Dr. Gerstmar's Thoughts on Health, Happiness, and Well-Being from Aspire Natural Health

From the excellent blog EvMed Forum (formerly called NephroPal) by the exceptional MD Dr. T (if you don’t follow the EvMed Forum at nephropal.blogspot.com I highly recommend you do so):

"I wonder why so few physicians embrace nutritional approaches to problems-perhaps you can shed some light. Do you find your patients are receptive to the nutritional advice that you give them or… "

The answer is sad and simple – time and lack of knowledge. Think about it. Most physicians are overwhelmed with patients suffering from the constellation of problems due to the metabolic syndrome – DM II, heart disease, dementia, cancer, neuropathy, kidney disease, HTN, etc… Moreover, with their large patient load, the average follow up time for an existing patient is 15 minutes. In that time, a physician needs to:

• inquire about new developments and medications
• review the medication list
• perform a physical exam
• review new labs
• write prescriptions
• go through the prescription and possible side effects
• answer any questions
• AND write his note
• I also personally take my own blood pressure measurements and pulse rates
• In addition, the physician may also have to contact another physician or family member and speak to them about the current situation

All of this in 15 minutes and new patients 30-45 minutes. So consider that a physician sees his patient for 15 minutes every three months. Truly, what kind of real medical care can a patient receive in this situation? Moreover, with HMOs, physicians have to see more patients to maintain the same salary and yet still pay their overhead. It is very common that the overhead expenses are 50-60%. With a 21% Medicare budget cut, who knows what the future will be like? However, my point is that when it comes to nutrition, how much education can a MD give and yet still perform the above duties as mentioned? It is far more simple for a physician to write a script and say "here take this" than spend an extra 15 minutes going through proper nutrition.

But what is a proper diet? I am breaking the mold and telling my patients to use coconut oil (saturated fat) and go on a low carbohydrate diet. By changing their dietary habits I am making efforts to get my patients OFF statins which has caused some arguments between myself and the cardiologists. I had one patient with a TOTAL CHOLESTEROL of 71! This is nothing to be proud of. And yet his cardiologist insisted that he remain on it after I objected. That truth is that I have noticed in the hospital that patients with myocardial infarctions have actually LOW LDLs and not surprisingly low HDLs.

So why don’t physicians go into nutritional education? Time limitations. It is far easier to write a script in 2 minutes then spend an extra 15 minutes on each patient. And secondly, very few physicians are going to go against the grain (pun intended) and recommend an Evolutionary approach. Above all, the average physician only receives 4 weeks of nutritional education during his/her WHOLE four year medical school training. And specialty training may entail little to no nutritional training.

I am proud to say that as a Naturopathic doctor (ND) we do have both the time and training to cover nutrition extensively with our patients.  Just last week I had a patient gasp at the fact that our first visit was 90 minutes long.  This gave us enough time to understand her chief concerns and also look at the other aspects of her life, both physical and mental/emotional.  We were able to talk about diet and get a sense of what she was eating on a regular basis, what supplements and medications she was using.  And also, critically, what her hopes and fears were, what her thoughts were about the direction of her care and what she wanted to do.  These longer visits, of course, step outside the mold of what health insurance is designed to cover (deems appropriate) but in my opinion is essential for understanding the person sitting in front of you, and not simply their chief concern.

It’s important for people to recognize that most MDs know next to nothing about nutrition.  If you are looking for nutrition advice, don’t go to your MD (unless they are one of the few exceptional docs like Dr. T).  Seek out a practitioner who has the training in nutrition, like a nutritionist or an ND or someone else who has taken the time to really become educated.  And MDs be honest and admit what you don’t know.  Patients still need you, you perform a vital service, but pretending you know about nutrition when you don’t not only doesn’t serve your patients, it hurts them.

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A fascinating bit of research that was brought to my attention by a colleague.  In this study of people with autoimmunity, from ~4-10% of those patients tested positive for antibodies to vitamin D.  While bizarre, it is possible to actually have antibodies against vitamin D (reinforcing the notion that it is possible to have antibodies to basically anything).  Might this be the reason that some people find benefit from Marshall’s protocol of vitamin D depletion in autoimmunity?  Could this be the reason that some people need really high doses of vitamin D to achieve normal blood levels?

This study raises far more questions than answers but provides us yet another piece in the absolutely fascinating, beautiful, and frustrating puzzle that is the human body, health, and disease.

Carvalho JF, Blank M, Kiss E, et al. Anti-vitamin D, vitamin D in SLE: Preliminary results. Ann N Y Acad Sci 2007;1109:550-7.

Abstract

The aim of this study was to detect antibodies to vitamin D in systemic lupus erythematosus (SLE) and other autoimmune diseases. The

results may shed light to a novel aspect of vitamin D deficiency in autoimmune diseases. Sera from 171 patients with SLE, 56 with

antiphospholipid syndrome (APS), and 18 with pemphigus vulgaris (PV) were studied employing an enzyme-linked immunosorbent assay for anti-

vitamin D antibodies along with 94 healthy blood donors. In parallel, vitamin D concentrations in the serum were determined by a DiaSorin

commercial kit (LIAISON 25 OH vitamin D). Antibody-positive and antibody-negative individuals were compared with respect to

demographic variables, SLE disease activity index (SLEDAI) score, autoantibodies profile, and serum vitamin D levels. Anti-vitamin D

antibodies were detected in 7 (4%) of 171 patients with SLE, in 2 (3.5%) of 56 of sera from patients with APS, and in 2 (11%) of 18 sera

from patients with PV. Vitamin D levels were similar in both SLE groups with and without anti-vitamin D antibodies. Demographic

features, organ involvement, SLEDAI score, and autoantibodies did not differ between the groups. Except for anti-dsDNA antibodies, in which

anti-vitamin D antibodies were strongly associated with these antibodies in sera from SLE patients (P = 0.0004). Anti-vitamin D

antibodies are observed in a subset of patients with SLE, APS, and PV, and are associated with anti-dsDNA antibodies in SLE. Further studies

are required to explore the potential diagnostic and prognostic role of these novel antibodies in SLE.

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Most of us recognize that things like money, houses, cars and other “stuff” isn’t what really counts or makes us happy.  What really makes us happy are the intangible things like caring, close relationships, meaning and a sense of purpose in our lives.  But how do we measure these things?  We don’t have bank accounts of relationships, meaning and purpose that we can glance at to tell us if we’re living a good life.

In this 18 minute video, Chip Conley discusses his search to find a way to measure these things so he can continue to build more and more of them into his hotel empire.  Conley talks about his trip to Bhutan, a tiny country sandwiched between India and China.  What’s remarkable about this tiny country is that it’s king, years ago upon taking the throne decided that he would not sacrifice his people’s happiness to further the wealth of the country.  Most countries measure their success in GDP (gross domestic product, which is how much money the country “makes” in a year), the higher their GDP the better off they consider themselves.  But the king of Bhutan realized that GNP was a really terrible way to measure the health and well-being of his country.  So alongside GDP he created GNH (gross national happiness), and stated that he would not push to increase GDP if it decreased GNH.

Bhutan became a country not focused on relentlessly increasing its GDP but focused on creating conditions to increase GNH.  I think we have a great deal to learn from this little country.

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In case you haven’t heard, Internet blogger Denise Minger published a statistics-based scathing review of the China Study (found here at http://rawfoodsos.com/2010/07/07/the-china-study-fact-or-fallac/ Continue Reading »

The following two pages have some wonderful quotes by some well-known and some less well-known people about the wonder of childhood. 

http://www.naturalchild.org/quotes/2009.html

http://www.naturalchild.org/quotes/2010.html

Our society and times place little value on childhood itself.  Childhood in this age of hyper-nervous parenting is about keeping children safe from any and all danger long enough that they can be molded  into future superstars.  On both accounts we do tremendous damage to children.

"I would like to know why it is that we have disregarded all children’s significantly spontaneous and comprehensive curiosity… Nothing seems to be more prominent about human life than its wanting to understand all and put everything together."

R. Buckminster Fuller

"A child does not have to be motivated to learn; in fact, learning cannot be stopped. A child will focus on the world around him and long to understand it. He will want to know why things are the way they are. He won’t have to be told to be curious; he will just be curious. He has no desire to be ignorant; rather he wants to know everything."

Valerie Fitzenreiter

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In 1983-84 a massive study was undertaken in China to catalogue the health and habits of rural Chinese living in 65 counties and was dubbed “The China Study”.

From http://webarchive.human.cornell.edu/chinaproject/index.html?CFID=111563459&CFTOKEN=99505440&jsessionid=c4308872a48b2b1a6829

“Within each of the 65 counties, 2 villages were selected and 50 families in each were randomly chosen for study. One adult from each household (half men and half women), 6500 for the entire survey, participated. Blood, urine and food samples were obtained for later analysis, while questionnaire and 3-day diet information was recorded.

A total of 367 items of information on these 6500 families eventually were judged to be reliable. These 1983-84 diet and lifestyle data included the 1973-75 mortality rates for about 4 dozen different kinds of cancers and other diseases.”

The assumption of the researchers was that “rich Western diets (high in fat and meat, low in dietary fiber) were strongly associated (correlated) with incidence of colon and breast cancer.”  A commonly held view by most medical professionals today.

In 2005 T. Colin Campbell, one of the researchers involved in the study published a book called “The China Study: Startling Implications for Diet, Weight Loss, and Long-Term Health” which quickly became a “bible” of the vegan/vegetarian movement.  Campbell became interested in the idea that protein (specifically animal protein) might cause cancer after observing in the Philippines that the children from the wealthiest families that ate the most protein had the highest rates of liver cancer.  The book “the China Study” presents Campbell’s proof that animal protein does indeed cause (increase the risk of) cancer as well as a variety of other diseases like heart disease, autoimmune diseases, etc. 

The book is divided into two sections.  In the first section Campbell discusses experiments he performed on rats showing that after exposure to aflatoxin (a cancer-causing mold) rats fed a high protein diet suffered from more cancer than a low protein diet.  A very interesting series of experiments.  However it’s important to recognize that the animal protein that Campbell fed the rats was casein.  Casein is one of the protein components of dairy and is not naturally found by itself.  Other research suggests that casein may indeed have a positive (bad) influence on cancers, but that whey the other component of dairy products has a strong negative influence (good).  Campbell incorrectly than goes on to label all animal protein bad from his experiments with one particular type of non-naturally occurring protein, isolated casein.  And he generalizes from rats to humans which is very often done in the scientific literature and needs to be taken with a large “grain of salt”.  Rats are not furry little humans.  While we share many of the same genes, enzymes and biochemistry as rats, we also have a number of important differences which means what is good (or bad) for rats is not always good (or bad) for humans.

In the second part of the book, Campbell then draws on the mass of data gathered in the China Study to prove his assumption that animal protein does “very bad things.”

Since 2005 a small minority have argued that  Campbell “cherry picked” the data from the China study to prove his point.  That is he started with the conclusion he wanted, that animal protein caused disease, and then sifted through the data looking for data that would prove his point.  A new critique proves that he did that very thing. 

Richard Nikoley who runs the popular blog Free the Animal broke the story to the blogosphere that a blogger named Denise Minger, a self-proclaimed statistics nut, had set out to see if the conclusions of the China Study (the book) were true.  She took the data from “the China Study” (the study) and began laboriously combing through it to see if the assertions that animal protein causes disease were true.  After analyzing the data her conclusion is that Campbell’s conclusion is WRONG.

If her site hasn’t crashed from the scads of new visitors, I highly recommend you check it out at http://rawfoodsos.com/

Even more interesting, Minger turned up a STRONG correlation between wheat consumption and heart disease.  That is, those people who ate the most wheat suffered from more heart disease.  Something that was never mentioned in the China Study (the book).

It’s also important to recognize that the data itself while interesting is only of limited value.  The China Study (the study) is what is known as an epidemiological study, that information was gathered on people and statistical analysis were done to attempt to attempt to relate various factors gathered (in this case what they ate) and diseases they suffered or died from.  As Michael Pollan talks about, this is the most common form of nutritional study performed.  Almost without exception when you see a new headline saying “X food linked to Y condition” it is an epidemiological study.  Examples include headlines like “processed meat intake linked to increased risks of cancer” and “eggs associated with increased OR not associated with increased risk of…”  Epidemiologic studies can show correlation not causation.

Correlation means two things appear together, but cannot say whether one thing causes another thing.  Causation implies that one thing causes another.  If I hold a match under my finger it burns my finger, that is causation.  Correlation is an entirely different thing.  For example we can do a study of obese people and find that increasing belt size is related to obesity, that is, the fatter the person is, the larger the belt they wear.  And the statistical significance is very strong, it holds true in almost every case.  This would be a correlation between obesity and belt size.  The mistake that is made in the nutritional community would be to imply correlation between the two, that is, the bigger the belt a person chooses to wear the fatter they will become (belts cause obesity).  This sounds absurd and it is.  But when we look at epidemiologic data (which is the majority of nutritional research currently being done) and we see that consumption of X and disease Y have been correlated with one another we want to jump to the conclusion that X causes Y and the data cannot tell us that.  Epidemiologic data is a useful starting point.  We can take it, look at correlations that emerge from the data, and then design more focused studies to actually try to test causation.

If you’re still not clear on the difference between correlation and causation and why it’s so important to make the distinction I recommend you check out the following two posts. 

The first which has nothing to do with the China Study is an excellent post by Dr. Michael Eades http://www.proteinpower.com/drmike/statistics/observational-studies-2/

The second is by Dr. Kurt Harris on the China Study at http://www.paleonu.com/panu-weblog/2010/7/8/polish-a-turd-and-find-a-diamond.html

We owe Denise Minger a debt of gratitude for slogging through reams of data to look at it with an unbiased eye.  What she shows is that even the correlations that Campbell drew from the China Study are wrong.  If eating vegan/vegetarian works for you, than keep at it, but please stop pointing to the China Study (the book) to justify yourself.  It’s wrong.  But don’t believe what someone else says, go check it out yourself.

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                If you have a “dumb” dog the following blog post should give you a good laugh.  http://hyperboleandahalf.blogspot.com/2010/07/dog.html

                My family is the proud caretakers of two dogs.  One is smart as a whip, the other…not so much.  After 10 years of training, he still does not know his name, his sit on command is at best 50-50.  Like most “dumb” dogs he has a heart of gold and we love him dearly, but he would not be our choice to go on Jeopardy.

                Humor and a good laugh is profound medicine, I hope you enjoy.

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                I recently spent a weekend on the strip in Las Vegas.  The strip, the area where the major casinos are located, feels to me like another planet.  Flying over empty desert, Las Vegas springs up suddenly like an oasis, or maybe a mirage, in the midst of nothing.  Green golf courses, gigantic buildings with gold windows, a miniature skyline of New York, the Eiffel tower, buildings styled to look like Venice and ancient Rome.  A bizarre, surrealistic landscape, with an uncountable number of lights and signs and crazy, sensory overload.

                I’m of two minds when it comes to Las Vegas.  Part of me admires what humanity can do.  Vegas to me is like we’ve taken an orchid (which grow naturally in rain forests) and by directing all our might towards it we’ve planted it and sustained it in the desert.  Against all sense, we’ve built a modern day oasis with every luxury available, if one can afford it.  In the Vegas strip, you’re in a different world.  It’s a fun place to get away to, for a short while at least.  In this other world, the worries and responsibilities of daily living fall away and people can focus on enjoying themselves.  It’s a hedonistic playground where you are free to eat as much as you want, drink as much as you want, have as much sex as you want or can pay for (if that’s your thing), feel the thrill of losing (mostly) and winning (sometimes) money, all divorced from your “real” life.  For me, it’s a fun getaway, once in a while for a day or two.

But I’m also repulsed by the Vegas strip.  It strikes me as so completely and outrageously artificial on every level.  Flying over housing developments as you come into Vegas you can see empty plots of land and see what the land in Vegas is really like, desert with some scrub brush and a few cacti.  And then sitting next to it, houses with green lawns and trees.  From our hotel room window I could see semi after semi bringing in “stuff” to the casino.  And you realize without bringing in water, power, food, and materials none of this would be here.  If those supplies were ever cut off, Vegas would wither and die, like those grass lawns in front of those houses.

                And while one of the failures of capitalism in general is that you are only valuable and worthwhile and worth caring about if you have money, this feels like it’s taken to an extreme in Vegas.  Have money, you can buy virtually anything.  If you’re broke, don’t let the door hit you as you’re being tossed out.

                Not coincidentally I was reading “The Value of Nothing” by Raj Patel over the weekend.  This slim book offers a scathing critique of modern hands-off capitalism.  Patel argues that the basic premise of capitalism is that the market will determine the price and therefore the value of everything.  Absent monopolies the market will correctly determine the value of something by its price.  If it’s expensive it’s valuable, if it’s cheap it’s less valuable.  This premise might work with toasters and Iphones, but do we really think it extends beyond that?

Over and over again life and science converge to tell us that the pursuit of wealth and the accumulation of “stuff” doesn’t create happiness.  The true happiness of life:  our relationships with others, the meaning we derive from our work and our lives, and the positive impact we have on the world are rendered worthless if we base our concept of value solely on capitalism, because after all what can you sell relationships, meaning and positive impact for?  They have no price, therefore they have no value, therefore they are worth nothing.

What if instead of defining the value of something as its ability to satisfy a craving, desire or vanity (often created by the very marketers trying to sell us the widget), we valued something by its desire to create well-being.

Bill Gates asked at a talk recently “Are the brightest minds working on the most important problems? Probably not.”  Is the newest widget an important problem?  We have a new Iphone and it must be valuable because it’s expensive, and it certainly satisfies a craving, a desire, and vanity.  But does it create well-being?

Patel closes his book talking about the emerging Zapatista democracy.  In this dirt poor little state in Mexico, where the people are harassed and oppressed by the Mexican government, poor, illiterate villagers are banding together to create a fair and compassionate society.  From the villages any adult can be selected to serve on their government council (for one week out of every six, for a term of three years, and after their term they never serve again).  Their meals and transportation are provided but otherwise they receive no payment (the job is a civic duty, not a form of personal enrichment).  These elected members wear face masks (balaclavas) while sitting in “power” both to protect them from persecution from the Mexican government and also as a sign that their position is not about personal power (not about the individual) but about the community which they serve.  By removing personal power and wealth from civic service (cravings, desires, and vanity) the Zapatistas have created a more fair and more compassionate form of government.  I think we have a lot to learn from their example.

If any of these ideas seem valuable to you, I recommend reading Raj Patel’s “The Value of Nothing” (unless you love Ayn Rand, Patel has nothing but scorn for Rand and her philosophy).  It is a short, stimulating read and well worth your time.

When I think of Vegas I’m of two minds.  I’m awed at what we can do, we can literally move mountains if we put our mind to it.  And I’m disgusted; this is what we do with that power?

As I walked around Vegas, amidst all the glitz and glamour, it was enjoyable, fun, an escape, but it also looked incredibly hollow and utterly fake.  It was fun, and despite being expensive, it had no value.

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Vitamin D looks like it’s as close to a “miracle” pill as we are likely to get.  This potent hormone (not really a vitamin) produced when sunlight strikes the skin or found in a few uncommon food sources (also now in fortified food) has been suggested in studies to help bones become and stay strong, to prevent and treat a variety of cancers (most notably breast, prostate, and colon), and to have potent immune normalizing properties.

The downsides are virtually non-existent, Vitamin D can be obtained for free if you live in a sunny climate or for penny’s from supplements.  Vitamin D is virtually non-toxic unless you take truly excessive amounts or have one of a few rare diseases such as sarcoidosis or certain kinds of lymphoma.

The following article shares Reinhold Veith, PhD’s frustration with government inaction in recommending more vitamin D.  http://www.ft.com/cms/s/2/11180df8-beaa-11de-b4ab-00144feab49a.html

Why are governments saying more vitamin D isn’t necessary?

Original studies done with vitamin D were concerned with preventing rickets (bone deformities in growing children) and found that only low levels of vitamin D (200-400 IU) were needed.  These levels do prevent rickets but do not have the anti-cancer and immune normalizing properties of higher doses.  Studies done with higher doses used doses that were still too low (800-1200 IU) to have a potent effect because of an irrational fear of vitamin D’s toxicity. These negative studies have lead conservative policy-makers to conclude that there is not sufficient evidence to recommend higher doses.

Then there is the issue of prevention.  Proving prevention is very difficult.  Current medical trials focus on treating a disease once it’s already present because it’s much simpler, cheaper, and easier to study.  Taking a group of healthy people and studying them over 20-30 years to prove the benefits of vitamin D would be enormously expensive and complicated.  There’s also the fact that vitamin D is unpatentable.  Unlike prescription drugs, no one can gain a monopoly on vitamin D so there’s no incentive for private companies to provide the money for studies.  So while the interest might be there, no one is ready to step up and devote enough money and time to get it done.  So the policy makers end up saying “there’s no evidence to prove your point, and we’re not interested in doing studies to provide that evidence.”

The Bottom Line

In the end we’re left with a lot of suggestive studies — they suggest vitamin D is a “miracle”.  What we understand of biochemistry and physiology and from these suggestive studies is that Vitamin D might be the single easiest, cheapest thing you can do for your health.  But what if it’s wrong?  What if all of us suggesting people take these larger amounts of Vitamin D are wrong?  At worst people will have wasted a very modest amount of money.  A few people who took excessive amount of vitamin D (greater than 10,000-20,000 IU per day over an extended period of time) or had underlying health conditions and weren’t properly managed may have caused some damage to themselves.  But what if we’re right?  Be normalizing your vitamin D levels you’ll have reduced your risk for a large number of serious health conditions.

In my mind it’s a no-brainer.  Ignore the government and the nay-sayers.  Get your vitamin D levels tested.  Get your levels up to 60-80 ng/dl and keep them there.  Ignore the experts afraid of the sun and get sensible sun exposure during the late spring, summer, early fall, and use supplements if they’re necessary.

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“Success in America is definitely defined by how much money you’ve made, not by how happy  you are with your life.”

That’s a quote from a young girl in the trailer for The Race to Nowhere, an interesting and relevant view of what we are doing to our kids in the name of helping them to be more successful.  The trailer is 3 minutes long and worth watching.

“We live in a society today where you have to smart, but you also have to be pretty, but you have to do sports, you have to be involved in arts, and amongst all that you have to find something unique about yourself and you have to know yourself because if you don’t know yourself  before you do all that, you’re going to lose yourself.”

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