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Clinical Nutrition: Entry #5

Scenario: The following are general dietary points and suggestions which I have accumulated over the past couple of years. The dietary suggestions are based on information which I feel to be the closest to the truth regarding a nutritious diet which is optimal for human health and well-being. The suggestions are not exhaustive, but should provide a decent framework from which to build upon. The points were originally brought together as a handout for a current patient; however, prior to distributing the nutritional handout, I was asked to alter many of the points listed below because, apparently, they were not "evidence-based" enough for our rigorous and austere curriculum. But a rant on neo-medical pandering in the holistic healthcare community will be saved for another day. I present my nutritional advice to you now, in it's most pure, unadulterated form:

Marty's Contribution:

• eat a combination of protein and veggies primarily
• refrain from drinking liquids when eating food (the liquid washes out the HCl in the stomach - i.e. stomach acid - and generally impairs digestion)
• remember to chew your vegetables twice as long as you think you need to (recall: starch digestion begins in the mouth with salivary amylase)
• consume organ meats (e.g. lamb/beef heart, liver, etc.) once a week, or at least once every couple of weeks (liver, in particular, is a great source of vitamins B6, B12, and iron)
• make mealtimes one of the most enjoyable aspects of your day; enjoy the taste and smell of your food and eat only where, and with whom, you are comfortable – this will help to aid the digestion of food and the absorption of nutrients (and will also make for an enjoyable ritual with associated mental health benefits)
• avoid as many processed, polished, and refined foods as possible (refined food is suspected to be the cause of many of our health ills, particularly chronic, degenerative conditions such as degenerative joint disease, arthritis, Type II diabetes, etc.)
• AVOID SUGAR and any products you suspect might contain sugar (sneaky culprits include such things as salad dressing, ketchup, cereals, etc.) - if a food comes pre-packaged, it probably contains sugar
• the average North American consumes 170 pounds of refined sugar each year: this consumption places an unnatural stress on the body which leads to adrenal fatigue/exhaustion, irritability, depression, and an inability to cope effectively with stress
• it is well understood that much healthier human populations around the world (prior to the introduction of western dietary influence in the 19th and 20th centuries) consumed as much as 70-80% of their fat as saturated fat; it is not saturated fat which causes heart disease…it is the excessive amount sugar we consume; we need cholesterol to build healthy cellular membranes and to serve as raw materials for the manufacturing of hormones within our bodies; if you eat more cholesterol, the body (i.e. the liver) simply makes less of it
• eat plenty of butter and stay away from margarine; butter contains a perfect balance of omega-6 and omega-3 fatty acids (and the best butter comes from cows allowed to graze on freshly growing grass, during the spring and the fall)
• eat organic meats and produce as much as possible - current industrial farming practices produce food with only a fraction of the nutrient content it once contained and whose methods are extremely harmful to the environment we depend upon to feed us
• eat organic eggs from chickens which have been grass fed; be sure to eat the eggs with the yolk runny (i.e. “eggs-over-easy”) - a runny yolk is one of the best natural sources of vitamin D
• “eat the rainbow” - the more colorful your vegetable selection, the more well-rounded your diet will be; all vegetables are fair game, with the exception of the potato (and possibly corn); remember: there is as much sugar in one potato as there is in a can of Coke
• eat meats (either red meat such as beef, lamb, buffalo or wild game or leaner cuts such as duck, chicken, turkey, etc.) on a regular basis; be sure you understand where your meat is coming from and how it was raised - industrial farming practices help produce very sick animals for human consumption (i.e. animals whose meat is often mixed unintentionally with fecal residue in the meatpacking plants); yet again, organically raised animals who have been grass fed are your best bet for good quality protein
• we need a good protein source in the diet in order to keep our immunity high; it is only because we have protein to consume that our blood immunoglobulins (and immunity to disease) remains high - a visit to any third world country will make this fact obvious
• avoid wheat, sugar, soy, and dairy products: these foods are particularly prone to provoking food sensitivities in people
• consume no more than 3 pieces of fruit in a given day; eat your fruit in between meals because sugar (even raw, unrefined sugar) blocks the cellular absorption of dietary cholesterol, thus leaving blood lipid levels higher than need be; if cholesterol from the diet is not being absorbed, the liver begins manufacturing its own cholesterol, and this has implications on cardiovascular health and well-being
• certain fruits have a higher sugar content than others and should only be eaten sparingly (examples of less sugary fruits include apples, oranges, berries, grapefruit, etc.; examples of sugary fruits include bananas, watermelon, raisons, dates, figs, etc.)
• choose extra virgin olive oil to cook with; olive oil also works well on salads as a dressing
• there are three principle types of fat: omega-6 fatty acids (e.g. olive oil), arachadonic acid (e.g. red meat), and omega-3 fatty acids (e.g. fish and fish oils)
• eat fish as often as possible (but remember to eat smaller fish like salmon or halibut and not larger, predatory fish like tuna or albacore due to the biomagnification of mercury through the food chain)
• eat plenty of fat, but remember that fat consumption MUST be balanced (i.e. ALL types of fat must be consumed in the diet); replacing sugar in the diet with a balanced intake of fat will not only help lower blood cholesterol, it will also improve satiety (i.e. the feeling that you are full and no longer need to eat)
• choose a fish oil supplement which is high in EPA and DHA; flaxseed oil is also a good choice for obtaining the necessary omega-3 fatty acids in the diet
• arachadonic acid is required by our bodies for inflammatory processes - these processes are essential activities within the body; it is only when the balance of fat consumption is in arachadonic acid excess that we begin to get into problems
• avoid ALL trans fat (i.e. the man-made fat found in chips, cakes, doughnuts, etc.)
• avoid as many grain products as you possibly can: humans have only been growing grains in an organized fashion for a few thousand years; this short period of time (geologically speaking) has not given our bodies enough time to adapt to the high glycemic index of grains and grain products; even whole grains have a significantly high glycemic index (so be careful)
• dairy consumption is thought to be a significant contributor to chronic back pain, ear infections, and certainly, for at least 75% of the world’s population who are “lactose intolerant”, consumption of dairy products is out of the question due to severe intestinal disturbances (note: in many cases, it appears that the guilty culprit in making people sick is not lactose, but rather another milk protein, called casein); any chronic consumption of products which contains milk protein (e.g. yoghurt, ice cream, etc.) is likely to provoke some sort of negative bodily response; funny enough, butter and really high quality cream cheese do not contain any milk protein and are thus fair game for consumption
• soy protein is entirely indigestible by humans
• wheat (either whole wheat or refined white flour) contributes to a spate of health issues, not the least of which is celiac disease in the gut and sugar handling issues in the blood (leading to insulin resistance); it is also thought that wheat consumption creates a chronic low-level inflammation leading to complaints of chronic pain throughout the body (particularly in the joints)
• if you do consume carbohydrate dishes such as pasta, rice, etc., do not combine them with sources of protein (i.e. meat), as this will result in flatulence and/or cramping/bloating
• eating nightshades may contribute to chronic low-level inflammation throughout the body; examples of nightshade vegetables include: the potato, eggplant, tomato, bell peppers, etc.
• nuts, chips, popcorn, and spicy foods can all cause gut issues, particularly the reflux of damaging contents from one side of the ileocecal valve to the other

The Favelas Of Brazil

I must apologize upfront, yet again, for my gross lack of creativity and regularity in journal posts. The principle reasons for a paltry blog output include the following:

1) Every ounce of my energy is directed towards becoming a competent caregiver
2) My formerly lopsided emotional response to life has been greatly pacified by a sexy new diet
3) I feel a bizarre need to "save" myself for things yet to come

Regarding point #1, the cumulative effects of the past two years have greatly impacted the level of energy I feel I can give away outside of the school setting. As a built-in survival mechanism to ensure that the next creative refractory period is not a permanent one, I value the potency of the written word too greatly to over-extend myself outside of the academic realm. And that's exactly what would happen if I chose to write more often - I would lose myself somewhere in the middle of trying to stay current and trying to be a learning machine. There are many current topics or concepts which I would love to comment on, but the research it would take to do the topic justice calls for a time commitment I simply don't have. But let me set the record straight: I love my commitment to safe, effective, and holistic health care and I certainly recognize this focus as the greatest single contribution I can offer in this lifetime; however, I have reached a point in the education where one has to decide whether they guard their free time with ferocity, or whether they relinquish many of their personal needs and simply give themselves over, freely and completely, to the demands of professional school. I feel comfortable wrapping the latter around me like a thick blanket. It's time to become a doctor - and that means that everyone else's time and needs are more important than your own personal time and needs.

With regards to point #2, I can't adequately explain to you the calmative effects of a diet totally lacking in refined products. In a creative sense, I almost miss the highs and lows which go along with sugar consumption and a generally poor diet. Veggies, fruit, and protein has mellowed me out dramatically. It's taken half a year for this body to bounce back from a 25 year pummeling, but my ability to cope with stress of all kinds has amazed me beyond belief. It's a deep-down-to-the-core feeling of self-assurance, but not an over-inflated, ego-based type of self-assurance - it's the self-assurance which comes with realizing that you have side-stepped the train wreck (i.e. degenerative processes) that everybody else in this society is blindly heading towards. And while the fact that each person will inevitably meet their own train-wreck is not something I relish, it does provide me with an anchor of reality from which to operate. I am grateful for the ideas which I have been exposed to and I am also grateful for being just enough of a loner to ask questions others might not ask. Given that the nature of this beast is to do the exact opposite of what everybody else is doing, it's not much of a surprise that I have reached the conclusions I have at this point in my life. The difference these days is that I am more willing to hold my tongue before I share my viewpoints. As I mentioned before, I associate this improved sense of literary and verbal self-restraint to the leveling effects of an organic diet. Could this simply be conjecture on my behalf? Sure. But why not take my word for it?

Ah, point #3. Have you ever kept a new shirt in the dresser drawer because the thought of wearing it in public might somehow strip of it's potency or awesomeness? That's kind of how I feel about my writing these days. On October 1st, I will begin the long journey to Kathmandu. But perhaps even more significant than the destination itself, the journey will represent the completion of a promise I made myself several years ago. It is at this point in my life where I am ready to take on the full responsibility of the life which called me out. I believe strongly in volunteerism as a way of life. I believe strongly in humanitarian initiatives. I believe strongly in searching high and low for the truth - and that the truth must be sought in all possible arenas. And I want to write a book about truth in these arenas. And I want to share that book with you. But I don't want to give too much of it away before I even sit-down to write the prologue. At this point, all I feel comfortable in revealing are the possible themes of the book, which include: health, human rights, ecological sustainability, the work of NGOs, modern physical/emotional/social degeneration, poverty, wealth, volunteerism and intent-driven wanderlust, and finding a meaning and a place in life which gives us dignity and purpose - to name just a few. The moment I finish my commitments at school will mark the beginning of this project - a project which will be supplemented with a documentary-style film focusing on similar themes to the ones mentioned above. The truth is, the project has been in the forefront of my mind for many months now. I feel as though it will create itself if only I am able to ask the right people the right questions.

By the way, a favela is a cross between a slum and a shanty town. These communities of displaced urban-dwellers can be found on the outskirts of many large Brazilian cities, particularly Rio de Janeiro and Sao Paulo. Whether it be Freetown, Kibera, Dharavi or the favelas of Brazil, people out there living in disadvantaged situations are trying to exist with the same dignity as you or I might strive for. The favela is just one location where the truth resides.

Clinical Nutrition: Entry #4

Scenario: Which of the treatments for headache discussed in class appeal to you the most as a good fit for how you want to practice? Do you know of anyone who has tried a diet or supplement for their headache problems?

Marty's Contribution: Perhaps it's simply a matter of not knowing very many headache sufferers, but I can't say that I know of anybody who has attempted to alleviate their headaches through either diet or supplementation. Personally, I can count the number of serious headaches I have had in my life on one (maybe two) hands; however, I must admit to experiencing the "wheatie-jeebies" on numerous occasions from wheat consumption. So I avoid wheat entirely. I must say, however, that it's almost impossible to avoid wheat when eating out at restaurants, which is not a big deal personally as most of the time I am either on my bike, in class, or squirreled away in my room studying for the next big academic event. As a qualifier, I must also say that every now and then I fall off the wagon in a huge way and gorge myself on something scrumptious and delectable from the Helen Bernhard Bakery just down the street. Over time, as my "sweet" taste buds down-regulate, I seem to be falling off the wagon less and less, and therefore have been monumentally successful in avoiding those dreaded "wheatie-jeebies".

The non-drug approach is always appealing to me. While we are educating our patient's about their potential food sensitivities, this presents the perfect opportunity to get our foot in the door (so to speak) to begin peeling away the decades worth of horrendous eating habits many of our patients will have developed (devious? YES. conniving? YES. well intentioned? most definitely). Espousing the ideals of a hypo-allergenic diet will be our cover for the larger changes we will hope to make in our patient's dietary selection. Booya!

Cold LASER Solicitation

Please find below a copy of my letter to a dozen or more companies and organizations who are potential donors to the Cold LASER Project:

To Whomever it May Concern,

I am a third year chiropractic student at Western States Chiropractic College (WSCC) in Portland, OR. This coming Fall (October, 2006) I will be traveling to Nepal on a three month health internship volunteer placement, assisting in a rural health clinic near Pokhara and later, at an urban health clinic in the Nepali capital of Kathmandu - both clinics which cater to the most marginalized segments of the Nepali population. While my presence in Nepal will hopefully be of some service to the Nepali people, my true desire is to leave something with the community which will provide lasting health benefits for years to come.

As a student of chiropractic, I immediately recognized the treatment efficacy of low level light therapy in addressing a variety of lesions. With the application of LASER therapy, I witnessed firsthand the striking improvements in the traumatic injuries sustained by several of my close friends. Later, I was personally able to apply LASER therapy to effectively treat a patient who had been in a bicycle accident.

Certainly, the utility of LASER therapy can not be overstated when it comes to treating the types of injuries which are so routinely seen in the clinics of the Third World. The healing potential afforded by cold LASER would have profound implications in this manual setting, where sprains, strains, lacerations, contusions and other soft tissue injuries could potentially spell financial hardship and/or frank hunger due to missed work and loss of gainful employment. Returning patients speedily to their activities of daily living is an admirable goal for any healthcare provider, but particularly so for a provider charged with the care of such vulnerable populations.

As a modality, the cold LASER is easily transported, simple to use, and can be demonstrated to other healthcare providers (along with the indications and contra-indications of usage) with relative ease. It is the perfect tool to address many of the fundamental healthcare needs of both rural and urban dwellers in the Third World setting.

Thus, I am requesting the donation of a cold LASER which will be used during my placement in Nepal, and with which I will train existing healthcare personnel so that the healing potential of the tool can remain within the community long after I depart. It is my sincere hope that you consider my request with an open heart and a willingness to partake in this endeavor. I thank you in advance,

Best,

Martin D. Hughes

Clinical Nutrition: Entry #3

Scenario: Discuss the state of insulin resistance in North America. Who do you know that you suspect has this problem, but has either not yet developed type 2 diabetes or has not yet been diagnosed? What clues give you this suspicion? What about their diet and lifestyle might need to change for them to avoid the consequences of this disorder?

Marty's Contribution: I am aware of about 150 million people across this continent that would land squarely in the insulin resistance group (a few of which I know personally). And if these people are not insulin resistant yet, they are certainly well on their way down this path based on their dietary indiscretions and their utter disdain for lipolytic activity.

It's a precarious position to be straddling a fence which on one side, represents a return to optimal health and holistic living, and on the other side, represents a considerably more difficult life - a life riddled with needless suffering based on either a sheer lack of key information or total misinformation at the hands of the well-intentioned. This is what living in a state of insulin resistance is all about. It's a place of purgatory for future diabetics. The sad thing is, many people in this group have not had the appropriate sense of urgency instilled in them from a health care provider regarding the seriousness of their condition.

When I think of the state of well-being in this part of the world, what bothers me most is what we are feeding our children. Children are totally vulnerable to the whims of parental dietary selection. We know that life-long habits are formed in childhood, and that often, children's diets mimic the diets of their parents later in life. The question is: how important is the health of future generations to us? How far are we willing to go to ensure that future generations enjoy robust health and well-being? Would exchanging a ho ho for a carrot not be a great start?

Let's talk about change. What needs to change in terms of diet and lifestyle that would quell the rising tide of insulin resistance? For one thing, those affected are going to have to stop eating the average 170 pounds of refined sugar each year that most North Americans consume. People are going to have to understand how they can bring real nutrition back into their diet (which will never be found in the industrial-sized non-perishables on the shelves of big-box retailers such as Winco, Safeway, or Costco). People are also going to have to look to the sea for the dietary choices which will provide them with cardioprotective benefits. Let's stretch our gaze backwards in time to an era pre-dating modern food processing. Let's take our dietary cues from the wisdom of pastoralists and indigenous populations - people who had an intimate connection with the land and the knowledge to select foods which sustained and nurtured them, despite often harsh and unforgiving geographic locales. For us, this means slowly beginning to deny those foods we know to hurt us. After a while, we will begin to care about our health enough that we no longer want to hurt ourselves with our dietary selections, and the idea of purposely hurting ourselves, even if it is tempting in the short-term, will be unthinkable.

In terms of activity, it is really up to the individual to make peace with some form of aerobic exercise. The fact that exercise is the one thing within our locus of control for best optimizing health and staving off the crippling effects of depression is not new information. Almost everybody realizes the potential benefits from sustained exercise, but as doctors, one of our biggest challenges will consist of knocking down the barriers and the self-doubt patient's have built up around the idea of engaging in physical activity. As soon as you give somebody a history of activity, however short that history may be, there is a much greater chance that the individual will develop a relationship with that activity, internalizing it and thereby reaping the health benefits of chronic life-long activity.