The Miracle of a Healthy Lifestyle

Recently, we have been able to reduce a patient's mortality by 20 to 30 percent by treating heart disease with a statin or beta-blocker. These two medications have had the most dramatic effects in secondary prevention. 

But now, the way we practice medicine has changed. We have a real choice to make. According to recent literature, primary prevention appears to work better than any other strategy in medicine. So, why do some physicians not implement primary prevention? Despite the literature, maybe physicians are not getting the news. We need to keep repeating the message to physicians and patients that primary prevention is simple and effective. Next, we need to take a look at our own behavior as physicians and determine if it makes sense in the context of primary prevention.

There are 10 major studies on the effects of primary prevention (Table IJ.-1 15 These studies demonstrate very large correlations between specific healthy lifestyle behaviors and decreases in major chronic diseases (e.g., diabetes mellitus, heart disease, stroke, cancer) and all-cause mortality. Although these studies offer a complex array of data to sift through, the elements of a healthy lifestyle are clear: not smoking, regular exercise, healthy diet, healthy body weight, and reduced stress.

Although exercise guidelines vary, I ascribe to the U.S. Department of Health and Human Services' Physical activity guidelines for Americans, which recommends at least 150 minutes of brisk walking or the equivalent per week. For the diet criterion, the Atherosclerosis Risk in Communities study illustrates that merely consuming five servings of fruits and vegetables per day is associated with the same benefits as consumption of a Mediterranean-style diet. A standard of five servings of fruits and vegetables is much easier to remember and adhere to.

There is strong support for at least one weight-related variable in a healthy life­ style. This may include body weight, body mass index (BMI), waist circumference, or waist: hip ratio. I use BMI as the metric, and a value less than 35 kg per m2 as the cutoff between a healthy and unhealthy lifestyle. The goal is to move away from this outer limit toward a more ideal parameter, such as less than 25 kg per m2•

The final variable of a healthy lifestyle, which has strong support from the INTERHEART study, is stress reduction. The TheINTERHEART study offers useful suggestions for measuring stress-perception of severe stress at home or at work, financial stress, or major life events. The minimal lifestyle intervention that would be beneficial is not defined. However, 15 to 20 minutes of silence, relaxation, or meditation appears to be a common interval. To be more inclusive of patients, I set the criterion to an even less restrictive amount, about 10 minutes per day. 17 This is enough time to produce a change in biorhythms and is achievable for most patients. 

Information alone does not lead to behavioral change. So, our patients need coaching. It may be helpful to point out to them the reported benefits of a healthy lifestyle.  

91 percent reduction in the risk of type 2 diabetes mellitus in women with five healthy lifestyle behaviors compared with no behaviors.

78 percent reduction in the incidence of hypertension in women with healthy lifestyle behaviors compared with no behaviors.

58 percent reduction in the incidence of diabetes with lifestyle intervention, versus a 31 percent reduction with metformin (Glucophage).

The presence of four healthy lifestyle behaviors reduced death from any cause by 65 percent, from heart disease by 77 percent, from other cardiovascular diseases by 67 percent, and from cancers by 68 percent.

Many people, including some providers, underestimate the importance of living a healthy lifestyle. We now have good scientific data that healthy lifestyles can produce greater changes in the incidence of our major disease and in our actual risk of death than any other treatment option. The formula is simple: 0  +   5  +  10  +  35  +  150 = HEALTH.