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The Chamberlain Foundation Parkview Medical Center The Pueblo Chieftain Pueblo City-County Health Department Ryals’ Family Foundation St. Mary-Corwin Medical Center University of Colorado School of Medicine
LIVING HEALTHIER AND LONGER – WHAT WORKS, WHAT DOESN’T
LIVING HEALTHIER AND LONGER – WHAT WORKS, WHAT DOESN’T
NO SMOKING IMMUNIZATIONS POTASSIUM SUNSHINE NO TOBACCO PRODUCTS SOCIAL CONTACTS NORMAL TRIGLYCERIDES NO ILLICIT DRUGS CALCIUM VITAMIN D MULTIPLE VITAMIN ALCOHOL MODERATION CANCER SCREENING FISH AND GRAINS GOOD HDL CHOLESTEROL LOW LDL CHOLESTEROL FRUITS AND VEGETABLES EXERCISE DAILY IDEAL BLOOD PRESSURE HEALTHY DIET IDEAL BODY WEIGHT NO SMOKING
By Carl E. Bartecchi, M.D. By Carl E. Bartecchi, M.D. Robert W. Schrier, M.D. Robert W. Schrier, M.D. Forward byby Richard D. Lamm Foreword Richard D. Lamm
Living Healthier and Longer – What Works, What Doesn’t
This educational text is made available to you thanks to the generous contributions of these donors: The Chamberlain Foundation Parkview Medical Center The Pueblo Chieftain Pueblo City-County Health Department Ryals’ Family Foundation St. Mary-Corwin Medical Center University of Colorado School of Medicine
Living Healthier and Longer – What Works, What Doesn’t
Carl E. Bartecchi, M.D. and Robert W. Schrier, M.D. Foreword by Richard D. Lamm Quotations sourced by Barbara Lindley Schrier
The medical information in this book is solely from the authors. can be sold by any party without the written permission of the authors. No part of this publication. M. Carl E. M. Colorado Copyright© 2008. They are also free to distribute this information to friends and family members. in any form.D. and Robert W. THIS BOOK OR CHAPTERS CAN BE DOWNLOADED AT: healthierlongerlife. Bartecchi. their medical Information resources and their colleagues. The authors have not received any funding or support from pharmaceutical firms. and not from any of the organizations that funded the printing and distribution of the book. for-profit health organizations or publishers.MFTP PUBLICATIONS Pueblo.D.org Printed in the United States of America . Schrier. The information in this text is made available to all individuals seeking to live healthier and thus live longer. Individuals are free to copy and or download this information for their own personal use.
To our wives. who continue to help us live longer. and happier lives. healthier. Kay and Barbara. .
... 98 14......... 1 Preface ... 87 13....................................................... High Blood Pressure .... Infections/HIV and the AIDS Epidemic ..........................................................................................................TABLE OF CONTENTS Foreword ....................................... Stroke . Diabetes: We are learning more about management ............. 44 6.................................................................................................................................................. Obesity ........................................... Sex .................... 124 ................ Bone Disease ........ 50 7........................................................................... Stress and Depression .. 106 15.......................... 81 RISK FACTORS 12................................................................................. 6 DISEASES 1........ Coronary Artery Disease ............................................................................. 76 11................................... 33 5...................................................... Smoking ....................... 10 2........ Dementia ........... 27 4.................... 3 Acknowledgements ............ 63 OTHER PROBLEMS 9............. 5 Introduction ......................................... The Bad (Polypharmacy) and the Ugly (Cocaine..................................................................................................... 20 3........... 58 8...................... Methamphetamines............... Marijuana) . Cancer ..................................... 70 10............................................................ Alcohol.... Good and Bad Cholesterol ...... Injuries/Accidents/Domestic Violence............................... 117 16..............................................
............... 132 18.............................................................. 171 GENERAL INFORMATION 23..................................................................................................... 188 CONCLUSION 27.......... In Summary ............................................ 220 30................ Would you like more information? ......... Aspirin ................................ 163 22................. Alternative Medicine: Alternative to What???? .................................................. About the Authors .......................................... Exercise ................................................................................ 206 28...............DISEASE PREVENTION/HEALTH AIDS 17.......................... 136 19......... Sleep ..................................... Immunizations .............................. 175 24............................... 149 20........ 184 26....... 156 21.............. The Physician ................................. 221 ............................ What Works – What Doesn’t............ Aging ...................................................... 208 29.................................................. 179 25......... Vitamins and Supplements ........ The Patient .... Diet .......................................
exercise. and it takes an understanding of both to live a longer and healthier life. Without casting aspersions on the brilliance of U. Japan 1 . such as “How do we keep a society healthy?” and “How do we invest limited funds to buy the most health?” I started asking these questions when I was in the Colorado legislature. This is important to both individuals and public policy.. and Germany spend the most on health care. National polls confirm that “health” is one of the American public’s most important priorities.S. Our habits are more important than our hospitals. yet they have (generally) the worst health statistics. Health. A nation’s health has more to do with its lifestyle and habits than the quality of its health care system. The authors know the most valuable thing they can do for the public is to educate people on what they can do for themselves. Victor Fuchs has written: The greatest current potential for improving the health of the American people is to be found in what they do and don’t do to and for themselves. It is important to distinguish between a doctor’s role and a public policy maker’s. and smoking are of critical importance. They recognize that “medicine” and “health” are related but are not Siamese twins. As a public policy maker.Living Healthier and Longer – What Works. The U. is both an art and a science.” Carl Bartecchi and Robert Schrier direct us to look at health with new eyes. These are obvious but still too often overlooked. we know clearly that your best doctor is yourself. medicine (which has saved one desperately important to me).S. Canada. ask macro questions. We can avoid many more diseases than we can cure. I feel that my patient is society. and collective decisions affecting pollution and other aspects of the environment are also relevant. Individual decisions about diet. by definition. I could not understand why there was (and is) an inverse correlation in the developed world between health spending and health. But how does one achieve a long and healthy life? The authors inform us of a wide variety of simple things we can do for ourselves. they suggest. Public policy must. What Doesn’t FOREWORD Proust once observed that “the real voyage of discovery is not in seeking new lands but seeing with new eyes.
We all must learn better what we can do for ourselves. Hygeia was the guardian of health. Medicare is fast heading toward bankruptcy. Aesculapius. families. Health care costs are bankrupting more and more businesses and are dampening needed wage increases. The authors. The U. the authors still remind us that our health depends more on ourselves than on them. but her role was to symbolize the belief that people would stay in good health if they lived according to reason. was concerned with identifying the cause of disease and the treatment of the sick. Our government pays more than 40 percent of health care costs. Bartecchi and Dr. They are concerned with both medicine and health and have given us a practical guide to use in our daily lives. one that will grow during the next 10 years.Living Healthier and Longer – What Works. These divergent views of health have never been resolved and remain a key issue today.S. thus. have risen above the excellence of their own specialties and have looked at the big picture. Medicine is a profession. of the 30 years that have been added to human life expectancy this century. yet both recognize that we currently do not inform the public enough on how people can take care of their own health. Department of Health and Human Services estimates that. Both are scholars in allopathic medicine. Richard Lamm Governor of Colorado 1975-1987 2 . Our aging bodies can thus bankrupt our children. Dr. What Doesn’t spends the least and has the best. only 5 of those years are due to clinical medicine. Inquiring minds increasingly ask “How do we keep a society healthy?” This argument is timeless. Schrier brilliantly bridge these 2 aspects of health. in contrast. With all their medical training. not treatment of the sick. Their book is filled with useful and practical suggestions on how individuals. I was told that the Japanese recognized that getting people jobs and increasing living standards will buy far more health for a country than having a health care system. The ancient Greeks had 2 theories concerning health: one symbolized by the goddess Hygeia and the other by the god Aesculapius. She represented moderation in lifestyles. and societies can best maintain health. but health policy is a public policy choice.
randomized. However. however. information is always changing. but several new considerations and therapeutic approaches have appeared that deserve inclusion in this new book. double-blinded clinical trials published in sophisticated. been modified or simply tossed aside. Sometimes. Even medical schools and medical centers might provide therapies that are not recognized as scientifically plausible. a medical center will compromise (or be compromised) by such financial pressures by offering to do “research” on scientifically suspect therapies. Not only have many health and therapeutic concepts changed. been modified. updated or even cast aside. may negate older information. unscientific concepts. Today. wealthy donors or sympathetic board members. Readers of the original book have pressed the authors for an updated version. Confusion may arise on some points. That’s the beauty of conventional medicine. in an otherwise crowded market of personalhealth related books. peer-reviewed medical journals. It isn’t sidetracked or delayed trying to explain or justify outdated. What Doesn’t PREFACE It has been 8 years since the publication of our book – The Science and Art of Living a Longer and Healthier Life. Many of the basic principles of maintaining good health and extending lives have remained unchanged. It moves forward with new scientific discoveries. Some might ask how much could have changed in 8 years to justify another book on the subject. They forget. Such centers are often under great pressures from supporting foundations.Living Healthier and Longer – What Works. The book proved popular. Such “research” may be quite profitable for the center and the researchers. These 3 . that supporters of these suspect therapies portray any such activity at a legitimate medical center as support for their scientifically questionable therapy. when well done. we are reaping the benefits from many large-scale. placebo-controlled. a book devoted to providing readers with documented strategies that can allow them to live a healthier and longer life. In the fields of health maintenance and disease prevention. be they centuries or months old. New studies. many concepts have changed. They justify this by “giving patients what they want or even demand” (or will pay for).
What Doesn’t. costeffective conventional medicine. This book helps resolve some of the apparent contradictions as to how to live a healthier and longer life. we demand proof and support for the concepts and recommendations that we pass on to our patients in order to help counter undocumented information that constantly bombards the public via radio. Conflicting data that the public is asked to decipher is confusing and lessens the public’s confidence in our health care systems and its providers. As physicians and educators. In this regard. 4 . television. We have also included an expanded chapter on alternative medicine.Living Healthier and Longer – What Works. newspapers. the title of the book has been changed to Living Healthier and Longer – What Works. Here we seek the same level of documentation for the promises and therapies of alternative medicine that are required and expected of high quality. magazines and the Internet. in view of the present popularity of treatments generated by that discipline and its disciples. What Doesn’t studies have provided new evidence-based insights into several difficult health problem areas.
Living Healthier and Longer – What Works. 5 . The book cover was designed by David Bartecchi.D. Ph. We appreciate the insightful and thought-provoking quotations provided by Barbara Lindley Schrier. We appreciate the assistance of literary consultant Yvonne Kellar-Guenther. What Doesn’t Acknowledgements The authors wish to recognize Jan Darling and Kay Bartecchi for expert technical assistance.
In 2005.S. cancer and stroke. The cost of health care for an older American is 3 to 5 times higher than the cost for those under 65. Making certain changes at almost any point in one’s life can improve one’s life. It is true that accidents. wars. Americans are living longer. However. The human body is very forgiving during those early years. Our population is rapidly aging. By 2030. By early adulthood many of us regularly use tobacco products. population. On the other hand. 6 . This is because heart disease. do not exercise enough and drink too much alcohol.Living Healthier and Longer – What Works. These changes can also result in living longer. Looking for ways to get and maintain good health is important for individuals and for society. By 2030. To help lower these costs we need to become more hands-on in preserving the health of older adults. people in the U. The goal of this book is to describe those factors that have been shown to help people to live healthier and longer lives. were expected to live 77. The human body is also willing to accept changes or corrections to improve one’s health. poor diet and not enough exercise cause almost 35 percent of deaths in the U. We plan to cover the factors that contributed to this decline in deaths.9 years.S. poor health choices of our youth lead to the 3 major causes of preventable death. our already high health care spending is expected to rise by 25 percent.S. it is important to recognize smoking. natural disasters and getting certain diseases can quickly end one’s life. We also wish to point out there are a high number of factors which claim such potential but have not been proven to do so. This increase is largely because of our aging population. the number of Americans 65 and older will more than double to 71 million. What Doesn’t INTRODUCTION Sadly. are causing fewer deaths each year. These older Americans will make up about 20 percent of the U. weigh too much. eat fast foods too often.
What Doesn’t Leading Causes of Death in the U.Americans are living longer.S. This is because heart disease. We plan to cover the factors that contributed to this decline in deaths. Somewhat unexpected are the leading causes of death for American women: 1 7 . Living Healthier and Longer – What Works.S. are causing fewer deaths each year. Leading Causes of Death in the U. cancer and stroke.
advances in genetic engineering will help to improve our chances for a better and longer life. We also do not discuss anything that is not available to the general public. In the future.14 millions US residents who died in 1990. In their study. For the present. In this book. That group had better blood pressures and cholesterol values than those where only one parent lived longer. 8 . These have also caused a shift in the leading causes of death from infectious diseases and acute illnesses to chronic conditions and degenerative illnesses. The major chronic conditions are high blood pressure. The behaviors discussed in this book are the tried and tested actions. arthritis. The group where both parents lived longer also had fewer of the other risk factors for heart disease and stroke. coronary heart disease. we will not advertise or support products that have not been shown by high-quality research to extend life or insure good health. however. prevention efforts and healthier lifestyles have led to the increase in life span. All of these conditions or their treatments reduce the quality of life for older adults. Healthy lifestyle choices however can offset poor genetics. Below is a list from McGinnis and Foege’s research study. What Doesn’t Improved medical care. doing the behaviors that have been shown to lead to better health is the path we should follow. cancers and diabetes. These are studies in high quality medical journals. We have made it a point not to write about advice that is hard to follow or expensive. beliefs and therapies supported by high quality studies. They point out that about half of deaths could have been avoided if people had changed their behaviors. A recent Framingham Heart study showed that people where both parents lived longer had fewer health problems when they reached middle age. We all get genes from our parents that have an important influence on the quality and length of our lives. they looked at the cause of death for the 2.Living Healthier and Longer – What Works.
Dietary factors and activity patterns 300. 9 . Actual causes of death in the United States. Microbial agents 90.000 3. What Doesn’t Number of Deaths 1.000 6. Tobacco 400.000 8. Alcohol 100.000 7.000 Total 1. High risk sexual behavior 30.000 Percentage of Total Deaths 19 14 5 4 3 2 1 1 49 Further Reading McGinnis JM.000 2.000 5. Foege WH.060. JAMA 1993.Living Healthier and Longer – What Works.270. Motor vehicle injuries 25. Firearms 35. Toxic agents 60.000 4.
Living Healthier and Longer – What Works. Coronary artery disease. 5. Heart attack is the single largest killer of American males and females. Something might be gaining on you. the chance is 10 . which angry up the blood. 3.000 Americans will have a heart attack. Each year as many as 1. Don’t look back.500. also called coronary heart disease. 6. Keep the juices flowing by jangling around gently as you move. A blood clot or a build-up of fatty substances causes the block. People who have what is called adult-onset diabetes mellitus have a higher chance of dying from coronary disease than those who do not have diabetes. About one-third of them will die. This disease accounts for more than onehalf of cardiovascular deaths. This group of diseases is often called cardiovascular disease. About one-third of all deaths in the US are a result of this disease. This is thought to cause at least 40. 7. 4. happens when blood carrying oxygen and nutrients to the heart is blocked. lie down and pacify it with cool thoughts. For men. There are many types of blood vessel and heart diseases. Men who eat a high fiber diet have a significantly lower risk of heart attack than those whose diet is poor in fiber-rich foods. Smoking is dangerous for people at high risk for coronary artery disease. -Satchel Paige Facts 1.S. Go very light on the vices. If your stomach disputes you. The social ramble ain’t restful. 8. A blocked artery that leads to the heart causes a heart attack. 2. This is especially true if the fiber comes from grains.000 heart disease deaths yearly in the U. Smokers with this disease die 10 to 15 years earlier than those who do not smoke. Twenty-seven percent of men and 44 percent of women die within 1 year of having a heart attack. What Doesn’t Coronary Heart Disease Avoid fried foods. Second-hand smoke is also dangerous. such as carrying on in society.
or both. a sudden tightening of the coronary artery. The key risk factors for heart disease include obesity. inactivity. This can significantly reduce the chance of having coronary heart disease as an adult. and high cholesterol. To steer clear of heart disease. Seventy percent of heart attacks happen in people whose coronary arteries are blocked less than 50 percent. Adult onset diabetes is type 2. the person needs to change their behavior to reduce the risk factors. 11 . high blood pressure. What Doesn’t 200 percent higher. 10. For women. 12. 9. Up to 80 percent of people who will develop heart disease could have avoided it. the chance is 400 percent higher. Not exercising increases your risk of heart problems. noninsulin-dependent diabetes. The block may be due to a blood clot.Living Healthier and Longer – What Works. Controlling weight in young adults is important. 11. Being inactive makes it twice as likely that you will have coronary artery disease.
12 . What Doesn’t Coronary heart disease (CHD) is the leading cause of death in the U. For a few people. To date. CHD is responsible for about 700. The arteries can become narrower and block the blood flow. This is over 16 million people. Yet. an American dies of heart disease. especially the serum LDL cholesterol known as the bad cholesterol. Dr. Recognizing that the most common LDL cholesterol number in people with heart attacks is about 140 mg/dl.000 U. Dr. heart rhythm disturbances. Dr.Living Healthier and Longer – What Works. • Seven percent of men and 6 percent of women will have sudden death. the common recommendations for drug intervention with statins would not be “preventive”.S. Others have high cholesterol because of a poor diet and lack of exercise. This leads to a heart attack. Roberts is a well-known cardiologist and pathologist. it is also known that only about half of the risk of heart failure comes from the identified risk factors. it causes the wall of the coronary arteries to change also. about 1 in 500. • Within 6 years of a first heart attack. Roberts thinks it is time to switch gears from decreasing risk of atherosclerotic events to preventing the plaque buildup. Roberts states. a number of studies have proven the value of lowering LDL cholesterol levels. In some cases the plaque buildup can rip apart. • 22 percent of men and 46 percent of women will have heart failure. Over 6 percent of all Americans have this disease. One way this can be done is by using drugs.S. Roberts says that the biggest risk is a person’s cholesterol level. called statins. Yet. high cholesterol is a genetic problem. CHD is caused by the buildup of plaque inside the coronary arteries. blocking the blood flow through the affected artery. Specifically. deaths each year. 25 percent of men and 38 percent of women will die. which help control the bad cholesterol. 18 percent of men and 35 percent of women will have another heart attack. Dr. There are several risk factors for the buildup of atherosclerotic plaque. The importance of a heart attack is related to its possible complications as follows: • Within 1 year of having a first heart attack. William C. • Every 60 seconds. As the plaque builds up. heart failure and potentially death.
in my view.). Roberts believes. These guidelines by Roberts are not widely accepted at this time. This is true even for people who show no other symptoms of heart disease. or be pure vegetation-fruit eaters. If such a goal was created. Therapy to reduce LDL cholesterol levels should continue as long as goals are met. that the following may be needed to prevent plaque formation: • You want your bad cholesterol or LDL level to be less than 70 mg/dl. • You want your good cholesterol or HDL level to be above 20 mg/dl. the great scourge of the Western World would be essentially eliminated. can help prevent plaque. “primary” and “secondary” prevention would be the same. we do not know how much HDL is needed to prevent plaque. If it is useful for the LDL cholesterol to be less than 100 mg/dl after a heart attack. such as having diabetes mellitus or a previous non-coronary atherosclerotic event). At this time. A low HDL cholesterol level may not be dangerous if the LDL cholesterol level is very low. however (or is at high risk of an atherosclerotic event. the LDL cholesterol goal is less than 100 mg/dl (with an “option” of less than 70 mg/dl. and we agree. (this very low level accepted only when the total and LDL are very low) • Your total cholesterol level should be less than 150 mg/dl. however. the goal for all populations – not just those with heart or brain attacks or diabetes mellitus or noncoronary atherosclerotic events – needs to be LDL cholesterol less than 100 mg/dl and ideally less than 70 mg/dl. For example an HDL of only 15 mg/dl might be alright if your LDL is only 50. also called good cholesterol. HDL. What Doesn’t If a patient has a coronary event. Thus.Living Healthier and Longer – What Works. surely it must be useful for the LDL cholesterol to be less than 100 mg/dl before a heart attack! Therefore. however. he makes a sound argument for starting to use this approach. 13 . and more than 100 million Americans – rather than the present 13 million – would need to be on a statin drug with or without ezetimibe (Zetia). treating increasing LDL cholesterol levels as early as possible will reduce heart disease.
The average life expectancy is 77. What Doesn’t Other risks have also been identified that increase the chance of heart disease and heart attacks. • Cigarette smoking. It is possible for people to have heart attacks and die without having a known risk factor.Living Healthier and Longer – What Works. • Enlarged heart. Things that you can do to effectively modify these risk factors include: • Eating foods that are good for you. Studies suggest that more than 90 percent of heart problems happen to people who have at least 1 risk factor. The most serious of these are: • Hypertension. These include high blood pressure medications and statins. these include: • Age. Only a few events typically occur in people with no high or borderline risk factors.9 years. It is clearly shown that people who have more risk factors are in the most danger of developing heart disease. • Not using cocaine. Some cannot be changed.8 to 9. • Diabetes mellitus – avoid it or keep it under control. • Exercising regularly. • Sex. • Taking medications that reduce your risk factors. Avoiding risk factors can help you live longer. People who reach middle age without having any major risk factors for heart problems can increase their life expectancy by another 5. Other risk factors can be changed. • High cholesterol levels.5 years. • Race. Risk factors can be viewed in several ways. • Quitting smoking. 14 . This is rare though. • Avoid becoming obese. • Heredity or genetic factors. • Diabetes control. • Cocaine use.
More than 3 quarters of people who die of coronary heart disease are 65 or older. 6. abnormalities such as abnormal platelets. etc. even when the blood sugar is reasonably well controlled. Smoking status. High blood pressure increases the workload of the heart. Higher levels are protective. Higher LDL (bad) Cholesterol. causing it to enlarge and become weaker. Too much stress. HDLs increase by exercising 3 to 5 times per week. Race and Heredity. Increasing age. In spite of the large number of risk factors. • A recent spousal loss or separation. Oral contraceptive use. 7. fibrinogen. Men are also more likely to have heart attacks earlier in life. Being male. Men have a greater risk of having a heart attack than women. Even exposure to secondhand smoke increases the risk of coronary heart disease. Setting at the time of a first heart attack. such as: • An individual living alone. A smoker’s risk of developing heart disease is 2 to 4 times that of a non-smoker. 2. the determination of the likelihood of development of coronary heart disease can be based on 8 tried and true factors: 1. Blood Pressure. Certain groups have a greater incidence of coronary heart disease problems. • Evidence of lack of social support. clotting factors. 5.Living Healthier and Longer – What Works. and native Hawaiians. Factors involved in increased blood clotting. There is evidence that not having a close group of family or friends increases the risk of heart attack.e. 8.. Low HDL (good) cholesterol levels. Diabetes significantly increases the risk of developing coronary heart disease. 4. 15 . 3. What Doesn’t • • • • • Other important modifiable risk factors include: Drinking too much alcohol. American Indians. i. These groups are: Blacks. Diabetes.
Use of aspirin if your doctor recommends it. Assure blood pressure control. 7. There are some bad combinations of risk factors. • Exercise is tied to a number of desirable goals. Numerous studies have shown that regular exercise can help prevent a first heart attack. Exercise more. kg body weight m2 height = 25 or less is recommended Body mass index (BMI) • • • • Elevating HDL cholesterol. Cigarette smoking is the most dangerous risk factor for coronary artery disease. 2. You would like your blood pressure to be under 130/80. This is important if the person already has coronary heart disease. Correct diet problems to avoid obesity. What Doesn’t Corrective actions can effectively modify risk factors. Quitting smoking allows the risk for coronary to go back to that of a non-smoker within 2 to 3 years. 16 . 6. The earlier a person with modifiable risk factors is aware of and changes these risk factors. • A woman who smokes and also uses oral birth control pills. 4. 3. Helping to manage stress. Protective actions include: 1. Stop smoking. Here are some deadly combinations: • A person with hypertension and high cholesterol who smokes cigarettes. Aim for no more than 1 or 2 glasses of wine or an equivalent per day. the better. Changing these risk factors help people avoid the lethal consequences. Moderate alcohol consumption. including: Maintaining desirable body weight (body mass index). Reducing blood pressure to 130/80. One tip is to walk for 30 minutes 7 times a week. 5. Aspirin decreases blood clots or atherosclerotic plaques in coronary arteries. Improving work capacity of the heart.Living Healthier and Longer – What Works. Improve HDL levels with increased exercise. Controlling your blood pressure reduces the chance of heart attacks and strokes.
This reduced the chance of death by 5 percent. Stresses caused 17 . and even wars. dense LDL particles. it is important to recognize that there are “triggers” that can contribute to the initiation of a heart attack. • Medicines for heart attack. • Increasing physical activity. • Reducing smoking. What Doesn’t An article in the June 7. and air pollution. This reduced the chance of death by 24 percent. These include: • Elevated lipoprotein (a) levels. These triggers range from stress. • Elevated fasting insulin levels in nondiabetic patients. 2007 New England Journal of Medicine noted a decline in death rates due to coronary heart disease since the 1980s. • Heart failure therapies such as ACE inhibitors and decreasing sodium and water retention with diuretics. to name but a few. • Reducing blood pressure.Living Healthier and Longer – What Works. This reduced the chance of death by 12 percent. This reduced the chance of death by 11 percent. dense particles have 3 times the risk of coronary artery disease as those with large LDL particles. This reduced the chance of death by 9 percent. The first 2 are believed to encourage the formation of blood clots. These include beta blockers and angiotensin blockers. natural disasters. These medicines reduced the chance of death by 10 percent. severe weather. The researchers believed this decrease was due to reducing risk factors and use of new technologies. • Greater amounts of small. In people with chronic heart disease. This reduced the chance of death by 20 percent. There are other risk factors but we will only discuss them briefly. The major contributors were: • Reducing cholesterol. anger. grief and great excitement to heavy physical exertion. They also can lead to a buildup of plaque on the walls of arteries. • Bypass surgery and angioplasty during or after a heart attack. sexual activity. Patients with small. excessive eating. The size and density of LDL particles can be important factors in estimating coronary artery disease risk.
What Doesn’t by infections or “recreational” drugs can also be triggers for heart attacks. 4. less meat. The ideal is a person between the ages of 35 and 74 who has: 1. This means a diet with less fat. Recognizing these triggers and either avoiding them or managing them as they arise will help keep you healthy. Keep your blood pressure below 140/90. Never smoked. If you are overweight lose weight. Recommendations 1. 8.Living Healthier and Longer – What Works. it is possible that you are at risk for chronic heart disease but do not know it yet. STOP. Fasting glucose level less than 110 mg/dl. 4. Maintain normal blood pressure. For females. 2. Systolic blood pressure less than 120. Eat a heart-healthy diet. Aim for desirable weight. Try to eat at least 6 portions of fruits and vegetables daily. For example males should aim for no more than 1 to 2 glasses of wine per day for males. Use alcohol only in moderation. For those who might wonder what a person with low risk factors would look like. Remember. 7. 2. 3. here is an example. and more fiber-rich foods like fresh fruits and vegetables. your cardiovascular risk factor status. 6. 8. 6. Diastolic blood pressure less than 80. LDL cholesterol less than 100 mg/dl. Assess. 5. 18 . Exercise regularly. or lead to permanent cardiac damage. 5. Reached the ideal weight. Re-evaluate your risk regularly. 7. Even the first use of this drug can cause a heart attack or sudden death. with the help of a physician. Regularly exercises. 3. HDL cholesterol higher than 60 mg/dl. People with kidney disease or diabetes should maintain a level of 130/80 or lower. Aim for 30 minutes per day 7 days per week. If you smoke. Never use cocaine. no more than 1 glass per day.
19 . The American Journal of Cardiology. talk to your doctor about taking aspirin at 81 mg per day. What Doesn’t 9. If you are a male age 50 years or older and have multiple cardiovascular risk factors. Time to end the mixed and often incorrect messages about prevention and treatment of atherosclerotic cardiovascular disease. Lloyd-Jones D. 2007:2133-2135. has not been proven to affect atherosclerosis or coronary heart disease. Primary prevention of coronary heart disease. 11. Journal of the American College of Cardiology. middle-aged people. October 2006:1550-1555. A “statin” should be the first drug used to lower elevated cholesterols. Greenland P. November 27. American Journal of Cardiology. Atherosclerosis: its cause and its prevention. Ezetimibe. 10. New England Journal of Medicine. A 5 percent weight loss maintained over 2 years has been shown to prevent adult diabetes in high-risk. Further Reading Roberts WC. try to lose weight. If you have adult-onset.Living Healthier and Longer – What Works. The editor’s roundtable: atherosclerosis regression. October 11. though shown to lower cholesterol levels. ulcers. type 2 diabetes. et al. Weight loss may actually “cure” your diabetes or at least allow for better blood sugar control. Domanski MJ. 2008:967-974. Ballantyne CM. Friedewald VE. and bleeding problems. April 1. Do not take an aspirin per day if you have poorly controlled hypertension. also called Zetia. 2007:1543-1545.
Living Healthier and Longer – What Works. and/or stroke. 20 . This means most people with hypertension have blood pressure that is at or above 140/80. The person taking the reading could also have a problem like difficulty hearing. Studies suggest that when people with hypertension reduce their diastolic blood pressure by 5 to 6 points. 4. 5. Less than one-third of hypertensive people have their blood pressure under control. they decrease the risk of coronary artery disease by 14 percent. treatment of high blood pressure can: • reduce death from all causes by 12 percent. • reduce death from coronary artery disease by 25 percent. This number represents the pressure in the arteries when the heart is at rest. making the reading too high. the patient could be nervous or have recently exercised. 3. it is important to have several repeated and accurate blood pressure measurements. More than half of all Americans over 65 years of age have high blood pressure. 6. For patients age 60 or older. • reduce death from stroke by 36 percent. Finally. These people do not know that they have hypertension with a risk of heart attack. Because so many issues can affect the reading. Over 90 percent will eventually develop it. -Oliver Wendell Holmes Facts 1. There are many things that can change your blood pressure reading. The risk of a stroke also goes down by 42 percent. These include problems with the tool used to take the reading. like using a blood pressure cuff that is the wrong size. 2. What Doesn’t High Blood Pressure To be 70 years young is sometimes far more cheerful and hopeful than to be 40 years old. heart failure. The second number of the blood pressure reading is the diastolic blood pressure (130/80). Statistics show that 35 percent of people whose blood pressure is at or above 140/90 were never told they had high blood pressure.
21 . It measures the blood pressure in the arteries when the heart squeezes. Studies have shown that every 20 point increase in this number doubles the chances of having a stroke. Always ask your pharmacist about this when you buy either prescribed or over-the-counter medicines. Keeping your systolic blood pressure down is important. and kidney disease. What Doesn’t 7. 8. Systolic blood pressure is the first number in the blood pressure (130/80). heart attack.Living Healthier and Longer – What Works. Some of the medicines your doctor may prescribe can cause high blood pressure. heart failure.
While this approach is expensive. We used to believe that the diastolic pressure. It is now known that the risk of cardiovascular disease goes up when blood pressure is over 110/80. the lower number. This is when the systolic number is high but the diastolic blood pressure is less than 90. that hypertension can easily be controlled. blood pressures taken in the doctor’s office are higher that those taken away from the office. Another measurement called the pulse pressure is also helpful to determine the risk of a heart attack or stroke. This is because there are very few symptoms of hypertension. it can help determine if blood pressure is high even outside of the doctor’s office. What Doesn’t Around 72 million Americans have hypertension. About 80 percent of the time. Usually. Of those who are aware. heart failure. Hypertension leads to heart attacks and strokes because it speeds up hardening of the arteries. and coronary artery disease. Pulse 22 . It is important to know if you have hypertension because it is a common cause of stroke. Often patients 60 years and older will have isolated systolic hypertension.Living Healthier and Longer – What Works. was more important for estimating risks of stroke and heart attack. Everyone 18 and over should be screened for hypertension regularly. Ambulatory blood pressure measurements over 24 hours are helpful. strokes. It is important to note. only about one-quarter of those who are getting treated are wellcontrolled. Studies have shown that more than 30 percent of those with hypertension do not know they have the disease. This is especially true for those over age 55. Having systolic hypertension is associated with increased coronary artery disease and strokes. only about one-half are under treatment. Furthermore. the diagnosis and treatment of hypertension is a major health care problem in this country. Systolic pressure measures blood pressure in the arteries when the heart squeezes. Hypertension has been called the “silent killer”. and kidney failure caused by hypertension. Large numbers of people die from the heart attacks. This means that they have had their blood pressure tested many times and their pressure is at or above 140/90. however. it is discovered during routine health evaluations or screenings. Thus. More recently it has been recognized that the systolic pressure is more important. This is especially true for the elderly.
Living Healthier and Longer – What Works. People with high risk of cardiovascular problems should try to keep their blood pressure at 130/80 or lower. This is especially true for African-Americans who tend to be more sensitive to salt. DASH stands for Dietary Approaches to Stop Hypertension. Preserved and canned foods have a high salt content. Drinking too much alcohol can cause hypertension. The best way to get potassium is to eat fruits and vegetables. One way to lower blood pressure is to make lifestyle changes. Stiffer arteries are linked with cardiovascular complications. • High in vegetables. The difference between these 2 numbers tells us about the stiffness of the artery. Reducing salt intake. Quitting smoking. What Doesn’t pressure is found by subtracting the diastolic pressure from the systolic pressure. People often do not realize how much salt they are getting in their food and drinks. Keeping the diastolic pressure. This diet is: • Low in red meat and other saturated fats. the second blood pressure number. Drinking small amounts of alcohol. It is estimated that about 8 percent of American men have hypertension 23 . • High in low-fat dairy products. Following the DASH diet has been proven to lower blood pressure. • High in fruits. If lifestyle change alone does not work. If you try to get this mineral from supplements. drug therapies can also be used. you can get too much which can be harmful. Salt restriction is important in all hypertension patients. The DASH diet is also rich in potassium. at 80 or lower is important for diabetic patients. • High in whole grains. Exercising regularly. • • • • • Lifestyle changes might include: Losing weight through exercise and diet. Potassium is a mineral that has the ability to lower blood pressure.
especially in the elderly. activities. and arthritis. These are medicines to make you less hungry. Drinking less alcohol can help decrease blood pressure. This allows the person to understand what signs their body is giving when their blood pressure is too high or just right. pains. Deaths have been reduced by at least 10 percent for drug-treated patients. 24 . Patients should tell their doctors about other medications they are taking. or other illnesses that can affect blood pressure. • Diet aids. blood pressures taken on physician/office monitors tend to be higher than those taken on home monitors. This includes medicine for colds and sinus you can get over the counter. • Female hormones including birth control pills. • Nonsteroidal anti-inflammatory drugs (NSAIDs). Advantages of home blood pressure measurements are many. • A quick connection between how you are feeling and your blood pressure. People with hypertension must work closely with their physicians for the best results. • Some arthritis medicine. If changes in diet and drinking less alcohol do not control blood pressure. • Anabolic steroids. As noted.Living Healthier and Longer – What Works. • Close monitoring of how well the blood pressure medicine is working. • A quick connection between stresses. They should have home blood pressure monitors to keep track of their own progress. including: • More realistic measures of actual blood pressure. These are medicines used to treat aches. What Doesn’t because they are drinking too much alcohol. then talk to your doctor about blood pressure medicine. • Cold and sinus medicine. This will help the person and their doctor make adjustments in therapy quickly. These are steroids used for building muscle. Here are some medicines that increase blood pressure. The use of drug therapy has reduced the numbers of strokes by one-third and heart attacks by one-fourth for the elderly. This medication has been shown to work well. • Some antidepressant medications.
It is easy for them to give you information that has been written specifically for patients. though. heart failure. 5. Aspirin and sulindac which is also called Clinoril. These drugs can be gotten over-the-counter. Patients must discuss with their doctors any changes in their body that they notice after starting. Large studies show that using blood pressure medicine decreases: • The death rate for people over 65 by almost 20 percent • Heart attacks by 25 to 30 percent. Some NSAIDs. Drugs used to treat hypertension can have major complications. This is true even if blood pressure measurements are normal. Recommendations 1.Living Healthier and Longer – What Works. What Doesn’t Cocaine can also increase blood pressure. your doctor may not realize you are using them. Take your own blood pressure at home. It is possible your blood pressure could become so high that you will have a stroke. Have your blood pressure checked at least every 2 years. or heart attack. 2. Understand your blood pressure medications. These problems can even be life-threatening. Ask your physician or pharmacist for written information about each drug. NSAIDs can be dangerous for elderly and those with hypertension or kidney problems. 4. 3. People often stop taking 25 . or modifying medicine. The benefits of treating hypertension start within months of beginning therapy. Stopping certain medications can result in your blood pressure going even higher than when you started. Age can change how a body reacts to medicines. however. • Strokes by about 25-30 percent. are less likely to affect blood pressure. NEVER stop taking blood pressure medications on your own. • Sudden cardiac deaths by 25 to 30 percent. can make antihypertensive medications less effective. These benefits can kick in before a person’s blood pressure is down in the desirable range. Work closely with your physician to achieve good blood pressure control. changing. This is especially true in the elderly. As a result.
Living Healthier and Longer – What Works. What Doesn’t their medications because of bad side effects or costs. • Certain fad diets. Losing as little as 5 to 10 percent of body weight may control blood pressure with fewer and/ or lower doses of antihypertensive medications. There are many therapies that say they can help but have not been proven yet. lose weight. Thus avoiding salty foods and not adding salt to food may help control blood pressure. and exercise. This risk is common in the hypertension patient. 8. • Yoga. chips. • Meditation. At least 20 percent of hypertension patients increase their blood pressure when eating foods high in salt.” While exercise does not appear to decrease blood pressure as much as weight loss. It is important to quit smoking.nih. Avoid non-drug or natural treatments for hypertension. Talk to your doctor about these concerns. • Hypnosis. their blood pressures are “salt sensitive. Of these 4. eat less salt. This is especially true of African-Americans. and canned foods. Lung and Blood Institute Health. quitting smoking is the most important. • Acupuncture. it does lower the increased cardiovascular risk. High cholesterol must be treated more aggressively in people with hypertension than those with normal blood pressure. 6. Cardiovascular complications are much higher for people with hypertension who smoke. the elderly and diabetic patients.gov 26 . These include french fries. Further Reading National Institutes of Health (NIH) National Heart. These include: • Biofeedback. 7. For these groups.
-Theodore Roosevelt Facts 1. Smokers have significantly greater risks for stroke than nonsmokers. The incidence of stroke more than doubles each decade after age 55. Stroke is the leading cause of serious long-term disability in the U. About 1 in 9 patients receiving early thrombolytic or clot dissolving therapy for stroke will be returned to minimal or no disability. The greatest risk. Each year about 550.000 will have a transient ischemic attack (TIA) defined as symptoms which last less than 24 hours. where you are. 6.Living Healthier and Longer – What Works. the risk for a stroke is about 10 percent over the next 90 day period. 4. A stroke is defined by symptoms lasting longer than 24 hours. 5. 27 . 8.S.S.000 Americans suffer new or recurrent strokes. After a TIA. 50. 9. What Doesn’t Stroke Do what you can with what you have. Stroke is the third leading cause of death after heart disease and cancer. 10. A smoker with high blood pressure has 20 times the risk of stroke as a nonsmoker with normal blood pressure. 7. however. High blood pressure is a major contributing factor in up to 70 percent of strokes. Patients who survive an initial stroke have a recurrence rate of up to 18 percent during the following year. in the U. About 31 percent of stroke victims die within a year. 2. is in the first week after a TIA. 3.
Improved treatment of high blood pressure over the past 25 years has been credited with the major reduction in stroke deaths during that period. Controllable risk factors for stroke include: • High blood pressure .Smokers are 50 percent more likely to have strokes than nonsmokers. Therefore.Hypertension (systolic pressure greater than 140 mm Hg and diastolic pressure greater than 90 mm Hg) may be the cause of 40 percent of strokes. The risk of having a stroke increases with age. previous heart valve disease. What Doesn’t Stroke refers to a sudden impairment of brain function sometimes termed “brain attack. The risk of having a stroke also increases with family history such as a close relative who has had a stroke. Strokes that occur in the setting of high blood sugars. a common cause of irregular 28 • • • . or transient ischemic attack [TIA]. however. Cigarette smoking . Atrial fibrillation.Living Healthier and Longer – What Works. Contrary to what one might expect. improving blood sugar control of insulin-dependent diabetes does not appear to reduce the incidence of stroke.” that results from the interruption of circulation to one or another part of the brain. Many studies have shown that lowering systolic blood pressure and maintaining good blood pressure control by almost any antihypertensive medication. when it begins to equal that of women. heart attack. Controlling blood pressure has been shown to decrease the occurrence of stroke in adult diabetic patients. has been effective in preventing strokes. Strokes can be prevented by identifying and treating people at high risk before the problem develops and by controlling risk factors. Heart disease . The risk is higher in men until the mid-50s. heart attack. both systolic and diastolic hypertension needs to be treated and controlled. Those who quit smoking have about the same risk of stroke as nonsmokers. following either blockage or hemorrhage of an artery supplying the area.It is estimated that diabetes can double the risk of stroke. the risk being highest after age 55. or valve replacement can increase the likelihood of having a stroke. The mechanism for this is not completely clear. Diabetes . tend to be more severe and disabling. but diabetes is a risk factor for cerebral arteriosclerosis. cigarette smoking predisposes to stroke by a variety of defined mechanisms.heart rhythm disturbances such as atrial fibrillation and heart failure.
• Distortion of speech. • Vascular disease . depending on associated factors. and ablation procedures can significantly reduce stroke risks in these patients. Aspirin and other medications have been shown to reduce the risk of stroke in patients with TIAs. as many as 5 percent of patients who elect surgery may suffer a stroke or die from the procedure itself. Medications. • Unsteadiness. • Loss of vision. Transient ischemic attacks (TIAs) . high monounsaturated fat. The physician will listen to the area over the carotid artery in the neck with a stethoscope to find evidence of blockage in the carotid artery.Significant blockage of the carotid artery in the neck (greater than 70 percent narrowing) occurs in about 5 percent of the elderly. • Numbness. lots of fruits and vegetables) is also valuable. contribute to the development of plaques in the arteries that supply the brain. • Double vision. which are evidenced by fleeting or transient episodes of: • Unilateral weakness. alone or accompanied by other cardiovascular risk factors. the risk of having a stroke is 3 to 4 percent each year. including blood thinners. Eating diets such as the Mediterranean diet (low saturated fat. If found. Even if these patients are without symptoms. However. can increase the risk of stroke to as high as 7 percent each year.The risk of stroke is increased in those who have had a TIA. The carotid artery narrowing can be managed by medications with or without surgery. further testing will determine the degree of blockage. What Doesn’t heart rhythm in the elderly. A recent study from Harvard reported that people who ate up to 6 servings of fruits and 29 • • .Living Healthier and Longer – What Works. Many studies have now shown that cholesterol lowering drugs (statins) are capable of significantly reducing the risk of stroke in people with lipid problems and especially those with coronary artery disease. Cholesterol – Elevated cholesterol levels. Over 20 percent of these people will subsequently have a stroke.
especially in men and in those with hypertension. Also valuable are daily exercise and the avoidance of salt if patients have tendencies to high blood pressure. • Though many believe that type A behavior (very active). Besides medications and surgical treatment. aspirin is the drug of first choice for stroke prevention. These methods act by preventing or limiting further vascular lesions. 30 . controlling blood pressure. This is especially a problem for women over 35 years. but doses from a baby aspirin to a couple regular aspirin daily are effective. however. clopidogrel (Plavix) is the drug of second choice. There is some suggestion that unrecognized or “silent” strokes occur in the elderly and are manifest only by a significant decline in intellectual ability. and grains at a calorie level sufficient to maintain healthy weight. psychological stress. for women who smoke. For those with carotid arterial disease that causes ischemic (deficient blood supply) events such as TIAs. • Alcohol . higher dose hormone pills. vegetables.Living Healthier and Longer – What Works. This approach involves the maintenance of a lowcholesterol. or providing nutrients or antioxidants that may prove helpful.Moderate alcohol intake (not more than 2 drinks daily) may be associated with a protective effect against stroke. The best dose of aspirin for stroke prevention has not been determined. low-fat diet with plenty of fruits. Oral Contraceptive Use – Women who use oral contraceptives have an increased risk of stroke. depression. data does not support this possibility. and highly emotional life events could be risk factors for stroke. other approaches to avoiding stroke are recommended. What Doesn’t vegetables daily were at more than a 30 percent lower risk of having a stroke compared with people who ate less than 3 servings daily. anxiety. Aspirin reduces the relative risk of stroke by about 25 percent with minimal side effects. has been associated with an increased risk of stroke. hopelessness. heavy alcohol intake. For those who cannot tolerate aspirin. and for those that use the older. Older people appear also to be at greater risk of developing the more commonly recognized stroke picture.
What Doesn’t Up to 85 percent of strokes that occur in the U. 2. 4.S. like heart attacks. the “clot-buster” – tissue plasminogen activator (t-PA). Eat at least 6 servings of fresh fruits and vegetables daily. Patients with a TIA should be treated with a statin therapy. A new approach to the treatment of acute ischemic stroke. eliminate cerebral hemorrhage and other problems that contraindicate clot-buster therapy. Know your blood pressure and check it often as you age. 31 . amphetamines). Unfortunately. Strokes. only about 5 percent of acute stroke patients receive this therapy because of their inability to reach hospital emergency rooms within the 3 hour period. if possible. has proven to be quite effective. with patients 30 percent more likely to have minimal or no disability 3 months after such treatment compared to patients not receiving this agent. 6. Notify your physician if your heart beats irregularly. and controlling body weight. when given within 3 hours of the onset of stroke symptoms. avoiding illicit drug use (cocaine. Once in the emergency room.Living Healthier and Longer – What Works. Patients with acute ischemic stroke who are not eligible for clot-busting therapy should be started on aspirin at 160 to 325 mg per day within 48 hours of initial stroke symptoms. Recommendations 1. patients should be studied to determine and. as noted above and seek help immediately if treatments such as clot-busters are to be effective. are medical emergencies. Other factors that are also important in preventing an initial or subsequent stroke include exercising. Aspirin also is valuable for its ability to prevent recurrent stroke in those who have already had a stroke. People must become more familiar with stroke symptoms. each year are ischemic strokes. 5. Do not smoke – smoking nearly doubles the risk of ischemic stroke. with the remainder of the hemorrhagic (bleeding) variety. 7. Recognize that acute stroke is a medical emergency that should be evaluated in a hospital emergency room as quickly as possible – call 911. Be able to recognize warning signs of TIAs or strokes. 3.
Exercise daily and aim for an ideal weight. Patients with ischemic strokes should be discharged on a “statin” drug along with lifestyle modifications and aspirin.gov 32 . 10. 11. 9. Further Reading National Institutes of Health (NIH) National Institute of Neurological Disorders and Stroke Health. Those having a stroke and who are non-ambulatory are at increased risk for developing blood clots in their legs (up to 1/3 of patients with a moderately severe stroke) and thus need interventions or medications to prevent this development.nih.Living Healthier and Longer – What Works. Stroke patients should have screening for dysphagia (swallowing problems) which can be found in 25-50 percent of such patients and could lead to aspiration and pneumonia. What Doesn’t 8.
S. A recent study shows a direct link between a defined cigarette smoke carcinogen (benzo [a] pyrene) and human cancer mutations. 33 . therefore. 8. Smoking and diet may cause up to two-thirds of U. 3. Man-made chemicals. pesticides. Each year about 1. artificial sweeteners. 6.S. and food additives are relatively insignificant or minor causes of cancer. 2.800 men and 210. People who are 40 percent over ideal weight have as high as a 55 percent greater risk of dying from cancer than those of normal weight. Diet. The mutation.S. About 60 percent of human lung cancers contain mutations in the P53 tumor suppressor gene. 4.000 women in the U. cancer deaths. -Nietzsche Facts 1.S. 5. abolishes the effect of this gene against cancer. particularly high-fat and low-fiber. What Doesn’t Cancer That which does not kill me makes me stronger. 7. learn that they have breast cancer. is a significant factor in cancer deaths in the U. Thirty percent of cancer deaths are caused by tobacco.Living Healthier and Longer – What Works. Lung cancer is the leading cause of cancer-related deaths in both males and females in the U.
lifestyle. Some tumors are more prevalent than might be suspected. Lymphoma 6. or biologic insults to a body part’s cells. Melanoma Of these cancers. Melanoma 7. physical. we can expect about 1.1 percent per year. while women have about a 38 percent chance. death rates declined for most cancers. Breast 2. and colorectal account for more than 50 percent of all cancer deaths. for example. the best method appears to be prevention and/or early detection. There are many different forms of cancer. In 2007. prostate. treatment. Colon and Rectal 4.000 deaths from cancer. Favorable trends in incidence and deaths were noted for lung and colorectal cancer in men and women and for breast cancer in women. nearly twice the annual decrease of prior years. of course. It is estimated that men have about a 45 percent chance of developing cancer in their lifetimes. Cancers can develop from any combination of genetic. Among both men and women. and environmental factors. indicate that unsuspected tumors occur in 30 percent of males at age 50 and as many as 100 percent of males by age 90. A relatively small number of cancers make up the majority of cancer cases: Males 1. Uterine 5. Cancer. and prognosis. The National Cancer Institute has estimated that early 34 . Lymphoma 6. Bladder 5. Lung 3. Studies of the prostate gland during autopsy. is not a single disease. Involved is also a complex contribution from diet. chemical. breast.Living Healthier and Longer – What Works. lung. Prostate 2. Recent reports show that cancer death rates are decreasing by 2. Because effective treatments for many cancers are not always available. each with its own pattern of progression and potential for early detection. Colon and Rectal 4.5 million new cases and about 560.S. Kidney Females 1. What Doesn’t Cancer is a major cause of sickness and death in the U. Lung 3.
Living Healthier and Longer – What Works, What Doesn’t
detection practices could reduce U.S. cancer death rates by 25 percent. Early detection is useful for cancers of the: • Breast. • Uterine cervix. • Skin. • Mouth. • Thyroid. • Colon and Rectum. • Endometrium. • Prostate. • Testicle. • Urinary bladder. • • • • • • Prevention is useful for the following cancers: Lung - smoking cessation. Head and neck – smoking and chewing tobacco cessation. Skin – decrease sun exposure. Breast – screening mammography. Colon – screening colonoscopy. Cervix – routine pap smear.
Epidemiological studies have shown that daily consumption of fresh fruits and vegetables is associated with decreased risks of cancers of the: • Lung. • Prostate. • Bladder. • Esophagus. • Colon/Rectum. • Stomach. • Cervix. Eating a high-fat diet may be a factor in the development of cancers of the: • Breast. • Colon. • Prostate.
Living Healthier and Longer – What Works, What Doesn’t
People who consume diets high in salt-cured and smoked foods have a higher incidence of cancers of the: • Esophagus. • Stomach. • • • • Increased risks of cancers can occur from exposure to: Certain tumor-killing drugs. Industrial agents (asbestos) and pollutants. Radiation. Gasses (radon).
Women, including those up to the age of early 50’s, who do aerobic exercises such as running, biking, and/or walking for 4 hours or more each week appear less likely to develop breast cancer. Eating large amounts of red meat (lamb, beef or pork) or processed meat (sausages, canned meat, hamburgers, meats that are smoked, salted or cured bacon) is associated with a higher risk of colorectal cancer. Meats that are prepared by grilling, barbecuing, roasting or frying can develop toxic materials on their surfaces, which in some people might be associated with polyp formation and bowel cancer. In one study of stomach cancer, those who ate beef medium well or well done had more that 3 times the risk of developing stomach cancer as those who ate meat rare or medium rare. That finding points to a relationship of some cancers to cooking habits. Also of interest is the fact that gravy made from meat drippings contains large amounts of cancer causing agents. High consumption of meat is also associated with cancers of the prostate and pancreas. The safest ways of cooking meat are by baking, stewing and boiling. Vitamin supplements have not been proven to prevent any cancer and could in fact be harmful. Although it is known that diets rich in fruits and vegetables lower risks of developing many types of cancer, the exact agent in these foods that lowers cancer risks is not known. Numerous studies have shown that foods high in vitamins C and E, beta carotene, and other antioxidants are associated with lower risks for virtually all cancers. Specific vitamin supplements by themselves, however,
Living Healthier and Longer – What Works, What Doesn’t
have not proven effective and may potentially prove harmful. It appears that it is the actual, natural food product itself and not the antioxidant supplement that provides the protective benefit. Plant foods are loaded with bioactive substances in various mixtures and in combinations with minerals, little-studied chemicals, and numerous unknown contributors that, in some ill-defined way, protect us from many cancers. What we need to do for beneficial effects is to eat a minimum of 6 servings of a variety of fruits and vegetables each day. The best recommendation for reducing the risk of colon cancer is to increase the intensity and duration of physical exercise, limit the intake of red and processed meat, consume recommended levels of calcium, eat more fruit and vegetables, and avoid obesity and excess alcohol consumption. Some recent studies are suggesting a protective role for vitamin D. Endometrial cancer is the most common female reproductive cancer in the U.S. There is strong evidence for a relationship between endometrial cancer and obesity. High levels of physical activity, increased vegetable and fiber intakes can decrease risk whereas red meat, saturated fat and animal fat may increase risk. The risk of prostate cancer can be reduced by eating more fruits and vegetables, limiting intake of red meats and dairy products and maintaining a healthy weight and an active lifestyle. One recent study relates to the increased risk of cancer to patients from the radiation exposure associated with overusing computed tomography (CT) scanning as a diagnostic tool. Estimates suggest that up to 2 percent of all cancers in the U.S. could be attributed to such radiation exposure. The American Cancer Society also offers guidelines for early detection of cancer in people without symptoms. It recommends cancer-related checkups by physicians every 3 years for persons ages 20 to 39 and annually for those ages 40 and older. People at particular risk for certain cancers or with strong family histories, however, should be evaluated more frequently. The American Cancer Society recommends that checkups include: • Health counseling (for instance, how to quit smoking). • Exams for cancers of the: • Breast.
Living Healthier and Longer – What Works, What Doesn’t
• • • • • • • • • •
Uterus. Cervix. Colon. Rectum. Prostate. Mouth. Skin. Testes. Thyroid. Lymph nodes.
It is well known that such screening is valuable, especially in the case of breast cancer. Studies suggest that, if all women ages 50 to 69 had appropriate examinations along with mammography annually, their death rate would decline 30 to 40 percent. To maintain the proper perspective, it is re-emphasized that smoking and improper diets are the causes of approximately 2/3 of U.S. cancer deaths, about 25 to 40 percent and 30 percent, respectively.
use appropriate sunscreens. 39 . stroke and blood clot concerns. such as whole grain cereal. hot flashes and vaginal dryness. 9. For Breast Cancer Screening 1. 6. When used for these problems. and nitrate-cured foods. Discuss needs versus risks of estrogen and progesterone replacement with your doctor. Estrogen however is useful and very effective in managing the disturbing symptoms of the menopause. Eat fruits and vegetables. and pastas. and avoid second-hand smoke. it is best to utilize the smallest effective dose and to take it with progesterone if you still have a uterus. What Doesn’t Recommendations (Modified from the American Cancer Society) For Cancer Prevention 1. Eat a varied diet with lots of high-fiber foods. smoked. 5. Women ages 20 and older should do monthly breast selfexaminations. Avoid all unproven herbal supplements for prevention or treatment of cancers. at least 6 servings daily. heart. do not use smokeless tobacco. Limit consumption of salt-cured. 8. 4. breads. Keep sun exposure to a minimum. Maintain a desirable body weight. 11. 3. 10. Recognize and avoid occupational cancer hazards and potential radiation problems.Living Healthier and Longer – What Works. Estrogen therapy has received a bad press because of cancer. Limit alcohol consumption to no more than 2 drinks daily. 7. especially night sweats. Cut down on total fat intake (less than 30 percent of total caloric intake). Stop smoking. 2.
Performing Pap tests every 3 years reduces invasive cervical cancer by 91. a research group led by an investigator from the Roswell Park Cancer Institute reported a study that demonstrated that women who smoked the most years.2 percent. Recently. Physicians’ recommendations should be heeded. at the physician’s discretion.3 percent results from annual screening.g. the American Cancer Society recommended that women at high risk for breast cancer (e. 4. 7. 3. This is only slightly less than 93. Gene studies are now available and can prove valuable. Still another reason why women shouldn’t smoke. Women ages 50 to 69 should have annual clinical breast examinations and mammograms. Mutations in BRCA 1 and BRCA 2 genes are the best known causes of an inherited predisposition to breast and ovarian cancer. For women ages 70 and older. obesity) get a breast MRI every year along with a regular mammogram. Women ages 40 to 49 should have mammograms every 1 to 2 years. were at significantly increased risk of breast cancer. and clinical breast examinations every year. For Cervical Cancer Screening Women ages 18 and older and those who were sexually active at younger ages should have Pap tests and pelvic examinations at least every 3 years and possibly yearly according to some recommendations. and had a specific gene. 5. 6. evidence of benefit of mammography is limited and conflicting. A review of screening effectiveness studies has led to the conclusion that such screening can reduce breast cancer deaths by 20 to 30 percent. Recently. consumed the highest number of cigarettes per day. Women with a significant family history of breast (or ovarian) cancer and female relatives of women who test positive for BRCA 1 and BRCA 2 mutations should be tested for these mutations. What Doesn’t 2. Regular testing can probably terminate at age 65 for women who have had regular previous screening with normal Pap smears..Living Healthier and Longer – What Works. fat intake. Worldwide studies show that deaths from cervical cancer have been reduced by 20 to 40 .
The best method for early detection of prostate cancer is to combine the digital rectal exam with measurement of the prostate-specific antigen (PSA). and individualize the decision to screen. Some organizations recommend that for men aged 50 years and older and men at higher risk of prostate cancer. and every 10 years a colonoscopy may be performed in place of the sigmoidoscopy or barium enema. What Doesn’t 60 percent since the implementation of cervical cancer screening programs. For Prostate Cancer Screening Digital rectal examination alone will miss 30 to 40 percent of prostate cancers. colorectal cancer screening is underutilized. lowers the risk of colorectal cancer by 76 to 90 percent. requires a colonscopy at least every 3 years. In spite of the availability of good screening tests with life saving potential. The prevalence of colorectal cancer in people over age 80 is about 4 percent. stopping early only when you don’t expect the patient to live 7 to 10 more years. Every 5 to 10 years. Earlier screening should be done for those with family histories or prior diagnoses of familial polyposis or ulcerative colitis. a barium enema may be performed in place of the sigmoidoscopy. A colonoscopy with the removal of all colonic adenomas. Annual fecal occult blood tests and sigmoidoscopy screening every 3 to 5 years currently appears reasonable. For Colorectal Cancer Screening Screening for colorectal cancer is recommended for all persons ages 50 and older. 41 .Living Healthier and Longer – What Works. such as one who had adenomas detected on colonoscopy. Not everyone agrees that regular PSA testing is important. Monitoring a high-risk patient. Studies have documented a 31 to 57 percent reduction in colon cancer risk among persons who receive fecal occult blood testing. clinicians should discuss with the patients the potential benefits and possible harm of PSA screening. Two in 5 adults aged 50 and older report not having been screened. consider patient preferences. Colorectal cancer screening should be continued even in the elderly.
Men with a first-degree relative diagnosed with prostate cancer at a young age should begin screening at age 45.0 as the upper limit of normal in their PSA reports. Men with a life expectancy of less than 10 years should not be screened. low-dose helical CT scanning for general lung cancer screening was not recommended by the American College of Chest Physicians. A slightly elevated PSA might indicate only prostate enlargement. They also give you a risk calculator (computer site below) to help you interpret the reading. An increased rate of change of PSA levels favors prostate cancer while free levels of PSA greater than 25 percent of total favor benign prostatic hypertrophy. For Lung Cancer Screening New and sensitive detection techniques to better identify people at highest risk for lung cancer are being developed. PSA screening should lead to further studies and an array of available treatments. 42 .compass. they include risk ranges. but are not yet available for general use. like The Cleveland Clinic.asp One definite value of PSA screening is its ability to detect disease in young men. Up to 20 percent of localized and curable prostate cancers can be associated with a normal PSA but are detected by rectal examination. in fact. Recently.Living Healthier and Longer – What Works. www. or prostate inflammation.org/edrnnci/bin/calculatory/main. even for smokers. all with their own potential risks and benefits that physicians must study and explain to their patients. What Doesn’t The percentage of men with prostate cancer related to PSA PSA Probability of Prostate Cancer 4-10 Above 10 Above 20 20 – 50 percent 50 – 75 percent 90 percent Some centers. The PSA test does not always indicate the presence or absence of prostate cancer. only 20 to 35 percent of men with elevated PSAs have prostate cancer.Fhcrc. in whom the disease is often more aggressive. which is common as men get older. Instead of a normal range. have eliminated 4. which provide a more meaningful clinical picture.
Summer 2006.epa.cancer. physicians should examine for cancers of the: • Skin. Cleveland Clinic Journal of Medicine. Jones JS. • Mouth. 2006. Four no more: The “psa cutoff era” is over. It is helpful for patients to point out to their physicians new. Clinical evidence. What Doesn’t For Other Cancer Screenings As part of the periodic examination. 43 . Further reading National Cancer Institute (NICH) www.gov/radon The Guide to Clinical Preventive Services.gov For Radon www. Klein E. • Testes. suspicious. British Medical Journal. January 2007:30-32. Concise.Living Healthier and Longer – What Works. or changing lesions on any parts of their bodies.
Being inactive may change a person’s blood sugar level. 2. Taking selenium supplements can increase the risk of getting diabetes. This is a group who has not yet been found to have diabetes but their blood sugar level shows they could get it. People with diabetes are 2 to 4 times more likely to die from cardiovascular disease than those without diabetes. About 20 percent of the people ages 65 to 74 in the U. It is believed that as many as one-half of all people with diabetes do not know they have it. have diabetes.S. What Doesn’t Diabetes: We are learning more about management. Over 70 percent of people with type 2 diabetes are either overweight now or have been in the past. Being overweight increases the risk of getting type 2 diabetes. Smoking can also lead to type 2 diabetes. -Jimmy Durante Facts 1. If I’d known I was going to live this long.S.Living Healthier and Longer – What Works. Smoking increases men’s risk of getting diabetes. Diabetes is the sixth leading cause of death in the U. 5. I’d have taken better care of myself. Up to 12 percent of people with type 2 diabetes may have diabetes because they smoked. People with pre-diabetes have a higher chance of getting cardiovascular disease. for people over 75. 3. 6. By not moving very much they can go from a normal to a diabetic range. 9. 8. 10. 4. 44 . 7. A Harvard School of Public Health study said that men who smoke 25 or more cigarettes each day are twice as likely to end up with diabetes as nonsmokers.
• Complications that lead to various disabling conditions and a shortened life. Fasting Plasma Glucose Level Normal Pre-Diabetes Below 100 mg/dl 100-125 mg/dl Diabetes 126 mg/dl or above Included in the realm of diabetes mellitus and its complications are: • High levels of sugar in the blood. We do know. Pre-diabetic patients have a glucose level which is higher than those without diabetes but lower than those with diabetes. What Doesn’t Diabetes affects about 20. This group is at risk for having disabling and life threatening problems. This is true for type 1 diabetic patients. They also have a higher risk for kidney. About 65 percent of diabetic patients die of heart disease and stroke. Type 1 diabetes is a disease in which the body does not produce enough insulin. This group is said to have pre-diabetes.S. Those who are obese and do not exercise are at risk for type 2 diabetes. There are people who do not yet have diabetes who are at high risk for it.Living Healthier and Longer – What Works.2 million have diabetes but do not know it yet.S. The cause of diabetes is not yet known.8 million Americans. that genetic and environmental factors play a role in type 2 diabetes. It is the sixth leading cause of death in the U. Another 6. Recent figures show that 1. Diabetes leads to at least 225. To see if someone has diabetes. eye and nerve disease. a fasting plasma glucose level test is done. • Having little or no insulin. 45 . Type 2 diabetes is when the body cannot properly use insulin.000 deaths every year in the U. however.5 million new cases of diabetes were in people 20 years or older. Insulin is a hormone made by the pancreas. Diabetic patients have an increased risk for heart attacks and strokes. This is for type 2 diabetes • Tissues and organs breaking down earlier. • Inability of your body to use insulin. This is about 7 percent of the population.
Complications seen in both types of diabetes are similar. These patients’ bodies can still make insulin but their body has a hard time using it. • Diseases in the blood vessels of the extremities. • Fractures. • Work-related accidents. • Kidney problems. This form of diabetes is most often seen in children and adolescents. Both types can lead to development of: • Coronary artery disease. There are no known methods to prevent type 1 diabetes. What Doesn’t About 9 percent of all diabetic patients have type 1 diabetes mellitus. however. Type 2 patients are often ages 40 or older. There are also drugs which increase insulin sensitivity in type 2 diabetes. Diabetic patients are more likely to die from a heart attack or stroke than someone without diabetes. This can include cataracts and retinal problems. • Stroke. patients can exercise and lose weight.Living Healthier and Longer – What Works. It should be noted that about 50 percent of adult blindness is due to diabetes. occur at any age. To help their body handle the high blood sugars in type 2 diabetes. Diabetic patients can also have problems with eyesight or pass out from low blood sugar. Diabetic patients are also more likely to have complications from a heart attack or stroke. This is a problem as depression can affect 46 . type 2 diabetes can possibly be prevented or delayed by lifestyle changes in adults at high risk. • Automobile accidents. This can lead to: • Falls. These patients are usually overweight and inactive. As noted above. Type 1 diabetes can. Around 91 percent of all diabetic patients have type 2 diabetes mellitus. Patients with type 1 diabetes have a pancreas that has little or no ability of make insulin. • Nerve disorders. • Eye problems. Depression is found in up to 70 percent of patients with diabetic complications.
As a result. Educating diabetic patients about the disease and the risk factors is important. and exercise programs.Living Healthier and Longer – What Works. These doctors can keep watch on good blood sugar and blood pressure control. kidney. Low blood pressure also helps. however. kidney and nerve disease by 40 percent. Thiazolidines. Studies have shown that improved blood sugar benefits people with either type 1 or type 2 diabetes. A low dose aspirin. and lack of exercise can make diabetes worse. and nerve diseases by about onethird. suggest that one class of oral agents might be a problem for older diabetic patients. dropping from 8 percent to 7 percent reduces the risk of developing eye. high cholesterol. Diabetes is also the leading reason adults in the US have their feet amputated or cut off. high blood pressure. Complete foot care programs can reduce amputation rates by 45 to 85 percent. They will also have a lower quality of life. Recent studies. Drugs such as ACE-I can improve how well the diabetic patient’s kidneys function. can increase the risk of heart failure and death in older diabetic patients. For example. medications. Finding and treating diabetic eye disease with lasers can reduce the development of severe vision loss by about 50-60 percent. They will then 47 . Control of cholesterol can reduce cardiovascular complications by 20 to 50 percent. for example Avandia. Diabetic patients should know that diet. Keeping blood pressure at or below 130/80 mm Hg or lower reduces the chance of a heart disease or stroke by about 33 to 50 percent. about 81 mg. smoking. up-to-date physicians interested in diabetes and skilled in teaching patients can be a real asset to patients. Depressed diabetic patients are less in control of their diets. It does not matter if you use an oral anti-diabetic agent or insulin. a person who is not in control of their diabetes will die sooner. It turns out that treating high blood sugar is more important than how it is treated. This can lead to other health problems. LDL and triglycerides are higher when you have diabetes. Your HDL. What Doesn’t the course of the illness. Every 1 percent reduction in the hemoglobin A1C (HbA1C) blood test helps. Knowledgeable. Lower blood pressure can also reduce eye. can help diabetic patients over 30 prevent cardiovascular problems.
48 . 4. and lack of exercise. to the team who cares for you. Diabetic patients already have vascular disease. Also control the risk factors that can increase the complications of your diabetes. think about working with a dietitian. A good exercise program is extremely important. Angina is chest pain or discomfort that happens because your heart muscle does not get enough blood. obesity. Some diabetic patients should take a low dose of aspirin every day. can be taken to effectively treat this problem. an eye doctor. This is particularly true for diabetic men taking nitrates for angina. Smoking is even worse for patients with diabetes. You may wish to add an ophthalmologist. These risk factors are cigarette smoking.Living Healthier and Longer – What Works. Learn as much as you can about your diabetes. Keep your blood pressure below 130/80 mm Hg. known as Viagra®. Be in control of risk factors that could make your diabetes worse. Diabetic patients with coronary artery disease may be at higher risk of problems if they use sildenafil. The American Diabetes Association recommends 81 to 325 mg each day. 3. Patients who have already had cardiovascular problems should also take a low dose of aspirin. and knowledgeable about diabetes. Smoking makes it more likely they will have cardiovascular problems. Diabetic patients who are over 30 and have cardiovascular disease risk factors should take a low dose aspirin. Organic erectile dysfunction is common in men with diabetes. Make the care of your feet a priority. 2. Sildenafil. What Doesn’t use this information to anticipate and help their patients avoid complications. high cholesterol. The doctor should also know about all the complications that happen with diabetes. 5. it is important for people with diabetes to stop smoking. Work with a doctor who is interested in. 6. Also. As a result. high blood pressure. This helps reduce the risk of having heart problems or a stroke. Recommendations 1.
8.Living Healthier and Longer – What Works. What Doesn’t 7. Further Reading National Institutes of Health (NIH) National Institute of Diabetes and Digestive and Kidney Diseases Health. quit.nih.org ADA website 49 .gov American Diabetes Association AskADA@diabetes. If you smoke. Watch for the development of symptoms and signs that point to depression and share this information with your physician.
-Agatha Christie Facts 1. 5. 10. 3. About half the patients who get long-term steroid treatments have osteoporosis. 12. About 15 percent of all women eventually suffer hip fractures. 50 . About 30 million over 50 are at risk. By age 65. As many as 20 percent of patients die within a year of hip fracture. About half of people with weak bones are not taking their medicine. 8. Women whose mothers had hip fractures before age 80 are twice as likely to have hip fractures themselves. 2. most women lose about 35 percent of their bone mass. 11. Osteoporosis is a bone disease that weakens your bones. Steroid treatments often lead to weaker bones. the older she gets. Only a small number of patients taking long-term oral cortisone get medication to prevent or treat weak bones.5 mg per day of prednisone can lead to bone loss. Treating and stopping this disease will allow the bones to become stronger.Living Healthier and Longer – What Works. It is estimated that 10 million people over 50 years of age have osteoporosis. Taking 7. 7. Seventy-five percent of women are still not on treatment the year following a fracture due to weak bones. We no longer use estrogen because of the risky side effects. Celiac disease can cause weak bones. 9. 6. the more interested he is in her. What Doesn’t Bone Disease An archeologist is the best husband a woman can have. 4. Bone loss occurs shortly after beginning glucocorticoid therapy. Estrogen is no longer approved for treatment of osteoporosis. This loss happens even for those who are using a low-dose treatment.
A bone density test helps determine your risk of developing fractures. and ribs. This disease has led to more than 1.5 million fractures yearly. About 20 percent of osteoporotic fractures occur in men. X-rays can reveal fractures and spinal deformities. sudden strain. One third of these men will die within a year of the fracture. Those younger than age 65 should have a bone density test if they: • Have gone through menopause. Each year. the stronger your bone is. Osteoporosis is often thought of as a “silent” disease.S. One of the best ways to do a bone density scan is to use a Dual-energy X-ray Absorpitometry. This is a painless way to look inside your body at your bones. Men with low levels of testosterone are at risk for osteoporosis. wrist.Living Healthier and Longer – What Works. This often happens at the time of a fall. or bump. What Doesn’t In the U. and drinking too much alcohol. 51 . Another 30 million more have low bone mass. Fractures due to weak bones are a major public health threat for 44 million Americans. X-rays cannot help see the early stages of decreased bone mineral density. • Have fractures.000 men have a hip fracture. Other causes include being treated for prostate cancer. Fragile bones make it more likely you will have a fracture of the hip. having glucocorticoid therapy. Bone mineral density testing has been recommended for all women over the age of 65. The first awareness of osteoporosis may follow a fracture or collapsed vertebra. spine. 10 million people already have osteoporosis. The higher the mineral density in your bones. • Have a family history of osteoporosis. 80. One out of every 2 women and 1 in 4 men over 50 will have an osteoporosis-related fracture in their lifetime. The test also helps doctors decide if you need to start therapy or if the therapy is working. Osteoporosis can be diagnosed by bone mineral density testing. Few people think about the fact that bone-related problems can shorten your lifespan. This is because bone loss can happen without any signs. Those with low bone mass are at increased risk for this disease. today. People really have no way of knowing their bones are becoming weak and fragile. also called a DEXA scan. Osteoporosis is a bone-thinning disease that leads to increased bone fragility. About 68 percent of those at risk are women. Over 2 million American men have osteoporosis.
Out of 100. the risk is much greater in women than in men. About 25 percent of those who were living independently when they got their hip fracture end up in long-term care. While the causes of osteoporosis are not fully known.000 hip fractures each year in the U. Have certain diseases that cause bone thinning. Take medicines like glucocorticoids and anticonvulsants. Women can lose up to 20 percent of their bone mass in the 5 to 7 years after they go through menopause.000 persons over 65 years old. This rapid bone loss makes them more likely to get osteoporosis. A person’s survival rate goes down 15 to 20 percent in the first year after a hip fracture. Osteoporotic fracture rates increase significantly with age in both men and women. Osteoporosis is responsible for more than 300.S. Because changes in bone mineral density occur slowly with treatment. The risk factors are: 52 . Some factors that increase the risk can not be changed. Women are also more likely to live longer and more likely to fall. All of this explains why women are more likely to get fractures due to weak bones. What Doesn’t • • • • • Smoke cigarettes.Living Healthier and Longer – What Works. They also can lead to disability and loss of independence. the death rate for men within 1 year of a hip fracture is 26 percent higher than for women. 840 will have a fracture due to osteoporosis. Talk to your doctor about how often you should have a test. it is best to get bone density tests every 2 years. Do not exercise. but at any age. Though women have more hip fractures than men. Drink too much alcohol. Elderly white women have about twice the incidence of fractures as African-American women. Others can be changed. Hip fractures also increase the risk of getting sick and dying. certain people are more likely to develop the disease than others. In special cases you may need to be tested more often. Hip fractures are painful and uncomfortable. living a year after the fracture.
• Certain treatments for endometriosis. Being older. Some examples are Dilantin® and barbiturates. or pituitary glands. Having an abnormal absence of menstrual periods. Having diabetes. Drinking too much alcohol. • Specialized medicines.Living Healthier and Longer – What Works. • • • • • • • Factors that Cannot Be Changed Being female. Kidney and liver diseases and certain tumors. What Doesn’t Factors that Can Be Changed • • • • • • • • • Consuming a low-calcium diet. asthma. Smoking. Only a small percentage of patients using steroids are 53 . Endocrine disorders involving thyroid. Having menopause early in life. Not moving around much. • Seizure medications. a type of steroid. Some examples are using proton pump inhibitors or taking H2 blockers. Taking certain medications. Having a small. These medications include: • Glucocorticoids. adrenal. Some examples of these are methotrexate. Malabsorption of calcium. Having a family history of osteoporosis. Low testosterone levels in men. • Antacids that have aluminum in them. and chronic lung disease. Not exercising. • Heparin that is used long-term at a high-dose. • • • An important and often overlooked risk factor for osteoporosis is taking medications that can damage bones. • Excessive doses of thyroid hormone. Taking oral cortisone long term can weaken bones. cyclosporin A. Being of a Caucasian or Asian race. Oral cortisone is commonly used for arthritis. thin frame. Being anorexic or bulimic (forced vomiting). and cholestyramine.
• Risedronate. Here are some activities that can be done to keep bones healthy: • Get enough calcium. Teriparatide. They should also take calcium and vitamin D to help keep their bones strong. The following 3 medicines have been found to effectively treat bone loss: • Alendronate. These behaviors are important for the health of your bones. Their bodies are not able to keep the calcium and use it. Most patients on steroids will need alendronate. The common name for this is Fosamax. and Vitamin K by choosing foods and drinks high in these vitamins. Some examples are walking. dark green vegetables are high in Vitamin K. • Do weight bearing exercises. Studies show that Fosamax is better than Vitamin D in preventing bone loss due to steroid use.Living Healthier and Longer – What Works. Vitamin-D. Start them early in life and keep doing them throughout your life. Prevention of osteoporosis is very important. • Ibandronate. • Get fluoride. a different medicine also known as Forteo. also called Forteo. Teriparatide. stair climbing. People who have been taking steroids for awhile should get a bone density test. The most common form is called Actonel. The most common form is called Boniva. is a drug used for special problems with high risk factors. jogging. Smokers should quit. What Doesn’t also on programs to keep their bones strong. People diagnosed with osteoporosis should follow the behaviors listed above. there is a new 54 . Smokers appear to absorb less calcium from their diets. They also recommend people using steroids do 30 to 60 minutes of weight bearing exercises each day. • Avoid getting too much Vitamin A. hiking.500 mg of calcium and at least 800 IU of Vitamin D daily while on steroids. Check to see if this is true for your area. For example. The American College of Rheumatology recommends getting 1. Taking medication can also help. and dancing. tennis. weight training. For those who cannot remember to take their medicine. The most common form is called Fosamax. Fluoride is often in the water supply. These bisphosphonates can reduce hip fractures by about 50 percent. also appears to be effective at stopping bone loss due to steroid use.
Falls can be due to: • Various medications that cause people to feel relaxed or sleepy. • Various medicines that can cause loss of balance and lowered blood pressure. lightheadeded. Get enough calcium and vitamin D and K. What Doesn’t approach that is being used. Recommendations 1. 3. Zoledronic acid. Stop smoking. • Loss of hearing. • Smoking or having smoked in the past. • Having a parent or sibling who has had a fracture because of weak bones. 55 . • Loss of coordination. These include: • Weighing less than 127 lbs.Living Healthier and Longer – What Works. Vitamin D can also help keep balance so you do not fall and injure yourself. Rather than taking a pill. • Combinations of medications that present special problems. This is especially important if you are in a high-risk category. Check with your doctor about medications you take that can cause osteoporosis. Understand the complications of falls. • Muscle weakness. Exercise. • Loss of vision. This is a drug. that is given once a year. 5. 4. or dizzy. Approximately one-third of people ages 65 and older will fall each year. 2. a person would go in to the doctor and be given the drug with a needle that goes into your veins. A recent study suggested that 5 years of bisphosphonate therapy was enough for many patients. Come up with ways to avoid falling. Be aware of personal risk factors you may have for osteoporosis. • Having already had a fracture because of weak bones. 6. • Diseases that affect balance.
1000 The average American diet usually has less than half of the calcium that is recommended.800 800 . Taking Nexium. or Prilosec. of skim milk or 8 oz. It is important that we get as much calcium from our diets as possible. Have adequate lighting and hand rails. Optimal Calcium and Vitamin-D Requirements Age Group 19-50 51 to 70 Over 70 Recommended Calcium Intake (mg of Calcium) 1000 1200 1200 Recommended Vitamin D Intake (IU) 400 600 . Avoid taking proton pump inhibitors. Prevacid. of calcium-fortified orange juice. By drinking 8 oz. Pay attention to household hazards like loose carpeting. or toys on the ground that can cause you to trip. Consider the many new drugs available to prevent and treat osteoporosis. 8. What Doesn’t 7. 10.Living Healthier and Longer – What Works. Calcium Supplement C alcium carbonate Calcium citrate Calcium gluconate Sample Source TUMS Fortified orange juice tablet Percent of Elemental Calcium 40 24 9 Elemental Calcium in 500 mg Tablet 200 mg 120 mg 45 mg Eating food when you take calcium supplements helps your body get the most calcium. calcium 56 . Elemental calcium is the form of calcium your body uses. for more than 12 months can increase your risk for hip fractures. Make your home a safe environment. The supplements contain different amounts of elemental calcium. you can get 300 mg of calcium. Limit how much alcohol you drink. Calcium supplements are available in several different forms. extension cords. 9. Keep things out of the way that you can trip over. Multivitamin preparations often contain about 400 IU of Vitamin D. When taken with food.
Further Reading National Institutes of Health National Institute of Arthritis and Musculoskeletal and Skin Disease Bone Health Health. magnesium. Be careful about how much calcium you get. It can also interfere with the absorption of phosphorous which is also needed for bones. 2006 57 . Aging skin is less efficient at producing Vitamin-D in association with sunlight.Living Healthier and Longer – What Works. Vitamin-D is necessary for your body to absorb the amounts of calcium you need. Also. elderly populations tend to drink less milk. If you take 2.nih. Older people may also need longer exposure. Usually. which is often fortified with Vitamin-D. Older people may have insufficient exposure to sunlight. A daily 10-minute exposure of the hands and face to sunlight can generate 200 IU of Vitamin-D. What Doesn’t carbonate and calcium citrate are equally well absorbed by the body. People with low levels of Vitamin-D are at increased risk for fractures due to weak bones. It can also lessen the absorption of phosphorous which is needed by your bones.gov The Guide to Clinical Preventive Services.500 mg or more daily you can keep your body from getting enough iron. Living in northern climates that lack sunlight also adds to this problem. Vitamin-D needs are met through exposure to sunlight. and zinc.
4 million of them have Alzheimer’s Disease (AD). About 5 percent of men and women ages 65 to 74 have AD.Living Healthier and Longer – What Works. but can survive for as many as 20 years. Advanced age and family history are the 2 most important risk factors for AD. 13. 12. No treatment has been proven to stop AD progress. 10. Dementia occurs in up to 20 percent of patients with HIV infection. 9. 58 . 11. and nearly half of those age 85 and older may have the disease. 8. Genetics is an important determinant of dementia.4 million Americans age 71 or older have dementia. up to 10 percent of those seen for memory problems are found to have reversible dementia related to medications. Regular exercise is thought to be able to delay the onset of dementia and AD. -Albert Schweitzer Facts 1. 2. Dementia may be reversible in approximately 10 percent of patients by treating hypothyroidism or depression or stopping causal medications. and 2. especially in early-onset AD. 4. 7. 6. AD patients live from 8 to 10 years after they are diagnosed. Delirium and depression may be misdiagnosed as dementia. In geriatric clinics. A large number of drugs lead to memory and/or thinking impairment. About 3. 3. 5. One in 7 Americans age 71 and older has some type of dementia. What Doesn’t Dementia Happiness? That’s nothing more than health and a poor memory.
• Problem-solving. such as those used for: • Pain. • Brain tumors or trauma. Medications. Alcohol abuse. which includes cerebrovascular phenomena such as: • Inflammation of blood vessels. Multiple areas of intellectual function are often affected. • High blood pressure. • Hypothyroidism. repetition. • Emboli or hemorrhages. • Judgment. with areas of impairment including: • Abstract thinking. • Memory. including: • HIV. • Creutzfeldt-Jakob disease. • Single or multiple brain infarctions. 59 • • • • • .Living Healthier and Longer – What Works. either alone or in combination. • Perception. What Doesn’t Dementia is an acquired loss of memory and other mental skills that interfere with the performance of daily activities and relationships. Vascular disease-10 to 20 percent. • • Important causes of dementia in older Americans include: Alzheimer's disease-50 to 85 percent. Poor nutrition. • Meningitis. • Syphilis. • Planning. • Tuberculosis. including: • Vitamin B12 deficiency. Infections. Metabolic disorders. • Sleep. • Parkinson's Disease. • Language.
Dementia is responsible for about 120.000 deaths annually. Dementia is commonly overlooked in its early stages. depression. As many as 33 percent of demented persons who were still driving had motor vehicle crashes or moving violations within the previous 6 months. high blood pressure in middle age. the deaths being strongly associated with its severity. or treatable endocrine problem like thyroid disease or a nutritional disorder. What Doesn’t • • Sedation. and high cholesterol values are all 60 . • Drug excess or toxicity.Living Healthier and Longer – What Works. This fact points to the potential for harm to patients. Treatment of psychiatric illnesses. Patients need to consult their physician or pharmacist about the role of medicines in dementia. The number of demented patients who experience long-term improvement is relatively small. • Vitamin B12 deficiency. Diabetes. • Hypothyroidism. the treatment of which could result in improvements for many patients. ulcer or heartburn treating drugs. Some estimates suggest that 10-15 percent of dementia patients have a potentially reversible condition such as a drug intoxication. Common medications often associated with memory impairment or dementia-like situations include steroids. • Normal pressure hydrocephalus. anxiety treating drugs and sleeping medications. and care-givers as well as to the public. • Space-occupying lesions such as a subdural hematoma. Finding and correcting underlying causes could result in improvement in some patients. Other studies have shown that about one-half of elderly dementia patients have at least 1 coexisting illness. the time when reversible factors that cause or contribute to the disorder can be managed best. these causes include: • Depression. family members. • Poor nutrition. • Alcohol abuse. Dementia patients are at increased risk for falls and automobile accidents. • High fever and dehydration.
Having lots of friends and acquaintances and participating in many social activities is associated with reduced cognitive decline and decreased risk of dementia in older adults. It is important to recognize that controlling cardiovascular risk factors might reduce the risk of experiencing cognitive decline. making judgments.” The acetylcholinesterase inhibitors donepezil (Aricept). cholesterol. 3. Regular exercise also appears valuable in delaying the onset of dementia and AD. blood pressure and diet control appear helpful. No treatment has been proven to stop AD. 61 . Be familiar with areas of impairment that suggest dementia.Living Healthier and Longer – What Works. bring a family member or close friend who is familiar with your day-today activities. According to the prestigious Medical Letter (February 2007) “currently available drugs for the treatment of AD and other dementias can produce some limited symptomatic improvement. More data are needed. 2. Once again. When consulting a physician regarding dementia. activities of daily living and behavior. Recommendations 1. More commonly used medications can be valuable in treating certain symptoms or associated disorders that are commonly seen with AD. however. psychosis and agitation. Stimulating the brain with crossword puzzles. Some observational studies suggest the possibility that “statin” drugs may be able to delay the onset of dementia. Evidence exists to support the association between cardiovascular health and cognitive health. are probably of little proven value in delaying or preventing dementia. reading newspapers and other challenges. The benefits of cholinesterase inhibitors are small and difficult to measure. Behavioral and other non-pharmacological interventions should always be attempted. consult your physician or one specializing in dementia. What Doesn’t associated with poorer mental performance later in life. such as depression. once thought to be effective. or communicating with others. If you have difficulty with memory. rivastigmine (Exelon) and galantamine (Razadyne) and the NMDA-receptor antagonist memantine (Namenda) have produced modest improvements in cognition.
Don’t overlook the possibility of AIDS as a cause of dementia in an elderly patient.Living Healthier and Longer – What Works. 5. 62 . 6. What Doesn’t 4. Check your family history for possible cases of dementia. realizing that diagnosis may have been missed or the symptoms attributed to aging. Exercise regularly.
8. occur in those aged 50 and older. Influenza is the major cause of death due to infectious disease in the U.S. Estimates suggest that there are approximately 1 million asymptomatic carriers of hepatitis B virus in the U. do not know that they are infected. 63 .S. 11. It is estimated that 250. for those ages 25 to 44 years. AIDS is the leading cause of death in the U. 9. About 10 percent of AIDS cases in the U. Sixty to eighty percent of people who use illicit drugs intravenously have evidence of hepatitis B virus infection 10. living with AIDS. Males make up about three quarters of patients diagnosed with AIDS in 2005. Over 16. 5.Living Healthier and Longer – What Works. 6.S. 4. become infected with HIV each year. What Doesn’t Infections/HIV and the AIDS Epidemic The biggest disease today is not leprosy or tuberculosis but rather the feeling of being unwanted. most coming from male to male sexual contact.000 persons in the U.000 persons died with AIDS in 2005. the last report suggested 56. Recent studies suggest that there are over 420.S. Severe pneumocooccal bacterial infections result in death in 30 to 40 percent of elderly patients.S. 3. 2.S.000 persons in the U.S.000 people infected with HIV in the U. -Mother Theresa Facts 1..000 deaths per year. About 40. 7.
AIDS is not only a problem for young adults. which can have symptoms like dementia and weight loss (not uncommon in the elderly). regulations for food handling. were infectious diseases such as influenza. Unfortunately. • Sexual partners of injection drug users. • Transfusion of infected blood or blood components. AIDS (acquired immunodeficiency syndrome). when considering infections that shorten life in significant numbers of people. About 10 percent of all cases diagnosed each year occur in both males and females. Viruses. and gastrointestinal infections. hantavirus. living with AIDS. diagnosis. The development of vaccines and antibiotics. men who have sex with men and injection drug users account for more than 80 percent of AIDS cases. this group makes up 14 percent of AIDS cases. however. In certain areas of the country with high concentrations of people over 50. with approximately 40. and hepatitis viruses. improved hygiene.S. The vast majority of people infected with HIV will develop AIDS.000 persons in the U. Today. and transmission.000 new infections occurring each year. the AIDS virus. ages 50 and older. new and often difficult to treat infectious agents have proven to be major threats to public health. recently have been of particular concern. Current estimates suggest that there are over 420. 64 . might not even be considered in diagnosing elderly populations. What Doesn’t At the turn of the twentieth century. the main causes of death in the U. tuberculosis. has become the leading cause of death for people ages 25 to 44 years. Increasing numbers from this group are from heterosexual transmissions and probably are also related to this population’s lack of knowledge about HIV infection and its characteristics. Recent information tells us that HIV/AIDS is the eighth leading cause of death in the U. and treated water supplies have led to major inroads in preventing and controlling these diseases. a term denoting the later stages of HIV infection with complications. bacterial pneumonia.S.S.Living Healthier and Longer – What Works. especially human immunodeficiency virus (HIV). Most other cases result from: • Transmission from mother to fetus. HIV infection quickly comes to mind. According to the Centers for Disease Control and Prevention.
is a viral respiratory illness caused by a coronavirus. • Sex partners of injection drug users. During outbreaks of avian influenza among poultry. saliva. Basic infection control measures are essential and effective in preventing transmission of this deadly virus. • Prostitutes and their sex partners. It is important to be aware of the fact that women on highly active antiretroviral therapy can still shed the virus intermittently in the genital tract. though uncommonly seen in the U. • Homosexual. Thus the potential exists for sexual transmission of HIV even among women whose virus appears to be controlled. or urine. • Those who have had blood product transfusions between 1978 and 1985. People at high risk for HIV infection include: • Men who have sex with men. • Injection drug users. viruses and fungi are common throughout life and are found to varying degrees in different age 65 . • Those having multiple sex partners. including emergency room visits and primary care appointments. Other infections from bacteria. Patients at high risk for HIV infection should be screened annually. The virus is spread mostly by close person-to-person contact and possibly by airborne spread. HIV screening tests using blood mostly. bisexual. SARS. not using latex condoms). or heterosexual people who have had HIV-infected sex partners. especially if engaging in unprotected sex (i. Rapid HIV tests and home testing kits are available. Positive tests are followed with more confirmatory studies. though such cases are rare. severe acute respiratory syndrome. the virus can be spread by contact with an infected individual's feces.. Such individuals can develop severe respiratory distress pictures associated with a high death rate.Living Healthier and Longer – What Works.. there is a possible risk to people who are in contact with infected birds or their excretions. What Doesn’t In theory. SARS. are available and effective. but also saliva or urine. Oseltamivir (Tamiflu) may be of some value in such cases. It is now recommended that HIV screening be applied to all patients age 13 to 64 years in all health care settings. has caused many deaths in certain countries.e.S. No vaccines are generally available yet.
They are effective when administered as treatment and when used as a preventative agent after an exposure to influenza virus. antiviral medications are available and can be used in support of vaccination.S. People infected with HIV are more likely to develop active TB than others. making them less able to withstand infections. if possible.S. Hispanics and Blacks continue to have the largest percentage of cases. there were over 14. The elderly are at increased risk for the major lethal complication of influenza which is pneumonia. In 2005. Oseltamivir (Tamiflu) and zanamivir (Relenza) are the only antiviral medications currently recommended. What Doesn’t groups. complicating treatment efforts. An effective influenza vaccine is available and can reduce deaths associated with influenza outbreaks. especially in the elderly who. cause a large amount of sickness and death.000 TB cases reported in the U. are thought to lose some immunologic functions. For the elderly or other individuals at high risk during community outbreaks. Pneumococcal bacterial disease can cause major sickness and death. pneumonias can be prevented by careful feeding and attention to swallowing mechanisms of sick patients and. A small number of infections in the U. Pneumonia may be difficult to diagnose in the elderly and some cases will be unresponsive or difficult to treat. Outbreaks of resistant pneumococcal pneumonias are still reported in nursing homes. Asians and Native Hawaiians or other Pacific islanders also have high case rates. Major problems and increased deaths have been associated with the development of resistance to many of the standard drugs used to treat TB. About 35 percent of pneumococcal bacteria responsible for infections are resistant to at least 1 drug and 17 percent were resistant to 3 or more drugs. Tuberculosis (TB) case rates and deaths from TB have been steadily declining. A pneumococcal conjugate vaccine is available and capable of preventing many infections due to drug-resistant pneumococci. by avoiding tubes that assist with feeding or breathing in such patients. In some cases. especially hospitalized patients.Living Healthier and Longer – What Works. 66 . through aging. Influenza can cause significant sickness and death during epidemics.. more than half occurring in foreign-born patients. and child care centers. Amantadine or rimantidine are no longer used. institutions caring for HIV-infected persons.
isoniazid. This is the first anti-cancer vaccine. • Healthcare workers. What Doesn’t Skin tests and chest x-rays can help detect TB infection in exposed people who do not have symptoms. • Residents of long-term care facilities. such as the medicine taken in presence of health care provider) is available and proving effective for this disease. A vaccine is available for hepatitis B. Such people include: • Persons infected with HIV. The incidence of all forms of hepatitis has been decreasing in recent years. Mother to baby/ child and child to child spread is also important. As many as 50. 67 . but also commonly from sexual activity. • Illicit drug users. Drug therapy (combined with directly observed therapy. • Alcoholics. The number of cases of multi-drug resistant TB has been steadily declining. Healthcare workers are especially at risk for these diseases. • Persons in close contact with TB patients. It should be given to those at increased risk including: • Healthcare workers. Viruses are also the cause of hepatitis B and C. • Immigrants. like liver cancer. It prevents hepatitis B disease and its serious consequences.Living Healthier and Longer – What Works. both of which can cause severe liver damage in the form of cirrhosis and liver cancer. now about 1 percent of cases. a blood test – QuantiFERON – TB Gold test (QFT-G) has become available to help diagnose TB and can be used in the same circumstances in which the tuberculin skin test is used. has proven effective in preventing the subsequent development of active TB in such people. The finding of a newly positive TB skin test reaction is important because a drug. Recently.000 new infections with hepatitis C are suggested annually. • People with hemophilia. The greatest risk coming from injecting illicit drugs. An estimated 20.000 persons become newly infected with hepatitis B each year.
blood transfusions. People traveling to parts of the world with a high prevalence of hepatitis B (e. 2.Living Healthier and Longer – What Works. 6. ages 50 or older and living in institutional settings. If you are in a high-risk category for HIV infection (such as engaged in unprotected sex with a person of unknown HIV status). sexual activity). Seek monogamous sexual relationships with uninfected partners. particularly if engaged in risky behaviors (e.. Patients who have had surgical removal of the spleen or have nonfunctional spleens (sickle cell disease) should obtain pneumococcal vaccines. Learn basic information about HIV infection and AIDS. Recommendations 1. People at high risk.. or chronic kidney problems should obtain pneumococcal vaccines. What Doesn’t • • • People living with hepatitis B infected persons. People with new or multiple sex partners should use latex condoms. Asia). or having problems such as diabetes. The risk of acquiring hepatitis C infection is also increased by the use of illegal drugs. discuss this situation with your physician and obtain HIV testing. chronic heart or lung disease (emphysema). 3. 5.g. There is no hepatitis C vaccine. 4. Patients ages 65 or older. solid organ transplants or long term kidney dialysis. Insure proper oral hygiene for patients in nursing homes or on ventilators to prevent pneumonias. Hand-washing (especially after bowel movements) is one of the most effective and most overlooked ways to prevent the spread of disease. 68 .g. 7. Educational material is often provided by hospitals and public health departments.
69 . National Center for HIV/AIDS.gov. National Institute of Allergy and Infectious Disease. Centers for Disease Control and Prevention (CDC). What Doesn’t Further Reading National Institutes of Health. 2006. STD. Health. and TB Prevention The Clinical Guide to Preventive Services.Living Healthier and Longer – What Works. Viral Hepatitis.nih.
but many enjoy sex into their 80s. or excessive alcohol. Over 60 percent of men with erectile dysfunction will respond positively to drugs like sildenafil (Viagra®). Numerous medications and recreational drugs can interfere with sexual functioning. sex and laughter do go very well together. 70 . About 15 percent is caused by psychological problems. are consistently unable to have an erection adequate for sexual intercourse. medications. neurological problems. -Hermione Gingold Facts 1. high blood pressure. 4. Between 20 and 30 million men in the U. diabetes. What Doesn’t Sex Really. A high percentage of people experience sexual problems at some time in their lives.Living Healthier and Longer – What Works. 5. About 85 percent of impotence is due to physical causes such as vascular disease. 2. and I wondered —and still do —which is the more important.S. 3. smoking.
For the female. however. which can worsen the sexual difficulties. Sexual dysfunction. • Depression. Impotence. Problems involving one or more of those systems interfere with normal sexual function. and physical examinations. Professional help from physicians or trained specialists may be needed in many cases. What Doesn’t To date. Good or bad sex is somewhat difficult to define. However. For satisfying sexual function to occur. interferes with interactions of the nervous. though the manifestations of sexual dysfunction are more easily recognized in men. vascular. Probably easiest is to say that the sexual experience depends on whatever the involved couple mutually finds satisfying or unsatisfying. • Dementia. few would deny that good sex throughout life makes life more enjoyable. thorough histories. the authors have found no good studies to indicate that good sex extends life. It is important. vascular. that people recognize that such a problem exists. and appropriate laboratory evaluations are essential. • Anxiety. Sexual dysfunction may be the earliest appearance of an illness that. loss of desire for sexual activity is the most common problem and often the most difficult to treat. most cases of sexual dysfunction are treatable by approaching the underlying physical or psychological problems. can be a result of: • An underlying emotional or psychiatric disorder. in one way or another. and endocrine systems.Living Healthier and Longer – What Works. as suggested by changes in sexual desire and ability. nervous. and endocrine systems. • Schizophrenia. the 71 . The most common problem regarding sexual function in the male is decreased erectile function. there must be a complex interaction of psychological. The causes of sexual dysfunction are similar in men and women. and the resulting sexual dysfunction can lead to interpersonal problems for the couple. Fortunately. In all cases. • Stress.
correction or control of illnesses may not always eliminate sexual dysfunction.Living Healthier and Longer – What Works. Recreational. is a distressing problem for men that can be caused by a variety of illnesses. • Certain blood vessel disorders. • Beta-blockers. spironolactone). • Alphamethyldopa. Unfortunately. including: • Parkinson's disease. • Herniated discs. • Guanethidine. • Endocrine disorders. if the dysfunction is caused by a medication. • Drugs that interfere with sexual function include: High blood pressure medications. • Multiple Sclerosis. • Opiates. • Cocaine. • Thyroid disorders. • Reserpine. abused. the problem can often be resolved. • Heroin. menopausal problems or menstrual irregularities are rarely the cause of sexual difficulties in women. • Strokes. • Prazosin. Low levels of the male hormone testosterone are responsible for only a small percentage of impotence cases. • Coronary artery disease. recognized disorders include: • Conditions involving the brain and spinal cord. • Estrogen. Likewise. • Hydralazine. including: • Tobacco. • Hypertension. What Doesn’t inability to achieve an erection adequate for sexual intercourse. including: • Diuretics (thiazides. 72 • . or illicit drugs. including: • Diabetes mellitus. However.
g. and tadalafil (Cialis®) are generally equal in effectiveness. Others. • Barbiturates. • Serotonin re-uptake inhibitors (e. Aphrodisiacs do not work (except for a possible placebo effect). Sildenafil (Viagra®). nor do such popular items as ginseng. • Trazodone. including: • Phenytoin (Dilantin®). • Clofibrate. or various other herbs. rhinoceros horn. melatonin. • Digoxin. • Estrogen. vardenafil (Levitra®).g. Antidepressant medications. drugs known as phosphodiesterase inhibitors can be tried.Living Healthier and Longer – What Works. including: • Tricyclics (e. • Monoamine oxidase inhibitors. A relatively common recent problem is the use or abuse of high doses of anabolic steroids by recreational body builders. including: • Antihistamines/decongestants. Men with sexual dysfunction who have low serum testosterone levels could benefit from testosterone replacement therapy. though tadalafil has a longer duration of effectiveness. Drugs that act on the central nervous system. All are contraindicated in men taking nitrate preparations for coronary artery disease. These drugs are effective.. • Cimetidine. • Tranquilizers. easy to use and without major side effects in most users. After all efforts have been made to determine a treatable cause of erectile dysfunction. • Cancer chemotherapeutic agents. The good news for men with impotence (erectile dysfunction) is that most can be helped. Elavil®). What Doesn’t • • • • Alcohol. 73 . • Phenothiazines. Prozac®). Use of these agents can be associated with a wide range of serious complications and even death.
if any. A common source of anxiety related to sexual activity occurs after a heart attack or coronary bypass surgery.Living Healthier and Longer – What Works. because erectile dysfunction is commonly associated with cardiovascular disease. is having sex with a person other than one’s usual partner. good control of cardiovascular risk factors may be good for sexual performance. What Doesn’t It is commonly recognized that blood levels of testosterone in men decline with age. Unfortunately. or cholesterol burner. research on female sexual dysfunction has not been as productive as that for male sexual dysfunction. • Diet. however. At present. If this is true. Of interest is the fact that. does not contribute to life extension. A study at the University of South Carolina School of Medicine found that men whose total cholesterol was greater than 240 mg/dl were almost twice as likely to become impotent as those whose cholesterol levels were below 180 mg/dl. It has been suggested that sexual intercourse as an exercise might be the equivalent of climbing about 20 stairs. The question often arises whether testosterone supplements are of any value in older men with low normal testosterone levels. However. which contributes to impotence. a happy wife is more likely to see that her husband gets 74 . Studies at Duke University also suggest that cholesterol-blocked vessels may slow the flow of blood to the penis. especially important are: • Exercise. it is better understood why sexual activity as an exercise factor. One recognized source of increased risk. A recent study of testosterone supplementation in older men did not support a net benefit on several indicators of health and functional and cognitive performance over a 6 month period. • Alcohol restriction. studies suggest that heart attack patients who are otherwise doing well have little. On the other hand. risk from sexual intercourse and should be able to resume sexual activity during the second week after hospital discharge. • Not smoking. there are no really effective drugs for the treatment of sexual dysfunction in females. The concern is that sexual intercourse may trigger another heart attack.
Recommendations 1. 3. takes his medications. 2008:39-52. Communicate to your partner the sexual feelings and behaviors in which you would like to engage. et al. Further Reading National Institutes of Health (NIH) Sexual Health (General) Health. caring physicians. 2.Living Healthier and Longer – What Works. Verharar HJ. cognition. 4. and other parameters in older men. Most couples eventually experience some form of sexual problems that can be satisfactorily resolved by knowledgeable. If you experience sexual dysfunction problems. Remember that certain diseases and various drugs can cause sexual dysfunction. avoids depression. 75 . and visits his doctor.gov Emmelot-Vonk MH. Ask your physician about trying a phosphodiesterase inhibitor for your erectile dysfunction. What Doesn’t his 6 servings of fruits and vegetables daily. do not hesitate to seek professional help. January 2. Journal of the American Medical Association.nih. Effect of testosterone supplementation on functional mobility. 5.
Smoking materials have been implicated in up to 33 percent of residential fire deaths among the elderly. M. you learn to play the hand well.S. Alvarez.S. 4. Facts 1. 9. and twice as likely to suffer other unintentional injuries. 8.S.5 times more likely to be injured at work. Falls are the second leading cause of unintentional injury death in the U.000 deaths. Battering accounts for about one-half of all serious injuries in women presenting to emergency departments. with an estimated 4. 5.5 times more likely to have motor vehicle crashes. 1.4 to 2. nature deals you a fine hand at cards. 7.Living Healthier and Longer – What Works. and 4 million emergency room visits. Increased use of automobile safety restraints contributed to a 32 percent decline in the death rate from car crashes. What Doesn’t Injuries/Accidents Domestic Violence With a good heredity. Injury is the third leading cause of death in the U.000 hospitalizations. Thirty percent of Americans do not routinely use seat belts. smokers are 1. 76 . -Walter C.. 6. More than 40 percent of crashes are alcohol related. 500. and with good environment. When compared with nonsmokers. 2.000 women killed each year. Domestic violence is the leading cause of injury to women in the U. Each year motor vehicle crashes result in 40.D. 3.
3 million potential years of life lost prematurely before age 70. because they usually can be attributed to preventable behavioral and environmental factors. • Dulled reaction times. What Doesn’t Injury is an important cause of death in the U. Motor vehicle crash-related injuries are important causes of death.Living Healthier and Longer – What Works. • Falls . • All others . In the U. • Drowning. • Burns.23 percent. • Falls. Injuries are not necessarily accidents. • Strikes by falling objects .12 percent. 17 workrelated fatalities occur each day. their leading causes are: • Motor vehicles . Dementia particularly impairs driving ability. Motor vehicle fatality rates are highest for the young and elderly.13 percent.7 percent. Helmets (bicycle or motorcycle). • Homicides .S.10 percent. as do alcohol and sleep disorders. Injuries commonly occur in the workplace. • Loss of hearing. • Poisoning. accounting each year for about 4. related to: • Loss of vision.S. Drivers ages 70 and older have more fatalities than middleaged drivers. • • • • • All drivers should recognize the value of: Seat belts. • Electrocutions . Driving free of the influence of: • Alcohol.7 percent. Periodic vision and hearing exams. 77 .. • Machines . Air bags. Important causes of injuries include: • Motor vehicle crashes.. meaning those that occur by chance and are unavoidable.28 percent.
result in death about 20 percent of the time within 1 year. in turn. physical or mental deficiencies. Drunk drivers are at a disadvantage because their driving skills are impaired. Among the elderly. which. or prescribed medications that can hamper your ability to drive or operate machines that require significant skill and attention. • Slippery floors. they are less likely to use seat belts and are more likely to speed. What Doesn’t • • • Illicit drugs. approximately 20 percent of falls result in direct impact on the hip. such as hip fractures. About one-third of drivers killed in crashes are intoxicated by alcohol. risk factors include: • Pavement irregularities. hip fractures are the most frequent serious consequence of falling. are: Weight bearing exercise.. Frontal air bags can potentially reduce the risk of death by an additional 9 percent among belted drivers and by 20 percent among unbelted front-seat passengers.S.000 deaths and 1. Many medications have mind-altering effects. Your physician may comment and advise you on the habits. and tranquilizers are also important contributors to lethal crashes. Wearing protective pads may reduce the risk of hip fractures in this group. resulting in over 14. Those thrown from vehicles are 24 to 40 times more likely to be killed. • Poor-fitting or inadequate shoe size. At least one-third of older adults fall each year in the U. Certain prescription medications. especially for the elderly.8 million emergency room visits. Drugs such as marijuana. Wearing a seat belt can increase the survival rate of car crash passengers by one-half.Living Healthier and Longer – What Works. • Poor lighting. Falls by elderly people lead to injuries. • • • Helping to protect against falls. 78 . Some environmental risk factors can be corrected to help prevent falls. cocaine. Gait aids such as a walker. Gait retraining. Certain over-the-counter medications.
• Confusion. yearly eye exams. The mistreatment of the elderly may be even more difficult to identify because of: • The relative isolation of this group. Homes often do not have smoke detectors. and attention to the temperatures of tap water. and drinks can greatly reduce the incidence of fire and burn injuries. have the highest death rate for those ages 60 and older. Men are the victims of about 2. • The subtle forms that this abuse can take so that it is often undetected. especially in bed. • The tendency not to report this form of abuse. 79 . • Pulmonary edema. Elderly patients with arthritis or other painful problems may use too much aspirin or other pain relievers that can lead to: • Gastrointestinal bleeding. In the U. Unintentional poisonings lead to a significant number of deaths among adults. Most of these deaths are related to overdose of alcohol or drugs such as heroin and cocaine. the highest incidence being in young adult men. Recognition of medication side effects. beaten. Adult women are more likely to be sexually assaulted. from all cultural and socioeconomic groups. Burn injuries. Avoiding smoking.9 million intimate partner-related physical assaults. Estimates also suggest that up to 2 million cases of elder abuse occur annually in the U. food. What Doesn’t • • Adequate vision correction. Combinations of these efforts can reduce the risk of falling by about 30 percent. This is of particular concern as the population ages. most commonly flame and scald injuries. Cigarette smoking is an important cause of fire and burn injury deaths and is associated with about 25 percent of residential fires.Living Healthier and Longer – What Works.S. 4 to 8 million women.S. and killed in their own homes at the hands of their male partners than any place else or by anyone else in society. • Kidney failure. and sometimes elderly patients may not hear or respond to alarms. each year. suffer physical abuse inflicted by their spouses or partners.
7. Be sure to have periodic vision and hearing tests. Victims should understand that they can initiate help simply by calling 911. 5. 4.Living Healthier and Longer – What Works. Violence and Safety Injury Center 80 . If you have difficulty walking or have frequent falls. do not drive or operate potentially dangerous machinery. who will look for and work to correct reversible causes. 2. Getting to a hospital emergency room will also initiate desired assistance. Further Reading Centers for Disease Control and Prevention (CDC) Injury. 3. What Doesn’t Help for such victims involves community efforts that include individuals. Do not smoke. and law enforcement organizations who are motivated to work together for the reduction and prevention of violence. 6. inform your physician. Recommendations 1. especially in bed. healthcare facilities. agencies. Learn what facilities your community has for aiding victims of domestic violence. Recognize that medicines you take may have potential mindaltering effects. If you have been drinking alcohol or using mind-altering drugs. Always wear a seat belt or helmet (motorcycle or bicycle).
In a given year. 10. methamphetamines. will visit an emergency room due to an adverse reaction to commonly prescribed medication.000 people in the U. 81 . 4. and cause more bad reactions with serious and life-threatening outcomes. The average nursing home patient receives 4 to 7 different medications daily. well over 175. 2. Warfarin (Coumadin). -Publius Syrus Facts 1. clopidogrel (Plavix) and digoxin are common offenders. and anabolic steroids) There are some remedies worse than the disease. aged 65 or older.000 patients annually for possible coronary artery problems. 7. Four percent of approved drugs are ultimately withdrawn from the market for safety reasons. marijuana. Elderly Americans (ages 65 and over) account for the purchase of 30 percent of all prescriptions and 40 percent of over-thecounter drugs.. 5. have unusual or unexpected actions. Cocaine-related injuries are a major cause of death among young adults in urban areas such as New York City.Living Healthier and Longer – What Works. aspirin. resulting in the evaluation of more than 64. What Doesn’t The Bad (Polypharmacy) and the Ugly (cocaine. 3. Chest pain is the most common cocaine-related medical problem. 9.S. A large study of patients 65 and older found that 20% filled at least 1 prescription for an inappropriate medicine. A heart attack is the most commonly reported cardiac complication of cocaine abuse. insulin. Fifty-one percent of drugs have label changes due to major safety issues discovered after marketing. 6. Age-related changes in elderly patients allow drugs to maintain their effects longer. 8.
recent developments have made more drug information available so that physicians may keep abreast of the latest findings. their interactions with other drugs. and the elderly population takes an average of 18 prescription drugs per year. deaths. the number of FDA-approved drugs available for the treatment of diseases and their medical complications has increased from 650 to more than 9. • Tens of thousands of fatalities in hospitalized patients in the U. • Twenty-eight percent of hospitalized patients experience adverse drug events annually. use of herbal preparations unknown to their physicians. Polypharmacy The seriousness of problems related to adverse drug events is apparent. • Noncompliance. and their altered activities in various disease states. occur annually due to drugs.Living Healthier and Longer – What Works. 82 . without the aid of sophisticated computer systems. • Thirty percent of elderly patients use 8 or more prescription drugs daily. their complications. • Adverse drug events. considering that: • Prescription-related drug problems result in about 119. for physicians to master knowledge of the complex actions of specific drugs.500. Elderly people are especially prone to adverse drug events because of their intake of multiple medications. • One in 4 people ages 65 and older receive at least 1 of 20 drugs that are potentially inappropriate for elderly patients. and their incidence of multiple chronic diseases.000 annual U. What Doesn’t During the last 30 years. This problem is of particular concern because the elderly population is expected to increase from 31 million in 1989 to 52 million in the year 2020.000 generic compounds.8 million hospitalizations each year.S. and of those there are approximately 1.S. thus occurring in 8. It is estimated that 10 to 30 percent of hospital admissions among the elderly are related to drug problems such as: • Inappropriate drug prescribing. Fortunately. The shear volume of drugs makes it impossible.
Living Healthier and Longer – What Works. What Doesn’t The FDA suggests 6 tips to avoid medication mistakes: 1. Cocaine Cocaine is a powerfully addictive stimulant drug. • • • Indirectly. more than 5 million Americans use cocaine. Keep your doctors informed. Heart attacks can occur shortly after use or on the following day. In a particular year. even in the first time user. Keep a list of all your medications. Read the labels and follow directions. The risk of heart attack is tremendously increased in the 60 minutes following cocaine use. or intravenous injection) and can be directly related to a variety of problems including: • Heart attacks. • Respiratory distress. • Muscle necrosis and renal failure. 4. Know what your drugs treat. Even small amounts of the drug can trigger an event. Cocaine can cause problems no matter what the route of administration (intranasal. suggesting the occurrence of spasm and occlusion of a coronary artery. such as: 83 . Cocaine can also cause sudden death by other mechanisms. 2. it has been estimated that more than 30 million Americans have tried cocaine at least once. with about onethird of those using the drug monthly. 3. and can occur in a young person with normal coronary arteries. Motor vehicle accidents. • Seizures and headaches. Know the names of your drugs. Suicides. cocaine can be associated with: Homicides. 6. • Mental problems. smoking. Though figures are difficult to determine. Ask your pharmacist or physician questions. 5. Heart attacks are the most commonly reported cardiac complication of cocaine use.
Street additives. Even small amounts can cause serious complications in some people. by snorting powder. along with Rohypnol and Ketamine. Strokes. Heroin Heroin is a highly addictive drug. heart attacks.3 percent of eighth graders and 2. mental problems. About 70 to 80 percent of new hepatitis C (HCV) infections in the U. Up to 8 percent of drug-related emergency room visits have been related to heroin abuse. Sudden major increases in blood pressure. odorless and tasteless. Their chronic long term use can lead to psychotic behavior. and strokes by their ability to affect the contraction of blood vessels. often poisonous. Methamphetamine abuse has been closely linked to risky behaviors. resulting in sexually transmitted diseases and other infectious diseases including HIV. A broad range of effective treatments are available for heroin addicts. by needle injection or by smoking. but have longer lasting and more toxic effects on the brain. Heroin is associated with significant incidence of overdose and death. 84 . A white powder processed from morphine. it is one of the most rapidly acting opiates. What Doesn’t • • • Heart rhythm disturbances. The extent of heroin use is suggested by surveys that show that 1. Ecstasy Ecstasy. Besides the drug itself. which allows them to be slipped into a victim’s drink. hallucinations. are among injection drug users. can cause ever further and occasionally lethal problems. The drug itself is associated with serious health problems. certain adulterants found in street cocaine can present major problems. Methamphetamines Methamphetamines are addictive stimulants that are closely related to amphetamines.S. heart and lung conditions. They can be taken orally.5 percent of tenth and twelfth graders used heroin at least once. and infectious diseases including HIV/AIDS and hepatitis.Living Healthier and Longer – What Works. They are colorless. More than 12 million Americans have tried methamphetamines at least once in their lifetimes. belong to a group known as date rape drugs. Cocaine along with alcohol is a combination that can easily result in a drug-related death.
unable to resist what is being done to them. or trance scene. Marijuana smoke contains 50-70 percent more cancer causing hydrocarbons than does tobacco smoke. It is estimated that adults. kidney failure and serious psychiatric problems. These drugs. strokes.Living Healthier and Longer – What Works. attention. Various injected steroid preparations have placed users at risk for contracting dangerous infections such as HIV/AIDS and hepatitis B and C. in the hundreds of thousands. can be deadly. Marijuana Marijuana is the most commonly used illicit drug. and leaving them unable to recall what happened to them. liver tumors. At least once a year. learning. 85 . Recommendations 1. An estimated 97 million Americans aged 12 or older have tried marijuana at least once in their lifetimes. take them to your doctor. These drugs can lead to early heart attacks. causing severe temperature elevations and organ damage. bar. Chronic use of these drugs can cause changes in brain function. but also women. One marijuana cigarette can have the same effect on the lungs as smoking up to 5 cigarettes in succession. Anabolic steroids The abuse of anabolic steroids is driven by a desire to change one’s appearance and performance. Users also are at risk for cancers and death. bag all your pills. have knowingly or unknowingly placed themselves at risk with these drugs. Young people and especially athletes are commonly recognized as abusers of these potent drugs. coma and seizures. coordination and anxiety. and ask if you still need them and if there are any you can do without. used mostly by teens and young adults who are part of a nightclub. Marijuana is an addictive drug that can have important effects on memory. Ecstasy can interfere with the body’s ability to regulate one’s temperature. rave. Marijuana smokers can have many of the same respiratory problems as tobacco smokers. Use of marijuana appears to facilitate one’s progression to even more dangerous drugs. What Doesn’t They can cause a victim to pass out. mostly men.
NEVER. What Doesn’t 2. Refrain from using heroin. Department of Health & Human Services halthfinder. Further Reading National Institutes of Health National Institute on Drug Abuse Health. new symptoms. etc.) with this sometimes burdensome task. or even a new illness. Food and Drug Administration (FDA) 86 . and anabolic steroids. 6. Be sure to inform your physician of any herbal preparations that you are taking.gov U.S. seek the assistance of your physician or a substance-abuse specialist. 5.S. Elderly patients should ask for help (from family.nih. 4. 7. 3.Living Healthier and Longer – What Works. USE ANY FORM OF COCAINE. ecstasy.gov U. methamphetamines. EVER. friends. If already dependent on cocaine. Learn as much as you can about your medications. marijuana. Remember that a medication (or combination of medications) you take could explain a worsening of your condition. caregivers.
What Doesn’t Smoking Tobacco drieth the brain. Female nonsmokers who are regularly exposed to others’ smoke are 91 percent more likely to have heart attacks than those not exposed. When you smoke. vitiateth the smell. Nonsmokers living with smokers have a 30 percent higher risk of dying from heart disease than do nonsmokers without such exposure. the leading cause of blindness in people older than age 65. exiccateth the windpipe. An average smoker dies 8 years earlier than a nonsmoker. lungs and liver. 6. Cigarette smoking is the leading risk factor for age-related macular degeneration. disturbeth the humors and spirits. Smoking is the cause of 30 percent of all deaths from cancer. 87 . 5. annoyeth the milt. 2. A 40-year study of British physicians has predicted that about half of all regular smokers will eventually die as a result of cigarette use. 8.S. dimmeth the sight. scorcheth the heart. induceth a trembling of the limbs. 11. Cigarette smoking is the number one preventable cause of premature death in the U. 4. . 3. hurteth the stomach.Living Healthier and Longer – What Works. 9. Studies suggest that 30 to 40 percent of the half million yearly U. 7. and causeth the blood to be adjusted. Smoking only 1 to 4 cigarettes a day can more than double the risk of death from coronary artery disease. deaths from coronary heart disease are due to smoking. 10. corrupteth the breath. Up to 12 percent of type 2 diabetes mellitus cases can be related to smoking. everyone around you smokes.S. destroyeth the concoction.Tobias Venner Facts 1.
is the main disease caused by smoking. 88 . Though heavy smoking for long periods is generally recognized as a problem. Smoking causes about 90 percent of lung cancer deaths in women and almost 80 percent of lung cancer deaths in men. including bars. and workplaces have cut down on heart attacks by up to 40 percent. Heart disease.S. What Doesn’t Smoking and other tobacco use has been chosen as the first risk factor discussed in this book because it best exemplifies the concept that is hoped to be relayed to readers: one’s life can be extended significantly by certain reasonable actions. and about 13 times higher among women who smoke cigarettes compared with never smokers. Non-smokers who are exposed to secondhand smoke at home or work increase their heart attack risk by 25-30 percent and their lung cancer risk by 20-30 percent. In the U. restaurants. when those who die from passive smoking (the breathing of sidestream smoke emitted from burning tobacco) are included. tobacco kills about 438. The best and most recent data indicate that smoking-related illnesses account for nearly 1 in 5 deaths and more than one-fourth of all deaths among those ages 35 to 64. Throat. In one major study of nurses.5-fold increase risk of fatal coronary artery disease and nonfatal heart attack when compared to nurses who did not smoke. according to the best recent estimate. not cancer. • • • • Smoking is associated with cancers of the: Mouth. and several foreign countries show that ordinances prohibiting smoking in all public places. occlude blood flow and cause chest pain and possible damage to the heart muscle. Some people are so sensitive to tobacco smoke that the mere entrance into a smoke-filled room can cause their coronary arteries to go into spasm.Living Healthier and Longer – What Works. Esophagus. smokers tend to ignore studies that show that lesser exposures can also be lethal.000 people each year.S.. The risk of dying from lung cancer is more than 23 times higher among men who smoke cigarettes. it was found that those who smoked 1 to 4 cigarettes daily had a 2. Recent studies from the U. Larynx.
Living Healthier and Longer – What Works. Problems related to use of tobacco products are present at each and every age. • Pneumonia. Cigarette smoking is also the leading cause of lung illness and death in the U. cancer. The popularity of cigars among young people is 89 . Cervix. Colon.000 deaths from such problems as: • Emphysema. The hazards of smoking extend well into later life. causing more than 84.000 yearly in the U. Estimates of deaths from pipe and cigar smoking just prior to the recent increase in cigar sales were 14. Pancreas. An article in Time magazine reported that even 3 insurance firms owned by tobacco companies charged smokers nearly double for term life insurance because smokers are about twice as likely to die at a given age. in certain unfortunate people. typically occurs in the older than age 65 group. The recent resurgence of cigar smoking overlooks the fact that there is no safe form of tobacco.. Passive smoking. Ureter. Kidney. Oral cancer in men who use smokeless tobacco (such as snuff and chewing tobacco). What Doesn’t • • • • • • • Stomach. Among those over age 65. Bladder.S. As occurs with heart disease. just as there is no safe period of time for tobacco use. such as exposure to parents' smoke during childhood and adolescence as well as exposure from living with a spouse who smokes or working with fellow employees who smoke. • Bronchitis. is also a recognized cause of lung and other cancers. About 90 percent of all deaths from emphysema are attributable to cigarette smoking. the rates of total deaths among current smokers were twice that of those who never smoked.S. can be caused by short periods of exposure to relatively small numbers of cigarettes. though it can be seen much earlier.
after any period of using any quantity or variety of tobacco (cigarettes. and esophageal cancers as cigarette smokers. cigars give off thick clouds of secondhand smoke containing similar cancer-causing substances as cigarettes.Living Healthier and Longer – What Works. In the past. It would not be unusual for a cigar smoker to take in more nicotine and other smoke toxins than a cigarette smoker. snuff. laryngeal. pipes. A recent study from London showed that primary or secondary cigar smokers were more likely than nonsmokers to suffer a fatal or non-fatal heart attack or stroke. cigars. Also. in the misguided belief that they can smoke more safely. Previous cigarette smokers who turn to cigars are more likely to inhale than those who have not smoked cigarettes. These include: 90 . Those fortunate enough to escape death from tobacco toxin exposure can still find themselves compromised in later life by damaged hearts or emphysematous lungs. That is provided the deadly condition has not yet become visible. of course. though in considerably higher concentrations. Even cigar smokers who do not inhale are exposed to their own environmental tobacco smoke. A wealth of scientific evidence contradicts this strategy. stroke) common to later life. However. quit. More study is needed to determine the degree of the health risks of the occasional cigar smoker. however. or chewing tobacco) at any age. many smokers switched to lower tar and nicotine cigarette brands rather than quitting. These and other consequences of tobacco-related injuries can make afflicted people more at risk for other illnesses (such as pneumonia. is definitely a risk factor for coronary artery disease and emphysema. depending on the person’s manner of smoking and the type of cigar smoked. a report from the National Cancer Institute suggests that people who smoke cigars daily have about the same risk for oral. Regular cigar smokers have a significantly increased risk of lung cancer as well as coronary artery disease. because smokers inhale these low-yield cigarettes more deeply and smoke more of them to obtain the same nicotine kick. What Doesn’t in part related to the belief that cigars are a safe alternative to cigarettes. and smoke. Much still can be gained by those who.
Risk of lung cancer is cut in half in 5 years. • Nicotine Lozenges • Nicotine nasal spray (Nicotrol NS). depression and even suicide concerns. Several studies point to its effectiveness. The FDA however warns that some patients on varenicline have experienced changes in behavior. • Nicotine inhaler (Nicotrol Inhaler). agitation. Varenicline is probably the best of the available drugs able to help those who are serious about ending their tobacco dependence. These changes point to the need to take this medication under a doctor’s supervision. Varenicline (Chantix) is a newly approved and effective drug that works by blocking the pleasant effect of nicotine on the brain. The nicotine nasal spray has the advantage of delivering nicotine more rapidly than gum. patches or inhalers. • The almost daily reports in the media regarding the dangers of tobacco. What Doesn’t • • • After about a year. • Acknowledgements of subversive activities of the tobacco industry. and we have seen some good responses in some difficult cases. Lifelong smokers who quit at age 50 double their chances of living to age 65. Smokers who die between ages 35 and 64 lose 23 years of life compared to age-matched nonsmokers. deaths from heart disease drops halfway back to that of nonsmokers and after 5 years to the rate equal to nonsmokers. Today smokers are quitting in large numbers with the help of sympathetic physicians and through the use of or help from: • Nicotine patches and gums (which can be purchased overthe-counter). The nicotine inhaler has added effectiveness because it simulates the habitual hand-to-mouth 91 . • Behavior modification programs.Living Healthier and Longer – What Works. and approaches the risk of non-smokers after about 15 years. • Bupropion (Zyban). • Effective medicines for associated anxiety. but not nearly as rapidly as cigarettes.
anywhere in your house. For those who find cost to be a factor. stop. in conjunction with a cognitive-behavioral smoking cessation program. Recommendations 1. Studies have shown added risk for those exposed to passive smoking both at home and at work. If you are exposed to passive smoke at work. quit. 4. if you must live in an apartment. The exercise program. physicians may detect and 92 .Living Healthier and Longer – What Works. It also appears. nortriptyline. 3. If you are a smoker. by themselves or in combination. look for a smoke-free apartment. If you live with a smoker. What Doesn’t action that is so common to smoking. discuss your concerns with fellow employees or your boss. 5. If you chew tobacco. It may be necessary to change jobs. if possible. For similar reasons. not only facilitated smoking cessation. discuss your concerns for your health with him/her and review data together. All these drugs. an inexpensive antidepressant. an extended-release antidepressant appears to work in smokers with or without a past history of depression. to lessen the common problem of weight gain that is often related to quitting smoking. Tobacco toxins have tremendous capabilities of moving from room to room and from one floor to another. in some people. but also delayed weight gain in women smokers and improved exercise capacity. Your personal physician may be able to document your distress or risks from such exposure. For help quitting smoking. especially when accompanied by some behavioral support. Such a program could be a valuable addition to all smoking cessation programs. vigorous physical exercise facilitates smoking cessation in women. 2. have value in helping people quit smoking and remain tobacco free. may be effective for nondepressed smokers. seek the assistance of your physician or a physician skilled in smoking cessation programs. Your goal should be that smokers not smoke in your presence or in rooms that you frequent or. Studies suggest that participation in regular. Bupropion (Zyban). Because smokers have more depression.
• Sore tongue. but should not be equated with total failure. It is important to keep trying. 93 . Of the various strategies for quitting. those who do so “cold turkey” are more likely to remain abstinent. and these can be particularly hard times. Relapses can occur in the first week after quitting and even for months afterwards.Living Healthier and Longer – What Works. Tips for individuals who require extra assistance in quitting are listed below. • Sore throat. • Headache. What Doesn’t treat this in the process of supporting their patients’ tobacco cessation programs. • Hunger. these include: • Dry mouth. These symptoms peak within a few days but usually last only a week or 2. • Coughing. Quitting rates are about twice as high for those who quit on their own as for those who participate in formal smoking cessation programs. Slips may occur. • Fatigue. Ongoing encouragement and assistance from physicians has also been cited by successful quitters as important in their decisions to quit and in preventing relapses. • Trouble sleeping. • Irritability. especially during periods of emotional turmoil. Those who want to quit smoking should realize that some short-term discomforts/withdrawal symptoms will occur. • Sore gums. 6. Many successful quitters failed repeatedly before they were finally able to quit. Tips to Help You Stop Smoking Patients should realize that approximately 40 million Americans have quit smoking and that about 95 percent of these stopped on their own without any formal cessation program. • Tenseness.
such as outdoors. make them difficult to find. or holiday. Getting Ready to Quit 1. drink more fluids. get plenty of rest. Keep your cigarettes in a different place. Share your feelings and offer mutual support. Start a modest exercise program. 5. Smoke only in certain places. Begin to condition yourself physically. 94 . 7. Change your smoking routines. Spend more and more time in places where smoking is not allowed. 3. 4. Read them whenever you are tempted to smoke. 6. Ask your spouse or a friend to quit with you. 10. This will remind you how many cigarettes you smoke each day. Notice when and why you smoke. Decide positively that you want to quit.Living Healthier and Longer – What Works. Don’t empty your ashtrays. Write them down and carry them with you. anniversary. Try to avoid negative thoughts about how difficult it might be. Select a target date for quitting. such as drinking your morning cup of coffee or talking on the telephone. the National Cancer Institute. and the American Heart Association to recommend the following tips to help smokers in their efforts to quit. 8. and avoid fatigue. What Doesn’t A great deal of experience with smokers and their efforts to quit has led organizations such as the National Institutes of Health. 9. possibly a special day. 11. or in places that are uncomfortable. 2. Switch to a brand of cigarettes you find distasteful. Choose your environment. Collect all your cigarette butts in 1 large glass container to remind yourself of the filth that smoking represents. such as a birthday. Try to find the things in your daily life that you often do while smoking. List all the reasons why you want to quit. Smoke with your other hand.
and enjoy your favorite meal. Limit your socializing to healthful. paper clip. When you eat breakfast. Spend this day and following days with non-smokers and in places where smoking is not allowed. 7. Stay busy. 11. hard candy. Change your morning routine. Avoid alcohol. coffee. Smoke only those cigarettes you really want. 4. 13. 5. Visit your dentist and have your teeth cleaned to get rid of tobacco stains. sit at a different place at the table. such as a pencil. The Day You Quit 1. 9. 10. Estimate the amount of money you saved and buy yourself a treat. Catch yourself before you light up a cigarette out of pure habit. Snack on celery or carrots. 8. Think of quitting in terms of 1 day at a time. Carry other things to put in your mouth. 3. outdoor activities and sports in situations in which it would be difficult to smoke. Try to replace the urge by chewing sugarless gum or mints. Put away your lighters and ashtrays. do something else instead. If you miss the sensation of having a cigarette in your hand. When you get the urge to smoke. such as gum. 2. Drink large quantities of water and fruit juices (avoid caffeine beverages). such as a movie or a book. Remind family and friends that this is your quit date and ask for their help over the next couple of weeks. or marble. play with something else. go to the movies. exercise. Reward yourself at the end of the day. or a toothpick.Living Healthier and Longer – What Works. or other beverages that you associate with cigarette smoking. Throw away all your cigarettes and matches. What Doesn’t 12. 95 . 12. 6.
such as how much you like yourself as a nonsmoker and the health benefits to you and your family.Living Healthier and Longer – What Works. 7. Review in your mind the positive things about quitting. What Doesn’t 13. 6. advice. Start a money jar with the money you save by not buying cigarettes. 2. Most people will support you. tell yourself smoking won’t make it any better. and do something else. and/or nicotine gum or patches might be suggested or instituted. may prove helpful. 10. If you slip and smoke. Let others know you quit smoking. 3. Many former smokers tried to stop several times before they finally succeeded. Follow-up visits with your physician. Think about ways to solve the problem. such as: • Working under pressure. These feelings will pass. Increased exercise can help burn calories. 11. • Feeling blue. Watch your food and calorie intake so as not to gain weight during this period. Don’t allow yourself to think that “1 cigarette won’t hurt. try to keep busy. Feeling hungry is sometimes mistaken for the desire to smoke. usually at the end of the second week. Don’t worry if you are sleepier or more short-tempered than usual. don’t be discouraged. Quit again. intense urge to smoke. Further help in the form of extra motivation. Count calories if necessary. 4. When you feel tense. A positive attitude can help through rough times.” It will! Staying Off Cigarettes 1. 5. Watch out for triggers that are commonly recognized as stimulating a sudden. Eat regular meals. 8. Begin to increase your exercise program. 9. 96 .
12. The Clinical Guide to Preventive Services. The authors recommend reviewing the list and selecting those items you can implement successfully. Smoking bans prevent heart attacks.becomeanex. Watching someone else smoke. list is not meant to be burdensome to the potential quitter. support new taxes that raise the price of cigarettes. write down new reasons why you’re happy you quit and post these where you’ll be sure to see them. though not exhaustive. Samet J. Circulation. 2006:1450-1451. Watching television.1-800-QUITNOW. 2006. Reduction in the incidence of acute myocardial infarction associated with a citywide smoking ordinance. Bartecchi C. Playing cards. 1994:906-912.Living Healthier and Longer – What Works. Periodically.. Schrier RW. What Doesn’t • • • • • • • • Talking on the telephone.org) and (http://www. Finishing a meal. New England Journal of Medicine. making the smoking habit even more painful.quitnet. Alsever R. Driving your car. Nevin-Woods C. et al. realizing that all have value and have proven effective for some people. Having a drink. 13. 2007:1490-1496. Further Reading and Information Centers for Disease Control and Prevention (CDC) Bartecchi C. This extensive. The human cost of tobacco use. 97 . A tobacco quitline . Drinking coffee. MacKenzie T. When possible.com). Circulation. Web sites that support quit attempts (http://www.
5. commonly called statins. the decision to treat should be left to one’s physician who is skilled in the principles of lipid management. In any case. however. 3. a 10 percent increase in serum cholesterol has been associated with a 20 percent or greater increased risk of coronary artery disease. What Doesn’t Good and Bad Cholesterol As I see it. there are not enough data to determine the value of screening or treating. not only have the ability to decrease the risk of the first or subsequent heart attack or stroke but also have the capacity to prevent such problems from occurring at all. At present. For individual cases. every day you do 1 of 2 things: build health or produce disease in yourself. it is suggested that lowering cholesterol can reduce the risk of having a heart attack by as much as 50%. Newer drugs that have been shown to lower cholesterol in patients with cardiovascular diseases also have been shown to prolong life significantly. These drugs. 98 . At least 40 million Americans are thought to have cholesterol levels high enough to require medical attention. 2.Living Healthier and Longer – What Works. for older people who already have heart disease. At any cholesterol blood test number. -Adelle Davis Facts 1. Studies suggest that only 45 to 65 percent of patients with high cholesterol had evidence of treatment. for cholesterol problems in persons 75 or older. A 10 percent reduction in serum cholesterol could result in as much as a 10 percent reduction in death from coronary artery disease. 6. 4. 7.
or smoking. waxy. and is necessary for healthy body function. inactivity. Diet and 99 . Others have cholesterol problems due to lifestyle choices such as diet. The total cholesterol measurement. Some helpful normal numbers to remember for people without known heart disease are: Cholesterol Type (mg/dL) Total Blood Cholesterol HDL (Good) Cholesterol Over 50 mg/dL (Women) LDL (Bad) Cholesterol Triglycerides Less than 200 mg/dL Over 40 mg/dL (Men) Less than 100 mg/dL Less than 150 mg/dL As discussed earlier. fat-like substance produced by animals. Cholesterol travels throughout the body in the blood stream packaged in units called lipoproteins: • Low-density lipoprotein (LDL). Very-low-density lipoprotein (VLDL) transports triglycerides to the tissues where they are broken down and used for energy or are stored. the most common test. it may be reasonable to have an LDL cholesterol goal of 100 mg/dL or less for all people. High-density lipoprotein (HDL). What Doesn’t Cholesterol is a soft. also known as good cholesterol. HDL. It plays an important role in plaque formation within arteries. Some have combinations of these behaviors. Levels of fats in the blood can be determined by direct measurements. It is normally found throughout the human body. Triglyceride formation is increased when excess calories are present. such as in the coronary arteries or arteries leading to the brain or blood vessels in the legs. also known as bad cholesterol. and other blood lipid particles. helps remove cholesterol from arteries and transports it to the liver for clearance from the bloodstream. is the main cholesterol-carrying compound in the blood. is made up of LDL.Living Healthier and Longer – What Works. The substance becomes a problem when too much is present and is deposited in the wrong places. • • Some people inherit a disorder that results in high cholesterol levels and severe coronary artery disease at a young age.
The presence of multiple risk factors further magnifies the problem in the affected patient. When combined with the following risk factors: • High blood pressure. • Peripheral vascular disease (even to ages in the mid-70s). LDL cholesterol levels above 100 increases significantly the risk of developing cardiovascular disease. • Unstable angina pectoris. What Doesn’t exercise might be able to achieve this goal in some people. can be most helpful. Those who are placed in the high-risk group due to the combination of elevated cholesterol and risk factors should seek their physician’s advice to outline programs for cholesterol control and risk factor reduction. such as replacing saturated fats with unsaturated fats or omega-3 fatty acids and increasing the fruits and vegetables in the diet even beyond the 6 daily recommended.Living Healthier and Longer – What Works. Reducing LDL levels not only decreases the number of recurrent events in heart patients but also prevents coronary heart disease in persons at low to moderate risk of developing such problems. there may be a 2 percent reduction in heart attack risk. Dietary modifications. If an individual is overweight. • Family history. Eating 25 grams 100 . Lowering LDL cholesterol levels has been shown to reduce complications of the atherosclerotic process. • Lower socioeconomic status. • Obesity. and thus requires further attention and probably medications. including: • Total deaths. • Lack of exercise. The value of lowering “bad” LDL cholesterol is now unquestioned. achieving a desirable body weight is important. Avoiding all trans-fats and eating more fiber is also helpful. • Incidence of strokes. • Smoking. • Age. The program to lower LDL cholesterol levels should begin with diet and exercise. but others may require medications to help one reach that goal. • Fatal and nonfatal heart attacks. It is suggested that for each 1 percent reduction in blood cholesterol. • Diabetes.
Two good commercial sources are the butter substitutes Take Control and Benecol. weight reduction. Plant sterols and stanols (2 grams per day) reduce the amount of cholesterol that gets absorbed by the gut. vegetables. timing of doses. a tendency to increase “good” HDL levels. • Atorvastatin (Lipitor) 10 mg. peas. Presently there are 6 statin drugs. and preventing rupture of obstructing plaque. They can reduce LDL cholesterol by about 10 percent.Living Healthier and Longer – What Works. listed doses are equivalent: All are effective. apples. In addition to lowering blood cholesterol levels. Sterols and stanols can also be obtained naturally from whole foods which offer even more benefits. All prove to be more effective when combined with healthy diets. stabilizing plaque in blood vessels. usually within 3-4 weeks. • Lovastatin (Mevacor) 40 mg. with few side effects. oatmeal. These agents have been associated with a 50 percent or greater decrease in LDL levels. exercise and other interventions. duration of activity and cost. use of a cholesterol lowering drug such as a statin. nuts. statins also have beneficial effects on the inner surfaces of blood vessels. it is often difficult for people to comply with some programs. side effects. • Pravastatin (Pravachol) 40 mg. What Doesn’t (women) and 38 grams (men) of soluble fiber can lower LDL levels. • Rosuvastatin (Crestor) 5 mg. and an ability to lower triglyceride levels. pears. beans. Plant sterols and stanols are found in fruits. is in order. vegetable oils. Examples of soluble fiber include barley. but each may vary somewhat in potency at certain dosages. especially for the long term. seeds. citrus fruits. • Simvastatin (Zocor) 20 mg. strawberries and eggplant. legumes and other plant sources. reducing inflammatory responses. Although use of specific diets can be effective. cereals. If desired LDL cholesterol levels cannot be achieved by these methods. An evaluation by a skilled dietitian with close follow-up can be most helpful. which can 101 . They are especially useful for heart attack patients with high cholesterols. • Fluvastatin (Lescol) 80 mg.
and how patients should prepare for the tests. those who have suffered heart attacks. It is also effective when combined with statin drugs. These include: Niacin – reduces LDL cholesterol. Finding elevated total cholesterol in young or middle –aged people suggests the need to measure other lipoprotein levels. Alternative lipid measurements have at times been proposed. Under any circumstances however. there is controversy about who should be screened for high cholesterol. At present. We must also keep in mind that people with high HDL levels can still have heart attacks. a particularly bad combination. Abnormal cholesterol studies are of less value in persons ages 70 years and older unless they are known to have coronary artery disease. This risk is further increased if the LDL cholesterol is high and the HDL is low. the higher the total cholesterol level. • • • Other drugs favorably affect cholesterol levels. and middle-aged men with cardiac risk factors are in need of screening studies. They also have an effect on clot formation in blood vessels. 102 . high LDL is undesirable because it causes atherosclerosis. Bile acid sequestrants – mild reduction in LDL cholesterol. and is well tolerated. Physicians will inform their patients about which tests are needed. also suggest benefit from screening. It can reduce LDL cholesterol by about 20 percent. Family or personal histories of cholesterol or vascular problems such as a stroke. It also has other roles that provide protection for arteries. the greater the risk of cardiovascular disease. However. Causes of low HDL cholesterol (less than 40 mg/dl) include: • Elevated triglycerides.Living Healthier and Longer – What Works. HDL cholesterol has important roles in the body. Certainly those at risk for coronary artery disease. Ezetimibe (Zetia) – a cholesterol absorption inhibitor. when they are needed. but fare no better than traditional LDL and HDL measurements. Unlike statins. it has not yet been shown to affect atherosclerosis or coronary heart disease. however. It can be added to the statins. It takes up excess cholesterol from the lining of the blood vessels and carries it off to the liver for disposal. What Doesn’t lead to blockage of coronary vessels and heart attacks. • Overweight and obesity. low HDL by itself is also of concern. For those at risk.
• Weight loss. progestational agents. 103 . Different diseases – type 2 diabetes. High carbohydrate diets. Type 2 diabetes. Mild to moderate hypertriglyceridemia has the potential to deteriorate into severe hypertriglyceridemia. The evidence for beneficial effects from treating hypertriglyceridemia. It appears that elevated triglyceride levels contribute to an increase in risk for cardiovascular disease. especially eating lesser amounts of foods containing trans-fats and replacing dietary calories from carbohydrates with those from unsaturated fats. High plasma triglyceride levels on their own or especially in combination with other cholesterol problems appear to be associated with coronary heart disease. Certain drugs – beta-blockers. is less well established than the treatment of LDL cholesterol elevations. It is especially important that triglycerides be measured while fasting because a recent meal or even a cup of coffee can raise triglyceride levels. • • • • • • Causes of elevated triglyceride levels: Obesity or overweight. it is advantageous to attempt to raise HDL levels.Living Healthier and Longer – What Works. • Stopping smoking. • Dietary changes. chronic renal failure. Genetic predisposition. What Doesn’t • • • • • • Physical inactivity. • Some drugs such as niacin and statins. however. and very high triglyceride levels can precipitate bouts of pancreatitis. Excess alcohol intake. This can be accomplished through: • Exercise. Physical inactivity. Cigarette smoking. Cigarette smoking. • Moderate alcohol drinking. Very high carbohydrate intake. anabolic steroids. Because low HDL levels are associated with greater risks for coronary heart disease.
higher doses of beta-blockers. Men aged 35 years and older and women aged 45 and older should be screened for lipid disorders. • Fibrates. Some people may require drug treatment along with diet and exercise. up to 3 grams daily. Various genetic lipid problems. Screening at 5 year intervals is reasonable in absence of recognized risk factors.Living Healthier and Longer – What Works. 3. • Statins. Know the risk factors that you have and eliminate or control as many as possible. 2. Good programs are available for control of abnormal triglyceride levels. • Combinations of a fibrate and ezetimibe (Zetia). Only about 25 percent of patients continue drug therapy through the end of the second year. estrogens. antipsychotics. retinoids. Borderline high 150-199. thyroid and liver diseases and systemic lupus. Serum triglyceride levels: Normal less than 150 mg/dl. • Niacin. High 200-499. Unfortunately. Recommendations 1. about 50 percent of patients on these drug programs discontinue therapy on their own within 1 year. Very high 500 or more. Effective drug programs require close cooperation between patients and physicians. because these drugs can have annoying as well as rare serious side effects. Know your lipid levels. diet and exercise should form the basis of any program. 104 . Weight loss for obese patients is definitely helpful. Earlier screening may be valuable if an individual has risk factors for coronary heart disease. tamoxifen. Lipid lowering drug programs need to be long-term and continuous. however. Certain drugs – corticosteroids. Drugs that can help reduce triglycerides include: • Omega-3 fatty acids – 4 grams daily. What Doesn’t • • • • • • nephrotic syndrome.
and cardiovascular events. 2007:1301-10. New England Journal of Medicine. 7. et al. 6. Further Reading Barter P. very low levels of ldl cholesterol. Lung and Blood Institute Health. What Doesn’t 4. Gotto A. HDL cholesterol. National Institutes of Health (NIH) National Heart.nih. Alcohol intake in excess of 1 to 2 drinks per day is not recommended. Eat at least 6 servings of fruits and vegetables daily. you may be a candidate for cholesterol-lowering drugs to be used along with your diet. If a low-cholesterol. Middle-aged men with high cholesterol and/or other risk factors may consider having 1 to 2 alcoholic drinks daily. 5.Living Healthier and Longer – What Works. You can enjoy shrimp and other shellfish which contain cholesterol but are low in saturated fat and thus less likely to raise the blood cholesterol levels. Follow a regular exercise program. September 27. low-fat diet does not control your lipid problem. 8.gov 105 .
People who are 20 percent or greater over ideal body weight are at higher risk of developing coronary artery disease. In America.000 excess deaths per year in the U. prostate. -John Kenneth Galbraith Facts 1. 10. and cancers of the colon.Living Healthier and Longer – What Works. up to 95 percent regain the weight in 5 years or less. Bariatric surgery with resultant weight loss can result in remission of diabetes in up to 90 percent of obese diabetic 106 . What Doesn’t Obesity More die in the United States of too much food than of too little. 8. You can eat yourself to death.S. uterus and cervix. 5. 7. 9. 13. 12. are overweight or obese. Overweight and obesity have been associated with gastroesophageal reflux disease (GERD). About one-third of all cases of hypertension are thought to be caused by obesity. nearly one-third are obese.S. 2. Obesity is associated with about 112. heart disease. People who are 40 percent or greater over ideal body weight are at much higher risk for diabetes. gallbladder. “Apple-shaped” women are more than twice as likely to develop heart disease as are “pear-shaped” women. ovary. The risk of diabetes increases from twofold in those who are mildly overweight to tenfold in those who are severely obese. 3. 11. breast. Of individuals who lose weight. Obesity is believed to be responsible for 14 percent of cancer deaths in men and 20 percent in women. only the Bible sells better than diet books. 6. 4. About 2/3 of adults in the U.
It can reduce the risk of death associated with obesity by as much as 30 percent. What Doesn’t patients. 15. A daily exercise program correlates best with sustaining weight loss. 14. 107 . The “latest” and “greatest” fad diet usually fails to enable longterm weight loss.Living Healthier and Longer – What Works.
is also important. What Doesn’t People who weigh 20 percent more than ideal body weight are considered obese. The size of an individual’s waist can be a reflection of both total and abdominal fat. Pear-shaped women are thought to have more difficulty than apples in changing their shape by dieting and exercise. apple-shaped bodies are more troublesome because they are associated with greater risks for: • Heart disease. • High blood pressure. Of the 2. Studies tell us that waist sizes greater than 40 inches in men and 35 inches in women are associated 108 . • Diabetes. indicated by body shape. Apple-shaped (top-heavy) bodies indicate that extra weight is centered around the waist. Obesity Shape Distribution of excess weight. pear-shaped (bottomheavy) bodies indicate that extra weight is centered on the hips and thighs. • Stroke.Living Healthier and Longer – What Works.
Living Healthier and Longer – What Works, What Doesn’t
with increased risks of acquiring a variety of significant medical problems. One must be careful however not to substitute belt size for waist measurement. The latter is more accurately determined at the level of the navel. One study showed that women with waist measurements of 38 inches or more had greater than 3 times the risk of developing cardiovascular disease than those with waists of 28 inches or less. Sophisticated studies of coronary artery calcium and the presence of abdominal aortic plaque showed strong associations with waistline measurements. Obesity can be found at all ages but is increasingly seen as people grow older and peak at middle-age. Consideration of weight category is often viewed in relation to an individual’s height.
Health professionals, however, often use the Body Mass Index (BMI) to determine if a patient might have problems. The BMI is calculated by determining a person’s weight and height and charting the findings on the BMI table; the column within which the findings are situated provides the BMI number, which serves as a reasonable estimate of fat mass. The largest study on obesity and deaths ever conducted, involving more than 1 million Americans, was published by the American Cancer Society in The New England Journal of Medicine. It showed a definite link between being overweight and a higher risk of dying from cancer or heart disease for people of all ages. This
Living Healthier and Longer – What Works, What Doesn’t
study focused on the BMI and showed that healthy non-smoking white men and women and black men had an increasing risk of death starting at a BMI of 25. The largest group of white males, with a BMI of 40 or greater, were found to be 2.5 times more likely to die than their healthiest peers. This study has led researchers to suggest that obesity is probably the second leading preventable cause of death in the U.S., cigarette smoking being the first. The fact that about one-fifth of U.S. adults have a BMI of 30 or more suggests the magnitude of the problem. • • • • • • • The BMIstudyinterpreted astofollows: obesity is probably the second This is has led researchers suggest that leading preventable cause of death in the less than smoking being the first. The U.S., cigarette 18.5 Underweight fact that about one-fifth of U.S. adults have a BMI of 30 or more suggests the magnitude Normal 18.5 – 24.9 of the problem. Overweightis interpreted as follows: 25 – 26.9 The BMI • Underweight less than 18.529.9 Obese 27 – • Normal 18.5 – 24.9 Moderately obese 30 • Overweight 25 – 26.9 – 34.9 • Obese obese 27 – 29.9 – 39.9 Severely 35 • Moderately obese 30 – 34.9 Morbidly obese obese more than 40 • Severely 35 – 39.9
• Morbidly obese
Body Mass Index
Body Mass Index
105 109 112 116 120 124 128 132 136 140 144 149 153 157 162 166 171 176 180 185 190 22 110 114 118 122 126 130 134 138 142 146 151 155 160 165 169 174 179 184 189 193 198 23 115 119 123 127 131 135 140 144 148 153 158 162 167 172 177 182 186 192 197 202 207 24 Body Weight (pounds) 119 124 129 134 124 128 133 138 128 133 138 143 132 137 143 148 136 142 147 153 141 146 152 158 145 151 157 163 150 156 162 168 155 161 167 173 159 166 172 178 164 170 177 184 169 176 182 189 174 181 188 195 179 186 193 200 184 191 199 206 189 197 204 212 194 202 210 218 200 208 216 224 205 213 221 230 210 219 227 235 216 224 233 242 25 26 27 28 138 143 148 153 158 163 169 174 179 185 190 196 202 208 213 219 225 232 238 244 250 29 143 148 153 158 164 169 174 180 186 191 197 203 209 215 221 227 233 240 246 252 259 30 148 153 158 164 169 175 180 186 192 198 203 209 216 222 228 235 241 248 254 261 268 31 153 158 163 169 175 180 186 192 198 204 210 216 222 229 235 242 249 256 263 269 276 32 158 163 168 174 180 186 192 198 204 211 216 223 229 236 242 250 256 264 271 278 285 33 162 168 174 180 186 191 197 204 210 217 223 230 236 243 250 257 264 272 279 286 293 34 167 173 179 185 191 197 204 210 216 223 230 236 243 250 258 265 272 279 287 294 302 35
more than 40
58 59 60 61 62 63 64 65 66 67 68 69 70 71 72 73 74 75 76 77 78 BMI =
91 94 97 100 104 107 110 114 118 121 125 128 132 136 140 144 148 152 156 160 164 19
96 99 102 106 109 113 116 120 124 127 131 135 139 143 147 151 155 160 164 168 173 20
100 104 107 111 115 118 122 126 130 134 138 142 146 150 154 159 163 168 172 177 181 21
To determine BMI, locate your height in the left-hand column, then move across to your weight. Your BMI will be listed at the bottom of the column where the height and weight intersect.
Living Healthier and Longer – What Works, What Doesn’t
Studies suggest that up to 50 percent of those with a tendency to weight excess have some form of inherited predisposition. A recent study, however, suggests that even those with a strong family history of obesity (implying strong genetic factors that control fat mass) are still able to lose weight in response to increased physical activity, thus pointing to the importance of our behavior in weight status. Other explanations for weight excess include: • The concept that a body mechanism, possibly controlled by genes, seeks a certain weight as if it were a set point for a given individual. • Deficient exercise. • Hormonal factors. • Eating or emotional disorders can occur with stress or depression. • Dietary factors, such as excess fat intake. A recent study suggested that friends, siblings, and spouses had more chance to become obese because they followed the lead of social partners. This concept would encourage us to look at obesity as a public health problem. In any case, weight gain occurs when calories taken in are greater than calories expended. Every 3,500 calories consumed in excess of those burned increase weight by about 1 pound. The reverse is true for weight loss. It has been estimated that the average American consumes 3,700 calories per day, though only one-half that amount for women and two-thirds that amount for men is probably needed for good body maintenance. People tend to eat more when serving sizes are larger. Our population is eating out more, where serving sizes are getting larger in recent years. This may explain the success of certain popular and successful restaurants and fast food outlets. Being overweight and especially being obese has serious adverse consequences for health and longevity. Even a mild to moderate degree of weight excess can increase the risk of health complications and death at every age group. Overweight people often have significant problems with blood fats (e.g., cholesterol and triglyceride levels), which partially explains the increased risk of coronary artery disease and the
Living Healthier and Longer – What Works, What Doesn’t
likelihood of heart attacks. People who weigh 40 percent or more than ideal body weight are at increased risk for cancers of the: • Colon. • Prostate. • Breast. • Gallbladder. • Kidney. • Stomach. • Uterus. • Ovary. One large study showed that women who gained more than 40 pounds after age 18 were 3 times more likely to have heart attacks than women who gained less than 12 pounds. Obesity is thought to be responsible for about one-third of all cases of high blood pressure. High blood pressure in overweight people is also associated with an increased incidence of stroke and risks of developing: • Diabetes. • Gallbladder disease. • Gout. Obesity can be associated with stresses on certain weightbearing joints, resulting in arthritis and varying degrees of disability. Obesity, without other risk factors, may increase the likelihood of heart attack, especially for apple-shaped people. In addition to known risk factors for cardiovascular disease, being of the male gender is associated with cardiovascular disease. In this regard, obesity in males is more of the appleshape variety. Overweight people also have more complications after surgery; wounds heal more slowly and infections are more common. Additionally, obesity is associated with: • Anxiety. • Stress. • Depression. • Sleep disturbances (sleep apnea). • Other consequences that affect quality and length of life.
but exercise provides additional benefits. Physicianprescribed appetite suppressants. and counselor. could come from a modest. and body builds. certain drugs can help in special situations. is a difficult way to actually lose pounds. A large study of nurses has put to rest concerns about adverse effects of thinness. What Doesn’t For improvement in quality and length of life. The need or desirability of further weight loss can then be considered. height. Also. 62 percent claimed to watch less than 10 hours of television each week. can provide better weight loss results compared with diet therapy alone. Sibutramine (Meridia) affects the brain chemicals that help control appetite. It takes a lot of exercise to lose 1 pound. sex. Dieting alone can help weight loss.Living Healthier and Longer – What Works. but can raise blood pressure levels in some people. always combined with prudent diets. phentermine and sibutramine. It has been suggested that the initial goal of weight loss therapy should be to reduce body weight by about 10 percent from the initial weight. on average. Physicians or psychiatrists/psychologists can assist with behavior modification programs. but even modest weight reduction has been associated with increased longevity and improved diabetes and high blood pressure control. To achieve this weight loss you should plan a diet with about 500 to 1000 calories a day less than you usually eat. Some of the calorie loss. The National Weight Control Registry that surveys people who have lost weight and kept it off states that most of these people did it on their own without going to the commercial weight loss programs. dietitian. about 1 hour per day. That study showed that increased death rates thought to be present in very thin people were partly due to cigarette smoking or weight loss associated with cancers or other serious conditions. Regular physical activity is especially important for weight maintenance. It may be impossible for some people to reach desired weights. daily exercise program. Exercise alone. However. Exercise is helpful in preventing one from regaining lost weight. as much as 20 percent. Registry participants cut their food intake and increased their physical activity – 90 percent exercised. some diet 113 . however. Weight reduction can be achieved with the help of physicians or by a team approach of a physician. overweight and obese people should strive to achieve weights that are close to ideal for their age.
above ideal) who is at high risk for adverse health problems related to their obesity. performed by skilled surgeons at specialized referral centers. An advantage of this agent over others is the fact that less than 1 percent of the drug passes from the bowel into the blood. Studies suggest that Xenical causes modest weight loss and certain health benefits related to that loss. vitamin supplements are needed with this therapy. Pregnant women and people ages 65 and older should not initiate diets without consulting their physicians. Another anti-obesity drug. surgery appears to be a reasonable option. Various surgical procedures. Long-term adverse effects of prolonged use are as yet unknown. Liposuction cannot be recommended for such patients because the fatty tissue removed has been known to reaccumulate in the same site or at times at other sites. offer the best long-term hope for these people.Living Healthier and Longer – What Works. What Doesn’t medications have significant side effects. Patients undergoing such procedures must be followed for extended periods postoperatively to avoid potential complications. For the severely obese patient (weight is 100 percent or 100 lbs. Problems related to Xenical have been largely centered in the gastrointestinal tract. A newer anti-obesity drug – rimonabat has been found to have major problems associated with its use. thus. making it less likely to cause side effects in other organs of the body. and cannot be recommended. The American public is deluged with dietary advice in the form of books. Appetite suppressants have also been associated with heart attacks. including an extremely rare form of irreversible high blood pressure in the pulmonary blood vessels. Alli. acts by inhibiting absorption from the gut of about 30 percent of the fat that we ingest. over-the-counter version. the advice is 114 . even in young patients with normal coronary arteries. In many cases. an individual can lose 50 to 60 percent of their excess weight. orlistat (Xenical) or its half-strength. tapes and videos. and due to increased fat in the stool. For certain people. The drug’s mechanism of action can affect blood levels of fatsoluble vitamins such as A and E. These medicines can be useful for significantly obese people whose serious health problems from their obesity outweigh the risk of taking them. weight-loss surgery results in impressive improvement in weight and health. Over a 1 to 2 year period after such surgery. Patients must be closely monitored.
and other organizations that have joined the Federal Trade Commission’s Partnership for Healthy Weight Management. patients should check with their physicians or with registered dietitians for advice. adrenal hormone excess.g. They are best avoided. build. sex. any diet that helps you eat less (fewer calories) will allow you to lose weight. height. determine if you have a medical condition (e. unhealthy. some of these products have been proven toxic. Enter the Zone. Before initiating any weight loss program. one would do best by avoiding presently popular plans suggested in: Dr. and musculature. The Five Day Miracle Diet. 2. to name but a few. Before embarking on any new diet program. 5. Such products as chromium picolinate. The Beverly Hills Diet.Living Healthier and Longer – What Works. Though it would be impossible to comment on all the dietary plans. 6. unsound. This will work even if you have inherited a tendency toward obesity. heart. The use of alternative medicine approaches to weight loss have become popular in recent years. Protein Power. hydroxycitric acid found in plants. lose as much weight as you can. ma huang. and exercise should be the basis of any weight-loss program. as suggested by your physician. or kidney. have not been proven effective and at times. Sugar Busters!. hypothyroidism. and dangerous. If you are unable to achieve ideal weight. Recommendations 1. Avoid fad diets and medications or programs not approved by your physician. Try to associate with leaner people. Another option is to seek help from weight-loss organizations such as Weight Watchers. cortisone preparations). In reality. Cushing’s syndrome. Dieting. 115 . or liver disease) that causes weight gain or if you take medications that contribute to weight gain (e. 7. 4. Avoid all dietary supplements or herbs that claim to promote long-term weight loss. Atkins’ New Diet Revolution. What Doesn’t wrong. 3.. Garcinia cambogia and Garcinia indica.g. Try to achieve a weight close to ideal for your age. Jenny Craig. as long as you follow it..
2007:1442-1444.Living Healthier and Longer – What Works. September 26. Khan T. Dellinger E. Toward the rational and equitable use of bariatric surgery. Journal of the American Medical Association.gov Centers for Disease Control and Prevention (CDC) Obesity and Overweight Flum D. What Doesn’t Further Reading National Institutes of Health National Institute of Diabetes and Digestive and Kidney Disease Obesity Health. 116 .nih.
in women. At blood alcohol concentrations of 0.S.Living Healthier and Longer – What Works. 6. 117 . 2 to 3 drinks per day is associated with a 30 percent increase in breast cancer incidence or deaths. 5. The risk of fatal single-vehicle crashes in drivers with blood alcohol concentrations of 0.15 percent or greater. About 30 percent of U. 50 percent are intoxicated with alcohol or other drugs. Excessive alcohol use is the third leading lifestyle-related cause of death in the U.09 percent is 11 times greater than for nondrinkers.7 million patient years of potential life lost annually in the U. higher levels of alcohol consumption are associated with a 70 percent increase. 8. 2. It appears that. the risk is 380 times greater. Alcohol can cause high blood pressure. Alcohol-related deaths account for 2. 4. 7. -Benjamin Franklin Facts 1.S. adults drink too much and have problems related to drinking alcohol. People dying from alcohol related causes lose an average of 26 years of normal life expectancy..S. Of suicide victims. 65 percent of that loss is due to alcohol-related injuries. What Doesn’t Alcohol Eat not to dullness. The risk of dying in a traffic accident is 8 times greater for heavy drinkers than for nondrinkers. 10. 3. Drink not to elevation. About one-third of drivers killed in vehicle crashes are intoxicated by alcohol. 9.
liver cirrhosis. naproxen. These are non-steroidal anti-inflammatory medicines (NSAIDS) recognized as over-the-counter pain relievers and fever reducers. • Suicides. What Doesn’t Alcohol is believed to be the most frequently abused drug throughout the world.S. In the U. One study found that ingestion of more than 2 drinks per day and progressively greater levels of consumption were associated with higher allcause mortality. • Other violent deaths. or 1½ oz. The presence of cirrhosis caused by alcohol considerably shortens the expected lifespan. It has become apparent that moderate to heavy drinkers (such as those who drink 3 or more alcoholic beverages per day) have an increased risk of liver damage and stomach bleeding when taking aspirin. of distilled spirits at 80 percent proof). or ketoprofen. wine. Additionally. such as in binge drinking. can lead to heart rhythm disturbances and even death.000 deaths each year are due to alcohol.Living Healthier and Longer – What Works. It is associated with shortening life as a prominent contributor to: • Death and bodily damage from automobile accidents. 5 oz. Moderate drinking is defined as 2 drinks per day for men and 1 per day for women (a drink equals 12 oz. Women who drink similar amounts as men appear to be more at risk for complications because they: • Appear to metabolize alcohol differently from men. • Have a lower volume of body water. and short-term heavy ingestion. is a relatively common cause of death among people ages 25 to 46. other salicylates. • Reach a higher blood alcohol concentration in a shorter period of time with the same intake. of regular beer. often a complication of alcoholism. acetaminophen. ibuprofen. About 5 percent of our population drinks heavily while 15 percent binge drink (drinking more than 4 drinks on a single occasion). 118 . Alcohol abuse also has been linked with cancers of the gastrointestinal and respiratory tracts and even the breast. over 75. Significant alcohol ingestion over many years can result in severe heart problems and heart failure.
What Doesn’t Excessive alcohol use has immediate effects that increase the risk of many harmful health conditions: 1. and mineral deficiencies. Because their body fluids are decreased. Alcohol is also a problem for the elderly. Alcohol poisoning that can result in death. • Frequent falls. burns and firearm injuries. stillbirth. • Depression. 4. Those who drink alcoholic beverages must determine their limitations of alcohol intake and maintain control of intake. miscarriage.Living Healthier and Longer – What Works. Alcohol excess in the elderly can lead to various other problems. If pregnant. 5. such as: • Blood pressure elevation. 3. Violence. Because older adults often live alone. including traffic injuries. their drinking problems may not be recognized until major problems develop. • Nutritional. vitamin. whose responses to treatment are as good as those of younger drinkers. Unintentional injuries. and a combination of physical and mental birth defects. Help in determining personal alcohol dependence can be obtained from answers to the CAGE questionnaire: 119 . Risky sexual behaviors. • Degenerative brain disorders. drowning. An even greater problem is seen in nursing homes. falls. Up to 10 percent of older adults living at home may have problems with alcohol. • Dementia. 2. • Damage to the pancreas. including intimate partner violence and child maltreatment. and their death rate is high. the elderly have resulting higher rates of blood alcohol levels and complications than younger people who drink the same amount of alcohol. Professional help is important in this group.
What Doesn’t C . Environmental factors such as adverse life events or work-related stresses are also important. The U. disulfiram (Antabuse) deters alcohol ingestion by triggering adverse reactions such as nausea. social.Have you ever felt Guilty about your drinking practices? E .Living Healthier and Longer – What Works. diarrhea and flushing in those who continue to drink. certain drug therapies can improve outcomes. A variety of psychological. The earlier that alcohol dependence is detected and treated. heart. Food and Drug Administration has approved 3 medications for the treatment of alcohol dependence. and medical interventions have proven effective to one degree or another.S. It does appear to benefit those patients who are highly compliant or receive their medications under supervision.Have you considered Cutting down on your drinking? A . Genes have a lot to do with our risks of becoming alcohol dependent.Have you ever become Angry or Annoyed about questions concerning your drinking? G . but are not exclusive predictors of such risk. drinkers with alcoholic parents are 4 times more likely to have problems with alcohol consumption than drinkers who have no family histories of alcohol problems. The recognition of alcohol dependence should be followed by treatment programs organized by personal physicians or special teams with recognized expertise. a result of “yes” answers to all 4 strongly points to it. In fact. Though potentially effective. this drug has been associated with significant problems and is not frequently used at this time. vomiting. and neurological disorders can be avoided. As many as 50 percent of alcohol-dependent people do not recognize their disorder.Do you ever begin your day with an Eye opener? A result of 2 or more “yes” answers to the questionnaire suggests the likelihood of alcohol dependence. An older drug. the more likely it can be successfully treated and complications involving the liver. there is no universally effective approach to the treatment of alcohol dependence. At present. In combination with these interventions. People with family histories of alcoholism are at risk of becoming alcoholics themselves. 120 .
that provides protection because it. It is especially useful when combined with other therapeutic interventions. Consuming 1 or 2 alcoholic drinks daily results in a 30 to 60 percent reduction in the risk of developing coronary artery disease and even appears to improve the chances of an individual’s survival should they develop a heart attack. incorporates the skins of red grapes (which contain large amounts of phenolic compounds that behave like antioxidants) into the 121 . popular in France. a situation termed the French Paradox. Another facet of alcohol ingestion must also be considered in view of recent findings. This effect occurs in alcoholic patients as well as in social drinkers. Some researchers suggest that it is red wine. Another drug that appears promising. a drug already used for seizure disorders and migraine headache prevention. It especially benefits patients with a family history of alcohol problems and also patients with strong alcohol cravings. unlike white wine. It has been approved to treat alcohol dependence in people who have quit drinking. Naltrexone has an advantage in that it can be given in a daily oral form or a monthly injectable formulation.Living Healthier and Longer – What Works. Much has been written about the type of alcohol that is most beneficial. It also reduces some of the problems caused by alcohol withdrawal. The mechanism for this beneficial effect could be its ability to elevate HDL cholesterol. Acamprosate (Campral) appears to reduce cravings for alcohol by an effect on neurotransmitters in the brain. is topiramate. In several regions of France. we do not recommend that individuals who do not drink begin drinking to gain this potential benefit. What Doesn’t Naltrexone (ReVia) has been effective in reducing alcohol consumption and increasing abstinence by lessening the pleasurable effects of alcohol and reducing cravings for it. Studies suggest that this consumption exerts a protective effect against coronary artery disease. and is effective. though not yet approved for alcoholism therapy. In spite of this suggested benefit. It appears that moderate consumption of alcohol (no more than 2 standard drinks daily for men and 1 for women) may be a reasonably good thing. people eat diets rich in saturated fats and cholesterol but have low incidence of coronary artery disease.
Still other explanations for the French Paradox have been suggested. which usually results from the development of a blood clot in an atherosclerotic blood vessel that supplies a portion of the brain. such as the increased amounts of fruits and vegetables (containing antioxidants) they consume. eating more heavily at midday than in the evening. it has been suggested that the French have not had a long enough exposure to the high animal fat diets they presently consume so as to allow them to show the consequences of these diets. The French may not classify all the same entities recognized by the Americans and British as causes of death from coronary artery disease. who boast the largest consumption of wine in the world. 122 . several factors. as are seen in other Western countries. have much higher rates than other groups with lesser alcohol intakes of: • Cirrhosis. Moreover. Alcohol in moderation (1 to 2 drinks daily) appears to lower risks for ischemic stroke. which then could explain similar benefits from drinking red or white wine. Many believe that other factors common to the French should also be considered. however.Living Healthier and Longer – What Works. Antioxidants. • Upper gastrointestinal malignancies. What Doesn’t production process. the most common type. Additionally. may explain the reduction of coronary risk. Also. or other spirits. no doubt. Other elements of the French or Mediterranean diet such as eating olive oil may also be important. • Violent deaths. • Suicides. the French drink alcohol in moderation and with meals. along with other substances in red wine that prevent blood clotting. Though the exact mechanism for this protective effect with alcohol is not known. It must be remembered. All forms of alcoholic beverages are beneficial in the modest consumption suggested. Such factors include alcohol’s ability to increase HDL cholesterol levels and to interfere with clot formation in cerebral and coronary arteries. contribute. beer. that the French. but larger amounts (7 or more drinks daily) significantly increase the risks of this stroke type. the French dine differently than Americans. Other researchers feel that the ethanol itself causes the beneficial effect. • Accidents.
4. 3. • Recovering alcoholics. or other medications that can magnify alcohol's effects. • People who plan to drive or perform other activities that require unimpaired attention or muscular coordination. New therapies for alcohol dependence open options for office-based treatment. some cardiac benefits may be derived from light to moderate drinking: • No more than 2 drinks daily for men. Journal of the American Medical Association. including: • Women who are pregnant or are trying to conceive. since alcohol is thought to affect their clinical course and response to treatment adversely. If you wish to drink. • Persons being treated for anxiety or depression. • No more than 1 drink daily for those ages 65 and older. don’t start. Some people should consider avoiding alcohol altogether. December 5. sedatives.Living Healthier and Longer – What Works. Further Reading National Institutes of Health (NIH) National Institute on Alcohol Abuse and Alcoholism Health. • People taking antihistamines. Discuss openly your alcohol intake with your physician. 2. What Doesn’t Recommendations 1. People with concerns about breast or gastrointestinal cancers or strong family histories of alcoholism should discuss these situations with their physicians. • No more than 1 drink daily for women. 2007:2467-2468. If you don’t drink alcohol.gov Centers for Disease Control and Prevention (CDC) Alcohol & Public Health Kuehn B.nih. 5. 123 .
124 . 11. Up to 50 percent of patients with unexplained chest pains are really suffering from anxiety. 9. hypertension. Depressed persons have suicide rates at least 8 times higher than those of the general population. 7. One-third of coronary artery patients have disease-related depression or anxiety. or diabetes. 12. relaxation training. Pet owners have fewer risk factors for heart disease than people without such companions. Between 10 percent and 15 percent of older people have depressive symptoms. 4. 10. What Doesn’t Stress and Depression A vigorous 5-mile walk will do more good for an unhappy but otherwise healthy adult than all the medicine and psychology in the world. and stress-reduction programs) reduce recurrent cardiac events (death and heart attacks) by 35 to 75 percent. About 16 percent of all suicides are committed by individuals ages 65 and older. 8. 2. Depressive disorders occur in an estimated 6 percent of the general population but may be found in as many as 50 percent of those with medical illnesses. -Paul Dudley White Facts 1. 6. counseling. Depression is common in smokers and those who are alcoholdependent. 3. Depressed people have increased deaths from coronary artery disease and cancer. Psychosocial stress interventions (group psychotherapy. Up to two-thirds of persons with depression go undetected and untreated. Primary care physicians treat depression and anxiety more than they treat heart disease. 5.Living Healthier and Longer – What Works.
Living Healthier and Longer – What Works. 125 . What Doesn’t 13. Depressive disorders are the fourth most important cause of disability worldwide.
Stressful life events themselves can significantly increase the risk of death. especially when problems are ongoing. Other stresses. may lead to various problems. • Death of someone close. What Doesn’t At many points in life. Such stresses can aggravate existing medical problems and possibly trigger new conditions. the risk was still 8 times higher than normal. • Financial difficulty. • Being present during an earthquake or like catastrophe. One interesting study showed that the risk of heart attack increases 14 times in the first 24 hours after the death of a loved one. • Divorce. People who have family histories of depression or live particularly stressful lives are also prone to depression. these include: • Divorce or separation. such stresses include: • Major financial problems. • Loss of loved ones. By the end of the second day. These include: • Anger. These responses to stresses and/or their complications can be associated with shortened life-spans. • Being sued. Various stressors have at times been associated with increased risks for heart attacks or strokes. especially if they: • Have sudden. • Occupational stress. people face various stresses of varying degrees. • Having certain diseases or physical problems. • Insecure feelings at work. major life changes. • Are unmarried or widowed. 126 . • Involvement in a war. from high blood pressure to cancer to sudden death. • Significant family problems. • Unresolved grief.Living Healthier and Longer – What Works.
Living Healthier and Longer – What Works, What Doesn’t
Lack supportive social networks. Have certain physical conditions such as: • Cancer. • Stroke. • Heart disease. • Dementia. • Any chronic illness. • Parkinson’s Disease.
Studies show that depression may run in families and children of depressed parents may be at a higher risk for depression. One study has shown that death occurs several times more frequently in heart attack patients who also meet criteria for major depression in the 6 months after the event than those without depression. It also appears that the recent development of depression (not chronic depression) in older men is a risk factor for heart attacks. Depression is also associated with biochemical disruptions in the brain, which fortunately respond to drug treatment. Drug treatment can also be effective in treating depression that results from stressful events. Depression is common in American society, with about 15 percent of the population suffering from a major depressive disorder at some time in their lives. Unfortunately, this disorder is diagnosed and treated in fewer than one-third of these people. Among the elderly, major or minor depression is seen in about 5 percent of patients in primary care clinics and up to 25 percent of patients in nursing homes. Sadly, most elderly with depression fail to seek help. Moreover, depression can mimic dementia in the elderly. Depressed people often have repeated visits to their physicians with complaints of: • Vague pain. • Low energy. • Fatigue. • Insomnia.
Living Healthier and Longer – What Works, What Doesn’t
Digestive problems. Sexual difficulties.
Physicians often fail to recognize symptoms of depression, which include: • Persistent feelings of: • Sadness. • Hopelessness. • Pessimism. • Anxiety. • Loss of interest or pleasure in ordinary activities, including sex. • Irritability. • Restlessness. • Decreased energy. • Fatigue. • Feeling slowed down. • Loss of appetite. • Weight loss. • Unintentional weight gain. • Sleeping too little or too much. • Difficulty with: • Concentration. • Remembering. • Making decisions. • Feelings of: • Guilt. • Worthlessness. • Helplessness. • Thoughts of death or suicide. • Suicide attempts. • Not caring whether one lives or dies from medical illness. • Excessive crying. • Recurrent aches and pains that do not respond to treatment. • Personality change. • Substance abuse. Of concern for all patients with depression is the possibility of
Living Healthier and Longer – What Works, What Doesn’t
suicide. Depression appears to be associated with about one-half of all suicides and is one of the strongest factors for attempted and completed suicides. Suicide is a special problem in depressed older adults. About 25 percent of all suicides are committed by people ages 60 and older. Depression is often a recurrent illness but can be treated effectively if it is recognized. Certain illicit drugs, alcohol, and prescription and non-prescription medicines can cause or complicate depression. Depression may also be a side effect of various medications or may be associated with numerous medical illnesses. Depression can also be related to seasonal decreases in the length of daylight, noted at both the northern and southern latitudes. It has become clear that isolation from others is bad. Though data on the value of human connections are difficult to obtain, it appears that people with adequate social networks suffer less depression and live longer than those without such support systems. Valuable support system assets that allow and help people cope with stresses and complexities of life include: • Friends. • Companions. • Acquaintances. • Comrades. • Spouses. • Associates. • Lovers. • Families. • Pets. • • • • • Of untold value is belonging to such groups as: Religious communities. Social networks. Families. Communities. Sports teams.
Living Healthier and Longer – What Works, What Doesn’t
Fortunately, medications are available that are safe and effective for the treatment of depression. Drugs, in fact, are the first-line treatment for depression. A variety of effective antidepressants are available; these include: • Selective serotonin reuptake inhibitors (SSRI’s). • Tricyclics. • Tetracyclics. • Lithium. Drugs from these groups, when combined with psychotherapy may be even more effective. These drugs can be effective within weeks, allowing the depressed individual to return to normal daily activities rather quickly. Continued therapy is effective in preventing recurrent bouts of depression. Electroconvulsive therapy is occasionally used and is effective for cases of severe depression. It is suggested that 80 percent of people with serious depression will improve with medications and/ or psychological counseling. Researchers are studying transcranial magnetic stimulation (TMS) as a possible therapy for major depression. This technique uses short magnetic pulses (roughly the strength of an MRI scanner’s magnetic field) to stimulate the cerebral cortex of the brain. Recommendations 1. Do not be afraid to ask for help. 2. If you can eliminate, reduce, or modify stresses in your life, do so. Discussion of your stresses with physicians, psychiatrists/ psychologists, or friends may help. 3. A routine exercise program often proves valuable for a variety of mental and emotional problems. 4. Maintain regular hours of adequate sleep (6 to 8 hours daily). 5. If you have symptoms of depression, seek your physician’s help to sort out possible causes such as drugs or illnesses and start you on a treatment program.
Develop and foster support groups in your life. 8.Living Healthier and Longer – What Works. 131 . such thoughts should encourage prompt consultation with your physician. What Doesn’t 6. 7. Although thoughts of suicide are common in depression. such drinks may increase symptoms. Do not drink alcohol if you are depressed or anxious or caffeine beverages if you are anxious.
more than 50. die from a vaccine preventable disease. Vaccines in adults can prevent up to 80 percent of deaths due to influenza. 7. 6. pneumococcus and hepatitis B virus were beneficially employed. Among older adults. A man may live long yet live very little.S. 5. An estimated 40.S. -Montaigne Facts 1. 2. Every year.000 annually) than any other vaccine preventable disease. More people die from pneumococcal infections (40. What Doesn’t Immunizations The value of life lies not in the length of days. but in the use we make of them. and the most common infectious cause of death in the U. 3. 132 . almost all of whom are adults. 60 percent of cases of invasive pneumococcal disease and 90 percent of hepatitis cases. Many times that number require hospitalization.000 Americans. Less than one-third of the high risk persons for whom influenza immunization is recommended have received the vaccine.000 lives would be saved each year in the U. if vaccines against influenza. only 52 percent receive influenza vaccines and 28 percent receive pneumococcal vaccines. These vaccines are free to Medicare and Medicaid beneficiaries.Living Healthier and Longer – What Works. 4. Influenza is one of the leading causes of death in people over age 65.
about 36. • Men who have sex with men.S. • Lower fever. Vaccination from influenza results in: • Less severe illness. About 5 percent of adults in the U. in those groups. protecting 95 percent of recipients from getting a serious form of disease.000 deaths and more than 225. Varicella Chicken pox tends to be more severe in adults and patients with immune deficiencies. The effectiveness of the hepatitis A vaccine appears to be quite good. given in 3 doses. • Lower medical expenses. It is given in a 2 dose schedule. but deaths increase with increasing age. A small risk of death is associated with hepatitis A. Certain people are at higher risk for hepatitis A.000 hospitalizations are recorded each year. • Users of injection or street drugs. including: • Institutionalized persons and workers at such institutions. • Considerably lowered deaths. • Those in close contact with hepatitis A persons. and death in adults.S. 6 or more months apart. Routine vaccination programs can save lives with minimal effort expended. • Travelers to countries where hepatitis A is common. Influenza Vaccine Most deaths from influenza virus infections occur in the elderly. 133 . In the U..S. What Doesn’t Immunizations can reduce the incidence of major causes of disease. A combined hepatitis A and hepatitis B vaccine. causing increased complications. are susceptible to varicella. disability. also can be used. Hepatitis A Vaccine Epidemics of hepatitis A are usually caused by fecally contaminated water or food. especially in older populations. but rates of infection are highest among children.000 cases each year. at least 27. Vaccination is effective. this is responsible for about one-half of cases in the U. such as encephalitis.Living Healthier and Longer – What Works.
precancerous genital lesions.consider having Obtain the necessary immunizations countries should and keep hepatitis vaccines as well at other vaccines suggested by the immunizations current. Girlsshould receive 9-26 years or older. 4-8 wks) Pneumococcal 1-2 doses 1 dose Influenza* 1 dose annually 1 dose annually (polysaccharide) Pneumococcal Hepatitis A* 2 doses (0. pages 2478 and pages and 2479 Journal of the the American Medical Association. 2. What Doesn’t Shingles Vaccine The shingles vaccine. Obtain the necessary 2. Travelers to third world at the appropriate ages. 1-2.2479. diphtheria. 2007. Tetanus.g. sexually active. if precancerous genitalreceive and precancerous genital lesions. or Hepatitis A* 2 doses (0. lack indications) documentation of vaccination or have no evidence of prior infection) Recommended if some other risk factor is present (e. if sexuallyas well Girls and women aged 9-26 years 3. Gardasil to genital warts. has been approved for people 60 years old and older. October 2007 September 2008) (United States. 6 mos) 1 or 2 doses Substitute 1 dose of Tdap for Td 1 dose * Covered by the VaccineifInjury Compensation is present (e. Postherpetic neuralgia can be a painful problem and occurs in one-third of untreated cases in people over 60.other vaccines suggested by the location. The vaccine is past... 1-2. 1. 6 (females) mos) (0. Further detailsand discussion can be be found in the Disease Control and Prevention. December 2007. 2. Travelers to third world countries should consider having hepatitis vaccines as well as Travelers to third world countries should consider having hepatitis vaccines active. by vaccine and age group Recommended adult immunization schedule. 6-12 mos. lack Zoster 1 dose 3 (females) doses (0. pertussis (Td/Tdap)* pertussis (Td/Tdap)* Human papillomavirus (HPV)* Human papillomavirus Age group (yrs) Age group (yrs) 19-49 50-64 19-49 50-64 1 dose Td booster every 10 years 1 1 dose of Tdap for Td Substitute dose Td booster every 10 years 3 doses > 65 > 65 (HPV)* Measles mumps.2. October 2007 ––September 2008) Vaccine Vaccine Tetanus. should receive and women aged Gardasil to protect against cervical cancers. Gardasil and womenagainst cervical or older.or more doses 0. immunizations asthe appropriate ages. 2478 and 2479 5. 4-6 mos) 1 dose * Covered by Meningococcal *the Vaccine Injury Compensation Program 1 or more doses For all persons in this category who meet the age requirements and who lack evidence of immunity (e.g. Zostavax. protect against cervical cancers. Girls to protect aged 9-26 years cancers. pages 2478 Journal of American Medical Recommended adult immunization schedule. or other Program Recommended some other risk factor For all persons in this category who meet the age requirements and who lack evidence of immunity (e. The vaccine is Recommendations expensive and it may not be needed if you had a documented case of shingles in the problem and occurs in one-third of untreated cases in people over 60. 3. if sexually active. 2. 6-18 mos 1-2 doses 1 dose (polysaccharide) Hepatitis B* 3 doses (0. location. It has been shown capable of reducing the risk of shingles by about 50 percent and postherpetic neuralgia by about 67 percent. by vaccine and age group (United States. and keep Recommendationsimmunizations current. diphtheria. Further details and found in the Association.g. 2007. should lesions.Living Healthier and Longer – What Works. rubella (MMR)* Measles mumps. past. 6-18 mos Zoster Hepatitis B* 3 doses (0. Obtain the necessary immunizations at the appropriate the expensive and it may not be needed if you had a documented case of shingles in ages. 4-6 mos) Meningococcal * 1 6-12 mos. rubella 1 or 2 doses Varicella* 2 doses (0. December Association. The following figures are the most recent recommendations of the Centers for Disease Control and Prevention. December 5. and genital warts. on the basis of medical occupational.5. The vaccine is expensive and it may not be needed if you had a documented case of shingles in the past. 3. Recommendations 1.g.. as other vaccines suggested by the location. or 0. Further details and TheThe following figures are themost recentrecommendations of the Centers for following figures are the most recent recommendations of discussion can be found in the Journal discussion can the Centers for of the American Medical Disease Control and Prevention. problem and occurs in one-third of untreated cases in people over 60. lifestyle. lifestyle. 4-8 wks) 1 dose (MMR)* Influenza* 1 dose annually 1 dose annually Varicella* 2 doses (0. or older. or other indications) documentation of vaccination or have no evidence of prior infection) 134 114 . and keep 1. and genital warts. on the basis of medical occupational.. immunizations current.
heart disease. 1-2. 2006. October 2007 – September 2008 Indication Immunocompromising conditions (excluding human immunodeficiency virus [HIV]). Temte JL. 6 mos) Contraindicated Contraindicated 1 dose annually 1 or 2 doses 2 doses (0. on the basis of medical occupational. receipt of hemodialysis Vaccine Tetanus. diphtheria. 2007-2008 adult immunization Clinical PreventiveAmerican Family Physician. 4-6 mos.g. pages 1558-1567.) Meningococcal * 1 or more doses Zoster Contraindicated 1 dose * Covered by the Vaccine Injury Compensation Program For all persons in this category who meet the age requirements and who lack evidence of immunity (e. ACIP Releases 2007-2008 Adult Immunization Schedule. Journal of the American Medical Association. Centers for Disease Control and Prevention (CDC).. Adult Immunization. lifestyle. Centers for Disease Control Campos-Outcalt D. Journal of the American Medical Association. 2. pertussis (Td/Tdap)* Human papillomavirus (HPV)* Measles mumps. 4-8 wks) 1 dose TIV or lAIV annually Pneumococcal 1-2 doses (polysaccharide) Hepatitis A* 2 doses (0. rubella (MMR)* Varicella* Influenza* Pregnancy < 200 cells/ L > 200 cells/ L Chronic liver disease Healthcare personnel 1 dose Td booster every 10 years Substitute 1 dose of Tdap for Td 3 doses for females through age 26 yrs (0. and Prevention (CDC). medications. radiation HIV Infection CD4+ T lymphocyte count Diabetes. December 5. Adult Immunization. lack documentation of vaccination or have no evidence of prior infection) Recommended if some other risk factor is present (e. Temte JL. Vaccines and Immunizations. The Guide to Clinical Preventive Services. Vaccines and Immunizations. December 5.Living Healthier and Longer – What Works. 6-18 mos Hepatitis B* 3 doses (0. Services. 2006. 6-12 mos. pages 2478-2479. 2007:2478-2479. 2007. November 15. or other indications) Further Reading Further Reading American Family D. What Doesn’t Vaccines that might be indicated for adults based on medical and other Vaccines (United indicated for adults based on medical and other indicationsthat might beStates. 2007:1558-1567. 115 135 . 2007. November The Guide to schedule. October 2007 – September 2008 indications (United States. Acip releases Campos-OutcaltPhysician. endstage renal disease. chronic alcoholism Asplenia (including elective splenectomy and terminal complement component deficiencies) Kidney failure..g. or 0. chronic pulmonary disease. 15.
Trans-fatty acids act like saturated fats. Up to 50 percent of the people living in nursing homes in the U. 6. 2. 5. may be not be getting all the nutrition they need. 8. Trans-fatty acids may be more harmful that saturated fats. Both increase level of bad cholesterol and reduce the level of good cholesterol in your blood. The average American’s diet is 36 percent fat. can of soda has up to 10 spoons of sugar. 3. A large British study showed that eating fresh fruit was important. not live to eat. 4. What Doesn’t Diet One should eat to live. -Moliére Facts 1. Trans-fatty acids come from a process that adds hydrogen atoms to unsaturated fats. A typical 12 oz. it is important that less than 30 percent of the total calories you eat and drink come from fat.S. This makes the fats more saturated and thus more solid. Making sure that less than 30 percent of your total calories come from fat will lower the chance of dying from coronary artery disease.Living Healthier and Longer – What Works. Eating fresh fruit every day led to fewer deaths from coronary artery disease and stroke. 7. 136 . Only 20 percent of the people in the US do this. According to research.
So. Nutrition and dietary experts often cannot agree. But. Once set up. They need about 10-12 calories per pound. A specific amount of calories that we get from food is needed to allow the body to function. However. Type 2 diabetes. first we need to know some of the vocabulary. each claiming to be the right one for you. let’s see if we can make it simple. Gallbladder disease. energy is released. What Doesn’t What we eat. how much we eat. It is important that we set up healthy dietary patterns as early in life as possible. and what we do not eat is important for the quality and length of our lives. Stroke. It used to be thought that a 150 pound man burning 100 calories/mile would need to run or walk 35 miles to lose 1 pound. there is controversy and confusion. the body will use what was previously stored.Living Healthier and Longer – What Works. Women need less. allowing the body to perform its functions. On the other hand. Can they all be so different and still work to keep you healthy? Even among the legitimate diets. What is eaten influences the development of such problems as: • • • • • • High blood pressure. it important they we keep these patterns throughout life. the person will lose weight. When foods are broken down in the body. The word diet scares many people. for the human body is 12-14 calories per pound of body weight per day for a male. you will gain a pound. If this happens a lot. Thus. Coronary artery disease.500 calories more than you eat. If not enough calories are available in the food for the body’s needs. if you are very active and burn 3. you will lose 1 pound. if you eat 3. Ralph La Forge at Duke University pointed out that our 137 . recent information suggest otherwise.500 calories more than the body needs. The basic calorie requirement. Extra calories can be stored as fat or carbohydrates. Now. just to maintain existence. A calorie is a measure of energy. We all know that foods have calories. There are many diets out there. Several cancers. resulting in weight gain. a 150 pound male would require 1800 calories per day to maintain existence.
Living Healthier and Longer – What Works. Figure 1 is a • the energy see on a of the food. Thisto help you learn more about by industry or about a type also available information is put out a type of food.000 calorie diet. He argues that running and walking burn different calories because the body has to work harder to run. It is important that whenever we can. These labels can tell us a lot of information. We also eat just for the pleasure and joy of eating or drinking something good. that we eat the foods that are best for us. Figure 1 is a typical label one might see on a container of food. We eat to satisfy 138 our hunger. fat and fiber of a standard • The amount of protein.5 to 5 miles per hour. government. Nutrition Facts Serving Size 2 crackers (14 g) Servings Per Container About 21 Amount Per Serving Calories 60 Calories from Fat 15 % Daily Value* 2% 0% 0% 3% 3% 3% Total Fat 1. . Your daily values may be higher or lower depending on your calorie needs: Calories: 2.000 2. If the same man was speed walking. Remember we eat for a number of reasons. carbohydrate. typical label one might content container of food.5 miles per hour. Thus. • how many calories are in a 100 grams of this food. Nutrition labels tell us: carbohydrate. Food manufacturers help us by providing labels on their products.5g Saturated Fat 0g Trans Fat 0g Cholesterol 0mg Sodium 70mg Total Carbohydrate 10g Dietary Fiber Less than 1g Sugars 0g Protein 2g Vitamin A 0% Calcium 0% • • Vitamin C 0% Iron 2% * Percent Daily Values are based on a 2. serving. This information is put out by industry or government. the 150 pound man would use 54 calories per mile when walking up to 3. and nourish our bodies.500 Total Fat Less than 65g 80g Sat Fat Less than 20g 25g Cholesterol Less than 300mg 300mg Sodium Less than 2400mg 2400mg Total carbohydrate 300g 375g Dietary Fiber 25g 30g We can now begin to look at which food groups have been proven to be most beneficial to our bodies. the man would burn 107 calories jogging or running. Running burns about twice the calories as a moderate walk over the same distance. fatavailableof a standard serving. more Many publications areof food. Finally. • the energy content of the food. he would burn 97 calories at 3. Many publications are also and fiber to help you learn • The amount of protein. Food manufacturers help us by providing labels on their products. What Doesn’t body uses calories even when sitting still. Nutrition labels tell us: • how many calories are in 100 grams of this food. These labels can tell us a lot of information.
we can talk about how to figure out how many calories we need in a day. Before talking about specific food items. It is important that whenever we can. We also eat just for the pleasure and joy of eating or drinking something good. and your gender. The American Cancer Society has a tool called a calorie counter. your activity level. the following is commonly considered the ideal combination: • Fat 20 – 35 percent of daily calories (saturated fat should be less than 10 percent). Now that we know how to figure out the number of calories that we need each day. Figuring out the best combination of dietary ingredients that will benefit our bodies and still meet our caloric need is important. These 3 also make up 100 percent of the energy needed. Here are some guidelines. • 1 gram = weight of a paperclip. Not all calories are equal. proteins and fats make up about 90 percent of the dry weight of the typical diet. Now that we have an idea of portions. • 1 cup = size of a fist. Carbohydrates and proteins contain 4 calories per gram. Some are better used by our bodies than others. 1 gram is equal to the weight of a paperclip. You can find the calorie counter on the American Cancer Society website. we should have some idea about portion or the size of a serving. • ½ cup = size of palm of hand or 4 ounces. What Doesn’t We can now begin to look at which food groups have been proven to be most beneficial to our bodies. • 3 ounces = size of a deck of cards. Remember we eat for a number of reasons. • 1 teaspoon = size of the tip of a thumb. 139 . that we eat the foods that are best for us. We eat to satisfy our hunger. we need to think about the best way to get those calories. and nourish our bodies. The number of calories you need is based on how much you currently weigh or how much you want to weigh. This counter allows you to estimate the number of calories that you need each day. When thinking about your whole diet. Carbohydrates. • ¼ cup = size of a golf ball.Living Healthier and Longer – What Works. • 1 portion = 3 ounces. Remember. Fats provide 9 calories per gram and ethanol 7 calories per gram.
Dietary fats are classified as saturated or unsaturated. food with trans-fatty acids is more harmful than food that has saturated fats. Great importance should be attached to the amounts and types of fat in the diet. 140 . Foods with trans-fatty acids lead to higher levels of LDL cholesterol and lower HDL cholesterol levels. LDL. Trans fats and saturated fats in our diet increase the level of triglycerides in the blood. There are of 2 kinds of unsaturated fats: monounsaturated and polyunsaturated. Diets high in trans fats. the cholesterol stays in the blood and builds. These fats can actually reduce the level of bad cholesterol. Saturated fats are the most powerful dietary contributors to high blood cholesterol levels. the bad cholesterol. These fats present a special problem because they interfere with removal of cholesterol from the blood.Living Healthier and Longer – What Works. They take their unsaturated fats and make them more solid and shelf-stable. You do not need to actually eat or drink any saturated fats. Unsaturated fats are found primarily in plants. The saturated fat in butter. This process creates trans-fatty acids. French fries. Your body is able to produce these on its own. As a result. What Doesn’t • Protein • Carbohydrates Fats 10 – 35 percent of daily calories. Saturated fats will increase the level of LDL. Most of the saturated fat in the American diet comes from cheeses and ground beef. Trans-fatty acids are formed when manufacturers’ process foods. whole milk and some cheeses can increase LDL cholesterol levels more than the saturated fat in beef. These foods can also increase triglyceride levels. when they are substituted for saturated fats in the diet. it is not always required to list the level of trans-fatty acids on food labels. saturated fats and cholesterol increase the risk of coronary heart disease and some cancers. As a result. like margarine. Many fast foods like doughnuts. 45 – 65 percent of daily calories. store bought breads and cookies have high levels of trans-fatty acids. However.
Fiber helps in achieving blood sugar control in diabetic patients. • Eat less fat. Fiber also helps protect against diabetes mellitus. can be found in: • Fruits and vegetables. do not replace the fat with carbohydrates. Fiber. What Doesn’t Examples of dietary fats are: Saturated Butter Cheese Chocolate Cocoa butter Coconut Cream Egg yoke Hydrogenated oil Ice cream Lard Meat Poultry Monounsaturated Avocado Canola oil Cashews Olives Olive oil Peanuts Peanut butter Macadamia nuts Hazelnuts Pistachios Almonds Polyunsaturated Corn oil Cottonseed oil Margarine Mayonnaise Pecans Safflower oil Soybean oil Sunflower seeds Walnuts Pine nuts It is better to eat monounsaturated fats than the polyunsaturated fats. Especially avoid animal fat and cholesterol. However. • Beans. too much of any kind of unsaturated fat increases the risk for heart disease and cancer. In such cases. the indigestible component of plant foods. which may include suggestions that patients: • Maintain desirable or ideal weights for their height. the risk of heart attack and stroke decreases. Some people may find it hard to follow diet programs. Doing this can lower the levels of good cholesterol. This is because it is harder to oxidize monounsaturated fats. 141 . There is some thought that fiber may be protective for some cancers. In attempting to lower the fat in one’s diet. • Whole grains.Living Healthier and Longer – What Works. Oxidization is needed to make a fat form a plaque that builds on the artery walls. • Eat less meat. This is done in part by lowering insulin levels. HDL. Fiber As the amount of fiber in a diet increases. it may be better for physicians to provide basic eating guidelines.
Whole grains are much more valuable than refined grains. Sources of insoluble fiber include whole-grain cereals. There are 2 types of fiber. and crackers. Whole grains also have more valuable phytochemicals with antioxidant capability.0 grams • Lima beans (1/2 cup) 13. Seeds.) 3.7 grams • Prunes (10. barley and some vegetables.0 grams • Apple (medium with skin) 3. Breads. oats. Unfortunately. What Doesn’t • • • • Nuts. Some examples of 142 .0 grams • Kellogg’s Raisin Bran (1 cup) 8. Soluble fiber is found in legumes. dried) 8.5 grams • Kidney beans.) 4. High fiber foods are also valuable because they tend to be filling. red (1 cup.4 grams • Citrucel (1 rounded tsp. Pastas. boiled) 6.6 grams • Perdiem. A variety of foods and supplements with high fiber content include: • Post 100 percent Bran (1/3 cup) 8. The goal is to get 25 to 30 grams every day. Soluble fiber helps reduce your cholesterol levels. plain (1 rounded tsp.0 grams • Metamucil (1 rounded tsp. fruits.Living Healthier and Longer – What Works. This is because whole grains have higher fiber contents and more nutrients.0 grams Fish Americans eat about 16 pounds of seafood each year.) 6.0 grams • General Mills Fiber One (1/2 cup) 13. whole-wheat bread. Your body needs both.0 grams • Kellogg’s All-Bran Extra Fiber (1/2 cup) 13. insoluble and soluble. Fish is a great source of protein. Eating a fatty fish even once per week has been associated with a reduced risk of coronary heart disease. most people get only 15 grams of fiber in their diet. Studies suggest that fiber may reduce calorie intake by blocking the digestion of fats and proteins eaten with it. Insoluble fiber tends to increase how quickly food moves through our digestive systems.
Most people eat less than 1 serving each day. Fruits and Vegetables Fruits and vegetables are loaded with micronutrients. The benefits of eating fish probably outweigh the risks. Some different forms are fresh.Living Healthier and Longer – What Works. Worse yet. What Doesn’t fatty fish are salmon. choose a wide range of colors. herring. canned. Though fish may contain mercury in varying amounts depending on the type of fish. These fatty acids are thought by some. the amounts are small. frozen. • phytoestrogens. The very popular shrimp dishes have very little omega-3 fats. only a small percentage of our population even know why it is important to eat fruit and 143 . and juice. • isothiocynates. but not all researchers to be cardioprotective. A host of other known and unknown agents are also found in fruits and vegetables. You can eat fruits and vegetables in any form. Studies show that less than one-third of the population actually eats 6 servings of fruit and vegetables a day. trout or tuna. • phenic acids. Fish intake has also been associated with a lower colorectal cancer risk. In choosing from the large variety of fruits and vegetables. Lobster has even less omega-3 than shrimp. dried. Micronutrients are vitamins and minerals that the body needs to function. • disease preventing or disease fighting indoles. Usually. Fruits and vegetables also have: • antioxidants • disease preventing phytochemicals. sardines. stroke and several cancers. We recommend 6 or more servings daily. • sulforaphane. • fiber. • infection fighting saponins. mackerel. 2 servings of 3 ounces of fish are recommended each week. Eating adequate amounts of fruits and vegetables is associated with a reduced risk of coronary heart disease. These fish may reduce the risk of coronary heart disease because they are high in omega-3 fatty acids.
Some are enriched with omega-3 fatty acids. If you eat meat. and less saturated fat than the same size or weight portion of red meat or dark poultry. Several variations of strict vegetarian diets are both attractive and healthful. about eating eggs in the earlier editions of this text. it is important to understand that eating lean cuts of red meat and white meats are best. less total fat. But for those who eat an otherwise healthy low-fat diet. Eggs are capable of raising one’s total and LDL cholesterol. According to one study. Two recent and rather large studies of eating eggs came to some surprising conclusions. This is important when considering that the total daily recommended allowance for cholesterol is 300 mg. Studies show that those eating meatless diets have much lower death rates. Vegetarian diets are also linked with a low risk of dying from cancer. It is not as harmful as the saturated fats found in many meats causing high blood levels of cholesterol. white meat does have fewer calories. As a point in fact. however. an occasional egg may not be as bad as once thought. eggs have become more heart-friendly. Currently there is a movement toward eating vegetarian diets. both lean red meats and white meats are lower in fat. people who ate 1 egg daily were no more likely to develop heart disease than those who ate less than 1 egg a week. What About Other Items in the Diet? Eggs We said little. the amount of eggs eaten should still be limited for those with known high cholesterol levels. In recent years. Cholesterol content is similar for all except fish. 144 . Fish is generally lower in cholesterol. This is especially true if they are known to already have coronary artery disease. White meats include poultry like chicken and turkey and fish. What Doesn’t vegetables. Red meats include beef. who must still limit their egg intake. Other eggs have gone through a process that lowers the cholesterol content of the egg. however.Living Healthier and Longer – What Works. and pork. An egg is still a good source of inexpensive protein and nutrients. As a result. This fact allows for greater flexibility in eating a lipid-lowering diet. veal. and certainly nothing good. One reason is that 1 egg contains 213 mg of cholesterol. Except for diabetic patients.
cereals. Especially good foods to eat are tinned soya beans and baked beans. Carbohydrates provide the fuel that the body needs in order to function. potatoes and corn. About 75 percent of the salt we get comes in the form of prepared or processed food.400 mg. Salt is also a problem for the obese and those who tend to retain fluid. Excess salt intake is a major cause of high blood pressure in certain people. sweet potatoes. peanuts. starches and fiber. breads. spaghetti.Living Healthier and Longer – What Works. also called salt. These foods lead to a lower rise in blood sugars. pastas. potato chips. sodas. each day. This is much more than the body needs. Some examples of these carbohydrates would be whole grains. Some of examples of sugary carbohydrates are candy. causing swelling. Diets where most of the carbohydrates come from sugars leads to high blood fat levels. It appears reasonable to avoid excess salt in the diet. crackers. Examples of both are as follows: Bad Carbs Sugar Honey Jelly 145 Good Carbs Whole-grain cereals Whole-wheat bread Bran . especially if blood pressure levels are borderline or elevated. People often forget the high salt content of pretzels.There are 3 types of carbohydrates: sugars. All-Bran and white rice. It is always best to include in our diets the good carbs over the bad carbs. The average American takes in about 3. Light salt or sea salt is not an acceptable substitute for table salt. jelly. Lowering salt intake can definitely be associated with a decrease in blood pressure. pastries and cookies. and soy sauces.” Good carbs are digested slowly and cause only a gradual rise in the blood sugar. Another 12 percent occurs naturally in foods. It is best if most of our carbohydrates come from starches and fibers. What Doesn’t Sodium The body actually needs less than one-fourth teaspoon of sodium each day. red lentils. A little over 5 percent is added at the table. popcorn. People often refer to “good carbs” and “bad carbs. Restaurant meals are often high in sodium. of sodium chloride. Carbohydrates More than half of our total daily calories will come from carbohydrates. That is the equivalent of 1-1/2 teaspoons of salt. also called edema.
meat substitutes and soy butter. Also. Though nuts contain between 14 and 20 grams of fat per ounce. Soy is a good substitute for meat in the diet. Soy foods are available as tofu which is made from the liquid extracted from processed soybeans. This means a person weighing 150 pounds needs 54 grams of protein each day. It is a good idea to have some soy products as part of your daily diet. it is recognized that a high protein diet is often a high fat diet. it is a good type of fat. hard cheese 3 oz. poultry or fish 1 cup yogurt 8 grams 7 grams 7 grams 21 grams 8 to 11 grams . Nuts Nuts can be a valuable addition to a healthy diet. Soybeans also have all 8 essential amino acids. soy milk.Living Healthier and Longer – What Works. soy nuts. Soy is also good for the body because it can have estrogen-like effects and antioxidant capabilities. As with too many calories from carbohydrates. These diets are also good for the blood vessels. Examples of common sources of protein include: • • • • • Soy Soybeans are legumes which is a pod or a bean.36 grams per pound of body weight. Soybeans are rich in fiber and free of cholesterol. The fat in nuts is monounsaturated and polyunsaturated 146 1 cup milk 1 egg 1 oz. They have monounsaturated and polyunsaturated fats and omega-3 fatty acids. The body’s daily protein requirement is . What Doesn’t Sodas White rice White bread French fries Crackers Potatoes Pastries Protein Brown rice Bulgur wheat Whole fruits Barley Lentils Oatmeal Nuts The average American eats far more protein than is needed. Diets containing soy and soy nuts are associated with slightly lower cholesterol levels. meat. excess calories from protein can end up as additions to our fat stores.
that olive oil is high in calories. cholesterol. rice milk. chips. Studies have shown that a person can reduce their LDL cholesterol by 8 to12 percent when certain nuts were substituted for saturated fats in the diet. Nuts are valuable sources of Vitamin E and other vitamins. granola bars. Benecol™ (pine tree wood pulp based) and Take Control™ (soy based) are good tasting. minerals. It is important to remember. 147 . People who have special sensitivities to caffeine products should be careful with their coffee drinking. Olive Oil Olive oil is a valued and tasty replacement for butter and meat.000 heart attack survivors showed that after an 18 month period. It is also best to eat 1 to 3 ounces of nuts a few times each week. There are about 120 calories per tablespoon. Both of these products make it so that most of the cholesterol moves through your body rather than staying in it. A recent Italian study of over 10. low-fat cheese. If you eat about 2 grams every day of one of these products. What Doesn’t and free of cholesterol.Living Healthier and Longer – What Works. and even a vitamin preparation. About 80 percent of the calories in most nuts come from fat. Reduce meat and fat in your diet. a variety of other food items. 2 products. These nuts include almonds and walnuts. Some suggest feeling more full and satisfied when you eat nuts. and antioxidants. if any. Both also have little. nuts are best eaten dry roasted. you should lower you LDL by about 10 to 15 percent. though. Because they are high in calories. strokes or sudden deaths than those who drank no coffee. Sterol and stanol enriched products can also be found in orange juice. Butter/Margarine Substitutes Often called “designer” margarines. and very low in saturated fat. 2. Coffee Coffee probably is not much of a health risk if you do not drink more than 5 cups a day. Recommendations 1. those who drank more than 4 cups of coffee daily had no more heart attacks. Follow a dietary program that allows you to maintain desirable weight.
5.Living Healthier and Longer – What Works. 7. Whenever possible. What Doesn’t 3.gov Centers for Disease Control and Prevention (CDC) Nutrition Topics 148 .nih. 4. 6. Avoid cooking meat at high temperatures or for lengthy periods. Consider adding soy products to your diet. Doing either of these can allow the meat to develop cancercausing chemicals. Eat at least 6 portions of fruits and vegetables each day. Further Reading National Institutes of Health (NIH) National Institute of Diabetes and Digestive and Kidney Disease Diet and Nutrition Health. substitute unsaturated for saturated fat. Watch out for and avoid trans fats.
5 to 3. Only one-third of patients with coronary heart disease do the recommended physical exercise that they require. It is estimated that 50 year olds with high levels of physical activity live 3. -Hippocrates Facts 1. Estimates suggest that only about 38 percent of women exercise regularly. we would have found the safest way to health. 11.S. About 59 percent of adults do no vigorous physical activity at all in their leisure time. 4. adults engage in vigorous leisure-time physical activity (lasting 10 or more minutes) 3 or more times per week.7 years longer than those with low physical activity. Only 26 percent of U. Routine exercise programs have proven valuable for a variety of mental and emotional problems. It has been estimated that about 12 percent of all deaths in the U. are related to lack of regular physical activity. 2. One study suggests that exercise may even be protective against the more serious type of macular degeneration. Regular strenuous leisure time exercise in middle-aged men can decrease the risk of cardiac arrest by up to 65 percent and that of sudden heart attack by up to 30 percent. 10. 38 percent report essentially sedentary lifestyles.S. 5. 9. 7. Among people ages 55 and older. 8. 6.Living Healthier and Longer – What Works. Exercise can reduce total deaths and cardiac deaths by 20 to 25 percent in patients with coronary heart disease. 3. not too little and not too much. 149 . What Doesn’t Exercise If we could give every individual the right amount of exercise.
• High blood pressure. vascular and biochemical changes leading to long term benefits of exercise. Many new studies are pointing to cellular.Living Healthier and Longer – What Works.S. Exercise can also improve functional work capacity and help control body weight. • Sometimes decreases LDL cholesterol levels. • Helps control weight. Exercise also appears to be able to delay onset of heart disease and. In a London study of middle-aged conductors of double-decker buses. conductors who constantly ran from the lower to upper decks and down again had smaller waist sizes and developed much less coronary artery disease than sedentary bus drivers. • Helps relieve stress. Exercise has been associated with lower blood pressure and improved blood fat tests as compared to sedentary people. • Cancer. • Reduces blood pressure.. • Improves blood flow to the heart. • Osteoporosis. 150 . improve survival rates. The exact manner in which exercise exerts its many beneficial effects is unknown. • Improves the work capacity of the heart. • Stroke. • Diabetes mellitus. Many studies have shown that physical activity reduces the risk of many diseases such as: • Heart disease.000 deaths are attributed to lack of regular physical activity. Exercise also appears to be able to reduce risks of dangerous blood clots in the body and heart irregularities. should a heart attack occur. In one study. • Improves muscles’ use of sugar. the risk of a heart attack was reduced by as much as 50 percent in active compared to sedentary men. as many as 250. Exercise: • Increases HDL cholesterol levels. What Doesn’t Each year in the U. • Lowers triglyceride levels.
The benefits of exercise are not limited to the heart. Studies show that exercise protects against: • Colon cancer. Studies have also suggested that elderly subjects who exercised developed disability at a much slower rate than those who did not. 24 percent are sedentary and do little if any exercise. About 54 percent are involved in some physical activity but not enough to meet the guidelines. Weight-bearing activities such as walking. • Cigarette smoking. along with other risk factors. • Hypercholesterolemia. where it includes 20 to 30 percent of the population. including: • High blood pressure. physical inactivity had been recognized as a contributor to development of coronary artery disease. • Mental health disorders. weight lifting and back strengthening exercises all have value. other studies suggest that physical activity also offers cardiovascular protection for women. One study found a 44 percent reduction in risk of heart attack associated with regular exercise in women. but is also useful in treating osteoporosis. Only about 22 percent of American adults meet or exceed recently recommended exercise guidelines. What Doesn’t For many years. a sedentary lifestyle has been noted as a major risk factor for coronary artery disease. This statistic indicates that 35 to 50 million Americans are at a two to fourfold increased risk for cardiovascular deaths. • Breast cancer. it has 151 . jogging and climbing stairs. More recently. along with other therapies. In the latter group. • Development of noninsulin-dependent diabetes (type 2) • Osteoporosis. Though earlier studies were conducted with male subjects. Exercise is not only important in preventing.Living Healthier and Longer – What Works. Patients with peripheral vascular disease can significantly improve their walking ability by taking part in exercise programs. • Symptomatic gallstone disease in men. however. Those in the exercise group also had fewer deaths.S. The problem of lack of exercise is particularly important in the U.
However. This can be accomplished in one effort or from several shorter bouts of activity during the course of a day. Other activities. mostly in the legs and spine. taking longer walks on the way to office meetings. parking the car farther from the office. 152 . walking around airports while waiting for flights. and cycling can be substituted according to personal desires and preferences. for example. Moderate exercise such as walking or bicycling for similar periods of time was not associated with reduction in risk for breast cancer. the health benefit derived from exercise can occur even as low as 100 calories per day (walking 1 mile. In these studies. Recent studies also suggest some hope for those who cannot fit a structured exercise program into their lives. walking around soccer fields at their children’s games. What Doesn’t been estimated that as much as 35 percent of excess coronary artery disease could be eliminated if these people became more physically active. experts recommend that most adults pursue moderate-intensity exercise programs. The question is how much exercise is enough? Recommendations from the Centers for Disease Control and Prevention and the American College of Sports Medicine are that every adult in the U. Studies that have shown a reduced incidence of breast cancer related to exercise appear to require 4 or more hours a week of vigorous exercise such as involvement in competitive sports for that benefit to occur. Walking has an added advantage (over swimming or cycling) in that it is a weight-bearing exercise and thus is able to increase bone density.S. The goal is to expend at least 200 extra calories each day by exercise. climbing stairs.Living Healthier and Longer – What Works. such as dancing. A brisk walk (at a rate of 3 to 4 miles per hour) is a good standard. preferably every day. accumulate about 30 minutes of moderately intense physical activity. Because of proven benefits of a moderate amount of physical activity. people were able to accumulate adequate periods of moderateintensity activity during the day by. climbing steps for 10 minutes). Some studies show that significant health benefits are achievable at exercise levels that exceed current minimum guidelines such as running up to 50 miles/week. There are certain risks and a variety of injuries that can occur with such vigorous exercise programs.
153 . A report from Stanford University suggests that older persons ages 50 to 72 who engage in vigorous running and other aerobic activities have lower death rates and slower development of disabilities than members of the general population. The large Harvard Alumni Health Study has shown that. and even result in improved walking capabilities.Living Healthier and Longer – What Works. What Doesn’t Lifting weights is also valuable. • Better ability to maintain independent lifestyles. Exercise is important for maintaining good balance. even for people in their 90s. 20 minutes of jogging burns about 200 calories). Benefits accrue from weight-lifting sessions at least 2 days a week. the better and the lower the risks of disabilities and death from coronary artery disease. It is the hope that such activities for this population will result in: • Improved: • Ambulation. The lowest death rates were in those who burned about 300 calories a day. within reason. Many commercially available books and pamphlets can provide specific amounts and/or durations of favorite activities required for specific benefits (for example. Exercise and strength-training sessions have been shown to be beneficial even for those ages 75 and older. • Balance. which is needed for maintaining balancing skills. Current exercise recommendations are considered minimum suggestions. • Coordination. they lose muscle strength in the legs. walking being one of the best exercises for achieving that goal. As people age and become less active. increase muscle mass. the more exercise performed. with such sessions consisting of 10 to 15 repetitions of 10 sets of a variety of exercises. • Fewer falls. Weight training programs can improve strength and balance in these people. One study suggested that men in the 60-80 age group who walked approximately 2 miles a day lived 5 years longer than those who walked less than 1 mile a day. death rates were significantly lower with moderately vigorous than with less vigorous physical activities. It appears that. at any given quantity of energy expenditure.
though many (unsupported) are claimed. stress reduction and a positive effect of Asian yoga on the quality of their life. The practice of yoga was believed to help its practitioners achieve inner peace and tranquility. If you are able. disabilities or other limitations. While there are a lot of anecdotal claims of benefits of Asian yoga. breathing and prescribed postures. 3. A more westernized view of yoga indicates that benefits might be derived from its exercise. practice some form of yoga. stretching and relaxation components.000 Americans were treated over the past 3 years for yoga related injuries. about 96 percent of heart attacks occur during rest. 154 . Yoga has become quite commercialized and is thought to be a 20+ billion dollar business. Different varieties of yoga. however. some of which is rigorous exercise. of those who have heart attacks during vigorous exertion. Recommendations 1. Walk briskly for at least one-half hour 6 to 7 days per week. can involve much more vigorous exercise. choose a more vigorous physical activity program for its added benefits. however. If you have medical problems. however. 2. The TIME article also points out the fact that 13. the majority had been sedentary or were among those who exercised infrequently. Some people. burns off fewer calories than are in 3 Oreo cookies. with only 4 percent related to vigorous exertion. Continue an exercise program throughout your life. we are unaware of any disease processes reversed by yoga.S. TIME magazine points to a study that showed that dedicated yoga practitioners show no improvement in cardiovascular health.Living Healthier and Longer – What Works. not help them meet their daily exercise goals. and that a typical 50 minute class of the popular hatha yoga variety. Yoga Asian yoga is a mystic and ascetic Hindu discipline of meditation. Also. Those who exercised regularly had an overall lower risk of heart attack. About 18 million people in the U. What Doesn’t Some have expressed concerns about possible development of cardiac problems during vigorous exercise. indicate mental and emotional well-being. 4. seek a physician’s advice and guidance in initiating and developing any exercise program.
Even if you are unable to increase activities to desired or recommended levels. 6. any increase is beneficial and can reduce risks of coronary heart disease. The benefits of exercise lie mostly in the aerobic category (activities that increase your heart rate and make you breathe hard). 7. October 1994. What Doesn’t 5. 155 . Singh G. Further Reading Fries JF. Seek activities that you enjoy.Living Healthier and Longer – What Works. Running and the development of disability with age. Ann Int Med. you are more likely to stick with them. et al.
For its sake one must stay awake all day. Automobile accidents occur about 2 to 3 times more often in people with sleep apnea (episodes of absence of breathing). Studies have shown that cigarette smokers are significantly more likely than nonsmokers to report problems going to sleep and staying asleep and daytime sleepiness. 2. -Neitzsche Facts 1. People with sleep apnea are at about a 3 times greater risk for stroke. Fifty-five percent of vehicle accidents in which drivers fell asleep involve people under 25 years old. 156 . What Doesn’t Sleep Sleeping is no mean art. 3. 5. 4.Living Healthier and Longer – What Works. Up to 5 percent of middle-aged men have sleep apnea. The incidence of heart attack is about 5 times greater in patients who snore and have sleep apnea. 6.
including: • Psychiatric illnesses (often depression). often are undiagnosed and. A large variety of nonprescription and prescription drugs can interfere with sleep. • Major medical illnesses. often associated with various identifiable factors. • Caffeine in drugs (e.Living Healthier and Longer – What Works. Sleep complaints suggest several important causes.. • Phenylpropanolamine. some people may be taking medications that have sedating effects or that disrupt routine sleeping patterns. these include: • Nonprescription (over-the-counter): • Pseudoephedrine. such as Anacin®. Also. • Lung.g. especially those involving the: • Thyroid gland. • Diphenhydramine. What Doesn’t Sleep occupies a significant portion of the average day. 157 . • Heart. Some people feel excessively sleepy during the day without realizing that something might be wrong with their sleep. Sleep apnea interferes with sleep on a regular basis and causes subsequent loss of daytime alertness and increased risk of automobile accidents. though many of them may have long-standing sleep disorders such as sleep apnea. These problems do not get reported to physicians. most people have complaints of difficulty falling asleep and staying asleep or not feeling rested after sleep. Transient problems with sleep. Probably most of these victims are healthy people who are sleep-deprived due to lifestyle or work schedules. At some time or other. left untreated. as well as problems related to the medicines used for its treatment. Excedrin® and Empirin®.). because their importance is unrecognized. Chronic problems. are recognized and usually managed by people. thus. however. Patients must discuss sleep problems with their physicians. • Illnesses associated with pain (such as arthritis). etc. • Chlorpheniramine. It is a common thing for people to fall asleep while driving and become involved in traffic accidents.
Caffeine can be a particular problem for some who are especially sensitive to its effects. This side effect of sleep disturbance may occur only in some people or under certain circumstances. • Metoprolol. • Clonidine. In the U. • Phenytoin. • Propranolol. even a single cup of coffee in the morning could prove to be a problem. • Decline in motor skill capabilities. • Decreased alertness. Few coffee drinkers realize that decaffeinated coffees at some chains can have as much as one-third the caffeine as that in a cup of regular coffee. caffeine. • Impaired thinking. Impairment in performance caused by sleep deprivation 158 .Living Healthier and Longer – What Works. even that found in tea. • Nonsteroidal anti-inflammatory agents. The average cup of regular coffee has 75 to 100 mg of caffeine.S. and even some medications thought to help sleep can cause problems with sleep for certain people. this would amount to up to 7. Some people may have to avoid caffeine completely. • Methyldopa. Reasonable estimates suggest that about 15 to 20 percent of all motor vehicle accidents are attributable to sleepiness. • Corticosteroids. For such people. • Bronchodilators (inhalers).. Alcohol. doxepin). • Progesterone. What Doesn’t • Prescription: • Antidepressants (amitriptyline. Fatigue has been recognized as the leading cause of trucking crashes.000 fatalities per year. which can remain in the body for up to 20 hours. Sleep problems are even more common in the elderly and become more prominent with advancing age. These effects are problematic when anyone drives a car or works with potentially dangerous machinery. colas and chocolate. Older people with sleep problems can be bothered during the day with: • Fatigue.
• Zaleplon (Sonata). • Sleep-Eze. • Eszopiclone (Lunesta). • Flurazepam (Dalmane). • Quazepam (Doral). Sustained wakefulness for 17 hours can decrease performance about as much as 2 (1½ oz.e. when used appropriately and under a doctor’s care.. • Sominex. Commonly used and effective drugs for problems sleeping include: • Estazolam (Pro Som). and these agents should be avoided if sleep apnea is suspected.) drinks of alcohol. • Anacin PM. • Triazolam (Halcion). shorter halflife drugs are less likely to have carry-over sedation that affects daytime functioning. can be helpful in treating insomnia. • Ramelteon (Rozerem). the time it takes for the medicine to be cleared from the body). These medicines can also mask underlying medical problems. What Doesn’t has been compared to impairment caused by alcohol. Alcohol should not be consumed when sleeping agents are being taken. Some people find non-prescription sleep-aids helpful. toxicity of the drug is important because of the higher risk of overdose with some preparations. • Tylenol PM. Available aids include: • Diphenhydramine-containing compounds: • Nytol. • Temazepam (Restoril). • Zolpidem (Ambien). Good medications. They should not be used for chronic insomnia because of their potential addictive qualities. 159 . Also. Such drugs should be used only for short periods because of the risk of developing dependency and withdrawal symptoms when discontinuing their use. • Excedrin PM. One must be concerned with the half-life of such medications (i.Living Healthier and Longer – What Works.
they can cause daytime drowsiness. Depression. These people are often unaware of their problem and often do not suspect any sleep problem.S. however. Also. As occurs with other sleep disorders. Melatonin. The most serious sleeping disorder is sleep apnea. • • • • • • Symptoms of sleep apnea include: Snoring. and disruptions of breathing noted by sleeping partners may be the best clue to sleep apnea. These symptoms often are overlooked. people stop breathing up to hundreds of times each night during sleep. a relatively common disorder seen in about 2 percent of women and 4 percent of men (about 2 to 5 million people in the U. toxicity. choking noises.). What Doesn’t • Doxylamine: • Unisom.Living Healthier and Longer – What Works. result from poor oxygenation of the blood during periods of disrupted breathing. Early morning headache. More important problems. Thought deficits. and optimal dosage. must be used with care. as with use of prescription drugs. Even if taken at night. though commonly touted as a sleep aid. does not have sufficient data to support its use in that role. though loud snoring. These products contain a sedating antihistamine and. Memory changes. Sleep apnea tends to be more common in the elderly. In sleep apnea. There also is not enough data about melatonin’s potential complications. It also is associated with obesity and high blood pressure. Certain airway obstruction problems may be found in such people. These problems are mostly complications of the more severe cases and include: 160 . tolerance can develop rapidly to the sedative effects of antihistamines. sleep apnea patients have a higher frequency of automobile accidents. which can make driving and other tasks risky. It occurs in 25 percent of people ages 60 and older. An excess of 10 such events per hour are generally necessary to establish diagnosis of sleep apnea. Daytime sleepiness.
many physicians are unfamiliar with the disorder and the varied and confusing forms that it can manifest. Recognize that lifestyle factors (smoking. elevating the head of the bed may also help. effective. • Sleeping in a non-supine position.Living Healthier and Longer – What Works. 3. • Use of a humidifier or nasal steroid if signs of rhinitis problems. Additionally. Stroke. There are specific. and often lifesaving treatments for sleep apnea and the diseases that may be associated with it. • Abstinence from alcohol. alcohol. 4. drugs) can interfere with sleep. What Doesn’t • • • • Heart attack. but several general measures can prove helpful: • Weight loss. Be suspicious of any medications you take as possible causes or contributors to sleeping disorders. 161 . Sudden death. Recognize that sleep disorders exist and can have serious consequences. If you are suspicious of sleep apnea. Hypertension. Complicating the ability to diagnose sleep apnea (breathing stops) is the fact that symptoms often are misinterpreted as anxiety or depression or the results of aging. • Smoking cessation. 5. 2. Recommendations 1. avoid sleeping on your back. if overweight. Seek your partner’s observations of your nighttime snoring or breathing habits. • Oral appliances and a variety of surgical procedures can also be considered. Continuous positive airway pressure (CPAP) is the most recognized form of treatment.
Elkholy O.gov Wolkove N. May 8. Sleep and aging: 2. Canadian Medical Association Journal. 7. Management of sleep disorders in older people. What Doesn’t 6. Lung and Blood Institute National Institute of Neurological Disorders and Stroke Sleep Disorders Health.nih. Lack of response to therapies.Living Healthier and Longer – What Works. 2007:1449-1453. or a picture suggesting sleep apnea or its complications should trigger a request for an evaluation at a recognized sleep disorder center which performs a sleep study. Any suspicion of a sleep disorder should be brought to the attention of a physician who is knowledgeable about and interested in the condition. et al. Further Reading National Institutes of Health (NIH) National Heart. suspicion of repeated sleep disorder-related accidents. Centers for Disease Control and Prevention (CDC) Sleep and Sleep Disorders 162 .
7. 3. though most do not need them. 8. No combination of vitamin or mineral supplements can do that.Living Healthier and Longer – What Works. Vitamins and minerals can be classified as dietary supplements. It also tells us that eating a wellbalanced diet provides us with a nice balance of nutrients. Studies do not show that a healthy person who takes extra nutrients has increased energy.” -Maya Angelou Facts 1. 163 . reduced fatigue. 2. varied diet. or added disease protection. kid. Many Americans take vitamin supplements. are without enough scientific support for their routine use. They do not decrease cardiac deaths and could possibly be harmful. Antioxidant supplements. Vitamins taken in excess of the Recommended Daily Allowances can be harmful. Mineral requirements can easily be met with a balanced. 4. “I am with you. 5. including Vitamin E. as has been the result of the use of beta carotene in certain settings. Studies suggest that up to one-half of Americans are vitamin D deficient. 6. Let’s go. The American Dietetic Association tells us that food is the best source of nutrients. What Doesn’t Vitamins and Supplements Life loves to be taken by the lapels and told.
• Skinless poultry. improve sexual prowess. Guidelines for vitamin and mineral requirements are set by the Food and Nutrition Board of the National Research Council and termed Recommended Dietary Allowances (RDAs). These recommendations exceed the needs of most healthy people but avoid the excesses that can be potentially harmful. • Fish. Essential nutrients can be obtained from balanced and varied diets that contain: • Lots of fruits and vegetables. • Grains. and other materials found in foods.Living Healthier and Longer – What Works. It also provides the various known and unknown materials in foods that assist and/or enhance the actions of vitamins. • Some dairy products. obtaining necessary nutrients from the diet avoids problems related to excess vitamin and mineral intake. prevent cancers and heart disease. Also. increase energy. What Doesn’t Millions of Americans take vitamin and mineral supplements. • Lean meat. Diets including the above may also be safer than taking vitamin and mineral supplements. Most adults in this country should not require vitamin and mineral supplements because their diets generally provide adequate nutrient intake. responding to suggestions by supplement manufacturers that their products can prolong life. 164 . and ward off disease. minerals.
People most likely to benefit from daily multiple vitamin/mineral supplements include: • Dieters with fewer than 1.000 IU daily. • Fish.200 calories daily. materials found in foods. Vitamin E. 165 . minerals. 141 Some people do require daily multiple vitamin/mineral supplements. • Elderly people who: • Miss meals. and other A reasonable vitamin and mineral preparation.5 IU • • • • • • • • • • • Significant problems can result from excessive doses of: Vitamin A – avoid more than 5. **Based on a conversion of 1 Alpha-Tocopherol Equivalent=1. It also – What Works. is shown below: Daily Value set by FDA 5. set by the FDA. • Appear malnourished. Zinc. Vitamin C.• Skinless poultry. Calcium. Vitamin D.000 IU 1. the supplements are safe if they contain no more than 150 percent of RDAs for each component. Selenium.7 mg 20 mg 2 mg 6 mcg 400 mcg 10 mg 300 mcg 60 mg 400 IU 30 IU 80 mcg Minerals Calcium Potassium Iron Phosphorus Iodine Magnesium Zinc Copper Selenium Chromium Daily Value set by FDA 1000 mg 3500 mg 18 mg 1000 mg 150 mcg 400 mg 15 mg 2 mg 70 mcg 120 mcg *Based on a conversion of 1 Retinol Activity Equivalent=3 IU. set by the FDA. What Doesn’t materials in foods that assist and/or enhance the actions of vitamins. • People with malabsorption syndromes. Also. For those who need them. Folate. obtaining necessary nutrients from the diet avoids problems related Living Healthier and Longer provides the various known and unknown to excess vitamin and mineral intake. Iron. Vitamin B6.5 mg 1. Niacin. is shown below: Vitamins Vitamin A* B Vitamins Thiamine (B1) Riboflavin (B2) Niacin (B3) B6 (Pyridoxine) B12 (Cobalamin) Folate (Folic acid) Panthothenic acid Biotin Vitamin C Vitamin D Vitamin E** Vitamin K A reasonable vitamin and mineral preparation. Diets including the above may also be safer than taking vitamin and mineral supplements.
Unfortunately. diets of many elderly Americans may not provide the desirable amount of certain beneficial vitamins. generic manufacturer. • Have poor appetites. who need calcium supplements. People taking drugs that distort the appetite. the safety factor that results from getting the true natural forms of vitamin supplements as they are found in foods becomes obvious. zinc. Pregnant and nursing women. multivitamin tablets are seen as valuable for this population. but consumers must be certain that the USP designation is on the label. People with kidney failure. especially if on dialysis.Living Healthier and Longer – What Works. Alcoholics. Strict vegetarians. fortified food products can also provide specific needed vitamins. 166 . Remember that it is best to take your multivitamin preparation with a meal. who may need iron supplements. Strict vegetarians need Vitamin B12. All vitamin supplements with the exception of Vitamin B12 are chemically produced by a manufacturing process that yields both the desired natural form of the vitamin supplement as well as undesirable chemical products which. Because of this. People taking orlistat (Xenical®) for weight reduction. Menstruating women. can be harmful. Smokers. inexpensive. iron. and calcium. Often the best buy is from a reputable. Thus. What Doesn’t • • • • • • • • • • • • Have poor diets. Most postmenopausal women. People with specific vitamin or mineral deficiencies due to a diagnosed disease. in high doses. cut-rate brands may not contain the desired ingredients in the most effective forms. Although age-related changes in elderly persons can bring about this potential need for vitamin supplements. who need vitamin D. It is also best to purchase a reputable brand name vitamin because unfamiliar. Elderly people with poor sunlight exposure.
In many studies in which increased antioxidant intake was shown to be correlated with reduced disease risks. however. Thus. Past interest had been generated by the possibility that betacarotene and vitamins C and E may help prevent cancer and heart disease because of their antioxidant qualities. The American Heart Association does not yet find enough evidence to recommend antioxidant supplementation for the general public. who often don’t drink enough milk and are not exposed to sunlight. 167 . adequate blood concentrations of antioxidant vitamins that are associated with improved health status can be acquired by appropriate dietary intake. Women of childbearing age need 400 mg of folic acid in the form of supplements or fortified foods in order to prevent neural tube birth defects. offers about 17 IU of vitamin E. What Doesn’t Many older Americans have atrophic gastritis with low acid production. this population’s aging skin is less efficient in converting UV light to Vitamin D. The American Heart Association does not recommend vitamin E supplements. Another study with beta-carotene supplementation showed an unexpected increase in deaths from lung cancer and coronary artery disease. Vitamin C supplements and certainly beta-carotene supplements are probably not needed by people who eat reasonable diets. Additionally. Elderly people. while the RDA is 30 IU. will need vitamin D supplements. High doses of antioxidants can be associated with significant health problems. Vitamin D supplements in the elderly appear to reduce the risk of falling. It does not believe that vitamin E reduces the risk of death from coronary artery disease. The average American diet. This makes it difficult for these people to absorb vitamin B12 and contributes to deficiency problems. and grains) be included in the diet. the best recommendation is that more of the natural foods that contain these antioxidants (such as fruits. may improve bladder function and possibly pulmonary function. which also contributes to deficiency.Living Healthier and Longer – What Works. vegetables. Vitamin D deficiency even appears to increase the risk of heart problems. the intake was from antioxidant-rich foods rather than vitamin supplementation. for example. At present. One study of vitamin E supplementation showed an unexpected increase in risk of death from hemorrhagic stroke.
however. vegetables. there is no evidence that fish oil supplements prevent cardiovascular diseases in the general population. Their value in patients with coronary artery disease has yet to be defined as they cannot be made in our body and must be acquired from food. nuts and seeds. • Selenium. Omega-3 fatty acids are essential nutrients. • Zinc. • Iron. What Doesn’t There had been some recent interest in lycopene. has been approved by the FDA and has proven very effective in reducing elevated triglyceride levels. The authors often see patients who take pills or powdered preparations that are “concentrates” of fruits and vegetables. and grains can easily achieve the recommended intake of minerals. These minerals include: • Calcium. who are without fish or fish oil in their diet. Lycopene was thought to reduce the risk of certain cancers. a phytochemical with potent antioxidant properties that is found in tomatoes and especially cooked tomatoes. mostly undocumented. but new data has been less supportive of that conclusion. Lovaza. Such products. Despite numerous and varied claims for mineral supplements. healthy people eating an appropriate number of calories in varied diets with plenty of fruits. Only one fish oil supplement. • Chromium. are made in the lay literature about the far. The convenience of these products is hardly worth their lesser value and often great cost.reaching benefits of fish oil supplements. often do not provide valuable fiber or some nutrients that are readily found in the food items they represent. Dietary sources include fatty fish (salmon) and to a much lesser degree. Presently. flaxseed oil. have a low incidence of coronary artery disease. 168 .Living Healthier and Longer – What Works. We all recognize that vegetarians. there is not enough evidence to recommend their routine use as a health food. Our best advice would be to eat a fatty fish meal twice weekly if possible. In spite of all the hype. Many claims. These are marketed aggressively to patients who wish to be certain they receive all important nutrients in their diet.
may be deficient in calcium and vitamin D. The elderly.Living Healthier and Longer – What Works. • Ages 71 and older – 800 IU -1000 IU/day. It is amazing what people are willing to take which they believe will achieve healthier and longer lives. Manufacturers of supplements. Manganese. Daily vitamin D recommendations for both men and women are: • 19 to 50 years old – 200 IU/day. and restore qualities and feelings associated with youth. of calcium per 8 oz. Molybdenum. supplements (such as calcium carbonate or calcium citrate taken 2 or 3 times daily with meals) are beneficial. health foods. due to dietary deficiencies and/or lack of sunlight exposure. partly because it stimulates calcium absorption from the intestine. The exception to this rule is calcium. contain about 300 mg. in the elderly has the potential to reduce the rate of hip and other fractures and also helps prevent osteoporosis. no FDA-approvals. along with calcium. Cobalt. and are good sources of dietary calcium. calcium supplements may be required. • 51 to 70 years old – 400 IU – 600 IU/day. including toxicity. individual minerals or combinations of them can cause problems. and associated increased deaths. For those unable to take in enough dietary calcium. Fluoride. Phosphorus. Copper. Vitamin D supplementation. skim to whole milk. serving. Toxicity is not expected from eating natural foods that contain these minerals. and natural products claim benefits for which there is no supporting evidence. Taken in excess. increased incidence of fractures in the elderly. Often these items are expensive and by themselves can be dangerous or prove to be especially toxic when combined with other drugs 169 . avoid problems associated with natural aging. Even higher doses may be beneficial in the elderly who are ill or are taking steroids. What Doesn’t • • • • • • • Iodine. To protect against osteoporosis. and usually no scientific basis. Most forms of milk.
3.Living Healthier and Longer – What Works. and dietary calcium intake. 5. The Medical Letter. gender. 2. National Institutes of Health (NIH) Vitamin and Mineral Supplements Office of Dietary Supplements Health. 2005:57-58. July 18. Additionally. and yellow) 6. A simple. and grains daily. Further Reading Vitamin supplements. Avoid vitamin/mineral supplements in dosages greater than RDA recommendations. A reasonable and effective way to obtain necessary antioxidants is to eat a variety of fruits and vegetables of different colors (green. 4. Prometheus Books:1994. What Doesn’t or products. Obtain vitamins and minerals by eating a balanced diet that includes at least 6 servings of fruits. there is inadequate knowledge about problems associated with long-term ingestion of these items. Herbert V. vegetables.gov Centers for Disease Control and Prevention (CDC) Vitamins and Other Micronutrients 170 . inexpensive multiple vitamin/mineral supplement based on RDAs benefit certain groups.nih. red. You may need calcium supplements. Recommendations 1. Barrett S. orange. depending on your age. It is best not to purchase supplements from your health care “professional” or from his or her office. The Vitamin Pushers.
-William Osler Facts 1. 6. 2. 5. 4. plain (never enteric coated) aspirin. What Doesn’t Aspirin The desire to take medicine is perhaps the greatest feature which distinguishes man from animals. If you feel like you are having a heart attack. A variety of herbals and dietary supplements can interfere with the beneficial actions of aspirin. a daily low dose aspirin could reduce the chances of a heart attack or a stroke by 25 percent. 171 . Ibuprofen can interfere with the action of aspirin. An 81 mg dose of aspirin is probably all that is needed for most indications. 3. do not take together. For certain populations.Living Healthier and Longer – What Works. For those who have had a heart attack. call 911 and then chew a 325 mg. a daily aspirin could reduce the risk of having another by 30 percent.
• Urinary tract. Though the desired effects of aspirin are seen across a wide range of doses. diabetic patients. and its anti-inflammatory ability appears to be a factor in the treatment and prevention of coronary artery disease. side effects increase with higher doses. The American Heart Association estimated that 5.000 to 10. Aspirin is a common cause of skin bruising but no reason to terminate its use. • Hemorrhage in the: • Upper gastrointestinal tract (stomach bleeding). The aspirin prevents blood clots from forming in the coronary artery by making blood platelets less sticky. and people with kidney diseases suggest a role for this drug in health maintenance. Aspirin can also be a problem for those with uncontrolled hypertension and for alcoholic subjects because of hemorrhagic strokes and gastrointestinal bleeding. What Doesn’t Aspirin is an important drug with many uses. gastrointestinal or brain hemorrhage. Even low doses of aspirin (81 mg) can cause gastric discomfort and. It is especially useful in lowering risk of death (by 50 percent) and in patients in the process of having heart attacks. Aspirin is effective for those with coronary artery disease and those who have had or are at increased risk for heart attack. Though aspirin has many potential beneficial effects. certain blood vessel problems. though rare. respectively. its widespread usage is limited by a variety of significant side effects that include: • Peptic ulcers. 172 . stroke. • Gastritis.000 lives could be saved each year if people took an aspirin (preferably chewed at the first sign of symptoms).Living Healthier and Longer – What Works. A recent study suggests that there is no significant difference in the rates of upper gastrointestinal bleeding with use of regular aspirin or the more expensive enteric-coated or buffered form. • Bowel. Potential beneficial effects of aspirin intake in people with heart disease. • Brain. It is also known to have numerous nonplatelet-related effects. • Allergic reactions (occasionally).
4. aspirin may prove more harmful than beneficial. Use the lowest dose of aspirin that is known to be effective for the condition under treatment. In men without symptoms or risk factors for coronary artery disease. have excessive side effects or are allergic to aspirin. are at great risk for a first heart attack. 3. Taking aspirin after a heart attack lowers rates of death and recurrent heart attack by 20 percent. 5. but potential side effects may negate the desired value. In fact. probably low-dose (1 baby aspirin) each day taken with food will provide benefit while minimizing risks. because of risk factors. clopidogren (Plavix). Use of aspirin in middle-aged or older men who. can be substituted. have or are prone to peptic ulcers. For those resistant to the effects of aspirin. Patients with angina pectoris or coronary bypass grafts also benefit from aspirin. in men without symptoms or risk factors for coronary artery disease. or have other potential bleeding problems. aspirin complications may negate the desired value. 173 . aspirin is not approved for decreasing heart attack risks in healthy people. such as chest pain (angina) or have had a heart attack. Take aspirin (under a physician’s guidance) if you have symptoms or signs suggesting an impending stroke (TIA) or after a completed stroke. What Doesn’t Following a heart attack or medical condition that enhances risks for heart attack or stroke. Because of its potential adverse effects. a daily aspirin (325 mg) or even a baby aspirin (81 mg) is of proven benefit. may be beneficial. Avoid aspirin if you are already taking other blood thinners. 2. Studies have shown a benefit of aspirin in reducing risks of stroke in patients with symptoms (transient ischemic attacks) but not as much benefit in asymptomatic people unless found to have significant carotid artery narrowing. Take aspirin (dose as recommended by your physician) if you have coronary artery disease and especially if you have poorly controlled symptoms. If it is used.Living Healthier and Longer – What Works. Recommendations 1. though expensive.
If you take aspirin regularly. For those with gastrointestinal side effects from aspirin. 8. What Doesn’t 6. or even younger if prominent cardiovascular risk factors exist. The National Kidney Foundation recommends a daily aspirin for people with kidney disease and especially those patients on dialysis. 9. do not stop suddenly due to a possible rebound effect that can increase the risk for a heart attack or stroke. 7.Living Healthier and Longer – What Works. Further reading U. a proton-pump inhibitor like omeprazole (Prilosec) can be utilized. Food and Drug Administration (FDA) Aspirin 174 . The American Diabetes Association recommends a daily low dose aspirin for all patients with type 1 or type 2 diabetic patients who are over the age of 40.S.
skin. 4. What Doesn’t Aging He that would pass the latter part of life with honor and decency. Lifestyle goals to avoid obesity. Depression and sexual dysfunction are common in the elderly and are treatable.S. Medicines for treating high blood pressure. 5. pneumococcal.Samuel Johnson Facts 1. tetanus. 8. visual. 10. 3. Immunization (influenza. population is growing older. There is no magic potion or medicine to reverse aging. . Daily exercise can prevent heart “deconditioning” and muscle atrophy in the elderly. 2. consider that he shall one day be old and remember when he is old that he was once young. shingles) is important in disease prevention in the elderly. 175 . must when he is young. Much that is considered “aging” is due to muscle atrophy. Undetected hearing. Social interaction and keeping one’s mind busy with reading. 9. and dental problems are common in the elderly. 11. and colon cancer is important. 7. and smoking cessation are equally important in the elderly. decreasing quality of life. and various other productive activities enhance mental health in the elderly. crossword puzzles. excessive alcohol intake (greater than 1-2 glasses per day). increased “bad” cholesterol and heart disease are effective in the elderly. Cancer increases with age and thus routine screening for breast. Polypharmacy (multiple medications) leading to unnecessary costs and side effects is common in the elderly. prostate. 6.Living Healthier and Longer – What Works. U. 12. and are treatable.
While daily physical exercise is equally or more important in the elderly. prevention of disease necessitates lifestyle changes and/or medications. biking. the fastest growing segment of our population is those over 75 years of age. the approach to living a long and healthy life for the elderly is of critical importance to our country’s future. Successful aging is a challenge which involves both lifestyle and genetic factors. in spite of decades of tobacco abuse. Modest weight lifting can avoid muscle atrophy which can predispose to falls and accidents. Thus. • Excessive alcohol intake can cause hypertension and undetected alcoholism is not uncommon in the elderly. While our genetic composition. as outlined in this book. Thus. What Doesn’t The population in America is growing older and. When the physician adds an additional medication for an elderly patient. • High blood pressure increases with age and treatment is important. crossword puzzles. as is statin treatment for “bad” cholesterol. as determined by our mother and father’s gene banks. and may be harmful. 30 minutes of walking daily is advised. by 2020. cardiovascular disease. walking. • Smoking cessation in the elderly. dementia. Alternative medicine therapies have been unproven in approaches to prevent aging. The cost and side effects of polypharmacy in the elderly are major problems which can decrease quality of life. 176 . Moreover. and some cancers. which will provide them with a longer and healthier life. At a minimum.Living Healthier and Longer – What Works. or other card games. The important lifestyle changes for the elderly are similar to those recommended for other Americans with appropriate alterations as specified by the individual’s physician. whether it be reading. Several studies indicate that the daily use of aspirin (81 mg) may help prevent stroke. Currently. • Mental exercise is equally important. Aerobic exercise (e.g. the intensity and duration of the exercise is best prescribed by one’s physician. he/she should ask whether any existing medications can be discontinued. can be associated with improved lung and heart function. the elderly should focus on the lifestyles. life expectancy at age 65 averages 17 years.. 20 percent of the population will be over 65 years of age. treadmill) has a beneficial effect on cardiovascular function. may predict predisposition to diseases. bridge.
each year. but they can also be associated with significant toxicity. There are immunizations that are mandatory and effective for the elderly including influenza. • Estrogen. pneumococcal. E and D. • Fetal stem cell injections Depression may be frequently missed in the elderly and just considered “withdrawing associated with aging. • Melatonin. • Testosterone. Tetanus vaccine also may need to be repeated as recommended by the patient’s physician. • Growth Hormone. Early detection of cancers can be life-prolonging and thus appropriate screening is recommended. • Vitamins A. psychosomatic disease. C. 177 . What Doesn’t The products listed below not only have no anti-aging value. • Antioxidants. Psychotherapy and antidepressant medications can be very effective in the elderly. • Nutritional supplements. Billions of dollars are wasted on these useless anti-aging products. Equally important in the elderly is social involvement with others – friends. children. and even suicide in the elderly. effective medications are available to treat erectile dysfunction in elderly males.” Mood.Living Healthier and Longer – What Works. Visual and auditory aids can enhance the quality of life for the elderly. grandchildren. and zoster (shingles). paranoia. Isolation fosters depression. non-compliance. eating and sleep disorders may be clues to depression in the elderly. Unproven Anti-aging Products • Hormones: • DHEA. As described elsewhere in this book. Sexual dysfunction is also frequently ignored in the elderly. alcoholism.
Sophocles Wrote his grand Oedipus.295(3):306-313. Rowe J. Michel J-P. . and Simonides Bore off the prize of verse from his compeers.nih. nothing is too late Till the tired heart shall cease to palpitate. 2006. Goethe at Weimar. Saunders Company:1990. Cato learned Greek at eighty. 2008:688-690. at Woodstock with the nightingales. Pantheon Books:New York:1998. . Journal of the American Medical Association. . though in another dress. invisible by day. et al. At sixty wrote the Canterbury tales. Berger J. And as the evening twilight fades away The sky is filled with stars. Kirkwood T. toiling to the last. but they show How far the gulf-stream of our youth may flow Into the arctic regions of our lives .Henry Wadsworth Longfellow Further Reading Schrier RW. Kahn R. Journal of the American Medical Association. . W. When each had numbered more than 4-score years . Medical challenges of improving the quality of a longer life. February 13. National Institutes of Health (NIH) National Institute of Neurological Disorders and Stroke Health.gov 178 . . Completed Faust when eighty years were past. These are indeed exceptions. Successful Aging.Living Healthier and Longer – What Works. Newton J. Geriatric Medicine. B. What Doesn’t Recommendation It is too late! Ah. Aspirin for the primary prevention of cardiovascular events in women and men: a sex-specific meta-analysis of randomized controlled trials. Chaucer. For age is opportunity no less Than youth itself.
” TIME reported on a study by the Mayo Clinic which found that up to 80 percent of physicians avoid talking to their patients about being obese. 3. but has no power over the sand in the hour-glass. The physician is the “coach” and the patient is the “player”. -Hester Lynch Piozzi Facts 1. The author of a TIME Magazine article said. 2. What Doesn’t The Physician A physician can sometimes parry the scythe of death.Living Healthier and Longer – What Works. “Doctors hate to tell you to lose weight as much as you hate hearing it. A quality physician could prove to be one of the most important pieces in a long and healthy life. The game is making your living longer and healthier. 4. 179 . A physician’s silence can put your health in danger. 5. The physician and the patient must work as a team.
Much care should go into selection of personal physicians. They should also think about the specialtyrelated interests and skills of the doctors they are considering. though. Keep in mind. Patients who work with good doctors will have a higher quality. These physicians often work at major university medical centers. When looking for the right physicians. They also want a doctor they can work with for many years. 180 . Some people may want to choose a doctor who is on a list like “Best Doctors in America”. For example. It is important to understand that many of the doctors at the university do not see many patients. longer life. Obviously. The physician should also have an excellent reputation. or especially other trusted physicians. can help people find a doctor who works for them. Sometimes recommendations from friends and relatives. patients should expect to be cared for by quality physicians. from the beginning. however. Patients must take time to find physicians they like and trust.Living Healthier and Longer – What Works. What Doesn’t There is little doubt that good physicians who have good relationships with their patients can influence the patient’s life. Personal physicians usually are internists or family physicians. Your primary care doctor does not need to know every specialty. A good visit with a doctor is one where you feel that your problems have been heard. a diabetic patient may want to find an internist with subspecialty interests in endocrinology. In recent years. Patients should feel free to check qualifications of a doctor they are considering. Patients should look for physicians who. People also should find a doctor with whom they have good personality matches. seem interested in them and their problems. people might consider their own special needs. People should also find a doctor who is interested in helping them get and stay healthy. They need to know other good physicians so they can make a good referral. many of these doctors are starting to spend more of their time treating patients. People want physicians with whom they work well. Physicians should be willing to spend a reasonable amount of time with patients during visits. Usually these doctors have to teach and do research as well as see patients. that primary care physicians can make referrals to a specialist for special problems.
Choose the best available specialist to help care for the patient. though. This will help the patient avoid a sometimes serious or life-shortening illness. Ask your doctor if you have read about new health information. Good physicians. will look for information and figure out how it applies to their patients’ illnesses and needs. Help their patients select the best places to get medical care. 181 • • • • • • • • . quickly look into problems. Use tried and tested medicines and treatments. This means doctors should be able to tell patients which hospitals. Things are always changing and we are always learning new things about health.Living Healthier and Longer – What Works. care centers. As you ask. the media does not always give the whole story. Avoid dangerous tests or procedures. Avoid tests or procedures the patient does not really need. Upon hearing patients' symptoms. that the media may report on something that is interesting but may not be helpful. however. The doctor will continue to work with the patient to make sure the therapy is working effectively. The doctor should know everything you are taking so they can make sure there is no dangerous mix. you will be able to see if your doctor is also learning about these new approaches. What Doesn’t Patients should see whether their doctor keeps reading about new medical practices and research. Keep watch over the patient to discover diseases at early stages. Good physicians will: • Make sure the patient gets the right immunizations. or emergency units they should use. This means the doctor will do screens and tests looking for the early signs of a disease. Remember. Be concerned about what could go wrong if certain drugs are used together. Diseases are easier to treat at the early stages. When the problem is uncovered. the doctor will start therapies right away. There are a number of ways in which a physician’s care can improve the quality and length of life. A good doctor will also know about the possible side effects and complications of what they recommend. Also.
Doctors can also help patients find programs to help them adopt healthy behaviors. depression. Patients sometimes want to have more visits or exams than the doctor feels are needed. A high quality relationship between the doctor and patient helps the patient really benefit from having a doctor. This means doctors should regularly talk about issues such as: • Smoking. Having anxiety. or therapies the doctor feels may be a problem. They should also take the time to understand each other. They can also make a disease worse. procedures. • Choosing not to exercise. What Doesn’t • • Help their patients find the best therapy and rehabilitation centers for their needs. The doctor should explain to the 182 . medicines. or dementia makes it hard for patients to follow the doctor’s recommendation. Make sure patients know about their cardiovascular risk factors. Doctors should work on their patients' behalf when there is a problem with insurance. Tell their patients when they are doing something that puts their health at risk. Help their patients find programs so they can change their diets. • Following an unhealthy diet. This person also needs to be able to meet patients' healthcare needs. This person should be qualified to help patients. Be advocates for the patient. • • • • • • It is important that the patient and the doctor work well together. weekends. These conditions can lead to bad outcomes such as suicide or an accident. Be interested in the cost of evaluating and treating the patient. Guarantee that their practice has someone patients can call for nights. and when the doctor is on vacation. Doctors should keep in mind that the patient may not be able to do something that is too expensive.Living Healthier and Longer – What Works. • Drinking too much alcohol. • Deciding not to have safe sex. Be interested in all their patients' problems. Patients may also want tests.
Recently. Recommendations 1. or dangerous. As a result. Patients may eventually need some form of home care. • hospice care. physicians are starting to understand the value of working with the patients’ spiritual and religious views when providing care. Today especially. Doctors also need to think about the role of family. Doctors should still be willing to discuss all the different medical choices with their patients. should be able to direct patients towards the best programs for them. • rehabilitation programs. friends. This can be: • supportive or custodial home care.Living Healthier and Longer – What Works. What Doesn’t patient why they disagree. • nursing home care. and community support activities in the life of their patient. As patients age. Physicians. The doctor should also keep the program in mind when thinking about future health care. use the information suggested in this chapter. These studies have shown that it is important for doctors to take patients’ spiritual and religious beliefs into consideration. Doctors might not agree with the patient if they feel some things are inappropriate. what they need from the doctor can change. some doctors have expanded the part of the patient exam (history) where they ask about a person’s background. 183 . physicians try to keep people out of expensive hospital settings when reasonable alternatives are available. by themselves or through team efforts. • assisted living programs. For example. They may also disagree if they think it is expensive with little benefit. Take the time and effort to find the best physician match for your needs. When looking for that person. studies have begun to look at the connection between a person’s spiritual beliefs and decisions about their health.
Fifty percent of patients in post-heart attack rehabilitation programs abandon them within a year. About half of all patients leave the doctor’s office not knowing what they have been advised to do. exercise. 5. 8. only 10 percent have their prescriptions filled often enough to be receiving the proper dose. 7.). Seventy-five percent of patients do not follow lifestyle recommendations (diet. 3. 4. Up to 20 percent of patients do not present their prescriptions to a pharmacy within 1 month of issue. 9. 10.Living Healthier and Longer – What Works. 2. Only 30 percent of patients follow dietary recommendations after 1 year. etc. Thirty-eight percent of patients fail to follow short-term treatment plans (such as taking antibiotics). -Hippocrates Facts 1. Forty-three percent of patients do not take long-term medications as prescribed. 11. 6. What Doesn’t The Patient The patient must combat the disease with the physician. Of patients taking digitalis for heart failure. One study found that patients with heart disease who took less than 80 percent of the prescribed medication (beta-blockers) had 4 times the number of cardiac events (heart attacks and strokes) as those who were fully adherent. 184 . At least one-third of patients cannot name the medications that they take. Up to 21 percent of prescriptions given to patients are never filled.
• Uncertainty of effectiveness. Making dose or time schedules too complicated. Failing to instruct patients as to the purpose and importance of medications. possibly receive less time and attention from the physician and the clinic staff. Adult patients are not compliant for a variety of reasons. gender. Some of these drugs can be harmful in and of themselves. It is becoming apparent that patients must become assertive with regards to their medical care. Not recognizing medication cost factors. Today. unquestioning and seemingly unconcerned about their medical problems are at a disadvantage. Patients who are passive. Not warning patients about significant or bothersome side effects. the problem is even worse. contribute to the problem by: Not giving patients clear instructions for taking medications. computer systems used in pharmacies are not capable of screening for potential drug interactions with all herbal products. discontinuing medications on their own because of: • Real or suspected side effects. nonprescription drugs. • • • • • • Doctors. Physicians may at times fail to recognize a drug's side effects that become manifest when added to other drugs on a patient's program. and give the false 185 . and various other pills with unknown components in varied forms and dosages without telling their physicians. • Just plain forgetfulness. or when used alongside prescribed medications. What Doesn’t Many of these above listed facts were noted in the September 1994 Johns Hopkins Medical Letter and explain why many physicians feel frustrated with problems of patient compliance. herbs. other medications and diseases to be treated. Unfortunately. at times. in combination with other medications patients take on their own (such as aspirin or sinus medications). • Drug costs. on the other hand. Not dosing medications based on age. Patients. kidney and liver function.Living Healthier and Longer – What Works. • Vacations. take supplements. • Confusion about dose or time of dose.
Ask your doctor about less expensive alternatives for expensive medications. Patients who become more involved in their care tend to feel more confident. A high percentage of people questioned on the subject felt that prayer sometimes influences recovery from illnesses. Other studies have shown that prayer has a beneficial therapeutic effect in a large number of patients. are less anxious about their illnesses. how they work. such concepts are often not communicated between physician and patient. especially older patients. Resources such as books and pamphlets. patients should mention their spiritual or belief areas so that physicians can be prepared to help satisfy patients’ spiritual needs when and if the time for such arises. have spiritual needs that must be met. and are more likely to comply with treatment regimens. especially regimens that are complex or more uncomfortable. Know the medications you take and why you are taking them. even though only half of those questioned described themselves as religious. Keep a list of your medications and instructions with you at all times. Unfortunately. how they should be used.Living Healthier and Longer – What Works. 5. At a relatively early point in the patient-physician relationship. especially those recommended by your physician. Have your doctor write down instructions. 4. What Doesn’t impression that their condition is not as serious as it actually is. 186 . or if splitting the pills will make them less expensive. Most physicians generally understand that patients. 3. Patients should learn as much about their illnesses as possible. Studies have shown that certain strictly observant religious groups have reduced deaths and decreased rates of some diseases. and quality Internet sites have potential value for patients to learn much about their medications. their side effects and potential complications. Ask your doctor about side effects of prescribed medications you are given. Recommendations 1. 2.
What Doesn’t 6. 10. Take a spouse. 7. relative. bring with you a list of your problems/concerns. 11. 187 . If possible. and list them in the order of your concern. 9. When you visit your physician. or friend with you to your doctor when you discuss confusing or complex treatment programs. Inform your doctor about your suspected medication side effects. A pill container divided into daily compartments holding each day’s medications is helpful for the patient. particularly the elderly. Take a list of your current medications at least yearly to your doctor and do so more often if you take numerous medications. choose a single pharmacy and personal pharmacist who is interested in providing information to you as well as in filling your prescriptions.Living Healthier and Longer – What Works. 8.
John’s wort. we cannot say for certain that these therapies are effective or safe. War and Peace Facts 1. A placebo is a pill or therapy that does not really do anything to the body.” it does not mean they are harmless. even though these are called “natural. Remember. 10. though. It is not clear whether or not these herbals hurt your body. 3. —Leo Tolstoy. 7. 6. About two-thirds of adults who use herbs do not pay attention to these studies.Living Healthier and Longer – What Works. What Doesn’t Alternative Medicine Alternative to what ???? Our body is a machine for living. People are paying a lot of money for something that has not been shown to work yet. 4. Most alternative therapies have not been thoroughly tested yet. About one-third of all Americans use some form of alternative medicine. St. John’s wort has the most documented interactions with other drugs. People can have a dangerous reaction to an herbal remedy. It is organized for that. As a result. 9. Let life go on in it unhindered and let it defend itself. it will do more than if you paralyze it by encumbering it with remedies. There is very little good data on the toxicity of herbals. There was a large study to see if those who used herbs pay attention to well-done studies that show the herbs do not work. 2. 5. 8. Less than one-third of patients who use some form of alternative methods tell their doctors about it. Tell your doctor if you are taking St. someone might get better even 188 . Sometimes. it is its nature. As many as 17 percent of adults report using herbal treatments at least once in the past year. Most studies that show herbals remedies work are paid for by the company that makes the product.
Barker Bausell’s talks about this in his 2007 book Snake Oil Science: How We Know That the Placebo Effect Exists. This is called the placebo effect. 11. People felt better because they thought the treatment would work. What Doesn’t though they are getting a placebo. The pill or therapy works because the person getting it believes it will work. 189 . Almost all positive responses to alternative medicine treatments are due to the placebo effect.Living Healthier and Longer – What Works. R.
We may even stop doing something that we once thought was effective. Some of the successes of traditional medicine are: • Offering cures for bacterial infections. and viral diseases such as AIDS. What Doesn’t Traditional medicine can also be called familiar. herb. It will never exist. Forget it. History shows that people have looked at everything from magic potions to snake oils. Those who practice traditional medicine know that new tests are always being done. To go along with these are a group of practices called Alternative Medicine. science based. metabolic illnesses such as diabetes. or magic potion that will allow us to be healthy without eating a healthy diet and exercising. That being said. They look for the pill. People feel comfortable with traditional medical practices because they have been well tested. • Creating medicines. Everyone dreams of living a long healthy life without having to worry about whether they smoke. The more common ones are: 190 . These medicines have helped treat and control heart disease. We are comfortable with the fact that something new may be learned. Most of these practices have been studied and found to work. • Creating therapies for inhibiting or slowing the growth of cancers. a lot of people continue to hope that the “pill of the day” that they are using. The silver bullet does not exist. or conventional medical practices. will be “the one”. The search for a quick and easy way to be healthy has gone on since ancient times. The successes of conventional medical practices have lead to people living longer. • The use of immunizations to keep people from getting serious illnesses. These successes have also led to controlling or getting rid of certain diseases that reduced the quality of our lives. people are looking to herbs and supplements. Doing new tests to see what works has been very successful. We are willing to use this new information to change a treatment. This type of medicine has been shown to extend and improve life. They include a wide-ranging group of hundreds of approaches that have not been supported by research. eat or drink too much. Just because something has been done a certain way for a long time does not mean that we would choose to continue it if we see data saying it did not work. Today.Living Healthier and Longer – What Works.
these CAM practices have crept into legitimate conventional medical programs. Bausell is a research biostatistician who worked with a center for complementary and alternative medical research. psychic or spiritual healing used for treatment of specific medical conditions or disease symptoms. They believe it can work with traditional medicine. They are practiced in the absence of both scientific evidence proving their effectiveness and a plausible biological explanation for why they should be effective. There are many different definitions for alternative medicine or CAM. chemical. Barker Bausell. Reiki. tai chi. CAM practices are often disguised 191 . Therapeutic touch. Until recently. herbs. homeopathy. the hospital. Magnet therapy.Living Healthier and Longer – What Works. Aromatherapy. folk medicine. The best that I have found is that suggested by R. the medical center and the medical school. qi gong. or psychic interventions such as acupuncture. nutraceuticals. hatha yoga. chelation. Spiritual healing. and their practice continues unabated even after (1) there is scientific evidence that they are ineffective and (2) their biological basis is discredited. Students could talk about these practices and debate about their effectiveness. Some definitions are probably in order. Instead. Massage therapy. Reflexology. naturopathy. Because of the hefty financial rewards for the CAM therapist. medical students were told that these practices existed. Iridology Naturopathy. biofeedback. alternative medical practices were not taught in medical schools. Medical students were also taught to recognize potential complications related to their use. massage. hypnosis. • • • • • • Homeopathy. Herbal medicine. Recently however that has changed. Integrative medicine is phrase used to suggest that alternative and traditional medicine can be used at the same time. and any sort of energetic. This is a difficult idea for conventional medical scientists. Another commonly used term is CAM. His definition of CAM is as follows: CAM therapies are physical. CAM stands for complementary and alternative medicine. megavitamin therapy. chiropractic manipulation. Those who support alternative medicine often called it complementary. mental. What Doesn’t • • • • • • Acupuncture.
Up to 15 percent of that money spent on CAM therapies is for herbal products. • mind over matter. Such funds might have been better used if they were given to conventional scientific research programs. public spent between $36 billion and $47 billion. • mind/body interaction. • treating the whole patient. • attacking the cause of disease. We do not have good data to say these approaches work. • complementary. the need to satisfy important politicians and powerful interest groups and a vague notion that providing CAM is politically correct. This group is part of the National Institute of Health. Instead. We believe that people spend a lot more today. Alternative therapies are often closely tied with certain “catch words” and phrases. What Doesn’t as “research”. alternative medicine practitioners defend their therapies by relying on stories from a few people. • time tested. the desire to address the “needs” of patients. • stimulating the body’s ability to heal itself. • power of positive thinking. • holistic. These products offer little medical help.S. The research used to support this approach is often from poor quality journals that often lack critical peer review. 192 . Some examples are included in the list below. This money has been spent without anyone being able to show that any alternative treatments work. Estimates from 1997 suggest that the U. • natural. The problem with most alternative therapies is that they are highly questionable practices that have not been thoroughly tested.Living Healthier and Longer – What Works. • alternative. hundreds of millions of tax dollars have been spent by the National Center for Complementary and Alternative Medicine (NCCAM). There are no recent figures on how much the public spends on CAM therapies. Since 1991. People who practice alternative medicine often feel that scientific studies do not apply to their particular therapy. They might also use a theory that has not been tested yet.
folk medicine or faith healing methods can seem like they are working. For instance. mind and spirit in health. When someone asks these patients about their good health. At times therapies that are not tested are associated with behaviors that have been shown to help. not their many years of living a healthy lifestyle. These people often make money from sales of the approach or product they are selling. What Doesn’t • • safer non-toxic alternative. or the Internet. There are in fact patients who use alternative medicine because of a bad experience with traditional medicine. forceful people. 2. however. What makes it hard to know if something is working. They may have gotten the idea to try alternative medicine from one of many sources. These include: 1. Others who have not seen the years of good living will just accept that the pill is what led to this person’s good health. belief in the importance of body. This is why traditional or scientific medicine demands something be tested on a lot of people using a high quality study before deciding what works. Some of today’s most notable alternative medicine healers are passionate. They seem to know a lot of facts even though some of the information they provide can not be supported. radio and television. The placebo effect. They are able to charm audiences with their seemingly endless knowledge. books or magazines. Most people. a therapy that has not been tested may 193 . These patients may have had a problem with the doctor or with the medical setting.Living Healthier and Longer – What Works. These include word of mouth. Sometimes we think something is working because we expect it to. use alternative medicine as another way to try and stay well. They are very easy to like. There are many reasons something might seem to work that really does not. is that the person might feel they are getting better when they are not. Some alternative medicine therapists see their role as taking care of people who “failed” in traditional medicine. We have often seen older people begin taking supplements they do not need. This is true for all forms of treatment. The healer effect. they often give credit to the supplement. The co-operative effect. These are people who are in excellent health and have always had a healthy lifestyle. At some point alternative. 3.
5. Professor E. Acupuncture Acupuncturists claim to be able to treat a large number of diseases. there is no evidence to show that it can reverse any disease process. Ernst from a Complementary Medicine program analyzed acupuncture. The misdiagnosis effect. The pattern of disease effect. People may feel the alternative medicine works because it supports their religious or spirituality ideas. they may think they were cured by whatever treatment they were doing when the disease stopped. Regardless. Yet. They have not proven to be effective for any clinical condition. The majority of studies of acupuncture do not show effects beyond a placebo response. This can happen because there was not information to tell what the patient had. He 194 . What Doesn’t be prescribed along with a change in diet.” It should not be used. and exercise. Even though the person got better on their own. We assume it works because we feel the other beliefs are true. 6. For example. It is also possible that at the time there were no good tests to find out what was wrong. Homeopathy has been called “The ultimate hoax. it is commonly thought that traditional medicine rejects religion or spirituality. At some point the disease will stop by itself or a patient’s body finally gains control of the process. Homeopathic products are so watered down that they really do not have a measurable effect. Even though the diet and exercise are what helps. The psychological effect.Living Healthier and Longer – What Works. the person might believe it is the unproven therapy. Alternative Medicine Therapies Homeopathy Homeopathy targets symptoms of disease. Often a disease is self-limiting. 4. the patient gets better even though the particular therapy did not help. This approach takes extremely small amounts of substances that treat similar symptoms in healthy people when taken in large amounts. A patient may be thought to have a disease he does not really have. This effect can assume many forms. A therapy may work because we see it as better fitting other things we believe.
What Doesn’t states. people in China are looking for higher quality medical care. This contradicts centuries’ old beliefs.7 million in China. There are about 270. This therapy is done by putting a synthetic amino acid.” Acupuncture is based on the claim that the body’s vital energy flows through channels connected to body organs and functions. There is no research to suggest that this therapy does this. peripheral vascular disease. People in China are also becoming better educated. however. Chelation Therapy Chelation therapy is used to treat coronary artery disease. There are now more than 1. 195 . This is done thorough a needle in their arm. Acupuncture and many other Oriental medical practices are becoming less popular in China. In that same period the number of Western-trained doctors has jumped twenty-fold. Chelation therapy proposes to reverse the swelling and disorder in the walls of the arteries. At this time. Recent studies however have shown that the acupuncture effect can occur no matter where the needles are placed. Those who study acupuncture believe disease is the result of an unbalanced or blocked energy flow. This is because China’s economy has improved. and a host of other major and minor illnesses. nothing appears more logical than acupuncture has a placebo effect. Twirling needles in the skin at certain specific sites is supposed to reverse both of these. the number of traditional doctors trained in China has fallen by nearly half since 1949.000 traditional doctors in China. Traditional Chinese medicine may still exist because the Chinese Government has given it a protected status. and other substances into a patient’s bloodstream.Living Healthier and Longer – What Works. EDTA. atherosclerosis. As a result. They argue that acupuncture helps produce endorphins. The therapy can. however. have serious side effects. “some findings are encouraging but others suggest that its clinical effects mainly depend on a placebo effect. The Los Angles Times notes that. Those who value acupuncture try hard for newer and better explanations for the “effect” of acupuncture.
the surplus energy you gather and enjoy can be channeled to create anything that you want. have never been documented. Critics have accused him of substituting superstition for medicine. He says patients need to use Ayurvedic methods to harness their consciousness as a healing force.” “They say you have to give up everything to be spiritual. more people are practicing alternative medicine and thus more people are prescribing herbs.” “…. we can influence the way we age biologically…. What Doesn’t Therapeutic Touch Proponents of therapeutic touch say that a therapist can change a patient’s “energy field”. Also.Living Healthier and Longer – What Works. Herbal Medicines People have begun to use herbs in addition to diets to help people stay healthy. all that junk. You 196 . extracts or essential oils. Also. Chopra does quite well financially from the products he offers. Energy fields. Here are some quotes from his books. get away from the world. herbs and aromatic oils. recent studies show that this therapy has no value.You can tell your body not to age. We do not recommend Ayurvedic methods or treatments. tapes. Herbs are processed or unprocessed plant parts. Problems have come up because herbal medicine is accepted more and more by the public. Ayurvedic Medicine Ayurvedic medicine is closely associated with Deepak Chopra. Herbs are also very popular. He has written several books. This change allows the patient’s body to heal.by consciously using our awareness. I satisfy a spiritual yearning without making (people) think they have to worry about God and punishment. He sells books.” • • Chopra promises “perfect health” to those who follow his advice. including limited wealth. They reach the public in a variety of forms. There is a large variety of herbal medicines now available. Herbal medicine is the most common form of alternative treatment in use. • “When your actions are motivated by love…. however.
This means that you can use the same type of pill from a company and have it be different in every bottle. and how safe it is. The herb may be in pure form or mixed with various other unknown substances. This all has to be decided before the 197 . It is hard to get complete information for most herbs. elixirs. Available information about herbs is often only to help sell the product. There are also rules about what you have to tell people about the product. It also prevents the FDA from removing worthless herbal ingredients from the marketplace. the FDA would oversee them. is often not easily found. The steps taken to make sure the herb supplement is high quality is also not known. What is in the herbal medicine. Herbs can also have both toxic and helpful materials. The lobbying led Congress to pass the Dietary Supplement Health and Education Act (DSHEA). It is also usually not clear how soon the herb needs to be taken. This classification allows manufacturers of herbal products to side-step FDA rules. the information is slanted and not clear in its claims. The FDA also pays attention to which drugs interact with other substances. As a result. teas. herbs have a large variety of active chemicals. herbal products are not examined as closely as other drugs. as they often in fact are. Most herbal products are considered unpatented dietary supplements. The FDA looks over drugs that are being used to make sure they are safe and that they work the way the say they do. This means there are rules about what information is needed to decide if the medicine is safe. This was done because of a very large lobbying effort by the health food industry. and powders. Because of the many different ways you can get them. If herbs were viewed as drugs. prescription medicines and foods. What is mixed with the herb and how much is often unknown and changes from batch to batch. the FDA says which dose or amount of the drug is safe. capsules. medicines are regulated. As a result. In the United States. Finally.Living Healthier and Longer – What Works. What Doesn’t can get herbs in tablets. Finally. how pure it is. This law said that herbs were not medicine but something you took to help with nutrition missing in your diet. Sometimes they have both. Herbs also have been known to contain recognized prescription compounds. This information is not based on sound scientific evidence. there is usually very little information on how the herb interacts with other herbs.
It has been reported that the German government has lower standards for herbal remedies than for conventional drugs. This process does not occur with herbal products. called the DSHEA. What Doesn’t FDA will allow a drug to be available to the public. the FDA still monitors their safety and effectiveness. Herbal remedies are quite popular in Germany. Different countries also watch over product safety differently. Some have had dangerous compounds including pesticides in them. This makes studies of how well the herb works very difficult. Because herbal medicines are not under the same rules as other drugs. also weakens the FDA’s ability to protect consumers. Sometimes there is not even enough of the desired herb to be effective.Living Healthier and Longer – What Works. This makes it harder to figure out if herbs work since something made in China may be very different than something with the same name made in the US. In summary. Herbal products are made and used all over the world. The Dietary Supplement Health and Education Act. information about what the herbal drug can do are only suggestions about what the drug might do. Quality control also varies from country to country. • the materials that are mixed in with the herb. • The way the herb was stored. It is well recognized that herbal preparations vary considerably from country to country. There are many things that can effect how the herb works on your body. the DSHEA requires no proof of efficacy or safety and sets no standards for quality control for products labeled as supplements. There are also other things about the way the herbs are prepared that are troubling. Chinese herbal preparations have been known to also have toxic heavy metals in them. Studies have shown that what is listed on the label does not always match what is in the herbal preparations. Often. This presents other problems. Some herbal preparations are such that the desired 198 . These include: • the soil or climatic conditions of the area where the herb was grown and picked. Once the drug is being used by the public. They do not tell you that the drug was well tested and found to work. the herbal industry does not have to prove the drug does what they claim.
gingko biloba. the herbal remedy would have to be under the same FDA rules as other drugs. The Center for Science in the Public Interest states that its vitamin. Anesthesiologists have voiced concerns about patients using herbal products prior to surgery. As plants do contain chemicals which could potentially prove to be effective medicines. These include: garlic. A recent example of the extent of the herbal problem is the popular cold remedy. Other herbs can boost the effect of warfarin. Anesthesiologists recommend that patients stop taking herbal preparations at least 2 to 3 weeks before scheduled surgeries. What Doesn’t active ingredient is broken down by the body’s digestive system. It claimed to prevent colds and protect people from germy environments. The makers of Airborne. have agreed to a $23 million settlement of a class action lawsuit for false advertising. and ginseng. approved by the FDA for the treatment of genital warts. Some preparations that seem like they will not be harmful. For this to happen though. in a recent success story for the proponents of evidence based medicine. Herbs should be under the same FDA scrutiny as other drugs. This means the desired herb never reaches the bloodstream. and feverfew. which is a water extract of green tea leaves from Carnellia sinensis. 199 . One common form of warfarin is Coumadin®. A recent example is a product. mineral and herbal mixture has no credible evidence to support its claims. Ginseng can reduce the blood thinning effect of warfarin. herbs would have to be made the same way if they were called by the same name. sinecatechins (Veregen). gingko biloba. John’s wort. Green tea has a high amount of vitamin K.Living Healthier and Longer – What Works. Most of these problems with herbal remedies would have been discovered and examined by the FDA. they could prove valuable if they can meet the FDA standards for approval. they should be treated as such. Airborne. Because herbal products are often real drug preparations. such as green tea. They have noticed major changes in heart rates and blood pressures in some patients taking St. Manufacturers would have to follow the generally accepted standards of effectiveness and safety for that preparation. can end up being harmful. which has made millions for its makers. If that were the case. Vitamin K can present real problems for patients taking the blood thinner warfarin. licorice root.
it must come from a study in the U. In the table we have summarized the best available data on several commonly used herbs.S. What Doesn’t There was a story in the newspaper about a well-known athlete who almost died after using an herbal remedy. In other cases. It would be even better if the studies were repeated by other quality researchers who had similar findings. that looked at how the herb affected humans and not just animals. was supposed to be used to help one sleep after strenuous physical activity. Appropriate studies will have been reviewed by people who can make sure the study was done correctly. The product also was supposed to help muscles recover more effectively. The best thing you can do is to talk to your doctor about your problems and the methods that you would like to use to treat 200 . the basketball player had seizures and stopped breathing. we have created a table. We will incorporate quality studies of both positive and negative findings. After taking the over the counter herb. the product. the herb can make the drug more powerful. According to the FDA. Some of these preparations can interfere with the effectiveness of other important prescription medications. It is also hard to know about the toxicity of unrecognized compounds mixed with the herbal preparations. It is impossible though to consider all potential complications of using herbs with other medicines. The other downside to using herbs is that someone might wait to get treatment for a cancer or illness that would do better if treated early. We will point out some of the suggested uses and the claims made for these preparations. The study should have been large enough to adequately test the drug. We will attempt to arrive at a consensus opinion as to the proven effectiveness of a particular herbal preparation. In an effort to make some sense out of the pages and pages of information on herbs. however. We will point out the presence and degree of toxicity of herbal preparations if they are known.Living Healthier and Longer – What Works. It is important that you understand that a lot of the information on herbs is not complete. gamma butyrolacton or GBL. This means the person would have too much of the drug in their body. These studies should have taken place over a long enough period of time so as not to distort the outcome. The information is also rarely supported with good data. We will attempt to point out the possible effectiveness of these herbs. We will only do this. For the data to be high quality. if there is high quality data to support their claims. The herb can also make another drug more toxic.
credible scientific evidence to suggest that any CAM therapy benefits any medical condition or reduces any medical symptom (pain or otherwise) better than a placebo. that therapy becomes part of conventional medicine. You should expect and even demand a thorough overview of products that are available for you. however. we will give our best recommendation as to whether these herbs should be incorporated into your health maintenance or life-sustaining/advancing program. What Doesn’t it. Another source of these claims are data which seem to show changes in some marker for the immune system in humans.Living Healthier and Longer – What Works. Finally. according to Professor Bausell.” Of course. “There is no compelling. The actual significance or value of these changes and their meaning for short or long term health itself is unknown. In fact. Many alternative medicines claim to improve the “immune system. Though these changes are real. We would hope. Similar changes can be brought about by such a simple thing as exercise. The researchers are guessing the medicine will help the immune system based on a change in a laboratory test which may or may not be relevant. alternative medicine practices are not short-cuts to living longer and healthier lives. If toxicity data are unknown or unavailable. we cannot guess how these medicines affect humans. Though interesting. In the past. that the public is capable of learning from the past. In spite of the many promises. these are only laboratory tests. in fact. Be careful about anything you would put into your often defenseless body systems. we will note that with a question mark. similar barriers might have prevented some of these herbs and supplements from being available for public use.” These claims are often based on animal studies. 201 . We are considering only usual dosages and not overdoses. Some may argue that we have said too many negative things about individual herbal products. should any of these CAM therapies be found to be effective.
Infections. as “statin” No Yes Yes Yes Yes Co Q10 Yes Yes Creatine No Yes Yes Dong Quai DHEA No No Yes Yes Yes Yes Further studies needed. Retard memory loss Wound healing.. etc. should any of these CAM therapies be found to be effective. Prevents aging Performance enhancer Regulate menses. Wound healing Blood purifier. Cardiac support. Antidiarrheal. Vascular health Treatment of atherosclerosis. Aphrodisiac. Lowering serum lipids. Medicinal Herbs Androstenedione Chamomile Chaparral Chondroitin. Muscle builder Treats high cholesterol Enhances energy levels. that Living Healthier and Longer – What Works.medical condition or reduces any medical symptom (pain or otherwise) better than a placebo. Relieve symptoms of aging. better treatments available. Asthma treatment Migraine Prophylaxis Preventing heart disease. Colds Weight control. Fighting infection For nausea and motion sickness No Yes. etc. Energy booster. Energy booster. Slow aging. more studies needed Avoid Ginger Gingko Biloba Ginseng Goldenseal Green tea Improve mental function. AntiInflammatory. studies in progress Avoid Best to take quality controlled FDAApproved “statin” Avoid Fat burner.” Of course. Senility and cancers. What Doesn’t therapy becomes part of conventional medicine. antiseptic Cancer prevention No Yes Yes Avoid Unknown Yes 202 Yes Yes Avoid More studies needed . Glucosamine Sulfate Chromium Picolinate Cholestin Use/Claims Boost athletic performance Sedative. ease cramps Anti-aging remedy. Cancer cure Arthritis relief Effective No No No No Toxicity Mild Serious Yes Yes Yes Yes Yes Yes Yes ? Recommendation Avoid Avoid Avoid Questionable value. won’t benefit most potential users Avoid Avoid Echinacea Ephedra No No Yes Yes Yes Yes Avoid Avoid Feverfew Yes Yes Yes Garlic No Yes Yes More studies needed Good with food preparations 173 Yes No Yes Yes ? Yes Possibly useful.
Energy Valerian Sleep aid Yes Yes Yes Better agents booster. 4. Retard available memory loss Yohimbe Treatment of Inconclusive Yes Yes Take Echinacea Wound healing. studies prevention needed in progress Kava kava Relieving Yes Yes Yes Better Chromium Fat burner. Fighting infection Ginger For nausea and Yes Yes ? Possibly useful. Energy booster. Arthritis No Yes ? Questionable Goldenseal Antidiarrheal. enlargement Cardiac support. No Avoidonly with male erectile physician Infections. Your doctor will help you decide if you need medical attention. no antiFDAaging aging use Approved “statin” Saw palmetto For symptoms Questionable Yes Yes ? Better Co Q10 Enhances No Avoid meds due to prostate available energy levels. won’t healthy joints benefit most St. Also. tell Yes Yes your physician. 3. Research to see if any herb you might take has toxic side effects. ease drugs available for cramps significant DHEA Anti-aging No Yes Yes Avoid depression remedy. Asthma Recommendations: treatment 174 Feverfew Migraine Yes More 1. Colds dysfunction supervision No Yes Yes Avoid Ephedra Weight control. medical condition motion sickness medical symptom (pain or otherwise) better than a or reduces any more studies placebo. What needed Doesn’t therapy becomes part of conventional medicine. Creatine Performance No Yes Yes Further studies maintains enhancer needed.studies Prophylaxis needed 2. If you are thinking about using an alternative medicine practice. No Yes Yes Avoid Aphrodisiac.lipids. etc. check to see if the herb can cause problems when taken with blood thinners. performance Relieve AntiChamomile Sedative. aging. Gingko Biloba Improve mental No Yes Yes Avoid function. Unknown Yes Yes Avoid Glucosamine value. Chaparral Blood purifier. No Avoid studied anxiety. Senility Wound healing and cancers. Shark cartilage Cancer aging No Yes ? Avoid Prevents treatment. See if the practice was 173 found to be effective. 203 . that Living Healthier and Longer – What Works.. better antiseptic Sulfate treatments Green tea Cancer Yes More studies available.relief Chondroitin. No Yes Yes Avoid symptoms of Inflammatory. Vascular Medicinal Toxicity Effective Recommendation Use/Claims health Herbs Mild Serious No Yes Yes Ginseng Androstenedione Treatment of Boost athletic Yes Yes Avoid atherosclerosis. should any of these CAM therapies be found to be effective. as Yes Yes Best to take Melatonin Helps with sleep Questionable Yes Yes More research cholesterol “statin” quality controlled and jet lag.builder drugs available Picolinate Muscle Sedative Cholestin Treats high Yes. Before using alternative remedies for any problem talk with your doctor. Anti(sleep) needed. Cancer cure etc. John’s Wort Natural Yes Yes Yes More long-term potential users antidepressant and better studies Dong Quai Regulate No Yes Yes Avoid needed. Slow aging.” Of course. If you are using herbal remedies. look for a sound study that tested it. Better menses.
2008:73-78. Avoid using any form of alternative medicine that has not been proven to work. Prometheus Books:1994. What Doesn’t 5. Blind Faith. Bartecchi CE. The New Republic. 204 . Relman A.Living Healthier and Longer – What Works. It is possible the herbs you take could react negatively with another medicine that you are already taking. Journal of the American Medical Association. Friedrich MJ. December 14. The Alternative Medicine Hoax. 2008:160-161. Oxford University Press:2007. Snake Oil Science: The Truth About Complementary And Alternative Medicine. November 8. Bausell RB. Excellent review of many alternative medicine. Exercise may boost aging immune system. Sloan RP. CAM treatments by a nonphysician. January 1. Cracking down on health fraud. 6. Leon. Gardiner P. Herbert V. Acupuncture: a critical analysis.:2003. Before you take an herb.” We agree with their advice. Garev Publishing Int. Herbal and dietary supplement drug interactions in patients with chronic illnesses. Shaugnessy AF. January 9. Martin’s Press:2006. 2006:125-137. A trip to stonesville. Ernst E. Further Reading Barrett S. St. The Vitamin Pushers. 7. What will happen to alternative medicine? Time Magazine. November-December. 2006. 1998. American Family Physician. talk with your doctor. Phillips R. Jaroff. The Vitamin Pushers. Barrett and Herbert strongly suggest that “The most prudent course of action is to forget about using herbs for medicinal purposes. FDA Consumer Magazine. 1999:77. In their book. bio-statistician. Journal of Internal Medicine.
quackwatch. Excellent source of information on all alternative medicine therapies.com. Dietary supplements: the wellness reports.nih. University of California. Berkeley School of Public Health.com/druginfo/druginterchecker http://www.medscape. What Doesn’t Swartzberg JE. For information about herbal and dietary supplement drug interactions: • • • http://nccam.org 205 . http://www.Living Healthier and Longer – What Works.gov http://www.herbmed.
• All that greasy food isn't good for you. Better yet. • You're getting fat. The fatal thing is rejection. In fact. who admonished: • Don't smoke. • Get your sleep. In this era of great medical advancements.Living Healthier and Longer – What Works. Go out and play! • Let's do some work around here. Life was meant to be lived. • Don't ever let me hear that you are using drugs. Avoid second-hand smoke. One must never. turn his back on life. • Know your blood pressure and be sure that it is normal. What Doesn’t IN SUMMARY I could not at any age be content to take my place in a corner by the fireside and simply look on. • Don't sit around. for whatever reason. • What did the doctor tell you to do? • Why don't you find yourself some nice friends? • Buckle-up. physicians feel compelled to modify somewhat the wonderful words of wisdom passed on to us by our mothers. 206 . • Eat at least 6 servings of fruits and vegetables each day. the things we must do to achieve this goal are not so difficult or unpleasant that we would need to wonder if they are worth the effort. saturated fat and cholesterol. -Eleanor Roosevelt Current scientific data provides a great deal of information on how to live a long and healthy life. Don't eat so much junk. Curiosity must be kept alive. • Why do you have to drink (alcohol)? • Drink your milk. • Leave the magnets on the refrigerator where they belong. • Eat your fruits and vegetables. especially trans-fats. • Eat a diet low in fat. They might rephrase the messages to say: • Don't smoke or use any tobacco product. Don't stay up all night. many healthy principles were taught to us by our mothers.
New York. inexpensively. FDA.. If you follow this advice. Palm Coast. either your mother's or your physician's. Boston. Stay away from all illicit drugs. What Doesn’t • • • • • • • Exercise. Johns Hopkins.O. Health after 50. MN 55905. Demand proof of efficacy before using any alternative medicine therapies. NIH. Rochester. The University of California. MA 02115 Berkeley Wellness Letter. Work closely with your physician on cancer screening. 200 First Street SW. for those seeking more. blood pressure control. Avoid more than 1 or 2 alcoholic drinks daily.. 10 Shattuck St. This can be done by addressing the web sites of several excellent government sources – CDC. NY 10007 207 . Maintain a supportive social network – friends. 53 Park Place. and immunizations. Further Reading We have made every effort to provide further reading information. The Johns Hopkins Medical Letter. you will live a longer and healthier life. P. Walk (or do some other aerobic activity) at least onehalf hour each day. 550 North Broadway. Keep your weight as close as possible to ideal for your height and build. etc. Boston. family. MD 212052011. FL 32142. Baltimore. Tufts University Health & Nutrition Letter. MA 02115. though at some extra cost.Living Healthier and Longer – What Works. 10 Shattuck St. Harvard Heart Letter. These excellent resources include: Harvard Health Letter. Suite 1100. Box 420235. Other outstanding sources of information on topics related to living a healthier and longer life are available. Mayo Clinic Health Letter.
or just a waste of money. Angiotensin receptor blockers (ARBs). • Strict cholesterol control. fibrates. CORONARY HEART DISEASE What works: • Diet. the patient’s age. • Exercise. The need to balance effects with potential side effects. • No smoking or contact with second-hand smoke. Also important to the consumer is knowing which. • Nitrates. • Aspirin. Drugs: • Statins. • If diabetic. What doesn’t work: • Illicit and recreational drugs. the authors have chosen to suggest those strategies – programs. Regarding drugs. weight reduction to ideal weight if overweight. which are best suited to help you live a healthy and longer life. • ACE inhibitors. alcohol limitations. activities. and drugs. • Efforts to manage stress. usually drug classes will be mentioned as specific drugs need to be determined by the patient’s physician according to the specific needs of the patient. • Diet. • Blood pressure control. 208 . What Doesn’t WHAT WORKS – WHAT DOESN’T In this chapter. the person’s weight and history of allergies to drugs or drug classes must be considered. Mediterranean diet desirable. niacin. • Beta-blockers. strict blood sugar control. don’t work and might be harmful. More detailed information will be found in the respective chapters or in the references provided at the end of each chapter. of all the media and Internet hyped treatments and drugs. • Any herbal preparation.Living Healthier and Longer – What Works.
Living Healthier and Longer – What Works, What Doesn’t
HIGH BLOOD PRESSURE What works: • Diet, DASH diet desirable. • Diet, weight reduction to ideal weight if overweight. • Sodium (salt) restriction. • Exercise. • Close blood pressure control, with goal of 130/80 mm Hg or less. • Smoking cessation. • Alcohol restrictions. • Efforts to manage stress. • Cholesterol control. • Home blood pressure measurements. Drugs: • Thiazides, beta-adrenergic antagonists, calcium channel antagonists, angiotensin-converting enzyme inhibitors (ACE-I), angiotensin receptor blockers (ARBs), direct-acting vasodilators. What doesn’t work: • Numerous medicines that raise the blood pressure such as appetite suppressants, cocaine, female hormones, pain medicines cold remedies, anabolic steroids, etc. • No herb or alternative medicine treatment is of any value in lowering significant blood pressure elevations. STROKE What works: • Good blood pressure control. • Diet, weight reduction, if overweight. • Avoid smoking and second-hand smoke. • Control cholesterol levels. • Control diabetes if present. • Periodic cardiac evaluations looking for rhythm problems, artery occlusions. • Thorough evaluations of TIAs. • Exercise.
Living Healthier and Longer – What Works, What Doesn’t
Drugs: • Aspirin or clopidogrel (Plavix). • Statin drugs for many. What doesn’t work: • Illicit and recreational drugs. • Herbs or other supplements. • Alternative medicine treatments for post stroke debilities. CANCER What works: • Diet, weight reduction if necessary. • Routine screening for cancers. • Avoiding cigarettes and second-hand smoke. • Checking homes for radon. • Attention to family histories. • Avoiding excessive exposure to ultraviolet radiation. • Exercise. • Alcohol restriction. • Avoiding unnecessary diagnostic X-rays. Drugs: • Numerous anti-tumor drugs, radiation therapy and surgery. What doesn’t work: • No herb or supplement has been shown to prevent, treat, or improve cancer. • No alternative medicine therapy has been shown to prevent, treat or improve cancer. DIABETES What works: • Diet, weight loss if necessary. • Good blood sugar monitoring and control. • Good diabetic education. • Exercise. • Not smoking, avoiding second-hand smoke. • Blood pressure control, less than 130/80 mm Hg. • Good cholesterol control.
Living Healthier and Longer – What Works, What Doesn’t
• • • •
Close watch for cardiac, kidney, and eye complications. Close follow-up with a skilled physician. Frequent evaluation and care of the feet. Yearly eye exams.
Drugs: • Aspirin. • Exenatide. • Oral antidiabetic drugs. • Insulin. • Statins. • ACE inhibitors. • Anti-hypertensive medicines if needed. • Erectile dysfunction medications if needed. What doesn’t work: • No herb has any value for diabetic patients. • No supplement other than a daily, standard multiple vitamin is of any value. • Thiazolidines could be a problem in older diabetic patients due to increasing sodium and water retention causing heart failure. • Selenium is not helpful and could cause problems. BONE DISEASE What works: • Diet. • Exercise. • Not smoking. • Limiting alcohol. • Knowledge of family osteoporosis history. • Checking for low testosterone in men. • DEXA scanning of certain age groups or suspects. • Reasonable amount of sun exposure. Drugs: • Adequate calcium in diet or supplements taken properly. • Vitamin D3.
Living Healthier and Longer – What Works, What Doesn’t
Bisphosphonates and human parathyroid hormone. Adequate Vitamin K in diet.
What doesn’t work: • Glucocorticoid therapy for other problems. • Certain medications, anticonvulsants, heparin, etc. • Proton pump inhibitors for long periods. • No herbal preparation is of any value. DEMENTIA What works: • Exercise. • Knowledge of family history. • Search for reversible causes. Drugs: • No treatment has been proven to stop Alzheimer’s Disease. • Acetylcholinesterase inhibitors are of limited value. • NMDA-receptor antagonist of some value. • Possibly some value for statin drugs. What doesn’t work: • Excess vitamins, minerals or other supplements. • No herbal has proven effective. INFECTIONS What works: • Immunizations. • Education of at-risk groups or people. • Avoidance of risky lifestyles. • Simple cleanliness activities like hand-washing. • HIV screening tests for most people. • Avoiding illicit or recreational drugs. What doesn’t work: • No alternative medicine treatment or herbal preparation has proven effective for an infectious disease, or HIV/AIDS.
antidepressants. there are many. • Herbs or other supplements have no effect unless they contain phosphodiesterase inhibitors. • Most aphrodisiacs have only a placebo effect. • In some cases. What doesn’t work: • Yohimbine – too many complications. • Testosterone therapy for some men. • Education of involved individual or couples. 213 . What doesn’t work: • Elderly people taking anti-anxiety medications. • Vision and hearing evaluations. • Considering problems from prescription medications. • Sleep disorder evaluation.Living Healthier and Longer – What Works. • Avoiding alcohol and illicit drugs. What Doesn’t SEX What works: • Correcting complicating diseases. • Demented elderly with drivers licenses. • Driving after drinking or using mind-altering drugs. • Treating emotional or psychiatric disorders. • Assuring safe environments at home. • Improving cardiovascular situation. INJURIES/ACCIDENTS What works: • Seat belts and helmets. • Tests for low testosterone in males. Drugs: • Phosphodiesterase inhibitors. • Not smoking. • Alcohol restriction. • Search for medications that can cause sexual dysfunction. • Not smoking. • Not overseeing medication taking by the elderly.
214 . • Bupropion (Zyban). • Nortriptyline. helpful pharmacist. • Seeking help from physician or counselor. What doesn’t work: • Hypnosis. • Not smoking. Drugs: • Varenicline (Chantix). • Quitting “cold-turkey”. • Help from family members for elderly patients. and potential side effects. What Doesn’t POLYPHARMACY AND ILLICIT DRUGS What works: • Knowing the name and dose of your drugs. • Non-smoking ordinances. • Education. • Herbs or supplements. CHOLESTEROL What works: • Diet. • Nicotine replacement therapy. What doesn’t work: • Trying to overcome drug addiction without help. what they do. • Knowledge of family history. • A knowledgeable. • Exercise. • Acupuncture or other alternative medicine treatments. • Supportive family and friends. • Education about illicit drugs.Living Healthier and Longer – What Works. • Exercise. SMOKING What works: • High tobacco taxes.
• High dose vitamins. What Doesn’t • • • Moderate alcohol drinking. • Niacin. • Exercise. • Education and a supportive physician • Thin friends and associates. Check for drugs and diseases that can elevate lipids. • Bariatric surgery. • Fibrates. though further supporting information needed. Knowing lipid levels and attaining goals. What doesn’t work: • Herbs or supplements. • Knowing body shape and waist measurement and resulting risk.Living Healthier and Longer – What Works. suppressants such as 215 . • Psychotherapy. • Omega-3 fatty acids. • Rimonabat. • Physician prescribed appetite phentermine and sibutramine. What doesn’t work: • Enviga (a drink). • “Fad” diets. OBESITY What works: • Diet/calorie reduction along with a multiple vitamin. Drugs: • Statins. • Ezetimibe. • Legitimate weight-loss organizations. • Herbs or supplements. Drugs: • Orlistat.
Drugs: • Disulfiram. tetracyclics. • Family support.Living Healthier and Longer – What Works. What doesn’t work: • Alcohol. • Herbs or supplements. naltrexone. Drugs: • Anxiolytic agents – many. • Special immunization needs related to travel. • Pets. • Treatment of associated depression. • Early detection by friends or family members. • Antidepressants – Selective serotonin re-uptake inhibitors. IMMUNIZATIONS What works: • Obtaining all the necessary immunizations at the appropriate ages. • Knowledge of family history. • Electroconvulsive therapy – rarely needed. lithium. • Balanced diet with vitamin and mineral supplements. tricyclics. • Belonging to religious community or other support groups. • Exercise. • Alcoholics Anonymous. and topiramate. What Doesn’t ALCOHOL What works: • Moderate drinking always. 216 . and keeping them current. acamprosate. • Psychotherapy. • Education. STRESS AND DEPRESSION What works: • Physician help and/or counseling.
• Aerobic exercises. • Trimspa. • Many forms of yoga. • Exercise daily throughout life.Living Healthier and Longer – What Works. • Don’t smoke. 217 . as suggested in this text. • Moderate alcohol intake. • Do exercises that you enjoy. What doesn’t work: • Anaerobic exercise. EXERCISE What works: • Exercise as much as possible within the guidelines suggested in this text. • Simple vitamin. • Antioxidants other than what is in foods. • Look for medical or psychiatric problems that can interfere with sleep. What Doesn’t What doesn’t work: • Herbs or supplements do little to prevent or reverse flu or viral problems or stimulate immune system. • Megavitamins. • Exercise. • Education. • Look for the many drugs that can interfere with sleep. DIET What works: • Diet. or Xenadrine. SLEEP What works: • Look for sleep apnea. • Herbs or supplements. mineral preparation. What doesn’t work: • Fad diets. Cortislim.
and likely could have some chemical effect in our bodies. provide a form of relaxation and a feeling of control of their bodies. alternative medicine therapies. • Education. What Doesn’t • • • Reducing coffee/caffeine intake. or placebo like effect. • Purchasing vitamins or supplements from your health care provider. vegetarians. VITAMINS AND SUPPLEMENTS What works: • A single daily vitamin/mineral supplement contents as set by the FDA. see text. Drugs: • Many effective short term sleep aids. pregnant. • Obtain vitamins from a quality manufacturer. • Some people with special needs.Living Healthier and Longer – What Works. • Though herbs are plants and do contain chemicals and compounds. • Always best to get vitamins/minerals from food. such as yoga. • Extra vitamin D as suggested in the text. Treatment of depression if present. • No alternative medicine therapy has been scientifically shown to cure any disease. What doesn’t work: • Herbs or supplements. 218 . ALTERNATIVE MEDICINE What works: • Nothing has been scientifically proven to work over and above the placebo effect. • For some people. What doesn’t work: • Megavitamin formulas. most have not been shown to relieve or cure any disease process. Weight loss if obese.
Not being skeptical about media and internet claims for a variety of physical and mental problems. vitamins. mistakes and well meaning therapies that could potentially shorten one’s lifespan. antioxidants and “secret” formulas that claim to extend life. nutritional supplements. What Doesn’t What doesn’t work: • • • • • Taking herbs with other prescription medications. Drugs: • None. Not telling your doctor what you are taking. 219 . Having a disease and not utilizing conventional medicine treatment.Living Healthier and Longer – What Works. Taking herbs prior to surgery. AGING What works: • Following the principles laid forth in this text can surely help one to live a healthy life and avoid problems. What doesn’t work: • All the hormones. habits.
this text. and has received many prestigious awards and honors from national and international medical associations. is written for the lay public in response to patients’ requests and the need for medically sound and substantiated data. and has received the John Phillips Award. the highest honor of that 124. Dr. Although educating physicians and patients has been the continual focus of Bartecchi and Schrier.000 member organization of internal medicine specialists. What Doesn’t. He was Chairman of the Department of Medicine at the University of Colorado for 26 years. He is also an Honorary Fellow of the Royal College of Physicians.Living Healthier and Longer – What Works. in 1996 he received the Robert H. What Doesn’t About The Authors Carl Bartecchi and Robert Schrier are a unique physician team that has worked together for nearly 3 decades in several health care and educational areas. Bartecchi is also Distinguished Clinical Professor of Medicine at the University of Colorado School of Medicine. Schrier has authored over 900 publications in respected medical journals. Dr. a pre-eminent practitioner of internal medicine for more than 30 years. Living Healthier and Longer – What Works. having received both the prestigious American College of Physicians’ Ralph O. 220 . Dr. Schrier is Professor of Medicine at the University of Colorado. Claypoole Memorial Award and Colorado’s Distinguished Internist Award of the American College of Physicians. For his contributions as Chair. Bartecchi. Williams Award from the Association of Professors of Medicine as the outstanding Chairman of Medicine in the country. The text includes the best scientific and practical information available for people who desire to make reasonable efforts to extend the quality and length of their lives. He is a Master of the American College of Physicians. has been recognized nationally.
Age 16 or younger 18-30 Not at all 31-50 50-65 66+ 3. Gender Female Male 2. I’d like more information about: Dementia Coronary Artery Disease Infections/HIV Hypertension Sexuality Stroke Injuries/Accidents/ Cancer Domestic Violence Diabetes Polypharmacy Bone Disease Smoking Cholesterol Obesity Diet Stress/Depression Immunizations Exercise Sleep Vitamins/Supplements Aging Alternative Medicine Please place this form in an envelope for mailing. What Doesn’t Would you like more information? Would you like more information? We are here to give you health information or tell you about community resources to help you get healthy! Take a moment to fill out this card and send it to us! First Name Address State Zip Email Last Name City 1. Was this book helpful to you? Yes! Somewhat 4. 221 .We are here to give you health information or tell you about community resources to help you get healthy! Take a moment to fill out this card and send it to us! Living Healthier and Longer – What Works.
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Living Healthier and Longer – What Works. What Doesn’t 223 .
What Doesn’t 224 .Living Healthier and Longer – What Works.