Top Ten List of Ways to Stay Healthy in 2023

Congrats, pandemic survivor. With renewed appreciation for your future existence, why not consider  2023 and beyond? As COVID wanes it’s time to revisit basic non-COVID health issues.

I occasionally give health talks. I offer a reminder that the purpose of life is not to stay healthy. Health remains a means to an end, empowering us to fulfil life’s purposes. We should attend to the basics and move on. I usually offer my “top ten,” a list of relatively easy steps to optimize health. Here’s the current edition:

1. Eat a balanced diet with emphasis on fruits and vegetables.
2. Maintain appropriate body weight.
3. Avoid cigarette smoking, excessive alcohol or other substance abuse.
4. Avoid unprotected/promiscuous sexual activity.
5. Get periodic medical evaluations and standard preventive care including vaccinations, mammography and colonoscopy.
6. Limit sun exposure.
7. Get routine dental care.
8. Stay physically active.
9. Stay interpersonally connected.
10. Wake up with a purpose.

That’s it. Stay true to the top ten and you’ll likely thrive. Is it possible to get partial credit? Absolutely. Seven to nine may work well depending upon the ones you de-emphasize.

The top ten list is about the power of habits. Over time good habits can create a positive personal health trajectory without excessive time expenditure. In contrast, bad habits damage health insidiously. Take smoking, still the common habit most corrosive to health. Some of my patients smoke a half pack (10) daily. Comparing themselves to one or two packs per day smokers, they consider their habit “light.” I remind them that health effects aren’t about daily use. They need to consider the 3500 cigarettes per year or 35,000 per decade on their horizon. How will the carcinogens in 100,000 cigarettes affect the chance of surviving three decades?

The same habit calculus applies to mild vices like soft drinks. A 150-calorie drink means almost nothing as a one-off. But drink it every day for a month and it’s 4500 calories, well over the 3500 that puts on an extra pound. One a day for a year? Over 15 pounds.

Over years of practice I’ve seen good health habits translate into longer, more productive lives. But one caveat: not always. So, the pursuit of happiness justifies some hedging. Is moderate alcohol a completely harmless choice? Perhaps not, but it’s also not catastrophic. As one of my medical school professors noted, “one out of one dies of something.” Overall, when betting with one’s life, like personal investing and other matters of chance, it’s sensible to focus mainly on the big picture issues. Additionally, expert opinion, seemingly out of fashion in the COVID era, deserves consideration.

Unfortunately, no 2023 health review would be complete without at least a mention of COVID-19. I still have about one patient per day newly diagnosed with the virus. Fortunately, most are vaccinated and do well with little risk of hospitalization or death. The new bivalent (two strain) booster is safe and effective. If you’re vaccinated with it you’ll be less likely to get sick. If you do get sick, the illness would likely be milder. If that seems threatening or inconvenient, be prepared to have your winter interrupted by an unpleasant febrile illness. Not surprisingly, influenza also causes flu-like symptoms. In a typical season, flu vaccines reduce risk of the illness by around 60%. That’s not bad for a mild vaccine that typically causes only a mildly sore arm for about half a day. And thousands of people, mostly seniors, still die from flu every year. So, getting flu vaccine should also be a no brainer.

Fortunately, we also have the COVID drug Paxlovid, which works reasonably well. Although it has some important drug interaction issues, it has only minor side effects. For flu, Tamiflu remains modestly helpful.

Once you’re fully vaccinated and caught up with the top ten, what about life’s purpose? On that subject, doctors like myself have less to offer. It’s like asking your mechanic where you should drive your car. If you went to Yom Kippur services this year, I’d suggest a three-month check on your progress. Try to help someone else. Pick a project. Whatever you do, don’t spend too much time and effort on health. Just stick to the top ten, then go chase some rainbows.

Daniel Stone is Regional Medical Director of Cedars-Sinai Valley Network and a practicing internist and geriatrician with Cedars Sinai Medical Group. The views expressed in this column do not necessarily reflect those of Cedars-Sinai.