by Rogier F. van Vlissingen and Varun Ponmudi
Some time ago, we had a Lifestyle Medicine Dinner at Neerob Restaurant and, together with Varun Ponmudi of Aayas Table, I gave a presentation on some of the financial dimensions of the Plant-based lifestyle. It is my view that the first motivation for choosing this lifestyle should simply be better health, but on this occasion, we decided to focus on some of the more pragmatic dimensions, in particular the financial angle, in order to provide some very practical motivations for why “business as usual” just won’t cut it any more. There are other side benefits – it is better for the planet, kinder to the animals, and probably also a solution to world hunger as human beings would no longer compete with livestock. It is also a great culinary opportunity, that just gets better all the time. In our presentation, I focused on the macro view, and Varun focused on the micro view, the very up-close and personal – how will it affect your pocket book. We will do the same in this blog post.
Our motivations for being involved in this field are different and complementary, I am the son of an MD father who raised him in the awareness of the conceptual dead end of Western medicine (allopathic medicine) and the germ theory of disease, which was then at its peak (in the 50’s and 60’s). I was raised vegetarian, for we knew little about plant-based nutrition in those days. I went into the business world and studied economics. Varun studied neurobiology and bioengineering, and worked in the area of medical device development as an engineer, and meanwhile saw many in his family die young from all the familiar chronic diseases people die from today, and he was motivated to make a bigger contribution by helping people adopt a healthy diet. He was also studying at Cornell just when the university infamously canceled the classes of Prof. T. Colin Campbell, which most suspect was due to food industry influences.
Economically, healthcare has eaten up our wealth to such a degree that any wage growth since the 1970’s has been outstripped by the cost increases of healthcare, and still the system is disproportionately more expensive and less effective than any other healthcare system in the world. It boils down to third world healthcare for world beating prices. Dave Chase, the founder of Health Rosetta, points this out repeatedly, starting with his book, The CEO’s guide to Restoring the American Dream: How to deliver world class healthcare to your employees at half the cost. And Chase is not even talking about the real revolution, towards lifestyle medicine, based on a plant-based diet!
In the meantime, increasing numbers of researchers have wondered about the explanations of better health outcomes in certain populations, the so-called blue zones. The research that was eventually popularized in The China Study really laid the groundwork. It publicized in popular form a lifetime of scientific research and published papers in nutrition by T. Colin Campbell, now Professor Emeritus at Cornell and head of his own institute, the T. Colin Campbell Institute for Nutrition Studies.
The Macro View of Lifestyle Medicine – (mostly) by Rogier
It pays to appreciate the history a little bit: the organization of modern medicine dates from the first half of the 20th century, and is grounded in the germ theory of disease: external agents causing illness. Indeed, the battle with infectious diseases is where medicine proved highly effective, though it may now have somewhat overshot the mark, given the emergence of antibiotic resistant bacteria. By and large, though, we no longer die from infectious diseases. We now die primarily as a result of a series of chronic illnesses, all of which are largely or wholly caused by diet.
The problem is the paradigm shift in what threatened our species most from acute bouts of infectious disease to long lasting chronic disease did not also see a complementary change in the medical science. Medical schools have persisted with using intervention as the primary treatment, whereas prevention has been wholly neglected for a half century.
Chronic illness: Cardiovascular Disease (CVD), type 2 diabetes, Cancer, Rheumatoid Arthritis, Multiple Sclerosis, Irritable Bowel Syndrome (IBS), and many others. Ninety percent of our healthcare spending is devoted to intervention and management of these conditions. They are the incurable diseases of today, when your doctor says to you that you will have to take this or that medication for the rest of your life. Kaching, Kaching for pharmageddon.
Where the supposed father of medicine, Hippocrates, always proposed that food should be our medicine and medicine our food and he clearly focused on maintaining health over curing disease, the shift to ‘modern’ medicine inverted the paradigm and started in the middle: what to do if you were ill, so treatment of disease became the focus and the economic system of healthcare evolved so that doctors made more money with more treatment and a for-profit pharmaceutical industry gained (at least in the US and New Zealand) the ability to market its ‘cures’ directly to consumers, effectively dis-intermediating doctors. Incurable diseases are financial goldmines for the medical-industrial complex, aka. ‘pharmageddon.’
The drivers of spiraling cost inflation are most easily understood by several analogies that people will cite frequently in Lifestyle Medicine circles:
- Our healthcare system is like the blind men describing an elephant, with every specialist seeing symptoms and treatments according to their specialty, without ever getting the picture of the whole elephant. Compare that to Dr. Dean Ornish’s focus on the unitary cause of all chronic illness: our diet. Whole Foods, Plant-Based nutrition is the universal preventive treatment and even in many cases the preferred therapy for disease reversal: for CVD complete reversal can be achieved in 95+% of cases, unless they are totally critical. Type 2 diabetes, 85+%, cancer 40-50% and so on.
- Another way of looking at it is that allopathic medicine only has a hammer and treats everything like a nail. The model is simply wrong: the unitary cause of almost all these chronic conditions is the food you stick in your mouth. The germ theory of disease is but a subset of illness and but the main health problems of today are internally caused. Pills and procedures can ‘manage’ these conditions to some degree, but cannot reverse or prevent them – food can.
- Many use the analogy that the treatments of our no longer modern healthcare system in these areas amount to mopping up the floor, but failing to first shut off the faucet and stop the leak. It is pointless Sisyphus labor, and causes ever escalating healthcare costs.
The upshot is that this 85-90% of healthcare costs is largely preventable with diet and lifestyle and the proof is in via The China Study, and tons more publications that came out in its wake. Leading clinicians in the field are Drs. John McDougall, Caldwell Esselstyn, Jr. Michael Klaper, Robert Ostfeld, Saray Stancic and a growing list of others. Let’s just assume we go to work on this, then the 85-90% of healthcare costs can be reduced by 75% or more within a generation (20 years). In short, once we commit ourselves to the whole foods, plant-based diet and lifestyle medicine, our healthcare cost should shrink rapidly. This experience is being confirmed over and over and over again by clinicians active in this field. For many doctors this goes with a new level of motivation and excitement about their chosen profession, when they realize that they can finally help their patients to get healthy, instead of being legal drug dealers, who merely manage conditions, by treating symptoms. For patients it is tremendously empowering to realize that to a large degree, their health is in their own hands. In short, we have a realistic path towards a healthcare system that produces world class health outcomes for a mere fraction of the cost we are incurring today.
Even prevention in the spirit of pharmageddon makes no sense: you have to do something like treat 100 patients for 7 or 8 years with statins, in order to prevent one heart attack. Meanwhile many of these patients suffer side effects of the statins. It is a proven fact that this model of disease prevention is obsolete, because of what we now know about diet, even aside from the costs for the medicines and the endless consultations because of side effects.
The Micro-Economics of Lifestyle Medicine – (mostly) by Varun
The financial implications of treating chronic illness through intervention and management for that chronic period, the rest of one’s life, are significant for an individual as much as they are the healthcare system. Our politicians focus their debates on changing models of payment, schemes to bundle medical treatments, reforming health insurance and even resorting to those oh so terrifying refrains of socialism. The financial burden of medical treatment on any single home is well known, but yet rarely are we empowered to affect change in our own lives without the influence of Washington. It gets worse, when you walk into a doctor’s office the first questionnaire is a personal and family history of diseases. On the one hand this is an indicator for the physician of red flags to keep an eye out for, and on the other, it’s an easy excuse to blame the genetics:
“You have a family history”.
“You are genetically predisposed”.
Nevermind that if you are following the standard American diet, you’re drinking soda regularly, fast food is a routine not an occasional indulgence, and fresh fruits and veggies are more infrequent than almost every other nation.
Many doctors will openly state their reluctance to emphasize the importance of any sort of lifestyle change when treating their patience because they don’t believe their patients will change. Prescriptions are easier, despite the fact that patient compliance with medicines like statins is remarkably poor in the 60% range.
So can we motivate lifestyle change in our sick? Anecdotally, lifestyle medicine doctors see their patients dedication as high as the mid 80-percentiles. It turns out empowerment in your own fate is effective. Having death knock at the door but knowing you can lock the door and say no one’s home is what many patients want to hear. Being told that their illness is just genetics is demovitaviting. Knowing you can change your family history with hard work, that’s more like the American dream.
So maybe the solution for the macro economic problem of our healthcare system lays in the micro view. Imagine if you could motivate an individual to change their lifestyle not only to resume their physical abilities and return to good health, but also because it would save them tens of thousands of dollars in medical expenses each year? All without needing to elect the right individual and wait for a bickering partisan congress to shun the pharma money that pays them and come to any consensus. It’s not a fantasy!
Studies by the CDC have shown single family medical expenditures for disease like type 2 diabetes growing three fold since five years ago, to almost $18,000. Other disease like, say, MS, cost upwards of $30,000 a year. All of this is to manage and perhaps slow the progression of disease. But then we have this whole foods, plant-based diet that not only stops the progression of many of these chronic illnesses, but also may reverse them. And that is without the need for medication! In fact, a dedicated approach to following this diet will require a physician to wean his or her T2D patient off of medication within the first few weeks.
And so there we have it, when a sick individual adopts a #WFPB diet, they are empowered to take both their medical and financial health back into their own hands. Even if we blindly agree with exaggerated claims that eating healthily is too expensive, the financial offset of the medicines and hospital visits still leaves us well in the black. Perhaps if enough families recognize and make this change, they can fix the healthcare system simply by fixing themselves.
Whether you look at the macro level, or the micro level, we cannot afford the healthcare system we have and compared to these changes, the whole political brouhaha over single payer systems and universal healthcare is a red herring issue, which distracts us from the real issue. What matters the cost of drugs, if you don’t need them in the first place?
Besides improving our physical health, a whole foods, plant-based diet will also improve our financial health. The bonus is that, once you get handy with this new style of cooking, you are opening up an incredible field of culinary opportunity. Your palate will change completely, and you will feel better, what could be better than that? Join the fun!