Young, newly married, in good health, and highly qualified … the world should be your oyster, right? That’s what Dr Thomas Joseph, currently a GP at Invercargill’s He Puna Waiora Wellness Centre, thought. But as he was to discover shortly after starting work as an anaesthesia registrar, nothing could have been further from the truth.
Thomas, who was twenty-five at the time and living in his former home of Kerala, India, was about to receive a devastating diagnosis. Just months after he was married, he started experiencing stomach pain, nausea and what seemed like repeated bouts of gastroenteritis. His first instinct was to attribute the symptoms to his hectic new work schedule and his associated poor diet of takeaways. However, when a bowel obstruction landed him in hospital and resulted in the loss of a significant portion of his intestine, he knew the situation was much more serious.
A subsequent diagnosis of Crohn’s Disease outlined a dismal future; the apparently incurable chronic inflammatory bowel disease would mean a lifetime of battling painful symptoms that could be mitigated only with steroids. However, the ever-increasing doses of steroids prescribed to him only exacerbated the symptoms, as did the advice from health professionals to eat more red meat and move away from fibre-rich, plant-based foods. It was not a future Thomas was prepared to accept, and so began his search for a better outcome
Drs Thomas Joseph with his wife Dr Reen Skaria. Together, they conduct free community-based health retreats in Southland, New Zealand, where they live. They are believed to be the world’s most southern and senior WFPB advocates.
Researching the facts
Having been raised a Seventh-Day Adventist, Thomas was aware of its vegetarian philosophy but wasn’t strictly following the Christian movement’s best dietary practice. Now, with science being of little help with managing his diagnosis, he turned more towards researching the facts behind the faith-based alternative. Gradually, Thomas began making changes to his diet, starting first with eating more fruit and vegetables, then eating only minimal amounts of meat, and eventually eschewing powdered spices. But, although his health improved dramatically, he was still not a complete convert to wholefood plant-based eating.
Then came a shattering relapse. A move to New Zealand in 2004 saw Thomas’ ill health return, with stomach ulcers necessitating more surgery – and more advice to continue eating red meat while avoiding fibrous foods. It was a turning point. This time, Thomas would ditch the steroids and other medications altogether and adopt a wholefood plant-based diet in a much more serious and dedicated way.
Meat and fish were the first to go, then all dairy products. As the beneficial affects were experienced, Thomas would seek out the research that helped explain them. A new job at Otago University was a huge help in this respect, as it gave him access to an academic library and the Internet. Along with his Adventist teaching and access to research at the church’s Loma Linda University in California, it was a valuable combination.
As we now know, it was only a matter of time until the world began accepting the healthy reality of ‘lifestyle medicine’, but it still came as a revelation to Thomas. Despite having grown up with an Adventist minister father who was dishing out this advice to his congregation on a daily basis, his son, it seems, had to go full circle before coming to believe in it himself.
Not all medical practitioners, however, are in agreement with the concept of lifestyle medicine, and even today, Thomas finds himself ‘flying under the radar’ when amongst his peers. Although his own health centre has been fully supportive of him providing patients with lifestyle medicine information he believes will benefit them, it’s not something he would necessarily feel comfortable sharing with doctors in other practices.
In fact, when Thomas presented a paper on nutrition and medicine when working as a medical registrar at Southland Hospital, some staff were outrightly dismissive of it. Even today, Thomas is discreet in offering lifestyle advice to patients – it’s not something he shouts about to the medical world in general.
According to Thomas, the difficulty in achieving mainstream adoption of lifestyle medicine is that, regardless of evidence-based research, practitioners themselves will be reluctant to suggest it to patients if they are not living it out in their own lives.
What is it, then, that sees medical professionals disregard the evidence? Thomas’ answer is short and clear: “Addiction”. If, in order to give out sound advice, one must practise what one preaches, and this practice involves giving up addictive lifestyle habits, how can it ever happen? How can a doctor who is overweight because she is addicted to sugar and oil ask her patient to give up the same? How can a dietician who is addicted to meat-eating advise their patient not to eat chicken and beef?
Even the GP who is practising what he preaches, is up against enormous odds, especially when his patients are drawn from economically and educationally marginalised sectors of the community. Thomas compensates for this by seeking out opportunities where he can.
Opportunities for discussion
“If I’m presented with a patient who’s just had an angina attack or whose blood sugar levels are through the roof,” he says, “there’s a chance they will be a little more open to suggestions of lifestyle change.”
If they are, Joseph lets them know the facts and that it’s their choice entirely as to just how far they can realistically move toward making changes. But with this comes an encouraging piece of news that every patient will want to hear.
“The further you go in making lifestyle changes,” says Thomas, “the more your health will improve. It’s not ‘all or nothing’. Even if all you can achieve is a wholefood plant-based meal once or twice a week, that will still make a difference. Even starting out small can allow your GP to begin cutting back on your medications.”
Unfortunately, food preference isn’t the only barrier to making healthy lifestyle changes. The reality for many, and especially for those who face poverty, mental illness, family violence and housing insecurity, is that mood, time, and economics play a major factor in the ability to embrace a healthier way of life. After all, how many in New Zealand (‘the land of plenty’), unless they are growing it themselves, can afford fresh fruit and vegetables in abundance?
Thomas is the first to acknowledge this and has gone some way towards addressing the social problems his patients face by helping them budget time and money. He has also taken on the role of dietician. One of the ways he’s done this is through offering free cooking classes and short health talks for the community, over the past ten years. He and his wife, nurse educator, Dr Reen Skaria, now also conduct free community-based health retreats in Southland, where they live. They are assisted by volunteers, without whom, the couple say, the retreats could not operate. Despite the fact that running retreats is not their ‘core business’, and that there is much Thomas and Reen are ‘learning on the job’, they are encouraged by the results.
A holistic approach
The 3-day holistically-approached lifestyle retreats take place at Camp Columba in Gore and include easy-recipe cooking classes and short talks on physical, mental and spiritual health issues. Thomas is quick to point out that spiritual health, in this context, is not about a religion but more about relationship, aspiration, contentment, and love. Forgiveness, empathy, and purpose in life are of equal importance, with all aspects of spiritual life impacting physical and mental health. He Puna Waiora Wellness Centre, which promotes the retreats, is instrumental in their continuing, affording Thomas 10 days paid leave a year so he can conduct the classes.
The retreats are not heavily advertised, but word is spreading outside of He Puna Waiora Wellness Centre, and the demand is there despite Southland being one of the more conservative regions in the country.
Southland’s tendency towards conservatism is certainly part of the difficulty of talking ‘lifestyle change’ admits Thomas. “It’s not easy for a meat worker, for instance, or a dairy worker, to hear that the very products they help produce on a daily basis are the cause of their poor health.”
Nor is it easy to dissuade a southern population to lay off the soft drink, beer and wine, in favour of water. But for all that, many patients are willing to make some changes to their lifestyle, and some even embrace, completely, the notion of wholefood plant-based eating. It’s not uncommon to hear the latter say the changes to their diet have completely turned their lives around – weight has dropped off, symptoms have disappeared, and the need for medications has been reduced or eliminated.
But what about those who have already, and for many years, embraced wholefood plant-based eating, along with other recommended lifestyle changes, yet still succumb to serious illnesses such as cancer? Does this negate the positive research Thomas talks about?
“Not at all,” he says. “We are living in a world surrounded by carcinogens. It’s unrealistic to expect we won’t be affected by these. The pesticides on our vegetables and fruit, herbicides in the soil, and household cleaners all destroy the helpful bacteria in our gut biome. When this important aspect of our health is lost, we cannot expect a wholefood plant-based diet alone will protect us. What it will do, however, is reduce the likelihood of illness occurring, (thus improving the quality of life), and extend our lifespan by 5 to 7 years.
For anyone considering adopting Thomas’ lifestyle advice, perhaps one of the greatest catalysts for change comes through the growing understanding of diet and intergenerational epigenetics.
There is much to suggest that a wholefood plant-based diet cannot only switch gene expression on and off in our own bodies but also influence the gene health of future offspring. When young people are already facing an uncertain future in a climate-changing world, what parent wouldn’t choose to give their children the very best start in life?
