Nutrition Matters to reduce Scotland’s healthcare burden – Dr Wayne Phimister

The growing field of lifestyle medicine, identified in the NHS strategic objectives, is a vital element in disease management. It reduces the financial load on the public purse but, more importantly, encourages practical health solutions for the individual, thus falling within the governmental framework statutorily designated to address personal health in Scotland.

The 2021 NHS Mission Statement is “to provide care and services that we and our families would want to use,” facilitating ease of access to information that informs them about their best health and well-being choices. The vision is “to enable people to live healthier and more independent lives through high quality seamless care”.1

Therefore, citizens deserve professional practices that encourage and foster individual responsibility for their health, focusing on how one eats, drinks, exercises, sleeps, thinks, feels, acts and the supportive environment. Facilitating a personal journey back to health needs to be personalised to support individual efforts.  

Hippocrates said, “All disease begins in the gut”.2 The recent discovery of the human microbiome and its relationship to health starts in the gut and affects all parts of the body through the nervous system, endocrine system and immune system.3-8 Eating nutrient-dense and non-harmful food and beverages, optimal sleep quantity and quality, daily exercise and a supportive environment reduces gut stress, releasing the overtaxed immune system from fighting chronic inflammation and infection, thus returning the body, brain and mind to health.9-11 Targeting this key element for change supports the healing process for each citizen and NHS. 

Background
NHS Education for Scotland (2021) says, “Our mission is to provide education that enables excellence in health and care for the people of Scotland”.12

Public Health Scotland (Nov 2023) has recognised that 30% of health is determined by healthy behaviours, including access to healthy food, minimum unit pricing of alcohol, regulation of tobacco, supporting active lives and quality addiction services.13

The Targeting Health Inequalities paper (Aug 2023) by Strathclyde and Newcastle Universities, the Health Foundation and Health Equity North has identified consuming five or more fruits and vegetables per day as one of the four interim measurement metrics chosen to show a potential reduction in life expectancy, healthy life expectancy, obesity and infant mortality rate.14 I would add that a healthier diet also reduces poor mental health. 

The current healthcare model needs to expand to encompass health and well-being at its core.15-16 

A 25-Year Health Plan
Primary and secondary schools must educate each individual on how to be healthy in each pillar of health, namely diet, sleep, substance reduction, mental health and maintaining relationships, and provide physical education for all students.17

Universities need to prioritise research and educate on healthy living for future healthcare practitioners and leaders.

In particular, medical schools need to integrate teaching on lifestyle medicine so every doctor can educate their patients on making healthier choices to prevent and help treat disease. GPs should educate patients at each consultation on one health-improving behaviour. Consultants can add lifestyle advice on Ref Help to guide all GPs on what to do for each medical condition, e.g. reduce ultra-processed foods and drinks and increase nutrient-dense foods.18 Ref Help is an excellent consultant-led database in Lothian that directs GPs to treat and refer patients for optimal secondary care, which all health boards in Scotland should promote. 

Health behaviours need to be tackled, like minimal unit pricing on alcohol, access to healthy food, regulation on tobacco, quality addiction services, and supporting active lives.15 Mental services must also expand with a culture of Realistic Medicine with compassion, intense listening, and colleague support, which needs to be in primary and secondary care, as the Chief Medical Officer of Scotland summarised in her 2017-2018 annual report.15,19

The Scottish Government should pursue the taxation of ultra-processed foods, the most likely cause of diet-associated disease.9,10 Diet is one of the top 6 causes of the global disease burden and is directly related to 3 other top 6 causes, namely hypertension, high body weight, and high cholesterol.20

The Scottish Government should consider integrating a personalised health plan, like the world-leading ZOE programme, run by Professor Tim Spector from Kings College London, for each adult and adolescent. This will educate and guide each person in individual food choices for health. It will also guide each person on lifestyle measures, such as exercise, sleep, alcohol and mental health strategies to be healthy.  ZOE’s main principles are to eat a flexible, non-restrictive diet low in ultra-processed foods and high in plant diversity to optimise sugar and fat blood levels with microbiome diversity.21,22

Artificial Intelligence (AI) can be used to personalise further health advice tailored to each person. 

Goals of this Plan

• Reduced health inequalities with increased life expectancy, healthy life expectancy, reduced obesity and overweight, lower infant mortality rates and reduced suicide, depression and anxiety rates. 
• Encouragement of patients’ individualised responsibility for their health with a personalised health plan with AI guidance.
• GP retention with an increased sense of accomplishment.
• Shorter waitlists for consultants, investigations and surgeries and shorter wait times in A&E. 
• Nurse retention and better remuneration through economic and accomplishment efficiencies.  
• The Scottish Government demonstrates “Health is Back in the NHS”, and Scotland champions NHS reform via this plan’s optimisation and proof of concept.

Dr Wayne Phimister is a GP with 23 years of experience and a special interest in chronic pain and lifestyle medicine.  He is a previous Assistant Professor of Family Medicine at the University of BC, Canada, and works as an NHS GP locum and private GP. 

References

1. https://mission-statement.com/nhs
2. Lloyd, G. (1983) Hippocratic Writings. London: Penguin.
3. Asnicar F, ‘Microbiome connections with host metabolism and habitual diet from 1,098 deeply phenotyped individuals’, NatureMedicine, 2021 Feb; 27, 321–332. https://pubmed.ncbi.nlm.nih.gov/33432175/
4. Harland J, ‘An update of the evidence relating to plant‐based diets and cardiovascular disease, type 2 diabetes and overweight’. Nutrition Bulletin, 2016 Nov 15; 41(4), 323-338. https://onlinelibrary.wiley.com/doi/full/10.1111/nbu.12235
5. Kearns CE, ‘Sugar Industry and Coronary Heart Disease Research. A Historical Analysis of Internal Industry Documents. JAMA International Medicine, 2016 Nov; 176(11), 1680-1685. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2548255
6. Gwak MG, ‘Gut-Brain Connection: Microbiome, Gut Barrier, and Environmental Sensors’, Immune Network, 2021 Jun 16;21(3):e20. https://pubmed.ncbi.nlm.nih.gov/34277110/

1. Guzel T, ‘The Role of Serotonin Neurotransmission in Gastrointestinal Tract and Pharmacotherapy’, Molecules, 2022 Mar 3;27(5):1680. https://pubmed.ncbi.nlm.nih.gov/35268781/
2. Wiertsema SP, ‘The Interplay between the Gut Microbiome and the Immune System in the Context of Infectious Diseases throughout Life and the Role of Nutrition in Optimizing Treatment Strategies’, Nutrients, 2021 Mar 9;13(3):886. https://pubmed.ncbi.nlm.nih.gov/33803407/
3. Elizabeth L, Machado P, Zinöcker M, Baker P, Lawrence M. ‘Ultra-Processed Foods and Health Outcomes: A Narrative Review’. Nutrients. 2020 Jun 30;12(7):1955. https://pubmed.ncbi.nlm.nih.gov/32630022/
4. Sroar B, ‘Ultra-processed foods and human health: What do we already know and what will further research tell us?’ The Lancet, 2021 Feb 3;32:100747. https://www.thelancet.com/journals/eclinm/article/PIIS2589-5370(21)00027-4/fulltext
5. Tsigos C, ‘Stress: Endocrine Physiology and Pathophysiology’, [Online] 2020 Oct 17. Available from: https://www.ncbi.nlm.nih.gov/books/NBK278995/ 
6. https://www.nes.scot.nhs.uk/about-us/what-we-do
7. https://publichealthscotland.scot/our-areas-of-work/public-health-approach-to-prevention/scotlands-public-health-challenges/
8. https://www.healthequitynorth.co.uk/app/uploads/TARGETING-HEALTH-INEQUALITIES-REPORT.pdf
9. https://publichealthscotland.scot/our-areas-of-work/public-health-approach-to-prevention/the-building-blocks-of-health/
10. https://carnegieuktrust.org.uk/publications/liuk2023/
11. https://bslm.org.uk
12. https://apps.nhslothian.scot/refhelp
13. https://www.gov.scot/publications/personalising-realistic-medicine-chief-medical-officer-scotland-annual-report-2017-2018
14. https://www.healthdata.org/research-analysis/gbd
15. https://podcasts.apple.com/gb/podcast/we-risked-it-all-does-zoe-work-heres-what-our-latest/id1611216298?i=1000635036853
16. Berry SE, ‘Human postprandial responses to food and potential for precision nutrition’, Nature Medicine, 2020 Jun;26(6):964-973. https://pubmed.ncbi.nlm.nih.gov/32528151/

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