1. Heart disease (heart attacks)
2. Malignant neoplasm (cancer)
3. Cerebrovascular disease (stroke)
4. Chronic obstructive respiratory disease (emphysema)
5. Unintentional injuries (accidents)
6. Diabetes mellitus
7. Pneumonia
A recent article in the Journal of the American Medical Association (JAMA) describes the "modifiable, non genetic
factors" that contributed to the leading causes of death (Mokdad AH et al. JAMA, March 10, 2004 – Vol. 291, No. 10).
These underlying factors are called the "actual causes of death". The top seven actual causes of death in the US
in 2000 included:
1. Tobacco
2. Poor diet and physical inactivity
3. Alcohol consumption
4. Microbial agents (infection)
5. Toxic agents (poisons)
6. Motor vehicle accidents
7. Firearms
Wellness programs try to focus their efforts on ways to alter the modifiable factors that make up the majority
of the list above. Recommendations include many vigorous lifestyle changes:
1. Stop smoking! (Of course)
2. Eat a more healthful diet
3. Exercise at least 30 minutes most days of the week
4. If one drinks alcohol, use only in "moderation"
5. Don't drink and drive!
6. Get into the habit of washing hands to prevent spread of infection
7. Identify and avoid exposure to toxic chemicals at work and in the home
8. Better driver training and the mandatory use of car safety restraints
9. Laws regulating the purchase and use of firearms as well as firearm safety programs for those who own firearms
Well, most of the items in the above list of lifestyle changes are readily understood, if not easily accomplished. But what
about item number two? What is a more healthful diet? The solution to losing weight and keeping it off seems so simple:
eat less and exercise more! But what diet works? The list of diets goes on and on: Atkins, Mediterranean, South Beach,
Weight Watchers, vegetarian, American Diabetic Diet, Zone, etc. Most of these diets are recommended to lose weight.
However, researchrs often find that even if there is an initial weight loss, with time, the dieter gains the weight back.
No matter which diet one goes on, most people fail to achieve their weight goals and/or maintain the achieved weight
loss for more than a relatively short period of time. Research reveals that most people eventually return to their old
eating habits including eating more calories than they burn up. And what do Americans eat? A recent survey revealed
that about one-third of the US diet consists of "junk food" including sweets, desserts, salty snacks, non-diet soft drinks
and fruit-flavored drinks. What about exercise to burn up those extra calories from the junk food? Well, researchers also
tell us that about 70% of the US public can be classified as living a sedentary lifestyle. As a population we seem to be
doing it all backwards: we are eating more and exercising less!
The poor diet along with a sedentary lifestyle has led to an epidemic of obesity. One-third of the adults in the U.S. are
now considered obese while an additional one-third are classified as at least overweight. The obesity (especially abdominal
obesity) is often associated with hypertension, abnormal cholesterol levels and pre-diabetes which makes up a condition
known as "metabolic syndrome". In the "Wellness Tip" published June 2003, I pointed out that approximately one-third of
middle-aged Americans are now felt to have metabolic syndrome. This condition has been shown to be associated with the
development of (and mortality from) cardiovascular disease and diabetes mellitus.
So… what is a more healthful diet? With so many different diet programs, which recommendations can be considered
as useful advice? Obviously, there is a tremendous amount of ongoing research into what is the best diet to counter
the ongoing epidemic of obesity, metabolic syndrome, and diabetes that is omnipresent in the American population.
At this time, there may not be an "absolute" answer to the question. It may be helpful to review some of the diet
recommendations that are often given to patients with obesity and/or metabolic syndrome. These often include:
• Reduce portion sizes
• Replace non-diet soda, fruit-flavored drinks and juices with water and diet drinks
• Limit "junk" foods (sweets, desserts, salty snacks)
• Consume at least five servings of fruits and vegetables daily
• Choose low-fat over full-fat dairy products
• Increase dietary fiber (legumes, certain fruits and vegetables, whole grains)
• Limit alcohol to no more than two drinks per day for men and one drink per day for women
• Reduce sodium (salt) intake to 2.4 grams per day (use more herbs in cooking and stop adding
salt to prepared food at the table)
• Eat fish (such as salmon) that are rich in omega-3 fatty acids at least once a week
(new food pyramid set to come out early 2005)
Since omega-3 fatty acids were mentioned, I feel I need to include a few points about "trans" fatty acids. The federal
government's advisory panel for the "food pyramid" recently delivered new recommended dietary guidelines. One
recommendation was to avoid eating artificial trans fatty acids (partially hydrogenated oils which are added to many
processed foods). Trans fat is created when hydrogen is added to liquid vegetable oil to create solid shortening.
Many experts consider this form of fat as the most unhealthy of fats because, in addition to raising blood levels
of bad cholesterol (LDL cholesterol), it reduces the levels of good cholesterol (HDL cholesterol). Potential major
sources of trans fatty acids include margarine, chips, fries, cookies, and many processed foods. Under a new
FDA rule, food companies must list trans fat on food labels by Jan.1, 2006. Some European countries have taken
bolder moves. Denmark, for example, has ordered a ban on the use of artificial trans fats in processed foods.
In conclusion, lifestyle modifications are essential to counteract the multiple modifiable, non genetic factors that
contribute to the leading causes of death in this country. Cessation of tobacco use, improved eating habits, and
adequate physical activity are especially important for better health. To educate and motivate the American public
to take these necessary steps will be an ongoing, formidable challenge.
Consultation with your personal physician is encouraged prior to initiating an exercise program as well as for
individualized diet recommendations.