It occurs to me I have not written as much as I should, and for that I am sorry. Fortunately for me, this is a blog and not a research paper, so I can relax a little in my style and more freely speak my natural tongue at this late hour. My two children are finally asleep and now I sit sipping warm water – continuing my 16 hour daily fast – typing on my f.lux blue light filter screen and monitoring the clock to ensure I get my 20 minutes meditation and 7.4 hours of sleep.
For those who don’t know the ASLM story, let me start there. About 15 years ago, a visionary man wrote the first Lifestyle Medicine textbook in Australia (the second worldwide). Soon after, he founded the Australasian Lifestyle Medicine Association (ALMA), a fully independent not-for-profit organisation, to open the conversation to evidence-based lifestyle interventions for chronic disease, and just as importantly, to the social and environmental drivers of lifestyle-related disease.
Professor Garry Egger AM was joined by other noble minds as he campaigned for timeless common sense; A/Prof John Stevens, Dr Andrew Binns, Dr Caroline West, Tanja McLeish, Dr Joanna McMillan, and the list goes on. In 2015, another great man joined the scene with a vision to reinvigorate the under-resourced ALMA as ASLM; the Australasian Society of Lifestyle Medicine.
Thanks to Stephen Penman, we are now leading a national and international multidisciplinary movement of doctors, allied health, nurses and public health professionals who promote evidence-based lifestyle interventions as the first-line treatment for many chronic diseases.
Lifestyle Medicine is often considered mainly about “diet”. But like so many, I tire of the nutrition wars, becoming often enveloped by ego, agendas and ideology, and all the while being the perfect breeding ground for populist bloggers and media to get more Facebook likes and retweets. Common sense will hopefully prevail and we shall all come back to real food one day.
Instead, we know Lifestyle Medicine is about so much more, and above all, it is about the principles of integrity and humility that must govern it as they have so loyally governed our greatest historical realisations. To examine our own bias as much as we examine others, if not more so. To participate in research and mature dialogue about the evidence as it stands, rather than how we want it to be. To accept we may not know it all, but work to advance scientific progress and innovation in application.
Diet of course matters, but we look to the rapidly growing evidence into sleep, movement, fasting, the strength of connection with others and nature, techniques for smoking cessation and sensible alcohol intake, the use of online and app technology, health coaching and behaviour change techniques, the role of public policy, the agriculture system, the impact of modern marketing, the health of our environments and further, right down to the deepest personal questions; the biological and psychological impacts of meaning and purpose in life.
As for the intricacies of the nutrition wars, I will save that for another night. As for now, I will say within the hubs of passionate lifestyle practitioners there exist certain groups, many sensible and a few zealous. It is so much easier to run from dissonance and remain in our echo chambers, but we must not succumb to the temptation of tribalism nor to the modern weakness of being unable to endure the short term for a greater long term vision. We must see the big picture and play the long game.
Look to any major guideline and there looking back at you, you will see “lifestyle intervention” to be used before and with every other treatment. Lifestyle Medicine is not opposed to medication nor procedure, rather it is simply another option for our patients to prevent and reverse their disease – and often the option they are most keen to do. How nice it is for me as a GP to suggest a treatment option that people actually want rather than trying to persuade them, and myself, that another medication is the answer to their diabetes or other significantly reversible chronic diseases? Of course, I, like every sensible clinician, celebrate and am deeply grateful for the advances in modern therapeutics, but why not use everything the evidence suggests we should for the betterment of our patients physical, psychological, and social lives?
And why stop with the patient? Lifestyle Medicine is also a social and cultural health movement. To change the system from top down and bottom up; from advocating regenerative agriculture and reconnecting with real food to advancing government policy, from medical school training to the sugar tax, and everything in between. There is a lot of work to be done, especially in addressing health inequities. Fortunately, it is also extremely cost-effective. I will explain all that in another blog soon, but to give you a taste; studies of the Ornish Lifestyle Medicine program to reverse heart disease have shown that it cut overall healthcare costs by 50% in the first year, and these were sustained for at least 3 years.
Whilst we are on the topic of culture, it may be more important for some to make it clear ASLM has no, and never has had, religious or industry influence. Rather, we have always been independent, and are striving to break down the historical occurrences of bias to yield clarity in evidence-based and personalised recommendations. Do we have sponsors for our events? Yes. I think it is a tad naive to think an organisation can host major events without financial support for them, and anyone who has ever run anything knows that partnerships and sponsors are par for the course. However, sponsors have no influence on our education, our actions, or the strategic direction of the Society. They never have and strictly never will.
Some will say – “but you are not professing exactly what I want you to”. My response is “join in”. If your reasoning is sound and the evidence is there then you have nothing to fear – so bring your ideas to the table and see if they stand the test of time and peer review. I can say with honesty (another crucial principle), that I do not agree with everything within the international Lifestyle Medicine movement, and that is completely normal in my opinion – I don’t agree with my wife about everything yet we still love each other. Total agreement isn’t necessary for progress, collaboration is necessary for progress. To interact, to learn, to evolve our own understanding, to evolve our own nature (ooh I am getting deep now) and change the movement from within after a period of observation and growth. Dare I say to change ourselves from within (getting really deep now). I encourage anyone to do the same.
We have been blessed this year to receive philanthropic funding (announcement coming soon!), and as a result are commencing a range of new initiatives like creating research projects for lifestyle interventions for specific conditions, for collaborative projects with other professional bodies and colleges, creating student groups for Lifestyle Medicine electives and curricula in university courses, for creating a suite of member resources to help members hit the ground running, Shared Medical Appointment education, health coaching training, utilisation of potential online and app technology, and so much more. And of course, we welcome your ideas.