ABSTRACT: Lifestyle diseases refers to diseases associated with modifiable risks from adjustment management, behavioural changes, inactivity to non-modifiable factors like age, gender, genetic and environmental influences. Lifestyle diseases are emerging concept in medicine and about 62% of total population affected by its fatal effect. Children, adult, elderly person all are vulnerable to the risk factors related to lifestyle leading to non communicable disease burden that has impact on DALYs and physical quality life index. The incidence of these diseases is rapidly increasing due to rapid unplanned urbanisation, globalisation and unhealthy lifestyle of the population. Homoeopathy can be a unique mode of treatment in the management of lifestyle diseases as it involves perceiving of each individual case of disease with a thorough consideration of obvious causes, accessory circumstances, constitution, temperament, and underlying miasm.
ABBREVIATION USED: Disability adjusted life years(DALYs). Physical quality life index(PQLI). Diabetes mellitus(DM). Chronic obstructive pulmonary disease(COPD). Polycystic ovary syndrome( PCOS), International Classification of Diseases(ICD), ventricular septal defect(VSD), atrial septal defect(ASD), diabetes mellitus(DM), polycystic ovarian syndrome(PCOS), chronic obstructive pulmonary disease(COPD), systemic lupus erythematosus (SLE).
The lifestyle of a particular person or group of people is the living conditions, behaviour, and habits that are typical of them or are chosen by them. Basically, a particular lifestyle of person is a cumulative product of his/her physical capacity co-ordinated with psychological functioning, displayed in the form of habits, behaviour, dietary and living pattern based on his own training sought from childhood, and mimicries he gained from his immediate companions including parents, siblings, peers, etc1,2,3.
In the era of evidence based medicine, the dictum of cause behind the cause is also included in the classification of diseases. From the life in womb to the late phase, a man becomes the victim of improperly managed lifestyle. In this growing world each and everyone is in a hurry to ride the train of urbanisation, modernisation, and social changes. The non communicable diseases accounts for 62% of total burden of DALYs and 53% of total deaths4,5. The physical quality life index (PQLI) reflects the well-being of a person, that measure the basic literacy rate, infant mortality rate, and life expectancy but not the disease burden of the person.
Lifestyle diseases are ailments that are primarily based on the day to day habits of people. Previously, the major non communicable diseases, i.e. coronary heart diseases, hypertension, COPD, obesity, diabetes mellitus, dyslipidaemia, and cancer were only regarded as life style disorders6. Recent decades have revealed a transform and massive increase in the incidence of lifestyle disorders.
Causes of lifestyle disorders can be divided into three broad categories:
A. Modifiable behavioural risk factors,
B. Non-modifiable risk factors, and
C. Metabolic risk factors.
A. MODIFIABLE BEHAVIOURAL RISK FACTORS: Behavioural risk factors such as excessive use of alcohol, bad food habits, eating and smoking tobacco, physical inactivity, wrong body posture and disturbed biological clock increase the likelihood of lifestyle disorders. The modern occupational setting (desk jobs) and the stress related to work is also being seen as a potent risk factor for lifestyle disorders. As per International Classification of Diseases, (ICD 10) problems related to lifestyle (Z72) includes tobacco use, lack of physical exercise, in appropriate diet and eating habits, high risk sexual behaviour, gambling and betting, anti-social behaviour, sleep deprivation, etc7.
As per Z73 of ICD 10, there are disease conditions where persons are affected by the difficulty in life management such burn out (state of vital exhaustion), behaviour pattern changes, lack of relaxation, stress, inadequate social skills, social role conflict, limitation of activities leading to disability, dual sensory impairments, etc7.
Eating disorders in children and teen can develop anorexia, bulimia, binge eating, etc. most of the causes are witnessed among children of low self esteem and deprivation of parental care. If these conditions are not corrected in time it develops anxiety disorders, depression, and substance abuse in young adult life.
Study reveals, incidence of PCOS is on a rise among 18 to 25 years girls due to faulty lifestyle. Sometimes teenagers and young adults develop life management problems without any definitive causes resulting in neuropsychoendocrinal disease such as migraine, inflammatory bowel disease, ankylosing spondylitis, irritable bowel diseases, allergic rhinitis, rheumatoid arthritis, SLE, scleroderma, etc. These disease condition leads to low productivity, financial burden and the patient becomes more depressed resulting in cluster of psychological, behavioural and cognitive phenomena, and sometimes indulges in various antisocial activities, addictions or substance abuse thus adding fuel to the fire.
Now-a-days the selfie wrist and cervical spondylitis, hardness of hearing from over using earphone, low back pain, high refractive errors all are the gifts of lifestyle that one can’t ignore.
Bargain counter medication and iatrogenic disease
Nowadays, it has become a routine of taking over the counter medication, such as medicines for headache, gastrointestinal upset, constipation, sleeplessness, etc. Their injudicious use increases the burden of diseases among the people. It is witnessed that some medicine taken during the pregnancy directly relates to the increased risk of childhood asthma, childhood epilepsy, childhood obesity, major congenital malformations, musculoskeletal system malformation, VSD, ASD, etc. and thus making the foetus or new born child a victim of lifestyle disorder8.
B. NON-MODIFIABLE RISK FACTORS: Risk factors that cannot be controlled or modified by the application of an intervention can be called non-modifiable risk factors and include:
C. METABOLIC RISK FACTORS: Metabolic risk factors lead to four major changes in the metabolic system that increase the possibility of lifestyle disorders:
i. Increased blood pressure (hypertension): chronic elevation of blood pressure above the normal range. Hypertension is the major contributor to cardiovascular diseases and complications. 13% of total global death is due to raised blood pressure. Blood pressure of 130/90 mm of Hg as per American college of cardiology and American heart association defined as hypertension.
Major risk factors: diabetes, unhealthy diet, physical inactivity, obesity, too much alcohol, tobacco uses, family and genetic predisposition
ii. Obesity – It is a man-made disorder of modern era and responsible for majority of health hazards. Body mass index of more than 30 is regarded as obesity. Increased mortality from obesity is primarily due to cardiovascular diseases, hypertension, gallbladder diseases, diabetes mellitus, polycystic ovary syndrome, several types of cancer such as cancer of oesophagus, colon, gallbladder, bile duct, rectum pancreas, prostate, breast, endometrium, cervix, ovaries, etc. obesity also associated with sleep apnoea, steatohepatitis, gastro-esophageal reflux diseases, osteoarthritis, gout, low back pain, skin infections, depression, hypogonadism etc.
Major risk factors: Obesity can result from increased calorie intake, decreased energy expenditure or a combination of two. Excess accumulation of body fat is also associated with environmental, genetic, social factors and economic condition.
iii. Increased blood glucose levels or hyperglycaemia- Diabetes mellitus comprises of a group of metabolic disorders that shows the common features of hyperglycaemia.
Major risk factors: overweight, obesity, physical inactivity, saturated fat consumption, stress, PCOS, alcohol, tobacco uses, family history of DM and risk factors for cardiovascular diseases comprises the risk factors for DM.
iv. Increased levels of fat in the blood or hyperlipidaemia resulting in coronary heart diseases.
Coronary heart diseases or ischaemic heart diseases is the impairment of the heart function due to inadequate flow to the heart as compared to its need, caused by the obstructive changes in coronary circulation. It expresses itself as angina with exertion or emotional upset, exertional dyspnoea. It may complicate as myocardial infarction, irregularities of heart, cardiac failure, sudden death.
Major risk factors: cigarette smoking, hypertension, hypercholesterolaemia, diabetes mellitus, obesity and family history of coronary artery diseases before age of 55.
Homoeopathic management of lifestyle disorders:
In this era, “a healthy person is one who has not yet been thoroughly examined”. All persons around us are affected by some or other sort of silent killer but not everyone is not suffering from the same fate. If we consider the basic nature of psora, the patients are very anxious about their little ailments and takes medicines for everything. From the early 30s the man, his lifestyle and the internal miasm of the person paves the way to the giant non communicable diseases. The psoric will be the victim of artificial chronic disease. The syco-syphilitic persons will indulge the debauchery, night watching, faulty sexual behaviour, etc. and that will lead to the complications of the diseases. Susceptibility of an individual, mental, physical, social environment (accessory circumstances), constitution, temperament, diathesis and the predominant miasm play a major role in the production of disease. Thus, a comprehensive approach is essential that involves all sectors including health, finance, education, planning and others, to minimise the impact of lifestyle diseases (inappropriately named chronic diseases) on individuals and society. Weight reduction, regular exercise and yoga, behavioural changes, stress reduction, smoking cessation, cholesterol lowering, nutritious balanced diet, stopping the injudicious use of drugs and other substances are the commonly recommended lifestyle modification along with required treatment.
The treatment of lifestyle disorder starts with a meticulous case taking or perceiving the case of disease. A proper investigation of the risk factors, obvious causes, accessory circumstances, constitution, temperament, and underlying miasm is essential for the management of these cases. Medicines should be prescribed only after the removal of the causa occasionalis (where it exists) and as per the totality of each individual case of disease. All these conditions if managed properly not only stop the progress of disease but also cure it10.
Medicines like Aurum metallicum, Calcarea phosphoricum, Staphysagria, Natrum muriaticum, Sepia, Fluoricum acidum, Nitricum acidum, Thuja occidentalis, Medorrhinum, etc. all having their own developmental phase and related to the different phases of life and their sufferings.
From J.T. Kent’s Repertory of Homoeopathic Materia Medica, we can consider some rubrics from “Generalities” chapter as: cancerous affection, narcotics, obesity, onanism from, tobacco, tumors, wine, etc11.
In O.E. Boericke’s Repertory in “Generalities” chapter: abuse of different substances and their effects as: abuse of alcohol, coffee, drugs in general, narcotics, tobacco, etc12.
Some useful rubrics from Robin Murphy’s Repertory13:
HYPERTENSION: Amyl nitrosum, Aurum metallicum, Crataegus oxyacantha, Glonoinum, Lachesis mutus, Natrum muriaticum, Nux vomica, Veratrum album, etc.
CORONARY INSUFFICIENCY: Aurum metallicum, Digitalis purpurea, Crataegus oxyacantha, Viscum album, etc.
CANCER: Arsenicum album, Asterias rubens, Bromium, Bufo rana, Cadmium sulphuricum, Carbo animalis, Conium maculatum, Cundurango, Hydrastis canadensis, Lapis alba, Lycopodium clavatum, etc.
OBESITY: Calcarea carbonicum, Capsicum annuum, Ferrum metallicum, Graphites, Phytolacca decandra, Kali carbonicum, Aurum metallicum, etc.
CHOLESTEROL INCREASED: Calcarea carbonicum, Cholesterinum, Cortison, Sulphur, Insulin, Lycopodium clavatum, etc.
ACID REFLUX, OESOPHAGUS: Arum triphyllum, Carbo vegetabilis, China officinalis, Lac caninum, Lycopodium clavatum, etc.
In Synthesis Repertory, some mental rubrics may be helpful in regarding causes to development of lifestyle and adjustment disorders14:
Mind- AILMENTS FROM: abused; after being: children / physically / sexually. Affection; lack of. Alcohol. Anxiety. Business failure. Contradiction. Debauchery. Embarrassment- poor job performance of. Father absence. Financial loss. Homesickness. Honour; wounded. Job having lost his. Mental shock from. Money; from losing. Rejected; from being. Responsibility- unusual. Sexual abused. Sexual excess. Sexual humiliation. Unhappiness.
CONCLUSION: Homoeopathy, the holistic medicine, may be a unique and effective mode of treatment in the management of the lifestyle diseases in its primordial, primary, secondary, and tertiary level.
ABOUT THE AUTHORS:
Dr Mahakas Mandal. PGT 2nd year. Depertment of Practice of Medicine. The Calcutta Homoeopathic Medical College and Hospital, Kolkata.
Dr Samit Dey. Reader and Head, Department of Repertory. D N De Homoeopathic Medical College and Hospital, Kolkata.
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About the authors
Dr Mahakas Mandal, PGT. Dept of Practice of medicine, The Calcutta Homoeopathic Medical College and Hospital. Kolkata 700009.
Dr Samit Dey,
Professor, Dept. of Repertory, Mahesh Bhattacharyya Homoeopathic Medical College & Hospital, Dumurjala, Howrah