July/August 2006

The Zen of Science

Taking care of yourself
by not getting down on yourself for not taking perfect care of yourself

By Marc Ringel, MD

Over the last year or so, I've been telling all my patients not to take Vitamin E. It wasn't I who'd suggested they take it in the first place. Most of them no doubt consumed the vitamin because they'd read magazine articles telling them it was good for their health.

Though there wasn't good scientific evidence that ingestion of more than a maintenance dose is good for you, I took the vitamin myself for years, under the theory that its antioxidant properties might help to retard diseases of aging, at least some of which are attributable to degradation by oxidation of the body's structural and metabolic machinery. Then the studies came out last year which imply that vitamin E supplements not only don't reduce incidence of chronic conditions like cancer and heart disease, but that too much E may actually increase risk of these maladies. So I counseled all my patients to stop taking vitamin E and, of course, I quit it myself.

And so it goes. I've practiced medicine long enough to have seen dozens and dozens of bright ideas about how to stay healthy bite the dust in the wake of reputable research, especially ideas about nutrition.

Diet and other lifestyle issues are exceptionally hard to study. The effects of lifestyle may take years or decades to manifest. For example, in the 1950s scientists conjectured about colon cancer, a disease that usually strikes after the age of 50, that a high lifetime intake of fat promoted this malignancy whereas a high roughage diet was protective. They based their ideas on much higher incidence of colon cancer in the rich, meat-eating developed world than in the poorer, vegetable-eating developing world. Research published in the last few years seems to have put such notions about the cause of colon cancer to rest. It took five decades to answer the question in part because estimating diet over a lifetime is a very tough proposition.
Unless you lock them up and monitor them directly, getting reliable information about what people really eat is always a problem. All of us forget by one meal what we ate at the last one (or we lie about it). Even if a dietary journal is accurate for the moment, its reliability tends to decline steeply over time.

Because of these and a host of other difficulties in correlating and quantifying the effects of lifestyle and health, we have little dependable research to tell us, “This is exactly how you ought to live.” Certainly, it's better to exercise and not to smoke. And fruits, vegetables and fish ought to receive more dietary emphasis than bacon, sausage and potato chips. We all know slim is better than fat, and everybody who's not slim understands how very much easier that's said than done.

So I want to let you off the hook. I don't mean to advise you not to try to eat a prudent diet, exercise regularly, manage stress, stay slender, quit smoking, all that stuff. Of course, you should do those things, to the best of your ability. But don't assume that there is a single correct way to live, certainly not an ideal lifestyle based on reputable scientific studies.

Some people crave more certainty than is supported by the evidence. They need to believe that there are strict rules which prescribe exactly what they ought to eat, how they ought to exercise and so on. If you're one of those people, at least try not to assume you're killing yourself if you don't adhere to the letter of your self-declared standards, which are probably impossibly hard to follow anyway. Most importantly, don't feel guilty about what you perceive to be your failings.

You can take solace from results published by the Women's Health Initiative Dietary Modification Trial published this year in the Journal of the American Medical Association: “Over a mean of 8.1 years, a dietary intervention that reduced total fat intake and increased intakes of vegetables, fruits, and grains did not significantly reduce the risk of CHD [coronary heart disease], stroke, or CVD [cardiovascular disease] in post-menopausal women and achieved only modest effects on CVD risk factors, suggesting that more focused diet and lifestyle interventions may be needed to improve risk factors and reduce CVD risk.”
In other words, improving their diet over the course of nearly a decade may have changed these women's cholesterol levels a little but otherwise didn't affect their incidence of heart disease. This is tantamount to killing a sacred cow (from which, if you're going to partake of it, try to select the leaner cuts, and roast rather than fry them). Nevertheless, the dietician who wrote the article in which I found the above quote boldly titled her piece, “Yes, Diet Matters!”

For every negative finding about the effect of diet or lifestyle on health, such as the study quoted above, you'll encounter a few dozen unsupported positive assertions in the medical literature and a few hundred dozen in the lay press. There are always so-called experts who will enthusiastically tell you how to eat and live, no matter what the evidence or lack thereof.

If I thought feeling guilty would actually help you to change your personal health habits, I'd add my voice to the chorus of unsolicited advisors. But guilt does not work. It just makes you feel worse and may actually de-motivate lifestyle change.

We Americans smoke too much, eat too much, work too much, watch too much television. Still, I seethe to hear experts opine that the problem with our healthcare system is that people do not take enough responsibility for their own health. So often that's a thinly veiled excuse for explaining away the inefficiencies and injustices borne of the profit motive that drives American healthcare. Instead of acknowledging the ubiquitous marketing of unhealthy products, instead of recognizing the crying need for universal healthcare, these commentators suggest that people ought to just take better care of themselves, so they'd be healthier and need doctors, hospitals, surgery, and medications less. It's an exercise in blaming the victim.

If you or your child is unhealthy, such critics imply, it's at least partly your fault. Unfortunately, not only are conservative pundits guilty of blaming the victim, so are many from the alternative medicine camp. Taking control of your own health is a fabulous concept, but one that can be taken too far. Coming to believe that you deserve everything bad that happens to your body may lead to paralysis, similar to the spiritual malaise that can afflict those who cast themselves as victims of their own karma.

Don't get me wrong, Nexus readers. I do encourage incorporating into your life a whole range of positive health practices, solid scientific evidence or no, so long as these activities make you feel better, they don't hurt you, and they don't keep you from getting effective medical care when indicated. I take handfuls of vitamins and herbal supplements every day myself, only a couple of which (fish oil and glucosamine) have even the slimmest of scientific support.

As for changing negative health practices, the stuff you ought to quit, this is tough work. Do what you can regarding smoking, over-eating, over-indulging in alcohol and in other mind-altering substances, succumbing to stress, and so on. Don't feel guilty about what you haven't accomplished yet. View your life and your health as a work-in-progress. And quit taking vitamin E.
Marc Ringel, MD, is a family practitioner and writer based in Greeley, Colorado.


Marc Ringel, MD, is a family practitioner and writer based in Greeley, Colorado.