Extremism in Health Care Part One: One Right Answer Nutrition

“Basically, many researchers are claiming that they have proved something to be true, but all they have actually done is to manipulate their research in order to confirm what they already ‘knew’ to be true….  I am deadly serious in my belief that the misguided war against cholesterol…represents something very close to a crime against humanity.  So close that you may not be able to spot the difference.”

-Dr. Malcolm Kendrick, author of The Great Cholesterol Con

Imagine my joy when I learned that a new certification in medicine has recently come to fore, that of lifestyle medicine.  The idea of lifestyle medicine is not only ancient and well-practiced across the world—especially in areas where people live far longer than we do and who suffer fewer chronic diseases or disabilities—but also is common sense.  Eat well, exercise, reduce stress, sleep better, and alas, you don’t need all those drugs and tests and procedures and doctors.  Lifestyle more than any other factor determines our health!  Societies that rely on lifestyle spend far less and live far longer than we do.  They rarely dive into the clutches of procedural-focused healthcare systems and certainly aren’t bombarded by measurement-obsessed doctors who rely on pharmaceutical guidelines and studies to assault their patients with fallacious myths and with number-fixing cures that make them sicker.  They take care of themselves, and they are rewarded with excellent health.

Anyone who knows me, my medical practice, and my writing knows that I am obsessed with lifestyle.  My practice website extolls nutrition and exercise as the paths to health, I created a nutrition triangle to help guide patients toward pragmatic and common-sense cures for diseases, I have made videos and have monthly nutrition workshops; the list goes on and on.  I always tell my patients that with proper diet and moderate fitness they can optimize their health; recently someone cured his diabetes in two months by changing eating patterns.  But I also tell them two other realities, and this is where my gap between those who direct this new Lifestyle Medicine organization and my view of healthcare is deepest.  First, measuring numbers and basing treatment on deceptive and invented diseases (like hyperlipidemia and prediabetes) is self-defeating.  For instance, while my patient who cured his diabetes with diet has not embraced healthy living and doesn’t need drugs, the Lifestyle medicine doctors would disagree, citing pharmacy-derived norms of diabetes control to suggest that he still needs medicines to push the sugars even lower.  And second, that while we do have foundational core knowledge about nutrition, there is a great deal we don’t know, and thus we must always be balanced and nuanced.

After taking several courses with them, speaking with several leaders in their organization, and speaking to like-minded colleagues who have derided this new specialty as being no different than anything else in our medical system, I am forced to sadly agree.  Ironically, after weighing the pros and cons of certification, I realize that this new Lifestyle medicine perpetuates a dysfunctional system rather than trying to repair it.  By relying on drug company data and specialty society protocols to arrive at their conclusions, and by not viewing lifestyle change as a holistic and largely unmeasurable tool to improve our health and well-being, this group clings to the notions of number-fixing, number-based diseases, and medical specialization.  It is disheartening!

And so, although they likely do not care, this organization has lost the allegiance of me and my lifestyle-oriented medical colleagues, one of whom summed up their modus operendi no differently than he would with any specialty society: “They need to be extremist and buy into the current dysfunctional model of care or they won’t be part of the club.”  When Alan Roth and I wrote A Return to Healing, we were attempting to do what so many others have attempted over the decades: to dispel the myths ingrained in our healthcare system that put numbers over people, fixing over healing, and common-sense over dogma.  We extoll lifestyle as the one and only path to health, one that should be embraced by the entirety of our healthcare infrastructure if we seek better outcomes at lower cost.  But to embrace lifestyle through the rubric of number-fixing, pharmacologic and specialty society protocols, and one-right-answer dogma is essentially sinking lifestyle changes in the muck of our medical industrial complex. 

Extremism sells books, puts people on TV, increases social media followers, and especially for doctors lands them academic success.  But it is self-serving, dishonest, and ultimately harmful to the very people that these doctors and other practitioners claim to be seeking to help.  When Alan and I tried to get on podcasts and radio show, we were told that our message is too nuanced; people want controversy and absolutism.  Well, the new Lifestyle medicine specialty joins the other players in our healthcare infrastructure in playing by those rules.  But for those of us who truly seek to help people find a holistic and pragmatic path to health, this is a great disappointment.

The credo of the Lifestyle Medicine Association is simple when it comes to its nutritional message: eat only plants, no animal products at all, or you will die sooner and be inflicted with more disease.  But for every observational, cohort, or longitudinal study they cite to prove their absolutist creed, one can find fault with their design and conclusions (much of which is documented), while multiple other studies that stand in stark contradiction to their hand-picked docket of research are ignored by them.  As we have discussed, observational studies are almost always dubious; we talked about how, employing criteria that these studies use, we can prove that driving a Subaru can cut your risk of heart disease by 75%.  These studies begin something they want to prove is true and then manipulate the criteria, randomization, patient selection, and length of time to arrive always at what they want to prove.  Drug companies are quite adept at this ploy, and it seems so are those who seek to steer us down a singular path of lifestyle changes.  Let’s talk about some flaws of this approach:

·       The creation of diseases, Prediabetes: The American Diabetes Association (ADA) and many of its drug-company allies that help finance it, along with the American Endocrinology Association—all organizations that benefit from scaring people into thinking they are ill with diabetes—not only doubled the number of diabetes in 2008 by lowering the threshold sugar that defines diabetes (without any evidence that the change would result in better outcomes), but also invented a disease called prediabetes that is both not dangerous and also not a precursor to diabetes, as we and many others have shown.  In fact, an article in Science demonstrates that this newly invented disease was created to scare people into taking more drugs and seeing more doctors.  And yet, the Lifestyle leaders cling to this fake disease as a pathway to measure success in their interventions.  While they may think that by embracing manufactured diabetic diseases (which now inflict 75% of adults) they can convince more people to change their diet, they are simply feeding into the narrative of making people feel sick, something that (as the inventors of this disease acknowledge) may lead to lip service about lifestyle changes, but in actuality generates more drug sales and specialty doctor visits with more tests and procedures and complications. 

·       The creation of diseases, Hyperlipidemia: Similarly, hyperlipemia is a “disease” that this group embraces, valuing any reduction in LDL cholesterol as proof of diet efficacy, and any high LDL as an aberration that must be treated.  We simply know this is not true.  Not only do copious studies demonstrate no link between LDL cholesterol and heart disease, but a new study in people over 60 shows an inverse relationship: that higher LDL portends a longer life.  We also know that most medicines that lower cholesterol do not improve heart outcomes, while some (like Niacin) lower cholesterol and increase death.  Osteopenia, mild cognitive impairment, high BMI obesity—all these are manufactured and well-studied “diseases” that lead to more drugs and tests and specialty visits while impairing health and longevity.    

·       The value of medical societies: The leaders of Lifestyle medicine base much of their dogma on protocols created by the CDC, medical specialty societies, consumer-oriented societies, and even the FDA.  We know, and discuss in our book, how all these societies manipulate data and recommendations for their own self-interest.  The American Diabetic Association and American Heart Association, widely cited as reliable sources, are largely funded by and run by drug companies; in fact, drug companies believe these to be their best investments.  While these societies always mention diet, their primary goals are to scare people into believing they are sick with the intention of selling drugs and instigating more specialty visits.  The American College of Cardiology and American Endocrinology Society are trade associations whose goal is to increase the income of their member doctors.  They lobby Congress more than most other groups, they create protocols to frighten people into thinking they are ill, and they recommend treatments that are profitable for their member-doctors; if they do discuss lifestyle changes, that is their cursory and largely symbolic attempt to seem balanced.  The CDC is also largely financed by and controlled by Big Pharma; many articles show how they manipulate data, discredit any facts that challenge their reliance on drugs and medical interventions to “cure” diseases, and are more of a hinderance to honest and effective healthcare than a resource.  And the FDA, which is fully financed and run by drug companies, has been corrupt and drug-happy for years; just read the new book No More Tears or the study by Shannon Brownlee and Jeanne Lenzer.  When promoters of lifestyle change rely on these organizations to arrive at medical truths, they are merely feeding drug companies and specialty doctors what they want rather than changing the direction of medical care.

·       A dogmatic view of nutrition: The leaders of Lifestyle medicine all adhere to a singular dogmatic supposition that whole plants are good (true) and all animals and animal products are dangerous (not true).  That they push people to whole-plant diets with less sugars, less processed food, and less meat is laudable.  But they don’t stop there.  Their fixation on saturated fat and cholesterol as unimpeachable evils is hardly proven science.  Cholesterol has been dissociated from disease for many decades, and while high levels of saturated fat are likely dangerous, lower levels may be helpful or at least neutral.  Whole milk, which they discredit, contains more nutrients and hardly more fat than skim milk.  Eggs, especially pasture-raised organic eggs, are an amazing source of good nutrients, and yet these doctors and nutritionists tell us they are universally harmful, even the primary cause of diabetes, something that shocks nutritionists I work with. A recent egg study that “proved” their harm has been poached and scrambled by many intelligent doctors and nutritionists; in fact, the authors of the study are linked to drug companies that make statins, and since such companies are not fond of wellness, one can infer that their assault on eggs is self-serving.  A similar article stating that seed oils are healthier than butter not only reverses what we know about seed oils but also is easy to tear apart and was authored by people who have an agenda.  While they claim red meat is horrific and that even small amounts will lower life expectancy and create numerous diseases, they rely on observational and longitudinal studies that compare people with high meat consumption/low plant consumption to those with low to no meat consumption/high plant consumption; there are no groups who eat a lot of plants and some meat in their database.  They do not at all discuss grass-fed beef which is loaded with beneficial fats and nutrients; they conflate good cuts of meat with fried processed meats; and they entirely selectively do not include any studies that dispute their dogmatic findings.  They are correct to laud fiber and whole plants, fruits and vegetables, nuts and seeds. But it’s not that simple.  What about pesticides, which they don’t mention? What about wild vs farmed fish and, as mentioned, industrial vs grass-fed meats and meat products as well as eggs, butter, and milk, also distinctions they ignore?  From our genetics we humans did eat plants and seeds predominantly, but also healthy meats and fish, eggs, and milk, even if less commonly.  Perhaps a mix of foods is the best path to health?  But the Lifestyle gurus see no nuance or compromise.  While they contend that some people may not be able to change to an all-plant diet, they suggest that making that change achieves the best health outcomes, something very debatable and only buttressed by using selectively accessed poor data and ignoring other data and all of human history.   

·       Numbers over People: Let’s face it, any group that relies on number-fixing as a path to health is feeding into everything dysfunctional and defective about our healthcare system.  We know that measuring and fixing numerical diseases is harmful, something we demonstrate in our book, especially since drug companies and specialty societies constantly change the norms to make more people numerically sick.  We know that a more holistic and nuanced approach to health is best, that lifestyle may not generate concrete measurable outcomes but has clearly been proven to keep people alive longer, keep them healthier and happier, and lower the cost of care.  Why is the American Society of Lifestyle Medicine so fixated not only on number fixing but in defining diseases through numerical norms?  That is the most difficult and disturbing question of all.  Perhaps it is so they can be valued by other players in our healthcare system.  Perhaps it is because it creates a tangible and measurable benefit that people have come to expect from any intervention.  Perhaps it is because such extremist, dogmatic, one-right-answer thinking is the very foundation of our Flexnerian healthcare system.  But in the end, relying on numbers will perpetuate our drug and specialty medical culture, not shift us to a holistic and lifestyle-focused healthcare system. 

When doctors like me and my colleagues, including Alan, reject the dogmatic and often deceptive precepts of a society the values lifestyle changes but only within the norms of a healthcare system that it seeks to be part of, when we reject it because that society relies on the same language and precepts as do those in our system who are most dangerous to our patients and simply piles more dogma upon an already littered system, there is a problem.  Such a group should embrace us, even listen to and work with us, rather than create a script that pushes us away.  Extremism even in lifestyle interventions is just as toxic as any extremist positions taken by other players in our medical industrial complex.  We seek to create a system that is predicated on lifestyle changes by rejecting the specialty-oriented and number-focused Flexnerian mess in which we live now.  By tying lifestyle to Flexnerian medicine we are only making the problem worse.