The four corners of health: Exercise regularly. Eat a Mediterranean diet. Don’t smoke. Maintain a healthy weight

This week Fitbit debuted the Wi-Fi-enabled Aria Smart Scale -- a scale that lets users weigh themselves and then digitally send that information to a website where it can be made public for their friends and family and strangers to see. (Los Angeles Times/MCT)

Want to reduce your chances of developing heart disease and cut the risk of dying from it, as well as cancer and all causes, by a whopping 80 percent?

In a study led by Johns Hopkins University, 6,200 men and women from racially diverse backgrounds, ages 44-84, were recruited from six academic medical centers and did not have a diagnosis of cardiovascular disease.

All participants had coronary calcium screening using computed tomography, or a CT scan, when they were first enrolled in the study to see if there were early signs of calcium deposits in their heart arteries that are known to contribute to heart attack risk.

As the study progressed, the researchers also assessed whether the participants had a heart attack, sudden cardiac arrest, chest pain, angioplasty or died due to coronary heart disease or other causes.

The researchers developed a lifestyle score for each of the participants, ranging from 0 for the least healthy to 4 for the healthiest, based on their diet, body-mass index (BMI), amount of regular moderate-intensity physical activity and smoking status.

All were followed for an average of 7.6 years.

Those who adopted all four healthy behaviors had an 80 percent lower death rate over that time period compared to participants with none of the healthy behaviors.

According to Johns Hopkins cardiologist Roger Blumenthal, “Of all the lifestyle factors, we found that smoking avoidance played the largest role in reducing the risk of coronary heart disease and mortality.

In fact, smokers who adopted two or more of the healthy behaviors still had lower survival rates after 7.6 years than did nonsmokers who were sedentary and obese.

Source: “Low-Risk Lifestyle, Coronary Calcium, Cardiovascular Events, and Mortality: Results From MESA (Multi-Ethnic Study of Atherosclerosis)”

Then establish these four habits:

Exercise regularly.

Eat a Mediterranean diet.

Don’t smoke.

And maintain a healthy weight.

In a landmark study published in the “American Journal of Epidemiology” earlier this month, Johns Hopkins University researchers scientifically validated the power of healthy living on dramatically curbing disease and death.

Researchers followed 6,200 racially diverse men and women, ages 44 to 84, who were free of heart disease at the beginning of the study, for a period of 7.6 years, monitoring those four lifestyle factors, according to lead researcher Haitham Ahmed of the Hopkins’ Ciccarone Center for the Prevention of Heart Disease.

“Those who adopted all four healthy behaviors had an 80 percent lower death rate over that time period compared to participants with none of the healthy behaviors,” says Ahmed.

The study adds, however, that only 2 percent, or 129 participants, satisfied all four healthy lifestyle criteria.

While local health professionals trumpeted the new study, they underscored the sobering realities of achieving those four habits. People still need discipline to reap the benefits of healthy living.

Reactions from three of them were remarkably consistent.

The heart surgeon

Dr. John “Jeb” Hallett, a vascular surgeon at Roper St. Francis Heart & Vascular Center, called the study “extraordinarily important” and says that every recommendation in it is “do-able.”

“The Mediterranean diet may take some education. Exercising can be as simple as a total of 30 minutes of walking throughout the day. It does not have to be excessive aerobic exercise,” says Hallett. “The two toughest things to do are control weight and not smoke.”

Hallett says balanced weight-loss programs are highly effective and that smoking cessation is helped significantly by working with a doctor who can prescribe both pharmacologic and psychological help.

“Chantix is one medication that is highly successful in my practice for smoking cessation,” adds Hallett.

Another helpful tool for many would be keeping a record, such as a journal, on eating, exercise and weight. Smokers who quit can benefit by recording the number of days since last smoking a cigarette.

“This all takes self-discipline, which is the greatest challenge for most of us,” says Hallett.

The dietitian

Registered dietitian Melissa Stevens Ohlson, who worked at the Cleveland Clinic’s Preventive Cardiology Department for 12 years and co-authored a lifestyle cookbook, says the study was consistent with others but that the “head turner” was the 80 percent reduction in health risks.

“Most people are acutely aware that not smoking, eating healthfully, maintaining a healthy body weight and exercising regularly lends some health benefit. There are scores of research studies to back it up,” says Ohlson.

“The problem is, most Americans have trouble bridging the ‘science’ with their everyday lives. Not smoking in our society is a given. Exercising, well, we all have too many excuses why we couldn’t fit it in. And Americans have been struggling with the battle of the bulge for far too long.”

Regarding diet, she says Americans are inundated with too much misinformation on what to eat for good health and that they miss the “common sense approach to eating that people from the Mediterranean regions have traditionally been following for centuries.”

“It’s really not that difficult to follow,” says Ohlson, who writes a blog, eatwellcharleston.com.

She notes that there is even confusion on the Mediterranean diet, which should be more of the traditional rather than modern Med diet.

“Unfortunately, they (people living in the Mediterranean Sea region), too, have succumbed to the Western style of eating, which includes more processed, ready-to-eat foods and fast foods,” says Ohlson.

“The Mediterranean diet that is referred to in studies that have shown health benefits are traditional diets that include foods grown or raised locally or regionally, an abundance of fresh, seasonal produce like leafy greens, squash, peppers, tomatoes, berries, figs and melon; a variety of nuts and healthy unsaturated fats such as olives, avocado, olive or grapeseed oils; whole grains or, at the very, least minimally processed grains; red meats served as a side dish and sparingly; and an abundance of fish,” says Ohlson.

“Those in the Mediterranean enjoy desserts, but more often in the form of fresh fruit and yogurt or a small pastry; not an abundance of highly processed store-bought desserts and sweets. Yes, they include wine or other alcohol on a regular basis, but in many cases, it’s in the context of being enjoyed at a meal in a small serving.”

Ohlson adds that the emphasis on vegetables should be on color — dark green and vibrant red, yellow, orange and purple — and variety. She urged people to go to local farmers markets, try new vegetables and fruits, buy freshly baked whole grain breads and pastas, and look for eggs from locally raised, cage-free chickens.

“Small steps toward a Mediterranean way of eating can reap big rewards and may even help shed excess weight.”

The culture changer

Susan Johnson, director of the Office of Health Promotion at the Medical University of South Carolina, says she was at a conference in Atlanta listening to a “culinary medicine” presentation specifically on the Mediterranean diet when she first heard about the study.

“It is powerful in that it provides further evidence of what we already know: that there are a few, fairly simple lifestyle behaviors that can provide significant protection against chronic disease ... and that they (the behaviors) are within everyone’s reach,” says Johnson.

“I think for us in the field of prevention, it has more to do with how to incorporate these behaviors into lifestyles, cultures and environments.”

Johnson, who has played a key role in leading MUSC toward having a smoke-free campus, says smoking continues to be “a tough one.”

“If we can continue to make smoking more difficult for people, it eventually will change behavior. As a result of our tobacco-free campus and smoke-free medical district policies, we have had over 150 people sign up for our cessation program. Think about the money and potential lives saved by that.”



Reach David Quick at 937-5516 or dquick@postand courier.com.

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