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Keys To Paleo Success Part 2: Understanding

30 May

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.

27 May

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

 
8 Comments

Posted by on May 27, 2012 in General Paleo Discussion

 

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Could Your Fatigue Put You at Risk for Cancer?

24 May

My world of modern medicine and my world of the Paleo lifestyle can, and must blend together to achieve ultimate health.  Your world should to.  Most assume you have to be overweight and snore like a freight train to have sleep apnea and that is just not true.  As many as 1/3 of OSA patients are normal weight, and as many as 1/3 do not snore significantly.  The main cause of this disease is a small airway that is susceptible to collapse during the normal relaxation process of sleep.  If you assume you because you are slim, trim, and fit there is no way you could have it…think again.

Two studies came out earlier this week linking untreated sleep apnea with an increased risk of cancer.  This is pretty amazing and as a Board Certified Sleep Specialist I find it very exciting.  Sleep apnea is already clearly recognized to have an association with obesity, high blood pressure, heart attacks, strokes, diabetes, and even asthma.  As if those were not impressive enough, now we can add cancer to the list.

You want real numbers?  One study showed that people with significant breathing problems at night (otherwise known as sleep disordered breathing) were 4.8 TIMES more likely to deveolop cancer thoughout their lifetime than those without SDB.  Did you just read that?

As a Paleo community we tend to think that we can control our own destiny healthwise by eating clean and exercising regularly.  Well, two weeks ago I saw a 26 year old female, 5 foot 6, 120 pounds who was as symptomatic from the sleep apnea standpoint as possible.  She did NOT snore.  She eats Paleo, and trains at crossfit regularly.  Her sleep study showed significant sleep apnea and we placed her on CPAP therapy at night.  She is lucky that her primary care provider is a thoughtful internist who refused to blame her fatigue on being a mother of two and waking early to exercise (as her prior doctor head).  She is young, lean,fit…and has a serious disease linked with the long list of scary conditions above.  Now she is being treated, and we are making her current symptoms and long term health better.  That’s why I love sleep medicine!

What’s my point with all this?  I know there is a general distrust of modern medicine among the Paleo community, and some of that is warrented.  But, I urge all of you to pay attention to your bodies.  If you are having symptoms that won’t go away, seek help.

More specifically, if you have trouble sleeping, see a well trained sleep physician to work out your problems.  You HAVE to sleep to be at your best.  Do you get sleepy in the afternoons?  Ever wake up with a headache you did not go to sleep with?  Do you wake up as tired as you went to bed?  Have you been told you have “funny” breathing at night while you sleep?  Sleepy at the wheel? Those are classic symptoms of sleep apnea.  It all comes down to this though regardless of symptoms: Are you more tired or sleepy than you THINK you should be?  If the answer is yes, take a long look at the list of conditions associated with sleep apnea and realize that these associations are real…no matter how good your diet is or how fit you are.  Don’t settle for how you feel, you could pay the price later in life.

Learn to listen to your body.  Are you just occasionally fatigued?  Could you be overtraining?  Take a well needed rest day or TWO!  Something hurt worse or in a new way?  Don’t injure further through ignorance of what is wrong!  Are you always tired or sleepy?  Are you ok as long as you are doing something, but have trouble staying awake or focused if you have some down time?  Don’t take the risk…see a sleep doctor and get the right answers.

-E

 

 
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Posted by on May 24, 2012 in General Paleo Discussion

 

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Keys to Paleo Success: Part 1

22 May

I have quickly come to understand what I believe are the major areas one must concentrate on in order to be successful for the long term with a Paleo lifestyle. I’m not talking about specifics when it comes to what you eat, or how you eat, it’s more about behaviors and attitudes. Today’s post is the first of a multi-part series discussing these areas, and today we concentrate on cooking at home.

Some of the biggest complaints I here from my patients about the Paleo lifestyle revolve around cooking. “I can’t cook like that,” or “I can’t cook at all” are what I often get. Being inLouisianapeople just can’t wrap their heads around coming out of the kitchen without biscuits, rice or potatoes playing a major role in dinner. The same is true for any regional cuisine and that cuisine’s traditional staples. It’s almost sacrilegious to tell people that Grandma’s famous dinner rolls gotta go! The Paleo lifestyle revolves around what goes in your mouth, and what goes in our mouths every night has to revolve around a home kitchen putting out the right kind of meals.

Let’s talk restaurants. The first thing I suggest is to get over the idea that you can successfully convert to the paleo lifestyle by eating out every night. Although I do not instruct my patients to count calories when eating Paleo, I do think some obvious restraint is necessary. The average meal at a chain restaurant these days contains 400-750 calories for an appetizer, and 1200-1800 for a main course. These are averages, and many far exceed these numbers. Want to scare yourself more, take a look at the calorie numbers at common kid’s meals these days! Even splitting an appetizer, having an run of the mill entrée, along with a little bread and salad, you still are easily at 2000 calories on a good night. You simply can’t do this 4-5 nights a week and succeed.

Another problem with restaurants is cost. I have absolutely no problem going to a very nice restaurant and spending a little money on a nice meal (in fact, I rather enjoy it!). That said, when one of the biggest issues patients complain about is the cost of eating Paleo, you have to be smart where you spend your money. A 16 oz Ribeye at a local steakhouse is 24-28 dollars, the same Ribeye is 12-14 dollars at my local butcher. Take this evening for example. I am cooking crabcakes with red pepper coconut sauce, roasted asparagus and a side salad. Here are some rough numbers on the cost.

Home:

1 pound of Crabmeat – $16.00

½ bell pepper – $1.00

1 Shallot – $0.50

Paleo Mayo – $0.50

OldBaySeasoning – $3.00 (For whole thing!)

Asparagus – $4.00

Salad Greens – $4.00

Total – $29.00 or $7.25 per person

Local Seafood Restaurant:

2 Adult Crabcakes – $18.00 each

2 Kid’s Chicken Strip Meals (We won’t battle the kids out to dinner!) – $8.00 Each

2 Sides of Asparagus – $4.00 each

2 Waters – $2.00 each

2 Kids Drinks – $1.00 each

Total – $76.00, with Tax and Tip – $95.00! or an average of $23.75 per person

Now this is just an example, and I didn’t even give the kids crabcakes (which they love by the way). There is just no way anyone can argue that cooking at home is not immensely cheaper than eating out. The problem is many people don’t really see this because it just adds up. Ten bucks for lunch here, 50 for dinner there, and before you know it you have spent tons on dining out. I hear it all the time…”It’s just too expensive to cook at home!” Man! Get a calculator and discover the truth!

Another area of concern with restaurants is that you have NO IDEA what they are cooking your food with. Did you know that a Wendy’s chicken sandwich actually contains some beef?! Even nicer restaurants are out for one thing (as they probably should be) and that is to make their food taste as good as they can so you will come back and eat again. They don’t do that, as well as turn a profit by cooking with natural oils or without cutting some nutritional corners. A major part of the Paleo lifestyle is being completely aware of what is going into your mouth. You can’t do that going out to eat unless you know who is cooking for you well, and you are able to given them specific instructions on what to do and what not to do. It can be done, you just have to be very proactive when you order and make them understand how important it is to you that things are done right.

One last issue with eating out is that you are always prone to eat more when going out to dinner. Have you seen serving sizes these days! You go to a restaurant to eat, you are presented with a plethora of options, and given little extras to fill you up while you wait for your food to be cooked. How are we not going to overeat in these situations? How many of us when cooking at home serve an appetizer, bread, salad, main dish, and sides at every meal? When’s the last time your local Mexican joint failed to refill your chips and salsa on demand?!

Enough about eating out, lets talk cooking at home for the rest of the post. I get it, I’m a foodie kitchen dork who loves to cook and make my family happy at meal time. I also have tons of time and don’t work but 3 hours a day….NOT!! Maybe you don’t like to cook? Or is it that you don’t feel comfortable in the kitchen? Or maybe nothing turns out as good as it does at Chilis? Here is a few suggestions.

The first thing I suggest is that you keep a well stocked pantry at all times. When we designed our new house I let my wife essentially do the whole thing…except for my pantry. I knew exactly what I wanted, and I even ended up having the builders rip a wall down and steal more space from an adjacent guest closet to increase the size. No matter the size though, you need to keep pantry staples on hand so you don’t have to constantly be running to the store to get everyday items. If you make it a priority to stock your pantry, you can spread the cost out over 3-4 months and end up with a good stock on hand. I can’t emphasize your pantry enough.

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Next I suggest you start easy and slow. Find some easy Paleo recipes on the internet or in a book and follow it step by step. Look here for a place to start! Read and understand the recipe well before starting, prepare your ingredients, and put it together. You just have to try! Don’t have much time, pull out the crock pot and take 10 minutes in the morning to fix dinner before you leave the house! This may sound obvious, but for a while I would stick to meals that you KNOW you and your family will love. If you are new to cooking, and your family is wishing Domino’s was delivering instead, the last thing you want is to try something a little out of the norm and (literally) leave a bad taste in their mouths. Cook some “fast balls down the middle of the plate” for a while to build your confidence, as well as the confidence of those you are cooking for. Once you feel pretty good about some easy recipes that everyone enjoys, start experimenting with new techniques and ingredients. Above all else, try to make cooking fun! Involve the kids and make a mess every once in a while. You are teaching your kids knowledge that will serve them a lifetime if they learn to produce great meals at home.

Another MAJOR component to successful cooking from the home is planning. If I don’t have anything planned for dinner when I leave the house in the morning, we probably have a 75% chance of getting take out that night. We spend more, eat more, and likely are eating some things we should not. Plan ahead for 2-3 days and try to have your ingredients on hand. Check your family schedule every week and look for things that could get in your way. Always have church till later on Wednesdays? Why not try making Wednesdays crock pot night and you don’t have to worry about dinner other than to get home and serve. We usually do go out to lunch every Sunday after church, so it gives everyone something to look forward to on the weekend. Just find a schedule and plan that is right for you and stick to it.

I want to give you guys two quick tips that I have discovered for myself over the years being the cook and planner in the house. First, I used to try to plan meals for the whole week on Sunday, and get everything bought early to cut on my trips to the grocery store. For me that just did not work very well. Almost always, what sounded good for dinner Thursday night when I was planning Sunday night did not sound as good when Thursday came around. This led to more going out to eat, and wasting of food I bought for that dinner if I did not quickly find another use for it. I now plan 2 days in advance maximum (unless I am using the Sous Vide for more than a 48 hour soak). I go to the store more, but it allows me to always keep what we eat fresh and more consistent with the moment.

Second I want to talk cooking temperature. If you have ever watched Mario Batali cook on TV he says often that the difference between a home cook and a chef is in the “aggressiveness of the heat.” What he means is that restaurant food tastes so good because they cook with high eat and are not afraid to slightly burn food to get that umami flavor we all love. Be aggressive, but to be so you have to be there while your food cooks. My wife can’t do this because she tries to do too many things at once and can’t concentrate on just cooking. Not a bad thing, it’s just who she is! To cook with high heat and get great flavor you have to watch and be there for all the action. Work on this and your food will start tasting better immediately.

I know this has been a sort of hodgepodge of thoughts, but cooking at home is absolutely essential to making Paleo fresh, affordable, and consistent in it’s results for you and your family. Make it fun for the whole family to find the best ingredients, visit local farmer’s markets, get to know the guy raising your beef if you can. If this is too much, maybe you can at least get to know the guy cutting your beef for you at the grocery store. One of my major goals as a dad and a cook is for my kids to know where food comes from. I don’t want them to think food comes though the car window, or from a box, or served mainly for us by a waiter at a restaurant. Real food comes from the home. And as I say; Real Food…Real Health.

-E

 
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Posted by on May 22, 2012 in Uncategorized

 

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The Worst Idea I EVER Had…

19 May

So what’s the worse idea you’ve ever had? Did you actually follow through with it? Well, I had a bad one, and I followed through with it, and it stunk!

For years I’ve tried to find the right “diet” for me and my family. I always tried to weigh the health benefits of what we ate and since I am the cook in the house, it falls primarily on my shoulders. Plus, being a doctor, my wife tends to go with what I say on nutrition since I “should” know best right?

Physicians receive about as much training in med school on nutrition as my 6 year old got about the Ming Dynasty in Kindergarten. We learn all kinds of things in and around the physiology of the human body, including the complex interaction between insulin, fat, and weight. We learn the details that is, but nothing that is the least practical in day to day life. As an internist your primary goal in training is to learn to keep people alive, but mainly when they are ACUTELY dying. Ho hum day to day primary care is covered, but not as well as more serious hospital care. So what we learn falls in line with the standard “calories in-calories out” teaching that I of coarse now reject. We learn about protein, carbs, and fat, and how fat contains twice as many calories as proteins and carbs, so they must be what make you fat!

It’s important for everyone to know that their doctors (most likely) preach this information because that is the little that they were taught, and it’s hard enough to keep up to date with all the new information when it comes to everyday practice. New drugs, new clinical trials; they all take precedent most of the time over relearning old topics. Especially when the “data” that has always been emphasized falls in line with the above train of thought. How can fat not make you fat? It just doesn’t make sense if you stick to the knowledge we are presented in our training.

So, how did I end up putting the time in to learning about Paleo? Well, that goes back to my big mistake! Around 4 years ago I read a book called the China Study just around the time my daughter was turning 2 years old. I was bound and determined to live a healthy life, avoid the chronic diseases my patients lived with everyday, and I knew my diet was the key. So, I became a Vegan. For a year…yes, a year. I bought all kinds of new cookbooks, swore bacon back to the fithly swine it came from, and became one with tofu. I’m nauseated just thinking about it.

I told everyone around me I was going to try it for a year and then re-evaluate. I knew two months in I should just quit, but I’m too darn stubborn to not go the whole year. I…FELT…TERRIBLE all the time. I was hungry, cranky, slept terribly, missed food, and even gained a little weight to boot. As a veggie all I did was try to find ways to make things taste like meat. Tempah, faux chicken stock…and the worst idea ever TO-freaking-FURKY. For the record, I never ate Tofurky, but the thought crossed my mind. It was obvious I craved meat, I was gaining weight, and I felt exhausted all the time. Come to think of it, how often do you run into a fit and energetic looking vegan? I will confess to all here, I did not make it a full year. Around 6 days before the year mark my wife and I were visiting friends in Manhattan and we booked reservations to a wonderful place called Del Frisco’s Double Eagle Steakhouse on 6th Avenue. The original Del Frisco’s is in Fort Worth,Tx, and we have been there many times. I ordered the biggest New York Strip on the menu and sat in awe as the blazing hot dry aged beef fat burst into my mouth on first bit. Meat was back, thank goodness!

I kind of gave up trying to even figure out what is best to eat. I stopped cooking as much, gave in to the kids desires to turn into a miniature chicken nugget, and took the easy way out for a year or more. Eventually I started cooking again, but never with much purpose other than to make tasty things. Now I can cook, and it was fun throwing together tons of classics, mastering homemade gnocchi, building a wood burning pizza oven, making artisan bread at home…all the foodie things you can think of! Still, my wife and I were just living. We didnt’ feel good, we didn’t feel bad; we didnt’ gain weight, we didn’t lose weight…you get the picture.

Around a year and a half ago our neighbor’s started eating Paleo. My initial thought was no way, I’m not trying another fad diet because they don’t work. Why give so much up for so little gain. So we just kept up with the status quo. In the fall of last year my wife was outside talking to our neighbor, and when she came in she said “I think we should go Paleo.” Secretly I was dying to do SOMETHING, I just hated feeling defeated and controlled by food. In typical fashion in our house, we decided I would read the book, and I would give her the short version in less than 10 minutes!

I bought Robb Wolf’s book on my iPad Kindle app, and away I went. I read the whole thing by the end of the weekend and I got energized in a way I have never been before. Why? Rob MADE SENSE, and he included all the science and data my medical mind needed. If you have not read his book, please do so you know why Paleo is important and correct. He gives you the option to skip the “why” of Paleo and just read the “how.” I urge you not to do this as I feel strongly that if you know why you will be more motivated to stay with it. That night I downloaded Why We Get Fat by Gary Taubes and I polished it off in two days (long nights rather). How could I change my mind so fast? This was completely against all I had been taught.

The reason is simple, my patients. I see patients all the time who come in, either have not lost weight, gained weight, or are the same; take your pick. All the while they swear they are counting calories, trying hard, and exercising where they can. I hear this story countless times a day. So there are two options: they are either all complete bold faced LIARS!, or what they are doing is not working. With Paleo, I found the answer… It’s not working.

From that day I have been very strict in my Paleo eating, and have eaten as clean as possible. Have I been perfect?; no I have not. But I can honestly say I have been 95% compliant in my eating and as you all know I am 13 days into my Whole 30 at the moment. My personal results are all the “data” I need to change the way I talk to my patients. I feel good, have lost 25 pounds or more without trying, I am NEVER hungry anymore, and I sleep like a log. Most importantly like I have mentioned on other posts, I am finally in control of my diet. Food no longer controls me and that is the most rewarding part of my journey. Will this lifestyle fizzle out in me? Guess you should never say never, but I just don’t know how I could ever go back to eating non-Paleo. Even now when I “cheat” there are certain absolute no-no’s like wheat, dairy, and soy.

All this has led to this blog, and I have plans for more Paleo projects in the future. I am a very lonely voice in the world of Internal Medicine when it comes to Paleo, but there are many years to come. I am not convinced that the government will, republican or democrat, ever change their views on nutrition and flip the food pyramid over the way it should be. It’s just so sticky, complicated, and political; but that should not stop me or all of you from trying to help others. Over the next few months I will be laying out several projects aimed at bringing Paleo more into the conversation in mainstream medicine. I’m most excited about an observational trial I am hoping to start soon with the help of the Hartwig’s over at Whole 9 Life looking at Paleolithic Nutrition in Diabetics. Exciting things to come!

I am most amazed by the quality, passion, and intelligence of the leaders of the Paleo community. This is not a fad movement, but rather a well educated, scientifically based, and compassionate group of people who want to help people get healthier with simple food choices. I humbly add myself to the mix in hopes of adding to the knowledge base and hopefully…changing the course of history. Together we can do it!

If you are a Vegan out of choice, or a vegetarian for religious reasons I certainly understand. I am simply sharing my experiences and personal frustrations in my life. Medically, I do have questions about how healthy a meat-free diet is, just as I have questions about the health of people following a traditional “heart-healthy” low fat diet. Thanks

-E

 
9 Comments

Posted by on May 19, 2012 in General Paleo Discussion

 

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Statin Drugs, Inflammation, and Paleo: My Take

16 May

I tweeted a link to a study today about the use of Statin cholesterol drugs in essentially any patient over the age of 50, and how routine use in these patients significantly lowered their risk for a significant cardiovascular event (heart attack or stroke).  Now before you just dismiss this as another example of how big pharma is trying to take over the world, let me tell you why you need to pay attention to this study.

First of all it’s big…like 175,000 people big.  In the world of clinical studies, that’s a very impressive number.  The more patients take part in a clinical trial the more powerful it is in general.  This study took 175K people and showed that even in patients with a very LOW risk for heart disease, statin drugs improved their risk of events significantly.  Is this surprising?  Not at all!

Several years ago the so called JUPITER trial looked at the ability of statin drugs to lower what is called highly sensitive CRP (hsCRP).  Studies have shown a very nice correlation between hsCRP levels and short term risk of heart attack.  Levels below 1 are good, between 2-3 are moderate risk, and between 4-10 are high risk for badness.  This trial took 18,000 patients with low LDL (bad cholesterol) and no cardiac risk factors and put them on statins vs. placebo.  The results were so beneficial for the statin group that the study was called off early to allow the placebo group the chance to take a statin.  The marker used to track benefit was a consistent drop in hsCRP in the statin group.

So what does that mean?  CRP is what we call a marker of inflammation.  A regular CRP measures levels of inflammation throughout the entire body, while hsCRP was developed specifically to look at inflammation in the cardiovascular system.  So if we can lower the hsCRP it means that we are lowering the inflammation in the cardiovascular system (easiest way to look at it).  In turn, if statins lower hsCRP, then they must have anti-inflammatory activity right?

That is absolutely right.  It has always been known that statin drugs have a kind of two tiered mechanism of action.  The significant improvement we see in cardiovascular risk seen in patient’s taking statins is too great to be coming only from a simple drop in the patient’s cholesterol.  Statins go into the inflamed walls of diseased arteries and block inflammation.  They are what we call “Plaque Stabilizers.”  Heart attacks and strokes occur when an artery wall is inflamed and swollen with inflammatory markers and cholesterol.  A plaque can be “stable” when it is relatively dense, or “unstable” when it is fluffy and chock full of inflammation and fat.  One little irritation in the cap of an unstable plaque leads to a lighting fast inflammatory response and acute blockage of the artery with a clot.  Anything downstream does not get oxygen; if its heart tissue you get a heart attack, if it’s brain you get a stroke.  So statins without doubt lower your risk of heart attack by lowering your cholesterol, as well as lowering the inflammation in your arterial walls.  This is essentially fact.

Another action statins have on the inflammatory cascade of heart disease is that they counteract the known inflammatory effects of Omega-6 fatty acids.  In our world where the fat pendulum has swung almost completely to the Omega-6 (over Omega-3) side of the aisle, there is no surprise that statins help so much.  Again, this is essentially fact.

The mistake that was made many years ago was in believing that statins purely lowered heart disease risk by lowering blood cholesterol levels.  Linear thinking led to the belief that lowering dietary cholesterol and fat MUST in turn lower heart disease risk as well.  Good idea, just not the right idea!  Statins REALLY work through their anti-inflammatory properties to lower cardiovascular risk, but we didn’t figure that out till later!  Easy mistake to make, but now that we know the rest of the story, we need to go back and correct our thinking.  Unfortunately that is proving more difficult than many of us would like.

One other thing to discuss is side effects of these medicines.  I am completely amazed at the generalized fear and misrepresentation of the side effects of statin drugs.  They have clear and known potential risks, particularly concerning the liver and with generalized muscle weakness.  That being said, I can say in my clinical experience these drugs are generally very well tolerated and safe.  I have been prescribing statins for near 11 years in both training and private practice, and I know of one definitive case of rhabodomyolosis (life threatening muscle breakdown) and only a handful of cases involving significant (but fully reversible) liver inflammation from the drugs.  Are statins for everyone? No.  Are they the most dangerous drugs in the world that should be pulled off the market?  Absolutely not.  They are safe, and they work.

So, what am I saying?  Does everyone need to be on a statin?  Well, if we don’t change our dietary ways as a society the answer may be yes!  In my humble opinion there is a better way of course!  Say for example we significantly curtail wheat in our diet, as well as any other similar proteins that can cause generalized inflammation in our bodies.   This should in theory lower our overall CRP levels, and likely our hsCRP levels as well.  In addition, what if we concentrated on changing the fatty acid profile of our foods to shift the Omega-3:Omega-6 ratio back to the side of Omega-3s.  This would be like turning back the hands of time in our food supply to a time when corn, soy, and wheat did not dominate our agriculture.  We know (fact) that Omega-3 fatty acids are not atherogenic so we would easily lower our cardiovascular risks as a whole.  With these two actions as a society we would accomplish the same thing as giving everyone a statin.  Amazing huh?

The problem is that these changes would be very hard to bring around.  It is easy for us to sit on our Paleo high-horses and state the obvious, but it will be a real battle.  A fundamental change in the way we raise our protein in America and around the world will be a daunting task.  Finding ways to affordably feed the world’s population without a dependence on extremely cheap wheat based products will take years of work.  It is not easy, but I feel it must be done.

I hope this helps you think twice next time you see a headline about the benefits of a drug.  Before you spout off some diatribe about the evils of big pharma, look closely at what it’s all about.  Are statins overused?…according to this study they should be used more!  And, we likely WILL use them more.  That being said Statins work, they are safe, and most interestingly they teach us a great deal about inflammation, heart disease, and why our beloved Paleo lifestyle works.

I hope this all made sense to everyone.  If you have any questions leave a comment or feel free to tweet me at @PaleolithicMD.

In the end…it’s ALL about inflammation!

-E

 
16 Comments

Posted by on May 16, 2012 in General Paleo Discussion

 

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My Experience Prescribing Diet Pills: An Internist’s Perspective

15 May

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

12 May

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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Can Going Paleo Help Your Sleep?

09 May

Being that I am a sleep doctor, one of the things that I found most curious about my transition to a Paleo diet is how much it seems to have improved my sleep. I was never necessarily a bad sleeper, but I find my sleep to be exceptional since my diet change. I fall asleep quickly, which I always have, but it’s the continuity of my sleep that has improved. In the past I would often toss and turn, waking up several times during the night for no particular reason. These days I fall asleep, and the next thing I know my alarm is going off and it’s morning. I feel more refreshed in the mornings and don’t feel the afternoon fatigue I used to have on occasion.

My wife has also noticed a difference. For almost two years she used Lunesta to help her fall asleep and she was tired of having to use it. It left her groggy in the mornings and she seemed to just drag all day. Without it she could not fall asleep easily so she used it out of necessity. Once she also committed 100% to a Paleo diet she began to sleep better. She got off the Lunesta and after a week or so of flushing it out of her system, she has been sleeping better than she has in over 10 years. She sleeps well, feels refreshed in the mornings, and has very infrequent awakenings throughout the night.

In almost all of my patients that have adapted their diet to the Paleolithic plan I have seen an improvement in sleep similar to our experience. So the question is why? Why does sleep, in particular sleep continuity seem to improve with a change in diet? I’ve searched the medical literature and have found no definitive studies to answer that question. So, I’m going to offer my OPINION on why this may be the case. Let’s look at a couple of things.

I discussed in a prior post that a fairly well timed hormonal dance occurs around the time we go to sleep. Cortisol nears its nadir at the time we normally fall asleep, and growth hormone is on the rise during this time. This exchange of hormone levels, along with an increase in our natural melatonin leads to us going to sleep. If these hormones are off for whatever reason, the result can be disjointed sleep. We know that cortisol and insulin are closely tied, so it makes perfect sense that by adapting a diet that lowers your overall insulin levels that will likely have a positive affect on your cortisol levels. Although maybe not completely understood, an interplay between insulin, cortisol, and growth hormone are involved in the improvements in sleep seen with Paleo.

Another area that affects sleep is your gastrointestinal system. When you eat a diet full of GI irritants, large meals are bound to affect how you feel. Your sleep is an ever changing state where you move between sleep stages freely throughout the night. Normally the changes in your sleep stages, or stage “shifts” are fairly well timed leading to a fairly small number of overall shifts though out the night. Anything that disrupts sleep such as Obstructive Sleep Apnea or Periodic Limb Movement Disorder does so by essentially increasing the number of stage shifts. This increase in shifts leads to a higher rate of arousal from sleep (aka waking up) and therefore less restful sleep. Any number of things can lead to stage shifts, including any pain or discomfort you may have. Chronic GI irritation from a traditional carb based diet leads to excessive gas, bloating, and cramping that I believe disrupts sleep quite a bit. You do not have to be completely conscious of your arousals, in fact you are not aware of most, but your brain recognizes them and you feel them in the morning as fatigue. I’m sure we all would agree that a Paleo lifestyle has led to much a much calmer GI system…to say it nicely. If we feel better in the day, we feel better at night, and we sleep better because of it as well.

Sleep is also very closely tied to one’s emotional well being. One of the most common signs of chronic depression is chronic insomnia. There are two basic forms of insomnia: sleep onset and sleep maintenance. As you may expect sleep onset insomnia is trouble falling asleep, and sleep maintenance is trouble staying asleep. A typical depressed sleep pattern is taking too long to fall asleep due to excessive thinking, and early morning awakening. This early morning awakening can be anywhere from 2-5 AM, and again is prolonged by what I call the “I can’s shut my brain off” syndrome. Once people wake up, they just can’t stop thinking enough about what they have to do or what has happened to them to fall back asleep. A gluten laden diet has been linked to depression in many studies, and many people report significant improvements in their underlying depression or hopelessness by changing to a gluten free diet. Paleo of course is gluten free and then some. It’s not hard to link a paleo diet with improved depression, and improved depression with improved sleep. When we treat depression with traditional antidepressants one of the first thing patients report is a dramatic improvement in sleep, particularly sleep maintenance. If you consider Paleo eating more of a natural antidepressant, then the improvements in sleep are easy to understand.

Lastly I think sleep is improved with the Paleo diet basically by association with other aspects of the so called Paleo “lifestyle”. When you decide to go Paleo, you normally do it with the basic intention of getting healthier and feeling better. To that end most do not stop only with their diet. Adapting a new lifestyle also includes increasing your physical activity and focusing on a more overall positive attitude. When you exercise you get tired, and getting more tired in the day leads to better sleep at night. Think of your kids; when they play hard or swim for hours they sleep like logs…we are the same!

Over the next few months, try to focus a little more on your sleep. See how certain things affect your sleep. In particular, notice how any “cheats” may affect your sleep. Some can be a little less compliant and get away with it, but many can’t. Gluten and dairy in particular can significantly affect your sleep, even in small doses.

One last thing, what if you are totally Paleo, and still can’t sleep? Paleo can make you sleep better, but it cannot treat or cure many sleep problems. Insomnia is not to be taken lightly, and can be a significant medical issue requiring sleeping pills to treat. From Restless Leg Syndrome to Delayed Sleep Phase Disorder, sleep disorders are real and are not always treatable “naturally.” Likewise, depression is a pervasive and life changing illness that often requires medication to manage. If you feel depressed despite a Paleo diet, or you can’t sleep, or both!, please do not feel “ashamed” or “weak” in any way by seeking appropriate care and treatment from a health professional. Don’t lose another night of sleep worrying about it.

-E

 
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Posted by on May 9, 2012 in General Paleo Discussion

 

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What Can Sleep Apnea Teach Us About Sleep Deprivation?

01 May

Around 25% of my medical practice is devoted to sleep related disorders.  Without question, the most common sleep disorder I diagnose is Obstructive Sleep Apnea (OSA) [Click HERE for a link to my guest blog article written for Dr. Samuel Bledsoe’s blog, Bariatric Freedom] Most believe insomnia would be the most common disorder, but that type of patient rarely visits my office.  Why you may ask?  Typically, because their family physician treats them with sleeping aids to band aid the problem, or they never complain because they do not recognize poor sleeping habits as a problem with a solution.

Americans do not value sleep.  I see it daily, and unfortunately I see the price my patient’s pay in their overall health.  The symptoms most commonly associated with poor sleep hygiene are daytime fatigue and poor work performance.   However, would it surprise you learn that inadequate amounts of sleep have also been linked to heart disease, high blood pressure, elevated insulin and thus blood sugar levels, worsening of asthma symptoms, and even death?  To learn why, look at one of the most common sleep problems, Obstructive Sleep Apnea.

OSA is a condition where you have intermittent pauses in breathing (apneas) while you sleep.  As you cycle through sleep, typically, you move from the lighter phases of sleep (Stages I and II) into the deeper stages (Stage III and REM).  The graph below illustrates a fairly normal sleep cycle in a healthy young adult.  I might point out that recently state III and IV sleep were combined into once stage known as Delta sleep in the sleep medical literature, and the hypnogram below still has the old nomenclature.

When you have intermittent apneas at night, usually from your airway closing on itself, it leads to at least a 10 second pause in breathing.  As your oxygen goes down, your carbon dioxide goes up.  It is this carbon dioxide that eventually reaches a level which tells your brain that it is time to breathe!  The key is when you start to breath again, you almost always experience what we call an arousal.  This means your brain waves, or EEG, shows a shift to a lighter stage of sleep, usually all the way back to wake.  Just as quickly as you woke, you fall right back asleep, but at a lighter level.  Therefore, if you have moderate sleep apnea, you may stop breathing 30 times an hour, and thus wake up 30 times an hour!  Of these, you may actually be aware of only once that you wake, but your brain is aware of each and every time.

What is the result of this very intermittent and choppy sleep?  Symptoms!  Classic symptoms of sleep apnea include feeling sleep deprived upon waking, morning headaches, drowsiness while driving, mental fogginess in the morning, fatigue, sexual dysfunction, and getting busted snoring in public places.  An analogy I tell patients is to imagine you slept 8 hours overnight; however, during this sleep period you were awakened every 30 seconds, then you immediately fell back asleep.  Obviously, you will not feel refreshed!  This is a life with sleep apnea.

It is important to note that you do NOT have to be overweight, or even snore to have sleep apnea!  Sleep apnea is caused by a narrow upper airway that has an abnormal tendency to close when relaxed.  If your airway has this propensity, you are at risk of developing OSA.  If you are at risk and gain too much weight, your chances increase dramatically.  Therefore, obesity makes OSA worse, but does not necessarily cause it.  Yes, I do diagnose 115 pound, 35 year old females with severe sleep apnea.  If you have these symptoms and they are unexplained, see a certified sleep physician.  Do not solely rely on how you feel.  Let me say that again, having sleep apnea is not necessarily related to poor life choices.  Like many disorders, you can inherit the tendency to have problems that can lead to poor health.

So, what does this have to do with anything you ask?  Let me just lay out a few of the hormonal changes that occur with sleep apnea.

-Cortisol is bad for you.  It’s bad for sleep, it’s bad for your insulin levels, and it’s bad for your blood sugars.  Cortisol normally reaches its low right before bed time, which allows for an easy transition from wake to sleep.  Sleep should be a relaxed time when your “stress-hormones”, of which cortisol is one, are at a low level.  Chronic sleep disruption from OSA leads to both, a slower level of cortisol decrease as sleep approaches, and a general increase in cortisol levels all night.  Given that cortisol increases insulin levels, which increases glucose levels and your risk for obesity and diabetes, this is clearly a problem.  This elevation in cortisol also makes controlling a diabetic’s blood sugars difficult if they have untreated OSA.

-The yin to cortisol’s yang is growth hormone (GH).  GH levels typically rise during the night as you sleep.  This is important, because GH has the ability to counteract insulin and grant you some relative protection against insulin resistance syndrome.

-Leptin is your friend.   This hormone essentially triggers to your brain that you are full.  Leptin also appears to be affected by sleep amounts!  Studies in patients subjected to sleep deprivation, in large and moderate amounts, show a significant fall in leptin levels.  This is because your bodys fat cells, which secrete leptin, are signaling to your body to eat, even when it is full! So yes, poor sleep makes you hungry.

-Grehlin, works basically the opposite of Leptin by stimulating the appetite.  If you had to guess what sleep does to Grehlin levels, what would you say?  Yep, sleep deprivation leads to abnormally high levels of Grehlin and thus hunger.

-This is just the tip of the iceberg.  The sleep medical literature is constantly finding new links to hormones and metabolism.  As things evolve, I will try to keep you informed.

So, now that I have potentially bored you all to death, what does this all mean?  OSA patients have chronic sleep disruption from the disease.  However, a result of the everyday choices we make, many of us also suffer these hormonal consequences. Think of the amount of sleep you need as a checking account.  You need to deposit a certain amount every night, in order to make withdrawals the next day.  If you fail to make nightly deposits, debt will accumulate.  Unfortunately, if you miss thirty minutes here, an hour there, and never make it up, the debt starts to accumulate fast.  After continuing this habit, your sleep debt has accumulated to such a large amount that you are bankrupt.  You are tired, cranky, sluggish at the gym, hungry, stalled on your weight loss, stressed…get the picture.  The cause of this common picture is the hormonal consequences detailed above.

WHETHER YOU HAVE SLEEP DISRUPTION FROM OSA OR CHRONIC PARTIAL SLEEP DEPRIVATION, THE CONSEQUENCES ARE THE SAME!!

The Paleo world tends to focus way too much on food, and forget about other aspects of health.  As a sleep doctor, I would sayAmerica’s overall sleep health grade is an F minus.  We don’t value sleep.  How can you want to be your best, do your best, have the best time possible without giving your body the proper rest?  It won’t work.

Like I said above, the hormonal landscape of sleep and how it affects your everyday life is a work in progress.  We just do not know everything there is about the neuroendocrine nature of sleep to connect all the dots.  However, we have connected a few important dots.

-We have mortality data demonstrating the risk of dying is 30% greater for untreated OSA at any point in your life.

-European data recently showed a significant increase in the mortality of individuals who reported sleeping less than 6 hours a night…regardless of BMI or lifestyle!

So people, no matter how “in shape” you think you are, how many pull-ups you can do, or how little carbs you eat…lack of sleep will catch up by making your long-term health worse.  Don’t get caught thinking you are above the fray because your WOD times are always best!  Get your sleep, invest in your health, you’ll be glad you did.

-E

 
3 Comments

Posted by on May 1, 2012 in General Paleo Discussion

 

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