Turning the Tide Lifestyle Medicine and The Finnish Heart Project (part 4) – South Coast Herald

Dr David Glass - MBChB, FCOG (SA)

I thought I had exhausted the Finnish Heart Project, but on reflection there is still much that emanates from the article last week. It is widely accepted that up to 80% of the chronic diseases affecting our population are related to lifestyle. These include heart disease caused by atherosclerosis (hardening of the arteries), obesity, diabetes type 2, auto-immune diseases (like lupus, psoriasis, ulcerative colitis, multiple sclerosis, rheumatoid arthritis, type 1 diabetes), high blood pressure, liver and kidney failure, dementia (including Alzheimers) and many cancers.

ALSO READ : Turning the Tide Lifestyle Medicine and The Finnish Heart Project (part 3)

Almost every day I see patients with gynaecological complaints, who also either themselves have diabetes, high blood pressure, obesity or else have family members who have or who have died from diabetes and high blood pressure and cancer. And I feel almost that the medical profession is so generally disinterested in lifestyle medicine interventions to reverse or prevent so many of the unnecessary disabilities and deaths caused by these conditions. Why are there so few lonely voices calling for a new approach because just managing these diseases is patently not making much impact. We know the incidence of diabetes, and obesity, and high blood pressure in South Africa is rising. Are we really just closing our ears and eyes and pretending the tsunami is not coming?

In last weeks blog I attached an article by one of the doyens of lifestyle medicine, cardiologist Dr James Rippe. He has recently completed the third edition of a standard textbook on lifestyle medicine. I will quote what he had to say about the role of medical practitioners in modern health care: What should we in the medical community be doing? The answer is both simple and complex. The simple answer is that we need to discuss positive lifestyle measures and their impact on health with every patient we see (emphasis supplied). The complex answer is that many aspects of medical practice make such discussions difficult, including time demands, lack of reimbursement, lack of knowledge and education in these areas among physicians, and perhaps most disturbing, skepticism that our patients will truly change their behaviour. Unfortunately, <40% of physicians routinely counsel their patients on lifestyle issues. (Im sure this is even less in S Africa).

This represents a squandered opportunity, because >70% of adults see a primary care physician (GP) on at least an annual basis. Furthermore, physician recommendation has been shown to be one of the most powerful predictors of behaviour change.

Doctors are generally busy, or are untrained and ill-equipped to discuss lifestyle interventions in any meaningful way with their patients. However one is also tempted to wonder whether there is much enthusiasm for helping patients to reverse their chronic diseases and thus their dependence upon the medical and pharmaceutical profession to provide ongoing reimbursement. Imagine how well an endocrinologist would survive if a sizeable proportion of his diabetic patients eliminated their diabetes to the point where they no longer needed to see their specialist. Imagine if a significant number of patients with ischaemic heart disease were able to reverse the narrowing of their coronary arteries through lifestyle interventions, such that they no longer needed by-pass surgery or stents. Cardiologists/Cardio-thoracic surgeons, and the specialised cardiac catheter labs and theatres would feel the pinch.

If there is no incentive by medical practitioners to advocate lifestyle change in their patients, then perhaps patients could start insisting on information about lifestyle options. More and more patients are becoming google-literate about their health conditions. And there is certainly plenty of information out there about lifestyle interventions. However, as with so much information from Dr Google, patients need guidance to negotiate their way through the various conflicting and competing interests of those peddling some new fad diet or intervention. Thankfully true lifestyle medicine is soundly researched and peer-reviewed. Most consensus management guidelines for diseases like diabetes, high blood pressure, and heart disease mention the importance of lifestyle interventions, but are still a bit vague on what that all incorporates.

Here is a powerful short video clip from the very instructive nutritionfacts.org resource of Dr Michael Greger, who quotes Dr David Katz, a former president of the American College of Lifestyle Medicine about the role of doctors incorporating lifestyle advice in interactions with their patients. Perhaps you could forward it to your doctor.

Here is a podcast that teaches people with diabetes how to approach their doctors with information they have gleaned from professional websites on reversing their diabetes. You might find the same principles apply to other chronic diseases of lifestyle as well.

I hope that this article will stimulate enthusiasm for change.

Have a week filled with hope and motivation to start a new life.

Dave Glass

Dr David Glass MBChB, FCOG (SA)

Dr David Glass graduated from UCT in 1975. He spent the next 12 years working at a mission hospital in Lesotho, where much of his work involved health education and interventions to improve health, aside from the normal busy clinical work of an under-resourced mission hospital.

He returned to UCT in 1990 to specialise in obstetrics/gynaecology and then moved to the South Coast where he had the privilege of, amongst other things, ushering 7000 babies into the world. He no longer delivers babies but is still very clinically active in gynaecology.

An old passion, preventive health care, has now replaced the obstetrics side of his work. He is eager to share insights he has gathered over the years on how to prevent and reverse so many of the modern scourges of lifestyle obesity, diabetes, ischaemic heart disease, high blood pressure, arthritis, common cancers, etc.

He is a family man, with a supportive wife, and two grown children, and four beautiful grandchildren. His hobbies include walking, cycling, vegetable gardening, bird-watching, travelling and writing. He is active in community health outreach and deeply involved in church activities. He enjoys teaching and sharing information.

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Turning the Tide Lifestyle Medicine and The Finnish Heart Project (part 4) - South Coast Herald