Op-Med is a collection of original articles contributed by Doximity members.
Name: David Donohue, MD, FACP
Specialty: Internal Medicine
Education: George Washington University, Baylor College of Medicine
Areas of Expertise: Health technology/informatics, Lifestyle medicine, Diabetes
Current Position: Internist, Progressive Health Of Delaware
1. Why did you choose lifestyle medicine and how does it differ from internal medicine?
There is no other choice. Lifestyle medicine seeks to treat and reverse the underlying cause of our most deadly and expensive diseases, whereas internal medicine seeks to manage these diseases using exclusively drugs or procedures. Ask most patients and they will tell you they would far rather be rid of disease than to remain a multidrug patient the rest of their lives.
They differ on what to do about disease. Internal medicine assumed it is someone else’s job to facilitate healthy lifestyle changes, so it rarely happens. Internal medicine moves on to its real order of business, to administer drugs. That would be swell except we know from copious research that drugs for these chronic western diseases offer only incremental improvements and a host of side effects.
By contrast, lifestyle medicine puts the change to a healthy lifestyle front and center. Philosophically, lifestyle medicine sees the body as naturally healing if we just get out of the way. We lifestyle medicine practitioners learn the skills to make those changes happen. In the end, most patients find the lifestyle changes fun, delicious, and rewarding. Far more doable than what conventional medicine offers: all those pills and all those tests and procedures and doctor visits you need for the rest of your life.
2. What are your research interests?
In my primary care internal medicine office, I run a program called Cure Diabetes. I am interested in ways we can reverse this deadly and expensive disease. The standard medical answer to this problem is drugs and more drugs.
The DiRECT study, published December 2017, randomized diabetics to intensive diet change vs standard counseling. At 1 year, almost half (46%) of the diabetics who were randomized to the diet program were free of diabetes. Off all diabetes drugs, normal blood glucose. In the allopathic medical world, diabetes is supposed to be a lifelong disease unless you get bariatric surgery. The results of our Cure Diabetes program have been similar. Those who learn the skills and make the lifestyle change can and do reverse their diabetes. And many people are successful.
3. Can you explain more about your Cure Diabetes program?
Cure Diabetes is a 6-week group program. No fee, we charge insurance using group visits. We have a curriculum that covers food, nutrition, exercise, positive psychology. In the course of the 6 weeks we show a lot of science. We do food preparation. We guide folks through a 21-day change in nutrition and physical activity. We share experiences of the group, what works and what does not.
We measure numerous biometrics and laboratories before and after. At the end of the 21 days, we give each participant a report detailing how far they have come.
We compare experiences, and learn what worked, what did not, who had the biggest results, what changes they made. Overall it is a super powerful experience.
4. Outside of your daily practice, do you have any personal or professional projects that you’re passionate about?
I am passionate that most people are missing the biggest win-win of their lives. Especially doctors. What the planet needs, what its creatures need, what your body needs, what your loved ones need, and what patients need, it is all aligned.
By switching our nutrition to a whole foods, plant-based diet, you can reverse and prevent disease in your own body. People who eat this way are the longest lived in the world. We have seen it has the power to reverse diabetes and heart disease. These are conditions still to this day thought to be irreversible by standard medicine. By eating this way, we are a positive role model to our loved ones and our patients. Research shows that just as smoking doctors are useless at counseling smokers to quit, meat eating doctors are ineffective at getting their patients to eat healthy.
5. What is a common misconception that other clinicians have about lifestyle medicine?
Some people think that because there are so few docs doing lifestyle medicine, then it must not be real medicine or give real results. To get real health care, you need to see the conventional medical doctor and get the standard drugs, tests, and procedures. For example, if you get heart disease, you will be placed on a statin drug and you will likely have almost no nutrition counseling. Statins do help, a little bit. About 4% of people with coronary disease who take those drugs for 5 years are helped in any way by the drug. Whereas with the Ornish Program for Intensive Cardiac Rehab, which is a 72 hour lifestyle modification program, it has been estimated that closer to 100% of people are helped by the therapy, with dramatic reductions in rates of heart attack, stroke, and death.
6. Who are your mentors?
My mentors are all the luminaries of the lifestyle medicine world, including Dean Ornish, Caldwell Esselstyn, Michael Greger, Brenda Davis, Neal Barnard. These folks are all knowledgeable, vibrant, friendly, approachable, and giving.
7. What has been your most gratifying moment of being a clinician?
When a patient of mine has made enough progress with her lifestyle that she can come off her last diabetes or blood pressure drug, we celebrate. When you talk to people with diabetes, they describe feeling imprisoned by their disease and the medical vortex of drugs and pharmacies and labs and specialists, over which they feel no control. And the rising expense.
So we celebrate the triumph of a patient against their imprisonment and their disease. I have had the great pleasure of helping patients accomplish this many times now.
8. How do you motivate patients to do what’s best for their health?
First tell them that the change is impactful. Share experience of others and scientific evidence. Next, understand their goals. Their core values, where they want their health to be. Understand the state of their lifestyle now. What skills and tastes do they have. Share with them a clear picture of what is the ideal. Don’t water down the message. This is the ideal and some people find the ideal lifestyle completely doable. But any movement in this direction is beneficial. Explore the changes they are willing to make now. Come to agreement on what specifically they will do, until next time we meet.
9. What is the biggest challenge or obstacle in lifestyle medicine?
Getting it paid for. Lifestyle medicine has been shown to reduce healthcare costs dramatically, but the system wants to pay doctors using the old fee-for-service model. When you are sick, see the doctor and pay for a visit. Chronic disease demands a different, more proactive approach. Lifestyle medicine is that proactive approach. But we do not get paid to be proactive. So to hire a health coach and to do so much of what is ideal for health, you have to get creative. We have found group visits is one way.
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