In his bestselling book How Not to Die, physician Michael Greger described how his grandmother, diagnosed with advanced heart disease at 65, transformed her health and lived for many years after switching to a whole-food, plant-based diet.
It was a seminal event for Dr. Greger that inspired a career dedicated to promoting the impact of lifestyle behavior on health. As lifestyle medicine-certified clinicians practicing in a palliative medicine setting, we also view his family experience as a powerful example of the potential role for lifestyle medicine in the field of palliative care.
First, it is important to understand what palliative care is — and what it is isn’t. Palliative medicine is defined by the World Health Organization as “an approach that improves the quality of life of patients and their families who are facing problems associated with life-threatening illness.” A frequent misconception about palliative care is that it is synonymous with hospice care, which is administered only after curative efforts have ended. Palliative medicine is not reserved only for people near the end of life.
Lifestyle medicine is an evidence-based approach to prevent, treat and often reverse chronic diseases by replacing unhealthy lifestyle habits with healthy ones. Lifestyle medicine interventions focus on six pillars —a whole-food, plant-predominant eating pattern, regular physical activity, restorative sleep, stress management, avoidance of risky substances, and positive social connection.
Palliative medicine and lifestyle medicine have more in common than you might think. Both are growing, emphasize team-based care, focus on the whole person, are often practiced in combination with other medical treatments intended to prolong life and meet patients and their families where they are, with the ultimate goal of improving quality of life.
According to the CDC, 60 percent of Americans have at least one chronic disease and 40 percent have two or more. Much of conventional medicine is actually palliative in nature. We have a plethora of interventions at our fingertips, from pharmaceutical to interventional, but few of these actually address the root cause of chronic conditions, which, for the majority of patients, are lifestyle factors.
It is worth noting that many palliative patients have multiple comorbidities aside from the diagnosis for which we are being consulted. There is a growing body of evidence, starting with Dr. Dean Ornish’s ground-breaking study on comprehensive lifestyle changes and regression of coronary heart disease, that support lifestyle interventions as a means to treat, prevent and reverse many diseases such as obesity, diabetes, or heart disease.
When applied in a palliative care setting, therapeutic lifestyle interventions can empower patients to take a sense of control over their disease and life. For example, people with advanced-stage cancer who get regular physical exercise experience increased quality of life, fitness and strength, and less fatigue. Simply helping a patient eat less inflammatory foods and increase their energy level is a valuable step toward improving their quality of life.
Stress management is critical for a palliative care patient. Anxiety over a serious health diagnosis and frustration from navigating the health care system can cause chronic stress, which leads to chronic inflammation, a cornerstone of chronic illnesses. Cognitive impairment, insomnia, decreased bone density and muscle mass, and lower immunity are a few of the adverse effects that can easily lead to worse outcomes for an already fragile patient population.
Evidence suggests that relaxation techniques, like meditation and deep breathing, can affect the way we handle stress. Randomized controlled trials document the benefits of meditation in young breast cancer survivors, who reported improvements in depressive symptoms, stress, and fatigue.
To some, the idea of introducing lifestyle medicine to someone just diagnosed with a life-threatening illness may sound like a tough sell. We have found the opposite. Our patients and their loved ones hunger to know what they can do to relieve symptoms and improve chances for survival. For the most part, they can control what food they eat, what physical movements they choose, how they think about stress and pursue healthy relationships. But they need information, education, and coaching to help them make sustainable changes to their lifestyle. That’s why lifestyle medicine certification important.
To successfully integrate lifestyle medicine into palliative care, we also need to change our thinking. Many people consider advanced-stage cancer or end-stage heart failure to be life-threatening illnesses, but we need to make silent killers such as hypertension and diabetes just as deserving of critical intervention. Otherwise, those illnesses will eventually lead to end-stage diseases such as heart failure, strokes, or renal failure.
We must work harder to remove stigmas about palliative care. Even many clinicians mistakenly consider palliative care as signifying the “loss of hope” and will not refer patients to palliative care until the patient no longer functions well enough to make lifestyle behavior changes. Palliative care consultation should occur at the time of a life-threatening diagnosis, and we should be coaching them all along the spectrum of severity.
Lifestyle interventions won’t be for everyone. It won’t treat or reverse disease in every patient, as it did for Dr. Greger’s grandmother. But palliative clinicians who educate themselves to prescribe lifestyle medicine can empower patients with the ability to change behaviors that make themselves feel better and, hopefully, add years to their lives.
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