One doctor’s take on Whole30: when the Magic doesn’t happen

I can’t take any credit for today’s post. Pam, a general practitioner from Wellington, NZ, has shared her recent Whole30 experience with Jamie and myself, and then kindly allowed me to make it public. We first got in contact with Pam via Twitter a few months ago. A New Zealand based doctor who is vocal about being anti-grain, anti-sugar and pro-real food? Yes, please, we are very interested! I don’t even know how she went from being from a voiceless Twitter handle to a huge part of our “kiwi Paleo gang” (not entirely sure how a Russian-born Australian got invited there either but they tell me it’s a privilege). Pam is 47 years young and her voice is loud and uncompromising. I have been greatly entertained and awestruck watching her take on conventional nutritionists, media and medical authorities, all in a 140 character format. When Jamie and I announced Whole9 South Pacific she became one of our most staunch supporters. It was only a matter of time before we convinced/coerced her into doing a Whole30. I found her insights particularly compelling because it was not all fireworks and champagne. Her motivation is to improve health, prevent becoming hypertensive and diabetic (yes, believe it or not, doctors worry about this too!). Here is her story.

My Whole30 roundup – When the Magic doesn’t happen

I am learning.  Learning to be patient. Learning to have realistic expectations. And learning to appreciate the value of small changes. I have learned that it’s ok not to experience the ‘magic’ that many other people do when they make purposeful changes to their lifestyles. It is hard not to feel disappointed or that you have been rather unsuccessful when you constantly read of these ‘magic’ stories and personal epiphanies. That is the nature of the beast. People crow unashamedly about their great achievements. And so they should. They have done the work. They should be proud of their achievements and we should share in their success. They inspire others to give change a go. I am happy for them. Really I am.

But what of those who put their very best efforts in and don’t experience that ‘magic’. I am sure there are as many or more who land up in this place. But they are not shouting from the ‘comments’ or ‘discussions’.  What happens to them?  I suspect many give up and slink quietly back to their old habits feeling as if they have failed yet again. I’ve been there. Many times.  Not any more. Part of the reason is that I have accepted reality. There is no ‘magic’ for most people. So, what would have been the ‘magic’ for me? Despite trying to convince myself otherwise, a dramatic weight loss would have been my magic. I didn’t start with health problems that others have had to suffer with. Gluten and dairy didn’t mess with me. I had no autoimmune issues. Just too much body fat. So I guess I could say I had /have hormonal issues! What I did learn was that even if there is no magic, there is hope. And there is certainty that you can become healthier.

My ‘aha’ moment occurred about 9 months ago. A chance comment at a random moment piqued my curiosity. With the world of information at my finger tips I could Google, follow links and find any information I wanted. I could formulate questions and find answers. I found the pathway to the truth about dieting, health and weight loss. I found amazing people and I also found out about the lies, politics, egos and money which have ruled the information about diet and health on which the average person relies on for better health. Information gives you knowledge. Knowledge is power.

So what the heck has all this got to do with Whole30? You may be wondering. It has everything to do with my Whole30. You own your own Whole30. I owned my Whole30 and because of this I got through the 30 days (and continuing on).

Whole30 was one of many plans/programs/guides that I came across. When Whole9SouthPacific put out the challenge and fronted the charge to lead by example, I made the decision to take up the challenge too. The time was right and the challenge was right. I had been eating pretty clean for 8 months. Too clean to bother with Whole30? Maybe, maybe not. In my head I decided to commit. Although the challenge was for January I made the decision to delay starting until after our holiday when I could be fully in control of my environment. We were going to stay with friends and I felt it would not be right to be too picky about everything I could and couldn’t eat ‘because it’s not Whole30’. That didn’t mean that I didn’t come pretty close to adhering most of the time.

Holiday over, time to start. My weight had not changed much for 2-3 months. Maybe up a kilo over Christmas/ New Year and holiday. I wasn’t expecting miracles but I was hoping for at least a small change in direction and getting off the stalled weight loss. In order to become totally Whole30 I needed to quit dairy (had already reduced a lot), no alcohol – not too difficult, no coke zero (a bit more challenging). I had already quit bread and wheat as well as other grains many months before. So that was the ‘leave out’ bit.

Whole30 was also about ‘adding in’ – more food and more meals. I was eating very low carb, not eating even starchy vegetables. I started adding in some pumpkin and sweet potato. I also added in occasional fruit as I had not been eating any for months. And it was berry season. I had to put more effort into having 3 meals a day. I was used to skipping breakfast at times. Sometimes because I just wasn’t hungry and other times just because I didn’t have time. My egg intake soared. Spinach became my ‘go to vegetable’ – I added it to everything where I needed more on my plate.

I didn’t find it particularly difficult to complete the Whole30. I made sure I wasn’t hungry. I also made sure I always had some compliant foods to grab if I was hungry coming home at meal times. A stash of ready boiled eggs, homemade mayo and salad greens made sure I had no excuse to eat the wrong things.

So what did I get from Whole30?

  • I lost about 3kg. I am sure that had I gone from SAD to Whole 30 directly I would have lost double that (the double bit being water loss). I think my clothes loosened fractionally.
  • I don’t miss my wine. I seldom really feel like my latte coffees. Black is fine (as long as it’s not too strong).
  • I am absolutely fine eating more vegetable sourced carbohydrates – very low carb is not necessary for me.
  • Bread does not have a hook out for me. The trick is not to be hungry – making sure I eat enough.
  • I think about sweet things less often and they are less tempting.

Perhaps a lot of this resilience to reverting to SAD food is pure willpower because I feel so strongly that I have to avoid unhealthy food to prevent future health problems. But maybe there is a biochemical change that has occurred and that I really have a true lessening of desire for those foods. Probably a bit of both.

The only Whole30 ‘rule’ I broke was the scales one. I make no apologies. This was MY Whole30 and I had to make it work for ME. I get why the rule is there but for me it wasn’t going to work. In the past when I have lost the scales it has started the slippery slope back to weight gain. I realised that I might not lose weight so I wasn’t too stressed about that. But there was no way I was going to contemplate gaining. I didn’t weigh myself every day. I weighed here and there, maybe 2-3 times a week and in a random fashion. It helped me knowing that despite eating well I was not creeping up the scales. After close tracking of weight for 8 months I can recognise the fact that weight loss is both slow and definitely not a straight-line graph. It is an alpine graph with lots of ups and downs but the overall gradient slopes downwards.

The direct and indirect support of the cyber-community has reinforced my awareness of why I need to stick to the plan. My own knowledge growth has made me realise that having knowledge is only part of the plan. It’s up to me to do the very best I can for my own health. Whole30 provides the rudder, its up to me to steer the ship. The pathway doesn’t have to be straight and narrow but if I lose the rudder, the ship will loose its way. The tighter I steer the more stable the ship.

My message: If you don’t feel the magic, don’t give up. Your health depends on following a real food template for the rest of your life. Give yourself years before you decide real food doesn’t make a difference. Your future health is not measured in days or months.

PS: there are no ‘before’ and ‘after’ photos. It’s not what you look like that tells you whether you are healthy or not. There is so much more to health than a picture. For me the pictures do not speak a thousand words.

A case for simplicity

Case 1. Bev

Bev is a jolly 63yo farmer who came in to the hospital after suffering a minor stroke. One quiet afternoon when I spot our medical student looking a bit out of place (well, even more so than usually) I take him to see Bev for a neurological exam practice. Bev looks flattered and obediently sits back in her bed, being the perfect patient. I remind the student that we start with a general observation of the patient,the side of bed assessment. He dutifully recites “alert, comfortable and in no respiratory distress”. I gently nudge him to describe the patient’s body habitus, the student gets instantly embarrassed and looks lost. How do you tell a patient she is fat? I explain while looking at Bev that her central obesity is an important risk factor which may be pertinent to diagnosis at hand. Bev chuckles good-naturedly: “I love me food, I’ve always been a good baker!”.

Most medical students hate the neuro exam: it’s tedious, long, complicated and seemingly impossible to make smooth. I don’t rush him and Bev seems happy with the attention. The student correctly identifies the weakness on the left side of Bev’s face. He asks Bev to blow up her cheeks, Bev makes a valiant attempt but ends up making a noise like letting out air of a balloon and promptly laughs. I hear laughs from the other side of the curtain: evidently this has been a source of amusement to other patients as well. Bev’s limb weakness is improving and we take her for a gait assessment. With her tiny feet, narrow shoulders, perfectly rotund middle and a wide crooked smile, she looks almost comically cute. The student summarises the findings of his examination and correctly identifies that Bev has likely suffered an ischaemic stroke in the area of a middle cerebral artery in the right brain hemisphere. I thank Bev for being the perfect model for us, she wisely nods:
- They all gotta learn somehow, don’t they? So you think it’s gonna get better for me, doc?
I point out that she already has made marked progress and then ask her how she feels about the future.
- Oh I know. I gotta watch that cholesterol, don’t I? No more fish’n’chips for this chickie! (laughs)
I tell her I’ll come back to chat to her about diet before her discharge, thinking I’ll get to her before she gets fed some pseudo-nutritional rubbish.

Two days later, on my day off, Bev suffered a major stroke. The nurse found her in the morning, stiff in her bed, unable to move, call out or ring the bell. The stroke affected the other side of her brain and left her completely paralysed on what just 2 days ago was her “good side”. I never got to see her again because she was transferred to another hospital to a dedicated stroke unit.

Case 2. John

I only find out about John at morning rounds as he was admitted last night. I barely have enough time to register “64yo male transferred post BKA” on my handover sheet as we enter his room. BKA stands for Below Knee Amputation. John has just had his second one. As I stand in the room while the consultant chats to John about his surgery my eyes keep drifting to an empty space below John’s knees. No matter how many times I have seen it, this sight still unnerves me.

I distinctly recollect one of my most distressing experiences in operating theatres when I was assisting in a BKA. My job was to stand at the bottom of the table and stabilise (a.k.a hold tightly) the foot and calf of the leg being amputated. I still remember own visceral startle when the toes suddenly started to move, as if in a mute protest, when the surgeon was severing the tendons at the knee. At some point through the cut the lower leg stopped being a part of the human being and became an object. As the last thread connecting it to the breathing body was dissected I was left holding that object in my hands, temporarily stunned, until the nurse offered a big bucket to deposit it in.

John is looking defiant. The consultant has just finished drawing a pretty bleak picture and suggesting a nursing home placement. I feel the hot wave of indignation at this seemingly cruel crushing of a patient’s determination to maintain independence and mobility. John repeats mulishly that he wants to have double prosthesis, he wants to walk again. Later that day I find out that my anger was misplaced. While his raging diabetes destroyed the small vessels in his feet and opened him up to ugly ulcers and gangrenous infections, John’s dementia caused him irretrievable short term memory loss and, consequently, an inability to learn new skills required for amputation rehab. He has been on insulin for years but has been steadily forgetting to inject himself in the evenings when he gets most confused.

Case 3. Pat

Pat is a 47 year old Indigenous woman who presented to our Emergency Department with chest pain. The ECG and cardiac markers do not show any signs of heart muscle damage but she is at high risk for coronary artery disease as she is a former heavy smoker and a diabetic. Routine nursing observations show that her average blood sugar has been between 25-30 mmol/L (450-540 mg/dL) over the last day. She normally takes metformin but it’s clearly not doing very much. Like many Indigenous patients she doesn’t look grossly overweight, with her skinny arms and legs sticking out of her hospital gown. The gown cannot fully hide her round belly though, and I have to double check the notes that she is not pregnant. No, she is not. I try to be gentle when I tell Pat that she is likely going to need “the needles”. Sometimes the mere mention of injecting insulin serves as a good wake up call and a good opener to the lifestyle modification conversation. Pat doesn’t seem phased: “Ok doc”. I feel a hint of frustration: the conversation is not going the way I planned. I try to bring it back to the diet, saying that stopping junk food may be an easier solution than injecting yourself every day. “I don’t eat junk food, doc! I didn’t have Maccas for yonks!” – she protests. I note a half empty 2 L apple juice bottle on her bedside table: “And what’s this? You can’t have that with your sugars!” She looks confused. I take a breath and start to rant about soft drinks and sugar but she has already turned off and when her mobile phone rings she picks it up leaving me with my mouth open mid-sentence. As she starts to chat, I walk away taking the juice bottle off her table and pouring it out into the nearest sink.

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My other life, on this blog, as a part of Whole9, on social media, is like another world. Highly motivated people sharing their success stories, intelligent eyes watching our Whole9 South Pacific presentation, challenging questions being asked – I find my enthusiasm recharged and renewed. Although recently I see more and more splinters appear in the community.

Recently a video made rounds in “Paleosphere”. Some bloggers that I respect and follow found it offensive in its simplicity. I won’t comment on the video itself, I have a few minor quibbles with it myself, although I wouldn’t hesitate for a moment to show it to my average patient. I want to comment on the “It’s not that simple” critique. Maybe it’s not that the message is too simple, maybe we are trying to make it too complicated. We dissect this diet thing to its smallest constituents, calories vs grams vs ratios vs micronutrients vs cytokines vs endocannabinoids. Critical scientific discussion is enormously valuable and discourse should only be viewed as the way forward. But somehow discourse all too quickly  turns into a personal attack, a spiteful tweet or a post from the safety of a computer screen. And, sadly, some who used to offer valuable contribution to the body of knowledge now seem to offer nothing but negativity. Are we turning into the equivalent of elderly cranky academics arguing about the best fire-fighting methods while the room is engulfed in flames?

What about your average reader who has just googled Paleo or primal or ancestral health? Are we causing “paralysis by analysis” by not making it crystal clear what we actually all agree on? Even those firmly indoctrinated in beef broth/bacon/kale seem occasionally lost. Sometimes getting lost is easy if you are given a way out – maybe Lustig is wrong and sugar is ok? Maybe Taubes is delusional and it’s time to count calories again? Oh no, this thing is not simple at all! Let’s browse through some blogs, maybe we can catch the author out, find an error in the archives and pronounce the final judgment. It’s not exactly helpful for own health problems but sure is satisfying.

I did not choose the three cases for their dramatic value, I chose them because they are average. I see between 20 and 30 Bevs, Johns and Pats daily. Sure, I love reading the latest research papers in a search for truth but for these guys I want SIMPLE. I need a heuristic. If your goals are getting to a single percentage body fat, running a marathon or continue setting PBs by doing smashfit 5 days a week (hopefully not all at the same time!) you may need more tweaking but you are not exactly your Average Joe, are you? My favourite Internet testimonial this year is a 71 yo lady on a social security budget who reduced her HbA1C, came off insulin and halved her blood pressure medications, probably without giving a second thought to the latest blogosphere drama.

We are onto something good here. It’s real and, let me tell you, it may better than any expensive medication I can offer my patients. SIMPLE will get most people most of the way there. Here is my heuristic:

- eat meat/fish/eggs + vegetables (tubers, greens) three times a day to satiety and activity levels

- prioritise your sleep

- move in a way you enjoy

Do this every day for 3 months. Without dissecting, or philosophising, or looking for a loophole. This may just be enough to see change.

 

 

 

 

 

 

Work, life, updates

It’s been pretty quiet on the blog recently. I have recently started my ED (emergency department) term and it has been quite decent. Most people imagine ED straight out of the episode of ER or Grey’s Anatomy: insanely chaotic with patients bleeding out of every orifice, relatives sobbing in the corridor, gurneys flying at warp speed and scrubs-clad doctors shouting “Epinephrine, STAT!” Errr… No. My small hospital is very civilised with crumbly oldies coming in with exacerbations of chronic conditions (COPD, heart failure, arrhythmia, diabetes), young lads with pub crawl injuries and a very occasional trauma. I feel like I inquired: “any burning or stinging on passing urine?” about a hundred times this last week. Just in case you thought the life of an ED doc was glamourous.

In addition to my ED duties I also share the out of hours cover of hospital wards on a rotating roster with other residents. This involves an occasional weekend shift, an evening cover or an all-night on call for operating theatres. On that note, a plea to women in the local area: please choose a decent time to require an urgent c-section other than 3am! And if you are having acute appendicitis please be so kind as to come to hospital during day hours. So inconsiderate.

Take into account food, sleep, exercise and personal life and I am left with about 15 mins a day for research, reading and blogging.

After experiencing massive nerdfest withdrawals post-AHS12 and Whole9 seminar I am now happily looking forward to another event in the ancestral/evomed community: Low Carb Down Under seminar series. If you are in Australia and reading this, you should definitely try to get involved. The event will bring together the inquisitive minds of doctors, nutritionists, fitness professionals, authors, media personalities and general public, keen to learn more about their bodies, nutrition and health. And then, of course, we’ll have the always galant Jimmy Moore and his wife Christine making a journey across the Pacific to be in all 5 cities.

Jamie Scott and I will be speaking at the Brisbane event (if we ever make it through a 7hr road trip without murdering each other).

Here is the outline of my little talk:

Why Paleo is the best low carb diet.

Anastasia will talk about the intersection of Paleolithic diets with low carb approach, point out the common misconceptions about Paleo vs LC and discuss the benefits of the evolutionary approach to LC diet and lifestyle.

Here is Jamie’s talk:

Pillow Talk: Taking low-carb living to the bedroom

When engaging in a low-carb lifestyle, people often meticulously plan every aspect of their diet. Yet rarely do we see this level of planning and regard for an aspect of our life that is absolutely vital to successful appetite regulation, and therefore, low-carb living; Sleep.

Nutritionist, Jamie Scott, will show you why your bed – and vitamin z – is as important to your diet as a well-stocked fridge.

If you can make it, feel free to come up and chat at the event. Otherwise, expect a blog post on my experiences.
There are a few things still brewing in that busy brain of mine so keep your open.

Something to read on your Sunday night:

1. Dr Rod Tayler, one of the organisers of LCDU, talks to 180 nutrition about his journey away from the conventional wisdom.
2. Jamie stupidly bravely takes on a food giant.
3. J. Stanton talks dental health.
4. A must see from Richard Dawkins: a 3 part series on life in an atheist world. Sex, Death and the Meaning of Life.

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A weekend trip to Elleborough Falls

Musings on a 40 hour week

Curled up on the couch with a massive cup of coffee, I am wrapping up one of the most horrific weeks since starting work. Having to deal with between 30 and 40 newly admitted patients daily, my pager going off every 5 minutes (god, I hate that sound), I’m on call tonight (please please please do not call me to rechart meds at 2am) and not having seen sunlight since last weekend makes me count the days (14…) till my trip to the US to AHS12.

The tension in the hospital is almost palpable by the end of the week. The conversations are shorter, comments are snarkier and the only smiles you see is when there is the obligatory Friday junk food fest is involved. Somebody is leaving floor 1 for floor 2 so we all have to subject our bodies to a sugar coma to honour this momentous occasion. Maybe this will help us survive the end of the week without killing someone. By the way, in medicine this is not a metaphor.

Child laborers in a coal mine. Source: The History Place photograph of American child labourer from 1908-1912 by Lewis Hine

Let’s talk working hours. I want to know what genius came up with a 40hr working week.  I am not that strong in history but I grew up in the Soviet Russia and the 8 hr day was celebrated a source of pride and a supreme achievement by unions and blue collar workers. The Industrial Revolution of the 18th century had a lot to answer for with explosion of factory-based manufacturing and resulting insane working hours. The British Factory Act of 1833 went soft and regulated child labour, limiting the work day of 14-18 year olds to 12hrs and 9-13 yo to 8 hrs. They were so concerned with kids’ education that they told under 9s to stay at school. In comparison to those conditions my working week seems like a walk in the park. Our civilised society is way more civilised nowadays and we should be grateful, right?

Well, actually, who says that a 40hr week is evolutionary appropriate at all? In 1966 an anthropologist by the name of Marshall Sahlins wrote “Notes on the Original Affluent Society” in which he described the lifestyle of modern and ancient hunter-gatherers, estimating their work day to be between 3-5 hrs to the total of 14-20hr working week. Closer to home, Jamie Scott wrote a nice report on the lifestyle of Vanuatu and he also mentioned that the villagers there seemed to have a lot more leisure and play time.

Now I am far from an expert on anthropology and by no means advocate discarding our society, culture and coffee machines to go live in the bush and eat ‘roos or whatever you can catch in your part of the world. But, dayam, a 20hr week sounds way more attractive than a 70 hr limit for hospital doctors recommended by the Australian Medical Association (which is successfully circumvented by hospitals and doctors themselves).

For those interested in an overview of the working conditions of Aussie doctors-in-training (or hospital residents and registrars) read this report on safe working hours from Andrew Lewis, an industrial relations advisor for AMA. Good thing they got a non-doctor to write it. Because doctors are masters at bitching about  their lack of sleep, nutritious food and any resemblance of personal life. However, that whining tends to come with a whiff of hidden pride. The expectations of our seniors (“back in my days we slept in the elevators”), peers and patients make this screwed up lifestyle “a rite of passage.”

Of course, doctors and nurses don’t have a monopoly on insane working conditions. But the media prefers juicy stories of sleepy surgeons armed with a scalpel than  tired cranky lawyers (armed with a Monblanc pen?). The talk inevitably becomes a tad hysterical as it turns to the risk to the community: “jeopardising patients’ safety… Impaired judgement…”  Fair enough, I say. I’d be worried too if I knew that a guy who is about to do a lumbar puncture on my daughter has been working for the last 17hrs. Apparently being awake (not just working, but AWAKE) for 18 hrs is comparable to a blood alcohol level of 0.05. Cool, I can come to work after a bottle of Shiraz and nobody will notice anything different.

Still, forgive me if I am more interested how this lifestyle is affecting my body and my mind. We all know it’s bad but how bad? Can you suck it up for a few years and hope to repair the damage when you have the money to afford holidays in the Pacific and a personal chef? Or is it something that we can mitigate by sleeping in till 8am on the weekend (oh, the luxury!)?

Not a place to be when you are stressed…

Here are some studies that I personally found quite interesting.

1. Acute sleep deprivation resulted in increased hunger and the activation of anterior cingulate gyrus reflected hedonic stimuli in the absence of fasting blood glucose changes. In other words, if you are sleep deprived, those cookies in the jar will call your name with an irresistible siren song. http://www.ncbi.nlm.nih.gov/pubmed/22259064?dopt=Abstract

2. Adults working more than 40hrs a week were 5 times more likely to have suboptimal glycemic control as measured by HbA1C >= 7% than those who worked 20hrs or under. So if your diabetic or pre-diabetic your working hours alone will make your doctor frown and reach for the script pad. http://www.ncbi.nlm.nih.gov/pubmed/21246586?dopt=Citation

3. An observational study of nearly 17000 Australian full time workers looked at the relationship between working hours and increased BMI. They found that the relationship between long hours and obesity seemed to be mediated by the lack of sleep. This might make you think that it is possible to mitigate the effects of long hours by just increasing your sleep time however…

http://www.ncbi.nlm.nih.gov/pubmed/20734126?dopt=Citation

4. …a study of Japanese white collar workers found that longer working hours had a negative effect on total sleep hours, sleep efficiency and daytime dysfunction. The effect was noticeable at 50hrs a week and the more hours they worked the worse their sleep quality was rated.

http://www.ncbi.nlm.nih.gov/pubmed/20561174?dopt=Citation

Just a note, the whole patronising “Just sleep more” really tends to push my buttons. It’s a bit like “Just eat less and move more” in its sheer unhelpfulness. Do we really think that those poor buggers who lie in bed for hours struggling to nod off because they like it? You can’t get that deep recovery sleep by willpower alone. Try telling any doctor on call that they should stop tossing and turning and get back to their restorative snooze… with a pager next to their ear.

5. Markers of oxidative stress were increased after a 16hr shift in medical residents and an 8 hr shift non-healthcare workers (so once again, you don’t get a free pass if you are in another field). http://www.ncbi.nlm.nih.gov/pubmed/20811270?dopt=Citation

6. Psychological stress has been found to cause very real physiological phenomena contributing to many diseases. This excellent review of the role of stress in the gut disorders concluded: http://www.jpp.krakow.pl/journal/archive/12_11/pdf/591_12_11_article.pdf

From Konturek et al ” Stress and the gut: pathophysiology, clinical consequences, diagnostic approach and treatment options”

“1) exposure to stress (especially chronic stress) is a major risk factor in the pathogenesis of different diseases of gastrointestinal tract including gastroesophageal reflux disease (GERD), peptic ulcer, functional dyspepsia, inflammatory bowel disease (IBD), irritable bowel disease (IBS), and other functional disorders of GI tract;

2) the dysregulation of brain-gut-axis plays a central role in the pathogenesis of stress- induced diseases;  

3) Stress increases intestinal permeability, visceral sensitivity, alteration in GI-motility and leads to profound mast cell activation resulting in release of many proinflammatory mediators

These articles are just a few in a sea of plenty. The scientific evidence is pretty conclusive and pretty overwhelming. Long hours = bad, psychological stress = very bad, lack of sleep = very very bad.

So it’s kind of bewildering that we choose to bury our heads in the sand and carry on with a stiff upper lip. Good luck repairing your leaky gut and undoing the oxidative damage with your superhuman willpower. I’m not suggesting that you should give up your career and go all hippie, greeting sunrise in the nude and weaving loin cloths out of bush plants. Sometimes the acknowledgment that this is not just in your head, but in your gut, your nervous, endocrine, immune and cardiovascular systems, can go a long way.

Imperfect Day

 

When people embark on a new venture, like a new nutrition program, they do not expect to fail. Full of vigour and enthusiasm, they feel ready to improve their diet, exercise and lifestyle. But if you ask them how they imagine their new life, almost inevitably you will get a picture of a PERFECT day. The day where they bounced out of bed early to go for workout (or at the very least, an energising walk), had all their meals prepared for the day, felt perfectly satisfied and full after each one, managed their work stress, astonished their work colleagues with own weight loss and vitality, had enough energy to attempt a deadlift PB in the evening, spent quality time with their family, browsed through at least 20 Paleo blogs, meditated, mastered a homemade jerky recipe and had a restoring 8 hour sleep undisturbed by blue light.

Nobody wants to think that one day they will want to throw their alarm clock across the room in the morning. Or that their work pressures will pile up over the course of the day culminating in a massive verbal punch up with a co-worker. Or that they will have a fight with their boyfriend and the thought of a pity party for one, complete with a tub of ice-cream and Lindt chocolate balls (ahem), seems like a perfectly reasonable idea.

Because that would be failure. And it wouldn’t happen. And, anyway, if it did, you would know exactly how to deal with it. Sure, 99.99% of people in your situation, would crumble and lose the plot. But you are different. You are SPECIAL. You have superhuman willpower, steely determination and you totally mean it this time.

Sorry to break it to you, a unique snowflake you are not.

But I was soooo strong…

Reality will bite you on the arse just like everyone else. Human physiology trumps willpower every single time. If you are working shift work, don’t expect to have energy for daily WODs. If you are stressed at work, don’t marvel at your increased appetite, and for God’s sake, don’t hover around a muffin platter. One of you is going to lose, and it ain’t gonna be the muffins.

So my new theory is, prepare for a IMPERFECT day. Think of everything that can go wrong (yes, I know, it’s a bit morbid) and work out a strategy of how you are going to overcome it, minimize it or at least mitigate the damage.

Here are a few of my strategies:

1. Too tired to cook healthy food at night -> Do a massive cook up prep with cut up veggies and pre-cooked meats Melissa Joulwan style on Sundays
2. No motivation to work out -> go for a long walk on uneven terrain, accelerate on a few stairs and recover in the open air
3. Fatigue/stress/frustration building in the afternoon -> take a 5 mins break outside, preferably on the open air, and take 20 deep breaths with your eyes closed
4. Cold/sore throat/cough/fever -> (I can’t believe I have to write this) please do not go to the gym. If energy levels are still ok, go for a short walk. If feeling tired, go home and curl up on the couch. Please.
5. Everything went wrong for you today, personal life in shambles, work has been shit, you want to cry, watch soppy movies and eat chocolate -> cry, watch soppy movies and eat the best goddam chocolate you can lay your hands on.


 

The health of health professionals or How to burn out while doing everything right

So you may or may not have noticed that I have not been blogging. As it turns out, being a hospital resident is a bit more than just a full time job (the understatement of the century). Besides, being on a busy surgical team played right into my ADHD tendencies: brief ward rounds (“Morning, how is your pain? Have you opened your bowels? Any nausea or vomiting? You are doing great, see you tomorrow morning”) and suddenly anything over 140 characters of writing seems impossibly long.  But now that I am back on the ward and have to ACTUALLY TALK to patients, I am finding my brain starting to slow down from the hectic pace of the last few months.

Something that I have become increasingly acquainted with in the last few months is the health habits and the lifestyle of my esteemed colleagues and other health professionals. And let me tell you health has nothing to do with  it.

Educating people on healthy diet and lifestyle choice is widely considered a panacea for the today’s obesity woes. Those poor Mums buying McCrap for their muffin-topped offspring just don’t know that this is not particularly good for them. Let’s horrify them with the consequences of not eating broccoli and the world will be right again, yes?

The same logic will tell you that healthcare professionals should be the healthiest people on the planet, right? The combination of a higher socio-economic status and specific education in disease prevention should almost guarantee them svelte figures, long life and no chronic disease struggles.

Health professionals KNOW better and they can AFFORD better. Is that the reality?

Here are real-life conversations I have had in the hospital with doctors, nurses, physios, etc. in the last few months:

- I am always tired, every day, I don’t know what’s wrong with me. I don’t even feel like training today. – How often do you train? – (puzzled look) Every day.

- (in a hospital cafeteria) I’ll have a banana bread and a skim extra large latte. No, no butter of course.

- I am doing a double shift today. It’s a shame the cafeteria closes at 6.30pm. I really need a few more coffees to last me to midnight.

- (11pm) Oooh, l just can’t say no to baked treats on a night shift.

- I really need to exercise more. I tried going to the gym after my night shift at 7am but I just can’t make myself do it. I am so naughty.

- I don’t know why I am always so cold. I might ask to have my croissant warmed up.

-I was good yesterday and had a salad for lunch and salmon for dinner. But for some reason I really crave sweets today. I’ll just have this TimTam and then I can always go for a run after work.

- Whose birthday cake is it? I thought Ann was yesterday? Ah, that was Michelle’s. Yum. Did I tell you that I started buying Flora ProActive for my husband because his cholesterol is through the roof? And he still has bacon and eggs for breakfast!

- I always put exercise as my number one priority before sleep. After I finish my night shift at 7am, I have a 2 hour nap and then go to the gym. If I don’t go to the gym I feel lethargic and cranky. Although recently I went to my GP complaining of increased breathlessness. Turns out I am really anaemic.

(This last conversation left me with my jaw dropped to the ground. And probably served as the catalyst to writing this blog post. Thank you, Sarah. )

Get your butt up and go for a run, you lazy sod. (Julia Fullerton-Batten/Getty Images)

Probably a repeat of conversations you hear at any office, workplace, any water cooler and tearoom. What strikes me every day,  apart from the obvious natural fat-phobia (which is nothing new), is the ridiculous amount pressure these people put themselves under.

It is understandable that seeing sick patients riddled with chronic disease makes us determined NOT to end up like them. We are more aware (=more paranoid?). Most health professionals go about it by reducing junk food. Sure, you find lots of “healthy” baked treats on the wards, homemade cakes making a resurgence in light of Masterchef and everyone is suddenly a gourmand. But to be fair, you won’t find many doctors in a line at KFC.

The next thing to be screwed up tight is exercise. And when health professionals get into it, they don’t hold back. Triathlons, marathons, bike rides before dawn, fitness classes at 6am. Exercise has become part of our healthy identity. The number of hours in the gym is the matter of competition, sports injuries are a badge of honour.

I don’t know at what point we have decided that exercise is going to solve our problems? Our lack of sleep, horrific work hours, shift work, mental stress, lack of sunlight, excess stimulants, daily exposure to pathogens, indoor lifestyle and, frequently, disconnect from nature and natural environment. Is exercise a cure-all or is it really a punishment that we impose on ourselves for failure to address other issues?

Hey, let’s face it. Exercise can (and should) be fun: cycling, yoga, surfing, bushwalking, kayaking, weights, rock climbing, having sex. If you need to guilt trip your way into any of those, maybe some other part of the equation is missing.

On the big scale of HEALTH vs DISEASE, where your ideal food intake is on one side and your crappy busy indoor work lifestyle is on the other, where do you think daily exercise is going to go? Will it add to your positive balance and compensate for that last 18 hr shift? Yes? Wrong answer.

Ignoring the pressures of work and lifestyle or hoping to willpower your way through them doesn’t work. Period. Even with the best nutrition strategy (no, a low fat muffin isn’t one of them) and the best intention of maintaining physical activity, you are always playing catch up unless you recognize all other areas of your life that have the ability to derail you.

 

News, interviews and Melbourne

Coffeez, many many coffeez

As you might have noticed it has been a little quiet on primalmeded. Anyone who has ever had personal contact with hospital residents would appreciate that we have very little time on our hands for anything other than sleepandeat. I have become very proficient with checking Twitter and reading other people’s posts while running between wards but I know it’s only a matter of time before I knock over a patient. I also once again have confirmed to myself that I am a secret introvert. While I enjoy interaction with patients, families and other doctors, I really need time on my own to regroup and recover. Blogging is a form of communication that requires giving the mental energy I do not have at the moment.

However, while I have not had any time to write anything I have been busy networking within this amazing community. First, the omnipresent Jimmy Moore kindly asked me for an interview and our conversation on everything from medical education to doctors’ nutrition knowledge and my own story was released on February 20 (you can listen to it here). It was a totally novel experience for me (you can tell by the amount of nervous “errs and ahms” I do in the first 10 minutes) but Jimmy was very patient and got me talking. A warm welcome to those of you who found me through Livin La Vida Low Carb and a heartfelt thank you to everybody who listened and sent their encouraging messages.

I also got invited to register on PrimalDocs, a website listing physicians and healthcare practitioners with an evolutionary approach to health and nutrition. At the moment I am one of 2 (!) medical doctors listed in Australia and I don’t even have my own practice so technically I would class myself as half a doctor anyway. But I guess it’s a start.

Which brings me to the third bit of news.

A few weeks ago I got contacted by Dr Rod Tayler, an anaesthetist from Melbourne and the principal investigator of The SWEET (Sugar and Weight Effect at Epworth sTudy). For those of you who have been diligently reading everything paleo for a while (i.e. you have no social life) you might recognise his name from a post by ThatPaleoGuy, Jamie Scott “Can eating fruit lead to weight gain?”. That post was the cause of several cordial e-mails between Australia and New Zealand (weird, huh?) and to cut a long story short Jamie put Rod in touch with me. The end result of our mutual emails and phone calls is a Melbourne get together with all interested parties in attendance.

The event will be held at Port Melbourne Town Hall, 333 Bay street Port Melbourne on Saturday March 17, 2012.

The program at the moment looks like this (the talks and titles are still being finalised):

9am:

“Are 30 Teaspoons of Sugar Per Day Too Many” Rod Tayler

“Fructose and Fat” Ken Sikaris (the Head of Chemical Pathology at Melbourne Pathology)

“What Should We Eat” Anastasia Boulais

“Evolutionary Mismatch in the Workplace” Jamie Scott

10.30am Morning Tea

11.00am “Big Fat Lies” book launch by David Gillespie

11.45am Break

12.00pm Forum

The best thing is that the event is FREE. If you happen to be in Melbourne and want to come and hang out with us, listen to some short talks and ask a few questions you are very welcome. As far as I know the hall can fit 200 so we have some room. If you have any questions you can shoot me an email on (anastasia at primalmeded dot com).

That’s all folks. My team is on take this weekend (i.e. every patient who comes through the door of this hospital since Friday night will be under our care tomorrow morning, yikes) so I am expecting a very hectic few days. Over and out.

 

 

 

 

 

 

 

 

 

 

First week of being a doctor

I hate you. I hate you. I hate you.

Nurses

- Are you Jasmine? No, Tenelle? No, Daniel? Ahhh, Anastasia.

- Here, have a cookie, dear, you look pekish.

- You can’t talk to me, I’m not even here! I’m on morning tea!

- Poor new doctors. They look like little lost puppies.

- You are so pretty and stylish. You must be from Melbourne.

- Can you re-chart Mr Smith’s meds ASAP? No, the next dose is not due for another 3 hrs. Yes, it’s still urgent.

- Yes, I can fax this for you. Yes, I will do the ECG. Yes, I will pass it on to the nurse who is looking after your patient. Yes, I will find the chart that you were carrying around and lost somewhere in the ward. No, I don’t do bloods.

Patients:

- Hello, Mr Wendell. I’m one of the doctors who will be looking after you. Yes, all  female doctors in this hospital are attractive. It’s one of the application criteria.

- Mrs Smith, I’m going to put you on high flow oxygen to help with your breathing. Yes, I know you are feeling just fine but I just saw your blood gas. Your blood oxygen level is incompatible with life.

- Now let’s not be naughty, Mr Brown. You cannot put your hand on my knee while I’m flushing your drip.

- (inserting a cannula) Mr Randall, look out the window. Blue sky and sunshine are so invigorating, arent they?

- (inserting a cannula) Mrs Clayton, look out the window. The torrential rain is so soothing, isn’t it?

- (inserting a cannula) I’m sorry, Mr Randall, your veins are being a little tricky today. Not to worry, we will have another go. I think I saw a vein on your foot that looked promising. No, I’m not turning you into my pin-cushion, you naughty man.

- Do you know where you are, Mrs Forrester? The bowling club? Not quite. Do you know what year it is? 1986? No, we are a bit past that. May? You are way ahead of us, it’s still January.  I think you should just go back to your bed and have a nice little nap. Now if I can only remember what ward you are in…

The most time wasted:

- Um, how come this discharge summary doesn’t print? I’m hitting the print button. The other print button? Ok, what does this mean? Click draft? Not draft? Oh draft here, but not there? I think it’s coming out. Oh no, that’s the wrong one. How did that happen? Um, thanks you’ve been great help.

- What’s the name of this printer? Pin-jko-fjr9? Cool, thanks

- What’s the code for the doctors’ room? 02938#? Cool, thanks.

- What’s the code for this drug room? 94847#? Cool, thanks

- Does anybody know the code for this coffee machine?

- Excuse me, where can I find blood tubes? Tongue depressors? A flashlight?   Blood culture bottles? Imaging request form? The OTHER imaging request form?

- I can’t log onto to my computer.  I can’t log onto the patient system. I can’t log on to the radiology system. I can’t log onto the pathology system.  What do you mean, I can log on to check my emails?

Pathology/Radiology

- Hi, I need an add-on to the morning blood test. Sure, I can drop everything and run the request up to the second floor.

- Hi, I need to order a blood test. So I order online but you don’t get it online? You need a hard copy which you will personally enter into your separate data system? And there is no human error involved? Awesome.

- Hi, I have ordered a blood test. Will it be collected? The collectors are gone? Sure, I would love to stick this old lady with the needle, this paperwork is driving me mental.

- Hi, I’m sorry I know I asked you this before but I’m chasing a result for Mrs Smith. I’m sorry, my boss is hassling me. When will it be ready? Is it ok if I call in 30 mins? I’m sorry, I don’t mean to be annoying. It’s ready? Thank you. I’m sorry. Thank you.

- Hi, I need an ultrasound on Mr Smith. Is it possible to get it done this afternoon? Really? What about a CT on Mr Brown? Cool. How about an MRI on Mr Collins? Yeah ok, I know I am pushing it.

Getting paged:

- Can you chart something for Mr Brown’s pain?

- Mr Smith is short of breath, can you come and see him?

- Mrs Lee has a temperature of 40, can you come and see her?

- Mr Clark is having chest pain, can you come and see him?

- Mrs Lang has a potassium of 2, can you come and see her?

- Mr Williams’s stool is really black, can you come and see him?

- Mrs Drake has passed away, can you come and see her?

- Mrs Wood is going home now. Is her discharge ready? What about Mr Williams? Mrs Nguyen? Mrs Tang? Is ANYBODY’s discharge ready?

- Can you talk to the patient’s family? The patient’s priest? The patient’s lover wants to talk to you separately from the patient’s wife?

- Can you insert a cannula? Or ten?

- Mrs Carmody’s sugar is 33mmols. Of course she had toast and margarine, and marmalade, and cornflakes, and skim milk, and apple juice for breakfast. It’s a standard diabetic diet.

Room 7. Certifying the death of Mrs Drake. Sitting down next to her bed is a luxury I cannot miss. I listen for her breath and heart sounds for way longer than the necessary one minute. For the first time today it’s very quiet. I close my eyes and keep listening. The pager beeps and gives me a jolt. Goodbye Mrs Drake. I have to go and see a patient.