The entire healthcare system is working against us.

“We are getting exactly what the system is designed to create,” Dr. Scott Conard and Vince Poscente write in their book Which Door? 

“We’re incentivizing hospitals and providers to produce more volume, not better health,” they write.

“In fact, if the system actually did help a person become healthier, it would be shooting itself in the foot and reducing future revenue,” they write. “If we want a different outcome, we must change incentives to spend less and to proactively create and support healthy, vital people who are living long, healthy lives.”

The bottom line?

“Healthcare in the USA is designed for profit, not people,” Scott and Vince observe. 

So what are we to do? We must be much more proactive about taking charge of our health. Disease strikes suddenly. But there is often a decades-long window where our actions and behaviors can delay or even prevent disease from occurring.

Dr. Conard has proposed a seven-step process to help us take charge of our health. He calls it the “Seven Numbers.”

“To make this easy, we created the acronym ‘TROUBLE,’ because we want to keep ourselves out of trouble,” the authors write.

#1: “T” is for Training. 

“It usually starts in our 20s or 30s, where we find it more challenging to be active due to our jobs, kids, and other things that keep us from exercising regularly. Our training goes down, and our fitness is reduced,” Scott and Vince write. “Exercise is the best medicine, so as this goes down, things start to get off track within our bodies.”

The numbers to track? Our steps and the number of minutes of exercise per week. 

The high-level goals: 10,000 steps a day; 150 min/wk of exercise

#2: “R” is for Roundness. 

“Due in part to this reduced activity, coupled with changes in our diet, often with more fast or processed food, our weight begins to go up,” Scott and Vince note. “In the US today, over 70% of Americans are overweight or obese as a result. This is particularly a problem if the weight gain is around the middle, right at the level of the belly button.” So, we need to pay attention to our waist circumference. When this number is over 40 inches for men or 35 inches for women, we “are at increased risk of sleep apnea, arthritis, colon and other cancers, diabetes, a heart attack, or a stroke.” 

The numbers to track? Our Body Mass Index (BMI), Percentage of Body Fat, and Waist Circumference.

The high-level goals: BMI: 19-25; % Fat: M: < 18 F: <25; Waist Circumference: M <35, F <30

#3: O” is for Oil. 

“As our fitness goes down and our waist circumference goes up, the process of having plaque buildup in our body accelerates. We can discover this with the simple blood tests that our doctor or our company does every year,” the authors write. “There are three lipids, or blood oil, values that we see on the blood work on the Seven Numbers card. If these are out of balance, it means we are at increased risk of developing diabetes, building up plaque, and having peripheral vascular disease, an aneurysm, or heart attack.

The numbers to track? Low-Density Lipoproteins (LDL), How-Density Lipoproteins (HDL), the ratio of HDL to Total Cholesterol, and Triglyceride Level

The high-level goals: LDL <70; HDL F: >60 M: >50; HDL/TC <3.5; and TRIGL < 90

#4: “U” is for Unacceptable Sugar.

“This was a hard one to find a word for,” Scott and Vince write, “but finally, we settled on U for Unacceptable Sugar. If our blood sugar, or glucose, goes up, things are starting to change in our body. This is usually one of the last changes indicating we have a metabolic syndrome – a symphony of changes that indicate the onset of diabetes with the complications of blindness, kidney failure, and/or nerve damage, a stroke, or a heart attack.”

The number to track: Glucose

The high-level goal: Glucose <100

#5: “B” is for Blood Pressure.

“When our blood pressure starts to go up, the risk of heart failure, strokes, and kidney failure start to go up,” the authors write. “In fact over 90% of kidney failure is due to two things – diabetes and high blood pressure – both things that could be treated, preventing this from happening. After 10 to 20 years for it to result in kidney failure, heart attacks, strokes, diabetes, or heart failure. With increased fitness, weight loss, and/or with medication, this process can be reversed or slowed dramatically.”

The numbers to track: Systollic and Diastolic Blood Pressure

The high-level goals: Systollic < 120; Diastollic < 80

#6: “L” is for Lousy Habits.

“The sixth number is actually the lousy habits that accelerate these risks,” they write. “Any tobacco use will accelerate the process of having lung disease, peripheral vascular disease, heart attack, or stroke.” Next, we must be aware of the dangers of a sedentary lifestyle, sometimes referred to as “the new smoking.” We want to pay attention to the hours we spend watching TV or just sitting around. The third number to consider is the average nightly hours of sleep. “I used to consider sleep a waste of time,” Scott notes, “but data has shown that if we get less than 7 hours per night, on average, our bodies are more stressed out and our numbers change for the worse.”

The numbers to track: Tobacco Usage, Hours of Sleep per Week, Hours of TV per Week

The high-level goals: Tobacco Usage: No; Hours of Sleep per Week >54; Hours of TV per Week <15

#7: “E” is for Exploding Plaque.

“Finally, all of the issues discussed above lead to the development of plaque in the blood vessels,” Scott and Vince write. “When plaque ruptures or breaks open, a blood clot forms, and we have a stroke or heart attack. There are tests that check the presence of plaque in our bodies. One is in our blood; another is a scan we can get. If either of these are elevated, it is time to really get in gear and get our numbers under control.”

The numbers to track: Calcium Score and High-sensitivity C-reactive protein (hsCRP)

The high-level goals: Calcium Score: 0; hsCRP: < 2.0

More tomorrow!


Reflection: Am I motivated to measure, track, and improve my Seven Numbers? What is the first area I commit to improving?

Action: Do it.

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