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6 Pillars of Lifestyle Medicine: Part 1

Posted by Renee Cocchi

Apr 14th 2022

Physicians can’t provide the best care for their patients if they aren’t physically and mentally well themselves. While this has long been patently obvious, it was underscored during the COVID-19 pandemic.

They also learned that having comorbidities, like heart disease, obesity and diabetes, put people at risk for COVID-19’s worse effects. Likewise, lifestyle factors such as smoking and being sedentary, were associated with severe COVID-19 cases.

All of this reinforced the need for Americans to focus on adopting and sustaining healthy lifestyles.

In this two-part series, we’ll reveal how physicians and their patients can achieve a healthy lifestyle by following the six pillars of Lifestyle Medicine:

        • Exercise
        • Nutrition
        • Stress management
        • Sleep
        • Social connections
        • Substance use modification/elimination

“These six pillars are extremely important to everyone’s well-being, especially during stressful times when people want to bolster their immune systems,” says Beth Frates, MD, FACLM, DipABLM, Clinical Assistant Professor, Harvard Medical School, Lifestyle Medicine Specialist.

Lifestyle Medicine focuses on using these pillars as the first line of defense in preventing chronic conditions, like high blood pressure, diabetes, cardiovascular disease, and metabolic syndrome. It provides physicians with the tools to counsel and coach patients in lifestyle changes, empowering them to manage their chronic conditions.

When physicians learn the evidence-based guidelines around the six pillars, they become aware of their own habits and lifestyles. When they make healthy changes, they can feel the benefits and are more likely to counsel patients on these healthy changes. So, learning about lifestyle medicine often improves the health of providers and patients alike.

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Pillar 1: Exercise

Physicians learn about exercise in medical school and review how it lowers blood pressure and heart rate and reduces the risk of cardiac disease and stroke. Rarely covered is the impact exercise has on the brain; specifically, the hippocampus, which is critical for consolidating memories.

“Many physicians see patients at risk for dementia and those with dementia. Everyone would agree that it’s important to preserve and improve our memory,” says Dr. Frates. “So, if we can increase the size of our hippocampus, all the better.” Exercise also helps with our immune system, which is critical during a pandemic.

In her research, Dr. Frates found that physicians who exercise are more likely to counsel their patients to exercise. But it works in the opposite way, too. The reason physicians give for not counseling on exercise is inadequate time and lack of knowledge/experience with exercise counseling.

The U.S. Health and Human Services Department’s 2008 exercise guidelines recommend 150 minutes of moderate intensity physical activity a week. Many research studies have shown a marked reduction in all-cause morbidity and mortality with this level of exercise. For more benefits, the recommendations are to go to 300 minutes for another marked reduction. However, if engaging in vigorous activity, the guidelines are halved.

“If you are sedentary and you move only 10 minutes a day, it can really decrease all-cause mortality,” says Dr. Frates. “If we can get all of our patients moving for at least 10 minutes a day that would really benefit them and our population at large.”

The guidelines also recommend strength training twice a week on non-consecutive days. “That’s the part people often forget,” says Dr. Frates. “But we need our strength, especially in our elder years, because that’s when we are at risk for falls.”

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Pillar 2: Nutrition

A healthy diet is one that limits refined starches, sugars, processed foods, and the intake of certain fats, and emphasizes whole plant foods including vegetables, fruits, whole grains, nuts, seeds and legumes with or without lean meats, fish, poultry, or seafood.

Research has been mounting as to why whole food, plant predominant diets, such as the Mediterranean and DASH diets, are recommended. The vegetables and fruit contain fiber which help improve the diversity of the microbiome and allows microorganisms to ferment it and produce short chain fatty acids like butyrate, pyruvate and acetate. These short chain fatty acids enter the systems and have an impact on energy, metabolism, lipid metabolism, glucose metabolism, inflammation, and immunity.

It’s also recommended to use the Harvard healthy eating plate – half the plate is vegetables and fruit, a quarter is whole grains, and the other quarter is a healthy protein.

“We focus in on vegetables and fruits because a lot of data shows it decreases the risk of heart disease and stroke,” says Dr. Frates. “We know the medicine is in the phytonutrients of the fruits and vegetables.”

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Pillar 3: Stress

The pandemic created added stress for everyone. And stress can create a desire for hyperpalatable foods which are often high in fats and sugars. High cortisol levels may be responsible for this, and stress increases cortisol.

“We have stress throughout our lives. What we want to do is harness the stress and get into eustress so we can be productive,” says Dr. Frates. Eustress is also considered flow. Flow is a state when you are fully engaged and concentrating on the task at hand to such a degree that you lose track of time. The trick is to find an activity or project that challenges you but is not overwhelming.

Excessive stress can have a negative impact on the brain, particularly the hippocampus. So, employing stress reduction techniques can help avoid many different medical conditions associated with stress like headaches, muscle tension, cardiovascular disease, depression, and anxiety. Deep breathing, meditation, and other stress reduction techniques will protect the hippocampus and keep the brain functioning well throughout a lifetime.

Stress reduction techniques include:

      • Getting out into nature
      • Exercising
      • Practicing mindfulness
      • Taking a vacation
      • Deep breathing
      • Listening to music
      • Laughing
      • Chewing gum
      • Checking email less frequently

In times like we’ve experienced during the pandemic, when stress is high, it’s important to do things that reduce stress levels. “Just a five-minute walk may reduce our state of anxiety,” states Dr. Frates. “Moreover, experiments done at Stamford have shown that a 20-minute walk can increase creative output by 60%. So, if you have a tough problem take a 20-minute walk. You’ll be less stressed and more creative.”

Stay tuned for part two where we’ll discuss pillars four through six (sleep, social connections and substance use modifications/elimination).


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