Prevent and Treat Chronic Medical Conditions – A New Approach

By Paul E. Lemanski, MD, MS, FACP

Editor’s Note: This is the 106th in a series on optimal diet and lifestyle to help prevent and treat disease. Any planned change in diet, exercise or treatment should be discussed with and approved by your personal physician before implementation. The help of a registered dietitian in the implementation of dietary changes is strongly recommended.

Medicines are a mainstay of American life and the healthcare system not only because they are perceived to work by the individuals taking them, but also because their benefit may be shown by the objective assessment of scientific study. Clinical research trials have shown that some of the medicines of Western science may reduce the risk of heart attacks, strokes and cardiovascular death.

In the first 105 installments of the Non-Medicated Life, certain dietary practices and a healthy lifestyle have been shown to accomplish naturally for the majority of individuals most of the benefits of medications in the prevention and treatment of chronic medical conditions such as hypertension, high cholesterol, pre-diabetes, diabetes and heart disease. How to change dietary and lifestyle practices with the necessary support from our existing healthcare delivery model, however, is not straightforward and requires, I believe, a new approach.

As the chronic conditions mentioned above are usually treated with medications by practitioners most comfortable with that approach, it may be a challenge to find one willing to integrate a lifestyle approach with the Western medicine model. Such an integrated approach requires a willingness to see medications as a bridge to a non-medicated state, whenever possible, and the use of medications only when absolutely necessary. And because an alteration in lifestyle requires the formation of new habits, it also requires a frequency of contact and accessibility to interaction with your provider not generally supported by the available healthcare model of one-to-three visits a year. In this article I will present one possible solution that I have developed for the integration of lifestyle medicine into usual care, a program called Prevent It Now!®

Prevent It Now! is a 12-week group class taught by a team of medical professions, made up of a physician, a dietitian, and, ideally, an exercise physiologist/exercise trainer. The weekly group class format allows sufficient monitoring and supervision to allow unhelpful health habits to be discontinued and replaced with healthy habits. The group meeting also fosters a sense of community with participants helping and supporting one another both to make the necessary changes and then maintain the new healthy behaviors.

Recognizing the challenges of the Covid-19 epidemic, the program offers a hybrid meeting format (either in person or virtual) weekly for one hour. An intake interview with all participants by the Prevent It Now! team determines the appropriateness for inclusion, identification of current challenges and goals, and an individualization of approach, as required. An established ongoing relationship with your primary care provider is helpful especially for those participants on multiple medications with multiple medical problems, potentially requiring medication modification, monitoring of blood pressure, and blood work during the course of the program. While your primary care provider need not be versed in nutrition or lifestyle medicine, they should be supportive of the approach.

Who should be interested in the Prevent It Now! program? Certainly, anyone at risk for the development of coronary heart disease, diabetes, stroke and certain cancers. The individuals would include those with a family history of heart attack, stent, coronary bypass surgery, diabetes or certain cancers. It would also include those who currently have been diagnosed with obesity, prediabetes, high cholesterol and hypertension. It would, additionally, include those individuals who have been already diagnosed with coronary heart disease, diabetes and stroke, whose intent should be secondary prevention, or help in preventing new heart attacks, strokes, possible blindness, possible dialysis, and an earlier than necessary death. And finally, it would include individuals on multiple medications who would like to safely and appropriately limit themselves to only those medications that were truly necessary.

Most individuals in the US are overweight or obese. Unfortunately, excess body weight increases the risk for coronary heart disease, diabetes, high cholesterol, hypertension and certain cancers. As a consequence, the Prevent it Now! program targets excess body weight with a choice of a high protein ketogenic diet or a vegan diet. The former relies on a moderate carbohydrate restriction to reduce appetite and the latter relies on volumetric eating, in which high volume low caloric density foods maintain satiety. The result is safe, effective weight loss in the easiest possible way. Even a modest weight loss can have significant health benefits. 

For example, even five pounds of weight loss may start to lower blood pressure, triglycerides and blood sugar. In the Diabetes Prevention Program, those who were overweight or obese and prediabetic could with a loss of 7% of their body weight reduce advancement to full blown diabetes by 60%. Thus, a 5’2” woman weighing 200lbs might be 60lbs above her ideal body weight, but would need to lose only 14lbs to reduce the risk for developing diabetes by 60%. In those with diabetes, 14lbs of weight loss may allow reduction or discontinuation of diabetes medication. It may allow reduction or discontinuation of medication for high blood pressure. It may allow reduction in high cholesterol medication. Most importantly, success with body weight reduction – especially when it relies on changes that are both doable and sustainable – empowers and motivates individuals to make other healthy changes including daily aerobic exercise. Exercise aids in weight loss and weight maintenance, in combating frailty and in preserving independence.

Once needed weight loss has been achieved, the Prevent It Now! program transitions to a Mediterranean Eating Plan (either predominately plant-based or vegan), or an Okinawan Eating Plan. The former has clinical trial evidence of efficacy: in the Lyon Diet Heart Study, published in the prestigious cardiology journal Circulation, a high omega-3 Mediterranean diet reduced fatal and non-fatal heart attacks by 70%. The latter’s efficacy is established by Okinawa as one of the earth’s five Blue Zones where humans living to age 100 and active are markedly increased.

In summary, the healthcare system has over the years turned to medication and procedures to prevent and treat chronic medical conditions. Increasing evidence suggests that diet, exercise and lifestyle change – so called lifestyle medicine – can accomplish many if not most of the benefits of medications without the additional costs and side effects. Yet lifestyle medicine, which requires specialized knowledge of nutrition and increased frequency of contact to form healthy new habits, is not supported by the present healthcare model. The Prevent It Now! program offers one possible solution to practically incorporate lifestyle medicine into usual care and to help prevent and treat medical conditions in a more natural, self-empowering way.

Paul E. Lemanski, MD, MS, FACP (plemanski3@gmail.com) is a board-certified internist practicing internal medicine and lifestyle medicine in Albany. Paul has a master’s degree in human nutrition, he’s an assistant clinical professor of medicine at Albany Medical College, and a fellow of the American College of Physicians.