A lockdown opportunity to bring lifestyle medicine into the mainstream

Shireen Kassam is a consultant haematologist, lifestyle medicine physician, and founder of Plant-Based Health Professionals UK (@plantbasedhpuk).

Laura Freeman is a dual licensed GP, lifestyle medicine physician and medical director of Plant-Based Health Online.

DOI: Dr Kassam and Dr Freeman are both co-founders of Plant Based Health Online.

It may seem an unlikely pairing for a new project – a Consultant Haematologist and a General Practitioner. Yet Laura and I have come via different paths to the same point in our careers where we want to offer patients a different approach to healthcare. For Laura, it started with her own diagnosis of thyroid cancer 5 years ago and the knowledge that she carried a gene that put her at higher risk of other cancers. This led her to investigate the impact of her own lifestyle choices on future risk of chronic illness. For me, it was when I decided to adopt a fully plant-based diet in 2013 that I began to investigate the impact of diet choice on the risk of chronic illness.

Our personal research into these areas led to a level of amazement and wonder at the power of diet and lifestyle for the prevention and even management of chronic illness. To learn that 80% of common chronic illnesses could be eliminated in Western societies by adopting healthy lifestyle habits was astounding to us. With this new knowledge Laura started using the power of lifestyle interventions in her own clinical practice, which at the time was as a family doctor in Canada. The results she saw in her patients were astonishing. For me, I was becoming increasingly frustrated at the level of chronic illness, such as type 2 diabetes and cardiovascular disease, in the patients I was treating for lymphoma. I had limited resources by which to address these issues that would ultimately impact their cancer outcomes. Both Laura and I went on to sit the lifestyle medicine diploma from the international board of lifestyle medicine in 2019 and it was around this time our paths crossed.

Laura returned from Canada to Scotland in 2019 and despite qualifying in the UK as a GP and also being licensed in Canada, was unable to easily return onto the UK GP register. This provided her with the impetus to set up her own private lifestyle medicine clinic and start to work with her community to improve their health through a lifestyle first approach. She was the first doctor in the UK to start up regular Walk with a Doc events and to implement the CHIP lifestyle intervention in a community setting. Then the pandemic struck, lockdown was implemented, and these activities had to be put on hold.

This is where our shared journey begins. We had both been searching for a way to bring lifestyle medicine to a wider audience. The pandemic had highlighted how underlying chronic illnesses were making the UK public vulnerable to the worst effects of COVID-19. Lockdown demonstrated that virtual consultations with healthcare providers had a number of benefits for the provider and the patient. Lifestyle medicine lends itself perfectly to the virtual setting given that its application is in the chronic rather than acute setting. From this the concept of Plant Based Health Online was born. We wanted to bring together a multi-disciplinary team of healthcare providers to deliver a lifestyle medicine service to everyone that needed it.

There were many hurdles to overcome before getting to the point of launch. We were lucky enough to secure donor funding in for this project in June 2020 as our vision was to be a community interest company that puts profits back into improving the health of families and communities. The main task was to get approval from the Care Quality Commission (CQC) as we felt this was essential for adding credibility to the service we are now providing. It provides patients and their NHS healthcare providers with the reassurance that we are providing safe and effective care. This was by no means an easy task and we opted to engage the services of a consultant to guide us through the process, a decision we never regretted. Most of you reading this article will know what this process entails and the policies and procedures that need to be in place prior to the CQC interview process. It is not something we want to repeat in a hurry but suffice to say the hard work was worth it in the end as we gained approval in mid-December. We are pleased to say we are the first online multi-disciplinary lifestyle medicine service with CQC approval.

Whilst working on the CQC approval processes we were getting together our core team which now consists of three GPs (including Laura), a dietitian, a nutritionist and a health coach. They have all been through an onboarding and induction process as with any healthcare provider. We have a GDPR compliant virtual consultation platform called Heydoc, which is also linked to an online pharmacy and laboratory such that the GPs in the practice can offer these services as required. We plan to hold clinical meetings and case discussion as our workload increases so that we can learn from each other’s expertise and experience.Why are we called Plant Based Health Online? Because we wanted to be upfront with patients about our dietary approach. The weight of evidence confirms that a plant-predominant diet is optimal for human health and is associated with the lowest risk of chronic disease. This is the approach has been adopted by the American College of Lifestyle Medicine, which sets international recommendations in this growing field of lifestyle medicine. In practice this means obtaining 85-90% of calories from whole plant foods; fruits, vegetables, whole grains, beans, nuts and seeds. If patients want to be fully plant-based, we will help them achieve this in a healthy way. Not only is this approach healthy for humans but it is now essential for planetary health as we highlighted in our previous article. Without a healthy planet there are no health people and therefore our fate is intertwined with the current climate and ecological crises.

We opened our virtual doors on January 26th, seven months after first coming up with the idea. We have had a number of inquiries and bookings from just the types of people we were expecting. Those with recently diagnosed illnesses such as heart disease, hypertension, cancer and type 2 diabetes who are seeking a more holistic approach to managing their health. We hope in time that by demonstrating the impact and efficacy of our service that the NHS will be willing to commission this for all patients who are motivated to make lifestyle changes to improve both their physical and mental health. Interestingly we have had a significant number of inquiries from doctors and allied health professionals who want to join our team.

We know that although healthy habits require commitment, evidence-based lifestyle medicine works very well in the real world – for those young or old, healthy or chronically ill. We also know that it offers a refreshing shift in practice for doctors and allied healthcare professionals alike. So, as we move forward in 2021, we are eager to both showcase the success of our patients and highlight the power of optimal nutrition and sustainable healthcare.

Featured photo by Drahomir Posteby-Mach on Unsplash

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