The Pillars of Health | Episode 2

In this episode, Dr. Norton discusses the primary causes of disease and early death and the major adjustments to your life you can make to reduce your risk.

What are my general themes for health (the 6 pillars)

What are the main causes of death & disease?

• CVD – 32% of global deaths, 20% of US deaths
• Cancer – 10% globally, 19% in US
• Stroke – 5% of US deaths
• Dementia/Alzheimer’s – 3-4%
• Diabetes – 11% Globally, 3% in US
• Respiratory diseases (COPD/Lower resp infection) – 20% Globally, 4-5% in US
• Accidents(intentional/unintentional) causes – 4-5% Globally, 7% in US
• Liver disease – 5% Globally, 1-2% US

Nutrition

• Don’t eat too much/gain excess body fat
  • Excess bodyfat increases mortality risk by 25-30% (BMI: 25-29.9, overweight), 60-70% (class 1 obesity, BMI: 30-34.9), and 85-100% (class 2 obesity, BMI: 35-39.9) 1
  • Obesity increases risk of CVD even in people who are obese but ‘metabolically healthy’ by over 80% and up to 250% increased risk for individuals with morbid obesity (BMI > 40). 2 3
  • Obesity increases the risk of cancer incidence for each 5 point increase in BMI by 4
    • 59% for endometrial cancer
    • 51% for Esophageal adenocarcinoma
    • 30% for kidney
    • 26% for LIver
    • 22% for stomach and gallbladder
    • 13% for Breast
    • 11% for thyroid
    • 10% for colon cancer
  • Obesity increases risk of Dementia/Alzheimer’s by 17% 5
  • The lifetime diabetes risk in men older than 18 years increases from 7% to 70% when BMI increases from less than 18.5 kg/m to more than 35 kg/m. Similarly, the lifetime diabetes risk in females increases from 12% to 74% with the same BMI values. 6
  • Obesity increases risk of Non-alcoholic fatty liver disease by 350%! 7

• Consume enough protein for composition goals
  • Protein can increase lean mass and reduce the loss of lean mass in people who diet. It can also reduce the risk of sarcopenia. 8 9 10
• Consume sufficient fiber/fruits/vegetables
  • Dietary fiber reduces the risk of mortality, CVD, and cancer in a dose-dependent manner. 11 12 13

Exercise

• Resistance training
  • Decreases the risk of mortality by 15%. 14
  • Decreases risk of CVD event by 40-70%. 15
  • Decreases risk of many cancers. 16
  • Improves cognition. 17
  • Improves depressive symptoms. 18
  • Improves quality of life. 19
• Cardiovascular exercise

Don’t smoke

• CVD
  • Increases risk by up to double for CVD and CVD Mortality 20
  • Effect appears to be mostly from tobacco & smoke, there is much less data on nicotine specifically.
  • Smokers with less than 8 pack years have the same risk for CVD as never smokers after 10 years of no smoking. For smokers with more than 8 pack years, it may take as long as 25 years to have a similar risk as never smokers. 21
  • Vaping may have less risk that cigarettes but more research is needed. 22
  • Smoking weed seems to have less risk that tobacco but it still elevates risk compared to no smoking at all. 23
  • Ingesting marijuana orally without smoke does not appear to increase risk of CVD. 24
• Cancer
  • Tobacco smoking drastically increases risk of many cancers, especially lung cancer by almost 900%! 25
    • Laryngeal – ~700%
    • Pharyngeal ~680%
    • Upper GI ~350%
    • Oral ~340%

Minimize consumption of drugs/alcohol

• Why do I say ‘minimize’ vs. eliminate?
• Are all drugs the same?
  • Alcohol – high intake increases CVD and cancer risk whereas low to moderate intake the associations are inconsistent. 26 27 28
• ‘Hard Drugs’
  • Opioids – ~200% increase risk of mortality from any cause. 29
  • Cocaine increases mortality risk by 80-90% and is estimated to reduce life expectancy by ~10 years for regular users. 30
  • Methamphetamine increases risk of mortality by almost 700%.
  • Psychedelics don’t seem to have the same effect.
    • MDMA confounded by usage of other drugs & dehydration
    • Psilacybin has very low toxicity. 31
    • No direct deaths attributed to LSD. 32
• Non physical ramifications of substance use
  • Quality of life declines 33
  • Much greater risk of being a victim of sexual assault or violent crimes 34 35

Sleep

• Deprivation but also too much sleep is associated with increased risk of mortality. 36 37 38
• 7 hours per night appears to be lowest risk of mortality with risk increasing by 6% per hour decreased sleep, and increasing by 13% per hour excess sleep

Mental health (managing psychological stress)

• Psychological stress increases risk of mortality by up to almost 200% in a dose dependent manner. 39
• Increases risk of CVD by 28% (high stress vs. low stress). 40
• Stressful life events lead to poorer cancer survival rates 41
• Stress is associated with autoimmune disorders 42