Lifestyle medicine: we must keep informed to best serve our patients

I was one of the first cohort of doctors to sit the lifestyle medicine examination in Edinburgh earlier this year, after years of study and practice.1 Although lifestyle and nutrition is listed as the initial step in guideline algorithms, it receives, at best, lip service. Part of the reason is that doctors are unaware of the profound benefits achievable with lifestyle changes, and part of this unawareness stems from the guidelines lagging behind the literature.

Most of my colleagues are unaware that research showing the reversal of coronary artery disease has been published in top peer reviewed journals for decades. One need only Google the names Esselstyn and Ornish to see this. Yet many busy doctors are not inclined to go to primary literature and are happy to rely on guidelines. This is understandable, but if we are not informed, we will not be able to offer our patients real choice about how to prevent or treat the conditions that cause the most morbidity and mortality.

This is an ethical problem for the profession—especially for creators of guidelines and for educators. We should not be leaving motivated patients at the mercy of the internet, which is full of unsubstantiated claims about nutrition, and we should not abandon less motivated patients because we do not think they will make changes. I hope that all doctors—but first and foremost, GPs—will regard the field of lifestyle medicine as a natural extension of our advice about smoking. We know that it is bad, and we know that we have to tell people and to continue developing ways to encourage choices that promote human health. Given that all physicians are also patients, or potential patients, we should examine how we can promote our own health through example and avoid an “us and them” situation. We are them.

As to whether the field of lifestyle medicine should be separate or integrated into medicine in general, I would like to make an analogy with palliative medicine. It started out as a separate endeavour but is now widely practised in general practice and is becoming integrated into other specialties. Yet, some situations will always require specialist palliative care expertise, and there is no contradiction here.