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Thursday, December 1, 2011

Wellness Corner - December 2011

Can We Prevent Chronic Illness?

The Problem
As we’re all aware, we are experiencing a crisis in funding for the  health-care system in our country.  Studies show a rapidly increasing percentage of the GNP is being consumed by all health-care expenditures.  A projection by the US Accounting Office estimates that if health care costs continue to increase at current rates, by 2044 spending in just Medicare and Medicaid will surpass all current tax revenues. 

Most spending on health care is going towards the diagnosis and treatment of chronic illness.  As an example, $465 billion is spent annually on diabetes related illnesses worldwide, and this is increasing rapidly.  A large proportion of the spending for health care goes to pharmaceuticals.  US sales in 2009 showed $14.6 billion went to anti-psychotic medication, $13.6 billion went to Proton Pump Inhibitors (to decrease stomach acid), $13.5 billion went to lipid lowering agents, and $9.9 billion went to antidepressants.  None of these medications work by curing a medical problem.  Instead, they aim to control a chronic condition, and usually they need to be taken on an ongoing basis.

The Illnesses
Current medical research is beginning to describe many of the underlying physiologic mechanisms leading to obesity, diabetes, poor lipid control, and to some extent, insomnia and mood disorders.  While we may worry about a “genetic predisposition,” current thinking about epigenetics points to the importance of lifestyle choices to activate or deactivate relevant genes.  The Agouti mouse is an amazing example of this.  This experimental mouse is bred to be obese, yellow, and generally dies young of heart disease.  When pregnant Agouti mice are fed certain types of diets, the offspring miraculously transcend their genetics, and they are normal in weight and color, with no increased risk of heart disease.  In this research, they have been able to map genetic activity, and the genes for the obesity and heart disease are actually inactivated by the special diet
This leads to some speculation that the underlying cause of much of escalating disease states lies not in our genetics, but in our modern American lifestyle.  It appears that lifestyle choices can affect genetic expression, which subsequently leads to an excess of inflammation.  Research is beginning to describe the important role of inflammation in many prevalent conditions, including heart disease, cancer, and Alzheimer’s Disease.

What Needs to Change? 
In this column over the next few months, we will look at the interventions that are being shown to  get at the root of these chronic illnesses—diet, exercise, and stress reduction.  The recommendations sound suspiciously like the things that our grandmothers used to tell us to do, “Eat your vegetables,” “Get outside and play,” and “Don’t let that stress get to you.”  Now, the scientific research is coming available to support these age-old encouragements, and we can discuss specific evidence-based recommendations for bringing about positive change. 

An example of the massive effort that will be required to make some of these shifts is embodied in article in the November 16 Press Democrat: “In a victory for makers of frozen pizzas, tomato paste and French fries, congressional negotiators this week agreed to block rules that … were meant to cut childhood obesity by adding more fruits and green vegetables to lunch menus.”  Two tablespoons of tomato paste on pizza can count as a vegetable in the school lunch program, even in this time of increased concern about diabetes and childhood obesity! Basically, in order to please their Food Industry supporters, Congress blocked attempts to change incentives towards a healthier, vegetable based diet in the schools.  

Clearly, doctors and pharmacies are not currently offering core solutions to chronic disease.  Rather than focusing on treating these diseases once they appear, it appears that we could really help by bringing about a societal shift that supports healthy eating, regular physical activity, and healthy relationships that mediate the effects of stress.  In the coming months, we will get into some of the specifics in each of these areas.  Shifting to a prevention model will be a difficult transition in American society, especially when the discussion involves completely changing habits that are an established part of our mainstream culture.