Discussion Board

I have often referred to these numbers and the importance of prioritizing our efforts. Here is some of the data and the information I have referred to.

Triage:

The determination of priorities for action in an emergency; A process in which things are ranked in terms of importance or priority

The Good:

EPIC is a large study of diet and health having recruited over half a million (520,000) people in ten European countries: Denmark, France, Germany, Greece, Italy, The Netherlands, Norway, Spain, Sweden and the United Kingdom.EPIC was designed to investigate the relationships between diet, nutritional status, lifestyle and environmental factors and the incidence of cancer and other chronic diseases.

Many studies have come out of this database but 2 important ones are..

1) They followed 25,663 Adults, Aged 45-79 Years Since 1993-2006

They found

- Eating 5 servings of fruit and vegetables a Day Gives You the Life Expectancy of Someone Three Years Younger.

- Not smoking turned the clock back by 4-5 years.

- Increasing exercise by a moderate amount takes up to three years off.

Following these three simple changes was the equivalent of adding 10 more healthy years to your life expectancy

Khaw KT, Bingham S, Welch A, Luben R, Wareham N, et al. (2001) Relation between plasma ascorbic acid and mortality in men and women in EPIC-Norfolk prospective study: a prospective population study. European Prospective Investigation into Cancer and Nutrition. Lancet 357: 657–663. Find this article online

Khaw KT, Jakes R, Bingham S, Welch A, Luben R, et al. (2006) Work and leisure time physical activity assessed using a simple, pragmatic, validated questionnaire and incident cardiovascular disease and all-cause mortality in men and women: The European Prospective Investigation into Cancer in Norfolk prospective population study. Int J Epidemiol 35: 1034–1043

2) In a separate study that came out about a year later, they added in alcohol intake and found if someone followed the three behaviors above and limited alcohol intake, it was the equivalent of adding up to 14 more healthy years to your life expectancy.

Khaw KT, Wareham N, Bingham S, Welch A, Luben R, et al. (2008) Combined Impact of Health Behaviours and Mortality in Men and Women: The EPIC-Norfolk Prospective Population Study . PLoS Med 5(1): e12 doi:10.1371/journal.pmed.0050012


In the WHO report,

'Preventing Chronic Diseases: A Vital Investment' 06/06/2005

They found that of the 35 million deaths from chronic disease each year, three most important modi?able risk factors are:

- unhealthy diet and excessive energy intake;
- physical inactivity;
- tobacco use.

And, that these 3 modifiable risk factors cause/lead to the intermediate risk factors of raised blood pressure, raised glucose levels, abnormal blood lipids (particularly low density lipoprotein-LDL cholesterol), and overweight (body mass index 25- 29.9 kg/m2) and obesity (body mass index > 30 kg/m2).

They Estimated that of the 3 most important modifiable risk factors,

-4.9 Mil Die As a Result of Tobacco Use,
-2.7 Mil Die As a Result of Low Fruit/Vegetable Intake,
-1.9 Mil Die As a Result of Physical Inactivity

Added together, these three simple lifestyle behaviors themselves account for over 40% of the lifestyle related premature deaths.

In addition, they estimated that

-2.6 million people die as a result of Excess Weight
-7.1 million people die as a result of raised blood pressure;
-4.4 million people die as a result of raised total cholesterol levels

These add up to almost 24 million deaths per year, which is 65% of the 35 million people who die prematurely from chronic diseases that can easily be prevented by a few simple lifestyle behaviors.

And, as the WHO says that the first 3 cause the second 3, then we can then also say that the first 3 simple lifestyle behaviors themselves could prevent over 65% of the premature death from chronic disease.

They also said, "the major causes of chronic diseases are known, and if these risk factors were eliminated, at least 80% of all heart disease, stroke and type 2 diabetes would be prevented; over 40% of cancer would be prevented."

While these are worldwide figures, lets apply this to just the USA..

In The USA right now

652,000 die from heart disease
559000 die from cancers
143000 die from stoke
75000 die from diabetes

That equals 1,429,000

If we can prevent 80% of heart disease, stroke and diabetes and 40% of the cancer, we can prevent about 928,000 of the 1,429,000. Thats over 65%.

(NOTE: The WHO believes their figures are underestimates of the impact and the real impact would be much higher than just 65% And, these are minimums. What if we looked at 9-12 servings of fruits & veggies, a BMI of 18.5-22, exercising 30-60 minutes 5-6 days per week, and being smoke free?)

That is the good news.

Now, The bad news..

In their report the WHO identified 10 misunderstandings that were obstacles to changing these modifiable risk factors. A few were relevant

1) Chronic diseases are often viewed as primarily affecting old people.

One quarter of all chronic disease deaths occur in people under 60 years of age.

2) The solutions for chronic disease prevention and control are too expensive to be feasible for low and middle income countries (populations).

In reality, a full range of chronic disease interventions are very cost- effective for all regions of the world. Many of these solutions are also inexpensive to implement.

3) Half Truths and kernels of truth. In these cases, the kernels of truth are distorted to become sweeping statements that are not true. Because they are based on the truth, such half-truths are among the most ubiquitous and persistent misunderstandings. Two principal half-truths are refuted below.

“ My grandfather smoked and was overweight and he lived to 96”.

Answer: In any population, there will be a certain number of people who do not demonstrate the typical patterns seen in the vast majority. For chronic diseases, there are two major types: 1) people with many chronic disease risk factors, who nonetheless live a healthy and long life; 2) people with no or few chronic disease risk factors, who nonetheless develop chronic disease and/or die from complications at a young age.

These people undeniably exist, but they are rare. The vast majority of chronic disease can be traced back to the common risk factors, and can be prevented by eliminating these risks.

4) ”Everyone has to die of something"

Answer: Certainly everyone has to die of something, but death does not need to be slow, painful, or premature. Most chronic diseases do not result in sudden death. Rather, they are likely to cause people to become progressively ill and debilitated, especially if their illness is not managed correctly. Death is inevitable, but a life of protracted ill-health is not. Chronic disease prevention and control helps people to live longer and healthier lives.


And more of the "bad"

In 2005, a study was published in the Archives of Internal Medicine, looked at how many Americans actually engage in these healthy lifestyle factors that are known to prevent most of the chronic diseases we die from.

Healthy Lifestyle Characteristics Among Adults in the United States, 2000. ARCH INTERN MED/VOL 165, APR 25, 2005

The surveyed over 153,000 Adults, age range from 18 to 74, through the
Behavioral Risk Factor Surveillance System, of the CDC.

The four Healthy Lifestyle Characteristics (HLC) were

1) Healthy Weight defined as a BMI 18.5 to 25

2) consumed the minimum of 5 Fruits & Vegetables Per Day

3) Engaged in Regular Physical Activity, defined as 30 Minutes, 5x/week

4) Did Not Smoke

For each individual HLC, the numbers were,

Not smoking was about 76%, healthy weight was about 40%, engaging in adequate exercise was 23% as was consuming the minimum fruits and veggies (22%).

However, when you put all 4 together, only 3% (2.8%) of Adults Followed All 4 HLC's.

The highest subgroup (well educated, upper income) was 5%

This study confirms the above.

They monitored 42 847 men in the Health Professionals Follow-up Study, 40 to 75 years of age and free of disease in 1986 for the following 5 healthy characteristics.

- Not currently smoking
- Diet score top 40%
- Exercise ≥30 min/d
- BMI <25 kg/m2
- Moderate alcohol (5–30 g/d) or less

Only 32% practiced any two of the above
Only 28% practiced any three of the above
Only 14% practiced any four of the above

and

Only 4% practiced all 5 Healthy Lifestyle Characteristics

Circulation. 2006 Jul 11;114(2):160-7. Epub 2006 Jul 3.Healthy lifestyle factors in the primary prevention of coronary heart disease among men: benefits among users and nonusers of lipid-lowering and antihypertensive medications.


As does this study, which also confirms the above.

They followed 84,129 women participating in the Nurses' Health Study, 30 to 55 years of age, from 1980-1994 for the following 5 healthy characteristics.

- Not currently smoking
- Diet score top 40%
- Exercise ≥30 min/d
- BMI <25 kg/m2
- Moderate alcohol (< 5g/d)

Only 12.7% practiced any three of the above
Only 7.2% practiced any four of the above

and

Only 3.1% practiced all 5 Healthy Lifestyle Characteristics

Socioeconomic status had no substantial effect on the estimates

Stampfer MJ, Hu FB, Manson JE, Rimm EB, Willett WC. Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med. 2000; 343: 16–22

That is the bad.

Now for the Ugly

In a article published in the NEJM in 2005,

Olshansky, Butler,, NEJM, March 17, 2005

The authors predicted that For The First Time in US History Average Adult Life Expectancy May Be Decreasing. And that Obesity May Shorten Average Life Spans More Than Accidents, Homicides and Suicides Combined

Their famous quote from the study was

“If the childhood obesity problem continues to grow at its current rate, the new generation could be the first in history to have a life expectancy less than its parents.”

In January of this year, a study came out confirming that this has already happened.

3141 Counties Grouped Into 2068 County Units (CU)

Ezzati M, Friedman AB, Kulkarni SC, Murray CJL (2008) The reversal of fortunes: Trends in county mortality and cross-county mortality disparities in the United States. Plos Med 5(4): e66. Doi:10. 1371/journal.pmed.0050066

The looked at 3141 Counties in the USA and Grouped then together Into 2068 of what they called, County Units (CU). They did this to even out populations in the counties groups and ratios of male to females

Between 1983 and 1999 Life Expectancies:
Declined Significantly In 11 CU For Males,
Declined Significantly In 180 CU For Females
Average Decline was 1.3 Yrs

Also, Life Expectancies
Declined In 48 Counties For Males
Declined In 783 Counties For Females
Average Decline Was .5 (Women) and .4 (Men)

This was most prevalent in the Deep South, Mississippi River, Appalachia, Midwest, Texas

The main reasons were Smoking, Poor Diet, Weight, Blood Pressure, & Inactivity.

We can prevent and/or stop about 70% of this by simply not smoking, being at a healthy weight, engaging in regular exercise and eating the minimum recommendations of fruits and veggies. Yet only about 3-4% of Americans do this.

Think about it. Especially in regard to prioritizing, or triaging, our efforts to improve our health and lifestyle behaviors.

What matters most is what matters most.

In Health
Jeff

Thanks for this post Jeff

I would like some clarification on one number:

For each individual HLC, the numbers were, Not smoking was about 50%.

Does that mean that in 2005 50% of the US adult population was still smoking?!! That is really hard to believe. Or does that mean that 50% of the population has never smoked? (Which is also hard to believe - but not as hard)

Or did I get this completely wrong?

No. you got it right, I typed the wrong numbers in. This is the side effect of multi-tasking

I have fixed the numbers above. It was 76% that did not smoke.



There is more supporting evidence which I will add as I get it so keep checking back.

Thanks Again.

In Health
Jeff

Thanks for correcting the numbers and I'm glad to be part or the 2.8% who adopted a healthy lifestyle.

And thanks for all this info in one single post. Great!

Thank you for this reminder, Jeff, substantiated "by the numbers" of the importance of simple lifestyle changes/behaviors/choices that we each can choose to do, to add years to our lives and life to our years. --and how it is up to each of us to do those things, and that we CAN! I want to live long AND be healthy!

I am "only" 67 yo (on August 25th) , and I feel there is a whole lot of life left for me to participate in. I have 17 grandchildren, and now the great grandchildren are on the way, and I have words to write, and places to visit, and people to love.

I appreciate the enhanced/advanced education I have received from your contributions since your forum was added to this board. Thanks!

Well said!!!!
f1jim

This just came out further supporting the dramatic impact of the above 5 lifestyle behaviors on health and longevity.

Arch Intern Med. 2008 Feb 11;168(3):284-90.

Exceptional longevity in men: modifiable factors associated with survival and function to age 90 years. Yates LB, Djoussé L, Kurth T, Buring JE, Gaziano JM.

BACKGROUND: Prospective data on nongenetic determinants of exceptional longevity are limited, and information on long-lived men and their functional status is particularly sparse. We examined modifiable factors associated with a life span of 90 or more years and late-life function in men.

METHODS: In this prospective cohort study of 2357 healthy men (mean age, 72 years) within the Physicians' Health Study (1981-2006), biological and lifestyle factors and comorbid conditions were assessed by self-report with baseline and annual questionnaires. Mortality and incidence of major diseases were confirmed by medical record review. Late-life function was assessed 16 years after baseline by the Medical Outcomes Study 36-Item Short-Form Health Survey.

RESULTS: A total of 970 men (41%) survived to at least age 90 years. Smoking was associated with increased risk of mortality before age 90 years (hazard ratio [HR]; 2.10; 95% confidence interval [CI], 1.75-2.51), and similar associations were observed with diabetes (HR, 1.86; 95% CI, 1.52-2.26), obesity (HR, 1.44; 95% CI, 1.10-1.90), and hypertension (HR, 1.28; 95% CI, 1.15-1.43). Regular exercise was associated with a nearly 30% lower mortality risk (HR, 0.72; 95% CI, 0.62-0.83). The probability of a 90-year life span at age 70 years was 54% in the absence of smoking, diabetes, obesity, hypertension, or sedentary lifestyle. It ranged from 36% to 22% with 2 adverse factors and was negligible (4%) with 5. Compared with nonsurvivors, men with exceptional longevity had a healthier lifestyle (67% vs 53% had <or=1 adverse factor), had a lower incidence of chronic diseases, and were 3 to 5 years older at disease onset. They had better late-life physical function (mean +/- SD score [maximum 100], 73 +/- 23 vs 62 +/- 30; P < .001) and mental well-being (mean score, 84 +/- 14 vs 81 +/- 17; P = .03). More than 68% (vs 45%) rated their late-life health as excellent or very good, and less than 8% (vs 22%) reported fair or poor health (P < .001 for trend). Regular exercise was associated with significantly better-and smoking and overweight with significantly worse-late-life physical function. Smoking also was associated with a significant decrement in mental function.

CONCLUSION: Modifiable healthy behaviors during early elderly years, including smoking abstinence, weight management, blood pressure control, and regular exercise, are associated not only with enhanced life span in men but also with good health and function during older age.

PMID: 18268169

and one more, also from the Nurses Health database.

From Reuters...

Healthy living cuts premature death risk in half
Tue Sep 16, 2008 7:38pm EDT

CHICAGO (Reuters) - Women who heed common sense health messages about smoking, diet and exercise can cut their risk of premature death in half, U.S. researchers said on Tuesday.

Many studies look at the impact of just one lifestyle change on overall health, but researchers at Harvard University wanted to see the total impact of a healthy diet, regular exercise, a healthy weight and a lifetime without smoking.

Dr. Rob van Dam and a team from the Harvard School of Public Health and Brigham and Women's Hospital followed 80,000 nurses for more than two decades.

The women kept detailed records of their diet, physical activity, alcohol consumption, weight, smoking and disease history. Over the study period, 8,882 of the women died, including 1,790 from heart disease and 4,527 from cancer.

Some 28 percent of these deaths could have been avoided if the women had never smoked, the researchers said.

And 55 percent of the deaths could have been avoided if the women had never smoked and exercised regularly, eaten a healthy diet low in red meat and trans-fats and maintained a healthy weight, they said.

Smoking played the biggest role in causing premature death, and alcohol consumption played the smallest, they said.

They found women who drank up to one drink a day had a lower risk of heart disease than those who abstained from alcohol.

"These findings underscore the importance of intensifying both efforts to eradicate cigarette smoking and those aimed at improving diet and physical activity," van Dam and colleagues wrote in the British Medical Journal.


The Official Abstract...

BMJ 2008;337:a1440

Combined impact of lifestyle factors on mortality: prospective cohort study in US women

Objective To evaluate the impact of combination's of lifestyle factors on mortality in middle aged women.

Design Prospective cohort study.

Setting Nurses’ health study, United States.

Participants 77 782 women aged 34 to 59 years and free from cardiovascular disease and cancer in 1980.

Main outcome measure Relative risk of mortality during 24 years of follow-up in relation to five lifestyle factors (cigarette smoking, being overweight, taking little moderate to vigorous physical activity, no light to moderate alcohol intake, and low diet quality score).

Results 8882 deaths were documented, including 1790 from cardiovascular disease and 4527 from cancer. Each lifestyle factor independently and significantly predicted mortality. Relative risks for five compared with zero lifestyle risk factors were 3.26 (95% confidence interval 2.45 to 4.34) for cancer mortality, 8.17 (4.96 to 13.47) for cardiovascular mortality, and 4.31 (3.51 to 5.31) for all cause mortality. A total of 28% (25% to 31%) of deaths during follow-up could be attributed to smoking and 55% (47% to 62%) to the combination of smoking, being overweight, lack of physical activity, and a low diet quality. Additionally considering alcohol intake did not substantially change this estimate.

Conclusions These results indicate that adherence to lifestyle guidelines is associated with markedly lower mortality in middle aged women. Both efforts to eradicate cigarette smoking and those to stimulate regular physical activity and a healthy diet should be intensified.

While I am sure most of do not smoke, avoiding second hand smoke is almost as an important of an issue. In addition, achieving a healthy weight , maintaining an active lifestyle, and consuming a healthy diet (adequate fruits and vegetables) and avoiding or minimizing alcohol intake are extremely important.

In Health
Jeff

I know this is a very old thread but I am brand new and doing my obligatory catch up reading.

I need help with this:



I thought a BMI of less than 25 (within reason) was a good thing. Or am I reading this incorrectly? Could you clarify what the 25 and 30 represent? Or should this read BMI >25 kg/m^2 and BMI >30 kg/m^2?

Thanks!

Correct

That should be overweight = BMI >25, and obesity = BMI > 30

Thanks
Jeff

I'm in the 3.1%! WHOO HOO!

Great article. Gives me some specific targets.

Thanks for putting this up on Facebook. I just discovered that I can be sure to always get your stuff via RSS subscription on Facebook. The articles can even be printed off to .pdf file. This one was a keeper.

The synergy between Dr. McDougall, Jeff Novick, Dr. Esselstyn, Dr. Campbell, Forks Over Knives, Engine 2, and others really seems to be making all of you much more effective.

I still wish you'd write a book. Your essays are excellent.

Thanks for the clarification, Jeff.

Fast Food I just arrived. Have to go watch it now!

well this is inspiring........

i started this diet july 29 2012..its now august 28 and ive dropped a lil over 10 lbs! ive noticed things changing like more energy, my hair and nails definitely look better, my mood has improved and a lot of my MS symptoms are easing!!!

a biggy ive noticed: im not smoking nearly as much! i just dont have the crave. i grab a banana or celery stick instead, although i wasnt aware of this change at first, when i did notice i am now making an honest attempt to quit smoking all together.

ive known for a while that i needed to but i just wasnt ready mentally i guess. eating all this healthy food and feeling better has made me more aware of what goes in my body. so now im slowly givin up the smokes..like 1 cig a day deleted. im down from a pack and a half to just a little over half....

im hopin by the end of 2012 ill be done with them completely.......well thats what im shootin for anyway...so i do have a goal.

the whole smokin thing is a downer anyway. i sometimes think there are more non-smokers than smokers. lets face it them non-smokers arent always nice to us hehehehe, but now i cant really blame them.

i did quit for about 6 months a few years back. i can admit during that time i had to wash ALL my clothes and everything in the house to rid my world of the stink.

another interesting thought:
when i bought this house the previous dwellers were 3 very large people who were heavy smokers. the bathroom walls were a mess. the walls were painted white but had brown marks like someone had dripped beef gravy down them. as i started cleaning and painting i realized it was nicotine. maybe they sat a lit cig in an ashtray in the bathroom as they showered idk. all i do know is that is was gross........and im doin that to my body. even worse do my kids go to school smellin yukky? hows this affecting them or my pets? --gee my pet rat is gettin over a sinus infection now i am thinkin i am the reason........
i have a ton of reasons to quit now! thank u!!!!

In reality, a full range of chronic disease interventions are very cost- effective for all regions of the world. Many of these solutions are also inexpensive to implement.(quote)

That is what is so great about this program. You can eat healthy anywhere and any income bracket.
thanks for everything you teach here.