Progress not Perfection

One of my mentors, Dan Sullivan, has many great ideas, but one of them that has been very valuable to me is the idea of progress not perfection. 
 
North American culture is obsessed with perfection. Not only does it keep us from finishing things, it stops us from even starting them in the first place because we are afraid it won’t be good enough. Perfection derails our efforts to make change or do something different, because if we are not perfect we fall off the wagon (which is normal and we all do it) and then we think we have failed and we just stop doing it. 
 
Making lifestyle change is not an easy thing to do. If it were everyone would be healthy and the multi-billion dollar diet and health industry would be no more. Change is hard–often it feels almost impossible–but when you keep in mind the idea of progress not perfection, it doesn’t seem as daunting. 
 
Perfection is not drinking at all. Progress is not drinking everyday. 
 
Perfection is never eating another piece of chocolate cake. Progress is eating only on special occasions.  

The first sets us up for the inevitable failure that comes with just living life. The second focuses on our successes and helps us build on them, getting us ever closer to where we want to be.

TLC vs CYA: The Medical-Legal Reality of Medicine

Imagine this scenario:
 
After a routine checkup with your doctor, which includes some blood work, you discover you have high cholesterol. Like millions of others, you’re prescribed Crestor. Later, your blood cholesterol level is checked again, and it’s lower.
 
All is right with the world. Right?
 
Several months later, though, you find you don’t like how you feel on the drug. Perhaps your muscles ache a little, your digestion is a little off, or you just don’t feel right.
 
After a little research, you begin to feel that maybe this stuff is neither good for you, nor is it particularly useful. You also discover that you can in fact lower your cholesterol by changing your lifestyle. Armed with this new info, you head to the doctor with your new plan.
 
Your doctor, however, has a different opinion. She says you must stay on the drug—if you don’t you could have a stroke or die of a heart attack. 
 
What’s going on? Why is your doctor reluctant to change your prescription despite a mountain of evidence that statin drugs are nonsense for all but a narrow demographic group?
 
Here’s what’s happening, and what you need to know to properly advocate for your health.
 
1. Standards are created based on averages, not individuals
The “gold standard” that your doctor uses to prescribe care isn’t usually based on you so much as a research done on large groups of people. That works, to an extent, and it’s cost effective for developing pharmaceuticals, but people are individuals. I can tell you that the average dress size in North America is 14, but does that mean it’s going to work for you? The same applies to treatment tools like statins. Your doctor is doing the best she can working from averages, not individuals.

2. Data is compromised
Time and time again we hear about the problems with research study. Data is faked or withheld. Studies are selectively chosen to support a hypothesis. The research with the best potential payoff is the one that’s funded. Some of these may be unavoidable, but you need to treat the “latest study” with a certain degree of caution. Research does not care about you. Research is also not terribly motivated to reveal how much impact lifestyle change can really have.

3. Legalities get in the way
In this highly litigious age patients will often get advice that will hold up in court, not necessarily a candid conversation about options. Don’t assume that you’ll get the information you need to make informed decisions and manage risks in the way you see fit. Never forget that the legal side of medicine is playing a role in the care you receive. It doesn’t mean you’re getting bad care…just don’t forget that it’s a factor.

4. The choices is ultimately yours
This is what matters the most.  Even the best doctor doesn’t care about you more than YOU do. No matter what any doctor tells you, it’s your choice how to deal with your health. The lesson is this: You cannot abdicate responsibility for your care. Not to doctors, not to research, not to pills, tablets, injections, tools or machines. If you want great health, you need to cover your own a**. You can’t rely on the system to do it for you.

Is Lack of Sleep Making You Fat?

Our culture has been buying the “calories in, calories out” theory of the weight gain and weight lose for decades. The assumption is that if you are overweight, you are eating too many Twinkies and sitting on your butt while doing it. And although what you eat and how you move your body are incredibly critical factors in your body composition, there are a multitude of others—sleep, for one.

Sleep is a vital function of the human body. We still don’t full know the full reasons for why we sleep, or understand all the very complicated biochemistry that goes along with it, but every single one of us knows that we feel great when we get a good night sleep and awful when we don’t. We don’t know everything about sleep, but we know enough to know that it matters. A lot.

But, how could not getting enough sleep make us fat? It seems counter-intuitive. Shouldn’t we lose more weight if we are awake for more hours, doing more stuff and burning more calories? Research seems to be suggesting that it’s actually the opposite.

For example, sleep-deprived people have:

  • Increased levels of ghrelin, the hunger hormones, making them feel more hunger and causing the overeating of calories.
  • Decreased levels of leptin, the “fullness” hormone, so your appetite is never sated.
  • Decrease energy levels which results in decreased exercise, therefore decreased metabolism.
  • Changes in the effectiveness of insulin in the body causing increased cravings for carbs.

In effect, then, sleep deprivation makes us eat more, crappier food, while doing less of just about anything else besides sitting on furniture.

How much is enough sleep? About 7-8 for guys, 8-9 for girls on average, but everyone is different. The right amount of sleep for you equals the amount that’s necessary to wake up naturally, without the help of an alarm, where you feel rested and refreshed.

Is lack of sleep making you fat? Not exclusively. But it’s probably a far greater influence on your ability to lead a healthy lifestyle than you might realize. So while you can’t just sleep your way to great health, perhaps your next “diet” ought to include getting enough rest, too.

Dear 40 & 50-Year-Olds

Dear 40 & 50-year-olds,

It’s me. Your future self. We’re over 70 now. (Can you believe it? Where did the time go?)

I was going to ask you if you wanted the good news first, or the bad, but I decided that you can’t be trusted with the choice, so I’m making it for you.

Here’s the Good News: We’re still alive! We survived the accidental-death teen years, the middle aged heart-disease-roulette, and we’re actually past most of the worst cancer period as well. Yes! 

Even better, all those things we worried about in middle-age, like money and jobs and petty disagreements with your sister and whether or not the leather seat option on the new car we didn’t need was worth it? It turned out that none of it mattered. Everything turned out fine. 

Who knew?

Here’s the Bad News: We’re a complete wreck, physically. 

It’s not good. We’ve finally reached that point we talked about, where we would “slow down and enjoy life” and guess what? It turns out it’s kinda hard when you can’t climb the stairs without getting winded, you’re too stiff to get down on the floor and play with the grandkids (yes, we’re grandparents), and half your friends are dead from doing the same stupid stuff we did for too long.

Oh boy. Where to begin. A lot’s happened since I was you.

Did you know that right now, we’re on three different medications for conditions we could fix with a little exercise? Of course, we don’t actually fix them. I mean, let’s just say it: we’re fat. Even walking is tough. 

We’re financially comfortable, sure. But physically, we ache like a bad country song. Sleeping is tough. Our memory is shot to hell, and every trip to the bathroom is some weird combination of winning the lottery and being water-boarded.

And our libido? It’s in the basement. Right next to that stupid elliptical trainer we never used.

By now you must be wondering why I’m writing to you. (How am I’m doing it, you ask? Writing to you through time? Hey – it’s 20+ years in the future. There have been some changes. But, I digress.)

Here’s the thing: This was all avoidable. 

Our lousy health right now is your fault. Which means it’s our fault, but let’s not split hairs, okay? There are so few remaining.

You see, you’re choosing what our life at 70 is like right now. Everything you put into your body – all the booze, extra calories and crappy food. Everything you do with your body, like watching TV, pretending one game of soccer or hockey a week is exercise, commuting for hours on end. Everything you think–I hate my spouse, I hate my job. All of these choices you are making today are laying the foundation for what life is going to be like when you’re a 70-something. They are creating my reality right now. 

Well, thanks for nothing. In just a few minutes a day you could have changed our future, but you didn’t. 

I am sympathetic, though. After all, I was you. Am you. Whatever. The point is that if I could go back and do it differently I would. But I can’t (we have time-travel correspondence, but no wormholes), so the best I can do is warn you: You need to take this stuff seriously.

  • No consistent cardio exercise now? It’s a heart attack or stroke waiting to happen.
  • No consistent weight bearing exercise now? Osteoporosis and poor sexual function.
  • Too much booze? Alzhemier’s and mood disorders.
  • Too much lousy food? Increased weight and diabetes. 

I know 20 wasn’t that long ago, and in those magical years you could put on 10 pounds and take it off by skipping dessert for a week. You could have a hangover that didn’t last for days, and try a new sport with only a couple of bruises instead of a torn Achilles tendon. 

That ship has sailed my dear friend. This is a final you can’t pull an all-nighter for. Cramming for health exams just doesn’t work.
 
I know you still feel 20 in your mind….and believe me, so do I sometimes. There are days when I feel like I can reach out and touch that time like it was yesterday. But I can’t. It’s gone. And it isn’t coming back. 

But you do get to choose for the days ahead. You get to choose how to spend the time now, and as a result, how your future days will be filled, and how they’ll feel.

They say life is short, but don’t believe it. Life is long, it turns out. The days never stop stretching out ahead, they just look a little less inviting all the time when you don’t take care of yourself. 

I know it’s hard. I know you’re busy. But please: just try. Harder. For us.
 
Love,

Your 70-Something Cranky Self