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Category Archives: Patient Experience

Real Patient Results – The Accidental Paleo and a Priority Check

Greetings everyone.  I saw a patient yesterday that I have seen for quite some time, and I noticed right away reviewing her chart before going in the room that she had lost 19 pounds since her last visit 4 months ago.  When I went in to see her I asked how she was, and she said she felt great.  Turns out she had gone to see a nutritionist and was following her advice.  Also, she was trying to walk more, but not too succesful with that endeavour.  I asked her what the nutritionist had recommended, and this was her answer.  “Well, essentially I can only eat meat and vegetables.  I can’t eat much fruit and no dairy or grains.  Basically doc, it’s meat and veggies.  And man, do I miss cheese!”  As we reviewed a bit more, you guessed it, she was basically eating a paleo diet without calling it one.  But, here is the kicker.  Once she reaches her goals, the nutritionist says she can slowly introduce things back into her diet and just watch her weight.  She could see in my face that she had finally said something I did not agree with!

So, how was she doing?  As expected she had lost weight (actually 19 pounds in two months since starting this), she had tons of energy, she had lost a total of 9 inches body wise, and “doc I sleep like a log!”  I can’t tell you how many people who go Paleo that swear that they have never slept so good in their entire lives.  It’s so predictable it’s not surprising anymore at all.

Labs you ask?  Well, fasting sugar from last visit was 105, this time 87.  Cholesterol?  Well she takes a statin for cholesterol because her numbers were as such off the meds 283/146/46/208 (Total Chol/Trig/HDL/LDL).  On the meds they had dropped to 197/150/43/124.  In the last two months she had decided to DROP her statin dose to every other day, and her numbers today were 166/73/46/105.  So, her numbers were much better on both the Paleo diet AND her statin every other day.  Then she revealed her secret…she had stopped the statin completely 5 days ago and was hoping to stay off.  I asked her if 1) she was planning on continuing her lifestyle change and 2) if she was willing to re-start the statin if off of it her numbers went back up to worrisome levels.  She said yes to both, and we hatched a plan to keep her off her meds for three months and see how she looks then.  We will recheck her cholesterol and hope we can keep her off the statin, and hope that she continues to lose more weight.  To be continued!

Now quickly, back to the nutritionist and her plan to “phase” things back into the diet after “goals are complete.”  Let me explain something to everyone, if your health related goals are “short-term” goals, you will create nothing but “short-term” health.  Why, why on earth would you do something that helps you lose weight, feel great, and sleep like a log for a while, then go back to your old ways?

Let’s say you made a ton of bad decisions, and get yourself in tons of debt.  You decide enough is enough, and you visit a financial planner who comes up with a comprehensive plan to get you out of debt.  Kill the credit cards, stop the travel, no more eating out etc.  Then he tells you “Once you get out of this hole, we will slowly re-introduce all your bad habits and hope for the best.”  No one in their right mind would say that’s a good plan!  But, since we LOVE cheese, we think re-introducing it after reaching our goals seems reasonable, if not “fair” in some way.  I mean after all, how can we survive without cheese??!  In reality, this is the theory behind every “diet” in the books, and that my friends is why diets don’t work!

Most of us care for and manage our money much more than we do our health.  Where are your priorities?  We put junk in our mouths when we would never think of putting 50 Octane gas into our precious vehicle.  We get the cheapest meat we can find and buy the most expensive cell phone and plan we very well can’t afford.  We afford the expensive car lease but not the gym membership that we so desperately need.  (The Nav and leather seats were only $40 more a month!) Why?  I would love to hear a good answer 😦

Your health is a long-term investment, don’t make it about short-term gains.  Your short-term gains lead to my long-term gains…my bank account that is.

Eat Clean, Be Smart, Think LONG-TERM

-Ernie

 
 

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Real Patient Data on an Insulin Pump Patient Plus 1

I saw a lady in follow up yesterday that was a great addition to our growing list of successful “Real Patient Data” series.  She is a 59 year old obese African American female with high blood pressure, diabetes, high cholesterol and sleep apnea.  I’ve seen her for many years and she has really struggled controlling her diabetes.  She actually ended up retiring a little early from her job over a year ago because she was finding it impossible to care for her diabetes and work at the same time.  We ramped up her insulin for a while and eventually convinced her to go on an insulin pump that should have taken care of things.

After starting the pump we saw a great decrease in her Hemoglobin A1C which dropped from above 12 to10 and then to 9.  The problem is that it got stuck on 9 and we have not been able to lower it much more.  I increased the basal insulin pump rate several times, and it just did not have much influence.  We reviewed her diet and she truly does not eat too much or too badly, but she continue to eat her “heart healthy” oatmeal and cereal for breakfast and other carbs that she has been told for years are good for her.

I have broached the subject of Paleo with her a few times, but she never really considered it.  A month ago I saw her and she was convinced her numbers would be better because she had really stuck to her diet and not cheated at all.  The good news for her is that her A1C dropped!  Bad news is, it dropped from 9.01 to 9.00.  Dejected does not touch where she stood at this point.

I talked to her again about Paleo and asked her what she had to lose?  She is a little different than many patients in that she REALLY wants to control her diabetes, to the point that as I mentioned she retired early to be able to concentrate on doing so.  We went over the entire thing again, I really took the time to explain WHY she could not eat the things Paleo restricts, and she finally realized what I already see…what she is doing is not working!  She agreed to give it 30 days and on her way she went.

She came back yesterday and felt pretty good.  When someone really tries to get better over time, and fails over and over, their confidence gets drained.  She had no confidence that Paleo would work, so imagine her smile when I told her that after 32 days of Paleo, her Hemoglobin A1C had dropped from 9.00 to 7.45, and she had shed 9 pounds.  I might add that we made NO adjustments to her insulin pump prior to starting Paleo, so this can be attributed to her diet as nothing else changed.

Several years of frustration corrected by a simple dietary change.  Will she get off her pump?  Absolutely not.  Will she get her diabetes under control?  I truly believe so as long as she can maintain her current diet.  Will we be able to cut her insulin requirements?  I hope so!  This is a real lady, with a real problem, and real problems controlling it.  She had tried hard the traditional way (heart healthy diet and more insulin) and gotten no where.  I don’t think she’ll be going back to the traditional way any time soon!

I’ll also share a quick story about another patient I saw yesterday.  I had spoken to him and his wife 3-4 months ago about Paleo, and they had agreed to give it a go.  He is mid 50’s and healthy aside from his high blood pressure, diabetes, and the stroke he suffered around a year ago!  They missed their 30 day follow up, so I figured they had not done the diet.  As expected they came in and they did not mention it at all (figure they hoped I had forgotten!)  We went over everything, and his numbers looked great.  His blood pressure was perfect, his cholesterol was lower than treatment goals, and his Hemoglobin A1C was in the “non-diabetic” range.  He smiled, looked at me and said “You see, I don’t need that crazy diet after all!”

That’s when I smiled and said “You are right, your numbers are perfect, and we can be happy with that.  My problem is this…your numbers have been perfect for the 4 years I have taken care of you.  They are always perfect…they were even perfect when you had your stroke!  So are you ok with that, having perfect numbers and having a stroke?”  He looked at me with a little smirk as if to say that I love when I’m right; and I do love when I’m right!

As we talked a little more I discovered that they had indeed taken some of my advice, and changed much of what they ate.  He still ate cheese, but had been able to cut much of the carbs from his diet…just not all.  As we looked at his numbers, we saw that even with these minor changes, we saw improvements in his A1C, Total Cholesterol, Triglycerides, HDL, and LDL.  They are not what I have seen with strict Paleo, but they were something.  I encouraged him to keep trying the best he could, and we would squeeze everything out of his dietary changes that we could.  Take home message: In patient care, 50% improvement is better than no improvement!

I hope these patient experiences do two things for everyone.  First, I hope they encourage all of you doing Paleo to keep doing it, and those considering it to give it a try (especially if you already suffer from chronic disease).  Second, I hope it encourages you to talk to others and try to convince them to change their ways as well.  What better gift to another than to help extend their quality of life and limit chronic disease!

Hope all have a great weekend, and keep a look out next week for the first in a series of collaborative posts with Sarah at ThePaleoMom.com!

-E

 
1 Comment

Posted by on June 22, 2012 in Patient Experience

 

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Why I Do What I Do: Check This Out! (Plus a Little Advice)

I hope most of you read my last post about my high school classmate turned patient who after several years of “gentle” encouragement finally decided to go Paleo and has done great. He texted me yesterday after he read the post and told me he is going strong! He is out of town working, and is faithful to his Paleo ways.

I got a wonderful surprise this morning in my inbox in the form of a comment to this post. Here it is…

Thank you for “bitching” at him to change his life. You have also changed mine, I am his mother and I also have diabetes and he has convinced me to start the diet also. I am feeling so much better and my fasting sugar has gone from 178 to 119 in 2 1/2 weeks and I have lost 5 lbs. Great diet, easy to do and I am proud of him and the support that his wife is giving to him and changing the children’s eating habits also. Thanks again Dr G!

Now tell me, how awesome is that!   My friend had often shared his concern about his mother and his desires for her to come see me.  Of course, I would always challenge him that the best way to help his mom change was to change himself. Well, he has listened, and so has she!

I want to take a moment to really commend these two people for changing their lives and giving Paleo a chance. I do not have diabetes and I can honestly say it would be an extremely difficult diagnosis to deal with. I ask all of you to not only encourage those around you with diabetes to talk to their doctors and try Paleo, but to do so with compassion. Most diabetics do poorly with their diet mainly out of a sense of rebellion; they just don’t want to live the life of, or accept the diagnosis of diabetes. If you do not have diabetes, you simply will never understand what they go through on a daily basis. If you are frustrated with a friend or family member because they won’t “listen,” try to put yourself in their shoes. Compassion, not criticism will ultimately lead to success!

Pass it on…

-E

 

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How an Old Classmate, Now Patient Changed His Life With Paleo

Being a doctor is always hard, but at times it can definitely be harder than others.  Taking care of friends is especially challenging as some of you may have experienced.  Most doctors, I believe, especially those who have long-term relationships with their patients, have more than just a business relationship with patients.  After a while you get to know them well, get to know their whole families (often take care of the whole family!), and you genuinely start to care for their well being on a different level.

When taking care of a friend that process is accelertated immediately.  Around 3 years ago an old high school classmate of mine came to see me.  He is a state trooper, in fact a very good trooper, and works in an area of law enforcement that takes a special person.  Growing up he was skinny as a pole, and I was very surprised to find out that he was a very poorly controlled diabetic.  When he came to see me his numbers were horrible, and he was not caring for himself at all.  That said, it was not all his fault!  He had been diagnosed as a Type 2 diabetic, and was really Type 1.  We tested his pancreatic function and it was essentially non-existent.  We put him on insulin, and so began the several years of too infrequent visits where I steadily yelled at him about having to change his life.

When you are young, skinny and healthy on the outside, and a cop; its very, very hard to change your life.  Youth can make you think you are invincible despite a bad disease, add a badge to that and it’s a nightmare!  He would come in and say all the right things, nod his head in agreeance, and come back the next time with worse numbers.  As his insulin requirements went up I talked to him about switching to an insulin pump.  His wife was worried that he would feel it was a liscence to eat as he wanted.  She was right, but he already thought he held that liscence so what harm could it do?

We put him on a pump and he initially did a little better.  His improvement was of course from the pump, but he was soon able to out eat the pump and his numbers worsened again.  Now before anyone says anything, I had several long and frank discussions with my friend about diabetes, what it would to to him, how his wife and kids needed a dad…all that stuff…even how diabetes would lead to premature erectile disfunction; nothing worked.  He just WANTED his cake and to eat it to (pun intended).  It’s so hard to talk to someone who is young, intelligent, and really knows what is going on; yet does not want to change much of what he is doing.  He hoped that, as his wife predicted, the pump would be his ticket to eating what he wanted.  Despite increasing his insulin, and increasing the amount we bolused him before meals, we got no where.

He started to dabble with CrossFit, that was great, but he still did not address his diet in any significant way.  Now it is easy for people in the Paleo community to just say “change your diet man, it’s easy!”  Most people who eat Paleo do so out of CHOICE…my friend felt he HAD to do it.  It is absolutely human nature to fight anything you feel you are forced to do, and he fought corageously!  Now I think he was right in that he was being forced, but it did not make it any easier.  I continued to see him and do my best to scare him into changing.  When I started Paleo myself I immediately talked to him about it.  He did it for a day or so, even texted me a few pictures of his Paleo meals, but it did not last.

On a recent visit we once again discussed his life and health long term.  He has kids, and life was starting to show him that he is not as invincible as he thought.  We looked deep into his kidney function and I explained that although “normal,” it is nowhere near normal for someone his age.  He realized that his body was changing.  We went over Paleo AGAIN, and he once again told me he would do it.  I didn’t hold my breathe…

I saw him a week ago and for once, he had actually changed.  Even more than that, his MIND had changed that he not only could do this, but that he HAD to.  His wife and kids were with him, she has been supportive, and he finally felt like he was getting somewhere.  More than anything, for the first time I did not have to do any…well, bitching for lack of a better term.  He was on board, he was happy with what he was doing, and he had all the determination in the world to continue.  Essentially I think my friend had finally seen his mortality, and he realized he has way to much to live for not to change his ways.

So what did he accompish in 30 days?

He lost 8 pounds

His fasting sugar went from 198 to 169

His liver functions (AST/ALT) went from 105/51 to 61/37

His Hemoglobin A1C went from 8.46 to 7.32

The numbers are great, but most importantly my friend saw his life for what it is, and he decided to take control of it.  If he follows Paleo the numbers will take care of themselves.  For those who know me they will certainly know who this is about.  He actually ASKED me to be on the blog and wanted a picture posted, but we will withhold for now 😉  He experienced the same thing I did that made me start this blog; the amazement that comes with changing your diet and seeing real results in how you feel followed closely by wanting to tell everyone you know!  I will keep everyone posted on how he does, and once he is a little farther along the way, I’ll try to convince him to write up his experience for all of you. (That statement was absolutely intended to pressure him into doing so!)

-E

 
7 Comments

Posted by on June 13, 2012 in Patient Experience

 

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Real Patient Follow-Up: Amazing Results Continue!

A couple of months ago I posted information on a 65 Year Old Diabetic gentleman who had adatped Paleo and I shared the results after one month of his new diet.  Well, good news, he was back today two months later, and here are his updated results!

Over A Three Month Period:

Weight: He has lost 30 Pounds

BMI: 34.58 (Start), 33.23 (1 month), 30.52 (3 months)

Hemoglobin A1C: Dropped from 7.36(0) to 6.57 (1) to 6.02 (3)

Liver Function Tests: AST/ALT 80/68 (0), 51/39 (1), 40/34 (3)

Cholesterol/Trigs/HDL/LDL: 186/211/45/98, 141/240/33/60 (1), 137/151/38/68 (3)

Now all of this is very impressive, but here is what I found most fascinating.  This was his medication regimen for his diabetes at time 0:

Levemir Insulin 100 Units at night (Long-acting insulin)

Apidra Insulin 20 Units Three Time a Day with Meals (Short-acting insulin)

Glucophage 1000mg Twice a Day

As he has lost weight, he has had to cut is Levemir in HALF to 50 Units nightly, and completely STOP his Apidra with meals. 

If only you could all see the smile on his face 🙂

-Ernie

 
3 Comments

Posted by on June 11, 2012 in Patient Experience

 

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Real Patient Data – A 65 Y/O Diabetic Male

Over time I plan on sharing patient experiences from my practice of people to take me up on my challenge to try a Paleo lifestyle. As the number grows, I continue to be impressed with the early results.

I have taken care of this gentleman for around 3 years. When I first met him his diabetes was tolerable, but not good. The key measurement for a diabetic is what is called a Hemoglobin A1C. It is a way for us to know the patient’s 3 month blood sugar average, and the goal for a diabetic is <7. His was initially around 8.5, and we were able to lower it to 7.5 with medication changes. At that point we got stuck, and began discussing insulin shots. On a recent visit he asked if he had any hope to avoid insulin, and I took the time to detail the Paleo diet, and why I felt it would be beneficial to him. He eagerly accepted the challenge, and went on his way with an appointment to return in 30 days. Here’s what we got…

Traditional Diabetic Diet to Paleo Diet 30 Days

Weight 255 to 245
Blood Pressure 140/80 to 116/70
Hgb A1C 7.36 to 6.57
Total Cholesterol 186 to 141
LDL (Bad) Chlesterol 98 to 60

Remember, we are talking about 30 days here. In real numbers he dropped his average blood sugar from 164.5 to 141.8. Please don’t forget, this is in 30 days, so his prior 60 days not on Paleo are still in the equation. For a true A1C we would have to get 90 day data (which we will in a few months!) If a drug company developed a drug that could get a 0.8 drop in Hgb A1C, they would be sitting on a solid little chunk of gold. Let’s not also discount the significant improvement in weight, blood pressure, and cholesterol. Pretty amazing if I say so myself.

So, what does this mean? We will have to see the sustainability of it as we continue to follow him over time. Now, not everyone may respond as well, and some will respond less. As I continue to interact with my patients, I will continue to fill everyone in on the results. I hope this is an encouragement for some, it certainly is to me.

Ernie

DISCLAIMER: Although I am a physician, this information is not meant as medical advice for you or anyone you know. These are simply my experiences with patients and the Paleo diet. Please consult your personal physician before making any significant changes in your diet or medication regimen.

 

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