Exercise as Medicine

screenshotAlthough Hippocrates was first credited with the observation that exercise keeps a man well, the evidence for the benefits of exercise in the prevention and treatment of disease has been clearly established.  There is in fact a linear relationship between physical activity and health status, and therefore inactivity is considered a powerful and modifiable risk factor for chronic disease, disability and premature death.  Given the unprecedented levels of sedentary lifestyles, should physicians not consider it an ethical obligation to assess and prescribe exercise?

Exercise represents one of the highest levels of physiologic stress to the body; for example, while a high fever can increase metabolism by 100%, a marathon race can increase metabolism by 2000%.  While the primary systems involved in exercise are cardiac, pulmonary, nervous, muscular, and metabolic, all systems benefit; exercise reduces both morbidity and mortality from most common illnesses, and a wide variety of symptoms are usually improved—anxiety, depression, headaches, heartburn, decreased libido, impotency, poor sleep, fatigue, decreased memory, joint pains, poor self esteem, to name a few. And so, regular exercise builds strength and reserve to withstand the everyday challenges to health, at the same time it improves blood flow and metabolic efficiency.

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screenshotAs our patients age, they want to preserve their functional capacity as long as possible.  Our goal as clinicians then is to “square off the screenshotgeriatric curve”.  And of course, there is no age where exercise ceases to be a benefit.  Ask 100 year old  marathoner Fauja Singh, who only started running at age 80 after his wife died.  Or sister Madonna Buder, who started her triathlon career at age 54, and who recently completed her 45th Ironman race at age 80.  You are only as old as you think you are.

Finally, it has been shown that physicians with healthy personal habits are more likely to counsel patients to adopt such habits; such physicians are more credible and motivating to their patients as well.  A healthy doc equals a healthy patient!  We need only start in our own back yard, and share what you know.

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Diet as Medicine

screenshotDespite the strong and likely justified belief that dietary changes can significantly alter a wide variety of disease risks, the topic remains contentious, with thousands of popular diets (check some out here) published, all proporting to improve health in some way.  These all have varying degrees of science behind them, although it takes considerable sleuthing to sort out what are observational studies that only imply cause and effect simply by association.  And, as it happens, nutritional research is hard to do because of the unreliability of food questionnaires, the costs of metabolic lab studies, and the difficulty of holding one variable constant while others are not in fact inversely affected.  It is often very hard to tease out the important element(s) within a diet that may be the linchpin in a given disease.

Traditional and modern diets vary considerably; high fat, low fat, medium fat, high carb, low carb, high animal food, high plant food. And they come with a multitude of confounders:  Seventh Day Adventists are often held up as having a healthy diet, yet their lower mortality rates may also be associated with lower incidences of smoking, alcohol consumption, better sleep, healthier exercise patterns, and a strong supportive community.  Many diets seem to offer benefits due to their high fruits and veggies content, but these diets may also have less refined foods such as refined oils and sugars as well.  Further, it appears that higher fat, salt and protein intakes have been a proxy for a country’s development, with inherent differences in fast food availability, access to refined foods, activity, stress, pollution, medical support, poor sleep, and loneliness– all possible confounders.

screenshotAnd what of the difficulty to accurately tabulate death rates of given diseases in underserviced and rural areas, especially when some countries report sudden death as a distinct entity?  Is the “French Paradox” just a statistical anomaly?  How do we explain the fat intakes of the traditional Innuit, who eat virtually no plant-based foods? And how do we reconcile significantly different food guidance systems in different countries, especially when these documents are created with stakeholders in place, namely the food industry, as occurs in Canada—are we not all the same, or are these politicized documents? And how is it that the understanding of, and the approach to, the epidemic of obesity seems to be so limited as to be ineffectual?  One would think, with the strong association with multiple other diseases, such an “epidemic” would stimulate an urgent response from a wide variety of sources, yet there is almost nothing.  How bad does it have to get? Confusion reigns in the marketplace.

Nevertheless, we plod on.  Despite the seeming hopelessness of this exercise, trends and common themes appear, although we are often forced to make sufficient conclusions from insufficient premises. Given the best seller lists, patients have done well on a wide variety of diets, so it may be that we are all special snowflakes, and one size does not fit all.  The n = 1.

What follows is a summary of various diets, the main principles and evidence behind them. So for the busy clinician who does not have the time to read these latest books, we can provide you with a one minute snapshot of what the diet proports to do, with more links to more references.  As well, a number of daily blogspots will be offered as well that are easily subscribed to if interested.  We hope to also be able to help you develop clinical strategies to help your patients improve their diets, and how to monitor the process.