What Other Maladies Contribute to These Killer Diseases

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You know your enemies—cancer, heart attack, and stroke. But in reality, these diseases are more like the four-star generals of the opposing forces. In any army the big brass may get all the attention, but foot soldiers lead the assault. Cancer, heart disease, and stroke couldn't wage their battles without lots of help from other medical conditions that get on the front line for these killer diseases.

Here is a rundown of the other culprits that help pave the way for these high-profile diseases. The good news is that if you control them, you can outflank the big three.

Atherosclerosis

Atherosclerosis is just the fancy name for hardening of the arteries. And that's what happens—they get stiff and narrow. But that's not all. "Bad" low-density lipoprotein (LDL) cholesterol starts the process, attaching to artery walls and even attracting other cells to the site. The walls thicken and stiffen. Tiny shards of bone actually form within the walls, which become inflamed. The body tries to repair the damage but ends up making plaque, the stuff that can break loose and form a clot—and increase your risk of a heart attack or stroke.

The destructive process picks up speed if you already have high blood pressure, diabetes, or high cholesterol levels. But you can fight the effects, says John Cantwell, M.D., director of preventive medicine and cardiac rehabilitation at Georgia Baptist Hospital in Atlanta.

Get hormonal protection. Until menopause, estrogen provides women with protection from hardening of the arteries. Hormone replacement therapy will help restore the benefits.

Slow it down with exercise. Exercise slows the progress of atherosclerosis. It doesn't matter whether you go to an exercise class, take walks, or just work in the house or garden. Strive for 30 minutes or more of vigorous exercise just about every day, says Dr. Cantwell.

Get control. If you can control your high blood pressure and cholesterol, you will help put the brakes on this condition, says Dr. Cantwell, who notes that just being 20 percent overweight can trigger insulin resistance or diabetes, key contributors to hardening of the arteries.

Adjust your diet. If you cut cholesterol and animal fats, you will also cut your risk, advises Frank Barry, M.D., a family practice physician in Colorado Springs and author of Make the Change for a Healthy Heart. You increase the effects of insulin resistance and diabetes (both of which speed up hardening of the arteries) if you consume a lot of polyunsaturated oils, such as corn, safflower, and sunflower oils. Monounsaturated fats, such as olive and canola oils, provide a healthy alternative.

Take vitamin E. Vitamin E spurs insulin activity and can prevent LDL cholesterol from being oxidized in the body, notes Dr. Barry. One study designed to find out how much vitamin E is necessary for this protection found that 400 international units of vitamin E is the minimum needed to prevent damage. It also found that 800 to 1,200 international units of vitamin E provided more protection. But talk with your doctor first, especially if you are already taking anticoagulant drugs, says Dr. Barry.

Think small. Large meals send insulin and blood sugar up steeply, giving your system more problems to deal with, especially if your cells aren't taking in insulin and sugar as effectively as they used to. Smaller, more frequent meals will take off some of the pressure, says Dr. Barry.

Atrial Fibrillation

With atrial fibrillation, your heart loses its sense of rhythm—and your risk of stroke shoots up. According to the American Heart Association, this disorder is responsible for 75,000 strokes a year.

Symptoms of atrial fibrillation are subtle, including palpitations and shortness of breath. Oftentimes, you don't know that you have it until a routine physical picks up the irregular beat or an electrocardiogram maps it out.

This condition increases your risk of a stroke because blood tends to pool and be more likely to congeal.

Atrial fibrillation usually goes along with other heart problems. You're at risk if you have had a stroke, heart attack, high blood pressure, congestive heart failure, hyperthyroidism, heart valve or rheumatic heart disease, or if you have abused alcohol.

Your doctor will probably prescribe an anticoagulant, followed by a regimen of drugs to help your heart keep its steady beat.

Barrett's Esophagus

It seems pretty innocent at first—little benign tumors on your esophagus, the pipe that moves food from mouth to stomach. The growths frequently start out as irritations caused by digestive juices that spurt upward from the stomach. Symptoms include heartburn and difficulty in swallowing.

But, as in the case of many cancers, harmless little lumps can turn malignant. Doctors once thought that this condition also increased your risk for colon cancer. But the good news is that a study performed in five French hospitals suggests that is not the case.

Chronic Infections

When your body's cells are damaged, repaired, then damaged again on a frequent basis, you're setting the stage for cancer, says Dr. Cantwell. Pay attention to skin sores, especially if they are exposed to the sun. Scar tissue, too, is more at risk.

"We know that chronic ulcerative colitis, an inflammatory disease of the colon, seems to be associated with increased risk of cancer. It is very likely that all of the body's tissues react the same way to chronic irritation," says Dr. Cantwell.

Colds and Respiratory Infections

In an English study of 96 older men and women, researchers found that the increased risk of winter colds may make the blood more likely to clot in the arteries that supply the heart. That may be caused by increased levels of fibrinogen and factor VIIc, substances in the blood that lead to increased clotting.

Fibrinogen actually provides the scaffolding around which clots form, and it is linked to higher rates of heart disease. An Israeli study, for instance, followed more than 3,000 male heart patients for three years. The 111 men who died during the study all had higher levels of fibrinogen than did the survivors.

One theory is that respiratory infections trigger the body's infection-fighting mechanisms, which also increase blood clotting. But the increase in winter strokes and heart attacks could also be due to seasonal variations in high blood pressure, weight gain, and lack of activity when the temperature drops.

One common bacterium, Chlamydia pneumoniae, may be tied to higher rates of heart disease. This bacterium causes upper and lower respiratory tract infections. It increases the concentration of fibrinogen and sialic acid in the blood, which is also associated with higher rates of heart disease. Furthermore, research shows that people with the high levels of fibrinogen may have twice the amount of the harmful LDL cholesterol. Their levels of protective high-density lipoprotein (HDL) cholesterol are lower than normal, too.

Still, experts aren't willing to put too much emphasis on colds and bacterial infections as risk factors for heart disease, cancer, and stroke. "It's much less significant than other factors, such as high blood pressure, cholesterol, and diabetes," says Dr. Cantwell.

All the same, you can make changes in your lifestyle to keep fibrinogen levels down: Lose weight and eat a diet low in saturated fat and high in unsaturated fat. Include vegetables, fruit, and fish in your diet, says Dr. Cantwell.

Depression

You may already know that the go-go-go type A personality weighs heavy on the heart. But depression is actually worse on the heart, says Robert Carney, Ph.D., professor of medical psychology at Washington University School of Medicine in St. Louis. "Depression appears to be a risk factor for heart disease," he says. "It's more important than a type A personality, but probably not as significant as high blood pressure and cholesterol." Still, he notes that depression is often treated long before patients show signs of heart disease. All the same, depressed people may have higher risk for heart trouble not because of their emotional states alone but because they're more likely to smoke and ignore doctors' recommendations.

Depression takes more than a mental toll. If you're depressed, the nervous system becomes more active and the heart beats faster—and it's more likely to beat irregularly. "Any kind of chronic illness or problem affects the nervous system and adds to risk," says Dr. Carney. Depression differs from normal mood changes. You may be depressed if you experience some of these symptoms for two weeks or more, says Dr. Carney.

* Loss of interest in things you normally enjoy

* Inability to concentrate

* Trouble sleeping

* Lack of appetite—you may lose 5 pounds or more

* A hopeless and helpless feeling, crying for no apparent reason

Even though you will need to see your doctor, you can help reverse depression. Here's how.

Do what's good for you. Even though it's hard to stick to it when you are depressed, exercise and a healthy diet will help bring you out of the depths, advises Dr. Carney.

Get emotional support. People who are depressed feel isolated, as if they don't have anyone who cares for them. Ask for support from family and friends. "You need someone to put an arm around you and help you get through this," says Dr. Carney. "It's a lot easier if you ask for help and know that someone hears you, understands you, and is with you."

Admit it to yourself. Often, just acknowledging to yourself that you are depressed helps, particularly if your depression stems from a specific event, such as an illness. "This kind of depression can be treated quickly and effectively," says Dr. Carney. It may require short-term psychotherapy or antidepressants.

Keep it simple. If you are depressed, you may feel out of control or overwhelmed. "Focus on simple tasks and goals, things you can accomplish," says Dr. Carney. "If you tell yourself that you have to stop smoking right now, you may not feel that you're in control enough to do so. You'll set yourself up for a failure and add to your depression."

Instead, try to cut down. If you smoke 30 cigarettes a day, try to smoke only 25 a day. "That way you can feel that you're making progress and setting goals that you can accomplish," he says.

Make a list. Depression robs you of your concentration and makes it hard to remember things, says Dr. Carney. Keep a list of just a few tasks that you want to accomplish each day. Mark them off when you finish them. Don't overdo it—keep your list short and easy to accomplish. Tell yourself, "I may not be coping very well with this right now, but here are some things I can do to help myself. If I accomplish them, I'll feel more in control and less depressed."

Make your own meaning. When you're depressed, you may feel that life has no meaning. Make a list of your personal reasons for living—the positive things you look forward to, says Dr. Carney. "For instance, that you can still enjoy your grandkids and you still play cards with friends," he suggests. When you feel down, pull out your list and read it to yourself.

Diabetes and Insulin Resistance

Insulin resistance often leads to diabetes—and that's not all. "Insulin resistance and the abnormalities associated with it accelerate atherosclerosis, which leads to heart disease and stroke," says Gerald Reaven, M.D., a researcher at Stanford University. He estimates that insulin resistance affects 25 percent of all Americans.

Both insulin resistance and diabetes wage guerilla warfare on your circulatory system and significantly increase your risk of heart disease or stroke. They also produce a domino effect in your body as other systems go haywire.

Here's what happens in your body. If you have insulin resistance, your system doesn't respond to the insulin you make. That's a problem because insulin is the substance that makes it possible for sugar to get into your cells and provide important nourishment. Think of insulin as the key that unlocks the door to your body's cells and allows nutrients to get in, says Dr. Reaven.

Your system is no slacker, so your pancreas gets the signal to work overtime to produce extra supplies of insulin because the insulin it makes is insufficient to do the job. Over time, it may not be able to sustain the extra insulin production, and you end up with not enough insulin. That's when insulin resistance turns into diabetes.

Though both insulin resistance and diabetes involve insulin, they are two different diseases affecting the body differently. First, let's look at the problems created by diabetes.

The lack of insulin means that blood sugar can't get into the cells where it is needed for energy, and it builds up in the blood. In type II diabetes, the most prevalent kind, some of this sugar gets into the cells by sheer force.

The blood sugar outside the cells exerts pressure—kicking the door down, so to speak, when the insulin key doesn't work. Having blood sugar levels that are either too high (hyperglycemia) or too low (hypoglycemia) is not good for your body.

As if that weren't enough, diabetes seriously increases your risk of developing cardiovascular disease. According to the American Heart Association, approximately 80 percent of people with diabetes die of some type of heart or blood vessel disease. This is because diabetes increases triglyceride levels and lowers helpful HDL cholesterol levels.

Diabetes is also the leading cause of blindness, kidney failure, and nerve damage.

Insulin resistance leads to its own share of problems. Several studies show that insulin resistance and high blood levels of insulin appear in as many as half of the patients with high blood pressure.

You'll want to alleviate insulin resistance because it changes the size of your LDL cholesterol, which is a risk factor in coronary heart disease. In this instance the LDL cholesterol particles become smaller and denser and more easily oxidized, allowing them to grab on to artery walls and narrow them.

If you are insulin-resistant, you have more insulin floating around in your system trying to get that blood sugar into the cells. This is not good because insulin raises levels of triglycerides, fats in the bloodstream that help clog up the works. High levels of triglycerides are normally associated with low levels of HDL cholesterol.

High insulin levels and insulin resistance interfere with your body's system for breaking up clots in the bloodstream.

But there is much you can do to help your body use sugar and insulin more efficiently, reversing insulin resistance and preventing or minimizing diabetes.

Get active. People who exercise can enhance how their bodies use insulin, decreasing their insulin resistance, says Dr. Reaven. In addition, physical activity can lower triglyceride and insulin levels, help lower blood pressure, and increase levels of "good" HDL cholesterol in the blood. The American Heart Association recommends that people get 30 to 60 minutes of aerobic exercise three or four times a week.

Lose weight. Being overweight is not the only factor that can lead to insulin resistance, but it is an important one. If you are overweight and subsequently lose weight, your body will improve its sensitivity to insulin, and you will become less insulin-resistant, says Dr. Reaven.

Where your body stores fat may be more important than how much your body stores. People who store fat in their upper body usually have more features of insulin resistance than those who store fat on their hips and thighs.

Check your inheritance. There is a genetic component to insulin resistance and diabetes. Your risk of developing insulin resistance or diabetes is higher if you are of non-European ancestry. If that fits your family's description, be particularly careful to lower your risk, advises Dr. Reaven.

Put out the cigarettes. Another good reason to quit now: Smoking increases insulin resistance, makes triglyceride levels go up, and makes HDL cholesterol levels go down, says Dr. Reaven.

Hepatitis

This highly infectious disease comes in several forms. Two kinds, hepatitis B and C, are linked to liver cancer. You get type C through blood transfusion or sharing contaminated needles. Type B can get into your system through blood transfusion, sexual contact, or sharing contaminated needles or instruments.

High Blood Pressure

Many people think that high blood pressure is a natural part of getting older. But it doesn't have to be that way. When you lower high blood pressure, you can cut your risk of heart disease and stroke in half or more, says Dr. Barry. That may seem hard to believe. After all, you can have high blood pressure and still feel great. But doctors don't call it "the silent killer" for nothing.

"When you blow up a balloon too much, you put too much pressure on a structure that's not built to take it. It pops," says Dr. Barry. "That's what high blood pressure does to your arteries."

The pressure rises when the muscles in your blood vessels constrict. Blood vessels narrow, and your heart works overtime, pumping more vigorously just to get enough oxygen and nutrients to your body's cells.

Because the blood is under more pressure, it travels more turbulently through your arteries. Imagine a wide river that suddenly narrows through a slender gorge. That wild river ride is close to what happens in your arteries. And other things start to go wrong. The smooth walls of your blood vessels get torn up and become more accessible to debris, or plaque, that builds up on artery walls—which narrows them still more.

Under extra pressure, the plaque may rupture. As it breaks lose, it turns into the stuff clots are made of, and your risk of heart attacks and strokes rises.

Sometimes high blood pressure doesn't start in your arteries. If your kidneys don't work right, they can produce hormones that tell the muscles in your blood vessels to tighten, constricting the arteries, and putting on the pressure. Stress can be another common cause of increased constriction of the blood vessels.

Your blood pressure also rises in response to things in your life that you can change. Here's how to take off the pressure.

Lower stress. Studies show that stress gets your heart pumping and your pressure rising, says Dr. Barry. As stress raises your heart rate and blood pressure, hormones may make the coronary arteries constrict, especially if they have been damaged by atherosclerosis (hardening of the arteries). The combination of reduced blood supply and greater demand for blood can lead to a heart attack.

Cut the salt. As you get older, your system becomes more sensitive to salt and hangs on to it longer. The average American diet contains 3,500 to 5,000 milligrams of salt a day. Consuming 1,000 to 1,500 milligrams a day puts you in the low-salt and high-health range. So check those nutrition labels when you shop and look for no-salt or low-salt products, suggests Dr. Barry.

Add the potassium. Low potassium intake can also increase blood pressure, says Dr. Barry. Get it from your diet: fresh fruit and vegetables, particularly bananas and potatoes.

Drop some pounds. Being overweight can contribute to high blood pressure, says Dr. Cantwell, and a weight loss of just 5 to 10 pounds can actually make blood pressure medication unnecessary in some cases.

Get active. Physical activity lowers high blood pressure. "If you're not doing anything, start to do something physical," says Dr. Barry. "Just accumulate 30 minutes of activity a day. This needn't be marathon running. You can walk, ride an exercise bicycle, work in the garden, or mow the lawn."

Reduce the fat. If you have been wondering why you've put on weight over the years, ponder this tidbit: 37 percent of most people's daily calories comes from fat.

To lower high blood pressure (and get your cholesterol down), Dr. Barry suggests that you try to get your fat consumption down to 10 percent of calories, the amount recommended by Dean Ornish, M.D., to reverse heart disease. Get into the habit of checking the labels on processed food—they will fill you in on the fat content.

Up the antioxidants. Some researchers suspect that high blood pressure is caused, in part, by a shortage of disease-fighting antioxidants in your system. Free radicals, compounds that antioxidants disarm, block your body's production of nitric oxide and prostacyclin, both of which relax blood vessels to help keep blood pressure down. You can get antioxidants through your diet by eating foods rich in beta-carotene and vitamins C and E, such as carrots, cantaloupe, broccoli, red bell peppers, and sweet potatoes. A multivitamin and a vitamin E supplement at 400 international units will also increase your intake, says Dr. Barry.

Don't Get X'd Out Your grandchildren might be Generation X. But the X you really want to keep your eye on is Syndrome X, a cluster of medical conditions that dramatically increase your risk of heart disease and stroke. Syndrome X is composed of several conditions, including high blood pressure, high triglyceride levels, low high-density lipoprotein (HDL) cholesterol levels, and premature coronary heart disease. Researchers see indications of this syndrome even in children, but it usually doesn't become a major problem until much later in life. "All the components of Syndrome X are related to insulin resistance," says Gerald Reaven, M.D., the researcher at Stanford University who coined the term and has pioneered the research into Syndrome X. When insulin can't get into the cells, the body gets the message and mistakenly thinks it needs to make more. High blood levels of insulin lead to high levels of triglycerides, fats in the blood. This high triglyceride level is related to a low HDL cholesterol level—that is, the level of good cholesterol in the blood. "You can make a big improvement with lifestyle changes, such as eating a healthy, low-fat diet and doing some aerobic exercise," says Dr. Reaven.

High Cholesterol

"High cholesterol is the number one risk factor for heart disease," says Dr. Barry. While HDL cholesterol protects you, LDL cholesterol and other fats do big-time damage to your arteries. Here's what happens.

The insides of your arteries start out with a smooth, elastic lining. Over time, it loses the elasticity and gets roughed up. The barrier between the cells in the lining breaks down. Fat cells get trapped within the lining and thicken artery walls. Microscopic fatty deposits even form on the artery surface. The result: narrowed, plaque-filled arteries.

If these deposits break free, they can lodge in the blood's passageway, causing a heart attack or stroke. The good news is that one form of cholesterol, HDL, actually helps the body get rid of the harmful stuff before it can do damage.

Here is what you can do to keep cholesterol levels where they belong.

Eat less fat. Eat the standard American diet, and you take in gobs of fat, typically accounting for 37 percent of your calories. Your body makes a valiant effort to deal with the problem, but there is just too much. So it ends up as cholesterol.

Taking fat out of your diet is the most important change that you can make because it helps lower cholesterol (especially LDL) levels.

Cut the fat. Not all fats affect the body equally. Saturated fat, which you get in red meat and dairy products, is the real culprit. Eat less of these foods, and you lower your total and LDL cholesterol levels, says Dr. Barry. Unfortunately, polyunsaturated fats (corn oil, for instance) are also problematic because they lower the beneficial HDL. If you need or crave fat, then lean toward monounsaturated fat instead (olive and canola oils), and you will get LDL levels down and also raise HDL levels. Keep in mind that you should eat as little fat as possible, even if it is monounsaturated.

The American Heart Association (AHA) recommends that you keep fat consumption to 30 percent of calories or less each day. But you will do your system even more favors if you get total fat intake below the AHA guidelines, down to 10 percent of calories, says Dr. Barry.

Stop smoking. No surprises here. Snuffing this habit tops doctors' lists, says Dr. Barry. Nonsmokers have higher levels of the beneficial HDL cholesterol, 5 to 9 milligrams per deciliter (or mg/dl, how doctors measure cholesterol) above that of most smokers.

Lose weight. HDL—the "good" cholesterol—protects your heart, so you need as much of it as you can get. The problem is that if you gain weight, your HDL levels actually drop. A study showed that men's HDL cholesterol levels drop by 4 percent for every 5 pounds they gain. Women lose 2 percent. Lose the weight, and the HDL levels go back up.

Raise a glass. Studies show that very light drinking raises beneficial HDL cholesterol by up to 15 percent and lowers risk of heart attack. But more than a couple drinks a day may do more harm than good, says J. Michael Gaziano, M.D., director of cardiovascular epidemiology at Brigham and Women's Hospital in Boston.

Add fiber. Fiber in your diet can lower cholesterol levels, says Dr. Cantwell. Go for oats, oat bran, barley, legumes, prunes, apples, carrots, and grapefruit. If you like, add products rich in psyllium seeds, which are often sold as laxatives.

Protect Yourself with a Low-Stress Life How do you lower stress? It depends on what motivates you, says Frank Barry, M.D., a family practice physician in Colorado Springs and author of Make the Change for a Healthy Heart. "Some people, in their heart of hearts, decide that it's easier to take a pill to reduce high blood pressure. Others prefer to make lifestyle changes." Whatever your approach, you will feel less stress if you feel in control of your life, notes Dr. Barry. Get that control by establishing goals, writing them down, and working toward them, giving less attention to little things that aren't really important to you. Ask yourself, "What do I want to accomplish in life?" Here are techniques that many people find effective in relieving stress, says Dr. Barry. Relax and enjoy. Believe it or not, relaxation and enjoyment take some effort—or at least some calculation. "A lot of people realize that if they sit in a chair all day, they will make their health worse. But in the years of work, they have forgotten how to enjoy themselves," says Dr. Barry. "If you enjoy life and develop a sense of playfulness and humor, you'll be less prone to stress, anxiety disorders, and depression." Make a study of what really relaxes you and what you really enjoy—the types of places (say, museums or parks) or activities (like cards, golf, or quilting). Then deliberately build those things into your day. Remind yourself that it is okay to have fun—you deserve it. Lend a helping hand. You may get your greatest satisfaction from helping your children or grandchildren. But if you are considering providing financial assistance, think carefully: Will you find that satisfying or just stressful? "But I've seen patients who have never had such joy as when they gave their grandchild a new car. In that case, money can be a stress reducer," says Dr. Barry. Pay attention to changes. Stress goes up with major life changes, such as the first few months after retirement. "Your routine changes immediately, but your mind and body are still tuned to the habits that may have taken 65 years to form," says Dr. Barry. Often, just acknowledging the stress helps to bring it down. Remember, less is more. Many older people feel the stress of a fixed income. "Take advantage of the burgeoning simplicity movement," says Dr. Barry. When you sit down and think about what makes you happy and what makes you worry, you may find that you don't need the second car, the cabin in the mountains, or the new furniture. You may find that what makes you happy are family and friends, and fewer material things. Letting go of what's not important helps cut costs and stop stress. Get on with life. Especially when you retire, you may be tempted to live vicariously through your children and grandchildren. That always produces stress because it doesn't work. Instead, live your own life. Do volunteer work to establish a larger circle of friends and responsibilities. Take courses at your local college. Change your inner environment. Biofeedback or meditation will relax you mentally and lower stress, says Dr. Barry. Try reducing the psychological stress that raises your blood pressure by repeating a sound, word, phrase, or muscle activity while you passively disregard other thoughts. Say good-bye to beepers. A lot of people feel as though they are always on call, says Dr. Barry, thanks to pagers, cellular phones, and the like. Take a break from technology, perhaps spending a restful day with the phone unplugged. Get unbusy. Allow yourself time to do nothing. Make like a B. People with type A personalities suffer stress more often. Type A's are impatient, competitive, hostile, easily angered, and constantly struggling against the demands of real or imagined deadlines. (If you ever had to work for one, they gave you stress.) Type Bs, on the other hand, are more relaxed, accepting, and less impatient. If you're a type A, practice being assertive but not hostile, advises John Cantwell, M.D., director of preventive medicine and cardiac rehabilitation at Georgia Baptist Hospital in Atlanta. You'll be more pleasant to be around—and you'll reduce stress, giving your heart a break.

Get an E. In a small study, researchers found that vitamin E supplements combined with a diet high in monounsaturated fat blocked LDL cholesterol and kept it from oxidizing. Some doctors recommend 400 international units of vitamin E a day for their patients that have coronary heart disease.

Soy to the world. Rather than a hamburger, reach for a soy or tofu burger. soy protein is low in fat and rich in genistein. While this substance has received a lot of attention because it may lower the risk of breast cancer, researchers believe that it also decreases total cholesterol.

Are You Hot? The standard tests that doctors use to tell whether you are an easily stressed "hot reactor" (and at greater risk for disease) are pretty simple, so take your pick, says Frank Barry, M.D., a family practice physician in Colorado Springs and author of Make the Change for a Healthy Heart. For the first two tests, you'll want to take a blood pressure reading twice—once before the test and once during the test for comparison. Test 1: Chill out. In Test 1, put your hand into a cold bucket of water for 1 minute and have someone measure your blood pressure right after you have done it. If it goes up into the high range in response to physical stress, you are a hot reactor. Test 2: Do some math. Test 2 is a little more cerebral. Start with the number 100 and mentally subtract 7, then continue to subtract 7s until you get to 2. In the midst of your figuring, have your blood pressure taken. "There's no exercise, no threat to your life, but a lot of people still feel mental stress and their blood pressures shoot up," says Dr. Barry. Test 3: Talk to yourself. You can also test yourself without the shock of cold water or the mental anguish of math. Ask yourself: Are you working toward your own true goals or someone else's? If you are busy trying to keep up with the Joneses, "you're still in the rat race, even if you have retired. You're much more likely to feel the effects of stress regardless of whether you're a hot reactor," says Dr. Barry.

Stomach Ailments

Results from one study suggest that stomach cancer may be tied to a type of common bacteria, Helicobacter pylori. The little organisms produce chronic upset that may eventually allow cancerous cells to take over. In an American study, doctors found that half of the people who visited their family doctors for stomach complaints had these bacteria to blame. Antibodies that your body produces to fight the bacterial infection may actually stimulate cancer cells in the stomach. Good news: The infection can be treated with antibiotics.

Stress

In the film West Side Story, members of the Jets, a New York street gang, urge each other to "stay cool." Researchers who study stress say the same thing: Stress can make you vulnerable to heart disease, cancer, and stroke.

Feeling stressed or overwhelmed raises your blood pressure and can even trigger heart arrhythmias. "We know that stress can contribute to increased cholesterol and hypertension," says Dr. Carney.

People who react strongly to stress are called hot reactors by cardiologists and psychologists. Their stress triggers an extra release in the flight-or-fight hormones that gave your Stone Age ancestors an edge over saber-toothed tigers. The hormones tell your heart to pump faster, which increases your blood pressure.

Stress also releases free fatty acids into your system, giving your body the energy boost it needs. But unless you're really going to wrestle a prehistoric feline, your body doesn't have a use for these compounds. They turn into dangerous, artery-clogging cholesterol.

Chronic stress may also decrease your body's immune response, leaving you more vulnerable to a cancer. Researchers at the National Institute of Mental Health in Bethesda, Maryland, found that stress activates hormones that allow viruses and cancerous cells to get to work.

Thyroid Imbalance

In a study of 2,000 men and women age 60 and over, researchers found that thyroid imbalance can interfere with the rhythm of your heart's beat. Those with slightly overactive thyroids were most at risk, a condition called subclinical hyperthyroidism. If you have it, your thyroid releases a low level of thyrotropin, a pituitary hormone that controls the production of the thyroid hormone. Your doctor can prescribe medication to regulate hormone production.

Prescription for Prevention

Cancer, heart disease, and stroke don't arrive out of the blue. Lots of little problems pave the way for these major maladies. All the little things you can do to assure your general health play important protective roles.

Do:

* Keep cholesterol, blood sugar, blood pressure, and body weight within normal limits.

* Exercise regularly to prevent the circulatory slowdowns that lead to heart disease and stroke.

* Take vitamin E at 400 international units daily to activate your insulin reserves and protect your cells from damage.

* Eat small meals to help your system take in insulin and sugar more efficiently.

Don't:

* Smoke.

* Let winter weather make you inactive.

* Be a hot reactor.

* Get low on potassium. You risk getting high blood pressure.

DISCLAIMER:
This book is intended as a reference volume only, not as a medical manual. The information given here is designed to help you make informed decisions about your health. It is not intended as a substitute for any treatment that may have been prescribed by your doctor. If you suspect that you have a medical problem, we urge you to seek competent medical help.