How diet and exercise lifestyle changes can prevent chronic diseases
With over 20 years as a high profile clinical researcher, Dr. Lawrence Appel, the Director at the Welch Center for Prevention, Epidemiology and International Health at Johns Hopkins University says he would "love to put doctors out of business." Dr. Appel's studies focus on chronic disease prevention and intervention across the lifespan. This includes understanding the causes and consequences of heart disease, kidney disease, hypertension and other chronic diseases, as well as investigating solutions through lifestyle changes such as diet and exercise. Dr. Appel's desire to reach a broad spectrum of individuals has led him to serve on both the 2005 and 2010 US Dietary Guidelines Scientific Advisory Committee - this group of experts creates the US dietary guidelines. Prior to that Dr. Appel was lead author on the DASH clinical trial; this study identified a diet that is now the benchmark diet recommended as part of the US dietary guidelines.
Dr. Appel's research affects large numbers of individuals, has a huge societal impact, and provides insight to the leading causes of preventable mortality. In addition to the US dietary guidelines committee, Dr. Appel's studies have been enormously influential. His current research focuses on the following:
- Lifestyle Interventions to Prevent Diseases: Dr. Appel is researching how Vitamin D supplements can help prevent falls in older individuals. 30% of people over the age of 70 fall every year. This study is attempting to identify whether or not Vitamin D supplements can prevent falls, and if so, the best dose. Early evidence suggests that vitamin D might improve balance and increase muscle strength.
- Behavioral Intervention Trials: Many of these studies look at ways in which individuals successfully lose weight, become more active, and sustain new lifestyle practices. One such study is, The Hopkins Power Trial which followed individuals through remote interactions - via telephone and Internet communications, as they changed their lifestyle behaviors through diet and exercise and cited the ways that these individuals were able to maintain their newer, healthier lifestyle.
- Controlled Feeding Studies: Dr. Appel studies the effects of diet and how it improves chronic health conditions. As the lead author of the DASH (Dietary Approaches to Stop Hypertension) Study he found a diet rich in fruits, vegetables, whole grains, and low-fat dairy foods; including meat, fish, poultry, nuts, and beans; and is limited in sugar-sweetened foods and beverages, red meat, and added fats, lowers blood pressure - a known risk factor for heart disease, stroke, and kidney disease. Of particular note, this study also showed the benefits of this diet in the African American population were greater than in the Caucasian population.
- Chronic Kidney Disease: Dr. Appel conducts trials and observations to understand risk factors for chronic kidney disease and complications. Promising results were found in one study that suggests aggressive blood pressure control might retard kidney disease progression in persons with protein in their urine (a sign of kidney damage).
As a practicing doctor, Dr. Appel felt great satisfaction as he managed individual patient and provided excellent healthcare. However, he feels that he can accomplish even more and have a bigger impact with clinical and transitional studies that directly evaluate therapies and prevention strategies that affect broad populations.
Dr. Appel has been actively involved in health care policy. He was a member of the 2005 and 2010 U.S. Dietary Guidelines Scientific Advisory Committees. For the American Heart Association, he has been a member of its Nutrition Committee for over 10 years and a past chair. He has also served on several Institute of Medicine Committees and chaired the committee that set dietary recommendations for sodium, potassium and water. He has served on numerous advisory committees for the National Institutes of Health.
A particularly notable feature of this research is the focus on conditions and diseases that disproportionately afflict minorities and on interventions that have the potential to substantially reduce racial disparities.
Over the course of his career, Dr. Appel has mentored numerous students, fellows and faculty (and continues to do so). He finds this aspect of his career incredibly enjoyable and rewarding.
As a clinician who studies lifestyle behaviors, he practices his studies in his own daily routines. He runs most days of the week, eats a healthy diet, and monitors his weight; he doesn't smoke, and he promotes a healthy home and working environment.