In conversation with Beth Frates | MEDICUS 2025 Issue 1

Beth Frates: Rewriting the prescription for a healthier life

Credit: Courtesy of Beth Frates

When Beth Frates’ father suffered a major health setback at the age of 52, it turned her world upside down. And she was just 18 years old. This unexpected episode would eventually steer her towards a transformative field in medicine: one that not only promises a longer life, but a better one.

The key to a healthier life, as Frates discovered, was surprisingly uncomplicated—and could be unlocked by specific adjustments to one’s lifestyle—a finding that has since led to the launch of a new medical specialty, lifestyle medicine.

To explore its intricacies, Dr Chua Li Min, MEDICUS’ science writer, speaks to Frates, now a lifestyle medicine clinician and pioneer in the field. The associate professor with Harvard Medical School who has spent three decades teaching, researching as well as practising in this field shares more.

MEDICUS: Thank you for joining us. How did your father’s illness impact you and your family?

Beth Frates: At that time, I was 18 and had only been going to my paediatrician for healthcare and routine visits, and no one in my family was in the medical field. We didn’t talk about health or disease in my family, not until my dad had a heart attack and stroke, and was paralysed on his left side at the age of 52.

I found it very disturbing and worrisome, because I loved my dad so much. He was a pillar of strength in the family, someone I looked up to as a role model. That was when a light bulb went off, prompting me to understand what causes these health setbacks.

Then seeing how he recovered—because in a year he recovered everything except fine motor movement in his left hand—was absolutely fascinating. He didn’t go back to work in the same way after this. It changed the way he connected with people around him. He really focused much more on that area of his life after the stroke, instead of letting the focus be work. And while he still wanted to carry on the family business, he did not want to do so at the expense of losing his health and ability to move one side of his body.

So those were the seeds: Understanding that there’s physical pain but also emotional pain that comes along with these health setbacks and then really trying to get to the cellular level of why this happened.

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MEDICUS: And how did your journey evolve after this?

Beth Frates: I started reading medical journals in the Countway library at Harvard Medical School, and that was when I stumbled upon an article in The New England Journal of Medicine by Alan Rozanski and his colleagues which reported on the impact of mental stress on the heart. It reminded me of what happened to my dad and made me realise that there’s a lot to our health that we understand and that we don’t understand.

So I went to medical school and decided to focus on rehabilitation medicine, because I wanted to help stroke patients like my dad. But it wasn’t until I co-wrote a book on how to prevent a second stroke with two colleagues, that we did a deep dive into how exercise, physiology, nutrition and stress resiliency played a role in disease prevention, which to me, clearly showed that there was another way called lifestyle medicine. And that, coupled with research I did sometime back studying the impact of a saturated fat diet or a nitric oxide-rich diet on vascular health, where I witnessed how food is truly medicine, really solidified it for me.

That was the moment I said, “Okay, I know there’s science to this”, and I knew that we had to bring lifestyle medicine to Harvard, which I did with another colleague. That was in 2006 and it’s been two decades since!

Beth Frates’ journey into lifestyle medicine began after her father experienced a health setback at the age of 52 // Credit: Duke-NUS Centre of Regulatory Excellence

MEDICUS: So what is lifestyle medicine?

Beth Frates: It is a medical specialty where we use these six pillars: exercise, nutrition, stress resiliency, sleep, social connection and avoidance of risky substances as a first-line therapy for helping to put into remission and preventing chronic conditions like heart disease, diabetes, high blood pressure and obesity.

So it factors in the physical, emotional and mental health of the patient as well as their readiness for change—and getting to know the patient and their needs is part and parcel of lifestyle medicine.

This is why I love the art of lifestyle medicine, which is really trying to figure out what resonates with the other person. How do you motivate, empower and inspire that person to want to live a healthy lifestyle. And that to me is the how and why of lifestyle medicine.

So as a medical doctor, if you’re board certified in lifestyle medicine, which you can be as of 2017, you are an MD (Doctor of Medicine) or DO (Doctor of Osteopathic Medicine). And that also means using medications and procedures in your approach to treat patients. So, if someone has pneumonia, you’re going to give them an antibiotic. And if someone has extremely high blood pressure, you’re going to, at times, need to put them on medication before anything else, especially if it’s dangerously high.

But the difference with lifestyle medicine is, there’s an understanding that medicine can be deprescribed. And that the six pillars of lifestyle medicine can be prescribed with dosing, frequencies and intensities.

Exercise is one of the six pillars in lifestyle medicine // Credit: istock.com / goo.gl/73nyq6

MEDICUS: And how do you incorporate science into your practice?

Beth Frates: We titrate the medication based on the signs and symptoms of disease. For instance, if the patient’s blood pressure is really high, say at about 170mmHg, you certainly want to get them on an eating plan that can help lower blood pressure, such as the Dietary Approaches to Stop Hypertension (DASH) diet (a healthy eating plan that helps to lower blood pressure by focusing on including whole food like vegetables and fruits in one’s diet to lower sodium levels and raise potassium levels). You want to get them moving, but you’re also going to use medication to get their blood pressure to a safe range.

So, we base our recommendations on the patient’s condition and how their body responds to lifestyle changes and medication, which we will monitor by studying the signs and symptoms of disease.

MEDICUS: Who might benefit most from lifestyle medicine? What about individuals who may be genetically predisposed to certain diseases?

Beth Frates: Everybody could use lifestyle medicine. You may have somebody young and healthy. So why talk about lifestyle medicine? Because you’re helping them to avoid any conditions in the future and helping them to function optimally now.

And if you know you’re genetically predisposed to a particular disease, then that is an added motivation. You can still make a difference because there is epigenetics—how we behave, our nutrition and our environment can trigger changes that also affect which genes are turned on or off. Regardless of whether you have a genetic predisposition or not, we’re still going to work the same way to tackle the six pillars.

For instance, if you have a genetic predisposition to heart disease like I do, you may work even harder with focus and determination, especially if you have witnessed the health setbacks experienced by family members.

MEDICUS: When would be the right time to start?

Beth Frates: Start as early as you can.For example, by creating a family culture where there is healthy food at the table, starting from the day the child eats table food.

The critical time, I think, would be around the teenage years, before they start living their own life. So, it’s important to get students to have ownership over their health and to understand how these six pillars are important to their health, happiness and productivity. And helping them feel confident about themselves, which goes a long way in shaping their behaviour around food, movement, stress resiliency and sleep. That’s also why we have created a lifestyle medicine handbook for teens.

There is also an entire Teen Curriculum available at the American College of Lifestyle Medicine on the Connect platform for download, along with decks of PowerPoint slides on each pillar targeted at a teen audience. Paired with the Teen Lifestyle Medicine Handbook, the Teen curriculum is a ready-to-use resource for paediatricians, teachers and parents alike.

Making healthy food the norm is important in encouraging children to maintain a healthy diet emphasised Beth Frates // Credit: istock.com / vaaseenaa

MEDICUS: With the increasing adoption of AI and tech in healthcare settings, how do you see them influencing lifestyle medicine?

Beth Frates: It’ll be very interesting to see how we progress with AI and tech. Currently, AI is used to analyse trends from tools like wearable devices, which help to generate data for both the patient and the care provider from key metrics tracked, and that can be very useful.

But one major limitation is that AI won’t be able to foster a close connection with a patient. So, the clinician should still be there to provide that human touch. You can’t really replace the clinician-patient relationship, the way that we interact, the moments we share over time—which is often years—with a physician.

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MEDICUS: For our readers looking to improve their health, what actionable steps can they take?

Beth Frates: You could start by designing your environment in a way that nudges you to make the healthier choice the easy choice.

For example, supplying your home kitchen with healthy options and just buying healthy food. And having little reminders in place that enable you to work in fitness routines during the day. To encourage myself to keep moving when I’m working from home, I have a stationary bike workstation that I sometimes pedal on during meetings. I also use an exercise ball as my chair for my office desk at home. Or it could also be as simple as walking, which most people can do safely.

Getting exercise helps because it reduces stress and increases your sleep quality, which help reduce cravings during the day. And really prioritising sleep and getting on what’s called a sleep schedule, which means going to bed by a particular time and waking up at the same time 7 days a week.

I would advise you to find a partner in adopting and sustaining healthy lifestyle patterns—somebody at work or at home who also wants to work on tackling these six pillars, so you can stay accountable with that person.

Find someone whom you can stay accountable with in sustaining a healthy lifestyle suggests Beth Frates // Credit: istock.com / DragonImages

MEDICUS: We’re curious: what do you do to relax and de-stress after a busy day?

Beth Frates: Yoga—I find that really helpful since I started practising it about 20 years ago. Running has always been a stress management technique for me, and mindfulness-based stress reduction is something I learned about during a conference/seminar? one decade ago. So, these three exercises in the form of running, yoga and practicing mindfulness are techniques that resonate and work for me.

MEDICUS: What is your vision for the future of lifestyle medicine?

Beth Frates: I think it’d be amazing if we could get lifestyle medicine into our schools and encourage our children to start adopting a healthy lifestyle from a young age. I would love to see this happen and then live long enough to see if that generation is kinder, more productive, lives longer or healthier.

“You have the power to transform your health. Start with one conscious choice today.”

MEDICUS: Thank you for sharing your insights and personal experience with us.

And to our readers: We’d love to hear about your journey. How have your health choices impacted you? Drop us a note here.