The Life Ahead Program, diet, exercise, weight, cardio fitness, health

The LIFE AHEAD HEALTH

RESEARCH LIBRARY

About the Library

Results of much of the important Health Research used in the Life Ahead Model is provided or discussed in this Library. Most of this research has not previously been organized, analyzed or published in the detail provided here, and a number of Global Analyses cited herein may represent new state-of-science on their subjects. No comparable library of summarized actual Health Research results is now known to exist, and hopefully this Library can expanded, refined and improved.

The Library includes summary analyses of most of the factors affecting major disease now researched and included in the Life Ahead program. These analyses include references to key research used. Much of the actual research data found and used is included in Tables for convenient review for most key health factors.

This Library is intended to be used by doctors, other health professionals, health researchers, and importantly, by any non-professional health-interested person. It is hoped that the research and analyses cited will lead to useful comments and exchange of information between the author and professionals. Help in improving and extending this library will be welcome.

Health Research data are not easy to find and review. Papers are scattered among hundreds different expensive medical journals. Locating the key research, getting copies of papers and reviewing methods and finding key facts buried in included tables can be a daunting task. A serious review of research on just one part of a health factor can require months or more of dedicated time. Thus most health writers, doctors, and professionals can do little more than keep track of abstracts of or media reports about more recent studies. Often the best research appeared a dozen or more years back, and single study abstracts can provide confusing and inaccurate pictures of true overall study results. Many years of effort were involved in developing the information in this Health Library. Thus it is hoped that the included summaries of much of this research will be helpful to others.

Conventional analyses of Health Research has consisted of tabulating and summarizing abstracts of various research papers and author conclusions on a given factor. Such analyses near invariably encounter much confusion of results with statistical dogma of "Significant" and "Not significant" and various author opinions and speculations. Life Ahead analyses usually involved revisiting critically the Actual Research Data provided in each study. Thus Life Ahead attempts to provide directly and not influenced by any present and popular dogma: "What all of the actual available research data found now really shows."

Any lay health-interested person, and especially anyone with even a minimal knowledge of statistics should be able to interpret and understand the results of research described in this Health Research Library. Understanding the extent and depth of actual research findings should convince many about the importance of the actions they need to take to enjoy a better and longer life. Also, an understanding of actual Health Research results can be very helpful in understanding the fallibilities of so much health advice that is based on just fragments of the true existing information. And this understanding can caution people from accepting too quickly some new or differing advice from some individual new individual study.

When stripped of a mass of jargon and statistical terms the key Health Research results on people nearly always reduce to one or more simple numbers called risk ratios. These are as used herein usually are:

The fraction of a disease suffered by a usually more healthful group vs. that suffered by another that is less healthy.

If a risk ratio is 0.5, this means that the risk from this habit change is half of that before the change. (Or the risk before was twice that after) A risk ratio of 0.25 denotes a very MAJOR reduction in risk of 75% or four times. A risk ratio of 0.8 means only a 20% reduction in risk. The ratios thus work backwards or inversely. Very low values mean much reduced risk, high values or 1.0 denote little or no reduction in risk. A risk value above 1.0 means increased risk. Risk ratios cited in various research studies are not reported in any consistent way. The Life Ahead Library values usually are shown similarly via the above basis.

A risk ratio nearly always is accompanied by a measure of "5% to 95%" accuracy. The fact that most health risks are measured with a VERY HIGH margin of error in individual studies is poorly understood. A typical margin of error in a health research risk ratio is difference or spread of about 0.6. This is ten times larger than a usual forecast error of a person in a political contest. For example, if a risk ratio cited is say 0.50, the usual health research study error margin is from 0.2 to 0.8. This means that the true value has a 9 in 10 chance of being between 0.2 and 0.8, and a 1 in 20 chance of being below 0.2 or above 0.8. Thus that risk number of 0.5 quoted by the media for an individual study is not very accurate or even meaningful.

Risk ratios sometimes are given for 3, 4, or 5 different groups exposed to varying amounts of an action or dietary intake vs. those exposed to the lowest amount of the factor. These later fractions are called tertiles (3rds), quartiles(4ths), or quintiles(5ths). The more of a desirable intake or action, the lower is the expected risk ratio. If there is a clear trend of risk with amounts of exposure, the factor is "dose" related and thus is better established.

Because risk ratios from single health studies usually have a high margin of error we usually need multiple studies to be more confident of truth. If a second study of same margin of error also shows a risk ratio of 0.5 our confidence is much improved. The risk is reconfirmed as 0.5, and the combined error from statistics now reduces to about 0.45, or a risk of 0.5 (limits 0.28 to 0.72). At this time we can be fairly confident that doing this is beneficial. And as benefits are confirmed by 3, 4 and 5 studies the likelihood of true benefit improves further and the probably risk is identified more accurately. But if a second study shows a 1.0 factor or no benefit, the averaged result of the two becomes a value of 0.75, and the total result to date is less significant. Thus it is of KEY IMPORTANCE to know the risk ratios and error margins of ALL STUDIES on a subject. Life Ahead research always attempts to locate all or nearly all useful research on every factor included and derive a most likely overall risk from all of this research.

A BIG problem in Health Research is for health factors that have risk ratios of 0.6 to 0.7 and higher. This includes the risk level of MOST health factors. A 30% reduction in a disease such as cancer can be quite important. But the usual error margin of usual health research simply is too high for this ratio to be consistently measured at the desired 95% levels of significance. Suppose for example a true risk ratio for an action taken is 0.7. The usual 90% range of study error now becomes 0.4 to 1.0. What this means is that if we conducted essentially similar studies ten times, nine of the results would be between 0.4 and 1.0, with individual values scattering from 0.4 to 1.0 as for example 0.4, 0.46, 0.51, 0.60, 0.72, 0.78, 0.90, 1.0 and with one value above 1.0 or below 0.4.

The arbitrary dogma of the 95% statistical test probably would then identify 4 or 5 of these studies as "Not significant" and 5 or 6 of the studies "Statistically significant". This is cited herein as "Statistical confusion." And confusing matters worse is the blatantly incorrect but common practice of calling a not 95% significant result as "No significant effect" as "No effect was found." This may be a key reason why health research on a factors such as diets, exercise, vitamins and even smoking continued for decades before a consensus was or will be reached. In contrast to this confusion, a proper analysis of the above 10 results taken together could show a probable risk of about 0.70 that is established with enormous significance.

Life Ahead avoids this problem by always viewing an average result of all studies. Life Ahead analysis found that 75-80% of all health research studies quoting "No significant effect was found" really confirmed a likely positive effect if such an effect was found by the majority! What this means is this: Be skeptical of any study report saying "No effect or no significant effect was found"! After we have several studies averaging a risk ratio of say 0.7, the proper overall Global margin of error usually is reduced to the level that confirms this result to be quite accurate and significant.

All health studies involve approximations and assumptions that are subject to criticism. Any health zealot can find reasons for rejecting and calling 'Flawed' all studies that do not meet some preconceived idea. Life Ahead embraces the long recognized tenet of research that "The Research Data are Usually Right." A corollary is that those that reject Research Data are nearly always wrong. See the section entitled "Concepts Differ --" for the bases used in Life Ahead for selecting and for rejecting research as not useful. Life Ahead attempts to use multiple study results from ALL research data located that meet certain minimal criteria that are described, and initiates conclusions objectively and conservatively with no preconceived position.

Research results in the this Health Library are first summarized, the analyses described, and the way results are used in Life Ahead discussed. Tables of actual research included are provided in similar format for all useful research found to be useful on each subject. First noted in the tables is a reference to the study that permits its abstract and description to be located in the important internet Medline library of the US National Institutes of Health. Next are measures of study size and scope. Risk ratios of each study are then listed in same column for comparison with margins of study error following in a next column. A next column usually includes some measure or estimate of the amount of a factor measured, as for example IU or mg of a mineral or vitamin, calories of exercise, etc. Columns in some comparisons note estimated durations of exposure to an agent involved in the risk measurement and risks as % per year of this exposure. A final column provides notes about the research procedures or data obtained in the study.

To view a result for a wellness factor as a vitamin, mineral, or health habit, first select the subject, and read the abstract. Then browse the analysis of this research. If you do not understand equations and correlation coefficients, skip over such because the key findings are noted in the abstract and in the text. Note any average risk ratio value noted that was included and used in Life Ahead. Then view in any Tables provided the risk ratios of the various studies to see how they compare with this average ratio. Note the margins of errors of studies vs. the study average risk ratio. If a study margin of error includes the average risk factor value within its range, it is considered Statistically Consistent with the average result. The few studies that are not Statistically Consistent usually are discussed separately in the study analyses.

For example, consider an average risk ratio of 0.67 for a vitamin and heart disease. The individual risk values of three studies may be 0.4 (range 0.3-0.7), 0.6 (range 0.3-0.9) ; and 0.85 (range 0.55 to 1.15). In each case the value of 0.67 is within the margin of error of each comparison. Thus these results all are statistically consistent. They each validate the same average value within their margin of error. This variation of results is expected because of the innate margin of error of this kind of research. The fact that the 0.85 value is "Not statistically significant at an arbitrary 95%" from a null hypothesis or zero effect is scientifically meaningless when considered in relation to the other available results. Yet nearly every review article by supposedly expert panels will quote these as "Conflicting" studies. This dogma simply is not true - and can keep the truth confused for decades.

Most medical reviews of a factor usually cite a succession of overall author findings from each contributing research. These reviews near invariably find that all studies do not agree. And claim that "We need more research." Poorly recognized is that fact the the problem of usual study error insures that the research results probably will not all agree. Further, this same problem of known study error will insure that all additional studies will not reach the dogma of 95% statistical significance. The only really valid and useful test for research information of this type must be that of statistical consistency: "Are the results statistically consistent with that of an average result." As an example, consider result A: a risk ratio of 0.67, 95% limits 0.4 to 0.98, and result B; a risk ratio of 1.05, 95% limits of 0.6 to 1.6. Most researchers will claim A "Found a significant effect, and that B 'Found no effect." In truth, these two results are statistically consistent, and confirm a likely risk roughly in the range of 0.67 to 0.98. But with recognition of B, more accurate statistical analysis will probably suggest a value somewhat above 0.67. A and B each confirm only a fairly wide range of possible values. The mean values of risk of each measured and that are the ones quoted in the media can have minor true significance.

You will note that the average and final factors used in Life Ahead usually are confirmed by research consistently and with very high significance. As an example, view the discussions of and results from the dozens of studies that show benefits for Vitamin E on both cancer and cardiovascular disease. Those who still dispute its value must never have viewed the extensive and consistent research results now available on this important factor. No similar published compilation of this research on both heart disease and cancer is now known to this author. The same is true for the research compilations on exercise, cardiofitness, and other vitamins.

Finally - and again: Read the analysis provided for each risk factor of interest. Then look down the column of risk ratios in tables of research results provided. In most cases these risk factors will be so obviously and consistently below the no effect value of 1.0 that a conclusion of benefit becomes obvious. You then should know what you should be doing to protect your health further. You yourself will have viewed the real evidence.

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