My thoughts on the "healthy lifestyle" - I at one point lost half my body weight, acquiring a normal BMI after a lifetime of obesity - and did not feel one tincy tiny bit better! The only thing that improved was the disappearance of weight stigma especially from health professionals - and my biomarkers improved! But I did not feel one iota better! Not a single symptom improved. So screw the healthy lifestyle (for me at least) - I'm back to overweight and highly suspect that the "feeling better" quality of life benefits of the healthy lifestyle are largely placebo. (At least in terms of getting people who aren't doing it to adopt it.)
The healthiest 74yo I know runs every day, lives a healthy lifestyle, no alcohol etc... and has significant dementia. A lovely couple, dear friends, he was a Professor of Medicine who was diagnosed with dementia soon after retirement at 70 - after a lifetime of healthy lifestyle-ing, and his wife ditto a couple of years later... My father died from an acknowledged medical mistake (I think we call them system errors nowadays) at 69, never had a sick day in his life, and he was the lucky one... My mother got to live another ten years, most of it rotting in a nursing home with the dementia that killed her. The mammogram detected breast cancer and mastectomy in her mid-sixties didn't 'save her life' - it just enabled us to remember her as a demented old woman, rather than the caring mother she was before dementia screwed her decision making. All healthy lifestyle offers me is a better chance of getting dementia... At best it'll halve my risk, which still leaves it at about 25% - and as that's the leading cause of death for Australian woman, and we don't have euthenasia for dementia - no way do I want to do anything that will only increase my chances of becoming frail aged. Untreated cardiovascular disease looks like my preferred way to go. I'm interested in an easy death, not in prolonging my life, and I have plenty of anecdotal evidence that healthy lifestyle doesn't give me an easy death, so you need to come up with hard evidence that it isn't just keeping me alive to rot in a nursing home, with or without dementia - as someone who'd rather die now at 50 than live another 30 years but end up in a nursing home (no euthanasia for nursing homes) - all this evidence that the healthy lifestyle extends my life just makes me shake in horror! I agree General Medicine rotations probably aren't the best introduction to geriatrics, but I've seen too many elderly patients when my gut response is 'I'd rather be dead' to be interested in living a long life.
I'm far more interested in an easy, accessible death when life no longer becomes worth living, than hanging on as long as possible... And until medicine gives stats on who's getting the easiest deaths, and how we can facilitate that, the healthy lifestyle agenda of living as long as possible leaves me cold.
In all honesty Adam I can’t help but feel like the primary driver of these toxic fanatics is how “traumatized” everyday people (AND their physicians) are by the absolute decimation of the once revered physician/patient relationship by our institutions, oligarchs & mal-aligned philosophy of governance-capitalism.
Thank you for this, the chronically ill among us owe you much gratitude.
This is a great example of why I chose after 20 years in holistic wellness, to go back to college for a 3rd time to earn a license as an NP. These are real life scenarios that rarely play out in the realm of clients that I worked with. That is to say, many of the people who need specialized support the most can’t afford it in the current “wellness” client or otherwise can’t access the right professional to support them appropriately.
Could not agree more … the complexification of basic health and fitness science by influencers discourages people from focusing on the basics — eat whole foods, move, sleep.
VO2max ( quantitative measurement of cardiovascular fitness ) is the single best indicator of long life and disease free existence. Yes, not every homeless veteran, or low income single parent with 2 jobs can make it to yoga and spin class 3 times a week. But you can’t throw the baby out with the bath water.
I am an internal medicine doc who works in the hospital caring for the sick folks in my small community. Being fit and strong, eating a good diet doesn’t guarantee long healthy life, but it is absolutely the best way to get there. I love evidenced based decisions in medicine as much as the next nerd, but the evidence is not there for everything. There is a significant lack of evidence for interventions that we can’t make money from. That is a fact. Comparing my fit healthy athletic friends , to the age matched patients who rely on their doctors “to keep them healthy “ is like looking at 2 different species. This article is a copout.
I think you have implied the movement and what most people think. Medicine has its place, but we are relying on it more than we should. We need to make living healthy easier. Our food has so many unhealthy additives and the least healthy is the cheapest. Both critical needs Medicine and promoting healthy intervention can live symbiotically. This one or the other isn't good for any of us. Wuth so much focus on pharmaceuticals it is time to focus on how to be healthy.
"Know the person who has the disease, not the disease that has the person." Hippocrates
"Start by doing what's necessary. Then do what's possible. Suddenly, you are doing the impossible." St. Francis of Assisi
That's what we do, Coaches.
There are no guarantees. But we sure can influence the way and the PACE at which we age if we invest in our Pillars of Robust Aging, earlier [35 yo] better than later. These Pillars, each with 3 BIG ROCKS, are not silos or 'programs'. They buttress each other when cemented in our DAILY, weekly and seasonal Habits, Patterns and Practices. And no, we don't need to live in Sparta, nor be obsessed with our health every waking second with our wearables. That is a chronic 'DIStressor', and counter-productive.
Modern medicine and procedures are incredible, when they extend QOL, autonomy, independence and the ability to pursue 'what matters most.' Physicians frequently are faced with patients with poly-morbidities and looming complications, so MEDS may be the only tools available to 'stop the bleeding', in addition to lifestyle advice. But ....
"A stent without lifestyle change is like an ant working alone." Unknown Cardiologist
Pre-EMPTing the PRE's ... that is PRE-frailty, PRE early Mobility Disability, PRE-sarco-osteo-dyna-penias, PRE-diabetes, PRE-hyperlipidemia, PRE-HTN, PRE-Metabolic Syndrome, PRE-Overweight-Obesity, etc. .... catching the folks BEFORE they head over the cliff into meds & procedures and more meds & procedures .... that may or may NOT improve QOL.
Death is inevitable when an organ-system fails. However we CAN extend our health-brain-strength+play spans, and nudge them up closer to our lifespan, that is 'square off' the trajectory of our aging curve, compressing decades of decline and dependence into years, even months.
PILLARS and ROCKS .... SIMPLE .... but NOT easy! Cults, of any type, steer clear!
As a new subscriber to sensible medicine, I appreciate your rant. I’ve been involved in both mental and physical health for many years. The issue as I see it is that many health influencers assume people have dozens of hours to spend exercising, and unlimited funds to buy questionable supplements and expensive health food. They also reinforce OCD tendencies by making people obsess over every morsel they eat, every activity they perform, and even worry about getting the exact amount of sleep each night. Just spend some time on YouTube. It’s all there. With my new substack newsletter, Vitality Vibes I’m trying to present a hopeful but realistic approach to lifelong health and fitness. Thx for the rant. https://vitalityvibes48.substack.com/p/the-chronic-disease-epidemic-understanding?r=m688q
Seriously, Dr Cifu? The "cult" of a healthy lifestyle? You are conflating good, well-supported advice with much of the nonsense discussed on social media in the name of longevity and health. Practicing a "healthy lifestyle", as you do, Dr Cifu, is mostly effective as preventive medicine. The chronic diseases you describe amongst your patient examples would be avoided or minimized if our society facilitated good food options and support for life's stressors. And it is never to late to encourage positive changes, even amidst obstacles--which would clearly help our patients, whatever their state of health is.. Calling it the "cult of a healthy lifestyle" is a very bad idea. Do not conflate the social media enthusiasm with exaggerated claims. The seed oil debate has nothing to do with the importance of encouraging a healthy lifestyle and our role as physicians in encouraging those efforts when counseling our patients. What you are really saying is that we need to be compassionate and patient with our patients and recognize their struggles. And we need to encourage good habits and steer them away from some of the nonsense and questionable advice they are exposed to on YouTube channels.
Incredible post and I have enjoyed reading so many comments from individuals much more educated in medicine than I am. The closest I have come to medical training was raising 3 children (which probably qualifies me for something….). I am an employee benefits consultant working with employers (hospitals and health systems specifically) so I see this from a slightly different lens. The theme I take from this and all of the comments is that there isn’t a one size fits all answer. While I obviously am not a practitioner, I wonder if the idea that treating each patient, as an individual has merit. And I am not in any way suggesting that nurses and doctors aren’t doing that…. Many times supporting people with diet and exercise assistance and sometimes medicines. I would love to see opportunities for employer plans to spend some money helping some of the individuals mentioned in the original post, whether through food delivery, social support, or other areas, in addition to the medical path that is warranted.
I was MP along the same pathway and stress levels and commutes.
BUT It actually is truly more important to focus on diet when it can be fixed. For decades, we've been giving and getting the wrong message.
If MP knew she would not need most of her meds if she instead fasted 14 hours a day and that her doctor really believed it too, she would likely find it doable. I did. It works!
As docs, we've been deceived and misled about diet just as much as our patients. Exercise isn't the key part of our metabolic issues anyways.
Its not a cult to find the truth and realize the medical system has led us astray. It's a revelation that we can no longer just follow along in a system that prioritizes money and counts number of statin prescriptions as "quality" care measure.
Unfortunately, we're kept so busy and don't all have time to look everything up for ourselves, but the information is out there.
Those of us seeing past the big con [of high fat diet equals bad and focus on calories as most important for weight loss] are not in a cult. We are just earlier accepters of scienctific facts.
As the definition requires 2 key elements to be a cult.
1. A set of beliefs not based in fact or reality, and
2. Systematic rejection of anyone who disbelieves.
Neither is the case.
I'ld advise you to think of this nutrition revolution as the newest frontier in medicine that will complement traditional medicine in a similar manner that we are supposed to consider naturalpathy, chiropathy, and Eastern medicine traditions. It'll be amazing!
This has always been my favorite Substack but Dr Cifu really plays his biased hand in this one. He beings his article by placing anyone who believes in lifestyle changes as some sort of anti medicine fanatic. You've really lost me on this one. If not for Drs Prasad and Makary I would delete by subscription to Sensible medicine. There is very little sensibility to this sort of garbage.
What about frozen vegetables you can easily "cook" by microwave? I have bags and bags of them in my freezer. I also have cans and cans of beans like chickpeas and cannellini. You can throw together a meal in a matter of minutes. Probably quicker than going to the closest McDonald's drive thru. But maybe it's just my privilege talking.
Wouldn't medicine have to fight and win the battle of closing McDonald's, Burger King, Popeye's, etc? This, in my mind is a lost battle before it begins, but also impossible because the their vastness and money, and lawyers, etc. Growing up every meal was eaten at home or packed for school. Once in a blue moon did we go to a fast food restaurant as a treat. Thinking back I can only remember a handful or less of kids who were obese. We all got our vaccines punctually. Because neighborhoods were so tight knit news of any illnesses other than chicken pox, colds, flu, were not heard. SMH. Whomever has the answer would be king of the world.
My thoughts on the "healthy lifestyle" - I at one point lost half my body weight, acquiring a normal BMI after a lifetime of obesity - and did not feel one tincy tiny bit better! The only thing that improved was the disappearance of weight stigma especially from health professionals - and my biomarkers improved! But I did not feel one iota better! Not a single symptom improved. So screw the healthy lifestyle (for me at least) - I'm back to overweight and highly suspect that the "feeling better" quality of life benefits of the healthy lifestyle are largely placebo. (At least in terms of getting people who aren't doing it to adopt it.)
The healthiest 74yo I know runs every day, lives a healthy lifestyle, no alcohol etc... and has significant dementia. A lovely couple, dear friends, he was a Professor of Medicine who was diagnosed with dementia soon after retirement at 70 - after a lifetime of healthy lifestyle-ing, and his wife ditto a couple of years later... My father died from an acknowledged medical mistake (I think we call them system errors nowadays) at 69, never had a sick day in his life, and he was the lucky one... My mother got to live another ten years, most of it rotting in a nursing home with the dementia that killed her. The mammogram detected breast cancer and mastectomy in her mid-sixties didn't 'save her life' - it just enabled us to remember her as a demented old woman, rather than the caring mother she was before dementia screwed her decision making. All healthy lifestyle offers me is a better chance of getting dementia... At best it'll halve my risk, which still leaves it at about 25% - and as that's the leading cause of death for Australian woman, and we don't have euthenasia for dementia - no way do I want to do anything that will only increase my chances of becoming frail aged. Untreated cardiovascular disease looks like my preferred way to go. I'm interested in an easy death, not in prolonging my life, and I have plenty of anecdotal evidence that healthy lifestyle doesn't give me an easy death, so you need to come up with hard evidence that it isn't just keeping me alive to rot in a nursing home, with or without dementia - as someone who'd rather die now at 50 than live another 30 years but end up in a nursing home (no euthanasia for nursing homes) - all this evidence that the healthy lifestyle extends my life just makes me shake in horror! I agree General Medicine rotations probably aren't the best introduction to geriatrics, but I've seen too many elderly patients when my gut response is 'I'd rather be dead' to be interested in living a long life.
I'm far more interested in an easy, accessible death when life no longer becomes worth living, than hanging on as long as possible... And until medicine gives stats on who's getting the easiest deaths, and how we can facilitate that, the healthy lifestyle agenda of living as long as possible leaves me cold.
OH MY GOD HE NOTICED! 🖤
In all honesty Adam I can’t help but feel like the primary driver of these toxic fanatics is how “traumatized” everyday people (AND their physicians) are by the absolute decimation of the once revered physician/patient relationship by our institutions, oligarchs & mal-aligned philosophy of governance-capitalism.
Thank you for this, the chronically ill among us owe you much gratitude.
This is a great example of why I chose after 20 years in holistic wellness, to go back to college for a 3rd time to earn a license as an NP. These are real life scenarios that rarely play out in the realm of clients that I worked with. That is to say, many of the people who need specialized support the most can’t afford it in the current “wellness” client or otherwise can’t access the right professional to support them appropriately.
Could not agree more … the complexification of basic health and fitness science by influencers discourages people from focusing on the basics — eat whole foods, move, sleep.
VO2max ( quantitative measurement of cardiovascular fitness ) is the single best indicator of long life and disease free existence. Yes, not every homeless veteran, or low income single parent with 2 jobs can make it to yoga and spin class 3 times a week. But you can’t throw the baby out with the bath water.
I am an internal medicine doc who works in the hospital caring for the sick folks in my small community. Being fit and strong, eating a good diet doesn’t guarantee long healthy life, but it is absolutely the best way to get there. I love evidenced based decisions in medicine as much as the next nerd, but the evidence is not there for everything. There is a significant lack of evidence for interventions that we can’t make money from. That is a fact. Comparing my fit healthy athletic friends , to the age matched patients who rely on their doctors “to keep them healthy “ is like looking at 2 different species. This article is a copout.
I think you have implied the movement and what most people think. Medicine has its place, but we are relying on it more than we should. We need to make living healthy easier. Our food has so many unhealthy additives and the least healthy is the cheapest. Both critical needs Medicine and promoting healthy intervention can live symbiotically. This one or the other isn't good for any of us. Wuth so much focus on pharmaceuticals it is time to focus on how to be healthy.
"Know the person who has the disease, not the disease that has the person." Hippocrates
"Start by doing what's necessary. Then do what's possible. Suddenly, you are doing the impossible." St. Francis of Assisi
That's what we do, Coaches.
There are no guarantees. But we sure can influence the way and the PACE at which we age if we invest in our Pillars of Robust Aging, earlier [35 yo] better than later. These Pillars, each with 3 BIG ROCKS, are not silos or 'programs'. They buttress each other when cemented in our DAILY, weekly and seasonal Habits, Patterns and Practices. And no, we don't need to live in Sparta, nor be obsessed with our health every waking second with our wearables. That is a chronic 'DIStressor', and counter-productive.
Modern medicine and procedures are incredible, when they extend QOL, autonomy, independence and the ability to pursue 'what matters most.' Physicians frequently are faced with patients with poly-morbidities and looming complications, so MEDS may be the only tools available to 'stop the bleeding', in addition to lifestyle advice. But ....
"A stent without lifestyle change is like an ant working alone." Unknown Cardiologist
Pre-EMPTing the PRE's ... that is PRE-frailty, PRE early Mobility Disability, PRE-sarco-osteo-dyna-penias, PRE-diabetes, PRE-hyperlipidemia, PRE-HTN, PRE-Metabolic Syndrome, PRE-Overweight-Obesity, etc. .... catching the folks BEFORE they head over the cliff into meds & procedures and more meds & procedures .... that may or may NOT improve QOL.
Death is inevitable when an organ-system fails. However we CAN extend our health-brain-strength+play spans, and nudge them up closer to our lifespan, that is 'square off' the trajectory of our aging curve, compressing decades of decline and dependence into years, even months.
PILLARS and ROCKS .... SIMPLE .... but NOT easy! Cults, of any type, steer clear!
As a new subscriber to sensible medicine, I appreciate your rant. I’ve been involved in both mental and physical health for many years. The issue as I see it is that many health influencers assume people have dozens of hours to spend exercising, and unlimited funds to buy questionable supplements and expensive health food. They also reinforce OCD tendencies by making people obsess over every morsel they eat, every activity they perform, and even worry about getting the exact amount of sleep each night. Just spend some time on YouTube. It’s all there. With my new substack newsletter, Vitality Vibes I’m trying to present a hopeful but realistic approach to lifelong health and fitness. Thx for the rant. https://vitalityvibes48.substack.com/p/the-chronic-disease-epidemic-understanding?r=m688q
I appreciate this so much. It's alarming to see just how many people fall for charlatans like RFK Jr.
Seriously, Dr Cifu? The "cult" of a healthy lifestyle? You are conflating good, well-supported advice with much of the nonsense discussed on social media in the name of longevity and health. Practicing a "healthy lifestyle", as you do, Dr Cifu, is mostly effective as preventive medicine. The chronic diseases you describe amongst your patient examples would be avoided or minimized if our society facilitated good food options and support for life's stressors. And it is never to late to encourage positive changes, even amidst obstacles--which would clearly help our patients, whatever their state of health is.. Calling it the "cult of a healthy lifestyle" is a very bad idea. Do not conflate the social media enthusiasm with exaggerated claims. The seed oil debate has nothing to do with the importance of encouraging a healthy lifestyle and our role as physicians in encouraging those efforts when counseling our patients. What you are really saying is that we need to be compassionate and patient with our patients and recognize their struggles. And we need to encourage good habits and steer them away from some of the nonsense and questionable advice they are exposed to on YouTube channels.
It is so much disinformation
Incredible post and I have enjoyed reading so many comments from individuals much more educated in medicine than I am. The closest I have come to medical training was raising 3 children (which probably qualifies me for something….). I am an employee benefits consultant working with employers (hospitals and health systems specifically) so I see this from a slightly different lens. The theme I take from this and all of the comments is that there isn’t a one size fits all answer. While I obviously am not a practitioner, I wonder if the idea that treating each patient, as an individual has merit. And I am not in any way suggesting that nurses and doctors aren’t doing that…. Many times supporting people with diet and exercise assistance and sometimes medicines. I would love to see opportunities for employer plans to spend some money helping some of the individuals mentioned in the original post, whether through food delivery, social support, or other areas, in addition to the medical path that is warranted.
I can relate to MP.
I was MP along the same pathway and stress levels and commutes.
BUT It actually is truly more important to focus on diet when it can be fixed. For decades, we've been giving and getting the wrong message.
If MP knew she would not need most of her meds if she instead fasted 14 hours a day and that her doctor really believed it too, she would likely find it doable. I did. It works!
As docs, we've been deceived and misled about diet just as much as our patients. Exercise isn't the key part of our metabolic issues anyways.
Its not a cult to find the truth and realize the medical system has led us astray. It's a revelation that we can no longer just follow along in a system that prioritizes money and counts number of statin prescriptions as "quality" care measure.
Unfortunately, we're kept so busy and don't all have time to look everything up for ourselves, but the information is out there.
Those of us seeing past the big con [of high fat diet equals bad and focus on calories as most important for weight loss] are not in a cult. We are just earlier accepters of scienctific facts.
As the definition requires 2 key elements to be a cult.
1. A set of beliefs not based in fact or reality, and
2. Systematic rejection of anyone who disbelieves.
Neither is the case.
I'ld advise you to think of this nutrition revolution as the newest frontier in medicine that will complement traditional medicine in a similar manner that we are supposed to consider naturalpathy, chiropathy, and Eastern medicine traditions. It'll be amazing!
This has always been my favorite Substack but Dr Cifu really plays his biased hand in this one. He beings his article by placing anyone who believes in lifestyle changes as some sort of anti medicine fanatic. You've really lost me on this one. If not for Drs Prasad and Makary I would delete by subscription to Sensible medicine. There is very little sensibility to this sort of garbage.
What about frozen vegetables you can easily "cook" by microwave? I have bags and bags of them in my freezer. I also have cans and cans of beans like chickpeas and cannellini. You can throw together a meal in a matter of minutes. Probably quicker than going to the closest McDonald's drive thru. But maybe it's just my privilege talking.
Wouldn't medicine have to fight and win the battle of closing McDonald's, Burger King, Popeye's, etc? This, in my mind is a lost battle before it begins, but also impossible because the their vastness and money, and lawyers, etc. Growing up every meal was eaten at home or packed for school. Once in a blue moon did we go to a fast food restaurant as a treat. Thinking back I can only remember a handful or less of kids who were obese. We all got our vaccines punctually. Because neighborhoods were so tight knit news of any illnesses other than chicken pox, colds, flu, were not heard. SMH. Whomever has the answer would be king of the world.