"Whenever I go into a restaurant, I order both a chicken and an egg to see which comes first"

Wednesday, January 11, 2017

Everything In Moderation–From Food To Fads Better Listen To The Buddha


An old family doctor who although hale and hearty recently retired at the age of 80 since following the principle of ‘do no harm’ was becoming increasingly hard to follow.  Not that he had lost any of his professionalism, medical currency, or sensitivity and insight; just that he was concerned about making a mistake – missing a clue to serious illness or overlooking a patient’s references to depression or family disorder.  Misplacing the keys to the car was one thing, aphasia and a wandering mind were other things altogether.



His children dismissed his concerns.  To them their father was as sharp-witted, competent, and perceptive as ever.  He had never made a diagnostic mistake or anything even close; and in theses days of specialization, much of the responsibility for diagnosis was in the hands of young physicians trained in computer-generated imaging, gene alignment, and organ interactivity.  No internist these days ever made a conclusive diagnosis without at least the standard round of blood tests, MRIs, CAT scans, and specialist consultations.

Yet the doctor persisted.  Better to go out on a positive note, he said, reputation intact and character as strong and untarnished as the day he first hung out his shingle.

What characterized the doctor’s approach to family medicine was his moderation and judicious patience.  Eat, sleep, drink, exercise in moderation, he advised his patients when they brought in articles about the latest medical research on the the effects of all the above on cancer, hypertension, and mental illness.  He knew from decades of his own scholarly review of medical science that research protocols are often  flawed, deceptively purposeful and far from objective;and that eager and enthusiastic researchers go overboard on interpreting and applying results.  Nine times out of ten, research conclusions are revisited, rethought, or downright discarded.



In recent years he saw eggs demonized for their pernicious effect on blood cholesterol and its damaging effect on blood circulation and cardiac health.  His patients swore off eggs completely despite their proven and well-known benefits.  A nearly perfect combination of protein and fat and egg had nutritional staying power, satisfied hunger and eliminated the need for empty calories and excess protein, were versatile and easy to prepare thus adding variety to routine diets, and tasted goods.  Nothing wrong with an egg one and a while or even frequently.

A few years back all fats became nutritional outlaws – not just saturated fats and trans-fats, but all fats.  These essential nutrients had been linked to all kinds of health disorders, and the consumer would be very wise to reduce them down to thimbles-full if that. 

Consumers heeded this advice and now deprived of the long-lasting calories derived from fat, turned to quick-burning carbohydrates, especially sugars.  It was no surprise that obesity rates began to rise.  Consumers, content and proud that they were following professional advice, not only ballooned, but lost the benefits of necessary fats.  Worst of all was that no more than twenty years after the medical consensus about fats, did the professional community do a volte face. Eggs were not as bad as once thought, fats did not contribute to morbidity and mortality as anticipated, and even the dreaded cholesterol was replaced in the pantheon of acceptable nutrients.



The doctors noticed that his young patients always brought mini-bottles of water with them to their appointments; and when asked about them, they replied that the more water the better to rid the body of toxins, hydrate the skin, keep the kidneys in good working order, and to boost mood and energy.
Although he knew that decades of research had shown that the average fluid consumption of the normal  person – approximately 2.5 liters from liquids, vegetables, and fruits – was approximately that recommended for reasonable health.  Eight 8oz. glasses of water over and above that amount would simply be of no use and excreted.  Worse, pounding water could adversely affect health by disrupting the normal electrolytic balance in the body, diluting urine and flushing important beneficial bacteria from the urinary tract, and giving the kidneys an unneeded workout.



Zero tolerance policies were in place for tobacco, when there was no evidence whatsoever relating the occasional cigar to oral cancer or other diseases.   A relaxing smoke by the fire with a brandy could certainly do no one any harm; but the psycho-social benefits of tobacco were dismissed in the hysteria to rid society of it.

Exercise was the next health fad to spread throughout the country.  Moderate exercise had always been promoted as a way to mental and physical health.  ‘Constitutionals’ were popular in the Victorian Age and long before.  Indians for centuries have incorporated physical exercise as part of their Vedic routines.  Yet as the doctor saw, exercise was being taken to an illogical and dangerous extreme.

No one had ever said that seven days of vigorous gym workouts, five of hot yoga, 100 miles of biking a week, and brisk walks during the day were necessary for anything – not cardiac health, not obesity, not mental fitness, not general well-being.  In fact for many exercise has become an addiction.  If men and women cannot go to the gym because of illness or other engagements, they cannot simply let it slide, or make do with a more moderate, temperate regime.  They have to redouble their efforts until they have made up for the loss. 



Most young active adults have some kind of activity monitor to measure their performance – distance, speed, level of difficulty – and these measurements are used to assure compliance with their ambitious goals. 

For young people, other than opportunity cost, little damage is done; but for older people, the constant banging, hammering, jolting, and torqueing will take its toll.

Many years ago a business colleague went hiking in the Adirondacks– not just a casual hike, but a serious all-day climb high up in the mountains.  Before starting off and not entirely trusting his trail maps, he asked a local shop owner the best way to get to Devil’s Ridge.  “Why aren’t you in bed with your girlfriend?”, the grocery store owner replied. 

Opportunity cost.  Why on earth would two young men waste their time, energy, and ambition on a mountain? And whether he knew it or not, the store owner had hit the nail on the head.  My colleague was an insatiable climber, unhappy, unsatisfied, and unrewarded unless he had climbed himself out.  Saturdays and Sundays were reserved for nothing else.

Imagine, then, the opportunity cost of today’s exercise regime?  Not only are Saturdays and Sundays occupied, but early morning, evenings, and lunch breaks.  Exercise in America has gone way past physical and mental health; far beyond self-image, allure, and self-confidence; and into the realm of the eccentric.  Except for the fact that everybody is doing it, these compulsive athletes would be social outliers.

Obsession, said the doctor, was the new disease.  If it wasn’t food and nutrition or exercise, it was accomplishment.  There was no end to Type A personalities who, despite what might be their very modest potential, talent, and promise, work like slave driven rowers in a Roman trireme.   Older people, seeing the end of the tunnel, have a compulsive need to do, accomplish, learn before it is too late.  Lounge chairs in Florida are out.  Teaching courses in literature or economics, taking courses in religion and philosophy, volunteering at church benefits, and politicking for local candidates have not only replaced kicking back and enjoying retirement, they have created a new, obsessive, and totally unnecessary industry.


                             www.lookfordiagnosis.com

“Too soon old, too late schmart”, says an old Jewish expression; but everyone who sits in the light of the setting sun knows that only the first phrase is accurate.  What’s the point?

The doctor lived well into his 90s and as he approached 100 he was often asked for the key to his longevity.  He was too smart to know that the reasons for his longevity had more to genes and dumb luck than any other purposeful principle. 

‘Everything in Moderation’ he knew was not advice to keep people healthy as much as it was to keep them happy.  What was the point of a punitively monastic lifestyle?  Death would come soon enough and in ways no one could ever predict; so why not enjoy foie gras, marbled steak, a week in the chaise longue, and a stack of romance novels?  We all go back to al dente green beans, an occasional beer, frequent workouts at the gym, and Dostoevsky; so why fret?  It all works out in the end.

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