GIVEN HOW random it sometimes appears to be, you would be forgiven for believing that becoming chronically ill is sometimes down to bad luck or karma.
We read about the strange things that can cause the killer diseases like cancer and heart disease – carcinogens lurking in the food we eat, radiation coming up from the ground beneath us, or pathogens hanging menacingly in the air waiting to strike us down at any moment.
We are inundated with (often conflicting) advice from health professionals, pharmaceutical companies and commentators. It’s little wonder that most of us think that avoiding serious illness is a mind-bogglingly complex affair.
According to a comprehensive new study however, avoiding chronic disease is in fact relatively simple and almost entirely within our own control.
The European Prospective Investigation into Cancer and Nutrition (EPIC Potsdam) looked at the effects of lifestyle on chronic disease and made a startling discovery. The three most deadly chronic conditions – heart disease, cancer and diabetes – can largely be prevented by healthy living.
Not only that but the ‘recipe’ for healthy living is pretty straightforward too – there are in fact just four simple lifestyle measures that we need to pay attention to: never smoking, maintaining a healthy weight, exercising regularly and following a healthy diet.
The findings are based on a major public health investigation involving more than 23,500 German adults aged between 35-65.
The study found that taken together, the four lifestyle measures reduce the risk of deadly chronic diseases by up to 80 per cent. The four factors were associated with a 93 per cent reduced risk of diabetes, 81 per cent reduced risk of heart attack, 50 per cent reduced risk of stroke and 36 per cent reduced risk of cancer.
If the lifestyle measures seem straightforward on the face of it, how easy are they to implement in reality? We talk to experts in each area and get some no-nonsense practical advice.
Smoking
Unlike some of the other lifestyle areas mentioned in the research (eg diet and exercise) where moderation is the key, smoking really is one of those “all or nothing” vices. “There is no safe limit really with smoking,” says Norma Cronin, health promotion manager with the Irish Cancer Society.
“There are over 4,000 chemicals in a cigarette and over 60 of them are known cancer-causing agents. Quitting really is the only option and it’s the single most important thing you can do to reduce your chance of getting cancer and other forms of chronic illness.” So how to go about it?
Prepare to quit:"The key to success is wanting to quit," says Cronin. "Think about the reasons why you want to quit and write them down. It could be health reasons or to save money. Keep that list to hand."
Make a date to stop:Pick your day to stop smoking and then stop. Cutting down doesn't work for most. "Switching to low-tar cigarettes is not a runner either," says Cronin. "They are just as bad."
Triggers:"Work out your triggers, which are the times and situations that you associate with smoking. It could be making a phone call, after a meal, or the first cigarette in the morning.
“Change your routine and replace these triggers with new activities that you don’t link with smoking.”
The 4Ds:Cravings are normal and linked to the addiction. The good news is that they pass. "The 4Ds can help you get over the craving," says Cronin. "They are: delay for three minutes to see if the urge passes; drink water; distract and move away from the situation; and finally take a deep breath."
Think positive:"It's important to remember that you are doing the most important thing of all in relation to your quality of life and that your body is starting to recover immediately. Feel good about it. Try to do some physical activities which will make you feel even better."
Get support:Nicotine Replacement Therapies such as patches and gum can help some smokers, according to Cronin.
“NRT therapies are available free on the medical card. There are also non-nicotine prescription medications available. You still need to want to quit however. Call the National Smokers Quitline on 1850-201203 or see www.cancer.ie.”
Weight
Hardly a week goes by without another “breakthrough” diet promising weight loss with no pain. There is, however, an increasing consensus that the reality of weight loss is maddeningly straightforward – a case of maintaining a balance between the energy you take in, in the form of calories, and the energy you expend through exercise.
According to Dr Eva Orsmond, a medical doctor who runs the Orsmond Clinics, we place far too much faith in the ability of exercise to work off sufficient calories to help us lose weight.
“Half-an-hour walking will burn about 150 calories,” she says.
“One of those chocolate muffins contains about 500 calories. And that’s before you have your cappuccino with it! You really would have to do a huge amount of exercise to make any difference to your weight.”
Exercise, she says, is vitally important in maintaining overall health and is an important component in weight loss – but the real key to weight loss is managing the calories that we put into our bodies.
“To achieve 2.2lb of weight loss you need to have a calorie deficit of 7,500kcal. When you consider that the average man should take in 2,500 calories per day and the average woman, 2,000 calories per day, you can appreciate the size of the task.
“People cut out their lunchtime sandwich for a week and then get frustrated that they are not seeing any changes. But that sandwich is only 500 calories. Losing weight takes time and commitment.”
So how do we know if we need to lose weight in the first instance?
Orsmond is scathing of the standard measurements used – eg Body Mass Index (BMI) or even standard waistline measures.
“BMI is based on 60-year-old pre-war data. It doesn’t take age or gender into consideration. The key is this. If you have visible weight around your waist, then you need to lose it. That’s the weight that will kill you.”
Top five tips for losing weight:
Understand calories
Cut down your intake of high energy density foods
Eat smaller portions
Eat more vegetables, particularly the ones that grow above the ground – at least 500g a day
Weight will go if you persevere
Exercise
It is generally accepted now that we need to be getting exercise every day to maintain optimal health. The Irish Cancer Society advises at least 30 minutes of moderate physical activity each day.
“Anything you do that gets your heart beating a little faster and makes you breathe a little faster counts as exercise,” says Norma Cronin.
“It could be gardening, walking, cycling or swimming or even doing vigorous housework.
“This doesn’t have to be about joining a gym or spending money. It also doesn’t have to be 30 consecutive minutes – two or three short sessions can be used to make up 30 minutes.”
Where do you start if you currently don’t get any exercise? “Start slowly with 10-15 minutes of physical activity three to four times per week and gradually build up to 30 minutes a day.
“Being physically active helps avoid weight gain, obesity and reduces your risk of cancer, heart disease and diabetes.
“But there is also an incredible feel-good factor.”
Diet
What constitutes a healthy diet? The fact that tens of thousands of books have been written in an attempt to answer that one question probably says it all about just how confusing dietary advice has become. But, according to nutrition consultant Paula Mee, there are really only five core areas to watch out for when it comes to maintaining a healthy diet.
Cut down on foods that are high in calories, fat and sugar.
“It’s not about having a no-fat diet or counting every single gram of fat we eat,” says Mee. “It’s about asking yourself – what good fats am I eating today? The good fats we get from olive and rapeseed oil and from oily fish such as salmon and tuna.
“There is nothing wrong with a little butter on your bread – it’s a natural product. But if you are eating butter with everything and then eating cakes and biscuits, that’s where we get problems. Avoid highly processed, sugary foods altogether.”
Eat more fruit, vegetables, wholegrains and pulses.
“Try to meet the requirements in terms of five servings a day,” she says. “Eat two portions of fruit and three of vegetables. The more natural and fresh they are the better. One of the vegetable servings should be green vegetables.”
In terms of carbohydrates, Mee recommends high fibre wholegrains rather than highly processed white breads and rice. “The more processed our carbohydrates are, the less nutritious they are. The advice is, if it’s white, don’t bite.”
Mee believes that when Irish people think protein they think meat. “We need to move away from animal protein and towards plant proteins such as lentils, peas, beans, nuts and seeds. It’s about having hummus in a sandwich rather than ham or lentil soup for lunch instead of chicken.”
Limit your intake of red and processed meat:There is nothing wrong with eating meat three times a week in moderate quantities, according to Mee.
“The problem is that we eat far too much processed meats like ham, sausages and salami. “It should be lean cuts of meat with the visible fat cut off.”
Limit your intake of alcohol:"In moderation alcohol is known to be beneficial. But too much of it is disastrous. Men should not drink any more than two standard drinks per day," she says, "while women shouldn't drink more than one standard drink per day." A standard drink, you may be sorry to hear, is a half pint of beer, lager, cider or stout, one measure of spirits or a small glass of wine.
Limit your intake of salt:Irish people take almost twice as much salt as they need, according to the Irish Cancer Society which advises people to cut out salt when cooking and at the table.
“There’s still too much salt in the food we eat,” says Mee, “so you shouldn’t add any more when cooking. The food industry is doing a lot in terms of reducing salt, but still has a long way to go.”
The Irish Cancer Society has produced a document called Reduce your risk of cancer by taking three positive steps – it covers diet, weight and physical activity. See: www.cancer.ie/pdfs/ PreventCancer_Lifestyle_web.pdf
kelly@irishtimes.com