Wellness

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We've all heard exercise helps you live longer. But a new study goes one step further, finding that a sedentary lifestyle is worse for your health than smoking, diabetes and heart disease.

Dr. Wael Jaber, a cardiologist at the Cleveland Clinic and senior author of the study, called the results "extremely surprising."

"Being unfit on a treadmill or in an exercise stress test has a worse prognosis, as far as death, than being hypertensive, being diabetic or being a current smoker," Jaber told CNN. "We've never seen something as pronounced as this and as objective as this."

Jaber said researchers must now convey the risks to the general population that "being unfit should be considered as strong of a risk factor as hypertension, diabetes and smoking -- if not stronger than all of them."

"It should be treated almost as a disease that has a prescription, which is called exercise," he said.

Researchers retrospectively studied 122,007 patients who underwent exercise treadmill testing at Cleveland Clinic between January 1, 1991 and December 31, 2014 to measure all-cause mortality relating to the benefits of exercise and fitness. Those with the lowest exercise rate accounted for 12% of the participants.

The study was published Friday in the journal JAMA Network Open.

"Cardiovascular disease and diabetes are the most expensive diseases in the United States. We spend more than $200 billion per year treating these diseases and their complications. Rather than pay huge sums for disease treatment, we should be encouraging our patients and communities to be active and exercise daily," said Dr. Jordan Metzl, sports medicine physician at the Hospital for Special Surgery and author of the book "The Exercise Cure."

Jaber said the other big revelation from the research is that fitness leads to longer life, with no limit to the benefit of aerobic exercise. Researchers have always been concerned that "ultra" exercisers might be at a higher risk of death, but the study found that not to be the case.

"There is no level of exercise or fitness that exposes you to risk," he said. "We can see from the study that the ultra-fit still have lower mortality."

"In this study, the most fit individuals did the best," said Metzl, who was not involved in the study. "Once cleared by their physicians, patients shouldn't be afraid of exercise intensity."

The benefits of exercise were seen across all ages and in both men and women, "probably a little more pronounced in females," Jaber said. "Whether you're in your 40s or your 80s, you will benefit in the same way."

The risks, he said, became more shocking when comparing those who don't exercise much. "We all know that a sedentary lifestyle or being unfit has some risk. But I'm surprised they overwhelm even the risk factors as strong as smoking, diabetes or even end-stage disease."

"People who do not perform very well on a treadmill test," Jaber said, "have almost double the risk of people with kidney failure on dialysis."

What made the study so unique, beyond the sheer number of people studied, he said was that researchers weren't relying on patients self-reporting their exercise. "This is not the patients telling us what they do," Jaber said. "This is us testing them and figuring out objectively the real measure of what they do."

Comparing those with a sedentary lifestyle to the top exercise performers, he said, the risk associated with death is "500% higher."

"If you compare the risk of sitting versus the highest performing on the exercise test, the risk is about three times higher than smoking," Jaber explained.

Comparing somebody who doesn't exercise much to somebody who exercises regularly, he said, still showed a risk 390% higher. "There actually is no ceiling for the benefit of exercise," he said. ""There's no age limit that doesn't benefit from being physically fit."

Dr. Satjit Bhusri, a cardiologist at Lenox Hill Hospital, who was not involved in the study, said this reinforces what we know. "Sedentary, Western lifestyles have lead to a higher incidence in heart disease and this shows that it's modifiable. It's reversible," he explained, adding that doctors are really good at treating patients who have had cardiovascular events but they can be prevented. "We're meant to walk, run, exercise. It's all about getting up and moving."

For patients, especially those who live a sedentary lifestyle, Jaber said, "You should demand a prescription from your doctor for exercise."

So get moving.

CNN's Debra Goldschmidt contributed to this report

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'Type 2 Diabetes Doesn’t Have a Body Type — My Diagnosis as a Fit 25-Year-Old Proves It'

One woman with type 2 diabetes shares how her health journey has changed her perspective on the disease, and how it may change yours as well.

By T’ara Smith

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T'ara Smith in summer 2017, around the time of her diagnosis.

Photos courtesy of T'ara Smith

Medically Reviewed by Kacy Church, MD

The term “skinny fat” is used to describe someone who looks slim but is maybe not as ripped as an athlete. They’re also the last type of person you’d probably suspect to be diagnosed with type 2 diabetes, which is a chronic illness that is stereotypically associated only with people who are overweight or obese.

I was diagnosed with type 2 diabetes on July 7, 2017, with a fasting blood sugar level of 566 milligrams per deciliter and an A1C (a two- to three-month average of blood sugar levels) of 15.2 percent. I was 187 pounds (lbs), around a size 8 or 10, had been training to compete in bodybuilding contests, and had been eating a healthy diet and exercising regularly for more than four years. I was also young — 25 years old, to be exact. Despite all of those things, I was diagnosed with a serious chronic illness I had worked hard to prevent.

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In hindsight, the signs over the months leading up to the diagnosis were there. My mother noticed how I went from drinking 1 gallon of water per day to drinking 2 gallons, and how I'd simultaneously started making constant trips to the bathroom. I found I was losing up to 5 lbs per week, and one month before my diagnosis, my hair began to fall out and thin around the edges. This is embarrassing to admit, but I also had my first yeast infection.

I thought the weight loss and increased thirst were the result of the time I was spending in the gym and eating a healthy diet. Hair loss? Well, maybe I used the wrong products and hadn’t been caring for my hair properly. But the yeast infection? That was definitely abnormal, and this prompted me to get an opinion from a professional.

Maybe it was my doctor’s impersonal approach to telling me I have type 2 diabetes or maybe it was my quick acceptance of the news, but I wasn’t shocked. After my first year of college, my former doctor told me I had prediabetes and put me on a diet and exercise plan to normalize my blood sugar levels. Diabetes also runs in my family, so I guessed it was only a matter of time for me before I was diagnosed as well.

RELATED: 5 Things to Tell Your Family About Diabetes

And yet, I felt ashamed and fraudulent after receiving the news. Spending several years documenting my weight-loss journey and efforts to become my healthiest self, only to be diagnosed with the one chronic illness I’d worked so hard to prevent? The whole thing was demoralizing. How could I, someone who had been earning a master’s degree in nutrition education and looked like the last person who’d have diabetes, in fact, have it? Had all my hard work been a waste? Even more emotional for me at the time, who would listen to me about living a healthy life by creating sustainable healthy habits?

The Unexpected Way My Diabetes Diagnosis Changed My Life

It seemed like a cruel joke to be diagnosed with type 2 diabetes after successfully keeping off more than 30 lbs for more than four years. But, confiding in close friends, family, and my professors helped me cope with the adjustment of living with diabetes and eventually identify the opportunities my new lifestyle could offer. In particular, my academic program helped make me an expert on how diabetes works, and my passion to help others lead healthier lives inspired me to pursue a career in diabetes education and health counseling.

Diabetes gave my life a new perspective. According to the American Diabetes Association, 30 million people live with diabetes (the majority of them type 2), and an increasing number of those people are young, like me. Ultimately, there’s always more room for people who are dedicated to diabetes awareness, prevention, and management.

RELATED: 4 Ways Diabetes Support Groups Can Change Your Life

A range of factors can contribute to prediabetes or a type 2 diabetes diagnosis, ranging from sedentary living and poor dietary habits to genetic factors and having high body fat.

It’s important to recognize the signs of type 2 diabetes. Frequent urination, increased thirst, unexpected major weight loss, yeast infections, and constant hunger are all indicators it’s time to see a doctor. Living with uncontrolled diabetes can increase the risk of heart disease, stroke, blindness, neuropathy (nerve damage), amputation, and more, per the ADA.

Even with those complications in mind, I live a full life with diabetes. I still eat what I love, just in smaller portions, and I still stick to the core values around healthy living that I’ve built over the last five years. I’m also adamant about taking my medication as prescribed and seeing the doctor as scheduled. I wish I visited my doctor as soon as I experienced symptoms like extreme thirst. Still, I’m happy I was diagnosed before I suffered major complications.

As a young person, I continue to face challenges that affect my diabetes care. My main challenges are health insurance, employment, and the costs of diabetes management. All of these challenges are intertwined because my job search depends on the quality of health benefits, which determines how much I pay out-of-pocket to see doctors and specialists, and to cover diabetes supplies. And finding a job to match the degree that came with a lot of student loan debt is a challenge in itself. Socially, I still have to remind others I only eat a limited amount of certain foods because I live with diabetes. Sometimes the responses have a hint of pity, but I usually have to quickly add I can still eat anything, just in small portions.

RELATED: Why Living With Type 2 Diabetes Doesn’t Have to Mean a Shorter Lifespan

Today, I’m a comfortable 200 lbs and am healthier overall. Since last summer’s diagnosis, I reduced my blood sugar levels by more than half, and my A1C is 8.4, which is closer to normal. I’m more passionate about dismantling the mental, emotional, physical, and financial stigmas attached to people living with diabetes than ever. People with diabetes come in all shapes and sizes, and assuming someone with type 2 diabetes is overweight or obese, or an older person, prevents us from helping others who don’t fit the stereotypical description.

Last Updated:10/15/2018

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f you’re a fan of fish, you may be in luck. It may help lower your risk for cardiovascular disease, according to a new report. 

» RELATED: You can avoid strokes and heart attacks with these two household fruits, study says

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The American Heart Association (AHA) recently conducted a study, published in the Circulation journal, to examine the link between the food and lower heart disease risk.

To do so, researchers examined previous research that explored the benefits of omega-3 fatty acids from seafood. It can decrease the possibility of abnormal heart rhythms and slow the growth of fatty deposits that clog arteries. It can also lower high triglyceride levels, which has been associated with diabetes and kidney disease.

While the AHA has previously evaluated past studies on fish, the more recent analyses have led the organization to “come up with a new statement on the beneficial effects of seafood in preventing not just heart disease, but stroke, heart failure, sudden cardiac death and congestive heart failure,” it said in a release. The last statement was in 2002. 

» RELATED: Got heart disease? You may have a better chance of survival if married

The AHA recommends that adults eat two 3.5-ounce servings of non-fried fish each week, which is more than Americans typically eat. 

Furthermore, it said the best types of omega-3 fatty fish for good heart health include salmon, mackerel, herring, lake trout, sardines and albacore tuna. Cod, catfish, tilapia and shrimp also contain omega-3s but not in as high amounts.

“Omega-3s get into cell membranes, which is important for signaling inside and outside of cells: Cell communication is very important for a properly functioning heart,” the authors said.

The advisory noted some fish, such as shark and swordfish, have mercury, which can harm fetal brain development and negatively affect cognition in young children. However, they believe “eating fish is so much better overall for the environment than eating red meat.”

“For adults eating a serving or two of fish a week,” they wrote, “the benefits of fish are likely at least fiftyfold more than any concerns over other compounds that may be in the fish.”

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I don't know if I agree with this. My parents were both milk drinkers and they stil became type 2, but it can't hurt you to try

Study Ties ‘Milk’ Hormone to Lower Type 2 Diabetes Risk

Researchers don’t yet know why, but future studies on the relationship may lead to improvements in diabetes preventative care.

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During pregnancy and while breastfeeding, levels of the hormone prolactin elevate.

Jamie Grill Atlas/Stocksy

October 19, 2018

New research suggests healthy levels of a hormone released during breastfeeding are linked with a reduced risk of diabetes in women, but researchers aren’t sure why this association exists and how the hormone may play a role in possibly preventing the disease.

For the study, published in October 2018 in the journal Diabetologia, researchers followed 8,615 women who were free of diabetes, heart disease, and cancer at the start of the study. After 22 years, they identified 699 new cases of type 2 diabetes. After adjusting for potentially confounding factors — including reproductive status, medication use, and lifestyle habits — the authors observed that women with the highest concentration of the hormone prolactin had about a 27 percent decreased risk of developing type 2 diabetes compared with those women with the lowest concentration of the hormone.

While the findings are too early to influence care, it’s well known that healthy levels of prolactin are important for optimal health. “If prolactin levels get lower or higher than the biological normal range, it is suggested to see the doctor to find out the underlying reason” and prescribe proper treatment to stabilize them, says Jun Li, PhD, study author and postdoctoral research fellow at the Harvard T.H. Chan School of Public Health in Boston. Thyroid and pituitary disorders are among the conditions also linked to abnormal prolactin levels that may necessitate treatment.

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RELATED: 8 Surprising Type 2 Diabetes Risk Factors

What Is Prolactin, the ‘Milk’ Hormone, and How Does It Work?

Prolactin is a hormone produced in the pituitary gland and nicknamed the “milk” hormone because it stimulates the production of breast milk, leading levels to increase during pregnancy. According to the Endocrine Society’s Hormone Health Network, prolactin also “regulates behavior, the immune system, metabolism, reproductive systems, and many different bodily fluids. This makes it a crucial hormone for overall health and well-being, for both men and women.”

Prolactin research published in July 2013 in the journal Diabetes Care suggested the hormone may stimulate release of the hormone insulin and lower the prevalence of diabetes. Insulin helps ferry glucose to the cells and muscles for energy, but in diabetes, this process is disrupted either due to genetic, lifestyle, or environmental factors, or a combination of these things, leading to high blood sugar (hyperglycemia) and increasing the risk of conditions such as nerve damage (neuropathy), heart disease, blindness, and kidney damage.

Research thus far has not confirmed how prolactin and diabetes risk are related, but the hormone also appears to play a role in the risk for other diseases. Too much prolactin, for example, is associated with a higher risk of breast cancer, according to the Susan G. Komen Breast Cancer Foundation. Dr. Li says high levels of prolactin are also linked with pituitary disorders, prolactinomas (pituitary tumors), hypothyroidism (when the body lacks sufficient thyroid hormone), and some liver, kidney, ovary diseases.

RELATED: What Are the Signs and Symptoms of Hypothyroidism?

Beyond Breastfeeding: Other Factors That May Influence Levels of Prolactin

The circulating level of prolactin significantly increases in women during pregnancy and varies physiologically in response to lactation, level of exercise (depending on the time period and intensity), sleep, menstrual cycle, and stress.

“It is not entirely clear whether certain patterns of lifestyles will promote the healthy levels of prolactin. Nevertheless, regular physical activity and good sleep, and not too much stress, are always good for homeostasis and health,” Li says.

Tomer Singer, MD, director of reproductive endocrinology at Lenox Hill Hospital in New York City, who was not involved in the study, adds that certain hormone treatments and psychiatric drugs may alter prolactin levels.

As mentioned, the current study adjusted for these confounding factors, along with factors such as diagnoses of hypothyroidism, hyperthyroidism (when too much thyroid hormone is produced), thyroid hormone use, and body mass index (BMI), which similarly may have impacted the women’s prolactin levels.

RELATED: An Essential Guide to Your Hormones

What We Still Don’t Know About the Link Between Prolactin and Type 2 Diabetes

One limitation is the investigation involved mostly white middle-age women, so the results cannot be generalized to men or to people of other age groups or ethnicities.

Study authors suggest that future research is needed to understand the biological mechanisms underlying the link between prolactin and type 2 diabetes risk.

“This may lead to the development of new strategies for early prevention and treatment of type 2 diabetes," Li and her colleagues wrote in their paper.

Last Updated:10/19/2018

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Vegetable of the month: Cauliflower

Published: October, 2018

Image: © Joe_Potato/Getty Images

Just a few years ago, cauliflower was considered kind of ho-hum, relegated mainly to frozen vegetable medleys or crudité platters. But these days, the mild white vegetable is far more popular, thanks to its versatility as a carbohydrate substitute. Recent diet trends that encourage people to eat fewer starchy and grain-based foods likely contributed to cauliflower's rise.

Even if you're not avoiding carbs, using cauliflower as a substitute for starchy foods such as rice is a good way to cut calories and eat more fiber. You can also make mashed cauliflower instead of mashed potatoes (see www.hsph.harvard.edu/nutritionsource/mashed-cauliflower). Or try making a pizza with one of the many cauliflower-based pizza crusts now available in most grocery stores.

Nutritional info: A cup of chopped cauliflower has only 25 calories and 5 grams of carbohydrate (compared with 150 calories and 34 grams of carbs in a similar amount of white rice). Cauliflower is also a good source of vitamin C, the B vitamin folate, and potassium.

Easy recipe: To make cauliflower rice, use a box grater to shred a whole cauliflower or put small chunks of the vegetable into a food processor and whirl until the pieces resemble rice. Sauté in a large pan with about a tablespoon of olive or vegetable oil until tender, about 5 to 8 minutes.