Clinical Update: Lifestyle Medicine S Arulrhaj, Vivek Chandra
Page numbers followed by b refer to box, f refer to figure and t refer to table.
Acidosis, metabolic 23
Adipocytes 31
Aerobic exercise 6, 7, 9
types of 7
Alcohol drinking 10
Alcoholism 49
Alzheimer's disease 2, 18, 56
American College of Sports Medicine 42
American Diabetes Association 29
American Heart Association 4, 25
American Institute for Cancer Research 31
American Pain Society 54
American Stroke Association 33
Anaerobic exercise 6, 7
Angina pectoris 10
Anorexia nervosa 2
Anxiety 50, 56
Arrhythmia 6
Arthritis 18
Asana 45
Asthma 18, 19
Atherosclerosis 18
Atherosclerotic cardiovascular disease 27
Balanced diet 3, 11
Behavioral therapy 9, 10
Bipolar disorder 49
cholesterol, treatment of 27
pressure 6, 10
sugar 6
Body 50
immunity of 11
mass index 9, 23, 40
weight 8
Bone 6
Breathing techniques 34, 45
Brisk walking 6, 7
Bruxism 49
Calcium 24
Cancer 2, 18, 31, 55, 56
breast 18
colonic 2
colorectal 18
endometrial 18
lung 18
prostate 18
types of 8
Carbohydrates 4
low-quality 5
Carcinoma 17, 19
Cardiac ischemia 6
Cardiomyopathy 10
Cardiovascular disease 13, 17, 19, 25, 39, 50, 56
prevention of 5
Cardiovascular health metrics 26, 39
Centers for Disease Control and Prevention 26
Cerebral dystrophy 2
Cerebrovascular disease 53
Chitta vritti 45
Cholesterol 2, 4
Chronic diseases 13, 19, 63
Chronic obstructive pulmonary disease 18, 19, 34
Circadian rhythm sleep disorders 49
Cirrhosis 18
Constipation 2
Coronary artery disease 3, 56
Coronary heart disease 8, 9, 26
Couch syndrome 3
Cycling 6, 7
Dementia 33, 56
Depression 18, 34, 49, 50, 54, 56
Dharana 45
Dhyana 45
Diabetes mellitus 2, 5, 8, 10, 19, 2729
type 1 28
type 2 2, 8, 17, 18, 28, 54, 62
Diabetes prevention program 28, 62
Dietary approach to stop hypertension 4, 27, 43
Diets 3, 40, 56
benefits of 59
Disability-adjusted life years 15
Dyslipidemia 2, 27
Dyspepsia 2
Dyssomnias 49
Endocrine function 56
Endothelial nitrous oxide 6
Exercise 40, 42
cardiovascular benefits of 6t
indoor 6
level 56
prescription 6
role of 5
monounsaturated 4
saturated 4
Fiber 4
Fibrinogen 6
Fibrinolytic activity 5, 6
Gallbladder disease 8
Gastrointestinal diseases 2
Ghrelin 8
Glomerular filtration rate 22
Glomerular protein 23
Glucose 2, 5
Glycemic control 5
Gout 8
Health 1
behaviors 56
Healthcare 51, 53
attack 3, 19
disease 2, 8, 18
failure 6
High-density lipoprotein 5, 6, 10
cholesterol 6, 30
HIV infection 16, 55
Hyperfiltration 23
Hyperglycemia 20
Hypersomnia 49
Hypertension 2, 3, 8, 18, 27, 39, 42, 54, 56
causes of 3
improvement of 5
Immune function 56
Immunity 11
Infections 35
Insomnia 49, 50
Insulin sensitivity 6
Internal bowel syndrome 2
International Diabetes Federation 28
International Society of Renal Nutrition and Metabolism 22
Jogging 6
Joint 39
Kidney 3, 24
disease, chronic 22
failure, chronic 18
Left ventricular mass 6
diseases 1, 2, 18
medicine 2, 13, 14, 39, 67, 68
rectification, benefits of 39
high-density 5, 6, 10
low-density 5, 6, 10
Liver 3
disease 18
Low carbohydrate 9
Low fat 9
Low-density lipoprotein 5, 6, 10
cholesterol 6, 30
Low-protein diet 23, 24
Malmo feasibility study 5
Medical nutrition therapy 29
Medicine 42, 51
Meditation 7
Mediterranean diet 9, 27, 60
Memory 45
Mental health 55
Mesangial-cell 24
Metabolic diseases 39
Metabolic risk factors 20
Metabolic syndrome 12, 18
Mind 50
Mobility 9
Modern medicine 51, 52
Mortality 54
rate 10
Multiple sclerosis 2
mass 6
strength 6
Myocardial infarction 5, 50
Narcolepsy 49
National Goals for Cardiovascular Health Promotion and Disease Reductions 25
National Institute of Health and Family Welfare 52
Nervous system diseases 2
Niyama 45
Noncommunicable diseases 1820, 39
control of 20
prevention of 20
Nutrition 26, 35, 42, 59
types 59
Obesity 2, 5, 8, 10, 18, 20, 29, 39, 43
abdominal 6
classification of 9t
society 26
Optimism 56
Oral hypoglycemic agents 7
Osteoarthritis 2, 8, 42
Osteoporosis 18
Overweight 20, 43
classification of 9t
Pain 56
Paleo diet 59
Pancreas 2
Parasomnias 49
Peptic ulcer 2
Physical activity 5, 9, 26, 39, 41, 44, 60
Plasma lipids 10
Platelet aggregation 6
Polycystic ovarian syndrome 18
Polyunsaturated fatty acid 4
Potassium phosphorus 24
Pranayama 45
Pratyahara 45
Prediabetes 27, 28
Protein 4
energy wasting 22
high 9
Pulmonary disease 2, 53
Quitting smoking and alcohol 61
Rapid eye movement 48
Raw food diet 60
Rehabilitation, pulmonary 36
Relaxation techniques 7, 34
Renal replacement therapy 24
Respiratory diseases, chronic 19
Retinopathy 6
Samadhi 45
Schizophrenia 56
Sexual behavior 40, 56
Skeletal diseases 39
Sleep 10, 40, 45, 48
apnea 49
Smoking 27, 35
Sodium 24
South beach diet 60
Special diets 9t
Spiritual health 50, 52
Spirituality 52
role of 53, 54
Stress 34, 50
Stroke 2, 8, 18, 19
Substance abuse 40, 56
Sugar 2
Suicide 56
Surgery 9
Swimming 6, 7
Therapeutic lifestyle changes diet 4b
Thromboembolism 2
Tobacco 10
products 44
use of 27
smoking, adverse effects of 11f
Traditional medicine 52
Triglycerides 5, 6
Vascular dementia 18
Vascular disease 2
Vegan diet 60
C 11
E 11
circumference 8
hip ratio 8
measurement 8
Weight 26, 56
control 8
loss 10
enhancement of 5
maintenance 5
management 8, 9, 43
World Cancer Research Fund 31
World Health Organization 2
recommendation 4b
Yama 45
Yoga 39, 45
Chapter Notes

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Lifestyle is Health: An OverviewCHAPTER 1

S Arulrhaj,
Aarathy Kannan,
Health is a state of complete physical, mental, social, and spiritual well-being and not merely the absence of disease or infirmity. The health of people is mainly determined by two factors: Heredity and environment. Likewise, disease is of two types: Inherited and acquired. At present, we do not have any control over inherited diseases. Though the way signs of genetics are progressing, one day we may have some control over genetically determined diseases also. On the other hand, acquired diseases are those which we acquire during our lifetime. The diseases are caused by environmental factors which include our lifestyle.
Lifestyle can be defined as “the way we live.” It includes our habits, diet, clothing, housing, occupation, pollution, and all those things which influence our day-to-day life such as inhouse and outside atmosphere, and workplace job satisfaction. Most important factor nowadays has become the stress and strain of life. There are many diseases which are solely related to stress and strain.
Lifestyle disease can be defined as the “disease whose frequency increases with economic and industrial development of a country.” It has been well documented by various studies that some diseases which were totally absent in preindustrialization period are now very common even now this disease or not seen in underdeveloped countries. Heart attack, obesity, and stroke are not known in tribal people who are untouched by modern lifestyle. It has also been proved without doubt that if a person migrates from underdeveloped to developed country and adopt lifestyle of his new country, becomes vulnerable to the lifestyle disease prevalent in that country. Because of improved nutrition and medical care, the life span of the people is increasing. We have more aged people now. Lifestyle diseases are more common in aged people. The diseases are also called “disease of longevity” and “disease of civilization.”2
Lifestyle medicine is a medical approach that uses evidence-based behavioral interventions to treat and manage chronic diseases related to lifestyle. 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.
The World Health Organization (WHO) says, from the year 1995–2025, worldwide, the adult population with diabetic population will increase to 122%. There will be a 42% increase, from 51 to 72 million, in the developed countries and a 170% increase, from 84 to 228 million, in the developing countries. The prevalence of diabetes for all age groups worldwide was estimated to rise from 171 million in 2000 to double in 2030. In India, in the year 1995, it was 19 million diabetics, which will be 57 million in 2025, which will make India the Diabetic capital of the world.
Most important lifestyle diseases are obesity, type 2 diabetes mellitus (T2DM), hypertension, thromboembolism, dyslipidemia, vascular disease, stroke, heart diseases, pulmonary disease, cancer, and osteoarthritis. Gastrointestinal diseases such as internal bowel syndrome, constipation, peptic ulcer, dyspepsia, anorexia nervosa, and colonic cancer are all related with lifestyle. Nervous system diseases such as dementia, Alzheimer's disease, multiple sclerosis, and cerebral dystrophy are also lifestyle diseases.
Sugar and Diabetes?
“Diabetes is a disease in which the body does not produce or properly use insulin, leading to blood glucose.” Glucose is the fuel of the body which is needed to keep cells of the body active (working). Glucose comes from the food. Liver processes it and is released in blood as an when needed. For the glucose to enter cells of the body, a hormone called insulin is needed, which is produced by the abdominal organ “pancreas.” When cells of the body need energy to perform work, then insulin is released; it helps the glucose in the blood to enter the cell. The glucose cannot enter the cells in absence of insulin.
What Cholesterol can Result in?
Cholesterol is a type of lipid or fat that is essential to the body. It plays a role in the manufacture of cells as well as hormone production. But if consumed in excess, deposit inside arteries, including the arteries that feed the heart and increasing the risk of heart disease and heart attacks.13
Problem with Hypertension?
Hypertension is also referred to as high blood pressure. Blood pressure is the force of blood pushing up against the blood vessel walls; the higher the pressure, the harder the heart has to pump, in turn damaging the heart. Causes of hypertension includes obesity, sedentary lifestyle, lack of physical activity, high levels of salt intake, high levels of alcohol consumption, and disease of other organs such as kidney and liver.2
Heart Attack
Worldwide, one-third of world deaths are due to coronary artery disease (CAD). In developing countries, 80% of population suffer CAD and 60% of this is preventable. Indians have high chances of heart attack. Here, blood vessels supplying heart are blocked and hence, heart muscles do not get blood and a portion dies.3 Fat is deposited on the inner side of blood channels over years. When the deposit is more, the flow of blood is reduced and at a particular time, it blocks the channels fully. Risk factors are grouped into modifiable factors and unchangeable risk factors. Modifiable factors include diabetes, blood pressure, high cholesterol, obesity, tobacco, alcohol, sedentary life, food habits, and mental stress. Unchangeable risk factors include birth, heredity, and male gender. Controlling these modifiable risk factors helps in preventing heart attack.4
Current public health campaigns to reduce obesity and T2DM have largely focused on increasing exercise levels but have paid little attention to the reduction of sedentary behaviors. Television (TV) watching is a major sedentary behavior, causing TV and Couch syndrome. Can doctors change it? Yes! Not fighting in Hospital but in Society, through therapeutic lifestyle changes (TLC). The healthy lifestyle is aimed at controlling the weight [maintaining body mass index (BMI)], blood sugar level, blood pressure, and blood cholesterol. These in turn reduce the incidence of diseases leading to a lengthy life. TLC is vital as it helps in prevention of diabetes by delaying the onset of diabetes, controlling diabetes prevention, or postponing the complications.
Balanced Diet
“Balanced diet is the one which contains a variety of foods in such quantities and proportions that the need for energy, proteins, vitamins, minerals, and fats is adequately met for maintaining physical fitness.”4
Carbohydrates include 45–60% of calories. Avoid nutritive sweeteners; encourage using non-nutritive sweeteners such as aspartame saccharin. Promote using complex carbohydrates such as whole grains, reducing rice, and adding vegetables and greens. Protein should be 15–20% of total calories including animal and vegetable protein. Fat should be 25–35% of total calories; saturated fat should be about 10% (in CAD 7%), polyunsaturated fatty acid (PUFA) about 7–10%, monounsaturated fatty acid (MUFA) about 12–16%. Trans fatty acids are to be avoided. Limit the cholesterol intake to 300 mg/day and in CAD, 200 mg/day. Fish—two to three servings per week—can be included. Greens, leafy vegetable, and fruits with skin should also be included (Boxes 1 and 2).
The DASH diet (dietary approaches to stop hypertension) is a dietary pattern promoted by the American Heart Association (AHA). Originally developed as an eating style to help lower blood pressure, but has fabulous results in weight loss and also lowering cholesterol.5
Lowering cholesterol by avoiding fried foods, fatty meats, and whole milk products. Cholesterol is found only in foods from animals (foods from plants contain no cholesterol). Saturated fats are usually found in animal products. However, we should avoid coconut, palm, and palm kernel oil. Use less hydrogenated or partially hydrogenated fats.5
For lowering triglycerides, avoid alcohol; even small amounts of alcohol can dramatically increase triglyceride levels. Use less fat in cooking grill, food can be dry roasted, can be cooked with microwave or steam. Include get more omega-3 fatty acids; they are effective at lowering triglyceride levels. You can add two servings of omega-3-rich fish in your diet, such as wild salmon, herring, mackerel, and sardines. Low-quality carbohydrates can cause a sudden rise in triglycerides. Dramatically limit the intake of refined carbohydrates, i.e., anything made with white (refined or enriched) flour—white bread, rolls, cereals, buns, and pastries. Restrict salt intake; eating a diet high in sodium (salt) can increase blood pressure. Avoid canned foods, dried meats, or fish.
Increase fiber intake; fiber found in oats, barley, dry beans, peas, fruits and vegetables may help to lower cholesterol levels. Choose five or more servings of vegetables and fruits per day. Choose six or more servings of whole-grain breads, cereals, pasta, rice, and dry beans per day. Water is an essential nutrient that is critical to reaching your best physical performance.
Therapeutic Lifestyle Changes: Physical Activity
Joslin wrote, “It is much better to discuss how far you have walked than how little you had eaten.”
The benefits of physical activity are (by the ADA):
  • Improved glycemic control
  • Prevention of cardiovascular disease
  • Possible reduction in low-density lipoproteins (LDL) and triglycerides and increase in high-density lipoproteins (HDL)
  • Improvement of hypertension
  • Possible improvement of fibrinolytic activity
  • Enhancement of weight loss and weight maintenance (Flowchart 1)
  • Upregulation of insulin receptors and normalization in glucose/insulin ratio. Prevent beta-cell exhaustion and T2DM.
    [Malmo Feasibility Study: 50% reduction in diabetes mellitus (DM); Finnish DM Prevention Study: 58% reduction in DM]
Problems arising out of lack of exercise:
  • Lack of exercise promotes 90% chances of diabetes
  • Increases 30% chances of hypertension
  • Death due to myocardial infarction (MI) is increased twice.
zoom view
FLOWCHART 1: Role of exercise in obesity.
Exercise Prescription
  • The US Department of Agriculture (USDA) recommendation: 30 minutes of moderate-intensity physical activity for most days of the week and reduce sedentary activities.
  • Aerobic exercise: Brisk walking, jogging, running, swimming, and cycling
  • Anaerobic exercise:
    • Strength training
    • Increases muscles mass and
    • Bone/muscle strength
  • Indoor exercise: Evaluate clinically and start.
Caution: Cardiac ischemia and retinopathy (Table 1).
  • Starting a fitness program may be one of the best things you can do for health.
  • The AHA recommends:
    • At least 150 min/week of moderate aerobic activity
    • 75 min/week of vigorous aerobic activity
    • Three to four sessions a week, lasting on average 40 minutes per session
    • Strength training exercises at least twice a week
  • The Journal of the American Medical Association (JAMA) says: Incorporate physical activity into daily living such as using stairs, avoiding lift, gardening, dancing, cycling, and playing actively with children.6
    • Washing and waxing a car or washing windows of floors for 45 minutes
    • Gardening, dancing fast (social), or raking for 30 minutes
    • Walking 13/4 miles in 35 minutes (20 min/mile)
    • Pushing a stroller 1½ miles or bicycling 5 miles for 30 minutes
    • Stair walking, shoveling snow, or jumping rope for 15 minutes
  • Isotonic/isometric:
    • Walk for life
    • Running
      TABLE 1   Potential mechanisms underlying the cardiovascular benefits of exercise.
      Decrease in following
      Increase in the following
      • Peripheral resistance
      • Sympathetic activity
      • Fibrinogen
      • Platelet aggregation
      • Triglycerides and LDL cholesterol
      • Blood sugar
      • Left ventricular mass
      • Abdominal obesity
      • BP
      • Endothelial nitrous oxide
      • HDL cholesterol
      • Insulin sensitivity
      • Fibrinolytic activity
      • LV ejection fraction
      • Hemodynamics in heart failure
      • Psychological well-being
      • Arrhythmia threshold
      (BP: blood pressure; LDL: low-density lipoprotein; LV: left ventricle; HDL: high-density lipoprotein)
    • 7Brisk walking
    • Cycling
    • Swimming
  • Aerobic exercise:
    • Regular aerobic exercise can help you live longer and healthier.
    • Keeps weight under control
    • Strengthens heart
    • Boosts your mood
    • Improves immunity
      Types of aerobic exercise:
    • Walking is one of the most natural forms of exercise.
    • Swimming
    • Bicycling
    • Jogging
    • Dancing
    • Jumping rope count
  • Anaerobic exercise:
    • Also called strength training exercises
    • Reduces body fat
    • Increases lean muscle mass
    • Burns calories more efficiently
    • Weightlifting is a type.
  • Stretching and flexibility:
    • Stretching is a powerful part of any exercise program.
    • Increases flexibility.
    • Improves range of motion of joints.
    • Boosts circulation.
    • Promote better posture and relieve stress.
  • Relaxation techniques:
    • Meditation
    • Laughter
    • Breathing exercise
    • Pets
    • Yoga
    • Prayer
    • Temperament modification
    • Dancing
    • Plants
    • Friends
    • Rest
    • Grandchildren
    • Sleep
  • Meditation: These will greatly help in reducing the need for oral hypoglycemic agents (OHA) and insulin
    • Asanas will help by:
      • Improving glycemic control
      • Reducing blood pressure8
      • Correcting dyslipidemia
      • Reducing insulin resistance and correcting hyperinsulinemia7
      • Eliminating stress
    • Pranayama will help by:
      • Decreasing plasma cortisol
      • Increasing insulin receptors
Weight Control
  • 1.1 billion adults are overweight and the number has tripled over the last two decades (Lancet 2005)8
  • Increased mortality and morbidity from T2DM, coronary heart disease (CHD), stroke, hypertension, etc.
Incidence: Above 70% of urban women and 50% of urban men are overweight and at any time, they can become obese. More than 30% of school children are obese.
Consequences: Abdominal fat tissue produces Neuropeptide Y, which stimulates fat cell production. Ghrelin is also secreted by excess fat to keep them ever hungrier.
People who are overweight are at increased health risk for diseases including:
  • Heart disease
  • Diabetes and stroke
  • Osteoarthritis
  • Gallbladder disease and gout
  • Certain types of cancer
Various parameters
  • Ideal body weight = Height (in cm) – 100 × 0.9
  • BMI = Weight in kg/(height) in m2
Ideal BMI for Indians is between 18 and 23 kg/m2 (up to 25) (Table 2).
    • Overweight: 25–30
    • Obesity: above 30
    • Morbid obesity: 200% of ideal body weight
  • Waist measurement: Men: 90 cm; women: 80 cm (The average waistline of Chennai people has increased by >5 cm: sign of definite obesity.) Visceral adiposity is an independent predictor of insulin sensitivity, impaired glucose tolerance, elevated blood pressure, and dyslipidemia.
  • Waist–hip ratio: 0.95 for men and more than 0.85 in women is indicative of abdominal obesity (Buddha belly).
Weight Management
Desirable body weight is: BMI: 20–25 kg/m2
Waste circumference: Less than 102 cm in males and <88 cm in females9
TABLE 2   Classification of overweight and obesity.
Waist circumference
Risk for type 2 diabetes mellitus, hypertension, CHD
N or ↑
N or ↑
N or ↑
Obesity class
Very high
N or ↑
Very high
N or ↑
Extremely high
(BMI: body mass index; CHD: coronary heart disease)
TABLE 3   Special diets.
Dean Ornish diet
High CHO
Pritikin diet
Moderate protein, very low fat
MUFA diet
37–40% CHO
(20% MUFA)
Atkins diet
Low CHO, high protein, high fat
Fat mimetics
Low calorie/taste of fat
Fat replacers
Paleo/DASH diet
(CHO: carbohydrate; DASH: dietary approaches to stop hypertension; MUFA: monounsaturated fatty acids)
Setting realistic goals is important rather than setting high at the beginning itself. It is like reduction of 2 kg/month or ↓ 10% of existing weight or ↓ 20% calories restriction.
Weight Management
It can be achieved by (Table 3):
  • Dietary restriction:
    • Low carbohydrate, low fat
    • High protein
    • 500 kcal/day ↓
    • Mediterranean diet
  • Physical activity (Table 4):
    • Aerobic exercise: 30 min/day
    • Mobility
  • Behavior therapy
  • Drug and surgery10
TABLE 4   Benefits of 10 kg loss of weight.
Category benefits
Mortality rate
↓ 20–25% total mortality
↓ 30–40% diabetes-related mortality
↓ 40–50% cancer-related mortality
Blood pressure
↓ 10 mm Hg systolic
↓ 20 mm Hg diastolic BP
Angina pectoris
↓ Symptoms
↑ 33% exercise tolerance
Plasma lipids
↓ 30% plasma triglycerides
↑ 8% HDL cholesterol
↓ 10% total cholesterol
↓ 15% LDL cholesterol
Diabetes mellitus
↓ 50% risk for developing diabetes
↓ 30–50% fasting blood glucose
↓ 15% glycated hemoglobin (HbA1c)
(BP: blood pressure; LDL: low-density lipoprotein; HDL: high-density lipoprotein)
Behavioral Therapy
  • Tobacco (Fig. 1):
    • Smoking increases CAD twice: 80% diabetics
    • Premature micro- and macrovascular disease
    • Passive smoking 20–70% risk than nonsmokers
    • Lung and bladder cancer
    • Stopping smoking: Reduces coronary risk 50% in 1 year
    • In 15 years equals nonsmokers
  • Alcohol drinking: Alcohol drinking causes—
    • Cardiomyopathy
    • Blood pressure raises
    • Lipids increase
    • Obesity
  • Sleep:
    • Rest with good sleep of 6–8 hours.
    • Sleep is the best way to recharge the body.
    • Lack of sleep can affect immune system and increases the risk of heart diseases.
    • Stick to a sleep schedule: Go to bed and get up at the same time every day.
    • Eat and drink correctly: Nicotine, caffeine, and alcohol lead to disrupt sleep later in the night.
    • Get comfortable: Create a room that is ideal for sleeping.
    • Increase physical activity in your daily routine.11
      zoom view
      FIG. 1: Common adverse effects of tobacco smoking.
  • Increase immunity:
    • Immunity of the body is important for protection of various diseases.
    • Adequately feeding your immune system boosts its fighting power. Balanced diet with various vitamins and minerals is needed. Vitamin C, E, and green leafy vegetables are the most important.
  • Maintain hygiene: Bathing daily or after exposure with contaminated water with proper application of soap is essential. Awareness of the specific diseases is important to keep us away from them.
Healthy life without lifestyle disease is your choice. The burden of modern lifestyle diseases is enormous. If we calculate the cost of investigation and diagnosis, treatment, and primary and secondary prevention, it will be huge in amounts. We have a meager health budget which is not even sufficient to meet the basic health needs of the people of the country. We are unable to provide primary healthcare to all people, especially to the poor people and villagers. On the other hand, whatever finance is available, it is being directed toward lifestyle diseases, which are basically disease of affluence.
The only proper way to control these diseases is prevention. Lifestyle diseases can be prevented by dietary intervention, regular physical exercise, abstinence from smoking and alcohol, and practicing relaxation techniques and yoga. Meditation is a very effective method for mental peace. It relieves stress and strain and keep the person mentally healthy and hearty. TLC is an effective lifestyle therapy in the treatment of both elevated LDL cholesterol 12levels and hypertension. Because it also promotes weight loss while improving CHD risk factors associated with the metabolic syndrome, TLC can also be an important therapeutic strategy in the prevention of T2DM.
  1. Eckel RH, Jakicic JM, Ard JD, de Jesus JM, Miller NH, Hubbard VS, et al. 2013 AHA/ ACC guideline on lifestyle management to reduce cardiovascular risk: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014;129(25 Suppl 2):S76-99.
  1. Howard BV, Rodriguez BL, Bennett PH, Harris MI, Hamman R, Kuller LH, et al. Prevention Conference VI: Diabetes and Cardiovascular disease: Writing Group I: epidemiology. Circulation. 2002;105(18):e132-7.
  1. Manson JE, Greenland P, LaCroix AZ, Stefanick ML, Mouton CP, Oberman A, et al. Walking compared with vigorous exercise for the prevention of cardiovascular events in women. N Engl J Med. 2002;347(10):716-25.
  1. The DASH diet solution and 60 day weight loss and fitness journal. Los Angeles, California: Learning Visions; 2013.
  1. Hu FB, Li TY, Colditz GA, Willett WC, Manson JE. Television watching and other sedentary behaviors in relation to risk of obesity and type 2 diabetes mellitus in women. JAMA. 2003;289(14):1785-91.
  1. Hamdy O, Ledbury S, Mullooly C, Jarema C, Porter S, Ovalle K, et al. Lifestyle modification improves endothelial function in obese subjects with the insulin resistance syndrome. Diabetes Care. 2003;26(7):2119-25.