Diseases of lifestyle or non-communicable diseases are responsible for 71% of all deaths globally (1).

How can this be?

Most of us think we are reasonably healthy but why are 70% of us dying from preventable diseases that seem crazy?

Well, it turns out we are beginning to normalize being unhealthy.
Let me show you what I mean.

There is a new buzzphrase in medicine.  It is the words “metabolic health”. Your metabolic health is a culmination of a few easily measurable areas and if you have good metabolic health your chances of having a heart attack, diabetes, cancer or stroke are low.  If you have poor metabolic health your chances of dying from a non-communicable disease go up, as does your risk of dying from COVID or the flu (by 50%).

Specifically, you would be considered metabolically healthy if you have ideal levels of blood sugar, triglycerides, high-density lipoprotein (HDL) cholesterol, blood pressure, and waist circumference, all without using medications.

Sounds easy enough right?

Surprisingly it isn’t.

A recent study of 8721 people in the US measured those key indicators and found that fewer than 18% of adults 20 years or older have optimal metabolic health. This increased to about 33% in normal-weight adults but dropped to 8.0% and 0.5% in overweight and obese individuals, respectively. (2)

It turns out the groups who had the best metabolic health were women, people under 40, nonsmokers, those who were physically active, and interestingly, those who had a higher level of education. We’ll explore why that is later.

It’s not just the US, when we look at the percentage of people in the UK, which are similar to the US and most of the Western World, that have an underlying component of metabolic disease and we can see the scope of the problem.
That’s because:

60% of adults in the UK are overweight.
35% of adults are pre-diabetic
25% have high blood pressure

Those are only the people who have been tested, which means their actual numbers might be higher. All these problems are preventable with lifestyle changes but most of us don’t know what to do about them.

We go to our regular doctors and dutifully take the medications they prescribe to treat these ails. We are blissfully unaware of the side effects and hope they don’t affect us. If we have more than one problem we will have more than one medication, ‘a pill for every ill’, or so they say, but no one really knows what happens when you combine all the medications.  It’s like an ongoing experiment in which we are the guinea pigs. In England, more than 1 in 10 people aged over 65 takes at least eight different prescribed medications weekly, and this increases to one in four among people who are aged over 85! (3)

To me, the most obvious recommendation the doctor could make is something that would be cheap to implement, have no side effects and go straight to the cause of these problems:

• High blood pressure can be helped by exercise, diet, and stress management
• Pre-diabetes can be helped by exercise, nutrition, and sleep
• Excess weight can be helped by community, nutrition, exercise, and sleep

But they don’t suggest these things, they continue to prescribe expensive drugs that can do more harm than good. As Michael Saks points out in his book “Closing Death’s Door” the third leading cause of death, behind heart disease and cancer, is death from iatrogenic causes. This means that the death was a result of a person interacting with the medical industry. Heart disease and cancer, the top 2 killers are largely preventable with lifestyle changes and iatrogenic deaths should also be preventable.

Does something seem wrong here?

In order to understand how this came about, we can take a look back at the American frontier.
Back then there were snake oil salesmen and compounding pharmacists who sold directly to the public. As different states started to build a medical infrastructure they wanted to protect the public from these shady characters and passed laws stating that it will only be possible to buy drugs from a pharmacist with a Doctor’s permission, aka the prescription. This was a good idea. Allowing the makers of the medicines to experiment directly on their customers wasn’t good for their health. The Doctors acted as a champion for the protection of public health. The pharmacist saw this as a problem. How could they sell more drugs with the Doctors standing in the way of them and their customers, especially when the Doctors didn’t know anything about the drugs they were making. The answer was simple, educate the Doctors. This was the beginning of the pharmaceutical industry’s role in medical education. Fast forward to the present day and in the US up to 16% of the funding for medical schools comes from the pharmaceutical industry (4). This physician-pharmaceutical industry relationship has not helped our health because Doctors believe there is now a pill for almost everything, but they don’t think about our bodies as a whole, integrated unit that includes the mind.

Let me explain what I mean.

Traditionally, at medical school, Doctors spend the first part of their training learning about the entire body and all aspects of medicine before specializing in an area that interests them. Then they tend to choose a system to master, like the cardiovascular system or the gastrointestinal system. The trouble is that once they have specialized this compartmentalization spills over to how they work. They become siloed in their specialism and don’t step back to look at the bigger picture.

For example, depression has been linked to poor gut health (5), but very rarely would a gastroenterologist ask about depression, and conversely when do psychiatrists ask about gut health? They think it is out of their area of specialism, which to some extent is true, but when someone is working with the body an understanding of its interconnected nature is key to managing diseases of lifestyle.

Most general practitioners have a very short amount of time with their patients, 5-8mins in the UK, and just aren’t equipped to delve deeply into someone’s life, to connect those dots. It’s not their fault, it’s more a product of the system.

The good news is there is a sea change happening in medicine. As Doctors and scientists continue to unravel the mysteries of the body these interconnections are getting harder to ignore. People are looking to be more healthy and realizing their regular Doctors aren’t a good source of information on wellness. Your regular Doctor might be able to stop you from dying or help you identify a disease but they aren’t trained to get you functioning and performing optimally, they just don’t know about wellness.

This is where lifestyle medicine comes in. The approach takes a step back from the systems approach and looks tries to ask the question of why did these problems occur. Dr. Mark Hyman, a functional medicine Doctor claims he “doesn’t even treat disease anymore”, but just looks for the cause. He says that conventional medicine can be likened to a farmer who uses pesticides to deal with bugs in the plants and fertilizers to deal with depleted soil nutrients. Functional medicine is like a farmer who takes care of the soil health and as a bi-product the plants become healthy. The aim of the lifestyle doctor is to help change a person’s lifestyle and as a byproduct the body becomes healthy.

To put that into context imagine a patient who has an autoimmune condition, say rheumatoid arthritis, they also are overweight, have migraines, insomnia, low energy, depression, and eczema. Under the normal medical model, she would see an autoimmune specialist, a migraine specialist, a dermatologist, and this would all be coordinated and managed by her family physician. A lifestyle medicine expert would ask how are all these things connected? These connections are all inflammatory, so one of the first things for her to try would be an anti-inflammatory diet and support her gut microbiome (the bacteria in her gut).
The health of the gut is so important and I’ll go more into this another time.

Simple foods that support gut bacteria and supplements of probiotics can improve gut health easily. This would help calm down the arthritis, eczema and begins to address the excess weight. Introducing more sunlight into her life can help with insomnia which will help reduce the depression and again help her lose weight. This can save the healthcare system a ton of money by reducing or eliminating her drugs and putting the control back into her hands.

Now, not everyone reading this will have as many identifiable diseases as the example above. In fact, most of you will feel healthy, but maybe not 100% healthy.

What’s stopping you from feeling 100%?
Is it lack of sleep?
Is it too much stress?
Do you drink a little too much?
Do you feel lonely or lacking purpose?
Is it that you don’t like to exercise?

In this blog I am going to explore all the aspects of lifestyle medicine using the 4 Ms.

Mission
Mindset
Mojo
Movement.

I’ll explain more about how I developed this concept in a later blog and how you can use it to radically change your life.

(1) https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases

(2) https://pubmed.ncbi.nlm.nih.gov/30484738/

(3) https://files.digital.nhs.uk/excel/4/2/hse2

(4)https://www.npr.org/templates/story/story.php?storyId=4696316016-pres-med.xlsx

(5) Gut health and depression https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7510518/

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