Healthy Lifestyle: 5 Keys to a Longer Life

By Monique Tello, MD, MPH, Contributor

How is it that the United States spends the most money on healthcare, and yet still has the one of the lowest life expectancies of all developed nations? (To be specific: $9,400 per capita, 79 years, and 31st.)

Maybe those of us in healthcare have been looking at it all wrong, for too long.

Healthy lifestyle and longevity
Researchers from the Harvard T.H. Chan School of Public Health conducted a massive study of the impact of health habits on life expectancy, using data from the well-known Nurses’ Health Study (NHS) and the Health Professionals Follow-up Study (HPFS). This means that they had data on a huge number of people over a very long period of time. The NHS included over 78,000 women and followed them from 1980 to 2014. The HPFS included over 40,000 men and followed them from 1986 to 2014. This is over 120,000 participants, 34 years of data for women, and 28 years of data for men.

The researchers looked at NHS and HPFS data on diet, physical activity, body weight, smoking, and alcohol consumption that had been collected from regularly administered, validated questionnaires.

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What is a healthy lifestyle, exactly?
These five areas were chosen because prior studies have shown them to have a large impact on risk of premature death. Here is how these healthy habits were defined and measured:

1.  Healthy diet, which was calculated and rated based on the reported intake of healthy foods like vegetables, fruits, nuts, whole grains, healthy fats, and omega-3 fatty acids, and unhealthy foods like red and processed meats, sugar-sweetened beverages, trans fat, and sodium.
2. Healthy physical activity level, which was measured as at least 30 minutes per day of moderate to vigorous activity daily.
3.  Healthy body weight, defined as a normal body mass index (BMI), which is between 18.5 and 24.9.
4.  Smoking, well, there is no healthy amount of smoking. “Healthy” here meant never having smoked.
5.  Moderate alcohol intake, which was measured as between 5 and 15 grams per day for women, and 5 to 30 grams per day for men. Generally, one drink contains about 14 grams of pure alcohol. That’s 12 ounces of regular beer, 5 ounces of wine, or 1.5 ounces of distilled spirits.

Researchers also looked at data on age, ethnicity, and medication use, as well as comparison data from the National Health and Nutrition Examination Surveys and the Centers for Disease Control and Prevention’s Wide-Ranging Online Data for Epidemiologic Research.

Does a healthy lifestyle make a difference?
As it turns out, healthy habits make a big difference. According to this analysis, people who met criteria for all five habits enjoyed significantly, impressively longer lives than those who had none: 14 years for women and 12 years for men (if they had these habits at age 50). People who had none of these habits were far more likely to die prematurely from cancer or cardiovascular disease.

Study investigators also calculated life expectancy by how many of these five healthy habits people had. Just one healthy habit (and it didn’t matter which one) … just one… extended life expectancy by two years in men and women. Not surprisingly, the more healthy habits people had, the longer their lifespan. This is one of those situations where I wish I could reprint their graphs for you, because they’re so cool.

This is huge. And, it confirms prior similar research — a lot of prior similar research. A 2017 study using data from the Health and Retirement Study found that people 50 and older who were normal weight, had never smoked, and drank alcohol in moderation lived on average seven years longer. A 2012 mega-analysis of 15 international studies that included over 500,000 participants found that over half of premature deaths were due to unhealthy lifestyle factors such as poor diet, inactivity, obesity, excessive alcohol intake, and smoking. And the list of supporting research goes on.

So what’s our (big) problem?
As the authors of this study point out, in the US we tend to spend outlandishly on developing fancy drugs and other treatments for diseases, rather than on trying to prevent them. This is a big problem.

Experts have suggested that the best way to help people make healthy diet and lifestyle change is at the large-scale, population level, through public health efforts and policy changes. (Kind of like motorcycle helmets and seat belt legislation…) We have made a little progress with tobacco and trans-fat legislation.

There’s a lot of pushback from big industry on that, of course. If we have guidelines and laws helping us to live healthier, big companies aren’t going to sell as much fast food, chips, and soda. And for companies hell-bent on making money at the cost of human life, well, that makes them very angry.

Sources
Impact of healthy lifestyle factors on life expectancies in the US population. Circulation, April 2018.

National Institute on Alcohol Abuse and Alcoholism, What is a standard drink?

The population health benefits of a healthy lifestyle: Life expectancy increased and onset of disability delayed. Health Affairs, August 2017.

The combined effects of healthy lifestyle behaviors on all-cause mortality: a systematic review and meta-analysis. Preventive Medicine, September 2012.

Changing minds about changing behavior. Lancet, January 2018.

The US Food and Drug Administration (FDA) Final Determination regarding Partially Hydrogenated Oils (trans fat)

The US Food and Drug Administration (FDA) Family Smoking Prevention and Tobacco Control Act- An Overview

About the Author
Monique Tello, MD, MPH, Contributor

Dr. Monique Tello is a practicing physician at Massachusetts General Hospital, director of research and academic affairs for the MGH DGM Healthy Lifestyle Program, clinical instructor at Harvard Medical School, and author of the evidence-based lifestyle.

Food Cravings: What They Mean and How to Curb Them

By Kaiser Permanente

Chewy cookies. Creamy chocolate. Salty chips. Melted cheese.

Besides being delicious, these foods have something in common. They’re the sugary, salty, or high-fat treats people can get strong urges to eat. It’s OK to occasionally indulge in cravings for these types of foods. But intense food cravings can lead to eating more than what feels comfortable.

What causes food cravings?
There are a wide range of reasons to crave specific foods. Often, cravings can mean your hunger hormones are out of balance, says Candace Morgan, registered dietitian for Kaiser Permanente’s regional center of healthy living in Pasadena, California. These gut hormones can increase or decrease your appetite. They’re affected by lifestyle habits — diet, stress, sleep, and exercise. When your body isn’t getting the right amount of sleep, for example, it can change how it releases your hormones. And that can throw off your hunger signals.

If you want to feel more in control of what you eat, a few lifestyle changes may help.

Here are 4 tips to help balance your hormones — and curb your food cravings.

Eat earlier in the day
The most common cause of overindulging in cravings isn’t a lack of willpower. Usually, it’s not eating enough earlier in the day, Morgan says. Your body craves sugar when you don’t consume enough calories. And that makes it hard to control what — and how much — you eat as the day goes on.

Most people can benefit from eating 3 healthy meals and 1 or 2 snacks each day. Aim to eat breakfast between 60 and 90 minutes after you wake up. Then, eat every 3 to 4 hours. Ideally, dinner should be the last thing you eat, so you’re not going to bed with high blood sugar.

When planning your meals and snacks, balance whole-grain carbohydrates with lean protein, Morgan says. These nutrients fuel your body’s cells and provide you with energy. Include a few servings of foods with healthy fats each day — like olive oil, salmon, flaxseeds, and avocado. Healthy fats give you energy and help you feel fuller longer. Also try to include at least one high-fiber food with every meal. Fiber helps control your blood sugar and keep your gut healthy.

Try to find different healthy food options that you enjoy. Depending on what you’re craving, Morgan recommends meals and snacks like:

Sweet foods
Oatmeal with cinnamon, diced apple, walnuts, and shredded coconut

• Whole-grain waffles topped with peanut butter and sliced bananas
• Spinach salad with balsamic vinegar and roasted salmon, carrots, and sweet potato
• Greek yogurt with berries and cacao nibs
• Chocolate chip oat date cookies

Savory foods
Whole-wheat tortilla with scrambled eggs, sliced avocado, and fresh salsa

• Smoked salmon and goat cheese on a slice of whole-wheat toast
• Baked potato with ground turkey, black beans, salsa, and corn
• Air-popped popcorn sprinkled with nutritional yeast
• Homemade kale chips

Reduce chronic stress
Chronic stress is one of the main factors affecting hunger hormones, Morgan says. Stress becomes chronic when you experience frustration or anxiety for a long period of time — like a difficult job or long-term illness. Stress releases the hormone cortisol, which fires up your appetite. It’s part of your body’s fight-or-flight response. Your brain thinks it needs fuel to fight off what’s causing your stress. That increases cravings, especially for high-fat, high-calorie foods, Morgan says.

It’s not always possible to remove stressors from your life, but you can try to manage stress better. Meditating and breathing exercises can help you stay calm.

Get more sleep
If you sleep fewer than 6 hours a night, you’ll likely crave sweet, high-calorie foods. When your body needs sleep, eating sugar is another way for it to get energy, Morgan says. Lack of sleep can also affect your hormone levels and increase your appetite.

Aim to get between 7 and 9 hours of sleep a night. You’ll want to go to bed 10 to 15 minutes earlier each night until you hit your target. And when you have time during the day, take a nap.

Increase your exercise
Exercise is beneficial for many reasons — the most important being that it can help you live longer. Research shows that it can also lower your appetite.¹ And in a recent study, strenuous exercise helped mice avoid weight gain.²

To get the most health benefits, adults should exercise at least 150 minutes a week at a moderate intensity. You may need to do more intense workouts, like strength training, to lower your appetite.

As you work on these lifestyle factors, you may notice how they’re each connected. Exercise can lower stress levels and help you sleep. Being well-rested can help you stay calm in stressful situations — and give you more energy to move your body. And as your hormones balance, you may experience fewer food cravings.

Keep in mind that hunger is a normal feeling, and you should respond to it in a positive way. It’s not healthy to ignore it — or to fill up on empty calories. So the next time an intense food craving strikes, check in with your body to see what it really needs — like a 20-minute nap or a healthy meal. And maybe a piece of chocolate.