Recently the lifestyle section in my local newspaper has been carrying wire service reports of major presentations of the 4th International Conference on Preventative Cardiology. Firstly, it was refreshing to see a medical conference with a philosophy of prevention. Secondly, it was reassuring to read some of their conclusions.

"The recommendations of the 14 member working group on Hypercholesterolemia were tabled on Wednesday. The recommendations will be sent to every doctor in Canada and are focussed sharply on lifestyle factors."

"Non-drug treatment remains the pivotal issue in managing cholesterol disorders. The best strategy for avoiding heart disease includes a balanced diet low in animal fats, sugar and salt, and high in fibre, fruits, grains, and vegetables, quitting smoking and regular exercise."

On one hand this is a cause for rejoicing, but it is also a cause for frustration. The frustration comes from the fact that our highly trained medical practitioners need to be reminded by their colleagues that a healthy diet and regular exercise are major keys to disease prevention and heart health. But of course it is not just heart health; diet and exercise are fundamental to health maintenance and are in the fine print for successful treatment and management of numerous diseases and health problems.

The word "diet" comes from the Greek "diata" and literally means 'prescribed way of living', which is far from the rigorous caloric restriction with which it is often associated in our culture. The need to exercise is fundamental to the human species. The Spaniard Ortega y Gasset said that "life is a struggle to become in fact that which we are by design". We are designed to be a vigorous, active, animal species, and we do well when we move and deteriorate when we are sedentary. As a trouble shooting strategy, diet and exercise should top almost any check list to find the origins of a problem or sickness.

Heart disease, cancer, hypertension, obesity, depression, fibromyalgia, osteoporosis, atherosclerosis, osteoarthritis and type II diabetes, each problem spawns an industry of laboratories, drugs, foundations, buildings, equipment, medical schools and jobs. Out of this vast medical/industrial complex come occasional breakthroughs in treatment and pharmacology. But overall there is a relatively poor return for the billions and billions of health care dollars we spend every year. Life expectancy at birth in Shanghai is 75.5 years, compared to a life expectancy in New York City of 73 years for whites and 70 years for people of colour. Shanghai spends $38 per person on medical care compared to New York City's $3000. Shanghai's figures would be even better with less pollution and a decrease in smoking.

There’s an old expression, "when you hear hoofbeats don’t look for zebras". The obvious thing to look for in our culture when you hear hoofbeats is a horse. The obvious prerequisite for high level health is good nutrition and regular exercise, it is so obvious that it often gets overlooked.