The Influence of our Behavior and Finding Optimal Health
Healthy behaviors increase lifespan and unhealthy behaviors reduce it. Studies have supported that a low-risk lifestyle is responsible for an 11 year delay of all-cause mortality. This lifestyle includes regular physical activity, eating a healthy diet, not smoking and drinking alcohol in moderation, Conversely, harmful behavior is largely responsible for up to three-quarters of chronic health conditions seen in clinical medicine.
A careful look at the world’s centenarian centers, or “blue zones”, reveals many common ingredients to longevity. The locations include Okinawa, Japan, Sardinia, Italy, Loma Linda California, Nikoya, Costa Rica and Ikaria, Greece. There is no coincidence that living in these places allows for the similar tenets of a low-risk lifestyle, including regular purposeful physical activity, a wholesome, natural diet, avoidance of smoking, stress management, plenty of leisure time, social support structures and a healthy environment.
Behavior is the source of our actions and our ability to adjust to external stressors, and likewise, the cornerstone for any health and longevity plan. We can often become blinded by our behaviors. It is at the crossroads of our involuntary and voluntary nervous system. In summary, actions that result in pleasure or less pain are reinforced and repeated, and actions that result in less pleasure or more pain are avoided. Sometimes, a more harmful behavior can be reinforced because of a perceived positive outcome. We often develop a complex network when it comes to addressing our behaviors, sometimes with a blockade to protect us from deeper fears. It is interesting to note that the way we address our emotional response can be the first, critical step to managing our behaviors patterns.
The result of a repeated negative behavior can lead to health issues. A person may come in with a complication, e.g. someone who smokes coming in with possible cardiac chest pain, and genuinely wants to avoid having health issues. During a short clinic visit or hospitalization, the behavior is often addressed with a “don’t do that, do this, or else” approach, a method that falls short in motivating behavior change. The patient may quit the behavior out of necessity for the short term, only to revert to the behavior when they feel better or when the stressors worsen. A “fear of death approach” is generally not effective, after a person feels better or doesn’t necessary experience ill-effects from the substance or is not motivated to change.
An approach that addresses consequences undercuts the understanding of the origin and reason for the behavior as a coping mechanism. The patient often meets these questions with a sense of shame and conflict, in some way fueling their fear of no longer having a substance as a coping strategy. Intertwined with this is the person’s physical dependence on the substance. The same holds for behaviors other than substances, including food choices, excessive phone or TV, gambling or sexual addictions. Harmful behaviors have one thing in common – they are resistant to change, even if one has reason and insight on the importance.
I once evaluated a patient who was a longstanding smoker for a necrotic, vascular insufficiency ulcer – an all-too common risk for infectious complications. I discussed with her to determine her readiness to quit smoking after she was taken to the operating room to remove the damaged tissue (a debridement). She stated that if she goes back home, she will start smoking again, regardless of the consequences. She simply wasn’t able to imagine herself not smoking. She knew that smoking was harmful to her but conceded to smoking in light of the possible consequence of amputation.
Another patient came in for a new visit and complained of generalized body pains and emotional challenges related to his dog being diagnosed with cancer. After a series of visits trying to assist and counsel the patient, it became clear that his preoccupation centered on whether I could prescribe him more pain medications to assist in his coping. Ultimately, he buckled under repeated visits and no increase in pain medications with displays of anger, arranging for a new doctor visit in another clinic. After establishing with a new physician who prescribed him a greater quantity of pain medications, he actually called our clinic and boasted to my medical assistant that he was able to get more pain meds.
Both patients had an underlying drug dependence that affected their behavior and usurped their ability to cope in another manner. Both patients did not realize that their behaviors were affected by the substance of abuse, whether their dependence was acknowledged or concealed. A common finding in a person with dependence on substances is that an attempt in coping with real or perceived stressors ropes in a substance that then becomes the favored coping strategy only to later become the central trigger to the stress.