One of these men is not like the other.
Story: Dr. Richard T. Bosshardt
They live in Everytown, U.S.A. You almost certainly know one of them, most likely both. Either could be your father, brother, best friend, boss, rabbi, or priest. They could be your doctor. They could be you. We’ll call them Clew and Les.
Clew and Les are both 60 years old. They’re boomers, the generation that grew up in the shadow of World War II and Korea. They have lived through the greatest advances of medical science in the history of mankind. Both are college educated and have had successful careers. The resemblance ends there.
Clew has a body mass index (BMI) of 23. Not quite a beanpole, but close. BMI is a function of height and weight. It is used as an estimate of health risk; 19 to 25 is ideal. Over 25 is overweight. Over 30 is obese. Les’ BMI is 34. He has the usual adult male “beer belly.” Just for fun, let’s compare Clew and Les in several areas of their respective lives.
Strokes and heart disease run in Clew’s family. Clew’s father died of a heart attack, as did his father and his grandfather. Les’ father was obese and suffered from arthritis and diabetes. He died of complications of the latter.
Neither of them has ever smoked. Clew drinks moderately, rarely more than a single beer, glass of wine, or mixed drink in a single evening. Les is what most would call a heavy social drinker, although he hardly ever gets drunk. He enjoys a couple of highballs most nights. When he drinks beer, he will have several at a time.
Clew exercises four to five days per week. His workouts last 30 to 60 minutes; half are moderate—he can hold a conversation while doing it. Half are intense—he can’t complete a sentence between gasps. Les plays softball once a week and golfs twice a week. He rides the course in a golf cart. After both, he heads out to a local bar for some beers with the guys.
Clew is not on any prescription medications. His blood pressure is normal. Cholesterol is high-normal but not high enough to be treated. His triglycerides are very low—a very good thing. His HDL/LDL ratio is good but not great. This is a measure of risk of heart disease. Clew dislikes seeing doctors and hates taking pills. Les is on five prescription meds. Two are for his high blood pressure, one for his rapid heartbeat, one is a statin for his cholesterol, and one is because he is “pre-diabetic.” As long as he is on these, his blood pressure is normal, cholesterol levels are good, his heartbeat is controlled, and his blood sugar is normal. Les believes in better living through pharmaceuticals and modern medicine.
Knowing his family history, Clew eats a plant-based diet 95 percent of the time. Breakfast is whole grain cereal with fruit, juice, and a cup of coffee with cream, no sugar. Les skips breakfast most days and grabs a big gulp coffee on the way to work, the first of several cups each day. Both men eat lunch on the go. Clew sticks with fruit smoothies with no added sugar, containing assorted fruit, yogurt, almond milk, and a large spoonful of flax, chia, or other seeds. Les grabs a deli sub or heats up a prepackaged meal in the microwave. Clew’s idea of a great dinner is a big salad or roasted vegetables over quinoa, brown rice, or couscous that he prepares at home. Les likes to eat out and a favorite meal is a large steak, pink in the middle, with potatoes swimming in gravy, and a salad with creamy ranch dressing. Clew doesn’t snack. Les does, mostly pretzels, chips, or Cheese-Its. Dessert for Clew is a square of dark chocolate. Les loves cookies.
Both are good family men, happily married for many years, and with several children and grandchildren who they dearly love and who love them back. Clew is more introverted. He has a few good friends of many years. He eschews large gatherings. Les is “Mr. Social.” He is funny, smart, and witty, and people gravitate to him. His circle of friends is huge and expanding steadily.
There you have it. Clew and Les, both living an arguably pretty good life. Both are pretty happy. Neither feels deprived. Clew thinks Les is on a fast track to disaster. Les thinks Clew is too uptight and missing out on the good things of life. Who is right?
Here’s the thing. As a doctor, I know that both Clew and Les are going to experience physical decline as they get older. Both will eventually die. These circumstances are inevitable. I think the late George Sheehan, runner, philosopher, author, and cardiologist, said it best. He was at a post-run party reflecting, as he often did, on why he and all these people around him ran. He knew that regardless of how fit and healthy they were, none would outrun death.
“It is beyond our control,” he said. “What is possible, however, is what is technically called ‘compression of morbidity.’ This means limiting the disability and dependence of our final years to a minimum.” George went on to say, “I dread to join the thousands who, as Graham (Wilfred Graham, a professor of religion at Michigan State University) points out, ‘languish in homes for the aged, their minds and spirits exhausted, but their bodies helpless to die.’”
Medical science has advanced to the point where we can keep people alive long after any meaningful quality of life is gone. George died in 1993, at the age of 74, after a seven-year battle with prostate cancer. He remained active and still was running races until a year before he died.
I am not a betting man, but if I were, I would bet the farm that Clew will have a better quality of life in his final years, however long they may be, than Les, even if he dies sooner. The question is, who would you rather be? Clew or Les. The choice is yours.