The parent who simply can't find time to cook a family dinner can, always, find time to take a kid to the ER or endocrinologist. People who can't afford mixed greens can afford diabetes test strips.
People who carefully and responsibly invest in the financial security of their retirement (although we know that's no guarantee of a good outcome!) routinely neglect altogether any investment in their health. If money can be put aside for future benefit, why can't time be "put aside" -- invested in physical activity, eating well, getting enough sleep? It can be, of course -- but our social norms don't encourage it, and it doesn't happen. A standard-issue, responsible modern adult -- carefully tends their money, and neglects their health. It's normal, and almost expected. But bizarre -- and often calamitously costly.
Many people reach retirement with the money they need, lacking the health they need to use that money for anything enjoyable. As a physician, it is excruciatingly painful to look into the imploring eyes of a retiree who has long anticipated their golden years -- and has cultivated the bank account to underwrite it -- now disabled by progressive diabetes, lung disease, brain disease or heart disease that need not have occurred.
And it is all too common. I have seen, and continue to see, many such patients. Patients who reach retirement age with robust good health and too few dollars come along, too, of course -- but far less often. And here's the news flash: Those with health but not much money are clearly a happier group than those with money but not much health. I have met them on the intimate turf of clinical care, and they have told me so.
This is the backstory for a careful consideration of the Alzheimer's disease crisis we now face.
There has been enormous attention of late to the grim and genuinely frightening problem of Alzheimer's disease. The problem is grim by its very nature -- there is little we contemplate with greater dread than the loss of our minds, our very selves. The problem is frightening at the personal level because we feel vulnerable to this increasingly common condition we don't know how to cure, and at the collective level, where estimates suggest it could cost the nation a trillion dollars annually by 2050. There is also the terrible burden on family members, who must face the high demands of care, compounded by the heart-wrenching loss of a loved one who is still there, yet already gone.
It is in this context that President Obama has declared a war of sorts on this scourge, calling for means of both prevention and treatment by 2025, or even 2020. There is lively debate about how realistic the goal is -- although on that issue, I note that the best way to predict the future is to create it. You don't get to the moon without committing to the trip.
To create the president's future, it will be important to develop new treatments, as it is for obesity and diabetes. But as with obesity and diabetes, it will be important not to let the hunt for breakthrough treatments become the tail that wags the dog.
Alzheimer's is overwhelmingly a vascular disease, and thus overwhelmingly preventable. Estimates are less well established than for other chronic diseases, but it seems likely the risk can be trimmed by nearly 80 percent -- and perhaps eliminated entirely but for the extremely genetically vulnerable -- by minding our general health.
It is only fair and honest to concede that we do not have perfect defenses against Alzheimer's. And, to some extent, we are hoisted on our own petard -- vulnerable to this condition of advancing age because we are better at living longer than ever before.
But the evidence is strong, if not incontrovertible, that whatever the genetic underpinnings, the epigenetics of Alzheimer's -- the exposures that influence how genes behave -- are of profound importance. By and large, Alzheimer's is a vascular disease. By and large, the practices that prevent cardiovascular disease -- eating well, being active, avoiding tobacco -- slash the risk of Alzheimer's.
Study after study after study after study that has shown an elimination of up to 80 percent of all chronic disease with the application of lifestyle as medicine has NOT carved out an exception for Alzheimer's. The evidence that we can alter gene expression with the power of lifestyle almost certainly pertains to Alzheimer's as it does to cancer. By minding our bodies, we can mind our minds, too. We can best mind both, by minding the short list of what matters most to health.
Available evidence suggests that controlling cardiac risk factors can lower dementia risk specifically by 50 percent or more.
via huffingtonpost.com
Each of us can make the choice to be well or not.
Why is this so hard? Why is it easier to get ill and then get treatment than to take charge up front.
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