All Posts tagged exercise

Stimulants are the new opioids

Over prescribing of ADD and ADHD stimulant medications, especially in adults, is a rapidly exploding issue. Inappropriate use is common at many universities and high pressure jobs. However, there remains a considerable number of patients who have legitimate need and should be cared for within the healthcare community.
Addressing a patient’s need for stimulant medications requires a careful and thoughtful approach. For many disorders, Trinity uses our multifaceted approach to therapy which so often improves, reverses, or even cures the common maladies of modern humankind. We address the three main pillars of health that are required for any person to be remain healthy: good nutrition, good exercise, and good sleep.
Nutritionally, studies have demonstrated that a lower carbohydrate dietary plan improves ADD/ADHD symptoms over other dietary interventions. Omega-3 fatty acids found in fish oil (or actually eating more fish) is one of the few supplements that improves ADD/ADHD symptoms. Vigorous aerobic activity consistently demonstrates improved symptom control especially if challenging tasks are performed within the 90 minute golden window following exercise. Finally, sleep is a critical element to good focus and concentration. Disorders such as sleep apnea, excessive screen time, as well as burning the candle at both ends severely limits the brain’s ability to concentrate for weeks and months on end.
Trinity has adopted the widely published guidelines from the American Academy of Pediatrics and the American Academy of Family Practice concerning the prescribing of stimulant medications These guidelines include such things as the following:
-Stimulants will only be prescribed after an appropriate history and physical is performed which supports the diagnosis
-Secondary causes for the symptoms including poor nutrition, poor exercise, and poor sleep have been fully addressed
-Follow up is required in person on a monthly basis until stable then every three months thereafter
-Medication changes are done in person only
-Regular use of Tennessee’s Controlled Substance Monitoring Database
-Refills are done on time. They are not filled early, after hours, or for long term supplies.
-Urine drug screens are required at random intervals to confirm the use of the prescribed medication as well as the absence of inappropriate chemicals.
-Long term prescribing of medications is not guaranteed and referral to a mental health specialist will be made if the situation warrants.
We feel that with our approach and the use of these guidelines we will continue to provide high quality care for individuals in need and limit the inappropriate use of these medications.

Risky Behaviors

Why do you have a question about wearing seat belts?  You’re a doctor not a policeman.”  This adolescent was expressing a rather common question among both youth and adults.  But the reality is the answer to that question, especially among youth, may have more impact on their health than almost anything else we will talk about in their visit.

What do adolescents and young adults (say age 10-24) die from in the U.S.?  Only 5% die from heart disease and other congenital diseases.  Seventeen percent die from a mix of causes such as infections and various uncommon maladies.  The three other causes that make up all the rest are suicide (11%), homicide (13%), and unintentional injury (accidents) at a whopping 48%.  Obviously the fact that suicide and homicide make up nearly a quarter of the deaths of youth is heart-breaking.  But today we want to focus in a little more on the nearly half of deaths in youth which are caused by accidents.

Out of these accidental deaths, almost ¾ of these are from motor vehicle accidents, and a substantial percentage of these involve alcohol.  Another 7% of accidental deaths in youth occur from unintentional poisoning, 5% from drowning, 3% from other recreational vehicle crashes, and 2% from firearms accidents.

Just to name one other example of accidental injury, over 25,000 traumatic brain injuries needing emergency room treatment occur in youth from bicycle accidents every year, usually in youth not wearing a helmet.

What about other behaviors that may cause disease or other unwanted outcomes?  Although 15-24 year olds make up only about a quarter of sexually-active individuals, they incur almost half of the sexually-transmitted infections, including 17% of the new HIV infections.  Also, three quarter of a million teens become pregnant each year, although the numbers are trending down a bit.

Substance abuse shows some slight drop in alcohol and tobacco use, but other substances such as marijuana, meth, and prescription drug abuse are not falling off or are increasing.

Finally, over the last 20 years, the US has experienced an obesity epidemic. In 1991, only four states reported an obesity prevalence rate over 15%, and no states reported rates above 20%.  In 2009, every state except for Colorado reported an obesity prevalence rate at or above 20%, with 9 states exceeding 30%, including Tennessee.  Between 1980 and 2008, obesity among adolescents shot up from 5% to 18%.

So, life happens, and we certainly can’t control it all… but our choices bring consequences, some sooner and some later, some good and some not so much.  High tech medicine can certainly bring life-extending treatments for many maladies.  But, for adults, and even more-so for youth, a few consistent good choices may make a world of difference – choices such as:

  • Buckling your seat belt every time you drive or ride in a car.
  • Not driving when you’re impaired or buzzed nor riding with someone else who is.
  • If you’re on a bike, motorcycle, snowboard, 4-wheeler or similar fast-moving objects and you have a brain, protect it with a helmet.
  • Skip the unhealthy, addicting substances that will wreck your life, health, and freedom in the long run, even if they’re advertised as making you feel cool and in in the short run.
  • Save yourself sexually for the person you’ve committed to be with for a lifetime
  • Skip the sugary drinks and refined carbs (starches) and go easy on the portions
  • Stay physically active and limit your screen time (phones, computers, t.v.)

No doubt these sound old-fashioned, but they can impact your life and health more than the most expensive, high-tech treatments.  So, it can be a corny cliché from grade B movies, but somehow in real life it still has some remarkable power:  “Make good choices… and keep on making them; they make a difference.”



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.



Exercise 2015

So here we are entering into a new year.  Typically the gyms experience a wave of increased activity only to see it flatten out after a few weeks.  Myriads of well-intentioned folks join up to make this the year that they get in shape, only to fall off the exercise wagon a short time later.  But here’s the thing: I also talk to and see a good number of patients who really do get something consistent going and keep reaping the benefits as they press on.  So how can you be one of those who press on and enjoy it this year?

Let’s take a moment to refresh our mind on the benefits of exercise; here are just a few: Improves your mood.  In studies, regular aerobic exercise has stacked up as well as taking an anti-depressant in treating depression.

  • Helps prevent diabetes.  Multiple studies show that both pre-diabetes and diabetes are prevented, delayed or improved substantially by regular exercise.
  • Helps delay or reduce the onset of Alzheimer’s disease.  Anything that can do this is worth the effort.
  • Promotes weight management and improves lean body mass.
  • Improves energy.
  • Enhances sleep.
  • Helps maintain joint health and mobility.

The bottom line is that the vast majority of us just feel and do a whole lot better for the long haul when exercise is happening in our life.

So what are some reasonable goals?  Something as simple (at least in concept) as a 30 minute brisk walk (3-4 miles per hour for most folks) is a good place to start.  Any substitute such as elliptical, biking, stationary bike, swimming, running, etc. is fine.  If some weights/resistance work can be added for 20 minutes twice a week, that’s helpful.  Others go beyond with longer exercise sessions, interval training, classes and a great variety of gym work-outs.

Now here’s the biggest question: How do I actually start doing something like this and stay with it?  Here are a few keys:

  • Start slow (but start).  If the last time you exercised you were running but that was 25 pounds and 5 or 10 years ago, don’t go out and try a multi-mile run. The last thing you want is an injury or discouragement right at the start.  I’ve had some patients where it had been so long since they exercised that I had them start with a 5 minute walk 5 days a week and add a minute a week until they got up to a 30 minute brisk walk a half year later.  Better to do that and avoid injury than to knock yourself out of the game early on.
  • Figure out a way to actually make it enjoyable.  I do a mix of biking, running, racquetball and swimming. The variety keeps it fun.  And back when I was trying to make it all more regular, I discovered that having a downloaded book, music or podcast helped turn a somewhat dull run into a more interesting outing.  That translated into my actively working to wedge it into my day instead of concluding that I was too tired or busy.
  • Be a can-do person.  In the midst of a list of many things you perhaps can’t do, figure out what you can do.  If due to injury or excess weight you really shouldn’t be running, or can’t bike and don’t have access to swimming, maybe you can still walk.  Or if not, get an inexpensive recumbent or other stationery bike on Craig’s list, get in front of something worthwhile and interesting to watch and go to it.
  • Make a weather-proof plan.  If you’re going to do outdoor exercise, be tough and don’t let a little rain or less than perfect temperature stop you.  But when necessary, have a ready indoor alternative.
  • If at all possible, find one or more encouragers.  Few of us do well as Lone Rangers for the long haul.  A friend, spouse, or trainer can help keep us on track when we just aren’t feeling it for exercise.
  • Have some guidelines and goals for yourself such as not letting yourself go two days in a row without exercise.

Much more could be said, but bottom line, go for it!  And when you mess up or slack off, pick yourself up and keep pressing on.  You’ll feel better, be on less meds, and help prevent a whole lot of illness and disability as you do.  Happy 2015!