The West Virginia University School of Medicine introduced a lifestyle medicine program five years ago when there was a call for grant proposals for curricula that focused on new and innovative topics for medical students. At that time, there was little in the school’s curriculum on nutrition and physical activity and the role these areas played in promoting health, preventing disease, and in treating chronic diseases.
For several years, I, Mark Cucuzzella, have been involved in military public health and preparing Air Force members for physical fitness tests. I have learned a lot about nutrition and fitness along the way. Some of my learning was achieved due to personal circumstances as I became prediabetic following what the military was promoting as a “healthy warfighters diet.” We taught low fat, count calories, with a focus on eating ample carbohydrates. My genetic predisposition to diabetes caught up with me, and even though I was running and winning marathons, I could not run away from a bad diet. For a year I spent my time reading almost everything I could about nutrition, as many Air Force members were failing their tests not because of lack of physical training but from obesity and poor diet. I realized that a lot of what I had learned in medical school about nutrition was not based on good science. Most of the information was either wrong, or certainly not helpful to my West Virginia population. Fortunately, excellent work in the research and clinical world was being conducted on the role of sugar and carbohydrates leading to insulin resistance–the root of many chronic diseases. Robert Lustig had just published a book entitled “Fat Chance” that challenged conventional wisdom. The school began to use this publication in the first medical school curriculum and have used it ever since. The book teaches students critical thinking, as well as the understanding of human metabolism in the real fast food world.
Through a partnership with a local culinary school, the School’s lifestyle medicine program takes medical students into the teaching kitchen and conducts classes on food and healthy ingredients, while at the same time providing information on metabolic syndrome, a primary driver of chronic disease in the state of West Virginia. Instructors teach the preparation of healthy low carbohydrate meals and substitutes for simple sugar and starches to keep flavor. We share recipes which contain healthy natural fats and unprocessed and unrefined oils which we believe have vital roles in a sustainable healthy diet. In the lifestyle medicine program there are also sessions on physical activity and the powerful role that movement and exercise have in health, longevity, and disease. Along with healthy eating, exercise is the miracle pill. We have presented what our program at conferences around the country where we come away with more innovative ideas from other schools.
It is fun to see the students in action on the hospital floor giving lifestyle counseling and connecting with patients after discharge to ensure they are staying on track. I believe if a patient knows someone cares, that goes a long way to providing optimal care. What has been helpful to me is a group of supportive colleagues who, with me, are willing to challenge conventional wisdom, read the literature, and look at the individual responses of patients to different methods of lifestyle management. Our state is unfortunately the nation’s lead in T2D and obesity. One of our main messages here is that there is not a “one size fits all” prescription. We want to give each patient simple ways to objectively measure how a lifestyle intervention is affecting them–a simple glucometer, the tape measure, and most importantly how one’s brain, mood, and energy are doing. For example, simply testing blood glucose after a meal can tell an individual if that meal is above their carb threshold. These parameters tell you how your body is responding and if something is generating a good response for you as an individual. My hospital has accepted and implemented low carbohydrate menus and education for patients as well as creating a “Sugar Free Hospital” as of January 2018.
I would like to share that we all have a lot to learn in nutrition and lifestyle and how this applies to the U.S. population as it exists today where most people are obese and prediabetic. Recently a survey we conducted of 1,500 people who have been on a low carbohydrate style of living (many for over two years) was accepted for publication. The results of the participants are nothing short of phenomenal, not just by their objective measures, but by the open-ended questions on how their lives are changed. We have dozens in my own local community, some hospital patients and some who have come to community meetings, who have lost and kept off 100 pounds without being hungry or depriving themselves. We place a big focus on the brain and the addictive properties of foods, and if we do not address this we cannot help people by giving them a script. There are some in the lifestyle medicine space who will state with “100% confidence” that a diet containing natural saturated fats and all animal products will lead to heart disease and diabetes, but if you read into the literature and observe the lives of healthy elderly this is not true. Now, if the fat comes along with a McDonald’s meal and tons of processed foods and junk food, yes, that is a path to disaster. So, I want us all to be friends and collaborators in the field and open to each other’s ideas as we learn and engage in good academic debate. That is why we are here. I am still searching for the truth, but probably will never find it in my lifetime. I believe the focus of attention and intervention at a societal level needs to be reducing and eliminating sugar-sweetened drinks and junk food.
Personally, I love the Quantified Self approach also. I am still a competitive distance runner at age 50, and I have been the subject of multiple physiologic, cardiac, metabolic, continuous glucose monitoring, and telomere testing–pretty much every test you could throw at a person at my age to assess their general state of health and performance. Fortunately, despite the stress and sleep deprivation of my day jobs, the lifestyle choices I have made are working close to perfect for me. Each of us are an experiment of “one” and each must find ways to assess for themselves if their chosen path is optimal.
Finally, engaging the community as partners is also critical in lifestyle medicine. Health lies in the community, and, to this end, I direct two running races a year and own a community running and walking center which focuses on education.
Thank you for the opportunity to share!
Mark Cucuzzella, MD, FAAFP
Professor Family Medicine
West Virginia University Department of Family Medicine
Mark Cucuzzella, MD, is a professor at West Virginia University School of Medicine. He is a Lieutenant Colonel in the U.S. Air Force, designing programs to promote health and fitness in the military with the USAF Efficient Running Project. In his community and medical school, he has been a tireless promoter of nutritional interventions in patients with any spectrum of the metabolic syndrome and introducing low carb options for hospital patients. Dr. Cucuzzella is a member of The Nutrition Coalition advocating for scientific scrutiny in nutritional policy, and he is the founder and lead teacher for Healthy Running CME Courses. Healthy Running courses bring together all the disciplines of sports science and sport medicine as well as coaches and running enthusiasts who desire to help their athletes and themselves have long healthy careers in the sport. Dr. Cucuzzella was a lead writer of one of the first grants supporting education of medical students in nutrition and physical activity through the MEDCHEFS program, now in its fourth year. A competitive runner for over 30 years with more than 100 marathon and ultramarathon finishes, he has a unique streak of 30 years running a marathon under three hours. He has won the Air Force Marathon twice. He is the race director of Freedom’s Run race series in West Virginia and director of the Natural Running Center, an education portal designed to teach healthier running. Dr. Cucuzzella’s innovative work and story has been featured in the New York Times, NPR, Outside Magazine, Running Times, Runners World, Air Force Times, the Washington Post, JAMA, Blue Ridge Outdoors, and other medical and media outlets.