1) The commonest factor that puts people off a healthier lifestyle is the 'all or none' principle.

This is what I have learnt after dealing with lifestyle diseases for over 5 years and having faced certain issues of my own.

I will explain this in my tweet.
2) What is the 'all or none' aka AON principle?

It is the presumption that you have to follow the diet/gym/morning walk schedule EXACTLY as it is.

If you don't complete it, there is no benefit.
3) This AON principle, in my humble opinion, pertains to medication only.

Why?

If you are taking meds for lifestyle diseases (LD) --> you are in the 2ndary prevention phase where you aim to prevent COMPLICATIONS! Image
4) If you miss your meds for say hypertension or diabetes --> you can experience a catastrophic bleed in your brain or develop a diabetic emergency.

So, its important to never miss your medication.
5) But what about exercise and dietary changes which occur at the PRIMARY prevention level ? --> where you wish to avoid DEVELOPING hypertension or diabetes in the first place.

Yes, AON is a great target but it can be UNREALISTIC for many people.
6) The 22 year old young and fit gym bro/sis with bulging muscles is NOT THE SAME as a 65 year old ex smoker with prediabetes and HTN who last went for a morning walk before the Modi wave.

Remember, this is a lifestyle disease.

You cannot change your lifestyle in a day.
7) You cannot expect the 65y old to suddenly start running marathons or stick to his diet --> he/she will sneak in a ladoo or two.

What you need is a graded approach aka the 'All or some' principle aka the AOS principle.
8) If you can't walk 10k steps in a day (this is a controversial topic) its perfectly fine to walk 7k steps.

If you can't stick to your diet 7 days a week, at least 6 days is fine.

Its important to TRY and GET BETTER with time.
9) Most people fail their diets or exercise programmes because they wish for miracles.

They will abuse their body for 10 years and suddenly expect a sculpted physique after a month in the gym prior to getting married.

That is UNREALISTIC and DANGEROUS.
10) Remember, its all or some.

If you can't do it all, do some and try to do better next time.

Being healthy is a marathon, not a sprint.
Disclaimer

1. This is not medical advice --> its an explanation of a common social phenomenon seen in medicine.

2. Please consult your physician before starting/making any changes in diet or exercise.

3. All or some is NOT AN EXCUSE to be lazy and idle about.
You must also remember that you need a mechanism to monitor your habits so that you can make changes accordingly.

I started using Fitbit since Dec 2020 and it took me 7-8 months before I was hitting 7k steps/day on average.

I will talk about this in another Tweetorial.

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More from @AdiG1993

Nov 15
1) If a medical college has 'mandatory' lectures, its most likely because the lectures are terrible and no sane person would spend hours there.
2) If you are a high brow academic institution and yet provide horrible slide based lectures that I can watch in a 10 min Marrow video --> I am not going to class.
3) Time is money and there is more to life than medicine.

Lets be real, most coaching institutes today rule the roost when it comes to medical education because they retain the best teachers.

Its as simple as that.
Read 6 tweets
Nov 14
1) A relatively poor quality digital CXR - PA view.

But this often the best that you get.

Hx --> Middle aged man with passage of reddish urine

What do you see? Image
Choose your answer
Read 11 tweets
Nov 14
I am anti PPI unless its for documented ulcers or H. pylori.

Unexplained dyspepsia +/- alarm symptoms should ALWAYS be evaluated.

PPI without a specific reason qnd for long term --> DANGER

#MedTwitter
#PPI
#dyspepsia
#pepticulcerdisease Image
Thanks to @MedRewind for the table!
*and
Read 4 tweets
Nov 9
1) If you are using Twitter for academic purposes, please stop the meaningless scrolling.

Use a targeted approach wrt the content you follow --> use a note taking app like Google Keep/Notion to organize a framework --> save the Tweetorials you find important.
2) 90% of academics = organization

The difference between great scholastic performance and merely ok --> repeat revisions of a highly organized and structured study material.
3) Bookmarking hundreds of Tweetorials without any system is foolish and unproductive.

It is a classical example of the TREADMILL effect.

You are running a lot but you are not going anywhere.
Read 5 tweets
Nov 8
1) If you are a resident, you really need to learn how to store academic/interesting cases in an easily accessible format so that you can produce them at a moment's notice.

Storing stuff on your phone = BAD MISTAKE!
2) First of all, no physical storage devices like pen drives or hard drives.

You WILL lose them and they are NOT easily accessible!
3) You HAVE to use a cloud service.

Google drive is a pretty nifty tool for beginners.

But uploading/downloading data can be a pain in the ass.
Read 10 tweets
Oct 7
The tragedy in Gambia underscores what many Indian physicians have known for decades.

There are cheap generic drugs flooding the market with little to no oversight on manufacturing protocol.

If you see patients --> your personal reputation is tied to whatever you prescribe.
But if you prescribe branded drugs with arguably more transparency --> you will be accused of making black money.

You will called a liar and a thief and Aamir Khan will proselytize on national TV.
Most patients and attendants have forgotten the basic rule of a capitalist economy.

NOTHING IS FREE.

If something is free or cheap --> its because YOU ARE THE PRODUCT.

In this case, it was the life of 66 Gambian children.

#MedTwitter
Read 4 tweets

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