What’s the Dosage?

This article was originaly published as an op-ed in The Jerusalem Post (28 Jan. 2025): https://www.jpost.com/opinion/article-839508

Two years ago, the biggest success story here at The Wellness Clinic was a client named Jeffery.  Our weekly Zoom sessions changed his life. Let’s review the status of Jeffery’s health before we met. He had every problem you can imagine in terms of chronic disease. He had obesity class 3, high blood pressure, type 2 diabetes, high cholesterol, and anxiety.  This is what we call metabolic syndrome. He got started on his program.

At first, it was slow going.  However, Jeffery was determined and persistent. He knew that if he didn’t tackle his health issues head on, the future of his quality of life wasn’t going to be great.  He had the advantage of an extremely supportive wife.  As time went on and we fine-tuned Jeffery’s program, and the progress became better and better.  Every time he was able to reduce another medication, his weight began to drop more steadily and in slightly larger amounts.

After about six months of work, he ceased taking five different medications.  Now, without all the meds, he no longer had a blood pressure problem and he was no longer a type 2 diabetic. Jeffery’s cholesterol was in a great place and his anxiety was very much under control.  Jeffery had lost 30 kilograms (66 pounds) and he felt like a brand new person with a new life.

It is now two years later. Overall, compared to what once was Jeffery is in a good place.  Yet, he was back in contact with me this past week.  The reasons were some slight weight gain and an uptick in cholesterol.  I asked him to track his food for a week and then we met.  There were some big lessons to learn from what we discovered.

What’s the dose?

When one gets sick with a common illness, say a throat infection or bacterial bronchitis, he will visit the doctor.  After examination and perhaps a test, the doctor verifies the infection and prescribes an antibiotic. He explains the dose to the patient – how much to take each day and how many times a day.  This is actually one of the tricky parts of prescribing medication.  Too little, and the drug is ineffective. Too much and the side effects can be pronounced and even damaging.

When it comes to using lifestyle medicine, the very same is true.  Based on thousands of studies we have certain general principles. However, there can be a certain individualism to the dosing.  Let’s look at an example.

Several years ago, a woman with very high cholesterol came to see me.  I helped her overhaul her diet and in 5 weeks, her cholesterol dropped 110 points.  Remarkable!  Both her physician and another doctor I showed the results to couldn’t believe it.  In contrast, let’s take a look at yours truly.  When I switched my diet, my cholesterol also dropped—but it took a year and a half to gain a similar drop.  It was only when I shifted to 99.5% whole-food, plant-based, low salt, low-sugar, and no oil did I see an even bigger and dramatic lowering of cholesterol.  That means that for this woman, 85% whole-food, plant-based and cutting out junk food brought a very quick and pronounced result.  For me, on a similar regimen, it took 18 months and only with 99% compliance, did I see as radical a drop as she experienced.  There is certainly dose dependency in lifestyle and it can be very individual.

What happened to Jeffery?

After looking carefully a Jeffery’s eating habits, I found he had made some very small changes in the wrong direction that put his health in reverse. I gave him 3-4 small portions of animal proteins as a maximum each week.  By anyone’s definition, that is a very plant-predominant way of eating.  He doesn’t eat junk food.

What happened? Those small portions became larger portions – still 3-4 times a week, but sometimes Jeffery’s portions were almost double my recommended serving size.  That means he was now eating more in the range of 6-7 portions weekly. Over a long period of time, this makes a big, big difference. It resulted in the rise in his cholesterol and the creeping weight gain.

The other poor habit that has snuck back into Jeffery’s life was eating solid food late at night.  That may not have affected his cholesterol, but it definitely contributed to his weight gain.  Jeffery is back on course now, and this should bring his cholesterol and weight back to a good place.

When is it enough?

How do we know how much is enough in dietary change to bring results?  What is the dose?

Here is what we know.  We know these behaviors are protective:

• eating a plant-predominant diet, meaning roughly 85% or more of the foods are unprocessed plants
• avoiding smoking
• staying active and exercising
• keeping weight in the normal range

Chances of chronic disease reduce by about 80% with these behaviors, resulting in longer life expectancy.  This is a great statistic based on a lot of reliable epidemiology. Nevertheless, different people have different needs and goals.  What helps one person may not be enough for the other.  Jeffery got a little too liberal on the consumption of animal protein and it cost him.

Here is my rule that I try to apply to my clients.  For those who wants to prevent disease or halt the progress of early stage disease, than the 85% compliance, along with eliminating ultra-processed food will usually do the trick.  For those with more advanced disease, the closer you are to 100% on a whole-food, plant-based diet, along with the exercise, good sleep and no smoking or other substance abuse, the more likely you are to get an amazing result.

The dose is important—very important.  It’s always beneficial to add positive health behaviors.  But in order to defeat disease, make sure your lifestyle medicine prescription is the right fit for you so you will be able to “add hours to your days, days to your years and years to your lives.”