Lifestyle Medicine

Lifestyle, the Environment and Preventive Medicine in Health and Disease

Michael Sagner, Garry Egger, Andrew Binns, Stephan Rossner, Garry Egger, Andrew Binns, Stephan Rossner, Michael Sagner

• Publisher: Academic Press
• Year: 2017
• ISBN:
  9780128104262
• Edition: 3
• Topic: Medicine
• Subtopic: General Health

Lifestyle Medicine: Lifestyle, the Environment and Preventive Medicine in Health and Disease, Third Edition, is an adjunct approach to health practice that seeks to deal with the more complex modern determinants of chronic diseases—primarily lifestyle and the environments driving such lifestyles—in contrast to the microbial 'causes' of infectious disease.

Our lifestyle choices have a profound effect on our health. As we live longer, one thing is clear: many of us will spend time living with injury and chronic illness due to our own choices. Changes in health patterns typically follow shifts in living conditions. Disease patterns have changed worldwide, from infectious to chronic diseases such as obesity, diabetes, and heart disease. This change has been so emphatic—nearly 70% of all presentations to a doctor in modern western societies are now chronic disease related—that medical services are being forced to change to accommodate this.

New chapters in this third edition explain the link between energy intake and expenditure; consider how modern technology are determinants of chronic disease; show how environmental influences, such as endocrine disruptors, influence our health; and summarize recent research on early childhood experiences and chronic disease.

• Explores the relationship between lifestyle and environmental drivers and the major modern chronic diseases
• Outlines the knowledge and skills bases required by health professionals to deal with lifestyle and environmental determinants of chronic disease, as well as the tools and procedures available for doing this
• Develops pedagogy for Lifestyle Medicine that will enable it to become a practical adjunct to conventional health and medical practice
• Features new chapters explaining the link between energy intake and expenditure, and more

Section II

Lifestyle and Environmental Determinants of Chronic disease

Outline

Chapter 8. Nutrition for the Nondietitian

Chapter 9. Fluids, Fitness, and Fatness

Chapter 10. Behavioral Aspects of Nutrition

Chapter 11. Physical Activity: Generic Prescription for Health

Chapter 12. Physical Activity: Specific Prescription for Disease Management and Rehabilitation

Chapter 13. Stress: Its Role in the S-AD Phenomenon

Chapter 14. Dealing With Worry and Anxiety

Chapter 15. Depression

Chapter 16. Happiness and Mental Health: The Flip Side of S-AD

Chapter 17. Technology-Induced Pathology: Watch (This) Space

Chapter 18. To Sleep, Perchance to … Get Everything Else Right

Chapter 19. Health and the Environment: Clinical Implications for Lifestyle Medicine

Chapter 20. Meaninglessness, Alienation, and Loss of Culture/Identity (MAL) as Determinants of Chronic Disease

Chapter 21. Preventing and Managing Injury at the Clinical Level

Chapter 22. Rethinking Chronic Pain in a Lifestyle Medicine Context

Chapter 23. Understanding Addictions: Tackling Smoking and Hazardous Drinking

Chapter 24. Medicines: The Good, The Not So Good, and The Sometimes Overused

Chapter 25. Relationships, Social Inequity, and Distal Factors in Lifestyle Medicine: Tackling the Big Determinants

Chapter 8

Nutrition for the Nondietitian

Joanna McMillan Price, and Garry Egger

Abstract

Nutrition is a relatively new science with many apparent contradictions. This chapter attempts to simplify the subject for the clinician by introducing the concept of food “volume” and its components (energy density, portion size, and frequency of eating). Basic information is also provided on the major macronutrients (protein, carbohydrate, fat), together with clinical recommendations.

Keywords

Calories; Energy density; Macronutrients; Overconsumption; Portion size; Salt; Trans fats

Research about diet and nutrition seems to contradict itself with aggravating regularity.

Walter Willet, 2005

Introduction: The Confusion of Nutrition

Peruse the pages of any mix of popular media and you will consistently find one thing: a lack of consistency on the supposed health benefits of different aspects of nutrition. One week we are told that coffee causes cancer, the next that it prevents it. All fat was once thought to be dangerous; now we are advised to eat more of some types to prevent heart disease. Dairy products were thought to be fattening; now they are actually promoted for weight loss.

So what is going on? Why is it so hard for scientists to reach a definitive conclusion on good nutrition? And how do we know that what we are promoting now is not likely to change in the future?

The Science of Nutrition

Nutrition is a comparatively young science, with much to be discovered. Because of the wide range of ingredients in foods and the multidimensional physiological responses to this, research can be tedious and demanding. Progress is made in stages, with inevitable controversies in small issues but a gradual evolution of understanding of major health-related factors.

To discuss nutrition and health in a single chapter in the context of lifestyle-related chronic diseases is therefore a daunting task. Consequently, we have chosen to focus only on those aspects of nutrition that are relevant to metabolic health and, in particular, obesity and weight control (and the extent to which these influence other aspects of metabolic health). Even here, we cannot hope to cover the full range of information available, so we have chosen to concentrate on those new and practical findings that have implications for lifestyle medicine. Again, this is not meant as a substitute for competent professional advice but to complement such information.

We look first at calorific volume in food and the factors contributing to this, then turn to new findings relating to specific aspects of the major nutrients and the implications of these findings for metabolic health. We have assumed a knowledge of nutritional components, and so do not elaborate on the basics. More detailed recommended nutritional reading is contained in the References and Professional resources. Energy intake from fluids and the influence of eating behaviors are considered in subsequent chapters.

The Concept of (Energy) Volume

It has long been known, at least for animals, that longevity is increased with relatively low total energy intake over the course of a lifetime. Why this may be so is not clear. Because of ethical considerations in doing the research, it is also not clear whether the same applies to humans, although the indications are that it does. Several hypotheses have been proposed as to why this may be so (Civitarese et al., 2007; Morgan et al., 2007). It is also not known whether a restriction of all or just some types of calories may be important (Heilbronn and Ravussin, 2005). Nevertheless, while there are diet books on just about every component of nutrition, the truth is that the most significant component of nutrition for weight control (and metabolic health) is its (calorific) volume (Rolls, 2007).

Volume, as outlined in Chapter 7, in energy input is made up of three components:

energy density (how...