The stresses associated with work as a truck driver—including irregular schedules and economic pressures—place them at substantial risk for a wide range of chronic health issues that are becoming pervasive within the industry, including sleep apnea, hypertension, cardiovascular disease, and adult-onset diabetes, just to name a few.
Truckers as a group also tend to exhibit higher rates of obesity and smoking than the overall American population as well.
In 2015, the National Institute for Occupational Safety and Health (NIOSH) conducted a national survey of long-haul truck driver health and injury, with the results published in the American Journal of Industrial Medicine—and the results weren’t good. NIOSH’s poll of 1,670 long-haul truck drivers found that over two-thirds of them were obese (69%), as defined by a body mass index (BMI) of 30 or higher, and 17% were morbidly obese (BMI of?40?or higher). In comparison, only one-third of U.S. working adults were reported to be obese and 7% morbidly obese.
The agency noted that obesity increases the chance for Type 2 diabetes, sleep apnea, heart disease, cancer, joint and back pain, and stroke—health conditions that can disqualify drivers from receiving their commercial driver’s license and essentially take away their livelihood.
NIOSH’s survey also revealed that more than half of the long-haul truck drivers it polled were current cigarette smokers —over twice the general working population (51% vs. 19%).
Smoking also increased the risk of suffering from several negative health conditions, such as heart disease, Type 2 diabetes, stroke, and cancer.
Yet that doesn’t mean truck drivers are fated to suffer the ill-effects of one or more of those conditions. In fact, with small lifestyle changes, some of those risk conditions can be reduced. Here’s how.
DEALING WITH DIABETES
A truck driver’s life is a recipe for diabetes—and the statistics prove it. In the U.S., about 9.4% of the population has diabetes, according to the Centers for Disease Control and Prevention (CDC). For truckers, that number is 14%.
Why do truckers suffer from diabetes at a rate almost 50% higher than the rest of the American population? They have more risk factors, according to physicians. Drivers smoke more; about half of truck drivers smoke compared to 19% of other adults. On top of that, they rarely exercise and their diet is high in calories and fat. Also, almost 70% of truck drivers are obese, which is more than twice the national average.
Physicians like Dr. Albert Osbahr, who treats truck drivers, among other patients, said many are surprised and taken aback when they find themselves medically disqualified from driving a truck.
“They have numbers that are high and wonder why we might give them short cards or actually, in some cases, disqualify them when their numbers are 450 or 500,” he explained. “They’ll look at me in disbelief and ask, ‘Why would you do that?’ I say, ‘This is not stable. This is not safe.’”
The American Diabetes Association recommends aiming for a blood sugar level of between 70 to 130 mg/dl (milligrams per deciliter) before meals and less than 180 mg/dl one to two hours after a meal. Fasting before a blood test gives the most accurate reading.
“If we don’t find ways to improve this, we’ll have more guys with eye problems, heart problems, kidney problems, stroke-like symptoms, or sensation problems because of diabetes,” noted Osbahr, who is the medical director of occupational health services at Spartanburg Regional Healthcare System in South Carolina and a Board of Trustees member of the American Medical Association.
“Weight loss is very crucial to diabetes control,” he added. “I’ve seen dramatic control of Type 2 diabetes when people lose weight. The two key issues in terms of weight, as long as there’s not something else in the way like another disease such as thyroid or a medication that is causing extra weight, are exercise and diet.”
About 90% to 95% of people with diabetes have Type 2, a condition in which your body doesn’t use insulin properly, a malady also known as “insulin resistance.”
Insulin is a hormone made by the pancreas that allows your body to produce sugar from carbohydrates in food. This sugar (glucose) gives you energy, which is why one of the first signs of diabetes is fatigue. Type 1 diabetes is rarer and usually presents itself in children, as the pancreas may be dysfunctional from birth and not produce any insulin. People with Type 1 diabetes must take insulin every day, usually by injection.
Contrary to what some people believe, Type 2 diabetes cannot become Type 1 diabetes. They are different diseases.
Because of how well medications work on Type 1 diabetes, the Federal Motor Carrier Safety Administration (FMCSA) has proposed that drivers who use insulin may no longer need a medical waiver to drive but instead can get certified annually by their health care provider that their diabetes is well controlled by insulin. (Note: The doctor doing the certification must be a certified medical examiner and listed in the National Registry of Certified Medical Examiners.)
Osbahr repeats what he says to every trucker with diabetes. “When I see guys in the office and they raise the issue [of how to lose weight], I say, ‘Add a little extra to your regular activities. Any little bit of extra exercise, walking, even doing some flexibility calisthenics for 15 minutes while you’re getting ready to sleep or getting up in the morning can help. Probably the biggest thing is parking farther away from the truck stop [building], making that walk in and out and do that [extra walking] with any other kind of activity.”
The other thing he tells them is “you guys have to inspect your trucks. Why don’t you make multiple trips around your truck in your inspection, but make it like a walk? You don’t need a gym or a running track. You can add some jumping jacks if you can. You can do some knee-ups if you can. You can do some running in place if you want to, but everybody is probably able to at least walk and that does not require any additional equipment.”
As for diet, Osbahr concedes that truckers have fewer healthy options on the road than most workers. “The foods that are offered on the road are not very good; they’re also highly caloric. You have to work to find the right ones. And I tell a lot of the guys, ‘How many fat vegetarians have you seen?’ Most of the guys will laugh and say, ‘You’re right; there are not too many of them.’ I tell them, ‘Yeah, I’ve seen a few but not that often.’
“There is something [healthier] about eating vegetables and fewer starches, breads and meats, even though I love them,” he continues. “There’s something to be said for eating more vegetarian foods. You probably would lose more weight, but we don’t always see those options on the road. In general, the lifestyle of a trucker does not lend itself to losing weight. There’s no question about that.”
Dr. Adrian Vella, who studies Type 2 diabetes at the Mayo Clinic and sees patients about 40% of his time, said that if he had to choose one thing for truckers to do that would prevent or handle diabetes, it would be to diet.
“To me, the most important thing is the amount of calories you eat compared to the amount of energy expended during the day,” Vella said. “The second most important thing is what those calories consist of. In general, it would be a good idea to avoid high-fat, calorie-dense foods.”
“Nine times out of 10, they’re [patients] doing bad things,” he added. “They are not compliant or following recommendations, and I understand that this is difficult for truck drivers. The other issue is what physicians face when they’re trying to choose medications for their patients. They want to avoid hypoglycemia at all costs for obvious reasons.”
Some diabetes medicines cause hypoglycemia or low blood sugar, which is deadly for drivers as it can cause blurry vision, poor coordination, tiredness, and confusion.
Both Vella and Osbahr said that most doctors would prefer not to prescribe medicines for diabetes if it can be controlled in other ways, but often they have no choice as many patients are noncompliant when it comes to diet and exercise.
Osbahr also knows that treating diabetes, especially in truckers, is an uphill battle. “The biggest problem I find is a lot of guys not taking care of themselves. It is hard for us as humans to stay disciplined in a way to take care of ourselves, and truckers are no different than the rest of us non-truckers,” Osbahr explained. “Motivation seems to come only when bad things happen to our health. Plus, most of the truckers are men and we, as men, do not keep up on our health like we should.”
Unfortunately, he views truck drivers and diabetes as indicative of our nation’s future. “We’re not talking about just truckers who are a window into what our culture is doing,” Osbahr added. “Our culture has gotten heavier—and truckers are at the extreme.”
VAPING OVER SMOKING
Over-the-road driver Tanner Peavler used to smoke three packs a day, and he wasn’t alone. As noted previously, more than half of truck drivers smoke cigarettes compared to 19% of the general adult population, according to the CDC, and the habit contributes to hypertension, stroke, diabetes, and cancer.
The 34-year-old trucker began smoking when he was only 18 years old, and three years ago, he noticed he had trouble breathing. Climbing in and out of his truck became harder. Doctors told him to stop smoking. He wanted to quit, but he couldn’t.
Not only was his health failing, but he was becoming a social outcast in a nation where smoking was steadily dropping. “You know what it’s like; you’ve been around people who smoke,” he explained. “They come in from outside and it’s like, ‘Wow, I’ve gotta get away from this person. They smell so bad.’ I just didn’t want to be that guy anymore.”
Desperate to quit, Peavler decided to try a vaporizer, which is a tobacco-less, electronic cigarette, or “e-cig,” that emits only water vapor. Touted as safer than cigarettes, vaping also allowed him to “smoke” in many facilities that bar tobacco smoking because of an open flame. “Some of them [loading docks and warehouses] still consider it smoking even though it’s technically not. Others are like, ‘it’s not combustible, so go ahead.’”
Electronic cigarettes are battery-powered devices with cartridges filled with a liquid, commonly called ‘e-juice,’ that usually contains nicotine and flavorings. A heating device converts the liquid into a vapor, which the person inhales.
Since switching over to e-cigs three years ago, Peavler said he feels much better and breathes easier. And while some doctors are still concerned about chemicals, including nicotine, in e-juices, others applaud his efforts. “They think, ‘Oh, it’s still nicotine.’ They don’t want you to do it. Out of most of the doctors I have talked to, there’s been one or two that said, ‘Hey, yeah, keep it up. Your lungs look good. Your sinuses sound clear. So do what you’re doing.’”
Peavler, who works for Western Flyer Express in Oklahoma City, may be on to something.
A recent article in Tobacco Control, a journal that does not accept papers from any researcher affiliated with or receives funding from tobacco interests, says that cigarette smokers who switch to e-cigs will live, on average, five to 10 years longer than those who continue to smoke cigarettes. “The key thing to remember is they need to switch completely,” said lead author David Levy, PhD, professor of oncology at Georgetown Lombardi Cancer Center in Washington, DC.
The study noted: “Compared with the status quo, replacement of cigarette by e-cigarette use over a 10-year period yields 6.6?million fewer premature deaths, with 86.7?million fewer life years lost in the Optimistic Scenario. Under the Pessimistic Scenario, 1.6?million premature deaths are averted with 20.8?million fewer life years lost.”
[Note: The study performed an ‘optimistic’ and ‘pessimistic’ view of outcomes depending on whether future studies show that e-cigs are more harmful than science now indicates.]
“[Switching] doesn’t have to be right away, (Peavler was a dual e-cig/ tobacco user for a while until he switched completely to e-cigs) but if you smoke any cigarettes at all, you still have double the heart risk, which is the big problem for people under age 65. It’s important to switch completely to e-cigarettes,” said Levy, who noted that remaining tobacco smokers may smoke more zealously.
“The price of cigarettes has gone up, so many people smoke the cigarette down closer to the butt,” he continued. “They also inhale more deeply. People who are left smoking may be more highly addicted. The evidence shows that over time the mortality from cigarettes is going up.”
To save money and control what he vaporizes, Peavler mixes his own e-juice. “I found a simple sugar cookie [flavored] recipe that is good, so I just keep making that. Basically, it’s nicotine flavoring and vegetable glycerin. It’s three or four different things. It’s actually not very hard to do for what you get.”
No one suggests that e-cigs are totally without harm, however. E-cigs usually contain nicotine—which is addictive—and some researchers suggest it can prime the brain’s reward system, putting vapers, especially teenage vapers, at risk for addiction to other drugs, according to some studies. Other research suggests that, depending on the e-juice and the vaporizer itself, the vapor may contain toxic or carcinogenic chemicals.
To those truckers who smoke, Levy offers this advice: “Many smokers have tried to quit and want to quit and probably feel the effects of smoking in terms of shortness of breath and that kind of thing. For a lot of people, e-cigarettes have worked. If you can switch completely to e-cigarettes, you’re definitely much better off health-wise than if you keep on smoking cigarettes.”
Peavler said it’s sometimes difficult to convince his fellow drivers that vaping is better than cigarettes. “I’ve got a lot of friends who smoke, and I’ve tried to tell them about vaping, but they’re just set in their ways. I tell them that it’s only $100 lost [if it doesn’t work], so give it a try. That’s all I can do.”