An Interview with Joel Fuhrman, MD

www.drfurhman.com

H=N/C is one of Dr. Fuhrman’s important original concepts, but what does it mean?

Your future health = the micronutrient/ calorie content of your diet.

This health equation outlines Fuhrman’s theory that a person's long-term health can be predicted by the nutrient per calorie density of their diet. According to Dr. Fuhrman’s years of study, life experience and work with patients, it is critical to eat more micronutrients per caloric-buck, for weight loss, disease prevention, disease reversal; i.e. health and healing. Profound, simple, uncomplicated and yet this formula for well-being is still not fully understood by many of us.

Joel Fuhrman’s interest in being healthy was inspired as a boy from watching his father, who was a sick man for many years, take hold of his own health by studying nutrition and being intentional about his food choices. Joel says his initial skepticism turned to awe as he witnessed his father’s transformation from being sick to being well.

As a young man, the quality of food became particularly important to Joel’s own life as he pursued and achieved great success in ice skating, placing 2nd with his sister at the 1973 U. S. National Pairs Championship and 3rd at the World Professional Pairs Championship in 1976. “As a competitive athlete,” Joel notes, “I would do everything to accelerate potential, and of course nutrition was key to maximize stamina and to prevent illness that could cut into training or competing at full potential.”

Joel later graduated from the University of Pennsylvania School of Medicine with the purpose of championing lifestyle medicine.

For the past 17 years he has focused his understanding about and commitment to nutrition by helping others to accelerate their own potential for health. He opened a nutritional-based practice with a sensible approach to education-based healing, seeing individual patients as well as offering group lectures in his office.

Dr. Fuhrman teaches patients that, contrary to popular belief, we don’t have to live our lives in pain or on medication. Disease can be reversed, high blood pressure reduced, unwanted weight lost, cholesterol levels lowered, heart disease and cancer prevented, and health improvedundefinedall without relying on drugs and fad diets. Dr. Fuhrman notes, “In many ways technology has hijacked medicine by focusing on drugs and surgery. It is amazingundefinedquite astonishing, how effective dietary excellence is when adopted as a therapeutic intervention for illness/disease.”

H=N/C and his experience with thousands following his diet-style led Dr. Fuhrman to also define a unique scientific theory regarding toxic hunger vs. true hunger, realizing that current descriptions of hunger are not accurate, because conventional sensations of hunger resolve with nutritional excellence and new symptoms take their place.

“We can’t separate physical addiction from psychological, emotional addiction, including addiction to low nutrient eating. Toxic hunger is a withdrawal state due to toxic metabolites. Toxic hunger goes away with an ideal (high micronutient) diet-style, true hunger being felt in the throat to mark the end of glycolysis, before gluconeogenisis. True hunger then directs us to the precise amount of calories to maintain our ideal weight or to prevent loss of muscle mass.”

Low nutrient eating (and toxic eating) leads to increased cellular toxicity with undesirable levels of free radicals and advanced glycation end products (AGE’s). This toxicity causes addictive withdrawal symptoms (toxic hunger) that occurs when digestive activity ends, which results in more frequent eating and overeating.

Understanding these concepts and incorporating a sufficient amount of nutrient rich foods is critical to overcoming this addictive cycle!

Time and Reimbursement limitations prompted structural changes to his practice.

After struggling seeing patients one-on-one and being limited by time and by the reimbursements of typical patient visits for years, Dr Fuhrman changed the structure of his practice. “What did not work, he says, “was setting up a time-consuming specialty practice and accepting standard HMO fees for complicated patients that often required visits of an hour or more. I found myself working over 50 hours a week, just to break even. I was often losing more money on overhead than I was being reimbursed. As a result in the first ten years out of residency I had to work a 70-hour work week in the medical office just to get by, which I knew I could not keep up forever. Then I went home and usually wrote until 1:00 in the morning.”

Now Dr. Fuhrman sees patients half time and no longer participates with managed care plans, though patients who have some out-of-network coverage can submit their bill for reimbursement for a substantial portion. His practice has grown to include writing, (he has published several books) running an internet member support site that sells his products, and speaking. “It wasn’t until I dropped HMO, Medicare, and managed care, that I was able to make a sustainable income without working obscene hours, and have a working style that I could maintain long-term. I did this by writing books and lecturing more and devoting more time to promoting what I do, and less time seeing patients.

However, it seems unreasonable and unfortunate to have to need to do this and develop such a high degree of marketing success to reach the public.” Dr. Fuhrman is hoping to finally be able to devote time to research interests.

From utilizing professional PR firms to ‘word of mouth’

“I have had multiple PR firms work for me in the past, right after one of my books were published, but in retrospect I think it was a poor use of resources. They never delivered the optimistic picture of what would happen and what placements they would obtain and it always cost much more than it was worth.

The best PR firm is word-of-mouth. Now I hire my own in-house events coordinator and PR person to work in my office booking radio shows and lecture appearances. I still think it is best to do this yourself even if it is just a part-time effort from one of your employees.

I found running around the country doing local radio and TV and speaking in book stores to be a huge cost that did not return on investment and almost bankrupted me. When you have a significant office overhead and employees to support it was not a wise business decision to reduce patient income and do travel to promote my books. The book sales do not meet the dollars lost in the publicity effort, travel expense, and overhead not met from not seeing patients.”

If he had to do it all over again Dr. Fuhrman says he would have stayed local to his area and focused all marketing and publicity in the regions he could drive to and still see patients that same day. “I may have still accepted managed care patients to build my practice, but I would have set up meeting groups for patients with similar medical conditions, making the lectures and meetings mandatory for new patients. It would have been better if I had developed more materials and assistants to deliver the message to the patients, rather than a one-on-one lecture for an hour with every patient.”

Dr. Fuhrman is optimistic about the future of Lifestyle Medicine. He is clear, however, that LM training needs to include appropriate marketing and practice building training, and that Lifestyle Medicine Physicians need to gain economic viability, band together, and collectively market the specialty. He sees our future as necessitating a study of the best ways to promote the specialty to the public as a viable and respectable option for the treatment of disease.

Dr. Fuhrman’s Nutrition Prescription

The quality of a diet can be judged on three simple criteria:

1. Levels and diversity of micronutrients (vitamins, minerals, phytochemicals) per calorie.
2. Amounts of macronutrients (fat, carbohydrate, protein) to meet individual needs, without excessive calories that may lead to weight gain or health compromise.
3. Avoidance of potentially toxic substances (such as trans fats) and other potentially harmful substances (such as sodium).

A person who eats for health is, in Dr. Fuhrman’s terms, a nutritarianundefinedone who seeks to consume a broad array of micronutrients via their food choices, understanding that food has powerful disease protecting and therapeutic effects. It is not sufficient to merely avoid fats. It is not sufficient for the diet to have a low glycemic index. It is not sufficient for the diet to be low in animal products. It is not sufficient for the diet to be predominantly raw.

A truly healthy diet must be micronutrient rich, and the micronutrient richness must be adjusted to meet individual needs. The foods with the highest micronutrients per calorie scores are green vegetables, colorful vegetables, and fresh fruits. For optimal health and to combat disease, it is necessary to consume enough of these foods.