By Stephen T. Sinatra, M.D., F.A.C.C., F.A.C.N., C.N.S., C.B.T.
No matter how old you are, learn from this handful of “don’ts,” and put more quality in your life and increase your longevity potential with some “dos.”
Despite all the best intentions and efforts on behalf of patients, one common challenge for all health professions is non-compliance. That means a patient who does not follow through for one reason or another on the recommendations of his/her health professional. Such “delinquency,” as I regard it, is widespread and includes not taking the prescribed amount of medication or adhering to advice on diet, exercise, or other lifestyle changes.
According to a 2008 study, estimated compliance rates run as high as 70-80 percent for short-term medication but drops down to 40-50 percent for the long haul. Lifestyle changes are generally recommended for the long haul and they – no surprise – are followed by only 20-30 percent of patients.
During my decades in medical practice, I encountered non-compliance on a regular basis among misguided, procrastinating patients who had a hard time accepting advice and the need to change. Sometimes they were nagged or dragged to my office by a concerned spouse. Stuck in lifestyle ruts or clinging to misinformation typically making them sick, they would distort, ignore, or minimize my recommendations and “inconvenient truths.”
Such behavior can be very detrimental for patients, and even deadly, particularly for a cardiology patient. That’s why I spent considerable time trying to re-orient non-compliant individuals back onto a healing path when they went off the tracks.
In this article I would like to share ten common patient errors, missteps, and misconceptions that I saw in my practice.
1. Not kicking the habit
Believe it or not, I heard patients reluctantly admit – when I grilled them – that they were still smoking even after a heart attack. I would get all kinds of excuses, like “it relaxes me,” “takes the edge off,” or “takes away my appetite so I eat less and lose weight.”
Excuses all of them, but deadly excuses. The facts, according to the U.S. Centers for Disease Control and Prevention, are these: smoking harms nearly every organ of the body, causes about one in five deaths in the U.S. every year, and is the No. 1 preventable cause of death. Quitting smoking can add years to your life.
I also had male patients tell me they enjoyed smoking cigars but didn’t inhale, as if that were some kind of healthy alternative. Pleasurable mouthfuls of smoke mean that toxic chemicals, pesticides, and insecticides are being absorbed into the bloodstream.
2. Not losing those 10 – 20 extra pounds
Many patients have the illusion that they don’t have to lose weight or that if they do, they have to lose a lot. I frequently saw patients 10-20 pounds heavier than they should have been and who did not think of themselves as overweight. I had great results encouraging them to trim a few extra pounds, like even 10 pounds.
Losing a little can indeed mean a lot. For one thing you reduce abdominal fat, a major source of potentially-damaging inflammatory chemicals, and you bring down high blood pressure numbers. It doesn’t take major – and challenging – weight reductions to do that.
3. Sedentary living
Getting patients to exercise is every doctor’s challenge. Patients have personally told me they hate the idea of going to the gym, lifting weights, and walking on a treadmill.
The mental boo-boo here is that you don’t have to sweat buckets or go to the gym. You just have to be physically active regularly, even if it is just a little!
I always reframe the idea in terms of activity to incorporate into one’s lifestyle, such as walking the dog, walking and talking with friends, gardening, or going ballroom dancing.
“But that’s not exercise, doc,” patients would tell me. Oh, yes it is, and it’s good for your heart and the rest of the body.
Many sedentary elderly patients came to me over the years asking about a prescription for constipation. I told them about a natural “prescription” for constipation that included drinking more water, eating more fiber, and going out for a bit of daily walking. The more you move your body the more you can move your bowels.
So start moving yourself. Even taking a few five-minute walk breaks during the day is a great way to launch yourself out of the sitting position and a sedentary lifestyle. Here’s a great book for moving yourself.
4. Eating whatever you want as long as you’re taking your vitamins
Many people regard their vitamin pills as a kind of “security blanket.” They think they can eat anything they desire as long as they take their supplements. A prime example of such misguided thinking was a middle-aged patient of mine, a professional man who came to see me just before going on a cruise.
“Hey doc,” he said, “now that I’m taking vitamins I guess it’s OK for me to eat anything I want, right?”
Absolutely not, I told him.
And, as I did for many others like him, I dispensed the following advice:
No, it’s not OK to wolf down sweets, fried food, and junk food willy-nilly and think you are protected just because you take vitamins. Yes, supplements are protective but they are not a license for wanton eating and certainly not a license for overeating. You can easily overwhelm their positive effect.
5. Substituting sugar for fat
Lurking behind the labels of those so-called healthy low-fat foods are often sugar, high-fructose corn syrup, and other unneeded sweeteners. Yes, you get less fat but instead you get more sweets, calories, and an insulin response. You don’t want that for sure.
A classic example is the organic fruit-flavored low-fat or no-fat yogurt. I always reminded patients to opt for the plain yogurt, and be sure to read labels.
Many patients on a low-fat diet told are puzzled by the fact that they still gain weight. They unwittingly replace sugar for fat, and the body responds by storing the excess calories as fat.
6. Cooking with the wrong oils
I’ve seen many patients set themselves up for potential problems by cooking with the wrong oils, namely canola, peanut,safflower, and sunflower. The problem is that these oils oxidize rapidly with heat and the resultant chemical changes are not healthy for you.
There are a lot of misconceptions here promoted by food manufacturers. One in particular relates to olive oil. For sure, extra virgin olive oil is heart-healthy, but not particularly for use in cooking. It will break down more easily, so save it for drizzling onto vegetables and salads. Use a light version olive oil for cooking at low temperatures for shorter periods of time, such as sautéing.
For cooking in general I recommend coconut oil, a saturated fat least vulnerable to oxidative deterioration from heat.
7. Buying into the saturated fat myth
Patients often proudly told me that they avoided saturated fats like the plague, meaning foods like meat, eggs, nuts, and butter. Their fear: these fats turn into cholesterol in the body. I told them what I’m telling you now (and wrote about in my book, The Great Cholesterol Myth): the cholesterol theory is humbug and there is absolutely nothing wrong with eating saturated fats in moderation.
Here’s more information about saturated fats and a 2014 scientific review pointing out that there is no convincing evidence to encourage avoidance or low consumption of saturated fats for the sake of cardiovascular health.
Like everything else, you want balance in your diet. You don’t want to be eating hot dogs and hamburgers all the time.
Eggs have taken a big hit because of the cholesterol fear. That’s a shame. Whole eggs are perfect protein and can be eaten frequently.
Besides the added protein factor that saturated fats provide, they also reduce the insulin response from carbohydrates.
8. Overeating meat in the name of the blood type diet
Type O is the most common type of blood, and, according to the popular blood type diet, the best suited for meat-eating. However, I have seen this advice taken to extremes, such as patients eating two, sometimes three, portions of meat a day. That’s too much. As I just mentioned, meat is OK as one part of a balanced diet.
Meat doesn’t have gut-cleansing fiber. I sometimes reminded my ultra-carnivorous patients about a Japanese researcher-gastroenterologist who had conducted some 300,000 colonoscopies during his career and found that cancer of the bowels was directly related to overeating meat. Without fiber, meat remains in the gut too long. And it putrefies there. Moreover, if meat isn’t organic, you likely have insecticides and pesticides and hormones being absorbed as well.
9. Drinking up for heart health
Scientific research shows that wine contains all sorts of healthy compounds and here, too, I have seen many patients go overboard.
I’ve had patients tell me they were drinking two or three glasses, or even a bottle of wine a day, thinking they were helping their heart. That’s too much on a regular basis, and increases the risk of cirrhosis. The French are big wine drinkers but they have the highest incidence of cirrhosis in the world. So again, moderation is the name of the game. Keep it to a glass, three or four times a week.
10. Taking an aspirin-a-day to keep heart attacks away
That’s the refrain I heard from many new patients, even healthy ones coming to see me about anti-aging and prevention. That’s what their doctors were telling them.
Here’s my opinion on aspirin: if you have coronary artery disease, an aspirin may be worth considering to keep the blood thin. But that’s it!
I’ve seen many new patients taking aspirin for primary prevention who had symptoms of aspirin side effects, including overt bruising and gastrointestinal bleeding. I got them off of the habit in a hurry.
For more information about using aspirin, check out my Should You Take an Aspirin-a-Day? Myth-or-Fact video.
There are many natural blood thinners, like omega-3 fatty acids and nattokinase, that should be used first. Unlike aspirin, they don’t carry a risk for bleeding.
There is also Earthing (grounding), which not only can have a blood thinning effect, but can also promote better sleep and help reduce inflammation and pain.
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