I would like to recount three small vignettes. From them I want to sketch a conclusion about the lost hopes, health and even lives due to the recitation of the phrase ‘eat right and exercise.’
A man joined my practice recently. He was a classic Adult Onset Diabetic. While he was relatively young he had already developed coronary artery disease; he was frankly lucky not to have already had a heart attack.
During the work up he showed me a copy of his most recent laboratory results. His physician had sent him a copy and had written across the face of the copy: “eat better and exercise more.” Now this was a motivated guy; he ‘worked out’ and ate what the nutritionist had told him to eat. He took his meds and did what he thought he was supposed to do but his diabetes was getting worse. We talked for a while in order for me to be clear about what his instructions had been. He recounted his time with his doctor, nutritionist and trainer and offered as a summary the by now routine ‘eat right and exercise’ as what they had told him. OK, hold that thought.
I’m talking to my professional peers, no, better, my professional betters; a gaggle of cardiologists. We get off on the role of long chain omega 3’s and one of them abruptly jumps to what he assumes is my conclusion and says: “if you are telling me to take fish oil capsules instead of Lipitor, I would rather take Lipitor, and eat right and exercise.” Well, that wasn’t where I was going and in fact I think this is not a good idea but there was that phrase again.
Third vignette: year after year at the Scientific Sessions of the American College of Cardiology thousands of physicians and researchers meet to present and discuss the latest findings in heart disease; findings of causes and cures. Picture some famous doc, from Harvard, Johns Hopkins, UCSF, on a raised, I mean high, dias, it is dark, he has a PowerPoint slide set all primed to enlighten about the very newest findings or medication, the medication conferences are by far the most attended, and he always, almost always, begins with a few sentences that go something like this: “we all know that if our patients would ‘eat right and exercise’ these meds would not be necessary but we also know they won’t do it. They are not compliant with our requests to ‘eat right and exercise.'” He then launches into his homily in praise of the newest drug. This is a ‘twofer;’ what to do and they won’t do it. And this is the mind-set of the modern practice of medicine. Good people, most of the docs warrant this description, being encouraged to be discouraged about people’s ability to take responsibility for their own health. And encouraged to encourage medication use which, in a different lecture at the same conference will tell them most people won’t take anyway. You heard that; not only will patients not ‘eat right and exercise’ they won’t take the Lipitor either. Well actually about a third of the time they will; a not substantially different number than those who will ‘eat right and exercise.’
What is the connection? Well, to put it in a nutshell: with all of that knowledge no one has the wisdom to know what to do.
In the substrate of believing people won’t do what is necessary for their own good, knowing they won’t take the drugs to compensate for that fact, people are given virtually useless, well actually harmful, advice to ‘eat right and exercise.’ It should not be a surprise that this is a recipe for disaster. Two different scales of disaster: individual and societal. People you know and love die and nations go broke.
There is a better way: measure everything. People are wonderful lab rats. If they actually, tangibly know the goal, can see whether or not they are ‘getting colder or hotter’ on their way they will do amazing things. So rather than the vague ‘eat right and exercise’ they can see by a wonderful feedback loop whether or not that switch from potatoes to iguana is helping or hurting them in their goal to be healthier. They have an amazing intuition that just weighing themselves is not the right metric. And sure enough recent studies have shown that people who develop diabetes who are thinner are actually sicker and will suffer and die sooner than an obese person who develops the same level of diabetes. Why? Because they are weaker and their weight reflects less muscle and bone than those who are heavier. So measure lean muscle mass. Is the diabetes associated with high triglycerides or low? It makes a difference. Gee, I feel great on this all beer diet and have bigger biceps I am so happy in the gym I could do reverse curls all day. Yes, but your testosterone went down and your triglycerides went up; so stop that one. In puny comic fashion I am illustrating how empty the advice to ‘eat right and exercise’ actually is; it is different for each of us and different at different times in our lives.
Given the vacuity of standard advice, the underlying scepticism of the medical profession and, let’s be honest, people’s denial and laziness it is no wonder so many are sick and getting sicker. The guy next to you in the gym, the one with the tattoos and big biceps, is probably sick as is his sainted grandmother who eats dumplings and crochets all day. We can’t cure denial and laziness but why doom ourselves with standard advice and professional doubt.
Other studies have shown that given the generic advice to ‘exercise’ about 15% of otherwise healthy people actually make their health markers worse. Why? Because ‘exercise’ isn’t really advice at all. Run, jog, lift, throw, push, pull, eccentric, concentric, curls for the girls, endurance, ultra-endurance, sprints; I’m just getting started and each one of these does different things to different people. Which is right for you? I don’t know. You’ll have to measure that to find out!
Smile, Have Fun and God Speed,
Dr. Mike
