It is worth pointing out that many patients who are afraid of becoming sick and possibly dying nevertheless do not take those measures which are known to lessen the risks of cancer and heart disease and many of the debilitating diseases of middle and old age. Since the exaggerated worry that characterizes health anxiety is partly a response to a sense of helplessness in the face of danger, it is important in a program of treatment for health anxiety to outline what can be done to prevent serious illness and premature death.
- Smoking cigarettes is the single most unhealthy thing anyone can do. Not only is smoking responsible for at least one third of all cardiovascular and cancer deaths, it leads to miserable diseases such as emphysema that can ruin life. Stopping smoking even after many years can lower much of this risk.
- Nutritional factors have a very considerable effect on health. The Mediterranean diet has been shown to diminish the risk from heart disease and also premature death from other causes. The diet emphasizes vegetables, fish, olive oil and moderate amounts of wine. The benefits from the diet probably do not derive solely from an effect on blood cholesterol.
Whether or not to take additional vitamins is still controversial. The Food and Drug Administration empanels a group of experts every so often to make recommendations in this regard; and, with a few exceptions, they have chosen not to recommend taking vitamins over and above what is present in a normal diet. But they are motivated to a considerable extent by the fear of giving advice which may turn out later to be wrong. For example, many nutritionists used to recommend taking beta carotene supplements, an antioxidant; but further research suggested that beta carotene may compete in the body with other more important carotenoids present in food. It may actually raise the risk of cancer rather than lower it. Similarly, it seems that the long emphasis on lowering the level of fat in the diet leads neither to a lower rate of obesity or to a lower overall death rate.
Because these authorities find it embarrassing to change their minds publicly, they hesitate much longer than they should to make recommendations and even longer before they change them. They finally decided to add folic acid, a B vitamin, to bread only years after it had been shown to lower the risk to pregnant women of giving birth to babies with neural tube defects. But the rest of us have to live in the present guided by the best information we have now, even if the future should prove us to be wrong. Besides, most people probably do not eat a proper diet: and many older people in particular have been shown to be vitamin deficient.
Except in unusual circumstances, vitamins are harmless in amounts somewhat greater than those generally recommended currently. There is reason to think that the risk of many serious illnesses would be lowered by taking a multivitamin without iron. Within limits, extra vitamin E may be helpful and there are probably benefits in taking still other B vitamins such as folic acid and B 12. Many people who live in latitudes corresponding to New York City are deficient in Vitamin D; and they should be taking extra amounts. Calcium lowers the risk of osteoporosis, hypertension and probably colon cancer. Of these substances only calcium, which may cause constipation, has any discernible side effects.
The evidence for and against taking extra vitamins and minerals has filled a library. It is reasonable for someone who is inclined to take them to check first with his or her physician. On the other hand, there are good reasons to avoid herbal supplements, only one of which is that little or none of the substance on the label is actually in the bottle. Also, they are dangerous. Some of the agents which have been in use for thousands of years have been injuring people for thousands of years.
- It is unhealthy and demoralizing to be obese, and not only because of social prejudices against fat people. The bad effects of obesity on arthritis and heart disease, among other diseases, are well known. It is probably healthier to be in the lower part of the normal weight range. It is known that caloric restriction can extend life in animals not otherwise nutritionally deficient. Recent evidence suggests that obesity is a risk factor in individuals who are otherwise healthy, who do not, for instance, suffer from diabetes or hypertension, conditions associated with obesity.
- There is a small but growing number of medicines that can be taken by normal people to lower the risk of developing certain diseases like osteoporosis or coronary artery disease. People should not shy away from these drugs as a matter of principle. A baby aspirin is one such drug.
- Many of the patients at our clinic for the treatment of health anxiety are at an age where the commonest cause of death is accidents and violence. If they use seat belts systematically, their risk of a serious injury from an automobile accident will be cut down considerably. Having a gun in the house for “protection” has been shown to increase greatly the chance of dying violently. Guns should be removed from the home. Also, health worriers should be willing to consider the possibility that they may be depressed. It is a common and treatable disorder; and it may lead to suicide. There are more than 30,000 deaths in this country every year from suicide..
- Exercise. Physical inactivity is an independent risk factor for heart disease and for other medical problems, including Alzheimer’s disease. Exercise also has an effect on morale. Someone doing well in a competitive sport is less likely to regard himself or herself as physically impaired. In addition, someone experiencing shortness of breath, an accelerated heart rate, dry mouth and unsteadiness as the result of vigorous exercise is less likely to attribute these symptoms at other times to the presence of some hidden medical problem.
There is a reason why some people who are preoccupied by the thought of dying from an obscure illness nevertheless put themselves at risk by failing to take these commonplace precautions. Although they say they are afraid of dying—or being dead—they are really afraid of something else: being helpless and being alone. But that is a more complicated subject for another time. © Fredric Neuman. Excerpted from “Worried Sick?” Follow Dr. Neuman’s blog at fredricneumanmd.com/blog/ or ask questions at fredricneumanmd.com/blog/ask-dr-neuman-advice-column/