Introduction:
Lifestyle Medicine is most meaningful and inspiring when adopting its principles brings dramatic improvement in health and wellbeing. This is especially so when a fellow medical practitioner discovers this transformational potential. I have personally known Michelle since she was a baby, and have had a keen interest in her professional development, in her enthusiasm for life, and her willingness to accomplish the extraordinary. I am happy to share with you.
BIO
Married with 3 children. Loves nature, diving, water-colour painting and more recently, whole food plant-based eating and running. Stellenbosch graduate – Undergrad (2007) and Family Medicine (2014). Clinical manager at Madwaleni Hospital in rural Eastern Cape (2015-2018). Sub-district Family Physician in Theewaterskloof 2019-2020. Family Physician at Helderberg Hospital 2020 to present.
DG: Hi Michelle, please share some of your background.
MA: I was born in the Eastern Cape in Cradock to teacher parents. I’m the only daughter of four children.
DG: What inspired you to study Medicine?
MA: My maternal grandparents were both doctors, and I grew up listening to stories of them working in Mount Ayliff in rural Eastern Cape and later in Cradock. I wanted to help people. However, the career guidance counsellor said I was too sensitive to practice medicine. My two older brothers studied medicine, As I didn’t want to fit into a mould, I started studying a BSc, majoring in psychology. I loved university and did quite well. Halfway through my first year, I decided to apply for medicine – obviously to help people, but also because someone told me I couldn’t!
DG: What field of Medicine have you chosen?
MA: As a student and intern, I always enjoyed everything I was busy with at the time. After being put off obstetrics as a student when my first delivery was a macerated stillbirth, I even found a love for obstetrics as an intern. I had dreams of becoming a rural doctor and serving communities where the need was the highest. I considered doing obstetrics and making massive improvements in antenatal care. I thought about ophthalmology, and doing cataract surgeries in remote areas to help people see again. I also loved surgery and anaesthetics and paediatrics and …. I realised that I loved it all and didn’t want to narrow my options. Then, one day, during community service, a friend of mine contacted me and said they were looking for registrars to do family medicine. I thought and prayed about it. At that time, I also had my first daughter. I decided maybe family medicine was a good direction, as I could still do all the different things I loved, and have colleagues who understood context and family well.
DG: Share some of the insights you gained working in rural Transkei.
MA: There were so many things, I’m not sure where to start answering this question. As my registrar time was coming to an end, I realised we could finally go anywhere we chose. Our programme head, Julia Blitz, suggested that I consider the rural Eastern Cape. I contacted Dr Gio Perez, who was working in Mthatha at the time. He suggested a few hospitals for me to think about. My husband, Darren, and I took our two kids on a road trip to visit some hospitals. I was blown away by the beauty of the Wild Coast. Visiting Madwaleni Hospital felt strangely like coming home. The raw, untainted beauty was starkly contrasted with extreme poverty, unemployment and lack of basic services: water, electricity, roads, cars, and jobs. This was an opportunity for our family and kids to be free range – clear air, unspoiled beaches, homeschooling, climbing trees, trawling rockpools, and kayaking rivers. It was a time of realising the importance of community and friends. Living, working, churching and doing life with colleagues, brought together from many walks of life, allowed us to form lasting relationships with special people. The sense of mission that we shared gave a purpose bigger than ourselves. Wherever we went, there were bright beacons of positivity and hope. So many inspiring people who wanted to help and make a difference despite limited resources. This led to unique opportunities to develop solutions. The adventure of working with so many incredible people and knowing that every improvement made a difference to many made it an exciting, memorable, and missed time.
DG: What has been your experience as head of Helderberg District Hospital Emergency Dept?
MA: I have been blessed to work at Helderberg Hospital in a functional system and with a supportive team. It provides opportunities for perspective and balance, and the development of skills across all disciplines and in the community. I am still challenged to develop innovative programmes with the team. I am reminded how much of what we see clinically is driven by lifestyle behaviours, particularly diet and substance abuse.
DG: What has inspired your interest in Lifestyle Medicine (LM)?
MA: About 2 years ago, I started watching some documentaries, like “Blue Zones” and “You Are What You Eat”. Around the same time, my second-oldest brother, Jonathan, was visiting from the U.K. He has always been extremely fit and healthy. I remember him making his own soya milk when I was a kid. The day before he was due to return to England, he had a massive bicycle accident that broke his back and ribs in multiple places, and meant he stayed in South Africa a little longer. I bounced off him some of my thoughts around what I had been watching. He suggested I listen to the Zoe Science and Nutrition podcasts. It kind of grew from there.
DG: Do you feel that your training in Family Medicine has given you all the tools needed to practice LM?
MA: There are many areas of overlap between Family Medicine and Lifestyle Medicine. Family medicine trains us in brief behaviour-change counselling, in understanding the individual in context as part of a family and community, but also trains us in community-oriented primary care (COPC). This is a fantastic overlap between public health and primary health care. We should focus more on Wellness instead of primary care – prevention rather than management of diseases. Evidence-based practice is another tool that both family medicine and lifestyle medicine emphasise.
DG: How has your journey been?
MA: My journey has been fun. I became a whole food plant-based convert and started implementing these changes in my life. I’ve lost 20 kg over the last 2 years and started doing resistance training and running last year. The results have spoken for themselves. I love to lead by example. I can’t ask or expect others to do what I am not doing myself. In my workplace and at home, I am also constantly reminded that people are responsible for their own lifestyle decisions and need to take responsibility for their health and wellness. The old saying, “You can take a horse to the water, but you can’t make it drink”, stands true.
DG: It is always challenging to share one’s enthusiasm with the rest of the family. Share your experience.
MA: As I mentioned above, I try to share by example. My husband and kids are quite a good example of how tricky it can sometimes be. When I stopped stocking junk food in the house, the kids were “inspired” to ride their bicycles to the local garage store to buy junk food with their own money. I do hope they are learning by my example, though. Last year, during a “Weight Warriors” programme at our hospital, my youngest, Jessie, decided to start a business selling the breakfast jars I had started making for myself. For a while, I was supplying some of the staff with healthy, whole-food, whole-grain breakfast jars. My husband was a bit more supportive and would happily eat the food I gave him – and more. A couple of months ago, my husband was diagnosed with Type 2 Diabetes. I duly went with him to the GP and listened to the explanation of what an HbA1C of 8.1 means. I accompanied him to the dietician (whom I emailed beforehand to give a heads-up on going with whole food plant-based suggestions if she wanted my buy-in). He then started listening to the podcasts I sent him and stopped the late-night snacking, cut out sugary drinks, and most of the ultra-processed foods. He increased his exercise and in about 2 months has lost 10 kg and dropped under 100kg for the first time in a while. (Without Ozempic).
DG: What benefits have you enjoyed from adopting behaviour change?
MA: There are innumerable benefits. I have more energy, my weight is normal, and I have started running (which I’d never really done before). I’m feeling well and healthy. What a blessing!
DG: Have you been able to incorporate any of what you have experienced into your patient interactions?
MA: Often! My team regularly chuckles to themselves when they overhear me talking with a patient about lifestyle.
DG: How have your colleagues responded to the new “you”?
MA: In general, I think they are proud of me and often want to know what to do. I look forward to taking them with me on my Lifestyle Medicine journey.
DG: How do you see undergraduate and even post-graduate training changing to incorporate LM in the future?
MA: The truth and the evidence must be explicitly, repeatedly, and emphatically shared with them. In many cases, taking tablets is like putting a plaster on an abscess. A revolution is needed. We should be in the business of Healthcare and not Disease care.
DG: Working in a Public Hospital, how do you view the incorporation of LM into state health services?
MA: I think the Western Cape Department of Health has taken great strides. They changed their name a few years ago to the Western Cape Department of Health and Wellness. They now need to change their practice by getting Public Health policies on board to help make the healthy choice the easy choice for everyone, especially the most vulnerable, where the social determinants of health play such a massive role.
DG: What are your views on needed regulations and policy changes to reduce NCD’s (Non-communicable diseases) in South Africa?
MA: I think the taxes and regulations on unhealthy foods should be massively higher – a similar campaign to the anti-tobacco efforts years ago. Ultra-processed foods, sugary drinks, etc., should not be cheaper and more readily available than whole, healthy foods. Alcohol in particular should not be so freely available. The cost to society, healthcare, families, and communities of harmful alcohol use is far, far higher than the revenue from alcohol.
DG: Is LM implementation accessible to all socio-economic sectors of society?
MA: Yes. It needs to be actively driven and education provided. Many aspects of LM are inexpensive and easily available in rural areas plagued by high levels of unemployment and poverty.
DG: Share your views on how this can happen in the more financially constrained areas of society?
MA: The cost to people and their families, and the healthcare system, of diseases of lifestyle, is exorbitant. Obesity, hypertension, harmful alcohol and substance use, diabetes, cancer, autoimmune conditions, violence, and so much more are directly the result of lifestyle. These are some interventions: Encouraging more home vegetable gardening can improve nutrition; alcohol use/sale curfews or bans, similar to during Covid; Spaza shops should have cheap whole foods available; and if ultra-processed junk food must be present, it should be at ridiculously high prices. That way, the educated rich can choose to be unhealthy, but for those with little choice and means, make the healthy choice the easy choice.
DG: Thank you, Michelle, for sharing your inspiring experience and insights. This powerful story encourages all of us to share what we know about LM and to advocate for change.
Michelle’s Breakfast Jar ingredients:
Oats groats (Steel-cut Oats), whole sorghum, amaranth, teff, cinnamon, apple, dates, cooked in the Instant Pot.
Added to that: chia seeds (sometimes mixed with apple sauce/ macadamia milk), mixed seeds, a variety of nuts, chopped seasonal fruit, and some more cinnamon.
Sometimes plain yoghurt.
The more different healthy ingredients I can pack in, the better!
Dr Michelle Allen
MBChB, FCFP(SA), MMed (Fam Med)
Dr Dave Glass
MBChB, FCOG(SA), DipIBLM