Dr. Larry Cohen is an emergency room physician and zealous advocate for improving health.
Cohen believes that the best medicine for curing or halting progression of chronic disease in the United States comes from whole foods and a plant-based diet. When combined with exercise, proper sleep and stress management, it’s a prescription for health.
Cohen says the novel coronavirus pandemic has placed a spotlight on overall health, and it’s a wonderful time to internalize and then act on ways to be healthier. The pandemic, he says, has shown that people with underlying health risk and compromised immune systems are more at risk for serious illness from COVID-19.
Among the few Lifestyle Medicine doctors in Colorado
Well-known in Colorado Springs for his “Walk with a Doc’’ devotion, Cohen wasn’t always an evangelist for diet and exercise. Years ago, he says, he ate plenty of vegetables – lettuce, tomato and ketchup – atop greasy cheeseburgers, a mainstay in his diet.
When his hospital co-workers gently chided him about his lousy diet, he had a quick response: “Well, at least I’ll die enjoying myself.’’
That was more than 20 years ago. He’s since made dramatic changes and is among only a few certified Lifestyle Medicine doctors in Colorado. The American College of Lifestyle Medicine defines the discipline as “the evidence-based practice of helping individuals and families adopt and sustain healthy behaviors that affect health and quality of life.’’
What is Lifestyle Medicine?
Lifestyle Medicine is built on six fundamentals:
- Eat healthy
- Manage stress
- Avoid risky substance abuse
- Get adequate sleep
- Create and maintain strong relationships
Two decades ago, the 5-foot-6 Cohen made a change from cheeseburgers to lean meats and vegetables because he weighed 196 pounds and didn’t like how he looked. He ate only vegetables, fish and skinless chicken and dropped 60 pounds in six months. His cholesterol dropped 100 points to 170. It wasn’t enough.
Four years after changing his diet, Cohen noticed a loss of endurance while training for a triathlon in 2003. He checked in with a cardiologist and a stress test found he needed three-vessel coronary bypass graft surgery.
Taking on a plant-based, whole foods diet
Since then, Cohen has consumed only plant-based, whole foods with no added fats or oils. He exercises regularly and said he feels great. Food is medicine, he believes. For breakfast, for instance, Cohen may eat a bowl of steel oats, perhaps a few flax seeds, three or four almonds and a cup of berries. For lunch and dinner, he eats a lot of whole-grain pasta, legumes, beans and tofu. He does not consume sugary beverages, dairy products, alcohol or processed vegan food.
“I never feel hungry and I never feel deprived,’’ Cohen said of the diet. He takes B-12 but no supplements or vitamins.
While practicing in the Emergency Department, Cohen does not suggest to patients that they stop taking their prescription medications. He introduces Lifestyle Medicine to some patients, promoting the six foundational tenets. He mostly lets patients know that a change in diet, coupled with exercise, can prevent, slow progression or reverse cardiovascular disease and diabetes.
Studies on Lifestyle Medicine benefits
Cohen can cite study after study that shows how plant-based, whole foods can substantially lower risk of coronary heart disease, like this study. Another study published in the New England Journal of Medicine found that lifestyle changes reduced the incidents of Type II diabetes by 58% and metformin by 31% compared to placebo.
The World Health Organization’s Chronic Disease Report says 80% of heart disease, stroke and Type 2 diabetes and 40% of cancer can be prevented, primarily with improvements to diet and lifestyle.
Making a change, he says, is entirely up to the individual – and it takes a month or so to acclimate to whole foods. Since Americans eat a lot of manufactured or processed food that is full of fat and salt, it takes about a month for taste buds to change.
“When people start doing this, everything tastes a little bland because you’re not eating packaged foods that are high in fat and salt. But after a few weeks, when you go back and eat something that is processed, you can’t stand it because everything is too oily and salty and grimy,’’ he said.
Cohen said that switching to a plant-based diet was not hard but “you have to want to do it and we are bombarded by other influences. I tell people the biggest obstacles to eating right are friends and families.’’
He recalled seeing a 350-pound man in the Emergency Department who was diabetic. His wife and two children were also overweight and Cohen suggested that try to change their diet, eat more fruits and vegetables and give up animal-based proteins. He told the man he could perhaps reverse his need to take medication for diabetes. Just when he thought he had the family convinced, the gentleman responded: “But I love my meat.’’
The benefits of more fiber
One of the best ways Americans could improve their health, Cohen, is by eating more fiber. Scientists are learning more and more about bacteria in the gut and how it affects cardiovascular health, specifically a chemical produced in the liver called TMAO, tryimethylamine oxide.
“Liver enzymes produce TMAO from its precursor, a gas called trimethylamine (TMA) that’s formed when gut bacteria break down foods with choline and l-carnitine, nutrients abundant in meat, poultry, fish, dairy and egg yolks. Multiple studies involving animals and humans now suggest that TMAO is atherogenic, prothrombotic, and inflammatory, making it a triple threat to the cardiovascular system,” Cohen said.
“The more we eat red meat, the more TMA-producing gut bacteria there are. Gut bacteria that feed on fiber cannot make TMA! The exact mechanisms haven’t been sorted out, but the metabolite appears to create and upset arterial plaques and increase blood clots through a variety of pathways like reducing cholesterol clearance; increasing cholesterol-laden foam cells and pro-inflammatory cytokines; and enhancing platelet activity,’’ Cohen said.
A study published in the Journal of the American Heart Association in 2017, found a more than 60% heightened risk of both major adverse cardiovascular events and death from all causes in people with elevated TMAO. Other research has associated higher TMAO levels with heart failure and chronic kidney disease.
What is medicine for our body?
Cohen emphasizes that while food is medicine, so is exercise, sleep, stress management, healthy relationships and avoidance of risky substances.
“We can prevent and treat chronic diseases with comprehensive lifestyle changes, but it doesn’t negate nor is a replacement for medicine and surgeries when needed. People should not stop taking medicines when starting to adopt healthy lifestyle changes, and should only do that when it is safe and only with consultation with your care provider,’’ Cohen said.
Lifestyle Medicine doctors believe that learning how to manage negative stress that can lead to anxiety, depression, obesity, immune dysfunction and more, promotes long-term health. Having the ability to recognize negative stress responses and learning reduction techniques like meditation can lead to improved wellbeing.
Maintaining healthy relationships and staying socially connected is essential to emotional resiliency. Studies show that isolation is associated with increased mortality. During the coronavirus pandemic, it is important to practice physical distancing by staying 6 feet apart from others, but always maintain social connections with others.
Cohen said that eating a healthy diet can fend off chronic disease and lead to a longer life.
“Literally, 80 percent of our chronic disease can be eliminated through diet,’’ he said.