What is Lifestyle Medicine?
8 min read
Dr Suresh Khirwadkar
I'm getting a lot of interest in my Lifestyle Medicine service, and a lot of questions - particularly around:
- What is Lifestyle Medicine?
- Are you a functional medicine doctor?
- Are you a naturopath?
- Are you an integrative GP?
I thought it would be easier to make an article on it that I can share.
What is Lifestyle Medicine?
I have a Teachable course that goes through this if you prefer to look at that, and I'll be making a video soon once I get my home studio up and running again. The Teachables course is free so please feel free to go through it.
Lifestyle Medicine is defined as 'The application of environmental, behavioural, medical and motivational principles to the management (including self-care and self-management) of lifestyle-related health problems in a clinical and/or public health setting'. What a mouthful! What does it mean?
Put another way, Lifestyle medicine 'provides an interdisciplinary, whole-systems approach to the prevention and reversal of chronic and lifestyle-related diseases through the modification of the behavioural, social and environmental drivers' - still a mouthful!
In simple terms, Lifestyle medicine employs true hollistic care and focusses on the '6 pillars':
- Diet and Nutrition
- Physical activity (including exercise)
- Smoking cessation
- Alcohol harm reduction
- Sleep and mental health
- Social connection
How is it different to conventional medicine?
Lifestyle medicine is somewhat different to 'conventional medicine' in that it focusses on the lifestyle aspects of health and chronic disease, and aims to prevent and treat illness and diseases through Lifestyle interventions (e.g. diet, exercise, sleep, mental health, stress reduction) as a primary tool, with medications as an adjunct (secondary tool), whereas conventional medicine tends to focus on the medications as a primary tool with lifestyle secondary.
It is estimated that well over 90% of modern diseases are either caused by, or at least contributed to by Lifestyle issues, so it makes the most sense to focus on these as a cure or prevention of those illnesses.
It is also somewhat different to conventional medicine in the sense that it really focusses on prevention, and is more proactive than reactive.
Another difference is that conventional medicine tends to have an attitude of 'you are ok' or 'you are not high risk', whereas lifestyle medicine aims to get you to you are as low risk as you can possibly be if you want to put the work in. And that's another key difference, if not the main difference. It is a much more active form of medicine. It's much less likely that we will just start medications and instead will focus on lifestyle interventions to prevent and treat illness.
This takes more effort on the patient's part and so requires a much more active engagement with their doctor. We tend to have more follow ups, and more sessions looking at diet, nutrition, exercise, sleep and mental health, but less prescribing.
We still prescribe where required.
But we also look to deprescribe where possible.
What is 'deprescribing'
Just what it sounds like - reducing or stopping medications. Conventional medicine practitioners of course deprescribe where possible, but as a Lifestyle GP my aim is to reduce patients' illness and disease burden through lifestyle interventions, to the point where medications are hopefully no longer required. This differs slightly to conventional medicine that tends to have a 'things are stable' approach.
Deprescribing is an art form, learned over many years of experience and training, and is not something we just jump into. I don't just stop all your medications as soon as I see you - I would never do this, but I am happy to work with you to reduce and stop your medications where possible, and hopefully not start them in the first place if we can treat you with lfiestyle interventions instead.
Whenever I see a patient that asks for a repeat prescription, my first question is always: "do you still need this?"
What is proactive medicine?
Lifestyle Medicine focusses on the root causes of illness and therefore tends to be a lot more proactive than reactive. I don't really want to wait for you to get a disease to then treat it, I would much rather investigate and identify risk factors for developing illness in the first place and fix them before the disease has a chance to start.
I like to work with patients on their sleep, their mental health, their diet and nutrtion, social relationships and exercise in the hope that making small changes can prevent big diseases. Common examples would be:
- Insulin Resistance to prevent Diabetes
- Sleep to prevent chronic raised cortisol and increased risk of heart disease and hypertension
- Diet to prevent nutritional deficiencies that can increase the risk of Cancer
- Exercise and physical activity to help sleep, weight and stress levels
These can be done with patients with pre-existing illness and disease of course, and it is equally effective.
Is Lifestyle Medicine still evidence based?
Absolutely.
Lifestyle Medicine is all evidence based, with high quality evidence backing the movement. There is an Australasian College, an American College and a European College.
The Australasian college provdies a fellowship which I am working towards, and a Board Certification through the American College which I am also working towards.
We use high quality evidence to back what we practice, and in many ways it follows conventional medicine guidelines and is not contradictory. We just look to provide that treatment where possible through lifestyle measures, not medications.
- I still use Vaccinations and I believe in them 100%.
- I still use Medications where required.
- I still follow national guidelines for disease treatment and prevention - we just go further.
So are you a naturopathy, functional GP or integrative GP?
I'm getting this question a lot lately.
No I am not.
The specialties are very different.
Naturopathy
"Is a form of alternative and complimentary medicine which focusses on the body's capacity to heal itself and employs many complimentary and alternative medications to achieve the goals." They do also employ diet and nutrition advice, but combine this with non-evidence based treatments such as herbal rememdies, homeopathic medication and tactile therapies. [Source]
Naturopathy tends to utilise a number of unproven and disproven methods and treatments and is widely criticsed. [Source]
Functional Medicine
"Another form of alternative medicine, Functional medicine is a systems biology-based approach that focusses on identifying and addressing the root cause of disease and focusses on the 'functional medicine matrix'"[Source]. Whilst there is much overlap with Lifestyle Medicine, Functional Medicine has a tendency to lean towards non-evidence based treatments and is weighted towards medications rather than lifestyle measures.
Functional Medicine tends to encompass a number of unproven and disproven methods and treatments, and critics describe it as dangerous and 'quackery' pseudoscience and indeed the American Academy of Family Physicians (AAFP) for a long time refused to provide course credits for Functional Medicine, and has only recently lifted the moratorium on this, only so much as to allow its members to learn more about it so they can educate their patients about it. [Source]
Integrative Medicine
"Another alternative form of Medicine, Integrative medicine is a philosophy of healthcare with a focus on individual patient care. It combines the best of conventional western medicine with evidence-based complementary medicine and therapies" [Source]
Again widely criticised [Source] as it focusses on largely unproven or disproven therapies, such as herbal remedies and homeopathy. Whilst claiming to integrate modern and complementary medicine, it appears to 'be in conflict with the principles of both evidence-based medicine and medical ethics.' [Source]
Why the criticism of other movements?
It may seem like that, but it is not. I do not have any particular quarrel with other specialties, but it is important to distinguish Lifestyle Medicine from other movements.
There is of course a lot of overlap and this is not to say that Practitioners of Naturopathy, Integrative medicine and functional medicine are not attentive and caring, in fact I know many who are lovely people and are very caring health care workers only trying to do the best they can for their patients.
But there is a difference.
Lifstyle Medicine is evidence based and still uses conventional medicine therapies, we just utilise lifestyle treatments where possible (diet, nutrition, exercise, sleep, good mental health). Other medical movements focus on alternative and complementary medicines and are largely not evidence based [Source].
If you are interested in learning more about Lifestyle Medicine, you can view my teachable or please look at the ASLM or ACLM websites, as there is a lot of information on there, or alternatively come and see me and we can discuss how I can help you.
In the interest of balance I tried to find criticism of Lifestyle Medicine but it was hard to find any. Please feel free to search for criticisms of Lifestyle Medicine and make your own mind up.