Minimalist shoe review and Sunday primal living

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Sunday posts are not supposed to be sciency right? Having a weekend off is a luxury and I like to treat it as such. Hence I decided to be a lazy tart and sleep in till 7.30am. A vat of coffee, a quick social media catch up and I was out the door to test my new Lucy VivoBarefoots.

I abhor the term “barefoot technology” because it sounds just a gimmicky as ShakeIt weights but I do agree with a concept that walking on 3 cm of very expensive rubber, otherwise known as “conventional sneaker”, is utter nonsense.

VivoBarefoot EvoII in their better days

I never got into Vibrams (I don’t like the idea of rubber between my toes or people jeering in glee as they point to my feet) but I own a pretty nice pair of VivoBarefoot EvoII which I wear to the gym or operating theatres. Which is pretty much the same thing. Their only problem is that they are damn slippery when you leave the safety of the indoor environment, especially if you like jumping on rocks. So to avoid ending up in my own emergency department I normally wear Sketchers. Yeah yeah, I know, don’t judge me.

I really didn’t want slippery soles here

My usual long walk is around 2.5 hrs which takes me down the coast and back, and has a good mix of beach walking, rock hopping, trekking up and down the hills between coves and a few steep sections through the rainforest. The sole of the Lucy is supposed to be ultra thin (3mm) and puncture resistant but it doesn’t feel quite as paper thin as the EvoII, which together with a pretty thick top covering adds to the sturdier feel. The first climb up the rocks went without a slip up but I did slide down a steep path on gravel a couple of times, gracefully landing on my buttocks, although I don’t know whether it was the shoe or my slightly tired quads. The harder top lining started to put a little pressure on my Achilles tendon after 2 hrs but wearing socks helped. The toe cage is wide enough for my narrow foot but if yours is on the wide side you may find it a little constricting.

Terra Plana sizing tends to run small. I normally wear 38 but ordered 39 in these and they were perfect with a sock. Interestingly, I also ordered VivoBarefoot Mary-Janes and they were a bit big in the same size.

Overall, a good walking shoe which feels more like a conventional shoe although does provide the benefit of good proprioception and a light feel.

The rules of the game: get to the other side without touching the sand. GO!

As always, my weekend walk provides me with a few excitements (I am a simple creature and get excited easily). A huge 1.5m goanna decided to leisurely cross my path causing a temporary bladder spasm and a jerky and too-slow reach for the camera. Gotta love Australia.

A young bright gen-Y sitting on a rock overlooking the ocean spreading Nutella on several pieces of white toast. I kid you not.

The usual quick eyes-on-the-sand dash through the nudist beach was again unsuccessful. The happy-in-his-bare-glory gentleman spotted me and jumped out of the bushes to take a lazy stroll towards me. Exhibitionism ain’t nudism.

Fun times.

As I finish off this post I notice that Victoria Prince has also recently written about her hiking adventures. Which makes me think that we have either all run out of science to talk about (unlikely), we are sick and tired of banging our heads against the wall (quite possible) or we are just moving past the obsessive food-will-cure-all-ails mentality. While it indeed starts with food, there is more to health and wellbeing than what you put in your gob.

Also a topic of our recent presentation at Whole9 seminar in Boston, non-nutrition lifestyle factors are starting to become a more prominent feature in this community. Thank heavens for that. At one stage it looked like we were turning into indoor nerds glued to our computers, obsessively arguing over minute details of the latest Pubmed offering, occasionally emerging from the social media dramas to bash our bodies in the variety of HIIT smashfit pursuits. Whaaat? Somebody still doing that? Crazy folks.

 

Rainforest stair sprints. Or walks.

Anyway, the majority of my activities nowadays are slow intensity performed in a glycogen-depleted state (and when Jamie finally writes up his AHS presentation I will have something to reference!). I try to go for 20-30min walk most days before work, fuelled by caffeine and nothing else; do yoga and strength training once or twice a week. Going for longer and more challenging walks on the weekend fits right into this schedule. So that’s my Slow Movement covered.

 

My shadow is not taller than me = vitamin D production

Sun exposure is another area I consider a powerful factor in overall wellbeing. Vitamin D is certainly the shiz nowadays but let’s not forget about other benefits of sun exposure: mood enhancing qualities, pain relief, better sleep, eye and skin health.

And finally, there’s something about the expansive vistas, the sound of the ocean and the smell of the rainforest that we, as humans, have long felt a connection with. We have seen a few studies emerge showing the benefit of being close to nature (Mark Sisson has written a good overview about it. What hasn’t this man written about???). But I like to look at this from another point of view. It’s not that being close to nature is better for us, it’s just our indoor artificially-lit air-conditioned existence is so very bad. Going back to nature is…well, natural. It’s another one of these instances when feeling “low level crap” has become the norm.

 

Well-deserved: scrambled eggs with lox, avocado, duck pate and local vintage cheddar

Hope you can find some restorative activity, sunlight, fresh air, awe-inspiring views and simple pleasures in your Sunday.

As if you need another AHS wrap up post…

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There have been a few wrap up posts on AHS already, some complimentary, some provocative. I will try to add my bit which will be purely my opinion on the event I have been looking forward to since last year and my impressions of it.

For those who are in the dark about what I am on about (gasp!) here is a good “AHS for dummies” round up. Also Beth has put together quite a list of AHS wrap ups for all your evolutionary medicine science and gossip needs.

Boston Gardens

To start with, I went this year in a purely observatory capacity. If you wondering why anyone would endure 24 hr flying time plus layover in 3 cities, here is my main reason. Evolutionary medicine in Australia is still for weird hippies and charlatans, not for Sydney University-trained doctors. Being in a group of passionate people, some including distinguished scientists, medical professionals and clinicians, was gratifying and encouraging.

*And before I get accused of ignoring minorities and lay folk: I see AHS as a primarily academic event designed to open the doors to new hypotheses, share scientific research and help move evolutionary medicine into mainstream consciousness. I think PaleoFX and its organisers, Keith and Michelle Norris, filled the niche of taking theory to practice very efficiently, and if I can ever afford 2 trips to the US a year (poor medical resident here) I would not hesitate to go. I think it’s fantastic that AHS is open to the lay public (let’s face it, the discerning Paleo “lay public” keep everyone on their toes) but I wouldn’t want for the conference to lose its academic edge. And if I ever want a Paleo group hug I will go to a Paleo meet up.*

Recalling my inability to sit through University lectures, I knew I couldn’t attend every talk so I tried to hedge my bets and pick from the program. Some I got right, some I didn’t. A few times, I opted to hear the “big names” only to miss out on a fascinating talk from a less known figure in the other room. I have already marked the ones I would like to download to watch on video.

The dairy debate continued in the ice-cream parlour

Rating on some memorable talks I saw in no particular order:

1. Dan Lieberman on evolutionary principles. A great talk to open up the symposium and a must-see for anyone as an Evolution 101 refresher. It set a nice tone to the event, steering it away from the romanticised hunter-gatherer image.

2. Dr Peter Attia gave an awesome lecture on cholesterol. This was probably the most sciency talk of the whole seminar and in my opinion the best. I wish I had a lecture like this in medical school! I will definitely re-watch this one on video, this time taking thorough notes. Highly recommend regardless of your knowledge level, you will learn something anyway.

3. Jamie Scott spoke about using evolutionary principles for endurance training. He effectively melted a few brains by stating a strong case for low intensity work performed in glycogen-depleted state. For the crowd largely indoctrinated enthusiastically involved in Crossfit it was a hard sell but I think he got a few converts.

4.  Dr O’Keefe on the effects of prolonged endurance exercise on cardiovascular system. He described exercise-induced cardiomyopathy in ultra-endurance athletes. As a runner himself, his position was a little biased toward running and in my view his recommended dosages (45-60 min 5 times a week) were still too high. Also he didn’t mention the significant degenerative joint effects and chronic inflammation on the body. Overall, the talk was very interesting and definitely something that running-obsessed Americans need to see (OMG, do you, people, do anything else other than run???)

5. Chris Kresser on iron overload. Chris gave a good view of haemachromatosis, its diagnosis, manifestations and treatment. Most of this material had been extensively covered in my medical school lectures (yes, believe it or not, they DO teach us something). I would have liked to hear a theory on the evolutionary explanation of haemachromatosis and Seth Roberts, I think, asked Chris that question but I didn’t gleam much from the response. Worth watching if you think that Paleo is a free pass to eat meat like it’s going out of fashion.

6. J. Stanton on hunger. JS presented very convincing evidence that hunger is a normal physiological response to the lack of nutrients to the cells (who would’ve thunk it, huh?) rather than a massive character flaw possessed universally by the fatties. It was a great complement to his series of posts on hunger (which are excellent to read). JS is, ahem, an unusual personality with a brainpower that makes the rest of us feel like schoolchildren. He was openly critical of the food reward theory during his presentation, however, when we all went out for dinner that night, he was extremely gracious and kept saying that he felt very honoured that people like Stephan (Guyenet) attended his talk. You can read Stephan’s review of this talk here.

7. Dr Terry Wahls gave an inspiring talk about managing own multiple sclerosis with MS. However, I was already familiar with her very excellent TED talk (which you should definitely see if you have been under a rock somewhere) and not sure I got much more out of this presentation.

8. Robb Wolf‘s talk about implementing Paleo diet principles at Reno municipality is inspiring to watch especially if you are interested in public policy and how to bridge the gap between a Paleo community, often seen as alternative and (let’s face it) weird, and real world. Big picture stuff.

9. Dr Emily Deans have a presentation on food and mental health. She gave a good overview of how fructose and trans fats affect us not only metabolically but also psychologically. It was fascinating to see the diametrically opposed views on sugar and mental health: does it make you happy or not?

10. Dr Andreas Eenfeld was a surprise to me. Even though he presented on carbohydrate controversy (yawn) he managed to make it entertaining (yes, really) and light-hearted. I thoroughly enjoyed it.

Watching squirrels was somewhat more entertaining than a safe starch debate

By the way, I think the whole audience was tweeting. It was absolutely surreal to listen to one talk and read tweets from the next room with people raving about the speaker I was missing.

Talks I cannot wait to see on video:

1. Peter Gray on the role play in the development of social and emotional competence. Here is a great example of his work and if I knew he was in the next room I would have dumped Stephan Guyenet in a heartbeat (sorry!)
2. Ubuntu: a paleolithic perspective on human community and health by Frank Foresich
3. Oxidative stress and CHO intolerance by Chris Masterjohn
4. Paleo nutrition and the brain by David Pendergrass.

Overall impression:
It was disappointing to see a few negative posts from attendees, in particular some who felt not included due to their age, appearance, weight, or some other factor. I was not aware of any such tension during the conference, except to note that people were quite naturally gravitating towards their friends and acquaintances, and of course “Paleo celebrities”. I find this community remarkably inclusive but then I am not an idealist and generally do not expect much of people. I certainly would never anticipate Robb Wolf to come up to me and strike up a conversation. Being quite introverted, I spoke to people who approached me or were introduced by others, and relaxed in the courtyard when the crowds got too much.

I would love to come back next year and reconnect with some new and old friends.

A few thanks:
To Ann and Dave Wendell – for making the most of the Aussie-Kiwi rivalry and teasing the hell out of us.
To Victoria Prince – for feeding us home cooked meals, taking us berry picking and showing us the green and luscious part of New Jersey
To J Stanton – for challenging our brain cells and being a very exciting dinner guest
To Jude – for her Aussie accent, sense of humour and constant and inappropriate swearing
To Melissa and Dallas Hartwig – for great conversations, amazing (very well organised!) meals, unwavering support and a hefty dose of inspiration

Many more Twitter names came alive (hey, these people do actually exist) and I fear I’ll miss someone if I start naming them but I enjoyed meeting all of you.

See you all next year.

Big jet plane

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I hate packing and always leave it till the last moment. But I finally conquered my procrastination and now (kind of) ready to jump on the plane to head off to Boston. As excited as I am to be in the midst of the biggest gathering of primal and ancestral health minded people in the world, I don’t think I will have it in me to write long Oscar-worthy reviews. Hopefully I’ll still have my Twitter and Facebook to share the overall buzz with those of you who are eagerly following the event. I was doing it last year so I hear ya!

See you after the AHS12!

Musings on a 40 hour week

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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

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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

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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.

 

Antipodean Paleo

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As I sit curled up on my couch at home I can’t help but look back with amazement at my whirlwind weekend in Melbourne. Here Down Under we occasionally feel like a poor cousin to our American nutrition superstars. We are sometimes left to watch yet another Twitter feed of yet another spectacular Paleo/primal/ancestral event from the sidelines. Not this time! While they were living it up in Austin for PaleoFX we organised an event of our own, which while not huge still went quite well, thank you very much.

First up, a huge thank you to Dr Rod Tayler who was instrumental in organising the event, sending off invitations and even ensuring we had some snack choices which didn’t consist of soggy sandwiches or sausage rolls (I’m truly traumatised by hospital food by now). His involvement ensured we had a small but receptive audience of Paleo enthusiasts, general practitioners, allied health professionals, parents and patients looking for answers.

Rod started us off with a talk about sugar. He is a principal investigator of the current SWEET study conducted in Epworth hospital in Melbourne. He demonstrated how easily sugar sneaks into our modern diets sometimes in most unexpected disguises.

Dr Ken Sikaris gave a fantastic lecture on fructose metabolism. My dearest wish is that every medical school and every nutrition degree would have that lecture as part of their curriculum.

Next I gave a talk on making food choices and how to step away from the conventional paradigm. Here is a little preview:

Jamie Scott gave a great overview of what the Paleo diet is and what it isn’t (not the latest trend on how to lose 30lbs in 30 days for your wedding). He also had some hard hitting messages on how to optimise the rest of your life in regards to sleep, physical activity, sunlight exposure and other frequently overlooked and under appreciated aspects of the Paleo lifestyle.

It was a pleasure and an honour to hear David Gillespie. With three fantastic books under his belt, Sweet Poison and his latest, The Sweet Poison Quit Plan, Big Fat Lies, the guy sure can talk. He played to his strengths, in particular his law background and the skill to sift through evidence. Having a long chat together afterwards, we discovered lots in common in our approach to health and nutrition; I sincerely hope we will get a chance to work and share more ideas in the future.

Unfortunately I missed the last two talks of the day by Dr Ted Arnold on the history of nutritional science and the ever-evolving food pyramids and by Dr Michael Axtens on his own personal low carb experience but I heard great things about both.

The best thing about the day was the audience. They were inquisitive, asking lots of questions after each talk and approaching the presenters in the breaks to share stories and ask opinions. Some were seasonal Paleo buffs, some were just starting to experiment with getting sugar and processed food out of the diet. I answered questions about veganism, infant formula, my own diet, veganism again, diet for MS, which specialty I’m leaning towards, why vegans look so healthy  (I must have looked really friendly and approachable), farmed vs wild caught fish and many others.

We descended on the nearby cafe, ordered a late lunch (while surreptitiously checking out each other’s order) and the discussion continued. I went back home exhausted but excited about the prospects of ancestral, primal and real food nutrition in Australia and New Zealand.

And this brings me to my next piece of news. A huge Paleo event is coming to Sydney on the second weekend of May. The first ever Australian Paleo Weekend will be held on 12-13 May, 2012 on the exclusive Cockatoo Island in Sydney. It’s a fully catered event with a very primal option of sleeping on the island in pre-erected tents. The price is not cheap but with the inclusions and the diversity of activities on offer, I know it will be worth it.

Here is a little preview of what the attendees will expect.

Learn about Paleo nutrition and health
Have the opportunity to quiz the experts
Learn through a demonstration session how to cook quick and healthy Paleo meals
Learn how to get on the fast track to peak sporting performance, by opening the door to their mind
Learn barefoot running techniques
Enjoy an early morning yoga session on the harbour shore to kick start the day
Enjoy a social Paleo feast on the Saturday night with like-minded new friends
Have the unique opportunity to sleep on the island
Enjoy fantastic Paleo meals prepared for them
Enjoy a life changing weekend in a unique venue like no other!

A Paleo event on the Sydney Harbour? Does it get any better than this?

I am still deciding on the topic of my presentation and once I narrow down from a hundred ideas in my head to, say, 10 or so, I will let you know.  For more information on the event please go to www.paleo.com.au or contact Suz directly through her website. I cannot wait to be a part of the first Antipodean Paleo event and I hope to see you all there.

News, interviews and Melbourne

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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.

 

 

 

 

 

 

 

 

 

 

The spice of life

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I’m sick of nutritional thought-terminating clichés. They are repeated ad nauseum everywhere from morning TV to a doctor’s surgery. One of my pet peeves is “Eat a wide variety of food“. I was not surprised to see this statement in the recent draft of Australian Dietary Guidelines.

What does it even mean?

There seems to be a strange notion floating around regarding our human nutritional  requirements. Since we need a wide variety of micronutrients and each food (apparently) only contains a limited amount, we best to stay on the safe side and eat a little bit of everything. This idea is perpetuated by the constant mentions of newly discovered “miracle” compounds in the media.

Reading all these you would be forgiven to think that to obtain optimal health you need a fridge full of exotic berries from Africa, a pseudo-grain from South America, tea leaves grown on a particular valley in Sri Lanka and a vegetable you have never heard of from the Pacific islands.

The ADG draft pitches another argument in support of the variety theory:

“Dietary variety has the benefit of diluting potential toxicants found naturally in food”

They go on to mention the potential vitamin A toxicity from excess liver consumption (most westerners today would gag at the mention of liver anyway) and a potential of mercury poisoning from fish for pregnant women (enough to scare off anyone from consuming any measurable quantities of DHA/EPA. What? Babies’ brains need those?)

This makes no sense (#FFS).

Let’s take ourselves from our first world everything-is-readily-available-when-I-need-it mentality and apply some good old fashioned common sense and a bit of evolutionary logic. Is it really likely that the compound which will turn on some beneficial gene expression in humans world wide just happens to be only found in a berry from Colombia? Hey, evolution, that’s a major oversight! It took the rest of us, non-Colombian population, 2 million years to work out how to build planes and stuff and this perfect nugget of nutrition was sitting there all this time?

It amused me no end that quinoa made it into the list of cereals recommended to be eaten as part of the 5 food groups daily (Guideline 1) in Australia.

“Eat a wide variety of nutritious foods from these five food groups daily: 3. grain (cereal) foods mostly wholegrain, such as bread, cereal, rice, pasta, noodles, polenta, cous cous, oats, quinoa, barley”.

But enough about South American wonder foods. What about a humble blueberry? All those anthocyanins and phenolics repairing the oxidative damage inflicted by the food group number 3. Has to be good for you, right? And lucky for us, health-conscious consumers, blueberries are available all year around courtesy your friendly local supermarket giant.

I still remember picking wild blueberries in a Russian forest as a child. We looked forward to a month-long blueberry season,  doing a few forest trips around July to check if berries were ready for picking. Some super keen villagers would go a few days early just to beat the crowds, their payback for keenness was a few extra hours of forest-wandering. The official start of the season would see whole families venture into the woods, each person laden with a ten litre bucket, me, a child, proudly carrying a one litre container. People would gorge on blueberries for a few short weeks, sell the excess, make mountains of blueberry jam. Every kid would be walking around with a dead giveaway of blueberry gluttony: purple lips. And then it was over for another year.

Think of it next time you buy your punnet of blueberries in the middle of February.

In the world where most fruit, vegetable and berries are farmed and/or transported across the planet we have lost a concept of seasonality. Even a 100 years ago these foods were not available everywhere all year round.  Is there any scientific evidence to suggest that eating food out of season or out of your area is harmful? Nope. But I don’t see any sense in chasing variety for variety’s sake.

“The most recent dietary survey data available for Australian adults – the National Nutrition Survey 1995 – showed an increasing number of foods being consumed by adults in that year compared with 1983 [44]. It is expected that the variety of foods consumed has continued to increase since 1995. This is largely as a result of cultural diversity in the population arising from waves of immigration from European countries after World War II and Asian and African countries since the 1970s [99, 100]. Initially, new varieties of fresh fruit and vegetables, grain (cereal) foods and different types of meat and legume/beans became available. Increasing demand for convenience and/or fast foods – also as a result of changes in social and economic conditions – has led to the availability of approximately 30,000 different types of foods and drinks [101]. However, many of these – particularly snack and fast foods and drinks – are energy-dense and nutrient-poor, so care is required to choose diets consistent with the Guidelines [102]. ” (the draft of ADG)

(my bold italics)

30,000 types of food? Looks like our diet is varied enough. And it’s not just the snacks, fast foods and drinks. Ask your grandmother if she knows what cous cous is (forgo this step if you grandmother is from North Africa).

Wow so much variety!

I am not for a minute suggesting that you should stick to the boring bland diet of steak and 3 veg (of which one is potato, the other is corn, the third is beans). But the concept of “you will develop a secret micronutrient deficiency unless you eat a huge variety of foods just in case” is dubious at best.

Once again they missed the mark, mistaking quantity for quality.

Milan vegetable market.

First week of being a doctor

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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.