Dear DOCTOR Owen:

I have a friend who is a “health nut.” A vegetarian, she takes handfuls of vitamins and herbal supplements. When I ask her why she does all this, she says that she wants to live long enough to see her great, great grandchildren. She rarely visits the doctor and seems to have great distrust about taking “medicine.” This seems like a lot about nothing. What do you think?

Not Nutty

Dear “Nutty”:

Your friend can’t see the forest for the trees—or should I say, “for the plants and herbal bushes.” I come across this daily in my practice, although on a much more subtle level than your friend. I often see people who “cannot afford” medication, yet spend more than $100 a month on herbal supplements. Some of these people even smoke. Talk about losing perspective.

Longevity is a subject that we cannot readily comprehend. Most people, even physicians, have not made the jump in thinking that is required to know how to manage—much less achieve— longevity. The old adage is truer than ever: “If I’d have known I would live this long, I’d have taken better care of myself.”

There are four major causes of death and disability: cardiovascular, cancer, mechanical (knees, hips, feet), and safety. The most important things that people can do to live longer and have quality of life are to clearly visualize potential obstacles and plan for their prevention or early treatment.

For instance, they can now:

• Stop or reverse atherosclerosis from cholesterol with aggressive treatment.
• Screen and find most early cancers.
• Detect and reverse osteoporosis.
• Enjoy living in an environment that—in many, many ways now (more than ever)—is safe.

Consider the following questions and answers to give you some perspective about your future:

Q. If we have successfully put a stop to 90% of the causes of death, what will be our biggest problems?

A. Probably, mechanical disabilities—knees, hips, feet. But, we can keep them in good shape with very specific exercises.

Q. What about eyesight?

A. Blindness from macular degeneration. But wearing sunglasses, not smoking, and taking hormone replacement will greatly reduce that risk. Supplements may help.

Q. What about hearing?

A. Deafness. “Oh, no! If only I’d protected my ears from all that noise during my lifetime!”

Q. Is it really worth the trouble? Why not simply take what comes?

A. The French say, “C’est la vie,” which involves some elements of denial as well as reality. In other words, keep things in perspective. Answer questions like the following honestly: “How much money do I really need?” “How hard do I want—or need—to work?” “Should I eat that steak and that cheese cake?” “What type—and technique—of exercise is best for me?” “What is my exercise goal: To reduce weight? To improve posture and balance? To strengthen my knees and feet?” “How much exercise?”

Q. What diet and/or medications and supplements are best for achieving longevity and quality of life?

A. Low-fat dieting (by and large), cholesterol medication, hormone replacement, and exercise are the staples for clean arteries. (Clogged arteries are responsible for 70% of all deaths.) Supplements may or may not help. They can only hurt if they distract you from the above staples. Cancer prevention is best achieved by screening—colon, breast, pelvic, and prostate—all of which are detectable early and curable.

Q. Briefly, what is the latest information on cancer and longevity, as well as bone disease and longevity?

A. Lung cancer is the number-one cause of cancer death, is not screenable, and is caused by cigarettes. Smoked products and fat seem to cause the greatest risk of gastrointestinal cancer. Hormone replacement decreases the risk of all cancer, except breast; the data on that cancer are very conflicting. Bone is preserved primarily by hormone replacement; supplements may add some benefit.

Exercise is key to quality life in the later years. In my opinion, quality life in the 80s, 90s, or 100s is impossible without exercise. Focused exercise, performed with good advice and supervision, is always better than “exercise”—in itself, a meaningless term.

So far, the modern medicine has scarcely had any impact on diseases of the elderly, but it may benefit focused baby boomers. In years to come, children who are educated and informed—and who utilize the available medical tools—will reach levels of longevity that we truthfully cannot comprehend.