restricted access 27. Dangers of Lifestyle Modification Advice
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Ablata causa tollitur effectus. If the cause is taken away, the effect ­ will dis­ appear. Medical maxim Case Study A 65-­year-­old man with a history of ischemic heart disease complicated by myo­car­dial infarction and coronary artery bypass surgery, arterial hypertension, type 2 diabetes mellitus, and body mass index (BMI) of 32 developed chest pain and was evaluated by a cardiologist, who ordered a nuclear stress test. The test showed a fixed inferior wall defect with a very mild peri-­ infarct ischemia. Based on past history, nuclear stress test, and symptoms, the patient was referred for a cardiac catheterization. The catheterization revealed that his bypass grafts ­ were open and functioning normally, but ­ there was a high-­ grade blockage in the posterior lateral back of the right coronary artery, which was subsequently treated with a drug-­ eluting stent. The procedure went well without complications, and the patient was sent home the next day. Throughout this initial evaluation, the patient was never asked about his nutritional habits , his physical activity level, stress level, degree of isolation, contact with ­ family members or friends, or any other lifestyle issues. Unfortunately, ­ after resuming physical activity, he developed chest pain again and was referred to another cardiologist. His second evaluation revealed that he weighed 275 pounds and ­ didn’t exercise regularly. His diet was poor with a very low intake of vegetables and fruit, and most of his caloric intake came from eating at fast food restaurants. He was estranged from his ­ family and lived alone in a small apartment. He also related that he had bilateral knee pain, fatigue, and constipation.­ Because of his medical history, the patient was enrolled in the Dean Ornish Intensive Cardiac Rehabilitation Program at a local hospital. Before enrollment, his labs (despite statin and diabetic medi­ cation) showed total cholesterol 220 mg/dl, LDL 188 mg /dl, and hemoglobin A1c 6.0%. The patient was very enthusiastic about taking part in the program. He connected immediately with all members of his group and the medical staff, and he embraced the vegetarian diet. ­ After nine weeks in the program, he no longer had angina, was adhering to the 10% fat vegetarian diet, practiced yoga on a regular basis, lost enough weight to lower his BMI to 27, and was meeting regularly in person and via Facebook with the other members of his group. His fatigue was gone and his knee pain was almost non­ ex­ is­ tent. He continued on CHAPTER 27 Dangers of Lifestyle Modification Advice Giovanni Campanile 328 / Dangers of Lifestyle Modification Advice ing on obesity, nutrition, and physical activity was very poor, and they did not feel confident in being able to counsel their patients (3). In a study performed by University of Pittsburgh Gradu­ ate School of Health, researchers found that participation in a community-­ based behavioral lifestyle program helped ­ people lose weight, reduce the risk of diabetes and heart disease, and lower their blood pressure as well as significantly improve their general sense of well-­ being. It is not a given that individuals need to feel ill as they age; many who improve their lifestyle choices at any age also heighten their joy in living (4). EXERCISE ADVICE The health benefits of exercise are widely known in the medical community. Exercise is a better antidepressant than antidepressant drugs. Regular aerobic exercise can increase serotonin, dopamine, and norepinephrine while significantly decreasing stress. Thirty minutes of daily exercise can help normalize body weight; prevent heart disease, stroke, cancers, and arthritis; reduce blood pressure ; increase HDL cholesterol; decrease triglycerides ; and improve metabolic syndrome, type 2 diabetes, and insomnia. Regular exercise also boosts energy levels, self-­esteem, self-­confidence, and quality of life. It is very impor­ tant for health care prac­ ti­ tion­ ers to counsel their patients on the importance of being physically active. A recent study showed that even ­ simple physical activity was associated with a lower risk of 13 dif­ fer­ ent cancers . With a global burden of 14 million new cancer cases per year, a figure that is expected to double by 2030, the advice to engage in physical INTRODUCTION Lifestyle medicine is a new discipline practiced by a wide variety of health care professionals in an effort to improve the deleterious effects of chronic disease. Averting prob­ lems by counseling patients on the modifiable risk ­ factors accounting for the five leading ­ causes of death—­ heart disease, cancer, lung disease, stroke, and accidents—is intuitive. However, many prac­ ti­ tion­ ers are...