Aussie GP advocates a ‘lifestyle medicine’ approach to combating mental illness

With mental health issues now the most common reason for patient visits, [1] one Australian GP is advocating for a ‘lifestyle medicine’ approach to help people who are suffering from these conditions.

Dr Sam Manger, President of the Australasian Society of Lifestyle Medicine (ASLM) and a local GP at Ochre Medical Centre Maleny, Queensland, says his own experience as a GP mirrors the health systems findings in which patient presentation for mental health issues has reached an all-time high.

According to the latest Health of the Nation report, which was released by the Royal Australian College of General Practitioners this month, mental health is the most prominent concern facing Australian GPs for the second consecutive year, having surpassed respiratory problems. [2] Doctors are now treating psychological issues, such as depression, mood disorders and anxiety, more than any other condition, with 50 per cent of the 1500 frontline GPs surveyed expressing concern for the future. [3]

Dr Manger says: “There are rising numbers of people experiencing psychological ailments, with major depression disorder now being the leading cause of disability worldwide. [4] When these people don’t know where to turn, their first point of contact is usually a GP.”

“Psychological illness is very complex and we cannot underestimate how many people are suffering from them. They can stem from a myriad of causes, such as early life trauma, domestic violence, bullying, and relationship breakdowns, and can’t be treated lightly,” he said.

Dr Manger also runs a lifestyle metabolic clinic for mental health patients at the Sunshine Coast Hospital and Health Service, where he – along with an experienced psychiatric team – are conducting research into the physical and psychological outcomes in those undergoing a lifestyle medicine approach on top of their usual care. He says there is a great opportunity to create evidence-based treatment programs that include lifestyle medicine interventions, which simultaneously improve physical, psychological and social outcomes.

“People with mental illness may be hesitant to present to GPs for help for a variety of reasons, such as feelings of shame, guilt, hopelessness, and embarrassment, or because of a misunderstanding of mental health conditions and the risk factors,” he said.

“For people in these situations, it’s important that they familiarise themselves with lifestyle therapies that can improve their mental health, such as nutrition, exercise, sleep, stress management and healthy relationships. When a therapist and patient work together in a shared-management approach, the outcome can be life changing.”

Dr Manger’s lifestyle-based approach to mental illness is crucial for FOUR reasons:  

  1. Lifestyle therapies work: healthy diets can help 1 in 3 people with depression. In major depression disorders, 32 per cent of people with moderate to severe depression may get better on a healthy diet alone. [5] In addition, exercise can be just as effective as psychological or pharmacological treatments[6] which is particularly true for conditions such as depression and anxiety. According to Dr Manger, sleep disorders, social isolation and a lack of vocation are also very common in people with severe mental illness, and improving these areas can have profoundly positive effects.
  1. Nutrition, sleep and exercise benefit a patient’s physical health. The same lifestyle therapies – nutrition, exercise, healthy relationships, stress management and quality sleep – can result in reversal of coronary artery disease(CAD), reduction in cardiac arrests and stroke incidences, and significant reductions in glycated haemoglobin (HbA1c) in people with diabetes. [7] Furthermore, intensive lifestyle treatments can also prevent cancer occurrence and slow progression in patients with dementia. [8]
  1. Lifestyle therapies can help improve life expectancy. People with severe mental illness can have a reduction in life expectancy of around 15-20 years. [9] This is largely because of chronic physical disease, such as metabolic and cardiovascular disease, which lifestyle medicine is particularly effective at treating.
  1. Mental illness risk factors are similar to chronic disease risk factors. While the cause(s) for mental illnesses are multi-factorial and sometimes unknown, there are certain factors that can increase an individual’s risk of developing a mental health disorder, and these are not all too dissimilar from the modifiable risk factors that contribute to chronic diseases – lack of physical activity, poor eating habits, excessive tobacco or alcohol use, lack of social support, environmental factors, and socioeconomic factors, among others.

 

 

 

 

 

[1] The Royal Australian College of General Practitioners (RACGP), General Practice: Health of the Nation 2018, September 2018: https://www.racgp.org.au/download/Documents/Publications/Health-of-the-Nation-2018-Report.pdf.

[2] The Royal Australian College of General Practitioners (RACGP), General Practice: Health of the Nation 2018, September 2018, p. 2: https://www.racgp.org.au/download/Documents/Publications/Health-of-the-Nation-2018-Report.pdf.

[3] The Royal Australian College of General Practitioners (RACGP), General Practice: Health of the Nation 2018, September 2018, p. 4: https://www.racgp.org.au/download/Documents/Publications/Health-of-the-Nation-2018-Report.pdf.

[4] World Health Organisation (WHO), ‘Depression,’ 22 March 2018: http://www.who.int/news-room/fact-sheets/detail/depression.

[5] Cooney, G., et al., ‘Exercise for Depression,’ JAMA, (Sept 2013): https://www.ncbi.nlm.nih.gov/pubmed/24026850, and Jacka, F. N., et al., ‘A randomised controlled trial of dietary improvements for adults with major depression (the ‘SMILES’ trail), BMC Medicine 15: 27, (2017): https://www.ncbi.nlm.nih.gov/pubmed/24026850.

[6] Cooney G. M., et al., ‘Exercise for depression,’ published by Cochrane 12 September 2013: https://www.cochrane.org/CD004366/DEPRESSN_exercise-for-depression.

[7] Ornish, D., et al., ‘Intensive lifestyle changes for reversal of coronary heart disease,’ JAMA 21: 281, (1999): https://www.ncbi.nlm.nih.gov/pubmed/9863851.

[8] Ornish D., et al., ‘Intensive lifestyle changes may affect the progression of prostate cancer,’ NCBI 174: 3, (2005): https://www.ncbi.nlm.nih.gov/pubmed/16094059.

[9] The British Medical Journal (BMJ), ‘Life expectancy gap widens between those with mental illness and general population,’ Published 21 May 2013: https://www.bmj.com/press-releases/2013/05/21/life-expectancy-gap-widens-between-those-mental-illness-and-general-popula.

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