May 01 2018

A Healthy Lifestyle Matters

I see patients nearly every day who sincerely want to live a healthy lifestyle. Most people want to be healthy and I don’t know anyone who is looking forward to a premature death from a preventable disease. That is why health products and advice are a huge market.

For those looking to adopt healthy habits there is good news and bad news. The good news is that we are among the first generations to have comprehensive scientific data to tell us how to do that. The bad news is that we are also living at a time of massive misinformation, and so many people get distracted from the real scientific answers by slick marketing and ideology.

There is even more good news – you already know the answer to healthy living, and it is mostly simple (maybe not easy, but simple). A new study now confirms with the largest set of epidemiological data on the topic to date what previous studies have already shown. There are five basic lifestyle factors that have a dramatic effect on longevity and the risk of death from heart disease, cancer, or other causes.

The researchers used two datasets –  Nurses’ Health Study (1980-2014; n=78,865) and the Health Professionals Follow-up Study (1986-2014, n=44,354), which means they have data from 34 years with 123,219 subjects. That’s a powerful study. They tracked the correlation between five lifestyle factors – healthy diet, regular exercise, lean body mass, not smoking, and limited alcohol use – with longevity and risk of dying. They found:

We estimated that the life expectancy at age 50 years was 29.0 years (95% CI, 28.3-29.8) for women and 25.5 years (95% CI, 24.7-26.2) for men who adopted zero low-risk lifestyle factors. In contrast, for those who adopted all 5 low-risk factors, we projected a life expectancy at age 50 years of 43.1 years (95% CI, 41.3-44.9) for women and 37.6 years (95% CI, 35.8-39.4) for men. The projected life expectancy at age 50 years was on average 14.0 years (95% CI, 11.8-16.2) longer among female Americans with 5 low-risk factors compared with those with zero low-risk factors; for men, the difference was 12.2 years (95% CI, 10.1-14.2).

So a 50 year old woman who drinks, smokes, is overweight, does not exercise regularly, and has a poor diet overall will die 14 years earlier than someone with none of those risk factors (and for men it is 12.2 years). That is significant. If you look at the full data, there is a fairly linear relationship between the number of risk factors and life expectancy – so each healthy lifestyle you adopt adds a couple years to your life expectancy.

There is a lot more data in the tables and perhaps some interesting side points to make. For example, the more healthy lifestyles people had, the more hours of exercise per week they typically would get. So each factor is not binary, and the more healthy habits someone has correlates with having more significantly healthy habits (exercising more, drinking less, etc.).

There was also a modestly higher daily aspirin use among those with more healthy habits. This is why observational studies like this can potentially have so many confounding factors. People who are generally healthy will engage in many healthy habits that might improve their outcomes. They may, for example, be more compliant with their medications. And of course this works both ways. People who are more compliant with prescribed medications are likely to be healthier in other ways, which makes the medication look good.

Another interesting wrinkle was the fact that more healthy lifestyles correlated with a lower percentage of people taking multivitamins (for women, 73% for zero healthy habits and 57% for five, and for men 43% and 33% respectively). So first of all, that is a lot of people taking regular multivitamins. Most probably don’t need it. Also the inverse correlation has several possible consequences.

First, it suggests that people who are not engaging in healthy habits may be taking a multivitamin because they think it will compensate. But we know from other studies that it won’t. Multivitamins may be giving them a false sense of security and enabling their bad habits. Second, studies that show that regular multivitamin use correlates with poor outcomes may just be seeing this inverse correlation with lifestyle.

This also gets back to my original point – this is also a manifestation of people getting distracted from the real answers with fake answers. Some people who want to be healthy, it seems, opt for taking multivitamins, rather than just eating more vegetables. My favorite example of this, which I have probably mentioned before, was the person who admitted to smoking but then said that they only smoke organic cigarettes, so it’s OK. That is a perfect example of this health decoy phenomenon.

I suspect that most people know that these are five important healthy behaviors. I would add getting sufficient sleep to the list, and it is a shame these data sets did not capture that information. Don’t smoke, don’t drink to excess, eat right, exercise regularly, and don’t be obese. This information is well established in the public consciousness.

However, there is not a lot of money to be made in the fake health and self-help market just repeating this common knowledge. Sure, there are some nuances to explore, but I would argue that for most people (those without special medical needs), not many. The big effects on health and longevity come from the simple basic healthy lifestyles. The only factors that need a little more discussion are – what constitutes a healthy diet, and how optimally to exercise. But even there the obvious basics get you most of the benefit, and there is diminishing returns to finer and finer detail.

It is unfortunate that people get distracted from these basic and clear health factors by fashionable nonsense, self-help gurus, and clever “Goopy” marketing ploys. There is no convincing evidence, for example, for any health benefits from an organic diet, avoiding GMOs, regular multivitamins, avoiding gluten (unless you have Celiac), detoxing, breathing pure oxygen, Himalayan salt lamps, an alkaline diet, eating right for your blood type, not vaccinating, wearing copper or magnetic anything, or taking any of the countless herbs, supplements, or homeopathic potions being sold for billions. All these things do is drain your wallet and give you a false sense of security, which seems to decrease the motivation for adopting truly healthy lifestyles.

These five factors (plus sleep) are the low-hanging fruit with clearly established benefits. That is where we should be focusing our efforts in terms of public health, and for individuals. Also, keep in mind that if you have all five healthy lifestyles at age 50, your life expectancy is 93 if you are a woman, and 87 if you are a man. That is pretty good, and it is unlikely that engaging in any dubious pseudoscience (or anything, really) is going to add much to it. There is probably diminishing returns even to legitimate additional factors at that point, and you have to think about cost-benefit. How much time, effort, and resources would you have to expend to eek out another 6 months or so?

For these five factors, it is clearly worth it, the evidence is solid, and really it is all quite simple (again, not necessarily easy, but at least simple). Don’t smoke, don’t drink to excess, don’t live on steak and cheesecake, exercise regularly, and watch your weight. But you already knew that.

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