Live forever!

Look, whether you like it or not, you can’t live forever. I bring this up because there is always a new book or new add purporting to have “the answer” to long life and good health, which never includes modern, evidence-based medicine. Still, perhaps some of these books contains good advice. Or not. Let me explain.

First let me disabuse some of you of the thought that doctors don’t “do” nutrition and life-style advice. In fact, we do. And as attractive as the idea seems, life-style modification will never be the answer to all of (or even most of) our medical problems. Leaving aside the fact that many people cannot make permanent and beneficial changes in their life-styles, there are many other reasons. Human health and disease is complex. Most diseases are multifactorial. For example, type II diabetes is caused by a combination of genetic factors and diet. Some patients can remain off medication using diet and exercise. Some cannot, as even with a good body mass index, good diet, and good exercise habits, their blood sugars are still out of control. Another example is hypertension. Dietary sodium reduction has been shown to reduce blood pressure, but many patients will not have significant enough improvements in blood pressure through diet and exercise alone.

Another reasons that lifestyle changes aren’t the whole answer is that sometimes drugs provide benefit that diet and exercise cannot. For example, beta blockers reduce blood pressure, but they also prevent sudden and premature death in certain groups of patients (i.e. those with significant heart failure), independent of the effect on blood pressure.

Finally, many purely genetic diseases are not amenable to lifestyle modification. No amount of diet and exercise will fix cystic fibrosis or congential adrenal hyperplasia.

Living healthy is important, but there is no miracle to maintaining health and treating disease. No one book is going to help you live forever. Lifestyle modification is not the answer to every medical question, no matter how much we all wish it were.


  1. #1 FutureMD
    August 16, 2008

    It may not be the only answer but lifestyle modification sure helps the people with enough determination to actually change.

  2. #2 Interrobang
    August 16, 2008

    I’d be more capable of mustering the determination to modify my lifestyle if my medical conditions didn’t get in the way…

    Some of us didn’t start out able-bodied, which doesn’t necessarily have anything to do with our reserves of willpower.

  3. #3 LindaCO
    August 16, 2008

    Latest and greatest books aside, do you have a sense as to the proportion of, say, type II diabetics who can get out of having to take meds because they implemented lifestyle changes versus those who will have to take the meds no matter what?

  4. #4 PalMD
    August 16, 2008

    There are data regarding dm prevention (, Both can prevent diabetes in those at risk. Neither can prevent it in everyone. I don’t know and haven’t found good evidence as to what percentage of people can keep their blood sugar in check with lifestyle mod. My personal experience (meaning the quality of the evidence is not great) is that a larger percentage of people could be successful at lifestyle mod for dm if there were programs in place to support them. This would reduce the disease burden a bit.

    However, lifestyle mod does not have the same effect on other dm-related problems. For instance, it is essential to keep LDL cholesterol and blood pressure under tight control in diabetics, and this control is often un-achieveable with lifestyle mod alone.

  5. #5 LindaCO
    August 16, 2008

    Thanks. It seems like prevention is pretty important, as opposed to helping people who are on meds to get off of them.

    BTW, I couldn’t get the second link to work.

  6. #6 Palm Sprangs
    August 16, 2008

    Look, whether you like it or not, you can’t liver forever.

    I don’t even like liver.

  7. #7 arby
    August 16, 2008

    I got a ‘page not found’ on the nejm link. rb

  8. #8 PalMD
    August 16, 2008
  9. #9 Doug Alder
    August 16, 2008

    As someone who was diagnosed last year with Type II diabetes I can say that lifestyle changes have made a world of difference in my health and life. My wife, a 40 year Type 1 diabetic, has greatly controlled the usual side effects of insulin dependency (neuropathy, circulatory problems, kidney/liver etc) through her diet. She took my diet in hand and in the year we have been married I have lost 30 lbs (15 to go) and my BG readings are completely under control without meds.

  10. #10 Ben
    August 17, 2008

    Hmmm… I think quite a few of your have missed the point of this post. It’s not as simple as “drugs are better than lifestyle changes”. The main problem here is that far too many people are being led to believe that lifestyle changes can always solve all your medical problems. Books that propagate this idea are doing harm by increasing false confidence in “drug-free treatment”. As a pharmacist I see this all too often. No, sir/madam, I do not think medication is the best solution to every problem. In YOUR CHILD’S case however, it is. He really is that ill. Take him to a doctor. Now please.

  11. #11 Suricou Raven
    August 17, 2008

    I have a plan for immortality:
    1. Live healthy. That gives me up to seventy or so, baring accident or illness.
    2. By then, medical technology will have advanced to the point I can probably extend that to around 120.
    3. By which point its a century into the future, and I hope there will be some super-science that can handle immortality. Brain-in-a-jar is quite acceptable to me, if hooked up to a good enough interface.

  12. #12 Dan
    August 17, 2008

    Another good post PalMD. I do not always make the right life style choices. For example, I smoke and get pleasure out of it. What I cannot stand is tobacco control claims the such and such many lives are saved based on second hand smoke (SHS). We will all die, I happy to go out having pleasure in life irregardless of the health consequences. I understand the health risks with my smoking, but I have trouble seeing any health risk with SHS. I like my little pleasures. Yes I saw your post with what can happen with smokers. The bad way to die. I think you, PalMD, really made a good addition to this blog. I visit you and Orac almost daily.

  13. #13 llewelly
    August 17, 2008

    Dan, please read what Orac has had to say about second hand smoke .

  14. #14 llewelly
    August 17, 2008

    With respect to lifestyle changes, if lifestyle changes were anything other than very hard, obesity would be rare.

  15. #15 Dan
    August 17, 2008

    @llewelly I already read ALL Orac’s articles on second hand smoke as well as MarkH’s. See my comments on the same threats.

  16. #16 Adrian
    August 17, 2008

    At some point in the comments at this link, someone claims that the claims about PET water bottles leaching carcinogens are spurious, other people are obviously scared of the possibilities. Any thoughts on this topic?

  17. #17 Rev. BigDumbChimp, KoT
    August 18, 2008

    Ernest Borgnine has the answer to long life.

  18. #18 tresmal
    August 19, 2008

    “Look, whether you like it or not, you can’t live forever.”
    What!? Citation please!

  19. #19 William Wallace
    August 20, 2008

    Well, you can live for eternity with God, according to the Bible.

    But, for those who do not believe, I do wonder, what now. You can’t live forever, you can live for a time or time plus some time, and so, how do you decide how long to live? If you could add 5 minutes to your life at the cost of 1 years’ hard work, would you?

  20. #20 LanceR
    August 20, 2008

    That has *got* to be the worst restatement of Pascal’s Wager I have ever had the misfortune to have inflicted on my poor overworked brain.

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