Breakthroughs in medicine are reaching a tipping point.
That's what Dr. David Agus claims in his new book, "The Lucky Years: How to Thrive in the Brave New World of Health," published by Simon & Schuster, a division of CBS. He argues cutting-edge science and technology will enable us to edit DNA to fight disease, reverse aging, prolong fertility and turn cancer into a manageable condition.
To customize your health care and help prevent illness, Dr. Agus, who leads the USC Norris Westside Cancer Center in California, stresses the importance of knowing your "context" and optimizing personal information to take full advantage of the latest science and technology behind medicine.
In this condensed excerpt from his book, Dr. Agus challenges readers to consider the top 10 factors that will help identify your personal context and inform your health decisions.
Here's what you'll need:
Factor 1: Chronological Age
The decade you are in today automatically provides a lot of context. A person in her thirties, for example, will have a different set of health issues and concerns than someone in her sixties.
Chronic disease doesn't happen spontaneously when you're older. It's the accumulation of insults to the body over time, coupled with underlying genes, that often result in illness later in life. The problem is that it's very difficult to think about the health challenges of aging when you're young or enjoying great health. But planning for optimal health is just as important as planning for future financial needs.
Whatever decade of life you're in, I encourage you to check your blood pressure twice daily over the next two weeks. See if you can find a pattern to it.
Does it go up after lunch and down after exercise? Check it at different times throughout the fourteen days, and note what's going on during those times ("just woke up" or "just had an argument with my teenage son"). This experiment will help you identify your blood pressure range, so months or even years from now you can tell if that range has shifted -- for better or worse.
Factor 2: Heritage and Family History
Do you know what killed your great-grandparents on both sides of the family? Or what kind of cancer your uncle Elroy had when he was forty?
Family history is one of the most underused but extremely powerful tools to understanding your health. And it may be the best tool to predict genetic cancer risks.
The U.S. Surgeon General operates a free website that will help you to create a family health history, learn about your risk for conditions that can run in families, and share it electronically with relatives and your doctor. Be sure to include as much information from both sides of the family as possible, and record any environmental or lifestyle factors that could have contributed to a family member's untimely death. Who smoked? Who was overweight? Who was hospitalized or treated for mental illness?
The answers to these questions can be enlightening on many levels and can lead to better personal care. Once you exhaust the limits of this kind of rough detective work, you may want to consider taking it to the next level and undergo genetic screening. But remember that DNA tests aren't as much of an oracle into your future risks and health as you might think, and they are not for everyone.
Factor 3: Daily Patterns and Habits
One of the most important things to know about your body is that it loves rhythms, patterns, and predictability. There is a reason we tend to get tired at the same time each day, to wake up within the same fifteen minutes each morning, to crave coffee at the same time, and to feel hunger for dinner at about the same time every day. Maintaining such routines reduces stress on the body and keeps its preferred, balanced state of being -- a state in medicine we call homeostasis. Another way of understanding homeostasis is to consider the human body's average temperature of 98.6 degrees Fahrenheit.
When it shoots up, it's a sign that something is wrong or out of balance inside, perhaps set off by an infection. The body then goes to work on remedying the problem to bring down the temperature back to normal. It does this all day long based on what you encounter and how you treat your body to either support its natural balance or challenge it.
The three chief areas where you can make great strides in honoring your body's homeostasis are your eating times, sleep-wake cycles, and periods of physical activity. If you take medications, scheduling that to occur at the same time daily is also important. Over the next fourteen days, keep track of these daily routines. I don't expect every single day to be identical to the next, but see if you can create a consistent pattern that's more or less the same on a daily basis.
- Wake up / go to bed: 6:30 a.m. / 10:30 p.m.
- Exercise: 7:00 a.m.
- Eating: 8:00 a.m.; 11:00 a.m. (snack); 1:00; 4:00 (snack); 7 p.m.
- Note: 11:00 snack unusual (office birthday party)
- Wake up / go to bed: 6:30 a.m. / 11:00 p.m.
- Exercise: none
- Eating: 7:30 a.m.; 12:00; 3:00 (snack); 7 p.m.
- Note: didn't feel as good in the afternoon; took Tylenol for headache
The goal is to record the most prominent activities in your daily life that repeat on a 24- to 48-hour cycle, which for most are at least these three items. Note any nuances or deviations.
Factor 4: Weight and Dietary Preferences
Do you have a plant-based diet? Or would you call yourself a bona fide carnivore? Is your weight in an ideal place today, or could you lose a few pounds, perhaps twenty? How many times have you tried to lose weight permanently via a popular diet protocol? Do you even know what you weigh and if it's within a healthy range for your height?
It should come as no surprise that carrying excess weight can sabotage the body's optimal functionality, especially in the absence of cardiorespiratory fitness. Being overweight increases your risk for most illnesses and chronic conditions, from the obvious ones such as heart disease and diabetes, to dementia and cancer.
If you don't know how much you weigh, get yourself on a scale to find out your poundage and then plug that number into an online body mass index calculator, which is a general measure of body fat based on height and weight. The National Heart, Lung, and Blood Institute has an easy-to-use calculator.
There is no such thing as the "best diet." The best one is the one that works for your physiology. And even though we have studies to show that, for example, a Mediterranean diet can reduce the risk of various diseases and decrease mortality, by no means is it the only diet. Also keep in mind that there's no such thing as the Mediterranean diet. It just has some universal features: plenty of whole fruits, vegetables, whole grains, legumes, nuts, and seeds; fat from healthy sources like olive oil; a little bit of dairy, fish, poultry, and eggs; a smaller bit of red meat; and maybe a glass of wine with dinner. How can you argue with that?
Over the next fourteen days, aim to record your eating habits. Try to be as precise as possible, recording amounts, quality, and types of, say, fat and protein. Distinguish between a meal from McDonald's and a homemade burger with grass-fed beef, or a green salad with olive oil versus a Cobb salad with commercially made ranch dressing. Include beverages, from water, juice, and milk, to wine, liquor, and beer.
Which foods make you feel good within the hours afterward and the next day? Which choices render you sluggish, achy, or moody?
Remember, there's a connection between the food you eat and how you feel. By keeping a food diary, you can quickly see how your choices are impacting you and where you can make adjustments. The goal is to see where your diet may be lacking or overly abundant. Don't worry about trying to count calories or grams of nutrients. I trust you'll be able to see easily where your diet could be improved using common sense. This exercise also might help you pinpoint foods that make you feel especially good or bad. Make any additional notes as you see fit.
Factor 5: Medications and Management of Conditions
How many pills do you take a day, prescription or otherwise? Do you know exactly what each drug is for and why you take it? Do you manage a chronic condition through these drugs alone? Do you know if there are additional ways to manage your condition aside from drugs?
One of my favorite quotes by Sir William Osler is "The person who takes medicine must recover twice, once from the disease and once from the medicine."
Don't get me wrong: drugs -- prescription and nonprescription -- do have their place in medicine and health. But it's true that far too many people rely on them for the wrong reasons.
In 2013, a study from Mayo Clinic researchers revealed the depth of our drug dependency: 7 out of 10 Americans take at least one prescription drug; more than half of Americans take two prescription medications, and 20 percent of Americans are on at least five prescription medications.
Although we'd like to think these drugs are prescribed for the most common chronic conditions--heart disease and diabetes--it turns out that antibiotics are the most prescribed drugs; they are taken by 17 percent of Americans, followed by antidepressants and opioids, each taken by 13 percent of Americans. Clearly, this goes to show how mental health is a huge issue that we should focus on.
Prescriptions for antidepressants are more common among women than among men, especially among women ages fifty to sixty-four, nearly 25 percent of which take these drugs.
So here's your challenge: take inventory of your medications and the conditions for which they are prescribed. Also include the over-the-counter drugs, vitamins, and supplements you take and why you take them. You may find that you can't fully answer the why part. And you may feel inspired to taper off certain medications and supplements or find alternative ways to manage your condition that are better for you and your body.
Don't underestimate those over-the-counter medications, many of which were once prescriptions. I'm glad to see the FDA strengthening the warning labels on popular OTC pain relievers. These commonly used drugs are not risk-free; they increase the risk of heart-related problems with regular use and can do so within a matter of weeks.
Factor 6: Unexplained Symptoms
Over the two-week challenge, make sure to record any unexplained symptoms you have that are out of the ordinary. They can be any number of things: feelings of nausea or stomach upset, a night sweat, an achy back or sore joint, an intense thirst, or the urge to nap on a Tuesday afternoon when you never nap. These symptoms are probably absolutely nothing to worry about, but they can nonetheless clue you in to signs that make up part of your context.
Factor 7: Sleep Needs
How many hours of sleep a night do you typically get? Is this enough? Do you ever suffer from insomnia or rely on sleep aids?
Although we used to think for a long time that a typical adult needs between seven and nine hours of sleep a night, newer research is showing that the magic number for most might be closer to seven, which is associated with the lowest mortality and morbidity.
Every system in the body is affected by the quality and amount of sleep you get per night. In fact, sleep directs so much of your body's physiological rhythms that you
can't reboot yourself artificially with any substance or technology. You need a regular, reliable pattern of wakefulness and rejuvenating sleep to refresh your cells and tissues, to support your hardworking immune system, and to regulate your hormones.
Which is why the proven benefits are plentiful: sleep can dictate how much you eat, how fat you get, whether you can fight off infections, how creative and insightful you can be, how well you can cope with stress, how fast you can process information, and how well you can store memories. The side effects of poor sleep habits are equally plentiful: hypertension, confusion, memory loss, chronic colds, the inability to learn new things, obesity, cardiovascular disease, and depression. So much of the body's natural rhythm that governs your health revolves around your sleep habits.
When people complain of feeling tired and blue, I often start by asking them about their sleep schedule. It's the easiest way to regulate your body and feel a positive difference in a short time.
You should be able to figure out your optimal amount of sleep in a matter of days. Don't use an alarm clock. Go to sleep when you get tired. Stay off electronic devices as much as possible beforehand (and definitely keep them out of the room). If you do enjoy watching TV or videos on a device with a screen, as for some this can be relaxing prior to bedtime, get a pair of glasses that has a lens to block the brain-activating wavelengths of light. These blue-light blocking glasses are the cost of a large pizza. I put mine on when I have a chance to watch late-night comedy or the news before going to sleep.
Track your sleep with a diary or a device that records your actual sleep time (lots of apps will help you track your sleep and circadian rhythm). If you feel refreshed and awake during the day, you've probably found your optimal sleep time.
Over these two weeks, in addition to finding your sleep number, document your sleep experience. Is it sound? Do you dream? If you do rely on sleep aids, be they over-the-counter drugs or prescription, can you make it a goal to wean yourself off of them? (Note that discontinuing some sleep aids may require the help of a doctor.)
Factor 8: Movement Matters
You already know that exercise does a body good. A daily brisk twenty-minute walk, for example, can reduce your risk of dying prematurely by a whopping 30 percent. Some studies say that a twenty five-minute stroll can add seven years to life.
How fast older people walk, in fact, is one of the most useful markers for determining future health. And it's just recently been shown that being sedentary may be twice as deadly as being obese.
How much do you move each day? How many consecutive hours do you sit? How many minutes do you get your heart rate up 50 percent above your resting baseline?
Answer these questions over the next two weeks as you record your physical activity habits. You can track your activities using apps on your smartphone or a wearable fitness tracker (accelerometer), but this is optional. You can do just as well being tuned in to your activities and writing them down. Again, no need to try and calculate calories burned. Just write down how many minutes you were engaged in a physical activity and its intensity. Be as honest as possible. As with underestimating how much we eat, we also tend to underestimate our sedentary times while inflating our level of physical activity, and men are more likely than women to exaggerate.
Factor 9: Mood and Motivation
One of the most powerful questions a doctor can ask a patient is simply, "How do you feel?" Which can be a surprisingly difficult question to address personally. I wonder, if people were more attuned to their changing moods, behavioral triggers, and other aspects of their daily lives, would so many people be taking powerful mind-altering medications to regulate their moods?
Not only does tracking your mood help you better understand why symptoms occur when they do, but the information can also reveal whether drugs or therapy that you may be using are actually working.
Mood monitoring can also help you find useful correlations, such as being predictably moody while talking to certain people or during the first half of the work week when your blood pressure tends to run high, too.
Plenty of online mood trackers and apps are available today, but again, you can do this the old-fashioned way just by using your intuition about how you feel and making note of that. Track your mood throughout the day or during the same times you're testing your blood pressure.
Factor 10: Energy Levels
How is your energy level today on a scale of 1 to 5 (5 being the highest)? Do you feel full of life and ready to tackle any challenge (5)? Could you barely get out of bed (1)? Or are you somewhere in between?
A confluence of factors determine your energy level: how well you slept the night before, what you've been eating, how stressed you are, whether you're exercising too much or too little, and health conditions.
While tracking energy levels is a little more amorphous than, say, logging your sleep time, see if you can find a pattern to your energy levels over these next two weeks. All of these details fill in the blanks for your context and help you to make sense of your behaviors, and whether or not you want to change them.
Putting It All Together
Although this two-week challenge is not meant to be a scientific experiment, it can nonetheless uncover lots of things about you that you might not have known before or that you've simply ignored. All of this data will help you establish a new baseline for your health today, one that you can compare with future "checkpoints" during which you tune in to yourself and take stock of where you are in your overall health equation.