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It's never too late

MagazineAugust 2014 (Vol. 25 Issue 5)It's never too late

Medicine tells us that once we have a disease, we always have the disease

It's never too late

Medicine tells us that once we have a disease, we always have the disease. But new research has discovered we can reverse chronic disease-and it's never too late to do it
One of the most common beliefs of conventional medicine-and one that sustains the pharmaceutical industry-has been confounded by two important studies over the last couple of months. The take-home message of both studies is simple and elevating: it's never too late. And the small print is almost as heartening-the body is a dynamic, healing system.
Jubilant as it all sounds, it's at variance with the current medical model. That maintains that any damage done to the body, and especially to our heart and its arteries, can't be undone when we're adults, and that symptoms can only be managed by drugs like statins and antihypertensives until surgery becomes necessary.
This dismal view fuels drug company revenues, as the vast majority of their income comes from drugs that manage chronic and intractable health problems like cardiovascular disease and diabetes. We might have been the architect of our fate through poor diet, lack of exercise and smoking, but we can't also be the dismantler of the edifice of ill health that we've created.
That's not true, say researchers from the Northwestern University Feinberg School of Medicine. Anyone of any age who adopts the following five healthy lifestyle choices can control-and even reverse-their heart disease.

1 Keep a healthy body weight
2 Don't smoke
3 Engage in at least 30 minutes of moderate-to-vigorous activity five times a week
4 Don't drink more than one alcoholic drink a day if you're a woman, or two if you're a man
5 Eat a healthy diet, with lots of fresh fruit and vegetables.

Adopting all five and sticking with them for 20 years or more can control, and even reverse, symptoms of coronary artery disease such as calcification and thickening of the arteries. Each healthy option that's introduced reduces the chances of developing cardiovascular disease-and conversely, people who take up an unhealthy habit or lifestyle option, such as becoming obese or starting to smoke, will see their odds increase.1
The Northwestern researchers made their discovery when they assessed the impact of the above five healthy lifestyle choices on 3,538 young adults aged 18 to 30 who, despite their relative youth, were already showing signs of cardiovascular disease and atherosclerosis (arterial hardening). Their symptoms were subclinical-which means they were starting to appear but didn't at that point require drugs or medical intervention.
They were then monitored for 20 years to determine whether they had kept to their healthy options or abandoned them, or started bad habits. By year 20, the cardio health of 25 per cent had improved, and these participants had maintained or even added to their healthy lifestyle choices; in contrast, 40 per cent saw their condition worsen and these had abandoned one or more of the options.
Just 10 per cent of the participants had adopted all of the healthy lifestyle options and stuck with them for the full 20 years, and these had seen their condition reverse.
The finding debunks two of medicine's myths, says lead researcher Bonnie Spring. "The first myth is that it's nearly impossible to change patients' behaviour. Yet we found that 25 per cent of adults made healthy lifestyle changes on their own. The second myth is that the damage has been done-adulthood is too late for healthy lifestyle changes to reduce the risk of developing coronary artery disease. Clearly, that's incorrect. Adulthood is not too late for healthy behaviour changes to help the heart." Conversely, adulthood is not the time to start unhealthy habits either, she says.
The bottom line is that it's never too late. "You're not doomed if you've hit young adulthood and acquired some bad habits. You can still make a change and it will have a benefit for your heart."

It's never too late: when you're 64

And it really isn't ever too late, another study has found. Even if you're 64 and adopt just one of the five healthy options-in this case, losing some weight-you'll see a big improvement in the health of your heart and arteries.2
To demonstrate the point, researchers from University College London (UCL) have been following the health and wellbeing of 5,362 people who were all born in the same week in March 1946 in the UK. In 2010 at age 64, 2,856 were still alive and, for their latest study, the UCL researchers chose 1,273 of them, and compared their weight and body fat to their risk profile for cardiovascular disease and atherosclerosis.
As expected, those who were overweight or obese already had signs of atherosclerosis and high blood pressure as well as diabetes. But the surprise was that those who dropped a body mass index (BMI) category-from obese to overweight, or from overweight to normal-saw their risk of atherosclerosis and heart disease fall as well. And here's the really good news: losing weight
for any length of time has long-term benefits, even if you put the weight back on again later.
"Losing weight at any age can result in long-term cardiovascular health benefits," said lead researcher Prof John Deanfield.

It's never too late: when you're 75-or 85

What about people who are age 75 years or older? It's never too late for them either. Giving up smoking or taking up exercise-even at that advanced age-can add years to your life. If you're a man, you can add six years to your life expectancy, while a woman can add another five if you clean up your act.
The same goes for people who have reached the grand old age of 85. Kick the weed or start walking and, even if you already have a chronic health problem, you can expect to live four years longer than someone else the same age who didn't take up any healthy options.3
This reassuring picture was drawn by researchers from the Karolinska Institute in Stockholm after assessing the lifestyles and longevity of 1,810 people who were at least 75 years old at the start of the study and who were, optimistically perhaps, followed for the next 18 years.
Not surprisingly, 1,661 of the participants died during the subsequent 18 years, although half of them had lived to age 90 or more.
There were some unexpected findings. For one, half of those who smoked lived just as long as non-smokers, and the other half died just a year before non-smokers, although their general health and levels of chronic disease weren't recorded. Many of the non-smokers had once been smokers, but had quit 15 to 35 years earlier.
Exercise was important, of course. Those who indulged in some physical activity-whether it was regular swimming, walking or gym workouts-lived, on average, two years longer than those who did no exercise.
But the biggest boost to longevity was seen in those who had an active social life. Combine that with exercise and you can add another five and a half years to your life expectancy compared with someone who never socializes or exercises. A similar benefit was seen even in those who were already 85 years old; they too could expect to live four years more than antisocial people.
And there's yet another interesting insight: the usual health claims of not drinking and watching your weight seem to be less important the older you are, so by the time you've reached the ripe old age of 85, they hardly matter at all. By then, exercise and social activity are the key determinants of how much longer you'll live.

It's never too late: when you're 100

Reach the magical age of 100 and it seems you get special immunity from all the usual diseases that remove others from this mortal coil. Researchers at King's College London reckon that centenarians develop 'immunity' to heart disease and cancer, the two biggest killers in the West. Instead, they die of pneumonia or of 'old age', although nobody is entirely sure what that means as a cause of death.
Tracking through 35,867 death certificates of people who had died between the ages of 100 and 115, the researchers found that cancer and heart disease were rarely cited as a cause of death. Instead, 28 per cent of deaths were recorded as due to frailty with "old age" and 18 per cent as pneumonia. Cancer was responsible for just 4 per cent of the deaths, and coronary artery disease for 9 per cent.4
Right now, there are over 13,000 centenarians living in the UK, and the King's College researchers reckon that figure will increase to more than 500,000 by 2066.
For them, and for you, it is never too late.

Bryan Hubbard

References
1 Circulation, 2104; 130: 10-7
2 Lancet Diabetes Endocrinol, 2014; doi:10.1916/2ss13-8587(14)70103-2
3 BMJ, 2012; 345:e568
4 PLoS Med, 2014; doi:10.1371/journal.pm ed.1001653


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