Live Long, Die Short (23 page)

The problems with these more simplistic motivators toward healthy lifestyles is that once we are beyond them in our lives, when sexual attraction or bragging rights are less powerful as reasons to undertake change, what then happens? Frequently, we are less likely to attempt change at all. We consider that growth and positive changes are things of the past and become accepting of the way things are.

Making changes for a particular beneficial outcome can be effective. For example, attempting to ward off heart disease, particularly if we have a family history, or a specific risk factor, makes sense. Even when the reason is superficial, such as vanity, these efforts can help people accomplish great things. Sometimes, even when the vanity fades, basic fear of getting old, or breaking a hip and losing independence, can be a powerful motivator with older adults. But the approaches that focus on a very specific and tangible outcome, in my opinion, miss a fundamental reality of managing our risk, and actually limit what we can achieve with lifestyle modification.

Being alive renders all of us at risk for disease, injury, and early death. But once again, it is not that fate one day decides to knock on your door and in comes heart disease or cancer or dementia. These threats are always with us by virtue of our having a pulse. It is as if they orbit above us waiting for an opportunity. Yes, for some unfortunates, they strike serendipitously, without regard for age or lifestyle. But for the majority of us, it is we who unintentionally open our doors to them.

The Art of War
is a series of essays written over 2,400 years ago by Chinese military strategist Sun Tzu. Although, as the title suggests, it is about the conduct of war, it has been a reference for many on how to conduct themselves in business, sports, or any competitive endeavor, and tucked within its pages on military strategy are gems for managing risk, including this one:

It is a doctrine of war not to assume the enemy will not come, but rather to rely on one’s readiness to meet him; not to presume that he will not attack, but rather to make oneself invincible.
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Making ourselves “invincible” against disease, is that possible? No, not completely invincible, but the research on aging and the lifestyle contribution to disease would indicate that we can go a long way in preventing disease or injury, or at least become more resistant. So, maybe the warrior analogy is a good one. In fact, many view staying healthy as a struggle, a competition against multiple threats to a healthy state. Rather than think in linear terms (i.e., doing one thing in order to prevent another), we should
think in whole-body terms. Approaching our risks in this way forces us to address our basic core requirements for health, those we have in common with our ancestors, those authentic needs.

So, how do we keep our whole selves strong, resilient, and resistant to all threats? Should we be like the warrior who keeps himself strong, not just physically but mentally, emotionally, and spiritually, and who is therefore ready to defend himself against any threat? The warrior who doesn’t “assume the enemy will not come,” but who in fact assumes that if he is not as strong as he can be, the enemy will come? This whole-person approach to defending oneself against disease threats is exactly what this book is about. The Ten Tips are in fact a training program for the health warrior, a way to keep oneself as invincible as possible. Not so much targeting any one disease, but
all threats
. It is a training program to develop a lifestyle that defends and strengthens our core needs: a training program in authentic health.

By keeping our bodies moving, we prevent falls, strengthen our heart, lower blood sugar, keep our mind sharp, strengthen our immune defenses, lower the chance for osteoporosis, have a more positive attitude, and more. By staying socially connected, our immune system functions better and we resist disease and recover more quickly when we do get sick. By laughing, we enhance our immune defenses and are more likely to stay engaged. Having a solid purpose will sustain us through lean and challenging times. And on and on. These lifestyle strategies are intricately interrelated, just like all our body systems. Strengthening one area affects others and builds a stronger, more robust, more invincible whole.

And there’s more to being invincible. The good warrior also understands that he must know his enemy. He must know where he is at risk of being overpowered. And he knows that when in battle, he must depend on comrades in order to triumph. So, too, when the enemy is disease. If we are to win against disease and impairment, we not only must be strong; we must also know our risk, and attack that risk. Reliable comrades in that battle are those who are committed to making and keeping us healthy and who know the enemy well. These comrades-in-arms are the health professionals available to us. To ignore them, to avoid them or the help they offer us, is both foolish and risky.

And as with most things, there is a potential dark side to our comrades. Recent research indicates that risks for unhealthy conditions or disease tend to occur in clusters.
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These findings tell us that risky lifestyle factors, such as obesity or smoking or a sedentary lifestyle, often are a common
characteristic of certain groups. Basically, we can draw one of two conclusions from this research: We associate with people who have lifestyles like our own, or we tend to adopt the lifestyle of those with whom we associate—along with the risks that come with it. The takeaway? Associate with people who have healthy lifestyles.

We have been discussing the fact that it is a whole-person approach to lifestyle that lowers risk and builds the resilience that leads to authentic health and successful aging. Two areas in particular relate to this approach and therefore deserve more discussion: stress and nutrition.

Most assume that the threats to our health and aging are in the environment around us. Yet one of the most deadly and pervasive enemies, like a Trojan horse, is potentially within each of us. As I have done a couple of times already in this book, I’m going to call stress “the Big Uneasy,” because this accurately represents its effects on us. The concept of stress and even the word itself is overused, poorly understood, and means different things to different people. In our achievement-oriented world, there are many strongly held yet unsubstantiated views about the relationship between stress and health and aging. How can we accomplish anything unless we challenge ourselves (read as “stress” ourselves)? Don’t we have to push ourselves beyond our comfort level to succeed? And even if we’re not in a dog-eat-dog competitive world, life has a way of bringing lots of “stuff” that “stresses us out.” Many believe that stress is necessary to stimulate our bodies and minds in order to be stronger; they see stress as providing us with a boot camp–type challenge so that we become more resilient.

So, we ask ourselves, is stress good or bad? Does it help us or hurt us? How does a whole-person, warrior approach to lifestyle relate to the stress in our lives? Does stress really cause disease?

Dr. Robert Sapolsky, professor of biological sciences at Stanford, in his foreword to Bruce McEwen’s brilliant book on stress and stress-related disease,
The End of Stress As We Know It
, underlines the importance of this holistic lifestyle approach:

We’ve entered the gilded genomics era just in time to have to admit that most of our ills have to do with extraordinarily
ungenomic things like your psychological makeup and patterns of social relations, your social status and the society in which you have that status, your lifestyle. And at the center of this nexus is stress—what stressors we are exposed to and how we cope. Most of us will live long enough and well enough to get seriously ill with a stress-related disease.
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Is Sapolsky telling us that that in addition to our lifestyle, stress can weaken our defenses? That stress, the Big Uneasy, that seemingly ever-present characteristic of modern life, can raise our risk of, and even perhaps bring on, disease?

The answer is a resounding yes, and Dr. McEwen, head of the neuroendocrinology lab at Rockefeller University in New York City, gives us a remarkably clear explanation of the mechanism of what some call the scourge of modern man in his excellent book.
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According to McEwen, all mammals developed in an environment rich in potential threats to their existence. It was necessary for survival, then, to be able to respond to those threats. There were threats targeting the internal state, such as environmentally caused changes in body temperature, the oxygen saturation of blood, or blood pressure. These threats were managed automatically by mechanisms that evolved to maintain a fairly steady internal state called homeostasis.

McEwen prefers the broader, newer term
allostasis
to describe the stable state provided by systems able to change with the requirements placed on them. Threats to mammals’ very lives, such as predators, required an intricate, variable, and immediate response, which basically provided the energy to fight or flee. This fight-or-flight response is common to all mammals and involves powerful “do or die” settings within many of our body’s systems. For many mammals, however, particularly humans, the threat environment has changed. As McEwen notes, “It seems that allostasis has not caught up with evolution and is not yet convinced that such dramatic physical responses are becoming less necessary.” So, he notes further, “a council member standing up at a town meeting, or a violinist stepping before the audience, may feel they are gearing up, involuntarily, to vanquish their opponent or propel themselves away.” We’ve all felt this. It’s the stuff of heroic stories of rescuers lifting cars off trapped people, but also of the pounding pulse, tremors, and rapid breathing associated with a job interview.

And there’s the rub. We humans are, as far as we know, the only mammal capable of
self-inducing
this fight-or-flight mechanism, and its all-systems-go response,
with our thoughts
! Moreover, we seem to be the
only mammal capable of
sustaining
a chronic state of hyper-response—our brains being the primary engine behind this—even when there is no immediate or even real threat. This type of stress McEwen calls “allostatic load.” “It usually seems to kick in when we don’t want it to,” he says. “Increasingly, the situations that ignite the stress response are ones for which neither fight or flight is an option—working for an overbearing boss, for example.… And so, deprived of its natural result, the very system designed to protect us begins to cause wear and tear instead, and illness sets in.”
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And indeed the list of illnesses and conditions related to chronic stress is impressive because the adverse effects of chronic stress involve the cardiovascular system, the brain, and the immune system itself. Sheldon Cohen, a Carnegie Mellon psychologist, writes, “Effects of stress on regulation of immune and inflammatory processes have the potential to influence depression, infectious, autoimmune, and coronary artery disease, and at least some (e.g., viral) cancers.”
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In fact, there are many who believe that stress has the potential to be a factor in the progression, if not the cause, of a virtual Who’s Who of ailments, from the common cold to ulcers to dementia. We see, then, that our internal protection system against threats, in an environment where stress is more common, as in our frenetic, multitasking, hard-charging, and noisy world, begins to cause us harm.

And how does Dr. McEwen propose we handle this stress so that we don’t become “stressed out”? You guessed it—with our lifestyle choices. Once again, the recommendations included in these Ten Tips offer opportunities to manage this allostatic load to a point where we can avoid the harm or at least minimize it. Yes, those things we heard about for so long—physical movement, social connection, adequate sleep, eating well—these turn out to be major players in our efforts to not only look and feel good but also to control our uniquely human response to stress so that it does not run awry and work against us. The warrior within us, in fact, must be, ironically, watchful of our self-induced threats.

The second major lifestyle characteristic I would like to focus on in order to lower our risks is nutrition. Although the Ten Tips are pretty comprehensive, eating right did not make the top ten primary topics, but not because I don’t consider nutrition essential to good health and successful aging. On the contrary, I consider it to be an essential part of healthy aging and
therefore decided to make it a key point in this discussion of lowering our risk for disease and impairment. I cannot hope to be comprehensive in my comments on eating as it applies to lifestyle and successful aging. There are bookshelves filled with solid information on the topic, and I am humble enough to not attempt to duplicate such erudite works. Instead, I would like to address some important considerations for aging in a better way that are rarely discussed in such works (at least not as primary considerations).

For decades now in the United States, the discourse regarding eating has been dominated by a fixation on weight, much like the focus on exercise. The term
diet
, in fact, is today synonymous with “weight-loss program,” even though the word derives from Greek and meant “a manner of living.” In our culture, the word usually refers to a manipulation of our food intake in order to achieve weight loss rather than to the entirety of
what
we eat. Nutrition, on the other hand, the more important consideration of providing our bodies the food necessary to support life, gets lost in the rhetoric and sensationalism of weight loss. It’s not that addressing the rampant problem of obesity is not important. Obesity is associated with multiple serious threats to our health, independence, and even our very lives: cardiovascular disease, cancer, diabetes, and dementia. A 2002 RAND research brief noted that obesity, in fact, poses more of a threat for having multiple chronic conditions than smoking or heavy drinking of alcohol.
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