Upcoming presentations

Wednesday, June 6, 1:00 Supermarket suicide and restaurant roulette. Escondido Senior Center. OASIS – see their website http://www.oasisnet.org.

Friday, June 15, 1:00 Emerging infectious diseases and safe travel guidelines, Temecula Higher Education Learning Center. Osher – see their website http://www.csusm.edu/el/olli.

Wednesday, June 20, 2:00 All about Shingrix, the new shingles vaccine, Escondido Senior Center http://www.oasisnet.org

Tuesday, June 26, 9:30 a.m. How wars changed medicine, Oceanside Senior Center, 455 Country Club Lane. Osher – see their website http://www.csusm.edu/el/olli.

Friday, June 29, 1:00 p.m. Emerging infectious diseases and safe travel guidelines, Carlsbad Library Learning Center. Osher – see their website http://www.csusm.edu/el/olli.

In the news

Trans fats are going away – finally!

Trans fats are vegetable oils that have been treated to keep them from becoming rancid. When they are used in baked goods they prolong their shelf life. That’s good for food manufacturers but bad for the heart. Trans fats raise LDL (bad) cholesterol, lower the levels of HDL (good) cholesterol, make blood more likely to clot in vessels of the heart and brain and increase inflammation, which plays a large role in heart disease, stroke, diabetes, cancer, osteoporosis and other diseases.

By June 18 – only days away – the FDA has ruled that food manufacturers must remove trans fats from processed foods. Health experts predict that this will prevent several thousand heart attacks per year.

If you are a label reader you have probably seen some nutrition facts labels that state that the trans fat content of the item is zero. Government folks aren’t very good at math: “zero trans fat” on a food label means that it can have up to 0.5 grams of trans fat. Maybe that helps to explain why the U.S. is a financial mess – the people that make the rules can’t do simple math!

Lifestyle

Dieting Guidelines

Your mother was right! Eating slowly is better for you but not for the reasons I heard when I was a kid: “Don’t eat so fast! You’ll choke on your food.” “It’ll make you sick..” Well, that second part was right but the sickness would take years, even decades to develop.

When we eat fast we eat more. That’s because it takes about 15 or 20 minutes for our hard-wired appetite-control mechanism to let us know that we’ve eaten enough. It was once thought that this was a simple mechanism brought into play by a hormone called cholecystokinin that was released when the stomach was full. We should have known! Nothing is really that simple in matters of biology. Scientists now know that there are several mechanisms, some regulated by hormone-like chemicals, that control appetite.

Some of this came to light after lots of people had a part of the stomach removed to lose weight. They didn’t get as hungry as they should have when portion sizes were limited to something about the size of a golf ball. The part of the stomach that had been removed contained cells that produced one of the hunger-causing hormones.

The bottom line: follow Mom’s advice and eat slowly. You’ll end up eating less, especially if your meals consist largely of fiber-rich vegetables.

The anti-inflammatory diet – not so new

The anti-inflammatory diet has been popping up in the media lately but is it really something new? It’s based on two diets that are not just old but ancient, the Mediterranean diet and the Asian diet. Both contain foods that lower inflammation and are devoid of those that promote it. Perhaps the term Mediterrasian is more inviting and less intimidating than anti-inflammatory.

Inflammation is the mainstay of the body’s defense mechanism, ranging from the pain, swelling and redness that we experience from a splinter lodged in a fingertip to the cough, fever and miserable feeling of a bout of the flu. These reactions are relatively brief, unlike the years-long gnawing damage that leads to heart attack, stroke and numerous other conditions.

The true Mediterranean diet and the traditional Asian diet are nothing like what is found on the menus of your local pizza parlor or Chinese restaurant. Both diets are plant-based, which means plenty of fiber, antioxidants and omega-3 fats, all of which lower inflammation. They lack processed foods that are heavy on the sugar, starch and saturated fat that contribute to obesity. Fat deposits don’t just take up unsightly space, they produce inflammatory chemicals that contribute heavily to cardiovascular disease and to cancer, type 2 diabetes and osteoporosis. Both food styles include very little red meat; there is no beef industry in greater Asia or the countries that surround the Mediterranean Sea. There’s not much of a dairy industry either; most Asians are unable to digest the sugar (lactose) in milk and the Mediterranean climate doesn’t allow milk or its products to maintain freshness. If you think that cheese is the exception that’s correct but it serves as a garnish, not a primary ingredient.

Instead of saturated fat the Mediterranean diet relies on olive oil for almost all of its fat calories. The Asian diet is naturally low in fat but what there is comes mainly from fish, an excellent source of the anti-inflammatory omega-3 variety.

What this hybrid diet lacks is one of its biggest advantages. There is no refined grain (white rice is the exception), no trans fat and no artificial colors or chemical preservatives.

The benefits of the Mediterrasian lifestyle are not entirely due to food. Until fairly recently labor-saving devices were not available to most people and almost every tool and vehicle required muscle power. That not only made obesity less likely it reduced the risk of osteoporosis.

Lifestyle

Exercise Tips

Is it pain or just soreness? When you work a muscle hard, especially if it’s the first time, you know how sore it feels the next day and possibly for several days. That is normal and it is known as Delayed Onset Muscle Soreness (DOMS). You can avoid it if you begin an exercise program – or a new type of exercise – with very low weight. I recommend that you go through a routine with no weight at all in your hands for at least two weeks to open up existing blood vessels and grow new ones. Walkers and runners should start with low speeds and short distances. That won’t completely eliminate DOMS but it sure will help.

Pain is different. It sometimes comes on suddenly during or after an exercise, and it’s usually asymmetric – involving only one side of the body, e.g., one shoulder.

Do not try to “work through” DOMS or pain. In the former it’s just not worth the discomfort and in the latter you are likely to make the injury worse.

Wednesday, May 9, 1:00 San Marcos Library Shingrix, the new shingles vaccine. No fee.

Wednesday, May 16, 1:00 Point Loma Library Supermarket suicide and restaurant roulette. OASIS – see their website http://www.oasisnet.org.

Friday, May 18, 1:00 LIFE program at Mira Costa College, Oceanside. How wars changed medicine. http://www.miracosta.edu/life.

Wednesday, May 30, 3:00 Encinitas Library. How to keep your wits; 10 ways to prevent dementia and Alzheimer’s disease. http://www.oasisnet.org

In the news

Am I preaching to the choir?

It’s likely that the vast majority of persons who are reading this blog have healthy habits but a recent study should give you even more resolve to continue and to get better if you’re falling short in some areas.

A study just published in the journal Circulation listed five lifestyle factors that lead to good health. What is newsworthy is how many more years are added to one’s life by following them consistently.

There are no great surprises here. Maintaining healthy weight, getting at least 30 minutes of moderately intense exercise every day, not smoking, healthy eating (at least five servings of vegetables, four servings of fruit, one serving of nuts, no red meat, no sugary drinks and low sodium) and moderate drinking (no more than two drinks a day for men and one drink per day for women).

Women who maintained all five good habits could expect to live 14 years longer than those with the least healthy lifestyles. Men could expect 12 more years than their least health-aware peers.

When these results were tabulated it turned out that only 8 percent of U.S. adults were “five-for-five”.

We have a long way to go!

Lifestyle

Minirobics

You need at least 30 minutes a day of moderately intense exercise in order to maintain muscle tone, hold your weight down and keep your heart and lungs working the way nature intended until old age. But do you need a gym membership or hundreds of dollars’ worth of home exercise equipment? Consider these Minirobics, short spurts of activity that are easy to incorporate into your daily routine.

If you use public transportation, don’t get off at the stop nearest your office. If you drive, park your car a couple of blocks farther away than usual. If these simple measures add just 2 blocks – about 1/8^th of a mile – to the distance to your place of business, that’s more than a mile a week. Not much but it’s a beginning and you might find yourself stretching that distance by a couple of blocks more every few weeks as you find that you can spare the extra minutes.

Get in the habit of walking up one flight of stairs and walking down three. That’s not just better for your fitness, it’s probably faster than waiting for an elevator.

Stay on your feet whenever you’re on the phone. You’ll burn a few calories and develop better tone in your legs. Standing up while you’re talking on the phone gives your voice more energy.

Don’t park near the entrance to the supermarket. Carrying a couple of bags of groceries to the farthest corner of the parking lot will burn a few more calories. You can usually park in the same place and you’ll never “lose” your car again. Your doors won’t get dinged as often, either.

Stop using the drive-up window at the bank. Wash your own car and save a few bucks per week. At work, use the rest room that’s farthest away from your desk.

If you take a few moments to review your daily routine you’ll find even more ways to use up calories. Some of these Minirobics burn just 5 or 10 extra calories but that’s enough to affect your long-term health. When you use 10 calories a day more than you take in you’ll lose about one pound per year. That doesn’t sound like much but that’s what the average American gains each year between graduating from high school and cashing that first Social Security check.

Mosquito season is here

Mosquitoes are becoming an increasing threat in disease transmission here in Southern California. West Nile virus has been marching westward from the East Coast for a couple of decades but it took a slight dip last year. That’s small consolation inasmuch as Zika virus is now on the horizon. Almost all the cases of Zika virus infection in the U.S. have occurred in persons who acquired the disease elsewhere but it’s probably a matter of time before it gains a foothold here.

Mosquitoes are remarkably adaptive creatures. They don’t need much water to raise their families. Small accumulations of standing water in discarded containers, flowerpots or even the cup-like leaves of decorative plants can support broods of the two species of mosquito that live in this area. You might want to check your yard about once a week to make sure that there are no mosquito havens there.

Don’t become a target for mosquitoes. Some species bite mainly at dawn and dusk but some, like Aedes aegypti that often carries the Zika virus, are all-day biters. We use perfume, cologne, hair spray and other fragrances to attract others but mosquitoes are drawn to them too. An insect repellent known as DEET has remained effective since it was first used the the Pacific theatre of WWII. You might want to have a spray can on hand if these critters show up in your neighborhood.

Lifestyle

Don’t be a slave to a calorie-counter! Unless you weigh and measure every portion of food that you eat it isn’t possible to get within 10 or 20 calories of that food’s actual value. What is important is to stick to foods that are naturally low in calories and to get in the habit of making your mealtime servings about 20 percent smaller than they were before you started trying to lose weight.

Two perspectives to keep in mind: First, if you take in 10 calories a day more than you burn off with physical activity you will gain about one pound  year. Ten calories!!! That’s about one bite of a banana and about one-fifth of an Oreo cookie! One pound might not seem like much but it sure adds up between the time you finish high school and the time you say hello to your first grandchild.

Second, by trimming your usual mealtime helpings by about 20 percent you’ll lower your daily intake by about 500 calories. At that rate you will lose more than one pound every week. One of the secrets to doing that is to eat high-fiber foods like fruits and vegetables that give you a feeling of fullness instead of things like French fries and rice, which have almost no fiber and that leave you wanting to eat more.

If you’re on the carb-reducing program (I hate to use the word diet) you can have larger servings of meat because protein leaves you with a feeling of fullness.

Ten ways to prevent cancer             OASIS Escondido     Senior Center      Wednesday April 4, 1:00 p.m.

A series of four presentations at the Dove Library, Carlsbad,

Tuesdays at 12:30 p.m.

April 10          Sleep, light and health

April 17          The true Mediterranean diet

April 24          How the computer affects your health and your brain

May 1             Ten ways to prevent cancer

Keeping your wits: how to avoid Alzheimer’s disease and  dementia   

Allied Gardens Library/OASIS     Friday April 20, 2:00 p.m.

            Visit http://www.oasisnet.org/sandiego for registration information

Shingrix: The new shingles vaccine       San Marcos Library

 Wednesday May 9 1:00 p.m.

In the news

The obesity paradox isn’t. From time to time journalists describe a study that shows that persons who are slightly overweight – perhaps even more than “slightly” – live longer than those whose weight is normal. Critical analysis usually shows that the lower-weight persons have lost weight due to illness, thus shortening their lives, or there is a sampling error. The correction rarely makes the news.

Perhaps the most recent study, published in the Journal of the American Medical Association, Cardiology in February 2018 will put the myth to rest. This was a large study involving more than 190,000 people and lasted from 1964 to 2015 – rather meaningful numbers. Overweight and obese persons had fewer years of disease-free life, being diagnosed with heart disease earlier than those of normal weight. Among the morbidly obese, being about 100 pounds or more over standard weight, sixty-five percent experienced a heart attack, stroke or heart failure during the study.

Overweight or obese persons live longer after being diagnosed with heart disease because they are diagnosed earlier in life. This study showed that normal weight was associated with a longer life overall. Which is a great lead-in to the item that follows.

Lifestyle

Beware of any diet program that claims that you will lose 5 or 10 pounds per week. That’s possible but it isn’t safe or wise. Your target should be about two pounds per week. After all, that’s about 50 pounds in six months, 100 pounds in a year, and there is no reason to lose it faster. You will still amaze your friends!

If you push your body into starvation mode you will lose a great deal of lean body mass, which includes muscle as well as tissue from other organs. There is also a much greater risk of gallbladder disease when weight loss exceeds 2 pounds per week.

Fatigue and irritability also accompany marked weight loss. The former will jeopardize your job and the latter your relationships. It just isn’t worth it.

 How well prepared are you?

No region of the country is free from the possibility that a natural or man-made disaster will force us to leave our homes, at least for a day or two. If it hasn’t happened yet to you, someone in your circle of friends, relatives or co-workers has probably had to leave their home and nearly all that they own behind on extremely short notice. Wildfires, floods, tornados, earthquakes, hurricanes and landslides are Mother Nature’s doing; gas leaks, chemical plant explosions and the like are the price we pay for technology.

What valuables and living essentials could you gather up with ten-minutes warning – or less? What if you couldn’t use your vehicle? How much could you carry? And what would you carry it in?

As prepared as Pat and I are with our “bug-out bags” that would allow us to survive outdoors for about three days, when we were recently threatened by wildfires and were the next neighborhood that would receive orders to evacuate, that ten minutes went by really fast! But we were ready.

If you are taking prescription medicines be sure to include those. Do you have credit cards, cash and checkbooks within reach? (I almost forgot the last but Pat didn’t.) How about what your pets will need?

You can find emergency evacuation kits on the Internet but it’s easy to make your own. Hint: a wheeled carry-on will hold most of what you need.

Lifestyle

How much water should you drink in a day?  “Ounces per pound per day” is meaningless. During a Santa Ana in San Diego when the humidity is less than 10 percent while you’re puttering around the yard it will take a lot more water than sitting in front of the TV on a chilly day. The best indicator is simple: your urine should be light yellow with little odor. If it’s dark and smelly you not only run the risk of developing kidney stones, but being only 2% dehydrated will make your thinking fuzzy. If your urine is almost as clear as tap water you’re overdoing it, and several hours of that might cause a seizure.

It’s not being overzealous to have a bottle of water available in the car, and a glass on the countertop when you’re at home. Stainless steel water bottles only cost about $15 and they will last longer than you will.

How does all this fit it with dieting? What passes for hunger is often thirst, and by drinking 6-8 ounces of water you can usually make the hunger pangs go away. If that doesn’t work, have a piece of fruit – not a handful of jellybeans!

Something to keep in mind: back in the Stone Age there was no beverage but water. That worked out fine for a couple of million years.

Another point: the single most important factor in excess weight gain in America is sweetened drinks. And the average size is now 20 ounces!!

Fish eat worms and vice-versa

Over the past few years there have been several reports of live or dead parasitic worms in fish that is sold in supermarkets, big box stores and in restaurants that specialize in sushi.  The past couple of months have seen more stories. This is not really news. I learned in medical school that we should avoid undercooked Great Lakes whitefish because of the possibility that an uncooked tapeworm might take up residence in our intestines. Uncooked is the key word. Thoroughly cooked and no longer alive, parasitic worms and their eggs are no threat to our health.

Worms are the largest parasites that live in the bodies of the animals that we have relied on for food for thousands of generations. Fresh water fish often contains the above-mentioned tapeworm’s eggs that hatch in the human digestive tract. Salt-water fish contain several species of worms, and salmon that spend their lives in both salt and fresh water carry them as well. Commercial cod fishermen often find their catch riddled with worms. When sushi is made from fish that has not been frozen there is a risk that a worm within it might make some customer’s stomach its new home.

The term parasite comes from the Greek words for alongside food and they recognized that such creatures were quite common in our food supply. In developing countries parasites are so common that virtually one hundred percent of the population carries them in the intestinal tract. That might explain why autoimmune diseases seldom occur in those groups. A new field of medical research, helminthic therapy, is exploring the ways in which certain parasitic worms favorably influence the course of multiple sclerosis, ulcerative colitis, celiac disease and asthma.

To be sure, parasitic worms are responsible for a host of diseases. Patients infected with fish tapeworm may develop anemia. Sushi lovers sometimes encounter worms that cause severe pain and discomfort when they attach themselves to the lining of the stomach. Trichinosis used to be fairly common when pigs were fed infected meat from other pigs; it still occurs among hunters who eat improperly cooked bear meat.

Finding a live worm – or several – in a package of store-bought fish can be unnerving and the product should be discarded (or returned for a refund). Cooking destroys worms that might not have been noticed, and so does freezing. Sushi restaurants usually – but not always – freeze their fish before it is prepared and served.

And who knows? Well-cooked worms might be good for you!

Exercise Tips

      Humans have a natural aversion to physical activity. It’s actually hard-wired in us because it’s a survival mechanism: if we expend less energy we will retain more stored energy in the form of fat or glycogen*. Even hunter-gatherers of today rest whenever they are not engaged in something.

Our modern levels of physical activity are so low that we should go out of our way to burn off calories whenever possible. Persons on a diet should seek out ways to do that, even if the movement is not strenuous. Use your car as little as possible. When you do drive, park at the farthest corner of the lot. Takes the stairs instead of the elevator. Those few extra burned calories a day will add up.

Don’t go more than three or four days without moderate exercise, even if it’s only a half-hour walk in your neighborhood. Do a few push-ups while you’re watching the evening news.

* – Glycogen is also known as animal starch. It is composed of chains of glucose molecules and is stored mainly in the liver and muscles.

Upcoming presentations in the San Diego area are scheduled for the Osher Lifelong Learning Center, Cal State San Marcos (www.csusm.edu/olli) and the OASIS Adult Learning Center (www.oasisnet.org). Dates, times and locations are posted on their websites.

Avoiding modern diseases –  Osher Lifelong Learning Center at the Temecula Higher Education Center,  February 19 and 26, March 5 and Mission San Luis Rey, March 22 and 29, April 5. Topics include Ten steps to avoid cancer, Baby Boomer blindness and Ten ways to avoid dementia and Alzheimer’s disease.

Sleep, light and health, Mission Valley Library (OASIS) February 20, 1:00 p.m.

Dieting Guidelines

Cravings occur because sheer survival is built into our behavior. Survival is an overriding instinct, so don’t feel guilty when you have cravings, even when they make you do irrational things like raiding the refrigerator when everyone else is asleep.

You can avoid cravings by snacking on foods that are high in fiber and low in calories, such as most fruit. Don’t be concerned about fruit sugar; a normal piece of fresh fruit usually has only about 70-80 calories but the fiber will satisfy your appetite. Protein snacks, such as protein food bars, will also help to prevent cravings but they should contain only small amounts of carbohydrate and fat.

A hint: eat snacks slowly. That’s especially true of nuts, a small handful of which will usually contain a little more than 100 calories but that is very filling – if you eat them slowly!

In the news

Tiny turtles – cute but dangerous.

Many of us had little turtles as kids, usually from the local Five-and-Dime with an American flag painted on the shell. But for decades those pets have been responsible for thousands of cases of illness due to various strains of Salmonella. The germ usually only causes diarrhea but in the very young and the very young it can cause serious bloodstream infection and even death.

The Centers for Disease Control has banned the interstate sale of small (carapace less than four inches in diameter) turtles since 1975 because of the high risk. Salmonella bacteria are common in turtles and the water of the tanks in which they are kept – and kids love to pet and kiss those cute critters.

Banned or not, tiny turtles continue to cause outbreaks, the latest in November of 2017 that spread to fourteen states. More than a third of the victims were below the age of five years.

Area Presentations…

Upcoming presentations in the San Diego area are scheduled for the Osher Lifelong Learning Center, Cal State San Marcos (www.csusm.edu/olli) and the OASIS Adult Learning Center (www.oasisnet.org). Dates, times and locations are posted on their websites.

Avoiding modern diseases –  Osher Lifelong Learning Center at the Temecula Higher Education Center,  February 19 and 26, March 5 and Mission San Luis Rey, March 22 and 29, April 5. Topics include Ten steps to avoid cancer, Baby Boomer blindness and Ten ways to avoid dementia and Alzheimer’s disease.

Sleep, light and health, Mission Valley Library (OASIS) February 20, 1:00 p.m.

In the news

After a few decades of being warned of the danger of cholesterol in eggs Americans are now being told that hen’s fruit is not the risk that we thought that it was. First, not all cholesterol is bad. “High cholesterol” is a meaningless term. It usually refers to the total cholesterol level but there are several different forms of cholesterol. High-density lipoprotein (HDL) is a beneficial marker of heart health while low-density and very low density lipoproteins (LDL and VLDL) should be the targets of treatment. It is these latter two forms of cholesterol that are clearly linked to the risk of coronary artery disease and heart attack but that is not the whole story. Persons whose blood cholesterol levels are normal often are victims of heart attack. Several other factors, especially high blood pressure, are part of the picture. Inflammation, largely due to excess body fat, plays an important role in heart attack and stroke.

Second, unless the intake is very high, cholesterol in the diet does not raise the level of cholesterol in the blood. The more cholesterol we eat the less the liver manufactures. This feedback mechanism ensures that we will maintain enough cholesterol to produce hormones, vitamin D, bile (needed for digestion) and other vital components. It also keeps blood levels from going too low, a condition that is associated with significant neurological problems, including depression and aggressive behavior.

Eggs have been part of the human diet since the Stone Age and our ancestors had a huge variety of birds’ eggs compared to chicken eggs, our only one. Even so, chicken eggs are a valuable source of protein, vitamins, calcium and iron.

When we eat eggs they are almost always part of a meal that includes saturated fat, the real cause of elevated cholesterol. Bacon, sausage, ham and other “egg helpers” that include butter and hash brown potatoes are hardly heart-healthy. On the other hand, an omelet made with assorted vegetables eliminates the saturated fat and includes healthy fiber, more vitamins and antioxidants.

Is there a limit to the number of eggs that we can safely eat in a week? One or two eggs most days of the week will have zero effect on your blood cholesterol. The exception might be persons with a genetic trait that keeps their cholesterol levels abnormally high. For the rest of the population, enjoy those veggie omelets – without the saturated fat!

Lifestyle

Hypertension, type 2 diabetes and colon cancer share some important characteristics. They affect large numbers of people, they are silent for long periods, they are difficult if not impossible to cure when they become established and they can be identified in their earliest stages with non-invasive screening tests. To be sure, there are other conditions such as coronary artery disease that kill more Americans but in that specific example there is no simple, reliable, non-invasive test that can identify its victims. In fact, among the 1,000 persons who die each day of sudden cardiac arrest, death is the first symptom of heart disease.

Yet, many heart disease victims’ lives could have been extended, perhaps for decades, if they had been screened for high blood pressure. Hypertension usually develops gradually over several years and it causes almost no symptoms. It is the single most important treatable cause of heart disease and stroke and it often begins in early adolescence. Everyone should have an annual blood pressure check starting in childhood, especially those who have a family history of heart disease or stroke, or who are overweight or obese.

Blood pressure devices are so inexpensive, reliable and easy to use that every family should have one. Since a single blood pressure reading is not diagnostic, especially in the stressful atmosphere of a physician’s office, measuring it a couple of times a day over several days is worth the time and effort. The upper number (systolic) should be less than 125 and the lower (diastolic) less than 80. It’s true that blood pressure increases with age but that is not normal; it is simply common.

We are in the midst of an epidemic of type 2 diabetes. Everyone should be screened with an annual fasting blood sugar starting at age 40. For those with a family history of the disease, obese individuals or any non-Caucasian, screening should start in adolescence. More than half of those who have type 2 diabetes have at least one complication at the time of diagnosis. The blood test can identify persons with pre-diabetes, half of whom will develop full-blown disease within a decade.

Colon cancer screening begins with a test for blood in the stool, done once yearly from age 50. A colonoscopy should be done at that time and repeated at 60. Yes, the preparation is uncomfortable but sedation makes the procedure itself quite tolerable. It can be a lifesaver.

Ignore those life expectancy numbers

Life expectancy is a number that is useful to actuaries who deal with population statistics, to healthcare planners and to the journalists who write about it. It has nothing to do with how long you will live. Life expectancy in the United States is more than eighty for women and somewhat less (seventy-six) for men. The not-so-good news is that life expectancy has decreased for two years in a row, the fall attributed to the rampant abuse of opioids. If drug-related deaths do not decrease this year and the flu season is worse than most years we can expect another decline, shattering a record that will provide much hand-wringing at all levels of government, in the halls of academia and in the media. The steady increase in drug-related deaths does demand our attention because it mostly affects those in mid-life, destroying families and ending productive careers. Perhaps the most frustrating aspect of the opioid problem is that these deaths are entirely preventable. Influenza deaths are also largely preventable. Although the influenza vaccine is far from perfect it does reduce mortality at both extremes of life, the very young and the very old, whose deaths are almost always due to secondary bacterial infection, not to the virus itself.

Although heart disease is still the leading cause of death in the United States, improvements in diagnosis and treatment have slowed its climb. Diabetes reportedly accounted for fewer than 80,000 deaths in 2015 but that is a misleading statistic. Type 2 diabetes now affects nearly ten percent of the population and contributes to heart disease and stroke, a fact that is not usually reflected in death certificates. Obesity is not listed as a cause of death in official records but it is a very important contributor to coronary artery disease and it is linked to more than a dozen cancers. Chronic lower respiratory disease, third on the list, is almost entirely the result of smoking.

As individuals it is within our power to postpone if not to avoid six of the seven leading causes of death: heart disease, cancer, lower respiratory disease, accidents (nearly half of which include drug/opioid victims), stroke and type 2 diabetes. Persons who maintain normal weight and do not smoke or use drugs don’t have to pay attention to life expectancy figures. Good habits will help you to exceed those numbers by a couple of decades.