I’m passionate about wellness and preventative medicine. It’s why I like primary care. I’ve learned a lot about different dietary approaches from my eating disorder recovery, training at the Institute for Integrative Nutrition, and just through running this blog for the past 7 years. I love exercise and have tried almost everything out there, including distance running, Crossfit, spinning, pilates, and of course yoga. So I was really interested to see how doctors talked about diet and exercise with patients on a day to day basis.
I’ve been on my family medicine rotation working in a primary care clinic for the past 5 weeks. Given that the majority of our patients struggling with diabetes and/or hypertension, we end up talking about diet and exercise a lot! We also have a fair amount of overweight kids and adults, so it’s rare that an appointment goes by without a discussion about lifestyle.
But we don’t have a ton of time. Appointments are 20 minute slots, and that includes the student going into examine the patient first! We often run long – hello waits at the doctor’s office! – but we really try to stay on track. So while we are able to give good advice to patients, we don’t have too much time for in depth lifestyle counseling. We can tell them what’s recommended and offer brief suggestions, but don’t get into the nitty gritty of how this stuff will fit into their individual lifestyles. That part is disappointing to me, but understandable given the challenges of medicine today.
So here is what we actually recommend to our primary care patients:
**Note: This is my experience from working with one primary care doctor at one clinic. I’m sure many other physicians are doing things differently! Please share in the comments if you have any experiences with different types of advice. Also, this is not to be used as personal medical advice. Always talk to your own doctor before making any changes to your diet or exercise.**
- We always recommend the DASH diet (Dietary Approaches to Stop Hypertension) to our patients with hypertension. It is low salt, high potassium, high calcium that has been shown to reduce blood pressure in an amount comparable to using a single drug for treatment. We print out a handout for our patients.
- We recommend 5 servings fruit and veggies to all patients. Although often times that’s such a far stretch that we start smaller and focus on just getting some fruits and veggies, period.
- We recommend fresh food if possible. We tell patients to rinse any canned foods to get rid of excess salt.
- Limit eating out.
- We always suggest mostly water and limiting sugary drinks. We ask about juice and soda.
- We try to be encouraging and realistic with our patients. We tell them to start small — studies show than loss of just 5% or more of initial body weight can improve cardiovascular disease risk.
- We usually recommend a minimum 3 days a week for 30 minutes. The official recommendation is 150 minutes a week of moderate to vigorous physical activity and we mention that too!
- Strength training recommended 3x per week, but we don’t often specifically talk about strength training vs. other types of exercise unless it’s an older patient with bone health issues.
- Really just whatever works for the patient. Some have conditions that limit their activity. We talk about yoga, pilates, walking, swimming, dancing, biking. We let seniors know they get a free membership at the YMCA.
Is this what you all expected? What do you think about the advice — do you think it’s good enough? What would you do differently? And what have your own doctors talked about with you?
Have a great Monday!