The Courier-Journal (Louisville)
Why denying health issues can be deadly
When I teach my nutrition class during our intensive one-month spring term at Hanover College, I focus on the impact of the strong relationship between diet and health.
For example, excess saturated fat in the diet promotes increased cholesterol production in the body. In turn, this contributes to the clogging of the arteries known as atherosclerosis. Excess caloric intake, especially from fast foods and processed foods loaded with dietary fat and sugar, leads to increased pounds of body fat that can cause insulin resistance resulting in Type 2 diabetes. The list goes on.
On the first day, I assign a term project due the last day of class. The project requires each student to identify someone they care about who is at least middle-aged. This person is their “client” and it’s important that their client believes they are in good health, but all indications from what the student has learned in class suggest otherwise. This false sense that all is well arises because chronic diseases, like heart disease, can be very advanced without symptoms.
For example, a main coronary artery in the heart can be severely clogged without any overt indication of a problem. However, when clogging reaches a critical stage, like 80%, the amount of blood flowing through the artery may be insufficient to meet the needs of heart tissue causing angina pectoris (chest pain). This typically is the first symptom to appear in men, the first sign of trouble despite long-term damage.
The main issue is that life has been rolling along seemingly trouble-free, then from out of nowhere there is chest pain. Surely, it can’t be a heart problem because there has never been a heart problem before. It must be indigestion or a strained muscle.
If you were paying attention, warning signals have been flashing loud and clear for years, but they have been ignored. The warning signals are recognized risk factors for heart disease. An elevated cholesterol level or high blood pressure promotes heart disease and should be controlled as soon as possible. Additional risk factors include smoking, lack of exercise, obesity, extreme insulin resistance (Type 2 diabetes), and psychological stress. When you have risk factors, especially multiple risk factors, it’s very likely that heart disease is progressing. Unfortunately, like termites, the progression goes undetected until it can no longer be hidden, and symptoms finally appear.
Medical experts tell us the vast majority of heart attacks are preventable, and addressing each risk factor as a means to preventing heart disease makes perfect sense. Sounds simple, but it’s not, and here is the challenge to my students. Instead of facing the truth, it’s human nature for their client to be in denial.
Why denying health issues can be deadly
John is a student who is worried about his father. From everything he has learned in class, his overweight dad is sprinting toward disaster but is totally unaware. Why? Dad has no symptoms of any kind, which falsely assures him that he is healthy. Therefore, it’s John’s job to break through the barriers.
Dad’s blood pressure is 135/86, far too high. When John learns this, he is alarmed and confronts his dad. Dad’s response is predictable, and I warn the class to expect resistance, and that they better really know their facts if they are going to be persuasive and bring about change. Dad assures John that his doctor is taking care of the problem. “Yes, the doc says my blood pressure is running a little high, but I figure if there was a problem I’d be on medication.”
Bingo, the stage is set for John to reply.
John: “Dad, first of all, you need to understand the guidelines. A blood pressure of 120/80 or lower is considered healthy, and you are far above that.”
Dad: “OK, it’s a little high, but again, if my blood pressure was too high as you seem to be saying, I’d be on medication.”
John: “Here is what you need to understand. Your doctor needs guidelines as to when to medicate, and when it comes to blood pressure, the decision to prescribe medications is often delayed until blood pressure hits the 140/90 level. Admittedly, you are not there yet, but instead, you are in between, in the socalled gray zone.”
Dad: “So, no problem, right?” John: “On the contrary. Look at it this way. Let’s say next year when you go for a checkup your blood pressure goes up a few points. If so, you may have entered the zone requiring medication. Here is the question I want you to think about. Does it make sense that the addition of a few more blood pressure points means that suddenly there is a problem now and there was none before this?”
Dad: “Well, hmm, since you put it that way, maybe not.”
John: “Millions of Americans are in the gray zone, meaning high enough to be dangerous to your health, but not quite high enough for medications. If we focused more effort on the gray zone with an emphasis on lifestyle changes, we could greatly reduce the incidence of heart disease in this country. And let me add, you have the same problem with cholesterol. You are at 232, a dangerously high level, but in the gray zone until you hit 240. You really need to get your cholesterol down, too.”
Dad nods sheepishly. “So, you think it’s time I dropped some pounds and started exercising?”
John: “Absolutely! And take one more step. I’m sure if you told your doctor you want to be healthier and are willing to change, he would be right there with you, helping you every step of the way.”
You can see how the deck often is stacked against change. It’s human nature not to change until we believe we must, which is why most patients with no symptoms stay on their destructive course.