Editor’s Note: This is the 55th in a series on optimal diet and lifestyle to help prevent and treat disease. Any planned change in diet, exercise or treatment should be discussed with and approved by your personal physician before implementation. The help of a registered dietitian in the implementation of dietary changes is strongly recommended.
Medicines are a mainstay of American life and the healthcare system not only because they are perceived to work by the individual taking them, but also because their benefit may be shown by the objective assessment of scientific study. Clinical research trials have shown that some of the medicines of Western science may reduce the risk of heart attacks, strokes and cardiovascular death, while others may reduce certain types of cancer.
In the first 54 installments of the Non-Medicated Life, informed diet and lifestyle have been shown to accomplish naturally for the majority of individuals, many, if not most of the benefits of medications in the treatment of chronic medical conditions. Moreover, informed diet and lifestyle as a medical intervention may accomplish such benefits at lower risk for side effects and at a lower cost. At a time when health care costs are becoming prohibitive for most Americans, an approach emphasizing diet and lifestyle that has the potential to dramatically lower costs through the actual prevention of disease, deserves fair hearing and consideration. Part One focused on why such an alternative strategy is needed. Part Two addresses the specific disease states which best lend themselves to this approach.
In Part One, I suggested that increased heath care costs are due to the population getting sicker and older and thus requiring more resources. Further, I suggested that any strategies that fail to address this are temporary and stopgap and ultimately will lead to financial insolvency. What is needed is a strategy to get the population more healthy in ways that do not require an increase in use of healthcare resources. The question is ‘do such strategies exist?’ Are there disease states which can be treated or prevented without expending healthcare dollars?
The answer – which should come as no surprise to readers of this column – is such disease states exist as do low cost strategies to address them. But implementation will take effort and will require a shift in focus. Let’s look at disease states such as coronary artery disease, diabetes and metabolic syndrome. The management of these diseases consumes a large and increasing portion of available health care dollars.
Coronary Artery Disease – Coronary artery disease or atherosclerosis of the arteries of the heart is the end of a long process of the deposition of excess cholesterol into artery walls. This deposition narrows those arteries resulting in a reduction of blood flow and debilitating condition called angina. For an individual with angina, physical exertion and the demand it creates for increased blood flow causes chest pain and shortness of breath. Other consequences of coronary artery disease are heart attack and sudden death.
Current approaches to the treatment of coronary artery disease include coronary artery bypass grafts, in which other arteries or veins are used to bypass the narrowed segment. Newer approaches include angioplasty and stenting, in which the narrowed segment is forced open with an inflatable balloon threaded into the artery, and then held open by a small perforated metal tube left in the artery.
While both approaches can reestablish blood flow and relieve chest pain and shortness of breath with exertion, they do not – contrary to common belief – prevent heart attacks or heart attack deaths in the great majority of patients. This was the surprising conclusion of the Courage Trial and it suggests that the great majority of patients do not obtain mortality benefit from the high tech, high cost procedures currently in use. Indeed, evidence suggests that low tech, low cost strategies such as reducing the cholesterol with diet and generic medications as well as exercise, and weight loss can slow and stop the deposition of cholesterol into artery walls and accomplish what the high tech, high cost approach cannot.
If those with established coronary artery disease represent those at highest risk, does a low tech, low cost approach work as well in those at risk but without evidence of heart disease?
Diabetes – Individuals with diabetes may have no evidence of coronary artery disease but have been shown to represent a coronary disease risk equivalent. In such individuals, heart attacks may occur with a similar frequency to those who have been established to have heart disease. For those with diabetes, reasonable control of diabetes and the abnormal cholesterol levels that result can reduce the risk of a heart attack. This can be accomplished again with a low tech, low cost approach emphasizing a reasonable diet, generic medications, and a healthy lifestyle including appropriate weight control. Weight loss and carbohydrate restriction can powerfully reduce blood sugar, but somehow have been given less emphasis than drugs including insulin.
When I place patients with diabetes on a low carbohydrate, low calorie diet it never ceases to amaze me how many will need to cut their insulin by half – or even completely stop insulin. Many times the patients themselves are amazed. Their surprise is a failure on our part as clinicians to show patients the viable, effective role diet and lifestyle play in avoiding more expensive and more side-effect laden treatments.
Metabolic Syndrome – This approach also will work in those with pre-diabetes or metabolic syndrome. Moreover, as shown in the Diabetes Prevention Program a proper diet resulting in a weight loss of 20 pounds can decrease conversion of pre-diabetes to diabetes by 57 percent. Preventing new cases of diabetes with diet and lifestyle is clearly the least expensive way to address this looming problem. While there are currently 20 million individuals in the United States with diabetes, there are 40 million more with pre-diabetes, and they are converting to diabetes at a rate of 11 percent per year. In ten years there will be 60 million individuals with diabetes less the ones who die. Preventing such cases alone will decrease health care costs dramatically going forward.
In summary, health care costs are rising for us all and are fueled by an increase in the number of individuals who are less healthy. It is possible to use low tech, low cost lifestyle interventions to decrease the number who are less healthy and also to actually prevent new cases of diabetes. As such informed diet and lifestyle can be seen as a powerful way to decrease both the financial cost of healthcare and the human cost of unnecessary disease.
Paul E. Lemanski, MD, MS, FACP is a board certified internist with a master’s degree in human nutrition. He is director of the Center for Preventive Medicine of Paul E Lemanski MD PLLC. Paul is an assistant clinical professor of medicine at Albany Medical College and a fellow of the American College of Physicians.
**Originally published in Adirondack life magazine