This is my fourth and final article in a series dealing with the new medical field called lifestyle medicine. [Articles 1-3 appeared in Dynamic Chiropractic, May 1 – June 1 issues.] In my first article, I defined the problem as I saw it – basically, how the medical profession is rapidly moving into mainstream wellness care by creating a new medical field called lifestyle medicine." In my second article, I wrote about what I perceive as the two biggest threats to chiropractors in the field of lifestyle intervention, which may cost them a "big share" of the wellness care market; namely, understanding and treating free-radical damage and chronic systemic inflammation.
In my third article, I explained my biggest concern of all, which is that chiropractors could lose their dominance in the musculoskeletal, neck and back pain market if they don't offer a lifestyle wellness solution for the lifestyle condition known as metabolic syndrome.
Since most medical physicians in the past did not have a valid solution for back pain except drugs, most did not choose to treat these types of cases.
Why Lifestyle Medicine and Why Now?
According to the World Health Organization, by 2020, two-thirds of all diseases worldwide will be the result of lifestyle choices. Currently, the leading causes of death in the United States are lifestyle related: poor diet, lack of exercise, obesity, tobacco use and overconsumption of alcohol.
The Institute of Lifestyle Medicine at Spaulding Rehabilitation Hospital and Harvard Medical School was founded in 2007 and is dedicated to "[reducing] lifestyle-related death and disease in society through clinician-directed interventions with patients." Their website states, "ILM is at the forefront of a broad-based collaborative effort to transform the practice of primary care through lifestyle medicine. The critical transformation is motivated by research indicating that modifiable behaviors, especially physical inactivity and unhealthy eating, are major drivers of death, disease and healthcare costs. While the medical profession is generally aware of this, there has yet to be a systematic and comprehensive effort to incorporate lifestyle medicine into standard practice."
They further suggest to physicians who attend lifestyle medicine courses that they're "designed to change your competence and performance-in-practice by increasing your knowledge of lifestyle medicine and helping you develop strategies to incorporate it into patient care."
You can be assured physicians are being brought up to speed on the connection between back pain, poor lifestyle habits, free-radical damage, chronic systemic inflammation and metabolic syndrome; and are being taught the best treatment approach is to prescribe multiple anti-inflammatory lifestyle modifications including dietary changes, nutritional supplements, stress management, proper sleep and exercise (and anti-inflammatory medications, of course).
You can also assume that MDs who get involved with lifestyle medicine will now feel they have a solution for back, neck and musculoskeletal pain syndromes. That revelation and the resulting care shift will decrease the numbers of their patients who find their way into chiropractic offices.
How Does Chiropractic Fit In? Lifestyle Wellness
I'm sure the movement by the Institute of Lifestyle Medicine is a sincere attempt to improve lifestyle behaviors of patients; after all, the research on lifestyle modification is overwhelming. With that in mind, what is the chiropractic profession doing in light of the same research that indicates modifiable behaviors are the major drivers of "death, disease and healthcare costs?" Who is leading the charge in our profession and offering a "systematic and comprehensive effort to incorporate lifestyle intervention into standard practice?" How do chiropractors get their "competence and performance-in-practice" up to speed in the field of lifestyle interventions; and where do they turn "to develop strategies to incorporate it into patient care?"
I feel it's time for our profession to take a position on modifiable lifestyle behaviors, and since I personally don't think the term lifestyle medicine is a good fit for chiropractors, let's change it up a bit. "Lifestyle Wellness" will incorporate the following unique roles in a chiropractic practice:
- Lifestyle wellness will have a strict focus on lifestyle behaviors in combination with conventional chiropractic treatment.
- The success of the program depends on patient motivation and must include staff or health care practitioner "coaching."
- The lifestyle wellness approach will apply to every patient in every practice.
- Lifestyle wellness emphasizes the use of a collaborative care model with other allied health care professionals.
- The limited number of lifestyle approaches in the lifestyle wellness model is more conducive to staff training.
- This type of care is already recommended in many state and national health care guidelines for use in both prevention and treatment.
Metabolic Health Analysis – Evidence-Based Evaluation of Lifestyle Wellness
What chiropractors need are evidence-based, non-invasive diagnostic tools and techniques for effecting healthy lifestyle changes in diet, supplementation, exercise, weight management, sleep and stress reduction. Since health and well-being are closely tied to a direct measurement of the complex impedance of the human body, such a non-invasive diagnostic device could provide a readout of critical electrical tissue conductivity, with results that could be used to make more effective recommendations for nutrition and lifestyle strategies; all while providing results that could be reported objectively.
In my previous articles I addressed the need to fully understand how to monitor and treat the conditions of free radical damage, chronic systemic inflammation and metabolic syndrome. There is a non-invasive parameter that could be used to measure and monitor all three health concerns and be used to make recommendations for lifestyle modifications to improve them: body cell mass (BCM).
Body Cell Mass – How to Measure and Monitor Lifestyle Wellness
Evaluation and monitoring of body cell mass is considered in the literature as the only true way to determine the "nutritional status" of the body, and could easily be interpreted as the state of overall lifestyle wellness.
Body cell mass is a function of height, weight, age and the critical non-invasive electrical tissue conductivity measurements of resistance and reactance values that are unique to every individual's body; and which change based on a person's health status.
Body cell mass is the functional mass of the body and is the place where all work in the body is performed. All oxygen consumption, all carbon dioxide production, glucose oxidation, protein synthesis and all other metabolic work takes place within the body cell mass. The body cell mass is, in effect, the total mass of all the cellular elements in the body and therefore represents the metabolically active components of the body – the part that is really alive!
Body cell mass is comprised of five major types of cells: muscle cells, which account for 60 percent; organ cells, which account for 20 percent; and the remaining 20 percent made up of red blood cells, immune cells and the living part of fat cells. The body cell mass also consists of the water inside each of the cells, called the intracellular water, containing 98-99 percent of the body's potassium.
Research has shown that body cell mass correlates directly to a continuum of health, ranging from mortality and morbidity to immunity, longevity, high function and athletic performance.
The purpose of BCM analysis is to monitor and improve function. For healthy patients, analysis of body cell mass can help maintain function, productivity, immunity, physical performance and longevity.
Normative body cell mass values exist that are categorized into eight different age groups, starting with ages 15 to 24 and continuing up to values over the age of 85. When a patient is first evaluated, the chiropractor will determine their state of lifestyle wellness based on whether or not the individual has a body cell mass that is normal, better or worse for their age as compared to their peers.
A patient who does not live a healthy lifestyle, smokes, does not exercise and has lots of stress, may suffer from excessive free-radical damage, chronic systemic inflammation and metabolic syndrome. That type of person will more than likely have a lower body cell mass value when compared with other people their age who eat well, exercise regularly and don't smoke.
With BCM and lifestyle wellness status known and used as a starting point, the chiropractor can now put the patient on a lifestyle wellness modification program and monitor them for progress on a monthly basis. Lifestyle wellness modifications that result in a progressive increase in body cell mass and subsequent stabilization within the normal range for their age are frequently associated with survival. On the other hand, progressive decline in body cell mass is frequently associated with multiple organ failure (MOF) and carries a poor prognosis.
By measuring body cell mass and a few other key non-invasive parameters, a chiropractor can easily monitor the lifestyle wellness status of their patients, make recommendations and incorporate a lifestyle wellness program into their chiropractic practice.
Marketing Lifestyle Wellness to Patients
The No. 1 issue facing chiropractors today is the struggle to get new patients. Leave new-patient marketing to chance and chiropractors could find themselves out of practice. If they master new-patient marketing, their practices will advance to new levels. More great chiropractors get stressed out by not having enough new patients than anything else, and by a wide margin. Thus, incorporating a lifestyle wellness program that generates new patients can help turn things around.
Lifestyle Wellness Screening Events
One possibility to end the new-patient problem for good is to hire a part-time person, 10-20 hours a week, to become your lifestyle education assistant (LEA) and have them conduct lifestyle wellness screenings at no charge in your community. The most significant way to reduce health care costs is to educate the public on lifestyle wellness protocols and ways to maintain their health and prevent disease. It's with that purpose in mind that you are pleased to offer your LEA to various businesses in your community.
This type of service could be well-received by corporations, women's associations, bookstores, health food stores and fitness centers, among many other locations. Simply have your LEA emphasize lifestyle wellness care protocols and preventative care as the keys to good health.
A lifestyle wellness screening could offer a non-invasive, pain-free nutrition status and metabolic health analysis at no charge. This analysis of the mass and fluid compartments of the body would record the measurements and analyze the results to be interpreted and used by you, the doctor, at a no-cost consultation in your office by separate appointment to provide support on nutritional status, lifestyle awareness, weight management and/or athletic performance issues.
Business Owners Will Host Lifestyle Wellness Screening Events
Hosting a lifestyle wellness screening event conducted by your LEA can benefit business owners in your community by helping their customers or employees in many ways. First, business owners are able to offer a value-added service to their customers or employees at no cost. Second, they can attract new customers to their business through these wellness screening events. Third, they can be seen as business owners who care about their employees or customers and who promote health through education and lifestyle wellness awareness.
Let's Get Started
Adding lifestyle wellness to your practice makes good sense. Government agencies, medical school representatives, insurance providers, medical licensing and certification boards and community-based organizations increasingly agree.
If lifestyle medicine is the new specialty going forward for the medical profession, created because of the overwhelming research on the need for lifestyle modification for our patients, how can we as chiropractors not stand up, take charge of the situation and offer our own lifestyle wellness version? After all, we are the wellness care profession!
Dr. Donald L. Hayes, DC is a clinician, educator and author of several books, including Lifestyle Wellness and, along with Michael E. Gerber, The E-Myth Nutritionist: Why Most Healthcare Practices Don't Work and What to Do About It. He is founder and president of the Greens First line of nutritional products and the Lifestyle Wellness Total Health Improvement Program. He can be reached at 866-410-1818 or through www.greensfirst.com.