By Professor Kylie O'Brien, Director of Education, ACNEM
ACNEM is committed to educating medical and health practitioners about those nutritional and environmental factors that impact on health.
We have distilled these many factors into four main categories, each of which can positively and negatively impact on wellbeing:
1. Diet and Nutrition
A healthy diet is one in which the nutritional needs of the individual is met and supports the mental and physical wellbeing of that person. When diet and nutrition is not adequate, or harmful, illness can result. Research suggests up to 30-35% of cancer-related deaths are estimated to be linked with diet, with the remainder due to other factors including infections, physical inactivity, stress, radiation and environmental pollutants . Poor diet can lead to overweight and obesity, risk factors for many chronic illnesses including cardiovascular disease, cancer, and many others [2-5]. The western diet is characterised by a high Omega 6: Omega 3 polyunsaturated fatty acid ratio which is pro-inflammatory  whilst other diets eg. Mediterranean Diet are associated with better health outcomes .
The good news is that there is much research evidence on the protective actions of many different diets and foods.
2. Physical Activity
Humans evolved to be physically active; a sedentary lifestyle and inactivity is unhealthy [8, 9] and are risk factors for obesity, chronic illnesses (eg. cardiovascular disease, cancer) and all-cause mortality [10, 11].
On the other hand, physical activity reduces risk of many illnesses and promotes optimal physical and mental wellbeing and healthy aging. Physical activity can reduce risk of many chronic illnesses including risk of developing cancer  and mortality risk (all-cause and cancer-specific mortality) after diagnosis [13, 14]. The benefits of physical activity carry on into old age: a meta-analysis of 9 cohort studies in older adults found a significantly lower (22%) risk of death from all causes in those who engaged in low-dose moderate to vigorous physical activity . Physical activity can lower blood pressure , assist blood glucose control in type 2 diabetics , reduce anxiety and depression, aid sleep, reduce pain, improve immune system functioning and more [14, 18-21].
Good sleep is vital for our health and wellbeing. Sleep helps regulate many of our bodily processes including appetite, memory, hormone levels, cell regeneration, DNA repair, and weight reduction . Sleep is vital for our emotional wellbeing, helping us recover from stress and regulating our emotions [22, 23].
It has been estimated that sleep disorders may contribute to up to 70% of diseases . Poor sleep is associated with many chronic illnesses including cancer [25, 26], cardiovascular disease [27-29], depression [30-32], anxiety , cognitive decline  and decreased immune functioning . You can see why it’s important to get regular, good quality sleep.
4. Environmental Factors
At ACNEM we envisage the concept of ‘environment’ to be broad, encompassing the inner milieu of the body, our personal environment (eg. exposure to stress), our home and office environment (eg. exposure to chemicals), and the global environment (eg. air pollution, pesticides, climate change). Environmental factors can detrimentally affect health . For example, the world’s water supplies and entire food chain are contaminated with chemicals that can damage human brains, reproductive systems and hormonal systems . It is critical that we address the potentially detrimental effects of such environmental factors on health.
Four Pillars of Health and ACNEM Education
In educating healthcare practitioners about nutritional and environmental medicine, ACNEM promotes the Four Pillars of Health as the foundation for a healthy life:
These four pillars of health are a focus of ACNEM’s educational offerings which include webinars, short courses, as well as structured training pathways to gain ACNEM Fellowship. ACNEM also have an annual conference, now in it’s 11th year. The ACNEM 2020 Conference focused on environmental disruptors which featured 8 weeks of online training on our inner environment, personal environment (including stress, physical activity, sleep, breathing), home and office environment, and global environment (still available for purchase).
We have just released a new short course focused on stress (Helping Your Patients Reduce Stress) and are soon to release two more - one focused on the potential health effects associated with electromagnetic radiation, and the other on oral health. These short courses allow practitioners to dive deep into the four pillars of health.
1. Anand P, Kunnumakara AB, Sundarum C et al. Cancer is a preventable disease that requires major lifestyle changes. Pharm Res 2008; 25(9): 2097-2116.
2. Bianchini F, Kaaks R, Vaino H. Overweight, obesity, and cancer risk. Lancet 2002; 3(9): 565-574.
3. Hardy OT, Czech MP, Coervera S. What causes the insulin resistance underlying obesity? Curr Opin Endocrinol Diab Obes 2012; 19(2): 81-87.
4. Mokdad AH, Ford ES. Bowman BA et al. Prevalence of obesity, diabetes, and obesity-related health risk factors. JAMA 2003; 289(1): 76-79.
5. National Institutes of Health. Overweight and Obesity. nd (no date) Available at: https://www.nhlbi.nih.gov/health-topics/overweight-and-obesity [accessed 12 October 2020]
6. Simopolous AP. The importance of the ratio of omega-6/omega-3 essential fatty acids. Biomed Pharmacother 2002; 56(8): 365-379.
7. Benetou V, Trichoploulou A, Orfanos P et al. Conformity to traditional Mediterranean diet and cancer incidence: the Greek EPIC cohort. Br J Cancer 2009; 99: 191-195.
8. Micozzi MS (ed). Complementary and integrative medicine in cancer care and prevention. New York: Springer, 2007.
9. American Institute for Cancer Research (AIRC). Food, Nutrition, Physical Activity and the Prevention of Cancer: A Global Perspective. Washington DC: AIRC, 2007.
10. Lynch B. Sedentary behaviour and cancer: a systematic review of the literature and proposed biological mechanisms. Cancer Epidemiol Biomark Prev 2010; 19(11): 2691-2709.
11. Peterson CB, Bauman A, Gronbaek M et al. Total sitting time and risk of myocardial infarction, coronary heart disease and all-cause mortality in a prospective cohort of Danish adults. Inte K Behav Nutr Phys Activity 2014; 11: 13.
12. Lahart IM, Metsios GS, Nevill AM, Carmichael AR. Physical activity, risk of death and recurrence in breast cancer survivors: a systemative review and meta-analysis of epidemiological studies. Acta Oncol 2015; 54(5): 635-654.
13. Hamer M, Stamatakis E, Saxton J. The impact of physical activity on all-cause mortality in men and women after cancer diagnosis. Cancer Causes Control 2009; 20: 225-231.
14. O’Brien K, Sali A. A Clinician’s Guide to Integrative Oncology: What You Should Be Talking About With Cancer Patients And Why. US: Springer, 2017.
15. Hupin D. Roche F, Gremeaus V et al. Even a low dose of moderate to vigorous physical activity reduces mortality by 22% in adults aged ≥ 60 years: a systematic review and meta-analysis. Br Sports Med 2015; 49(19): 1262-1267.
16. Elley R, Bagrie E, Arroll B. Do snacks of exercise lower blood pressure? A randomised cross-over trial. NZ J Med 2006; 119(1235): U1996.
17. Karstoft K, Winding K, Knudsen SH et al. The effects of free-living interval walking training on glycaemic control, body composition, and physical fitness in type 2 diabetic patients. Diabetes Care 2013; 26(2): 228-236.
18. Conn VS. Anxiety outcomes after physical activity interventions: meta-analysis findings. Nurs Res 2010; 59(3): 224-231.
19. Josefsson T, Lindwall M, Archer T. Physical exercise intervention in depressive disorders: a meta-analysis and systematic review. Scand J Med Sci 2014; 24(2): 259-272.
20. Martinsen EW. Physical activity in the prevention and treatment of anxiety and depression. Nordic J Psychiatry 2008; 62(Supp 47): 25-29.
21. Schuch FB, Cancampfort D, Richards J et al. Exercise as a treatment for depression: a meta-analysis adjusting for publication bias. J Psychiat Res 2016; 77: 42-51.
22. Vandekerckhove M, Cluydts R. The emotional brain and sleep: an intimate relationship. Sleep Med Rev 2010; 14(4): 219-226.
23. Racine C, Kalra K, Ceide M et al. Sleep duration, insomnia symptoms and emotion regulation among black women. J Sleep Dis Ther 2013; 2(122): pii 1000122
24. Samvat R, Osiecki H, Sleep, health and consciousness- a physician’s guide. Queensland: Bio Concepts Publishing, 2009.
25. Jiao L, Duan Z, Sangi-Haghpeykar H et al. Sleep duration and incidence of colorectal cancer in postmenopausal women. Br J Cancer 2013; 108: 213-221.
26. Sigurdottir L, Valdimarsdottir UA, Mucci L et al. Insomnia among elderly men and risk of prostate cancer. J Clin Oncol 2012; 30(5): 78.
27. Laugsand LE, Vatten LJ, Platou C, Jansky I. Insomnia and the risk of acute myocardial infarction: a population study. Circulation 2011; 124: 2073-2081.
29. Cappuccio FP, Cooper D, D’Elia L et al. Sleep duration predicts cardiovascular outcomes: a systematic review and meta-analysis of prospective studies. Eur Heart J 2011; 32(12): 1484-1492.
29. Heslop P, Smith GD, Metcalfe C et al. Sleep duration and mortality: The effect of short or long sleep duration on cardiovascular and all-cause mortality in working men and women. Sleep Med 2002; 3(4):305-314.
30. Johnson EO, Roth T, Breslau N. The association of insomnia with anxiety orders and depression: exploration of the direction of risk. J Psychiat Res 2006; 40(8): 700-708.
31. Baglioni C, Battagliese G, Feige B., et al. Insomnia as a predictor of depression: a meta-analytic evaluation of longitudinal epidemiological studies. J Affect Disord 2011; 135: 10-19.
32. Taylor DJ, Lichstein KL, Durrence HH, Reidel BW, Bush AJ. Epidemiology of insomnia, depression and anxiety. Sleep 2005; 28(11): 1457-1464.
33. Yaffe K, Falvey CM, Hoang T. Connections between sleep and cognition in older adults. Lancet Neurol 2014; 10: 1017-1028.
34. Savard J, Laroche L, Simard S, Ivers H, Morin C. Chronic insomnia and immune functioning. Psychosomatic Med 2003; 65(2): 211-221.
35. Cribb J. Poisoned Planet. Crows Nest: Allen & Unwin, 2014.