I am in the process of introducing a new friend to healthy living. This is a challenge, because he does not yet realize that the absence of disease does not define health and wellness. For example, the absence of chest pain at a given point in time says little or nothing about the health of the arteries carrying blood to the heart. An individual may feel just fine when a heart attack is just one beat away.

As I was presenting this concept to a group of people several years ago one of the men grasped the point immediately. Dr. Peterson, he said, you are so right. I had my heart attack at 8:04 a.m. on a Thursday morning. I didn’t think about it at the time, but I wasn’t perfectly healthy at 8:03!

Health is not a static condition. Each minute of every day we are either moving toward wellness or we are heading for sickness. The decisions we make day-by-day, week-by-week and year-by-year have consequences. Some are immediately apparent, but most appear many years later.

We live in a society in which people desire immediate gratification. Because symptoms demand attention many find it appealing and gratifying to treat them when they appear. Few find it satisfying to pursue wellness, because progress is often apparent only after months or years rather than in minutes or days.

Even as a wellness physician most of my time is spent addressing the signs and symptoms of disease, for it is only when illness presents that the average individual begins to seek the health that has been lost. As this newsletter enters its third year of publication it seems appropriate to devote an article to the principles that underline the pursuit of wellness, and which provide the only true hope for recovery from disease.

Over the years I have identified seven controllable factors that determine our state of health. There may be others, but addressing these will keep most diseases from appearing and allow the body to carry out the process of healing if a disease is already present.

Perhaps this is one of the reasons so many physicians choose to pursue diagnoses and treat symptoms rather than promote wellness. Learning the intricacies of hundreds of diseases and thousands of symptoms, each with a specific treatment, is intellectually challenging. On the surface, continually teaching seven basic principles seems quite elementary, and unworthy of someone with 11 to 15 years of formal training.

This is a false perception. Understanding the subtleties of the seven factors and the intricate way in which those variables affect the body’s ability to maintain and restore health is a never-ending quest. The pursuit of wellness is the pursuit of a lifetime.

The seven controllable factors that determine our state of health are the quality of the air we breathe, what we opt to put into our bodies, what we choose to put onto our bodies, what activities we select, the quality of rest we receive, what we allow to enter our mind, and what we decide to feed our spirit.

The first factor I have listed is the quality of the air we breathe. Nothing seems to be more taken for granted than breathing when the respiratory system is working well yet more desperately sought when it is not. I can think of no symptom that drives people to seek medical attention faster than the sensation of being unable to breathe properly.

This is understandable when one realizes that we can live for weeks without food and days without water but for only a few minutes without oxygen. This is why panic attacks are so terrifying. The sensation of not being able to get enough air is inevitably accompanied by the thought that death is imminent.

Given the importance of clean air to survival it is strange that most people give hardly any thought to the quality of the air they are breathing. What consideration is given usually relates to the outdoor air quality as defined by the Environmental Protection Agency. General air quality is important, but the air quality that we can control affects us to a much greater extent than the air that is outside of our personal control.

Having never smoked I have great difficulty empathizing with those who choose to do so. It is difficult for me to imagine voluntarily breathing hot noxious gases on a regular basis. Nothing influences personal air quality to a greater extent than the decision to smoke cigarettes, cigars or pipes.

Neither do I feel any sympathy for those who argue that governmental restrictions on smoking in public areas are an invasion of privacy. Even if one assumes that each person has a fundamental right to destroy his or her health it cannot be asserted that they have the right to adversely affect the health of others.

Personal air quality is adversely affected in other ways. The introduction of toxic fumes into the home is quite commonplace. People routinely purchase and use household cleaners that emit harmful gases. Room deodorizers are commonly used even though most simply “cover” odors by overwhelming the body’s sense of smell.

Many have been overcome by fumes while cleaning a confined space such as a shower or bathroom, but the body can be damaged when using such products in open areas as well. A man recently consulted me regarding a cough that had been present for two weeks. We determined that the cough had been triggered by inhaling naphthalene in his home after his wife had scattered mothballs around the outside walls of the house to repel pests.

Personal air quality cannot only be adversely affected; it can also be improved by taking the proper steps. A mask or approved respirator should be used when performing tasks that generate airborne dust or fumes. Farmers, miners and welders, for example, can decrease their occupational risk of lung disease by wearing approved devices when air quality is poor. Hobbyists as well as professionals should wear masks when sanding or spray painting articles.

Indoor air quality is often far worse than that outside homes and offices. The EPA estimates that the air inside homes and offices contains chemicals at levels up to 70 times that of outdoor air, and that overall indoor air pollution is 5 to 10 times worse than that of outdoor air. Dust mites, animal dander, molds and other particulates are typically present. Levels of carbon monoxide, carbon dioxide, sulfur dioxide and nitrogen oxides from cooking and heating fuels can reach dangerously high levels. Carpets, paneling and insulation can infuse formaldehyde and other chemicals into the home environment for years after installation.

Unlike the outside air, which is periodically cleansed by falling rain, the air inside most buildings is not freshened automatically. It is necessary to take specific steps to improve and maintain indoor air quality.

Electrostatic air filters should be standard equipment on heating and air conditioning systems. These are able to remove more than 90 % of the fungi, mold, lint, animal hair and dander, pollen, dust, smoke and other particles from the circulating air, a much higher percentage than is removed by disposable fiber filters.

Air purification systems are also available and should be considered. Most operate by producing ozone. This causes particulate matter to settle and gases to be oxidized; cleansing the air in much the same way that rainfall cleanses the air outside. It is important that these units fit the size of the rooms that are being treated. Units that are too large for an interior space will put too much ozone into the air, which is itself a concern. Ozone creates a smell similar to that emitted by sheets coming out of an automatic dryer. A properly adjusted air purifier will be set at a level just below that at which the odor of ozone is present.

Finally, controlling the humidity of the air we breathe is important, particularly in the winter when the indoor air is being heated. Indoor air in heated homes is often drier than the air in Death Valley. This is very irritating to the membranes lining the respiratory tract. Dry air can cause nosebleeds, cracked lips, and predispose people to colds and other infections.

Simply placing a teapot or pan of water on the stove is woefully inadequate to humidify winter air. A humidifier of proper capacity should be used. It is important that it be cleaned regularly to prevent the growth of mold, which, if present, will be blown into the air and become a health risk.