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The genesis of Wellness Garage came several years ago when I was working at a local clinic. Linda, a 58 year old woman with Type II Diabetes came in to review her lab results and get a prescription refill. In the ten minutes that I had to spend with her, I was confronted with many of the challenges of our current healthcare system. Linda was struggling, she had diagnoses for Diabetes, Heart Disease, high blood pressure, high cholesterol and osteoarthritis. She was on 12 medications, carefully taking them all at various times of the day. She was measuring her blood sugars 2-3 times per day and recording them in a diary that she had me review. The results were not encouraging, her blood sugars were increasing, and I could see from her lab results that this was a definite trend. Linda was doing all that we asked from her as a patient – she was taking her pills and doing her blood work. As her doctor, in our health system, I was about to do my job – increase her meds and order more blood work. This did not feel right. I asked Linda about diet, a major factor in diabetes control. She told me that she was not doing anything different than what she had always done. She had seen the Diabetic Nutritionist but what she was told did not make sense to her, she did not know how to make the changes she was being asked to do, so she did what she knew. When I asked about exercise, another behavior that has been shown to positively influence the trajectory of diabetes independent of diet, Linda pointed to her knee and told me that the pain she gets limits her ability to do anything, so she was not exercising, in fact she was sedentary much of the time. I offered to refer her for physiotherapy but she declined as she had tried that before to no avail. And so as our ten minutes was coming to a close, I increased Linda’s medications and asked her to get more blood work. I left the room, discouraged with myself and the system, knowing that we would be there when Linda had a heart attack, went into renal failure or had a stroke, but we were not going to be there for her today, we were not going to help her prevent these horrible, potential outcomes of her disease. While I am sure that my ten minutes with Linda had little impact on her life, her situation has had a profound effect on mine. Leaving that exam room I began to think more and more about where the health problems that are affecting our society come from. I did not have to dig very far to realize that chronic diseases are the primary driver of cost for our healthcare system, and that many chronic diseases such as Type II Diabetes, heart disease, high blood pressure, stroke, obesity, osteoporosis and many types of cancer were lifestyle related, and can be prevented, treated and in many cases reversed using evidence-based lifestyle approaches such as a predominantly whole food, plant-based diet, exercise, sleep, and stress management. The extent and effect of chronic disease on our society cannot be overstated:
There are a lot of Linda’s out there and the importance of lifestyle factors is irrefutable, yet our current approach is not working. So it did not take long for me to understand where “bad health” comes from, but to understand the right way to address this massive problem, I needed to understand where “good health” comes from. Fortunately, many have already answered this question, and by investigating the determinants of health, many very precise estimates have been made. By immersing myself in this body of work, I came to understand the roots of my frustration after my encounter with Linda. As a physician it is isn’t easy to accept that clinical medicine contributes a small fraction to health outcomes. In fact when analyzed across multiple studies clinical medicine only determines 11% of health outcomes. Social circumstances determine 23% of health outcomes, the environment 7%, genetics 23% and behaviors 38%! Given the extent of chronic disease and the role of lifestyle behaviors in their etiology, this made sense, but there is something more profound at play here. When you look at the inter-relationships between various determinants of health a case can be made to think about health in three domains:
 This interplay of environment, behaviors and genetics drives 68% of health outcomes and it is clearly upstream from our current healthcare system, in that health approaches here offer the potential of prevention and even reversal of disease.  The determinant of health approach should have us rethink our approach to healthcare – clearly we underinvest in Population and Personal health while pouring ever increasing amounts of resources into clinical medicine to treat diseases that could have been prevented in the first place.
Once I made the realization that Personal Health is the future of healthcare, I became very motivated to work upstream from disease and create a practice that is dedicated to preventing and reversing disease. Wellness Garage is founded with the belief that optimizing one’s environment and behaviors while understanding one’s unique genetic and biological system risks is the key to good health. Wellness Garage focuses on six core behaviors:
After each tune-up, we reassess make adjustments and start over. We believe that wellness is a process, requiring an ongoing practice; it is not a goal, a destination or an outcome. We believe that we are all responsible for our own individual health; at Wellness Garage we are here to help you find your own way, not to prescribe medications or one size fits all recommendations. We believe we all need Wellness Practices – a set of habits and behaviors that make us feel better physically, mentally and socially. Finally we believe that wellness is fun!
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AuthorDr. Brendan Byrne Archives
January 2020
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