BSLM Newsletter: November 2018

Dear Colleagues,

There is plenty to read in this newsletter and please do find the time to read it.

Our growing membership is busy, varied in background and all have an interest in doing their bit for the aspect of healthcare which most matters to them and to their patients. 

There are always plenty of words written about food — most of it confirming our own particular biases. However, it is most important that BSLM encourages polite debate and exchange of evidence. To that end this issue has three opinion pieces from three perspectives. All are great reads.  Maybe one day we will reach the stage where we will know from which option the person in front us will most benefit.  That is a big maybe! In the meantime most agreement centres around the need to encourage ‘whole’ food, not too much of it, and avoiding ‘processed’ food.

Also in this edition is a report from our sister organisations’ event in the USA, references to social prescribing, arts and health, a blog on sitting — and another invitation to a ‘healing thyself’ break in the Highlands. Ideas for other such BSLM AdventurEd outings are welcome.

Congratulations to our directors and members who have organised events (the latest a very successful one in London) and organising future events in Liverpool, Oxford, Birmingham, Windsor, Wrexham and London. And please sign up for the BSLM 2019 Conference in Cardiff on June 21/22nd 2019. The programme is taking shape and we will let you know as soon as it is ready.

There are many enquiries every day about the Diploma and many have signed up already.  In a short space of time real Lifestyle Medicine in the UK is featuring more prominently than ever.  The future is bright so many thanks to you all.

Rob Lawson FRCGP Dip BSLM/IBLM
Chairman
 

Highlights from The American School of Lifestyle Medicine 2018 Annual Conference 

by Dr Ifeoma Monye

The American College of Lifestyle Medicine (ACLM) held its annual conference recently in the historic town of Indianapolis, Indiana.

The JW Marriot located in Downtown Indy, played host to a four day meeting of about 1,200 health professionals, which included USA delegates and 130 international delegates. It was a very memorable event within the conference venue and the buzz never seemed to end in the Circle City of the Midwest.

This CME accredited conference featured prominent keynote speakers, a very impressive line-up of presenters, who are recognised the world over as the foremost experts in the field. The theme of the conference was “Real Healthcare Reforms”.

The pre-conference, which took place on the 20th of October 2018, had an interesting line up of seminars and workshops. Due to the vast number of patients I encounter in primary care who have little or no relief from conventional pain management, I was very keen to learn a thing or two about “Implementing an evidence -based Lifestyle Medicine Pain Programme”. It was very insightful and revealing to see how much more we can achieve using Lifestyle Medicine interventions. It was interesting to learn about the model of care used in the Eskenazi Hospital, where this meeting was held. The thrill of the day was not the workshop per se, but the tour of the roof top organic vegetable garden at the hospital. Patients were not only treated for their pain, they were also shown first hand how to grow their own organic vegetables. They was a strong emphasis on the benefits of a plant-based eating for pain management, amongst other Lifestyle Medicine interventions.

The main conference, which took place from the 21-24 October, had interesting topics drawn from several areas of Lifestyle Medicine; Nutrition, Physician Health, Physical Activity, Sleep, Lifestyle Medicine Group Viosits, Lifestyle Medicine Education and others. The highlight of the first day was the Legend’s Panel. The popular, gregarious and accomplished author, Dr Michael Gregor, directed the affairs of the evening. Sharing tons of jokes with a cracking sense of humour, he compered this evening with finesse. Among the panel were Dr Dean Ornish, Dr Caldwell Esseltyn Jr, and Dr T. Colin Campbell. Listening to these legends of Lifestyle Medicine was a pleasant experience. The second evening held its own attraction with the Lifestyle Medicine Global alliance Dinner, which hosted all the sister organisations and international delegates. Dr Rob Lawson, our President was duly recognised in absentia and accolades poured on him for the great work he is doing for the growth of Lifestyle Medicine in the United Kingdom. Dr Jonneke Brouwers and I were there representing the BSLM. Another highlight of this evening was the public announcement of the new sister organisations that have joined the global movement in Lifestyle Medicine. The Society of Lifestyle Medicine of Nigeria was among those formally welcomed as new sister organisations.

The third evening featured the ACLM annual banquet where the 2017 Lifetime Achievement Award was bestowed on legendary Winner, T. Colin Campbell, MD. Campbell is the 84 year old American Biochemist who specializes in the effect of nutrition on long-term health. He has become known for his advocacy of a low-fat, whole foods, plant-based diet to promote healthy longevity.

The conference which ended by lunch time on the fourth day was immediately followed by post-conference sessions for those who were not too knackered to go on. The overarching principle that rang through the entire conference was the strong and undeniable scientific evidence to back up the advocacy that the real healthcare reform that is needed, not only in the USA, but the entire world, lies in the full implementation of Lifestyle Medicine in all areas of health care.

Lifestyle Medicine is the Medicine for today and the clear choice for future health care. 

The ACLM 2018 conference has been an exciting and inspiring meeting where networking opportunities with like-minded professionals and industry leaders was an added bonus. The next annual conference is scheduled for the 27-30 October, 2019 in the City of Orlando in Sunny Florida.  

Member Spotlight:
Dr Gemma Newman

Why did you go into the caring profession? It sounds a bit twee to say I wanted to help people, but that is really what it boils down to for me. It was all about empowering people to health, and building relationships with them along the way to facilitate that journey. I am loathe to say it, but the science came second for me at first, although I did find the science fascinating at medical school. In recent years, learning how to read a study (especially nutrition studies) has become crucially important! But when I started in practice, I felt my medical toolbox was only half full. Despite all I had learnt! There were patients I saw who left me feeling there was so much more they needed - if only I knew how to help. Equally, there were patients who made seemingly miraculous recoveries – often through changes in attitude, environment and excitingly for me, through the power of the relationship we had built as clinician and patient partners. What could explain this? How could I get more consistent results?  In my years of training and working, I began to read about nutrition, the power of community and emotional and spiritual health, therapeutic journaling, counselling, meditation, mindfulness and more. I realised that these were the tools with which to fill my toolbox. To help me bring something more to the people I was seeing each day, desperate for health but not really knowing where to turn. This is the essence of lifestyle medicine for me. How can it fit into ten minute consults? Well, it’s not easy. But I often comfort myself in the knowledge that my patients genuinely seem prepared to wait when they know they have my full attention. Plus it’s very rarely just ten minutes. It’s ten minutes many times over the course of a therapeutic relationship. And sometimes all it really takes to create #1change is a moment, a pin drop, a simple question that flips a patient’s perception of who they are, or what they feel they can achieve. That can be all it takes to bring a little lifestyle magic into your patient’s consultation experience. What a powerful tool to have.

Biography:

I have worked in medicine for 15 years and am the Senior Partner at a family medical practice. I studied at the University of Wales College of Medicine and have worked in many specialities as a doctor, including elderly care, endocrinology, paediatrics, obstetrics and gynaecology, psychiatry, general surgery, urology, vascular surgery, rehabilitation medicine and General Practice. I also gained additional qualifications in gynaecology and family planning and am a graduate of the AFMCP course. I have a specialist interest in plant based nutrition and lifestyle medicine, and am an advisory board member of Plant Based Health Professionals UK. I give nutrition and lifestyle advice to my patients, who have gained tremendous results using the power of their plate. As a broadcaster and writer, I have been regularly featured on television, including ITV, Channel 4, Channel 5 and Sky News Sunrise. I have also contributed to articles for magazines including Glamour, Zest and Health magazine. My family lead a fully plant based lifestyle, following the extensive research that I have done on the scientific literature on the health benefits associated with whole-food plant based nutrition. I am regularly invited to teach other doctors and the general public via training programmes, podcasts and conferences about the benefits of plant-based nutrition. You can get in touch via Facebook Dr Gemma Newman, or follow me on Instagram @plantpowerdoctor, or via plantbasedhealthprofessionals.com

Opinion: World Vegan Day

by Dr Sue Kenneally

Thursday 1st November 2018 was World Vegan Day, and veganism is rapidly gaining popularity in the UK with more than 3.5 million people here now following a vegan diet (myself included!). Far from being considered extremist, judgemental or frankly a little odd, veganism seems to have made the transition to be a small but accepted part of our society. Whether for health, environmental or ethical reasons, the message that plants are our friends is gaining momentum.

Eating in restaurants used to be a major challenge, with very limited choices – I have many happy memories of making do with sweet potato fries and a side salad while my loved ones enjoyed haute cuisine. Not so in 2018, now almost every eating establishment has a number of vegan options on its menu, and supermarkets are bucking the trend; announcements about new and exciting options for their valued vegan customers are occurring so frequently that they too have become routine.

With all of this in mind, it is worth a brief look at the positives and pitfalls to consider when consulting with vegan patients. First the good news! There are a number of dietary patterns that are healthful and appropriate to discuss with patients in a lifestyle medicine context, and a vegan – or plant based – diet is one of them. The American College of Lifestyle Medicine recently published a position statement on diet:

‘For the treatment, reversal and prevention of lifestyle-related chronic disease, the ACLM recommends an eating plan based predominantly on a variety of minimally processed vegetables, fruits, whole grains, legumes, nuts and seeds.’

The two key words here are ‘predominantly’, suggesting that including small quantities of animal-based products in the diet would be reasonable – although not essential - and also ‘minimally processed’ – vegan junk food is still junk food!

People who follow a healthful vegan diet appear to gain a number of health benefits; compared with those who eat a standard Western diet, they enjoy a lower risk of ischaemic heart disease and some cancers, lower incidence of metabolic dysfunction and have a lower body mass index on average, and a healthier gut microbiome, all of which is associated with a longer healthy lifespan. There is clear evidence that a whole food, plant based diet can prevent, treat and even reverse chronic diseases, including heart disease, obesity and insulin resistance.

There are, however, a few other things to consider when consulting with vegan patients. There have been many occasions when I have heard a patient proudly proclaim, ‘Of course I eat a healthy diet, I’m a vegan!’ While it is true that a whole food, plant based diet is among the most beneficial dietary patterns in the world, there are some vegan options that would not be considered ‘healthy’; many of our foods that are associated with significant metabolic dysfunction are vegan, including refined sugar, flour, vegetable oils, salt and most alcoholic beverages. It is perfectly possible to eat a vegan diet consisting entirely of processed foods, and evidence suggests that people who do this, for example some people who become vegan for ethical or environmental reasons rather than health, do not have any of the associated health benefits seen with those who eat a whole food, plant based diet. This is why many vegans will describe themselves as ‘plant based’ rather than ‘vegan’.

A well balanced plant based approach can provide all of the nutrients required to constitute a nutritionally complete diet, but there are some deficiencies that are more common on a plant based diet compared with an omnivorous alternative. These include omega 3 fatty acids – plant based sources include seeds, particularly flax seeds, but this is one of the few situations where a supplement may be wise. There are algae based supplements available in health food stores or online. Similarly, vitamin B12; our primate cousins get their B12 from the specks of soil left on the fruits and vegetables they eat, but we effectively remove all soil from our foods. While there are plant based sources of B12, many vegans also take a B12 supplement. Lastly iodine. The main dietary source of iodine in the UK is dairy; not because there is any naturally occurring iodine in dairy, but because iodine is used to clean the large containers in which milk is stored, and the iodine becomes absorbed into the milk from there. Sea vegetables are a great – and very enjoyable! - alternative source.

So, in summary – it seems as though veganism is on the rise and here to stay. A whole food, plant based approach has a wealth of evidence to support it as being one of the most healthful diets and is associated with the treatment and reversal of chronic disease. Appreciate your vegan patients; as long as they avoid the ever increasingly available junk food options on offer most of the time and put some thought into making some simple additions to their diet to avoid nutrient deficiencies, they will likely be among the healthier cohort of visitors to your consulting room and take less of your time and energy than many of their peers. And speaking as someone who spends most of my time working in the ever struggling NHS, that is something I am most grateful for.

Opinion: To Fat Phobia and Beyond…

Dr Joanne McCormack

I have been thinking about fat difficulties I have with some patients, GPs and health care workers. 

I am a family GP with a website called fatismyfriend.co.uk which reflects my comfort with eating natural fat, my non acceptance of the saturated fat- heart hypothesis, and the fact that the body’s ability to make body fat is a mechanism for protecting the body from too much glucose. 

My patients and colleagues take to the ideas to a variable degree. Some eat natural foods with gay abandon, even adding butter and coconut oil to coffees and double cream to their berries, several times a day. Others will take on board the ideas about low carb, but are still frightened of eating natural fats in foods like meat, cheese and yoghurts, despite my reassurance that they need not worry, can check their lipids and that 90% of those people get a lower cholesterol (I say this even though I know there is no proven link between total cholesterol and heart disease).

People do set their own goals in terms of weight loss and Hba1c, blood glucose, and more tangible things they would love to achieve, like fitting into their thinner clothes, getting down on the floor with their grandchildren and up again, or stopping medication. 

Various things happen to the overweight people who pig out on the fat:

They lose weight, normalise their Hba1c and achieve their tangible goals, and get normal lipids.

They do not lose weight but their Hba1c normalises and they achieve their tangible goals

They put on weight and then they forget about the rest and get disillusioned.

Their lipids in any situation may show a high TC , high HDL, high LDL and lower TG, or they may have a more classic picture that people are comfortable with. You may know all about Dave Feldman and the references below, but many of my patients and colleagues do not.

If these patients are not happy with their progress, I encourage them to cut back the fat, not because it is saturated fat, it is all fats after all, but because they have a lot of fat on their bodies that they want to use up. I tell them that they are still on a high fat low carb diet, but the high fat bit can come from their body fat, rather than bulletproof coffees and bowls of cream. There is a nice pie chart doing the rounds, which shows how the proportion of fat from the body and diet changes over time, as a fat person gets thin.

Could people achieve their goals with either a high fat/low carb or low fat /high carb diet? When we are talking about individual people the answer may be yes on both counts. Never say never, and some people have very limited goals, but if the traditional method (low fat, high carb)is not working we now have many other tools at our disposal. 

*Isn’t that absolutely fantastic and something to be curious about, maybe excited about ......rather than dismissed out of hand, or derided?*

My narrative has changed over the 5 years that I have been learning about these alternative tools. This alternative tool narrative is how I get along with the advocates of the low fat, high carb methods. Low fat, high carb is just one tool and one that does not work for me as a person. I’d still be fat. End of. It’s not useful for the two thirds of my patients currently trying to follow a low fat life and failing to achieve their goals. 

Most people I work with have tried and failed with low fat, high carb diets for many years. That is why they have come to me. 

I talk about a variety of tools they can choose to use for a healthier life. Their choice, not mine.

These tools include the concepts of:

• Hopes and dreams
• Real food
• Unprocessed foods
• Foods that have never seen a factory
• Intermittent fasting
• Sleep management 
• Mindful movement and exercise and relaxation techniques
• Processed food addiction, processed food avoidance. 
• Ketogenic ways of eating
• Low carb
• The microbiome
• Normal fat eating - milk and yoghurt at 3.5% fat and 11% fat (tops) are not exactly high fat products.
• Natural fat eating

These tools can be used in meat eaters, fish eaters, vegetarians, vegans, people who are frightened of fat (where hopefully they will eat a bit more of the fat containing foods they are comfortable with), anyone who wants to give it a go.

If people say low fat/ high carb is better, I say...for whom? Does it work better work for you? (Great, but you need to compare the methods to really know and it is just one tool) Does it work for every single one of your patients? (Clearly not) and when they admit it does not, I can discuss the wide variety of other tools at their disposal. 

I advise testing to show if real food eating improves the lipid profile even though this may not matter. It makes me comfortable with the GMC and myself. It also keeps those GPs and patients who still believe in the sat fat/ heart disease hypothesis happy. I expect some of my patients do not bother because they have read in detail about the controversy and I don’t push it, I don’t force them to check or badger them repeatedly. In the 10% who get higher cholesterols I deal with it. I am confident that in the short and long run that technology will prove what is going on. If someone has a cholesterol of 11 for 25 years and a normal CAC score then there is something strange going on that is incompatible with the chol- heart disease hypothesis.  

https://www.healthylivingsite.me/cholesterol-references is a list of references I put together when I first realised it was much more complicated than the Pharma companies portrayed.

Opinion: The Mediterranean Diet

Dr Simon Poole, GP Cambridge, Author ‘The Olive Oil Diet’

The Mediterranean Diet (MD) describes a pattern of eating and lifestyle which is associated with an impressive reduction in risk of many chronic diseases, ranging from cardiovascular disease, stroke, many types of neoplasia including bowel and breast cancers, and neurodegenerative conditions such as Alzheimer’s and Parkinson’s disease. Insulin resistance and markers of inflammation are significantly reduced with the MD. Studies have shown that a calorie-controlled MD compares well with equivalent low fat and low carbohydrate diets for achieving and sustaining weight loss. Risks of diabetes and obesity are lowered and where populations in the Mediterranean stray from their traditional lifestyle there is a corresponding increase in levels of chronic illness and obesity.

Modest portion size and the traditional habits of eating slowly in company as a communal event contribute to the MD being a diet which is consistent with satiety and maintenance of a healthy weight as well as delivering protection from chronic illness. 

The focus if the MD is on meals and enjoying wholesome, natural food rather than an obsession with macronutrient proportions. It is a diet generally rich in extra virgin olive oil, vegetables, legumes, fruits, nuts, seeds, herbs and spices and fish with low consumption of animal fats, red meat, and processed foods. 
As it happens this is a diet which provides a good supply of healthy unsaturated fats, with more modest intake of short and medium chain saturated fats mainly in fermented dairy products such as cheese and yoghurt. The omega 3 to omega 6 ratio is considered to be a healthier 1;4 ratio rather than the 1;16 ratio we associate with diets with a greater presence of processed foods. Carbohydrates are generally wholegrains with low glycaemic index and are an important source of fibre and micronutrients. The plant-based nature of the diet provides a rich provision of polyphenol antioxidant and anti-inflammatory compounds, including rather unique phytochemicals from extra virgin olive oil, the main source of fat in the traditional MD used for flavour, creating texture for dishes and as the desired cooking medium at all usual temperatures of food preparation. 

As we learn the lessons of past decades that simple, wholesome, natural and unprocessed foods in modest amounts are the key to a healthy diet and that arguments about macronutrients can confuse and result in dietary fads or replacing one poor nutrient with another, we are also understanding the more fascinating and complex issues of food interactions and quality. The MD has been shown to have advantages for the gut microbiome in addition to showing early positive effects in the study of epigenetics. The MD is associated with lengthened telomeres – the DNA markers of longevity. 
The quality of food matters. Modern industrialised systems of food production tend to focus on cost reduction and ease of supply rather than nurturing local seasonal production and storage. The marketing of processed foods with poor nutritional quality, high in sugar and additives and chemically preserved is an obvious example of this, but there are rather more subtle factors as well in some of the common foods we eat. Modern wheat, whilst easy to harvest is far higher in gluten, gliadin and lower in micronutrients than ancient grain counterparts. It is associated with greater risks of obesity as well as gastrointestinal symptoms. Fruits and vegetables vary dramatically in their levels of polyphenolics depending on the way in which they are produced and stored. The MD relies on traditionally produced, locally sourced high quality ingredients.

The relationship between foods in meals and the interactions during preparation is also an emerging area of interest. For example, pasta when consumed with extra virgin olive oil in the MD produces a lower glycaemic load and increased insulin sensitivity. Antioxidant availability and micronutrient absorption are enhanced when foods are prepared together in traditional ways of cooking with fewer nutrients lost and lower levels of potentially harmful by- products of cooking are observed.

As we see the effects of our industrialised world threaten the long term survival of the planet, it is irresponsible to promote any dietary pattern which does not make reference to sustainability and its contribution to climate change. 

In particular the increasing consumption of red meat and dairy products has a significant impact on greenhouse gas emissions. Although methods of husbandry might reduce these effects somewhat, the farming of larger ruminant animals on grassland which might otherwise contribute to the production of plant foods or as forestry represents a concerning imbalance which is unsustainable. A world population with an increasingly insatiable appetite for meat produced in current agricultural systems is at risk of irreversibly harming the environment.

The plant based but omnivorous Mediterranean Diet is one which allows for modest intake of all foods, and is achievable and sustainable for populations who seek not only to reverse the obesity crisis, but also to tackle the increasing burden of chronic disease.

The Power of the Arts and Social Activities
to Improve the Nations Health

Health and Social Care Secretary Matt Hancock speaks to the King's Fund about the benefits of social prescribing.

Arts and Health:
Much We Can Do and Even More to Learn About COPD

by Dr James Dodd (via Life of Breath)

Image by Jordan Collver. Breathlessness is a complex and subjective experience

For anyone interested in understanding how artists like Elspeth Penny can help with health care, this link could be of interest. BSLM colleagues might — as a result of this link — begin to explore the way in which the "graphic novel" can help patients to understand their conditions and discover "treatment options" and "support groups"

Gut Health – How Your Gut Directly
Impacts Your Wellbeing

by Dr Sophie Newton

You may not think you are interested in gut health and the microbiome, or perhaps you have a basic understanding, but watch this video to learn about why this is one of the most exciting areas of Lifestyle Medicine and what simple changes you can make to your life to make you happier and healthier...

Sitting — Is It Really the New Smoking
and Where Do We Stand?

by Dr Lucy Loveday

Last week, my 6 yr old son was innocently squatting in his pyjamas on a bright red hard wooden kitchen chair (pictured above) eating his breakfast. Totally at ease in his chosen position, and remarkably skilled at placing porridge into his mouth without any spillage.

And then, as if by magic, I found myself saying ‘Sit Down’ in a rather stern tone…

Ironically, I then sat back and reflected on this instruction. Then I backtracked …‘Hang on, DON’T Sit Down‘ And I went on to mention something about the evidence for reducing sedentary behaviour being a positive thing to do...

BSLM AdventurEd – Weekend of Healing Thyself!

Objectives:

Relax: enjoy being physically activity and socialising.

Learn: expert tuition and great presentations

Event: Highland Retreat

Location: Taymouth Marina, Kenmore & Ardtalnaig (Loch Tay)
Dates: TBC subject to numbers interested.

Structure: 2 nights 2 days

• Physical activity - walking, kayaking, open-water swimming, SUP boarding
   
• Practical: bush craft & survival or shooting lessons from former Special Forces
   
• Educational: Networking and formal
   
• Relaxation: 30 person sauna with loch to swim in to cool down & cocktail bar!

Weekend Itinerary

Proposed B&B - luxury flats @ Taymouth Marina

NB: Thursday night included in cost if we choose luxury accommodation.

Price does not cover any food & activities during the day on Friday.

Friday

1900hrs - welcome talk & social drinks at bar

Saturday

0800 - 0900 - breakfast at restaurant

0930 - 1200 - moderate hill walk to bothy

1200 -1300 - pack lunch

1300 - 1600 – bush craft & survival teach/ rifle shooting teach @ bothy

1600 - 1700 - walk/lift back

1700 – 1830 - Education - 2 or 3 guest presentations

1900 – 2000 - sauna

19.00 - 20.00 – Cocktail bar

 2000 - late- Dinner & bush craft/shooting awards

Sunday

0800 -1000- breakfast

1030 -1200- activity options: kayaking on Loch Tay/ swimming/ SUP boarding/ walking

1230 -1400- lunch at Marina

1400 -1430- final presentation/ farewell

Staff named are BSLM members:

• Jamie Gilbertson: event organiser & coordinator
   
• Dr Tim Smith - mountain leader & guide
   
• Lesley Aitkenhead - kayak and SUP board instructor & guide
   
• Bush craft instructor / shooting instructor: TBC.
   
• Presenters: TBC but will be fascinating!

Rough cost:

£500pp (based on attendance of 10).

Costs all covered apart from travel and refreshments.

Mini bus costs not included assuming there will be enough vehicles for short journeys.

Community Events

There are many great community events coming up in the next year. Here are just a few from the BSLM events page:

30 March 2019
Orthopaedics and Lifestyle – A Powerful Duo
Liverpool
Event Details +
A one day Clinical symposium covering examination techniques of the Musculoskeletal system and basics of Lifestyle medicine as applied to Orthopaedics / Bone and joint disorders…

21-22 June 2019
Lifestyle Medicine 2019: Science and Art of Healthy Longevity
Cardiff
Event Details +
For all interested in lifestyle as medicine – prevention and self-management of non-communicable disease. From cell to community. World renowned speakers and leaders in their fields. More details to come...
 

Submit events that you'd like to see included on the BSLM events page

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