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Dr. Darrell White's Personal Blog

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Archive for October, 2016

Musings on “Exercise as Medicine”

The “exercise is medicine” movement is kind of a confusing thing. On the one hand we in CrossFit are the uber example of how exercise as an independent variable can enhance health. On the other we have the “Big Sugar” industry funding research and promoting the notion that exercise is all that you need, that there is no effect of nutrition on health. Train your way out of any kind of diet, if you will. This has led to the toxic effect of “BS” industry money supporting academic research that is in effect little more than marketing for their products. (Visit TheRussells.CrossFit.com for details). Indeed, the soda industry in particular has come in for some very pointed criticism which includes being accused of acting like the tobacco industry ( https://blogs.scientificamerican.com/food-matters/if-soda-companies-don-t-want-to-be-treated-like-tobacco-companies-they-need-to-stop-acting-like-them/ ). Pretty harsh, but probably deserved.

Here’s the rub: exercise really is a medicine equivalent for a very large number of medical problems. Heck, if it were only to work for cardiovascular health and Type 2 diabetes it would be considered, or should be considered, a miracle treatment. Not only that, but exercise very well might work independently of diet. While exercise should not be used as an excuse to consume a poor, dangerous diet, you may actually be able to at least partly out-train a poor diet to at least some degree.

In 2009 a study was published in the International Journal of Epidemiology (http://m.ije.oxfordjournals.org/content/39/1/197.full) examining the effect of aerobic exercise on longevity (hat tip to Michael Joyner, MD at Mayo). Mind you, the study was enrolled prior to the creation of the CrossFit fitness program (completed in 2003), so the definition of fitness (aerobic health) will be viewed as incomplete by CrossFitters since it includes only aerobic fitness. In addition, what is defined as an unhealthy diet would only partially pass muster here; we would agree that simple carbohydrates (sugars) are unhealthy, but there is a plethora of more recent data that strongly suggests that red meat and healthy fat do not render a diet worrisome in the least.

A careful reading of the study revealed a couple of nuggets that should not surprise even a little bit. Eating the unhealthiest diet was associated with a 40% increase in all-cause mortality in comparison with the healthiest diet. Those who ate that worst diet and reported that they did moderate or greater levels of exercise had a 13.5% decrease in mortality. That group of bad eaters who exercised and were proven on a modified cardiac stress test to actually have greater aerobic fitness levels had a 55% decrease in mortality. Let that sink in for a minute: people who ate a shitty diet who exercised to the degree that they were fit by the testing criteria in the study were half as likely to die in any period than those who were unfit.

Boom.

Frankly, I don’t care who funded this study. Eating a shitty diet that is high in sugar increases your risk of death by 40%. Proof. Exercise that produces improved fitness, even fitness that I would view as partial or incomplete, reduces all-cause mortality in people who eat a diet high in sugar by more than half. Proof. Yeah, sure, I get that this could be used to justify or excuse eating that way, but the reality has always been that most people don’t exercise at all. Nada. Bupkis. Those who do certainly don’t achieve much in the way of any kind of fitness because they don’t exercise effectively—saying you exercise only got you a 15% decrease in mortality, after all. These results only apply if you get fitness results, and let’s face it, working hard at exercise is not the default setting in the developed world. By comparison eating better is a breeze.

Studies such as this one are mint, man. Especially to people like me, people who follow the CrossFit Rx and other programs that ask you to work hard. It’s exercise AND nutrition. Says so in the study. Sure, we can pick at this one if we want, like I did above, but my bid is that we use studies such as this one as talking points to prove that our worldview is the gold standard by which all public health initiatives ought to be compared. We can turn the cynical “exercise is medicine” campaign of “BS” on its head and use their own data against them. Eat like a CrossFitter (protein, nuts and seeds, little starch, no sugar). Exercise like a CrossFitter (functional movements performed at relatively high intensity). Seek ever-higher levels of fitness (work capacity across broad time and modal domains) like we do.

“Exercise is medicine” is just fine as long as we continue to call BS on “BS”. Health requires both exercise AND nutrition. People who are fit, especially physicians, are just the right people to tell that story.

 

Hugs, Kisses, and Cultural Norms

It takes very little effort to observe the intersection of cultural norms. Indeed, it takes a substantial effort NOT to notice them when they collide, as they must, in the polyglot that is the United States. Physicians, it’s been noted, are little more than paid observers; I see these collisions daily. What are we to do when cultures collide?

Now, I’m not talking about the “old as eternity” cultural divide between teenagers and their parents; in the end the teens will either hew closely to the cultural norms of their heritage or fall more in line with those of their present address. What I am interested in are those cultural norms that remain an integral part of the fully formed adult one might encounter in a rather typical day, and by extension whether and how one should respond to any cultural dissonance. Or for that matter, WHO should be the one to respond.

It’s the tiny ones that catch my attention. Personal space for example. The typical American personal space extends one arm length between individuals. Something shorter than a handshake, more like a handshake distance with bent elbows. The Mediterranean space involves an elbow, too: put your hand on your shoulder and point your elbow to the front and you have measured the personal space of a Sicilian. Asians on the other hand occupy a much larger personal space that can be loosely measured by a fully extended fist-bump. Something which would be anathema in polite Japanese company, but no matter.

My favorite little example of the variety of cultural norms that swirl in the soup of the great Melting Pot is the affectionate greeting. You know, what most fully acclimatized Americans would recognize as the “bro hug” shoulder bump and clasp, something that would be appalling to a Parisian or Persian, or indeed even to a Princess of the Antebellum South. Yet even here there are differences. The Princess, joined by legions of Housewives of Wherever and Junior Leaguers everywhere are ninjas in the practice of the single-cheek air kiss. It should be noted that ~90% of men are NOT ninjas in this particular art, and are expected by its practitioners to bungle the act.

Persians and Parisians, on the other hand, find the one-cheek air kiss to accomplish only half the job. They, and others who share centuries old cultures, warmly greet each other with a two-cheek kiss. I am sure that there are nuances involved here that remain unseen and unknown to both most men and certainly most (all?) who don’t share the heritage. (As an aside let me just say that I am a huge fan of this particular cultural norm because it means that one of my very favorite colleagues, Neda, always arrives bearing TWO kisses).

So what’s the point here? Two, I think. First, there is a certain boorishness in the failure to observe and recognize the existence of these cultural norms when they are encountered. Some, like those I’ve mentioned, are the relative equivalent of a soft breeze, neither strong enough to fill a sail nor de-leaf a tree. Recognizing them, even in the tiny manner that one tries not to trample on them even if they will be ignored, is a tiny gesture of kindness, respect, and courtesy.

The flip side, number two, is deciding which of these norms is the default setting. Here things get a bit stickier, especially when cultural norms run afoul of SOP on the particular ground they occupy. Think air kiss in Afghanistan, for example. Bowing in the boardroom of Samsung in San Clemente. There are more, and bigger examples, but you get the idea. Here I think geography holds the trump card: “when in Rome” should be your guide, especially with cultural norms where the collision may be substantially more impactful then whether or when you turn the other cheek, a tornado to the above tickling breeze.

If only we could agree on the universal appeal of the two-cheek kiss.

Sunday musings 10/9/16: Grateful

Sunday musings…

1) Camping. Recreational homelessness.

2) Enough. Perfection is finally attained not when there is no longer anything to add, but when there is no longer anything to take away.” Antoine de Saint Exupery

3) Khakis. As in the khakis that somehow didn’t make it yesterday morning on the way to the airport. Per Mrs. bingo they are right where the rest of the pile was before I crammed it into my backpack.

Did you know that Target is open at 0800 Sunday mornings?

3) Grateful. A quorum of the White family congregated in Rhode Island this morning to mark the 1-year anniversary of my Dad’s passing. Appropriately, the main event was Sunday mass in the tiny little Catholic church of my youth. Rock hard wooden pews with a 90-degree angle, just to make sure you suffer a little every week. We arrived 20 minutes early to make sure that Grambingo could sit in the front row.

Even the priest made fun of us.

Father is that (now) rare priest who reads far outside the lines and then brings his reading to the homily each Sunday. Today’s gospel was about gratitude, and Father’s take on the topic lined up perfectly with how we were all feeling about the day. You see, my Dad was a medical train wreck, a disaster just waiting to happen for about 3 decades or so. We, his family, were on borrowed time since a bypass surgery went off without a hitch in 1985.  Kinda like 30 years of extra time on a pinball machine. We were playing with house money.

Funny thing: not a one of us took any of that for granted. My siblings and I, our children, and of course Grambingo have been forever grateful for all of that time with Dad. No one was more grateful than he was, though. My Dad and Arnold Palmer were contemporaries. The great writer Dan Jenkins once said of him that no one was ever happier with his life than Arnold Palmer was with his. With all respect to both Messrs. Jenkins and Palmer my Dad was certainly at least as happy as Arnie.

When I read about Arnold Palmer, his life and his family, I see my Dad. Each day was a new and wonderful adventure, a unique gift that was as unexpected as a Depression era gift under a Christmas tree. Big or small, each daily victory was another reason to be thankful. Being grateful was the default setting for a man who began each day with enough. The lesson is very, very powerful.

Perhaps unconsciously channeling Saint Exupery Father finished by describing the most simple, elegant prayer yet written. “Thank you.” For all of the sadness that each of us has felt this past year without my Dad we are, each of us, grateful for the privilege of having had him in our lives for as long as we did. Each day he showed us what gratitude looked like. “Perfect” is likely unobtainable, but we can always choose to be grateful.

Thanks again, Dad.

I’ll see you next week…

–bingo

Fall Weekends Free of Football

My son Randy texted me about the exciting finish to a Saturday college football game. It made me smile. Not the result, not even the topic, but the excitement. A parent is only as happy as his least happy kid, and at that moment one of my kids was very happy. Randy’s football playing days are long behind him, but the game still brings him joy.

Me? Not so much.

Oh sure, there was a time when football never seemed to be any lower on my list of wonderful things than number 2 or 3. I was a medium-sized fish in a puddle as a high school football player, but still I didn’t have the game out of my system when I graduated. Accepted at one Ivy League school and waitlisted at another, I turned down both because I was too small to have any chance of playing football at that level. Instead I went to a very old, very small school and played a some all 4 years. Now done as a player once graduation came, I was nonetheless still enthralled by all other things football.

Many of my closest friends were met on the freshly cut football fields of my youth. Wins and losses followed on those fields, most of which I’ve long forgotten. Indeed, I’ve written before that it is only the losses I remember, especially those that resulted from some personal failure in a game. A fumble, perhaps, or a blown coverage. And yet there is no escaping the fact that those countless hours at practice, in the locker room, and on the field are in large part responsible for who I am, the adult I’ve become.

It’s a powerful thing, football. The game itself is exhilarating to both play and watch. At least, it was. I find myself finding all kinds of reasons not to watch football games now. Not consciously finding “big picture” reasons so much as tiny reasons, like Beth wants me to tag along to the barn, or Abbie the world’s smartest (and most easily bored) dog would like an adventure kind of reasons. Football of all sorts played at any and all levels has sunken to a kind of triviality, easily trumped by a trip to the grocery store. Indeed, my fall weekends have been liberated.

No one thing is responsible for this falling out of love, as it were. This fall is different from the last, and the one before only in that it is now glaringly obvious that football holds for me no essential attraction by itself. Looking back my only surprise is that it took me so long. Why didn’t I begin to turn away as my friend the ER doc buzzed through my other son Dan’s shoulder pads with a saw in order to get him into the MRI? Or when I walked onto the field after Randy knocked himself out cold with a helmet-to helmet tackle to force a fourth down, his first concussion? I was still young, still sure that the game would bring my sons what I thought it had brought me.

I see them now, both of my boys, face down and immobile, and I shudder. I started to see them each time I saw a player go down in high school, or college, or the pros. I began to see that I valued those young men nearly as much as my own boys, and I started to notice that the game of football had become The Game. Those entrusted with The Game did not–do not–appear to share my feelings about the players. Any of them, at any level.

The junior high coach carries the star running back to the bench, there to wrap the sprained ankle in the hope of returning him to the game. In a high school freshman game, a rout, the first string defense is still on the field in the fourth quarter, the opportunity to play in a game slipping away for kids on the bench who may never get another chance, when the starting safety goes down with a severed spine on a play he should have been watching from the sideline. They were up by six touchdowns. SIX! They’re freshmen. What was the first string learning at that point in that game?

Alumni and athletic directors and coaches at colleges noted for academic excellence openly opine that they cannot win without lowering the admission standards for football players, and just as openly run those kids off the team and out of their scholarships when they are no longer needed to win. The game in the NFL becomes ever more violent, with ever more gratuitous violence magnifying the carnage wreaked upon the bodies of the players. Ex-pros roam the earth as a kind of walking dead.

When did football become The Game? When did the keepers of the game become keepers of The Game? When did football players as young as high school become little more than a modern stand-in for gladiators thrown into the arena for no more than the amusement of the many and the benefit of a tiny protected few? I’d like to think that there was such a time, an inflection point, when it did change, but I fear it has been ever thus. If that is so then I, too, bear some responsibility for what The Game has become. I did not turn away, or turn my own sons away, at the time of my own dawning awareness that The Game and its keepers cared naught for our sons at all, but only for themselves and their respective place and privilege.

There was a time when my playing days were long over when I still found myself on edge as the weather chilled and the smell of cut grass filled the autumn air. It was time to get ready to play football. Those days are long past, and I find that I no longer even think about watching, indeed can no longer see myself watching, except as a vehicle with which I might channel the joy of a child. And this is perhaps why: I can no longer watch a game whose keepers have lost sight of the fact that someone’s child plays in The Game. I am a man who consciously strives to live a life free of regret, but I regret that I lacked the courage to say “enough” when my own children played.

One wonders about the parents of gladiators past.

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