This is a recent letter from my Faculty Mentor, Dr. David P. Rakel:
Two studies last week add to the vast amount of evidence of the positive effect lifestyle choices have on disease risk. Tangney, et al showed that eating a Mediterranean diet or a DASH diet were both associated with less cognitive decline in elderly. This was equivalent to reducing cognitive age by 4.4 years. And Akesson, et al showed that those men who practiced 5 healthy behaviors had a 79% less risk of MI when compared to all other men in the study. This number increased to 86% reduction when those men who practiced all 5 were compared to those who did not practice any.
Lets look at some other large studies showing similar results when those who practiced four healthy behaviors were compared to those who didn’t. The behaviors were, 1)Don’t smoke 2)Exercise 3)Eat healthy food 4)Limit ETOH.
• Nurse’s Health Study (n 84,129) = 83% reduction (coronary events)
• Health Professionals F/U Study (n 42,847) = 87% reduction (CAD)
• Women’s Health Study (n 37,636) = 71% reduction (stroke)
• EPIC-Norfolk Study (n 20,244) = + 14 years of life
An ironic limitation of Akesson’s study was that out of 20,721 men, there were 1,361 heart attacks but only 3 in those who met all 5 low risk behaviors making the power suspect. And only 1% of the study population practiced all 5 behaviors. But despite only 3 heart attacks in this 1%, the data was statistically significant.
When we can’t find enough disease for statistical significance in those who practice the healthiest lifestyles, this is a good sign! On the other hand, the researchers could only find 1% of the study population who practiced all five behaviors!!
If we want to influence health outcomes based on strong (some might say burly!) evidence, we need to get better at changing things, not just giving things. This is the potential of inter-disciplinary community health interventions that many of you will be the future leaders of!
1. Tangney CC, Li H, Wang Y, et al. Relation of DASH- and Mediterranean-like dietary patterns to cognitive decline in older persons. Neurology. Sep 17 2014.
2. Akesson A, Larsson SC, Discacciati A, Wolk A. Low-Risk Diet and Lifestyle Habits in the Primary Prevention of Myocardial Infarction in Men: A Population-Based Prospective Cohort Study. J Am Coll Cardiol. Sep 30 2014;64(13):1299-1306.
Dr. Rakel is board certified in family medicine, sports medicine and holistic medicine. He also is certified in interactive guided imagery. He was one of the first graduates of a two-year fellowship in Integrative Medicine at the University of Arizona. He then came to the University of Wisconsin to start the Integrative Medicine program in 2001. He is editor of one of the main texts in the field, entitled Integrative Medicine. He has been awarded a number of teaching awards including the Baldwin E. Lloyd clinical teacher award, the UW Department of Family Medicine faculty excellence award, the Marc Hansen lecture award and the resident teacher-of-the-year award. His interests include learning how the body self-heals, mind- body health influences, sports medicine, nutrition and incorporating health and healing curriculum into medical school education, a project for which he has NIH funding.