Telling It Like It Is: Too Many HCWs Are Unhealthy
Plant-based diets can prevent chronic disease
March 1, 2024 5 minutes read
With more than 35 years of experience in employee health, wellness coaching, and lifestyle medicine, Leticia Nichols, NP-C, is not afraid to share a few inconvenient truths about poor diets and disease, which the healthcare system is primarily designed to treat rather than prevent.
Speaking at a recent webinar held by the Association of Occupational Health Professionals in Healthcare, Nichols urged the audience to get this message out to healthcare workers.
“We want to reduce inflammatory diseases, put them in remission — whatever we can do to help our employees get to a better state of health,” Nichols said. “One of our roles as healthcare providers [is] we’ve got to educate ourselves. Once I knew the power of food and the power of lifestyle, I thought that it was malpractice for me not to share this. Educate yourself so you can educate your population of workers.”
Nichols recommended conducting a written A1c survey for workers who want to know if they are prediabetic. Those who are can then test their A1c level and receive coaching and counseling about the results.
“There are lots of things that you can do,” Nichols said. “Do [group] walks, do any kind of collaboration you can with other departments. Do a hypertensive screening survey. Do the things that you can do to identify these killers and help your population stay healthy. We also have to be role models. We have to practice what we’re preaching. If there are areas that you have to deal with yourself, then deal with them. We want to add years to life and life to years.”
About six in 10 adults have a chronic disease, and four in 10 have two or more. These include cardiovascular diseases, chronic lung disease, diabetes, and chronic kidney disease.
“I’m going to talk about obesity,” Nichols said. “None of this is intended to be construed as fat shaming. Obesity needs to be seen as a condition that can have concomitant comorbidities and can be a serious health issue. It is something we need to look at and not shy away from conversations with our workforce.”
Using the standard body mass index reveals that more than 40% of the population is obese, Nichols said. “It is rampant, and it contributes to other morbidities such as diabetes,” she added. “Diabetes is costly in terms of physical injury to the individual and costly in money. Billions of dollars are expended in care for diabetics, who have significant risks of blindness, kidney failure, and heart disease. My mantra is diabetes takes no prisoners. In my opinion, once you’re a diabetic, you’re also a heart patient. Also, stroke is significant in this population.”
The ‘Bliss Point’
The right question to ask is: How many of these chronic diseases can be prevented or mitigated by consuming a healthier diet?
“Salt, sugar, and fat are just inundating our tastebuds as we taste the foods that are out there in the standard American diet,” Nichols lamented. “There is also this addictive quality of food. There are research food scientists who are looking for that ‘bliss point’ — the point that will bring you back to eating this food once again.”
Throw in sedentary jobs, with millions working on computers at home, and Nichols reaches this conclusion: “Sitting is the new smoking. … We’re couch potatoes in a fast food nation. We have a standard American diet which brings about the standard American diseases. A lot of these are inflammatory types of diseases, but a low-inflammation diet can counteract some of them.”
As to healthcare delivery, Nichols cited a 2019 book called Code Blue: Inside America’s Medical Industrial Complex. “First of all, [the author] says that the primary focus of our healthcare system is the bottom line,” Nichols said. “Now, you know I worked in healthcare for many years. I’m not trying to beat up on healthcare — it’s just a fact. Don’t take this personally, but it is a business, and we all realize that. They want cure over care. In doing this, they are trying to conquer diseases instead of looking at the underlying determinants that are causing this health condition.”
It is essentially an illness model of care, not a wellness model, Nichols added, noting that the book concluded that focusing on illness instead of wellness and prevention is the “original sin” of the healthcare system. Yet evidence-based alternative approaches are slow to integrate into medical education and clinical practice.
“Some of the things that I’ll be sharing with you today about the transforming power of lifestyle medicine have been out there for decades in the literature — 30 [or] 40 years — yet it’s not really fully integrated into practice,” Nichols said. “The question has to be: Why is that? I think we have to go back to the medical industrial complex, because it does not fit that system. It’s very easy to do lifestyle medicine, and it’s not something you can bill big for.”
Lifestyle Medicine
Lifestyle medicine is multifaceted but includes primarily a plant-based diet, physical exercise, adequate sleep, stress management, avoidance of substance abuse, and maintaining positive social connections.
“We want to have our folks looking at exercise as something that’s really beneficial to their body,” Nichols said. “Moderate to vigorous exercise about 150 minutes a week — that’s 30 minutes, five days a week. Restorative sleep is essential. Our body is repairing and restoring and detoxifying as we sleep.”
A simple tool to manage stress is to teach employees deep breathing techniques that relax the body. “I don’t mean deep breathing when you raise your shoulders — I mean deep breathing when you use your gut, your belly,” Nichols said. “These are belly breaths, and belly breaths stimulate the vagus nerve, which is part of the parasympathetic system, which is going to help slow things down, bring your blood pressure down, bring your heart rate down, and calm you.”
Social bonds and connections are a common trait of so-called “blue zones” where people live long lifespans. “There is an old African proverb that says, ‘If you want to go fast, go alone — but if you want to go far, go together,’” Nichols explained. “There is a power in unity and community.”
The basic elements of a diet leaning into plant-based nutrition include fruits, vegetables, whole grains, nuts, and seeds. Regarding meat being commonly referred to as the main source of protein, Nichols noted that all protein is initially made by plants and then consumed by animals.
“Why a plant-based diet? The nutritional value is high,” Nichols said. “A lot of these highly processed foods that we talked about earlier [have] low nutritional value [and] high caloric value. This is the opposite. It’s high nutrition, low calorie. It gives you some sense of satiety and you do not feel like you’re starving. High fiber — that is something that we just do not eat enough of in America. This is what we need to be looking at as our powerful plate of food that will sustain us and strengthen us.”
With more than 35 years of experience in employee health, wellness coaching, and lifestyle medicine, Leticia Nichols, NP-C, is not afraid to share a few inconvenient truths about poor diets and disease, which the healthcare system is primarily designed to treat rather than prevent.
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