Tag Archives: Health

The mind boggles…

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Hello, my name is Anastasia. It’s been 32 days since my last nutrition rant. I thought I had everything under control. I was calmly writing a huge post on polyunsaturated fatty acids. It came out of the blue. I walked into a scheduled lecture on major clinical concepts surrounding diabetes naively believing I had the willpower. Those of you watching me implode on Twitter know just how wrong I was.

The endocrinologist who was standing in front of us is probably a fantastic doctor. He was just asked to help some medical students revise the clinical approach to Type I and Type II diabetes. I cannot judge his level of knowledge or his expertise based on a few slides. But maybe you can.

After briefly recapping the definitions of Type 1, Type 2 and LADA (late onset autoimmune), he got my attention by declaring that Type 2 Diabetes was a genetic condition. I was a bit flummoxed. Sure, I know of the studies isolating the genes involved. I also know of the popular quoted statistic that the identical twin of a diabetic patient has 90% chances of getting the disease. Still I think of Marfan’s or hemophilia as a typical genetic condition: a known mutation of a certain gene causing a problem.

The next important fact to be addressed was the increase in the prevalence of diabetes. I thought you had to have spent some serious time under a rock not to have noticed that but nevertheless I observed many students scribbling furiously.

At this point I was getting a little confused: why would a genetic condition increase in prevalence in such a short period of time? The answer was on the next slide.

Causes of increasing prevalence of T2D:
– increasing gene pool
– obesity
– high fat and high GI diets
– less physical activity

“Increasing gene pool” had me slide down my chair in a fit of silent giggles as I was mentally fighting off in a image of all those sex-crazed diabetics hellbent on spreading their defective genes.

And you all know how the obesity story goes: being a glutton and a sloth makes you fat. Being fat makes you a diabetic. Hang on, wasn’t it genetic? I’m lost.

This disease is so horrible that if you are thin then it’s your genes, and if you are fat then it’s your fault!

So is there any hope???

Here is a long awaited lifestyle slide:

1. Refer to a dietician for diet advice.
Good to know that we as doctors are prepared to admit that we are totally inept in giving diet advice.
2. Lose weight.
If only somebody ever told a fat diabetic that all they have to do is to lose weight! They wouldn’t have had years of silent small vessel damage destroying their retina, eyes and kidneys.
3. Maintain physical fitness, eg walking 30 minutes a day 5 times a week.
My sarcasm has actually failed me at this point. I honestly have nothing.

The discussion on the lifestyle changes for diabetes was pessimistically concluded with: it’s too hard to convince patients to change their diet and increase their physical activity. The lecturer sounded genuinely upset about this fact, lamenting that most lifestyle changes tend to fail, at which point all diabetics inevitably progress to medication.

Ah, yes, the medication. Quick rundown on the drugs: from metformin (“a fantastic drug which assists with weight loss and improves the liver insulin sensitivity”) to sulphonylureas (“fantastic drugs with a proven safety record which increase the insulin output from the pancreas”) to glitazones (“recent drugs exciting some cautious optimism, still associated with some unfortunate side effects, like HEART FAILURE”) and so on. Until, finally, insulin. All roads lead to Rome, all drains lead to the ocean. All diabetics end up with insulin.

Apparently, the trick with insulin is not to forget to increase the dose when you know that you are about to shock your system with a gargantuan serving of pasta with a low fat sauce. Silly me, I would have thought it sensible to reduce your requirements for insulin in the first place.

And of course as any medical student knows, a discussion on diabetes has to be wrapped up with some happy snaps of gangrenous toes. That will drive the message home!

I know that many of you are reading this with a mixture of exasperation and amusement. And a shadow of superiority. Surely any intelligent person would critically appraise the information given, research the best sources, analyse primary studies, draw their own conclusions and use their own brain???

What if you are a medical student? You have 5 months till people call you “Doctor”.  You need to be able to deal with trauma, haemorrhage, heart attack, delirium, burns, sepsis, anaphylaxis, organ failure, psychotic episode, dislocated shoulder, meningitis, testicular torsion and a spider bite.

Senior doctors inspire our admiration with their wealth of knowledge, confidence in dealing with the unexpected, their people skills (not always) and the sheer fact that they have been through what we are going through and survived! Even if you were crazy enough to start a nutrition blog in your last year of med school, do own research on the train to the hospital and write angry posts instead of studying for exams… would you question an esteemed professor during his lecture?

Everything we know is just what we have been told. Based on that, the future of medicine has me worried.

I am eagerly awaiting your comments.

Natural my a#%!

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Natural. The popular catch cry of nutrition gurus, the favorite fallback of all diets.

Let’s start with a simple fact. Just because it is natural doesn’t mean it is good for you. Take cyanide… Ok, let’s not go that far. Let’s have a closer look at the new darling of weight loss magazines: “heart healthy whole grains”. The clever advertising normally involves one of the following: vast expansive fields, shimmering gold wheat, sunburnt farmers, a shape of a heart and a coy mention of “regularity”.

Apply STEP 1 of the FCS: Metabolism
How many mammal species eat grains as a major part of their diet, let alone the base of the food pyramid? When did the human digestive system learn how to process the food group that in the animal kingdom is a leftover for birds only? The reason why you don’t see herds of cows stampeding the wheat fields is that they instinctively know the toxic components of grains: gliadin proteins, wheat germ agglutinin and other lectins, phytic acids and enzyme inhibitors.

STEP 2: Evolution
Since the advent of agriculture people used many processing methods to neutralise the poisons in grains: milling, sifting to remove most of the toxic bran (yes, the one in your bran muffin), fermenting (8-12 days for traditional sourdough), forming into batter, fermenting again for a few hours and finally baking. Making bread was hard work and you can be sure it wasn’t possible to make 6-11 serves recommended today. Bread became a poor man’s meat, an inferior substitute source of nutrition when precious animal products were no longer available on regular hunts.
Today life is so much easier. The industrial processes mill grains into super-fine flour. The fermentation process is largely unused. For “health conscious” consumers, seeds and bran are added back into the mix.

STEP 3: Scientific evidence
Much evidence exists on the damage grains cause to our body. Coeliac disease is the most well-known condition in which gluten causes widespread damage to intestinal lining, causing malabsorption, debilitating digestive complaints, skin rash and higher rates of some cancers. But coeliac is just the tip of a big ugly iceberg. Other conditions linked to grains are less well known: autoimmune thyroid and liver disease, multiple sclerosis, rheumatoid arthritis, lupus, type I diabetes and even schizophrenia.

Natural? You gotta be kidding me.
Sigh… Moving on…

In the yuppy heaven of the trendy suburbs of Sydney, Melbourne, Los Angeles or London you will come across organic/natural cafes frequented by very casually but expensively dressed 20-somethings who look like they desperately need a feed. The drink of choice is usually soy (possibly chai) latte. Somebody please tell me what is so very natural about soy milk. Have you ever seen a soy bean and does it look like you can easily get “milk” from it? The process of creating this dubiously “natural” beverage is a genius of food chemistry and machinery.

Click for better resolution

Baby food and Adhesives… Yummm

Organic soymilk coffee: the irony

And why is it sold in a dairy section of the supermarkets? (together with margarine made from industrial seed oils in a container with a picture of a cow). To grow herbs on your own balcony and to shop at local farmers markets does not go with drinking soy milk! Let’s not even get started on phytoestrogen and isoflavone content of unfermented soy products and its effect on your thyroid and testosterone. Every time I walk past a baby food aisle in the supermarket and see baby soy formula it makes me physically sick. Some of the most prominent New Zealand scientists, like  Dr  Mike Fitzpatrick and Professor Cliff Irvine, have been calling on NZ Government to completely ban infant soy formula after what they have discovered in the course of their research. (Fitzpatrick “Soy formulas and the effects of isoflavons on the thyroid” NZMJ 2000)

Other pseudo-natural food items that come to mind are egg whites and skinless chicken breasts. I’m trying to  remember the last time I saw an animal documentary where a predator raiding a birds nest carefully breaks each egg into two pieces, decants the whites into a prepared container and then discards the nasty yellow in the centre. Eggs are a complete food. Yes, they have cholesterol and (gasp!) even saturated fat. But they provide a complete profile of essential nutrients, including choline, the deficiency of which has been linked with fatty liver disease. Eating egg whites is a bit like eating the peeled skin off an apple and discarding the rest. Ditto applies to chicken skin, fat on the meat and offal (highly prized in the animal kingdom).

The prize goes to low fat dairy products. If you are lactose-intolerant or just sensitive to dairy due to digestive or autoimmune conditions, that’s another story (unless you substitute it with soy – see above). People who drink skim milk because of their lipophobia have a lack of basic understanding of what  a natural product actually is. Every constituent of food plays an important role. You can’t just remove fat in isolation and expect everything else to remain the same. Fat content of dairy products allows for the absorption of fat-soluble vitamins A and D. Why do you think skim milk is often “fortified” with these vitamins and calcium? Milk is another nutritionally complete food. The
macronutrient content of human breast milk is as follows.

Human Breast Milk. Per 250 mL. Source: CalorieKing.com

As you can see the saturated fat content is very high. The medical profession is united in advocating breastfeeding. However, according to conventional wisdom, on the day the child turns 2 years of age they miraculously cease requiring fatty acids for healthy brain development. What was highly beneficial at 1 year and 364 days becomes a silent killer the very next day. No, it doesn’t make sense to me either.

Four pillars of modern “natural” nutrition: wholegrains, low fat dairy, egg whites and soy.

I don’t care whether you believe in God or Mother Nature: neither are stupid enough to provide us with natural foods that need industrial-strength modifications and pharmaceutically-supported supplementation just to make them edible. Humans are the only species on this planet which require multi-million dollar investigations to tell them what to eat. Because clearly after 2 million years in existence we clearly still haven’t worked it out.

End rant.

Moment of truth: quiz answers

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If you haven’t done the quiz yet, what are you waiting for?

Aaaaand… drum roll… here are the answers!

1. Predominant fat in lard is monounsaturated. Yes, just like in olive oil. The composition of lard is as follows:
Saturated fat – 38-43%
Monounsaturated fat – 47-50%
Polyunsaturated fat 6-10%
It is a common misconception that animal fat = saturated fat. Most animal fats like lard or beef tallow have loads of monounsaturated fatty acids. Even butter contains around 30%. In addition 12-15% of saturated fat in lard is in form of stearic acid, which is converted by the liver to oleic acid( = more monounsaturated fat!).

2. Saturated fat consumption has decreased over the last 100 years.
According to this paper, published in the American Journal of Clinical Nutrition, saturated fat consumption in the US reduced from 16.6% in 1950-1959 down to 11.8% in 1980-1985. At the same time period the number of obese people has increased from 9.7% to 35% in women (33% in men).

3. Triglycerides are blood fats measured when you have a cholesterol test or a lipid profile test. It is very tempting to reason that fat in the diet raises fat in your blood. Sounds so simple and logical? But… The diet component most responsible for high triglycerides is carbohydrates. Consumed in excess, they get converted in the liver into triglycerides and transported to fat tissue for storage. The process is called ”de novo lipogenesis” (new fat formation). Dr William Davies, a cardiologist from the US, describes it well here.

4. HDL is sometimes called “good cholesterol” and we are advised to eat foods which increase HDL to reduce our risk of heart disease. Low carb diets are found to raise HDL.

5. Glycemic index classifies carbohydrates by how much they raise blood glucose. We are told to stick to low GI foods for weight loss and diabetes management.
Baked potato – 101
“Frosties” – 55
“Peanut M&M’s” – 33
Muesli bar with dried fruit – 61
Super supreme pan pizza – 36
Eggs – 0
It seems blindingly obvious that GI system has major flaws as nobody in their right mind would consider M&M’s healthier than a potato. Eggs, beef, lamb, pork and other animal products have a GI of zero.

6. Cholesterol levels are tightly regulated in our bodies as this substance performs many vital functions. Up to 80% of cholesterol is synthesized in the body with 20% coming from dietary sources. When you reduce dietary sources of cholesterol, your cells try to increase their own cholesterol production to make up the difference. 

7. Our heart prefers fat in form of fatty acids as its main fuel source. Ketones, which are formed when the body burns fats, make up around 1/3 of the heart’s requirements. During fasting conditions, they provide up to 60-70% of the heart’s energy.

8. Vitamin A (retinol) is a fat-soluble vitamin essential for growth and repair, healthy bones and teeth, good eyesight, thyroid and immune system.
Vitamin A concentration in mcg for 100 g:
Liver 23000
Full fat milk 28
Butter 895
Sweet potato 700
Eggs 200
Carrots 8000
Carrots and sweet potatoes are traditionally advised as a good source of vitamin A. However vitamin A in plants is in the form on beta-carotene which has to be converted to retinol at a ratio of 6:1. In addition, your body needs fat to absorb vitamin A. So slather some butter on those veggies!

9. It is a common misconception that your body needs a constant top-up of carbohydrates to keep the bloods sugar up. If I could have a dollar for every time I heard someone say: “My blood sugar is dropping after my gym session. I better get a Gatorade/piece of fruit/cereal bar”. Somehow I don’t think that our ancestors were munching every 3-4 hours to avoid a blood sugar drop. Any biochemistry textbook will tell you that our body has several hormones, the job of which is to keep your blood sugar up. They do it by switching to fat-burning for energy, releasing glycogen (stored form of glucose) into the blood and using ketones to provide energy for the brain. Muscle protein is spared for as long as possible.

10. Saturated fats and trans fats are often lumped together although they have vastly different structure and effects on the body. The only thing they have in common is that they are solid at room temperature. Trans fats are highly processed vegetable oils, hydrogenated to resemble butter. They have been linked to obesity, heart disease and cancer. Mary G. Enig, a renowned expert in lipid biochemistry, gives an excellent explanation on fats here.

So how did you go? Please send me some comments with your thoughts: what you knew, what surprised you, what you want me to cover in greater detail.

I am still working on Resources page but I promise to get it going soon.

Welcome to primalmeded

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I am a final year medical student and I have a confession: I know precious little about health.

 
I have been taught about the mechanisms of heart attacks. I know how to diagnose one, what medications to prescribe, what complications to expect and how to look after my patient on the cardiac ward. The patient gets better, I discharge them home with a list of medications, a referral to a cardiologist and strong advice to “address lifestyle factors”. This is where things get a bit tricky.
 
I used to know what to say: avoid saturated fat, exercise up to 150 minutes a week, reduce your cholesterol, avoid salt, eat plenty of whole grains… But somehow “lifestyle modification” remained this vague elusive concept. Doubt made me get off my butt and do my own research.
 
My partner says that after I read Gary Taubes “Diet Delusion” (“Good Calories Bad Calories” as it is published in the US) I went quiet for a week. I hated the way that book made me question everything I thought I knew. I struggled through it and then promptly read it again. I began ferociously searching for information on nutrition and exercise. I still am.
 
There are people out there who are much smarter than me. They refuse to accept the nutritional dogma of the last 50-100 years which led us to be the fattest and unhealthiest generation yet. I will endeavour to follow their example and take charge of my medical education.
 
This blog is to share my ideas with you: my friends, family and anybody else who is tired of the latest gimmick and the newest fad. And to put my money where my mouth is, I promise to share my personal journey to health and fitness. Please do not expect “before and after” bikini shots, it ain’t gonna happen.
 
Drop me a line if you like what you see, or maybe two lines if you hate it.
 
Thanks,
Anastasia