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Omega-3 Fatty Acids Come From Green Plants

The food industry has been urging me to eat fish. The supplement companies have been urging me to take fish oil supplements. They claim that omega-3 fatty acids prevent heart attacks. Some people even claim that a baby cannot develop a normal brain unless its mother ate fish or took fish oil supplements. In contrast, nutrition scientists tell me that green plants are an excellent source of the only omega-3 fatty acid that is essential in human nutrition. This could explain why populations that rarely if ever eat fish can have healthy hearts and healthy brains. In fact, the healthiest populations are the ones that eat very little fat of any kind and lots of vegetables.

All of the omega-3 fatty acids in the food supply came originally from the green plants and blue-green algae (cyanobacteria) that are at the bottom of the food chain. An omega-3 fatty acid called alpha-linolenic acid is an important part of the thylakoid membranes that are involved in photosynthesis. No animal can make an omega-3 fatty acid. Animals do not have the enzymes that would be needed to put a double-bond in the omega-3 position in the hydrocarbon chain of a fatty acid. However, animals can lengthen the carbon chain of an omega-3 fatty acid. Thus, fish and other animals (including human beings) can convert alpha-linolenic acid to longer-chain omega-3 fatty acids, such as eicosapentaenoic acid (EPA) and docosahexaenoic acid (DHA). For this reason, you can find EPA and DHA in fish but not in ordinary plant-source foods.

According to the Food and Nutrition Board of the National Academy of Sciences, there is only one omega-3 fatty acid that is essential in human nutrition. It is the alpha-linolenic acid that is found in thylakoid membranes of the chloroplasts of green plants. For this reason, you can get this omega-3 fatty acid from eating green vegetables. Flaxseeds, hempseed, and walnuts are also good sources of alpha-linolenic acid.

You need only a little bit of alpha-linolenic acid from your food. The dietary requirement for the two essential fatty acids (alpha-linolenic acid and an omega 6 fatty acid called linoleic acid) was discovered only after hospitalized patients started being fed fat-free solutions for an extended period. Yet even their need for these essential fatty acids could be met by rubbing a little bit of vegetable oil on the skin.

For years, many people have been urging the public to eat fish or take fish oil supplements, to reduce the risk of heart attack. Populations that eat a lot of omega-3 acids, from cold-water fish, do have a somewhat lower-than-expected rate of fatal heart attacks. However, this is probably because of the blood-thinning effects of omega-3 fatty acids, which could also lead to more deaths from major bleeding. If you really want to make yourself heart-attack-proof, eat a low-fat, plant-based diet to keep your total cholesterol below 150 mg/dL.

Some manufacturers of baby formula have been adding DHA so that the formula will have a DHA content similar to that of breast milk. Yet whether the additional DHA provides real benefits to the baby is still unclear. However, these studies do raise concerns about giving too much long-chain omega-3 fatty acid without also providing a supplement of arachidonic acid.

I do not know whether any vegans (such as pregnant women or the elderly) would benefit from supplementation with the longer-chain omega-3 fatty acids. If these supplements are beneficial, it would be best for them to come from a plant source. Plants are less likely to be contaminated by the pollutants that build up in animal tissue.

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Cats Cannot Get Vitamin A From Carrots

Beta-carotene is a yellow pigment that is found in many yellow, orange, and dark-green vegetables. For human beings and many other mammals, beta-carotene is a provitamin of vitamin A. This means that beta-carotene does not have vitamin A effects until the body converts it to retinol. Human beings can convert beta-carotene to retinol. Thus, human beings can get vitamin A from the beta-carotene in fruits and vegetables. In contrast, cats cannot convert beta-carotene to retinol. Retinol is found only in meat and other animal products, such as egg yolk. For this reason, cats cannot survive on a purely plant-based diet. If you want to make a purely plant-based (vegan) cat food, you must add the nutrients, such as retinol, that normally come only from animal sources.

Cats must get their vitamin A in the form of retinol or related compounds (such as retinyl palmitate). In contrast, it is better for human beings to get their vitamin A in the form of beta-carotene. The human body converts beta-carotene to retinol on an as-needed basis. If you eat a huge amount of the fruits and vegetables that contain beta-carotene, some of the extra beta-carotene might build up in your skin. As a result, you will get a healthy golden glow that is more attractive than a suntan. In contrast, if you overdose on retinol, either from taking supplements or from eating polar bear liver, you will get a potentially fatal swelling of the brain. This condition is called pseudotumor cerebri (which literally means fake tumor of the brain). If the brain swelling damages the nerves that connect the eyes to the brain, the result can be permanent blindness.

Human beings should get their vitamin A in the form of beta-carotene. And they should get their beta-carotene from fruits and vegetables, rather than from pills. People who eat a lot of fruits and vegetables tend to have better health, including lower rates of cancer. You cannot get the same effect by taking the vitamins in pill form. In fact, the vitamin pills might actually increase the risk of cancer.

In the 1980s, the National Cancer Institute launched a major study called the Carotene and Retinol Efficacy Trial (CARET). The purpose of the study was to see whether pills containing beta-carotene and retinol (in the form of retinyl palmitate) could reduce the risk of cancer in people who were at high risk for lung cancer. The study was stopped early because the cancer rate turned out to be higher in the people who got the vitamin A pills than in people who got a placebo.

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Teach Doctors Nutrition, Then Let Them Practice Medicine

The major causes of death and disability in the United States today are diet-related diseases. As I explain in my book Where Do Gorillas Get Their Protein?, you can prevent heart attacks and many cancers by eating a low-fat, purely plant-based (vegan) diet. That same diet can also prevent and even cure some serious autoimmune diseases, such as rheumatoid arthritis. Yet doctors are not being taught about diet. Instead, they learn how to use medications and surgery to treat diet-related diseases. To avoid paying for those expensive treatments, insurance companies are putting restrictions on what kind of care they will cover.

Often, insurance companies refuse to pay for an expensive treatment until the doctor has proved that all of the cheaper treatments have failed to help that patient. This policy is called “fail first” or step therapy. Unfortunately, a patient with a serious condition could die or end up permanently disabled unless the right treatment is used right away. As a result, doctors have been spending more and more of their time in negotiations with insurance company clerks. Tragically, those clerks often end up making the treatment decisions, even though they are not qualified to practice medicine and have never even met the patient. To solve this problem, we must give doctors better training in nutrition, and then let the doctors, rather than insurance company clerks, practice medicine.

Step therapy is a perversion of a good medical idea called stepped care. Stepped care is the idea that patients with a less urgent or less serious case should get treatment of a lower intensity, at least at first. For many illnesses, it makes sense to start with a less-intensive treatment (such as a change in diet) rather than using a more-intensive treatment (such as medication). Even if medication is needed, it may make sense to start with a cheap generic medication with a well-established safety profile, rather than using an expensive new drug whose long-term safety is unknown. Yet even if doctors are using the stepped care model, they do not need to start with the bottom step. They can jump to a middle step or even the top step in serious cases.

In stepped care, the doctor and the patient make the medical decisions. But in “fail first” or step therapy, the bean-counters at the insurance company make the medical decisions. By requiring “fail first,” insurance companies ensure that a lot of patients will have treatment that fails. In contrast, doctors want to pick the therapy that is most likely to succeed.

Since so many deadly and disabling diseases are caused by an overly rich diet, dietary management should be the first step in managing them. Dietary therapy itself can follow a stepped care approach. For arthritis patients, the first step in dietary management is a low-fat vegan (purely plant-based) diet. Animal proteins and fatty foods promote arthritis. If the animal proteins enter the bloodstream before they are broken down into individual amino acids, they can provoke the immune system to make antibodies. Since the animal proteins resemble human proteins, those antibodies can then attack the person’s own tissue. Diets that are high in fat and cholesterol make this problem worse by damaging the lining of the intestine, making it leak. (Some of the medications used to treat arthritis pain also damage the intestine.)

If a low-fat vegan diet does not provide adequate relief within a few weeks, the patient can also eliminate the gluten-containing grains (wheat, rye, and barley). If problems persist, the patient can be taught how to follow a formal elimination diet, which excludes the other plant-source foods that are known to cause problems in some patients (e.g., corn, soy, strawberries, citrus fruits). After the patient feels better, plant-source foods can be carefully reintroduced, one at a time, to identify the foods that were causing problems.

In severe cases, such as a flare of rheumatoid arthritis, the doctor may want to start with a therapeutic fast, which is the top step in dietary management. A therapeutic fast involves taking nothing but water by mouth for days to weeks, in a setting of complete rest. This is the ultimate elimination diet. By eating nothing at all, the patient avoids all possible dietary triggers of disease. A therapeutic fast also causes hormonal changes that stop runaway inflammation. After the fast, foods should be reintroduced carefully, one at a time. Therapeutic fasting should be done only under medical supervision. It is powerful medicine against the diseases of overnutrition, such as type 2 diabetes and hypertension (see chapter 9 of my book Thin Diabetes, Fat Diabetes: Prevent Type 1, Cure Type 2). It has long been known to be a safe and effective treatment for a flare of rheumatoid arthritis.

Insurance companies develop policies to boost their own profits, not to protect their subscribers from getting the wrong treatment. There is a better way to control healthcare spending, while improving public health. Give doctors basic training in nutrition. Teach them how to use diet rather than drugs to solve diet-related problems. Then, let the doctor decide what other kinds of treatment his or her patient needs, even if that treatment is expensive. Let the doctors, not the accountants, practice medicine.

Start Giving Vitamin C to Septic Patients Now!

It sounds almost too good to be true. Dr. Paul Marik, the Chief of Pulmonary and Critical Care Medicine at Eastern Virginia Medical School, in Norfolk, Virginia, has found that a cocktail of intravenous vitamin C and corticosteroids, along with a little bit of thiamine, may be a cure for sepsis, which is a major cause of death. (Sepsis killed Patty Duke and Muhammad Ali.) Many physicians are skeptical of Marik’s claim, for two reasons. First, they have heard a lot of nonsense about vitamin C over the years. Second, they have been trained to wait for the results of a double-blind randomized controlled trial before they make any change in how they practice medicine. As a result, they may be slow to adopt Marik’s protocol. But if they hesitate, they will miss the chance to save lives. Physicians have nothing to lose by trying the Marik’s protocol. Patients have everything to lose if their physician hesitates.

Marik’s breakthrough came in January of 2016, as he struggled to save the life of a 48-year-old woman suffering from overwhelming sepsis. He had recently read that vitamin C might be a useful treatment for sepsis. He recalled that steroids, which are commonly used for treating sepsis, might work well in concert with vitamin C. So he ordered that the patient be given a combination of steroids and vitamin C intravenously. Within hours, she started to recover. Two days later, she was well enough to leave the intensive care unit. Then, Marik and his colleagues used the same treatment on two more patients who seemed destined to die of sepsis. Those patients also recovered. At that point, Marik and his team adopted the combination therapy as standard practice. They eventually added a small dose of thiamine to the protocol, because sepsis patients are also often deficient in thiamine. Since then, they have not seen a single patient die of sepsis. (However, some did die of the underlying disease that led to sepsis.)

Marik’s claims have been supported by an adequately powered clinical study. However, that study was retrospective. It compared 47 consecutive septic patients treated with his protocol to 47 septic patients who had been treated before his institution began using the protocol. Only 4 of the 47 patients treated with the vitamin C protocol died, as compared with 19 of the 47 patients in the control group (P<.001). Most importantly, none of the patients in the treatment group developed progressive organ failure. That finding suggests that the treatment is effective against the sepsis, in particular.

Marik’s claim makes biological sense. In 2012, Wilson and Wu explained the mechanisms by which vitamin C could improve microvascular function in sepsis patients. They explained that the vitamin C would have to be given intravenously to provide adequate ascorbate concentrations in plasma and tissue. In 2015, Carr et al pointed out that septic patients present with hypovitaminosis C and explained that the enzymes that are involved in the synthesis of norepinephrine and vasopressin require vitamin C as a cofactor for optimal activity.

Some methodological purists may quibble about the supposed “flaws” of the design of Marik’s study. They may insist on a prospective, randomized, placebo-controlled study before they adopt the vitamin C protocol. Yet such a study would violate a basic principle of medical research ethics. Researchers are not supposed to assign patients with a serious illness to different treatment arms unless there is real uncertainty about which of the treatments would be better. This principle is called clinical equipoise. Yet there is no real uncertainty. The probability that the results of the retrospective study were due to random chance are less than one in a thousand. Nor was there any reason to suspect that the differences in outcome were due to any confounding variables. Nor are there any serious safety concerns about adding vitamin C and some thiamine to the commonly used corticosteroid treatment for sepsis.

Regulatory agencies typically require drug companies to do double-blind, randomized controlled trials to support a new drug application. Yet there are some exceptions. For example, the Food and Drug Administration approved lepirudin (Refludan®) for anticoagulation in patients with heparin-induced thrombocytopenia on the basis of a clinical trial that used historical controls, rather than assigning patients to a placebo treatment that would have threatened life and limb.

So we now know that a vitamin C, which is a cheap, easily available product with a long history of safe use, is probably the key to the successful treatment of a major cause of death. The medical profession will be judged by how fast or how slowly it acts on this information.

Photo by Unhindered by Talent

 

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Is the Alkaline Diet Good for Your Health?

The proponents of the Alkaline Diet are urging you to eat the right foods, but for the wrong reasons. The Alkaline Diet is based on the idea that you should eat foods that have an alkalinizing (pH-raising) effect on the body, while avoiding foods that have an acidifying (pH-lowering) effect on the body. The proponents of the Alkaline Diet often make claims that are clearly nonsense. For example, some of them claim that the diet will cause your blood pH to rise to 8.5, thus killing cancer cells while allowing ordinary cells to survive. That is clearly false. On the other hand, some detractors of the Alkaline Diet also say some things that are false. Some of them are simply against vegan diets, for ideological reasons. Others fail to grasp how an acidic food, such as lemon juice, could end up having a net alkalinizing effect on the body, as I’ll explain below.

If you eat the kind of diet that the promoters of the Alkaline Diet recommend, your health will almost certainly improve. The foods that have the strongest acidifying effect on the body come from animals: dairy foods, meats, fish, and eggs. Grains and beans have only a small acidifying effect. In contrast, nearly all fruits and vegetables have a net alkalinizing effect. For this reason, people who avoid the most acidifying foods will end up eating a vegan diet, including lots of fruit and vegetables.

A vegan diet is great for your health, as long as you don’t eat too much fat (from oils, nuts, or avocadoes) or too much refined sugar (empty calories) and as long as you take a vitamin B12 supplement. A low-fat vegan diet provides plenty of fiber and carbohydrate. It provides no cholesterol or animal protein. As a result, a low-fat vegan diet will stabilize your blood sugar, help you lose weight, and reduce your risk of heart attack, stroke, and many cancers and autoimmune diseases. Yet even if you are eating a lot of alkalinizing fruits and vegetables, your blood pH will not change. It will stay at almost exactly 7.4, unless you get really sick. Nevertheless, the alkalinizing effect of a vegan diet does provide a few benefits: a decrease in the risk of gout, kidney stones, and osteoporosis.

The Alkaline Diet has come under fire from skeptics who point out (correctly) that this diet does not really alter the pH of your blood. Unfortunately, many of these skeptics are unaware of (or in denial about) the health benefits of a low-fat vegan diet. Some of them even fail to understand how an acidic food like lemon juice (pH of 2.0 to 3.0) could have a net alkalinizing effect on the body.

All foods are mixtures of organic and inorganic compounds. If you burn a piece of food in a laboratory, most of the organic compounds will be oxidized to form carbon dioxide and water. After the food is completely burned, you will be left with an ash that contains inorganic compounds. The ash will contain some important cations (pronounced cat-eye-ons), including the alkaline metals (sodium and potassium) and alkaline earth metals (calcium and magnesium), and some important anions, including sulfates and phosphates. If you dissolve that ash in water, the pH of the water could go up or down. If the ash is richer in the alkaline metals and alkaline earth metals than in sulfates and phosphates, the pH of the water will go up (alkalinizing effect). If the ash is richer in sulfates and phosphates than in the alkaline and alkaline earth metals, the pH of the water will go down (acidifying effect).

When you metabolize your food, you burn up most of the organic compounds, including many (but not all) of the organic acids. You will be left with an alkaline or acidic ash, plus the organic acids that your body cannot metabolize. These acidic and alkaline byproducts of metabolism will circulate in your bloodstream until they are lost in your urine. In the meantime, they will seem to have little or no effect on the pH of your blood. Instead, they will mainly affect the pH of your urine. You can make a reasonably accurate prediction of how much of an effect a serving of any food will have on the pH of urine by measuring the amounts of protein (a source of sulfur), phosphorus, calcium, potassium, and magnesium that are in the food and plugging the results into an equation.

The pH of your blood must stay at almost exactly 7.4 (slightly alkaline) all the time, or you will die. To keep the blood pH at 7.4, the body has an elaborate system of buffers. The main buffer is derived from carbon dioxide. The body uses an enzyme called carbonic anhydrase to speed up the conversion of carbon dioxide and water to carbonic acid (H2CO3) and vice versa. Carbonic acid is a weak acid, which means that when it is dissolved in water, only a small percentage of its molecules get pulled apart into hydrogen ions (H+) and the acid’s conjugate base (bicarbonate, HCO3). An even smaller percentage of the bicarbonate ions get pulled apart into H+ and carbonate ions (CO3–2).

The pH of an aqueous solution is a measure of the concentration of H+ ions. In pure water, the H+ concentration is about 1 ten millionth of a mole per liter, or 1 × 10–7 M, which is a pH of 7 (the negative of the base-10 logarithm of the H+ concentration). If you added enough acid to make the H+ concentration go up to one millionth of a mole per liter (1 × 10–6 M), the pH would go down to 6. In other words, more H+ means lower pH. (That explains why sea water is becoming more acidic as the amount of carbon dioxide in the atmosphere rises!) In contrast, when the concentration of H+ in an aqueous solution goes down, the pH of the solution goes up.

The conjugate bases of a weak acid (e.g., bicarbonate and carbonate ions) are unstable. When they meet up with a hydrogen ion in solution, they are likely to react with it. Thus, a carbonate ion is likely to bond with an H+, to become a bicarbonate ion. A bicarbonate ion is likely to bond with an H+, to become carbonic acid. If the carbonic acid content of the solution rises, more of the carbonic acid gets converted back to carbon dioxide and water. The carbon dioxide can then be lost to the atmosphere.

When you mix a weak acid with its conjugate base, such as mixing carbonic acid with sodium bicarbonate, you get a pH buffer. If you add a little bit of acid to blood, the bicarbonate and carbonate ions will immediately bind most of the incoming hydrogen ions. Thus, the number of hydrogen ions in the solution will go up very little (i.e., the pH will not drop by much). The ability of a solution to take in acids or alkalis without changing its pH is called the buffer capacity.

The carbonic acid/bicarbonate buffer system plays an important role in stabilizing the pH of your blood. If you hold your breath, carbon dioxide will start to build up in your blood. As a result, the pH of your blood will drop (respiratory acidosis). Your brain will notice this drop in pH and tell your respiratory system to breathe faster. As you blow off that extra carbon dioxide, your blood pH will rise back to a normal level. If you hyperventilate, you will cause the carbon dioxide levels in your blood to drop to abnormally low levels. As a result, your blood pH will go up. This effect is called respiratory alkalosis. If some process in your body is generating excess acid or alkali, your respiratory system will try to compensate by adjusting your respiratory rate, to adjust the amount of carbon dioxide in your blood. As a result, your blood pH may still stay close to 7.4, even if you have a serious problem with acid-base balance.

The kidneys also play a role in controlling the pH of the blood. If your blood pH drops too low, you will pass more H+ and less bicarbonate in your urine. As a result, your urine will become more acidic. If the pH of the blood rises too high, you will pass less H+ and more bicarbonate in your urine. As a result, your urine will become more alkaline. Because of these and other regulatory systems, the pH of your blood will stay remarkably steady at about 7.4 (slightly alkaline), as long as you are in reasonably good health. Meanwhile, the pH of your urine will change dramatically, depending on what you have been eating.

If you start eating the Alkaline Diet, your blood pH will not change much. However, your body’s ability to buffer an acid load will increase. This increase in buffering capacity explains why vegan diets are useful in the management of gout. Gout results when the blood becomes oversaturated with uric acid. Uric acid is produced when your body breaks down purines, which come from the breakdown of DNA and RNA. Tissue that is highly active metabolically (e.g., organ meats) is rich in purines. So is beer, because yeast is highly active metabolically. When the blood becomes oversaturated with uric acid from the digestion of purines, the uric acid starts to precipitate out as crystals in the joints (especially of the big toe) and the kidneys. The result is gouty arthritis and kidney stones.

Although many vegetables are also fairly rich sources of purines, vegetable foods do not seem to increase the risk of gout, probably because they raise the blood’s acid-buffering capacity. When the blood’s acid-buffering capacity is high, more of the uric acid can remain dissolved in the blood and urine. As a result, fewer urate crystals will form in the joints or in the urinary tract.

Not all kidney stones are made of urate crystals. Many kidney stones are made of calcium oxalate. Calcium oxalate kidney stones are also a common result of an acid-forming diet. When the ordinary buffering systems are not enough to keep the blood pH at 7.4, the body may borrow some calcium from the bones, to use as an antacid. However, the body must also keep the calcium levels in the blood within a narrow range, or the heart will stop. For this reason, the excess calcium is quickly lost in the urine. In the short run, this problem can lead to the formation of calcium oxalate kidney stones. In the long run, it can contribute to osteoporosis.

Osteoporosis is common only where people eat a highly acidifying high-protein diet. Taking calcium supplements may help to correct the metabolic acidosis in the short run, because of the calcium’s alkalinizing effect. But in the long run, the combination of an acid overload and a calcium overload (either from dairy foods or fish bones or from supplements) can undermine the body’s ability to regulate its calcium content. If the blood calcium levels are chronically high, the body may eventually lose the ability to conserve calcium. As a result, the calcium that has been borrowed from the bones is not effectively replaced. So instead of recommending calcium supplements, doctors should be urging patients to avoid eating animal foods and to eat more vegetables and fruit. Doctors should also urge patients to go outside and play: to get exercise and reasonable exposure to sunshine.

You can measure the effects of diet on urine pH within a matter of hours. But to see the effects of diet on health, you often must study a large number of people over a long period of time. For this reason, much of what we know about the effects of diet has been learned from epidemiologic studies. Some of these studies compare different populations at one point in time. Others focus on people who have migrated from one country to another. Still others track the same population over time. Each of these kinds of studies has its own strengths and weaknesses. For example, differences between countries could be due to confounding variables, such as genetic differences. Unfortunately, many “skeptics” dismiss all of these studies as “pseudoscience” because these epidemiologic studies do not follow the same methods as pharmaceutical research. Up until recently, “skeptics” who worked for the tobacco industry used the same kind of arguments to make people doubt that cigarette smoking causes lung cancer.

In other words, the proponents of the Alkaline Diet are urging you to eat a good diet, but for bad reasons. Meanwhile, the skeptics who debunk the Alkaline Diet are often trying to scare you away from eating a good diet, for equally bad reasons.

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Chronic Fatigue Syndrome Is Not Depression

Many people go to the doctor because they feel tired all the time. Many of these patients are suffering from major depression. These depressed patients often feel better if they get more exercise. However, some patients feel tired because they are teetering on the edge of physical collapse because of some serious circulatory, metabolic, or neurologic disorder. If these seriously ill people try to exercise more, they may end up in big trouble. So it is important for doctors to make the correct diagnosis in these cases. Otherwise, the doctor may offer advice that does more harm than good.

According to the dictionary, fatigue is extreme tiredness, typically resulting from mental or physical exertion or illness. In other words, fatigue is nature’s way of telling you to rest. However, a person may feel fatigue for many different reasons. As psychologist Doug Lisle explained in his book The Pleasure Trap, all animals must balance three conflicting motivations: to feel pleasure, to avoid pain, and to conserve energy. So besides deciding whether an activity is pleasurable or painful, animals must also predict whether a pleasure is worth the energy they would have to expend to obtain it, and whether a pain would be so bad that the effort to avoid the pain would be worthwhile. This estimation that some effort would be either unproductive or dangerous can produce a sensation that is felt as fatigue.

Depression involves a problem with the brain’s ability to predict and feel pleasure. For this reason, the depressed person’s brain concludes that many kinds of physical and mental efforts would not be worthwhile. As a result, depressed people often feel fatigue, even if they are nowhere near their physical limits. (In contrast, people with mania often run themselves into a state of physical exhaustion.) When nondepressed people are approaching their physical limits, their brain warns them that further effort would be dangerous. This warning is also felt as fatigue, even if the person’s activity level is abnormally low. People who push themselves despite this warning can make themselves much sicker. This result is called post-exertional malaise, or the push-crash phenomenon. People who are this sick have a low health-related quality of life. As a result, they may look and feel depressed, which complicates the diagnosis.

Do not assume that someone can exercise his or her way out of a case of a chronic fatiguing illness. Many of these people have an underlying disorder that must be found and corrected. In the meantime, the people may have to avoid exercise, so that they can use their limited supply of energy to do the things that are most important to them.

Many of the problems that cause disabling fatigue fall into two basic, overlapping categories: problems with energy metabolism (cellular respiration) and problems with standing or sitting up (orthostasis).

Many different kinds of problems can interfere with cellular respiration. Lung diseases can limit the flow of oxygen into the bloodstream. Anemia limits the blood’s ability to pick up the oxygen and carry it to tissue. Circulatory disease limits the body’s ability to deliver oxygenated blood to tissue. Nutritional deficiencies or damage to the cells’ mitochondria can interfere with the body’s ability to use oxygen to burn fuel to release energy.

In other words, chronic fatigue can result from a wide variety of serious diseases, many of which are so rare that doctors do not routinely test for them or even know about them. Each of these rare diseases affects only a few people. Yet together, these rare but serious fatiguing illnesses could account for a large number of people, most of whose illnesses never get a proper diagnosis.

Some of these rare problems can be caught if the doctor listens and looks: takes a careful history and does a careful physical examination. For example, to catch cases of spinal fluid leak, doctors must look for patients who have a connective tissue disorder (abnormally tall or abnormally flexible) or a history of spinal injury/surgery or lumbar puncture. They must also listen to the patient’s complaints. Patients with a spinal fluid leak will typically say that they feel better in the morning or after prolonged bed rest but worse in the afternoon or evening or after prolonged sitting or standing. An ordinary MRI might not reveal the leak. Instead, the patient may need magnetic resonance myelography. Yet if the leak is found and patched, the patient can get well.

Low blood volume (hypovolemia) can easily be mistaken for an anxiety disorder. These patients are pale because of poor circulation. The extra norepinephrine that their adrenal glands release to compensate for the shortage of blood can cause tremor and mood disturbance. Their pulse tends to be rapid and weak. In addition to fatigue, hypovolemic patients may complain of dizziness or fainting and an inability to see when they stand up. Yet the results of their complete blood count may be perfectly normal. However, the complete blood count only tells you whether the blood is good. It does not tell you how much blood the patient has. To test for low blood volume, start with a poor-man’s tilt table test: take the pulse and pressure while the patient is lying down, sitting, and then standing. If the pulse goes up a lot or the pulse pressure (systolic minus diastolic pressure) goes down while the patient is standing, the patient probably has low blood volume.

Remember that many vague symptoms, including fatigue, can result from food allergy or intolerances. Doctors can solve many of these problems just by giving the patient a simple handout with instructions on how to follow an elimination diet.

Many patients who are on the edge of physical collapse are mistakenly thought to be suffering from a primarily psychiatric problem. Yet if the patient is on the edge of physical collapse, misguided psychotherapy and the pressure to exercise can do a great deal of harm. If the underlying physical problem cannot be resolved, the patient needs coping skills for living with the disability, as well as help in getting others to understand and accept his or her level of disability.

See a Registered Dietitian (RD) Instead of a Lyme Literate MD (LLMD)

Many people have been told by an LLMD (Lyme-literate medical doctor) that they have chronic Lyme disease. However, there is really no such thing as an LLMD, and there might be no such thing as chronic Lyme disease. Continue reading “See a Registered Dietitian (RD) Instead of a Lyme Literate MD (LLMD)”

On a high-carb diet, people with diabetes need less insulin

The more carbohydrate you eat, the more responsive your body becomes to the hormone insulin. That is why high-carbohydrate diets cure type 2 diabetes. They also reduce insulin requirements in people with type 1 diabetes. If you are taking insulin, talk to your doctor before you switch to a high-carbohydrate diet. Otherwise, you could end up with a dangerous bout of low blood sugar. Continue reading “On a high-carb diet, people with diabetes need less insulin”

Addictive, Low-Fat Cornbread

Corn is a great food for human beings. Unfortunately, many cornbread recipes contain cow’s milk and lots of fat. Some of the low-fat vegan cornbread recipes produce a product that is too dry. This recipe makes cornbread with a golden brown crust (thanks to the sugar and the cast-iron pan) and a moist and tender crumb, thanks to the applesauce.

Continue reading “Addictive, Low-Fat Cornbread”

The Diabetic Food Exchange System Is Not a Weight-Loss Plan

Recently, I saw that a friend of mine had posted on her refrigerator a simplified list of food exchanges for diabetics. She does not have diabetes, so I asked her why she would need that list. She said that she wants to lose weight. I tried to explain that the exchange system is not a weight-loss plan. Its purpose is to help people with type 1 diabetes (insulin-dependent diabetes) figure out how much insulin to inject. And it does not do a particularly good job at that. She said that she was using the list to help her count calories.

Continue reading “The Diabetic Food Exchange System Is Not a Weight-Loss Plan”