Random Thoughts from a Restless Mind

Dr. Darrell White's Personal Blog

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Posts Tagged ‘musings’

DNA Always Wins

DNA always wins.

In the fitness world, and sometimes even at that tiny intersection where fitness and health or healthcare cross paths, there is a recurring theme: you can’t out-train a bad diet. For whatever it’s worth, I think that’s true. Having said so there is a dangling little assumption that hangs off the back end of our axiom, that if you are fit and follow an evidence-based nutrition program that you will inevitably be healthy. Indeed, every worthwhile fitness program I’ve ever encountered pretty much says just that. “Fitness in 100 Words” on CrossFit.com was my first exposure to this as a mission statement. Loads of folks from the substantive (The Brand X Method) to the frivolous (The Biggest Loser) support this logic as the foundation of health-based fitness. For the most part it is true, and for most people the combination of general physical fitness and solid nutritional strategy results in health.

Except, you know, the whole Jim Fixx thing.

For all of you puppies and kittens out there Jim Fixx was the original running guru in the United States, the author of The Joy Of Running. You could make a case that only the late, great Jack Lalanne was a more influential historical figure when it comes to promoting health through exercise in the U.S. Jim Fixx was responsible for the surge in interest in running as both exercise and as sport, and his writing launched an era in which U.S. runners were competitive on the international stage in ALL distances from the mile all the way to the marathon.

As it turns out Jim Fixx may also be the single most influential non-medical individual in the history of the cholesterol theory of heart disease. You see, Fixx had hereditary hyperlipidemia. Despite his epic running history he was found one day in his running shorts at the side of the road, dead from a massive heart attack. Blood work at the time of his autopsy revealed a cholesterol of 750 or something like that, as well as other elevated serum lipids. His healthy diet, his outsized VO2 Max, and his prodigious training schedule were no match for his DNA. He died with epic fitness numbers, a single-digit bodyweight fat %, and coronary arteries that were so clogged red blood cells had to pass single-file. You can trace many of the USDA dietary guidelines and literally billions of dollars in research to the death of Jim Fixx.

Why bring up Jim Fixx now, in 2018, when we know that hyperlipidemia is a significant part of the cardiac risk story, albeit not the whole story? Well, we should harken back to the beginning of my thoughts: DNA always wins. While you can reduce your health risks by adopting a healthy, evidence-based diet and couple that with an exercise program that produces a comprehensive degree of fitness, you cannot escape genetics. Why at this particular moment? Yours truly just got all of his lab work back and despite 13+ years of a clean Zone diet and varying degrees of devotion to functional fitness, most of my serum lipid numbers have continued on their ever-upward march and have now reached a level where they simply must be addressed by modern medicine.

To do else wise would be madness.

I must confess that this is deeply disappointing. Quite frankly it feels like failure. At 58 I am relatively lean and strong, albeit a bit under-trained in the aerobic domain. Why didn’t this inoculate me from the need to take medication to lower my LDL? In the last couple of days I have chatted with my docs locally (both of whom are close friends who care about me) as well as really significant, nationally recognized experts in the science of health and cardiac risk mitigation. There is a consensus; nay, the voting was unanimous across the board. Don’t be stupid. Continue my program of fitness and nutrition and take the meds. We’ve now moved on the the minutia of choosing which one, a not-trivial discussion to be sure, but one that is less than earth-moving, you know?

Some years ago while proposing a unified theory of health on my personal blog I received an advance copy of Coach Greg Glassman’s definition: if fitness is WCABTMD then health is Fitness Over Time. As a physician and scientist I readily saw the value of this concept. However, I also saw and pointed out the deficiencies inherent in such a narrow definition. For example, any definition of health must explicitly address mental health. Over the years I have championed the term “well-being” and have suggested several metrics that can be used to measure this state of mental and emotional health. Mind you, I was openly mocked at the time for this, here and elsewhere. If you have followed the conversation in the CrossFit world since you will see an evolution of thought along this line, though. “Well-being” has been openly discussed in various ways as an integral part of health in most medical, health, and fitness communities. I like to think I played a small role in that.

I wrote before, then, and subsequently over the years that any definition of health must be more than a snapshot of how “healthy” you may be at any given moment. You may have a 2.5X body weight deadlift and squat, run a sub 5:00 mile and do “Fran” in under 3:00, but can you truly be declared “healthy” if you also harbor a malignant tumor in your gut or are running around with an LDL of 175? Like it or not, any comprehensive definition of health must be able to provide some degree of probability that you will remain healthy in the future. It must have some predictive value. Traditional health metrics–blood pressure, lipid levels, family history, etc.–added to a measurement of fitness and well-being do just that.

In practice such a value has proven elusive for a number of reasons, none the leasts of which is the difficulty in designing a truly measurable variable for fitness that would be accessible to the masses. Once such a measure exists the rest is just math, right? It will be necessary to determine the relative value of our three variables–fitness, well-being, and risk predictors–and then plug them into a formula to kick out something that we might call “True Health”. While this is still “pie-in-the-sky” stuff I am convinced that it is only a matter of time before it is a reality. To do my part I have tried to enlist new “partners” like my brother-in-law Pete, the cardiology savant, and others.

But for now there are lessons to be learned from Jim Fixx, and yes, once again there is a teachable moment in my little epiphany and “Sunday musings” this week. You can’t out-train a poor diet. A healthy diet of any type combined with a program of functional fitness meant to produce general physical preparedness that includes both strength and metabolic conditioning is the optimal strategy. Even here, though, you cannot escape genetics. DNA always wins. Good, bad, or in between, your DNA talks to you in the language of traditional health risk metrics.

Your DNA doesn’t care how fast you can run a mile or how much you can bench. I start my new meds tomorrow.

 

Where Do You Live and Why? From Sunday musings 6/24/18

Why do you live where you live? Do you ever give any thought to that? We have, over the years, for sure. Beth and I are in Cleveburg because of a good job opportunity many years ago. When that changed we stayed because our kids were in school and reasonably wished to finish where they started. Where once we gave serious thought to leaving once the chicks fledged, the return of our sons followed by the arrival of our grandchildren put all such talk to rest. Casa Blanco is home for now.

How about you? Both of our boys have extended family in the area on both sides of their marriages. We hope that anchors them a bit, but our own experience teaches that golden opportunities must sometimes be grasped. Lovely Daughter and The Prince describe their own “golden handcuffs”, a combination of terrific jobs, great home and wonderful friends. They seem ever on the lookout for a similar vibe in a terroir more in tune with their inner muse, but those golden handcuffs are also lined with fur. Their home is likely to remain on our frequent flyer speed dial, and ours on their’s.

One of my closest professional friends finds himself at a crossroad. He is in a particularly stressful job situation with what he feels is an ever darker future ahead. While extended family lives nearby his children are just beginning their journeys, destinations unknown. What to do? Where to go? More importantly, why to go to any particular “there”? My bid to him echoes the wise and kind words of my friend Hari: after half-time the rest of your life is about taking all of those things you prepared in the first half and putting them into play for yourself (and if applicable your spouse). The second half is now about you.

It should be all about ending up in a place where it’s just a joy to live.

Like the surfer who does whatever it takes to eke out a living on Maui. Same thing for the boarder who works 2 or 3 jobs so that he is right there when the next epic dump lands on the mountain. Your bag is threadbare and your grips like racing slicks, but you are a 2 minute drive from a golf course that makes you smile just thinking about playing it. An on and on. At some point you break free of your golden handcuffs and you are no longer just in the place where you make a living, but the place where you are alive.

Think about it. Why do you live where you live? Whatever the answer, what can you do to make that place somewhere where you feel alive?

 

Thoughts About Kate Spade and Anthony Bourdain at 28,000 Feet

As is often the case when flying I was rewarded for offering a greeting to my row mate on the plane with a bit of insight and knowledge I’d have missed had I not simply reached out a hand and said “Hi, I’m Darrell.” My momentary companion (we each moved to more spacious seats) had been a schoolmate of the recently deceased Kate Spade. He confirmed her years-long struggle with a depression that defied logic and was thus a depression that was as pathological as diabetes or heart disease or cancer. Opening my Sunday papers brings stories from the friends of Anthony Bourdain, also deceased, and his decades long struggles with the same demon disease.

Like so many others, both Mrs. Spade and Mr. Bourdain were killed by illness, cause of death: suicide.

First, a couple of statistics. Suicide is presently the 10th most frequent cause of death in the U.S. currently responsible for taking roughly 45,000 lives each year. I am a physician. Doctors die from suicide at a rate 0f 40 per 100,000, the highest rate of any profession and twice the rate of Americans in general. Suicide is the second leading cause of death among teenagers (behind accidents), having surpassed homicide for the first time in 2017. [As an aside, the U.S. loses more young lives from all causes than any other developed country. This drag on life-expectancy should always be considered when you compare the health outcomes of various countries] A very large percentage of these deaths occur in those who suffer from some kind of mental illness, of which depression is far and away the most common.

It is time for us in America to reframe our conversation about suicide for the good of those who are at risk as well as those who have lost a loved one for whom the cause of death was suicide. Let us start, as we should in all serious discussions, with the language we use. For decades at least we have used the phrase “committed suicide” when describing such deaths. It is well past time for us to retire this phrase, at least for people like Kate Spade and Anthony Bourdain. To commit is to perform a willful act while under the full control of all of your faculties. Commitment implies the performance of an action that is the culmination of rational thought. Outside of war, the act of taking a life after rational thought is the purview of the psychopath; it bespeaks the presence of evil.

People like Spade and Bourdain who are killed by suicide are not evil.

We will all come upon well-meaning entreaties from those around us offering help should one be considering suicide. We will see headlines and the like proclaiming that “Suicide can be prevented”. Can it? Can suicide be prevented by addressing suicide and the thought of suicide itself? By and large suicide is an effect, not a cause. Some suicides do, indeed, follow the rapid appearance of dismay and despair, and these may very well respond to the well-meaning aid of those who offer a phone number, an ear, or a ride to a doctor or therapist. For some, especially the young, suicide is an impulsive reaction to an overwhelming emotion. For those left behind these are the hardest for we all surely ask “what if”, and we all as surely respond “if only.”

There is suicide that kills as the consequence of illness too long in development, even with the best of care possible. Depression, Bi-polar Disease, Schizophrenia and their ilk sometimes prove untreatable in the exact same manner as cancer or heart disease. Suicide is the cause of death in the same way that liver failure might take someone with widespread cancer that began in another organ; the ultimate cause was neither the failed liver nor the suicide but the underlying disease. It is so very, very important for the family and friends and acquaintances of those who ultimately pass by suicide to understand and accept this, especially if their loved one was being actively treated. Here, in these circumstances, we the living must guard against “what if” and “if only” as if our own lives depended on it.

Because they do.

I have known you all, you who have lost and who are still here to remember. I am one of you. Friends and acquaintances, friends and family members of acquaintances–I, too, have losses. “What if” and “If only” haunt us all. For us, as it so often is, the solution lies in love and kindness extended not only to those who are suffering, but to those we have lost and most especially to ourselves. No one who loved us as we loved them would have chosen to hurt us in life; how they ultimately died was not a choice to hurt us in the passing. We will surely hurt but we must not allow ourselves to feel that we have been hurt on purpose. More so, in time we must forgive ourselves for that which we could not change as surely as we could not have saved the parent or the sibling or the friend who died from cancer. We must forgive ourselves, be kind and loving to ourselves and all of the others who share our loss, for the alternative for us is despair and dismay.

We can begin this cycle of kindness and love by choosing a different way to discuss suicide and calling it what it is: the cause of death. Do reach out to those you know who have been buried by despair and are drowning in dismay, for they might be saved. Fight for the right to do so. Do champion the recognition that mental health diseases that have no outward signs such as true depression are as real as an open fracture at the scene of an accident; they should be treated as seriously and with the same sense of urgency. Fight for the right to have these diseases treated the same way. Doing so will save lives. Love those you love as much as they will let you for as long as they are alive for the loving, and let them do the same for you.

Peace and grace be upon those who have lost loved ones who were killed by suicide. Joy and love to all who have stood with toes across the precipice and stepped back, and to those who were there to embrace them when they did.

 

Sunday musings 6/3/18: 40th Reunion Thoughts

2018 is the year of my 40th high school reunions (we moved after my freshman year so I have two). It’s a nice time to return to one of my frequent themes, identity. Who are you when you are all alone, just you and the mirror? Who are you when you are in any particular group of people? Do you feel that there is more confluence between those versions of you than not? How much confluence do you think there is between who you think you are and who it is that those around you think you are? As this is my 40th year away from my classmates, have you evolved from who you thought you were and who your classmates thought you were over the years?

First a couple of disclaimers. One should not be all that too terribly concerned about the thoughts of others since this gives all too much power to individuals who may not have your best interests at heart. Sorry, but our world is altogether too filled with people who will opt to climb over your downtrodden psychological carcass if you allow them to do so. Also, there is no reason for you to ossify as an individual at any stage of your life. Indeed, if you haven’t evolved since high school you’re probably doing it wrong.

Over the years I admit that I have not made much of an effort to remain in contact with the vast majority of my classmates in either of my childhood towns. I could certainly lay the blame for that on my Dad who held that true friendships were rare and the effort to stay in touch with acquaintances too arduous for the ROI. The truth is more that I’ve always done the deepest dive possible into whatever ocean of opportunity I happened to be sailing on at any given moment; those oceans have always been rather distant from the shores of my youth. It was simply too hard and too time consuming to maintain a large number of close contacts behind as I was ever looking ahead. Looking back there is no way to know if this was the best strategy. Like my Dad, though, I have tried to be the best friend I could be to those who were with me at any given time.

Today Facebook has made it rather easy to re-forge ties, however delicate the fibers may be. These tiny, tenuous connections have me very curious about my childhood mates in both towns. Much to the surprise (and amusement) of my family I have found myself moving all kinds of the chess pieces of my life so that I might attend both reunions. Who will I meet when I do? With the exception of a very few people I still do chat with, so many years have passed that literally everyone I see will be someone I am pretty much meeting for the first time.

40 years is a lot of years of growth and change.

Who will my classmates be meeting when they see me for the first time in at least 30 years (I went to one school’s 10th)? Judging by a post on our Reunion FB page in which a classmate unearthed some commentary about our class from graduation day I will be largely unrecognizable. You see (and this gets back to who you think you are and who others see you as being) what I once thought of as self-assurance and confidence came across (to some people at least) as self-centeredness and arrogance. This is not really a revelation mind you, nor is the re-appearnace of this item from Graduation Day distressing. I’ve long held that I was an arrogant putz when I was a young man, although that may have been a part of whatever successes I may have accrued over the years; I pretty much always assumed I was gonna turn out OK.

What does bother me though, at least the me of the last 20 or so years, is the possibility (probability?) that my younger self may have run roughshod over people who didn’t deserve anything rough out of me at all. That does make me sad, frankly. You see, a large part of my own personal development, the ongoing changes to the person I try to see in the mirror (and project for any and all to see in me) is a foundation of kindness in all that I do and in all that I am. It’s hard–no, impossible– to be good at all times, and I’m not sure at all that you can be truly kind always and everywhere. But you can try, and it is in the trying that I have evolved over the years.

Who will my classmates remember as they think about our upcoming reunions? Will our memories of the children we were be so strong that we will be prevented from seeing the adults we have become? Regardless it’s been an interesting part of the journey to be reminded of who people thought I was so long ago and to peruse the pages of each intervening “Yearbook” as I’ve gone from cocky teenage jock to whatever it is I am today.

Wow. 40 years.

Optimization vs. Diminishing Returns

Some time ago I wrote about the Minimum Effective Dose (MED), the concept in which we seek to optimize our results with the smallest amount of whatever it is that we are using to achieve that outcome. The quest to find the MED is one that crosses quite easily between my day job (medical) and my own quest for health (CrossFit). A quick mention of Eva T in Outside magazine and the program she uses with her clients made me think a bit more on the MED. The Everyday Math column in the WSJ provided an enhanced vocabulary for the journey.

Sometimes the MED really is a “something” you take. Here one thinks of medicine or food, for example. More often is the case that we are looking at a dose of time or effort. Or perhaps both. In this case we are seeking to optimize the effort as it relates to the outcome, to make the value of outcome divided by effort as large as possible. The rate limiting factor here is the Law of Diminishing Returns, of course: at some point additional effort produces such a small incremental increase in the outcome that it becomes not worth making. This applies to everything from WODs/week (or day) to decorating a birthday cake. At a certain point you just have to feel you’ve succeeded.

How, then, to know when you have reached this optimal level? Eugenia Cheng, the mathematician who wrote the WSJ piece, offers the concept of the “minimal acceptable standard”. Once she has reached this outcome the additional effects garnered from more effort have moved beyond the point where Diminishing Returns kicks in and she simply accepts the outcome. We would call these “minimal standards” goals, but the concept is essentially the same. We want an outcome; setting a target or a goal is step one in optimization.

Cheng then goes on to refine optimization with a discussion about boundaries. One is your goal, of course. In real life others also exist, things like a 24 hour day and a 7 day week and the need to make a living. The dose you choose, both qualitatively (what it is) and quantitatively (how much you get) is unavoidably affected by boundary conditions over which you have less control.In the end no outcome worth getting happens without effort. Health, friendship, or the unraveling of a gnarly math problem–you’re going to put effort in to get your results out.

Maximizing your outcome-to-effort ratio is just another way to say you are seeking your Minimum Effective Dose, in CrossFit and elsewhere.

Offloading info/Work

Why do I write? Why do I sit down and use time that could otherwise be put to use in the gym, or in the office, or even just hanging with the Man Cub? As a long-standing lover of language I am always on the lookout for the best vocabulary to explain concepts I sometimes struggle with. Offloading is a term that is used in this case to describe what it is that humans do with information that they do not need to keep on hand in “useful memory” space.

This is what I do with ideas when my “wetware” memory is full.

This is hardly new. Indeed, the sturm und drang associated with the mega-trends in education, etc. associated with our massive information/recall apparatus that is the internet actually has its origin in the Greek era of Socrates and the transition from an oral tradition to one in which teachings were written. (HT to Frank Wilczek). Prominent adherents to the oral tradition such as Socrates and Simonides argued forcefully that the advent of the written transfer of information would weaken the mind and produce an inferior type of intelligence. In a fascinating and delicious ironic twist, all we know of either of these men we know because someone else wrote down what they recalled hearing.

In my day job we are still encased in a paradigm in which information is transferred from teacher to student and then tested to see if that information has been committed to memory. Imagine, with the explosion of data now available in the world of medicine we test (and test, and test…) both new doctors and established ones to see if they remember a certain percentage of facts, regardless of how often those facts come into play in the act of practicing medicine. The CrossFit analogy is to test a trainer on the precise moment that the obturator engages in the deadlift. One neither needs to know this to teach the deadlift, nor does one need to have memorized this in order to have it on hand in the gym. So, too, in medicine.

Please don’t get me wrong, I still enjoy knowing a bunch of stuff and being able to call up that stuff without needing to use my Google-Fu. The reality is that we have made a move from memory in written form to memory in digital form that is just as profound and disruptive as that from oral to written. We have only to remember where it is we have stored our memories, our books and our music and our musings.

And our passwords. We still need to remember our passwords.

On the Beach 2018

(Surely you knew this was coming) This weekend begins the Royal Hawaiian Eye Meeting, an annual gathering of eye surgeons that I have thus far managed to avoid attending every year of my career. Why, you ask? Meh. 6 time zones for 3 days of work is the best answer. If that doesn’t do it I’ll add that Mrs. bingo won’t join me for the trip, and I really dislike most travel without the company of Mrs. bingo.

As you may have heard there was a bit of excitement in Hawaii yesterday. Seems a rather fumble-fingered employee jabbed the “alert all” button when taking his turn at the helm of the Emergency Response Center and sent off a 1960′s style, death from the air is coming, curl up under your desk kids and kiss your ass goodbye nuclear attack warning. Funny (funnier?), the doof figured out what happened when he got a text on his own cellphone.

Note to Expedia: this guy needs his own “Wanna get away” commercial.

What was your reaction? Mrs. bingo is away visiting her ailing Mom so I was alone chez bingo to contemplate what I would have done (interestingly, I would have been alone in Hawaii as noted above for real). The good folks of Hawaii and their 10′s of thousands of weekend guests were handed the dubious privilege of contemplating, if for just 30 minutes or so, how they would spend the last couple of hours of their lives knowing that they were about to spend the last couple hours of their lives. Did this occur to you, too?

Yesterday also brought me a couple of articles in a similar vein. One, from the WSJ, was not quite so stark. It asked when you would take a pill that arrested the aging process. At what age would you decide that the balance of physical prowess and age-begotten wisdom was optimized? (N.B. this was going to be the main topic of “musings”…) I also stumbled across a review of a book or a movie or something in which 3 siblings are told as young children the precise date of their deaths. What followed was the decisions these young children made based on that knowledge. Gotta admit, I went right to that place when I heard about the Hawaiian modern air-raid siren.

T’was a time when this type of inquiry was a rather commonplace occurrence. You could do worse than reading Neville Shute’s novel or the Stanley Kramer movie “On the Beach” based on it to get a sense of what a nuclear fraught world felt like. Both the novel and the movie depict a world destroyed by nuclear war, and life in Australia as the end-of-life nuclear cloud approaches the continent. How and what normal people decide to do in the face of an unavoidable expiration date some weeks ahead is central to the story. Yesterday’s equivalent would have been some hours ahead it seems.

What would you have done? Would you have sought shelter, as suggested, and hoped to somehow miraculously escape incineration if you were at ground zero? (As an aside, can you even imagine the horror of taking part in the effort to get off the islands to escape the radiation? We’d learn what savages we actually are, I fear) Would you go all Sartre or Beckett and choose an earlier “departure” of your own making as did so many in “On the Beach”? If it were real, what do you think you would have done?

As it turns out this kind of hypothetical is not solely the enterprise of the nuclear age. In fact a Parisian newspaper asked essentially the same question of its readers in 1922, long before the dawn of the nuclear age. Marcel Proust, the famous philosopher, offered perhaps the most lovely response I’ve heard before or since. “I think life would suddenly seem wonderful to us if www were threatened to die as you say. Just think of how many projects, travels, love affairs, studies, it–our life–hides from us, made invisible by our laziness which, certain of a future, delays them incessantly. But let all this threaten to become impossible forever, how beautiful it would become again!”

I surely know not what came before, as surely as none of us truly knows what, if anything, comes in the end. Questions that arise from the (usually) hypothetical “what if you knew when” scenarios lack the urgency to force an honest appraisal. Again, Proust: without the cataclysm “we find ourselves back in the heart of normal life, where negligence deadens desire. And yet we shouldn’t have needed the cataclysm to love life today.” It will be interesting for me to have a chance to chat with folks I know who are in Hawaii right now (a couple are close friends), but for now it was enough for me to have undergone this thought experiment for the umpteenth time and come to the same conclusion: I would have sought my people. Some how, in some way, with my last dwindling moments I would do whatever it took to be with my people.

Greater personal meaning will come from Proust: I will seek my people every day, for it is with them where lies joy. It is for others to seek the greater societal and geopolitical meaning and impact of yesterday’s blunder.

 

As We Turn the Page on 2017

Chief Justice John Roberts gave a commencement speech to a group of 9th graders this year in which he wished them “bad luck”. Now, lest you think ill of the Chief Justice, that he was being churlish and mean-spirited, what he meant was that he wished that these young people would experience some degree of hardship in their youth so that they would develop tactics to persevere as adults when those same hardships inevitably arose.

“I hope you will be treated unfairly, to that you will come to know the value of justice. I hope that you will suffer betrayal, because that will teach you the importance of loyalty. I hope that you will be lonely from time to time so that you don’t take friends for granted. I wish you bad luck from time to time so that you will be conscious of the role of chance in life, and understand that your success is not completely deserved and that the failure of others is not completely deserved either.

And when you lose, as you will from time to time, I hope every now and then your opponent will gloat over your failure. It is a way for you to understand the importance of sportsmanship. I hope you’ll be ignored so that you know the importance of listening to others, and I hope you have just enough pain to learn compassion.”

My hope for each of you is encapsulated in Justice Roberts’ conclusion: I hope that you will have the ability to see the message in any of your misfortunes, and that you will express appreciation for the people who help you overcome them.

Let me leave 2017 with a final thought, inspired by Ben Reiter’s review of the movie “I, Tonya”.

“Each of us, “I, Tonya” suggests, is more than the worst thing we’ve ever done–or, in Tonya’s case, the worst thing she might have done.” In our present days of instantly available and infinitely scalable opinion, we should add that we are more than the worst thing that someone says we did.

Let us, each of us, resolve that in 2018 we will look first to that which is good about each other, and endeavor to see that each of us is more like the best thing we’ve ever done than not.

 

Evaluating and Treating Stress

Let’s talk about stress, shall we? It’s the Holiday Season in North America after all. Frankly, it’s been on my mind pretty much all day, every day, for a couple of years now. Probably because it appears to have taken up permanent residence in my body and soul for that same couple of years. Lots and lots of talk about stress around me, too. Everybody is talking about “having stress” in their lives, especially as the holidays roll around, so let’s talk.

First of all, as in all things it’s important that we lay some ground rules, establish some definitions so that we are sure to be talking about the same thing. Stress is what appears in your body in response to stressors; stressors are what you have in your life that produce stress, like serving dinner to family on Christmas Eve. I know, I know, it’s a pretty fine point, but bear with me because I think it will make a bit more sense in a moment.

In my day job I am constantly asked if various and sundry ailments are caused by stress. The most accurate and honest answer, from a strictly medical/scientific standpoint, is “yes”. What people are actually asking me, though, is: are the ailments that they have a direct result of the stressors in their lives? Again, perhaps a bit of a fine point, but it will matter. Everyone routinely conflates “stress” with “stressors”.

You can reduce the stress in your body; you may or may not be able to effectively reduce the stressors that cause it.

Think about that for a moment. You can do quite a few things that will reduce the ailments you may have because stress has been induced in your body. The simple science is that chronic stress throws your neuro-endocrine “fight or flight” response out of whack. Our bodies secrete cortisol when faced with acute stress. This is in turn associated with a release of adrenaline. Your pupils dilate, your BP and heart rate go up, and you shunt blood to skeletal muscle in preparation to do battle or to flee.

Chronic stress, on the other hand, causes an increase in both the basal cortisol secretion and a blunting of the normal daily secretion pattern of more in the AM and less in the PM. You have a flatter curve over the day, and the whole curve is elevated. In time you have a chronically elevated BP, and your state of chronic “readiness” begins to affect all manner of the rest of your systems. Stress then becomes a stressor itself, a repeating negative feedback loop. For example, your sleep pattern gets fried. Heck you may not sleep very much at all. That makes stress worse. That “lump in your throat” feeling when you are just pre-panic”? Yeah, that can be there all the time. It even has a name: globus.

Rather ominous word, that. Globus. Stresses me out just typing it.

Here’s the rub: if you could avoid stress—the adverse affect on your body—who wouldn’t do so? When people talk about trying to have less stress in their lives what they are actually saying is that they wish they had fewer and less powerful stressors causing that stress. Work issues, illness, family strife, money issues…life would just be better if we didn’t have them. Pretty simple. Get rid of stressors, get rid of stress. Sadly, our ability to excise stressors from our lives, or even insulate ourselves from them, is somewhere beyond inadequate and approaches impossible.

What to do then? If we cannot avoid the root causes of our stress, how can we relieve it? It turns out that both the magnitude and particular variety of stress can often be measured. Specific symptoms (sleep abnormalities, globus) will point toward equally specific interventions. There are laboratory tests that can be ordered given your particular stress (e.g. midline fat deposition); nutrition adjustments can be made in response (elevated cortisol reduces insulin sensitivity->consume carbohydrates during periods of lower daily cortisol levels).

For me the bottom line is this: we likely have little to no ability to control stressors, those exogenous factors that incite stress. Further, left to its own devices, our body will respond with stress. We can manage that stress by acknowledging it, evaluating it, and then proactively going about counteracting it. You are a Black Box experiment with an n=1.

Attack stress in exactly the way you attack fitness or nutrition. Weigh it, measure it, analyze it, and then attack it.

Sunday musings 12/17/17

Sunday mornings are quiet mornings at Casa Blanco. Re-rack after feeding the dogs, catch up with newspapers that have piled up in addition to the Sunday papers, a third cup of coffee just for the linger. Over the course of a week I collect thoughts and ideas for either musings or an eventual longer piece here, but as often as not it’s something that I read over coffee that turns up in my little Sunday piece. One fertile hunting ground is The Ethicist in the Sunday NYT Magazine, and it is here that I found my muse this week.

I have offered, here and elsewhere, that it is perfectly proper to make an enemy as long as you do it with forethought, and do it on purpose. In my long-held opinion to make an enemy by accident is the second greatest insult one can extend to another human being; it suggests that the newly formed enemy was not even significant enough to consider that they existed prior to your actions (or inactions). This leads, of course, to the single greatest insult that you could ever foment: to actively and purposely choose indifference to the existence of another.

This is a part of a topic addressed by The Ethicist on Sunday. He defines a “decent person” in part by whether or not they have what philosophers call appropriate “reactive attitudes”. In short how we react to others, and by extension how we react to what others in turn display toward us. The philosopher Peter F. Strawson mentions resentment, gratitude, and anger that we may have in response to how we perceive that others have treated us, or treated someone who we care about. Simply feeling these emotional reactions acknowledges that we feel the others are a part of our lives. They exist. They matter.

This time of year is fraught with the entire spectrum of emotions as we come into close contact with family and others with whom we have history. The simple fact that we come together means that we are not, cannot be, indifferent to either them or their feelings about us. Now to be sure there are some among us who have family members who are truly disturbed and either cannot or will not extend any type of goodwill or positive emotion whatsoever. Those, I believe, are rare exceptions, and to you who may be in this position you have my deepest, heartfelt sympathy. For the rest of us, though, in North America the Holiday season presents us an opportunity to re-boot our “reactive attitudes” toward family and friends.

Do you remember what it felt like to go home those first couple of years after you got out of high school? Remember how excited you were to see your folks, your grandparents, and your siblings? There was a buzz in your circle of friends as you conspired to sneak away and re-convene right where you left off the last time you were together. Remember? Trust me, the feeling was at least mutual (if not even stronger) on the part of your parents (and grandparents).

Families are complex and messy, but for all of that no matter what your particular story may be families are never indifferent. You could certainly take the position that we should always be connecting with family, and that the pressure of the Holidays would be lessened if we made more of an effort to be with those who trigger our “reactive attitudes” throughout the year. I’m OK with that. Actually, as a son, brother, in-law, father and grandfather I’d be thrilled with that. But here we are during Hanukkah, with Christmas a week away, so how much we see folks over the year is a topic for another Sunday.

Today, it’s time to go home.