The poor lifestyle habits of the medical profession, the contradictory results of certain studies, the difficulties we face adopting healthy lifestyles…

…and that scientific studies on the beneficial effects of healthy lifestyles have increased only recently (less than 20 years ago), are just a few of the reasons why we do not prescribe a healthy lifestyle with greater emphasis, despite being the best medicine for the prevention of diseases related to the ageing process.

Neolife medical management

The objective of the 4Ps of Medicine is to promote healthy lifestyle habits.

We live more, much more than we did 100 years ago. The average life expectancy in developed countries has lengthened by 30 years in just a century. However, in general terms, our quality of life during these 30 years is not very good. This situation is what has driven the so-called “21st Century Healthcare Paradigm”, the “Preventive, Proactive, Predictive and Personalized Medicine” (4P Medicine), that is responsible for extending the quality of life and delaying the appearance of age-related diseases until our last moments (what is known as compression of morbidity).

The most important element in 4P Medicine (or MP4) is to instill in the population the importance of healthy lifestyles in relation to exercise, nutrition, rest, inner harmony and how best to avoid toxic habits. Each of these can be complemented with bioidentical hormone replacement therapy (BHRT), personalized nutritional supplementation and longitudinal monitoring of biomarkers which combined form the pillars of our Age Management Medicine approach. 4P Medicine is applied to people older than 35.

This is not a new concept. Hippocrates is known to have stated the same beliefs (460-377 BC) 2500 years ago: “If we could give every individual the right amount of nourishment and exercise, not too little and not too much, we would have found the safest way to health.” So what has changed? The North American writer Ralph Waldo Emerson (1803-1882) said: “Society is constantly taken by surprise at any new example of common sense.” The truth is that now we are surprised to learn that exercise and eating well is healthy. What has happened is because the scientific evidence for this statement did not exist until recently. Most of the scientific studies on the beneficial effects of exercise are from less than 20 years ago, and the same applies to nutrition, rest and exposure to toxic substances. Now we can scientifically confirm what Hippocrates said was true. But ultimately this is part of the arrogance of modern science…

In the same vein, the AHA (American Heart Association – American Heart Association) proposed in 2010 seven national objectives in relation to cardiovascular health and disease prevention to be met by 2012 ⁽¹⁾:

1. Do not smoke.
2. Possess a normal BMI (body mass index).
3. Participate in regular physical activity.
4. Maintain a healthy diet.
5. Normal cholesterol.
6. Normal blood pressure.
7. Normal glucose.

If only the first four objectives are met this will effectively reduce your risk of any cause of mortality in the next 7.5 years by 81%.

The INTERHEART study, conducted in 52 countries ⁽²⁾ has estimated that more than 90% of cardiac risk factors are modifiable through healthy lifestyle choices.

Despite the ever growing interest in 4P Medicine and the recommendations put forward by the AHA, healthy lifestyles are still not openly encouraged.

There is no drug capable of achieving the same results as a health lifestyle can – a healthy lifestyle ensures prevention and management of the chronic diseases commonly associated with ageing. So why is it that we do not prescribe such changes with more emphasis?

There are a number of reasons:

– There are still numerous doctors, even more than in other professions who possess very poor lifestyle habits: they smoke, lead a sedentary lifestyle, they are overweight or eat a poor nutritional balance due to poor habits… You can not preach and you can only lead by example. Many doctors do not believe in the effectiveness of changing their lifestyle and, as a result, these reluctant doctors will continue to prescribe tests and drugs to solve problems that could be managed using healthy lifestyle habits.

– Science often provides conflicting results within the same area and this can confuse the clinician, who needs to digest only clear ideas and not scientific debates. For example, the Look AHEAD study ⁽³⁾ did not yield any positive results relating to lifestyle interventions in the reduction of cardiovascular risk in 5,000 obese diabetics; however, the STENO-2 ⁽⁴⁾ and WHEL ⁽⁵⁾ studies did demonstrate that such changes could result in significant benefits for the patient. Doctors also subconsciously promote concepts that closely resemble their beliefs or viewpoints: if a doctor with a sedentary lifestyle reads a scientific study in which no value is attributed to exercise then he/she will continue to cling to the article and argue that his/her unwillingness to exercise is justified no matter how many other articles say otherwise.

– Changing lifestyle habits is very difficult. It is widely understood that it is easier to change your religion or your partner than your lifestyle. This probably does not surprise anyone reading this article. Numerous scientific studies have provided promising results whilst the study subjects are under supervision. Once the study is finished the participants progression is reviewed. Currently the trend is for the majority of the participants to return to their previous lifestyles and undermine what they once improved. Studies of all kinds have been carried out, even paying participants as an incentive to achieve health related objectives; however, once the money has been claimed, the previous habits return. The motivation to achieve compliance and persevere towards a healthy lifestyle is incredibly varied, personal and fluid. A wedding, bikini season, a sporting event, a disease, are each of the most frequent motivations. Want is nothing without will: to be able to initiate change often requires professional help. What is clear is that good lifestyle habits must be acquired during childhood-adolescence.

– Are we doctors and should we prescribe healthy lifestyles? A study published in 2007 ⁽⁶⁾ noted that between 1996 and 2001 medical advice concerning diet and exercise fell by 22% amongst family physicians. In medical schools, the importance of healthy lifestyles is still not taught to students. In addition, students and medical residents dedicate a significant amount of time and effort to completing their studies and internships which inevitably are incompatible with a healthy lifestyle. As a consequence, the medical profession is not exactly a paradigm of healthy living. Although advice from a doctor remains highly valued irrespective of the health issue at hand, the intervention of other professionals such as nutritionists, nurses, graduates in physical activity, psychologists etc. can be decisive when it comes to successfully transitioning to a healthy lifestyle.

At Neolife as an Anti-ageing Medicine clinic, we have formed a multi-disciplinary team that advocates by example: we exercise regularly, we follow a low glycemic index diet, we do not smoke, we take nutritional supplements and we frequently monitor our health and longevity biomarkers. We enjoy spending time with patients and we want to help you understand why you should take care of yourself, we want to illustrate to you how important even the smallest change is to your health by reviewing your biomarkers and above all else we want to motivate and maintain consistency through frequent appointments.

BIBLIOGRAPHY

(1) Lloyd-Jones DM, Hong, Y., Labarthe, D. et al; “American Herat Association Strategic Planning Task Force and Statistics Committee. Defining and setting national goals for cardiovascular health promotion and disease reduction: The American Heart Association´s strategic impact goal through 2020 and beyond”. Circulation 2010; 121:586-613.

(2) Ford ES, Greenlund KJ, Hong Y. “Ideal cardiovascular health and mortality from all causes and diseases of the circulatory system among adults in the United States”. Circulation. 2012; 125:987-995

(3) Look AHEAD Research Group, Wing RR, Bolin P., el al. “Cardiovascular effects of intensive lifestyle intervention in type 2 diabetes”. N Engl J of Med. 2013; 369:145-154

(4) Gaede P., Vedel P., Larsen N., et al. “Multifactorial Intervention and Cardiovascular Disease in Patients with Type 2 Diabetes.”, N Engl J Med. 2003; 348: 383-393

(5) Perce JP., Natarajan L., Caan BJ, et al. “Influence of a diet very high in vegetables, fruit, and fiber and low in fat on prognosis following treatment for breast cancer: the Women´s Healthy Eating and Living (WHEL) randomized trial. JAMA. 2007; 298:289-298

(6) McAlpine DD, Wilson AR. “Trends in obesity-related counseling in primary care: 1995-2004. Med Care.  2007; 45:322-329