A Sensible Strategy for Health Promotion and Disease Prevention. Health is a precious national resource and nothing at all is being done to conserve it. There is almost no disease prevention, health or nutrition education in the public school system or in college. Virtually all the 3.2 trillion US healthcare dollars are spent in 2016 was used to treat the disease not promote or preserve health. If the past is any guide the prognosis for the currently healthy young people in the future is to become overweight and obese just like their parents. The problem with that is we now recognize that becoming overweight and obese due to poor diet choices and lack of exercise is the common pathway most follow on the way to becoming an adult with one or more serious chronic diseases that consume trillions of health dollars each year. Obesity is a disease that causes diabetes, high blood pressure, cardiovascular disease, cancer, and arthritis of the back, hip, and knee. These are the 10 leading causes of chronic disease in the US and responsible for the vast majority of the health-related suffering, disability, and death experienced by people here.
70% of Americans Now Obese or Overweight
Now using Body Mass Index (BMI) that is a measure of your weight divided by your height new data from the Centers for Disease Control and Prevention released in October 2017 shows that about 70% of the US adult population is obese or overweight. The numbers for women are worse and much worse if modern high technology methods of measuring body fat percentage are used like DXA instead of BMI that misclassifies many postmenopausal women as normal when they are really obese. In 1960 only 12% of the US population was overweight or obese.
Bringing Discoveries to the Clinic
Understanding the patient, their issues, concerns, and health means establishing their baseline, where they are at the beginning of their journey to improved health and wellness. Next comes stabilization of all health and wellness issues identified on the comprehensive problem list. Once the stabilization plan has been put in place now it is time to begin the fun stuff, optimization. This is really exciting because there have been so many wonderful discoveries made by thousands of brilliant scientists, physicians, nutritionists, pharmacologists, geneticists and many others through the latter half of the 20th and the first quarter of the 21st century We are all the beneficiaries of this great body of research that flourished and ripened over these past 75 years and that knowledge is available to all medical practitioners to make use of to vastly improve the health and quality of life of their patients. It takes time for knowledge developed in the laboratory to transition into the clinic but the information is there and published. In fact, in many cases such as stem cell treatment, it was the subject of a Noble Prize for Medicine in the early 2000s and that technology is just now making its way into the clinic.
We employ all the available science to assist our patients to achieve their health and wellness goals. This includes technological developments like measuring body composition by DXA, defining the presence of early cardiovascular disease using ultrasound-based intimal medial thickness (IMT) of the common carotid artery and advanced means of compounding and delivery of pharmaceuticals. New uses for old pharmaceuticals and using combinations of low doses of several drugs to achieve a specific benefit while reducing side effects is one of my special medical interests.
Nature Vs Nurture
We are making progress in genetics or nature and recognize that many common chronic diseases have a genetic component. But not everyone with the genes that we identify as causing the condition get it. From the point of view of disease prevention and genetics, the most important family members are parents, siblings, children, and grandparents. Uncles, aunts, and 1st cousins can be added but going beyond those dilutes the genes too much to be very predictive for you and your offspring. Sometimes we recognize that there is a family pattern of a specific disease where a high percentage of the family members have the condition but we don’t have a specific gene or genes that we can measure that cause the condition. We think there is a genetic link though because the disease has clustered in that family at a higher rate than in the population as a whole. We have some diseases where the genetics are thoroughly established and we can accurately predict that all, half, or one-quarter of the offspring of a particular couple will have the gene and there for the disease. In some cases, though even if they get the gene they may not show signs of the disease or only very mild indications.
The nurture or environment issue is also becoming clearer in disease prevention. For instance, take for example someone whose family has multiple members with cardiovascular disease (CVD) that is higher than the normal population. CVD means heart attack, stroke, and peripheral vascular disease. This suggests a genetic factor at work. We can’t change that presently but we have learned a whole lot about how to modify lifestyle in ways that lower risk for CVD. As you know these include not smoking cigarettes, becoming athletically fit through exercising, eating a healthy diet and losing weight becoming anatomically fit, and if the LDL “bad” cholesterol is high lowering it, which means becoming metabolically fit. To become Physically Fit from prospective of Integral Medicine requires that you are athletically, anatomically, and metabolically fit all at the same time. That, in my opinion, is being really fit. Doing so is just about all you can do in the Physical domain to reduce your risk for CVD. There are other ways to reduce the risk that involve other domains. These include practicing meditation, mindfulness, or simple relaxation techniques for the Inner domain, making changes in the Relational domain that result in more stratifying interactions with others, and spending more time outside walking in the park by the river or in the forest appreciating natural beauty that serves as an antidote to the stressful world of man.
Approaching Disease Prevention as a Whole
Integral Internal Medicine approaches disease prevention on many fronts simultaneously. Our goal is to prevent every preventable disease not just one condition and fortunately, the method we have chosen does just that. Sure, we do add a few tweaks here and there to target specific cancer or disease like CVD when there is good science-based evidence that doing so is helpful meaning statistically significant. An example is using 81 mg aspirin once daily. This has been shown to reduce both CVD (50%) and all gastrointestinal cancers (30%). Likewise maintaining a healthy serum 25 hydroxy Vitamin D3 level between 40 ng/ml and 60 ng/ml reduces the risk for most solid cancers (breast, colon, prostate, lung, skin, ovary, uterus) by 50%. These are all no-brainers. Take a baby aspirin and 2,000 IU of vitamin D3 every day and be done with it.
Helping you obtain our rigorous definition of Physical Fitness is how we approach both disease prevention and optimal health and wellness. For what is optimal health and wellness if not a state of being where you are least likely to become ill. The goals and methods for obtaining one are the goals for the other.
The methods are following the Diet of the Ancestors nutritional approach that recommends a low carbohydrate, high protein, moderate fat diet. We couple that with moderate regular exercise and use medications when needed to increase your metabolism slightly and significantly decrease appetite. Finally, for postmenopausal women, we recommend balanced hormone supplementation that is compounded here in our laboratory to help them convert body fat that has accumulated since menopause back into the muscle. We provide professional coaching and support throughout the process, which is an organic one that is dependent on your body, your diet, and exercise habits to achieve the goal of optimal health and wellness. Time, persistence, and dedication are required to succeed. The benefits begin to accrue soon after beginning the program in the form of having more energy, fewer aches and pains, and improved digestion. In a month or two, your body will begin to reshape itself. This is seen in the mirror but also in those skinny jeans that you can now wear again. This happens even though your weight does not change much because what is happening is through adhering to the program principals your body has begun to replace fat with muscle. Muscle takes less space than fat but weighs more. That’s why the jeans fit but the scale has stayed the same. When your body weight to height (BMI) is already normal (between 19 to 25) you don’t need to lose weight. What you need to do is remodel your body by replacing fat with muscle. As this happens your body will reshape itself. The exercise you do during this time will influence the shape and final form the body will assume. This is one of the reasons for having a good exercise coach is important.
This is a natural process and cannot be rushed and more than we are already doing. I promise you that I employ everything I have learned or discovered to make this process as quick, painless, and effective as possible but you are a natural being, a creation of Mother Nature. Everyone knows you can’t rush Mother Nature and the same is true with this process. That is what I mean when I say that it is an organic process. It’s organic because you are organic. Remember what it was like as a child. Growing seemed to take forever. That was true even though it was not uncommon for your mother to buy you a new pair of shoes at the beginning of the school year only to have to get a new pair before school ended because your feet grew so much. Hooray for cheap kids shoes back in the day. It still seemed to take a long time to grow and it will also seem to take a long time for your body to reshape itself. That is because it does take a long time. Children grow much faster than adults especially 50-year-old adults. We will teach you how you can speed it up some, and there are some cool ways to do this that you actually control.
This is a very exciting and satisfactory experience that takes time to accomplish, is hard work, and requires will power and devotion to the goal. The goal is your achieving lifelong optimal health and wellness an intrinsically preventive state of being. You deserve this so get on with it.