You Can’t Make This Stuff Up

Following on the heels of my previous entry regarding the absolute lack of credentials that MDs have in the field of nutrition, I discovered today that there is actually a movement afoot in the medical community to define an interest in healthy eating as a disease. I kid you not.

Their new "disease" is called orthorexia. Of course, they are defining an interest in healthy eating as an "obsession," but eating a raw foods diet, an Ornish diet, a vegetarian diet, a paleolithic diet, or essentially anything but an SAD (Standard American Diet), is considered prima facie evidence of an "obsession" with healthy eating.

Of course, if any of these doctors actually followed the nutritional research, they would know that the SAD diet is incredibly unhealthy. It is undeniably the root cause of both obesity and adult-onset diabetes, as well as the primary cause of heart disease.

In comparison, the diets which are claimed to be symptoms of orthorexia are actually quite useful for clearing up a variety of health problems, many of which were caused by the combination of a SAD diet and prescription drugs in the first place.

Of course, that brings us to the recommended cure for this "disease." It is drugs, of course! Specifically, antidepressants, because, by all means, a focus on improving one's health through diet is a sign of depression, right?

Err...no. Actually, quite the opposite. But that's a topic for another day.

What is also interesting is the background of some of the medical "authorities" promoting this imaginary illness.

Let me first point you in the direction of Steven Bratman, MD. No, I'm not going to post his URL here, because just reading that site makes me a little ill, but you can find it easily enough with the help of Mr. Google.

Bratman is a self-proclaimed "quackbuster," which means he ignores all research which disagrees with his preconceived opinions. He has also written a book, "Health Food Junkies," which -- surprise -- is all about this mythical disease of orthorexia.

Of course, Bratman has the qualifications to address nutritional disorders and therapeutics because, according to his biography,  he opened a now-defunct health clinic, where he "worked closely with a wide variety of alternative practitioners, and received training in acupuncture, herbal medicine, nutrition, massage, osteopathic manipulation, and body-oriented psychotherapy."

Ok. So this guy's qualifications are...he watched someone else do nutritional counseling? Holy cow, asking Bratman for nutritional advice would be like asking someone to pilot an airplane because they've watched a few take off.

He's also written a lot of books, mostly for the pharmaceutical industry, and serves as a "consultant" in alternative medicine, whatever that may be. Pretty good for a guy who, according to his own data, possesses no certifications, license, or formal education in the field of alternative medicine.

In fact, I would be willing to bet I have had more formal education in pharmacology -- drugs, that is -- than Bratman has had in clinical nutrition.

Unfortunately, people do listen to unqualified individuals such as Bratman, and thus incredibly inane ideas such as orthorexia get wheels.

All of this wrongheaded manipulation over proper eating reminds me of a case I had a number of years ago. A mother came to me concerned because she thought her teenage daughters should be on a diet. Of course, I agreed to evaluate the girls and see if there would be some way in which I could help.

A few days later,  the patients came in. I conducted a history and physical exam, and low and behold, the girls were healthy. While perhaps a bit on the high side of normal in terms of their body fat, they were still within the normal range. They were physically active, with no complaints. Their diet, while not the best in the world, actually included some fruits and vegetables, which I considered an astounding success for two late-20th-century adolescents.

In short, there was really nothing much to do.

I consulted with the parent, and said that the girls looked fine, and I thought any special diet was unnecessary.

Mom began arguing with me. "Isn't there some diet you could give them?" she asked.

I told her to bring the girls back in a few days, during which time I would do a more thorough analysis of their food journals and see if there were some pertinent recommendations that I could make.

When they came back,  they entered the office with an air of excitement and anticipation. And it slowly began to dawn on me what was happening.

I was the instrument of a rite of passage: A Girl's First Diet. Like menarche or a training bra, the Diet was a step on the pathway to womanhood, because, of course, dieting is something all women must do.

I brought the girls and their mother in, and sat them all down. I explained to them that I had reviewed their diets carefully, as well as their physical exam findings, and that the best thing that they could do for their diet would be to include more fish and have more vegetables, particularly cruciferous vegetables. They should also make sure they should drink plenty of water.

Their faces fell with disappointment.

"Don't you have a meal plan for us?" One asked.

"I don't really like fish," said the other.

"What about foods they shouldn't have?" said the mother.

I explained to the disappointed multitude that, in fact, their diets were already pretty good, except for the absence of omega 3 fatty acids, which would be satisfied by the inclusion of fish. I added that I saw no reason to restrict their foods or create an unnecessary diet plan to follow, given their overall good health.

Their disbelief was palpable. I had ignored all of the sacraments of this ritual, developed at the Church of Weight Watchers and practiced at the altar of Jenny Craig. There was no arcane list of proscribed foods. No complex eating plan. No admonishments against those foods which medical doctors consider bad for you, like butter, or whole milk, or red meat.

We went back and forth for a while; it really took a good 15 minutes to get through to them that I really didn't want them to restrict their eating, but rather they should just emphasize certain foods. After they eventually realized I was not about to capitulate to their desire for their First Real Diet, two confused girls and a rather angry mother left.

I don't know whether or not the girls eventually got their diet or not, but the encounter did get me thinking about how twisted the messages about healthy eating and good nutrition get in this society. Somehow, medicine and marketing have turned a wholesome diet full of a range of nutrients, with an emphasis on foods that do not contain pesticides, hormones, chemical additives and preservatives, into an illness.

Orthorexia? If it were really a disease instead of a chimera, I would wish that more of my patients suffered from it.

Bad Advice from the Wrong Source

Would you accept investment advice from a physical therapist? Would you do an exercise program designed by an attorney?

Of course not. While  those people may have expertise in their own field, they lack any qualifications for advising others outside of their field.

So why on earth do people listen to nutritional recommendations from their medical doctors?

Over the past few months, I have noticed with disturbingly increasing regularity, patients coming in and telling me that their MD has recommended that they take XYZ supplement or the herb Herpatoxicus hippocratus or some such.

Unfortunately, however, the quality of the advice which my patients are receiving is only slightly worse than that which they would get from the high school kid at the cash register of the local health food store.

In one case at my office, the recommendations so helpfully supplied by one of my patient's MDs was downright dangerous, because the MD was apparently unaware of the interaction between the nutrient she was recommending and the drugs that she had  herself prescribed!

Fortunately, I was able to rectify the error before it became an emergency room visit.

But increasingly, MDs are trying to provide their patients with nutritional advice when, in fact,  they really don't have any background, education, qualifications, training or clinical experience on which to base their recommendations.

In all likelihood, they are probably only repeating something which their friendly drug rep passed on to them. Which, according to more than one recent study, is how most MDs decide which drugs to prescribe. (Don't believe me? Look here. Or here.  Or here. Or...do you really need more?)

So, in short, most prescriptions are written by doctors on the advice of a good-looking 30-40 year old with a bachelor's degree, a hot car, and who buys pizza for the staff. (By the way, before you listen to any nutritional advice from any medical doctor, go check out the food in the staff room.)

Each day more than 101,000 drug company reps—one for every five office-based physicians—call on the nation's doctors. Primary care physicians, on average, have 28 interactions a week with drug reps, according to a 2005 report by the Health Strategies Group, a consulting firm for manufacturers of health care products.

Honestly, I'm feeling kind of left out. The last time I saw a rep from one of the nutrient companies whose products I recommend was two months ago.

But I'm afraid I got away from my main point here, which is that MDs are  "prescribing" supplements and nutritional regimens to their patients and they don't have a clue what they are talking about!

Seriously. You know how many hours of education an MD has in nutrition?

0

Ok, if you didn't get it the first time, I'll repeat it.

0. None. Nada. Zilch.

This wouldn't be so bad if they were actually honest with their patients, and said something like, "Gee, um, I really don't have a clue about how nutrition works, but this guy who was in my office the other day and brought us all egg rolls and pork fried rice told me he heard from another one of his clients that this works, and actually I suggested it to my cousin's in-law's sister, and she said it worked great, so I think you should take it."

Truthfully, this is the level of critical decision-making that goes on in an MD's brain when making nutritional recommendations.

Which is in part because (1) the average MD doesn't have a clue how clinical nutrition actually works, and (2)  as I mentioned above, most of their prescriptive recommendations are made on heresay, anyway.

In the medical/mechanistic model of the human body, MDs are taught basic one-to-one correspondences. Pain is paired with antiinflammatories; hypothyroidism is paired with synthetic thyroid hormone;  infection is paired with antibiotic.

Within that framework, there may be subsets of, for example, painkillers or antibiotics. But the one-to-one correspondence is the essence of modern medical thinking.

In comparison, approaching a health problem from a nutritional  point of view requires that you look beneath the condition to the process which created the condition. You then alter that process, by altering the environment in the body which allows that process to exist. When the environment is no longer conducive to the behavior, the process is discontinued and the symptoms resolve.

So there can be no one-to-one correspondence, because many different processes can cause the same problem.

Take osteoarthritis, for example. The typical MD approach is to (1) prescribe a painkiller and (2) recommend (or "prescribe") glucosamine or chondroitin sulfates.

All well and good, except for the fact that glucosamine actually doesn't work that often. It does work in the percentage of the population whose chondrocytes actually have the ability to utilize the additional glucosamine, or people who are glucosamine deficient. In short, probably about 20-30% of the population.

On the other hand, what I and other alternative physicians try to do is understand where the body's processes have gone awry, and for what reason. So for four patients with "osteoarthritis," one might recieve chiropractic manipulation, one might recieve MSM, one might recieve Chui Feng Tou Gu Wan, a third will be placed on a detoxification diet, and the fourth will receive omega-3 fatty acids.

That's how nutrition is done. Unlike medicine which is pathology-oriented, clinical nutrition is process oriented, not pathology oriented.

And it is this basic, fundamental concept that MDs don't understand,  which only compounds their overall lack of knowledge about nutrition.

So my recommendation to anybody is: Take any nutritional recommendation from an MD with a grain of salt.

(By the way, did you know that salt plays a role in high blood pressure in only 10 percent of those who have this problem? I'll bet your MD didn't.)

Secondly, if you receive a nutritional "prescription" from an MD, for your own safety, consult with a chiropractic physician before taking it.

And, finally, for any medical doctors who are reading this (fess up, I know you do): For your own patient's safety, please refrain from making nutritional recommendations and refer your patients to a doctor more appropriate for this type of therapeutic intervention.

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Garden of Health

This lovely garden around our sign was created by one of my patients. It  is especially beautiful at night, when illuminated by the sign's spotlights.

Now I remember why I became a doctor

As you might imagine, the transition from two weeks on two wheels on the shores and islands of Scotland back to Litchfield took a bit more than a soft landing by the KLM pilot, a healthy meal and a sound night's sleep. And like anyone else returning  to work from a holiday, I was not over-enthused about unlocking the office door on that Monday morning. Oh, the paperwork! The bills! The inventory!

So  it was with some trepidation on Monday morning that I leaned my mechanical steed into the parking lot, slowed to a stop, and looked around. The first thing that I noticed was that the lawn was neatly manicured and the walk swept clean.

I unlocked the door and walked in. The dark blue carpet of the waiting room was the first thing that jumped out at me.  Usually this carpet is a bit of a mess, receiving a daily coating of dirt, grass clippings, and whatever else patients bring in with them (note to those starting their own businesses: Never, ever, ever use a solid dark color in public areas, never mind how impressive it looks. You will spend either half of your working life or half of your payroll budget keeping the darn thing clean.)

Today, however, it was spotless. I opened the door to the hallway, and was greeted by more clean carpeting, cupboards and countertops neatly wiped down, everything sparkling.

While it was tempting to attribute this to worker fairies who stole in during the night and plied their cleanliness magic, the truth was much more prosaic and important.

During my abscence, my ever-suffering office manager Teresa had taken it upon herself to make a clean sweep of the place and return it to the pristine condition that she knows I prefer.  She even pressed her sons into maintaining the premises outside, and although I understand there was some largesse involved on my part, it still went above and beyond what I could expect from an employee.  And it is true, Teresa is far more than an employee. She is part of what makes the Center a living breathing entity. She's the first person that patients see and the last to say goodbye to them. To a large extent, my success as a doctor rides on her capable shoulders.

And I probably don't say this nearly enough. Thank you very much Teresa.

After that brighter-than-expected start, I settled in to the business of being a doctor, which, in primary care, often involves seeing patients. And one after another asked about my trip, and said how glad they were that I had returned.  Slowly, my mind and spirit was dragged back -- however unwillingly -- from magical Dunedin, and not  only to the business at hand, but a slowly dawning recognition. Or, perhaps, re-recognition.

Over the years, I had begun to forget the magic that I represent to many of my patients, most of whom had unsuccessfully sought relief for their illnesses for months or years before landing on my doorstep. Somehow, I developed the reputation of being the house of last resort, which may be seen by some as a backhanded compliment -- "Heck, nothing else works, might as well try Dr. J..." but which I've always felt to be an honor.  To some patients, I'm the guy who could fix what nobody else could.

The interesting thing is that, really, I'm just doing what I'm trained to do. Observing, listening, testing, looking for patterns...I just use a different map than most doctors do, and that map gives me landmarks and lesser-known paths that are obscured by the superhighways on other doctors' maps.

Still, though, I had forgotten what an actual honor it is to be that person in someone's life. Until, that Monday, when patients started hugging me.

I had timed several therapeutic interventions to launch and proceed through the early phases, where my assistance might be required, before I left for Scotland, and to conclude upon my return so that I could again assist on re-entry, as it were.

Happily, we were successful in all quarters, and my patients' achievements were manifest. They were so happy and enthused over their success, and I reveled with them. And they thanked me, and to a man or woman, they each hugged me.

And with those hugs, I remembered that beyond the bills, the thieving insurance companies, the  mendacious pharma companies, and the tremendous forces levied against my profession -- beyond all of that is the heartfelt thanks of one person to another.

And that, I remembered, is why 20 years ago, I embarked on a radical journey to become a chiropractic physician.

So, to all of my patients, let me say: Thank you. You are doing all the hard work, I'm just here to guide you along the way a little bit.  And thank you for trusting me with your health, and the health of your loved ones.

Scotland, Part III: The Scottish Character

One of the reasons that I so enjoyed my trip to Scotland was because of the Scots themselves. I like them. They are unpretentious. What you see is what you get with a Scot. And they enjoy some of the more famous stereotypes about themselves. I was standing outside of a pay toilet when a man walked up and said in the distinctive Scottish burr, "Is that thing working?"

I said, "Yeah, but you'll have to pay 20p to get inside it."

He snorted in derision. "That'll be the day, when a Scotsman pays to go to the toilet," he said.

We both laughed, and he ambled off, presumably to find a suitable facility in a less pricey neighborhood.

I've not quite figured out the whole relationship between Scotland and England, despite having read all I can find about it. Essentially it boils down to a thousand years of the two populations intermingling, beating the snot out of each other, exchanging royalty, signing treaties, breaking treaties, beating the snot out of each other some more, and then intermingling some more. Go figure.

There was not an individual I met who was not willing to stand around and chat, and some of my favorite memories of Scotland will be of the long, wonderful conversations I had there.

I spent a couple of nights in a hostel, and I must say that I loved it. The hostel was a gathering point for travelers, a bit of a community center, overtly friendly, and overtly counter-culture, minus the drugs. It almost made me think I was back in Berkeley. Again, far different from the hostels I have stayed in America.

The people of Scotland are more reserved than Americans, even the notoriously taciturn New Englanders I live among, and despite my shy and retiring nature, I could tell at times I was accidentally being the brash, noisy 'merkin.

Such as the time I finally reached the top of a particularly nasty hill, after just hammering my way up, at which point I threw my fist into the air and let out a bit of a war-whoop. Nothing that I would bet 90 percent of the Americans reading this haven't done before.

I also stopped to catch my breath, and a few minutes later, a man came out of the nearby lodge to chat with me. For the next 10 minutes he proceeded to very humorously bust my chops for my very un-British outburst. It was one of the funniest interactions I had there. (The ride down the other side of that hill was a hoot, by the way).

Finally, one of the things that consistently impressed me, was the ingenious use of technology. As an American, I'm used to thinking of my country as being the most technologically advanced in the world.

I'm afraid I had to re-think that one. It seems that the British have far surpassed us in their civic implementation of technology.

For example: Solar-powered parking meters that you can pay either by coin or by cellphone. Or traffic signals that are intelligently controlled by radar constantly monitoring traffic patterns. Or pay phones from which text messages can be sent as easily as making a telephone call. These weren't big-city Edinburgh features, either. I found such innovation in small towns as well as large.

There are more, but you get the idea. We have some catchin' up to do.

All told, I would go back to Scotland in the blink of an eye, and, in fact, I hope to do so. After all, I've only had the chance to explore one small slice of this most beautiful country.

Yeah. I'm going back there.

Scotland Part II: Edinburgh, City of Philosophers, Poets, Royalty, and…Cyclists

My trip to Scotland began with several days in Edinburgh, home of scientists, philosophers and poets. Today it is also the location of the Scottish Parliament. The city is ancient, buried layer upon layer, and you can cycle through succeeding eras, pedaling through time as you cross the city. If I were to make a comparison to an American city, Edinburgh was like Boston times 1,000. Unlike Boston, however, Edinburgh is a city of hills, and some sights which you cannot miss if you are there.

The first is Arthur's Seat (yes, that Arthur), a volcanic hill situated virtually in the center of the city. It is the first thing that you will see when your plane descends, and it is worth getting off the bike to climb to the summit.

Another path to follow would be the cycle/footpath along the Water of Leith, hilariously described here by the irrepressible Jacquie Phelan. This is a hidden gem in the city.

But one of the truly interesting thing for me, cycling through Edinburgh, was how cyclists are treated, both by the infrastructure and by other motorists. Edinburgh makes even Portland look like a shallow poseur in its treatment of cyclists.

First of all, the British in general are very polite. They somehow even manage to honk at you politely, as a few did as I clumsily adapted to the different traffic directionality. I thought their treatment of me, as I would make turns into the wrong lane to bear down on them head-on, or dart in front of them in a roundabout as I looked in the wrong direction, to be very appropriate.

And as I got better with the whole left-hand driving thing, I found that the motorists would invariable pass with a wide berth, expect me at intersections, and generally recognize me as a valid part of the traffic. Even the closest brush I had during the two weeks I was in Scotland was a mere whisper of what I face daily in Connecticut.

There are bike lanes. There are spaces at the head of intersections reserved for bicyclists. There are special traffic signals for cyclists. (Sometimes, these can get a bit confusing. At one light I counted no less than eight signals, not including the directional sign for the nearest gents' toilet.)

But, most of all, there are cyclists! I counted more utility cyclists in an afternoon there than I have seen in an entire year here. Some in cyclist-specific clothing, some in their work clothing, some in whatever they felt like wearing. All of them, though, treating their cycles as their vehicle of choice. (As opposed the the utility cyclists I see here, most of whom are using the bicycle only because the court temporarily removed their access to an auto.)

Yeah. It was heaven.

I cannot help but to think that should the same environment exist here, the number of utility cyclists would skyrocket. Yes, build it and they will come.

The other thing that I must mention is helmet use. Here in America, helmet use is de rigeur for any serious cyclist, a standard to which I have adhered for many years. Yet in Edinburgh, in fact in most of Scotland, helmet users are by far in the minority. Even though these are clearly serious, daily cyclists.

So, when in Rome...

Don't tell anybody but for two weeks, I left my helmet packed in my suitcase. The entire trip was done sans head protection, and, frankly, I will have some trouble re-conforming to the American standard.

Which was a sentiment which lasted for about 45 minutes of cycling in America. After two close brushes (less than 24 inches) and one extended honk, which clearly meant "Get off *my* road," I remembered why we wear helmets here.

NEXT: The Scottish Character

Scotland, Part I

While this is not quite in the theme of this blog, many patients have been asking me about my recent trip to Scotland.  So, herewith are some of my thoughts, written from the vantage point of the avid cyclist that you know I am... Part I: Geography To Stir The Soul

First of all, Scotland is the most beautiful country in the world. I will make that statement despite the U.S., Canada, and Scotland comprising the entirety of my experience. Naysayers will have to accept simply being wrong.

For some reason which I have been unable to define, the hills of Scotland reached out and grabbed my soul like no other mountains ever have, except for the White Mountains of New Hampshire. Their barren, craggy peaks and steep green sides have an in-your-face grandeur that simply challenge you to best them. You could have thrown me off the train with my hiking boots and rucksack, and I would have been perfectly happy for months exploring those hills.

Except for the fact that I would have missed the shoreline. No namby-pamby white sandy beaches here, oh no. The rocks and the water rush to meet each other in a salty embrace both powerful as the waves hit and the spray flies, and gentle, as the water laps and gurgles around the well-worn curves of its partner.

Small villages wrap themselves along the shore, squeezing themselves in between the water and the hills, utterly unpretentious in their proud claim to this hard land. The architecture is ancient, strong and functionally beautiful. These villages have refused to debase themselves to the tourist dollar. Make no doubt, the tourist economy is important here and accommodations exist, but in only one case did I encounter anything even remotely resembling the typical American tourist town, and even that place had many saving graces.

Granted, the route I traveled was a bit off the beaten tourist path, and intentionally so. I wanted to avoid the hordes of cars and people that invade the prime tourist areas during this time of year, and was successful at it.

Oh, yeah. Scotland also has castles. Reams of them. Which makes the whole castle thing entirely ho-hum from a Scot's point of view, but for me -- even coming from New England, where structures which could at least reasonably be called old exist -- something built six centuries ago, and not only still standing but still being lived in is absolutely extraordinary. If there is any warrior blood in your soul, seeing a Scottish castle perched on a rocky outcrop with a dark, brooding sky behind it will quicken your pulse and send your hand to your side searching for the hilt of your sword.

"How does this translate into cycling?" you may ask. Cycling in Scotland is not for the flatlander, of that you may be sure.

First of all, the road conditions. To listen to a Scot describe his or her roads, you would think that the pavement was nothing but a string of potholes connected by brief bits of crumbling tarmac. Accompanied by maniac motorists threatening your very existence.

This is not true.

The roads of Scotland are glass-smooth, and allow the tire to grip the surface like a baby holds its mother's hand, every curve is banked and motorists defer to cyclists on each occasion.

OK, that might be a bit of exaggeration.

The truth of the matter is that the roads I rode were in most cases in better shape than the roads I cycle daily in Connecticut. There are no shoulders to speak of, and I also rode on many single-track roads, but the well-mannered British driver obviated the need for any sort of additional accommodation (more on that later).

The roads were hilly, to be expected as I was traveling in the southwestern end of the Highlands. But they were not hills as I am used to them in the foothills of the Berkshires. Here, I am accustomed to finding long, slow grinds of several miles in length, as you work your way from valley to ridge. Scottish hills are nothing like that. They are short, sharp, steep, lung-gasping climbs from loch's edge to cliff's edge, with sheer drop-offs to the sides and pitches that will pummel your legs, if only for a short while. Then a quick drop, and you get to reclaim that elevation, plus a little bit more, on the next climb, until you have reached the height of land.

In fact, I found myself on one hill that was so steep that my trusty recumbent bicycle was popping wheelies with each stroke. Not that he is the most sedate steed, but I've never felt myself almost pitched from the saddle in that way before!

In short, they are perfect hills for the sprinter, which I am not. Nonetheless they reward you with some extraordinary fast and fun downhill riding, with curves that will encourage you to test your handling skills and to answer the eternal question of just how far can I lay this bike over? All while gaping in awe at the majestic scenery all about you.

Dumb Idea of the Week

And, not surprisingly, it comes from the American Medical Association. The AMA has proposed a resolution which would call upon state and federal legislatures to restrict the use of the term "Doctor" to only those who have an MD, DO, DDS, or DPM degree.

That's right. According to the AMA, it should be illegal to call me Dr. Jenkins, even though I posess a valid doctor's degree from a federally and state accredited university with permission to offer that degree.

Even though getting my doctor degree required more hours than required to get a medical degree.

Even though I posess not one, but two post-graduate board certifications, each requiring hundreds of hours of education.

And certainly, there couldn't be a single psychologist in the country worthy of being called doctor. Nor should anyone holding a PhD be worthy of the term.

I don't know whether to attribute this  brand-spanking-new medical folly to a bad case of acute arrogance or simply institutional dementia.

Or, it could be that  the fear is starting to set in.

The fear that the medical "doctors" will continue to lose patients to professions like mine, real doctors who know how to create health, not just dress illness up in a drug and call it healthy.

The fear that people will start to realize that yes, according to the CDC's own statistics, medical "doctors" kill as many people as 5 jumbo jets crashing every day.

The fear that the curtain of concealment is starting to tear, and patients are beginning to recognize that the wizards of health -- those so-called medical "doctors" -- are little more than Kansan hucksters selling cartloads of high-tech snake oil.

Frankly, I'm livid. Can you tell?

Walking the Talk

As a primary care physician preaching the gospel of nutrition and exercise, I have always tried to follow my own advice. Particularly this year, with my overseas adventure rapidly approaching, I have been ramping up the fitness quota, and am now pushing six training days weekly. Nobody as yet has mistaken me for Thor, God of Thunder. There's always hope, though; after all, myopia is a common disorder. Nonetheless, despite the general public's oversight in this regard, I think I'm in pretty good shape. At least, I did until yesterday.

Marilyn Gansel, a personal trainer with studios in Stamford and Kent, CT, graciously invited me for a one-on-one with her in her Kent facility. Marilyn is multi-degreed and is currently working on her PhD in sports psychology. Marilyn and I have talked with each other on many occasions about her functional approach to training, and she offered me the chance to experience it first-hand.

A Different Path to Fitness

Before we get to the embarrassing parts, first a word about functional exercise. Traditionally, strength training has been performed by isolated muscles, using benches, barbells, dumbells or machines. The exercises will work one set of muscles at a time; for example, the classic bench press, which is used to strengthen the muscles of the chest.

Functional exercise, on the other hand, uses more complex motions with weights in a variety of forms when additional resistance is needed. For example, at one point Marilyn had me doing lunges off of a step, while at the same time raising a medicine ball above my head and in front of my chest.

For fairly obvious reasons, these exercises, and the benefits they give you, translate much more readily into our day to day activities and the sports in which we participate.

And for the majority of my patients, it is these exercises, not the leg-curl machine at the gym or the physical therapist's office, that will provide the greatest benefit.

Sure, following orthopedic surgery, the isolated, single-joint, single-muscle approach is the way to go. But most of my patients with musculoskeletal complaints suffer from more chronic soft-tissue injuries. In these cases, functional exercises are leaps and bounds ahead of traditional techniques.

And for people whose disorders affect their sense of balance or coordination, training such as this can be especially helpful.

Indeed, as I found out, functional exercise training can provide benefits for those seeking to improve their overall fitness, a goal I try to impress on all of my patients, regardless of disorder.

Finding the Weak Spots

It took Marilyn all of 15 minutes to isolate some extraordinarily weak areas of which I was utterly oblivious. Because my strength training routine has focused on the larger muscle groups, some of the smaller muscles used to control posture and stabilize movement have gone somewhat neglected. Strengthening them will only improve my performance in my two primary activities, Aikido and cycling.

But as with any weak area, the path to improvement is by incorporating those exercises into my workout routine.

To this end, Marilyn showed me proper form and timing for the exercises. Although her studio is equipped with high-end exercise equipment, many functional exercises can be performed with low-tech aids. Form, posture and timing are key, however, which makes her one-on-one instruction imperative.

And even working at the slower pace required by my introduction to these exercises, I could tell that the possibilities for cardiovascular conditioning are clearly present, making Marilyn's methodology a very balanced approach.

At the end of my hour with Marilyn, I could feel that I had gotten a good, solid workout. More than that, I had discovered new ways to boost my fitness, not necessarily in a win-the-swimsuit-contest way, but in an improve-my-overall-health way.

And that's something we could all use. Regardless of your fitness level, I highly recommend you get in touch with Marilyn. Her website is www.fitnessmatters.com.

Research Isn’t Always Good Science.

Patients often come see me because they are confused about all of the conflicting information they are getting about nutrition. Last week, tomatoes were good. This week, they will make your pancreas explode. Last week, fish were full of mercury and should be eaten only every third Sunday in months with the letter "t" in them. This week, damn the mercury, get those omega 3 fatty acids! It seems that every day there is a new study coming out that conflicts with last week's study.

There are two sources of this confusion. The first is the demands of mainstream news processing and distribution. By the time the media is finished with a useful news item, it has usually been stripped of any valuable content, much like what happens to an ear of corn on its way to becoming a Doritos chip. It is then unsurprising that conflicting information should appear, sometimes stemming from the same study.

The second source of confusion is the frequent poor quality of the research itself. If you have a background in the sciences, and you actually read the articles themselves, rather than the abstract, you often begin to wonder how on earth the authors reached the conclusions that they did.

It is a little bit like looking at a painting and thinking to yourself, "what a beautiful study in yellow I see here," then having the artist walk up and tell you how red the whole thing is. You just have to shake your head and wonder.

Which is exactly what I did when I came across this little gem of an article, "A High-Fat Meal Increases Cardiovascular Reactivity to Psychological Stress in Healthy Young Adults." (Article here.)

At first blush, this is right up my alley. Nutrition, mind/body interaction, cardiovascular disease, gee, I couldn't ask for more out of a journal. And the conclusion was very interesting. "The consumption of high levels of saturated fat over the course of several weeks may lead to exaggerated cardiovascular reactivity," the authors wrote. In fact, "the consumption of a single high-fat meal has been associated with a transient impairment of vascular function."

Translation: A high-fat meal is bad for your heart and arteries.

It would seem to be common wisdom, after all, that's the party line that has been thrown at the public over the past 20 years. But the party line, as we know all too well, is rarely the whole truth.

Comparing junk to junk

Which it turns out, is the case here. The high fat meal consisted of 2 McDonald's hash brown patties, a Sausage McMuffin and an Egg McMuffin. Holy Toledo! But wait -- the "healthy" meal included Kellog's Frosted Flakes, skim milk, Source fat-free yogurt, a Kellogs Fruit Loops Fruit Bar and Sunny Delight orange juice.

In short, both meals were nutritionally unsound. The low-fat meal turns out to be a high-sugar meal, also accompanied by hormones, antibiotics and a cornucopia of chemical additives, most of which have unknown effects on physiology.

Perhaps that did not matter to these investigators. However, were I conducting nutritional research, I would choose a nutritionally balanced and healthy meal as my baseline. All we are doing here is comparing junk to junk.

"All well and good," some might say, "but it still tells us about the effects of fat on the heart."

It actually tells us nothing of the kind. There were no controls in place for any of the following:

1. Hormones, which are known to exist in physiologically effective concentrations in the meat sources used by McDonald's and other fast-food chains;

2. Antibiotics, also present in physiologically effective concentrations;

3. Trans fats and unsaturated fats, which have significantly different cardiovascular effects;

4. Sugar. Although the long-term ingestion of high amounts of sugar eventually lead to ongoing high blood pressure, the immediate effect of eating sugar is to temporarily lower blood pressure.

So not only were the researchers comparing junk to junk, they also failed to control for significantly important nutrients which could influence the outcome, and in particular, chose a baseline meal that would have the effects of exaggerating the outcome of the experiment.

In short, in addition to using junk nutrition, these researchers produced junk science.

Nonetheless, it  will be cited in yet other journal articles as yet more proof that high-fat diets are bad for your health.

When, actually, this research said much and proved nothing.

Good Health Begins Right Here:

It Happened. Again.

Sometimes I kind of feel bad about always pointing out the shortfalls of my medical colleagues, as I noted a couple of posts ago. But then I get yet another reminder or two of why I just can't get the warm fuzzies about them. My most recent bout of slap-me-Emma-I-must-be-sleeping medical foolishness began late last week, when a patient told me that her MD did not mind her seeing me, so long as I was not trying to treat disorders like diabetes and asthma.

Screeech! Back that up a second and replay it. Don't treat diabetes? Or asthma?

I'm sorry, but the most common form of diabetes, Type 2 diabetes, is the quintessential lifestyle disease. It is caused by a combination of couch potatoism and a lousy diet, usually leading to obesity. Any doctor, medical, chiropractic or otherwise, should know that fact, since just about everybody else in America does.

And, frankly, I'm the quintessential lifestyle doctor. To say that my knowledge, skills or tools are inadequate for the treatment of diabetes is like saying that a Porsche is an inadequate car for the Autobahn. OK, even to me that sounded a little cocky. But you know what I mean.

I don't think I even need to point to the research here, except to remind my readers that time after time, the research has demonstrated that lifestyle intervention should be the first line of therapy for diabetes. Ergo, the first stop for someone with this disorder ought to be a doctor board-certified in, nutrition, perhaps?

I'll grant you, however, that alternative treatment of asthma might be a little obscure for the average MD to have picked up on. But the research is there.

For example, in October, 2002, Ray Hayek, PhD, released the results of his 420-patient study at the International Conference on Spinal Manipulation. Dr. Hayek found that patients treated with spinal manipulation for asthma improved not only symptomatically, but demonstrated positive immunologic and hormonal changes in laboratory testing. (For you citation mavens, the abstract may be found here.)

Another study, albeit of small size, found that children combining chiropractic treatment with medical management of asthma experienced a substantial decrease in symptoms with an increase in their quality of life. (Look here for details.)

Which brings me back to one of my earliest experiences as a chiropractic physician. A little over a year after opening my first practice, a patient came busting through the door of my office, clearly in distress.

She was having an asthma attack, and communicated to me that she had left her inhaler at home. I had my assistant call for an ambulance, but I also knew that the arrival of a volunteer squad in my rural town might not be quite timely enough. Having heard the stories as a student doctor of chiropractic physicians treating asthma, I did that which I was best trained to do.

I had the patient lay face down on the treatment table, while I palpated the thoracic vertebrae for restrictions, and adjusted them with a quick thrust.

As quickly as it began, it was over. The patient sat up, already exhibiting patent relief, and within a minute was breathing normally.

I lectured her on the foolishness of being asthmatic and wandering about without her inhaler. When the ambulance arrived, she refused the ride and went home to obtain the missing pharmaceuticals.

So can chiropractic physicians treat asthma? Yes, and apparently quite well, thank you very much.

That said, it is clear that asthma is one of those disorders that lies at the intersection of conservative and pharmaceutical care, and patients with asthma would probably benefit best by appropriate employment of both forms of care.

It's just a crying shame that medical doctors, unaware of the research and informed only by longstanding bigotry, would advise our common patients to avoid the treatments which may help them most.

Seminar Rescheduled!

Due to the inclement weather -- that wonderful mixture of ice, snow, sleet and rain that we've been experiencing for the past 24 hours -- I have had to reschedule the lecture on infertility. It will now be held at the same time (7 p.m.) at the same place (Litchfield Community Center), but on a new date: Feb. 20, 2008.

Infertility

I have been getting a number of requests from people for information on the topic of infertility and treating it with acupuncture. I have helped several patients with fertility treatment, and have done well. But when I looked at the literature, I was surprised to see that the success rate for treatment of infertility was much higher with acupuncture than with standard medical treatment. So I've decided to offer a public lecture on the topic. For more information, go here.

I like medicine. Really.

Honestly, sometimes I get a little tired of having to constantly proclaim that the emperor has no clothes. And I suspect that because I do it so much, many people get the wrong impression of my opinion of mainstream medicine. I don't oppose mainstream medicine, in fact, I'm all for it. For many acute diseases, certainly for trauma care, and for survival through heart attack or stroke, mainstream medicine has no peer. Indeed, I have friends for whom surgery and medicine have permanently transformed their lives for the better.

I'm even friends with a few medical doctors, and I know them to be upstanding, intelligent people with a great deal of integrity, compassion and the desire to help their patients as best they can with the tools that they have.

The problem is that success in acute/critical care has allowed drugs and surgery to become the answers to health problems where they really are not that effective. Daily, research shows us that prevention and elimination of some of our leading killers, as well as the chronic diseases that afflict our society, lies in alterations of diet and lifestyle. And daily, that research is ignored in favor of more drugs, more surgery.

If I had my druthers -- and I'm old enough to recognize that I won't -- I would like to see a tiered healthcare system, where most of the primary care physicians were chiropractic doctors such as myself. Study after study has shown the safety, effectiveness and cost-effectiveness of the techniques we use for a wide variety of disorders, whether it be physical medicine such as adjusting, nutrition and herbal therapy, or acupuncture.

For those patients who don't respond to my form of care, I could then refer them to my medical colleagues for their form of care. Which, although it is riskier, more expensive and may be more invasive, may also be exactly what the patient needs.

There is not a single individual who would not benefit from a health care system so constructed. It would be less expensive. It would be more effective. It would be safer, and medicine would no longer be the fourth leading cause of death in this country. And, slowly, the lifestyle diseases which plague us could be overcome.

Wouldn't that just be the ticket.

Lowering the Bar

Exercise and diets are to me what antidepressants, statins, insulin and beta-blockers are to a medical doctor. They are my most powerful tools for treating the major chronic diseases. In fact, the research demonstrates that for the leading chronic disorders in the U.S., exercise and nutrition should be the first line of treatment. So when a major study about either of those subjects comes out, I'm usually on it like spandex on a cyclist. Thus, when the Centers for Disease Control (CDC) published a report on the prevalence of physical activities among adults in the U.S., I grabbed it. And, at first blush, it paints an amazingly positive picture.

According to this report, between 2001 and 2005, "the prevalence of regular physical activity increased 8.6% among women overall (from 43.0% to 46.7%) and 3.5% among men (from 48.0% to 49.7%)," the study said. In short, almost one-half of all adult males are engaging in regular physical activity.

"Wow," I thought to myself. "That's some incredible progress," and for an all-to-brief moment I glowed with pride at the very small role I have played in that achievement.

But as I thought more about it, these results did not gibe with other epidemiological data. If we are exercising more, why is heart disease still so prevalent? And diabetes? And, for that matter, obesity, where the U.S. population hovers around the 35% mark? If we were, in fact, exercising more, there would be less of each of those diseases; instead, they have increased, dramatically so. Nor is this data consistent with my personal, albeit anecdotal, observations.

So I dug a little bit further. And found, to my horror, what the researchers were defining as "regular physical activity."

According to this study, regular physical activity includes doing "anything that causes some increase in breathing or heart rate" for 10 minutes once per week. Among the examples given were vacuuming. Now, I'm not one for derogating the value, or difficulty, of housecleaning. But I just cannot wrap my mind around the idea that 10 minutes of vacuuming a week could be considered "regular physical activity."

I mean, Holy Cow! By that standard, getting up off the couch during a commercial to get another bag of Doritos qualifies as "regular physical activity" if you have to go upstairs to the pantry to do it!

Vigorous physical activity, according to the study, was self-referentially defined as "10 minutes of vigorous activity" the report said, "such as...heavy yard work."

I must -- must! -- put forward the argument that, when raking leaves has become "vigorous physical activity," something has gone very, very wrong in our perception of things.

There are other problems with the study which limit its utility, but to me, the distorted view of what constitutes physical activity sufficient enough to positively influence health overrides every other consideration.

If we have lowered the bar that far, simply in order to pat ourselves on our overfed backs, then it makes me wonder if this country will ever get back on its feet again health-wise, so to speak.

Based on this superficially reassuring study -- I'm not very optimistic.

Prevent Colds and Flus — Skip the Vaccine

At this time of the year, the get-your-flu-shot sales pitch is in full roar. In fact, the roar is so loud, you can only barely hear the sound of science getting bulldozed in the process.

You can reduce the risk of getting colds and influenza this winter. Unfortunately, getting a flu shot is a bad way to do it. You see, according to the research, the flu shot doesn't really work that well.

Take the elderly population, for example, who are the hardest-hit target of the vaccination sales pitch. According to the popular wisdom, this group is the most susceptible to getting the flu, and also the group most likely to die from the flu. Therefore, everyone over the age of 65 should be getting a flu shot, right?

Wrong. According to the most comprehensive study done to date, flu vaccination does not reduce mortality among the elderly. (Archives of Internal Medicine, Feb. 14, 2005) In other words, the flu shot does absolutely nothing to reduce the risk of death from getting the flu.

That's ok, you say, at least the kids should get it, right?

Well, not really. Again, let's look at the research. The second group being targeted by the drug companies for influenza vaccination are children. But according to the world-respected Cochrane Reviews,  neither spray vaccines nor injected vaccines prevent the flu very well, stating that there is "no evidence that injecting children...with flu vaccines is any more effective than placebo." The study additionally noted that inadequate safety studies have been conducted on the use of influenza vaccines on children.

Do you really want your child to be part of a mass experiment?

Finally, what about healthy adults? Here again, the research is clear. As summarized by the Cochrane Reviews, "there is not enough evidence to decide whether routine vaccination to prevent influenza in healthy adults is effective."

Which is a polite way of saying don't bother.

Interestingly, in comparison, alternative medicine has a number of well-researched, well-documented ways of helping you to avoid winter's infections. To discover what they are, your best bet would be to make an appointment to see your chiropractic physician.

Fattening Pharmaceuticals

Last night, I delivered a talk to the Litchfield county chapter of the Connecticut Medical Assistants Society. This is an association of terrific women and men who daily turn your doctor's office into a functioning enterprise. If you think your last visit to a mainstream doctor was bad, try it at an office without the top-notch kind of staff that the CMAS represents. My lecture was titled, rather cleverly I thought, "What's Weighing You Down: Or, what to do when weight loss diets fail."

I think it is abundantly clear that Americans' weight problem sits squarely in our own ample laps. We eat too much, watch too much television, drive too much and exercise too little. The majority of the overweight population would see a significant reduction if they took the following simple steps:

1. Unplug the television. Take it to the attic, basement or garage or town dump and don't bring it back for six months.

2. Spend 1/2 of the time you spent lollygagging in front of the television in some form of physical activity. Walk, run, stretch, jog, do yoga, bench press with a can of peas -- I don't care, just move.

3. Do not drive your car for any trip under two miles. Walk or bicycle. You've got plenty of time, now that you aren't turning your brain into jelly in front of the television.

4. Spend the remaining extra time you've gained preparing home-cooked, nutritious meals. From fresh, raw ingredients.

(To those enquiring minds who want to know: Yes, I follow my own guidelines).

Even if you do 3 out of 4, you are almost guaranteed to lose weight. I say almost, because there are many people for whom some confounding factor is inhibiting their best efforts to shed pounds. Many of them end up in my office, and over the years, I have been able to pinpoint some common causes.

However, there is one cause of intractible weight gain that is consistently overlooked and ignored. For one simple reason: Too many people would stand to lose too much money if it became widely known that obesity is frequently a result of prescribed medications.

It is a somewhat horrifying reality, at least to me, to know that 45% of all Americans have taken a prescription drug in the past month.

And when you look at the top 10 classes of drugs prescribed, every single one of them is for a problem whose first-line treatment should be non-pharmaceutical.

The top ten on your friendly pharmaceutical hit list are:

1. Antidepressants 2. Non-Steroidal Anti-Inflammatories (e.g. Tylenol, Ibuprofen) 3. Antiasthmatics 4. Blood pressure control 5. Cholesterol control 6. Antihistamines 7. Stomach acid control 8. Antiarthritics 9. Blood sugar control 10. Non-narcotic analgesics

So, let's do a quick breakdown. These 10 drugs represent about 90 percent of the drugs that 45 percent of the population is taking. And every single one of these drugs can cause weight gain as a side effect. (I find it particularly interesting that drugs used for diabetes treatment cause weight gain; an excellent example of the often muddle-headed logic that clouds much medical thinking).

Granted, not everyone taking one of these drugs will experience this side effect. But the enormous number of people involved makes it a sure bet that a significant portion of the American population is overweight as a direct result of the drugs that they are taking.

Odds are you won't see that critical piece of information in the mass media anytime soon.

But what's important is that you know it. And you probably know somebody who has exactly this problem -- whether they realize it or not.

So pass the word. Odds are that with the help of an alternative medicine physician such as a chiropractor, they can find a way to manage their disorder without using drugs. And they could lose weight at the same time.

On Being A Quack

The patient sat in front of me and told me her story. It took quite a while, thirty minutes, in fact, but that wasn't unusual for a patient's initial visit in my office. You see, I'm a quack.

At least that was the term applied to me and my chiropractic colleagues by the American Medical Association, until we took them to court in the 1970s and won an anti-trust lawsuit.

Today, the AMA isn't allowed to brand chiropractic physicians with such epithets. But, as with all forms of illogical bigotry, it will take a few generations before the stain which mainstream medicine painted on us begins to fade. Even today, we have misguided individuals branding our care as “dangerous,” when in fact, no procedure taking place in the chiropractic doctor's office is even as dangerous as taking an over-the-counter painkiller.

So, to many people, I'm still a quack. Which is why it took so many patients, such as the one in front of me today, so long to tell me their stories. Because of the anti-chiropractic sentiment fostered by mainstream medicine, I was the last of a very long list of doctors that she had seen.

On the Medical Merry-Go-Round

As she had trudged from one (medical) doctor to the next, undergoing ever more expensive diagnostic procedures and treatments, her condition simply worsened.

By the time she reached me, she was not only sick, but sick of being sick. And resigned to the fact that she would always be sick, as the last few of her high-powered, high-priced specialists advised her.

The fact of the matter was that this patient's symptoms began to take on a familiar shape to me. Although her primary complaint was gastrointestinal, I began to interject questions about her allergies, her fatigue, her depression. As she finished, I had a pretty good idea of what might be going on.

My examination of her did not take that long. I needed to rule out a couple of possible diagnoses that her previous doctors should also have ruled out. But I've been in practice long enough to not make assumptions like that.

So I poked and prodded, measured and weighed, listened and provoked various body parts and organs, just like mainstream doctors used to do before they were seduced by HMOs into selling their patients short.

After her exam, I told the patient I wanted to do a single laboratory test. She said she had already had all the tests that there were. She said she did not want to pay for it, because insurance would not. We discussed it.

I knew she had never had this test before, because I know of no medical doctors who have the necessary training to even interpret the results. Finally she agreed.

Two weeks later, I got the test results back. I called the patient.

No Drugs Required

“I know what's wrong with you,” I said, “and I think we can fix it.” We set up an appointment during which I outlined some dietary changes, recommended an herb, and suggested some nutritional supplements.

Three weeks after beginning her treatment, her symptoms, years in the making, began to disappear. Two months later she was symptom-free. She was amazed. I didn't think that much about it; I've treated the same problem hundreds of times, and usually get  similar results.

Of course, her insurance covered none of the examination, treatment or lab test, even though the total cost of her entire course of care at my office was less than it would cost to say hello to the receptionist at one of those high-powered specialist offices.

A Shameful Secret

Studies have found that when chiropractic physicians are their primary care providers, patients end up less dependent on drugs and surgery. Under the care of a chiropractic physician, the studies show, patients become healthier while their health care costs go down.

But as the debate regarding universal health insurance picks up steam in many states around the country, the twin benefits of improved health and decreased costs offered by chiropractic physicians gets lost.

It's the shameful secret that the AMA tried for so many years to keep hidden. And the secret the drug companies today don't want you to know.

This patient, and many others, see me as a lifesaver. But to the pharmaceutical companies, insurance companies, and most mainstream doctors, I'm a quack.

And damn proud of it.