When I was in medical school and learning how to perform basic tasks, like reading an ECG or a chest x-ray, I was taught very specific protocols for each process. For example, reading an ECG was RRABEIIM - rate, rhythm, axis, bundles, enlargements, intervals, ischemia, morphology. The goal was to make sure nothing was missed, nothing was inadvertently overlooked.
In other words, taking shortcuts - such as jumping to the evidence of a heart attack occurring - might mean missing a long QT interval, which could lead to serious problems if medication choice did not take this into account.
Pilots, auto mechanics, chefs, and in fact almost every profession uses checklists or SOP's in some form to make sure a vital process does not get short-circuited.
Supplements - Do They Work?
I have to admit, it seems logical to assume that if a substance is found to have health benefit in nature, it should have similar benefit if taken in the form of a supplement. But is this true?
It turns out...
This is Daisy. She's our "pandemic dog." You know, since the world is turning upside down, why not throw a new creature into the household mix?
She came to join our family a month ago, a one-year-old rescue from Texas, and when she arrived she was incredibly timid. She wouldn't come within about 6 feet of me without lots of coaxing (and food bribes), and she spent most of her time hiding under our bed.
Now that she's been with us for a month, she's starting to show a lot of personality, and there are lots of ways she brings me joy. I love how excited she gets for her food every morning, leaping about and quivering with excitement - it's like Christmas morning with a toddler every day! She likes to hoard toys. She'll find systematically take one item at a time to her bed until she's sitting on a pile of 8-10 bones, balls, and other assorted toys. When she's in a mellow mood, she'll follow me around and just rest peacefully nearby wherever I might...
I've noticed something interesting. When someone is diagnosed with type 2 diabetes, the doctor thinks about controlling risk factors. Control the blood sugar. Control the blood pressure. Control the cholesterol. All of this to reduce the risk of developing problems related to diabetes.
Most people when diagnosed, however, think about reversing diabetes. Make it go away. Get off medications. Punch diabetes in the face so it never comes back.
Unfortunately studies and experience have not suggested that people are likely to make and sustain the changes needed to reverse type 2 diabetes.
But could diabetes reversal be possible?
The "Twin Cycle" Hypothesis
Dr. Roy Taylor from Newcastle, UK, developed an interesting hypothesis about the cause for diabetes which gives hope that it can be reversed commonly, especially within the first 4-6 years after diagnosis. He published about the twin cycle hypothesis in 2012 after performing preliminary studies showing support for the idea.
Meet your river guide
Just before I got married, several of my friends took me on a guys' adventure day, which included a day whitewater rafting on the Arkansas River. As we signed in, we received instruction about river safety, got our life vests, and hopped on a bus that took us to our starting point.
On this day we would be hitting class 3 and class 4 rapids, which are not as big as they come, but plenty big for a novice like me.
And then we met our guide. He would be in charge of steering the raft, helping us to make our way down the river safely, showing us where to go, what to avoid, and how to get past obstacles. He was skilled and knowledgeable, a good teacher, and he delivered us to our destination safely. Along the way we had an amazing time together.
The healthcare system - a contrasting approach
In some ways, I believe that the healthcare system uses a very different approach. As you try to make healthy choices, overcome obstacles, and make progress, how often do you...
Yesterday I swept out my garage in the morning. It's amazing how quickly the dust and dirt accumulates in that space. Then I swept the kitchen. We have a new dog (our pandemic addition), doubling our canine count and apparently our dog hair production. In the evening, I sat on the front porch for my final Zoom meeting of the day and couldn't help but notice the cobwebs and old blossoms accumulating around the bench and front door. Sigh. I saved that cleaning for another day.
It struck me that just like debris seems to accumulate around my house, debris accumulates in my lifestyle. It's a slow creep, but little things start to show up. A bit more liberal with snacks in the evening after dinner. A bit less attention to getting enough vegetables. Even a bit less focus on staying connected with my wife.
Does this happen to you too? I suspect it does. And just like our homes need a periodic sweeping and dusting, our lifestyle choices would likely benefit from periodic...
"Eat breakfast like a king, lunch like a prince, and dinner like a pauper."
It's likely you've heard this statement before. Results from a new study add additional support for the idea that this might be the way the human body was designed to eat.
Bigger dinners may increase risk of metabolic disease
Researchers analyzed data from the NHANES nutrition survey, specifically from almost 4700 people with diabetes. Based on food recall questionnaires performed on 2 separate occasions, they broke people into 5 groups based on the amount of food eaten at dinner compared with breakfast.
What they found was that compared with the group the ate the least at dinner, the group that ate the most had an increased risk of diabetes-related mortality (1.9 times greater risk) and heart disease-related mortality (1.7 times).
The authors of the study also created risk models based on their data, and concluded that:
The Value of Exercise
You know that exercise is important. The body just doesn't work right if you are not moving. In particular, it becomes harder for you to efficiently burn fat when you are sedentary. But even though we know exercise is important, it can be really hard to get it done, right?
Let me tell you about two of my clients, each of whom has diabetes or prediabetes. I was struck by their stories, and I'd like to share a bit with you.
Matthew* uses insulin to control his blood sugar, and he tests his glucose regularly. Over the past year he has gone back and forth from being well-controlled, to not well-controlled, and back to controlled again. Now Mr. L will admit he doesn't like to exercise. It is hard for him to get out for a walk on a regular basis. But interestingly, the key factor we identified for when he is well-controlled is that during both of these periods he was remodeling his house - first his kitchen and then his garage. And he really...
Is this food healthy?
Before the pandemic, I ordered a latte from a local barista. In our exchange, the barista mentioned I might like to try it with coconut milk, because it's "healthier than cow's milk." Whether it's a blessing or a curse I haven't decided, but statements like these catch my attention. Where does this claim come from? Is it true? What is the evidence that supports this claim?
With all of us basically trapped at home these days because of COVID-19 and social distancing, many of us have much more time to spend online. Of course we want to stay healthy, even though the world seems like it got turned upside down, so seeking nutrition advice is common. And in the online world, there is no shortage of nutrition claims! But alas, online there is a great shortage of evidence.
Let's discuss what comprises good nutrition, emphasizing a few concepts that you will hopefully find useful.
The hero's body
Last week I wrote about how The World Needs You to Be a Hero. I believe...
Everyone loves a hero
When I was a kid, every week I could not wait for Saturday morning cartoons. I would get up, race downstairs with my sister, and spend the next 2-3 hours watching the week's new shows.
My favorite cartoon was Super Friends, which brought together all the superheroes from the Justice League - Superman, Batman & Robin, Aquaman, and Wonder Woman - who would use their superpowers to battle the forces of evil.
While watching Saturday morning cartoons is no longer a childhood ritual, I believe most children still dream of using their special gifts to save others, fight for justice, and bring goodness into the world.
What is a hero?
Reconnecting with old friends during COVID-19
As I write this, one of my college housemates, a cardiologist in Miami, has been sick with COVID-19 and on a ventilator for almost a month. He is showing signs of improvement but it's been really slow, nail-biting progress.
While this is of course a terrible a circumstance, one of the blessings that has come out of it has been the opportunity to reconnect with my 6 other housemates, several of whom I've not seen for more than 10 years. We had a great Zoom call this last weekend, with prayers and worry broken up by laughter and fun memories.
While maintaining relationships has never been something I've been good at, right now I'm encouraged to be on the lookout for other opportunities to re-establish old friendships or family bonds.
Immune function and social connections
Perhaps because of this, an older study caught my eye this week. Published in 1997, researchers actively placed cold virus in the noses of 276 healthy...
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