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Monday, October 28, 2013

We can be disease proof

When you board a plane, as I do very often, I presume you count on the skill of the pilot. You know, of course, that the pilot can’t control everything. Just like the ship captains of old controlled ship and sail, but not wind and wave, so do modern airline pilots control the cockpit, but not the atmospheric conditions. But controlling the cockpit is good enough for me and my fellow frequent fliers. We know we can’t get a “guarantee” of a safe flight, but we also know that with a skillful captain at the helm of a properly assembled plane, the odds are overwhelmingly in our favor.

Well folks, I am here to tell you exactly the same is true of health. The differences are only these: your body is the plane and you are the captain.

Assuming your body is put together about like a body ought to be, and you wouldn’t be here if it wasn’t, then you can be the captain of your fate. You can be the master of your medical destiny. You can even be the boss of your DNA. You can be, in essence, disease-proof.

We can reduce our lifetime risk of all major chronic disease by an incredible 80%. We can even alter our gene expression through the power of lifestyle. DNA is not destiny. To a much greater extent, choices under our control determine our fate. We have scientific evidence to show that if we change our own behavior, we change the behavior of our genes. We can nurture nature.

But just like a captain needs to learn how to fly that plane, you need to learn how to navigate your body to health. Both enterprises are skill dependent. It takes will to want to be an airline captain in the first place, but it takes skill to fly the plane. Similarly, you need willpower to get to health, because you do have to care. But once you care, you will need skill-power to get there from here. You and those you love really can be disease proof, but it takes skill. Fortunately, a lot less skill than flying a plane. Maybe it’s more like learning to ride a bike.

And to that end, I am pleased and proud to bring to your attention my brand new book, Disease-Proof, now available online and coming to bookstores nationwide on September 26. I can’t fly a plane, but I can ride a bike, and I do have the skill set for being healthy. I live the benefits of that skill set every day, and I live the benefits of sharing those skills with those I love, notably my wife and five children.

I have the skills needed to reduce my lifetime risk of any major chronic disease, heart disease, cancer, stroke, diabetes, dementia, by 80% and I want to pay it forward.

We have known this is possible for literal decades, but it’s a case study demonstrating that knowledge isn’t power. Knowing what isn’t the same as knowing how. Knowing how is all about skill-power. Disease-Proof is all about knowing both what and how.

The book lays out the case and presents the ironclad evidence for this 80 percent reduction in the risk of all chronic disease that is within reach of us all. It highlights what this would mean if we applied it to ourselves, and those we love. We might sum that up by noting simply this: healthy people have more fun! Better health means a better life. Longer, too, in all probability. The combination of more years of life, more life in years is about the best gift you can give yourself, and it’s the gift that keeps on giving, because if you know how to get there from here, you, too, can pay it forward to everyone you love.

What do I mean by “skill-power”? Well, for instance, let’s imagine you have a sweet tooth, as most of us do. Trying to file that down to size so it doesn’t become a sweet fang that takes over your life is usually very hard. It could be all about giving up your favorite desserts and just toughing it out. That’s the willpower approach.

When that approach fails, as it generally does, we beat up on ourselves (and sometimes one another) for not having enough willpower. But just as time and wind and rain can wear away even mountains, so can time and effort and frustration wear down even a mountain of willpower. Yes, will matters, and there are ways to maximize it (that, too, is addressed in Disease-Proof). But when even a mountain of willpower isn’t enough, then willpower is no longer the problem.

What if instead of giving up your favorite dessert, you give up gram after gram of sugar from your diet by trading up foods that didn’t need to be sweet in the first place? You won’t miss sugar from pasta sauce, after all. You won’t miss it in crackers, either. I refer to this as “stealth” sugar, sugar in foods we don’t consider sweet. There is a lot of it, but most people don’t know it’s there, let alone where it’s hiding. The good news is that when you find out, you can easily trade up to choices in the same categories that don’t have the added sugar (without spending more money, by the way).

And then, the news gets even better. Taste buds are very malleable little fellas, they learn to love the foods they’re with. That’s why you probably love way too much sugar and salt right now. Your taste buds have been “corrupted” by the unnecessary processing of the modern food supply. But that same food supply provides really good options in every category, and if you know which ones those are, they are all you need to rehabilitate your taste buds. You really can learn to prefer and love the very foods that love you back.

In the end, after taste bud rehab mediated by skill-power, you can give up that too-sweet dessert with no force of will, but just because you don’t like it anymore. Your newly rehabilitated taste buds will tell you it is too sweet, and you will trade up by choice, without effort and permanently. That’s what skill-power can do. The book is filled with an entire inventory of just such skills.

We know, as well, that we are all generally far too sedentary, and that just sitting more and moving less can take literal years off our lives. But fitting “exercise” into a crammed schedule can prove daunting to even an indomitable will. But there are in fact, ways to exercise without exercising, by having recreational fun. There are ways to space activity bursts directly into your work day, and get those elusive 30 minutes of physical activity without ever leaving the office (or living room). Such approaches require knowledge of, and access to, relevant tools and program and resources. Such solutions require skill. Skill can be acquired. Skill can be shared.

That is why my co-author, Stacey Colino, and I wrote Disease-Proof. The skill set for healthy living can be shared. So, quite simply, it should be. We’ve done our best to do exactly that.

These days, most books about health will tell you there’s just one thing to focus on: to lose weight, or find health, or stop aging. But those who read my columns routinely know I don’t accept any such nonsense. What worthwhile aspect of your life is all about just one thing? No one emotion makes a relationship. No one word makes a conversation. No one outfit makes a wardrobe. No one food makes a diet. No one tool can do every job (I am a pretty good carpenter, and have a well-stocked wood shop). No one skill makes a business. Life’s activities inevitably require a skill set. Imagine a pilot being great at takeoff, but lousy at landing. Or really good at controlling altitude, but not so good at turning. No thanks, I want a pilot with the full skill set for flying a plane, if you please.

Similarly, you should want, and you can have, the full skill set for healthy living. That was the idea that turned into Disease-Proof. We have known for decades how to slash the risk of all serious chronic diseases, but only some of us have the skills to turn that knowledge into the power of better living. That shouldn’t be. Everyone should have that power.

I do think the best way for that to happen is for our culture and our environment to change. I think health should be on a path of much lesser resistance, and then it wouldn’t be on the road so seldom taken. My day job is devoted to accelerating just such changes, and we address them in Disease-Proof. But I don’t recommend you hold your breath while waiting on the world to change. The world changes slowly and you and those you love can’t afford to wait. Fortunately, there’s no need. The right skill set can give you mastery over health (and weight) in the world as it is.

It’s not rocket science. It’s not even plane travel. The relevant skills aren’t trivial, but they aren’t really hard, either. You can have them, but you have to get them. Remember you once had to learn how to ride a bike. But then … you’ve known how ever since.

Without the right skill set, health is elusive. You can’t get there from here. The relevant skills are yours for the taking, and with them, you and those you love truly can be to an astonishing degree, disease-proof. I want that to happen, and will be deeply gratified to be any part of the reason it does.

David L. Katz, MD, FACP, MPH, FACPM, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care. He is a board certified specialist in both Internal Medicine, and Preventive Medicine/Public Health, and Associate Professor (adjunct) in Public Health Practice at the Yale University School of Medicine. He is the Director and founder (1998) of Yale University's Prevention Research Center; Director and founder of the Integrative Medicine Center at Griffin Hospital (2000) in Derby, Conn.; founder and president of the non-profit Turn the Tide Foundation; and formerly the Director of Medical Studies in Public Health at the Yale School of Medicine for eight years. This post originally appeared on his blog at The Huffington Post.

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Blog log

Members of the American College of Physicians contribute posts from their own sites to ACP Internistand ACP Hospitalist. Contributors include:

Albert Fuchs, MD
Albert Fuchs, MD, FACP, graduated from the University of California, Los Angeles School of Medicine, where he also did his internal medicine training. Certified by the American Board of Internal Medicine, Dr. Fuchs spent three years as a full-time faculty member at UCLA School of Medicine before opening his private practice in Beverly Hills in 2000.

And Thus, It Begins
Amanda Xi, ACP Medical Student Member, is a first-year medical student at the OUWB School of Medicine, charter class of 2015, in Rochester, Mich., from which she which chronicles her journey through medical training from day 1 of medical school.

Auscultation
Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital.

Zackary Berger
Zackary Berger, MD, ACP Member, is a primary care doctor and general internist in the Division of General Internal Medicine at Johns Hopkins. His research interests include doctor-patient communication, bioethics, and systematic reviews.

Controversies in Hospital Infection Prevention
Run by three ACP Fellows, this blog ponders vexing issues in infection prevention and control, inside and outside the hospital. Daniel J Diekema, MD, FACP, practices infectious diseases, clinical microbiology, and hospital epidemiology in Iowa City, Iowa, splitting time between seeing patients with infectious diseases, diagnosing infections in the microbiology laboratory, and trying to prevent infections in the hospital. Michael B. Edmond, MD, FACP, is a hospital epidemiologist in Richmond, Va., with a focus on understanding why infections occur in the hospital and ways to prevent these infections, and sees patients in the inpatient and outpatient settings. Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands).

db's Medical Rants
Robert M. Centor, MD, FACP, contributes short essays contemplating medicine and the health care system.

Suneel Dhand, MD, ACP Member
Suneel Dhand, MD, ACP Member, is a practicing physician in Massachusetts. He has published numerous articles in clinical medicine, covering a wide range of specialty areas including; pulmonology, cardiology, endocrinology, hematology, and infectious disease. He has also authored chapters in the prestigious "5-Minute Clinical Consult" medical textbook. His other clinical interests include quality improvement, hospital safety, hospital utilization, and the use of technology in health care.

DrDialogue
Juliet K. Mavromatis, MD, FACP, provides a conversation about health topics for patients and health professionals.

Dr. Mintz' Blog
Matthew Mintz, MD, FACP, has practiced internal medicine for more than a decade and is an Associate Professor of Medicine at an academic medical center on the East Coast. His time is split between teaching medical students and residents, and caring for patients.

Everything Health
Toni Brayer, MD, FACP, blogs about the rapid changes in science, medicine, health and healing in the 21st century.

FutureDocs
Vineet Arora, MD, FACP, is Associate Program Director for the Internal Medicine Residency and Assistant Dean of Scholarship & Discovery at the Pritzker School of Medicine for the University of Chicago. Her education and research focus is on resident duty hours, patient handoffs, medical professionalism, and quality of hospital care. She is also an academic hospitalist.

Glass Hospital
John H. Schumann, MD, FACP, provides transparency on the workings of medical practice and the complexities of hospital care, illuminates the emotional and cognitive aspects of caregiving and decision-making from the perspective of an active primary care physician, and offers behind-the-scenes portraits of hospital sanctums and the people who inhabit them.

Gut Check
Ryan Madanick, MD, ACP Member, is a gastroenterologist at the University of North Carolina School of Medicine, and the Program Director for the GI & Hepatology Fellowship Program. He specializes in diseases of the esophagus, with a strong interest in the diagnosis and treatment of patients who have difficult-to-manage esophageal problems such as refractory GERD, heartburn, and chest pain.

I'm dok
Mike Aref, MD, PhD, FACP, is an academic hospitalist with an interest in basic and clinical science and education, with interests in noninvasive monitoring and diagnostic testing using novel bedside imaging modalities, diagnostic reasoning, medical informatics, new medical education modalities, pre-code/code management, palliative care, patient-physician communication, quality improvement, and quantitative biomedical imaging.

Informatics Professor
William Hersh, MD, FACP, Professor and Chair, Department of Medical Informatics & Clinical Epidemiology, Oregon Health & Science University, posts his thoughts on various topics related to biomedical and health informatics.

David Katz, MD
David L. Katz, MD, MPH, FACP, is an internationally renowned authority on nutrition, weight management, and the prevention of chronic disease, and an internationally recognized leader in integrative medicine and patient-centered care.

Just Oncology
Richard Just, MD, ACP Member, has 36 years in clinical practice of hematology and medical oncology. His blog is a joint publication with Gregg Masters, MPH.

KevinMD
Kevin Pho, MD, ACP Member, offers one of the Web's definitive sites for influential health commentary.

MD Whistleblower
Michael Kirsch, MD, FACP, addresses the joys and challenges of medical practice, including controversies in the doctor-patient relationship, medical ethics and measuring medical quality. When he's not writing, he's performing colonoscopies.

Medical Lessons
Elaine Schattner, MD, FACP, shares her ideas on education, ethics in medicine, health care news and culture. Her views on medicine are informed by her past experiences in caring for patients, as a researcher in cancer immunology, and as a patient who's had breast cancer.

Mired in MedEd
Alexander M. Djuricich, MD, FACP, is the Associate Dean for Continuing Medical Education (CME), and a Program Director in Medicine-Pediatrics at the Indiana University School of Medicine in Indianapolis, where he blogs about medical education.

More Musings
Rob Lamberts, MD, ACP Member, a med-peds and general practice internist, returns with "volume 2" of his personal musings about medicine, life, armadillos and Sasquatch at More Musings (of a Distractible Kind).

Prescriptions
David M. Sack, MD, FACP, practices general gastroenterology at a small community hospital in Connecticut. His blog is a series of musings on medicine, medical care, the health care system and medical ethics, in no particular order.

Reflections of a Grady Doctor
Kimberly Manning, MD, FACP, reflects on the personal side of being a doctor in a community hospital in Atlanta.

The Blog of Paul Sufka
Paul Sufka, MD, ACP Member, is a board certified rheumatologist in St. Paul, Minn. He was a chief resident in internal medicine with the University of Minnesota and then completed his fellowship training in rheumatology in June 2011 at the University of Minnesota Department of Rheumatology. His interests include the use of technology in medicine.

Technology in (Medical) Education
Neil Mehta, MBBS, MS, FACP, is interested in use of technology in education, social media and networking, practice management and evidence-based medicine tools, personal information and knowledge management.

Peter A. Lipson, MD
Peter A. Lipson, MD, ACP Member, is a practicing internist and teaching physician in Southeast Michigan. The blog, which has been around in various forms since 2007, offers musings on the intersection of science, medicine, and culture.

Why is American Health Care So Expensive?
Janice Boughton, MD, FACP, practiced internal medicine for 20 years before adopting a career in hospital and primary care medicine as a locum tenens physician. She lives in Idaho when not traveling.

World's Best Site
Daniel Ginsberg, MD, FACP, is an internal medicine physician who has avidly applied computers to medicine since 1986, when he first wrote medically oriented computer programs. He is in practice in Tacoma, Washington.

Other blogs of note:

American Journal of Medicine
Also known as the Green Journal, the American Journal of Medicine publishes original clinical articles of interest to physicians in internal medicine and its subspecialities, both in academia and community-based practice.

Clinical Correlations
A collaborative medical blog started by Neil Shapiro, MD, ACP Member, associate program director at New York University Medical Center's internal medicine residency program. Faculty, residents and students contribute case studies, mystery quizzes, news, commentary and more.

Interact MD
Michael Benjamin, MD, ACP member, doesn't accept industry money so he can create an independent, clinician-reviewed space on the Internet for physicians to report and comment on the medical news of the day.

PLoS Blog
The Public Library of Science's open access materials include a blog.

White Coat Rants
One of the most popular anonymous blogs written by an emergency room physician.

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