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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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The Road to Fitness: Exciting Application of Paleo to Weight Loss Surgery Patients

Wanted to share a very interesting and exciting program I will be getting started with tomorrow.  Our local bariatric surgeon Dr. Sam Bledsoe has teamed up with myself and William Albritton, a first class trainer from our local Alexandria Crossfit, to put together an 8 week “The Road to Fitness” class.  Sam and William came up with the idea and asked me to come on board, but William is truly the work behind the program. Dr. Bledsoe has recruited 8 patients who have all had successful weight loss surgery and have lost over 50% of their pre-surgery body weight, but have reached a plateau and are unable to reach their ultimate goals.  They will go through the following program.

-Tomorrow night we kick it off with an Introduction covering the program overview, an introduction to crossfit, and a nutrition review discussing Paleo concepts (Will be encouraged to follow Whole 30 guidelines for first month)

-Over 8 weeks they will be scheduled for a series of physical activities including introductary low level crossfit WODs which will be adaptable to their current abilities and individual/group exercise away from the box

-They will maintain daily food logs which will be reviewed weekly by the coaches

-We will also have several get togethers to exchange Paleo recipes and food

Weight Loss Surgery patients are like any other patient, and the concepts of the Paleo lifestyle are a great way to kickstart their weight loss again, help them reach their goals, and further limit their exposure to chronic disease long term.  We will also be getting a group of people to utilize CrossFit who normally would be very intimidated to even show up for an introduction class.

Win-win all around!

Hope all have a great day, and please wish all our participants luck!

-E

 
2 Comments

Posted by on June 21, 2012 in General Paleo Discussion

 

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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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Keys to Paleo Success Part 4: Being Conscious

In the final part of this series on my keys to Paleo success we will talk about consciousness; not being awake, but being alert!  Together with cooking, understanding, and patience this will conclude the series on keys to success.  How conscious you are on a day to day basis may ultimately determine just how successful the Paleo lifestyle will be for you.

Eating: It’s fairly obvious that you must be supremely aware of what you are eating to be successful.  There are certain areas though that I think are more important as they are the most likely to make you slip up. 

Although I don’t encourage calorie counting to my patients, I do ask my patients to be conscious overall of how much food they are eating.  Eat slowly and enjoy your food that way you give it time to settle and for your natural sense of satiety to kick in.  It is not uncommon to overeat even while eating clean.  There is a sense at times that since the food is clean, you can eat as much as you want.  Although technically true, try to be aware of what your body really needs and not just what you think it wants. 

When you are shopping at the grocery always be aware of this; even when you have multiple food choices, there is almost always one that is better than the other.  For example choosing a leaner cut of meat will be better than a fattier cut.  By all means, eat a ribeye at times, but fit in some leaner meats as well.  I want you to also read every label you can in the grocery.  Even when you think that you know what is in there, check again.  Are there nitrate free choices for some of your meat choices?  If so, try to get them as often as you can. 

Also take the time to ask your grocer, or preferably a butcher or meat farmer where the meat you are buying is from, what it is fed,  and how it is raised.  Do not feel obligated to eat only grass fed meat; although optimal, it is not possible or practical for many people out there, even myself at times.  Lastly, look at anything that is processed in any way with skepticism.  As my goal is 90% compliance with my Paleo diet, I very rarely blatantly eat what I know is not good for me.  I look at what I consume that is processed, or not prepared by me as being unclean, and it accounts for my 10% fudge factor. 

Eating is an absolute joy for me, and it should be for you as well.  When you do it consciously, ALL the time, it can be fun and enjoyable instead of the dread it has become for many.

Feelings:  I want you to be completely aware of how you are feeling at all times.  Before you eat make yourself aware of just how hungry you are.  While eating, enjoy how the food makes you feel, and eat slowly enough to feel how full your meal is making you before you overeat.  Tie your feelings together with eating in every way that you can and it will really help you be more successful.

One key are of feelings I want you to be aware of is how certain foods make you feel, especially pay attention when you cheat.  Everybody reacts differently to foods, and even to non-Paleo foods.  I have learned over time what kinds of foods I can and can’t cheat with if I expect to feel well.  Keeping a food diary early in your journey will really help with this are of your lifestyle.  You want to be able to look back and say “I feel really sluggish, what could I have eating in the last few days to cause this?”  Is your stomach more unsettled than usual?  It’s probably something you ate!

Another thing to really pay attention to when you cheat is WHY did you cheat?  If you are like me, emotional eating can be a problem.  Don’t just look back at cheats and see how they made you feel, but look at what emotions led to you cheating.  Over time you can analyze what circumstances or emotions trigger cheating so you can control them.  You want cheating to make you feel GOOD when you do it because there is no guilt involved, but that will take time and patience to achieve.

Are you hurting somewhere that you normally don’t day to day, or after a workout?  I’m not talking about typical soreness post workout; you know when something is not right. People come in to the office all the time and complain to me about something.  I talk to them about it, and come up with a plan to figure out what could be causing it.  Commonly the patient then says something along the lines of “It’s not that big a deal, let’s just not worry about it.”  Symptoms are your body’s way of talking to you.  People who ignore their symptoms are the one’s that end up with medical conditions or injuries that could likely have been prevented with earlier intervention.  If you feel something is wrong, there probably I something wrong.  Instead of just living with it, how about calling your doctor, making an apt, and getting it sorted out!

Food and feelings always go hand in hand.  Get a good hold on both concerning all aspects of your life and your diet and you will be happy you did.

Sleep:  This is such an important part of your life, I don’t want you to overlook it in any way.  The number of people out there who chronically get too little sleep is staggering.  Do something for me, for the next month keep a sleep log.  You can get great little apps for your smart phone if you would like, but it’s easy enough to do on your own.  Here is a link to the sleep diary Sleep Diary my sleep center gives out to patients and it is very useful.  I want everyone to be very aware of how much sleep they are getting and how much they are not getting.  Everyone is also different with how much sleep it “enough” for them.  The sleep literature says normal sleep is anywhere from 6-10 hours a night, but you have to see what is best for you. 

The most common cause of chronic fatigue is a very technical sleep diagnosis known as ISS, or Insufficient Sleep Syndrome J.  Do you suffer from this?  Well, do the sleep log and see how many hours of sleep you are getting.  Then ask yourself this question: “Am I more tired in the day than I feel I should be?”  If the answer is yes, make a concerted effort to increase your nightly sleep by at least one hour and keep logging your sleep.  Do you see an improvement in how you feel?  If you do, then keep getting more sleep.  If you don’t, or you have trouble falling asleep, don’t settle for how you feel please.  Look up a board certified sleep physician and make an appointment.  You will NEVER feel or be your best if you are not sleeping enough.  Insufficient sleep does more than make you tired, it is dangerous and increases your risk of chronic disease.  Most people simply go through life dealing with how they feel and not trying to fix it.  Become conscious of your sleep patterns and sleep volume, and make adjustments to improve them if needed. 

Ultimately you can read every book and follow every blog, but nobody out there is talking directly to you.  Only your body is talking directly to you, but you have to learn to be conscious of it and adjust to its needs.  Always remember that success with a Paleo lifestyle is up to you, and nobody can change that.  Don’t fall victim of thinking you can’t do it “right” so why bother, or that you are doing all you can.  Are you really?  Is there some place you can improve your health?  Do you have strongholds you are still not willing to give up? 

You want to succeed with your Paleo goals?  Learn to cook at home, be patient with yourself, acquire the understanding of why Paleo is right for you, and become conscious of every aspect of your life. 

Do you have specific keys that have helped you?  Post a response and share your experiences with everyone else.  If you have specific questions, always feel free to email me at PaleolithicMD@gmail.com.  And as always, share this blog with anyone out there who you feel could benefit from learning more about the Paleo lifestyle. 

-E

 
3 Comments

Posted by on June 3, 2012 in General Paleo Discussion

 

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Keys To Paleo Success Part 2: Understanding

This is the second part in a series on what I feel are some of the keys to making the Paleo lifestyle successful for you over the long haul.  The first part of the series was on cooking and it seemed to be pretty well received.  Today’s topic? Understanding…

One of the most important things that will allow for long term commitment to anything in your life is understanding why you are doing it.  This may sound a bit simplistic or obvious, but take the time to think about it.  Changing your life in a way many consider “drastic” is not easy, and you need a good reason to do it!  When I started the journey on a Paleo diet I asked quite a few questions about why I should do this.  Being a physician and the fact that many Paleo principles go against much of what I was taught about diet and nutrition I set about learning as much as I could.  Making a fundamental change in your life, no matter what area it is in, requires a real belief in what you are doing.  Belief can only come with knowledge.

When my wife and I decided to go paleo, I downloaded and read Robb Wolf’s book The Paleo Solution.  I mentioned it in an earlier post, but I will give you this advice.  You need to understand two things about Paleo; how we do it, and why we do it.  Robb’s book gives you the option to simply read about the how to do it, and suggests you can follow Paleo without worrying about the why.  Of course he is right, but I think to be most affective you need to know the why.  How to follow Paleo is pretty simple as we all know.  There will be a point, or likely many points when you will feel like going back to your old ways.  A solid foundational knowledge on why you follow Paleo will serve you well during these times and get you back on track.

When I discuss any topic with my patients I hope that they ask me questions.  Curiosity about why I am telling them to do things a certain way lets me know they are thinking, and that they care about what we are talking about.  Simply taking something on blind faith is a risky proposition.  Don’t get me wrong, you have every reason to trust any of the major Paleo book writers like Robb Wolf, and his book is extremely well written, researched, and presented.  That said, you need to take ownership of your own life and health.  My experience with patients is simple; if they just accept what I’m saying to do and nod absent mindedly they are unlikely to have followed through with any recommendations I made when they return for their next follow up visit.  If they show interest and ask good questions, they are much more likely to show improvement.

So take the time to read The Paleo Solution cover to cover and UNDERSTAND.  Although the Paleo lifestyle will offer you significant improvements in many areas of your life it is not good as a means to an end of a single specific goal such as weight loss.  Look at your health as a whole and see all the ways changing your diet could help you.  Look FORWARD in your life and see how changes today can change your life tremendously many years from now.  Don’t simplify the decision to go Paleo but rather make it about long term happiness and health.

Once you fully understand the driving principles behind why following the Paleo lifestyle is best for you, you will be able to pass it on to others.  Whether it be to patients or clients of your own, friends, or even family, proper understanding will allow you to successfully lead those you care about to also go Paleo.  This ultimately is where we can make the most impact on our future.

So take the time to learn and understand Paleo, what it does, and why it does it.  You do not need a medical degree to grasp the basic concepts.  I try to learn something new about Paleo everyday, and you have all the resources you will ever need with a computer and an internet connection. You will be questioned about your diet by many, and if you plan on helping them understand why you are right (and they are wrong!) you need convincing knowledge on your side.  Study up, past the test, and join the fight!

-E

 
2 Comments

Posted by on May 30, 2012 in General Paleo Discussion

 

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Have Trouble Talking to Others About Paleo? Here’s What I Do.

One of my biggest challenges is introducing the Paleo diet to patients who are initially very reluctant to listen.  I’m sure all of you have this problem whether it’s to your friends or family members who are curious about all this “caveman” business.  Several of my twitter friends asked if I could post about how I approach this problem with my patients, so I’ll give it a try.  I will attempt to write it as a dialogue between me (E) and a patient (P).  Along the way I may stop and fill in with some additional info.  I certainly do not review this entire thing with every single patient, but I hit the high points and address the most pressing questions they may have.

Most of the time the question of diet and weight loss comes up in this fashion…

P: I swear I’m doing everything right doc, and I just can’t lose any weight.  I’m very frustrated and I really don’t think that I am eating very much.  What can I do?

E: Ok, so what you are doing is not working.  Let’s start with you taking me through a typical day in your diet.  Take yesterday for example, what did you eat?

P: Ok, I eat oatmeal every morning because it is good for my cholesterol.  Most days I also eat a yogurt, and maybe a piece of fruit.  For lunch I normally eat a sandwich like tuna salad or chicken salad…with low fat mayo and whole grain bread.  Baked Lays or something on the side, all low fat stuff or I won’t eat it.  For dinner I may eat a little more, but I figure I haven’t eaten much all day so I allow myself to eat a bit more.  I’ll typically eat chicken or fish, usually broiled, and some vegetables on the side.  My husband loves cornbread, so we eat a lot of that as well.  I’ll usually eat a little desert, like a little chocolate or a few cookies; just a little something sweet ya know to kill my sweet tooth.  That’s really it.

E: So no snacking during the day?

P: Well yeah, I snack on things here or there.  Come to think of it, I probably eat more junk snacking than anything else.  Just little stuff though; a few chips here, a couple of M&Ms there, not enough to really matter though I think.

E: Ok, that’s what you eat, what do you drink all day?

P: Well, I hate water, and I can’t stand Diet Coke.  I do force myself to drink water as much as I can, but I just HAVE to have at least a coke every day.  I just can’t do without it.  Maybe some days I’ll drink two, but that’s not the norm for me.

E: What size cokes?  Are we talking a can, or a bigger soda like from Sonic or something?

P: Oh I just love Sonic Ice, so I go there almost every day.  So yeah, it’s usually a large coke from Sonic or McDonalds when I’m swinging through there to get the kids something after school.

E: So how long have you been eating this way trying to lose weight?

P: I’ve been doing this for years.  I may lose a little weight here or there, but I can’t seem to make any real ground?  I swear I just don’t see where I eat that much food.

E: So what you are saying is what you are doing isn’t working right?

P: YES!

Ok, this is a good time for a note.  When you are talking to patients, or even friends who are questioning the Paleo diet, you want to get a good foothold on what their current “diet” is, and whether it is working or not.  Most people do not inquire about lifestyles or diets if they are totally content with how things are going for them.  Ask them questions, establish patterns and identify weaknesses.  Most importantly, make them admit that what they are doing, although they feel it is “right”, is not working!

E: Ok, I’m going to tell you how I eat.  I spent years also trying to figure out what the best way to get off weight and keep it off, and this is what I feel is your best bet.  I’ll make it easy by just saying what I do eat.  I eat meat, vegetables, fruits in moderation, eggs, any nut except for a peanut, and healthy oils like olive oil, coconut oil, or avocado oil.  Anything else is off limits.

P: So how do you make a sandwich?

E: I don’t.

P: What do you eat for breakfast?  I mean I need to eat oatmeal for my cholesterol don’t I?  And calcium, where do I get my calcium for my bones?  Wait a minute (desperate opening of mouth)…what about cheese?

E: No cheese, no dairy of any kind.  I eat whatever I want for breakfast as long as it is on the list I just gave you.  It’s not hard it’s just different.

P: There is no way I could do that.  I can’t live without a lot of things on that list.  I mean what do you drink?  Don’t say water, I told you I hate water.

E: I drink water.

P: (Blank stare of disbelief as if I didn’t hear her water comment) That sounds crazy.

E:  Well them I’m crazy I guess because I’ve been eating this way for quite a while and it has done wonders for how I feel and for my health overall.  I sleep better than I ever have, I’m hardly ever hungry, I don’t fight the cravings for food I used to, my stomach isn’t upset all the time, and I’ve lost weight without tons of effort and have no trouble keeping it off.  Isn’t that what you are looking for?

P: Yes, but I can’t eat that way.  I’ve tried Atkins before and I just can’t take it for too long.  You basically eat Atkins right?

E: No, not at all.  I eat based on what is called the Paleo diet, or the Caveman diet.  The key is that it’s not a diet at all, it’s a change in the way you do things.  You have to be willing to change permanently; it’s a lifestyle cha…

P: Yeah, yeah, I know, a lifestyle change and all that.  But why, why can’t you eat dairy?  Milk is good for you, everyone knows that!  And oatmeal, I mean come on, oatmeal is so healthy!

E: I disagree.  We can look at each individual area of foods you need to avoid and discuss why if you would like, but I can simplify it in one word: insulin.  Insulin’s job is to make sure that your blood sugar stays controlled in a very tight range.  When you eat a diet based primarily on carbohydrates it causes your global insulin levels to be higher than they should be because your body is working overtime to keep your sugar tightly controlled.  This increased insulin causes two things; it makes you hungry, and it stores sugar as fat.  So the more carbohydrates you eat, the more insulin your pancreas produces.  All the while this insulin is making you hungrier and fatter.  As a consequence of accumulating more fat your body also starts to require more and more insulin to control blood sugar, and eventually your body stops listening…you become resistant to your own insulin.  At that point you develop Type 2, or insulin resistant diabetes.  This is how your current diet is leading to your downfall.  Understand?

P: Well, sort of.  But I don’t eat donuts or potatoes or anything, I just don’t see where I eat that many carbs?

E: You told me you eat bread for sandwiches, yogurt, oatmeal, chocolate, cookies, and soda.  All those are carb based right?  It sounds like to me you eat primarily carbs on a daily basis, am I wrong?

P: But I eat whole wheat bread and pasta, and low fat yogurt or skim milk for dairy!

E: Pasta, you never said anything about pasta?

P: Oh, pasta is a major weakness.  I love pasta so much, and I was so proud of myself for finally getting used to the whole wheat stuff.

E: To your body bread is bread, and pasta is pasta no matter the type of wheat…they are carbs.  And milk, ever notice that a cup of skim milk has around 100 calories, and a cup of whole milk has a little over 140 calories?

P: Oh, I don’t drink whole milk or skim milk, I drink 2%!

E: Focus, you’re missing the point here.  Like I was saying, you would figure if they take all that high calorie fat out of milk it should really drop the calories right?  Fat does have twice as many calories as carbs or protein after all.  But, it only drop it 40 calories or so per cup!  The reason is that when food manufacturers take fat out of food, they add in carbohydrates to make the food taste ok.  So by avoiding the fat, you are contributing to the insulin train we discussed earlier.  What I’m trying to tell you is that fat is not your enemy, as long as it is the right kind of fat.  Carbs on the other hand are for the most part universally bad, unless it is in fruit and you want to eat that in moderation as I said earlier.  After all, a carb is a carb.

P: You are killing me here doc.

E: Sorry, but you asked!

P: Ok, so I kind of get the milk thing.  So why can’t I just change to whole milk?

E: Good question! The answer is that milk is not just made of fat, it also contains sugars and proteins.  It’s these sugars and proteins that cause an increase in your insulin levels when you drink it.  Importantly, this increase in insulin that is seen when milk raises your blood sugar is essentially the same for any milk: Whole, 2%, or skim.  So milk may be a source of calcium, but it comes with significant baggage.

P: So that’s it, all these foods increase my blood sugar and my insulin levels, so I can’t eat them.  Guess it sort of makes sense.

E: Yes, and no.  Dairy products can also teach us about the other main reason the Paleo diet eliminates what it does.  It’s called inflammation.

P: Inflammation?  Like a bug bite or something?

E: Yeah, exactly.  This can get complicated, but I’ll try to make it as easy as I can.  Milk proteins lead to chronic inflammation in your GI tract that change the way we absorb many foods.  To expand the list, other foods like wheat, legumes, and even soy to some extent cause this inflammation.  Think of your GI tract like an impenetrable wall.  That wall was designed to keep everything out of your bloodstream that is not supposed to get in there.  When you eat these pro-inflammatory foods, that smooth impenetrable wall becomes leaky and more like swiss cheese.  All sorts of proteins that are not supposed to enter the blood stream do so, and your body sees them as foreign.  Just like ant venom is foreign and your body builds an inflammatory response to it on your skin, your body will build an inflammatory response to say for example gluten in wheat products.  This chronic inflammation is felt to increase your risk of heart disease and stroke in particular over time.  Like I said, this can get complicated and I can give you some good information to read up on it.  Big picture is, you have to eliminate foods that will lead to chronic inflammation in your arteries.

P: But you are eliminating all these foods that I hear all the time are healthy?  How can I eat that much fat and stay healthy?  Isn’t eating fat the worst thing for your heart?

E: Like I said, it depends on the type of fat.  You know that fish oil you take?  I presume you take it because you read or heard that Omega-3 fats are good for you right?  Well, that’s right indeed.  Omega-3 fats are known to be much less atherogenic than Omega-6 fats…in other words, they don’t cause heart attacks or strokes.  So eating this way will help shift your diet from one primarily composed of Omega-6 fats to one mainly of Omega-3 fats.  Also, it will change the size of your cholesterol molecules.  Omega-6 fats lead to LDL, or bad cholesterol, molecules that are small and dense.  These small and dense molecules can easily lodge themselves into the “swiss cheese” like walls of your arteries at the moment.  When they lodge into the walls they form plaque, and that plaque leads to blockage, and that blockage leads to heart attacks and strokes.  If you can shift your diet to Omega-3 fats your LDL becomes what we call large and fluffy.  These large molecules pass smoothly along your artery walls and are not stored as plaque.  In other words, even if your cholesterol is a little high, it won’t be the dangerous kind.  Is this all coming together for you?

P: Yeah, I guess.  I just don’t understand why the government doesn’t talk about all this if it is true?  I mean look at the food pyramid.  My kid brought one home the other day from school and it’s build on whole grains!  I don’t understand that at all if what you are saying is true.

E: Well….that’s a hard one.  We could talk for hours on this one, but I’ll just tell you this.  The government and multiple medical associations bought into the fat = heart disease theory long ago.  They have spent decades trying to get people to eat less fat and more carbs.  In fact, they have succeeded.  As a nation we eat less fat today than we did 40 years ago.  But just look around and answer this question: Is it working?!  In the 1960’s the government took the data from one study that appeared to correlate rate of heart attacks with national dietary fat intake.  The study was terribly flawed and most of the data was not reported, but it was taken as law.  When the government decided to push the low fat diet as a cure for heart disease the obesity rate in America was just under 10%, and now it’s nearing 30%.  20% more obesity in 40 years or so, you tell me if it’s working.  My simple answer is that the government is wrong, and they are too deep into their beliefs to change their ways.  We’ve already agreed their plan hasn’t worked for you yet right?

P: Yeah, you’re right.

E: I’m always right.

P: Thanks for the confidence doc.  Here’s the deal though, I can’t do this.  You like to cook and stuff, and it sounds expensive.  There is no way I can so it.

E: What if you gave me 30 days?  Just 30 days to change your life.  You can go home today and kind of try it a bit, eat a few less sandwiches, and say you give it a shot.  But why not do it super strict for 30 days.  Get everything out of your system and see how you feel.  I’ll see you in 30 days and we’ll evaluate how you feel and if you think it’s worth continuing.  I’ll warn you though, I haven’t had one person who did the 30 days right who wanted to go back to eating the way they used to eat.  Go 30 days strict, and then I’ll ask for 90% compliance from here on out.  You can do anything for 30 days right?

P: I guess, but I’m not sure it’s worth it anyway.

E: Do you think I hate chocolate chip cookies? Or wedding cake? Or Chimichangas? Or fresh baked cinnamon rolls? Absolutely not! I love each and every one of them!  Almost everyone that follows a Paleo lifestyle loves these things.  So ask yourself this question.  If we all love those foods, why did we keep eating Paleo after 30 days?  It’s simple, cause it works and we feel better.  In fact, I never want to feel the way I used to feel before I changed my diet.  I’m pretty sure you won’t want to go back either.  Only one way to find out though…

P: Well doc, I’m going to reluctantly agree to give this a try.  I love many of the foods you have explained I can’t eat, but I’m so sick and tired of feeling like this I’m willing to give anything a try I guess.

E: You know what the best thing for me about this lifestyle change for me has been?  I am no longer in any way controlled by food.  You are controlled by food right now, you said yourself you cannot “live” without a coke every day.  Think about it, that soda controls your life!  I don’t worry about food as much anymore because I’m not as hungry and I don’t crave things as much.  Don’t get me wrong, I love food more than ever; just in a different way.  You have the power to change your life so much, all you have to do is give me 30 days.

P: All right doc, you win.  Let’s do it.

Now before you ask, no, I don’t have 45 minutes with every patient!  I made this conversation as complete as I can for educational purposes.  I challenge most patients to get a book on Paleo and educated themselves as much as possible about the dos, don’ts, and whys of the lifestyle.  If people put the effort to learn why they should do things a certain way, they are more likely to stick to it long term.  All you can do is start the educational process for people whether it be clients, friends, or family.  Always challenge them to learn more about Paleo before they just dismiss it as a “fad” diet sure to play out.  Memorize some numbers on our nation’s rates of obesity, diabetes, childhood diabetes, cancer, and other medical conditions tied closely to what we eat.  Above all else, challenge them to tell you that what they believe to be true is actually working.  If they insist that it is, they may be drinking too much of the Kool-Aid to ever see the light.  Don’t worry about that though, like I said all you can do is try.

I really hope this will help some of you talk to other people about Paleo, why you changed to it, and why they should as well.  It’s not easy since everyone has been exposed since birth to the vastly superior health qualities of milk and whole wheat among others.  Debunk them one point at a time, know your science, and point them to more detailed sources to complete the picture.

Fight the good fight everyone!  We must keep spreading the word about Paleo and science will continue to fall in our favor.  If you know of someone who may benefit from reading this, please direct them here, RT my tweet about it, or whatever!   Together we can change history, one loaf of whole wheat bread at a time 😉

-E

 
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Posted by on May 27, 2012 in General Paleo Discussion

 

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Whole 30: Day 11

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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

 
 

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My Experience Prescribing Diet Pills: An Internist’s Perspective

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

 
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Posted by on May 15, 2012 in General Paleo Discussion

 

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What I Think Makes Paleo Different…Control

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

 
6 Comments

Posted by on May 12, 2012 in Uncategorized

 

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Whole 30: Day 4

Day 4 down, I’m getting more used to this!  For breakfast I managed just a handful of almonds because I was on the go early this morning.  For lunch I had some chicken…pretty ho hum.  I got home for dinner and pulled out some pork ribs from my Sous Vide.  Around the time I pulled them out I got called by the ER to admit a lady with a possible stroke.  I quickly finished the ribs off on the grill and scarfed a few down.  As SOON as I got back from the ER, the other ER called me with a lady having a dangerously low heart rate.  Went and admitted her, probably getting a pacemaker tomorrow.  Got home exhausted, hoping my night gets a little calmer!  I took down a few dried pears and I guess I’ll call it a night.  Nothing exciting today, no pictures, just tired!  Pork loin for tomorrow is in the Sous Vide, I’ll take pictures and post!  Along with some roasted butternut squash and a side salad.  Can’t wait for the weekend…

 
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Posted by on May 10, 2012 in Uncategorized

 

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