What Is Really Killing Us (March 24, 2015)

Recently I have been called to task for writing the following paragraph. Really, some people.

“We know already HOW TO PREVENT 80% OF CHRONIC DISEASE. That is what would disappear if we all made the lifestyle-related changes that we already know about. Heck, that number even applies to individuals -- you follow the rules, you're 80% less likely to get those chronic diseases.”

What I am talking about here, of course, is PREVENTABLE disease. If your life expectancy at birth was 75 years old, and you smoke and drink yourself into a fatal heart attack at 55, that’s considered a preventable disease and a preventable death. Although of course you would have died of something else eventually (unless you have figured out a way to transition bodily into heaven or somewhere else, in which case I would like to hear from you as soon as possible).

So this is a point that it seems I must make a little more clearly. You are not less likely to EVER DIE because you live like a healthy person, for pete’s sake. However, you will be 50%-80% less likely to die before your time and also 50%-80% less likely to suffer the long period of suffering and decline in function that accompanies each of those premature causes of death if you make a few changes, and that factual statement is as solid as any that can can be made in the area of health and disease.
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I think it would be helpful here if we switched from thinking about disease to thinking about actual causes of sickness and death. What I mean is this; our main causes of death in this society are caused, or very strongly promoted, by underlying factors. It’s simpler to think of those underlying factors as what is actually killing us rather than the diseases that they eventually produce.

For example, it is sort of self-defeating if you are generally worried about getting some type of cancer down the line and that results in you becoming crushed under an avalanche of details about that disease. Worrying about having a gene that slightly increases your risk (or not), whether this or that form of screening is best worth doing and when, what this and that number on your blood panel might mean and what supplement might alter it, etc., etc. can overwhelm you in short order. If you look past that to what you are doing that is genuinely unhealthy and changeable it clarifies the whole issue. 

This point was first made in a now-famous paper in the Journal of the American Medical Association in 1993. Here are their rankings (which I don’t believe have changed). When you look at a traditional list of the leading causes of death in the United States, you find that the top three are (all numbers from 1990): 

Heart Disease               600,000
Cancer                            575,000
Chronic lower respiratory disease 
   (COPD, asthma, bronchitis,
    emphysema)             145,000

Those three accounted (and still do) for over 50% of all U.S. deaths, when you group them this way. Here are the rest of the top ten, still in order of prevalence:

Stroke
Accidents
Alzheimer’s Disease
Diabetes
Influenza and pneumonia
Kidney disease
Suicide

But the guys who wrote that 1993 JAMA paper thought that looking at death and disease this way was not the most helpful way to think about it.  They thought that, when you are thinking about prevention rather than treatment, we are better off taking  a step back and looking at what is CAUSING those diseases and considering THOSE the real causes of death. When you do that, your list changes quite a bit, to

Tobacco                       400,000
Diet / Inactivity            300,000
Alcohol                         100,000

and these three as well account for about 50% of all U.S. deaths. (Incidentally, even back in 2000 writers on this subject were predicting that tobacco would soon be overtaken by obesity and inactivity as the leading actual cause of death. I wasn’t able to find if that is actually the case, but the trend was certainly apparent even back then.) The rest of this list is:

Microbial agents
Toxic agents
Firearms
Sexual behavior
Motor vehicles
Illicit use of drugs

Kind of changes your perspective, doesn’t it? Well, maybe it doesn’t, but it did for me. 

I would like to make more two comments. 

First, when you start looking for deeper causes than the “cause of death” line on a death certificate, you get into interesting philosophical territory. Because when you are looking for a substance or activity that needs to be modified to promote your health, your attitude can cause you to overlook things of great importance. As I have said many times, doctor error is a major leading cause of death in the U.S. It is conspicuously absent from the second list, which is where it ought to be, and the number of deaths resulting from it has been variously estimated to be from 98,000 to 440,000 deaths per year. Although I don’t usually burden you with references for my numbers (although you can have them any time you ask) this one requires it.

http://www.npr.org/blogs/health/2013/09/20/224507654/how-many-die-from-medical-mistakes-in-u-s-hospitals

About 220,000 would be a good guesstimate here. Which would make medical care the THIRD leading cause of death in the U.S. Therefore the best approach would be to not just take care of yourself to minimize any necessity of entering the medical system, but to always approach your doctor -- and certainly your hospital -- with the utmost suspicion. 

So you can see that when you look at these kinds of lists, you need to keep in mind that they will never give you the whole story. Or maybe not even the real story. 

The other thing is that the reason I’ve gone into all this is to make a point you may well be weary of by now, and that is most of our illness – considerably over half of it – is self-inflicted. This is because we are living lives that we were not designed to live. 

Our stress-response system was evolved to deal with physical threats, not mental and emotional ones. The bursts of hormones that work so fabulously well in helping you run away from a tiger will kill you slowly when they never leave your system. Likewise, we evolved over millions of years to have to constantly exert ourselves just to get barely enough to eat, not to live a life of little or no physical effort with endless calories at our fingertips. A body that was designed for physical stressors, lots of activity and shrewd conservation of limited calories can’t cope with an environment that is exactly the opposite. 

You see what I’m getting at here, I think. Diseases themselves are caused by underlying factors. THOSE factors are the actual causes of ill health and death, and they overwhelmingly fall into a few general categories that are easily understood and easily (in theory, at least) modified. They are of course the old boring ones of eat well and not too much, exercise, reduce stress, and stay safe. 

And when you DO make those modifications and live more like your DNA expected you to live, you ARE 50%-80% less likely to die prematurely and endure the pain and loss of function that accompanies each one of those scourges that fills the blank on the death certificate. 

So please make living healthy a priority now, and illness will be far less likely to be a priority in your life later.

--dr. diane holmes
  Copyright © 2015