Needle-less Vaccines on the Horizon

Scientists at King’s have demonstrated
the ability to deliver a dried live
vaccine to the skin without
a traditional needle
(credit: King’s College London)

Researchers at King's College in London have demonstrated the ability to deliver dried live vaccine without a traditional needle.  The vaccine is delivered via a silicone mold with micro-needles made of sugar. They have also demonstrated which cells the body uses to trigger the immune response in the skin.  See the fascinating article here.

Television & Sperm Don't Mix

All right men, STEP AWAY FROM THE TELEVISION! 

The British Journal of sports medicine recently published research showing that men who watch more than 20 hours of television per week have nearly half the sperm production (44% less) of a normal male. Interestingly, however, men who exercise more than 15 hours per week at 73% more sperm than the average male.

Allan Pacey, PhD, British Fertility Society chairman suspects that the prolonged sitting heats up the mail testicle causing decreased from production. This phenomenon has already been seen and documented in men who wear tight undergarments.

The research shows that the intensity of exercise does not seem to play a roll as long as even light exercise is participated in for over 15 hours per week.

So, drop your remote, put on your gym shoes and go take a walk. 

Keep Calm . . .

Saw this today and I just couldn't pass it up. Whether it's a cold, the flu, or hemorrhoids, . . .  a thyroid problem or diabetes, your family physician can help.  Just give him or her a call . . .

Hypocrisy

Fat Thoughts . . .

As a bariatrician, I think about fat all the time.  I guess you could say I have a lot of "fat thoughts."

I frequently hear patient's tell me, "Dr. Nally, I'm eating RIGHT, but I'm just NOT losing weight!"

If you're not losing weight, your not eating correctly. 99% of your weight loss success is related to your diet. We have been poorly misinformed over last 40 years as to what a "correct" diet contains. We've been told to follow a low fat diet for the last 40-50 years.  However, it is very apparent as patient's follow a low fat diet that only a small percentage of them have success in weight loss, and the majority actually gains more weight and remains significantly hungry.  When you look at the body's physiology, fat restriction only stimulates increased hunger.  The intake of any form of carbohydrate, whether that be simple or complex, stimulates an insulin response.  Based on our genetics, that insulin response can be variable. some of us respond normally and others respond with between 2-10 times the normal insulin surge.  Insulin is actually the hormone that drives weight loss or weight gain.

You and I will not be able to effectively lose weight until we control the response of insulin, and this can only be done through carbohydrate restriction.

Brush Fires in our Minds . . .

You’re sound asleep when you hear a thump outside your bedroom door.  Half-awake, and nearly paralyzed with fear, you hear muffled whispers.

At least two people have broken into your house and are moving your way.

With your heart pumping, you reach down beside your bed and pick up your shotgun.  You rack a shell into the chamber, then inch toward the door and open it.

In the darkness, you make out two shadows. One holds something that looks like a crowbar.  When the intruder brandishes it as if to strike, you raise the shotgun and fire.

The blast knocks both thugs to the floor. One writhes and screams while the second man crawls to the front door and lurches outside.

As you pick up the telephone to call police, you know you're in trouble.  In your country, most guns were outlawed years before, and the few that are privately owned are so stringently regulated as to make them useless…Yours was never registered.

Police arrive and inform you that the second burglar has died.

They arrest you for First Degree Murder and Illegal Possession of a Firearm.

When you talk to your attorney, he tells you not to worry, the authorities will probably plea the case down to manslaughter.

"What kind of sentence will I get?" you ask.

"Only ten-to-twelve years," he replies, as if that's nothing. "Behave yourself, and you'll be out in seven."

The next day, the shooting is the lead story in the local newspaper.

Somehow, you're portrayed as an eccentric vigilante while the two men you shot are represented as choirboys. Their friends and relatives can't find an unkind word to say about them. Buried deep down in the article, authorities acknowledge that both "victims" have been arrested numerous times.

But the next day's headline says it all:  "Lovable Rogue Son Didn't Deserve to Die."  The thieves have been transformed from career criminals into Robin Hood-type pranksters. 

As the days wear on, the story takes wings.  The national media picks it up, then the international media.  The surviving burglar has become a folk hero.

Your attorney says the thief is preparing to sue you, and he'll probably win.

The media publishes reports that your home has been burglarized several times in the past and that you've been critical of local police for their lack of effort in apprehending the suspects.  After the last break-in, you told your neighbor that you would be prepared next time.

The District Attorney uses this to allege that you were lying in wait for the burglars.

A few months later, you go to trial.

The charges haven't been reduced, as your lawyer had so confidently predicted.

When you take the stand, your anger at the injustice of it all works against you. Prosecutors paint a picture of you as a mean, vengeful man.

It doesn't take long for the jury to convict you of all charges. The judge sentences you to life in prison. . .

This case really happened.

On August 22, 1999, Tony Martin of Emneth, Norfolk , England , killed one burglar and wounded a second.

In April, 2000, he was convicted and is now serving a life term.

How did it become a crime to defend one's own life in the once great British Empire ?  It started with the Pistols Act of 1903.  This seemingly reasonable law forbade selling pistols to minors or felons and established that handgun sales were to be made only to those who had a license.

The Firearms Act of 1920 expanded licensing to include not only handguns but all firearms except shotguns..

Later laws passed in 1953 and 1967 outlawed the carrying of any weapon by private citizens and mandated the registration of all shotguns.

Momentum for total handgun confiscation began in earnest after the Hungerford mass shooting in 1987. Michael Ryan, a mentally disturbed man with a Kalashnikov rifle, walked down the streets shooting everyone he saw. When the smoke cleared, 17 people were dead.

The British public, already de-sensitized by eighty years of "gun control", demanded even tougher restrictions.  (The seizure of all privately owned handguns was the objective even though Ryan used a rifle.)

Nine years later, at Dunblane , Scotland , Thomas Hamilton used a semi-automatic weapon to murder 16 children and a teacher at a public school.  For many years, the media had portrayed all gun owners as mentally unstable or worse, criminals.  Now the press had a real kook with which to beat up law-abiding gun owners. 

 
Day after day, week after week, the media gave up all pretense of objectivity and demanded a total ban on all handguns.  The Dunblane Inquiry, a few months later, sealed the fate of the few sidearms still owned by private citizens.

During the years in which the British government incrementally took away most gun rights, the notion that a citizen had the right to armed self-defense came to be seen as vigilantism.
Authorities refused to grant gun licenses to people who were threatened, claiming that self-defense was no longer considered a reason to own a gun.

Citizens who shot burglars or robbers or rapists were charged while the real criminals were released.  Indeed, after the Martin shooting, a police spokesman was quoted as saying,
"We cannot have people take the law into their own hands."

All of Martin's neighbors had been robbed numerous times, and several elderly people were severely injured in beatings by young thugs who had no fear of the consequences.  Martin himself, a collector of antiques, had seen most of his collection trashed or stolen by burglars.

It didn't help. Gun related crimes rose to an all time high over the next 15 years peaking at over 24,000 incidents in 2003/04.

When the Dunblane Inquiry ended, citizens who owned handguns were given three months to turn them over to local authorities.

Being good British subjects, most people obeyed the law. The few who didn't were visited by police and threatened with ten-year prison sentences if they didn't comply.

Police later bragged that they'd taken nearly 200,000 handguns from private citizens.

How did the authorities know who had handguns? The guns had been registered and licensed. Kind of like cars.  Has the brush fire been started in your mind ?

Artificial Pancreas . . . on the horizon

Montreal researchers are perfecting a dual hormone insulin pump that controls blood sugar through the release of insulin and glucose based on your blood sugar levels. . . now that's cool . . . and useful! I can't wait to see this in clinical practice . . .

List of Low-Carb Bloggers

Nice list of low-carb bloggers in no particular order . . . HERE.

Stand Up and be Counted

If you stand up to be counted, from time to time you may get yourself knocked down. 

However, remember this:

A man flattened by an opponent can get up again...
A man flattened by conformity stays down for good.

NRA ENSURES BLACKS HAVE GUNS

Great article by Ann Coulter about how the NRA was instrumental in protecting the rights of blacks to own guns and defend themselves.  This article includes a little known story about how the NRA and Second Amendment rights prevented a black physician and his wife from being lynched by the KKK. 

Read it here:
NEGROES WITH GUNS

Researchers Identify Gene with Role in Obesity and Diabetes

Scientists observed that blocking the expression of the gene TRIP-Br2 in mice protects them against obesity and insulin resistance. The study shows that the gene modulates fat storage by ... read the rest of the article

Brief History of Medicine

A Short History of Medicine:
2000 B.C. – “Here, eat this root.”
1000 B.C. – “That root is heathen, say this prayer.”

1850 A.D. – “That prayer is superstition, drink this potion.”

1940 A.D. – “That potion is snake oil, swallow this pill.”

1985 A.D. – “That pill is ineffective, take this antibiotic.”

2000 A.D. – “That antibiotic is artificial. Here, eat this root.”

- Author Unknown

Happy New Year!!

I spent a wonderful New Year's Eve with family and friends.  I hope that you did too. I've done a great deal of reflecting over the events and experiences of the year.  I'm reminded of New Year's Resolutions:

With all that goes on around us, I hope you can smile when in trouble, who can gather strength from distress, and grow brave by reflection. 

May 2013 be a wonderful year for each of us. 

Dangerous! UN Convention on Rights of Persons with Disabilities

The Senate will be voting on ratification of the "UN Convention on Rights of Persons with Disabilities."  This is a very dangerous ratification because it drastically changes the rights of the family.  Michael Farris, an attorney well versed in Federal and State law relating to the family, states it best below.  Please read his article and call your Senator today.  If you're in Arizona, please call Senator McCain's office in Washington, D.C., as he has recently vocalized that he sees no problem with this convention treaty.

"HSLDA has written about the threats posed to homeschool freedom by the UN Convention on the Rights of the Child (CRC) and the UN Convention on the Elimination of All Forms of Discrimination against Women (CEDAW).

"However, there is a third dangerous United Nations convention. This is the UN Convention on the Rights of Persons with Disabilities (CRPD).¹ President Obama sent it to the U.S. Senate for ratification on May 18, 2012.

"CRPD was adopted by the UN General Assembly on December 13, 2006, and entered into force on May 3, 2008, after it received its 20th ratification. The Optional Protocol to the Convention went into force on the same day after it received its 10th ratification. The CRPD was signed by President Obama on July 30, 2009. Since it has been sent to the U.S. Senate for ratification by President Obama, the U.S. Senate could vote to ratify this treaty at any time.

"CRPD calls for numerous protections for people with disabilities. Many of these protections are included in U.S. law as part of the Americans with Disabilities Act (ADA). However, CRPD also includes numerous provisions drafted by the United Nations which would concern many U.S. citizens. Like the CRC and CEDAW, if ratified, the Convention on the Rights of Persons with Disabilities would become the supreme law of the land under the U.S. Constitution’s Supremacy Clause in Article VI, would trump state laws, and would be used as binding precedent by state and federal judges. Since it is a treaty, the U.S. Constitution requires that it must be ratified by two-thirds of the U.S. senators present at the time of the vote, or 67 senators if all 100 U.S. senators were present.

"Ten Specific Problems with the Convention on the Rights of Persons with Disabilities

"1. Any remaining state sovereignty on the issue of disability law will be entirely eliminated by the ratification of this treaty. The rule of international law is that the nation-state that ratifies the treaty has the obligation to ensure compliance. This gives Congress total authority to legislate on all matters regarding disability law—a power that is substantially limited today. Article 4(5) makes this explicit.

"2. Article 4(1)(a) demands that all American law on this subject be conformed to the standards of the UN.

"3. Article 4(1)(e) remands that “every person, organization, or private enterprise” must eliminate discrimination on the basis of disability. On its face, this means that every home owner would have to make their own home fully accessible to those with disabilities. If the UN wants to make exceptions, perhaps they could. But, on its face this is the meaning of the treaty.

"4. Article 4(1)(e) also means that the legal standard for the number of handicapped spaces required for parking at your church will be established by the UN—not your local government or your church.

"5. Article 4(2) requires the United States to use its maximum resources for compliance with these standards. The UN has interpreted similar provisions in the UN Convention on the Rights of the Child to criticize nations who spend too much on military issues and not enough on social programs. There is every reason to believe that the UN would interpret these provisions in a similar fashion. The UN believes that it has the power to determine the legitimacy and lawfulness of the budget of the United States to assess compliance with such treaties.

"6. Article 6(2) is a backdoor method of requiring the United States to comply with the general provisions of the UN Convention on the Elimination of All Forms of Discrimination against Women. This treaty enshrines abortion rights, homosexual rights, and demands the complete disarmament of all people.

"7. Article 7(2) advances the identical standard for the control of children with disabilities as is contained in the UN Convention on the Rights of the Child. This means that the government—acting under UN directives—gets to determine for all children with disabilities what the government thinks is best.

"Additionally, under current American law, federal law requires public schools to offer special assistance to children with disabilities. However, no parent is required to accept such assistance. Under this section the government—and not the parent—would have the ultimate authority to determine if a child with special needs will be homeschooled, attend a private school, or be required to accept the program offered by the public school.

"8. The United States, as a wealthy nation, would be obligated to fund disability programs in nations that could not afford their own programs under the dictates of Article 4(2). This is what “the framework of international cooperation” means.

"9. Article 15’s call for a ban on “inhuman or degrading treatment or punishment” is the exact same language used in the UN CRC which has been authoritatively interpreted to ban any spanking by parents. It should be noted that Article 15 is not limited to persons with disabilities. It says “no one shall be subjected to … inhuman or degrading treatment.” This means that spanking will be banned entirely in the United States.

"10. Article 25 on Education does not repeat the parental rights rules of earlier human rights treaties such as the International Covenant on Civil and Political Rights or the International Covenant on Economic, Social, and Cultural Rights. This is an important omission. Coupling this omission with the direct declaration of “the best interest of the child” standard in Article 7(2), this convention is nothing less than the complete eradication of parental rights for the education of children with disabilities.

"HSLDA urges . . . all freedom-loving Americans to contact their U.S. senators and urge them to oppose this dangerous UN treaty. (by Michael P. Farris, Esq., LL.M.; Taken from http://www.hslda.org/docs/news/2012/201205250.asp)"

To speak with your Senator, call Washington, D.C., at (202) 224-3121 and ask for your State's Senator office.  Ask to speak with your Senator's staff and let them know you oppose the CRPD.

The Skinny On Artificial Sweeteners

I am frequently asked about the sweeteners that can be used along with a low carbohydrate diet.  I am a strong proponent of a high fat, moderate protein, very low carbohydrate diet, and I use this dietary approach in my medical practice daily.  What follows is a reprint of my article about sweeteners that can be found on my low carb website.  

So what is the "Skinny on Sweeteners?" There are a number of sweeteners available that can be used with cooking; however, many of them are not appropriate for use with a low carbohydrate diet.

With an understanding that weight gain or weight loss is controlled by the hormone insulin, our overall goal is to lower the insulin levels in the blood stream.  Glucose (a carbohydrate in its most simple form) stimulates insulin to rise.   A Low carbohydrate diet works because insulin levels are significantly lowered throughout the day.  Elevation in cholesterol, elevation in triglycerides and stimulus for production of uric acid also occur because of surges in the hormone insulin. The most common stimulus for insulin to rise is the body’s recognition of the presence of carbohydrates or sugars.

First, and foremost, we must understand how these carbohydrates or sugars are labeled or named so that we can identify them in the food products we eat.  Most sugars are labeled with the ending “ose". 

Sucrose, fructose, glucose, dextrose, lactose, and maltose are very common sugars you’ll see in the ingredient list of many products containing carbohydrates. All of these types of sugars will stimulate a significant insulin rise and lead to weight gain, elevation in cholesterol and triglycerides. 

Other very commonly used names that you will find containing the sugars above are: white and brown sugar, succanat, corn syrup, high fructose corn syrup, honey, malt syrup, cane juice, cane syrup, rice syrup, barley syrup, maple syrup, molasses, turbinado, and fruit juice concentrate.  Beware of products that contain "no added sugar" because they will often contain sugar concentrates in the form of concentrated grape or apple juice.

Fructose is sometimes promoted as a suitable sweetener for patients with diabetes or people who are wanting to follow a low-carb diet; however even though it does not cause a significant insulin rise, it is rapidly absorbed by the liver and converted into glycerol which leads to increased triglyceride and cholesterol levels.  Even though fructose occurs naturally in regular fruits and some vegetables, it is usually only present in small amounts. The fiber in these fruits or vegetables balances out the fructose content.  Today, fructose is added commercially to many foods in a highly refined purified form as high fructose corn syrup. Be careful because this form of fructose is found in soft drinks, ice teas, fruit drinks, jams, jellies, desserts, baked goods and even in many baby foods.  This form stimulates an extremely powerful stimulus in the liver to form triglycerides and leads to fatty liver disease, a form of non-alcoholic cirrhosis (J Am Diet Assoc, Lustig RH, 2010 Sep; 110 (9):1307-21).

Artificial Sweeteners
Most artificial sweeteners fall into a class that is referred to as “non-nutritive” meaning that they have no nutrient value to the human body. They provide a sweet taste to the senses without raising the blood sugar. These sweeteners can be useful in cooking and in maintaining blood sugars; however, it is important to realize that many of them still stimulate an insulin response.

Aspartame
The most popular artificial sweetener in use today is aspartame (NutraSweet™, Equal™).  Aspartame is calorie and carbohydrate free; however, it is not the ideal sweetener. Because of its chemical instability, it breaks down under heat into its chemical constituents - namely phenylalanine and aspartic acid. This makes it notably unsuitable for cooking or for storage for more than a few days. 

Second, in light of its safety profile maintained by the manufacturer, a number of people of experience side effects including headache, stomach upset, migraine and exacerbation of depression (Neurology October 1, 1994, vol. 44: 1787). Most people enjoy without problem, however.

Acesulfame Potassium
A second popular sweetener has been identified by the food and beverage companies called acesulfame potassium (Ace-K™, Sunette™). This sweetener is not fully absorbed by the gut, and yields no calories, nor does it raise blood sugar.  It also contains no carbohydrates.  To many palates, it has a slightly bitter savor, so it is often combined with aspartame to eliminate the bitter aftertaste.  The problem with acesulfame potassium is that there are a number of studies revealing it significantly increases insulin response without raising blood sugar.  Studies show that the insulin response is as remarkable as if a person ingested an equivalent amount of glucose (Horm Metab Res. 1987 Jun; 19(6):233-8.).  It appears thatacesulfame potassium works directly on the pancreas to stimulate insulin release (Horm Metab Res. 1987 Jul; 19(7):285-9).

This product appears to be one of the most popular artificial sweeteners currently used in a number of low-carb products. It can be found in many of the protein bars and protein shakes on the market.   It is also found in Coke Zero™, Pepsi One™ and a number of other diet sodas.  I have found in my private medical practice that this sweetener significantly limits weight loss.

Sucralose
Sucralose (Splenda™) is actually derived from regular sugar in such a way that the body doesn't recognize it, and it is not absorbed. It contributes no calories or carbohydrates to the body in its pure form. Amazingly, it remains stable in heat and has become ideal for cooking and baking.  It is available as a bulk sweetener and actually measures equivalently to table sugar.  Be aware, however, Splenda™ is not carbohydrate free. Because of the maltodextrin used to make it bulk in nature, it contains about 0.5 g of carbohydrate per teaspoon, or about 1/8 of the carbohydrate of sugar. It does cause some insulin release and may lead to weight gain or difficulty with weight loss when used in excess (J Clin Oncol [Meeting Abstracts] June 2007 vol. 25no. 18_suppl 15127).  1 cup of Splenda™ is equivalent to 2 tablespoons of sugar, or 12-15 grams of carbohydrate in 1 cup of Splenda™.

Saccharine
Saccharine (Sweet’N Low™, SugarTwin™) is another unstable chemical when heated, however, it does not react chemically with other food ingredients and thereby stores well. It was used for quite some time as one of the original sweeteners.  It does not increase glucose or blood sugar, but it does stimulate an insulin response and can be problematic in weight loss (Am Jour Physiol - Endo April 1980 vol. 238 no. 4 E336-E340). It is often combined with other sweeteners to preserve their shelf life.

Cyclamate
Cyclamate (SugarTwin™, Sucaryl™) is a sweetener available in Canada that is often combined with saccharine and is similar to sucralose. However, there is some controversy over this substance as it is known to cause bladder cancer in rats. There has been no human occurrence in its 30 years of study (Ann Oncol, October 2004, 15(10): 1460-1465.doi: 10.1093/annonc/mdh256). This product is currently banned in the US because of the notable potential for cancer. Cyclamate is stable in heat and therefore is an alternative for cooking and baking.

Stevia
Stevia is a non-caloric natural sweetener which contains no carbohydrate. He is to rise from a South American plant and has been widely available for use in Asia for many years. It comes from a shrub called Stevia rebaudiana that has very sweet leaves. Stevia is in extract, a white powder that is derived from these leaves.  It can be found today commercially in extract, powder, or in a powdered green herbal leaf. It has an intense sweet taste which actually does have the potential to be slightly bitter.  Stevia has two faults. First, it is so very sweet that it is hard to know just how much to use when cooking. Second, he often has a slight bitter taste as well as a sweet one. Therefore, stevia is often combined with fructooligosaccharide (FOS). FOS is a sugar, but it is such a large molecule that humans cannot absorb it. It does not raise blood sugar and it does not stimulate insulin release.  Stevia does not increase blood sugar and appears to improve insulin sensitivity in the pancreas (Metabolism, 2003 Mar;52(3):372-8.). FOS is only half as sweet in table sugar; therefore, it makes it a perfect partner for stevia.  

Sugar Alcohols
Sugar alcohols are also called polyols.  These are a class of long-chain carbohydrates that are neither sugar nor alcohol. Included in this group are maltitol, sorbitol, mannitol, xylitol, erythritol, lactitol, and hydrolyzed starch hydrolysates (HSH).  These sweeteners give the texture and sweetness of sugar to corn syrup and can be used to make crunchy toffee, chewy jelly beans, and slick hard candies, moist brownies and creamy chocolate.  However, they are incompletely absorbed by the human intestine.  This causes problems, as side-effects of these long-chain carbohydrates include gas, bloating and diarrhea for a significant portion of people. The other issue is that there seems to be notable variability in people's ability to absorb these long-chain carbohydrates.  In other words, these sweeteners affect people differently and may actually increase the blood sugar and insulin release in varying degrees among individuals. 

Maltitol, sorbitol and xylitol seemed to be worse offending culprits in this class of artificial sweeteners. They cause an insulin response of about half that of normal sugar (American Journal of Clinical Nutrition, Vol 65, 947-950).  Maltitol and sorbitolhave also been shown to increase cholesterol (International Journal for Vitamin and Nutrition Research, 1990 Vol. 60 No. 3 pp. 296-297). Erythritol is absorbed and excreted unchanged and appears to have no insulin response (Food and Chemical Toxicology Volume 36, Issue 12, December 1998, Pages 1139-1174). Erythritol also seems to inhibit fructose absorption (http://rave.ohiolink.edu/etdc/view?acc_num=osu1180462637).

So, in summary, which sweeteners will not cause weight gain or cholesterol changes?  From the research that is presently available, aspartame, Stevia, anderythritol have no weight gain or cholesterol changes associated with them. Splendais a great sweetener, but excessive quantities will limit your ability to loose weight. All of the other sweeteners listed above have significant insulin response when ingested and will make it more difficult to lose weight.  I have found that combinations of Stevia, Splenda and erythritol seem to provide adequate texture and remove any aftertaste that may be found when using them individually.

Legend Has It . . . How Diabetes Was Discovered and How That Makes Me Fat

The German physiologist Oskar Minkowki was the first person to identify the role of the pancreas in diabetes.  Legend has it that on a momentous day in 1889 Oscar  noticed that urine collected from his pancreatectomized dogs (dogs that had surgical removal of their pancreas) attracted a very large number of flies.  He is said to have "tasted" the urine and to have been struck by its sweetness.  (Only in 1889 could you get away with tasting dog urine.)  He then made a very astute observation and realized that the pancreas controlled blood sugar concentration and was a key factor in diabetes mellitus.
Thirty years later, Fredrick Banting and Charles Best identified insulin as the key hormone produced by the pancreas controlling the level of blood sugar.  However, what Oscare Minkowski couldn't taste was the very high level of acetone in the urine which is produced by the liver in the conversion of fat to ketone bodies.  Had Oscar lost his sense of taste, instead of noting the sweetness to the urine he might have noted the pungent smell of acetone.  He would have then concluded that the removal of the pancreas causes fatty acid metabolism to go awry.  He then would could have extended his hypothesis and concluded that the preeminent role of insulin was not in the control of blood sugar alone, but in the control of fat metabolism.
We have become fixated upon the function of insulin and its effect upon diabetes, and in doing so, we have neglected the fact that insulin has even greater effect upon the storage and use of fat and protein in the body.
A series of discoveries from the 1920s-1960s let to a revolution in the understanding of the role of insulin in fat metabolism.  At that time, fat was assumed to be relatively inert and carbohydrates were seen at the primary fuel for muscular activity (which is still commonly believed today).  The belief was that fat is used for fuel only after being converted in the liver to suspiciously toxic ketone bodies.  Forty years of research overturned this assumption, however, it had no influence upon mainstream thinking about fat gain and obesity.  In 1973 when all the details of fat metabolism had been worked out, Hilde Bruch, the foremost authority on childhood obesity, stated "it is amazing how little of this increased awareness . . . is reflected in the clinical literature on obesity."
JAMA just released it's compendium on obesity research and the simple science of insulin's effect on fatty acid metabolism is STILL being ignored. Instead, main stream medicine is starting to push patients toward a very expensive and risky gastric bypass surgery. This scares me.
Hippocrates said, "Let food be your medicine and let medicine be your food."  The body responds with hormonal effect to what we feed it and the science explaining this has been ignored. We have been brainwashed with the dogma that the "calorie is king."

Mayor Bloomburg eating donuts
two days after trans fat ban

Based on this we are now legislating food behavior.  New York has now banned trans fats by the New York City Board of Health and has legislated all soda sizes to no larger than 12 oz. We are creating health policy on bad science.  Let's go back and look at the science before we let our legislators start cooking for us, or soon our grocery stores will look like our government run school cafeterias offering school lunches.

Policy & Politics

I read a thought provoking post from Dr. Vartabedian over at 33 Charts.  Should your doctor be involved in politics?  It is a very good question.
Stepping into the quagmire of political discourse often leaves an oratory odor.  I, too, am guilty of this.  However, in a time when transparency is important, being genuine and true to our values is essential.
Through social media and daily office interactions, I come in contact with many physician's and patent's viewpoints and compare them with my own. One thing that I find interesting is that many don't differentiate or understand the difference between policy and politics.  There is a difference.
It is very important, from the perspective of voice, to make a distinction between policy and politics when we interact.  Policy is a course of action based upon principles or values.  Politics are inter-relationships or activities that we engage into move policy in a desired direction. Don't confuse the two.
When listening to the talking heads and political pundits, it is essential that we see the difference.  Just spewing rhetoric without understanding our position on a policy seems to be what fuels the cesspool like arena of politics. It is often what turns us away from important and productive political conversation about policy.

You Know You're Married to A Homeschooler When . . .

We've been homeschooling our kids for the last two years . . . well, let me clarify . . . my wife has been homeschooling our kids with the occasional help I can give her.  (She's my hero because of this, by the way).  
You know you're married to a homeschooling mom when:

• The only time your wife looks refreshed is during the summer and at Christmas.
• Your wife's eyes light up when you say Homeschooling Curriculum Conference
• You give your wife a love note and . . . she grades it.
• Your wife gets misty eyed when a school bus drives by.
• Your wife prays nightly for the return of the Lord before school starts tomorrow.
• Your wife scolds in her sleep.
• You've eaten cereal for dinner at least once this week.
• The first place you look for your wife when you come home from work is in the closet.
• Your wife will only talk to you if you raise your hand.

Homeschooling is a tough job. . . I think it is one of the toughest jobs on the earth.
Thanks, dear.

What the ACA (Affordable Care Act) Means to Me

Yesterday morning I read the Michigan Osteopathic Association (MOA) and the American Osteopathic Association (AOA) statement's on the SCOTUS decision and got nauseated.

I was not surprised when I read that the American Medical Association is a comfortable socialist bed partner with the White House, we have had evidence of this for the last four years. But, I was notably surprised that the American Academy of Family Practioners joined them as the dirty mistress with their recent positive support.

However, I was physically nauseated when I read that the American Association of Colleges of Osteopathic Medicine "applauded the decision," that same SCOTUS decision that the AOA and the MOA took a position of quiet neutrality.  

To them all I say, "All that is necessary for the triumph of evil is that good men do nothing."  Doing nothing . . . that I what I see many of the medical society and organizations, including the AOA, doing. Doing nothing with quiet neutrality.  

They say, this is a "sticky" issue and there are strong feelings on both sides, and we have to approach this delicately. If I recall, similar words were issued when the Titanic sunk!

I cannot support the statement by the AOA that the passage of the Affordable Care Act demonstrates "significant strides have been made" to improve access and quality. 

This act has already priced at least 100 of my senior patient's out of insurance by causing an increase in their premiums by 100-500%, has made obtaining their current medications more difficult, and will likely make it impossible for me, a small business owner, to provide adequate insurance for my staff of 14 people as premiums continue to rise.  If I don't provide insurance for them, then I will be taxed out of business in 2014.

This is the largest tax increase in American history with twenty new taxes on each of us individually found within this bill.  It also brings 159 bureaucracies, 47 new governmental agencies, and adds 16,500 new IRS agents. This bill now makes the IRS the most powerful arm of the government.

I am appalled that the AOA and the MOA would release a statement that their position is one of neutrality. Do they not actively practice in the trenches and see what this bill is already doing to the good people, small or solo practice physician and seniors of these United States?

Because of this bill, I have already had a pay cut of 1.5% on Medicare reimbursement and will most likely receive another 1.5% on July 1st because the Medicare electronic prescribing submissions were "not qualified" according to Medicare and I can do nothing about it.

The decision that this bill is constitutional was NOT an overwhelming majority, it was split 50/50 and passed only because our senior Supreme Court Justice lost his spine.  This only accelerates the destruction of health care as we know it and will push our system to a single payer system within the next 3 years.

This mandate does not fix the SGR, medical liability reform, or adoption of improved clinical communications.  In fact, it appears to have made them worse by placing them further from our view and moving them off the table for the last 2 years.

A position of neutrality by the medical societies is interpreted by the lay public that we as physicians feel further socialization of health care paid for by increased governmental control and increased tax is what "every physician" wants. 

The only statement that I have read that seems to take a position other than weak political coddling is that issued by the American College of Osteopathic Family Practitioners (ACOFP).

Sincerely, mortified.

Adam Nally, D.O.

Vanilla Low Carb Ice Cream

I love ice cream. I mean I really love ice cream. This has been one of my vices for years that I thought I would have to forever give up to follow a low carbohydrate dietary lifestyle . . .but worry myself no more!  
My sweet wife did it again.  She perfected the ice cream recipe she has been working on for the last year. 

You have to try this recipe.  It's delicious.  

Thanks, sweetheart!

Vanilla Low Carb Ice Cream:

1 cup Almond or Coconut Milk

1 quart of Heavy Cream

1 tsp Vanilla

1/2 cup Erythritol

1 scoop Vanilla Protein Powder

1/2 tsp of Salt

Blend for approximately 20 minutes in a 2 Quart Cuisinart Ice Cream Maker (that's the one we use) or the ice cream maker of your choice until the desired consistency and then place what you don't finish eating in the freezer for later.