If you're one of the more than 90 million Americans who suffer from a chronic illness, such as high blood pressure, diabetes, kidney disease or asthma, chances are your doctor has recommended that you take medication and/or change your lifestyle.

Following your doctors' orders isn't always easy, but a bit of judicious cheating" is almost always OK.

Julian Seifter, MD, is a Harvard nephrologist (kidney specialist) who has diabetes himself. He shares some advice based on his personal experiences...

My Health Challenges

As a nephrologist, I'm an expert in the complications of diabetes, but I've sometimes been unable to change my own habits to keep my diabetes under control. At different times, I've been out of shape and overweight and allowed my blood pressure and blood sugar to get too high. What I've learned…

Why We Cheat

Being diagnosed with a chronic illness profoundly affects your sense of identity. You may need to give up things that are important to you...forever. And doing what you're told by your doctor means that you're losing some control over your life.

It's only human that we often respond to these losses with denial. That's especially true if you don't feel particularly sick, as with high blood pressure. You can ignore dietary guidelines your doctor has given you or not take your medication--and if you're lucky enough to not suffer ill effects, this cheating lets you tell the world, and yourself, there's nothing wrong with you.

Even if you accept your illness, giving up favorite foods or pleasurable habits can hurt your quality of life. And letting your illness define you becoming afraid to do things you enjoy and worrying about everything you eat-isn't healthy either. Life has to be worth living, which requires compromise.

Find The Right Doctor

Doctors shouldn't just be instruction givers... they should be problem solvers. They should meet their patients halfway and help them figure out how to do what's necessary for their health while maintaining their pleasure in life.

If your doctor is rigid and moralistic, this creates a communication barrier that makes matters worse. You will be tempted to lie or simply cancel your appointment if you haven't followed your diet or you stopped taking medication that was causing uncomfortable side effects.

To find out if you can work with your doctor, say something like, "I'm worried that I'll never be able to have corned beef or a glass of wine...or a piece of pie) again. Is there any way we can compromise on my diet?" You also may want to ask about larger worries, such as how you can continue to travel or participate in your favorite sport.

Strike A Balance

It's almost always possible to build flexibility into a diet or medical regimen and still achieve a high level of care.

Example: A pastrami sandwich is not part of a low-fat or low-salt diet. But one every other week won't make much difference to most people's health, and if you love pastrami, it's likely to make you a lot happier with the whole eating plan.

If you're prescribed a low-salt diet for hypertension, can you name three salty foods that you wouldn't mind giving up? And are there three foods that you would truly miss? Talk to your doctor about the foods you will miss most to see whether a compromise can be made. The "special foods" may need to be rotated or scheduled with appropriate portion sizes.

If you feel that you must cheat, work with your doctor to find a creative solution.

Example: When I told one of my patients that alcohol contributed to his high blood pressure, he insisted that he had to have his two martinis nightly. To compromise, I said he could have one martini per night but without the high-sodium olive.

Forget You’re Sick

With my diabetes, the turning point for me came after I collapsed, due to poorly controlled blood sugar that was compounded by anxiety, while visiting Paris with my wife.

What I realized: Ironically, cheating less could give me what I wanted most-to simply forget about my illness. Thereafter, I made it a habit to check my blood sugar before and after meals, as well as to exercise, take my blood pressure pills and eat the right foods.

I'm not perfect. But I make repeated efforts to get it right, and this has allowed me to live with greater confidence and freedom and simply have more fun. I aim for the art of the possible and try to help my patients do the same.

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