By J. Ron Eaker, M.D.
I love to classify things. It helps me understand the world when I can put things into categories that make sense. Unfortunately these categories may not make any sense to the rest of the world, so often I am a bit hesitant to share. For example, I find it helpful to classify time as pre-Lucy and post-Lucy. By this I don’t mean Lucy the 3.2 million year old Australopithecus hominid rumored to be our ancestor, I mean the red headed zany comedian Lucille Ball.
One useful classification tool is in characterizing diseases. Virtually every malady can be placed into one of two categories, either they are acute or chronic. Acute illnesses are things like colds and the flu, while chronic problems typically are represented by illnesses such as hypertension and arthritis. This designation is important on several levels, but the most important utility of this division relates to prevention.
Acute illnesses, such as traumas, bird flu, and worms, are largely random events that don’t generally respond well to preventative techniques. If you get an acute illness you are more interested in treatment rather than prevention, because prevention of these types of problems is notoriously ineffective. Sure, you can wear a mask on a plane when you are traveling internationally to cut down on bird flu susceptibility, but is it really worth the stares and questions from your fellow passengers? And certainly you can cook your pork sausage thoroughly to rid it of any worms that have set up shop (there is an image that sausage makers don’t want you to share), but in general, preventing acute illnesses is about as fruitful as getting a politician to give you an honest answer.
On the other hand, chronic illnesses are not only often preventable but possibly thwarted by relatively simple changes. Yes, there are those things that we can’t control such as genetic disorders (although with epigenetic research that is changing), chronic exposure to toxic substances, and Donald Trump’s tweets, but for the most part chronic illnesses are amenable to prevention at a much greater degree than acute diseases. The reason is the law of accumulation.
This law states that most chronic illnesses are an accumulation of insults over time that eventually leads to disease symptoms. For example, when a person suffers an obstructive stroke there is not usually any precipitating event that creates the blockage (of course there are exceptions). The blockage is the result of years, probably decades, of inflammatory changes that gradually narrow the blood vessel lumen which, at some critical moment, limits the blood supply to an area of the brain. We perceive the loss of function as an acute event, but unfortunately Grandpa’s 30 years of smoking and 40 pounds of excess fat are the real culprits.
It is this accumulation of little insults along the way that produces the bad outcome. That is why most chronic illnesses manifest as we age. The more insults over a longer time period, the more likely permanent damage.
The good news is that for many of these chronic problems, the reverse is true. Smart decisions made early in life can have a massive effect in reducing long term risks. It is sort of like compounded interest in that if we begin early in our biological life filling our coffers with health dollars, they magnify exponentially once we are in the greying decades.
Our ancestors died at early ages largely due to acute illnesses or trauma. When Og ventured out of the cave to snag a brontosaurus burger for dinner, his chance of becoming something else’s dinner was fairly substantial. The Black Death, Yersinia Pestis for you Latin aficionados, is estimated to have killed 55% of the European population in the 14th century. Today most deaths are due to chronic illnesses and not some hungry dinosaur or bacteria laden rat bite.
While we have effectively eliminated The Plague with good hygiene and rat poison, the new plagues are lifestyle illnesses like hypertension and diabetes that actually kill as many people, just more slowly. The solution is alarmingly simple, but devastatingly difficult to implement.
Folks have to make better lifestyle choices, and begin them early in life. This was one of the premises in my book Healthy Habits For a Fit Family (shameless plug) in that the greatest health impact on culture and future generations begins within the family. The choices we make now for ourselves and our children will affect the incidence of chronic illness worldwide for generations to come.
This article appears in the September 2017 issue of Augusta Family Magazine.
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