Today’s special Well guide offers readers head-to-toe advice for healthy aging. Whether you’re worried about your heart, expanding waistline, wrinkles or aching feet, you’ll find answers to some of your most pressing health problems.
To read the full report, go to www.nytimes.com/wellguide and be sure to check out the online options. Click to find memory games, health quizzes and cool three-dimensional graphics around the Web. And when you’re done, take the Well quiz below to test your body knowledge.
To take the quiz, click here.
Healthy living doesn't happen at the doctor's office. The road to better health is paved with the small decisions we make every day. It's about the choices we make when we buy groceries, drive our cars and hang out with our kids. Join columnist Tara Parker-Pope as she sifts through medical research and expert opinions for practical advice to help readers take control of their health and live well every day. You can reach Ms. Parker-Pope at 
The easiest and most pleasurable way to eat well is to cook. Recipes for Health offers recipes with an eye towards empowering you to cook healthy meals every day. 
From 1 to 25 of 39 Comments
A fun and informative interactive quiz. Even a practicing primary care doctor can learn new things. As doctors, it is when we fail continue to be open-minded and willing to learn new facts and concepts is when we fail to grow.
Davis Liu, M.D.
— Davis Liu, M.D.Author of Stay Healthy, Live Longer, Spend Wisely - Making Intelligent Choices in America’s Healthcare System
http://www.davisliumd.com
It’s unfortunate when discussions regarding dementia, including Alzheimer’s, present strategies such as exercise, certain foods, e.g., the Mediterranean Diet, puzzles, etc. as though there is evidence of their success. While exercise, nutrition, mentally stimulating puzzles and games are necessary ingredients to a healthy lifestyle, many individuals live their lives without any form of dementia, including Alzheimer’s and don’t have the Mediterranean Diet foods or play puzzles and games. These present a false hope, although profitable to some proponents.
It would appear that the informational focus should be on making the public aware of ways that are “known” to have the potential for causing dementia. There are obviously many causes of dementia, including heredity. However, why not work first with what’s within your control.
One such cause of dementia, accepted by medical authorites, is drug-induced dementia. As a person ages, the kidneys are less efficient in filtering toxins from the body. As a result, older people who have major surgeries such as hip replacement, knee replacement, heart surgery, etc. are at risk for having “drug induced” dementia. One possible cause is that the anesthesia used during surgery is not removed from the body as quickly as in a younger person and memory portions of the brain are affected. A second possible route is due to “post-operative epidurals”, where the patient has control over the amount of drugs administered for pain, after surgery.
In most cases, memory loss may last for only a brief period. However, for others, especially the very elderly, cognitive changes can be immediate and lasting. It is at this point that medical authorities and families appear to “forget” that the dementia was “drug induced” and the person is deemed to have Alzheimer’s disease. The next step is to naturally prescribe Alzheimer’s drugs, ALL of which have been shown to have NO efficacy (see New York Times article). The patient went into surgery with a high degree of cognition and came out with a dementia.
Medical authorities and patients/families should address this significant risk “before” any major surgery, if the patient can be considered “older”, e.g., over 65. The surgeon should not “downplay” the risk by giving “assurances”. Rather, there should be some understanding of the specific anthesia to be used and its history of inducing dementia, along with whether the patient and family want to make the “choice” to use a post-operative epidural or some other way to reduce pain. For example, it may be less risky to use conventional pain medications (which have no dementia risk) during the post-operative recovery rather than to use a post-operative epidural. The doctor and the patient/family can make these decisions. It would also be interesting to know just how many people are in nursing homes due to drug-induced dementia, but classified as Alzheimer’s disease.
— Phil, NebraskaFrom the general to the specific it seems that you have gone out of your way to not mention Chiropractic . . . is there any reason for this, other than the obvious ?
FROM TPP — obviously there were limits of space and time. I could give you a long list of things that didn’t get mentioned in all the stories. We focused on areas of practical concern to readers and treatments/practices backed by science,
— John WhitneyThis was a very nice guide. I doubt, somehow, that people will read everything and follow much of the advice. That is the way that most people are. As a nurse, I see it all the time. Most people don’t feel the symptoms of high blood pressure, so why take the medicine? Oh, that donut won’t hurt me. What is wrong with a few beers? You only live once…and on and on. The simple ways are still the best; eat your fruits and vegetables (organic if possible), don’t smoke, don’t drink alcohol to excess, wear sunscreen, walk a lot, get out into the sunshine and stretch your body daily. Brush your teeth twice a day, go to the dentist every 6 months, get a physical yearly, if you feel tired get to bed early,take a mutivitamin every day and drink water (not from plastic bottles). Take deep breaths several times a day and attempt to reduce your stress. Wear a seatbelt, slow down on the road and turn off the cell phone. And chill out once in a while, cause life does end, yes it really does, so enjoy it now while you can. Too simple? Well, maybe so, but proven to help. Also, if you do get a disease, and you may anyway, your body will be better equipped to handle it. And you may actually survive. If your body is a train wreck, then it will be harder for it to heal. The best advice is to use your common sense. Now, if only there were a guide for that…..
— Janice NelsonRegarding the quiz:
question #7 asks which drug is NOT used to treat an enlarged prostate. Since both ARE used then the correct answer should be NEITHER (neither is not used) not BOTH.
Or did I read it completely wrong?
— SpayPetsFROM TPP — You are right. We messed up, and will fix soonest. Thanks for letting us know!
Not sure that how often you should have your eyes checked is a question about your body, just a question of the professional consensus in your area. That does vary in the US, and across the first world nations. Same with pap smears. The US has a much higher rate of cervical cancer than say, Australia, so you are recommended to get pap smears every year whereas we are told only ever 2 years (and we still have fewer cases of cancer). There are reasons specific to different places for different policies, it isn’t really a body question.
In the pap smear case it is a combination of a lower rate of disease and a national register of pap smears - so even if you change doctors you will be sent a reminder every 2 years. It is pretty efficient, I had one in each of consecutive years once but it didn’t mess up and send me two, it just sent it 2 years after the last one.
— JillyFlowerI had to laugh when I read in one article that even one glass of wine increased breast cancer risk while another article stated that drinking moderate amounts of alcohol decreases one’s risk of dying in a given year! I think a great deal remains unknown about the mysteries of disease. While healthy eating and exercise is certainly a good thing, it is not a panacea.
FROM TPP — Both articles stated that drinking wine raises a woman’s breast cancer risk.
— SEAOur bodies are made of cells. That is where illness and disease start and that is where disease and illness can be primarily prevented
and stopped.
Healthy cells supported by healthy behavior can stop and slow “normal” aging and allow a vibrant life before that cellular dysfunction overwhelms our cells. We start to age at birth so the effort to stop and slow “normal” aging needs to start then, not at some artifical milestone (30, 40, 50, 60). Living in healthy ways should begin at birth, not at age 40.
What should we do to live a long and vibrant life?
The answer is that we are not sure because our efforts in research and the education of medical doctors is geared toward diagnosing and treating disease, not in advancing wellness, health and primary prevention. We react to this situation by retelling personal stories to prove a point. But we do not have consistant, documented, scientific research to support our stories. Therefore, the “Doubting Thomas” effect comes into play with each person claiming knowledge that others can as easily deny. That process moves nowhere and is used to continue the status quo.
So, we need to counter this objection by developing new directions 1) in research to study primary prevention and life style impacts; 2) by applying the findings of that research through effective, motivating education of the public; and 3) by creating a new breed of primary prevention, health and wellness practitioners whose roles include teaching, supporting and showing us how to primarily prevent disease and illness based on that research.
It is clear that we need new directions because the over $2.2 trillion we spend in America for medical care received (MCR) is no longer affordable, sustainable, consistently safe or as effective as we want to believe. MCR is one of the few areas where just about everyone is dissatisfied except the vested interests that as a cancer profit under the present dysfunction.
We now have the incentives-social and economic reasons and other ingredients-to take new directions. Now would be a good time to act.
— ed gComment #4 by Janice Nelson should be matted and framed. Excellent contribution!
— Mark ForstnegerIn the section concerning breast health the author writes that “having high breast-tissue density can drastically raise your risk of developing breast cancer,”—what exactly does “drastically” mean? That seems so vague and scary. Is there a certain percentage, or something quantifiable?
FROM TPP — Risk is about five times higher for women with dense breasts. So an average 50 year old woman has about a 3% 10 year risk for breast cancer — that jumps to about 15% if you have particularly dense breasts. Here’s a link to a New England Journal of Medicine study that explains more.
— Katharine# 6 raises an interesting point that is often confused. Tests that are designed to detect some indicator of a disease should not be confused with primary prevention. They are just detectors. The artifical date of detection is not the actual date the dysfunction started. This is important because early detection of dysfunction is not the same as producing effectiveness in treatment, a claim sometimes made by the misuse of “survivor” rates.
In Austalia, says the author, certain tests occur less often than in America. That seems sensible because other factors have determined the frequency of the dysfunction to be less than in America. Those factors, not the test determine the frequency of the dysfunction. Obviously, Australians are doing something to reduce their cellular dysfunction when compared to America. This comparision certainly argues for more research into life styles and efforts to improve wellness and health.
Many Americans have been taught to believe tests are the equivalent of prevention. That unfortunately is not the case. As unfortunately, many of those tests as we have seen from other “Well” pieces are heavily laden with fear, of the possibility of false and real positive findings, the anticipated adverse impact of treatment, less than favorable outcomes (rarely cure), limited quality and life after treatment and the financial costs.
One part of our body is the brain and one less physical aspect is the mind. We do know that some research indicates that a healthy body is associated with a healthy, positive mind. Fear driven tests are in themselves not healthy in this regard.
We have a great deal to learn. A new direction in funded research and education for better health and wellness is needed. Americans should support a new direction.
— healthinfoIf I may reply to your reply (#7) with all due respect: the lifestyle change recommendations in both articles contradict one another. I do not want breast cancer (so I should not drink) and I want to live longer (so I should drink.) What should I do?
— SEAHealthinfo - if you have a much higher incidence, especially due to unknown factors, then I think that more frequent testing is warranted. But it isn’t a comment on our bodies, it is a comment on our environment (ie where we live, what our gene pool is). I can’t really speculate on why Americans have much more cervical cancer. Perhaps it correlates with higher teen pregnancy rates (ie you have sex younger)… perhaps not.
— JillyFlowerBy the way I was repeating what a gynae told me (whose wife is a researcher in the field), but it seems to be true which is a bonus.
http://www.mja.com.au/public/issues/185_09_061106/wai10809_fm.html
— JillyFlowerWell I started slow but worked back up to a B+. I think this is valuable and think it would be a nice thing to see on a semi regular basis with different subjects or areas of specialization. Anything we can do to improve our odds of keeping our health on track is valuable.
http://www.aftercancernowwhat.wordpress.com
— KateThis is great information - we have shared this with our facial plastic surgery patients through a link on our blog (www.kochmd.com). Facial plastic surgery involves the entire person - we look to inspire our patients to consider total wellness of body and mind before, during and after medical treatments - whether elective or not. Thank you!
— Daphne ChristensenI agree, entry #4 says it all!
http://www.kochmd.com
SEA:
I think your question is disingenuous.
We should all know by now that there’s no ‘magic bullet’ for everyone. We have to take family history, early habits, body type, health issues, and environment into account. ‘A glass of wine’ isn’t going to magically change your life one way or another, and I think you knew that and were just picking nits.
Common sense and the research with which we’re daily inundated would suggest that if you have other risk factors for breast cancer, like a family history or other medications, you would consider your breast cancer risk a primary factor in your other healthcare decisions. You would say, “Hmmm, a daily glass of wine reduces my risk of certain diseases and illnesses, but increases my breast cancer risk. As I am at a low risk for heart attack and stroke and a higher risk for breast cancer, I’ll weigh my healthcare decisions based on an understanding of my own health, and not drink that glass of wine.” Whereas, I would say, “I have no family history of breast cancer and have taken no medications that increase my risk. A daily glass of wine decreases my risk of certain conditions which I do have in my family history, so I will consider my healthcare decisions based on an understanding of my own health, and drink that glass of wine.”
Everything, in some way, increases and decreases a health risk. Wine, green tea, red meat, bottled water, multivitamins, exercise. You look at your *OWN* health and you figure out what your risks are and you tailor your *OWN* medical decisions based on an understanding of risks and concerns related to your health.
I get very frustrated with people who say to me, “I take eleven different pills and eat four specific foods every day because they all prevent cancer.” A balanced, reasonable, moderate diet in combination with regular exercise is healthy for almost everyone, but we’re all going to need to be grownups about it, learn about our own health risks, and figure out what exactly a balanced, reasonable, moderate diet is going to mean for us, and how much exercise is ‘enough’ without risking injury.
People who want magic “take this pill with a glass of wine every day and you’ll never get cancer/Alzheimer’s/Parkinson’s/heart disease” solutions don’t seem to understand that when we talk about increased and decreased risk, it’s very rarely substantial enough that every single person on the planet would absolutely and unquestionably benefit from making a certain healthcare choice.
Healthcare’s not one-size-fits-all. An antibiotic may be a great treatment for strep throat, but it’s kind of ineffective for a sprained ankle. Prevention is the same way. You can’t prevent everything, so you look at the things you already have risk factors on, and make those your primary concern while trying not to go too far afield on other health issues.
— RowanThe article on breast cancer risk is interesting but not very helpful. It suggests that we can reduce our risk of breast cancer but there is no specific information on how much individual risk factors - such as known genes (not mutable), reproductive history (mutable or not depends on a. current age, b. on complicated life choices - reproduce? at what age? breastfeed? and for how long? etc etc), c. individual biology - age at menarche and menopause), alcohol consumption, and hormone use (no mention of oral contraceptives!) - interact to affect risk.
Even I as an epidemiologist have no idea whether women with an identified genetic risk can raise or lower that risk by life choices. How much does alcohol add to anyone’s risk? Does it have more or less effect than early childbearing (good) or late childbearing (bad)?
Life is complicated. Really, how many young women will decide to have children early in life because that will decrease (but not eliminate) their risk of breast cancer? In all the public talk about “teen-age childbearing” no one points out that it can have the effect of reducing breast cancer risk. And for women choosing to have their first child well into their 30’s who’s banging the drum saying that that choice may increase the risk of breast cancer more than remaining childless?
Not so long ago hormone replacement therapy was highly touted as a preventive for heart disease and osteoporosis. Who was even paying attention to breast cancer?
In my own circle of friends and family I know 2 women who had children early, around age 20, were slender and then had pre-menopausal breast cancer. Others with post-menopausal breast cancer were all slender, some probably drank, some didn’t.
I think I’ll keep enjoying my nightly glass or two of wine, keep my heart risk under control and take pleasure in life. I had my first child at 24, breast fed her and her brother. Never took HRT.
— Colleen ClarkI would like to say thanks to Rowan for really stating what I was thinking well (You do seem to do that a lot!). I am a health services researcher and my friends are always asking me what they should not to get sick. They don’t understand exactly what Rowan points out–that it depends on your family history, personal history, environment, etc. Not only is there no one size fits all, but there is no guarantee. You can never fully prevent yourself from getting sick. The best you can do is take good care of yourself and weigh the risks and benefits of things based on your own situation. These recommendations are all population based and may or may not really apply to you.
— LisaThe head-to-toe guide was informative and fun! I’m curious about the source of those great vintage illustrations: “E. J. Stanley, 1901″. Can you give any more information about where these come from?
Readers who liked those pictures might also enjoy the recent work of artist Megan Canning, whose wonderful embroidery/applique interpretations of vintage medical illustrations will be featured in an exhibition at the Pink Elephant Projects gallery in Brooklyn, opening on May 16: http://www.pepgallery.com/pages/news.html (I’m not connected with the gallery, just a fan of its artists!).
— TerryFROM TPP — Unfortunately I don’t think we have much more information than that. They came from an amazing book with layers and layers of images. If I learn more I will post more information here.
Rowan,
I understand and agree with your point. My criticism is not aimed at the journalism, but rather at the daily reports of studies which tell people things to do, to avoid, etc. There was nothing insincere about my posts. There are limits to the nature of discourse on web blogs.
All the best,
— SEASEA
Regarding the wine issue; sometimes we should do things simply for the pure enjoyment of it. Perhaps that is why the French are healthier. They do not worry that their risk of breast cancer may increase because they enjoyed a glass of wine. They simply do things in moderation. Our society is too consumed by “bigger is better” and “will this make me healthy?”. We should be more concerned with putting a smile on our face once in a while by something that we enjoy.
Mary Poppins once famously said, “Enough is as good as a feast”. Maybe we should rely more on her judgement than all the so called experts out there. Just a thought.
BTW, drinking water from plastic containers is much more estrogenic than wine will ever be. Increased estrogen=increased breast cancer risk. So, pick your poison. Use common sense and smile anyway!
— Janice NelsonThis is a very nice health guide for the general public, except for a very egregious and glaring omission–colon cancer screening. The facts are: colorectal cancer is the second most common cause of cancer deaths in this country; it affects BOTH sexes; in those who are properly screened, the risk is reduced by about NINE-FOLD. In fact, the historic reductions in incidence of all cancers that we see over the past few years are largely attributable to decrease in this largely preventable disease. I think you would do your readers a much greater service by including what we already know about colorectal cancer and the proven preventative strategies.
— meThe cause of all disease is being born. In fact being
— Rachel Englerborn causes 100% mortality. So to avoid illness and death all you have to do is not be born.
The quiz item about physician recommendations for frequency of eye exams is not a question about the human body. It is a question about physician recommendations, which may change with fluctuations in the state of science and the income needs of physicians!
— Celia