June 5, 2002 -- I am now going to engage in the popular game of constructing a list — in this case, of the most important choices for staying sound in body and mind for years to come.
And since we are dealing with the game of life, I am taking this game very seriously. Obviously, there is no scientific way to prove that these are the 12 most important health practices for all men — or that I have ranked them in the right order. But I think that I can make a pretty good case for both the list and the order.
At the very least, it will be good way of summarizing what I feel are some of the most important health messages to come out of my new book, Dr. Timothy Johnson's OnCall Guide to Men's Health, which help give men of all ages a strategy for staying fit and well.
As you will see, I have cheated a little by combining two items in some cases. And I have chosen both screening tests and preventative practices for the list. But every item shares this one dynamic: They are all under your control. So here goes.
The Top 12
1) Don't smoke. Smoking is estimated to kill 400,000 Americans every single year. That's the equivalent death toll of three jumbo jet crashes every single day! Choosing not to smoke is, without a doubt, the single most important health decision you can make.
2) Control your weight. This is not as easy a No. 2 choice for me as was No. 1. That's because the connection between obesity and actual illnesses or deaths is often more indirect than is the case with smoking. But I have come to accept the estimates of the Surgeon General's Office that obesity is responsible for approximately 350,000 deaths every year, and that if American men continue to stop smoking in large numbers, it may even replace smoking as the No. 1 cause of death for men.
3) Drink alcohol in moderation. This message can be taken in both positive and negative terms. Truly moderate drinking (one to two standard size drinks per day) does reduce the risk of coronary artery disease, the No. 1 cause of death in our country. However, excessive drinking is a major cause of both physical disease and social tragedy. Approximately 10 percent of people who start drinking socially will become alcoholics. The decision to drink even socially should not be taken lightly.
4) Exercise regularly. This health practice has enormous physical and emotional benefits. Besides reducing the risk for high blood pressure, high blood cholesterol, diabetes, obesity and osteoporosis, regular exercise can be helpful in raising our general mood and reducing the risk for depression.
5) Have regular cholesterol and blood pressure tests. Both high cholesterol and high blood pressure can be described as "silent killers," since they can cause extensive damage to our heart and arteries without producing any telltale symptoms until it is often too late. Therefore, the only way to find out if you have a potential problem is to get tested.
6) Have regular colonoscopy and prostate serum antigen testing. I strongly believe in the value of both of these tests in detecting two common and potentially lethal diseases — colon and prostate cancer — when they are still curable. There are not many cancers that we can either prevent of detect early enough to make a difference, but these are two.
7) Take a baby aspirin every day (for most men). Unless you are truly allergic to aspirin (very rare) or at high risk for gastrointestinal bleeding (not very common), this daily dose of aspirin is one of the most beneficial and simple things you can do. It acts to reduce the risk of clot formation in the arteries leading to your heart and brain, thereby reducing the risk of both heart attacks and strokes. And it probably acts in many other beneficial ways we don't yet fully understand.
8) Practice safe sex. In this age of AIDS, you could make a good case for putting this higher on the list. But even less lethal sexually transmitted diseases can cause a wide range of disability, such as infertility problems and pelvic pain in women. And unless you are in a truly monogamous relationship, there is no good way to tell a partner is safe, so prevention using condoms is key.
9) Have regular glaucoma screenings. I put this on the list because glaucoma is a major cause of blindness and it usually doesn't produce visual symptoms until it has caused significant damage to the optic nerve. That's why eye doctors call it a "thief in the night." The other benefit of glaucoma screening is that your ophthalmologist will have the opportunity to check for other eye problems such as macular degeneration.
10) Use a sunscreen of at least 15 SPF. Skin cancers are the most common of all cancers by far. Fortunately, most of them (basal cell and squamous cell carcinomas) are rarely lethal, though they can certainly cause local disfigurement if not diagnosed early. Melanoma is both disfiguring and lethal, so it must be diagnosed as early as possible. But since it is so inconvenient to do a truly thorough check of the skin, at least by yourself, prevention is a very helpful tool. And that means the use of sunscreen and protective clothing and the avoidance of direct sun exposure between the "high hours" of 10 a.m. and 2 p.m., when the sun is strongest.
11) Increase good fats and good carbs in your diet. Some of the standard nutritional advice of the past is undergoing change. And this is particularly true in the growing emphasis on making a distinction between good fats and carbs — such as omega-3 fatty acids and whole grains, which should actually be increased in our diet — and bad fats and carbs, such as saturated fats and highly refined grains, which of course should be decreased. In other words, just "cutting down" on fats and carbs is not precise enough anymore.
12) Find time for some kind of meditation/relaxation practice. This goal is very flexible. It is more important to set aside some time for relaxation than it is to worry about a specific relaxation technique. Even physical activity that is "relaxing" in the sense that it gets your mind away from stressful thoughts can be helpful. All of us should take the time to "get away" mentally and emotionally at least once a day, wherever we are, or whatever we are doing.
Tips are excerpted from Dr. Timothy Johnson's OnCall Guide to Men's Health by Dr. Tim Johnson, Hyperion, Copyright May 2002. Used with permission.