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By Michael Brickey, Ph.D., ABPP
If at first you don’t succeed, don’t try skydiving.
To live as long and as healthily as possible we need to intelligently manage risks. That is not to say we shouldn’t take risks–that would certainly make for a dull life! The risks we take, however, should be worth the payoff. When Aristotle said “all things in moderation,” he did not mean that we should be average. Rather, he was counseling us that most things taken to extremes are problematic. The hallmark of intelligent risk management is pragmatism. Pragmatism asks what gives the most benefit for the least sacrifice.
The Japanese have a long-standing passion and obsession for cleanliness. Indeed, the Japanese word for clean is also the Japanese word for beautiful. Japanese stores are filled with products that are touted as bacteria free. Taxi drivers wear white gloves. Chop sticks are often discarded after one use. Millions of Japanese take pills to remove odor from their perspiration and feces. Are the Japanese healthier? The question is controversial but at least one leading Japanese expert on parasites believes the extreme measures are actually impairing Japanese immune systems by not building resistance to infections. Also, some bacteria perform useful functions and these bacteria are often killed when killing bacteria in general. To support his belief Koichiro Fujita1 notes that allergic conditions such as bronchial asthma and atopic dermatitis (skin diseases) have a 30% incidence rate in Japan but only 10% incidence rate in the U.S. Certainly, more study is needed. It seems probable, however, that a Felix Unger lifestyle (the obsessive compulsive character in The Odd Couple) probably impairs longevity rather than fostering it.
Needless to say, the more risks you take, the more likely you will be burned. I am not saying you have to avoid all risks. If you love driving a sports car or skydiving, you might decide the enjoyment is worth the risk. If you are going to take risks, do your homework so you know how to reduce the risks as much as possible. The goal is to be prudent. If you find yourself becoming a worry wart or obsessive and compulsive about risks, the remedy has become worse than the disease.
Managing risks means becoming your own OSHA (Occupational Safety and Health Administration) investigator. Your “OSHA investigator” should identify the greatest risks in your life and whether the risks are worth the pay offs. Employers spend a lot of time and money meeting safety and accreditation standards. The efforts have saved many lives and prevented millions of injuries. Most large businesses conduct safety inspections periodically (monthly, semiannually, annually). Is risk reduction at work more important than risk reduction in your personal life? You might want to do an initial safety/risk assessment for your own life and then conduct assessments periodically; for example, a year from now, each January 1, or every birthday. The following are some areas that merit your investigative scrutiny.
Athletics
Being physically active is vital to longevity. People who jog ten miles a day outdoors, however, are at high risk for serious health problems and injuries. People who will be fit at 150 are likely to have chosen a combination of sports and exercises that rarely result in serious injuries, do not wear out body parts, and address all their fitness needs (strength, cardiovascular, flexibility, coordination, and enjoyment).
Boxers often develop brain damage from repeated blows to their heads. Professional football is just starting to acknowledge how widespread concussions are among football players. Research is showing that head butting soccer balls can cause subtle brain impairments. The evidence is mounting that even mild head traumas, when repeated, cause brain damage. 23 Perhaps one reason women live longer than men is that fewer women play football, hockey, and other contact sports that often cause subtle brain injuries. Think twice before head butting a soccer ball or engaging in sports that involve even mild head trauma.
I heard on National Public Radio that the average life span of a National Football League player is 55. Imagine, teenagers who were some of the healthiest boys in the country, who had plenty of money as adults, having a life span two decades shorter than the rest of U.S. men. Quite a price! A study of more than two thousand Harvard students compared non athletes, major athletes, and minor athletes (who did not earn a letter or participated in a sport that did not award letters). Although presumably major athletes started with the most exceptional health, the minor athletes had the longest life spans and the major athletes the shortest life spans. 4
Automobile Travel
There are 13 million automobile accidents in the U.S. each year5 (and most other countries have comparable or even higher per mile accident rates). The accidents cause 38,200 fatalities a year and 2.3 million disabling injuries a year. Thus, almost 1% of the population dies or has a disabling injury each year. If accident rates were evenly distributed, you would have about a 50% chance of experiencing a disabling injury (or dying) from an automobile accident by the time you are 60. This is a much bigger risk than heart disease or cancer. Reducing your chances of an automobile accident is one of the most effective actions you can take to foster your longevity.
Whatever you can do to reduce the amount of time you spend driving or riding in cars helps reduce this enormous risk of disability or death. Consolidating trips reduces exposure and gives you more time for more productive things than driving. If you are planning on moving, consider the commuting risks and whether you would be driving into the blinding sunlight when commuting. When you purchase a car, buy one of the safer cars. As a rule of thumb, larger and heavier cars fare better in accidents, though safety features are important too. If you live in an area that has a lot of snow and ice, traction can be a critical safety factor. If you use a car phone while driving, use one that is hands free. Within a few decades auto safety should improve substantially with the introduction of radar devices that warn and protect cars from getting too close to other cars.
Your odds of being in an automobile accident in any given year are one in five. While only 8% of these motorists suffer significant injuries, 90% of motorcyclists suffer significant injuries. Almost 25% of motorcycle accidents involve head injuries. In 25% of motorcycle accidents the operator had less than three months experience operating a motorcycle. If you want to live a long, healthy life, don’t get on a motorcycle.
Food
Nutrition is a very complex and controversial topic. For this chapter the focus is limited to reducing risks. The ideal is to obtain foods that are seasonal, locally grown, organic, and not processed. Rinsing food reduces the number of chemicals you ingest from pesticides, preservatives, and surface additives to make the food look more attractive. Many stores sell special detergents for washing food. Even organic produce needs to be washed; bacteria can grow on them as well. Note that the term “natural” is unregulated and practically meaningless.
The primary advantage of organic produce is avoiding the pesticides, preservatives, and cosmetic additives. If you have a limited budget, the organic foods that have the biggest health advantage are tomatoes, celery, peppers, spinach, salad greens, berries, apples, pears, grapes (and raisins), peaches, nectarines, and apricots.
Nonorganic dairy products and meat contain a lot of growth hormones and antibiotics. These are concentrated in the fat so the less fat, the fewer unwanted hormones and antibiotics you will consume. Skim milk for example, has far fewer hormones and antibiotics than whole milk. Lean meat and white chicken have less fat than other meats and thus fewer hormone and antibiotics (as well as less saturated fat to clog your blood vessels).
One of the biggest concerns with fish is mercury. Generally salmon, tilapia, shrimp, clams, and light tuna are relatively low in mercury and other metals. (Light tuna is smaller and younger than albacore tuna.) For ocean fish wild caught is better. For fresh water fish it depends a on what lake or river the fish came from. Consumer Reports indicates that the quality of farm raised fish varies considerably so if you regularly consume it, some research on its source is a good idea.
Undercooking meat runs the risk of not killing bacteria. Overcooking meat increases the number of carcinogens. Eating raw seafood increases the risk of disease. Cooking acidic foods in aluminum or cast iron6 pans poses the risk of absorbing the metals into your food.
Having a healthy ratio of carbohydrates, protein, and fat is important to reducing the risk of health problems. Most people fail at suddenly trying to follow an ideal diet. It is usually far more effective to take small steps to gradually improve your diet.
Home Safety
If you are choosing a new residence, it is worth playing detective and considering all the risks before you make a down payment or deposit. How much air pollution is in the neighborhood (e.g., smog trapped in valleys, pollution from local industries, auto emissions from freeways and traffic)? What is the water quality in the neighborhood? Is there a problem with radon, lead, or other chemicals in the area or residence? Some of the information is available from the library, some by asking neighbors, and some from hiring an expert for a few hundred dollars to do an inspection.
At home, periodically pretend you have been hired to conduct a safety inspection and advise the owner (yourself) on practical things that could be done to improve home safety. Better yet, arrange with a friend or a professional to do the inspection. The largest cause of home accidents (62%) is falls. If you were to fall at home, where how would you be most likely to fall? Consider whether the bathtub or shower is slippery, whether stairs are slippery, and whether you might trip or slide on lose rugs.
Health
Oliver Wendell Holmes, Sr.’s formula for longevity was to have a chronic disease and take care of it. 7
Most of us have some body systems that are extremely hardy and some that are more vulnerable to illness. You want to focus on what would help your weakest system. For example:
If you get a lot of colds, you would want to:
Perform daily personal hygiene functions such as irrigating your sinuses and scraping your tongue. (Sinus irrigation involves filling a baby syringe or ear syringe with filtered or distilled warm salt water, tilting your head back, squirting the water into your nostrils, and allowing the water to drain into your throat. Tongue scraping involves using a U-shaped instrument to scrape bacteria laden mucus off your tongue. (Scrapers are available in many drug stores and health food stores for ten dollars or less.)
Check your home for proper humidity and for mold and dust.
Be keenly attuned to how lack of sleep and/or getting depressed might make you vulnerable to colds.
If you get a lot of colds in winter, determine if you are getting enough sunlight or have problems with Seasonal Affective Disorder (SAD).
If you get a lot of headaches, you want to:
Light
John Ott’s8 classic research showed how we need sunlight to be healthy and how indoor lighting alone leads to health problems. If you cannot obtain at least fifteen to thirty minutes a day of sunlight, consider using light bulbs that more closely mimic the sun’s spectrum of light. Spectrum corrected light bulbs, e.g., Chromolux, are available in many hardware stores and by mail and Internet for less than ten dollars a bulb. Another option, particularly if you tend to have depression in late fall and winter, is to get a SAD (Seasonal Affective Disorder) light. There are several SAD light distributors on the Internet. Prices range from $200-$600.
Occupational Hazards
Consider whether your job poses health risks and how you can minimize them. If the risks are serious, you might consider other positions or occupations that would be as rewarding and safer.
Shoes
We ask a lot of our feet. The least we can do is to make sure we take good care of our feet. Eventually, custom-made shoes will be affordable and easy to obtain in popular styles. This would involve making a mold of your feet and then ordering shoes to fit the specifications. Once your feet are measured, you could order custom shoes locally or by phone or Internet. Until then most people will settle for what is available in stores.
It is worth the extra money to go to a shoe store that has staff who specialize in orthopedic shoes. Many of these stores carry nonorthopedic shoes as well. They know more about healthy fit than most shoe salespeople and they can better fit each foot’s arch, shape, and peculiarities. Once you learn what your feet need and what brands often fit those needs, you will be better at selecting shoes from any store. Women in particular need to find shoes that do not sacrifice comfort for style and to minimize wearing high heels. Fashionable healthy shoes will become more readily available as Baby Boomers insist on them. Loafers do not provide good support and should be worn sparingly. If you wear athletic shoes a lot, select shoes to match your sports and activities (e.g., walking, running, basketball, racquetball). If the bottoms of your shoes wear unevenly, it is a sign of posture or gait problems. Consult someone who is knowledgeable about these problems.
Skin Care
80.97 and 75.15 years—that’s the current life expectancy for American women and men. Having survived childhood and young adulthood, your life expectancy is longer. Eighty some years or longer is a lot of years you are going to be looking in the mirror every morning. How you look can have a big effect on how you feel and how others respond to you. Unfortunately a lot of Americans are doing really stupid things to make their skin dry, wrinkled, blemished, and cancer prone. Some people take better care of their furniture or car upholstery than their own skin. And no, skin care isn’t just for women. Here are five ways to help your skin:
1. Soap: Your sebaceous glands keep your skin at a pH between 5.5 and 6.5 (slightly acidic) for optimal health. Most soap is very alkaline and strips your skin of its protective oils. What may feel “squeaky clean” is really dehydrated and vulnerable to free radical damage. All soaps, shampoos, shaving cream, moisturizers, and cosmetics should be pH balanced to protect your skin.
2. Fragrances and dyes: The most common causes of skin reactions and allergic reactions are the fragrances and dyes added to soaps, shampoos, shaving cream, moisturizers, and cosmetics. Insist on having your hair smell like coconuts, or mangos or bananas or be a pretty color if you want, but it often comes with a cost. For the healthiest skin—no fragrances, no dyes.
3. Mineral oil: Baby oil is 100% mineral oil. Why? Cloth diapers needed a barrier between the baby’s skin and wet diaper. A plastic lining protected the baby from the urine soaked diaper. With absorbent paper diapers, a barrier isn’t needed. So now we can use baby products that nurture your baby’s skin, lets it breathe, and avoids diaper rash. In the U.S. cosmetic companies use mineral oil because it is much less expensive than water based alternatives and seems to be a moisturizer because it coats your skin. Your body is water based and like oil in salad dressing, mineral oil just doesn’t mix. Most European countries ban mineral oil from cosmetics and skin care products. Some pricey cosmetics even use water-based moisteners in Europe and mineral oil based moisturizers in US creams and cosmetics. Mineral oil coats your skin, clogs you pores, prevents your skin from breathing, from exfoliating dead skin cells and toxins, and from absorbing the vitamins, nutrients, and antioxidants the skin care products should provide. Chose skin products that do not contain mineral oil.
4. Chlorine: You know that residue chlorine leaves on you when you use a swimming pool. Municipal water systems also add chlorine to kill bacteria. The concentration is lower than at the pool, but your exposure is far more frequent. Chlorine irritates your skin and when you take a shower you breath evaporating chlorine gas. The best solution is a whole house water filter that filters out chlorine and a lot of harmful chemicals. These cost about $500 to purchase and install and about $100 a year to maintain (periodically replacing filters and the charcoal material). Note that these systems remove fluoride as well which may less protection from cavities. I don’t advocate osmosis systems as they remove all chemicals. When you drink the water, it not only tastes flat, it can leach minerals from your body.
5. Sun damage: Most people don’t get enough sun. Sun is vital to feeling good and avoiding depression. Like bears, many people respond to less sunlight in winter by becoming depressed, grouchy, and less active. Our bodies use sunshine to produce Vitamin D. Many Americans have insufficient Vitamin D, a vitamin whose functions include absorbing calcium and preventing osteoporosis. By all means try to get some sunshine every day.
But sun is also the biggest cause of skin damage—wrinkling, drying, and skin cancer. Skin cancer is three times more common than breast cancer and lung cancer combined. Sun tans are a sign of sun damage to the skin and sunburn greatly increases the risk of skin cancer. Sun tans may look good in the short run but in the long run they contribute to leathery, wrinkled skin and high risk for skin cancer. With the ozone depletion, sunscreen becomes even more important to healthy skin. For prolonged sun exposure, use a sunscreen and if your skin gets red, a postsun skin treatment. For modest sun exposure, use a moisturizer that includes a sunscreen—they are becoming increasing common in moisturizers.
Surgery Snd Hospitals
Twenty percent of hospital patients leave with a condition they didn’t have when they entered the hospital
At least 44,000 and perhaps as many as 98,000 hospitalized Americans die every year from medical mistakes.
–The Institute of Medicine10
If your physician has recommended surgery, investigate options and alternatives, e.g.:
Explore non surgical alternatives, e.g., exercise, change in diet, body manipulation.
Research the track record on the surgery using books such as the People’s Medical Society’s Good Operations–Bad Operations.
Obtain a second opinion.
Inquire about the specific procedures and whether any of them have less risky alternatives (e.g., is a catheter really needed? depilation vs. shaving a surgical area and risking cuts).
Check the credentials and experience of the surgeon. Strategies for obtaining this information include:
Check to see if the surgeon is Board Certified.
Ask the surgeon or hospital how many of these surgeries he or she has performed in the last two years.
Ask the hospital Utilization Review Department for data on the surgery.
Call the Operating Room and asking to speak with a nurse who assists in that type of surgery. Ask the nurse off the record whom he or she would choose if the surgery was on herself/himself.
Ask your primary care physician to check his/her sources for who has the best reputation for performing that operation.
Ask a Utilization Review nurse at your insurance company for his/her recommendations.
According to Consumer Reports, 11 the most common needless surgeries are inserting tubes in children’s ears, removing cataracts, low-back surgeries, gall bladder removals, hysterectomies, Cesarean sections for childbirth, and surgeries to correct sleep apnea, snoring, and jaw pain.
While surgeries are becoming less invasive, many still involve cutting muscle tissue and fascia. It is not unusual for people to have a normal recovery only to develop pain several months later. This can be due to postural changes in adapting to the cut tissue. Most physicians are unaware of this problem. People who are very skilled in body work (e.g., some massage therapists, osteopaths, movement specialists, chiropractors) might be able to help.
Water
Our bodies are 75% water and we should be drinking eight glasses of water a day. Most tap water contains chlorine (to kill bacteria) and traces of toxic chemicals. Bottled water is one solution. If you don’t want to spend money on bottled water, water filters (whole house or on a specific faucet) are inexpensive and efficient. That doesn’t mean never taking a drink from a water fountain or a glass of water when it is served to you. A hassle that extreme is more wearing than occasionally drinking unfiltered water.
Exercise Assessing Your Risks
The following assessment focuses on modest changes to reduce risks. After answering the questions, put a T beside items you are willing to take action on starting today. Put a W beside the ones you are willing to take action on starting this week. Put an M beside items you are willing to take action on later this month. Write this week and this month items on your calendar on a specific date.
1. Without compromising the quality of my life, how can I significantly reduce the number of miles I travel by car?
2. What can I do to make my car safer?
3. The next time I buy a car, what car would meet my needs and be safer than my current car?
4. What changes in my driving habits would make me a safer driver?
5. What could I easily do to lower my exposure to electromagnetic fields (from electrical wires, appliances, electrical equipment, power lines, etc.)? 12
6. What is the most likely way a fire could start in my residence? What reasonable steps can I take to reduce the risk or contain the fire?
7. What would I be most likely to trip on or slip on at home?
8. If I were to conduct just one health or safety test of my residence (e.g., water, radon, asbestos, wiring, formaldehyde, furnace, gas lines), what would be my priority?
9. What single act would most improve sanitation and reduce the risk of disease in my residence (e.g., removing dust or mold, better cleaning of cutting boards, washing foods, not storing cosmetics and toiletries near the toilet)?
10. Are there any parts of my residence that need better lighting at night (even if just a nightlight)?
11. What could I do to improve the air quality in my home (e.g., change the furnace filter more often, periodically ventilate the home, more house plants)?
12. Could I use fewer insecticides in my home or yard?
13. Do I have an adequate number of functional smoke alarms and fire extinguishers at home?
14. What painless steps could I take to make myself less likely to be a crime victim?
15. What minor change or changes in my eating habits would reduce my risk of health problems?
16. Do I avoid cooking acidic foods in aluminum or iron pots and pans?
17. Are there times when I should wash my hands and don’t?
18. Do I brush my teeth at least twice a day and floss my teeth at least once a day?
19. Could I reduce my exposure to chemicals by using less deodorant or using deodorants that do not contain harmful chemicals?
20. What can I do to reduce the frequency or intensity of my most frequent health problems (e.g., colds, pulled muscles, backaches)?
21. When and where would I be willing to engage in better posture when sitting or standing?
22. When and where might I wear healthier shoes?
References
1. Weiner, Eric. (2000, February 17). Is cleanliness dangerous? National Public Radio Morning Edition. [On-line]. www.npr.com.
2. Asken, Michael, & Schwartz R. (1998). Heading the ball in soccer: What’s the risk of brain injury? The Physician and Sportsmedicine, 11,37-45.
3. Kelly, James P. (1999). Traumatic brain injury and concussion in sports, Journal of the American Medical Association, 282,989-991.
4. Polednak, Anthony, & Damon, Albert. (1970). College athletics, longevity, and cause of death, Human Biology, 42,28-46.
5. National Safety Council. (1998). Accident facts.National Safety Council. (Data cited is for 1997.)
6. Current thinking is that most adults have too much iron and that iron is one of the nastiest oxidants. Many multiple vitamins for men have removed iron from the formula. Some fanatics even recommend donating blood to lower the iron content of your blood. Women who menstruate, however, might need extra iron as iron is essential to making new blood. The principle sources of iron in people’s diets are red meats, seafood, soybeans, liver, and greens.
7. As cited in Gale’s Quotations.
8. Ott, John. (1973). Health and light.Columbus, OH: Ariel Press.
9. Inlander, C. B., Levin, L. S., & Weiner, E. (1988). Medicine on trial. New York: Prentice Hall.
10. Neegaard, Lauran. (1999, November 30). Clinton urges war on medical errors. Associated Press [On-line]. www.infobear.com/stories/cgi/story.cgi?id=2562333201-bb3.
11. Consumer Reports on Health. (1998, March). Needless surgery, needless drugs, 1-5.
12. Most research has not supported electromagnetic fields causing disease. The famous study of electromagnetic fields in Denver had serious methodological flaws, e.g., it was a phone survey conducted during the day time and respondents were limited to people who were home during the day. Nevertheless, research has shown that our bodies have electromagnetic fields and it seems prudent to avoid undue exposure to electromagnetic fields. See: Austad, Steven. (1997). Why we age: What science is discovering about the body’s journey through life.New York: John Wiley & Sons, p. 169.