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In support of lifestyle medicine

By George Winter - 27th Jan 2025

lifestyle medicine

The evidence on the impact of lifestyle behaviours on health is overwhelming 

According to the Viennese writer Peter Altenberg (1859-1919) there are only two things that can destroy a healthy person: “Love trouble, ambition, and financial catastrophe. And that’s already three things and there are a lot more.” A fourth factor, I suggest, is health professionals ignoring peer-reviewed studies demonstrating that lifestyle behaviours influence health and that drugs don’t always help.

Thus, Srivistava, in Am J Lifestyle Med (Jan/Feb 2024), notes that “[l]ifestyles described as unhealthy may contribute to over 60 per cent of all deaths…”; pharmacist Graham Phillips, in the Pharmaceutical Journal (2024; 312:7982), states: “The NHS acknowledges that overprescribing is widespread, systemic, and cultural in origin, amounting to at least 10 per cent of primary care prescribing… and adverse drug reactions are responsible for as many as 20 per cent of hospitalisations”; and Mair et al, in their iSIMPATHY Consortium Evaluation Report (2023), observe: “If comprehensive medicines reviews were provided to all patients aged 65 and over taking five or more medicines in [Ireland, N Ireland, and Scotland] the maximum avoidable inpatient cost would be (annually)… €28.9 million for the Republic of Ireland [and] £11.0 million for Northern Ireland….”

On diet and dementia, Power et al, in Eur J Nutr (2015, 54:557-568), reported that in a “community-dwelling elderly Irish cohort, consumption of a high glycaemic diet is associated with poorer cognitive performance…”; while Crane et al, in N Engl J Med (2013;369:540-8) found that “higher glucose levels” may be a risk factor for dementia, even among people without diabetes.

On diet and psychiatry, noting that “patients with major mental illness have an elevated risk of type 2 diabetes (T2D), with more than half of those with bipolar disorder experiencing glucose metabolism issues”, Sethi et al in Psychiatry Res (2024, 335: 115866) reported their ‘Ketogenic diet intervention on metabolic and psychiatric health in bipolar and schizophrenia: A pilot trial’, commenting: “The psychiatric outcomes indicate that, on average, the severity of mental illness, as assessed by the Clinical Global Impressions scale, improved by 31 per cent.”

On diet and T2D, on 3 January, the UK’s ITV News broadcast a prime-time report on Southport-based GP Dr David Unwin’s low-carbohydrate, real food approach – BMJ Nutr Prev Health (2023;6: e000544) – that saw 150 of his patients achieve drug-free T2D remission.

And yet… many healthcare professionals insist that carbohydrates must predominate on Eatwell-type guides. And anyway, some might even argue, we’ve got anti-obesity injections.

Why favour drugs over lifestyle (notwithstanding the important role of drug prescription where required)? Perhaps it’s worth pondering Moriarty et al in Health Policy (2021, 125: 1297-1304) on ‘Payments reported by the pharmaceutical industry in Ireland from 2015 to 2019’ when “[p]ayments totalling €163 million were reported by 47 companies during 2015-2019, €84.6 million for R&D, with non-R&D payments of €45.1 million to healthcare organisations and €33.6 million to healthcare professionals”.

Addressing sodium glucose co-transport-2 inhibitors (SGLT2i) in J Hum Hypertens (2021, 35:649-656), Murray et al cite evidence that adopting a carbohydrate restricted diet “can have profound benefits in the control of diabetes; blood pressure; weight and some lipid markers”. And they make three profound points: First, in relation to “dietary changes and lifestyle, if we know SGLT2i waste glucose from the body, then why not simply avoid consuming excess glucose in the form of free sugar or simple starch?”; second, “[i]f we found out tomorrow that cancer could be prevented in 50 per cent of people (or put into drug-free ‘remission’) by avoiding the ingestion of known substances, but at the same time an expensive drug could eliminate those substances from the body, what would be the best course of action for everybody?”; and a third compelling observation is that “[t]ight physiological glycaemic homoeostasis should be a human right, but it has been somewhat hijacked by our need for food ‘rewards’ and the vested interests of the processed food industrial complex.”

Is it acceptable to assert human rights in scientific journals? Absolutely. Why separate knowledge from values? In his The Moral Landscape (2010, p85) Sam Harris cites psychologist Jonathan Haidt’s view that humans’ moral decisions tend to be based on emotion: They “justify these decisions with post hoc reasoning and stick to their guns even when their reasoning demonstrably fails”. One might even wonder if those who ignore reason are inspired by Wilde’s Lady Bracknell: ‘I do not approve of anything that tampers with natural ignorance.’

Recently, two former members of the expert committee for the US dietary guidelines admitted that “our guidelines are part of the problem” (‘The hidden costs of our dietary guidelines’, The Hill, 22 September 2024). They deplored “the continued unjustified demonisation of nutrient-dense foods such as eggs, meat, and full-fat dairy, which together play a crucial role in a healthy diet”.

Will this be the year when lifestyle medicine receives the attention it deserves?

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