A TOTAL HEALTH FRAMEWORK
Dr D W Allen M.B,B.S, F.R.A.C.G.P.

Rather than dealing with health problems (dysfunction or dis-ease), it is sometimes more useful to look at health from a positive perspective, to encourage constructive health practices (e.g. physical activity and deep breathing of pure air) rather than railing against negatives (e.g. obesity, smoking).

This article will deal primarily with physical health, and begin to explore mental health, which also incorporates social and spiritual health, which can also be divided into input and function or environment and behaviour. None of these can be viewed in isolation, since what we eat and drink can affect the way we think and relate, and visa versa.

The following total health framework was developed with the help of Robert Brinsmead in the 1970’s and is still useful today. It does not include the third vital component for health – heredity – as it is too late for those of us now living to pick our parents! But our genetics has a major bearing on the relative importance of these various aspects of health. For instance, sun protection is more important for Caucasians than Polynesians living in the tropics, and a good diet is more important for sedentary people with a family history of diabetes or coronary heart disease under 70.

Some of our original advice was rather extreme: no alcohol, tea, coffee, chocolate, meat or spices. We made no promise you would live to 100 but, it would sure seem like it! We have since moderated our philosophy and advice as scientific evidence has become available.

INPUT FUNCTION

1. PURE AIR 5. GOOD POSTURE
2. CLEAN WATER 6. REGULAR EXERCISE
3. GOOD FOOD 7. SUFFICIENT SLEEP
4. SUFFICIENT SUNLIGHT 8. Regular & Moderate HABITS
9. HYGIENE
10. RIGHT MENTAL ATTITUDE

1. PURE AIR
The good news is that our city air has actually become cleaner and almost lead-free despite the population doubling, thanks to legislation relating to air pollution, automobiles and smoking in public places.

The house dust mite is the major cause of asthma and hay fever. Avoiding woollen carpets and blankets may help, but pillow covers and mattress covers don’t. Immunotherapy helps about 70% of sufferers.

Cigarette smoke is still our number 1 killer – now killing nearly as many women as men. Children of smoking mums have physical and intellectual impairment that is still measurable at 5 years of age. Passive smoking doubles a child’s risk of respiratory infections and asthma. Smoking is the major cause of premature aging, wrinkling, blindness and impotence.

Smokers who quit usually find their sense of taste and smell improves, their blood carries up to 20% more oxygen to the brain & muscles, and they feel much fitter. It has never been easier to quit. We now have effective products [e.g. Zyban, nicotine patches and inhalers etc] to help smokers who want to stop before cancer cures their habit.

2. WATER
In cool weather, sedentary people need 4-6 glasses of water a day to prevent constipation, irritable bowel, diverticulosis, kidney stones and urinary tract infections. Fluid requirement may be 2-3 times this when working hard in hot weather, when thirst is often an unreliable guide (drinking to maintain stable body weight is the best guide). Dehydration can also cause headache, fatigue and muscle cramps.

But you can drink too much, even when exercising – a few years ago a marathon runner died from encephalopathy due to fluid overload. Most people actually drink enough fluid - they just mix too much sugar, caffeine, alcohol and other chemicals with it.

a) Tea whether black, white or green, is rich in antioxidants and beneficial to health. It also contains fluoride, which strengthens bones and teeth. Too much, however, may cause excessive hardening of subchondral bone, predisposing to arthritis. Tea also contains caffeine, a stimulant and weak diuretic. Unless it is very strong, up to five or six cups a day should be quite safe.

b) Coffee has twice the caffeine of tea and fewer antioxidants and should probably be restricted to 2-3 cups a day, preferably not close to bedtime unless you need to stay awake. A cup or two early in the day has been shown to help weight control. Excessive coffee can increase blood pressure and thin the bones.

c) Alcohol is actually good for you – in small amounts. A glass or two, preferably antioxidant-rich red wine with the evening meal improves the good HDL cholesterol and reduces overall mortality risk, especially from heart attack, stroke and diabetes.

Too much alcohol, however, increases the risk of liver damage, pancreatitis, many cancers [including breast cancer], blood pressure, stroke and accidental deaths. How much is too much? Hazardous drinking is a weekly consumption of more than 28 standard drinks for men or just 12 for women. Binge drinking (over 6 drinks for men or 3 for women) probably does the most damage.

One in ten drinkers is genetically predisposed to alcoholism. If a person can not stop after one or two drinks, they would be advised not drink at all. There are several effective medications [Campral, Naltrexone] to help alcoholics stay dry.

3. GOOD FOOD
Our original recommendation for eating a wide variety of unrefined unprocessed or home processed food low in fat, salt and sugar applies now more than ever in our fast-fattening fast-food society.

Nearly one in four children, every second woman and two thirds of men are overweight. Obesity, our number one health problem, is associated with diabetes, cardiovascular disease, cancer, arthritis, sleep apnoea, a common cause of tiredness and accidents, gout, gallstones, kidney stones and many other problems.

While fast-food outlets are having a field day, so are the magazine publishers. The plethora of fad diets on the market attest to the fact that none of them work for long. Whether it is the high CHO fruit diet or the low CHO Aitkin’s diet, all fad diets work in the short term because they are boring! After all, there are only so many bananas or steaks you can eat in a day. Many of them are quite unbalanced and unhealthy. Athletes on the Aitkin’s diet fatigue much more quickly. This high fat diet can also increase cholesterol levels. We now know it is not the high-fat but the high-protein aspect of the Aitkin’s diet that suppresses appetite. Yo-yoing on and off fad diets, with intervening binging, actually increases the risk of obesity and nutritional deficiencies.

Then there are the silly diets dreamed up for your specific blood group or body shape. Although there is no scientific basis to such diets, some people feel better after changing their diet to one that contains nutrients they were missing out on, or that changes their gut flora. Then there are the silly names, like Sandra Cabot’s so-called “Liver Cleansing Diet” which is a sound diet but does nothing special for the liver. By also recommending supplements, such authors know that the health food stores will promote and sell their books.

The purveyors of health foods and supplements would have us believe that our food is so depleted we can’t possibly enjoy good health unless we swallow bucket loads of expensive vitamins and minerals. Australians spend over $2b a year making the most expensive urine in the world! More is not better.
Most supplements are safe enough, but some may actually be injurious. When researchers discovered that green and yellow vegetables appeared to prevent cancer, they attributed it to the anti-oxidant beta carotene. But two large trials found that beta carotene actually increased cancer rates! We now know that Vitamin A in doses previously considered safe promotes bone loss. Large doses of Vitamin B6 can damage nerves, and excessive Vitamin C can cause kidney stones. Vitamin E is supposed to protect the heart. However, the recent Heart Protection Study of 40,000 people followed over 10 years showed that vitamin E made no difference at all. It actually inhibited the beneficial effects of certain cholesterol lowering drugs that do reduce heart attacks and mortality by around 40%.

Some herbs such as St John’s Wort are effective (e.g. as an anti-depressant) but can interact with many other medications. Even grapefruit juice can more than double the blood level of some drugs, so it pays to inform your doctor if you are taking any herbs, including ginger, garlic and liquorice (which can increase blood pressure).

There are over 600 anti-oxidants in the diet, and the safest way to get them is in your food, not pills. Hippocrates wisely said “Let your food be your medicine”. You can obtain all the nutrients you require from food. Selenium is a trace element the body incorporates into an anti-oxidant. You need a prescription for tablets containing as much selenium as you can consume in just one Brazil nut.

Never before have we been able to be so nutritionally well fed so cheaply. Rapid transport, snap freezing and canning of fruit and vegetables allows us to get high quality produce on our tables from a wide range of soils, greatly reducing the risk of local trace element deficiencies. The most common deficiencies we see are:

a) Calcium and Iron deficiency in women, especially vegetarian women.
b) Folic acid deficiency before and during pregnancy (a cause of spina bifida)
c) Vitamin B1 deficiency in alcoholics and some children on very poor diets
d) Vitamin B12 deficiency in vegans (causing anaemia and nervous disorders)
e) Vitamin D deficiency in nursing home residents, veiled/over-clad women
f) Vitamin C deficiency on some low carbohydrate diets

Red meat is OK in moderation – people with a cholesterol problem should ensure it is very lean and limit it to about the size of the palm of the hand three times a week. It is the best source of iron, and greatly increases iron absorption from vegetables eaten at the same meal. Lot-fed beef is high in omega-6 fatty acids, which we already get too much of from wheat and other grains. Processed meats, especially sausages, are usually high in fat and salt, and can carry bacteria like. Listeria, Toxoplasma and pathogenic E coli.

Poultry is lower in fat, especially the skinned breast. Because antibiotics are added to the feed of non-organic chickens (produced in just 5 weeks), one in ten is contaminated with the deadly VRE super bug. Raw chicken must therefore be handled with care so as to not contaminate other food, and it must be thoroughly cooked before being eaten. Contrary to popular opinion, hormones cannot be fed to Australian poultry.

Fish [especially salmon and sardines] are high in omega-3 fatty acids and EPA. Eating fish twice a week halves the risk of heart attack and asthma. Small fish (e.g. sardines) are lower in mercury than large fish (e.g. swordfish) and flake.

Margarines and many fats and oils are high in omega-6 fatty acids and trans-fatty acids, associated with increased free radicals and a three-fold risk of macular degeneration, the major cause of blindness in old age. Linseed (flaxseed) or cold-pressed refrigerated linseed oil (which oxidises rapidly on exposure to light and heat) is an excellent source of omega-3 fatty acids to balance our high intake of omega-6 fatty acids. Avocado, almond butter, tahini, non-fat cottage cheese, olive or linseed oil, or freshly ground linseed can all be used instead of margarine or butter. Butter in moderation is OK if you don’t have a cholesterol problem. Remember that there are usually more calories in the butter or margarine than in the bread you spread.

The Mediterranean diet, with lots of fruit, vegies, whole grains, legumes and fish, and moderate amounts of nuts, olives and olive oil, with a drop of red wine, is palatable and associated with longevity.

You can buy highly priced ‘organic’ food if you wish, but all plants are ‘organic’, and tests show no nutritional advantage. Indeed, confining yourself to ‘organic’ food from a single locality may actually increase your risk of a trace element deficiency. And the ‘organic’ label does not always guarantee that it is spray-free. It is reassuring to know that some of the most heavily sprayed vegetables – the Brassica family of cabbages, broccoli, Brussels sprouts etc – are high in indoles and associated with reduced cancer rates. Such vegetables, especially lettuce should be washed thoroughly, also to remove dirt (listeria) and small snails that can carry disease. The decline in our incidence of gastric cancer is thought to be partly due to the use of [antioxidant] preservatives in grain, inhibiting natural aflatoxins [there are many ‘natural’ toxins]. Lycopene, which is concentrated in tomato sauce, is thought to reduce the risk of prostate cancer.

The best sources of anti-ageing anti-oxidants are the brightly coloured and preferably plant ripened fruit and vegetables. Most Australians need to eat a lot more of these. Blueberries and kiwi fruit are thought to be particularly beneficial in preventing macular degeneration.

Why don’t people eat salads in winter, when needed most, but still eat ice cream? Most vegetables are better digested if lightly cooked, grated or chewed thoroughly. If you swallow a whole pea, it will come out a whole pea! Gut bacteria ferment poorly chewed plant food and grains, producing excess gas. If you need to lose weight, eat slowly and you will feel just as satiated after eating one third less food. More importantly, spread your calories out over the day.

Many overweight people have the night eating syndrome - they eat too much too late, sleep badly and wonder why they feel lousy in the mornings. So they skip breakfast and are ravenous by dinner time. I am sometimes asked about fasting, and my advice is to fast from 6pm every night. That way you feel terrific every morning and look forward to a good break-fast, especially after your early morning walk/run, bike ride or swim. A good breakfast keeps you going for the day, and your daily activities burn up to 30% more calories than if you skip breakfast. You can even make it your main meal. Or have low fat milk and diced fruit on porridge or high fibre low sugar cereal, plus egg or beans on wholemeal toast with avocado. Cornflakes are low fibre, high sugar and high salt – even higher than potato crisps.

You can get excellent food from the supermarkets – but read the labels, looking especially for fibre, fat and salt content. And don’t be fooled by ‘fat reduced’ or ‘96% fat free’. Whole milk is just under 4% fat but will certainly increase your weight and cholesterol if you drink enough of it. Trim milk is around 2% fat and skim milk is only 0.2% fat.

4. SUFFICIENT SUNLIGHT
Skin cancer is by far the most common cancer we see, and they are almost invariably caused by too much sun. Living in the melanoma capital of the world, we see it often in fair skinned people, mostly in middle age but at any age from 9-90. Unlike other more common skin cancers, it is caused by sunburn anywhere, often well away from the melanoma. Any spot that changes over a month or two should be checked with your GP or Skin Cancer Clinic. Although sunburn can cause cancer, we now know that moderate sun exposure can slow the growth of many cancers, including some skin cancers, probably through the effect of vitamin D.

The slip slop slap message has been so successful that we now see some people who live or work indoors all day and have weak bones from insufficient sunlight. The Melbourne University recently found that only 6% of 900 women had above recommended blood levels of vitamin D, essential for calcium absorption. Those most at risk were dark skinned women who wore veils. You need only about 10 minutes daily of early morning sun on your hands and face to get enough vitamin D. Early morning exposure also helps to set your biological clock, resist depression and sleep better at night. A 20-30 minute brisk walk in the morning sun is a great way to keep your bones, muscles and heart strong.


5. GOOD POSTURE
The intricate body-mind connection is graphically illustrated by one’s posture. I often diagnose low self esteem or depression before the patient says a word. The slumped posture and sagging shoulders says it all. But the reverse also applies - improving your posture can help you feel better about yourself.

A lot of headaches, backache and joint problems are caused by poor posture, poor ergonomics at work, weak muscles, instability and muscle tensions.

6. REGULAR EXERCISE
A hundred years ago, sedentary people walked about 18 kilomters a day! Today they are lucky to walk two! Anyone walking 10k a day is called a fitness fanatic! No wonder we are getting 1kg fatter every year. We only need 30 minutes of exercise [such as brisk walking] each day to keep reasonably fit. Most people spend far more time than that in front of the TV. Performing lots of mini-activities [fidgeting while sitting, using ones legs instead of the remote control to change channels, using steps instead of lifts etc] are even more effective than workouts at the gym for losing weight.

Active work, such as gardening, is probably the best exercise. And it is good for your back. Far more back pain is due to inactivity than overactivity. Doctors used to tell people with bad backs to rest, but we now know that is the worst advice. The sooner people get back to work after injuring their back, the better the outcome. Too much rest weakens the muscles, creates instability and results in chronic pain and disability.

When a chiropractor manipulates your back, the ‘crack’ simply frees it up to move. Never imagine you must now rest it or go about carefully, lest you put it ‘out’ again. Keep it moving. It won’t go out.

Our joints seldom wear out from overuse – they rust out from disuse. Joint cartilage has no blood supply, but depends on nourishing synovial fluid swilling around the joint as it moves. Like a micro-fine sponge, the old fluid gets squeezed out as the cartilage is compressed, and new fluid is sucked in as the cartilage re-expands. No movement = no nourishment. And so the cells die. Weakened cartilage then breaks down under stress, or overload, causing osteoarthritis. The motto is: use it or lose it!


7. ADEQUATE SLEEP
Studies show adults need 7-8 hours sleep for optimum health. Too much sleep is almost as bad as too little. But the quality of sleep is even more important than the quantity. Many people wake tired and unrefreshed after 8-9 hours sleep.

In the 1970’s, Dr. Moldovsky found that deprivation of deep sleep resulted in Fibromyalgia, except in endurance athletes. The body produces growth hormone and sex hormones during deep sleep and during exercise.

Sleeping tablets suppress essential REM sleep, often resulting in anxiety and rebound insomnia. It is much better to correct causes and practice good ‘sleep hygiene’. Becoming anxious about sleep is sure to prevent it, and trying to stay awake almost invariably fails!

Many snorers have sleep apnoea (obstructed breathing) causing severe daytime drowsiness, mini-cat-naps, and accidents. It is also associated with high blood pressure, heart attacks and stroke. Obesity, producing a double chin pushing the tongue up, enlarged adenoids or tonsils, alcohol and sleeping tablets can all aggravate the problem.

Stretching exercises can prevent cramps, and sometimes restless legs. This is a fairly common problem that is sometimes due to iron deficiency in women with heavy periods, especially vegetarians.

8. REGULAR & MODERATE HABITS
The biological clock regulates stomach acid production, the sleep/wake cycle, hormone production, metabolic rate and fluctuations in blood pressure, metabolic rate and body temperature. It is regulated primarily by the timing of exposure to morning sunlight. A regular time for waking is therefore vital for good health. Many a migraine is triggered by sleeping in.

Moderation is important – we can have too much of a good thing, especially food and drink. Even overexercising can result in fatigue, muscle strains, tendonitis, stress fractures, excessive weight loss, amenorrhoea etc. But most of us don’t get enough exercise, especially as we get older. There is also good evidence that maintaining regular sexual activity promotes health and longevity.

9. HYGIENE
Immunisations have all but eliminated many deadly infectious diseases in Australia, except for the blood borne viruses [hepatitis B and C, and HIV /AIDS] which are most commonly transmitted by sharing needles or pewrhaps shavers and, except for hepatitis C, by unprotected sex. Genital warts, herpes and chlamydia are our most prevalent STDs. Chlamydia, a major cause of infertility, is often asymptomatic. Around 20% of young men and women have it without knowing.

The SARS corona [cold] virus reminded us that we still need to be careful about hand washing after handling public utilities such as money, door knobs, lift buttons etc, and to cover our face when coughing or sneezing.

Being too careful with hygiene, however, may put children at increased risk of asthma. There is a lower incidence of asthma in developing countries, among aboriginal children and those exposed to more infections in crèches and child care facilities. A recent US study of 450 children followed from birth to age seven, also shows that living with pets in the first year of life reduces susceptibility to asthma, and having antibiotics in the first six months of life more than doubles the risk.

10. RIGHT MENTAL ATTITUDE
It is not stress that is harmful, but the way we react to it. Stress does not cause heart attacks or cancer, but optimists recover much better. Depression is a major risk factor for both. The way we think affects our brain chemistry and our chemistry affects the way we think.

Belief systems play a vital role in our thinking and feeling. For example, sailing on a ‘flat earth’ used to be a lot more terrifying than sailing on a round one today. You can still live comfortably with a ‘flat earth’ belief so long as you never activate it by going to sea. Believing that we must do everything perfectly or be liked by everybody creates enormous pressures and anxieties, especially when activated by criticism. Valium is not the answer. The real solution is found in re-evaluating our belief systems – about ourselves, about the world around us and about life and death itself.

A very common faulty belief concerns chronic pain. Most people with chronic back ache have perfectly normal spines and many people with no pain have terrible x-rays, CT or MRI scans. If you believe your chronic pain represents a severe ongoing and potentially crippling injury, and focus on it, it probably will cripple you. But if you focus instead on what you can do, despite the pain, you can usually get on top of it.

You can focus either on what you have lost or what you have left. You can be jealous of those better off or be thankful for what you have, and make the most of it. You can allow yourself to wallow in self-pity or be proactive in making the world a better place.

My friend, Ken Aitken, whose promising career as a landscape architect was cut short by brain damage as a result of a surfing accident, sent me the following emails:

“My job is to choose what kind of day I am going to have.
· Today I can complain because the weather is rainy,
Or I can be thankful that the grass is getting watered for free.
· Today I can feel sad that I do not have more money
Or I can be glad that my finances encourage me to plan my purchases wisely and guide me away from waste.
· Today I can grumble about my health,
Or I can rejoice that I am alive.
· Today I can lament over all my parents didn't give me when I was growing up,
Or I can grateful they allowed me to be born.
· Today I can cry because roses have thorns,
Or I can celebrate that thorns have roses.
· Today I can bemoan my partner’s imperfections
Or I can be thankful I have a partner who loves me despite my imperfections
· Today I can feel unloved and unappreciated
Or I can make it my business to love and appreciate others
· Today I can mourn my lack of friends,
Or I can excitedly embark upon a quest to discover new relationships.
· Today I can whine because I have to go to work,
Or I can shout for joy because I have a job to do.
· Today I can complain because I have go to school,
Or eagerly open my mind and fill my mind with rich tidbits of knowledge.
· Today I can murmur dejectedly because I have to housework,
Or I can feel honoured because God has provided shelter for my mind, body and soul.”

MENTAL ATTITUDE ..... via Deidre Bowman The 92-year-old, petite, well-poised and proud lady, who is fully dressed each morning by eight o'clock, with her hair fashionably coifed and makeup perfectly applied even though she is legally blind, moved to a nursing home today. Her husband of 70 years recently passed away, making the move necessary. After many hours of waiting patiently in the lobby of the nursing home, she smiled sweetly when told her room was ready. As she maneuvered her walker to the elevator, I provided a visual description of her tiny room, including the eyelet sheets that had been hung on her window. "I love it," she stated with the enthusiasm of an eight-year-old having just been presented with a new puppy. "Mrs. Jones, you haven't seen the room .... just wait." "That doesn't have anything to do with it," she replied. "Happiness is something you decide on ahead of time. Whether I like my room or not doesn't depend on how the furniture is arranged... it's how I arrange my mind. I already decided to love it ... "It's a decision I make every morning when I wake up. I have a choice; I can spend the day in bed recounting the difficulty I have with the parts of my body that no longer work, or get out of bed and be thankful for the ones that do. Each day is a gift, and as long as my eyes open I'll focus on the new day and all the happy memories I've stored away just for this time in my life. Old age is like a bank account ... you withdraw from what you've put in .. So, my advice to you would be to deposit a lot of happiness in the bank account of memories. Thank you for your part in filling my Memory bank. I am still depositing. Remember the five simple rules to be happy: 1. Free your heart from hatred. 2. Free your mind from worries. 3. Live simply. 4. Give more. 5. Expect less.

Today stretches ahead of me, waiting to be shaped. And here am I, the sculptor who gets to do the shaping.
What today will be like is up to me. I get to choose what kind of day I will have!
So have a great day ..... unless you have other plans.