In summary, Outlive offers an aggressive recipe for longevity, served up by an intense individual. I can believe that Dr. Attia is on a path to a long and healthy life. But it’s a path marked by blood tests during three-hour work outs.
A few months ago, I watched a two hour blog that he did with Chris Williamson and found it very interesting. ...but I would agree with you, because the normal person may not have the time or resources to follow all his admonitions.
...but nonetheless it is mind opening and helps you take an inventory of things.
Excellent summary, Dr Fenyves - I too, like hearing what Peter Attia says, but as a Geriatrician I spend much of my time trying to convince people to stop taking meds, stop doing screening tests, and stop getting procedures that will have little or no benefit for their quality of life and longevity, and distinct possibility of harm. Latest example - a 78 year old somewhat frail woman whose Internist recommended Cologard, which was positive, for which she underwent colonoscopy which was negative for malignancy. Unfortunately, during the procedure she suffered bowel perforation, necessitating major surgery and resection. Post-operatively she suffered acute MI, spent time in ICU, and is now in a long course of rehab at a facility. She was the primary and only caregiver for her husband, who deteriorated significantly during her hospitalization; he too ended up in the hospital with a CHF exacerbation, and is now getting rehab himself.
All this could have been avoided if she had not had the unnecessary colon cancer screening, which USPSTF recommends up to age 75. When I asked why she had it done, she said her doctor recommended that she get it. As mentioned, she is frail, had history of cardiac disease, and was on blood thinners when she did the test, all of which should have caused her internist to have real doubts about doing this test in the first place. Now, 2 elders have suffered as a result.
This has been on my list for quite some time. Think this post is the motivation to picking it up. Sounds like a doctor trying to be an author in some of the catchy taglines. I appreciate you parsing this out with the actual valuable information contained within the book. Will probably do a review of my thoughts on it as well.
Yes -- read the book. No, I definitely don’t think Attia is giving superficial takes or jumping on any bandwagons. He is very deep into prevention and longevity.
Thanks for sharing. I agree with your points about cancer screening and Alzheimer’s. I do like Attia’s push for LP(a) and APOb tests for heart disease as I’ve personally found them helpful for my family. He seems to be the first to admit how intense he is but there’s still a lot to glean from his work. Discernment is a practice in and of itself and doing so with this work has proven helpful for me. I appreciate your insight as well.
I agree with you completely Maggie. I tried to indicate that I agree with much of what he says, but did not give these specifics for the sake of brevity. I agree that Lipoprotein(a) is a very important test, especially for anyone with a family history of cardiovascular disease. Although there is no direct therapy for elevated Lipoprotein(a), I believe that this should lower one's threshold to start a statin and aim for a lower LDL goal. There is no direct evidence for this strategy (more aggressive statin therapy in the setting of high LP(a)), but it seems very reasonable to me. And on that note, I do agree with Dr. Attia that we should not dismiss these sorts of reasonable strategies, just because we don't have direct evidence. But I do try to be straightforward when I do this ("Unfortunately, your LP(a) is elevated, and we don't have any treatments to directly lower this risk, but since cardiovascular risk factors are additive, I think your elevated LP(a) should encourage use to be more aggressive with the factor that we can control....").
Incidentally, I am trying to read and respond to as many of these comments as possible, because I really am honored that people have taken the time to read my article and engage with me. However, my bandwidth is limited, and right now it’s hard to spend time doing anything other than reading the news from Israel
Oct 11, 2023·edited Oct 11, 2023Liked by Paul Fenyves
Lots of insults and animosity towards Dr. Attia in the comments. Ad hominem is a failed counterargument strategy. Disagree with his approach as you see fit, but cannot dispute he is a well read, highly motivated, impassioned researcher who is mission driven to increase healthspan of his patients. Dr. Attia effectively communicates complex health topics for lay people while keeping it interesting and empowering people to take action.
I don't agree with all his approaches, similar to the author, but I find him to be a great resource and a pioneer and early adopter of true prevention strategies and would recommend folks read his book.
Just because you can, doesn’t mean you should. It seems like a lot of things he pushes are certainly things you can do, but with relatively little data to suggest you actually should do them.
Only order a test if you’re going to act on the result….is the basic med school teaching. I’d add that any predicated action should have an evidence basis of actual downstream benefit. Finding a gene that “might” predispose to Alzheimer’s with no effective treatment to offer….maybe finding cancer that you can treat but which was never going to harm you much less kill you….that’s pretty cavalier in my book.
It sounds like his book is for the group that lies at the Venn diagram intersection of “OCD” and “worried well”. Not sure it’s a good idea or if net benefit to most people, beyond the motherhood stuff of “getting good sleep” and “exercise”.
Paul, thank you so much for your thoughts on his book. This is very timely for me as I recently watched two interviews with him and came away from the first one buying his book and deciding that it was time to build muscle for every good reason he gave plus some. But the second interview he was talking about cancer and getting screened, and I felt uncomfortable with this, but also his statement that "a lot of cancer is random." I don't believe this - cancer grows for a reason - often too much food (ie sugar) and a depressed immune system - and if you understand the reasons, then maybe you can fight cancer, not just detect it.
So I really appreciate your sentiments here as they align with my gut feeling - more testing isn't always better, and it can be very invasive which isn't always healthy
Thank you Terri! I completely agree that there is a lot of disease to be avoided with a healthy lifestyle. But I also agree with Dr. Attia that much of disease is random, and so it helps to have good luck! There is a beautiful quote, I think from Saint Augustine, that says: work as if it all depends on you, pray as if it all depends on God. I am not a religious person, and yet I still completely agree with this sentiment. On the one hand, we have to do everything in our power to control what we can, but at the same time have a certain recognition or resignation that much is out of our control
I enjoyed reading your critique of Dr Attic’s book and confess that I haven’t read it myself. It would seem to me that it’s a dangerous book if read by too many gullible people. The statistics used to show that the gain from having yearly Pap smears compared with having them every 5 years is minimal but it certainly plays into money making Dr’s hands. Similarly the detailed analyses of bowel cancer screening and mammography don’t show a decrease in all cause mortality but these screening programmes and procedures line Drs pockets and they have become a political hot potato. I’m summary I think that instead of suggesting that we should read the book we readers of sensible medicine should widely recommend that Dr Attia stops earning money from his writing and starts reading and subscribing to Sensible Medicine
So much of what we do is the product of our personality (as much and sometimes more than what we "know"). Dr Attia is a "type" we are all familiar with. Caveat emptor!
This was my exact take on his book. I am a paid subscriber to his podcast and really appreciate how in depth he goes into topics (better than some of my med school lectures and I take notes) but I agree, his approach isn’t really practical for most people and is VERY aggressive about screening. “Know thyself” is apt advice for the patient considering doing screening and testing. Bur what are you gonna do with this information? All information isn’t always useful.
Ditto. As an uber health conscious physician myself, I find most of my primary care docs are disinterested in "optimizing" my health (e.g. "you're ASCVD score is low, why lower your cholesterol?") and I appreciate the "surgeon" approach.
Re: ApoB being a superior to LDL-C as a marker for risk of cardiovascular disease -- Yes, there definitely is evidence to suggests this, and there is mainstream support for using this marker.
Re: Very aggressive targets for ApoB suppression in primary prevention. This is an interesting question. We currently start recommending a statin when someone's 10-year risk of CVD is above 5%. Would people get additional benefit if they started that statin say 10 years earlier? I do think this is very possible, but we don't know how much additional benefit would be seen, if any. I also agree with Attia that waiting for an RCT to answer this question is impractical. So, for now, people need to go with their own inclination about whether they are ready to start a daily preventive medication based on a reasonable hypothesis, but without direct evidence and with an anticipated benefit far in the future.
I'd be curious to hear Dr. Mandrola's take on ApoB and aggressive primary prevention of CVD.
Great article about various approaches in medicine. I ended up in the overdiagnosis category about five years ago. Because of lingering back pain I was given an MRI. a few days later I was told that I needed to see an endocrinologist because something bad showed up in my thyroid. They were supposed to be looking at my lower back but I guess at Kaiser they look at everything from your neck to your sacrum.
The visit to the endocrinologist contained about 30 needle pokes into my throat to determine what kind of lesions were on my thyroid.
By the following week they had me scheduled to speak with the head and neck cancer surgeon because I probably had thyroid cancer.
I was about to start work in the national tour of (wicked) and I was trying to imagine when I would get my thyroid removed and when I would then begin rehearsal.
Thank God for the Internet. I started doing a Google search on everything they had described to me and found the doctor at Sloan Kettering in New York City who studied thyroid cancers and spoke about the option of ‘active surveillance’.
He wrote about the fact that many of these small papillary thyroid cancers never grow and that active surveillance is a good option for many people.
The next time I spoke with the doctors at Kaiser I explained that I was not going to have my thyroid removed and that I was going to find a doctor that had an active surveillance study.
Sloan Kettering recommended a doctor down at Cedars Sinai in Los Angeles and for the past five years I go down there every year and with ultrasound they determine that it is not growing and I am relieved and grateful that I did my research and have kept my thyroid.
Apparently there is a massive amount of overdiagnosis with these kinds of thyroid lesions.
Jo, thanks for sharing this. And you're with Kaiser - they don't have a financial incentive to treat you. Imagine what is happening with people who see docs for which that surgery means income.
I wish you the best and pray they will stay stable for the rest of your life.
Thank you! I feel lucky that I found the work if Dr. Tuttle at MSK and he knew about the study at Cedars. And I also understand that many people when they hear the word ‘cancer’ would want surgery immediately no matter what. And I understand that because we do not understand that some of these lesions will not kill us until we do a little poking around.
Having a cervical MRI for a nerve function issue showed a thyroid tumor. I have nine thyroid tumors that have been under active surveillance for 10 years. One is growing slowly but so far no cancer.
On my last visit to Cedars Sinai in Los Angeles they gave me a genetic blood test and thank goodness the information showed that my lesions or tumors did not have the bad genetics usually associated with negative outcomes.
It is so confusing to me as a lay person why a growth is called cancer if it does not grow or metastasize because we were all brought up to believe that cancer means nonstop growth and metastasis.
Thank you for the excellent review. It took me back to a short article I posted on Junkscience.com several years ago titled The Delusion of Health Care. In the article I explain that a fundamental problem is that most people fail to understand the difference between health and the way they feel. For example, diet and exercise will often improve the way one feels but there is no credible scientific evidence that they will do anything to promote health or prevent disease. It sounds like this book is another in the never-ending stream of nonsense that dominates the best seller lists year after year.
I believe there is actually plenty of credible scientific evidence that exercise promotes health.
I don't have a reference handy but I have read studies that showed all-cause mortality rates were lower among the groups that exercised versus the groups that didn't. Yes, there are always questions about reverse causation - the sicker people are unable to exercise rather than exercise making people more healthy - and probably reality is a mix of both.
Anyway, hopefully someone will chime in with a link to some credible scientific evidence that exercise promotes health.
To be fair, it is logistically difficult, if not impossible to carry out a scientifically valid study on exercise and health and/or diet and health. How on earth is it possible to quantitate and then compare the variable exercise patterns of different individuals over many years? Exercise physiologists have shown that people can improve the efficiency of their oxygen utilization and even raise the number of mitochondria in their muscle cells. But even these benefits disappear after about two weeks of inactivity. Most importantly, there is no biologically plausible mechanism by which exercise could possibly prevent disease. In my medical practice I often advised patients to do regular exercise in order to feel better and there is nothing wrong with that. I think it is intuitively obvious that some level of exercise permits people to get around with less effort and helps promote a feeling of well being. But that is a far cry from preventing actual disease.
I think we are arguing about the imprecise use of words here more than actual opinions about diet and exercise. You wrote there is "no scientific evidence that they will ..." but I guess that you meant we lack randomized control trials.
We have scientific evidence. True, we lack RCTs, generally considered the best standard of evidence in medicine.
I suspect our opinions about the merits of diet and exercise are identical, and I am just nit-picking you to death over wording. If that is correct, please accept my apologies.
Edward, thank you for your thoughtful comment. I agree that many discussions go nowhere because the discussants are indeed using words that they define differently and therefore often talk past each other. I define disease as a physical and/or biochemical alteration that causes one or more bodily organs or organ systems to malfunction. Health is simply the absence of disease and is our natural condition. Most people think of science as a body of knowledge. But this is incorrect. Science is a method used to discover and determine truths about the physical world. Science has nothing to say, for example about the spiritual world or even if it actually exists apart from the physical world. So when I say there is no scientific evidence of something, that is what I mean and it may be that science has no way of showing certain things to be true or false. I think this is true for analyzing the effects of diet and exercise on health or disease. That doesn't mean that this is a closed subject. But for now ,we are limited to what we know to be true about physiology and that knowledge shows no biologically plausible mechanism by which diet and/or exercise can ameliorate or prevent actual disease.
Same with "diet" though what that means to each of us may be different. I guarantee that if my diet is kit kats and soda, I'm going to have more disease than if it's brocolli and veggies...... I'd end up diabetic to start.....
Yes, with diet, depending on how broadly defined that word is, it is extremely clear. The wrong diet and you’ll develop scurvy or rickets or etc. There are countless examples of nutritional deficiencies resulting in actual disease. And, as you mentioned, even if you get appropriate macronutrients, certain diets predispose us to type 2 diabetes, among other issues.
A few months ago, I watched a two hour blog that he did with Chris Williamson and found it very interesting. ...but I would agree with you, because the normal person may not have the time or resources to follow all his admonitions.
...but nonetheless it is mind opening and helps you take an inventory of things.
Excellent summary, Dr Fenyves - I too, like hearing what Peter Attia says, but as a Geriatrician I spend much of my time trying to convince people to stop taking meds, stop doing screening tests, and stop getting procedures that will have little or no benefit for their quality of life and longevity, and distinct possibility of harm. Latest example - a 78 year old somewhat frail woman whose Internist recommended Cologard, which was positive, for which she underwent colonoscopy which was negative for malignancy. Unfortunately, during the procedure she suffered bowel perforation, necessitating major surgery and resection. Post-operatively she suffered acute MI, spent time in ICU, and is now in a long course of rehab at a facility. She was the primary and only caregiver for her husband, who deteriorated significantly during her hospitalization; he too ended up in the hospital with a CHF exacerbation, and is now getting rehab himself.
All this could have been avoided if she had not had the unnecessary colon cancer screening, which USPSTF recommends up to age 75. When I asked why she had it done, she said her doctor recommended that she get it. As mentioned, she is frail, had history of cardiac disease, and was on blood thinners when she did the test, all of which should have caused her internist to have real doubts about doing this test in the first place. Now, 2 elders have suffered as a result.
This has been on my list for quite some time. Think this post is the motivation to picking it up. Sounds like a doctor trying to be an author in some of the catchy taglines. I appreciate you parsing this out with the actual valuable information contained within the book. Will probably do a review of my thoughts on it as well.
Yes -- read the book. No, I definitely don’t think Attia is giving superficial takes or jumping on any bandwagons. He is very deep into prevention and longevity.
Thanks for sharing. I agree with your points about cancer screening and Alzheimer’s. I do like Attia’s push for LP(a) and APOb tests for heart disease as I’ve personally found them helpful for my family. He seems to be the first to admit how intense he is but there’s still a lot to glean from his work. Discernment is a practice in and of itself and doing so with this work has proven helpful for me. I appreciate your insight as well.
I agree with you completely Maggie. I tried to indicate that I agree with much of what he says, but did not give these specifics for the sake of brevity. I agree that Lipoprotein(a) is a very important test, especially for anyone with a family history of cardiovascular disease. Although there is no direct therapy for elevated Lipoprotein(a), I believe that this should lower one's threshold to start a statin and aim for a lower LDL goal. There is no direct evidence for this strategy (more aggressive statin therapy in the setting of high LP(a)), but it seems very reasonable to me. And on that note, I do agree with Dr. Attia that we should not dismiss these sorts of reasonable strategies, just because we don't have direct evidence. But I do try to be straightforward when I do this ("Unfortunately, your LP(a) is elevated, and we don't have any treatments to directly lower this risk, but since cardiovascular risk factors are additive, I think your elevated LP(a) should encourage use to be more aggressive with the factor that we can control....").
Incidentally, I am trying to read and respond to as many of these comments as possible, because I really am honored that people have taken the time to read my article and engage with me. However, my bandwidth is limited, and right now it’s hard to spend time doing anything other than reading the news from Israel
I understand and appreciate your time. 🙏
Lots of insults and animosity towards Dr. Attia in the comments. Ad hominem is a failed counterargument strategy. Disagree with his approach as you see fit, but cannot dispute he is a well read, highly motivated, impassioned researcher who is mission driven to increase healthspan of his patients. Dr. Attia effectively communicates complex health topics for lay people while keeping it interesting and empowering people to take action.
I don't agree with all his approaches, similar to the author, but I find him to be a great resource and a pioneer and early adopter of true prevention strategies and would recommend folks read his book.
Totally agree James -- he is a super sharp doctor and an excellent communicator. And ad hominem attacks are never productive.
Just because you can, doesn’t mean you should. It seems like a lot of things he pushes are certainly things you can do, but with relatively little data to suggest you actually should do them.
Only order a test if you’re going to act on the result….is the basic med school teaching. I’d add that any predicated action should have an evidence basis of actual downstream benefit. Finding a gene that “might” predispose to Alzheimer’s with no effective treatment to offer….maybe finding cancer that you can treat but which was never going to harm you much less kill you….that’s pretty cavalier in my book.
It sounds like his book is for the group that lies at the Venn diagram intersection of “OCD” and “worried well”. Not sure it’s a good idea or if net benefit to most people, beyond the motherhood stuff of “getting good sleep” and “exercise”.
Paul, thank you so much for your thoughts on his book. This is very timely for me as I recently watched two interviews with him and came away from the first one buying his book and deciding that it was time to build muscle for every good reason he gave plus some. But the second interview he was talking about cancer and getting screened, and I felt uncomfortable with this, but also his statement that "a lot of cancer is random." I don't believe this - cancer grows for a reason - often too much food (ie sugar) and a depressed immune system - and if you understand the reasons, then maybe you can fight cancer, not just detect it.
So I really appreciate your sentiments here as they align with my gut feeling - more testing isn't always better, and it can be very invasive which isn't always healthy
Thank you Terri! I completely agree that there is a lot of disease to be avoided with a healthy lifestyle. But I also agree with Dr. Attia that much of disease is random, and so it helps to have good luck! There is a beautiful quote, I think from Saint Augustine, that says: work as if it all depends on you, pray as if it all depends on God. I am not a religious person, and yet I still completely agree with this sentiment. On the one hand, we have to do everything in our power to control what we can, but at the same time have a certain recognition or resignation that much is out of our control
I enjoyed reading your critique of Dr Attic’s book and confess that I haven’t read it myself. It would seem to me that it’s a dangerous book if read by too many gullible people. The statistics used to show that the gain from having yearly Pap smears compared with having them every 5 years is minimal but it certainly plays into money making Dr’s hands. Similarly the detailed analyses of bowel cancer screening and mammography don’t show a decrease in all cause mortality but these screening programmes and procedures line Drs pockets and they have become a political hot potato. I’m summary I think that instead of suggesting that we should read the book we readers of sensible medicine should widely recommend that Dr Attia stops earning money from his writing and starts reading and subscribing to Sensible Medicine
I don't care for Attia since he is still firmly in the statin camp. He has presented some good articles, but I wouldn't blindly follow him.
So much of what we do is the product of our personality (as much and sometimes more than what we "know"). Dr Attia is a "type" we are all familiar with. Caveat emptor!
This was my exact take on his book. I am a paid subscriber to his podcast and really appreciate how in depth he goes into topics (better than some of my med school lectures and I take notes) but I agree, his approach isn’t really practical for most people and is VERY aggressive about screening. “Know thyself” is apt advice for the patient considering doing screening and testing. Bur what are you gonna do with this information? All information isn’t always useful.
Thank you. And despite my criticism, I do enjoy, listening to Attia’s takes -- I hope that came across.
Great work Paul. I love the line "Outlive is definitely a book about primary care written by a surgeon."
Ditto. As an uber health conscious physician myself, I find most of my primary care docs are disinterested in "optimizing" my health (e.g. "you're ASCVD score is low, why lower your cholesterol?") and I appreciate the "surgeon" approach.
Thanks Adam!
He needs to bone up a bit on the epidemiology of iatrogenic illness
Any comments on his ApoB advice?
Re: ApoB being a superior to LDL-C as a marker for risk of cardiovascular disease -- Yes, there definitely is evidence to suggests this, and there is mainstream support for using this marker.
Re: Very aggressive targets for ApoB suppression in primary prevention. This is an interesting question. We currently start recommending a statin when someone's 10-year risk of CVD is above 5%. Would people get additional benefit if they started that statin say 10 years earlier? I do think this is very possible, but we don't know how much additional benefit would be seen, if any. I also agree with Attia that waiting for an RCT to answer this question is impractical. So, for now, people need to go with their own inclination about whether they are ready to start a daily preventive medication based on a reasonable hypothesis, but without direct evidence and with an anticipated benefit far in the future.
I'd be curious to hear Dr. Mandrola's take on ApoB and aggressive primary prevention of CVD.
Great article about various approaches in medicine. I ended up in the overdiagnosis category about five years ago. Because of lingering back pain I was given an MRI. a few days later I was told that I needed to see an endocrinologist because something bad showed up in my thyroid. They were supposed to be looking at my lower back but I guess at Kaiser they look at everything from your neck to your sacrum.
The visit to the endocrinologist contained about 30 needle pokes into my throat to determine what kind of lesions were on my thyroid.
By the following week they had me scheduled to speak with the head and neck cancer surgeon because I probably had thyroid cancer.
I was about to start work in the national tour of (wicked) and I was trying to imagine when I would get my thyroid removed and when I would then begin rehearsal.
Thank God for the Internet. I started doing a Google search on everything they had described to me and found the doctor at Sloan Kettering in New York City who studied thyroid cancers and spoke about the option of ‘active surveillance’.
He wrote about the fact that many of these small papillary thyroid cancers never grow and that active surveillance is a good option for many people.
The next time I spoke with the doctors at Kaiser I explained that I was not going to have my thyroid removed and that I was going to find a doctor that had an active surveillance study.
Sloan Kettering recommended a doctor down at Cedars Sinai in Los Angeles and for the past five years I go down there every year and with ultrasound they determine that it is not growing and I am relieved and grateful that I did my research and have kept my thyroid.
Apparently there is a massive amount of overdiagnosis with these kinds of thyroid lesions.
Thank you for your article.
Jo, thanks for sharing this. And you're with Kaiser - they don't have a financial incentive to treat you. Imagine what is happening with people who see docs for which that surgery means income.
I wish you the best and pray they will stay stable for the rest of your life.
Thank you! I feel lucky that I found the work if Dr. Tuttle at MSK and he knew about the study at Cedars. And I also understand that many people when they hear the word ‘cancer’ would want surgery immediately no matter what. And I understand that because we do not understand that some of these lesions will not kill us until we do a little poking around.
We are so fortunate to live in an age where this research is possible for us to do without going to a library!
Yes!
Having a cervical MRI for a nerve function issue showed a thyroid tumor. I have nine thyroid tumors that have been under active surveillance for 10 years. One is growing slowly but so far no cancer.
Hallelujah.
It has been very nerve-racking at times.
On my last visit to Cedars Sinai in Los Angeles they gave me a genetic blood test and thank goodness the information showed that my lesions or tumors did not have the bad genetics usually associated with negative outcomes.
It is so confusing to me as a lay person why a growth is called cancer if it does not grow or metastasize because we were all brought up to believe that cancer means nonstop growth and metastasis.
Thank you for the excellent review. It took me back to a short article I posted on Junkscience.com several years ago titled The Delusion of Health Care. In the article I explain that a fundamental problem is that most people fail to understand the difference between health and the way they feel. For example, diet and exercise will often improve the way one feels but there is no credible scientific evidence that they will do anything to promote health or prevent disease. It sounds like this book is another in the never-ending stream of nonsense that dominates the best seller lists year after year.
I believe there is actually plenty of credible scientific evidence that exercise promotes health.
I don't have a reference handy but I have read studies that showed all-cause mortality rates were lower among the groups that exercised versus the groups that didn't. Yes, there are always questions about reverse causation - the sicker people are unable to exercise rather than exercise making people more healthy - and probably reality is a mix of both.
Anyway, hopefully someone will chime in with a link to some credible scientific evidence that exercise promotes health.
To be fair, it is logistically difficult, if not impossible to carry out a scientifically valid study on exercise and health and/or diet and health. How on earth is it possible to quantitate and then compare the variable exercise patterns of different individuals over many years? Exercise physiologists have shown that people can improve the efficiency of their oxygen utilization and even raise the number of mitochondria in their muscle cells. But even these benefits disappear after about two weeks of inactivity. Most importantly, there is no biologically plausible mechanism by which exercise could possibly prevent disease. In my medical practice I often advised patients to do regular exercise in order to feel better and there is nothing wrong with that. I think it is intuitively obvious that some level of exercise permits people to get around with less effort and helps promote a feeling of well being. But that is a far cry from preventing actual disease.
I think we are arguing about the imprecise use of words here more than actual opinions about diet and exercise. You wrote there is "no scientific evidence that they will ..." but I guess that you meant we lack randomized control trials.
We have scientific evidence. True, we lack RCTs, generally considered the best standard of evidence in medicine.
I suspect our opinions about the merits of diet and exercise are identical, and I am just nit-picking you to death over wording. If that is correct, please accept my apologies.
Edward, thank you for your thoughtful comment. I agree that many discussions go nowhere because the discussants are indeed using words that they define differently and therefore often talk past each other. I define disease as a physical and/or biochemical alteration that causes one or more bodily organs or organ systems to malfunction. Health is simply the absence of disease and is our natural condition. Most people think of science as a body of knowledge. But this is incorrect. Science is a method used to discover and determine truths about the physical world. Science has nothing to say, for example about the spiritual world or even if it actually exists apart from the physical world. So when I say there is no scientific evidence of something, that is what I mean and it may be that science has no way of showing certain things to be true or false. I think this is true for analyzing the effects of diet and exercise on health or disease. That doesn't mean that this is a closed subject. But for now ,we are limited to what we know to be true about physiology and that knowledge shows no biologically plausible mechanism by which diet and/or exercise can ameliorate or prevent actual disease.
Same with "diet" though what that means to each of us may be different. I guarantee that if my diet is kit kats and soda, I'm going to have more disease than if it's brocolli and veggies...... I'd end up diabetic to start.....
Yes, with diet, depending on how broadly defined that word is, it is extremely clear. The wrong diet and you’ll develop scurvy or rickets or etc. There are countless examples of nutritional deficiencies resulting in actual disease. And, as you mentioned, even if you get appropriate macronutrients, certain diets predispose us to type 2 diabetes, among other issues.