Minimum effective dose: A prescription for success

When I ask my patients, “What do you do?” they invariably answer by telling me what their job is. This is pretty much standard fare everywhere in the U.S. except California. If you ask a Californian what it is that he or she does, you will get the same sort of reply as I receive from my follow-up question to my patients in Ohio: “What do you do for fun?” Those of you who know me a little better than others know that my answer to question No. 2 — and to No. 1, if I happen to be visiting California — is, “I do CrossFit.” For 9 years or so, CrossFit has been my fitness and health program, as well as my hobby.

What does this have to do with dry eye syndrome (DES)? While doing some fun reading in my CrossFit world, I came across a rather famous proponent of the Paleo lifestyle, Mark Sisson, and a blog post in which he discusses the “minimum effective dose” of all the elements in his life approach. Paleo is a partly philosophical/partly actionable way of living and eating that attempts to bring some of the aspects of prehistoric life to the activities and diets of modern men and women. It is quite popular with a certain segment of CrossFitters. Indeed, we tend to talk about exercise and nutrition in rather med-tech fashion. We do our workouts “as Rx’d,” as prescribed, and we talk about following the “CrossFit prescription” in our diet.

Sisson discussed applying his very CrossFitty life principles in terms of meeting defined goals as efficiently as possible. Specifically, he was talking about what to eat and how much, as well as how to exercise and how much, in order to achieve a defined health and well-being outcome. I immediately saw the parallel between what I do for work and what I “do” in the concept of minimum effective dose (MED). Let’s explore that a bit as it relates to treating DES and associated problems.

In the seminal essay “What is fitness?” Greg Glassman establishes as his overarching goal a type of general physical fitness he defines as “broad and inclusive.” Sisson is both less and more specific in his goal setting, acknowledging the power of a general goal like Glassman’s while at the same time recognizing that some people will have much more specific endpoints in mind. For us as doctors treating DES, the critical concept is that we consciously set a goal, an outcome that we will pursue with our treatment. It sounds trite, but the power of explicitly defining what constitutes success cannot be overstated whether we are discussing DES or dress sizes.

Click here to read the full publication exclusive, The Dry Eye, published in Ocular Surgery News U.S. Edition, January 25, 2015.