Live a Little!

Chapter One
The Myth of Perfect Health


What woman can't rattle off a list of to--do items for healthy living? Exercise for a healthy heart; train with weights to build muscle and bone; stretch to maintain mobility; eat meals that are carefully designed for good artery and bowel function; drink one glass of red wine daily to avoid heart disease; resist the temptation to drink two glasses of said wine to avoid breast cancer; get a full night’s sleep to promote immune function; expose the skin to sunlight for ten minutes to absorb vitamin D, then immediately apply sunscreen to avoid skin cancer; relieve stress to strengthen the immune system; build a social support network to ward off Alzheimer’s; book appointments with our mates for healthy sexual pleasure; and, of course, maintain a body mass index that falls exactly within the “healthy” range listed in every women’s magazine.

And don’t forget the Kegels.


This list is so impossible that it leaves most women either consumed with panic or doubled over with laughter. Yet if you have picked up this book, chances are you feel at least some obligation to follow what we’ll call, with more than a dab of irony, the “health rules.” The individual rules themselves may change with unsettling frequency—by the time you read this book, at least one of the rules we listed will probably be out of date—but one thing remains constant: Every time you turn on the television or read a magazine, you are bombarded with a highly specific set of dos and don’ts for staying healthy. Of course, you want to be healthy. And if you do get sick, you definitely don’t want people to say, in an accusing tone, “She brought it on herself, you know, because she -didn’t eat enough broccoli.” So you try.


But despite earnest efforts to follow these rules, you probably find it tough-going. Maybe you’ve experienced the “what the hell” effect. I’ve been “bad” and eaten a cookie. What the hell, I’ll eat the whole bag. Or: There’s no way I can exercise for sixty minutes every day. What the hell! I won’t exercise at all. Or perhaps you’ve done your level best to follow every piece of health advice and then been riddled with a sense of failure when you fell short. These experiences are common—all too common, we believe. The health rules, which are supposed to help us live longer and live better, have become a source of pressure, guilt, and stress. This is not a healthy situation.


We’ve written this book as a corrective to the narrowly laid--out health rules; in their place, we’ll offer a more relaxed definition of both health and health habits. You might argue that we’re exactly the kind of people who ought to be vigorously defending the conventional rules, not questioning them. And, yes, we’ve both devoted our lives to bettering the health of women. Susan is a breast cancer surgeon; the author of books about menopause and breast health; and president of the Dr. Susan Love Research Foundation, an organization dedicated to ending breast cancer. Ali is a psychologist and author specializing in women’s health; the head of the Domar Center for Mind/Body Health; the director of Mind/Body Services for Boston IVF; and an assistant professor of obstetrics, gynecology, and reproductive biology at Harvard Medical School. We’re both part of BeWell, a team of health care professionals at the forefront of helping women live healthier lives.


In our jobs, we rarely encounter women who blithely ignore the health rules. Instead, we see women who are overwhelmed by them. So we decided to review the evidence for the health rules, sifting through piles of data—and guess what? We’ve come to believe what you have probably suspected all along: These rules are a little rediculous. They are unrealistic, and, worse, their scientific foundation is often shaky. We’re frustrated that you are made to feel guilty or hopeless when you can’t conform to impractical and sometimes unsupported health guidelines. And we suspect that there are negative health consequences of worrying about your health all the time!


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Great News: You Don’t Have Total Control Over Your Health


We’d like to help you take on the health police—you know, those well--intentioned but literal--minded policy makers, television experts, magazine writers, personal trainers, and neighbors who make you feel like a lawbreaker every time you eat a gram of saturated fat. But to do this we have to address a difficult truth, which is that we don’t have total control over our health. For too long, we’ve all been coached that if we follow certain health habits we will create a kind of protective bubble around our bodies, one that instantly deflects chronic diseases such as arthritis and hypertension. Pain--free and feeling great, we’ll sally forth into old age with our bubbles intact, our bodies fortified by perfect diets and exercise regimens. The big nasties—cancer and heart disease—won’t stand a chance against our flexible arteries and robust, well--regulated cells. Finally, at the age of 110, we’ll say a moving good--bye to our loved ones and die peacefully in our sleep.


Sorry, but health -doesn’t work like this. Although there are habits clearly associated with premature disease, there are some determinants of illness and death that are beyond our control. (As the stress humorist and BeWell member Loretta LaRoche likes to say, those health nuts are going to be really surprised when they die of nothing.) All the yoga and stress reduction in the world might not be enough to counteract a genetic tendency toward, say, back pain. Or from being hit by that favorite morbid cliché of mothers everywhere, the city bus. On the other hand, we’ve all read the stories about one--hundred--year--old ladies who attribute their long lives to a diet of unfiltered cigarettes and butter. A true understanding of health takes into account the very real presence of luck, both bad and good.


But, you might ask, isn’t there evidence showing that we can control our health by engaging in good habits? Well, if you poke at some of this evidence, you’ll find it doesn’t take long for that “total control” illusion to pop. For example, studies show that people who eat lots of fiber are less likely to develop heart disease than people who don’t. What those studies don’t tell us is whether the fiber--eating people live any longer. Do they have more years in which to enjoy life? Or do they simply die at the same age of an alternative disease, perhaps one that is not as mercifully quick and relatively painless as a heart attack? If they do live longer, are their lives any better, or are the added years spent in disability, senility, and depression? We simply don’t know.

What we do know is that the health rules can mislead you into halfway believing that if you eat only the right things, or exercise in the proper way, you can escape not just run--of--the--mill illnesses but death itself. This way of thinking leads to a distorted set of priorities: Instead of trying to be healthy so that you can enjoy life, you squander your happiness in the pursuit of more health. But as Nortin Hadler, a professor of medicine at the University of North Carolina, points out in his book Worried Sick, “The death rate is one per person.” We can’t stop death, not even with oat bran.


Bleak news, yes. When you realize, though, that health is not under your total control, a lot of guilt and stress slide off your shoulders. It no longer feels as if your very life depends on how frantically you monitor your nutritional intake, exercise habits, and stress level. Better still, you can trade in your illusion of becoming perfectly healthy for something much more fun: being pretty healthy. Pretty Healthy means, first of all, that your health habits contribute to, not distract from, your enjoyment of life.


When you’re Pretty Healthy, you live in such a way that you don’t bring untimely disability or death upon yourself. You have sufficient supplies of energy, and you’re free from obsession about the state of your body or your mind. Although you may suffer from illness now and then, or even develop a chronic health problem like osteoarthritis, you can still be Pretty Healthy if you take pleasure in life most of the time and possess the general sense that you can cope with the challenges that come your way.

There is good reason to think that pretty good health encompasses a much wider set of behaviors than we’ve been led to believe. We don’t have to achieve maximum vegetable consumption or get eight straight hours of sleep every night to “get it right.”


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Where’s the Evidence?


In the chapters that follow, we’ll look at six areas—sleep, stress management, health screenings, exercise, nutrition, and personal relationships—that are the subject of many a health rule. Some of these rules are based on excellent evidence. But many are not. Plenty are based on scanty evidence or even bald corporate interest.


This is a sorry situation, but not a new one. Take a quick glimpse back at the past decade of health journalism, and it’s easy to think of examples of health fads that rose on a wave of conjecture then receded when someone finally pointed out a lack of evidence. Just a few years ago, you -couldn’t open a newspaper or magazine without reading about the importance of drinking eight glasses of water a day. Told they were in constant danger of dehydration, the women of America (and many of the men, too) toted around giant bottles of fancy, expensive water. Then the Institute of Medicine reviewed the clinical literature and discovered there is absolutely no evidence for the eight--glasses--of--water--a--day theory. It’s hard to know how the original myth got started, but it’s impossible not to note that bottled-water companies profited immensely.

Or take hormone replacement therapy (HRT). Actually, don’t take it. When Susan published books and articles that questioned the widespread use of HRT for menopausal women—arguing in particular that there was not enough evidence to draw conclusions about either its benefits or its safety—she was attacked by both colleagues and the press. (One memorable article, published in the New Yorker, was entitled “How Wrong Is Susan Love?”) Then, in 2002, the first large--scale study of these treatments was halted before its completion, because clear evidence was already in: HRT not only fails to offer protection against heart disease and Alzheimer’s, it increases the risk of breast cancer.


Now the time is ripe for examining other claims that are promoted as hard fact. Do we really need to eat a cup of blueberries every day? Must we exercise an hour daily, as the U.S. government announced in 2005? Is it necessary to have a baseline mammogram at age thirty--five? The answers are no, no, and no!


In the pages to come we are going to challenge the evidence for several health rules. But our point is not that we should give up on science entirely; instead, we should lighten up. The scientific method remains our best method for understanding what makes us healthy and what makes us sick. Sometimes the evidence is incomplete, but that’s okay, because you are capable of making good judgments based on incomplete evidence. You do it every day when you make decisions about what to buy; the best route to work or school; and how to raise your children, if you’ve got them. Although the current medical evidence does not justify the kind of persnickety behaviors demanded by the health rules, you can still draw on a combination of the existing science and good judgment to determine which type of actions are probably Pretty Healthy. This rational process is what led us to the Pretty Healthy Zone.