"Lifestyle Medicine: A Modern Approach to Chronic Diseases", Apuntes de Medicina

¡Descarga "Lifestyle Medicine: A Modern Approach to Chronic Diseases" y más Apuntes en PDF de Medicina solo en Docsity! The Advent of Lifestyle Medicine Byung-Il Yeh1 and In Deok Kong2,* 1Wellcome Unit for the History of Medicine, Oxford University, Oxford, United Kingdom, 2Department of Physiology and Center for Exercise Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea The fact that lifestyle is closely associated with the pathogenesis of chronic diseases has been known for more than three decades. Smoking may cause lung cancer, and a lifestyle of fast food consumption and little exercise can cause metabolic diseases. The importance of lifestyle changes in terms of a new medical paradigm to solve chronic diseases is becoming popular in modern times. Lifestyle medicine is a medicine based on personal lifestyle. To apply it to patients and ordinary people, physicians have to cooperate with experts in many fields such as nutrition, exercise, psychology, etc. In addition, patients must be partners in the treatment rather than passive recipients. The advent of lifestyle medicine has been caused by changes in disease patterns. In the past, acute diseases like infectious disease were prevalent; however, in the late 20th century, chronic diseases such as metabolic diseases, cancers, neurological disease, etc. increased in occurrence. As lifestyle is closely related with these diseases, the attitudes toward medicine need to be changed. Recently, the concept of “Lifestyle Medicine” was proposed, and we predict it will be an important field in future medicine. Key Words: A new medical paradigm, Chronic disease, Lifestyle, Lifestyle medicine Received: March 13, 2013, Accepted: March 20, 2013 *Corresponding author: In Deok Kong Department of Physiology and Center for Exercise Medicine, Yonsei University Wonju College of Medicine, 20 Ilsan-ro, Wonju, Gangwon-do 220-701, Republic of Korea Tel: 82-33-741-0292, Fax: 82-33-745-6461 E-mail: kong@yonsei.ac.kr Review Article Vol. 3, No. 1, 1-8 INTRODUCTION Mankind has historically suffered from a scarcity of food. The traditional Korean word “Borigogae” (pass of barley) refers to such a situation, that is, the scarcity of food during the spring when they depended on rice until barley was ready for harvest. The reason many people today have health problems such as obesity, diabetes, metabolic syn- drome, hypertension, etc. is related to this historical back- ground. Through the evolutionary history of limited food conditions, the bodies of our ancestors adapted to accom- modate for this scarcity. Thus, the human body’s storage ca- pacity developed to conserve energy sources [1]. However, as Golub asserted in ＜Limits of Medicine＞, many things have changed in the last century [2]. As acute diseases by microbiological infection is no more important problem, diseases pattern was changed. Instead, chronic dis- eases became an important topic. The insistence that in- sufficient food supply would cause a population reduction in undesirable situations like war, as described in ＜An Essay on the Principle of Population＞ by Thomas Robert Malthus [3], was proved wrong. Since the end of World War II, the food supply have become more and more abun- dant, and the population has increased. In advanced coun- tries, people walk less because they use their own cars and work in their offices instead of running around to catch up with wild animals to provide proteins for their bodies. In modern times, a new paradigm is needed to address modern health problems because chronic diseases are be- coming more and more common, replacing acute diseases like infectious disease. The characteristics of these increas- ing chronic diseases are associated with the lifestyles of Journal of Lifestyle Medicine 2 Journal of Lifestyle Medicine Vol. 3, No. 1, March 2013 people. This association resulted in the birth of the term “Lifestyle Medicine.” In this review, we analyze the history and backgrounds of the birth of lifestyle medicine and discuss its current state. Lifestyle medicine will become more important in the future, and the clarification of the purposes of lifestyle medicine will assist in the revision of modern medicine. THE DEFINITION OF LIFESTYLE MEDICINE The term “lifestyle medicine” was first used in as a title of a symposium in 1989 [4]; it first appeared in publication as a title of an article in 1990 [5]. In 1999, Rippe stated that “lifestyle medicine involves the integration of lifestyle practices into the modern practice of medicine both to lower the risk factors for chronic disease and/or, if disease is al- ready present, serve as an adjunct in its therapy. Lifestyle medicine brings together sound, scientific evidence in di- verse health-related fields to assist the clinician in the proc- ess of not only treating disease, but also promoting good health.” His book entitled ＜Lifestyle Medicine＞ is consid- ered to be the first textbook and landmark publication of lifestyle medicine [6]. In another textbook also titled ＜Lifestyle Medicine＞, lifestyle medicine was defined as “the application of envi- ronmental, behavioural, medical, and motivational principles to the management of lifestyle-related health problems in a clinical setting” [7]; the second edition of this book issued four years later added “inducing self-care and self-manage- ment to reflect the recent emphasis on self-management as essential for the proper treatment of chronic disease.” The second edition also included four additional chapters, and the subtitle “managing disease of lifestyle in the 21st cen- tury” was added. The American College of Lifestyle Medicine defines Lifestyle Medicine as “the use of lifestyle interventions in the treatment and management of disease.” It continues that “Such interventions include diet (nutrition), exercise, stress management, smoking cessation, and a variety of other non-drug modalities” [8]. The European College of Preven- tive and Lifestyle Medicine (ECLM) defines lifestyle medi- cine as “the research and clinical prevention and treatment of dysfunctions caused by a non-physiological lifestyle ac- cumulating allostatic load (lifestyle-related diseases, LRDs)” and/or “prevention and treatment of LRDs through nutri- tional, exercise, psychological, social, environmental and pharmaceutical interventions” [9]. Thus, lifestyle medicine is defined in many ways and has changed with time. The common point of these definitions of lifestyle medicine is the focus on lifestyle and its im- portant role in treatment and rehabilitation of disease as well as prevention. WHY IS LIFESTYLE MEDICINE NEEDED FOR HEALTH? About 2,500 years ago, the Greek physician Hippocrates stated, “in order to keep well, one should simply avoid too much food, too little toil” [10]. Both Chinese and Greek philosophers have said “Use moderation” and “All things in moderation.” These attitudes are also important to maintain individual health. The current health problems in developed countries are related to excess energy supplies and are due to such factors as fast food and limited physical activity arising from auto- mation, commuting by car, generalization of office work, and the increase in stationary indoor activities like watching television. Due to these changes of lifestyle, diverse diseases like cardiovascular and metabolic diseases are more and more common. Hence, the authors of ＜Lifestyle Medicine: Managing disease of lifestyle in the 21 st century＞ insisted “The Hip- pocratic prescription now needs to be expanded.” This can be interpreted in a more modern tone to say ‘don’t smoke, don’t eat too much fat (or eat or drink too much in gen- eral), don’t drink too much (or too little) alcohol, try not to get anxious or depressed, balance your stress, don’t do too many drugs (of any kind), don’t have unsafe sex, eat breakfast, perform regular physical activity, sleep well and for long enough, do some stretching and strength work ev- ery other day, wear sunscreen, use a moisturizer, avoid air conditioning where possible, keep the skin well hydrated, chew gum, floss regularly, and remember, moderation in all things-including moderation’ [11]. The lives of contemporary man vary from person to per- 5 Byung-Il Yeh and In Deok Kong : The Advent of Lifestyle Medicine may have contributed to the high rate of diabetes. The pop- ulation has minimal European admixture [17], and type 1 diabetes is very rare even in young subjects [18]. The facts that this population has limited genetic and environmental variability and a low incidence of type 1 diabetes makes them a good population in which medical scientists can search for the genes associated with type 2 diabetes. One such study showed that the diabetes in the Pima Indians’ was familial [19]. The population contains individuals who suffer from most of the clinical characteristic of diabetes such as obesity, insulin resistance, dysfunction of insulin se- cretion, and increased rates of endogenous glucose pro- duction [20]. As the diagnostic criteria for type 2 diabetes according to the World Health Organization were based on a Native American population [21], the findings in Pima Indians indicate that major metabolic pathways related to the pathogenesis of diabetes are common to both Native and non-Native Americans. Until the 1940s, obesity and diabetes were very rare among Pima Indians who lived in mountainous area and re- tained a traditional lifestyle. In order to investigate the prevalence of diabetes and obesity in the 1960’s, scientists noted the change in their lifestyle. Pima Indians were div- ided into those in Arizona and Mexico 700-1,000 years ago, which means these two groups were genetically linked [22]. Medical scientists compared the prevalence of Pima pop- ulations in Arizona, USA and Mexico. Inevitably, the dia- betes prevalence was very low in Mexican Pima Indians, as in the Pima Indians in Arizona. Different disease patterns between the two populations resulted from environmental influences on lifestyle, especially food intake [23]. Pima Indians currently living in Arizona follow the Western life- style, including ingestion of fast food, which contributes to diabetes and obesity. Similar changes have been observed in Mexican Pima Indians. When a cohort study was performed in 1995, the Mexican Pima Indians were practicing tradi- tional methods of farming, involving long walks to remote farm and many hours of daily work. However, the same re- search team found that the prevalence of obesity and dia- betes had increased after 15 years due to increased avail- ability of electricity and grocery stores. Thus, the lifestyle of Mexican Pima Indians began to look like that in the Arizona population, resulting in an increase in the preva- lence of obesity and diabetes in Mexican Pima Indians [24]. Meanwhile, many researchers tried to identify the genetic factors which resulted in type 2 diabetes of Pima Indians. Hanson et al. published an article which showed chromo- some 11q23-q24 region might influence type 2 diabetes [25], but another group of researchers reported that “Identi- fying a single functional variant within a gene is not always equivalent to identifying the causative variant/variants. A difference that is measured in vitro may be insufficient to cause, or ever be unrelated to, the in vivo physiologic per- turbations that lead to type 2 diabetes” [26]. Developments in genetics led to the discovery of candi- date genes for specific diseases like Huntington’s chorea and/or phenylketonuria. When the candidate genes for obe- sity, dementia, height, IQ, were discovered, it was believed that many diseases and signs could be explained by one’s genetic background. However, to explain diseases and body conditions using only genetics has proved impossible. The candidate genes for type 2 diabetes have been reported by many researches, but many loci vary among races and eth- nic groups [27-29]. The fact that candidate genes for the same disease are different according to race or ethnic group shows that life- style must be considered as an important factor in lifestyle medicine. THE DEVELOPMENT OF LIFESTYLE MEDICINE DURING THE PREVIOUS DECADE The term “lifestyle medicine” has become more prevalent since its first use in 1989 [4]. For many medical scientists, it is no longer new to regard lifestyle as an important factor in human medicine. Articles discussing lifestyle medicine have been increasingly published. Here we introduce several review articles issued in the previous decade. The insistence that lifestyle can improve health and be helpful to treat diseases has been posited by many authors [30-34]. Some articles targeted specific groups on the basis of age [35,36]. In addition, a review of a military pop- ulation, which can be regarded as a closed society, was re- ported [37]. This showed the influences and effectiveness of lifestyle medicine in many different populations. 6 Journal of Lifestyle Medicine Vol. 3, No. 1, March 2013 Lifestyle medicine is actively developing in America, Australia, and several European countries and is starting to grow in some Asian countries like Japan [38,39], Taiwan [33], and India [40]. Articles devoted to lifestyle medicine have been increasing, indicating that lifestyle medicine is becoming popular around the world. Recently, review articles aimed at special disease groups have also been introduced, particularly for cardiovascular diseases [31,32,41,42]. One such study showed how to re- duce high blood pressure through lifestyle control [42]. In the preface of ＜Lifestyle Medicine＞ involving “Lifestyle management and prevention of cardiovascular disease”, Rippe wrote “risk factor management in the clinical management of cardiovascular disease has taken a prominent position amongst lifestyle interventions in American medicine,” in- dicating that cardiovascular diseases are the most useful field using lifestyle medicine. The three editors of ＜Lifestyle Medicine＞ published in Australia in 2007 proposed that lifestyle medicine would be used to manage chronic diseases. The authors described life- style as an etiology of chronic disease and emphasized its significance for primary care consultations. They insisted “A modified clinical approach, based around the concept of lifestyle medicine, helps fill the gap by adding behavioural, motivational and environmental skills to conventional medi- cal practices” [43]. The suggestion that the clinician role has to be extended for expanding lifestyle medicine was pro- posed not only in this review, but also in another one in 2004 [30]. USE OF LIFESTYLE MEDICINE TO SOLVE MEDICAL PROBLEMS Chronic diseases are the leading causes of mortality around the world [44]. This indicates that lifestyle factors such as nutrition, smoking, alcohol consumption, stress, and physical inactivity have a major role in the pathogenesis of these diseases [45-47]. In general, metabolic diseases are closely related to lifestyle, and chronic diseases including cardiovascular disease, metabolic syndrome, obesity, type 2 diabetes, and some kinds of cancer are known as life- style-related diseases (LRDs). Lifestyle medicine appeared with the expectation of aid- ing in the prevention, treatment, and rehabilitation of LRDs as well as improving public health. Lifestyle is practiced outside of the medical clinic, so lifestyle intervention has to be administered on an outpatient basis. To accomplish the aim of lifestyle medicine, a clinician has to cooperate with experts in other fields. For this, clinicians have to intervene in people’s lifestyle. As lifestyle medicine has emerged as a major issue, its relation to medication has changed. Physicians generally prescribe medication at a known fixed dosed. However, tailored reduced amounts must be consid- ered when lifestyle is taken into consideration. The Medical Board of California has begun to guide the process and content of lifestyle medicine training for chron- ic diseases [48]. This is one example illustrating the increas- ing popularity of lifestyle medicine. To solve medical prob- lems by control of lifestyle, continuous education and in- formation is required. The main problem in convincing people of the importance of lifestyle medicine is the difficulty of motivating patients to change their lifestyles. A previous study showed that fol- low-up with a health educator as well as physician- struc- tured counseling increased the amount of weekly walking exercises compared with the control group receiving only standard care [49]. Another study showed that only 11% of patients with diabetes follow their instructed diet [50]. To overcome this resistance to lifestyle change, clinicians need to be more active in the encouragement of patients. According to one previous study, in addition to the need to cultivate confidence and knowledge about lifestyle control programs, a lifestyle medicine education program is also required. In conclusion, the important thing for wellness in modern times is to change undesirable behavior and maintain a healthy lifestyle. A healthy lifestyle is the foundation of prevention, treatment, and rehabilitation of diseases, in ad- dition to health promotion. To encourage patients and ordi- nary people to live healthy lifestyles, physicians armed with sufficient knowledge must participate with confidence and in accompaniment with a healthcare team. Therefore, medi- cal policy and community programs are also needed to sup- port the spread of lifestyle medicine. 7 Byung-Il Yeh and In Deok Kong : The Advent of Lifestyle Medicine CONCLUSION Lifestyle has changed as time passes. Such changes of lifestyle are closely related with the changes of disease pattern. To solve the health problems today and future med- ical doctors as well as ordinary people need to be interested in lifestyle. The important role of physicians has been to diagnose and treat diseases so far, but in the future they will have to solve them focusing the lifestyles. Therefore, lifestyle medicine will be an important field in future medicine. 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