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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 preg­nant women need to eat fish or fish oil. But in real­i­ty, green plants are an excel­lent source of the essen­tial omega-3 fat­ty acid. This could explain why peo­ple who 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.

Con­tin­ue read­ing “Omega-3 Fat­ty Acids Come From Green Plants”

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.

Pho­to by mattbuck4950

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.

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.

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”