Day 12 down, and it was a busy day. Morning started with a quick 2 egg omelette that came out perfect if I do say so myself!
For lunch I had some olives and cantaloupe. Dinner came around and I wanted something meaty but had nothing planned. I heated up some bone broth, threw in some of the meat I had made it with,man’s whisked in an egg. Guess we’ll call it a egg drop bone broth soup, and it was good!
Hope all are well, excited for a weekend off after my call tonight…
Another day down on my journey of food discovery. I had something happen to me today that has never happened…I had the distinct desire to drink WATER! May sound crazy, but I’ve never been a water drinker. In fact, I’ve kind of really not liked the stuff. I think I always just wanted some flavor in my drinks, and the “plain” taste of water never did it for me. I guess that is changing, and I’m excited about that.
For breakfast I sped out the door after grabbing a few dried figs and headed to the hospital. I had a rare treat at lunch as I got to meet my wife and son for lunch along with another couple we are best friends with and their son. The chance to laugh with friends in the midst of a crazy day is always more than welcome. For dinner I roasted off a spaghetti squash and made a quick tomato sauce with canned tomatoes and and ground beef. Man, for some reason it really hit the spot!
This afternoon I had to have a conversation that is never fun. I have a very sweet lady in her 80’s who we diagnosed with pancreatic cancer around two months ago and she came in for a visit today. She is too frail to stand chemotherapy, so she underwent 30 radiation treatments with the hope of shrinking the tumor. The tumor did not respond, and she is out of options. She is weak, tired, hungry but nauseated all the time, and hurting. I’ve taken care of her almost 8 years and we have pulled her through several problems in the past including a broken hip and a heart attack. Some of her family are pushing her to go to MD Anderson for more tests and possible experimental treatment. She asked me what I would do. Over time you establish a real friendship with patients that often goes deeper than just business. You tend to take care of entire families, so the dynamic can be difficult when one of them gets sick. There is no magic bullet for her in Houston, and she is old and tired. If she goes there she will die away from home undergoing treatment that won’t work. I simply looked at her told her I would stay home to die with my family. She asked if she would die from this for sure, and I old her yes, and likely soon. At that point she almost seemed relieved to know what was going to happen. I’m amazed at the strength of her generation when faced with death. She told me she appreciated my care and my honesty, and that she just didn’t want to hurt anymore. We will make sure of that…
Why do I eat Paleo?…because I want to avoid chronic disease. Why am I a doctor?…because I want to try to help people avoid chronic disease. I hope that by living and recommending a Paleo lifestyle fewer people will have to face what my patient now faces.
I pray for her tonight, and I ask any of you so inclined to do so as well. Help her be strong in her time of sickness as God will soon be calling her home.
-E
I tweeted a link to a study today about the use of Statin cholesterol drugs in essentially any patient over the age of 50, and how routine use in these patients significantly lowered their risk for a significant cardiovascular event (heart attack or stroke). Now before you just dismiss this as another example of how big pharma is trying to take over the world, let me tell you why you need to pay attention to this study.
First of all it’s big…like 175,000 people big. In the world of clinical studies, that’s a very impressive number. The more patients take part in a clinical trial the more powerful it is in general. This study took 175K people and showed that even in patients with a very LOW risk for heart disease, statin drugs improved their risk of events significantly. Is this surprising? Not at all!
Several years ago the so called JUPITER trial looked at the ability of statin drugs to lower what is called highly sensitive CRP (hsCRP). Studies have shown a very nice correlation between hsCRP levels and short term risk of heart attack. Levels below 1 are good, between 2-3 are moderate risk, and between 4-10 are high risk for badness. This trial took 18,000 patients with low LDL (bad cholesterol) and no cardiac risk factors and put them on statins vs. placebo. The results were so beneficial for the statin group that the study was called off early to allow the placebo group the chance to take a statin. The marker used to track benefit was a consistent drop in hsCRP in the statin group.
So what does that mean? CRP is what we call a marker of inflammation. A regular CRP measures levels of inflammation throughout the entire body, while hsCRP was developed specifically to look at inflammation in the cardiovascular system. So if we can lower the hsCRP it means that we are lowering the inflammation in the cardiovascular system (easiest way to look at it). In turn, if statins lower hsCRP, then they must have anti-inflammatory activity right?
That is absolutely right. It has always been known that statin drugs have a kind of two tiered mechanism of action. The significant improvement we see in cardiovascular risk seen in patient’s taking statins is too great to be coming only from a simple drop in the patient’s cholesterol. Statins go into the inflamed walls of diseased arteries and block inflammation. They are what we call “Plaque Stabilizers.” Heart attacks and strokes occur when an artery wall is inflamed and swollen with inflammatory markers and cholesterol. A plaque can be “stable” when it is relatively dense, or “unstable” when it is fluffy and chock full of inflammation and fat. One little irritation in the cap of an unstable plaque leads to a lighting fast inflammatory response and acute blockage of the artery with a clot. Anything downstream does not get oxygen; if its heart tissue you get a heart attack, if it’s brain you get a stroke. So statins without doubt lower your risk of heart attack by lowering your cholesterol, as well as lowering the inflammation in your arterial walls. This is essentially fact.
Another action statins have on the inflammatory cascade of heart disease is that they counteract the known inflammatory effects of Omega-6 fatty acids. In our world where the fat pendulum has swung almost completely to the Omega-6 (over Omega-3) side of the aisle, there is no surprise that statins help so much. Again, this is essentially fact.
The mistake that was made many years ago was in believing that statins purely lowered heart disease risk by lowering blood cholesterol levels. Linear thinking led to the belief that lowering dietary cholesterol and fat MUST in turn lower heart disease risk as well. Good idea, just not the right idea! Statins REALLY work through their anti-inflammatory properties to lower cardiovascular risk, but we didn’t figure that out till later! Easy mistake to make, but now that we know the rest of the story, we need to go back and correct our thinking. Unfortunately that is proving more difficult than many of us would like.
One other thing to discuss is side effects of these medicines. I am completely amazed at the generalized fear and misrepresentation of the side effects of statin drugs. They have clear and known potential risks, particularly concerning the liver and with generalized muscle weakness. That being said, I can say in my clinical experience these drugs are generally very well tolerated and safe. I have been prescribing statins for near 11 years in both training and private practice, and I know of one definitive case of rhabodomyolosis (life threatening muscle breakdown) and only a handful of cases involving significant (but fully reversible) liver inflammation from the drugs. Are statins for everyone? No. Are they the most dangerous drugs in the world that should be pulled off the market? Absolutely not. They are safe, and they work.
So, what am I saying? Does everyone need to be on a statin? Well, if we don’t change our dietary ways as a society the answer may be yes! In my humble opinion there is a better way of course! Say for example we significantly curtail wheat in our diet, as well as any other similar proteins that can cause generalized inflammation in our bodies. This should in theory lower our overall CRP levels, and likely our hsCRP levels as well. In addition, what if we concentrated on changing the fatty acid profile of our foods to shift the Omega-3:Omega-6 ratio back to the side of Omega-3s. This would be like turning back the hands of time in our food supply to a time when corn, soy, and wheat did not dominate our agriculture. We know (fact) that Omega-3 fatty acids are not atherogenic so we would easily lower our cardiovascular risks as a whole. With these two actions as a society we would accomplish the same thing as giving everyone a statin. Amazing huh?
The problem is that these changes would be very hard to bring around. It is easy for us to sit on our Paleo high-horses and state the obvious, but it will be a real battle. A fundamental change in the way we raise our protein in America and around the world will be a daunting task. Finding ways to affordably feed the world’s population without a dependence on extremely cheap wheat based products will take years of work. It is not easy, but I feel it must be done.
I hope this helps you think twice next time you see a headline about the benefits of a drug. Before you spout off some diatribe about the evils of big pharma, look closely at what it’s all about. Are statins overused?…according to this study they should be used more! And, we likely WILL use them more. That being said Statins work, they are safe, and most interestingly they teach us a great deal about inflammation, heart disease, and why our beloved Paleo lifestyle works.
I hope this all made sense to everyone. If you have any questions leave a comment or feel free to tweet me at @PaleolithicMD.
In the end…it’s ALL about inflammation!
-E
Well today’s post is not going to be too exciting! I made a quick two egg omelette for breakfast and had some leftover sous vide chuck roast and roasted vegetables for lunch. I ran crazy late getting home from work today and any chance of cooking at home was dashed. I stopped by a local eatery and picked up some chicken wings for my wife and I while the kids shared a steak. Absolutely busy day, and I’m ready for bed. Sorry for the lack of details, but I’ve also finished up a post on statin drugs…see above. Catch yall tomorrow!
Today I stand at the verge of hitting double digits in my 30 day challenge! Tomorrow will be 1/3 down, and I’m pretty excited about it. I was off today which was nice. I started the day doing some home visits for a hospice that I work for. It’s not often we get out in patient’s homes these days, so the visits have become quite enjoyable for me even though it is my day off! This morning I made a two egg omelette for breakfast with my super fresh farm eggs. Yum! My wife and I had the rare chance to grab some lunch today sans kids and we headed to a local burger joint and ate amazing burgers minus the buns of course. Some sweet potato on the side and we were stuffed!
Dinner tonight actually started two days ago when I defrosted a beef chuck shoulder roast from Butterfield Farms and vacuum packed it after lightly seasoning it.
I prepared my Sous Vide Supreme and warmed the water to 130 F. Using my newly purchased metal rack I put the roast in, and let the magic happen for 48 hours…till tonight. I got the roast out and this is what I found!
In the mean time I chopped up a red pepper, yellow onion, and a head of cauliflower and cranked up the convection oven to 385F. I tossed them with olive oil, salt, and pepper and cooked them for around 40 minutes shaking them around every 10 minutes or so.
I removed the roast from the bag and dried it thoroughly. Using my Iwatani Butane torch I browned it nicely all over. As you can see the meat was perfectly cooked edge to edge…Sous Vide style! The taste of the grass fed beef is definitely different, but we all agree better. My daughter (6 years old) inhaled around a third of the darn roast and declared…”Dad, grass fed is the way to go!” This chuck roast was transformed into meat comparable in taste and texture to prime rib. Cheap cut + warm tub + time = Expensive cut results! The best way I can describe the difference in taste is to say that the grass fed beef tastes like a dry aged steak at a steak house. It must be the grass coming through, but it was very enjoyable. Here is what the end result looked like.
All in all, a very good day off. I really want to encourage anyone out there who is even considering a Sous Vide purchase to do it! I bought the Demi version which reportedly has 85% of the cooking area as the more expensive regular sized unit. The cost of $299 is worth every penny. I do not consider this a kitchen gadget, or fluffy luxury, it is an integral part of my cooking equipment on a day to day basis. Even my wife, the “expensive kitchen gadget we don’t need” queen has admitted that I was…wait for it…”right” about how awesome this thing would be. She is even trying to convince her friends to buy one! If you are serious about Paleo and spend the money on Grass fed meat and wild caught seafood you DON’T want to waste your money and improperly cook things. The Sous Vide is like a guarantee that your investment will be worth it.
I hope all had a wonderful day. I will continue to keep posting about my Whole 30 experience, and plan on continuing to share my insights as a Paleo Physician in a very non-Paleo world. I appreciate everyone who follows, comments, and supports my blog. May you all have a blessed evening.
-E
I’ve been reading in the news lately that the FDA is considering approving the use of several diet pills in the next few months. Although the drugs will likely be approved, even the approval committee members are impressed by one aspect of the drugs…their apparent lack of data supporting effectiveness. The rationale for approving them anyway is that they feel physicians need SOMETHING to battle the growing obesity epidemic. It’s essentially an “all we got at this point” attitude. Just think about that!
I would like to give you my experience on prescribing diet pills in detail. I hope that through my eyes you can ultimately see how I feel about them. So, here we go. In 3 years of residency, and going on 8 years of private practice, I have prescribed diet pills a grand total of ZERO times. Have I been asked for them…many, many, many times. Why don’t I give them out?
First is the safety factor. For years diet pills have emerged and one by one they have been taken off the market for unforeseen side effects. Normally these are not run of the mill side effects; they are normally severe cardiovascular ones. In my first few months in private practice I was called to the ER to see a 30’s year old female that apparently had congestive heart failure. I found it odd of course because of her age, and I was curious to talk to her more in detail. Come to find out she had take Fen-Phen for around ONE MONTH a few years earlier, and had developed severe valvular heart disease which had stricken her with chronic and severe heart failure. Just telling me the story you could see that she felt like a fool for having done it, especially since she was not that overweight to start with. What started out as a quest to lose a quick 6-8 pounds had landed her with a chronic incurable problem. As we all know she was not alone, and this drug was fairly quickly taken off the market due to serious cardiovascular adverse events.
It has been 13 years since a weight loss pill has been approved by the FDA. Both drugs up for approval were denied in 2010 due to safety concerns. The first issue seems to be an increase in tumors when studied in rats. In addition, the more serious concern is that the drugs could cause damage to heart valves (sound familiar). Is it worth the risk?
So, what do I tell my patients when they ask for pills? Diets by nature are designed to either be on them, or be off them. You lose weight when on a diet, and gain weight when off a diet. If you can transform a “diet” into a permanent lifestyle change then you have a chance of success long term. Successful long term weight loss on traditional low fat, high carbohydrate diets is uncommon because it is very hard to lose weight in an excess-insulin environment. Read some books by Gary Taubes to learn more about how low fat diets can actually lead to weight gain long term. I agree with him not only because I believe and understand the science, but also because I see it week in and week out in my patients.
Diet pills have always been something you prescribe for a short period of time as they are not safe at all over more than a month or two. Losing weight with pills requires simple steps…insert pill and swallow water. There is no associated change in eating patterns, exercise habits, meal preparation, etc. Diet pills do not lead to CHANGE, they simply may lead to minimal short term gain in the form of weight loss. They do not work long term, end of story. If there was a magic pill, does anyone think there would be a fat doctor on the planet?!
The Paleo diet stops the insulin train and allows you to control your cravings and hunger with an easy to follow long term LIFESTYLE change. You cannot “do” Paleo for a few months and then go back…it just won’t work. That’s the difference between a lifestyle change and a diet plan. One works…one does not.
Do we know for certain that one or both of the diet pills likely soon to gain FDA approval will cause serious side effects? Of course not. Do we know that people taking the pill will gain minimal short term success, and very little if any long term success? Absolutely! How about working on changing school diets, improving access to fresh and local produce/protein, eliminate misleading advertising on products making them look healthier than they are (my personal favorite would be the “Heart Healthy Whole Grain” sign on a box of Lucky Charms), changing the food pyramid to better agree with the science of nutrition as we know it, or something as simple as requiring calorie information on every menu in the country? As long as these ideas are harder than “Open mouth, insert pill, swallow water”…we will continue to lose this battle.
Diet Pills?…just go Paleo instead J
-E
This will be short and sweet as I’m tired, and I have an early morning tomorrow!
Headed out early and dropped my daughter off at school. For lunch I ate some left over Sous Vide Brisket, an avocado, and some watermelon. Man the watermelon is good! We had dinner at my parent’s house to celebrate my brother’s birthday, and they were kind enough to cook Paleo friendly for my wife and I. We had nice big New York Strips, asparagus, and salad. It was excellent indeed!
Today was by far the easiest day to go without diet soda although I had a weak moment and really wanted one this evening. None-the-less, another day of very clean eating. On to tomorrow!
Today makes a week, and that is pretty exciting!
I taught my first sunday school lesson today, and that went pretty well. Fairly intimidating process, but none-the-less it seemed to go over well, and I’ll be teaching again in around a month.
This morning was absolutely crazy getting to church. My wife had to work as a volunteer in the nursery, and I was teaching. In the process of eating some cheerios my son decided he did not like the cup they were in, and proceeded to kick the cup across the room. Bad news…he got in a fair bit of trouble; good news…he may have a future in the NFL as a field goal kicker 😉
Breakfast throughout this fiasco consisted of a hard boiled egg. For lunch I took my wife and mother in law out to a mexican joint with the kids. Had a steak and grilled veggies…it was quite tasty. They are awesome and don’t mind me asking tons of questions about how EXACTLY they are cooking my food! For dinner we ate over at our neighbors house. It is quickly becoming a sunday tradition to eat over there while all the kids play in their pool. I make the main dish, she makes the sides. Of course they are also Paleo followers so it makes the whole thing great. Tonight for the main dish I made a Sous Vide Brisket that I cooked for 48 hours. This is what it looks like when you take it out.
Once out of the bag and completely dried, it’s time to hit the smoking hot cast iron skillet to brown on all sides. I put the skillet on high and let it heat up for 10 minutes so that it’s crazy hot. The results are always amazing.
My neighbor whipped up a few sides of roasted asparagus which were amazing, and the Pesto Spaghetti squash from the Make it Paleo cookbook. We all agreed that this side dish was the winner of the night. Absolutely amazing job by Kathryn on the sides again tonight!
Another great weekend has come to an end. Looking forward to a good week, and for the weekend. This saturday will be my wife and I’s first venture to our local Alexandria CrossFit. It’s about time we get more serious about our physical fitness…and we are ready to go! Hope everyone had a good weekend, and all the mothers had a good mother’s day!
In my practice I see tons of patients every week, and a large majority of them need to lose weight to become healthier overall. Most of them are aware of this, they do not want to be overweight, and have often tried various diet plans over the years without success. Through the course of our normal conversation about their health I typically hear lots of things like…
–> I just don’t know why I can’t lose weight, I don’t eat that much…
–> I did pretty good on diet “X”, but after a good start I stopped losing weight…
–> I’ve been doing really well, I only splurge a couple of times a week…
–> I just need to exercise more and I’ll lose weight…
There is a disconnect between the desires of what and how much they want to eat, and how much weight they want to lose to be healthier. I hear things like “I want to lose weight, but I can’t give up my two cokes a day.” The challenge is to help them see the disconnect in their thinking. It’s not easy…
I’ll admit, there are some patients I feel useless doing so with, but at some point I have to decide to introduce the Paleo diet as an option to them, and then fight their pre-conceived notions about the dangers of fat and cholesterol. Most see a cardiologist, and they have been preached to about for years about the low fat, high carbohydrate diet that is most “heart-healthy” for them. One of our local heart doctors is a firm believer in a vegan diet for his patients. Most hear what he has to say and say there is no way they can follow it. They basically reside themselves to the fact that they will not lose weight, and that their next heart attack or stroke will happen inevitably. This is the backdrop against which I get to approach my patients with about Paleo! The story changes to…
–> It’s too expensive to eat that way…
–> What exactly do you eat if you can’t eat bread and rice…
–> I need calcium for my bones so I have to eat dairy…
–> I don’t eat red meat because it’s bad for me…
Ultimately what I have to do is prove to my patients that Paleo is different, that it WILL work for them. Over time I’ve developed a few a strategies for talking with patients about this, so let’s go over a few.
A common response to hearing the restrictions (as seen by patients) of Paleo is to proclaim what they cannot live without! I can’t live without bread, sweet tea, rice, gravy, potatoes, among others. Some will defend their “healthy” food choices stating that yogurt is good for them, and they need milk for calcium (especially since they drink 2% milk!). What about whole wheat pasta, EVERYBODY says it’s good for you right?!
So I carefully debunk all these misconceptions and present this scenario. Take rice for instance. I ask them “If a doctor came in the room today, and told you that if you ever eat rice again, you will die 30 days after, no questions. Guaranteed death if you touch even a grain again. Would you eat it again?” The answer is (almost) always no!, “I would not eat it again if I was going to die”. So, they just proved without a doubt that they could in fact live without rice. Simple…check please.
Next is the concept of how RADICAL this lifestyle is. They simply can’t imagine life without their favorite things. I explain to them that it seemed that way to me as well when I first heard of it, but that the more I looked into it, the more sense it made to me. I challenged myself to do it for 30 days and re-evaluate at that time. I have not looked back for one second because of how many positive changes I saw in my health and life. So I simply challenge them to the same thing. I ask them to give me 30 days to change their life. Can they honestly not do something for just 30 days?! It is key that they understand that not only do I believe this is best for them, but that I actually DO IT myself! That is the biggest thing they need to hear. At that point it’s simply up to them, can they do it for 30 days?
After all this, many patients are still skeptical, they want the “hook”. They need for me to tell them something they can really relate too. So what is it? What to me makes Paleo different to me?
It’s all about control. For the first time in my life I do not in any way, shape, or form feel the least bit controlled by food. Cookies, cinnamon rolls, King Cakes (a Louisiana Mardi Gras Tradition), gumbo…whatever! can go in and out of my station at the office and I honestly don’t give them a second thought. In traditional diets food always seemed to be in control. Goodies would enter the office and my attention turned to them, and more specifically that I could not have them. It was all about what I could NOT eat, what I felt I could NOT have, what I was consistently depriving myself of. So how am I not depriving myself of bread? Or rice? Or whatever? In truth I guess I am, but it doesn’t matter to me because I’m not hungry anymore. When you eat a certain way and stop feeling hungry or craving things, it’s hard to feel deprived.
Once you make these simple changes in your diet, you in turn slow down the insulin train that makes you hungry at all times…even when you are not hungry, and your emotional tie with food changes. What I find most associated with obesity in my patients is emotion, depression, isolation, boredom, poor self-esteem, poor relationships, etc. When you cut the fuel to these triggers, which I consider to be the hunger carbohydrate based eaters experience, you begin to be set free of all these negative things. Hunger is a pervasive reminder of everything you find bad about yourself. Despite knowing it’s not good for them, carb eaters feel the only path to feeling better is to satiate their hunger. Once they do they get upset about their actions, and the cycle starts to go round and round. Low-fat, High Carb diets lead to hunger and energy conservation through inactivity, which in turn leads to weight gain. Yep, these diets make you gain weight in the long run.
Enter Paleo. You cut the carbs, cut the insulin, and cut the hunger that leads to weight gain. Once you start to succeed, and are not constantly thinking about food, you can start to cut the cord between you and your crutch. In a nut shell your life is not controlled by food. Food becomes a means to an end…you want to live, and to live you have to fuel your body, and you fuel your body with food. For years I spent a life dominated by food. Vacations were all about where we were going to eat, I spent the day wondering what would be for dinner. I would eat out of boredom, not even worrying if I was hungry or not. Now that I’ve erased the hunger, I just don’t care as much anymore. Don’t get me wrong, I still LOVE food! I love to plan and cook meals for my family. I can’t fully explain it…but I’m no longer controlled by food…I can finally ENJOY food! Now I hear things from my patients like…
–> That sounds exactly like me, and I had given up hope I could change…
–> It’s worth a try because I don’t want to feel like this anymore…
–> I finally understand why I’ve failed over and over again losing weight…
Obese people don’t want to be obese. They want to succeed. Once they hear that Paleo can set them free of hunger…that they can take CONTROL of their lives again…I finally see a sparkle in their eye…
-E
Another day down, and all is well! Breakfast consisted of a handful of nuts as I ran out the door. Went out to lunch with my wife and kids and I ordered a diet coke as usual. My wife looked kind of funny at me and asked if I realized I had ordered one! I had to send it back and get my water…total habit! For lunch I had some chicken and a side of fruit. For dinner tonight I was excited to try out the first of our grassfed beef shipment we got in yesterday! I decided to go simple and cooked up some hamburger steaks. To complete the Umami fest I fried up some freerange eggs I also picked up from Butterfield Farms along with some enoki mushrooms from the store. Man…talk about good!
Big day tomorrow…I teach my first Sunday School Lesson at church…wish me luck!
-E
PaleoHikerMD 