My patient smiles broadly at me as I walk in the room.  He gives me a firm handshake and a hearty hello, as if we were old friends.  I ask him how he is, and he lights up as he talks about his family. He’s been married for 42 years. A retired cabinetmaker, he still keeps active with home improvement projects and fishing trips with the grandkids. His joyful spirit is apparent as he talks about the richness of his life.  We touch on recent current events, and shake our heads at the craziness of New England weather.

As our talk turns to his health issues and medications, his smile fades a bit.  He is significantly overweight and has high blood pressure, diabetes, high cholesterol, emphysema, and a strong family history of heart disease. He has not had a heart attack, but he’s worried. He takes a total of eight medicines on a daily basis: two for his blood pressure, two for his diabetes plus injectable insulin, one for his cholesterol, and two inhalers for his lungs.  He sighs as I review this list; he’ll need blood work to monitor for liver and kidney problems, which can be side effects of some of these medications, and to check that his blood sugar and cholesterol are adequately controlled.

There’s a term we use in medicine to describe the phenomenon of someone taking multiple medications. It’s called polypharmacy. And this patient is one of the lucky ones. Some people take upwards of fifteen to twenty pills daily.  There’s a word for that, too: pill burden.

In the remaining time that we have together, we talk about nutrition and exercise.  I gaze at this intelligent, hard-working man who has every intention of leaving my office and making some improvements to the way he eats, but who will most likely be derailed by his daily routine and the behavioral and familial patterns that have been established for years.  This is the challenge that confronts most people: how to make real and lasting changes that will lead to better health.  And this is the challenge that confronts most physicians: how to help people be successful in their efforts at change.

As I see it, one of the problems is that there’s a disconnect between people and their food. In many corners, we’ve lost the experience of working with nature and seeing things grow.  Those basic elements of soil, seed, water and sun work together magically to produce plants that bear fruit, roots and leaves that are delicious and filled with nutrients.  There’s a sense of pride and accomplishment that comes from tending something from its infancy until the time of harvest. There is a relationship with food that goes beyond the experience of the trip to the grocery store.  And this disconnect extends to our relationship with our bodies. We don’t recognize when we’re full or how the quality of what we eat translates into how we feel.

Things are changing.  Farm to School programs are emerging across the country.  At The Farm School here in Massachusetts, city kids who have never seen a farm animal are tending chickens, sheep and pigs.  Restaurants and hospitals are recognizing the importance of incorporating whole, fresh, locally grown foods into their menus. Backyard gardens in homes and businesses are peppering the landscape.  Folks in urban and suburban areas who don’t have access to land are joining community gardens or farm share programs.  There is a vegetable garden on the grounds of The White House, thanks to our First Lady.

My patient’s health problems and resulting polypharmacy didn’t happen overnight.  There’s no easy fix, just the slow recognition that we need to strengthen the relationship we have with ourselves and the natural world around us. This is a tall order to fill in our contemporary society, which relies heavily on technology to drive our choices.

My advice?  Slow down. Breathe. Move your body. Plant a garden. Buy local. Cultivate awareness in yourself and others.  These are small changes that can lead to big payoffs. And no prescription is required.