From Dr Sam Manger, writing in reply to Dr Nikki Stamp’s article ‘Robert chose the pill-free route; he ended up on my operating table‘.

I have a lot of respect for Dr Stamp and her work advocating for heart health, women’s health and healthier lifestyles. I agree with her that lifestyle changes are undeniably important and are another tool in the battle against disease along with life-saving medications and surgery. By definition then, any intervention that is effective in preventing or treating disease is a medicine.

I suspect that Dr Stamp is like me, frustrated with the ideology and online wellness warriors who spread superficial and often misleading information without looking at the evidence or respecting the scientific process, or without having to help people in the real world or deal with the consequences of their poor advice. It frustrates and saddens me when people have been so persuaded by ideological pseudoscience that they forego lifesaving interventions such as medicine or surgery. I have seen too many people suffer unnecessarily. Like Dr Stamp I see it with increasing frequency as bloggers become more popular sources of health misinformation.

However, I am also frustrated by the misuse and misunderstanding of the term ‘Lifestyle Medicine’. What Dr Stamp is describing is not Lifestyle Medicine at all – she is concerned about the same social media influencers and self-appointed health gurus that we are concerned about. Unfortunately as Lifestyle Medicine gains popularity for all the right reasons, all manner of people jump on the bandwagon describing their approach as Lifestyle Medicine. Importantly, Lifestyle Medicine is not a non-drug approach as Dr Stamp’s article suggests. Nor is it fad diets or chakra reorientation. In short, if it’s not evidence-based, it’s not Lifestyle Medicine.

The loss of trust in medications she refers to is part of a wider problem – a crisis of confidence in the health system. One in which attitudes from some sections of medicine like “it’s all nonsense if it isn’t drugs or surgery”, ironically pushes more people towards online pseudoscience in search of answers outside of what their doctors tell them.

Patients want and deserve to know all their options and more than ever want their practitioners to listen, discuss and help direct them towards lifestyle changes that will truly make a difference. Evidence-based Lifestyle Medicine includes the use of nutrition, movement, sleep, social connection, stress management and smoking and substance abuse cessation combined with health coaching to treat and prevent disease.

The DiRECT trial in the UK showed that lifestyle interventions can reverse type 2 diabetes, a problem soon to be at epidemic proportions, and something that medications cannot do. Dr Dean Ornish’s program is the only lifestyle-based Medicare funded program in the USA (which is no small feat) for reversal of heart disease. Our own Aussie Professor Felice Jacka’s work shows lifestyle interventions can be effective in preventing and treating mental illness. Studies published in the Lancet show lifestyle interventions are effective in improving cognitive function in those with early dementia.

In almost all clinical guidelines, the first intervention recommended is ‘lifestyle advice’, yet practitioners have limited training, resources and time in which to do this. This has to change because failing to deliver on effective lifestyle advice is borderline negligence. But nowhere does Lifestyle Medicine say you shouldn’t use pharmaceutical medicine while pursuing longer term lifestyle improvements.

It takes a bit of effort to separate fact from fiction, but our patients deserve a healthcare system that can do this without bias or agenda from either end of the health spectrum. I too am frustrated by the rise of pseudoscience and online gurus but evidence-based Lifestyle Medicine is not the problem, it’s the solution.

[See also: ‘What Lifestyle Medicine is and what it is not’.]