How I Found Lifestyle Medicine
“So what are you doing these days?” my former colleague asked me, when we ran into each other at a wellness committee school district meeting. “I am practicing nutrition and lifestyle medicine.” I reply. “How interesting….” he says with a smile clearly indicating he has no idea what I am talking about. Unfortunately I have seen this reaction many times. I almost don’t expect any other reaction.
Mona Sigal, MD
Founder, Nourish Health With Food for Life
“So, how does that work?” he asks. “I treat patients who have chronic diseases such as type 2 diabetes or cardiovascular disease. For example, I educate them about plant based nutrition and disease prevention and reversal. If they are motivated and cooperative, these patients can reverse their disease or greatly ameliorate it. Some get off their medications completely.” At this point I usually get an incredulous, but polite smile. He follows up with, “Really?!”
“Yes, at the core is education. A wide array of people come to my office to take courses. If they decide they want to become patients, they are required to take one or more courses. Without the education, such lifestyle changes just don’t work,” I explain and give a brief overview on what the courses are about.
I teach Physicians Committee for Responsible Medicine (PCRM) approved curriculum, including; Kick-start Your Health, general knowledge about plant based nutrition and the diet-disease connection; Plant Based Diet for Diabetes, aimed at anyone with metabolic syndrome, diabetes type 2 and even diabetes type 1; and The Power of Plants and Cancer, aimed at cancer survivors, those undergoing treatment, and those aiming to prevent cancer in the first place. These courses are appropriate for patients and family members of anyone with medical conditions.
In these courses, I cover a lot of information far beyond the PCRM content. Because I am a physician and I have dedicated my practice and knowledge to this area of medicine. Each course is 7-8 weeks long and is held weekly for two hours in duration. In these courses, I hold cooking demos allowing participants to witness how easy and tasty meals can be. I also experiment with foods they may not be as familiar with like tofu, tempeh, seitan, collards or hummus. It often fascinates me how many people have never tried these food items as well as a wide range of vegetables available to them.
“Oh, so you teach cooking classes!” exclaims my colleague at the end of my monologue, almost relieved. Unfortunately this fellow physician represents the vast majority of encounters I have had so far in my lifestyle medicine journey.
Another common questions I get is, “Don’t you miss the ED?” or “How did you get from emergency medicine to nutrition and lifestyle?” The latter is a more common question from laypeople, doctors that have known me from my past days in medicine, and know about my strong interest in diet and disease.
The answer, “No.” I never wanted to do anything else other than emergency medicine but believe I only lasted as long as I did because I was fortunate to be the department Chief for 6.5 years, in addition to working as a MD. I loved every second of it.
My professional frustration grew with my increased EM experience. My interest in the diet-disease connection began in medical school, but became a conscious effort to educate myself while a resident. My educational road was somewhat tortuous; medical school in Israel, internship and residency in OB/GYN for a couple of years, but a great affinity to working in the ER, since as a medical student that’s where I worked as a nurse for 4 years.
I first learned about EM as a specialty when I came to the US. While on a surgical ICU rotation, I was stunned to realize that patients were kept on IV fluids for days before TPN was ever considered. It seemed somehow wrong to me that nutrition was treated as an afterthought while patients were at their metabolically worst.
One day, someone gave me an article written by Dr. George Blackburn. It was about nutritional needs in the critical care setting. I carried this article around for months. FINALLY I had found someone who was validating my thoughts with scientific evidence! This was truly a turning moment for me and I remained hooked on the diet-disease connection. I read as much as I possibly could, given I had so many other reading obligations during residency, and later as an attending.
My personal life changed after my gallbladder surgery at the age of 36. Unfortunately, the surgery did not resolve my symptoms. I still felt poorly after eating meaty meals. It was only after excluding meat from my diet that I felt better but I still consumed fish, dairy and eggs. Did I truly feel better? Later, as I read more over the ensuing years, the remaining animal based foods were eliminated from my diet, with considerable positive consequences for my health.
While these changes were going on in my personal life, I began to develop a keen appreciation for what I was experiencing professionally. Once the allure of emergency medicine wore off, my frustration and despair began to grow. I realized I wasn’t really helping anybody, at least not in the way I had always wanted and believed that I had been. Patients who survived their catastrophic crises, such as heart attacks, strokes, and diabetic comas went home to the exact same lifestyle that they had led before. Nothing changed. These patients often came back to the ED worse than before. It felt like we were all on a merry-go-round and no one was getting off. It was a terrible realization and it took me several year to finally jump off.
In 2007, I finally decided it was a now-or-never moment. I HAD to change direction. Thinking about nutrition and lifestyle wasn’t enough. There was no real opportunity for me to concentrate on nutrition and lifestyle while practicing EM. I clearly needed to focus on a more structured approach.
In my opinion there still is no formal way to train in nutrition and lifestyle medicine. One must seek education and experience where ever possible. In my case, I studied the MD modules at eCornell towards a certificate in plant based nutrition. I studied with Dr. Pam Popper at the Ohio Wellness Forum Institute toward a certificate in nutrition and lifestyle medicine, and I got certified with the PCRM in order to become a Food for Life instructor. I also began my studies at the University of MA Amherst towards a MPH in nutrition, which I am still studying at.
Last year, I was given the opportunity to work alongside Dr. John McDougall at one of his 10 day residential patient programs in Santa Rosa, CA. The experience was nothing less than earth shattering. It is one thing to have the knowledge and an entirely different thing to see it in action.
In the meantime, I began teaching the PCRM curricula in my community. I was also seeing a small number of patients as part of my husband’s practice. The major challenge I came across was finding venues that would agree to host my courses over a 4-5 week period. It was overwhelming. These courses were abbreviated but approved versions of the PCRM courses. The majority of venues would either not commit to such an extended period of time, or felt there were conflicts of interest if I presented an educational program touting the virtues of a plant based, no added oils diet. Such venues were usually YMCA community centers or schools. They all had one things in common, either selling or serving USDA guidelines and approved foods or meals. They did not want to stir up trouble.
In 2010, I discovered the textbook, Lifestyle Medicine by Garry Egger. It opened a whole new world of thought. In 2011, I joined ACLM. Finally I had found a forum of like-minded and oriented peers. Around the same time my plans for the future began to take shape. I founded Nourish Health With Food For Life. I also began searching for team members who would share my philosophy and vision for the practice.
Working for several months with a billing and coding specialist, I made some important business decisions along the way. The future will show whether or not these decisions were appropriate.
At this time, I have surrounded myself with a team of enthusiastic and experienced professionals in the fields of exercise physiology, psychological therapy, dietetics and mind-body work. The practice is in its infancy but already taking shape. These are very exciting times and I’m excited for things to come.
Nutrition and lifestyle medicine is the future without any doubt. Beyond the education to better ways of eating and living, we also have the obligation to educate patients about unnecessary medical testing and procedures. How they should become active partners in their own health care, rather than recipients of orders from providers. Lastly, I tell all of my course attendees to carry an obligation to share the knowledge they acquire. Also the importance of showing others the benefits by living them. The rewards for me as a provider are immeasurable.
To learn more about Mona and Nourish Health With Food for Life, visit www.nourishhealthwithfoodforlife.com.