medicine.

In reality, less than 50% of physicians across the U.S. discuss lifestyle and behavior change with their patients.

If lifestyle medicine were standard of care in clinics across the land; if government actions and activities supported the education of these core tenets as a federal mandate—a national imperative; if clinical delivery of lifestyle medicine was properly incentivized by CMS and commercial payers… then this article would have been unnecessary to pen.

Lifestyle Medicine Provides Access and Helps Level the Field

What lifestyle medicine represents is the indisputable gateway to true disease prevention and health creation that no health educator, clinician, investigator, or healthcare bureaucrat can deny—because the literature is robust, and this has been undeniable for years.

The foundational elements of lifestyle medicine are accessible to all consumers, so long as they learn about them. These activities need not be expensive. No gym membership required. These are mostly pivots—expending the same total sums of money heretofore spent on unhelpful processed foodstuff products and unhealthy activities.

Academia, Health Systems, Self-Insured Employers

The growth of private, integrative health clinics, including those specializing in lifestyle medicine, has exploded since I was diagnosed with leukemia in 1991.

What I have consistently shared in my writings and consulting work in the field is the power and timing of now to influence and educate academia, health systems, self-insured corporations, and local governments on the power of lifestyle medicine as the basis of homeostasis.

As we near the end of the second decade of this 21^st century, no physician, C-suite executive, healthcare administrator, health insurance provider, or governmental population health expert can legitimately say (with a straight face and clear conscious) that nutrition, physical activity, stress reduction, restorative sleep, community, and environment has no impact on disease prevention or disease care.

This is why all of these institutions, nonprofits, for profits, and government entities alike, will inevitably, eventually, embrace lifestyle medicine and, more broadly, integrative health approaches, in service of population health.

Opportunities Abound

Lifestyle medicine is the gateway to health and access. There’s a profound opportunity for those within the integrative health umbrella to become chief wellness officers (and program and product directors) across medical delivery systems, institutions, and enterprises.

The adoption of health and wellness over ‘disease care’—partially fueled by the demands of millennials—provides lifestyle medicine an entrée to standard of care practice. Medical school curriculums will provide more coursework on nutrition, exercise, and stress reduction, and this knowledge will be transmitted to more patients.

[Access this Lifestyle Medicine Syllabus from the American College of Lifestyle Medicine.]

Lifestyle medicine is the indisputable foundation of health and access. Wherever true disease prevention, health creation, and effective low-cost healthcare are valued, they must also be properly incentivized. The economics of lifestyle medicine must align with quality outcomes for the patient, and the fiscal needs of providers, payers, and the government (CMS) alike.

The next decade will see a massive shift toward health creation as scientific investigation continues to provide solid evidence on the efficacy and cost-effectiveness of core integrative health practices.

The roles and business models of integrative health practices, enterprises, and institutional health delivery systems will need to evolve to satisfy growing, unmet patient need, and a new generation of consumers  who are demanding a focus on health creation and wellness.

Is your integrative health business or organization positioned to ensure its long-term sustainability and growth? Contact FON for a 30 minute exploratory phone or Skype consult to discuss your specific goals, opportunities, and challenges.  

Photo credit: bigstock.com/udra11