"Health care" does not, as the term is currently used, focus on health. Health care providers treat illness. The government’s Medicare and Medicaid programs defray the cost of treating diseases that its beneficiaries get. These programs (and private insurance plans) pay for "sickness care," not health care.
Six thousand people die each day in the U.S. Most of them die from diseases that are preventable. The leading cause of death is coronary heart disease, which accounts for 2,000 of these deaths each day. Cancer and stroke are the next two leading causes, with 1,400 and 500 deaths a day respectively. In contrast, 125 people die in automobile accidents and 60 are murdered each day. You may not be able to avoid getting killed in an automobile accident, but coronary artery disease (atherosclerosis), most cancers, and carotid disease (the principal cause of strokes) are preventable diseases. You can avoid them.
Fortunately, modern medicine has come up with some remarkable remedies for people who do acquire these diseases, like coronary artery bypass surgery (CABG), which one of us has been doing and teaching for thirty years. While this operation has helped many people — 15 million Americans since this operation was introduced in 1969 — you can avoid ever needing to have it. One can do this by taking the six-fold path to optimum health, beginning with one’s diet.
Eat a Mediterranean Diet (and Take Nutritional Supplements)
Medical doctors, including the editors of The New England Journal of Medicine, are just now beginning to understand the value of a Mediterranean diet in preventing and treating disease, particularly coronary artery disease. Two doctors at the Harvard School of Public Health, Walter Willert and Meir Stampfer, present a strong case in the January 2003 issue of Scientific American for their modified Mediterranean diet, shown in the "New Food Pyramid" below. They examine the Department of Agriculture’s (USDA) Food Guide Pyramid and show why it is seriously flawed. This food pyramid, introduced in 1992, conveys the message that "Fat is bad" and "Carbs are good." Actually, some fats are good for you, and some kinds of carbohydrates, particularly the kind that Americans eat, are bad. This is the opposite of what the USDA says.
A Mediterranean diet has a relatively high percentage of fats. Plant oils, especially olive oil (along with other unrefined vegetable oils, if you can find them) are at the base of the pyramid, to be used on a daily basis with most meals. Researchers have found that people who eat a Mediterranean diet with its 40 percent fat content have a lower incidence of coronary heart disease than people in Japan who consume a very low fat diet (10 percent fat). Not all fat is bad, just saturated and trans fats. (For a larger view of this pyramid, click here.)
There are four kinds of fats. Two kinds — monounsaturated and polyunsaturated fats, notably the Omega 3 fatty acids — are good for you and promote optimum health, Olive oil, with its monounsaturated oleic acid, is the mainstay of the Mediterranean diet. Omega 3 fatty acids, found in flaxseed, walnuts, and fish, confer important health benefits. Researchers have found that Omega 3 fatty acids thin the blood, reduce arrhythmias (heart rhythm disturbances), and help prevent breast and colon cancer. Eskimos, with no fruit and vegetables, eat a diet high in fats, and they have a very low incidence of coronary disease. This is because the fats they consume are the good ones — omega-3 fatty acids — found in cold-water fish.
With regard to the other two kinds of fats, saturated and trans fats, saturated fats are bad and trans fatty acids are terrible. Food companies insufflate hydrogen into food in order to increase its shelf life. This process, called "partial hydrogenation," turns less stable polyunsaturated fats into stable, but unnatural trans fats. This straight-chained monounsaturated fatty acid has the physical characteristics of saturated fats. It is not a normal component of human fat and is found in nature only in small amounts (2 percent of total body fat) in antelope, buffalo, and other ruminants. Trans fats, however, can comprise up to 60 percent or more of the total fat present in processed "partially hydrogenated" foods such as crackers and margarine, and in such fast foods as French fries and McDonalds’ chicken McNuggets. Consumption of trans fatty acids lowers the good HDL cholesterol and raises bad LDL cholesterol, thereby increasing your risk of getting heart disease. They also increase one’s risk of getting cancer.
In their New Food Pyramid, the Harvard researchers place bad carbohydrates at the top of the pyramid, alongside red meat, with its saturated fat, to "use sparingly." Foods made with flour, milled (refined and processed) from whole grains, contain carbohydrates in the form of starch — glucose molecules loosely bound together that can be quickly broken down and metabolized. Consumption of starch raises blood sugar levels higher than eating pure sugar does. (Sugar is sucrose, a disaccharide containing a 1:1 mixture of glucose and fructose.) Foods made with flour include white bread, white rice, white pasta, and donuts. These foods, as the New Food Pyramid shows, should be used sparingly. Foods that have unprocessed, good carbohydrates are fruit and vegetables, legumes (beans, peas, and lentils), oatmeal, whole wheat bread and pasta, and brown rice. They are at the base of the pyramid, to be eaten daily.
Most Americans eat too much and make poor food choices. We need to "Trade French Fries for Fruit." This is the essence of the type of diet we must follow in order to remain in optimum health into old age. We should eat a lot of fruit and vegetables, nuts, legumes, whole grains, and fiber; and we should avoid processed foods, with their high content of starch and trans fats. If you see the phrase "partially hydrogenated" in the chemistry list of ingredients in the box of "Nutrition Facts" displayed on the food’s package, avoid it. That phrase is the tip off that the product contains trans fats. Take Wheat Thins, for example. Its label says that it has "no cholesterol;" but left unsaid is the fact that it contains trans fats, which are far worse than cholesterol. Most crackers and pretzels are partially hydrogenated to increase their shelf life. Eat nuts (almonds and walnuts, especially) instead for snacks, perhaps mixed with some dried cranberries, dates, raisins, sunflower seeds, and dry roasted soybeans.
The best vegetables from a health standpoint are broccoli, Brussels sprouts, cauliflower, beets, tomatoes, cilantro, kale, spinach, parsley, and purple or red cabbage. The best fruits are blueberries, blackberries, raspberries, apples, grapes, prunes, cranberries, pineapple, currants, oranges, and tangerines. These fruits and vegetables contain health-enhancing antioxidants and flavenoids. Rather than going to a pharmacy to have prescriptions filled, we should frequent the produce section of a grocery store. With the help of the antioxidants and flavenoids that these fruits and vegetables contain, we can help avoid coming down with diseases that prescription drugs are designed to treat.
We also need to take nutritional supplements — also termed dietary supplements and micronutrients — with the food we eat, which is being grown in increasingly nutritionally depleted soil, and to help us better cope with modern-day environmental toxins. In addition to vitamins and minerals, these micronutrients include various antioxidants, flavenoids, Omega 3 fatty acids, coenzyme Q 10, and other herbal substances.
A growing body of evidence indicates that nutritional supplements strengthen the immune system, prevent cancer, and delay aging. A study in The Lancet, for example, shows that elderly people who take vitamin and mineral supplements have fewer sick days and improved immune function compared with those who do not. Supplements that investigators have found will help a person keep from getting coronary artery disease include Vitamin E, Coenzyme Q10, Selenium, Magnesium, Zinc, l-carnitine, flavenoids, Vitamins A and C, Folate, Vitamins B6 and B12, Omega-3 fatty acids, and other herbal substances. Supplements that reduce the risk of acquiring prostrate cancer, for example, include zinc, selenium, Omega-3 fatty acids, and Saw palmetto.
We offer recommendations on specific supplements to take, with their doses, in a separate article titled "Recommended Nutritional Supplements" that is posted on our website (www.donaldmiller.com).
Drink Filtered Water
The human brain, with its 100 billion nerve cells interconnected in an exceedingly intricate way, is 80 percent water, and the body as a whole is 72 percent water. In order to have optimum physical and mental health our bodies need good water.
Public health officials add chlorine and fluoride to municipal water supplies. Chlorine removes harmful bacteria, but it has a number of not-well-publicized adverse effects. For example, drinking chlorinated water increases the risk of breast, prostrate, and colon cancer by 15 to 93 percent. Trihalomethane, a chlorinated byproduct found in tap water, is a known carcinogen; and studies show that women with breast cancer have 50 to 60 percent more chlorinated byproducts in their breast tissue than women without breast cancer.
In this regard, chickens fare better than people. Poultry producers have learned to raise their chickens on dechlorinated water because if raised drinking chlorinated tap water they will have drooped feathers, show signs of poor circulation, and have a reduced level of activity.
Adding fluoride to the water is supposed to prevent tooth decay. Most dentists say, however, that any benefit that fluoride may provide in preventing tooth decay requires that it be applied with a toothbrush. Fluorinated water, in fact, is bad for one’s health. People who drink fluorinated water have an increased incidence of hip fractures. Fluoride binds with any aluminum in the blood and takes it across the blood-brain barrier into the brain, producing pathologic changes similar to those seen in Alzheimer’s disease. A neurosurgeon, Russell Blaylock, M.D., spells out in chilling detail the danger fluoride poses to one’s brain, and health in general, in his book Health and Nutrition Secrets that can Save Your Life (2002). (Dr. Blaylock also shows how the excitotoxins monosodium glutamate and aspartame — NutraSweet — damage the brain.)
One needs to drink chlorine and fluoride-free filtered water on the path to optimum health.
We should filter all the water that we drink. In addition to removing chlorine and fluoride, a good water filter also removes harmful pathogens such as Cryptosporidium, Guardia, and other chlorine-resistant microscopic waterborne cysts and spores; toxic chemicals, detergents, pesticides, and other harmful industrial and agricultural wastes; and heavy metals such as aluminum, copper, lead, and mercury. Filters also remove unpleasant taste, odors and sediment from tap water.
In addition to removing unwanted chemicals and contaminants, our bodies become better hydrated when we drink healthy water. Our intervertebral disks, in particular, stay better hydrated and full. People become shorter as they grow older because their intervertebral disks dry up and shrink.
For optimum health you should drink eight glasses of water a day (a half-gallon, which is eight 8-ounce glasses).
Bottled water is not the answer. It is very difficult, if not impossible, to determine the quality of a given brand of bottled water. Federal regulations require that bottled water only be "as good as" tap water. And bottled water is very expensive. At four to five dollars a gallon, it is more expensive than gasoline.
Drinking filtered water is not enough. Since we bathe with chlorinated tap water, we also need to shower with filtered water. You should put a filter on your shower head for these two reasons: to prevent absorption of chlorine through the skin and to avoid inhaling chlorine in the steam that a hot shower generates. The amount of chlorine a person absorbs through the skin and the lungs during a long shower is equivalent to drinking tap water for a month!
There are a large variety of good, reasonably priced filters on the market — point-of-use, tabletop, and under counter water filters. There are also a variety of portable filters for filtering water we drink outside the home — at work, hiking, and when traveling. Thus equipped, there is no reason you ever have to drink tap water. Once you stop drinking chlorinated water you will find that its taste, when you do drink some tap water, will be noticeable and rather unpleasant. You will find it alarming, as we did, to realize that you had been ingesting this kind of water all your life.
We discuss water filters in more detail, and recommend some, in On Filtered Water, which is posted on our website.
The path to optimum health requires that one not be obese. The most dangerous form of obesity is abdominal obesity, also known as visceral obesity. It is a major risk factor for coronary heart disease, particularly in men who have a waist circumference of 40 inches or more. There is something about fatty tissue inside the abdomen, with its thrombotic and pro-inflammatory properties, that predisposes one to coronary disease. A relatively small amount of weight loss, however, will selectively melt away a greater percent of visceral as compared to subcutaneous fat and thereby substantially reduce the risk of coronary heart disease. (Click here to enlarge the above illustration.)
Obesity also increases a person’s risk of getting cancer, particularly colon, pancreas, and uterine cancer. And it is a major risk factor for developing Type 2 Diabetes.
In addition to waist circumference, another measure of obesity is the body mass index (BMI), which is weight (in kilograms) divided by height (in meters) squared — BMI = Kg/M2. (The formula for calculating BMI using pounds and inches is: BMI = Weight [lbs.] x 703/ Height [in.] x Height [in.].) You can use this table to quickly determine your BMI, and you can easily calculate your exact BMI with this online calculator. As defined by doctors and insurance companies, a normal weight person will have a BMI of 19—25. A person is considered to be overweight when his or her BMI is 25—30; moderately obese at 30—35; severely obese, 35—40; and morbidly obese when the BMI is over 40. Over the last 15 years Americans have gained an average of 8 pounds, and today one-third of Americans are obese (BMI >30). Another third are overweight, and only one-third of the people in the U.S. maintain a normal weight.
Despite what proponents of various diets say, going on a diet to lose weight does not work. Most people regain two-thirds of the weight they lose on any given diet, be it a Pritikin low fat or an Atkins low carbohydrate-high protein diet, within a year after stopping it and resuming their normal eating habits. Within five years, the vast majority of people regain all of the weight they had before going on a diet, and often add on even more weight than they started out with.
Rather than go on a "diet," to keep our weight at an ideal level, which for most people is what they weighed when they were 20 years old, we must adopt a palatable life-long eating plan. In addition to being good for your health, a Mediterranean diet/eating plan, with its fats, fruit and vegetables, fish and occasional meat, fiber, and wine, is also good-tasting. Studies show that a Mediterranean diet is the only eating plan that enables people to keep off the weight they lose.
Maintaining a normal weight requires that we eat right and make an effort to restrict the number of calories that we consume. It also requires that we exercise on a daily basis.
Exercise is essential to good health. Not only does it keep our muscles in good shape, but exercise also improves mental function, by 20—30 percent according to one study. Muscles burn calories more quickly than other tissues in the body, so having an adequate muscle mass is an important factor in maintaining a healthful weight.
The foundation of an exercise program is aerobic movement, such as walking, bicycle riding, swimming, jogging, rowing, dancing, skating, and jumping rope. One also needs to do stretching exercises to increase flexibility, and weight training to tone and strengthen the muscles and increase muscle mass.
We should exercise a minimum of four hours a week — 35 to 45 minutes a day. An hour-long walk with your dog is a good form of exercise, arguably better than jogging. You don’t injure your joints walking, and it benefits both you and the dog.
One form of aerobic exercise we particularly like is called rebound exercise. You do it on a 40-inch diameter mini-trampoline. (We use and recommend the sturdy, well-constructed rebounder made by Needak.) Rebound exercise is low impact and much easier on one’s joints than jogging, and it gives you a very good workout. Studies show that this kind of exercise, in particular, strengthens the immune system and helps improve lymphatic circulation. (In its study of rebound exercise, NASA concluded: "…for similar levels of heart rate and oxygen consumption, the magnitude of the bio-mechanical stimuli is greater with jumping on a rebounder than with running, a finding that might help identify acceleration parameters needed for the design of remedial procedures to avert de-conditioning in persons exposed to weightlessness.")
Investigators at Harvard studied 72,000 female nurses aged 40 to 65 years over an eight-year period and found that sedentary women had substantially higher rates of coronary events (death and nonfatal heart attacks) than women who were active. They compared the relative merits of moderate versus vigorous exercise and found that moderate exercise was equally as good in reducing the risk of coronary disease. Walking three to four hours a week reduced the risk of coronary events by 30 to 40 percent. Using statistically sophisticated multivariate relative-risk analyses, the authors of this study estimate that more than one-third of coronary events among middle-aged women in the U.S. are attributable to physical inactivity.
Children, adolescents, and adults — men and women of all ages — benefit from walking. A study of childhood obesity published in Medicine & Science in Sports & Exercise in 2002 (a meta-analysis) found that the exercise program which was most effective in reducing body weight and percent body fat in this age group (age 5—17) was long walks combined with repetition resistance exercise.
Manage Stress and Meditate
Chronic stress damages one’s health, especially the kind that breeds hostility and repressed anger. Investigators have shown that death rates from coronary artery disease and cancer are four to seven times higher among people who harbor hostile attitudes. Stress is a major cause of disease. Another study showed that people who reported a history of workplace stress over the previous 10 years developed colon and rectal cancer at a rate 5.5 times greater than that of unstressed people.
The website holistic-online.com presents a nice in-depth discussion of this subject. Titled "Stress, the Silent Killer," it covers the leading causes and early warning signs of stress, its effects on the body, and the various ways to cope with this malady. Owning a pet, for example, helps one cope with stress. Pets keep us healthy. Studies show pet owners are less likely to get heart disease than their pet-less counterparts. Meditation is another important way to manage stress. It not only relieves stress, but also helps one to establish an inner peace that is good for your health.
Meditation is a state of consciousness different than sleep, dreaming (during REM sleep), and our regular awake state. Although done awake, it is a unique form of consciousness, unlike daydreaming and relaxing in an easy chair. Meditation, as commonly practiced, is "sitting still and doing nothing" in an attitude of poised awareness, the mind quiet and one’s attention anchored in the present moment, not reacting to thoughts and feelings that you let pass by like clouds going across the sky. Meditation is a form of "mental fasting," where one stills the mind, enabling it to recharge its batteries and regain clarity and focus, better for the latter than taking a nap. Practiced daily, meditation confers important health benefits.
There are many different ways one can meditate. The most common way is to sit still in a quiet place and focus attention on an image, a sound (mantra), or on your breathing. Another kind, which involves physical activity, is yoga. Also, prayer can be a form of meditation. We are personally familiar with two types of meditation, Transcendental Meditation (TM) and Zazen. TM focuses on a mantra and Zazen, on one’s breathing. In TM one sits comfortably for 20 minutes with the eyes closed and recites silently a two-word mantra, like "la ling," assigned specifically to that person by an instructor. When the mind quiets you stop thinking the mantra, returning to it when your attention is diverted by thoughts that bubble up into consciousness or distracting sounds (like the dog barking). While a quiet place is preferable, experienced TM practitioners are able to meditate in noisy, crowded places, like commuter trains and airplanes. With Zazen one assumes a straight posture seated on a cushion or on a chair with the eyelids kept partially open. You look down towards the floor, not focusing on anything, and silently count, or mentally follow, each inhalation and exhalation, emptying the mind of everything else. Zen Buddhists practice Zazen, but you don’t have to be a Buddhist to do it.
More than 500 scientific studies have been done on the health benefits of Transcendental Meditation. One randomized, well-controlled study in African-Americans showed that TM, practiced twice a day, reduces the thickness of the vessel-obstructing plaques (atherosclerosis) that form in carotid arteries. In addition to causing strokes, these plaques predict a high likelihood of coronary artery disease. A similar study showed that TM can lower the blood pressure in people who suffer from high blood pressures, down to levels comparable to those achieved with prescription drugs. Overall, people who do TM on a daily basis need less "health care." Studies show that they reduce their health care utilization by 50 to 55 percent compared with people who do not meditate. While most scientific studies on the benefits of meditation have been done on TM, the findings may apply to other kinds of meditation as well. Similar studies are now being done on Zazen.
Stress is not all bad. It triggers a neuroendrocrine and hormonal "fight or flight" response, which is necessary from an evolutionary standpoint to help preserve the lives of the members of a given species. Chronic unrelieved stress, however, destabilizes the immune system and generates free radicals, which injure the body’s tissues, particularly the vital structures in the brain.
Dr. Allen Elkin, of the Stress Management and Counseling Center in New York, likens stress to a violin string. "If there’s no tension, there’s no music. But if the string is too tight, it will break. You want to find the right level of tension for you — the level that lets you make harmony in your life." In corporate America, people who handle stress well rise to the top. But according to one government study, more than 50 percent of U.S. workers view job stress as a major problem in their lives. The number of workers calling in sick due to stress has tripled over the last four years. Analysts estimate that $200 billion a year is lost to industry from stress-related ailments, and over the last ten years the new discipline of stress management has become a $10 billion industry.
To enjoy optimum health and avoid needing "health care" you should meditate, ideally, as with TM, for 20 minutes twice a day. It is a much healthier thing to do than watch television.
Get Enough Sleep
Sleep takes up one-third of our existence. It is one of the pillars of health, equally important as nutrition, water, and exercise. Dr. William Dement, a pioneer in sleep research, calls physical fitness, good nutrition, and adequate sleep the "fundamental triumvirate of health." All animals need sleep, including fruit flies (the most widely studied of invertebrates) and fish. Birds and reptiles sleep with one eye open; and aquatic mammals, like dolphins and whales, have one side of their brain sleep while the other side stays awake, enabling them to swim up to the surface for air.
Researchers divide sleep into non-rapid eye movement (NREM) and rapid eye movement (REM) sleep, with NREM sleep having four stages going from light to deep (delta wave), dreamless sleep. REM sleep follows the successive stages of NREM sleep, all of which occur in a 90-minute cycle — 5 cycles in a 71/2 hour period of sleep — with the percent of REM sleep increasing in each successive cycle so that it winds up comprising 20—25 percent of total sleep time. When your dog’s legs start twitching when she is sleeping that means she is in the REM phase of sleep and is likely to be dreaming.
Sleep rejuvenates both the mind and the body, consolidating memory and processing new information, repairing tissues, and allowing the immune system to perform vital housekeeping tasks. It is vital for our mental and physical health. In addition to cognitive impairment and an inability to concentrate, sleep deprived people have increased blood pressure, signs of incipient diabetes, and markers (like an increased C reactive protein) of systemic inflammation.
Investigators have shown that disturbances in the normal 5-part sleep pattern, as measured by an EEG (electroencephalogram), predict a shortened life span. Also, people who habitually get six hours or less of sleep a day have a shorter life span than people who sleep 7 to 8 hours a day, which is the requisite amount for most people.
A person who does not get an adequate amount of sleep builds up a sleep debt that must, sooner or later, be repaid if one is to function normally. One can make up for lost sleep. Over a given period of time, you simply have to sleep the extra hours required to pay back the accumulated hours of sleep lost. Unrepayed sleep deprivation has a number of adverse consequences.
One researcher terms sleep deprivation "the royal route to obesity" because people who don’t sleep adequately have physiologic abnormalities that increase appetite and caloric intake. Obesity results, with all its sequelae.
American adults today sleep an average of 6.85 hours, and 31 percent report sleeping less than 6 hours per night. (Thirty years ago Americans slept 7.7 hours; and 80 years ago, 8.7 hours a night.). Most of us need to sleep more than we do. You might want to take the "How’s Your Sleep?" test that is on the National Sleep Foundation Web site (www.sleepfoundation.org). If you have a sleep problem, seek help for it.
The Relative Importance of Genes and Lifestyle on Health
Each species of living thing has a genetically programmed maximum life span. In turtles it is 150 years; for dogs, 20 years; and for a bristlecone pine it is 5,000 years. Longevity medicine specialists reckon that the maximum life span for humans is 120 years. The world’s oldest person with an authenticated birth certificate, Jeanne Calment in Arles, France, died in 1997 at the age of 122. The world’s oldest man with a well-documented birth date also died in 1997 at the age of 115. Jeanne Calment attributed her record long life to olive oil and port wine.
Very few people live to become centenarians (over the age of 100), only about 1 in 20,000 in most developed countries. In the U.S., 1 in 4,000 people are centenarians — 70,000 in a population of 275 million.
One’s genetic makeup is an important determinant of life span, but the lifestyle one adopts plays an equally, if not more important role in determining how long you will live.
Coronary artery disease (atherosclerosis), the most common cause of death in both men and women, is principally a lifestyle disease. People with a genetic predisposition for coronary disease that maintain a good, i.e., healthy lifestyle will not live as long as people with good genes and a good lifestyle. But having good genes does not insulate you from needing to adopt a good lifestyle if you want to live a long life in good health. People with bad genes and a good lifestyle live longer free of heart disease than people that have good genes who adopt a poor lifestyle.
The current life expectancy for people in the U. S. is 76.9 years, three more years for women and three less for men. This is the highest average life expectancy in the recorded history of our species. (In 1900, it was 47.3 years.) But 76.9 years is still 43 years short the human species’ maximum life span. There is a lot that we can do on the six-fold path to optimum health, good genes or not, to stay healthy avoid needing "health care."