When I started working in Malaysia at the Institute for Medical Research (IMR) in 1969 I was placed in the Division of Nutrition, which is one of my areas of specialization and expertise. After a few years, I was transferred to other divisions, namely, Rural Health Research, Community Medicine, Clinical Research, Behavioral Science and Behavioral Medicine, Epidemiology, Bio-statistics before being transferred back to the Division of Nutrition.
During those 25 years of working life as a medical researcher at IMR and also a year with the Massachusetts Institute of Technology (MIT) which was prior to joining IMR, I have seen trends in changing patterns of diseases in the country and elsewhere due to lifestyles changes and behavioral patterns, especially in nutrition and dietary lifestyles. I shall write a separate article on this.
In the 1969 we saw malnutrition and deficiency diseases due to under nutrition, and by the time I was transferred back into the Division of Nutrition 25 years later the disease scenario was at the opposite end of malnutrition - it was over nutrition causing a lot of chronic lifestyle diseases such as cardiovascular diseases (heart disease, stroke, hypertension), metabolic disorders: (type 2 diabetes, obesity, metabolic syndrome, high cholesterol), certain cancers: (lung cancer from smoking, colon cancer), chronic respiratory diseases: (COPD), and other chronic conditions (chronic liver disease/cirrhosis, chronic kidney disease, and certain allergic or hearing issues began to emerge rapidly due to rising affluence and lifestyle changes.
When we use the word ‘malnutrition’ technically and correctly this applies to both under-nutrition and over-nutrition.
Most people use the term malnutrition erroneously to mean prolonged under nourishment, or a lack of nutrients, but the World Health Organization (WHO) and Cleveland Clinic define it as a broader problem involving "deficiencies, excesses, or imbalances in a person's intake of energy and/or nutrients. That is technically the correct meaning because the term 'mal' in Latin mean 'bad' that applies to either end - under and over.
Looking back over the years of my working experiences in epidemiology and trends of non-communicable diseases due to dietary and other lifestyles changes that has overtaking infectious and communicable diseases, I thought I should write a simple and easy to understand research paper here for doctors and clinicians to understand when treating their patients with drugs, influenced by drug salespeople from pharmaceutical industries, but also for them to understand the true root causes of their disease - diseases that can never be cured by chemicals - under the hidden and gloried name as ‘medicine’ unless we are willing to change their lifestyles that are the true root causes of their chronic ailments.
There is nothing extraordinary or scientifically advanced about conventional allopathic medicine if we continue to rely on pharmaceuticals (chemicals) to alleviate or eliminate harmful lifestyles because drugs do not cure disease. This was the same sentiments expressed by many doctors including Dr Yukie Niwa, M.D., D.M.S. Head of the Institute of Immunology, Tokyo who wrote a book on that about free radicals.
A paradigm shift towards more rational approaches in disease management is crucial, including the adoption of traditional, complementary, and integrative medicine, as recommended by the World Health Organization (WHO). This is especially important considering that 80% of the global population has turned to traditional medicine after being disillusioned with drug-based treatments that have not delivered real cures.
Hospitals are overwhelmed with patients, not because of the rise of new diseases, but because the same individuals come back for follow-up visits, depending on the same medications with increasing dosages until reaching a point where toxicity becomes a worry. Subsequently, they are often transitioned to an alternative pharmaceutical or a combination of similar agents, ultimately leading to poly-pharmacy, a state wherein patients are burdened with an excessive number of medications due to comorbidity stemming from the original ailment, which was never addressed at its root cause but merely managed through pharmacological means.
Let me use this analogy to illustrate. Suppose we are sickened by some continuously loud noise from a loudspeaker. So in order to ‘cure’ this problem, we buy ear-plugs (drugs) to plug out the noise, when the loudspeaker was actually the root cause. Why not we permanently cure the problem by shutting out the loudspeaker, or removing it elsewhere.
But we did not remove the real cause of the disturbances (disease) but merely supressing it with drugs for a continuous profit for both the pharmaceutical companies and the doctor like the adage that says:
"A patient cured, is a customer lost"
Thus, we can see the alarming scenario of overcrowding in hospitals and clinics, exacerbated by the influx of new patients suffering from identical chronic conditions, contributes to a burgeoning crisis in healthcare accessibility, perpetuated by the reliance on pharmaceutical interventions.
Having introduced this personal experience, below is my technical paper on lifestyle medicine that schools of medicine are now introducing and teaching to medical students to be future doctors.
But before I write my paper below the dotted line, let's have a look at this cartoon:
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Emerging New Discipline of Medicine: Lifestyle Medicine
Abstract
Chronic diseases are the leading causes of mortality and disability worldwide, often driven by lifestyle factors such as poor diet, physical inactivity, smoking, stress, and inadequate sleep. Conventional allopathic medicine has largely focused on treating these diseases with drugs, often addressing symptoms rather than root causes.
Lifestyle medicine, a relatively new discipline, shifts the paradigm by promoting behavioral and environmental changes as both preventive and therapeutic strategies. This paper explores the history, evolution, definitions, principles, and acceptance of lifestyle medicine, and highlights its potential to complement and, in some contexts, replace drug-based interventions.
Summary
Lifestyle medicine (LM) has emerged as a powerful response to the global rise in chronic diseases driven by poor diet, inactivity, stress, smoking, and other lifestyle factors. Rooted in ancient medical wisdom from Hippocrates and further formalized in the late 20th century, LM emphasizes prevention, treatment, and sometimes reversal of disease through evidence-based lifestyle interventions. Its six foundational pillars, healthy eating, physical activity, sleep, stress management, social connections, and avoidance of harmful substances, form the core of its practice.
Unlike drug-centered medicine, LM addresses the underlying causes of disease, offering safer, more sustainable, and cost-effective solutions. Landmark studies such as the Diabetes Prevention Program and Dean Ornish’s cardiac research provide strong evidence of its effectiveness. While barriers to widespread adoption remain, including healthcare system inertia, cultural resistance, and limited physician training, LM continues to gain global recognition. By integrating modern science with timeless principles of moderation and balance, LM represents a transformative path toward reducing chronic disease burden and redefining the future of medicine.
Introduction
Chronic diseases including cardiovascular disease, type 2 diabetes, obesity, and cancer, are strongly linked to lifestyle habits. Current pharmacological treatments manage symptoms but rarely reverse the underlying pathology. Lifestyle medicine (LM) has emerged as a patient-centered, evidence-based approach that addresses root causes through behavioral modifications in diet, exercise, sleep, stress, and psychosocial well-being. Its foundations lie in ancient wisdom, later formalized in modern clinical practice. LM offers an integrated approach, aiming to reduce reliance on pharmaceuticals while empowering individuals to regain health through sustainable lifestyle changes.
Historical Foundations
The roots of lifestyle medicine can be traced back to Hippocrates (c. 460–370 BCE), who emphasized balance, moderation, and the role of diet and exercise in health. His maxim, “Let food be thy medicine” anticipated the modern principle of lifestyle as therapy. Ancient Chinese and Greek philosophies also advocated moderation in food, drink, and behavior, highlighting the timeless role of lifestyle in health maintenance.
Emergence of Lifestyle Medicine as a Discipline
The term “lifestyle medicine” was first introduced at a symposium in 1989 and appeared in publication in 1990. Rippe (1999) provided the first formal textbook, Lifestyle Medicine, describing LM as “the integration of lifestyle practices into the modern practice of medicine both to lower the risk factors for chronic disease and/or, if disease is already present, serve as an adjunct in its therapy.” This publication is considered the landmark in establishing LM as a recognized discipline.
A subsequent textbook (2007) expanded the definition, highlighting the role of environmental, behavioral, motivational, and medical principles in treating lifestyle-related diseases (LRDs). Its second edition (2011) further emphasized patient self-care and self-management, recognizing that sustainable behavioral change is central to long-term disease control.
Definitions and Institutional Endorsements
The American College of Lifestyle Medicine (ACLM) defines LM as “the use of lifestyle interventions in the treatment and management of disease,” citing nutrition, physical activity, stress management, smoking cessation, and other non-drug modalities. Similarly, the European College of Preventive and Lifestyle Medicine (ECLM) defines LM as “the research and clinical prevention and treatment of dysfunctions caused by a non-physiological lifestyle accumulating allostatic load.” Both emphasize LM as evidence-based, patient-centered, and preventive in nature.
Key Principles of Lifestyle Medicine
LM is built around six core pillars:
1. Healthy Eating – whole-food, plant-predominant diets shown to reduce chronic disease risk.
3. Sleep Hygiene – ensuring adequate and restorative sleep.
4. Stress Management – mindfulness, resilience training, and relaxation techniques.
5. Healthy Relationships – strong social support networks linked to improved longevity.
6. Avoidance of Risky Substances – reducing or eliminating tobacco, alcohol, and recreational drug use.
These pillars collectively address the root determinants of health and disease.
Evolution and Integration with Modern Medicine
While initially regarded as complementary, LM has gained increasing recognition as an essential branch of evidence-based medicine. Randomized controlled trials (RCTs) demonstrate that lifestyle interventions can prevent, treat, and even reverse chronic diseases. For example, the Diabetes Prevention Program (DPP) showed that lifestyle interventions were nearly twice as effective as metformin in preventing progression from prediabetes to diabetes. Similarly, Dr. Dean Ornish’s studies demonstrated regression of coronary artery disease through plant-based diets, exercise, and stress management.
In addition, LM principles are now being incorporated into medical curricula, with the ACLM and other organizations advocating formal physician training. Health systems are also recognizing LM as a cost-effective means of reducing healthcare expenditure by addressing the root causes of disease.
Advantages Over Drug-Based Medicine
1. Addresses Root Causes – Unlike pharmaceuticals, which often treat symptoms, LM targets lifestyle-related origins of disease.
2. Reduced Side Effects – Lifestyle interventions carry minimal risk compared to long-term pharmacological use.
3. Cost-Effectiveness – Prevention and reversal of disease through LM reduces healthcare costs.
4. Sustainability – Promotes long-term health and reduces polypharmacy.
Challenges and Barriers to Adoption
Despite its benefits, LM faces barriers:
1. Cultural resistance – Both physicians and patients are accustomed to pharmacological solutions.
4. Time and resource limitations – LM requires intensive patient engagement and support.
5. Lack of widespread training – Most physicians receive little to no formal education in nutrition or behavioral medicine.
The growing burden of chronic disease necessitates a paradigm shift in healthcare. LM is well positioned to meet this need, particularly as precision medicine, digital health tools, and artificial intelligence enable personalized and scalable interventions. Integration of LM into public health policies, insurance reimbursement models, and community health initiatives will further accelerate adoption.
Conclusion
Lifestyle medicine is not merely an adjunct to conventional allopathic medicine, but a transformative approach that realigns clinical care with the root causes of disease. Its historical foundation, scientific validation, and growing institutional acceptance highlight its potential to reshape modern medicine. By prioritizing sustainable behavior change over symptom management, LM offers a pathway to reduced chronic disease burden, enhanced quality of life, and decreased reliance on pharmaceuticals.
References
1. Hippocrates. Aphorisms. (c. 460–370 BCE).
2. Egger G, Binns A, Rossner S. Lifestyle Medicine: Managing Disease of Lifestyle in the 21st Century. McGraw-Hill; 2007.3. Egger G, Binns A, Rossner S. Lifestyle Medicine (2nd ed.). McGraw-Hill; 2011.
4. Rippe JM. Lifestyle Medicine. Blackwell Science; 1999.
5. American College of Lifestyle Medicine. https://www.lifestylemedicine.org
6. European College of Preventive and Lifestyle Medicine. https://www.eclm.org
7. Knowler WC, et al. “Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin.” N Engl J Med. 2002;346(6):393–403.
8. Ornish D, et al. “Intensive lifestyle changes for reversal of coronary heart disease.” JAMA. 1998;280(23):2001–2007.
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