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Ep. 5 - Primary versus secondary prevention

Have you heard the old adage "an ounce of prevention is worth a pound of cure"-? What if I could convince you that an ounce of prevention is worth a ton of cure? Do you think that maybe that could move you to action? Dr. Chet Zelasko discusses Primary versus Secondary Prevention on this edition of Straight Talk on Health

Welcome to Straight Talk on Health, I’m your host Dr. Chet Zelasko. I’ve got a question for you: have you heard the old adage an ounce of prevention is worth a pound of cure? Ben Franklin was talking about fire departments. But what about health? What if I told you that an ounce of prevention is worth a TON of cure? You think that maybe that could move you to action? It's time to talk about prevention, primary prevention, secondary prevention and why they are important to our health. Let's take a look. Now, the key to aging with a vengeance is certainly prevention. One of the obvious goals is to prevent problems such as strokes or heart attacks in healthy people and in people who have had risk factors for disease. So why the difference between primary and secondary?

Well, let me explain it this way. Primary prevention focuses on helping apparently healthy people prevent the onset of disease. Eating a healthy diet that focuses on plant based sources of food would be an obvious preventive measure. So would a regular exercise program. Supplementation, if you need to fill in any gaps in the diet, would also fit in here. We all need to supplement because none of us have a perfect diet. But that's not the only thing. There are more steps that we don't typically consider. How about a physical? A yearly physical is important as you pass 30 years of age. I cringe every time people in their 60 say “I've never had a physical.” Something as simple as examining your skin for a misshapen mole or measuring blood pressure regularly can be critical to prevention because early treatment can prevent a disease such as skin cancer or hypertension and that can certainly cause life threatening issues. Then add keeping your vaccinations up to date and flossing your teeth daily and you know what? You've got a great start to primary prevention.

I'm going to do an aside here. Every time we talk about vaccinations, I know that some people cringe. When I write about them, I lose some readers. I would imagine the same thing happens when I talk about them, I lose some listeners. You know, that used to really bug me? It doesn't anymore. Why not? Because the track record of vaccination is pretty darned good. We virtually eliminated polio only to have it come back again because so many people refuse vaccinations for their kids when 20 years ago and that trend continues today. The same thing is true for chicken pox. Let's hope that that period doesn’t come back anytime soon. And let me reinforce that with this story. When I was a kid used to go with my grandfather to the cemetery where he would take care of his parent’s grave. You know, the one to make sure there were flowers, things like that. What I would do is wander around looking at gravestones, seeing if there were any people with the same last names anywhere near close. I happened one gravestone that has 5 different names on it, both first and last names. So I asked my grandfather. He said that there were times when he was young, that diphtheria, a severe lung infection would kill all the babies on a given Street because it is highly contagious. So, when the babies died, to save space in the cemetery, they used very little coffins, one on top of another, hence there were multiple names on the gravestone.

We haven't seen anything like that in probably a 100 years, but it's always a possibility that things could come back if people don't get vaccinated or get boosters as adults. You know, as I planned to do this segment, my father-in-law's twin died of just such an infection. He got it, my father in law, but he survived. But his brother, his name was Ronald, did not. Too many people have been convinced by fraudulent study in England and one person's opinion.

We leave you with this thought. You don't like vaccinations. It's not just all about you. You may have the right genetic makeup, the right immune system to survive any of these very serious or potentially serious infections. What about the other members of your family? What about your neighbors? What about people you may work with? This is more than just being about you. There's no argument that you can make that I haven't already heard. Keeping vaccinations up to date is a part of primary prevention. It's your body and it's your choice. But remember the greater scheme of things. So that's primary prevention. Let's turn to secondary prevention.

What the heck is that? Secondary prevention encompasses a wide range of health related conditions. It includes people with risk factors such as high cholesterol and blood pressure, cigarette smoking, elevated HbA1c, I’ll explain that in a moment, atrial fibrillation and more. HbA1c is a protein that floats around in your blood and it can give an accurate reading of what your blood sugar has been for the last 90 days by the number of receptors that had insulin attached or glucose attached to them. It's something that's pretty common now. Why? Because we have an obesity epidemic close to 70% of the population is overweight and over half of those almost 40% of the entire population is obese. And so Type 2 diabetes is what it's used for to diagnose it and secondary prevention will include people who also have had a heart attack, stroke, cancer or retreated and are trying to prevent a recurrence or another incident. Lot of pharmaceutical trials attempt to examine this question of secondary prevention with statins and beta-blockers and many other kinds of medications. They all fall under the umbrella of secondary prevention.

Here's the problem. We don't take the risk factor seriously enough to prevent the occurrence of serious health events and a diagnosis of type 2 diabetes is a serious health event. Let's say, for example, that a person gets reading of 5.9% in their HbA1c reading. Okay. 5.6 is normal. 5.7 starts where the you might be pre diabetic. An actual diagnosis of type 2 diabetes is when you're HbA1c gets to 6.4% or above the solution is pretty straightforward, people. Reduce refined carbohydrate intake and total caloric intake, if you're overweight, and then start an exercise program and stick to it.

Here's a little known fact. Did you know that within 3 days of beginning to walk, or exercise, or bike program, your body will begin to utilize insulin better? That's how quickly your body reduces insulin resistance and starts the path back to lower HbA1c and thus reducing the risk of type 2 diabetes. How do I know that? Well, I did that research back when I was at Michigan State University. The purpose of the study was to get at least, well, possibly more obese people and then, in this case, morbidly obese tend to be at least a 100 pounds’ overweight or body mass index of over 40, to stick to an exercise program and not lose weight. So the first thing that they all do while they're exercising. They change their diet. But because the study was 6 months long. That didn't last long. I didn't force them to eat less, I didn't ask them to eat more. I just asked them to live their lives.

And so we found that within 72 hours, changes occur in insulin receptors, fat cells and others, and your body starts using sugar very much better. And so doing something as simple as a walking program is going to help to reduce that HbA1c. Aging with a vengeance is all about prevention. Primary prevention to prevent serious diseases and conditions from occurring in the first place and secondary prevention to deal with them if they do occur.

Now, look, aging is a risk factor in and of itself, but not because of a calendar. It's the changes that occur naturally as we age. Sarcopenia is one of them, which is a loss of muscle mass. We lose muscle mass, are metabolism goes down and therefore we become more prone to muscle wasting diseases that can contribute to things like type 2 diabetes. What we do to resist or delay changes is at least partly in our hands. We can't reverse the clock, but you can be better than you are today. That's why I always say aging with a vengeance begins in your 30's and maybe even younger.

It all begins with the 6 simple words, eat less, eat better, move more. I'm going to continue to comb the research to find strategies to deal with other issues that we faced. Until then, just remember that health is a choice, people. Choose wisely today and every day. I’m Dr. Chet Zelasko


Straight Talk on health with Dr. Chet Zelasko was recorded in the studios of WGVU Public Radio in Grand Rapids, Michigan. The views and opinions expressed on Straight Talk on health are not necessarily those of WGVU, its underwriters, or Grand Valley State University. Episodes are found at wgvunews.org and wherever you get your podcast, please rate and subscribe.


Dr. Chet Zelasko is a scientist, speaker, and author. Dr. Chet has a Ph.D. and MA in Exercise Physiology and Health Education from Michigan State University and a BS in Physical Education from Canisius College. He’s certified by the American College of Sports Medicine as a Health and Fitness Specialist, belongs to the American Society of Nutrition, and has conducted research and been published in peer-reviewed journals. You can find him online at drchet.com.
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