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Study links four lifestyle habits to reduced risk of major diseases. (Don’t yawn.)

It’s frustrating, at times, to have a conversation with my friends and others about what they’ve decided to do to improve their health.

They tell me excitedly about some supplement or diet or other health fad they’ve just heard about. Surely, this is just the thing that will help them live a healthier and longer life.

Then comes the moment I silently dread. They turn to me and ask, “What do you think?”

Save your money, I tell them. The best thing you can do for your long-term health is change the way you’re living. Now. Exercise daily — with vigor. And be sure to throw in twice-weekly (at least) weight-lifting and stretching sessions. Also, eat a mostly vegetarian diet (lots and lots of fruits and vegetables, only a smidgeon of red meat, and switch to whole-grain carbohydrates — real whole grains, not, for example, brown “wheat” bread that’s dyed to look like whole-wheat bread). Watch your calories — and thus your weight. Make sure your waistline stays flat. And stop staying up so late watching TV. Get more sleep.

Well, I’m probably a little more diplomatic than that.

Everybody is looking for a quick fix for staying healthy. This or that vitamin. Probiotics. “Natural” hormones. Detox diets. Mesotherapy. Oxygen bars. Even eating placenta. But there isn’t a quick fix. To stay healthy into your old age — to avoid diabetes, heart disease, stroke and cancer, the chronic diseases that cause the greatest number of premature deaths in the United States — you need, of course a bit of luck (“good” genes and a good job with health insurance). But you also need healthful habits. It’s that simple. And that difficult.

Most people, I find, are bored by that message. Whenever I start talking about exercise and diet and keeping the pounds off, my friends’ eyes seem to glaze over and the conversation soon drifts on to something else.

The fabulous four factors
Perhaps a study published Tuesday in the Archives of Internal Medicine will give me stronger talking points. Called “Healthy Living Is the Best Revenge,” the study analyzed almost eight years of data from more than 23,000 Germans between the ages of 35 and 65. From that data, it found that adherence to just four lifestyle factors (never smoking, exercising regularly, following a healthful diet and maintaining a healthy weight) was associated with an 80 percent reduction in the risk of developing those four potentially deadly chronic diseases I mentioned above.

During the course of the study, people who had all four healthy lifestyle factors were 93 percent less likely to develop diabetes, 81 percent less likely to have a heart attack, 50 percent less likely to have a stroke, and 36 percent less likely to be diagnosed with cancer.

Even adhering to just one of these healthy behaviors sliced the risk of chronic disease in half.

What supplement is going to give you that kind of return?

The greatest drop in risk was associated with having a BMI of under 30, followed by not smoking, exercising at least three-and-a-half hours weekly, and eating healthy (defined in this study as a high consumption of fruits and vegetables and a limited consumption of meat).

Yes, the study had some limitations. Most notably, participants self-reported how much they exercised and what they ate. And who knows if German data reflects what happens in the United States?

A tough sell
The study’s findings aren’t all that surprising. Plenty of other research has come up with similar results. In fact, as an editorial accompanying the study notes, the same modifiable behaviors have persisted as the leading causes of both premature death and chronic disease for more than a decade, yet we seem unable to persuade “those not already choosing health on their own to join with those who are.”

In a phone interview earlier this week, I asked Earl Ford, M.D., the lead author of the study and a public health official with the Centers for Disease Control and Prevention in Atlanta, Ga., why the healthy-lifestyle message is so difficult to sell to people.

He acknowledged that, except for improvements in the number of people not smoking, “we really are not making a whole lot of progress.” The growing number of people who are overweight and obese is probably inhibiting much of that progress, he added, particularly given the strong association between obesity and diabetes.

“All we can do is hopefully hammer away at [the healthy lifestyle message], and hope that people will maybe see the light and practice as many of these as they can,” Ford said.

We’re going to be pounding at that message for a long, long time, though, as David Katz, M.D., director of the Yale Prevention Research Center, noted (a bit poetically) in the editorial that ran with Ford’s study:

Ford and colleagues have offered us yet another glimpse of a public health promised land. For all concerned with the human condition, the arduous traverse from here to there, from knowledge of what most matters to health to the power of its application, beckons. Across an expanse of policies, practices, programs, personal responsibility, and political will yet to be mustered and in some cases yet to be devised — we have miles to go before we sleep.

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Comments (12)

  1. Submitted by Paul Scott on 08/12/2009 - 12:20 pm.

    “Everybody is looking for a quick fix for staying healthy. This or that vitamin. Probiotics. “Natural” hormones. Detox diets. Mesotherapy. Oxygen bars. Even eating placenta. But there isn’t a quick fix.”

    To which, depending upon the circumstances, one could also add: statins, antidepressants, antipsychotics, back surgery, stents, Ambien, Chantix, reflux meds, functional foods, low-fat foods, full body scans, unwarranted cancer screening, etc. etc. etc.

    The finding that weight is the best predictor is also problematic, given that weight may just be a symptom of a metabolic condition. Necessary but not sufficient, as they say.

  2. Submitted by Cathy Madison on 08/12/2009 - 12:57 pm.

    Best to remember Michael Pollan’s simple (seven words) recipe:
    “Eat food. Not too much. Mostly plants.”

  3. Submitted by dan buechler on 08/12/2009 - 03:10 pm.

    Paul, I agree with you on this 50% but I think you are wrong on back surgery, stents (we pay and doctors profit but overall “results” are good) psychoactive drugs, reflux meds (how would you like to be a healthy active fit 12 year old with reflua, smoking cessation meds. Almost a number #1 rule is most times most people will not change. Compliance is one of the most difficuult issues in patient care.

  4. Submitted by Sheila Ehrich on 08/12/2009 - 03:16 pm.

    When you hit the road at 6:15 in the morning and get back home at 5:30 pm after work, have to be the one to fix dinner, do the laundry, keep the house picked up and clean, as someone living alone does, by the time you’re done doing all that, sitting down with what passes for a newspaper these days sure looks good.

    Exercise needs to be looked at a being more than just “exercise” – walking, lifting weights, streatching. As part of Dakota County’s Simple Steps program, participants are not only supposed to count the minutes they walk, but also the minutes they spend mowing, gardening, doing housework, etc. All things that truly are “exercise” if you’re on your feet the most of the time.

    If you’re carrying laundry upstairs and down, you’re “weightlifting”, maybe not 50 lbs., but you’re carrying weight. If it takes you 30 minutes to mow your lawn with a walk-behind mower, you’ve walked for 30 minutes. If you’ve spent the evening pulling weeds, deadheading, etc., you’ve been streatching.

    More articles that discuss the need for exercise need to point out that these things ARE exercise and so you shouldn’t feel guilty if after mowing the lawn you can’t find time for a walk. Far too often people are de-motivated by seeing the amount of “exercise” they’re supposed to fit into their busy day as being unrealistic.

  5. Submitted by Paul Scott on 08/12/2009 - 06:13 pm.

    Back surgery and stents are no more effective than less invasive methods, according to comparative effectiveness research. Statins are lacking proof of effectiveness for women, men with no heart disease and men over 70, and their benefit for those with heart disease is limited to reducing likelihood of another heart attack but not overall mortality. Antidepressants do not outperform placebos save for the most severely depressed, and even then, their unique benefit is marginal to the point of inconsequence. Antipsychotics, the latest psychoactive drug to become subject to stealth marketing by way of medical journals, are being prescribed at rates that far outpace the organic prevalence of disease. Smoking cessation meds carry a risk of suicidal ideation. Reflux? Raise the bed!

  6. Submitted by Paul Scott on 08/12/2009 - 06:14 pm.

    P.S. Sheila, I couldn’t agree more. Someone should do a study of how many people in a typical health club pay someone to mow their lawn.

  7. Submitted by Ann Spencer on 08/12/2009 - 07:41 pm.

    Sheila, I’m in your corner, and what you’ve said goes double for working parents, who do all the tasks you’ve enumerated, plus help with homework, sign permission slips, read bedtime stories, etc., etc. When the medical establishment upped the exercise guidelines a few years ago from 30 minutes a day, to 60, then to 90, I wondered what planet they were living on. Those recommendations were wildly unrealistic for most people, and the reaction of many, I’m sure, was to throw up their hands, say “the hell with it” and not exercise at all.

    Time magazine has an interesting and controversial cover story this week about the effect of exercise on weight loss (less than is commonly thought according to the article). The article is not saying that excercise is a waste of time; it has many health benefits aside from weight loss. Further, the experts cited in the article recommend exactly the incorporation of exercise into daily life that Sheila describes. This type of steady, consistent, moving around, rather than intense bouts of exercise at the health club, is just as beneficial and does not have the unwelcome effect of making a person hungry enough to eat the woodwork afterwards.

    My husband and I were at an event at our health club a few weeks ago and I wandered through the exercise rooms on the way to the restroom. As I threaded my way through aisles of complicated, bizarre-looking machines, some occupied by humanoids plugged into iPods and staring vacantly into space as they pumped their limbs, I wondered what our ancestors, who did hard physical work every day just to survive, would make of the spectacle.

    As for the wonders of possessing a BMI less than 30, BMI as a measurement of obesity (let alone health) is under increasing attack. It’s a blunt instrument at best. The study the author of this piece cites makes the common mistake of confusing correlation with causation.

  8. Submitted by dan buechler on 08/12/2009 - 08:03 pm.

    Paul, Arguing with you is like being with my older brother. After a strenuous soccer or cross country practice we encourage our kids to have a glass of chocolate milk as read in the mayo news. He says I should feed my kids kale; a bit too pure. Note I did not disagree with you on statins although 1000 people will take them it will have a beneficial for 10 but this is a cost that has been determined (always subject to question) to be worth bearing.
    With stents the case often is “we are in here with angiogram/angioplasty and a stent could be beneficial” its a magic pill rather than poorly hoped for lifestyle changes.
    By the way have you ever tried smoking cessation? Nicotine has been compared to opium in its addictive power. The suicidal ideations could be related to the withdrawal.
    I think your ideas on psychoactive medications are truly dangerous as you seem to place emphasis on mind vs. body rather than brain and body. But I am probably mispeaking and such topics would be better in the articles with two or three doctors. A good idea for future articles. The day will come when diagnostics and tailored meds arrive.
    Now where I most seriously disagree with you is on reflux. For sufferers it can often happen sitting up. It also carries a 1 in 72 cancer risk with erosion if the lower chamber. Minnpost had a truly excellent article on this matter a couple of months ago. Hyperlink anyone? By a young local doctor/researcher who is improving the odds for patients where we don’t have to take a watchful waiting testing mode but can be proactive.
    Respectfully submitted dan b by the way my son is having a mid life crisis he is a teenager. Rejoice in our improved health!!

  9. Submitted by Paul Scott on 08/12/2009 - 09:00 pm.

    Dear Dan, sorry to remind you of your brother with the kale as treat fantasy. For what it’s worth, I fed my kids donuts and cookies today. (Though I broke them apart to reign in the portions, and bought them from a bakery to reign in the trans fats.) Hey, I will give you the reflux point. I know very little about it all, other than wonder how the world survived before Pepcid, which it did. The suicidal ideation with Chantix is real, the FDA just said so. Nothing to do with withdrawal. Neww York magazine ran a harrowing article about it a year ago by a guy who took it spontaneously reported wanting to walk out into traffic. Not everyone gets it of course, But the brain is strangola sometimes. No, I have no mind/body bias. To the contrary, I have simply read the literature about efficacy. (Google Kirsch and Deacon in PLoS medicine last year. Google Healy on the bipolar issue.) In all respect “the day will come when diagnostics and tailored meds will arrive” is what sounds a little scary to me, a little Radioheadlike, Dr. Strangelovian-ish. If we insist on placing our faith in the drug industry to solve our problems, I think we need to watch more carefully what they are selling (a lot of “me-too” drugs), and how they are selling them (expanding off-label uses, studies written by ghostwriting companies and signed by doctors, gee whiz media reports of the sort Gary Schwartz spends his days having to endure,) But I realize you mean it in a hopeful way. Happy to hear about the mid life crisis. My daughter is having hers at 5!

  10. Submitted by Rebecca Hoover on 08/12/2009 - 09:54 pm.

    This is a great article but, unfortunately, I think it makes things a bit too simple to be truly helpful. For example, a healthy diet should include no more than 15 grams of saturated fat each day but it is perfectly possible to follow the advice in this article and eat oneself right into a heart attack or stroke.

    I think we need to have classes in school for kids and teach the details of healthy living. There is more involved than the four simple steps laid out here. For example, it is vital that we teach kids to get enough Vitamin D especially now that about up to 70% of those in the USA probably have lower serum levels of Vitamin D than ideal. We need to offer free adult education in healthy living too.

  11. Submitted by Sheila Ehrich on 08/13/2009 - 12:19 pm.

    Rebecca, I couldn’t agree more. A part of a healthy living curriculum should include lifetime sports like tennis, karate, tai chi, swimming, nordic walking, golf, bowling, cycling, etc., instead of the constant emphasis on team sports. If kids find out at a young age that they enjoy these activities, they are more likely to continue them into adulthood than they are football or wrestling.

  12. Submitted by dan buechler on 08/13/2009 - 02:01 pm.

    Paul it gets easier with kids you are entering the golden age 6-11. As most everyone has noted we are living longer with its attendant problems. I for one think we use too much sunscreen best to avoid a really nasty sunburn but some gradual tanning as few middle class kids seem to be out at noon much anymore would help us with the vitamin D issue. I also think tennis could be made much more enjoyable for everyday by lowering the net 4″ and extending the baseline by 6″ I played at high school level. Also with team sports we got it wrong now we start at 5 or 6 when 8 would be better so they play my god into jr high and their teens. Also pick up or intermaural is making a comeback amongst Hmong youth lets hope it comes back with teens even if it comes at the expense of first graders. Enjoyable reading all and gosh darn it you women are so nice you should comment on politics too!!!

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