Lifestyle Medicine: what is it?

Dr Milli is passionate about lifestyle medicine and its use in hormone health. In our upcoming issues, she will take us through the pillars of lifestyle medicine, from how it can help you sleep to positive psychology.

Lifestyle medicine is a new emerging medical discipline which looks at the current evidence and research and how we can use this to prevent, treat and reverse long-term health conditions. These conditions include obesity, heart disease, strokes, cancer, high blood pressure, chronic pain, high cholesterol, joint issue, hormonal dysfunction and even some skin conditions.  This way of practising is very much needed due to the burden on the NHS and healthcare system, and we need to educate people on how to improve their health and empower them on this journey.

Lifestyle medicine is not just a case of eating less, moving more and sleeping better; it has much more depth. It comprises six key pillar areas below, many closely interrelated and overlapping.

Six Key Pillar Areas

1. Nutrition
2. Physical activity
3. Sleep
4. Mental health
5. Positive psychology
6. Avoidance of toxic substances

This highlights the importance of understanding everyone and being detailed in our questioning to ensure we obtain all the necessary information to inform management, which should be shared and done with the patient to improve outcomes.

We know that 80% of early deaths are related to three critical aspects of our lifestyle and behaviours; poor diet, physical inactivity and smoking. It, therefore, stands to reason that we can and should target our lifestyle to make improvements.

Let’s look at a few examples; if we eat more processed foods and engage in unhealthy behaviours such as smoking and binge drinking alcohol, this can result in obesity and less desire to engage in physical activity. Obesity can cause chronic joint pain, which can negatively affect our mental health and cause low mood and depression, further impacting our sleep quality. Poor sleep can lead to increased hunger, overeating processed food, and further weight gain, worsening joint pain. This cycle can be self-perpetuating and continues around in circles. Breaking this cycle is critical, and much work in lifestyle medicine involves supporting individuals in making these changes.

“The answer is not to just put a plaster on these symptoms and take a magic pill to fix them; it is to address the underlying lifestyle issues contributing to the problem…”

An example is a middle-aged female with two teenage children who is in a stressful job juggling and spinning too many plates, with multiple after-school activities and events. Time is limited, resulting in fast food, takeaways a couple of times a week, and copious caffeine intake. To counteract the onset of stubborn belly fat, multiple high-intensity interval training sessions ensue throughout her menstrual cycle with little rest and sleep. The consequence is high-stress levels, high cortisol and subsequent inflammation, low progesterone and feelings of stress. This leads to increased alcohol intake during the week to help cope, which impacts the quality of sleep—poor sleep results in tiredness, more caffeine and increased hunger and calorie intake the following day. The weight continues to rise, and anxiety further increases due to this, and further unhealthy lifestyle behaviours are adopted. The answer is not to just put a plaster on these symptoms and take a magic pill to fix them; it is to address the underlying lifestyle issues contributing to the problem; it is educating women on how to eat and train according to their menstrual cycle and how to reduce levels of stress.

“Many factors determine our health; it’s a delicate interaction between nature and nurture.”

Another example is a middle-aged man in a sedentary job as a taxi driver who smokes 20 cigarettes daily and has recently been diagnosed with type 2 diabetes. He constantly feels hungry despite what he eats, which he believes is a healthy diet; breakfast cereal and orange juice for breakfast, a sandwich for lunch with some crisps and then pasta for tea. The weight continues to increase, which worsens his sugar level control. His weight interferes with his sleep as he has started snoring, so he feels tired. The tiredness means he struggles to exercise, contributing to his feeling low and negative about his condition. For most, type 2 diabetes is a lifestyle-related chronic condition and CAN be prevented, treated, and, in many cases, reversed with lifestyle changes.

What is unique about lifestyle medicine is that it uses lifestyle first in managing conditions. Yes, some people may need medications and conventional medicine to complement this, but adopting lifestyle change is paramount first.

Many factors determine our health; it’s a delicate interaction between nature and nurture. Our destiny is not just the information written in our ‘genes’ – the information in our cells that tell our body what to do. Our lifestyle and surrounding environment can also interact with our genes and turn them ‘on’ and ‘off’ – an area known as epigenetics.  It stands to reason that if we can modulate and promote our health by modifying our lifestyle, we can use this to help prevent adverse health outcomes.

“There is no one size fits all approach with it. This holistic approach to care is vital for better outcomes.”

As we are all different genetically and have other life goals, everyone should have a personalised management plan for the above pillars and be actively involved in their care, which should address the person as a whole; there is no one size fits all approach to it.  This holistic approach to care is vital for better outcomes.

Moreover, behaviour and motivation are critical fundamental areas underpinning the above pillars. We must ‘want’ to change our poor habits in each area and have adequate support to make a change.  Your healthcare professional should be able to give you key actionable lifestyle medicine prescriptions on what you can do to improve your health. It is beneficial to use ‘positive’ prescriptions to add something beneficial to our lifestyle, e.g., eat 30 diverse plant foods a week, rather than negatives, e.g., don’t eat as many biscuits! Prescriptions and goals must be specific, measurable, attainable, realistic and time-bound (SMART). SMART goals are more likely to be achieved. It is not just a case of ‘do more exercise’. A SMART prescription example for someone recovering from a knee replacement a month ago would include; walking daily for the next two weeks, for 30 minutes a day – this encompasses all features of a SMART goal, with the walking being a specific exercise which is doable and realistic given the recent knee operation and 30 minutes a day for two weeks is measurable and time-bound.

Over the following months, we will dive deeply into the six pillars of lifestyle medicine in more depth and detail.  Do you know your kimchi from your kombucha or your sourdough from your sauerkraut? How much physical exercise should we do a week? What are macros? How much sleep do we need? What is the egg myth? What are prebiotics? What are probiotics? What is the gut microbiome? – a hot topic receiving much media attention at present. Some common conceptions and misconceptions will be addressed and answered with top tips and actionable takeaway points to empower you to change.

I am passionate about education and ensuring people understand the science and reason behind illnesses. If we know where the problem lies, we can try to fix and reverse the issue. Prevention is better than cure, so awareness of maintaining a healthy lifestyle is crucial.

Until next time…

Dr Milli Raizada, GP, lifestyle medicine physician

Follow: @drmilli

Podcast show host: Boost & Biohack your health with Dr Milli

NorthernLife July/Aug 23