Abstract
‘The field of lifestyle medicine continues to make significant strides and expand its vision of improved health and health care . . .’
We at the American Journal of Lifestyle Medicine (AJLM) are delighted to publish our annual issue of AJLM devoted largely to the proceedings of the fall 2017 national meeting of the American College of Lifestyle Medicine. This is the third consecutive year we have published an issue devoted largely to these proceedings. As in the past, this issue demonstrates that lifestyle medicine is growing and thriving.
The field of lifestyle medicine continues to make significant strides and expand its vision of improved health and health care both in the United States and around the world. The theme of the 2017 American College of Lifestyle Medicine (ACLM) conference was “Transforming Health, Redefining Healthcare.” The depth and breadth of the articles chosen for inclusion in this issue of AJLM show that this mission is continuing to thrive and fulfill its promise of improving health for individuals around the world.
The articles selected for this issue, by our Guest Editor, Dr Salvatore Lacagnina, were based on presentations at the national meeting of ACLM, which took place October 22-25, 2017 in Tucson, Arizona. These articles show a great range of applications of lifestyle medicine. They range from the utilization of lifestyle medicine theories and practice in the area of psychology and mental health to worksite wellness, plant-based nutrition, and education for medical students. In addition, one article depicts the inspiring story of how one physician adopted lifestyle medicine principles to overcome a life-threatening chronic illness. Another article reports on the use of lifestyle medicine as a means of improving nutrition and productivity in the workplace setting. An interesting article shows the use of lifestyle medicine nutritional concepts to improve dietary habits of athletes, a surprisingly underserved population. An additional article documents the use of lifestyle medicine strategies to potentially prevent or reverse cognitive decline. This issue of AJLM also contains a very interesting article on how one university health system has established a lifestyle medicine outpatient clinic that is meeting with enormous success.
These articles illustrate the great range of work being done in the ever-expanding field of lifestyle medicine. We have also selected 3 additional articles that have been accepted in AJLM to underscore complementary themes of interest to lifestyle medicine practitioners.
The article by Chappell discusses new nomenclature now called illness anxiety disorder, which was formally called hypochondriasis. 1 This article provides strategies based on lifestyle medicine to help combat this chronic disease. Showing how lifestyle medicine practices can improve illness anxiety disorder is consistent with other literature that has emerged over the past decade about the use of such modalities as increased physical activity as an effective means of treating anxiety in general. 2
The article by Stancic describes her inspiring journey from the diagnosis of multiple sclerosis to its long-term remission by employing lifestyle medicine techniques in her personal life after traditional medical therapy had not been unsuccessful. 3 This personal success inspired Dr Stancic to discontinue her work as an infectious disease specialist and open a clinic devoted to lifestyle medicine principles that were so effective in her own life.
Darren Morton provides an important and thought-provoking article linking lifestyle medicine and positive psychology to improve mental health and emotional well-being. 4 Positive psychology has grown significantly as an academic discipline over the past decade. 5 Dr Morton’s article elucidates how lifestyle medicine can play an important role in helping individuals improve both their mental health and emotional well-being through its incorporation into positive psychology. This emerging area in psychology is very welcome since most of the psychological theories and practices in the past have dealt with how to overcome negative emotions. It is refreshing and important to see that positive psychological practices can have a significant impact on individual overall mental health and well-being. This adds an important component and perspective to lifestyle medicine.
Dr Joel Fuhrman presents an impassioned explication on his take for the benefits of plant-based diets. 6 Plant based diets are one of the most exciting emerging trends in all of nutrition. While previous diets from the American Heart Association 7 and American Diabetes Association 8 were, in essence, “plant based,” many of the diets now being developed and researched take this concept even further and have shown dramatic improvements in risk factors for heart disease and other chronic diseases.
The article by Sutliffe et al 9 reports on an interesting nutritional intervention delivered in a workplace environment. This team delivered a nutrient-dense plant rich diet to 77 individuals and showed significant improvement in cardiovascular risk factors as well as workers’ quality of life and well-being. Importantly, the research team was able to track health care expenditures and demonstrated a savings of more than $232 000 over the 15-month period between January 2016 and May 2017. Demonstration that lifestyle measures such as a plant-based diet can be effectively delivered in the work place setting and result in improved health outcomes while achieving significant cost savings will be very important as the field moves forward. As the authors point out, individuals spend nearly 100 000 hours in the course of their lives in work-related activities. Demonstration of economic, as well as health benefits, is an area where research is just beginning to emerge which will be very important as we move the lifestyle medicine initiative forward.10,11
The article by Muscato et al 12 summarizes the workshop “Champions of Change” at the ACLM meeting related to how a lifestyle medicine education collaborative program is being adopted in many medical schools. It is impressive and gratifying to see this program take off and provide innovative educational offerings in lifestyle medicine to the important audience of medical students.
We have elected to also include in this issue an article by Trilk et al, 13 which had been schedule to be published in a future issue of AJLM. This article provides background information on numerous Lifestyle Medicine Education Collaborative (LMEd) accomplishments and milestones. Most notable is the linkage to the Association of American Medical Colleges’ (AAMC) publishing suite, MedEdPORTAL, 14 which assures wide-spread dissemination of publications in the emerging area of how medical students are educated on aspects of lifestyle medicine. Those of us who have gone to medical school in the past 30 years often lament that these topics have not been previously included in traditional medical school curricula. The Lifestyle Medicine Education Initiative offers great promise to ameliorate this problem.
The article by Cramer and Rea 15 provides detail about the great success achieved in the Lifestyle Medicine Outpatient Clinic at Loma Linda University Health. After this clinic was established, the demand for it became so great that it was expanded from 1 clinic session a week to 5 sessions per week. This article should provide both inspiration and a road map for other individuals seeking to establish lifestyle medicine clinics within large health care organizations.
The article by Stoll points out an interesting and somewhat surprising finding that high-level athletes often are very poorly educated in the area of nutrition and health. 16 These individuals, who rely on good health, conditioning, and optimum nutrition to fuel athletic performance, often are hindering their own results by not getting the most important facts about nutrition in sports. Oftentimes, they rely on popular magazines or word of mouth when they should be consulting individuals who are skilled in the basics of human nutrition and performance. This would seem to be another area where lifestyle medicine practitioners can play a very important role in educating individuals through an involvement with athletic teams.
The article by Shetty and Youngberg 17 demonstrates an intriguing early application of multiple lifestyle medicine practices and principles as a strategy for reversing memory loss in individuals who have Alzheimer’s disease. As the authors point out, cognitive decline is one of the great fears of individuals as they age. This initial program, using protocols developed by Dr Bredesen at University of California Los Angeles 18 has now been applied to more than 70 individuals at the Youngberg Clinic and holds considerable promise for helping individuals who have cognitive impairment to achieve improvements which can be very significant and even life altering.
In a sense it is not surprising that lifestyle medicine principles could affect the function of the brain. After all, multiple lifestyle medicine principles have played a significant role in helping reverse or decrease risk factors for such chronic diseases such as heart disease and diabetes. This innovative, multifaceted approach as described by Shetty and Youngberg may offer the same kind of hope and opportunity that we have seen in other organ systems as lifestyle medicine principles are now applied to the brain and cognitive function.
This research also comes at a time when we are seeing increasing academic research published in the area of nutrition and cognition as well as exercise and cognition. The simple strategy of drinking more cocoa has been demonstrated to result in multiple cognitive benefits for individuals older than 60 years who have not yet experienced any cognitive decline. 19 A similar strategy has also been shown to be successful in individuals with mild cognitive decline. 20 Regular exercise has now been shown in multiple studies to improve cognitive function. In addition, Petruzzello et al 21 have theorized that regular exercise creates “cognitive reserve,” which allows individuals to maintain cognitive function later in life. It is a little bit like making regular bank deposits—the long-term benefits accrue over a lifetime.
In addition to the articles that came directly from presentations from the national meeting of the ACLM, we elected to add several other articles that had been scheduled to be published in future issues of AJLM, which we felt were particularly germane to advances in lifestyle medicine and the other articles in this issue. As already indicated, the article by Trilk et al 13 falls into this category. In addition, the article by Egger 22 represents an attempt to provide guidance about how structure and methodology within the practice of lifestyle medicine are important to its effective delivery. Dr Egger has been a leader in both the theory and practice of lifestyle medicine and makes a number of important points which we all should heed as the field moves forward. The article by Houlden et al 23 provides a useful and interesting guidance as well as practical advice about how to incorporate lifestyle medicine principles into the regular medical history. Since all of us in medicine grew up recognizing that an accurate and robust history is critical to diagnosis, focusing on the lifestyle history will be very valuable for lifestyle practitioners.
Finally, we are pleased to be able to publish the bimonthly “From the ACLM President’s Desk” column from Dr George Guthrie where he provides a thought-provoking attempt to define what lifestyle medicine is. 24 In any new field, it is important to have clear parameters about what we consider both to be the essence of the field and things that we consider to not be within the purview of lifestyle medicine. Dr Guthrie provides useful and provocative thoughts on this. The Editorial by our Guest Editor, Dr Sal Lacagnina, places the articles that he selected and his experience at the most recent national conference of the ACLM within the context of his 25 years of practicing internal medicine. 25
As ACLM has continued to grow, AJLM is proud to be both a partner and the official journal of ACLM. I am also pleased to inform you that AJLM has also been making great strides. We have a subscription base of more than 10 000 subscribers—4000 of which are institutions. In the past calendar year, there were more than 75 000 downloads of articles from AJLM. These downloads come from practitioners all over the world. Clearly, as Bob Dylan so famously wrote “The times, they are a changing.”
AJLM also continues to strive to bring important and relevant content to members of the ACLM. With that end in mind, in the past 2 years, we have inaugurated 3 regular columns—namely, Education in Lifestyle Medicine, the Business of Lifestyle Medicine, and Case Studies in Lifestyle Medicine. These columns are all supervised and/or written by recognized experts who are members of the ACLM. In recognition that lifestyle medicine has become an increasingly international discipline, we have also added 3 more international members of our Editorial Board with more to be added in the near future.
As the field of lifestyle medicine continues to advance, it is important that we maintain the broadest possible audience and credibility within mainstream medicine. With that in mind, I also have the privilege of editing the major academic textbook in lifestyle medicine (Lifestyle Medicine; third edition to be published in late 2018). 26 This mammoth work draws on the expertise of more than 200 researchers and educators in fields that are germane to lifestyle medicine. These are as varied as cancer prevention (section delivered by senior investigators from the Centers for Disease Control and Prevention), obstetrics and gynecology, cardiac rehabilitation and secondary prevention, and injury prevention to name only a few of the 21 sections in the book. This effort continues to create a dialogue between high level researchers in various aspects of lifestyle medicine and also stimulates them to think about what constitutes the highest level evidence in how lifestyle habits and practices impact on health.
I am pleased that this third edition of Lifestyle Medicine also has input from multiple leaders of the ACLM who serve as section editors in the book. These include Dr Beth Frates (section editor in Behavioral Medicine and Substance Abuse and Addiction sections), Dr Eddie Phillips (section editor for Physical Activity), Dr Amanda McKinney (section editor for Obstetrics and Gynecology), and Dr George Guthrie (section editor for the Practice of Lifestyle Medicine).
These academic efforts, including both the AJLM and my Lifestyle Medicine textbook are based on the philosophy that the broadest possible application of lifestyle medicine principles and practices will only come by drawing on recognized experts from the many diverse fields where lifestyle practices and habits are known to impact on health and combining their efforts with the passion and expertise of members of ACLM.
I would be remiss if I did not close this editorial by extending gratitude and congratulations to Dr Sal Lacagnina, who served as Guest Editor for this issue of AJLM. Dr Lacagnina took on this significant responsibility and handled it with exemplary skills, grace, and commitment. He is a natural born “editor” as well as a gifted writer. I have asked Dr Lacagnina to join our Editorial Board of AJLM in the very important area of “Communications in Lifestyle Medicine” and he has graciously accepted.
Over the past 25 years as I have continued to work in the area of lifestyle medicine, I am struck by its growth and the commitment and passion of the individuals who practice it. We truly have a once in a lifetime opportunity to change the course of medicine around the world by emphasizing the central role that daily habits and actions play in both our own and our patients’ short- and long-term health and quality of life. That is the essence of lifestyle medicine! The field continues to grow and thrive and it is gratifying to know that it is in the hands of such a dedicated and talented cadre of health care professionals.