Does Lifestyle Beat Drugs? It Just Might….


Drugs, Drugs, Drugs. Everywhere we turn we see new ads, new guidelines, and new marketing campaigns showing us how beneficial prescription medications can be for our lives. As we swim in the sea of medications, it is important to step back and realize we do have better options for maintaining our health and preventing chronic diseases.


Drugs Get All the Attention


Why do prescription drugs get most of the attention from medical science?

  • They are easier to study. It’s easy to measure compliance, it’s easy to isolate the intervention to one thing. Just take the pill. You either get the drug or the placebo. No grey zone there
  • It’s where the money is. A well-designed study that involves thousands of subjects over many years is expensive! Who’s going to pay for that research? Usually it’s someone who has something to gain. The pharmaceutical companies have the most to gain by studying their drugs, and they have the deep pockets to back it up.
  • It’s in our medical culture. Over the years, our medical culture has become medication focused. It’s almost an inherent assumption that medications are beneficial and should be used to “help” everyone. That doesn’t make it right. It just makes it common.


Fortunately, despite our pill-centric culture, we are starting to see a small increase in lifestyle focused studies in the medical literature.


A study recently published in the NEJM showed that maintaining 3 out of 4 healthy lifestyle habits (following a healthy diet, regular physical activity, not smoking and not being obese) reduces the risk of developing heart disease by almost 50%.


The media may be reporting this as if it’s a brand new revelation, but it turns out it’s not completely new.


Previous Studies


The INTERHART study published in 2004 showed that 5 risk factors (daily fruit and vegetable consumption, Apo B/Apo AI ratio, current smoking, abdominal obesity, diabetes) accounted for 80% of all heart attacks. All those factors can be controlled with lifestyle interventions.


In addition, A 2014 in JACC study showed that 80% of all first heart attacks are explained by 5 risk factors (smoking, waist circumference, healthy diet, regular physical activity, moderate alcohol consumption).


While these aren’t randomized controlled trials, they are still very powerful suggestions that we can be in control of our health. We can dramatically reduce or cardiovascular risk without the need for prescription drugs.


Bad News Persists


Despite this encouraging information, heart disease remains the leading cause of death in men and women. There are approximately 900,000 heart attacks annually in the U.S., one every 42 seconds, with 365,000 dying from their heart attack every year. Heart disease costs $207billion annually in the U.S. alone.


And for the first time in 20 years, the life expectancy in the U.S. has started to decline. This decline has occurred even though prescription drug use has increased consistently over time with 60% of adults taking at least one drug, and 15% taking more that 5 drugs!


How can this be happening?


2.7% Americans Lead a Healthy Lifestyle

There is a clear disconnect between knowing that lifestyle improves our health and the implementation of this knowledge. Knowledge by itself is not power. We need to put that knowledge into action to realize that power.


A study published in the Mayo Clinic Proceedings concluded that an only 2.7% of all Americans led a healthy lifestyle (defined as regular physical activity, healthy eating, not smoking, and having a recommended body fat level). Less than 3%! That is an astounding finding.


When it comes to our failures with maintaining a healthy lifestyle, the excuses are many and varied. Not enough time. Not enough motivation. Not enough knowledge. Not believing it really matters. Not enough “will-power.” And on and on.


Each reason may have its own unique solution. But fortunately, recent science can put to rest the question of if leading a healthy lifestyle really makes a difference.


We can control our genes


A November 2016 study in NEJM showed that even those with the highest genetic risk of cardiovascular disease can reduce their heart disease risk by almost 50%.


They retrospectively looked at four large trials totaling almost 55,000 subjects. They were able to quantify risk of coronary artery disease based on genetic polymorphisms, and they also could determine adherence to a healthy lifestyle (defined as getting regular physical activity, eating a healthy diet, not smoking, and not being obese).


In the group with the highest genetic risk for heart disease, they found that adhering to 3 of the 4 healthy lifestyle practices reduced the risk of heart disease by 46% (relative risk). In one of the studies, that corresponded to an absolute 5.6% reduction over 10 years.


For comparison sake, statin trials in general demonstrate a 1-3% reduction over 10 years.


(Disclaimer: It is not scientifically valid to compare statin trials with this trial and claim that lifestyle was “proven” to be more beneficial than statin. We would need a head-to-head trial to scientifically prove that. Given the amount of money such a trial would require, and the fact that pharmaceutical companies would never fund it, we are unlikely to see that trial completed in our lifetime).


Can Your Pill Do This?

The results showed that practically everything is improved in the “favorable lifestyle group.” LDL is better, HDL is better, Triglycerides are better. Diabetes is lower. Hypertension is lower. Body mass index is lower. And most importantly, the risk for heart disease is lower.


Do you have any idea how many pills someone would need to take to get those same effects? Two different pills for cholesterol. One for blood pressure. One for diabetes. One for weight loss.


Up to 5 pills! And after all that, it may still not significantly reduce the risk for heart disease.


Impressively, this study shows you can achieve those results with ZERO pills. And most importantly, you can significantly reduce your heart disease risk with ZERO pills. If that isn’t an empowering finding, then I’m not sure what is.


Time to Take Control


The time has come to understand that our health destiny is within our control. We don’t have to be dependent on prescription drugs. We don’t have to “accept our fate” that a heart attack is inevitable.


We can commit to healthy lifestyle practices and enjoy the benefits of improving our health and lowering our risk of heart disease. The science is there. It shows that lifestyle really does make a difference.


Now it’s our job to embrace it, break through our healthy lifestyle barriers and start making meaningful changes in our lives today. Our health depends on it.

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