physically resemble, other members of our immediate or extended families, we all are individuals.
own individual characters, mind-sets, culinary habits, and athletic abilities.
Why, then, do dietitians and doctors and authors of popular diet books offer one and the same prescription for all of us? Let us now suppose that you and I develop the same disease, hypertension (high blood pressure). It turns out that you and I live in the same neighborhood and go to the same doctor, a friendly and knowledgeable family physician. When you and I visit our doctor, we do not expect to be treated in exactly the same way. The doctor is likely to prescribe different medications for us or, at least, different doses of the same medication. We realize that even though we have the same diagnosis, the disease is acting upon two
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distinct individuals—you and me— causing somewhat different problems and requiring individualized therapy.
Exactly the same principle applies to recommendations with regard to diet and exercise. They simply cannot, and should not, be the same for everyone. The key is to select the most appropriate regimen for a given patient. Not everyone has to avoid egg yolk, and not everyone must be on chromium and manganese. The amounts of carbohydrate in the diet must be adjusted to the degree of physical activity of the individual person, whereas the amounts of protein must be adjusted according to the ability of the kidneys to handle the protein load.
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Although the goal of a physician who treats many patients is uniform—to achieve the best possible control of blood pressure and sugar levels and to design the best program for weight maintenance—the means to reach this goal can be as distinct as night and day. The approach and the means ought to be routinely individualized by paying close attention to the patient’s state of mind, physical abilities, tastes, habits, and work and leisure schedules, as well as the presence of other medical conditions.
Two Brothers, Two Treatment Plans
Here is a fairly straightforward example of how different Tom is from his brother, Johnny. Tom is a forty-six-year-old selfemployed plumber who gets his job assignments from a general contractor. He is usually out his door at 6:00
AM after drinking a glass of orange juice and on a construction site forty-five minutes later. His first meal is about 10:00 AM, and lunch is at about 1:00 or 1:30 PM. Both meals are usually eaten at the nearest fast-food restaurant.
Tom tries to be home before 6:00
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PM, and he eats dinner with his family at 6:30 or 7:00 PM.
Tom is five feet nine inches tall and weighs 190 lb. His body mass index (BMI) is 28. His weight has been stable for the past five years. Two years ago he developed diabetes, which is treated with two pills a day. His fasting blood-sugar levels are still moderately elevated, running at about 150–
160 mg/dl, except for weekends, when they go up to 200 mg/dl. His cholesterol and triglycerides are also moderately increased.
His brother Johnny is a forty-nine-year-old clerk with the state motor vehicle department. He eats breakfast at home at 7:00 AM, lunch in the cafeteria at noon, and dinner at home at about 6:30 PM. At home, Johnny is as sedentary as his brother, mainly watching TV and thumbing through his favorite
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magazines. However, unlike Tom, who toils on construction sites five days a week, Johnny is sedentary at work as well, spending eight hours at his desk and occasionally taking a leisurely stroll to the men’s room. Johnny is five feet ten inches tall and weighs 215 lb. His BMI is 31. He has had diabetes for five years, and despite therapy, his blood-sugar levels constantly hover near and above 200 mg/dl. His lipids are significantly elevated; his blood pressure is mildly elevated.
Discussion
Both Tom and Johnny are overweight and have diabetes.
Both brothers have elevated lipids and higher than normal blood pressure. Johnny’s BMI is in the obesity range, most likely because he leads a much more sedentary life than his younger brother does. Tom is very active during work hours, and his sugar levels are lower because of the vigorous manual labor he is engaged in five days each week. Neither brother pays much attention to his diet. More severe obesity
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and higher sugar levels are probably responsible for higher lipids and blood pressure in Johnny. What shall we recommend to Tom and Johnny? If we look solely at the diagnoses, the two brothers appear to have the same disease.
One may even assume that they should be treated in an identical manner.
This assumption would be incorrect and far from the reality of the situation. Tom should start by bringing lunch from home, instead of eating on the go, gobbling up hamburgers and pizzas. Because he is so active, his daily caloric intake should probably stay at about 3,000 calories.
I would encourage him to do three Draznin Miles on Saturdays and Sundays and two Draznin Miles twice a week on weekdays. With just a little more structured exercise and better nutrition, Tom should do
145 Living with Diabetes
very well. Obviously, adjustments will have to be made if Tom’s blood sugar and lipids do not drop to normal levels, despite the changes in diet and exercise. He may need to start taking lipid-lowering medications if his cholesterol remains higher than is optimal for patients with diabetes. In addition, Tom should definitely stop drinking beer on weekends.
Johnny, however, has a much longer way to go to reduce his weight and to improve his diabetes, blood pressure, and lipid levels. His diet should be reduced to approximately 2 ,200– 2,500 calories, consisting of no more than 45%
carbohydrate, mainly as vegetables, fruit, and fiber. He must
also begin an
exerciseprogram,buildingtothreeDrazninMilesfivedaysawe ek, as described earlier in this book. He might also benefit from meditation exercises, which could help lower his blood pressure. Johnny should start antihypertensive and lipid-lowering therapies right away. Just like his younger brother, he should forget about drinking beer or other alcoholic beverages.
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As you can see, despite
. . . despite fairly similar conditions,
fairlysimilarconditions,Tom