There was a time when I thought I knew what it meant to be healthy. I was younger then and much thinner too. I swam five hours per day, 5 days per week, lifted weights three times per week and competed on weekends. I loved training, especially the long, grueling, descending interval sets when I could lock into a rhythm and just go, racing the guys in the lanes next to me.
At times I ate really well, but mostly, my diet was crap, filled with diet coke and fast food typical of my generation. I was on birth control pills (high dose, back then), allergy pills (the ones recalled for the risk of heart attack), topped with regular doses of ibuprofen to compensate for training pain and monthly menstrual hell. But I looked good and could compete with the best of them so I thought I was healthy.
Though I knew it wasn’t normal for a teenager or an early 20 something to have high blood pressure and pass out periodically, I neither considered those symptoms as signs of ill-health nor as side-effects of the medications and dietary choices I had made. I had, and still have, a resting heart rate in low the 50 beats per minute – how could someone with such good cardiovascular training be unhealthy? How could someone who was slim and muscular be unhealthy? The blood pressure, the black outs must be a fluke, I reasoned. And the monthly menstrual pain, well, that was normal right? All women writhe on the bathroom floor once a month.
It was years before I began connecting the dots between my symptoms, my diet and the meds. It took even longer for me to question my definitions of health. What does it mean to be healthy? Is it about weight? Many of us tell ourselves that health is all about weight, especially women. I am guilty of this even now. Does weight really correspond to health? Is health something that simple? Certainly, at the extreme ends of weight, there are significant, linear correlations between health and weight, but for the rest of us who fall somewhere in the middle it is not that clear cut.
We know now that body mass index or BMI, the shorthand calculation that most physicians use to determine obesity and by association ill-health, falls short for most athletes, many women, and is especially problematic for older women and men because it doesn’t consider muscle mass. Neither does it consider fitness level nor cardiovascular health, the primary driver for most weight loss campaigns. If weight is not correlated with these other measures of health, one has to wonder if weight is sufficiently sensitive to gauge human health. Perhaps, it is not.
Using myself as an example, I have learned over the years that my blood pressure is sensitive to many medications and toxicants. I cannot take oral contraceptives or I suspect synthetic hormones of any sort. Micronized progesterone landed me in the hospital. Pregnancy also increased my blood pressure exponentially, though it is likely that this was exacerbated by the tocolytics given to slow my contractions and my diet which was low salt but high carbs (sugars).
I cannot take cold medicines (pseudo-ephedrine). Vaccines too spike my blood pressure. Heck, if I am not careful with my coffee intake (I would be better off quitting altogether), that too spikes my blood pressure. As a result, I rarely if ever take any medications now but this was not so for the first 40 some odd years of my life. To say this was a long process, would be an understatement. I, like most of us, tell myself lies about my healthiness. I have always considered myself healthy, even in the face of evidence to the contrary. Now, I know better.
Was my weight ever correlated with my blood pressure? Perhaps, sometimes, but even though my weight has fluctuated dramatically over the last decades, if I dig a little deeper, I can always find another more plausible reason for the increased blood pressure; generally an illness, in itself a stressor, but often one requiring a medication known to increase blood pressure. What is so sad about this realization is that no physician ever made these connections (not even between the oral contraceptives and blood pressure), preferring instead to treat my blood pressure as an entirely discrete entity and with medications that invariably lowered my blood pressure, but also tanked my heart rate into the 30s-40s, something I knew was not safe. And the blood pressure medications working by different mechanisms that didn’t lower my heart rate, well, they had far too many serious side effects. To consider taking any of those meds for the rest of my life was out of the question, at least to me. The cardiologists, on the other hand, had no problem piling on medication after medication.
So when we go back the question of health markers, are weight and blood pressure sufficiently sensitive to detect ill-health? The answer is yes and no. While weight is sometimes associated with high blood pressure, I would suspect both weight and blood pressure are markers of other illnesses or medication reactions. Remove or reduce the burden of those illnesses and blood pressure as well as other indices of heart disease and inflammatory disease processes may diminish as well.
How do we do this? Well, diet and lifestyle contribute immensely. For me, diet has been huge. Using myself as an example again, when I was younger, I was slim and athletic, but had very high blood pressure. My diet was crap back then and I used medications known to exacerbate blood pressure. I am now much heavier (almost obese by BMI standards), still very athletic (currently, CrossFit 4-5 times per week; previously water polo, running, spin) and through diet (non-processed, no sodas, no gluten, only organic vegetables, fruits and proteins) and nutrient supplements, I have maintained ‘normal’ blood pressure, perhaps for the first time in my life. Sure, I’d like to lose 40 pounds or so and maybe at some point my body will begin releasing those fat stores, but it really doesn’t matter. I am healthy and completely medication free, not even ibuprofen for training pain.
Long story short, when we think about health, what it is and what it isn’t, addressing medications, diet and lifestyle (exercise) variables are critical. I always had the exercise component in my favor, but diet and medication use has been problematic. I have recently come to understand, that if we have symptoms ‘requiring’ medications, then we are not healthy, no matter what we tell ourselves and how good we look in those tight or not so tight jeans. In fact, those meds are probably masking and/or exacerbating the real causes of ill-health. Instead of piling on more and more medications, begin disentangling the root of your symptoms, address dietary problems, nutrient insufficiencies and lifestyle variables. I suspect for many of us, with a bit of detective work combined with some lifestyle adjustments, health is within reach. It just may not look like what we have been conditioned to believe it should.
This post was published originally on March 11, 2015.
Postscript: in the three years since writing this post, I still maintain a healthy diet and blood pressure, save except for my bout with turmeric induced hypertension (even ‘healthy’ supplements can have some interesting effects on BP). I still workout regularly, though now my sport is powerlifting, where I hold several world records in the old lady divisions. And I weigh more now than I ever have in my life, except during the last week of a pre-eclamptic twin pregnancy where I exploded with water weight. The muscle mass I have gained has moved me ever closer to the BMI obese category. Despite what the scale says, however, I am skinnier than I have been long time and I am certainly fitter and stronger. At 50, I am healthier than I was in my 20s. Diet and lifestyle are critical to health. BMI is not.
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