Good Calories, Bad Calories: Ignoring the Paradox And Trashing Carbs.

In reading Good Calories, Bad Calories, there is a hope that the author will give a balanced viewpoint of the situation.  He disproves the idea that fat causes weight gain, then takes issue with the idea that carbs cause weight gain. 

In a chapter entitle the Paradox, he points out that when you starve people they lose various amounts of weight.  He also shows that when you stuff people they gain various amounts of weight.  So any blanket statement about weight gain and weight loss is moot.  It doesn't exist.

Then, because everyone needs an ending, he goes back to carbs and makes them the villain.  It isn't just the carbs, it's the insulin imbalance caused by the carbs.  But wait, didn't we just show that it wasn't straight carbs and that any weight gain or loss is a highly individualized process?   Under those circumstances, wouldn't it be possible that some individuals might even gain weight by eating fat? 

What starts off extremely well becomes one more carb trash fest while glorying the joys of meat and fat.  What's missing from all this is some allowance for the fact that we all cannot eat meat and survive as a planet.  It isn't a sustainable eating pattern, and it isn't terribly healthy.  We've got other books that make that clear.  They are focused on lifespan, rather than weight loss. 

The End Of Illness. David Agus' Inability to See His Own Prejudices.

One day I too hope to write the definitive book on the cure for Cancer.  But I think I will base my treatment protocols on more than one reference book.   

Let me begin by saying I like much of The End of Illness.  Dr. Agus and I agree on many things, including that Michael Pollan does a wonderful job of talking about food.  But my admiration for Pollan does not distract me from the simple reality that Pollan is one of hundreds of opinions about food and what we should eat. 



So, I do not base my recommendations about food while referencing a single author, no matter how authoritative. 

Given that Dr. Agus' focus is on food, and that he spends a great deal of time trashing supplements of all kinds, I would expect a little more emphasis on what will be the most curative diet.  For it is diet alone, and nothing else, that will impact our genetic inheritance and help us live. 

I disagree with the concept that we'll be getting personalized medication any time soon.  Perhaps the very wealthy will be able to afford the sort of technological testing Dr. Agus describes, but the reality is that for almost everyone modern medicine is too expensive already. 

And here is the the fundamental flaw I see in the End of Illness.  Dr. Agus dedicates a huge section of the book to really making readers second-guess taking even a multivitamin because of the possible health consequences.  But he waxes rhapsodic about the benefits of the Statin medications and baby aspirin, taking both himself for "preventative purposes."  Hello?  We're not talking about inert medications.  A statistic percent of those following Dr. Agus' recommendations of daily statins and baby aspirins will suffer debilitating muscle pains and/or hemorrhagic stroke as a result of his "preventative" pharmaceutical supplements.  While we have large studies that show possible risks from overuse of multivitamins, we have no large scale studies that confirm the benefits of statins or aspirin for the general population without the real risk of side effects for a minority of those individuals. 

To place preventative supplementation off limits as a clear negative while recommending pharmaceutical medications as healthy and safe clearly shows a prejudice and double-standard for conventional medical "solutions."  Given the cost and safety profile of the statins, they are at least as dangerous for the general population as the Vitamin E supplements that Dr. Agus so effectively vilifies.  And aspirin is as dangerous to elderly populations as their multivitamin.  So we are left with food as the only panacea, and that needs a bit more book time that simply gushing over Pollan's ideas. 

17 Day Diet, Really the 68 Day Diet

Well, like anyone I was intrigued by the idea of a 17 day diet.  Really?  That's all it takes to conquer obesity in America?  How could we have been so foolish? 

But then I found out it was really four cycles of 17 days, and I thought:  this guy's been watching too many late night infomercials:  "Just four cycles of 17 days each..."  but the 68 day diet just doesn't sound as sexy.

You can do the 17 minute workout, get the 17 day meal packages, spend a great deal of time thinking about why it isn't the 15.7 day diet or the 18.33 day diet.  When you watch Dr. Moreno defend the 17 there really isn't any reason why the other two numbers wouldn't work.  Wouldn't part of a day be better at confusing the body? 

In the end, it's one more young, healthy male doctor explaining to middle aged women that they just need more discipline when really it's a matter of hormones.

Does Alternative Medicine Cost More Money Or Less For Fibromyalgia?

There are two schools of thought on this issue.  One says that adding insurance coverage for alternative medicine will cost more money because people will use both.  The other says that using alternative medicine saves money because people get less sick and take care of themselves more.  Can we have the drumroll please?  The cost less people win!  Washington state did an analysis of people who had coverage and the people who use alternative medicine cost the insurance companies about $400 dollars less.  Most interesting is that the really sick people cost insurers almost $1500 less per year.  Some of these people had  back pain, fibromyalgia or menopausal symptoms. 

In terms of Fibromyalgia, I went looking for the alternatives for Fibromyalgia on WebMD.  The person writing about Fibromyalgia is an M.D. who happens to have Fibromyalgia.  He's written thirteen books on Fibromyalgia.  He also happens to be "a physician speaker for pharmaceutical companies that make medications used to treat fibromyalgia."  I sense a vague conflict of interest when discussing alternative treatments as primary. Not surprisingly, he doesn't mention dietary change, GABA, DHEA, probiotics, or a range of other likely treatments.  Instead he focuses on a number of antidepressant herbs that are basically milder versions of the antidepressant pharmaceuticals being used.   

In focusing on the antidepressant aspect of treatment, our expert is playing to the "all in your head" phenomenon I see more and more often in chronic diseases.  But the reality is that a range of other factors affect Fibromyalgia patients, including a blunted adrenal response.  A number of different studies support this connection (one is below).  So rather than saying it's all in your head, we should be looking at the rest of the body.  Maybe this is why alternative medicine saves people money.  We look toward the big picture rather than just managing the symptoms. 

J Rehabil Med. 2010 Sep;42(8):765-72.


Evidence of reduced sympatho-adrenal and hypothalamic-pituitary activity during static muscular work in patients with fibromyalgia.

Kadetoff D, Kosek E.

SourceOsher Center For Integrative Medicine, Stockholm Brain Institute, Department of Clinical Neuroscience, Karolinska Institute, Stockholm, Sweden.
Abstract

OBJECTIVE: To assess activation of the sympathetic nervous system and the hypothalamic-pituitary-adrenocortical axis during static exercise in patients with fibromyalgia.
PATIENTS AND METHODS: Sixteen patients with fibromyalgia and 16 healthy controls performed a static knee extension until exhaustion. Plasma catecholamines, adrenocorticotropic hormone and cortisol, as well as blood pressure and heart rate, were assessed before, during and following contraction. Plasma C reactive protein was analysed at baseline.
RESULTS: Blood pressure and heart rate increased during contraction (p < 0.001) and decreased following contraction (p < 0.001) in both groups alike. Compared with baseline, plasma catecholamines increased during contraction in both groups (p < 0.001), but patients with fibromyalgia had lower levels of plasma adrenaline (p < 0.04) and noradrenaline (p < 0.08) at all times. Adrenocorticotropic hormone increased at exhaustion in controls (p < 0.001), but not in patients with fibromyalgia, who also had lower adrenocorticotropic hormone at exhaustion (p < 0.02) compared with controls. There were no group differences, or changes over time in plasma cortisol. High sensitivity C reactive protein was higher in patients with fibromyalgia compared with controls (p < 0.02).

Why We Get Fat: It's the Carbs or our Genotype?

Gary Taubes has a new book that explains why we get fat.  Guess what?  It has nothing to do with calories.  Well, it does to some extent, but what should be obvious from the title of his previous work is that all calories are not equal.
So Taubes sets out to convince that calories alone do not explain our weight gain.  Then he progresses on to basically say:  meat is good.  Carbs are bad.  The first part is great the second part has yet to be proven (NY Times reviewer agrees.)

Ok, I'm already convinced that calories don't work.  But I'll also say that low carb is effective for only some people.  Yes, it is an answer for a very select subsection of the population.  But the rest of us do not need a blanket prescription for low carb.  We need to look at individual variation in food choices. 

The D'Adamos had at least a little variety, although they based it all on blood type, which is only one factor in individual makeup.  Now Peter D'Adamo has moved on to genotyping the diet, which is really cool and hopefully leads to more options.  But it isn't the genes, it's the histones.  They determine the activation of the genes.  So maybe I'll get a jump on everyone and start promoting the Histone Diet (patent pending).  Watch for it!  

By the way, Taubes Good Calories book does a number on a lot of diet myths.  It just concludes the way he wants it to conclude, because we don't have the perfect diet data yet. 

More information on radiation than you should want to read.

Wow, it just keeps getting more scary in Japan.  So here's a whole range of resources for those of you who are busy watching it real time and hearing about it on the news. 

First, take a minute to check the EPA's up-to-date radiation readings for your area.  (When are they going to start adding this to the weather report?)

Then, take a few moments to read what the National Institutes of Health has to say about radiation exposure. 

If you're more of a visual person, here is a fun (in a gallows humor sort of way) way to visualize your relative exposures to radiation. 

As I've pointed out at alternative health answers and at my website, the ionizing radiation you receive from medical testing is likely to far outweigh your exposure from Japan. 

If we take that idea to the next level, there is a whole group that irradiates people for a living.  Radiation oncologists specialize in treating you with radiation.  They just celebrated a century of using radiation as a treatment for cancer.  If you look at the second abstract, in many cases radiation therapy is the only available treatment.  The doses being used to palliate suffering are astronomically higher than anything we see anywhere else. 

If you look at the third abstract, in cases of advanced head and neck cancer the application of radiation in huge doses directly to the area is often not sufficient to cause hypothyroidism.  We're talking about extraordinary exposure, and still the body keeps on ticking.  It's a wonderful thing. 


If you are still panting for more information on radiation,  I've attached links to three books on the subject.  Bring your medical dictionaries and dig in.  Or maybe take a walk outside and breathe easy. 

Nat Rev Cancer. 2004 Sep;4(9):737-47.



Radiation oncology: a century of achievements.

Bernier J, Hall EJ, Giaccia A.

Department of Radio-Oncology, Oncology Institute of Southern Switzerland, CH-6504 Bellinzona, Switzerland. jacques.bernier@hcuge.ch



Abstract

Over the twentieth century the discipline of radiation oncology has developed from an experimental application of X-rays to a highly sophisticated treatment of cancer. Experts from many disciplines - chiefly clinicians, physicists and biologists - have contributed to these advances. Whereas the emphasis in the past was on refining techniques to ensure the accurate delivery of radiation, the future of radiation oncology lies in exploiting the genetics or the microenvironment of the tumour to turn cancer from an acute disease to a chronic disease that can be treated effectively with radiation.

PMID: 15343280


Radiother Oncol. 2011 Mar;98(3):287-91.

Palliative radiotherapy for cervical carcinoma, a systematic review.

van Lonkhuijzen L, Thomas G.

Odette Cancer Centre, ON, Canada.

Abstract

Purpose: Worldwide, particularly in developing countries, many women present with advanced stage cervical cancer for which palliative radiotherapy is the treatment of choice or may be the only available treatment. The purpose of this study was to determine from the literature the optimal palliative radiation scheme for the treatment of advanced cervical cancer. Design: A systematic literature review up to January 2010 was performed in Medline, Embase, the Cochrane database, CinHL and Google Scholar using a combination of synonyms for: cervical cancer, palliative treatment and radiation therapy. No limitations were applied for language or study types. For included papers data were extracted and described. Results: Only eight papers were identified and none compared the results of different fractionation schemes. Most used observational retrospective study design with considerable sources of bias. No studies used validated endpoints for symptom relief nor did they include measures of the quality of life. Several papers described the experience with single or multiple monthly 10Gy doses or with a higher total dose delivered in 2-4 fractions within 48h to 1week. Studies report varying amounts of relief from bleeding. The effect on other symptoms such as pain and discharge is not evaluable. Acute and late toxicity is poorly documented. Conclusion: There is a dearth of information in the current literature to guide selection of an optimal palliative radiation schedule for treatment of patients with advanced cervical cancer. Based on this review and information from other solid tumors, there is no evidence to support the common belief that better and longer palliation is achieved with a high dose delivered in multiple smaller fractions. There is a clear need for comparative studies of different radiation fractionation schedules in order to identify an optimal palliative radiation scheme. These studies require the use of validated endpoints to measure specific symptom relief as well as accompanying quality of life.

Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

PMID: 21316785

Radiother Oncol. 2011 Apr 1. [Epub ahead of print]

Radiation-induced hypothyroidism in head and neck cancer patients: A systematic review.

Boomsma MJ, Bijl HP, Langendijk JA.

Department of Radiation Oncology, University Medical Center Groningen, The Netherlands.

Abstract

PURPOSE: To review literature on the relationship between the dose distribution in the thyroid gland and the incidence of radiation-induced hypothyroidism in adults.

MATERIAL AND METHODS: Articles were identified through a search in MEDLINE, EMBASE and the Cochrane Library. Approximately 2449 articles were screened and selected by inclusion- and exclusion criteria. Eventually, there were five papers that fulfilled the eligibility criteria to be included in this review.

RESULTS: The sample sizes of the reviewed studies vary from 57 to 390 patients. The incidence of hypothyroidism was much higher (23-53%) than would be expected in a non-irradiated cohort. There was a large heterogeneity between the studies regarding study design, estimation of the dose to the thyroid gland and definition of endpoints. In general, the relationship between thyroid gland volume absorbing 10-70Gy (V10-V70), mean dose (Dmean), minimal dose (Dmin), maximum dose (Dmax) and point doses with hypothyroidism were analysed. An association between dose-volume parameters and hypothyroidism was found in two studies.

CONCLUSIONS: Hypothyroidism is frequently observed after radiation. Although the results suggest that higher radiation doses to the thyroid gland are associated with hypothyroidism, it was not possible to define a clear threshold radiation dose for the thyroid gland.

Copyright © 2011 Elsevier Ireland Ltd. All rights reserved.

PMID: 21459468



 

Ernst Reporting On Colic Alternatives.

Since I can link to Amazon easily from Blogger, I thought I would provide a link to Ernst's book.  He's not an objective observer of alternative medicine, he's one of the outspoken skeptics.  So his reporting on studies involving alternative medicine should not be taken as definitive.  Here's my other report on colic, and my webpage showing his review, a previous review by the same journal, and the evidence in support of alternative medicine. 

Homeopathy: Science or Myth?

I was very excited to find this fine book by a Stanford Physician trained by five Nobel Laureates.  And I found it on Google books! Or you could get it via Amazon.  It's a fascinating story of a physician who put homeopathy to the test, not simply in a study, but in the emergency wards while he was a staff physician.  His stories are extraordinary, and his science is impeccable. 

How Many of Us Have Read It?

I just read a fascinating article about how our Christianity in America has little to do with the Bible.  In the past I have questioned exactly how many people have taken to heart some of the new testament teachings of giving all they have to the poor.  When asked, my conservative father (one set of vows from being a monk) slid around the issue by discussing works vs. faith.  

So how many of us have read the bible through?  I admit to always skipping over the begats and moving again and again to the new testament, which is blessedly shorter than what comes before.  But estimates that the majority of Christians have not read the bible are very troubling.  Especially for the group that sees the Bible as the literal word of God (my too clever response is always "which translation?").  If I truly hung on every word as God's, I think I would have committed whole sections to memory and read through the whole every year.  As it is, at one time I knew the variations of the four gospels. 

When I look at Amazon for the holy bible, I get seventeen thousand books.  Somehow that does not lend itself to a single text, but rather a multitude of translations.  Many of these are not true to the original Greek.  I remember an extensive argument with a Baptist pastor over the meaning of second Timothy.  The Greek text differentiated between an overbearing person and someone who acted in a teaching capacity.  The English translation we were using did not.  At stake was whether women could teach Sunday school. 
I love the King James version, but I know full well that the translators went for the poetry of the work, not the literal translation.  It's still my favorite.  Second would be those texts that give Jesus' actual words in red. 

The Prophet: Eye Opening If You Actually Read It.

I truly love the passages about children and how to think of our responsibility to them.  But in continuing reading, I found myself in strong disagreement with a range of Gibran's other assessments of how we should live our lives. 

How often do we hear quotations about Gibran's take on the law?  Forgiveness and looking inward toward our own guilt concerning the crime do not seem to answer many of the needs I see around us. 

So I find myself wanting to explore the book with a group.  Can we truly ask any society to live the way he describes?  Can we live in any society that does not aspire to the ideals, knowing that they are out of reach? 

William Shakespeare: Would He Be Writing Now?

It is unfortunate to think, that were Shakespeare alive today, he probably be a speechwriter or an advertising executive.  He might even be in one of those high priced think tanks where they come up with catchy names for new pharmaceutical drugs.  But he most definitely would not be writing for some theater in England.  And he probably would have given up on iambic pentameter, because his editor would have given him heck for "making up words." 

Sometimes a man is perfect for his time. 

Probiotic Capsules: A New Pharmacy Section in the Supermarket.

I'm suddenly seeing a great number of probiotic products on the supermarket pharmacy section shelves.  Looking through the claims and labels, these products are overwhelmingly similar to health food store offerings with one exception.  They are not refrigerated. 

Consumer reports did an analysis of probiotics some years back and found that the die off from manufacture date to purchase time was pretty extraordinary.  An equivalent metaphor would be packaged fish.  It might be possible to package fish well enough that they wouldn't start to stink, but that would be a pretty gamey fish by the time you got it. 

For any and all of you considering probiotics, either go to a refrigerated product or use the yogurts in the dairy aisle.  Ounce for ounce probiotic capsules are more concentrated, but we generally eat far more yogurt at a sitting.  So they work out to be equivalent.  Consumer reports found that all yogurt brands continued to have live bacteria. 

If you are determined to buy probiotics, consult someone like me.  I can at least tell you what brands are doing independent testing at the consumer end to make the little guys are still alive. 

Inositol and Bipolar Disorder: Do Not Supplement On Your Own.

It's rare to see a supplement so directly problematic for a drug, but inositol regulation may be how lithium works in the brain.  As such, patients wanting to supplement with inositol could be inactivating their lithium.  Definitely discuss and monitor with your physician. 

Here's a link to the August 2010 study and here's the abstract below.  Another study looks at the complexities of the interaction (inositol supplementation might even be helpful, but don't chance it.)

Prog Neuropsychopharmacol Biol Psychiatry. 2010 Aug 26. [Epub ahead of print]


Association analysis between polymorphisms in the myo-inositol monophosphatase 2 (IMPA2) gene and bipolar disorder.

Bloch PJ, Weller AE, Doyle GA, Ferraro TN, Berrettini WH, Hodge R, Lohoff FW.

Psychiatric Pharmacogenetics Laboratory, Department of Psychiatry, University of Pennsylvania School of Medicine, Philadelphia, PA, USA.

Abstract

Linkage studies in bipolar disorder (BPD) suggest that a susceptibility locus exists on chromosome 18p11. The myo-inositol monophosphatase 2 gene (IMPA2) maps to this genomic region. Myo-inositol monophosphatase dephosphorylates inositol monophosphate, regenerating free inositol. Lithium, a common treatment for BPD, has been shown to inhibit IMPA2 activity and decrease levels of inositol. It is hypothesized that lithium conveys its therapeutic effect for BPD patients partially through inositol regulation. Hence, dysfunction of inositol caused by IMPA2 irregularity may contribute to the pathophysiology of BPD. In this study, we hypothesize that genetic variations in the IMPA2 gene contributes to increased susceptibility to BPD. We tested this hypothesis by genotyping 9 SNPs (rs1787984; rs585247; rs3974759; rs650727; rs589247; rs669838; rs636173; rs3786285; rs613993) in BPD patients (n=556) and controls (n=735). Genotype and allele frequencies were compared between groups using Chi square contingency analysis. Linkage disequilibrium (LD) between markers was calculated and estimated haplotype frequencies were compared between groups. Single marker analysis revealed several associations between IMPA2 variations and BPD, which were subsequently rendered non-significant after correction for multiple testing. Although our study did not show strong support for an association between the tested IMPA2 polymorphisms and susceptibility to BPD, additional larger studies are necessary to comprehensively investigate a role of the IMPA2 gene in the pathophysiology of BPD.

Copyright © 2010 Elsevier Inc. All rights reserved.

PMID: 20800640

Civil War: A Reminder

I just got the issue of Newsweek talking about armed militias.  It reminded me that we desperately need a sense of history in this country.  Any type of armed conflict within the United States is unthinkable.  We did that, and it was terrible for everyone concerned.  Whatever our disagreements, our children deserve to hear us debate them rather than fight them out. 

Back pain: Nonsurgical Options.

I just did an update on long term outcomes for back pain surgery and we still aren't seeing large studies.  The patients are there, but no one is doing follow up over a couple years.  In the meantime, there are a great many home treatments that are available. 

The little guy on the left is a TENS unit, every person with chronic pain's best friend (unless you have an inflammatory condition, in which case stay away).  Clinicians can get these for about $45 and they run on a nine volt battery.  I just don't see them being used instead of pain drugs, which is sad, because they are a much better option for specific pain.    

Khalil Gibran

Just a very good poet.  Lots of other things too, but focus on that alone. 

Hayao Miyazaki: Japanese Spielberg

Although Miyazaki works with animation, don't let that fool you into thinking he isn't the best thing for the genre.  Unlike U.S. animation, the movies have a much more complex feel, with views and down moments.  The Incredibles was very much influenced by the complexity and you can often see Pixar's Lasseter talking about Miyazaki.

Kiki is the only full length animation movies I know of without a villain.  Yet it holds your interest and lives within Miyazaki's world of a futuristic Victorian era. 

Learn Japanese with Manga.

For anyone who does not have a tween son into Manga, the idea of learning basic Japanese with a comic book may seem a bit farfetched.  But trust me, this is one language book that will get read over and over. 

Eat, Pray, and Love, but not with a Dragon Tattoo

I watched both these movies recently.  EPL the book is better and more complex, but there are aspects of the movie that come to life more, and Julia Roberts is great.  The second movie is pretty graphic and disturbing, a good mystery, but seeing Lisabeth, well, if you read the book you know.  So I'd watch the first as part of a chick flick night, but I wouldn't recommend watching Girl with a Dragon Tattoo unless you've read the book and loved it (and don't mind subtitles). 

Nobody is Perfick.

A little book about being a child, but it makes you realize just how little we all grow as we get older.  Cartoons, and little vignettes, which makes it a quick read.  It's the only place I've seen the word "yilkes," as a term of disgust.