Category Archives: obesity

Functional Medicine: Getting to the Root Causes of Illness, A cure for Alzheimer’s

Today I watched a great TED talk by Dr. Rangan Chaterjee discussing his own journey in the discovery and implementation of a functional medicine approach to caring for his patients. The concept of using basic science and clinical science to diagnose and treat the root causes of illness, rather than treating symptoms, has been around for more than two decades.  This approach has recently started to attract more attention, especially within the community of younger physicians who have become more dissatisfied with the frustrations of traditional allopathic medicine.

Here is the talk. Dr. Chatterjee covers lots of ground in a passionate and informative talk.

Enjoy this talk. If you would like to learn about how a functional medicine approach can CURE ALZHEIMER’S DISEASE then watch this video of Dr. Bredesen who gave this lecture at a meeting of the American College of Nutrition.

Doctor Bredesen, an acclaimed neuroscientist, researcher, and more recently a brilliant clinician, has been criticized by the academic research community for implementing a clinical research protocol that addresses more than one variable at a time! Unfortunately, medical science has been handcuffed by the drug-model of clinical research wherein only one variable (drug vs. placebo for example) is studied. But if an illness has many potential contributing root causes, changing only one variable is doomed to failure, as Dr. Bredesen explains in this lecture.

Sleep well, eat clean, get outdoors every morning to help keep your circadian rhythm and biological clock in order.

Bob Hansen MD

The Obesity Code, a must read book by Dr. Jason Fung.

Doctor Jason Fung just published a terrific book titled The Obesity Code: Unlocking the Secrets of Weight Loss: 

Dr. Fung’s genius excels at simple, direct explanations with clarity and humor. His analogies are often hilarious and through his humor and logic he communicates simple but important truths. The major message is that obesity is a hormonal problem. Obesity is not a disease of excess caloric intake, nor is it a disease of sedentary lifestyle. Dr. Fung cites study after study in which obese patients (young and old alike) consumed less calories and exercised more with dismal results. He reviews the medical literature on the effects of refined carbohydrates and sugar on insulin and other hormones. He explains how sustained high insulin levels cause insulin resistance and weight gain. He clearly and decisively explains how 100 calories of sugar or flour effects the human body in a manner immensely different from 100 calories of broccoli.

“Have you ever seen anyone get fat from eating too much broccoli?”

Most importantly, Dr. Fung provides the solution that has helped hundreds of his patients. The solution is elimination of refined carbohydrates and sugar in combination with intermittent fasting. Intermittent fasting (consuming only water, coffee, tea, broth) for 24 -36 hours a few to several times per month helps to reset the brain’s set point for body weight. When combined with restriction of sugar and refined carbohydrate (foods made with flour) intermittent fasting presents a powerful tool to not only lose weight but to manage diabetes and prevent the many complications of obesity and diabetes.

Intermittent fasting increases the human metabolic rate, Your body actually burns more calories at rest per hour during fasting. The effects of intermittent fasting are distinctly different from what has been referred to as the “starvation response”. The “starvation response” ironically and confusingly refers to human studies that restricted (reduced) caloric intake but continued low calorie meals throughout the day.  It is unfortunate that those studies coined the term “starvation response” which is a decrease in resting metabolic rate. Caloric restriction diets reduce the human metabolic rate and therein lies the cause for the failure of all caloric restriction diets.

The confusion of these two approaches and their effects on human metabolism have clouded the discussion of obesity for decades.

Dr. Fung’s communication skills can be enjoyed by reading his book and viewing his many talks on YouTube.

His book and lectures should be mandatory for every medical student, physician, nutritionist and public health official. His book’s exhaustive medical references document the science that supports his theory and his clinical solution.

So take a leap, click on the link above for his book and the links below for some of his videos which are free on-line.

I think that Dr. Fung’s book is the most important book published on this topic in the 21st Century. His work will have profound influence during the next few decades. I encourage you to enjoy his genius.

Bob Hansen MD

The BigFatFix, a crowd funded film that explores the proper nutritional approach to diabetes epidemic

This new film created by a GP in UK, funded by small contributions, describes how elimination of added sugar and implementation of carbohydrate restriction can cure diabetes and result in weight loss. The film also covers how the low-fat craze, based on bad science (ignoring the full data) began with Ancel Keyes and evolved into arguably the worst public health disaster experienced by the modern world.

Bariatric surgery is NOT superior to lifestyle changes

There have been multiple studies comparing “lifestyle” interventions to bariatric surgery in treating obesity and diabetes. Repeatedly the authors conclude that bariatric surgery is superior to “lifestyle” interventions.

But none of these studies have utilized very low carbohydrate diets or medically supervised fasting as a lifestyle intervention. Instead, the diets employed for the “lifestyle” intervention are typically an ADA calorie restricted low-fat diet. I find this very frustrating as a physician.

The science in this area has demonstrated that very low carbohydrate diets consistently out-perform the low fat calorie restricted diet in terms of weight loss, blood sugar control, blood pressure control and lipid profiles.

Bariatric surgery carries a mortality rate of up to 3% depending on the surgeon, hospital and other circumstances. As an anesthesiologist and pain management physician I have seen multiple complications of bariatric surgery including but not limited to multiple chronic nutritional deficiencies (malabsorption), hernias, sepsis, renal failure, rhabdomyalisis, respiratory failure requiring prolonged ventilation, multi-organ failure requiring prolonged ICU care, and death.

And although many patients have profound weight loss in the first year after bariatric surgery many patients ultimately gain back most of the weight initially lost.

We need studies that compare bariatric surgery to very low carbohydrate and paleo diets. We need studies that compare bariatric surgery to intermittent medically supervised fasting. Until those studies are performed we should not conclude that bariatric surgery is superior to lifestyle interventions, particularly given the high complication rates of this surgery and the proven effects of VLC diets and medically supervised fasting.

Here are links to videos that discuss this topic.

They are all worth watching.

The SkinnyNews-Tim Noakes

The Aetiology of Obesity Part 1 of 6: A New Hope

The Science and Practice of Low-Carb Diets {Duke University Office Hours}

Prof. Tim Noakes; Medical aspects of the low carbohydrate lifestyles

Low-Carb Experts: Eric Westman, MD, MHS – Segment One (9:30)

Dr Eric Westman – Duke University New Atkins Ketogenic Diet for Weight Loss and Health

Dr Eric Westman about the new Atkins diet, part 1/2

Debunking Low Carb Myths with Dr. Eric Westman

Insulin Toxicity and How to Cure Type 2 Diabetes

How to Reverse Type 2 Diabetes Naturally

I have previously discussed the issue of carbohydrate restriction, diabetes and obesity with multiple scientific references provided in previous posts.

Peace,

Bob Hansen MD

 

 

Nutrition Journals and the influence of the food industry

Ever wonder why the public is so confused about nutrition recommendations? Just follow the money and you will understand that most of the professional societies that publish nutrition articles are funded by big food companies that are trying to sell more sugar, refined carbs and junk food. I recently read an excellent post about this topic here:

The Vilest Villain: American Society of Nutrition

This theme is repeated by medical journals that are “The Official Journal of the Society of >>>>>>” Just fill in the blanks for just about any medical society. Funding comes from big pharmaceutical companies the same way that funding in the nutrition Journals comes from large (junk) “food” manufacturers.

Don’t get me wrong, there are plenty of very valuable, life-saving drugs out there.

But most chronic human disease in developed societies is generated by various combinations of poor nutrition, lack of exercise, disruption of circadian rhythm, inadequate restorative sleep, stress and lack of social support systems.

The obesity and diabetes epidemics continue to worsen yet the failed dietary advise of major health organizations is slow to respond to the data. Excess refined carbs (especially in the form of “food” made with flour) and added sugar (especially in the form of HFCS) are the major driving forces for obesity, diabetes and cardiovascular disease. Red meat is not the culprit, provided the meat is properly sourced (hormone and antibiotic free, grass fed) and cooked in a manner that does not create carcinogens and inflammatory mediators (cook with slow, low, moist heat, high temperature grilling and smoking cause problems, but that topic  is for another post).

Americans consume an average 130 pounds per year of added sugar and 140 pounds per year of refined flour. Those are averages so there are many people who consume more. The added sugar is not the white stuff people put in their coffee. It comes in all sorts of forms but is found in energy drinks, soda, lattes and mochas, salad dressing,  ketchup, canned soups, canned vegetables, white AND whole grain breads, pasta (even “whole grain”), crackers, breakfast cereal,  just about any packaged food that has more than one ingredient on the label. These foods represent 70% of the American diet. The problems created by this situation are enormous and will bankrupt our “healthcare system”. This is a cultural and economic problem.

The solutions are simple but largely ignored in our society. We are creatures of habit and convenience.

Eat whole foods, nothing from a package that has more than one ingredient. Eat meat, seafood, poultry, fresh organic vegetables (6-9 servings per day), fresh organic fruits, and nuts. Meat should be hormone and antibiotic free (free range, grass fed). Seafood should be wild. Poultry should be free range and the eggs should come from free range chickens, ducks, geese.

Do not worry about eating fat as long as it comes from healthy animals and sources such as coconut oil, extra-virgin olive oil, avocado oil and clarified butter (ghee).

Do not use any “vegetable” oils (corn, soy, and other oils from grains or seeds) The vegetable oils are highly refined and inflammatory. They contain easily oxidized omega 6 fats that feed the production of inflammatory mediators in your body and create oxidized LDL leading to atherosclerosis.

Exercise daily, preferably outside in a green space. Twice per week spend 20-30 minutes  doing resistance training (lift weights, work against the resistance of bands, use your own body weight doing pushups, pull-ups etc)

Reduce stress with mediation, yoga, tai chi, dancing, engaging in fun sports and social activities. Walk on the beach, by a lake, river or stream, in the woods, listen to music.

Get some sunshine regularly especially during the morning to get your circadian rhythm in order and to produce adequate amounts of vitamin D.

Spend time with family, friends and colleagues who are supportive and fun to be around.

Sleep in the dark.

Get at least 7 hours of sleep per night. Avoid TV, computer screens and other electronic devices for at least 2 hours before bedtime.

Unplug from the internet, email, etc on a regular basis.

We evolved as hunter-gatherers.

Peace

Bob Hansen MD

 

 

Don’t drink beverages or water from plastic bottles.

This week the European Court of Justice  ruled that the European Commission has not adequately identified and banned harmful endocrine disrupting chemicals that play a role in hormone related cancers like prostate, thyroid and breast as well as obesity and type two diabetes.

The FDA, European Union and Canadian authorities have claimed that BPA exposure likely does not pose health risks but the endocrinology societies, research scientists, and now the European Court of Justice thinks otherwise.

Most folks have heard about BPA (bis-phenol A). But there are over one hundred endocrine disrupting chemicals (EDCs)  in our environment. These chemicals interfere with our hormone function by mimicking hormones or blocking normal hormone signals. Using BPA free plastic bottles and cans does not guarantee you are safe from the toxic effects of these chemicals because BPA is often replaced by one of many other disrupting alternative chemicals. There are 13 types of bisphenols alone, along with over one hundred total identified EDCs. Many beverage and food items come in plastic containers or cans lined with EDCs, exposing us to the  unnecessary risk of endocrine disruptors. Acidic beverages and acidic foods (such as coffee, soda, lemon juice, etc) are particularly more likely to leach out these chemicals into the foods and beverages contained therein. Extremes of temperature (hot or cold) will also increase the amount of chemicals leached into the food and then into your body. So sipping a hot coffee or tea through a plastic lid is not an innocuous event, yet millions of Americans do it every day. Serving “bottled water” in plastic containers that have been sitting on shelves, shipped in hot trucks, or sitting in the sun at a party may not be very helpful to your guests.

Emerging evidence has established a role for these endocrine disruptors not only for cancer but for obesity, diabetes, ADD and autism.

A recent study has suggested that because of endocrine disruptors in our environment, we must today consume less calories and exercise more to avoid obesity. (Obes Res Clin Pract. 2015; DOI:10.1016/j.orcp.2015.08.007).

“for a given amount of caloric intake, macronutrient intake or leisure time physical activity, the predicted BMI was up to 2.3 kg/m2 higher in 2006 that in 1988 in the mutually adjusted model (P < 0.05).”

From a Medscape report on this topic:

“A European ( study ) reported earlier this year suggested that health effects from endocrine-disrupting chemicals cost the European Community €157 billion annually, and this report linked prenatal exposure to BPA to childhood obesity, with associated lifetime costs of €1.54 billion.”

Links to some articles and resources are listed below.

Be careful out there!

Dr. Bob

Emerging Picture on Role of EDCs, Microbiome in Obesity, Diabetes

Endocrine Disruptors Cause Range of Diseases; Cost 157 Billion Euros

US Endocrine Society Warns Again on Endocrine Disrupters

Endocrine disruptor – Wikipedia, the free encyclopedia

endocrine disruptors AND obesity – Google Scholar

endocrine disruptors AND cancer – Google Scholar

endocrine disruptors AND autism – Google Scholar

endocrine disruptors AND attention deficit disorder – Google Scholar

 

 

Chronic Pain: How does it occur and what can be done about it?

I have discussed the effects of nutrition, stress-reduction, sleep, and circadian rhythm on pain in previous posts . I have not yet discussed the theory of how chronic pain develops and persists. This post discusses some of the mechanisms involved in chronic pain as well as therapeutic approaches that have proven to be effective in addressing the root causes of chronic pain and suffering.

THE CENTRAL NERVOUS SYSTEM (BRAIN AND SPINAL CORD) CAN INDEPENDENTLY CAUSE PAIN AND OTHER PHYSICAL SYMPTOMS THROUGH THE DEVELOPMENT OF LEARNED NERVE PATHWAYS. THESE PATHWAYS INCLUDE CIRCUITS WITHIN THE BRAIN AND CIRCUITS CONNECTING THE SPINAL CORD TO VARIOUS PARTS OF THE BRAIN. THEY CAN PRODUCE PAIN EVEN IN THE ABSENCE OF ONGOING TISSUE DAMAGE.

THESE LEARNED NERVE PATHWAYS CAN DEVELOP AS A RESULT OF SEVERAL WEEKS OR MONTHS OF CONTINUOUS PAIN CAUSED BY AN INJURY OR DEGENERATIVE-INFLAMMATORY DISEASE. IF WE EXPERIENCE RELENTLESS PAINFUL IMPULSES COURSING THROUGH THE BODY THESE BOMBARD THE SPINAL CORD AND BRAIN WITH PAINFUL MESSAGES AND OUR BRAIN AND SPINAL CORD EXPERIENCE A CHANGE SIMILAR TO THE CHANGES THAT CAN OCCUR WITH PTSD CAUSED BY ONE OR MORE TRAUMATIC EVENTS.

THESE LEARNED NERVOUS SYSTEM PATHWAYS REPRESENT “NEUROPLASTICITY” MEANING CHANGES IN THE NERVOUS SYSTEM BROUGHT ABOUT BY EVENTS SUCH AS TRAUMA AND STRESS. THEY REPRESENT A “MEMORY” OF THE PAIN, TRAUMA AND STRESS IMPRINTED ON THE NERVOUS SYSTEM. THIS “MEMORY” INCLUDES NEWLY (AND OFTEN PERMANENTLY) FORMED CIRCUITS THAT OFTEN CONNECT VARIOUS PARTS OF THE BRAIN ASSOCIATED WITH PAIN, ANXIETY, DEPRESSION AND ANGER TO PARTS OF THE BRAIN AND SPINAL CORD THAT MEDIATE SENSATIONS OF LIGHT TOUCH AND PRESSURE. THESE CONNECTIONS PRODUCE “ALLODYNIA” WHICH IS A PAINFUL RESPONSE TO A STIMULUS WHICH IS USUALLY NOT PAINFUL. WE CAN ALSO EXPERIENCE “HYPERALGESIA” WHICH IS AN EXAGGERATED PAIN EXPERIENCE, OUT OF PROPORTION TO THE PAINFUL STIMULUS.

THE NERVOUS SYSTEM HAS A BUILT IN “MUFFLER” DESIGNED TO DAMPEN DOWN PAIN MESSAGES BUT IN CHRONIC PAIN THIS MUFFLER BECOMES AN AMPLIFIER THAT NOT ONLY AMPLIFIES THE TRANSMISSION OF PAIN BUT ALSO CONNECTS THIS AMPLIFIED PAIN SYSTEM TO PARTS OF THE BRAIN ASSOCIATED WITH ANXIETY, ANGER, AND DEPRESSION.

ONCE THESE CIRCUITS OR PATHWAYS ARE IN PLACE (“LEARNED”) THEY CAN NOT BE ELIMINATED (“UNLEARNED”). EFFECTIVE PAIN REDUCTION REQUIRES ACTIVATING ON A REGULAR BASIS ALTERNATIVE PATHWAYS THAT ALREADY EXIST SUCH AS THOSE ASSOCIATED WITH PLAY, MUSIC, DANCE, HUMOR, LAUGHING. ACTIVATING OTHER PATHWAYS CAN ALLOW THE PAIN PATHWAYS TO BE “TURNED OFF” OR MUFFLED. AS CHILDREN WE LEARN TO PLAY AND THOSE LEARNED PATHWAYS STAY WITH US FOR LIFE. WITH PRACTICE WE CAN REGULARLY ACTIVATE THOSE BRAIN PATHWAYS AND MAKE THEM AND OTHER PATHWAYS THE PREDOMINANT PATHWAYS OF OUR BRAIN ACTIVITY.

BUT BEFORE WE CAN UTILIZE THE PLEASANT ALREADY-LEARNED PATHWAYS IN THE BRAIN TO CIRCUMVENT THE PAINFUL-ANXIOUS PATHWAYS WE MUST FIRST DEAL WITH OUR ANGER. DEALING WITH OUR NATURAL AND JUSTIFIABLE ANGER REQUIRES FORGIVENESS. UNTIL THE ANGER IS RELEASED AND FORGIVENESS ACHIEVED WE CANNOT MAKE USE OF THE THERAPIES AND STRATEGIES AVAILABLE TO DECREASE AND MANAGE OUR PAIN. ANGER BLOCKS THE PATH TO HEALING AND PAIN REDUCTION.

The brain processes an emotional insult in exactly the same way that the brain processes a physical insult. Stressful life events and our emotional reactions to them may cause pain that is severe. This is why chronic pain becomes worse when we experience a stressful event. Vicious cycles develop as multiple circuits connecting pain pathways to areas of the brain associated with anxiety and depression become activated and stay activated.

COGNITIVE BEHAVIORAL THERAPY: Over the course of months and years, our reaction to chronic pain often includes repetitive negative thoughts. Cognitive behavioral therapy helps us learn techniques to avoid repetitive negative thoughts.

Mindfulness Based Stress Reduction is another technique that can help mitigate the suffering associated with pain. Mindful Meditation practiced 30 minutes per day produces measurable changes in brain activity that can be seen on Functional MRI scans of the brain within 90 days. These changes demonstrate decreased brain activity in areas associated with pain, depression, anxiety and anger. Scientific studies have also demonstrated that MBSR produces improved immune function, reduces blood pressure, reduces heart rate, improves sleep and provides other beneficial physiologic changes associated with healing and wellness. Yoga and meditation are essential components of an MBSR program.

SLEEP: Pain cannot be managed or successfully treated unless an individual gets 8-9 hours of restorative sleep per night. Sleep hygiene recommendations are an essential part of the path to wellness. Daily exposure to sunlight outdoors and restoring normal circadian rhythm are essential for pain management. Going to bed at the same time every evening and sticking to a regular schedule is the most important part of improving sleep. Daytime exposure to sunlight and dimming the lights in the evening are also required. Regular exercise (daily walking) is essential. Wearing blue-light blocking glasses for 2-3 hours before bedtime can facilitate sleep. When blue light wavelengths (light bulbs, computer screens, TV screens) hit the retina of the eye a message is immediately relayed to the “internal clock” of the brain that tells the brain there is still daylight. This inhibits the production of melatonin (the “sleep hormone”). Avoiding bright light (especially from TV or computer screens) for 2-3 hours before bedtime is important. If you must watch TV or work on the computer in the evening that blue light blocking glasses or goggles are a must. There are free software programs that will eliminate the blue light from your computer screen as an alternative to blue light blockers.

NUTRITION: Pain involves inflammatory pathways. An anti-inflammatory diet is essential for treating pain and providing the nutritional components necessary for healing tissue and establishing better brain chemistry. Paleo Diet removes potential sources of inflammation from the diet. If a patient suffers from an auto-immune disorder the more restrictive Autoimmune Protocol version of the Paleo-diet can help put the disease into remission and decrease the inflammation associated with the auto-immune process.

OBESITY AND OVERWEIGHT: Extra fat around the belly and internal organs causes chronic inflammation throughout the body. The fat cells around internal organs and the immune cells that reside alongside the fat cells both produce a steady stream of chemicals that circulate throughout the body stimulating inflammation everywhere. These circulating chemicals are called cytokines and chemokines. Certain cytokines and chemokines cause fatigue, brain fog, and sensitize the nerves, increasing pain. They also interfere with sleep. Weight loss is an essential component to pain reduction for overweight and obese patients. The best nutritional approach to weight loss includes a Paleo Diet with carbohydrate restriction (low carbohydrate, high-healthy-fat whole food diet). Adding medically supervised intermittent fasting (such as an 18- 24 hour fast every 1-2 weeks, consuming only water for 18-24 hours) can also be effective especially combined with a carbohydrate restricted Paleo Diet and lifestyle.

Exercise and Physical Conditioning: Chronic pain causes sedentary behavior which results in physical de-conditioning. This process involves loss of muscle, decreased bone density, shortening of ligaments and tendons and shrinkage of the tissues that envelope muscle. This leads to more pain when physical activity is increased and a vicious cycle is created. This cycle must be broken with a graduated daily exercise and physical conditioning program. If you follow a medically prescribed exercise program you will not damage your body even though it may be painful during the first several days. Exercise also helps to convert the “amplifier” back to a “muffler” in the nervous system.

Below are some links to articles related to this discussion.

Eat clean, live clean.

Bob Hansen MD

Applying modern pain neuroscience in clinical practice: criteria for the classification of central sensitization pain.

Central sensitization and altered central pain processing in chronic low back pain: fact or myth?

How to explain central sensitization to patients with ‘unexplained’ chronic musculoskeletal pain: practice guidelines.

Addressing sleep problems and cognitive dysfunctions in comprehensive rehabilitation for chronic musculoskeletal pain.

Exercise therapy for chronic musculoskeletal pain: Innovation by altering pain memories.

Efficacy of a modern neuroscience approach versus usual care evidence-based physiotherapy on pain, disability and brain characteristics in chronic spinal pain patients: protocol of a randomized clinical trial.

The effect of relaxation therapy on autonomic functioning, symptoms and daily functioning, in patients with chronic fatigue syndrome or fibromyalgia: a systematic review.

Pro-nociceptive and anti-nociceptive effects of a conditioned pain modulation protocol in participants with chronic low back pain and healthy control subjects.

Vagal modulation and symptomatology following a 6-month aerobic exercise program for women with fibromyalgia.

Brain-derived neurotrophic factor as a driving force behind neuroplasticity in neuropathic and central sensitization pain: a new therapeutic target?

The role of central sensitization in shoulder pain: A systematic literature review.

Chronic whiplash-associated disorders: to exercise or not?

Exercise, not to exercise, or how to exercise in patients with chronic pain? Applying science to practice.

Evidence for central sensitization in patients with osteoarthritis pain: a systematic literature review.

Malfunctioning of the autonomic nervous system in patients with chronic fatigue syndrome: a systematic literature review.

Endogenous pain modulation in response to exercise in patients with rheumatoid arthritis, patients with chronic fatigue syndrome and comorbid fibromyalgia, and healthy controls: a double-blind randomized controlled trial.

You may need a nerve to treat pain: the neurobiological rationale for vagal nerve activation in pain management.

Avoidance behavior towards physical activity in chronic fatigue syndrome and fibromyalgia: the fear for post-exertional malaise.

The role of mitochondrial dysfunctions due to oxidative and nitrosative stress in the chronic pain or chronic fatigue syndromes and fibromyalgia patients: peripheral and central mechanisms as therapeutic targets?

Thinking beyond muscles and joints: therapists’ and patients’ attitudes and beliefs regarding chronic musculoskeletal pain are key to applying effective treatment.

Evidence for central sensitization in chronic whiplash: a systematic literature review.

Pain in patients with chronic fatigue syndrome: time for specific pain treatment?

Kinesiophobia, catastrophizing and anticipated symptoms before stair climbing in chronic fatigue syndrome: an experimental study.

Central sensitization in patients with rheumatoid arthritis: a systematic literature review.