Lifestyle Medicine and mental health – a short introduction
What is Lifestyle Medicine?
You may have heard of Lifestyle Medicine, but what actually is it? It is a scientifically backed evidence-based approach to long term health problems. It supports you to change and maintain healthy behaviors using techniques tailored to your situation, to improve your mental and physical well-being.
It aims to reverse disease and restore health, by making sustainable long-term changes to six main areas for people like you:
- Getting enough restorative sleep
- Managing your stress levels
- Eating a whole-food, predominantly plant-based diet
- Exercising regularly
- Avoiding risky substances
- Having positive social connections
It also considers there are broader influences on our well-being, also known as the Determinants of Health. Some are potentially changeable, but can be more difficult to do so. These include:
- Adverse Childhood Experiences (ACEs) such as childhood abuse, or absence of a parent.
- Genetic influences – what conditions we are more likely to have due to our genetic coding
- Health Literacy – what we know and understand about our health and well-being
- Environmental issues, such as access to clean water, safe housing, and air free from pollution
- Social and economic states such as having enough money
Why is Lifestyle Medicine important for Mental Health?
As we have already seen, Lifestyle Medicine understands there are multiple influences upon your well-being, and this is true for and Mental Health, where there are often multiple factors at work.
Over 100 potential influencing causes have been identified for causing Depression and Anxiety, which ca n be sub-divided into 10 categories. Where 4 or more of these categories are in place, there is a much higher likelihood of Depression and Anxiety occurring, and the risk increases the more that are in place. The 10 categories are:
- Genetic mutations
- Adverse Childhood Experiences
- Lack of exercise
- Insufficient sleep and interrupted sleep-wake cycle
- Addictions to substances and non-substances
- Poor Nutrition and diet
- Exposure to toxins
- Social stressors
- Chronic diseases (such as High Blood pressure and Diabetes) and medication use
- Not having meaningful, positive socially engaging activities and relationships, or living against your values
Treating the reversible causes can improve and potentially reverse Depression and Anxiety
An example of Lifestyle Medicine for Mental Health difficulties
Having studied Lifestyle Medicine, I’ve been able to help patients analyse what difficulties they’ve been having and where they’ve been struggling to make sustained improvements in their mental wellbeing.
One example from my testimonials page is a patient in their 30s who had struggled intermittently with Depression and Anxiety their whole life. By taking a look at their lifestyle, we were able to understand together various difficulties:
- Unwinding after work
- No regular exercise
- Limited intake of fruit and vegetables, eating on-the-go
- Adverse childhood experiences
- Workplace difficulties
Over our sessions together, we built a plan tailored to the patient’s needs
- Time off work
- Access to psychological therapies
- Access to support to resolve workplace difficulties
- Regular meditation practice
- Regular exercise regime
- Eating regularly homecooked meals with lots of plants
Over 3 months there were great improvements:
‘Lifestyle changes… have provided me with the information and skills to come out of my depression, as well as manage my chronic anxiety in the long term (something that I have never before been able to achieve).
‘The holistic approach that Dr Rainbow has used with me, has made a significant difference in the way I am able to manage my mental wellbeing – this has ultimately enabled me to live a more fulfilled and happy life. I would recommend this approach to anyone.’
Why don’t all doctors use Lifestyle Medicine?
It seems so obvious to understand how we lead our lives affects how we feel, so why is this approach not used when you see the doctor?
One element is that it just isn’t historically taught at medical school, so the current generations of doctors isn’t familiar with it, or how to help patients make changes. There is some evidence of this changing over the past few years however, with courses incorporating some learning in these key areas.
A further area is that changing your lifestyle involves changing your behaviour. There are scientifally backed techniques which can help with this. Doctors maybe aware of these, but rarely use them to help patients.
Also, there can be a tendency for Doctors not to consider you as a whole person, your story experiences and self-understanding. These need to be understood by both you and the doctor so you are both able to make sense of what is happening, why and what can be done about it.
Another thought is that our current guidelines are largely focused on medication, like antidepressants. If you look at how it’s recommended that we Depression and Anxiety are managed, only sleep, psychological help and alcohol and drug use are mentioned briefly. Other elements such as diet, positive social connection and stress management are not mentioned at all.
This is shown more generally in the Western, reductionist approach to medicine, considering things by just one organ in our body (our brain) and how it is not working properly in a biochemical way making us feel bad (by not making enough Serotonin), and correcting this with a tablet we take regularly (to make us feel happy, or not as the case may be). This is at best an over-simplified model,
On final point is that the net effect of all of this on you as the patient. It makes you passive and powerless. The knowledge, power and the solution are all with the doctor. This isn’t right, and doesn’t work for the majority of people.
In summary, our current system does not educate or support doctors in Lifestyle Medicine, or how to address these changes with patients. The Western Biomedical model is constrained in its understanding and treatment of Mental Health problems like Depression and Anxiety, and generally limits treatments to medication and talking therapy. The effect is to leave the patient powerless, and often without any long term improvement.
In summary – Lifestyle Medicine and Mental Health
Lifestyle Medicine is an evidence based whole person approach to long term health conditions. It allows people like you to understand where you are, how you came to be there, and what can be done to improve your situation. My professional and personal experiences and the scientific evidence all show you need to tackle multiple areas simultaneously for long term improvement of Mental Health problems like Depression and Anxiety. Unfortunately, the current medical model isn’t embracing this area, and relies upon medication, which is often ineffective and removes the power of self-improvement from people like you. The good news is that change is possible, with the right knowledge and support.
Start changing today
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Post below to let me know what you think about this crucial area.
References
Brisitish Society of Lifestyle Medicine – Lifestyle Medicine
Rippe J . M .Lifestyle Medicine, 3rd ed .Boca Raton, FL: CRC Press; 2019
Lifestyle Medicine: The Health Promoting Power of Daily Habits and Practices. Am J Lifestyle Med. 2018 Nov-Dec; 12(6): 499–512. Published online 2018 Jul 20. doi: 10.1177/1559827618785554
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6367881/
The Impact of Nutrients on Mental Health and Well-Being: Insights From the Literature, Maurizio Muscaritoli
Roger A.H. Adan, Eline M. van der Beek, Jan K. Buitelaar, John F. Cryan, Johannes Hebebrand, Suzanne Higgs, Harriet Schellekens, Suzanne L. Dickson, Nutritional psychiatry: Towards improving mental health by what you eat, European Neuropsychopharmacology,Volume 29, Issue 12, 2019, Pages 1321-1332,
https://doi.org/10.1016/j.euroneuro.2019.10.011
Lifestyle Medicine and Mental Health
Nedley N ., Ramirez F. E. Nedley Depression hit hypothesis: identifying depression and its causes . Am J Lifestyle Med. 2016;10(6):422-428
https://journals.sagepub.com/doi/full/10.1177/1559827614550779
Voinov B ., Richie W . D ., Bailey R . K . Depression and chronic diseases: it is time for a synergistic mental health and primary care approach .Prim Care Companion CNS Disord. 2013;15(2)
https://pubmed.ncbi.nlm.nih.gov/23930236/
Nedley N ., Francisco R ., Jessica C . lifestyle education program improves depression and anxiety in 8 weeks . Presented at American College of Lifestyle Medicine; October, 2019; Orlando, FL
Nedley N ., Ramirez F . E ., Payton H . Abstract P215: medical lifestyle residential program reduces anxiety in 10 days. Circulation . 2020;
https://www.ahajournals.org/doi/10.1161/circ.141.suppl_1.P215
Medical Schools and Lifestyle Medicine
Current teaching amounts in the US & UK:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3985221/
https://www.bbc.co.uk/news/health-43504125
An article in the BMJ looking at the benefits of learning about Lifestyle Medicine
Examples of Medical schools which are teaching Lifestyle Medicine
https://www.imperial.ac.uk/school-public-health/study/undergraduate/lmap/
https://orca.cardiff.ac.uk/108700/1/thebsdj_2_1_bsdj.42.pdf (Leicester Medical school)
National Institute of Clinical Evidence (UK Clinical guidance) for Depression & Anxiety Management
https://cks.nice.org.uk/topics/depression/management/initial-management/
https://cks.nice.org.uk/topics/generalized-anxiety-disorder/management/management/
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This is really interesting, especially about how doctors are trained to look at problems and organs in isolation and the treat symptoms instead of a holistic view. Unfortunately doesn;t seem like doctors have much time to get to know us properly.