Inflammation

Inflammation is the body's response to injury which can be due to trauma, pathogens (bacteria, viruses, fungi), irritants like chemicals. With inflammation blood flow is increased, blood vessels might leak fluid and white blood cells can accumulate. Signs of this response are redness from increased blood flow; swelling from fluid leakage; pus if enough white blood cells are recruited.

Without the inflammatory response we would not survive long, but excess or inappropriate inflammation causes many serious chronic diseases. Atherosclerosis and acute heart attacks result from an inflammatory response to cholesterol in an artery lining. Many cancers are triggered by cell damage from the inflammatory response. An example is the response to the chemicals in cigarette smoke. Auto immune diseases like rheumatoid, lupus, Crohn's, multiple sclerosis are inflammatory attacks against the body's own cells. With these diseases a specific trigger for the damaging inflammation is rarely apparent.

Inflammation is looked for with common medical tests: temperature, white blood cell count, sedimentation (sed) rate, CRP (C reactive protein.) Most visits to your physician will include one or all of these tests as your doctor determines if you are sick or likely to become sick. Abnormality in any of these tests is a sign of a problem, one that may not have surfaced with any symptoms so far. For example, people with occult atherosclerosis often have a high CRP.

The most common cause of inflammation is not pathogens or chemicals but the food we eat. This is a major reason why a healthy diet works- it decreases general body inflammation-- less atherosclerosis, cancer, auto immune disease. How powerful this can be is illustrated by a tribe in the jungles of New Guinea where the men are all heavy smokers but eat a diet of almost entirely unprocessed plant foods. There is no lung cancer in these men! Their diet has reduced inflammation so much that they don't respond to the carcinogenic smoke by developing cancer. No surprise that foods most likely to cause inflammation are meats, dairy, fried foods, sugars, refined grains. Vegetables, fruits, legumes, nuts and seeds reduce inflammation, but medical science keeps searching for pills to accomplish the same thing. Nobel prizes are not awarded for diet; no promotions are offered at the university; no patents or other sources of income are available.

                Dr. H. Gilbert Welch

"An internationally recognized expert on the effects of medical screening and overdiagnosis, H. Gilbert Welch’s work is leading many patients and physicians to think carefully about what leads to good health. For Welch, the answer is often “less testing” and “less medicine” with more emphasis on non-medical factors, such as diet, exercise, and finding purpose in life.

Welch’s research examines the problems created by medicine’s efforts to detect disease early: physicians test too often, treat too aggressively, and tell too many people that they are sick. Most of his work has focused on overdiagnosis in cancer screening: in particular, screening for melanoma, thyroid, breast, and prostate cancer. He is the author of three books: Less Medicine, More Health: 7 Assumptions That Drive Too Much Health Care (2015), Overdiagnosed: Making People Sick in the Pursuit of Health (2012), and Should I Be Tested for Cancer? (2006).  His op-eds on health care have appeared in numerous national media outlets, including the Los Angeles Times, the New York Times, the Washington Post, and the Wall Street Journal." (From Dartmouth Medical School website)

Medicine has been haunted by the myth that early diagnosis allowed by screening provides optimal results for most diseases especially cancer. This is true for colon and cervical cancer but not so for many others: breast, prostate, thyroid, kidney for example.

Welch is an expert in medical outcomes analysis- what happens after different interventions. His work has received attention by independent observers but the medical community has not paid much heed. Medical centers and physicians make a lot of money because of ill advised screening and treatments. The validity of Welch's conclusions are ignored and many patients are harmed.

             The Cochrane Collaboration

"The Cochrane Collaboration is an international network of more than 37,000 dedicated contributors from over 130 countries, working together to prepare, update, and promote Cochrane Reviews. Cochrane Reviews provide evidence based advice to help health care practitioners and patients make well informed decisions about health care.

The Cochrane Collaboration’s work is internationally recognised as the benchmark for high quality information about the effectiveness of health care." (Australian Government National Health and Medical Research Council website)

Medicine is filled with misinformation and poor treatment choices. The best medical journals have reviewed their distant past articles and found that a high percentage of conclusions have later been shown to be wrong. One of the major problems is bias. Authors are often funded by drug and equipment companies. Their future research support is dependent on how much the supporting companies like their work. Specialists often make their livelihood on a particular procedure such as surgery, endoscopy, mammography. When they write and teach about this procedure they have an enormous bias but they are the "experts" whose teaching on the subject is studied and followed by physicians and patients.

The Cochrane Collaboration was created in the early 1990's to have impartial non-funded reviews of important medical topics. It's recognized as the gold standard for evaluation of medical issues. Unfortunately few physicians or patients use this free internet resource; most don't even know of its existence. Check out their website and make use of its search engine when you have a medical topic you want to pursue. http://www.cochranelibrary.com

                         Food Preferences

Most people have strong food preferences which are almost entirely learned. The book First Bite by Bee Wilson offers an excellent review of the study of eating habits and food preferences. Wilson references hundreds of experiments and studies of eating. Her observations and conclusions should be very helpful for those trying to eat a healthier diet or lose weight.

The French designed Sapere Project introduces children to a variety of unfamiliar foods. Pre-school children are divided into small groups and given a variety of foods which they are encouraged to handle, taste and discuss. Each food is offered several times over a period of a few months. Parents report that children request and eat a much wider variety of foods at home; their palates expand without coercion. Finnish educators modified this technique to emphasize fruits and vegetables, using it in a large number of kindergartens countrywide. Several years later control groups of children were compared to those who had been exposed to the Sapere technique. The Sapere group had much less overweight and obese children. This technique has been tried in teenagers and residents of retirement homes with similar results, but changes are greater when it is applied to children up to six years old. All groups on whom this has been used enjoyed the process and the results.

In parts of the world where spicy foods are common and preferred, children usually start to try these foods around age five and they don't like them. Since the older people eat and enjoy the spicy foods children keep trying them and eventually prefer them. Everyone who eliminates all added salt for a month comes to prefer less salt on food. Avoiding all sweets for two weeks allows less craving for them. These sorts of trial periods allow children and adults to come to prefer something besides the high sugar, fat and salt of the standard American diet which is captured so well in fast and prepared foods. "Eating is a skill that each of us learns, and we retain the capacity for learning it, no matter how old we are."

Happy childhood memories of unhealthy foods like candy bars, ice cream and extra rich holiday meals are strongly imprinted. We eat these foods to regain that time and place with terrible results for our waistline and health.

Wilson also examines other approaches to health through better eating habits. She concludes that exercise is healthy but not a major source of weight loss unless done to potentially dangerous extremes. Taking small tastes of healthy foods over and over often allows an expansion of good dietary options. Smaller plates and wineglasses cut down on consumption. Soup before or during the meal has the same effect mainly because it's hard to eat soup quickly and slower eating by any technique cuts calorie consumption. Foods grown and/or prepared yourself are more enjoyed and appreciated.

            Understanding Diabetes

Most diabetics don't understand their disease. This is usually because their physicians don't understand diabetes either.

Unfortunately it is not uncommon for diabetics whose blood sugar has been controlled by diet and/or oral drugs to have their blood sugar skyrocket because the pancreas no longer produces enough insulin. This overworked organ has failed and effectively their type 2 diabetes has become type 1 diabetes. Insulin is now necessary to maintain normal blood sugar levels. A tragedy often ensues. The patient assumes that an unhealthy diet is now okay since they can just take more insulin to control blood sugar levels. This is the basic misunderstanding of diabetes.

A good analogy for diabetes is a brush fire.  Brush fires are usually easily handled unless they start in California during the dry season. Diabetics are like dry season California. They have the underlying conditions to allow massive damage mainly because of vascular disease which is always present in diabetics. Macro-vascular disease leads to heart attacks, heart failure, strokes, limb infections and amputations. Microvascular disease leads to dementia, blindness, kidney failure, neuropathy. Diabetics on insulin have hugely increased rates of all these conditions.

The only way to avoid the progression of this vascular disease is through diet. Blood sugar control with insulin helps; it postpones the dreadful vascular complications for a while. But only diet prevents them. A good diet is like a long, drenching rainfall for California fires; it is the only way to prevent and treat diabetic complications. As prior blogs have explained, this means little or no animal products including dairy, vegetable oils, refined sugars and refined grains, salt. Good diet also requires plenty of vegetables, fruits, legumes, nuts, seeds, herbs and spices to provide nutrients necessary for health of blood vessels and all organ systems.

                     Eating Awareness Training

The first book I recall reading about diet is Eating Awareness Training written in 1985 by Molly Groger. It's subtitle is "The Natural Way to Permanent Weight Loss." Groger observed that her friends of optimal weight took food in more deliberately and often left food on their plates rather than finishing portions. She changed to this eating style, lost weight, and maintained good body weight with this approach. Her technique was to pay attention to the eating process, chew food thoroughly, and not eat while watching TV or reading. When she realized she was full she stopped eating.

Mindfulness techniques adapted from Buddhist meditation practices have been applied to eating, effectively the same approach Groger advocated.

German researchers recently designed an experiment in which obese people had their mouths wired so that they could not eat quickly or put a large amount in their mouths. There were no restrictions on types of food or quantity. All subjects lost significant weight, often in the hundreds of pounds, and many maintained much of the weight loss after the mouth wiring was removed. They had learned to eat more deliberately and consume less food.

My observations of overweight people support this approach. Many eat large quantities quickly and robotically not allowing time to recognize satiety (or often even enjoy their meal.) For those trying to lose weight this is a logical, painless way to cut back on calories without formal dieting.

                                      XULA

Xavier University of Louisiana is a small(2300 undergrads), traditionally black school in New Orleans started in 1925 by Katharine Drexel. Drexel, now honored as a saint by the Catholic church, was a Philadelphia heiress who became a nun and devoted her life and fortune to helping native and black Americans. 

We discovered Xavier through an article in the New York Times which described it as the school that had sent the most African Americans to medical school. Since then I've seen several other college evaluations rating Xavier as exceptional value for education received (tuition is $23,000 a year, less than half of most private schools.) Xavier is 70% African American students and over 70% women. Most students receive full or partial scholarships. A quarter of the students are pre-med and 90+% of those completing the pre-med program are admitted to medical school. Rochester University Medical School has a strong affiliation with 2-6 students a year offered early acceptance, summer school in Rochester and scholarships. A recent affiliation with UCSD sends Xavier students to San Diego to work in the biology department. Alumni are strong contributors, recognizing the valuable education they have received.

We decided to support Xavier because of the urgent need for black physicians. African American communities are poorly served medically and rates of chronic diseases are very high. Urban African Americans have four times the rate of severe kidney disease; twice the diabetes; an 80% greater risk of fatal stroke; and much more cancer. (Fuhrman, Fast Food Genocide, Harper One, 2017.) The major cause of this chronic disease is diet; fast and processed foods filled with sugar, fat, salt and chemicals are the dietary staples of this population.

Deb and I visited Xavier last week where I made a presentation on diet and nutrition to a group of public health and pre-med students. Students, faculty and staff are remarkable, many dedicated, intelligent, hard working people. The campus is filled with small study spaces each with a schedule of tutorial times from early morning until late in the evening. Faculty and upperclassmen help students as needed in every class. Xavier has fostered a strong spirit of cooperation rather than competition among the students. This is an institution where learning is taken seriously; even the dormitories are quiet to allow studying.