Bob: A Case Study

Bob first came to me after a major medical scare. After months of stomach cramps, diarrhea, and feeling fatigued, he finally consulted with his doctor. Several tests later a spot was found on Bob's liver. Several more tests determined that it probably wasn't cancer (though it could easily turn into cancer) and there was a slight possibility that it was cancer. How could this happen to an otherwise typical 54 year old guy whose father was still a vibrant 90 year old?

As part of the evaluation process for a double lung transplant at New York Presbyterian Hospital, you have to meet with a transplant surgeon. In this meeting, they will discuss the surgery, what they will do, how they will do it, and how long it will take. At NYP, it is clear from the outset that education is paramount. While I was looking forward to meeting with one of the surgeons, I had no idea that I was about to receive the greatest lesson of my life.

 NYP has 3 transplant surgeons and they are all very much qualified. The day I was to meet with the transplant surgeon, my excitement was heightened. When he walked into the room, I could sense the overwhelming responsibility on his shoulders. While running in the NYC marathon, I had asked Dr. Sonett if he had to cut off his emotions to perform a major operation. I imagined the trauma these surgeons  may experience when they lost a patient. Dr. Sonett's answer surprised me. He told me that he could never cut off his emotions and that he actually does care deeply about each patient on a personal level. That was a big cross to bare.

 After the transplant surgeon was done telling me, in rather graphic detail, what a double lung transplant consists of, I was able to ask questions to help fill in the holes in my mind. My last question was the most important to me.

"What can I do to improve my chances?" Even though I had spent my life helping others achieve better health and fitness, the surgeon's answer surprised me. He told me to exercise as much as possible. I told him, quite defensively, that I could barely walk across the room without having to stop to catch my breath. How was I supposed to workout? It had been a long time since I had the desire to workout and an even longer time since I had a hard workout. The surgeon didn't hesitate with his reply. "If you can't walk 50 feet, walk 40. If you can't lift 5lbs, lift 4."

His message was simple and clear and it hit me like a stack of bricks. Get busy moving or get busy dying. The saying I heard often while waiting for a transplant is: if you walk into surgery, you'll walk out. The pieces suddenly connected and a fire had been lit. I was going to run as fast as I could into surgery so that after surgery I could run home as fast as possible to my family.

 While living at the hospital in the weeks leading up to the call for new lungs, I spent my days walking up and down the hallways of the hospital while dragging my oxygen tank behind me. When the tank ran out of oxygen, which happened frequently, I simply stopped by the nurse's station for a fill up. A few times a day I would go into my room, sit in my chair, and lift 5lb dummbells over my head and did countless chair squats all while huffing and puffing. It turned out that the hospital had some small dumbbells tucked away somewhere (probably in the basement!). Dr. Wilt told me that I was the only patient she had ever seen lifting weights in my room with so much oxygen being pumped into my nose. Since I was doing everything I could possibly do to increase my chances of survival, her comment surprised me. Why wasn't everyone doing this?

One of the more frequently asked questions I get is how I was able to go home after only 6 days post transplant. The answer lies in the greatest lesson I learned before dying. Get busy living or get busy dying. Few people saw me dragging that damn oxygen tank around the 7th floor and when I went home after only 6 days, I got on my treadmill in the basement and walked as slow as the machine could go for as long as I could. (1.5 mph for 12 minutes). The next night I walked at 1.6mph for 13 minutes. I was home, but my work was only beginning. I had survived and now it was time to get busy living.

From the New York Times Best Seller Wheat Belly, Dr. William Davis uncovers what he calls the greatest health threat facing the world today. Dr. Davis presents the argument that modern day wheat is worse for our consumption than any other processed food, saturated/trans fat, processed sugar, additives, preservatives, and alcohol. In other words, modern day wheat is more harmful to our health than salted potato chips, candy, or soda.

Dr. Davis notes that 50 years ago, people were thinner than we are today. The molecular structure of wheat was also different 50 years ago. In an attempt to eliminate world hunger, wheat was seen as the answer and has been genetically modified to create more yield. Compared to its ancestor 50 years ago, modern day wheat has been altered to have an enlarged seed head to produce more wheat per stalk. As a result, wheat fields today are only 18 inches tall (compared to nearly 4 feet in the 1950’s) so that the modern day wheat stalk wouldn't fall over and die. This dwarf wheat stalk also reaches maturity quicker and its life cycle is faster, which also yields more wheat. Furthermore, wheat has been genetically modified to be resistant to heat, cold, and drought.

These changes have created a wheat product that is fairly close to its ancestor, but with some important changes. For example, many people have sensitivity to gluten (a protein in wheat) that wasn’t present 50 years ago. Compared to its counterpart 50 years ago, modern day gluten is different by only 5%, which is significant according to Dr. Davis. This subtle change has important implications for blood sugar levels and our sensitivity to gluten.

Dr. Davis does an excellent job in describing in detail the history and evolution of wheat in terms of agriculture, socioeconomic ramifications, and its impact on the human body, in reference to blood sugar and gluten sensitivity. Dr. Davis clearly lays out an argument against wheat and how absolute avoidance will lead to optimal health. Although his message is somewhat repetitive and often technical with periodic attempts at humor, the lifestyle change Dr. Davis is suggesting becomes blurred as his philosophy emerges in later chapters. Particularly interesting is his rather sudden turn in suggesting that a low carb diet is ultimately the answer. Wheat Belly starts to look more like an Atkins diet book rather than an evocative and revolutionary examination into the most common food we consume. Also lacking in Wheat Belly is any form of real guidance in the reader’s newfound avoidance of wheat. The recipes are much to be desired and he only includes a handful. I’m willing to bet that Dr. Davis will launch a second book to address where Wheat Belly falls short.

Dr. Davis pulls the available information we have on body weight from 50 years ago from military records and examines soldiers’ body mass index (BMI). BMI is simply our weight (in kilograms) divided by the square our height (in meters). The resultant number was once used as a diagnostic tool to assess if someone was at high risk for weight or health risks. Today, BMI is largely considered outdated because a person who has more muscle could be considered obese. In fact, the average running back in the NFL who is 5’10” and weighs 215lbs would be considered morbidly obese. So, BMI is hardly a great diagnostic tool anymore. This doesn’t stop Dr. Davis from using it to prove his point that men in the military were healthier 50 years ago because they had a lower BMI than their modern day counterpart. Dr. Davis doesn’t consider that the average military solider is in much better shape and has more lean muscle mass. To me, this type of gross misuse to an audience who may not understand BMI only discredits Dr. Davis as an author and as a cardiologist.

In the end, we all know that wheat impact blood sugar and too much wheat isn’t healthy. We also know that if you have a true food allergy or even sensitivity to gluten you probably shouldn’t eat it. I also know that soda, potato chips, sugar, processed food, high saturated fat foods, additives and preservatives aren’t healthy either. Dr. Davis stresses multiple times throughout the book that wheat is higher on the glycemic index (which means it has more impact on blood sugar and the resultant insulin response). However, Dr. Davis fails to mention that there are plenty of foods that are even higher than wheat on the glycemic index. For example, rice cakes, dates, apricots, raisins, pineapple, watermelon, parsnips, and a baked potato are all higher than wheat on the GI. Should we run for the hills with these foods, too? Dr. Davis would love to see everyone eat more leafy green vegetables. This is hardly groundbreaking news.