Maggie's Farm

Is consumer access to genetic testing, without a doctor's involvement, beneficial or harmful for patients? 

Crazy question.  Of course people should have that info if they want to pay for it. Facts are facts.

There are several reasons why calories- in and calories- burned equations are too simple for the complexity of animal physiology. For one thing, the calories in protein are handled differently from those in fat or in  carbohydrates. Another reason is that our metabolism adapts to our nutritional intake as best it is able to.

Other than hibernating animals, few animals are adapted to handle the sort of abundance that humans have remarkably produced with brains capable of entirely changing the planet's surface and modifying nutritional sources for its own purposes. Humans are nutritional outliers, and it is not "natural." In a sense, humans are not natural animals because of the extent to which they remake nature for their convenience.

One example:  What Does It Mean to Be Fat-Adapted?

It means you have trained your body to adapt to a plentiful flow of fresh carbs and sugars (sugar is carbs and vice-versa) so it takes the burden off using fat as a fuel. Intake trains the body that way. Thus what we term the "False Hunger" of overweight people. Human physiology will never adapt to modern abundance of food because fatness tends to kill or disable people after child-bearing years.

Among other reasons, Fat Adaptation is one of the reasons heavy people feel more hunger and end up consuming food more avidly and in higher volume than trim people.  In fact, overweight people have zero dietary energy requirements and minimal nutritional requirements despite subjective hunger.

40 percent of US cancers linked to excess weight

Everybody knows that having a belly is the major risk factor for heart and cardiovascular disease, diabetes, arthritis, and dozens of other nasty ailments, but the association of overweight with at least 13 cancers is not so well known. 

Being heavy may be one of the greatest risk factors for a large variety of cancers. There are many theories about why this might be. Breast and prostate cancers are high on the list.

It is worth thinking about, even though we all must accept that the odds are, now that we can handle most infectious diseases, that we will die either of cancer or cardiovascular disease sooner or later. But why rush it?

Physical (and mental) fitness begin slowly going downhill after age 30-35 and accelerate thereafter. Deconditioning by avoiding strenuous exertion makes it worse.  I am a skeptic about mental exercise, but not about the role of exercise in slowing natural physical decline.

How To Prevent Muscle Loss And Why You Should Care begins:

 A variety of social forces extradited muscle from respectable mainstream health. Muscularity once suggested physical labor and therefore a lower class station. More recently body builders hijacked the mesomorphic, minting steroid-fueled Rodin caricatures that were anything but a model of health.

Muscle also has been perceived as anti-intellectual. In the organ kingdom, it is the antithesis of the exalted brain, as in brain or brawn. It is our brain that distinguishes us from the great apes. Even within the muscle category one finds a hierarchy. Cardiac muscle appeared to carry none of skeletal muscle’s stigma. Academics might have jogged, meatheads pumped iron...

Skeletal muscles, and the bones to which they attach (muscle stress is what keeps bones strong), undergo continual alteration and renovation. They are both adaptive: they respond to lack of stress by weakening or atrophying, and to stress by becoming more robust. This occurs regardless of age. Those 80 year-old women I see lifting weights in the gym are doing a smart thing. Weights are good for females.

There is also growing evidence that regular intense physical exertion is good for maintaining mental functioning. It's definitely good for mental health.

Then he became one. Dr. Dennis Charney studied resilience in the face of trauma, then was shot by a pissed-off former employee.

A good story. He survived. Yes, he had always worked out and lifted weights. 

From the 1977 Massachusetts Medical Society's Annual Oration, Dr. James Tullis on diseases in Biblical times.

Historically, it was the medical staff that ran the place.  In this new era, businessmen run the hospitals and the docs have become employees: Lawsuit fights “existential threat” to medical staff independence

Last week, I posted on one reason for the paradox of why overweight people tend to feel more hunger, and to eat more avidly, than others even though they have no nutritional needs.

How can that be adaptive? Not all of physiology is adaptive to everything.

Today, we'll look at why cardio workouts suppress appetite and subjective hunger. Weight-lifting sessions, not so much.  High-intensity exercise suppresses Appetite By Affecting Appetite Hormones

It's an interesting effect which may have some adaptive value, or maybe not. It does explain why many normal-weight fitness-seekers need to force themselves to eat some protein when they have no appetite and no interest in food. It could be part of why hard cardio exercisers lose weight. Exercise doesn't provide fat loss, but the cardio reduces appetite. I am not talking about anorectics, just regular people who want to be in fighting shape and kind to their joints.

Weight Gain and Aging: An explanation and solution

Good info on this depressing topic.

Aging is characterized by changes in body composition. CT studies demonstrate that as we age, subcutaneous fat (below the skin, SF) decreases and visceral fat (in abdominal cavity, VF) increases. VF is the enemy. Because it causes systemic inflammation, it is an independent risk factor for coronary artery disease, stroke and death. If that’s not enough, VF also provides the Buddha-belly mid-life midriff.

The other most common age-related change in body composition is muscle loss. Because muscle has a high metabolic rate, its loss is associated with a reduction in energy expenditure. This decrease in caloric burn lends itself to weight (fat) gain.

We term this phenomenon "False Hunger" because overweight people have no need for outside energy sources.  In fact, though, overweight people tend to experience more subjective hunger than normal-weight or ectomorphic people. Is that cause, or effect?

A bit of both but mostly effect, as it turns out. It mostly has to do with how pudgy people ramp up their insulin response and the resulting, or related, insulin insensitivity. Illogical as it seems, having extra body fat makes people feel hungrier. Feed me, Seymour. It's a vicious cycle: Always Hungry? Here’s Why.

Overweight people can survive weeks or months without carbohydrates/sugars using their body fat as an energy source as long as they consume protein, fats, and oils to prevent muscle deterioration.

Can you lose weight via exercise? No, not practically

Does high-intensity exercise reduce appetite? Yes, usually. Dedicated fitness people force-feed themselves to keep their strength and endurance improving.

Stomach-stretching? People who eat bulky meals on any regular basis do stretch their stomachs, which can result in increased subjective appetite and hunger. We recommend small meals for everybody, regardless of weight. Except on feast days or special occasions.  People feel less tired, more energetic, and more productive with small meals. 

Fast eaters, voracious eaters?  Fast eaters trick their satiety signals by overeating (ie, greater volume of nutrients than needed to thrive) before satiety can kick in. Very few fast eaters are in good shape. A bad habit, and bad manners too.

General anesthesia has risks which are well-known and calculable. Sadly, Anesthesia may have lingering side effects on the brain, even years after an operation.

It is not just the compensation that discourages physicians, especially internists and pediatricians, from working for the government (eg Medicare, Medicaid).  A major issue is the paperwork burden. The government paperwork requires a specialized back office staff which only large practices can afford. 

A recent sample of the bureaucratic mess doctors are supposed to figure out.  A Medicare billing error is a potential felony, even if inadvertent.  

There are plenty of fad but fake diseases out there. Peak US public health body warns of risk from treatments for disease that doesn’t exist.

From knee and hip replacements to coronary bypass, there is considerable evidence for permanent brain damage in some individuals.

This phenomenon seems to be not unusual in patients over age 55. It seems to be an unmentioned risk of surgery. I have seen several cases of long-lasting (? permanent) cognitive setbacks after surgeries, so I am glad that people are exploring the topic.

Much or most of what you know about health, nutrition, and medical practice is already obsolete, but it can take years for new information to be accepted by doctors, hospitals and, God knows, the government.

It's a truism that all knowledge is transient. I sometimes catch myself thinking "I can't believe they used to believe...." before I call myself on it and realize that in fifty years people will be saying that about us.

Dr. Semmelweiss possibly did more for women than any other person in history, or at least in medical history. He is a stand-out in the medical pantheon, but acceptance of his ideas was extremely slow and he was thought a nut and a crank by the medical establishment.

His life was a sad one, and short. I suspect he died of neurosyphilis, known then as General Paresis of the Insane. He might have gotten syphilis from the many prostitutes he tended to, or from prostitutes who tended to him.

Out of consideration for the delicate sensibilities of Maggie's readers, I have refrained from including a photo of advanced Toenail Fungus

These unpleasant, common, but generally not-dangerous fungal infections (except, for example, in diabetics or the immunosuppressed) are caused by several species of fungi which thrive in the moist, confined area of shoes. Those fungi are basically everywhere. You do not need to be a barefoot gym rat to pick them up, but most people probably pick them up around pools, gyms, locker rooms, and the like. If you never go anywhere, you probably won't pick these things up.

Put plainly, these are examples of your body trying to rot while still alive - but that applies to any bacterial infection too. Both are associated with the same several fungi, often with Athlete's Foot progressing to Toenail Fungus (aka Onchymycosis). 

Athlete's Foot can be just a little itching, but it can get nasty sometimes.  It is manageable or even curable with anti-fungal creams used diligently.

The Toenail Fungus infection is more of a problem, because topical treatments have trouble penetrating the nails to attack the infection in them and beneath them. They are not just cosmetically problematic but can be painful because of the distortion of the nails. Toenail infections are the bread and butter of Podiatric practices, partly because of their chronicity. People sometimes think they just have one or two toenails affected, but usually all of the nails have some of it.

Some people just decide to live with it and let a Podiatrist attack it when wanted, but what you want to do for treatment is to treat any Athlete's Foot and then decide to go for a topical nail treatment (sometimes effective, like Jublia Topical), Toenail removal (ouch but most effective) with oral treatment with Jublia, oral Jublia alone, or Laser treatment (of uncertain effectiveness, unfortunately).  Jublia is very expensive.

'Patient zero': The misunderstood stories of how disease spreads.

I have always been interested in how psychological disorders/aberrations spread, too. Mass hysterias, fad diseases, and the like. In the 1990s it seemed as if half the hysteric women in New England believed they had chronic Lyme disease and there was no way to dissuade them. Before that, it was Chronic Fatigue. Both are now old hat and no longer in vogue.

I have been reading about the sudden upsurge of trans children. What is that about? It seems rather unusual, and disturbing.

There is no settled science on dietary fat and cardiovascular disease except in the case of the familial hyperlipidemias. However, in those cases, the hyperlipidemia is generated by the liver far more than by diet. The liver is the main controller of blood lipids.

A high-fat meal, or any meal, produces a temporary surge of blood lipids just as a high-sugar or high-carb meal produces a surge in blood sugar. That is normal. 

The low saturated fat craze was triggered by a 1950 study by Ancel Keys, a study which is now generally accepted as fraudulent. It spurred many further studies over the years but, as yet, there is no proven causal relationship between dietary fat and cardiovascular disease.  In fact, there are very high saturated fat cultures (Eskimos, Masai) with very low cardiovascular disease rates. 

Does your cholesterol level matter? Other than in familial hypercholesterolemia, probably not. So why check them on your every-3 year physical exams?  Medical advice is conservative, slow to change, and fearful of being wrong so too-often adopts the precautionary principle. Thus when articles like this one comes out: Popular belief that saturated fat clogs up arteries is a myth, experts say, there is always pushback like "Don't tell people that, they'll get confused."

While it is established that arterial disease is related to inflammation in arterial walls, the cause of that is elusive. The known risk factors for arterial disease seem to be smoking, overweight, diabetes, familial hyperlipidemia, and sedentary life style. Almost forgot the biggest one: age. Avoid ageing at all costs because it has a 100% mortality rate.

We are far from settled science with cardiovascular diseases. In recent years, we were advised to eat margarine not butter. Now advised to eat butter and avoid margarine. Now advised to eat olive oil. It's all a shot in the dark and it could be that diet has little or nothing at all do do with it.

If you feel like putting a non-lethal curse on somebody, curse them with a case of Plantar Fasciitis. It's like an epidemic these days.

It's a common affliction of the middle-aged (like Frozen Shoulder), and usually there is never an identifiable cause although weight gain seems to be one. It can be in one foot or both. Sometimes it can be easily fixed with ice and stretching but it can be a chronic problem which eventually will disappear as mysteriously and suddenly as it appeared.

The most common symptom is feeling like somebody put thumbtacks in the heel of your shoe. The problem is not your shoe (although arch supports sometimes help it). The problem is inflamed tendons. 

The differential diagnosis is Achilles Tendonitis.

Besides the pain of simple walking around, Plantar pain can lead to other joint or lower back problems because of altering one's gait to minimize the foot pain. 

Some basics on Plantar Fasciitis 

More info from the Pain Doctor 

Stanford researcher: “Most published research findings are false.”

Always be a skeptic.