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Healthy Living in the 21st Century

Chapters: Basic Nutrients and Special Diets | Exercise for Life Tips | Obesity Epidemic | Best (Recommended) Diet | Stress Management |

Please download this FREE book for further detail.

This text gives many great examples on how to get started on healthy eating, regular physical fitness and details stress management for persons of all ages.

This text is directed toward health care providers to assist them in the education of their patients. Feel free to distribute it to all your patients as even non-medical personnel may also find a lot of useful information. This text will review basic nutrition as well as common fad diets and give an introduction to stress management and exercise techniques that can be used to enhance longevity. 

***The information from this text was entirely drawn from the Clinical Medicine Consult (see below), which also contains detailed treatment protocols for nutrition, diabetes, cancer, cardiovascular diseases and covers 99% of all ailments primary care physicians manage. It is indexed and enhanced with hyperlinks to over 12,000 terms, medicines and conditions for fast navigation. It contains over 2,450 clinical (medical-surgical) topics for rapid reference along with specific drug doses and essential treatment pearls.


The Best Diet for the 21 Century Person:

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   Why all the fuss about diet and exercise?  There are countless epidemiologic studies linking diet to the pathogenesis chronic diseases such as cancer and cardiovascular disease, the number one causes of death in Western countries.    
• Our “current” modern diet is clearly maladaptive as cardiovascular disease (heart attacks and strokes) is the main cause of death in Western societies (41% of all fatalities) (J Am Coll Card 2000;35:66-80B).
• The majority of adults (65%) in the United States and other Western countries are overweight (defined as body mass index [BMI] 25 to 29.9 kg/m2) or obese (BMI >30 kg/m2). The prevalence of overweight adults has increased from 31% to 64% in the last four decades and the prevalence of obesity has increased from 13% to 31% (JAMA 2002;288:1723-7).  The adverse health consequences of obesity are well established and include increased risk of cardiovascular disease, type 2 diabetes, some types of cancer, and a reduced life expectancy. 
• There is sufficient evidence to argue that diet contributes directly or indirectly to the rates of 7 of the top 10 causes of death in the Wester countries and just 4 causes (heart disease, cancer, stroke, and diabetes) together account for 61% of all deaths in the US (Deaths: Leading Causes for 2002. National Vital Statistics Reports. March 7. 2005;53:17). While smoking remains the leading underlying cause of mortality in the US (18.1%), a poor diet and physical inactivity (16.1%) may soon overtake tobacco as the underlying cause of death (Actual Causes of Death in the United States, 2000.  JAMA 2004;291:1238-45).  For details on smoking cessation, see Psychiatry chapter, substance abuse section.  
• Smoking, overweight, lack of exercise, and poor diet were associated with excess cardiovascular, cancer, and all-cause mortality in the 24-year Nurses’ Health Study (BMJ 2008;337:a1440).....Overall, 28% of deaths could be attributed to smoking, 17% to low physical activity, 14% to being overweight, 13% to low-quality diet, and 7% to no or heavy alcohol consumption.
• Diabetes mellitus (DM) Type 2 is an epidemic in modern society, there has been a 61% increase in incidence between 1990 and 2001 (JAMA 2003;290:1884-90).  This is a direct result of lifestyle changes that have resulted in overweight, obesity, and decreased physical activity levels. By 2050, 12% of US citizens will have diabetes according to the CDC (Diabetes Care 2006;29:2114-2116) (prevalence of 5.62% in 2005).
• The lifetime risk of developing diabetes mellitus for individuals born in 2000 is 32.8% for males and 38.5% for females AND a male who is diagnosed at age 40 years old will lose 11.6 life-years (14.3 if female) and 18.6 quality-adjusted life years (22 if female) (JAMA 2003;290:1884-90). Estimates suggest that 195 million people around the world have diabetes, and this will increase up to 330 or perhaps even 500 million by 2050 (Eur Heart J. 2007;28:88-136). For details on diabetes management see the Endocrinology chapter / module.  
• Cancer it the cause of 25% of the deaths in our society and can clearly be linked to certain environmental risks (60-80%).  Our cravings for sweets and fats gave us a survival advantage during times of famine.  In modern times with an abundance of inexpensive, calorie-dense foods, these cravings are working against us.   The higher the consumption of sugar-sweetened beverages (>1 per day), the greater the magnitude of weight gain (4.69kg = 10lg) and development of type 2 diabetes (1.8-fold risk) in women over a 4 year period (JAMA 2004;292:927-34). 
• A 12-week lifestyle intervention helped an ethnically diverse group of 2,390 adults with HTN, hyperlipidemia and hyperglycemia reach their goal risk factor levels without using drug therapy (Am J Cardiol 2004;94:1558-1561) (the program involving an initial health assessment followed by the generation of risk factor goals and lifestyle changes designed to achieve these goals). 
• According to data on 153,000 adults in the US, a combination of 4 healthy lifestyle characteristics including nonsmoking (76%), healthy weight (40.1%), 5 fruits & vegetables qd (23.3%) and regular physical activity (22.2%) were found in only 3% of the total (Arch Int Med 2005;165:854-7) (5.1% if household income is >$75,000 Vs 1.7% if <$20,000).
• The main “diet problem” with the average Western diet is that is we eat too much saturated fat (fast-food is a major culprit), too much refined sugars (soft drinks are a major culprit) and too little fiber (refined food is a major culprit).  Our body is best suited for a balanced diet that contain foods from all the food groups and is low in saturated fat and low in refined sugar.   Healthy eating combined with regular exercise is the best ways to reduce and / or prevent age-related functional decline, improve daily function (energy and sleep) and ultimately reduce the costs arising from a sedentary lifestyle (diabetes, cancer, cardiovascular).  For those who are over-weight and attempting to lose weight should follow the same recommendations below in addition to dieting tips for those trying to lose weight (endocrine chapter) as specific behavioral modifications are also needed to promote a change in life-long eating habits.  “Dieting” alone will not suffice for most of those attempting to lose weight AND maintain that loss. Much time and energy is spent searching for the causes of obesity. Blame is placed on specific foods, classes of macronutrients and genetics. Adding to the confusion is the erroneous belief that the obese maintain very high bodyweights despite low caloric intakes. Many studies show that as body weight increases, reported caloric intake decreases. A recent study showed that self reported energy intakes in American women are approximately 750-1000 calories below energy expenditures as calculated by the doubly labeled water method. This discrepancy increases as body mass index (BMI) increases. This is more proof that obesity is, at its most basic level, an issue of energy imbalance. This imbalance perpetuates itself through a combination of constantly available, palatable food and a society that promotes a sedentary lifestyle.