In the last chapter we talked about getting back on the wagon before falling off. This is a figurative way of speaking. It involves translating feelings experienced early on in the day into mental images. (The assumption is that
we all can do this, if only we will.) Too, it involves knowing our favorite hero well enough, so that he or she can be instantaneously experienced-- seen and heard right there beside us when we start feeling ourselves going off course. All of that is the essence of forethought--what we need to remain consistent with a diet, supplement and exercise.
What we didn't explicitly talk about is that falling off the wagon will (
not can) have some serious consequences. It really will require
a pound of cure. Backslides or lapses always need to be addressed, assuming we want to get back up to speed. Without doing so, the one "little" deviation results in "big" trouble : it causes the second, third, and fourth, which ultimately results in the allegedly reasonable need to quit. As we all know, this ultimately causes a loss of self-confidence (requiring a
ton of cure.)
However, using the ounce of prevention pound of cure analogy in this sense is not the only one of importance. We may really need the same type of thinking long
before the first day of getting into a new fitness lifestyle. This refers to the doctor's visit--that essential afternoon appointment, which is the only responsible thing to do before a lifestyle change. Why? Because there are things, sometimes hidden from us, which would make exercise temporarily unwise. Too, there may be drug interactions which could make the addition of supplements problematic. Last but not least, calorie reduction with the substitution of gluten-free for wheat, fish and chicken for red meat, fruits and vegetable for snacks may be somehow unwise (though it is unclear how) at least for the present. In short, it's always good to check with our doctor first.
But this shouldn't just be to find out if we're medically OK. It's also to put our doctors
on notice. They need to be explicitly told ( not asked, unless we need to hear
better take it slow and the like) about our getting into a fitness lifestyle. The best way to be explicit about our intent is to simply have a list of exact dosages of supplements, an outline of expected exercises with their regularity and duration, along with two weeks of meal plans (listing grams of sugars carbohydrates and protein along with calories.)
Being confronted by anyone this
together (having used their head so much) may be alarming even to a seasoned professional. Most people just ask if they're
healthy enough for healthy activities, to paraphrase the latest libido stimulant commercial. Of course, we can do that, if we must. But this helps no one really, even it passes for grown up mature protocol. It's what we've all come to expect--something which says virtually nothing (other than that we'll surely seek
immediate help for a problematic condition lasting more than four hours!) What's really needed is an OK stamp to train like our version of Rocky, ie. not a permission slip to walk a few blocks after dinner three times a week, which is what the standard inquiry brings to mind.
To get what we really need from our MD requires quite a bit of homework on our part. So, that should be started very early on. But it needs to be remembered that it will have to be read, and there are others behind you in the waiting room. So, our written plan should be double spaced and cut up with bold headers. Color coding makes some sense as well. That all should at least get a professional glance, a courtesy scan of about the same amount of time as it takes to scribble out a prescription.
More than likely, this will result in the MD finding something questionable with what's been put together. Only working out every other day as opposed to every day (as your hero and corporate fitness director think best) is most common. That's the alleged
cut in stone advice straight out of the sixties, which "everyone" is supposed to know anyway. Ignore the fact that most doctors don't even work out three days a week. Anyway, finding something amiss with your plan is to be expected. Therefore, all that should be cared about is obtaining a
good to go stamp, nothing more.
The most unfortunate thing about this visit is the lack of encouragement. That's what people generally expect from these professionals. Partially this is due to their heavy patient loads, wherein a check-up for a healthy person is far less important than anticipating a by-pass surgery for someone really bad off. Too, it it is the result of their training in curing disorders, not preventing them.
Perhaps all of this will change as more MDs actually prescribe fitness lifestyles for their patients and live them themselves. But lamenting over that not being the case right now is a waste of energy. (This is a job for ACSM. See below.) Too, allowing their lack of enthusiasm to become an excuse for not getting a check-up, or for having second thoughts about getting fit is simply childish.
Again, an OK stamp or a good to go stamp is all that should be sought. That, they are more than willing to give if they see that there is nothing wrong right now--something which should be very reassuring.
Beyond this, the over-arching goal should be to meet doctors where they are at after one hundred fifty years of modern medical advancement, and go from there. In other words, fitness without a doctor's blessing is foolish. That's why scheduling a follow up appointment for six months down the road makes good sense as well. In this way, problems can be headed off should they happen to appear (another ounce of prevention,) and first powerful complements of how great things are going may also be received. Both will make the rest of the year go even better.
What appears to be comingIt can never be stressed enough that most doctors come across as apathetic toward fitness. That can be something which kills the enthusiasm to start a fitness lifestyle. How this can be has been touched on in previous chapters. Perhaps these professionals ought to be more supportive than they are; but they cannot be because they themselves do not workout, do not supplement (though this may be changing as will be discussed below,) and do not really know much about nutrition other than one really shouldn't overeat. People often expect that doctors
know everything at least when it comes to health. Thus, anything which would make us healthier should in fact be well-received and encouraged by them. However, aspects of fitness are not part of their schooling and, with back to back appointments, hospital visits, operations time is just severely limited.
The not too distant future may be different. As can be seen in the letter below, physicians are encouraging other physicians to get
with it at least relative to exercise. The letter below is from ACSM --the American College of Sports Medicine, which has over 45,000 members and an impressive staff of highly educated leaders and trustees. (Google their website.) Hopefully, with their influence, doctors will in fact start being more proactive about recommending exercise to their people for preventative and recuperative purposes. But it's unlikely that there will be any great difference in the country until more Mercedes with MD stickers are seen in front of the local health clubs.
Still, there is hope, as can be seen from the following letter. With as many people currently involved in ACSM, and with as impressive of a staff, it may be that gradually more doctors will actually start practicing what we erroneously think they preach, namely preventive health and dynamic physical excellence.
Dear Health Care Provider,
What if there was one prescription that could
prevent and treat dozens of diseases, such as diabetes, hypertension
and obesity? Would you prescribe it to your patients? Certainly.
The guiding principles of Exercise is Medicine® are
shared by the American College of Sports Medicine (ACSM) and the
American Medical Association (AMA). They are designed to help improve
the health and well-being of our nation through a regular physical
activity prescription from doctors and other health care providers.
The guiding principles of Exercise is Medicine are as follows:
- Exercise and physical activity are important to health and the prevention and treatment of many chronic diseases
- More should be done to address physical activity and exercise in healthcare settings
- ACSM and AMA are making efforts to bring a greater focus on physical activity and exercise in healthcare settings
Please feel free to peruse this Web site for additional information. You will find a more detailed description of Exercise is Medicine,
ways you can counsel patients on their exercise regimens, and
information on how physical activity can be an integral part of any
patient’s healthcare program.
We urge you to make exercise consultation a
regular, important part of your interaction with every patient at every
visit.
Thank you very much for your interest in
this initiative. We look forward to working with you more in the future
to help advance the Exercise is Medicine program.
Sincerely,
|
Robert E. Sallis, M.D., FACSM
Task Force Chairman, Exercise is
Medicine
2007-08 Past-President,
American College
of Sports Medicine |
Ronald M. Davis, M.D., FACPM
Past-President, American Medical
Association
|
Doctors and SupplementsMost doctors are not pro-supplements. This is for a number of reasons : 1.) they fear that people may substitute vitamins for regular medical care and a good diet; 2.) they know of occasional scare stories (
miniscule numbers in comparison those of big drug companies, pharmacies and hospitals) of supplement abuse; 3.) they feel there may be adverse drug interactions with their prescribed drugs either at present or down the road; 4.) they believe there are poor quality supplements out there presumably from outside the USA; 5.) they have been steeped in professional skepticism over claims made by supplement manufacturers and even fellow doctors. Consequently, most
MDs will do little more than mildly tolerate a patient's desire to try supplements out for whatever reason.
Nevertheless the following article from UPI appeared in 2011. While it may make the reader wonder about how the data was collected, who was asked (ages, parts of the country and the like,) it at least suggests that there
may be some breakthrough in doctor's attitudes toward supplements. Perhaps it says no more than
it seems there are more doctors who are willing to try supplements with the possible intent of augmenting their practice by recommending them when they feel more comfortable. But the fact remains that even the humble mufti-vitamin is only reluctantly encouraged.
WASHINGTON, March 13 (UPI) -- Not only do many physicians recommend supplements to their patients, many take them themselves, U.S. researchers say.
The study, published in Nutrition Journal, found 75 percent of
dermatologists say they use dietary supplements and 66 percent recommend
them to their patients; 57 percent of cardiologists use supplements and
72 percent recommend them to their patients; and 73 percent of
orthopedic specialists use supplements and 91 percent recommend them.
"Health professionals, including physicians, have an interest in
healthy lifestyles and in habits that may contribute to wellness, which
may include the use of dietary supplements," Annette Dickinson,
consultant to and past president of the Council for Responsible
Nutrition, said in a statement.
The multivitamin is most of often taken by the specialists -- 44
percent of all cardiologists, 61 percent of all dermatologists and 57
percent of all orthopedists say they had taken a multivitamin within the
past year.
More than 25 percent of physicians in each specialty said they had
used omega-3/fish body oil, while 20 percent of each of the three
specialty groups said they had taken a botanical supplement in the past
year. Green tea was the most popular.
Health and wellness were the top reasons physicians said they took
supplements -- including 32 percent of cardiologists, 42 percent of
dermatologists and 43 percent of orthopedists.
Are supplements good? If Jack
Lalanne were asked he would say,
absolutely. So too would
Jillian Michaels, and Jane Fonda. Are these people nothing more than a happy result of the placebo effect as our
MDs seem to think? It's unlikely. But our doctors, even with their obstinacy on this issue, are still worthy of our respect. Therefore, being completely honest with what we're taking to complement our fitness lifestyle should be a top priority. This means bringing the list to the check-up and having it put in our file. If nothing other, that will save having to remember when being treated for a something severe, such as a car accident. No one wants to think like this, though these things do happen, and the first professional to be called is one's physician. To do the best possible job for us, they need to know all of the facts.
But are our doctors using these products and not telling us? If so, what does that say? Perhaps the most charitable answer is that some may be experimenting on themselves to see if there might not be some good in what so many fitness folks seem to believe is so essential. Nevertheless, it needs to be remembered that our doctors weren't trained for this in college or grad school, and even their more well-known peer celebrities such as Dr.
Weill, Dr.
Mercola and Dr.Oz are looked on with suspicion. Thus, it may be a while before our doctors get as enthusiastic as we might like.
Doctors and Diets
Unfortunately, there
don't appear to be any studies on what doctors are telling patients to eat. Nutrition is an important part of health, but really this area does not yet seem to getting the same attention as supplements and exercise. This will probably change as more of the newer diets incorporate and go beyond the
three meals a day from the four food groups advice from fifty years ago. But for now, people should continue to do as they're doing, namely be content with seeking nutrition specifics from their heroes, or other reputable institutions, such as the Mayo Clinic.
Perhaps that's why few people would ask a doctor's advice on diet, unless they're overweight. The assumption is that most of us don't think we have to. We already know what we'd be told.
Don't overeat; eat a balanced diet; stay away from snacks and alcohol; drink enough water and watch the coffee. Actually this is not bad advice. It really will keep us looking as good as our physician. But what if we'd rather look like our favorite movie star?
Sharing this aspiration with our doctor is not only unwise but a waste of time. It is the former because it puts us in the second childhood category, (forget about any good coming from enlightened self esteem,) and the latter because doctors not only don't know, but don't care. It needs to be remembered that doctors have been trained to cure "real problems"--not do
cosmetic counseling.
For diets, we need good advice. That can be gotten off the internet, from books and from our heroes. But we should always make sure that whatever we decide on does not contain too many calories, is not imbalanced, is not boring. These things we all pretty much know, meaning we shouldn't burden the doctor with any of this. The MD is neither nutritionist nor Olympic coach, and shouldn't be expected to be either.
In short, when it comes to diet, we're
on our own... unless, of course, we're obese. If that's the case, we may be put on (or request that we put on) an appetite suppressant. The ones from the doctor have very plain labels, no brochures with models
who've never been fat, and they do work. Moreover, the doctor knows the result will not be due to the placebo effect.
Wrapping it upAlmost all of us have doctors whom we like, trust, and who do a great a job for us. Possibly we've been with them for decades. They're well-meaning and very good people.
When it comes to fitness, however, they may prove disappointing. If so, it's because we are expecting things from them which we shouldn't. Specifically, this refers to positive input relative to diet, exercise and supplements.
That is why we really need to get familiar with our heroes--Jack,
Jillian, Jane or whomever. Many of the answers to our questions are on their
websites and in their newsletters. That's where we should be doing our brainstorming. In other words, we shouldn't be assembling a notebook page of questions (completely different than a straightforward workout plan) for the preliminary check up.
Nevertheless, our doctor is a great ally. This person can let us know that we are OK or
good to go with a fitness routine--that there's nothing drastically wrong either with us or with our plan. In other words,
nothing should hold us back. Being told that is
huge, as many of us have never embarked on fitness lifestyle, ever.
No company, no corporate fitness director, no hero or heroine would ever expect us to do anything counter to what our doctors have to say. Their word is respected and greatly appreciated whenever its given. And, of course, no one would want to think about not having one in case of an emergency.
The trouble is that we may be unrealistically expecting fitness encouragement from these professionals. That may come in a few years, when more
MDs frequent the health clubs, use vitamins, and become more knowledgeable about the latest nutrition facts and advances. But, until that time, we should all be content with the mere knowledge that we are OK and
good to go. Of course, Rocky was never seen going to the doctor before starting to train for his big fight. But he wasn't necessarily doing the wisest thing either. In other words, listening to Mom when she says
it's only a movie may really be best in this instance. Like all of us, a real Rocky
could've had something amiss with him--a bug which would have made a two week delay (with a small bottle of antibiotics) completely in order.
Doctors are invaluable for this type of thing and may become even more helpful as they become more comfortable with fitness. But for now, one should simply expect only what they know how to give. Knowing that we can always depend on them for this makes them at least one step above a lot of people.
For further thought on doctors and fitness
order my e-book "Think and Grow Fit."