Thanks for your interest.
I'd love to share more about my background and why I've come to the conclusion that we can do better in medicine and offer more options for health than pills and surgery alone.
Supporting Lifestyle Medicine Practice in the UK
The bigger picture
Throughout medical training I've been fascinated by the insights gained from standing back from the science and current practice to understand the bigger picture. As a medical student at Oxford, an additional course in the history and philosophy of medicine introduced the concept of scientific revolutions and the paradigms we inhabit in research and healthcare. These paradigms or "ways of thinking" often define the questions we ask in research and approaches we take to delivering healthcare - one of our current paradigms is to ask "what pill treats this disease?" and at times, to risk over-valuing the role of genes in health outcomes in a paradigm of so-called "genetic determinism". We now know that gene expression can be significantly changed through epigenetic mechanisms that are impacted by lifestyle factors such as what we eat, the stress we experience, our sleep and how active we are. During my undergraduate training, I had the opportunity to take an evidence-based critique of alternative health care and a deeper dive into the role of shared-decision making in health; this was an incredible opportunity to explore the diverse ways we've tried to improve health over the millennia as disease and healthcare challenges change. We've moved from being primarily threatened by infectious disease to now being threatened by diseases driven by environmental, social, commercial determinants which in turn drive lifestyle behaviours. As a student and junior doctor, I was able to experience many different health care systems, cultures and paradigms from the UK NHS to Australia, South Africa, India, Ghana and Eastern approaches in Japan and South Korea. There is so much to learn from how we all try to address health across the globe and the common challenges of being human.
Becoming an expert generalist
I come from a family of GPs, growing up across the road from my father's GP surgery meant I saw first hand the vital community role that a family doctor plays and the exhaustive toll it took on his own health. These were the days of long weekends on-call when the phone would go at home and he'd be off late into the night. These were the days of patients coming to our home, including a memorable visit from a bridal party following a very unfortunate but luckily inconsequential road traffic accident on the way to the church. I'm one of seven children, five siblings are also NHS GPs, the other two made their escape into teaching. I've always been driven to be a generalist doctor - someone who can support the whole person, not just a small part of us - I can't see the point in perfect kidney function if the rest of the body is unhappy and sick. I wanted to be a doctor who could integrate complex and wide ranging issues from the existential to the mundane, from urgent to routine and from cradle to grave. It's been a wonderful journey of life-long learning; not knowing who and which problems will come through the door and the constant challenge of insufficient time and resources. I continue to train and encourage doctors to become GPs, it simply is the best vocation. Uniquely, I believe, it is the one medical specialty that will be critical to get the best for patients out of AI health tools of the future. Whilst these AI tools can often provide support to bring the latest technical medical knowledge to our finger-tips, integrating the nuance, complexity and values of real human lives through longitudinal relationship-based, generalist care will require expert generalists; this complexity is precisely our thing. Whilst the growing pressure of NHS primary care have at times been unbearable and distressing, they've also forced me to think outside the box. We simply can't continue as we are. People are sicker, there are more of us, we are ageing, our environment and economic situation is deteriorating. This is all happening whilst healthcare seems to be driven more by the influences of those who profit from the sick than those who care for them; pharmaceutical companies, tech companies and the modern medical system which can sometimes be stuck on a focus on pills and surgery when the evidence is clear that today's long-term conditions are driven by commercial, and socioeconomic factors such as poverty, air and water pollution, poor access to safe green spaces or healthy food which drive lifestyle factors such as eating poor quality food, smoking, alcohol, isolation, inactivity, poor sleep from shift work and even impacts of harmful tech use.  These issues are best addressed outside of medicine with strong collective policy action and public health measures. However, when these have failed, and we meet people in healthcare, scientific evidence suggests we can offer more choices through lifestyle interventions as well as medications and surgery.
Metabolic health, mood, food and too many pills
As a GP partner in a large market town in Oxfordshire, I developed an interest in metabolic health. I'd taken on the retired senior partner's list of patients. He'd had an interest in Type- 2 diabetes. Most of the people I saw day to day as a full-time GP therefore struggled with obesity, high blood sugars, unhealthy lipids and nearly all seemed  to report low mood and fatigue. The people I met also had in common a phenomenon of so-called "polypharmacy" - medical speak for too many pills. So many pills, the evidence suggests, that this in itself could also be adversely affecting their health. I was shocked at the number of people with repeat medication lists going up to 15 a day. However, I enthusiastically embraced this medication driven approach, going on a pharmaceutically funded insulin titration course and sharing these new found skills with patients whose blood sugar numbers went down beautifully whilst their weight and fatigue went up and satisfaction in my approach definitely dropped. Shortly after, I was lucky to be part of the team delivering the DIAMOND trial at Oxford University lead by Dr Elizabeth Morris - a small trial protocol to test feasibility and acceptability of a primary care delivered intervention to support people to change the food they were eating to treat Type-2 diabetes. At the time this approach was ground breaking, the concept that Type-2 diabetes could be treated, let alone put into medication free remission, was not yet accepted (some would say cured rather than in remission, although our risks remain life long and it returns if lifestyle changes aren't maintained). My role as the doctor was simply to take people off all the medications I'd been enthusiastically prescribing whilst the amazing nursing team and patients did the real work of addressing what turns out to have been some of the root causes for many people; food quality, quantity and timing. The individual results for some people were incredible, I'd never experienced supporting people with disease remission before - I'd been taught that Type-2 diabetes was chronic and progressive and to prepare all patients for the eventuality of a lifetime of insulin injections. It seemed that through simply supporting people to change the quality and quantity of the food they were eating that people were losing weight, their blood pressure and sugar was dropping and all with fewer medications. Most importantly people were describing improvements in mood, pain and energy - issues that really speak to what matters most to people, in my experience. Not everyone saw these improvements, but where they did, the results were wide-ranging. At the same time, I met a number of patients who had read the late, great Dr Michael Mosely's work (The 8-week blood sugar diet, Fast800 etc.) and made their own changes. At the time, I was alarmed to hear that they had stopped all their medications, stating they had "cured" their Type-2 diabetes. My scepticism was misplaced, as on checking their bloods and listening to them more carefully, they had indeed done this themselves. I also met a patient who was concerned about recurrent fungal infections, fatigue and thirst and had very high blood sugar levels which when repeated confirmed Type-2 diabetes. Unusually at the time, I asked what they were eating and drinking only to discover they were quenching their thirst with litres of Lucozade resulting in consumption of over 10 times the recommended daily sugar allowance. We explored cutting this out and just drinking water and within a month their blood sugar was completely normal and they felt well - I was astounded. I couldn't believe this type of "acute glucose toxicity" existed and that such high sugars were so easily reversed. If I hadn't explored their food and drink intake, I could have followed guidelines that at the time may have committed this person to a life-time of insulin and resulting likely obesity. I had been failing to explore the cause of raised blood sugar and just been treating the symptoms.  I was forced to take a long and hard look at the way I was practicing and prescribing medicines given some of my patients were frankly doing a better job at improving their health by themselves. I set about finding out more. Was remission really achievable and sustainable? What was going on here and what did the scientific literature say on this? If this did work, why had I not encountered anything on nutrition and lifestyle as a therapeutic intervention (rather than just as a public health approach) in my medical training? Could modern medicine really have a blind spot for one of the most powerful tools in the box? And if so, how had this happened?
Global lifestyle medicine
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Joining the drive to formalise lifestyle medicine as a discipline in the UK
In 2018 I was introduced to the British Society of Lifestyle Medicine (BSLM), an educational charity driven by the passion and energy of a group of doctors led by GP Dr Rob Lawson (now president of the European Lifestyle Medicine Organisation). At the BSLM conference I met many other clinicians from hospital specialists, to GPs, public health physicians, physios, pharmacists and nurses who were asking similar questions about our current over focus on medications at the expense of supporting people with lifestyle. I heard about some of the long-standing research that confirmed that this approach could be effective. I learned from clinicians who were trying to deliver lifestyle medicine in practice, particularly using an approach called group consultations. Shortly after, I applied for and was awarded a Thames Valley Health Education England fellowship to set up group clinics to support people with Type-2 diabetes with lifestyle approaches to help treat and remit diabetes. Group consultations (or group clinics) are where 10-15 people with similar health concerns or conditions come together with a trained facilitator to learn more about their condition and problem solve with each other and a clinician. An audit of these clinics at my practice found that this approach, for those who chose it, was effective in supporting weight loss, blood pressure improvement and for some, Type-2 diabetes remission and a reduction in medications. The Peter Sowerby Trust and Cherwell District Council then funded scaling this up in a more deprived area of Banbury for people with chronic pain and musculoskeletal issues. These clinics were the most joy I've had practicing medicine - we were able to have time for really in depth conversations with people who had felt marginalised and abandoned whilst on hospital waiting lists. Unfortunately, just as we'd hoped to scale these up further, Covid arrived and we had to move clinics on-line as video group clinics delivering the Complete Health Improvement Programme (CHIP) - a well researched and structured lifestyle medicine and group consultation approach to support Type-2 diabetes remission.  Again, this proved acceptable and effective for those who chose this approach. Seeing how effective lifestyle medicine and group clinics were in practice and how interested patients were in this approach led me to join the BSLM as a trustee and become their Learning Academy Lead in 2021 to develop the UK's first course in lifestyle medicine which now forms part of the Core Accreditation led by GP Dr Kate Woolley. I spent a year researching this course, drawing on epidemiological and trial data as well my own and other's experience including global use of this approach from the Australasian Society of Lifestyle Medicine and American College of Lifestyle Medicine. It was fascinating to explore the role of isolation, nature, sleep, food, tech and social media on health in particular - areas that rarely feature in medical training. We created a course that is self-paced, evidence-based for practicing clinicians. It was the first lifestyle medicine course to comprehensively describe this approach in socialised health models such as the NHS - covering social prescribing, health coaching, person-centered care and group clinics. I loved the opportunity to bring complex concepts together and describe how we can turn knowledge in practice - for example how to take a lifestyle medicine history, use a lifestyle screening tool, the role of compassionate care and how to understand the socio-economic drivers of health behaviours avoid blame and stigma when supporting health behaviour change. We also explored the critical role of physician health for patient safety and good quality care and my favourite topic of deprescribing - reducing long term medication burden safely. In 2023 I joined forces with Dr Richard Pinder, Director of Undergraduate Public Health Education at the School of Public Health - Faculty of Medicine at Imperial College, London and Dr Christopher James-Harvey Senior Strategic Teaching Fellow Head of Academic Tutoring for the first core curriculum lifestyle medicine course in undergraduate medicine at Imperial. We worked together to find experts in the various fields that make up lifestyle medicine to create the UK's first textbook of lifestyle medicine published by Cambridge University Press. This textbook covers the principles of lifestyle medicine practice including an understanding of the drivers of health behaviours as well as behavioural science and the 6 pillars. This textbook brings together diverse fields of sociology, health behaviour change as well as the cellular mechanisms such as an understanding of chronic inflammation, epigenetics and the role of the gut microbiome. I also worked with a group of clinicians including Dr Rob Lawson, Dr Callum Leese and Dr Hussain Al-Zubaidi with the Royal College of General Practitioners (RCGP) to lay out a framework for practice of lifestyle medicine within primary care. This now hosts many free resources to guide good practice.
Scaling up lifestyle medicine practice
For too long we've been overly focused on medications and surgery at the expense of wider scientific options both in a consulting room and outside, to address the root causes of ill health. These root causes include social, economic, environmental and commercial factors that require strong policy and public health action; these are by far the most equitable, effective and sustainable approaches to achieve better population health. However, if these approaches have failed and we develop long-term conditions such as obesity, depression or type-2 diabetes for example, there is good quality evidence for the use of multi-component lifestyle interventions having a similar role to long-term medications for some conditions. There is also evidence that people want the choice of support for this approach (particularly from the James Lind Alliance who work with people with lived experience and ask them where they want public research funds to be spent - most often researching lifestyle interventions) However, medical training and practice has neglected these options in favour of more and more medications and surgical interventions. Whilst there will always be a place for these treatments (particularly vaccines), it's time to scale up the delivery of lifestyle medicine interventions, particularly for chronic disease remission. Lifestyle medicine interventions can be powerful preventive and treatment options to improve health, however, the most exciting area of research and practice is the use of intensive, personalised, multi-component lifestyle interventions to achieve chronic disease remission. When clinicians talk about remission we mean reversal of the underlying drivers and physiological processes involved in long term conditions such as obesity, hypertension, metabolic liver disease, depression, type-2 diabetes and potentially some autoimmune diseases and even early low-grade cancers. Clinicians tend to avoid the word cure or reversal because if lifestyle changes are not maintained, then the disease can come back. For example, if weight is regained, Type-2 diabetes tends to recur. A personalised approach is used in lifestyle medicine; this means we assess multiple factors including sleep, activity, fitness, diet, nutritional status, clinical risk factors and tailor the support to these issues. This avoids impersonal diet sheets or blanket advice to "eat less and move more" which have not been found to be helpful. Some people with obesity and Type-2 diabetes for example are very active and eat good quality whole foods. For these people, obesity may be driven by stress, poor sleep or prescribed medications. For others, obesity may be due to rarer genetic variants. Lifestyle medicine is a low-tech and low-intervention approach that aims to de-medicalise people's lives and minimise medications. It has huge potential to be cost-effective and sustainable. It matters to me that this approach is equitable and available particularly for those who need it most. To increase access, we need to be able to evaluate at scale and develop clinical pathways so this approach can be taught and spread widely. Innovation is extremely challenging within the busy NHS. Whilst I prefer the free at the point-of-need access, stability and security of working within the NHS and have innovated within the NHS, bringing in group clinics for example, I know we need good quality data to prove to commissioners that this approach can be scaled up. Such innovation often has to happen outside the NHS. I will be bringing together a team to deliver safe and effective care initially for those who can pay for this approach. The long-term aim however, is to produce data on clinical effectiveness and cost-effectiveness so this can be commissioned by the NHS. I will also be creating the resources to deliver out-reach education and group clinics to where this is most needed alongside continuing to support the work of the BSLM, the educational charity dedicated to teaching and promoting this approach.
Who pays me and why this matters
Conflicts of interest are a huge challenge in medicine, they can influence how and why we promote certain interventions.
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It is important that whilst I work for better recognition of the evidence for lifestyle medicine interventions to balance the interests of pharmaceutical and commercial bodies, that you can be clear who pays me.
I am paid as an NHS GP, clinical lecturer and medical director to the NHS Paths to Remission Programme. I have received speaker fees and a small textbook honorarium. I see NHS, private self-pay and insured patients. I have never received funds from tech, supplement or pharmaceutical companies. My work with the BSLM is honorary, therefore unpaid. You can check out my on-going financial declarations at Sunshine Doctor.
Are you looking for support to achieve remission of a long-term condition with fewer long term medications?
Are you an academic looking to research lifestyle medicine interventions?
Do you commission NHS services and want to support access to chronic disease remission?
Are you a clinician who wants to learn more about lifestyle medicine (I'm particularly keen to hear from nurses and allied health)?
Do you work in media and want to reach the public with good quality information about effective health interventions beyond pills? ​