Exploring Lifestyle Medicine: Preventing, Treating and Managing Chronic Disease Through Behavioral Interventions

October 17, 2022

More than two-thousand years ago Aristotle stated, “we are what we repeatedly do”, a profound insight that still holds true when it comes to the impact that repetitive behaviors have on lifestyle, and in turn, health. The rapidly growing demand for lifestyle interventions among patients seeking to make sustainable and healthy behavior changes has led to the emergence of an evidence-based practice called lifestyle medicine.

What is Lifestyle Medicine?

Lifestyle medicine (LM) is a medical approach that uses evidence-based behavioral interventions to prevent, treat, and manage chronic disease. Most chronic lifestyle related diseases (LRD) are preventable. Chronic disease and mental health conditions are leading causes of death and disability in the United States and are responsible for $3.4 trillion in annual health care expenditures.1 The Centers for Disease Control and Prevention (CDC) estimates that six in 10 Americans have at least one chronic disease and four in 10 have two or more chronic diseases.2

The European Lifestyle Medicine Organization states that to treat the causes of these chronic, lifestyle related diseases, and to be successful in prevention, a strong focus must be placed on lifestyle.3 The American College of Lifestyle Medicine (ACLM) defines Lifestyle Medicine as “the use of lifestyle interventions in the treatment and management of disease.” It continues that “such interventions include diet (nutrition), exercise, stress management, smoking cessation, and a variety of other non- drug modalities.”4 The goal and primary focus of Lifestyle Medicine is to promote healthier lives through beneficial environments and healthier lifestyle choices.

Key Pillars of Lifestyle Medicine

While the specific pillars for what comprise lifestyle medicine vary by institution, the primary tenets are consistent. According to the ACLM, the six pillars of lifestyle medicine include a whole-food, plant- predominant eating pattern, physical activity, restorative sleep, stress management, avoidance of risky substances and positive social connections. Dr. Dean Ornish, who has been studying lifestyle medicine for over 35 years summarizes the pillars by saying to “eat well, move more, stress less, love more.”5

The below table demonstrates important differences between lifestyle medicine and traditional western medicine6:

Differences between traditional/conventional and lifestyle medicine approaches in primary care

Traditional/Conventional medicine

Lifestyle Medicine

Treats individual risk factors

Treats lifestyle causes

Patient is a passive recipient of care

Patient is an active partner in care

Patient is not required to make major changes

Patient is required to make major changes

Treatment is often short term

Treatment is always long term

Medication is often the ‘end’ treatment

Medication may be needed, but the emphasis is on lifestyle change

Emphasizes diagnosis and prescription

Emphasizes motivation and compliance

Goal is disease management

Goal is primary/secondary/tertiary prevention

Less consideration of environment

More consideration of environment

Side effects are balanced by benefits

Side effects that impact lifestyle require greater attention

Involves other medical specialties

Involves allied health professionals

Doctor generally operates independently, on a one-to-one basis

Doctor is part of a team of health professionals
This table is cited from <Lifestyle Medicine: Managing disease of lifestyle in the 21st century> Battersby M, Egger G, Litt J. Introduction to lifestyle medicine. In: Egger G, Binns A, Rossner S, editors. Lifestyle medicine: managing disease of lifestyle in the 21st century. 2nd ed. McGraw- Hill Australia Pty Ltd; Noth Ryde: 2011. p. 5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4390753/

Research Review: How Lifestyle Medicine May Treat, Prevent, and Even Reverse Disease

As it stands today, there is an ever-growing body of research that demonstrates lifestyle medicine as an effective and economical tool for treating, preventing, and even reversing disease. Literature shows that conditions such as heart disease7, diabetes8, depression9 and some cancers10, 11, amongst many other lifestyle related diseases, can be effectively managed with lifestyle medicine.

It is suspected that prevention and treatment of illness occurs on a genetic level. However, research shows lifestyle changes significantly increase telomerase; the enzyme responsible for maintaining telomere length. Telomeres are the ends of chromosomes that influence how long we live.12 In addition, it has been shown that lifestyle changes can turn on health-promoting genes and turn off disease-promoting genes.13

The Role of Healthcare Professionals

As healthcare professionals it is our job to advocate healthy lifestyles to our patients. This means connecting with patients on a human level and speaking with them about their lives to better understand their daily habits, stressors, diet, sleep, movement, homelife. This ultimately helps patients strategize and problem-solve ways to manage and balance their lives, while making health a priority.

Erin Palinski-Wade RD, CDE, and Orgain Nutrition Advisory Board Member recommends the following stress-reduction tips to her clients:

  1. Practice belly breathing. The simple act of taking slow, controlled breathes in through your nose deep into the abdomen, holding for a few seconds, and then exhaling fully through pursed lips like you are whistling can instantly calm the body. These deep breathes can lower heart rate and reduce circulating stress hormones while helping you to feel relaxed and energized.
  2. Get moving. Physical activity can help to manage stress by releasing the feel-good chemical serotonin which can elevate mood. In addition, physical activity can support improved sleep, which further benefits stress levels.
  3. Make sleep a priority. When you get inadequate sleep, fatigue can cause a decline in mood which can exasperate stress. Prioritize sleep by scheduling a set sleep and awake time each night, removing distractions from the bedroom, and avoiding stimulating activities right before bed such as using electronics, performing vigorous exercise, or consuming excessive caffeine.
  4. Increase your intake of vitamin C. This antioxidant has been found to help reduce levels of circulating stress hormones in the blood. Add plenty of dark green leafy vegetables, tomatoes, peppers, and citrus fruits to ensure you are meeting your daily needs.
  5. Avoid skipping meals. When you skip meals, blood sugar can crash which can cause irritability and a poor mood…which only elevates feelings of stress. Instead, eating meals and snacks balanced in lean protein, fiber, and healthy fats can help to stabilize blood sugar (and mood) throughout the day. Keeping on-the-go options such as Orgain Clean Protein Shakes with 20 grams of quality protein on hand can be a great way to ensure balanced nutrition no matter how busy the day may get.

Implementing the Lifestyle Medicine Approach in Practice

Research shows the field of lifestyle medicine is growing rapidly as individuals and communities seek solutions to the hardship of chronic disease. Providers across various medical specialties and health professions are gaining certification in this field but struggling with implementation. Time constraints, concern about reimbursement, and lack of clinical experience in counseling patients are often cited as obstacles. There are new resources being created to address these issues and demonstrate how lifestyle medicine can be successfully practiced in standard primary care settings.14

The American Academy of Family Physicians has created a comprehensive guide “Incorporating Lifestyle Medicine into Everyday Family Practice: Implementation Guide and Resources” to help practitioners incorporate lifestyle medicine and better serve their patients.15 Elizabeth Motley, MD has come up with “A Model for Aspiring Lifestyle Medicine Practitioners” to build a lifestyle medicine care clinic and identified the following clear steps: Engage local community, utilize a primary certification, use lifestyle medicine intake form, teach simple concepts in the office, provide at-home learning activities, bill effectively, refer to health coaches and outside programs.16 As lifestyle medicine continues to improve health, cut healthcare costs and prove its effectiveness, it will continue to grow, as practitioners it will be important to advocate for lifestyle medicine amongst our peers and allied health professionals and implement this meaningful treatment with our patients.

Learn more with Orgain Healthcare!

For more science-based education on lifestyle medicine and the key pillars of health and wellness, tune in to episode 18 of The Good Clean Nutrition Podcast which features lifestyle medicine guru, Dr. Dean Ornish. For over 35 years, Dean Ornish, M.D., has been a leader in the field of lifestyle medicine. Dr. Ornish and his colleagues at the Preventive Medicine Research Institute (PMRI), have conducted research studies showing that changes in diet and lifestyle can make a powerful difference in our health and well-being, how quickly these changes may occur, and how dynamic these mechanisms can be.

Episode 18: Mind, Body, Community: The Connection between Relationships, Stress & Health with Dean Ornish, MD.

Listen Here >>

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  1. Centers for Disease Control and Prevention. Health and economic costs of chronic diseases. www.cdc.gov/chronicdisease/about/costs/index.htm
  2. Centers for Disease Control and Prevention. Chronic diseases in America. National Center for Chronic Disease Prevention and Health Promotion. Accessed April 2, 2021. www.cdc.gov/chronicdisease/ resources/infographic/chronic-diseases.htm
  3. What is lifestyle medicine? The European Lifestyle Medicine Organization. (n.d.). Retrieved September 19, 2022, from https://www.eulm.org/what-is-lifestyle-medicine
  4. American College of Lifestyle Medicine. (n.d.). Retrieved September 19, 2022, from https://lifestylemedicine.org/about-us/
  5. Ornish, D., & Ornish, A. (2019). Undo it!: How simple lifestyle changes can reverse most chronic diseases: Move more, eat well, stress less, Love more. Ballantine Books.
  6. Egger G, Binns A, Rossner S, editors. Lifestyle Medicine: Managing Disease of Lifestyle in the 21st Century. 2nd ed. McGraw-Hill Australia Pty Ltd; Noth Ryde: 2011. p. 5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4390753/
  7. Ornish, D., Scherwitz, L. W., Billings, J. H., Brown, S. E., Gould, K. L., Merritt, T. A., Sparler, S., Armstrong, W. T., Ports, T. A., Kirkeeide, R. L., Hogeboom, C., & Brand, R. J. (1998). Intensive lifestyle changes for reversal of coronary heart disease. JAMA, 280(23), 2001–2007.
  8. Pischke, C. R., Weidner, G., Elliott-Eller, M., Scherwitz, L., Merritt-Worden, T. A., Marlin, R., Lipsenthal, L., Finkel, R., Saunders, D., McCormac, P., Scheer, J. M., Collins, R. E., Guarneri, E. M., & Ornish, D. (2006). Comparison of coronary risk factors and quality of life in coronary artery disease patients with versus without diabetes mellitus. The American journal of cardiology, 97(9), 1267–1273. https://doi.org/10.1016/j.amjcard.2005.11.051
  9. Pischke, C. R., Frenda, S., Ornish, D., & Weidner, G. (2010). Lifestyle changes are related to reductions in depression in persons with elevated coronary risk factors. Psychology & health, 25(9), 1077–1100. https://doi.org/10.1080/08870440903002986
  10. Orman, A., Johnson, D. L., Comander, A., & Brockton, N. (2020). Breast Cancer: A Lifestyle Medicine Approach. American journal of lifestyle medicine, 14(5), 483–494. https://doi.org/10.1177/1559827620913263
  11. Ornish, D., Weidner, G., Fair, W. R., Marlin, R., Pettengill, E. B., Raisin, C. J., Dunn-Emke, S., Crutchfield, L., Jacobs, F. N., Barnard, R. J., Aronson, W. J., McCormac, P., McKnight, D. J., Fein, J. D., Dnistrian, A. M., Weinstein, J., Ngo, T. H., Mendell, N. R., & Carroll, P. R. (2005). Intensive lifestyle changes may affect the progression of prostate cancer. The Journal of urology, 174(3), 1065–1070. https://doi.org/10.1097/01.ju.0000169487.49018.73
  12. Ornish, D., Lin, J., Daubenmier, J., Weidner, G., Epel, E., Kemp, C., Magbanua, M. J., Marlin, R., Yglecias, L., Carroll, P. R., & Blackburn, E. H. (2008). Increased telomerase activity and comprehensive lifestyle changes: a pilot study. The Lancet. Oncology, 9(11), 1048–1057. https://doi.org/10.1016/S1470-2045(08)70234-1
  13. Ornish, D., Magbanua, M. J., Weidner, G., Weinberg, V., Kemp, C., Green, C., Mattie, M. D., Marlin, R., Simko, J., Shinohara, K., Haqq, C. M., & Carroll, P. R. (2008). Changes in prostate gene expression in men undergoing an intensive nutrition and lifestyle intervention. Proceedings of the National Academy of Sciences of the United States of America, 105(24), 8369–8374. https://doi.org/10.1073/pnas.0803080105
  14. Freeman KJ, Grega ML, Friedman SM, Patel PM, Stout RW, Campbell TM, Tollefson ML, Lianov LS, Pauly KR, Pollard KJ, Karlsen MC. Lifestyle Medicine Reimbursement: A Proposal for Policy Priorities Informed by a Cross-Sectional Survey of Lifestyle Medicine Practitioners. International Journal of Environmental Research and Public Health. 2021; 18(21):11632. https://doi.org/10.3390/ijerph182111632
  15. Bonnet, J., Bharati, R., Vorbeck, L., Kovach, K., Harvey Mansfield, K., Polk, E., & Sayess, P. (2021). Incorporating lifestyle medicine into everyday family practice. Incorporating Lifestyle Medicine into Everyday Family Practice: implementation guide and resources. Retrieved from https://www.aafp.org/dam/AAFP/documents/patient_care/lifestyle-medicine/lifestyle- medicine-guide.pdf
  16. Motley E. (2020). Building a Thriving Lifestyle Medicine Practice Within a Primary Care Clinic: A Model for Aspiring Lifestyle Medicine Practitioners. American journal of lifestyle medicine, 14(2), 133–136. https://doi.org/10.1177/1559827620904868

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