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What is Paleo Truly Guilty Of? – Carb Addiction and the Industry That Supports It

When people are passionate about things, they tend to get very defensive.  Question someone’s child, and they are bound to get upset in a hurry.  I certainly do!  So why is it people get so defensive when you start explaining the Paleo diet to them?

Today I saw a lady at my office.  Fairly typical middle-aged, over weight female with poorly controlled diabetes.  She recently started on an insulin pump but her glucose control is no better at all.  I had a suspicion why, and again started to question the details of what she eats.  Of course, she eats carb after carb after carb.  Whole wheat this, and low fat that.  She has tried to cut the carbs in the past, and actually had pretty decent success, but quickly falls back into your carbilicious ways.  Why?  Why go back when a change in diet shows clear improvement in her sugars?

Another gentleman today saw me for his second visit with me.  He changed from another physician because he heard I was good at treating diabetes, and felt his prior physician was not doing a good job.  During his first visit he explained what he was looking for; excellent sugars with minimal medications, and to be able to eat what he wants.  No problem right?!  Over around 20 minutes I proceeded to deflate his balloon to the point it may have actually been a black hole by the end of the visit.  He was very frustrated because his sugars were regularly bottoming out, yet his Hemoglobin A1C (90 day sugar average we use to direct care of diabetics) was still too high.  He was essentially convinced that the labs were repeatedly wrong.  He swore his sugars were always “around 100.”  So, luckily for me, and unluckily for him, I did a 72 Hour Glucose monitor on him.  This is a device that is connected to your belly via a microscopic fiber, and it checks your glucose every 5 minutes for 72 hours.  What did we find?  For three days in a row the pattern was clear…  Every evening his sugar shot up around 7:30 like one of the Blue Angels during an air show.  It would hover around 400 a few hours, then slowly drop overnight.  In the morning, as he would typically skip breakfast it would plummet.  By noon he would eat a “sandwich and chips” and it would shoot up to around 300 for a few hours before things started again before dinner.  So, clearly his prior physician was doing a terrible job (insert sarcasm here) and all I had to do was change a few things up and it would be ok!

On todays visit we reviewed the 72 hour glucose monitor, and I broke it down for him that if HE wanted to control his sugars we could do it, but HE would have to make some significant changes.  What kind of changes?  Changes of OMISSION.  I started to tell him the typical Paleo diet rules…and he became, you guessed it, very defensive.  “But how do I eat a sandwich???….”

I would love someone to please answer this question for me; What is so terribly crazy about the Paleo Diet?  You hear it talked about on the news and they make it sound so revolutionary or “different.”.  Simply stated, Paleo is not about what you eat, it’s about what you DON’T eat.  The Paleo diet does not ADD anything to your diet that is out of the ordinary, extremely controversial, or generally crazy.  Even the devil that is an egg is getting off the hot seat lately.  All it truly does is OMIT certain things from your diet.  But not all diets of omission are so highly scrutinized.  Remove meat and become a Vegan and it’s “chic and trendy,” cut out carbs and it’s reckless and dangerous!  Give me a break!  So why is it so crazy?  Why are people so, and I mean this literally, offended by the notion of changing to a Paleo lifestyle?  It’s because they are passionate about their carbs…

People are addicted to carbs.  Tell a heroin addict you are going to take away their heroin, and they get very defensive.  Tell a carb addict you are going to take away their pasta Primavera and it’s time to break it down Bruce Lee style.  Let’s look at this simply, eating Paleo allows you to eat meat, vegetables, fruit, eggs, and nuts.  All these are 100% natural, nothing fancy here.  Please, how is this dangerous or controversial?  The extra meat you eat to replace the pasta is dangerous?  “But there is no data that so much meat is good for you…”  Well guess what, there is plenty of data that too much pasta is BAD for you.  Want data?  Talk to my two patients above.  They both love pasta, and they are both diabetics in their 50’s who keep eating pasta and can’t control their blood sugars.

Can meat hurt you?  Can vegetables hurt you?  Can fruit hurt you?  Can eggs hurt you?  Can nuts hurt you?  Barring actual allergies, I say the answers are no.

Ok, let’s look at the other side.  Can dairy hurt you?  Can grains hurt you?  Can sugar hurt you?  Can artificial crap hurt you?  I’m going to go with yes on these, and there is science to prove it.  (See rising rates of diabetes, lactose intolerance, fatty liver, cancer, auto-immune disease etc, etc)

So, what is Paleo truly guilty of?  In my opinion, it is guilty of exposing people for what they are…carbohydrate addicts.  It can’t possibly be guilty of making people eat un-natural foods, or unrecognizable concoctions companies sells as “food.”  It’s not a fad diet, as fads make you eat things that come in and out of style.  What is a fad anyway?  It is defined as: an intense and widely shared enthusiasm for something, especially one that is short-lived and without basis in the object’s qualities; a craze.  Last I checked meat, vegetables, fruit, eggs, and nuts have been around a long time.  Probably a little longer than a tortilla chip or fat-free cheese.  A rice cake…now that was a fad!

What do addicts do?  They generally know what they do is bad for them, and they have periods of clarity where they do better.  Eventually though, the pull of their drug of choice draws them back in.  Or, they slip up and use just a little and BAM…right back to square one.  They feel shame for their addiction, people look down upon them for it, and they wish so badly they could make a permanent change, but they always fall back into old habits.  Now, imagine a heroin addict who is advised to control the addiction by sticking with “moderation” because of course, everything is good in moderation right?

Sadly, if you insert carbs as the addiction in this scenario, you might as well see pictures of my two patients above.  They literally can’t imagine life without eating their daily carbohydrates.  There is real fear and confusion when I try to take away what makes them feel best. Heroin is clearly bad for you, but a loaf of french bread or rice and gravy certainly can’t fit in the same category can they?  Well they certainly are not as ACUTELY dangerous for you, but a long-standing addiction to carbs lead to the same result as any other addiction.  Without the same pattern of addiction is there regardless of the “drug” of choice.

What’s worst than that?  Diabetics are told to control their sugars by using the very carbs they are addicted to in “moderation”…and somehow we are surprised that they can’t stop over eating carbs.  As the Hartwig’s in their book It Starts With Food label it, OVER-carbsumption.  Paleo simply OMITs the drug…and somehow it is a bad thing…  The current food pyramid does the same thing with obesity!  Lose weight by eating the things that make you gain weight in moderation.  It’s a lose-lose situation.

Oh, and one more thing Paleo is guilty of.  It makes the sugar people, and the wheat people, and the dairy people, and the soybean people, and the corn people….you guessed it, defensive 🙂  Their “bottom line” is very defensive about their products potentially being a major cause for obesity and chronic disease.  They rely on the government to make sure that nothing about their industry gets labeled as a potential problem.  Can I blame the government?  Yes and No.  But, that’s a whole other blog post entirely…

Meat, vegetables, fruit, eggs, nuts…these actual foods, 100% natural FOODS can’t hurt you.  Instead Paleo is guilty of simply exposing people, industry, pundits etc for who they are.  They are either addicted to carbs, their livelihoods depend on your carb addiction, or their election depends on your carb addition.  It’s sad, it’s true, and I’m afraid it’s here to stay.

-Ernie

By the way, do you agree with this post?  Do you know people who could stand to hear it?  Do me a favor, share it everywhere you can.  Post on Facebook, tweet it to followers, reblog it, pin it on pinterest to your heart’s content.  In many ways I preach to the choir.  Most who follow my blog agree with these concepts because you already follow a Paleo Lifestyle.  But, many do not.  The only way to bring about change is to spread the word!  So, if you want to help, share away!  Thanks for reading, and thanks for your support.  Please comment all you want, conversation is a good thing!

 
18 Comments

Posted by on February 17, 2015 in General Paleo Discussion, Paleo Advice

 

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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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An Update on Things!

Greetings everyone! Just a quick update on how things are going, since I totally suck at consistently updating the blog… I have to be honest, keeping up with posting on a regular basis while keeping up a full time medical practice, being a husband and dad, exercising when I can, and sleeping adequately is hard!! I’m on vacation right now in North Georgia and am enjoying relaxing!

Things are well, kids are growing, and this update will be short as I’m pecking away at my iPad keyboard which tends to aggregate me! So what’s going on?

-The family garden is going well. This is our first actual attempt to grow a garden and we are starting to enjoy the harvest. Regular tomatoes, cucumbers, okra, and ton of peppers so far. Also, our apple trees that we planted 5 years ago have applets this year! It takes years to produce, and you have to hope they cross pollinate….woohoo!!

-I continue to push the Paleo lifestyle in my traditional Internal Medicine practice…and of coarse many patients remain resistant (shocker). That said, I am very pleased that in my small Louisiana town the Paleo community is growing. My good friend and next door neighbor the Fit Paleo Mom even has a special Summer Cooking Series on a local TV station spotlighting Paleo cooking. Honestly guys, if you have not checked out her recipe blog DO IT, it’s great. In the last several years since I began my Paleo life, our small town has really come a long way, and I feel it is very much fueled by the Paleo community. We have two local farms producing grass fed beef, a local organic farm producing amazing produce they sell twice a week (they also sell pastured pork, fresh farm eggs, and are developing ducks to sell), and our local big chain grocery has tremendously expanded their organic produce and food area. Our community is passionate about sourcing our food, and local business has responded.

-I have personally started to push my road cycling. I dabbled in it a few years ago and bought a nice starter Specialized bike. I enjoyed it, but rode off and on. A few months ago I decided to push it, make goals, trying to get faster and better. More than anything the quiet time it gives me is amazing. I cherish alone time, and my bike has become a sanctuary. Cycling is now my main exercise, and I’m loving it. I’m doing what I normally do…reading all I can on improving my cycling and am already seeing the steady results. I entered a local race, the Tour de Bayou 2013 in November. This is very unlike me, as I’m not that competitive by nature. I’m pretty excited though, should be fun (I’ll get a T-shirt too 🙂 ).

-Lastly I’m staring to make it a point to get my kids and I outside much more. With them small my wife and I’s enjoyment of hiking, camping, kayaking etc slowed down tremendously. They just could not enjoy these activities being so small. At Easter we went camping in Texas, and after a VERY cold first night we really enjoyed being outside. Nighttime fireside chats with my daughter were priceless. We are utilizing our love of Geocaching to get outside as well, and if you are looking for a way to get your kids excited about getting outside, CHECK IT OUT! On this vacation we took the kids on a 3 hour river Kayak trip and they absolutely loved it. Kourt and I are so excited as we feel we can start enjoying this part of our life again now that the kids are old enough to tag along, and most importantly enjoy it! We have many plans coming together, the first of which is a 4-5 night canoe camping trip next year…float by day, fireside by night :). This way the kids don’t have to carry much, the canoes can do that for us. Oh how I love being outside…

I’m honest, I’m not as good at updating the blog as I should be. I’ll get better, but I know it will be intermittent while my kids are small. If you want though, please follow my Instagram feed as I update it regularly with my meals and adventures. I really enjoy interacting with you all, and truly love our inspirational community. As always, you can find me on Twitter @PaleolothicMD.

Keep in touch, God bless, and stay safe.

Ernie

 
6 Comments

Posted by on July 26, 2013 in General Paleo Discussion

 

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Restless Leg Syndrome: Is Your Diet Related?

As an everyday part of my sleep practice, I often see patients who complain of problems falling asleep due to symptoms in their legs when they get in bed. It can be anything from “restlessness” to “deep pain” in the legs, but almost always follows a typical pattern. What these patients suffer from is called Restless Leg Syndrome (RLS), and it is more common than you may think. Lets learn a little about it, and investigate whether or not diet can either lead to, or relieve the symptoms of this often misunderstood condition.

Epidemiology: The numbers vary widely in the literature as far as the overall prevalence of RLS across the population, but it’s safe to say 5-10% of Americans suffer from some form of RLS throughout their lives. Importantly, this is not just a disease of adults, as it is felt that the overall prevalence is similar in children as well. In these children, RLS symptoms are often misdiagnosed as “growing pains” and the sleep disruption it causes often leads to night after night of unrestful and disjointed sleep. When adults get tired we get sleepy, when kids get tired they get cranky, agitated, disruptive, and even hyper. Needless to say, many experts believe unrecognized RLS in kids could account for a good number of cases labeled as ADHD. As in many things in sleep medicine, this remains controversial.

Pathogenesis: RLS can be grouped into two main categories, as can many disease states; it is either primary or secondary.

Primary RLS is idiopathic, meaning there is no real identifiable cause. Observational studies point to it being a genetic disease with autosomal dominant inheritance. The underlying genetic defect occurs somewhere in the metabolism of dopamine in the central nervous system, although imaging studies using SPECT and PET imaging of dopamine producing areas have produced often conflicting data. Given that Parkinson’s disease is clearly known to be related to dopamine defects in the CNS, and the fact that Parkinson’s medicines have been successfully used to treat RLS, this is an important area of current research in Neuroscience.

Secondary RLS is felt to be caused by a number of other conditions; in other words, RLS is a symptom of these problems. Here are a few of the most common (and the one we are most interested in).

-Iron Deficiency – Since the original description of RLS, iron deficiency has been considered one of the most likely causes. Study after study have consistently showed decreased iron stores (ferritin) in RLS patients vs. controls. MRI estimates of brain iron concentration in the substantia nigra (the area that makes dopamine) have also been consistently lower in RLS patients. That said, these findings are FAR from universal, so it is only part of the story.

End-Stage Renal Disease – If you take care of hemodialysis patients for very long, you quickly hear the same complaints of RLS pop up time after time. The cause of RLS in these patients has many theories, from iron deficiency to low parathyroid hormone (PTH) levels. Research is ongoing.

Diabetes Mellitus – RLS often co-exists with peripheral neuropathy and can be quite debilitating.

Multiple Sclerosis – The data on RLS and MS is in its infancy, but I can tell you that over half of my MS patients have clear RLS. There is a connection.

Parkinson’s Disease – Although dopamine is related to both conditions, studies have failed to consistently find a link between RLS and Parkinson’s. This is frustrating as both disorders clearly point to the substantial nigra in the CNS as to location of disease. Our hope is that a breakthrough in one disease will lead to a ray of hope in the other. Only time will tell…

-There are many other disease states related to RLS, and often listed in the miscellaneous file are vitamin deficiencies and obesity. We’ll talk more about them later.

Clinical Manifestations and Diagnosis: Here is how UpToDate.com describes RLS.

Although the subjective symptoms of RLS are often difficult to describe, the clinical features are highly stereotyped. The hallmark of RLS is a marked discomfort in the legs that occurs only at rest and is immediately relieved by movement. The abnormal feelings are typically deep seated and localized below the knees. Distribution is usually bilateral, but some asymmetry may occur and the arms can be affected in more severe cases.

Terms that patients use to describe the symptoms include crawling, creeping, pulling, itching, drawing, or stretching, all localized to deep structures rather than the skin. Pain and tingling paresthesia of the type that occurs in painful peripheral neuropathy are usually absent, and there is no sensitivity to touching of the skin.

Symptoms typically worsen towards the end of the day and are maximal at night, when they appear within 15 to 30 minutes of reclining in bed. In severe cases symptoms may occur earlier in the day while the patient is seated, thereby interfering with attending meetings, sitting in a movie theater, and similar activities. In milder cases patients will fidget, move in bed, and kick or massage their legs for relief. Patients with more severe symptoms feel forced to get out of bed and pace the floor to relieve symptoms.

The International Restless Legs Study Group proposed the following four features as essential criteria for the diagnosis of RLS:

1) An urge to move the legs, usually accompanied or caused by uncomfortable and unpleasant sensations in the legs. Sometimes the urge to move is present without the uncomfortable sensations, and sometimes the arms or other body parts are involved in addition to the legs.

2) The urge to move or unpleasant sensations begin or worsen during periods of rest or inactivity such as lying or sitting.

3) The urge to move or unpleasant sensations are partially or totally relieved by movement, such as walking or stretching, at least as long as the activity continues.

4) The urge to move or unpleasant sensations are worse in the evening or night than during the day or only occur in the evening or night. When symptoms are severe, the worsening at night may not be noticeable but must have been previously present.

Dietary Treatment: There are tons of resources on the internet about standard pharmacologic treatment of RLS, and that is not the main topic of this post. What we are going to look at now is common non-pharmacologic treatments for RLS, in particular diet related treatments. Let’s see where this takes us!

According to the RLS Foundation there are multiple foods that should be avoided in order to minimize or eliminate RLS symptoms. These include caffeine, alcohol, ice cream, as well as pasta and bread.

Now you all know this is a Paleo blog, and are you seeing what I just saw? Pasta and bread??? Why? We all know why…say it with me…GLUTEN!

Both Celiac Disease(CD) and Gluten Sensitive Enteropathy (GSE) lead to abnormal small intestine mucosa due to inflammation. This inflammation leads to malabsorption, and this is the pathway which connects it with RLS. We saw above that a classic cause of secondary RLS is iron deficiency anemia. We all know gluten is indigestible by the human small intestine, and it causes some degree of inflammation for anyone who eats it. People with CD or GSE have pathologic inflammation in their gut, thus making it impossible for them to appropriately absorb dietary iron. Give these people long enough and their ferritin and iron levels get low enough to put them at risk for developing RLS symptoms.

So how related are CD and RLS? Lets look at some clinical data for answers. One study showed the incidence of RLS in CD patients to be 35%, of these, 40% also had iron deficiency. In another study, 31% of CD patients had RLS vs only 4% of the control group. Also, iron levels in this study were statistically significantly lower in the CD patients with RLS than in those without the disease. BUT, after all was said and done, no clear correlation was found in this study between RLS and either a gluten free diet or iron metabolism.

Yet another study showed that GSE antibodies were NOT associated with RLS unless there was an associated underlying anemia. Everyone confused yet?! Let’s look at one more thing before we try to figure all this out.

Interestingly enough, another commonly recognized cause of secondary RLS is magnesium deficiency. Many people with RLS are amazed to see a rapid resolution of symptoms simply by taking OTC magnesium supplements…but not all get relief. Why do some get relief, and some not? Why do very controlled studies show some people get complete resolution of RLS symptoms when adapting a gluten free diet, and other get no relief at all?

Conclusion: Lets say your mom has RLS, and her mom had RLS, and her dad had RLS…what are your chances? I would say pretty good. In this case, there is clearly a autosomal dominant gene being passed down through the generations causing RLS. That gene leads to a yet unknown defect in dopamine metabolism in the substantia nigra of your CNS, and thus to your RLS. Gluten is no where in this picture! Although many want to believe that Paleo can fix everything, it simply can’t. Lets say one day your car stops running, and after checking it over you realize it’s just out of gas! You fill her up and she fires right up. I think we would all agree that your view is skewed if you believe that no matter what happens to your car, if it stops running, all you need to do is put gas in and it will work. Gas is not the only necessary part of your car to make it run! Likewise, gluten is just a piece of the puzzle.

That said, gluten can be and often is an important issue to address in RLS. What is the pathway to a gluten free diet improving RLS symptoms? First of all, you have to have RLS that is secondary in nature, not primary. Next, the cause of your RLS needs to be either iron deficiency anemia or magnesium deficiency. (I by no means believe these are the only two nutritional causes of RLS, but they are the most common and most studied) Now, if your iron or magnesium deficiency is caused by malabsorption from CD or GSE, you may be in luck! This pathway explains why we have such variable results in studies concerning gluten, iron metabolism, and RLS. For someone’s RLS to respond positively to a gluten free diet they not only need to have an underlying gluten problem, but that problem must also be leading to clinical iron or magnesium deficiency. If we look at one of the studies above where the incidence of RLS in CD patients was 35%, and only 40% of those had iron deficiency; that means a gluten free diet will likely only help 40% of 35% of the original study population! Even that is if you get 100% response to the diet in those who are “primed” to respond.

One of my biggest messages I try to get out through my blog is that although adapting a Paleo diet can do amazing things for your life and for your health, it can not substitute for traditional Western medicine in every instance. If your RLS is related to dopamine (in other words, genetically handed down), and you want relief of your symptoms, it’s best if you see your doctor and get a prescription for medicines that will increase dopamine in your CNS. You can go gluten free forever and never get the results that you need. Do not become single minded, it won’t get you anywhere but walking around at midnight again frustrated and tired.

In the end RLS is a very important cause of morbidity in America, and around the world. How do I use this information in my practice?

-In RLS patients I often recommend a trial of gluten free diet to see how symptoms respond, particularly in patients with no family history of RLS, or a positive family history of CD.

-In iron deficiency anemia patients who fail to respond to iron replacement, I often test them for CD as an underlying cause of malabsorption.

Think you may have RLS? Talk to your doctor or contact a local board certified sleep physician to get evaluated. I often used to tell patients that RLS would not kill them, it would just make them want to kill themselves. Recent data showing how short sleep times, in and of themselves, can increase overall mortality has me changing my tune. That topic though…is for another blog post in the future!

I hope this post finds you all well, God Bless.

Ernie

PS – Because it’s fun to share, I thought I might give yall my two favorite “home remedies” that I’ve heard over the years for treating RLS. Now please, I DO NOT RECOMMEND THEM, just sharing. One gentleman told me his best method was putting homemade charcoal in a sock, smashing it up a bit, and rubbing the sock all over his legs before bed time. The blacker his legs got, the better he said he slept.

This can only be outdone by the man who told me after years of experimenting, he found that rubbing paint thinner on his legs at bedtime led to a nice sound sleep…….. I quickly made sure neither he or his wife smoked! You just can’t make this stuff up…!

Sources:

Restless Leg Syndrome Foundation: About RLS

UpToDate.com Section on RLS

Dig Dis Sci. 2010 Jun;55(6):1667-73. doi: 10.1007/s10620-009-0943-9.

Celiac disease is associated with restless legs syndrome.

Weinstock LB, Walters AS, Mullin GE, Duntley SP.

Source Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63141, USA

Mov Disord. 2010 May 15;25(7):877-81. doi: 10.1002/mds.22903.

Restless legs syndrome is a common feature of adult celiac disease.

Moccia M, Pellecchia MT, Erro R, Zingone F, Marelli S, Barone DG, Ciacci C, Strambi LF, Barone P.

Source Department of Neurological Sciences, University Federico II and IDC Hermitage Capodimonte, Naples, Italy.

Acta Neurol Belg. 2011 Dec;111(4):282-6.

Prevalence of gluten sensitive enteropathy antibodies in restless legs syndrome.

Cikrikcioglu MA, Halac G, Hursitoglu M, Erkal H, Cakirca M, Kinas BE, Erek A, Yetmis M, Gundogan E, Tukek T.

Source Department of Internal Medicine, Bezmialem Vakif University, Medical Faculty, Fatih, Istanbul, Turkey

Sleep Med. 2009 Aug;10(7):763-5. doi: 10.1016/j.sleep.2008.07.014. Epub 2009 Jan 12.

Celiac disease as a possible cause for low serum ferritin in patients with restless legs syndrome.

Manchanda S, Davies CR, Picchietti D.

Source University of Illinois at Urbana-Champaign, College of Medicine, 506 S. Mathews Avenue, Suite 190, Urbana, IL 61801, USA.

 
8 Comments

Posted by on April 23, 2013 in General Paleo Discussion

 

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In Defense of Paleo: No WORDs Needed!

Courtesy of a Quick Google Images Search or Two…

Problem:

Cause:

SAD

Carb Consumption/Obesity DIRECTLY Proportional

Affect:

Adult Obesity Related Diseases

Incidence of Diabetes

Incidence of Childhood Diabetes

Incidence of Vascular Disease (Flat Line)

Incidence of Heart Attack (Flat Line)

How Many Are Diet/Obesity Related?

Solution:

P-A-L-E-O

The End…

-E

 
25 Comments

Posted by on September 10, 2012 in General Paleo Discussion

 

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My Take on the New Diet Pills Approved by the FDA (Do You Really Need to Ask!)

I’m sure many of you have seen that two new “Diet” pills were recently approved by the FDA.  Once I saw this, I braced myself for the inevitable flood of people coming to my office asking to be prescribed the latest quick fix; and as expected, I was not disappointed.  I’ve had at least 10 people over the last month ask for one of the new pills, and I thought this would be a great topic to discuss in this setting.  I’ve mentioned in prior posts that in my 15 years of training and private practice I have prescribed diet pills a grand total of ZERO times.  So, will these new medicines change my habits?  Lets look and see what we got.

Qsymia is a combination of phentermine and topiramate and has been approved by the FDA for “chronic weight management in adults who are obese, or overweight with at least one weight-related medical condition such as high blood pressure, Type II Diabetes, or High Cholesterol”.  [I would vote that these conditions, although they are “weight” related, should be more properly described as “nutrition” related…but I digress]  That is a quote from the product web page, and lets keep the information coming from the same source, the producers of Qsymia:

-The effect of Qsymia on cardiovascular morbidity and mortality has not been established. [emphasis added]

-The safety and effectiveness of Qsymia in combination with other products intended for weight loss…has not been established.

-Qsymia can harm your unborn baby.

-Qsymia can increase your heart rate at rest.

-Qsymia increases the risk of suicidal thoughts or behavior.

-Qsymia may affect how you think and is associated with difficulty with attention and concentration, memory, and word-finding. Therefore, use caution when operating hazardous machinery, including automobiles [emphasis added]

-The most common side effects seen in Qsymia clinical studies were tingling in the hands and feet, dizziness, change in taste, trouble sleeping, constipation, and dry mouth.

Because Qsymia contains phentermine (a pharmacologic cousin to amphetamine) it is classified as a federally controlled substance, indicating it can be abused or lead to drug dependence.  It’s basic mechanism of action is to reduce hunger and increase the release of serotonin and dopamine in the brain.  It’s important to note that topiramate, also known commercially as Topamax is a seizure and migraine medicine that just so happens to make people feel full.

The other drug recently approved is called Belviq (lorcaserin hydrochloride) and is approved for essentially the same indications as Qsymia.  Again, let’s look at the package insert for some indications and cautions:

-The safety and efficacy of coadministration with other products for weight loss have not been established

-The effect of Belviq on cardiovascular morbidity and mortality has not been established [emphasis added]

-Warnings and Precautions were listed for:

1) Serotonin Syndrome or Neuroleptic Malignant Syndrome – which means this drug should be VERY cautiously given with traditional antidepressants

2) Valvular Heart Disease

3) Cognitive Impairment

4) Psychiatric euphoria and dissociation

5) Monitor for depression or suicidal thoughts

Most common adverse reactions (greater than 5%) in non-diabetic patients are headache, dizziness, fatigue, nausea, dry mouth, and constipation, and in diabetic patients are hypoglycemia, headache, back pain, cough, and fatigue.

Belviq’s mechanism of action is that it stimulates brain receptors for serotonin, a neurotransmitter that initiates feelings of fullness.  Basically, both of these drugs try to trick your brain into thinking that you are full.

So, will I prescribe any of these medicines for my patients?  Well you guessed it, the answer is no!  The reason is simple, SAFETY.  We may all remember Fen Phen, a diet pill from some years back that was taken off the market due to causing serious valvular heart disease resulting in congestive heart failure.  I remember vividly being called to the ER soon after I moved back to Louisiana to admit a young lady with heart failure.  I remember thinking it odd that a 32 year old female would be in severe heart failure, but the mystery was revealed once I got to the ER and spoke to her.  Turns out she had taken Fen Phen for TWO WEEKS in an effort to lose a few pounds and fit in a dress for a friend’s wedding.  She developed severe Mitral Valvular Heart Disease and resultant heart failure.  She had a valve replacement, but it never worked well and she had severe chronic congestive heart failure as a result.  The look on her face telling me the story said it all…”I was an idiot, looked for a quick fix, and look at me now.”  I really felt bad for her.

A year ago both of these drugs came up for FDA approval and they were denied…why?  They were not felt to be safe from the cardiovascular standpoint, and both seemed to have significant teratogenic effects.  It is simply not known if these drugs can potentially cause the same valvular heart disease that Fen Phen caused.  Now look, I’m not at all saying they will, but information from the MANUFACTURERS themselves clearly state that the risks are unknown.  Also not, the Phen is Fen Phen…yep, it’s short for phentermine.  The FDA stated that the medicines were given approval essentially because doctors needed “something” to combat the worsening obesity epidemic.  I see it as a basic act of desperation from the FDA, and truthfully I understand their viewpoint on this.  Do I agree with it? No, but I understand where they are coming from.  Regardless, this physician won’t be writing out scripts for these meds any time soon.

Now that I got this out of the way, let me make one simple point for anyone out there considering asking their doctor for one of these pills.  There is the misconception out there amongst many people that diet pills are an answer.  Some great conspiracy is holding back doctors from prescribing these meds and we should all be thinner and get to eat more of the things we want without consequences.  Well, let me ask you a few questions…

-If these pills worked, would there be ONE FAT DOCTOR IN THE WORLD? I may not be able to prescribe these meds for myself, but I certainly have 50 buddies on speed dial that could.  Think about it!

-Let’s take it a step farther, would there be any fat people in the world at all, especially those with money? Ever seen a fat rich person?  Sure!  There are plenty around.  Would there be ONE FAT RICH PERSON in the world if it was as easy as finding the right pill?

If you make a statement about your plan to lose weight, and the word “diet” is somewhere in the sentence, just give up because you are going to fail.  By definition a diet is something you are either “on” or “off”.  You will likely lose weight while on it, and gain it back when you get off it.  So essentially all “diets” will result in a yo-yo affect to your weight.

One other thing, the FDA has approved these medicines as “an addition to a reduced-calorie diet and exercise program.”  They are not designed to simply remove the weight without requiring any effort from the patient.  What does that mean?  If you simply take the pills and do not change any of your already bad habits…you will fail again in improving your health longterm through significant weight loss.

There are certain things in life that are easy, and some that are hard.  There are also differences in how difficult or hard those same things are for some to achieve versus others.  Take a look at this well demonstrated problem in America…

Obesity is a very complex problem and it’s rise in America is multi-factorial: lack of exercise, reliance on cheap food built on the backbone of highly processed carbohydrates, poverty, lack of nutritional education, reliance on “quick-fixes” as a society, government subsidies on corn and soy, the gradual extinction of cooking at home combined with increasing numbers of families chronically obtaining dinner through the car window, lack of sleep, an abundance of stress (and cortisol) in our lives!, manipulation of the food supply to promote weight gain, etc.  I could go on and on.  So, REALLY, does ANYONE think a little pill can even put a dent in any of this?

How do we fix obesity?  Well, it’s not easy, but we must get at the root cause if we are to get anywhere.  My motto is Real Food…Real Health.  In the end, the beginning of the end of obesity must itself begin with a transition back to eating Real Food as a society.  I’ve seen it around the web and twitter as JERF (Just Eat Real Food).  This must start on an individual level, with individual families deciding that enough junk is enough.  My family has made that choice, so can yours!

Know anyone thinking about asking their doctor for one of these new pills?  Invite them to read this post, and then ask them to join you on a journey to Real Health by emphasizing Real Food in their life again.  Need more information?  Browse around my blog for ways to change your life.  Are you a reader, check out It Starts with Food by my friends Dallas and Melissa Hartwig.  Don’t know where to start?  Easy…JERF!

-E

 
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Posted by on August 25, 2012 in General Paleo Discussion

 

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A Physician’s Manifesto: In Defense of My Profession in Our World

This weekend the Ancestral Health Society had its annual symposium in Boston, MA.  Unfortunately for me I was home (on call none the less!) and was forced to follow the proceedings via the Twitterverse.  I also recently posted about how my change to the Paleo lifestyle has affected the way I approach three common chronic diseases: Hypertension, High Cholesterol, and Diabetes.  Several comments I read from the AHS and that I received on my blog post have got me thinking, and I need to get a few things off my chest.

First of all, I must confess to everyone that although I run a blog site called PaleolithicMD, I am still a common variety Internist in the South of our great nation.  I absolutely push Paleolithic nutrition to everyone in my practice, but it does not in any way stop me from prescribing medicines to my patients on a daily basis.  I am forced to ride the fine line between strict Ancestral Medicine and Modern Day Medicine.  Some may say that is a negative, I even had one comment from someone who chose not to apply to medical school because he could not deal with people who simply want a pill to fix everything.  I find that unfortunate, but respect the opinion none the less.

I had several responses particularly to my stance on aggressive treatment of hypertension.  Several kind readers directed to me to articles stating that the treatment of chronic hypertension with medical intervention to prevent disease is weakly supported.  What concerns me is the “blanket” nature of people’s opinions about high blood pressure.  I, like most practicing physicians in America and around the world routinely review the latest scientific journals pertaining to our field of specialty.  We are true life long learners, one of the aspects of my job that I most enjoy.  That said, arterial hypertension is a systemic disorder, with wide ranging system consequences.  Chronic untreated Hypertension is/will (among others):

-The most common major risk factor for premature cardiovascular disease 1

-Directly lead to Left Ventricular Enlargement and consequently chronic systolic Congestive Heart Failure and increased incidence of ventricular arrythmias 2

-The most common and important risk factor for ischemic stroke, the incidence of which has been shown to be markedly reduced with effective BP control 3

-The most common risk factor for the development of intracerebral hemorrhage 4

-Major risk factor for chronic and end-stage renal disease 5

It is cool and sexy to take a universal stand against all medicine, it must ALL be bad for you.  Not only that, EVERYTHING can be cured by changing one’s diet right!  Take this tweet for instance…

Disease can be prevented, treated and cured by food. Amazing results from research & studies being presented at #AHS12. Totally blown away!

What a far ranging statement!  Most common “Paleo” folk live in and out of gyms, hang out with their fit friends, and search far and wide for the cleanest restaurants to eat at.  We (I include myself in this crowd) source the best farm raised protein and organically grown produce…we live in this perfect little sustainable world!  I live in this world, but I also live in a very different world; one where I take care of very sick individuals.  How am I to care for critically ill patients without medicine to give them, or surgery to fix things? This leads me to my two favorite quotes from today on twitter, both from Dr. Wahls.

“Superior doctors prevent disease. Mediocre doctors treat impending disease. Inferior doctors treat actual disease.”

and

“The doctor of the future will give no medicine. You guys are the doctors of the future. I salute you.”

Let’s talk about each of them in turn.  The first quote is, how can I put it, an incredibly arrogant and asinine thing to say!  What Dr. Wahls is doing is playing to her crowd.  She figures she is in front of a group of AHS attendees who WANT to hear something like this.  Why not make a ridiculous statement and get a few oohs and aahs (I wasn’t there, so I admit some speculation here!)  Her statement takes a very far reaching stance that is dependent on one important thing…that ALL DISEASE is completely preventable by proper nutrition or following the right “Protocol.”  Make no mistake, her story is remarkable and inspirational, but it is not grounds to advocate that all disease is preventable, and that the only “superior” doctors are those who prevent disease.  I guess the ER physician who initiates the life saving care of a motorcycle victim, or the radiologist who diagnoses his injuries, or the trauma surgeon who saves his life from a ruptured spleen, or the orthopedic surgeon who repairs his broken bones, or the nephrologist who temporarily supports his kidney function through hemodialysis, or the critical care specialist who keeps him alive in the ICU until his body starts to heal itself, or the Internist who takes over his care once out of the ICU and methodically advances his care, or the Physical Medicine & Rehabilitation physician who expertly crafts his rehab program…I guess none of these doctors are “superior”…in fact, they are surely “inferior.”  One can read a statement like this by Dr. Wahls and feel all nice and tingly because WE can do this, WE can fight disease through Ancestral Health alone, WHO needs inferior doctors!!!  I can just hear William Wallace himself yelling “But they can’t…take away… our BACON!!!”  What if that motorcycle victim is your dad, or husband, or son…what about those inferior doctors now?  Is all disease preventable by eating more bacon and coconut?  I won’t answer that, you can do that on your own…  You may take this as simply a doctor being defensive, but that is not the case.  Thousands of doctors will be away from their families tonight on call caring for your loved ones with a great deal of compassion and heart.  I refuse to accept a fellow physician downgrading the status of 99% of her fellow physicians simply to get a rise out of a crowd or to advance her personal agenda.  Say what you will, so will I.

So what about the “doctor of the future” comment?  Amazing, talk about playing up to the crowd again with another far fetched statement.  I guess the future will have no doctors nor need any doctors.  All everyone will have to do is read a book on how to eat and live, and we’ll all live to be 120 years old.  Seriously, who will need a doctor?  Again, this is a “cool” statement to make, but it’s just ridiculous in my opinion.  You may agree with her, or just hope she is right, but I can assure you she is 110% wrong.  What will a doctor without medicine do for a broken bone, or a gunshot wound, or a pneumonia, or an appendicitis, or a cataract causing blindness, or a skin cancer caused by SUN exposure, or a congenital heart defect, or an abscessed tooth, or a kidney stone, or a… I hope you get my point.  The thought that the only thing doctors in the future will do is prescribe you their nutritional “protocol” is terribly short sighted and misleading.

Let me explain to everyone where I live, I live in REALITY!  One of the main reasons I started my blog was to stress that there is a real and valid place for both Paleolithic Nutrition AND Modern Medicine in each and every person’s life.  INCLUSION rather than EXCLUSION.  I agree with each of you who is saying things like “but wait, if everyone ate Paleo we wouldn’t have as much heart disease, or diabetes, or high blood pressure, or autoimmune disease, or osteoporosis, or whatever…”  You know what, I think you are absolutely right, but I also believe strongly that Paleolithic Nutrition is not going to be taking the world by storm any time soon.  My job as a doctor is multi-faceted.

-My primary role is to catch people early, before chronic diseases set in, and get them to buy into the idea that their actions, particularly through what they eat, can and will significantly affect their health both short and long-term.  As I like to say, Real Food…Real Health.

-My secondary role is to treat those who have not followed the right lifestyle and consequently have developed any number of chronic diseases.  The most exciting ones are those who are willing to re-adapt their lives and change the habits that got them in trouble in the first place.  The use of medication in these patients is necessary and frequent, but is also often diminished if they can adapt to following a strict Paleo lifestyle.

-My final role is to treat those who will simply not listen to what they are doing wrong, and want to live life the way that they please.  I have said it many times that I believe strongly in NOT JUDGING people in any aspect of life (no, I’m not perfect in this).  What am I to do if someone is unwilling to adapt their diet? Fire them as a patient?  Refuse them treatments that HAVE been proven in studies to help them live longer lives?  If I run a Paleo-Only medical practice I will do two bad things: go broke, and miss out on the amazing relationships and interactions that I have with most of my patients.  You see, just because someone will not give up their carbohydrates despite their terrible blood sugars does not mean that they are not a wonderful person, or that they don’t get benefit from seeing me.  Likewise, just because a physician will not abandon all modern practices and preach only a Paleo lifestyle as the treatment for chronic disease does not make him or her “inferior.”  

So many people advocate for social tolerance all the while berating the many American’s who for whatever reason, cannot adapt to the lifestyle we find so helpful to us.  Or for that matter, look down upon the majority of doctors who simply “push pills” to the benefit of them and the all powerful and evil drug companies.  What about the grandma with pneumonia, or the grandpa with a broken hip, or the mother of two whose husband left her and tried to kill herself, or the 17 year old college student with meningitis…what do I do, hang an IV of bacon fat or pureed beef liver and hope for the best?

This is not us against them, or “superior” vs “inferior” doctors, this is simply the story of humanity played out for all to see.  I’ll say it again, be INCLUSIVE and not EXCLUSIVE.  I absolutely love my job; I enjoy finally breaking through to the diabetic who agrees to give Paleo a try just as much as I enjoy laughing with the 86 year old who knew he was having a stroke because his cigarette kept falling out of the right side of his mouth.  I admitted this gentleman to the hospital, worked him up, put him on Aspirin, and sent him home…where he picked right back up smoking.  I can get mad at him, or just understand my role in his life.  What did he do about all this? He laughed!  The German’s didn’t kill him on the beaches at Normandy, and he’s not too concerned about what the cigarettes are doing to him at this point.

There is nothing inherently bad about you if you can’t fellow a 100% Paleo diet, nor is there anything particularly special about you simply because you can.  I see you as an amazing human being with as much to offer me as I have to offer you.  Guess all this makes me and Inferior doctor…and I’m very proud of my work and the influence I have on people’s lives.

Thank you. I came here tonight… and I didn’t know what to expect. I’ve seen a lot of people hating me… and I didn’t know… what to feel about that, so… I guess I didn’t like you much either. During this fight… I seen a lot of changing: the way you felt about me… and the way I felt about you. In here… there were two guys… killing each other. But I guess that’s better than million. What I’m trying to say is… if I can change… and you can change… everybody can change!          -Rocky Balboa

-E

PS – Also, check out this like-minded quote from Dr. Emily Deans at her blog Evolutionary Psychiatry.

1 Established risk factors and coronary artery disease: the Framingham Study, Am J Hypertension. 1994;7(7 Pt 2):7S.

2 Prognostic implications of left ventricular hypertrophy. Vakili BA, Okin PM, Devereux RB Am Heart J. 2001;141(3):334.

3 Randomized double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Staessen JA, Fagard R, Thijs L, Celis H, Arabidze GG, Birkenhäger WH, Bulpitt CJ, de Leeuw PW, Dollery CT, Fletcher AE, Forette F, Leonetti G, Nachev C, O’Brien ET, Rosenfeld J, Rodicio JL, Tuomilehto J, Zanchetti A Lancet. 1997;350(9080):757.

4Risk factors for cerebral hemorrhage in the era of well-controlled hypertension. Melbourne Risk Factor Study (MERFS) Group. Thrift AG, McNeil JJ, Forbes A, Donnan GA Stroke. 1996;27(11):2020.

5Elevated blood pressure and risk of end-stage renal disease in subjects without baseline kidney disease. Hsu CY, McCulloch CE, Darbinian J, Go AS, Iribarren C Arch Intern Med. 2005;165(8):923.

 
81 Comments

Posted by on August 11, 2012 in General Paleo Discussion

 

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