A Prevent Defense - How to Greatly Reduce the Risk of Most Aging-Related Disease
In preparing this special Aging Well issue, we wanted to do a story not on the illnesses associated with aging, but with how to prevent those illnesses: heart disease, dementia, diabetes, high blood pressure, arthritis, osteoporosis and any number of cancers. We braced for a story exploring the leading edge of genomics, customized pharmaceuticals, advanced multidimensional imaging and, we figured, something or other about nanotechnology.
Alas, we were disappointed -- or disabused. A majority of the most conclusive research studies we found on prevention of age-related disease kept pointing to the same things: Get lots of exercise and enough sleep. Eat plenty of fruit, vegetables, lean protein and whole grains; go easy on the fat, sugar and junk. Don't smoke at all, and don't drink alcohol a lot. Relax.
While drugs, supplements and other purported "anti-aging" magic bullets get a lot of attention, the power of simple lifestyle change is well-known in the disease prevention community.
"When you compare people with poor habits to people that have very good habits, you see remarkable differences in how long they live and remarkable differences in their functional status," said David Buchner, chief of the Centers for Disease Control and Prevention's physical activity and health branch. "So it would be common to see 40 to 50 percent differences [in life spans and function] between people that have the poorest habits and people that have the best habits."
"Prevention" of illness isn't really possible, of course. Research shows that certain things you eat or do can substantially reduce your risk of getting, say, Alzheimer's or heart disease. But many other factors influence whether you get sick or not: Family history. Environmental exposure to things we can't avoid or haven't identified. Subtle relationships between genes and environment. Obscure biological processes not yet discovered. In many cases these things are the most powerful determinants of illness. Trouble is, you can't do anything about them.
Until we understand the biology of disease better, all we know for sure is that a very short list of behaviors appears to reduce -- sometimes substantially -- the likelihood that you'll get sick and die too early. As the following report shows, we're basically talking about the eat-right/exercise-often/live-clean stuff you've been trying to deny, ignore or avoid for most of your life.
Unlike some prevention methods whose research is more ambivalent, or which carry risks themselves -- taking aspirin to prevent heart attacks, for example, or drinking wine to reduce heart disease -- the methods we cite are well-documented, almost completely harmless and widely applicable.
As a helpful reminder, we detail some of the most powerful recent findings connecting lifestyle habits and reduced disease risk. We hope it inspires you, or at least usefully annoys you. Until that nanotechnology-enhanced neuroimaging device leads to personalized pharmaceuticals that turn off the aging gene, this is all we've got.
1. BE ACTIVE.
Walking and Dementia A September study published in the Journal of the American Medical Association (JAMA) found that elderly women who walked at least six hours a week or did similar activities had a 20 percent lower risk of cognitive impairment than their least active peers. Another September JAMA study found that older men who walked less than a quarter-mile per day had almost twice the risk of developing dementia as men who walked at least two miles per day.
Exercise and Diabetes The Diabetes Prevention Program clinical trial published in 2002 found that people at high risk for type 2 diabetes cut their risk by almost 60 percent by exercising (about 30 minutes a day) and losing weight (5 to 7 percent of body weight).
Exercise and Osteoporosis Aerobics, walking, weight-bearing or resistance exercises, particularly if they're performed for more than two years, can improve osteoporosis and reduce fractures in women after menopause, according to a 2004 review of literature by the Cochrane Library. Endurance exercise programs lasting six months to two years can prevent or reverse bone loss in postmenopausal women by almost 1 percent per year, according to a 1999 analysis of published studies appearing in Osteoporosis International.
Exercise and Breast Cancer According to a 2003 JAMA report based on the Women's Health Initiative study, increased physical activity for a few hours per week, regardless of intensity, is associated with lowered risk of breast cancer in post-menopausal women.
Exercise and Osteoarthritis A 2001 review published in the Annals of Internal Medicine found that using exercise to strengthen the quadriceps muscles by 20 to 25 percent led to a 20 to 30 percent decrease in the risk of osteoarthritis of the knee.
Exercise and Colon Cancer The Surgeon General's 1996 report on physical activity and health, citing more than 30 studies, concluded that physical activity has a protective effect against the risk of colon cancer. While the association is strong, whether it is due to the activity or the resulting weight loss is unclear.
Exercise and High Blood Pressure The same Surgeon General's report, based on studies on men and women, estimates that those who exercise least face a 30 percent greater risk of high blood pressure compared to those who exercise regularly.
Sloth and Death A December New England Journal of Medicine study found that the combination of excess weight and physical inactivity (less than 3.5 hours of exercise per week) were responsible for 31 percent of all premature deaths among the study's participants.
2. EAT SMART.
Diet and High Blood Pressure A federal study showed that a reduced-salt diet and the DASH diet -- rich in fruits, vegetables, fiber and lowfat dairy, and lower in fats, saturated fats, red meats, sweets and sugared beverages than a typical American diet -- both reduced blood pressure substantially in all demographic groups studied. The two diets together were even more powerful.
Calcium and Colon Cancer A July National Cancer Institute analysis of 10 previous studies concluded that people who get about 1,100 milligrams per day of calcium from food and supplements were 21 percent less likely to get colon cancer than those getting 500 milligrams per day. Among foods alone, drinking more than eight ounces of milk every day was associated with a reduced risk of colon cancer, too.
Diet and Heart Disease A diet comprised of seven types of food -- fruit, vegetables, garlic, wine, fish, dark chocolate and almonds -- among people 50 and over was linked to a 76 percent reduction in cardiovascular disease, according to a study in the December issue of the British Medical Journal. The meal plan added an average of 6.6 years to life expectancies.
Fiber and Heart Disease An analysis of 10 published studies appearing in the Archives of Internal Medicine in 2004 found that for every 10 grams of fiber participants ate per day, there was a 14 percent decreased risk of coronary heart disease and a 27 percent decreased risk of death from heart disease. uit and Heart-Related Death Men who eat more fruit live longer and have fewer cardiovascular deaths, suggests a 2000 European Journal of Clinical Nutrition study. Researchers found that eating fruit daily seemed to lengthen life independent of such other risk factors as high blood pressure, smoking and high cholesterol.
Fruit, Vegetables and Bone Loss Eating alkaline-producing foods -- potassium, magnesium and fruit and vegetables -- helps protect your bones, says a 1999 study in the American Journal of Clinical Nutrition. Researchers found that eating more of these foods increased the hip and forearm bone density of elderly participants taking part in the Framingham Heart Study.
Calcium, Vitamin D and Bone Loss Taking calcium and vitamin D supplements protected women from bone loss in a study published in the December issue of Pharmacological Research.
Diet and Diabetes The Finnish Diabetes Prevention Study found that a healthy diet plays a major role (along with regular exercise and maintaining a healthy weight) in reducing the risk for type 2 diabetes. Participants taking part in the large clinical trial lowered their intake of fat and saturated fat and increased their intake of fiber, according to findings published in 2001 in the New England Journal of Medicine. Those in the lifestyle change group had a 50 percent reduction in the number of new diabetes cases after four years.
Fast Food and Diabetes A study in this month's Lancet found that young adults who ate fast food more than twice a week gained an average of 10 more pounds than and had twice the insulin resistance (a risk factor and frequent precursor of diabetes) by early middle age of young adults who ate fast food less than once per week.
3. CONTROL YOUR WEIGHT.
Obesity and Heart Disease Framingham Heart Study researchers found that obese men were one and half times more likely to develop coronary heart disease than lean men; obese women were twice as likely to develop heart disease as lean women, according to findings published in the American Journal of Cardiology in 2002.
Excess Body Weight and Heart Disease A December study in the International Journal of Obesity and Related Metabolic Disorders found that 47 percent of men's high coronary heart disease risk could be attributed to excess body weight, making it the dominant risk factor for heart disease among men, the authors wrote.
Weight Gain and Stroke A 1997 study published in JAMA found a "direct relationship" between weight gain and stroke risk in women.
4. DON'T SMOKE.
Smoking and Cancer, Heart Disease and Death As if we had to tell you: Tobacco accounts for an estimated 30 percent of U.S. cancer deaths, including the vast majority of lung cancer fatalities. Smoking increases the risk for cancers of the throat, mouth, pancreas, kidney, bladder, cervix and more. Smokers' risk of developing coronary heart disease is two to four times that of nonsmokers. Smokers have twice the risk of sudden cardiac death as nonsmokers. We could go on.
5. GET ENOUGH SLEEP.
Sleep and Heart Disease Harvard researchers, publishing in the Archives of Internal Medicine in 2003, reported that women who got eight hours of sleep per night had the lowest rates of coronary heart disease among studied groups. Those who slept five hours or less per night had a 30 percent greater risk than the eight-hour group; six hours was linked to an 18 percent increased risk.
Sleep Disturbance and Death A federal study in 2003 found that healthy older adults who suffered sleep disturbances -- waking up for 30 minutes or longer on many nights -- had twice the risk of death compared with those who sleep more restfully.
6. CONTROL YOUR STRESS.
Stress and Heart Disease A 2002 study of older adults published in Psychosomatic Medicine found that men with the chronic stress of caregiving for an ailing spouse were twice as likely to develop heart disease as other men.
Stress and Death Stress can reduce blood flow to the heart, and almost triple the risk of death in people with coronary artery disease, concluded a 2002 study in the journal Circulation.
7. LIVE WELL.
Healthy Eating, Regular Exercise, Smoking and Heart Disease Researchers at Brigham and Women's Hospital and Harvard Medical School found that a healthy diet, regular exercise and not smoking were associated with a lower risk of coronary heart disease among women, according to findings from the Nurses' Health Study, published in 2000 in the New England Journal of Medicine. Eighty-two percent of coronary problems that the participants developed were attributed to not following the prescribed diet and exercise habits.
Smoking, Obesity, Exercise and Disability A 1998 New England Journal of Medicine study found that smoking, a high body mass index and little exercise at midlife doubled the risk for later disability faced by lighter, active nonsmokers. Onset of disability was delayed an average of five years in the low-risk group compared to those with the worst habits.
By Craig Stoltz and January W. Payne
Washington Post Staff Writers
Tuesday, January 11, 2005; Page HE01
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