This is a question often asked, as Lifestyle Medicine is still a small (but exponentially increasing as the need is so great!) specialty, with relatively few board-certified physicians as yet. It centers on six main pillars as the primary modalities to prevent, treat, and often reverse chronic disease. These pillars are a whole-plant-based eating pattern, regular physical activity, restorative sleep, stress management, avoidance of risky substances, and positive social connection. Medications are occasionally necessary, particularly as a patient is working on the lifestyle choices contributing to disease, but there are few things as enjoyable as de-prescribing medications when they are no longer necessary. 

Diseases are more preventable and reversible than most know. For instance, who knew that just by eating healthier, half of the diabetic patients were able to get off insulin in just days in one study?¹ And in another study, they were able to reverse diabetic nerve damage with diet change alone, within days.²  Who knew that over 90% of heart attacks could be avoided with simple lifestyle changes?³

Georgetown University’s Health Policy Institute found that nearly 70% of Americans take at least one prescription drug, and that folks over age 80 take an average of 22 prescription medications!Indeed, our medical system does seem to be predicated on having “a pill for an ill.” Johns Hopkins recently found that almost half of all social security checks go toward medical expenses.5 A 2021 study found that we spend (by far) more of our GDP on healthcare, yet have worse outcomes than many other Western countries.6

Out of necessity, the new term of “quaternary prevention” has entered our lexicon. If primary care is preventing a heart attack from occurring in the first place, secondary prevention is preventing a second one from occurring, tertiary care would be mitigating the long-term effects of advanced heart disease, and quaternary prevention would be reducing the complications of the drugs and surgeries of all three prior levels.7  

 In the past, many of our diseases were related to malnutrition, but currently the majority of disease is related to overnutrition. The current rate of obesity in American adults is 42% and increasing.8 Something needs to change. We are taught in medical school not to implicate any patient action or inaction as a contributor to the disease process. However this is a disservice to the patient, as it disempowers them and robs them of the chance to participate in their own prevention and healing.

To that end, we will be hosting small group dinners at Blueroot restaurant in Pepper Place, where we enjoy their greenery, learn why they exist and what is their purpose, enjoy each other’s company, and get a brief overview of food-as-medicine. The dinners are limited to 6 participants, so that all feel comfortable conversing and asking questions. Seats can be secured by going to the practice website,

And if more physical activity and social connection is what you need most, I am starting a Walk With a Doc program in Birmingham at Railroad Park. Walk website here: Walk With a Doc is a program started in 2005 by an Ohio physician who was concerned that his patients were not more active. He posted his intent to walk the coming weekend on social media, and to his surprise, 100 folks showed up! Hence the WWAD program was born and has since spread to more than 500 walks in all 50 states and 38 countries!

Noah Gudel, D.O. is an Internal Medicine Physician specializing in Lifestyle Medicine. She is currently accepting patients in AL, FL and TN and is available for in person or telehealth visits. Visit to learn more and schedule a consult.





  1. Anderson JW, Ward K. High-carbohydrate, high-fiber diets for insulin-treated men with diabetes mellitus. Am J Clin Nutr. 1979; 32(11) :2312-21.
  2. Crane MG. Sample C. Regression of diabetic neuropathy with total vegetarian (vegan) diet. J Nutr Med. 1994;4(4):431-9.
  3. Yusuf S, Hawken S, Ounpuu S, et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-controlled study. Lancet. 2004;364(9438):937-52.
  4. (accessed 2/3/22)
  5. (accessed 2/3/22)
  6. (accessed 2/3/22)
  7. Gofrit ON, Shemer J, Leibrovici D et al. Quaternary prevention: a new look at an old challenge. 1st Med Assoc J. 2000;2(7):498-500.
  8. (accessed 2/3/22)
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