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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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How Has My Transition to Paleo Changed My Approach To Treating the Big Three In My Patients?

It has been around a year now since I changed to a Paleo lifestyle in my own life, and I thought it would be interesting to look back on my practice and see how I think I have changed in how I approach three common problems: Hypertension or High Blood Pressure, High Cholesterol, and Diabetes.  I can’t stress to everyone how fundamentally different a “Paleo” way of thinking is compared with what I was taught in school.  Most physicians are simply not exposed to information other than the status quo, and whose fault that it is a long story…so, let’s just look at me!

High Blood Pressure:  Statistically, this is the number one problem that I treat in my office on a day to day basis.  95% or so of hypertension (HTN) is of an unknown cause, and is known as “Essential HTN.”  Even over the 8 years I have been out of training our approach to HTN has changed.  We are much more aggressive from the start in treating people’s blood pressure because the more we study the problem, the more it is linked with medical badness in the form of strokes, heart attacks, and kidney failure (among others).  There used to be something called “Pre-Hypertension,” which is now simply known as Stage I HTN.  There are lots of conspiracy theories on the internet about Statin medicines for cholesterol and the evils that they bring.  Notice this though, you DON’T see much bad press for high blood pressure treatment.  The simple answer for this is that HTN kills, and treating it helps prevent death.  It’s very clear cut, our medication options are affective and affordable, and the standard of care is to be aggressive with medical treatment.

Another interesting thing about HTN is that it does not traditionally respond tremendously to weight loss.  Although you can see modest decreases in blood pressure with the shedding of pounds, it’s not often as effective as people wish it would be.  Don’t get me wrong, it helps, but shedding 15-20 pounds rarely leads to the elimination of HTN medications for the grand majority of people.

The one side of Paleo that does certainly help HTN is the decreased sodium intake which accompanies the elimination of processed foods from one’s diet.  What this does is help control a patient’s BP with LESS medicine in many cases.  I used to tell patients that HTN is like a train rolling down the tracks…it’s always rolling, even ever so slowly, and we would have to increase their meds over time to keep up.  I suspect that lowering sodium intake over time MAY help shut the train down.  As I said, the train will likely still be there, just more under control.  Ultimately if I can control blood pressure and keep it from getting worse I will be happy.

So how has Paleo changed my treatment of HTN?  I recommend Paleo to all as an overall way to best improve their health, but I don’t expect people to be able to stop their BP meds, particularly if they are on multiple meds with difficult to control blood pressure.  I emphasize Paleo to limit lifetime drug burden and keep things controlled with hopefully less medicine.  I never partially treat high blood pressure with “watchful waiting.” Take home: don’t mess with your blood pressure!  If it’s high, see your doctor and control it one way or the other.

Cholesterol:  This is a condition that has certainly changed when it comes to the way that I approach patients.  I have always been very aggressive as a doctor overall, and I was typically aggressive in getting a patient’s cholesterol down.  Don’t get me wrong, I still am!  I just may approach it a little differently.  I’ll concentrate on one particular patient type.

In generally healthy patient’s with high cholesterol, but without a known history of cardiovascular disease or strong family history of CV disease, I am definitely less quick to prescribe a statin.  I have an honest discussion with the patient and explain that we need to decide whether or not to treat their high cholesterol.  I am increasingly ordering a more sophisticated cholesterol profile known as a VAP cholesterol to help make that determination, along with assessing how serious the patient is in changing his/her diet to create a generally healthier cholesterol environment in their bloodstream.  What I’m interested in is lowering the bad cholesterol in their body, and also changing the characteristics of that cholesterol from a more dangerous small/dense cholesterol to a less dangerous large/fluffy cholesterol.  If we can do that with a Paleo lifestyle, awesome! This is ALWAYS my first choice.  If patients are unwilling to do that, the next step is cholesterol meds.  The newer statins have indeed shown the ability to shift particle size in the right direction, but I feel it is no where near as powerful as the shift we can see with a strong Paleo lifestyle.  This is my BELIEF, and it is my hope that over time we will have the data to support that.

I treat people, and some people are more willing and able to approach medical problems with lifestyle changes, while some are simply “give me a pill” type of people.  I encourage, but I do not judge.  I’m honest and realistic with all my patients, and I just want to try to help everyone that I can.  I explain my position, and allow them to take a position they are comfortable with…after all, I am treating THEIR health, not mine!

The use of statins in patients with known heart disease is a very complex topic fraught with questions, controversy, and medico-legal issues I’m not up for entertaining.  It would be easy, but foolish to preach on this subject.  If you have known heart disease I’ll simply tell you: educate yourself, consult a physician you are comfortable with, and come up with a plan together you are each comfortable with.

Diabetes:  This is the condition I probably have been most affected by when it comes to my approach to patients and the Paleo lifestyle.  I have had many diabetics commit to a Paleo lifestyle, and the results have been remarkable.  I am currently working on a prospective study looking at the effectiveness of going Paleo on diabetics over a three month period (but more on that later!).

For me, treating diabetes has always been the most difficult of the big three because of how much a patient’s habits ultimately decide the “success” of my treatment regimen.  Blood pressure high?…I can bring it down no problem!  Cholesterol up?…just take this medicine and you’ll look great on paper in 6 weeks!  Diabetes on the other hand is no where near as simple.  Patient’s can quite easily overwhelm their pancreas’ ability to produce insulin, a medicine’s ability to assist their pancreas, or both!, by simply eating the wrong things.  I became quite frustrated as traditional “diabetic” diets seemed useless at improving LONGTERM control of a patient’s disease process.

My Paleo journey began as a personal one.  I did it to feel better, get fitter, and live longer.  The more I researched the science behind it, the more it was obvious to me that it should be a tremendous treatment for diabetes.  It may not eliminate the treatment of the disease with pills or shots, but it could be a great baseline on which to manage everyone.  Again, there is no argument that elevated blood sugars are bad for you, and must be corrected at all costs.  I see Paleo as an alternative for patients to keep their blood sugars lower with LESS medicine!  In the end, only one thing matters…get those sugars down.  Paleo adds another weapon in the arsenal.

Again, with my diabetics I sit down and explain why I feel Paleo will benefit them.  I do this in detail, and utilize some simple handouts I’ve written up as to how making the right food choices can truly help control blood sugar.  I then discuss the experiences my other patients have had after adapting their lifestyle.  I make it perfectly clear that in my opinion, their best chance for long term sugar control and limiting the meds they will need to use is to adapt an 85-90% Paleolithic lifestyle.  If I can get them to bite, I hand them a flash drive with my clinic’s Nutrition Guide we obtained from our friends at Whole 9 Life.  This is all they need to be successful right in the palm of their hand.  Do all patient’s follow through? Absolutely not.  But, it’s a crack in the armor.  Eventually we will have the discussion again, and the next time they may be more willing to give Paleo a more serious try.  As always…one patient at a time.

I’ll admit, it really bums me out when people won’t give it a try.  I practically beg for patient’s to try it for 30 days because I know they won’t go back.  Literally, I have not had one patient who went 30 days go back to eating non-Paleo.  100% success rate for my patients…not too shabby.

There are many applications of the Paleo diet to chronic disease, but my passion at the moment has to do with it’s application in the diabetic population.  From the hormonal standpoint it strikes at the core of the disease, and offers AMAZING potential for REAL change in people’s lives.  I have so many plans…and so little time…

——-

My personal journey in the Paleo lifestyle is far from over, as is my re-orientation as a PaleolithicMD.  I would have never thought a year ago that I would have changed my personal health and diet so much, or that my views on the treatment of these three diseases would have changed so much.  I certainly would not have guessed I would be moderating this blog in an effort to spread the word that Paleo is a valid addition to the traditional fight against chronic disease.  Basically it shows that you can indeed teach an old dog new tricks!  So, let’s see what the next year will bring!

-E

 
21 Comments

Posted by on August 9, 2012 in General Paleo Discussion

 

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Will Paleo Ever Go Mainstream?

Many people ask me what I think the future of Paleo is? Will it ever by mainstream and recommended by doctors, government, and society alike? In many ways Paleolithic Nutrition is at it’s infancy in the scientific world and although it is the oldest “diet” in human history, it’s concepts are foreign to most people around us. In order for Paleo to have any chance to become more accepted, we will have to overcome several barriers…let’s see what I think they are.

Cost – There is a great deal of debate about how expensive eating Paleo really is. Some say it is extremely cost prohibitive while others insist that’s just a misperception. What do I think? I think the answer lies somewhere in the middle.

When people say that eating Paleo is no more expensive than eating the typical carb based diet most American’s eat these days, I would have to disagree. If you look at food at the grocery store as a whole, it is often cheaper to feed your family with processed foods than with fresh foods. Put it this way, IF you don’t care in the least about the health of the food you put on your families table, and you don’t really care what it is you eat anyway, you can find cheaper ways to feed your family with unhealthy food. If your family is hungry, and you have very little money, it is very hard to beat 4 packs of Ramen noodles at 15 cents each. Unless you really are extremely poor, I caution anyone from making assumptions that Paleo is “easy” to accomplish.

Next is the significant price difference between regular and organic produce, or bulk raised vs grass fed/free range meats. A whole chicken at my local Kroger costs 4-5 Dollars, while a whole organic bird costs $15. Now look, I agree with most of you that the organic bird has too many benefits to discuss as far as quality and lack of questionable processing practices, but many folks JUST DON’T HAVE THE MONEY! I am very up front with my patients and tell them that they simply have to buy what they can afford, as well as source what they can depending on their geographic location.

The bottom line is that you have to try much harder to eat a Paleo lifestyle on a budget. Can it be done, of coarse it can! But in our world of both parents working long hours, more and more meals being eaten outside of the home, and ever raising prices of food on the grocery store floors, the idea that cost does not present a significant barrier to more widespread adoption of the Paleo diet is foolish at best.

Social Environment – I touched on this just a bit above, but the way our society approaches food and free time is a major factor. The days of learning to cook from your parents, who learned to cook from their parents is becoming a lost art. Convenience is what drives the food industry and most families feel forced to take advantage of that convenience on a nearly daily basis. Late hours at work, ball practice that never ends, homework that takes up more time than it should…there are so many factors that force families to put the quality of the food they eat on the back burner.

I am saddened by the way most people choose their food. When is the last time you saw someone pull up to a car lot and ask for “the crappiest thing on the lot, I don’t care what it looks like, smells like, came from, how old it is, or how long it will last; I just need it to get me through the day.” Most take much more care in picking their cell phones than in picking their dinners. Sad as this is, it is reality. I wish I could change it, but the scale of the changes society would have to undertake to change this are so monumental, I don’t see it every happening. That train has simply left the station, and it does not have a reverse.

Overcoming these social forces is amazingly difficult, especially with the food industry catering at every turn to keep them going. Take an onion for example; you can now buy an onion, pay a bit more for a peeled onion, pay a bit more for sliced onions off the salad bar, pay a bit more for a container of (who knows how old) diced onions, or forget the whole darn thing and just buy something called “onion juice”. Buy a whole chicken for $4, four thighs for $6, or 4 boneless skinless thighs for $8! Imagine, having to butcher your own chicken!!! The nerve… With this type of social and retail environment, can you ever see Paleo hitting the mainstream?

Logistics – Have you ever had this thought? I can go down to my local grocery store and find so many items it is unreal. Take a simple red delicious apple. I would be willing to say that basically every grocery store in America has red delicious apples in it. Let’s say every store has a modest 10 apples, and a quick google search yielded that there are around 250,000 grocery stores in the US. So at any given point, I think it’s reasonable to assume that there are conservatively 2.5 Million red delicious apples on the shelves across America. Does that not just amaze you? How many trees does it take to produce that many apples? How many varieties of apples does your grocery store have? Realize we have these apples ALL YEAR LONG. What I’m trying to emphasize is that it takes an insane amount of food to feed Americans on even a daily basis. How many cans of corn stand on grocery shelves? Loaves of bread? Gallons of milk? Every day we have to feed approximately 310,000,000 people in America! Seriously, just stop a minute and appreciate the infrastructure that can accomplish this monumental task.

So, I have a question for you. Let’s say a third of the American population suddenly decided to go Paleo. I would first join you in saying Hooray!, I can’t believe so many others are going to experience the benefits of this lifestyle. So to my question… do we have enough food? I can’t say that I know the answer, but I would think a pretty good educated guess would be absolutely not. Let’s say Americans took it a step farther and decided they would only eat organic and pastured animals and produce, what then? Do we have the land to produce enough beef in a responsible fashion for the masses to consume? Again, I don’t know (although I’m comfortable saying I don’t think so by a long shot), but I can see where this could be a very real problem. There is a reason that cows are pumped full of antibiotics and steroids, and their health is sacrificed in the name of growth…we need the food!! Never given this much thought? Sit down for a few minutes, discuss with your Paleo friends…can America logistically be a primarily Paleo society?

Politics – Oh how I hate the word…Politics. I really don’t care what side of the aisle you are on, your party of choice has likely failed miserably over the years when it comes to nutrition in America. (Please, don’t leave me a comment and preach about why it’s all red’s fault, or blue’s fault…there are no clean hands in Washington. Believing otherwise shows nothing but blind faith.) Why is that so? One word…Lobbyists. Take for example last week when the USDA released a statement supporting “Meatless Mondays” as a way to enhance the sustainability of our food industry. Now personally the idea of a meatless any-day is depressing, but I guess I can see where the USDA was coming from. Problem is, they hacked off a lot of people! Beef people, pork people, chicken people… hell, probably even the Veal people were upset! ONE DAY later the USDA retracted their statement, and said they did not support the practice of Meatless Mondays. Amazing, truly amazing.

I don’t care what side of the issue you are on, I think we can all agree that it is sad that a government agency can be influenced so swiftly by big business. Don’t like it, I think you are gonna have to sort of get over it…welcome to America.

For Paleo to go mainstream, the government along with it’s health advisory committees, the American Heart Association, the American Medical Association (of which I am a proud NON-Member), the American Diabetes Association, etc…etc, would have to completely reverse their stance on fat, carbohydrates, obesity, and heart disease. In order to do that they would have to do something they will never do…ADMIT THEY ARE WRONG! Even if they had the intestinal fortitude to admit their beliefs have been wrong for decades, they would then have to convince a few other people that it is important to change their views and recommendations. Who you ask? I can think of the Dairy Industry, the Corn Industry, the Potato Industry, the Sugar Industry, the Fast Food Industry, the Peanut Industry, the Pharmaceutical Industry, the Beef Industry (yes, they would have to address how our modern livestock rearing practices adversely affect the quality and danger of the fats inside our animals), the Poultry Industry…I’m getting bored now, you get the picture. The entire food industry would have to change in order for Paleo to go mainstream. What do you think? That gonna happen anytime soon?

Nobody wants to hear it, but politics and money are at the core of how our country work. It should be no surprise then that politics and money have an un-alterable effect on the food that we eat.

So, Will Paleo Ever Go Mainstream? – In a word, no. I don’t see a time where the Paleo lifestyle is commonplace in American society. Call me negative if you want, but I see it as more realistic. Cost, social pressures, logistics, and politics; each contribute greatly to the low likelihood that Paleo takes America by storm.

I guess that means we just go on our merry way and live with this reality? Also in a word, NO! The Paleo community must band together and be as inclusive and understanding as possible so that anyone with an inclination to join us is able. Don’t look down on those who can’t afford grassfed meat, and instead applaud them for doing all THEY can do improve their health. Support your local farmer’s market, CSA, or grass fed farm if you are able. If you can’t afford their products, spread the word to someone who might be able to. Can’t afford a quarter of a cow, find a family or two to split the cost with. Grow a garden. Find ways to sustain YOURSELF in an environment of mass sustainability.

I’ll never likely get a chance to lobby in front of congress as to why the Paleo lifestyle should be moved to the forefront of our country’s war on the worsening epidemics of obesity, heart disease, strokes, or cancer. I will on the other hand have the chance, likely as soon as tomorrow, to talk to a single patient about why changing their nutritional habits could very well save their life. Don’t get caught up ruminating with anger about the injustices of our political system, while as a consequence missing the chance to make the world a better place one person at a time. Don’t get caught up in going mainstream, instead relish the opportunity to go UP-stream against the forces that hold back the Paleo lifestyle. The war may very well be un-winnable, but the little battles are where the real satisfaction must lay.

Agree? Disagree? Let me and everyone else know what you think!

-E

 
9 Comments

Posted by on July 29, 2012 in General Paleo Discussion

 

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Overcoming Medical Dogma Series: Eczema

The recurring series “Overcoming Medical Dogma” is a collaborative effort between The Paleo Mom Sarah Ballantyne, PhD, scientist turned stay-at-home-mom, and Paleolithic MD Dr. Ernie Garcia, MD, Internal Medicine and Sleep Medicine specialist.  The goal of these co-written posts is to go beyond the typical physician-patient interaction where the patient describes symptoms, the physician diagnoses and prescribes medication and/or dispenses diet and lifestyle advice. In each post, we will discuss a common medical condition, the typical treatments that your doctor may recommend, and what you should know about these conditions that your doctor may not tell you. We will reference relevant research and present our recommendations for addressing this condition.  Lastly, we will address the benefits of pharmaceuticals (prescription and OTC) as well as home/natural remedies which may help.

What is Eczema?  Eczema is a general term used to describe a collection of skin conditions (the most common being atopic dermatitis) in which the skin is inflamed and irritated.  The inflammation in these skin conditions is in the epidermis, or outer layer of the skin, and this is the main distinction between eczema and other skin conditions.  The presentation varies and can include any of the following symptoms:  redness, skin edema (swelling), itching, dryness, crusting, flaking, blistering, cracking, oozing, or bleeding.  It can affect any area of the body and areas can range in size from quite small to very large.  Eczema affects about 10% to 20% of infants and about 3% of adults and children in the U.S.

It was once thought that eczema was a primary immune system disorder, where an overactive immune system, led by a type of white blood cell called T-Cells, responded to environmental factors by initiating an inflammatory response.  This idea made sense because not only would inflammation produce the red, irritated skin characteristic of eczema, but this dysfunctional immune response also provided an explanation for the observed incidence of atopic dermatitis in conjunction with asthma, hay fever, and other allergies.  However, the most up-to-date research does not support this explanation.

The most current research points to a different origin of eczema.  It is now thought that eczema results from structural defects in the epidermis resulting in “impaired barrier function”.  Essentially, abnormalities in the skin make it more permeable to toxins and antigens, which then causes an exaggerated immune response 1 You could think of this as “leaky skin”, where the skin no longer is able to fulfil its primary role as the first line of defence between the body and the outside world.  Once the barrier function of the skin is disrupted, various substances (like toxins, allergens, antigens; basically anything that the immune system views as a foreign invader) can “leak” in from the outside and this is what activates the immune response.  This model is supported by recent isolation of specific mutations in the gene for filaggrin, a structural protein in the epithelial cells of the skin.  This defective gene (and perhaps other similar gene mutations) may lead to a dysfunctional epidermal barrier and is likely the primary cause of eczema.

What is your doctor likely to tell you about it?  Your doctor will likely tell you that the exact cause of eczema is unknown, but it’s thought to be linked to an overactive response by the body’s immune system to an irritant.  He or she may not be aware of the newest research on eczema, but that will not affect decisions on treatment.  It’s fairly common and not life threatening.

What is your doctor likely to prescribe?  Treatment of any skin condition should always start with proper care of your skin.  In the case of eczema, you should avoid triggers such as heat, perspiration, and low humidity, and keep the skin well hydrated at all times. The standard pharmaceutical treatment is the application of topical corticosteroid creams, which can be purchased in your local pharmacy or prescribed in stronger strengths by your doctor.  If allergies are suspected, a daily antihistamine such as loratidine (Claritin) may be suggested.  In severe cases, your doctor may prescribe an oral corticosteroid, such as prednisone.

Now if you have your thinking hats on (and we’re sure you do), you are asking “If eczema is no longer considered a primary immune disorder, why is the standard of treatment aimed at stopping inflammation and controlling the immune response?” The answer is that the symptoms of eczema are indeed caused by an immune response, but it is a response from environmental triggers entering the body through “leaky” skin as opposed to an immune system run wild and attacking itself. 

What should you know that your doctor may not tell you? As discussed above, the most current belief is that those with eczema carry a genetic predisposition to “disrupted epidermal barrier function” 1.  This could be thought of as “leaky skin” and is a very analogous to a “leaky gut”.  In fact, because of the similar roles of the skin and the gut to act as a barrier, it is no surprise that eczema is also associated with increased intestinal permeability 2, i.e., a leaky gut.  It is still unknown whether a leaky gut contributes to the development of eczema, however.

Eczema is also often seen in conjunction with a multitude of autoimmune diseases.  For example, eczema occurs about three times more frequently in celiac disease patients and about two times more frequently in relatives of celiac patients, potentially indicating a genetic link between the two conditions.  For this reason, gluten sensitivity is suspected as a possible root cause for eczema, but that is still unconfirmed.  Anecdotally, many people find that their eczema goes away when they adopt a gluten-free diet.  Other people find elimination of additional foods, such as eggs, are required to see improvement.  There also appears to be a strong link between eczema and immune hypersensitivity 3.  For example, more than 50% of children with atopic dermatitis go on to develop asthma and allergies.  This may be related to the association with increased intestinal permeability or may reflect an as yet unknown common causal mechanism (such as a gene mutation or environmental factors).   

Although progress had been made toward understanding this complex condition and how it relates to other health issues, the cause of eczema remains unknown. We are certain the coming years will bring more information and we will try to update everyone as it is available.

A Comprehensive Approach to Treatment:  We believe that a paleo diet is an excellent initial approach to dealing with eczema.  This is because a paleo diet reduces inflammation and heals the gut.  Including glycine-rich foods like homemade bone broth and organ meat can help speed the healing of both the gut and the skin (glycine is an essential component of connective tissue and the extracellular matrix that acts as a scaffold for cells).  Sun exposure and eating vitamin D-rich foods such as fish and organ meat can be very helpful in speeding healing (you might also consider a Vitamin D3 supplement, but check with your doctor first).  Consuming plenty of oily cold-water fish (at least three times per week) as well as eating grass-fed and pastured meat will also help because the high omega-3 content of these foods (and low omega-6 content) could help resolve inflammation.

Anecdotally, most people report alleviation of their symptoms with adoption of a paleo diet.  In extreme cases, or in individuals who do not see alleviation of their symptoms with out-of-the-box paleo, it may be worth trying a more restricted implementation of the paleo diet, such as the Autoimmune Protocol, a paleo version of the GAPS diet, or even something as simple as completing the Whole 30 Challenge from Whole 9 Life.

Over the counter topical corticosteroid creams may still provide some alleviation of symptoms (most notably the itching) and might be required initially.  Other moisturizers which may help heal the skin faster and relieve itching include extra virgin coconut oil and lotions containing calamine, aloe vera, arnica montana, Vitamin D and/or Vitamin E.  Diane Sanfilippo provides herbal supplement recommendations in her new book Practical Paleo (herbal supplement recommendations are generally beyond both of our backgrounds and we recommend that you consult with someone with specific training in these supplements such as a Naturopathic Physician).  If your attempts to control symptoms with diet and supplements alone do not produce adequate relief, we suggest visiting your doctor for advice on more specific pharmaceutical intervention in the form of stronger topical steroids or short courses of oral steroids in extreme cases.

 

1 Elias PM and Steinhoff M  “Outside-to-Inside” (and Now Back to “Outside”) Pathogenic Mechanisms in Atopic Dermatitis. J Invest Dermatol. 2008 May; 128(5): 1067–1070.

2 Pike MG et. al. Increased intestinal permeability in atopic eczema. J Invest Dermatol. 1986 Feb;86(2):101-4.

3 Boguniewicz M.  Atopic dermatitis: beyond the itch that rashes. Immunol Allergy Clin North Am. 2005 May;25(2):333-51.

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Posted by on July 28, 2012 in Overcoming Medical Doma

 

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Review of Nutrition Guide Created by Whole 9 Life for My Clinic

I’m at my office and on my desk if a nice crisp and spiral bound copy of our new Nutrition guide that was created by Dallas and Melissa Hartwig and Whole 9 Life for my clinic the Freedman Clinic of Internal Medicine.  Here is the Cover…

Many of you may know Whole 9 as an online community for a Paleo based diet and the source of an amazing amount of easy to understand information about the science of Paleo.  You are correct of course, but they are also a tremendous partner for offices like mine as Nutritional Consultants.  For a very reasonable fee you can partner with them to create a COMPLETE guide to paleo centered nutritional recommendations for your clients or patients.  I feel like a kid in a candy store now that I finally have it, and I’m handing them out like hot cakes.

I agree with the Hartwigs that concentrating on a “paleo” diet is not optimal, and instead we emphasize picking foods that are simply healthy for us regardless of whether a caveman actually had it!  As in their book It Starts With Food we pick foods that:

1) Produce a Healthy Hormonal Response

2) Produce a Healthy Psychological Response

3) Maintain GI Integrity

4) Limit Systemic Inflammatory Response

As many of you know, taking a Paleo naive patient and explaining to them in detail what we eat, what we don’t eat, and most importantly why, is very difficult to do in the restraints of a typical 15 minute appointment.  With this guide I am able to introduce the key concepts, explain to them why I feel it is so important, and give them a product to take home that will be a complete introductary guide to how and what to eat, as well as explaining to them WHY!  The guide is able to do so in 10 pages or so and is very easy for a layperson to understand.  It also includes further vital information for a newbie such as a grocery guide, meal planning guide, a comprehensive FAQ section answering most common questions I can think of, and a good set of recipes to start.  As a bonus, it also includes a custom personal guide to the Whole 30 program for each patient if they are so inclined.  Like I said, this is a extremely well put together and laid out collection of information for a very reasonable price.  Here is a look at the Table of Contents!

If you are in the business of helping people improve their health, and you are looking for a comprehensive guide to helping people adapt to a Paleo based lifestyle, I highly recommend partnering with Whole 9 Life and having them customize a Nutritional Guide for your business.  I have no financial relationship with Whole 9, and get nothing if you work with them, I just feel this kind of product can help you as much as it has helped me and my partners.  I can finally concentrate simply on pointing patients in the right direction, and letting our Nutrition Guide educate them and fill in the details.

Interested in how I approach patients about adapting to a Paleo lifestyle, check THIS out.

-E

 
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Posted by on July 26, 2012 in Book Reviews

 

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Further Adventures in Sous Vide Cooking!

Hey everyone, hope everyone is well out there! Started my day meeting with 7 employees at my office who are ready to take a 30 day Paleo challenge. Reviewed everything, and we start Monday! Will keep everyone informed how it goes.

Sunday I made a Pork Loin Roast in the Sous Vide Supreme and it turned out perfectly. I used a recipe on Nom Nom Paleo’s page for the temperature (137 F for 4-5 hours) and seasoned it with her Magic Mushroom Powder which you can find on her amazing iPad app! Season, vacuum seal, bath for 4-5 hours minimum, and seal in cast iron skillet. Served it with amazing roasted while okra.

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Today I pulled out the Grassfed Chuck Roast I put in the Sous Vide right after pulling the pork out. I put it in at 130 F for 48 hours. Here are the picture start to finish for the meat and sides. First the chuck roast, then the roasted butternut squash “fries”, and some sautéed peaches and apples with cinnamon and ghee. YUM!

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And here is the finished plate courtesy of instagram!

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Have a meeting tomorrow night so no cooking, and likely no blogging! Hope all have a wonderful and blessed day tomorrow!

-E

 
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Posted by on July 24, 2012 in Main Entree, Pictures, Side Dishes

 

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An Easy Fool-Proof Paleo Meal Every Night of the Week From PaleolithicMD

A lot of people, particularly my patients, ask how I can work all day, and still have time to put dinner on the table each and every night.  I have an amazing wife, and she does everything around the house…but she does not like to cook.  Works out great for me since cooking is very much my way of winding down in the evening.  I like to get my kids involved, and we have already begun to enjoy time chopping veggies as a family.  I love to spend hours prepping and making more complex dishes, but that is more of a once a week deal these days.  Most nights I get home after a long day and need to get food on the table for the family in less than an hour.  So, here is how I go about my most basic meals.

Any meal at my house starts with what kind of meat we are going to eat!  I try to keep things interesting, and my kids are used to eating all types of beef, veal, lamb, chicken, turkey, and various seafoods.  When I need an animal based protein quick I turn to two methods: Either a quick cook on the grill, or a quick finish on a pre-soaked Sous Vide meat.

Grilling is obviously easy and accessible to almost everyone these days and you don’t have to spend tons of money to have a more than functional grill.  I may be in the minority here, but I just don’t understand the concept of overdone MARINATION of meat.  When I eat beef, I want to taste BEEF!  Although at times I will marinate meats with specific goals in mind, I generally never do so.  I also always cook my meat as little as is safe to maximize the flavors.  Here are my preferred meats when it comes to grilling.

Food

Preferred Cuts

Beef

Traditional Steaks (Ribeye, Filet, Strip, Sirloin, etc), Flank Steak, Flat Iron Steak, Skirt Steak

Chicken

Anything with the bone in; Thighs, Drumsticks, Breasts

Veal

Veal Chops

Seafood

Salmon, Tuna, Shrimp

The Sous Vide style of cooking is relatively new to my household as I purchased my Sous Vide Supreme Demi around 6 months ago.  For those who do not know what sous vide cooking is, it is best described as cooking vacuum sealed food in a precisely controlled water bath for a set period of time.  I will be posting on more specifics of sous vide cooking soon, but until then just google the topic or search YouTube and you can learn quickly about it.  Now, if you are like my wife, this will all sound extremely complicated and like a way to spend more money on unnecessary kitchen equipment!  That said, she has told me repeatedly over the last 6 months that the Sous Vide has been one of the best investments we have made for the kitchen…ever!  Why is it so great?  You can take any cut of meat, vacuum seal it, and as long as you leave it in there for the minimum time to cook it, you are good to go.  The best part is that although there is a minimum time to cook it, there is generally no maximum time (unless you are cooking more delicate protein like seafood in particular).  What this means is that like today for example, before I left to round at the hospital I filled up the sous vide, set the temp for 137 F, and popped in the 3 pound pork loin roast I vacuum sealed last night.  It will cook in 4-5 hours, but I’ll just pop it out at dinner time, dry it thoroughly, and finish it off in a very hot cast iron skillet for 90 seconds or so a side.  What this means practically is that with a little planning, I can have my meat finished and on the cutting board in literally 5 minutes after coming home.  All the above cuts of meat will work in the sous vide, but feel free to add tougher cuts of meat like a regular old beef chuck roast or brisket for example.  Let the less expensive roast or brisket cook at 130 F for 48 hours and finish off in the skillet.  Chuck roast turns to prime rib by just taking a bath on your counter for 2 days!  Anyway, I could go on forever about my sous vide.  For some awesome recipes visit my friend over at Nom Nom Paleo, and if you have an iPad check out her App which even has it’s very own sous vide section!

 

So, now the protein is out of the way, what’s next?  My next step is usually to attack a vegetable.  When I’m crunched for time, there is only one way in my book to make vegetables taste great…roasting them at high heat!  The process is pretty simple, I take whatever vegetable I want to roast (or a combination of them), chop them up into similar sized pieces, line a baking sheet with heavy duty aluminum foil, and toss them with olive oil, salt, and pepper.  I set the sheet in a pre-heated oven set on convection 425 F.  All you do next is set the time for 10 minutes, check the veggies and toss around a bit on the sheet.  Set the timer for 10 more minutes, and repeat.  Just keep doing this until the veggies are charred, crisp, and delicious.  Here is a list of veggies I have cooked in this way, at least what I can remember.

…Asparagus, Broccoli, Brussel Sprouts, Green Beans, Cauliflower, Sweet Potatoes, Turnips, Parsnips, Onions, Bell Peppers, Beets, Carrots, Eggplant, Mushrooms, Butternut Squash, Zucchini, Tomatoes, Summer Squash…

If you can think of others, I’ve probably roasted it!  The other important thing is, especially if you are trying to get picky eaters like kids to eat veggies, is there is a BIG difference in flavor from for example cauliflower boiled in water and drained vs roasted to crisp perfection in the oven.  In fact, if there is a veggie on this list that you think you don’t like, do yourself a favor and try roasting it.  I’ll almost guarantee you will like it cooked this way.  Oh, and one last thing.  Steaming and boiling will no doubt leach some vitamins and minerals out of the vegetables, so high heat cooking should help seal those nutrients in so they can benefit you and your family.

 

 

Well, at that point I’m feeling pretty good about dinner with a solid protein and tasty vegetable on the side.  The last thing I will often do is cut up some fresh fruit or berries and serve it on the side in a little bowl as a “dessert” of sorts.  To my family there is nothing better than ending a meal with the fresh flavor of naturally occurring sweetness you can only find in for example a perfect strawberry.

This may all sound complicated, but once you put it into practice, you will be amazed at the ease with which you can get great tasting Paleo meals on the table with a tremendous amount of variety.  Add a salad on the side if the fruit is getting old, you can really do anything you want!

All this being said, nothing is more important to cooking for the family in a timely fashion than good old fashioned planning.  Think ahead 1-2 days and make sure you have your meat bought and thawed, or sealed and placed in the Sous Vide if required.  Shop for veggies 1-2 days in advance only to ensure freshness, and also to make sure that whatever you are cooking sounds good to eat on that particular day.  How many times have you bought something on sunday to cook thursday, and by the time thursday rolls around it just doesn’t sound very good?  Avoid that by shopping more often.  It’s a bit of a pain, but it’s just the way I do it.

I hope this helps a little on giving you the confidence to try consistently to create fresh and delicious Paleo meals for your family in a time frame that works for you.  Once you get organized, putting together a meal in this fashion should take anywhere between 30-45 minutes start to finish.  Admit it, even YOU can do that!

I’ll try to post pictures of the Sous Vide Pork Roast tonight or tomorrow if able.

-E

 
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Posted by on July 22, 2012 in General Paleo Discussion

 

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The Paleo Mom and PaleolithicMD Team Up to Tackle Medical Topics!

Sarah Ballantyne AKA The Paleo Mom

I’m very excited to announce that I have teamed up with Sarah Ballantyne at The Paleo Mom in a long-term collaborative blogging effort! Every month we will tackle a new medical problem and discuss in detail what it is, what you should know about it, what you should ask your doctor when seeing him or her for it, and how Paleo may affect your treatment plans.

Our goal is to provide you with the most up to date medical information we can so you feel best educated to deal with these sometimes difficult illnesses. It’s not all about Paleo, but more about education and results.

Check out her website for a post introducing the collaboration where she interviewed me and we lay out our plans. Look out soon as we tackle our first topic…Eczema! Click here to visit her site!

-E

 
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Posted by on June 26, 2012 in General Paleo Discussion

 

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Update on Calcium Supplementation in Post-Menopausal Women

One of the most common topics I discuss with my female patients concerns osteoporosis and calcium supplementation.  There have been several recent studies related to calcium supplementation in the news lately and I thought it would be a great topic to discuss, particularly in conjunction with the Paleo lifestyle.

Osteoporosis is a condition where bones lose strength from loss of the calcium matrix that makes them strong to begin with.  Once bones start to demineralize it leaves you more susceptible to fractures.  Every year millions of females fall and break their hips often leading to nursing home stays, and death from secondary infections are not uncommon.  For years the mainstay of prevention for post-menopausal women has been appropriate supplementation with calcium and Vitamin D.  Vitamin D is necessary for your body to be able to absorb dietary calcium.  Recently these recommendations have come under fire from several areas.

Before we get too far into this it’s important you discuss calcium supplementation in the context of how old the patient is and what her menopausal status is.  This post is concerning post-menopausal women who do not have a diagnosis of osteoporosis.  Optimum bone health is a different topic all together for pre-menopausal women as the presence of female hormones changes the game completely.  Also, if a women has already been diagnosed with osteoporosis, supplementation with calcium would likely still be recommended given a risk-benefit analysis.

That said, it has always been common knowledge that if you want to keep your bones strong after menopause, you need to make sure and take in enough calcium and vitamin D.  Recommended daily supplements vary but often call for at least 400 IUs of Vitamin D and 1000mg of Calcium.  This is in fact what I have recommended for my patients for years…but that is changing rapidly.

The first problem came last year when a meta-analysis came out in the British Journal of Medicine that showed a modest increase in the risk of cardiovascular events, especially heart attacks, with routine use of calcium supplementation with or without vitamin D.  The most interesting thing is that this was a meta-analysis of the Women’s Health Initiative Study, the same study we had used for years to justify our use of calcium to prevent fractures!

Calcium supplements with or without vitamin D and risk of cardiovascular events: reanalysis of the Women’s Health Initiative limited access dataset and meta-analysis BMJ 2011; 342 doi: 10.1136/bmj.d2040 (Published 19 April 2011)

To help you better understand the connection between calcium and vascular disease look at these pictures.

The picture on the left is a normal heart, notice the relative consistency in the density of the chambers and the vessels.  On the right is a diseased heart with hardened arteries.  Note first the size difference, diseased hearts tend to work harder, enlarging the muscles and making it less efficient.  Also notice the white spots noted by the arrows; these are the coronary arteries that supply blood flow to the heart itself.  When you have a heart attack, it is these arteries that are affected.

Here is an example of calcified arteries in the brain.  Hardening of the arteries can happen anywhere; in the heart as above leads to heart attacks, and examples like these in the cerebral arteries lead to strokes.  Calcium shows up bright white on Xray which is why bones show up that way.  Note there is very little difference between the skull bones and these cerebral arteries!  So you need calcium intake, but could too much intake lead to accumulation in the wrong places?  This study seems to indicate that may be the case.

More recently the US Preventive Services Task Force released recommendations that post-menopausal women should not take daily low doses of calcium and vitamin D to prevent bone fractures.  They cited a lack of definitive evidence to show it actually works, and also pointed to the chance of increased rate of heart disease and kidney stones from too much calcium.  Vitamin D has also been a hot topic of late as some say it can help prevent some cancers.  The task force also reported that at this time there is insufficient evidence to support these claims.

So what are we to do?  The fact that there are 1.5 MILLION osteoporosis related fractures in the US every year makes this a massively important topic.  Here is what a typical femoral neck fracture looks like before and after total hip replacement.

But, before we get to what to do, let’s talk about how we got here in the first place?

It’s very common in medicine to find something in nature that helps prevent disease and try to replicate that benefit with supplementation.  Take lycopene for example, which is found naturally in tomatoes.  It was found that lycopene could reduce the risk of prostate cancer in men, so it was isolated and given to men in supplement form.  Funny thing is, it only seemed to help prevent cancer when it was in a TOMATO!  Supplements offered no benefit.

Taking this concept to calcium, a recent study showed that females who took the recommended daily calcium dose in SUPPLEMENT form had a higher risk of heart disease, while women getting the same amount of calcium from FOOD did not have this higher risk.  Imagine that, God designed calcium to strengthen your bones, but only when you eat it the way he meant you to!

I hear everyone now, but how do I get enough calcium doing Paleo when I can’t eat dairy?  You ladies sitting down?  There are more sources of calcium then just dairy…quite a few actually.  Here are some examples:

(Ignore the soybeans listed above, and replace with a favorite of mine…figs!)

Listen to this statement from Suzanne Steinbaum, spokeswoman for the American Heart Association.  “To tell people, ‘take calcium and vitamin D to prevent fractures as you get older.’ that’s not panning out anymore.  Even if you are at risk for a fracture, maybe you have to try other lifestyle changes, like diet and weight-bearing exercise.”  Don’t you like the way she put it…MAYBE you’ll just have to try actually eating right and moving around a bit!  If this statement does not sum up why we have an osteoporosis problem in the first place, nothing will.

There is no question that osteoporosis is on the rise.  This is due to multiple reasons, but in my opinion it is from over reliance on supplementation for prevention over the traditional recommendations of dietary calcium, Vitamin D from the sun, and plenty of weight bearing exercise.  Many hoped you could just stay on the couch and take some pills and all would be well.  Like so many times before, we have learned that taking the easy way out just does not work.

So what is a post-menopausal female to do to prevent osteoporosis?  That’s pretty simple.  I think the recommended daily intake of Calcium still needs to be around 1000mg, but just make sure you get it from your diet, not from supplements.  The take home message of these recent studies is that calcium in the form of supplements do not appear to minimize fracture risk in this population, and that they may in fact increase the risk of heart attack and kidney stones.

Make an appointment and talk to your doctor about calcium and whether you should be taking it.  Are you pre-menopausal?  Prevention strategies will be very different for you, and again I encourage you to talk to your doctor to make sure you are on the right track.

The PaleolithicMD motto is Real Food…Real Health.  I can’t think of a simpler way to combine all the lessons calcium supplementation has shown us.  You need more calcium, just eat it in REAL FOOD!  Don’t ignore God’s gifts of calcium rich foods in favor of modern day convenience.  After all, calcium pills don’t grow on trees…figs do.

-E

 
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Posted by on June 26, 2012 in General Paleo Discussion

 

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The Negative Side of Paleo: Yes, There is One!

Last night I had the pleasure of participating in a lecture which served as the start of an 8 week Paleo/Crossfit challenge for 6 patients who have undergone successful bariatric surgery.  To be considered a success you must lose over 50% of your weight so they have all undergone significant transformations.  That said, they were all selected for this program by their surgeon because they have stopped losing weight and have not reached their goals.  They came into the night with no clue what lie ahead or any knowledge that the Paleo diet would be recommended for the program

As William Albritton (CrossFit Alexandria Trainer) and I presented the information, the reaction was typical.  They did not understand why the Paleo no-nos are bad for you, and wanted explanations of how many of these supposedly “healthy” foods are bad for them.  As we talked to them, I started to think about how I would react when presented so much information in so little time.  I could see intimidation in their eyes as we checked off every common kind of food they could no longer eat.  This got me thinking on a grander scale about some of the negative that Paleo can bring out in people.  Yes, I think there is in fact negative that can come from Paleo!  So, here are some of the things I consider to be the negative side of Paleo.

Stress:  Nobody in life is perfect, and even the person you consider to be the most amazing follower of Paleo there is does in fact eat the wrong things at times.  Sometimes people overtly cheat, but often we will cheat with things we are not even aware of.  I think it is vital not to obsess about being perfect when you were in fact created to not be.  When I first started Paleo I was quite guilty of this.  I worried so much about cheating that even on the odd occasions when I would, I would almost get depressed afterwards for losing my discipline.  I eventually realized that the pressure I was putting myself under was a major stress in my life, and it was quite frankly unhealthy to live with that kind of stress.  To the contrary, part of the Paleo lifestyle should be about minimizing the stress in your life in order to maximize the hormonal environment in which we live.  By constantly micro-managing my life and my diet I was defeating one of the most vital parts of this lifestyle.  On top of that, I was pretty much not making it as fun as it should be.  When I think of Paleo I think of fun, varied, energetic, delicious, simple, healthy, freeing…all things you can only experience if you don’t stress about perfection.

Turning Others Off:  Ok, it’s one thing if you obsess and stress about your own diet, but have you ever been around the Paleo guy who has a seizure when you put Splenda in your coffee?  I see you out there!  I think it is so important to be supportive of your fellow Paleo brothers and sisters with a great deal of understanding.  In my house for example, I will confess to all of you that I can in fact be….a little annoying about the Paleo thing.  (I’m certain my wife will make herself available for interviews on this topic if needed 🙂  I was so crazy about it the first few months that my wife has since confessed to me that the reason she did not get on board at first is that I was smothering her with Paleo talk and I may, although I’m not completely accepting this, have looked at her a little funny when she ate certain things.  Who wants to deal with that?!

Don’t make that mistake, and luckily I think I figured it out pretty quick.  One of the things I emphasized during our talk last night was that we are all humans and that I certainly was not 100% on Paleo.  I do in fact try my best to eat clean, but it’s not worth alienating others over.  When people follow the Paleo lifestyle for some time I find that they start to feel proud to be a little different, proud to know that they are making a difference in their long term health with their diet.  That said, care must be taken not to look down on others for either not following Paleo, or not following as “well” as you do.  Don’t be that guy!

Missing the Big Picture:  If you do it, why do you follow Paleo?  To lose weight?  To look better?  To get stronger?  To get faster?  As a doctor I think your answer should be simple…to be healthier.  When you are trying to talk to others about the lifestyle it is easy to get off track.  Just last night during our “Introduction to Paleo” talk here are some of the tangents we went on:  How the food industry manipulates foods to trick us, fast food companies targeting kids with advertising, the use of “heart-healthy” labels on foods such as cereals, what does “cage free” really mean, are artificial sweeteners healthy, are green beans really Paleo, are cows treated humanely in typical slaughter houses?  Now look, each of these questions are important in certain conversations, but I personally don’t think they belong in an intro to Paleo talk.  Paleo comes down to two simple lists: what you can eat, and what you can’t eat.  You eat these things and don’t eat these things in order to get healthier.  What can topics like these do?  What could they easily have done last night?  They quite simply get in the way of Paleo’s basic message.  Several times during the talk I could see people’s eyes start to glaze over with too much information.  One lady asked where in the grocery store she could find “omega-3s”.  We were emphasizing them too much and it was getting confusing.  Topics like these are details that are less important than the big picture with Paleo.  Don’t get lost in the forest of Paleo facts and politics, just eat real food and get healthy!

Making Paleo an Idol:  “You shall have no other god’s before me.” Exodus 20:3 (ESV)  I don’t want to get biblical here on you…well ok, yes I do…but this is really important.  Your life ultimately needs to be about God, family, love, relationships; things that matter more than others.  Not ten days into changing to Paleo I told my wife that I feared it was becoming an idol for me, and that if I could not separate myself from that I may have to give it up.  Obsession with Paleo can be a major battle for many, just like obsession with exercise is for others.  Following Paleo cannot become more important to you than your spouse, or your kids, or your family.  Before you dismiss this, think a moment and I’m sure you know someone who fits this mold.  It may even be you!  Know anyone who won’t go to family get togethers because the rest of the family doesn’t eat Paleo?  Have you completely shut off friends from your life because they eat bread?!  Paleo cannot and must not stand between you and the important things in life.  If Paleo is an idol in your life don’t panic, just take a step back and evaluate how it is affecting those things you love the most.  Make it important, but make a list of things that must always go ahead of it.  Stick to your list and all will be well.

These are just a few of the thoughts that I jotted down during our talk last night.  I have lived through some of the negatives of Paleo myself, and I want to warn others of the dangers!  Our goal must always be to spread paleo to as many others as possible with the hope of making them happier and healthier.  If people see you more stressed than you were before you went Paleo, if you turn others off by being critical of their diets, if you miss the big picture and concentrate instead on minor aspects of the lifestyle, or if you make Paleo an idol that stands before your beloved friends and family; you likely won’t make many converts!

Paleo is good!  If there are any areas of your life where it comes to Paleo that are negative or bad, address them and change them!

-E

 
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Posted by on June 24, 2012 in General Paleo Discussion

 

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