Glossary

Lifestyle Medicine Principles

• Chronic Lifestyle Diseases

  Chronic diseases such as heart disease, high blood pressure, Type 2 diabetes, and obesity  are long-lasting conditions that require ongoing medical attention and often adversely impact quality of life. Chronic diseases are the leading causes of death and disability in the US. They are often referred to as lifestyle diseases due to the large impact our lifestyle choices have on their development.

• Disease Reversal

  Disease reversal is not merely symptom or risk factor management but an actual reversal in the progression of disease development. For example, the shrinking of plaques in the arteries of patients with coronary artery disease in response to treatment is disease reversal.  Research has shown that intensive, multi-domain lifestyle interventions can result in disease reversal in some patients.

• Inflammation

  Acute inflammation is a normal response of the body to injury, such as a cut or an infection, and it is a vital part of the healing process. However, chronic inflammation is not beneficial. An increasing number of common lifestyle-related conditions, such as heart disease, Type 2 diabetes, obesity and arthritis have been associated with chronic low-grade inflammation. 

• Lifestyle Medicine

  The delivery by trained and certified clinicians of evidence-based therapeutic lifestyle interventions—including a whole-food, plant-predominant eating pattern, regular physical activity, restorative sleep, stress management, avoidance of risky substances, and positive social connection—as a primary modality to prevent, treat, and often reverse chronic disease.

• Physical Activity

  Any kind of movement that leads to an elevated heart rate and breathing harder than normal. Brisk walking, dancing, biking, hiking, gardening or raking, running, swimming, playing sports, etc.  The goal is to get at least 150 minutes per week of moderate activity or 75 minutes per week of vigorous activity. 

  Moderate activity

  “Moderate activity” is defined as activity that causes your heart to beat faster and your breathing to be heavier than normal but you’ll still be able to talk.  

  Vigorous activity

  “Vigorous activity” means your heart rate and breathing are increased significantly, you’ll be sweating and it will be hard to talk much without getting out of breath.

• Plant-rich, Minimally Processed Diet

  A healthy diet incorporating at least 7-9 servings per day of whole plant foods that is is rich in leafy greens, whole grains, legumes and includes a modest amount of nuts and seeds is foundational to any lifestyle medicine intervention. 

  People who follow plant-rich diets – including the DASH and Mediterranean diet as well as various types of vegetarian diets (pesca-vegetarian, lacto-ovo vegetarian or vegan) – have significantly lower risk for cardiovascular disease, Type 2 diabetes, obesity, and certain cancers compared to people who eat diets high in meats and processed foods.

• Relationships

  Most people don’t think of social relationships as an essential factor in health but research shows that having healthy relationships can have as big an impact on health and longevity as factors like physical activity and obesity. All types of healthy relationships – family, friends, colleagues and neighbors – can bring value to our lives and improve our overall physical and mental health.  

• Risky Substances

  This includes addictive substances like tobacco and alcohol which can increase risk for cancer and heart disease, but also commonly used substances like caffeine – which in excess may be harmful for some people.  It also considers environmental toxins and pollutants which can be harmful to health.

• Sleep and Rest

  Many studies show that 7-9 hours of restorative sleep are essential for lowering risk and helping manage chronic diseases like obesity, diabetes and heart disease, while getting < 6 hours per night increases risk.  In addition to sleep, we all need periods of daily, weekly and annual rest – times when we take a break to rejuvenate and get a clearer perspective. 

• Stress

  Being able to respond to an acute physical threat with a “fight, flight or freeze” response is essential for survival. But chronic stress – which is often related to mental or emotional stressors – is very harmful, increasing risk for heart disease, high blood pressure, diabetes and obesity.  Developing a regular stress management practice is a key element to reducing our reaction to the chronic stressors of modern life.

Biometrics and Clinical Labs

• Blood pressure

  Your blood pressure is recorded as two numbers.  The first (top) number is “Systolic Blood Pressure”, which measures how much pressure your blood exerts on the artery walls when the heart beats.  The second (bottom) number is “Diastolic Blood Pressure”, which is the amount of pressure exerted on your artery walls while your heart is resting between beats.  Optimal blood pressure is less than 120/80 mm Hg.

• Body Mass Index (BMI)

  BMI is a ratio of weight to height that is used to categorize obesity and can reflect body fatness.  BMI is calculated by dividing your weight (in kilograms) by your height (in meters squared). A healthy BMI is 18-25 kg/m², overweight is defined as BMI of 25-30 kg/m², and obesity as a BMI>30 kg/m².

• Cholesterol (blood)

  Cholesterol is a waxy substance that is part of all animal cells and is essential for many body functions, including production of some hormones and vitamin D.  High blood cholesterol is a key contributor to cardiovascular disease risk.  A normal value for total cholesterol is <200 mg/dl.

• Glucose (Blood)

  Blood glucose, or “blood sugar”, is a lab measurement related to diabetes risk.  Your blood glucose reflects a combination of glucose produced by the body and glucose derived from food. A blood glucose level between 100-125 mg/dl may indicate prediabetes, while a blood glucose level>126 mg/dl may indicate diabetes.  Lifestyle interventions can be very effective for lowering blood glucose.

• HbA1c (Hemoglobin A1c)

  HbA1c, sometimes called “glycated hemoglobin” is a marker of diabetes risk. Blood levels of HbA1c reflect your average amount glucose levels over the past three months. A normal level of HbA1c is below 5.7%.  HbA1c between 5.7 and 6.4% may indicate prediabetes and greater than 6.5% may indicate diabetes.  If you have diagnosed diabetes, the American Diabetes Association recommends keeping HbA1c below 7%, but you should discuss optimal levels for you with your provider.

• HDL Cholesterol

  High density lipoprotein(HDL) cholesterol is sometimes referred to as “good cholesterol” and helps remove excess LDL (“bad”) cholesterol from the blood.  For optimal health, you HDL cholesterol levels should be greater than 40 mg/dl (men) or 50 mg/dl (women).

• LDL Cholesterol

  Low density lipoprotein(LDL) cholesterol is sometimes called “bad cholesterol,” because an excess can build up inside the walls of the arteries, causing them to become narrower and increasing your risk for cardiovascular disease.  Optimal levels of LDL-cholesterol are <100 mg/dl.

• Triglycerides

  Triglycerides are another type of fat in the blood and blood levels are easily influenced by diet from one day to the next. Triglycerides are an important part of the total picture of cardiovascular diseases risk.  Normal levels of triglycerides are less than 150 mg/dl. 

• Waist Circumference

  Your waist circumference is a marker of fat distribution in the abdomen, the riskiest area to carry excess fat.  High waist circumference is associated with increased risk for Type 2 diabetes, high blood pressure and heart disease regardless of your body weight.  Waist circumference should be measured at the level of the top of the hip bone to determine risk (not at the belly button or smallest part of waist).  A waist circumference <35 inches in women or <40 inches in men is optimal.

Diet and Nutrition

• “Plant-Based” Diet

  Although originally referring to any diet that is relatively high in plant foods, today the term “plant-based” is commonly used to mean vegan or consisting of 100% plant-derived foods.

• Fiber

  Dietary fiber, or “roughage”, is the edible part of plants that is your body can’t digest or absorb. Fiber is a type of carbohydrate found in mainly whole grains, vegetables, fruits and legumes.  Animal foods do not contain fiber.  High fiber diets are associated with lower rates of heart disease, Type 2 diabetes and certain cancers.  CHIP recommends getting at least 40 grams of fiber daily.

• Insoluble Fiber

  Insoluble fiber does not soak up water. This type of fiber acts like a broom that sweeps through the colon and aids in elimination and bowel regularity.

• Ketogenic (“Keto”) Diet

  The ketogenic (keto) diet was initially developed to aid in the treatment of pediatric epilepsy. It involves a strict restriction of carbohydrates, with the majority of dietary energy coming from fat. It  has become popular as a weight loss diet, however it comes with many potential adverse side effects and no research to show its long-term safety or efficacy. 

• Legumes

  A group of high-fiber plant foods including beans (pinto, garbanzo, black beans), peas and lentils.  Legumes are high in protein and contain no cholesterol, so they make a good meat substitute.  They are also rich in iron, magnesium, potassium, and certain B vitamins. 

• Low-fat Diets

  Although there is a common misperception that low-fat diets are not effective for weight loss or reducing chronic disease risk, the truth is that hundreds of studies demonstrate the health benefits of low-fat diets. What is important is that when you remove the dietary fat, you don’t replace it with sugar and processed foods! 

  Low-fat diets are associated with reduced risk for heart disease, high blood pressure, Type 2 diabetes and certain cancers.  And, because fat is so high in calories, reducing dietary fat can naturally lead to weight loss.  CHIP recommends eating <40 grams of fat per day.

• Macronutrients

  Macronutrients include proteins, carbohydrates and fats. These nutrients provide most of the energy, or fuel, your body needs to function normally.  These nutrients provide the calories in your diet.  Proteins and carbohydrates both provide 4 calories/gram, while fat is more than twice as calorie-dense, providing 9 calories/gram.

• Micronutrients

  Micronutrients include vitamins and minerals, as well as compounds like phytonutrients (plant nutrients) that play a vital role in optimal health.  Micronutrients are only needed in small amounts. Eating a varied diet, high in multi-colored fruits and vegetables, is the best way to get all the necessary micronutrients.

• Paleo Diet

  The Palaeolithic (paleo) diet is a diet that typically involves avoiding dairy products, legumes, grains and some starchy vegetables. The diet composition tends to be high in fat, particularly saturated fat from animal sources. The diet is supposedly based on the diets of Palaeolithic humans typically ate, however such a claim does not hold up to scientific scrutiny. There is currently no long-term data showing the safety of following a Paleo diet long-term.

• Plant-rich, minimally processed Diet

  A healthy diet incorporating at least 7-9 servings per day of whole plant foods that is is rich in leafy greens, whole grains, legumes and includes a modest amount of nuts and seeds is foundational to any lifestyle medicine intervention.

  People who follow plant-rich diets – including the DASH and Mediterranean diet as well as various types of vegetarian diets (pesca-vegetarian, lacto-ovo vegetarian or vegan) – have significantly lower risk for cardiovascular disease, Type 2 diabetes, obesity and certain cancers compared to people who eat diets high in meats and processed foods.

• Soluble Fiber

  Soluble fiber has the ability to soak up water. It stimulates the muscles in your intestines and binds to cholesterol and toxins allowing them to be eliminated from the body. Soluble fiber can increase feelings of fullness after eating, and is associated with lowering cholesterol, improving blood sugar balance, maintaining a healthy weight and promoting the growth of friendly bacteria in the gut.

• Standard American Diet (SAD)

  Often referred to as a “Western Diet”, it’s characterized by high amounts of processed foods, refined carbohydrates and added sugars, refined fats, high fat dairy products and red meat. As a result, it is also typically low in a healthy variety of minimally processed vegetables, fruits, legumes and whole grains.