At one Downtown health practice, food is the first component in an integrative and innovative approach to care

by Meredith Napolitano Stettner and Industry staff

At PhysioLogic—a Downtown integrative wellness center, a tight-knit team is at work bending the contemporary medical model into a more adaptive and multi-disciplinary approach to health. Led by board certified internal and integrative physician, Dr. Robert E. Graham, (MD, MPH, ABOIM, FACP), clinical nutritionist Michelle Miller (MSACN), and certified health coach and yoga instructor Julie Graham, the practice’s mandate is to look at a broader and interconnected picture of patient well being. For staff members here, the concept is encapsulated in the word FRESH—an acronym for five pillars of health Physio Logic deems central: Food (“What, when, and how do you eat?”); Relaxation (“Do you find time?”); Exercise (“What are the best forms?”); Sleep/Stress (“What are the principal tools for sleep and stress management?”); and Happiness (“What are its sources in your life?”). Simple questions, but ones seldom asked at a typical doctor’s appointment. The result is the practice-branded FRESH Integrative Health, a program with roots grounded in both conventional/allopathic medicine and holistic medicine, and with an emphasis on diet.

“I was offering this type of integrative care in a conventional hospital setting, but was asked to increase productivity,” said Dr. Graham, who received his medical degree from the School of Medicine at Stony Brook University Medical Center and completed his residency in Internal Medicine at Lenox Hill Hospital. But if he sped up, as requested, Graham explained that he could no longer offer his style of care, and even worse, would become part of an epidemic of doctor burnout. After spending 10 years in that structure, he realized it was contrary to why he became a physician, so he left his practice in June and joined PhysioLogic’s team to launch FRESH Integrative Health.

Also a holder of a Master’s Degree in Public Health from the Harvard School of Public Health, Graham knew the statistics: studies have shown most chronic diseases are 80% preventable through lifestyle changes. FRESH, then, was designed to treat such conditions as heart disease, obesity, chronic stress, diabetes, and GI issues like acid reflux, heartburn, Crohn’s disease, and ulcerative colitis—with one goal in mind: reversal. Using the program’s model and addressing its five pillars, starting with Food, Graham and his team encourage patients to make small, steady lifestyle changes that produce effective, long-lasting results. People are eager, he explained, for approaches not necessarily dependent upon prescription drugs. He referenced a recent patient with a 17-year history of migraine headaches who sought various medications and scans before consulting with Physio Logic.

“We did a food sensitivity panel and a major trigger was artificial sweetener; she was putting Splenda in her daily coffee,” Graham explained. “Between nixing that and prescribing a supplement, her migraines went from seven to two per month.”

Miller offered additional examples of the vital role of diet in integrative medicine.

“We treated a 40-year-old woman with a two-year history of night sweats, brain fog, and fatigue,” the nutritionist recalled. “She came to us having tried thyroid medication, hormone therapy, and a variety of supplements and herbs. Following initial blood work, we found her to be deficient in iron and vitamin D. Through experimenting with an elimination diet, we found her night sweats to be triggered by soy. She was ecstatic to be able to stop the hormone therapy and sleep through the night. More recently, I had two patients suffering from irritable bowel syndrome, one 28 and one 77, with both reporting that they had been tapering off their IBS medications due to changes in diet. For the younger patient, inflammatory foods were the key. She is highly sensitive to gluten, dairy, and processed sugars. For the older patient, she simply needed to increase her water intake and get a better variety of fibrous foods. Another IBS patient found relief through the use of enteric peppermint oil, along with counseling on food combining, proper chewing, and hydration during mealtimes.”

Gastrointestinal health treatment includes a variety of approaches. Recently, fecal transplants, for example, have been used to treat inflammatory bowel diseases. Dr. Graham is careful, however, not to jump to that too quickly as an answer. (“Why not fix what you have first?” he said.) Through comprehensive blood testing and stool analysis (checking bacteria, yeast levels, and parasites, among other factors), FRESH Med looks at a patient’s composition before devising an individualized prescription for health.

Another priority of the program is accountability. Patients are oftentimes encouraged to bring a loved one into the room during consults, which not only raises the stakes for healing, but frames it beyond the one afflicted.

“I have gotten the best results when loved ones are in attendance,” Graham said. Miller added that, “Sometimes patients become emotional, as they have gone years dealing with something and we hit a point where there is finally an answer.” It’s all part, Graham explained, of Physio Logic’s goal for collaborative and synergistic medicine, rather than just prescriptions, which he will still prescribe, if necessary.

“I have never met a patient who said, ‘I am happy with this high dose of medication.’ I hear, ‘Thank you for getting me off medication,’” he said, adding that it is often his wife, Julie Graham, who, through conversations with a patient, discovers the hurdle that needs to be overcome and helps to create a treatment plan accordingly.

For Miller’s nutrition work, she explained that, “Figuring out how to break through walls is key. Whether it is emotional eating, overeating, or other choices. I see a lot of people who, say, don’t cook. They don’t have time or the know-how…so we work with making time to think ahead about the what and when of preparation, and the outcome is almost always life improvement on a variety of levels.”

With integrative care, however, comes the less controllable question of insurance coverage. It’s an issue the practice doesn’t avoid addressing, especially since wellness programs are often not covered by insurance companies. While an out-of-network provider, they offer assistance like payment plans and dialoguing with more progressive insurance companies and employers.

“Patients are frustrated by a limited set of options and an eight-minute visit,” Graham explained. “Sadly, they have to pay a premium for wanting more. I want to prove that this way of treatment in the long run is cost effective. I want to make this insurance- based—but the reimbursement model has to change. We don’t reimburse enough for wellness.” He thinks it will come down to rallying policy makers and politicians, such as the effort chef, restaurateur, and Food Policy Action Education Fund founder Tom Colicchio and other industry chefs put in when they traveled to Capitol Hill this May to educate lawmakers on food waste reduction possibilities in the American food system.

“We need to put well-being at the forefront,” concluded Graham, while detailing that his practice and its FRESH Integrative Health program have one goal: to make patients healthier by treating body, mind, and spirit, not just symptoms. As each pillar of that treatment model is synergistic with the others, it constitutes a new formula for success, succinctly communicated in the practice’s tagline: “Go To Health!”

Physio Logic
409 Fulton Street
718.260.1000 / physiologicnyc.com