Recently my classmates and I were involved in an assignment called “walking in their shoes.” This involved taking “pills,” which were actually tic tacs meant to simulate medication for CHF, DM, and HTN. With these we were supposed to record our compliance to taking the medication, and also, depending what type of patient you were, you were to count calories, calculate saturated fat, or calculate sodium in your daily diet. This simple exercise was then discussed in group sessions of about 65 students. I can’t particularly say this was in any way useful to my furthering my training, rather it was three hours of discussion that I could have used for studying for an upcoming microbiology exam. Instead of paying much attention I sat in the back with my friend Mike playing Scrabble. Maybe not all that professional, but life will go on. I did share my food journal though / daily saturated fat counts with the class. Let’s just say my sat fat count averaged 5.0g/day, all from almonds, flax seed, and protein powder. I’d almost like to discredit the counts from almonds and flax as those are sources of omega-3s.
The American Hearth Association recommends that no more than 7% of your daily calories come from saturated fat. That means in a 1500 calorie diet only 105 calories should be from saturated fat. That adds up to about 11g.
To put that count into perspective I’m going to use my recent trip to McDonalds to purchase a large unsweetened iced tea for a drive I was about to embark on. I walked into the “restaurant” as I’m not particularly found of drive-throughs. In front of me in line there was a man and his young son, I’d put the son at about 11 years of age. The father ordered a McChicken, large fries, and a dc (tot cal 860, 6.5 g sat fat, 6.8%). The son ordered a double cheeseburger, large fries, and a dc (940 cal, 14.5g fat, 13.8%). Come on now parents, take care of your kid’s health if not your own. But I was actually surprised by these counts, thinking the saturated fat counts / percentages would be higher. However, I don’t want to neglect that there are actually 25 total grams of fat in those large fries with 500 calories each and minimal nutritional value. Nevertheless, McDonalds you still don’t gain any positive points in my world, I will continue to only visit you for my occasional unsweetened iced tea ($1 for the largest size!) or the rare ice cream cone treat on very hot summer days.
Here is where this post might raise some opposition from fellow classmates and colleagues of mine.
The current epidemics of CHF, DM, and HTN in America and most of the developed world really chap my ass.
I am unable to have much compassion for the majority of individuals “suffering” from these diseases, or I suppose the more PC term “conditions.”
(This does not include those, like a classmate of mine… who happens to do just about everything to keep his health pristine, who are HIGHLY genetically predisposed to these diseases)
There is currently an add on the radio about treating
Metabolic Syndrome that basically refers to this “condition” as something that just unfortunately happens to 25% of Americans.
FALSE.
If I, as a medical student, am able to find time to stay physically active and eat healthfully on a budget, then so too is everyone else.
I certainly will never expect all others to do so with the neurosis that I have come to adopt (I put protein on my protein and actually enjoy crazy endurance events) but I also do not consider general ignorance an excuse for the average American’s lifestyle.
I recently read an article in the Economist regarding the plight of the global community and general preventative health.
And here is a link to a global map showing BMI, cholesterol levels, and systolic BP averaged in all nations.
Surprising America looks fairly healthy on the BP measure with most people have a systolic below 126.2 mm Hg.
For those not in the medical field, it is commonly suggested that a healthy systolic BP is at or below 120.
Unfortunatley, what this map fails to mention is the number of patients on BP control medications.
If I had to make an educated guess as to what color the great US of A would turn if they used pre-medicated measures I’d say we’d be bright red and even higher.
http://www5.imperial.ac.uk/medicine/metabolic%5Frisks/blood%5Fpressure/
Just last week I saw a patient coming in for lower back pain and a hypertension check. I measured his blood pressure at 185 over 102. He was in no apparent distress nor did he have any great concern for the condition of his heart, even after I explained his risk of stroke to him. He’d been taking a two medication for a month at that point that brought his systolic down to 185 from 200…. 200! We changed his medications and encouraged him to cut the salt out of his diet. To this he replied that he didn’t think he could do that but would try only put half as much on. Really, sir, this is your life. You were just blessed with a new grandson.
I could go on for hours and hours about my frustration with individuals who lack the self-respect to take care of themselves and keep themselves healthy. Actually thought, I should be thankful, I’ll always have a job. If only money were my incentive for entering medicine. This is a gold mine! Their loss = my gain. Rather, I hope to include in my future practice (if I enter a field or join a group where this is applicable) a weekly morning run session guided by me, healthy cooking classes at least once a month, and a yoga or strength one afternoon a week. These will all be free to my patients. There will be a catch. Once patients are seeking medical care under me they will have to sign a compliance contract and if they are not compliant I’ll have to refer them out to another more considerate physician. Call it patient boot camp if you will, but my job is to save lives and improve individual’s health. They need to be even more committed than I am to build an effective relationship and new lifestyle.
I believe one of the most direct ways you can help another is by giving them their health. Living in Memphis, TN for four years and spending a good deal of time with underserved populations I’ve learned health is a major contributing factor to poverty. For adults poor diet / activity / spiritual health = more sickness and aches and pains = more days they can’t work = loss of jobs and less support for their children. For children poor health = stunted growth or obesity or anger or missing more days at school (if their parents are even well enough to make them go) or….etc = less productive members of society and more likely to continue the trend. These kids know no better and need their parents to play a positive role in their life. Don’t get me wrong, I’m not naïve enough to think that increasing health status of America will fix all it’s problems but I think it’s a place to start. Despite my frustrations with the health care bill that is currently a cause of dispute though out pretty much all community in this great land I do applaud Obama for the initiative he has taken in bringing about extensive discussion and attempts at some change in health(care). Still, I do have problems with my tax money going to support the care of those who choose not to take care of themselves.
