BP Oil Spill Timeline

Oil Spill Timeline from RightChange on Vimeo.

Weight Loss Quackery

Ok.  I couldn't resist.  Here is some recent weight loss quackery, much of which is still being propagated on the internet.

Magic Tights Weight Loss -

Embedding into the fabric of the "Slim fit 20 Caffeine Tights" are tiny capsules of caffeine.  When the caffeine comes into contact with the skin it is supposed to be absorbed and stimulates metabolism, burn fat, and tighten leg muscles.  The manufacturer, a British company called Palmer's, promises that if the tights (which cost about $50 for a three pack) are worn for a month, about an inch in diameter can be lost from each leg.  If this catches on (apparently over 50,000 units have already been sold - mainly to men) it may replace the phrase "Hey, you smell like pizza" with, "Hey, how come you smell like Starbucks?"

Spray-On Weight Loss -

CLAmor is sprayed onto food.  It contains a chemical called "clarinol" that's thought to shrink fat cells.  When clarinol-sprayed food is eaten, it reduces fat on the food and fat that's already inside the body.  It comes in four flavors: butter, olive oil, garlic and plain.  So what is clarinol?  CLAmor, the name of the product and the company , says it is a naturally occurring bacteria found in the stomach of cows.  It's "harvested" from fried ground beef. Clarinol is now sold as CLA and is essentially worthless as as weight loss medication, however, it has been show to have a minimal additive effects to muscle building. (And there's nothing like the taste of ground beef cultured bacteria!)

Alchemy Weight Loss -

A magic pill called Phena-Frene/MD sold in the mid-1990s claiming to turn fat into water, which was then flushed from the body forever by simply urinating it out.  Packaging claimed users could loose up to 10 inches off their waist in just two weeks.  Only one small problem: It is chemically impossible to turn fat into water!  The product bombed despite "medical school proof" from non-existent institutions such as the California Medical School and the U.S. Obesity Research Center.

Magic Pants -

Sold via the late night TV infomercial in the 1980's, "Slim Jeans" weren't actually jeans, and they probably didn't make anybody slim.  Slim Jeans were silver, futuristic-looking sweat pants made of "an amazing polymer material" that turned out to be a cheap rayon knockoff.  They were supposed to cause weight loss by trapping in body heat, making the wearer lose water weight by sweating. The makers of Slim Jeans said weight loss could occur if the pants were worn exercising, sleeping or even watching TV.  For a while, Slim Jeans were sold with a matching shiny sweatshirt to allow for even more good-looking weight loss.

Clip-On Weight Loss -

According to Ninzu, the manufacturers of a 1990s device called the B-Trim, weight loss could be attained by clamping this little object onto the ear.  Here's how it was supposed to have worked:  The clip put pressure on a nerve ending, which supposedly stopped stomach muscles from moving, signalling the brain that the stomach was full.  This was apparently supposed to control appetite leading to weight loss.  Ads for the B-Trim said these claims were proven by "scientific evidence."  The only problem: they didn't actually list any of that evidence.  The result was that the Federal Trade Commission made Ninzu stop selling the B-Trim in 1995. (Don't they call these "ear rings" now?)

Phrase of the Day: "The only thing I like better than a low fat diet are my Magic Pants!"

Our New Medicare Czar

Donald Berwick, our new Medicare Czar, was appointed by President Obama during Senate recess to avoid partisan voting.  Again, we see Obama's abuse of the "recess appointment" to push his agenda and install a Center for Medicare and Medicaid leader in place that firmly believes in "redistribution of wealth."



Donald Berwick will use Medicare to "redistribute wealth."

Health Care Reform Costs Are Out Of Control

The heat on the Obama Administration and Congressional leadership over the cost of health care reform is not expected to ease anytime soon, with the release last week of additional information from the Congressional Budget Office on the Patient Protection and Affordable Care Act. The updated analysis shows the cost of the new law could easily exceed $1 trillion because of possible discretionary spending of at least $115 billion over the 2010-2019 period.(http://www.cbo.gov/ftpdocs/114xx/doc11493/Additional_Information_PPACA_Discretionary.pdf)

The number of states now challenging the new law in court stands at 20, and the states have been joined in the suit by the National Federation of Independent Business. Also last week, the Milliman Medical Index for 2010 was released, and it contains more worrisome news -- health care costs continue to rise at an unsustainable rate. The report found that costs increased $1,303 for the typical family of four in the past year and now stand at $18,074. (http://www.milliman.com/expertise/healthcare/publications/mmi/pdfs/milliman-medical-index-2010.pdf)

If health care reform goes forward, brace for a depression. That's my prediction.

The Real Reason For Obamacare . . .

Nancy Pelosi explains the Obama Administration's real view of the health care bill.  She explains that it is "entreprenurial" and allows us to all "quit our jobs and be creative" because we will still have health care.  That's only if they can keep the doctors around, you know, 'cause I would like to be creative, too!!  I think instead of actually seeing and treating the patients,  I will just draw and paint pictures of healthy people and spend my day imagining a healthier planet because Nancy says health care will be provided for everyone. . .

Can you say "Welfare State?!!"  So who is going to actually pay for this health care?

Calcium Deficiency Early in Life May Lead to Obesity

It appears that calcium plays an even larger role in bone health in the first few days of life than it does later in life.  It also appears that getting your calcium may keep you skinnier!  See the story below:
Calcium-Deficient Piglets Form Fat Cells in Place of Bone Cells
(Story from "The Medical News" http://www.news-medical.net/news/20100514/Calcium-deficiency-may-make-people-more-prone-to-osteoporosis-obesity-in-later-life-Study.aspx)

"There's no denying that people need calcium for strong, healthy bones. But new research from North Carolina State University suggests that not getting enough calcium in the earliest days of life could have a more profound, lifelong impact on bone health and perhaps even obesity than previously thought.

"During an 18-day trial involving 24 newborn pigs, the researchers documented markedly lower levels of bone density and strength in 12 piglets fed a calcium-deficient diet compared to 12 piglets that received more calcium. Not only that, but when researchers looked at certain stem cells in bone marrow, they found that many of these cells in the calcium-deficient piglets appeared to have already been programmed to become fat cells instead of bone-forming cells.

"Because these programmed mesenchymal stem cells replicate to provide all the bone-forming cells for an animal's entire life, very early calcium deficiency may have predisposed the piglets to have bones that contain more fat and less mineral. That could make those pigs more prone to osteoporosis and obesity in later life, said Dr. Chad Stahl, an associate professor of animal science who led the study.

"In a longer-term study that Stahl plans to begin this month, the researchers will look at whether that's the case: By conducting a longer feeding trial, the scientists will be able to see if the changes persist through sexual maturity, which occurs for pigs at around eight months of age.

"The researchers are using pigs as a model for human health because pigs and humans are similar when it comes to bone growth and nutrition. Pigs are one of the few animals known to experience bone breaks related to osteoporosis, Stahl said.

"One of the most surprising findings of the 18-day feeding study was that while the calcium-deficient pigs had substantially lower bone strength and density, blood tests didn't indicate any difference in levels of the hormonal form of vitamin D, which regulates the amount of calcium circulating in the blood of older children and adults. Stahl said this suggests that calcium regulation in newborns isn't dependent on vitamin D.

"Stahl thinks the research is relevant to the infant food industry and suggests the significance of the nutritional status of breastfeeding mothers. It also points to a need for greater emphasis in very early life on bone health, not just during those times when children are growing most rapidly.

"'While the importance of calcium nutrition throughout childhood and adolescence is well-recognized, our work suggests that calcium nutrition of the neonate may be of greater importance to lifelong bone health, due to its programming effects on mesenchymal stem cells,' Stahl reported at the recent Experimental Biology 2010 meeting in Anaheim. 'It also points to a potential paradigm shift in which health professionals might want to begin thinking about osteoporosis not so much as a disease of the elderly, but instead as a pediatric disease with later onset.'

"'For me,' Stahl said, 'the biggest message is that calcium nutrition, or mineral nutrition as a whole, needs to be a priority from day one. Early life nutrition is setting children up physiologically for the rest of their lives.'

"Source: North Carolina State University"

Open Letter to Progressives

Fibromyalgia, Exercise and Obesity

ScienceDaily (Apr. 29, 2010) — Researchers at the Norwegian University of Science and Technology have found an association between the level of leisure time physical exercise and a future risk of developing fibromyalgia. The research team also identified BMI as an independent risk factor for fibromyalgia.

Details of the study appear in the May issue of Arthritis Care & Research, a journal published by Wiley-Blackwell on behalf of the American College of Rheumatology.

Fibromyalgia (FM) is a chronic pain syndrome characterized by widespread pain lasting more than 3 months, and tender point sites in the neck, shoulders, back, hips, arms, and legs. Associated features often include unexplained fatigue, sleep disturbances, headache, cognitive difficulty, and mood disturbances. The prevalence of FM increases with age and is considerably higher among women than men. Although the etiology of FM is poorly understood, many authors have suggested that a dysfunctional autonomic nervous system involving deficiencies in the hypothalamic-pituitary-adrenal (HPA) axis and sympathetic nervous system contributes to the development of FM by altering pain perception and endogenous pain inhibition.

According to the National Institute of Arthritis and Musculoskeletal and Skin Diseases, FM has been linked to stressful or traumatic events, such as car accidents, repetitive injuries, illness, certain diseases, or FM can occur spontaneously. Some scientists speculate that a gene or genes might be involved in fibromyalgia that could make a person react strongly to things that other people would not find painful.

Longitudinal studies have shown that physical exercise is associated with less musculoskeletal pain and stiff or painful joints among aging women. The Norwegian researchers, led by Paul Mork, D.Phil., proposed that first, there is an association between levels of leisure time physical exercise and future risk of FM and, second, being overweight/obese may represent an independent risk factor for future development of FM. Data for the study was collected from the Nord-Trøndelag Health (HUNT) Study, the first part conducted in 1984-1986 (HUNT 1) and the second in 1995-1997 (HUNT 2). During the 11 years between HUNT 1 and HUNT 2, 380 cases of incident FM were reported among 15,990 women who provided information on relevant variables at both surveys and who reported no FM or physical impairment at HUNT 1.

"Women who reported exercising 4 times per week had a 29% lower risk of FM compared with inactive women," says Dr. Mork. "Similar results were found in the analysis of the summary score combining information on frequency, duration, and intensity of exercise; women with the highest exercise level had a somewhat lower risk than inactive women. The study further shows that a high BMI (i.e., being overweight or obese) is a strong and independent risk factor for future development of FM. Moreover, the higher relative risks for the combined effect of being overweight/obese and inactive, relative to being overweight/obese alone, point to a further disadvantage for overweight women who do not exercise."

While the causal relationship between obesity and FM remains unknown, there are some etiologic factors in common. Studies suggest that proinflammatory cytokines play a role in FM and the relationship between FM and obesity. Other studies point to dysregulation of the HPA axis, which has been observed in both FM and obesity. Finally, increased sympathetic tonus and reduced sympathetic reactivity, as recorded by heart rate variability, has been observed in patients with FM as well as in overweight and obese subjects. Dr. Mork concludes, "These findings, together with the current study, indicate that regular physical exercise, and thereby improved physical fitness, may serve as a buffer against the perpetuation of musculoskeletal symptoms that eventually lead to the development of FM."

Health Care and Politics

I have been told by many that there are two things you never talk about: politics and religion.  I realize that I have broken these rules, but these seem to be the things that are most important in life and are at the forefront of the mind recently. 

It has been interesting to hear from my liberal friends and collegues about my last comments.  I find that the conversation and communication is important for two reasons.  First, truth is independant, and the only way to identify truth is to hear it, read about it, or find it through civil discussion with those around you. The truth about health care has been weighing upon my mind in the last year.

It has been upon my mind because it is what I do for 12-16 hours per day.  I am in the business of rendering care and attempting to provide the best care possible in few minutes I have with each patient.  But I am finding that political influences of both our state and nation have drastically affected the number of minutes I can spend, the type of care I can render and the choices I can offer to my beloved patients.  I have found that these political voices can no longer be silently ignored.  

As I have read, listened and discussed this with many around me (both conservative and liberal), I am finding there are really only two voices.  Those voices speak at various points along a spectrum of desired liberties, but there are really only two voices.  There are those voices that speak the language of the founders of this republic who understood that true freedom comes from liberty, and there are those that speak the voice of progressivism whos concepts of freedom are defined by various degrees of socialism. 

I have been accused of not understanding socialism and seeing all change in society as socialistic.  This is not the case.  Socialism, as it was defined in "school," is that society in which there is no private property. It is where the collective or governmental ownership oversees the distribution of goods and services. Socialism as defined by Marxist theory is a stage in society between capitalism and communism.  These political doctrines are founded in our understanding and acceptance of the concept of property ownership.  We see this in governments around the world in varying degrees in countries like France, Venisuala, Sweden, and Laos, etc.

Private property and liberty are insperable. We lose our liberty as the right to hold private property is removed. The difference in views between our country's founders and the progressives is their understanding of the conferrance of freedoms based on the liberties granted by ownership of private property.  Communism is defined as a society where ownership of private property does not exist.  In the words of Abraham Lincoln, "We all declare for liberty; but in using the same word we do not all mean the same thing.  With some the word liberty may mean for each man to do as he pleases with himself, and the product of his labor; while with others, the same word may mean for some men to do as they please with other men, and the product of other men's labor.  Here are two, not only different, but incompatible things, called by the same name liberty.  And it follows that each of the things is, by the respective parties, called by two different and incompatible names - liberty and tyranny."

How do these political ideologies relate to medicine?  Well, lets think about a three other concepts.  First, those things that make us different from every other country in the world are defined in our Declaration of Independance: 
   "We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of Happiness."
We believe that being created in equality, we each have the right to life, liberty and the pursuit of happiness.  This statement does not guarantee happiness, but states that we have a right to liberty and life.  We have a right to act in this life in those ways that will bring us liberty, the right do those things that allow us the ownership of personal property and seeking those things in our lives that bring us happiness.

Second, life is full of change.  Our society is different from what it was in 1776, the time when our founders wrote the words of the Declaration, and our society will be different 100 years from now.  Change is important; however, our assessment and acceptance of change must be done with prudence.  But, that which is lost in our society today is prudence.  Prudence is of the highest of virtues because its judgement is drawn from wisdom.  Prudence was exercised as a basis of society in 1776 because of man's view of himself before his maker.  Our Declaration states that these rights are "God given."  Today, many question even the existance of a maker, and prudence is lost. With prudence being lost in our society, our general ability to assess the way societal changes affect us now and in the future is greatly limited.

Third, it is important that we understand the definition of capitalism.  Capitalism is defined as an economic system characterized by private or corporate ownership of goods or services, by investments that are determined by private decision, and by prices, production, and the distribution of goods that are determined mainly by competition in a free market
So, how then does this relate you your medical care?  Your ability to obtain care relates you your understanding of what medical care actually is.  Medical care is essentially property.  You buy services. Medical care is a service or commodity, just as your home or car is a commodity with ownership. The progressive view goes beyond the statement that "men are created equal" and asserts that men should receive equally, a socialistic view.  They extrapolate that men should therefore recieve medical care equally as it paints medical care as a right.  Medical care is not a right.  Medical care is a commodity which is purchased.  Your body was designed to heal itself.  When disease, illness or injury occurs, assistance to those bodily functions of healing can and should be sought as the "pursuit of happiness."  Medical care is thereby a service that is rendered either through purchase or through a charitable act. 
 
So then the politics of medical care then also pertain to our liberties and our freedoms. Our government was designed as a republic for our protection and to ensure life, liberty and pursuit of happiness.  Our constitution provides an environment for us to seek our own happiness while not infringing upon the lives of those around us.  We are free then to seek happiness through our own inginuity, free to protect ourselves, and free to take individual risks.  When injury or illness arises, we are free to seek care and healing above and beyond what our body will do on its own. 
 
The progressive or socialistic view is that men have the right to recieve the same or equal care.  Seen as a right, the progressive government mandates this care.  The problem with this view is that our liberties are then taken away, because a politician decides what care is best and how often you can recieve it.  In a capitalistic society, the medical provider will attempt to provide the best most efficient care to be competative in that society.  In a socialistic society, the medical provider has no incetive to become better or to provide a better service, because the same service is mandated by the governmental politician.   Yes, the care is free, but your liberties of "pursuing happiness" through the type and quality of your care is now infringed upon, and your freedom is restricted. 
 
I am affraid that our so-called "liberals," as well as our progressive republicans in society, desire to recieve the benefits of socialism in a capitalistic society.  These two concepts are diametrically opposed to each other.  Capitalism, and the medical services created and rendered therein, cannot succeed in a socialistic society requiring limitation of liberty under the guise of "medical equality."
 
Our medical system is broken.  We have allowed our government to create programs like Medicare and Medicaid, socialistic programs, trying to create equality and limiting our liberty.  We are now dependant upon these medical insurance programs created and expanded 50 years ago under progressive presidencies and congress.  We, the children and grandchildren of these leaders, must now deal with the consequences of socialistic action.
 
May we recognize our real rights, and may we pick leadership to help us solve these problems and learn to more effectively pursue life, liberty and happiness.

My Two Cents on Healthcare

I have had multiple patients ask me what my "take" on our current health care issue is and how I think it will affect the practice of medicine and my office.  So many patient's have asked me this question, that I figure I would just blog my thoughts here for all to read. 

Interestingly, I got spamed an e-mail today from Lori Heim, MD, president of the American Academy of Family Physicians, stating how wonderful this new "Obamacare" is and what a great "step forward this is for healthcare."  Let me give you my impressions on how "wonderful" this really is.

In order to understand Healthcare reform as it stands today, it is important that we look at three specific issues.  First, lets take a look at history, at some societies that have taken paths similar to ours.  Muselini, Stalin, Mao and others have shown that there are five steps in leading a society to socialism.  Those steps are 1) to take over the financial institutions, 2) take over major industry, 3) take over healthcare, 4) take over gun control and 5) control immigration.  Our great but sleeping country has allowed the first three of those steps to occur in the last year.

The banks were bought by Obama's Czars under the guise of "bail out money," car manufacturing, the largest private industry in our country, is now under the thumb and major ownership of our government by the same method. Now healthcare is under the control of the Obama Administration.  In this healthcare plan, Obama has succeeded in creating 159 new buerocratic agencies to oversee your doctor in rendering healthcare to you.  And to top this off, this new plan that Nancy Pelosi was so sure you and I would love will only raise our income tax by 9.7% by 2012.  That's right a 10% tax hike for a buerocraticly driven healthcare system.  Healthcare is not the goal, socialism is the goal, and healthcare control is just one of five steps in that direction.  Watch the news for control of guns and immigration as the next steps.

Second, Obama told us that this health care plan would pay for itself.  That's because the cost of this $940 billion (yes, that billion with a "b") plan at the time it was voted on was offset by the fact that the Medicare paycut, that would cost $930 billion to fix, had already taken place.  The Obama Administration used the money from the pay cut to balance the new healthcare plan.  The media just sucked this right up and never said a word about it. 

Interestingly, they tried to throw the physicians a bone by saying, "Hey, well will give you a 10% raise for seeing medicare patients."  That won't help because they have already cut reimbursement to physicians by 21.5%.  This cut is occuring because Bill Clinton, in his wisdom at the end of his presidency, decided to balance the budget by cutting reimbursement by 5% every year starting in 2002 for 10 years.  Medicare currently only reimburses physicians payment rates equivalent to the 1986 economy.  (You look around and see if there are any other industries functioning that haven't had a pay raise in 30+ years) We as physicians have never had a pay raise since.  Congress has "deferred" this pay cut each year but never fixed it. Congress missed deferring it this year on April 1st because of Obama's push to "fix healthcare instead."

As of Monday, congress again retroactivly deferred this cut until May 30th, however, patient's seen from April 1st to April 18th will be paid at the cut rate.  Medicare will "try to ensure that these are corrected" but have you ever tried to get Medicare to correct a payment error?  Good luck! You're more likely to get the IRS to waive your taxes this year.

Third, the balance of the pay cut will continue to rise each year.  As of September 1st, this pay cut will increase to 26.5%. 

Let me explain to you what this means.  If the 21.5%  pay cut occurs May 30th, I will have to lay off three of my employees and drop my personal health insurance and insurance for my remaining staff just to keep my doors open.  As an employer, the 10% personal income tax my employees pay starting in 2012 is matched by the business they work for, that means that my employer taxes go up by 10% per employee.  Commercial health care sets their rates on the Medicare reimbursement, so with in 6 months of the pay cut ALL insurance will cut their rates too.  A 21.5% pay cut to physcian's offices and a 10% increase  per employee payroll tax will put me out of business.  Good thing I have kept my shovels around, I may be digging diches soon.

Unless this is fixed, 2012 will see thousands of physician offices closing their doors.  There are already not enough primary care physicians and the need will drastically increase to cover the additional 30 million people "Obamacare" claims it will cover.  This means healthcare shortages will occur beyond what this country has ever seen.  You thought wait times to get in to see your doctor were bad, wait until 2012.

Our wonderful Republican party has done nothing but vote no.  In fact, Arizona's Senator Kyle, Senator McCain and House Representative Franks all voted "no" on Monday's Medicare deferrment.  I have been watching their voting each week for the last year.  When questioned in a recent town hall meeting by multiple physicians as to what the Republican Party was doing to create legislation that would fix the problem, all Senator McCain could say was "we are determined to vote down Obamacare."  Great line Senator McCain! That's all you've been doing for the last year.

So, as a physican with 40% of my practice Medicare based, healthcare reform is "wonderful." It fills my mind "full of wonder" as to what type of work I will be doing in 2012, and wondering where my patient's will find care.

I suggest two things to you.  First, pray, and pray sincerely.  The only way out of this fiasco is by the hand of divine intervention.  Second,  watch closely for and vote for congressional leadership that understands these issues.   That's what I'll be doing.

HCG & Weight Loss Fads

A number of patient have heard and asked me about Human Chorionic Gonadotropin (HCG). It is a hormone normally secreted by the trophoblastic cells of the placenta during pregnancy. It was first described as a treatment for obesity in conjunction with a very low calorie diet by Dr. A. Simeons in 1954.  Dr. Simeons reported weight loss success combining HCG with a very low calorie diet.  Multiple subsequent studies revealed that this method has been ineffective and that there has been no significant effect of HCG over placebo.  It appears that the weight loss occuring in these patients was due to the very low calorie diet used at the time and not the HCG; however, it has also since been shown that the diet used by Dr. Simeons was deficient in protein content based on current standards accepted in the bariatric (weight and metabolism specialist) community. 

The American Society of Bariatric Physicians released a position statement on HCG including the following summary and conclusions:
"Numerous clinical trials have shown HCG to be ineffectual in producing weight loss. HCG injections can induce a slight increase in muscle mass in androgen-deficient males. The diet used in the Simeons method provides a lower protein intake than is advisable in view of current knowledge and practice. There are few medical literature reports favorable to the Simeons method; the overwhelming majority of medical reports are critical of it. . .
Conclusions:
It is the position of the American Society of Bariatric Physicians that:
1. The Simeons method for weight loss is not recommended.
2. The Simeons diet is not recommended.
3. The use of HCG for weight loss is not recommended."
(http://www.asbp.org/resources/uploads/files/HCG%20Position%20Statement.pdf)

It is important that you consult your doctor before you begin any weight loss program and that you are aware of the recent data on current fads like the use of injectible and subligual HCG.

Dr. Nally is a member of the American Society of Bariatric Physicans and adheres to the metabolic and weight managment guidelines set forth by this medical society.

The Obesity Epidemic

I find it interesting that last year there were 435,000 deaths from cigarette smoking. Last year, there were also 400,000 deaths from obesity related illness. Obesity is second only to smoking as a cause of death. That is significant.
I have spent the last year reading and researching everything available on weight control. For the last 10 years of my clinical practice, two things have been elusive. First, almost two-thirds of the patient's in my practice are overweight or obese. That correlates with the current figures in the united states. However, most of these patients are very closely watching their diets and are exercising. However, the average patient is only able to loose 5-10 lbs and then the weight seems to return. Despite the depth and certainty of our faith that saturated fat is the nutritional bane of our lives and that sedentary behavior and over-indulgence or over-eating are the cause of our nations obesity, there is, and always has been, significant and plenteous evidence that the above assumptions are wrong . . . dead wrong.
I have patient after patient that comes to my office limiting their intake of fat and limiting their calories (sometimes to less than 1000 per day) and exercising more than most triathletes and they are still gaining weight.
Second, these same patients continue to have a climb in their cholesterol levels. It seems that I just continue to raise their doses of cholesterol lowering medicine to chase the numbers as they increase in adiposity.
To quote H.L Mencken, "There is always and easy solution to every human problem, neat, plausible, and wrong." After, a year of reviewing study after study and reading every legitimate source of research I can get my hands on I have come to the conclusion, as have many others, that fat doesn't make you fat.

Case in point, obesity rates remained fairly constant in the United States from 1960-1980 and then around the time the surgeon general released his "Report on Nutrition and Health" recommending that we all cut the fat out of our diets, our weight has increased to almost 33% being overweight in 2009.

This surge in obesity seems to correlate extremely closely with the constant message that obesity, diabetes and heart disease are caused by fat. We have been told for the last 30 years that we should eat less fat and eat more carbohydrates. Our society has been bombarded by this message and for the most part, we have believed it and followed suite. And the proof is in the statistics. We are getting fatter and fatter.

However, seeing what I have seen in the last 10 years of my practice, a large number of people have turned to the message of Dr. William Banting published in his "Letter on Corpulence" published in 1863 after he lost over 50 lbs. This message has been republished and repackaged in a number of ways, but the physiologic message is the same: Eat Fat and Grow Slim(1958), Calories Don't Count (1961), The Doctor's Quick Weight Loss Diet (1968), Dr. Atkin's Diet Revolution (1972), The Complete Scarsdale Medical Diet (1978), The Zone (1995), Protein Power (1996), Sugar Busters! (1998), and The South Beach Diet (2003). All of these advocate that it is the carbohydrates that are the problem and not the fat. It is fascinating to me that these have all been dismissed by the American Heart Association, The American Medical Association, and multiple nutritional authorities as misdirected fads. I, myself, told patients for years that these were just "fad diets." However, we were wrong.

Claude Bernard explained it this way, "In medicine, we are often confronted with poorly observed and indefinite facts which form actual obstacles to science, in that men always bring them up, saying: it is a fact, it must be accepted." (An Introduction to the Study of Experimental Medicine, 1865) The fact of the matter is that body weight is set by a complex interaction of hormones regulated by the body to maintain a homeostatic balance. The urge to simplify this complex situation so that physicians and apply it and patients can embrace it seems to have taken precedence over the obligation of science to present the evidence with relentless honesty. Unfortunately, this is an area of science where an enormous amount of data has been theorized and instead of rigorously proving those theories, there has become a dedicated practice of convincing the public that those theories have already been tested and the answers are already known. This is an area of medicine that, in the words of Gary Taubes, "purports itself to be science and yet function like a religion."

We have understood the actual science of fatty acid metabolism since the 1930's when Rudolf Schoenheimer & David Rittenberg identified the stages of cholesterol in the metabolism.

In 1965, we had a clear understanding of which hormones stimulate fat mobilization and which hormones promote fat accumulation. Forty years ago, there was no controversy to this. And the facts have not change, in fact we know more about hunger and the hormonal balance of fat mobilization and fat storage than we ever did before. And in 1976, Stephen Woods and Dan Porte described the evidence that insulin is the primary factor in the drive to store fat as "overwhelming."

So what is the bottom line? It is this. When your body sees carbohydrates or sugars of any type, it produces insulin. Insulin is the driving force to store fat. Whenever insulin is present, the body is told to store fat. When insulin is not present the body will use is previously stored fats for fuel. The key then to weight management is management of carbohydrates. The fewer carbohydrates you eat, the less insulin you make and the less fat you will store.

Click here for further information about weight loss and obesity treatments.

Six Degrees of Obama

This is the direction that Obama seems to be taking us regarding health care. Keep your eyes open because I see this happening around us without any checks and balances on the Socialistic slide.

More Success Occurs When Behavior Changes are Fun!

The video below shows that just some simple behavior changes can make a difference and making those behavior changes occurs more often when it is enjoyable or fun.



Enjoy!!

Weight Loss Tips - You Can Be Successful

I am asked daily about weight loss. At last count there are over 17,000 different diets all claiming to help you loose weight. There are a few things you should know about loosing weight and doing it appropriately.

First, 65-70% of those with weight problems have some form of insulin resistance. This is a precursor state to diabetes. It doesn't mean you will become diabetic, however, it means that if you continue to gain weight (the average America continues to gain an additional 1-2% of his or her body weight each year) you have a 15% chance of becoming diabetic in the next 5 years. This is why two thirds of people can only loose a small amount of weight over the short term and then see a rebound in the weight almost immediately. Our societies current approaches to weight loss with the "low fat" diets will only be truly effective in 30-35% of people. This is why most people feel like they are going to DIE, as this is the first part of "diet."

Therefore, if you are overweight, you should see your physician and get checked for insulin resistance or impaired fasting glucose (another term that is used interchangeably with insulin resistance) or see our website to make an appointment at http://www.nallyfamilypractice.com/.

If you are not insulin resistant, the low fat approach is important and will be successful if applied correctly. If you are insulin resistant, then an appropriate carbohydrate limiting approach will be the only way you will see success.

Second, in either case, it is important that you body does not think it is hungry or starving. When your body is hungry it thinks it is starving it will turn on the storage of fat for up to 24 hours. To solve this problem, it is important to eat five to six small meals per day every three to four hours. This helps keep your body feeling fed and turns of the drive to store fat.

Third, drink enough water. Water is key to weight management. If your body is thirsty it thinks it is starving and turns on fat storage. It is important to hydrate yourself regularly. I recommend drinking 64 oz of water per day as a base. That is eight 8oz glasses of water per day. You should know that drinking anything more concentrated than water (soda, juice, tea, coffee) will dehydrate your body. So, chase these drinks with a glass of water.

Fourth, some form of exercise regularly is essential. I recommend that if you are not participating in a regular exercise program, start a simple walking program. Start out walking for 10-15 minutes three times per week. You can increase the time you walk by a few minutes every two weeks. It is important, however, that you get checked out by your doctor before you engage in any moderate or vigorous exercise program.

Last, it is important to know that being overweight and obese are diseases that are treatable. It is important to understand that recent science shows that your body releases hormones that cause very strong cravings and appetites in response to both physical and psychological stimuli. Keeping a dietary journal is important. Write down what you eat and record why you ate it. After a while, you will see patterns to why you are eating and when. Habits of eating are some of the most challenging to break and a diet journal is a key to unlocking these habits, both good and bad.

I have heard many physicians state that the only reason people can't loose weight is because they just don't push away from the table. For the majority of people weight control is possible as you appropriately regulate your hormones. I know very few women who can just concentrate or focus their will power and stop their menstrual cycle for a few months. Why they would anyone think that just pushing away from the table will reduce their weight?

You can loose weight and you can be successful. Start with these simple tips and follow up with your doctor if you are not seeing the success you desire.

Swine Flu and You

What is swine flu?
Swine Influenza (swine flu) is a respiratory disease of pigs caused by type A influenza viruses that causes regular outbreaks in the animal and specifically the pig populations. The Center For Disease Control has reported that between April and August, 2009, there has been a surge in hospitalization of school aged children due to infection with Influenza A, novel H1N1 virus. This virus has not been as problematic as suspected in persons older than 20 years old (http://www.cdc.gov/h1n1flu/update.htm). Swine flu or Influenza A viruses have been reported to spread from person-to-person.



In late March and early April 2009, cases of human infection with swine influenza A (novel H1N1) viruses were first reported in Southern California and near Guadalupe County, Texas. Other U.S. states have reported cases of swine flu infection in humans and cases have been reported internationally as well.

What are the signs and symptoms of swine flu in people?
The symptoms of swine flu in people are similar to the symptoms of regular human flu and include low grade fever (99-101 degrees), cough, sore throat, body aches, headache, chills and fatigue. Some people have reported diarrhea and vomiting associated with swine flu. In the past, severe illness (pneumonia and respiratory failure) and deaths have been reported with swine flu infection in people, however, like seasonal flu, swine flu may cause a worsening of underlying chronic medical conditions. If you are having any of the above symptoms, Dr. Nally recommends you get evaluated for the flu.

Many patients have been extremely concerned about the constant media coverage of the recent documentation of increased numbers of swine flu cases. Please do not be alarmed by all the “Media Hype” and “Shock Tactics” used by television and radio.

What should I do to keep from getting the flu?
First and most important: wash your hands. Try to stay in good general health. Get plenty of sleep, be physically active, manage your stress, drink plenty of fluids, and eat nutritious food. Try not touch surfaces that may be contaminated with the flu virus. Avoid close contact with people who are sick.



There is a vaccine that will be available in mid-October to help prevent the spread of this virus. This vaccine will be given to school-aged children, pregnant women, and the health care providers that treat them first, then as the vaccine is made available, it will be offered to the rest of the community.



See your doctor for further information about the flu or if you suspect you may have the symptoms above.

Super Size Me?

I appreciate the message in this documentary. I see these exact side effects of fast food indulgance and gluttony in my office daily. Since I originally saw this video four years ago, I have not been able to bring myself to eat in a McDonald's or Burger King since.

Pre-Diabetes: One in Four Americans Have It

It is estimated that one fourth of the US population has pre-diabetes - that's 54 million people. The findings reported in the November 7th, Morbidity and Mortality Weekly Report states that as many as one in four Americans have this condition and only 4% are aware of it.

Pre-diabetes is defined as having fasting blood sugars between 100-125 mg/dl. Normal blood sugar should be between 60-99 mg/dl after fasting. Pre-diabetes or impaired fasting glucose as it is now more commonly referred to is a precursor condition for diabetes. As many as 50% of those with impaired fasting glucose will become diabetic and 15% will progress to diabetes within five years. Unless drastic measures are taken it is estimated that one in three people born after the year 2000 will be diabetic.

This is a treatable condition, however, and progression to diabetes is not inevitable. Recent studies have shown that 150 minutes of exercise per week (that's only 30 minutes a day 5 days a week) decreases your risk of progression by nearly 70%.

What is your risk for pre-diabetes? Take the following screening test and find out:
Age: Score:
20-27 . . . . . . . . . . . 0
28-35 . . . . . . . . . . . 1
26-44 . . . . . . . . . . . 2
45-64 . . . . . . . . . . . 3

Sex:
Male . . . . . . . . . . . . 3
Female . . . . . . . . . . 0

Body Mass Index:
Less than 25 . . . . . 0
25-29.9 . . . . . . . . . .2
30 or greater . . . . . 3

Family History of Diabetes:
No . . . . . . . . . . . . . . 0
Yes . . . . . . . . . . . . . .1

Heart Rate (bpm)
Less than 60 . . . . . . 0
60-69 . . . . . . . . . . . . 1
70-79 . . . . . . . . . . . . .1
80-89 . . . . . . . . . . . . 2
90-99 . . . . . . . . . . . . 2
> 100 . . . . . . . . . . . . 4

Hypertension:
No . . . . . . . . . . . . . . . 0
Yes . . . . . . . . . . . . . . .1

Add up the score in each area. If your number is 7 or more, you need to be screened.

Again the key in prevention is exercise. Just a simple 30 minute walk 5 times per week is all it takes.

Death by Caffeine

I drank a wonderful cup of hot chocolate this evening while watching a nice Christmas movie with my wife and children. Now, I sit here at my computer at 1am wondering why I am not tired. . . and I realize it is the caffeine ingested with that wonderfully smooth and chocolaty hot cocoa. This got me to wondering . . . how long is this going to be in my system?

Well, the half-life of caffeine is about 6-8 hours. That means it takes up to 36 hours for your body to metabolize the caffeine and remove 95% of it from your system and it takes another 36 hours to completely remove it. Will I still be sitting here on my computer in 6 days? I hope not.

Caffeine is metabolized or broken down in the liver by the cytochrome P450 oxidase enzyme (This is the same metabolic component important in steroid synthesis) system into three metabolic dimethylxanthines, which each have their own effects on the body:
Paraxanthine (84%): Has the effect of increasing lipolysis, leading to elevated glycerol and free fatty acid levels in the blood plasma.
Theobromine (12%): Dilates blood vessels and increases urine volume. Theobromine is also the principal alkaloid in cocoa, and therefore chocolate.
Theophylline (4%): Relaxes smooth muscles of the bronchi, and is used to treat asthma. The therapeutic dose of theophylline, however, is many times greater than the levels attained from caffeine metabolism.
Each of these metabolites is further metabolized and then excreted in the urine.

The interesting effect of all this is that caffeine secondarily stimulates insulin secretion which then lowers blood sugar, thereby stimulating hunger. This can cause weight gain. Caffeine, inhibiting the Cytochrome P450 system also can effect steroid synthesis and can lead to lower testosterone levels and weight gain. Funny isn't it? Caffeine sold in all the weight loss products has just the opposite effect on weight - it will cause you to gain weight.

So, how much caffeine is really problematic? Well, physicians use caffeine to help with fatigue and to help with cognition (your ability to think clearly). However, only 100-200mg are needed to have these effects. The precise amount of caffeine necessary to produce effects varies from person to person depending on body size and degree of tolerance to caffeine. It takes less than an hour for caffeine to begin affecting the body and a mild dose wears off in three to four hours. Consumption of caffeine does not eliminate the need for sleep: it only temporarily reduces the sensation of being tired.

250-700mg of caffeine in your system can, and often does, cause anxiety, nervousness, hypertension, and insomnia (you are probably reading this at 1am because of your hot chocolate, too, aren't you!?) Caffeine relaxes the internal anal sphincter muscles and thus should be avoided by those with fecal incontinence. (I now understand why they never serve caffeinated drinks at and open house for a proctologist).

Caffeine has a drastic effect on spiders as you can see. The picture is the same spider "caffeine free" on top and "caffeinated" on the bottom.

Greater than 1000mg of caffeine will often cause tachycardia (rapid heart rate over 110 bpm), heart palpitations (the sensation of your heart pounding or beating heavily in your chest), insomnia, tinnitus (ringing in the ears), cognitive difficulty (cloudy thinking).

How much caffeine is too much? Well, over 10 grams is lethal. Yes, caffeine can kill you . . . literally.

So how much caffeine did I get in my cup of hot chocolate? Well, I drank about 10 oz and that contains roughly 0.6mg per oz. I don't drink caffeine very often and so that 6-7mg is actually affecting me and has given me a short burst of energy (not to mention the sugar content of the hot cocoa - that's for another nights blogging). Here's a list of common drinks and their caffeine content, just in case you wanted to know:

Amount/ Product/ Caffeine content:

12 oz Most cola drinks. . . . . . . . . . . . . . . . . .40-100mg

8 oz Hot Cocoa . . . . . . . . . . . . . . . . . . . . . . . .5mg

1 cup Espresso. . . . . . . . . . . . . . . . . . . . . . . .200mg

6 oz Coffee (American). . . . . . . . . . . . . . . . .100mg

1 cup Instant Coffee . . . . . . . . . . . . . . . . . . .75mg

1 cup Decaff Coffee. . . . . . . . . . . . . . . . . . . . 3mg

16 oz Rock Star. . . . . . . . . . . . . . . . . . . . . . . 300mg

1 cup Starbucks Grand Coffee. . . . . . . . . . .360mg

1 cup Tea. . . . . . . . . . . . . . . . . . . . . . . . . . . . 60mg

4 oz Chocolate bar. . . . . . . . . . . . . . . . . . . . .80mg

1 Excedrin. . . . . . . . . . . . . . . . . . . . . . . . . . 65mg

1 Midol . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .32mg

1 No-Doz. . . . . . . . . . . . . . . . . . . . . . . . . . . . .100mg

Well, for what it is worth, I think I will save my next cup of hot chocolate for next Christmas.

I am going to go find the Benadryl . . . right after I find the bathroom . . .

Recommendations for General Health

I am often asked "how often should I have a physical and what should it include?" In response to this question the following things should be considered realizing that this is not a comprehensive list and each item should be discussed with your doctor.

First, it is recommended that you have a physical exam at least yearly. A physical exam or "physical" is an opportunity for your physician to review all of you body systems and identify your risk for major diseases and more significantly identify ways to prevent these diseases.

A "physical" should routinely include a head to toe exam including vital signs (blood pressure, pulse, respirations, and temperature) and a vision screening. This should include an examination of your eyes, ears, nose, throat, neck, heart, lungs, abdomen, genitourinary systems and extremities. If you are over the age of 30, this should routinely include an EKG (Electrocardiogram). This exam should also include basic blood work including a complete blood count, comprehensive metabolic panel, thyroid stimulating hormone level, urinalysis and fasting lipid (cholestero) panel.

If you are a smoker or have any history of lung diseases including asthma, emphesema or chronic bronchitis, you should have a yearly chest x-ray.

Men between the ages of 40 and 70 years old should have a prostate exam yearly and this should include a PSA (Prostate Specific Antigen) blood test to screen for prostate cancer.

Women who are sexually active or over the age of 18 should have a yearly pap smear to screen for human papilloma virus (HPV) and cervical cancer.

Men and women over the age of 50 should have a screening colonoscopy every 10 years to check for colon cancer.

Women over age 40 should have yearly mammograms, and women who are menopausal or who have had a hysterectomy should have a bone densometry test every 2 years.

During your physical exam the following vaccinations can be considered:

Influenza - yearly for the very young and for those over the age of 65 or with any lung disease

Pneumonia - every 5 years.

Hepatitis B - anyone with freqent exposure to the public or any healthcare worker

Hepatitis A - anyone with freqent exposure to the public, healthcare or daycare worker.

The following vaccines are very helpful but you should talk to your doctor about risks and benefits of their use:

Guardasil - Vaccine for prevention of Human Papilloma Virus

Zostavax - Vaccine for prevention of Herpes Zoster (Shingles).

It is recommended that most people without significant complicating illness eat a diet low in fat and exercise for 30 minutes at least 3 times per week to maintain their level of health.

For specific information on medical problems or symptoms, please see your doctor.