CENTRAL  SOUTH  DAKOTA  MEDICAL NEWS
THE CLINICAL VIEW
By: Phillip E. Hoffsten, M.D.
24  MAY  2001

The Advantages of Success

This last weekend there was a discussion group held at the Medicine Rock Cafe in Gettysburg regarding diabetes and how to help care for it. One of the themes that was emphasized in this meeting was how important dietary control and exercise are in treating and even "curing" diabetes mellitus in the adult. I gave the example of a gentleman who was elderly, far overweight at 330 pounds and newly found to be diabetic. He indicated that he did not want to take insulin or medication and frankly did not want to be diabetic either. I discussed with him all of the ravages that diabetes can generate and the discussion ended with his refusing to take medication. He did accept the challenge to lose 60 pounds over the winter from October until May when he returned from his winter home in the south. On his return, indeed he had lost 60 pounds although he was still very overweight at 270 pounds. His blood sugar was normal, his blood pressure had returned to normal, his cholesterol had returned to normal and he required no medications to control these three very dangerous measures of health. He indicated that he felt better than he had for many years and vowed to lose further weight to improve his health status.

n past columns, the topic of excessive weight has been addressed on many occasions. Unfortunately, overweight in our society has exploded into an epidemic at least partially related to our labor-saving devices and our sedentary lifestyle in front of a computer or TV set munching on large amounts of food. Diabetes currently affects about 5% of the population with prediabetes affecting approximately an additional 10% of the population. These numbers are expected to increase dramatically in the next 10 to 15 years based upon the present trend.

At the end of the discussion group on Saturday, questions were raised about what to discuss in two weeks when we return to the Medicine Rock Cafe at 10:00 a.m. for another presentation. It was elected to represent the material about stress management as related to avoidance and treatment of disease. It is a well-accepted medical observation that over 80% of the disease and mortality in our society is related to personal practices that are avoidable. As an example, coronary artery disease which accounts for one-third of the deaths in the United States is the result of high blood pressure, diabetes, cigarette abuse and high blood cholesterol. These four factors account for 90% of the coronary artery deaths in our country. Each of these four factors are preventable and are primarily stress-related problems.

To put stress-related problems in perspective, it must first be understood that humans have a hierarchy of needs. This was first delineated by Victor Maslow many years ago when he described level one needs as the provision of food, shelter, water, etc. He described level two needs as being related to safety. For the most part, these two basic needs have been provided by our society today. He described level three needs as being those of social interaction. This is where our society is so terribly frustrating. Receiving recognition, nuturing, care and comfort from others and being successful is intensely competitive. That competition begins in our school system and carries into the workplace after school.  Some people are able to achieve a balance between their need for social recognition and the amount of social recognition that they get.  With our society constantly advertising material wealth of cars, homes, computers, televisions, untold wondrous devices and gadgets that we are all told that we need, it is very hard to keep a balance between our social needs and our resources.

Thus come the health-related problems. When we encounter an imbalance between what we think we need for happiness and what we actually have, many people are left with a sensation that what they have is not enough. They can make themselves feel better if they have a candy bar or a piece of pie or a cigarette or a beer or perhaps one of the illegal drugs in our society such as cocaine. Used in moderation, these various substances are not harmful but the problem of alcoholism is rampant in our society. The problem of being overweight and all of the social problems that this brings is rampant in our society and the problem of cigarette abuse is still a leading case of preventable medical expense in our society. Thus, the problem of substance abuse is perhaps the leading manifestation of destructive stress-management in our society.

The medical data to illustrate what I have described above is richly available in the medical literature. This last month, an article appeared in the Annals of Internal Medicine describing the longevity of an actor or actress who had won an Academy Award. Their lifespans were compared to actors who had never been nominated for an Academy Award and also those who had been nominated for an Academy Award but had not won. The authors of this article pointed out that Academy Award winners had on the average four more years of functional life than those who had only been nominated or who had never been nominated for an Academy Award. In other words, success carries with it a survival advantage.

This is not to say that you need to be an Academy Award winner to live to an old age. Rather it says that you need to feel like a winner and have the sensation in your own mind that you are successful. This requires an effective stress-management strategy to deal with the frustrations of today's society.