It's an all-too-often neglected little step in the treatment guidelines of common chronic
diseases - "lifestyle changes."
But it's there for a reason - these guidelines are based on the best-available evidence,
and the evidence is clear that simple changes to diet and lifestyle not only give us the
potential to help prevent these diseases, but can have a profound effect on the progression
of chronic disease once it has already taken hold, including the possibility of cure.
No drug will ever cure a chronic disease, and that is why lifestyle changes are the
first-line treatment.
This isn't fringe quackery or pseudo-science, it's written into the actual clinical practice
guidelines, which favour the revered randomised controlled trial, the systematic reviews RCTs
are based on and other strong forms of evidence, and thus provide a steadfast aid to clinical
decision-making.
So let's take a look at some specific guidelines for various common chronic diseases and their
risk factors.
These are the European Society of Cardiology/European Society of Hypertension clinical practice
guidelines for the management of hypertension, recommending lifestyle advice for all grades
of high blood pressure, with the decision to add drugs dependent on the success of these
lifestyle changes and the presence of other risk factors and severity of hypertension.
Which lifestyle changes to they recommend?
Unsurprisingly, it's all the usual stuff - reduce salt and alcohol, increase fruit and veg,
reduce unhealthy animal products, lose weight and exercise and stop smoking.
Next we have the European Society of Cardiology's guidelines for prevention of cardiovascular
disease, including lipid control.
Again, lifestyle advice is recommended first-line for all cholesterol levels and risk scores,
and the advice is all the stuff we're used to seeing - exercise, don't smoke and aim
for a mostly whole foods, plant-based diet.
The American Association of Clinical Endocrinologists recommends lifestyle therapy as the foundation
of treatment for both pre-diabetes and diabetes, as well as for atherosclerotic cardiovascular
disease risk factor modification in diabetes, and overweight/obesity.
Lifestyle intervention is universally regarded as the first and most important step in the
treatment of non-alcoholic fatty liver diseases, with a particular emphasis placed on weight
loss, exercise and avoidance of sugar-sweetened beverages.
Because chronic kidney disease shares common risk factors with cardiovascular disease and
diabetes, similar lifestyle measures are recommended for this disease, as seen here in the Canadian
Medical Association's guidelines.
But poor lifestyle habits play a role in the development and progression of almost all
chronic diseases through multiple different mechanisms, so I'll finish with osteoporosis
as the last example here, with the British Columbia guidelines recommending lifestyle
advice as the foundation of treatment of the disease.
We should view the identification of a risk factor or the diagnosis of a disease, especially
if in it's early stage, as a teachable moment to educate patients on the role poor lifestyle
habits have played in the pathogenesis of their health problems, and how healthy lifestyle
changes can reverse these health problems.
However, some doctors may be discouraged from advising lifestyle changes, even if they are
convinced of their efficacy, because of the assumption that their advice will be ignored.
But patients do listen to lifestyle advice from their doctors and act on that advice,
again highlighting the vital importance of proper education for doctors on diet and lifestyle.
Another stumbling block is that the established lifestyle changes and diets may be sub-optimal,
even if properly implemented.
For example, a whole foods, plant-based diet has been shown to be superior to the American
Diabetes Association's dietary recommendations for patients with type 2 diabetes for glycaemic
and lipid control.
The usual diet prescribed for hypertension, the DASH diet, whilst being a huge step in
the right direction and streets ahead of the standard Western diet, still includes animal
products despite the knowledge that they are associated with higher blood pressure.
And a vegan diet produced significantly less of that all-important inflammation than the
American Heart Association's diet in people with coronary heart disease when tested head-to-head.
How many heart disease patients are told about Dr. Dean Ornish's landmark studies in which
he has reversed heart disease and early-stage prostate cancer with his lifestyle program?
Nevertheless, even with all these problems in implementing this vital but oft-neglected
first step in the treatment of chronic disease, people are starting to realise it's potential.
Dr. Ornish's program is now reimbursable for reversal of coronary artery disease in the
US under Medicare, and other insurance companies are reimbursing it for reversal of type 2
diabetes, hypertension, obesity and high cholesterol, as well as heart disease.
There are similar reimbursement policies in place for other lifestyle medicine programs,
such as the Pritikin Program.
Progress IS being made!
So to summarise, lifestyle changes are in clinical practice guidelines for a reason
and should not be skipped over.
They are the only interventions capable of reversing a chronic disease, and patients
receiving a diagnosis have a right to know the power they have over their health destiny
with diet and lifestyle, especially given the power of using a diagnosis as a teachable
moment.
It is vital that doctors get more education about the potential of lifestyle medicine
so they can fully implement this step in practice.
Lastly, we need to prescribe the lifestyle changes proven to be the most effective.
There is great potential to fight disease with this one little step, we just need to
use it!
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know if you have any questions or comments.
That's it for now guys, talk to ye next time!
Sláinte!