Gettysburg Medical News
The Clinical View
by P.E. Hoffsten, M.D.
27 February 2002

LIFESTYLE CHANGE, CHEAPER THAN MEDICINE

     The thrust of these columns is very frequently towards preventive medicine.  It is so much easier to never get a disease as opposed to getting a disease and then trying to treat it.  In America in 2002, unhealthy lifestyle results in more than half of all of the deaths that occur and the majority of medical expense.  What an awesome and paradoxical situation!   A leading social cause of concern is the high cost of medical insurance, drugs and medical bills.  What an abhorrent concept that we are creating our own disease that is costing us so much in comfort, lives, and money.

     An article recently published in a New England Journal of Medicine illustrates how effective lifestyle modification can be.  The disease process evaluated was diabetes mellitus which is epidemic in our society at this time.  The adult form of diabetes which accounts for 90% of all cases doesn’t occur in a day, or a week, or a month, or even year.  By the time adult onset diabetes is diagnosed, the person has had a disease process going on at least 10 years.   The process is slow and begins with over nutrition and under exercise, those same two points that our healthcare professionals have been harping on for years.  As the person eats more than they need and exercises less, their natural source of insulin in their pancreas becomes less effective creating so called “insulin resistance”.  Since the usual amount of insulin doesn’t lower the blood sugar adequately, the body naturally secretes a little more insulin to keep the blood sugar in check.  This process goes on and on and the person’s poor pancreas is being asked to run uphill day after day.  Our bodies were created with substantial ability to increase function when need arose.  But they were not made to face day in and day out stress for years.  Body organs wear out when abused by asking them to function at twice or three times the normal level year after year.  As a person’s weight increases several pounds a year and their exercise becomes less, the pancreas soon wears out and simply cannot make enough insulin to keep the blood sugar down.  It is at this point that the person becomes “diabetic” .  In fact the process has been going on for 10 years before this.  Diabetes occurs slowly but seems to be found quickly.

     The article in the New England Journal of Medicine addressed the question of whether or not medication could prevent the onset of diabetes or whether lifestyle modification could be effective.  We all know that trying to lose weight and exercise more is something often tried and not often achieved.  The question asked was whether those who are effective in losing weight, increasing exercise and improving their general health, succeed better than a medication.  A thousand individuals were identified as having all the characteristics marking them for diabetes in the future.  A third of them were put in a control group and told “best of luck”.  They received no medication or counseling.  Left to their own devices, 40% of them developed diabetes within four years.  A similar group was given a drug called Metformin (Glucophage) at 850 mg twice a day.  They were not counseled regarding lifestyle change.  Only 30% of this group developed diabetes within four years.

       A third group received no medications but instead were provided lifestyle change support whereby they lost 7% of their body weight and exercised 30 minutes per day.  In this group only 20% of the patients developed diabetes.  The exercise consisted simply of walking at about 3 miles/hr or 30 minutes a day.  For a 150 lb person, the weight loss was only 10 lbs   For a 200 lb person, the weight loss was only 15 lbs. and yet these simple steps resulted in the prevention of half the cases of diabetes.

     So here is a program that has no medical expense. There are no side effects or medications,  a person doesn’t have to take a pill each or twice a day, it simply involves saving money on food and half hour walk each day.  The half hour walk has the fringe benefits of preventing osteoporosis, maintaining better bowel function, preventing heart attacks, lowering blood pressures, and it doesn’t cost a dime.  You don’t have to go walk a mile and a half in 30 minutes today.  The needed characteristic is a faithfulness to a program and the willingness to work up ones exercise capability striving for the mile and a half in 30 minutes daily.

       The challenge is there.  A person with a predisposition to diabetes can do nothing and runs a 40% chance of developing the disease within four years and then all the miseries that comes after that.  Alternatively a person can take medication that prevents 10% of the cases, costs $45.00 a month and has frequent side effects.  Or one can exercise dietary control and start an exercise program that is twice as effective as the use of a medication, costs nothing, has no drug side effects, and a lot of fringe benefits.  The healthcare professionals at your local clinics are well aware of this information and to many sound like a broken record with this diet and exercise prescription.  The reason that you keep hearing it is because it works, it’s cheap and there are no side effects.