Lifestyle Medicine as the foundation of all medicine

Susan Benigas is the executive director at the American College of Lifestyle Medicine, where she works with countless physicians and other professionals in the health sector, to aid in the evolution of healthcare as we know it. She’s also the co-founder of The Plantrician Project, which produces the International Plant-based Nutrition Healthcare Conference, as well as other tools and resources to support medical professionals and their patients in adopting a whole food, plant-based dietary lifestyle.

Could you please explain the difference between functional, integrated and lifestyle medicine?

S. Benigas: The vision of the American College of Lifestyle Medicine is that lifestyle medicine would become the foundation of all healthcare, not only across the United States but around the world. Lifestyle medicine is the use of lifestyle as a therapeutic intervention to treat, reverse and prevent disease. This includes what we eat, how we sleep, how we move, how we manage our stress, the avoidance of risky substances such as tobacco, and having healthy relationships in our lives. Then, when we look at functional medicine, lifestyle medicine is the foundation, with functional medicine focused more on emerging diagnostics, with a heavy emphasis on gut health, nutraceuticals and dietary supplements, which are not typically part of lifestyle medicine. Lifestyle medicine is focused on lifestyle behaviors, such as eating from the rainbow of foods that grow from the ground in as close to nature’s package as possible, as these are the foods that are fiber-filled, nutrient-dense and antioxidant-rich. The only supplementation that’s typically recommended would be methyl B12 and D3. There is not a heavy emphasis on nutraceutical and dietary supplements as is the case with functional medicine. With integrative medicine, again, lifestyle medicine is the foundation, but it is focused on the use of complementary medicine. So you can get into acupuncture, acupressure, some of these other forms of treatment that may be very beneficial, but are really outside the scope of the true definition of lifestyle medicine.

What is the focus of the American College of Lifestyle Medicine? What are some of the most rewarding challenges your organization has tackled and accomplished in the past two years?

S. Benigas: The American College of Lifestyle Medicine (ACLM) is the nation’s medical professional association representing physicians, allied health professionals, and healthcare executives who are truly passionate about the urgent need to transform health and redefine healthcare with this lifestyle medicine-first approach and that is focused on identifying and eradicating the causes of disease. Even recently, the Institute of Health Metrics and Evaluation issued the Global Burden of Disease Report. It looked at data from 129 countries, and it was what people are and are not eating that’s the leading cause of disease and death around the world. At ACLM, as clinicians, we are focused heavily on filling the gaping void in medical education that exists where lifestyle medicine is concerned. We’re also focused heavily on advocacy and policy efforts that will help to aid reimbursement and establish quality measures in this country that help to support the practice of lifestyle medicine. ACLM is an organization established in 2004 and has just over the past five years seen a 500 percent growth in membership, which is quite remarkable. About 130 new members are being added every month, all organically because ACLM has never had a proactive membership drive. And I often say that ACLM and the field of lifestyle medicine are magnets for purpose, passion-driven people. We have epidemic levels of physician burnout in the U.S., where physicians are having to see 30, 40, 50 patients a day and have little time other than to diagnose symptoms and treat with ever-increasing quantities of pills and procedures. They’re just saying, no more, as this is not in the best interest of patients or providers. That’s why lifestyle medicine is experiencing such an extraordinary growth trajectory. Because physicians can become true healers, they can work with their patients to restore health, whether that’s from cardiovascular disease or type 2 diabetes. It’s all the chronic noncommunicable diseases that are looming pandemics around the world. And lifestyle medicine truly is the antidote.

Is it lifestyle versus traditional, from the patient’s perspective now, rather than the physician’s perspective?

S. Benigas: I often say that all things old are made new again. Lifestyle medicine is the newest field of medicine, but, at the same time, it could be viewed as the oldest field of medicine, because it was Hippocrates who is often quoted as saying, over 2,000 years ago, ‘Let food be thy medicine and medicine be thy food.’ He was really seen as the father of medicine, and the Hippocratic oath, which we often say, ‘to first do no harm.’ And yet, we’ve strayed so far from that. I think that the pendulum does swing, and the pendulum is swinging back in the direction of patient empowerment. Truly empowering individuals to become the locus of control of their own health destinies. They no longer believe the lie that they are a victim of their genes and destined to become chronically ill, and dependent on pharmaceuticals for the rest of their lives. Lifestyle medicine is part of traditional medicine. It should be the foundation of traditional medicine – of all healthcare. We’re enormously grateful for modern medicine and modern pharmaceuticals and procedures, they all have their place where acute care is concerned. In the United States, right now, we have 70 percent of all Americans, and 90 percent of all seniors, taking prescription meds. We spend more in this country on pharmaceuticals than the rest of the world combined. And that is simply unsustainable, nor is it in the best interest of patients or their providers. We are advocating that lifestyle medicine be embraced more and more comprehensively, and by the entire medical establishment as the foundation of traditional medicine. So that when the patient comes in, the first treatment option is to try to identify and eradicate the cause of that disease. And then there are times when that may not be possible. That’s where pharmaceuticals and other treatments have their place.

Are more and more physicians, embracing or subscribing to lifestyle medicine? What is their view? What are today’s views from the physicians’ perspective?

S. Benigas: Absolutely, that’s why we’re seeing such explosive growth within our membership. It isn’t just the American College of Lifestyle Medicine. Under the umbrella of the Lifestyle Medicine Global Alliance, there are lifestyle medicine medical professional associations that are emerging all over the world. I recently had the opportunity to be in Lithuania and Poland. I spoke at the brand-new Polish Society of Lifestyle Medicine and at the Lithuanian Lifestyle Medicine Association, hosted by Kaunas University. Lifestyle medicine medical professional associations are emerging in Germany, the Mediterranean and other parts of Europe, as well as in South America, Central America, Australia, and throughout Asia. There is this awakening around the world that identifying and eradicating the cause of disease, treating those root causes of disease must become that first treatment option. One of the biggest challenges we face in the United States is that in our allopathic only approach to medical education, the emphasis is on diagnosing symptoms and treating them. Our medical education system here has been pretty much devoid of any training on lifestyle medicine, which includes evidence-based clinical nutrition, for example. We recently surveyed our physician members, and on average, they had received about 180 minutes of training on clinical nutrition as part of their entire medical education. A big emphasis for us is creating awareness because too many medical professionals still do not know what they do not know, because they just have not been trained in this. It’s awareness building. And then again promoting the incredible repository of educational resources that we now have at lifestylemedicine.org that fills that void. Now with scalable, online education, as well as live events, and now certification in the field that’s also offered through the American Board of Lifestyle Medicine and the International Board of Lifestyle Medicine, physicians and allied health professionals around the world are being effectively trained now and even certified in the field of lifestyle medicine. I think that having the availability of those educational and certification resources is helping to drive interest in the field. Physicians and medical professionals are embracing lifestyle medicine and integrating it into their personal lives, as well as into their clinical practices.

Is the ACLM a proponent of integrating lifestyle medicine into the medical curriculum?

S. Benigas: Yes, lifestyle medicine is in no way alternative medicine. It is the foundation of all medicine. We’re investing heavily in developing educational resources that can be found at lifestylemedicine.org. Education in lifestyle medicine is essential for all medical professionals. It’s amazing to see even at Kaunas University in Lithuania the first lifestyle medicine Master’s program in all of Europe. How very visionary that it exists there. More and more programs throughout the United States are now beginning to incorporate lifestyle medicine training. We see it as four tiers. We are developing a very robust curriculum that will be rolled out to preprofessional medical education. There’s a downloadable syllabus on our website. It’s a 50-page lifestyle medicine syllabus that has already been downloaded nearly 2,000 times by educators in over 80 countries. We have a very active medical education task force that is working with several medical universities and schools around the country on helping to integrate lifestyle medicine into all aspects of their medical education. And then residency through the generous support of the Ardmore Institute of Health. We’re building a very comprehensive lifestyle medicine residency curriculum currently being piloted which we will debut in its final form in the spring or summer of 2020. Then we are addressing continuing medical education for all those millions of already practicing physicians and allied health professionals who didn’t have the benefit of lifestyle medicine being woven into their medical school curriculum. We are working hard to address that, as well through continuing medical education that focuses on the core competencies of lifestyle medicine. All the pillars of the field are vital, including an emphasis on food as medicine and evidence-based clinical nutrition that is efficacious in treating, reversing and preventing disease.

For the public, would there be one book that you would prescribe?

S. Benigas: There’s a new lifestyle medicine handbook that was published last year by the lead author who is one of our board members, Dr. Beth Frates of Harvard University; it is called The Lifestyle Medicine Handbook: An Introduction to the Power of Healthy Habits. It’s really a wonderfully comprehensive overview of the field of lifestyle medicine. There are many books. I would say for myself personally, the book that truly changed the trajectory of my personal and professional life was one that I was introduced to by a breast cancer oncologist back in the fall of 2007. It was ‘The China Study’ by T. Colin Campbell. She held up the book and said, “This book has changed my life and is changing the lives of many of my patients.” It was even hailed by the Los Angeles Times as the most in-depth study of the relationship between nutrition and human health ever done in the history of mankind. A profound book that really connected the dots between the power of our food choices, and our optimal health or lack thereof, but also really shining a bright light on the fact that we didn’t so much have a healthcare system in the United States as we did a disease and disability care system. That was very paradigm-shifting for me. Others include ‘Prevent Reverse Heart Disease’ by Caldwell Esselstyn Jr., many of the books written by Dean Ornish, Dr. David Katz has authored several outstanding books, ‘How Not to Die: The 15 Leading Causes of Death” by Dr. Michael Greger, who’s also a founding member of the American College of Lifestyle Medicine. There are wonderful books and resources that are available to medical professionals and to their patients. It’s exciting to see that patient empowerment is happening, and that we are rising up and saying that we will not accept as inevitable the continued rise of noncommunicable disease and the associated costs, and that as patients and medical professionals, we will step forward and say, “We will be empowered to protect our health, prevent disease, even treat and reverse disease through the power of our own lifestyle choices.” I’m hopeful. I think that we’re seeing changes across the United States and around the world as we come together. This is the good news that far too few people have heard and we’re seeing lives transformed and health restored. It’s truly inspiring and the time is now. The time has really come for lifestyle medicine to lead the way.