It’s Not Your Fault (Until It Is)

“Healing also means taking an honest look at the role you play in your own suffering”
- Unknown

About 20 percent of Americans suffer from mental health issues. 30 percent of Americans have metabolic syndrome. This disease is the combination of excess body fat, high blood pressure, and high blood sugar which is associated with cardiovascular disease. About 40 percent of Americans are obese. America is getting sicker and our health care system is failing under the burden. In the past, physicians blamed the patients for any excess weight. Patients were often considered lazy with a lack of will power if they could not control their size. It is now a common occurrence during a doctors visit to explain why a patient's illness is made worse by excess weight, or how their chronic inflammation is contributing to their symptoms. My hope is that the majority of physicians are now more compassionate with patients struggling with obesity, metabolic syndrome, or mental health issues. When I discuss these issues with patients I often start with explaining that it is not the patients fault. I try to make it clear that I'm not blaming the victim. We all have different metabolisms and as such there is no one size fits all answer. 

Extreme ownership is a leadership concept that all responsibility for any outcome falls on the leader. Watch the video and consider being the leader of your own health.

This may make you scratch your head. How can someone who believes in “extreme ownership” take this stance? “Extreme ownership” is a concept presented by Navy SEAL Lieutenant commander, Jocko Willink, which means taking absolute responsibility for everything that impacts you or your team’s mission. This includes challenges, successes, failures, and everything in between. When applied to health, the vast majority of diseases are self-inflicted wounds. Our poor nutrition, lack of exercise, lack of sleep, and poor stress management are ruining our health. However, all these things are under our control to correct and we should absolutely take full responsibility, but do not start by blaming yourself. You get one “Get Out of Jail Free” card. 

If you are middle aged, you get a pass because everything you were taught in the 70s and 80s was wrong. Just take a look at the classic 1980s food pyramid. The base of the food pyramid was bread, cereal, rice, and pasta. Fruits and vegetables were the next level, followed by dairy and meat, and fats at the top. Some people with good metabolism were able to maintain a healthy weight eating this way, but the majority of Americans have seen their waistlines expand along with the epidemic of metabolic syndrome, type 2 diabetes, heart disease and cancer. We have all heard stories of the 95 year old, active grandfather who ignored government advice and started every day with bacon and eggs and ended everyday with steak and vegetables. We thought he just had incredible genes, but in reality he was eating what we should have been eating all along. Just turn the food pyramid upside down and that is a good start. We can argue all day about the best human diet, but they all work if you eliminate or decrease sugar and processed foods. Sugar is the toxin that drives all the diseases of chronic inflammation. Even in the 70s we knew sugar was a treat. Your dentist would warn you that too much sugar would rot your teeth. Now we know sugar is the enemy. If you need further convincing, consider reading, The Case Against Sugar, by Gary Taubes which explains how sugar has led to the most common diseases. He explains how sugar was defended by the sugar industry and how dietary fat and overeating was blamed. Most importantly, he explains that sugar is not only in the treats, sweets, and desserts you eat, but in most packaged and processed foods. With this knowledge, some people eliminate sugar, but most of us start with trying to decrease it. This means when we eat sugar we consider it a treat with no nutritional value. So, where did the classic food pyramid go wrong? As soon as bread, rice, pasta, and cereal hit your body they are converted to sugar. In reality, all carbohydrates (sugars) are eventually converted to glucose in the body so they can be used for energy production. In this way, the bagel may have even more sugar than the donut one it is broken down by your body. The stack of pancakes, waffles, French toast, and cereal are just as much a breakfast dessert as pop tarts. Another mistake was that we were told eggs were the villain. Simply stated, the logic against eggs is that the plaques that clog coronary(heart) arteries and cause heart attacks contain cholesterol. Eggs contain cholesterol, so eggs must cause heart attacks. Unfortunately, for a whole generation this has not passed scientific evaluation. The nutritional science now supports eggs as one of the healthiest foods you can eat. Fats found in meat were in a similar situation as eggs. We were told to limit meat, but we replaced the meat with processed carbohydrates to the detriment of our health. Finally, we were told almost to the point of harassment to drink milk for strong bones. Some people can enjoy dairy and some can not, but it is not vital to our health past infancy. Many people suffer abdominal issues and upper respiratory congestion from dairy.

Growing up in the 70s and 80s, my parents were concerned with my health and fed me what everyone thought was a healthy diet. On most days, I had a bowl of cereal with a pop tart or toast, a glass of orange juice, and a large glass of milk. Occasionally, I would have pancakes or waffles. As I explained, the bread, cereal, pancakes, waffles and orange juice are all converted to sugar, so I was sent off to school jacked up on sugar. Most days I was able to release the energy during morning recess, but occasionally I ended up in the principal's office. By middle school, I was struggling to stay awake after the natural sugar crash. I drank milk several times a day and struggled with congestion and allergies that resolved when I dropped my milk habit. Now, most nutritionists would encourage a protein rich breakfast. We now know a breakfast of eggs will set you up for a successful day with stable energy levels. Back in the day, lunch was not any better. The brown bag special contained a peanut butter sandwich, an apple, a Ho Ho or Twinkie, a bag of chips, and a chocolate milk. Again, almost pure sugar. Not to mention some cookies as a snack when I got home. Dinner was where there was a glimmer of hope with some protein, but pasta, rice, or bread were usually on the table. When I reached high school, I was trying to gain weight for sports, so I’d have a milkshake or Coke Float prior to bed. Fortunately, I was extremely active. I had two recesses and sports at school followed by running around the neighborhood and more backyard sports when I got home. My activity level and high metabolism kept my weight down, but many who grew up in this era may not have been blessed with a good metabolism and were perhaps less active. These people would be on their way towards weight issues and metabolic syndrome. The main point, is nutritional science was still in its infancy in the 70s and 80s when most of the now middle aged patients were forming their habits. I am not going to hold you responsible for all the false nutritional science you were given.

Now, we know better, but there are road blocks everywhere. Many middle aged patients have given up on improving their nutrition in order to improve their health long ago. If you were brainwashed that eggs and meat were unhealthy it may be hard to start every day with 3 eggs and finish with steak, chicken or fish. If you were never taught that bread, cereal, rice, and pasta are turned into sugar by your digestive system you may keep congratulating yourself for eating the bagel instead of the bacon, or eating the bowl of pasta instead of the beef. Even if you take the deep dive and educate yourself on nutrition you still need to avoid all the unhealthy food options. In an ideal world, we would all enjoy fruits, vegetables, healthy meats, and nuts without the distraction of sugar and processed foods. Unfortunately, the “Big Food Industry" is a constant roadblock to our health. Take one drive down the road and see all the fast food restaurants and convenience stores. One trip to the grocery store and you will see far more unhealthy options than healthy ones. A common piece of advice is to only allow yourself to shop on the periphery of the store where the veggies, fruits, fish and meats are. 

This is a great explanation on how we were all led astray by nutritional science and how our diet was influenced by food corporations and government.

If we are not going to blame ourselves, maybe we can at least blame the “Big Food Industry” for making us sicker, right? This is a common target of the wellness community, but I'd be cautious about getting too upset. Although we now struggle with obesity, we have struggled with starvation for the majority of human history. The goal of the entirety of human history has been to survive and procreate. To survive we needed a steady food supply. A drought, a flood, a freeze, or over hunting could starve a whole population. The goal has been to create a calorie dense food supply that could be cheap and stored. Bonus points for making it taste good. Take a look around and the human race should be congratulated. We have more than accomplished our goal. Cheap, calorie dense, delicious food is everywhere. Mass starvation is only an issue where governments have mismanaged resources, aid, or other extreme circumstances. Now we have the opposite problem of too much food. It seems unfair to blame “Big Food” for doing too good a job. I would love to see the industry change, but such a complex system can not be expected to change direction on a dime. It is also a decision of personal freedom. Even some of the healthiest among us prefer the choice of eating whatever we want. As a society, we eat too many Big Macs and French fries, but that does not mean we want to give up our right to eat them on occasion. The companies are only following supply and demand. If we keep eating these foods in large quantities they will continue to make them. Ultimately, the food companies are after profit. You decide if you never eat junk food, eat it occasionally or every day.  So putting our blame on “Big Food” may not be the answer.

The government is another easy target. Certainly, the FDA’s food recommendations have been incorrect in hindsight. We have preservatives and flavorings in our food here in the United States that are not allowed in Europe. On top of this, we subsidize farmers who make sugar, corn, and grains rather than fruits and vegetables. We have allowed food companies to influence our food policies. The funding for government research needs to come from somewhere. Either we pay for it with taxes, or it is funded/donated by corporate interests. Much of the original sugar research was funded by the sugar industry. The original funding for the Department of Nutritional Science at Harvard University came from the manufacturers of Kool Aid, the sugar water we grew up on. Once again, it is a complex system that we can not expect to change in an instant, but government agencies have proven to be helpful in the past. We have made progress in decreasing smoking with the help of the government, but it certainly did not happen overnight. Seat belt requirements and drunk driving awareness are additional areas where the government gave significant aid to the cause. Someday we may look back and see that the government helped improve our nutrition, but if you are anywhere near middle age you do not have the time to wait. A healthy diet would certainly be easier without the junk food temptations, but we are not ready to give up our freedom to decide what we eat. On the other hand, making healthy food available and affordable should be supported by all. 

Only recently have physicians connected poor nutrition and mental health issues. Once again, sugar and processed carbs are the culprit. Sugar and processed carbohydrates can often be addictive and give a dopamine surge similar to other addictive substances. In order to resist, you need to be aware that in the long run these foods are harmful. You are trading away a healthy future for a temporary hit of pleasure. With education most of us are aware of the trade off. However, if you have mental health issues such as depression or anxiety you may be self medicating your illness with unhealthy food. The unhealthy food only makes your mental health issues worse and it is a vicious cycle. If you find yourself in this situation, then jumping on the bandwagon of the latest diet craze is not the answer. You should do your best to eat healthy, but addressing your mental health issues will be critical to long term success. You may need to contact the therapist before the nutrtionist. Hopefully, you have a doctor who will offer you encouragement rather than blame.

“Nutrition determines your weight, exercise determines how you look at that weight.”
- Dr. House

Other factors affect your metabolic health such as exercise, sleep, and stress management. Sleep and stress management were not factors we considered, much less discussed, as contributing to poor health until recently. Poor sleep habits will not only slow your metabolism, but contribute to craving junk food and having less willpower to resist it. Stress will result in high levels of stress hormones such as cortisol. Constant stress will slow your metabolism and contribute to obesity, type 2 diabetes, chronic inflammation, and heart disease. We did not recognise these factors in the past so we could not remedy them. The importance of exercise has been recognised for decades, but we have not understood the whole story. Many of us believed we could outrun a poor diet. This may work for some when they are young, but ultimately you will be slowed by the diseases of chronic inflammation. Too many of us blame our weight gain on lack of exercise rather than the true villain which is our poor nutrition. I am a big advocate of exercise, but it is only one component of health.

Many middle aged patients who are told to start exercising turn to jogging. Jogging or running is a great form of exercise. For many, it is not only great for cardiovascular health, but also as a form of stress release. If your mind can escape while you run you will likely remain a runner. For many others, running is a chore and as a result may increase stress. Running is also not necessarily the best form of exercise for weight control. There are many runners who could still be considered overweight by BMI measure. If you grew up in the running craze of the 70s and 80s, you may have thought running was the only way to get in a workout. Now we know better. The menu of great workouts is long, but the most important factor is finding movement you can enjoy. If you are not a runner do not give up. You may be a strength trainer, a swimmer, a walker, yogi, rock climber or martial artist. The list of options is never ending and you will always be able to find something or a combination of things that keep you fit and healthy. Exercise will reduce your stress and improve your sleep as long as you find the form that you can enjoy even when it is challenging.

So, now who is to blame if you find yourself struggling with obesity, metabolic syndrome, or the diseases of chronic inflammation? We can not blame the “Big Food” industry because they accomplished their mission of supplying high calorie, good tasting, food that is easy to store. We can not blame the government who was acting on the information they had at hand, and due to the complexity of our system can not change course as quickly as nutritional science changes. As I explained in last week's blog, “Medicine and Health”, you can not always blame your doctor. You can not even blame your type of exercise or lack of exercise. Most importantly, you should not blame yourself. It was an uphill battle to eat a nutritious diet when we were given the wrong information. So whose fault is it? Herein lies the paradox. It was not your fault, but now you need to take “extreme ownership” of your health if you want to be healthy. Now you know why your doctor does not talk about nutrition all the time. Now you know why you need to look beyond the government recommendations and make your own decisions. Now you know the role of “Big Food'' is to make cheap, addictive, calorie dense food.. Their goal is not to keep you healthy, but rather keep you coming back to buy more food. Now you know that you may need to address your underlying mental health issues along with improving your nutrition. Now you know your exercise is not enough. Now you know from this point on you are responsible for your own nutritional decisions. Once you take “extreme ownership” all the blame is on you. You are no longer the victim, but the leader of your own health. This is the path to success.

Life is tough but you are tougher