I see a common theme of patients, one that is very hard to diagnose, yet is very common.  It is one of chronic fatigue.  Patients complain about losing their energy…they just don’t feel well..their get up and go, got up and left.  There are a host of tests that are ordered to rule out things like anemia and a low functioning thyroid, but a majority of the tests are returned as normal.  Though I explain that these tests are ok, it is usually met with disappointment in that they are hoping for something easily fixable.  

   When our diagnostic tests are returned as normal, looking into the habits and activity of a person is very revealing.  Though the patient is complaining about being tired, they also usualy don’t sleep well.  This leads to daytime sleepiness and napping which in turn steals from their nighttime sleeping ability.  

    I speculate that some of these patients aren’t really awake in the day.  When you just “smolder” though the day, you haven’t exerted enough energy to make you truly tired at bedtime and therefore don’t sleep well.  The downward cycle begins and unfortunately it is self perpetuating.

    I think this way because I have also dealt with patients who initially suffer with this type of fatigue, then create action to treat the problem.  The treatment isn’t in the form of a pill, rather it’s a change in their lifestyle.  Getting on an exercise plan that is intense (IE really wakes you up) will create a level of tiredness at night.  Have you ever been so active in the day that the bed just feels wonderful and you sleep like a log through the night?  I see this in my children that are full speed ahead all day long with boundless energy…until it’s time to crash…they sleep well, wake up well rested and are ready for the next day.

    Really living (while you are awake) allows you to really rest at night.  Our bodies were designed to move!  When we aren’t active our bodies literally slow down, leaving us fatigued, however when push ourselves with activity and exercise it becomes evident that our previously understood limits are also pushed and a new space of possibilities arises with an increased energy.

The following is an interpretation about how heart disease is not only the number
one killer in the US, but it is also growing. I speculate that only after a clear
understanding of this disease, its growing prevalence, and our current limitations
for progress, can we make any meaningful change.

Every 26 seconds someone in the US has a major cardiac event.

Think about that, at least two people in America, every minute are dealing with a
heart attack. Though our healthcare system is getting better at keeping people
alive after these events, I still see people suffer once they have had a heart related
event. For example, we have new and more innovative ways to treat a heart
attack, but at the end of the day, a “successful outcome” is usually accompanied
by the patient suffering from the effects of a weaker heart. These symptoms
include fatigue, shortness of breath, chest pressure and pain with activity and a
resulting depression that occurs while trying to deal with a new set of physical
limitations. I have had patients tell me that they would have rather died than live
with not being able to enjoy playing with their grandchildren or be too weak to
take a walk with their spouse.

One of the scariest aspects of this disease is that in more than half of all cases
the first sign of a problem is a significant heart attack or sudden death. This is
truly the silent killer and waiting until you feel bad to do something about it is too
late. Once you have the symptoms of heart disease, your capacity to prevent the
disease is over, but there are steps you can take now to significantly reduce the
likelihood of dealing with this disease.

If heart disease is a relatively new problem, how did it begin?…

Cardiovascular disease began to appear in men and women in the early 1900s.
The cause is not a virus or bacteria but a change in lifestyle that began to creep
into American culture following the Great Depression.

After the Great Depression and into the mid-twentieth century, we as a society
made many advancements in technology, including the introduction of the
automobile, lawnmower, washing machine and television. The impact on
American lifestyle was that we literally engineered exercise out of our lives. We
started relying on machines for convenience, rather than using our bodies. Those
who used to walk, drove. Those who used to visit with neighbors, sat back to relax
in front of the TV. Our culture in the last several decades has invented the “couch
potato.”

In addition, our diets changed. The people who survived the Great Depression and
the war sought foods that had previously been scarce—foods that were richer,
fatter and that ultimately had more cholesterol.

To top it off, smoking increased. Fifty years ago, no one knew that smoking was
bad for your health. In fact, the government issued cigarettes to every soldier in
the hopes that they would benefit from its “calming” effect. At one time the
government reported close to a 100 percent smoking rate in the armed services.
Our reliance to our modern conveniences has allowed us to move through life
without exerting ourselves. The invention of the computer and internet has
allowed us to shop, pay bills, work and be entertained without even needing to
stand up. Travel is so efficient that we are able to fly across the country in less
than a day all while never leaving our seat. Though we all enjoy these
conveniences, we are hurting ourselves when we don’t take the time to do what
our body is designed for in the first place.

1. Consume water and a variety of foods
2. We are designed to move

When we don’t move and exercise our bodies, it is similar to having a race car in
our garage and never driving it. How long can it go without the battery going
dead, or the engine becoming corroded?

Why past prevention strategies have failed

About 40 years ago, researchers began to detect the rise of the new “disease” in
America and established the causes of cardiovascular disease, including
elements of the American diet, a sedentary lifestyle and smoking.

However, given we’ve known about the problem and its cause for 40 years, why is cardiovascular disease still killing half of all Americans?

The culture in which we live in is not conducive for preventing problems in health.
As a doctor I see patients wanting the “quick fix” to their health breakdown. Our
culture has us expecting instant gratification, from minute rice to fast food, to an
endless hope that the next diet pill will work automatically to reverse years of
poor eating habits and magically and quickly reduce our weight. Because of this,I think that most people move through life in a mood of resignation concerningtheir capacity to make meaningful changes in their health and are blind to theirown power when it comes to avoiding heart attacks or strokes. We are living in aculture in which we want someone or something to act upon us and fix ourproblems rather than taking responsibility and becoming actors in our own life to move towards the future we desire.

We as physicians are also limited when it comes to prevention…we mean well and
want to help but we aren’t set up to be as effective as we could be in the area of
helping you avoid your future health problems. Most of the clinics and hospitals
are structured to react to your already existing breakdowns. Sure, we speak of
prevention, but we are usually referring to “preventative tests” like colonoscopies,
mammograms, breast exams and bony density tests. Though these tests have
tremendous value in that they detect already existing problems earlier on a
timeline when therapy is most beneficial, they don’t prevent anything. A new and
more powerful interpretation of prevention is one, that through lifestyle and
dietary tactics that are grounded in science, we are able to help you open
possibilities for avoiding major health problems rather than trying to detect it
once it has arrived.

Besides getting off track with the fundamental definition of prevention I also
haven’t seen a holistic plan that involves a group of expert individuals to help with
this important task. You need a team! Humans are insufficient alone and without
help, support, and a multi disciplinary team your chances of success are slim.
Dr. Edward Miller, the dean of medical school and the CEO of the hospital at
Johns Hopkins University recently pointed out that of the many people who have
undergone bypass surgery, an extensive procedure that requires patients to
change their lifestyle or literally face death, only 10% are found to have changed
their lifestyle after two years following surgery!

What’s most important, however, isn’t why treatment haven’t worked, but how we
can work to prevent cardiovascular disease.

Having an understanding of what you’re up against is fundamental. Realizing
that your lifestyle today plays a major role in what happens to you in the future is
critical but just as important is an understanding that the environment that we
live in doesn’t have your best health interests at heart.

Think about this, we are born into an existing set of practices inherited from our
culture. We do what we do, speak the language that we speak, and act certain
ways that are “appropriate” based on our community’s established practices. For
example in the US it is required that we drive our cars on the right side of the
road, not because we decided that it is the best way to act, but because we
inherited this tradition from our history, just as people in England learned to drive
on the left side of the road. The advantages of being in a culture or tradition
helps us be more powerful and efficient to a point as we don’t have spend the
time to invent new practices, but blindly accepting certain practices can be
dangerous.

In the domain of diet and nutrition, most of our parents, aunts, uncles, and
grandparents didn’t understand how their diet and lifestyle led to problems with
their heart. Scientific advancements now allows us to understand that the
lifestyle and eating habits that we have accepted as the norm in society actually
increase the threat of heart disease, even though our intuition leads us to believe
that these comfortable habits are “right.”

The Herd Mentality

Someone told me a long time ago, “When you follow the herd, make sure it is
traveling in a direction that you want to go!” Unfortunately, the overwhelming
majority of our society is traveling through life in a way that has been statistically
shown to lead to a shorter life as well as an increased rate of suffering while
living. We are pacified by an incorrect notion that since everyone is acting a
certain way then it must not be bad. A closer and more grounded observation
demonstrates that Heart disease is the number one killer and growing, taking
more lives than the next five causes of death combined, and is linked to our
outdated understanding of what it is to live a healthy life.

Meaningful change

A change for the better is possible, but its not as easy as our culture would have
us believe. There are numerous articles and studies that prove that we have the
capacity to improve our outcomes with our health. Most of these studies are
unpopular as they require action by you to achieve the intended result. The more
popular claims are made on TV about the next “weight loss program” that makes
living healthy easy, however they usually return a similar result of failure and
frustration. The truth is that there aren’t any quick fix or tips to achieve the
results, rather it is dependent on our willingness to accept that our body is a
liability and work with new thinking, habits and practices to better take care of
ourselves. That may sound trivial but it has been shown to be very difficult in that
we find comfort in having a habit or routine. Change is possible and starts with
the realization and acceptance of the negative situation that will most likely
happen if no change occurs.

The purpose of this paper is not just to allow you to have a clearer picture of the
health dangers ahead but to give you the information to be an actor in your life
rather than having heart disease act upon you. In the upcoming articles, we will
discuss how to develop an ambition as it pertains to your health. The practice of
having an ambition is powerful as it helps you clearly define why doing something
different is important in the first place. Having a goal of living a longer life
sounds like obvious to most people but in my experience it is not enough to
produce a lasting change. In the next article, we will discuss the specifics of
developing an ambition, through the realization of how your health affects all the
other areas of your life including your capacity to take care of challenges in your
work, family, recreation, and finances.