My One Quarter Research Journey in Nutrition and Lifestyle Related Diseases

Nutrition, Public Health, and the Evolution of Lifestyle-Related Diseases: Reflections from My One Quarter Century  Research Journey

Abstract

This article reflects on over two decades of my professional experience in nutrition and public health research at the Institute for Medical Research (IMR), Malaysia, complemented by international exposure at the Massachusetts Institute of Technology (MIT). It highlights the observed epidemiological transition from infectious to non-communicable diseases (NCDs), emphasizing the influence of lifestyle and dietary patterns. Drawing on multidisciplinary collaboration, it underscores the importance of culturally sensitive interventions, community engagement, and evidence-based nutrition in addressing contemporary health challenges. Emerging frontiers such as personalized nutrition, digital health, and sustainability are discussed as vital components of the future of global nutrition science.

Introduction

When I began my professional journey at the Institute for Medical Research (IMR), Malaysia, in 1969, I was assigned to the Division of Nutrition, aligning with my training and expertise. Over the next 25 years, including research rotations in Rural Health Research, Community Medicine, Clinical Research, Behavioral Science and Behavioural Medicine, Epidemiology, and Biostatistics, I observed profound changes in disease trends. These observations were further enriched by a formative year at the Massachusetts Institute of Technology (MIT) prior to joining IMR. Collectively, these experiences provided a unique vantage point to examine how lifestyle modifications and nutritional habits influence public health.

Nutrition and the Epidemiological Transition

As Malaysia, and indeed much of the world, underwent rapid urbanization and globalization, dietary practices shifted markedly. Traditional diets rich in grains, legumes, and fresh produce gradually gave way to calorie-dense, processed foods high in fat, sugar, and salt. These dietary transformations, compounded by increasingly sedentary lifestyles, contributed to the rise of NCDs such as obesity, type 2 diabetes, cardiovascular disease, and certain cancers (Popkin, 2017; WHO, 2020).

This epidemiological transition, moving from infectious to chronic diseases, mirrors global patterns observed in other low- and middle-income countries (Omran, 2005). It highlights the inseparable link between nutrition, behavior, and disease prevalence.

Evidence-Based Nutrition and Multidisciplinary Research

Through research at IMR, I sought to advance evidence-based nutrition interventions aimed at mitigating the health risks associated with poor dietary practices. Collaborative efforts spanning behavioral science, epidemiology, and clinical research were integral to designing interventions that addressed the multifaceted nature of nutritional challenges.

Importantly, culturally sensitive approaches were necessary to ensure effectiveness and sustainability. Dietary habits are deeply rooted in tradition, identity, and community; thus, recognizing these sociocultural dimensions was crucial in promoting healthier practices (Kumar & Prelip, 2019).

Nutrition in the Modern Context: Technology and Misinformation

The advent of digital technology and social media has revolutionized how people access information about health and nutrition. While these platforms provide opportunities for education and outreach, they also amplify the spread of misinformation, leading to harmful dietary behaviors (Pomeranz et al., 2022).

Harnessing technology, through mobile applications, online platforms, and wearable health devices, presents a dual challenge and opportunity. Used wisely, these tools can promote nutrition literacy, encourage self-monitoring, and foster supportive communities for sustainable health choices.

Addressing Social and Environmental Determinants

Nutrition cannot be understood in isolation from its broader determinants. Economic, social, and environmental factors shape food access, affordability, and choice (Swinburn et al., 2019). Policies that support healthier food environments, equitable access to nutritious food, and sustainable agriculture are fundamental components of a comprehensive public health strategy.

Moreover, nutrition intersects with planetary health. Climate change, food insecurity, and agricultural sustainability are increasingly recognized as central to the discourse on public health nutrition (Willett et al., 2019). Encouraging sustainable dietary practices, such as reducing food waste and supporting local food systems, benefits both human health and environmental resilience.

Emerging Frontiers in Nutrition Science

Recent advances have opened new frontiers in nutrition science. Personalized nutrition, guided by genetic, metabolic, and microbiome profiles, holds promise for tailoring interventions to individual needs (Zeevi et al., 2015). Similarly, expanding research on the gut microbiome underscores its central role in digestion, immunity, and metabolic health, providing new avenues for preventive and therapeutic interventions.

Integrating these innovations into public health practice requires careful translation of findings into accessible and culturally appropriate strategies.

Community Engagement and Equity

Grassroots engagement remains vital for effecting meaningful change. Community-based initiatives, such as nutrition workshops, cooking demonstrations, and school-based programs, empower individuals to make informed choices and cultivate a shared sense of responsibility for health outcomes. Importantly, these initiatives must address socioeconomic disparities that limit access to healthy foods, ensuring equity across populations (Beauchamp et al., 2019).

Conclusion:

Reflecting on my professional journey, I am reassured by the progress made in understanding the central role of nutrition in public health. Yet, the challenges of misinformation, inequities, and environmental sustainability call for renewed dedication to evidence-based research, education, and advocacy.

The path forward lies in interdisciplinary collaboration, culturally sensitive strategies, and the judicious use of technology. By fostering community engagement and global cooperation, we can mitigate the burden of diet-related diseases and build a healthier, more sustainable future.

Ultimately, the promise of nutrition science lies not only in improving individual well-being but also in advancing equity, resilience, and planetary health.

References

1. Beauchamp, A., Backholer, K., Magliano, D., & Peeters, A. (2019). The effect of obesity prevention interventions according to socioeconomic position: a systematic review. Obesity Reviews, 20(10), 1382–1399.

2. Kumar, S., & Prelip, M. (2019). Promoting healthy diets and nutrition: An evidence-based policy approach. Annual Review of Public Health, 40, 187–206.

3. Omran, A. R. (2005). The epidemiologic transition: A theory of the epidemiology of population change. The Milbank Quarterly, 83(4), 731–757.

4. Popkin, B. M. (2017). Relationship between shifts in food system dynamics and acceleration of the global nutrition transition. Nutrition Reviews, 75(2), 73–82.

5. Pomeranz, J. L., Mozaffarian, D., Micha, R., & Wilde, P. (2022). The role of digital media in nutrition. Annual Review of Nutrition, 42, 55–75.

6. Swinburn, B. A., et al. (2019). The global syndemic of obesity, undernutrition, and climate change. The Lancet, 393(10173), 791–846.

7. WHO. (2020). Noncommunicable diseases. World Health Organization. https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases

8. Willett, W., Rockström, J., Loken, B., et al. (2019). Food in the Anthropocene: the EAT–Lancet Commission on healthy diets from sustainable food systems. The Lancet, 393(10170), 447–492.

9. Zeevi, D., Korem, T., Zmora, N., et al. (2015). Personalized nutrition by prediction of glycemic responses. Cell, 163(5), 1079–1094.

Integrative Medical Education in China: Bridging Traditional Chinese Medicine and Modern Biomedicine (Part 2)

 

Integrative Medical Education in China: Bridging Traditional Chinese Medicine and Modern Biomedicine

Abstract

Reflections on Patient Dissatisfaction and the Role of the Pharmaceutical Industry

While the integrative model of medical education in China offers a hopeful vision for the future of healthcare, it also brings to light an important debate surrounding patient dissatisfaction with conventional biomedical treatments and the influence of the pharmaceutical industry. Here, I would like to share my own perspective, which is grounded in both medical observation and patient experiences.

Lifelong Dependence on Drugs: A Source of Patient Frustration

Many patients, especially those suffering from chronic and lifestyle-related diseases such as hypertension, diabetes, asthma, coronary artery disease, and cancer, often express frustration with being prescribed lifelong medication regimens. These drugs, largely developed from petrochemical sources, are typically aimed at controlling symptoms rather than curing disease. While they play an indispensable role in acute and emergency care, such as antibiotics for infections or anticoagulants in life-threatening conditions, patients often feel dissatisfied when their daily lives become defined by a lifelong reliance on pills that only manage, but rarely eliminate, the underlying condition.

This dissatisfaction has been amplified in recent decades by rising patient awareness. Educated and well-informed individuals increasingly question why modern medicine, with all its advances, cannot offer definitive cures for common chronic diseases. Their disappointment often leads them to explore complementary and alternative therapies, including Traditional Chinese Medicine (TCM), Ayurveda, naturopathy, and other holistic approaches that promise more than symptomatic relief.

Big Pharma and the Economics of Medicine

The persistence of symptom-management rather than curative medicine cannot be understood without examining the structure of the pharmaceutical industry, often referred to as "Big Pharma." The industry’s reliance on patents and its profit-driven business model has shaped the landscape of modern therapeutics.

Drug development is enormously expensive, requiring billions of dollars and over a decade of research, trials, and regulatory approval. Once a new drug is patented, companies naturally seek to maximize profits during the patent’s lifespan. This often leads to pricing strategies that prioritize financial returns over accessibility, as seen in the case of insulin analogs, statins, and cancer therapeutics.

Moreover, there is an incentive to produce treatments that require continuous consumption rather than one-time cures. Chronic diseases, by their very nature, guarantee recurring revenue streams for pharmaceutical companies. Patients taking lifelong medications ensure stable profits, while definitive cures could reduce long-term demand.

A Brief History of Profit-Driven Drug Manufacturing

Historically, medicine was rooted in nature: willow bark for fever, cinchona bark for malaria, and countless other remedies derived from plants, minerals, and animal products. The 19th century ushered in a new era with the isolation of morphine in 1804 and the synthesis of aspirin in 1897, shifting medicine from natural remedies to laboratory-based chemistry. The mid-20th century marked the true birth of Big Pharma, with penicillin mass-produced during World War II and blockbuster drugs like benzodiazepines and corticosteroids dominating markets.

The thalidomide tragedy of the 1950s–60s highlighted the dangers of unchecked pharmaceutical ambition, as thousands of infants were born with birth defects due to inadequate testing. By the late 20th century, the patent-driven era fully matured, leading to enormous profits but also growing skepticism about the industry’s motives.

COVID-19 and the Question of Public Good

The COVID-19 pandemic further revealed the tension between public health needs and corporate profit. While vaccines were developed with unprecedented speed, intellectual property rights and patent protections restricted global access, especially in lower-income countries. This reinforced public perceptions that profit, rather than human well-being, remains the industry’s primary motive.

The Future: Integrative and Patient-Centered Medicine

Despite these challenges, I believe the future of medicine lies in integration, personalization, and prevention. Integrative medicine, combining the scientific rigor of biomedicine with the holistic, preventive, and patient-centered approaches of TCM and other traditional systems, can offer patients a sense of empowerment, choice, and hope beyond lifelong dependence on pharmaceuticals.

Pharmaceuticals will always remain vital for acute care and emergency interventions. However, in the realm of chronic disease, where prevention and lifestyle modification play central roles, a more balanced and humane approach is essential. The pharmaceutical industry must evolve from a profit-maximizing enterprise into a public health partner, aligning its goals with long-term patient outcomes rather than short-term financial returns.

If patients continue to feel disillusioned with allopathic medicine’s inability to cure lifestyle diseases, they will increasingly turn toward traditional systems of healing. The sooner mainstream medicine acknowledges this shift and embraces integrative, evidence-based approaches, the better the outcomes for patients, physicians, and society at large.

Integrative education in China exemplifies a model where the strengths of both TCM and modern biomedicine can be harmonized. Yet, as patient dissatisfaction and skepticism toward the pharmaceutical industry continue to grow, it is clear that integration alone is not enough. Medicine must also address the structural economic and ethical issues that shape healthcare delivery. Only then can integrative medicine truly fulfill its promise of being not only holistic and science-based but also compassionate, equitable, and patient-centered.

Integrative Medical Education in China: Bridging Conventional and Traditional Systems (Part 1)

 In 1980's till I retired from medical research in 1994. I was given the rare chance to be selected as one of the members of a powerful policy-making committee called 

"Joint WHO-Ministry of Health-Institute for Medical Research (WHO-MOH-IMR) Expert Technical Committee"  

There were some 25 members in the committee, most of them were directors from the different divisions of the Ministry of Health, some six of them from WHO, and only my boss and myself were from the IMR 

 

The government in that committee, on the advice and recommendation of WHO wanted to integrate traditional and complementary systems of medicine into the main health-care system of this country.  

 

During the meeting WHO officials who sat in that committee told us that in China all medical students, irrespective on conventional allopathic drug-based medicine, or on  Traditional Chinee Medicine must learn at least 30 % of each other's system of medicine, and in the  examinations at least 30 % of the examination papers contain questions from each system of medicine. On graduation, both doctors in conventional medicine and in TCM, work together side -by-side  in the same hospital referring cases to each other using the best therapeutic approach or integrated approaches for different cases. 

 

Today, having learnt much from such a powerful committee, I decided to write a paper on such a beautiful integrated system of medicine in China here: 

      

Abstract

 

China has pioneered a distinctive model of medical education by integrating Western biomedicine and Traditional Chinese Medicine (TCM) into undergraduate training. All medical students, regardless of their primary program, are required to study both systems, with standardized curricula and examinations reflecting this dual approach. This paper reviews the rationale, structure, and outcomes of integrative medical education in China, situating it in its historical context and addressing global challenges in healthcare shaped by the pharmaceutical industry. It argues that integrative education fosters holistic, patient-centered care and has potential relevance for international health systems.

Introduction

Medical education worldwide is often polarized between Western biomedicine, which emphasizes scientific rigor and technological innovation, and traditional medical systems, which prioritize holistic and culturally embedded practices. China represents a unique exception. Since the 1980s, the Ministry of Education has mandated that all medical students, whether pursuing a Western MBBS or a TCM degree, receive training in both traditions, with at least 30% of coursework and examinations devoted to the “opposite” system (Zhao et al., 2019). This model reflects both the historical role of TCM in Chinese society and the government’s vision of healthcare as an integrative enterprise.

TCM Training for Western Medical Students

Standardized Curriculum

Western medical schools in China incorporate mandatory TCM modules into undergraduate programs. These courses cover TCM theory, diagnostics, and practical techniques such as acupuncture, moxibustion, and herbal pharmacology (Liu et al., 2015). The national curriculum ensures uniformity, with students expected to acquire not only theoretical knowledge but also clinical competence (Wang & Xu, 2021).

Holistic Perspectives

Studying TCM allows medical students to appreciate systems-based approaches to health, emphasizing prevention, balance, and individualized care. These perspectives contrast with biomedicine’s reductionist disease model and provide a complementary framework for patient management (Cheung, 2011).

Global Relevance

Even international students enrolled in English-medium MBBS programs in China are required to study TCM, underscoring its strategic role in promoting integrative medicine globally (Wu et al., 2019).

Western Medical Training for TCM Students

Biomedical Foundations

TCM universities likewise include Western medical sciences like anatomy, physiology, pathology, and pharmacology, within their curricula (Zhang et al., 2010). This ensures graduates are competent to work in modern clinical settings.

Integrated Clinical Practice

Affiliated hospitals provide dual-system rotations, where Western and traditional modalities are used side by side. Examples include combining acupuncture with anesthetics in surgical contexts or integrating herbal medicine with chemotherapy in oncology (Chen et al., 2020).

Institutional Models

Beijing University of Chinese Medicine and Shanghai University of Traditional Chinese Medicine exemplify this model, producing graduates who can navigate both paradigms effectively.

Rationale for Integration

Cultural and Historical Legacy

1. With over 2,500 years of history, TCM remains deeply woven into Chinese culture and public trust in healthcare (Lo & Chen, 2013).

2. Complementary Roles in Healthcare
In contemporary hospitals, TCM and Western medicine are often used together. During the COVID-19 pandemic, integrative protocols reflected this approach at scale (Zhao et al., 2021).

3. Global Recognition. The World Health Organization reports that over 80% of the world’s population uses some form of traditional medicine, affirming its global relevance (WHO, 2019).

 

Challenges

Evidence-Based Evaluation

The greatest challenge for integrative medicine is the need to evaluate TCM practices with rigorous scientific methodologies without disregarding their cultural value (Fønnebø et al., 2007).

Pharmaceutical Industry Influence

Globally, the pharmaceutical industry often resists integrative approaches, prioritizing patented synthetic drugs. This reflects a historical shift from natural remedies to profit-driven pharmaceuticals, beginning in the 19th century with the synthesis of morphine and aspirin, and expanding during the 20th century with antibiotics, statins, and other blockbusters (Greene & Podolsky, 2012; Light & Lexchin, 2012).

Patient Expectations

Patients with chronic diseases often express dissatisfaction with conventional treatments that focus on symptom control rather than cure. This has contributed to rising demand for integrative and holistic care (Hsu, 2020).

Historical Context: From Natural Remedies to Modern Pharmaceuticals

For most of human history, medicine relied on natural sources, plants, minerals, and animal products. With the industrial revolution, drug development shifted toward laboratory-based synthesis:

19th century: Isolation of morphine (1804) and synthesis of aspirin (1897).

20th century: Industrial production of antibiotics and expansion of patented synthetic drugs.

Contemporary era: Patent-driven pharmaceuticals dominate, with chronic disease therapies marketed for long-term use. While these advances have saved countless lives, they have also reinforced a profit-driven model often at odds with holistic care (Light & Lexchin, 2012).

Future Perspectives

China’s integrative medical education offers insights for global healthcare reform. The future may involve:

1. Science-based validation of both traditional and biomedical therapies.

2. Personalized medicine, accounting for genetics, lifestyle, and environment.

3. Preventive strategies, reducing reliance on pharmaceuticals in chronic disease.

4. Complementary roles, reserving pharmaceuticals for acute and emergency care, while employing TCM and other holistic methods for prevention and rehabilitation.

Just to emphasize once again in summary 

The integration of conventional medicine and traditional healing systems remains a global challenge, often characterized by tension between evidence-based biomedicine and longstanding cultural practices. In China, however, medical education has institutionalized this integration. Since the 1980s, all medical students, whether enrolled in Western-style or TCM universities, must study at least 30% of each other’s systems during training, and examinations also assess both domains. This dual exposure aims to cultivate a more comprehensive understanding of health and disease, preparing practitioners for China’s pluralistic healthcare environment (Zhao et al., 2019).

Structure of TCM Education for Western Medical Students

Mandatory Integration

China’s Ministry of Education mandates that all undergraduate medical programs, including MBBS degrees, incorporate courses in TCM (Liu et al., 2015).

Standardized Curriculum

The curriculum is standardized nationally and includes theoretical instruction and practical training. Students learn the fundamentals of acupuncture, moxibustion, herbal pharmacology, and the classical texts of TCM (Wang & Xu, 2021).

Holistic Healthcare Understanding

By studying TCM, students are exposed to a systems-based, preventive philosophy of health. This complements the disease-focused model of Western biomedicine, encouraging practitioners to adopt a patient-centered and holistic perspective (Cheung, 2011).

International Programs

Even MBBS programs taught in English to international students include TCM components, reflecting the global importance of integrative healthcare (Wu et al., 2019).

Structure of Western Medical Education for TCM Students

Dual System Approach

Students in TCM universities are also required to study Western medical sciences, including anatomy, physiology, pathology, and pharmacology, so that they can function effectively in modern hospitals (Zhang et al., 2010).

Integrated Clinical Practice

Clinical rotations in Chinese hospitals expose students to integrated wards where TCM and Western interventions are used in parallel. For example, acupuncture may be combined with anesthetics during surgery, or herbal formulas with chemotherapy for cancer care (Chen et al., 2020).

Examples in Practice

Institutions such as Beijing University of Chinese Medicine and Shanghai University of Traditional Chinese Medicine exemplify this dual-system approach, producing graduates trained to operate at the intersection of both traditions.

Why Integration is Central in China

1. Historical and Cultural Legacy

2. TCM has been practiced for over 2,500 years and remains deeply embedded in Chinese culture and identity (Lo & Chen, 2013).

3. Complementary Role in Healthcare

4. Many Chinese patients receive care that combines TCM and Western medicine. During the COVID-19 pandemic, integrated protocols that used herbal medicines alongside antivirals and supportive care were widely implemented (Zhao et al., 2021).

5. Global Interest.

The World Health Organization recognizes the role of traditional medicine in primary healthcare, noting that over 80% of the world’s population uses some form of it, even in developed nations where patients often turn to alternative therapies after conventional treatments fail to provide cures (WHO, 2019).

Challenges and Critiques

Pharmaceutical Industry Influence

The global pharmaceutical industry, dominated by profit-driven models, often resists integrative medicine. The patent-driven approach prioritizes synthetic drugs with commercial potential, sidelining natural remedies despite centuries of efficacy. The historical trajectory of pharmaceuticals, from natural remedies to synthetic monopolies, reflects this shift (Greene & Podolsky, 2012).

Patient Dissatisfaction

Chronic disease management in biomedicine often emphasizes lifelong pharmacological control rather than cure, leading many patients to seek alternative or complementary approaches (Hsu, 2020).

Evidence and Standards

A key challenge is applying rigorous, science-based methods to evaluate TCM therapies without dismissing their cultural and experiential value. Integrative medicine should be personalized, preventive, and evidence-based, using pharmaceuticals where necessary but not exclusively (Fønnebø et al., 2007).

Historical Context: From Natural Medicines to Big Pharma

Early Natural Medicines

Pre-19th century medicine relied on plant-based remedies such as willow bark (precursor of aspirin) and cinchona bark (quinine).
Rise of Synthetic Drugs

The isolation of morphine in 1804 and the synthesis of aspirin in 1897 by Bayer marked the transition to laboratory-produced pharmaceuticals.
Industrial Expansion

Penicillin’s mass production during WWII showed the profit potential of pharmaceuticals. By the mid-20th century, patented synthetic drugs such as statins and benzodiazepines dominated healthcare markets.

Profit-Driven Era

Today, pharmaceutical companies often prioritize high-profit chronic disease drugs, employing lobbying and patent strategies like evergreening to sustain revenues (Light & Lexchin, 2012).

The Ideal Future: A Balanced Approach

Integrative medicine offers a pathway to more comprehensive and sustainable healthcare. This vision emphasizes:

1. Science-based validation of both traditional and biomedical interventions.

2. Personalized medicine, incorporating genetics, lifestyle, and environment.

3. Preventive strategies, reducing reliance on pharmaceuticals for chronic diseases.

4. Complementarity, using pharmaceuticals for acute/emergency care while leveraging TCM for prevention, rehabilitation, and chronic disease management.

China’s model of integrative medical education represents a bold attempt to reconcile the strengths of two medical paradigms. While challenges remain, particularly the influence of profit-driven pharmaceutical industries, integrative medicine provides an opportunity to reshape healthcare into a more holistic, patient-centered system. As patients worldwide increasingly demand alternatives to lifelong pharmacological management, integrative models rooted in science, culture, and prevention may become the future of global medicine.

In  China TCM is so well recognized by all parties that  Chinese basic medical insurance covers Traditional Chinese Medicine (TCM) services, with many TCM hospitals and treatments included in national and provincial insurance schemes in China. Both TCM and Western medicine are covered, and policies are designed to support the integrated use of both approaches for a wider range of health conditions. 

In Malaysia too when the government has officially and legally recognized TCM, medical insurance coverage also applies to TCM  as “adds on” for all registered and licensed TCM practitioners

 

By embedding integration within medical education, China has institutionalized a model that values both modern scientific advances and traditional wisdom. While challenges remain, particularly around evidence evaluation and the influence of global pharmaceutical industries, China’s dual training system prepares practitioners to provide patient-centered, culturally responsive, and scientifically grounded care. As healthcare worldwide confronts the growing burden of chronic disease, integrative education offers a pathway toward more balanced, holistic, and sustainable models of care.

 

References

1. Chen, K., Xu, H., & Xu, H. (2020). The integration of traditional Chinese medicine and Western medicine in China. European Review, 28(S1), S55–S70.

2. Cheung, F. (2011). TCM: Made in China. Nature, 480(7378), S82–S83.

3. Fønnebø, V., Grimsgaard, S., Walach, H., Ritenbaugh, C., Norheim, A. J., MacPherson, H.,  & Berman, B. (2007). Researching complementary and alternative treatments, the gatekeepers are not at home. BMC Medical Research Methodology, 7, 7.

4. Greene, J. A., & Podolsky, S. H. (2012). Keeping modern in medicine: Pharmaceutical innovation and the longevity of a medical tradition. Bulletin of the History of Medicine, 86(1), 93–122.

4. Hsu, E. (2020). Patients’ use of Chinese medicine in relation to conventional healthcare in East Asia. Medical Anthropology, 39(4), 311–326.

5. Light, D. W., & Lexchin, J. (2012). Pharmaceutical research and development: what do we get for all that money? BMJ, 345, e4348.

6. Liu, J., Wang, S., & Zhang, W. (2015). Medical education in China: Progress and challenges. Medical Teacher, 37(1), 61–67.

7. Lo, V., & Chen, H. (2013). Ancient and modern TCM: Continuity and change. Lancet, 381(9880), 173–174.

8. Wang, J., & Xu, H. (2021). Integration of traditional Chinese medicine and Western medicine in medical education. Journal of Integrative Medicine, 19(1), 1–7.

9. World Health Organization. (2019). WHO global report on traditional and complementary medicine. Geneva: WHO.

10. Wu, Y., Chen, J., & Xu, H. (2019). The role of TCM in international medical education: MBBS programs in China. Education for Health, 32(3), 131–136.

11. Zhang, Q., Yue, J., & Xu, H. (2010). Training in integrative medicine in China: A review. Chinese Journal of Integrative Medicine, 16(3), 210–218.

12. Zhao, J., Gao, Y., & Xu, H. (2019). The development of integrative medicine education in China. Journal of Alternative and Complementary Medicine, 25(7), 691–696.

13. Zhao, Z., Li, Y., & Zhou, L. (2021). TCM in the treatment of COVID-19 in China. Frontiers in Pharmacology, 12, 615857.

Emerging New Discipline of Medicine: Lifestyle Medicine

 

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.

However, that does not mean conventional medicine and drugs are useless. I have written many articles  about  life saving drugs and their properties, especially in a medical emergency primarily because  of their powerful and fast acting pharmacology. 

Here are  some of them: 

1. All On Drugs. How Do They Work? Are They Safe?

https://scientificlogic.blogspot.com/search?q=emergency+drugs

2. Life-saving drugs in Medical Emergency 

https://scientificlogic.blogspot.com/2023/03/life-saving-drugs-in-medical-emergency.html

3. Emergency :Protocol for the Management of the  Unconscious or Critically Ill Patient   

https://scientificlogic.blogspot.com/search?q=critically+ill+patients

Conventional allopathic medicine also has its usefulness in surgery that cannot be replaced by other non-invasive systems of medicine,  and perhaps in controlling infectious and communicable diseases, although through evolution for better survival of the fittest, many of these infective agents have developed drug-resistant strains.  

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:

https://x.com/BRConnorDPT/status/115446068474417971

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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.

2. Physical Activity – regular aerobic, resistance, and flexibility training.

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.

2. Healthcare system incentives – Current models favor treatment over prevention.

3. Lobbying by pharmaceutical companies and even by doctors against LM due to loss of their revenues 

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.

Future Directions

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.