How to Prevent Heart Disease, Cancer, Diabetes, Alzheimer's and Arthritis

How to Prevent Heart Disease, Cancer, Diabetes, Alzheimer's and Arthritis.

Ross Finesmith MD

The delivery of healthcare in the United States provides the most advanced treatment options and highest quality of care in the world. However, there are often limitations in applying our scientific knowledge to healthcare and disease prevention. The abundance of medical guidelines and treatment recommendations directed towards busy society often results in overwhelming information and most people can not independently identify the proven strategies.

The current focus in improving healthcare is the maintenance of good health and the prevention of disease. Disease prevention strategies described in this paper provides accepted guidelines that target prevention of the first onset of symptoms related to specific disease states. The aim is to identify and reduce disease-promoting risk factors at an early age.

It is evident that promotion of healthy lifestyles and prevention of chronic disease states not only requires changes in diet and behavior, but also physical and social influences.

Weight Management

Maintaining, or achieving, appropriate weight is critical for reducing the risk or preventing many health conditions. An individual’s healthy weight can be determined using height and weight in a calculation of the body mass index (BMI). This essentially calculates the appropriate weight a person should weigh, based on height. The National Institute of Health (NIH) provides an easy to use BMI calculator on their website. [1]

A sedentary lifestyle for many people starts in the workplace. There are more employment settings than ever before that require virtually no physical activity.  The advent of the computer and automated machines has contributed significantly to this health risk. A recent study of 878 participants, were monitored with an ambulatory accelerometer to record sedentary time through out a workday.  It was reported that greater activity during the day has similar results on adiposity measurements as working out 3 times a week. Several subsequent studies have confirmed these findings. [2] [3] [4]

Generally accepted guidelines issued by healthcare organizations are provided in the table below. Health care organizations include: Department of Health and Human Services, American Heart Association, American College of Sports Medicine and Surgeon General Reports.

Routine Healthy Lifestyle Guidelines

Target Behavior		Health Recommendation
Diet [5] [6] [7]	Calories	1600-2400 cal per day-Women
		2000-3000 cal per day-Men
	Fruits & Vegetables		Whole grains	3-4 1 oz. servings per day
	Fish	2-3 servings of 3.5 oz. per week
	Sugar	<100 cal per day-Women	Approx. 36 oz. of soda or juice
		<150 cal per day-Men
	Sodium	<1500 mg per day
Physical Activity [8, 9]	Aerobic	150 min moderate exercise per week	Walking, swimming
		or 75 min vigorous exercise per week	Running, Stairmaster
	Resistance	2-4 times per week	Weights, calisthenics
Tobacco [10]		No use is recommended
2nd hand smoke[11]

Diabetes-type II and Obesity

Obesity is a prominent risk factor for developing type II diabetes, but is also the highly responsive to intervention. There is a direct relationship between the progression of obesity and risk of developing diabetes. [12] Approximately 50% of individuals with type II diabetes are obese.[13] There is also a correlation between weight loss and a reduction in diabetes risk. For every 1 kg weight lose in obese, type II diabetic patients, one study reported a 3-4 month prolonged lifetime survival.[14, 15]

In patients at-risk for developing type II diabetes mellitus, a recent study reported a strong association between the amount of time a person is sedentary throughout the day to the risk of developing CVD. An inactive lifestyle is a more significant indicator of poor health and diabetes risk than even regular exercise.[16] [3]

Coronary artery disease-Atherosclerotic cardiovascular disease.

Atherosclerotic cardiovascular disease (CVD) develops gradually and progressively impairs blood flow to the heart and most organs in the body. Symptoms do not manifest until the plaques have disrupted vital oxygen delivery to tissue resulting in a heart attack or stroke. Lifestyle and behavioral habits greatly increase the risk of heart disease and therefore early preventive measures have a great impact on a person’s life span. Smoking, poor diet habits, limited physical activity and stress are the leading recognized contributing lifestyle related risk factors for developing CVD.[17-20]. Although many studies have shown CVD preventions effective in middle age and older patients, there is also substantial evidence that preventive strategies in childhood effect and prevent adult cardiovascular disease.[21, 22] Therefore, promoting regular exercise, healthy diets, limited salt intake and no tobacco use are crucial for avoiding CVD.

Major risk factors for developing heart disease are; BMI >25 kg/m² , physical inactivity, hyperlipidemia, hyperglycemia and hypertension. BMI is essentially a measured proportion between your height and weight. 

Significant psychosocial risk factors are; social isolation, stress, depression, anxiety, frequent displays of hostility and anger.

There has been many conflicting reports regarding cancer prevention, but there are basic strategies that are well supported and scientifically proven.

Use of tobacco in any form increases the risk of cancer dramatically. Smoking and second hand is highly associated with lung, bladder, cervical and kidney cancer. Chewing tobacco increases the risk of oral cavity and pancreas cancer. Healthy eating certainly does not guarantee cancer prevention, but does reduce the risk. Eat several servings of fruits and vegetables. Beans or legumes are especially noted to be beneficial. These food selections have brought much attention to the benefits of the Mediterranean diet that also includes daily consumption of a variety of nuts. [19] Reduce fatty foods and drink alcohol only in moderation. Maintaining a healthy weight and regular exercise have been shown to reduce the risk of breast and colon cancer

Arthritis

There are over 100 clinical conditions that include arthritis as a symptom. Arthritis is the result of inflammation that causes cartage erosion and joint pain. This occurs as a result of a reduction in the smooth cartridge surface in joints that allow two bones to slide easily back and forth. With out cartilage, the two bones rub against each other which cases irritation and inflammation.

The most common form of arthritis is osteoarthritis. This occurs to some extend to most people as we age and the cartilage is gradually worn down simply as a result of repetitive use over decades. [23]

The Arthritis foundation and the Center for Disease Control (CDC)  recommend several strategies to prevent or delay the onset of osteoarthritis. {Brady, 2009 #1164} Remaining physically active while protecting your joints is the key. [24]

Physical activity helps your joints in several ways. [25] First, physical activity results in a lower body weight. The more you weigh, the more pressure there is on your knee and ankle joints. [23] This weight pressure is magnified because all of the body weight is concentrated on the knee’s small surface area positioned between the femur of the upper leg and the tibia of the lower leg. [26] [27]  The majority of bodyweight is above the ankle and knee joints. If a person weights 250 pounds, approximately 125 pounds are compressing each knee. If that same person loses 70 pounds, the weight pressure is only 90 pounds, a reduction of 28%. This is a direct benefit to the cartridge and will significant preserve it, thereby preventing arthritis. [28]

Research has shown that exercise decreases levels of inflammatory chemicals that contribute the degradation on joint cartilage. [3] Low impact exercise include activities that provide cardiovascular and weight benefits while minimizing stress on joints. [29] The best examples of this are swimming and walking. The bouncy of the body in water greatly reduces pressure on knees and ankles. Although there certainly is more pressure on joints while walking it is significantly less than running of jumping jacks. Walking also strengthens the muscles around the knees that provide better alignment of the bones and cartilage. [30]

There are several ways to protect your joints throughout the day. [31] Try to alternate between sitting and standing. Persistent standing creates an additive pressure effects over many hours, and sitting does not allow for a healthy amount of activity joint use. High heels increase the pressure on ankle joints and create an abnormal joint angle across the knee. Uses of a wrist rest for the keyboard prevents excess stress and wear on the joints of the wrist and hands. When carry heavy objects, position the weight on your palm spearing the excessive pressure across the joints in the fingers. Use strategies to prevent bending and stooping during housework. This may include an extension on a duster to reach high objects and reach lower shelves and tables. A lightweight vacuum reduces the joint stress of carrying a heavy vacuum up and down stairs. Gripping a dust or cleaning rag for extended periods can be replaced by wearing an old glove or socks.

Alzheimer’s Disease

Alzheimer’s is a complex process that progresses over many years, much like diabetes, arthritis and heart disease. There are a few factors may influence person’s chances of developing Alzheimer’s dementia. These greatest risk factors are ones were cannot prevent: age, and genetics.  Modifiable risk factors including environment, and lifestyle are still not yet confirmed or completely understood. The importance of these factors likely varies for different people with different genetics.

No series of studies have proven this, but an active lifestyle, healthy eating and challenging mental activity as you age may delay the onset of Alzheimer’s.

1.         (NIH), N.I.o.H. Calculate Your Body Mass Index. Aim for a Healthy Weight 2014; BMI Calculator]. Available from: https://http://www.nhlbi.nih.gov/guidelines/obesity/BMI/bmicalc.htm.

2.         Agrawal, P., et al., Effects of sedentary lifestyle and dietary habits on body mass index change among adult women in India: findings from a follow-up study. Ecol Food Nutr, 2013. 52(5): p. 387-406.

3.         Leon-Latre, M., et al., Sedentary Lifestyle and Its Relation to Cardiovascular Risk Factors, Insulin Resistance and Inflammatory Profile. Rev Esp Cardiol, 2014.

4.         Jebb, S.A. and M.S. Moore, Contribution of a sedentary lifestyle and inactivity to the etiology of overweight and obesity: current evidence and research issues. Med Sci Sports Exerc, 1999. 31(11 Suppl): p. S534-41.

5.         McGuire, S., U.S. Department of Agriculture and U.S. Department of Health and Human Services, Dietary Guidelines for Americans, 2010. 7th Edition, Washington, DC: U.S. Government Printing Office, January 2011. Adv Nutr, 2011. 2(3): p. 293-4.

6.         Hite, A.H., et al., In the face of contradictory evidence: report of the Dietary Guidelines for Americans Committee. Nutrition, 2010. 26(10): p. 915-24.

7.         Lloyd-Jones, D.M., et al., Defining and setting national goals for cardiovascular health promotion and disease reduction: the American Heart Association's strategic Impact Goal through 2020 and beyond. Circulation, 2010. 121(4): p. 586-613.

8.         Physical Activity Guidelines Advisory Committee report, 2008. To the Secretary of Health and Human Services. Part A: executive summary. Nutr Rev, 2009. 67(2): p. 114-20.

9.         Haskell, W.L., et al., Physical activity and public health: updated recommendation for adults from the American College of Sports Medicine and the American Heart Association. Med Sci Sports Exerc, 2007. 39(8): p. 1423-34.

10.       Koop, C.E. and J. Luoto, "The health consequences of smoking: cancer," overview of a report of the Surgeon General. 1982. Public Health Rep, 2006. 121 Suppl 1: p. 269-75; discussion 268.

11.       Moritsugu, K.P., The 2006 Report of the Surgeon General: the health consequences of involuntary exposure to tobacco smoke. Am J Prev Med, 2007. 32(6): p. 542-3.

12.       Mishra, G.D., et al., Short-term weight change and the incidence of diabetes in midlife: results from the Australian Longitudinal Study on Women's Health. Diabetes Care, 2007. 30(6): p. 1418-24.

13.       Nguyen, N.T., et al., Relationship between obesity and diabetes in a US adult population: findings from the National Health and Nutrition Examination Survey, 1999-2006. Obes Surg, 2011. 21(3): p. 351-5.

14.       Lean, M.E., et al., Obesity, weight loss and prognosis in type 2 diabetes. Diabet Med, 1990. 7(3): p. 228-33.

15.       Ford, E.S., D.F. Williamson, and S. Liu, Weight change and diabetes incidence: findings from a national cohort of US adults. Am J Epidemiol, 1997. 146(3): p. 214-22.

16.       Henson, J., et al., Associations of objectively measured sedentary behaviour and physical activity with markers of cardiometabolic health. Diabetologia, 2013. 56(5): p. 1012-20.

17.       Perk, J., et al., European Guidelines on cardiovascular disease prevention in clinical practice (version 2012). The Fifth Joint Task Force of the European Society of Cardiology and Other Societies on Cardiovascular Disease Prevention in Clinical Practice (constituted by representatives of nine societies and by invited experts). Eur Heart J, 2012. 33(13): p. 1635-701.

18.       Stampfer, M.J., et al., Primary prevention of coronary heart disease in women through diet and lifestyle. N Engl J Med, 2000. 343(1): p. 16-22.

19.       Knoops, K.T., et al., Mediterranean diet, lifestyle factors, and 10-year mortality in elderly European men and women: the HALE project. JAMA, 2004. 292(12): p. 1433-9.

20.       Maruthur, N.M., N.Y. Wang, and L.J. Appel, Lifestyle interventions reduce coronary heart disease risk: results from the PREMIER Trial. Circulation, 2009. 119(15): p. 2026-31.

21.       Vos, L.E., et al., Adolescent blood pressure and blood pressure tracking into young adulthood are related to subclinical atherosclerosis: the Atherosclerosis Risk in Young Adults (ARYA) study. Am J Hypertens, 2003. 16(7): p. 549-55.

22.       Painter, R.C., et al., Early onset of coronary artery disease after prenatal exposure to the Dutch famine. Am J Clin Nutr, 2006. 84(2): p. 322-7; quiz 466-7.

23.       From the Centers for Disease Control and Prevention. Health-related quality of life among adults with arthritis--Behavioral Risk Factor Surveillance System, 11 states, 1996-1998. JAMA, 2000. 283(21): p. 2783-5.

24.       Penninx, B.W., et al., Physical exercise and the prevention of disability in activities of daily living in older persons with osteoarthritis. Arch Intern Med, 2001. 161(19): p. 2309-16.

25.       Musumeci, G., et al., Advantages of exercise in rehabilitation, treatment and prevention of altered morphological features in knee osteoarthritis. A narrative review. Histol Histopathol, 2014.

26.       Vincent, H.K., et al., Obesity and weight loss in the treatment and prevention of osteoarthritis. PM R, 2012. 4(5 Suppl): p. S59-67.

27.       Bijlsma, J.W. and K. Knahr, Strategies for the prevention and management of osteoarthritis of the hip and knee. Best Pract Res Clin Rheumatol, 2007. 21(1): p. 59-76.

28.       Neogi, T. and Y. Zhang, Osteoarthritis prevention. Curr Opin Rheumatol, 2011. 23(2): p. 185-91.

29.       Valderrabano, V. and C. Steiger, Treatment and Prevention of Osteoarthritis through Exercise and Sports. J Aging Res, 2011. 2011: p. 374653.

30.       Bennell, K.L., et al., Muscle and exercise in the prevention and management of knee osteoarthritis: an internal medicine specialist's guide. Med Clin North Am, 2009. 93(1): p. 161-77, xii.

31.       Ratzlaff, C.R. and M.H. Liang, New developments in osteoarthritis. Prevention of injury-related knee osteoarthritis: opportunities for the primary and secondary prevention of knee osteoarthritis. Arthritis Res Ther, 2010. 12(4): p. 215.