Joey Wahler (Host): This is Meaningful Medicine, a Novant Health Podcast, bringing you access to leading doctors who answer questions they wish you would ask. From routine care to rare conditions, our physicians offer tips to navigate medical decisions and build a healthier future. Our guest is Dr. Alicia Beal. She's a Family Medicine physician, also board-certified in Lifestyle Medicine with Novant Health. Hi there, Dr. Beal. Welcome to you.

Alicia Beal, MD: Hello. How are you doing?

Host: Great. Yourself?

Alicia Beal, MD: I am doing well. Thank you.

Host: Excellent. So first, what in a nutshell for those uninitiated is Lifestyle Medicine? What do we mean by that and how would you say it mainly differs from the conventional medical approaches people are used to?

Alicia Beal, MD: Okay. The first thing I want to say is just that all doctors want to help people. So whether you go to a conventional doctor or a Lifestyle Medicine, we're all trying to help people be better. But sometimes our approaches are a little bit different. And also, I want to let you know that I do western medicine as well. I do both a western medicine clinic and I have a lifestyle medicine clinic as well separately.

Lifestyle medicine takes more time than typically my Western Medicine Clinic appointment times do. With Western medicine, what you're going to have is more of the model where people have a problem and then they come in. Like, "I have a rash. I need to be fixed for my rash," "I have a sinus infection. Give me an antibiotic." So, it's much more of a, "You have a problem, let's fix it." And usually, it's going to entail medication. Sometimes it's going to entail some lifestyle changes. It's not that Western medicine doesn't do lifestyle, but it's much more problem and medication-oriented treatment.

When you're talking Lifestyle Medicine, what you're doing is you're looking at diet, exercise, sleep, risky behaviors, social connection, and stress management as a way to prevent, treat, or reverse chronic health disease. And the reason why this is so important when it comes to lifestyle medicine is that 80% of all chronic diseases that people have nowadays are related to lifestyle. So if you really want to get at the source of why am I having poor health? How do I prevent having poor health? How do I treat my poor health? We really need to be looking at the source as well, and that's where lifestyle medicine comes in.

Host: So, we're really talking there about looking more at the big picture down the road. How can we make some changes so that whatever brought someone to you, hopefully, it doesn't bring them to you again, right?

Alicia Beal, MD: Yes. And I wouldn't even say down the road, I would say immediately some of these changes can make people feel better very quickly. I think we're all geared to thinking like, "Well, my gene have done it. My grandma had it. My mom had it. My sister has it. Clearly, I'm going to have it. Just give me the pill, Doc, and let me go on my way." And the good news is that you are not trapped by your genes. You are not a genetic prisoner. Some people say 80-90% of the chronic health problems we're suffering from-- and when I say chronic health problems, I mean things that you don't catch. Hypertension, diabetes, cholesterol issues, heart disease. You're not going to catch that from anybody. This is just a health problem you have acquired. And 80-90% of the source of that problem is lifestyle. And only probably 10-20% is genetic. And that's actually good news, because that means there's something you can do about it.

Host: Means it's within our control, right? So having said that, Doctor, as a family medicine physician, what inspired you to incorporate this Lifestyle Medicine into your practice?

Alicia Beal, MD: Really, it was personal. I was living the life of every American. Not getting enough sleep, not getting enough exercise. In fact, when you get stressed, what's the first thing to go? It's your Bible study, your exercise, your social connections with people, you're just trying to get work done. And eventually, I realized my body was breaking. And I went looking for answers. And as I was looking for the traditional way of doing things, it was helping, but it wasn't really making me feel better. I wasn't reaching my goals. And I thought, there has to be a better way. There must be something else. And as I started looking for myself for better answers, eventually, I was feeling so much better. I thought, "Why am I not bringing this to my patients?"

Host: So, it was a personal experience and your passion comes from your own experience, right?

Alicia Beal, MD: Absolutely. And at the heart of things, I mean, doctors want people to feel better. That's why we get into medicine. We get into medicine because we want to help people, we want to help people feel better. And this is one way of doing it. And I've always had a heart for preventative medicine anyway.

In Western medicine, we still do talk about preventative medicine. It's just we don't have a lot of time allotted in our day per patient to really spend the time that it takes to help patients make these kind of changes, because it's not easy.

Host: Absolutely. So, there are six pillars, if you will, of lifestyle medicine. So, what are they? And how do they all work together to prevent and treat chronic disease?

Alicia Beal, MD: I mentioned them earlier. So, it's diet, exercise, sleep, addressing risky behavior, social connection and stress management. And they do all work together. They're all interconnected. If I had to say one was foundational, I would say it was probably diet. And a lot of them rest on top of the diet pillar, but they're all important, but they do interconnect. If you are not getting adequate sleep, like seven to eight hours of sleep a night, which is really what's needed, you'll on average crave an extra 300 calories per day. If you're doing an extra 300 calories per day, you're going to tend to gain weight. And often, those calories are not healthy calories. They're ones that are more like the saturated fats. You know, like going for the chocolate chip cookie, not going for your broccoli. So, you can see how they start being interconnected with one another. A lot of times when people are stressed, they become emotional eaters. They're not sleeping as well. If you're not sleeping as well, then, well, what are you going to be doing? You're going to be craving the saturated foods, more the processed foods, saturated fat foods. So, you can see how it would all start to connect together.

Host: So, having said that, how do you introduce lifestyle medicine to your patients that are more accustomed to traditional treatment methods, like medications and such?

Alicia Beal, MD: That is actually an interesting question. With almost anybody, if I immediately identify a lifestyle issue, i'll just talk to them about how it's contributing to their health problem. I don't go into all six pillars. I'm not trying to make a convert into Lifestyle Medicine. I'm just giving them options. And often, a lot of patients don't want pills. A lot of patients are wanting to know what they can do. And so for those people, it's great. I can continue on and help them and introduce them into more Lifestyle Medicine interventions. Some patients don't want to hear it, they don't want to change, they don't want to stop smoking yet. And so, everybody's along a continuum. Some people are not ready to even think about this yet, other people are contemplating it. So, I really look at what stage of change they're in. And then based on their stage of change, that's what I offer to them.

Host: Understood. So, what role do family and community, those surrounding us, play in supporting patients on a lifestyle medicine journey? Because often these kinds of changes take a lot of support, sometimes advice from others. So, talk about that if you would, please.

Alicia Beal, MD: I think community is very important. A lot of times when patients are making changes and they feel very alone, it's harder for them to make lasting change. It's not impossible. You can. But it's so much easier when there's somebody in it with you. And that's where, as a doctor, often I kind of put on the coach's hat as well and trying to coach them through and help them through this and give them the support that they need. But when you have family coming all around you and everybody's doing it, everybody's holding each other accountable, it becomes much easier. And just the social connection itself is Lifestyle Medicine.

There was a Harvard study that was done many, many years. I mean, we're talking over a hundred years ago, I guess. They took young Harvard men and they compared them to inner city Boston men. And they looked to see over their lifespan, because they followed them all the way through. And they said, "What gives people greater happiness and longevity?" And social connection was the number one thing that predicted whether or not they were going to have longevity and happiness.

Host: Regardless of where they went to school and background and things like that, I guess you're saying.

Alicia Beal, MD: Exactly. So, you would think that these well-educated Harvard men would have better outcomes, but not necessarily. If you were inner city, but socially connected with a good environment around you of people that were supportive, you had better outcomes in terms of your emotional health and how long you lived.

Host: Interesting. So, how about a success story? I would imagine you have many, but how about a particular one, Doctor, where lifestyle changes made really a significant impact on a particular patient's health?

Alicia Beal, MD: I think, yeah, I want to be careful because I don't want to-- patient confidentiality. You have to be careful with that. But I will say, I had someone who I had talked to about making changes. And this person actually did it independently. A lot of people need a lot of help. They just decided to do it. And they came back to me a year later. They had reached a healthy body weight. They felt better. They felt emotionally better. And because they felt emotionally better, they were relating to their husband better. And she said, "I get along with my husband better because I like me better." And it was very interesting to see how much impact changing her lifestyle, her diet, and her exercise primarily were the two things she really was honing in on, ended up impacting her emotionally and socially.

Host: Wow. That's really great to hear. What strategies do you recommend to help patients to sustain these long-term behavioral changes you're talking about, especially when motivation dips? Because for many people, these are radical changes from what they've been doing for years, right?

Alicia Beal, MD: Well, it can be radical. If you decide to change on a dime, it's going to be a radical change for a lot of people. But really, to try to help people be more successful, I go by the 80% rule where, what change do you feel 80% sure you can make next week? Like, this coming week. And it can't be a 100% because it's not really stretching you. It can't be 50/50, you're too likely to fail. So, you make it 80% and then you build success on top of success because the 80% goal may be a small change, but then they feel successful. And then because they're successful, they feel like they're open to the next change. And you build it gradually. And that's probably one of the best things that we can do for patients, is to help them not think of this as an all-or-nothing affair. Because when you think of it all or nothing, you make a "mistake" and you're like, "Well, see? There. I can't do it. It just goes to show you lifestyle is not going to work for me." And instead, I'll say, "Well, okay, well let's look at the thing that you weren't successful with and maybe it wasn't a good goal." Maybe we just made a crummy goal. Maybe it was circumstances outside you and we need to problem solve on how to still accomplish your goal in the circumstance you're sitting in. And those are probably two big things there.

One of the other things that I actually ask people to do is when they make a change to try to link it to a normal behavior. Because if you try to do something totally separate from what you would normally do, it's unlikely to happen. For example, somebody carrying around a big jar of water all day. That's probably not going to be a lifetime thing, right? But what if you say have a 16 ounce glass of water with each meal, drink half of it before you start, because some people confuse hydration with hunger. So, you take care of the hydration part first, then you won't tend to overeat as much, and you're not filling yourself up. You're just giving your body the cues it needs. And if you do that at every meal and at one other time during the day, you drink another 16 ounce glass of water, you've gotten your 64 ounces of water in for the day. So, that's much more agreeable to patients. And you've linked it to, "I eat breakfast, lunch, and dinner, easy. And I might get thirsty another part of the day." Now, you've got a habit change.

Host: So, manageable steps or manageable sips, right?

Alicia Beal, MD: Well, yeah, the most important thing, I kind of gave a long answer there, but I think if I had to take it down in a more narrow fashion is when you're making a change, try to link it to something you already do. Because you want it to become thoughtless, like you don't congratulate yourself when you stop for a red light. You just stop for a red light because it's what you do. When you brush your teeth or put your socks on you and like, "I'm such a good girl. I put on my socks today." You don't do that. You just put them on. And so, we want to start getting these habitual changes in that are thoughtless and no longer have to be thought of. And if you can link it to normal behavior, that happens much more quickly.

Host: Gotcha. A couple other things before we let you go. For instance, any challenges integrating Lifestyle Medicine within the traditional healthcare system as we know it, or insurance models? And is it covered by insurance?

Alicia Beal, MD: That's a two-part question. One is it's challenging for doctors to do Lifestyle medicine because of the timeframe we typically have to take care of patients. A lot of doctors are doing 15 and 30-minute visits, or 20 and 40, depending on-- like 40 would maybe for physical and 20 would be for a sinusitis. And some are doing it 15 and 30 and some people are doing just 15-minute appointments. And when you have that kind of time constraint, really being able to delve into lifestyle is difficult. It's not impossible. It can still be done. But I found that I needed 20-minute appointments. I do 15 minutes to do my western medicine. And then, the last five minutes trying to throw some lifestyle in. So, that's one challenge.

The other is insurance will cover this for a lot of patients. But there's a lot of hesitancy in the medical community because they have never really done this before. They're not sure that it's a chargeable or billable event, but it is. And especially since we're now allowed to bill for time, instead of just the problem, that also makes it easier. Because now we can say, it's going to take this much time to really address this problem. Your insurance will cover it with this diagnosis, and we can do this. And some of it's just educating that you can.

Host: And then, in summary here, doctor, looking ahead, how do you see lifestyle medicine evolving in, say, the next five to 10 years, especially within primary care, which is your realm?

Alicia Beal, MD: I think it's going to become more common, honestly. When you consider, as I mentioned earlier, that 80% of all chronic disease is related to lifestyle, Lifestyle Medicine is evidence-based medicine. So as the evidence builds, I think people are going to have to start looking at this more as a legitimate treatment and not just a, "Oh yeah. And by the way, you can try this, but, you know, wink, wink." We know that we're not going to really do that. And you know, we're going to really be looking at this as this is doable, it's helpful, and you're going to feel better at the end of this.

And generally, people feel better when they take care of their bodies. Lifestyle medicine is really teaching the care and the feeding of the human body. And I mean, we're just like a high performance machine. If you have a Porsche, you're not going to put horrible gas in it. You're not going to not lube it up. You are not going to leave it in your garage to dry rot. You're going to be out there rolling it around on nice days and putting the best gas in it and rubbing it with a diaper, you know, trying to get the gloss up. And if we start treating our bodies more like we're high performance machines, and everybody starts seeing it more as that, I think it's going to become much more common that we are looking at the care and feeding off that.

Host: And one thing we can all agree on is we'd all like to feel better, right?

Alicia Beal, MD: Absolutely. Everybody wants to feel better. Nobody wakes up in the morning, says, "Gee, what can I do today to make myself feel worse?" And I tell my patients that all the time, 97% of Americans are not doing the four most basic things you need to do in order to have a healthy life. And those are exercising, eating at about five servings of fruits and vegetables a day, maintaining a healthy body weight and not smoking. And if you are doing all four of those, you are now in 3% of the population of the U.S. So give yourself a pat on the back. But if you are not doing those, don't beat yourself up. You and 97% of America is not doing that. And there are answers for people who are not doing those things, and we can help you.

Host: Certainly eye-opening numbers for people to think about indeed. Well, folks, we trust you are now more familiar with Lifestyle Medicine. Dr. Beal, definitely valuable information for all of us. Thanks so much again.

Alicia Beal, MD: Thank you.

Host: For more information or to find a physician, please visit novanthealth.org. For more health and wellness information from our experts, please visit healthyheadlines.org. Now, if you found this podcast helpful, please do share it on your social media. Thanks again for being part of Meaningful Medicine, a Novant Health Podcast.