Research: One Cup of Broccoli at a Time

This past week I went to hear Dr. Mark Hyman speak to our medical students about functional medicine. My brain was spinning a mile a minute. That happens whenever I spend time thinking about actually preventing illness instead of chasing it. I channeled my energies by spending a good part of the time busily writing tweets to send out on my Twitter feed:

Roxanne Sukol @roxannesukolmd
Biological networks are the future of medicine. I believe it.

Roxanne Sukol @roxannesukolmd
@markhymanmd says he uses the #krebscycle every day. #ohyeh? #letssee

Roxanne Sukol @roxannesukolmd
Is it evidence-based medicine or reimbursement-based medicine? You rock @markhymanmd

And, my favorite:

Roxanne Sukol @roxannesukolmd
Think about what it would be like to make functional medicine the new primary care.

That last one thrills me to the bone. But none of these are what I’m planning to tell you today. Instead, what I want to talk about is something that Mark Hyman said in the most offhanded of manners. It was just a toss away, a side bar. A comment about research.

Our research systems have been designed to test a single variable at a time, he pointed out. Like the effect of, say, a single cholesterol-lowering medication of interest on heart attack rates vs. no cholesterol-lowering medication in an otherwise identical group. Or 5 mg/kg of a particular antihypertensive (blood pressure) agent in one particular group of individuals who may be having a heart attack vs. 2 mg/kg in a different group, and 10 mg/kg in a third, all to try and discover the optimum dose.

But that’s not how the real world works. Which is why this system doesn’t work at all in lifestyle medicine. Can you imagine separating a large group of children into equal halves, and begging just half of them to eat a cup of broccoli every day? Or, in a different study, instructing half the participants to eat a bowl of oatmeal for breakfast every day? How about a study on the benefits of exercise that provides all the participants with a short video on the benefits of exercise, but e-mails just half the participants several times a week to check on progress? This, in case you’re wondering, would be a study on the effectiveness of e-mailing, not exercise.

But back to the subject at hand. Real life cannot be fit into research designed to test one ingredient at a time. So the naysayers who continue to ask for hard data will still be asking, even as the rates of obesity and diabetes begin to fall. Which they both will, I am certain.

The bottom line? Life doesn’t happen 1 cup of broccoli at a time. Lifestyle changes are highly synergistic. Get a lousy night’s sleep, and the next day you find yourself buying stupid things from the vending machine. Go for a long, happy hike, and that night you sleep like a baby. Everything is connected. Which is why a small improvement on all fronts simultaneously sometimes makes an enormous difference.

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