Chronic disease is shortening our lifespan, destroying our quality of life, bankrupting governments, and threatening the health of future generations. Unfortunately, conventional medicine has failed to adequately address this challenge, and the prevalence of most chronic health problems continues to rise. In this article I explore why that is and outline a new approach to healthcare that would much more effectively tackle the chronic disease challenge.
Chronic disease is the biggest healthcare challenge we face today—by a long shot.
Consider the following (scary) statistics:
- One in two Americans now suffers from chronic disease, and one in four has multiple chronic conditions.
- Chronic disease is responsible for seven of ten deaths each year.
- The rate of chronic disease in kids more than doubled between 1994 and 2006.
- 84 percent of the $3.8 trillion we spend on healthcare in the United States each year goes toward treating chronic disease.
We’ve reached the point where chronic disease has become so common that we think it’s normal. But there’s a big difference between common and normal.
Even in the United States, at the turn of the last century, the three major causes of death were all acute, infectious diseases: tuberculosis, typhoid, and pneumonia.
You might argue that this is simply because our recent ancestors didn’t live long enough to acquire chronic diseases. But although it’s true that our average life expectancy has increased significantly over the past century, it’s also true that chronic diseases like heart disease, diabetes, and Alzheimer’s—which are now among the top causes of death in the United States—are rare in contemporary hunter–gatherers that have maintained their traditional diet and lifestyle.
How would you rate conventional medicine’s approach to chronic disease?
As a case in point, consider the Tsimané, a subsistence farmer and hunter–gatherer population in Bolivia. They eat meat, fish, fruit, vegetables, nuts and seeds, and some starchy plants. They walk an average of 17,000 steps (~8 miles) a day. They spend a lot of time outdoors, get plenty of sleep, and aren’t exposed to a lot of artificial light at night.
In a recent study, researchers found that the prevalence of atherosclerosis was 80 percent lower in the Tsimané than in the United States. Nearly nine in ten Tsimané adults between the ages of 40 and 94 had clean arteries and faced virtually no risk of cardiovascular disease. What’s more, this study included elderly people—it was estimated that the average 80-year-old in the Tsimané group had the same vascular age as an American in his mid-50s. (1)
The consequences of chronic disease are profound
Chronic disease is not a small problem. It’s an insidious, slow-motion plague that is exploding through Western populations, shortening our lifespan, destroying our quality of life, bankrupting our country, and threatening the very survival of our species.
The consequences for patients are painfully obvious. Consider the following:
- Two-thirds of Americans are overweight, and one in three is obese. According to a recent report, half of Americans will be obese by 2030. (2)
- The prevalence of autism spectrum disorder (ASD) more than doubled from 2000 to 2010—and not just because of increased rates of detection. (3)
- Rates of autoimmune disease have doubled or tripled over the past 50 years (depending on which estimate you look at) and are expected to continue to rise sharply.
- Over half of adults take prescription drugs, and 40 percent of the elderly take more than five medications. (4)
But it’s not just patients that are affected; doctors and healthcare professionals are also victims. For example:
- 90 percent of doctors feel medicine is on the wrong track.
- 83 percent of doctors have thought of quitting medicine.
- Half of doctors describe themselves as either often or always feeling “burned out.”
- In inflation-adjusted dollars, the average physician earns the same wage as she did in 1970 but sees twice the number of patients. (5, 6)
Above and beyond the effects of chronic disease on individual patients and healthcare professionals, the costs to society at large are enormous and potentially catastrophic:
- Annual healthcare expenditures in the United States hit $3.8 trillion in 2013—more than $10,000 for every man, woman, and child and about 24 percent of our GDP.
- If healthcare spending continues to rise at its current pace, the United States will be insolvent (bankrupt) by 2035.
- Globally, spending on chronic disease is expected to reach $47 trillion by 2030, an amount greater than the GDP of the six largest economies in the world.
I think it’s pretty safe to say that chronic disease is literally bringing the world to its knees, and what we’ve been doing to address it isn’t working.
But why?
Two reasons conventional medicine has failed to address chronic disease
There are many reasons conventional medicine has failed to address the chronic disease epidemic, but I’d like to focus on what I believe are the two most fundamental issues.
#1: The wrong medical paradigm
Conventional medicine evolved during a time when acute, infectious diseases were the leading causes of death. Most other problems that brought people to the doctor were also acute, like appendicitis or gall bladder attack.
Treatment in these cases was relatively simple: the patient developed pneumonia, went to see the doctor, received an antibiotic (once they were invented), and either got well or died. One problem, one doctor, one treatment.
Today things aren’t quite so simple. The average patient sees the doctor not for an acute problem, but for a chronic one (or in many cases, more than one chronic issue). Chronic diseases are difficult to manage, expensive to treat, require more than one doctor, and typically last a lifetime. They don’t lend themselves to the “one problem, one doctor, one treatment” approach of the past.
Unfortunately, the application of the conventional medical paradigm to the modern problem of chronic disease has led to a system that emphasizes suppressing symptoms with drugs (and sometimes surgery), rather than addressing the underlying cause of the problem.
For example, if you go to the doctor and find out you have high cholesterol and/or high blood pressure, you’ll be given a drug to lower them—and expected to take that drug for the rest of your life. There is rarely any serious investigation into why your cholesterol or blood pressure is high in the first place.
If we consider health and disease on a spectrum, where perfect health is on the left and death is on the right, conventional medicine is focused on intervening at the far right of the spectrum.
If I get hit by a bus, I definitely want to go to the hospital! Conventional medicine is also embracing new technologies to do some amazing things, like restoring sight to the blind, re-attaching limbs, and potentially fighting cancer with nanorobots.
However, these approaches are not the best way to prevent and reverse chronic disease. Recent statistics suggest that more than 85 percent of chronic disease is caused by environmental factors like diet, behavior, environmental toxins, and lifestyle. (7)
More specifically, chronic disease is the direct result of a mismatch between our genes and biology on the one hand and the modern environment on the other. I summarized the research supporting this argument in my first book, The Paleo Cure, and there are numerous examples everywhere we look.
For instance, in 1980 only 1 percent of the Chinese population had diabetes. In just one generation, the incidence of diabetes rose by an astounding 1,160 percent! (8) What happened? Was there some kind of massive gene mutation in Chinese people over the past 30 years that caused an outbreak of diabetes?
Of course not. Genetic changes take a lot longer than that to occur. Instead, during this period the Chinese shifted from a more traditional diet to a more industrialized, processed diet.
The takeaway is clear: if we want to prevent and reverse chronic disease, we need a medical paradigm that:
- Recognizes the mismatch between our genes and our behavior and environment as the primary driver of chronic disease; and
- Focuses on preventing and reversing the underlying causes of disease, rather than just suppressing symptoms
#2 The wrong delivery model
It’s not just our approach to chronic disease that is inadequate; our model for how care is delivered is also a huge problem.
Why? For several reasons.
First, it’s not structured to support the most important interventions. As I mentioned above, the primary causes of the chronic disease epidemic are not genetic, but behavioral. It boils down to people making the wrong choices about diet, physical activity, sleep, stress management, etc.—over and over again, throughout a lifetime.
This makes it clear that one of the most important roles healthcare providers should play is supporting our patients in making positive behavior changes.
Unfortunately, the conventional medical system makes this extremely difficult. The average patient visit with a primary care provider (PCP) lasts about 10 to 12 minutes, and the average PCP has about 2,500 patients on his roster. If a patient has multiple chronic conditions, is taking several medications, and presents with new symptoms, it is nearly impossible to provide quality care during that 10-minute visit.
Once the initial intake and review of medications has taken place, there’s just barely enough time to prescribe a new drug for the new symptoms—and no time at all for a detailed discussion of diet and lifestyle factors that might be contributing. And since the PCP has 2,499 other patients and is already overworked, there’s no other time or place for that kind of discussion.
Even if the provider does happen to make a diet or lifestyle suggestion as the patient is on her way out, will it be successful? It’s now widely accepted that knowledge is not enough to change behavior; we’ve all encountered crazy shrinks and divorced marriage counselors, right? The expectation is that if the PCP tells the patient to change her diet, she’ll just do it. But in reality, we know that rarely happens. Patients need a lot of additional support in order to make those changes successful and long-lasting.
What’s more, if 95 percent of the appointment is spent talking about symptoms and medications and only the last 5 percent on potential diet and lifestyle causes and solutions—what do you think the patient will take more seriously?
To truly address chronic disease, we need a different model of delivering care. Among other things, this model should:
- Make possible and encourage longer visits with with patients, with more detailed intake and history and time for discussion and support. Ten- to 12-minute visits may be fine for prescribing drugs for symptoms, but they fall hopelessly short for actually addressing the cause of those symptoms.
- Emphasize collaborative care, where the doctor works with the patient as a partner, rather than in the “expert” model that characterizes our current system. The patient also has access to a care team that includes nurse practitioners/physician assistants, nutritionists, health coaches, and other allied providers to provide another layer of care and more support between appointments.
- Be both high-tech and high-touch, utilizing current technology and practices to streamline and automate cumbersome administrative processes and reduce overhead, both of which free up more time for practitioners to provide quality care to patients.
The future is already here
The good news—both for patients and practitioners—is that this future has already arrived. The new model I’ve described above is one that hundreds of clinics across the country (including my own clinic, CCFM) have begun to implement.
But as you might expect, there’s a lot more to this story. And that’s exactly why it’s the subject of my upcoming book, Unconventional Medicine: Join the Revolution to Reinvent Healthcare, Reverse Chronic Disease, and Create a Practice You Love.
The book will go into more depth on why conventional medicine has failed to address the chronic disease epidemic. But more importantly, it outlines a solution that has the potential not only to prevent and reverse chronic disease, but also to reinvent the healthcare system in a way that satisfies the needs of both clinicians/practitioners and patients.
Although the book is primarily written for those currently working or considering working in healthcare, it’s also intended for people in the general population who are interested in functional medicine, ancestral health (i.e., “genetically aligned, species-appropriate diet and lifestyle”), innovation, and even revolution in healthcare and playing some role—however small—in helping to co-create the future of medicine.
We don’t have a firm release date yet, but the current plan is for a late-August or early-September launch. I’m really excited about it and I hope you are too!
Now I’d like to hear from you. How would you rate conventional medicine’s approach to chronic disease? Have you had trouble finding the support you need for a chronic illness within the conventional paradigm? If you’re a practitioner working within this model, how has it served and not served you and your patients? Let me know in the comments section!
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George McWhirter says
It’s all simple really. What is needed is an agreed and universally accepted best diet (paleo, ketogenic, vegan etc) and maybe two alternatives. This to be widely taught in schools. Secondly a detailed, grade, set of bodyweight exercises put online for all to use with different versions according to age and fitness. Thirdly a whole series of yoga/meditation exercises also put online. These all to be free. Then the rest of the time encourage people to follow them and hey! 80% of strokes go, heart attacks, obesity, illnesses…..
Liz says
I think you are spot on in this article and bring up a lot of interesting points.
The stat from China illustrates something that has been bugging me for a while. You say that in 1980 1% of the population had diabetes and in 1 generation it went up by 1,160%. This raises an interesting point, in 1980, the Chinese were not eating a Paleo diet.
If we go back even a 100 years in Europe, although there were many more deaths from infectious diseases, diseases like autism were unheard of and people that did live to a ripe old age were not chronically ill like they are today. Again, they were not on a Paleo diet.
Now, I do think a Paleo diet is healthy and I used a less strict version myself to successfully reverse an auto-immune disease, but I keep on thinking that we shouldn’t have to go so far (both in time and in extremity of diet). The Chinese diabetes statistic illustrates that and we can find many other examples of chronic diseases that have skyrocketed just in the past few decades, without going back to Paleolithic times. 50 years ago, autism was extremely rare, almost unheard of, again, without a Paleo diet. Kids were eating gluten and cow diary and they didn’t have the current rates of asthma, allergies, autism, auto-immune disease etc. What I’d like to know, is without going all the way to Paleo, what needs to change, so that simply eating the traditional way our not-so-distant ancestors ate (which will allow us to eat a much more varied diet and be able to eat grandma’s traditional recipes)? I do eat almost paleo, but it saddens me that I can no longer connect with my heritage through the food my Eastern European family eats. Yet, those very same recipes kept my own family members in good health.
I feel like we are missing something.
Rob says
Good comment, Liz. I think the reason chronic diseases have become so prevalent in the last 40-50 years is mainly due to the explosion of highly-processed foods many of us now consume. Sure, grandma used flour for baked goods and ate some other things that are probably not all that healthy, but the difference now is that about 80-90% of the grocery store is filled with nothing but highly processed junk foods. Plus we consume WAY more sugar than ever before, along with toxic substances like trans-fats and industrial seed oils. Grandma probably never ate that stuff. So, I think it is still possible to cook and eat many of the things that grandma ate (especially if they are mostly whole-food based), but just be smart about it and avoid all the toxic, highly-processed crap, and you’ll probably be fine.
mda says
Liz, I’ve had the same thoughts. My grandmother born in the 1860’s lived into the 1960’s super healthy and sharp as could be. She was an amazing cook and made everything from scratch. She always tended her own garden, had fruit trees, and in her younger days had her own dairy cow, made her own butter, her own pasta and regularly baked fabulous pies, cobblers, etc. Due to her lifestyle she did get lots of fresh air and reasonable exercise with her daily chores and probably most importantly lived in an era before processed food. But she loved diary products, grain and meat.
Both of her daughters, however, were caught up in the beginning of processed food craze in the 60’s, 70’s and 80’s and both passed away with Alzheimer’s.
My husband on I went on a strict Paleo diet for 6 months and did feel a huge improvement in our digestive system. Health wise, however, we have found we do better about 80 to 90% GF and have brought some diary back into our diet.
But I too think a lot about my grandmother, her delicious fresh food and wonderful home cooking. I can’t help but think the problems our generation and the ones following are faced with is due to the chemical additives in our food plus the high amount of sugar, corn syrup and other environmental factors. Going Paleo forces one off processed food and back to basics, but in time I think experimenting with adding organic dairy or even some gluten back into the diet is reasonable.
Nancy Sutton says
I think Michael Pollan says, if your grandmother wouldn’t recognize it, don’t eat it. And that applies to raw milk; original wheat, that we ate up to the Green Revolution, when the height dropped and gluten rose; fermented foods, including long leavened, natural sourdough breads, etc.; animal fats; vegetables grown on rich soil, etc., etc., etc. But, we have to also remember the scandals in the dairy industry in New York, food adulteration elsewhere, etc., all to maximize profits. Maybe we have to shoot for fair profits, to fix the real problem.
Liz says
Thanks for your reply mda. I personally have found that sticking to goat, sheep or buffalo dairy is fine, but cow dairy isn’t (The whole A1 or A2 casein type issue).
I have read that if you can manage to heal your digestive system, it’s possible to bring gluten back in, as long as it’s traditionally prepared. There is a really interesting article and book on that: http://articles.mercola.com/sites/articles/archive/2017/01/22/how-to-safely-bring-wheat-back-into-your-diet.aspx
Personally, I won’t risk it because the stakes are just too high having suffered with a gluten intolerance for decades and I don’t want to bring back an auto-immune disease, but I do find the concepts discussed in the above article intriguing and I think it would be reasonable to try it if one doesn’t have any major health issues you’re trying to keep in check. I wouldn’t do it any other way though. I think the hardest part is finding out if your digestive system is truly healed or not.
Maria says
Liz and Rob – here is a link that you may find interesting. You are right in that there’s more to health than simply going Paleo. This investigation into the food industry is shocking, and it’s only going to get worse whilst ever people are prepared to shop in supermarkets and eat ‘frankenfood’. How did we ever get to a situation where governments allowed all this scientific intrusion into how we eat? For my money we have paid an inordinate price for convenience. Those of us who elect to get back into the kitchen and only eat real food, are hopefully those who will escape chronic disease. https://www.theguardian.com/lifeandstyle/2015/feb/21/a-feast-of-engineering-whats-really-in-your-food
Alessio says
Great! I’m looking forward to read your new book. I’m craving all you write.
There’s a huge interest behind symptom centered medicine and there’s no need to wonder why. Your book will be really helpful and it will give hope to break down this nasty circle where we are all trapped.
Let’s get rid of interest based healthcare.
chiropractic treatment rockville says
Thanks Chris, for the icredible article. I completely agree with your statement that “conventional medicines will never solve chronic disease”. I also believe that “85 percent of chronic disease is caused by environmental factors like diet, behavior, environmental toxins, and lifestyle”. In the name of career development, achievements we are harming ourselves and harming Environment.
Vivek says
Thanks, Chris kresser, for the informative article. I completely agree with your statement that “conventional medicines will never solve chronic disease”. I also believe that “85 percent of chronic disease is caused by environmental factors like diet, behavior, environmental toxins, and lifestyle”. In the name of career development, achievements we are harming ourselves and harming Environment.
We are detaching from the nature and the environment in the busy life style. We will be healthy when we have an attachment to nature and environment.
To solve chronic diseases completely homeopathy medicines will be the best choice, as homeopathy treats the patient, not just the disease.
Kathy says
PM has some good thoughts, which I will follow with the revenue stream of pharmaceuticals. Any revenue stream that large is the basis for massive investment (read: dependence!) by large retirement funds (federal and state workers are a huge chunk of that). Moreover, health care as a business is not competitive such that a person’s health care on alternative (read: uninsured) care is more expensive than on conventional care. Would love to see a discussion of these matters in your book, Chris!
mda says
Agree completely, the elephant in the room is immense profit from sickness as opposed to little profit from wellness. Due to the greed both in big pharma and corporate owned medical facilities there is no motivation to change. Private insurance has also gamed the system to make huge profit. It seems the overriding culture in the U.S. is to expect and accept huge corporate profit as compared to a system based on wellness and efficiency without emphasis on profiteering.
pm says
The problem with conventional medicine is that it is a business. As long as profit is the bottom line, and it is regardless of whether the doctor is sincerely caring or not, nothing will change to do what medicine is supposed to do: prevent and cure disease. There is just no recurring revenue stream in that medical paradigm.
The solution should be to make medical care a utility. Give doctors a good salary and job security albeit with the strict mandate to do what functional medicine does, which is to address root causes of chronic diseases with natural non toxic protocols and changes in diet that are inexpensive and can be done at home.
Paul Richard says
We can use healthy diet to cure chronic diseases. This is one of the best ways to avoid those medications that have side effects on your health.
Jenna says
I have actually been impressed with my HMO in Seattle (Group Health Cooperative, recently acquired by Kaiser). Group Health covered preventive services long before Obamacare required it. I am able to communicate w my doctors via email, which means I don’t avoid the doctor for fear of a big bill.
All of the doctors I have ever seen there have taken as much time as necessary to talk about my issues. When I told my dermatologist that I thought my skin conditions were gluten-related even though celiac testing was negative, she took me seriously and talked about non-celiac gluten sensitivity with me.
I even had a gastroenterologist at Group Health talk me out of a procedure that he believed was unnecessary and held more risk than benefit. How often does a surgeon do that?
Group Health covers naturopathy, massage, and acupuncture. I have never had problems getting as many referrals as I need for those services.
So far, the takeover by Kaiser hasn’t affected my care. Hoping that continues.
So it’s not all hopeless, Chris!
Becky says
I was given three years of antibiotic in 2005. Started having problem all over my body right a way and told doctor so for 11 years. Now I have a very serious systemic Candida infection that cannot be treated with antifungals and Lyme disease. Conventional medicine failed me badly. I’ve lost all faith. I am a new grandma and only 46. My life if full of pain and I feel I will only suffer until the end. It’s truely criminal!
They will not recognize either condition
pm says
I just registered for The Chronic Lyme Disease Summit 2! You should, too! http://chroniclymediseasesummit2.com/
This summit is free and hosts lyme disease experts in the natural & functional health field. I hope this helps you find a proper doctor. It’s never too late to heal.
Rob says
I completely agree that conventional medicine is a dismal failure at treating chronic diseases. Unfortunately, there are no functional medicine doctors where I live, so I’ve had to resort to doing my own research to help diagnose and help solve the medical issues I’ve had in recent years. A majority of doctors around here do not want to collaborate with the patient at all……in fact they get angry when patients (like me) do some of their own research and ask questions of them based on that research. The current state of health care is really a mess.
treblig says
Rob, I couldn’t agree with you more!! The doctors I have seen for my heart and my diverticulosis were of no help at all. The more questions I asked the more angry they became. I care about my health and don’t mind doing research but I would expect doctors to care about a patient’s questions??? My Gastroenterologist told me that there no cure for my Diver and that there wasn’t much he could do to help me. He told me to eat more fiber. I eventually found that my Diver symptoms were being caused by the things I eat. So I changed my diet and I have been symptom free for years….HE NEVER TOLD TO TRY A CHANGE IN DIET and eating more fiber didn’t help at all??/
My heart specialist (after my heart attack) told me there was nothing they could do because my clogged arteries were too small to stint and too small to bypass. My only option was to go home with all the medications and suffer through numerous severe angina attacks each day. Again, I did extensive research on the internet and have worked my way “completely” out of my angina and have cut back dramatically on all the medications I was told to take. It was diet again!!!
Seems like doctors only care about how many drugs they can get you hooked on and don’t have time to actually try and help you solve your problem. For the most part, drugs don’t fix anything, they usually cause more problems with your kidneys or liver or whatever.
My Kidney specialist told me that my kidneys were only functioning at 75 percent and that it was natural for kidney function to decline as you get older and that there’s nothing that modern medicine can do to stop the degradation. I went to a Master Acupuncturist, he gave me some special herb drink to take for 3 weeks. The next time I went to the kidney specialist my kidneys function was at 87 percent (90 percent is normal). The kidney specialist couldn’t understand how such a thing could happen, when I told him what I had done he had no interest at all….WHY did he have no interest in something that reverses Kidney failure???
Treblig