In the second week of September 2015, the National Heart Blood Lung Institute released partial results of a clinical trial name SPRINT. They found that adults who had controlled their systolic blood pressure below 120mmHg had fewer than one-third of the cardiovascular events than those who maintained it below 140 mmHg. As of now, the practice guidelines recommend to maintain systolic blood pressure under 140 mmHg. Because of the new information, there are speculations that these guidelines might drop this cutoff to 120 mmHg. It means that a 60 year old person who maintained his systolic blood pressure at 130mmHg, might not be doing enough. On the other hand, some experts may exert caution for this drop. There would be concerns that in persons with aged, poorly elastic arteries, blood may not circulate well to the brain if the systolic blood pressure dropped too low. There may also be debates whether this is a conspiracy of Big Pharma to sell more drugs.
Health indicators or disease indicators?
Studies like these and other community based studies are well intended, as they strive to update the quantitative ‘cut-offs’ (QC) associated with diseases later. Examples of QCs are body weight, body mass index, blood pressure, pulse rate, blood work. These QCs first became popular with the Framingham Heart Study in which a large community of people was assessed and followed up for many years to see who developed which diseases, when and when they died. Such retrospective information, is analysed to help predict future diseases. The emergent QCs are assumed to be indicators of health, falsely so, as they actually indicate current and future disease.
QCs give us a sense of certainty and the healthcare systems a manageable working module. However, the experience of being in health is much more subjective and QCs may not grasp the whole picture. You may have normal blood work, but may be prone to infections. You may be lean, but feel constipated and uneasy frequently. You might have all the perfect numbers, but just can’t sleep well and are increasingly fatigued. These are the real day-to-day health issues which represent the grey areas between health and disease. These ‘fuzzy’ symptoms are sometimes strong enough to trigger the change from physiology (normal functioning) to pathology (abnormal functioning). For example: Sleep deprivation is known to increase insulin resistance which leads to diabetes. In a Honolulu aging study, it was found that men with constipation had 2.7 times the risk of developing Parkinson’s Disease than those who had atleast one bowel movement per day.
A ‘health indicator’ worth adopting
Do we have an assessment for health that values the experience of health today and also considers the future risk of diseases? Here is a Checklist for Health that can also signal if you might be on a downhill road towards disease. It reminds us of things to address in the immediate and near future, to take care of long term health. It helps us know ourselves and our environment better.
- I feel hungry regularly.
(It is not too poor or uncontrollable)
- My food digests in time.
(I donot have abdominal heaviness for long hours post meals, no thick, stubborn, white coating on my tongue)
- My poop is regular and happens daily.
(Not sticky, or dry or hard or loose stools, or difficult to evacuate)
- I’m peeing well.
(Adequate, pale yellow — transparent, with no discomfort)
- I sleep sound, on time, wake up fresh!
(No daytime sleepiness or laziness post meals)
- I feel light and energetic.
- I can see, smell, taste, feel, hear well.
(No altered tastes, intolerance to normally bearable noises, distorted skin sensations, snubbed sense of smell, hazy vision)
- I have adequate strength for daily activities and some exercise.
- I can think clearly and feel emotionally tuned with the world.
- I do not fall victim to diseases easily.
- I can tolerate extremes of heat and cold well.
- I have adequate muscle strength and a built with strong enough bones (Body composition, BMI, Muscle and bone mass tests are helpful here)
Questions one to six relate to how your internal physiology affects the experience of health. Questions seven to nine indicate how you engage with the world outside. The remaining indicate longterm physical health.
Advantages of adopting the health indicator
It is one that is used by the oldest system of organized medicine — Ayurveda (Traditional Indian Medicine). People who add it to their health radar find themselves comparing notes with it often. They understand themselves and their environment better, get empowered to make healthful choices. They feel healthier and happier and are not bogged down by the fear of disease. This checklist is an enabler of all other descriptions of health and should be used in conjunction with the updated QCs.
Much needed contemporary biomedical evidence for these suggestions is currently on its way. One such example is the increasing interest in gut health. The friendly bacteria living on us outnumber our cells by a ratio of 10:1. Consequently, their genomic sequences are thought to play an active role in our health. Hence, projects like American Gut (crowd funded) and µbiome, are requesting people for their stool samples to study the bacterial genomes and draw insights for health and disease. Among the mainstream medical fraternity too, symptoms like gas and constipation are slowly being discussed more openly, without being belittled.
There is another debate is about daily required water intake. Eight cups has been suggested for adults, but a static number has drawn much controversy because hydration depends on many factors like exercise, body weight, ambient temperature among others. So the recent dynamic recommendations are similar to those suggested in this checklist — drink till your urine is pale yellow or lighter.
Contemporary biomedical evidence for the other suggestions may emerge in the next few years and trickle down into health and medical practices. Until we expand our knowledge about them, we can plunge in some safe, effective practices for our own selves and our families.
So, what can you do if you are at the tipping point?
Initiate self-education for health — Eastern and Western health approaches, and watch out for my posts!
For those who may be interested, here is the original Sanskrit text of the checklist:
सममांसप्रमाणस्तु समसंहननो नरः|
दृढेन्द्रियो विकाराणां  न बलेनाभिभूयते||18||
समपक्ता समजरः सममांसचयो मतः||19||
Agnivesha. Charaka Samhita. Sutra sthana. Chapter 21. Sutra 18–19