The Freedom to Not Choose

Today is Memorial Day. We dedicate today to remembering those who have served and given their lives for the freedom that we all enjoy. The fact that we live in a country with a constitutional republic, in which we are free to express our views and opinions without fear of censorship, oppression, or even death is due to the actions of countless brave men and women over the course of two centuries and counting.

Freedom is something that must be constantly defended, because it is not a natural state. Ever since man has existed, we have tried to exert power over our fellows, and force them to work toward our ends. Sadly, most of the ancient wonders of the world were built with forced labor, and up until very recently, slavery was not only acceptable, but common practice. We are very fortunate to live in a country in which we are free to choose the course of our lives.

By now, you might be wondering how this all ties in to a health and wellness blog. Good question. There is one crucial point that most of us never think of with regard to freedom. Just because we can do something, does not mean that we should, or that it is best for us. Besides having unprecedented legal and social freedoms, Americans (and residents of other industrialized countries) also have culinary freedom which has never been experienced on the planet before.

To realize this point, you need to look no further than the cookout you will likely attend this afternoon. Represented at your Memorial Day cookout will likely be hamburgers, hotdogs, fried chicken, potato salad, potato chips, corn, fruit salad, watermelon, cantaloupe, beer, soft drinks, green beans, deviled eggs, cupcakes, cookies, and countless other foods. Before eating today, let's think for just a minute on what foods will be represented in the average American backyard today:

Beef                                         Chicken                                  Pork
Potatoes                                  Eggs                                        Corn
Mayonnaise                            Bananas                                 Grapes
Watermelon                           Cantaloupe                             Sugar
Beans                                      Milk                                        Wheat
Rice                                         Soybeans                                Pineapple

This list is far from inclusive, but it gives you the basic idea. As important as how many foods we have access to is how easily we can obtain them. Unlike our caveman ancestors, we don't have to forage and hunt in order to obtain the foods we eat. All we have to do is go to the grocery store, and we see all of the foods above and more sitting on the shelves. Cavemen would never have been able to match either the quantity or variety of food that we have at our fingertips. The foods above come from all over the world, from Europe to America to tropical islands in the middle of the pacific ocean.

It is wonderful that we have access to all of these foods, in quantities that ensure most people don't have to worry about where their next meal is going to come from. It is also somewhat ironic that this freedom is slowly killing us. In the past fifty years, we have been getting larger and larger and larger. Two-thirds of all Americans are now either overweight or obese. Infectious diseases like pneumonia, which used to be the biggest killers of people, have been supplanted with diseases of lifestyle like heart disease, cancer, hypertension, and diabetes. Mounting evidence in the past 20 years has shown that some foods, particularly meat, milk, and eggs, are directly related to the diseases which now kill us in epidemic proportions.

I, like all of you, dear readers, am extremely grateful for the men and women who died to allow us to live free of oppression and slavery, and to pursue our dreams. I shudder to consider what those men and women would think if they were to see how we are slowly killing ourselves. I have never served in the military. The fight I participate in is not for our freedom, but for our health. This Memorial Day, I would like to humbly suggest that we try to honor the memory of those who served by trying to take care of our bodies, and using some of our freedom to not choose some of the foods which cause us so much harm.


Happy Memorial Day,

M. Jacob Ott, M.D.

Supplemental Danger

Yesterday, I read a fairly disturbing study about calcium intake. The study, which was a retrospective study which took into account various factors, including supplement intake, showed that taking calcium supplements significantly increased the risk of heart attack. The exact findings are as follows:

• Participants who took supplements that included calcium were 86 percent more likely to have a heart attack, compared to people who didn’t take any supplements.
• Participants who only took calcium pills were more than twice as likely to have a heart attack. 

This is fairly disturbing, but not the first time a supplement has been indicated in a problem. A 2004 study showed that taking mega-doses of Vitamin E as supplements increased risk of death. Just like calcium, Vitamin E was previously shown to be helpful. Several other studies have shown single supplements, and even the ubiquitous multivitamin to be harmful.

What is the common link between all of these studies? The fact that it is a supplement. When we isolate a chemical from food, and put it in a pill, something happens. At best, it loses its effectiveness. At worst, it becomes harmful. The supplement study is only part of the story. In fact, rarely has a supplement ever been shown to be helpful in pill form. I have previously spoken about fiber, which is not effective in the myriad of powders and pills that are sold, and is only beneficial when taken as part of the food.

Why is it that our pills do not help us? I believe it is because we have an incomplete understanding of how food works. While we do our chemistry and isolate these chemicals, and then take them, we are unaware of the thousands of other compounds in the food which contribute to the action of the "vitamin" that we have isolated.

But Jake, you ask, what about calcium? I know I have to take a supplement of at least 1500 mg of calcium a day for bone health? My doctor told me so. All parts of the above statement are wrong. I will spend the rest of this post debunking the calcium myth:

1. Calcium intake is required to prevent osteoporosis: Point one is a partial truth. Bones are comprised of a matrix of calcium phosphate. In order to build or maintain bone, you must have some calcium. Where this truth gets distorted is in the advertising. People in this country have spent billions of dollars associating two items in our brain: milk and calcium. I wrote a previous post about this, but the short version is that milk does nothing to prevent osteoporosis. If it did, then the countries with the most milk intake would have the lowest rates of osteoporosis. In fact, the opposite is true. The more milk a country consumes, the HIGHER rate of osteoporosis it has.

2. Calcium supplements (or mega-doses of milk) are needed, because dietary sources are inadequate: The milk people, and the people who sell the pills would have you believe that people cannot get enough calcium from their diets, and thus some form of supplementation is necessary. Though good for the old bottom line, this "fact" is simply not true. Here is a list of foods which are rich dietary sources of calcium:


Spinach
Turnip greens
Mustard greens
Collard greens
Blackstrap molasses
Swiss chard
Kale
Basil, thyme, dill seed, cinnamon, and peppermint leaves
Romaine lettuce
Rhubarb
Broccoli
Sesame seeds
Fennel
Cabbage
Summer squash
Green beans
Garlic
Tofu
Brussel sprouts
Oranges
Asparagus
Crimini mushrooms

Many of these foods have as much or more calcium as milk, and are rich in untold other nutrients as well.

So, in summary, there is no need to take a calcium supplement, especially given the results of the study that came out yesterday. The formula for bone health is simple:

1. Eat a wide variety of plant foods, which are rich in all the nutrients you need.
2. Avoid excess protein intake. The acid load that proteins provide actually dissolve bone.
3. Perform load bearing exercise (running, jumping, etc...) the impact stimulates bone formation.

Good Eating,

 




M. Jacob Ott, M.D.

...You'd Better Be Running

Sir Roger Bannister was once credited with the following quote:

"Every morning in Africa, a gazelle wakes up. It knows it must outrun the fastest lion or it will be killed. Every morning in Africa a lion wakes up. It knows it must outrun the slowest gazelle or it will starve. It doesn't matter if you are a lion or a gazelle-- when the sun comes up, you'd better be running."


Sir Roger Bannister, is a personal hero of mine. He is  a runner and a physician. In addition to becoming a renowned neurologist, he is also the first person to break the four minute mile. Prior to Sir Roger, the four minute mile was thought to be an unbreakable barrier. It was generally thought to be the absolute maximum speed that a human being could run. Sir Roger shattered that barrier, and was an obvious believer in the merits of running.

It turns out that his quote was not just good advice for gazelles and lions, but for human beings as well. Based on the results of a Danish study, running just 1 - 2.5 hours per week can add as much as six years to your life. You can click on the link above, but here are the highlights:

The results are part of a population study which involved 20,000 participants over 35 years. There were about 18,000 non runners and 2000 runners in the study. Long story short, running increased life expectancy for about 5.6 years for women, and about 6.2 years for men. This sounds great, but here is the most staggering fact from the study to me: over the period of the study, 10,158 non runners died, but only 122 runners. The mortality rate for the non runners was almost DOUBLE over the 35 year period of the study!

This study basically confirms something that many of us have believed for years. We were made to run. Running, or other cardio intensive exercise is mandatory for human health. In this blog, I spend a lot of time talking about caveman nutrition, and eating like our primal ancestors, but I would point out that running is how our primal ancestors got their food. Before we drove cars or rode horses, we ran. We ran to find food. We occasionally chased our food down. We ran to escape predators, and we ran to take shelter from nature. Running was not just a way to lose weight. It was a way of life.

It is not so hard to believe that the same running which our ancestors used to prolong their lives would also work to prolong our lives. After all, we have the same bodies, and mostly the same DNA. Although we are no longer dependent on running to find food or avoid predators, our bodies don't know it. There is little to no doubt: our bodies need to run.

Jake, you say, that's great, but I'm not interested in living longer. I hear that a lot, but not exactly in those words. Usually the person expressing this sentiment says "well, you have to die of something." True enough, and I will be the first to admit that you can't live forever. In my opinion, it's not about quantity, but about quality.  To those of you who were thinking those words, how about a life free of high blood pressure, diabetes, stroke, heart attack, depression, arthritis, chronic pain, and chronic lung disease. Running has been shown to impact all of these illnesses. If you don't care about having a heart attack or stroke, how about having more energy to perform your daily activities, and freedom from feeling tired or worn out throughout the day. All of these benefits come from running or other strenuous exercise. Not too bad for a 1 - 2.5 hour per week investment.

All things considered, I have to agree with Sir Roger Bannister: you'd better be running

M. Jacob Ott, M. D.

The Protein Myth

They are usually the first words out of someone's mouth when I tell them that I am a vegan. It is almost a rhetorical response, kind of like "how's it going" and "ok." These six words form what I call the dreaded question. I am referring of course to "how do you get your protein?"

I call this the dreaded question not because I don't have an answer to it (in fact I have scads of answers and supporting data, which I will tell you about), but because it provides a little glimpse into the misconceptions that most people have about what constitutes correct nutrition.

You see, in America and throughout the industrialized world, we have a significant misunderstanding of protein, what it does and its possible dangers. That's right, I said dangers. If you are nutritionally naive and are reading this, you probably have never been told that protein is potentially dangerous. If you are like most of us, you have been taught that protein is good for you, and the more the better. You may even believe that foods are not good for you if they don't contain enough protein. Finally, you might even think that the only way to get enough of the "right kind" of protein is to eat meat. Sadly, this is at best a distortion of the truth, and at worst, a baldfaced lie. Worst of all, the lie is perpetuated by the people who produce the meat, to the expense of our national health.

The protein myth began innocently enough. At the turn of the 20th century, we finally had enough of a working knowledge of organic and biochemistry to begin analyzing the contents of the food we ate. It didn't take very long for food scientists to figure out that the food we eat is composed of three macronutrients: carbohydrates, fat, and protein. By experimenting on animals, it also didn't take long for them to figure out that if you deprive an animal of protein completely, it dies before too long. This was not so of carbohydrates or fat (in truth, it is a little more complex than what I write here, but the gist is the same). Thus, the scientists correctly concluded that protein was absolutely necessary for life. Even its name, protein, is from the latin proteus, meaning "first."

To this point the scientists were absolutely correct. In fact, if a human being does not get enough protein, they develop a malnutrition condition called kwashiorkor, which eventually leads to death. Protein is important, and that fact became widely known among laypeople. No problem there. Unfortunately, this is where the train began to go down the wrong track. Scientists, wanting to completely understand protein, began to experiment to define how much is enough. Most of there experiments were done on rats, and they settled on a "dose" of 1 gram per kilogram of body weight. What they did not realize at the time is that not all animals had the same protein requirements, and rats happen to require far more protein than humans do.

The problem only got worse from here. Of course, if some is good, more is better, right? Thus, we began to eat more and more protein, usually in the form of animal flesh (meat), since it was the "perfect protein" as it provides all the amino acids in once source. In fact, scientists define the "quality" of a protein by two factors: how easy it is to digest, and how many of the 20 amino acids it supplies. This led to a vast increase in protein intake, from about 10% of our daily calories to about 45% or so today.

You can imagine that the people who produce the meat are rather happy about this, and do everything they can to promote the virtues of protein. Most people in our culture are educated (read: brainwashed) to believe that if you do not eat meat with virtually every meal, you are sickly and weak, and cannot build muscle or do anything athletic.

So what, you might ask. Why is protein so bad anyway? The answer is, it's not, if eaten in the right amount, from the right sources. Here are some myths about protein:

1. The more protein, the better: This is not only false, but potentially deadly. In fact, the human body only needs about 10-15% of its daily calories from protein. This is enough for the body to repair the tissues of its organs, and to build new muscle and connective tissue as needed. More than this, however, can be quite detrimental, for two main reasons. First, the more protein you eat, the less carbohydrates and fat you eat. These nutrients are also important for a variety of body functions, and the micronutrients (such as vitamins, phytochemicals, and fiber) which go along with the carbohydrates in plant foods are lost when you eat a meat heavy diet. Second, protein is composed of amino acids. When you eat a large amount of protein, your body takes on a huge acid load, which it must then deal with. Since the body operates at a slightly alkaline pH, it must buffer this acid load. It has two ways to buffer. The weaker of the two is to shift acid back and forth between the lungs and the kidneys. The stronger of the two is to dissolve your bones, freeing up phosphorous to bind up the extra acid. Thus, a heavy protein load is hard on the kidneys, and many doctors now think that the high rate of osteoporosis in America and other industrialized countries is related to our massive protein intake.

2. Meat is the best source of protein: The main reason that food scientists originally thought this was due to what are called essential amino acids. You see, your body can make 12 of the 20 amino acids that you need from scratch. We are unable, however, to manufacture the other 8. These must be obtained from the diet. For the early food scientists, meat seemed like an optimal protein source because it contains all 20 amino acids. No vegetable protein source other than soy has all 20. This would be  a really big deal if it made the slightest difference practically. In reality, however, it is not important to have all 20 amino acids together. In fact, you don't even need to take in all 20 from your diet. You only need 8 of them, remember? Thus, as long as you get enough of those 8 amino acids, your body has everything it needs to repair old tissues and build new ones. Whether you are a world class body builder or an infant, that is all the protein you need. Taking in more does not make you build more muscle, it just damages your kidneys and bones. Therefore, vegetables are a perfectly good protein source, and meat is in no way necessary for health or life. Eating meat also comes with some inherent dangers, such as cholesterol intake, as well as significantly higher rates of hypertension, heart disease, cancer (multiple types), osteoporosis, depression, heart attack, stroke, and premature death.

3. Athletes need more protein than non athletes: If you are an athlete, this will come as a complete shock to you, but your protein requirements (amount and type) are no more than anyone else's. All you need to eat is enough of the essential amino acids (10-15% of daily calories), and your body can build all the muscle you need. If you don't believe me, just ask Mac Danzig. He is a vegan MMA fighter. If anyone needs to build a lot of muscle, it is him, but he manages to do it on an all plant diet.

4. Chicken and fish are better than beef: In a wonderful bit of animal product in fighting, the chicken people try to convince you that their product is better than the evil beef, which is loaded with fat, and will kill you. That is true, but it is also true of chicken. Chicken may be slightly lower in fat, but as we have discussed, it is not necessarily the fat which is dangerous in animal products. Chicken still gives you the same excessive protein load, with no redeeming vitamins, minerals, phytochemicals, or fiber, all of which you get when you eat plant based proteins.

5. Plant foods don't have enough protein in them: This is the final argument of the animal producers. You have to eat meat, to supplement (or replace) plants, because they don't have enough protein. Excellent propaganda, but completely not true. Let's take the much maligned potato for example. The potato, which is often decried for being a starchy carb bomb, and having little health value, has quite a bit of protein. Depending on the type of potato, it can have anywhere between 8 and 11% protein by weight. Interestingly, this is just about the amount that you need. Potatoes do not have all of the essential amino acids, so you could not survive on a diet of just potatoes, but you get the point. A diet consisting of a variety of vegetables can easily provide enough protein for good health and muscle development.

By now, you might wonder what my answer is when I am asked the dreaded question. Obviously, I don't carry around a pamphlet with all this information on it, to pass out on demand (although maybe I should). Depending on how much time I have, I either give the short and slightly snarky answer- from food, or the answer which leads to a long discussion- why do you think that protein is so important? Hopefully you will ask yourself that question the next time you sit down to a steak or some chicken.

M. Jacob Ott, M. D.

Dollars and Sense

As most of you are aware, this year is an election year. Much of Congress and the Presidency will be up for grabs. Already, the power players are jockeying for position and votes. Billions have already been "earned" and spent on political campaigns. Both Republicans and Democrats are hotly debating the issues that are important to most Americans.

Two of the most important issues this time around are health care and the federal budget. This year, the debt limit of the government received special scrutiny, and with it, the fact that we grossly overspend what we make as a country. The federal debt is in the trillions of dollars. We are practically bankrupt as a country, and can barely afford to pay the interest on our outstanding debts. Regardless of how you personally feel that we should increase our income (tax the rich vs tax everyone), it is clear that we must reduce the amount we spend. Like any poorly managed household, it is the fact that we spend more than we make that is forcing us in to ever more debt.

That brings us to the second hot issue of 2012: health care. With the passing of Obamacare, everyone is talking about it. For those of you who are not well versed on the topic, the major issue in the health care debate is not how to deliver it, or the quality, or even who should get what services. The issue is who will pay for all of the healthcare that we deliver.

Why, you might ask, is who pays so important? Well, it is because of the sheer amount we spend on health care. In America, we spend about $7,538 per person on health care. This is by far the most of any industrialized country. In fact, it is almost 1.5 times as much as the next biggest (Norway at $5,003). Here is a bar chart showing the average per person health expenditure for the major industrialized nations:

As you can see, we outstrip everyone else in healthcare spending. This comes to a staggering total of 2.26 TRILLION dollars. To put it another way, healthcare spending accounts for about 16% of our Gross Domestic Product, meaning about 1 out of every 6 dollars that US industry and jobs produce goes to health care.

Thus, the who pays for it discussion. To understand the debate, you have to understand who pays for it now. About 15% of Americans are uninsured, meaning that they pay for it themselves. Accordingly, about half of all bankruptcies are due to medical expenses. The other 85% is split between private insurance (36%), the federal government (34%), state/ local government (11%), and miscellaneous (4%). Obamacare is mainly aimed at the 15% or so who don't have insurance. The federal government aims to provide insurance to those people, absorbing the additional cost, as well as a myriad of other costs so that everyone will have health insurance.

While this is a noble goal, and no one should have to go without at least essential and emergency health care, we have to ask what we are getting in return. Surely, if we spend the most of healthcare, we must be the healthiest nation on the planet, right? Nope. In fact, we are one of the sickest industrialized nations on earth. Below is a listing of life expectancy for developed nations:

As you can see, the United States is no where near the top of the list. In fact, as of 2011, we rank 42nd globally in life expectancy. This is terrible, considering the amount we spend on health care. Thus, the question must be asked, why are we so sick?

Some people would say that this is an indicator of poor quality health care. I may be somewhat biased, being a doctor, but I disagree. We have by far the best health care system in terms of quality in the world. No one can surpass our developments in pharmaceuticals and life saving technology. We are sick despite our quality health care.

In truth, the health problem and the money problem are related to the same thing: our personal choices. We choose not to take care of ourselves, and suffer the consequences. The vast majority of the diseases we suffer from today in America are what I like to call diseases of lifestyle: cancer, heart disease, high blood pressure, type II diabetes, stroke, chronic pain and obesity. I call these diseases of lifestyle because whether or not you develop them is almost directly related to what you eat and whether or not you choose to exercise. The fact is, in America, we eat mostly processed crap, and exercise little if at all. I have covered this at length in prior posts, so I will not go into it here. Click on the links if you want more info.

Thus, the problem with health care is not health care itself, but the amount we deliver. We are forced to deliver way too much healthcare, because we do whatever we want, and ignore the consequences. A recent study showed that obese people suck up over $2,000 more per person in health care dollars than a non-obese person. Maybe if we actually took care of ourselves, we would not have to spend five times more on health care than on national defense. If we only took care of ourselves, we could solve the healthcare crisis and the budget crisis without any help from the federal government. As a nation, we need to begin to regard the consequences of our actions, and adjust those actions to avoid the collapse that is coming.

Regardless of who you plan to vote for, politicians and government cannot solve our problems. Only we as individuals can!

M. Jacob Ott, M.D.

Meat is (Self) Murder

Most of you who read my blog or view my web page probably know that I am a vegan. I eat virtually no animal products. You probably also know my bias toward meat and animal products. Based on years of reading the research on nutrition and the link between animal proteins and various diseases, such as cancer, heart disease, high blood pressure, diabetes, and stroke, my opinion is that eating animal products is similar to slowly killing yourself.

The paragraph above is just my humble opinion. I am not the smartest person on earth, and my opinion may not mean much to you, but now some far smarter people than I have put forth evidence to that same effect. A day or two ago, the Harvard School of Public Health released the results of a 20 year, 110,000 person study into the consumption of meat, specifically red meat. The results of the study were conclusive and fairly startling.

In short, eating meat is similar to slowly killing yourself. Over 20 years, 24,000 people out of 110,000 died, about half from either heart disease or cancer. By analyzing the diets of the people in the study, the researchers concluded that eating just one serving of red meat per day was associated with a 13% higher risk of death. If the meat was processed (think bacon, salami, sausage, etc...), the risk of death was almost 20% higher.

Before you start to deny the results, or push back and make excuses as to why you want to continue to eat meat, really think about this. You face a 20% higher risk of death just for eating one serving a day. Who knows how much increased risk you face for eating 2-3 servings, like most people do.

I know. I've been there. This is a lot to stomach (pardon the bad pun). The first lie rationalization that you probably had was "everyone has to die of something, I would rather be happy and die sooner, than deny myself and die later." At least, this was the first one that I had. As I came to discover, that logic is flawed on two counts. First, it is not the early death that I am concerned about. There are fates worse than death. Imagine being unable to play with your children, because you only have a third of your heart function left. This is the consequence of a heart attack. Consider being unable to move one side of your body, or knowing what words you want to say, but being unable to say them. These are the consequences of a stroke. The risk of both are increased by meat intake.

Second, once you get over the brainwashing of our culture, and realize that meat intake is not necessary for health, life, or enjoyment, abstaining from meat is not denying yourself. I have experimented with a wider variety of foods since becoming vegan than I ever did before. Contrary to the idea of deprivation, avoiding animal products has opened up my dietary choices more than ever, and I enjoy food much more knowing that I can eat it without fear.

If you want more information on how to start down the path to health by removing animal products from your diet, please visit my websites:

www.devolvehealth.com
devolvehealth.blogspot.com
www.facebook.com/devolvehealth
www.twitter.com/devolvehealth

If you would like personalized help, feel free to contact me through my website.

M. Jacob Ott, M. D.

Runnin' in a Winter Wonderland

I don't know where you may be reading from, but at least here in Kansas, winter has arrived. For the past few months, the weather had been toying with us, offering temperatures in the 50's. There were even a few days in the 60's. Not very winter like.

I am an Ohioan by birth, so the cold does not really bother me very much. That doesn't mean I like it. I would definitely prefer 70 and sunny every day. Add some grey clouds and snow to the cold, and you have a recipe for some dreary days.

Since the cold is on my mind today, I thought I'd write about how workouts should change due to the short days and cold weather. I know that many people who are habitual exercisers tend to take winters off, because of the cold and the holidays, and then begin working out again in the spring. Though rest is good for your body, taking off three months can be seriously damaging to your fitness level as well as potentially your waistline.

I definitely continue to work out over the winter months, and I recommend that you do the same. If you want to use the winter as something of a rest period, consider working out 3-4 days a week, and taking the other days to rest.

You may need to modify your workouts as well. It is still OK to exercise outside. In fact, I kind of like winter runs. They can be rather invigorating. Be sure to take a few precautions, however:

     1. Dress for the cold. Be sure to cover your head, fingers, and toes well. If the temperature is in the 20's or below, frostbite can set in rather quickly, even in as fast as 30 minutes. As long as you are moving and active, hypothermia is not much of an issue in the short term, but be sure to get in out of the cold as soon as you are done. Also, wear some layers, preferably of a heat retaining tech fabric. Avoid wearing too much clothing, however, as you can still overheat. You should feel a little chilly when you start, or you are wearing too many layers. Trust me, you will warm up as you go.

     2. Be careful of slipping. In the ER, I see many patients who slip on the ice. Obviously, if you are running fast, this danger is increased. Be careful, especially going down hills or on pavement. Try to keep an eye on the ground a few yards in front of you, so you can identify any slick spots before you actually hit them.  If you do slip, try to sit down on your bottom, rather than extending your hand or leading with your head.

     3. Prepare for emergencies. carry with you at least a little water, a small amount of food (like an energy bar), and your cell phone. You don't want to sprain an ankle three miles from any sort of aid, and be unable to call for help.

Follow these precautions, and you will be able to safely work out through the winter. Who knows, you may even enjoy running in the snow!

M. Jacob Ott, M.D.

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.