What Healthy People Do

Great health requires three nearly equal components: (1) Genetics and luck, (2) a healthy lifestyle, and (3) good preventive medical care.  You control two and half of these.  

1. Genetics and luck.  
   
   Genetics and luck — for both good and bad — account for no more than a third of our health. And, here's the control part: knowing your family history (the single best and cheapest genetic test around) can lead us to take steps to prevent, stop, or reverse the health effect of the genetic dice. For example, if your father and two paternal uncles had heart attacks in their early 50s, you know you are at risk. But you can use that knowledge to aggressively manage your cardiac risk factors and prevent or even stop your own heart attack.  
   
   
2. A healthy lifestyle.
   
   Many people make the serious mistake of underestimating the tremendous benefit of a healthy lifestyle.  Walking two miles a day can lower your risk of a heart attack by 30 percent, eating a Mediterranean diet can lower your risk of cancer, diabetes, and heart disease, and doing both can lower your risk of type-2 diabetes by 50 percent, and not smoking can lower your risk of lung cancer by 90 percent. Big pharma does not have any pills more powerful than a healthy lifestyle.  
   
   
3. Preventive medical care.
   
   Prevention is very powerful medicine. Primary prevention works to prevent disease by treating risk factors (treating high blood pressure lowers the risks of stroke) while secondary prevention works to prevent the complications after a disease has already been diagnosed (aggressively lowering cholesterols to prevent a second heart attack).  
   
   Unfortunately, our medical system gives short shrift to good primary prevention — a physician and hospital earn more money putting in cardiac stents than in telling people to take their statins, let alone telling people to take a brisk two-mile walk.      
    

But you know  the value of asking about your family history, the tremendous benefit of a brisk walk every day, and the advantage of taking your blood pressure pills every single day. You know you want to be a healthy, active, and vibrant 85-year old.   

The Swedish Heart Epidemiology Program has followed for eight years 1,369 people who had their first heart attack between 1992 and 1994.  276 participants died during the study. After a multivariant analysis, coffee consumption showed a "strong inverse relationship with mortality." 

People were categorized by the number of cups consumed per day: less than 1, 1 to 3, 3 to 5, 5 to 7 and greater than 7.  Compared with those who drank less than 1 cup a day, mortality was 32 percent lower for those who drank 1 to 3 cups, 48 percent lower for those who drank 3 to 5 cups, and 42 percent lower for those who drank more than 7 cups. Sorry, I cannot find a link to the study, but my source is the Internal Medicine News, Dec. 1, 2008, page 40.  

Then, if you like coffee, you simply must read this delightfully illustrated op-ed piece from today's New York Times online.   

 

Here is a link to a wonderfully written weekly post about a better, more sane life.  "Spiritual Wealth" is a soul-satisfying, stress-reducing, life-affirming essay, a reminder of what is important.  Please check it out; it's free and without advertising. 

Americans are less healthy today than four years ago.       

That is the astonishing conclusion of a report of 23 measures of America's health done by the huge health insurer United Health Group.  The leading problems are the number of uninsured, the exploding obesity epidemic, and the 20 percent who still smoke.  

What part of preventive medicine do we not yet understand? 

"An investment of $10 per person per year in programs to increase physical activity, improve nutrition, and prevent smoking would cut national healthcare costs by $16 billion annually within five years, according to the Robert Wood Johnson Foundation. That is a return of $5.60 for each dollar spent."  That quote is from the Minneapolis Star Tribune article, which captures the problem nicely.  

Click through these CDC obesity maps to watch the obesity epidemic explode over the past 28 years.  (I am talking about obesity, not overweight.)   Then consider that obesity causes 90 percent of all type-2 diabetes, 20+ percent of cancers of the breast and colon, that obese teenagers have the arteries of 40- or even 50- year-olds.  Then remember that 90 percent of all lung cancers and maybe 50 percent of oral cancers are caused by cigarette smoking.  Think about the fact that Americans spend more on health care than any other nation, but rank only about 50th in life expectancy.   

Ouch.  We can, and indeed must, do better. 

Dr. Bob