Lies My Doctor Told Me Second Edition: Medical Myths That Can Harm Your Health by Ken Berry
My rating: 2 of 5 stars
So, I was excited to read this book. As a healthcare provider I am all too aware of our medical system's shortcomings, and I believe in being critical, even if it means pointing the finger at myself. That's part of learning. Part of growing. And unlike the doctors that Berry describes as intellectually lazy, I am a lifelong student who loves to read and devours books they way some people devour brownies.
Needless to say, the intro was strong, though I should have seen where things were leading. After all I've read enough of these books to know they have the same M.O. Tell people how they've been lied to, deceived and misled by the establishment. Take down the USDA guidelines one recommendation at a time, claiming lack of research and scientific support. Throw in some villains like the inept Big Government, greedy Big Pharma, evil Big Food, and irresponsible Big You Fill in the Blank. Then set the record straight without giving a shred of evidence to support your claims, which actually happens to be exactly what you've just criticized and chastised the establishment for doing. Offer up your own personal success story as irrefutable proof, and hope you throw enough reasonable sounding if not scientifically sound "truisms" at them so that they don't realize you're no better than the villains you're supposed to be fighting.
Here are some examples of the author's flawed logic:
Author claims that milk is not good for us because we are the only animals who consume another animal's milk.
Clearly, this is a flawed argument. I mean, surely he realizes that we are the only animals that can harvest another animal's milk. And it's probable, even likely, that a lion who kills a lactating gazelle consumes (and enjoys) her milk as part of the meal.
He also suggests that most people around the world can not properly digest milk. Unfortunately, he provides absolutely no evidence to support this claim.
Author claims the USDA dietary guidelines to eat whole grains is not only flawed but flat out wrong.
In providing support for his claim the author repeatedly uses "whole wheat" interchangeably with "whole grains," which is confusing and somewhat conflates the argument. Wheat is just one type of grain that we consume today that has recently received a lot of attention thanks to gluten, a protein contained in wheat that some people should probably avoid.
Interestingly, my daughter has Celiac disease and must avoid gluten, but that does not mean that she should avoid all whole grains.
Another point the author makes is just because whole grains may not be as bad for us as processed grains, that doesn't mean that they are good for us. And he is right, just because something isn't bad for us, doesn't mean it is good for us and certainly doesn't mean there isn't something better for us. But when discussing diet, we need to look at the overall content of the diet, the nutrient density of the foods, and the variety, balance, palatability, and sustainability of a diet. Just because we've only been eating grains for the past 10,000 years, doesn't mean we can't or shouldn't eat them. And just because some people don't tolerate gluten, doesn't mean that everyone needs to avoid it.
Again, he seems to be making a claim that just isn't supported by any meaningful research. This is not to say that what he is saying is wrong, only that the claim lacks the scientific basis that he insists we should have before making dietary recommendations.
He repeatedly criticizes the cherry pickers as he goes about picking his own brand of cherries.
He attacks the food pyramid, claiming that if anyone/anything is responsible for the obesity epidemic it is the USDA and their dietary guidelines.
Honestly, in one sense he's right. The USDA dietary guidelines are the culmination of input from scientists around the world that ultimately gets watered down by special interest groups like the Dairy Council and the Pharmaceutical Industry, etc. because not only does the government have a responsibility to protect the interests of individual citizens, it also has the responsibility to protect and promote American industry. So is it any surprise that the guidelines don't necessarily represent the best science we have?
That said, my experience is despite all their failings, the original guidelines really weren't all that bad. It has also been my experience that very few people followed them.
For example, I happened to be a Nutritional Sciences major in the 80s. The recommendation was not to avoid fat as the author insinuates...the recommendation was to limit fat to 30% of your total calories, with less than 10% of your total calories coming from saturated fat. We were also taught that for most of the population, cholesterol in the diet was not an issue as the body makes cholesterol, but that people with elevated levels might need to avoid it in their diets. The guidelines also suggested that about 60% of calories should come from carbs (and at least half should be from complex sources) including fruits and vegetables, whole grains, beans, lentils, legumes. The remaining 20% should come from lean meats and include 2 servings a week of fish. 2 servings of dairy was recommended and it was suggested that we should limit salt to under 2300 mg...although we were taught that for those who didn't already have high blood pressure, salt in the diet probably wasn't a huge issue.
I mean seriously???? This isn't all that crazy.
But you can't have a book like this without a villain, so there you go. Ironically, he warns about mistaking an association with causation. Just because weight has been steadily increasing since the introduction of the guidelines, doesn't mean that the guidelines are to blame...especially if no one was following them. And no one did. Like so much of the science, the guidelines were bent and molded (sometimes aggressively so into something unrecognizable) to suit the needs of all the someones trying to sell us their somethings.
He claims that hormone replacement therapy is not only safe but ideal.
I don't know enough about this topic to agree or disagree. It's something I'd like to learn more about. I have read that some of the studies that associated negative health outcomes with estrogen replacement were done on estrogens that weren't biologically identical, as he points out.
He briefly discusses the microbiome and blames the overprescribing of antibiotics for damaging it.
In some respects, he's probably right. But I also don't think it was part of some conspiracy. I just don't think we realized that there was a negative side to taking antibiotics, and now that we do, most doctors are responding appropriately.
He says we should use as much salt as we want.
I tend to agree with him. Unfortunately, I think the initial concerns regarding salt intake was more directed toward those who already had high blood pressure. At some point, the recommendation got taken out of context and ultimately bastardized.
He claims that the medical community is responsible for the lie that all calories are equal.
Once again, he feels the need to identify a villain. I'm not sure the medical community ever agreed that all calories are equal, though I think that many people (doctors also being people) ultimately developed that impression. Part of the problem is that when it comes to nutrition, the public isn't getting educated by the experts, people who actually study nutrition, but by doctors who don't really know that much about nutrition and by special interests that have ulterior motives. (I dated a physician for several years while in PT school and he laughed when he told me that the nutrition advice he gave his patients came from his mother.) Sounds about right.
He claims that hypothyroidism is underdiagnosed because doctors rely only on TSH levels for a diagnosis.
Actually, my experience is that most doctors do a TSH along with T4, but I think he's right in that many doctors simply look at ranges and no longer correlate blood tests with physical findings and patient complaints. I have some personal experience here. In my twenties, I suffered from cold intolerance, severe constipation, and fatigue. I was young, fit, and not exactly what you think of when you picture hypothyroidism. And so I suffered until my gynecologist, who was examining my neck, asked if I had been tired and constipated lately, and I about fell off the table. Apparently, my thyroid was enlarged, a key physical finding. So I went to my primary care who did the blood tests. Both my TSH and T4 were in the range but at opposite ends. He told me my thyroid was fine despite the fact that I had extreme cold intolerance, severe constipation, fatigue and had started to lose the outer third of my eyebrows (another classic physical finding) and an enlarged thyroid. Clearly he was not a good doctor.
I ended up going to a specialist, an endocrinologist, who actually correlated my symptoms with my blood work and prescribed treatment. I have been fine for the past 2.5 decades, no thanks to my doctor.
I have a client right now who fits the hypothyroidism profile. She is overweight and can not lose weight despite following a healthy diet. Her blood tests are normal but on the outer ranges with a high TSH and a low T4. She also has mildly elevated fasting blood sugar at 100. She also complains of feeling tired all the time...and she's in her 40s. I suspect that her thyroid is petering out...or that she has Hashimotos. Of course, because her labs are technically normal her doctor says she is fine. Which would not be so bad, if her doctor were doing additional testing to determine the cause of her symptoms.
So, yeah. He makes a point. Doctors need to be able to put the pieces together and not simply depend on lab tests and normal ranges to make a diagnosis. Unfortunately, in a managed care setting, doctors have become more dependent on labs.
He makes a big stink about vitamin D and needing more, much, much more.
Anyone who has been in the nutrition field for any significant period of time understands it is always good to be skeptical when some new "super vitamin" comes out. In the '80s it was the antioxidants Vitamin A, C and E. In the '90s it was fish oil. Come 2000 it was vitamin D.
Talk about jumping on a band wagon. Not only does the author suggest that we all need vitamin D supplements, he also suggests without evidence that our blood range should be much higher than the established safe minimum range, but offers no basis for how he arrived at that number.
Interestingly, if you follow this sort of thing, you'll know that the vitamin D craze has lost steam, and there are many studies now questioning the role of vitamin D supplementation as well as its long term safety.
He claims that we need to stop slathering on the sun screen and start soaking up the sun.
Ironically, given sufficient exposure to the sun, our skin can make vitamin D. So maybe if we got more sun, this whole vitamin D think would never have started. Truthfully, I've long been skeptical of the call to avoid the sun at all costs, though I understand the concerns regarding skin cancer based on what we've been told. The author, however, claims that sun exposure isn't the problem. It's our diet. According to him, the quality of our skin is impacted by our poor diets and it is our diet that is making skin cancer more prevalent, not a hole in the ozone.
I'll admit, I find this idea intriguing, partly because I've always had a hard time believing a little sun was detrimental. I kind of want to believe what he says is true, although I'd have to read more on the topic to have an informed opinion.
He claims fiber is bad.
Ah, I can't even respond here as I think he wants so badly validate his new found love affair with keto, that he'll go anywhere his new love takes him. I think there is a lot of science that would refute this whole section. Period.
He claims that not only is red meat not bad for us, but neither are processed meats like bacon and sausage.
So, I might be willing to hear him out on red meat as I don't think that red is innately bad, though it's also not innately good. It's a food that provides certain nutrients that might be good and might be bad depending on the context of the diet and the person's health. But bacon? Seriously, you want me to believe that processed meats like lunch meat, bologna, sausage, spam for God's sake are not only not bad for me but good for me. NOPE. NADA. Me thinks somebody needs to do a PubMed search and soon. This is a classic example of cognitive dissonance and one of the things that irks me most about the Keto enthusiasts. It's almost like a religion where people will go to any length to explain away any inconsistency because delegitimizing one aspect of the religion tends to bring the entire religion itself into question.
I agree with the author, clinicians are often decades behind the science. I also agree that we are giving our profession away to alternative medicine. Somewhere along the way, we forgot that medicine is an art as much as a science...partly because the science is everchanging. I also wish that more doctors and clinicians were more open-minded. It's possible to remain skeptical but still willing to hear alternative ideas.
I also agree that the best clinicians are the ones that continue to read and learn. The ones that challenge themselves and are willing to be wrong so that they can be right.
Unfortunately, I think this particular doctor has parked his car in the keto garage and in doing so has stymied his own intellectual growth when it comes to matters of nutrition as it relates to health. His logic and his arguments are often as flawed if not more flawed than the ones he's supposedly debunking.
Ultimately, I think that this doctor in trying to jump outside the box has simply landed in another box, a different box (maybe a slightly better box, maybe not), but a box all the same. Bacon...??? Seriously?
A common perception (or rather misperception) is that weight loss requires a calorie deficit. Simply put, you must burn more calories than you consume in order to lose weight. And while there is some truth to this statement, it doesn't quite capture the true nature of the relationship that exists between what we eat, the total number of calories we eat, and how much we weigh.
For example, it's pretty obvious to most people that 10 calories of double-chocolate chocolate cake is not nutritionally equivalent to 10 calories of a dark, leafy green like spinach. Clearly, there's more to a food than simply the number of calories it provides or the grams of protein, carbs, and fat contained in each bite. Food is a vehicle for many other nutrients like fiber, vitamins, minerals, and phytonutrients, all of which may ultimately impact not just our health but also our weight, even beyond the number of calories a particular food contains.
There's a growing consensus in the health and wellness community that the number of calories we eat isn't nearly as important as the quality of those calories. And while calories do matter, they don't matter nearly as much as once believed. This is because our bodies aren't simply furnaces that burn fuel. They are a complex system of complementary systems that are capable of deriving more or less energy from a food depending on our physiological need, the type of food, the overall makeup of the food and the nutrients it contains, our metabolic health, as well as the impact of our gut microflora, which appear to play a key role in the digestion of the foods we eat as well as eating the foods themselves.
Case in point. In the past, well-meaning health experts have cautioned against eating too many nuts, which happen to be high in healthy fats and other macro, micro, and phytonutrients but also high in calories. Adhering to the "too many calories in model," the belief was that while nuts may be good for us thanks to all their nutrition, they also contribute a lot of fat and ultimately calories to a diet, and thus have the potential to make us fat. As a result we were told not to eat too many nuts. Epidemiological studies suggest otherwise. Not only do diets that include nuts not lead to weight gain as one would assume based on the "too many calories in model," the regular consumption of nuts actually seems to be protective against weight gain.
Several theories have emerged to explain these unexpected observations. For one, nuts contain lots of fiber and other lipid-storing granules that are not completely digested. Nuts, thanks to their high fat content, also tend to be incredibly satiating and may lead to less overeating. Finally, thanks to their high protein content, high fiber content, and high polyunsaturated to saturated fat ratio, nuts simply take more energy to digest. In a nutshell, it takes energy to digest nuts, thus lowering the net energy (calories) gain we get from eating them.
Likewise, there is some evidence that the number and types of bacteria populating our guts can impact how many calories we are able to extract and absorb from the foods we eat. It is also believed that the types of bacteria that populate and thrive in our gut are highly dependent upon the quality of our diets, aka they types of food we eat. For example, plant-based, whole-food diets are associated with a healthier gut microbiome than diets high in sugar, animal protein, and ultra-processed foods.
Another possible factor might relate to the glycemic load of the foods we are eating. For example, foods with a high glycemic load (sugar, starches and processed grains) tend to cause large spikes in blood sugar which then cause insulin to be released from the pancreas. Insulin's job is to remove this excess blood sugar from circulation and then transport and deliver it into cells where it can be used as energy or stored as fat for to meet a future need. There is some evidence that large, repeated spikes in blood sugar and the subsequent release of insulin favors the storage of fat and thus may contribute to excessive weight gain as the years pass. Furthermore, repeatedly exposing the cells to high levels of insulin may also desensitize the cell membrane over time and possibly contribute to the development of Type II diabetes.
Take home point:
While calories do matter, they aren't the only thing to consider when making food choices. They're also probably not even the most important thing. When it comes to our health and our waistlines, quality is key. Choose plant-based foods that are as close to their natural form as possible rather than foods that are made in a plant and come in a box or a bag. The fewer ingredients, the better. Think fruits, vegetables, nuts, seeds, legumes, beans, whole (unrefined) grains and grain products like quinoa, whole grain brown rice, and whole oats. Quality meat and dairy can also be eaten in moderation. Don't worry so much about counting calories, or grams of macronutrients (protein, fat, and carbs), but aim for eating a colorful plant-based diet. Doing so will promote better health and trimmer bodies. It will also allow you to eat more, while achieving and maintaining an ideal weight.
The Whole Heart Solution: Halt Heart Disease Now with the Best Alternative and Traditional Medicine by Joel K. Kahn
My rating: 3 of 5 stars
This book could have been a solid four star if not for the last section that deals with the use of supplements.
For the most part, Kahn, a cardiac specialist, promotes approaching heart disease through diet (plant-based nearly vegan, whole foods diet) and exercise (& in come cases supplements), as opposed to emphasizing only meds and various medical procedures.
There is a lot of good advice here that ultimately gets lost when he starts talking about supplements. Listen, I get it. There are likely alternatives to traditional meds that may be safer and ultimately better for us. Maybe. But by Kahn's own admission, the supplement industry is so poorly regulated, you don't always know what your getting in the pill or potion from the health food store.
I also get that he is trying to cover a lot of ground and that the supplements he is recommending aren't meant to apply to every patient with a heart problem. But the discussion and the way it is presented seems to take away from the books most redeeming quality which is that it celebrates the preventative and curative power of a heart healthy diet.
Supplements are not regulated for the most part. There is no concrete proof that supplements are any less harmful or more helpful than traditional pharmaceuticals. And like traditional pharmaceuticals, you probably shouldn't be taking supplements unless you are being monitored by a physician to determine what supplement is indicated, how much is indicated, and if it actually impacts the body in the desired way. Bottom line, if a supplement is indeed exerting a therapeutic effect, what makes it substantially different than other pharmaceuticals? I'll tell you what makes it different. The pharmaceutical companies actually have to have some evidence to back up their claims. They are also required to maintain quality-control. But when it comes to supplements, there is very little regulation and almost no standardization and/or testing for safety and possible side-effects.
In that sense, Kahn should have stopped when he said, and I'm paraphrasing, that it is best to get the nutrition we nee from the foods we eat. Period.
Thyroid & Menopause Madness: Why It Feels Like You’re Falling Apart and What You Can Do About It by Joni Labbe
My rating: 1 of 5 stars
I only made it halfway through this book.
Though I had high hopes, it fell short on every count.
I think the author probably has something to contribute to the subject, but her writing skills are lacking. The information is provided in a hodge-podge way that makes it hard to follow.
I have two science based degrees, work in the medical field, and have read more than my fair share of health-related books. So, it's not an issue of being able to grasp the information, but more an issue of the author saying too much that means nothing.
She talks about auto-immune thyroiditis or Hashimotos. She talks about the infamous "leaky gut." She mentions the danger of wheat and an overtaxed, worn-out adrenal system. Unfortunately, she's all over the place and never provides a sound logical basis for her claims that are jumbled together in a non-sensical way.
I just don't see how the average person will walk away from anything useful from this book. I know I didn't.
The Johns Hopkins Guide to Diabetes: For Patients and Families by Christopher D. Saudek
My rating: 2 of 5 stars
If I had to describe this book in one word, it would be "dense," 470 pages small print, few pic/illustrations dense.
I was disappointed in this book as it kind of summarized for me what I see as a major failing in the US system of sick care.
First and foremost, I think the authors do Type 1 diabetics and Type 2 diabetics a disservice by not giving them each their own book. They are such different diseases and the demographics are generally quite different as well.
Type 1 diabetes is caused by an auto-immune disease that attacks the pancreas, essentially killing the insulin producing cells. It is historically referred to as juvenile diabetes because it is often diagnosed during childhood, though sometimes does not show up until later in life. These diabetics will be on insulin for the rest of their lives. There is a genetic component to the disease, but genes alone are not the only determining factor. It is believed someone has the genetic predisposition, but than something turns on the gene. What, we still don't know.
Type 2 diabetes, once called adult-onset diabetes because it was generally only seen later in life, is characterized by a resistance to insulin. So that their bodies are still producing insulin, just not enough to get the job done, thanks to a resistance. There is a strong association between diabetes and Type 2, and there is also a strong genetic link.
Working in health care, I would say your average Type 2 patient is much different than your average Type 1, and while they share some of the same struggles, they differ in many significant ways and those difference get lost in this book.
The book is also very technical, going into the nuances of dosing insulin, the struggles of glucose monitoring, and the various associated health conditions. And while nutrition, exercise, and sleep are mentioned in passing, few of the 470 pages are dedicated to their role in preventing and/or managing diabetes, Type 1 or Type 2.
I did learn a few things that even as a clinician with medical training I did not know, which is always nice. I just do not see how this book would be helpful to 99.9% of the patients I deal with who live with diabetes or its complications. And as is the case with medicine these days, it focused more on treatment. At least one chapter on prevention would have been nice. I also think the authors did not take enough time to discuss prediabetes, the risks, or concerns.
Finally, I thought this book seemed more geared toward and more useful for the Type 1 diabetic, which is a shame seeing as according to the authors the majority of diabetics worldwide are Type 2.
Whether you want to eat healthier, commit to regular exercise, get more sleep, or destress, effective lifestyle change often requires replacing old less productive habits with newer and healthier ones. This can be a challenge, particularly if the habits you are trying to change or replace are deeply ingrained.
By definition, a habit is a behavior that has been practiced or engaged in so frequently that it's almost involuntary. The benefit of a habit, particularly a healthy one, is that it becomes automatic and doesn't require executive function or significant mental energy.
We used to believe it took approximately twenty-one days to change a behavior; however, newer research suggests that the time frame is significantly longer and extremely variable. A more updated estimation for successful habit formation is closer to sixty-six days on average. Unfortunately, it could also take up to a year. How easily an old habit is ditched or a new habit is acquired depends on many factors including motivation, internal and external resources, as well as the nature and complexity of the habit you are trying to change.
When attempting to form new healthier habits, sometimes the best way to facilitate a big change is via small more gradual changes. Since big change is often met with big resistance, it’s helpful to think big but act small. In addition, drastic change that happens too quickly is often unsustainable and short-lived. When it comes to making lifestyle changes, you want to be the turtle and not the hare, since slow and steady wins this race every time.
For example, maybe you want to consistently make healthier food choices. On the surface, ditching cake for a healthier snack such as fruit might seem like a piece of cake. And if that is the only food choice you are trying to change, it might just be that easy. But a complete overhaul of your diet is likely to be a whole lot harder. Fortunately, swapping out blueberries for a blueberry muffin could be the first of many small steps that propel you forward on the path toward a more nutritious diet. So, rather than up-end your entire meal plan all at once, a more manageable and practical approach might be to first focus on breakfast, or if need be, one aspect of breakfast.
Likewise, if you would like to go from couch potato to 5K enthusiast, your best bet is to come up with a plan that includes a manageable daily or weekly commitment. You might decide to complete a few two-mile walks at a moderate pace the first week. If all goes well, you can up the ante the following week by either increasing the number of days you walk, distance and/or time you walk, or your walking intensity. The main point is that you consistently meet your commitments and methodically build upon them. It may take a little while before you reach your goal, but chances are when you finally cross the finish-line the behavior will be more permanent.
Whatever the change you’ve settled on, it’s helpful to have a plan for those days where life is sure to get in the way. For these worse case scenarios, you want to think of a behavior you can commit to regardless. So, for example, if you are trying to exercise regularly, think of an activity that you could do under any circumstances. This might be one push-up. It might be ten jumping jacks or ten air squats. These behaviors are simply placeholders. The idea is that maybe you can’t make it to the gym, but you still do your one push-up because, seriously, who can’t find the time or energy to do at least one push-up. The hope is that you won’t stop at one, but even if you do, you’ve successfully held that space for exercise, and that is how habits are ultimately formed.
What won’t help to form a habit is skipping the pre-planned commitment all together. In this case, something will always be better than nothing.
In conclusion, when forming or breaking habits, it’s okay to think big, providing you realize you might have to act small. In the end, the most important aspect of change isn’t necessarily the size of the steps you take but the consistency of the steps you take. Patience (and a little self-forgiveness) is a virtue as you are sure to encounter hiccups along the way. How you manage these hiccups through planning and action determines your success.
Mindful eating is the practice of paying attention to not only what we eat but also why we eat it. It's a practice that emphasizes bringing awareness to the table, and can ultimately help us to minimize non-hungry eating which accounts for many of the excess calories we ingest on any given day.
In fact, research has shown that external cues for eating can have a greater influence over our food consumption (both type and amount) than internal ones. For example, we often eat out of habit not hunger. We down an omelet because it's time for breakfast and a slice of pizza because it's time for lunch, irrespective of whether we are truly hungry or not. Likewise, more often than not, we continue to eat beyond feelings of fullness, the meal ending only once our plate is clean or the bag is empty. The external factors influencing how much we eat can even include the color and the size of the plate, whether we are eating alone or in a group, and even the lighting and ambiance in a restaurant.
By taking time to understand the triggers and motivation behind our eating behaviors, we can begin to eliminate some of the excessive calorie consumption that often leaves us feeling uncomfortable, sluggish, and maybe even guilty because we overdid it or made choices we regret because they are inconsistent with our health and wellness goals. It can also help us to achieve a healthier weight, since all those extra calories we don't need end up stored as fat around our bellies, hips or thighs.
Mindful eating begins with the decision to eat and involves asking ourselves if we are truly hungry, as opposed to bored, stressed, or tired. Whether or not you ultimately decide to eat isn't as important as an awareness of why you are eating. After all, food is more than sustenance. It has cultural and social contexts as well. But acknowledging the motivation for eating affords us more conscious control over when and how much we eat.
Mindfulness could also manifest itself in our food choices. For example, if you decide to eat, you still have to decide what to eat. The foods we choose tend to be influenced by a number of factors such as when we are eating, where we are eating, who we are eating with, the choices we have immediately available, and also what we feel like eating at that time. The key is to be conscious of the motivation behind our choices as well as the consequences of those choices, both short-term and long-term. Maybe you crave pizza, but maybe you are also trying to make healthier choices. Ultimately, you could decide on a compromise, to order a slice (sans the pepperoni) along with a side salad, instead of eating your normal two slices. Or you might decide that while eating pizza fulfills a momentary desire, honoring your decision to make better food choices is more important, so you order the baked salmon instead. Again, by choosing mindfully, you are more likely to make choices that are consistent with your values and goals.
Finally, mindful eating can be practiced during the meal itself. For example, before digging in, many experts suggest taking a moment to either express gratitude for the food you are about to consume or to contemplate the chain of events that brought this food to your table. Or you could try taking a few deep breaths, a practice known to activate the parasympathetic nervous system which aids in digestion. Another recommendation is to allow yourself to fully experience the meal with all your senses. Note how the food looks, how it smells, how it feels in your mouth, and how it tastes. While eating, keep conversation to a minimum. Allow yourself to be truly be engaged in the eating process. Chew slowly and/or put your fork down in between bites, taking regular inventory of your internal sensations so that you can stop when you are starting to get full but not yet stuffed.
In a nutshell, mindful eating is about building an awareness of why, when, how, and what we eat. In doing so, we are less likely to engage in non-hungry eating, and more likely to make food choices that reflect our goals, values, and desires for our bodies and our health.
Tips for Mindful Eating
1. Plan meals: This might involve developing a weekly menu, preparing a grocery list, and/or setting aside time for meal prep and will facilitate making more mindful food choices.
2. Take a quick inventory prior to eating: Non-hungry eating, while inevitable, can be a significant source of extra calories. Prior to eating, make sure you understand the motivation behind putting something in your mouth. Is it true hunger or are you responding to stress or boredom? If the motivation is not real hunger, ask yourself if eating and your food choices really are the solution that honors your health goals.
3. Take a deep breath: Deep breathing can not only slow you down, it also activates the parasympathetic nervous system which can aid in digestion. Additionally, it allows you to take a moment to show gratitude for your food and also to fully appreciate the act of eating.
4. Slow down: All too often we are eating on the run, literally shoving food in our mouths and stopping only when the food is gone. Chew slowly, try placing your fork down in between bites, avoid mealtime distractions like eating in front of the TV, and whenever possible try to focus on the food being consumed, its presentation, color, texture, smell, and taste.
5. Pay attention to how you feel: Does the food still taste as good as it did when you started the meal? Are there signs that you are getting full? The Okinawans are a Japanese community in which an unusually high number of residents live into their hundreds. They have a custom called hara hachi bu, which is a practice of eating until about 80% full and which is credited with their longevity. Many experts advocate a similar practice. The idea is to stop eating before you are stuffed. Eating more slowly and increasing your awareness of internal sensations will help you learn to identify when you should stop. And like anything, practice makes perfect
Simply put, a fast is a period of time for which one abstains from eating. In the most general sense, we all engage in a form of intermittent fasting: the hours between our last meal of the previous day and the first meal of the current day. Hence the term breakfast, which literally means to break the overnight fast.
Intermittent fasting as a dietary strategy simply extends the fast a little longer, in some instances from 12-16 hours, but possibly as long as 24 hours. And while there are those who recommend fasting longer, it should be noted that as the length of the fast increases, so do the potential risks. The one possible exception is for those with diabetes/prediabetes/metabolic syndrome or the morbidly obese. For these individuals longer fasts of two or more days may offer a significant metabolic payoff. Think gastric bypass, which is in some respects little more than a forced fasting state. Benefits aside, prolonged fasts (greater than 24 hours) particularly in the presence of metabolic diseases should always be approved and monitored by your doctor.
For the average person, however, short-term fasts (12-24 hours) appear to be relatively safe.
What are the benefits of intermittent fasting?
There are several benefits attributed to intermittent fasting and perhaps why historically it has been practiced by so many religions.
1. It is believed that intermittent fasts give the digestive tract a much needed break.
2. Short fasts may help alleviate inflammation associated with a number of disorders that are impacted by the gut and the microbiome.
3. Over the long-term, fasting may help to improve insulin sensitivity and thus improve glucose control. Again, it's important to note that those with diabetes or another metabolic disorder should be cautious when attempting fasts, particularly if they are taking insulin as there may be unwanted side effects in this special population even with short-term fasts.
4. Intermittent fasting may assist in weight loss as it not only restricts calories but also encourages the body to burn more fat for fuel.
5. Fasting can reacquaint us with hunger. Too often we eat out of habit. In fact, I often have clients tell me that they don't even know what it feels like to be hungry. In that sense, short fasts may allow people to experience hunger on a low level, which can ultimately help to reduce non-hungry eating.
What is a safe approach to intermittent fasting?
An intermittent fast as a dietary strategy generally lasts between 12-16 hours as mentioned above. I personally like the idea of an overnight fast since you are working with your body, which naturally prepares for a state of fasting during your sleeping hours. Typically, I tell clients who are interested in experimenting with intermittent fasting to eat nothing after 6, 7 or 8 p.m. and then not eat again until 6, 7 or 8 a.m. the next morning. If all goes well, and they want to up the ante, they can increase the fasting period by eating their last meal at 4 or 6 p.m. and not eating again until 8 a.m. the next morning. I usually have clients start with one day and then progress to two non-consecutive days if desired.
I don't generally recommend fasting beyond 16 hours to my clients because I'm conservative. I also believe that for most, fasting from 12-16 hours is long enough to get many of the benefits, but short enough to minimize any significant risk. Finally, as I've mentioned several times already, as a precaution, anyone who currently has a metabolic disorder like diabetes should probably discuss fasting, even short-term fasting, with their doctor.
During fasts, you want to continue to drink water or unsweetened tea or coffee. Some more extended fasting approaches allow consumption of bone broth or other fillers during the fasting period that do not provided any substantial calories.
Intermittent fasting when practiced over short periods (12-16 hours) is generally safe for most individuals. Benefits include weightloss, improved insulin sensitivity, and increased awareness of true hunger. Fasts that last longer than 24 hours may convey additional benefits to certain special populations like those who are obese or have a metabolic disorder. However, those with a previously known metabolic condition like diabetes should always consult a physican before making any major dietary changes as even small changes like short fasts may have unwanted and even dangerous side effects.
Missing Microbes: How the Overuse of Antibiotics Is Fueling Our Modern Plagues by Martin J. Blaser
My rating: 5 of 5 stars
I love books like this.
Taken from the book jacket:
Martin Blaser "is the director of the Human Microbiome Program at NYU, served as the chair of medicine at NYU and as the president of the Infectious Diseases Society of America, and has had major advisory roles at the National Institutes of Health."
He has studied the bacterium H. pylori extensively. Linked to stomach ulcers, gastritis, and ultimately stomach cancer, this "stomach bug" is generally treated aggressively when found. Interestingly, Blaser and colleagues have established that while H. pylori can cause negative health outcomes in later life, it may also be protective against other diseases like asthma, esophageal adenocarcinoma, and possibly a whole host of other diseases earlier in life, a notion supported by research performed by Blaser and his cohorts. And, good or bad, it appears that H. pylori is slowly disappearing from the human microbiome.
Blaser's main point seems to be that humans have evolved as a complex ecosystem in which some inhabitants can be helpful at some turns and harmful at others. And thanks to relatively new changes like the invention of antibiotics, the increased incidence of C-section, and other changes to our environment, our microbiome may be undergoing a shift. It is possible, even likely, that this shift may be contributing to the increased incidence of diabetes, asthma, food allergies, and auto immune diseases...possibly others.
He acknowledges the importance of antibiotics, which save lives. Yet, he also points out that until now we did not know what the true cost of using them was/is. Assuming there was no downside to taking them, we may have been too indiscriminate and overly liberal when prescribing them, using them even if not absolutely necessary because we assumed they could only help and never hurt. But as we learn more about the role of microbes, whether they are good, bad, or possibly both, the more that assumption is looking to be false. In the end, like H. pylori, antibiotics could be both beneficial and harmful at the same time.
He also worries about antibiotics that are given to livestock, not to treat disease, but to fatten them up. He fears it will not only contribute to antibiotic resistant strains of harmful even deadly bacteria, but may also be exposing us to antibiotics indirectly through the foods we eat.
He also worries about the increasing prevalence of birth by C-section. It has been shown that babies born via C-section are missing certain microbes that appear critical for optimal health and development of the baby. And while the microbiomes of both groups eventually converge so that by age three there are no significant differences, the damage may already have been done. Again, he is not saying women should not have C-sections, just that we might not truly understand the long-term risks to the baby.
Bottom line: we are only now beginning to understand the immense impact the bugs living among us and even in us have. And as we learn more, we need to rethink standard practices to ensure that we aren't throwing out the baby with the bathwater, or worse, drowning the baby in the bathwater. We also need to take these bugs seriously and remember that they are older, and, at least from a evolutionary standpoint, wiser. They aren't simply going to go away. Good thing, too, since we need them probably more than they need us. And if we hope to avoid another massive plague thanks to a microscopic organism, we better start being smarter about how we use the antibiotics we currently have in addition to finding new ones. (He claims that the pharmaceutical companies have found many of the easy ones and aren't particularly motivated to find a cure for rogue bacteria like MRSA, simply because it isn't cost effective.)
Good book written with a lot of passion, yet not alarmist in its message.
Healing Arthritis: Your 3-Step Guide to Conquering Arthritis Naturally by Susan Blum
My rating: 2 of 5 stars
This book had a great start as it promised to explore the relationship between gut health and different classifications of arthritis (particularly those caused by an auto immune disorder like rheumatoid arthritis.) She even provided some of the mounting scientific evidence. Then the narrative quickly takes a nose dive.
Blum is an MD with a MPH and founder of the Blum Center for health. She also takes a more wholistic approach to treating patients. The problem is many of the treatments she advocates by her own admission predate the research she provides to justify them. Clearly, the research is starting to support the notion that our microbiome does play a role in many disease processes including auto immune disorders. The problem is there is a still a lot we don't know. Blum's approach is presented as scientifically based, but it's really not. That is not to say that some of the treatments she advocates for are useless, it's just I'm not sure they are for the average person.
Though she admits it is always best to get what we need through the diet and promotes a healthy diet (two areas which have a lot of support among health professionals of all flavors), she also promotes a number of supplements at therapeutic doses. But should we really be blindly taking therapeutic doses of a supplement without some oversight?
So unless you're a doctor who is in a position to do more extensive testing and follow-up, I'm not sure her program is safe for everyone. As far as the science...maybe the science will get there, but despite her claims, I don't think it's there yet.
Just because we know the microbiome is a factor that is likely contributing to our health, doesn't mean we understand all the nuances. And just because we don't understand all the nuances doesn't mean we can't experiment a little. So as an alternative to drugs, under supervision, maybe some of the supplements she suggests are a lesser evil. Maybe not.
However, it sounds as if her treatment protocol predated the research to date and now she's saying, "Look, we were right." Yet while the research certainly supports the notion that the microbiome plays a role, to say it validates her treatment approach is misleading, IMO.
On one hand, I hate to give this just 2 stars as I feel there is some good stuff here. I do support a more personalized approach to medicine. I do believe that the gut is a much more significant player than we ever realized, and I totally agree that diet is so important to our health on so many levels. On the other hand, I think she twists and molds what we do know to fit her views and approach, rather than basing her approach on what we know. And I get it. That's often how progress happens. Visionaries push the boundaries. Still, when writing a book for the masses, you have a responsibility to make it clear that what you are doing while logical based on what we do know, is not necessarily proven.
I'll use a personal example to illustrate. I have a patient who sought the advice of a naturopath regarding her daughter who had several chronic issues. The naturopath immediately diagnosed her with a mold allergy even though there was no testing to confirm. She put this girl on a pretty strict diet that is healthy albeit restrictive. As one might expect, the girl lost weight and started to feel better. Case closed!? The family is now convinced that the girl has a mold allergy. She is currently sticking to the prescribed diet. But if I've learned anything about restrictive diets it's that they are difficult to maintain over the long haul. And this girl may be needlessly restricting certain foods based on the diagnosis of a mold allergy that has no basis other than a suspicion on the part of the naturopath.
Some people might say...well, who cares. The girl is feeling better. And they are right. And maybe it won't matter in the long run. Similar to the way many people feel better after they cut out gluten, not necessarily because they had a sensitivity to gluten but because by default when they cut out gluten they also cut out a lot of processed crap and generally eat better quality foods. Again. Then who cares? I guess I kind of feel like we shouldn't be treating people blindly. We shouldn't just take a supplement because someone says it's good for us. We should have a basis for what we do and some objective way to measure success.
Why can't we just promote healthy eating as being good us.
Again, yes some people have mold allergies. And some people don't tolerate gluten or lactose or soy. But many of us do. We know from experience that the best diets are the ones that people follow consistently and restrictive diets are hard to follow consistently.
After reading this book, I feel as if Dr. Blum treats many of her patients the way this naturopath treated my patient's daughter. Blindly. How is that personalized or medicine?