A recent study on healthy lifestyle changes got me thinking about why heart disease remains the most deadly human disease. A small study of just a few motivated men with low-risk prostate cancer garnered attention because it contained two important key words: Ornish and Telomeres.
Everyone knows Dr. Dean Ornish. And most of us know that telomeres are the caps at the end of chromosomes. Accumulating birthdays associates with telomere shortening, and some feel this has a causative role in cellular aging. Long telomeres are good; short ones are bad.
In short, researchers showed that patients who stuck with the Ornish plan (strict diet, exercise, stress reduction and social support) had longer telomeres. People are excited about this because telomeres are the hottest new surrogate for health and longevity. Maybe so, more studies will tell that story. The bottom line is the same: people who eat well, exercise a lot, manage stress and have social support look good, feel good and live longer. That fact is so old, itâ€™s hard to write an interesting sentence about it.
What grabbed my attention about the study was not the cellular aspects, the specifics of the diet or the rigor of the science. What struck me were the comments from the president of the American Heart Association, Dr. Donna Arnett. Recall the AHAâ€™s mission is to build healthier lives, free of cardiovascular diseases and stroke.
Here is a quote from Larryâ€™s piece concerning Dr. Arnettâ€™s comments: (The last line was the zinger.)
The study was â€œinterestingâ€ and â€œfascinatingâ€ but pointed out that it was a very small pilot study with only 10 people in the intervention group. â€œThe fact that they could increase telomere length is impressive,â€ she said. Interventions that increase telomere length are worth further study, but it will be extremely difficult to prove a link between the effect on telomeres of an intervention and an improvement in outcomes. She also noted that patients in the treatment group were â€œclearly a very motivated groupâ€ who had good adherence to the program. For â€œpeople with time and motivation this may be feasibleâ€¦ for other people this might be a challenge.â€
That last sentence is the problem. It encompasses everything that is wrong about how the AHA, ACC, most doctors and most people approach heart health. â€œFor people with time and motivation, this may be feasibleâ€¦â€
Good health isnâ€™t something that comes from anything else other than motivation and taking time for healthy behavior. Sure, you can wrestle about what diet plan is best, but everyone knows a bad diet from a good one. Good food is real food, and less of it. You can haggle about which exercise is best, but again, itâ€™s not complicated. Good exercise is that which makes you sweat for more than twenty minutes each day that you eat. Stress management is simple too. Life canâ€™t be lived without stress; itâ€™s how we manage it that matters. In most cases, itâ€™s our choice how much inflammation we bring onto ourselves. We can choose less inflammation; our doctor cannot. Finally, on the matter of social support, this, too, is a choice. We can choose to interact with others with compassion and kindness. Or we can choose the opposite.
That paragraph is old news as well.
The major point here is that doctors canâ€™t gift people time and motivation. Neither can the AHA and ACC. The problem with statements like those made by the AHA president is the assumption that motivated people who do make the time for health are extraordinary. â€œFor other people, this might be a challenge.â€
That bothers me because inherent in those words is the idea that for the other people, the busy people for instance, we have a shortcutâ€”a blood pressure pill, a cholesterol pill, a stent, an AF ablation. This sort of thinking eliminated physical education from the normal school dayâ€”we donâ€™t have time for gym. (I bet they do in Finland.)
I always come back to the 240lb fat man with high blood pressure and adult onset diabetes. Whose job is it to treat these problems? The answer is obvious: itâ€™s both of our jobs. The problem now is that the sick-care culture puts too much emphasis on what doctors and scientists can do, and far too little on what people can do. You don’t really think taking 5 different chemicals is the answer for a 240lb fat man, do you?
Far too many patients think there is a solution other than taking time and being motivated. Good lifestyle behaviors are not extraordinary. We have to stop saying that. The magical thinking must end. There is no â€˜easyâ€™ substitute for time and motivation.