Give kids lifestyle medicine

Dr George Cho MFSc CEP ND
Clinic Director, Pathways Lifestyle Medicine Clinics
Medical Director, Lifestyle is Medicine
Certified Exercise Physiologist, Cleveland Clinic Canada

I remember some particularly poignant patient-interactions I had not too long ago while serving at an under-serviced community in northern Ontario. On one occasion, there was an individual who came presenting with hypertension, excess weight and a diagnosis of type 2 diabetes. Though it is not rare to see these conditions present together, what stood out was his age; he was only in his 20’s. I also recall a conversation with a young mother who came to clinic. I was shocked to learn that this woman’s adolescent children had type 2 diabetes. They were in their early teens. 

Our children are in trouble

This was surprising and shocking to me, but the reality is that these are not one-off, unique cases. The scientific data is coming out now that diseases once thought of as “old peoples’ diseases” is occurring in people at younger and younger ages. For example, Chen et al released a review paper in the scientific journal: Nature Reviews: Endocrinology, in which they observed a: 

“rising prevalence of T2DM in youth,” (1).

and also that:

“the trend of prediabetes among adolescents is increasing” (1).

Data from the National Health and Nutrition Examination Survey (NHANES) suggests a 87.1% increase in the prevalence of impaired glucose regulation among adolescents between 12 to 19 yrs old from 1999 to 2006 (2,3). This is worrisome that young people are not able to optimally metabolize the glucose they are putting into their bodies. 

The Journal of the American Medical Association (JAMA) released a report in 2014 in which they make the same observation that the rates of type 2 diabetes is increasing among our youth. In fact, in this report, they say that now 20% to 50% of new-onset diabetes cases will be from among youth populations (4).

The even more sad news is that type 2 diabetes is creeping in among people even younger than adolescent age. Scientists now report that:

“T2DM, traditionally considered a metabolic disorder exclusively of adults, has become more common not only in young adults but also in adolescents and, occasionally, in children.” (1) 

What a travesty that now children are starting to get type 2 diabetes!

The process can start young

Learning about these things should teach us a very important lesson: the disease process can start at a very early age. As we have noted already, the foundation for glucose dysregulation is starting in younger people and this dysfunction in their metabolic systems will eventually set them up for full blown disease in the future (2, 3). Clearly even our childrens’ young and vibrant bodies are not impenetrable to the forces of chronic degeneration and disease. 

Unfortunately, this is not just for sugar regulation but for other disease processes as well. For example, it is becoming increasingly clear that the foundation for coronary artery diseases and heart attacks are laid, not in our 40’s, 50’s and 60’s, but at a very young age; in our teens and 20’s. Investigation into this interesting discovery was sparked by the findings of fatty streaks within the blood vessels of US soldiers fighting during the Korean war (5). They discovered that 77.3% of autopsied hearts had evidence of coronary arteriosclerosis; some even had atheromatous plaques causing complete occlusion (full blockage of the blood vessel). The average age of these soldiers was only 22 (5). Since this report came out, further scientific investigations have confirmed that fatty streaks and plaque formation can start as early as our adolescent and teen years (6, 7, 8). One study found that up to 45% to 57% of teenagers have fatty streaks in the right coronary artery and this percentage reaches to above 70% by the 30’s (6). Another study found that half of those in the 2 to 15 age group had fatty streaks and this number jumped to a staggering 85% in the 21 to 39 age bracket (8).

Now think about it; our teens and children are already developing the foundations for devastating diseases in their later years, and the reality is that many of them will not need to wait for six decades until they get type 2 diabetes and heart disease, some may get it even earlier. This calls for pause and reflection. 

The following statement from one of these papers are a warning to all of us:

“This study demonstrates that coronary atherosclerosis begins at a young age” (7).

There is a solution

So what is the solution then? How can we prevent and also treat this growing issue among our young people? The best hope lies in the new and emerging medical and scientific field of: Lifestyle medicine. Studies have been mounting that a healthy lifestyle can be a powerful tool for both prevention and reversal of chronic diseases. For example:

• Dr Dean Ornish and colleagues began the reversal of coronary artery disease in patients by getting them to eat a low-fat vegetarian diet, manage stress, stop smoking and exercise (9 – 10).

• Dr Caldwell Esselstyn of the Cleveland clinic has shown similar results by getting his patients to adopt a whole-foods, plant-based diet. He has been arguing for the power of whole foods, plant-based nutrition in the prevention, treatment and reversal of heart disease for many years (11, 12, 13, 14, 15).

• In the Diabetes Prevention Program studies, they discovered that lifestyle behaviors including physical activity, were superior to drugs in the prevention of diabetes (16).

• Dr I-Min Lee of Harvard university and her colleagues reported that meeting the physical activity guidelines can lower the risk of type 2 diabetes by 17%, colon cancer by 24%, and coronary heart disease by 14%. On the other hand, not meeting the physical activity guidelines increases the risk of type 2 diabetes by 20%, colon cancer by 32% and breast cancer by 33%. This is exercise alone, not even factoring in diet.  (17)

•  A fully plant-based diet has been shown to reduce the risk of getting type 2 diabetes and hypertension by up to 50% to 70%. Vegetarian, mostly plant-based diets can potentially decrease the risk of colon cancer by about 50%, gastrointestinal cancer by 23%, prostate cancer by 35%, and ischemic heart disease by 55%, as well as lower the risk of elevated triglycerides, glucose, blood pressure, waist circumference and BMI’s. These associations were found in very large studies done on Seventh-day Adventists (18, 19, 20).

These are just a sampling of the many studies that have come out in recent years which demonstrate the power of lifestyle to prevent, treat and reverse many chronic diseases. These studies may hint to us that  if we want to set up our children and young people for the  healthiest lives possible, their best chance lies in adopting a healthy lifestyle with whole-plant foods and physical activity, as the foundation. 

 
Put your kids on medicine

So the point is this: Put kids on medicine, lifestyle medicine. It’s the medicine that encompasses how we eat, sleep, move, socialize, stress and pray.  The medicine that comes in the form of salads, fruits, yams, nuts, dumbells and running shoes. We are referring to kids getting out and sweating, and to bed for sleeping. It’s the medicine that instructs us to exchange our sugary drinks and cappuccinos in favor of water, and preferring whole, home-cooked, plant-based foods rather than processed and packaged products. Our kids need real food as God made it, and less of these industry-manufactured, imitation stuff. We are talking about using our kids’ own lifestyles as their primary medicine. 

The next time you look at your children, you may see a kid who seems healthy on the outside. They may not be coughing, feverish or have a tummy ache, but ask yourself, “Are they healthy on the inside?” and one of the fastest ways to gauge that is to look at their breakfast bowl, lunch box and dinner plate.

Folks, we need to wake up to what the food industry and we ourselves are doing to our beloved children. If things continue the way they are, our loved ones are headed for metabolic disaster in the future, and unfortunately the science shows that disaster may hit sooner than we think. It is time for everyone, including our young ones to start taking lifestyle medicine. 

References

1. Chen L et al. The worldwide epidemiology of type 2 diabetes mellitus – present and future perspectives. Nat Rev Endocrinol. 8, 228 – 236 (2012)

2. Williams, D.E et al. Prevalence of impaired fasting glucose and its relationship with cardiovascular disease risk factors in US adolescents, 1999 – 2000. Pediatrics 116, 1122- 1126 (2005)

3.  Li, c et al. Prevalence of prediabetes and its association with clustering cardiometabolic risk factors and hyperinsulinemia among U.S. adolescents: National Health and Nutrition Examination Survey 2005 – 2006. Diabetes Care 32, 342 – 347 (2009)

4. Dabelea, D et al. Prevalence of Type 1 and Type 2 Diabetes among children and adolescents from 2001 to 2009. JAMA. 2014. 311(17):1778 – 1786

5.  Enos W & Holmes R. Coronary disease among United States soldiers killed in action in Korea. JAMA., July 18, 1953

6. Strong J et al. prevalence and extent of atherosclerosis in adolescents and young adults. JAMA 1999; 281:727 – 735

7. Tuzcu, E et al. High prevalence of coronary atherosclerosis in asymptomatic teenagers and young adults. Evidence from intravascular ultrasound. Circulation. 2001; 103;2705 – 2710

8. Berenson, G et al. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. N Engl J Med 1998; 338:1650 – 6 

9. Ornish D et al. Can lifestyle changes reverse coronary heart disease? The lifestyle heart trial. Lancet 1990; 336:129 – 33

10. Ornish D et al. Intensive lifestyle changes for reversal of coronary heart disease. JAMA. 1998; 280: 2001 – 2007 

11. Esselstyn, C. Resolving the coronary artery disease epidemic through plant-based nutrition. Preventive cardiology. 2001

12. .Esselstyn, C. Defining an overdue requiem for palliative cardiovascular medicine. Am J of Lifestyle Medicine. 2016. Vol 10, No. 5. 313 – 317

13. Esselstyn C. Upating a 12-year experience with arrest and reversal therapy for coronary heart disease (an overdue requiem for palliative cardiology). Am J Cardiology. Vol 84, Aug 1, 1999

14. .Esselstyn, C. A plant-based diet and coronary artery disease: a mandate for effective therapy. J Geratric Cardiology (2017) 14; 317 – 320

15. Esselstyn, C. Is the present therapy for coronary artery disease the radical mastectomy of the twenty-first century? Am J Cardiology. 2010. 902 – 904

16. Knowler W et al. Reduction in incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med. 2002 Feb 7; 34696):393 – 403

17. Lee, I-Min. et al. Impact of physical inactivity on the world’s major non-communicable diseases. Lancet. 2012 July 21 ; 380 (9383): 219 – 229

18. Le, LT & Sabate, J. Beyond meatless, the health effects of vegan diets: Findings from the Adventist cohorts. Nutrients 2014, 6, 2131 – 2147 

19. Rizzo, N et al. Vegetarian dietary patterns are associated with a lower risk of metabolic syndrome. Diabetes Care, Vol 34, May 2011. p 1225 – 1227

20. Fraser, G. Vegetarian diets: what do we know of their effects on common chronic diseases?  Am J Clin Nutr 2009; 89 (suppl): 1607 – 12S