A Death that was Completely Preventable

One of my patients, Kathy Mitchell, died from heart disease this past December. Her death left me feeling deeply saddened and somewhat shaken. Kathy passed away at the age of 47 from Cardio Vascular Disease. This was the result of complications caused by Type II Diabetes. She was African American. African Americans are already 20% more at risk then the population as a whole from death caused by a stroke and cardio vascular disease. Kathy first came to see me about 4 months ago. She was on dialysis. Her kidney function was greatly diminished as a result of diabetes. Despite the insulin she was taking for the diabetes and the beta-blocker to lower her blood pressure, she was still in trouble.

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Unfortunately, Kathy’s case is not unique. Cardio Vascular Disease (CVD) and complications from Type II Diabetes are the second cause of death in the US. There are an estimated 8 million people in this country with undiagnosed Type II Diabetes. But what upset me the most is that, the majority of the time, these conditions are completely preventable; Kathy’s death was completely preventable.

The key to lessening your risk for such common illnesses as Diabetes and heart disease is to catch them as early as possible; then make the necessary life-style changes, which can be as simple as changing your diet. Kathy’s life, for example, could have been drastically different with something as simple as restricting intake of processed food and simple carbs at the very onset of her Diabetes. But before I talk about that, let’s look at ways to catch the progression of Diabetes and CVD, before they become irreversible.

Before Kathy ever had Diabetes or CVD, she had Metabolic Syndrome—the root of these more serious illnesses. Metabolic Syndrome refers to a series of conditions that occur simultaneously and drastically increase a person’s risk of developing diabetes, stroke, and heart disease. These conditions include obesity, hypertension, high blood sugar, abnormal blood cholesterol, and high blood triglycerides. When a person has three or more of these disorders, that person is said to have Metabolic Syndrome, or, equivalently, Insulin Resistance. Insulin resistance occurs just in case a body can produce insulin normally, but is unable to use it effectively. It is the precursor of Type 2 Diabetes. Other risk factors of Metabolic Syndrome include obesity, physical inactivity, poor diet, age, sleep apnea, and hormonal imbalance—all of which are also precursors of Diabetes.

According to the Journal of Diabetes36.1% of adult men and 32.4% of women had metabolic syndrome in the US in 2010; this puts an alarmingly large portion of the population at risk of developing a life-threatening condition. But thankfully, Metabolic Syndrome alone is completely reversible. But time is of the essence; once you actually develop Diabetes, contract heart disease, or have a stroke, it becomes almost impossible to reverse the damage. If you have one or more of the five symptoms of Metabolic Syndrome, but don’t see an immediate need for a life-style change, you should know that many people develop Diabetes unknowingly—that is, until the first complications show up (blurred vision, heart problems, etc.). But by that time, treatment is already less promising. In fact, it takes merely a single night of sleep deprivation for a body to start developing insulin resistance, even in completely healthy people.

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The most important takeaway here is that Metabolic Syndrome is reversible—but, when left unaddressed, leads to much more serious illnesses, and can even result in death. Diabetes, in particular, can cause tragedies like heart attacks, strokes, kidney disease, blindness, and even amputations. The number one thing you can do to prevent (or rid yourself of) Metabolic Syndrome and, consequently, Diabetes or Heart Disease, is to maintain a healthy life style at every age, which, as I stated earlier, can be as simple as eating healthy.

This brings me to a second important takeaway: being healthy is not equated with eating fewer calories. It matters where those calories come from; i.e., a calorie is not just a calorie. There is a HUGE difference between eating 2,000 calories of carbs a day versus eating 2,000 calories of fat and protein. Due to growing research in the way carbs and gluten affect our bodies, scientists are starting to see a very negative relationship between brain health and carbohydrates. Dr. David Perlmutter calls this phenomen “Grain Brain” in his New York Times bestseller, also titled Grain Brain. He references studies that specifically link higher levels of blood glucose (a result of eating a lot of carbohydrates) to shrinkage of a critical part of the brain. Several acclaimed journals have come out with reports linking even slight increases in blood glucose to significantly increased risk for developing Dementia. The results of one study in particular showed that people who ate high amounts of Carbohydrates (as compared to those who ate more fat and protein) were 89% more at risk of developing dementia.

It was only recently in the timeline of the human race that we started eating large amounts of carbohydrates. Our bodies evolved in a completely different environment, producing a genome that thrived most when nourished with healthy fats and protein. As a result, we are now seeing many harmful side effects of eating large amounts of refined carbs, including but not limited to, depression, cognitive dysfunction, obesity, and, subsequently, Diabetes. But just as the causes of these conditions can be traced back to diet, so too their cures. One study comparing Diabetes patients on a standard, low-fat “diabetes” diet versus those on the Paleo diet showed that patients on the Paleo diet had greater improvements in weight, blood sugar, triglycerides, blood pressure and waist circumference.

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With this in mind, I would suggest a diet low in simple carbohydrates and grains when it comes to tackling Metabolic syndrome (or any of the other conditions it causes). The Paleo diet is a practice I embrace clinically and personally. I also suggest the Mediterranean diet, which includes olive oil as the main source of fat, plenty of vegetables and fruits, legumes, a moderate-to-high amount of fish and seafood, small quantities of red meat and dairy products, and moderate amounts of wine. The most general advice I can give is to always avoid processed foods, especially any industrial seed oils, like Canola oil or Vegetable oil, which are tremendously processed and often contain harmful chemicals.

Diet change should also be supplemented by moderate exercise for 30-60 minutes a day for the best results. This can be as simple as taking a walk. But if you can’t fit a walk in everyday, try standing at your desk as opposed to sitting; you’ll burn 75% more calories that way.

If Kathy’s doctors had advised her to make any of these changes, she might still be here today. Instead of addressing her Metabolic Syndrome before it progressed, she was given medical attention only after she had already developed diabetes. By that stage, most doctors treat their patients merely by giving them insulin. Because insulin feeds off of glucose, patients then tend to crave even more carbs—the very thing that caused their condition in the first place! Kathy motivated me to write this newsletter precisely because her death was no unnecessary. No one should have to die from a disease that is entirely preventable. Kathy’s life may have been spared if only more doctors were looking for Metabolic Syndrome in its early stages and advocating low-carb diets and exercise, as opposed to prescribing useless pills after it is already too late.

Ultimately, our diets are one of the best tools we have for living a long and healthy life, even when it seems like more and more practitioners are relying on pills and medication. Eating healthy is never something that one does unnecessarily, gratuitously, or overcautiously. It can, however, be something that you do too late.

Please call 734-726-0153 to schedule a free consultation and evaluation. At Digestive Health Ann Arbor we are known for providing professional and compassionate care. We strive to guide people towards a comprehensive and holistic healing strategy. Restoring your body to health will restore the quality of your life.

Part Two: How To Include Carbs Into Your Diet.

First off, I hope everyone had a great thanksgiving. While you all know I endorse a Paleo lifestyle, I will admit that I myself ate my fair share of carbs last Thursday—and lived to tell the tale. Hopefully my last newsletter helped you to understand important role carbohydrates play in both physical and mental health. But an informed decision to include this macronutrient into your balanced diet is only the first step. Now, the questions you're probably asking are: which carbs are the healthiest? How can I incorporate them into my diet with maximum results? And finally, how do I know what exactly what my carb-intake should be? This last question is perhaps the most important, as a lot of people tend to mentally misconstrue how much of a certain food group they are ingesting. Do you know what are the recommended daily allotments of carbohydrates for someone of your age and weight? Have you ever kept track of the grams or percentage of calories you are receiving from carbs? 

As I explained in part-1 of this 2-part series on carbohydrates, something as basic as carb-intake can have an effect on health conditions from depression and lethargy to digestive upset and athletic performance. Keeping a balanced diet is undeniably one of our most valuable roots to good health. So, I have written the following newsletter to expose just which carbohydrate-containing foods offer the most benefits, like increased energy, healthier sleep patterns, etc., and I have included an easy process to help you calculate your own individual, optimum carb-intake based on health conditions, exercise level, age, weight and other factors, so that you can all get the most health benefits out of your diet.

If you’ve been shying away from carbohydrates until now, I’m guessing that’s because you think they make you gain weight. And that’s true—in some cases. If you generally eat very low amounts of carbs but binge on pizza or bread every once in a while, you will probably find that these slip-ups do add on some pounds. Don’t blame carbohydrates as a whole though; blame the refined and processed carbs that constitute America’s favorite junk foods. Carbs must be incorporated into a diet strategically and thoughtfully in order to avoid the harmful side effects that can result from ingesting certain refined carbs, like sugar and white flour. Following are some charts of diet-friendly foods and the amount of carbs (in grams) they contain. If you want to know more about which carb-containing foods to keep and which to toss, take a look at the November newsletter (click here). 

The moral of the story is that, when you’re choosing which carbohydrates to eat, please choose carefully; i.e. go for fruit, not chips. 

Knowing which carbs to eat is only half the work though. The next step is figuring out how much of your daily calories should come from carbohydrates—something that will ultimately be a result of personal factors and preferences. The following information is meant to help you customize your own diet in a way that can have you feeling your best; it just takes a little diligence and patience.

Step 1 is to assess what percentage of carbs will work best with your life-style and weight goals. First, look at any diseases or health conditions you may be suffering from. For example, if you have diabetes or small intestinal bacteria overgrowth, you are going to want to start off in the low-carb category. If you have adrenal fatigue, are breastfeeding, or are a moderate to heavy exerciser, you’ll probably want to start at a moderate carb level. There are many other conditions that can affect how well your body receives carbs, so please be sure to assess your overall health when deciding what amount of carbs might work best for you. If you have multiple conditions that require opposite amounts of carbs, you should consider working personally with a practitioner. 

If you don’t have a condition that places you in a particular spot on the carb-intake spectrum, the best place to start is with a moderate carb diet. I suggest keeping a food diary in order to keep track of any symptom regression/improvement. Ultimately, the best indicator of carb-intake is how you feel, e.g. good, bloated, weak, etc.. Based on this diary, you can experiment by increasing and decreasing your carb percentage until you find a level that benefits you the most.

Step 2 is to figure out how many calories you should be eating each day from carbohydrates. If you know what your daily calorie-intake should be, simply multiply it by your target-percentage of carbohydrates. The following chart details what percentages constitute which carb-levels (low, moderate, high), as well as which populations would benefit most from each level:

 If you are unsure how many calories you should be consuming each day, you may want to search the web for an online calorie calculator. Otherwise, 2000 is a reasonable number to start with. So if you want 20% of your calories to come from carbs, multiply .20 x 2000 = 400. This is the number of calories you should be getting each day from carbohydrates. If you don’t feel like counting calories you can divide this number by 4 to figure out how many grams of carbohydrates you should be eating each day. 400 / 4 = 100g of carbs a day. Based on the first few charts, we see this goal can be met by eating a banana and an apple between meals, ½ a head of romaine lettuce in a salad for lunch, and a sweet potato with dinner, for example. 

If this process sounds a little too mathematical to you, you can also use the basic rule of thirds, which requires your plate to be 1/3 protein, 1/3 starch, and 1/3 low-carb vegetables and tubers. Following this rule will put you somewhere near the moderate-carb level.

I would like to stress that the diet calculation process as a whole is somewhat imprecise and for most, it will take some experimenting. Start in a moderate position unless you have one of the aforementioned health conditions, see how you feel, and adjust your carb-intake from there. My final advice is to please give each stage of your experimenting a fair amount time for your body to acclimate. If you eat only 10%-15% of calories from carbohydrates and you start feeling sluggish, have a harder time shedding that last pound or two of fat, or aren’t sleeping as well, you might need to consider slightly raising your carb-level. If you’re eating 30% or more of calories from carbs and you notice weight gain or digestive upset, you should consider a moderate or low-carb diet.

Remember: patience is key. There’s no miracle diet or one-size-fits-all approach. But, if you do give your diet the time and attention it deserves, the results should be well worth it.

Please call 734-726-0153 to schedule a free consultation and evaluation. At Digestive Health Ann Arbor we are known for providing professional and compassionate care. We strive to guide people towards a comprehensive and holistic healing strategy. Restoring your body to health will restore the quality of your life.

How Low of a Low Carb Diet is Correct for You?

As most of you know, I am a strong proponent of the Paleo lifestyle. My practice is very Paleo focused. Paleo eating leans heavily on vegies, fruits, nuts, seeds, eggs and grass fed protein. It strongly suggests a very limited consumption of grains, simple carbs and little dairy. Having said that, there is an important place for carbohydrates in your diet. They play are critical roles in many aspects of our health and metabolism. So the real questions is “What is the correct about of carbs you should be consuming?” This is the first of two news letters that will examine living a truly healthy life in relationship to the role carbs play in our diet.

Chances are, you have, at least once, been solicited to buy into some sort of miracle diet touting low-carb high protein intake as a fast and painless way of losing weight, such as Atkins or Southbeach. Many of you may even have entertained trying out this kind of extreme diet for yourself.  What most people don’t realize is that carb-intake can affect everything from your gut to your brain. Have your been feeling sluggish, anxious, or depressed? Having problems with digestion? These issues and more can all be influenced by carb-intake. When you choose to go low-carb, you are actually inviting a host of risks upon yourself. Let’s explore how to clarify the low-carb myth:

Let’s begin with the basics. For the sake of simplicity, carbohydrates are sugars, fibers, and starches. They can be found in a huge variety of foods including bread, potatoes, beans, milk, vegetables, pasta, and fruits, with the unhealthiest carbs being found in highly processed, refined foods like white bread, pastries and soda. When you eat any carb-containing food your body is provided with glucose, which is converted to energy. Our bodies need this energy to support daily bodily functions and physical activity. However, choosing unhealthy and too easily digested carbs (like white bread and soda) is a proven cause of weight gain, diabetes, and even heart disease (Harvard). In light of this new-age plague of obesity and heart disease that has stricken the country, it is no surprise that low-carb diets have been thrown into the spotlight in the past decade or so.

Low-carb diets are, obviously, based on limiting carbohydrate intake, while also encouraging consumption of foods high in protein and fat, like meat, eggs, and cheese. Most diets will give you a certain percentage of your daily calorie intake that should come from carbs. A diet low in carbohydrates would typically require somewhere around 10-20% of your daily calories to come from carbs (whereas the typical American will consume 45%-65% of calories a day from carbs) (Mayoclinic). These diets can be quite tricky, as avoiding carbs is surprisingly hard to do for most people. Imagine going to the grocery store and having to walk past all the grains, beans, nuts, fruits, pastas and starchy vegetables!

However, ad campaigns and the media will have you believe that managing to attain the sort of excessive discipline a low-carb diet requires can have great pay-offs. Carbs, particularly refined ones, can cause a quick rise in blood sugar and subsequently an increase in insulin, which can then lead to an increase in hunger and naturally, weight gain (UMM). Therefore avoiding carbs supposedly forces the body to burn stored fat for energy due to lower insulin levels, which in turn encourages weight loss (Mayoclinic). Some people have reported shedding up to 15 pounds in two weeks on the Atkins diet. However, it would be a fallacy to judge diets based on only the first few weeks of trials, for a lot can change—and reverse—when held to the test of time (US News). That being said, if a low-carb diet sounds a little too good to be true to you, you’re absolutely right! The following is a carefully researched list of what really takes place when you make the choice to go low-carb:

-As I hinted at before, low-carb diets seem a bit less promising when evaluated over long periods of time. In the short term, much of what’s shed on low-carb diets is actually just water-weight (US news). Most studies find that, after 12-24 months, low-carb diets don’t produce significantly more weight-loss when compared to diets based on mere increases in protein-intake unaccompanied by a carb decrease (Mayoclinic).

-A sudden and drastic decrease in carb-intake can inspire some pretty bad side effects including weakness, fatigue, bad breath, and headache. Severely restricted carb-intake has also been shown to result in vitamin or mineral deficiencies and/or bone loss over time (Mayoclinic). Further, carbohydrates contain valuable probiotics that help keep our guts healthy, so avoiding them could lead to an alteration of gut-flora, which often manifests as diarrhea or constipation. (Kresser).

-If you engage in moderate exercise several times a week, restricting your carb-intake can lead to severely damaging conditions, including but not limited to: decreased thyroid output, decreased testosterone, impaired cognitive function, suppressed immune function, and slowed metabolism. In other words, depriving your body of one of its main sources of energy is likely to make you feel sick and sluggish, and inspire more than just your average bad mood.

-Women are particularly prone to experiencing the negative side effects of carb deficiencies. Unbeknownst to many, low-carb diets can disrupt hormone production, leading to a stopped or irregular menstrual cycle, more body fat, and, more gravely, lowered fertility, hypoglycemia, anxiety, and depression (Precision Nutrition). 

-And finally, while low-carb diets almost always promise you heart-healthy benefits, a report from the American Heart Association concluded that there is not enough evidence to say whether or not diets low in carbohydrates are, in fact, good for the heart (Mayoclinic).

Given the evidence, it is safe to say that low-carb diets are not a good choice for most people, despite all that jazz you may hear about the Paleo diet and carb-free diets being “man’s original way of eating.” 

I would like to stress that, regardless of whether you need to diet or not, every one of you should be aware of the amount of carbs you are in fact ingesting. Many people who experience physical and mental ailments may not consider the possibility that the culprit is their diet; even worse, many are blissfully unaware of how skewed their diet is from the national recommendation, and how profound an effect these small divergences can have on the body. So if you find yourself suffering from any of the aforementioned symptoms (lethargy, indigestion, anxiety, etc.) please stay tuned for part two of this newsletter, which will be out in December and contain a guide on how to find your optimal carb–intake, without having to go to any extremes.

Please call 734-726-0153 to schedule a free consultation and evaluation. At Digestive Health Ann Arbor we are known for providing professional and compassionate care. We strive to guide people towards a comprehensive and holistic healing strategy. Restoring your body to health will restore the quality of your life.