Lifestyle Medicine: Prevention, Treatment, and Reversal of Disease

Lifestyle, caries, and apical periodontitis: Results from a university-based cross-sectional study

AIM

Lifestyle factors significantly influence the development of inflammatory diseases, and emerging evidence suggests they may also impact oral health. However, no studies have explored their role in apical periodontitis (AP) amongst adults. This study aimed to assess the association between adherence to the Mediterranean diet (MD), physical activity, perceived stress, and sleep quality with the periapical and caries status in a university-based cohort.

METHODOLOGY

A total of 149 periodontally healthy patients were included in the study. Clinical assessments and radiographic examinations [Orthopantomography (opt) and periapical radiographs] were conducted to evaluate the periapical status. Data on their periapical index (PAI) score and the decayed, missing and filled teeth (DMFT) index were recorded. Validated questionnaires were used to investigate patient's lifestyles. A final logistic regression model was performed for the multivariable analysis to evaluate the predictive ability of adherence to Mediterranean lifestyle on the presence of AP; other local, systemic and environmental factors were included as independent factors in the model.

RESULTS

Significant associations were observed between AP and high/low adherence to the MD (p = .00), high/low-moderate physical activity (p = .00), high/low sleep quality (p = .00) and high/low perceived stress (p = .00). The final multivariable regression model showed that low adherence to MD (OR = 3.68; 95% confidence interval [CI]: 1.24-10.83; p = . 01) and reduced sleep quality (OR = 3.04; 95% CI: 1.42-6.50; p = .00) were identified as potential risk factors for AP development. On the other hand, the DMFT index showed no significant association with lifestyle factors (OR = 1.0; CI: 1.01-1.14; p = .02) but was correlated with the development of AP (OR = 1.07; CI: 1.01-1.14; p = .02).

CONCLUSION

Results from the present study suggest a potential association between low adherence to MD and reduced sleep quality with the development of AP. Individuals with low adherence to MD and inadequate sleep quality faced respectively 4-fold and 3-fold increased odds of developing periapical lesions. Further research is essential to elucidate the causal mechanisms underlying these associations and to determine whether lifestyle adjustments could improve endodontic success rate.

Are the ways women cope with stressors related to their health behaviors over time?

OBJECTIVE

Emerging research suggests the use of certain strategies to cope with stressors relate to disease and mortality risk, and lifestyle habits may be underlying mechanisms. Studies show psychological symptoms (eg, anxiety) and states (eg, happiness) predict the likelihood of adopting an integrated lifestyle that encompasses key health-related behaviors, like smoking. Yet, whether psychological processes, including stress-related coping, influence the adoption of a healthy lifestyle is unknown. We investigated whether coping strategies typically deemed adaptive (eg, seeking emotional support) and maladaptive (eg, denial) relate to sustaining a healthy lifestyle over a 16-year follow-up. We also explored whether variability in the use of these strategies, reflecting attempts to find the best strategy for a given stressor, subsequently relates to lifestyle.

METHODS

Women (N = 46 067) from the Nurses' Health Study II cohort reported their use of 8 coping strategies in 2001, from which we also derived coping variability levels (lower, moderate, greater). Health behaviors (eg, physical activity, smoking, sleep), self-reported every 4 years from baseline until 2017, were combined into a lifestyle score. Generalized estimating equations, controlling for baseline demographics and health-related factors, were performed.

RESULTS

Most adaptive strategies and greater variability levels were associated with a higher likelihood of sustaining a healthy lifestyle (eg, active coping, relative risk [RR] = 1.09, 95% confidence interval [CI], 1.08-1.11), with the reverse evident with maladaptive strategies (eg, behavioral disengagement, RR = 0.94, CI, 0.93-0.95), but some unexpected results also emerged.

CONCLUSIONS

Findings highlight the importance of going beyond the usual (mal)adaptive categorization of coping strategies when investigating their predictive value with behavioral outcomes.

Using lifestyle interventions and the gut microbiota to improve PTSD symptoms

Posttraumatic stress disorder is part of a spectrum of psychological symptoms that are frequently linked with a single defining traumatic experience. Symptoms can vary over the lifespan in intensity based on additional life stressors, individual stability, and connectedness to purpose. Historically, treatment has centered on psychotropic agents and individual and group therapy to increase the individual's window of tolerance, improve emotional dysregulation, and strengthen relationships. Unfortunately, there is a growing segment of individuals with posttraumatic stress disorder who do not respond to these traditional treatments, perhaps because they do not address the multidirectional relationships between chronic cortisol, changes in the brain gut microbiota system, neuroinflammation, and posttraumatic symptoms. We will review the literature and explain how trauma impacts the neuroendocrine and neuroimmunology within the brain, how these processes influence the brain gut microbiota system, and provide a mechanism for the development of posttraumatic stress disorder symptoms. Finally, we will show how the lifestyle psychiatry model provides symptom amelioration.

Whole Health Revolution: Value-Based Care + Lifestyle Medicine

An outdated and burdensome fee-for-service (FFS) reimbursement system has significantly compromised primary care delivery in the US for decades, leading to a dire shortage of primary care workers. Support for primary care must increase from all public and private payers with well-designed value-based primary care payment. Patient care enabled by value-based payment is typically described or "labeled" as value-based care and commonly viewed as distinctly different from other models of care delivery. Unfortunately, labels tend to put individuals in camps that can make the differences seem greater than they are in practice. Achieving the aims of value-based care, aligned with the quintuple aims of health care, is common across many delivery models. The shrinking primary care workforce is too fragile to be fragmented across competing camps. Seeing the alignment across otherwise separate disciplines, such as lifestyle medicine and value-based care, is essential. In this article, we point to the opportunities that arise when we widen the lens to look beyond these labels and make the case that a variety of models and perspectives can meld together in practice to produce the kind of high-quality primary care physicians, care teams, and patients are seeking.

Strengthening Neuroplasticity in Substance Use Recovery Through Lifestyle Intervention

The incidence of substance use and behavioral addictions continues to increase throughout the world. The Global Burden of Disease Study shows a growing impact in disability-adjusted life years due to substance use. Substance use impacts families, communities, health care, and legal systems; yet, the vast majority of individuals with substance use disorders do not seek treatment. Within the United States, new legislation has attempted to increase the availability of buprenorphine, but the impact of substance use continues. Although medications and group support therapy have been the mainstay of treatment for substance use, lifestyle medicine offers a valuable adjunct therapy that may help strengthen substance use recovery through healthy neuroplastic changes.

Lifestyle Interventions in a Patient Identified as Super-Super Obese With a Body Mass Index of 90.5

Obesity is a growing global health concern. Saudi Arabia is experiencing a higher prevalence of obesity compared to the globe. This case report focuses on a 38-year-old female with a body mass index (BMI) of 90.5 kg/m2, prediabetes, and obstructive sleep apnea who successfully underwent a lifestyle modification process resulting in remarkable weight loss. The patient's past unsuccessful attempts at weight loss had left her with a reluctance to try again initially. A multidisciplinary team collaborated to develop a management plan starting with an intensive lifestyle intervention. Lifestyle was assessed, then a structured personalized lifestyle intervention based on a plant-based diet and a gradual increase in physical activity was implemented. Over 6 months, the patient succeeded in losing 23 kg, a percent weight loss of 11.9%. An additional 5 kg was lost when liraglutide "Saxenda" was added. This case report represents the effectiveness of intensive lifestyle interventions in patients with super-super obesity for weight loss and long-term health improvement. Additional research is required to determine if the positive outcomes seen in treating a single patient can be applied to a larger population with super-super obesity. This brings up the question of whether pharmacotherapy or surgical interventions should be the primary approaches for addressing these cases, considering that surgical interventions usually involve lifestyle changes. What we already know about such cases: patients with super-super obesity often require interventions such as surgery or medication to aid in weight reduction, as they typically do not respond to lifestyle interventions alone. What this case report adds to existing knowledge: the use of lifestyle interventions proved effective in such cases as super-super obesity and delayed the need for surgical intervention even without weight reduction medications.

Clinical Interviewing: An Essential but Neglected Method of Medicine

Clinical interviewing is the basic method to understand how a person feels and what are the presenting complaints, obtain medical history, evaluate personal attitudes and behavior related to health and disease, give the patient information about diagnosis, prognosis, and treatment, and establish a bond between patient and physician that is crucial for shared decision making and self-management. However, the value of this basic skill is threatened by time pressures and emphasis on technology. Current health care trends privilege expensive tests and procedures and tag the time devoted to interaction with the patient as lacking cost-effectiveness. Instead, the time spent to inquire about problems and life setting may actually help to avoid further testing, procedures, and referrals. Moreover, the dialogue between patient and physician is an essential instrument to increase patient's motivation to engage in healthy behavior. The aim of this paper was to provide an overview of clinical interviewing and its optimal use in relation to style, flow and hypothesis testing, clinical domains, modifications according to settings and goals, and teaching. This review points to the primacy of interviewing in the clinical process. The quality of interviewing determines the quality of data that are collected and, eventually, of assessment and treatment. Thus, interviewing deserves more attention in educational training and more space in clinical encounters than it is currently receiving.