We all would like to improve on the quality and quantity of our lives. In order to make choices that will increase our chances of living longer and better we need to be well informed. An understanding of the more common causes of death and some of the factors involved helps us make better health choices by taking charge of what we can control and letting go of what is beyond our control. 

We now live far longer than our predecessors. As a citizen of Rome you would have been lucky to live to the ripe old age of thirty. As a U.S. citizen around 1900 you could expect to live about forty-five years. To this day there are many countries around the world that aren't blessed with the sanitation systems, clean drinking water, access to immunizations and adequate food that we take for granted. In many of these countries fifty years is still a long life while in North America you can expect on average to live to seventy-two if you're a man or seventy-nine if you're a woman. 

In North America we have all kinds of technologic wonders to prolong life and there are few places in the world where people live longer. But we do die and we die of very different causes than they do in third world countries. Our predecessors and our less fortunate neighbors around the world die predominantly of infectious diseases that are largely preventable through improved sanitation, basic nutrition and immunizations. We, on the other hand, die of the so-called "diseases of affluence" caused by our out of balance lifestyles. In North America the number one cause of death, by far, is heart disease. The number two cause of death is cancer. The number three cause of death is strokes. The fourth leading cause of death, surprisingly, is side effects of medications according to a study published in JAMA (4-15-98). The fifth leading cause of death is chronic lung disease. Numbers six through ten are accidents, pneumonia/influenza, diabetes, suicide and liver disease. If we were to summarize, our top three causes of death are heavily influenced by lifestyle. The fourth leading cause of death is a function of how we treat illness. This is a prime example of the cure being worse than the disease in over 100,000 people per year in the USA alone. Lifestyle or risky behavior plays a significant role in four out of the next six causes of death. 

Another way of looking at these statistics is to ask what are the top ten causes of life? Aside from the basic sanitation, clean water, immunizations and adequate food that most of us have access to in North America what are the causes or factors that allow some people to live longer and better than others? Some are factors that we have no control over - like genetics. We can't choose our parents. If you have good genes you might live to ninety-nine, like the late comedian George Burns, even though you smoke and drink, eat junk food and don't exercise. If you have bad genes you could die at fifty two, like the late Jim Fixx, even though you are vegetarian, run marathons and don't smoke or drink. For the rest of us - those not at one extreme of the gene pool or the other - how we live can make a huge difference in how and when we die. For that group, the genetic majority who live in North America where sanitation, clean water, immunizations and food are a given, letÕs look at the top ten things you can do to live longer and better: 
 

*	education
*	use good fuel
*	exercise regularly
*	avoid risky behavior
*	cultivate relationships
*	use preventive supplementation
*	health screening and early intervention
*	use less aggressive interventions preferentially,
*	in an emergency "do not pass go, do not collect $200," GET HELP
*	reduce stress.

Education 
Demographic studies consistently show that lower levels of education correlate with more health problems. Some would argue that this is because lower levels of education result in being economically disadvantaged and in having less access to health care. While this may be partly true it is also true that there is more risky behavior and less preventive measures are taken in groups with lower levels of education. In other words being well informed (educated) increases your chances of making good health choices and the opposite is true of those who aren't well informed. So it is to your advantage to be well educated and to seek out information which impacts your health. The mere fact that you are reading this increases your chances of living a longer, healthier life!
 

Use Good Fuel 
The typical North American diet, which is high in fat, sugar, protein, and salt, is associated with a higher incidence of obesity, heart disease, cancer (breast, colon, ovarian, and prostate) diabetes, hypertension, strokes, kidney disease and osteoporosis. Countless studies have noted the health benefits of a diet low in fat, and high in fruits, vegetables and whole grains. This type of diet is high in nutrients and fiber, with fewer animal products and less empty calories. 

Several studies have looked at the incidence of health problems in Seventh-Day Adventists because their diet differs, as a group, from the typical North American diet. Perhaps one half of Seventh-Day Adventists are vegetarian with a majority of those being lacto-ovo vegetarians (consuming eggs and dairy products but not meat) and a smaller number being vegans (total vegetarians consuming no animal products). The statistics show that SDA men live, on average, 8.9 years longer than the typical North American male, while SDA women live, on average, 7.5 years longer than the typical North American female. Vegetarian Seventh-Day Adventists have a lower incidence of osteoporosis compared to the general population. This is probably because the excessive protein intake associated with a high-meat diet causes increased excretion of calcium in the urine. The incidence of breast, pancreatic, prostate and ovarian cancer is lower in Seventh-Day Adventists than in the general population with one half the risk of colon or rectal cancer in vegetarian SDAs. Non-vegetarian SDA men have 44% fewer deaths associated with heart disease, while lacto-ovo vegetarian SDA men have 61% fewer deaths and vegan SDA men have 88% fewer deaths from heart disease compared to the typical North American male. When you remember that heart disease is overwhelmingly the leading cause of death in North America it is amazing to realize that you can reduce your risk of heart disease to one eighth that of the general population with simple dietary and lifestyle measures. 

Now don't think that a vegetarian diet is, by itself, the answer to all of the health problems facing our society. It is possible to be a junk food vegetarian getting by on potato chips and candy. Even though there are no animal products in a potato chip and candy diet there is a lot of fat, sugar, salt and empty calories with few nutrients. A well balanced diet is rich in nutrients (such as anti-oxidants) and fiber without excessive fat, refined sugar, salt and protein. Salt, which is usually thought of as contributing to hypertension, probably contributes as much or more to osteoporosis since excessive salt intake results in calcium wasting in the urine much as does excessive protein. Fiber, which is usually credited with reducing the risk of colon cancer (despite recent studies to the contrary) by speeding up transit time and thereby reducing the amount of time carcinogens are in contact with the bowel, also results in the production of butyric acid by bacteria in the colon. Butyric acid has been shown to inhibit the growth of cancer cells. Fat, on the other hand, slows down transit time and thereby increases the amount of time carcinogens are in contact with the bowel. Also fats tend to increase the production of inflammatory and carcinogenic substances in the body - particularly if the fats are damaged by heat. Oils that appear to have health promoting properties are olive oil (which is resistant to heat damage) and the omega-3 fatty acids present in fish oil and flax seeds. The omega-3 fatty acids have been shown to reduce the risk of both heart disease and autoimmune disease.

A particularly bad type of fat is the hydrogenated oil you find in most processed foods. While hydrogenated oils are convenient for the food industry (because they don't go rancid as quickly and thus have a longer shelf life), several studies have implicated them as a risk factor for both heart disease and cancer. One European study was particularly interesting. They measured the percentage of hydrogenated oil present in fat biopsies of European women and found a linear correlation with breast cancer - the more hydrogenated oil was present in their fat, the higher the risk of breast cancer. That's not to say that hydrogenated oils are THE cause of breast cancer but they certainly appear to be one of many contributing factors in a society that relies more and more on processed and fast foods. With breast cancer now affecting one in eight North American women during their lifetimes it is advisable to avoid processed foods containing hydrogenated oils. Prostate cancer has many of the same risk factors as does breast cancer. Even though no research has yet linked hydrogenated oils to increased risk of prostate cancer because of the similarity in these two cancers it would be prudent for men to also avoid processed foods containing hydrogenated oils.

Aside from the problem of hydrogenated oils or other potentially harmful substances added to processed foods (such as sulfites, nitrites and others that are too difficult for most of us to pronounce) we know that many beneficial nutrients are destroyed or stripped from the foods during processing. A classic example is the production of processed grain products such as white bread, white rice and pasta. The fiber and many nutrients (such as vitamins and minerals) are, for the most part, stripped out of these foods and you are simply left with starchy complex carbohydrates. Many of these products tout that they are "fortified" or "enriched" which simply means the food manufacturer chose to put back in a fraction of the nutrients removed from the food to make it appear more nutritious. If you eat Wonder Bread you should really wonder where the nutrients went! In general it is preferable to eat whole grain products and to eat foods that are less processed and closer to their natural state. For this same reason it is better to eat fruit than to consume processed fruit products or fruit juice. 

The best way to consume fluids is in the form of water. Most of us don't drink enough water. A good rule of thumb to figure out how much water to consume is to divide your ideal body weight (in pounds) by two. That's how many ounces of water you should consume in a day. For instance a man weighing 160 pounds should shoot for 80 ounces (ten, 8 ounce glasses per day) of water daily. Obviously this would increase with exercise or a hot environment. Our body chemistry functions more effectively when we are well hydrated. To give just a few examples of the many consequences of dehydration documented by research it - places undue strain on the kidneys, makes it easier for heart attacks to occur (because the blood clots more), increases the chance of kidney stones and gout and makes you more susceptible to viral infections. Given the choice between the former problems and going to the bathroom more frequently due to increased fluid consumption the latter is the better option. 

Another somewhat more controversial issue to consider is the consumption of organic foods. Residues of hormones, antibiotics and carcinogenic pesticides can be measured in the foods purchased at your local supermarket. Organic foods do not use pesticides, hormones or antibiotics in their production. Organic foods tend to be a little more expensive but considering the widespread transmission of antibiotic resistant bacteria through foods and the negative effect of hormones and pesticides on our bodies it is probably worth spending the extra money. If you are willing to spend a few extra cents for premium fuel at the gas pump to improve the performance and longevity of your car's engine you should be all the more willing to spend a little extra to put the best food fuel in your body.

In summary, the research shows that the food we fuel our bodies with makes a huge impact on our health for better or for worse. The best fuel for our bodies is high in vegetables, fruits and whole grains and has only moderate amounts of protein with low amounts of animal products, fat, refined sugar and salt. In general these foods are best consumed in a more natural state without a lot of processing and the problems associated with that.

Exercise Regularly 
The benefits of exercise have been well documented in numerous studies. Aside from the more obvious benefits of helping maintain ideal body weight and reducing the risk of heart disease and diabetes regular exercise has been found to reduce the incidence and/or severity of Alzheimer's, anxiety, breast cancer, depression, disability from osteoarthritis, endometrial cancer, gallstones, lung disease, prostate cancer and sleep disorders. Not all of us are athletic and inclined to start running marathons. Fortunately we don't need to be because the research shows that simply walking can make a huge difference. In a study of retired men aged 61 to 81 those who walked less than one mile daily had a 43% death rate in 12 years while those who walked more than two miles per day had a 22% death rate over the same 12-year period. Simply walking more than two miles daily cut the death rate in half. The men in this study literally walked away from the grave! When you die you stop moving - so keep moving! Not only will you live longer, you will live and feel better. 

Avoid Risky Behavior 
It goes without saying that smoking or chewing tobacco is a risky behavior. Aside from being a major risk factor for lung cancer, emphysema, heart disease and circulatory disorders it also increases the risk of asthma, bladder cancer, breast cancer, oral cancers, prostate cancer and recurrent infections of the ears, lungs and sinuses. Smoking increases free radical formation in the body, increases blood clotting and paralyzes the self-cleaning mechanism of the mucus membranes in the respiratory tract. The litigation involving the tobacco industry can't begin to compensate society or individuals for the medical expenses, decreased productivity and suffering caused by tobacco consumption.

Alcohol, while promoted to some extent as a means of lowering the risk of heart disease, causes far more problems than it solves. Alcohol increases the risk of breast cancer in a linear fashion. The more alcohol you consume the greater the risk of breast cancer. The mechanism for this is that alcohol raises estrogen levels threefold in the blood by slowing down the liver metabolism and excretion of estrogen. In fact, alcohol will "cut to the front of the line" when it comes to anything that needs to be metabolized by the liver. The result is that toxic substances remain in the body longer and achieve higher concentrations when alcohol is consumed. We are living in an increasingly toxic environment and consuming anything that impairs our ability to rid the body of toxic substances doesn't make sense. The liver is a prime candidate for damage by alcohol and liver disease is in turn a risk factor for a variety of other health problems. The appalling statistics regarding alcohol and motor vehicle accidents and deaths are also worth remembering. In short the small potential benefits of alcohol on cardiovascular health are far outweighed by the potential for harm in other areas. 

Biking and rollerblading while good forms of exercise are also major causes of head trauma. Using a helmet significantly reduces the risk of serious head injuries. Similarly, using a seat belt when driving dramatically cuts back on death and injuries in auto accidents. The inconvenience of messed up hair with a helmet or wrinkled clothes with a seat belt is nothing in comparison to the potential consequences of not using them. 

Needlessly putting yourself in harms way by using tobacco or alcohol and not using a helmet or seat belt doesn't make sense. If you want to live longer avoid the former and use the latter. 

Cultivate Relationships
Having a social network is healthy. The saying, "No man is an island" makes good sense from what we are beginning to understand of how the mind-body connection affects physiology. In a study by Dr David Spiegel, breast cancer patients involved in support groups doubled their survival rate compared to women with equal tumor staging and otherwise identical medical treatment who were not in support groups. There are also studies demonstrating increased numbers and activity of immune cells in patients participating in support groups. In subjects inoculated with rhinovirus those with richer, more diverse social networks were less susceptible to infection, shed less virus and had fewer cold symptoms than those with small social networks according to a study published in JAMA in 1997. Other studies have shown that married men have lower death rates from heart disease and prostate cancer. 

Social isolation increases the risk of depression, which in turn can increase the risk of many other medical problems. Social interactions (which by their nature involve communication, sharing, acceptance, forgiveness and respect) tend to counteract or attenuate the effects of stress in the body. Stress raises cortisone and adrenaline levels and the result is lowered immunity, increased blood pressure, increased heart rate and increased blood clotting. Interacting with coworkers, family, friends and peers is good for you. It is said that if you want to have friends you need to be friendly. Do yourself a favor and be friendly! 

Use Preventive Supplementation
A wealth of research has shown that the use of antioxidants (such as Vitamins A, C & E, grape seed extract and selenium) reduces the risk of heart disease and some types of cancer. By neutralizing free radicals that damage cell DNA, cause cell mutation and accelerate atherosclerosis, antioxidants can significantly impact the top two causes of death in North America. It is important that antioxidants be taken in a balanced combination since high doses of single antioxidants taken in isolation can actually increase the risk of cell damage and cancer.

B vitamins (such as B-12, folic acid, pantothenic acid, pyridoxine, and thiamine) are important for production of energy in cells. B vitamins can reduce the risk of birth defects, heart disease (by lowering homocysteine levels), migraines and premenstrual symptoms. As with the antioxidants it is important to take a balance of B vitamins to avoid problems caused by high doses of a single B vitamin taken in isolation. 

Vitamin D, in addition to protecting against osteoporosis, reduces the risk of both breast and prostate cancer. Your skin generates plenty of vitamin D with as little as 30 minutes of exposure to sunlight per day. If regular exposure to sunlight is not practical taking a Vitamin D supplement of 400 - 800 IU daily is helpful. 

A baby aspirin (80 mg.) per day has been shown to reduce the risk of having a heart attack. While aspirin can cause stomach upset and increase the chances of gastrointestinal bleeding the likelihood of this happening with such a low dose of aspirin is minuscule and far outweighed by the potential benefits. 

There are many other supplements that might be beneficial but which are not as well researched and are probably not worth spending the money on for most people. In order to simplify your life and save yourself some money the best thing to do is to just take a high dose multivitamin that has extra amounts of antioxidants and the B -complex vitamins in a balanced blend. That and your baby aspirin may reduce your risk of heart disease and cancer with a minimum of expense and inconvenience.

Health Screening and Early Intervention
Preventive health check ups and tests screening for breast cancer, colon cancer, diabetes, glaucoma, heart disease, high cholesterol and hypertension can allow problems or potential problems to be identified at an early stage. We have interventions for all these conditions that have been proven effective when used at an early stage. Treating advanced disease is almost always less effective and associated with more side effects due to the more aggressive nature of the treatments at this later stage.

Use Less Aggressive Interventions Preferentially
The risk of gastrointestinal bleeding, kidney damage, liver damage and even death from using prescribed anti-inflammatories is well documented in the medical literature. If a patient with osteoarthritis is able to control his or her symptoms through the use of biomagnets, glucosamine sulfate, water exercises and weight loss without running the risk of using anti-inflammatories this would be far safer and also less expensive in the long run. 

If a patient with chronic, disabling back pain is able to avoid addictive medications and back surgery by using acupuncture, biofeedback, massage and physical therapy there will be a much lower risk of complications. 

If a patient is able to use echinacea, elderberry, garlic, vitamin C and zinc lozenges instead of antibiotics for a respiratory infection there will be less chance of adverse reactions and less likelihood of antibiotic resistant bacteria evolving. Our profligate use of antibiotics and the increasing prevalence of resistant organisms has led many medical authors and journals to talk about the "post-antibiotic era." 

If "Dean Ornish" type programs which involve dietary changes, exercise, and stress reduction can reverse heart disease it is far safer and less costly than coronary angioplasty or bypass which will be needed again in a few years. 

Using less aggressive interventions preferentially could significantly reduce the incidence of deaths and serious adverse reactions due to medication or surgery. This is particularly true when we are dealing with early stages of disease. Obviously if there is a medical emergency crisis measures are called for. 

In an Emergency "do not pass go, do not collect $200," GET HELP
In a medical emergency your survival depends on getting prompt and aggressive treatment. If you have broken bones, have cancer, are hemorrhaging, are having chest pain, difficulty breathing, symptoms of a stroke or the worst headache of your life (suggestive of an aneurysm) you don't want to rely on dietary measures, supplements, stress reduction, exercise or over the counter remedies. There may be a place for these types of self-help measures after the immediate problem has been diagnosed and treated medically. There are times when you need to get immediate help and it is vital for you to recognize these situations and act accordingly. When things are out of your control it is important to "let go" and get help from professionals.

Reduce Stress
Stress reduction is the process of "letting go." The stress response which raises adrenaline and cortisol levels is appropriate in acute, short-term situations. However, long-term stress associated with job dissatisfaction, financial problems, and family or relationship problems has been shown to lower immunity and increase the risk of heart disease and depression. In some cases we can do something about the stressful situation such as changing jobs. In many cases the stressors are beyond our control. The only thing we can control in this case is our response to the situation. People who are able to respond to adversity with humor and optimism are better able to handle stress without suffering adverse health consequences. Being grumpy and angry has been shown to increase your risk of having a heart attack.

A variety of methods have been shown effective in reducing stress including, among others, biofeedback, exercise, laughter, massage, meditation, pets, prayer and, as mentioned earlier, a social network. The health benefits of prayer and religious beliefs are receiving more and more attention recently in the medical literature. Prayer is the ultimate "letting go" which in essence turns over situations out of our control to a loving, all powerful God who is in control. The additional sense of meaning and purpose found in spiritual beliefs also tends to provide comfort and reduce stress in the midst of tragedy and situations beyond our control. Medical studies have shown that those who attend religious services regularly tend to have lower blood pressure, better immune function, recover more quickly from depression, require less hospitalizations and when admitted to the hospital are discharged sooner. Religious beliefs also tend to increase one's sense of self worth and reduce risky behaviors.

Summary
Being well informed can help you make better health choices. The quality and quantity of your life can be significantly improved by things which are within your control such as diet, exercise, avoidance of risky behaviors, social interactions, preventive supplementation, health screening and early intervention with less aggressive measures. When faced with situations out of our control our health depends on getting help and "letting go" to reduce the negative impact of stress. If we take charge of what we can do and let go of what we can't we will have a better chance of enjoying longer, healthier lives. Let's take charge and let go!