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Tuesday
Feb192013

Modern Medicine Gets a Failing Grade: Birth of the Lifestyle Approach By: Gary Null, Ph.D

Modern Medicine Gets a Failing Grade: Birth of the Lifestyle Approach
by Gary Null, Ph.D.

There is no longer a debate about the fact that we are an unhealthy nation. Neither is there a debate about the causes: smoking, unhealthy diet, and lack of physical exercise to name the most obvious. The debate is enjoined when we search for solutions. We expect solutions to come from within our health care system, from the Surgeon General, the CDC, the Department of Health and Welfare. However, it comes as no surprise that there has never been a national health program and no one is giving us important lifestyle direction.

We do have a solution. It's called CLIP, the Comprehensive Lifestyle Intervention Program, a program that has improved the health of people from all over the country, of all ages, and all walks of life. It's a program that involves diet, supplements, exercise, stress reduction, and behavioral counseling . But first let's define the problem.

Death By Cigarettes and Chocolate
The Journal of the American Medical Association (JAMA) is arguably the most prestigious peer reviewed medical journal in the U.S, even in the world. What JAMA says between its covers is state-of-the art medical science. Therefore, in March 2004, when JAMA published the paper "Actual Causes of Death in the United States, 2000," it was sending a message to the American people.1

One of the authors of this paper is none other than Dr. Julie Gerberding, the head of the Centers for Disease Control (CDC), whose name became a household word when she calmed the fears of the American people about the SARS epidemic in 2003. During her long career, Dr. Gerberding has written over 101 medical journal articles since 1985. Another author, Dr. Donna Stroup, has accumulated at least sixty-three journal publications since 1987 and mainly writes extensive medical literature reviews on a wide variety of topics. Dr. J. S. Marks has over 133 journal articles stretching back to 1960 with a focus on public health and lifestyle factors. Dr. Ali Mokdad's fifty-eight papers written since 1994 also follow lifestyle health risks such as obesity, arthritis, diabetes heart disease, and the distribution of measures such as C-reactive protein (a sign of inflammation) in the population.

These four doctors who wrote "Actual Causes of Death in the United States, 2000" are obviously very accomplished researchers and writers, and considering that Dr. Gerberding is head of the CDC, they wield considerable power. The important message that they are sending to the American public concerns lifestyle. Echoing what the World Health Organization has been saying for decades, that tobacco and lifestyle are the major causes of death in North America, Gerberding, et al. have quantified these deaths.

We have long been told that heart disease and cancer are the leading causes of death. We are shown these numbers every few years as the epidemic of these chronic diseases escalates. However, Gerberding and her colleagues have not just counted the end result of a lifetime of illness and called it heart disease or cancer, they have quantified the actual causes of disease and labeled them accordingly.

Actual Causes of Death

1. Tobacco 435,000
2. Poor diet and Poor physical inactivity 400,000
3. Alcohol consumption 85,000
4. Infectious agents (e.g., influenza and pneumonia) 75,000
5. Toxic agents (e.g., pollutants and asbestos) 55,000
6. Motor vehicle accidents 43,000
7. Firearms 29,000
8. Sexual behavior 20,000
9. Illicit use of drugs 17,000

The fact that tobacco causes deaths due to cancer, respiratory disease, and chronic infection is nothing new but what is alarming is that, according to this chart in Gerberding's paper, most deaths in the American population are due to tobacco smoking. Even more shocking is the 400,000 deaths due to poor diet and lack of physical activity. The number is a shock and so is the admission. As the so-called richest country in the world we are admitting that this extraordinary number of people are so malnourished and in such bad physical conditioning that it's killing them.

The World View
Dr. Pekka Puska, Director of the Department of Non-Communicable Disease (NCD) Prevention for the World Health Organization (WHO) presented at a WHO Global Forum on NCD Prevention and Control in Rio de Janeiro, November 9-12, 2003. In his presentation "Working Together for a Healthy Future: Setting the Scene", he outlined the worldwide causes of death in 2000. The assembly was shocked when he stated that seven out of ten main mortality risk factors are impacted by lifestyle choices. These risk factors, that affect both adults and children include:

  1. Blood pressure
  2. Tobacco
  3. Cholesterol
  4. Fruit and vegetable intake
  5. Alcohol
  6. High BMI
  7. Physical Activity

Dr. Puska warned of the emerging epidemic of NCDs that is "to a great extent a consequence of rapid changes in the diets, of declining physical activity and of increase of tobacco use." He emphasized that medical evidence for prevention exists and that population-based prevention is the most cost-effective and the only affordable option for major public health improvement in NCD rates. He said that WHO is making NCDs a priority with an emphasis on prevention. In the case of tobacco, Dr. Puska suggested higher taxes and a comprehensive advertisement ban. Three health programs were also launched.

  1. Tobacco: Quit and Win
  2. Physical Activity: Move for Health
  3. Diet: Global Fruit and Vegetable Initiative

Blame the Victim
It's very important that the CDC and the WHO are admitting that poor diet and lack of exercise is a major concern. Is their concern coming a little too late to help the already millions of sufferers of chronic disease? It shouldn't be forgotten that alternative medicine and integrative medicine doctors have been harping about this situation for decades.

Should we, in fact, be suspicious of the timing" After all, President Bush has made the statement that the health care system in America is on a collision course with bankruptcy and has set the date of the final fire sale on our health care for 2011. Perhaps a cynical mind can see the statistics on tobacco and lifestyle as a "blame the victim" ploy. After all, we are the ones that take a drag on the cigarette and SuperSize ourselves on a regular basis.

Morgan Spurlock, the writer, directory, producer, actor, and now nutrition media star, in his own reality drama of a one-month "mac attack" proved that we are the cause of our own. After one month of a MacDonald's diet he gained twenty-five pounds, had elevated blood levels of cholesterol, triglycerides, liver enzymes, uric acid. He also developed mood swings, depression, fatigue, and apathy.

Preventive Medicine
But let's be positive, perhaps the CDC is finally gearing up their preventive medicine forces because the standard practice of medicine is not working. Evidence of adverse drug reactions, medical mistakes, malnutrition in hospitals and nursing homes, thousands dying of bedsores are all reaching the inevitable crescendo of loss of faith in the "standard practice of care" because the standard practice of care seems to wholly embrace drugs and eschews alternatives in every form.

Dangerous Supplements
Witness the current attempt by the FDA to control "dangerous" supplements. In 2003, Sen. Richard Durbin of Illinois introduced the Supplement Safety Act (S.722) that would treat nutritional supplements like drugs. Let's compare the deaths caused by supplements and those caused by drugs. In a paper published in JAMA in 1998, the authors reported that in American hospitals, in one year alone, 2.2 million people suffered serious adverse effects from properly prescribed drugs, 106,000 died.2 Countless others died later, from their injuries. In any given year in America from 0-2 people might die from taking a hefty overdose of a potent herb, rarely, if ever, from taking the prescribed or recommended amount.

Majority of Americans Use Complementary Alternative Medicine (CAM)
CAM is defined as everything that standard medicine is not. So, everything that is not a drug, or surgery, or chemotherapy, or radiation-is CAM. Modern medicine has a monopoly on health care and it is in charge of creating the standards of practice of medicine. CAM is everything else and is routinely reminded that it is the black sheep in the health care family. However, that is not the opinion of the American people in a recent survey.

In a chilling indictment of the "standard practice of medical care," 28 percent of the American adult population is turning to alternative medical and health modalities because they say they no longer have trust or faith in modern medicine.1 That percentage translates into 79 million disenfranchised citizens that are sufficiently fed up with the "standard practice of medicine" that they are looking for and paying for alternatives. In the words of the authors of a 2004 nationwide study conducted by the CDC and the National Center for Complementary and Alternative Medicine (NCCAM), 28 percent of 31,000 people surveyed admitted that they used CAM because "they believed conventional medical treatments would not help them with their health problem." The authors found this view was in contrast to previous surveys that CAM users were not, in general, dissatisfied with conventional medicine.

The survey offered the most thorough look at CAM modalities and interviewed a much larger population than ever before. Interviewers met directly with participants and asked questions about twenty-seven types of CAM therapies commonly used in the U.S. Ten therapies were administered by a practitioner such as chiropractic, acupuncture, and massage and the rest involved self-care-diets, herbs, vitamins, minerals, aromatherapy, etc. Thirty-six percent of the individuals surveyed used some form of CAM. This translates into 102 million Americans. When prayer, used specifically for health, was included as a CAM therapy the number rose to 62 percent.

The highest percentage of users of CAM have a higher education; are women; people who had been hospitalized within the past year; and former smokers. The director of the CDC's National Center for Health Statistics (NCHS) Edward J. Sondik, Ph.D. admitted that, "Over the years we've concentrated on traditional medical treatment, (in our surveys) but this new collection of CAM data taps into another dimension entirely. What we see is that a sizable percentage of the public puts their personal health into their own hands."

What a surprise! The researchers were also surprised that "only about 12 percent of adults sought care from a licensed CAM practitioner, suggesting that most people who use CAM do so without consulting a practitioner."

We would suggest that all along a certain segment of the population has been quietly taking care of their own health. Women over the ages have been herbalists, midwives, and caregivers. Then several centuries ago herbalists were targeted as witches, then midwives were no longer allowed to practice without a doctor's supervision and everyone who wanted to help another had to be "regulated" - read: controlled, by a license. And, it's only in the past 100 years or so that modern medicine has imbued people with the idea that only doctors can diagnose and treat disease and offer a drug or surgery as their only cure. We would suggest that many people are waking up to the problems of the standard practice of medicine and taking matters into their own hands.

Drug Companies Lose their Grip
It takes very little imagination to see what is happening with the attack on natural supplements and the recent CAM survey. Pharmaceutical companies make tens of billions of dollars selling drugs and they don't want 36-62 percent of American population relying on CAM instead of a steady diet of drugs.

Is the CDC's Prevention Program Enough to Break the Drug Monopoly?
On the CDC website are "CDC's Prevention Activities that Target Actual Causes of Death."4

  • Tobacco: The CDC supports and funds programs all over the country to prevent and control tobacco use. Their most active programs are "Quitline" - telephone-based tobacco cessation services, which include educational materials, referral to local programs, and individualized telephone counseling.
  • Obesity: The CDC supports state nutrition and physical activity programs and currently funds twenty states to "prevent and reduce the prevalence of obesity and the chronic diseases associated with obesity."
  • Infectious Diseases: The main thrust surveillance and an education program about the overuse of antibiotics called the "Get Smart: Know When Antibiotics Work" campaign.
  • Toxic Agents: The CDC is working to determine which environmental chemicals get into people's bodies and at what levels. It is assessing the effectiveness of public health efforts to reduce people's exposure to specific chemicals. CDC is also tracking trends in levels of people's exposure to environmental chemicals and setting priorities for research on human health effects of exposure to environmental chemicals. CDC is funding schools of public health to support state and local health departments and to investigate possible links between the health and the environment.

Deconstructing the CDC's Prevention Program
What's wrong with the CDC's Prevention Program? It just doesn't go far enough.

Tobacco: Let's look at this sensibly. The CDC on it's own website claims that it "serves as the national focus for developing and applying disease prevention and control, environmental health, and health promotion and education activities designed to improve the health of the people of the United States." The May 2004, Surgeon General's Report on Smoking and Health, expanded the list of diseases caused by tobacco. Dr. Richard H. Carmona revealed for the first time that smoking causes diseases in "nearly every organ of the body." We've known for many years that smoking causes cancer, heart disease, and strokes but this newest report finds that cigarette smoking "is conclusively linked to diseases such as leukemia, cataracts, pneumonia, and cancers of the cervix, kidney, pancreas and stomach."

As with DDT, and as with almost every toxic chemical that has been tested over the past several decades we have some official saying exactly what Dr. Carmona says about smoking "We've known for decades that smoking is bad for your health, but this report shows that it's even worse than we knew. The toxins from cigarette smoke go everywhere the blood flows.

According to a Department of Health and Human Services report on smoking, on average, men who smoke cut their lives short by 13.2 years, and female smokers lose 14.5 years. The economic toll exceeds $157 billion each year in the United States -- $75 billion in direct medical costs and $82 billion in lost productivity. Knowing all this, if you were in charge of the CDC, wouldn't you want to do a little more to curb tobacco smoking in our population

Obesity: Unfortunately schools are supported by soft drink companies that sell soda in schools adding to the rate of obesity in children. By allowing sugar to comprise up to 25 percent of the dietary calories, for children, adolescents, and young people, we will continue to have the highest rate of obesity in the world.

Infectious Diseases: Nowhere in the recommendations about preventing infectious disease is there mention of alternatives to antibiotics. Even though there are natural antibiotics such as garlic and colloidal silver, which have been scientifically proven to kill many pathogens, the CDC continues to promote the notion that there is no other treatment for infections but antibiotics.

Toxic Agents: To say that the CDC has a prevention program for toxic agents is disingenuous. They merely continue to collect data. They make no mention of the 100,000 chemicals in existence, the fact that few of them have passed safety tests, and the fact that most of those, when they are tested are found to be carcinogenic.

Sugar and Health
In the report "Actual Causes of Death" 34 percent of U.S. adults are considered overweight, and an additional 31 percent are obese. In 2001, chronic diseases contributed approximately 59% of the 56.5 million total reported deaths in the world and 46% of the global burden of disease. Yet, the sugar industry will not admit that sugar has anything to do with causing weight, heart disease, or cancer. The most it will admit to is that sugar can cause cavities, but then all you need to do is take a poisonous chemical called fluoride and rub that on your teeth but not swallow it and you will be just fine.

The sugar industry is currently lobbying congress to stop funding the UN because of a UN health recommendation to reduce the amount of calories in the world's diet. Presently, U.S. diet recommendations allow 25 percent of calories to come from sugar! Imagine four meals in one day, three square and one snack, but mix them all up and take 1/4 of that amount and make it all sugar that is what most young people are eating-up to 40-teaspoons of sugar a day. Estimates of sugar consumption say that every American consumes an annual 150 pounds of sugar. These are the facts we need to learn. However, as long as the sugar industry controls the government and won't allow the proper nutrition education, we will continue to be a SuperSized nation.

Thirty international experts, commissioned by two U.N. agencies, the World Health Organization (WHO) and the Food and Agriculture Organization (FAO) came out with a new report. It's called The Joint WHO/FAO Expert Report, Diet, Nutrition and the Prevention of Chronic Disease. The experts agree that it's time that people limited their sugar intake to no more than 10 percent of calories. They also crossed that imaginary line in the sand when they said that cutting back on sugar would help put the brakes on the global epidemic of obesity-related disease. The UN is coming out against sugar and therefore against the sugar industry.

USA Today reported that the sugar industry is criticizing the document, refuting once again that sugar affects weight. The US National Soft Drink Association made the oft heard claim that the scientific literature does not show an association between sugar intake and obesity. They just don't recognize the fact that all Americans are the experiment and the results are obvious. The sugar industry is making their own health recommendation that exercise is what Americans are lacking. Actually, the UN report did advise twice as much exercise as the US guidelines, one hour instead of thirty minutes as well as a deep cut in sugar.5

The CDC and Chronic Disease
Nowhere in the CDC Prevention Activities does it mention the need to curb chronic disease. However, the CDC has it's own Chronic Disease Prevention website and chronic disease programs that "provide national leadership by offering guidelines and recommendations and by helping state health and education agencies promote healthy behaviors."6 The CDC is all in favor of promoting health behaviors but there are no recommendations for detoxification programs, an organic diet, or nutritional supplements. Looking at their specific programs it's all about measuring data, screening for disease, and using billions of dollars in the process. The CDC overview of chronic disease makes their lack of aggressive treatment and prevention chilling.7 The CDC says that Today, chronic diseases such as cardiovascular disease (primarily heart disease and stroke), cancer, and diabetes "are among the most prevalent, costly, and preventable of all health problems. Seven of every 10 Americans who die each year, which is more than 1.7 million people, succumb to chronic disease."

The Cost of Chronic Disease
The CDC admits that the United States cannot effectively address escalating health care costs without addressing the problem of chronic diseases. The following stunning statistics are taken from the CDC's Chronic Disease Overview:8

  • More than 90 million Americans live with chronic illnesses.
  • Chronic diseases account for 70% of all deaths in the United States.
  • The medical care costs of people with chronic diseases account for more than 75% of the nation's $1.4 trillion annual medical care costs.
  • Chronic diseases account for one-third of the years of potential life lost before age 65.
  • Hospitalizations for pregnancy-related complications occurring before delivery account for more than $1 billion annually.
  • The direct and indirect costs of diabetes are nearly $132 billion a year.
  • Each year, arthritis results in estimated medical care costs of more than $22 billion, and estimated total costs (medical care and lost productivity) of almost $82 billion.
  • The estimated direct and indirect costs associated with smoking exceed $75 billion annually.
  • In 2001, approximately $300 billion was spent on all cardiovascular diseases. Over $129 billion in lost productivity was due to cardiovascular disease.
  • The direct medical costs associated with physical inactivity was nearly $76.6 billion in 2000.
  • Nearly $68 billion is spent on dental services each year.

The Lifestyle Approach
WHO and FAO hope their Report on Diet and Chronic Disease findings will provide member states with enough ammunition to prepare national health strategies. Dr. Richard Uauy, lead author of the report made a number of astute observations.9

Dr. Uauy said that

  • Not all fats or all carbohydrates are the same; it pays to know the difference
  • People should eat less high-calorie foods, especially foods high in saturated fat and sugar, be physically active, prefer unsaturated for saturated fat and use less salt; enjoy fruits, vegetables and legumes and prefer foods of plant and marine origin.
  • A diet rich in fruit and vegetables containing immune-system boosting micronutrients could also help the body's natural defenses against infectious diseases.

The specific recommendations on diet are as follows:

  • Limit fat to between 15 and 30 percent of total daily energy
  • Limit saturated fats to less than 10 percent of this total fat consumer
  • Carbohydrates, provide the bulk of energy requirements, between 55 and 75 percent of daily intake
  • Free sugars should remain beneath 10 percent
  • Protein should make up a further 10-15 percent of calorie intake
  • Salt should be restricted to less than 5 grams a day
  • Intake of fruit and vegetables should reach at least 400 grams a day (about 14 ounces)

The report warns that obesity is not the only factor of concern with a poor diet but that chronic disease, such as hypertension and heart disease are caused by a diet high in saturated fats and excess salt. The amount of exercise recommended by the UN report is double the amount suggested in the US. One full hour a day of moderate-intensity activity, such as walking, as many days as possible is said to be needed to maintain a healthy body weight. Unlike the CDC preventive activities, the WHO/FAO report does recognize chronic disease as a prevalent but preventable problem, which is directly related to diet and exercise. The importance of creating an environment that supports health is also stressed.

Comprehensive Lifestyle Intervention Program (CLIP)
One of the only programs that comes close to the recommendations of the WHO/FAO has been tested over the past twelve years in the U.S. on thousands of participants. CLIP, conducted over a six month or a twelve month period, is a analysis of whether comprehensive lifestyle changes lead to improvement in several parameters: heart disease risk factors, obesity, symptoms of arthritis, menopause symptoms, and general health.

CLIP consists of a diverse group of individuals, including those who wish to maintain their health and those who are suffering from one or more illnesses. A total of 11,214 people participated in CLIP over a span of twelve years. The protocols involved comprehensive lifestyle changes non-calorie-restricted whole foods vegetarian and fish diet, supplements, aerobic exercise, resistance exercise, stress management, and two-hour weekly meetings, which included behavior modification. These protocols were implemented and participants were followed, sometimes for several years, after completion of their protocol.

The following objective data was collected from participants, first when the entered the program and when they graduated: cholesterol, LDL cholesterol, cholesterol/HDL ratio, homocysteine, blood pressure, weight, and impedance. Subjective data from participants consisted of daily journals and formatted questionnaires covering weight loss, menopause, arthritis, fatigue, aging, hair loss, anxiety/depression, and men's health.

Analysis of data from the study was able to determine that adherence to intensive lifestyle changes showed improvement in blood tests, physical exams, and health scores. The participants' detailed questionnaires showed improvements in nine different physical and mental functions and specific disease symptoms rated on a scale of 1 to 10. Markers included: energy, endurance, immune system function (catching colds etc.), mental function (memory, concentration), sugar problems (craving carbohydrates, hypoglycemia), skin (changes), joints, digestion, and hair.

Laboratory and clinical data revealed the following average reductions: a reduction of 16.3 percent in blood homocysteine levels; a reduction of 10.7 percent in total cholesterol; a reduction of 5.3 percent in LDL; a reduction of 10.3 percent in total cholesterol/HDL; an 11.6 percent reduction in systolic blood pressure, and a 13.8 percent reduction in diastolic blood pressure.

Researchers implementing CLIP were able to demonstrate that a comprehensive lifestyle intervention approach offers a safe and healthy way to lower cholesterol, homocysteine, blood pressure, and weight, and enhance overall general wellness, with no adverse side effects.

Because the focus of CLIP is on a comprehensive approach, including many different interventions, we did not measure the effect of each individual nutrient or lifestyle change. It is difficult, if not impossible, to measure scientifically, the power of individual causes in a lifestyle study. In implementing CLIP we chose to do what very few studies have done before. We chose to incorporate a totality of lifestyle changes that we felt could impact the progression of disease and enhancement of wellness and measure their overall effect.

In background research we recognized that large survey studies like the 122,000-person Nurses Health Study don't give definitive answers about health and neither are they double-blind, cross over.10 For example, the Nurses Health Study published the following conclusion - by consuming an extra two pieces of fruit per week you can lower your risk of acquiring a particular disease by a certain percentage. But, how do we know that consuming the two extra pieces of fruit per week were a cause, and not a coincidental factor, among many factors, that led to lower risk of acquiring the particular disease? The answer is that with such large survey studies, we do not know with scientific precision what constitutes a cause of a particular health condition and what may just be a coincidental effect. Yet, this lack of precision as to the determination of cause and effect does not render these studies meaningless. Instead, they are helpful to the extent that they demonstrate important correlations that may be further studied.

Lifestyle
Americans are increasingly overweight, fatigued, and suffer multiple types of pain, which diminishes their quality of life. The concept of lifestyle intervention is becoming more common in the literature.11-20 This study did not address any specific illnesses, rather its focus was on the outcome of major changes in a person's lifestyle and environment. Therefore, diet, supplements, exercise, stress management, behavior modification, and making an environmentally safer work and home environment were the main variables.

The following background information on cholesterol, blood pressure, obesity, and chronic disease serves to emphasize why CLIP is not directed at any particular disease, but at an epidemic of disease and bad health.

Cholesterol Facts
One-third of Americans have borderline-high risk cholesterol levels. Coronary heart disease (CHD) is the leading cause of death in America and high cholesterol levels contribute to the incidence of this disease. According to the American Heart Association borderline-high risk cholesterol levels are between 200-239 mg/dl.21 Desirable cholesterol is below 200 mg/dl and optimum LDL is below 100 mg/dl.22,23 And the optimum ratio of cholesterol to HDL is 3.5:1.24

Blood Pressure Facts
According to the American Heart Association, one in four Americans have high blood pressure and one-third of those are unaware that they do.25 The Seventh Report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure presented its guidelines for doctors in a JAMA article.26 The following are some highlights from the JAMA article.

  1. The risk of cardiovascular disease, beginning at 115/75 mm Hg, doubles with each increment of 20/10 mm Hg.
  2. People who have normal blood pressure at 55 years of age have a 90% lifetime risk for developing hypertension.
  3. People with a systolic BP of 120 to 139 mm Hg or a diastolic BP of 80 to 89 mm Hg should be considered as pre-hypertensive and require health-promoting lifestyle modifications to prevent CVD.

Homocysteine Facts
In 1998 the American Medical Association's (AMA) Council of Scientific Affairs addressed the relationship of folic acid, vitamins B6, B12, and homocysteine; folic acid and vitamin B12 deficiency and potential risk factors for cardiovascular and Alzheimer's disease; and folate and colorectal cancer in Report 8. Also in 1998, feeling an urgency to investigate homocysteine, the AMA "encouraged the CDC and the NIH to fund basic and epidemiological studies and clinical trials to determine causal and metabolic relationships among homocysteine, vitamins B12 and B6, and folic acid, so as to reduce the risks for and incidence of associated diseases and deficiency states." The AMA also urged the FDA to increase folic acid fortification to 350 g per 100 g of enriched cereal grain.27 There has been no update on homocysteine since 1998 but it continues to be a topic of considerable research activity.28-36

Chronic Disease Facts
Several major chronic diseases are greatly impacted by environmental and lifestyle factors. According to the American Heart Association, approximately 61.8 million people suffer from cardiovascular disease, which includes hypertension, heart diseases, and stroke.37 A 2003 study released by the Centers for Disease Control and Prevention (CDC) revealed that since 1997, the incidence of arthritis has soared from 43 million to 70 million. Therefore, at least one out of every three adults in the United States suffers from arthritis and/or chronic joint symptoms. The CEO of the Arthritis Foundation said that, "We are a nation in pain. Arthritis is the number one cause of disability and affects more people than ever imagined."38

Obesity Facts
According to the Centers for Disease Control (CDC), "Obesity has risen at an epidemic rate during the past 20 years."39 The CDC says that in 2003, the number of obese Americans is 44 million. In 2000, 64% of U.S. adults were overweight or obese. Fifteen percent of adolescents and children were also overweight. A Rand Corporation study published in October, 2003, shows that for the years 1986-2000, an alarming 1 in 50 Americans are 100 pounds overweight or more. The number of morbidly obese Americans has thus risen dramatically from its 1986 level of only 1 in 200. What was thought to be a rare group of overweight individuals, who are 150 pounds or more overweight, is becoming more common. That group grew from 1 in 2,000 Americans to 1 in 400 during the same 14-year study period.40

Metabolic Syndrome Facts
The health impact of obesity becomes obvious when addressing the condition called metabolic syndrome. A 2002 JAMA study estimates that 47 million Americans may exhibit this syndrome characterized by insulin resistance, obesity, abdominal fat, high blood sugar, high triglycerides, high blood cholesterol, and high blood pressure.41 Editorializing on this study the CDC advises that, "Because the root causes of the metabolic syndrome for a majority of individuals may be poor diet and insufficient physical activity, the high prevalence of the syndrome underscores an urgent need to develop comprehensive efforts directed at controlling the U.S. obesity epidemic and improving physical activity levels within the U.S. population."42

The intent of CLIP is to provide a diet, exercise, supplements, and lifestyle intervention program for preventing and reversing heart disease, arthritis, obesity, and the metabolic syndrome.

One Example of the Importance of Nutrients
Time and space does not permit an in depth description of specific nutrients but we offer one example of the importance of a group of nutrients in disease improvement and wellness. Other areas of nutrient research, such as antioxidant nutrition, essential fatty acids, or amino acids have similar bodies of evidence and will be a topic for a future paper.

Researchers have found that simple, food-based, methyl groups that are components of common nutrients - folic acid, choline, B-12, and B-6 - can turn on or off genes. During methylation, a methyl group attaches to a gene at a specific point and induces changes in the way the gene is expressed.43 In one very important study with implications for pregnant women and their offspring, a diet rich in methyl groups (folic acid, choline, B-12, and B-6) turned off a gene that led to adult obesity and diabetes in mice. Methyl groups are entirely derived from the foods people eat; they include vitamin B12, folic acid, choline, and betaine from sugar beets.44

Interestingly, these same nutrients, folic acid, B-12 and B-6 have a role to play in preventing heart disease. A genetic weakness in the body's ability to lower the levels of the amino acid homocysteine has been linked to premature vascular disease. These nutrients prevent homocysteine build up and consequent heart disease by changing homocysteine to the safer amino acid, methionine.

Risk Factor Analysis
The state of the art in assessing risk factors contributing to disease began with the Framingham Heart Study (1948), followed by the all-female, Nurses Health Study (1976), and the all-male Health Professionals Follow-Up Study (1986). Hundreds of journal articles have flourished from excavating reams of statistics compiled every two years in these surveys consisting of tens of thousands of people. Over time, as the number of participants succumb to a particular disease, those who were inflicted with the disease are compared in numerous ways with those who were not. The limitations of such studies are considerable. Manipulating the statistics of such large numbers of people (the original Nurses Health Study enrolled 122,000) makes the final results appear impressive. However, nutritional data compiled from diet histories alone may be insufficient to tell us enough about a specific nutrient to determine true risk reduction.

Human and animal short-term nutrient studies done on one nutrient at a time merely show that a specific nutrient deficiency contributes to symptoms and a specific nutrient replacement may modify those symptoms. But, isolating one symptom and treating it with one nutrient in a simple cause and effect approach should not be our only criteria for understanding the role of nutrients in health. We believe that by examining the human in the larger context of their life, including diet, supplement intake, exercise status, and stress reduction, is much more relevant and can be examined statistically using the objective and subjective measures that we have chosen.

Specific Dietary Requirements:

  • A mostly, non-caloric-restricted (people were not limited to a certain number of calories) vegetarian diet which included fish, soybeans and soy products, quinoa (high protein grain), mixed grains and beans, soy isoflavone or rice protein powder drinks (20 grams three times a day).
  • From six to nine servings of fruits and vegetables a day, Four servings of beans and whole grains such as whole brown rice, millet, oats, barley, kamut, amaranth, quinoa, spelt.
  • Two servings of starchy vegetables per day, such as kohlrabi, turnips, squash.
  • One whole onion and a 1/2 bulb of garlic a day.
  • One serving of sea vegetables a day.
  • Four ounces of fresh organic vegetable juice diluted with 4 oz of water building up gradually to six times a day. Most vegetables were used including celery, cucumber, beet, cabbage and could include apple for taste, and several ounces of aloe vera juice per day.

Specific Nutrient Supplementation
The total daily intake of nutrients was as follows. The selection of nutrients was based on a literature review of over 50,000 journal articles showing positive health indications for these supplements.

  • Vitamin B1 - 25 mg
  • Vitamin B2 - 25 mg
  • Vitamin B6 - 50 mg
  • Vitamin B12 - 1,000 micrograms
  • Folic Acid - 800 micrograms
  • Biotin - 100 micrograms
  • Pantothenic acid - 100 mg
  • PABA - 100 mg
  • Niacin - 100 mg
  • Calcium and magnesium - 1,000mg
  • Chromium - 200 micrograms
  • Selenium - 200 micrograms
  • Vitamin D - 400 IU
  • Vitamin E - 400 IU
  • Vitamin C- 5,000 mg
  • Choline and inositol - 100 mg
  • L-Carnosine - 500 mg
  • Coenzyme Q10 - 200 mg
  • TMG - 400 mg

Exercise
Participants gradually increased their level of activity to one hour a day with 1/2 hour resistance training (weight training) and 1/2 hour general aerobic training. Power walking was offered as one of the best ways to get aerobic exercise. Power walking is basically walking very fast, always with one foot on the ground, to maintain cardiovascular health and burn calories.

Behavior Modification
We took the "no more excuses" approach in the form of detailed journaling of day-to-day life issues and challenges. At each weekly session people were able to discuss their problems and shared solutions with each other with input from professionals. In group discussions participants learned to identify their "sublimation of choice," whether it was overworking, complaining, overeating, drug taking, gambling, or sex, and sought to modify this behavior. Specific behavior modification educators in the mass media such as Norman Cousins, Wayne Dwyer, George Leonard and Herbert Benson were models for this part of CLIP and their books were recommended reading. 145-148

Stress Management
Stress management consisted of two 1/2 hour sessions per day of prayer, meditation, journal writing, listening to calming music, walking, yoga, tai chi, or any other soothing, de-stressing technique.

Environment 
Participants were instructed to clean up their living and work environments, remove toxins such as paint thinners, pesticides, and strong cleaning products, and obtain air and water filtration systems.

Results of a Lifestyle Approach
The total number of participants enrolled in CLIP over a ten-year period was 11,124. The percentage of participants who were not able to complete the program was 36 percent.

Blood Pressure
We found that not only could we modify blood pressure in the pre-hypertensive range, but also in the hypertensive range, and without resorting to anti-hypertensive medications. The average drop in systolic pressure was 12 percent and the average drop in diastolic pressure was 14 percent.

Cholesterol 
The average reduction of total cholesterol for all three groups was 10.7 percent. The average reduction in LDL cholesterol was 15.3 percent.

Homocysteine 
Homocysteine is a relatively new, but very important marker for heart disease that we have only been measuring since 2001, and only in our Open Groups. The following represents preliminary data collection on all participants. There was an average of 16.3% reduction in homocysteine levels with consistently greater reduction for subjects who began the study with levels 11.5 units or greater.

Targeted Groups 
From 1990-1999 all participants were only entered into Open Groups. From 1999-2003 there were Open Groups and Targeted Groups. Targeted Groups consisted of participants with specific disease criteria confirmed by a doctor's letter. In these groups, there was an average 82 percent improvement in health parameters for people who completed their program. People lost weight-in some cases over 150 pounds; arthritis sufferers eliminated their pain and were taken off their medication; those with fatigue got their energy back; women with menopause no longer had symptoms; seniors slowed down the aging process; men improved their libido and reversed impotence; people with mood disorders greatly decreased their symptoms of anxiety and depression and were often taken off their medications. At the routine six-months follow up 73 percent continued to have sustained improvement and did not relapse into past bad habits and behaviors. They acknowledged how easy it was to maintain their lifestyle. People continued to report that they felt extremely well. Those who lost up to 100 pounds maintained their weight loss.

The CLIP results clearly show that a conscientious shift toward healthier lifestyle choices: diet, supplements, exercise, behavior modification, and stress reduction can make a difference in health outcome. CLIP provides proof that lifestyle modification is able to change biochemistry and physical and mental symptoms, and disease symptoms in many individuals. CLIP also shows that health improvement is possible in a diverse group of individuals who are making incremental adjustments to their daily routine. Not only was change possible in people who presented with disease conditions but CLIP provided relatively healthy people with the tools to maintain wellness.


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