Letter from America – The ACLM conference
9th Nov, 2020
The American College of Lifestyle Medicine held its 10th annual virtual conference a month after BSLM’s first ever online event.
The US five-day conference opened with the big-name movers and shakers in the field of lifestyle medicine; Dexter Shurney, Dean Ornish, David Katz, Caldwell Esselstyn and John McDougall MDs.
David Katz moved straight to the COVID-19 crisis that is currently gripping us all, declaring: “food is an easily modifiable factor that contributes to 500,000 deaths a year; let’s be clear that the toll of diet every year is more than twice that of Covid.”
His timely research showed that 40% of US Covid hospitalisation could be avoided if US healthcare supported behaviour change1.
Love more
Dean Ornish followed with his heartfelt style, setting out a strong case for the importance of social connection for health; his “love more” component of lifestyle medicine.
He described how the effects of loneliness and stress have been seen at a genetic level in the work of Nobel prize winner Dr Elizabeth Blackburn.
This seminal work demonstrated that it was not the stress itself, but how people reacted to it that shortened their telomeres, resulting in accelerated ageing.
He got to the crux of quality, health promoting relationships which involve “people [who] know you … (who say) I see you, not just your good stuff, but your demons and the ways you messed up, yet they are still there for you, love and care for you”.
He pointed out that our connections on social media aren’t health promoting, with a link between time on Facebook and lower mood and negative tweets being associated with heart disease mortality2.
The pertinent issue of social isolation was again picked up by Professor Julianne Holt-Lunstad, who described her influential research into the effects of isolation; a study of 3.4 million people showing that loneliness increased earlier death by 26%, posing greater risks to health than smoking, alcohol, physical inactivity and obesity3.
Prof Holt-Lunstad explained why some of us might be finding it difficult to follow our current social distancing measures given that 10 hours of isolation has a similar neurochemical signature to 10 hours without food; so we may experience craving for contact in the same way we do food.
“Humans are social beings,” she concluded. “We aren’t meant to be alone.” She made a compelling case for asking patients about social isolation in our medical consultations, and recording it in our patient’s records. We must also increase our efforts to educate clinicians and policy makers about this key area of health.
‘Change is possible’
Caldwell Esselstyn, former US surgeon general, declared that current cardiology is “palliative cardiology” which does not treat the cause of the condition.
He warned us not to underestimate the public when they learn about the power of lifestyle approaches, citing the evidence needed (over 7000 papers) for smoking to be declared a health risk.
“When the surgeon general said smoking was bad for health; 20 million people quit,” he said, adding: “Change is possible!”
If the former surgeon general is now stating that there is “irrefutable science that cardiovascular disease (CVD) can be halted and reversed, the method is safe, cheap, effective and easily taught,” and that it is, “unconscionable that patients with a diagnosis of CVD are not being informed of this,” we may be on the cusp of a healthcare revolution.
Lifestyle and dementia
Moving to the next biggest killer in the US; dementia, Dr Ornish reviewed the evidence that lifestyle is critical. He explained the promising evidence from the Finnish Geriatric Intervention Study4 showing that a lifestyle intervention improved cognitive function after two years.
Dr Ornish ended by explaining how he continues to push boundaries with an exciting research programme testing whether lifestyle changes can reverse early-stage Alzheimer’s disease.
“Team Sherzai”, Dean and Ayesha Sherzai MD, followed by boldly stating that “90% of Alzheimers can be avoided,” pointing out the US Alzheimer’s Association International Conference statement that “lifestyle factors are the best and only bet now for reducing dementia risk.”
They laid out their “NEURO Plan” to prevent dementia with, “Nutrition, Exercise, Unwind, Restorative Sleep and Optimisation of cognitive activity” that came from their community-based study of lifestyle and cognitive health in over 1000 people over three years5.
Type 2 Diabetes causes
It was a proud moment to see our own Professor Roy Taylor explaining his ground-breaking DiRECT study6 that challenges the commonly held views that Type-2 Diabetes is a chronic progressive condition that can’t be reversed, that rapid weight loss is harmful and that exercise helps weight loss.
Prof Taylor showcased Newcastle landmarks to illustrate his “twin-cycle hypothesis” that Type 2 diabetes is caused by excess fat in the liver and pancreas causing liver insulin resistance and pancreatic failure. He talked us through the findings that Type-2 Diabetes was put into remission in those who lost over 15kg and shared his view that a total liquid diet replacement works so well for some patients because of the simplicity of the intervention. He also presented evidence that exercise helps healthy weight maintenance along with many other health benefits, but it is not helpful during rapid weight loss as it increases appetite.
Dr Michael Greger put most of us to shame by going one up from standing desks to present his talk on plant-based nutrition whilst pacing on his treadmill. He slightly breathlessly laid out the case that these dietary patterns could avoid intensive farming practice which puts livestock and humans under the type of pressure that results in pandemic virus emergence as we have seen with Covid-19.
Having been worn out just watching Dr Greger, Param Dedhia encouraged us to place more importance on sleep. He explained that the first half of sleep is key for physical repair and memory processing, whereas the second half processes emotions, solves problems and stimulates creativity.
He laid out the link between poor quality sleep and hypertension, diabetes, obesity, cancer and memory problems; something I will now enquire more carefully about, even if my patients don’t volunteer concerns. His top-10 tips for healthy sleep included getting morning light, having a set wake-up time, keeping caffeine to the morning and practicing relaxation, stillness and being in the present.
For a good night’s sleep, we can reflect on the present healthy state of the lifestyle medicine movement: with the ACLM and BSLM conferences attracting record numbers of delegates who have engaged with influential speakers to create a powerful push for change. My take-home conference message would be from Dean Ornish: “lifestyle medicine is a wave that hasn’t even started to crest yet!” Sleep well …
Dr Ellen Fallows BSLM Learning Academy lead (interim)
November 2020
REFERENCES
1. Reducing COVID-19 hospitalization risk through behavior change, MARY L ADAMS, David L Katz, Joseph Grandpre, Douglas Shenson, Pre-print; medRxiv 2020.07.21.20159350;
2. Eichstaedt JC, Schwartz HA, Kern ML, et al. Psychological language on Twitter predicts county-level heart disease mortality. Psychol Sci. 2015;26(2):159-169. 
3. Holt-Lunstad J, Smith TB, Baker M, Harris T, Stephenson D. Loneliness and Social Isolation as Risk Factors for Mortality: A Meta-Analytic Review. Perspectives on Psychological Science. 2015;10(2):227-237. 
4. Ngandu T et al, A 2 year multidomain intervention of diet, exercise, cognitive training, and vascular risk monitoring versus control to prevent cognitive decline in at-risk elderly people (FINGER): a randomised controlled trial, Lancet 2015, 385 (9984): 2255-63  healthymindsinitiative.org 
5. Lean M et al, Primary care-lead weight management for remission of type-2 diabetes (DiRECT): an open-label, cluster-randomised trial, The Lancet (2018), Vol 391 (Issue 10120), p541