Take Good Care by Walt Larimore, M.D. Make a few changes to prevent disease and improve your longevity. This is part two in our on-going series about essentials of happy, healthy people. Essential #2: Self-Care One of the secrets of becoming and staying happy and healthy is to work to prevent “disease”—in body, mind, spirit, and relationships. As a family physician, I rarely saw a patient with a previously preventable medical problem who didn’t wish he or she had expended more time and effort on healthy choices. I spent my first year of medical practice in the Smoky Mountains of western North Carolina. There I had the privilege of caring for a number of patients who were in their 90s—and several who were over 100 years old. Caring for these men and women taught me much about what it means to be a highly healthy person. One of these patients, Margaret, had just turned 90 when we first met. Her reason for changing from her doctor of three decades? “He is so old. I’m afraid he’s not going to be around much longer,” she told me. When I asked his age, she giggled and blushed, putting her hand over her mouth. “Oh, honey, he’s barely 60. He just doesn’t know how to live very well, and I think he’s working himself into an early grave.” I smiled to myself. Here was a woman 30 years older than her physician, predicting his death. But, barely one month later, I saw his obituary in the newspaper. Margaret had my attention, and, over the next four years, I listened and she taught. Hardly a visit went by during which she didn’t share her wisdom. Here are some of what my office staff called “Margaretisms”: When asked why she always seemed so upbeat, even when an illness flared, she exclaimed, “I’m too blessed to be stressed or depressed!” When talking about a local politician who had been accused of an ethical indiscretion, she quipped, “Forbidden fruits create many jams.” She told me that she exercised twice as much as most people: “Every day I walk an hour along Deep Creek and I walk 24 hours with the Lord.” One afternoon, I noticed my nurse, Beth, doubled over in laughter as Margaret was leaving the office. I had prescribed a mild medication to help her with occasional insomnia. She also was taking a laxative sporadically for bouts of constipation. She had pointed out to Beth, “Honey, whatever else you do, never, never, under any circumstances, have a patient take a sleeping pill and a laxative on the same night.” Then she headed out the door to conquer the world. Margaret had a number of physical and mental ailments, but minor “mechanical” problems aren’t too noticeable in an “older vehicle” that has been well cared for and is otherwise running efficiently. And Margaret was running efficiently. Secrets of Centenarians Margaret shared a number of similarities with her long-lived friends, as well as with other seniors from various cultures who have been studied because of their longevity. Leonard W. Poon, the lead researcher in one of the largest studies of centenarians ever conducted, reported that centenarians find meaning in life’s trials and respond effectively to problems. They’re not “wallowers.” Certainly, Margaret was no wallower! Among some of the longest long-lived groups of people in the world are said to be the Georgians of the Caucasus Mountains in southern Russia, the Vilcabamba Indians of the Ecuadorian Andes, the people of the Hunza Valley in Kashmir, and residents of Okinawa, Japan. The studies revealed that, not only are they long-lived, with significant numbers of individuals exceeding age 100, but they also have a high quality of life. As scientists have tried to identify common elements, they’ve reported the following characteristics of these non- American centenarians: They exercise regularly and consistently. Walking and other forms of active exercise are part of their everyday lives. They avoid highly processed foods. In fact, virtually none of their food is highly processed, unlike many of the junk foods and fast foods available in the United States. They eat a nutritious diet. They don’t overeat, and their diet is high in fiber, whole grains, nuts, and “good” fats (and, in some cultures, yogurt or soy) and low in calories, salt, saturated fats, and refined sugars. Fruits and vegetables and, in some cultures, health-enhancing fish, are important dietary staples. They drink lots of water. In most of these cultures, the water is usually from wells or mountain streams and has a high mineral content. They avoid loneliness. Relationships with neighbors, family, and friends are vital. They practice and enjoy regular sex— usually with their spouse, who is their longtime partner in a mutually monogamous relationship—even after the age of 100. They live with and depend upon their extended families, who offer cradleto- grave security and support. They seldom use alcohol or tobacco products. They intensely respect their elders. And, when they become elderly, they enjoy the admiration, honor, esteem, and affection of their families and of society. They lead active, fruitful lives well into their second century. There is no retirement. They may slow down a bit, but they never stop. They emphasize relationships and harmony over the pursuit of wealth or success. Many of these people would be considered poor by Western standards, yet they consider themselves wealthy and satisfied. Closer to home, a group of more than 100 centenarians living within an eighttown radius of Boston, Mass., were the subjects of a study initiated in 1994. These are some of the important characteristics they share: Significant obesity is rare. Smoking history is extremely rare. They score low in a type of personality testing that measures neuroticism. This indicates they don’t dwell on problems and, therefore, manage stress well. They have a history of showing signs of aging very slowly and markedly delaying or even escaping age-associated diseases, such as heart attack, stroke, cancer, diabetes, and Alzheimer’s disease. Ninety percent of the Boston-area centenarians in the study remained functionally independent for most of their lives—up until the average age of 92. These centenarians correct the erroneous perception that, the older you become, the sicker you get, teaching us that the healthier you’ve been, the older you get. At least 50 percent of the group members have close relatives and/or grandparents who lived to a very old age, and many have exceptionally old siblings. Male siblings of centenarians have an 11 times greater chance of reaching age 97 than other men born around the same time, and female siblings have an 8 ½ times greater chance of surviving to the century mark than other females born around the same time. Many children of these centenarians (age range of 65-82) appear to be following in their parents’ footsteps. I think the most reassuring message of these studies is that, while the centenarians share certain characteristics, they are not all alike. In fact, they have a wide range of different characteristics—their ethnicity, religion, level of education, socioeconomic status, dietary patterns, and exercise habits. Do You Measure Up? Researchers tell us that the odds of living to 100 are increasing every year. There are already many centenarians alive today—about 50,000 in the United States alone—and at least half of them are well enough to live independently. Are they just lucky in the “good genes” department? Or is their health due to the way they live? While scientists continue to debate the factors that are most likely to assist us in becoming centenarians, most now say that long life is not just a result of good genes. Genes are important, but the decisions we make about a variety of daily lifestyle issues—eating, sleeping, diet, exercise, work, leisure, and our relationships— have even greater impact. So, in large measure, you determine your own destiny with regard to becoming and remaining a highly healthy person. Family history and genetics play a role, to be sure, but it is increasingly obvious that our lifestyle decisions play a much larger role. The Bible teaches that it is our sacred duty to be proactive about our own selfcare. God considers the human body, which he designed, to be a “temple.” Paul writes in 1 Corinthians 3:16-17, “Don’t you know that you yourselves are God’s temple and that God’s Spirit lives in you? . . . God’s temple is sacred, and you are that temple.” To that end, here’s a list of the top 10 rules I’ve long suggested to my patients and my radio and television audiences. Self-Care Top 10 These “Ten Commandments” exclusively target the physical wheel of health. In future articles, we’ll discuss the emotional, relational, and spiritual wheels of health and happiness. Though I suspect we could identify several more “commandments” related to preventing disease, these are an excellent start: 1. See a primary care physician for regular preventive maintenance and care. 2. Avoid or reduce obesity. 3. Exercise regularly. 4. If you’re married, commit to working on and improving your marriage. 5. Protect your dental health. 6. Be very careful with alcohol. 7. Don’t smoke or use tobacco products. 8. Check out all alternative therapies and natural medications (herbs, vitamins, supplements) with your doctor or pharmacist before buying or trying them. 9. Use automobile safety devices consistently. 10. Install and maintain smoke detectors and carbon monoxide detectors in your home. You can find more detail on each of these commandments in my blog. Go to www.DrWalt.com/blog and search for “The Ten Commandments of Preventive Medicine.” You may not find a lot of surprises here—but the real questions are these: Which of these rules do you need to begin to follow? When do you plan to start? What strategies will ensure your success? By beginning with a single step and then continuing to improve on a day-today, week-to-week, or even a month-tomonth basis, you’ll be on your way to becoming a happier and more healthful person. I wish you the best New Year and encourage you to make a thoughtful and prayerful resolution to begin caring for you. Adapted from Dr. Walt’s book, 10 Essentials of Happy, Healthy People, available at www.DrWalt.com. To read or subscribe to Dr. Walt’s three-timea- week Christian health blog, go to www.DrWalt.com/blog.