Lifestyle Medicine - the paradigm shift changing the health of the nation

By ACLM Member Sal Lacagnina, DO

April 2017

During my 20 year career delivering traditional internal medical care to thousands of wonderful people—many of whom, unfortunately, suffering from a multitude of chronic illnesses—I was fortunate in 2010 to transition into a branch of health care which is changing the health of the nation.

Traditional health care is focused on the care of sick people. This is the reason many people say we have a sick care system and not a health care system. Traditional health care providers deal with the symptoms and attempt to cure rather than prevent disease. This type of health care focuses on the end of the pathologic process (disease reversal) rather than on the early development of disease, at which time we can be more effective if we can work with the individual to institute significant lifestyle behavior change. We know without question that the vast majority of chronic illnesses, and many of the cancers people suffer from daily, are the direct result of unhealthy living. We also know that a change in lifestyle directly results in less risk and less incidence of chronic disease and cancer. Hundreds if not thousands of research studies have proven these points.

My transition and the paradigm shift in my clinical practice and thought process came long before I accepted a new role in the health system—a role called VP of Health & Wellness. Over the 20 years of practicing Internal Medicine, I consistently encouraged patients to adopt a healthy lifestyle; and, since 2010, I have been able to focus all of my attention on doing just this as the System Medical Director of Wellness & Employee Health, which was formerly the VP of Health & Wellness. The health system I work for is now called “Lee Health.” The previous name, Lee Memorial Health System, was recently changed to Lee Health to communicate t that we are “Caring people, inspiring health.” This mission statement is meant to help people understand that we work to help individuals become and stay healthy. We want to keep people healthy and not have them get sick and require hospital care. Hippocrates stated as the first tenet of medicine: “Do no harm.” As medical professionals, if we don’t do all we can to help people avoid illness; have we succeeded with what Hippocrates was stating? This is why I love my current practice which focuses on wellness rather that sickness.

I have also realized over the years that lifestyle modification is a perfect part of the treatment and reversal plan. I have seen many patients over the years already diagnosed with a chronic illness reverse their disease after intensive lifestyle behavior modification. I have witnessed this so often in people with cardiovascular disease, high blood pressure, diabetes and many inflammatory illnesses. Clinical research and many anecdotal reports reveal the power of healthy nutrition and healthy living. In the past 7 years my clinic has morphed into a lifestyle management practice. Since 2010, I have visited over 700 times with sometimes desperate people looking for advice on how to become and stay well. Many have had significant weight problems. Others have had many risk factors for chronic disease and cancer. But invariably for almost all, I ask them to tell me the specifics of their diet in attempt to understand if they eat the “CRAP-SAD” diet (calorie-rich and processed standard American diet) or if they eat more plant-based, nutritious foods. During the initial visit I usually find out that most of the folks who come to see me eat the former, and this is when I tell them about the power of the latter. I emphasize the tremendous health benefits of a “whole food, plant-based diet” and discuss how processed foods promote disease. We also talk about the health benefits of being physically active, minimizing stress, getting enough quality sleep, knowing what he/she is passionate about and having a purpose in life. During the time we spend together at the initial visit and in later on sessions we talk extensively about the major influence lifestyle has over genetics explaining that even when a person inherits “bad genes” the individual has the power to keep these bad genes “turned off” by living a healthy life. I emphasize that health has to be the number one priority each day when getting out of bed. I mention that failing health causes all other priorities to also fail; but that a person can achieve so much in life when he/she remains healthy.

My role as System Medical Director of Wellness & Employee Health is to work on motivating people to see the benefits explained above. In this role I have the responsibility to be a coach, an advocate, a role model, a teacher, a health care quarterback, and also a teammate. I emphasize that the patient and the physician should function as a team (with other health care providers, family members and friends) in order to develop a healthy living action plan. Goals should be developed, and, over time, together, we tweak the action plan in order to move closer to the most important health care goals.

As of this past November I have been working for Lee Health for 23 years and I am proud to be a part of their team of dedicated health care providers and administrators. I have seen significant changes in how the leaders of this health system think and act in order to provide the best health care possible. Over the last 7-10 years I have seen how the lifestyle medicine approach to health care has gained support, and how products and services have been developed in order to improve the health of the 19,000 employees and dependents on our health plan. As a self- insured company, Lee Health has a vested interest in keeping its employees healthy, knowing that they are the organization’s most valuable asset. It is well understood that healthier employees are more productive, efficient and effective health care providers. I believe they are also more compassionate if they are not dealing with their own health care problems, allowing them to focus more intensely on the health of the patients they serve.

When I first started to practice Internal Medicine in 1993, the focus was (and still is in many cases) on treating the symptoms and trying to cure disease. But now in 2017, and for the past few years, there has been a paradigm shift in not only thinking but also in actions. Many more health care providers now focus on the cause of the disease and help individuals avoid disease through risk factor modification. Many physicians and health care systems have now incorporated what in the past was termed “CAM / complimentary & alternative medicine.” We know that traditional medical care consists of prescription medications, procedures and surgery. But not all people need medications, procedures and surgery to resolve a health care problem. Many times a change in lifestyle is all that is needed. And even when traditional medical approaches are necessary, the addition of “Lifestyle Medicine” makes traditional health care more effective. Examples of this are seen daily when treating people for diabetes, high blood pressure, high cholesterol, osteoarthritis, etc.

Since 2012 I have been involved in the “CHIP program” which is the Complete Health Care Improvement program. This is a 9 week program run by a facilitator who teaches people about the tremendous power of plant based nutrition. In a classroom session the facilitator works with groups of about 25 -30 individuals teaching how to shop for, store, cook and enjoy plant based foods. She helps the participants understand the importance of nutrition in health. I chair a committee called “Food is Medicine,” and in these meeting I teach similar concepts to physicians and other health care providers and encourage them to use lifestyle modification for all patients. Incidentally, the name of this committee will be changing to “Lifestyle is Medicine” since we are now teaching about the importance of all aspects of lifestyle in relation to health promotion and disease avoidance.

As I work with physicians, nurse practitioners and other health care providers, I continue to be struck by the overall lack of education in the area of Lifestyle Medicine. Even the medical residents graduating now are still not learning all they need to know to incorporate Lifestyle Medicine into their daily work with patients. This is so unfortunate since many hundreds if not thousands of research articles have been published in national, peer reviewed journals showing the power of Lifestyle Medicine. Therefore, some physicians (myself included) have taken it upon themselves to learn on their own. I have recently completed a certification program in Anti-Aging Medicine through A4M (American Academy of Anti-Aging Medicine) and now I’m working on a certification in Lifestyle Medicine through the American Board of Lifestyle Medicine (ABLM). In addition, I have attended many conferences put on by A4M, ACLM, PCRM (Physicians Committee for Responsible Medicine), and The Plantrician Project, which produces the International Plant-based Nutrition Healthcare Conference. I have learned from the national leaders in this field including Dr. Esselstyn, Dr. Fuhrman, Dr. Barnard, Dr. Campbell, Dr. Hans Diehl, Dr. Stoll, Dr. Braman, Dr. Greger, Dr. Tuso, Brendan Brazier, and more – most of whom have been so gracious to visit Lee Health to lecture to our medical staff and to our community neighbors.

What I have learned over the past 7 years as I have focused intensely on Lifestyle Medicine is that not only is this a paradigm shift in how health care is delivered, but that it is a health care revolution. Traditional health care is strongly influenced by the pharmaceutical companies and agribusiness. We know from experience that the health of Americans over the past 50 years continues to decline as a result of unhealthy processed foods and unhealthy lifestyles. We have become a pill-driven society and a fast food nation. This has resulted in Americans spending the most money on health care but getting far less than optimal health care outcomes. It is high time for us to find a better way to deliver health care, and I strongly believe that the Lifestyle Medicine approach to health care is the answer.

Over the coming years I plan to devote my time and effort to advancing the specialty of Lifestyle Medicine. The focus needs to be on teaching medical professionals and the lay public about the power of this approach. Through awareness, education and action we collectively can change the world, and I am humbled to play a small role in this transition.