Why Is It Hard To Live Healthy?

Why is it so hard to live healthy?

The Happy Hospitalist recently pointed out that we could prevent 80% of premature death by following some very basic health rules: don't smoke, eat healthy, exercise often, and don't get fat. He then notes out that only 10% of people do all four. Happy says the other 90% of us are “fat smoking lazy food-junkies,” and he doesn't want to pay for healthcare for such stupid people.

Are Americans really that stupid? No, but we do often ignore the basic rules of healthy living. Why? We learned this stuff in health class as kids, but why is it so hard to actually do?

The answer lies in history. The diseases that kill people now are not the same ones that threatened our ancestors. The human mind comes pre-programed with survival instincts for a completely different world. Up until just a few generations ago humans survived on the edge of starvation. Life involved a lot of work and there was barely enough food to go around. Starvation ended the lives of millions, and the many malnourished were at much higher risk from death when confronted with infection or violence. These things killed our ancestors far more often than heart disease or cancer.

The human body is built to live on low-calorie high-fiber foods while doing a tremendous amount of physical exertion—bodies always need these “healthy” things, but your ancestors never needed to look for them any more than they needed to look for oxygen.

The human mind, however, is finely tuned to constantly search out high calorie foods and ways to avoid strenuous work. Your ancestors didn't find these luxuries often, but they were constantly striving for them. An avoided exertion or a caloric meal could make the difference between life and death.

Only in the last 100 years or so have we reached a point technologically in the US where high-calorie foods are unlimited and a person can go indefinitely without any real exercise. We created the world in the shape of our instinctual desires and now it is killing us.

But our brains did not change quickly like the world around us. Your mind still works like that of a sustenance farmer preparing for a long winter. When millennia of human survival instincts tell you to skip the work-out and eat seconds you cannot help but pay attention. Happy Hospitalist threatening you with cutting you off his insurance plan isn't going to change your behavior much. You don't even really worry about getting heart disease in a few decades either, your brain is much more preoccupied with that famine it keeps expecting to show up.

Doctor D has never found that name-calling or threatening people with premature death does much to motivate them to live healthy. When doctors order people to eat better and slim down patients often go to crazy quick-fix diets that usually do more harm in the long run. It is just difficult for the human mind to accept a healthy lifestyle that runs contrary to our instincts.

Doctor D is not saying lifestyle change is impossible, but that it is difficult. Change requires understanding and respecting the power of instinctual drives. Most people who eat too much and avoid exercise don't even know why they do what they do. Doctors commanding patients to "just live healthy" is about as useful as telling an addict to just stop getting high or a depressed person to just cheer up.

Instincts have a strong influence on us, but they are not irresistible. It takes significant motivation, insight, and encouragement to resist the power of survival instincts. Doctors who understand this will do more for their patients' health than doctors who simply order patients to be healthy.

Masking Drug Use

As previously mentioned, diuretics can be used to reduce the presence of drugs in urine samples. Other compounds, including epitestosterone, plasma expanders and secretion inhibitors, can be used to reduce the presence of banned substances in blood samples.

Epitestosterone
Epitestosterone is a biological form of testosterone that does not enhance performance. Drug tests for testosterone typically measure the ratio of testosterone to epitestosterone (T/E ratio). An athlete can inject epitestosterone, lower the T/E ratio and hide the use of testosterone. By itself, epitestosterone has no real harmful side effects.

Plasma Expanders
Plasma expanders are substances that are used to increase the fluid component of blood. They are used to treat victims of shock, trauma and surgery. Athletes can use these substances to dilute the concentration of banned substances (EPO) in their blood. Most side effects include moderate to severe allergic reactions.

Secretion Inhibitors
Many drugs and foreign substances have structures that are shaped like organic acids. In the body, these organic acids are removed by a protein in the kidney that transports organic acids. If this protein can be blocked, then these drugs or foreign substances would not appear in the urine. Doctors use these inhibitors to treat gout. However, the drugs can be used to manipulate the results of urine drug tests. Possible side effects include nausea, vomiting, allergic reactions and kidney problems.

Masking Pain

What about Cortisone? Cortisone is one of the adrenal cortex hormones. Clinically, it is injected to reduce inflammation in injuries and allergic responses. The advantages and side effects of its use are the same as with ACTH.

Along with training and performing to be a world-class athlete comes the pain of injuries. Sometimes, athletes try to mask their injury pain with drugs, including narcotics, protein hormonesand local anesthetics.

Narcotics
Narcotics are used to treat pain and include substances such as morphine, methadone,Vicodin, Percocet and heroin. Narcotics are highly addictive, and the "high" associated with their use can impair mental abilities such as judgment, balance and concentration. Also, athletes who continue to compete with an injury run the risk of further damage or complications.

Protein Hormones
Adrenocorticotropic hormone (ACTH) is a naturally occurring protein hormone that is secreted by the pituitary gland and stimulates the production of hormones from the adrenal cortex. These adrenal cortex hormones are important in reducing inflammation in injuries and allergic responses. So, by using ACTH to stimulate internal adrenal cortex hormones, an athlete could mask an injury. Possible side effects include stomach irritation, ulcers, mental irritation and long-term effects (weakening bones and muscles).

Local Anesthetics
Local anesthetics, like those your dentist or doctor use, are used to mask pain in the short-term without impairing mental abilities. They include novocaine, procaine, lidocaine and lignocaine. Athletes may use them so that they can continue to compete while injured. The major problem with their use is the possibility of further aggravating an injury.

3-Building Mass and Strength

Mass- and strength-enhancing drugs used by athletes include:

• Anabolic steroids
• Beta-2 agonists
• Human chorionic gonadotropin (HCG)
• Luteinizing hormone (LH)
• Human growth hormone (HGH)
• Insulin-like growth factor (IGF-1)
• Insulin

Anabolic Steroids
A steroid is a chemical substance derived from cholesterol. The body has several major steroid hormones -- cortisol and testosterone in the male, estrogen and progesterone in the female. Catabolic steroids break down tissue, and anabolic steroids build up tissue. Anabolic steroids build muscle and bone mass primarily by stimulating the muscle and bone cells to make new protein.

Athletes use anabolic steroids because they increase muscle strength by encouraging new muscle growth. Anabolic steroids are similar in structure to the male sex hormone, testosterone, so they enhance male reproductive and secondary sex characteristics (testicle development, hair growth, thickening of the vocal cords). They allow the athlete to train harder and longer at any given period.

Anabolic steroids are mostly testosterone (male sex hormone) and its derivatives. Examples of anabolic steroids include: testosterone, dihydrotestosterone, androstenedione (andro), dehydroepiandrosterone (DHEA), clostebol, nandrolone.

These substances can be injected or taken as pills. Anabolic steroids have a number of possible and well-known side effects, including: jaundice and liver damage because these substances are normally broken down in the liver; mood swings, depression and aggression because they act on various centers of the brain.

In males, the excessive concentrations interfere with normal sexual function and cause baldness, infertility and breast development.

In females, the excessive concentrations cause male characteristics to develop and interfere with normal female functions. The drugs can stimulate hair growth on the face and body, suppress or interfere with the menstrual cycle -- possibly leading to infertility; thicken the vocal cords, which causes the voice to deepen, possibly permanently; interfere with the developing fetus in pregnant women.

Beta-2 Adrenergic Agonists
When inhaled, beta-2 agonists relax the smooth muscle in the airways of asthma patients by mimicking the actions of epinephrine and norepinephrine, substances that are secreted by sympathetic nerves. However when injected into the bloodstream, these drugs can build muscle mass (anabolic effect) and reduce body fat (catabolic effect). The anabolic effect appears to directly affect building proteins in the muscles, which is independent of nervous or cardiovascular effects. Some examples of beta-2 agonists include:

• Clenbuterol
• Terbutaline
• Salbutamol
• Fenoterol
• Bambuterol

Some of these substances are permitted in inhaler forms with written medical consent.

The major side effects include: nausea, headaches and dizziness because these substances constrict blood vessels in the brain; muscle cramps because they constrict blood vessels in muscles; and rapid heartbeats or flutters because they stimulate heart rate. We'll look at human growth hormones in the next section.

2-How Performance-enhancing Drugs Work

Why Some Athletes Use Drugs

Athletes face enormous pressure to excel in competition. They also know that winning can reap them more than a gold medal. A star athlete can earn a lot of money and a lot of fame, and athletes only have a short time to do their best work. Athletes know that training is the best path to victory, but they also get the message that some drugs and other practices can boost their efforts and give them a shortcut, even as they risk their health and their athletic careers.

As far back as ancient Greece, athletes have often been willing to take any preparation that would improve their performance. But it appears that drug use increased in the 1960s. The precise reason for the increase is uncertain, but we do know that anabolic-androgenic steroids were made available for sale during this period and the East German government began giving drugs to its athletes in an attempt to excel on an international level [source: The Guardian] [source: Sports Injury Bulletin]. Athletes may also misuse drugs to relax, cope with stress or boost their own confidence.

Athletes may have several reasons for using performance-enhancing drugs. An athlete may want to: build mass and strength of muscles and/or bones; increase delivery of oxygen to exercising tissues; mask pain; stimulate the body; relax; reduce weight or hide the use of other drugs.

The classes of drugs used for these purposes are shown above. Most of the drugs shown are banned outright in Olympic competitions. However, some of these drugs, such as cortisone and local anesthetics, are allowed with certain restrictions in Olympic competition because they have legitimate clinical uses. We'll look at each major class of drug and tell you about the dangerous side effects.

How Performance-enhancing Drugs Work

"If I could give you a pill that would make you an Olympic champion -- and also kill you in a year -- would you take it?" Dr. Gabe Mirkin asked competitive runners that question in advance of a Washington, D.C., road race in 1967. Of the approximately 100 athletes who returned Mirkin's questionnaire, more than half responded that they would take the pill.

The prevalence of performance-enhancing drugs in sports has increased in the 43 years since Mirkin, a physician and sports medicine expert, handed out his survey. The desire to win is, naturally, ever present while, at the same time, new research and technologies have expanded the number of options for cheating your way onto the podium. For example, today's performance-enhancing drugs come in many forms other than a pill ("the cream and the clear," a testosterone-based ointment described by accused athletes in court testimony, comes to mind), but the results they produce are still highly sought after. Professional cycling has been repeatedly rocked by revelations and allegations of drug use. Every two years as the Olympic Games begin, we hear about athletes using or at least being tested for performance-enhancing drugs. Major League Baseball is still trying to repair its image from the steroid era. And the list goes on.

Some athletes get away with using drugs; others wind up suspended from their sport or even in jail, and still others die prematurely. It's a risky and complex game within a game that plays itself out on a public stage. In this article, we'll discuss why some athletes take drugs, what the major classes of drugs and their side effects are, and how people test for drug use.

the Dangers of Sleep Deprivation

Recognizing the Dangers of Sleep Deprivation

If you regularly get less sleep than your brain requires, then you are, by definition, sleep deprived. Every year, thousands of sleep-deprived people are involved in automobile and industrial accidents, and their sleepiness is frequently cited as a contributing factor in the accidents. The National Sleep Foundation believes the problem is so pervasive that it has established a national Drowsy Driver education program to inform people about the dangers of driving while sleep deprived. But an increased risk for accidents is just one part of the consequences you may suffer if you continue to deprive your brain and body of the sleep they require to keep you healthy.

Problems associated with poor sleep

If you're sleeping poorly on most nights, you probably feeling pretty pooped. If you can keep your eyes open long enough, read through the following list of problems associated with chronic sleep deprivation.

If you're sleep deprived, you may:

• Age more rapidly

• Be more susceptible to colds, flu, and other infections

• Display an increased risk of accidents due to sleepiness and poor coordination

• Experience more emotional problems, including depression and anxiety

• Feel irritable and experience mood swings

• Forget important information

• Have reduced ability to deal with stress

• Increase your risk of obesity, heart disease, diabetes, and death

• Show poor judgment, poor concentration, and an inability to make decisions

Unfortunately, if you're stumbling around like a zombie during the day because you're sleep deprived, your sleepiness could pose a real danger for you and those around you.

Sleepiness and driving

U.S. roadways and highways are littered with the corpses of drunk and sleepy drivers and their victims. The National Highway Transportation Safety Association reports that sleepy drivers are involved in as many crashes as drunk drivers. And sleepy driving accidents tend to be more violent than drunk-driving accidents because even the drunkest driver has some sort of ability to react and respond to an emergency situation, even if that ability is impaired. A driver who is asleep doesn't react to the emergency situation at all because he or she is completely unaware.

Public awareness of drunk driving is high, but sleepy driving is barely on the radar. Sleepy drivers cause more than 100,000 traffic accidents every year, accidents that could all be prevented if everyone made sure they had enough sleep before operating a motor vehicle. According to the National Sleep Foundation, drowsy-driving accidents cause 1,550 unnecessary deaths, 71,000 injuries, and $12.5 billion in property losses and lost productivity every year. The National Highway Traffic Safety Administration reports 1 million accidents are caused annually by driver inattention. Two of the highest risk factors for inattentiveness behind the wheel are sleep deprivation and fatigue. Sleepy drivers aren't just putting themselves at risk by getting behind the wheel; they're putting their passengers as well as other drivers and their passengers at risk. They are also a threat to pedestrians.

People who drive for a living have an even higher risk of being in an accident while driving. Approximately 47 percent of all truck drivers report that they've fallen asleep at the wheel at least once during their driving careers.

Sleepiness and industrial accidents

The list of industrial accidents caused, at least in part, by sleepy workers in key positions reads like a "Who's Who" of disaster headlines over the past several decades.

Pilot fatigue and the resulting diminished judgment were given part of the blame for the 1999 American Airlines crash in Little Rock, Arkansas. Sleep deprivation was also involved in the accident with the Staten Island Ferry that crashed into the dock at full speed in October 2003. The assistant captain piloting the ferry made no attempt to slow the boat down because he was sound asleep at the controls. Many other disasters were caused by key personnel who made bad decisions because they were operating on too little sleep.

Many industries are finally waking up to the fact that allowing their employees to work with too little sleep is dangerous. However, just as many employers ignore the fact that humans require adequate sleep to function well. So for every intern program that now allows its young doctors to sleep six hours every night, you still have a program that pushes its doctors to perform on one or two hours sleep (or no sleep), and that lack of sleep can lead to serious medical mistakes. Even worse, these programs may require house staff to work back-to-back shifts with no break in between. Increasing pressure has come to bear on work schedules during medical training in the wake of several high-profile wrongful death cases.