Thomas B. Repas
A 42-year-old physician who is a lipid specialist had never previously had problems with dyslipidemia himself. He has followed the advice he gives to his own patients. He eats a diet low in saturated fat and high in fruits, vegetables and whole grains. He engages in regular intense physical activity.
For several months, however, he had taken a break from vigorous exercise. Instead, he only had time to participate in less intense activities. The physician-patient then traveled to Texas to attend a medical conference the weekend before his annual physical with his primary care provider. While there, he enjoyed sampling large quantities of local deep pit barbeque.
Normally, he does not eat many high-fat foods. He thought to himself, “I only eat barbeque once or twice a year. The rest of the year I eat very healthy. What’ll be the harm?”
The week of his return, routine labs were drawn. His lipid profile was as follows:
- Total cholesterol: 243 mg/dL
- Triglycerides: 293 mg/dL
- HDL cholesterol: 36 mg/dL
- LDL cholesterol (direct): 148 mg/dL
His primary care provider called to inform him of the results, “It feels strange to tell a lipid specialist how bad his lipids are.”
Rather than starting medication, the physician-patient decided to return to his routine of regular intense exercise. He continued his diet, which is typically high in plant-based foods and low in saturated fat. Coincidentally, the weekend before follow up labs were to be drawn, he returned to Texas for another trip. This time he avoided eating barbeque.
His follow up lipid profile was:
- Total cholesterol: 176 mg/dL
- Triglycerides: 107 mg/dL
- HDL cholesterol: 42 mg/dL
- LDL cholesterol (direct): 106 mg/dL
His primary care provider was amazed by the change. “What did you do?” he asked.
“I started exercising again,” the physician-patient replied. “Oh, and I made sure to not gorge myself on barbeque before my labs were drawn.”
Dietary and therapeutic lifestyle modification is effective. Of that there is no doubt.
Unfortunately, diet and lifestyle change can also work in reverse, when the change that is made is an unhealthy one. Medications are not effective unless they are taken regularly, just as diet and lifestyle modification will not work unless it is continued long term.
Everyone may lapse and have an occasional moment of dietary indiscretion. What would life be like if we never enjoyed epicurean pleasures? What should only be a rare exception, however, must never become the rule.
A confession: the physician-patient described in this post is me.
Every physician is human, just like our patients. Even though we have the knowledge of what to do, it does not mean that we are always perfect in adhering to it. When our patients fail to succeed in following the diet and lifestyle changes we advise: remember, our patients have as much difficulty in making and continuing these changes over the long term as we do.
- Thomas B. Repas, DO, FACP, FACE, CDE, is an endocrinologist, lipidologist and physician nutrition specialist in clinical practice at the Regional Medical Clinic Endocrinology and Diabetes Education Center in Rapid City, SD. Dr. Repas is the former chairman of the professional diabetes advisory committees of the Wyoming and the Wisconsin Diabetes Prevention and Control Programs. He is board certified in the areas of endocrinology, diabetes and metabolism, clinical lipidology, internal medicine and nutrition, and is also a certified diabetes educator. Dr. Repas is also a blogger at Healio.com/Endocrinology.