Diet High in Saturated Fat Improves Heart Failure

Impaired contractile function of the heart is a hallmark of heart failure. A recent study published in the American Journal of Physiology revealed that a diet high in saturated fat actually improved the contractile effect of the heart muscle. This may be related to the effect of ketone as the primary source of fuel in place of glucose. Read more about this here.

Ketogenic Diet Reduces Diabetic Neuropathy

Very impressive kidney results were found in both Type I and Type II diabetic mice placed on a low carbohydrate ketogenic causing diet in just 8 weeks. The nephropathy (passage of protein through the kidneys) was completely reversed in all the mice. This is the first in what I suspect will be a series of articles showing that ketogenic diets have significant effect on reversal of age related and diabetic tissue damage.  See the article here.

Never Give Up!

Failure should not mean defeat.  Remember all good things require effort and patience and time. . .

Message From The Future . . .

I wish I could do this for many of my patients.  Thanks, Ryan.

Look, Dad, My Thumb Turned Green!

For many years I was under the impression that I had a black thumb.  My father was an avid gardener and never failed to have a lush beautiful garden in his back yard.  He states that he learned his gardening from his grandmother.  He often tried to pass those skills on to me in my youth, but try as I might, I had not been able to grow much in the garden other than weeds until just recently.

I have been following my own very low carbohydrate diet for the last 18 months.  While discussing this lifestyle with my wife one evening, she commented to me about the significant amount of leafy greens that our family eats.  She noted a significant chunk of change goes to Sprouts grocery store every week because of the changes in our family's diet.  After talking about it, she located a book a few family members had previously mentioned on gardening and picked it up.

The book is "Square Foot Gardening" by Mel Bartholomew.  We read it together.   (I recommend reading something regularly with your wife and family. We either read or listen to an audio book as often as possible. It really is refreshing.)  Mel Bartholomew does a wonderful job. He makes the process of gardening simple.  For someone with limited time and limited space, this is an amazing approach to gardening.
I found myself standing in my yard looking over what is beginning to look like one of my father's gardens.  He passed away a few years ago, but I felt as though he was standing there with his arm around me saying, "Well done, Adam. Well done."

Thanks, Mel.

Senate Nixes 1099 ACA Health Requirement . . .

April 5, 2011 — Following the lead of the House, the Senate today voted 87 to 12 to eliminate an onerous tax-reporting duty in the new healthcare reform law.

The repeal measure now goes to President Barack Obama, who has signaled that he will sign it . . .

Read the full report here on Medscape.

Bill Cosby's Take On Liberty

Bill Cosby has a great way of"distilling" things . . .              I  HAVE DECIDED TO BECOME A WRITE-IN CANDIDATE FOR PRESIDENT IN THE YEAR 2012...   HERE IS MY PLATFORM:  (1). Any use of the phrase:'Press 1 for English'  is immediately BANNED!!!.    English  is  the official language;   speak it or wait outside of our borders until you can.  (2). We will immediately go into a two year isolationist  attitude in order to straighten out the greedy big business posture in this country. America will allow NO imports,  and we'll do no exports.     We will begin using Wal-Mart 's policy,   'If  we  ain't got it, you don't need it.' We'll make and sell it here!  (3). When imports are allowed, there will be a 100% import tax on it coming in here.  (4). All retired military personnel will be required to man one of the many observation towers located on the southern border of the United States  (six month tour).They will be under strict orders not to fire on SOUTH BOUND aliens.  (5). Social Security will immediately return to its original state.   If you didn't put nuttin in, you AIN'T getting nuttin out.  Neither the President nor any other politician will be able to touch it.  (6). Welfare. -- Checks will be handed out on Fridays, at the end of the 40 hour school week, AFTER the successful completion of a urinalysis test for drugs, and passing grades.  (7). Professional Athletes -- Steroids?  The FIRST time you check positive you're banned from sports ... for life.  (8). Crime -- We will adopt the Turkish method,  i.e.,  the first time you steal,  you lose your right hand.  There is no more 'life sentences'.  If convicted of murder, you will be put to death by the same method you chose for the victim you killed: gun, knife, strangulation,  etc.  (9). One export of ours will be allowed: wheat; because the world needs to eat.  However, a bushel of wheat will be the EXACT price of a barrel of oil.  (10).  All foreign aid, using American taxpayer money, will immediately cease and the saved money will help to pay off the national debt and, ultimately, lower taxes.  When disasters occur around the world, we'll ask The American People if they want to donate to a disaster fund, and each citizen can make the decision as to whether, or not, it's a worthy cause.  (11). The Pledge of Allegiance will  be said EVERY day at school and  every day in CONGRESS.  (12). The National Anthem  will be played at all appropriate ceremonies,  sporting events,  outings, etc.  My apology is offered if I've stepped on anyone's toes .... nevertheless......  GOD  BLESS AMERICA ! Sincerely,  Bill Cosby

The Infamous Stool Sample

Toward the end of a very rough day in the office, one of my patients tells me, "Doc, I have just one more complaint. . . ."  When a patient phrases it like that I have learned to brace myself, 'cause it's usually chest pain, or something major they saved for the last minute. Today, however, this patient says, "I brought you a stool sample thinking you were going to need it."  

Now, when a patient brings you a stool sample and reaches into their pocket to pull it out, you really begin to worry. He tells me he has been having trouble with his stools and thought he would bring me this sample to examine.  He wanted a diagnosis right there on the spot. . . 

So, I ask you, what's your diagnosis?

Medical News: Marijuana Use Precedes Psychosis - in Psychiatry, General Psychiatry from MedPage Today

A recent German study reports that users of marijuana have twice the risk of developing subsequent psychosis than those who have never used marijuana. The study was completed over an 8.5 year period with close to 2,000 participants ages 14-24. Risk for psychosis increased to 20% of those using marijuana. Read a summary of the study here.

Source reference:
Kuepper R, et al "Continued cannabis use and risk of incidence and persistence of psychotic symptoms: 10-year follow-up cohort study" BMJ 2011; DOI: 10.1136/bmj.d738.

6 Tips to Prepare Your Child For Vaccinations

See this great article about preparing your child for vaccinations at Dr. Wendy Sue Swanson's blog (Seattle Mama Doc). I agree with all of her points.

What makes fructose fattening? Some answers found in the brain

Recent MRI data in research reported in Science Daily finds that fructose has an opposite effect on the brain than glucose. It appears that fructose stimulates weight gaining hormones in the brain and can have an addictive effect stimulating increased appetite and fat storage. The research is published in the online edition of the journal Diabetes, Obesity and Metabolism and will appear in the March print edition. You can read the full article here.

May The Force Be With You

Yes, I too remember trying to exercise my powers of the force at this age.  May the force be with you . . .

Through The Eyes of My Dog

Ok, yes. I am a dog lover. I have three of them. I am amazed at how they never fail to greet me at the door when I come home and they never fail to greet me in the morning.

If only everyone saw things like my dogs do . . .

Three Reasons Obamacare Is Bad For the Nation

Former white collar undercover FBI agent, Representative Michael Grimm explains why Obamacare will hurt our nation and why it should be repealed.

Colon Cleansing? Yea, Right.

I had a few patients ask about an article I read published on the Men's Health blog today: "Ashton Kutcher's Plan to Survive the Apocalypse." I had to laugh. It's quite entertaining to read about his plans to thwart the apocalypse with colon cleansing. 
I'm not quite sure how cleansing your colon will protect you from the apocalypse, at least the the apocalypse I envision and have read about in the Bible's Book of Revelations.  Either way, there's only one problem with colon cleansing including the Master Cleanse diet. Colon cleansing is a sham.  Yes, a sham. 
The body was designed to clean itself and to heal itself, especially the colon and liver. There is a constant turnover of colon cells and liver cells each week and each month.  There is no need to plug yourself full of "detoxifiers" or use a combination of  "fresh lemon juice, rich maple syrup, and cayenne pepper into pure water" (Master Cleanse recipe) acting as a laxative to cleans your colon.  A simple fast for 18-24 hours does the same trick.  The only reason to clean yourself out in this way would be to prepare for a colonoscopy where the gastroenterologist needs to see a colon that is "spic and span" clean.  Now, if you are just worried that at the time of the apocalypse you'll need clean underwear and you think you would just feel fresher with a clean colon, then be my guest, more power to ya!
So what do you need for the end of the world?
Well, for starters, studies show that many of us are not really ready for an emergency including the worlds demise. But here are a few things to think about having ready just in case the need arises:
Water. You'll need at least a 3 day supply for each person in an emergency and enough to last up to 2 weeks if you're at home. 
Food.  Fresh lemon juice and maple syrup will only last you a week before the diarrhea is so bad you would wish you died from the apocalypse.  So I would suggest at least a 3 day supply for evacuation and at least a 3 month supply for your home. 
First Aid Kit. Hey, I'm a doctor, and you're reading my medical blog, so the first things I think about are food and band-aids. 
Medications for 7 days. Having a 7 day supply of medications on hand is essential, especially for those with significant heart or lung diseases. 
Personal Hygiene Items. Placing all of these items in an emergency 3 day pack or bag that can be easily grabbed on your way out the door is a very good idea.
Emergency Blankets. You never know where a good blanket could come in handy in an emergency.
Batteries.  These are self explanatory.
Extra Cash.  In an emergency, the last place you want to be is at the bank (cause everyone else will be there too).   So it is a good idea to have a little stash of cash available for emergencies. 
Flashlight. Self explanatory.
Radio (battery powered or handcrank). 
Hopefully, you are already prepared.  If not, you should consider the above list along with any other items you think may be handy.  Regardless of what Ashton Kurcher or Demi Moore says,  the colon cleanse really won't do you much good at the worlds end. 

Super Jump

Crossing the street can be a challenge. Remember to look both ways! A friend and neighbor of mine got a new camera and video editing software.  He is quite the filmaker.  Here is a short that my kids love.  Enjoy. Thanks Ryan.

Three Things

Most days, I feel like I am a contestant on that continuously running game show "The Price Is Right".  I go from room to room, often wondering what is behind Door #1 - surprised at what I find behind Door #3 - occasionally wishing I never when into Door #2.

This can be really exciting. (Not as exciting as a carotid endarterectomy or a colonoscopy, I'll admit, but hey, this is outpatient medicine.) There is always something interesting behind the next door.
It can also be fatiguing.  This morning brought two cases of valley fever, three cases of depression, four episodes of constipation, two cases of shingles, and four upper respiratory infections. That was just part of my morning. Oh, there was a nice external plump hemorrhoid and a really ugly looking wart for kicks. (No, I didn't kick them, but it sounded nice, didn't it?)  Don't get me wrong, I really enjoy what I do.  It is rewarding, but I have found over the last 10 years that I have to work faster and faster and see an increasing number of people with increasingly complex medical problems to cover the overhead.  This is the fatiguing part.
I'm sure I'm not alone in my feelings. Many people I see in the office are working harder in their fields for less and many are without work, looking for a job.  There seems to be a general feeling of worry and fatigue among many that I see.
In looking for relief to my fatigue, I came across a few thoughts.  The first was that of John White. "There are three kinds of people in the world: those that can't stand Picasso, those that can't stand Raphael, and those who've never heard of either of them."
That didn't help.
The second was a comment made by Albert Einstein. "He who marches joyfully to the music rank and file has already earned my contempt.  He has been given a large brain by mistake, since for him the spinal cord would suffice."

Really? Now, I just feel bad.
But, I was reminded of "three things" at the New Year that seemed to lighten the load. The Holidays were wonderful at my house.  I hope they were at yours.  Not that great gifts were showered, or that the Christmas fudge was better than ever this year, or that I got exactly what I wanted for Christmas, but that my understanding of a person's basic needs was enlightened.
A drugstore psychiatrist was once heard stating that a healthy psyche really only needs three things:
1. Someone to Love
2. Something Important to Do
3. Something Pleasant to Look Forward to
The holidays were refreshing, as I had a chance to spend time with those that I love, my wife and children, and to think about extended family and friends that are close to my heart.  Taking a little time each day to think about or do something simple with those you love is energizing.  I was involved in a serious auto accident recently and for a brief time during that ordeal I was not sure how much longer I would spend upon this earth. It drove home the point to me that this life is short and we really have no idea what tomorrow holds for us. I have found that this just takes a little focus. In the words of Albert Einstein, "Any man that can drive safely while kissing a pretty girl is simply not giving the kiss the attention it deserves."  I have committed myself to focusing a little time each day on making sure that I can express my love in meaningful ways.
Each of us needs a task.  That task needs to be important in some way.  I have had many patients over the years arrive at retirement and within a few short month, looking forward to enjoying the "easy life," become depressed, irritable, and reclusive because they are no longer contributing in a productive way to something meaningful.  We need to feel like we are making a difference. We need to feel like we are making a contribution in some way.  This keeps us healthy and it keeps us strong.  It keeps us engaged. Find something in your day that is meaningful to those around you or your community, and make it a priority to contribute your skills and energies to improve this world because you were here today. To put it in the words of one of our generations great thinkers, "Strive not to be a success, but rather to be of value."

Lastly, we each need something enjoyable to look forward to.  King Solomon of the biblical Old Testament states that "where there is no vision, the people perish" (Proverbs 29:18). How much happier a person is when they have something pleasant to work toward or to look forward to.  Our day to day lives often involve a great deal of repetition.  This can bring monotony and boredom. Looking forward to even a simple change of pace each week can be invigorating and rejuvenating.  I have found that spending an hour or two each week working on a hobby, reading a good book, taking my wife on a date, taking my child for an ice cream, or taking a trip to someplace interesting can be welcome activities you look forward too all week. These need be expensive, yet can be refreshing and renewing for your outlook on the week Commit yourself to planning a simple activity this week you look forward experiencing.

Your Parking Ability as a Determinant for Medical Career Choice?

One of the most fascinating and questionably relevant studies this author has ever read was recently published.  A covert observational study was conducted by R. Scott McCain et al., published last week in the British Medical Journal showing some very interesting findings.  103 medical practioners were covertly observed as they entered the parking area of a British Hospital over a three day period.  Their speed to enter the parking garage, exit their car, and walk to the facility were each measured. The study looked specifically at the approach to the entrance where a key swipe was necessary, total time to park and then exit the car, and the speed with which they walked to from the car to the facility.
The results are most interesting in that surgeons appeared to be the quickest, followed by anesthseologists, radiologists, then general medical practitioners.  Sex of the physician did not seem to play a role, however, as the males and females physicians did not differ in their specialty.

Unique and consistent behavior has been identified among specialties by this study.  Suggestion is made by the author that this could be a good and inexpensive aptitude test for medical specialty selection.  This is, however, the first study of its kind, and further evaluation should be conducted as the researcher himself was a surgeon.

Fructose Sets You Up for Weight Gain Without Warning

Fructose Sets Table For Weight Gain Without Warning

(Adapted from ScienceDaily)

"Eating too much fructose can induce leptin resistance, a condition that can easily lead to becoming overweight when combined with a high-fat, high-calorie diet, according to a study with rats.

"Although previous studies have shown that being leptin resistant can lead to rapid weight gain on a high-fat, high-calorie diet, this is the first study to show that leptin resistance can develop as a result of high fructose consumption. The study also showed for the first time that leptin resistance can develop silently, that is, with little indication that it is happening.

"The study, “Fructose-induced leptin resistance exacerbates weight gain in response to subsequent high-fat feeding,” was carried out by Alexandra Shapiro, Wei Mu, Carlos Roncal, Kit-Yan Cheng, Richard J. Johnson and Philip J. Scarpace, all at the University of Florida College of Medicine in Gainesville. The study appears in the American Journal of Physiology – Regulatory, Integrative and Comparative Physiology, published by The American Physiological Society.

Leptin as regulator

"Leptin is a hormone that plays a role in helping the body to balance food intake with energy expenditure. When leptin isn’t working -- that is, when the body no longer responds to the leptin it produces -- it’s called leptin resistance. Leptin resistance is associated with weight gain and obesity in the face of a high-fat, high-calorie diet.

Obesity has been a growing problem in the U.S. and in other parts of the world and fructose has been suspected of playing a role. Fructose is the sugar found in fruit, but it’s not the normal consumption of fruit that is the problem. Table sugar and high-fructose corn syrup are about 50% fructose and these ingredients have become increasingly common in many foods and beverages. With sugar and high-fructose corn syrup being added to many foods, people now eat much more fructose than ever before.

"The University of Florida researchers hypothesized that a high-fructose diet could lead to leptin resistance, which in turn could lead to exacerbated weight gain in the face of a high-fat, high-calorie diet, a typical diet in industrialized countries. To test their hypothesis, the research team performed a study with two groups of rats. They fed both groups the same diet, with one important exception: one group consumed a lot of fructose while the other received no fructose.

Two groups similar over six months

"During these six months, there were no differences in food intake, body weight, and body fat between rats on the high-fructose and the rats on the fructose-free diets. In addition, there was no difference between the two groups in the levels of leptin, glucose, cholesterol or insulin found in their blood. There was only one difference at the end of the six months: The rats on the high-fructose diet had higher levels of triglycerides in their blood.

"The researchers next tested the animals to see if they were leptin resistant. They injected all the animals with leptin, to see if they would respond by eating less. Animals whose leptin response is functioning normally will lower their food intake. The researchers discovered that the rats on the high-fructose diet were leptin resistant, that is, they did not lower their food intake when given leptin. The no-fructose animals responded normally to leptin by eating less.

"This first six months of the study showed that leptin resistance can develop silently. “Usually, leptin resistance is associated with obesity, but in this case, leptin resistance developed without obesity,” Shapiro said. “This was very surprising.”

Role of diet

"Having seen that leptin resistance could develop silently, the researchers next wanted to find out what would happen if they switched the rats to a high-fat, high-calorie diet -- the kind many Americans eat. They found that the animals exposed to the high-fructose diet, the leptin resistant rats, ate more and gained much more weight and fat than the leptin responsive animals on the fructose-free diet. All told, this study showed that leptin resistance can:

• develop by eating a lot of fructose
• develop silently, that is, with very little indication it is happening
• result in weight gain when paired with a high fat, calorie dense diet

Scarpace said the study suggests it is the interaction between consumption of large amounts of fructose-containing foods and eating a high-fat, high-calorie diet that produces the weight gain. “This study may explain how the global increase in fructose consumption is related to the current obesity epidemic,” Shapiro said.

How it happens

"Other studies have shown that elevated triglycerides impair the transport of leptin across the blood brain barrier. The researchers hypothesize that the elevation in triglycerides produced by fructose prevented leptin from reaching the brain. If leptin does not reach the brain, the brain will not send out the signal to stop eating.

“'The presence of high fructose alters the way leptin works, fooling the brain so that it ignores leptin,'” Scarpace said. Consumers should be cautious about what they eat, checking labels to see how much sugar the items contain, Shapiro said.

"The researchers hope to perform future studies to find out if leptin resistance can be reversed by removing or reducing the fructose content of the diet.

What can I do to increase leptin?

Leptin is a "protein" hormone and is broken down by the stomach when ingested. Therefore, it is not possible to "take a pill" to increase leptin.

Other things that promote leptin resistance include lack of sleep, lack of omega 3 & 6 fatty acids, and lack of exercise. So, getting appropriate sleep, eating fish 2-3 times per week and regular exercise actually increase your ability to make and use leptin and help you loose weight. Intake of protein dense foods also improve leptin sensitivity.

Decreasing your intake of any product containing high fructose corn syrup, and decreasing intake of products containing simple table sugar (which is broken down into glucose and fructose in almost equal portions) will drastically help. This is why a low carbohydrate diet works so effectively in weight loss.

---

Journal Reference:

1. Shapiro et al. Fructose-Induced Leptin Resistance Exacerbates Weight Gain in Response to Subsequent High Fat Feeding. AJP Regulatory Integrative and Comparative Physiology, October, 2008; DOI:10.1152/ajpregu.00195.2008

Adapted from ScienceDaily (Oct. 19, 2008)

Lunar Eclipse In Time Lapse

Amazing and rare lunar eclipse occured last night and was seen around the world. Here are some of the spectacular shots and time lapse photography that was recorded. Unfortunately, I slept through it, but, thanks to the world wide web, we get to see it in full color.