Verdant Community Wellness Day: Using lifestyle medicine to reduce health risks

This is the third of a three-part series summarizing Verdant Community Wellness Day presentations. You can read part 1, addressing domestic violence among West African women, here; and part 2, on how to build a healthy media diet for teens, here.

Shoreline family physician Dr. Margaret Towolawi presented how lifestyle medicine can help reduce the risk of getting major chronic diseases during a March 9 community wellness day presentation sponsored by the the Verdant Health Commission. 

Lifestyle medicine is a budding medical field that emerged in 2004. It focuses on prioritizing patient care through six lifestyle interventions:

• Advocating a diet rich in whole foods and plants
• Regular physical activity
• Restorative sleep
• Stress reduction techniques
• Avoidance of harmful substances, such as nicotine and addictive drugs
• Fostering healthy social relationships

Lifestyle medicine was first mentioned in the title of a paper that was presented at a 1989 Brussels Conference on indoor air quality. The idea did not gain momentum until the 1998 publication of a study – led by Dr. Dean Ornish – that showed a regression of atherosclerosis among 28 patients who for five years adopted a low-fat, plant-based diet, regular aerobic exercise, stress management training, smoking cessation and group psychosocial support. Meanwhile, the control group’s heart condition continued to progress, with nearly twice the amount of cardiac symptoms compared to the experimental group. 

Since then, many studies related to  lifestyle medicine emerged, which influenced guidelines issued by several major health organizations, such as the American Association of Clinical Endocrinology and the American Institute for Cancer Research. However, the practice is not yet widely found  in the U.S.

“When I started medical school, it was all about pushing statins and things like that to lower cholesterol,” Towolawi said. “But now, if you look at [the American Heart Association] guidelines, they talk about lifestyle medicine as a main way to decrease all sorts of cardiovascular disease.” 

It isn’t just cardiovascular disease, she added. Major chronic diseases that affect 6 out of 10 Americans include type 2 diabetes, cancer, stroke and Alzheimer’s. About 90% of the $3.3 trillion annual health care costs in the U.S. are attributed to the treatment of these chronic issues. 

“Less than 3% of Americans live a healthy lifestyle. Isn’t that crazy?” Towolawi said. She defined a healthy lifestyle as:

– Doing moderate or vigorous exercise for at least 150 minutes a week.

– Having a diet score in the top 40% on the Healthy Eating Index.

– Having a body fat percentage below 20% for men and below 30% for women.

– Not smoking, which includes vaping, e-cigarettes and marijuana.

She emphasizes a plant-dominant diet, which does not mean that people have to be vegan or vegetarian. “This means that plants are your main energy source,” Towolawi said. “It might be 80% or 70% of your diet.” Such a diet includes fresh fruits and vegetables and whole-grain foods while limiting processed or packaged foods.

“Limiting consumption of red meat is so important, and I wish in the grocery stores they would have that [message] in the back of every red meat item in the deli,” Towolawi said. “We’re seeing a link to red meat consumption and colon cancer.”

This reflects increasing research to such link worldwide. In 2021, a systematic review of 148 studies found that high red meat or processed meat consumption (more than 90 grams a day) can increase colorectal cancer risk by 8%, colon cancer risk by 21% and rectal cancer risk by 22%.

However, addressing the biology of disease and health is not enough. Towolawi said that the social and psychological components of health need to be factored in.

“I can’t stand up here as a Black physician and not talk about health care disparities,” she said. “It’s not fun to talk about but it’s super necessary. When we think about high blood pressure, obesity, type 2 diabetes, lung diseases…people of color – Black, brown – are disproportionately affected.”

Approximately 40% of Black people have hypertension compared to nearly 28% of whites, and Blacks are two to three times more likely than whites to die of preventable heart disease and stroke, Towolawi said. In addition, Black children are seven times more likely to die from asthma than white children.

“Lifestyle medicine can help us take charge of our health so that we can narrow this inequity gap a bit,” she said. Towolawi also encouraged any health care professionals in the audience to consider how existing social programs, racism, bias and accessibility affect health care outcomes. 

“It’s not always, ‘Oh, it’s genetics!’ In epigenetics, genes can be turned on or off based on behavior and environmental changes,” she said. “People said to me, ‘My mom had type 2 diabetes, and I’m gonna have it too,’ and I can say to them, ‘Not necessarily true!’ “Your genes and your DNA are not your fate, you may be more prone to certain chronic diseases, but lifestyle choices… ‘flip the switch’ on.”

Born and raised in Inglewood, California, Towolawi attended a pre-med summer program at the University of Washington in 2004. Two years later, she attended medical school at the UW School of Medicine, including a residency in family medicine with an emphasis in nutrition. After working at Swedish Hospital for almost eight years, she opened her private practice Nurture Well Center in Shoreline in late 2020. In 2022, she also published her book Ayomide and Seyi’s Kitchen: A kids’ guide to plant based nutrition from A to Z. It’s an introduction to a variety of plant-based food for children and a guide for families to create their own meals.

Unlike traditional medicine, lifestyle medicine emphasizes the importance of lifestyle changes not only in preventing chronic diseases but also in potentially reversing them through intensive interventions. Dutch physician Hanno Pijl from the Leiden University Medical Center wrote that the traditional medicine model works well with infectious diseases and fractures but often fails to treat and address the underlying problems of chronic diseases, such as cardiovascular diseases, type 2 diabetes and obesity.

“The vast majority of chronic non-communicable diseases is caused by gene-environment interactions,” Pijl wrote. “Behavioral and environmental cues trigger illness, the nature of which is determined by our (epi-)genetic architecture. Too much of the wrong food, prolonged stress, lack of physical exercise, bad sleep, smoking, and toxins are the most important ‘exogenous’ triggers. Indeed, the environment is paramount in the pathogenesis of chronic disease.”

During the Q&A session after her presentation, Towolawi said that she does not shame people for eating more meat than she does, including her husband. “I never tell [my best friend] ‘Stop eating at Chick-fil-A!’” she said. “When you get someone to embrace more of the way you’re eating, the best way is being encouraging and supportive.”

For more information about lifestyle medicine, visit the American College of Lifestyle Medicine and contact Dr. Margaret Towolawi at [email protected].

— Story and photos by Nick Ng