I’m changing tack a little this week for my blog, on account of a couple of different patients I’ve seen which have highlighted what I think is a really common problem, and indeed misconception in my view. Let me explain. The first is a lady in her 80s who has had atrial fibrillation (AF) in the past, treated with an ablation. I’m not sure quite how, but we got to talking about alcohol. She had never been a big drinker, but told me how she did really miss the odd glass of good red wine. Exploring further, it transpired that she had been told never to drink again as it may set off her AF. I don’t drink much these days, but I too enjoy a glass of good red wine. I take the view I would rather have the occasional glass of good stuff than more regular average wine! (A vacuum stopper is one of my most used gadgets as it means my wife and I can keep a bottle going over the weekend without it going bad!) I would also agree that purely on health grounds, there is probably no completely ‘safe’ lower limit, and being teetotal is healthier than drinking alcohol. In my view however that misses a vital point – that life is to be enjoyed! I really enjoy the odd glass of wine, and choose that pleasure over the very small health effects at that level of consumption.
Back to my patient – my advice was to go out and buy a good bottle of red, enjoy it with friends (and use a wine stopper if needed). I think that’s a first in terms of advice in clinic! If I was in my 80s with various medical conditions, I would absolutely prioritise enjoyment. I want to be clear that I’m not saying everyone should go and drink alcohol, but I think sometimes medical advice can be too draconian, and doesn’t look at the bigger picture. Sure alcohol and AF are linked, but in this particular case there’s more to it (and I can confirm my patient took my advice and was glad to do so!)
My second patient is in his 50s, and had a heart attack earlier this year out of the blue having been fit and well. He came to see me for a second opinion to discuss lifestyle, and get some clarity on what had actually happened to him. He has been absolutely meticulous with his diet since his heart attack, and whilst he acknowledged he was feeling well, was psychologically I think having a hard time adjusting to the fact he would never again have a ‘naughty’ treat like a biscuit.
Wait a second, never again have a cookie?!! Who had told him that? Again, whilst I totally agree cookies aren’t good for you, and processed and ultra-processed food is a major issue and risk for heart disease, to never again eat anything from that category of food is essentially impossible in my view. To chastise yourself for having the odd cookie, or desert, is also really unhelpful from a psychological standpoint.
I would much rather my patients, and in fact everyone, prioritised consistency over intensity in their health endeavours. I do this in my own life. With exercise, I try and do something every day, even if it’s only very short in time. If life crops up and I miss a day here and there, I’m much better now at not getting down on myself for it. If I’m doing the right thing most of the time, I’m allowed some slips, I’m human. Same thing with food. Most of the time I’m really quite nerdy about what I eat – whole food, plant-based, home-cooked. Last night I had a big slice of shop-bought cheesecake, and it was delicious. I’m not giving myself a hard time over it, far from it. I enjoyed it, and forgot it. I also had all-butter croissants for breakfast!
Alexander Pope’s 1711 line ‘To err is human’ is quite right! I wonder how many other people and patients out there are getting down on themselves for the smallest of things in the lifestyle space, or following overly restrictive advice from well meaning professionals which fails to look at the bigger picture? Clearly I’m not advocating a diet of cookies and wine, but I’m perfectly happy with my patients having a ‘treat’ from time to time.