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Nutrition and Lifestyle • Research • Reviews Summer/ Volume 13 Issue 2 Autumn 2016 ISSN 1743-9493 JOURNALOF holistic healthcare Food as Medicine conference Healthy farming = healthy food An ethical approach to obesity Do doctors underestimate patient’s interest in lifestyle change? Lifestyle medicine Kitchen on prescription Ayurvedic perspectives on self-care Are we medicalising normal human experience? Medical student resilience symposium Plus Nutrition and lifestyle • Research • Reviews IN COLLABORATION WITH THE COLLEGEOF MEDICINE JOURNALOF holistic healthcare Contents ISSN 1743-9493 Editorial . 2 Published by Doctors can only tackle chronic disease with the right tools. Teach them nutrition. 3 British Holistic Medical Association West Barn, Chewton Keynsham Jerome Burne BRISTOL BS31 2SR Good nutrition begins in the soil. 6 [email protected] www.bhma.org Patrick Holden An ethical approach to obesity. 9 Reg. Charity No. 289459 Robyn Toomath Editor-in-chief Do we doctors underestimate our patients’ interest in lifestyle David Peters change and willingness to collaborate to improve health?. 12 [email protected] David Unwin Editorial Board Lifestyle medicine . 15 Peter Donebauer Rob Lawson Ian Henghes Dr William House (Chair) Social prescribing in action: Professor David Peters Bristol’s Kitchen on Prescription Alliance . 20 Dr Thuli Whitehouse Helen Cooke & Elizabeth Thompson Dr Antonia Wrigley Nurturing health with traditional herbal medicine. 25 Production editor Sebastian Pole Edwina Rowling [email protected] Self-care and self-cultivation: the necessary foundation to heal. 30 Thuli Whitehouse Advertising Rates 1/4 page £130; 1/2 page £210; Diagnosis: are we medicalising human experience? full page £400; loose inserts £140. A radical review . 33 Rates are exclusive of origination Vinay Mandagere where applicable. To advertise Report on Tomorrow’s Doctors: a symposium of email [email protected] medical teachers . 36 Products and services offered by William House . 38 advertisers in these pages are not necessarily endorsed by the BHMA. Research. 39 Design Reviews. 41 [email protected] Cover illustration Theo Peters http://theopeters.co.uk Printing Spinnaker Press Unless otherwise stated, material is copyright BHMA and reproduction for educational, non-profit purposes is welcomed. However we do ask that you credit the journal. With this exception no part of this publication may be reproduced in any form or by any other means – graphically, electronically, or mechanically, including photocopying, recording, taping or information storage and retrieval systems – without the prior written permission from the British Holistic Medical Association. Every effort is made to ensure the accuracy of material published in the Journal of Volume 13 G Issue 2 Holistic Healthcare. However, the publishers will not be liable for any inaccuracies. The Summer/Autumn 2016 views expressed by contributors are not necessarily those of the editor or publisher. 1 David Peters Editorial Editor Lifestyle, seat belts and sugar tax unhealthy foods, and drinks that pack ten teaspoons of sugar into every can, and to market them aggressively. This Nutrition and lifestyle are the roots of much chronic is one unholy alliance: we pay Big Food to make us ill and disease. So what should be done: coercion, persuasion, then pay Big Pharma to pick up the pieces! neo-liberal laissez faire? Libertarians say it is up to the You might think people would eat more wisely once individual, but for liberty to work there has to be an they were told that the pounds they were piling on made equality, something that’s in short supply in our divided them odds on for diabetes or an early coronary. This society where deprivation plays a big part in how people would work if human beings were completely rational, eat, live their lives, and die. The inverse care law tells us and didn’t live in an obesogenic society and accept being that those needing a nutritional leg up most and who lack called ‘consumers’; and where an unending supply of the resources for leading healthier lifestyles are the least food, for many of us wakes up unconscious famine-fear, likely to get them. This issue of JHH considers different compelling us to stoke up even though we no longer need sides of the lifestyle coin. the calories to fuel hunting and gathering or labouring in Whether or not the force of law, or better information, the fields. or neo-liberal policies are the way forward, the fact is that Somehow, in the long term, our unsustainable ways – if post-2000 trends continue 18% of men and more than our entire society’s ‘lifestyle’ – will have to change. But 21% of women will be obese worldwide by 2025; 6% of the NHS doesn’t have that long. Let’s hope the diabetes/ men and 9% of women severely. Meanwhile ironically, obesity/CVD tsunami brings it home; food can be tragically, predictably, under-nourishment will still be medicine, or it can be health-toxic. It’s a message that may killing most of the world’s poorest (NCD Risk Factor soon be hitting cardiologists hardest. Aseem Malhotra is Collaboration 2016). an NHS cardiologist who gets it. He is saying loud and Freedom to choose how you live sounds like a good clear that healthcare systems must incorporate lifestyle idea, yet there is a place for the law in all this. After 1983 medicine because it is cheap, and without side-effects. He using seatbelts was no longer a ‘lifestyle choice’; fatalities also sees promoting low-fat foods as perhaps the biggest have fallen by 60% and serious injuries by 67%. The 2007 mistake in modern medical history (Malhotra 2016). And smoking ban has seen heart attack rates in the UK falling he dismisses so-called ‘bad cholesterol’ as a factor in by more than 40% – much of this attributable to reduced cardiovascular disease once people are over the age of 60. second hand smoke exposure. It seems laws can make a Can we expect the tanker-turning political acts needed difference if certain lifestyle choices harm innocent to ‘incorporate lifestyle medicine into health systems’ to bystanders. Should the state intervene if the way people eat be driven by neoliberal economics? Or on the contrary, or live their lives harms others? Is the tide of diet- and does ‘the market’ prefer its ‘consumers’ to be infantilised lifestyle-related chronic disease harming us all by threatening and disempowered? Would a benign ‘nanny state’ be to inundate and sink our increasingly unsustainable NHS? better at treating society’s oral obsession with having Treating type 2 diabetes and its complications currently more stuff? Then what kind of professional development costs the NHS £8.8 billion a year (Hex et al 2012), just campaign could free doctors – too long constrained by big over 8% of its annual budget. The prevalence of diabetes pharma’s blinkers – to start practising lifestyle medicine? is estimated to rise to 4 million by 2025. As long as it is In a society founded on liberty, equality, brother-sisterhood viewed as a chronic, irreversible condition, diabetes and sustainability all this could happen. ‘You can be in my management will remain very much pharmaceutical. Yet dream if I can be in yours’ (Dylan 1963). the drugs used cost the NHS hundreds of millions of pounds though they barely reduce its awful complications Dylan B (1963) Talkin’ World War III Blues. The Freewheelin Bob – kidney, eye and nerve disease – and have even less Dylan, CBS Records. impact on diabetics’ very high incidence of heart attacks, Hex N, Bartlett C, Wright D, Taylor M, Varley D (2012) Estimating the current and future costs of Type 1 and Type 2 diabetes in the UK, stroke or early death. So why are people with type 2 including direct health costs and indirect societal and productivity diabetes seldom told that they are carbohydrate intolerant, costs. Diabet Med 29(7) 855–62. and should foreswear bread, rice, and sugar and can eat Malhotra A (2016) We need a healthy dose of lifestyle medicine. healthy fats now that cheese and butter, as a result of new The Telegraph, 4 August. Available at: www.telegraph.co.uk/wellbeing/ health-advice/we-need-a-healthy-dose-of-lifestyle-medicine (accessed research, have been taken off the danger list? 7 September 2016). Are doctors to blame if the information on which NCD Risk Factor Collaboration (2016) Trends in adult body-mass they base their clinical decisions and advice to patient is index in 200 countries from 1975 to 2014: a pooled analysis of 1698 distorted by commercial pressures? The pharma industry population-based measurement studies with 19·2 million participants. The Lancet 387(10026) pp 1377–1396. Available at: has found a vast goldmine in ‘treating’ diabetes and high www.thelancet.com/journals/lancet/article/ cholesterol. The food industry remains free to make cheap PIIS0140-6736(16)30054-X/abstract (accessed 7 September 2016). 2 © Journal of holistic healthcare G Volume 13 Issue 2 Summer/Autumn 2016 FOOD AS MEDICINE Doctors can only tackle chronic disease with the right tools. Teach them nutrition Jerome Burne I am an award-winning journalist specialising in medicine and health for the last 10 Editor, HealthInsightUK years. My most recent book is 10 Secrets of Healthy Ageing, written with nutritionist Patrick Holford. I blog at Body of Evidence – jeromeburne.com and was a finalist for the 2015 Blogger of the Year award from the Medical Journalists’ Association. The current mismatch between what doctors know and what patients need Here’s a really bad idea. Send a dozen die over years rather than hours. The must change. The College nutritionists to work alongside regular GPs’ toolbox needs a major upgrade. doctors in a Medecins Sans Frontières Why this mismatch between of Medicine’s recent team providing emergency treatment medical skills and what patients need conference presented the to the wounded in a war zone.
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