Lifestyle Medicine, technology and a mandate for mentorship.
Musings on my journey to LIfestyle Medicine, the importance of mentorship and a path towards scaling our work.
By Mark Berman, MD, FACLM
My resonance with Lifestyle Medicine began when I was a teenager learning to teach tennis, long before medical school and well before the term was coined. I could never have predicted the windy road to establishing a career in Lifestyle Medicine. The mechanics of the journey might appear straight-forward in retrospect, but the destination has never been clear. And while my journey has been constantly fueled by a passion for plant-based nutrition, it was the wisdom and help of many mentors that lit the way forward.
There is a long lineage of family members fascinated by the medicine found in our diet and lifestyle. It began with my great-great-great aunt, a matron of a ward in the Johannesburg General Hospital, South Africa. She died tragically in labor, but her passion lived on like a mysterious light that has compelled several in our family to look in the same direction. As it turned out, that was also true for me -- despite the fact that this bit of family history was not known to me when I met my first mentor. At the time I was a scrawny 15 year old aspiring tennis instructor who had never even heard of Lifestyle Medicine, much less a plant-based diet.
Men·tor: noun 1. an experienced and trusted adviser.
Peter Burwash, one of Canada’s best tennis players, was featured in and championed John Robbins’ work. It was Peter’s inspiring training talks (the other tennis pros dubbed him Peter Brainwash) along with Robbins’ Diet for a New America - the Silent Spring of our generation - that set the wheels of my career in motion.
I was captivated by the idea that we could shape our destiny simply by eating well. We were not all doomed to poor health and rapid aging. There is something we can do. And I was compelled by the idea that these selfish actions were actually the best and most compassionate thing you could do for an Earth in peril and the animals (including us) that depend on a healthy Earth. And so I read whatever I could find on these topics and through a combination of luck and tunnel vision, found incredible mentors that enabled my pursuit of a career.
David Jenkins, perhaps the most understated genius in Lifestyle Medicine, was my second unofficial mentor. He offered a nutrition mentorship course at the University of Toronto for high school students. It was probably the only afterschool program I was excited to apply for. We completed independent research projects - mine on the intersection of human evolution and comparative anatomy; the idea that despite our ability (and at times necessity) to survive as omnivores, for most of hominid existence we actually evolved and thrived as plant-eaters and our biological basis still reflects that history. But more memorable was Dr Jenkins excited gesticulating as he revealed bristol board posters of his early glycemic index studies. We mostly looked on with blank stares, pretending to understand, all of us completely oblivious to the relevance of that work.
I chose physical therapy as my college major at McGill University in Montreal. It was the closest thing to medical school and that seemed to make logical sense, especially to someone who lacked much worldly perspective. In my summers, I had the honor of interning at John Robbins’ non-profit EarthSave and instead of going to the library, spent much of my energy pestering school officials and other students about the importance of shifting to a plant-based diet.
Upon graduating, I met David Katz on my interview trip to the Yale School of Medicine. I stumbled upon a poster advertising optional after-school nutrition classes for medical students which just so happened to be held that night and showed up to hear my first Dr Katz oration. When it was over, I recall cornering David as an over eager pre-med student, telling him about a defunct book project I was working on and asked, or rather warned him, that I’d like him to be my mentor if I was able to somehow convince the admissions committee to take a chance on this Canuck.
As it turned out, that was a fateful day. Dr Katz changed my medical trajectory in many ways. I assisted with one of his obesity prevention grants in my first year at Yale and that inspired me to focus my passion for nutrition on obesity and metabolic health. He helped me understand that the science of what to eat was a lot more straightforward than the science of getting people to change habits. He offered an introduction to Dean Ornish, which resulted in a clinical research fellowship with one of the people that inspired me to go to medical school in the first place. Fast forward many years, it was David who suggested I attend the ACLM conference 4 years ago and nudged me to throw my hat in the ring and serve on the Board of Directors.
It was observing Dean’s work first hand, and meeting his patients and the passionate Lifestyle Medicine team he brought together that really convinced me that dedicating my career to this field, while certainly not the most lucrative, was the most rewarding. Lifestyle Medicine is about much more than nutrition. It’s about fundamentally changing how people live and experience their life. It’s not something I’ve figured out how to put into words. I went into medicine to help change the world, but as it turns out the closest I can come to that is to be a clinical mentor of sorts and watch someone change their own life. And that’s rather profound.
While the idea of Lifestyle Medicine is in fact centuries old, it was Dean, the Davids and others who used the scientific method to prove that lifestyle can be used as medicine. And yet, despite that proof we now have the great challenge of figuring out how to implement this medicine, efficiently and at scale. Training in Internal Medicine, it was painfully obvious that Lifestyle Medicine is rare medicine, underutilized, paid mostly lip service and unaccessible to the billions of humans who need it.
My transition out of academic training brought me to the Robert Wood Johnson Foundation where I served as a special assistant to then CEO and President, Risa Lavizzo-Mourey. It was an honor to work for Risa -- a Geriatrician with an MBA -- and gain a national perspective on health and health care through her unique vantage point and counsel. Both Howard Lewine, my mentor at Harvard Health Publications, and Risa were supportive of my leap to the digital health world, where I have dedicated my efforts (in addition to my clinical work) over the past 8 years.
Over this time, I have had the honor of serving ACLM as a board member. One key take-away from that time has been the clear need we have to come together to bring Lifestyle Medicine to the world. We are not going to do it as lone soldiers. We need an army. To this end, another great mentor, not surprisingly also named David, impressed upon me the importance of relationships and the power of being a convener. David Eisenberg, at Harvard’s School of Nutrition, has been one of the most generous supporters and mentors. Dr. Eisenberg is a leading advocate of teaching kitchens and not surprisingly was the connecting force that brought us together with Dr. Katz to collaborate on our current work: FareWell.
FareWell aims to bring a scalable and cost-effective Lifestyle Medicine model to the world, leveraging the emerging power of digital tools. We are working on the How of Lifestyle Medicine. The What - a whole foods plant-based diet, regular exercise, avoiding smoking and excess alcohol, stress management, love and meaning - has been well established by the pioneers in our field. But it is the How - how to apply and implement what we know that is our current challenge. To this end, we feel there is a role for emerging social technology and components of artificial intelligence, which enables an infinitely more rapid and efficient spread of information and an ability to stay connected with our patients and even automate some aspects of clinical mentorship and population management.
My path to Lifestyle Medicine grew from a passion to apply what we know. As I reflect on the journey thus far, it is obvious that I would be nowhere without the generous support of many mentors. Mentorship comes in many forms. Some of my mentors might not even know they were just that, and many others are not even mentioned here.
We are just beginning. Delivering Lifestyle Medicine is going to depend on the creation of new models of care, methods of payment, as well as the continued nurturing of a much larger community of aspiring clinicians. To achieve that, mentorship is a must. All of us must find some time in our lives to offer encouragement and guidance to those who share a passion for Lifestyle Medicine. In my experience, the honor of providing mentorship is as great as the honor of caring for patients.
ABOUT THE AUTHOR:
Mark Berman, MD FACLM is a Lifestyle Medicine physician whose work focuses on plant-based diets for the prevention and treatment of disease, obesity and metabolic health, and digital health. Dr Berman practices Lifestyle Medicine at One Medical Group in San Francisco and is the Head of Health for FareWell, inc. He is a Fellow of ACLM and served on the Board of Directors from 2013 to 2016. He lives next to the magical Presidio park in San Francisco with his wife and daughter. Contact Dr. Berman at firstname.lastname@example.org.
If you have patients that would benefit from FareWell, they can save $25 using referral code: ACLM2017