choices – Steven Piriano, MD

Does an Occasional Inconsistency Really Matter?

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We often behave based on incentives and anticipated consequences. If a specific behavior will have a positive effect, we will likely move forward with it. Conversely, if an action is expected to have negative ramifications, we will most likely refrain from it. In my last post, I discussed immediate and delayed consequences, noting that our actions will often be based on immediate rather than delayed consequences. For instance, if a person is presented with the opportunity to experiment with a recreational drug, he may only consider the here-and-now pleasant experience rather than the possibility of lifelong addiction.

I would like to provide two points of clarification. Within reason, it is what you do most of the time that counts. Doing something once or twice will not have a major impact on your life. I qualified this by stating “within reason” because many times, performing reckless behavior, even once or twice, can create catastrophic, lifelong repercussions. In addition to the recreational substance example, deciding to drive while intoxicated only once can produce irreparable damage for your entire life.

However, aside from careless behaviors, it is what you do most of the time that counts. Just as eating a single cheeseburger is not going to give you a heart attack, eating a single serving of veggies is not going to turn you into the picture of health. Conversely, eat cheeseburgers regularly, and you will likely see your health decline. Eat vegetables consistently, and you will likely enjoy good health.

The second point of clarification is somewhat in opposition to the first point. Whereas it is true that a single act will not have major consequences on your health, it may have significant effects on your mind. There is a school of thought that believes the occasional indulgence will set you back mentally and emotionally. Suppose you have been eating healthy for a while and decide to reward yourself with that one cheeseburger. This will certainly have no ill effects on your health. However, you may savor its flavors so much that you decide to have another one tomorrow and perhaps again next week. If you have refrained from smoking for many months and then experience a stressful situation and choose to smoke a single cigarette to “help calm down,” this will have no adverse health impacts. However, you might have enjoyed this small indulgence so much that you decide to come back for more. Again, although no immediate health impacts, there may be instantaneous mental effects, which can result in the restoration of the bad habit that you worked so hard to abolish.

Although consistency matters the most, sometimes, seemingly minor inconsistencies can have significant negative impacts.

Thank you for taking the time to read this post. I hope you have enjoyed it and found it informative. Please feel free to share it with anyone who may benefit from it.

Which Consequences Matter to You?

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One day this past summer, I was driving a friend home, and he was hungry. I stopped at a pizzeria, and he bought a meatball parm hero that he began eating on the drive. At one point, he took a bite, and a small piece of meatball, along with some sauce and oil, dropped out of the sandwich and onto his shirt. He immediately tried wiping it off with a napkin and was understandably upset because he thought his shirt might be permanently stained.

As I glanced over at him, a thought popped into my head. Yes, he was justifiably concerned that his shirt may be ruined. However, what about the other consequences of that meatball hero? He was eating a sandwich filled with sodium, saturated fat, and cholesterol. Although these substances would increase his risk of developing diseases such as diabetes, high blood pressure, and heart disease, he did not seem disturbed about these potential health outcomes. Why was that? Why was he more concerned about what the sandwich did to his shirt than what it could potentially do to his health?

The major reason lies in the various types of consequences. His stained shirt was an immediate consequence. It happened at the time he was eating it, was quite obvious, and thus connected to the sandwich. However, the possible adverse health consequences mentioned are not so apparent. If they are going to occur, they will likely not arise for five, ten, or even twenty years. Those would be considered delayed consequences, occurring so far into the future that it would be exceedingly difficult to link them to the sandwich.

Immediate consequences clearly have an enormous difference in impact compared to delayed consequences. Let us imagine that the opposite was possible for a moment—that immediately after eating the sandwich, my friend suffered a heart attack. If this was the case, I could pretty much guarantee that he would never eat a meatball parm hero again.

I realize that I’ve made a bit of a stretch here. Eating a single unhealthy meal is not going to have unfavorable health effects, even after years have passed. However, consistently consuming unhealthy foods will most certainly increase the risk of poor health. The impact of each meal will add up over time until the outcomes become apparent.

Please remember the difference between immediate and delayed consequences and their importance in your life. Just some food for thought (pun intended).

Thank you for taking the time to read this post. I hope you enjoyed it and found it informative. If you know of anyone who may benefit, please feel free to share it.

What is the Key Factor That Determines Your Outcomes?

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Your outcomes in life will be determined by the actions that you take on a consistent basis.

For instance, if you are working towards a specific goal, then it is the actions you take regularly in the service of that goal that will determine if and when it is accomplished.

Regarding health, if you consistently eat unhealthy foods, then you are likely going to go on to develop lifestyle-related diseases such as diabetes, high blood pressure, heart disease, and cancer.

Conversely, if you consistently eat healthy foods, you will significantly lower your risk of developing such conditions.

Consistency is key.

Just like eating a single slice of pizza will not cause you to suffer a heart attack, eating a single bean and quinoa salad will not turn you into a picture of good health.

Within reason, doing something once or twice will not have an appreciable impact on your outcomes.

It’s what you do most of the time that counts. Your small actions, added up over time, will have enormous effects on your life, whether good or bad.

Consistency is king.

Thank you for taking the time to read this post. I hope you enjoyed it. Please feel free to share it with anyone you think may benefit from it.

A Food-Borne Illness

As an Emergency Medicine physician, when I hear the term “food-borne illness,” it immediately conjures images of people with vomiting and diarrhea secondary to consuming undercooked or spoiled food contaminated with bacteria or their toxins. However, I recently learned of a new usage of this term. In his article, “Is the Present Therapy for Coronary Artery Disease the Radical Mastectomy of the Twenty-First Century?” Dr. Caldwell Esselstyn ascribes a new meaning to the phrase “food-borne illness,” referring to coronary artery disease as this type of illness. According to the CDC, coronary artery disease (CAD) is the most common type of heart disease in the United States. It is the narrowing and blockage of blood vessels supplying blood to the heart, which can eventually lead to heart attacks. The CDC also states that in the United States, over 20 million adults over age 20 have CAD and that someone has a heart attack every 40 seconds.

Those are some pretty frightening statistics. But luckily, doctors have treatments for heart disease. We have an armamentarium of medications as well as procedures such as coronary stents and coronary artery bypass surgeries. These are remarkable advances that are lifesaving for those that are having a heart attack. However, as Dr. Esselstyn states, “…none of the present therapies targets the cause: the Western diet.” Yes, our Western diet—filled with processed foods, fried foods, meats, oils, and dairy. He describes cultures that consume a plant-based diet in which CAD is almost non-existent. Moreover, the converse is also true. When plant-based cultures adopt a Western diet, guess what? Yes, that’s right, they develop CAD. Thus, it seems as though heart disease really is a food-borne illness.

History also teaches us this lesson. Between 1939 and 1945, Norway was occupied by Nazi Germany. During this time, the Germans removed all animal livestock, forcing the population to subsist on whole grains, legumes, fruits, and vegetables. Following this, deaths from heart attacks and strokes fell. When the war ended, and animal products became available again, deaths from these illnesses rose to prewar levels. Thought-provoking, isn’t it?

In his article, Dr. Esselstyn mentions a study he conducted on very ill patients with CAD that he placed on a plant-based diet. These patients have thus far been followed for twenty years, and the results are fascinating. A plant-based diet not only stopped the progression of heart disease but even reversed it! Yes, reversed it. Furthermore, this study and its follow-up showed that people with CAD would stick with dietary changes for decades. If provided with an understanding of the link between diet and disease, I believe that people will want to take control of their own health and give themselves the opportunity to be better.

Consequences

Cheeseburgers and chocolate cake are delicious. Eat a cheeseburger for lunch, and you will likely feel really good. And that piece of rich chocolate cake—definitely mouthwatering. The same goes for pizza dripping with cheese, juicy porterhouse steaks, hot dogs with all the fixins, moist frosted creme donuts, and many others. Undoubtedly tasty and gratifying.

Eating such foods on infrequent occasions is pleasurable and will probably cause no harm. However, filling your plate with these types of foods on most days of the week is an entirely different story—one whose ending is difficult to visualize in the present moment.

Many of us are probably aware that foods high in sugars, fats, and cholesterol are not the healthiest options. They increase the risk of developing many chronic diseases, including heart disease. Moreover, this risk increases the more often these foods are consumed. I’d bet that countless people who understand the dangers of eating these foods consistently still do so. Why would this be?

The likely answer is that the consequences of regularly eating unhealthy foods do not occur right away. As a matter of fact, the results of these actions will typically take years to manifest. If you knew that eating cheeseburgers a few times every week would increase your risk of suffering a heart attack ten or fifteen years down the road, it might not bother you too much. However, if you knew that eating a cheeseburger on Monday would cause you to have a heart attack on Tuesday, I’ll bet that you’d think twice about it.

The converse is also true. Eating a vegetable salad on Monday will not turn you into a picture of good health on Tuesday. But eat lots of fruits and vegetables every day, and you will undoubtedly see and feel the difference in the following months and years. Again, when there is a lot of time separating actions and consequences, people will oftentimes only care about the immediate or near-term results without giving much regard to the long-term effects of their choices.

This concept was explained very well by Ray Dalio in his book Principles. He refers to near-term effects as first-order consequences and long-term effects as second- and subsequent-order consequences. As Mr. Dalio says, “Quite often the first-order consequences are the temptations that cost us what we really want, and sometimes they are the barriers that stand in our way.”

The next time you are about to order that cheeseburger, don’t just think about how it will make you feel as you’re eating it. Consider how it may affect you a few years into the future. After all, it is still you that will bear the consequences.