The Magic Pill

When patients come in to one of my two exam rooms to wait for me, they see written on the white board THE MAGIC PILL "Walking five times weekly, 30 minutes (minimum)" Originally I had written the exercise recommendation for a specific patient but did not erase it. It generated so many conversations from patients coming in for other reasons that afternoon that now it resides permanently on the board (except when a helpful cleaning person erases it).

What has been surprising to me is that most patients WANT to talk about it. They frequently reference that they are walking, they want to walk or they hope to walk. It has been a great conversation generator. In addition to that it has given me the opportunity to talk about studies that illustrate how good walking is, or more generally, how important exercise is to well-being and longer living.

There are numerous studies linking improvement in depression with physical activity and a list of several of them can be found here. Thanks to direct-to-consumer ads, especially on TV, patients often have a magical idea of how anti-depressants work. When we talk about the number of side effects associated with these drugs, especially weight gain, medications become much less appealing.

Another important discussion often begins with how many patients have been told to stop moving because their back/knees/hips hurt. This is bad advice and it often comes from medical professionals. Of course it is USUALLY necessary to quit activity with an acute injury but if you stop too long muscle atrophy sets in and joint stiffness occur. More and more studies point to how important it is to keep moving. Denise Mann writes about this in a great article on WebMD entitled "Dealing With Osteoarthritis? Try WebMD's Joint-Friendly Walking Program".

Brisk walking (defined as a 15-20 minute mile) can reduce heart disease (NEJM), improve function in osteoarthritis of the knee (Annals of Int Med), and prevent the development of diabetes (J of Epid), among other health benefits.

To sum up I want to introduce a video I first saw in Dr. Mandrola's blog because it is entertaining and educational:

The data is IN

Eating a diet high in fruits, vegetables, and whole grains will help you to live longer, healthier, happier lives.

• Longer--it lowers the risk of heart disease.
• Longer--it lowers the risk of diabetes and reduces the amount of medications necessary once you have diabetes.
• Healthier--it appears to reduce risk of certain cancers.
• Healthier--it may reduce incidence of Alzheimer's.
• Happier--well the happier supposition is all mine. But it stands to reason that if you are losing weight and looking better, it should make you happier.  

Specifically, physicians and nutritionists are recommending the Mediterranean diet, unless you want to go "all out" and try being a vegan. That's a LOT of work I am personally not yet prepared to tackle.

From the Harvard Food Pyramid

Couple this diet with the magic pill of exercise and people truly do feel better. It is amazing. It is also hard a hell to get people to change their lifestyles. My husband had his heart attack at 50 and we still eat red meat more than we should (which apparently is at all), I still cook with cheese and cream and pasta is an easy-out when I need a "go to" quick meal. Certainly there is plenty of data to support these lifestyle changes but the more impressive thing is the rare individual who makes the switch and comes in for a check up. They feel better, they look better, they move better, they have less pain, and most importantly, they never regret what they are doing. Their labwork improves and their blood pressure goes down. We get to stop some or all of their medications. Since it is a complete lifestyle change, they tend to stick with it, as opposed to trying to stick with Atkin's or Sugar-busters, or whatever the latest fad diet is.

Personally, the hardest thing for me to incorporate these dietary changes is the lack of a really good cookbook. So far, I've bought three and they are not "basic" enough. I want a Julia Child of Mediterranean cooking. Less recipe, more basics followed by recipes. THEN it would be easier  to "think Mediterranean" with future meals. In the meantime I did find a great website for that purpose (except the print is TOO small!). I'm such a visual thinker.

With the beautiful weather outside right now and spring plants coming up from the ground, I can't help but push the exercise button. I'm out there and hope to see you as well!

        

Doctor I want...

My most vivid recollection of a patient requesting a medication he didn't need was several years ago. He had esophagitis--inflammation of the esophagus, and was taking a medication called Aciphex and as far as I knew it was working splendidly with no ill effects. When I asked him why he wanted to change to Nexium he said to me, "Well, I saw it on TV. The 'purple pill' is MUCH better than what I'm on, right?" What?!? I spent a few minutes explaining that the medication that takes care of the problem IS the best medicine, not the one that some pharmaceutical company is pushing on television.

While the drug companies argue that their "direct to consumer" advertising contains important public service information about the condition that their drugs treat, I think most of us are pretty cognizant that "public service" is NOT what those ads are all about. Worse than that, the advertisements push treatments that are more expensive than other, often equally effective medications; create anxiety in patients that think they have a disease they've never even heard of before; and the worst, give consumers the idea that "everything" can be easily treated with a pill. Got depression? Here take this pill, it'll help. Erectile dysfunction? You don't have to exercise and lose those pounds, just take this pill. Diabetes? You don't need to change your diet, just look at Paula Dean and take this pill. High cholesterol? Here's your pill, no need to worry about those extra pounds and big helpings.

I get downright huffy about the direct-to-consumer route with pharmaceutical reps (who are feeding me lunch, so I suppose some would call me hypocritical) and consider it unethical for these companies to push complicated pharmaceuticals to patients with complicated medical problems in a 60 second time slot. We have a "pill culture" in this country that is aggravated by individuals who want a quick fix for all their problems. The only "magic pill", if there is one, is exercise. Like all therapies, it will not cure everyone and people who do it still get sick. BUT exercise will make people feel better--look better--have more energy--lose weight (when coupled with dietary changes)--ache less--treat depression--increase "good" cholesterol--reduce your risk of Alzheimer's--reduce risk of diabetes and heart disease and stroke--improve sleep--the list goes on and on. If exercise DID come in a pill, people would be clamoring for it and it would probably be illegal!