What do menstrual cramps, hot flashes, one bowel movement every three days and heartburn have in common?
They are all symptoms we would classify as common, but none of them are normal. We have grown up in a culture where we pop an anti-inflammatory to manage pain and an antacid to cope with post-consumptive heartburn. We do it over and over again, rarely stopping to ask, does this happen to everyone?
I spend my days talking to people about their health. We examine the big things that brought them through the door, but we dedicate an equal amount of time to checking-in on the small stuff. Bowel habits, menstrual cramps, pain during intercourse -- we discuss it all.
Remarkable in this investigation is not that we have the opportunity to discuss these matters, it is the amazement on people's faces when they realize that their weekly headaches, post-nasal drip or joint pain are a common, but not necessarily 'normal' part of our physiological experience.
Acknowledging these common symptoms does not negate the notion that the range of normal for a population can be varied, or that it is in fact expected that we will oscillate in and out of a state 'ideal' health. It is the chronic presence of 'common' symptoms that I am attempting to honour. Appropriate medical evaluations will help to elucidate when, as clinicians, we are seeing a variation of normal or just de-prioritizing something that is common.
The danger in mistaking common for normal is not usually that there is something larger lurking below the surface (although this can be the case); it is the fact that someone is missing out on the opportunity to operate at his or her highest potential.
I frequently create an association for my patients between the concept of an oil light and symptoms. When an oil light begins to flash on the dashboard of your car you are faced with several options. You can ignore it and drive a little further, cover it with tape, disconnect the cables all together or maybe you can try adding some oil at your next stop.
It is rare that when an oil light comes on that you would assume that it is just a normal occurrence. Without the simplistic insight of a dashboard, the human body has different mechanism of communicating when it requires attention. Your symptoms become your oil light.
My story, like so many of my patient's started with my own incapacity to differentiate common from normal. My symptoms were relatively innocuous. Gas, bloating, looser bowel movements -- everyone had those. I was also plagued with unrelenting leg cramps. For years I would massage my legs to keep them from cramping up while I slept and sat through classes. These are normal symptoms I was told and then began to tell myself.
It was not until someone challenged me to try a gluten-free diet that I realized that what I thought was normal for everyone, was really just common for me. Unsatisfied with simply the anecdotal removal of my favourite grains, I decided to follow through by seeing a gastroenterologist. Several tests and biopsies later, there was a diagnosis -- I had celiac disease. My common, seemingly normal symptoms were in fact my dashboard, politely trying to get me to pull over and seek assistance.
The importance of my story was not that I had an odd presentation of celiac disease; it is in recognizing the value in acknowledging the common symptoms we all carry around. In hindsight, my mother was horrified to learn of my diagnosis. As a kid she used to feed me bread or pasta as comfort foods when I was particularly distressed, at night, because of those 'common', but pesky growing pains in my legs.
Taking control of one's health means eating well, exercising and sleeping sufficiently, but it also means listening to what your body is whispering. Start to ask yourself, whether the common heartburn, cramping or headache are in fact your oil light, politely seeking attention.
5 common, but not necessarily normal symptoms:
1. Constipation: Despite what anyone tells you, one to two bowel movements per week is not normal. Aim for one per day, and at the least, every other day. Lack of fibre, dehydration and food sensitivities are commonly implicated in chronic constipation.
2. Heartburn: We all have it on occasion, but it doesn't mean it should be happening. Adjustments to diet -- including the amount of water you consume while eating -- can make a significant difference. Frequent reliance on antacids aren't fixing the problem, they are simply placing tape on the oil light.
3. Menstrual cramps: For many of us, menstrual cramps have become synonymous with womanhood. While they may be indicative of something deeper, pre-menstrual cramping is something frequently improved with simple lifestyle adjustments -- for some, the removal of dairy is particularly effective.
4. Eczema in children: As clinicians, we see this all the time. Mild eczema in children can frequently be eliminated without the need for corticosteroids by adjusting your little person's diet. Consider the eczema an early oil light signal.
5. Insomnia: Insomnia is frequently a symptom of something else, not necessarily an endpoint on it's own. Speak to your clinician about possible causes, including your need to create an effective stress management plan.
<strong>We always hear you should spend some time away from screens before bed -- but if you <em>have</em> to work late one night, is it better to spend time unwinding, even if it means staying up a bit later, or is it better to just go right to bed?</strong> I am a big proponent of consistent <em>wake</em> times. Bed times, in my opinion, are much less important; if a patient is consistent with their wake time and routines, bed times usually take care of themselves. Plus, deemphasizing when an individual goes to bed often helps remove the performance anxiety we associate with insomnia. For me, this one is a no brainer: Unwind first, if you feel like you need it. If you are someone who can go to sleep without that down time, knock yourself out. --W. Christopher Winter, M.D., medical director of the Martha Jefferson Hospital Sleep Medicine Center in Charlottesville, Va.
<strong>If you've decided to indulge in one thing while out for a meal, which should it be: the bread basket or dessert?</strong> I think it's better to share a dessert (of course be the last to taste so there's only a bite or two left). The bread basket is a trigger point for the whole meal. Once people make the choice to have the bread they are subconsciously choosing to let the whole meal go and they ultimately end up eating dessert too. If you save it for dessert (eating clean the whole meal before and skipping the bread), you'll save a ton of calories. --Heather Bauer, R.D., CDN, founder of bestowed.com and HuffPost blogger
<strong>More steps are almost always better -- but is it still worth walking that extra bit if you're wearing heels?</strong> No! I do not subscribe to walking in heels for exercise being a good idea. High heels shift your body weight to the ball of your feet and misalign your whole skeleton. Exercise in this body position makes you very prone to injury to knees, hips, back and feet. Exercising later in more appropriate shoes is ideal. Everyone wants to get in as much physical activity as possible, but putting yourself at risk for injury and trauma isn't smart. Exercise should be done with the goal of strengthening your body, not causing harm. Sneakers are always best for physical activity. --Jackie Sutera, D.P.M., podiatrist in New York City
<strong>If you're really stressed about your to-do list, should you tackle the biggest or the smallest item first?</strong> When we are really stressed we need a positive experience, and one that can be accomplished pretty soon. So pick something, but not the biggest or the most difficult; instead, something that can realistically be tackled and done. Then congratulate yourself for doing that and pick another, then another, then another... --Lloyd Sederer, HuffPost mental health editor and Medical Director of the New York State Office of Mental Health
<strong>If you only have 15 minutes to exercise, is it better to opt for cardio or weight training?</strong> If you only have 15 or 20 minutes to work out, your goal should be to subject your body to an ideal combination of muscular strain and cardiovascular stress. While this may sound unpleasant, it's going to give you the most bang for your buck if you want to get lean, strong and fast in as little time as possible. To achieve this effect, use any of my favorite resistance training exercises that "crossover" to also be cardio exercises, including: Dumbbell or Kettlebell Swing, Squat to Overhead Press, Turkish Get-Up, Uphill Sprints Holding or Carrying a Weight and Burpees. --Ben Greenfield, fitness and triathlon expert, Get-Fit Guy podcast host
<strong>If your only protein choice for hours is high in saturated fats, should you eat a bit, or skip it?</strong> Personally I would try my best to avoid a high saturated fat protein source. It would probably make me feel sick. People who eat a lower fat diet and then dive into a high fat meal tend to complain of stomach aches. When you look at the nutrient analysis for protein sources that are high in saturated fat like fried fish, the amount of protein is very low. Therefore a protein source that is high in saturated fat may not always be your best source of protein. Best bet is to plan ahead. I always carry nuts or roasted edamame in my purse to fill in any gaps of missing protein in my meal. --Toby Smithson, R.D., founder of <a href="http://diabeteseveryday.com/">DiabetesEveryDay.com</a>
<strong>We all know how important sleep and exercise are for our health -- so if you got a bad night's rest, is it better to sleep in for an extra hour, or push through your morning workout?</strong> From the fitness expert: One of the most important recovery, mental and immune system boosting activities for the human body is sleep. If you're short on sleep, you experience higher levels of inflammation and a decrease in the hormones that help you lose fat and stabilize your appetite. For this reason, you should never sacrifice sleep to exercise -- as you're likely to put your body into an unhealthy state. --Ben Greenfield, fitness and triathlon expert, Get-Fit Guy podcast host From the sleep expert: It is better to get up at your usual time to keep your body clock on consistent timing. --Philip Gehrman, Ph.D., clinical director of the Behavioral Sleep Medicine Program at the University of Pennsylvania
<strong>We've heard it's not great to nosh late at night -- but if you haven't had a chance to eat dinner all evening, is it better to eat late or go to bed starving?</strong> Eat something but more <em>snack</em> size rather than meal size. Having a gnawing hunger or eating too much food both will lead to poor sleep quality. Try 1/4 cup tuna salad (homemade/healthy mayo), six multi-seed crackers and cut fresh veggies. --Dawn Jackson Blatner, R.D., author of The Flexitarian Diet
<strong>Ideally we'd be prepared -- but if you're stuck in an all-morning meeting and the only food choice is a pastry, is it better to eat it or skip breakfast?</strong> SKIP IT. There is nothing actually filling about a pastry -- no fiber, no water -- so it wouldn't help my hunger. In fact, many times eating something high in sugar like this will lead to an energy crash, so I wouldn't be full and it makes me tired. No thank you! (I have apples and almonds at my office for situations like this.) ----Dawn Jackson Blatner, R.D., author of The Flexitarian Diet
<strong>Pouding headache? A weird pain in your side? When you have an unusual system, is it a good idea to Google your symptoms to be a better informed patient, or does searching the internet for a diagnosis only put you at risk for cyberchondria?</strong> We all know the saying that a little knowledge is a dangerous thing, and that's certainly true when you think you know more than you do! Medical information emphasizes the dire, with good reason. It is the most dire explanation for any given set of symptoms that most needs to be found, and addressed. That by no means indicates it is the most likely, however. But while a little knowledge is a potentially dangerous thing, total ignorance is even more so. Doctors are human, and fallible. Mea culpa! There have been times I have come faster to a correct diagnosis, or considered something important, because my patient came to me armed with a Google search, and asked me: 'what about ______?' So, yes -- Google your symptoms. But do so reasonably, and humbly. Reasonably means prioritize credible sites- not those devoted to conspiracy theories. One very good portal is healthfinder.gov. Humbly means to remember that an hour of Internet surfing is NOT a substitute for four years of medical school and several more of residency training. So, use a Google search to generate good questions- but not to cultivate a passion for any given answer. There have been times I have struggled mightily to disabuse a patient of a false conviction based on a wayward Internet search, and we have both suffered for it. Don't let that be you. Informed is empowered, and is much better than uninformed. But misinformed and unwilling to recognize it may be the worst of all. Google accordingly! --David Katz, M.D., founding director of Yale University's Prevention Research Center
<strong>If you're having a disagreement with your partner late at night, is it better to "never go to bed angry" or "sleep on it"?</strong> Most psychologists will recommend that people take the time that they need to calm down to think rationally about conflicts. They are much more likely to develop effective solutions or understand another person's perspective when they aren't upset. Sleep does allow time to pass, and many people report that they are able to view their situation from a different angle the following day. Perhaps one exception is when a person is unable to fall asleep at all because they are so angry. In these situations, addressing the problem before bed may provide some closure. --Steven Meyers, professor of psychology at Roosevelt University in Chicago, Ill.
Follow Dr. Meghan Walker on Twitter: www.twitter.com/drmeghanwalker