Live right, live longer E-Book

Heinz Ludwig

• Herausgeber: edition a
• Kategorie: Fachliteratur
• Sprache: Englisch
• Veröffentlichungsjahr: 2019

Seitenzahl: 300

Beschreibung

Staying healthy is at the very top of most people's wish list. The question is which of the abundant, often contradictory advice given in this connection is really sound. The internationally recognized physician and clinical cancer researcher Heinz Ludwig, M.D. shows how we can go through life healthier, longer, and more fulfilled. He demonstrates this on the basis of results from scientific research, his personal experience, and examples from his professional life. The five points that he recommends - loving, laughter, learning, lifetime fitness, and lighter eating - are easy to understand and achievable by everyone.

Leseprobe

Heinz Ludwig, M.D.

Live Right,Live Longer

5 things we can doto stay healthy

edition a

Heinz Ludwig, M.D:Live Right, Live Longer

All rights reserved © 2017 edition a, Vienna, Austriawww.edition-a.at

Editing: Andreas Görg Cover: JaeHee Lee Layout: Lucas Reisigl

E-Book-ISBN: 978-3-99001-377-9

E-Book-Production and delivery: Brockhaus Commission, Kornwestheimwww.brocom.de

TABLE OF CONTENTS

MARTHA ALLEN

ROBERT TUCKER

A PLAN FOR LIFE

LOVING

Compassion in the Health System

Contented Loners

Unhealthy Egotism

The Health Effects of the Digital Revolution

Healthy Love Between Two People

Esteem Within Social Circles

Adaptability in Partnerships

Sexuality and Health

Undervalued Physical Contact

The Healing Effect of Pets

Passion as a Health Factor

LAUGHTER

Healthful Comedies

Practice Laughing

A Brighter Prevailing Tone in Life

The Harmful Dogma of Positive Thinking

Where Our Life’s Happiness Lies

Love Is a Chemical Reaction

LEARNING

The Interactions Between the Body and the Brain

Mental Lethargy

Thinking and Subordination

Suppressing Inquisitiveness

Hard Times for Our Brain

The Future of Learning

Learning About Ourselves

What Fuels Our Learning

The Intelligent Management of Our Health

LIFELONG FITNESS

The Preventive Effect of Physical Activity

The Effect of Physical Activity on Our Brain

Physical Lethargy

LIGHTER EATING

The Most Difficult of All Changes in Eating Habits

Fighting for the Right Thing

What Industries Promise Us

Fasting for Health and Healing

Healthy Realism With Regard to Eating

The Obesity Epidemic

Preventing Cancer With Proper Nutrition

IT’S UP TO US

Genetic Predisposition

Survival of the Fittest Is a Thing of the Past

The Significance of Environmental Influences

The Tiresome Issues of Smoking and Alcohol

The Question of Personal Responsibility

The Old Values

REFERENCES

MARTHA ALLEN

She appeared as agile and impatient as she had on her first visit to me, a petite, forty-year-old woman. With her findings in hand, I motioned to the seating in my practice. »Well,« she asked, »What did the biopsy reveal?«

I would not have thought Martha Allen younger than she was. However, she was one of those people who have retained at forty the energy of their early youth.

A subway door had closed on her and the pain had not gone away. She remembered that she had had pain previously that she had ignored. She had also suffered from an unusually stubborn flu. Her more recent problems had been emotionally more trying than usual, and she had been altogether more debilitated.

Martha Allen suffered from breast cancer with bone metastases, which was confirmed by the new test results. The fact that I have delivered many such diagnoses in the course of my professional life does not mean that it has become routine for me.

Some patients have great difficulty in processing all the eventualities of a grave diagnosis and prefer the situation to be laid out gradually. I therefore asked her how much detail she wanted me to go into. I also offered to discuss some issues and questions in the course of upcoming appointments to give her time to process the information gradually. But Martha Allen thought nothing of that or of beating about the bush. »1 want to know,« she said. »How does it look?«

»I’m afraid I don’t have good news for you,« I said. She had evidently expected that. In any event, a brief flicker in her eyes was all the emotion she showed.

I handed her the findings and told her the result of the examinations.

She looked at the findings, apparently without reading them. But she did not seem paralyzed; she seemed rather to be pursuing a concrete thought. Finally, she raised her head. »How much longer do I have?« she asked.

Some patients do not want to know that. Others consider for quite a while whether they want to know or not. Understandable, because someone who has to deal with the information, for example, that she has an estimated thirty months left to live, can easily lose the ground under her feet.

In serious illnesses like cancer it is common practice for doctors – at least in the United States, where litigation is common – to turn on a tape recorder and press »record,« before beginning to discuss the situation with the patients and their closest relatives. Their statements are formulated in a legally incontestable manner. The patient is told, »Your average life expectancy is thirty months,« which is documented with the relevant references. Then the available treatments, their benefits, and the risks involved are listed objectively. And this is done with good reason, since every misinterpreted word can be used against the doctor in any possible lawsuit. But when it comes to cancer diagnoses, I do not think much of giving concrete information about expected survival time. These are average values that say little about an individual patient’s prognosis. Patients and the course of their illness always differ. On the basis of the findings and the patient’s status, i.e., the aggressiveness of the cancer and the fitness of the patient, I can assess reasonably well whether the disease course will be favorable or rather unfavorable, but I can’t do more than that.

I currently look after and follow several patients who, on the basis of the statistical average, should no longer be alive. Even patients of mine with difficult-to-cure cancers such as pancreatic cancer, with an estimated life expectancy of eight to twelve months, lived for years after the diagnosis or are still alive.

Unusual disease courses can never be ruled out, especially as medicine is making rapid progress. If patients do not ask, then I do not mention any concrete figures on the subject of survival time. Instead, I tell them about cases in which people have coped particularly well with their illness. That gives them hope, and hope is a strong motivating force. If, however, they insist and want an answer to the question, I draw a survival curve that shows how different the course can be. It shows that there is an average, but that some patients die very early and others survive unexpectedly long.

But Martha Allen was not interested in any curve. She definitely wanted to hear a number. To be absolutely sure, I asked her again. "Are you certain? Please think about it again. Perhaps you‘d like to sleep on it."

She shook her head. "I have to know," she said. "My daughter is still in school and I’m a single parent. I need to know what she can expect."

Her cheeks were now reddened. That was the only sign that she was in a situation that no one would want to be in. She was a fighter, that much was clear, and if a patient wants clarity, then my job as a doctor is to provide it.

"The average life expectancy for your illness at this stage is three to four years," I said. "That’s just an average, as I said. It can be less, but it can also be more. Average values are just average values."

We discussed the therapies available, their advantages and disadvantages, as well as possible side effects. The histological examination showed that the tumor was hormone-sensitive, which meant that hormone therapy could be used and for the time being at least, chemotherapy, which is associated with more severe side effects, would not be necessary.

Martha Allen had already said goodbye when she turned around again at the door of my practice. "My daughter is twelve now," she said. "She has six more years in school. I have to hold on that long. After that she’ll be able to manage without me."

I nodded.

She responded well to the therapy. Again and again, she emphasized that under all circumstances she would have to hold out until her daughter’s graduation. I wished it for her and her daughter, and I thought it was possible from a medical point of view. Six years, that was two to three years longer than the statistical average in her situation.

Time passed. Martha Allen’s daughter, whose name I now knew was Sophie, was a reasonably good student. Without major problems, she moved on to the upper high school levels, successfully passed a make-up test in Latin, and finally reached her senior year.

Around this time, Martha Allen stopped stating her life goals. I got word that Sophie passed her final exams and then went on graduation holiday to Gran Canaria with her class. I asked myself what this event might have triggered in Martha Allen, but she did not speak to it just then and I did not ask.

Not until the autumn of that year did we talk about it again. Martha Allen told me that Sophie wanted to study biology and environmental studies. "I want to be here when she gets her Master’s degree," she said. "After that, I can leave peacefully."

I smiled.

"Don’t worry," she said. "Sophie won’t dawdle in her studies. She has become very purposeful in the past two years."

Could well be she has that from her mother, I thought.

"Eight semesters," said Martha Allen. "That would be another four years."

She said that in a jesting tone, but I could see in her eyes how serious she was. She did not even ask me if I thought that was possible. "What was that again about average values?" With an amused smile, she answered the question herself. "Averages are just averages, right?"

I do not know whether Martha Allen counted the years, I myself did not. One day I found an invitation to a Master’s degree party in the mail. Sophie Allen had completed her studies in the minimum period of time.

I went to the party and saw Sophie there for the first time. She was a tall young woman, elegantly dressed for the occasion, and often at her side was an even taller young man.

Martha Allen came to stand next to me as I studied the two of them. "A good-looking pair, aren’t they?" she said.

"Yes, very. Looks serious," I said. We exchanged a glance. I suspected that Martha Allen had found a new life goal. She presumably wanted to hold out until her daughter was married. We both laughed, because it was clear to us that we were thinking the same thought.

"It can be less than the average, but also more," she said. "You told me that at the time of the diagnosis. Would you tell me again what that means exactly?"

"That it can be a lot less," I said, "but also much more."

She smiled gratefully. She had aged since then, and her illness and the treatments had doubtless contributed a lot to that. But she still radiated some of that energy. "Well, much less is no longer possible now," she said. "Then it can only be a lot more."

A few days ago, as I write this, I received an invitation to the wedding of Sophie Allen. I will also be attending this event and hope that the young couple will soon have children. Then Martha Allen will be able to set a number of new life goals, motivated by her love and the strong feeling of being needed.

Postscript:

Unfortunately, Martha’s disease became resistant to hormone therapy, which required initiation chemotherapy, to which she initially responded remarkably well. But as time passed, the treatment had to be changed because the disease progressed with the development of liver metastases. Although second-line chemotherapy induced considerable tumor regression, it was becoming clear that her life span was nearing its end. But she did not leave before her daughter gave birth to her grandson, whom she was able to hold in her hands with deep joy and love after his birth. A few days thereafter, she was ready to let go and passed away in the evening with a smile on her lips after her young family had visited her.

ROBERT TUCKER

The first time I saw Robert Tucker, he was sun-tanned and elegantly dressed. On second glance, I noticed that he colored his still full hair. Eighteen years earlier, at the age of 49, he had immigrated to the United States and gone into the real estate business, having earlier had business connections there. He impressed me as having been quite successful, although I also had the impression that he had invested in an expensive life style rather than providing for old age.

Mr. Tucker had lived a good life, so much was certain, enviably free and often exciting, with friends who lived as he did. In any event, that is how he described it to me. The years went by, his youth was gone, the greatest part of his life was behind him. Now he had colon cancer with metastases in the liver.

Robert Tucker regretted nothing. He had lived his life the way he had wanted to, independent, aware of what he was doing and also of what he had given up. He had always been ready to make his decisions clearly, soberly, and without illusions. He had done that, too, when local doctors had informed him of his illness. He had returned to his native city, Vienna, which many patients in his situation do when they have this possibility.

There were practical reasons for this. Mr. Tucker’s health insurance in the States cost about $10,000 per year. In addition, there was a deductible of 20% for every treatment. As the medications needed for a chemo-immunotherapy cost about $100,000 per year, the deduction plus the insurance meant a personal outlay to begin with of $30,000. The costs for a hospital stay, for the necessary tests, and for carrying out the treatments were in addition. For a self-employed person without major financial reserves this is not a very pleasant situation. I, for my part, could well understand Mr. Tucker’s decision to return to the health system in Vienna, where he had continued to be insured and would at least not have to worry about financing the treatment costs of his illness.

I suspected that he had already been soberly informed about his survival chances and his life expectancy. In any event, we did not talk about either, and we began treatment immediately. A part of this was chemo-immunotherapy, administered every three weeks, so that he could fly overseas between-times. However, the treatments lost their effectiveness relatively quickly. At some point he decided to stay in Vienna, as he was slowly losing strength and had developed a metastasis in the spine, which, after having been treated successfully with radiation, began to grow again and to be painful. We inserted a catheter into the spinal cord in order to initiate continuous opioid treatment.

After a few weeks he asked me for a confidential conversation. »Quite honestly,« he said, »I would like to end it.« He said that every additional day was just an additional burden, and the prospects were not good.

Mr. Tucker had no one outside of his care team with whom he could speak about these things and share his fears and worries. Even those of his overseas friends who were close enough did not come to Europe to see him, and had they in fact come, they would not have been able to stay for the duration to give him support on his final path. Occasionally old Austrian friends visited him, although his contact with them, as far as I could tell, had cooled in the interim.

I told him that his charming personality made him a particular favorite of the team on the ward, quite apart from the fact that in line with our credo we would, as for every other patient, make every effort to attain the best possible outcome for him. Both of these statements were true, of course, but it was clear to me, too, that as motivation to continue to fight it was rather thin. He left it at that, doubtless rather out of consideration for me than out of a newly-found will to live.

A few weeks later, he brought the subject up again. »The situation is extremely burdensome to me, but I have resigned myself to it«, he said. »I just want to see things realistically, I’ve done that my entire life.« He said that despite all the pain medication, he was always in pain.

Also, he was suffering from the side effects of the pain therapy, had a dry mouth, his digestion functioned only with the help of strong laxatives, in addition to which he had the impression that the morphine treatment was interfering with his ability to think. »I’m not the person I was. I’m alone. There is nothing that I could be looking forward to, either a visit from someone tomorrow or something in the more distant future, because, the way things are developing, I don’t have a more distant future. Looked at objectively, continuing to live no longer makes sense to me, quite the contrary. It has become a terrible burden for me.«

It would have been nonsense to speak encouragingly to him again. My one hope was that, despite all of his pain, he might experience at least a few hours that were of value to him. I told him that. But it was not sufficiently convincing to change his point of view. Nonetheless, I could not have fulfilled Robert Tucker’s wish for a premature end, even had I wanted to. It’s against the law in Austria.

As far as that point is concerned, we are living in a paradoxical world. We kill the unborn, who cannot participate in that decision, and in some countries we force adult persons to continue to suffer who have no chance of improvement, are devoid of every other perspective, and who wish to make a rational decision to exit with dignity while they are still competent. The issue here is that there is in fact such a thing as suffering that cannot be alleviated and situations in life in which there is no future, which leave patients with a deep sense of futility and in despair.

There are different approaches to this throughout the world. They range from prohibition of euthanasia, to »passive euthanasia,« which means allowing the ill patient to die if he or she has requested it, to »active euthanasia,« in which the physician on request of the patient administers the life-ending drug – which is what Mr. Tucker asked for and which is legal in a few countries such as the Netherlands and Belgium –, to physician-assisted suicide, in which the patient must himself take the lethal dose provided by a physician – the case in Oregon and other U.S. states –, to assisted suicide in which the assistance does not have to come from a physician (as in Switzerland). For all of these variations there are careful measures in place to prevent any possible abuse.

All we could do for Robert Tucker was what is called palliative sedation. That made it possible for him not to have to suffer pain in his final days.

In the meanwhile, he put his estate in order. To this end, a notary spoke with him at bedside. Given what I had come to know about him, I suspect that he left his remaining financial resources to a charitable organization. He made his body over to the Medical University to be used for teaching purposes. He had earlier been informed that his remains would be buried in a specially designated grave provided by the City of Vienna. I admired him for the sobriety with which he proceeded in this issue. I told him that in our last conversation.

We also talked about death. I told him of the many similar reports from persons who had had near-death experiences. These are persons who, for example, have been reanimated after a circulatory collapse. While these persons are being reanimated, they experience the separation of their consciousness from their body, which floats, for example, above the cardiac emergency team that is working on their heart. They remember many details of the efforts of the emergency service to save them, and they describe as with one voice a never before experienced feeling of euphoria. It is true that no one can prove that this is also the case at the time of actual death. But these persons have the impression of being pulled forward through a tunnel by a glorious stream of light into a world of sanctuary and bliss. »Should this be the reality,« I said, »then we shouldn’t waste another day on this earth, but instead follow the blazing light into happiness.«

»That certainly sounds fantastic. Only, I lack the necessary faith,« he answered. »It’s okay for me to go. But it would in fact have been helpful if there had been a few people I could now say goodbye to. But then perhaps all of this would have developed differently anyway.«

A PLAN FOR LIFE

When people ask me as an oncologist, cancer researcher and hematologist, what they can do not to get sick in the first place, I sometimes think of Martha Allen and Robert Tucker. I cannot say whether Martha Allen would have lived so long if her love and concern for her daughter had not compelled her to set those goals for herself. I also cannot say for sure whether Robert Tucker’s bout with cancer would have ended differently had there been friends and family in his life who had stood by him, supported him and cared for his needs, and, when the end did come, to whom he could have said goodbye. Nevertheless, these two outcomes stand for one of the five things that I always enumerate for those who want to take the maintenance of their health into their own hands and contribute to it to the extent possible. Mrs. Allen and Mr. Tucker are examples of the importance of being integrated into a social network, of the value of close human relationships, of the profound effects of loving as well as of being seen and loved for who we are. Our experiences in this connection can have not only healing effects on our mind and spirit but also enormous influence on our body.

Usually patients consult me when they are already ill and not at a point in time when they are still in good health and should be dealing with the question of how to stay that way. It is human nature not to concern ourselves much with our health as long as we have it. We push thoughts of illness aside and do not consult a doctor until we absolutely need to. This often has negative consequences, inasmuch as many illnesses could be prevented that are difficult to reverse once the characteristic symptoms of the disease have appeared.

Because the possibilities of preventive medicine have become a subject of discussion in schools and the media, and because of the efforts of the national health agencies and physicians’ organizations, more and more people are asking themselves what they can do to stay healthy. The awareness of one’s responsibility for one’s own health is growing steadily. This is certainly a welcome development, but it has a problematic aspect, and that aspect is the role of the media.

The amount of information that is in part contradictory and not scientifically founded is also growing, made available to us especially through the internet, and accepted by large parts of the population. This will probably also be the case in the foreseeable future. When the subject is popular and likely to stimulate the human desire for magic or for extraordinary healing power, certain members of the media can make incorrect information public, sometimes because of sloppiness, but more often with a scandal-mongering intent, to maintain circulation, or the number of times accessed, or to attract listeners or viewers.

Thus, society should demand a greater sense of responsibility and the pledge of careful background research. Particularly in medicine, unrealistic claims can create an enormous amount of uncertainty, unrealistic hopes and expectations, which raises the question of whether severe transgressions should be liable to appropriate consequences.

People turn to me as an oncologist in order to discuss, among other things, preventive measures and/or how and which cancers to screen for. During these conversations, it becomes clear that people are unsettled by the anxiety-producing and often contradictory information about cancer, which maintains that there is a generally increasing threat of developing it. This, so stated, is not correct. The risk of developing cancer and dying from it has declined steadily over the past 25 years,1 but the overall number of cancer cases is rising. This is due to increasing life expectancy, since cancer is for the most part an illness of older persons, and the population, not only in Western countries, is getting older.

Some forms of cancer, such as stomach cancer, have recently become less frequent, whereas others, such as lung cancer, are more frequent. The reduced frequency of stomach cancer presumably has to do with the improved quality of food. Let’s take Europe. In the years immediately after the Second World War, the luxury that today’s throw-away society allows itself was unthinkable.

At the time, many people ate moldy or otherwise spoiled bread when there was nothing else available. They also ate other food that was spoiled simply because the refrigeration was not as good as it is today. The ice man brought ice in blocks to keep food cool in the icebox (in the U.S., too) until the ice melted and had to be replaced, and there was no such thing as a use-by or best-before date on the packaging. Luckily, much has changed since then. Eating moldy and otherwise spoiled food increases the risk of developing stomach cancer, as does the consumption of cured meat, which back then was usual and frequent.

In contrast, lung cancer has become more frequent. This is a result of the fact that more women are smoking than ever before. I do understand it when, for example, people who have to deal with considerable stress find relief in smoking: Besides smoking’s innumerable negative effects on the body, there are also positive effects. It reduces the experience of stress, strengthens cardiovascular activity, makes one more alert, lifts one’s spirits, and encourages communication. We would have to invent something that has the same positive effects as smoking without at the same time harming the body. The connection between smoking and the increased risk of cancer, not only of the lung, has been proven beyond any doubt by the cancer research of recent decades.

Nonetheless, far fewer people die of cancer than of cardiovascular disease, which results from the high frequency of hypertension, high levels of blood fats, and overweight. Another reason for the difference lies in the progress made in cancer treatments. In a number of forms of cancer it has been possible to find a cure or to transform the cancer from a fatal to a chronic illness.

We expect further rapid progress, to which the correction of defects in the steering mechanism of cancer cells as well as immunotherapy and cell therapy will contribute. This rapid progress will, in addition, be supported by the new quality of data processing, which can be summed up in the concept of big-data mining.

Still, the question of what each and every one of us can do personally to stay healthy is of major relevance. Certainly, there are factors in all illnesses on which we have little or no influence, as, for example, our genetic makeup or environmental factors, which I will go into in the course of the book. There are also factors, however, that we can very well influence. We have available to us a range of actions we can take, and we would do well to take them. It sometimes depresses me to see how people irresponsibly do without the knowledge that is available, either because they haven’t made the effort to look for it or because they ignore it when they do have it.

I started thinking in a more systematic fashion about the actions that are available to us, because patients frequently asked me what they themselves could do beyond the proposed treatment. It became clear to me that there were, in fact, different things they could do to support the medical treatment and thereby improve their prognosis and their quality of life. At that point, I started looking at the scientific basis for the different activities that came under consideration. And right then and at the very top of the list of meaningful activities I wrote the word »Love«. Inspired by cases such as those of Martha Allen and Robert Tucker, I mean not only love between two persons but rather the entire scope of our interpersonal relationships and our social integration, and in addition, our love of and devotion to a given task, to our work, or to a hobby.

In the course of time, my list of sensible activities grew, without at the same time getting out of hand. That is because the list can basically be reduced to five elements that I not only warmly recommend to my patients but also suggest to healthy individuals as life maxims. The things that patients can do to regain their health or at least to improve their prognosis are the same as those that the healthy can do to stay healthy.

These five activities can be deduced from many scientific studies that are often very comprehensive, carried out by physicians all over the world. Their results are in conformity with my own observations and insights. Therefore, these five activities mirror the current state of scientific knowledge as well as my personal experiences in patient treatment, from which I have for a long time been continually and systematically drawing my conclusions.

I have always asked myself what it is that makes us the persons we are. How important are our genetic makeup, our life experiences, our surroundings?

When I was studying, immunology was considered the most promising medical research area, comparable today to molecular biology or modern genetics. I wanted then to know more about the biological and biochemical fundamentals of our bodily defenses against pathogens such as bacteria, viruses and fungi. I was also particularly interested in the so-called autoimmune diseases, in which our own bodily defense system turns against components of our organism. How does this system, whose central task it is to keep us healthy, function? What strengthens it and what weakens it?

At the time, these fundamental questions were an enormous field that was barely researched. That spoke to my ambitions and my curiosity. I therefore applied for a research assistantship at the Vienna Institute of Immunology, which had shortly before been founded as the first German-language institute in this field.

I was accepted. After having familiarized myself thoroughly with the scientific method, I was very soon given projects of my own. Three years later I was ready to start my clinical training in internal medicine. At the time there were two university departments for internal medicine that were in competition with each other. That can be good, of course, since competition is stimulating.

A question at the time was whether type-1 diabetes (the form in which little or no insulin is produced and which usually develops in childhood) was the result of a viral infection with a subsequent autoimmune reaction. Having learned at the Institute of Immunology a variety of then modern research techniques, I was of interest to both departments. In consequence, I had the privilege at the age of 27 of being able to make the choice myself.

Because it is directly connected with the message of this book, I describe in the following how I made my decision. Before my interview in the first of the two departments, the secretary of the department head asked me, »How much time do you need? Five minutes… or ten?« That bothered me rather a lot. But in the conversation itself I sensed that the department worked very efficiently and professionally. That impressed me. But because I wanted to be able to compare, I also applied to the other department. The physician responsible for recruitment of medical staff greeted me in friendly fashion. He explained his research area and also touched on the organization of the department. In the end, he gave me half an hour of his time.

Both departments were very promising. But I made my decision not on the basis of the scientific activities and clinical successes of either department – and in any event, I didn’t know what they were in detail. Rather, and without having thought the issue through to the end, it seemed to me even then that the interpersonal aspect, which will be covered more fully later in this book, was more important. The head of the first department might have been the better scientist, but the conversation in the second department, which I experienced as friendly and interested, motivated my choice.

That was the beginning of my clinical career, in which I later specialized in oncology and hematology while doing cancer research. Since then I have been able to accompany, treat, and support many patients like Martha Allen and Robert Tucker with cancer and other serious illnesses. I have experienced how individual patients deal with the cancer diagnosis and the burdens associated with it, how they fight to regain their health, or how they come out of it healed but with the fear of relapse or of late consequences as unloved companions, or how they lose the fight and die of the disease.

On my list of recommendations for patients there were originally four entries. I made a point of having them all start with the letter »L« as in »Love«, so they might be easily remembered.

LovingLaughterLearningLifelong fitness

The list was well received just on the basis of the speech rhythm, but it clearly compressed the recommendations for which the words stood. In »Love« I include, as I have mentioned, the entire area of social integration and passion for a given task. With »Laughter« I mean the entire range of humor, a positive view of life, and contentment. With »Learning« I mean the conscious use of and training of our cognitive abilities. And with »Lifelong fitness« physical activity altogether.

Finally, my four L-concepts were joined by a fifth, of which I had long assumed that it was surely already sufficiently anchored in the heads of most people – until I realized that particularly in this case there were quite a lot of misunderstandings. The issue is how we nourish ourselves, and I had to make a bit of an effort to get this point into an L-concept. What resulted was:

Lighter eating

So – Loving, Laughter, Learning, Lifelong fitness, Lighter eating. Those are the five things we can practice in order to stay healthy. They are fundamental to our humanity, they pervade our entire life, and they influence our physical as well as our mental health, as I will show in the following chapters. I am writing these chapters not with the purpose of producing a book of advice that will guarantee a healthy life to everyone who follows it blindly. That, of course, is impossible because we do not have an unlimited range of action in our efforts to stay healthy. Additionally, I believe that the success of such books depends importantly on their readers and their ability actually to integrate the respective recommendations into their lives. I myself bought a book of advice once. Its title was Don’t Say Yes When You Want to Say No.2 It was meant for people like me who have problems with refusing someone a favor. I’m not entirely sure that I succeed in the meanwhile in saying »No« when I really ought to, and, if I do, what role this book of advice played in that success. I would say that I have in any event been made more aware of the problem and possible solutions.

Should I succeed with this book in making the reader more aware of the problems and possible solutions in matters of health, then I would be satisfied for a start. The five things that we can do in order to stay healthy basically constitute a plan for a fulfilled life – a plan that we possibly already have at the back of our minds, but the realization of which is all too often sabotaged by our habits, our going along thoughtlessly with the mainstream, or simply our inherent laziness. But it is a plan that can only do us good when followed even for a short distance.