When creating a strategy to maintain lifelong health I have found it helpful to think in terms of a pyramid. At the base are diet and activity. On the second level are essential nutrients. Other dietary supplements are found on the third level, herbs on the fourth, and drugs are the capstone.

The foundation of the pyramid is made up of diet and activity. All health is founded on these two aspects of our life: What and how we eat and how much physical activity we pursue. Without a solid foundation other steps will be of little benefit. There is no vitamin, no mineral, no supplement, no herb, and certainly no drug that will bring optimum health if there is no foundation upon which to build.

Once, after I had presented the Health Maintenance Pyramid concept to a group of young physicians, one of them asked, “How do you get a patient to change his or her diet? I certainly haven’t had any success!”

I advised her that people facing health challenges are often motivated to make basic changes in their lifestyle when shown the way. I realized, however, that the difficulty did not lie so much with those seeking her advice as it did with her own attitude. How could she, I wondered, convince someone else of the importance of healthy eating when she had just finished washing down greasy barbecued ribs with Coke from an aluminum can? People can spot a phony from a hundred paces; they detect insincerity and respond accordingly.

“Ignorance,” wrote Camus, “has a knack of getting its way; something we would soon realize were we not distracted by our own affairs.” So it is with many of my peers today. American medicine has become distracted by its own affairs. Physicians are taught how to treat patient symptoms with drugs and how to conduct and read scientific studies that document the results. Unfortunately, this stands the pyramid on its head, a delicate and nearly impossible balancing act.

The use of prescription drugs should be a rarity. Yet, for many people, this has become a way of life. Pharmaceuticals invariably have undesirable side effects. It is not uncommon to see individuals who are taking medications to treat the side effects of other agents. Only by returning to the basics can the situation stabilize and health emerge.

The second level of the pyramid consists of what I believe to be essential nutrients – vitamins, minerals, and other basic nutrients without which the body is incapable of operating as it was designed. I recommend levels of nutrients that are often far above the established recommended daily allowances (RDAs). This is because the RDA of a nutrient is often set by determining the level at which no disease is immediately apparent. For example, the current RDA of vitamin C is 60 mg. Individual receiving 60 mg. of vitamin C daily will not develop scurvy, a deficiency disease. It is clear that this is the minimum, not the optimum daily intake. Observations of animals (nearly all animals are capable of manufacturing their own vitamin C and do not need to obtain it from food) suggest that the optimum intake of vitamin C in a typical sized adult would be closer to 1000 mg. daily. The RDA of vitamin E is 30 IU, but studies have shown that 400 IR of vitamin E daily is the amount necessary to prevent oxidation of LDL cholesterol and decrease the incidence of heart attacks. I often suggest to people that, when it comes to nutritional supplementation, RDA stands for Really Dumb Advice!

The third level consists of additional supplements beyond the basic nutrients needed for the body’s ongoing maintenance and repair. Nutritional supplements commonly referred to as phytochemicals would fall into this classification, as would non-vitamin nutrients like coenzyme Q10. These are substances that would be safe to continue to consume over a lifetime and that help the body utilize vitamins and minerals more effectively.

I place herbs on the next level. Most herbs are best when used short-term for the management of specific problems rather than for long-range nutritional support. I believe that, used properly, they are safer than prescription drugs for comparable conditions. They have a greater range of dosing before toxic levels are achieved, are easier for the body to eliminate, and have fewer unwanted side-effects. I do treat them with respect, however, and encourage others to do likewise.

Prescription and non-prescription drugs are the capstone of the pyramid. The use of pharmaceuticals should be to help restore health when other measures cannot adequately do so. An example of proper drug use would be the administration of an appropriate antibiotic for a serious bacterial infection. There are some drugs that are necessary to maintain the health of certain individuals. These would include hormones such as insulin, thyroid hormone, progesterone, and testosterone.

Some have objected to the presence of drugs in the pyramid. I understand this in theory, but my experience has been that in practice people are individuals. Menopause, for example, is not a “one size fits all” phenomenon. While one person may do very well with a diet rich in soy, another may need to add a glandular or herbal preparation and another may require prescriptive hormone replacement to maintain optimum health.