Gettysburg Medical News
 The Clinical View
 by P.E. Hoffsten, MD
 28, December 2005

A NEW YEARS RESOLUTION TO CHANGE LIFESTYLES

            In 1950, 65% of the adult population in the United States smoked cigarettes.  Governmental and societal programs to decrease this intensely deleterious health habit have now reduced the number to around 27% of the United States population.  Cigarettes are still a scourge for that group of people but as far as being the scourge of disease for the American people, it has fallen into second place as the habit causing the most disease in our population.

            Emerging as the #1 deleterious health factors in our society is our eating.   The population of the United States eats too much.  The population of the United States eats the wrong kinds of food.  Our consumption of foods that are highly caloric concentrated and foods that consist of refined carbohydrates are the worst diet we could ask for.  Yet this is what our fast food restaurants and prepared foods in grocery stores make most available and easiest.

            Many surveys have shown that the American population believes that the worst aspect of our obesity epidemic is a cosmetic consideration.  People that are overweight do not appear physically as attractive as those that are closer to ideal body weight.  While this is important to the general population, those involved in healthcare see the ravages of disease that is being caused by our obesity epidemic.

            To be specific, overeating, and especially refined carbohydrates and fats, predisposes to an insulin resistance which is the first step before diabetes.  It raises blood cholesterol, lowers the good cholesterol and it causes high uric acid which leads to gouty arthritis.  Overeating leads to high blood pressure, high blood cholesterol, and diabetes account for approximately 75% of all of the heart attacks and strokes that occur in our society.  For every 100 people that die in the United States, 50 of them die of a heart attack or stroke.  Often times, these deaths are preceded by paralysis of one side of the body or heart failure that leave the person short of breath with any effort at all.  Thus, the obesity epidemic is a major factor in the diseased state of our population.

            People in central South Dakota believe that “health is natural”.  Most of us were given a healthy body when we were born and for the first 40-50 years most people paid little attention to the medical aspects of their health.  But that is when the high blood cholesterol, high blood pressure and diabetes is beginning and the price to pay comes in the 40-50’s and later.  When a person gets into the 40’s, 50’s and 60’s, healthcare professionals often see them for checkups and various medications are suggested.  As a healthcare professional working with medications, the clear message I get from most people is that they would rather eat dirt or sleep on a bed of nails rather than take a medicine.  “Medicines just aren’t natural, they have side effects and they are expensive.”

            Well now there are studies that offer an alternative.  Several years ago, I wrote a column showing that lifestyle change was effective in preventing diabetes.  The lifestyle change asked for was a 7% decrease in body weight along with 150 minutes per week of an exercise program.  Granting a 7% decrease in body weight level only has a modest impact on personal appearance:  however, it virtually cut the rate of new onset diabetes in half.

            More recently I wrote a column about the “metabolic syndrome”.  Recall that the metabolic syndrome consists of:  1.  Glucose intolerance “diabetes”.  2.  A low good cholesterol (HDL).  3.   High triglyceride level.  4.  High blood pressure.  and 5.  A waist circumference greater than 40 inches in men or 35 inches in woman.  While diabetes is a strong predictor alone of heart attacks or strokes, if a person has three of the five components of the metabolic syndrome, they have an even higher likelihood of having a heart attack or stroke at a young age.

            A new study, published in the April 19, 2005 issue of the Annuals of Internal Medicine, showed that lifestyle change as described above was associated with a beneficial effect on four of the five components of the metabolic syndrome.

            Stated another way, if you are willing to exercise about 30 minutes, 6 days a week, and lose 7% of your body weight, most people won’t need a medication to treat the diabetes, hypertension, and bad cholesterol problem that they have.  Lifestyle change doesn’t require any insurance forms, there are no medication side effects, there are no drugs and thus no cost, you eat less and thus save money.  This is the start of a new year when resolutions are made and unfortunately, quickly broken.  For those who really mean it when they say they want to avoid heart attacks and strokes, here is the chance to make a resolution that costs no money and has no side effects and you don’t have to take pill.