Lifestyle medicine is becoming more prominent. It’s an approach to medicine which uses lifestyle changes (for example in nutrition, physical activity, sleep, stress management and social support) to prevent, treat and reverse chronic diseases.
In the UK, GPs Rangan Chatterjee and Ayan Panja are well known to TV viewers for BBC1’s Doctor in the house and Street doctor respectively, both using a lifestyle medicine approach to improving health. Dr Chatterjee’s lifestyle medicine book The Four Pillar Plan topped the book sales charts for weeks when it was launched earlier this year and Dr Aseem Malhotra and Donal O’Neill’s 2017 book The Pioppi Diet – A 21-day lifestyle plan continues to be a best seller. GP Dr Rupy Aujla’s website and accompanying book The Doctor’s Kitchen promotes food as medicine and he has 120,000 followers on Instagram. Every week the media report new research, books and stories about the importance of sleep and physical activity, mindfulness and managing stress on our health and wellbeing. And updates about the gut microbiome’s role in physical and mental health are very exciting. So it appears that the lifestyle medicine approach might be starting to make sense to the public.
But although professional lifestyle medicine associations are established in the UK (British Society of Lifestyle Medicine (BSLM)), Europe and internationally, it looks like GPs and other healthcare professionals are not always supported in their efforts to use a lifestyle approach with their patients.
At the recent Inspired Medics Lifestyle Medicine Conference in Leeds, I spoke to several GPs who were keen to use a lifestyle medicine approach but were not supported by their GP partners. “It’s not proper medicine” and “you were trained to treat sick people with medication not to advise them on nutrition” were typical admonishments. This is interesting because the use of nutrition in medicine is not exactly new. Hippocrates is reported to have said, “Let food be thy medicine and medicine be thy food”…
However, as a 2017 BMJ (British Medical Journal) article entitled Students need to understand the role of diet in health promotion and disease prevention pointed out, “The National Institute for Health and Care Excellence guidelines state that a first line intervention for diabetes, obesity, and high cholesterol is to give “lifestyle advice”—but this phrase is so vague that it is left up to doctors and patients to define it and, potentially, ignore it” (my bold text)(1). Supporting this comment, many questions to the panel of speakers at the end of the Inspired Medics conference asked whether a lifestyle approach met NICE guidelines and asked for guidance and evidence to support lifestyle medicine efforts. One of the speakers, Dr David Unwin, a GP from Merseyside, reminded delegates that NICE recommends that with type 2 diabetes patients, an individualised approach (para 1.3.1) and low glycaemic index sources of carbohydrate (para 1.3.3) should be used – both lifestyle medicine approaches.
Dr Unwin’s presentation outlined how he has worked to improve the health of type 2 diabetes patients in his surgery (not an affluent area) using lifestyle advice, all within the usual 10 minute appointment slot. In fact, not only is patients’ blood sugar successfully managed, around half could be said to be in remission, ie technically no longer diabetic. So successful has this approach been over recent years that his surgery now has the lowest per patient spend on diabetes medication in the area, spending around £40,000 less than the average surgery in the CCG (Fig 1). If this could be replicated by all NHS GP surgeries, it would save the NHS £375m annually on diabetes medication alone – around half of the current total spend(2). But diabetes medication represents only about 6% of the cost of type 2 diabetes(2). So if type 2 diabetes is being put into remission, the total costs including non-diabetes medication (cardiovascular disease medication constitutes the largest proportion of prescription costs for people with diabetes) as well as spend on short and long term complications will also reduce.
Fig 1: Dr Unwin’s Northwood Surgery diabetes mediation spend compared to other surgeries in the same CCG (reproduced with permission)
Several conference delegates I spoke to had moved to the private sector, were working part time or had retrained in a lifestyle-related speciality such as functional medicine. They had suffered burn out or had lost their GP mojos through the strain of trying to treat patients within a 10 minute appointment, following protocols that tackled symptoms but not root causes. Some of the speakers mentioned this, too – that becoming a doctor to help people but never seeming to improve patients’ health was very wearing. Last year, Rangan Chatterjee and Ayan Panja set up Lobe Medical to run Royal College of GPs-accredited lifestyle medicine courses. They have said that course attendees report increased energy and satisfaction at work, partly because they can see they are making a real difference to their patients. We are short of GPs so it makes sense to keep and motivate the ones we have and encourage medical students to take an interest, both in general practice and lifestyle medicine. In fact there is a growing student-led movement to improve nutrition training for medical students. Nutritank was originally set up as a student society by Bristol University medical students to promote awareness of the need for nutrition training for medical students. It has now spread to 15 UK universities plus others in Europe. Bristol and Cambridge universities are reportedly redesigning their student curriculum to increase nutrition tuition.
A parallel education focus is encouraging UK universities to include physical activity science and therapy as part of medical and health-based curricula. A recent report commissioned by Public Health England and Sport England found universities recognised the value of physical activity education for health professionals. Even more important, they seemed keen to make the changes. Report author Ann Gates, of physical activity advocates Exercise Works said, “A qualified doctor, nurse, midwife or allied health professional may see half a million patients during their professional career: this has enormous potential for advocacy and the promotion of physical activity.” This concept has been given a boost by organisers of the free weekly 5k runs, parkrun, who partnered with the Royal College of GPs to launch parkrun practice earlier this year. Over 450 GP surgeries have become ‘parkrun practices’, forming close links with their local parkrun. Staff and patients benefit from any or all of the parkrun benefits of walking or running, being outside n a green space, talking to others, volunteering and being part of a community.
Looking in as an interested observer, I perceive a real appetite for lifestyle medicine. It makes so much sense in terms of prevention and treatment. Just think. Data from Dr Unwin’s patients shows that a low GI diet and lifestyle approach not only improves diabetes symptoms, it also improves liver function, blood pressure and lipid scores. Other research indicates improvement with mental health, gut and kidney issues and cardiovascular health. A win for patients, a win for GPs, a win for the NHS and a win for society.
So let’s hope the lifestyle medicine movement continues to grow.
Watch this space!
- Womersley K, Ripullone K (2018) Medical schools should be prioritising nutrition and lifestyle education. British journal of sports medicine 52, e6-e6.
- Diabetes.co.uk Cost of diabetes in the UK. https://www.diabetes.co.uk/cost-of-diabetes.html (accessed Oct 2018)