Longevity is everywhere except in the doctor’s office.
The medical profession exists in a bubble, and the concept of longevity hasn’t fully pierced it yet.1
I recently wrote about why your doctor probably isn’t spending time discussing diet and exercise with you, but today I wanted to write about why your doctor isn’t discussing it with themselves.
Since your doctor spends basically their whole professional life dealing with the impact of chronic diseases that are caused by lifestyle factors, why don’t they take their own health more seriously?
How come more physicians are radicalized about the healthcare system than about their own health?2
This post is a bit of explanation and a bit of conjecture from inside the world of medicine.
The vast majority of the health care system is filled with medical problems that are directly caused by lifestyle
The vast majority of my professional life is focused on mitigating the impact of chronic disease on health.
I treat diseases like heart disease,3 hypertension, hyperlipidemia, diabetes, heart failure, and atrial fibrillation.4
And while some other specialties treat things that aren’t the result of chronic diseases brought on by lifestyle factors, even some of the things that you wouldn’t think about as being related to lifestyle often are.5
Here’s a non-exhaustive list of chronic diseases that are related to lifestyle factors where you might not intuitively recognize the connection: osteoarthritis, cancer, GERD, sleep apnea, chronic kidney disease, liver disease.6
Chronic disease related to lifestyle covers almost everything that doctors treat and almost everything that our healthcare dollars pay for.
Even if you don’t have chronic conditions, you are still paying for them in the form of tax dollars and health insurance premiums.
Metabolic syndrome is everywhere, but we ignore it most of the time in medicine
I’ve written a lot about the way that the epidemic of metabolic dysfunction impacts our health.
By some estimates, 7 out of 8 Americans have suboptimal metabolic health.
And while metabolic syndrome has made its way into this newsletter many times, doctors are way too commonly glossing over the early signs of metabolic syndrome when it hasn’t met the formal criteria of a disorder.
We gloss over it because, in its early stages, metabolic syndrome isn’t treated with medications.
I think that’s a key point - we treat metabolic syndrome with diet and exercise, but not medications (unless you include Ozempic).
Doctors are taught to think about diseases and medical treatments, we aren’t taught to think about disease reversal in its early stages.
And while we are taught about the importance of exercise and diet, since they aren’t a common part of most clinical practice, we never really learn them well unless we spend our own time and energy learning to put those things into practice.7
Just looking at chronic diseases vastly understates our health problems
If all you do is think about the direct impact of disease, you miss a major problem that’s a lot worse in many ways: frailty.
Frailty is particularly interesting as it relates to chronic illness, because there is a huge body of research categorizing the ways that patients who are frail have worse outcomes from medical interventions and procedures.
Frailty is a huge risk factor for poor health outcomes.
There are frailty indexes and validated frailty risk calculators, so this concept has gotten into the mainstream medical world.
The concept of frailty has been professionalized in the medical research and is well understood by doctors to be linked to bad health outcomes.
But what is frailty?
Frailty is a multisystem degenerative process that puts people at risk for bad things like disability, falls, institutionalization, and death.
Frailty relates very closely with sarcopenia, which is a loss of muscle mass.
Sarcopenia is often the canary in the coal mine to indicate someone at risk for frailty.
I’ve written about the impact of sarcopenia on health before, when I advocated a couple of years ago that your New Year’s resolution should be to build muscle mass.
Frailty is a gigantic deal - not being frail is the difference between a freak illness or accident being a temporary setback versus that same illness or accident totally and permanently derailing your life.
We know how to prevent and even reverse frailty: lift weights
There is a ton of data looking at short term studies in different patient populations who are given the intervention of weight training to see the impact on functional status and quality of life.8
The results are completely consistent across the data - weight training works to improve muscle mass, muscle strength, functional status, visceral fat, mental health.
You name the positive health outcome, and weight training improves it.
This type of intervention works across populations too: frail elderly people, disabled people with coronary artery disease, people with chronic kidney disease.
The list of people that resistance training helps seems infinite.
Oh, and resistance training also doesn’t make symptoms of arthritis worse.
There’s even a Cochrane Review on the topic if you want to look through the data on almost every patient population that’s been studied here.
And while the idea of resistance training has made its way onto the radar screen of some doctors, it certainly hasn’t penetrated into a mainstream concept in medicine.
That’s why the Docs Who Lift podcast guys named themselves that - describing yourself as a doctor who lifts weights make you an anomaly.
Metabolic syndrome and almost all other chronic diseases can be reversed just life frailty can through diet, exercise, and sleep changes - and there are plenty of Netflix documentaries cataloguing examples.
And so why isn’t your doctor laser focused on their own health?
One of the things about the medical world that I find perplexing is that people who spend their whole lives taking care of the negative consequences of chronic disease, metabolic dysfunction, and frailty aren’t completely radicalized about preventing it in themselves.
A lot of people I’ve worked with have described their experiences during their medical training or during the height of Covid as being radicalizing events - they see human suffering caused by inequities in the healthcare system and it inspires them to political action.
But it’s pretty uncommon to see a doctor talk about their experience with chronic disease radicalizing them to change their own lives.
So here are my guesses about why:
We aren’t trained about this and we never see it, so it doesn’t feel real
I suspect that part of this has to do with the fact that we rarely see patients actually reverse their chronic diseases through lifestyle changes (which is part of why we don’t always talk about that).
Plus our medical training barely teaches us that achieving disease remission and frailty reversal through lifestyle changes is possible.
All of the long term data on these interventions stinks - but it stinks because of lack of adherence, not because the interventions themselves don’t work.
The fact that the data isn’t strong probably plays a role in why it hasn’t made its way into mainstream medical thinking.
But I’m not sure why the data on preventing and reversing frailty through exercise hasn’t become widely talked about the way that frailty assessments for our patients has.
Exercise takes an equal amount of time no matter how smart or successful you are
I’m also convinced that there’s another psychological component happening with some doctors that I’ve also seen in some of my wealthiest, smartest, and most professionally successful patients: when everything in life comes easy to you, but exercise doesn’t, it’s hard to put the time in.
You can’t exercise more quickly or do fewer reps on the leg extension just because you’re smarter than the people around you.
There isn’t a shortcut that you can figure out by being clever.
You have to put in the time and the uncomfortable physical effort yourself.
But, as with most things in life, the most mundane and straightforward explanation is probably the best one.
Doctors are human and struggle with motivation and consistency just like all other people.
Plus, being a physician is a sedentary job with high levels of stress, a lot of hours of work, dysregulated sleep/wake cycles, and a never ending stream of tasks to do outside of work.
Doctors are part of the group that perpetuate our sick care system, but we’re also patients in it too.
Anyone who has worked in medicine and also worked in any other industry will confirm that medicine is a bubble for you. And when I write longevity, I’m referring to the way it’s used in the wellness world, where longevity basically means staying healthy for as long as you can. It sounds esoteric, but it’s actually what most people want from their health, even if they haven’t put a name to it.
You will see a lot of physicians post on social media about their support for a national health care system, capping the cost of prescription drugs, and the evils of health insurance companies. This isn’t an article on any of these topics, so this footnote is as deep as I’m getting on these issues, and I’m not endorsing or opposing any political stances.
The correct term for heart disease really should be “atherosclerotic cardiovascular disease” or ASCVD, but since most people know it as heart disease, that’s often what I call it.
A non-exhaustive list of the conditions I commonly treat.
We’ll leave COPD and other smoking related conditions out of the discussion, but you can consider those to be chronic diseases related to lifestyle as well.
You can probably even put dementia on that list, although that’s probably a more controversial perspective. And note that when I say related to lifestyle factors, it doesn’t mean completely caused by lifestyle factors. It just means that lifestyle factors play a role, and the size of that role is going to be different from case to case.
Ask any doctor how they get good at their job, and they’ll tell you that what they were taught is only a small part of what they do. Nothing prepares you for actually taking care of patients other than actually taking care of patients. So incorporating this into medical training is likely to be less than a rousing success.
Weight training and resistance training are essentially interchangeable here. The goal isn’t lifting weights, per se, it’s putting stress on our skeletal muscle. Body weight, band, and machine exercises do that too.