I have a number of quotes hanging in my study for inspiration. For example, some of my favorites: “Leave your drugs in the chemist's pot if you can heal the patient with food,” attributed to Hippocrates, and "Let nothing which can be treated by diet be treated by other means," which Maimonides wrote 1,000 years ago.
But it's important to note that inherent in these famous statements is a caveat: the words “if you can” and “can.”
As powerful as preventive medicine is, it does not correct all ailments and risks.
For example, the numbers show that 90% of adult diabetes, 80% of heart disease and 50% to 60% of strokes and cancers can be prevented with lifestyle. In other words, no matter how dedicated you are, an unidentified toxicity or genetic factor may require more than just healthy living.
So is it a failure to combine a dose of medication with a commitment to eating, moving, sleeping and breathing in a healthy manner? I think not.
In my integrative cardiology clinic, I pull out of my toolbox whatever is needed at the time — whether that’s a pill, a yoga mat or both.
To further understand this philosophy of merging lifestyle, "farmacy," and pharmacy, it’s important to know the three phases of preventive medicine:
1. Lifestyle Only
Officially called “primordial prevention,” this is the goal we should all strive for. Simply put, it’s the state of having no disease conditions and maintaining a program to avoid them completely.
That means having a healthy lifestyle, as well as attending regular checkups to evaluate for normal weight, blood pressure, blood sugar, and blood lipids.
Generally, there's no need for medications in this category, and chronic diseases are reduced dramatically. As powerful as preventive medicine is, it does not correct all ailments and risks.
2. Lifestyle Cure
This phase, called “primary prevention,” means having a medical diagnosis — such as adult diabetes, hypertension, or high cholesterol — while working toward avoiding complications like renal failure, stroke, heart attack and death.
In the standard medical model, many medications would be prescribed, as well as some recommendations for lifestyle therapies.
In my practice, I continue medications at the minimal effective doses while providing education on the opportunity to reverse these conditions with lifestyle. Plant-based diets, exercise, stress management via yoga and meditation, sleep therapies, and targeted supplements can often lead to the reduction and ultimate elimination of prescriptions, while monitoring end points such as blood pressure and lab results.
It’s in this group where you hear terms like “former diabetic,” which are cause for great celebration.
3. Lifestyle Plus
In the third stage, we have what’s called “secondary prevention.” This approach is for patients who are already experiencing advanced complications of disease like a heart attack, stent, heart bypass, stroke or surgery on leg arteries. It’s likely that medication will be needed to some extent — for instance, a daily low-dose aspirin is often essential for people in this category.
As the group with the highest risk, this is also the stage that benefits the most from a smart combination of lifestyle medicine, farmacy and pharmacy.
Sure, there have been concerning examples of drug withdrawals and fraud in the pharmaceutical market. But I wouldn’t throw out the baby with the bathwater and consider a drug-free “natural” lifestyle to be the only goal.
Voltaire said that "the art of medicine consists in amusing the patient while nature cures the disease," and I agree. But I believe that some of that art is the combination of pharmacy Rx with lifestyle Rx, until the lifestyle practice is fully in place.
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