Healthy Living September Issue
PRINCIPLES FOR OPTIMAL HEALTH
Health Depends Largely on Lifestyle
Many erroneously believe that inherited traits (genetic factors) are
the primary factors determining their quality of life and how long they
will live. For the vast majority of us, our health is primarily
dependent on two other factors: (1) what we put into our bodies, and
(2) what we do with our bodies. A simple word that encapsulates both
of these concepts is "lifestyle." The good news is that even though
we cannot change our genetics, we can change our lifestyle. Those
lifestyle choices can prevent or forestall the development of diseases
for which we are genetically predisposed. Regarding the most common
diseases, Dr. Lamont Murdoch of Loma Linda University School of Medicine
has put it aptly: "faulty genetics loads the gun, lifestyle pulls the
I have often wondered why people take better care of their cars than
their bodies. I have yet to meet a person who said, "God has a plan
as to when my car should ’die,’ and I do not need to worry
about it. I don’t need to check or change the oil, or perform any routine
maintenance. And I don’t need to worry about the type of gasoline
I use." We recognize the necessity of proper care to get the longest
life and best performance out of our automobiles. When will we
realize that proper care also gives our bodies the longest life and
What are the root causes of death? When someone dies with a heart
attack, stroke, or other fatal condition, what really caused that
fatal disease at that time in a person’s life? Researchers McGinnis
and Foege recently analyzed the root causes of what Americans die from
and published their findings in the Journal of the American Medical
Association. The nine leading causes of death were largely related
to lifestyle choices: what we put into our bodies and what we do with
our bodies. These causes are listed for the year 1990 in Figure 1:
Underlying Factors that Caused Death in the U.S. (1990).1
All of the factors with asterisks are directly impacted by lifestyle.
The total of these factors is about 1.25 million, which is over half
of the total number of deaths in America each year. We see that the
root causes of death are largely unhealthful lifestyles. As surprisingly
high as this total is, it may greatly underestimate the total number
of lifestyle-related deaths. Many deaths due to infectious diseases
are caused by an immune system that is weakened by a poor lifestyle.
Also, the researchers listed only the deaths that could be attributed
to known lifestyle factors. As we continue to learn more about
lifestyle and health, we likely will discover how other lifestyle
choices could prevent still more deaths. Nonetheless, the figures
demonstrate that the number of premature deaths in our country would
be dramatically decreased if Americans would be willing to replace all
of their harmful lifestyle factors with helpful ones.
There would be benefits even beyond the reduction in premature deaths.
Quality of life would improve, as diseases would strike less frequently
at any given age. You can help to change these statistics by joining the
growing number of Americans who are focusing on healthy lifestyle
choices to attain the highest quality of life and optimal longevity.
Prevention is the Key
Today, a wealth of scientific research has confirmed that most of the
leading causes of death are preventable. The most common afflictions
that cause death in America are listed in Figure 2: The Ten Leading
Afflictions that Caused Death in the U.S. (1995).2
C. Everett Koop, M.D., Sc.D, former Surgeon General of the United
States, produced the first Surgeon General’s Report on Nutrition and
Health in 1988. It was based on an exhaustive review of the scientific
literature. He concluded that "dietary excess and imbalance"
contributed significantly to eight of the leading killer diseases in
our country. Excerpts from his report are shown in Figure 3: Dietary
Excess and Imbalance Cause Much Disease and Death.3
Longevity Studies Related to Lifestyle
Just what are these lifestyle factors that will help us to live a
longer life? Drs. Nedra Belloc and Lester Breslow were among the
first researchers to present a convincing answer. In their classic
study of nearly 7000 individuals living in Alameda County, California,
they found that there were seven lifestyle factors that influenced
how long people lived. These factors are listed in Figure 4: Belloc
& Breslow’s Seven Health Factors for Longevity.4 The number of these
habits that an individual followed made a tremendous impact on their
longevity. After nine years, the number of healthful lifestyle
practices a person followed was directly related to the likelihood
of dying. The results are depicted in Figure 5: Relation of Longevity
to Health Habits.5Notice that only about 5 percent of men and women
who followed all seven health habits died in the nine year period,
compared to 12.3 to 20 percent who followed three habits or less.
Another way of looking at the impact of lifestyle on longevity is by
considering something referred to as "health age." As an example,
a 50-year-old who embraces enough healthful lifestyle factors may have
the same health or physiologic age as the average 35-year-old person.
We could say that this individual has a "health age" of 35.
On the other hand, another 50-year-old who had no regard for a healthful
lifestyle may have a much older health age, perhaps as high as 72.
In other words, a person’s health age can be lower or higher than the
actual chronological age, depending on the number of lifestyle factors
Health age tables have been created from the Alameda County statistics.
They cover the chronological age range from 20 years to 70, and are
based on the same seven health habits listed in Figure 4: Belloc &
Breslow’s Seven Health Factors for Longevity. One such table is
depicted in Figure 6: Health Age Related to Lifestyle Habits.6
You can use this figure as a guide to get a feel for your own health age.
For example, assume that you are an average 40-year-old Alameda county
resident. If you are following only two of the seven Belloc and
Breslow’s health habits, your health age is 40 plus 19.4, or about 59,
indicating a dramatic shortening of your life expectancy. You would
have the same life expectancy as the average individual 19 years older.
If you continue the same lifestyle for 10 more years, when you are 50
your health age will be 50 plus 22, or 72. At age 40, you had a 19-year
health handicap, but at age 50, the handicap will even be worse by 3
years. In 10 years you will age 13 years!
On the other hand, if you, at 40, are consistently following all seven
of Belloc and Breslow¡¯s health habits, your health age is only 27
(40 minus 12.9). Furthermore, at age 50 your health age will be only
35. In 10 years, you will only age 8 years! The concept of health age
illustrates how much our lifestyle can either hasten or slow the aging
But What About Quality of Life at Old Age?
Some individuals believe that they are able to extend their lives, yet
they fear the results of living longer. Tracy, a respiratory therapist,
recently said to me, "I don’t want to live to be 70 years old.
People that age seem to have so many problems. I think I want to die before
I said in response, "Tracy, you may say that now, but wait until you’re
69. Then you will want to live until 70, and once you get to 70 you
will likely want to live to 71, particularly if you have good health.
I know many individuals in their 70’s and 80’s that are enjoying a good
quality of life. The so-called ’golden years’ are a reality for them."
More recent research has further helped to answer Tracy’s concern.
Although the original Alameda County reports focused primarily on the
age at death, subsequent work has looked at quality of life issues.
For example, the "Alameda seven" have emerged as powerful ways
to prevent probably the most feared complication of aging: disability.
A recent report demonstrated that those who followed the greatest
number of these health habits experienced only half the risk of
disability as those with the poorest habits. Those with an intermediate
number of health habits also fared better than those who spurned most
of Belloc and Breslow’s seven. They experienced only two thirds the
risk of disability as the least health-conscious group.7
Let us look at some of the individual habits that Belloc and Breslow
identified and see how they have a bearing on life’s quality as well
Eat Breakfast Regularly
Many people reading the Alameda County study are surprised to find
"eating breakfast" included in a list of seven of the most important
longevity factors. Eating breakfast in and of itself increases
longevity. In some of the original data it was found that men who
ate breakfast and did not eat between meals had less than half the
risk of death of men who skipped breakfast and snacked.8 A more recent
analysis of the Alameda County study data focused particularly on
individuals in the 60 to 94 year old range. Those who did not eat
breakfast regularly had a 50 percent increased risk of death compared
to the regular breakfast eaters.9 Remarkably, in this group of older
Americans, long life was as dependent on eating a good breakfast as it
was on not smoking and getting regular physical exercise.
Despite these facts (and what their mothers likely told them), most
people give a variety of reasons for not eating breakfast. A common
reason is that they are not hungry in the morning, which is the usual
result of eating a full meal in the evening. A lighter evening meal
will tend to solve the problem. Better yet, if you have the resolve,
try eating no suppers for a week. By the end of the week you will
likely be hungry for a good breakfast. You might also find that you
are sleeping more soundly, even though you may go to bed hungry for a
few nights until your body adjusts. With a little planning, breakfasts
are usually easier to prepare than lunch or supper. Be creative with
your use of grains and be sure to have several servings of fresh fruit.
Sleep, Exercise, and Smoking
The Alameda County study showed that our lifestyle habits regarding
sleep, exercise, and smoking impact the risk of death. Results are
presented in Figure 7: Mortality Risk Related to Sleep, Exercise,
and Smoking.8,9. Six to nine hours of sleep per night appears to be
ideal for most people. It is actually possible to get too much sleep
as well as too little. Those that slept significantly more or less
than this experienced a 60 to 70 percent increased risk of dying
within a nine year period. For men, too much or too little sleep
carried a risk similar to not exercising regularly. Within the nine-year
period, the non-exercisers had a 50 percent increased risk of dying
compared to those who made a consistent effort to keep fit. Women
with low physical activity fared even worse. They had over twice the
risk of dying within that nine year period.
It is never too late to begin an exercise program. A separate study
found that regardless of how out of shape a person is, the risk of
death from all causes could be reduced by merely becoming fit through
a regular exercise program. The amount of benefit is tabulated in
Figure 8: Exercise Reduces Death Rate.10
Notice that the death rate of physically fit men is only one-third of
the rate of those that are unfit. For those that were unfit and then
became fit, the death rate is about half as much as for those who are
Many people in America in addition to my treadmill patient, Harold,
think that because of their genetics or because of some celestial clock,
the day and hour of death are fixed in stone. This fatalistic attitude
forces them to conclude that they can do nothing to prolong their lives.
The evidence presented in this chapter dispels all such myths.
W. C. Willett of the Harvard School of Public Health, Department of
Nutrition states, "One clear conclusion from existing epidemiologic
evidence is that many individuals in the United States have suboptimal
diets and that the potential for disease prevention by improved nutrition
is substantial."11 Belloc and Breslow summarized their findings in
these words: "These data are consistent with the idea...that a lifetime
of good health practices produces good health and extends the period of
relatively good physical health status by some 30 years."12
Indeed, Belloc and Breslow’s seven health principles are simple, yet
they are extremely effective. Furthermore, they have no adverse long-term
side effects and offer profound benefits in the quality of life. If any
one of these seven health principles were a medication it would be
classified as a "wonder drug." The originator and manufacturer
would no doubt be rewarded with fame and fortune. However, as an Internal
Medicine specialist, I can unequivocally say that no medication even comes
close to a single one of these health principles in its power to improve
and maintain health.
The good news does not stop there. This book will reveal a host of
additional health principles that careful researchers have discovered in
the 25 years following Belloc and Breslow’s original studies. These
principles offer additional benefits for maintaining health and treating
certain disease states. You will see that the health principles brought
to light in this book are dependable. They can be relied on with
confidence to help you reach and maintain your health goals.
Reaping health benefits by following sound lifestyle principles is not a
new concept. Centuries ago God made a promise recorded in the Bible to
the newly formed nation of Israel, "If thou wilt diligently hearken
to the voice of the Lord thy God, and wilt do that which is right in
his sight, and wilt give ear to his commandments, and keep all his
statutes, I will put none of these diseases upon thee, which I have
brought upon the Egyptians: for I am the Lord that healeth thee."13
Yes, following certain principles that result in good health is not a new
concept. But this very old concept needs to be resurrected in our
personal lives, across America, and throughout the world. As Egyptian
diseases could be avoided in ancient times, the ten leading causes of
death in these modern times can largely be avoided by following sound
health principles. In the chapters that follow you will find the
information you need to successfully guide you to "do what is right"
and thus experience the optimal health promised.
1. McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA 1993 Nov 10;270(18):2207-2212. Figure adapted and adjusted from full article. Upper ranges used for tobacco, alcohol, and diet/exercise based on additional information presented in this book.
2. Preliminary data on births and deaths-United States, 1995. MMWR Morb Mortal Wkly Rep 1996 Oct 25;45(42):914-919.
3. The Surgeon General’s Report on Nutrition and Health. U.S. Dept. of Health and Human Services (Public Health Service), 1988.
4. Belloc NB, Breslow L. Relationship of physical health status and health practices. Prev Med 1972 Aug;1(3):409-421.
5. Breslow L, Enstrom JE. Persistence of health habits and their relationship to mortality. Prev Med 1980 Jul;9(4):469-483.
6. Adapted from Alameda County Study data. For a similar table see Table X, page 79 In: Belloc NB. Relationship of health practices and mortality. Prev Med 1973 Mar;2(1):67-81.
7. Breslow L, Breslow N. Health practices and disability: some evidence from Alameda County. Prev Med 1993 Jan;22(1):86-95.
8. Wingard DL, Berkman LF. Mortality risk associated with sleeping patterns among adults. Sleep 1983;6(2):102-107.
9. Wingard DL, Berkman, LF, Brand, RJ. A multivariate analysis of health-related practices: A nine-year mortality follow-up of the Alameda county study. Am J Epidemiol 1982 Nov;116(5):765-775.
10. Blair SN, Kohl HW 3rd, et al. Changes in physical fitness and all-cause mortality. A prospective study of healthy and unhealthy men. JAMA 1995 Apr 12;273(14):1093-1098.
11. Willett WC. Diet and health: what should we eat? Science 1994 Apr ;264(5158):532-537.
12. Belloc NB, Breslow L. Relationship of physical health status and health practices. Prev Med 1972 Aug;1(3):409-421.
13. Exodus 15:26. The Holy Bible. Authorized King James version
Go to Alternative Living Index Page