For decades, Bottom Line Personal has shared information about non-traditional approaches to wellness. Recently, lifestyle medicine has been gaining traction within the traditional Western medicine community. We asked Alex McDonald, MD, family medicine doctor and assistant clinical professor at Kaiser Permanente School of Medicine, to explain this approach and how it can help people looking to prevent chronic conditions as well as those who need chronic disease management.
What Is Lifestyle Medicine?
Lifestyle medicine is a person-centered approach grounded in the philosophy that key lifestyle steps can have a greater impact on wellness than pills and/or procedures. It is all about personalizing care for the individual and helping him/her figure out what tools he needs to maximize health or minimize disease. Family physicians have been practicing lifestyle medicine for the past 70 years—we just didn’t call it that until more recently. But now there is a growing body of research and medical evidence to support lifestyle intervention as part of a patient’s medical care plan. Lifestyle medicine is more of a formalized approach that even includes mechanisms for physicians to be reimbursed for the longer amounts of time that they spend with patients.
Why Seek Out Lifestyle Medicine?
Lifestyle medicine provides a deeper level of care than traditional doctor visits. A lifestyle medicine physician builds a relationship with the patient, offering comprehensive, continuous “whole person” attention to help make the decisions that will allow him to be as healthy as possible. I tell my patients that they are the expert on their own body, and I’m their guide for interpreting medical information and how it applies to them.
Core Tenets of Lifestyle Medicine
Lifestyle medicine recommendations focus on six key steps…
- Doing 30 minutes of physical activity most days of the week.
- Eating a whole-food, plant-based diet.
- Getting eight hours of sleep nightly.
- Practicing daily stress relief.
- Maintaining social connections.
- Avoiding alcohol, drugs and other risky substances.
Your lifestyle medicine doctor will work with you to make these core practices part of your daily routine. Example: A traditional doctor might say, “You should exercise more,” but not tell you how much or what type of exercise. Lifestyle medicine is much more specific and prescriptive. A lifestyle medicine practitioner might say, “I want you to walk or swim starting with 15 minutes day for five days a week,” and then outline a plan to build from there.
Diet is another step that will be tailored to you, not just to your tastes and cultural traditions but also to your lifestyle—whether you have time to cook or eat a lot of meals on the go, for instance. The focus is on a whole-food diet (unprocessed or minimally processed foods), but it’s not necessarily vegetarian although it has less animal protein and more protein from plant-based sources. Many people notice that cutting out meat just once or twice a week can make a difference in how they feel.
The relaxation piece is highly individualized. Certain amounts of physical activity (150 minutes per week) and sleep (roughly eight hours a night) are good for you. But relaxation “prescriptions” are a lot more nuanced and individualized, and it can be hard for people to work relaxation into their day. Example: When I ask patients what they do to relax or de-stress, most say they don’t have time for that. But when we drill down to what they would do if they had time, the answer might be watching movies, reading, hiking or listening to music. I’ll recommend spending five or 10 minutes a day on whichever activity works for them and their schedule. One patient with a demanding professional and home life parks her car around the corner from her house and spends five minutes just listening to music before pulling into her driveway.
The truth is, it is a lot easier just to take a pill or have surgery—that’s part of the challenge of getting people to adopt lifestyle medicine recommendations. But that pill or surgery is not necessarily the best thing in the long run.
It is fine to start with whatever small lifestyle changes you can make. Exercising just once a week is better than not exercising at all. Such incremental improvements will add up over time.
Lifestyle Medicine and Chronic Disease Management
Historically, lifestyle medicine—and family medicine—has always been about prevention. But with the right level of intervention, you also can use it to treat or even reverse some conditions. Example: 150 minutes of exercise a week may not be enough when it comes to treating obesity or diabetes—it could be that 300 minutes and an intensive diet are needed.
Having preexisting conditions is even more of a reason to see a lifestyle medicine doctor. Examples…
If you’re under the care of specialists for medical conditions, your lifestyle medicine doctor will be the hub of your health wheel, collaborating or communicating with those specialists even if they don’t practice lifestyle medicine. The lifestyle medicine physician can navigate between multiple different spokes for you. Example: A patient’s nephrologist and cardiologist gave them exact opposite directions. A lifestyle medicine doctor can assess the treatment benefits to the heart and the kidneys and look at the patient as whole person to find the right balance of these competing interests.
Even within the context of cancer care, lifestyle medicine can have a positive impact. One patient with lymphoma was told by his oncologist not to exercise to “save strength” for chemotherapy. But I said, with all due respect to your oncologist, I want you walking, even if only for five minutes a day because some physical activity will benefit your heart, lungs, muscles, bones and mental health—that is especially important when you’re going through an experience as life-altering as cancer therapy. It is all about context and tailoring treatment to the individual.
Finding a Lifestyle Medicine Doctor
It is best to work with a physician who meets your needs and will be your partner in health. That patient-physician relationship is important—comprehensive, continuous and longitudinal. Start your search at the website of the American College of Lifestyle Medicine (LifestyleMedicine.org, click on “Find a Clinician” on the top right).
