Part 2: p 15-19

Question 1

Since conventional medicine may also include nutrition & physical activity, what makes lifestyle medicine any different ?

Answer 1

Although portions of lifestyle medicine (eg nutrition, physical activity) are included in other fields of medicine, LS medicine is distinct because lifestyle change is prescribed and the FIRST-LINE and MOST IMPORTANT therapy for disease treatment and reversal.

• evidence-based medications and other modalities are used, but only to supplement changes in lifestyle.

BR 15

Question 2

Does a lifestyle medicine practitioner prescribe medications ?

Answer 2

• evidence-based medications and other modalities are used, but only to supplement changes in lifestyle.

BR 15

Question 3

Interventions in LS medicine

What are the intervention modalities for lifestyle medicine ?

Answer 3

Definition of LS medicine (BR13): Feet, fingers, forks, sleep, stress, love

Feet - regular physical activity

Forks - predominantly WFPB diet

Fingers - avoid risky substances - tobacco, EtOH

Sleep - adequate sleep

Stress - stress management

Love - positive psychology & connectedness

BR 15

Question 4

In lifestyle medicine, what is meant by ‘disease reversal’ ?

Answer 4

Disease Reversal - DRS (‘doctors’)

D - Diagnostic tests/labs (-)

R - Rx - without current use of any medications

S - Signs/symptoms are not present

(BR-15)

Question 5

In lifestyle medicine, what is meant by ‘control of a chronic disease’ ?

Answer 5

cONTrOL

L - labs IMPROVED to accepted standard levels but N.O.T. normal

O- optional drugs/medical therapies

BR 15

Question 6

What is complementary / alternative medicine (CAM)

Answer 6

• an approach to medical care that is not currently considered part of conventional medicine
• uses conventional PLUS complementary/alternative medicine treatments that historically HAVE NOT BEEN WELL RESEARCHED.

BR 16

Question 7

Is it appropriate to use complementary +/or alternative medicine ?

Answer 7

• evidence-based complementary modalities are appropriate and should be utiilized
• non-evidence-based alternative treatments should be excluded.

Question 8

What is integrative medicine ?

Answer 8

• addresses patient’s whole person needs (physical, social, emotional, mental, environmental & spiritual) thru a COMBINATION of conventional AND complementary/alternative medicine
• this ‘integration’ is seen by some as a strength, and by others as a weakness.

Question 9

What is functional medicine ?

Answer 9

• focuses on the physiologic & biochemical functions of the body - cellular metabolism, digestive function, detoxification & control of oxidative stress
• tends to emphasize testing of hormones/metabolites that are not well-proven or generally accepted within evidence-based medicine and is thus still somewhat controversial.

BR 16

Question 10

Describe mind-body medicine & its modalities

Is it evidence-based ?

Answer 10

• investigates the interactions between the body & mind behaviourly, emotionally, mentally, socially & spiritually
• treats using relaxation, hypnosis, visual imagery, meditation, yoga, biofeedback, spirituality, tai chi etc
• while some mind-body medicine is very solidly evidence-based, other aspects are still unproven.

BR 16

Question 11

What does preventive medicine include ?

What sort of interventions does it emphasize ?

Answer 11

• includes all aspects of morbidity and mortality prevention for the general public (ie oversees the field of public health)
• emphasizes population-based interventions that include immunizations, screening and protection from bioterrorism.

Question 12

What is the role of the patient and provider in conventional medicine ?

Answer 12

• pts are recipients of care and other than complying with treatments are not required to make signficiant changes.
• providers are considered responsible for care and outcomes while the patient is a passive reciever of medical services.

BR 16

Question 13

What is the role of the provider in lifestyle medicine ?

Answer 13

Provider acts as both a medical expert and a coach

BR 15

Question 14

Name two key elements for clinicians wanting to improve patient health behaviours & outcomes (relatiing to the doctor & the patient) ?

(context: role of behavioural determinants of positive health outcomes)

Answer 14

1) A trusting relationship betweeen physician & patient
2) Patient support: multidisciplinary team, loved ones, greater community

BR 17

Question 15

List the top 10 causes of death in the USA in 2015

Answer 15

(Not in order, BR 17)

1) Heart disease
2) CNS - stroke, Alzheimmer’s
3) Resp - chronic lwr respiratory diseases, influenza/pneumonia
4) Cancer
5) Accidents & self-harm
6) Diabetes
7) Renal - nephritis, nephrotic

Question 16

3 factors

What factors account for 80% of all premature deaths ?

Answer 16

1) Tobacco use
2) Poor diet
3) Lack of physical activity

(Other- BMI, EtOH)

BR 18

Question 17

What proportion of people still smoke (USA) ?

Answer 17

1 in 7 still smoke

BR 18

Question 18

What proportion of people eat a diet low in fruits & vegetables ?

Answer 18

About 3 out of 4

BR 18

Mn “Know about 3 - 4 - 5 if you want to stay alive”:

• 3/4 insufficient vegetables
• 4/5 in sufficient exercise

Question 19

What proportion of people don’t get enough physical activity ?

Answer 19

About 4 out of 5 (80%)

BR 18

Mn “Know about 3 - 4 - 5 if you want to stay alive”:

• 3/4 insufficient vegetables
• 4/5 in sufficient exercise

Question 20

What proportion of diabetics follow accepted dietary guidelines for saturated fat ?

Answer 20

Only 11%

BR 18 (ref 29)

Mn: Gerstein

Question 21

What proportion of patients with heart disease continue to smoke ?

Answer 21

8%

BR 18 (ref 30, 31)

Mn: Suzanne A on gate w cigarette

Question 22

What proportion of the variance in health can be explained by DNA sequence (genes) vs epigenetics (environment) ?

Answer 22

When it comes to variance in health status:

• about 10% is from DNA sequence (genes)

~ 70-90% is from epigenetics (gene switches)

BR 18

PNAS 2005 (July 26):102(30):10604-9

Question 23

What predicts health literacy rates ?

Answer 23

People with higher education have higher health literacy rates

BR 19

Question 24

What do we see in subjects with low health literacy rates ?

Answer 24

1) Higher rates of hospital admissions & physican visits
2) Less knowledge & poorer managment of serious health conditions (eg HIV, asthma, diabetes)

BR 19

Question 25

5 conditions

List local environmental conditions which are determinants of health

Answer 25

1) Air pollution
2) Second hand smoke
3) Water supply
4) Food deserts
5) War, famine, earthquakes etc

Question 26

What role does socioeconomic status have in health ?

Answer 26

Lower SES correlates with poorer health regardless of country studied.

BR 19

Question 27

What influence does race have on access to health interventions ?

Answer 27

Racial minorities have less access to interventions

BR 19

Question 28

Which socioeconomic factor best predicts good health ?

BR 19

Answer 28

Higher education best predicts good health

BR 19

Question 29

List factors which result in different underlying rates of illness (and thus lead to disparities in health outcomes & health care):

Answer 29

1) Genetic predisposition
2) Local environmental conditions
3) Poorer care
4) Poor lifestyle choices
5) Different care-seeking behaviors
6) Linguistic barriers
7) Lact of trust in health care providers.

BR 19

Question 30

List 4 broad determinants of health

Answer 30

1) Adverse childhood events
2) Genetic & epigenetic predisposistions
3) Health literacy
4) Local environmental conditions

BR 18-19

Question 31

Name 4 lifestyle modification services to be provided by health care providers under the first and current National Prevention Strategy (2011)

Answer 31

1) Physicial activity - assessments & counselling
2) Obesity - screening & nutrition counseling
3) EtOH - screening & conselling for excessive use
4) Smoking - cessation services

BR 20

• implemented by Regina Benjamin MD (surgeon general)

Question 32

Smoking, BMI, F&V, Exercise

What proportion of patients had healthy levels of 4 key health behaviours ?

BR 18

Answer 32

• only 3% had healhty levels of all four health behaviours:

Five Fruits + veggies/day 23%

Non-Obese (BMI<25) 40%

Regular Exercise 22%

Non-Smoking - 76%

BR 18

Mn - ‘FOES to good health for 97%” (by Regina Benjamin)