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Real Patient Results – The Accidental Paleo and a Priority Check

Greetings everyone.  I saw a patient yesterday that I have seen for quite some time, and I noticed right away reviewing her chart before going in the room that she had lost 19 pounds since her last visit 4 months ago.  When I went in to see her I asked how she was, and she said she felt great.  Turns out she had gone to see a nutritionist and was following her advice.  Also, she was trying to walk more, but not too succesful with that endeavour.  I asked her what the nutritionist had recommended, and this was her answer.  “Well, essentially I can only eat meat and vegetables.  I can’t eat much fruit and no dairy or grains.  Basically doc, it’s meat and veggies.  And man, do I miss cheese!”  As we reviewed a bit more, you guessed it, she was basically eating a paleo diet without calling it one.  But, here is the kicker.  Once she reaches her goals, the nutritionist says she can slowly introduce things back into her diet and just watch her weight.  She could see in my face that she had finally said something I did not agree with!

So, how was she doing?  As expected she had lost weight (actually 19 pounds in two months since starting this), she had tons of energy, she had lost a total of 9 inches body wise, and “doc I sleep like a log!”  I can’t tell you how many people who go Paleo that swear that they have never slept so good in their entire lives.  It’s so predictable it’s not surprising anymore at all.

Labs you ask?  Well, fasting sugar from last visit was 105, this time 87.  Cholesterol?  Well she takes a statin for cholesterol because her numbers were as such off the meds 283/146/46/208 (Total Chol/Trig/HDL/LDL).  On the meds they had dropped to 197/150/43/124.  In the last two months she had decided to DROP her statin dose to every other day, and her numbers today were 166/73/46/105.  So, her numbers were much better on both the Paleo diet AND her statin every other day.  Then she revealed her secret…she had stopped the statin completely 5 days ago and was hoping to stay off.  I asked her if 1) she was planning on continuing her lifestyle change and 2) if she was willing to re-start the statin if off of it her numbers went back up to worrisome levels.  She said yes to both, and we hatched a plan to keep her off her meds for three months and see how she looks then.  We will recheck her cholesterol and hope we can keep her off the statin, and hope that she continues to lose more weight.  To be continued!

Now quickly, back to the nutritionist and her plan to “phase” things back into the diet after “goals are complete.”  Let me explain something to everyone, if your health related goals are “short-term” goals, you will create nothing but “short-term” health.  Why, why on earth would you do something that helps you lose weight, feel great, and sleep like a log for a while, then go back to your old ways?

Let’s say you made a ton of bad decisions, and get yourself in tons of debt.  You decide enough is enough, and you visit a financial planner who comes up with a comprehensive plan to get you out of debt.  Kill the credit cards, stop the travel, no more eating out etc.  Then he tells you “Once you get out of this hole, we will slowly re-introduce all your bad habits and hope for the best.”  No one in their right mind would say that’s a good plan!  But, since we LOVE cheese, we think re-introducing it after reaching our goals seems reasonable, if not “fair” in some way.  I mean after all, how can we survive without cheese??!  In reality, this is the theory behind every “diet” in the books, and that my friends is why diets don’t work!

Most of us care for and manage our money much more than we do our health.  Where are your priorities?  We put junk in our mouths when we would never think of putting 50 Octane gas into our precious vehicle.  We get the cheapest meat we can find and buy the most expensive cell phone and plan we very well can’t afford.  We afford the expensive car lease but not the gym membership that we so desperately need.  (The Nav and leather seats were only $40 more a month!) Why?  I would love to hear a good answer 😦

Your health is a long-term investment, don’t make it about short-term gains.  Your short-term gains lead to my long-term gains…my bank account that is.

Eat Clean, Be Smart, Think LONG-TERM

-Ernie

 
 

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Restless Leg Syndrome: Is Your Diet Related?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Ernie

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

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

Sources:

Restless Leg Syndrome Foundation: About RLS

UpToDate.com Section on RLS

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

Celiac disease is associated with restless legs syndrome.

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

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

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

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

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

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

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

Prevalence of gluten sensitive enteropathy antibodies in restless legs syndrome.

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

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

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

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

Manchanda S, Davies CR, Picchietti D.

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

 
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Posted by on April 23, 2013 in General Paleo Discussion

 

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A Real “Genesis Experience”: 6 WLS Patients and How Paleo Changed Their Lives

Well Hurricane Issac came our way and thankfully we were spared any significant weather.  Many folks south of us are still struggling, and I ask for everyone to pray for their safety and a quick resolution to the chaos that has come into their lives. On top of the hurricane, much has been going on…where to begin…

Several months ago two of my friends and I decided to try something new.  All three of us follow a Paleo lifestyle, participate in CrossFit (each on very different levels as William is part owner of our local gym and one of the it’s trainers, and Sam has been attending CrossFit for much longer than I) and have a passion for helping others.  William Albritton is an engineer by trade, but spends all of his spare time as a CrossFit trainer and health coach.  Sam Bledsoe is somewhat of a rarity as I’m almost certain he is the only Paleo Bariatric Surgeon in the country!  He identified a group of his successful weight loss surgery (WLS) patients who had stopped losing weight after surgery, or plateaued.  He and William devised a plan to put them in an 8 week program based on strict Paleolithic nutrition and consistent application of CrossFit…lucky for me they asked me to join in the fun!  In total, there were 6 lucky participants.

Looking back at our first meeting it was pretty comical.  They really did not know what they were getting into, and we had to completely define the term “paleo” to them.  We set about explaining to them what and why we eat the way we do, and in the process I think I may have broken a few hearts.  Who knew what a stronghold someone’s oatmeal could be!  Regardless, they are all people of integrity, and they committed to our program by trusting our judgement.

So lets just look at this for a moment.  How much more difficult of a challenge could we ask for?  Here are 6 individuals who have fought their weight their whole lives, and who have lifelong food relationships that often were unhealthy.  When you have WLS a certain amount of weight loss is almost automatic, but the last of the loss is much harder.  Here is the thing though, each of these individuals was working hard through traditional weight loss regimens.  Low calorie, low fat, exercise at the gym when you can, walk when you can’t get to the gym…it just was not working.  There is a misconception that overweight individuals are inherently lazy, and this group of people blow that mold out of the water.  They were all trying, they were just trying the wrong things.  One of our group members had already lost 120 pounds since surgery, but had only lost 5 pounds in the 6 months or so before our challenge.  Bottom line is that they did not necessarily “get” what we were telling them, but they were willing to try something new.

So began the process, some form of exercise 5-6 times a week, half of them being CrossFit WODs, and the other days much more light walks or runs.  All along we held them accountable to following a Paleo regimen by turning in weekly food logs and helping them sort through the best choices to make.  Each had their own issues at the start, but they all worked hard to get through the beginning, and quickly began to thrive.  Their group workouts became a source of encouragement and our consistent interaction with them kept their eyes open at all times.  Slowly the magic started to happen, but they did not know exactly how much magic.  Why?  We strictly prohibited them from weighing themselves over the 8 weeks.  It was time to worry about health, not weight!

The results of our 8 weeks was amazing, and I’ll let two things do the talking.  First is a chart of the results.

The numbers in the first row are where each person started, the middle row is their end measurements, and the bottom row is the difference between the start and finish of the 8 weeks.  You are reading right, each person averaged around 20 INCHES of loss over the program.  Now THAT is results!

Please notice that even though overall weight loss was not earth shattering for all, the number of inches lost and overall improvement in body “tone” was awesome.  We did not have one unhappy participant!

Second I’ll let everyone read an essay that one of our participants wrote at the end of the program.  He is an amazing gentleman whose transformation following WLS and our program is nothing short of remarkable.  Here is what he had to say…

At the end of our journey we had a little get together at my home where we were all able to talk and share about the program, and we enjoyed some amazing Paleo food (including a healthy dose of @FitPaleoMom’s Chocolate Chip Cookies).  It was so inspirational to hear everyone’s stories about the struggles over the years, and the positive light that our program was able to put on their circumstances.  All six participants have officially joined CrossFit, and the road ahead will be nothing but success for them.  As a physician is it easy to get discouraged in the day to day grind of taking care of people.  I can honestly say at the end of the 8 weeks we owed, and gave, a heartfelt thanks to each participant for giving their all, and reminding us how much of a difference we all can make.  It was one of the most enjoyable journeys in both my personal and professional life.

So what do we do from here?  We have decided to spread the wealth and open our program to all comers in our area. [www.Genesis-Experience.com] We want to keep attracting people who would never consider coming to the gym and helping them revolutionize their lives.  People looking to “forge elite fitness” will find the gym, we need to go out and FIND everyday people who stand to benefit so much from a dramatic lifestyle change.  As a physician this is what really excites me, changing lives that have been abandoned and failed by the “system”.  If 6 WLS patients can see these changes, anyone can!

Hope all are well…

-E

 
7 Comments

Posted by on September 3, 2012 in General Paleo Discussion

 

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Real Patient Data on an Insulin Pump Patient Plus 1

I saw a lady in follow up yesterday that was a great addition to our growing list of successful “Real Patient Data” series.  She is a 59 year old obese African American female with high blood pressure, diabetes, high cholesterol and sleep apnea.  I’ve seen her for many years and she has really struggled controlling her diabetes.  She actually ended up retiring a little early from her job over a year ago because she was finding it impossible to care for her diabetes and work at the same time.  We ramped up her insulin for a while and eventually convinced her to go on an insulin pump that should have taken care of things.

After starting the pump we saw a great decrease in her Hemoglobin A1C which dropped from above 12 to10 and then to 9.  The problem is that it got stuck on 9 and we have not been able to lower it much more.  I increased the basal insulin pump rate several times, and it just did not have much influence.  We reviewed her diet and she truly does not eat too much or too badly, but she continue to eat her “heart healthy” oatmeal and cereal for breakfast and other carbs that she has been told for years are good for her.

I have broached the subject of Paleo with her a few times, but she never really considered it.  A month ago I saw her and she was convinced her numbers would be better because she had really stuck to her diet and not cheated at all.  The good news for her is that her A1C dropped!  Bad news is, it dropped from 9.01 to 9.00.  Dejected does not touch where she stood at this point.

I talked to her again about Paleo and asked her what she had to lose?  She is a little different than many patients in that she REALLY wants to control her diabetes, to the point that as I mentioned she retired early to be able to concentrate on doing so.  We went over the entire thing again, I really took the time to explain WHY she could not eat the things Paleo restricts, and she finally realized what I already see…what she is doing is not working!  She agreed to give it 30 days and on her way she went.

She came back yesterday and felt pretty good.  When someone really tries to get better over time, and fails over and over, their confidence gets drained.  She had no confidence that Paleo would work, so imagine her smile when I told her that after 32 days of Paleo, her Hemoglobin A1C had dropped from 9.00 to 7.45, and she had shed 9 pounds.  I might add that we made NO adjustments to her insulin pump prior to starting Paleo, so this can be attributed to her diet as nothing else changed.

Several years of frustration corrected by a simple dietary change.  Will she get off her pump?  Absolutely not.  Will she get her diabetes under control?  I truly believe so as long as she can maintain her current diet.  Will we be able to cut her insulin requirements?  I hope so!  This is a real lady, with a real problem, and real problems controlling it.  She had tried hard the traditional way (heart healthy diet and more insulin) and gotten no where.  I don’t think she’ll be going back to the traditional way any time soon!

I’ll also share a quick story about another patient I saw yesterday.  I had spoken to him and his wife 3-4 months ago about Paleo, and they had agreed to give it a go.  He is mid 50’s and healthy aside from his high blood pressure, diabetes, and the stroke he suffered around a year ago!  They missed their 30 day follow up, so I figured they had not done the diet.  As expected they came in and they did not mention it at all (figure they hoped I had forgotten!)  We went over everything, and his numbers looked great.  His blood pressure was perfect, his cholesterol was lower than treatment goals, and his Hemoglobin A1C was in the “non-diabetic” range.  He smiled, looked at me and said “You see, I don’t need that crazy diet after all!”

That’s when I smiled and said “You are right, your numbers are perfect, and we can be happy with that.  My problem is this…your numbers have been perfect for the 4 years I have taken care of you.  They are always perfect…they were even perfect when you had your stroke!  So are you ok with that, having perfect numbers and having a stroke?”  He looked at me with a little smirk as if to say that I love when I’m right; and I do love when I’m right!

As we talked a little more I discovered that they had indeed taken some of my advice, and changed much of what they ate.  He still ate cheese, but had been able to cut much of the carbs from his diet…just not all.  As we looked at his numbers, we saw that even with these minor changes, we saw improvements in his A1C, Total Cholesterol, Triglycerides, HDL, and LDL.  They are not what I have seen with strict Paleo, but they were something.  I encouraged him to keep trying the best he could, and we would squeeze everything out of his dietary changes that we could.  Take home message: In patient care, 50% improvement is better than no improvement!

I hope these patient experiences do two things for everyone.  First, I hope they encourage all of you doing Paleo to keep doing it, and those considering it to give it a try (especially if you already suffer from chronic disease).  Second, I hope it encourages you to talk to others and try to convince them to change their ways as well.  What better gift to another than to help extend their quality of life and limit chronic disease!

Hope all have a great weekend, and keep a look out next week for the first in a series of collaborative posts with Sarah at ThePaleoMom.com!

-E

 
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Posted by on June 22, 2012 in Patient Experience

 

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

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

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

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

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

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

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

Win-win all around!

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

-E

 
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Posted by on June 21, 2012 in General Paleo Discussion

 

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How an Old Classmate, Now Patient Changed His Life With Paleo

Being a doctor is always hard, but at times it can definitely be harder than others.  Taking care of friends is especially challenging as some of you may have experienced.  Most doctors, I believe, especially those who have long-term relationships with their patients, have more than just a business relationship with patients.  After a while you get to know them well, get to know their whole families (often take care of the whole family!), and you genuinely start to care for their well being on a different level.

When taking care of a friend that process is accelertated immediately.  Around 3 years ago an old high school classmate of mine came to see me.  He is a state trooper, in fact a very good trooper, and works in an area of law enforcement that takes a special person.  Growing up he was skinny as a pole, and I was very surprised to find out that he was a very poorly controlled diabetic.  When he came to see me his numbers were horrible, and he was not caring for himself at all.  That said, it was not all his fault!  He had been diagnosed as a Type 2 diabetic, and was really Type 1.  We tested his pancreatic function and it was essentially non-existent.  We put him on insulin, and so began the several years of too infrequent visits where I steadily yelled at him about having to change his life.

When you are young, skinny and healthy on the outside, and a cop; its very, very hard to change your life.  Youth can make you think you are invincible despite a bad disease, add a badge to that and it’s a nightmare!  He would come in and say all the right things, nod his head in agreeance, and come back the next time with worse numbers.  As his insulin requirements went up I talked to him about switching to an insulin pump.  His wife was worried that he would feel it was a liscence to eat as he wanted.  She was right, but he already thought he held that liscence so what harm could it do?

We put him on a pump and he initially did a little better.  His improvement was of course from the pump, but he was soon able to out eat the pump and his numbers worsened again.  Now before anyone says anything, I had several long and frank discussions with my friend about diabetes, what it would to to him, how his wife and kids needed a dad…all that stuff…even how diabetes would lead to premature erectile disfunction; nothing worked.  He just WANTED his cake and to eat it to (pun intended).  It’s so hard to talk to someone who is young, intelligent, and really knows what is going on; yet does not want to change much of what he is doing.  He hoped that, as his wife predicted, the pump would be his ticket to eating what he wanted.  Despite increasing his insulin, and increasing the amount we bolused him before meals, we got no where.

He started to dabble with CrossFit, that was great, but he still did not address his diet in any significant way.  Now it is easy for people in the Paleo community to just say “change your diet man, it’s easy!”  Most people who eat Paleo do so out of CHOICE…my friend felt he HAD to do it.  It is absolutely human nature to fight anything you feel you are forced to do, and he fought corageously!  Now I think he was right in that he was being forced, but it did not make it any easier.  I continued to see him and do my best to scare him into changing.  When I started Paleo myself I immediately talked to him about it.  He did it for a day or so, even texted me a few pictures of his Paleo meals, but it did not last.

On a recent visit we once again discussed his life and health long term.  He has kids, and life was starting to show him that he is not as invincible as he thought.  We looked deep into his kidney function and I explained that although “normal,” it is nowhere near normal for someone his age.  He realized that his body was changing.  We went over Paleo AGAIN, and he once again told me he would do it.  I didn’t hold my breathe…

I saw him a week ago and for once, he had actually changed.  Even more than that, his MIND had changed that he not only could do this, but that he HAD to.  His wife and kids were with him, she has been supportive, and he finally felt like he was getting somewhere.  More than anything, for the first time I did not have to do any…well, bitching for lack of a better term.  He was on board, he was happy with what he was doing, and he had all the determination in the world to continue.  Essentially I think my friend had finally seen his mortality, and he realized he has way to much to live for not to change his ways.

So what did he accompish in 30 days?

He lost 8 pounds

His fasting sugar went from 198 to 169

His liver functions (AST/ALT) went from 105/51 to 61/37

His Hemoglobin A1C went from 8.46 to 7.32

The numbers are great, but most importantly my friend saw his life for what it is, and he decided to take control of it.  If he follows Paleo the numbers will take care of themselves.  For those who know me they will certainly know who this is about.  He actually ASKED me to be on the blog and wanted a picture posted, but we will withhold for now 😉  He experienced the same thing I did that made me start this blog; the amazement that comes with changing your diet and seeing real results in how you feel followed closely by wanting to tell everyone you know!  I will keep everyone posted on how he does, and once he is a little farther along the way, I’ll try to convince him to write up his experience for all of you. (That statement was absolutely intended to pressure him into doing so!)

-E

 
7 Comments

Posted by on June 13, 2012 in Patient Experience

 

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Real Patient Follow-Up: Amazing Results Continue!

A couple of months ago I posted information on a 65 Year Old Diabetic gentleman who had adatped Paleo and I shared the results after one month of his new diet.  Well, good news, he was back today two months later, and here are his updated results!

Over A Three Month Period:

Weight: He has lost 30 Pounds

BMI: 34.58 (Start), 33.23 (1 month), 30.52 (3 months)

Hemoglobin A1C: Dropped from 7.36(0) to 6.57 (1) to 6.02 (3)

Liver Function Tests: AST/ALT 80/68 (0), 51/39 (1), 40/34 (3)

Cholesterol/Trigs/HDL/LDL: 186/211/45/98, 141/240/33/60 (1), 137/151/38/68 (3)

Now all of this is very impressive, but here is what I found most fascinating.  This was his medication regimen for his diabetes at time 0:

Levemir Insulin 100 Units at night (Long-acting insulin)

Apidra Insulin 20 Units Three Time a Day with Meals (Short-acting insulin)

Glucophage 1000mg Twice a Day

As he has lost weight, he has had to cut is Levemir in HALF to 50 Units nightly, and completely STOP his Apidra with meals. 

If only you could all see the smile on his face 🙂

-Ernie

 
3 Comments

Posted by on June 11, 2012 in Patient Experience

 

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