The FDA just banned trans fat. The American Heart Association issued a statement that the move would prevent 20,000 heart attacks a year mirroring that made by the CDC. Where this number came from is a mystery. I suspect they made it up after a series of extrapolations from metabolic data to epidemiological conclusions based on no epidemiological studies. Professional societies do this all the time. Will eliminating trans fats from a healthy person’s diet (note healthy) reduce his likelihood of a heart attack? While many of my colleagues express no doubt that it will, the correct answer is that no one knows because the data needed to justify such a conclusion haven’t been assembled. I’ve already written about this subject and you can read it here.
You must have noticed that medical recommendations are constantly changing. A big reason for this perpetual mutation of “good” medical advice is that doctors in their zeal to do good or just boss people around cannot resist getting ahead of the data or forgetting the basic principles of scientific method.
Most of the advice aimed at healthy people has an effect which is at best at the margins of good health and which if ignored will have little effect on overall well being. Again, I am writing only about healthy people. Those with chronic disease need to be under the care of a physician and to follow his advice about their health.
Let’s start with a healthy diet. Is their such a diet for a healthy person who is anywhere near ideal body weight (more on weight later)? There is no – zero – evidence that one diet or another will impact health in a sane person without a chronic disease. You will see many claims that attribute a cornucopia of benefits from one or another diet, but they all lack scientific rigor. “Eat healthy” is a common refrain, but what does that mean in someone who is already healthy? Of course if your health status changes then your diet may have to change as well. You could argue that whatever diet is in vogue, they change regularly, might delay bad health. But again, there is no evidence that such is the case in completely healthy individuals. And if rigorous analysis should one day show that there is such a beneficial diet, its effect on health in the already healthy would be very small.
Americans worry to much about their health. Are there some good guidelines about maintaining good health? There are just a few. Note that none requires a visit to the doctor.
1. Wear your seat belt while driving – front or back seats. And don’t drive like an idiot.
2. Keep you BMI at 25-30 (30-35 doesn’t convey much additional risk if you’re healthy).
3. Don’t smoke.
4. Use sunscreen if you’re going to be in the sun for more than a brief period.
5. Eat whatever you please within the limits of common sense.
6. Stay away from doctors unless you have a complaint. Routine examinations in asymptomatic patients are a waste of time and money and can lead to dangerous interventions.
7. Learn all you can about screening tests (other than blood pressure which you can measure yourself). The benefit of many, if not most, is based on shaky ground.
8. Hope you’re lucky. Many diseases are the result of bad luck. Perhaps as many as two thirds of all cancers fall into this category.
9. Try not to read what the lay press has to say about medicine. Doing so will only confuse and discourage you.
10. A little bit of exercise (walking is probably best) can’t hurt and will help keep you active and limber. Vigorous and prolonged exercise is only for those who enjoy it. There’s no proven health benefit from it.
11. Don’t drink alcohol to excess.
12. Maintain good oral hygiene. Poor oral health is a chronic inflammatory state which is bad for blood vessels and most other organs,
13. Try to enjoy yourself. While most want to live to a ripe old age almost no one wants to be old.
14. Beware of doctors who think every social pathology is a medical problem.