San Diego Doctor Helping Patients Drop Weight, Medications

MAUREEN CAVANAUGH: This is KPBS Midday Edition, I am Maureen Cavanaugh. It is advice many people hear from the doctors. Lose weight, improve your diet, and exercise. People hear it over and over and over again, as their weight continues to go up and health problems continue to increase. What if your doctor was also your workout partner, met you at the gym, and traded healthy recipes with you? That is the unusual approach taken by one Scripps internist, Doctor David Clayton. He is taking his medical advice about living a healthy life style out of the clinic and into the workout room. Doctor David Clayton is the director of the Clayton M.D. total health program. Welcome to the program. DR. DAVE CLAYTON: Thank you, Maureen. MAUREEN CAVANAUGH: Joining him is one of his patients, Paul Fanfera. Welcome to the show. PAUL FANFERA: Thank you, Maureen. MAUREEN CAVANAUGH: When did you realize that telling people to lose weight, exercise, and see you six months later was not enough? DR. DAVE CLAYTON: This came about two years ago when I was hearing a complaint from patients saying I'm really getting frustrated at the fact that even though I have put my best effort into exercising more and eating better, my blood pressure is going up and cholesterol is going up. The typical response from a doctor, you're absolutely right, is to say do more. Eat better, exercise, go buy a book, get a trainer. But it is hard to translate that vague advice that you get every 4 to 5 months from your doctor into something meaningful, and to move the needle on your health. I have always been into this. I try to eat well myself. It was around two years ago that I began see my blood pressure and cholesterol go up. If it is so hard for me to put this into fact is, as a trained professional, how can I expect the average person to get the same results I expect? Research says we should be able to dramatically reduce blood pressure, cholesterol, blood sugars, and lose weight, if we are doing the right things. MAUREEN CAVANAUGH: So what happened to you, even though you are fit, you found detrimental health effects, even after years of working out, and you thought you were eating correctly? DR. DAVE CLAYTON: Exactly. At age 20 or thirty, it is very easy to out train your diet. We look at weight as a proxy for health. If you restrict calories, exercise more, and our bodies will work better and we will feel better. But the reality is, the body is a complex industry set. We can adapt to aberrations in our diet, even if we are thin, for so many years. At forty, fifty, or sixty, all of those metabolic abnormalities catch up with us, and even then people and up with hypertension, and diabetes. And they end up with revascularization. Certainly we know that thin people are still subject to cancer and Alzheimer's. Or conditions that we know to be related intricately to diet and lifestyle. MAUREEN CAVANAUGH: I want to talk about the diet aspect of your program in a moment, but I'm interested when, where, and how you actually started working out with your patients. DR. DAVE CLAYTON: The story of this is really of one individual that I was able to thankfully convince to meet me in the parking lot about two years ago, for an early morning workout. I was having this conversation with him, he said he lost 50 pounds, three times, on weight loss programs, and yet he is sitting in front of me with the weight back and on blood pressure medications. We are talking about a great gentleman in his mid-fifties trying to do everything right. I talked him into coming to meet me in the parking lot for an early morning workout. He agreed, and we started working on the fitness. I followed his diet and saw exactly what I thought we could see, which is that all of these metrics would start moving in the right direction. I talked to other patients, into joining me, we moved from a parking lot into a gym and another gym, and in four months we opened this as a standalone center, trying to take these best practices and translate them into a physical environment that you could make a part of your lifestyle. MAUREEN CAVANAUGH: Paul, as one of Doctor Clayton's original workout patients, did you know what you're getting yourself into? PAUL FANFERA: I didn't. All I knew was that I was tremendously overweight, and very uncomfortable. I needed cholesterol medication, blood pressure medication, I am sixty-seven. I was in the bad part of the gene pool, in my family, for heart disease. When he asked if I could vote a few hours a week to working out, I jumped at the chance. How often do you get the chance to work out with your doctor? MAUREEN CAVANAUGH: What was more challenging? Working out, or changing your diet? PAUL FANFERA: Tending the diet was actually easy. There was about a month transition, especially with breakfast. I carb loaded every breakfast. That took a little getting used to, turning it into a protein event as opposed to carbohydrates. After that, it all got easy. What we are doing Beasley does not involve counting calories, it's just eating meat, fish, vegetables, fruit and nuts. MAUREEN CAVANAUGH: What results have you seen? PAUL FANFERA: In a year, I lost 45 pounds. MAUREEN CAVANAUGH: That is good result. PAUL FANFERA: My waist size went from 40 to 32. This works. I have been able to maintain that in the second year I have been in this. MAUREEN CAVANAUGH: It sounds as if the diet aspect of this program is something along the ilio diet. With a heavy emphasis on protein is that right? DR. DAVE CLAYTON: It's similar to patio, But rather than emphasizing protein, it's looking at what drives beneficial health within the construct of the ilio diet. If we look at shelves full of different diets and different ways of approaching attrition, it is overwhelming. What we want to do is make it actionable and easy to implement, so that two years later, Paul is still following good nutritional principles, and it is easy for him the way that he says it is. The patio diet in itself is a framework for nutrition is incredibly validated. It really underpins everything that we know about nutrition. You and I all evolved in the natural habitat and returning to that habitat solves a lot of metabolic problems. MAUREEN CAVANAUGH: What results have you seen from the patients? A lot of them have lost weight, What else has happened? DR. DAVE CLAYTON: I look at the whole person looking at the nutrition and fitness program. When I look at what we can influence by diet and exercise, about 70% of chronic disease or problems that we take medications for as we age, it runs the gamut from high blood pressure, high cholesterol, blood sugars, and looking at disease mentioned down the road. But metrics really come down to the metabolic indices that we will talk about at the annual physical. Blood pressure, cholesterol, blood sugar, and the waistline. Those of the metrics we know will translate to better health down the road. MAUREEN CAVANAUGH: I think I am right in saying that not all medical community agrees with you that diet and exercise alone can control things like high cholesterol, or diabetes. Or can protect people from Alzheimer's disease. Where do you see yourself in the medical mainstream? Or do you see yourself as an outlier? DR. DAVE CLAYTON: I would like to say that I am at the forefront of what I hope to be a transition that really starts to embrace a comprehensive approach to patient care, that we are not looking at the doctors office, and the gym or fitness center, as being different sides of the town. That you will get a different level of care at each place. And we will start to appreciate the fact that there is a formula to good health. That formula right now is, to a large extent, locked up in the ivory tower. If I look at the research published last year, There were literally over 40,000 research articles that referenced fitness or attrition published in the last twelve months. How are you going to get access to that information, sort through it, figure out what really matters to your health? You only see your doctor every 6 to 12 months. It is not part of our medical training. I am trained to give you medication when I see you, and I'm only allowed 8 to 10 minutes to make a diagnosis and treatment adjustments. To take nutrition and fitness information and translate it into a program you can work with, that's where pioneering comes in, something that is currently on the fringe of where medicine is going. MAUREEN CAVANAUGH: To make an appointment and see you for eight minutes in the clinic, that is covered by insurance, but to join your program, that is not covered. DR. DAVE CLAYTON: No, and I think fitness now is to a large extent paid out of pocket. It is something that we used to get paid to exercise when we were doing manual labor, and now we have to pay to exercise. Unfortunately, it is the way that life has come. We are all behind our desks. I look at this as replacing what you would ordinarily be spending on trainers, gym memberships, books, and other things that we put in to keeping our bodies healthy. It's an investment we all make already. MAUREEN CAVANAUGH: How is Doctor Clayton as a coach? PAUL FANFERA: He's great. He's easy to work with. Last earlier whether it was a difficult transition in terms of exercise, it was not. In fact, what is easy about it, as an older person, I'm not in a gym with a bunch of twenty and thirty somethings. Who are looking over in the corner at the old fat guy trying to take off a couple of pounds. Together in a group, We are sharing the same age range, between mid-50s and mid-eighties. Doctor Clayton has meted very comfortable with a couple of trainers who come in and focus on balance, flex ability, and so forth, as well as weight loss regimens. The whole thing is very comfortable, very easy to work with it. You make friends and comrades. MAUREEN CAVANAUGH: Do you maintain your practice at Scripps? DR. DAVE CLAYTON: I do. Almost 50-50, between traditional clinical practice and working in the fitness center. MAUREEN CAVANAUGH: It sounds to me as if what you are saying is that you expect to see more of this kind of hybrid approach, whereas you do not often go in one direction or the other. You stay with what medicine can do for you. But then, you also take that responsibility on your own, guide its by someone in the medical profession. DR. DAVE CLAYTON: 100%, I would love to see more of this coming from all different areas. If I look at what we have been able to accomplish with our first group of persons, about a third of the people who participated out of our first group over the first 2 to 3 months have dropped at least one medication for disease. It is small numbers and anecdotal data, but when I compare that to what you can get at the average fitness center, I do not know there are any other places where you can follow a structured program and expect to see measurable improvements in health the way that fitness and nutrition should. MAUREEN CAVANAUGH: Will you be presenting this data in a paper? DR. DAVE CLAYTON: I would absolutely love to. I think what the world suffers more from is a lack of education than a lack of data. I think that we have probably got enough data to publish a small trial or at least in attic total study. More importantly, I think it is reaching into what is already established, and proven already, and delivering it into the hands of Paul and other members. The research is already out, we know what it takes to lower blood pressure 20%, with diet and exercise. The question is, will Paul know how to implement that on his own? MAUREEN CAVANAUGH: My last question, how does somebody get your book Clayton M.D., total health program? DR. DAVE CLAYTON: It is on Amazon, it is freely available to anyone. It is the same diet program that I prescribed to my members, and that Paul follows. It outlines the Palio diet as mentioned earlier, but the common mistakes that people make within any diet, that account for a lot of failures. When we look at things that drive health outcomes, it really comes down to a few metrics. That is what I was on. MAUREEN CAVANAUGH: Thank you very much for speaking with us.