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Tom Kottke, M.D.: In the New Year, focus on health — and well-being

It’s the time of year when many of us are looking for advice on how to live a healthier life. Since much of my writing is focused on mental health, I’m usually not all that interested in typical “health” tips about how to lose those pesky holiday pounds, so when I saw that Thomas Kottke, M.D., a clinical cardiologist and HealthPartners medical director for well-being, had compiled a list titled, “How to give yourself the gift of health and well-being,” I was intrigued.

Turns out it’s a strong list, full of tips and reminders on how our physical and mental health are inexorably linked, and how developing and maintaining emotionally healthy habits — not just exercise routines — can help people live longer, stronger lives.

I wanted to find out more about how Kottke put his list together, so I gave him a call. He was more than happy to fill me in on his methodology. (Kottke also explained that elements of the list are based on a survey that his organization regularly sends out to randomly selected members.)

Helping others maintain their health has always been central to Kottke’s career. “I’m a doctor because before I was born my mother decided that I should be a doctor,” the long-time physician told me. That sense of predestination didn’t bother him one bit: “I always wanted to be physician, and I think I’ve been able to make a difference with my work. It brings me great satisfaction.”

Good thing, because finding career satisfaction is No. 3 on his well-being list.

MinnPost: The first area that you highlight in your list is physical health. That seems pretty obvious, but why do you think that maintaining physical health is key to well-being? 

Tom Kottke: Physical health is one important element of overall well-being. It made sense to start this list with physical health because we’re a health care organization, but you actually don’t have to be physically healthy to achieve well-being. Take my dad, for instance. He died at 95. Even though his health had failed, I’d say that my dad died with well-being. He had well-being because he had children and grandchildren and great-grandchildren. He had a successful career and a happy life. When his time came, he felt he was ready to die. His body had given out. My mother had died 10 years before him. He had a good death because he had hospice care. His well-being was honored and encouraged throughout his life, even to the end.

People who have diseases or conditions that we don’t always associate with good health have well-being, too. Many people who are quadriplegic, who can’t move their arms or legs, will still say they have a happy life. People with cancer sometimes say that cancer is the best thing that ever happened to them. It gave them a clearer focus and something to shape their goals and actions around. This is a central part of well-being.

MP: In some ways this list reads like a kind of checklist, a way for people to make sure they’re on track for living a physically and emotionally healthy life. Was that your goal?

TK: For the first part of our lives, maintaining good health doesn’t have to take too much work. As long as they don’t shoot themselves or get traumatized or get HIV, most men do pretty well health-wise until they are about 50, then the wheels start falling off. Women do pretty well until about 60. If you follow the tips in this list, odds are that you will be able to sustain your good health and well-being, to hold off chronic conditions like pulmonary problems, heart disease, diabetes or obesity for some time.

MP: Do you follow your own advice? 

TK: I do. I am just 6 months short of 70. I rode my bike to work this morning.

MP: Your list emphasizes getting adequate sleep. Why do you think that’s important?

Tom Kottke, M.D.
Tom Kottke, M.D.

TK: In so many ways, good health and well-being are interconnected. Taking care of yourself in one area can help you stay healthy in another. Inadequate sleep is associated with obesity and all sorts of chronic problems. As Americans, we haven’t appreciated the importance of sleep as much as we should. Too often we seem to resent having to sleep and having to take time out to eat. Again, those are two key factors for health and well-being of families and individuals. Again, it’s interconnected.

MP: Exercise, or physical activity, is also on your list. I know that a daily workout does wonders for my mental health. Does research back this up? 

TK: It does. The positive impact that physical activity has on mild-to-moderate depression has been proven. Physical activity is far more effective than common antidepressants in battling depression.

It works that way for me, too. If I get really grouchy, my wife says, “Go for a bike ride.” When I get on my bike the things that once seemed so important become trivial. You can’t separate these things. Physical health leads to emotional health. And if you are emotionally healthy, you see a reason for taking that time out to go to the gym.

MP: Your list advises limiting alcohol consumption to one or two drinks a day. Why’s that?

TK: The reasons for limiting alcohol consumption should be obvious to everyone. Overconsumption has an impact on so many levels. When I read today’s paper, I saw that a Ramsey County judge is going to spend 90 days in the workhouse for driving with a blood alcohol level of .17. Drinking and driving can be a career-wrecker. 

MP: The first part of your list focuses on healthy behaviors, but then you throw in a comment about healthy thinking. Can you explain how you define “healthy thinking,” and how it impacts overall well-being? 

TK: Healthy thinking is important to well-being. I’ve studied positive psychology, which identifies three behaviors that can contribute to general well-being. Those behaviors are:

1) Being kind to others;

2) Thanking others for the little things they do; and

3) Taking time in a structured way to note at least three good things that happen every day.

MP: This practice of noting good things sounds interesting. Does it have a larger benefit? 

TK: It does. And once you get started, it’s hard to stop. I could write down a dozen good things that have happened already today, but maybe I’ll just start with the fact that the weather was good enough for me to ride my bike to work. I could also add that I live and work in the best place in the world, and that I have a family that I love.

I’m advocating a practice of noting and recording good things that happen each day. There have been double-blind studies where participants were asked to write down three good things that happen to them every day. After 3 months, participants were more likely to report feelings of happiness and less likely to report symptoms of depression. This simple practice changes the brain.

MP: Career satisfaction is No. 3 on your list. How do you define “career?  Does a person need to have a high-paying or a high-prestige job to feel satisfied?

TK: By “career,” I am talking about what a person does every day. It doesn’t have to be paid employment. My wife, for example, hasn’t been employed outside of the home for many years, but she still has a satisfying career. She raised our now-adult children. Now she takes care of me and our dogs. She completes these phenomenal knitting projects. She manages our household and loves her life. She has career satisfaction.

People who want to experience well-being around career may need to tell themselves, “I’m going to lead the life I want to lead, not the life that everyone else expects me to lead.” For instance, I know a chap whose father was a doctor. He grew up in Rochester where he learned that if he didn’t want to be a doctor he should at least be a lawyer. He didn’t want to be a lawyer, either. It took him 10 years but he eventually got licensed as a biology teacher. He’s had a fulfilling life and a satisfying career. He decided to live the life he wanted to live. It is hard to have a sense of well-being if you are living the life that someone else wants you to live.

MP: Sounds like you’re saying that the pursuit of wealth doesn’t always equal emotional health.

TK: If your financial appetite is bigger than your income, you’re in trouble. It can lead to a lot of anxiety and emotional distress. The key to adequate finances is controlling your appetites. The most stressful times for my wife and me through the years have been when our financial appetites got out of control.

Everyone can think about how to live within their budget. Do you really need the deluxe cable package? Do you need an iPhone X? In the end, everything comes down to relationships. People won’t remember what you gave them. They’ll remember how you made them feel. People around the world who live on pennies a day can be very happy. It is important to realize that material goods at some point become a burden.

MP: One thing that money can’t buy is friendship. Cultivating and maintaining healthy social relationships is No. 5 on your list. How does having friends improve health and well-being?

TK: There was a landmark study published about 40 years ago called the Alameda County Study. In this research, they found that subjects who reported feeling lonely had mortality rates that were markedly higher than the general public. Building social relationships is key to well-being. It’s important to make connections with other people. Those connections could be through a book club, a religious organization or a walking club. We understand from functional MRI brain research that doing things like volunteering and helping other people is also really good for our health.

MP: Connected to, but slightly different from social relationships is building a sense of community. You name this as another important factor in long-term well-being. Why is that? 

TK: In his book “Blue Zones,” author Dan Buettner visits parts of the world where citizens live long, healthy lives. One of the things Buettner does when he goes into these communities is to ask around and find out if the people there know their neighbors, if they have built strong relationships with people who live nearby. In these “Blue Zone” communities, they usually do. It’s that important.

MP: But how can a person build a community? Minnesotans, for instance, are notorious for being superficially friendly but not fully welcoming newcomers.

TK: Sometimes you have to do the work to build a community for yourself. If you don’t feel comfortable just stopping by your neighbor’s house, maybe you should host an open house and invite all the neighbors over. Or you could join a walking club. It’s about getting out in the world. My wife walks our dogs and she knows nearly everybody in the neighborhood. We have a sense of security because we know who people are. This enhances our well-being.  

MP: The last category on your list is developing a sense of purpose. This sounds important. Can you tell me more? 

TK: It is important. Finding a sense of purpose is central to overall well-being. In Japan, it is known as ikigai. This is your reason for being, something beyond self, your sense of purpose. Maybe your sense of purpose is taking care of family. Maybe it is your job; maybe it is your place of worship. Whatever it is, your ikiagi is the defining factor of who you are, and how you choose to live your life. 

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