Thomas Edison stated, “The doctor of the future will give no medicine but will instruct his patient in the care of the human frame, in diet, and in the cause and prevention of disease.” He was envisioning lifestyle medicine for the future. Imagine how forward-thinking that must have been at that time. And it still is!
Unfortunately, Edison’s vision of what medicine would look like hasn’t materialized in this country yet. In fact, according to the Centers for Disease Control and Prevention (CDC), six in 10 Americans have at least one chronic illness, and four in 10 have two or more.1 In 1900, the leading cause of death in this country was infectious disease at 53%. By 2010 that statistic had dropped to 3%, but chronic illnesses, including heart disease and cancer, captured the statistic of 53% of all-cause mortality.2
Benefits of lifestyle medicine
Obesity and diabetes are comorbidities that contribute to both heart disease and cancer, increasing the chance of dying due to chronic diseases. Lifestyle medicine can be described not only as prevention of diseases through lifestyle choices but can also be implemented as a strategy to improve outcomes with traditional approaches to treat chronic illnesses. Lifestyle medicine can benefit many organs in the body and also augment strategies to improve oral health.
In 2018, “Lifestyle medicine: A brief review of its dramatic impact on health and survival” was published in The Permanente Journal and written by a team of esteemed physicians.2 It summarizes how lifestyle choices can interrupt the slow but steady decline to health. I have personally worked on using these concepts, and I encourage patients to do the same. My challenge for those of you reading is to start with yourself, and then determine how to encourage your patients to adopt lifestyle medicine to prevent disease or adjunctively improve outcomes.
4 lifestyle interventions
There are four lifestyle interventions encompassed in the 2018 “Lifestyle medicine” article—healthy eating, active living, healthy weight, and emotional resilience. An analysis of adherence and nonadherence based upon data about the American population is reported in each category.
This is sobering. Here is the breakdown of adherence and nonadherence to each category:
- Adherent to healthy eating, 23% / nonadherent, 77%
- Adherent to active living, 40% / nonadherent, 60%
- Adherent to healthy weight, 40% / nonadherent, 60%
- Adherent to emotional resilience, 50% / nonadherent, 50%
For every nonadherent lifestyle result, one moves further away from optimal health and is propelled toward poor health and disease. That may sound simplistic, but the entire impact of epigenetics reminds us that you can influence your genetic expression with lifestyle interventions. That means that even though you may have parents and grandparents with diabetes, cardiovascular disease, or Alzheimer’s, you can lower your risk exponentially by behaviors and lifestyle choices that reduce inflammation that promotes these diseases. The same applies to our patients who claim, “My gums have always bled. Both of my parents had gum disease.”
We know today that there are several influencers of periodontal disease promotion in susceptible hosts that are impacted by lifestyle choices. The conclusion of an 11-year follow-up study on diet in 2020 found that poor diet predicts periodontal disease. It found that low dietary scores are strongly associated with probing pocket depths, and strongest in the nonsmoking middle-aged group.3 Does this mean poor diet trumps tobacco in the risk category for periodontal diseases? Well, this is one study, but dental professionals should be as engaged and committed to dietary education and coaching as they are to tobacco cessation for disease prevention.
Another study is compelling in its findings regarding exercise and periodontal disease.4 This was an intervention study in relationship to periodontal health with surprising conclusions. In this study, 71 obese men participated in either a dietary or exercise intervention program for 12 weeks. Periodontal data, health indices, and DNA analysis of periodontal pathogens were collected before and after the intervention periods.
Results of the two intervention groups showed that probing pocket depths (PPD), the number of teeth with bleeding on probing (BOP), and the total count of periodontal pathogen T. denticola decreased significantly more in the exercise intervention group than in the dietary group. In addition, the exercise intervention group saw significant improvement in body weight, LDL cholesterol, and fasting insulin levels, indicating systemic improvements.
Does this mean exercise trumps diet? Again, this is one study. Interestingly, another study published in 2020 with similar results confirmed improvements in clinical parameters such as perio probing depth and bleeding on probing in an exercise group of patients.5 Chronic periodontitis patients should implore dental professionals to include recommendations for active living and exercise into treatment plans for nonsurgical periodontal treatment, if they desire to achieve optimal results.
Regarding the impact emotional resilience may have on periodontal disease, there are many studies correlating an increase in periodontal diseases to those suffering from depression and anxiety. A recent systematic review of the data examining psychological stressors and their correlation to periodontal diseases confirms a high correlation in nine of the 11 studies analyzed.6 Stressors such as anxiety, depression, loneliness, negative life events, and poor socioeconomic status correlated to increased levels of chronic periodontitis in smokers and nonsmokers alike.
While many of us have been thrown into the awkward position of “counselor” for patients freely asking for advice from their trusted health-care professional, it is important to have professional resources available to refer them to for objective and therapeutic intervention. Adherence to emotional resilience as opposed to nonadherence could be the catalyst that enables a patient to finally achieve optimal clinical results as opposed to experiencing the discouraging reality of inflammatory response and bleeding gums visit after visit.
Lifestyle medicine isn’t easy because it requires deliberate healthy choices. But it’s worth it, isn’t it, not to join the six out of 10 Americans suffering from at least one chronic illness?
Editor's note: This article appeared in the April 2022 print edition of RDH magazine. Dental hygienists in North America are eligible for a complimentary print subscription. Sign up here.
- Chronic diseases in America. Centers for Disease Control and Prevention. https://www.cdc.gov/chronicdisease/resources/infographic/chronic-diseases.htm
- Bodai BI, Nakata TE, Wong WT, et al. Lifestyle medicine: A brief review of its dramatic impact on health and survival. Perm J. 2018;22:17-025.doi:https://doi.org/10.7812/TPP/17-025
- Jauhiainen LM, Ylöstalo PV, Knuuttila M, et al. Poor diet predicts periodontal disease development in 11-year follow-up study. Community Dent Oral Epidemiol. 2020;48(2):143-151. doi:10.1111/cdoe.12513
- Omori S, Uchida F, Oh S, et al. Exercise habituation is effective for improvement of periodontal disease status: a prospective intervention study. Ther Clin Risk Manag. 2018;14:565-574. doi:10.2147/TCRM.S153397
- Alkan B, Guzeldemir-Akcakanat E, Odabas-Ozgur B, et al. Effects of exercise on periodontal parameters in obese women. Niger J Clin Pract. 2020;23(10):1345-1355. doi:4103/njcp.njcp_627_19
- Decker A, Askar H, Tattan M, et al. The assessment of stress, depression, and inflammation as a collective risk factor for periodontal diseases: a systematic review. Clin Oral Investig. 2020;24(1):1-12. doi:10.1007/s00784-019-03089-3