A Doctor’s Advice on Living a Long, Healthy Life: “No idea!”

 

Hilton Head is an odd place to practice medicine.  No one is from here.  They all spend their lives somewhere else (usually Midwest or Northeast) working hard enough to make enough money to retire in a place like Hilton Head.  Then they move down here and begin their long-anticipated life of leisure.  They sleep until they’re hungry and they eat until they’re sleepy and after a few years of this they notice that they don’t feel very well, their pants don’t fit, and they’re on more BP meds now than they were when they were stressed out and working so they decide to get in shape.

My patient Jim followed this path and reached the point where he decided to rededicate himself to his health.  I tell him that’s a great idea.  He says he’s going to buy a bicycle; I tell him that’s a bad idea.  I tell him that bicycles make you healthier but they don’t make you live longer.  I’ve seen horrible accidents over the years.  I mean horrible stuff.  I have four close friends who either died or were crippled by bicycle accidents.  Jim figures that I’m just being a typical overly cautious doctor (which was probably true), and buys a bike.  He rides a lot, starts losing weight, and feels much better.  We even stopped some of his meds.

Then, he wiped out.  He wasn’t going very fast (he says less than 10mph), and he thinks maybe he hit a pine cone or something.  Anyway, he broke his pelvis in two places plus various other bones.  Very serious injuries for a 68-year-old man.  The surgical repair went well, but he developed pneumonia in the hospital.  We treated that, sent him home, and he came back a week later with a blood clot.  The next year was a brutal journey of one setback after another, being transferred from nursing facilities to hospitals to rehab centers and back again, but he eventually overcame everything, and a year later was nearly back to normal, although he had a lot of back pain at that point.  Since his wife now takes a similar view of his bicycle as I do, he’s looking for another way to get back in shape.

I see this sort of thing all the time.  What’s frustrating is that Jim really didn’t do anything wrong.  He worked hard, and saved for a nice retirement.  He sat around a bit too much for a while – big deal.  Then he responds appropriately by getting back in shape, and in the process nearly dies several times in a long series of medical catastrophes.  It happens.  Where exactly did Jim screw up?  I’m not sure.

Because of my job, I have a bias against bicycles, but a lot of people really do get healthy on them.

If they don’t end up in a wheelchair.

Ha!  Sorry!

But that’s the trick, right?  Was it a good idea for Jim to start riding a bicycle?  Absolutely.  Of course, it was. Until it wasn’t.

How is he supposed to be able to anticipate when that is likely to transition from a good decision to a bad decision?  It’s still the same decision.  It only looks different in retrospect.

I’m sometimes asked how much of what I treat is a self-inflicted disease.  I’ve noticed that the people who ask me this are often very trim, fit, and tan.  But whatever.

I answer that everything I treat is self-inflicted.  Or, possibly none of it.  It’s surprisingly difficult to say because it’s not always clear which of our actions are self-destructive until later when we see how everything turns out.

I’ve noticed that my 90-year-old patients generally did not follow a particularly healthy lifestyle.  Some of them did, of course, but many did not.

Americans have the longest lifespan on the planet (if you don’t count inner-city gun violence), and we’re mostly fat and out of shape.  We eat garbage.  We drink and smoke too much.  And we live a really long time.  I don’t get it.

So how does one live a long, healthy life?  My first two suggestions are genetics and luck.

Some things are clearly dangerous.  Cigarettes, excessive alcohol, street drugs, motorcycles, bicycles.  But some people who indulge in all those things live long healthy lives.  Still, you’re not helping your odds by engaging in certain behaviors.

But I see so many horrible things happen to people for no real good reason.

Winston Churchill, whose healthy lifestyle enabled him to live to the age of 90.

So my patients ask me how they can live a long, healthy, happy life.  Early in my career, I wasn’t sure how to answer that.  Now, after decades of study, I have absolutely no idea how to answer that.  The more I learn, the less I understand.  This stuff doesn’t make any sense.

It was simpler when I didn’t know all this stuff.  “Get in shape!  C’mon!”  But now, having studied this for decades, I really don’t understand what it is that makes people live long, healthy lives.  I just don’t understand.

Gosh, I’m a great physician.  Sheesh…

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  1. Percival Thatcher
    Percival
    @Percival

    I know for a fact that Winston didn’t smoke any more than one of those cigars at a time. And he he had a doctor’s note that said he required access to “indefinite alcohol” when he visited the United States in 1932. (He was convalescing from being hit by a car in New York in 1931.)

    Doctor’s orders, you see.

    • #1
  2. RufusRJones Member
    RufusRJones
    @RufusRJones

    Minneapolis is trying to force everybody onto a bicycle and it’s making everything more dangerous. They put all of these crazy lines on the road and nobody knows what the hell they are for. It’s chaos around the light rail because of this. They won’t even put in interceptor/bypass roads around the city so people get sick of being in their car. The freeways are too crowded. I just upgraded cars two years ago mostly for the anti-collision systems because of this stuff. I’m going to do it again soon I think.

    We have some very fancy bike paths, but the ROI is really horrible.

    I just don’t see the upside.

    • #2
  3. Scott Wilmot Member
    Scott Wilmot
    @ScottWilmot

    Prayer and gin soaked raisins is the trick.

    • #3
  4. Percival Thatcher
    Percival
    @Percival

    Scott Wilmot (View Comment):

    Prayer and gin soaked raisins is the trick.

    Then drinking the gin the raisins were soaking in?

    • #4
  5. sawatdeeka Member
    sawatdeeka
    @sawatdeeka

    Dr. Bastiat: e himself to his health.  I tell him that’s a great idea.  He says he’s going to buy a bicycle.  I tell him that’s a bad idea.  I tell him that bicycles make you healthier but they don’t make you live longer. 

    That’s why I just walk for exercise. Not many downsides, except bear attacks if you’re at the wrong place at the wrong time. 

    • #5
  6. Doug Kimball Thatcher
    Doug Kimball
    @DougKimball

    There are answers to healthy longevity, but few that can be controlled.  The age of your mother at birth seems to point to one clue.  Also, your birth order among siblings; (being first to live means you have a good chance you’ll be the last to die.)  There are genetic issues that contribute to early death; there are dozens of “cancer” genes for example.  Hope you don’t inherit any.  There seems to be an inherited link to addictions of all kinds, so if you have a lot of drug addicts and alcoholics on your family tree, you may be predisposed to those life-stealing bad habits.  Likewise, cardiovascular disease may be largely an inherited problem, so there is that.  And if you live past, say 80, things just go sideways.  So a long life is not usually a healthy life; I’ll take a dirt nap over say, dementia or progressive Parkinson’s.  Life in old age can be miserable.  So the advice should be: drink in moderation, exercise moderately if you can (walks and hikes are best), stretch and stay as limber as you can, don’t overeat, smoke rarely (if ever), don’t be reckless, stay close to loved ones and don’t run out of money.

    • #6
  7. Some Call Me ...Tim Coolidge
    Some Call Me ...Tim
    @SomeCallMeTim

    sawatdeeka (View Comment):

    Dr. Bastiat: e himself to his health. I tell him that’s a great idea. He says he’s going to buy a bicycle. I tell him that’s a bad idea. I tell him that bicycles make you healthier but they don’t make you live longer.

    That’s why I just walk for exercise. Not many downsides, except bear attacks if you’re at the wrong place at the wrong time.

    Being in the wrong place at the wrong time is a major contributing factor in 100% of accidents (and bear attacks). 

     

    • #7
  8. Percival Thatcher
    Percival
    @Percival

    Some Call Me …Tim (View Comment):

    sawatdeeka (View Comment):

    Dr. Bastiat: e himself to his health. I tell him that’s a great idea. He says he’s going to buy a bicycle. I tell him that’s a bad idea. I tell him that bicycles make you healthier but they don’t make you live longer.

    That’s why I just walk for exercise. Not many downsides, except bear attacks if you’re at the wrong place at the wrong time.

    Being in the wrong place at the wrong time is a major contributing factor in 100% of accidents (and bear attacks).

     

    The most important factor in avoiding bear attacks is to always hike with someone slower than you are.

    • #8
  9. Phil Turmel Coolidge
    Phil Turmel
    @PhilTurmel

    sawatdeeka (View Comment):

    Dr. Bastiat: e himself to his health. I tell him that’s a great idea. He says he’s going to buy a bicycle. I tell him that’s a bad idea. I tell him that bicycles make you healthier but they don’t make you live longer.

    That’s why I just walk for exercise. Not many downsides, except bear attacks if you’re at the wrong place at the wrong time.

    The right carry weapon will take care of the bear.  (Hard on the wrist, though, I understand.)

    • #9
  10. Some Call Me ...Tim Coolidge
    Some Call Me ...Tim
    @SomeCallMeTim

    Now, I am not a physician, nor did I play one on TV, nor have I recently stayed at a Holiday Inn Express, but my best guess would be genetics. 

     

    • #10
  11. Dr. Bastiat Member
    Dr. Bastiat
    @drbastiat

    Doug Kimball (View Comment):
    There are genetic issues that contribute to early death; there are dozens of “cancer” genes for example.

    We’ve found tens of thousands of “cancer” genes so far, but all are impacted by variable penetrance & other activating and inhibiting factors, so it’s turned out to be much, much, much more complicated than it at first appears.

    • #11
  12. Dr. Bastiat Member
    Dr. Bastiat
    @drbastiat

    Doug Kimball (View Comment):
    And if you live past, say 80, things just go sideways.  So a long life is not usually a health life; I’ll take a dirt nap over say, dementia or progressive Parkinson’s.  Life in old age can be miserable. 

    I understand your point, but a lot of my 90 year olds are really pretty healthy, which is why they didn’t die of an MI or pneumonia or whatever.  I have around 15 patients over 95 years old, and I would guess that they take maybe 2 medications each.  Those on 10 drugs all died in their 70’s and 80’s.  So if you survive that long, you’re probably pretty healthy.

    Although you’re right – you reach an age where you’re just really, really old.  Nobody wants to live to be 100 years old.

    Well, nobody except 99 year olds, of course.

    • #12
  13. Flicker Coolidge
    Flicker
    @Flicker

    sawatdeeka (View Comment):

    Dr. Bastiat: e himself to his health. I tell him that’s a great idea. He says he’s going to buy a bicycle. I tell him that’s a bad idea. I tell him that bicycles make you healthier but they don’t make you live longer.

    That’s why I just walk for exercise. Not many downsides, except bear attacks if you’re at the wrong place at the wrong time.

    Which is worse.  Bears?  Or rattle snakes.

    • #13
  14. Phil Turmel Coolidge
    Phil Turmel
    @PhilTurmel

    I was listening to the latest EconTalk Podcast the other day.  The subject was Michael Easter’s The Comfort Crisis.  Fascinating discussion about how our lives and lifestyles have changed over the past couple centuries.  It seems the healthiest people on the planet are the graduates of the toughest military specialty training programs.  And the common denominator for those training programs seems to be a great deal of marching with heavy packs.  “Rucking” as it is now abbreviated.

    I recommend listening to the whole thing.

    • #14
  15. Dr. Bastiat Member
    Dr. Bastiat
    @drbastiat

    Phil Turmel (View Comment):

    I was listening to the latest EconTalk Podcast the other day. The subject was Michael Easter’s The Comfort Crisis. Fascinating discussion about how our lives and lifestyles have changed over the past couple centuries. It seems the healthiest people on the planet are the graduates of the toughest military specialty training programs. And the common denominator for those training programs seems to be a great deal of marching with heavy packs. “Rucking” as it is now abbreviated.

    I recommend listening to the whole thing.

    Ok.

    But on the other hand, you’d have to be pretty healthy to be accepted at such a program.  I wonder if they just took the healthiest kids they could find and then had them play video games for 20 years, I wonder if they would live a long time too?

    Studies like this are impossible to interpret.  Too many variables.

    • #15
  16. Western Chauvinist Member
    Western Chauvinist
    @WesternChauvinist

    sawatdeeka (View Comment):

    Dr. Bastiat: e himself to his health. I tell him that’s a great idea. He says he’s going to buy a bicycle. I tell him that’s a bad idea. I tell him that bicycles make you healthier but they don’t make you live longer.

    That’s why I just walk for exercise. Not many downsides, except bear attacks if you’re at the wrong place at the wrong time.

    Yeah, my first rule of exercise is keep your feet on the ground — unless your bum is on the seat of a stationary bike. None of that fancy weekend warrior stuff. They say pickle ball is the bane of ER docs around The Villages. 

    • #16
  17. Phil Turmel Coolidge
    Phil Turmel
    @PhilTurmel

    Dr. Bastiat (View Comment):

    Phil Turmel (View Comment):

    I was listening to the latest EconTalk Podcast the other day. The subject was Michael Easter’s The Comfort Crisis. Fascinating discussion about how our lives and lifestyles have changed over the past couple centuries. It seems the healthiest people on the planet are the graduates of the toughest military specialty training programs. And the common denominator for those training programs seems to be a great deal of marching with heavy packs. “Rucking” as it is now abbreviated.

    I recommend listening to the whole thing.

    Ok.

    But on the other hand, you’d have to be pretty healthy to be accepted at such a program. I wonder if they just took the healthiest kids they could find and then had them play video games for 20 years, I wonder if they would live a long time too?

    Studies like this are impossible to interpret. Too many variables.

    Oh, I know.  Selection bias.  But some non-military are taking up rucking for exercise with good results.  Think light cardio plus strength training in one.

    • #17
  18. navyjag Coolidge
    navyjag
    @navyjag

    Good news Doc. Just got the new treadmill so can do something useful besides walk the dog 4 times a day. Just need to figure out how to put it together and carry down some stairs. Maybe the sons can do it. Then just need the formula for how many miles I have to walk to get another glass of port. 

    • #18
  19. sawatdeeka Member
    sawatdeeka
    @sawatdeeka

    Phil Turmel (View Comment):

    Dr. Bastiat (View Comment):

    Phil Turmel (View Comment):

    I was listening to the latest EconTalk Podcast the other day. The subject was Michael Easter’s The Comfort Crisis. Fascinating discussion about how our lives and lifestyles have changed over the past couple centuries. It seems the healthiest people on the planet are the graduates of the toughest military specialty training programs. And the common denominator for those training programs seems to be a great deal of marching with heavy packs. “Rucking” as it is now abbreviated.

    I recommend listening to the whole thing.

    Ok.

    But on the other hand, you’d have to be pretty healthy to be accepted at such a program. I wonder if they just took the healthiest kids they could find and then had them play video games for 20 years, I wonder if they would live a long time too?

    Studies like this are impossible to interpret. Too many variables.

    Oh, I know. Selection bias. But some non-military are taking up rucking for exercise with good results. Think light cardio plus strength training in one.

    Sounds like it would make my back hurt(?) 

    • #19
  20. Django Member
    Django
    @Django

    As far as I’m concerned, being “in shape” has nothing to do with living longer. It is mostly about quality of life. Being strong enough to move your furniture without straining something. Being in good enough cardio-vascular condition to walk up a long flight of stairs without being out of breath. And so on. Bodyweight exercises, The Big Six: 1) Squats, 2) Pull-ups, 3) Pushups, 4) handstand pushups, 5) leg raises or sit-ups, 6) back bridges. Add a weight-bearing exercise like a properly-performed deadlift. Take it slow and work within your limits so you don’t hurt yourself. And wear your seatbelts. 

    • #20
  21. Miffed White Male Member
    Miffed White Male
    @MiffedWhiteMale

    sawatdeeka (View Comment):

    Dr. Bastiat: e himself to his health. I tell him that’s a great idea. He says he’s going to buy a bicycle. I tell him that’s a bad idea. I tell him that bicycles make you healthier but they don’t make you live longer.

    That’s why I just walk for exercise. Not many downsides, except bear attacks if you’re at the wrong place at the wrong time.

    Or getting hit by a bicyclist.

    • #21
  22. The Cynthonian Member
    The Cynthonian
    @TheCynthonian

    Phil Turmel (View Comment):

    Dr. Bastiat (View Comment):

    Phil Turmel (View Comment):

    I was listening to the latest EconTalk Podcast the other day. The subject was Michael Easter’s The Comfort Crisis. Fascinating discussion about how our lives and lifestyles have changed over the past couple centuries. It seems the healthiest people on the planet are the graduates of the toughest military specialty training programs. And the common denominator for those training programs seems to be a great deal of marching with heavy packs. “Rucking” as it is now abbreviated.

    I recommend listening to the whole thing.

    Ok.

    But on the other hand, you’d have to be pretty healthy to be accepted at such a program. I wonder if they just took the healthiest kids they could find and then had them play video games for 20 years, I wonder if they would live a long time too?

    Studies like this are impossible to interpret. Too many variables.

    Oh, I know. Selection bias. But some non-military are taking up rucking for exercise with good results. Think light cardio plus strength training in one.

    Wouldn’t the heavy packs eventually result in back/shoulder problems?    My late father’s back problems were blamed on years of wearing a heavy parachute in the USAF.

    • #22
  23. sawatdeeka Member
    sawatdeeka
    @sawatdeeka

    Django (View Comment):

    As far as I’m concerned, being “in shape” has nothing to do with living longer. It is mostly about quality of life. Being strong enough to move your furniture without straining something. Being in good enough cardio-vascular condition to walk up a long flight of stairs without being out of breath. And so on. Bodyweight exercises, The Big Six: 1) Squats, 2) Pull-ups, 3) Pushups, 4) handstand pushups, 5) leg raises or sit-ups, 6) back bridges. Add a weight-bearing exercise like a properly-performed deadlift. Take it slow and work within your limits so you don’t hurt yourself. And wear your seatbelts.

    These would injure me for sure, even if I eased in. I’m not sure what all the factors are, but it seems like a physically demanding week at work (chores, lifting child(ren)) leaves me with muscle and joint fatigue. I embrace the opportunities to be physically active, and I walk every day. I’m no longer at the computer constantly, but up and down all afternoon with one of my jobs. Not sure whether it’s weak muscles (all weights are replaced with long walks during the summer) or something else.  I’m moderately active, and my body behaves as if I’m recovering from a gymnastics meet.

    • #23
  24. Mark Alexander Coolidge
    Mark Alexander
    @MarkAlexander

    Tip #1: Live in a completely non-totalitarian-influenced country.

    Tip #2: Keep your mind full and your bowels empty.

    • #24
  25. EJHill Podcaster
    EJHill
    @EJHill

    I’m thinking of going on the George Burns plan. Work two hours a day, take a nap, have a cigar and some martinis and send for my piano player. Sit down, Doc, I’ll sing you 14 or 15 numbers.

    At this point my Gracie is still with me so dating younger women wouldn’t have the health benefits it did for Burns.

    • #25
  26. Flicker Coolidge
    Flicker
    @Flicker

    Mark Alexander (View Comment):

    Tip #1: Live in a completely non-totalitarian-influenced country.

    Tip #2: Keep your mind full and your bowels empty.

    You mean, Stay hungry, my friend?

    • #26
  27. Django Member
    Django
    @Django

    sawatdeeka (View Comment):

    Django (View Comment):

    As far as I’m concerned, being “in shape” has nothing to do with living longer. It is mostly about quality of life. Being strong enough to move your furniture without straining something. Being in good enough cardio-vascular condition to walk up a long flight of stairs without being out of breath. And so on. Bodyweight exercises, The Big Six: 1) Squats, 2) Pull-ups, 3) Pushups, 4) handstand pushups, 5) leg raises or sit-ups, 6) back bridges. Add a weight-bearing exercise like a properly-performed deadlift. Take it slow and work within your limits so you don’t hurt yourself. And wear your seatbelts.

    These would injure me for sure, even if I eased in. I’m not sure what all the factors are, but it seems like a physically demanding week at work (chores, lifting child(ren)) leaves me with muscle and joint fatigue. I embrace the opportunities to be physically active, and I walk every day. I’m no longer at the computer constantly, but up and down all afternoon with one of my jobs. Not sure whether it’s weak muscles (all weights are replaced with long walks during the summer) or something else. I’m moderately active, and my body behaves as if I’m recovering from a gymnastics meet.

    Over at Dragon Door there is a book on “bodyweight conditioning”. It shows 10 levels and the progressions to advanced calisthenics. The first level is one that anyone can do unless there is some medical condition. The point is just to get the joints, ligaments, muscles used to the movement. Only a fool, and I plead guilty, would start at level 5. Yes, I could do them, but not in good form, so I dropped back and began again. I never made it to 10 in any of the movements and never will at my age, but it was worth it to get to level six on all and level 8 on a couple. 

    • #27
  28. Some Call Me ...Tim Coolidge
    Some Call Me ...Tim
    @SomeCallMeTim

    sawatdeeka (View Comment):

    Phil Turmel (View Comment):

    Dr. Bastiat (View Comment):

    Phil Turmel (View Comment):

    I was listening to the latest EconTalk Podcast the other day. The subject was Michael Easter’s The Comfort Crisis. Fascinating discussion about how our lives and lifestyles have changed over the past couple centuries. It seems the healthiest people on the planet are the graduates of the toughest military specialty training programs. And the common denominator for those training programs seems to be a great deal of marching with heavy packs. “Rucking” as it is now abbreviated.

    I recommend listening to the whole thing.

    Ok.

    But on the other hand, you’d have to be pretty healthy to be accepted at such a program. I wonder if they just took the healthiest kids they could find and then had them play video games for 20 years, I wonder if they would live a long time too?

    Studies like this are impossible to interpret. Too many variables.

    Oh, I know. Selection bias. But some non-military are taking up rucking for exercise with good results. Think light cardio plus strength training in one.

    Sounds like it would make my back hurt(?)

    Hiking is, IMHO, the best exercise for an infantryman.  If you can hike 15-20 miles in in 5-6 hours with a full combat load and STILL transition effectively into the attack, you are in good shape.

    The problem is that soldiers and Marines are routinely overloaded with gear, sometimes over 50-60% of their body weight.  That’s bad for your knees, back, etc.  The Mountain Warfare Training Center had a course in which they taught you how to use/pack/care for mules.  The cardinal rule for packing a mule was no more than 30% of the mule’s weight, otherwise he’d go lame. We routinely violated that rule for Marines.  But it’s an old problem.  S.L.A. Marshall wrote about it in 1950 in The Soldier’s and the Mobility of a Nation.

    • #28
  29. navyjag Coolidge
    navyjag
    @navyjag

    Some Call Me …Tim (View Comment):

    sawatdeeka (View Comment):

    Phil Turmel (View Comment):

    Dr. Bastiat (View Comment):

    Phil Turmel (View Comment):

    I was listening to the latest EconTalk Podcast the other day. The subject was Michael Easter’s The Comfort Crisis. Fascinating discussion about how our lives and lifestyles have changed over the past couple centuries. It seems the healthiest people on the planet are the graduates of the toughest military specialty training programs. And the common denominator for those training programs seems to be a great deal of marching with heavy packs. “Rucking” as it is now abbreviated.

    I recommend listening to the whole thing.

    Ok.

    But on the other hand, you’d have to be pretty healthy to be accepted at such a program. I wonder if they just took the healthiest kids they could find and then had them play video games for 20 years, I wonder if they would live a long time too?

    Studies like this are impossible to interpret. Too many variables.

    Oh, I know. Selection bias. But some non-military are taking up rucking for exercise with good results. Think light cardio plus strength training in one.

    Sounds like it would make my back hurt(?)

    Hiking is, IMHO, the best exercise for an infantryman. If you can hike 15-20 miles in in 5-6 hours with a full combat load and STILL transition effectively into the attack, you are in good shape.

    The problem is that soldiers and Marines are routinely overloaded with gear, sometimes over 50-60% of their body weight. That’s bad for your knees, back, etc. The Mountain Warfare Training Center had a course in which they taught you how to use/pack/care for mules. The cardinal rule for packing a mule was no more than 30% of the mule’s weight, otherwise he’d go lame. We routinely violated that rule for Marines. But it’s an old problem. S.L.A. Marshall wrote about it in 1950 in The Soldier’s and the Mobility of a Nation.

    Thank God for my Navy service.

    • #29
  30. Dr. Bastiat Member
    Dr. Bastiat
    @drbastiat

    Some Call Me …Tim (View Comment):
    The problem is that soldiers and Marines are routinely overloaded with gear, sometimes over 50-60% of their body weight.  That’s bad for your knees, back, etc.  The Mountain Warfare Training Center had a course in which they taught you how to use/pack/care for mules.  The cardinal rule for packing a mule was no more than 30% of the mule’s weight, otherwise he’d go lame. We routinely violated that rule for Marines.

    Marines are better pack animals than mules, because they’re more stubborn.

    • #30