By now the obesity epidemic and the accompanying increases in the occurrence of Type 2 diabetes, cardiovascular disease and common cancers have become old news. So the question many healthcare providers are asking is, “how is the healthcare system responding to this crisis?”
“We don’t have a healthcare system,” says Mona Sigal, MD, Founder of Nourish Health With Food for Life (NHWFFL). “We have a sick care system of the first order.”
Dr. Sigal ought to know; she has been in medicine for over 26 years. As a board-certified emergency physician, she has seen firsthand what chronic disease in crisis mode looks like.
“Very early on in my career, I became extremely interested in the connection between disease and lifestyle,” she says. “I began to realize that much of the pathology I learned about in medical school and residency, and later saw in practice was very much either lifestyle-induced or lifestyle-exacerbated.”
As an emergency physician, she came to the realization that, at best, she was putting out fires, but she wasn’t really making a difference in anyone’s life.
“If patients survived to go home, they just returned to their old ways of eating and living,” she says. “And they kept coming back to the ED, worse with each visit.”
The more Dr. Sigal read and researched the matter, the clearer it became: Of all lifestyle measures, nutrition seemed to be the key. And so began a journey into medical nutrition education and the science behind it.
“Two facts became strikingly obvious,” she recalls. “I needed to change course, and I needed to become an educator.”
But the world around her also began to change. In 2004, the American College of Lifestyle Medicine was founded as an offshoot of the American College of Preventive Medicine.
“The more I was educating myself through reading and attending conferences, the clearer it became that if I wanted to dedicate my work to a different way of practicing medicine, I needed to change careers.”
A New Career
In 2007, Dr. Sigal left emergency medicine to pursue the practice of nutrition and lifestyle medicine full-time.
“There is no formal residency or fellowship training in lifestyle medicine yet,” she explains. “Some programs are underway, particularly in California. But the direction is clearly shifting in medicine. The scientific evidence is overwhelming, and there is no denying anymore that we have to address the medical issues we face with a completely new mind-set. There is a need for a change in paradigm.”
Dr. Sigal’s educational journey has been an exciting one.
“It’s not as if I had to go back to medical school,” she says. “But I definitely needed to become familiar with a completely different world of research and a totally new approach to the way I look at patients.”
She obtained certificates in plant-based nutrition from E. Cornell University, the T. Colin Campbell Foundation, and in nutrition and lifestyle medicine from the Wellness Forum Institute in Ohio.
She also became a certified Food For Life Instructor with Physicians Committee for Responsible Medicine.
“I didn’t want to reinvent the wheel,” she says. “I knew that I wanted to teach, and the plant-based nutrition for disease prevention and reversal curricula developed by PCRM are top-notch. Having their backup and expertise at my fingertips has been very important.”
Dr. Sigal also had the unique opportunity to observe one of the best in the field when, in 2012, she worked alongside John McDougall, MD, at his inpatient program in Santa Rosa, California.
“It is simply mind-boggling what happens to people who have diabetes, high blood pressure, high cholesterol, and who take a bagful of medications once you put them on a delicious, plant-based, minimally processed, low-fat eating regimen, without counting calories, carbs, proteins, or weighing or measuring anything else. I was there, I took care of those people 24/7. In only 10 days, the average decrease in cholesterol was 60 points. Blood pressures plummeted, oral hypoglycemic drugs were discontinued, insulin needs cut.
“Engaging with patients in lifestyle medicine is a dynamic partnership between two equals. I may provide the expertise, tools and unconditional support, but the patient is in the driver’s seat, doing all the work. My job is to help patients find the motivation to change.”
But lifestyle medicine is more than nutrition. Dr. Sigal, in an effort to expand her tool kit beyond nutritional advice, has also been trained as a Health Coach by Wellcoaches School of Coaching.
In addition to diet and regular physical activity, stress management is the third fundamental cornerstone in lifestyle medicine. So Dr. Mona Sigal is also a Mindfulness-Based Stress Reduction (MBSR) Teacher-in-Training at the Mind Body Institute at UMass Medical Center in Worcester, Massachusetts.
“Mindfulness-based stress reduction techniques change the way you perceive life’s stressors and respond to everyday challenges, small or huge,” she says. “These are life-altering skills.”
Dr. Sigal trained with Jean Kristeller, PhD, who has developed and researched the MB-EAT (mindfulness-based eating awareness training) curriculum, a derivative of the MBSR program. MB-EAT deals specifically with the issues of maladaptive eating behaviors, which contribute a significant burden to many of the overweight and obese patients Dr. Sigal encounters. Emotional eating can be among the most stress-inducing behaviors in many people’s lives.
Lifestyle medicine has rapidly gained traction over the last few years and is becoming increasingly mainstream. Mona Sigal, MD, is able to work with most major health insurance carriers in Massachusetts.
“Food is the most commonly self-prescribed medication when it comes to stress,” Dr. Sigal explains. “At some point, even the healthiest food is counterproductive if it is being misused. One’s relationship to food and one’s own body can cause a lifetime of pain and suffering.”
A New Practice
And so the path was set for Dr. Sigal to start a new practice, Nourish Health With Food For Life, LLC, a nutrition and lifestyle medicine center located in Peabody, Massachusetts. At the core of the practice are courses taught at the office, with Dr. Sigal as the teacher.
“We know from many studies, that the group experience is extremely successful in reinforcing new habits and providing a unique and supportive learning environment,” she says.
Dr. Sigal teaches nutrition courses in a constantly repeating cycle.
Mona Sigal, MD, conducts a cooking demonstration during one of the nutrition classes at NHWFFL.
In addition to the nutrition courses (A New Beginning, Beat Back Cancer, Defy Diabetes), which cover the benefits of a whole foods, plant-based, minimally processed diet for disease prevention, arrest and reversal, Dr. Sigal teaches mindfulness-based stress management and eating awareness training courses. But although she has embraced the role of teacher, Dr. Sigal still maintains an equally important role as physician.
“Many clients who understand the benefits and want to embrace the lifestyle need close monitoring and supervision when medications need to be adjusted,” Dr. Sigal explains. “These clients are seen by me one-on-one, as regular patients would be.
“Anyone can come and take any of the courses; in fact, most people take more than one. But those who wish to see me as patients are required to take one of the courses, depending on their medical needs, since this education is key to success and cannot be provided one-on-one.”
The clients who seek Dr. Sigal’s medical expertise are often complex — cancer patients, patients with autoimmune disorders on powerful immunosuppressive drugs, patients with long-standing chronic bowel problems that have defied therapy in the past, just to name a few. And, of course, Dr. Sigal meets with patients who struggle with weight, cardiovascular disease and Type 2 diabetes.
“I do not replace the PCP or their other specialists in any form or fashion. On the contrary, I collaborate. I also take a lot of time with the patient.”
Indeed, the first encounter typically lasts 90 minutes or more and occurs only after the client has completed a 16-page questionnaire for Dr. Sigal to review. Follow-up visits last between 30 and 45 minutes.
“Keeping food journals is extremely important,” Dr. Sigal explains. “They allow me to analyze and correct a patient’s dietary habits, with highly disease-specific input. On the patient’s end, food journals encourage mindfulness and awareness, which often has profound effects on the client.
“Initially, some patients need frequent follow-ups. Coaching patients in making sustainable changes is the key. The beauty of this approach is that patients learn tools and become independent and self-motivated. The relationship they have with me is relatively short-term. Some like to have refreshers after a while, but most are on their way and do great.”
This year, Dr. Sigal is launching the practice’s first live, online nutrition course, which will allow patients who cannot make it to the office in person to benefit from the same great learning in a supportive and dynamic group environment.
Each class is two hours long and consists of lectures, videos and quizzes. But the most important aspect of the class is the cooking demonstration, which happens in each class. Dr. Sigal demonstrates two or three recipes in each class, and the participants get to taste all the foods.
The online nutrition course contains the same components, without the tasting experience.
“Once patients experience the freedom from drugs and the improvement in health, which usually carries with it weight loss, newfound energy, vigor, stamina and better sleep, they never want to go back to the way they felt before. People are empowered.
“I can say today for the first time in my professional life that I am truly helping people and making a real difference in their lives. That’s why I went into medicine all those years ago. I still have that passion.”
For more information about Nourish Health With Food For Life, or to refer a patient, please call 978-717-5804 or visit www.nourishhealthforlife.com.