The Power of Prevention

At around age 50, Kristin Fish felt that she had to start taking her health seriously.

She was always active, but her interactions with doctors were mainly limited to visits to an urgent care center when she was sick. Because of that, Fish, a Bend commodities trader, had never put much thought into what was going on inside her body.

But Fish had a change of heart.

“Especially for women my age, there is a lot of stuff that changes that you can do something about,” said Fish, who is now 57 and is a single mother of a 15-year-old son.

“I don’t really feel like leaving my son without a mom,” she said, reflecting on what motivated her to seek help from a doctor. “I’d rather know more and spend more time preventing.”

Fish enlisted the help of Dr. Evelyn Brust, a naturopathic doctor who runs the Preventative Medicine Clinic in Bend. Though Fish was in generally good shape, her genetic makeup had predisposed her to high cholesterol.

Brust did not prescribe an anti-cholesterol drug. Instead Brust suggested Fish take supplements such as fish oil and niacin and put her on natural hormone therapy, which Brust considers a building block to preventative health for older adults. And at the suggestion of Brust, Fish also made modest adjustments to her lifestyle, such as paying closer attention to her diet.

Even modest changes can yield results.

“It brought my cholesterol all the way down to normal and healthy without using any pharmaceuticals,” Fish said.

Like many patients, Fish had been treating her health reactively, focusing on treatment of symptoms or illness instead of working to prevent them before they ever became a problem. Now she is learning first-hand the power of preventative medicine.

The notion is nothing new. Preventing disease before it develops can save money, increase productivity, and of course, lengthen lives. But the problem as Brust sees it is that few patients know much about preventative medicine.

“There is such a misunderstanding about what preventative medicine is,” said Brust, suggesting that prevention is a combination of lifestyle choices, healthy relationships and knowledge of one’s own body.

And the effects of proper prevention are real, Brust said.

“If you look at where some of these people have been and where they are now, it’s a miracle,” Brust said. “And it is so satisfying as a doctor.”

The cost savings of preventative care are not universal, but there can be real savings with “preventable causes of death, such as tobacco smoking, poor diet and physical inactivity, and misuse of alcohol,” according to a 2008 Tufts-New England Medical Center Study in the New England Journal of Medicine.

Preventative medicine can also help patients live longer, more productive lives. And much of preventative medicine does not require a medical degree to implement.

“I think prevention is mostly about lifestyle and choices,” said Dr. David Holloway, chief medical officer at Bend Memorial Clinic and a former practicing family physician. “A lot of disease can be stopped before it even starts with proper exercise, it doesn’t even have to be a lot, even 20 or 30 minutes of walking each day. Eating right, less sugar and more vegetables and fruits. Eating in moderation.”

The health benefits of regular physical activity (at least 150 minutes a week) helps reduce the risk for cardiovascular disease, Type 2 diabetes, metabolic syndrome, and some cancers. This is in addition to helping to control weight, strengthening bones and muscles, and improving mental health, according to the Centers for Disease Control.

Of course, there is a bit more to it. Knowing a patient’s body (using tests such as blood labs to get a baseline) and how genetics factor in with each patient is important, too. So is building healthy relationships, Brust added.

“Prevention is a philosophy,” said Brust. “It’s how you live. It’s like when we ride bikes, we wear helmets because we don’t want to have a brain injury if in fact we’re going to have a bike crash.

“Health and disease prevention is multi-faceted, yet it’s not that complicated.”

In fact, many naturopaths such as Brust and medical doctors such as Holloway agree on the majority of prevention measures.

What can be done?

Regular movement is critical to living a healthy lifestyle, and it doesn’t have to mean two hours a day in the gym. Bicycling, kayaking, playing tennis or going on a hike all provide significant heart-healthy benefits. And studies show that simple movements like walking a dog can be significantly beneficial. An activity-rich life can also reduce the chances of knee and hip replacements later in life, Holloway said.

Eat whole, preferably organic, foods. Spend your time shopping on the outer edges of the grocery store, where fresh produce, meats and fish are typically found.

“You want to avoid the processed foods, because that’s where you’re going to get the sugar, excess salt and chemicals,” Holloway said.

Drink plenty of water and stay hydrated. (No, coffee does not count.) Brust does not offer a specific guideline on how much, suggesting to “drink to thirst.”

“Most people don’t drink enough, not even two or three cups (a day),” Brust said. “Most of us can do better.”

Strive for regular, uninterrupted sleep. The National Sleep Foundation suggests adults need seven to nine hours of sleep per night. And Brust suggests that in a night a person needs at least four hours of deep, uninterrupted sleep as part of a full night’s rest.

Build healthy personal relationships in your life. A lack of such relationships increases the risk of premature death from all causes by 50 percent, according to a Harvard Women’s Health Watch report.

“Friends, social life, personal relationships, they all go into the same category,” Brust said. “You don’t have to a have a lot of friends, but having that special guy you go skiing with or that girlfriend you can go to coffee with — it can be a family member — that emotional connection is so critical.”

Build a solid and trusting relationship with a primary doctor, who can then run the right tests and get to know your body specifically.

“Pick a doctor you trust and stick with him,” Holloway said. “I think that healing relationship is therapeutic in itself. Not just catching things early, but I think there is something about the longstanding relationship with a provider you trust that helps things.”

Full blood panels, measuring such things as cholesterol and blood sugar levels, play a crucial role in long-term health. And a patient should get one early, around at least college age, to set a healthy baseline when the body is still optimal, Brust said.

“So that in three years, five years, 10 years, no matter what they will know what they were when they were optimal,” Brust added.

The baseline helps alert a doctor to any changes in the body chemistry that must be dealt with.

Periodic exams are important for everybody, and at age 40 men and women should have more frequent exams. If a patient has a family history of say, heart disease, then more frequent exams might also be beneficial, even before age 40.

“If something is going a little bit sideways we can catch it in that annual exam,” Brust said.

At age 40 patients should take the proper tests to establish a baseline. This includes a bone density scan (to catch signs of osteoporosis, for example), coronary calcium scoring and some cancer screenings for cancers such as colon cancer.

Track your body fat index. It seems obvious, but generally speaking the leaner you are the healthier you tend to be.

According to a Harvard study that tracked more than 50,000 men and 120,000 women over 10 years, obesity increased the risk of diabetes 20 times and substantially boosted the risk of developing high blood pressure, heart disease, stroke, and gallstones. Of those in the study who were overweight, there was also a direct relationship between body mass index and risk. Simply put, an increased BMI increased the chances of disease.

“If you just do all the lifestyle things (on the list), you’re going to take care of a huge percentage to having a happier, healthier life, and probably extending your life,” Holloway said. “You’re certainly going to feel a lot better.”

It seems to have worked for Glenn Whittington, a 44-year-old from Bend. Two years ago, Whittington was taking seven prescription drugs, including antidepressants. His weight had ballooned to 238 pounds and he felt generally weak.

He enlisted the help of Brust, and he immediately began to alter his habits. Now he no longer takes prescription drugs and he lowered his weight to 194 pounds.

“He’s done massive lifestyle changes, gotten off a whole bunch of medications, including statin drugs for heart disease,” Brust said. “He’s completely changed his life and his lifestyle and it’s been really fun to see.”

Whittington is now a true believer in the power of preventative measures.

For him, it is just the start to a life spent doing the right things to help him not only live longer, but live a healthier and more energetic life.

“I haven’t felt better in forever,” Whittington said. “My ultimate goal is to not rely on pharmaceuticals. When I get old, I don’t want to spend my fortune on pharmaceuticals. I want to be as natural as possible.”

Fish shares the same goal.

For her, she wants to stay healthy and active as long as she can. And there is only one real way to give herself the best chance.

“It’s common sense, right?” Fish said. “If only all of us it would follow it, and I am not saying I am perfect. Trust me.

“But if I do all these things, and also enjoy a great craft beer, then I’ll be OK.”