“Numbers,” a/k/a “Don’t ‘Do the Dew.’”

One of the cognitive distortions I learned about in Psychology is “minimizing.” A cognitive distortion is how you and your brain inaccurately frames or interprets something, sort of like “rose-colored glasses.” These glasses distort the way you see and interpret things, lying to yourself (and others), for lack of a better term. Minimizing is what happens when we report something to ourselves and others as insignificant or unimportant (but it IS). This can be conscious or subconscious.  

In medicine, patients OFTEN underreport, especially people-pleasers. Maybe they want to impress their provider and leave with a good report that makes their spouse happy. Maybe they aren’t ready to admit out loud what the real problem is. Or MAYBE they really don’t understand the significance of something. That was the case with who we’ll call, “Mr. Dew, Mr. MOUNTAIN Dew.”

Mr. Dew’s primary care doctor referred him to me because he needed to lose a few pounds and although his Hgb A1C and glucose were normal, other labs like his triglycerides, fasting insulin, and small, dense LDL cholesterol suggested he was pre-diabetic. He also had a lot of inflammation. He did NOT want to add more medication. Mr. Dew was an engineer, very smart, and very analytical. He was on his feet most of the day and obtained more than his fair share of steps taken. His diet was generally unremarkable. Not perfect but no one is. We made a few tweaks to what he was doing and agreed to follow-up in a few weeks. Not much had changed and the patient was frustrated. I am so happy he came back to see me, even without much to celebrate, because this time he offered more info, “Oh, yeah, I do drink a good amount of Mountain Dew.” Well, what’s a good amount??

PRO TIP: I prefer to say, “Walk me through your day yesterday, from the time you woke up to the time you went to bed and everything you did, ate, and drank in between.” Sounds nosey, I know. When asked, “What did you eat yesterday?” most people will report what they had at their breakfast, lunch, and dinner. Drinks, snacks, food/drink with meds, alcohol, bedtime ice cream – those tend to be unreported. And those add up.

The engineer and I put our math caps on:

“Good amount” per Mr. Dew = 2-3 x 20oz bottles Mountain Dew a day

(Sure, 2-3 units of anything doesn’t seem like much…)

One 20-ounce bottle = 290 Cal, 77gm Sugar

Average 2.5 bottles a day = 725 Cal a day and 192.5gm Sugar

(Ok, but he’s a big guy and active during the day, surely 725 Calories isn’t a big deal…)

Enter something called “context” …ONE sugar packet = ~4gm sugar

Therefore, 192.5gm Sugar / 4gm per packet =

48 PACKETS OF SUGAR A DAY

This poor man was inhaling the equivalent of 48 packets of sugar a day (maybe more?!) and had no idea. “Would you ever challenge yourself to eat 48 packets of sugar throughout the course of one day?” Of course not! That’s disgusting. It’s just more discreet in syrup form. We had found the culprit – that much sugar DOES explain the triglycerides, small particles, insulin, inflammation, stubborn body fat. I dare say that Buddy-the-Elf, himself, would have a hard time choking that down.

So, what did we do? First and foremost, titrate the sugary sodas before eliminating them – to avoid caffeine withdrawal and feeling deprived. (No, we didn’t switch to diet, that’s another blog for another day.) While the Mountain Dew came down, we increased the caloric density of his FOOD with healthier options in a more balanced way so to help with his energy levels.

Did Dew-man intentionally omit this information in our first meeting? Or did he truly think it was benign? I think both. Even an engineer didn’t realize the significance of his sugar intake. Moral of the story: Your nutrition is a LOT more than calories in and calories out and you don’t know what you don’t know.

#yowza #DONTdothedew #buddytheelf

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Fiction on the Inside

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The Genesis (& Exodus) of Reformed Nutrition: Part II