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THE TICKING TIME BOMB
Americans are fatter and sicker than ever. We are eating horrendously, moving and exercising less, and not getting enough sleep. This has made us fatigued, depressed, irritable, achy, and generally miserable. And if feeling terrible isn't bad enough, these habits are also making us sick-- with diseases like diabetes, heart disease, and cancer, to name just a few. We compensate by taking a lot of pills and supplements and resort to fad diets and other quick fixes that work temporarily or not at all. If we stay on this course, things are only going to get worse. If you don't believe me, keep reading. Even if you do believe me, but feel helpless to do anything about it, keep reading. My goal is to "wake" you up so that you can understand how we got to this sorry state and how you can turn things around for yourself, your family, your community, and, yes, for your country.
First let me introduce you to Marianne B. whose story illustrates the challenges we face.
Marianne, a 30-year-old nurse, is scared that the small Midwestern town where she and her husband are raising their two school-age children is literally dying before her eyes. What she's worried about is something that should be obvious, even to someone who's not a health-care professional. Nearly everyone in her town is either overweight or obese--including the kids. Diabetes is rampant. Heart disease is on the rise, especially among young adults. And at the hospital where she works, she is seeing more cases of severe allergies, chronic sinus and ear infections, asthma, and potentially life-threatening lung ailments than ever before.
It's no mystery to Marianne why so many people in her community are sick. "It's primarily the sedentary lifestyle and the poor diet, but people seem to be oblivious to the impact that their lifestyle is having on their health," she explains. What is perplexing to her is how many of them just don't get it.
Marianne's town isn't the only one that's in trouble--chances are your town is not much different from hers, and like the folks in her town, you too may have simply stopped noticing. That's hard to do, though, if you look at the maps on the Centers for Disease Control and Prevention Web site (www.cdc.gov/obesity/data/trends.html) that show obesity trends across the United States rising dramatically between 1985 and 2010. It really is astounding. In 1985, for all states for which there were data, the obesity rate was less than 15 percent, with many states having rates of less than 10 percent. Today, 36 states have obesity rates greater than 25 percent, with 12 of them at more than 30 percent! The state with the lowest obesity rate (21 percent) is Colorado. But if Colorado had the same obesity rate in 1985 that it has now, it would have been the fattest state in the Union instead of the thinnest. We've come a long way baby! Our country is headed for a medical and economic disaster.
A DOUBLE DEBT CRISIS
Every day we are witnessing the political battles over our national debt on TV, in the newspapers, and online. We have heard the debt crisis likened to a ticking time bomb, yet we continue to borrow money, seemingly without enough concern that we are just putting off the painful budget cuts that will have to be made later on. It appears that it will be our children and grandchildren who will have to pay for our lack of fiscal discipline today. That ticking time bomb will eventually blow up in our faces--or theirs.
We are unfortunately accumulating another national debt, and although it's not economic per se, the financial costs as well as the human costs could be insurmountable. It is also very much like a ticking time bomb that threatens us as individuals, as families, and as a nation. Our fast-food, sedentary lifestyle is wreaking havoc on our cells, tissues, and organs, and this will eventually lead to chronic diseases, some occurring sooner rather than later. These changes begin in childhood (and some possibly in the womb; see "A Toxic Lifestyle Can Begin in the Womb," page 6). One example, and the one closest to my own experience and expertise, is coronary artery disease (atherosclerosis), which we know can begin in childhood. Atherosclerotic plaques arise in the walls of our arteries and progress silently. They usually cause no symptoms until the day one ruptures, potentially blocking a coronary artery and causing a heart attack. Most of us do not know how many of these ticking time bombs are growing in our vessels or when they will explode. As a society, what we also don't realize is that we are amassing other ticking time bombs that may well go off in the future and affect our health in different ways--some as strokes, others as cancers, Alzheimer's, macular degeneration, or myriad other diseases.
We are already experiencing the adverse health consequences of our poor lifestyle choices, and at the rate we're going, things will only get worse. The solution does not lie in health-care delivery once diseases become clinically apparent. Rather, it lies in the preventive lifestyle measures we can take long before. The hard truth is that whatever form health-care coverage ultimately takes--one-payer, multiple-payer, or a combination of coverages--it won't matter, because we won't be able to pay for it. If we do not make the positive lifestyle changes needed to halt and reverse the obesity epidemic now--today--our health-care system will be overwhelmed by a nation plagued by chronic disease. The system will be bankrupted by the sheer numbers of sick Americans.
THE SICKEST GENERATION
Journalist Tom Brokaw dubbed the men and women who lived through and fought in World War II the "greatest generation." If current trends continue, many adult readers of this book could have the dubious distinction of being remembered as the "sickest generation." If you are between the ages of 30 and 45, you should be very worried. You have the misfortune of being the first generation born into the fast-food, sedentary, screen-obsessed culture we have become. For the first time since I started practicing cardiology more than 30 years ago, heart attacks are on the rise for this age group, reversing decades of steady decline in deaths from heart disease in all age groups.
A Toxic Lifestyle Can Begin in the Womb
Without immediate intervention, many children in the United States today are doomed to die prematurely. One out of six kids is currently so obese that he or she is vulnerable to a long list of diseases, like diabetes, heart disease, and nonalcoholic fatty liver disease, that open the door to a whole host of horrors, like limb amputation, kidney failure, and early death. If we continue along the same trajectory, one out of three babies born today will become diabetic at some point, and for the first time in modern history we will see a reduction in life span. We need to start protecting our children as early as possible, even before conception.
A woman who begins her pregnancy at a healthy weight and gains weight judiciously throughout its duration is doing herself and her baby a big favor. Unfortunately, half of all women who become pregnant are already overweight or obese. Obesity poses a health risk to pregnant women, predisposing them to preeclampsia (a potentially deadly type of high blood pressure), diabetes, premature delivery, and bigger babies (which increases the odds of having a C-section). It also makes it far more difficult to get down to a healthy weight after pregnancy, which, in turn, increases the risk of post-pregnancy prediabetes, heart disease, and many different forms of cancer.
And now it appears that maternal obesity may be dangerous for the offspring later in life as well. Researchers in England assessed the cardiovascular risk of more than 5,000 9-year-old children and compared those results with their mothers' prepregnancy weight and subsequent weight gain during pregnancy. Their report, published in 2010 in the American Heart Association journal Circulation, shows a clear correlation between a high prepregnancy weight and/or excess weight gain during pregnancy and an increase in heart disease risk factors in the children of these mothers, as opposed to the children of mothers who gained only the recommended amount of weight. The children of mothers who were of excessive weight were themselves heavier and had larger waistlines, more body fat, higher systolic blood pressure, lower levels of good HDL cholesterol, and higher levels of inflammatory markers (chemicals in their blood that could predispose them to heart disease, cancer, arthritis, and a slew of other ailments when they get older). Now, the exact mechanism by which a mother's excess weight leads to heavier children isn't precisely understood at this time. It could be due to the mom's genetic or metabolic tendency to gain weight being passed on to her child; it could be the effect of excessive sweets and refined foods eaten during pregnancy on the developing fetus's metabolism; or it could be her lifestyle choices that influence her child during his or her early years--or a combination. Whatever the mechanism, it's not a great legacy to leave for your kids.
I'm not suggesting that a child's fate is necessarily sealed in the womb and that there's nothing that you can do later to make it right. Rather, I view this study and others like it as red flags reminding us of the important role that parents play in their children's health and well-being before, as well as after, they are born.
And here's a real surprise: It may not just be obese mothers who are passing the effects of their unhealthy condition on to their offspring. Paternal obesity may also be a factor in determining the health of children down the road--at least it is in rats. In a widely publicized study published in Nature, Australian researchers at the University of New South Wales in Sydney fed one group of male laboratory rats a high-fat diet to make them obese and induce prediabetes, and fed another group of male rats a normal diet. They mated both groups of male rats with normal-weight female rats, and they found that the female offspring of the obese male rats developed prediabetes by the time they were young adults, whereas the female offspring of the male rats who were fed the normal diet did not. (Whether similar effects emerge in male offspring remains to be seen.) Moreover, numerous studies confirm that obese parents are at much higher risk of having obese children, which probably has as much to do with the example they set for their children and the environment they create in their home as it does with any genetic factors.
Recently, some very disturbing trends have been reported. In Olmsted County, Minnesota, home of the Mayo Clinic, autopsies have been performed since 1981 on young victims of unnatural deaths like accidents. For years, when doctors looked inside the coronary arteries of these young people, they saw a progressive decrease in the amount of atherosclerotic plaque that corresponded with a decrease in heart disease death rates. This decrease in both the amount of plaque and heart disease mortality continued until 1995, but then it began to slow down. The bad news is that since 2000, this slowdown has come to a halt: Plaque deposits in young people are no longer on the decline and are now increasing. These findings are consistent with the overall heart attack rates in Olmsted County and the rest of the country, where the decrease in heart attacks has plateaued and appears to be increasing among young Americans.
A 2007 study in the New England Journal of Medicine demonstrated that reduction in coronary artery disease deaths (mortality rates fell by more than 40 percent) from 1980 to 2000 would have been even more dramatic if not for the increase in deaths caused by obesity and resultant diabetes. It appears that since 2000 the skyrocketing increase in obesity and diabetes has halted the downward trend in heart attack deaths in young adults. Anecdotally, my colleagues and I, who screen for early vascular disease in our cardiology practices, are seeing more overweight young adults with the blood vessels typical of people decades older. I describe this phenomenon further in Chapter 2.
I call this generation of young adults the first fast-food, sedentary, computer-addicted, online-shopping, smart-phone-using, video-game-playing, social-networking generation. OK, let's just call them the "sickest generation," or "Generation S." The inescapable conclusion is that whatever we call them, their fast-food, sedentary lifestyle is trumping the advances in medical science that have been responsible for at least four decades of decreasing death rates from heart disease. And make no mistake: The same processes that are making our vessels prematurely old are also attacking the rest of our organs. And while their effects are becoming clinically apparent in the form of heart attacks and coronary artery disease in young adults, other manifestations are increasingly rearing their ugly heads in all age groups. In fact, our blood vessels and many of our organs are, in a sense, "rusting," and this process is beginning earlier and progressing faster than ever before.
Soon after I first became interested in disease prevention in the 1980s, the early detection of atherosclerosis in the arteries of the heart became my focus. In the late 1980s and early 1990s, my colleagues and I pioneered the use of noninvasive computed tomography (CT) heart scanning to quickly and non-invasively image coronary atherosclerosis. Using this new technology, we began seeing atherosclerotic plaques in the arteries of young adults years before they were likely to cause heart attacks. I learned soon thereafter that the recently described metabolic syndrome (prediabetes) was a major cause of the progression of atherosclerosis to eventual heart attacks in my patients. I also learned that metabolic syndrome was a problem of lifestyle, not one that could be banished with medications. This piqued my interest in advances in nutrition science and led to the development of a healthy eating plan for my patients, which ultimately became the South Beach Diet.