As we go about the business of selecting a healthcare provider, it can be a bit of a quandary to know who to select. Should I see a Family Medicine physician, an Internal Medicine specialist, a General Practitioner, or perhaps a more specialized practitioner? My preference is to engage a physician who is specifically trained in Lifestyle Medicine because here we have, by definition, a focus not on disease maintenance, but a focus on getting at the root of the disease causation, and both the primary prevention and secondary prevention of disease.
This unique branch of medicine, by its very nature, addresses the dilemma we have of dedicating a tremendous amount of physical, financial and human resources to the treatment of disease; and, paradoxically, it appears that we have more disease than ever despite all of these pointed efforts to provide treatment through surgery, medications, elaborate genetic interventions, many thousands of food supplements and other self-care products, radiological interventions and more and more. With LM however, what we have is a means of attenuating disease, a means of preventing the onset of medical illnesses in first place (primary prevention) and a means of attenuating the effect the various illnesses after they take hold (secondary prevention).
So, lifestyle medicine is a scientific approach to decreasing disease risk and illness burden by utilizing lifestyle interventions such as nutrition, physical activity, stress reduction, rest, smoking cessation, avoidance of alcohol and other drug abuse, and many other lifestyle factors. One of the things that is so very exciting about this approach to medical care is that lifestyle behaviors are largely under our control, so the focus is on the patient’s behavior; the patient can have a sense of empowerment as they become more accurately educated about the critical link between their own behavior and their health span. Also, by being empowered around the issue of positive lifestyle change, we become very good advocates for our own health status, and thereby enhance our psychological hardiness and our ability to better cope with challenges in life. I discuss psychological hardiness in our second book: Synergy in the Dynamics of Lifestyle Change.
LM is the evidence-based practice of assisting individuals and their families to adopt and sustain behaviors that can improve health and quality of life. Poor lifestyle choices like dietary patterns, physical inactivity, tobacco use, excessive alcohol consumption, as well as psychosocial factors like chronic stress and lack of social support can contribute in a major way to the onset of chronic disease. So then, lifestyle medicine inventions have the potential to dramatically moderate healthcare costs and to make a major contribution to nationwide economic stability. LM is an incredibly important remedy for runaway medical costs by assisting patients to optimize their lifestyle factors. This pertains to both primary prevention and secondary prevention measures.
And, we want to make clear that, depending on the nature of the presenting problem, lifestyle medicine is most often practiced as part of an inter-disciplinary team where ancillary medical personnel and other medical specialties may be part of the patient’s treatment.
Some of the instructional competencies for those trained in LM might include the following:
⦁ Yoga, tai chi, spinning, swimming, competitive and noncompetitive walking and other related exercise-based activities
⦁ Responsible food shopping and the essentials of understanding food labels
⦁ How to stay hydrated and the healthiest drinks
⦁ The essentials of phytonutrients
⦁ The essentials of sun exposure
⦁ Risk taking and lifestyle management
⦁ Avoiding toxins
⦁ Self-care products
⦁ Weight management
⦁ Relationship issues
It is clearly important that education in life style medicine principals be extended to most physician assistants, physical therapists, psychologists, social workers, nurses and other healthcare professionals. Continuing medical education in LM should be consistently available for a variety of healthcare professionals. It would be easy to justify lifestyle management courses in undergraduate schools, and to be a requirement during all levels of medical school education to include residencies and postdoctoral education; this education would ideally be provided by fully credentialed lifestyle medicine physicians. The primary justification for this is that LM provides us with the primary tools for the primary and secondary prevention of disease.
Here are some comments about lifestyle that provide us with an important focus on the link between our daily rituals and the onset of chronic disease; also, our lifestyle behaviors can play a role in the prevention of accidental injury, viral infections and maintenance of supportive relationships.
⦁ A healthy lifestyle may retard the aging process as much as 30 years
⦁ Heart attacks are extremely frequent, occurring about 4,000 times a day in the United States; a healthy lifestyle can eliminate the large majority of those unfortunate occurrences.
⦁ There is always a huge advantage to preventing heart disease, rather than repairing its affects.
⦁ Engaging patients to take responsibility for their care via an effective physician-patient collaboration can have a substantial positive impact on health outcome.
⦁ We believe that the longest living people groups in the world, the people living in the blue zones, have longer health spans because of healthy lifestyle behaviors.
⦁ The people who have experienced radical remission from cancer have all changed their lifestyles in important ways.
Epigenetics
Epigenetics refers to external modifications to DNA that turn genes "on" or "off." These modifications do not change the DNA sequence, but instead, they affect how cells "read" genes. It is the study of biological mechanisms that will switch genes on and off. So, now we know that a variety of lifestyle behaviors result in favorable genetic expression; that is to say that, for example, a cancer gene may be able to be turned off if one is practicing positive lifestyle behaviors like avoiding excess stress, avoiding excessive intake of toxins of all sorts, consuming a healthy plant-based eating plan, practicing good sleep hygiene, and exercising regularly. Contrariwise, eating pork chops, being sedentary, using alcohol regularly and being stressed out we will contribute to a whole series of harmful genes being expressed and turned on.
Telomeres
Telomeres are the caps at the end of each strand of DNA that protect our chromosomes, like the plastic tips at the end of shoelaces. Telomere length shortens with age. Progressive shortening of telomeres leads to senescence, affecting the health and lifespan of an individual. It has been consistently demonstrated that practicing positive lifestyle behaviors lengthens telomeres; longer telomeres are indicative of better health and longer longevity. On the other hand, shorter telomeres increase the likelihood of chronic disease and a longer disease span.
So here we can see that a lifestyle medicine physician has very good reason to assess healthfulness of the patient’s lifestyle behaviors; both telomere length and epigenetic processes are in action as a direct result of a variety of lifestyle factors.
Lifestyle Factors
What are some of the main lifestyle factors that predispose us to disease or, on the other hand, that can help to supportoptimal health? Here are 39 of the main ones:
Lifestyle Factors
⦁ Attend to your spiritual health in a serious way
⦁ Get adequate but not excessive sun exposure
⦁ Avoid excessive use of medications, or if possible, avoid medications altogether
⦁ Maintain adequate vitamin B12 levels
⦁ Maintain adequate vitamin D levels
⦁ Avoid tobacco use and vaping
⦁ Avoid use of cannabis except for medically indicated conditions
⦁ Avoid excessive use of alcohol or eliminate alcohol if it is a problem
⦁ Avoid use of all illicit drugs including illicitly obtained prescribed medications
⦁ Avoid unnecessary risk taking
⦁ Get sufficient restorative sleep
⦁ Laugh, have fun, be playful and rest
⦁ Avoid excessive negative stress
⦁ Avoid excessive busyness when possible
⦁ Remain physically active; exercise five to six times weekly
⦁ Consume a plant strong diet
⦁ Consume adequate clean water daily; avoid soda and ‘sweet tea’
⦁ Mostly avoid fast food and processed foods
⦁ Use your kitchen more
⦁ Learn to interpret food labels, especially focusing on the ingredients list
⦁ Be your own best health care advocate
⦁ Select, purchase, and prepare your own food regularly
⦁ Consume certified organic and non-GMO foods when possible
⦁ Put limits on frequenting restaurants
⦁ Consider limiting exposure to popular media
⦁ Educate yourself about toxins in the air, water, food, self-care products and etc.
⦁ Seek out and maintain primary relationships that are loving and nurturing
⦁ Maintain an ideal body weight and body mass index (BMI)
⦁ Educate yourself about epigenetics, doing things that give us some control over gene expression; and adjust your lifestyle to optimize positive lifestyle behaviors
⦁ Avoid excessive financial debt
⦁ Challenge your brain; read, listen to some classical music, try to think outside the box
⦁ Use the traditional medical system selectively but attend to all medical conditions in order to maintain a healthy medical status; ideally, medical conditions will be minimized via healthy lifestyle practices
⦁ Grow and consume your own produce, including herbs, when possible
⦁ Maintain optimal gut health by consuming adequate plant-based foods
⦁ Use food supplements only after having an optimal plant-based eating regimen in place or in the case of deficiencies in vitamin B 12 or vitamin D. Unnecessary food supplements can create nutritional imbalance and may serve as a substitute for healthy food and drink, thereby compromising optimal nutrition.
⦁ Avoid screen addiction
⦁ Caretaking: if you are a caretaker for multiple children or for any late stage chronically ill person you will want to take extra good care of yourself because of the stress involved.
⦁ Get help for food addiction
⦁ Both poverty and significant wealth can pose unique lifestyle challenges
LM Resources
⦁ Seventh-day Adventist Lifestyle Centers; the Adventists operate one of the most comprehensive systems of medical and treatment centers in North America.
⦁ The American College of Lifestyle Medicine (ACLM) is the world’s flagship professional medical Association for physicians, clinicians and allied health professionals, as well as those in professions devoted to advancing the mission of lifestyle medicine.
⦁ The Institute of Lifestyle Medicine (ILM) is at the forefront of a broad-based collaborative effort to transform the practice of medicine through lifestyle medicine. This critical transformation is motivated by research indicating that modifiable behaviors — especially physical inactivity and unhealthy eating — are major drivers of death, disease, and healthcare costs. While the medical profession is generally aware of this, there has yet to be a systematic and comprehensive effort to incorporate lifestyle medicine into standard practice. We accomplish this by providing professional education focusing on knowledge, skills, tools, and clinician self-care and by creating resources for patients.
⦁ The American Board of Lifestyle Medicine (ABLM) provides Lifestyle Medicine (LM) certification including a diplomat credential, and a certification for continuing medical education providers.
⦁ The International Board of Lifestyle Medicine (IBLM), in close collaboration with the ABLM, has set out to create the first truly international Lifestyle Medicine certification, appointing the Executive Directors of the European Lifestyle Medicine Organization (ELMO), Australasian Society of Lifestyle Medicine (ASLM), the Latin American Lifestyle Medicine Association (LALMA) and the Asian Society of Lifestyle Medicine (ASLM) to the IBLM board.
⦁ The American College of Preventive Medicine (ACPM) Lifestyle Medicine Initiative. The ACPM believes that Lifestyle Medicine is a core competency of preventative preventive medicine (PM).
⦁ Greger, Michael: Nutritionfacts.org
⦁ Barnnard, Neal: Physicians Committee for Responsible Medicine
⦁ Loma Linda University Medical Center (LLUMC)
References
Buettner, Dan: ‘Blue Zones: lessons for living longer from the people who’ve lived the longest,’ National Geographic Society, 2008.
Diehl, Hans and Ludington, Aileen: ‘Health power: healthy by choice, not by chance!,’Review and Herald publishing Association, 2011.
Greger, Michael with Stone, Gene: ‘How Not to Die,’ Flatiron Books, 2015.
Katz D. Lifestyle is the medicine, culture is the spoon: the covariance of proposition and preposition. Am J Lifestyle Med. 2014;8:301-305.
Ornish, Dean, et al.: ‘Intensive lifestyle changes may affect the progression of prostate cancer,’ J Urology, September, 2005.
Polak, Rani, Poiednic, Rachele, and Phillips, Edward: ‘Lifestyle Medicine Education,’ American Journal of lifestyle Medicine, 2015 Sep; 9(5): 361–367.
Zahler, William A: ‘Health, inertia, and information: why are we sick?’ Create Space and KDP, paperback and Kindle editions, 2018.
Zahler, William A: ‘Synergy and the Dynamics of Lifestyle Change’, Create Space, pending publication, 2018.
William A. Zahler, MSW
November 29, 2018
