I get referred patients regularly because I practice what people call “holistic medicine.” And the story is almost always the same: they’ve been through conventional medicine, they keep getting more prescriptions, their numbers may look fine on paper, but they don’t feel any better. Sometimes they feel worse. There’s a lack of vitality that nobody seems to be addressing, and nobody is asking why. That conversation stuck with me, because it’s exactly the kind of gap Chris Miller MD and I discussed in our latest live. Chris is a physician I trust, someone I go to when I have clinical questions that sit outside my own lane. She’s board-certified in lifestyle medicine like I am, and she’s gone further into integrative and functional medicine training. She practices in 23 states via telemedicine, and she brings a perspective shaped by her own health challenges, including managing lupus. What follows is a summary of our conversation, along with some practical guidance if you’re trying to find a physician who actually sees you, not just your lab results. The Habit Healers is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber. The Problem With “Holistic” I deliberately chose the phrase “whole person medicine” for this conversation instead of “holistic.” Not because holistic is a bad word, but because it carries so much baggage that it can mean almost anything. For some people, holistic means walking away from conventional medicine entirely. That’s not what Chris and I practice, and it’s not what we’d recommend for anyone. Whole person medicine, the way we define it, means something specific. It means your physician doesn’t just treat the complaint that brought you through the door. If you come in with high blood pressure, a whole person approach doesn’t stop at a prescription. It looks at your blood sugar. It checks inflammatory markers. It asks about your sleep, your stress, your diet, how connected you feel to the people around you. It recognizes that inflammation in one system doesn’t stay in one system. Your cardiovascular health, your brain, your gut, your immune function are all talking to each other. And the treatment plan reflects that. Diet and lifestyle come first. Integrative tools like yoga, acupuncture, or mind-body practices can support recovery. Supplements fill actual documented gaps (not guesswork). And medications are used when they’re indicated, because keeping someone safe is always the priority. As Chris put it during our conversation, her first job with every patient is to keep them safe. If something is dangerously abnormal, you address it with whatever tools you have, including pharmaceuticals. Then you build the lifestyle foundation underneath. Evidence-Based Shared Decision-Making One of the things I talked about in the live was an article by Greg Katz, MD, a cardiologist on Substack, about a patient who came in with exertional chest pain during exercise. His primary care doctor hadn’t been too alarmed. That would have set off alarm bells for me. The patient eventually ended up seeing Dr. Katz, had imaging that showed significant blockage in the LAD (sometimes called the “widowmaker”), and then faced a decision: stent, or medical management? What made Dr. Katz’s approach stand out was the shared decision-making process. He looked at the data, including the ISCHEMIA trial, which shows that for stable patients, stenting and medical management produce comparable long-term outcomes. He discussed it with colleagues. He presented the evidence to the patient. And together, they decided. That model is what whole person medicine looks like in action. It doesn’t mean your doctor avoids modern interventions. It means your doctor uses evidence to guide the conversation and treats you as a partner in the decision, not a passive recipient. Where Lifestyle Medicine Fits (and Where It Stops) Chris and I are both board-certified in lifestyle medicine through the American College of Lifestyle Medicine (lifestylemedicine.org). That certification means a physician has foundational training in nutrition, physical activity, sleep, stress management, and behavior change as therapeutic tools. For a lot of people, that foundation is enough. Shift to a more plant-forward diet, improve sleep quality, add consistent movement, manage stress, and many chronic conditions start to improve. But Chris’s own story is a good example of when it’s not enough. She changed her diet. She optimized sleep and stress management. Her lupus didn’t budge. So she went deeper. She trained in integrative medicine with Dr. Andrew Weil, studying mind-body techniques, vagal nerve activation, and the role of the parasympathetic nervous system in healing. Then she trained in functional medicine, which uses more advanced testing (microbiome analysis, heavy metals, mold exposure) when standard approaches haven’t uncovered the root problem. What she found was that she had genetic variants affecting methylation and B vitamin activation. No amount of dietary change alone was going to correct those abnormalities. She needed targeted supplementation and a more precise approach. The lesson isn’t that diet and lifestyle don’t matter. They remain the foundation for the vast majority of people. The lesson is that autoimmune disease, and really any chronic condition, is not one-size-fits-all. If you’ve made meaningful lifestyle changes and you’re still not getting better, that doesn’t mean you’re doing something wrong. It may mean there’s a layer underneath that hasn’t been addressed yet. Inflammation: What to Know, What to Ask For Chris and I spent a good chunk of our conversation on inflammation, because it sits at the crossroads of so many conditions. Joint stiffness, brain fog, depression, difficulty sleeping, waking up sore. These can all be signs of chronic low-grade inflammation. And at its worst, acute inflammation is what triggers heart attacks and strokes. There are a few basic markers your doctor can check. A CBC (complete blood count) is drawn at most annual visits, and shifts in your white blood cell count from your personal baseline can signal something brewing, even if the number still falls in the “normal” range. If you usually run around 3.5 and now you’re at 6 or 7, that’s worth investigating. Beyond the CBC, high-sensitivity C-reactive protein (hs-CRP) is one of the most useful inflammatory markers. It’s produced by the liver in response to inflammatory signals anywhere in the body, and research has linked elevated hs-CRP to increased risk for cardiovascular events, neurodegenerative disease, and autoimmune flares. A target of less than 1.0 mg/L is generally considered protective. One caveat Chris raised that I think is important: hs-CRP can spike temporarily after an intense workout or during an acute viral infection. If you just ran 20 miles or you’re fighting a cold, recheck it a week later before drawing conclusions. ESR (erythrocyte sedimentation rate) is another inflammatory marker, and it can sometimes catch what CRP misses, particularly in certain autoimmune conditions. The two tests use different mechanisms and respond to different inflammatory signals, so it’s not uncommon to see one elevated while the other is normal. The point is this: if you’re feeling off and your doctor isn’t checking inflammatory markers, it’s worth asking. The Bigger Metabolic Picture I’ve been spending more time writing and thinking about metabolic health, and one statistic has stuck with me. Research looking at cardiometabolic health criteria in American adults found that only a small fraction, roughly one in fourteen, met all five markers of optimal metabolic health. That data only goes through 2018, so the real number now is likely worse. Metabolic health is, at its simplest, how well your body processes and uses energy. Insulin resistance is part of it. Blood sugar regulation is part of it. And poor metabolic health doesn’t just show up as diabetes. It accelerates heart disease, contributes to cognitive decline, worsens GI issues, and fuels chronic inflammation. This is where every conversation about whole person medicine eventually leads. The daily habits, what you eat, how you move, whether you sleep well, how you manage stress, whether you have meaningful social connection, build or erode your metabolic health over time. No single doctor’s visit can undo years of accumulated damage. But the right physician can help you understand where you stand and build a plan that actually addresses the full picture. A Word on GLP-1 Medications Chris and I both shared that our thinking on GLP-1 medications has evolved. Neither of us is a pill-first physician. But the data on these drugs keeps expanding in directions that are hard to ignore. The most obvious use is for food noise, that constant mental chatter about the next meal that some people experience no matter how carefully they eat. For patients who have solid lifestyle habits and are still battling that relentless drive, GLP-1 medications can lower the volume enough to let everything else work. Beyond weight management, emerging research suggests GLP-1 medications may lower systemic inflammation, reduce cardiovascular events in high-risk individuals, and show protective effects for brain health and cognitive decline. There’s also growing interest in their role for autoimmune conditions, where they may help quiet an overactive immune response that persists even after lifestyle optimization. None of this means GLP-1s are for everyone. But they’re a tool, and a whole person physician uses every appropriate tool available while keeping lifestyle as the foundation. Menopause Hormone Therapy: Evolving With the Data I also brought up menopausal hormone therapy in our conversation, because roughly 90% of my patients are women in this ag
