Vindicated

On my first day of medical school one of the first lectures we attended we were told that even though we would be studying and memorizing facts we should expect that everything would change and that in 20 years we would probably find out everything we had learned was no longer correct. I took that bit of wisdom to heart and I maintained a healthy skepticism of everything we were taught.

About six months in to medical school we were studying renal, kidney, physiology and the associated pathologic diseases.  One of the most important of these is hypertension or high blood pressure. The kidney in the process of filtering our blood is responsible for controlling how much water is excreted as well as maintenance of our electrolytes such as potassium and sodium.

According to our professor increased sodium intake in the form of table salt leads to water retention and therefore hypertension. According to our professor the main way to manage this was via sodium restriction. The study referenced basically showed that if a group of patients went on a severe restriction of sodium their blood pressure went down. Also if they took medication that depleted sodium it would have the same impact. The conclusion was that sodium intake caused high blood pressure.

To my critical mind the conclusion wasn't necessarily supported by the facts. Just because the blood pressure decreases in a person with hypertension when the sodium goes down didn't mean the sodium caused the problem in the first place. At the time in the mid 80's we didn't have a lot of medication and this was one of the primary treatment methods.

At the end of the lecture I approached the professor and stated my concern that the conclusion made wasn't necessarily supported. The professor looked at me like I was a complete idiot and said I was wrong and of course he was right. Unfortunately, the way I was spoken to discouraged me from confronting faculty in the future. I chose to keep my criticisms to myself. I can only assume other students of medicine or science must have experienced this as well and may have held back on their expresson of critical thinking which is vital to the advancement of science and medicine.

Over the years we have all learned of previous dogma that many years later was proven wrong. One recent major example had to do with cholesterol and heart disease. Decades ago when heart disease started increasing scientist looked at the blood vessels especially in the heart and saw atherosclerosis plaques blocking the blood flow. These plaques looked like cheese under the microscope and were indeed full of cholesterol.  The conclusion was that cholesterol caused heart disease. The result was a complete change of the American diet to low fat, low protein, high carbohydrate diets. Ironically these changes have had no benefit in managing heart disease and has caused a huge jump in diabetes. We now know that the food pyramid was wrong and it is OK to eat meat, eggs, butter, and milk.

The pharmaceutical industry is still focused on lowering our cholesterol but there are no studies showing benefit in otherwise healthy people and very limited benefit in those with heart disease. In fact what does help is advice any mother could give. Eat a balanced diet, fresh vegetables, get plenty of rest, and exercise regularly.

Now back to the original reason why I wrote this story. Yesterday I was reading time magazine and they quoted a scientific study that showed that dietary sodium intake in otherwise healthy people had no impact on high blood pressure. While i was glad to see this l can only guess it took 30 years to reverse this dogma because inquisitive critical thinkers were discouraged from questioning these ideas. In fact, I think it takes a great deal of courage to be willing to go against accepted opinions. When a courageous person is shot down early in their career we as a society potentially lose a great deal.

Fortunately, those who know me will confirm that despite the occasional episode of discouragement I remain eager to express my critical reviews of dogmatic ideas that aren't well supported by the facts. We should all remember to be patient and supportive of those who are willing to swim against the current for they may be the next one to discover the real answer to that which plagues us.

7 Pounds in 7 Weeks! Thanks to my 12 Year Old Dietician

I really have lost 7 pounds in 7 weeks and it wasn't hard so I feel compelled to share this. This isn't the first time i lost weight and I wouldn't describe myself as someone who desperately needs to lose weight but like most of you I want to look and feel good.

I imagine many of you have noticed the same thing I have which is that as I get older my weight goes up. This has happened despite exercising 3 to 4 times a week. I also am afflicted with stratospheric cholesterol and lipids. That did improve with medication but I had severe side effects which could be the subject of a post in the future. So for 20 years I have played with my diet following the food pyramid avoiding red meat eating grains and fruits and vegetables. I even tried being a vegetarian several years ago.

Despite all those efforts my weight slowly went up. I weighed about 165 when I finished my residency at 32. By the time I was 39 I weighed 175 and just looked chubby. But, then over the next year I last 16 pounds.  This was a result of two factors. I started surfing which was responsible for about 2 pounds. The other 14 were because I went through a divorce and was anxious and  lost my appetite. I don't recommend that weight loss program and my current wife who is beautiful, wonderful and perfect has voted against the strategy.

Anyway, after the divorce over the next 11 years my weight slowly climbed to 177.5. This occurred despite watching my diet and exercising. I did notice over the years that my weight would drop a pound or two if I stopped consuming alcohol. Also I would have a drop a couple days after returning from a surfing vacation. But the weight would creep back up.

Now, I'm sure many of you are familiar with the recent diet trends such as the paleo diet or the Adkins diet. I have considered them too much of a fad and also not really the way I want to eat. I even had a friend try to convince me to do the fasting diet. In that one you basically starve yourself once a week for at least 24 hours. The idea is that fasting causes a systemic glucose depletion and so fat will be burned at a high rate to replace the necessary brain food. That one just seemed to hard for me.

So, I was in Michigan 8 weeks ago. Michigan is usually very bad on my waistline. I feared returning home with a new record weight. I was at dinner with my close friend, Ross Halpern and his son Ariel. Ariel is a bright high energy 12 year old. Ross and I are discussing our slow weight gain over the years and how frustrating it is. Ariel interrupted Ross and said "Dad you need to go back on your no carb diet! " Ross agreed and took his piece of bread he was ready to bite and put it down. Ironically, skinny Ariel immediately grabbed it and ate it.

Ross went on to tell me that whenever he did a strict low carb diet he would lose weight. Ariel was pleased to confirm his father's success. I told them it would be wayy too hard for me to give up carbs. I like them too much. But, I was going with my family in a couple of days to family camp in northern Michigan and I thought maybe I would work on it there.

So, I did do my best at camp. I wasn't going to skip all carbs but i gave up on breads and other starches. Sometimes I would break down in the evening but I stayed pretty true. When we got back to California my weight surprisingly was stable at 177. I decided to hold the course with some exceptions. I decided I wouldn't eat my morning oatmeal and instead would do a protein bar. For lunch I would give up bread but I was going to increase the meats and make big salads.

A strange thing happened. I noticed my appetite went down. I also found myself not as tired in the afternoon. I like to weigh myself everyday. This is against all the books but I know my weight fluctuates and I like to keep mental track of my highest high and my lowest low. So by the end of the first week at home my high was 177 and my low was 176.

The next week I peaked at 176.5 and bottomed at 175. At that point I thought it was intriguing but not a trend. In fact i was so skeptical I didn't say a word to my wife. But nonetheless I stayed true and despite my skepticism I wasn't hungry and things progressed.

About 2 weeks ago I asked Cynthia if she noticed anything and she said my face looked skinnier. I noticed pants that were tight 2 months ago were fitting nicely. I started to think a real tend was happening. I didn't want to share any of this until i crossed a significant milestone. For me that was a week where I consistently hit 172.5. That was my old standard weight where I could wear a 32 inch waist pants.

I crossed that last week. This week i peaked at 172.5 and my low shocked me at 170.5. I haven't been there in over 5 years. So now I'm beginning to think this is more than a trend. The interesting thing is that I'm not doing a no carb diet. I'm only avoiding breads and starchesee for breakfast and lunch. Dinner I do whatever I want including a cocktail if I desire. I have increased my protein and even the fats.

I've thought a lot about why this is working so well for me. Obviously,  my metabolism is performing very well with this. I believe that since there are no simple carbs after dinner until dinner the next day my body is forced to burn fat for glucose. I'm not starved but my body has to adjust.  When I do eat carbs at night it isn't enough to carry my body in to the next day.

The result is burning fat without much discomfort. I don't know how this will impact my cholesterol and lipids. I'm going to wait until I get down to 168, my ideal weight,  and then get tested. At this point I'm very hopeful. You can be assured I will let you know.

Realistically we are all different and what works for me may not work for you but if you give it a try and it works, or even if it doesn't let me know. By the way, I still exercise 3 to 4 days a week and I think that is critical to success.

Finally, I would like to thank my 12 year old buddy Ariel for pushing me to do this.