Holistic Gastroenterology:  "taking care of digestive disease in a way that improves overall health." (Roger Greenlaw)

Like most of his colleagues, while attending medical school in the 1960s Dr. Roger Greenlaw wanted to be a specialist.

“The growing role of science in medicine and specialization convinced me we were going to make a difference,” said Greenlaw, a gastroenterologist who retired recently after 35 years of practice.

Greenlaw did make a difference, but not in the manner he expected.

“I started with a traditional practice, treating patient’s symptoms with a medication,” said Greenlaw, founder and president of Rockford Gastroenterology Associates, a 16-physician single specialty group serving Rockford, Ill. for more than 30 years.

“But after reading Dean Ornish’s results of his lifestyle intervention trial in 1990 about the ability to reverse heart disease with lifestyle change alone, without medicine or surgery, I switched to a more holistic approach,” he said.

As Greenlaw’s treatment paradigm shifted, so did his personal lifestyle. He began to model what he wanted his patients to learn: people often have the power to heal themselves.

“Initially, I found one person a week who was interested in making lifestyle changes to address their medical problems,” he said. “Over the next six months, I was finding one or two people a day who were ready to make lifestyle changes. And by the end of the year, more than half my patients every day were responding to the idea of self care.  I realized the increase was not due to more interested patients, rather it was due to my development of better listening and coaching skills.”

Inspired, Greenlaw began to search for a formula to bring Lifestyle Medicine to daily practice, and “to put health back into medical care,” he said.

Greenlaw received a grant from the Swedish American Health System that allowed him to lead the development of the Swedish American Center for Complementary Medicine, which initially offered the Ornish program for reversing heart disease. However, this treatment was expensive, insurance coverage limited, and only about 60 patients a year enrolled in the program.  Published research confirmed reproduction of Ornish’s results.

Seeking to find a way to reach larger groups of people with the message of the power of Lifestyle Medicine, he heard about Dr. Hans Diehl’s Coronary Health Improvement Project (CHIP), a community-based Lifestyle Medicine program being taught at that time in Kalamazoo, Mich.  After a group of doctors, nurses and medical students visited the program, it was chosen for Rockford.

“This program could be offered live or as a video class for groups of 30 to 500 people,” Greenlaw said. “CHIP included not only transformational information, but also clinical measures and skill training. Our group envisioned teaching Lifestyle Medicine to hundreds of people throughout the community – at the worksite, in faith-based groups, in schools, and in medical settings.”

Greenlaw began to “take care of digestive disease in a way that improves overall health,” a tagline he applied to his growing practice.

This approach fostered many successes, including one patient who was recently placed on the impending renal dialysis list because of chronic kidney disease.

“After three months on the CHIP program for her GI complaints of heartburn and irritable bowel, her kidney blood tests are improving along with blood sugar, cholesterol and blood pressure,” Greenlaw said. “She illustrates the power of the individual to have a significant impact on their condition, either as an alternative or a complementary therapy.”

Today, a growing number of physicians at Rockford Gastroenterology Associates emphasize prevention, early diagnosis, and state-of-the-art care for digestive disease with an eye toward the power of the patient to improve their own health.

 “We do not limit our practice based on anyone’s insurance or lack thereof,” Greenlaw said. “And we emphasize teaching medical students, continuing education for physicians, and patient and public education.”

Greenlaw, also a clinical professor of medicine at the University of Illinois, College of Medicine, and former medical director of the Swedish American Center for Complementary Medicine, loves teaching medical students and family practice residents about the power people have to heal themselves.

Newly retired, he looks forward to “taking care of myself with exercise and relaxation, and spending quality time with friends and family,” he said. As medical advisor for the CHIP program in Rockford, he also plans to continue to work with physicians who have questions about lifestyle change programs as well as teach medical students about complementary and alternative medicine. He also sees a ‘faith based option’ for lifestyle medicine as stewardship of health.

“Our country’s chronic disease and obesity crisis demands multiple options for teaching self-care, which can become the new primary care.

“Specialists often miss the opportunity to include preventive medicine counseling in their practices,” Greenlaw added. “Cost is not such a major factor when specialists are well reimbursed for their procedures. I was able to do my Lifestyle Medicine work as part of consultation and follow-up, just build it into the time without charging for it – like slipping a “quit smoking” or “lose weight” message into an annual physical.”

Greenlaw frequently ordered C-reactive protein as a measure of inflammation in the body, and when elevated, emphasized an anti-inflammatory diet, with plenty of fruits, vegetables, whole grains, beans and supplements with Omega-3 fatty acid foods such as walnuts, almonds, olive/flax seed oil and deep cold water fish like salmon. 

Follow-up consisted of lab tests (to document lower inflammation) and observation for increased disease-free intervals in patients.

“So if someone has ulcerative colitis, I would look for longer periods of remission,” he explained.

 “One of the unique outcomes I observe in my practice is when you treat the root cause of one condition, (obesity, heartburn and constipation caused by poor diet, inactivity and stress) many of the patient’s other conditions begin to improve simultaneously, (blood pressure, cholesterol, blood sugar and resting pulse). When you treat one, you treat them all.” 

Now at the end of a decade of treating patients with a holistic approach Greenlaw said he finds that almost all his patients are interested in lifestyle change.

 “I think because I was becoming interested, experienced and sensitive in meeting the person where they were rather than telling them where they ought to be,” he said. “They want to know what they can do, rather than just take pills for the rest of their lives, with the usual side effects that nightly TV warns about.”

The most common condition in both family practice and gastroenterology is irritable bowel syndrome. Greenlaw’s holistic approach calls for avoiding sweets, adding fruits and vegetables, whole grains, beans and Omega-3 fatty acids.

“Plus probiotics, the good bacteria supplements like the live bacteria found in some yogurt,” he said.

According to Greenlaw, the major challenge for practicing holistic Lifestyle Medicine as a specialist was that some doctors view this as stepping into their practice area. Other obvious challenges include time constraints and lack of reimbursement for health education and disease prevention skills.

The greatest success he experienced was helping the patient feel empowered in the outcome of their disease management, he said. “Most diseases in our society are lifestyle related, and therefore preventable and modifiable by self care.”

His recommendation to other practitioners is embrace the arrival of the age of Lifestyle Medicine and the modification of disease through self care and natural therapies.

“And encourage their study through the multiple medical groups that are teaching this new direction in medicine,” he added, citing as examples American College of Lifestyle Medicine, Institute for Functional Medicine, American Holistic Medical Association and the American College of Preventive Medicine, among others.

For students opting for a career in Lifestyle Medicine, Greenlaw suggests following a traditional path in internal medicine or family practice, followed by a residency in Lifestyle Medicine or public health.

“Lifestyle Medicine may be our best treatment ally yet to facilitate disease prevention, reversal and rehabilitation,” Greenlaw said. “The lifestyle changes that prevent a disease make excellent complementary therapy for treating that advanced disease.  For example the Ornish Program is excellent for preventing heart disease or treating advanced cases.”

ACLM Disclaimer: Our Practice Spotlights are intended to provide examples of Lifestyle Medicine in practice. We recognize that Lifestyle Medicine practices vary widely, and inclusion in Practice Spotlight is not intended to imply official endorsement of individuals or practices.