
Veterans and servicemembers are following the six pillars of lifestyle medicine to influence their health and wellness. A certified lifestyle medicine clinician shares how you can too.
Lifestyle medicine is transforming the way health-care professionals are helping their patients, and themselves, take control of their health – and future health – by learning sustainable daily behavior changes. These changes involve a six-pillar approach – eating well by adding in more whole-food plants into diet, getting better sleep, managing stress, avoiding risky substances like tobacco and alcohol, cultivating positive social connections, and exercising daily.
This whole-person health approach gets to the root cause of diseases and helps people make small changes, or even big changes, and see transformations that they may never have thought were possible. While physicians certified in lifestyle medicine still prescribe pharmaceuticals and refer patients to specialists when needed, they are “always bringing it back to that comprehensive approach to getting down to the foundation of those six pillars and how we can help people use them more effectively to meet their short term and long-term goals,” said Dr. Mary Anne Kiel, a retired Air Force physician and a board-certified pediatrician and lifestyle medicine physician, who was a special guest on The American Legion Tango Alpha Lima Podcast where she spoke more about lifestyle medicine. Listen here.
Over the next few weeks, The American Legion will share testimonials from veterans and servicemembers who have positively transformed their health by following the six pillars of lifestyle medicine.
The American Legion spoke with Kiel more about lifestyle medicine and how others interested in it can learn more and get started on transforming their health now and for the future.
Q: What is the lifestyle medicine approach?
Kiel: It’s really about getting back to the roots of prevention and disease alleviation through lifestyle changes, whereas conventional medicine often in today's world goes straight to pharmaceuticals or referrals to a specialist. Lifestyle medicine really looks at the whole person – how can we help them be more in control of their health and their lives, and what things can they do daily that are going to make a significant difference down the road, and not just in the long term, but what will start helping them today? It's engaging in what the patient sees as important in their lives and how can we tap into that motivation to help them meet their goals by using those six pillars. It doesn't mean that we don't use pharmaceuticals when we need to or referrals to specialists. But certainly, always keeping in the forefront of our mind those foundational pillars and how can we help people make tiny steps, or sometimes big steps, to advance their health.
Q: Who can benefit from lifestyle medicine?
A: It benefits everyone who decides to use it, and not just the patients, but also healthcare professionals. I can't think of a scenario where I wouldn't recommend lifestyle medicine. It may look different depending on the person, their abilities, their situation, and their environment, of course. Whether it's talking about prevention, for example, a patient with a family history that is wrought with certain chronic diseases wanting to know how they can keep themselves from being in that health situation down the road, or for others who have experienced their own chronic illness; for example, people who have autoimmune conditions wanting help with their pain, or people who unfortunately may have faced cancer and survived it, but not wanting to have it return. There are all kinds of chronic disease concerns that can benefit in some form or fashion from implementing the lifestyle medicine pillars.
Regarding healthcare professionals who use lifestyle medicine, we have seen significant improvements in reducing burnout and bringing back that passion for practicing medicine. It helps because you're not just applying the Band-Aid approach to patient after patient without seeing significant improvements. What we've noticed, and what the literature seems to support, is that lifestyle medicine is invigorating healthcare professionals because we're doing what we were taught to do – we’re actually healing our patients. And patients are happy because, for many, they are improving their quality of life by reversing their disease or maybe not having the side effects from the pharmaceuticals. So, clinicians practicing lifestyle medicine are seeing benefits both professionally and personally.
Q: Are practitioners aware of lifestyle medicine to address this with patients?
A: Awareness about lifestyle medicine has grown tremendously over the last decade , but we still have work to be done to make it accessible to all patients. When I first started off on this journey eight years ago in the Air Force as an active-duty member, I would say lifestyle medicine, and few knew what I was talking about. It's only been eight years, but now when I give presentations or do speaking events for healthcare practitioners and I say lifestyle medicine, almost every hand in the room is raised because they at least know what it is and they recognize that there's value in those six pillars. You don't have to be certified to practice lifestyle medicine because the skills are evidenced-based and are recommended to be first-line treatment for many conditions, yet certification helps solidify tactics for successful interventions. Although not all healthcare professionals are skilled in lifestyle medicine, many should have some sense over how to steer patients in the right direction or how to at least give them the resources that they would need to get started. If they don’t, then perhaps our patients can help educate them by making them aware.
The Veterans Affairs system promotes their Whole Health program, and they're very advanced in using a lot of these techniques that support lifestyle medicine, but we're trying to advocate for overlaying lifestyle medicine along with the Whole Health program so that it provides the foundational evidence-based support with those six pillars. Lifestyle medicine would help standardize the language and techniques that are used amongst clinicians promoting lifestyle change. This approach empowers patients, it gives them something tangible that they can use if they choose to use it. I think sometimes conventional medicine, in my experience, makes patients feel like they're kind of stuck between a rock and a hard place; that the only options are to take this medication or perhaps do nothing or see a specialist. I think lifestyle medicine provides an additional option that isn't often talked about and isn't often portrayed as something that can significantly change the trajectory of one’s health and life. Those of us practicing lifestyle medicine are open to talking with patients about this and supporting them in making those changes if they want to.
Q: Is there one pillar over another that someone should start with?
A: In reality, whichever pillar the patient is willing to try first is the one they should start with.
Let’s say for whatever reason someone may not be able to fix their sleep issues now, even though I as the clinician feel sleep is such a critical pillar. If you aren't sleeping well, oftentimes you're stressed and you don't have the energy to do physical activity.. But maybe the person is willing to change their food habits. Maybe they can somehow eat more leafy greens for their breakfast, lunch, and dinner, and even just that small step may propel them to make other changes.
I do feel like nutrition is a big component of so many disease processes, and in fact one of the articles that came out several years ago reviewed the research studies and showed that poor nutrition is the leading cause of chronic disease in the United States now, surpassing tobacco use. If we can help people make any changes toward better nutrition, I feel like that is huge, and we need to do our best to help support them in that.
When we talk to people about making changes with food, it can feel scary because food is everywhere in our environment and so much processed food, in particular. It has been normalized to run through the drive-thru or pick up pepperoni pizza at the grocery store. Eating is also a very social activity and it can be intimidating or scary to think about making changes when your circle of friends isn’t moving along that same path. That can be challenging for some people, but with the right support and the right skills, we see enormous success with it.
One thing that I find very interesting is that while all the pillars are distinct, they're also very much intertwined. We oftentimes see that whichever pillar the patient chooses to start with, the effects bleed over into other pillars and the patient suddenly sees an upward spiral of positive side effects because of the synchronization.
Q: What is the diet for lifestyle medicine?
A: We call it a whole food plant-based or plant-predominant lifestyle (not really a diet), but it essentially involves minimizing processed foods and focusing on as many whole plant foods as you're able to pack into your meals. Cutting out the ultra-processed foods and planning how we can get more plants on the plate is really the goal. We focus on vegetables, fruits, whole grains, legumes (beans and lentils), nuts and seeds. It doesn't mean that you necessarily have to be 100% plant-based, but moving in that direction is key to better health. Patients often notice that they can eat a large amount of food (because it is full of fiber and very filling) and that they are very satiated. It is generally much fewer calories because it is whole food from plants which are naturally lower in calories. We do not typically recommend calorie counting because it becomes less relevant when you are choosing nutrient-dense plant foods.
With all these recommendations and with medicine in general, what we have found is that especially when trying to reverse chronic disease, it often boils down to the dose. For example, when we're giving a medication to treat a condition, it’s important that we get the right dose to treat whatever we're treating, and the same thing applies to lifestyle medicine. If you're just doing a sprinkling of whole plant foods, but you have severe chronic disease, sometimes that is not enough to see significant positive effects, especially rapidly. So we do try to have a conversation with patients that strikes a balance between what will optimize their health and what they are willing to do, knowing that the dose plays a key role. But any movement toward a whole food plant-based eating pattern is cause for celebration!
Q: How can someone get started with lifestyle medicine?
A: Find a lifestyle medicine clinician in your area; find a registered dietician certified in plant-based nutrition. The Veterans Affairs Whole Health program has many resources, as well as the Military Health System for active servicemembers. The resources may not be specific to lifestyle medicine, but they can certainly help support patients along a lifestyle medicine journey.
Identifying a clinician that recognizes the value of the lifestyle medicine pillars and how to optimize them is a wonderful thing. My goal would be for every primary care clinician to embrace that in their care, but we are just not there yet. I think we must help patients find additional resources that are going to support them in making these changes
Kiel provided the following lifestyle medicine resources to get started. Click the following to find:
· A lifestyle medicine trained clinician
· A preferred registered dietitian knowledgeable about plant-based eating
· Veterans Affairs whole health resources
· Military personnel and families health and wellness coaching
· Veterans Affair practical plant-based cooking guide
· More information at American College of Lifestyle Medicine
Q: What are a few final thoughts for veterans and servicemembers about lifestyle medicine?
A: First, I would encourage them to start asking their primary care providers and specialists about lifestyle medicine. If they are asking about it, then the healthcare community that doesn't know about it is going to go learn. They should be educated about it to be able to help their patients.
Let me address barriers. It is hard to make change, and we understand that. But one misconception that people often have is that things have to be expensive or time consuming to even get started, especially for people wanting to make changes with nutrition or changes with exercise. We try to help patients recognize how they can make small, inexpensive, easy changes that add up to have significant impact over time. How can they fit this into their lives? You don't have to join a gym to start your exercise routine. Are you able to walk up and down stairs? Are you able to do some squats or lunges in your living room or at your desk at work just a few minutes twice a day or after meals? The evidence is there to show that those things are significantly impactful to health, and so it's helping people figure out how to work these things into their busy lives
I would also encourage individuals to seek out a health coach. Many health systems are offering them, even the Military Health System and the Veterans Affairs. I think health coaching is one of those services that's becoming more and more utilized in the community, but not everybody knows about it or feels comfortable using one. But they're the ones that can really help patients get the support they need to make small changes that stick. Getting support and encouragement is really critical to making lifestyle changes and having someone help us stay accountable and to cheer for us when we make progress can be really motivating.
The last point I will make is that we have a wonderful opportunity to share these success stories of servicemembers and veterans to highlight how lifestyle medicine not only can improve their lifespan, but their quality of life. That is what we want. It comes back to what the patient’s goals are, where do they to be down the road? Do they want to be able to travel, play with their kids or grandkids, run a marathon? Just because we get older does not mean that we must be ill. We often see veterans suffering from ill health due to lifestyle measures that prevent them from attaining their dreams. How can we bring that quality of life back to veterans now?
Lifestyle medicine is the way I see that happening.
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