tag:blogger.com,1999:blog-61782724143097180032024-03-13T10:34:23.605-07:00The PaleoPathologistA pathologist who has gone "low carb" and writes about the experience and the science. The PaleoPathologist has moved to his own site at PaleoPathologist.comAnonymoushttp://www.blogger.com/profile/05905834084963591163noreply@blogger.comBlogger20125tag:blogger.com,1999:blog-6178272414309718003.post-42483435605964877972014-02-07T18:29:00.001-08:002014-03-06T13:33:22.974-08:00PaleoPathologist is migrating to a new site!<a href="http://www.paleopathologist.com/">Come and see the new site</a>. The name is simple: <a href="http://paleopathologist.com/">PaleoPathologist.com</a>. <a href="http://www.paleopathologist.com/uncategorized/how-much-protein-is-right-high-protein-low-moderate/">Most recent post is on low, moderate, and high protein diets.</a> See you there!<br />
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It is my own domain now so I don't have to share my "cave" any more, but there is so much to learn about WordPress! Pretty cool though and PaleoPathTotter3 is helping me design the site. Anonymoushttp://www.blogger.com/profile/05905834084963591163noreply@blogger.com2tag:blogger.com,1999:blog-6178272414309718003.post-42180505931818047182014-01-27T20:25:00.001-08:002014-01-27T20:25:59.719-08:00Low carb, super low carb, ultra low carb, what does it all MEAN?Ordinary words can seem so clear. "Low carbohydrate" sounds precise, right? But it really isn't. No standard definition can be found for "low carbohydrate diets."<br />
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The "Standard American Diet" (or SAD for short; the irony should not be lost on us) has somewhere around 250-350 grams of carbohydrate <a href="http://healthyeating.sfgate.com/recommended-daily-carbohydrate-requirements-women-2027.html">according to USDA recommendations</a>, with the "bare minimum for women" being 130 gm. Remember that there are about 4 Kcal (kilocalories, also called a Calorie with capital C) per gram of carbohydrate, so that recommendation comes to 1000-1400 Calories per day from carbohydrates. From this article, 130 gm/day would be "low carb."<br />
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Take down your copy of <a href="http://www.amazon.com/New-Atkins-You-Ultimate-Shedding/dp/1439190275/ref=sr_1_3?ie=UTF8&qid=1390881864&sr=8-3&keywords=atkins">The New Atkins for a New You.</a> In the initial, induction phase, the authors recommend<a href="http://www.atkins.com/Program/Phase-1.aspx"> 20 grams/day</a> of carbohydrate. 20 grams is only 80 calories! Now that's low carb!<br />
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Other people say 50 gm/day, 75 gm/day, etc. All call their diets "low carbohydrate." <br />
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It's all a bit confusing. Let's look at a couple of physiologic facts to gain some perspective.<br />
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Our brains are real energy hogs. The three pounds of brain, 1-3% of our body weight, burns 400-600 Calories/day. If our brains really burned only glucose, as legend says (like the legend I learned at Mr. Duke's Medical School) then we would need 100-150 gm of glucose/carbohydrate per day just to stay alive. How on earth can we live on only 20 grams of carbohydrate per day, like I've been doing many days for a year and a half? (I'm going to cheat. The answer is, Ketone Bodies! Our brains love them. When your body learns to burn fat instead of carbohydrate, your brain burns ketones like beta hydroxybutyrate.)<br />
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Another fact for perspective. A high-normal blood sugar is 100 mg/dl (milligrams per deciliter.) That is 1000 mg, or 1 gm/ per liter of blood. Most of us walking around have about 5 liters of blood volume, and so our total circulating glucose at any point in time is about 5 grams. 5 grams. If that doubles, we have a toxic blood sugar of 200 mg/dl and are considred diabetic. And yet 5 grams of glucose is almost nothing at all. In fact i<a href="http://wiki.answers.com/Q/How_many_grams_are_in_a_teaspoon_of_sugar?#slide=2">t is just over two teaspoons </a>of table sugar (which is half glucose and half fructose.)<br />
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Another confusing concept is "net carbohydrates" or net carbs. When you look on a label, you'll see total carbohydrate and fiber. Fiber is just another name for a complex chain of simple sugars that our bodies don't have enzymes to break down. Many in the low carb world think you should count "net carbs" instead of total carbs. For example, a cup of broccoli contains about 4 "net carbs" plus 2 grams of "fiber" for a total carb count of 6 gm. <br />
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As you read about low carbohydrate diets, remember to ask the question about just how much carbohydrate is really in the diet? Also keep in mind your diet needs--if you are a 5'7 buff 59 year old 155 pound powerhouse of ripped muscle like me, you might need 2500 calories a day to stay huge while a little slip of someone with a totally sedentary job might only need 1600 Cal/day.<br />
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Maybe next time we'll take on an even more emotional topic: <i>What is a low fat, moderate fat, or high fat diet???</i>Anonymoushttp://www.blogger.com/profile/05905834084963591163noreply@blogger.com2tag:blogger.com,1999:blog-6178272414309718003.post-17023234119553326622014-01-25T08:56:00.003-08:002014-01-25T08:56:54.569-08:00What other than weight loss has eating low carb done for people?<a href="http://www.livinlowcarbdiscussion.com/showthread.php?tid=11327&highlight=reflux">Here is a post</a> from a forum I sometimes haunt. There is a surprising list of health and life improvements that people report.<br />
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A big surprise for me was that I stopped snoring within a few weeks of going low carb. PaleoPathologistMate was incredibly delighted with this and when the Mate is happy (and ahem rested,) so am I. My reflux disease stopped being a problem fairly quickly as well. (It returns if I eat too many carbs or have wine with dinner. Kind of a bummer but for me the benefits of no GERD are huge.) I also got my first case of sinusitis in a long time this year after a week in smoke, dust, wind, heat, humidity in Managua, Nicaragua; first real sickness in a good while, seems like my sinuses are a lot healthier. And last spring was supposed to be a heavy pollen load, and my usual hay fever actually seemed better controlled.<br />
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I know of people who claim that depression has decreased, digestive problems improved, skin healthier, increased perceived energy level, and many other things. One young woman told me she is completely off antidepressants and no longer has terrible irritable bowel symptoms.<br />
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Don't know what to do with all this as yet; as a doc I'm FULLY aware of the power of the placebo effect and suggestion. I also know the word "anecdotal."<br />
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On the other hand...if it IS all anecdotal and placebo...and I feel better...who really cares? These are good hypotheses for someone to test (if they can overcome their biases, and the funding organizations' biases--see previous post.)Anonymoushttp://www.blogger.com/profile/05905834084963591163noreply@blogger.com3tag:blogger.com,1999:blog-6178272414309718003.post-19776964223084172532014-01-25T08:35:00.001-08:002014-01-25T08:35:22.117-08:00Cholesterol, courage, and normal human biases.Chris Masterjohn, Phd is an interesting young man. I heard him on one of <a href="http://www.thelivinlowcarbshow.com/shownotes/9373/771-llvlc-classic-lipid-expert-dr-chris-masterjohn-examines-traditional-diets/">Jimmy Moore's interviews</a>. He has a sharp mind, enthusiasm, and seems willing to listen to all sides. He has <a href="http://www.cholesterol-and-health.com/">an informative website</a> that I'm just starting to get into. Warning: your preconceptions about cholesterol are very likely wrong. It is an essential molecule, present in every cell membrane in your body, the raw material for many hormones. It is NOT an intrinsically toxic evil substance created by Satan to tempt you to evil delicious tasting foods and then kill you before your time with crushing chest pain.<br />
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One of the most important myths Dr. Masterjohn discussed was that people seem to take on faith that industry (food and drug, for example) are terminally biased whereas universities and government are not. <br />
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Bull. What an unbelievably faith based thought this is!<br />
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Government subsidizes the corn and soybean industries; therefore they are biased. Government is interested in increasing their control over each of us (if you don't believe this you really are naive.) That's why people put up with all the garbage they have to put up with to get elected! The desire to tell us all what to do for our own good is behind the "food pyramid" which very likely fed the obesity epidemic worldwide and <a href="http://paleopathologist.blogspot.com/2014/01/forgiveness-and-reconciliation-will-be.html">has caused enormous harm.</a><br />
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Governments are also incredibly <a href="http://en.wikipedia.org/wiki/Risk_averse">risk averse</a> in many ways. Our own FDA has been known to delay approval of new drugs and allow Europeans to risk their lives first. Sounded OK to me, until I realized that thousands of Americans won't get needed treatment for several extra years because some FDA dude doesn't want to get blamed for the next <a href="http://en.wikipedia.org/wiki/Thalidomide">Thalidomide</a>. My father's life was turned around thirty years ago by a drug available in Europe and Canada but held up here; he could easily have died. <br />
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Universities increasingly get big dollars from patents from their research and have big donors to satisfy. They are biased. Universities and government funding have done a lot of good, but they also tend to fossilize "conventional wisdom" and, again, risk aversion leads them to not fund things that are "too radical." They want a safe payoff for their investments. Part of the incredibly sordid and contaminated "global warming" tale has to do with biased grants. I'm not claiming any expertise in climate science, but having been, years ago, part of a medical research team, anyone who wants to get a grant learns the buzz phrases you must insert into your applications.<br />
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In truth we all are biased; I am too (read the above.) Some biases I know about firsthand include beneficence bias (the desire to do good overwhelms my objectivity) and <a href="http://en.wikipedia.org/wiki/Confirmation_bias">confirmation bias </a>(I give extra weight to things that confirm my previous opinions.) Maybe I'll look into biases in an upcoming post! Could be interesting. (Wikipedia has a short list of <a href="http://en.wikipedia.org/wiki/Bias">various biases here,</a> a place to start.)<br />
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A good place to start with ourselves is, what are my biases? (NOT "do I have any biases?". I promise you that you do.) What are my biases and how do they hamper my life?Anonymoushttp://www.blogger.com/profile/05905834084963591163noreply@blogger.com2tag:blogger.com,1999:blog-6178272414309718003.post-41338756105100712722014-01-21T14:56:00.000-08:002014-01-21T14:56:11.156-08:00What? Calcium supplements might do more harm than good?Just came across this<a href="http://chriskresser.com/calcium-supplements-why-you-should-think-twice?kme=CK.com%20AR%2FWhy%20You%20Should%20Think%20Twice%20About%20Calcium%20Supplements"> from Chris Kresse</a>r. Seems that several recent studies have punctured the myth that taking supplemental calcium is good for you! What's next? How am I going to break this to PaleoPathologistMate?<br />
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Actually as a kidney stone sufferer (and suffer is the correct word for kidney stones) this intrigues me. Supplements have their place and I take some, but more and more studies which perhaps I can look into later seem to show that supplementing with pure chemicals just doesn't work as well as eating foods that contain the same chemicals.<br />
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Scientific humility is called for here. We assume that our scientific approach can figure out exactly what chemicals are doing good for us (trace elements, vitamins, antioxidants) and if we just pop those we're good and can live on McDonalds plus pills! <br />
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But nature is ALWAYS a step more complex. Always. And then when you figure out the next step, she surprises you again with yet another level of complexity. There are probably, who knows, dozens? hundreds? more chemical compounds in plants, meats, that we need to thrive. <br />
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I'm going to continue taking my vitamin D, glucosamine until I get my bone broth factory going at home, vitamin K2 and some others, but in the past year plus I've really increased my vegetables, colored foods, organ meats, etc. (I would wager that very few pathologists or other docs eat liver!) Anonymoushttp://www.blogger.com/profile/05905834084963591163noreply@blogger.com3tag:blogger.com,1999:blog-6178272414309718003.post-999436284706193072014-01-21T14:26:00.001-08:002014-01-21T14:26:27.380-08:00Another tribe to add to the list of lowcarbersSo last week was spent doing pap smears on a desperately poor population of women, Nicaraguan prostitutes. There is a faith-based Christian outreach down there and we go twice a year for a week long trip. It's incredibly rewarding.<br />
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My roommate, Richard, and I got to talking. We're about the same age and he was bemoaning how he just can't lose weight despite having hired a personal trainer. The PaleoPathologist began evangelizing Richard on the virtues of low carb for losing weight. He was fascinated and said he would be ordering the <a href="http://smile.amazon.com/New-Atkins-You-Ultimate-Shedding/dp/1439190275/ref=sr_1_1?s=books&ie=UTF8&qid=1390343051&sr=1-1&keywords=atkins+westman">Atkins book</a> when we got back to the states.<br />
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He then began talking about the two years he spent among the <a href="http://en.wikipedia.org/wiki/Gabra_people">Gabbra of northern Kenya</a>. He mentioned that they were desperately poor nomadic pastoral people who packed up their tents a few times a year and moved their herds. To imagine where they live, Americans should just think of the "lush" desert terrain of southern Arizona!<br />
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As I told him about the Inuit and their almost total lack of plant foods, he exclaimed that the Gabbra seemed to live off milk from Camels and Goats, with the occasional bit of meat from a worn out goat or camel. (He loved the camel's milk, said it was incredibly delicious.) He said he never saw them eat ANY plant food at all, and they were tall, strong, good looking, healthy happy people. In fact he said if you made it out of childhood (tough in any primitive setting) the people had good long lives. <br />
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In fact, the only plant food they get is wheat and sugar they trade for, unfortunately.Anonymoushttp://www.blogger.com/profile/05905834084963591163noreply@blogger.com0tag:blogger.com,1999:blog-6178272414309718003.post-44617771724719312022014-01-07T20:24:00.000-08:002014-01-07T20:24:06.880-08:00Forgiveness and reconciliation will be neededWe who have been thinking about the health benefits of Low Carb have, understandably, been acting a bit like a guerilla force with language like "we have to attack the (fill in the blank; drug companies, organized medicine, Food Pyramid or Myplate, etc.). We tend to make disparaging comments about our physicians and how they are stuck in the past, don't read the medical literature, etc. (We also attack each other for not sticking precisely to whichever Paleo church we belong to: safe starches vs low carb, dairy vs no dairy, sprinting vs high intensity weight lifting, etc. That is for another day!)<br />
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Yes, I'm a physician and former scientist but also am a believing Christian and something shocking came to me over the weekend. Have you ever thought what an emotional bombshell it will be for my colleagues to change their minds to Low Carb/Paleo? How much forgiveness will it take?<br />
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For years or decades, we (I include myself) have been dispensing bad advice. Yes, our intentions were good (well, mostly good; <a href="http://paleopathologist.blogspot.com/2013/12/judge-not-lest-ye-be-judged.html">see this post</a>) but we all know <a href="http://en.wikipedia.org/wiki/The_road_to_hell_is_paved_with_good_intentions">which road</a> is paved with good intentions, right? Good intentions and five bucks will get you a Venti at Starbucks.<br />
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For me to accept that I've potentially harmed, or maybe even killed, many patients in my past would be an incredibly bitter pill to swallow. This is not a purely intellectual problem; the emotional resistance to letting this in could be quite striking for many people.<br />
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Even worse may be the policy makers, who have affected FAR more people than any individual physician. Congress rushed to judgement. The population became sick and fat. Diabetes is now estimated at causing nearly a <a href="http://www.diabetes.org/diabetes-basics/diabetes-statistics/">quarter of a million deaths annually,</a> just in the US. Over forty years, that might be 10 million deaths. That does not count the excess deaths from metabolic syndrome sufferers who don't quite become diabetics. For comparison, the<a href="http://www.cdc.gov/tobacco/data_statistics/fact_sheets/health_effects/tobacco_related_mortality/"> CDC estimates 440,000 smoking related </a>deaths annually.<br />
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A case could be made that the misguided high carbohydrate low fat uncontrolled experiment inflicted on us by well meaning but badly educated leadership killed as many of us as cigarettes, as many as Adolf Hitler executed.<br />
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A message of forgiveness and reconciliation will HAVE to be part of our communications. The emotional barrier may well be stronger than the intellectual barrier to bringing rational diet back to the human race.Anonymoushttp://www.blogger.com/profile/05905834084963591163noreply@blogger.com4tag:blogger.com,1999:blog-6178272414309718003.post-36842620957571566892013-12-30T08:29:00.002-08:002013-12-30T08:29:51.999-08:00How 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, <a href="http://www.amazon.com/The-Willpower-Instinct-Self-Control-Matters/dp/1583335080/ref=sr_1_1?ie=UTF8&qid=1388420857&sr=8-1&keywords=mcgonigal">"The Willpower Instinct." </a> <a href="http://www.karmatube.org/videos.php?id=4495">In this new video</a> 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.<br />
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Take homes for me:<br />
1. Revision the stress response. The pounding heart? Energy, not anxiety.<br />
2. When feeling the stress response, reach out to your trusted community.<br />
3. Pursue meaning, NOT comfort.Anonymoushttp://www.blogger.com/profile/05905834084963591163noreply@blogger.com0tag:blogger.com,1999:blog-6178272414309718003.post-28256825119683121892013-12-24T13:11:00.001-08:002013-12-24T13:11:38.426-08:00Jimmy Moore blog post about "cognitive dissonance" in Low CarbJimmy 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. <a href="http://livinlavidalowcarb.com/blog/a-tale-of-two-worlds-the-cognitive-disconnect-about-ketogenic-living/21223">His latest is about how</a> to respond to the people around you trying to convince you to eat, etc. <br />
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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.)<br />
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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.<br />
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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 <a href="http://www.bible-reading.com/screwtape.html">letter 1 </a>he (the Senior Devil) says, near the end:<br />
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"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."<br />
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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. Anonymoushttp://www.blogger.com/profile/05905834084963591163noreply@blogger.com2tag:blogger.com,1999:blog-6178272414309718003.post-90146264072858481682013-12-14T20:55:00.000-08:002013-12-14T20:55:37.496-08:00Judge Not, lest ye be judged...So says Jesus of Nazareth to the crowds in the <a href="http://www.biblegateway.com/passage/?search=Matthew+7%3A1-3&version=KJV">Sermon on the Mount</a>. 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? <br />
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The overweight. They're almost as bad as smokers. There are proposals to <a href="http://www.huffingtonpost.com/2012/06/29/health-plans-obese-smokers-supreme-court_n_1636139.html">charge the obese more</a> 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?<br />
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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?<br />
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We have biases, that's why. <br />
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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.<br />
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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.<br />
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In high school and college, on the swim team, here was an average days' food:<br />
Breakfast: Bacon and eggs, two coconut donuts, hash browns, milk and OJ.<br />
Lunch: whatever hot lunch Saga health service at Colorado College served.<br />
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.<br />
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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.<br />
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Somewhere along the way, though, some disturbing things started happening.<br />
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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.<br />
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But then I hurtled into my fifties. I did a couple of amazing hundred mile bike rides: t<a href="http://spcycling.org/stonewall-century.php">he Stonewall Century</a> and the <a href="http://teamevergreen.org/triple">Triple Bypass</a>. 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 <a href="http://www.bicycling.com/training-nutrition/training-fitness/trainingpeaks-power-profiles-cyclists">"power to weight ratio"</a> is for hill climbing on your bike. Guess what? Weight was slowly coming on...155...160...165...170.<br />
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And then <a href="http://www.amazon.com/New-Atkins-You-Ultimate-Shedding/dp/1439190275/ref=sr_1_1?ie=UTF8&qid=1387081374&sr=8-1&keywords=westman+atkins">I went on Atkins</a>. Biked less, ate a lot of fat, very low carbohydrate. 170...165...160...155...150. Bottomed out at 149.2. Not particularly hungry. <br />
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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.)<br />
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<i>But what if...</i><br />
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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?<br />
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And on the other side...<br />
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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."<br />
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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?<br />
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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.<br />
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If you are interested, there are a couple of terrific books on willpower. <a href="http://www.amazon.com/Willpower-Rediscovering-Greatest-Human-Strength/dp/0143122231/ref=sr_1_1?ie=UTF8&qid=1387081969&sr=8-1&keywords=willpower">Willpower: Rediscovering the Greatest Human Strength</a> and <a href="http://www.amazon.com/The-Willpower-Instinct-Self-Control-Matters/dp/1583334386/ref=sr_1_2?ie=UTF8&qid=1387082041&sr=8-2&keywords=willpower">The Willpower Instinct</a> 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.<br />
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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. <br />
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Judge not, folks. <a href="https://www.fanfiction.net/s/4558506/">Instead, be like CSI and Follow the Evidence. </a>Anonymoushttp://www.blogger.com/profile/05905834084963591163noreply@blogger.com0tag:blogger.com,1999:blog-6178272414309718003.post-58209657601741965582013-12-04T14:29:00.003-08:002013-12-04T14:29:39.947-08:00Who 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.<br />
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Low carbohydrate, high fat, moderate protein diets, meanwhile, keep getting examined and keep coming out on top. <a href="http://www.dietdoctor.com/science">According to this review post</a>, 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 <a href="http://ajcn.nutrition.org/content/91/3/535.long">big meta-analysis </a>says that saturated fat is not toxic. )<br />
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Dietary fat does NOT become fat in your coronary arteries. Another phobia.<br />
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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.<br />
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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.<br />
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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 (<a href="http://paleopathologist.blogspot.com/2013/12/a-perfect-natural-squat.html">see the Squat post!</a>) Anonymoushttp://www.blogger.com/profile/05905834084963591163noreply@blogger.com0tag:blogger.com,1999:blog-6178272414309718003.post-17191458027538375862013-12-03T08:39:00.001-08:002013-12-03T08:39:21.652-08:00A 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!<br />
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<br />Anonymoushttp://www.blogger.com/profile/05905834084963591163noreply@blogger.com0tag:blogger.com,1999:blog-6178272414309718003.post-52999208697981738732013-12-01T19:28:00.002-08:002013-12-01T19:28:39.976-08:00BroScience. What a great term.Bro Science is science that isn't really science, but a Bro (i.e., <a href="http://broscience.com/">big jock with muscles, </a>someone famous, or just someone you trust) says something with great sincerity and belief. Heck, I've probably done my share of <a href="http://rationalwiki.org/wiki/Broscience">BroSciencing</a> and my degrees give me credibility, whether I deserve it or not.<br />
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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.<br />
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Here's some things I think may be BroScience.<br />
<a href="http://baye.com/machine-training-myths/">Free weights are better than machines.</a><br />
You can't lose fat and gain muscle at the same time.<br />
Low carb diets cause your thyroid to crap out.<br />
<a href="http://snopes.com/horrors/gruesome/fecalcolon.asp">Carnivorous humans have up to 40 pounds of rotting meat in their colons.</a><br />
Just about anything else about "colon health."<br />
Vegetarian diets are healthier than omnivorous diets.<br />
Dietary saturated fat is bad for you and will cause heart disease.<br />
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.)<br />
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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.)<br />
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.<br />
Actually "inflammatory" in general seems like a BroScience buzzword.<br />
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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!<br />
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By the way, there are some words that tickle MY BS detector after doing that show for several years.<br />
1. "Toxins." People blame "toxins" for all kinds of things. Toxins are real, but I think get blamed for a lot of lifestyle defects.<br />
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!<br />
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.<br />
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<br />Anonymoushttp://www.blogger.com/profile/05905834084963591163noreply@blogger.com0tag:blogger.com,1999:blog-6178272414309718003.post-5525545103943292012013-11-24T13:21:00.003-08:002013-11-24T13:21:56.178-08:00Made 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 <a href="http://paleopathologist.blogspot.com/2013/11/but-what-do-you-eat-my-breakfast.html">basic recipe</a>.Anonymoushttp://www.blogger.com/profile/05905834084963591163noreply@blogger.com0tag:blogger.com,1999:blog-6178272414309718003.post-70363404607680655252013-11-20T18:56:00.000-08:002013-11-20T18:56:35.159-08:00Low Carb for Native Peoples in CanadaTake a look at the <a href="http://www.thelivinlowcarbshow.com/shownotes/8980/746-dr-jay-wortman-2013-low-carb-cruise-lecture/">post by Dr. Jay Wortman</a>, 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.<br />
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I've seen<a href="http://www.ncbi.nlm.nih.gov/pubmed/15925009"> native peoples in Mexico</a> and <a href="http://api.ning.com/files/WJJnmMrgUIr8A55UJBXtjkk3CeHUbeiYjRua4L2MWtfZsrSErRzOm9BDd8KSVhgYIJtv7E1UMMFu8xCdmfaDidWWtv6Z*sCP/Type2DiabetesonRiseInNicaragua.pdf">Nicaragua</a> who have gotten very rotund, and on my mission trips see seventeen year olds with type II diabetes. Diabetes is <a href="http://www.ncbi.nlm.nih.gov/pubmed/17098087">epidemic in south Asia</a> 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.Anonymoushttp://www.blogger.com/profile/05905834084963591163noreply@blogger.com0tag:blogger.com,1999:blog-6178272414309718003.post-52534427489678176812013-11-20T18:40:00.000-08:002013-11-20T18:40:06.588-08:00Something to think about. Drug companies, "Big Pharma", and Big GovernmentBefore 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.<br />
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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.<br />
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Did they do a big clinical trial before making sweeping recommendations and regulations that affected the health of hundreds of millions of us?<br />
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No. <br />
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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? <br />
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No.<br />
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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?Anonymoushttp://www.blogger.com/profile/05905834084963591163noreply@blogger.com0tag:blogger.com,1999:blog-6178272414309718003.post-53598059702546744172013-11-19T17:06:00.005-08:002013-11-19T17:06:59.699-08:00"eat like a predator, not like prey." Fun little article.I heard J. Stanton interviewed on <a href="http://www.thelivinlowcarbshow.com/shownotes/8917/745-j-stanton-from-gnolls-org-on-metabolic-flexibility-hunger-calories/">Jimmy Moore's LivinLaVidaLowCarb show</a>. 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!)<br />
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J. Stanton has a nice plan for "paleo" eating <a href="http://www.gnolls.org/1141/eat-like-a-predator-not-like-prey-paleo-in-six-easy-steps-a-motivational-guide/">here</a>. <br />
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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.<br />
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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 href="http://www.gnolls.org/">gnolls.org</a> a visit.Anonymoushttp://www.blogger.com/profile/05905834084963591163noreply@blogger.com0tag:blogger.com,1999:blog-6178272414309718003.post-80283685268030112392013-11-18T20:11:00.000-08:002013-11-18T20:11:02.902-08:00But what do you eat? My breakfast frittataIn 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!"<br />
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In response, here is my breakfast this week:<br />
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Fry in one pan, several strips of bacon chopped; half an Andouille sausage, and about six ounces of fresh elk sausage.<br />
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.<br />
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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.<br />
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Six slices of goodness. Beats the heck out of a bagel! Serve with some green tabasco sauce and plenty of salt.<br />
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Basically, I eat every day like most people eat when they are on vacation. I don't miss the bread at all actually.<br />
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But Doc, what about your cholesterol? Aren't you killing yourself?<br />
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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.<br />
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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.Anonymoushttp://www.blogger.com/profile/05905834084963591163noreply@blogger.com0tag:blogger.com,1999:blog-6178272414309718003.post-34103593791120030072013-11-18T19:58:00.002-08:002013-11-18T19:58:41.759-08:00High intensity weight training (HIT) for beginnersA 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.<br />
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As part of my obsessive-compulsive trait (a good thing in a physician) I did a lot of surfing and found <a href="http://www.marksdailyapple.com/#axzz2l3jEvIrs">Mark's Daily Apple</a>. In the forums, someone mentioned "high intensity training." Perhaps you've seen the <a href="http://vimeo.com/59210902">BBC documentary</a> on high intensity interval training? I had just restarted weight training and of course hurt my shoulder doing the <a href="http://www.youtube.com/watch?v=Qls96q4Phs4">stupid Steinborn</a> Lift (hurt for months.) Then I found a Forum post on "<a href="http://www.bodybyscience.net/home.html/">Body by Science</a>."<br />
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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. <br />
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There are a couple of other resources I like. <a href="http://baye.com/wp-content/uploads/2011/09/ebrtr-Fisher1.pdf">First is an article about the evidence</a> 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.<br />
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What about machines vs free weights? <a href="http://baye.com/machine-training-myths/">Either is probably fin</a>e. At my age I'm liking the machines. Strength gains are just fine and I'm not hurting myself.<br />
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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.<br />
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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.<br />
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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.<br />
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My trainer is at <a href="http://trufithealth.com/">TruFit in Denver</a> and they have been terrific. The Body by Science Website has <a href="http://www.bodybyscience.net/home.html/?page_id=889">a list of trainers</a> around the country. So efficient, so safe, such good results! Highly recommended. Anonymoushttp://www.blogger.com/profile/05905834084963591163noreply@blogger.com0tag:blogger.com,1999:blog-6178272414309718003.post-44716997042379446542013-11-12T11:49:00.001-08:002013-11-12T11:49:20.503-08:00Welcome to the PaleoPathologist BlogWelcome 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 JimAnonymoushttp://www.blogger.com/profile/05905834084963591163noreply@blogger.com0