Scientific research and technological breakthroughs make health headlines daily. Of course, so do all sorts of “miracle cures” that turn out to be nothing but hype and nonsense. It’s impossible to filter and evaluate every newsflash you encounter. But some health and fitness advancements are very much worth tracking – because they might improve the way you live, or even help save your life.
These are the things we want you to know about. So with help from experts like the pros at the Harvard School of Public Health and lifestyle-change agent Dean Ornish, MD, we’ve boiled down a multitude of studies, reports and research advances, and extracted what we see as some of the most fundamental insights emerging from the ever-changing health-and-fitness landscape.
Of course, the eight developments profiled here represent just a smattering of the significant advances made in the past decade, or even since the start of the 21st century. But we are hopeful that getting a bead on even a few of these important topics – including the links between the body and mind, advances in heart health, the power of nutrition, and more – could help you achieve some major breakthroughs of your own.
1. Brains, Biochemistry and Emotion
Today, even conventional medical experts are recognizing that emotional stresses have negative biochemical effects that can increase risks for heart disease, cancer, blood-sugar disorders and more. Since the advent of functional magnetic resonance imaging (fMRI) in brain research in the 1990s, scientists have gained a much keener appreciation of the deep and intrinsic ways in which the emotional and the physical are connected.
Advanced imaging techniques – particularly noninvasive, diagnostic fMRI scanning procedures that cause active areas of the brain to “light up” on-screen – are allowing researchers to peer into the human brain while it’s at work. As a result, they can better see, in real time, how we react both neurologically and biochemically to emotional triggers.
Such glimpses are giving scientists a new understanding of the biological basis of emotion, says Joseph E. LeDoux, PhD, professor of neural science and psychology at New York University’s Center for Neural Science. Our brains detect danger, for example, and initiate bodywide physiological responses like increased heart rate, perspiration and muscle tension – sometimes before we even realize we’re afraid.
It turns out that many of our emotional responses are hardwired into the brain, meaning that our conscious “feelings” may play less of a role in creating such responses than we’ve believed, and that our automatic emotional reactions may have a much stronger impact on our physiology than previously understood, according to LeDoux. He says understanding how the brain works – under both normal and emotionally stressed conditions – will have important consequences for how we treat all kinds of emotional conditions, including phobias and posttraumatic stress disorder.
Much of the founding research into the biochemistry of emotion started more than 30 years ago when neuroscientist Candace Pert, PhD, now a research professor in the Department of Physiology and Biophysics at Georgetown University Medical Center in Washington, D.C., discovered that certain types of molecules (known as peptides) carried emotionally triggered information to cell receptors throughout the body, creating a wide range of simultaneous biochemical and cellular-function reactions.
Through recent fMRI research, scientists have been better able to see this biochemical and neurological machinery in action. Consider a 2003 fMRI study, led by researchers at the University of California, Los Angeles, that watched the brains of college students who thought they were being snubbed socially: The parts of the brain that reacted to help them recover from their hurt feelings were the same areas that trigger the release of biochemicals known to blunt physical perceptions of pain. In other research, scientists learned that biochemical and neurological reactions stimulated by emotion can affect the immune system: For instance, levels of stress hormones such as epinephrine and cortisol increase when spouses argue, and that, in turn, can weaken their immune systems and make them more susceptible to illness. (Check out “Civil Unions” in the September 2005 archives.)
Today’s research is bearing out what Pert’s “molecules of emotion” were beginning to suggest decades ago: The physical and the emotional are inextricably linked. We’ve now got proof positive that stewing in stress and negative emotion is likely to have a nasty effect on our physical health. We also know that through better emotional stewardship we can positively influence our body’s well-being. For more on this topic, see “Emotional Biochemistry” in the November 2003 archives.
2. A Pyramid Overturned
During the past few years, the original one-size-fits-all food pyramid, given to us in 1992 by the U.S. Department of Agriculture, was officially declared a dud. It seems that while the government and food industry were busy plastering the pyramid on everything from the backs of cereal boxes to elementary-school bulletin boards, Americans were busy putting on weight and losing their battle with a variety of nutritionally related ills. Obesity rates reached 30 percent among American adults by the time of the 1999–2002 National Health and Nutrition Examination Survey, up from 23 percent reported in the 1988–1994 survey.
This year, the USDA released a revised pyramid that addressed some of its critics’ biggest complaints. The new pyramid also took into account some important advances in nutritional science – an approach many leading health experts had already adopted in developing alternative food pyramids of their own.
One such expert was Harvard Medical School’s Walter C. Willett, MD. Starting in the ’90s, Willett asserted that the original pyramid was a dangerous and misleading dietary guide that contributed to the generally poor state of American nutrition. He pointed out that the pyramid’s?design was based on shaky scientific evidence and that?it hadn’t changed to reflect major advances in our understanding of the connection between diet and health. Willett and his colleagues ultimately presented their own pyramid in what turned out to be a bestselling book: Eat, Drink, and Be Healthy (Simon & Schuster [hardcover], 2001). Willett’s “Healthy Eating Pyramid” was grounded in daily exercise and weight control, and it put a greater emphasis on whole foods and healthy fats.
When the USDA issued its new pyramid this year, it appeared to have adopted at least a few alternative-pyramid building blocks: The new “MyPyramid” interactive module (available at www.mypyramid.gov) includes an exercise component and offers nutritional advice based on age, gender and activity level. It emphasizes more whole foods and calls for reduced intake of processed sugar.
Still, many experts think it falls short of emphasizing truly healthy eating habits. For an example of a more ambitious and holistic approach, see the University of Michigan’s “Healing Foods Pyramid,” which addresses foods’ healing benefits, mindful eating and the role of a healthy environment (www.med.umich.edu/umim).
3. Cracking the Code
In April 2003, the National Institutes of Health announced the earlier-than-expected completion of the Human Genome Project (HGP), which unveiled the sequencing of all the genes in the human body. The cracking of the genetic code was widely hailed as a tremendous technological achievement that would change the way we approach human health.
The publicity surrounding the HGP also led to a greater public understanding of how genetic information (nature) and environmental or behavioral variables (nurture) can interact in our bodies. We learned that almost all genes have slight variations, called single nucleotide polymorphisms (SNPs), and that we inherit these from our parents. But whether or not a “bad” SNP actually causes disease depends in part on lifestyle and environmental factors, including diet, exercise, smoking and exposure to stress. For someone who inherited an “obesity SNP,” for example, poor eating and exercise habits are more likely to lead to marked weight gain. The presence of this SNP, once activated, can also make weight loss much more difficult.
A feature in our May/June 2003 issue, “Emerging From the Gene Pool,” explained it this way: “What we do (or don’t do) to our bodies – right here and now – can make all the difference in how our genes ultimately behave, or ‘express.’ In short, our everyday choices can affect whether countless tiny genetic ‘switches’ in our DNA are turned on or off, and by extension, whether we develop or successfully avoid all kinds of hereditarily influenced health woes.”
During the past several years, experts have made significant progress in understanding the genetics of disease. For many common ailments – diabetes, heart disease and colon cancer in particular – we know for sure that altering diet and lifestyle benefits high-risk individuals. For diseases that are rare, like inherited breast cancer and cystic fibrosis, genetic testing can be helpful in screening, prevention and early diagnosis, says Lawrence C. Brody, PhD, senior investigator at the Genome Technology Branch at the National Human Genome Research Institute, in Bethesda, Md. Some 900 genetic tests already offer insights into our predispositions and vulnerabilities to certain diseases and conditions. In the future, Brody says, testing may be used to gauge the possibility of future illness, confirm a suspected diagnosis, predict response to therapy, and detect the presence of a harmful gene in an unaffected person whose child could later be affected.
4. Heart Mending
Want a healthy heart? Diet and lifestyle choices have long been considered critical in maintaining a rock-solid ticker, but now new evidence proves that a combination of proper nutrition, exercise and managing stress play an even bigger role than previously understood.
In 2002, a 20-year study reported in Stroke: Journal of the American Heart Association showed that diets high in folate (a B vitamin found in okra, citrus fruits, tomatoes, legumes and leafy green vegetables like spinach) resulted in a 20 percent lower risk of stroke and a 13 percent lower risk of cardiovascular disease than lower-folate diets. And dating back to the early 1970s, studies conducted at Boston’s Beth Israel Hospital and Harvard Medical School by Herbert Benson, MD, showed that relaxation techniques based on the principles of transcendental meditation could have enormous health benefits, from lowering blood pressure to decreasing heart disease.
In 1998, two major medical journals – the Journal of the American Medical Association (JAMA) and the American Journal of Cardiology – reported the results of groundbreaking studies linking diet, behavior and coronary disease. The unique aspect of this research, conducted by University of California-San Francisco medical professor Dean Ornish, MD, was the idea that heart disease could not only be prevented but also reversed – something previously seen as impossible.
One study showed that of 48 people with moderate to severe heart disease, the 20 who made intensive diet and lifestyle changes had substantially diminished blockages after five years. The 15 patients who made smaller changes actually had more severe blockages after five years, and nearly three times as many heart attacks and other “cardiac events” as the more compliant group. (Thirteen of the subjects dropped out of the study before its completion.)
Another study, designed to determine if comprehensive lifestyle changes could safely and effectively substitute for surgery, showed that 77 percent of patients who had been told they needed surgery were able to avoid it by following Ornish’s program, with no accompanying increase in cardiac events.
Prior to Ornish’s studies, it was generally accepted that heart disease could not be reversed. Arterial blockages take decades to build up, so the idea that they could diminish in a short time without surgery was radical.
But research now shows that nutritional and lifestyle adjustments can make it much harder for fats to collect inside artery walls – and much easier for the body to repair existing damage. Ornish’s early studies showed that blood flow to the heart, the ability of the heart to pump blood, and angina and chest pain improved after only one month on his program. In later studies, Ornish’s research team saw 90 percent reductions in the frequency of chest pain in just weeks. The biggest barrier to the heart-health improvement plan? According to critics (including the American Heart Association), it’s compliance with the program, which calls for stringent diet and exercise adjustments. But Ornish sees it differently: “There are a lot more people [who] are willing to make these changes,” he says, “once they understand how beneficial they could be and how quickly those improvements can be experienced.” The heart-healthy program includes:
1. A reversal diet, consisting of very-low-fat, vegetarian, whole foods.
2. Thirty minutes a day of moderate aerobic exercise, such as walking.
3. At least an hour a day of stress management and relaxation, such as stretching, meditation, yoga, etc.
4. Psychological support such as weekly participation in a support group and/or increased time spent talking about feelings with friends and family; participation in religious or spiritual activities.
5. No smoking.
More information can be found at the Preventive Medicine Research Institute Web site, www.pmri.org.
5. Inflammatory News
Sometimes the body’s defense systems go a little haywire and end up doing more harm than good. Take inflammation: An integral part of your immune system’s defenses, it can also target and break down the very tissues it’s supposed to protect. Inflammation also seems to play a role in many other kinds of diseases, and that has put it – and its potential for destruction – in the medical spotlight in recent years.
While inflammation’s destructive side has long been evident in autoimmune diseases like rheumatoid arthritis, multiple sclerosis and lupus, scientists have only recently implicated it in diseases such as diabetes, Alzheimer’s, osteoporosis, asthma, cirrhosis of the liver, psoriasis, meningitis and cystic fibrosis.
A growing body of research, as reported in The New York Times in January 2002, indicates that chronic inflammation also plays a significant role in the development of today’s top three killers: heart attack, cancer and stroke. Two studies in the Jan. 6, 2005, issue of the New England Journal of Medicine show that the C-reactive protein (CRP), a marker of inflammation, works in tandem with LDL cholesterol (the “bad” kind) to increase the risk of cardiovascular problems.
In addition to showing up in diseases that tend to strike as we age, inflammation can be a problem for younger people who are inactive and out of shape. Researchers are discovering that reckless health habits – such as poor diet, smoking and lifestyle choices that lead to obesity – can contribute to chronic inflammation, which was once considered an affliction of older bodies that had lost the ability to “turn off” inflammatory reactions. The result of chronic inflammation? The body relentlessly attacks itself, from the cartilage in the joints to the cells in the brain.
Science is likely to produce a variety of new drugs aimed at suppressing and reducing inflammation. But since inflammation is a natural, necessary and protective process in the body, those same drugs are likely to have a host of unintended side effects. The best way to steer clear of inflammation is to transform our reckless habits into healthier, more conscious ones. For more advice on that, see “Fighting Inflammation” in the July 2004 archives.
6. Solving for X
For quite some time, we’ve been aware of the biggest heart-disease risk factors: Excess abdominal fat, “bad” cholesterol, high blood pressure, elevated triglyceride and CRP levels, and abnormal glucose intolerance. What we’re finding out, though, is that when you rack up three or more of those problems, your risk for coronary heart disease (CHD) skyrockets. This syndrome of combined symptoms, known as metabolic syndrome X (and usually called metabolic syndrome or syndrome X), is usually linked to obesity, physical inactivity and genetic factors, and it is directly tied to increased risk of premature death from CHD.
In a study in the Aug. 23, 2004, issue of the American Heart Association’s medical journal, Circulation, researchers examined data from more than 6,000 people who took part in the second National Health and Nutrition Examination Survey from 1976 through 1980. Causes of death among this group were documented for an average of 13 years. The researchers compared the risk of death among four groups of people: sufferers of syndrome X, people with cardiovascular disease, diabetics, and people who didn’t have any of those problems. The results showed that compared to people who had no metabolic syndrome factors, the risk of death from CHD was twice as high for people with one or two factors, and three-and-a-half times greater for people with at least three factors.
For people with multiple heart-disease risk factors, these data are serving as a sobering wake-up call. The good news is that this information may also be convincing many folks who might not have otherwise sought medical or fitness support to go in search of it, pronto. Researchers at Johns Hopkins University in Baltimore, Md., found that moderate physical exercise can significantly offset metabolic syndrome. “Older people can benefit greatly from exercise, especially to reduce their risk for developing metabolic syndrome,” according to Kerry Stewart, EdD, director of clinical exercise physiology and heart- health programs at the university’s medical school and its Heart Institute. “Our results show that this population can be motivated to follow through with a moderate exercise program, and for some risk factors, such as abdominal fat, exercise can be as effective as what is accomplished today with drugs.”
7. The Truth About Hormones
Hormone replacement therapy (HRT) is one of those things that seemed like a good idea at the time. For decades, from the ’40s right up until 2002, many doctors asserted that by replacing and rebalancing certain hormones women produced in declining levels as they aged, they could counteract specific menopausal symptoms, such as hot flashes and hair loss, while helping to prevent a whole range of other maladies. For a while there, HRT was thought to reduce breast cancer (as observed in a 1962 study), to counteract heart disease (as research indicated in 1985) and to thwart the development of Alzheimer’s disease (as a study suggested in 1997). To some doctors, the potential health benefits seemed so promising that they even started women on the drugs years after they had gone through menopause.
That all unraveled when the Women’s Health Initiative (WHI) of 2002, a government-run study of 16,608 women, found that five years of HRT actually increased a woman’s risk of breast cancer by 26 percent, stroke by 41 percent and heart disease by 29 percent. The findings of the WHI about hormone therapy in general, and stroke in particular, are important to women because the prevailing wisdom had been that estrogen protected the brain, says Sylvia Wassertheil-Smoller, PhD, professor in the Department of Epidemiology and Population Health at Albert Einstein College of Medicine in Bronx, New York. But the WHI found that estrogen alone (for women who have had a hysterectomy) and estrogen plus progestin (for women whose reproductive systems are intact) pose increased risks of stroke as well as dementia.
Menopause and its related drop in hormone levels is, of course, a natural part of a woman’s life cycle. But the typical medical approach was to treat the loss of hormones as though that were some sort of disease. “While hormones do prevent osteoporosis fractures and colorectal cancer,” Smoller says, “they do not prevent heart disease and stroke or Alzheimer’s, so the risks [of HRT as a disease preventative] outweigh the benefits.” Because of these surprising findings, the estrogen-plus-progestin arm of the WHI study was cut short in July 2002.
What’s left to ease the discomfort of menopause? So-called natural hormones, made from plant estrogens that mimic what is produced in the body, help some women, according to Christine Gustafson, MD, an integrative medicine practitioner in Alpharetta, Ga. Others are focusing on healthy diets, regular exercise, mind-body practices like yoga and acupuncture, vitamin and calcium supplements, and in some cases, herbal remedies for which clinical studies have been inconclusive, according to the North American Menopause Society.
8. The Rise of Integrative Medicine
Although they have ancient roots in Chinese, Indian and other time-honored healing traditions, “integrative” and “holistic” medicine have only begun nudging their way into the U.S. mainstream during the past decade or so. But recent research suggests that this trend is an important and rapidly expanding one, in part because a growing body of scientific research is offering empirical evidence of alternative therapies’ beneficial results. Studies have shown that massage, for example, reduces heart rate, lowers blood pressure, increases blood circulation and lymph flow, and increases endorphins. In 1997, the National Institutes of Health issued a consensus statement acknowledging “clear evidence” that acupuncture was effective in managing certain types of nausea, vomiting and pain and likely had many other as-yet-unproven applications.
Today, various types of integrative, holistic or complementary medical therapies are available in 25 percent of metropolitan hospitals (32 percent of hospitals with 500 or more beds), as well as in a wide range of outpatient clinical settings. “Holistic” medicine acknowledges the importance of treating the whole person, as opposed to just responding to individual symptoms. The term “integrative medicine” refers to the idea that conventional medical treatment can successfully be combined with complementary and alternative medicines (CAM).
“The ideal approach [to healthcare] is integrative in methodology and holistic in attitude,” says Karen Lawson, MD, president of the American Holistic Medical Association and director of Integrative Clinical Services at the University of Minnesota’s Center for Spirituality and Healing. Today, the interdisciplinary healthcare team can include bodyworkers, herbalists, naturopathic doctors, practitioners of traditional Chinese medicine, homeopaths, nutritionists, mind-body teachers, chiropractors, spiritual directors and many others.
Alternative and complementary therapies already play an important role in many Americans’ approach to healthcare: A 2002 survey of 31,000 people by the U.S. Centers for Disease Control and Prevention indicated that 36 percent of American adults used some form of CAM; the numbers soared to 62 percent when prayer was included. With this shift, Lawson notes, each of us is more empowered to choose our own healthcare team, make our own informed decisions and steer the direction of our own healing process.
Science and technology have been redefining our ideas about health, well-being and longevity since the Enlightenment, and that evolution continues today. Cancer, for instance, once perceived as a death-sentence disease, has become a more manageable, and in many cases beatable, condition. Government guidelines for nutrition and exercise are slowly shifting to reflect the intelligence borne out by decades of research, as well as by the realities of our rapidly changing cultural environment. Studies into the genetic underpinnings of health and disease are enhancing our understanding of the intertwining roles nature and nurture play in creating our physiology.
In general, though, the most important gift wrapped up in all this scientific progress is the increasingly clear picture of how intricately connected the body’s systems are, and how important it is for us to be proactive in our care of those systems. In many cases, all this high-tech research is showing us that it’s the low-tech efforts – eating nutritious food, staying fit, managing stress – that offer the most promise.