Copyrighted 2004, by Steven
Aldana
|
We cannot
become what we need to be by remaining what we are. Max De Pree |
The
Gap
In the past few decades, the amount of scientific information
on the importance of regular physical activity and good nutrition has grown
dramatically. This information has
helped researchers better understand how a healthy diet and regular exercise
affect disease processes and what benefits are available to those who have a
healthy lifestyle. Each day new research
findings are reported in scientific journals, conferences, and press
releases. As new information is
produced, it is added to what is already known, and the entire collection of
findings is reevaluated and critiqued in an effort to determine the best ways
to live our lives. Unfortunately, there
is a huge gap between what is scientifically known about eating healthy and
exercising and what most citizens of the
For example, we now know that over 40% of all cancers are
caused by the typical American diet and that cancer is mostly a preventable
disease. (The Harvard Report, 1996)
Research has shown that if individuals eat five servings of fruits and
vegetables per day, the chance of getting dozens of cancers can be reduced by
half. (Block et al, 1992) Despite this
information, only 20% of Americans consume five servings of fruits and
vegetables a day. (BRFSS, 2002) Equally
important information regarding the importance of regular physical activity has
been reported, yet most Americans fail to get enough physical activity to
receive health benefits. (BRFSS, 2001)
In order to extend life, to improve the quality of life, and to avoid
the onset of chronic diseases, the gap between what is currently known and what
Americans actually do needs to narrow.
What We Know
We all suffer from the normal short-term bumps, bruises,
and illnesses of life, but can you think of any illnesses or conditions that
last for many years, are persistent, and eventually lead to death? Most people list cancer, heart disease,
stroke, arthritis, Alzheimer’s disease, and diabetes. These diseases are called chronic diseases and are responsible for
7 out of every 10 deaths in the
Chronic diseases don’t just happen; they are almost
entirely the result of decades of unhealthy living. This means children, teenagers, and young
adults who eat a typical American diet and don’t exercise regularly are
currently developing chronic diseases such as diabetes and heart disease and
are increasing their risk of cancer. It
is scary to think that children might be developing heart disease, but that is
precisely what is happening. If a person
has a healthy diet, does not smoke, and exercises regularly, the odds of
getting one of these diseases is much lower.
There is no guarantee that if you do have a healthy lifestyle that you
won’t get chronically ill, but the odds are heavily tilted in your favor.
Figure 1 shows the results from a variety of studies that
have evaluated the relationship between healthy lifestyle and several chronic
diseases. The bars indicate the
percentage of all cases of the diseases listed that could be prevented. Let’s put this into perspective. Each year in the
Figure 1 Percent of Selected Chronic Diseases
That Are Avoidable
Sources: Stampfer, 2000; Platz, 2000; Hu, 2001
Some
might say that if you prevent chronic diseases, you prevent death, and if you prevent
death, you live forever. Well, no one is
claiming to have a surefire way to avoid the grim reaper, and preventing
chronic diseases does not mean preventing death, but it does mean you can
determine, in large measure, how and when you will die. In fact, more than likely you have already
done this: Have you ever taken an
antibiotic? Have you ever been in a car
accident and been wearing a seatbelt?
Have you ever been vaccinated or had surgery? If you have, than most likely you have
delayed the time of your death.
The
exact impact of healthy living on lifespan is not known, but several very large
studies have provided some fairly accurate estimates. Let’s assume that you decide to eat meat no
more than once a week. Would that affect
how long you live? A review of all
studies on this topic show that on average you would gain almost four years of
life compared to those who eat meat more than once a week. Similar studies have been completed on other
risks:
|
People
who: |
Live an
Extra: |
|
Eat meat less than once per
week |
3.6 years |
|
Are vegetarian |
1.5 years |
|
Exercise regularly |
2.4 years |
|
Eat nuts five times a week |
2.5 years |
|
Are not diabetic |
6.6 years |
|
Have normal blood pressure |
3.7 years |
|
Maintain normal weight |
11 years |
Sources: Singh, 2003; Frazer, 2001;
Fontaine, 2003
The differences in lifespan
shown here are independent of each other, meaning that if you changed just one part
of your life, like exercise, there is an increase in the lifespan associated
with that one change. What happens in
you change several aspects of your lifestyle?
Let’s assume someone eats meat less than once a week (3.6 years),
exercises regularly (2.4 years), eats plenty of nuts (2.5 years), and has
normal blood pressure (3.7 years). What
could happen to his or her lifespan? One
could roughly estimate that the total years saved by not having these health
risks equals 12 years (3.6+2.4+2.5+3.7=12.2 years). In reality, these calculations are not exact,
but they are possible given the amount of scientific data that support
them. These additional years don’t tell
us how many years life will be extended, but they do tell us that if you were
to compare the lifespan of someone who maintained this lifestyle with someone
who did not, the difference would be around 12 years.
There are several populations located in the
What about Genetics?
There
are some chronic diseases that are not lifestyle related. These are generally caused by an inherited
genetic mutation or a toxic environment.
Genes certainly play a role in the disease process, but that role is
much smaller than you might believe. (Winkelmann,
2000) Within some families a gene that
causes cancer or heart disease at an early age may be passed from generation to
generation. These particularly
aggressive genes can affect many members of a single family line and, though
they almost always cause disease, they are rare—less than 5% of all cases of
cancer and cardiovascular disease fall into this category. Other genes, which
are not quite so aggressive, can also cause these diseases, but just carrying
the gene doesn’t mean you will develop the disease.
These
weaker genes, called polymorphisms,
can only cause health problems if they have the right environment. If you were a polymorphism and you wanted to
develop into a disease, you would want to be found in someone who ate a typical
American diet, didn’t exercise much, and smoked, because this type of lifestyle
would create an environment within the body that encourages unhealthy
genes. On the other hand, when these
less aggressive genes are surrounded by a diet of fruits, vegetables, and whole
grains, they have difficulty reproducing successfully and cannot cause life
threatening conditions. Just because you
inherit a gene that is known to cause problems doesn’t mean you are destined to
get it. Most genes can only express
themselves if they have the right environment.
This is another way a healthy lifestyle can prevent chronic diseases.
Living Well Up to the Very
End
There
are more benefits in living healthy than in preventing chronic diseases and in
postponing death. The type of life you
live is just as important as how long you live.
Many researchers study factors that contribute to the goodness and
meaning of life as well as peoples’ happiness and contentment. These factors refer to a person’s quality of life. Besides avoiding chronic diseases, people who
have a healthy lifestyle often report having more energy, feeling more
productive, having less stress, and being able to cope better with the demands
and trials of everyday life. They are
able to maintain a healthy body weight and to enjoy all of the social,
physical, and psychological benefits that come from not being overweight or
obese. One of the most important
benefits of living well is the improvement of quality of life that occurs in
the later years of life. Every year the
average lifespan in the
At
some point in the later years of life, most people experience a significant medical
event. This could be a broken hip, a
stroke, bypass surgery, or cancer. From
that point until death, quality of life and the ability to function physically
is dramatically reduced. (Lubitz,
2003) The amount of illness and
limitations that occur between this medical event and death is called the
end-of-life morbidity. (Fries, 2002)
This relatively unhealthy portion of life precedes death for
everyone. Research into the impact of
living a healthy lifestyle on end-of-life morbidity tells us that there are
even more benefits to healthy living. (Wang, 2002)
Individuals who eat right and exercise throughout their
lives live longer. They still experience
significant medical events toward the end of life, but on average the events
are delayed between 7–13 years, and the time between the events and death is
shortened. (Hubert, 2002; Fries, 2001)
The term used to explain this phenomenon is called compression of
morbidity. Major illness and significant
physical and functional limitations still occur, but they don’t seem to span as
long a period of time, and they occur closer to the time of death. I like to joke with students and tell them
that by living a healthy lifestyle, I plan to die at the age of 94 while skiing
with my great grand kids. I will probably
hit a tree, suffer a significant medical event (fractured skull), slip into a
coma (significant physical and functional limitation), and die a week or two
later. Now that’s high quality living
and real compression of morbidity!
Realistically, those with a healthy lifestyle will live longer, suffer a
serious medical event much later in life, and have a shorter period of time
between the event and death than if they did not have a healthy lifestyle. It’s as if living a healthy lifestyle allows
you to live a full, rich life well into old age at which time you become ill,
experience a rapid decline in health, and pass away.
Extension
and improvement of life is possible because of the avoidance of chronic
diseases. By providing the body with the
correct diet, and exposing it regularly to the physiological and physical
status that comes from regular exercise, the processes that lead to the onset
of chronic diseases stop. These
disease-preventing processes occur at the cellular level within the body. Even if you have not been eating well or
exercising in the past and chronic diseases processes have begun, you can still
stop the progression—suggesting that it is never too late to change your
lifestyle. Ideally these diseases should
be prevented, but, even if you have certain chronic diseases, a healthy
lifestyle may be able to reverse the disease process and repair damaged
tissues. (Esselstyne, 2001, 1999; Ornish, 1998,
Gould, 1995) Besides all of the
medication and treatment options that are available, many physicians are
realizing that a healthy lifestyle is important to prevent, arrest, and even
reverse many chronic diseases. Some
research has shown that a healthy diet and an active lifestyle can have a
greater treatment effect than most of the common medications that are routinely
prescribed. (Diabetes Prevention Program Research Group, 2003; Knowler et al, 2002; Aldana et al. 2002)
How to Live
The
next chapter explains why it is so difficult to determine what lifestyles are
the best and why much of the information you hear is sometimes contradictory
and confusing. So, how can you be sure
that what you are about to read is not another pitch from just another health
expert who thinks he knows what is best for you and your health? I am only a messenger. Though I have contributed to the body of
scientific research on the importance of a healthy lifestyle, the information
presented here is an up-to-date summary of all that is currently known. This information comes from the best
scientists and researchers worldwide who have devoted their lives to
understanding how to achieve good health.
If you reject this information, you reject the advice from the brightest
and wisest minds in the world.
Every
day new research on diet and exercise is reported at scientific meetings or
published in scientific journals.
Sometimes this new information fits nicely with previously discovered
concepts, but, unfortunately, research sometimes produces results that force us
to think in ways that may not completely match what was previously
thought. This is why recommendations for
physical activity and good nutrition are updated and refined constantly.
The
recommendations for physical activity and nutrition are simple to understand
and follow. This book is designed to help
you understand why the current recommendations are accurate and vital to good
health. Be warned that in the years to
come more information will be gathered that will force even these
recommendations to be adjusted, but I wouldn’t expect any drastic changes.
Hundreds of scientists and health professionals
studied thousands of scientific results and concluded that in order to attain
the most benefits from physical activity all
individuals should accumulate 30 minutes or more of moderate intensity physical
activity on most, preferably all, days of the week. This is it—decades of research, hundreds of
millions of research dollars, all condensed into one simple statement. (Surgeon
General, 1996) This statement does not
reveal how a sedentary lifestyle can lead to premature death and disease and
what happens to your body when you do exercise.
This information is found in subsequent chapters. This physical activity recommendation seems
simple, but few people get enough activity to get the benefits because in
today’s society it is difficult to stay physically active. That’s why several chapters are devoted to
helping you adopt a physically active lifestyle and maintain regular activity
for the rest of your life.
What should you eat to enjoy good health benefits? Thousands of research studies can be
summarized in the Healthy Eating Pyramid. (Willet, 2001) This pyramid is different from the Food Guide
Pyramid you already know because it is based on the most current and complete
scientific literature. It is not
influenced by any dairy, meat, produce, or other special interest group with a
vested interest in seeing a particular food displayed more prominently on the
pyramid. It is based entirely on science
and not on a combination of science and business/lobby interests.
Adapted from
(http://home.comcast.net/~cnmpat/images/HealthyEatingPyramid.gif)
You’ll notice that this
Healthy Eating Pyramid starts with a foundation of physical activity and
healthy body weight. These are placed at
the bottom because they are of critical importance to good health. Perhaps the most notable impression this
pyramid gives is that the healthiest foods are generally foods in their natural
form as grown without heavy processing or alteration. I’m keenly aware that some of you are looking
at this recommendation and are rapidly entering a state of shock. Your current diet may look nothing like this
and you have no desire to change it. I
sympathize with you and appeal to your sense of fairness. If, after reading the rest of the evidence
presented in this book, you still have no desire to make even small changes in
your diet, I respect your traditions and opinions, and thank you for your
attention. Some see this pyramid and
think, “I’m doing pretty good, look at all the foods on that pyramid I already
eat!” You will find the evidence that
supports this type of diet is so compelling that it motivates you to do even
better, and the better you do, the more benefits you
will receive. This book contains helpful
tips and strategies you can use to help you make positive changes in your diet
and physical activity that will bring improvements in your health.
How Are We Doing Now?
Throughout
this book the most current information regarding healthy lifestyles and chronic
diseases is provided, but to understand the importance of this information, it
is good to know what our country’s current lifestyles are. Each year the federal government conducts
national health surveys to assess the health status of the nation. The information from these surveys helps us
see trends and identify areas where the public needs to be informed and
educated about important health concerns.
The organization responsible for these studies is the Centers for
Disease Control (now the Centers for Disease Control and Prevention) which provides a hint to how our national focus is
changing.
Let
me throw out a few tidbits about common health risks, and you draw your own
conclusions about our current health status:
1
out of 4 adults smokes
1
out of 3 adults has high blood pressure
1
out of 3 adults has high blood cholesterol
2
out of 3 adults are overweight or obese
2
out of 3 adults fail to get enough exercise
4
out of 5 adults need to significantly improve their diets
Over the past 40 years fewer people have smoked, but
blood pressure, blood cholesterol, and exercise participation have remained
relatively unchanged. Over that same
period, the number of overweight American children has quadrupled—more than 15%
of all grade school children are overweight today; as people age, the problem
gets much worse. (BRFSS, 2002) In 2002,
72% of all adults in the
How Did We Get This Way?
Before the 1900’s, the average American spent most hours
of the day preparing meals, and gathering, growing, harvesting, and preserving
food. Animals and humans provided the
labor required for daily subsistence.
Physical labor was the norm. The
primary mode of transportation was walking.
It was common for someone to walk for miles to communicate, transact
business, or purchase supplies. The
foods consumed were very close to their natural form because processing was
unavailable or expensive. For example,
flour used in most bread was whole wheat, not the bleached white flour used
today. Fruits, vegetables, grains, and
cereals were the source of most carbohydrates and fats consumed and meat was
eaten sparingly. (Brown Bread, 1937, Liu, 2003)
There has been a drastic change in dietary and physical
activity patterns in the past 100 years.
Rather than walking, cars and public transportation have become the
dominant modes of travel. Physical labor
is still the norm for some construction workers, farm laborers, and
manufacturers, but many Americans, both young and old, spend much of the day
sitting in chairs either at work, school, or play. According to the U.S. Census in 2000, half of
all homes have computers and internet access (and chairs to go with those
computers). In addition to computer and
video game time, 26% of
Washing machines, garage door openers, golf carts,
television remotes, microwave ovens, bread mixers, dish washers, and escalators
help us avoid activity. We work
diligently to avoid physical activity and inventors have done a fabulous job of
developing labor-saving devices which make our lives easier and leave us more
leisure time. Chances are you drive
around the parking lot of a store or office until you find the parking stall
that is closest to the door you wish to enter.
We work hard to avoid exertion.
Advances in technology, machines, and societal changes have altered our
lives to such an extent that the causes of death so common a century ago have
been almost entirely replaced by diseases of affluence—chronic diseases
associated with an unlimited supply of inexpensive food and little need for
physical activity.
Some
of the most evident changes in our society are in the types and amounts of
foods we eat. We now enjoy a tremendous
variety food and are confident that most foods are safe and protected from
toxins and bacteria. Virtually any food can be acquired at any time of the
year. But, compared to 100 years ago,
today’s diets consists of less fiber, fewer fruits and vegetables, and more
meat, sugar, fats, and vitamins. (Nestle, 2002, Ministry of Agriculture,
1990) Foods as they
naturally occur, such as fruits, vegetables, and whole grains, are still
available, but the pressure to purchase processed, rich-tasting convenience
foods is intense. In our free
market society, those who can produce, market, and sell foods that people want
can influence public nutrition for better or worse. These marketing campaigns are extremely well
funded, carefully targeted, and highly effective. To see if any of these marketing campaigns
have affected you, take the following quiz. Read the corporate slogans and see
if you can finish the slogans by filling in the missing word or words. The answers are found at the end.
You
deserve a break today at McDonalds.
Have
it your way at Burger
King.
Yo Quiero Taco
Everything’s
better with Blue
Bonnet on it.
Finger Lickin’ Good.
Betcha
can’t eat just one.
Breakfast of Champions.
M
& M’s melt in your mouth and not in your hand.
Snap!
Crackle! Pop!
Sometimes you feel like a nut, sometimes you don’t.
McDonalds, Burger King, Taco Bell, Blue Bonnet, Milk,
Good (KFC), One (Lay’s potato chips), champions (Wheaties),
M&Ms, Pop! (Kellogg’s Rice Krispies), sometimes
you don’t (Peter Paul Mounds)
Isn’t
it amazing how we remember slogans for food products we may not even like after
years of radio and television advertising?
The effective marketing of food permeates nearly every aspect of our
lives. We see food promoted
everywhere—strategically stacked at checkout stands, and beautifully depicted
in newspaper ads, cleverly incorporated into television shows and radio
ads. Pervasive morning television
commercials specifically target children by advertising foods high in sugar and
low in nutritional value. A daily news
and current events program called Channel One is viewed by 8.3 million school
children every day. Schools pay nothing
for the televisions, installation, or programming, but children must watch the
program and the fast food commercials that support it. Virtually every school district receives
lucrative contracts with food vendors if they agree to house vending machines. Visit any junior high or high school, and you
see rows of vending machines promoting all sorts of yummy candies, soda, and
high fat foods children love to eat. Who
can resist?
Adults
are also targets of primetime television commercials displaying fabulous
buffets, endless refills, juicy meats, and serving sizes easily sufficient for
two. Regardless of where you live in
Some
would say that as long as no one is being forced to consume unhealthy foods and
individuals are free to choose, then the individual and not the producers of
food should be blamed for the obesity and chronic disease problems. Our communities and environments are so
inundated with food advertising and marketing that it is extremely difficulty
to eat healthy when healthy choices are not available, and you are under
tremendous marketing pressure to do just the opposite. When was the last time you saw a primetime
television commercial promoting fresh fruits, vegetables, or whole grains?
Change Is Possible, But It
Isn’t Easy
If
the benefits of a healthy lifestyle are so great, why don’t more people eat
right and exercise regularly? Eating and
exercising are basic human behaviors. A
behavior is nothing more than a human response to some stimulus. When we feel hungry we eat. Eating is the response or behavior that
results from the hunger stimulus. Since
everyone has to eat, the real decision is in choosing what to eat. Local culture, money, education, time, and availability
of food all help us determine what to eat, and changing this decision-making
process is difficult. Some people don’t
change because they may not have had the opportunity to learn what a healthy
diet consists of, how much exercise is enough, and how these two lifestyles are
directly related to the causes of death, disease, and a poor quality of
life. Even if people know why they
should live a healthy life, lack of motivation, time, social support, and
environmental pressure to eat unhealthy foods and to be sedentary overwhelm our
abilities to change.
Eating
and exercising behaviors are not unlike our financial behaviors. Most working adults are under pressure to use
all of their current income for things that are important to them. Of all working adults, only 44% voluntarily
participate in any form of retirement savings because other, more pressing
needs require any funds that might be saved. (Employee Benefit Research
Institute, 2002) But as working adults
get closer to retirement age, the number of individuals who are actively saving
for retirement increases dramatically.
Retirement, like chronic diseases, doesn’t happen till later in life,
but must be planned for early in life if individuals want to adequately prepare
for the future. For many, changing the
types of food eaten is hard, getting regular exercise is even harder, and
maintaining a healthy weight is a losing battle.
Most people, when confronted with the most
current information on diet, exercise, and disease, will at least begin to think
about their own lives and how they might start to live better, and thinking
about making change is the first step.
But to get the benefits of a healthy lifestyle, new behaviors need to be
adopted. To help you overcome the
difficulty of changing behaviors, the last part of this book gives you the
skills, ideas, and practical know-how to adopt healthy lifestyles and maintain
them for life. One of the most common
questions students ask when starting an exercise program or making dietary
changes is, “How long do I have to do this?”
This is a good question, which I usually answer with another question,
“How long do you want the benefits?” The
benefits come relatively quickly and last for as long as the healthy foods are
eaten and physical activity is enjoyed.
One
man, attempting to adopt a healthy lifestyle, concluded that it wasn’t worth it
because if he followed this advice for 50 years, the time he spent exercising
would add up to one year—about the amount of time his life would be extended,
or so he figured. It wouldn’t be worth
it because he would have to spend a year exercising to gain one year of extra
life. He decided he’d rather be
sedentary and die a year earlier. This
interesting analytical justification for not
exercising is only partially accurate.
Sure, a 20-year-old who exercises regularly will spend about one year in
physical activity by the age of 70, but this does not result in the simple
addition of one year of life with an accumulated year of exercise. The benefits of regular physical activity are
much greater. Individuals who are
physically active have an average lifespan closer to three years longer than
individuals who are sedentary, and the quality of life enjoyed by active
individuals is considerably better. It
is difficult to imagine how spending time hiking, golfing, walking with
friends, or working in the yard could be all that bad.
After
hearing a lecture on the importance of living a healthy lifestyle, two
participants came by my office. The
first, a 20-year-old male college student, came in to complain that he was not
interested in changing his diet or getting exercise because he felt great, he
could eat whatever he wanted, live however he wanted, and he generally felt
great all the time. He even gladly
reported that his blood pressure was perfect, his cholesterol was low, and he
didn’t smoke. Right now he didn’t have
any major health problems and most likely wouldn’t for another 30 years. He was not convinced that he should do
anything differently, especially if what he was currently doing was working
fine. He finished by saying, “‘If it ain’t broke, don’t fix it’, and even if I do have problems,
I’ll just have the doctor fix me up.”
The second individual was a 58-year-old female who had
raised a family and now lived at home with her husband. Like most over age 50, she was by definition
obese, had high blood pressure, high blood cholesterol, and was recently told
by her physician that she had diabetes, and that she would likely be diabetic
for the rest of her life. When she heard
her doctor’s diagnosis she was shocked.
Something must have happened in the past 30 years because when she was
twenty, she could eat anything, exercise if she wanted, and was always thin and
healthy. After hearing both of these
stories, I introduced the young man to the woman and let them visit for a few
minutes. The need to adopt a healthy
lifestyle is important for all ages, but the level of motivation for changing
is somewhat dependent on age.
You can do this; others already have. The long life spans of Mormons and
Seventh-Day Adventists show that it is possible. Studies of diabetics, cardiac patients,
cancer patients, obese, children, college students, adults, and even seniors
have shown that regular exercise and a healthy diet can be achieved at any age
and in any health condition. More
importantly, these new behaviors can be maintained for years.
In
the 1900’s the advent of antibiotics dramatically changed public health and
death as it was then known. Infectious
diseases, which used to be responsible for almost 30% of all deaths then, are
responsible for just 2% of deaths now. (Jacobs, 1985) This dramatic improvement in public health
can now be repeated. The adoption of
healthy lifestyles can have a greater national impact on chronic disease and
death than any other single factor known in all of medicine. This transformation starts with you.
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