Making age just a number with lifestyle medicine 

Studies and practice confirm that lifestyle medicine can positively impact both physical and brain health as we age.

By Sally Crocker 

Practicing tai chi in the park. Preparing healthy plant-predominant meals to enjoy with friends and family. Taking time for mindfulness. Those are just some of the ways older adults are applying the six pillars of lifestyle medicine to remain mentally and physically engaged as the years tick by.  

The effect of healthy behaviors on both body and mind is powerful. As an example, lifestyle medicine pioneer Dean Ornish, MD, FACLM, recently published results from the first randomized, controlled trial to demonstrate that an intensive lifestyle intervention, without drugs, significantly improved cognition and function in many patients with early dementia and Alzheimer’s disease. 

By treating the whole person—considering a patient’s genetics, lifestyle and social environment–clinicians have an opportunity to support healthy cognitive aging and reduce the future public health burden of dementia. Furthermore, by understanding and addressing specific risk and resilience factors in women, who have twice the risk of Alzheimer’s disease than men, clinicians are better able to personalize treatment approaches to well-being and healthspan, concluded ACLM member Nancy B. Isenberg, MD, MPH, FAAN, DipABLM, and colleague Jessica Z.K. Caldwell, PhD, in a 2023 review on “The aging brain: risk factors and interventions for long term brain health in women.” 

“Aging is inevitable,” Dr. Isenberg said. “But how we age is not.” 

In an article published by The Journal on Active Aging, ACLM Executive Director Susan Benigas described lifestyle medicine as a way of “adding years to lives and life to years.”  

Dean Sherzai, MD, MPH, PhD(c), and Ayesha Sherzai, MD, in a 2019 American Journal of Lifestyle Medicine article titled, “Preventing Alzheimer’s: Our Most Urgent Health Care Priority,” noted that the prevalence of dementia is one in 10 individuals older than 65 and increases to 50% among individuals over age 85.   

“The prevalence of Alzheimer’s dementia (AD), the most common form of dementia, has been increasing rapidly and is projected to reach 16 million individuals by the year 2050,” they wrote. 

Body health equals brain health 

While there is currently no cure for Alzheimer’s disease, there are simple lifestyle behavior changes that may improve memory and lower cognitive risks, said Dr. Isenberg, a cognitive neurologist at Seattle’s Swedish Neuroscience Institute.  

Dr. Isenberg cares for people living with cognitive challenges, including patients with Alzheimer’s disease and other forms of dementia. She is also co-director of Project ECHO Dementia at the University of Washington, which aims to broaden the population health impact of prevention, early detection, and treatment (with a specific focus on rural and chronically underserved areas) and to expand dementia programs and services for communities to better address health disparities across Washington.  

The body and brain are connected, Dr. Isenberg said. Heart health and gut health affect brain health. Physical strength and exercise help reduce inflammation, increase blood flow and maintain balance. Keeping bodies moving helps reduce frailty and promote brain health as we age.  

Insomnia and sleep apnea have been linked to dementia, and loneliness has been called a silent killer, making positive social connections also a vital part of brain health. Lifelong learning, too, keeps the brain active.  

“Learning something new is weightlifting for the brain,” Dr. Isenberg said. 

Dr. Isenberg, medical director of the Swedish Neuroscience Institute’s Center for Healthy Aging and Women’s Brain Health Program, and her team incorporate food as medicine.  

“We already know the power of healthy food to prevent, better manage and even reverse certain chronic diseases, and we are taking it a step further. Thanks to a grant from the Institute for Human Caring at Providence, we’ve been able to send nutritious ingredients, along with instructional videos on how to cook brain-healthy meals at home, to our patients through our ‘Food for Thought’ program,” Dr. Isenberg said. 

“So far, 100 families have benefited from this program, including recipients who wrote to say, ‘We received our special groceries! We found the classes inspirational — you filled us with knowledge, hope and opened new possibilities for us.’”  

This approach to healthcare also extends beyond the team’s work in the clinic. The program offers online exercise videos with a neurological physical therapist for patients and their families at all levels of physical ability to strengthen skeletal muscle, support an active lifestyle and improve mental and physical well-being.  

This program will also be available in the upcoming Women’s Brain Health Program research initiative, FemStrong. This innovative care model includes a series of virtual shared medical appointments — one-hour sessions that create a community of learning and support where patients receive information about the foundational pillars of well-being and how to better attain their brain health goals. There is also an opportunity to spend more time with their healthcare professionals to ask questions and share successes.   

A participant wrote to Dr. Isenberg’s team to say, “I just want to follow up with you personally for making the Healthy Aging Program available. I found the information very helpful and learned a great deal. I encourage your continuation of such programs for the growing population of aging folks like me. Also, I want to thank your staff for their backstage support. What a great surprise to receive the wide variety of healthful groceries. This undoubtedly required a substantial effort to coordinate, and this extended effort is also greatly appreciated. Thank you again!”   

The Center also offers a quarterly Brain Health newsletter and monthly book group series, along with a biannual, free Healthy Aging Summit.  

“While chronic diseases are largely preventable, approximately six out of 10 U.S. adults have one chronic illness, with four out of 10 facing two or more chronic conditions like hypertension, type 2 diabetes or coronary artery disease,” Dr. Isenberg said. “This has been emphasized in numerous national guidelines, recommendations and studies over decades, and it’s our calling to address the lifestyle factors to prevent, treat or reverse these chronic diseases.”  

Putting mind and body into action 

Maryland-based primary care physician and lifestyle medicine specialist Aruna Nathan, MD, DipABLM, has always viewed the management of chronic health conditions holistically.  

Growing up in Mumbai, India, food was considered medicine. Her grandmother taught the family about the healing power of herbs and cooking fresh, healthy foods. Participating in sports and staying active were important. In 2013, Dr. Nathan, who serves as co-chair of ACLM’s Geriatric Member Interest Group and chair of the Fitness Committee for the Maryland Department of Health Wellness Council formally incorporated nutrition, physical activity, mindfulness-based stress management, restorative sleep, social connection and avoidance of risky substances into her practice where she cared for chronically ill patients or those at high risk of chronic disease.    

 Through a 14-week lifestyle program that Dr. Nathan created in 2020, she coached patients through simple, effective lifestyle techniques for improving their overall health. Patients set long-term and medium/short-term goals, then created a structured action plan to improve measures in blood pressure, weight, glucose and energy levels, and quality of sleep. 

“It started in a very traditional way,” she said. “We engaged in activities like tai chi in the park and taking a ‘Walk with a Doc’ to inspire patients and others who wanted to join in movement and group conversation. We hosted cooking classes, preparing meals and eating together as a community. As people inquired about the different herbs and fresh vegetables we were using, they also began learning about each other’s cultures and different ways of eating.” 

Friendships blossomed, enhancing the important social aspects that keep the mind stimulated and active at any age. The program is rooted in “doing” rather than just listening.  

“We often get so focused on knowledge–knowing what we should be doing–instead of actually putting what we know is good for us into action,” she said.  

Aging faster 

After working in an internal medicine group and later opening her own concierge practice, Dr. Nathan saw a unique opportunity in AbsoluteCare® to deliver lifestyle medicine to the most vulnerable members of society with multiple chronic medical conditions.  

In these patients, Dr. Nathan saw a faster rate of aging due to environment and living conditions. High levels of oxidative stress and chronic inflammation, which have been linked to Alzheimer’s disease, memory loss, high blood pressure, heart disease and other chronic illnesses, were prematurely aging patients still in their 40s and 50s.  

The first patient Dr. Nathan met was in her 50s. She had most of the common chronic conditions – obesity, diabetes, hypertension, sleep apnea and heart disease. She had worked all night as a parking lot security guard and made it to her appointment on time in the morning.  During the conversation, she mentioned that she relied on vending machines and consumed high quantities of caffeinated drinks to stay awake at night. 

“However, she had many questions about circadian rhythms once this was introduced during the visit, and she wanted to know more about how the body responds to food timings,” Dr. Nathan said. “She came up with some ideas for small changes, and I immediately knew I was in the right place to practice lifestyle medicine.” 

Other patients live in food deserts and face limited meal choices. Some patients Dr. Nathan has consulted with were surprised to learn the calorie, salt and sugar content in many of the foods they regularly consumed. Many conversations and classes have revolved around ways of using available alternatives, like frozen or canned foods, to build flavor and add nutritional value.  

AbsoluteCare’s team-based approach has helped Dr. Nathan bring lifestyle medicine to many. Patients have gained valuable tips on nutrition, the powerful impact of sleep, mindfulness and self-care during group discussions, and have learned from each other’s successes, Dr. Nathan said.  

Starting early 

Starting early along a positive lifestyle medicine journey can make a difference and may change the course of brain health in aging, Dr. Isenberg said. While aging does present challenges, people can still live well as they advance over the years.  

“It’s a matter of reframing aging, with an understanding of how the mind and body work in tandem, and empowering our patients through lifestyle medicine to stay as healthy as they can throughout their lives,” Dr. Isenberg said.