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Sous Vide Cooking – What a Warm Bath Can Do For Your Food

30 Apr

For those of you who have read my blog for some time, you know how much value I place on cooking.  In fact, one of my 4 Keys to Paleo Success is cooking at home!  I have a wife, two hungry kids, and a full medical practice.  I also happen to be the one and only cook in my home…so, I am always looking for ways to make easy and convenient food that my family enjoys.

Some may say I have a bit of an obsession with kitchen equipment (especially my wife).  That said, no matter how big your kitchen is you eventually run out of room to store things.  So a couple of years ago when I started to look into Sous Vide technology to say that my wife was a little cold on the idea would be an understatement.  She was convinced that this would be another high dollar toy to collect dust in the pantry (I would like to say, there are none of those to speak of…:).  After several years, my Sous Vide is still going strong, and even my wife has admitted to me that it was probably the most useful appliance we have ever bought to cook with!  Now that’s saying something.  I use my sous vide so much that it has a permanent place on our kitchen counter because it is pretty much always on!

If you have ever uttered the words “I just don’t have time to cook”, the sous vide could be the answer you have been looking for. When I mention the sous vide to others they are usually intrigued and completely in the dark about the technology.  That’s why I decided why not do a blog post on it and see if we can get more people perfectly cooking meals at home!

The Concept:  Sous Vide is French for “Under Vacuum.”  This method of cooking uses a precisely controlled water bath to cook food that is vacuum sealed in airtight plastic bags.  To do it you need a vacuum seal device like your typical Food Saver, and a way to precisely control a water bath’s temperature.  By cooking food in this way you assure that the food is always cooked to the precise temperature that you would like, and you never have to worry about ruining that expensive piece of meat you bought!  In the end it is a very simple concept: cook food to precisely the right temperature to get optimum results (oh, and it can’t be any easier to do).

All you do is decide on what you want to cook, soak it at the appropriate temperature for an adequate amount of time, and finish it off with a quick sear to achieve the crispy brown exterior that adds so much to the flavor of meat.  Now the science behind sous vide cooking is extensive, and can be very complex, but you can keep it pretty simple by experimenting with cooking times on your own and never rushing the process.  Check out this page at SousVideSupreme.com for specific cooking times, or totally geek out with the Sous Vide Dash mobile app to better control your cooking times!

The most important thing to remember is my opinion is to adequately season your food before vacuum sealing AND before searing.  This leads to the most consistent results and great flavor.  In addition, don’t forget to thoroughly DRY off your meat prior to searing or you just won’t get the amazing results your food deserves.

The Cost:  You can spend thousands on amazing sous vide systems, but unless you are commercial chef there is absolutely no need.  I use the Sous Vide Supreme Demi that I paid $329 on Amazon for (you can spend an extra $100 for the slightly larger standard side Supreme).  I also bought a Food Saver vacuum machine from Sam’s Club for around $130, and I was ready to go.  Is this equipment cheap? Absolutely not!  Is it worth it, I would have to say every penny.

Sous Vide Supreme has a home on my countertop.

Sous Vide Supreme has a home on my countertop.

The Convenience:  Most large pieces of meat take hours to cook in the oven, and the results are often variable.  You cook a Ribeye roast and the outer parts are overcooked while the interior can be a bit raw.  A very expensive piece of meat normally turns out good, but why risk it and instead always make it great!  Lets say you have a 4 pound Ribeye roast and you want to cook it perfectly rare/medium rare.  Hands on time includes getting it out of its packaging and seasoning it.  Next you place it in a Food Saver bag and seal it.  So far, total time, maybe two minutes.  Get your Sous Vide out, fill it with water, set it to your desired temperature (I prefer 130F for beef), and place your roast inside.  Using a chart or the mobile app you can easily determine the minimum time needed to cook your roast.  The key is that you find out the MINIMUM time, but that is not a MAXIMUM time!  You cannot overcook your meat, as it will never go above 130F no matter how long it sits in the water.  Let’s say it takes 5 hours to cook, you can leave it 8-9 hours until you get home from work without any issue whatsoever.  In fact, with tougher cuts of meat I often cook them for 24-72 hours.  I’m sure you can keep meat in too long and it will mess with the texture, but I have yet to have any major issues with that.  The key is that under most circumstances, the meat can wait for YOU to be ready to finish it off, not vice versa.  Once I get home I put a cast iron skillet on full blast gas to heat up while I take the roast out of the bag and thoroughly dry it.  I add a little more seasoning and brown it on each side in a little coconut oil for 30-45 seconds.  Total hands on time for the roast 10 minutes MAX, and the results are perfect.

Ribeye Roast drying off

Ribeye Roast drying off

Finished Ribeye Roast (Notice edge to edge perfection)

Finished Ribeye Roast (Notice edge to edge perfection)

This convenience aspect is why we love the sous vide so much.  The main part of our dinner many nights is perfectly cooked animal based protein, and the sous vide makes it amazingly easy to prepare with very little time invested.  I have cooked countless cuts of meat this way, and I am yet to have a problem with the results.

Here are two more things to keep in mind when it comes to the convenience of sous vide cooking.  Lets say you find a good deal and want to buy some meat in bulk…you are likely going to freeze some of your bounty.  Simply season the meat, vacuum seal it, label it, and stuff it in the freezer.  When it comes time to cook your meat no need to defrost it, simply stick it into the sous vide at the right temperature frozen, and add an hour or so to the cooking time.  Perfect meat, straight from the freezer, and no time consuming defrost!

Lastly, how many of you have had this happen?  You plan to make chicken thighs for dinner and they are soaking away in the sous vide.  For whatever reason you end up staying out later than you want, the kids get hungry, and you take them to a local eatery for dinner to less complicate your life.  What to do with the thighs?  When you get home take them out of the sous vide and dunk them in a cold water bath.  Once completely cooled place them, bag and all, into your fridge.  In the next day or two simply pop them back into the pre-heated sous vide for an hour to heat them through and proceed with dinner as usual!  I have even frozen completely cooked sous vide meat as an experiment and reheated it straight from the freezer.  Meat was perfect…you just can’t seem to go wrong.

The Consistency:  I can’t tell you how nice it is to know that what I cook will be perfectly cooked to my family’s liking every single time.  As many of you we spend the time to source our meat locally and make sure it is raised in a healthy and responsible manner.  Those of you who do the same no doubt know that this meat does come at a cost.  Nothing aggravates me more than taking an expensive piece of meat and not having it come out just right…or even worse, totally killing it!  That simply does not happen with the Sous Vide.  It’s 100% guaranteed to be perfect if you can just set the temperature right and cook it long enough.

This consistency also leads to enjoying meat at it’s best.  While beef is often cooked rare and enjoyed that way (my 7 year old daughter recently sent a steak back at a restaurant because it was medium…much to done for her!), other meats in particular pork are often overcooked for fear of food borne illness.  When you calculate the time to cook meats you can calculate the time for the core of your meat to reach a certain temperature, or you can calculate the time to Pasteurize the meat to the core.

Sous Vide Dash for iPad

Sous Vide Dash for iPad

That means you can cook a pork tenderloin or roast to medium long enough to kill any potential bacteria, and finally be able to enjoy amazingly juicy pork!  I had honestly given up on pork tenderloin as it always turned out too dry for my liking no matter what I did!  The sous vide has brought all pork back to my kitchen, and I am amazed at what I was missing with poor temperature control!

The Versatility:  To say you can cook anything in the Sous Vide is not an over-statement.  I have cooked just about every type of animal and cut of animal out there, and I have gotten amazing results.  Want to cook seafood? Go for it.  Veggies? Have at it.  You can even cook eggs in a sous vide!

The Results:  If you have not figured it out yet, the Sous Vide has led to some of the most amazing meat dishes I have every made, with little to no energy expended on my part.  I never have to worry about how dinner will turn out.  Here are some examples of dinners from my Sous Vide Supreme.

Searing off a roast in the cast iron skillet

Searing off a roast in the cast iron skillet

Sliced Roast, perfectly cooked

Sliced Roast, perfectly cooked

Sealed and ready for a dip!

Sealed and ready for a dip!

Steaks dried off before the sear

Steaks dried off before the sear

Finished Steak

Finished Steak

Grass Fed Chuck Roast

Grass Fed Chuck Roast

Finished Roast

Finished Roast

Chicken Thighs ready for searing

Chicken Thighs ready for searing

Chicken Thighs, Skin Crisped to Perfection

Chicken Thighs, Skin Crisped to Perfection

Crispiest Chicken Thighs ever

Crispiest Chicken Thighs ever

Grass fed roast being sealed

Grass fed roast being sealed

Roast out of the Sous Vide

Roast out of the Sous Vide

Finished and perfectly cooked roast

Finished and perfectly cooked roast

Pork roast completed

Pork roast completed

Perfectly cooked Pork Roast

Perfectly cooked Pork Roast

I hope this has given you even a little bit of interest in Sous Vide cooking!  There is no doubt that the cost of the equipment to cook this way can be hard to afford.  All I can tell you is that I have owned my fair share of kitchen equipment in my day, and I would be hard pressed to find a more valuable member of my cooking arsenal than my fancy water bath.  Have experience with a Sous Vide of your own?  Share your experiences and new ideas on what to throw in and at what temperature!  Here are some useful links for Sous Vide cooking!

Nom Nom Paleo – Amazing food blog that first peaked my interest in Sous Vide Cooking.  I really can’t tell you guys enough how much you need to check out Michelle’s blog.  It’s beautiful, witty, and delicious!  Check out her recipes and her iPad app that includes many recipes specific to Sous Vide.  The chicken thigh recipe above?  All Nom Nom!

Sous Vide Supreme – Makers of what I think are the most affordable and easy to use Sous Vide cookers for the home cook.

Douglas Baldwin – Expert if Sous Vide Cooking and Non-Linear Waves

Modernist Cuisine – Great article on “Why cook Sous Vide”

Sous Vide Cooking – A Blog all about Sous Vide Cooking!

 
3 Comments

Posted by on April 30, 2013 in General Paleo Discussion

 

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Restless Leg Syndrome: Is Your Diet Related?

23 Apr

As an everyday part of my sleep practice, I often see patients who complain of problems falling asleep due to symptoms in their legs when they get in bed. It can be anything from “restlessness” to “deep pain” in the legs, but almost always follows a typical pattern. What these patients suffer from is called Restless Leg Syndrome (RLS), and it is more common than you may think. Lets learn a little about it, and investigate whether or not diet can either lead to, or relieve the symptoms of this often misunderstood condition.

Epidemiology: The numbers vary widely in the literature as far as the overall prevalence of RLS across the population, but it’s safe to say 5-10% of Americans suffer from some form of RLS throughout their lives. Importantly, this is not just a disease of adults, as it is felt that the overall prevalence is similar in children as well. In these children, RLS symptoms are often misdiagnosed as “growing pains” and the sleep disruption it causes often leads to night after night of unrestful and disjointed sleep. When adults get tired we get sleepy, when kids get tired they get cranky, agitated, disruptive, and even hyper. Needless to say, many experts believe unrecognized RLS in kids could account for a good number of cases labeled as ADHD. As in many things in sleep medicine, this remains controversial.

Pathogenesis: RLS can be grouped into two main categories, as can many disease states; it is either primary or secondary.

-Primary RLS is idiopathic, meaning there is no real identifiable cause. Observational studies point to it being a genetic disease with autosomal dominant inheritance. The underlying genetic defect occurs somewhere in the metabolism of dopamine in the central nervous system, although imaging studies using SPECT and PET imaging of dopamine producing areas have produced often conflicting data. Given that Parkinson’s disease is clearly known to be related to dopamine defects in the CNS, and the fact that Parkinson’s medicines have been successfully used to treat RLS, this is an important area of current research in Neuroscience.

-Secondary RLS is felt to be caused by a number of other conditions; in other words, RLS is a symptom of these problems. Here are a few of the most common (and the one we are most interested in).

-Iron Deficiency – Since the original description of RLS, iron deficiency has been considered one of the most likely causes. Study after study have consistently showed decreased iron stores (ferritin) in RLS patients vs. controls. MRI estimates of brain iron concentration in the substantia nigra (the area that makes dopamine) have also been consistently lower in RLS patients. That said, these findings are FAR from universal, so it is only part of the story.

-End-Stage Renal Disease – If you take care of hemodialysis patients for very long, you quickly hear the same complaints of RLS pop up time after time. The cause of RLS in these patients has many theories, from iron deficiency to low parathyroid hormone (PTH) levels. Research is ongoing.

-Diabetes Mellitus – RLS often co-exists with peripheral neuropathy and can be quite debilitating.

-Multiple Sclerosis – The data on RLS and MS is in its infancy, but I can tell you that over half of my MS patients have clear RLS. There is a connection.

-Parkinson’s Disease – Although dopamine is related to both conditions, studies have failed to consistently find a link between RLS and Parkinson’s. This is frustrating as both disorders clearly point to the substantial nigra in the CNS as to location of disease. Our hope is that a breakthrough in one disease will lead to a ray of hope in the other. Only time will tell…

-There are many other disease states related to RLS, and often listed in the miscellaneous file are vitamin deficiencies and obesity. We’ll talk more about them later.

Clinical Manifestations and Diagnosis: Here is how UpToDate.com describes RLS.

Although the subjective symptoms of RLS are often difficult to describe, the clinical features are highly stereotyped. The hallmark of RLS is a marked discomfort in the legs that occurs only at rest and is immediately relieved by movement. The abnormal feelings are typically deep seated and localized below the knees. Distribution is usually bilateral, but some asymmetry may occur and the arms can be affected in more severe cases.

Terms that patients use to describe the symptoms include crawling, creeping, pulling, itching, drawing, or stretching, all localized to deep structures rather than the skin. Pain and tingling paresthesia of the type that occurs in painful peripheral neuropathy are usually absent, and there is no sensitivity to touching of the skin.

Symptoms typically worsen towards the end of the day and are maximal at night, when they appear within 15 to 30 minutes of reclining in bed. In severe cases symptoms may occur earlier in the day while the patient is seated, thereby interfering with attending meetings, sitting in a movie theater, and similar activities. In milder cases patients will fidget, move in bed, and kick or massage their legs for relief. Patients with more severe symptoms feel forced to get out of bed and pace the floor to relieve symptoms.

The International Restless Legs Study Group proposed the following four features as essential criteria for the diagnosis of RLS:

1) An urge to move the legs, usually accompanied or caused by uncomfortable and unpleasant sensations in the legs. Sometimes the urge to move is present without the uncomfortable sensations, and sometimes the arms or other body parts are involved in addition to the legs.

2) The urge to move or unpleasant sensations begin or worsen during periods of rest or inactivity such as lying or sitting.

3) The urge to move or unpleasant sensations are partially or totally relieved by movement, such as walking or stretching, at least as long as the activity continues.

4) The urge to move or unpleasant sensations are worse in the evening or night than during the day or only occur in the evening or night. When symptoms are severe, the worsening at night may not be noticeable but must have been previously present.

Dietary Treatment: There are tons of resources on the internet about standard pharmacologic treatment of RLS, and that is not the main topic of this post. What we are going to look at now is common non-pharmacologic treatments for RLS, in particular diet related treatments. Let’s see where this takes us!

According to the RLS Foundation there are multiple foods that should be avoided in order to minimize or eliminate RLS symptoms. These include caffeine, alcohol, ice cream, as well as pasta and bread.

Now you all know this is a Paleo blog, and are you seeing what I just saw? Pasta and bread??? Why? We all know why…say it with me…GLUTEN!

Both Celiac Disease(CD) and Gluten Sensitive Enteropathy (GSE) lead to abnormal small intestine mucosa due to inflammation. This inflammation leads to malabsorption, and this is the pathway which connects it with RLS. We saw above that a classic cause of secondary RLS is iron deficiency anemia. We all know gluten is indigestible by the human small intestine, and it causes some degree of inflammation for anyone who eats it. People with CD or GSE have pathologic inflammation in their gut, thus making it impossible for them to appropriately absorb dietary iron. Give these people long enough and their ferritin and iron levels get low enough to put them at risk for developing RLS symptoms.

So how related are CD and RLS? Lets look at some clinical data for answers. One study showed the incidence of RLS in CD patients to be 35%, of these, 40% also had iron deficiency. In another study, 31% of CD patients had RLS vs only 4% of the control group. Also, iron levels in this study were statistically significantly lower in the CD patients with RLS than in those without the disease. BUT, after all was said and done, no clear correlation was found in this study between RLS and either a gluten free diet or iron metabolism.

Yet another study showed that GSE antibodies were NOT associated with RLS unless there was an associated underlying anemia. Everyone confused yet?! Let’s look at one more thing before we try to figure all this out.

Interestingly enough, another commonly recognized cause of secondary RLS is magnesium deficiency. Many people with RLS are amazed to see a rapid resolution of symptoms simply by taking OTC magnesium supplements…but not all get relief. Why do some get relief, and some not? Why do very controlled studies show some people get complete resolution of RLS symptoms when adapting a gluten free diet, and other get no relief at all?

Conclusion: Lets say your mom has RLS, and her mom had RLS, and her dad had RLS…what are your chances? I would say pretty good. In this case, there is clearly a autosomal dominant gene being passed down through the generations causing RLS. That gene leads to a yet unknown defect in dopamine metabolism in the substantia nigra of your CNS, and thus to your RLS. Gluten is no where in this picture! Although many want to believe that Paleo can fix everything, it simply can’t. Lets say one day your car stops running, and after checking it over you realize it’s just out of gas! You fill her up and she fires right up. I think we would all agree that your view is skewed if you believe that no matter what happens to your car, if it stops running, all you need to do is put gas in and it will work. Gas is not the only necessary part of your car to make it run! Likewise, gluten is just a piece of the puzzle.

That said, gluten can be and often is an important issue to address in RLS. What is the pathway to a gluten free diet improving RLS symptoms? First of all, you have to have RLS that is secondary in nature, not primary. Next, the cause of your RLS needs to be either iron deficiency anemia or magnesium deficiency. (I by no means believe these are the only two nutritional causes of RLS, but they are the most common and most studied) Now, if your iron or magnesium deficiency is caused by malabsorption from CD or GSE, you may be in luck! This pathway explains why we have such variable results in studies concerning gluten, iron metabolism, and RLS. For someone’s RLS to respond positively to a gluten free diet they not only need to have an underlying gluten problem, but that problem must also be leading to clinical iron or magnesium deficiency. If we look at one of the studies above where the incidence of RLS in CD patients was 35%, and only 40% of those had iron deficiency; that means a gluten free diet will likely only help 40% of 35% of the original study population! Even that is if you get 100% response to the diet in those who are “primed” to respond.

One of my biggest messages I try to get out through my blog is that although adapting a Paleo diet can do amazing things for your life and for your health, it can not substitute for traditional Western medicine in every instance. If your RLS is related to dopamine (in other words, genetically handed down), and you want relief of your symptoms, it’s best if you see your doctor and get a prescription for medicines that will increase dopamine in your CNS. You can go gluten free forever and never get the results that you need. Do not become single minded, it won’t get you anywhere but walking around at midnight again frustrated and tired.

In the end RLS is a very important cause of morbidity in America, and around the world. How do I use this information in my practice?

-In RLS patients I often recommend a trial of gluten free diet to see how symptoms respond, particularly in patients with no family history of RLS, or a positive family history of CD.

-In iron deficiency anemia patients who fail to respond to iron replacement, I often test them for CD as an underlying cause of malabsorption.

Think you may have RLS? Talk to your doctor or contact a local board certified sleep physician to get evaluated. I often used to tell patients that RLS would not kill them, it would just make them want to kill themselves. Recent data showing how short sleep times, in and of themselves, can increase overall mortality has me changing my tune. That topic though…is for another blog post in the future!

I hope this post finds you all well, God Bless.

Ernie

PS – Because it’s fun to share, I thought I might give yall my two favorite “home remedies” that I’ve heard over the years for treating RLS. Now please, I DO NOT RECOMMEND THEM, just sharing. One gentleman told me his best method was putting homemade charcoal in a sock, smashing it up a bit, and rubbing the sock all over his legs before bed time. The blacker his legs got, the better he said he slept.

This can only be outdone by the man who told me after years of experimenting, he found that rubbing paint thinner on his legs at bedtime led to a nice sound sleep…….. I quickly made sure neither he or his wife smoked! You just can’t make this stuff up…!

Sources:

Restless Leg Syndrome Foundation: About RLS

UpToDate.com Section on RLS

Dig Dis Sci. 2010 Jun;55(6):1667-73. doi: 10.1007/s10620-009-0943-9.

Celiac disease is associated with restless legs syndrome.

Weinstock LB, Walters AS, Mullin GE, Duntley SP.

Source Department of Internal Medicine, Washington University School of Medicine, St. Louis, MO 63141, USA

Mov Disord. 2010 May 15;25(7):877-81. doi: 10.1002/mds.22903.

Restless legs syndrome is a common feature of adult celiac disease.

Moccia M, Pellecchia MT, Erro R, Zingone F, Marelli S, Barone DG, Ciacci C, Strambi LF, Barone P.

Source Department of Neurological Sciences, University Federico II and IDC Hermitage Capodimonte, Naples, Italy.

Acta Neurol Belg. 2011 Dec;111(4):282-6.

Prevalence of gluten sensitive enteropathy antibodies in restless legs syndrome.

Cikrikcioglu MA, Halac G, Hursitoglu M, Erkal H, Cakirca M, Kinas BE, Erek A, Yetmis M, Gundogan E, Tukek T.

Source Department of Internal Medicine, Bezmialem Vakif University, Medical Faculty, Fatih, Istanbul, Turkey

Sleep Med. 2009 Aug;10(7):763-5. doi: 10.1016/j.sleep.2008.07.014. Epub 2009 Jan 12.

Celiac disease as a possible cause for low serum ferritin in patients with restless legs syndrome.

Manchanda S, Davies CR, Picchietti D.

Source University of Illinois at Urbana-Champaign, College of Medicine, 506 S. Mathews Avenue, Suite 190, Urbana, IL 61801, USA.

 
8 Comments

Posted by on April 23, 2013 in General Paleo Discussion

 

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Miss Me?! I’m back…Here’s an update.

17 Apr

Well, it’s been around 8 months since I last posted, and I’m glad to be back! I’m sorry to all that I just kind of disappeared, but I hope this post explains what’s been going on, and I hope to be back to regular blogging now.

My wife and I have two beautiful children, now ages 4 and 7, and last summer we adopted a teenage family member from my wife’s side of the family. This child had been through a great deal in her young life including losing both her parents at a very early age, and being the victim of various types of abuse I’d rather not write about. To say that a teenager in the house changed things would be an understatement!

My life suddenly became very full, and any extra time I had was quickly eaten up by activities and working on moving our new child in the right direction. I won’t get into much, but I can tell you all it has been a very long year filled with highs and lows. My priority in life is leading my home in a Godly fashion, and given the new presence in the home, my roles quickly changed and required a lot more hands on approach. What did this do to “paleo”? It essentially put it on the back burner! Although I was able to maintain a primarily primal lifestyle, there were definitely more episodes of “stress eating” than I am used to having! It’s hard, if not impossible to try to teach someone all the lessons they need to live a good life in a matter of months, but none-the-less you try. In the end after approximately 9 months in our home, our adopted child decided to move back home out of state with her grandmother. It was hard to see her go, but I do believe God is in control and will guide her. It was a major period of growth for me personally, for my wife, and for our marriage.

As complex a situation as that was, it was only part of the story of the “PaleolithicMD’s” near demise. I’m not certain how many of my readers share my deep faith, but I am not afraid to say that my relationship with Jesus Christ takes priority in my life. I am a very blessed individual, and I try daily to give thanks to the one who blesses me through appropriate actions, attitudes, and commitment based on his teachings. One of the 10 Commandments states “Thou Shall Have No Idols Before Me.” So, what does Paleo have to do with that?

To put it plainly, Paleo became and idol. The PaleolithicMD became and idol! I started to prioritize my cooking plan, blog posts, twitter chatter, FB likes, Paleo networking, etc above my daily time studying scripture, as well as much needed time with my kids. I struggled with it for several months, and my loving wife called me out on it as gently as she could! Like many battles with pride, I did my best to ignore it. So what happened? The episode above happened! My home changed, my priorities were forced to change, and Paleo was essentially removed from my life for almost a year. I knew what I needed to do, I ignored what I should do, and God took care of it for me…

So why write about this? Well, first because I’ve been gone; second, because I’m human, and third, because it is a testimony to how you should not ignore where your heart leads you after deliberate prayer. I love my job, and one of the more important things to me is that I am always honest with my patients. Whether it’s me telling them the biopsy shows cancer and they are not going to live very long, or that the reason their test wasn’t done is because I simply forgot to order it, honesty is vital to a good relationship with my patients. Although you all are not patients, you do come here looking for some Paleo advice with a good dose of medical knowledge. I am who I am! I’m not perfect by any means… I’m human, I really like being human, and I want all of you to identify with me as fellow struggler in this thing we call life.

So where do I go from here? Well, my home has gone back to normal in the last few months, and slowly but surely my passion for the Paleo Lifestyle has been brewing up. More specifically, my passion for helping others through the blog has been rekindled. That said, I can’t make the same mistakes twice. So, I’m going in with some ground rules this time that I intend to keep!

  1. I plan on having only one major blog post per week, likely on Tuesdays. Before I was putting way to much pressure on myself to blog every day or two (because of coarse the best way to gain followers and subscribers is to publish, publish, publish!). I want to enjoy this blog, have time to put together my posts, and not have the blog be a burden or distraction to my life.
  2. I still plan on posting Twitter and Instagram posts frequently, so stay tuned to both those feeds for frequent pics of dinner at our house, and anything else I think may be the least bit entertaining of funny.
  3. I hope to develop more recipes in the coming months and emphasize what really got me into Paleo in the first place…cooking food!

So there it is, a long winded explanation of my absence. If you understand where I’m coming from…thanks. If you don’t, sorry, but it is what it is!

One last thing, while you are here, check out my newest venture called The Genesis Experience. In a nutshell, it’s a two month Paleo/CrossFit program I’ve put together with two good friends of mine designed to “shock” people’s systems. Away with the SAD diet and gym visits to watch TV on the stationary bike, and in with Paleo education and eating combined with tri-weekly CrossFit workouts. Results have been awesome!

Thanks for listening, and I look forward to interacting with ya’ll on into the future.

Ernie Garcia

 
10 Comments

Posted by on April 17, 2013 in Uncategorized

 

In Defense of Paleo: No WORDs Needed!

10 Sep

Courtesy of a Quick Google Images Search or Two…

Problem:

Cause:

SAD

Carb Consumption/Obesity DIRECTLY Proportional

Affect:

Adult Obesity Related Diseases

Incidence of Diabetes

Incidence of Childhood Diabetes

Incidence of Vascular Disease (Flat Line)

Incidence of Heart Attack (Flat Line)

How Many Are Diet/Obesity Related?

Solution:

P-A-L-E-O

The End…

-E

 
25 Comments

Posted by on September 10, 2012 in General Paleo Discussion

 

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A Real “Genesis Experience”: 6 WLS Patients and How Paleo Changed Their Lives

03 Sep

Well Hurricane Issac came our way and thankfully we were spared any significant weather.  Many folks south of us are still struggling, and I ask for everyone to pray for their safety and a quick resolution to the chaos that has come into their lives. On top of the hurricane, much has been going on…where to begin…

Several months ago two of my friends and I decided to try something new.  All three of us follow a Paleo lifestyle, participate in CrossFit (each on very different levels as William is part owner of our local gym and one of the it’s trainers, and Sam has been attending CrossFit for much longer than I) and have a passion for helping others.  William Albritton is an engineer by trade, but spends all of his spare time as a CrossFit trainer and health coach.  Sam Bledsoe is somewhat of a rarity as I’m almost certain he is the only Paleo Bariatric Surgeon in the country!  He identified a group of his successful weight loss surgery (WLS) patients who had stopped losing weight after surgery, or plateaued.  He and William devised a plan to put them in an 8 week program based on strict Paleolithic nutrition and consistent application of CrossFit…lucky for me they asked me to join in the fun!  In total, there were 6 lucky participants.

Looking back at our first meeting it was pretty comical.  They really did not know what they were getting into, and we had to completely define the term “paleo” to them.  We set about explaining to them what and why we eat the way we do, and in the process I think I may have broken a few hearts.  Who knew what a stronghold someone’s oatmeal could be!  Regardless, they are all people of integrity, and they committed to our program by trusting our judgement.

So lets just look at this for a moment.  How much more difficult of a challenge could we ask for?  Here are 6 individuals who have fought their weight their whole lives, and who have lifelong food relationships that often were unhealthy.  When you have WLS a certain amount of weight loss is almost automatic, but the last of the loss is much harder.  Here is the thing though, each of these individuals was working hard through traditional weight loss regimens.  Low calorie, low fat, exercise at the gym when you can, walk when you can’t get to the gym…it just was not working.  There is a misconception that overweight individuals are inherently lazy, and this group of people blow that mold out of the water.  They were all trying, they were just trying the wrong things.  One of our group members had already lost 120 pounds since surgery, but had only lost 5 pounds in the 6 months or so before our challenge.  Bottom line is that they did not necessarily “get” what we were telling them, but they were willing to try something new.

So began the process, some form of exercise 5-6 times a week, half of them being CrossFit WODs, and the other days much more light walks or runs.  All along we held them accountable to following a Paleo regimen by turning in weekly food logs and helping them sort through the best choices to make.  Each had their own issues at the start, but they all worked hard to get through the beginning, and quickly began to thrive.  Their group workouts became a source of encouragement and our consistent interaction with them kept their eyes open at all times.  Slowly the magic started to happen, but they did not know exactly how much magic.  Why?  We strictly prohibited them from weighing themselves over the 8 weeks.  It was time to worry about health, not weight!

The results of our 8 weeks was amazing, and I’ll let two things do the talking.  First is a chart of the results.

The numbers in the first row are where each person started, the middle row is their end measurements, and the bottom row is the difference between the start and finish of the 8 weeks.  You are reading right, each person averaged around 20 INCHES of loss over the program.  Now THAT is results!

Please notice that even though overall weight loss was not earth shattering for all, the number of inches lost and overall improvement in body “tone” was awesome.  We did not have one unhappy participant!

Second I’ll let everyone read an essay that one of our participants wrote at the end of the program.  He is an amazing gentleman whose transformation following WLS and our program is nothing short of remarkable.  Here is what he had to say…

At the end of our journey we had a little get together at my home where we were all able to talk and share about the program, and we enjoyed some amazing Paleo food (including a healthy dose of @FitPaleoMom’s Chocolate Chip Cookies).  It was so inspirational to hear everyone’s stories about the struggles over the years, and the positive light that our program was able to put on their circumstances.  All six participants have officially joined CrossFit, and the road ahead will be nothing but success for them.  As a physician is it easy to get discouraged in the day to day grind of taking care of people.  I can honestly say at the end of the 8 weeks we owed, and gave, a heartfelt thanks to each participant for giving their all, and reminding us how much of a difference we all can make.  It was one of the most enjoyable journeys in both my personal and professional life.

So what do we do from here?  We have decided to spread the wealth and open our program to all comers in our area. [www.Genesis-Experience.com] We want to keep attracting people who would never consider coming to the gym and helping them revolutionize their lives.  People looking to “forge elite fitness” will find the gym, we need to go out and FIND everyday people who stand to benefit so much from a dramatic lifestyle change.  As a physician this is what really excites me, changing lives that have been abandoned and failed by the “system”.  If 6 WLS patients can see these changes, anyone can!

Hope all are well…

-E

 
7 Comments

Posted by on September 3, 2012 in General Paleo Discussion

 

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My Take on the New Diet Pills Approved by the FDA (Do You Really Need to Ask!)

25 Aug

I’m sure many of you have seen that two new “Diet” pills were recently approved by the FDA.  Once I saw this, I braced myself for the inevitable flood of people coming to my office asking to be prescribed the latest quick fix; and as expected, I was not disappointed.  I’ve had at least 10 people over the last month ask for one of the new pills, and I thought this would be a great topic to discuss in this setting.  I’ve mentioned in prior posts that in my 15 years of training and private practice I have prescribed diet pills a grand total of ZERO times.  So, will these new medicines change my habits?  Lets look and see what we got.

Qsymia is a combination of phentermine and topiramate and has been approved by the FDA for “chronic weight management in adults who are obese, or overweight with at least one weight-related medical condition such as high blood pressure, Type II Diabetes, or High Cholesterol”.  [I would vote that these conditions, although they are "weight" related, should be more properly described as "nutrition" related...but I digress]  That is a quote from the product web page, and lets keep the information coming from the same source, the producers of Qsymia:

-The effect of Qsymia on cardiovascular morbidity and mortality has not been established. [emphasis added]

-The safety and effectiveness of Qsymia in combination with other products intended for weight loss…has not been established.

-Qsymia can harm your unborn baby.

-Qsymia can increase your heart rate at rest.

-Qsymia increases the risk of suicidal thoughts or behavior.

-Qsymia may affect how you think and is associated with difficulty with attention and concentration, memory, and word-finding. Therefore, use caution when operating hazardous machinery, including automobiles [emphasis added]

-The most common side effects seen in Qsymia clinical studies were tingling in the hands and feet, dizziness, change in taste, trouble sleeping, constipation, and dry mouth.

Because Qsymia contains phentermine (a pharmacologic cousin to amphetamine) it is classified as a federally controlled substance, indicating it can be abused or lead to drug dependence.  It’s basic mechanism of action is to reduce hunger and increase the release of serotonin and dopamine in the brain.  It’s important to note that topiramate, also known commercially as Topamax is a seizure and migraine medicine that just so happens to make people feel full.

The other drug recently approved is called Belviq (lorcaserin hydrochloride) and is approved for essentially the same indications as Qsymia.  Again, let’s look at the package insert for some indications and cautions:

-The safety and efficacy of coadministration with other products for weight loss have not been established

-The effect of Belviq on cardiovascular morbidity and mortality has not been established [emphasis added]

-Warnings and Precautions were listed for:

1) Serotonin Syndrome or Neuroleptic Malignant Syndrome – which means this drug should be VERY cautiously given with traditional antidepressants

2) Valvular Heart Disease

3) Cognitive Impairment

4) Psychiatric euphoria and dissociation

5) Monitor for depression or suicidal thoughts

Most common adverse reactions (greater than 5%) in non-diabetic patients are headache, dizziness, fatigue, nausea, dry mouth, and constipation, and in diabetic patients are hypoglycemia, headache, back pain, cough, and fatigue.

Belviq’s mechanism of action is that it stimulates brain receptors for serotonin, a neurotransmitter that initiates feelings of fullness.  Basically, both of these drugs try to trick your brain into thinking that you are full.

So, will I prescribe any of these medicines for my patients?  Well you guessed it, the answer is no!  The reason is simple, SAFETY.  We may all remember Fen Phen, a diet pill from some years back that was taken off the market due to causing serious valvular heart disease resulting in congestive heart failure.  I remember vividly being called to the ER soon after I moved back to Louisiana to admit a young lady with heart failure.  I remember thinking it odd that a 32 year old female would be in severe heart failure, but the mystery was revealed once I got to the ER and spoke to her.  Turns out she had taken Fen Phen for TWO WEEKS in an effort to lose a few pounds and fit in a dress for a friend’s wedding.  She developed severe Mitral Valvular Heart Disease and resultant heart failure.  She had a valve replacement, but it never worked well and she had severe chronic congestive heart failure as a result.  The look on her face telling me the story said it all…”I was an idiot, looked for a quick fix, and look at me now.”  I really felt bad for her.

A year ago both of these drugs came up for FDA approval and they were denied…why?  They were not felt to be safe from the cardiovascular standpoint, and both seemed to have significant teratogenic effects.  It is simply not known if these drugs can potentially cause the same valvular heart disease that Fen Phen caused.  Now look, I’m not at all saying they will, but information from the MANUFACTURERS themselves clearly state that the risks are unknown.  Also not, the Phen is Fen Phen…yep, it’s short for phentermine.  The FDA stated that the medicines were given approval essentially because doctors needed “something” to combat the worsening obesity epidemic.  I see it as a basic act of desperation from the FDA, and truthfully I understand their viewpoint on this.  Do I agree with it? No, but I understand where they are coming from.  Regardless, this physician won’t be writing out scripts for these meds any time soon.

Now that I got this out of the way, let me make one simple point for anyone out there considering asking their doctor for one of these pills.  There is the misconception out there amongst many people that diet pills are an answer.  Some great conspiracy is holding back doctors from prescribing these meds and we should all be thinner and get to eat more of the things we want without consequences.  Well, let me ask you a few questions…

-If these pills worked, would there be ONE FAT DOCTOR IN THE WORLD? I may not be able to prescribe these meds for myself, but I certainly have 50 buddies on speed dial that could.  Think about it!

-Let’s take it a step farther, would there be any fat people in the world at all, especially those with money? Ever seen a fat rich person?  Sure!  There are plenty around.  Would there be ONE FAT RICH PERSON in the world if it was as easy as finding the right pill?

If you make a statement about your plan to lose weight, and the word “diet” is somewhere in the sentence, just give up because you are going to fail.  By definition a diet is something you are either “on” or “off”.  You will likely lose weight while on it, and gain it back when you get off it.  So essentially all “diets” will result in a yo-yo affect to your weight.

One other thing, the FDA has approved these medicines as “an addition to a reduced-calorie diet and exercise program.”  They are not designed to simply remove the weight without requiring any effort from the patient.  What does that mean?  If you simply take the pills and do not change any of your already bad habits…you will fail again in improving your health longterm through significant weight loss.

There are certain things in life that are easy, and some that are hard.  There are also differences in how difficult or hard those same things are for some to achieve versus others.  Take a look at this well demonstrated problem in America…

Obesity is a very complex problem and it’s rise in America is multi-factorial: lack of exercise, reliance on cheap food built on the backbone of highly processed carbohydrates, poverty, lack of nutritional education, reliance on “quick-fixes” as a society, government subsidies on corn and soy, the gradual extinction of cooking at home combined with increasing numbers of families chronically obtaining dinner through the car window, lack of sleep, an abundance of stress (and cortisol) in our lives!, manipulation of the food supply to promote weight gain, etc.  I could go on and on.  So, REALLY, does ANYONE think a little pill can even put a dent in any of this?

How do we fix obesity?  Well, it’s not easy, but we must get at the root cause if we are to get anywhere.  My motto is Real Food…Real Health.  In the end, the beginning of the end of obesity must itself begin with a transition back to eating Real Food as a society.  I’ve seen it around the web and twitter as JERF (Just Eat Real Food).  This must start on an individual level, with individual families deciding that enough junk is enough.  My family has made that choice, so can yours!

Know anyone thinking about asking their doctor for one of these new pills?  Invite them to read this post, and then ask them to join you on a journey to Real Health by emphasizing Real Food in their life again.  Need more information?  Browse around my blog for ways to change your life.  Are you a reader, check out It Starts with Food by my friends Dallas and Melissa Hartwig.  Don’t know where to start?  Easy…JERF!

-E

 
5 Comments

Posted by on August 25, 2012 in General Paleo Discussion

 

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Just What This Doctor Ordered

20 Aug

Just a quick note to everyone.  It’s easy sometimes to get a little lost as both a physician and a blogger.  Long days, long nights, all trying to get people to be healthier by making simple changes in their lives.  Many do not, but the ones that do keep you putting in the hard work.

I came across this post from Nancy at JustStartsWithMonday about her 4 month journey with the Paleo lifestyle.  I remember her post that many months back that she would have to “check into Paleo,” or something to that affect.  Well check in she did!  And just look at her results!!!  This is the kind of stuff that keeps me going.  If you are new to this blog, and wonder if it can work for you…just ask Nancy!  Talk to your doctor, check your labs, come up with a plan, and make a change.  It’s worth it…

-E

 
4 Comments

Posted by on August 20, 2012 in Uncategorized

 

Easy Paleo Tomato Basil Soup!

17 Aug

I have not posted a new recipe in a while, so here goes!

I absolutely love Tomato Soup, and although the grilled cheese that used to go with it is definitely not Paleo, the soup can easily be made.  You’ll need:

One Small Onion

8-10 Leaves of Fresh Basil

28 oz can of High Quality Whole Tomatos (I use San Marzano’s and they are the best!)

Olive Oil

3-4 T of Organic Heavy Cream or Coconut Cream

It’s just so simple.  Roughly chop the onion and sweat it in the olive oil over medium heat.  Once they are semi-soft add the basil and stir for a minute or so.  Add the tomatos to the pan and heat through.  I usually smoosh them with my wooden spoon just to get the process started.  Season with a bit of salt and pepper, then get out your immersion blender.  Blend until smooth, and add your cream of choice.  Re-season to taste, and you are all set!

Seriously, I dare anyone to say this does not taste AMAZING!!!

If you give it a try let me know, I think you’ll be pleased.  I served it alone side a quick spinach salad for a light and satisfying meal.

-E

 
9 Comments

Posted by on August 17, 2012 in Recipes

 

A Physician’s Manifesto: In Defense of My Profession in Our World

11 Aug

This weekend the Ancestral Health Society had its annual symposium in Boston, MA.  Unfortunately for me I was home (on call none the less!) and was forced to follow the proceedings via the Twitterverse.  I also recently posted about how my change to the Paleo lifestyle has affected the way I approach three common chronic diseases: Hypertension, High Cholesterol, and Diabetes.  Several comments I read from the AHS and that I received on my blog post have got me thinking, and I need to get a few things off my chest.

First of all, I must confess to everyone that although I run a blog site called PaleolithicMD, I am still a common variety Internist in the South of our great nation.  I absolutely push Paleolithic nutrition to everyone in my practice, but it does not in any way stop me from prescribing medicines to my patients on a daily basis.  I am forced to ride the fine line between strict Ancestral Medicine and Modern Day Medicine.  Some may say that is a negative, I even had one comment from someone who chose not to apply to medical school because he could not deal with people who simply want a pill to fix everything.  I find that unfortunate, but respect the opinion none the less.

I had several responses particularly to my stance on aggressive treatment of hypertension.  Several kind readers directed to me to articles stating that the treatment of chronic hypertension with medical intervention to prevent disease is weakly supported.  What concerns me is the “blanket” nature of people’s opinions about high blood pressure.  I, like most practicing physicians in America and around the world routinely review the latest scientific journals pertaining to our field of specialty.  We are true life long learners, one of the aspects of my job that I most enjoy.  That said, arterial hypertension is a systemic disorder, with wide ranging system consequences.  Chronic untreated Hypertension is/will (among others):

-The most common major risk factor for premature cardiovascular disease 1

-Directly lead to Left Ventricular Enlargement and consequently chronic systolic Congestive Heart Failure and increased incidence of ventricular arrythmias 2

-The most common and important risk factor for ischemic stroke, the incidence of which has been shown to be markedly reduced with effective BP control 3

-The most common risk factor for the development of intracerebral hemorrhage 4

-Major risk factor for chronic and end-stage renal disease 5

It is cool and sexy to take a universal stand against all medicine, it must ALL be bad for you.  Not only that, EVERYTHING can be cured by changing one’s diet right!  Take this tweet for instance…

Disease can be prevented, treated and cured by food. Amazing results from research & studies being presented at #AHS12. Totally blown away!

What a far ranging statement!  Most common “Paleo” folk live in and out of gyms, hang out with their fit friends, and search far and wide for the cleanest restaurants to eat at.  We (I include myself in this crowd) source the best farm raised protein and organically grown produce…we live in this perfect little sustainable world!  I live in this world, but I also live in a very different world; one where I take care of very sick individuals.  How am I to care for critically ill patients without medicine to give them, or surgery to fix things? This leads me to my two favorite quotes from today on twitter, both from Dr. Wahls.

“Superior doctors prevent disease. Mediocre doctors treat impending disease. Inferior doctors treat actual disease.”

and

“The doctor of the future will give no medicine. You guys are the doctors of the future. I salute you.”

Let’s talk about each of them in turn.  The first quote is, how can I put it, an incredibly arrogant and asinine thing to say!  What Dr. Wahls is doing is playing to her crowd.  She figures she is in front of a group of AHS attendees who WANT to hear something like this.  Why not make a ridiculous statement and get a few oohs and aahs (I wasn’t there, so I admit some speculation here!)  Her statement takes a very far reaching stance that is dependent on one important thing…that ALL DISEASE is completely preventable by proper nutrition or following the right “Protocol.”  Make no mistake, her story is remarkable and inspirational, but it is not grounds to advocate that all disease is preventable, and that the only “superior” doctors are those who prevent disease.  I guess the ER physician who initiates the life saving care of a motorcycle victim, or the radiologist who diagnoses his injuries, or the trauma surgeon who saves his life from a ruptured spleen, or the orthopedic surgeon who repairs his broken bones, or the nephrologist who temporarily supports his kidney function through hemodialysis, or the critical care specialist who keeps him alive in the ICU until his body starts to heal itself, or the Internist who takes over his care once out of the ICU and methodically advances his care, or the Physical Medicine & Rehabilitation physician who expertly crafts his rehab program…I guess none of these doctors are “superior”…in fact, they are surely “inferior.”  One can read a statement like this by Dr. Wahls and feel all nice and tingly because WE can do this, WE can fight disease through Ancestral Health alone, WHO needs inferior doctors!!!  I can just hear William Wallace himself yelling “But they can’t…take away… our BACON!!!”  What if that motorcycle victim is your dad, or husband, or son…what about those inferior doctors now?  Is all disease preventable by eating more bacon and coconut?  I won’t answer that, you can do that on your own…  You may take this as simply a doctor being defensive, but that is not the case.  Thousands of doctors will be away from their families tonight on call caring for your loved ones with a great deal of compassion and heart.  I refuse to accept a fellow physician downgrading the status of 99% of her fellow physicians simply to get a rise out of a crowd or to advance her personal agenda.  Say what you will, so will I.

So what about the “doctor of the future” comment?  Amazing, talk about playing up to the crowd again with another far fetched statement.  I guess the future will have no doctors nor need any doctors.  All everyone will have to do is read a book on how to eat and live, and we’ll all live to be 120 years old.  Seriously, who will need a doctor?  Again, this is a “cool” statement to make, but it’s just ridiculous in my opinion.  You may agree with her, or just hope she is right, but I can assure you she is 110% wrong.  What will a doctor without medicine do for a broken bone, or a gunshot wound, or a pneumonia, or an appendicitis, or a cataract causing blindness, or a skin cancer caused by SUN exposure, or a congenital heart defect, or an abscessed tooth, or a kidney stone, or a… I hope you get my point.  The thought that the only thing doctors in the future will do is prescribe you their nutritional “protocol” is terribly short sighted and misleading.

Let me explain to everyone where I live, I live in REALITY!  One of the main reasons I started my blog was to stress that there is a real and valid place for both Paleolithic Nutrition AND Modern Medicine in each and every person’s life.  INCLUSION rather than EXCLUSION.  I agree with each of you who is saying things like “but wait, if everyone ate Paleo we wouldn’t have as much heart disease, or diabetes, or high blood pressure, or autoimmune disease, or osteoporosis, or whatever…”  You know what, I think you are absolutely right, but I also believe strongly that Paleolithic Nutrition is not going to be taking the world by storm any time soon.  My job as a doctor is multi-faceted.

-My primary role is to catch people early, before chronic diseases set in, and get them to buy into the idea that their actions, particularly through what they eat, can and will significantly affect their health both short and long-term.  As I like to say, Real Food…Real Health.

-My secondary role is to treat those who have not followed the right lifestyle and consequently have developed any number of chronic diseases.  The most exciting ones are those who are willing to re-adapt their lives and change the habits that got them in trouble in the first place.  The use of medication in these patients is necessary and frequent, but is also often diminished if they can adapt to following a strict Paleo lifestyle.

-My final role is to treat those who will simply not listen to what they are doing wrong, and want to live life the way that they please.  I have said it many times that I believe strongly in NOT JUDGING people in any aspect of life (no, I’m not perfect in this).  What am I to do if someone is unwilling to adapt their diet? Fire them as a patient?  Refuse them treatments that HAVE been proven in studies to help them live longer lives?  If I run a Paleo-Only medical practice I will do two bad things: go broke, and miss out on the amazing relationships and interactions that I have with most of my patients.  You see, just because someone will not give up their carbohydrates despite their terrible blood sugars does not mean that they are not a wonderful person, or that they don’t get benefit from seeing me.  Likewise, just because a physician will not abandon all modern practices and preach only a Paleo lifestyle as the treatment for chronic disease does not make him or her “inferior.”  

So many people advocate for social tolerance all the while berating the many American’s who for whatever reason, cannot adapt to the lifestyle we find so helpful to us.  Or for that matter, look down upon the majority of doctors who simply “push pills” to the benefit of them and the all powerful and evil drug companies.  What about the grandma with pneumonia, or the grandpa with a broken hip, or the mother of two whose husband left her and tried to kill herself, or the 17 year old college student with meningitis…what do I do, hang an IV of bacon fat or pureed beef liver and hope for the best?

This is not us against them, or “superior” vs “inferior” doctors, this is simply the story of humanity played out for all to see.  I’ll say it again, be INCLUSIVE and not EXCLUSIVE.  I absolutely love my job; I enjoy finally breaking through to the diabetic who agrees to give Paleo a try just as much as I enjoy laughing with the 86 year old who knew he was having a stroke because his cigarette kept falling out of the right side of his mouth.  I admitted this gentleman to the hospital, worked him up, put him on Aspirin, and sent him home…where he picked right back up smoking.  I can get mad at him, or just understand my role in his life.  What did he do about all this? He laughed!  The German’s didn’t kill him on the beaches at Normandy, and he’s not too concerned about what the cigarettes are doing to him at this point.

There is nothing inherently bad about you if you can’t fellow a 100% Paleo diet, nor is there anything particularly special about you simply because you can.  I see you as an amazing human being with as much to offer me as I have to offer you.  Guess all this makes me and Inferior doctor…and I’m very proud of my work and the influence I have on people’s lives.

Thank you. I came here tonight… and I didn’t know what to expect. I’ve seen a lot of people hating me… and I didn’t know… what to feel about that, so… I guess I didn’t like you much either. During this fight… I seen a lot of changing: the way you felt about me… and the way I felt about you. In here… there were two guys… killing each other. But I guess that’s better than million. What I’m trying to say is… if I can change… and you can change… everybody can change!          -Rocky Balboa

-E

PS - Also, check out this like-minded quote from Dr. Emily Deans at her blog Evolutionary Psychiatry.

1 Established risk factors and coronary artery disease: the Framingham Study, Am J Hypertension. 1994;7(7 Pt 2):7S.

2 Prognostic implications of left ventricular hypertrophy. Vakili BA, Okin PM, Devereux RB Am Heart J. 2001;141(3):334.

3 Randomized double-blind comparison of placebo and active treatment for older patients with isolated systolic hypertension. The Systolic Hypertension in Europe (Syst-Eur) Trial Investigators. Staessen JA, Fagard R, Thijs L, Celis H, Arabidze GG, Birkenhäger WH, Bulpitt CJ, de Leeuw PW, Dollery CT, Fletcher AE, Forette F, Leonetti G, Nachev C, O’Brien ET, Rosenfeld J, Rodicio JL, Tuomilehto J, Zanchetti A Lancet. 1997;350(9080):757.

4Risk factors for cerebral hemorrhage in the era of well-controlled hypertension. Melbourne Risk Factor Study (MERFS) Group. Thrift AG, McNeil JJ, Forbes A, Donnan GA Stroke. 1996;27(11):2020.

5Elevated blood pressure and risk of end-stage renal disease in subjects without baseline kidney disease. Hsu CY, McCulloch CE, Darbinian J, Go AS, Iribarren C Arch Intern Med. 2005;165(8):923.

 
81 Comments

Posted by on August 11, 2012 in General Paleo Discussion

 

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How Has My Transition to Paleo Changed My Approach To Treating the Big Three In My Patients?

09 Aug

It has been around a year now since I changed to a Paleo lifestyle in my own life, and I thought it would be interesting to look back on my practice and see how I think I have changed in how I approach three common problems: Hypertension or High Blood Pressure, High Cholesterol, and Diabetes.  I can’t stress to everyone how fundamentally different a “Paleo” way of thinking is compared with what I was taught in school.  Most physicians are simply not exposed to information other than the status quo, and whose fault that it is a long story…so, let’s just look at me!

High Blood Pressure:  Statistically, this is the number one problem that I treat in my office on a day to day basis.  95% or so of hypertension (HTN) is of an unknown cause, and is known as “Essential HTN.”  Even over the 8 years I have been out of training our approach to HTN has changed.  We are much more aggressive from the start in treating people’s blood pressure because the more we study the problem, the more it is linked with medical badness in the form of strokes, heart attacks, and kidney failure (among others).  There used to be something called “Pre-Hypertension,” which is now simply known as Stage I HTN.  There are lots of conspiracy theories on the internet about Statin medicines for cholesterol and the evils that they bring.  Notice this though, you DON’T see much bad press for high blood pressure treatment.  The simple answer for this is that HTN kills, and treating it helps prevent death.  It’s very clear cut, our medication options are affective and affordable, and the standard of care is to be aggressive with medical treatment.

Another interesting thing about HTN is that it does not traditionally respond tremendously to weight loss.  Although you can see modest decreases in blood pressure with the shedding of pounds, it’s not often as effective as people wish it would be.  Don’t get me wrong, it helps, but shedding 15-20 pounds rarely leads to the elimination of HTN medications for the grand majority of people.

The one side of Paleo that does certainly help HTN is the decreased sodium intake which accompanies the elimination of processed foods from one’s diet.  What this does is help control a patient’s BP with LESS medicine in many cases.  I used to tell patients that HTN is like a train rolling down the tracks…it’s always rolling, even ever so slowly, and we would have to increase their meds over time to keep up.  I suspect that lowering sodium intake over time MAY help shut the train down.  As I said, the train will likely still be there, just more under control.  Ultimately if I can control blood pressure and keep it from getting worse I will be happy.

So how has Paleo changed my treatment of HTN?  I recommend Paleo to all as an overall way to best improve their health, but I don’t expect people to be able to stop their BP meds, particularly if they are on multiple meds with difficult to control blood pressure.  I emphasize Paleo to limit lifetime drug burden and keep things controlled with hopefully less medicine.  I never partially treat high blood pressure with “watchful waiting.” Take home: don’t mess with your blood pressure!  If it’s high, see your doctor and control it one way or the other.

Cholesterol:  This is a condition that has certainly changed when it comes to the way that I approach patients.  I have always been very aggressive as a doctor overall, and I was typically aggressive in getting a patient’s cholesterol down.  Don’t get me wrong, I still am!  I just may approach it a little differently.  I’ll concentrate on one particular patient type.

In generally healthy patient’s with high cholesterol, but without a known history of cardiovascular disease or strong family history of CV disease, I am definitely less quick to prescribe a statin.  I have an honest discussion with the patient and explain that we need to decide whether or not to treat their high cholesterol.  I am increasingly ordering a more sophisticated cholesterol profile known as a VAP cholesterol to help make that determination, along with assessing how serious the patient is in changing his/her diet to create a generally healthier cholesterol environment in their bloodstream.  What I’m interested in is lowering the bad cholesterol in their body, and also changing the characteristics of that cholesterol from a more dangerous small/dense cholesterol to a less dangerous large/fluffy cholesterol.  If we can do that with a Paleo lifestyle, awesome! This is ALWAYS my first choice.  If patients are unwilling to do that, the next step is cholesterol meds.  The newer statins have indeed shown the ability to shift particle size in the right direction, but I feel it is no where near as powerful as the shift we can see with a strong Paleo lifestyle.  This is my BELIEF, and it is my hope that over time we will have the data to support that.

I treat people, and some people are more willing and able to approach medical problems with lifestyle changes, while some are simply “give me a pill” type of people.  I encourage, but I do not judge.  I’m honest and realistic with all my patients, and I just want to try to help everyone that I can.  I explain my position, and allow them to take a position they are comfortable with…after all, I am treating THEIR health, not mine!

The use of statins in patients with known heart disease is a very complex topic fraught with questions, controversy, and medico-legal issues I’m not up for entertaining.  It would be easy, but foolish to preach on this subject.  If you have known heart disease I’ll simply tell you: educate yourself, consult a physician you are comfortable with, and come up with a plan together you are each comfortable with.

Diabetes:  This is the condition I probably have been most affected by when it comes to my approach to patients and the Paleo lifestyle.  I have had many diabetics commit to a Paleo lifestyle, and the results have been remarkable.  I am currently working on a prospective study looking at the effectiveness of going Paleo on diabetics over a three month period (but more on that later!).

For me, treating diabetes has always been the most difficult of the big three because of how much a patient’s habits ultimately decide the “success” of my treatment regimen.  Blood pressure high?…I can bring it down no problem!  Cholesterol up?…just take this medicine and you’ll look great on paper in 6 weeks!  Diabetes on the other hand is no where near as simple.  Patient’s can quite easily overwhelm their pancreas’ ability to produce insulin, a medicine’s ability to assist their pancreas, or both!, by simply eating the wrong things.  I became quite frustrated as traditional “diabetic” diets seemed useless at improving LONGTERM control of a patient’s disease process.

My Paleo journey began as a personal one.  I did it to feel better, get fitter, and live longer.  The more I researched the science behind it, the more it was obvious to me that it should be a tremendous treatment for diabetes.  It may not eliminate the treatment of the disease with pills or shots, but it could be a great baseline on which to manage everyone.  Again, there is no argument that elevated blood sugars are bad for you, and must be corrected at all costs.  I see Paleo as an alternative for patients to keep their blood sugars lower with LESS medicine!  In the end, only one thing matters…get those sugars down.  Paleo adds another weapon in the arsenal.

Again, with my diabetics I sit down and explain why I feel Paleo will benefit them.  I do this in detail, and utilize some simple handouts I’ve written up as to how making the right food choices can truly help control blood sugar.  I then discuss the experiences my other patients have had after adapting their lifestyle.  I make it perfectly clear that in my opinion, their best chance for long term sugar control and limiting the meds they will need to use is to adapt an 85-90% Paleolithic lifestyle.  If I can get them to bite, I hand them a flash drive with my clinic’s Nutrition Guide we obtained from our friends at Whole 9 Life.  This is all they need to be successful right in the palm of their hand.  Do all patient’s follow through? Absolutely not.  But, it’s a crack in the armor.  Eventually we will have the discussion again, and the next time they may be more willing to give Paleo a more serious try.  As always…one patient at a time.

I’ll admit, it really bums me out when people won’t give it a try.  I practically beg for patient’s to try it for 30 days because I know they won’t go back.  Literally, I have not had one patient who went 30 days go back to eating non-Paleo.  100% success rate for my patients…not too shabby.

There are many applications of the Paleo diet to chronic disease, but my passion at the moment has to do with it’s application in the diabetic population.  From the hormonal standpoint it strikes at the core of the disease, and offers AMAZING potential for REAL change in people’s lives.  I have so many plans…and so little time…

——-

My personal journey in the Paleo lifestyle is far from over, as is my re-orientation as a PaleolithicMD.  I would have never thought a year ago that I would have changed my personal health and diet so much, or that my views on the treatment of these three diseases would have changed so much.  I certainly would not have guessed I would be moderating this blog in an effort to spread the word that Paleo is a valid addition to the traditional fight against chronic disease.  Basically it shows that you can indeed teach an old dog new tricks!  So, let’s see what the next year will bring!

-E

 
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Posted by on August 9, 2012 in General Paleo Discussion

 

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