How each lifestyle medicine pillar supports good nutrition 

Prescribing food as medicine to treat chronic disease is gaining support from health leaders and policymakers, but focusing narrowly on nutrition without applying the other five lifestyle medicine pillars is short-sighted. To achieve optimal health, including the other five lifestyle medicine pillars is essential. 

The high value of food as medicine (FAM) is finally catching on. For 20 years, the American College of Lifestyle Medicine (ACLM) has emphasized the critical role of nutrition in treating chronic disease and led the way in educating clinicians on evidence-based FAM approaches. Now health leaders, policymakers, and payers are recognizing that, if we are to alter the trajectory of chronic disease in the U.S., our health care system must begin to address the poor state of nutrition. 

However, we should not pursue the practice of FAM in a vacuum. Optimal nutrition is just one of the six pillars of lifestyle medicine. To fully harness the power of FAM and achieve the best possible outcomes, it should be integrated with the other five pillars: physical activity, restorative sleep, stress management, positive social connections, and avoidance of risky substances.  

Lifestyle medicine clinicians are uniquely positioned to lead the integration of food as medicine into health care due to our holistic, whole-person approach to treating, reversing, and preventing noncommunicable chronic diseases. Everyone deserves the opportunity to live a healthy lifestyle. Lifestyle clinicians can apply the pillars to individuals in under-resourced communities while acknowledging individuals’ social determinants of health and helping them discover ways to make affordable and sustainable lifestyle behavior changes.  

I’ll briefly highlight examples of the connection between the pillars of lifestyle medicine and optimal nutrition. In a new textbook that I co-edited titled, “Essentials of Clinical Nutrition in Healthcare,” I co-authored a chapter that discusses these connections at length.  

A whole-food, plant-predominant eating pattern 

We know that our food has a powerful role in our health. Extensive scientific evidence supports the use of a whole-food, plant-predominant eating pattern as an essential strategy in the prevention of chronic disease and treatment of chronic conditions. In intensive, therapeutic doses, lifestyle medicine interventions can put chronic illnesses, like diabetes, heart disease, and high blood pressure into remission. ACLM promotes eating a variety of whole-food, minimally processed vegetables, fruits, whole grains, beans, legumes, nuts, and seeds. Eating in season is ideal, but not everyone has access to a farmer’s market. Frozen fruits and vegetables are a good option. Additionally, finding food pantries that provide healthy food options is critical for many. ACLM has resources for eating healthy on a budget that help make it accessible to all.  

Physical activity 

Physical activity significantly influences how we eat. As we build more muscle, our metabolic rate increases. An increased metabolic rate allows us to burn more calories, even while resting. Physical activity also stimulates the release of irisin, a myokine that affects appetite regulation in the brain. Even taking brisk walks can help reduce sugary snack cravings. Staying active can naturally support better nutrition choices and metabolic health. The guidelines are to accumulate 150 to 300 minutes of moderate-intensity physical activity each week, such as walking or following an exercise class online in the safety of your own home.   

Restorative sleep 

Like food, sleep affects our physical and mental energy levels. That’s why when we are low on one of these energy sources, we likely try to compensate with increased desire for the other. Sleep deprivation increases levels of ghrelin, the hormone that signals the brain to feel hungry, and reduces levels of leptin, the hormone that suppresses appetite. This imbalance leads to increased appetite and a tendency to crave foods high in sugar, fat, and salt. Guidelines call for seven to nine hours of sleep each night. Using an eye mask to block out street lights or a white noise machine to neutralize street sounds may be helpful.  

Stress management 

We have all heard of “stress eating” or “emotional eating.” Under stress, our cortisol levels rise, prompting many people to seek comfort in highly processed, calorie-dense foods. Chronic stress also keeps the body in a sympathetic “fight or flight” mode, which directs blood flow away from the digestive tract and toward large muscles. This mode impairs digestion and nutrient absorption. Learning to manage stress effectively and transition into a parasympathetic “rest and digest” state before meals is important for optimal digestion and nutrient utilization. In addition, healthy eating patterns are often disrupted in times of stress, and having routine stress resilience practices like meditation, yoga, listening to music or taking mindful walks can help people when tensions are high.  

While many stressors can affect how much and what we eat, food insecurity is of particular concern. When a household doesn’t have consistent access to enough food for everyone to live a healthy life, it is challenging to eat healthfully and, therefore, may impair sleep and physical activity. Checking in on a person’s social determinants of health is critical to make sure healthcare professionals are doing all they can to reduce stress and referring patients to the appropriate services for help.  

Positive social connections 

Social influences also play a significant role in eating patterns. Household dynamics determine who buys and prepares food, what foods are readily available, and whether the family supports or hinders healthy eating habits. When family members and social circles align with healthy nutritional goals, individuals find adhering to their dietary plans easier. Social support also helps to alleviate stress. A supportive community fosters accountability and long-term success. 

Avoidance of risky substances 

The use of risky substances, particularly alcohol, is linked to poor dietary patterns. In addition to containing alcohol, which is toxic to the body, alcoholic beverages are high in caloric content and often leads to the consumption of high-fat foods during, after, or while recovering from drinking. Studies show that consuming alcohol before a meal leads to increased calorie intake during the meal. Heavy drinking or binge drinking is also linked to poor adherence to healthy food consumption guidelines.  

These examples illustrate why physicians and other health professionals should not consider nutrition in isolation when working to help patients adopt and sustain healthy eating patterns. By addressing nutrition in connection with physical activity, sleep, stress management, positive social connections, and avoidance of risky substances, we can better create lasting, positive health outcomes. True health transformation occurs when we recognize each lifestyle medicine pillar’s interconnectedness and apply them holistically to patient care. Only then can we fully unlock the full potential of food as medicine and its ability to restore health.