En Garde: The Power Of Self Deception

OK, long standing patient; 60’s, handsome, charming male. Very focused, very motivated. Intent on living long and well. Access to the finest foods, the finest wines, the best trainers. He had it all and wanted to keep it. Good man to boot! I wanted to help him.

While trim and athletic he was not in great shape looked at from a deeper exercise physiological perspective. Good, not great VO2. He already had impaired fasting glucose; no real diabetes but where impaired fasting glucose often leads.

I will describe an arc of 4 years in his life. In the background remember he had all of the woes of a normal life; work stress, family stress, business trials: ups and downs. Great food, good wine, leisure and a desire to live long and well.

He had elevated markers associated with a tendency to form clots: thus at risk for stroke; perhaps heart attack by that route rather than slowly clogged arteries. His kidney function was normal but only just barely; this is a good marker, other things being equal, of small or micro vascular health. You know: how the finger tips, toes, eyes, brain, kidney and genitals are doing. Testosterone was low too.

I put him to work, changed his diet, still great food but fewer of some of the things he liked and more of some other things he liked as well. Everything got better; everyone told him he looked great and as he was prone to feeling good he said he ‘never felt better in my life.’ Kidneys didn’t change but testosterone, VO2, some of the clot risk factors got better. Boy did he say “thank you.” Within 6 more months he was half way back to his start point: still getting compliments, still feeling great. But I recognized the slippery slope by objective measurement.

“But Doc I eat so much better and I am so much stronger and healthier.” A little less wine, a little more attention to snacks, meal timing, sleep and stress. Better again and then some. A health set back; trauma. A year to recover. Data got worse; never back to baseline.

Four years later, always guided by objective numbers and not subjective assessment, always looking for everything to line up like some mystic atrological sign it all showed a man by every objective measure 20 years younger than when he started 4 years ago.

His kidney function is now like a teenager, his testosterone is twice its old baseline – remember this is up and down anyway so must be tracked over seasons and stressors to be valid- his growth hormone is up, all risk of inadvertent clotting and thus stroke is gone and his fasting glucose is down as well as his A1c; average glucose over 90 days. Vo2 is up, skin is better. Well guess what? He will walk out of the office, this is a prediction, and slip. He will slip some and never know he did because life and self awareness is like that. He will come in get new numbers and then walk back from his new edge, much better by the way, he will walk back from the edge again and he will then be better still.

Imagine! A man in his 60’s with the right kind of information getting younger and younger. It can happen. It can happen to you. No tricks, no supplements just the right information sought, accepted and acted on.

Please do not be misled by your bench-press, your splits, your mile time or by the fact that you can do a ‘muscle-up’ that you are on the right track. You may be, but are you sure? Observational bias, you see what you are looking for, entails too narrow a field of view and you will miss the big picture. ‘Got my muscle-up therefore my kidneys must be better.’ Well you didn’t draw that conclusion exactly but that illustrates the risk of too narrow a line of sight leading to overlooking, an important kind of self-deception, to overlooking the big picture. Remember gymnasts can do an Iron Cross yet they have a high incidence of osteoporosis. Cyclists? High VO2 and still have a lot of osteoporosis. Bodybuilders? Chronotropic Incompetence- several articles in this site about this problem- from steady state training. You know, spin for 20 minutes- aerobics!- and then big poundage for long periods of time. A very high incidence of heart disease and not all from the drugs by the way less you be deceived about that.

The take home of all of this? Even if you are twenty and feel like an immortal begin to look at your workouts in the broader vista of your overall health because some day, take it from an old guy, some day much sooner than you think you will care about those injuries and illnesses you could have prevented or made better along the way.

Smile,

Dr. Mike

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