For 30 years, Lillie Rosenthal, DO, a Manhattan, NY, based Integrative Medicine Pain and board-certified Physical and Medical Rehabilitation physician, specializes in a unique approach to the prevention of injury and pain management. Her combination of integrative and osteopathic expertise has transformed patients' lives. Dr. Rosenthal says that a thorough history and physical examination along with a non-pharmacological approach that focuses on lifestyle medicine and a whole-food plant-based diet are major healing aspects of her approach.
Q: Can you please describe your lifestyle medicine approach in your clinical practice?
Lillie Rosenthal, DO: As a DO physiatrist for 30 years, I chose my career in osteopathic medicine because I believe that an integrative approach to medicine is always best when solving health problems. Patients seek me out because I am an osteopathic physiatrist, and people have a need for an integrative clinician in order to connect the dots and see the whole picture.
The typical patient I see in my practice is someone in pain—musculoskeletal pain, neuropathic pain, migraines, etc. —and they are not coming to me for drugs or medications. The conventional path to treating pain is with medications and procedures to address symptoms. I treat pain with zero (or very rarely) medication. I have a non-pharmacological based practice. I uncover the patients' issues through a thorough medical history and physical examination, and I get to the root cause(s) of where the pain is coming from.
Pain is a signal that something is out of balance. So I carefully explore what physical anatomical structures are involved as well as the lifestyle behaviors the patient follows. I obtain 99% of the information I need from the history taking regarding diet, stress, posture, exercise, tobacco and alcohol use. That is how I discover the multifactorial factors contributing to their issues. As an osteopathic physician, I am experienced at taking a deep dive to determine what structures are involved with the pain. I then partner with patients to determine how they can optimize their health through food, exercise, stress management, sleep, and vice and device management (too many screens).
Q: When did you become interested in the importance of plant-based diets for health?
Dr. Rosenthal: As a medical student, whole-food plant-based nutrition courses were not taught, and this is an irresponsibility of medical training. We know from the science that food is the master key to better or worse health. Medical schools, however, typically haven't given attention to this in their curriculum even though it is a major factor in preventing and treating chronic disease. Fortunately, this is changing and some schools are now getting on board with this very important aspect of medicine.
Often patients have comorbid conditions such as diabetes and autoimmune disease who come to see me, often their lives are changed through changing their diet. I've been a vegetarian for many years, educated myself on the science, read many books and seen films, and attended medical conferences addressing these issues. I dive into the solid data that obesity and diabetes continue as epidemics and a food as medicine approach is how we can best help our patients.
Q: What is your plant-based prescription for pain? What does this include?
Dr. Rosenthal: One of the most powerful prescriptions we have for patients is to prescribe a whole-food plant-based diet. I have a prescription pad and specifically write that patients should consume more fruits, vegetables, beans, nuts and whole grains, and stay away from or minimize consumption of animal based and processed foods. Many are not aware that all products that are vegan may not be good choices, because they are overly processed and unhealthy. I'm following the gold standard of health when I write this prescription for patients. I work with my patients, and emphasize that there is no better prescription than food.
To Contact Dr. Lillie Rosenthal
Lillie Rosenthal, DO
Physical Medicine and Rehabilitation Physician
Integrative Medicine Pain Specialist
Manhattan, New York, USA
Website:
https://drlillierosenthal.com/
E-mail:
drlillierosenthal@gmail.com
For pain patients that I see, I explain that food can have potent inflammatory effects or anti-inflammatory effects, so we must choose wisely. Patients with muscle and joint pain respond very well with my literal prescription for food. There are so many examples of patients improving. I have treated professional dancers and athletes who were recommended by their coaches or other professionals to eat more meat and protein, thinking this would help their performance. In fact, they suffered injuries and inflammatory problems. When I suggested a whole-food plant-based diet, which they adopted, they experienced reduced injuries, more energy and better digestion. This change made a dramatic impact for these high level performers. It is very rewarding for me and for the patients.
Q: Do you find that there is patient compliance with this program or are there any challenges?
Dr. Rosenthal: There are challenges, and yes, people do comply. It may seem radical to some people to change their diet in this way, and therefore, the challenges are real, and people need support. The Standard American Diet (SAD) causes a lot of disease and the challenges are significant because a whole-food plant-based diet is not mainstream. The science agrees with this diet, but the culture is slow to change.
It is difficult, for example, for people to make changes especially if friends and family members are following different dietary patterns. It is not easy on the behavioral change side; however, with my support I can have a significant impact on patients' food choices. I often recommend a two-week challenge for eating clean and plant-forward. After the challenge, many people say they feel better and the food tastes good. Not everyone complies, but I plant seeds for the future. Community support in the dietary change area is very important.
There is a misconception about healthy food being expensive—the more we can align ourselves with nature the better we do. We need to break some of these myths. Communities that are taking agency of their own health and food choices are the foundation for feeling and functioning optimally. Support groups, community meetings, local organizations and/or aligning with a family member or friend helps make the changes easier. I sometimes suggest that people order in plant-based foods for a while to get a sense of the diet. The biggest challenge for many is not knowing what to buy and cook, so I recommend cookbooks for ideas.
Q: Are there any patient groups that would particularly benefit from this plant-based protocol?
Dr. Rosenthal: Everyone would benefit from this approach! The best group to influence is children who have the opportunity to live their whole life optimally and help prevent disease. On the other hand, it is never too little or too late to make changes. I work with my senior population in helping them to understand that there are so many foods that can help or harm them. From an epigenetic standpoint, food is information for our cells and can literally switch on and off our genetic predisposition for disease. At any entry point/age we can make a difference. There are even modifiable risk factors for COVID severity symptoms including food, which can support a healthy body and mind.
Q: Can you share your insights on any top beneficial foods of note for clinicians to consider recommending to patients?
Dr. Rosenthal: The ones I mentioned above. It is important to focus on whole-foods that are plant based. When clinicians consider talking with patients it can sound so restrictive. I tell my patients, however, that you can eat more food—more vegetables and fruits. Most people are eating too much of the wrong things and not enough of the right things. This presents an opportunity to help people focus in the right direction. If a person doesn't like broccoli there are so many other vegetables—I recommend that patients focus on the foods that they like. We have an emotional and physiological reaction to food, and therefore, people should choose the foods that they prefer. The goal is to get people to enjoy what they are eating. The body wants to eat healthy foods; however, we are addicted to many unhealthy foods that are not supporting our mental and physical health.
The bottom line is that we are talking about behavior change. In order to have an impact I have to make practical suggestions. For example, I recommend the foods that I eat to people and ask what they enjoy. The best way to eat healthy today is to go food shopping in advance so that one has the food around them at home so they aren't reaching for less healthy items. As a supportive partner with my patients, I know I have impact because people do make changes. Clinicians often feel that patients won't make such significant changes, but that is just not true. In follow-up visits, I ask patients how they are doing, what are they eating and write and refine a food prescription again. Clinicians have a lot to cover in one visit and yet, they should not underestimate the impact they have on people's lifestyle choices.
Q: Are there any recent developments or initiatives in nutritional medicine in clinical practice that may be beneficial for patients?
Dr. Rosenthal: Yes. There is a passionate movement of plant based physicians who have had impact in nutritional curriculum for medical students. Michael Greger, MD, is a well-known plant-based advocate who is a wonderful resource. His website is packed with all types of important information (https://nutritionfacts.org/). There are many initiatives that are increasing around the country such as programs in New York to help people grow community vegetable gardens and move toward plant-based eating. One of those programs is called “Plant Powered Metro NY” (www.ppmny.org). There are also a growing number of plant-based physicians who are advocating about the importance of plant-based health. There is a Cornell University nutrition course and many other available courses for clinicians as well as increasing numbers of conferences. The ACLM (American College of Lifestyle Medicine) has a plant-based focus and is another good resource. My main role as a physician is to treat my patients effectively and responsibly; with the least amount of side effects. I also share the importance of plant-based eating through articles and my podcast “Power to the Patient” (follow the Spotify link on my website) where I interview people who made it a priority to pivot towards better health with lifestyle changes, and I talk with them about their victories. With about 80% of the people I interview, it is about food and changing one's diet.
Q: Is there anything else you would like to share with our readers?
Dr. Rosenthal: Do not underestimate your impact as a clinician or practitioner to help your patients change their lifestyle habits and behaviors including a whole-food plant-based diet. Next, focus on lifestyle changes first. When patients present with health issues, listen to and examine your patients. Finally, stay healthy yourself through self-care and healthy lifestyle choices because this has been scientifically proven to positively affect the health of your patients. We have science as a guide to optimize patients' chances of preventing and managing disease, injury, and pain. The information I have shared must be a priority in patient care. Finally, plant-based eating has a huge impact on improving climate change, so this is good for people as well as the planet.▪
