The Healthiest People I Know Never Talk About Health

A question I almost never ask my patients is this.

What makes you happy?

Not because I don’t want to know. Because if I ask that question in a busy clinic, I may never finish the consultation.

A retired bank manager will pull out photographs of his grandchildren before I can interrupt him. An elderly lady will describe, in astonishing detail, how the jasmine plant she thought had died has suddenly begun to flower again. A software engineer who came for acidity will spend six uninterrupted minutes explaining why Bengaluru traffic is shortening his life. Someone else will proudly show me a video of a grandson taking his first steps. Doctors ask about pain. Patients answer with stories. After decades in practice, I have begun to suspect the stories are usually more important.

Medical colleges teach us to listen to the heart, examine the liver and inspect the tongue. Nobody teaches us to notice what occupies a person’s mind when illness is not occupying the body. Yet that is where some of medicine’s most interesting lessons quietly hide. The healthiest people I know almost never begin a conversation with cholesterol, blood sugar or vitamins. They begin with people. Someone they love. Somewhere they went. Something they planted. Something they laughed about. At first, I dismissed this as a coincidence. After seeing nearly two lakh patients, I no longer think it is.

One morning, a gentleman entered my consultation room looking genuinely distressed.

I think I have a serious problem, Doctor.

I prepared myself for difficult news.

Instead, he unlocked his phone and pushed it towards me.

“My sleep score.”

For a moment, I thought he was joking. He wasn’t. His smartwatch had awarded him sixty-eight. His wife’s watch had awarded her eighty-nine. That, apparently, had ruined his morning. I looked at the numbers. Seven hours and forty-three minutes of sleep. Normal heart rate. Normal oxygen level. Nothing remotely alarming. Yet there he sat, looking as though life itself had become a competitive examination.

There are moments in medicine that no textbook prepares you for. I briefly wondered whether I should prescribe better sleep or ask his wife to stop winning.

Thirty years ago, patients came carrying urine bottles wrapped discreetly inside newspapers. Today they carry colourful graphs. Technology has become smarter. Human worry has simply become digital.

Barely twenty minutes later, another gentleman walked into my clinic.

He was eighty-three.

His shirt had exactly one pocket containing a folded handkerchief, a few currency notes and a small packet of fennel seeds. No smartwatch. No fitness tracker. No health app. His blood pressure was excellent. His blood sugar was normal. He walked with surprising confidence.

“What exercise do you do?” I asked.

He looked puzzled.

“Exercise?”

“Yes.”

“I have two cows.”

That was his entire fitness programme.

Those cows, I realised, had quietly delivered strength training, aerobic exercise, squats, balance training and sunlight exposure every single day for forty years. Not once had they sent him a notification saying, “Congratulations! You’ve reached today’s activity goal.”

Those two consultations have stayed with me ever since. Not because one man was right and the other was wrong. Because they represented two completely different ways of thinking about health.

One was trying to measure life. The other was simply living it.

The more I thought about those two men, the more another pattern emerged from memory. The healthiest patients I know rarely spend much time thinking about health. They think about grandchildren who are writing examinations. They worry about whether this year’s mango crop will be good. They discuss weddings, cricket, neighbours, temple festivals, leaking roofs and rising tomato prices. Health is certainly part of their lives. It simply isn’t the loudest person in the conversation. Somewhere along the way, many of us have promoted health from being a trusted companion to becoming the chief executive officer of our lives.

Curiously, the opposite is often true as well. I meet perfectly healthy people who know their vitamin D and vitamin B12 levels, liver enzymes, cholesterol fractions, and body fat percentage, yet cannot remember the last afternoon they laughed until tears rolled down their cheeks. A surprising amount of modern life has become an attempt to optimise living instead of actually living. We have apps that tell us when to stand, watches that remind us to breathe, bottles that glow when we forget to drink water and mattresses that score our sleep. Somewhere in all this technological brilliance, we seem to have outsourced common sense.

A software engineer once spent nearly fifteen minutes explaining why walking after dinner reduces blood sugar. He cited scientific papers, podcasts, a famous American longevity expert, and a billionaire who apparently spends millions trying to become younger each birthday. His knowledge was impeccable. “Wonderful,” I said. “So how long do you walk after dinner?” He smiled sheepishly. “I’ve been meaning to start.” That sentence deserves its own national monument. Entire lives have been built upon the foundation of “I’ll start from Monday.”

Psychologists have observed something fascinating. It is called the measurement effect. Sometimes, measuring a behaviour begins to replace the behaviour itself. Recording meals feels suspiciously like eating better. Buying expensive walking shoes feels strangely similar to walking. Reading ten books on sleep creates the comforting illusion that one is sleeping well. The brain quietly mistakes preparation for progress. Every January, gyms across the country fill with people carrying expensive new shoes. By March, the shoes are still enthusiastic. Their owners, less so.

Sleep researchers have identified an even stranger phenomenon called orthosomnia. Some people become so obsessed with achieving perfect sleep scores that the anxiety itself keeps them awake. Imagine lying in bed desperately hoping to sleep because your watch expects eight hours and twelve minutes of excellence. The technology meant to reduce stress quietly becomes another source of stress. It is one of medicine’s favourite ironies. We invent tools to make life simpler. Then we need new tools to recover from the old ones.

An elderly lady who visits me every few months has never heard of intermittent fasting. If I used that phrase, she would probably assume it was the name of a television serial. Every evening she finishes dinner, washes the last plate, wipes the kitchen counter and announces, “The kitchen has gone to sleep.” That is the end of eating for the day. No biscuits while watching television. No midnight trip to the refrigerator. No handful of Haldiram mixture pretending not to count because it was eaten standing up. Modern research now suggests that giving the digestive system a longer overnight break may improve insulin sensitivity, blood sugar regulation and circadian rhythm. She arrived there without ever opening a medical journal. Sometimes science spends decades explaining what grandmothers simply practised all along.

One of the strangest questions I ask elderly patients is, “What kept you healthy all these years?” Their answers are almost always disappointing if you are looking for miracle supplements. Nobody says turmeric latte. Nobody says collagen peptides. Nobody proudly announces magnesium glycinate. Instead, they say things like, “I always had work.” “We walked because there was no bus.” “Our family ate together.” “I never stayed angry for very long.” “There was always someone waiting for me at home.” Then I return to my desk and smile. Medical journals use thousands of words to describe inflammation, stress hormones, insulin resistance and social connection. My patients somehow explain the same science in one sentence.

That may be the biggest lesson medicine has taught me. The healthiest people are not less interested in health. They are simply more interested in something bigger than themselves. A garden that needs watering. Children who need teaching. A spouse who needs company. A village that needs visiting. A dog waiting at the gate. Purpose is difficult to measure in a blood test, yet it silently influences almost everything blood tests try to measure.

Researchers who study longevity repeatedly run into an awkward scientific problem known as the healthy user effect. Imagine a study showing that people who drink coffee live longer. Is coffee the reason? Or is it because coffee drinkers in that study also happened to exercise more, smoke less, sleep better, keep medical appointments and enjoy stronger social relationships? Healthy habits rarely arrive alone. They travel in groups, like relatives attending an Indian wedding. Good sleep shakes hands with regular exercise. Exercise introduces better food. Better food improves energy. Energy makes tomorrow’s walk a little easier. We spend astonishing amounts of money searching for one magical ingredient while quietly ignoring the orchestra playing behind it.

The same thing is true of friendships. Decades of research have consistently shown that loneliness is associated with poorer health, a higher risk of depression, heart disease and earlier death. Yet hardly anyone visits my clinic saying, “Doctor, I think I need two more good friends.” They ask for vitamins instead. It is easier to swallow a capsule than to call an old classmate. We have become remarkably efficient at buying health and surprisingly reluctant to borrow a cup of sugar from the neighbour next door. Somewhere between apartment living and smartphone living, we learned how to stay connected to everyone and close to almost no one.

Children, thankfully, have not yet mastered this art of overthinking. Have you ever seen a child count steps before running? They simply disappear. They chase butterflies. Climb compound walls. Invent cricket matches with three players and impossible rules. They return home covered in dust, sweat and stories. Twenty-five years later, those same children become adults who proudly announce they have bought a treadmill with sixteen workout modes. Life has a delightful sense of irony. We pay monthly subscriptions to recreate the childhood we once escaped from for free.

Perhaps the greatest surprise of my career has come from people recovering from serious illness. I have never had a patient recovering from bypass surgery tell me, “Doctor, I cannot wait to lower my LDL cholesterol.” Instead, they say, “My granddaughter is getting married in December. I must dance.” A lady recovering from cancer once told me, “Doctor, my music class starts next month. I have already promised the children I will come.” An elderly farmer who had survived a stroke asked me only one question. “When can I go back to my field?” That was the day I realised something profound. People do not fight illness because they love health. They fight illness because they love life.

A few weeks after our first consultation, the gentleman with the sleep score returned. He looked different. Not because he had lost weight or because his laboratory reports had changed. He simply looked lighter. “So,” I asked, “what happened to your sleep score?” He laughed. “I don’t know.” “Didn’t you check?” “For four nights, I forgot to wear the watch.” I smiled. “And?” He smiled back. “Doctor, I slept wonderfully.” Then he added, almost as an afterthought, “My wife forgot to wear hers too.” That may have been the healthiest sentence I heard all month.

As he walked out, I looked around my waiting area. A retired teacher and an auto driver were laughing over a cricket match. An old couple were sharing homemade chakkulis from a steel box despite my repeated advice about moderation. A young mother was chasing a toddler who had decided every chair in the clinic was a mountain waiting to be climbed. Nobody was discussing antioxidants. Nobody was comparing sleep scores. Nobody seemed terribly interested in living forever. They were all gloriously occupied with something far more urgent. Living today.

After twenty-six years of medicine, I have slowly arrived at a conclusion no textbook ever taught me. Health behaves a little like happiness. Ignore it, and it slips away. Obsess over it, and it slips away differently. Care for it with discipline. Walk every day. Sleep well. Eat sensibly. Take your medicines. Listen to your doctor. But once those quiet responsibilities are done, let health quietly return to where it belongs—in the background of a life that is busy loving, laughing, working, forgiving, gardening, reading, travelling, cooking, arguing, celebrating and occasionally doing absolutely nothing. The healthiest people I know have never made health the purpose of their lives. They made life the purpose of their health. Health stays longest with those who are too busy living to keep looking for it.

***

I have written a book.
If this blog spoke to you, the book will stay with you longer.

You can get your copy here.