Monday, December 30, 2013

How you REACT to stress is more important than how much.

Kelly McGonigal is a very smart PhD psychologist from Stanford. She wrote one of my faves, "The Willpower Instinct."  In this new video she talks about how our reaction to stress is more important than the stress--in fact, believing that stress is harmful is more harmful than the stress!  I will be watching this video over and over.

Take homes for me:
1.  Revision the stress response. The pounding heart? Energy, not anxiety.
2.  When feeling the stress response, reach out to your trusted community.
3.  Pursue meaning, NOT comfort.

Tuesday, December 24, 2013

Jimmy Moore blog post about "cognitive dissonance" in Low Carb

Jimmy Moore has lost over 100 pounds and improved his blood lipids. He has a blog, podcasts, hosts cruises, and generally carries the torch for Low Carbing. His latest is about how to respond to the people around you trying to convince you to eat, etc.

It is almost analogous to religion or politics. People (myself included) love to try to persuade others to our points of view. Sometimes we get a bit nasty, pushy, or obnoxious about it!  (Not me of course. I'm always completely reasonable.)

Think of the word Jimmy uses: counterintuitive. Why is Low Carb/High Fat counterintuitive? Only one reason: our intuition has been trained and programmed to think Fat=Bad. It's not intuition, it's programming.

One of my favorite books is The Screwtape Letters by C. S. Lewis (author of the Narnia books.)  In it he writes letters from a senior devil to a junior one, giving him human weaknesses to exploit in his "patient."  In letter 1 he (the Senior Devil) says, near the end:

"But the best of all is to let him read no science but to give him a grand general idea that he knows it all and that everything he happens to have picked up in casual talk and reading is "the results of modern investigation."

I read a lot of science. After all, I'm an MD-PhD pathologist!  Even I am guilty of the above. So are all of your family and friends. Be gentle with them all, as the old saying goes, everyone is fighting a great battle.

Saturday, December 14, 2013

Judge Not, lest ye be judged...

So says Jesus of Nazareth to the crowds in the Sermon on the Mount.  Judging other people must be a problem.  We hear the requirement to not judge anyone based on sex, religion, disability, etc. But whom DO we judge, without apology? 

The overweight. They're almost as bad as smokers. There are proposals to charge the obese more for health insurance. And why not? These lazy, will-power-challenged fat slobs are causing all of us to pay more for our insurance, right?

Why do we make the judgement that they are lazy and have no character strength? Have you ever questioned that assumption? If not, why not?

We have biases, that's why. 

First, we have been taught that obesity is a simple matter of too many calories in and not enough burned.  Humans are really very simple machines, like locomotives or something, and if you shovel more coal in and don't' burn it you get fat. Very few of us, in or out of medicine, every question this assumption.

Second, those of us who are not obese take the first assumption and make an even deeper assumption: "I am better than those FAT people.  I have the strength of character to not stuff my face like a sausage, and I exercise while they are too lazy to move their butts off the couch."  How do I know this? Because it was me, saying and thinking those things. And I was not alone; most doctors are built like me and are HIGHLY susceptible to the temptation to think that because we were disciplined enough to get into Medical School, that discipline MUST explain why I'm not overweight.

In high school and college, on the swim team, here was an average days' food:
Breakfast: Bacon and eggs, two coconut donuts, hash browns, milk and OJ.
Lunch: whatever hot lunch Saga health service at Colorado College served.
Dinner (after swimming 6K yards): two to three full dinners followed by a PB and J on whole wheat for dessert.  During swim season, I went from 145# to 138# eating everything that didn't actually run away from me. Meanwhile my younger brother was not swimming and was getting heavier.

Conclusion? Obvious. I am a superior person with willpower and self control. The Food Pyramid, Aerobics, and the McGovern report were all coming out. Low fat made sense to me!  Less calories.

Somewhere along the way, though, some disturbing things started happening.

I met some overweight people with drive, decisiveness, intelligence, and, yes, tremendous willpower in all ways except food.  But my ego overcame that in a moment; they were still weak when it came to food and exercise and if they would only be as virtuous as me all would be well.

But then I hurtled into my fifties. I did a couple of amazing hundred mile bike rides: the Stonewall Century and the Triple Bypass. These are outrageous rides with many thousands of feet of climbing, at altitude in Colorado. I biked many, many miles training for these and thought I was doing a good job eating. I know that the more weight you lose, the better your "power to weight ratio" is for hill climbing on your bike. Guess what? Weight was slowly coming on...155...160...165...170.

And then I went on Atkins. Biked less, ate a lot of fat, very low carbohydrate. 170...165...160...155...150. Bottomed out at 149.2. Not particularly hungry.

So what do I think is going on?  In short, we judge fat people to be weak and shut off our brains. We don't look any further (we in medicine, we elsewhere.)

But what if...

What if I was thin and athletic as a kid because my body responded a bit less to blood sugar? What if my body handled it a bit better due to some genetic accident? What if (gasp) it wasn't my superior character? What if it was that the islet cells in my pancreas dumped a bit less insulin in response to a coca cola?

And on the other side...

What if the obese just happen to dump more insulin, overshooting, in response to the same Coke? The insulin forces the blood sugar out of the blood stream into muscles, liver, and fat, and blood glucose falls. Their brains start to scream, "Famine!  I need sugar NOW!  The long Neanderthal ice age winter is coming and we need to store FAT to survive. No, slow down, don't move so much, you are burning the calories that you will need to get past February."

What if they feel more urgent hunger than I, and feel a deeply alarming reluctance coming from their bodies to exercise?  Remember what it was like to be REALLY hungry? What if our overweight friends and family feel that way all the time? How long do you think YOUR willpower would hold out? Hours, days, maybe even a few weeks?

I can tell you that the same bias that I mentioned above, that getting through All Those Years of Medical School, working hard, whispers to me that all I need to do is use my incredible willpower to muscle through.  And when it fails, as sooner or later it always does, it's easy to beat myself up as a loser and just try again.

If you are interested, there are a couple of terrific books on willpower. Willpower: Rediscovering the Greatest Human Strength and The Willpower Instinct both tell us that willpower is somewhat like a muscle: it can be strengthened some, but it ALSO just runs out if you rely on it too much. There is a finite daily supply of willpower. If your body is screaming "FAMINE!!!" sooner or later your willpower will fail and look out, chocolate bars.  I've been there.

In modern medicine we are always being told to be "outcomes based" and "evidence based."  We as a culture have decreased our fat and increased our carbs just like the nice folks in the government told us. (Governments don't have to be outcome based; have you noticed? They don't have to be evidence based. They just have to convince enough people to vote them back in.) The outcome has, basically, been a disaster. And yet we just keep slavishly thinking that if we just try harder, ban large drinks, cut fat and eat HealthyWholeGrains (notice how it's now one word) a miracle will happen and it will all start working. We won't be fat and ugly any more.

Judge not, folks. Instead, be like CSI and Follow the Evidence.

Wednesday, December 4, 2013

Who is Phat Phobic out there?

We've been programmed since the 70's that dietary fat will kill you. Since that time we've reduced our dietary fat and exploded in weight. Fat phobia is irrational. It is unscientific. There is no credible evidence to support it. Clear?  Use your mind, be strong and intelligent, and fight the phobia.

Low carbohydrate, high fat, moderate protein diets, meanwhile, keep getting examined and keep coming out on top. According to this review post, the score is low carb 18, others 0 for weight loss. (There is also a lot about fat in the diet.  The science says fat is NOT YOUR ENEMY.  Even Saturated Fat; a big meta-analysis says that saturated fat is not toxic. )

Dietary fat does NOT become fat in your coronary arteries. Another phobia.

In the doctor's lounge, one comment keeps coming up: "Well, yes, people lose weight on Atkins but nobody can sustain it."  The irony is, that in diet trials for the past twenty years nobody can sustain any diet. The fact that it's tough to sustain Atkins or other low carb diets just means it's hard for people to overcome habits, and especially habits built by professional marketers and neuroscientists who have been bombarding us with low fat, high carb, zero nutrition, processed foods for decades.

Oh, by the way, don't try to do a low carb, low fat diet!  Happens all the time. See above, Fat Phobia. There are only three calorie containing foods: protein, fat, and carbs. Excess protein has nowhere to go (our bodies cannot store it) so it gets turned into, you guessed it, carbs and nitrogen waste.  If you cut carbs, fat HAS to go up.   Just remember, so what?  Fat is good for you.

Building motivation is what we all need to think about, the motivation to persist, to endure,  to carry on. For me, low carb for over a year, it's my new grandsons (see the Squat post!

Tuesday, December 3, 2013

A perfect, natural squat.

My grandson, Isaac, hard at work. Note the minimal curve in the back and the knees do not extend beyond the toes.  He can sit this way and work the blocks for quite a while.  Grandpa can squat but not this gracefully!

Sunday, December 1, 2013

BroScience. What a great term.

Bro Science is science that isn't really science, but a Bro (i.e., big jock with muscles, someone famous, or just someone you trust) says something with great sincerity and belief. Heck, I've probably done my share of BroSciencing and my degrees give me credibility, whether I deserve it or not.

A couple more thoughts.  Some BroScience is really marketing science.  Some people hype scientific sounding stuff to sell their stuff. That's actually easier to deal with than the people who are true believers in something that is just wrong. They don't send any of the usual warning signals that trigger our BS detectors.

Here's some things I think may be BroScience.
Free weights are better than machines.
You can't lose fat and gain muscle at the same time.
Low carb diets cause your thyroid to crap out.
Carnivorous humans have up to 40 pounds of rotting meat in their colons.
Just about anything else about "colon health."
Vegetarian diets are healthier than omnivorous diets.
Dietary saturated fat is bad for you and will cause heart disease.
It is good for you to keep LDL levels below 100, and below 70 if you have heart disease. (these are based on something called "expert opinion", not on randomized trials.)

Something I keep reading about but just haven't seen any real science on (doesn't mean it doesn't exist, just that I haven't found or seen it yet.)
The whole deal about omega 6 unsaturated fatty acids being "inflammatory." Now I know that they get turned into inflammatory compounds in the body, BUT it's not necessarily true that eating more omega 6's automatically raises the levels of the inflammatory compounds. The body MIGHT just burn up the excess.  Again I just haven't seen it.
Actually "inflammatory" in general seems like a BroScience buzzword.

Years ago on a radio call-in show someone called with the claim that at autopsy John Wayne (must have been Paleo as manly as he was, right?) had 40 pounds of rotting meat in his colon.  A brief internet search revealed that the claim must have been bogus as he was not autopsied!  Also I can tell you after doing hundreds of autopsies myself that I've never seen this 40 pounds thing happen.  BroScience or Urban Legend, take your pick.  It is BS!

By the way, there are some words that tickle MY BS detector after doing that show for several years.
1.  "Toxins."  People blame "toxins" for all kinds of things. Toxins are real, but I think get blamed for a lot of lifestyle defects.
2.  "Parasites."  Listen. I have a PhD in Microbiology and I find parasites particularly fascinating. I've diagnosed a lot of them in my life. They are rare in the US. Rare. They sound icky and make great marketing material; who wants to be harboring a parasite? Unless you've been to the third world and been careless I can pretty much guarantee you don't have one!
3.  "Colon health."  Goes along with all kinds of awful treatments: enemas, purgatives, fiber supplements, etc. I don't know why the colon holds such fascination for people. I remember my mother telling me (we were watching TV) that "regularity" which seemed to be the goal of any healthy person simply meant having a bowel movement daily. Important? Not really.

Sunday, November 24, 2013

Made another great frittata today.

The one last week was a tiny bit dry so on PPW's suggestion (PaleoPathWife) we baked it for 15 minutes instead of 20. Also it has more vegies and...jalapenos!  Yeah baby. Here is the link with the basic recipe.

Wednesday, November 20, 2013

Low Carb for Native Peoples in Canada

Take a look at the post by Dr. Jay Wortman, a Canadian physician. Dr. Wortman tells the story of the First Nations peoples of Canada who have not responded well to the SAD (Standard American Diet.)  Guess what? They DO respond well to the traditional "eskimo" high fat, moderate protein, very low carbohydrate diet.

I've seen native peoples in Mexico and Nicaragua who have gotten very rotund, and on my mission trips see seventeen year olds with type II diabetes.  Diabetes is epidemic in south Asia as well. It is becoming a major cause of death, disease, and unhappiness world-wide.  The way we're working on diabetes is not working.

Something to think about. Drug companies, "Big Pharma", and Big Government

Before a drug company, part of "Big Pharma" (whatever that propaganda phrase means) can sell a new prescription drug, they have to do big clinical trials. This is expensive, overseen by the FDA, and they have to prove safety and efficacy. The process is imperfect but most new drugs are really pretty good.

What about Big Gov? They had big televised hearings and told us that we should cut fat from our diets, eat a lot more HealthyWholeGrains, cut back on cholesterol. We did so. America blimped.

Did they do a big clinical trial before making sweeping recommendations and regulations that affected the health of hundreds of millions of us?


They very likely have killed more people than any bad drug ever came close to. Did we vote McGovern and his other senators out for fattening up an entire generation?


The lawyers that advertise on cable TV go fishing all night for the few people who have bad reactions to medications. How come they aren't fishing for people who got diabetes, heart disease, obesity, bad knees from following untested government guidelines?

Tuesday, November 19, 2013

"eat like a predator, not like prey." Fun little article.

I heard J. Stanton interviewed on Jimmy Moore's LivinLaVidaLowCarb show. He seems like a smart guy and so I went to his website while waiting for specimens from a cancer case to show up. (Welcome to the strange and wonderful way I make a living as a pathologist!)

J. Stanton has a nice plan for "paleo" eating here.

I like his steps: Eat meat, not birdseed; eat food, not biodiesel fuel; consider some supplements (like vitamin D); play like a predator; optimize; and never stop hunting.

His writing style is pretty crisp and to the point. Just shows that an intelligent layman can learn how to read medical and scientific literature and draw good conclusions. Give a visit.

Monday, November 18, 2013

But what do you eat? My breakfast frittata

In the Doctor's Lounge sometimes we talk about different ways to eat. When I mention that I've been doing Low Carb for the last 15 months, one question that continues to come up is, "You can't have bread? I couldn't live without bread!"

In response, here is my breakfast this week:

Fry in one pan, several strips of bacon chopped; half an Andouille sausage, and about six ounces of fresh elk sausage.
In a large cast iron pan, put a couple of tablespoons of coconut oil and stir fry about 2 cups of chopped sweet yellow, red, and orange peppers, part of a chopped onion, then add a box of Shiitake mushrooms and a couple of handfuls of baby kale. Stir and fry until the kale is limp.

Dump the meat in the cast iron pan, then pour in a dozen eggs (yes, a dozen eggs) beaten. Stir it up and put in a 350 oven for 20 minutes to harden up.

Six slices of goodness. Beats the heck out of a bagel! Serve with some green tabasco sauce and plenty of salt.

Basically, I eat every day like most people eat when they are on vacation. I don't miss the bread at all actually.

But Doc, what about your cholesterol? Aren't you killing yourself?

Actually no. My HDL went from 50 to 77 in six months, and triglycerides from 90 to 38. My doc couldn't believe it; he had never seen such a change in HDL.

It's not the fat. It's not the fat. It's not the fat. It's the carbohydrates that are killing us. But more on that in another post.

High intensity weight training (HIT) for beginners

A bit over a year ago I re-instituted Low Carb a la Atkins. My belly weight had crept up, and as a doc I knew that was not good. My dad had had a mysterious heart "event" in the previous couple of years. My age keeps increasing and had reached upper fifties. And the final straw was the birth of two perfectly fabulous grandsons that summer. Time to make changes.

As part of my obsessive-compulsive trait (a good thing in a physician) I did a lot of surfing and found Mark's Daily Apple. In the forums, someone mentioned "high intensity training." Perhaps you've seen the BBC documentary on high intensity interval training? I had just restarted weight training and of course hurt my shoulder doing the stupid Steinborn Lift (hurt for months.) Then I found a Forum post on "Body by Science."

Could it really be true that half an hour, once a week, could give as good a result as the usual prescription of 3x/week, complex circuits, rapid movements? It turned out to be true. In the past six months my weights have basically doubled and I continue to gain strength.It feels great.

There are a couple of other resources I like. First is an article about the evidence for various types of weight training, which basically says that working muscles to momentary failure, once per week, gives as good gains as more frequent schedules of less intense exercise. A followup article which I can't find right now says that the HIT schedule also does a good job of training aerobic capacity.

What about machines vs free weights? Either is probably fine. At my age I'm liking the machines. Strength gains are just fine and I'm not hurting myself.

So, in brief, my workout is a "slow movement to failure" workout. For each exercise, the trainer sets the weight based on the previous session. I sit on the machine and start pushing the weight, slowly, out and back, out and back, usually to a count of about ten. It is KEY to never let the muscle relax--the important measures are the weight and the total time under load.

The first push is pretty straightforward, and usually the second one is as well. Third push starts to feel difficult. Fourth is when the lactic acid really builds up and it gets really tough. At this point I'm huffing and puffing! You do it slow in part so that you don't injure yourself by doing a momentary overstress of muscle or tendon.

My current goal is to reach 2 minutes under load, then he raises the weight for the next time. Abs, leg extension, isometric leg curl, lower back machine, leg press, lat pulldown, chest press, and horizontal row. 30 minutes once a week.

My trainer is at TruFit in Denver and they have been terrific. The Body by Science Website has a list of trainers around the country. So efficient, so safe, such good results! Highly recommended.

Tuesday, November 12, 2013

Welcome to the PaleoPathologist Blog

Welcome to the PaleoPathologist blog! Where does the name come from? Paleo means old, pathologist is, well, a doctor who does pathology! That would be me, an old pathologist? Well I am pushing 60. but as they say 60 is the new 40, unless you are hiking up a steep snowcovered mountain with your two sons in law, one a former Army Ranger, the other a high school baseball player turned marathon runner, in pursuit of the Mighty elk. Then 60 is the new, uh, 55? Another kind of paleopathologist is a scientist who studies the disease of ancient folks (no, not 60 year old ancient like me, more like 600 or 6,000 or 60,000 year olds.) That would definitely NOT be me. Another meaning of "paleo" comes from the "Paleo community" which is a movement trying to figure out how we are supposed to be eating and living based on evolutionary ideas. Other names are "primal", "Cave man", etc. The Paleo community generates a lot of interesting hypotheses and I'll link to some of the sites that I've found most interesting. There is an older, more scientifically solid community that also interests me, the low carbohydrate community (the best known is Dr. Atkins of the "diet revolution.") Modern players: Volek, Phinney, Westman, Taubes, and Attia come to mind. Follow along; I'll try to link to interesting stuff and also try to figure out how the blogger interface works! Doc Jim