Lifestyle
Loren Bonner
The scientific evidence supporting healthy lifestyle habits for disease prevention and treatment is coming into focus.
“It is the unhealthy lifestyle choices that typically lead to the medical condition,” said Susan Cornell, PharmD, CDE, FAPhA, FAADE, associate professor of pharmacy practice at Midwestern University Chicago College of Pharmacy.
Lifestyle can include, but is not limited to, healthy eating, physical activity, quality sleep, coping skills, and stress reduction.
Processed foods, large portion sizes, macronutrient imbalance, inactivity, sitting for lengthy periods of time, fewer than 7 hours of sound, uninterrupted sleep per night, and stress are the “bad” lifestyle habits that lead to elevated cortisol levels, an increase in inflammatory factors, and changes in the gut microbiome, according to Cornell.
Recent research and scientific statements on the benefits of “good” lifestyle modifications—and improving nutrition, in particular—demonstrate the effectiveness of these strategies.
“Making simple changes, one at a time, can lead to healthy lifestyle improvements,” said Cornell. “Pharmacists are in the ideal position to counsel on lifestyle in conjunction with medication education.”
Managing and preventing AF
In a new scientific statement, the American Heart Association (AHA) said that making healthy lifestyle changes, such as committing to regular physical activity, are “effective yet underused strategies” that can help manage atrial fibrillation (AF), an abnormal heart rhythm that can cause ischemic stroke. The statement, “Lifestyle and Risk Factor Modification for Reduction of Atrial Fibrillation,” was published in AHA’s journal, Circulation, in March.
Mina Chung, MD, a cardiologist and professor of medicine at the Cleveland Clinic and chair of the writing group for the scientific statement, said in a press release that while medications or procedures to prevent AF and reduce blood clotting are still important, adopting healthier lifestyle habits whenever possible “may further help to reduce episodes of AF”.
The AHA statement pointed out that obesity is one of the main risk factors for AF. For overweight or obese patients, data suggests that even a 10% reduction in weight can reduce the likelihood of developing AF or prevent the disease from becoming persistent.
Other AF risk factors include physical inactivity, sleep apnea, diabetes, hypertension, smoking, moderate or high alcohol use, and other modifiable lifestyle-related factors.
While more research—especially randomized trials—are needed on lifestyle, Chung said data that is currently emerging supports how beneficial positive lifestyle modifications can be in reducing AF.
“We encourage health care teams to consider lifestyle interventions in addition to medical management for all patients with AF,” said Chung.
New studies on diet and nutrition
The medical literature increasingly supports the claim that too much salt is never a good thing. A study from He and colleagues published in The BMJ examined the dose–response relationship between sodium intake and blood pressure change using existing studies.
Their meta-analysis looked at 133 studies with roughly 12,200 participants who had different levels of sodium intake. The researchers found that blood pressure was lowered when sodium was reduced and was greater in older populations, non-white populations, and for those individuals who had high blood pressure.
Another study looking into cardiovascular risk and diet found that higher olive oil intake was associated with a lower risk of cardiovascular disease and coronary heart disease.
The study, published in the April issue of the Journal of the American College of Cardiology by Hu and colleagues, examined data from two large prospective cohorts of men and women in the United States. Diet was assessed using food frequency questionnaires at baseline and then every 4 years for 24 years. After adjusting for major diet and lifestyle factors, researchers found that those who consumed olive oil had a 14% lower risk of cardiovascular disease and an 18% lower risk of coronary heart disease at the end of the study period.
In addition, substituting 5 grams per day of olive oil instead of the equivalent amount of margarine, butter, mayonnaise, or dairy fat was associated with a 5% to 7% lower risk of total cardiovascular disease and coronary heart disease.
A study published March 17 in Neurology by Lin and colleagues found that the Taiwanese vegetarian diet was associated with a lower risk of ischemic and hemorrhagic strokes. Participants, divided into two cohorts, were mainly Buddhists, many of whom practice vegetarianism. About 30% of the volunteers were full-time vegetarians in both cohorts and were followed up to identify stroke events through the National Health Insurance Research Database. Whether vegetarian or not, participants in the study abstained from alcohol and tobacco—an important factor for the research.
Diet and nutrition for inflammatory bowel disease
For the first time, patients and health care practitioners will have guidance about nutrition and diet for inflammatory bowel disease (IBD).
Using the best available evidence, the International Organization for the Study of Inflammatory Bowel Disease (IOIBD) developed the guideline for patients with Crohn’s disease and ulcerative colitis. It appeared in the May issue of Clinical Gastroenterology and Hepatology.
Rather than focusing on very proscriptive diets, James D. Lewis, MD, MSCE, who led the research, said the review provides general guidance that patients, physicians, dietitians, and other health care practitioners can use every day.
“All of our recommendations are subject to change as more information becomes available, said Lewis, who is a professor of medicine and associate director of the Inflammatory Bowel Disease program at the University of Pennsylvania’s Perelman School of Medicine. “The good news is that there is a renewed interest in clinical trials of dietary interventions and the trials are of increasingly high quality. Additionally, leveraging advances in the ability to study the microbiome, metabolome, proteome, and transcriptome, there are tremendous opportunities for translational researchers to make major advances in our understanding of the mechanisms of diet and nutrition in the coming decade.”
Below are the general recommendations for patients with IBD about which foods to consume and which to avoid in order to control and prevent a relapse.
Reprinted with permission from Clinical Gastroenterology and Hepatology. Dietary guidance from the international organization for the study of inflammatory bowel diseases. 18(6):1381-92.
‘Think beyond medications’
Cornell noted that diet and lifestyle changes are never accomplished by a “one size fits all” approach. What works for one person may not necessarily work for others.
“Pharmacists need to use motivational interviewing skills to assist the patient in solving their own problems and making lifestyle changes that will fit into their life,” she said.
Cornell also encourages pharmacists to think beyond medications.
“Assessing adherence at every pharmacy visit is key to medication therapy management and optimal care [and] outcomes,” she said. “However, pharmacists need to assess lifestyle, as well.”
Cornell often tells her patients who have diabetes that most diabetes medications mimic lifestyle.
“For example, metformin’s mechanism of action is the same as ‘eating breakfast.’ So, to get the most out of the medication [make it work better], as well as improve your diabetes management, try to eat breakfast daily, within 2 hours of waking up,” she said.
In other words, medication is adjunct to lifestyle. “If a person makes healthy lifestyle changes, there is a potential to decrease or eliminate medication therapies,” she said.
Cornell added that pharmacists can provide simple lifestyle advice but should have a referral list on hand.
“Pharmacists must know their limitations. I know the basics regarding medical nutrition therapy. However, I also know when I need to refer to a registered dietitian,” she said.
The referral list should include medical specialists, such as endocrinologists, dietitians, exercise physiologists, audiologists, dentists, podiatrists, behavioral health specialists, and others.