Michael Carlston, M.D. - Family Practice & Complementary Medicine

Carlston, M.D.
Family Practice and Complementary Medicine

www.carlstonmd.com

November 10, 2009

Dear Patients,

Much of this newsletter is about diet - appropriate perhaps, so soon after Halloween. I have lots more to share with you (several studies on reflux/GERD affecting infants and those taking medications for the problem, exercises for sleep apnea, stress and brain function, sleep and heart disease, etc) that will have to wait. I am still trying to catch up after driving back across the country. Such a journey is always enlightening but certainly not because it is easy.

A couple of notes on the H1N1 flu - Early indications are that the CDC’s estimate was correct and that the US passed the peak of the epidemic 2 weeks ago. The word from my close friend and prominent Minnesota physician is that his experience has been similar to mine - few people with this flu have been very sick. None of my patients has been hospitalized to date or even very sick. If you want to read further dissenting views on flu vaccination and H1N1 fears, look at this article in Atlantic: http://www.theatlantic.com/doc/200911/brownlee-h1n1. Please excuse my cynicism, but hopefully vaccine manufacturers have at least made a positive contribution to US financial health, with the 35% rise in their stock prices over the past six months.

Melanie works very hard to make sure the office runs smoothly, so that your needs are well met. When the office is closed, she continues to answer the phone, process paperwork for your insurance, order supplies and deal with the innumerable other matters required to run a medical office. Fortunately, she balances her tendency to take Medicare forms along on vacation with her passion for music. Some of you know that for many years she has also worked as the publicist for Bill Champlin (multiple Grammy winner, Sons of Champlin, Chicago). After 28 years Bill recently left the band Chicago, pleasing many of his fans who felt that that was a compromise of his talents. For several months Melanie has been working on Bill’s solo tour. She gets to enjoy the fruits of her labor this week as the tour comes to Northern California (including Wednesday night at the Throckmorton in Mill Valley and the Last Day Saloon in Santa Rosa next Saturday) so she can dance and have some fun. http://www.billchamplin.net

I hope you find time to reward your hard work with some fun yourselves.

Best,
Michael Carlston, MD
www.carlstonmd.com

Omega-3 Blood Testing Now Available
Doing What Comes Naturally
Diet and Depression
Dietary Carbohydrates, Fat, Protein and Cognitive Performance
Breast Cancer and Strength Training
Diet and Weight Control - Water
Diet and Weight Control - Carbs

Omega-3 Blood Testing Now Available
Most adults know their cholesterol levels. Many assume fats are bad. Actually, not only are some fats vitally important to health, a new blood test for fatty acids gives a much more accurate assessment of a variety of health risks than does cholesterol testing.

For decades we have known that there is a consistent relationship between cholesterol levels and death rates from heart disease, which is evident worldwide. But we have also known that cholesterol levels only tell us a small part of an individual’s risk of heart attack, sudden cardiac death or stroke. We also know that the dramatic differences in heart disease death rates from country to country are not explained by cholesterol levels.

It is now well-established that omega-3 oil intake lowers risk of heart disease and many other diseases (asthma, allergy, cancer, arthritis, depression, ADHD, etc). It is also well established that blood levels of omega-3 fatty acids are closely correlated with death rates from heart disease. Unlike cholesterol levels, omega-3 blood levels are very sensitive predictors of cardiac deaths, including sudden cardiac death. Studies of tens of thousands of people show that those individuals with high levels of omega-3 oils are 90% less likely to suffer sudden cardiac death. Cholesterol numbers can’t touch that.
Over the years we have discovered many dietary factors associated with heart disease. Disappointingly, intervening to change many of those factors does not have much impact on death rates. The story is quite different for omega-3 fatty acids. Although only recently accepted as beneficial, already several large studies have shown that supplementing the diet with omega-3 fish oil lowers cardiac death rates dramatically. Omega-3 supplementation clearly works.

Nearly all of you have heard me tell you that you need to take an omega-3 oil supplement. That is because our diets are uniformly deficient in omega-3 fatty acids relative to longer chain fatty acids (omega-6 and omega-9). My dosage recommendations have necessarily been estimates based upon my clinical experience and medical research.

The problem with that approach is that, as with other nutrients, we are learning that each person’s ability to process omega-3 fatty acids is unique. I have paid close attention to my diet since I began learning about nutrition nearly 40 years ago. As there is a great deal of early heart disease in my family, in addition to doing what I can to lower my risk in other ways, I have been working to boost my omega-3 levels for many years. When I had my blood tested recently, I thought my number would be fantastic. As it turns out, I was above average but below the target level. Maybe one reason for the heart disease in my family is that we don’t absorb omega-3 oils very well? Theory aside, the test told me that I needed to take more omega-3 oils. If you are tested you will learn if you need more or less omega-3 than you are taking.

We are now offering this test through my office. Only a few drops of blood are needed, so you can do it yourself or I can collect the specimen for you. A 10 hour fast is required for accurate readings. As the test is new, it is not available from other labs (you can order it yourself online) and there is no insurance coverage at this time.

Doing What Comes Naturally
You are a member of the greatest group of endurance animals on land that the world has ever seen. Seriously.

Have you ever heard the phrases “running to ground” or “I’ll run that down for you”? They come from one of humankind’s most unique abilities. We have greater capacity for running and running and running than any other land animal. That is how our ancestors and some rare tribal peoples still today, got their meat. They would chase an animal all day, until the animal could run no longer, and they would then kill it with a spear. Those animals are faster than us in a sprint, but they can’t keep going at a slow or fast pace as long as humans can. We are special.

Some believe that humans developed as we did (upright posture, ability to cool ourselves in hot weather by sweating and mouth breathing, big ligament to hold our heads upright, big buttock muscles) because of running. Some even believe that our endurance abilities helped our brains develop, and in essence, made us human. (See the 2004 article in NATURE by Bramble and Lieberman)

So, when I tell you that the official recommendation, that you need to exercise for 1.5 hours a day, is unrealistic, I mean that 1.5 hours is way less than our bodies and brains are designed to do. Truthfully, to be fully healthy we need to be very active.

Our ancestors did all of this very well without fancy running shoes, or ANY shoes for that matter. In fact, I am seriously beginning to wonder if our fancy shoes are a problem for many of us. I have seen many dedicated patients work very very hard to find the best shoes, only to develop the problems that they are trying to prevent. I have helped them by getting them to run in the conditions that most would assume would make them worse - irregular, uneven terrain, less cushioned shoes, ditching the treadmill.

Back in the dark ages when I was a marathon runner, my friends who were sponsored by running shoe companies had the best shoes available. These 1980-top-of-the-line shoes were crude and hugely unsupportive by today’s standards. These friends were the very best distance runners in the world (and WAY WAY better than me), winning Olympic medals, major international marathons and other distance races. One of them, Lorraine Moller, began her racing career in New Zealand as a barefoot runner.

Just over a week ago, I turned on the TV to see an American leading the NYC marathon with less than 2 miles to go, and 3 other Americans in the top 10. The last time an American won the NYC marathon was Alberto Salazar 27 years ago, dramatically beating one of the best runners I knew back then - Dick Beardsley in a race that is one of the landmarks in US running history. Until very recently, the times each of them ran that race remained among the fastest marathon times ever. That is quite striking because, during the same decades, athletic records in all sports have fallen like autumn leaves. Maybe those crude shoes we all wore had nothing to do with it, but when you see me out there running faster than I have in years in the minimalist shoes I wear or testing my newest ones that seriously look like gorilla feet, please don’t laugh (and try to catch me). If you find this interesting, read the book, BORN TO RUN, by Christopher McDougall.

Diet and Depression
The link between certain dietary factors and mood (omega-3 oils, B vitamins, carbohydrate-protein imbalance) has been documented for years. A recent 5 year study in England adds to our knowledge of the influence of diet on depression. This was a study of 3,500 middle aged civil service workers. Those who ate a diet high in whole foods, fish, fruits and veggies were much less likely to develop depression than were those who ate more processed foods (meats, refined cereals), high dairy fat, fried foods and sweets. Unfortunately, we cannot confidently say which dietary elements were most important; however as all of these factors are known to be important for other reasons, the lesson should be obvious.

Another study suggests that salt is an antidepressant. http://www.newswise.com/articles/view/549924/?sc=dwhn Apparently salt alters brain activity in rats very much as do drugs that cause addiction. Rats deprived of salt develop depressive behavioral patterns. I find this quite interesting, for a couple of reasons. One is that the classic homeopathic remedy for chronically depressed patients is made from salt. Another reason is that I have seen that patients who limit their salt intake excessively develop many of the clinical signs of depression.

Dietary Carbohydrates, Fat, Protein and Cognitive Performance
Thankfully, medical staff working with military personnel are working to make certain that those engaged dangerous activities maintain optimal brain functioning. Many years ago after a lecture I gave in San Diego on various herbs and supplements, the medical director of the naval submarine service asked me about the effects of melatonin on cognitive performance, seeking a better choice to help sailors adapt to shift work.

Recently pilots were studied to learn if the composition of major nutrients (carbohydrates, protein and fat) influenced their brain performance, assuming that high protein diets would be the best. Investigators were surprised to learn that high protein diets were the worst, seemingly because they made pilots irritable. They slept the best on high carbohydrate diets, while their short-term memory performance was optimized when they consumed a high fat diet.

Breast Cancer and Strength Training
One reason I attend the American College of Sports Medicine meetings is that exercise is such a basic part of human physiology that inevitably I learn practical information which is applicable to many patients, not just athletes.

Too often after a woman has surgery for breast cancer she will suffer a serious problem with her arm on the same side as the cancer. This problem is called lymphedema. Lymphedema occurs because the blood vessel-like tubes that carry the infection fighting lymph around the body are inevitably damaged by the surgery. The lymph then cannot move freely. Women have been told there is little that can be done, except to wear a compression sleeve on their arm which is uncomfortable and often leads to other problems.

I am happy to report that that is not true, and apparently the most effective intervention is one that has also been shown to improve other problems (low energy levels, poor bone density, depressed mood, increased risk of cancer recurrence, etc) that these women are prone to suffer.

Generations of physicians have warned women to avoid lifting and moving the affected arm. Many of us questioned this logic, as it would seem that using the muscles would actually relieve this problem by helping move the lymph when the muscles contract, rather than making the problem worse. As all the major cancer organizations adamantly clung to the the anti-exercise point of view, it was difficult to win the argument. It was also extremely difficult to conduct any formal research into the matter, as human subjects committees supervising research at universities refused to approve studies, as they were “certain” to hurt the patients.

During a session on cancer and exercise at the ACSM meeting in Seattle this past May, one topic of discussion was the evidence regarding strength training and lymphedema. While there was little evidence, the studies we did have (and others soon to be published) all consistently showed that strength training was not only NOT harmful but instead significantly reduced the risk of lymphedema. It was becoming increasingly clear from the limited evidence that, once again, the entrenched conventional medical advice was wrong. The larger study we were given hints about has now been published, and the major cancer organizations are reappraising their, now clearly erroneous, position on strength training and lymphedema.

When I began my medical career the idea of encouraging people with heart disease to exercise was very controversial. It is now routine. Not so long ago we warned parents about the danger of letting their newborns sleep on their backs. After we learned that our advice markedly increased the risk of Sudden Infant Death Syndrome, we started the “Back to Sleep” campaign. Fortunately, these recent lymphedema studies will erase another tradition of bad medical advice.

Diet and Weight Control - Water
An interesting study in Germany found that drinking water reduced weight problems among 1,300 2nd and 3rd grade school children. Investigators randomly selected 32 schools for the study. In 17 schools they installed one or two drinking fountains and gave water bottles to each child at the beginning of the school year. In addition, teachers presented four classroom lessons on the water needs of human bodies. At the end of the year the children in the “treated” schools were 20% less likely to be overweight than the children in the schools that did not have these interventions. Also, the children in the schools with the water access and education programs on average drank eight ouncse more water each day.

Diet and Weight Control - Carbs
A study of 4,500 healthy Canadians published this summer contradicts some of the most thoughtless anticarb ideology. They found that those who ate the fewest carbs were the most likely to be obese or overweight.

I really like this study, for a number of reasons. Admittedly, I like the study partly because I like it when assumptions are challenged, no matter whose assumptions they are. Confusion is an important step towards greater understanding.

The Canadians who ate more carbs also ate more fruits, veggies and fiber, all of which are good for us. High protein/low carb diets are effective in short term weight loss, but after a year the differences tend to disappear. I do find that emphasizing protein is a good way to get started on a program to reduce weight. Consuming sufficient protein steadies blood sugar and helps patients build muscle in response to their exercise program. Exercise and building muscle are essential components to any successful weight loss/body composition effort.

The big message is the reminder that what you eat is less important than how much. Certainly, eating healthy, nutrient-laden whole foods is essential for a healthy diet and for weight control. Yes, eating too many carbs, especially as simple sugars, will damage your health in many ways and put you on a blood sugar roller coaster. Also, high protein low carb diets do help many people jump-start their weight loss programs. However, high protein low carb diets are very calorie dense, as the protein often comes with a goodly portion of fat. Like all nutrients, some fat, especially the right kind of fat, is good for you in limited amounts. Remember that a given amount of fat has twice the calories of the quantity of protein or carbohydrates. That makes it very easy to unintentionally slip and consume too many calories, defeating your weight loss efforts.

top

Archives