Why Prescribe Lifestyle?

Why Prescribe Lifestyle?

Do you associate prescriptions with pharmaceuticals rather than lifestyle?

Doctors and other healthcare practitioners give us prescriptions, and we go to a pharmacy to pick up our drugs. We know that healthy lifestyles can help prevent diseases, but they are no longer recommended only for prevention. Healthful lifestyle interventions are now also being prescribed to treat chronic illnesses.

Most of our healthcare cash is spent on chronic diseases rooted in our lifestyle choices and environment. According to the CDC, "90% of the US $4.1 trillion in annual healthcare expenditures are for people with chronic and mental health conditions". [1, 2, 3.] Heart disease and stroke kill more Americans than any other medical condition.

High blood pressure is a risk factor for heart disease and stroke and is the world's biggest silent killer [4]. Diabetes, obesity, and arthritis are other costly, potentially preventable chronic illnesses. However, in some cases, we have the power to change the outcomes because many other things can fall into place if we focus on a healthier lifestyle.

Prescribing lifestyle is a way to tackle the root cause of disease rather than look at the symptoms and throw drugs at it. In the long run, treating the symptoms may not help without establishing the underlying cause. And, even if you are taking a pill for a specific condition, a lifestyle prescription can positively impact your overall recovery.

Lifestyle medicine is oriented toward your health. The World Health Organization (WHO) constitution defines health as "a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." [14] That means the goal is to achieve health and vitality, not just eliminate sickness.

Our bodies have multiple systems, such as immune, cardiovascular, endocrine, and gastrointestinal, to maintain homeostasis and to keep us balanced, so trying to eliminate a narrow aspect of sickness with a pill may throw those systems out of whack. In addition, when employing lifestyle prescriptions, you get to have something personalized to you. You may have the same complaint as somebody else but receive a completely different lifestyle recommendation because it's tailored to your body and your needs.

Lifestyle medicine goes beyond temporarily suppressing the symptoms you are experiencing. It's there to fully address the problem, which will require you and your doctor to spend enough time to get familiarized with you and your medical history. It is a patient-centered and collaborative approach, which requires a patient to be well-informed about decisions that need to be made to make the necessary changes and to understand why they are important. The patient then becomes a more active participant in making the change.

Since multiple processes go awry when it comes to illness, and drugs often only target one aspect of the process, it's essential to look at other ways to maintain balance that doesn't involve multiple prescription medications.

For example, Type 2 diabetes affects 37.3 million Americans currently (11.3% of the US population) [2]. Research informs us that healthy food and physical activity can help to reduce the symptoms and bring blood sugar levels to a more manageable range. Even more astounding than that, and a success that I have observed in my patients, is that the correct movement and nutrition can achieve diabetes reversal or remission [15]. Thus, it is possible to decrease and even wholly discontinue medications. This process needs to be safely managed under medical supervision by an experienced doctor. This approach not only works with type 2 diabetes, it can also be helpful for other illnesses and conditions.

Lifestyle medicine is not an alternative. It can work alongside conventional medicine methods to improve our lives.

Our current healthcare systems are overloaded and lack of time with patients is one of the most cited frustrations both on the part of the patients and on the part of physicians—with the average consultation duration being around 15 minutes [5]. Even more concerning, according to a 2018 survey, 1-in-4 doctors spent approximately 10 minutes with their patients [6].

Let's compare a typical doctor's consultation with my lifestyle prescription consultation:

Scenario 1.

A patient with diabetes on metformin comes in for a typical doctor visit (a 15-minute consultation) to review blood test results and is discovered to have high blood pressure and high cholesterol. The patient will usually be prescribed a high blood pressure pill and a statin or other cholesterol-lowering medication. The doctor will discuss potential side effects, check for drug interactions, give general advice about eating healthier and being more active and advise the patient to follow up in a few weeks to months.

The follow-up will focus on monitoring for side effects and checking if the medications are working and whether the doses need to be adjusted or if additional drugs are needed.

Scenario 2.

An initial lifestyle medicine visit with me (an hour or even longer if needed) gives us enough time to obtain in-depth history and review current health habits, such as sleep, nutrition, physical activity, stress management, etc. Based on collected information, the patient and I can together find specific and individually tailored opportunities for improvement. I will then provide personalized lifestyle prescriptions, allowing the patient to manage their high blood pressure and high cholesterol only with lifestyle modifications, without using any medications.

Depending on the case, we will do a checkup in a few days to weeks to monitor progress and determine if any adjustments are necessary. This approach avoids potential side effects of medications and achieves longer lasting and more effective results as we address the problem's root cause. When pharmaceuticals must be used, we can strive to use the minimal effective dose. For instance, we could reduce or discontinue pills, such as metformin, in our patient's case.

Medication errors [9] sometimes lead to devastating consequences, and the fewer medications are used, the less chances for mistakes. Overprescribing [8] (using a few drugs at the same time by one person) and polypharmacy [10,11] (taking five or more medications daily) have been recognized as a problem worldwide.

We are so used to sickness that we consider it inevitable, yet there is no reason for this. We can maintain good health into old age. When we are aware of our nutrition, exercise, stress, and sleep patterns, we can change how we treat our bodies. Drugs do not tackle the root causes of diseases or illnesses and certainly do not address how we live our lives.

Prescribing Lifestyle is what I do in each of my patient encounters. It is an excellent way to help people avoid taking pills (where possible), and it is one of the most important things I can do as a physician. It is the cornerstone of my practice.

Lifestyle is Medicine™

REFERENCES

1.  Health and economic costs of chronic diseases. Centers for Disease Control and Prevention. https://www.cdc.gov/chronicdisease/about/costs/index.htm. Published September 8, 2022. Accessed December 10, 2022. 

2.  Buttorff C, Ruder T, Bauman M. Multiple chronic conditions in the United States. 2017. doi:10.7249/tl221 

3.  National Health Expenditure Data: Historical. CMS. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NationalHealthAccountsHistorical. Accessed December 10, 2022. 

4.   Hypertension. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/hypertension. Accessed December 10, 2022. 

5.   Medscape Physician Compensation Report 2016. https://www.medscape.com/features/slideshow/compensation/2016/public/overview. Accessed December 10, 2022. 

6.   Michas F. Time Physicians spent with patient U.S. 2018. Statista. https://www.statista.com/statistics/250219/us-physicians-opinion-about-their-compensation/. Published August 9, 2019. Accessed December 10, 2022. 

7.   Choi KW, Chen C-Y, Stein MB, et al. Assessment of bidirectional relationships between physical activity and depression among adults. JAMA Psychiatry. 2019;76(4):399. doi:10.1001/jamapsychiatry.2018.4175 

8.   Bennett F, Ferner R, Sofat R. Overprescribing and rational therapeutics: Barriers to change and opportunities to improve. Br J Clin Pharmacol. 2021 Jan;87(1):34-38. doi: 10.1111/bcp.14291. Epub 2020 Apr 14. PMID: 32216108.

9.   Riaz MK, Riaz M, Latif A. Review - Medication errors and strategies for their prevention. Pak J Pharm Sci. 2017 May;30(3):921-928. PMID: 28653940.

10.  Masnoon N, Shakib S, Kalisch-Ellett L, Caughey GE. What is polypharmacy? A systematic review of definitions. BMC Geriatrics. 2017;17(1). doi:10.1186/s12877-017-0621-2 

11.  Pazan F, Wehling M. Polypharmacy in older adults: A narrative review of Definitions, Epidemiology and Consequences. European Geriatric Medicine. 2021;12(3):443-452. doi:10.1007/s41999-021-00479-3 

12.  Halli-Tierney AD, Scarbrough C, Carroll D. Polypharmacy: Evaluating Risks and Deprescribing. Am Fam Physician. 2019;100(1):32-38.

13.  What is deprescribing? Deprescribing.org. https://deprescribing.org/what-is-deprescribing/. Published November 11, 2022. Accessed December 9, 2022. 

14.  Constitution of the World Health Organization. World Health Organization. https://www.who.int/about/governance/constitution. Accessed December 10, 2022. 

15.  Hallberg SJ, Gershuni VM, Hazbun TL, Athinarayanan SJ. Reversing type 2 diabetes: A narrative review of the evidence. Nutrients. 2019;11(4):766. doi:10.3390/nu11040766