Jeffrey Bland, Phd: lifestyle medicine for cancer and other chronic conditions.
Subject: Cancer (Drug therapy)
Cancer (Risk factors)
Cancer (Patient outcomes)
Chronic diseases (Drug therapy)
Chronic diseases (Risk factors)
Chronic diseases (Patient outcomes)
Alternative medicine (Methods)
Alternative medicine (Patient outcomes)
Author: Faass, Nancy
Pub Date: 08/01/2012
Publication: Name: Townsend Letter Publisher: The Townsend Letter Group Audience: General; Professional Format: Magazine/Journal Subject: Health Copyright: COPYRIGHT 2012 The Townsend Letter Group ISSN: 1940-5464
Issue: Date: August-Sept, 2012 Source Issue: 349-350
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 303012904
Full Text: New ICD9 codes now make it possible to obtain reimbursement for lifestyle medicine services. These changes in funding are likely to initiate a sea change in the way medicine is practiced today.

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Many physicians in integrative medicine are already aware of the power of science-based lifestyle protocols to reduce or reverse chronic health conditions. These providers also walk the talk--many of them believe in healthy lifestyle and practice it in their own lives. However, systematic integration of these principles into the clinical setting has been challenging. The essential elements of an effective lifestyle practice have not been fully realized until now.

A systematic approach. The first issue has been the deployment and delivery of personalized lifestyle medicine and its systematization within clinical practice. This requires a system that can be cohesively integrated into the flow of the office to provide the time necessary for individual assessments and counseling--despite tight scheduling and constant demands.

Consistent reimbursement. The second important concern is reimbursement and how the provider is paid for services related to the delivery of personalized lifestyle medicine. How can services be structured to fit ICD9 reimbursement models?

For the past 15 years, we have been involved in the ongoing development of a program called First Line Therapy[R], specifically designed to develop the concepts of lifestyle medicine into a more streamlined, reproducible form that can be readily applied in a clinical setting. This program has been expanded, and our new perspective will be presented in a forthcoming initial Lifestyle Medicine Summit to be held September 28-30, 2012.

CLINICAL STRATEGIES

For each patient, lifestyle is a variable that needs to be controlled to maximize the benefit of whatever form of treatment the provider offers, whether that is pharmaceutical therapy, functional medicine, acupuncture, or structural work. Regardless of the intervention, any type of therapy will be more effective if a personalized lifestyle assessment is the foundation of care. Lifestyle interventions need to be systematic, yet tailored to the patient, in order to achieve successful and reproducible results. By controlling for lifestyle and adapting it to the individual's health needs, the provider maximizes the benefit of other therapies.

Assessment. How is a lifestyle program personalized? What are the most important aspects of an initial evaluation? How is that information woven together with signs and symptoms, personal health history, dietary review, exercise, environmental review, and biomarkers in a composite portfolio of information reflecting individual need? When are genomic testing and proteomic testing of greatest value as predictive tools?

Intervention groups. Many aspects of the intervention can be handled through patient education groups and clinical group services. These intervention groups are now reimbursable under the new ICD9 therapeutic codes.

Practitioner extenders. It is also important to know specifically how to structure and codify services using paraprofessional staff members who are often well-trained and suited to be lifestyle educators and counselors. These staff can be employed to maximum effectiveness to reduce some of the time demanded of the primary care provider, while improving patient education, compliance, and outcomes.

POPULATIONS SERVED BY A LIFESTYLE APPROACH

Although we know intuitively that efforts at prevention are pivotal variables in health, it has been difficult to quantify these outcomes in the research. Since patients typically see health care providers because they do not feel well, rather than for guidance on preventive services, our initial program in lifestyle medicine will focus beyond prevention. Rather, the emphasis will be on the needs of patients with early symptomology and dysfunction and those with chronic health conditions.

Early intervention. Patients with nonspecific health issues are often described as the "walking wounded," characterized by stooped shoulders and shuffling gait, suffering fatigue, mood swings, or chronic pain. They typically come to the provider reporting, "I feel miserable most of the time, but no one seems to know what's wrong."

Addressing chronic illness. The research shows that a lifestyle approach can be individualized for patients with early symptomology and also for those with advanced chronic conditions. The challenge is in the specifics of implementation. Once a patient develops sequelae of increasing symptom severity, duration, and frequency, how can the clinician personalize and then amp up interventions to be consistent with the needs of that patient?

THE MATRIX OF LIFESTYLE AND CANCER

Cancer serves as a good case in point--a disorder that is frequently experienced as a recurring condition. We predict that in the future, cancer will be managed as a chronic disorder, just as we manage hypertension, arthritis, and other persistent health issues today. That perspective has several implications.

Early intervention becomes more possible: many cancers have a long preclinical stage that is susceptible to intervention. Research on lung cancer, for example, indicates that "primary care utilization in the early phase of cancer treatment has a marked effect that results in a reduced mortality risk in patients with incident lung cancer," reflected in a 56% lower death rate for patients who received just two or three primary care visits in the first six months after a cancer diagnosis.

Frequently cancer manifests as a chronic disease state that demands ongoing management. We know from research such as the Ornish studies on prostate cancer that improved diet and physical activity can interact to increase cancer survival, even in individuals challenged by health issues such as obesity. Primary care providers have a significant opportunity to deliver this important, ongoing care to cancer patients using functional medicine principles and lifestyle medicine.

Examples of Nutritional Factors in Cancer

A broad range of nutritional factors have the potential to either increase or decrease cancer risk. For example, gluten sensitivity has been found to elevate susceptibility to lymphoma. Gluten fractions can switch immunologic response from TH1 to TH2, compromising the capacity of the immune system to destroy emerging malignant cells.

Diabetes. Individuals with diabetes are 40% more likely to develop cancer. Obesity, insulin resistance, and diabetes are associated with breast cancer, particularly postmenopausal incidence, and may be related to colon cancer as well. Lifetime risk for carriers of the genes associated with high breast cancer risk (BRCA1 and 2 genes) is 82%. Before 1940, the risk level was 24%. Obesity and sedentary lifestyle may play a major role in this threefold increase in susceptibility. Insulin is a known tumor promoter, and hyperinsulinemia can lead to cancer. The effects of insulin and insulin-like growth factor 1 on cancer development and progression have been demonstrated in both animal and human studies. Primary clinical goals include decreasing hyperglycemia, reducing hyperinsulinemia, downregulating inflammation, and moderating parameters of metabolic syndrome.

Soy in the diet. In the discussion regarding breast cancer risk and soy phytoestrogens, soy has been misnomered as a form of estrogen. The phytoestrogens in soy are about 1:1,000 the strength of estrogen. Soy fractions are much less of an agonist at estrogen receptors than estradiol. Metabolite ratios of estrogen 2116 are frequently improved by soy, as well as cruciferous vegetables, flax, and omega-3 fatty acids. Further, soy apparently does not have a testosterone-reducing effect. In the Shanghai Breast Cancer Survival Study, women with breast cancer who consumed soy foods had decreased risk of death and recurrence due to intake of soy during childhood.

Folate and methylation. Low levels of folate can lead to demethylation and unmasking of oncogenes. Epigenetic methylation is related to the folate cycle, and diet can also modify methylation. Disturbed methylation has a range of effects on cancer. While some regions of the genome are hypomethylated, others are hypermethylated in cancer. Initiation might be prevented by folate supplementation. Conversely, existing cancer promotion can be stimulated by folic acid supplementation, so there may be multiple pathways involved.

Vitamins C and K. Nutrient levels have been found to play a role in cancer risk. An NHANES survey of more than 14,000 individuals representative of the general population found that men who consumed 50 mg or more of vitamin C per day and took other supplements had a 22% reduction in cancer risk and a 42% reduction in the risk of cardiovascular disease. Women with these nutrient levels had on average a 14% reduction in cancer risk and 25% lower cardiovascular risk. Vitamin K at low levels (whether caused by depletion or low binding) is associated with increased occurrence of spontaneous cancers and mitotic spindle abnormalities.

Risks of Sedentary Lifestyle

Those who are physically fit have a fourfold lower risk of premature mortality due to cancer than the risk level of individuals who lack physical fitness. For cancer patients, the research shows that exercise, walking, and yoga programs improve quality of life, lessen fatigue, reduce symptoms associated with treatment, and enhance social functioning. Exercise and diet have also been found to reduce inflammation, which unopposed is a poor prognostic indicator in cancer conditions.

OUTCOMES OF LIFESTYLE MEDICINE

We have published three studies from our own clinical work, the last of which was an independent, multicentered trial involving women with cardiometabolic disorders, which are frequently the precursor to cancer. This research evaluated the outcomes of lifestyle intervention in comparison with a control group. Our results, like many other studies now being published, are demonstrating that personalizing a lifestyle medicine program can be an exceptionally powerful therapy. Rather than just treating the numbers, with different drugs for each biomarker, lifestyle interventions address underlying causes, as well as effects. This can result in the resolution of distortions in the individual's metabolic web, system wide. These comprehensive interventions are a major point of differentiation between a pharmacological intervention and an effective personalized lifestyle medicine program.

JEFFREY BLAND, PhD, FACN, FACB

Dr. Bland is an internationally recognized leader in the fields of nutritional and functional medicine. He was the first member of the Board of Trustees of Bastyr University, the first federally accredited university in the United States offering graduate and undergraduate degrees in natural medicine, and he contributed significantly to its founding and accreditation. A nutritional biochemist and registered clinical laboratory director, Dr. Bland has served as professor of biochemistry at the University of Puget Sound, and as Director of Nutritional Research at the Linus Pauling Institute of Science and Medicine. In 1984, he established HealthComm International, now Metagenics, where he currently serves as Chief Science Officer. In 1990, Dr. Bland developed the concept of functional medicine to address the growing problems associated with chronic disease. The following year, he and his wife, Susan, established the Institute for Functional Medicine, a respected nonprofit in the fields of metabolic and systems medicine,

EDITORIAL

Nancy Faass, MSW, MPH, is a writer and editor in San Francisco who has worked on more than 40 books for publishers that include Elsevier, Harper, McGraw-Hill, Mosby, and others. Director of the Writers' Group, she also provides articles, white papers, and writing for the Web. For more information, see www.HealthWritersGroup.com.

LIFESTYLE MEDICINE SUMMIT

Dr. Bland, with other key opinion leaders in lifestyle and functional medicine, will convene at Metagenics' inaugural Lifestyle Medicine Summit this September 28-30. These experts will discuss the latest research and protocols to effectively implement lifestyle medicine in clinical practice. This landmark educational event provides a unique opportunity for health care professionals to share advancements in lifestyle medicine and innovative approaches to address and reverse the onset of chronic diseases such as heart disease, cancer, and diabetes. Presentations will include:

Jeffrey Bland, PhD--Chief Science Officer, Metagenics

Systems, Syndromes & Solutions: Concepts That Will Change Health Care

Mark Hyman, MD--Chairman, IFM

Diabesity: A Whole-Systems Approach

Joel Evans, MD--Faculty, Albert Einstein College of Medicine, IFM, and Center for Mind-Body Medicine

A Functional Approach to Women's Hormonal Health

Lise Alschuler, ND--Naturopathic Oncologist

Strategies to Alter the Epigenetics of Cancer

Jay Lombard, MD--Neurologist and Chief of Neurology, Bronx-Lebanon Hospital Center

Mood and Memory: Diagnosis and New Treatments

kristi Hughes ND--Faculty. IFM Medical Education

Medically Supervised Metabolic Detoxification

Joseph Lamb, MD--Internist and Director of Intramural Clinical Research, Metagenics

Managing Cardiac Disease as a Chronic Illness

Robert Rakowski, DC, Clinic Director

The Natural Medicine Center, Houston, Texas

Performance Nutrition: A Functional Approach

John Gray, PhD--Best-selling Author on gender-based communication

Effective Stress Management for the Clinician

This event will take place in Dana Point, California, September 28-30, 2012. Register at: www.metagenics.com/2012summit

an interview with Nancy Faass, MSW, MPH
Gale Copyright: Copyright 2012 Gale, Cengage Learning. All rights reserved.