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Healthy Living September Issue

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 trigger."

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 best performance?

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 adopted.

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 process.

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’m 70."

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 as longevity.

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 unfit.


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

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