Online Health Chat with Dr. Mladen Golubic

February 22, 2011


Cleveland_Clinic_Host: Turn your life around with Lifestyle 180®! Do you want to feel better? Look better? Actually be healthier? You don’t have to live with constant pain, fatigue, mobility problems, sleep deprivation, and other obstacles to quality living, even if you have a chronic illness. You can turn your life around by making positive lifestyle changes.

If you are among the more than 100 million Americans with a chronic disease, your risks for death and disability are significantly higher than average. You are also likely to be coping with ongoing pain, fatigue, difficulty moving, poor quality of sleep, or other obstacles to a vibrant, healthy life. Each year that passes without taking charge of your health is an opportunity missed – an opportunity to feel good, look good, enjoy greater energy, and feel less stressed.

The good news is that if you are committed to making positive changes in your lifestyle, Cleveland Clinic's Lifestyle 180® program can teach you how to reclaim your health and vitality.

Learning to take care of your body and mind
Participation in the Lifestyle 180® program improves quality of life for patients with 10 common chronic diseases that include obesity, high cholesterol, high blood pressure, diabetes, multiple sclerosis, fatty liver disease, ulcerative colitis, Crohn's Disease, and early prostate or breast cancer (within two years of diagnosis). In the beautiful, convenient, and stress-free surroundings of Cleveland Clinic’s campus in Lyndhurst, Ohio (the former home of TRW), and Lifestyle 180® participants will learn the skills they need to make lasting changes in their lives.

Make a solid investment in your health
Lifestyle 180® will empower participants with all the tools they’ll need to embrace wellness. They’ll experience the benefits of healthy living first-hand.

Our one-year program consists of 18 four-hour classes. In the first four weeks, participants take part in two classes per week in the evenings, depending upon individual schedules. Groups of 8 to 12 people will engage in four-hour sessions, in stress-free settings, including the kitchen, exercise facility, and yoga studio. Participants are also eligible for additional follow-up sessions in the future. The remaining 10 four-hour sessions are dispersed throughout the remainder of the year.

The results
What makes Lifestyle 180® stand out is its blend of evidence-based lifestyle medicine and a group wellness experience. Our medical wellness experts will guide participants on setting specific, achievable goals for their personal health and well-being. After six months in the program, Lifestyle 180® participants experience significant improvements in biometric, laboratory, and quality-of-life measurements:

  • They lose an average of 15 pounds
  • They see an average 6% reduction in LDL cholesterol;7% increase in HDL; and 17% decrease in triglycerides
  • They report improved sleep, balance, muscle strength, and mood

Turn your life around with the help of our experts in a program tailored to you. Call 877.331.WELL (9355) toll-free or email to reclaim your health with Lifestyle 180®. While not yet covered by many insurance programs, Lifestyle 180® will offset increasingly high co-pays for doctor visits and medications.

Cleveland_Clinic_Host: Welcome to our Online Health Chat with Dr. Mladen Golubic. We are thrilled to have him here today for this chat. Let’s begin with the questions.

What is Lifestyle 180®?

sweets: What is the philosophy behind the Lifestyle180® program?

Dr__Mladen_Golubic: Participation in Lifestyle 180® program is aimed at treating chronic diseases through lifestyle modifications. Interactions between lifestyle and genetic factors cause the development and progression of a spectrum of chronic conditions, including obesity, type 2 diabetes mellitus, hypertension, cardiovascular disease and several types of cancer. For some of these major causes of death, more than 80% may be related to environmental, primarily lifestyle factors. Without addressing the key underlying causes of modern chronic conditions, that is, lifestyle factors, it is hard to imagine that we can make progress in alleviating suffering and reduce cost of chronic conditions in a long-term, sustainable fashion.

chelsea: How does participating in a program such as this really help someone with one of the 10 conditions listed? I can understand high cholesterol or high blood pressure, as well as some of the others, but how is it beneficial for someone with breast cancer?

Dr__Mladen_Golubic: There is evidence from randomized clinical trials of women with breast cancer that shows that those women who consume diets high in fruits and vegetables in combination with daily physical activity, as well as women who ate diets low in fat, had better survival rates than women who did not attend to those lifestyle modifications

sunsets: As a working mother of three, I am always on the go. How can I incorporate this program into my lifestyle? Is it time consuming? Can I include my family as part of the program, having them do it with me?

Dr__Mladen_Golubic: We all need to eat; therefore there is no 'extra time' really needed because you are spending the same amount of time as before. The skills learned in the program will help you become a more efficient and healthy cook. This benefits not just you, but the entire family. Often the family members also lose weight because of the type of foods being prepared. We engage in hands on kitchen skills that teaches you how to keep the taste in and unhealthy ingredients out.

Regarding physical activity - use the stairs instead of elevators, park your car further from your destination and walk. Bottom line - get more steps any way that you can.

Stress management may take some regular practice to develop a relaxation response instead of the fight or flight response, which we are all conditioned to do. Once we get familiar with stress reduction techniques, it might take only a few seconds to remind ourselves to breathe and be fully in the present moment to relieve our stress.

As you practice all of these - your family will possibly learn by observation. Living your lifestyle will be a powerful tool to enhance your family’s well-being.

1aday: Is this program designed for the individual based on their condition? Their lifestyle? Their present health? Or based on a set of standards?

Dr__Mladen_Golubic: The program is primarily designed around a condition, but the individual capacities and skills of participants are taken into consideration. For example, if someone is only taking 2,000 steps per day, he or she will not be expected to run a 1/2 marathon within 3 months. The exercise routine is adjusted according to his or her physical abilities. Likewise, an individual with food allergies will receive appropriate modifications of recipes and food selections.

phone_call: Are there medications included in this program or is it all behavior/thought modification?

Dr__Mladen_Golubic: Participants enrolled in the program continue taking medication as instructed by their primary care physician (PCP). When there is a need to change the dose of certain medications such as those for high blood pressure or diabetes, this is done by the PCP not L180 staff. After 6 months of incorporating Lifestyle 180 program principles into everyday living, many participants were able to stop or decrease dose of medications. For every medication that is started or dosage is increased, there are four medications that are stopped, decreased, or avoided.

healthy_life: Is this a life-long program? If you go off the program, what are the consequences?

Dr__Mladen_Golubic: The program is one year, but the intention of the program is to provide you with the skills to sustain healthy lifestyle long-term. Regarding consequences, the root causes of chronic conditions are lifestyle-related, that is smoking, eating poor diet, not being physically active, and poorly managing everyday stress. In other words, the only consequences are related to your everyday lifestyle choices.


joiner: Is anyone eligible to participate in L180?

Dr__Mladen_Golubic: Potential participants must have one of 10 chronic conditions that include hypertension (high blood pressure),  hyperlipidemia (high cholesterol and triglycerides), diabetes, obesity (not overweight), Crohn’s disease, ulcerative colitis, fatty liver disease (NASH), multiple sclerosis, or breast or prostate cancer (early diagnosis for both).

blather: Besides having a chronic condition, are there other requirements to participate in the program?

Dr__Mladen_Golubic: The participant needs to provide a signed statement by her or his primary care physician that he or she can participate in the program. There are other conditions/circumstances that rule out participation:
• Pregnancy
• Having had a cardiac event within the last three months
• Tobacco use of ANY kind, not just smoking, and not having been enrolled and participated in the CLEVELAND CLINIC tobacco cessation program for at least one month

out_there: How would someone from out of state participate in this program?

Dr__Mladen_Golubic: Currently this program is only offered at the Cleveland Clinic Lyndhurst location. We do have participants who travel from out of town. The program consists of 18 classes, 4 hours each. During the first 4 weeks, there are two 4-hour classes per week (total of eight classes.) The remaining 10 classes are distributed throughout the remaining 11 months.

chili: If you don’t have one of the 10 conditions you listed, can you still take part in this program for overall and life-long good health?

Dr__Mladen_Golubic: No. L180 is a program aimed at arresting or reversing chronic conditions. Therefore, you must have one of the chronic conditions to participate. Many people are interested in the concept but do not qualify with one of the conditions. We are currently developing a program that will be available for anyone who desires to improve their lifestyles but does not currently have a chronic condition. Please visit the website for updates about future programs.

Weight Loss

SBlack: Is Lifestyle 180® just another weight loss program?

Dr__Mladen_Golubic: Enjoying a healthier lifestyle benefits ALL facets of your life. Weight loss can be a great component of this. However, sleeping better, having more energy, feeling less pain, gaining flexibility, expanding your thinking on what is good for you and how to enjoy it – not to mention, you may decrease or eliminate prescription medications -- weight loss is just ONE of the wonderful potential benefits of participating in the Lifestyle 180® Program!

Participants who choose to implement lifestyle practices into their daily activities invariably experience weight loss, on average 16 pounds or about 7% of body weight after six months. Weight loss is one of many beneficial side effects of living a healthy lifestyle, which is, eating well, being physically active, and managing better the psychological stressors of everyday life.

shotgun: I am quite obese. If I were to enter into this program, what should I expect? How slow or fast is it likely that someone like me will adapt to the program? What happens if you fail the program after a short time?

Dr__Mladen_Golubic: Among L180 participants, we have seen impressive results after only six weeks of engagement in the program. Participants lost an average of >15 pounds or 7% body weight at six months. Lifestyle change is not easy and our staff works with you to support your unique lifestyle journey.

Healthy Eating/Cooking

songs: I can understand the need to learn about healthy eating and exercising, but the Lifestyle 180® program practices such as meditation or yoga seem too much based on New Age philosophy and too little on good science.

Dr__Mladen_Golubic: All three key “ingredients” of a healthy lifestyle are evidence-based, that is, supported by findings not only of clinical intervention trials, but basic science studies. In fact, the cutting edge medical technologies of magnetic resonance imaging and gene chip technologies were used to document the beneficial effects on brain structure and function, as well as gene expression in previously untrained people who learned and practiced daily meditation and/or yoga for as brief periods as 8 to 12 weeks.

jackie: Why do I need to learn how to cook? I don’t have time to cook now and I don’t think I will have more time if I start exercising more regularly and practicing daily stress management routines as suggested in Lifestyle 180®.

Dr__Mladen_Golubic: While all three aspects of Lifestyle 180® intervention are mutually interlocked and supportive of each other, eating is the only activity that we all need to do on an everyday basis. While we can go without stress management or exercise for several days without any acute serious health effects, this is not the case with eating. Because we all need to eat, the basic question to answer is “How we can eat, in a sustainable manner, year after year, to support the highest level of our health rather than contributing to a number of chronic disease development and progression”? If we truly want to improve our dietary habits, there is no way around the kitchen. Anybody who can read can learn to cook; it just takes some adventurous spirit, desire to experiment, and practice. Your culinary adventures will start with learning how to buy the best foods (if you enroll in the program, in the second week you will attend a grocery store tour with our chef and registered dietitian) and blossom under the guidance of our chefs, who will teach you knife skills and a spectrum of cooking techniques in our teaching kitchen so that you can be confident and time efficient in your own kitchen.

bambi: The cooking/diet portion of the program, what are the recommendations? I have been told that a vegetarian or vegan diet is the healthiest. What diet do you recommend in this program?

Dr__Mladen_Golubic: Diet is plant-based with the only sources of animal protein/fat are skinless chicken/turkey breast and fish. That is, the diet consists of vegetables, legumes, only 100% whole grain products, and fruits.

Vegan diets that consist of refined carbohydrates and other processed foods may not be the healthy  However, vegan diets that use unrefined, whole foods, such as those developed by Drs. Esselstyn, Ornish and others , are healthy choices and have been shown to help patients arrest or reverse with coronary artery disease and other chronic conditions..


cheesey: What does the program cost?

Dr__Mladen_Golubic: It is $3,000. Currently, there are no existing Current Procedural Terminology (CPT) codes for lifestyle intervention to which insurance may bill. Additionally, it seems that most insurance companies look at these requests on a case by case basis, and if they are amenable to reimbursement, it is usually a partial reimbursement because Lifestyle 180 is an educational program versus "treatment" (it is not like a prescription medication or a surgical procedure).

newsie: When is the payment due?

Dr__Mladen_Golubic: 10% ($300) of the total fee ($3,000) is due upon enrollment; and the balance is due prior to participation ($2,700)

General Questions

cubicle_dancer: What are the psychological aspects to this program? Do you see a psychiatrist/psychologist as part of the program?

Dr__Mladen_Golubic: As a participant, you will see a behavioral health specialist or a yoga therapist. Our behavioral health therapists and certified yoga therapists work with participants to become more aware of their thoughts and feelings, and to address behavioral issues that may be barriers to achieving a healthier lifestyle. If additional counseling or treatment is needed, our staff will work with you to identify the appropriate mental health professional (psychiatrist/ clinical psychologist.)

moon_beam: I see that a lot of this is done in a group setting. If I prefer an individual appointment(s), is that possible?

Dr__Mladen_Golubic: No. The entire program is conducted in a group setting. There is research evidence that overwhelmingly supports greater implementation of lifestyle changes when conducted in a group setting. If there is a need for individual counseling regarding nutrition, behavioral health, or exercise, we will put you in touch with our medical doctors and experts in our Center for Integrative Medicine or other medical professionals as appropriate.

blurry: Is Cleveland Clinic the only place where one can participate in this program?

Dr__Mladen_Golubic: At this moment - yes. Cleveland Clinic is the only medical facility that offers a Lifestyle 180® Program with these attributes.


Cleveland_Clinic_Host: I'm sorry to say that our time with Dr. Mladen Golubic is now over. Thank you again for taking the time to answer our questions about Lifestyle 180®.

Dr__Mladen_Golubic: Thank you very much for your questions today.

More Information
  • Turn your life around with the help of our experts in a program tailored to you. Call 877.331.WELL (9355) toll-free or email to reclaim your health with Lifestyle 180®. While not yet covered by many insurance programs, Lifestyle 180® will offset increasingly high co-pays for doctor visits and medications.
  • A remote second opinion may also be requested from Cleveland Clinic through the secure eCleveland Clinic MyConsult Web site. To request a remote second opinion, visit