“We who are about to die demand a miracle.”
W.H. Auden
We all have to die, but we don’t have to die prematurely. In Part 1 of this article, the death records of New Jersey dentists were categorized. The results show that, unfortunately, similar to many other Americans, dentists are dying from lifestyle diseases such as cardiovascular diseases, type II diabetes, cancer, and Alzheimer’s disease. These diseases most often manifest in middle age or later. However, this epidemic is, for the most part, preventable. In Part 2 of this article, these lifestyle diseases are now considered, and methods of prevention are examined.
CARDIOVASCULAR DISEASES
Cardiovascular diseases include heart disease, hypertension, and cerebral stroke.
Prevalence: According to federal statistics, more than 690,000 people died in 2002 from heart disease compared to more than 550,000 deaths from cancer.1
Etiology: A recent disclosure by the World Health Organization (WHO)2 stated that 4.4 million people die due to raised cholesterol levels, 7.1 million people die because of hypertension, 4.9 million people die from tobacco use, and 2.6 million people die as a result of being overweight or obese. A 30-year study revealed that 90% of men and 70% of women who start adulthood at healthy weights eventually wound up being either overweight or obese.3,4 A recent study5 of 29,000 people in 52 countries conducted by 262 scientists found heart disease etiology was the same worldwide. They found that 90% of the risk factors (presented in decreasing importance) can be prevented: 1 = ratio between lipid particles ApoB (bad) and ApoA1 (good); 2 = smoking; 3 = diabetes; 4 = hypertension; 5 = fat belly; 6 = stress; 7 = inadequate intake of fruits and vegetables; and 8 = lack of exercise. New research has shown that smoking only 4 cigarettes a day can be fatal.6
Lack of deep sleep leads to an increased production of the hormone ghrelin, which stimulates appetite. A recent study showed that sleep-deprived individuals eat more sweet, salty, and starchy foods.7 Cortisone in high doses and in long-term use can increase fat deposits. Cocaine can cause cardiac arrhythmias and sudden cardiac death. More than 2 alcoholic drinks daily can lead to cardiovascular diseases. The lack of vitamins B6, B12, and folic acid results in high homocysteine levels (related to heart attacks). Depression can lead to heart disease. Streptococcal infections can result in rheumatic heart disease and subsequent subacute bacterial endocarditis.8 A lack of social support can have a negative effect on the cardiovascular system, and with aging, the immune system becomes less effective and arterial calcification often increases.
Prevention (see also General Preventive Methods in “Live Longer, Live Better: Lifestyle Diseases and Their Prevention, Part 1” in the June 2006 issue of Dentistry Today):
(1) Don’t smoke, or stop smoking.
(2) Drink 1 to 2 glasses of alcoholic beverages per day and a few cups of green tea.
(3) Eat sensibly (don’t overeat) and cut down on snacks.
(4) Eat low-glycemic index complex carbohydrates and reduce high-glycemic index complex carbohydrates.
(5) Have most of your fat intake as monounsaturates and omega-3 oils.
(6) Eat nonfat or low-fat dairy products and a minimal amount of red meat (high saturated fat). Substitute white meat and soy products.
(7) Eat dark chocolate, which has cardiovascular benefits. However, too much can lead to obesity.
(8) Supplement with vitamins B6, B12, folic acid, and vitamin C, and the minerals magnesium, calcium, and potassium, all of which have cardiovascular benefits.
(9) Drink 8 to 10 glasses of water daily, which can help in weight loss (if overweight) and decrease the risk of cardiovascular disease.
(10) Exercise. Aerobic exercise improves cardiovascular fitness. About 30 minutes 5 to 6 days a week is sufficient. Prolonged aerobics (1 hour or more) can yield excessive free radicals, which can promote the onset of cardiovascular diseases.9 Regular bodybuilding lowers body fat percentage and increases muscle tissue, both of which can help prevent cardiovascular diseases.
In order to lose body fat and gain muscle most effectively, the following workout order is suggested:
• A 5-minute warm-up such as running (fast walking) on the track (treadmill), or using exercise bike.
• A 15-minute whole-body stretch.
• About a 45-minute bodybuilding workout. This burns carbohydrates for energy if done to maximum effort. If aerobics is done first, you will be too fatigued to give maximum effort at bodybuilding.
• About 30 minutes of aerobics. Since the bodybuilding will have burned the carbohydrates, the aerobics will then burn fat (helps in weight loss). Also, aerobics often gives a burst of endorphins for a natural high.
• A 5- to 10-minute stretch.
(11) Control stress. Meditate or use other relaxation methods every day. These techniques invoke the relaxation response, which can reduce blood pressure, heart rate, and LDL-cholesterol.10
(12) Get adequate sleep.11 Try to sleep from 7 to 9 hours a night. Research has shown that sleeping too little (6 hours or less) can increase the risk for obesity, heart disease, and premature death.
(13) Reduce or eliminate intake of COX-2 inhibitors (eg, Vioxx, Celebrex, Bextra), which have been implicated in heart attacks.
TYPE II DIABETES (ADULT-ONSET DIABETES, INSULIN-RESISTANT DIABETES)
Prevalence: Currently 18 million Americans have diabetes and approximately 800,000 new cases of diabetes are diagnosed annually.12 Most are type II diabetes, and many more diabetics are undiagnosed. In addition, 2 out of 5 Americans age 40 to 74 are prediabetic; they have a 30% risk of becoming diabetic within 3 years and a 50% risk within 10 years.13
Etiology: Type II diabetes results from obesity; elevated triglycerides; low HDL cholesterol; hypertension; cigarette smoking; low intake of fruits and vegetables; high levels of stress;8,14 lack of exercise; metabolic syndrome; amphetamine use (can raise blood glucose level and increase insulin resistance); lack of deep sleep; genetics; and aging.
Prevention: The preventive methods discussed under Cardiovascular Diseases are equally as important for preventing type II diabetes. Since drinking 8 to 10 glasses of water daily helps in weight loss, it can also help prevent type II diabetes.
CANCER
Prevalence: It has been estimated that there will be more than 1,370,000 new cases of cancer in the United States this year, and more than 570,000 deaths.1
Etiology: A recent estimate by the American Cancer Society is that one third of all cancers are related to smoking, and another one third are related to obesity, poor diet, and lack of exercise. Researchers at the American Cancer Society did a 16-year study of 900,000 people who were cancer-free at the start.15 They found that excess body fat could account for 14% of all cancer deaths in men and 20% of those in women. Re-evaluation of the data by Gabe Mirkin revealed that lack of muscle, rather than just having too much fat, causes cancer. Muscles get smaller with aging because of the lack of bodybuilding. Muscle is the main source of protein needed to fight infection and tumors.16
Recent studies17,18 have found that excess weight and physical inactivity together could account for 31% of all premature deaths, 59% of deaths from cardiovascular disease, and 21% of deaths from cancer in nonsmokers. Both increased body fat and reduced exercise were found to be strong and independent predictors of death. Other etiological factors are obesity; smoking and tobacco chewing; excessive alcohol intake; aflatoxins; excess red meat consumption (especially processed meats); pollution; toxins; radiation; viruses, fungi, bacteria, and parasites;19,20 stress; insufficient sleep; lack of social support; sunlight (melanoma); genetics (higher risk for being male, older, and African American); and having type I diabetes.19 Aerobic exercise may decrease the possibility of getting colon, prostate, breast, and endometrial cancers.21 However, as mentioned before with respect to heart disease, prolonged aerobics can yield excessive free radicals, which can promote the onset of cancer and premature aging.9 Regular bodybuilding lowers the percentage of body fat and increases muscle tissue, which in addition to helping prevent cardiovascular disease can also help prevent cancer.
Sarcopenia is a loss of muscle mass that is more prevalent with older individuals. It has been estimated that skeletal muscle mass decreases between 35% and 40% in men and women in the 5 decades of life between 20 and 80 years of age. A recent study examined 200 adults aged 64 to 93 and found that the prevalence of sarcopenia was 22.6% in women and 26.8% in men. Other studies have shown that almost half of men and women more than 80 years old suffer from sarcopenia.22 Sarcopenia results from agerelated declines in testosterone and growth hormone; decreased muscle protein synthesis in the elderly; poor nutritional status in the elderly; lack of exercise (especially of the progressive resistance type); and genetics. Even though aging and genetics might be involved, recent research has shown that sarcopenia can be prevented to a significant degree22 (discussed below). Sarcopenia can lead to fractures, injuries, and falls, which could be fatal. Also, loss of muscle can increase the chance of getting cancer or infectious diseases such as pneumonia. Both outcomes are related to depressed immunity subsequent to lack of muscle protein.22 Several studies have shown that strength training (bodybuilding) in the elderly can improve body composition, increase muscle mass, and prevent and even reverse sarcopenia.
Prevention: The preventive methods discussed under Cardiovascular Diseases and Type II Diabetes can also help prevent cancer. The following methods are also recommended:
(1) Increase insoluble fiber (see also General Preventive Methods in “Live Longer, Live Better: Lifestyle Diseases and Their Prevention, Part 1” in the June 2006 issue of Dentistry Today), which promotes gastrointestinal tract health and may help prevent colon cancer.
(2) Reduce omega-6 oils (polyunsaturates) such as corn, safflower, and cottonseed oils. Excess amounts have been implicated in cancer etiology.
(3) Decrease the intake of red meat and eliminate processed meats such as bacon, bologna, salami, sausages, and hot dogs. The nitrites and nitrates in these foods have been implicated as carcinogens.
(4) Drinking 8 to 10 glasses of water reduces the risk of colon cancer by 45%, bladder cancer by 50%, and can lower the risk of breast cancer.23
(5) Green tea and lycopene (in tomatoes) appear to help prevent cancer.
ALZHEIMER’S DISEASE
Although cancers are debilitating, destructive, and often fatal, at least the individual is aware of his or her surroundings. This is not true with Alzheimer’s disease.
Prevalence: According to the CDC, more than 4 million Americans have Alzheimer’s disesase.24
Etiology: Although the etiology is uncertain, certain predisposing factors exist: excess dietary fat and cholesterol; excessive total caloric intake and obesity; exposure to aluminum; certain viruses, especially Herpes simplex virus 1; head trauma;24,25 and chronic stress. A recent study showed that people who constantly worry had more than double the risk of developing Alzheimer’s disease than nonworriers.26
Genetics is the only definite etiologic factor. Restricted blood flow in the brain could contribute to the series of events that lead to the tangles and clumps of protein in the brain that characterize Alzheimer’s disease. Memory loss and changes in thinking skills and personality are more likely to have occurred when tangles and clumps are accompanied by signs of stroke and narrowed, clogged blood vessels feeding the brain.26,27
Prevention: A new study has shown that doing 4 or more different exercises (eg, swimming, biking, walking, running) reduces the risk of Alzheimer’s disease.27 About 30 minutes of activity 5 to 6 days a week is sufficient.
Other possible preventive methods are as follows:28,29
(1) Perform bodybuilding exercises.
(2) Use relaxation techniques such as deep breathing, yoga, and meditation.
(3) Use other methods to counteract stress (eg, aerobic exercise, have friends, take vacations, have hobbies).
(4) Do mental exercises such as crossword puzzles, flash cards, and chess.
(5) Take stimulating classes and have a stimulating job.
(6) Improve organizational skills.
(7) Have a balanced diet. This includes fruits and vegetables; white meat chicken and turkey; and omega-3-containing fish such as wild salmon.
A MAJOR CONSIDERATION
Considering these chronic diseases, the recent report from WHO30 is frightening and hopefully will awaken the readers of this article. The report stated that ailments such as heart disease, cancer, and diabetes would kill nearly 400 million people over the next 10 years. Lee Jong-Woo, the director-general of WHO, drew attention to the increasing threat from diseases that in part can be prevented by healthier diets and giving up smoking. Until recently, these chronic diseases were overshadowed by infectious diseases such as HIV/AIDS, even though these chronic diseases cause far more deaths. Chronic or noncommunicable diseases account for 3 out of 5 deaths worldwide, the WHO report stated. As has already been discussed, the report emphasized that exercise and better diets (more fruits and vegetables and less saturated fats, sugar, and salt) can help prevent 80% of premature cases of heart disease, strokes, and diabetes, and at least 60% of all cancers.
CONCLUSION
A recent study found that only 3% of a large sampling of Americans practice a healthy lifestyle (not smoking, being normal weight, eating 5 or more servings of fruits and vegetables daily, and engaging in at least 30 minutes of physical activity 5 times a week or more).31 However, it is never too late to begin a positive lifestyle program.
(1) Stop smoking (for smokers). This is essential.
(2) A healthy diet is easy to implement, and healthy food can taste good.
(3) A variety of exercises can be done in your own office; elaborate equipment is not needed. A recent study, which is the first one to determine if exercise helps people live longer, has shown that people who exercise regularly, which means getting a good workout almost every day, can add about 4 years to their life spans.32 (A good diet, not smoking, and controlling stress can add several additional years.) The study was substantial, as it followed 5,000 middle-aged and elderly Americans for more than 40 years.
(4) Learn to relax; meditation is easy to learn and very effective.
Start today to change (unless you are already following a healthy lifestyle). Improved health and a long life are the rewards.
References
1. American Cancer Society. Cancer Facts and Figures 2005. Atlanta, Ga: American Cancer Society; 2005. Available at: http://www.cancer.org/docroot/STT/content/STT_1x_Cancer_Facts__Figures_2005.asp. Accessed April 28, 2006.
2. World Health Organization. Preventing chronic diseases: a vital investment. Available at:
http://www.who.int/chp/chronic_disease_report/contents/en/index.html. Accessed May 16, 2006.
3. Hitti M. Getting older without adding extra weight. WebMD Medical News. Available at: http://my.webmd.com/content/article/113/110593.htm. Accessed May 20, 2006.
4. Vasan RS, Pencina MJ, Cobain M, et al. Estimated risks for developing obesity in the Framingham Heart Study. Ann Intern Med. 2005;143:473-480.
5. Ross E. Study: heart disease causes same globally. Philadelphia Inquirer. August 30, 2004:A9. Available at:
http://www.phillyburbs.com/pb-dyn/news/94-08292004-357250.html. Accessed May 16, 2006.
6. Bjartveit K, Tverdal A. Health consequences of smoking 1-4 cigarettes per day. Tob Control. 2005;14:315-320.
7. Davis JL. Sleep loss feeds appetite: mixed-up hormones lead to munchies, bigger waistlines. WebMD Medical News. Available at: http://my.webmd.com/content/article/98/104617.htm. Accessed May 20, 2006.
8. Giessel BE, Koenig CJ, Blake RL. Management of bacterial endocarditis.
Amer. Fam. Phys., 2000; 61(6). Available at: http://www.aafp.org/afp/20000315/1725.html. Accessed June 7, 2006.
9. Morse D. Surviving Stress: Simple, Safe, Strategic Solutions. College Station, Tex: Virtualbookworm.com Publishing; 2004.
10. Morse D. Electronic Pharmacy of the Mind: Use of Brain Wave Synchronizers and Other Relaxation Methods to Control Stress. Atlanta, Ga: Cryptic Press; 1998:82-84.
11. Stein R. Scientists finding out what losing sleep does to a body. Washington-post.com, October 10, 2005;Health section:A01. Available at: http://www.lef.org/lefcms/aspx/PrintVersion.aspx. Accessed May 22, 2006.
12. Hudnall C. Defying diabetes. AARP Bulletin. 2005;46:22-23.
13. Prevalence and incidence of diabetes. Available at: http://www.wrongdiagnosis.com/d/diabetes/prevalence.htm. Accessed October 10, 2005.
14. Diabetes: type 2 diabetes. WebMD Health. Available at: http://my.webmd.com/content/article/59/66844?z=1667_00000_0000_rl_03. Accessed October 6, 2005.
15. Calle EE, Rodriguez C, Walker-Thurmond K, et al. Overweight, obesity, and mortality from cancer in a prospectively studied cohort of U.S. adults. N Engl J Med. 2003;348:1625-1638.
16. Mirkin G. Lack of muscle increases cancer risk. Available at: http://ezinearticles.com/?Lack-of-Muscle-Increases-Cancer-Risk&id=125751. Accessed June 7, 2006.
17. Hu FB, Willett WC, Li T, et al. Adiposity as compared with physical activity in predicting mortality among women. N Engl J Med. 2004;351:2694-2703.
18. Calle EE, Teras LR, Thun MJ, et al. Adiposity and physical activity as predictors of mortality. N Engl J Med 2005; 352:1381-1384.
19. Buche J. Fungal/mycotoxin etiology of human disease (particularly cancer). Healing Cancer Naturally Web site. Available at: http://www.healingcancernaturally.com/causes6.html. Accessed May 22, 2006.
20. Gross L. The role of viruses in the etiology of cancer and leukemia in animals and in humans. Proc Natl Acad Sci U S A. 1997;94:4237-4238.
21. Aerobic exercise: What 30 minutes a day can do for your body. MayoClinic.com. Available at:
http://www.mayoclinic.com/health/aerobic-exercise/EP00002. Accessed May 23, 2006.
22. Rosick ER. Protecting muscle mass as you age. Life Extension. 2003;9:45-51. Available at: http://www.lef.org/magazine/mag2003/aug2003_report_muscle_01.html. Accessed May 28, 2006.
23. Moore D. The health benefits of drinking water. DrDonnica.com. Available at: http://www.drdonnica.com/today/00007230.htm. Accessed May 23, 2006.
24. Prevalence and incidence of Alzheimer’s disease. Available at: http://www.wrongdiagnosis.com/a/alzheimers_disease/prevalence.htm. Accessed May 23, 2006.
25. Itzhaki RF. Possible factors in the etiology of Alzheimer’s disease. Mol Neurobiol. 1994;9:1-13.
26. Wilson RS, Barnes LL, Bennett DA, et al. Proneness to psychological distress and risk of Alzheimer disease in a biracial community. Neurology. 2005;64:380-382.
27. Grant WB, Campbell A, Itzhaki RF, et al. The significance of environmental factors in the etiology of Alzheimer’s disease. J Alzheimers Dis. 2002;4:179-189.
28. Podewils LJ, Guallar E, Kuller LH, et al. Physical activity, APOE genotype, and dementia risk: findings from the Cardiovascular Health Cognition Study. Am J Epidemiol. 2005;161:639-651.
29. Khalsa DS. Preserving memory as we age. Life Extension. 2005;11:83-85. Available at: http://www.lef.org/magazine/mag2005/nov2005_atd_01.htm. Accessed May 28, 2006.
30. Harnischfeger U. WHO: chronic disease may kill 400M by 2015. Report on UN study, October 5, 2005. Available at: http://abcnews.go.com/Health/wireStory?id=1184865. Accessed May 24, 2006.
31. Reeves MJ, Rafferty AP. Healthy lifestyle characteristics among adults in the United States, 2000. Arch Intern Med. 2005;165:854-857.
32. Franco OH, deLaet C, Peeters A, et al. Effects of physical activity on life expectancy with cardiovascular disease. Arch Intern. Med. 2005; 165: 2355-2360.
Dr. Morse is professor emeritus from Temple University and adjunct professor at Camden County College, where he teaches “Stress Manage-ment” and “Health and Wellness.” In addition to his dental degree, he has graduate degrees in endodontics, microbiology, clinical psychology, and clinical nutrition. He has written more than 250 scientific articles and 16 books, including 4 medical mystery thrillers (the latest is Malprac-tice, PublishAmerica, Baltimore, Md, 2003) and 12 nonfiction books (the latest is Surviving Stress: Simple Safe Strategic Solutions, Virtualbookworm.com Publ, College Station, Tex, 2004). He has lectured throughout the United States and in 30 countries and presents courses on stress management, humor and spirituality in pain management, dealing with dental malpractice, overcoming death anxiety, health and wellness, and fitness for life. Dr. Morse tries to “practice what he preaches.” He has been meditating regularly for more than 30 years, trying to eat healthfully for more than 50 years, and doing bodybuilding and aerobics for almost 60 years. At age 74, in July 2005, he took first place in the Natural USA Bodybuilding Championships for Men Age 70 and Older. Dr. Morse can be reached at dentpsych@aol.com, (856) 795-1360, or publishedauthors. net/donmorse/index.html.
