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An Ounce of Prevention

Author: Steven Levenberg, D.O.
October, 2014 Issue

It’s estimated that 40 to 50 percent of the influence on our risks for developing a variety of chronic illnesses is the result of lifestyle choices.

Here in the developed world, we’re seeing tremendous advances in treating chronic illness. But we’re losing the battle in terms of prevention: Chronic illnesses like type 2 diabetes, high blood pressure, various heart conditions and others are cropping up with increasing frequency. It’s estimated that 40 to 50 percent of the influence on our risks for developing a variety of chronic illnesses is the result of lifestyle choices—all things over which we have total control. Medical intervention accounts for only 10 percent influence on those risks. Family history is just that: history. We can’t change it.
Let’s examine some of those lifestyle factors that contribute to our increased risks and the ones that can reduce them. The message is remarkably simple. You’ve all heard it: “An ounce of prevention is worth a pound of cure.”
Type 2 diabetes is truly the poster-child condition for the effect of lifestyle on risk. Quite simply, this is a story about excess: excessive calories and excess weight coupled with too little activity. The prevalence of obesity has increased dramatically in every state over the last 50 years, and the increase in type 2 diabetes parallels that progression.
In type 2 diabetes, the capacity of the pancreas is eventually just exhausted over time from supplying too much insulin to a body that’s too large and is trying to process too many calories. At some point, blood sugars start to rise above normal, a condition we now call “pre-diabetes.” Changes in lifestyle at that point—with calorie reduction, increased exercise and real weight loss—can sometimes turn things around, but often it’s too little, too late, and we see things progress on to overt diabetes.
The moral of this story?
Avoid excessive amounts of calories, keep your weight in an ideal range and exercise regularly. It seems too simple and, in that form, it’s never going to get an hour’s worth of airtime with Dr. Oz. But it’s your most potent ounce of prevention.
Of course, there’s more to the story and more detail about each piece. With regard to diet, we’re bombarded with claims, hype and some measure of hokum every day, at every turn. It’s hard to find the simple truth in all that babble. Michael Pollan, renowned writer and researcher on food and nutrition, sums it up in one simple adage: “Eat food. Not much. Mostly plants.” Real food, mostly unprocessed and unpackaged, is where you find the most nutrients in forms that are most effective without added sugar, salt or questionable chemical additives. Avoid excess, and minimize the role of animal products and animal fats in your diet. Generally, animal products are where we find the greatest burden of oxidants and free radicals that can be damaging to tissues, organs and blood vessels and may actually increase our cancer risks. Vegetables and fruits of many colors, not supplements, contain the most potent antioxidants that help prevent that damage and minimize those risks.
With exercise, more is probably better, but some moderation is important, too. In pooled data from some of the large U.S. weight loss programs, about 2,000 calories of exercise per week (five hours of vigorous walking) was what it took to help people actually keep their excess weight off. That’s similar to many other recommendations for 40 to 50 minutes of activity five to seven days per week. Where moderation is important is in avoiding high-impact activities such as those that injure joints and the spine, predisposing us to arthritis later in life.
Avoiding tobacco smoke is vitally important to reduce the increased risks of lung cancer, lung disease, high blood pressure, heart disease and stroke. Other kinds of smoke may be just as damaging to the lungs.
Wearing a seatbelt when in a vehicle is crucial and wearing a helmet when bicycling is important, too. Riding in a vehicle is the biggest immediate health risk for most of us.
Other lifestyle factors that can also have an influence on risk for chronic illness: Avoiding excessive intake of alcohol is critical, but moderate intake (one to two drinks a few days per week) may actually contribute to health. Avoiding dangerous drugs and risky sexual behavior is critical. Having interests (family, hobbies, friends, interesting work, spiritual beliefs) can contribute very positively to health. Adequate rest and good sleep is very important.
Many advances have been made in allowing us to live longer, but true prevention through lifestyle improvement is the key to being healthier in our later years.  
Dr. Steven Levenberg, a member of Sutter Medical Group of the Redwoods, is board certified in the specialty of family medicine. He’s been in practice for 30 years, in Cotati and Rohnert Park since 1989, and is a native of Santa Rosa.


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