Thursday, February 6, 2014
Health: know what, or no how
You doubtless know the old saw about Carnegie Hall: How do you get there? Practice, practice, practice.
We might invoke similar reasoning about a far greater prize, with far more universal implications: vitality. How do you add years to life, and life to years? Good old-fashioned knowhow.
Note that it isn’t good old-fashioned “knowhat.” The term “knowhow” is in the dictionary, sometimes hyphenated (“know-how”), sometimes not. But “knowhat” isn’t there, hyphen or no hyphen. And with good reason. Without knowing “what” there is no job in the first place. Once we know what, and the job is before us, knowhow gets it done. Knowing what provides purpose. Know-how provides a process for getting there from here.
Having a process with no purpose is like having a route with no destination; it makes no sense. Knowing what is prerequisite to the application of knowhow.
Perhaps that’s why I so often find myself frustrated. More often than not, I vent my frustrations in a column like this one. Sometimes I rant a bit. Sometimes I try to give myself (and others) a good laugh because it’s better than crying. But there are those occasional temptations to throw in the towel. What is the point of trying to share know-how for health, when we can’t agree we know what?
We carry on about health as if we didn’t know what cultivates it. We act as if any given theory about diet or exercise is as valid as any other. We actually seem to be disappointed when an effort to facilitate health reiterates what we already thought was true (e.g., vegetables are good for us) instead of blasting conventional wisdom to smithereens.
If we are truly so uninformed about what it takes to be healthy, we really have no business trying to get there. We can’t work at being healthy if we are genuinely clueless about what makes us so.
The obvious analogy is geographical. Imagine if you wanted to go to, say, Cleveland, but had absolutely no idea where it was. Imagine that for some reason, there was intense controversy about the location of Cleveland, and cartographic factions competed for attention, notoriety and presumably related profits by espousing different theories, and producing discrepant maps. On one map, it’s in Ohio. On another, it’s in Arizona. On another, it’s in Japan. And the blogosphere is alight with commentary by each faction’s legion of devotees, all hurling insults at the benighted nincompoops in all the other legions. You think it’s in Ohio? Moron!
Under such circumstances, what hope would there be of ever getting to Cleveland? Not much.
Of course, we do know where Cleveland is, and for whatever reason, it has not proven good fodder for controversy. At least not yet.
Would that it were so for health. From my perspective, having read thousands of articles, written numerous textbooks, published hundreds of research papers, and cared for patients for 25 years, I don’t find the fundamentals of good health any murkier than the location of Cleveland. I can find both.
The evidence indicating what is most likely to endow us with more years in life, more life in years, and the vitality that makes life better and more fun, is nothing less than staggering.
We have epidemiologic analysis showing, repeatedly, that roughly 80% of all chronic disease and related premature death is attributable to what we do with our feet, forks and fingers. Be active, eat well and don’t smoke, and close to 80% of your lifetime risk of any major chronic disease could go away. Add to that list 3 more: sleep (get enough); stress (manage it); and love (share some), and the benefits are even greater.
There are epidemiologic studies in diverse populations corroborating these effects again, andagain, and again, and again, and … Truly, the list of supporting studies is far too long to capture here. Prove it to yourself by going to PubMed and typing any variant on the theme of “lifestyle factors AND health” in the search box, and then perusing the thousands of citations retrieved. Yes, it will be thousands.
There is, as well, the Blue Zones project which gives us a window to the cultures and habits of the longest-lived, most vital and happiest populations around the world. The findings here correspond perfectly with a focus on feet, forks, fingers, sleep, stress and love.
To the extent that diet is the complicated variable on the list, we make it far more so than it needs to be. As long as we eat wholesome foods, mostly plants, we can eat relatively high fat or low, relatively high carb or low, relatively high protein or low, include or exclude dairy, include or exclude meat, include or exclude grains, and be healthy. We can also adopt any of these competing theories, populate it with highly processed junk foods, and eat badly. By ignoring the basic theme of healthful eating and fixating on details, we predictably risk losing the forest for the trees. Public health nutrition has for just this reason been lost in the woods for decades.
Having written 3 editions of an extensively referenced nutrition textbook for health care professionals, I know, despite appearances to the contrary, that we aren’t clueless about the basic care and feeding of Homo sapiens. But it doesn’t really matter, because the tendency to act as if we were creates a seller’s market for fad diets and quick fixes. There’s a sucker born every minute, after all.
But that doesn’t mean it needs to be you.
So let’s decide: Do we, or don’t we, know the fundamental “what” required to promote human health? If you think not, there’s no reason to try, or waste your money on the latest confabulated theory.
But if you are like me and know that we do know what, the obvious question is why aren’t more of us benefiting from that knowledge? The answer is: knowhat, but no how.
The definition of knowhow refers to expertise, skills, and the capacity to do something well. These are interesting considerations that collectively suggest knowhow is not about making it happen with iron will, no matter how poorly prepared we may be. The definitional details of knowhow imply preparation, and competency. Skillpower, in other words, rather than just will power.
I genuinely believe the luminous prize of vitality—more years of life, more life in years—is tantalizingly, almost agonizingly within reach. I believe the knowhow to get there from here is available, manageable, shareable and eminently applicable. I believe all of our efforts, attention and resources should be focused on the dissemination of just such knowhow, and on facilitating its application. I believe these just as fervently as I believe that Cleveland is, indeed, in Ohio -- and if you want to get there from here, your time is better spent choosing plane, train or automobile rather than choosing among competing maps that put it in different places.
I believe we know what makes human beings healthy. But until more of us can agree we do know what, there simply is no how.
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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