This is my dissertation for my EPQ in 2019, I received full marks (A*). This is a biochemistry and human biology based dissertation so can be used as a perfect example of how to write, structure and complete the extended writing portion of the EPQ.
Can Lifestyle Medicine Be Used to
Treat Chronic Conditions?
Chronic disease is a complex field with many varying definitions of the term, adding
to the confusion. The World Health Organisation describes chronic disease as being
diseases that have a ‘long duration and generally slow progression’ that are ‘not passed
from person to person’, while another source describes them as ‘lasting three months or
more’ that ‘generally cannot be prevented by vaccines or cured by medication’. With these
conditions in mind, diseases such as Myalgic Encephalomyelitis (CFS/ME), Polycystic
Ovarian Syndrome (PCOS), Alzheimer's Disease and Hypertension have become baffling to
researchers and practitioners due to their lack of response to conventional methods of
treatment. Thus, in recent years, some medical professionals have begun to focus their
efforts for treatments and preventions on lifestyle medicine which includes nutrition,
exercise, stress management and tackling substance abuse, among others. As many know,
maintaining a healthy weight, exercising regularly, reducing stress levels and cutting
consumption of substances such as alcohol and tobacco can dramatically improve an
individual's health; however, an intriguing examination is whether these factors can help to
prevent or potentially cure chronic diseases.
As the UK population ages, the number of sufferers with chronic conditions is
growing rapidly; the number of patients in England has increased from 1.9 million in 2008 to
2.9 million in 2018 and is forecast to grow. It also accounts for nine in every ten deaths in
Australia as of 2015. This places an immense pressure on services within the NHS, as it is
estimated that chronic conditions account for around 70% of the health and social care
spending in England along with 80% of all GP consultations. Therefore, it would seem that
the investment of time and research into understanding and employing lifestyle medicine
would not only aid the population’s health, but also help to decrease the burden on public
spending.
How can diet affect chronic disease?
It is common knowledge that diet can have a dramatic impact on personal health with
new research constantly being conducted in new areas of the field in an attempt to create a
healthier general population. As of 2015, the health, nutrition and weight loss industry in the
United States was estimated to be worth 648 billion dollars. Food has been used has
medicine for thousands of years but in the modern day, doctors veer more towards treating
patients with pharmaceuticals and medications to eliminate the symptoms of the chronic
condition rather than treating the root cause with lifestyle changes such as changes in diet.
Recent figures confirm this as it has been reported that, in the UK, the total cost of NHS
prescribed medicines rose by around 5% annually between 2010 to 2017, increasing
spending from £13 billion to £17.4 billion per year.
Part 1: Alzheimer’s and Diabetes
The dramatic increase in chronic conditions such as Diabetes and Alzheimer’s in
recent years has caused chronic disease to be the biggest killer worldwide with Diabetes
and brain diseases becoming America's highest expense burden. As of 2018, the total cost
of prescriptions for Diabetes rose by more than £422 million in the last ten years alone with
almost one in twenty prescriptions written by GPs for treatment of Diabetes.
, In order to combat this health crisis, neurologist Dr David Perlmutter advises people
to stray from the recommended food pyramid by eliminating carbohydrates in the diet to
treat, cure and prevent brain degenerative diseases such as Alzheimer's in his book ‘Grain
Brain: The Surprising Truth About Wheat, Carbs and Sugar - Your Brain’s Silent Killers’. He
boldly states that ‘the origin of brain disease is in many cases predominantly dietary’ and he
believes that the change in our diet is to blame. He acknowledges the development ‘from
high-fat, low-carb to today’s low-fat, high-carb diet’ and concludes that this evolution ‘is the
origin of many of our modern scourges linked to the brain, including chronic headaches,
insomnia, anxiety [and] depression’. Perlmutter believes that consumption of carbohydrates
and grains are the root cause of brain dysfunction, including those deemed as healthy such
as multigrain, whole grain, whole wheat, and so forth. He notes how different our diet is from
our Neolithic ancestors; how we not only consume far more grain but how the wheat we eat
shares little to no genetic, structural or chemical likeliness to the wheat 12,000 years ago.
Due to the similarities between Diabetes and Alzheimer’s and the fact that a person
is far more likely to develop Alzheimer’s if they already suffer from Type 2 Diabetes, the
Journal of Alzheimer’s Disease first recommended the term ‘Type 3 Diabetes’ in 2005. The
research article that introduced this proposed the term due to abnormalities associated with
low levels of insulin receptor substrate measured in brains with Alzheimer’s Disease.
Perlmutter describes how Type 2 Diabetes can eventually develop into Alzheimer’s. It is
known that abnormalities can begin to present themselves when cells are exposed to high
levels of insulin caused by persistent intake of high amounts of glucose. The following then
occurs:
The body cells begin to adapt by reducing the number of insulin receptors on their
surface.
This leads to insulin resistance, along with a failure to retrieve glucose from the
bloodstream.
The pancreas responds by pumping out more insulin, eventually culminating into
Type 2 Diabetes.
People with Diabetes have high blood sugar levels which can cause damage such as
blindness, nerve damage and can eventually lead to brain degeneration in the form of
Alzheimer’s. Insulin is an anabolic hormone produced by the pituitary gland which means
that it stimulates growth, encourages inflammation and promotes fat formation. High levels of
insulin can have an adverse effect on other hormones causing more issues. Insulin keeps
the blood vessels that supply the brain healthy whilst encouraging the brain’s neurons to
absorb glucose. This allows the neurons to change and become stronger. Reduced brain
function can be caused by low insulin levels. Although the term ‘Type 3 Diabetes’ links
Alzheimer’s Disease and Diabetes, there is an important distinction to be made that this is
referring to Type 2 Diabetes, which occurs as a direct result of the overconsumption of
glucose, rather than Type 1, a genetic condition thought to be an autoimmune disorder. In
relation to a study on the ‘Science Daily’ website, Perlmutter notes that ‘those with higher
blood sugar levels within the normal range were more likely to show a loss of brain volume in
regions involved with memory and cognitive skills. After cancelling out other factors including
age, blood pressure and smoking, they found that blood sugar levels at the high end of
normal still accounted for 6 to 10% of brain shrinkage.
As a result of his findings in this area, Perlmutter concludes that ‘the cornerstone of
all degenerative conditions, including brain disorders, is inflammation’ and that ‘gluten and a
high-carbohydrate diet is among the most prominent stimulations of inflammatory pathways
that reach the brain’. Brain inflammation cannot be felt in the same way that we feel it in
other parts of our body, so it can easily go unnoticed. It has been found that one of the main
culprits of chronic inflammation is oxidative stress which gradually corrodes all tissues.
Oxidative stress is a result of free radicals formed in the body by pollution, stress, dietary
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