Archive for February 2015

Rock-Paper-Scissors

In the game of Rock-Paper-Scissors each choice has the possibility of winning.  In the pursuit of health, patients often want to play a similar game of Diet-Exercise-Medication.

Patients, one of which I am known to be from time to time, like to eat.  They like to eat food that tastes good and makes them happy.  So our choice of diet tends to be unintentionally lax and undisciplined.  However, we most often claim that our poor health and obesity is due to not exercising enough.  It’s a pretty easy target to pick on because virtually everyone feels like they could exercise more.  Even athletes admit they could shoot for a higher goal.  We do all that while failing to recognize how far off a good dietary plan we really are.  The thought is that EXERCISE BEATS DIET.  If only we could exercise more, we’d be healthy.

Well, as exercise gets better and better but health actually becomes worse and worse, patients and physicians start turning to medications hoping to forestall what appears to be inevitable.  We try this new cholesterol drug and ask about that new diabetes drug which, generally speaking, are fantastic advancements in the pharmaceutical arts.  We become so very thankful for technological achievements that allow us to bolster our failing body.  I’m eternally grateful to Salvino D’Armante who allowed me to see my beautiful wife from across the room by inventing corrective lenses around 1285 A.D.  Yet we know these achievements fail to truly make us healthy.  They bolster not cure.  Even still, at our core, we know we can’t exercise forever.  Eventually we must stop and eventually our disorders and dysfunctions and diseases  will get the better of us.  We inherently hope that MEDICATION BEATS EXERCISE.  Maybe they’ll find a cure one day.

What I have learned and what I try to teach myself everyday is this: DIET BEATS EVERYTHING.  Your food choices will dictate your health more than any other factor.  You will never be able to out exercise a bad diet but you can always out eat good medication.  It is easy for me to eat such that I still have a heart attack after finishing the Appalachian Trail (my version of marathon running).  DIET BEATS EXERCISE.   It is easy for me to eat such as to develop diabetes and go blind never to see my wife again.  DIET BEATS MEDICATION.

Focus today on what you eat.  Focus right now on making your next meal better, healthier, and more life-giving.  Stop eating the poison however pretty or tasty or fulfilling it might be. (Desires of the eyes, desires of the flesh, pride of life, anyone?  1 John 2:16)

If you don’t know how to change, call me.  My office number is 539-0270.  Call it right now.  Call my office and set up some time with me or our Medical Nutrition Management Counselors.  These board certified, medical professionals are experts at helping you make your dietary plan one that beats anything else you will ever do to be healthy and functional.

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Cholesterol Myths

“So, my cholesterol’s running high?  It’s probably all those eggs I’m eating.  Give me a couple of months and I can fix that with my diet.  I don’t want a heart attack… but I also don’t want to be on one of those statin drugs.  Who wants something that saves your heart but then wrecks your liver?

Those are the kinds of statements I hear day in and day out in my practice.  They express several of the myths that are rampant about cholesterol.  In fact cholesterol has recently been in the news because the government’s Dietary Guidelines Advisory Committee is reportedly going to remove their longstanding recommendation to restrict cholesterol in the diet.

The wheels of science often grind very slowly and sometimes get stuck in a misguided rut for long stretches.  One of those ruts has been the idea that cholesterol in the diet, such as is contained in the yolk of an egg, needs to be carefully limited in order to protect one’s heart health.  It seemed to make sense since cholesterol is found in some of the plaque that blocks arteries and leads to heart attack and stroke.  But over the years the evidence for the evils of dietary cholesterol has simply not shown up.  In fact, as heretical as this may at first sound, a lot of folks with the very common pre-diabetic metabolic syndrome would do better having an egg and a little cheese for breakfast rather than a bowl of oatmeal.

Even after decades of study, we are far from figuring out all that there is to know about cholesterol and cardiovascular health.  But if we can’t give all the answers, let’s at least explode a few myths.  Besides the one noted above about the assumed dangers of dietary cholesterol, here are three more:

  • Myth #1: High cholesterol is mostly due to a bad diet and can be readily fixed by adjusting your diet.  Reality: For most people cholesterol is about 80% genetics and 20% lifestyle.  So it can certainly be improved with a healthy lifestyle, but there is a large part of it over which we have little control.  It’s still good to work at the 20%, but it’s not a simple fix.
  • Myth #2: Anyone with high cholesterol is at risk and would probably benefit from a statin drug.  Reality: These cholesterol-lowering medicines do work very well to lower cholesterol.  However, the main place that they have shown a reduction in events (such as heart attacks) is in folks with known heart disease, or (less so) in those with very high risk factors for heart disease.  Some folks with high cholesterol are actually at very low risk for heart disease and stroke.  That’s why in trying to better answer whether one of our high cholesterol patients should consider a statin, we employ tests such as the coronary calcium scores and/or a specialized arterial ultrasound called a carotid intimal medial thickness test.  These are non-invasive and affordable tests which help us sort our high cholesterol patients into those who are clearly plaque-formers and those who don’t seem to be.  We then recommend consideration of a statin, as well as other aggressive preventive measures only for the plaque-formers.
  • Myth #3: Cholesterol-lowering statin drugs are quite dangerous and can wreck your liver. Reality: Although, as noted above, they are certainly not needed by everyone with high cholesterol, they have been quite thoroughly tested and their side-effects are well-known and manageable.  For example, there is no statistical increase in liver failure among those on statin drugs vs. those not taking a statin.  However they do bump blood sugar up mildly and probably around 15% of folks get muscle aches that cause us to switch brands or take them off statins entirely.  So statins are neither the big answer nor the big villain; they’re just another tool.

We could go on, but you get the idea. As with most things, reality is a little more complicated than the myths.  It is often said that half of what we put forth as medical truth is false… and the trouble is we don’t know which half is which.  It should keep us humble, but it shouldn’t make us despair.  After all, for about 1900 years after Christ, the average life-span was stuck at about 38 years (partly because of the high number of infant and childhood deaths) whereas we’re at more than double that now.  Over time, if we follow the evidence and resist impatiently grabbing the newest too-good-to-be-true fix-all promises, we do arrive at some helpful realities.  In cholesterol management as with the rest of life, hang in there and keep holding out for the true and the good.

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Forgetting your daily medications or vitamins?

rx remind me

 

Rxmindme app

 

Walgreens has a great app you can download on your phone called Rxmindme http://download.cnet.com/RxmindMe-Prescription-Medicine-Reminder-and-Pill-Tracker/3000-2129_4-75311057.html   It’s a great way to set up reminders for medications or vitamins.

 

 

If medication has been prescribed by your healthcare provider there is an important reason they have recommended them.

If high blood pressure, diabetes, thyroid, cholesterol, asthma, etc. are not properly managed….there can be REAL consequences. If you have questions or concerns about medications, then schedule an appointment with your provider to discuss these concerns. Keep in  mind, there is a difference between allergic reaction and side effects. Or if you just simply don’t see the value or understand the importance of taking something that has been prescribed to you-be sure to discuss this with your provider. Sometimes there may be other options available.

This is a simple application to use and can be very beneficial for a variety of people. The most important thing is that you have your meds nearby when the app alarm goes off…..otherwise the reminder isn’t all that helpful. Try one of these handy pill boxes to keep things compact, organized and portable!

pill box

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