Fewer Pills, Longer Life

Despite what the drug companies say, pills aren't the solution to a longer life. A new study shows exercising, not smoking, and healthy eating are what really work

by John Carey

How can we live longer, healthier lives? Judging from the bombardment of advertisements, the answer is pharmacology. There are pills to lower cholesterol, reduce blood pressure, ward off osteoporosis, fight sadness, induce sleep, even improve sex. And overall, Americans have bought into the idea that drugs are essential. The average American now gets 12 prescriptions a year. For the elderly the number jumps to 30.

Yet study after study shows that the most important steps people can take to improve their health don't require the medicine cabinet at all. Instead, the best course to take is to eat better, get moderate physical activity, lose weight, and reduce stress. Before considering drugs, "it makes so much more sense to me to get as far as you can with lifestyle," says Dr. Joseph Keenan, professor of family medicine at the University of Minnesota. Just take exercise alone: "It has so many benefits," he says. It improves heart function, helps ward off diabetes and being overweight, raises "good" cholesterol (HDL), and decreases the chances of falling and breaking a hip.

A New Look at a Study

The latest reminder of the importance of lifestyle comes from a new study looking at men who lived into their 90s. It was led by researchers at Harvard Medical School, and published in the Archives of Internal Medicine. The new work piggybacks on a classic study on the health of thousands of doctors over several decades. Dubbed the "Physicians' Health Study," the research originally was intended to find out if taking aspirin or beta-carotene (a form of Vitamin A) led to better health or longer lives. It gathered information on the men for 26 years, from 1981 to 2006.

Some of those men lived exceptionally long lives, making it into their nineties. Others died much earlier. Why the difference? Dr. Laurel Yates, an instructor in medicine at Harvard, realized that the mass of data collected in the study offered "a unique opportunity to ask questions about aging," she says.

Yates decided to ask those questions. Out of the 12,000 doctors in the Physicians' Health Study, she and her colleagues picked out 2,357 men who were already past middle age (at an average age of 72) when the study began in 1981, but who were also in relatively good health. A trove of health information had been gathered about these men, looking at factors such as exercise habits, weight, cholesterol levels, and the presence or absence of diabetes, high blood pressure, and other problems.

Of those men, 970 lived to be 90 or longer. The others died at an average age of 83. What were the secrets of those with the longer lives?

Biggest Contributors to Longevity

It wasn't taking aspirin or beta-carotene. That made no difference to lifespan. Neither did the men's cholesterol levels, casting additional doubt on the relentless push to lower cholesterol (BusinessWeek, 1/17/08). And neither did drinking alcohol.

Instead, the data pinpointed two factors. One was not smoking. The other was a higher level of physical activity. "Exercise is such a do-gooder," says Yates. It helps prevent a litany of woes: obesity, high blood pressure, diabetes. It improves emotional and mental health., Plus, "for the older population, it has the benefit of maintaining and improving balance," says Yates, which lowers the risk of falls.

None of this is a big surprise, of course. "It's really all common sense," says Yates. "It isn't rocket science." Yet it's also a encouraging message, she believes. "It gives people a reason to believe they have some control over their destiny. Yes, genetics plays a part. But no one is saying genetics is worth more than 25% to 30% [of the difference in longevity]. That still leaves the majority being something controllable or modifiable."

Prescribing Exercise

The problem is that this is easier said than done, especially at a time when the level of physical activity in the U.S. has been on a long-term decline. Doctors wring their hands at how hard it is to get people to exercise, compared to the ease of popping a pill. Better lifestyles could dramatically reduce the number of people who need drugs, says Dr. Ronald Krauss, director of atherosclerosis research at the Oakland Research Institute. "But it's a losing battle given the trends in the population."

That's why some doctors are turning to more creative ways to get the message across. "Exercise does take a lot of time," says Dr. Keenan. "But I try to get my patients to commit to that as a prescription, just like Lipitor. If they understand that exercise is as important every day as a pill is, and that they have to take their exercise 'medicine,' it gives them a little different view of exercise as a requirement rather than just recreation."

Keenan, whose own research has shown that oats and soluble fiber improve health, also points to the benefits of other lifestyle changes. Stress reduction, whether accomplished through exercise or more quiet time, has payoffs. Stress hormones make the body more insulin resistant, speeding the path to diabetes, and are also associated with potentially dangerous heart arrhythmias, he says.

The final step: better nutrition. That means more fruits and vegetables, whole grains, plenty of "good" fat (like olive oil and fish oils), and for Keenan, a couple of glasses of red wine a day.

It does take some effort, but these are simple steps that people can take to boost their chances of healthy living into their nineties.

Carey is a senior correspondent for BusinessWeek in Washington .

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