Section 1: Introduction (4%) Flashcards
define Lifestyle Medicine
ACLM: LM uses evidence-based lifestyle therapeutic approaches to prevent, treat and oftentimes reverse lifestyle-related chronic disease. The LS approach includes: a predominantly whole-food, plant based diet, regular physical activity, adequate sleep, stress management, avoidance of risky substance use, use of other non-drug modalities that promote health and prevent disease
2018 LM Core Competencies: LM offers a unique approach that leaverages a whole food, plant based diet, phys act, sleep, emot wellbeing, avoiding risky substances to not only prevent but also treat and reverse ls-related diseases
LM G Egger: LM is application of medical, behavoural, motivational and environmental principles to the management of LS related health problems in a clinical setting. Teaching self care and self-management are important elements of LS medicine.
what is ITLC and name some notable published ones
Intensive Therapeutic Lifestyle change programs:
- drastic changes in LS domains
- usu delivered in gps
- usu 60 min visits, one to 3/ week, 3 to 18 weeks; shorter progs exist
- always involves multidisciplinary team
- evidence based methods
- accepted research methods
- Pritkin, Ornish, Diehl CHIP prog’s
- induction–> maintenance
Briefly outline the role of: Hippocrietes, Edison
- Hippocrites “let you food be your medicine and your medicine be your food”
- Thomas Edison: “ the docotr of the future will give no medicine but will interest his patients in the care of human frame, in diet and in the cause and prevention of disease”
BRiefly describe the role of Nnathan PRitkin in LMM
1970’s: residential healthcare centre that used nutrition , exercise and education to treat ad reverse heart dis
BRiefly describe the role of John Mc Dougal in LM
1970: residential; unlimited plant based diet, stress reduction, exercise to treat and reverse HD
BRiefly describe the role of Dean Ornish in LM
Dean Ornish Preventive MEdicine Research Center (1980’s)
The Lifestyle Heart Trial - regression of coronary stenosis @ 1 year and cont impr @5 y: low fat vegetarian diet, stress management, smoking cessation in small gp setting; positive psychology and connectedness
BRiefly describe the role of HAns Diehl in LM
founder of CHIP: Coronary HEalth Improvement Program, now Complete HEalth improvement program (1990’s)
- OP, ITLC; whole food, plant based, exercise
BRiefly describe the role of Caldwell B Esselstyn Jr in LM
Cleveland Clinic (1990’s): began a >20 y longit. study about areesting and reversing heart dis in critically ill patients (A way to reverse CAD? J Fam Prac, 2014), “In cholesterol lowering, moderation kills. Cleve Clin J Med, 2000)
Which WHO document highlight the importance of diet in chronic disease and when was it first published?
WHO “Diet, nutrition, and the prevention of chronic disease” ; included nutrient guidance on the optimal intake of fats, carbohydrates and salt (1990’s)
BRiefly describe the role of JAme Rippe
First comprehensive LM text: Lifestyle MEdicine (1990)
when and where was ACLM founded
2004, JOhn Kelly, incollab w. Loma Linda Unov
NAme and briefly describe the landmark article describing competencies in LM
“physician Competencies for Prescribing Lifestyle Medicine”, JAMA 2010: written by a pannel of experts from multiple disciplines and organisations
What makes LM unique?
- focuses on treating causes of chronic disease
- uses evidence based LS interventions based on evidence as FIRST line
- can use evidence based medicasions as supplement (NOT first line)
- requires patient engagement and resposibility
- focuses on long term outcomes
- provider = expert and coach
- is cost saving
Name the evidence based modalities of LM (6)
- whole food, plant based diet
- physical activity
- stress management and emotional wellness
- sleep
- smoking cessation and avoidance of riskyt substance use
- positive psychology and connectedness
what is the definition of disease reversal for the purposes of LM foundations manual
laboratory makers and other diagnostic tests within normal limits without current use of medications, no present signs or symptoms of the disease
what is the definition of disease cotnrol for the purposes of LM foundations manual
improvement in lab markers and diagnostic tests to accepted standards but without complete normalisation (with or without current medications or mnedical interventions)
what is the defnition of complementary and alternative medicine?
- not currently considered part of conventional medicine
- uses complimentary (together w/ conventional med) or alternative (instead of conventionl med)
- historically not been researched
- EVIDENCE BASED COMPLIMENTARY MODALITIES = APPROPRIATE, not ev-based should not be used
what is the defnition of INTEGRATIVE MEDICINE
- addresses pat whole person needs (physical, social, emotional, mental, environmental, spiritual), through a combination of conventional, complimentary and alternative medicine
- “integrates” evidence based conventional methods w/ not evidence based methods (strength/ handicap?)
what is the defnition of FUNCTIONAL MEDICINE
- focuses on the physiologic and biochemical functions of the body (from cells to organ systems); investigating the processes of cellular metabolism, digestive function, detoxification and control of oxidative stress
- tends to emphasise testing of various hormones and metabolites that are not well-proven or generally accepted w/in evidence baswed medicine, and this is still somewhat controversial
what is the defnition of MIND BODY MEDICINE
investigates interactions betw body and mind behaviourally, emotionally, mentally, socially and spiritually
- uses modalities like relaxation, hypnosis, visual imaginery,, meditation, yoga, biofeedback, spirituality, thai chi etc.
- some very solid evidence, others not
what is the defnition of PREVENTITIVE MEDICINE
- all aspects of morbidity and mortality prevention for gen public, ie oversses the field of public health
- emphasises population based interentions that inc. immunisation, screening, protection from bioterrorism
what is the defnition of CONVENTIONAL MEDICINE
- uses medications, surgical techniquesm etc.; often at highest level of care and “end” treatmetn
- dis thought to occur from exposure to a pathogen or environmental factor, or genetic predisposition
- treatments acute/ long term
- disease focused
- pat = recipient of care, complies w/ treatment, not required to make signif changes
- provider considered responsible for care and outcomes, patient passive recepient
Name the shaping forces of medicine in the US and challenges of LM
- consts increasing, quickly becoming unstable and unsustainable, complicated by health care repeals and replacements
- employers and goverment = main payers, destroying self-balancing market place
- direct-to-consumer marketing= legal => incr demand for pharmaceuticals and interventions
- America = ill-prepared to embrace LM , almost all reimbursements = misaligned
- prevalent belief: pharmaceuticals, supplements, biochem treatments are the key to longevity
- internet = source of information; medical system not fully utilising technology
what is the role of behavioural determinants for positive health outcomes?
Lifestyle practices and health habits = most important deterinants of positive health outcomes
- improving health beh = foundational to effective medical care, dis prevention and health promotion
what are the key elements for improving health behaviours and outcomes
- trusting relationship betw physiician and patient
2. patient support; MDT, loved ones, greater community
what are the 10 leading causes of death in the US (2010)
- heart disease (633,842; 31.5%)
- Cancer (595.930; 29.6%)
- chronic lower respiratory disease (155,041; 7.7%)
- accidents (unintentional injuries) ( 146,571; 7.3%)
- stroke (CVD) ( 140,323; 7%)
- Alzheimer’s dis (110,561; 5.5%)\
- Diabetes (79.565; 4.0%)
- Influenza and pneumonia (57,062; 2.8%)
- nephritis, neprotic syndr, nephrosis (49,959; 2.5%)
- Intentional self-harm (suicide) (44,193; 2.2%)
What proportion of presentations to family physicians are due to chronic disease, in the US? And what are the top 8?
78% (Holman 2004)
- obesity
- metabolic syndrome
- hypertension
- cardiovascular disease
- dyslipidaemia
- arthritis
- diabetes
- osteoporosis
what proportion of premature deaths are attributable to lifestyle factors and name these lifestyle factors.
80%
- tobacco use
- poor diet
- lack of physical activity
waht proportion of patients have sufficient amount of all four healthy behaviours and name these behaviours>
3%
- non-smoking 76%
- healthy we3ight (BMI <25) 40%
- 5 fruits and veg/day 23%
- regular physical activity 22%
what proportion of people in the US smoke?
1 / 7
what proportion of people in the US eat diet low in fruit and vegetables?
3/ 4
what proportion of people in the US do not get enough physical activity?
4/5
what proportion of people in the US follow dietary guidelines for saturated fat after diagnosed with medical problems attributable to lifestyle>?
11%
what proportion of people in the US continues smoking after a diagnosis w/ heart disease
8%
name the determinants of health
- Adverse childhood events
- genetic and epigenetic predisposition
- health literacy
- local environmental conditions
what is the relationship between the ACEs (Adverse Childhood Events) and health
the more ACEs the higher the risk of adverse health outcome: eg self-rated health, functional limitations, mental illness, slef harm, drug and alcohol abuse, diabetes, cancer,m respiratory disease, heart attacks
what is the relationship between genetic predisposition and health?
- dna sequence (genes) explains appx 10% variance in health status