Narrator - Dr. Abel 00:00 Welcome to HelixTalk, an educational podcast for healthcare students and providers, covering real life clinical pearls, professional pharmacy topics and drug therapy discussions. Narrator - ? 00:11 This podcast is provided by pharmacists and faculty members at Rosalind Franklin University, College of Pharmacy. Narrator - Dr. Abel 00:17 This podcast contains general information for educational purposes only. This is not professional advice and should not be used in lieu of obtaining advice from a qualified health care provider. Narrator - ? 00:27 And now on to the show. Speaker 1 00:31 Welcome to HelixTalk. Episode 108 I'm your co host, Dr. Kane. Speaker 2 00:35 I'm Dr. Patel, and today with us, we have Dr. Srivastava, who is back with us, and we're going to talk about some exciting steps, so I'll have her introduce the topic. Thanks. Speaker 3 00:46 And I'm excited to be here today with you all. Our title is six reasons to be addicted to lifestyle medicine. Speaker 1 00:53 And really, today we're focusing on, really, the six pillars of lifestyle medicine. And Dr. Srivastava, I understand you're kind of an expert in this field because of a recent exam that you took. Right? Speaker 3 01:05 Yes, I recently became certified in lifestyle medicine, and maybe partly expert, but definitely very passionate about lifestyle medicine. And I'm Speaker 1 01:13 going to be honest here, I actually don't know that much about lifestyle medicine, so I'm excited to understand why there's even a certification for this, and kind of what that entails. And really, for anyone listening, whether you're certified or not, how you can apply some of the principles of lifestyle medicine to how you care for patients. So maybe we should just start with what is lifestyle medicine and why are we talking about it today? Speaker 3 01:35 Okay, so I can just take a minute to actually tell you what the actual definition is so pretend I have quotes up, and it's the evidence based approach to preventing, treating and even reversing diseases by replacing unhealthy behaviors with positive ones. And then this is where the six pillars come in. So eating healthfully, a predominantly whole food, plant based diet, being physically active, managing stress, avoiding risky substance abuse, adequate sleep and having a strong support system. So let's Speaker 1 02:05 say that this is kind of along the lines of non pharmacologic therapy, which is what we talk somewhat about in pharmacy school. But it sounds like this is a little bit more targeted at specific things with respect to that, and probably specific guidance within those six pillars in Absolutely. Speaker 3 02:20 So this is something that most of us have had a slide right where, when we're teaching or we're learning, there's non pharmacologic treatment, and this is what we should do, but this is taking it a step further, and really it's focusing on the evidence that supports it, and we can take some time to talk about the evidence and what each part actually recommends. And it's not just the recommendations on that evidence, but it's also how to implement it, right? Because we can all know something, but unless we know how to teach somebody on how to make that health behavior change about it, it's only half the battle. Speaker 2 02:49 And so, you know, we've all heard the DASH diet, and, you know, the healthy, healthy diet for the diabetes patients and whatnot. Where did it all start? We have the basis of that, you know, kind of scattered all throughout the different organizations and recommendation. But where does the lifestyle medicine come from? And where did it start? Speaker 3 03:09 If you guys will indulge me, can I go back? I don't know, to our ancient philosophers, Socrates and Plato. Socrates said, you know, the secret of change is focusing all your energy not on fighting the old, but building the new. And Plato said, the part can never be well unless the whole is well. And that's where, really, in some ways, lifestyle medicine started. But of course, we fast forward many, many years, and we have our forefathers of lifestyle medicine, and many of these people that have been impacted on it were the ones to start making the changes. So maybe you've heard of Dr. Nathan Pritikin. I have not actually, no, he has the longevity centers, and he had a heart attack, and this was in the 1970s so now we're hearing a lot more about it, and it's more in mainstream. But at that time, the concept was pretty, pretty novel, recommending whole foods diet. And for many people, it's hard to make that change, especially in the acute phase after certain conditions like heart attacks. And so he has both inpatient and then outpatient plans on how to incorporate this into into one's life. Speaker 1 04:19 I feel like that is some again, 1970s a long time ago, right? But even in the last decade, I feel like the movement towards, you know, more whole foods, more organic foods, is something that is a little bit catching fire, versus in the 1970s I don't know that that was as big of a deal at that point, at least. Speaker 3 04:36 Yeah, absolutely. And then we have Dr. Caldwell Esselstyn. Dr. Esselstyn is a clinician and researcher and an Olympic rowing champion at Cleveland Clinic. His research has shown on whole foods and plant based nutrition therapies to reverse coronary artery disease. And then we have Dr. Dean Ornish. He's the founder of the Preventative Medicine Research Institute, and he's done, he's conducted research. Showing lifestyle medicine reverses severe cases of heart disease and also early stages of prostate cancer. And what do you all think about our genes like? Are we predestined? I hope not too. Yeah. And that's what he's found, that while our genes may put us at a higher risk of one thing or another, it's not our complete destiny. And in one of those studies that he's looked at, he looked that telomere length can actually increase, and with this plant based whole food diet, and with that increase, we actually it correlates with longer life spans. So it Speaker 1 05:34 sounds like, you know, there's many forefathers of lifestyle medicine, and it's something that is again catching hold. But as we talked about earlier, we have talked about non pharmacologic therapy and pharmacy school as an example. So what puts this different than any of the other forms of medicine that we might, you know, recommend to patients or even practice ourselves. Speaker 3 05:56 There are so many different types of medicine, right? So we have our conventional medicine, this is the one that's most commonly practiced. It's where the highest level of care is usually medications and surgery, and there's not too much emphasis on changing behaviors. Speaker 2 06:13 And then we have the complementary and alternative medicine that kind of combines the conventional medicine, or it could be for some patient in lieu of it. And the treatments that are kind of like over the counter medications, not valve research. We don't have the evidence behind it, but these are going to be combination of certain behavioral techniques, psychological techniques, as well as some over the counter supplements and nutrients. Speaker 1 06:40 And then we have integrative medicine. This is basically taking into account the whole person, you know, all aspects of lifestyle, and then using a lot of different therapies to treat the patient, especially emphasizing the relationship between the practitioner and the patient, kind of the mind body connection. And this could potentially involve conventional medicine, complementary and alternative medicine. So integrative means integrating a lot of different things into one care plan for that patient, Speaker 3 07:09 and then we have functional medicine. And I should note that there's also certifications for functional medicine as well. And this type of medicine really focuses on the inner parts of us, our physiologic and biochemical functions. Functional Medicine is a biology based and looks at identifying and treating that root cause of the disease. Speaker 1 07:28 So where exactly does lifestyle medicine fit into these different forms of how we practice medicine? Speaker 3 07:34 So I think it can fit in anywhere and everywhere. It can be incorporated within the practice of medicine. We can also empower people to practice it on their own. But most often, I would say, if we had to say where in the healthcare field, primary care would be, would be the optimal place that they should absolutely be getting it. Speaker 2 07:54 And you're basically trying to say that this could be well incorporated with the conventional medicine and things that we see in daily routine, like long term diseases, such as heart disease, diabetes and even maybe some short term illnesses too, that this medicine can help it absolutely. Speaker 3 08:12 And it can be at the bedside when we're discharging our patients after a coronary event, or at the endocrinology clinics or, yep, basically everywhere. Speaker 1 08:21 I think probably one distinction to make is the degree of emphasis that you're putting on some of these non pharmacologic, more lifestyle related things, that you're not just printing the handout on the DASH diet, but you spend more than a minute talking to a patient about how important dietary changes are, and that's part of your care plan, as opposed to an afterthought, as you're giving them their new anti hypertensive, yeah. Speaker 2 08:44 And, you know, one thing I want to talk about before we get even get into the, you know, the pillars of lifestyle medicine is probably the concept that we need to make it across to our patient, is that this is lifestyle medicine. We heard longevity earlier to how it improves life too. It does it because you use it on a daily basis thereafter, right? So it's we need behavioral changes. We need to incorporate these changes as a long term changes. It's not going to have the same effect if they're only going to do it for certain period of time, right? This is really life altering changes they're making to not just help one disease, but perhaps prevent future diseases and conditions, like you mentioned. You know, we're not predestined, so here we are trying to change something that may occur in future, that's not there yet, right? Speaker 3 09:33 And just the day to day quality of life as well. So not just preventing chronic conditions, but improving our day to day quality of life. Speaker 1 09:42 So I think one question that is a logical question is that, of course, it makes sense to eat, healthy and exercise and things like that. Do we actually have evidence that this approach called Lifestyle Medicine is a healthy approach and that it actually changes outcomes of patients? Speaker 3 09:58 We absolutely have evidence. Evidence. And why do I know all the evidence? Because I needed to know it for my exam, and also because, of course, us as pharmacists, as healthcare providers, we want to be practicing evidence based medicine. And so there is lots of evidence out there, and we can talk about some of it, but there's also resources that are available if you're more interested in learning. So we have data to support that 1/3 of cancers are related to lifestyle factors. This include substance use, lack of physical activity, dietary factors and obesity. Speaker 1 10:30 The Lifestyle Heart trial, so this was Dr. Ornish and colleagues showed that this comprehensive lifestyle changes may be able to bring about regression or even severe corner atherosclerosis after only one year, and this is without using lipid lowering therapy like statins as an example, Speaker 2 10:49 and talking about chronic diseases, the Diabetes Prevention Program, which was a landmark trial that showed that lifestyle interventions was actually more effective than Metformin, which is also used in, you know, pre diabetes patients, and reducing the incidences of diabetes a progression to diabetes, which is phenomenal. Speaker 1 11:07 So given that, you know, these are typically inexpensive therapies, they're pretty easy to recommend to a patient. Why is it that we aren't doing more of this, and why? Especially in conventional medicine, we're focused on what drug therapy to give, as opposed to what lifestyle changes to recommend. Speaker 3 11:26 That's a great question. And you know, you brought up cost, and I didn't even mention Dr. Greger. He's one of my heroes, and is so dedicated to the field of lifestyle medicine, and in so many of his podcasts, as he's talking about the evidence, he's also saying this can be done for pennies a day, literally pennies a day. So why isn't it? I think there's a few reasons. So one is lifestyle, medicine education. So not just in the pharmacy curriculum, but in the medicine curriculum. How much do you think occurs? Speaker 2 11:55 Perhaps, as we speak out right now, not so much. And that's probably the reason that physicians at first don't feel comfortable talking to the patient about it. They may put referrals to either nutritionist or dieticians, and these are called advanced providers. And so patients, you know, may not have coverage for these providers. I think what happens in my clinic as to what I see daily, day to day basis, is that they're 15 minutes appointments, and you have a patient in front of you, especially patients who really need lifestyle medicine with like 1015, different issues at hand. How can you discuss all of that, plus lifestyle medicine changes in that 1520, minute appointment? It's just impossible. Speaker 3 12:37 And then to top that off, with if you don't have that education or that training or practice to be able to provide that education to the patients, it makes it that much harder. So there has been a study that looked at this, and only 25% of schools of medical schools have offered a dedicated nutrition course that and that physicians and training receive, on average, only 19.6 contact hours of nutrition instruction. Speaker 1 13:02 And even if you think about in pharmacy education, you know, I remember things like DASH diet. I remember things like 150 minutes a week of moderate or vigorous activity, things like that. And those are kind of like bullet points, right? It's not so much about how to talk to a patient who doesn't want to exercise, how to put in 150 minutes. Very little is really spent on specific dietary interventions for the DASH diet, just because we have so many things to cover in our curricula as it is, let alone being able to incorporate all of these other things while they're important and we certainly mention them, we probably don't do them justice in order to empower students and future healthcare providers to be really effective in making those interventions for patients. Speaker 3 13:47 But a positive note, it is changing. More and more schools are incorporating lifestyle, medicine education. We have teams of people that are dedicated to promoting and sharing their material so everybody doesn't have to recreate what may exist already in terms of teaching materials. So that's really, really exciting. Speaker 1 14:06 I think one other potential barrier here. So we talked about just education and time. I think another barrier is that clinicians get jaded a little bit and that you have someone who's 300 pounds in front of you, do you really think in the next two minutes you can motivate them to lose 100 pounds in the next year. That jadedness makes people just give up and not even try. And it's really too bad, and yes, it is really difficult, given the circumstances of time and things like that. But I think that that's another major barrier that everyone has to address as well, absolutely. Speaker 3 14:40 And I also want to bring up, if we talk about lifestyle related conditions, maybe some people feel that then you're saying it's their fault. So you have this patient in front of you, you don't have enough time to talk to them, you're jaded, and now your patient feels like you're reprimanding them. And I do think it's just important for all of us to think about that when we're saying their lifestyle. Related. We're not putting any judgment on it. It's just a fact. And if we kind of take it as a fact rather than judgment, then we're able to maybe better address it. Speaker 1 15:08 Well, why don't we jump into those six pillars of lifestyle medicine? And granted, you know, we're not going to be able to go into depth on each one of these, but I think it'll give the audience a sense of what are some of the most important facets of lifestyle medicine that are really the core of what we're talking about today. Speaker 3 15:25 So let's start at the very heart of it, nutrition. Have you heard of fork over knives? Speaker 1 15:31 I've seen it on my Netflix queue, but I have not actually watched it. Unknown Speaker 15:35 I have not either yet. Speaker 3 15:36 So we know there's lots of diets out there, right? And there's a lot of promoters for every one of those diets, and there's a lot of haters. Am I allowed to say that for any of those diets as well and everything and everyone in between? So lifestyle medicine stands behind the evidence of a predominantly whole food, plant based diet. Speaker 1 15:57 When you say whole food, does that mean less processed food? Absolutely. Speaker 3 16:01 So what do you think of when I say plant? Based, just in mainstream right now, vegetarian Speaker 2 16:07 or the food that comes from plant sources and not from any animal sources? Speaker 3 16:12 Maybe how the Impossible Burger is going to be sold at McDonald's and Burger King now, right? And so plant based is a very overarching concept. There's a lot of foods that fit under that, but part of what lifestyle medicine is, yes, it's plant based, but the emphasis should also be on whole foods. Speaker 1 16:33 So what you're saying is that there may be certain plant based foods that are kind of heavily processed that wouldn't necessarily meet the criteria that we're talking about with this first pillar of whole foods that are also plant based, Unknown Speaker 16:46 Impossible Burger. Speaker 3 16:50 And I'm not knocking it. I think it's a great alternative some of the time, but we just want to make sure that the whole food concept doesn't Speaker 1 16:57 get lost. And I think it's also important to mention that this is not like a religion, right? So it's not like you must be a specific whole food, plant based, and everything that you do this is the goal of what your dietary approach should be, is that you should focus on these healthier foods that are whole foods, that are plant based, as opposed to you cannot eat anything outside of that, that spectrum, Speaker 2 17:19 and there will be transition time right where you're going to do a mix of it, and then you kind of your goal is eventually become where you're consuming more of whole food, plant based diet. But if you have cravings for a hamburger once in a while, if you just can't live without it, that's okay to do, as long as you know the majority of the focus is the plant Speaker 3 17:40 based, absolutely, and the evidence behind eating a whole food plant based diet. But then we also have evidence to support specific foods. Have you heard of The Daily Dozen? I have not. What is that? So some people may have heard of The Daily Dozen when it comes to maybe certain organic foods, if you're only going to pick but this isn't what this daily doesn't refers to. It's created. This list is created by Dr. Greger, and it's foods that are functional foods. So it's foods such as blueberries or walnuts or flax seeds, specific foods that have very specific impact on our body, causing positive outcomes. So there is an app for it, for any of those that are interested. Unknown Speaker 18:27 And I believe this app is a free app. It's a free app, okay, Speaker 1 18:30 called the Daily Dozen. Yep, okay. And basically what that does is it tracks your consumption of these kind of specific, higher quality foods over the day, and you can kind of make sure that you're trying to get in these recommended nutrients. Speaker 2 18:45 Absolutely. So, Dr. Srivastava, about nutrition, whole food, plant based diet, somebody who has not done this, you know at all how what are some of the fun ways and resources that they can learn about plant based diet and maybe the approaches to it, Speaker 3 19:03 culinary medicine. So maybe this all started with the thought food is medicine, or let thy food be your medicine, or some variation of that saying. And where we were talking about there's certain foods that actually promote health and eating the right way reverses or mitigates or prevents chronic diseases, we do need to learn how to actually incorporate that. And so culinary medicine is one approach to it. And so there are healthcare providers that offer these courses within their they'll invite they'll have a kitchen at their practice, and they'll invite patients to come and learn with whoever's leading that course. Maybe it's a dietitian or a specialist in culinary medicine who teaches them hands on on how to cook the right foods and how to make those changes. And you know what? Quite frankly, if you've never had something that's plant based, you might think that it's not going to taste good, so it just gives you a chance to even. Try it and see and learn how to incorporate it. And some of these courses are much longer even us as practitioners, we can take these culinary medicine courses, so then we have the right tools to teach our patients. Speaker 2 20:13 And so I think naturally after nutrition comes activity. We're talking about physical activity, right? So are the recommendations for lifestyle, medicines activity different than what we already know about that 150 minutes aerobic activity, etc, etc. Speaker 3 20:28 So with physical activity, the recommendations themselves have been made into their own guidelines. So of course, we have the guidelines within our blood pressure guidelines or our diabetes guidelines, but we also have physical activity guidelines. Specifically. They were created in 2008 and Recently Updated in 2018 in terms of the number, the number of week, the type of activity, similar that we might see. But really, what it goes into detail more about is that prescribers should be making physical activity a vital sign. And patients, you know, just like we give them prescriptions for a medication, we should also be giving them prescriptions for exercises and specific ones, right? It's one thing to say, work out three days a week. Maybe do some strength training, but what if we said, All right, what are some things you like to do? Okay, jump rope three times a week for 10 minutes, and that's something more specific, more achievable for that patient. Speaker 1 21:25 Again, I think one important thing to highlight here is that this is not dramatically different than the conventional medicine that you know, most students or practitioners have learned in school. It's the difference in degree of emphasis that we're putting on it. So not just saying 150 minutes a week. It's being more specific, more prescriptive about it for that patient, to really emphasize that that's really a core part of the treatment plan, as opposed to kind of an afterthought at the end of the visit. You know, that ends up on the printout for the patient when they go home. Speaker 2 21:55 Yeah, and I think I hear the highlight here that it's a lot about individualizing it, right? Like, what does your patient want? What can they fit in? What are their goals? Speaker 3 22:03 Etc, absolutely. And there are resources for this. Just like we were saying, We're all very busy in our practices, and there's just so much that we're able to incorporate into everything. We don't need to recreate everything. So one good resource for this is exercise. Is medicine. It's a great website to visit, and it's their mission to make the assessment and promotion of evidence based physical activity happen for people of all abilities. Speaker 1 22:29 So then our third pillar is to minimize alcohol and also to not smoke, or to stop smoking if you're currently smoking, Speaker 3 22:36 absolutely and for this pillar, they go through the evidence that we all know about the increased risk of chronic health conditions and other medical conditions with the use of alcohol and tobacco products, and so it just once again emphasizes, Dr. Kane, you said it best. It's nothing new. It's just putting the emphasis on it and really encouraging practitioners to empower their patient to go through these intensive interventions to make a difference in their lives. Speaker 2 23:07 And those interventions will be things like, you know, use those five A's, you know, use appropriate pharmacotherapeutic interventions and stuff, and really refer them to these behavioral specialists. Because this is not only going to be a medication induced change is going to be behavioral induced change as well. So controlling the triggers and how to, you know, prevent the relapse, and how can they continue the cessation, either back or alcohol throughout their life, is important. Speaker 1 23:33 And I will say, specifically in pharmacy education, I do think we generally do a really good job when we teach students about tobacco cessation, the importance of non pharmacologic therapy. Of course, we talked about the drug therapy, but so much of the approach to tobacco cessation does involve non pharmacologic therapy. It would be really nice if we could take that emphasis, and I think that's what lifestyle medicine is about, is taking that same emphasis that we do on smoking cessation, and have an equal amount of emphasis for many of these other chronic disease states and like states and lifestyle changes that are being reinforced with the six pillars, Speaker 3 24:07 absolutely, and maybe this is a good time to mention that they actually do talk about using that pharmacotherapy alongside, as the studies have shown, tackling tobacco addiction is best with both behavioral And pharmacotherapy, especially in the beginning, and lifestyle medicine absolutely supports that, but it's also really talking about the like the behavioral changes. Speaker 2 24:29 The next one is my favorite. It's my favorite two decade something that I don't do enough. And I think I realized that we probably all don't do it enough, and it's sleep, and I wish I could be sleeping right now. Unknown Speaker 24:42 So how many hours do you sleep? Unknown Speaker 24:44 So I woke up at 3am today, Speaker 2 24:48 and I was working at the five in the morning on Saturday. So there Unknown Speaker 24:51 you go. I'm hoping that you went to bed at like 6pm Speaker 1 24:54 then not exactly. So how much sleep do you think is enough? I think for 10. Typical person approaching seven hours or so is probably the sweet spot, but for many people, it's going to be individualized. Speaker 3 25:07 There is a study that has looked at this, and they found that the average adult sleeps for six hours and 57 minutes, and 20% actually sleeps less than six hours. When it comes to our younger adults, think about our college age students. They're sleeping most nights less than Speaker 1 25:26 seven hours. And I would argue that the number of children in the household is directly proportional to the amount of sleep one does or does not get. Speaker 3 25:34 Yes, and not just the amount, but the quality. True. I must have been kicked at least three times last night. Speaker 1 25:42 And, yeah, I mean, this is one of those things that I think, just like smoking cessation, most people know that they should get more sleep, but it's, again, a difference of degree of emphasis. And in saying that this is part of your treatment plan to help with your anxiety, for example, that you need to get more sleep so that you cognitively are in a better spot to be able to deal with other things that are going on. Speaker 2 26:02 And, you know, interestingly enough, not to toot my own horn, but I've kind of incorporated evaluating sleep behaviors as part of my initial evaluation when I see patients for diabetes, and that kind of evaluate, if that was identified as an issue, have they been referred to appropriate specialists that they need, you know, sleep mask and sleep have so, you know, they have that sleep apnea and stuff. Has those referrals and interventions have been made? You know, if it's a stress related sleep issues, have they been referred to behavioral specialist or counseling services and things like that? So I've kind of incorporated that. But again, if you think about grand scheme of things where physicians don't have enough time to spend to evaluate each and every little details like this, it probably is not part of every single evaluation that occurs out there, Speaker 3 26:50 and I absolutely love that you do that specifically for your diabetes patients. We know poor sleep can cause higher cortisol levels, higher glucose levels, decrease insulin sensitivity, and so you're trying to control their blood sugars, but maybe helping with the sleep could help with that. So that's so great that you do that. Speaker 1 27:09 It's interesting. I don't think I've ever been asked by a primary care provider, like, how is your sleep quality, or how much sleep do you have at night? And again, as a point of emphasis, maybe we should be asking that for all of our patients, as you have been in your clinic, Dr. Patella, I think that's great. Speaker 2 27:24 Of course, I practice and I don't preach. So what's our Unknown Speaker 27:30 next pillar? Then number five, Speaker 3 27:32 there's several different terms that are used, but relationships, healthy relationships, social connectedness, emotional, well being. Speaker 1 27:40 So this basically deals with having good quality relationships with people around you that gets you in a better emotional state than if you were more independent and kind of were on your own and didn't have that social network of people that you can confide in and enjoy life with and things like that. Speaker 3 27:55 And why does it matter? Because there is a link between isolation and loneliness and morbidity and mortality, and if that is something that is discussed during patient visits, you know, even if it's maybe some of these things can't all be long discussions, but just talking to your patient about it and then maybe recommending resources in the area, maybe there are social groups or something through the park district or something like that, just to help that part of it, which makes the whole thing of treating the whole and not just the parts. Speaker 1 28:28 So then that brings us to our last pillar, which is stress. And stress comes in a lot of different formats, but if you think about it, you know, sometimes stress can be helpful. It can help you meet deadlines. It can, I mean, in a way, you're stressing your body when you exercise, but there's also bad stresses, things that have negative consequences, and that's kind of what we're focusing on with this last pillar, absolutely. Speaker 3 28:51 And it's not about taking stress away completely, but it's reducing the amount of stress, and even more importantly, our reaction to Speaker 2 29:00 that stress, the coping mechanism you're talking Exactly, Speaker 3 29:04 exactly, because without that, there's increased rates of anxiety, depression, obesity, and maybe now you're beginning to see how all these six pillars Connect. Sure, right? One is making the other one worse, and then we're trying to treat and I don't know you can keep going in circles. Speaker 1 29:19 So now you're stressed, so you won't be able to fall asleep, or you wake up in the middle of the night, you can fall back asleep. So again, dealing with your coping mechanism for that stress is important for how you and your body react to the stress. And that's really, I think, the focus of this pillar. Speaker 2 29:32 And this is something, again, I've also incorporated to talk to patients about I obviously am not a mental healthcare provider. I don't, you know, sit there and treat their anxiety or depression, but it gives one money for patients to talk about it, perhaps kind of categorize what areas of life they're having issue or where is the stress coming from, and perhaps not talking about it and kind of keeping it down. Now they have talked about it with somebody, maybe next time they get. Open up even more, they can find some other venues and referrals and appropriate treatments can be provided to them. So those are the six pillars of lifestyle medicine. And I feel like just sitting here, I learned a whole lot, but then earlier, you talked about some certification and passing the exam, and I believe you can achieve a diplomat level. What is that? Dr. Srivastava? Speaker 3 30:22 So to me, personally, it means that I'm getting to live out a dream that I didn't know. I always had. I knew that, I knew that I was really interested in a lot of these aspects, but I truly didn't know that lifestyle medicine was a thing. And the more I looked into it, I was like, wow, okay, I love to help people, and I love to learn. How can I combine the both of this? And I want the evidence. I believe in it, but I want to also speak to the evidence. And so that's where I started with this. And I love the momentous impact it can have on people, and it makes me want to shout it out. Thank you so much for inviting me on this podcast to talk about it, to share what it is, and hopefully help people implement it. That's what you wanted to know, right? Speaker 1 31:02 Yeah, what is like a typical path if one was to want to become a diplomat, what does that involve? And tell us a little bit more about that. Speaker 3 31:09 You need 30 hours of specific lifestyle, medicine, online continuing education. You need 10 hours of in person education from specific conferences. So over the last couple of years, I've attended the American College of lifestyle medicine conference. It's a conference that has all different healthcare providers. I met dietitians, doctors, even pharmacists. We have a pharmacist special interest group, while small, it's growing. Nurses, I mean, physical therapists, basically any healthcare profession, you can think of they're there. And during that conference, I earned my 10 hours, and then I sat for the exam. That's a four hour exam, and I would say, used most of it. I was not used to that. I'm usually the one, the first one to leave the room back when I was in school. But I needed the time this time, and then soon after I found out that I passed. So yay. Congratulations. Speaker 1 32:05 So Dr. Srivastava, for someone who maybe isn't going to become a diplomat in lifestyle medicine, but they want to know a little bit more, what are some resources, or what are some things that they could look into, just to get more information about some of these pillars, and you know how that might play a role, and how they talk to their patients about lifestyle medicine. Speaker 3 32:25 I think a good place to start is maybe just watching this documentary that I recently saw, that maybe some of you have seen, called game changers. It's fascinating. It's about how, you know, athletes and people are told we don't get enough protein in order to be an Olympic champion, or in order to be the best athlete, best runner, you need to get all this protein. And this follows athletes that are in the Olympics, that have beat records for biking and running and weight lifting on a whole foods based, plant based diet, and it's absolutely fascinating, and it talks about the evidence, and you see the possibilities, and all of a sudden, everything that you maybe thought has just been overturned. And I just think it's a good place and a fun way to see the impact of a whole foods based diet. Speaker 1 33:21 Are there any other dietary interventions that kind of come up within the realm of lifestyle medicine? Absolutely. Speaker 3 33:27 So you know how our phones are always listening to us, or you type one thing, and all of a sudden on your Instagram, you have 15 different things pop up. And so ever since I started following lifestyle medicine, a lot of things that do pop up are things like intermittent fasting and gratitude journals and daily meditations or mindfulness. And a lot of this all connects back to what the pillars of lifestyle medicine is about. There are lots of different interventions that people practice, and the big thing with lifestyle medicine is that is there evidence behind it. And when we do look at mindfulness or meditation, there is evidence showing powerful and positive health outcomes. There is data to support eating certain foods within certain hours may impact a healthier lifestyle. And so I would argue that these are all tools under those pillars, and as long as those tools are evidence based, and that is our job to figure that out right, like something may sound really exciting, and may seem that it had these this impact, but we always are going to double check to see if that's really true. And if it is, I bet we can find a way that it does connect to that pillar. I'm just so excited that people are wanting to learn how to live a healthier life, and that there are practitioners and researchers that are showing us the how and why. I think that's great. Speaker 1 34:42 Dr. Srivastava, thank you so much for your time. Would you mind just running through the six pillars, kind of to conclude us here, in terms of what lifestyle medicine really stands for, Speaker 3 34:52 absolutely nutrition, specifically, a plant based whole foods, diet, physical activity. Mm. Minimizing alcohol and no tobacco, sleep, proper duration and quality relationship and that social connectedness and stress and stress reduction. Speaker 2 35:15 I think all that sounds really good if we can practice this long term and it can improve health. Can minimize the need for therapeutic interventions as well. Speaker 1 35:26 So wonderful for the listeners. If you'd like to learn a little bit more, we'll have some links on our website, HelixTalk.com Again, this is episode 108 we're also on Twitter at HelixTalk, and we love those five star reviews and iTunes or your favorite podcast player. Keep those coming. We love to read those. So with that, I'm Dr. Kane, I'm Dr Speaker 2 35:45 Srivastava, and I'm Dr. Patel and thank you for listening. Thank you for joining us, Dr. Srivastava, and to our listeners, study hard. Narrator - Dr. Abel 35:53 If you enjoyed the show, please help us climb the iTunes rankings for medical podcasts by giving us a five star review in the iTunes Store, search for HelixTalk and place your review there to Narrator - ? 36:04 suggest an episode or contact us. We're online at HelixTalk.com thank you for listening to this episode of HelixTalk. This is an educational production copyright Rosalind Franklin University of Medicine and Science.