Sunday, September 23, 2012

If It Doesn't Make Sense...

I often like to say that "If it doesn't make sense, it doesn't make sense." Now this may not strike you as the most pithy of sayings, but I find it to be astoundingly profound for its accuracy.  Basically, it means that if you hear something that doesn't make sense, then it usually means you didn't hear it right or it isn't true. This has been a long-standing belief of mine since high school. A few anecdotes may explain why.

When I was in high school, Jeff, a close friend of mine often did well on tests.  I thought like me that he didn't really study so he did well because he was simply smarter than me and absorbed the material in class better than I did.  I was convinced of this until one day when I was at his home the night before a history examination.  While I watched the Yankees play ball, he repeatedly snuck away for some reason. Finally, I followed him only to discover that he was studying the history book for the upcoming test. I realized then that in general, one can't do well for a test unless one prepares. This may have been obvious to others, but it took this incident for this reality to resonate with me. (What can I tell you, I was a slow starter.)

When my children would tell me that their friends were doing well on tests without studying, I would often respond that I was sure this was not true. Inevitably they would discover the truth. When I built my national health care practice, my fervent belief in things needing to make sense saved me from making many mistakes.  Whenever I heard something that didn't make sense, rather than reacting to the information, I would first search out the facts. Inevitably, they either told a different story or there was more information that offered clarity to the situation.

In my current medical practice, the constant search for things to make sense continues to serve me well. Two recent incidents are excellent cases in point. The first involves a patient who said he lost 35 pounds by limiting his salt intake and consuming a lower fat diet.  While there are mechanisms to explain how both of these may contribute to some weight loss, in and of themselves, they are not sufficient enough factors to result in major weight loss.  Why? Low fat diets often result in greater consumption of high carbohydrate foods that are major weight gain culprits.  Although the patient insisted that switching from dark chicken to white chicken were among the major changes he made to lose weight, I knew that it didn't make sense, and upon further questioning, it became readily apparent that simultaneously with decreasing the fat and salt content of his food, he had likewise decreased his carbohydrate intake. Now it made sense.

Another recent situation involves a patient who admits to being an alcoholic. She asked me innocently enough why she was suffering from the ravages of alcoholism (multiple abnormal blood results) while those around her that drank with equal aplomb seemed to be spared from such consequences.  I assured her that this was simply not the case. Looking at her, you would not expect her to have anemia, blood in the urine, abnormal liver function tests, very high cholesterol, inflammation of the esophagus, etc. It is only because she admits her problem and sought the care of a doctor that her issues were identified. My rule that things make sense guides me in telling her that her friends will also suffer, if they aren't already, the consequences of alcoholism sooner or later.

I have numerous other examples that I won't bore you with the details. The bottom line is we live in a world where most things make sense (except maybe liposuction) even if we don't agree with them. One of the most sensible things is that taking care of your health yields great benefits under almost any circumstances. Yet, book after book gets published and people pay good money to hear the same advice over and over again. On the surface, this would seem nonsensical. Why don't people get it?  It seems to be simple enough. Avoid processed foods and eat mostly unprocessed foods. Yet, so many people are overweight and suffer from poor food choices. It's a huge problem and may seem like it doesn't make sense.

The problem is it actually makes sense. We know sugar and trans-fats are bad for us, sometimes even vowing to avoid them, yet the moment someone puts a piece of creamy 'Midnight Dark Chocolate Belgium Chocolate Cake' in front of us we throw caution to the wind and disavow any previous resolutions.

It actually makes sense because the lure of such a treat overpowers even the best of us. For some, it's not chocolate cake but ice cream, hot dogs, french fries, movie theater popcorn, pizza, pasta, etc. The list is endless and each of us knows our poison -- the devilish food we can't resist. So what's a reasonable person to do in a world that forever tempts us to corrupt healthy eating?

The answer is planning. If you have unhealthy food at home, expect that you will eat it. If you go hungry to a restaurant and do not know what's on the menu in advance, expect to choose poorly. If you go to a friend's house and haven't explained to your friend what you are trying to accomplish with your eating, expect things to go awry.


If you plan out as many meals as possible in advance, then you are more likely to eat the right foods. If you eat some nuts before going out to a restaurant for dinner and check the menu on-line before the meal so you can pre-select your choice, you will be less likely to eat the bread and butter and choose the unhealthier fare off the menu. If you go grocery shopping when you are not starved and avoid impulse purchases along the aisles, you are more likely to choose wisely.

Willpower will fail you.  In an interesting study in which two groups were asked to eat foods at different rates, the group that ate slower were surveyed to be less hungry two hours later. However, when both groups were shown delicious deserts shortly thereafter, they ate the deserts in similar quantities. The researchers explained that our bodies' natural appetite stimulants allow us to eat favorite foods even when we are not hungry. 

Eating healthy takes effort and planning. It's not simple, but it's usually the only thing that works. It also makes sense. So the next time you hear something that doesn't make sense, remember that what you are hearing may be wrong or you may be hearing it wrong.

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