Lifestyle Medicine Interest Group at

UCSF

Thomas Edison once said...

Lifestyle

• Inheritance• Habits• Your choice

Eat Move

SexLife

Spiritual

Life

SocialLife

Fun

Sleep

Culture

Stress

WorkFamil

y

Values Study

Creative

Outlets

What is Lifestyle Medicine?

• “Lifestyle medicine is the evidence-based practice of helping individuals and families adopt and sustain healthy behaviors that affect health and quality of life1.” –ACLM

1. http://www.lifestylemedicine.org/What-is-Lifestyle-Medicine

Four Principles of LM (Dean Ornish):1. Diet

2. Exercise3. Relaxation Techniques

4. Social Interactions Stress/Mindfulness

Early Death Causes - USA

McGinnis JM, Russo PG, Knickman, JR. Health Affairs, April 2002(Funding: Robert Wood Johnson Foundation)

Obesity – USA

Ogden, et al. NCHS Data Briefs. 219, Nov 2015. CDCImage: medicalnewstoday.com/categories/fitness-obesity

38%30%

2000 2014

All-cause mortality ages 45-54, USA 1990-2013

•Pain & Opiods•Lifestyle?Case, A; Deaton, A. PNAS Early Edition 2015

Poisonings

Lifestyle Medicine Applied

• Lifestyle Medicine (LM) is the use of lifestyle interventions in the treatment and management of disease.

• Such interventions:• nutrition• exercise • stress management • smoking cessation• a variety of other non-drug modalities

Hippocrates once

said...

Evidence• European Prospective Investigation into Cancer and Nutrition (EPIC) study, patients who adhered to healthy dietary principles (low meat consumption and high intake of fruits, vegetables, and whole-grain bread), never smoked, were not overweight, and had at least 30 minutes a day of physical activity had a 78% lower overall risk of developing a chronic disease1.

1. Ford, E. S., Bergmann, M. M., Kroger, J., Schienkiewitz, A., Weikert, C., & Boeing, H. (2009). Healthy living is the best revenge: findings from the European Prospective Investigation Into Cancer and Nutrition-Potsdam study. Archives of internal medicine, 169(15), 1355.

• 93% reduced risk of diabetes

• 81% lower risk of heart attacks

• 50% reduction in risk of stroke

• 36% overall reduction in risk of cancer

Evidence• Our genes are a predisposition, but our genes are not

our fate. LM changes your genes—turning on genes that keep you healthy, and turning off genes that promote heart disease, prostate cancer, breast cancer, and diabetes—over 500 genes in only three months1.

• Diet and lifestyle changes may lengthen telomeres. Effects still significant after 5 years2.

• Lifestyle factors accounted for 90% of the PAR (population attributed risk) in men and 94% in women for coronary heart disease (52 country study)3.

1. Ornish, D., Magbanua, M. J. M., Weidner, G., Weinberg, V., Kemp, C., Green, C., ... & 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, 105(24), 8369-8374.

2. Ornish, D., Lin, J., Chan, J. M., Epel, E., Kemp, C., Weidner, G., ... & Blackburn, E. H. (2013). Effect of comprehensive lifestyle changes on telomerase activity and telomere length in men with biopsy-proven low-risk prostate cancer: 5-year follow-up of a descriptive pilot study. The lancet oncology, 14(11), 1112-1120.

3. Yusuf, S., Hawken, S., Ôunpuu, S., Dans, T., Avezum, A., Lanas, F., ... & INTERHEART Study Investigators. (2004). Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. The Lancet, 364(9438), 937-952.

Evidence

Adapted from:Yusuf, S., Hawken, S., Ôunpuu, S., Dans, T., Avezum, A., Lanas, F., ... & INTERHEART Study Investigators. (2004). Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. The Lancet, 364(9438), 937-952.

Evidence

Adapted from:Diabetes Prevention Program Research Group. (2002). Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. The New England journal of medicine, 346(6), 393.

Evidence•Can help reduce greenhouse gases, promote more sustainable environment. Livestock greenhouse gas emissions account for 18-51% of total emissions1.

• Reduces healthcare costs

1. Herrero, M., Gerber, P., Vellinga, T., Garnett, T., Leip, A., Opio, C., ... & McAllister, T. A. (2011). Livestock and greenhouse gas emissions: The importance of getting the numbers right. Animal Feed Science and Technology, 166, 779-782.

2. Hersey, J. C., Khavjou, O., Strange, L. B., Atkinson, R. L., Blair, S. N., Campbell, S., ... & Britt, M. (2012). The efficacy and cost-effectiveness of a community weight management intervention: a randomized controlled trial of the health weight management demonstration. Preventive medicine, 54(1), 42-49.

Table adapted from:Herman, W. H., Hoerger, T. J., Brandle, M., Hicks, K., Sorensen, S., Zhang, P., ... & Ratner, R. E. (2005). The cost-effectiveness of lifestyle modification or metformin in preventing type 2 diabetes in adults with impaired glucose tolerance. Annals of Internal medicine, 142(5), 323-332.

Prevention & Treatment with Lifestyle Medicine

• LM is becoming the preferred modality for not only the prevention but also the treatment of most chronic diseases, including:

• Type 2 diabetes

• Coronary heart disease

• Hypertension

• Obesity

• Insulin resistance syndrome

• Osteoporosis

• and many types of cancer

Why Lifestyle Medicine?

• “ As a nation, more than 75% of our health care spending is on people with chronic conditions1.” — CDC 2009

• “If the major risk factors from chronic disease were eliminated, at least 80% of all heart disease, stroke, and type 2 diabetes would be prevented, and more than 40% of cancer cases would be prevented2.” —WHO

1. CDC. (2009). The Power of Prevention. Retrieved November 10, 2015, from http://www.cdc.gov/chronicdisease/pdf/2009-Power-of-Prevention.pdf2. World Health Organization. Preventing chronic diseases: a vital investment. Geneva: World Health Organization;2005. Available from: http://www.who.int/chp/chronic_disease_report/full_report.pdf

Value StatementFrom the ACLM:Lifestyle practices and health habits are among the nation’s most important health determinants.

Changing unhealthy behaviors is foundational to medical care, disease prevention, and health promotion.

The physician’s trusted relationship with the patient, with the support of the family, an interdisciplinary team and the community is the key to improving health behaviors and outcomes.

How Can We Get Started?

“It’s not all or nothing. In all of our studies, we found that the more people changed their diet and lifestyle, the more they improved and the better they felt—at any age. So, if you indulge yourself one day, just eat healthier the next. If you don’t have time to exercise one day, do a little more the next. If you don’t have time to meditate for an hour, do it for a minute. What matters most is your overall way of eating and

living.” –Dean Ornish

Lifestyle Med Interest Group1. Develop Expertise

2. Practice Healhy Living

3. Outreach & CoachingYOUR INPUT!

• learn together• scientific evidence• address fads• assemble resources• larger context • up to you!

• exercise• sleep• cooking• mindfulness• anything!

• learning workshop• help real people

Meeting Logistics• Monthly Meetings

Interactive Discussions Speakers Health Education Goal-Setting

• Potential Topics: Nutrition Exercise Mindfulness Social Support Relaxation Techniques Inspiration

Health Policy Population Health Chronic Disease (i.e. diabetes,

hypertension, etc.) Ideas???

Lifestyle Medicine Interest Group at

UCSF