Category Archives: obesity

Fat Fiction: this movie could save your life

The USDA Dietary Guidelines are about to be published again with an update. Unfortunately, despite much input from the scientific community requesting that the dietary guidelines address the epidemics of obesity and diabetes, it looks like nothing will change. More than 50 scientific papers that support a Very Low Carbohydrate approach to address obesity, diabetes and pre-diabetes will be ignored.

But if you want a more scientific perspective I suggest you watch this movie. You can watch it free on Amazon Prime.

If you have read Good Calories Bad Calories by Gary Taubes or Big Fat Surprise by Nina Teicholtz. then you have already been exposed to the sad history of dietary recommendations in the United States and the tragic results.

Both books are well researched and present accurate science. The movie Fat Fiction reviews the sad history of dietary advice in the US. It presents many examples of patients whose lives were changed and improved by following the advice of nutritionists and physicians who have instead, followed the science and abandoned the ideological-unscientific USDA dietary guidelines.

The American Diabetes Association has finally recognized a VLC ketogenic diet as a valid approach to treating type 2 diabetes. In fact, a ketogenic diet is the only diet that has ever been documented in controlled clinical trials to reverse diabetes type 2 and get patients off insulin and oral medications used to treat diabetes.

Unfortunately, the USDA guidelines and the American Heart Association recommendations continue to recommend unhealthy inflammatory refined “vegetable oils” (processed/refined oils from corn, soy, safflower, peanuts, cottonseed, etc.) and high carbohydrate/low fat meals. The high carb/low fat approach to cardiovascular disease, obesity, and diabetes has been an absolute failure, increasing rather than decreasing the risk of heart attack and stroke as well as contributing to the explosive epidemics of obesity and DM2. The low fat dogma has fostered the obesity and diabetes epidemics since this dogma was first introduced in the mid 20th century. The low-fat ideology remains fully supported by financial contributions from the processed-food industry, creating a financial conflict of interest for the AHA and similar organizations.

In the context of the COVID 19 pandemic, where obesity, insulin resistance, pre-diabetes and diabetes type II are major risk factors for death from the infection, it is even more imperative that individuals suffering from these risk factors stop using medications to treat problems created by food and instead clean up their diet.

You can’t throw drugs at a nutritional disease and expect it to work” (Dr. Sarah Hallberg, TEDtalk)

You can fight systemic inflammation with the anti-inflammatory diet I present on this website, but if you have obesity, diabetes or pre-diabetes, the very low-carb version is the most effective and sustainable nutritional approach. Full fat dairy is optional (although technically not part of our evolutionary nutrition) and if you are obese, overweight, diabetic or pre-diabetic and full fat dairy is necessary for you to achieve a ketogenic diet, then go for it. But make sure you include an abundance of non-starchy vegetables which are an important component of a healthy ketogenic diet.

In the context of our present pandemic I will repeatedly say:

  1. Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
  2. Get plenty of sleep (without adequate sleep your immune system does not work well )
  3. Follow good sleep habits
  4. Exercise, especially out of doors in a green space, supports the immune system
  5. Get some sunshine and make sure you have adequate Vitamin D levels.
  6. Eat an anti-inflammatory diet rich in micronutrients.
  7. Practice stress reduction like meditation and yoga which improves the immune system
  8. Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
  9. Eliminate refined-inflammatory vegetable oils from your diet, instead eat healthy fat.
  10. Clean up your home environment and minimize your family’s exposure to environmental toxins by following recommendations at EWG.org with regards to household products, personal care products, and organic foods. (https://www.ewg.org/)

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob

Chronic Inflammation, the silent killer

I was recently interviewed by a health blogger for his podcast. The topic was chronic inflammation. Here it is.

I prepared some notes for the interview. Here are the questions and answers.

What made you so interested in the topic of chronic inflammation?

Interest in chronic inflammation:

  • Emerging evidence, source of most chronic disease including mental health (depression, etc.) is inflammation
  • family health issues experience personally
  • health care policy interest since graduate school
  •  First started to question USDA dietary advice after reading GOOD CALORIES, BAD CALORIES, by Gary Taubes,
  • Experienced Statin myopathy, researched statin drugs, bad data, financial conflicts of interest. Sought alternative approaches to Coronary Artery Disease prevention.
  • In USA, Profit driven health care system evolved from more benign not-for-profit earlier system in medical insurance and hospital system. Drug and surgery oriented. Corporate ownership of multiple hospitals, concentration of wealth and power in the industry and in society in general
  • Saw this every day: growing obesity, Metabolic Syndrome, DMII, auto-immune disease. Root causes NOT ADDRESSED.
  • While recovering from surgery attended on line functional medicine conference on auto-immune disease, covering diet, sleep, exercise, sunshine, Vitamin D, environmental toxins, gut dysbiosis, intestinal permeability (THE GATEWAY TO AUTOIMMUNITY IS THROUGH THE GUT).
  • Introduced to EVOLUTIONARY BIOLOGY and Paleo Diet by my son

What diseases does chronic inflammation typically lead to? 

  • Cancer
  • Diabetes
  • Obesity epidemic, DIABESITY
  • Hypertension
  • Metabolic Syndrome (3/5: HTN, insulin resistance/high blood sugar, abdominal obesity, high TGs, low HDL),
  • Autoimmune diseases
  • Degenerative arthritis
  • Neurodegenerative disorders (dementia, Parkinson’s, neuropathy, multiple sclerosis)
  • Works of Dale Bredesen (dementia, “The End of Alzheimer’s”), Ron Perlmutter (Grain Brain), Terry Wahls (The Wahls protocol for MS), all FUNCTIONAL MEDICINE looking at root cause of illness, common-overlapping threads.
  • Interplay between sleep, circadian rhythm, exercise, sunlight, stress, environmental toxins, diet, processed foods, nutritional deficiency, gut microbiome, endocrine disruptors, intestinal permeability, oral and skin microbiome, social disruptors, GUT BRAIN AXIS. These are all part of one large ECOSYSTEM.
  • Positive and negative feedback systems requiring a SYSTEMS ENGINEERING approach to understanding root causes.
  • Butyrate is the preferred substrate for colonocytes, providing 60-70% of the energy requirements for colonic epithelial cells1,2Butyrate suppresses colonic inflammation,3 is immunoregulatory in the gut,4 and improves gut barrier permeability by accelerating assembly of tight junction proteins.5,6
  • Improves insulin sensitivity, increase energy expenditure, reduce adiposity, increases satiety hormones,
  • HDAC activity inhibitor, PROTECTS GENES from removal of necessary acetyl groups.
  • Butyrate also influences the mucus layer. A healthy colonic epithelium is coated in a double layer of mucus. The thick, inner layer is dense and largely devoid of microbes, protecting the epithelium from contact with commensals and pathogens alike. The loose, outer layer of mucus is home to many bacteria, some of which feed on the glycoproteins of the outer mucus layer itself. Both of these mucus layers are organized by the MUC2 mucin protein, which is secreted by goblet cells in the epithelium. Supplementation of physiological concentrations of butyrate has been shown to increase MUC2 gene expression and MUC2 secretion in a human goblet cell line.7,8

What are the population groups which have higher risk of chronic inflammation? 

  • Obese
  • Sedentary
  • Poor-urban-polluted environment dwelling (air, water, noise, crowding, violence, racism, oppression)
  • Divergence from ancestral evolutionary biology
  • Working environment: indoors, polluted, oppressive supervisors, no sunlight, noise pollution, air pollution, toxic social situations, repetitive motion, bad ergonomics,
  • night shift, disruption of circadian rhythm
  • both parents working, no time for real food and family interaction, supervision of children.
  • screen time- sedentary behavior, lack of outdoor activity
  • Stress of social inequality, food insecurity, violent neighborhoods, nutritional deserts

What are the “danger signs” or typical symptoms which may signal a chronic inflammation? 

DANGER SIGNS:

  • Waistline (waist to height ratio, BMI)
  • Sarcopenia (muscle as an endocrine organ)
  • Sleep disturbance
  • Pain
  • Headaches
  • Depression
  • Lack of joy.
  • Brain fog, fatigue

What are the typical biomarkers of chronic inflammation?

  • METABOLIC SYNDROME (3 or more of the following: high blood pressure, elevated blood sugar, elevated Triglycerides, low HDL, obesity)
  • CRP predictive of cardiovascular events,
  • ESR associated with arthritis
  • Stress hormones (morning cortisol levels)
  • Resting Heart Rate and Heart Rate Variability

What are the typical sources of systemic chronic inflammation?

Sources of Chronic Inflammation:

Diet

  • N6/N3 FA ratio determined by too much Refined Easily Oxidized Vegetable Oils, not enough marine sources of N3 FA,  grain fed vs grass fed/finished ruminant meat. Loren Cordain research wild game FA composition = grass fed. Margarine vs Butter. Fried foods using Vegetable oils. Oxidized fats/oils, oxy-sterols in diet.
  • Sugar excess leading to insulin resistance
  • Refined carbs leading to insulin resistance (dense acellular….)
  • Disturbance of gut  microbiome from poor nutrition (sugar, refined carbs and vegetable oils all disrupt the microbiome)
  • Gut brain axis.
  • Food ADDITIVES AND PRESERVATIVES
  • Trans Fats (finally banned)

Endocrine disruptors/ BIOACCUMULATION

  • Plastics (microparticles in our fish, food and bottled water)
  • Plastic breakdown products
  • Phthalates added to plastics to increase flexibility ( also pill coatings, binders, dispersants, film formers, personal care products, perfumes, detergents, surfactants, packaging, children’s toys, shower curtains, floor tiles, vinyl upholstery, it is everywhere) 8.4 million tons of plasticizers produced annually. EWG.org
  • Pesticides, herbicides, glyphosate (Monsanto), DIRTY DOZEN, CLEAN FIFTEEN EWG.org
  • Medications
  • ABSORBED skin, eat, drink, breath,
  • BPS is as bad as the BPA it replaced
  • Polychlorinated biphenyls used in INDUSTRIAL COOLANTS AND LUBRICANTS
  • Flame retardants (PBDEs, polybrominated dipheyl ethers) are ubiquitous in furniture and children’s clothing. Also linked to autoimmune disease
  • Dioxins
  • PAHs (polycyclic aromatic hydrocarbons
  • Sunblock
  • CUMULATIVE BURDEN, INTERACTIONS, SYNERGY?

SLEEP DEPRIVATION CHRONIC IN OUR SOCIETY

Eating late vs time restricted eating

Gut Microbiome disrupted by

  • 1/3 of prescribed medications disrupt the microbiome AND increase intestinal permeability
  • Stress
  • Sleep deprivation
  • Sugar
  • Refined carbs
  • Refined veg oils
  • Over exercise and Under exercise, both are bad.
  • Environmental toxins

Gut dysbiosis and infections include (often chronic, low grade, not diagnosed)

  • Pathogenic bacteria, infection or overgrowth/imbalance
  • SIBO
  • Parasites
  • Viruses
  • BAD bugs > good bugs
  • Good bugs make vitamins and SCFAs required for colonocyte energy
  • Gut-Brain axis huge topic, VAGUS NERVE COMMUNICATION both ways, SCFA in gut and in CIRCULATION (butyrate, propionate, acetate), NEUROTRANSMITTER PRODUCTION (SEROTONIN, OTHERS), enterochromaffin cells producing > 30 peptides.
  • Overuse of antibiotics in medicine
  • AND use of antibiotics in raising our food.
  • Vaginal delivery vs C-section
  • Breast feeding vs bottle feeding

INCREASED INTESTINAL PERMEABILITY:

  • Caused by all factors above
  • Leads to higher levels of circulating LPS-endotoxin, bacterial products that create an immune-inflammatory response.
  • Incompletely digested proteins with AA sequences overlapping our own tissue causing autoimmunity/inflammation through molecular mimicry

Heavy Metal toxicity

  • Lead
  • Mercury
  • Cadmium
  • Arsenic

MOLD TOXICITY (> 400 identified mycotoxins, can cause dementia, asthma, allergies, auto-immunity)

  • At home
  • At work

What are the most efficient natural (non-medication) ways to address chronic inflammation?

  • Anti-inflammatory Diet, real whole food that our ancestors ate through evolutionary history (grass fed/finished ruminant meat, free range poultry, antibiotic free, and pesticide free food, wild seafood (low mercury varieties), organic vegetables and fruit, nuts, fermented foods, eggs)
  • Low mercury fish and seafood for omega three fatty acids
  • Sleep hygiene
  • Exercise, not too much, not too little, rest days, out of doors, resistance training, walking, yoga, Pilates, tai chi, chi gong, dancing, PLAYING!!!!!!!!!!!!!
  • Stress reduction: meditation, mindful living, forest bathing, sunlight, Playing, music, praying, SOCIAL CONNECTION, laughter, comedy, quit the toxic job, quit the toxic relationship, SAUNA/SWEAT, heat shock proteins, exercise
  • Vitamin D, sunshine, check levels
  • PLAY, PLAY, PLAY, LAUGH, DANCE, ENJOY, LOVE
  • Be aware of potential dangers of EMF, WiFi, hand held devices, blue tooth headphones.
  • Address environmental justice
  • Address social inequality, food insecurity
  • Tobacco addiction
  • Ethanol
  • Other substance abuse
  • Agricultural subsidies in US distort the food supply
  • Loss of soil threatens food supply
  • Suppression of science (global warming, environment, etc.,) worsens environmental degradation, creating an EXISTENTIAL THREAT.
  1. Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
  2. Get plenty of sleep (without adequate sleep your immune system does not work well )
  3. Follow good sleep habits
  4. Exercise, especially out of doors in a green space, supports the immune system
  5. Get some sunshine and make sure you have adequate Vitamin D levels.
  6. Eat an anti-inflammatory diet rich in micronutrients.
  7. Practice stress reduction like meditation and yoga which improves the immune system
  8. Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
  9. Clean up your home environment and minimize your family’s exposure to environmental toxins by following recommendations at EWG.org with regards to household products, personal care products, and organic foods. (https://www.ewg.org/)

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob

USDA Dietary Guidelines Flawed

The NUTRITION COALITION is a non-profit organization dedicated to bringing science to dietary recommendations in the US. The COALITION recently called upon the USDA to hold off on publishing it’s updated Dietary Guidelines for US Citizens because of reported improprieties in the process of scientific review.

https://www.nutritioncoalition.us/news/usda-members-blow-whistle-flaws-in-process

The guidelines since their inception have been biased and flawed, ignoring much of the dissenting scientific opinion in testimony before the committee and cherry picking studies without a balanced approach to the scientific literature.

The confluence of the Covid-19 pandemic with the epidemics of obesity and diabetes in the US have created a perfect public health storm, as discussed in my last post. The USDA Dietary Guidelines Committee chose to ignore more than 50 studies that confirm the benefits of a Very Low Carbohydrate nutritional approach to address obesity and diabetes.

Because of the importance of the guidelines influencing US dietary choices in the context of COVID-19 I have copied the informative letter from the NUTRITION COALITION below. There is a link in the letter that will allow you to send emails to your senators, congressman, and the Secretary of Agriculture, supporting the recommendations of the NUTRITION COALITION.

Here is the letter.

Dear Friends and Colleagues, 

In a remarkable development, one or more member(s) of the Dietary Guidelines Advisory Committee recently came forth and blew the whistle, identifying serious flaws in the Dietary Guidelines process. I write to you today to ask that you contribute your voice to our effort to have these allegations taken seriously by the U.S. Departments of Agriculture and Health and Human Services (USDA-HHS). We are specifically asking these federal agencies to delay the Committee’s report, which is due out in just a matter of weeks, until the allegations can be investigated and addressed.  

The Dietary Guidelines are considered the “gold standard” of science and are a powerful lever on government feeding programs, military rations, professional medical associations, and much more—including nutrition guidelines around the world. It is imperative that they be based on good science.  

However, the current 2020 process is clearly flawed. We know, for instance, that almost all studies on weight loss have been excluded from consideration. We also know that virtually all studies on carbohydrate restriction have been excluded. Some USDA reviews of the science include the science only up to 2016, despite a Congressional mandate that the Dietary Guidelines include a comprehensive review of the science “that is current at the time.” It’s clear that the expert committee, in addition to excluding crucial science, has not been given enough time to do its work and has, essentially, had to cut corners.  

Moreover, the Advisory Committee, in its draft conclusions, indicated that the cap on saturated fats is likely to stay firmly in place. The evidence linking saturated fats to heart disease was judged to be “strong,” not only for adults, but also, for the first time, children. Yet scientific justification for a continuation of these caps is lacking, and the Subcommittee presented weak evidence to make its case. The past decade has seen a thorough reconsideration of saturated fats, and now, there are close to 20 review papers reexamining the evidence—which have near-universally concluded that saturated fats have no effect on cardiovascular or total mortality.  

Delaying the report will give time for a thorough investigation into these allegations. 

By signing this letter, you are helping to push for Dietary Guidelines that are based on a comprehensive review of the science and are therefore more likely to help the public regain its health. Thank you for any contribution to this effort!  

Click here to sign a physicians’ letter of support. In addition, it would be extremely helpful if you could also take time here to contact your representatives in Congress and let them know the importance of getting the Guidelines right. As an expert in the field, your voice will be able to resonate more than most, I hope you will take some time to try to help generate change to our far-reaching nutrition policy. 

Thank you,  

Nina Teicholz 

Executive Director 

The Nutrition Coalition  

Read more about the allegations in our press release and letter to USDA-HHS. 

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob

COVID-19, Lifestyle interventions more effective than drugs.

So far drug intervention trials for treating COVID-19 have been disappointing. No studies have shown benefit for hydroxychloroquine, with or without azithromycin. This topic has been covered in previous posts. Remdesivir has been FDA approved based upon one study that showed reduction in duration of symptoms. The mortality rate with Remdesivir, however, did not demonstrate a statistically significant difference when compared to “usual care”. https://www.niaid.nih.gov/news-events/nih-clinical-trial-shows-remdesivir-accelerates-recovery-advanced-covid-19

Another study published in Lancet failed to show any clinical benefit from Remdesivir.

“No statistically significant benefits were observed for remdesivir treatment beyond those of standard of care treatment. Our trial did not attain the predetermined sample size because the outbreak of COVID-19 was brought under control in China. Future studies of remdesivir, including earlier treatment in patients with COVID-19 and higher-dose regimens or in combination with other antivirals or SARS-CoV-2 neutralising antibodies in those with severe COVID-19 are needed to better understand its potential effectiveness.”

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31022-9/fulltext

But we do know that certain underlying conditions such as obesity, diabetes, pre-diabetes (insulin resistance) and hypertension significantly increase risk of DEATH AND COMPLICATIONS with COVID-19. Since there are lifestyle interventions that can quickly and effectively mitigate these problems (diet, exercise, sleep, stress reduction….) now would seem like a good time to take our epidemics of obesity and diabetes in hand with aggressive lifestyle interventions to decrease the mortality rate of COVID-19 infection. Such measures do not require expensive drugs or expensive drug trials, they simply require knowledge, guidelines and the will to implement change in our daily habits. Yet there has been little discussion about this in the media or on the part of public health officials.

Lets look at obesity in the US.

From 1999–2000 through 2017–2018, the age-adjusted prevalence of obesity increased from

30.5% to 42.4%, and the prevalence of severe obesity increased from 4.7% to 9.2%.

The most effective tool for addressing obesity and diabetes is a very low carbohydrate diet.

Effects of the Low Carbohydrate, High Fat Diet on Glycemic Control and Body Weight in Patients With Type 2 Diabetes: Experience From a Community-Based Cohort

https://pubmed.ncbi.nlm.nih.gov/32193200/

This study was a done in a community-based program, not an academic practice setting. That is significant since it demonstrates feasibility outside of academic centers with standard community resources. The results of this study confirmed the results of many previous studies done in academic settings including better blood sugar control, reduction or elimination of diabetic medications, and significant weight loss.

All patients following the LCHF diet who initially took
insulin had either a reduction or discontinuation of
this therapy by their healthcare provider when clinically
indicated, compared with less than a quarter of
those receiving usual care.

In another study done in Italy, significant weight reduction (7 kg), waistline reduction (7 cm.), fat mass reduction (3.8%) and systolic blood pressure reduction (10.5 mmHg) were achieved in 3 months with a Very Low Carbohydrate diet.

Middle and Long-Term Impact of a Very Low-Carbohydrate Ketogenic Diet on Cardiometabolic Factors: A Multi-Center, Cross-Sectional, Clinical Study (https://pubmed.ncbi.nlm.nih.gov/25986079/

Nina Teicholz had an opinion piece published in the Wall Street Journal on May 30, discussing the USDA dietary guidelines that have largely ignored a massive body of evidence supporting a Very Low Carbohydrate Diet for obesity and diabetes. She cites many studies that have been ignored by the USDA dietary guidelines committee. Here is here opening statement.

“Americans with obesity, diabetes, heart disease and other diet-related diseases are about three times more likely to suffer worsened outcomes from Covid-19, including death. Had we flattened the still-rising curves of these conditions, it’s quite possible that our fight against the virus would today look very different.”

You can read the full article here:

https://www.wsj.com/articles/a-low-carb-strategy-for-fighting-the-pandemics-toll-11590811260

But think about that simple statement, THREE TIMES MORE LIKELY TO SUFFER WORSENED OUTCOMES FROM COVID-19. Yet these conditions are highly responsive to lifestyle interventions that not only mitigate obesity, insulin resistance and high blood pressure, but also enhance immune function.

More from Teicholz’s opinion piece:

Other studies have found that dietary changes can rapidly and substantially improve cardiovascular risk factors, including conditions like hypertension that are major risk factors for worsened Covid-19 outcomes. A 2011 study in the journal Obesity on 300 clinic patients eating a very low-carbohydrate diet saw blood pressure quickly drop and remain low for years. And a 2014 trial on 148 subjects, funded by the National Institutes of Health, found a low-carb diet to be “more effective for weight loss and cardiovascular risk factor reduction” than a low-fat control diet at the end of the 1-year experiment.

In a recent letter to the editor published in the journal METABOLISM, Dr. Casey Means points out:

A diagnosis of diabetes has been a key indicator of the severity of
COVID-19, and in this regard, the virus has relentlessly highlighted our
global Achilles heel of metabolic dysfunction, and points to a prime opportunity
to fight back.
That fight, however, is not going to be won with Clorox, Purell,
masks, or anti-IL-6 drugs. The fight will only be won through a serious
commitment to improving everyone’s foundational metabolic health,
starting with the lowest hanging evidence-based fruit: dietary and lifestyle
interventions.

Read the full letter here: https://www.metabolismjournal.com/article/S0026-0495(20)30118-9/pdf

In 2 pages the letter describes multiple benefits of better glucose control relative to COVID -19 infection and the immune system as well as reduction of factors that lead to cytokine storm (terminal event for many COVID-19 patients). The letter also discusses the benefit of reducing environmental toxins (discussed in previous posts about COVID-19 and other health problems) that would likely benefit COVID-19 patients.

Research published April 18th, 2020 found that patients exposed to
highest amount of environmental nitrogen dioxide (NO2) had increased
risk of death fromCOVID-19, and that long-term exposure to this pollutant
may be one of the most important contributors to fatality by
compounding lung inflammation [20].

Minimizing exposure to environmental
pollutants may serve a role in quelling the underlying pro-inflammatory
state that characterizes metabolic disease and COVID-19 associated
cytokine storms
.

Other environmental toxins, including persistent organic pollutants
(POPs) found in air, water, and food generated from pesticides
and industrial chemicals, are also strongly implicated in the pathogenesis
of metabolic syndrome; promoting “clean living,” toxin-avoidant
strategies for patients as simple as emphasizing organic foods, home
air purification, and non-toxic home supplies could be considered, although
the clinical utility of these measures in the acute setting is unknown
[21].

In discussing the white elephant in the room he states:

What is starkly missing is the clear, simple, and strong recommendation for no added
sugar or ultra-refined carbohydrates, both of which are known drivers
of postprandial hyperglycemia and inflammation. As a medical community, we must not miss the opportunity to serve patients with straightforward, evidence-based nutritional and lifestyle strategies to assist in glycemic control.

I would encourage you to follow the link and read the 2 pages supported by multiple peer-reviewed references.

Evidence based nutritional and lifestyle strategies, so often discussed on this website include:

  1. Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
  2. Get plenty of sleep (without adequate sleep your immune system does not work well )
  3. Follow good sleep habits
  4. Exercise, especially out of doors in a green space, supports the immune system
  5. Get some sunshine and make sure you have adequate Vitamin D levels.
  6. Eat an anti-inflammatory diet rich in micronutrients.
  7. Practice stress reduction like meditation and yoga which improves the immune system
  8. Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.
  9. Clean up your home environment and minimize your family’s exposure to environmental toxins by following recommendations at EWG.org with regards to household products, personal care products, and organic foods. (https://www.ewg.org/)

If you have obesity, diabetes or pre-diabetes the Very Low Carbohydrate version of the anti-inflammatory diet linked above would be the fastest and most effective intervention you can immediately employ to reduce your risk of succumbing to COVID-19. (Of course wear a mask, follow good hygiene with hand-washing frequently, and practice social distancing)

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob

COVID-19: Hydroxychloroquine and Chloroquine, BAD NEWS.

The most comprehensive study on the use of these 2 drugs, including 96,032 patients in multiple hospitals and multiple countries shows increased risk of death with either of these two drugs in patients hospitalized with COVID-19. This was a retrospective study but offers the most amount of data to date on the issue of clinical efficacy and risk. You can read the full article https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)31180-6/fulltext.

TreatmentDeath rateventricular arrhythmia
No drug9.30%0.30%
Hydroxychloroquine18%6.10%
Hydroxychloroquine plus Macrolide23.80%8.10%
Chloroquine16.40%4.30%
Chloroquine plus Macrolide22.20%6.50%
Macrolide is an antibiotic like Zithromax.
Differences between no drug and all drug treatment categories statistically significant.

This was not a randomized prospective controlled clinical trial. However the data were adjusted for:

age, sex, race or ethnicity, body-mass index, underlying cardiovascular disease and its risk factors, diabetes, underlying lung disease, smoking, immunosuppressed condition, and baseline disease severity.

So far it is the best information we have available.

There have been many physicians who have supported the use of these drugs without randomized controlled trials based on anecdotal reports in the medical literature. Given the desparate situation without a known effective drug that is understandable.

The authors note:

The absence of an effective treatment against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has led clinicians to redirect drugs that are known to be effective for other medical conditions to the treatment of COVID-19. Key among these repurposed therapeutic agents are the antimalarial drug chloroquine and its analogue hydroxychloroquine, which is used for the treatment of autoimmune diseases, such as systemic lupus erythematosus and rheumatoid arthritis.

However, the use of this class of drugs for COVID-19 is based on a small number of anecdotal experiences that have shown variable responses in uncontrolled observational analyses, and small, open-label, randomised trials that have largely been inconclusive.

 The combination of hydroxychloroquine with a second-generation macrolide, such as azithromycin (or clarithromycin), has also been advocated, despite limited evidence for its effectiveness.

This study is an important milestone, disappointing but illustrative of a common phenomenon in medicine.

Previous warnings about potential lethal heart rhythm issues were viewed with skepticism by armchair pundits claiming that there was not much data on sudden death related to use of these widely used drugs. Those pundits failed to understand that sudden death caused by prolonged QT interval (effect of these and many other drugs) cannot be diagnosed without an EKG during the event. When this occurs outside the hospital setting, or even in the hospital without a continuous EKG monitor on the patient, it goes unrecognized.

An important dictum in medicine is “first do no harm” (primum non nocere).

In the meantime, we do know what reduces risk:

Test/Trace/Isolate, social distance, MASKS4ALL, wash hands frequently, disinfect surfaces, show consideration for others. To understand why and how these measures can make a big difference you can go to this website. https://www.erinbromage.com/

In addition you can read a great article about the same topic here. https://www.newyorker.com/science/medical-dispatch/amid-the-coronavirus-crisis-a-regimen-for-reentry

I will close with the sermon on lifestyle and COVID-19.

  1. Avoid alcohol consumption (alcohol wreaks havoc with your immunity)
  2. Get plenty of sleep (without adequate sleep your immune system does not work well )
  3. You must follow good sleep habits
  4. Exercise, especially out of doors in a green space, supports the immune system
  5. Get some sunshine and make sure you have adequate Vitamin D levels.
  6. Eat an anti-inflammatory diet rich in micronutrients.
  7. Practice stress reduction like meditation and yoga which improves the immune system
  8. Eliminate sugar-added foods and beverages from your diet. These increase inflammation, cause metabolic dysfunction, and suppress immunity.

THIS WEBSITE PROVIDES INFORMATION FOR EDUCATIONAL PURPOSES ONLY. CONSULT YOUR HEALTH CARE PROVIDER FOR MEDICAL ADVICE.

Eat clean, drink filtered water, love, laugh, exercise outdoors in a greenspace, get some morning sunlight, block the blue light before bed, engage in meaningful work, find a sense of purpose, spend time with those you love, AND sleep well tonight.

Doctor Bob

Study shows only 12% of US adults are metabolically healthy!

What does this mean? The authors of this study looked at several important markers of health: waist circumference, fasting blood sugar, hemoglobin A1c, blood pressure, triglycerides, HDL, and whether someone was taking any medication related to these markers. They used data from the National Health and Nutrition Examination Survey 2009-2016. Only 12.3% of US adults qualified as healthy on all measures. So how did we get into this horrible situation?

Let’s step back and look at modifiable factors that play into these health measures.

  • Adequate restorative sleep
  • Stress
  • Nutrition
  • Exercise
  • Sunlight (Vitamin D)
  • Social connection
  • Environmental toxins
  • Rest

I have discussed the importance of sleep in several posts. Following this link you will find recommendations for good sleep habits that can enhance the quality and duration of your sleep.

If you have not watched Dan Pardi’s discussion of “HOW TO OPTIMIZE LIGHT FOR HEALTH” I recommend you watch this.

STRESS

Stress reduction is a huge topic. Managing stress involves so many areas it deserves a separate discussion. But here are some basics. Getting adequate sleep is the place to start. Activities like Meditation, Yoga, moderate exercise (walking outdoors in a green space) Tai Chi, music, practicing Mindfulness, and spending time with family and friends are all potential avenues to reduce the deletrious effects of stress in our lives.

NUTRITION

I have presented one approach to an anti-inflammatory diet  and if you have not read through the details just follow the link. The low hanging fruit begins with elimination of processed foods, sweetened beverages, and pro-inflammatory “vegetable oils” (OILS made from corn, soy, cottonseed, safflower, sunflower, canola, margarine). EAT WHOLE FOODS.

TO LEARN ABOUT THE ILL-EFFECTS OF “VEGETABLE OILS” LISTEN TO NINA:

EXERCISE

My post about exercise as medicine can be found here. 

The best way to exercise is to play as described by my friend Daryl Edwards in his TED talk.

 

Most Americans do not get enough, but some get too much. Moderation is important.

SUNLIGHT

Getting outdoor light exposure early in the day and avoiding the deleterious effects of artificial light in the evening (wear blue light blocking glasses in the evening) are two important ways to get the most benefit from light exposure, improve your sleep and enhance your Vitamin D level. Exercise outdoors in a green space provides more benefit than walking the treadmill indoors.

SOCIAL CONNECTION

Blue Zones are areas in the world that have the greatest numbers of individuals living to age 100. The climates and food varies among the various areas. They  all have two things in common. First is a high degree of social connection, strong family ties, lifelong friends. Social connection within a supportive community is arguably one of the most important factors affecting health, longevity, and healthspan. Second, they eat REAL WHOLE FOOD.

blue zones longevity hotspots.jpg

 

ENVIORNMENTAL TOXINS

Part of eliminating environmental toxins includes consuming organic fruits and vegetables and eating meat, poultry and eggs from hormone-free, antibiotic-free, free- range/pastured sources. (ALL PART OF AN ANCESTRAL/PALEO DIET) If you are not familiar with the “dirty dozen” and the “clean 15” head on over to EWG.org where you will learn not only about what foods have the most/least residual pesticides, but also what personal care products and household cleaners are safe for you and your family.

WATER: Because humans have spent the last 4-5 decades polluting our air and water there is probably no water supply that is totally free of enviornmental toxins. To minimize your consumption of enviornmental toxins, filter your drinking water through a high quality system.

REST

Matthew Redlund MD has written a great book “THE POWER OF REST”. Here he discusses why sleep is not enough.

The fact that only 12% of American adults are metabolically healthy should be cause for great alarm. All chronic and degenerative  diseases including dementia, heart disease, stroke, arthritis and cancer rise as metabolic health deteriorates.

Remember, this website offers educational information only. Consult your health care provider for medical advice.

Sleep well, exercise outdoors, laugh, love, engage in meaningful work, drink filtered water, eat clean, eat whole foods, get plenty of sunshine, spend time with those you love.

Doctor Bob

 

Ketogenic Diet, Keto-Medicine

I have spent a few days watching lectures from various low-carb-healthy-fat meetings. There is an impressive amount of solid clinical data to support Very Low Carb (with healthy fat)  diets to treat obesity, insulin resistance, diabetes, pre-diabetes, metabolic syndrome, and seizure disorders. Eric Westman MD, author, Associate Professor of Medicine, Past Chairman of the Obesity Medicine Association,  and director of Duke University Lifestyle Medical Clinic gave an impassioned and authoritative talk on the success of LCHF in treating all of these disorders here.

 

Dr. Steven Phinney,  Professor Emeritus UC Davis and presently Chief Medical Officer for VIRTA has given numerous talks on the beneficial effects of a ketogenic diet. He and Jeff Volek Ph.D. have done research for decades on the physiology of low carbohydrate diets. They elucidated the changes that occur in high level athletes as they adapt to burning fat as their major fuel source during and after a period of “fat adaptation”. It turns out that endurance athletes, after a period of 1 to 3 months of adaptation to a low carb-high fat diet (variable from person to person) perform at equal or higher levels as compared to their performance when previously on a high carbohydrate diet. In fact, because lean athletes have much greater energy stored in fat as compared to glycogen (carbohydrate) they can go for many hours longer than an athlete who is dependent on carbohydrate metabolism (not fat adapted). Glycogen is the starch source of energy that humans store in the liver (100 grams) and in muscle (400 grams). Compared to glycogen, fat stores in lean individuals, including buff athletes,  can provide more than 10 times the amount of energy. Endurance athletes who are keto-adapted (fat burners) can ride a bike all day or run an ultra-marathon (100 miles) without taking in any energy source. (They must of course replace fluid and electrolytes). Whereas athletes who have followed a traditional high carb diet must start consuming calories after about 3 hours of moderate-high intensity exercise. Doctors Phinney and Volek have done clinical research on humans with obesity, pre-diabetes and diabetes and they have demonstrated superior results when compared to any other dietary approach.

You can learn about their work here:

And here:

So what is this all about? If carbohydrates are restricted to very low levels and instead we consume (healthy) fat as our major source of energy with moderate amounts of protein, then the human body starts to burn fat. This process results in the production of ketones (in the liver) which serve not only as a source of energy but also act as “signaling” molecules that turn on beneficial genes that fight inflammation and turn off genes that produce inflammation. When a well formulated ketogenic diet is followed under medical supervision, diabetics can often get off most or all of their diabetes medications within weeks to months as they lose weight. Improvements are seen quickly in blood pressure, fasting blood sugar, liver function tests, insulin sensitivity, inflammatory markers, subjective energy levels, mental clarity and mood. Triglycerides are reduced, HDL increases, and improvements are seen in the “atherogenic profile” with reductions in small dense LDL particles with a shift to large buoyant LDL particles. On a ketogenic diet humans spontaneously consume lower caloric intake because fat and protein are more satiating compared to carbohydrate. Circulating saturated fat in the blood DECREASES on a keto-genic diet. Refined carbohydrates and sugar (so prevalent in processed foods) produce increased circulating fat in the blood and increased fat storage throughout the body, often leading to fatty liver disease and the long list of chronic diseases caused by and associated with insulin resistance.

A ketogenic diet is also part of Dr. Dale Bredesen’s effective treatment program for early dementia (ReCoDe-Reversal of Cognitive Decline). I have discussed Dr. Bredesen’s approach before. Here is one of his discussions.

You can read Dr. Bredesen’s report of 100 patients who have reversed cognitive decline using a ketogenic diet as PART of the ReCoDe program here.

So what are the healthy fats in a low carb high fat diet?

They include fats found in whole foods such as nuts and avocados, pasture raised animals free of hormones and antibiotics, free range poultry and eggs, wild fish and seafood (avoiding large fish that have high mercury levels), extra virgin olive oil, avocado oil, butter from pastured grass-fed animals, and coconut oil. (yes butter is included despite that fact that strict paleo excludes dairy)

You should avoid all of the processed/refined oils that come from seeds, grains and legumes including soy oil, corn oil, cottonseed oil, canola oil, safflower oil, sunflower oil, sesame oil. You can learn why these (misnamed) “vegetable oils” are dangerous and how they were marketed to an unwitting public with the help and support of faulty science by listening to Nina Teicholz here:

There are many great lectures about the low-carb-high-fat ketogenic diet in addressing obesity, insulin resistance, pre-diabetes, metabolic syndrome, diabetes, seizures and more. Go to youtube and search “keto diet”, “low carb high fat”.

Before I sign off I will provide one more link:

Remember, this website offers educational information only. Consult your health care provider for medical advice.

Sleep well, exercise outdoors, laugh, love, engage in meaningful work, drink filtered water, eat clean, eat whole foods, get plenty of sunshine, spend time with those you love.

Doctor Bob

 

 

Can LED light bulbs, computer screens and TV make your pain worse?

The answer is probably yes.

The mechanism(s) go like this:

Exposure to full spectrum light in the evening > reduces quantity and quality of restorative sleep which in turn > increases chronic inflammation and contributes to depression both of which make pain worse.

Exposure to full spectrum light in the evening also > reduces nitric oxide production > which increases blood pressure and risk of cardiovascular disease and metabolic disorders.

In animal studies interruption of circadian rhythm with artificial light exposure when the animal would typically be sleeping decreases memory capacity.

And fat tissue has specific receptors for light which alters fat storage. Increased visceral fat produces more inflammatory cytokines and chemokines which sensitize pain fibers and increase inflammation throughout the body.

Exposure to artificial light in the evening even worsens the grades of children in school.

Adequate restorative sleep is so important that I prescribe all patients with chronic pain 2 pages of  sleep hygiene recommendations.

To optimize your circadian rhythm get some early morning light exposure (without sunglasses) before 12 noon and at sundown reduce your ambient light exposure to mimic the natural light outdoors. Sleep in absolute darkness and wear blue light blocking glasses in the evening.

You can learn more about this topic by listening to a 12 minute TEDtalk by Dan Pardi who does research in the Circadian LAB at Stanford.

Hat tip to Tommy Wood for bringing this TEDtalk to my attention.

Sleep well.

Doctor Bob.

Western Diet (high sugar, refined carbs, unhealthy fats) alters genes and causes inflammation

New study (in mice) shows fast food makes the immune system more aggressive in a detrimental way.

Major points:

  1. The immune system reacts similarly to a high sugar, high (unhealthy) fat and high calorie diet as to a bacterial infection.
  2. Unhealthy food seems to make the body’s defenses (innate immune system) more aggressive in the long term. Even long after switching to a healthy diet, inflammation towards innate immune stimulation is more pronounced.
  3. These changes may be involved in the development of arteriosclerosis and diabetes.
  4. These changes are due to alterations in gene transcription (up-regulation of genes associated with inflammation)
  5. This up regulation of pro-inflammatory genes persists even after converting to a healthier diet.

Read more at News from IRT

Here: Fast food makes the immune system more aggressive in the long term: Study shows that even after a change to a healthy diet, the body’s defenses remain hyperactive — ScienceDaily

And here Western Diet Triggers NLRP3-Dependent Innate Immune Reprogramming: Cell

This study is an example of epigenetics, where an environmental factor (diet) alters the expression of genes. We know that regular consumption of a variety of colorful vegetables mediates many beneficial effects and part of that process involves altering the transcription of many genes related to health and our ability to defend against Oxidative Stress .

The epigenetic effect of nutrition can be transmitted to the next generation.

The epigenetic effects of diet include many aspects of health including  cancer risk.

And epigenetic changes in humans can begin  before birth in response to maternal nutrition and maternal exposure to environmental toxins .

Diet also effects the gut microbiome, which in turn affects health .

So avoid fast food and other forms of processed-refined foods. Eat a whole foods-ancestral diet that includes a variety of organic colorful vegetables and fruits, grass fed/finished meats and wild seafood. This will not only provide important micro and macro nutrients but will also turn up and turn on genes that prevent disease.

Live clean, sleep well, laugh and love.

Doctor Bob

Anti-inflammatory diet, are 9 servings of vegetables per day possible?

I often recommend a specific diet to decrease inflammation, decrease pain, and improve healing of tissue. I have been asked by patients to post this nutritional plan on my website so here it is (see below). In addition to this post, I will place the diet on a separate page along with recipes for vegetable soup and bone broth.

The recipes (vegetable soup and bone broth) meet the anti-inflammatory diet guidelines and also follow the more restrictive “Autoimmune Protocol”. This nutritional approach provides an array of micro nutrients that fight inflammation, support tissue repair, decrease the risk of chronic disease, and help maintain  a healthy gut flora (good bacteria in the intestines).

When I recommend 9 servings per day of vegetables patients often tell me it is impossible to achieve.  But it is not impossible, nor is it impractical. Every Sunday afternoon I make a large pot of vegetable soup that will keep all week in the refrigerator. I bring  generous servings to work every day for breakfast, brunch, and/or lunch and add some meat or seafood prepared the evening before (left-overs) on the side. The key to eating 9 servings per day is to have a variety of vegetables at every meal. The vegetable soup makes that goal not just achievable but convenient.

The anti-inflammatory diet described below provides ample fiber to feed your healthy gut bacteria and avoids the sugar and refined starches that can produce gut dysbiosis (unhealthy balance of bacteria in the intestines). Vegetables provide five times the amount of fiber per calorie compared to grains. You do not need to eat bread or cereal to get fiber.

So here is the anti-inflammatory diet. it is consistent with the Mediterranean diet as well as an Ancestral-Paleo diet.

Caution: if you have diabetes and are taking medications, this diet reduces carbohydrates and eliminates added sugar so adjustments in diabetes medications are necessary to avoid potentially dangerous low blood sugars. So consult your physician or primary care practitioner.

9 SERVINGS  OF NON-STARCHY VEGETABLES PER DAY, 3 SERVINGS FROM EACH OF THREE CATEGORIES. Organic as much as possible. (Read about the Dirty Dozen here: Dirty Dozen | EWG’s 2017 Shopper’s Guide to Pesticides in Produce )

  1. DARK GREEN LEAFY VEGETABLES, 3 SERVINGS PER DAY EQUALS 3 CUPS MEASURED COOKED OR 6 CUPS MEASURED RAW
  • Arugula, Beet Greens, Bok Choy, Chard all colors, Chicory, Cilantro
  •  Dandelion Greens, Endive, Escarole, Kale-all kinds, Parsley, Radicchio
  • Radish leaves, Spinach, Turnip Greens, Watercress
  1. Colored vegetables, 3 cups daily:
  • GREEN: Artichoke, Asparagus, Avocado (FRUIT), Cabbage (red and green) Celery, Cucumber with skin, Okra, Olives, Peppers, Zucchini with skin
  • RED: Beets, red cabbage, red peppers, cooked tomatoes (fruit)
  • YELLOW: Carrots, Pumpkin, Squash-summer and winter, Sweet potato,
  1. SULFUR RICH VEGETABLES, 3 CUPS DAILY: Some leafy greens are also sulfur rich so there is overlap in these categories
  • Arugula, Asparagus, Bok Choy, Broccoli, Brussel sprouts, Cabbage, Cauliflower, Collard Greens, Garlic, Kale, Kohlrabi, Leeks, Mushrooms, Onions red-yellow-white, Radishes, Scallions, Shallots, Turnip Greens, Watercress.

Berries (any kind) ½ cup per day. This can be substituted for one serving of vegetables.

OMEGA-3 rich fish-seafood (at least 16 ounces per week)

  • Anchovies, clams, herring, mackerel, mussels, oysters, salmon, sardines, trout, calamari (squid), saltwater fish should be wild, shellfish farmed OK, farmed trout OK.

Meat ideally grass fed and grass finished, hormone and antibiotic free.

Poultry and eggs free range, any wild game meat or poultry.

Drink only filtered water, coffee, tea, bone broth (homemade is best) and kombucha.

No grains, cereal, bread, pasta, no food made from flour, no oats, wheat, barley, corn etc.

No legumes (beans), no peanuts

No dairy except Ghee for cooking (optional)

No processed food made with added sugar or hydrogenated oils (which contain trans-fats)

No “vegetable oils” (soy oil, corn oil, etc.)

Use only extra-virgin olive oil, coconut oil, avocado oil and ghee. Limit EVOO to low heat cooking or add after food is cooked. The other oils on this list have higher smoke points.

Do not use store-bought salad dressing which usually has added sugar and inflammatory vegetable oils. Make your own salad dressing with EVOO and vinegar or lemon juice.

For more information about the AIP (Autoimmune protocol)  I suggest you visit these websites:

Autoimmune gut-repair diet – Autoimmune protocol | Dr. K. News

The Autoimmune Protocol – The Paleo Mom

The Autoimmune protocol is more restrictive than the anti-inflammatory diet and is beneficial for individuals with autoimmune disease.

Live clean, sleep well, exercise outside in the sunshine, love and laugh.

Dr. Bob