The Elements of Good Health Monte Ladner, M.D. www.fitnessrocks.org www.fitnessrocks.org www.fitnessrocks.org

Healthy Lifestyle Habits Arch Intern Med. 2005;165:854-857

Healthy Lifestyle Habits Don’t Smoke BMI 18.5 - 24.9 Five/day 30 minutes/day “ Magic Formula”

A Fifth Healthy Habit? AmJMed March 2008

Chronic Diseases Leading cause of death and disability 45 percent of the U.S. population (125 million Americans) 78 percent of all health care spending http://www.ahrq.gov/news/ulp/chronic/ulpchron1.htm

Leading cause of death and disability

45 percent of the U.S. population (125 million Americans)

78 percent of all health care spending

Causes of Death Tobacco 435,000/year Poor diet/inactivity 365,000/year Excessive alcohol 85,000/year JAMA. 2004;291:1238-1245 Heart Cancer All Other Stroke Lung Alzheimer’s Diabetes Influenza Injury http://www.cdc.gov/nccdphp/publications/aag/aging.htm

Tobacco 435,000/year

Poor diet/inactivity 365,000/year

Excessive alcohol 85,000/year

World Health Organization Estimates of Possible Prevention Estimates of Possible Prevention http://www.who.int/dietphysicalactivity/publications/facts/chronic/en/

Diabetes Prevention Program NEJM February 7, 2002 February 7, 2002

Type 2 Diabetes in Pima Indians Diabetes Care August 2006

Compression of Morbidity

DASH Diet Fruits, vegetables, low-fat dairy, and reduced total fat BP lowered 11.4/5.5 mm Hg in people with hypertension Lowering sodium to 1500 mg/day further reduced BP

Fruits, vegetables, low-fat dairy, and reduced total fat

BP lowered 11.4/5.5 mm Hg in people with hypertension

Lowering sodium to 1500 mg/day further reduced BP

Mediterranean Diet (Mostly Plants) High Consumption of: Fruits Vegetables Beans Nuts Whole grains Olive oil Fish - moderate Alcohol - moderate Low Consumption of: Saturated fat Dairy products Red meat and poultry NEJM June 26, 2003

Mediterranean Diet and Risk of Type 2 Diabetes BMJ 2008;336:1348-1351 83% reduced risk

83% reduced risk

Exercise Capacity and All-Cause Mortality NEJM March 14, 2002 Stronger Predictor Than: Diabetes High Cholesterol High Blood Pressure Smoking

Stronger Predictor Than:

Diabetes

High Cholesterol

High Blood Pressure

Smoking

Exercise Capacity and Cancer Risk Cancer Mortality Hazard Ratios Maximum Treadmill Duration Obesity December 2007

Diet, Lifestyle, and Mortality in Elderly Men and Women JAMA September 22/29, 2004 23% 22% 37% 35% 63% Reduction in 10-Year All-Cause Mortality in People Aged 70 - 90

Still “Magic” After Age 45 AMJMED July 2007 July 2007 5 fruits and vegetables/day BMI between 18.5 - 29.9 150 minutes/week of exercise Not smoking All-cause mortality down 40% Cardiovascular disease down 35%

5 fruits and vegetables/day

BMI between 18.5 - 29.9

150 minutes/week of exercise

Not smoking

All-cause mortality down 40%

Cardiovascular disease down 35%

Genomic Medicine?

Obese Kids One third overweight/obese Increased risk for adult heart disease Kids developing: High blood pressure High Cholesterol Type 2 Diabetes Fatty infiltration of the Liver Ref: Fitness Rocks Podcast 137

One third overweight/obese

Increased risk for adult heart disease

Kids developing:

High blood pressure

High Cholesterol

Type 2 Diabetes

Fatty infiltration of the Liver

Ref: Fitness Rocks Podcast 137

Fitness & Academics Decline in school physical education participation Fit kids score higher on standardized testing - 38% for math and 24% for english Ref: Fitness Rocks Podcast 131

Decline in school physical education participation

Fit kids score higher on standardized testing - 38% for math and 24% for english

Ref: Fitness Rocks Podcast 131