Fit over 50: Make Simple Choices for a Healthier, Happier You
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Introduction (Even though Walt and Phil wrote this book together, for clarity, "I" will refer to Walt, while "we" will refer to Walt and Phil)
During medical school and a family medicine residency, I was taught to recognize and treat diseases. I had little training in keeping people healthy and even less in motivating people to become fit and healthy. So, for most of my career, I have had to learn ways to promote health, not just treat sickness. During his training, Phil had much more emphasis on helping folks become healthier, but over the last four decades, we have both encountered far too many people who come to us for advice who are highly unhealthy. Many of these people think physical health is the only aspect of health. But if you’re in great physical shape and yet suffering emotionally/mentally, relationally, or spiritually, are you highly healthy? You are not!
What motivated you to pick up this book? For what results are you hoping? We hope you desire to be highly healthy in all aspects of your life. As evidence-based scientists and educators, we want to teach you how to live better and to live longer—how to become, and stay, fit after age 50. But even more, we want to share lifesaving, life-prolonging, and life-enhancing options for becoming a happier and healthier you by using the latest evidence-based research and the most up-to-date national and international guidelines. Each of our chapters and tips could be expanded into a book of its own. But our prayer is that our introduction to each will fit together like a quilt that you will begin to see the big picture of your design and your Designer.
Of course, we understand that some information in books can become out-of-date quickly with new research being published daily and national guidelines being promulgated and updated frequently. So, to that end, we will be publishing updates to the essentials and tips we’re sharing in this book on a frequent basis at www.DrWalt.com/blog. You can either sign up for a free subscription at that site or just return to it every week or two to see what’s new.
As followers of Jesus, we know the Bible speaks of us having healthful lives (Deuteronomy 7:12-15; Proverbs 3:7-8, 4:20-22; Jeremiah 33:6). The apostle John wrote, “Dear friend, I pray that you may enjoy good health and that all may go well with you, even as your soul is getting along well” (3 John 1:2). So we’ll be infusing our essentials and tips with the eternal truth from God’s Word. Because He designed us, we’ll be sharing His guidelines for how you can become healthier and happier.
We are not using the terms happy or happier to mean fortunate, lucky, cheerful, or jovial. The word happy in the Bible is much more meaningful—it is not an event or occurrence or feeling, but a state that is present even when experiencing a correction from God or enduring hardships (Job 5:17; 1 Peter 3:14, 4:14). Happy means being blessed. In fact, the word blessed used by Jesus in the Sermon on the Mount is derived from the Greek word makarios, which also translates to “happy” or “content.”
Throughout the book, we’ll primarily refer to these three types of large research studies:
- A “review” or “systematic review” answers defined research questions by collecting and summarizing the studies that fit prespecified criteria.
- A “meta-analysis” is the use of statistical methods to summarize the results of multiple clinical studies that fit prespecified criteria.
- A “randomized controlled trial” (RCT) is a type of scientific experiment which aims to reduce bias when testing an intervention (i.e., a procedure or medication). The people participating in the trial are randomly assigned to either a group receiving a new intervention or to a group receiving either a standard treatment or a placebo. It’s often considered the gold standard of human research.
For many footnotes and endnotes on the internet, we have utilized TinyURLs. Just enter the TinyURL into your web browser, and you should be able to find the referenced materials. Any references not available online are cited using the standard format.
We have used some primary references, but for medical studies, more often than not we’ve used trusted secondary resources from medical journalists. These secondary resources not only usually give you a link to the primary resource, but they also give you interview quotes from the researchers and other commentators that will help you understand and interpret the data.
Our goal is to use evidence-based, trustworthy, and medically reliable information (no hocus pocus, quick, impossible cures here) while also being biblically sound, so you and your loved ones can live a happy (blessed), healthful life—a life with increased quantity and quality—with eternal life as the ultimate end. Who doesn’t want that?
Our prayers for you, as we wrote this book for you, are summed up in these verses that amplify our title and our desires for you:
Physical training is of some value, but godliness has value for all things, holding promise for both the present life and the life to come. (1 Timothy 4:8)
Sound the trumpet throughout your land. Consecrate the fiftieth year...It shall be a jubilee for you...and is to be holy for you. (Leviticus 25:9-10,12)
Make Simple Choices Today
This day I call the heavens and the earth as witnesses against you that I have set before you life and death, blessings and curses. Now choose life, so that you and your children may live. (Deuteronomy 30:19)
For a Healthier
Dear friend, I pray that you may enjoy good health and that all may go well with you, even as your soul is getting along well. (3 John 1:2)
A happy heart makes the face cheerful...A cheerful heart is good medicine. (Proverbs 15:13, 17:22)
“As the Father has loved me, so have I loved you. Now remain in my love. If you keep my commands, you will remain in my love...just as I have kept my Father’s commands and remain in his love. I have told you this so that my joy may be in you and that your joy may be complete.” (John 15:9-11)
So if you’re ready, let’s get started.
Essential 1 – Balance
About ten years ago, I informally surveyed more than 200 physicians and health experts from many countries, asking them:
- What is health?
- What are the essentials of health?
- What tips would you give your friends and family on becoming healthier and living longer?
After cataloging their responses, I searched the medical literature, scores of studies, and trustworthy medical recommendations, looking primarily at those focusing on wellness and longevity. Much evidence suggested that living long and well depended on the powerful connection between our physical health and our emotional/mental, relational/family, and spiritual health.
In 2003, I first called these the four wheels of health. I proposed that if these four tires were not fully inflated and finely balanced, that one’s ride down the road of life would not be as smooth or as long as it could be. And breakdowns could be more frequent than desired. I proposed that of the four wheels of health, the spiritual wheel was the most important because it was connected to the “power steering” Himself. Dr. John Fisher agrees, writing, “At our core, or coeur, we humans are spiritual beings…Spiritual health is a, if not THE, fundamental dimension of people’s overall health and well-being, permeating and integrating all the other dimensions of health.”
Many of the respondents to my survey commented on patients who suffered from poor physical or mental health yet were highly healthy people just because they were so healthy spiritually. One doctor wrote me about a patient who, in the prime of his adult life, became paralyzed from the neck down in an accident, yet exuded hope and enthusiasm due to his deep relationship with God, supplemented by his rich family and social relationships. The doctor said:
The essence of true health is physical, emotional, social, and spiritual well-being. When these four dimensions are singing in harmony, you’re healthy. That doesn’t mean there’s no room for a dissonant chord, but that the music of life is pleasant to the ear. My quadriplegic patient seems to me to be highly healthy, despite his sobering physical disability.
I have spoken with many seriously disabled or diseased people who seem healthier than most of my patients. What they all share is a conscious and continuous effort to seek the highest possible degree of health in four aspects of their lives: physical, emotional/mental, relational/social, and spiritual/religious.
Results of a 2018 Harris Poll survey of more than 2,000 American adults examined how people define being healthy. “Ninety-two percent of adults agreed with the statement, ‘Health is so much more than just not being sick.’ When asked to further define health…[a]mong the factors most frequently cited:
- 59 percent defined it as being happy,
- 56 percent defined it as being calm and relaxed, and
- 53 percent defined it as the ability to live independently.”
Interestingly, these four components of health are similar to the definitions given by many experts. One group of experts write, “Spirituality has now been identified globally as an important aspect for providing answers to many questions related to health and happiness. The World Health Organization is also keen at looking beyond physical, mental, and social dimensions of health and the member countries are actively exploring the 4th Dimension of health, i.e. the spiritual health and its impact on the overall health and happiness of an individual.”
I defined the four wheels of highly healthy people as:
- Relational/social health. The well-being of one’s associations with family, friends, and faith in the context of a healthy community.
- Emotional/mental health. The well-being of one’s mental faculties and one’s connection with their emotions.
- Physical health. The well-being of one’s body.
- Spiritual health. The well-being of one’s relationship with God.
These four factors continue to be emphasized in the latest scientific research. Harold G. Koenig, MD, a family physician and psychiatrist who is director of the Center for Spirituality, Theology, and Health at Duke University, wrote,
I have reviewed and summarized hundreds of quantitative original data-based research reports examining relationships between religion/spirituality (R/S) and health. These reports have been published in peer-reviewed journals in medicine, nursing, social work, rehabilitation, social sciences, counseling, psychology, psychiatry, public health, demography, economics, and religion. The majority of studies report significant relationships between R/S and better health.
The Oxford University Handbook on Religion and Health exhaustively documents thousands of peer-reviewed studies reporting the direct relationships between R/S and physical, emotional, and social health. Family physician Wayne Jonas, MD, says, “As physicians, we should be asking, ‘What matters?’ instead of just, ‘What’s the matter?’”
English cleric and theologian John Wesley (1703–1791), a co-founder of Methodism, wanted his family, friends, and followers to enjoy healthy lives. In 1747 he penned “Primitive Physick, or An Easy and Natural Method of Curing Most Diseases.” He defines physic as “the art of healing.” In this treatise, he suggested 37 rules for living a balanced life and preventing disease—rules that involve all four wheels of health. These are my favorites:
- People should have those who…are much about them (who are) sound, sweet, and healthy.
- Water is the wholesomest of all drinks.
- Persons should eat very light suppers and that two or three hours before going to bed.
- Constantly go to bed about nine and rise at four or five.
- A due degree of exercise is indispensably necessary to health and long life. Walking is the best exercise…The open air, when the weather is fair, contributes much to the benefit of exercise.
- Those who read or write much, should learn to do it standing; otherwise, it will impair their health.
- Exercise first, should be always on an empty stomach; secondly, should never be continued to weariness; thirdly, after it, we should take to cool by degrees.
- The slow and lasting passions, such as grief and hopeless love, bring on chronical diseases.
- Till the passion which caused the disease is calmed, medicine is applied in vain.
- The love of God, as it is the sovereign remedy of all miseries…and by the unspeakable joy and perfect calm serenity and tranquility it gives the mind; it becomes the most powerful of all the means of health and long life.
These four wheels are also outlined in the Bible, where Luke, the only physician who authored a book in the Bible (and he wrote two books, the Gospel of Luke and Acts), observed, “Jesus grew in wisdom (emotional/mental health) and stature (physical health), and in favor with God (spiritual health) and man (relational/social health)” (Luke 2:52). Of course, we added the parentheticals, but they make sense, don’t they?
How many people have we met (other than Jesus) who have all four wheels perfectly balanced? None. Not a single person! The important thing to remember is that we all share a common need to constantly balance the different parts of our life. Maintaining a highly healthy balance is a lifelong and life-enhancing task.
Unfortunately, simply scrutinizing these pages won’t produce results. To become a highly healthy person, you’ll need to understand the four wheels of health and then take personal responsibility for your health. You’ll be tempted to neglect what is needed to become highly healthy. It takes work. It takes time. You may be enticed by some healthcare scammers who promise that their particular therapy, tonic, or tablet will simply, easily, and quickly cure all that ails you. It won’t.
But we have tried to make this work easier, more enjoyable, and more effective by identifying for you ten essentials and dozens of tips for highly healthy living after age 50 that encompass all four wheels of health. Of course, there are many, many more tips we have not included, but we believe the ones we have chosen are some of the most important and helpful. As a result, our prayer is that you will consider and apply as many as you can.
Essential 2 – Preventive Care
For millennia, the only tool physicians utilized for health promotion was called secondary prevention, where a physician saw a patient, treated disease, and then attempted, secondarily, to prevent worsening or recurrence. But now it is widely accepted that primary prevention is the most effective and arguably economical strategy in healthcare. Many choices and behaviors are associated with dramatic increases in length of life and quality of life—especially by preventing or delaying chronic debilitating diseases such as obesity, diabetes, heart disease, stroke, and cancer. In other words, you can often prevent disease before it starts with primary prevention. It boils down to a series of choices you, your family, and your loved ones will make on a day-to-day basis.
I once had a patient tell me, “Doc, I’ve just got poor genes. Everyone in my family has died young. Guess I will also.” I explained to him that a long, high-quality life is not solely a result of good genetics. Sure, genes are important, but even more important are the decisions we make about daily lifestyle issues—sleeping, diet, exercise, work, leisure, meditation, prayer, reducing stress, and improving relationships. About 20 years ago, some experts believed that as much as 70 to 80 percent of what controls our lifespan was related to our lifestyle, not our genes. In other words, genetics only accounted for 20 to 30 percent of an individual’s chance of surviving to old age. A 2018 study in the journal Genetics reported that “genes accounted for well under 7 percent of people’s life span, versus the 20 to 30 percent of most previous estimates.”
The five leading causes of death in the United States are heart disease, cancer, chronic lower respiratory diseases (such as emphysema and chronic bronchitis), stroke, and accidental injuries. For persons aged 80 years or less, these represented nearly 900,000 deaths in 2010 according to the Centers for Disease Control and Prevention (CDC). The good news is that nearly a quarter (more than 200,000) of these deaths are considered preventable—in other words, they are premature deaths that could have been avoided.
Another study by the Harvard School of Public Health examined the reversible risk factors for premature death in the US. Here are the estimated numbers of premature lives lost annually—virtually all of which could have been be prevented, reversed, or treated:
- smoking: 467,000
- high blood pressure: 395,000
- overweight/obesity: 216,000
- inadequate physical activity/inactivity: 191,000
- high blood sugar: 190,000
- high LDL (low-density lipoprotein) or “bad” cholesterol: 113,000
In late 2018, a first-of-its-kind measurement by the Blue Cross Blue Shield Association (BCBS) pinpointed, by county, what is impacting Americans’ health both by lowering quality and quantity of life. The top five health conditions that have the greatest impact include:
- Hypertension—National Health Impact 12.5 percent. More commonly known as high blood pressure, it can cause a heart attack or stroke and is also known as the silent killer because it has no early noticeable symptoms but creates an extra load on the heart and blood vessels.
- Major Depression— National Health Impact 9 percent. Depression frequently goes undiagnosed or untreated.
- High Cholesterol—National Health Impact 8.6 percent. High cholesterol can be hereditary or from the result of unhealthy diet and lifestyle choices and can increase the risk of heart attack and stroke.
- Coronary Artery Disease — National Health Impact 7 percent. High blood pressure, high cholesterol, smoking, and diabetes can all damage or obstruct the inner layer of coronary arteries, which, over time, can worsen and become coronary artery disease, putting you at much higher risk of heart attack.
- Type 2 Diabetes—National Health Impact 5.5 percent. In people with diabetes, blood sugar levels rise higher than normal. Type 2 diabetes, the most common form of the disease, is caused by obesity and lack of physical activity in about 90 percent of cases.
Once again, the many lifestyle tips we’re going to teach you can prevent many and help treat almost all of these disorders. To learn more about the health issues impacting your county or state, take a tour on the interactive BCBS Health Index map at tinyurl.com/y6oyrfpv.
The National Research Council and Institute of Medicine report that up to half of all premature deaths in the US are attributable to behavioral and other preventable factors—including modifiable habits such as tobacco use, poor diet, and lack of exercise. A 2018 study from the CDC found “heart disease is the leading cause of death among American adults” and “heart problems that were largely preventable (including heart attacks, strokes, heart failure) killed around 415,000 Americans” in 2016.
The number one killer of women is heart disease, accounting for about one in every four female deaths. Despite increases in public awareness over the past decade, only one in five American women believe heart disease is their greatest health threat. Many women believe breast cancer is their major health concern when, in fact, this disease is far down the list. In reality, more women die of cardiovascular disease than all cancers put together. For example, only about 1 in 31 deaths of women is caused by breast cancer.
Breast cancer is an appropriate concern for women, and we’ve devoted an entire tip to it. But our point is that cardiovascular disease should be of even more concern because 90 percent of women have one or more risk factors for developing heart disease or stroke. Almost two-thirds of women who die suddenly of coronary heart disease have no symptoms.
As simple a choice as improving your nutrition can have substantial benefits. According to one report, “A diet quality score based on the PURE study, which advocates eating more of seven key foods—fruits, vegetables, nuts, legumes, fish, dairy, and non-processed red meat—has been linked to lower premature deaths and reduced cardiovascular events such as heart attack and stroke in at least three large independent studies.”
Smoking is a major factor in four of the five leading causes of death: heart disease, cancer, lung disease, and stroke. Smoking one to five cigarettes a day increases heart attack risk by 38 percent—40 cigarettes a day increases risk by 900 percent. In a 2017 study of more than 235,000 adults aged 59 to 82, the National Institutes of Health (NIH) found smokers who smoked one to ten cigarettes per day had more than twice the risk of developing a tobacco‐related cancer (such as lung, bladder, or pancreatic cancer). Even less than one cigarette a day almost doubled the risks of these cancers. The NIH concluded, “Even low‐levels of cigarette smoking causes cancer” and all smokers “would benefit from cessation.”
Data from 52 countries reported that nine factors (abnormal lipids, smoking, hypertension, diabetes, abdominal obesity, psychosocial factors, low consumption of fruits and vegetables, alcohol use, and low regular physical activity) account for most of the risk of cardiovascular disease worldwide. This huge study also found that stress—whether at home or at work, finances, or major life events—although less dangerous to our health than smoking, was as bad as high blood pressure or abdominal obesity. The minimal lifestyle intervention that has been suggested to be healthful for stress reduction is 10 to 20 minutes a day of silence, relaxation, prayer, or meditation.
“This makes sense, and I want to improve my health,” you may say, “but why buy another book on health? Can’t I just find all this on the internet?” Not necessarily. In fact, one group of researchers found that among health websites, retail websites presenting information on products they were selling had the lowest level of medical accuracy (only 9 percent). On the other hand, government websites (.gov) and websites of national organizations (.org) had the highest level of accuracy (81 and 73 percent, respectively). Note that even these “reputable” sources weren’t close to 100 percent accurate!
Shockingly, educational websites (.edu sites, e-books, peer-reviewed articles) only had 50 percent accurate medical information. The majority of the books found by search engines either provided outdated or irrelevant information. Blogs and websites of individuals are even worse, having low rates of accuracy (26 and 30 percent, respectively).
The American Academy of Family Physicians (AAFP) reported in 2018 that 97 percent of family physicians polled said they have had patients come to an office visit with inaccurate medical information from an online source. Another study by researchers from Harvard Medical School and Boston’s Children’s Hospital found internet symptom checkers varied widely in accuracy. On average, they included the correct diagnosis in the first three results only 51 percent of the time. Individual symptom checkers ranged from 34 percent to 84 percent accurate. Overall, the chances of finding the right diagnosis listed first were poor. On the low end, one checker listed the correct condition first only 5 percent of the time, whereas the best only listed it 50 percent of the time. Understandably, the sites did better at identifying common conditions than uncommon ones. Therefore, when researching health conditions or treatments online or in books (including this one) or magazines, your best bet is to always check the advice with your physician or pharmacist.
Our prayer is that you come to understand and appreciate the great privilege of stewardship you have in becoming and remaining a highly healthy person. Family history and genetics play a role, to be sure, but it is increasingly obvious that your lifestyle decisions play a much larger role.
The Bible teaches that it is our sacred duty to be proactive about our own self-care. God considers the human body, which He designed, to be His temple. “Do you not know that your bodies are temples of the Holy Spirit, who is in you, whom you have received from God? You are not your own; you were bought at a price. Therefore, honor God with your bodies” (1 Corinthians 6:19-20). This book was written to help you do just this by giving you medically trustworthy and biblically sound advice that is reliable, reputable, and reproducible to help you and your family live longer and higher quality lives.
Many of our tips grow out of what I have called the Ten Commandments of Preventive Medicine. We could identify several more tips related to preventing disease, but these should get us off to an excellent start. And, of course, we’ll be adding other tips for your physical, emotional/mental, relational/social, and spiritual health.
- See a primary care physician for regular preventive maintenance and care.
- Avoid or reduce obesity.
- Exercise regularly—and wisely.
- Pursue a lifelong monogamous marriage relationship.
- Protect your dental health.
- Be careful with alcohol.
- Stay away from tobacco.
- Reduce unnecessary stress.
- Double-check alternative health approaches with your physician or pharmacist.
- Use automobile safety devices and install and maintain smoke detectors and carbon monoxide detectors in your home.
You may not find a lot of surprises in these first ten tips—but the real questions are these:
- To which of these guidelines do you need to begin paying attention?
- When do you plan to start implementing some of these tips?
- What strategies will ensure your success?
A colleague of mine has suggested a simple formula for good health: 0-5-10-30-150. Zero cigarettes; five servings of fruit and vegetables a day; 10 minutes of silence, relaxation, meditation, or prayer a day; a body mass index (BMI) of less than 30; and 150 minutes of exercise per week. We’ll have more tips for you in each of these areas.
Primary prevention is not the only critical aspect of maintaining and improving your health; screening for early disease and vaccinations against disease is also lifesaving. A 2018 study revealed some shocking information. Only 8 percent of US adults age 35 and older had received all high-priority recommended preventive services. Five percent of adults did not receive any such services. How many of the following 13 services have you had? Men (♂) should have up to 11, while women (♀) should have up to 13.
Percentage of US Adults (> 35 years old) Receiving Recommended Preventive Services
- Blood Pressure 87%
- Breast Cancer (♀) 74%
- Cervical Cancer (♀) 68-75%
- Cholesterol 82%
- Colon Cancer (> 45 y/o) 64%
- Osteoporosis (♀) 63%
SCREENING AND COUNSELING
- Alcohol use 41%
- Depression 41%
- Obesity 64%
- Tobacco use 62%
- Influenza (Flu) 49%
- Zoster (Shingles) 38%
- Pneumococcal (Pneumonia) 66%
Don’t be surprised if you had a low score. A 2018 study by the National Cancer Institute (NCI) found Americans lack understanding of cancer screening. In fact, only about one in twenty folks answered correctly four true-false questions about cancer screening. This suggested that “most people have inaccurate beliefs about what cancer screening tests can do and what they cannot.” The NCI’s lead author remarked, “That’s a little bit alarming,” adding, “We just haven’t done a good job in educating the public about these nuances in cancer screening that are important to understand.” But, our tips will help you grasp these lifesaving concepts.
We hope that this book will help you increase your knowledge and assist you in making wise decisions about your health. By beginning with a single step and continuing to improve on a day-to-day basis, you, your family, and your loved ones will be on your way to not only becoming happier and healthier but living longer.
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