美国《新闻周刊》：健康生活七攻略

Martin

　　美国《新闻周刊》专栏作家、医学博士迪恩·奥尼什日前撰文，讲述他和他在加州医学院的同事们进行长达30年的跟踪研究关于健康的生活习惯，包括健康的饮食结构会给人带来的很多好处：

　　在我们的研究中，采用了高技术的手段来评估健康的生活方式会给人带来哪些明显的好处，这些手段包括最先进的高科技定量冠状动脉X射线拍照技术及心脏扫瞄技术，来证明其实往往很简单和低成本的改变举措就能够带来意想不到的大收获。

　　很多人经常以为要想身体好就得多吃贵重的营养品或是保健食品或是购买昂贵的健身器械来锻炼身体，但实际上我们每天在生活里做出的最简单的选择往往更对我们的健康起着直接的作用，这些选择包括吃什么，如何应对压力，是否吸烟，锻炼时间长短以及人际关系如何，这些因素会对我们的健康甚至性命产生极大的影响。

　　我们在研究中发现，对生活方式的全面改变也许可以遏制心脏疾病、前列腺癌、糖尿病、高血压、肥胖症、高胆固醇以及其他血管疾病的发展，健康的生活方式会让人们远离这些疾病的困扰。我们还发现，一旦向好的方向改变你的生活方式，大多数人会感觉越来越好，而不是越来越糟，而且感觉好转的速度也要比你想像得快得多。

　　我们的研究结果已经在多家知名的医学杂志上发表，并已经帮助很多人找到了改变他们生活方式和饮食结构的好方法。

　　从1993年以来，我们已经记录下了很多人在改变生活方式之后身体变得更健康，体重更标准，同时还节省了更多用来看病的花费。

　　在这段时间里，我们确定了可以鼓励他人在生活方式和饮食结构上做出改变并能够保持下去的真正有效的途径，下述就是在这次理论加临床研究中做出的七大发现。

　　1、人们可以选择很不相同的生活方式或是饮食结构，但你越注意这种方式或是结构的健康和科学性，你就会感觉更好、面容更漂亮、身材更标准。每个人都有不同的需求、目标以及喜好，未来的药物应该是极具个性化的药物。

　　最重要的是你的整体生活方式，如果某一天你躺在沙发上大吃薯片，第二天你应该多锻炼一下。如果你没有时间冥想20分钟，那你就冥想1分钟，因为持续性较之锻炼时间的长短更重要。研究显示，那些饮食情况整体来看最健康的人往往是那些偶尔也会放纵一下自己的人。

　　如果你不想得心脏病或是想防范自己患上癌症，那么你可能需要对你的饮食和生活方式进行较之那些仅仅是想减轻几磅体重的人更大幅度的改变。如果你想降低血压或胆固醇，你可以在开始时在饮食和生活方式做出较为温和的改变，如果这对于你实现自己的目标已经足够了，那很好，如果不行，那再考虑做出更大的改变。

　　例如，大多数美国人都是高胆固醇，最初他们被建议遵照美国心脏病研究协会和美国胆固醇研究协会的建议改变自己的饮食，对于一些人来说，这已经足可以起到降低胆固醇的作用，但对大多数人而言却并不奏效。很多人于是被告之：“抱歉，看起来仅仅是改变饮食对你并不奏效。”接下来这些人被建议购买一些降胆固醇的药，他们被告之他们需要在接下来的日子里一直服用这些药物。而在现实生活当中，大多数人都可以在并不需要吃药的前提下通过改变饮食和生活方式来渐渐使自己变得更健康。

　　2、大多数人与其说更希望自我感觉健康，还不如说希望感觉能够控制自己的生活方式或是饮食结构。

　　如果我告诫他人，“吃这个不要吃那个，不要吸烟”，那别人可能会立即去做我不让他们做的事。这是人的本性。就象有人告诉你“不要去吃那个苹果”，而你也许会反而更想去尝一下。

　　如果你正在节食减肥，你会感觉受到限制不自由，你迟早会坚持不下去。所以，提供更多的选择往往效果会更好，如果你认为每天自己可以选择想吃的食物或是不同的生活方式，你就会更容易地适应这种改变。

　　3、吃的食物不健康并不意味着你这个人有问题。

　　不能从一个人吃的食物上来说明这个人的好坏，食物仅仅是食物而已，有的人也许就爱吃垃圾食品，但这不等于这个人本质上有问题。

　　4、你的饮食方式与你吃的食物同等重要。

　　如果我一边看电视、一边与他人聊天或是一边阅读还一边不停地吃东西，我可能并不知道自己这一顿饭都吃了什么。饭后盘子是空了，你只是增加了身体里的热量但却没有享受到美食，相反，如果你能够专心志致地吃饭，你就会发现自己很容易就产生了愉悦感。即使是一小块黑巧克力也许都会带给你特别的快感。

　　如果你在吃饭时足够专注，你就会注意到不同的食物对你的影响是不同的，有的影响很好，有的影响就不好，更健康的食物会让你感觉更有活力，头脑更清醒，而不太健康的食物就会让你感觉昏昏欲睡、疲倦劳累。这些通过你自己的体验就能够感觉得到。

　　　5、让人领略生活的乐趣会比吓得他人改变生活方式更好。

　　试图吓得别人改变并不会奏效，告诉他人如果他们过多地吃夹有干酪的三明治就会得心脏病或吸烟就会得肺癌并不一定有用，激发他人改变的动因是威吓，这往往收不到成效。在威吓他人做出改变否则就会生病或是死亡这种前提下试图说服对方往往是难以成功的。为什么？因为这听起来太吓人了。大家都知道有一天我们会死，还没有人能够长生不死，但谁愿意想这件事？即使是那些患有心脏病的人也往往会仅改变几个星期的时间然后就又回到了他们以往的生活方式和饮食结构上。

　　同样的道理，所谓的防范举措也会让大多数人感到无聊，对某人说他们可能活到86岁而不是85岁，这种激励意义不大，如果他觉得生活无趣，活得再长也没有意思。他们会问：“我是能够更长寿还是看起来我可以活得更长一些？”

　　你还不如告诉他们，如果改变自己的饮食，他们可能会感觉更好、大脑得到更多的氧气和血液的补充，他们不会那么容易困倦，他们的面部肌肤也会得到更多的血液供应，皮肤会更加有光彩，皱纹也会更少，他们的心脏也会得到更多的血液供应，他们会感觉更有体力，也不容易患上心脏病。他们的生殖器官也会得到更多的血液供应，他们会在性方面变得更强大，就象壮阳药伟哥起到的作用一样，而且还不必担心吃壮阳药后会产生副作用。

　　6、我们吃的东西与不吃的东西一样重要。

　　至少有1000种食物具有抗癌、抗心脏病、抗衰老等作用，水果、蔬菜、全麦、豆类以及鱼均富含优质的碳水化合物、脂肪、蛋白质以及其他营养物质。这些食物都会让你感到对身体有益而不是有害。　

　　7、还需要解决掩藏在人们的行为下面的一些深层次的问题。　

　　一般情况下，人们通过各种渠道了解的信息往往并不足以鼓励他们去做出持久性的改变。如果能够做到这一点，那也就没有人会再去吸烟了。我们有必要对更深层次的问题加以分析。在我们的研究当中，我问被调查的人：“你为什么吸烟？过度进食？喝过量的酒？工作过于拼命、看电视过多或是吸毒？我怎么不会这样？”

　　他们经常会回答说：“因为你不知道这里面的乐趣，这样做可以排解很多压力和烦恼。” 事实上，孤独和压抑的确是现代人的通病，如果我们能够解决这些深层的问题，那么也许说服他人对自己的生活方式或饮食结构做出改变就容易得多了。　　生活是用来享受乐趣的，除非你做出改变得到了更好的东西，你放弃另一件东西就毫无意义了。如果我们的建议能够让大家感到生活得更好，那么这项研究的结果就极具意义。


Small Steps for Big ResultsBy Dean Ornish, M.D.
Newsweek
Updated: 3:55 p.m. ET June 19, 2006

June 19, 2006 - For the past 30 years, my colleagues and I at the nonprofit Preventive Medicine Research Institute and the School of Medicine at the University of California, San Francisco (UCSF), have conducted research showing how powerful changes in diet and lifestyle can be.

In our studies, we've used the latest in high-tech state-of-the-art measures such as quantitative coronary arteriography and cardiac PET scans to prove how powerful these very simple, low-tech and low-cost interventions can be.

People often think an intervention has to be a new drug, a new laser or something really high-tech and expensive in order to be powerful. They often have a hard time believing that the simple choices that we make in our lives every day—what we eat, how we respond to stress, whether or not we smoke, how much we exercise and the quality of our relationships—can make such a powerful difference in our health, our well-being and even our survival. But they often do.

We showed that comprehensive lifestyle changes may reverse the progression of coronary heart disease, prostate cancer, diabetes, hypertension, obesity, hypercholesterolemia and other chronic conditions. We found that instead of getting worse and worse, most people got better and better, and much more quickly than had once been thought possible.

These studies were published in leading peer-reviewed medical journals and are empowering many people with new hope and new choices.

Beginning in 1993, we conducted three demonstration projects with Mutual of Omaha, Highmark Blue Cross Blue Shield and, most recently, with the Centers for Medicare and Medicaid Services. We have consistently documented bigger, sustained changes in diet and lifestyle, better clinical outcomes (including weight loss) and greater cost savings than have ever been shown—not only in San Francisco and New York, but also in Charleston, W.Va.; Des Moines, Iowa; Omaha, and Columbia, S.C. (where, a cardiologist told me, "gravy is a beverage").

Along the way, we identified what really works to motivate people to make and maintain long-term changes in diet and lifestyle. What have we learned from this research and clinical experience?

1. You have a wide spectrum of nutrition and lifestyle choices.
It's not all or nothing. To the degree you move in a healthful direction on this spectrum, you're likely to feel better, look better, lose weight and gain health. People have different needs, goals and preferences. The medicine of the future is personalized medicine.

What matters most is your overall way of eating and living. If you indulge yourself one day, you can eat more healthfully the next. If you're a couch potato one day, exercise a little more the next. If you don't have time to meditate for 20 minutes, do it for one minute—the consistency is more important than the duration. Then, you're less likely to feel restricted. Studies have shown that those who eat the healthiest overall are the ones who allow themselves some indulgences.

If you're trying to reverse heart disease or prevent the recurrence of cancer (the "pound of cure"), then you probably need to make much bigger changes in diet and lifestyle than someone who just wants to lose a few pounds and is otherwise healthy (the "ounce of prevention"). If you want to lower your cholesterol or blood pressure, you can begin by making moderate changes in diet and lifestyle. If that's enough to achieve your goals, great; if not, then consider making bigger changes.

For example, most people in this country have elevated cholesterol levels. They are initially advised to follow a diet based on the American Heart Association and National Cholesterol Education Program guidelines. For some, that's sufficient to lower their cholesterol levels enough, but not for most people. Many are then told, "Sorry, it looks like diet didn't work for you." And they are prescribed cholesterol-lowering drugs, which they are told they will need to take for the rest of their lives. In reality, most people can make progressively bigger changes in nutrition and lifestyle to achieve their goals—often without medications.

2. Even more than feeling healthy, most people want to feel free and in control.
The food police are counterproductive. If I tell people, "Eat this and don't eat that," or "Don't smoke," they immediately want to do the opposite. It's just human nature, and it goes back to the first dietary intervention that failed—"Don't eat the apple"—and that was God talking, so we're not likely to do better than that....

If you go on a diet and feel constrained, you're likely to go off it sooner or later. Offering a spectrum of choices is much more effective; then, you feel free. If you see your food choices each day as part of a spectrum, a way of living, then you are more likely to feel empowered.

3. Eating bad food does not make you a bad person.
The language of behavioral modification often has a moralistic quality to it that turns off a lot of people (like "cheating" on a diet). It's a small step from thinking of foods as "good" or "bad" to seeing yourself as a "good person" or a "bad person" if you eat these. The term "patient compliance" has a fascist, creepy quality to it, sounding like one person bending his or her will to another. Food is just food.

4. How you eat is as important as what you eat.
If I eat mindlessly while watching television, reading or talking with someone else, I can go through an entire meal without tasting the food. The plate is empty, but I didn't enjoy it; I had all of the calories and none of the pleasure. Instead, if I eat mindfully, paying attention to what I'm eating, smaller portions of food can be exquisitely satisfying. I can meditate on a single piece of dark chocolate.

Also, when you pay attention to what you're eating, you notice how different foods affect you, for better and for worse. More healthful foods make you feel good—light, clear, energetic. Less healthful foods make you feel bad—heavy, dull, sluggish. Then, it comes out of your own experience.

5. Joy of living is a much better motivator than fear of dying.
Trying to scare people into changing doesn't work very well. Telling someone that they're likely to have a heart attack if they eat cheeseburgers or may get lung cancer if they don't quit smoking doesn't work very well. Efforts to motivate people to change based on fear of getting sick or dying prematurely are generally unsuccessful.

Why? It's too scary. We all know we're going to die one day—the mortality rate is still 100 percent—but who wants to think about it? Even someone who has had a heart attack usually changes for only a few weeks before they go back to their old patterns of living and eating.

For the same reasons, talking about "prevention" or "risk-factor reduction" is boring to most people. Telling someone they're going to live to be 86 instead of 85 is not very motivating, for who wants to live longer if you're not enjoying life? They ask, "Am I going to live longer or is it just going to seem longer?"

When you change your diet and lifestyle, you feel good and look good. Your brain receives more blood and oxygen, so you think more clearly, have more energy and need less sleep. Your face gets more blood flow, so your skin glows more and wrinkles less. Your heart gets more blood flow, so you have more stamina and can even begin to reverse heart disease. Your sexual organs receive more blood flow, so you may become more potent, the same way that drugs like Viagra work (without troubling, if rare, side effects such as going blind).

6. What we do eat is at least as important as what we don't eat.
There are at least a thousand substances that have anticancer, anti-heart-disease and anti-aging properties. Fruits, vegetables, whole grains, legumes, soy products and fish are rich in good carbohydrates, good fats, good proteins and other protective substances, leading to feelings of abundance rather than deprivation.

7. It's important to address the deeper issues that underlie our behaviors.
Information is not usually enough to motivate lasting changes. If it were, no one would smoke. We need to work at a deeper level. In our studies, I asked people, "Why do you smoke? Overeat? Drink too much? Work too hard? Abuse substances? Watch too much television? These behaviors seem so maladaptive to me."

They would reply, "You just don't get it. These behaviors are very adaptive because they help us get through the day." As I wrote in an earlier column, loneliness and depression are epidemic in our culture. If we address these deeper issues, then it becomes easier for people to make lasting changes in their behaviors.

Life is to be enjoyed. There's no point in giving up something you enjoy unless you get back something even better—and quickly. Most people find that they feel so much better, so quickly, that these are choices worth making—not only to live longer, but also to live better.