Textbook of Lifestyle Medicine - Labros S. Sidossis

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us, continue to inspire us, and make us work hard, because they know that physical exertion is good for our health! This book would not have been possible without you.

      Dr Labros S. Sidossis, PhD, FTOS, FAHA, FNAK is a Distinguished Professor and Chairperson of the Department of Kinesiology and Health and Professor of Medicine at the Robert Wood Johnson Medical School at Rutgers University. He has a BS in Kinesiology, an MS in Exercise Physiology, an MA in Exercise Biochemistry and Nutrition, and a PhD in Nutrition – Metabolic Biochemistry from the University of Texas Medical Branch at Galveston.

      His research over the past 30 years has focused on the role of lifestyle factors in the pathophysiology, prevention, and treatment of various noncommunicable diseases, including obesity, insulin resistance, and dyslipidemias. His studies have been funded by the US National Institutes of Health, the American Diabetes Association, the Shriners Hospitals for Children, the European Union, and the industry. His 200+ publications in peer‐reviewed journals have been cited >15,000 times.

      Dr. Sidossis has been an inspiring teacher for undergraduate and graduate students in the fields of nutrition, physical activity, and health. He has developed and taught numerous undergraduate and graduate courses in these disciplines in the European and US universities, and has published four textbooks.

      Dr. Stefanos N. Kales, MD, MPH, FACP, FACOEM is Professor of Medicine, Harvard Medical School; Professor ' Director of the Occupational Medicine Residency, Harvard Chan School of Public Health; and Chief of Occupational Medicine /Employee Health, Cambridge Health Alliance, a Harvard-affiliated system. He has participated in medical and public health activities on five continents resulting in over 200 publications and wide recognition internationally. He is a faculty member in Harvard‛s Cardiovascular Epidemiology Program and its Division of Sleep Medicine.

      Dr. Kales has received numerous honors, including the Kehoe and Harriet Hardy Awards for outstanding scientific contributions. He has organized several groundbreaking Mediterranean Diet/Lifestyle Conferences (Harvard Chan 2014, Halkidiki-Greece 2017 and Harvard‛s Radcliffe Institute 2019). Dr. Kales leads by example, following a Mediterranean diet, practicing regular physical fitness and good sleep hygiene. Based on the scientific evidence, he is convinced that lifestyle measures are the most accessible and cost-effective of chronic disease prevention and control.

      We are thrilled to share this book with you. It is the product of more than 50 years of combined research, practice, and teaching on modifiable lifestyle factors affecting human health. We have been struggling in the lab, classroom, clinic, and workplace for years to understand the epidemiology and pathophysiology of some of today's most common diseases (e.g., obesity, type 2 diabetes mellitus, hypertension, and dyslipidemia) and to find nonpharmacological ways to prevent and mitigate these disorders. Our work has contributed a small fraction to the tremendous progress that has been accomplished during the past few decades by many excellent labs, research institutions, and centers around the world, led by brilliant colleagues, investigators, teachers, and clinicians.

      We have tried to evaluate, understand, organize, and translate all this knowledge into clinical practice and share it with you. You will be the judge if we have succeeded in this endeavor. Our main goal was not only to provide accurate and trusted knowledge to undergratuate and graduate students but also to make available the tools for current and future clinicians to translate this knowledge into best practices.

      Lifestyle factors and the way individuals conduct their lives have recently received great attention, since these factors are modifiable and, therefore, may be subject to considerable intervention and improvement. Many healthy lifestyle choices – such as sensible diets, adequate physical activity, avoiding tobacco use, moderate alcohol intake, good social life, and stress‐reduction – have been associated with lower risks of obesity, insulin resistance, hypertension, dyslipidemia, and other chronic diseases, which are considered the major public health concerns of our time. Therefore, scientific research on the lifestyle factors that may have negative (unhealthy lifestyle) or positive (healthy lifestyle) effects on health has intensified during the past 20 years.

      The findings are very encouraging; even small changes toward healthier lifestyle choices can translate into substantial health benefits. The clinical implications are so significant that the first professional organizations to promote lifestyle changes as a primary means to treat diseases were formed. In 2004, the American College of Lifestyle Medicine (ACLM) was formed to provide education and certification to health professionals who want to use lifestyle changes as the foundation of transformed and sustainable health‐care systems. Soon after, many similar organizations were formed around the world (e.g., Lifestyle Medicine Global Alliance, European Lifestyle Medicine Council, European Lifestyle Medicine Organization, British Society of Lifestyle Medicine, Australasian Society of Lifestyle Medicine). According to the ACLM, “Lifestyle Medicine is the use of a whole food, plant‐predominant dietary lifestyle, regular physical activity, restorative sleep, stress management, avoidance of risky substances, and positive social connection as a primary therapeutic modality for treatment and reversal of chronic disease.”

      We do not consider ourselves the ultimate authorities in all the scientific areas covered in this book. But this is exactly the main message of our book: metabolic health is a multifaceted entity requiring a multidisciplinary approach. No one can be an expert in all components of lifestyle: diet, physical activity, stress, sleep, substance use and abuse. However, it is crucial for all health‐care professionals who treat patients suffering from chronic diseases to understand the importance of lifestyle choices and help patients to best utilize those choices to their own benefit.

      The book is divided into four units to present these complex subjects in a clear and concise manner.

      Unit I: Lifestyle Choices and Human Health begins by providing the basic knowledge necessary to introduce students and scientists with diverse backgrounds to this relatively new area of research and practice and the related terminology: healthy lifestyle, wellness, and lifestyle medicine. Next it presents in detail the characteristics and principles of healthy and unhealthy lifestyle choices.

      Unit II: Healthy Diets presents the history of how our nutrition habits, the most studied of all lifestyle factors, evolved to what they are today, and discusses the methods scientists have used to evaluate the connections among food, health, and disease. Subsequently, we present several of the world's most important dietary models/patterns, followed by billions of people. Finally, we finish this unit with one of the best‐known and evidence‐based eating patterns, the Mediterranean dietary pattern. One‐day sample meal plans for all dietary models/patterns are presented in Appendix B.

      Unit III: From Mediterranean Diet to Mediterranean Lifestyle describes the major milestones in the development of our current understanding of building and maintaining health and well‐being. We can no longer consider diet as the sole determinant of health. We now recognize that other lifestyle factors (physical activity, sleep, stress management, social life, substance use and abuse) are equally important; furthermore, it is the synergistic effect of all these factors that leads to a healthy lifestyle, a life not only with less disease but a state of physical, mental, and social well‐being.

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