Repairing the Damage
	Ready to turn your life around? It's simple. Eat right. Quit smoking. Get fit. Watch your weight. Drink less. And take it easy. Think it's too late to reverse a lifetime of bad habits? The latest research will surprise you By Christine Gorman

Feb. 5, 2001
Behind most of the bad things we do to our bodies as adults — eat too much, drink too much, fret too much, veg out too much — are two contradictory ideas we carry with us from childhood. On the one hand, we assume that we are indestructible. And on the other, we think that any damage we inflict on our delicate biological systems can be undone later, when we finally decide to clean up our act.

If the evidence for how wrong the first idea is isn't apparent when you stand naked in front of the mirror, just wait. Or, if you can't wait, compare the ideal human forms represented in, say, Greek statuary with the bodies of the folks queuing up at Disney World or Taco Bell or Ben and Jerry's.

But what about that second idea? What if you eat right, get into shape, drop all your bad habits and start treating your body like the temple the ancients said it is? Is it too late? If you start today, can you repair the damage?

To a surprising degree, the answer is yes. Over the past five years, scientists have accumulated a wealth of data about what happens when aging boomers and slackers decide to turn their lives around. The heartening conclusion: the body has an amazing ability to heal itself, provided the underlying damage is not too great.

The effects of some bad habits — smoking, in particular — can haunt you for decades. But the damage from other habits — especially those that affect the circulatory system — can be largely offset. "At any time you decide to improve your behavior and make lifestyle changes, they make a difference from that point on," says Dr. Jeffrey Koplan, director of the Centers for Disease Control (CDC). "Maybe not right away. It's like slamming on the brakes. You do need a certain skid distance."

But the skid distance can be remarkably short. Consider these recent dispatches from the front lines of medical research:

— Just two weeks ago, a study in the Journal of the American Medical Association concluded that women who consume as little as 8 oz. of fish a week cut their risk of suffering a stroke almost in half.

— Laboratory measurements show that eating more fruits, vegetables and fiber changes the blood's sensitivity to insulin within two weeks, helping decrease the risk of diabetes almost immediately.

— Scientists have found that hitherto sedentary 40-year-old women who start walking briskly for half an hour a day, four days a week, enjoy almost the same low risk of heart attack as women who have exercised conscientiously their entire lives.

— The day you quit smoking, the carbon monoxide levels in your body drop dramatically. Within a week, your blood becomes less sticky and your risk of dying suddenly from a heart attack starts to decline. Four to five years later, the chance you will have a heart attack falls to nearly that of someone who has never smoked.

Adopting healthy habits won't cure all that ails you, of course. But doctors believe that as much as 70% of all chronic diseases in the U.S. — from diabetes and high blood pressure to heart disease and even some cancers — can be warded off with some timely, sensible changes in lifestyle.

Still, we have our work cut out for us. Nearly 50 million Americans continue to smoke. More than 60% are obese or overweight — 20 years ago, it was 47%. One in four Americans gets no regular exercise at all. Perhaps 25% of the populace consumes the recommended minimum of five servings a day of fruits and vegetables. The incidence of adult-onset (or Type 2) diabetes, having jumped 33% from 1990 to 1998, climbed an additional 6% in 1999, according to a report released last week by the CDC. Health experts worry that if present trends continue, the incidence of cancer could increase and the death rate from heart disease — which had been leveling off — could reverse itself.

Wouldn't it be great if there were a vitamin or a drug or a fad diet that would protect you? Unfortunately, undoing the damage from a lifetime of bad habits means learning — and sticking with — a whole new set of behaviors. After all, anybody can lose 10 or 20 lbs., and many of us have — over and over again. It's only by maintaining that weight loss, however, that you derive real, lasting benefits.

That's the bad news. The good news is that even small changes can lead to big improvements. For example, doctors for years thought that lowering cholesterol levels reduces the risk of heart attack by shrinking artery-choking plaques. As it turns out, lowering cholesterol levels doesn't change the size of the plaques very much. But it makes them less reactive, thereby lowering the chances that they will rupture. Similarly, even a modest reduction in blood pressure decreases the likelihood that a plaque will burst, reducing the risk of both heart attack and stroke. The payoff can be huge. "It isn't just a matter of living an extra day," explains Dr. James Cleeman, coordinator of the National Cholesterol Education Program at the National Institutes of Health. "Avoiding strokes and heart attacks adds quality to your life."

Not sure where to start? Surprisingly, it doesn't really matter, since one positive change usually leads to another. Becoming more active physically, for example, inspires many people to eat a healthier diet. Make enough changes, and eventually you'll discover you've adopted a new way of life. It won't make you invincible or doctors unnecessary, and you can't wait forever. But you'll never know just how much damage you can undo if you don't try.

It's Never Too Late To...

EAT RIGHT
For more than a decade, dietitians and nutritionists harangued us to lower the amount of fat in our diet. As it happens, their message was only partly correct. Although all fats are high in calories, certain fats, like the omega-3 fatty acids commonly found in fish, are actually good for you, provided you consume them in moderation. Not only do omega-3s reduce the risk of clot formation in blood vessels, they also lower the amount of triglycerides, another fatty substance in the blood. The bottom line is that folks who eat 6 to 8 oz. of fatty fish a week experience significantly fewer heart attacks and strokes. (A caveat: the Food and Drug Administration warns pregnant women not to ingest such species as swordfish and king mackerel to avoid birth defects due to possible mercury poisoning.)

Still on the consume-sparingly list are saturated fats, commonly found in red meats and whole-milk dairy products. Recent studies also suggest that another group of fats, called trans-fatty acids, found in abundance in crackers and cookies prepared with hydrogenated oils, may be an even more dangerous promoter of high cholesterol than saturated fats.

The most immediate benefit from adopting a healthy diet is that it can lower blood pressure. Even if you don't have hypertension, decreasing your blood pressure makes your blood vessels springier and can help stabilize potentially dangerous plaques in the arteries. Two major studies, one published last month, have shown that the DASH (for Dietary Approaches to Stopping Hypertension) diet — which emphasizes fruits and vegetables, promotes low-fat dairy and high-fiber grains, permits modest portions of lean meat and reduces sodium intake — can lower blood pressure as effectively as taking a prescription anti-hypertension drug. Just as important, the foods are filling, taste good and aren't that different from what most Americans are used to eating.

Lower blood pressure isn't the only reason to put a little DASH in your life. The extra calcium in the diet helps reduce the risk of osteoporosis. The fiber in the fruits, vegetables and other foods can decrease insulin resistance in many diabetics and even lower their need for medication. There's also the possibility, over the very long term, that it may help diminish the risk of some types of cancer. "It's not a diet for one disease," says Dr. Lawrence Appel, a DASH researcher at Johns Hopkins Hospital in Baltimore, Md. "It's a diet for all diseases." (For more on DASH, visit dash.bwh.harvard.edu.)

QUIT SMOKING
Long-term studies now indicate that it is harder to undo the damage to the lungs from smoking than most people and even many doctors realize. While quitting can eventually restore the lungs to their original bright pink form, that doesn't necessarily mean that all the cells deep within their folds are now healthy. "Quitters 30 years out still get lung cancer," notes Dr. Eva Szabo, chief of the lung-cancer research group at the National Cancer Institute. But their risk, she hastens to add, is substantially lower than it would be had they continued to smoke.

Fortunately, the circulatory system is more resilient. In the past few years doctors have learned that blood vessels and coronary tissue respond almost immediately to quitting smoking — even in smokers who are 60 or 70 years old. The risk of suddenly dying begins to drop within the first weeks and five years after quitting is nearly indistinguishable from that of someone who has never smoked. "I tell this all the time to my patients to help motivate them to quit smoking," says Dr. JoAnn Manson, chief of preventive medicine at Brigham and Women's Hospital in Boston. "They're always surprised to learn they're going to get benefits quickly."

GET FIT
Among the more surprising findings of the past decade is that weight training can reverse some effects of aging. In 1990 researchers from Tufts University showed that elderly nursing-home residents, ranging in age from 86 to 96, dramatically increased their strength and improved their balance in just eight weeks of supervised weight training. Further studies have since proved that working out with either free weights or machines helps restore lost bone density, diminish knee pain from arthritis, and moderate insulin insensitivity in Type 2 diabetics.

You don't have to wait until you're 90 to get started. Studies show that some of the greatest benefits occur in men and women who pick up weight training in their 30s and 40s. That doesn't mean you can ignore aerobic activity, however. Even a brisk walk three times a week for half an hour at a stretch does some good. But the best cardiovascular results appear once you start breaking a sweat at least five days a week. As you become more fit, you may need to increase the intensity or duration of physical activity.

Your circulatory system benefits the most in the early going. Practically from the moment your heart starts pounding harder, your blood vessels become more flexible, lowering blood pressure. For 18 to 24 hours after you exercise, your body becomes more sensitive to the insulin it produces, keeping your sugar levels efficiently in check and reducing your risk of diabetes. A study of more than 5,000 women with diabetes published in the Annals of Internal Medicine last month found that those who walked the most (and at a brisk pace) lowered their risk of heart disease and stroke better than 40%.

"We know that if everybody exercised a few hours a week, Type 2 diabetes would be virtually nonexistent," says Ken Goodrick, associate professor at Baylor College of Medicine in Houston. "The trick is motivating everyone to do it."

Somewhat unexpectedly, the benefits of regular exercise appear to be relatively independent of how much you weigh. A 1999 study of 25,000 men (average age: 44) showed that, all other things being equal, men who were obese and physically fit had about the same risk of death over a 10-year period as men who were both physically fit and of normal weight. By contrast, men of normal weight who were unfit were twice as likely to die as the obese but fit men. "It's pretty clear that if you follow a healthy diet and don't smoke but don't exercise, you are still at high risk [of chronic illness]," says Steve Blair, an author of the study and director for research at the Cooper Institute in Dallas. Men who were both obese and inactive faced the worst odds: they were three times as likely to die of heart disease as physically fit men of normal weight.

So get moving — even if you don't need to lose weight or have given up trying. Top choices include brisk walking, moderately fast dancing and swimming. "A lot of it comes down to trying to do more than you're already doing," says Abby King, a health researcher at Stanford. "We start people where they are and encourage them to build on that. If they jump in too quickly and get sore, they quit."

WATCH YOUR WEIGHT
Doctors have long known that being 30 lbs. or more overweight dramatically increases your risk of heart disease, diabetes, gallbladder disorders and arthritis. The most effective strategies for losing weight and keeping it off, according to a 1997 study of men and women who had dropped at least 30 lbs. for more than five years, consist of cutting back on caloric intake while significantly boosting physical activity. Yet only about 20% of folks who say they're trying to lose weight depend on a combination of diet and nearly daily exercise in their efforts.

Can't imagine losing 30 lbs.? Current research shows that many overweight folks who shed as few as 10 lbs. can lower their blood pressure (though it won't necessarily make it normal) and, in some cases, reduce their risk of diabetes. The goal is to drop just a pound or two a week so that the body doesn't lower its metabolic thermostat to starvation-level readings. (Paradoxically, losing weight too rapidly increases the risk of developing gallstones.) Even such a gradual regimen has recently been shown to result in the loss of muscle as well as fat, however, unless you also include a moderate strength-training routine.

Is 10 lbs. too much to ask? Then just make sure not to gain any more. Indeed, such a large proportion of the U.S. population is overweight that the American Heart Association decided last year for the first time to stress the importance for adults of trying to maintain their current weight rather than just urge the overweight to slim down. Of course, the older you get, the harder this is to do. For most folks, the solution is to combine eating moderately with exercise that strengthens both the heart and skeletal muscles.

DRINK LESS (if at all)
What is it about alcohol that triggers our most moralistic impulses and feeds our deepest reserves of denial? There is no question that many people can drink alcohol without suffering lasting side effects and may, in some cases, be healthier for it. There is also no question that for some folks — not all of them alcoholics — even a single drink is poison.

The evidence suggests that consuming a moderate amount of alcohol, equal to a glass or two of wine, may benefit the heart and blood vessels. But the results aren't overwhelmingly positive. Furthermore, it doesn't take much to trigger a host of ills--from fistfights to high blood pressure. A lot depends on circumstances and individual physiology. "A young healthy woman may, for example, be able to drink one or two glasses of wine a week," says Samir Zakhari, director of the division of basic research at the National Institute on Alcohol Abuse and Alcoholism. "But that's not something she should be doing if she's pregnant or trying to become pregnant."

Driving while drinking is obviously a bad idea. And alcohol can cause devastating side effects with a number of medications, including some over-the-counter remedies, like acetaminophen, often sold under the brand name Tylenol.

The liver and the brain are the most susceptible to alcohol's harmful effects. Contrary to popular mythology, the liver doesn't always regenerate itself. As long as extensive damage hasn't occurred, the liver can recover. But once cirrhosis or scarring of the organ sets in — a process that generally takes years of intense drinking — the damage is no longer reversible; the best you can do is avoid making it worse. The brain, on the other hand, tolerates much less abuse. A weekend of binge drinking will kill some neurons. Whether or not you notice depends on how often you do it.

Perhaps one of the most overlooked dangers of alcohol use is that it masks or even exacerbates mental illness, particularly depression. In such cases, undoing the damage caused by the alcohol requires treating the underlying psychiatric disorder as well.

TAKE IT EASY
Although doctors have studied meditation, prayer and anger-management programs since the 1970s, research into the effects of the mind on the body is still in its infancy. The latest evidence suggests that a holistic approach that touches both the heart and head offers the best chance of success. Dr. James Blumenthal and his colleagues at Duke University, for example, have shown that heart patients who exercise and learn how to control their anger are less likely to suffer from ischemia, a sometimes painful condition in which the cardiac muscle is starved for oxygen. Exercise alone was only half as effective.

Attitude also makes a difference. Blumenthal and his colleagues have determined that exercise, combined with weight loss in a support-group setting, allows more people with mild hypertension to normalize their blood pressure than does changing just one of those variables. The message is clear: if you want to improve your health, you need to make several changes in your routine.

More controversial has been the handful of studies that suggest that practicing yoga may help decrease the number of asthma attacks in some patients. The idea is that the regular, measured breathing that yoga teaches may reduce the level of stress hormones in the blood, making the airways less vulnerable to an asthma attack. But if research into lifestyle changes has proved anything over the past few years, it's that while undoing the damage caused by chronic illnesses or unhealthy habits is possible, it's not always easy or foolproof. So be sure to keep your doctor's phone number handy, just in case.

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