SOUTH AFRICAN LIFESTYLE MEDICINE ASSOCIATION

The Power of Lifestyle Medicine to Restore Health


By Dr David Glass

We fall and scrape our knees, and a few weeks later,  the scars are barely visible.  We slip off a rock and land hard on our chest, breaking a rib.  For a few weeks, we have to sleep at night lying propped up in bed because of the pain.  But six months later, we have almost forgotten about the incident.  Abdominal surgery is performed for a burst appendix, and for a few days, we hobble around and don’t dare to cough.  But three months down the line, we are jogging,  playing badminton, or riding our bicycles.

The body has an amazing capacity to heal.  That is why surgeons can cut their patients open without being charged for grievous bodily harm.  That is why patients shower us with appreciation and referrals to their friends.  Yet, the physiology of healing is not confined only to structural tissues.  Many of the diseases we suffer are caused by infections.  We heal after a bout of ‘flu, bladder infection, or conjunctivitis, sometimes assisted by antibiotics.  The immune system’s complexity and capacity to heal is incredible.

One of the best studied reclamations of health happens with quitting smoking 1.  Within 20 minutes after quitting the heart rate drops to normal; 12-14 hours after quitting, carbon monoxide levels return to normal, and the risk of a heart attack is significantly reduced;  after 2 weeks to 3 months, lung function begins to improve; after 1-9 months, coughing and shortness of breath decrease; at one year, the risk of heart attack is half that of tobacco users; at 5-15 years the risk of having a stroke is the same as a non-smoker, and the risk of getting cancer of the mouth, throat or oesophagus reduces to half that of smokers; at 10 years, the risk of dying from lung cancer, or getting bladder cancer is reduced by half, and the risk of cervical, laryngeal, kidney, or pancreatic cancer is reduced; finally 15 years after quitting, the risk of heart attack is the same as a non-smoker.

What about chronic conditions like hypertension, type 2 diabetes, rheumatoid arthritis, lupus, or atherosclerosis?  If we remove the underlying causes, are the body’s healing mechanisms up to the task of restoring health?  We know that the common denominator of all these chronic conditions is chronic systemic inflammation (CSI).2  Thus, incorporating lifestyle changes that reduce CSI can promote healing and normalisation of physiology.  These include a healthy diet, adequate restorative sleep, sufficient physical activity, avoidance of harmful substances and behaviours, reduction of stress through appropriate interventions, and supportive social connections.  One of the most significant factors influencing CSI is the gut microbiome.  A large body of research has demonstrated that the diversity and number of microorganisms can change within 24-48 hours after lifestyle changes, especially by increasing the amount and diversity of dietary fibre. 3 Short-chain fatty acids, produced by large numbers of fibre-feeding bacteria, have multiple functions in feeding colonocytes, promoting the integrity of the gut epithelium, modulating inflammatory pathways, influencing appetite, modulating liver and pancreatic function, influencing glucose control, and even influencing affective brain disorders.4

Dean Ornish’s 1998 landmark study on coronary artery stenosis reversal was the first to show that atherosclerosis could be significantly reduced by intensive lifestyle behaviour changes.5  In many patients, angina subsided within weeks.  In Caldwell Esselstyn’s larger study,6,7 intensive lifestyle behaviour changes not only reversed coronary artery progression, but also peripheral vascular disease, as well as diabetes, obesity, hypertension, and hyperlipidaemia. This has been confirmed by many other clinicians who recommend and support their patients in adopting intensive lifestyle behaviour change.8

In my practice, I have been blessed to help a theatre nurse reverse her debilitating rheumatoid arthritis pain through lifestyle behaviour change in just 6 months, where years of potent anti-inflammatory and chemotherapeutic treatments failed.  This remission persisted for 5 years.  During a period of heavy study, doing her bridging course, she started eating ultra-processed food, and the pain reappeared.  Thankfully, reversion to her whole-food plant-rich diet arrested the pain once again.  A colleague of hers who suffered from obesity and resistant hypertension for ten years became normotensive and lost 18 kg of mass in 6 months through adopting intensive lifestyle recommendations.  Recently, a 13-year-old scholar with severe dysmenorrhoea had a painless menstruation for the first time after only 4 weeks of a predominantly whole-food plant-rich diet.

Both patients and clinicians find the outcomes of lifestyle behaviour change thoroughly rewarding.  We often think patients’ ill-health is beyond help, but many are finding that it is never too late to adopt change.  Although we can’t expect a complete reversal, the quality of life can be dramatically improved.9

David Glass
MBChB, FCOG(SA), DipIBLM
Chair, SALMA
VP AfLMC,
ExCom WLMO

References:

  1. https://www.lung.org/quit-smoking/i-want-to-quit/benefits-of-quitting
  2. Furman D, Campisi J, Verdin E. et al. Chronic inflammation in the etiology of disease across the life span.  Nat Med 25, 1822-1832 (2019).  https://doi.org/10.1038/s41591-019-0675-0
  3. Leeming ER, Johnson AJ, Spector TD, Le Roy CI. Effect of diet on the gut microbiota: Rethinking intervention Duration.  2019 Nov 22;11(12):2862. Doi:10.3390/nu11122862.  PMID: 31766592; PMCID: PMC6950569
  4. Du Y, He C, An Y, et al. The Role of Short Chain Fatty Acids in Inflammation and Body Health. Int J Mol Sci. 2024 Jul 5;25(13):7379. doi: 10.3390/ijms25137379. PMID: 39000498; PMCID: PMC11242198.
  5. Ornish D, Scherwitz LW, Billings JH, et al. Intensive Lifestyle Changes for Reversal of Coronary Heart Disease. JAMA. 1998;280(23):2001–2007. doi:10.1001/jama.280.23.2001
  6. Esselstyn CB. A plant-based diet and coronary artery disease: a mandate for effective therapy. J Geriatr Cardiol. 2017 May;14(5):317-320. doi: 10.11909/j.issn.1671-5411.2017.05.004. PMID: 28630609; PMCID: PMC5466936.
  7. https://onlinelibrary.wiley.com/doi/full/10.1111/j.1520-037X.2001.00538.x
  8. Tuso PJ, Ismail MH, Ha BP, Bartolotto C. Nutritional update for physicians: plant-based diets. Perm J. 2013 Spring;17(2):61-6. doi: 10.7812/TPP/12-085. PMID: 23704846; PMCID: PMC3662288.
  9. https://nutritionstudies.org/never-too-late-reversing-my-heart-disease-on-a-wfpb-diet-at-80/