"The health choices you make will determine if we can compete for jobs against Europe and Asia.
Why? We are twice as expensive as Europe & 3 times as expensive as Asia--and that's because we have twice the chronic diseases of Europe, and three times the chronic diseases of Asia.
We will not have jobs in America the way we know it now if we have that big of a differential. In 2009, 17.9% of our gross domestic product was spent on health care. And the way we're going, we'll be at 24% in just 7 years.
We are more expensive NOT because our procedures and medical care costs more--but because we have more procedures and we have more disease.
We either get more competitive--like spending 4% or 5% of our gross domestic product on healthcare, not the present 17.9+%--or we lose jobs & the kind of society we now know. And that's possible only if we can get control over the Four Factors that determine 75% of of our health care costs."
- Food choices and portion size
- Physical Inactivity
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Two weeks ago, on a Saturday afternoon I'm in my car, on my way home, enjoying Marketplace Money on NPR. Then, darn--the City Club comes on with an hour long broadcast of their Friday forum. Not what I was interested in hearing at all. I was just about to turn it off, until I heard that Dr. Michael Roizen was the day's speaker. Not only did I listen to the entire broadcast, but I downloaded the podcast, listened to it again, and took notes so I could share it.
Everyone knows Dr. Roizen--he's a regular guest on Oprah, Dr. Oz's Show, an occasional host of PBS health specials. He's the author of many best-selling health books, all part of his continuing You--An Owner's Manual series. He also happens to be the Chief Wellness Officer of the Cleveland Clinic. And, in a few weeks this poster child for healthy aging will be 65!
He's a tireless cheerleader for staying health, and now he's added one more super important reason to get healthy: like JOBS, having a Manufacturing Base, & $$$$. If we can make the "very doable" lifestyle changes that are needed to control 75% of our chronic diseases--we can cut 75% of our health care costs--and regain our competitiveness in the world market.
Roizen speaks a mile a minute--and he covered a lot of ground in his City Club talk. But here are some the highlights!
Note: I apologize that I don't have the sources for the data or statements presented in this post. They come from my careful notes of Dr. Roizen's lecture--I didn't have the benefit of his slides. Where it was obvious to me what studies he was citing, I made some corrections.
Dr. Roizen's Tour of Our Health By the Numbers
75% of Chronic Disease in the U.S. is Caused by Four Factors That Can Be Easily Controlled with Lifestyle Changes:
- Tobacco Use
- Bad food choices/over-sized food portions
- Lack of exercise
75% of Our Health Care Costs are Caused by Chronic Diseases that Could Be Controlled by Lifestyle Changes. In 2007 these conditions were responsible for:
- 81% of our hospital admissions
- 91% of all prescriptions
- 76% of physician visits
- A cost of $1.4 trillion dollars dollars--about $6000 a year per person
Obesity is on the Rise and It's a Driver for Diabetes, Heart Disease, Hypertension, and Some Cancers
- In 1990 6.9% of the U.S. was obese--NO state had an obesity rate greater than 15%
- In 2008 27.9% of the U.S. was obese
- We quadrupled our obesity rate in 18 years
- Obesity is the PRIMARY UNDERLYING CAUSE of our rising medical costs
- The U.S. leads all other countries in obesity--and our rate is rising faster than all other countries
- Diabetes rates increase 17 years after obesity rates increase. The South was the first to increase its rate of obesity--and its now seeing a corresponding increase in diabetes 17 years later.
- Heart disease rates increase 25 years after obesity rates increase.
- Cancer rates increase 35 years after obesity rates increase.
The U.S. has twice as much chronic disease as Europe. Three times as much chronic disease as Asia.
- 80% more hypertension in the U.S.
- 110% more heart disease in the U.S.
- 40% more type 2 diabetes in the U.S.
- 800% more strokes in the U.S.
- In the 55-65 year old group for both men & women: Cancer in Europe is 5.5%; Cancer in U.S. is 12.2%; Arthritis in Europe is 21.3%; Arthritis in the U.S. is 53%
The Percentage of the U.S. Gross Domestic Product spent on treating Chronic Health Diseases (GDP is the total value of all the goods and services produced in one year):
- 5.2% in 1960
- 7.2% in 1970 (in 1970, Roizen's epidemiology prof said, "At this rate, by 2000, we'll be spending 12% of GDP on medical care, & we'll be twice as expensive as Europe & Asia, & we'll lose our manufacturing base." We beat his prediction--we got to 12% ten years sooner)
- 12% in 1990
- 17.9% in 2009 (twice that of Europe/3 times that of Asia)
- 24% projected by 2015 at the rate we are going
- If we could control our chronic diseases by eliminating tobacco use, making the right food & portion choices, exercising, and controlling stress the health care GDP could be at 4-5%.
We Have Control of Our Health - It's Not a Genes Thing - After 35 It's All Up to You!
"Most people think they've hit their peak quality of life at 25-35, and it's all downhill after that. And it is! If you do nothing about it--you hit your peak quality then, and then you start to decline. Before you're 35 it's your genes that take you--but from age 35 on--it's your choices. You can live at the top--prevent & reverse disease--it just not that tough."
-Dr. Michael Roizen-
The Physician's Health Study. Roizen's favorite all-time medical study in the Physican's Health Study, run out of Harvard University since 1982. And by the way--my (H.L.) personal favorite outcome from this 30+ year study is this factoid: Men with healthy behaviors, including smoking abstinence, weight management, blood pressure control, and regular exercise, are not only more likely to survive to age 90 but also to have good health and function at an advanced age (Yates LB et al., Archives of Internal Medicine 2008; 168:284-90.
Roizen's fave has to do with IQ/cognitive decline. As the physicians in the study got older--IQ went down in many, & it's not a trivial decrease--it declined about 5% every 10 years.
But here's the good part: If you look at the ranges, you'll see some people in the study stayed at the top. That's the key. How do you stay at the top of the curve? 25% of the physicians didn't lose their sharpness. Roizen says it's all about the health choices they made: diet, exercise, & not smoking!
Dr. Oz and Rocco, the Cowboy's Turn-around. You can read the whole story here. According to Roizen, in 28 days Rocco "cured" his diabetes, got rid of his hypertension, and started to pull plaque from his arteries, just by changing his diet, and walking 12,000 steps a day. Roizen says, "That's doable for everyone!"
On September 24th, 2009, 53 year old Rocco Wachman of Scottsdale, Arizona was overweight, diabetic, with the heart of an 85 year old. On his meat-heavy diet he was eating the equivalent of 2 1/2 pounds of saturated fat a week! If he kept up this lifestyle, he was headed for serious trouble.
Dr. Oz came to the rescue--challenging him to take on a 28 day vegan diet that cut out meat, dairy, and eggs. He was coached and monitored by Dr. Oz's sidekick, Dr. Michael Roizen--known as the "Enforcer" for his caring, consistent, "positive pushiness". To read more about "Dr. Oz's 28-Day Vegan Challenge for Cowboy Rocco - Heart Disease Reversal Through a Plant-Based Diet Goes Mainstream - Sort Of" click here.
Dr. Caldwell Esselstyn's Heart Disease Do-Over for the sickest of patients. Roizen credits Dr. Esselstyn of the Cleveland Clinic as the pioneer in reversing heart disease through diet. One example of many on the Esselstyn program: A patient with an over 98% artery blockage--and not one normal artery that was usable for a coronary graft. The patient says, "What can I do? I'm going to die, right?" Dr. Esselstyn replies, "No, you change your diet!" 2 1/2 years later the patient's artery is normal--no surgery--just changing his diet. It's not impossible. It's very easy. Of Dr. Esselstyn's program, Roizen says, "If you have significant [cardiovascular disease] you need to do significantly tougher things to reverse it. The Esselstyn program is a little tougher than the Cleveland Clinic's Lifestyle 180 program, but it's something that's very doable. It's a great program, and it's run once a month at the Cleveland Clinic."
Turning Your Bad Genes Off. Turning Your Good Genes On. Ornish's Prostate Cancer Study
The red squares on the left represent the prostate cancer genes. After 3 months of lifestyle interventons, they were down-regulated, showing up as green.
This is Roizen's favorite slide. (not having the benefit of attending the lecture--I'm assuming this slide from the Ornish study is what he's taking about) It demonstrates how our lifestyle choices can literally change our genes. Ornish took 30 men with low-risk prostate cancer tumors, and for 3 months put them on a low-fat (10%) plant-based diet, had them exercise for 30 minutes a day, 6 days a week, and participate in stress management sessions with yoga, stretching, and meditation for 60 minutes a day. Before the intervention, their cancer genes are red--three months later, the cancer genes are turned off, and show green. The men literally "turned off" the RAS family of genes--these are the ones that promote the growth of breast, colon and prostate cancer. Yes, they turned off cancer genes with lifestyle changes. And it gets even better--the also "turned on" the GSTM-1 genes--the protein-producing genes that cause breast, colon, and prostate cancer cells to commit suicide.
They turned off the genes that promote cancer--and turned on the genes that promote its death.
One year later: Roizen shows a slide of one patient's prostate tumor. It is smaller, and his PSA is lower. Low-fat plant-based diet, exercise, stress management, quitting smoking. That's the key.
The Four Fatal Foods Responsible for Our Health Problems - Or, Why You Want to Skip that Ice Cream Cone
Rocco, Dr. Esselstyn's heart disease patients, and Dr. Ornish's prostate cancer patients all avoided these big bad four fatal food groups. You can, too.
- Saturated fat. The kind found in meat, full-fat dairy, palm, coconut oils, poultry skin, and animal products.
- Trans fat. It's poison for your body. Found in hydrogenated & partially hydrogenated oils. Think, fried foods, margarine, fast food, cookies, processed food, crackers, chips, and snack foods. Check labels carefully.
- Added sugars & syrups. High fructose corn syrup (soda pop), malt, maple, agave, fruit juice concentrates, dextrose, maltose, molasses, raw sugars, table sugar. "Added sugar does not naturally occur in food," according to Roizen.
- Any grain that's not 100% whole grain. "Unless the grain you're eating is made from 100% whole grain, it's not much better for you than white flour, that has been stripped of the healthy outer shell and germ," says Roizen.
According to Roizen, if you have an ice cream cone tonight (that's saturated fat, combined with sugar, and white flour) the sugar from that cone is going to negatively affect the proteins in your body for the length of life of that protein--anywhere from 90 to 100 days--far outlasting the 10-30 minutes of pleasure you're going to get from that ice cream cone.
Yes, that "extra sugar causes the proteins in your body to be less functional and as a result, directly ages your immune and arterial systems and even your joints (hello, arthritis). The joy of the food might last 10 minutes. The protein change lasts months," says Roizen. Click here for more info.
Here's how a sweet innocent thing like sugar can eventually damage your arteries. When sugar gets inside of a protein called "phosphokinase-3", it weakens it, causing a rift or tear between the cells that line our arteries. When those tiny rifts/tears occur in our blood vessels, the body tries to repair them with LDL (our lousy cholesterol) and bingo--plaque begins to form in our blood vessels. Next thing you know, if your blood pressure is high, your blood comes pounding against the blood vessels, further damaging them. Then throw in more saturated fat from your food--like ice cream cones--and over time you've got some nice inflammation going on--which can bring on a rupture of some of your squishy plaque--which sets you up for blood clots to form--and before you know it...you've got a heart attack, a stroke, memory loss, impotence, and yes, wrinkles. "By the way," says Roizen, "impotence or wrinkles in the skin are no different than a heart attack or a stroke, it's just where the damage occurs."
What can you do to forestall the damage? The key point is to look at what starts it in the first place. It's food choices. Your level of blood sugar affects the health of your cells. For the brain & kidneys to stay healthy, that blood sugar level needs to stay below 250 (very high). And you don't get a blood sugar level of 250 from just what you're eating, unless you are diabetic.
But, for the heart and gonads to stay healthy, that blood sugar level needs to be at 110, and every single one of us can get our blood sugar that high with just two ounces of sugared cola. When was the last time you saw someone with a 20 ounce Coke, who only drank 2 ounces of it?
We can't do moderation in the United States. Avoidance is the only answer.
Avoid the sugar in the first place. It will damage the proteins of your heart, gonads, kidneys, brain, and skin.
Avoid the saturated fat in the first place. It will cause inflammation that will change the way your genes function from between 3 to 21 days.
The pleasure of an ice cream cone doesn't last anywhere near that long.
All you have to do to avoid the major instigators of atherosclerosis is to avoid sugar, fat, and any grain that's not 100% whole grain.
The good news is--it's the same thing with cancer. So, we can prevent many common cancers by avoiding the same big bad four: sugar, saturated fat, trans fat, and any grain that's not 100% whole grain.
Dr. Roizen's Thirteen Pearls of Health Wisdom
1. You control what goes into your body, and yes, it that important for your health!
2. You CAN GET A DO-OVER, just like Rocco, the cowboy did, and just like Dr. Esselstyn's patients do.
3. Avoid the known toxins
- BPA--and the largest source of BPA is in thermally printed receipts.
- Air your dry cleaning outside before bringing it into the house.
- Avoid excess radiation from unnecessary medical tests. TSA is no biggie--it has 1/12,000th of the radiation of one CT scan. Avoid CT scans whenever you can.
4. Walk at least 10,000 steps a day. Overpay for a pedometer, if you're going to overpay for anything. Dog walking doesn't cut it. The average dog walker gets 8 minutes of walking a day. You have to do much more than that!
5. Manage stress daily--with friends, friends, friends. They're the biggest stress managers out there, #1, #2, and #3.
6. Have a purpose in life.
7. Learn to meditate.
8. Daily physical activity is not optional.
9. Avoid the 4 fatal foods:
- Saturated fat found in 4 legged & 2 legged animals (birds), poultry skin, palm & coconut oils.
- Trans fats--partially hydrogenated vegetable oil, margarine.
- Added sugars & syrups
- Any grains that aren't 100% whole grain
10. Take Five (maybe 6) Pills a Day:
- DHA - from fish oil or algal sources. With the growth of farmed fish, the only fish in the U.S. with a predictable fish oil, is wild salmon or trout. Molecularly distilled DHA from fish oil, or algae are safer, and more dependable.
- D3 - Take 1000 IUs a day. The IOM report sets the DRI at 600-800 IUs--but their upper safe limit was set at 4000 IUs.
- Calcium - be sure you are getting 600 mg a day - most people can get this from their diets.
- Magnesium - 400 mg/a day. Most of us aren't getting enough of this vital mineral.
- Take 1/2 a multivitamin twice a day--once in the morning, once at night. Why? The vitamin level gets too high if you take it once a day--and you just urinate it out. Use a pill cutter, split it up, and have 1/2 in the AM, and 1/2 in the PM.
- Talk to your doctor about taking 2 baby aspirins with a glass of water every day in you're over 40 years old.
11. Sleep--6 1/2 to 8 hours a night. It's the most under-rated commodity in the U.S.
12. Lift weights!! Roizen says he can't emphasize this one enough. Resistance exercise is absolutely key for staying healthy.
13. Love something--and do it everyday!
Follow-up post: How's the Cleveland Clinic's Chief Wellness Officer championing wellness in his own shop? They're making tremendous strides--definitely walking their talk over there, with a trend-setting employee wellness program, a hospital food makeover that cuts out the big bad fatal four ingredients, and community outreach wellness programs.