The COVID 19 pandemic has left us all thinking about ways and means to reduce the risk of contracting the virus. The concern is indeed befitting. COVID-19 has a case-fatality rate estimated between 2-4 per cent (compared to <1 per cent for seasonal influenza) and as high as 20 per cent in those over 80 years old. Those with comorbidities are especially vulnerable. Therefore, we have all learnt the significance of practising adequate social distancing, proper hand hygiene etc. In the midst of the global conversation around these essential measures, the role of lifestyle medicine seems to have been mentioned infrequently, yet it is one of the most important areas many healthcare providers are now focussing on. Dr V Mohan, Chairman and Chief Diabetologist of Dr Mohan’s Diabetes Specialities shares insights on the concept of lifestyle medicine in clinical practice in a chat with Raelene Kambli
How have you been dealing with this COVID- 19 situation?
COVID-19 has proved to be one of the greatest challenges that this world has faced, perhaps in the last 100 years. It has disrupted the lives of almost everyone. People have lost their jobs, money and many have lost their lives due to COVID-19. Personally, I have been locked down in my home for three months. However, I converted this into an opportunity, and instead of getting depressed, I decided to make full use of it. Hence, I increased everything that I had been doing and also learned many new skills. I could eat healthier, do more exercise, increase my spirituality and also was able to work much harder, seeing a lot of patients through telemedicine. I was able to write several research papers. So I have no regrets as I found I could make full use of the COVID-19 situation, despite all the bad things that we keep hearing all around us.
How have your patients responded during these times?
For the first month, in April, we had to completely close down our centres and hence patients could not come. Luckily, the Government of India legalised telemedicine. Hence, we found new ways of reaching out to our patients. We sent our teams home to collect blood samples from patients and teleconsultations were arranged. Patients found this to be a great boon. Although we could never match the usual number of patients that we see in a day, we were able to service up to 30 -40 per cent of our usual patients in this manner. Patients have been extremely understanding and have responded very well. In a recent research paper that we published, we reported that many of them looked after their diabetes better and improved their diabetes control during this period.
Given the current situation and emphasis that we now lay on our health and holistic healing of body, improving immunity etc., how do you think the concept of lifestyle medicine will take flight?
This situation has emphasised more than anything else in the past, that holistic healing of the body and mind is very important. People who had never thought about immunity, are now all talking about improving their immunity. However, they think of it as a quick fix which they can get by just swallowing a pill which will give them all the immunity that they need. In my videos which I have published on YouTube, I have shown how one needs to go far beyond that. To improve one’s immunity, one has to eat healthily, exercise more, reduce stress, sleep on time, and also control chronic disorders like diabetes, hypertension and heart disease. Only if all these are done, does the immunity improve in the body.
As an endocrinologist, how does lifestyle medicine fit into your scope of care provision?
As a diabetes specialist, I am convinced that lifestyle medicine is the most important factor in controlling diabetes. Even if one takes one’s medicines regularly, if one does not modify one’s lifestyle, diabetes can get very badly out of control. To give an example, if one is stressed, sugar levels can go through the roof. An unhealthy diet can either produce diabetes or worsen diabetes. Similarly, a lack of exercise can lead to obesity, hypertension, diabetes, and heart disease. Hence, lifestyle factors, or what you refer to as lifestyle medicine, is very important.
From a clinical perspective, how does lifestyle medicine become a unique concept?
Lifestyle medicine is a combination of several factors. It includes eating a healthy diet, improving physical activity, and doing enough physical exercise, reducing weight wherever there is overweight or obesity, and getting good quality sleep. The fact that during COVID-19, the number of heart attacks in India came down and that many of my patients actually controlled their diabetes better, shows the power of lifestyle medicine.
How are you educating your patients on how to live a healthy lifestyle? What are the lifestyle medicine solutions that providers need to offer?
One of the important factors in chronic disorders like diabetes is that one needs to constantly motivate and coach patients. Just prescribing a diet or asking people to exercise is not enough. One should be a mentor and a coach and be empathetic to them, as this is a lifelong condition. Moreover, instead of finding fault with them or making them feel guilty, if one empathises with them and encourages them, we can see remarkable improvements in compliance with a healthy lifestyle. Many organisations try to convert this into a business model by charging patients for a healthy lifestyle. We don’t do that at our centre, because we feel that diet and exercise is part of the treatment that the patient already pays for and hence, at every visit, we emphasise the importance of healthy living. This has definitely helped to improve the compliance to lifestyle in our patients.
How can one go about measuring the rate of patient satisfaction and health outcomes using lifestyle medicine?
There are many scales which can be used to assess the quality of life. The WHO has a short question as well as a long question. These are specific questions which ask about patient satisfaction level and assess the patient’s quality of life. Health outcomes can, of course, be measured in quantitative terms by looking at the blood sugar, lipid Profile, eg. cholesterol and triglyceride levels, blood pressure control, bodyweight of the individual and other metabolic parameters. In our speciality of diabetology, it is quite easy to assess the health outcomes, as there are robust, quantifiable, health outcome measures. One of the recent developments is what is called continuous glucose monitoring or ambulatory glucose profile, which measures what percentage of the day that the patient’s sugar is under control. We call it ‘Time in Range’. The Time in Range should be at least 70 per cent if one is to prevent complications.
In times to come, what would you recommend people to do to resort to lifestyle changes in order to stay healthy?
COVID has taught us that if one remains healthy, even if one is exposed to a deadly disease like COVID-19, the chances of improved outcomes and survival is much more than those who adopt very poor lifestyles and have chronic diseases. Hence, I would recommend the following, in my speciality:
- Those who have a high risk of diabetes and hypertension can take measures to prevent these disorders.
- Those who already have them should keep them under good control.
Lastly, what is your perspective on the integration of Ayush into lifestyle medicine and the use of nutraceutical?
The Ayush system is a very broad term and encompasses Ayurveda, Yoga, Unani, Siddha, Homeopathy etc. So, one cannot generalise about Ayush. Each one of them has their own benefits and Ayurveda and Yoga lay a lot of emphasis on lifestyle modification, stress reduction, yoga and pranayama. These are obviously very healthy and there is nothing Ayush about them. I think everybody should do these and even allopathic medicine has accepted these measures. Nutraceuticals should be used only when necessary and under the prescription of a doctor, as some of them can have side effects. I would not uniformly advise everyone to take it without the proper medical prescription, guidance and check-up.