I was watching tv the other night and an ad came on for a nutritional supplement for brain health. Supposed to improve the functioning of your brain and help you remember better and cognitively function at a higher level. You know that’s just bullshit, don’t you? So is the supplement that is supposed to prevent you from getting a cold when you get on an airplane. So, if you’ve ever turned to someone in the room and asked , “I wonder if that works” I’m here with your answer, “No, it doesn’t.”

We now have an extremely active, anti-vax, conspiracy theorist with a worm in his brain as the Secretary of HHS and are about to suffer a 39 year old woman who quit her medical residency to sell supplements as the US Surgeon General. Add to those 2 winners, Dr. Oz, a tv physician whose show was bankrolled by suspicious supplements and quack cures, as the head of the Center for Medicare and Medicaid Services. In short, things are about to get much weirder and much worse. Even worse than the shocking $45 billion that Americans spend on these mostly useless tablets, powders, and liquids every year.

I thought it is probably the right time to get back to basics and maybe review the main determinants of health, how they impact us, and how we can influence these factors to improve our health. Barring a major, catastrophic event, your health status is pretty much determined by three factors.

Heredity

Genetics is the primary driver of your health at every age, from birth to death. The more we learn about our genes, the more we realize how important they are in every aspect of who we are and how we function. These are the cards you are dealt when the game first begins.

In a way, this heredity stuff is kind of great. I mean you might as well find a silver lining here because you can’t change your genes. Since you don’t control the genes you receive, you don’t get the blame for anything that happens. Better yet, all of the blame goes to your parents. Heredity is about the same as therapy, but without the $200 per hour bill: you good; parents bad. I can’t even count the number of times that my siblings and I have blamed my mother for this weird immune system with which we’ve been saddled.

On the personal front, I was sailing along in my 64th year, the envy of everyone (I think. I’m sure I was) with my robust health when my thyroid ceased to function and the wheels came off. Try as I might, I’ve never gotten back to the level of physical functioning that I had prior to my hypothyroidism. Purely genetic impact on my health. I’ve blamed my parents ever since. I think that’s a healthy response for an older adult.

Habits

The way you live directly affects your health every day of your life, although the health impacts of your lifestyle increase as you age. So, this is the area that you can control. Your habits are how you can improve your physical, mental, and emotional well being, both short-term and long-term. Extending our card game analogy, this is how you play those cards that you’ve been dealt. When contemplating your habits, though, there is one characteristic of habits that must be considered. Habits are not easy to alter. They can, in fact, be changed and those changed habits can improve your life, but the deck is stacked against you in when trying to permanently change long-held habits.

I have a friend who, every night when he sat down to watch tv, would eat a bowl of ice cream. Every night for decades. The electric impulse produced by his sitting down to watch tv would travel in his brain on the neurologic pathway of least resistance (that is the habit) to arrive at the part of his brain that told him that he desired ice cream. So, he would go get ice cream. Every single night until he found himself on a helicopter, with a massive heart attack, having paddles on his chest as they life flighted him to the hospital. He is fine, but he lost his taste for ice cream. The habit was broken, but that is probably further than most of us are willing to go to change an unhealthy habit.

Much of the health messaging, both public and individual, over the last 10 years or so has been aimed at encouraging people to begin to develop healthy habits. Stopping smoking, buckling your seatbelt, don’t drive drunk, walking 10,000 steps per day, and many others have all been focused on reducing risks and improving our lifestyles. Habits are ingrained, so they’re tough to change, but it can be done. We all know people who have jettisoned some bad behavior and decreased their risk for a tragic outcome.

Social Access

What do I mean by social access when I am discussing individual and public health? Frequently, this field is called social determinants of health, but I’ve found that term sometimes turns people off. I prefer to consider these wide-ranging, incredibly important factors under the rubric of access. In short, how available are these support systems to me as an individual or, from a broader perspective, to different strata of society? To close the card game analogy, this area represents how the game is run by the house.

What am I really talking about here? I mean access to regular, quality, cost free health care. I mean access to healthy foods (urban and rural food deserts are all too real). I mean access to support networks for improved chronic disease care and for improved mental health. I mean access to fact-based, accurate, understandable health information. I mean access to clean air and water and safe neighborhoods. I mean access to all of the benefits that upper middle and upper class segments of society take for granted. In simple terms, the opportunity to live a healthy life for everyone, regardless of individual income or social strata.

Although considered separately here, these 3 pillars of our health should not be viewed as silos, existing in and of themselves. Your genetic code, daily habits, and social access are constantly interacting with and influencing each other. As an example, high cholesterol is a known risk factor for cardiovascular disease. Clearly, many of your day to day activities and habits (exercise and diet primarily) directly impact your cholesterol levels, but so can your genes. Many active people who follow ideal diets still have cholesterol levels in the mid 200’s because of inherited traits. To identify these elevated levels and control serum cholesterol requires access to regular medical care, effective therapy regimens, and lifetime monitoring. The same amalgam of these factors can be seen in the development, diagnosis, treatment, and control of Type I and Type II diabetes, hypothyroidism, Afib, bipolar disorder, cancer, and a host of other chronic diseases and mental illnesses.

Given everything that we’ve discussed, what should you do to achieve your best health? As best you can, know what your genes may have in store for you and take steps to prepare for those risks. My father, my uncles, and my brother all had prostate cancer, so I’ve been tested and examined every year since I was 49. I can’t change my genes, but I can use the information for my benefit. Look at your habits and try to reduce your risks. Don’t try to make too many changes at once or to make radical changes. You probably don’t need to do that much anyway, but take inventory and see what you might improve. It’s your life, after all. And finally, pay attention to what is happening around you and in Washington. The all important access that I mentioned may be severely curtailed for all of us, not just the poor.

Oh, and don’t spend your time, energy, and money on all of those supplements unless recommended by your personal physician, who I hope is not named Oz. Although I do wonder if I might have written this essay better and faster with that brain supplement.

Post It Notes

I love to listen to music and I love to read. When I look back at all the words by great artists that I have processed through my mind, some just stand out more than others. This is one of my favorites. I know of nothing I have ever read or heard that speaks more to me or what I value than these words.

the beauty of the days gone by

it brings a longing to my soul

to contemplate my own true self

and keep me young as I grow old

Van Morrison