Scientists are telling us we are entering a new epoch. The last one has lasted 12,000 years, covers years of stable climate and is called the Holocene epoch. The new epoch is called the Anthropocene, the first created by mankind and where it is the dominant influence on climate and the environment. Its reference point is likely to be the 1950s due to fallout from Hydrogen bomb testing, ash from the burning of fossil fuels, plastics and concrete.
There is another phase we have entered. The age of Chronic Disease. And lo, it also has been created by mankind! So, let’s call it the age of Anthropogens. The determinants (cannot really call them causes) of these diseases contribute to metabolic inflammation in humans to which we cannot possibly have adapted within the last fifty or sixty years. After all it has taken 540 million years for life to ‘bloom’ into current living forms. These determinants include malnutrition, inactivity, stress(strain), technical pathology, insomnia, environment (built and cultural, pollutants), occupation, drugs (smoking, alcohol, prescribed), relationships (loneliness, alienation, adverse childhood experiences) and social inequities including meaninglessness, relative poverty. Is metabolic inflammation then the Grand Unifying Theory of Chronic Disease? Some scientists have come around to this viewpoint and arguably is the fundamental science of the Lifestyle Medicine approach.
Lifestyle Medicine includes, but is more than, behavioural change. All of the above anthropogens are influenced by societal beliefs, local culture, economics and politics. So to be relevant and effective Lifestyle Medicine has to address these modifiable anthropogenic determinants of our increasing ill health at a personal level (setting a good example), local and wider community level and in setting national health policy. It is therefore not appropriate to be consumed by, and associated with, a single issue such as a particular nutritional approach.
As front-line health practitioners we really need to be pragmatic and professional. To my mind that means not only attempting to understand the evidence/science of the day (as uncertain as that really is) but more importantly putting ourselves into the position of an understanding of our patients’ concerns and mindset. How else we will make the difference?
Evidence Based Medicine has been detached from its real origins so bringing it back to include clinical context and patient context is the only way we can achieve our common aims of preventing, managing and even reversing lifestyle-related diseases. A bit of humility (yes, maybe the science is wrong) and open engagement (polite curiosity with active listening) with differing views will assist that process on the front-line. After all, give two ‘experts’ the same research (especially nutritional) studies to examine and differing conclusions can be reached. Even as the knowledge out there is fixed at any given moment in time, it is authors’ beliefs and values which drive the conclusions. In addition, we are told by eminent Journal editors that to our cost some research science is corrupted by data falsification and omission.
This is why BSLM will continue to follow its mission and values as recorded on our website. We will remain an open society, open to healthy debate and welcoming. Seeking solutions, including salutogenesis and health creation have to be part of what we offer.
One determinant which is dominating this debate is nutrition. Increasingly, those who can afford it are defining themselves by what they eat. As a Society we believe we should be moving folk towards less processed meat and more vegetables #1change at a time - and all of us should be quite open about reducing and eliminating ultra-processed ‘food’. I personally believe there is much more that unites the nutrition scientists than we pretend but I do think that it these experts who urgently need to get their act together and agree a methodology of research which gives us all confidence instead of the often contradictory advice being peddled at present. Linking back to the fact that nutrition is only one determinant of disease, and in considering Lifestyle Medicine’s approach in dealing with the upstream causes of lifestyle-related diseases such as the behaviour around sustainable food production, food manufacture, marketing techniques, meal habits and the obesogenic environment, it may be helpful for nutritional scientists to apply a metabolic inflammatory index to food in the same way that a glycaemic index has been created. How processed does a food have to be before it is metabolically inflammatory? Is there a dose effect for example? This might become a better guide for the front line health professionals than endless, confusing debate about macronutrients and calories.
And then of course there is gene expression…….! We are definitely not all the same so another reason to be humble about our current state of knowledge. If we see two patients with Diabetes reversing their disease by current accepted metrics in different ways then who can honestly decree that one approach is correct and the other is not. Epigenetics is an evolving science, much like the microbiome, which will have its day in the sun then we will move on to a new science.
However, rather like epochs, medical science advances at glacial pace. The basic tenets of lifestyle as medicine have been tested over time and the benefits understood. Sometimes dealing with the basics is all we need in order to acieve a big difference #1change at a time. Let’s do this, together, and live this ‘new’ paradigm in this new epoch.
BSc MBChB MRCGP FRCGP Dip BSLM/IBLM
BSLM Trustee & Founder
Having qualified in Medicine in 1975, Rob has gained extensive experience as a GP in Scotland. His principal interests have been primary and secondary prevention of disease and the specialty of Lifestyle Medicine. As well as leading his NHS team to the highest awards for quality (2003-2013) he founded a charity in 1991 providing weekly activity and support in venues around East Lothian for sufferers of long term conditions including heart disease, Type 2 diabetes, stroke, lung disease and frailty. He has retired from NHS practice to concentrate on the applications of Lifestyle Medicine to healthcare. In 2016 he co-founded BSLM, a registered charity, to promote the principles of Lifestyle Medicine to healthcare professionals and the public. On a personal note he is a cancer ‘survivor’. He can be contacted at firstname.lastname@example.org.