Mark Fromberg: “I Think I Made a Mistake!”

SFU’s Kinesiology program seems a natural fit for someone with athletic interests.  Basic anatomy, physiology, biomechanics, biochemistry, sports training techniques and sports physiology — all great offerings for all those who want to be the best they could be, no matter what their sport.  And when it comes time to graduate, this healthy interest seems to propel many committed students into the study of medicine, as it did for me.

It only took a few weeks of medical school to realize that the focus of study was on disease, and not optimizing health as it was in kinesiology.  But it all seemed part of the overall understanding of how to help someone improve their life.  Yet, I wondered if I had made a mistake—was my real interest in optimizing health?  Should I have stayed in kinesiology?  At the time, I presented my quandary in these terms:

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I stuck with it, and eventually recognized the value of being able to help someone with a knowledge base that would cover the entire spectrum of health.  So many diseases to know about, and so many seemed to be related to lifestyle in some way; So many drugs, and so many with either limited efficacy, high cost, or troublesome side effects.  And just how much does big Pharma really influence the practice of medicine?

Remarkably, there was no course on nutritional intervention, no training in exercise prescribing, or any other preventive strategy for that matter.  It seemed that the mandate for family medicine was prescription writing for most problems, with a few procedures thrown in for good measure.  More troubling was that there was more of an interest to maintain or stabilize a disease entity, than to possibly cure it—hypertension, diabetes, hyperlipidemia, arthritis, to name a few—all respond to lifestyle interventions more convincingly than most of the medications thrown at them.  Patient empowerment with health education seemed then, as it does now, a waste of time.  Medical paternalism still reigns, and the patient centred approach remains an ivory tower ideal.  Call it fee schedule medicine.

Faithfully I followed the dogma of primary care.  My first few years were stressful, lots of round the clock work, and my health suffered with years of poor sleep, declining exercise patterns, and erratic eating patterns, causing progressive weight gain and more frequent and often debilitating migraines.  For me, drugs helped in the short term, but ultimately solved nothing,

My watershed moment came when I had to leave work because a migraine  I had became unmanageable.  I felt embarrassed about having to let down my patients that day, but I resolved to change something.  I had read that there were dietary triggers for migraines, and that dairy products could be one of them.  Although I didn’t really see a relationship with dairy products (I ate them virtually every day, yet I didn’t have headaches every day), I resolved to stop consuming them outright, which I discovered was hard to do.

But I did it.  After a few days of feeling vaguely like withdrawal symptoms mostly as a dull but manageable headache, I then went 3 months without a single migraine; and without trying I lost 25 lbs!  And this without any other change—of workload, of exercise, of medications, or of any other dietary factor.  The migraine I had 3 months later came with the accidental ingestion of pasta sauce that contained cream.  It was clear to me that, at least in my “n=1” experiment, dairy products were a significant contributor to my migraine frequency and intensity.  In the years since, I have eliminated all other triggers with diet and lifestyle change, and it has been more than a decade since I have had a migraine.  For me, a lifestyle intervention worked very well.  Yet, I had not been taught this.  So, for my migraineur patients, my experience was worth sharing, even though there was little evidence to support my theory….. the beauty of Big Pharma-driven research.

My personal explorations continued with various diets, including vegetarian and vegan patterns, and more recently with the Paleolithic diet.  Each time something works for me, I share it with any patient who might benefit from a similar trial.  I have many success stories.

After a decade in family and emergency medicine, 3 years in interdisciplinary chronic pain medicine, and 15 years in an urgent care centre, I have been delighted to offer counsel to patients who want more than a prescription for their problems.  And it is clear that, in most cases, patients don’t want drugs to ameliorate symptoms; they want definitive solutions.  And while it is true that many may not be ready to make a lifestyle change, we clinicians do not have a right to make those decisions for them.  We need to offer them all of the possible solution options for their consideration.  Drugs, while sometimes miraculous, are expensive—patients want our expertise in non-drug solutions as well.

So, I admit I have been conflicted about how I approach patients’ problems.  Sadly, I think the opportunity to get the preventive health story from their family doctors will remain limited for some time to come.  But, now I want to change this…..with a website that can be used as a reliable resource for non-pharmacologic, evidence-based solutions to every day health care problems.

I hope it is a small step in the right direction.