Tuesday, July 22, 2008

More “Low Carb” Misunderstandings

Recently, the New England of Medicine published an article showing that “low carb” diets help people lose more weight than both the Mediterranean and the “low fat” diets. Sure enough, before the ink dried on this study we started seeing the general public react in predictable ways, like wolfing down sausages, red meat, and all kinds of high fat and animal based foods.

While more studies are welcome in the “alternative” field of nutrition (yes, the National Institute of Health considers nutrition an alternative,) most studies are done by researchers who view this burgeoning field through their training-induced reductionist lenses. In other words, many studies seem oddly detached from significant variables, like economic, political and behavioral issues. They also tend to ignore the fact that weight is not the most important variable when we talk about nutrition. Often, these studies also neglect to consider that the kind of food we eat is one thing, while the way we process it in our intestines is another. Then, the new recognition that food itself influences the hormonal connections between our gut and the “thermostat” we have in our brain (hippothalamus) is often ignored. In other words, what kinds of food tend to mess up our thermostats and thus perpetuate our deranged metabolisms is not accounted for in these studies.

Last of all, the issue of addiction, yes addiction to certain foods is seldom addressed.

In my opinion, all these factors may be simply summarized in one short sentence: people become addicted to PROCESSED FOODS, such as refined carbs, which are laden with high fructose corn syrup, trans fats, preservatives, food colorings, artificial sweeteners and many other questionable molecules that alter our metabolism, or the way our thermostat works.

I know that many will disagree with this statement. No doubt they will drag out the worn-our refrain “calories in = calories out.” But, as stated above, many factors influence how we handle the calories we consume. Some will also argue that no one diet is OK for all of us. I agree with this statement, but with reservations. Some people do better as vegetarians, while others do best avoiding grains. But, on the whole, WE ALL NEED TO GET OFF PROCESSED FOOD.

This is the main issue with our nutritional problems. Focusing on slight differences, like “low carb” vs. “low fat” is like choking on a gnat and swallowing a camel. In my opinion, these studies are little more than “paying attention to the man behind the curtain.” Yes, Big Food stands to benefit by diverting attention away from their processed garbage with studies like this. In the meantime, Big Food continues to produce processed foods that have repeatedly been shown to be toxic and addictive. Since they are cheaper than natural foods, people tend to eat them, forced by a deteriorating economy. The “bottom line” is that our bottom line and Big Food’s get bigger….

Still, the proof of the pudding is in the eating: have these “low carb, low fat” studies, and the “calories in = calories out” studies born good results? Have we been getting any thinner? The answer is a resounding NO.

Here is what I feel the problem is, practically stated: we need carbs in the form of complex carbs, such as what we find in fruits, vegetables, legumes and whole grains. We need fats such as the ones contained in fish nuts, olives and several other vegetable-based fats. If we wish to eat animal fats, they would be best to come from lean, organic poultry. To continue to demonize all fats and all carbs is not only unscientific but harmful.

So, you wish to eat the right diet for you?

Start with the ABCs and lick your sugar addiction. Once you do that, focus on filling up with veggies, fruits and nuts. If you need more food, add the grains and legumes. If you wish to eat animal protein, reach for poultry and fish. After that, you could experiment with more “advanced” concepts. But, first things first.

The fields of Nutrigenomics and Nutrigenetics may help you determine whether you, like most people, may eat all types of GOD GIVEN FOODS (as opposed to processed foods.) Or, you may need to refrain from all animal meat (book “The China Study,”) or refrain from grains (book “The Paleo Diet.”) But, it is more practical to try both extremes for a while, rather than checking out your genetic information.

But, again, those two extremes are not the norm, but the exceptions. Besides, nobody does well eliminating whole groups of food.

And refined foods are not “food groups,” like Big Food would like you to believe.

Wednesday, July 16, 2008

More on Drugs to Treat Kids’s Cholesterol

I hope you read the blog I posted before this one. Were you upset? Well, the New York Times was (editorial, Sunday July 13th, 2008) and so were a lot of doctors across the country. Yes, about 13% of children have an elevated cholesterol. Yes, some of them have a genetic problem that cause the elevation. The docs who recommended these drugs for kids are saying they were misunderstood; they only intended to treat those 1/500 kids with said genetics issues. “I don’t see it as a major groundswell for the indiscriminate use of lipid-lowering drugs,” said one of the panel docs.

What do you think?

In my opinion, either the recommending docs are extremely naïve, or they are not old enough to remember (probably both) what happens in health care when a drug is first introduced “for only a few people.” For example, Listerine was introduced as a disinfectant in the Operating Room; now we all gargle it before a hot date. The purple pill for really bad ulcers was introduced when I was in Medical School to use only when everything else failed. Now, everyone takes it OTC for gastritis and reflux. I saw a commercial where they recommend it before you eat pizza…

The most glaring example is what happened to antidepressants. Only used for patients who were in really dire straights, now everyone gets it for any little “bump on the road” of life.
So, what is Big Pharma going to do with the marketing of these drugs recommended only for 1/500 kids? Is it hard to imagine that after a while, any kid having weight problems is going to be put on these drugs? What will the message be to these kids? They will soon learn, if they have not already, that any problem needs a pill. Oh, but they don’t like taking pills. Well, let’s put the drugs in their ice cream or in their jell-o…

Then there is the matter of nutrition: I still hear docs say that food will not correct a cholesterol problem. This is blatantly wrong (see blogs above.) Besides, the new field of “Nutrigenomics” (see cover issue of Discover Journal, November 2007) makes it very clear that diet may improve genetic profiles in any disease, including cholesterol problems. True, there will be a few patients, adult and children, where diet fails. In those patients, we would do well to check their thyroids, diabetic tendencies, levels of iodine, vitamin D, etc, etc, before prescribing a pill.

If so many adults are having side effects from these drugs, can you imagine what we are exposing our children to, for the rest of their lives? There is very little data on how these drugs will affect them long term. The studies we do have followed kids on these drugs for only two years. Also, we must remember that kids metabolize differently than adults. How do we know if they are going to have less/more side effects? Some docs feel these drugs may mess up kids’ hormones, especially those that regulate their development.

As I feared, the New York Times editorial reports that the American Academy of Pediatrics has received contributions from Big Pharma. Three of the docs on the recommending committee have been employed as consultants and as researchers for the drug companies that make cholesterol-lowering drugs: as always, “follow the money.”

Friday, July 11, 2008

Seeing REDDER Now That Kids are Involved

This morning, July 7th 2008, the American Pediatric Association lost my respect: they announced that in view of the obesity epidemic and pre-diabetes in our children, they now recommend that kids 8 years and older take statin drugs to lower their cholesterol.

Before we outline the problems with this recommendation, we must try to understand where they are coming from. No doubt, they care about children and wish to prevent the onset of heart disease, now widely documented to start at an early age. This is wonderful. Nobody disagrees with this worthy goal.

BUT, and that is a big but, starting drugs on children is likely to impress upon their minds that a medical problem is to be managed with a pill. Will it surprise anyone to see these children grow up to pop a pill for any health issue they encounter? This is great… for Big Pharma, who likely influenced the panel of docs at the American Pediatric Association who made the recommendation to use these drugs.

Sure, they did mention diet; but did you know that any doctor in private practice who emphasizes diet is said to be a quack? This attitude flies in the face of the American Heart Association’s recommendation that TLC, Therapeutic Lifestyle Changes like diet should be tried for 6 months, before drugs are used.

You may say that children have no chance to implement TLC measures when their own parents cannot give up their addiction to refined sugars and trans fats. Therein lies the problem. So, therein is the solution, that is, educating people so that they may open their eyes and wake up to the fact that Big Food and Big Pharma have a commercial interest in people remaining uneducated and unable to implement the simplest of nutritional interventions to save themselves, and their children from premature heart disease and diabetes.

Let us say that most people will fail to face their addiction to refined foods. OK, then, some kind of intervention is justified. In that case, why don’t we look at the evidence to see that cholesterol-lowering drugs have significant problems and questionable benefits? Instead, we could give children a much safer item, RED RICE, which was prominently featured in the American J. Cardiology this year (See blog “Seeing RED.”) The Mayo clinic just proved that RED RICE, fish oil and a good diet are the equivalent of Zocor 40 mg and without the side effects (J. Mayo Clinic Proceedings 2008;83:758.)

Now, why didn’t the American Academy of Pediatrics even consider RED RICE? Could it be that the industry making this item, which has been persecuted by Big Pharma, doesn’t have the resources to influence those who are making the recommendation to start statins on our kids? Did you know that Big Pharma has literally taken RED RICE makers to court, arguing that RED RICE is much like a drug, so much so that it should not be sold over the counter? Never mind that it is from RED RICE that Big Pharma got the first of the statin drugs. Talk about throwing grandpa out in the cold… and never mind that now statin makers want to approval to have their drugs sold over the counter.

But, there is another reason why we will not see RED RICE or TLC emphasized to our kids: any doc who tries to do so is labeled a quack. Because I have done this, there are some docs in my community who feel that I am just that, a quack. They have so judged me without ever meeting me, without discussing the evidence in our own journals, without visiting my website, and without even looking up the evidence that fills our medical journals, as you can see by studying my newsletter and blogs.

One such doc, Dr. W______, recently traumatized and verbally abused a patient we had in common by lecturing her that she should not see quacks like me. His attitude is not only immature but unethical, subject to legal repercussions and plain wrong and close-minded. My patient left his office in tears. She contacted me in agony, deeply hurt and wondering what she could do about this episode. I advised her to forget about it, since these types of docs and people like him will never change. Truly, we cannot put new wine in old bottles. Perhaps she will write to Dr. W., to make him aware of his faux-pas, perhaps not.

After all, patients are to be encouraged to find the health care they prefer, without recrimination from their docs. Interestingly, my patient happened to be a highly trained and educated health care worker herself, who, looking at the evidence, and the healthy results from nutritional therapies, has made the choice to postpone pharmaceutical solutions to her problems, unless TLC, nutrition and kindness fail.

So, I am seeing RED some more, because now children will be brainwashed when it comes to metabolic problems. I am seeing RED because of Drs like Dr. W. And I am seeing RED because the perverse economic incentives that drive this madness are not likely to go away in the near future.

Since seeing RED is not good for me, I am seriously considering retiring from this madness. After 25+ years of fighting ignorance, prejudice and close mindedness, I am tired, and somewhat hopeless that our society can turn this thing around. So, don’t be surprised if, just like my hero George Carlin, I just fade into the sunset one of these days…