We are born, we develop, we decline, and we die. The purpose of this essay is to prolong the “develop” and delay the “decline” by building muscle through exercise and diet, as well as by understanding how your body works. The most important aid to good health and longevity is knowledge. We need to understand how our bodies work. We inherit the genes of our parents; we learn from our parents what to eat; and we mimic their lifestyle—at least early in life. To improve, we need to learn from their mistakes and learn the new knowledge available today. Today, there is an epidemic of obesity leading to an epidemic of metabolic diseases. All of these problems can be prevented or lessened with the new knowledge published in scientific journals. Modern medicine prefers to palliate metabolic syndrome, hypertension, insulin resistant diabetes and hyperlipidemia with simple medications, yet many of these problems can be eliminated by lifestyle changes—if you are motivated and if you understand your body. An aging cell loses the ability to divide and so dies. Cells collectively make up tissues and organs. The testes, ovaries, kidneys and liver lose cell numbers relatively early in the aging body. The muscles, soft tissues and bones are among the first tissues to show measurable change. Distinct muscle changes occur in humans usually in the fourth decade. We lose skeletal muscle mass as we age, and we become weaker. Older muscle is also less efficient at protein synthesis than is younger muscle of the same size and weight. This decrease in muscle mass and strength as we age leads to decreased activity and a more sedentary lifestyle. These age-related changes in muscle mass and strength alone lead to a less active lifestyle and a concomitant increase in body fat.

Body fat measurably increases as we age. There are only three variables that we can control with regard to our healthy lives: diet/food; activity/exercise; and supplements/medicines. I cannot provide all of this information in this short essay, but I can summarize my 17 years of study.

Most of us learn about food from our parents and from the media. Marketing companies spend billions of dollars in order to alter our behavior. We all assume that we know what is healthy to eat. Because most people have no idea of what foods are actually healthy, insulin-resistant diabetes, heart disease and obesity are major health problems. There is no diet that fits all people equally; your food choices are part of a healthy lifestyle that achieves your goals and lasts your entire life. Your diet is a pathway to health, and lasts a lifetime. Your diet should not be a race to lose weight—but if it were a race, it would be a race won by the turtle and not the hare. Think of your diet as one small step each day towards your goals.

Obesity has been defined as an abnormal accumulation of body fat—approximately 20% or more of your ideal body weight. Ideal body weight is the weight for a specific age, gender and height that has the lowest death rate. This definition is more important for the life insurance industry than for you, because it does not take into account your body composition. How much of your body is bone, muscle or fat? Body composition cannot be measured with a scale. Obesity is also defined by your body mass index (BMI). A simple and quick way to determine your BMI is to use your tablet or iPad and obtain the BOD Keeper app. This app is very easy to use. A BMI of over 25 is considered to be overweight, and a BMI of 30 or more is obese. Again, this does not take into account body composition. The Centers for Disease Control and Prevention calculate that 69% of adults over 20 years of age are overweight or obese. Not every obese person has a metabolic problem, but most do have—or will develop—a metabolic problem. . Asians have metabolic problems starting at a BMI of 25; Caucasians at 30; African Americans at 35. Obesity does not kill you, but the metabolic problems that occur will kill you.

The more sugar there is in the blood, the higher the insulin levels, and the greater production of fat. A new finding reveals that high insulin levels cause both a low metabolic rate and simultaneous fat storage. This is how most people become obese. As your body ages, it is the excess body fat that increases the risk of hypertension, insulin-resistant diabetes, coronary artery disease, stroke, dementia, and bone and joint injury. These are the “metabolic problems” that will kill you.

For our purposes, we will define “exercise” as physical activity requiring effort whch is designed to improve health. Exercise can be designed to improve endurance, strength, balance and flexibility. Even a small amount of daily exercise will prolong your life, and will reverse the changes that occur in aging muscle. Exercise is the only way to reverse these aging muscle changes and restore your strength. With increased strength, you will be more active and feel stronger. Exercise is the missing ingredient in most unhealthy life styles. It can reverse the “metabolic problems” outlined above. Epidemiological studies reveal a higher incidence of metabolic problems in people who do not exercise. Supervised long-term intense exercise raises high-density lipoprotein, lowers triglycerides, and reduces blood pressure. Both diet and exercise are required to lower insulin resistance. The Centers for Disease Control and Prevention recommends 150 minutes of cardiovascular exercise every week, along with muscle-building exercise for each muscle group over 2 to 3 days every week. There is much more to this program, as well as different types of exercise, but space limits my ability to elaborate. Remember this one thing: “Exercise and diet will cure where pills palliate.” Prescription medications for metabolic abnormalities [obesity, hypertension, diabetes, coronary artery disease, stroke] reward your unhealthy behavior and give you a false sense of security.

I can summarize, but cannot explain, all of the scientific data regarding my diet recommendations in this short essay. My diet eliminates obesity, diabetes, hypertension, coronary artery disease and stroke. It was published in the New England Journal of Medicine in 1985. If it walks, flies, swims or grows in the ground, you can eat it. This diet eliminates most milk products and grains. Remember that if you can measure your weight and waist size, you can control your weight and body fat.
This is the big picture. What you do next will determine your metabolic future.

Robert Drapkin, MD, FACP