Harmony in Health: Bridging the Gap Between Lifestyle Interventions and Traditional Medicine—A Personal and Professional Perspective
Author: Chhaya Makhija, MD (American Board certified Endocrinologist & Lifestyle Medicine Specialist)
The Question? In the realm of preventing and managing complex conditions like diabetes mellitus, hypertension, heart disease, hypercholesterolemia, stroke, obesity, fatty liver disease, mental health, certain malignancies and beyond, guidelines consistently advocate for a foundational approach—lifestyle modification. However, the pivotal question arises: who guides patients through this intricate maze of lifestyle changes, customizing recommendations to suit individual needs?
This dilemma echoes in the minds of patients, physicians, and even within community discussions. While a referral to a nutritionist or dietitian is a plausible step, it often falls short of immediately addressing the myriad questions our patient’s harbor. But it's not just about nutrition. What about physical activity or movement? How does one navigate the labyrinth of sleep hygiene? What coping mechanisms are in place for managing stressors? Substance use counseling and fostering social connections—are these not integral components of overall health? World Health Organization defines, “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. The holistic nature of well-being demands aligning evidence-based strategies and lifestyle interventions for a comprehensive approach.
In our roles as physicians and educators, the bedrock of our practice lies in evidence-based science and medicine. The American Diabetes Association highlights a range of lifestyle programs, demonstrating the evidence and possibility of reducing the risk of developing type 2 diabetes by almost 50% by adopting small changes overtime. The American College of Cardiology is actively engaged in promoting cardiovascular health through its "Food as Medicine Initiative". Recognizing the pivotal role of nutrition in heart health, this initiative reinforces the idea that dietary choices are integral to cardiovascular disease prevention. The American Heart Association provides evidence-based educational steps encapsulated in "Life's Eight Essentials." These comprehensive steps include Eat Better, Be more Active, Quit Tobacco, Get Healthy Sleep, Manage Weight, Control Cholesterol, Manage Blood Sugar, and Manage Blood Pressure. For Non-Alcoholic Fatty Liver Disease (NAFLD) and fibrosis, the American Gastroenterology Association advocates lifestyle modifications as a foundational approach. Their best practice advice underscores the benefits of lifestyle changes, particularly weight loss ≥5% of total body weight can decrease hepatic steatosis, weight loss ≥7% of total body weight can lead to nonalcoholic steatohepatitis resolution, and weight loss ≥10% of total body weight can result in fibrosis regression or stability. The World Health Organization (WHO) Guidelines on risk reduction of cognitive decline and dementia emphasize evidence-based recommendations on lifestyle behaviors. These guidelines provide a roadmap for individuals to adopt interventions that can delay or prevent cognitive decline and dementia.
Other prominent societies, including the American Rheumatology Association and the American Psychological Association, echo this sentiment. Their recommendations center on behavioral modifications and lifestyle changes, with a specific focus on nutrition, physical activity, sleep, and stress management. The substantial evidence supports these interventions for both disease prevention and management, often complementing medications synergistically.
The Challenges: Reflecting on our own educational journeys during medical school, residency, and fellowship, the absence of a dedicated class or subject on lifestyle, nutrition, or the psychology behind understanding a patient's readiness for lifestyle interventions is palpable. The constraints of time during medical appointments exacerbate the challenge, leaving a mere window for a cursory discussion. Referrals to nutritionists, dietitians, and cognitive behavioral therapists come along with limited availabilities as well as long waits for referrals.
Within the confines of clinics and hospitals, handouts listing lifestyle changes abound. However, for our patients and the community, it's not just about the "What" but the critical "How to." The missing link lies in the practical application of these changes in the day-to-day lives of individuals.
The Solutions: As an endocrinologist, this integration has not only empowered my patients but has also become a source of professional fulfillment. It's a journey that transcends the traditional disease-centric model, focusing on reducing both disease and medication burden. Witnessing, in certain cases, the reversal of disease adds a profound dimension to the therapeutic relationship. This is more than a clinical strategy; it's a commitment to improving health outcomes and enriching lives. Lifestyle medicine is a medical specialty with focus on six pillars —a whole-food, plant-predominant eating pattern, physical activity, restorative sleep, stress management, avoidance of risky substances and positive social connections.
The emphasis on the importance of these factors, as we advance in science and witness groundbreaking discoveries in areas such as diabetes, obesity, cardiovascular diseases, mental health, oncology, and rheumatology, becomes even more crucial in the contemporary medical landscape. Commendably, our near-future physicians at CHSU-COM, Clovis, CA are equipped with the indispensable tool of nutrition education.
Undoubtedly, the integration of Lifestyle Medicine demands time, access, education, and ongoing support for patients and their families. It's a testament to the enduring commitment required for a transformational shift in health. The long-end game that Lifestyle interventions embodies is not without its challenges, but the absence of side effects makes it a remarkable endeavor.
As a physician, I recognize that education stands as a potent ally, a tool that not only alleviates anxiety but also addresses the myriad worries and concerns that accompany chronic conditions.
Education becomes the catalyst, offering a platform where patients can voice their questions, clarify doubts, and seek guidance. Sometimes, it's the gift of time—time to delve into their concerns, understand their fears, and empower them with knowledge. At other times, it's about steering them towards the right physical activities, educating them about foods that nourish their bodies, or assisting them in budgeting for weekly food expenses. By stabilizing the mental and psychological aspects of health, patients are better equipped to navigate the intricate path toward controlling parameters like blood sugar, weight, blood pressure, cholesterol, and more.
As physicians, educators, and advocates for health, our role extends beyond the confines of diagnosis and prescription. It's about instilling confidence, providing the right tools, and fostering a mindset that views health as an ongoing journey, not a destination. Crucially, patient accountability takes center stage. The narrative shifts from passive recipients of healthcare to active participants in their well-being. Tracking progress, celebrating victories—no matter how small—and fostering a sense of ownership become integral aspects of patient care.
The epidemic of obesity, type 2 diabetes, fatty liver disease, insulin resistance, and hypertension looms large, casting a shadow over both adults and the younger generation. For pediatricians, the urgency is amplified. Obesity, diabetes type 2, and hypertension are increasingly infiltrating childhood, setting the stage for a lifetime of health challenges. It's about instilling habits that transcend the clinic walls, creating an environment where health is an integral part of daily life.
Small changes, when embraced collectively by families, have the potential to exert major impacts. It's not about radical transformations; it's about introducing healthier choices into our everyday routines. Discussions about nutrition become family dialogues, physical activities transform into shared adventures, and sleep hygiene becomes a household priority.
In this era of interconnectedness, the impact reverberates beyond individual lives. It extends to communities—a shared commitment to a healthier, more resilient future. It's about inspiring change, providing the tools for transformation, and fostering a culture where health is an evolving journey—a journey that, even in its smallest steps, holds the promise of a brighter, healthier tomorrow.