All In

Now, I know that cavemen did not formally gamble. They did not have casinos and poker chips, so a blog post titled "all in" might seem a little odd in the context of either caveman style living or health education, but bear with me. I do have a point to this analogy.

In fact, it could be said that cavemen gambled much more frequently than we do nowadays. All parts of the life of a caveman were an exercise in risk. Do I run from the predator, or try to hide? Do I risk going out into the open to gather food, or wait until a better time? Do I waste precious energy chasing down the deer, or do I just go with the easily gathered vegetables?

By comparison, the risks we take with our lives in today's society are fairly mild. Driving in a car is about the riskiest activity that most of us will undertake on a daily basis, and even driving is really quite safe. In the industrialized world, unless you serve in the military or live in the worst portions of the inner city, your life is infinitely safer than that of a caveman.

Ironically, the safer we get as a society, the less willing we are to take risks. We are unwilling to risk our lives, our money, and our social standing. In fact, we have gotten to the point where few people say anything controversial or take bold action because they are afraid to risk what they have.

The practical result of fear of risk is a kind of wishy-washiness, that forces people to take halfhearted action, then give up their course of action at the first sign of resistance. No great achievement can come out of this kind of action. Only commitment and bold action can lead to great achievement.

So, how does this apply to health, you might ask? Well, just like the caveman, the quality of your health and life depend on how committed you are. If the caveman decided to give up as soon as the search for food got hard, he would quickly starve to death. If he decided that hiding from the lion was just too much trouble, he would quickly have become lunch.

In modern society, we have the opposite problem. Obtaining food is easy, far too easy in most cases. To make the situation worse, the foods that are the easiest to obtain are the the worst for us. Thus, if we don't really commit to eating the right foods and follow the easy path, the result will be poor health, obesity, and chronic disease.

Similarly, with exercise, the easiest path nowadays is to get little or no physical activity. That was not an option in the past. Cavemen had no cars, planters, harvesters, or grocery stores. The search for food and safety was all consuming and HARD. Nothing short of complete dedication would get the job done.

One thing hasn't changed after all these years: if you want optimal health and wellness, as well as to avoid obesity and chronic disease, you will have to dedicate yourself completely. Like a poker player pushing their whole pile of chips into the pot, you will have to go all in with your health and wellness efforts.

Even if you go all in, I cannot promise that you will achieve every one of your goals. If you don't go all in however, and take the type of wishy washy action that most people take, I can promise that you will not. Any difficult achievement requires both passion and commitment, and nothing worth having is easy. So if you really want something, and this goes for anything in life, not just your health, stir up your passion and commit fully to the effort. You will be amazed at the results!

M. Jacob Ott, M.D.

Choices, Choices

Many of you probably know that my day job is that of Emergency Medicine physician. I work in several busy emergency departments, and see a wide variety of patients. All of my patients have at least one thing in common: they have something wrong with them. No one comes to the emergency room when they feel great, except for the staff members. In addition, most of them are scared that what is wrong may be serious. Most people will not come to the emergency room unless they think what they have is serious. The fact of the matter is that the majority of patients that I see don't have an actual emergency, but that is irrelevant. It is the perception of an emergency that drives them in to see me.

The fact that I find most interesting in my job is that the things people worry about the most are usually the least deadly. Every year, during the winter months, I see hundreds of people in the ER for colds, coughs, bronchitis, the flu, and upper respiratory infections. I know why they come in for these problems: a cold or the flu will make you feel pretty crappy. That being said, all of these diseases are self- limited. What that means is they will go away on their own no matter what you do, and there is no medicine that we have which will make them better in any way. What I do with these patients is put them on medicine which will cover up their symptoms (almost all of which can be bought over the counter) until the disease goes away.

Now, it is true that infectious diseases used to be very deadly. In fact, Sir William Osler, one of the patriarchs of modern medicine, called pneumonia "captain of the men of death." In the days before vaccines and antibiotics, infectious diseases were the leading cause of death in all age groups. To illustrate this, here is a list of the leading causes of death in New Jersey in 1900 vs 2000:

Leading Causes of Death, New Jersey, 1900 and 2000

Rank                         1900                                                        2000
                     1 Acute lung diseases                                     1. Diseases of the heart
                     2 Consumption                                                 2. Malignant neoplasms
                     3 Diarrheal diseases of children                     3. Cerebrovascular diseases 


                     4 Adult brain and spinal diseases                 4. Chronic lower respiratory diseases


                     5 Diseases of heart and circulation               5. Diabetes mellitus
                     6 Deaths under one month of age                 6. Unintentional injuries
                     7 Contagious diseases (not TB)                    7. Influenza & pneumonia
                     8 Renal and cystic diseases                            8.  Septicemia
                     9 Brain and nervous diseases of children     9.  Nephritis, nephrotic syndrome, & nephrosis
                    10 Violent deaths                                               10. Alzheimer's
                    11 Digestive and intestinal diseases              11. HIV disease 


                    12 Cancer                                                            12. Chronic liver disease & cirrhosis
                    13 Puerperal                                                       13.  Pneumonitis due to solids & liquids
                    14 Acute rheumatism                                       14. Suicide
Here is what I find interesting about this list: in the year 1900, You have to go down to #5 on the list to find the first cause of death that is not an infection. The first four are: acute lung diseases (pneumonia), consumption (TB), Diarrheal diseases of children (almost all are bacteria or viruses), and Adult brain and spinal diseases (such as meningitis and polio). Finally, with #5, you get to a non infectious cause of death: heart disease. In the list from 2000, you have to go down to #8 to find a cause of death which IS from an infection: Septicemia (systemic blood bacterial infection, commonly called blood poisoning).
 
That's great, Jake, you may be saying, but what does this mean? I'll tell you. Infectious diseases are random. If you are exposed, you can be infected and get sick. Though lifestyle choices can make you more or less likely to get sick, they only play a limited role. The modern death list is filled with what I like to call "diseases of lifestyle." Though there are some environmental factors at play, diseases such as heart disease, cancer, cerebrovascular disease (stroke), and chronic lower respiratory diseases (such as emphysema), are largely based upon the choices we make. Having a heart attack or stroke is mainly based on what you choose to eat and whether or not you choose to exercise. The vast majority of cancers are either diet or tobacco related, and emphysema and other lower respiratory diseases are almost exclusively smoking related.
 
Thus, in the modern world, whether you get sick or not, and how well you heal is based largely upon the choices you make. Modern medicine has come up with many fancy drugs, and many fancy procedures, but other than antibiotics for infections, heart catheterizations for heart attacks, and emergency surgery for conditions such as appendicitis, these medicines and procedures don't really cure anything. Drugs for high blood pressure don't cure high blood pressure, and patients are placed on a treadmill of ever escalating doses as their body adapts to the medicine. Drugs for cholesterol are far less effective than proper diet and regular exercise in treating cholesterol problems. Drugs for heart disease and emphysema do nothing to reverse these diseases, only slow their progression somewhat.
 
Somehow we as doctors have failed in our education of patients, and this information does not reach people. I say this because I have a stream of people through the doors of my ER wanting me to rescue them from their self limited infections and the end consequences of their poor lifestyle choices, but relatively few are ever interested in how they can prevent these diseases in the first place. In America today, we want to go to the doctor, get a prescription pill, and continue to eat however we want, and neglect our responsibility to exercise.
 
The main reason I write this blog is to try and bring home this point. Proper nutrition and exercise are far better medicines than anything the drug companies can mix up in a lab. If you fuel your body properly, and exercise every day or nearly every day, you can avoid most of the diseases on the list above.
 
In the end, it all comes down to choices.

M. Jacob Ott, M.D.

New Year's Commitments

Have you ever made a New Year's resolution? Most of us have. You resolve to go to church more, talk to your family more, do more things with your friends, or quit smoking or drinking.

Perhaps the most common New Year's resolution that is made each year in America is the resolution to lose weight. After holiday face stuffing, during which people gain an average of 4 pounds a year, the guilty parties (I was one for years) resolve to lose weight and get down to an arbitrary goal weight. Full of piss and vinegar, they go to the local gym. The gym just happens to be running a big special designed to help people lose weight in the region of their wallet, and is happy to relieve them of a years worth of membership fees.

The resolutioner, let's just call him Jake, since this was me for years, goes to the gym every day for the first week. He hits the treadmill and the weight machines, and gets sore and feels like crap. Soon after, daily turns to weekly, which becomes not at all. Don't believe me? Go to your local gym this week, and notice how many people are there. Then go on February 1st, and do another count. I would be surprised if more than 60% the number of people are there. Prove me wrong, and leave a comment if you disagree!

The same happens with our diets. A friend of mine who is a reporter in New York just did a segment on the top ten diets as rated by US News and World report (I am not linking to it, because they are mostly useless. Since when can a news magazine tell you anything about losing weight). The point is that people want to hear a lot about diets this time of year. The gym phenomenon plays out in the area of diet as well. Jake goes out to diet until he weighs 180 lbs, and begins a program, such as Weight Watchers. He follows the rules very strictly... for a week or so, until the first time he messes up. Once he messes up, he feels like a failure, and the shame and self-loathing come back, along with the comfort food to bury those feelings. Before long, Jake has given up and gained another five pounds.

I know this story so well because I lived it for years. I am guessing that many of you know it as well. Fortunately, over long bitter experience, I learned how to break the cycle, and finally lose the weight for real. It's not about a gym, and it's not about a diet, although those are both necessary tools. It is all about attitude.

The reason that virtually all New Year's resolutions fail is because the focus is all wrong. Jake was never really committed to his health. All he cared about was losing a little weight so that he could feel good about himself. Thus, when his commitment was tested, as all commitments are, he gave up. If you want to lose weight and achieve optimum health, your focus must be on something deeper than just fitting into a pair of jeans, or even looking good in the mirror. These superficial ideals will never sustain the dedication required to lose a significant amount of weight.

Instead, your focus must be on something greater than yourself. Only dedicating yourself to a cause outside yourself will give you the staying power to endure through the days that you don't want to work out, and the days where it seems like cookies are everywhere, and the days that it seems that your scale is possessed by demons.

What should your focus be? Frankly, I have no idea. Mine, just so you know is my family and God. I want to be around on Earth as long as possible, to do God's work, and to help grow and lead my family. That commitment gets me through the rough patches and down days, and strengthens me when I am feeling weak.

Don't get me wrong, life is not perfect. In fact, it is brutally IMperfect. Temptation is still ever present, and for me at least, it is very strong. Having a higher cause makes my success mean more than a momentary temptation, and allows me to persevere, even if (when) I fail.

This year, instead of a New Year's resolution, I encourage you to make a New Year's commitment. Commit yourself to your health because of something other than your looks, emotions, or jeans size. Make that commitment public, and dedicate yourself to it totally. That is the only way to truly succeed.

If you do commit to your health, do me two favors: first, comment about what your greater cause is, so that I can help encourage you, and pass this blog along to your friends who might be struggling.

Good Luck!

M. Jacob Ott, M.D.