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



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.

Pho­to by blu­men­bi­ene

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.

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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.

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High-Carb Diets Improve Blood Sugar Control

Back in 1927, an Amer­i­can physi­cian named Shirley Sweeney recruit­ed some healthy male med­ical stu­dents for a study of how diet affects blood sug­ar con­trol. That study showed that you could make healthy young men seem dia­bet­ic by feed­ing them too much fat or too much pro­tein or noth­ing at all for only two days.

Sweeney divid­ed his vol­un­teers into four groups. He asked the mem­bers of each group to eat a par­tic­u­lar test diet for two days. One group ate main­ly car­bo­hy­drates (starch and sug­ar). Anoth­er ate main­ly pro­tein. A third group ate main­ly fats. The fourth group fast­ed for two days. On the morn­ing of the third day, before the sub­jects had eat­en or drunk any­thing else, they had a glu­cose tol­er­ance test. They drank a bev­er­age with a known amount of the sug­ar called glu­cose. Then, their blood sug­ar (blood glu­cose) lev­els were mea­sured over the fol­low­ing few hours.

Dur­ing the glu­cose tol­er­ance test, the men who had been eat­ing noth­ing but car­bo­hy­drates for two days had remark­ably sta­ble blood sug­ar lev­els. But the oth­er men’s blood sug­ar lev­els spiked to abnor­mal­ly high lev­els. The men who had been eat­ing noth­ing but fat got results that sug­gest­ed severe dia­betes. Remem­ber, these were healthy young men who had been eat­ing an abnor­mal diet for only two days.

From these results, Sweeney con­clud­ed that a high-car­bo­hy­drate diet helps to improve the body’s abil­i­ty to tol­er­ate car­bo­hy­drates. In con­trast, high-pro­tein diets, high-fat diets, and fast­ing under­mine the body’s abil­i­ty to con­trol blood sug­ar. In a fol­low-up arti­cle, Sweeney sug­gest­ed that some patients might have abnor­mal glu­cose tol­er­ance test results because of the diet that their doc­tors had been urg­ing them to fol­low, rather than because of some under­ly­ing med­ical prob­lem.

Sweeney was not the only researcher to show that high-fat diets cause prob­lems with blood sug­ar con­trol. In the 1930s, a British physi­cian named Sir Harold Per­ci­val Himsworth did sim­i­lar stud­ies and got sim­i­lar results.

Start­ing in the late 1930s, a Ger­man émi­gré physi­cian named Wal­ter Kemp­n­er start­ed apply­ing these lessons to the treat­ment of patients at Duke Uni­ver­si­ty. Kemp­n­er start­ed off by try­ing to find a dietary solu­tion to severe­ly high blood pres­sure. Back then, no effec­tive drugs were avail­able to reduce blood pres­sure. Kemp­n­er rea­soned that since heart and kid­ney dis­ease were rare in soci­eties that ate a rice-based diet, his patients should eat a rice-based diet.

Because his patients had kid­ney prob­lems and ath­er­o­scle­ro­sis, Kemp­n­er designed a diet to be as low as pos­si­ble in pro­tein and fat. So he told his patients to eat noth­ing but rice, fruit, and fruit juice. If they lost too much weight on that low-fat diet, they were told to add some pure sug­ar. This diet pro­duced dra­mat­ic improve­ments in patients with heart and kid­ney dis­ease. It also did won­ders for patients with dia­betes.

Patients with what is now called type 2 dia­betes, which is a com­pli­ca­tion of being over­weight, lost weight and became undi­a­bet­ic. Patients with type 1 dia­betes, which results when the immune sys­tem destroys the pancreas’s abil­i­ty to make insulin, had much bet­ter con­trol of blood sug­ar lev­els and could get by on much small­er insulin dos­es. Even their eyes were health­i­er. (Dia­betes is a major cause of blind­ness.)

The fact that high-carb diets are good for dia­bet­ics has been known since the 1920s. Nev­er­the­less, many doc­tors in the Unit­ed States are still urg­ing their over­weight and dia­bet­ic patients to avoid eat­ing carbs. Unfor­tu­nate­ly, a low-carb diet can make even a healthy young per­son look dia­bet­ic with­in a mat­ter of days. For­tu­nate­ly, a high-carb diet can cure the most com­mon form of dia­betes and can improve the health of peo­ple with the incur­able form of dia­betes.

Behind Barbed Wire_PrintUpdate: I explain the rela­tion­ship between car­bo­hy­drate intake and blood sug­ar in more detail in my book Thin Dia­betes, Fat Dia­betes: Pre­vent Type 1, Cure Type 2.

An Elimination Diet Could Cure Eczema

If you have eczema or any oth­er mys­te­ri­ous chron­ic ill­ness, a change in diet might pro­vide the cure. Food aller­gies and intol­er­ances can cause many dif­fer­ent kinds of health prob­lems, includ­ing eczema. In fact, aller­gy to the pro­tein in cow’s milk has long been known to be a com­mon cause of eczema, espe­cial­ly in chil­dren. Elim­i­nat­ing trou­ble­some foods from the diet is a cheap, safe, and drug-free way to solve many health prob­lems.

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Eating Meat, Dairy, Eggs, and Fish Can Make Your Breath Stink!

You know the old say­ing, “You are what you eat.” To that, we can add anoth­er one, “You smell like what you eat.” My father-in-law learned that les­son when he served in the Per­sian Gulf Com­mand dur­ing World War II. He heard that the local peo­ple in Iran com­plained that the Amer­i­can sol­diers smelled like sour milk. He laughed it off at the time; but when he got back to the Unit­ed States after the war, he noticed the same thing. Peo­ple who had been eat­ing the stan­dard Amer­i­can diet did smell like sour milk! Peo­ple who had been eat­ing Per­sian food did not. The rea­son was sim­ple. The Amer­i­cans were eat­ing far more meat and milk and eggs and fish than the Per­sian peo­ple were.

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