ORIGINAL RESEARCH & CONTRIBUTIONS Special Report Lifestyle Medicine: A Brief Review of Its Dramatic Impact on Health and Survival Balazs I Bodai, MD, FACS; Therese E Nakata, STAR Provider, CWFPBN; William T Wong, MD; Dawn R Clark, MD, FACOG; Steven Lawenda, MD, ABFM; Christine Tsou, MD; Raymond Liu, MD; Linda Shiue, MD; Neil Cooper, MD; Michael Rehbein, MD, FACP; Benjamin P Ha, MD, ABFM; Anne McKeirnan, MD, FACOG; Rajiv Misquitta, MD; Pankaj Vij, MD, FACP; Andrew Klonecke, MD; Carmelo S Mejia, MD; Emil Dionysian, MD, FACOS; Sean Hashmi, MD, FACM; Michael Greger, MD, FACLM; Scott Stoll, MD, FABPMR; Thomas M Campbell, MD Perm J 2018;22:17-025 E-pub: 09/20/2017 https://doi.org/10.7812/TPP/17-025 ABSTRACT of an unhealthy lifestyle.3 More than 80% By ignoring the root causes of disease and neglecting to prioritize lifestyle measures of chronic conditions could be avoided for prevention, the medical community is placing people at harm. Advanced nations, through the adoption of healthy lifestyle influenced by a Western lifestyle, are in the midst of a health crisis, resulting largely from recommendations.3-5 Eighty percent of the poor lifestyle choices. Epidemiologic, ecologic, and interventional studies have repeatedly population wants to live in a better state of indicated that most chronic illnesses, including cardiovascular disease, cancer, and type health but do not know how to pursue it.6 2 diabetes, are the result of lifestyles fueled by poor nutrition and physical inactivity. Minimal information is given by health In this article, we describe the practice of lifestyle medicine and its powerful effect on care practitioners on how to implement an these modern instigators of premature disability and death. We address the economic effective, long-term plan to achieve health.3 benefits of prevention-based lifestyle medicine and its effect on our health care system: A The ongoing acceptance and adoption system on the verge of bankruptcy. We recommend vital changes to a disastrous course. of a healthy lifestyle remains our great- Many deaths and many causes of pain, suffering, and disability could be circumvented if est challenge. Implementation of lifestyle the medical community could effectively implement and share the power of healthy life- recommendations can save lives because style choices. We believe that lifestyle medicine should become the primary approach to lifestyle-related diseases are now the lead- the management of chronic conditions and, more importantly, their prevention. For future ing cause of mortality in the “modernized” generations, for our own health, and for the Hippocratic Oath we swore to uphold (“First world.7 An aggressive analysis is needed to do no harm”), the medical community must take action. It is our hope that the information review the impact of lifestyle on our health. presented will inspire our colleagues to pursue lifestyle medicine research and incorpo- So why are we sick and dying prema- rate such practices into their daily care of patients. The time to make this change is now. turely? Cardiovascular disease (CVD) and cancer have come to be known as the two INTRODUCTION of chronic diseases but rather on their pre- “killer diseases” and account for more than Many consider lifestyle medicine to be vention. Chronic diseases are presently the half of all deaths in the US.8 We are expe- a relatively new subspecialty, although it leading cause of morbidity and mortality riencing these diseases in the wealthiest has been practiced for thousands of years.1 and are responsible for most of our health nation in the world, which spends more Unlike conventional medicine, the focus of care expenditure.2 Most of these chronic on health care per capita than any other lifestyle medicine is not on the treatment conditions are preventable and are the result advanced economy and yet has some of Balazs I Bodai, MD, FACS, is the Director of The Breast Cancer Survivorship Institute in Sacramento, CA. E-mail: [email protected]. Therese E Nakata, STAR Provider, CWFPBN, is the Program Manager of The Breast Cancer Survivorship Institute in Sacramento, CA. E-mail: [email protected]. William T Wong, MD, is a Psychiatrist at the Redwood City Medical Center in CA. E-mail: [email protected]. Dawn R Clark, MD, FACOG, is the Chief Facilitator of the Physician Wellness Program and an Obstetrician/Gynecologist at the San Dimas-Baldwin Park Medical Center in San Dimas, CA. E-mail: [email protected]. Steven Lawenda, MD, ABFM, is an Internist at the Antelope Valley Medical Center in Lancaster, CA. E-mail: [email protected]. Christine Tsou, MD, is an Internist at the San Jose Medical Center in CA. E-mail: [email protected]. Raymond Liu, MD, is the Chief of Hematology-Oncology at the San Francisco Medical Center in CA. E-mail: [email protected]. Linda Shiue, MD, is an Internist and the Director of Culinary Medicine at the San Francisco Medical Center in CA. E-mail: [email protected]. Neil Cooper, MD, is a Radiologist at the Glenlake Medical Center in Atlanta, GA. E-mail: [email protected]. Michael Rehbein, MD, FACP, is a Pediatrician and Assistant Physician-in-Charge for Outpatient Service at the Stockton Medical Office in CA. E-mail: [email protected]. Benjamin P Ha, MD, ABFM, is the Associate Area Medical Director for Family Medicine at the Bakersfield Medical Center in CA. E-mail: [email protected]. Anne McKeirnan, MD, FACOG, is an Obstetrician/Gynecologist at the San Diego Medical Center in CA. E-mail: [email protected]. Rajiv Misquitta, MD, is a Primary Care Physician at the South Sacramento Medical Center in CA. He is also an Elected Representative on The Permanente Medical Group Board of Directors. E-mail: [email protected]. Pankaj Vij, MD, FACP, is the Medical Director of the Kaiser Permanente Weight Management Program in Pleasanton, CA. E-mail: [email protected]. Andrew Klonecke, MD, is a Nuclear Medicine Specialist at the Sacramento Medical Center and at the Roseville Medical Center in CA. E-mail: [email protected]. Carmelo S Mejia, MD, is an Internist at the Skyline Medical Offices in Salem, OR. E-mail: [email protected]. Emil Dionysian, MD, FACOS, is an Orthopedic Surgeon at the Lakeview Medical Offices and at the Orange County Medical Center in Anaheim, CA. E-mail: [email protected]. Sean Hashmi, MD, FACM, is an Internist at the Woodland Hills Medical Center in CA. E-mail: [email protected]. Michael Greger, MD, FACLM, is a Physician and Founder of NutritionFacts.org in Kensington, MD. E-mail: [email protected]. Scott Stoll, MD, FABPMR, is the Co-Founder and Chairman of the Plantrician Project in Rieglesville, PA. E-mail: [email protected]. Thomas M Campbell, MD, is an Instructor of Clinical Family Medicine at the University of Rochester School of Medicine and Dentistry and the Co-Founder and Clinical Director of the University of Rochester Program for Nutrition in Medicine in NY. E-mail: [email protected]. The Permanente Journal/Perm J 2018;22:17-025 1 ORIGINAL RESEARCH & CONTRIBUTIONS Lifestyle Medicine: A Brief Review of Its Dramatic Impact on Health and Survival the poorest health outcomes.2 The most important problem is our poor lifestyle choices based on misinformation.1,4 There has been a dramatic shift in the leading causes of death in the US in the past 100 years. Whereas infectious dis- eases were the primary cause of death in the early 20th century, CVD and cancer have now assumed dominance in mortal- ity (Figure 1).9 Additionally, obesity and diabetes are inflammatory conditions that not only contribute to CVD and cancer but also serve as profound comor- bidities; their shared etiologies promote Figure 1. Leading causes of death in the US, 1900 and 2010.a one another. Both are sentinel signals of a Source: Centers for Disease Control and Infection data from Jones et al.9 seriously eroding health, each harboring its own morbidities. This can be changed through a shift in how we take charge of managing our health and the health of our patients—through lifestyle medicine. In this article, we address the pervasive effects of inflammation, obesity, and type 2 diabetes and their cost on the health care system. We review evidence on how implementation of lifestyle medicine rec- ommendations may lead to a paradigm shift not only in health care delivery but also on its dramatic impact on chronic conditions. Lifestyle medicine addresses basic recom- mendations, which may extend lives and may allow patients to live longer, in better health, with fewer disabilities, and with an improved quality of life. The intervention recommendations in lifestyle medicine are healthy eating, active living, healthy Figure 2. Quadrants of total health. weight, and emotional resilience (see Figure 2 and the Sidebar: A Special Note on Emotional Resilience). Also represented diet promotes the increased consumption ENDEMIC CONDITIONS OF in Figure 2 is what we refer to as the “red of leafy greens, vegetables, fruits, legumes, THE WESTERN WORLD zone”—the percentage of the Western and whole grains as staple foods.3,11,12 The In the Western world, we subject our- population that fails to adhere to such benefits of a whole-foods, plant-based diet selves to a poorly recognized, self-inflicted recommendations. Lifestyle determines have been shown to substantially influence death sentence. We have become victims in substantial ways the state of health; a the development of CVD as well as many of three major conditions endemic to the poor lifestyle leads to poor health, and a common malignancies.13-15 In addition, Western World: inflammation, obesity, good lifestyle generally leads to good health.