I have a carrot and a stent, you pick!
Koushik R. Reddy, MD
About three years ago, at the end of a work day that I call routine, it dawned on me that all the five men on which I had performed coronary angioplasties had various combinations of some of the most common chronic diseases, such as high blood pressure, high cholesterol, obesity and diabetes. These patients, while on “Guideline” driven, aggressive, medical therapy, were presented to the cardiac catheterization laboratory needing either an elective intervention due to angina, or an urgent intervention due to an acute coronary syndrome.
This is a very common observation: Most patients presenting to cardiac catheterization laboratories for elective procedures are burdened with the combination of multiple chronic medical conditions. We have to stop and ask ourselves this: If our conventional, aggressive, evidence-based medical therapies are at work, why are patients requiring coronary interventions in such large numbers?
My quest to answer this question led me to the science of evidence-based clinical nutrition and lifestyle medicine. I felt like there is a deeper and better understanding to health, the kind of understanding that I did not have, nor had I been trained in. As I took pride in my procedural skills and disease management, I found myself excluded from the arena of maintaining health. Health as in not the mere absence of disease or infirmity but the wholesome presence of physical, social, mental, and emotional wellbeing.
I made it my mission to seek and master the knowledge of lifestyle and nutrition to help people live wholesome lives. During that period of quest and introspection it was by good fortune that I accidentally tuned into one of Dr. Joel Fuhrman’s shows on a local PBS channel. For all practical purposes, that one hour changed my personal and professional life. I took it upon myself to read his books and the writing of many other physicians and learn as much as I could. The authors of these books became my “mentors by proxy.” The past three years have been the most transformative in my medical career.
United States medical education system, it takes anywhere between 15-17 years
of post-high school education to be board certified in Interventional
Cardiology. During those years, we seldom receive didactic or clinical training
in dietary and lifestyle-based approach to preventing, treating and potentially
reversing some of the chronic cardiac diseases by which society is burdened. After
many years of training and experience, I found myself completely void of
knowledge, when it came to clinical nutrition. I had to resort to books, blogs and
programs geared towards nonprofessionals. This was a humbling experience and a moment
of awakening, both in a personal and a clinical sense.
By continuously implementing these methods of learning and educating, I have seen tremendous success. Success in terms of disease modification, symptom regression and overall risk reduction amongst my patients. I spend most of my clinical encounters discussing nutrition, lifestyle and prevention. This pays off in ways that are lot more gratifying than some of the most complex coronary interventions I perform.
Based on my renewed appreciation for clinical nutrition and feedback from my patients, I strongly believe that the teaching of lifestyle medicine and evidence based clinical nutrition should be an integral part of our medical education and practice. The food that we eat and smoking are ranked as the number one and number two cause of morbidity and disability in the U.S. We are literally hurting ourselves with our own hands. Poor lifestyle choices are the leading causes of almost all common chronic disease. However, there is an unmet need to teach lifestyle and nutrition in our medical schools and residency programs. There is also an unmet need for research funding. With increasing risk factor and disease burden across the society, current treatment programs are neither cost effective nor clinically efficient. Our current system is unsustainable on a personal, societal and planetary scales. We can and must do better than the status quo. We as physicians start our careers by taking the Hippocratic Oath. Hippocrates once asked, “He who does not know food, how can he know the disease of man?” The prevailing theme amongst physicians during the time of Hippocrates was “Let food be thy medicine and medicine thy food.” That adage is still true today. For all the glory we seek in the name of Hippocrates, it is about time we put his words into practice.
Over the course of past year, as I continued to seek information and resources to educate myself in the areas of lifestyle medicine and evidence-based clinical nutrition, I joined the American College of Lifestyle Medicine, got Board Certified by the American Board of Lifestyle Medicine. Recently, it was an honor for me to be added to the American College of Cardiology’s working group on Lifestyle and Nutrition. That inspired me to co-initiate the foundation of a Veterans Health Administration and Department of Defense Working Group under the American College of Lifestyle Medicine. I feel honored and privileged to serve as the national co-chair for this working group.
As I continue to learn, I feel compelled and obligated to share the scientific evidence in support of whole food, plant-based nutrition and lifestyle changes. To disseminate information, I took the initiative to start a Lifestyle Medicine Clinic for patients with coronary artery disease. Recently, I worked with the office of graduate medical education at my university and started a Lifestyle Medicine Interest Group (LMIG) of students and residents that meets once a month to discuss various areas of lifestyle medicine and nutrition in an organized format that is outlined by the American College of Lifestyle Medicine.
In addition, it was an honor when I was asked to join and partner with a Veterans Health Administration initiative called Whole Health. My role as one of the education champions for our Whole Health program, is to focus on employee education. It is refreshingly inspiring and humbling for me to step outside of my comfort zone of cardiology and coronary interventions and discuss topics such as food and drink, mindfulness, working your body, and personal development. These are some of the core components of our Whole Health program. A program where the renewed perspective is to ask, “What matters to you?” not “What is the matter with you?”
It is with this renewed perspective I tell my patients that I have a carrot and a stent, you pick!
R. Reddy, MD
A. Haley VA Medical Center