Written by Jess Mullins
We’ve all heard the buzz around the term ‘Lifestyle Medicine’ lately. And while the hype and focus may be a modern phenomenon, the concept and principles definitely aren’t. In this article, we explore some of the biggest impacts on Lifestyle Medicine and unpack how this practice evolved into what it’s become today.
What is Lifestyle Medicine?
In Lifestyle Medicine lifestyle interventions are used as medicine to prevent and treat lifestyle-related conditions. It sounds simple and obvious that if we know the cause of an illness, treatment should be focused on removing the cause. This is easy in acute medicine – for example, if you get pneumonia, you’ll be treated with antibiotics to get rid of the bacteria causing the infection. All you, as the patient, would need to do, is to take your tablets as prescribed, and you’ll get better.
The ‘treat the cause to get rid of the disease’ approach doesn’t work so well for lifestyle-related illnesses. It is also not easy to implement. Treating the cause requires behaviour change. Behaviour change requires social, emotional and physical capacity to make changes. And each patient will present with a unique biological, emotional and social package that will challenge their ability to change their behaviour. The physician’s role is to educate, motivate and support, the patient’s responsibility is to go home and make the changes. It is often a two steps forward, one step back journey, and it takes time. It is easy to see why treating the cause of chronic illnesses may be considered ‘too hard’. It is much easier to prescribe medications to control the symptoms and effects of these conditions.
How our lifestyles have drastically changed
Hippocrates, born 2,400 years ago and considered the father of modern medicine, was the first to describe diseases and their treatment in the context of a diagnostic system based on clinical observation and logical reasoning. He focused on the natural causes of disease, and believed that illness could be prevented and that nature can heal. He also emphasised the importance of treating the whole person, i.e. body and mind in the context of a patient’s natural environment.
He suggested that ‘in order to stay healthy, one should simply avoid too much food and too little toil’. His quotes ‘If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health’, and ‘It is far more important to know what person the disease has than what disease the person has’ perfectly describe what personalised lifestyle and nutritional medicine is about. One can only assume that he practiced what he preached as he lived to the ripe old age of 104!
The Industrial Revolution in the 18th and 19th centuries brought with it significant economical, industrial and technological advances. It also brought with it a change in lifestyle. People moved from living on farms to living in populated cities and working in factories. This increased their exposure to infectious illnesses. Scientists developed the ‘germ theory’ and started to focus on hygiene and antiseptics for the treatment of wounds. In 1804, the first pharmaceutical medicine was produced in a laboratory. It was morphine. Up until then illnesses were treated with different plants and minerals processed into potions, powders and creams. While some of these worked and are included in modern medicines, most were quite useless.
This may explain why Thomas Edison, the famous inventor, predicted in 1902 that “the doctor of the future will give no medicine, but will instruct his patient in the care of the human frame, in diet and the cause and prevention of disease”. He stated that ‘every new discovery of bacteria shows us all the more convincingly that we have been wrong and that the million tons of stuff we have taken was all useless’, and concluded that ‘surgery, diet, antiseptics – these are the vital things of the future in preserving the health of humanity. There were never so many able, active minds at work on the problems of diseases as now, and all their discoveries are tending to the simple truth – that you can’t improve on nature’.
And then, along came the successful isolation of insulin to treat diabetes and the accidental discovery of Penicillin in 1928 and sulfa antibiotics in 1935. The war was followed by a ‘golden age’ of drug development, thanks to generous funding and support for the pharmaceutical companies. The 1900s also saw the introduction of ready-to-eat packaged food, complete with preservatives, colourants and flavourings to make it more palatable. Easy access to high energy foods, eating on the run, sedentary desk jobs and increasing couch-time, and increased stress medicated with alcohol and tobacco saw lifestyle related illnesses overtake infectious diseases as the main causes of death by the late 1990s. Pharmaceutical advances mean that we can live longer, but not necessarily healthier, as most chronic lifestyle-related illnesses can not be cured with medicines.
Evolution of Lifestyle Medicine
The term ‘Lifestyle Medicine’ was first coined in 1990, when Rippe stated that ‘’lifestyle medicine involves the integration of lifestyle practices into the modern practice of medicine both to lower the risk factors for chronic disease and / or, if disease is already present, serve as an adjunct to therapy’.
The discovery in 1999 of a form of low-grade, systemic inflammation, associated with almost all chronic conditions, and closely linked with lifestyle factors, has changed the way we look at chronic illness. In a way it allowed for the ‘germ theory’ to be applied to chronic illness.
Yes, there are many drivers of chronic illness, but downstream from all these drivers, fuelling the disease process, is a chronically activated immune system responding to the effect of our energy-dense nutrient-poor diets, our lack of activity, our excessive stress levels, our disrupted sleep patterns, etc. on our body. Suddenly we could put all the different lifestyle-related causes in one basket and label it inflammation. And inflammation is reversible. This gave us a compelling reason to take a fresh look at lifestyle and behaviour change and explains the ‘emerging’ field of Lifestyle Medicine.
Rather than emerging, I would say it is a dusting off and a revamping of a common sense, holistic, back-to-basics approach to our patients, as practiced almost 2,500 years ago by Hippocrates.