Pills for Cheap

Comic actor John Candy. Professional baseball player Nolan Ryan. At age 43, both hit milestones in their lives. One had just pitched two no-hitters, putting the finishing touches on a glorious major-league career that spanned 27 years. The other smoked and had a weight problem and was dead of a heart attack. Sometimes our destiny isn’t in our hands. But sometimes it is.

Lots of guys point their fingers at the fates when talking about their health, says Walter M. Bortz II, M.D., clinical associate professor of medicine at Stanford University School of Medicine and author of Dare to Be 100. Or worse, they believe that coming from “good stock” gives them license for self-abuse. The truth is that our genes generally have less to do with how long we live than we’d like to believe, says Dr. Bortz. “Genetics have about a 20 percent influence on life span,” he says. “The rest is in your hands.”

“The length of your life is hugely affected by your lifestyle,” agrees Dr. George Webster, researcher in molecular biology and aging. “Lots of people today are living a hell of a long time because they’re finally doing what they ought to be doing-not smoking, getting out of their chairs, and becoming more active.” Here are the top seven behaviors experts say will shorten your life and what you can do about them.

The Meat-and-Potato Men

Sixty-nine percent of men admit that they struggle with eating a balanced diet. Most of us eat about 10 percent more than the 30-percent-calories-from-fat-a-day plan we’re supposed to stick to. We’re eating a measly three or four servings of fruits and vegetables each day instead of the five to nine the U.S. Department of Agriculture Food Guide Pyramid recommends. And about one-third of men are overweight. “Then we’re surprised when our health gives out,” Dr. Webster says.

“We need to and can do much better,” says Ken Goldberg, M.D., founder and director of the Male Health Institute in Dallas and author of How Men Can Live As Long As Women. “The key is to follow a healthy diet most of the time, so you can have nachos and beer at the ball game and it won’t matter.” Here’s what experts recommend.

Eat just one. If each time you eat, you include a fruit or a vegetable, you’ll steadily improve your health, says Dr. Goldberg. The 30-year Framingham Heart Study by Harvard researchers found that with each additional serving of fruits and vegetables that 832 men ages 45 to 65 ate, the lower their risk of stroke became. And that’s only one benefit. Eating more fruits and vegetables also lowers your risk for colon cancer and heart disease, adds Dr. Goldberg.

Get the red out. When faced with a choice in meats, choose fish, turkey, or chicken, Dr. Goldberg says. A landmark study of close to 48,000 male health professionals found that men who ate the most red meat had a significantly higher risk for advanced prostate cancer than those who ate the least.

Stop, drop, and live. A side benefit of eating more fruits and vegetables and less fatty red meat is that you’ll also likely shed a few pounds, says Dr. Goldberg. Even the least bit of waist-whittling can add to your life. In another landmark, 22-year study of nearly 20,000 men, researchers found that being just 2 to 6 percent over your ideal weight increases your risk for cardiovascular disease. Being as much as 20 percent over increases your risk by more than 2Ó2 times that of ideal-weight men.

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The Australian Heart Foundation has a different set of reference ranges for several tests, for what are called “at risk individuals”. The criteria you must meet to be an “at risk individual” include:

•     Known coronary artery disease

•     Other known signs of atherosclerosis such as peripheral artery disease (eg. Intermittent claudication), blocked carotid arteries (which lead to the brain), or aortic aneurysms.

•     Diabetes mellitus

•     Chronic kidney failure, or kidney transplantation

•     Aboriginal or Torres Strait Islander

•     Familial hypercholesterolemia (a genetic disorder)

•     Familial combined hyperlipidaemia (another kind of genetic disorder)

•     If your total cholesterol is >6mmol/L or LDL is >4mmol/L, and you have any 2 or more of the following risk factors:

•     HDL<1.0mmol/L

• Significant family history of heart disease

•     High blood pressure (hypertension)

• Overweight or obesity

• Smoking

• Impaired fasting glucose (blood sugar level between 6.1 and 6.9mmol/L)

•     Age >45 years

•     Below normal levels of albumin in the blood and/or impaired kidney function.

If you fall into this category, the target levels recommended for you by the Heart Foundation are as follows:

Total cholesterol:         < 4.0mmol/L

HDL cholesterol:         > l.0mmol/L

LDL cholesterol:         <2.5mmol/L

Triglycerides:         < 2.0mmol/L

If your blood test results do not match up to these standards, your doctor is supposed to ask you to follow a cholesterol lowering diet (this usually means a low fat diet) for six weeks and then retest your lipid levels. Almost everyone will not be able to achieve the low levels of blood fats recommended; nor is it necessarily healthy. With a cholesterol level that low you will probably be feeling ill in other ways. The next step then is to put the patient on cholesterol lowering drugs.

It is very easy to fall into this “high risk” category; all you need to be is over 45 years of age and overweight, with a total cholesterol level above 6.0mmol/L and you qualify for drug treatment. No wonder such a high proportion of the population are making the drug companies richer at the expense of their health. Studies have shown that the cholesterol lowering drugs statins and fibrates may increase the risk of cancer, and thus should be restricted to only the most urgent cases. These studies seem to have been forgotten.

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Case 1

A grossly obese 41 year old male was admitted to hospital for knee surgery. He lived alone in a small unit, was unemployed, had no interest in outdoor activities or hobbies and had very poor dietary habits. At 180 Kg, with high blood pressure and a failing heart he was not a good candidate for anesthesia. It was decided to seek the opinion of a respiratory specialist when nursing staff and fellow inpatients complained of his loud and unrestrained snoring and it was with obvious relief that he was transferred to the sleep unit. Overnight studies demonstrated severe sleep apnoea with both obstructive and central components. He was fitted with a nasal CPAP mask which greatly improved his nocturnal oxygenation but surgery was still considered too great a risk for such a patient. He was advised to continue nasal CPAP at night for the remainder of his time in hospital to familiarize himself with the procedure for home use. He was discharged from hospital following a thorough assessment of his heart disease and blood pressure, and placed on a strict weight reduction diet. The man was seen a month later in an outpatient clinic. He had reverted to his previous eating habits, put back on the small amount of weight lost during hospitalization and had discontinued the use of CPAP. He could not be convinced of its benefits and remains untreated for this serious condition.

Comment: An unmotivated patient with this sort of medical history can only expect further deterioration. It takes some time to become accustomed to CPAP, but failing that there should at least be an urgent reappraisal of one’s lifestyle.

Case 1

After many years of recurring tonsillitis in a 7 year old girl, her parents had reached the point of desperation. This first manifested itself as snoring when the child was about 18 months old but a pediatrician assured the parents that the young girl would eventually grow into her large tonsils. Sleep related snoring and occasional episodes of tonsillitis marked the early years of her life until she was 4 years old when her mother became aware of times when the child seemed to be struggling for breath. In retrospect, judging by a description of events in the following years, the child had developed OSA, the consequences of which were to disrupt the life of parents and child for a further three years. Severity of the child’s airway obstruction no doubt reflected the status of the child’s tonsils. At best there was always a degree of snoring but a common cold or any inflammation of her tonsils would guarantee a succession of traumatic nights; traumatic for the child who would awake several times a night crying and further complicated by instances of bed-wetting and falling out of bed. It was also traumatic for the parents who were anxious about their daughter’s distress at night, not to mention the considerable disruption to their own sleep. Antibiotics probably helped to minimize the duration of these episodes but it was becoming increasingly clear that prescription of these medications was not addressing the underlying problem.

For a girl of above average ability, she was not progressing as well as could be expected and frustrated teachers would report on her tiredness and lack of application. The parents finally sought help from a pediatrician with some expertise in sleep apnoea. A hospital admission and overnight studies documented airway obstruction and oxygen desaturation consistent with OSA. Tonsils and adenoids were surgically removed a month later and the results were immediately apparent. Snoring was virtually abolished and her parents no longer had to comfort a distressed child at night, indicating an improvement in sleep quality and although she still experiences occasional colds and upper respiratory tract infections, heavy snoring and complete airway obstruction has never reoccurred.

Comment: Disruption of home and school life could have been avoided with earlier detection of OSA.

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Preventive medicine can be divided into three categories.

Primary prevention involves the removal of causes so that the condition doesn’t occur in the first place. Diseases related to smoking are obvious examples here: stop people smoking (primary prevention) and the smoking-related diseases disappear.

Secondary prevention picks up disease before symptoms occur. This is the essence of health screening which, by detecting disease early, can prevent the development of more serious manifestations of the disease. Detecting previously undiagnosed high blood pressure is a good example of this kind of prevention.

Tertiary prevention involves the management of diagnosed disease in such a way as to prevent or limit the development of a disability or to prevent the person dying prematurely. The best example here is diabetes. Diabetics with good tertiary prevention can now live long and near-normal lives.

But what are we aiming for with all the prevention-eternal life? No. Most people, when asked, are happy to settle for a reasonably long lifespan spent in good health. In simple terms medicine over the last hundred years or so has shifted deaths in early years to later life. However, despite a four-fold increase over the last century in the number of men living to be 100 and a nine-fold increase in the number of women living to that age, the proportion is still only one in 1,000 and 5 in 100 respectively. Suggestions that we could all live to 130 or more are as yet somewhat fanciful but we can now reasonably aim to live to about 85 or 90, with few of us dying of disease under the age of 70. If we are to achieve this we have to attack cancers and heart disease, which account for more than half of all life lost under the age of 85, and those few diseases that stand out as special cases. These include diseases associated with the excessive use of alcohol, addictive drugs, motorcycles, cigarette smoking in women and large numbers of sexual partners.

But being healthy is not just a matter of what you do or do not do. It seems that health and long life are often a gift bestowed on a person at conception when they inherit good genes. With the combined effects of healthy habits and good luck many people’s health can be maintained for years with good medical care taking the edge off diseases and accidents. Until fairly recently, living longer usually meant accumulating more and more disorders, diseases and disabilities which, together with social isolation, poverty, failing memory, a loss of purpose, reduced family contacts and other limitations, have led to a vast increase in the numbers of elderly people living out the last years of their lives in residential care. Younger people, seeing this as a depressing future for themselves, are beginning to get concerned-and rightly so. A questionnaire in a Swedish magazine in 1971 asked readers how they most wanted to did A large majority said they wanted to pass away quickly and without worrying. So, ironically, what we are all trying so desperately to prevent-heart disease – appears to be exactly what, in one form, many of those ‘at risk’ most want to die from. But as in the old monk’s prayer-’Dear Lord, give me patience; but give it to me now’-we can’t choose when this sudden and quick form of death will take us. None of us would mind dying like this in our seventies or eighties but the tragedy is that increasing numbers of men in their forties or fifties are losing their lives in this way.

Some people worry about the long-term effects of a population with an ever increasing proportion of ever older people, and they have a point which has to be taken seriously by those who try to prolong life at almost any price. Viewed in the widest possible socio-economic perspective, the gradual move from a three-generation society to a four-generation one is likely to produce increasing strain between the productive and reproductive groups and those who are mainly ‘takers’ from society. Our industrial society cannot find enough jobs for its working-age people, let alone the elderly. So we could soon see countless millions of pensioners in the western world with many years of life to live but with nothing to do.

No one would dispute the benefits preventive medicine has brought in the earliest part of life but, some people are asking, should it be allowed to do the same for the other end of the life scale – at least in those societies where already those who reach middle age tend to live into their eighties? All of this may appear somewhat pessimistic but it could well be that within the reasonably near future the elderly will be taking up so much of the nation’s resources that curative medicine for the productive sector of society will be seriously put at risk. There are those who would say that this is already happening, at least to some extent.

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Remember when you were a kid and you brought home an excellent report card? You knew that your high grades would earn praise from your parents, and you looked forward to hearing what a good student you were. The quarters that you’d get from Grandpa weren’t bad, either.

All of us like to be recognized for what we do well. This is just as true when we’re trying to lose weight as when we earned an “A” in arithmetic.

Some of the most memorable rewards that you receive will come from others. But even more important are the rewards that you give yourself.

Remember the first commandment, “Believe in yourself”? When you acknowledge each weight-loss goal that you have achieved, you are honoring the commitment and hard work that you’ve put into creating a new, healthier life for yourself. You don’t have to wait for the big, “I-lost-75-pounds!” sorts of goals, either. Something as small as adding an extra mile to your daily walk or not eating french fries for a week can be cause for celebration.

So go ahead! Take a half-day off from work. Go shopping. Get a manicure. Buy tickets to the Yankees game. Do something that you really love but don’t usually make the time to do.

When you reward yourself for a job well-done, you reinforce your belief in yourself and tell yourself that you’re proud of what you’ve accomplished. It makes you want to do more, to see how far you can go. And that’s what living life to the fullest is all about.

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